An interdisciplinary research method for new models for elderly living environments in an aging society

Peer-reviewed Conference Paper / Full Paper

Integration of needs – inclusive, integrated design enabling health, care and well-being

An interdisciplinary research method for new models for elderly living environments in an aging society.

Birgit Jürgenhake¹*, Peter Boerenfijn²

¹ Tu Delft; B.M.Jurgenhake@tudelft.nl

² Habion, P.Boerenfijn@habion.nl

* Use * to indicate the corresponding author.

Abstract: This study focuses on research into the spatial and social living environment of the elderly with care needs. It developed from the urge for new ways of thinking about the design of care for the elderly in neighbourhoods and houses. In a collaboration between an architectural school of education and a social housing association housing the elderly, an interdisciplinary research method to come up with new models for elderly living was developed. The study describes the method and main findings.
In the Netherlands, the demographic transition to an aging society runs parallel to changes in the policy and practice of elderly care. Due to a steep rise in the cost of care and a shortage of staff, care moves away from institutional buildings and organisations towards a more informal support network with professionals in the background. The research questions addressed in this study concern the everyday lives of the elderly who need care. Within a one-week stay in a nursing home or elderly care home, participating in daily life, we aim to get answers through anthropological and participatory research to understand, document, and visualise the needs and living conditions of the elderly today. Finally, these data are translated into architectural design. We argue that the person we design should be the first to meet and talk to. In that way, we learn about their wishes, needs, and capabilities. This argument was our starting point for collaboration. Our methodology leads to unexpected results. The study will show the main findings and topics of discussion. 

Keywords: elderly; new models for a home; user-centred research

1. Introduction

This article describes an ongoing study into innovative housing concepts for elderly people in need of care. The main aspect of the research is the development and implementation of a research method to gain a deeper understanding of the elderly's daily routines and their needs. Then, subsequently, translate these into architectural models and innovative housing. The method was developed in close collaboration between teachers and students of the Faculty of Architecture at TU Delft and Habion, a Dutch social housing association that houses the elderly. Anthropological research, aimed at observing the daily practices of the residents, their habits, and their social networks, is combined with architectural research, aimed at the spatial, material, and organisational qualities of the living environment. The resident is central to the research. With this attitude as the starting point, innovative living concepts are gradually developed.

Currently, there is a shortage of housing for the elderly, as well as a lack of suitable houses. According to the Ministry of Health, Welfare, and Sport, around 200.000 homes for the elderly must be added by 2030 (Eichholtz, 2021). This also includes the care that many of the elderly will eventually need. If there were 1.4 million people over 75 in the Netherlands in 2020, it will already be 2 million by 2030. And due to the effect of double ageing, over 1.5 million people will be over 80 by 2040. In contrast, the younger age group, between 50 and 74 years old, will decline over the next 10 years, making informal and professional support increasingly difficult. Conversations with the elderly themselves show that today's elderly want to be able to choose (Witter, Harkes, 2018, p. 8). Many elderly express the wish to continue living at home for as long as possible. For them, this is linked to maintaining independence. A dilemma has arisen. On the one hand, continuing to live independently is a great need; on the other, many homes are not at all suitable for this.

In recent decades, living and care have been separated from each other due to budget cuts by the government. The old retirement home, a result of the welfare state after the Second World War, was abolished as such. The elderly had to live at home for longer, even moving back to rental houses. Research done in 2013 showed that 800 retirement homes had to be demolished and new construction projects were cancelled (Algemeen Dagblad, 21-02-2013). According to Habion, this can also be done differently. "Demolition is not sustainable; it is a destruction of capital, and in light of the aging population, we could really need those buildings," says Peter Boerenfijn, director of the housing corporation that has been exclusively involved in the housing of the elderly since its foundation in 1952.

Today, 92% of all over-75s still live at home (Ministerie van Volksgezondheid, Welzijn en Sport, 2020). Yet there is a growing number of elderly people who need care and cannot find alternatives due to the disappearance of retirement homes. Between staying at home and the nursing home, the supply is scarce. This shortage manifests itself in neighborhoods where the elderly live alone. In other words, staying at home is not always the best solution, but there are no attractive and suitable alternatives. There is a major challenge in both the transformation of the retirement homes and in new construction. This challenge was the starting point for us to start a collaboration between education and practice.

