Launch Slideshow

Old Age, New Models

With 76 million baby boomers contemplating life after retirement, the traditional nursing home model is in sore need of an upgrade.

Old Age, New Models

With 76 million baby boomers contemplating life after retirement, the traditional nursing home model is in sore need of an upgrade.

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    Under the Poor Laws in England and Wales, the infirm elderly are classed as "the impotent poor," and some are housed in almshouses or poorhouses.

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    Les Invalides in Paris and the Christopher Wren-designed Royal Hospital Chelsea (1681) in London are established to care for old and injured soldiers.

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    Ankrom Moisan Associated Architects

    The Mirabella, Portland, Ore. (Ankrom Moisan Associated Architects; client: Pacific Retirement Services; under construction) This 30-story CCRC tower will have only eight units per floor and will feature, around its base, a full spa/fitness center, a café, a library, and a computer center.

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    Ankrom Moisan Associated Architects

    It is expected to achieve LEED Platinum. Living here won't come cheap though: Entry fees approach $700,000.

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    Institutionalization of elderly care has become the norm. The William Enston Home in Charleston, S.C., is an early model for a planned retirement community.

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    CSD

    Querencia at Barton Creek, Austin, Texas (CSD; client: Senior Quality Lifestyles Corp.; completed June 2007)

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    CSD

    The master-planned 38-acre Querencia campus, just outside Austin's city limits, includes 10 cottage duplexes, 150 independent living units, 40 assisted living units, 40 units for skilled nursing, and 20 for memory support.

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    CSD

    It has a spa and several dining options, among them the restaurant shown at left.

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    At the first-ever White House Conference on Aging, the AARP unveils Freedom House.

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    RIEN VAN RIJTHOVEN

    Parkview Terrace, San Francisco (Kwan Henmi Architecture/Planning and Fougeron Architecture; client: AF Evans/Chinatown Community Development Center; completed March 2008)

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    Rien Van Rijothen

    This 98,000-squarefoot project brings 101 affordable apartments for seniors to San Francisco, a few blocks away from the city's Civic Center. Natural light bathes the lobby and the small living units, 40 percent of which are handicapped accessible and all of which can be adapted as residents' needs change.

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    Rien Van Rijothen

    A large courtyard offers sheltered outdoor space.

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    Corbis

    CCRCs gain in popularity-jumping from 800 at the beginning of the decade to around 2,000 today.

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    The Green House® Project

    The first Green House opens in Tupelo, Miss.

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    Dimella Shaffer

    Leonard Florence Center for Living, Chelsea, Mass. (DiMella Shaffer; client: Chelsea Jewish Nursing Home; on the boards) Slated to break ground this month, Leonard Florence will be the nation's first urban Green House community, based on the model devised by physician William Thomas. The basic model, which is flexible and can be produced on any scale, stipulates a homelike environment with six to 10 private rooms situated around an open kitchen and dining area.

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    DIMELLA SHAFFER

    One hundred seniors will reside at Leonard Florence, in "houses" of 10 residents each. Two of the houses will be set aside for ALS (Lou Gehrig's Disease) patients.

There's a wonderful photo of Ethel Percy Andrus, founder of AARP, with President Dwight D. Eisenhower. It's 1961 and Andrus is standing in the White House during the first-ever Conference on Aging. Ike has just lifted the roof off a model of Freedom House, a home designed and built by AARP in honor of the event, and is peering inside, smiling. The result of exhaustive research into the needs of the elderly, Freedom House included special features such as 3-foot-wide door openings and strategically placed master light switches. This approach would later become known as universal design; it aimed to allow people to age in place with dignity.

The country went in another direction, building nursing homes and continued care retirement communities (CCRCs), those sprawling behemoths with tiered levels of care ranging from independent living to assisted living and skilled nursing. Today there are some 16,000 nursing homes and nearly 2,000 CCRCs around the country, according to the American Association of Homes and Services for the Aging.

"Forty-seven years after Freedom House, and we're still working on this," Elinor Ginzler says today. Ginzler directs AARP's Livable Communities initiative, which aims, she says, to "change the way consumers and the industry approach how houses are built so that people can age with independence, choice, and control."

AARP's latest research finds a majority of people over 50 concerned about their housing options as they age. Many say they'd prefer to stay where they are, but recognize their current home is ill equipped for future needs. The alternative—the conventional nursing home—is less than appealing.

The stark reality is that America is aging, and fast. There are 76 million baby boomers, and one of them turns 50 every seven seconds. By 2026, the population of Americans over 65 will have doubled to 71.5 million. In addition to the sheer crush of housing and healthcare demand, the market desires of this aging demographic will be quite different from generations past. "This is a population for whom design does count," Ginzler says. "They pay attention to it."

Architects specializing in the field agree that design for aging needs a dramatic culture change. "In our industry, we think about museums and schools as the 'hot' thing, but people have an old image about our work relating to the communities that we create for our elders. We need to break that image," says Leslie Moldow, a principal at Perkins Eastman. Moldow also chairs the AIA's Design for Aging Advisory Group. "We can't think of it as 'one size fits all' anymore and we can't think of it as designing for our grandparents," she adds. "We need to realize that what we're doing today is what we will inherit. We should be designing for us."

The Evolution of the CCRC

Most CCRCs follow a similar model: a campus of mid-rise buildings with double-loaded corridors, massive centralized nursing stations, and wide hallways designed for ease of medical delivery and food service. Form definitely follows function, with institutional efficiency trumping individual autonomy, especially as more CCRCs move from nonprofit to for-profit entities (about 20 percent are for-profit, according to AAHSA, with private corporations like Hyatt and Marriott entering the game in the 1990s). "When you drive by one on these on the highway, you know exactly what it is," Moldow says, echoing a common complaint.

David Dillard, president of the Baltimore firm CSD, has been designing senior living for 30 years out of CSD's Dallas office, but it wasn't until 2003 that he got a true taste of life inside a CCRC. He and an associate spent the night in a facility in Iowa before embarking on a renovation. Dillard simulated the symptoms of a stroke patient with limited mobility. He was not allowed to go outside and read without the oversight of a caregiver; he couldn't adjust the light in his room once he was in bed. Sleep was difficult due to the beeping and chattering from a centralized nursing station he called "Grand Central." "We've got to make a place look and feel like home, not a hospital," Dillard says today.

For Querencia at Barton Creek, a CCRC located just outside the city limits of Austin, Texas, Dillard and his team enhanced the 38-acre campus with a destination spa-inspired by a nearby celebrity retreat-that includes an infinity pool looking out over the desert. Ten large villas, two independent living towers, a healthcare building with memory support (services for those with dementia and Alzheimer's), skilled nursing, and assisted living sit on just 28 percent of the land, leaving the remaining acreage open to nature. There are a variety of dining options, including an outdoor, rooftop bistro with a fireplace. It looks less like a CCRC and more like a five-star hotel.

The spa concept is not unique to Querencia. Moldow says Perkins Eastman is increasingly designing CCRCs like health resorts. "We've been looking at how to take models that are not senior-oriented, like Canyon Ranch, and bring the health spa into [retirement] communities," she says. "Residents have the ability to direct what they want their lives to be, and there's the support and infrastructure in place to help them achieve it."