by Jerald D. Peters Architect AAA AIBC MAA OAA SAA FRAIC LEED AP, Principal at ft3
When asked what the most important issue is for the aging senior as they transition from living independently to a care environment, the most common response is:
STAYING CONNECTED TO FAMILY AND FRIENDS
This is undoubtedly true. And, it points to a critical component of the human condition – we are inherently connected to each other and we need socialization (to a more or less degree) to remain mentally and physically healthy.
And that is the wonder of moving into a seniors' community for our elders. So what are some of the critical issues to think about and address as we plan for the next 20 years in seniors' housing and long-term care?
Today’s Up and Coming Seniors Aren’t Planning for Retirement, They are Planning to LIVE
In recent years, we have seen a significant move in the mindset of the over 55 age group. We no longer call retirement communities a CCRC (Continuing Care Retirement Community). They are now known as Life Plan Communities. The physical buildings may be the same, but the perception is dramatically different. These are not places where you go to do less. Rather, they are a home base for the bucket list.
Perhaps it is simply an attitude adjustment. A glass half-full compared to a glass half-empty approach. Or, maybe there is something more to it; a personalized approach to doing the things you want to do ‘now that you are no longer burdened with every day responsibilities’. Or, challenging oneself to do more despite reduced physical abilities. Or, living life to the fullest while overcoming memory loss. And living contentedly in spite of the challenges of dementia.
Tailored lifestyles that suit personal preferences is now commonplace. We make statements with our clothing choices, the design and colour of the case on our mobile phones, our hybrid car or pick-up truck. And so our expectations of life choice and statements about who we are don’t cease as we enter a seniors' community. Do we have preferences for the arts, literature, sports, higher education, religion, outdoor adventures, ecological issues, culinary experiences, gardening, history, culture, crafts, woodworking, or mechanics? The list is endless. So what is it for the seniors’ community? As we consider the future of the Life Plan Community, will the activity director evolve into a life coach?
Tailored lifestyle communities allow individuals to stay connected to like-minded friends.
Technology is our Friend
The use of technology is ubiquitous with modern life. Today’s seniors are adopting technology as rapidly as the rest of society. Certainly there may be limitations to how they utilize the options that are available; nonetheless, they are familiar and increasingly adept. In the days and months ahead, we anticipate the growth and utilization of the following amongst seniors, particularly customized to their communities:
- Transportation services like Uber or Lyft, yet specific to seniors, perhaps linking retired volunteer drivers to seniors in need of a ride.
- Restaurant delivery services like Skip-the-Dishes or Grubhub.
- Grocery delivery, like Instacart or Peapod, perhaps also linking retired volunteers to shut-ins.
- Vacuums, which are already available.
- Personal care robots or ‘nursebots’ which are in development to address:
- Cognitive Prosthesis. A large fraction of the elderly population suffers from varying degrees of dementia. The inability to remember can have severe consequences, such as forgetting to take medicine. People also might use a robot for lesser purposes, such as finding out what's on TV. Reminding is an important (and time-consuming) activity in a healthcare professional's life.
- Systematic Data Collection. A key problem currently faced in the healthcare sector is the inability to collect data for people living in private homes. Such data includes statistics on medication, daily living activities, and factors related to specific medical risks.
- Remote Tele-Medicine. In the US and Canada, home visits by healthcare professionals are extremely rare, due to the high costs involved. The idea of robotic tele-presence is to use internet technology to relay live video and audio from the doctor's office to the patient's living room.
- Social Interaction. Finally, the vast majority of independently living elderly people are forced to live alone, and are deprived of social interaction. Social engagement can significantly delay the deterioration and health-related problems. While robots cannot replace humans, we seek to understand the degree to which robots can augment humans, either by directly interacting with the person or by providing a communication interface between different people, that is more usable than current alternatives.1
- Home operating and monitoring systems are currently available and may be adapted to suit the needs of seniors, families, home care, and seniors’ facility providers.
- Medication / vital sign monitoring utilizing remote internet communication to home care and healthcare providers.
- Check-in systems to confirm that the senior is awake and well in the morning are common in many apartment buildings. Simple electronic systems may be deployed throughout communities.
- Remote monitoring, GPS tracking, and ‘Granny Cams’ may be available for families to check-in on loved ones, beyond phone calls and ‘face-time’ – which is a fantastic way to communicate.
Technology allows individuals to stay connected to family, caregivers, and service providers.
Assisted Living is about Activities of Daily Living, Not a Small Apartment
Assisted living complexes are defined by the services they offer, primarily:
- A Meal Program. One, two, or three per day. Nutritious, consistent, and included in the monthly rent (to reduce opting out). Attending the meal is an important part of connecting with the community. Social interaction improves appetite and consequently leads to increased levels of activity. It is ‘peer pressure’ for seniors.
- ADL Support. Housekeeping and laundry services are the initial services often needed. Future services are home care and nursing support for issues such as personal hygiene and medication. Social interaction with caregivers is a significant side benefit of these services.
- Transportation. Providing access to the extended community for shopping, appointments, and activities. Once again, social interaction with friends, acquaintances, and the broader community is a significant benefit of access beyond the seniors’ facility.
Oftentimes assisted living facilities are defined by the buildings. This need not be the case. The services are the most critical component, and they can be delivered anywhere. More and more, we are seeing Life Plan Communities / CCRCs eliminate the assisted living buildings from campuses, providing two types of facilities with independent living apartments and long-term care households. The ‘assisted living’ services are then delivered in the independent living apartment on an as-needed basis.
The real benefit of the modest, one-bedroom assisted living apartment with a small kitchenette is financial. A more modest accommodation allows for a transfer of accommodation costs (or rent) to meal, housekeeping, and laundry services – effectively paying for services from a reduced rent savings. Perhaps this is an additional financial planning element that may be considered as a senior prepares to leave the family home and move into a seniors' community.
Grouping assisted living apartments together is not a significant benefit to the provision of services. As long as residents requiring care are in reasonable proximity such as neighborhood clusters, service delivery is reasonably efficient
Reducing the number of moves and staying connected to neighbours and friends is a significant benefit to the wellbeing of our seniors.
Staying connected to family and friends is a guiding principle we would do well to adopt as we contemplate future Life Plan Communities. Because living well is part of planning to LIVE!
Jerald Peters brings nearly 25 years of experience creating vibrant, functional spaces, and has provided leadership and technical expertise on an extensive array of projects in healthcare, institutional, housing, and commercial environments. Jerald has a passion for personal care home design beginning with his graduate thesis more than two decades ago and continuing throughout his professional career.