2. Theories and Methods

When writing about seniors, we must state that there is no clear age for a senior. Our research focuses on the elderly who need care, and today they often live in a nursing home where the average age is 80+. There are different options for senior homes, depending on the gradient of care that is provided and not on age. Initiatives have been launched in the Netherlands to move elderly care from institutional settings, such as nursing homes, to more informally organized care in districts and neighborhoods. As a result, innovative living ideas for seniors are emerging. In the meantime, the Netherlands has a scale of housing forms for seniors, but it’s still not enough. Between staying at home and staying in a nursing home, there are some intermediate forms. In general, you can find four categories: ‘Ageing in Place’, ‘Independent Living for the Elderly’, ‘Residential Care Homes', and ‘Nursing Home’. The care component is the variable component, which gets more important and prominent towards the nursing home. The in-between concepts are still developing, and the elderly are, like other age groups, a diverse group of people with different demands and wishes. Research into the housing preferences of the elderly shows that most elderly people try to continue living at home, with some adjustments (Koerten, 2020, p. 61–63). One out of six average 74-year-olds plans to move in the next five years. Their housing requirements primarily focus on a single-story house with a small garden in close proximity to like-minded people. However, there is still a lot of information missing. It seems that too little attention is paid to how seniors in need of care manage daily life, and there is little insight into the use of space by the elderly. How could this knowledge be incorporated into the design and (re)development of the built environment? Anthropological studies show that the domestic practices of the elderly are scarce (Makay, Reinder, 2016).

It is precisely these studies that could provide information about the daily lives of the elderly and provide valuable information about necessary adjustments to the home or the design of new buildings. Knowledge that is still missing, and that is obvious. The authors of the senior’s organisation KBO-PCOB, which conducted the research into the housing needs of the elderly, advise primarily engaging in a dialogue with the target group themselves: “The discussion with seniors is of great added value for the way in which we should organise our housing stock in the Netherlands. As parties to a housing assignment, talk to each other and to the people for whom the building is to be built. Seniors know better than anyone what is needed.” (Koerten, 2020).

The lack of information about daily practices was the main reason for us to do research on the living environment of elderly people with care needs. We decided to integrate this study into a graduation studio for architecture students. The students would establish contact with the target group, observe them in their daily lives, and engage in dialogue with them.

In recent years, anthropological or ethnographic research has increasingly been applied in architecture education. In doing so, we move from very concrete observations and conversations to architectural models. The students meet the people they will design for. This creates a much more direct relationship between user and designer.

The main questions the students start their research with are global: Who is the elderly person in need of care? What does one day in his or her life look like? What are the meeting moments, and where do they take place? The structure of the research method has been refined in the last four years and has now become a purported method for us. We follow four phases: 

Phase 1: Anthropological research

Learning how to observe requires a neutral view, without interpretation or judgement. In her teaching as an anthropologist, Andre Gaspar describes how she manages to teach this by using small experimental exercises, and that is what we do as well (Gaspar, 2018). Students are instructed to spend an hour looking at what they see, without assessment or appreciation. This seems more difficult than expected because our mind immediately interprets and judges. The students then continue with this exercise, but now it is aimed at the elderly. In the second week, the students take pictures, sketch their observations, and bring them with them. They are also asked to nominate a photographer who portrays the daily lives of people in series and to explain how he works.

Phase 2: Fieldwork

The fieldwork is divided into experimental exercises and on-site explorations.

The first experimental exercise is to spend a day in a wheelchair, which opens eyes to how wheelchair users experience the barriers in the building environment. The students felt the need to get assistance. They found themselves in constant need to adapt to the built environment. Besides this adventure, another exercise is to wear glasses, which simulate different kinds of eye diseases you might get as you get older.

To get more information about the daily life and the use of spaces by the people whom the students finally would design for, the on-site explorations start after these first experimental exercises. The students stay (in couples) one week in one of the selected sheltered elderly homes, which is a unique experience for them. They do anthropological research through observation and interviews. They all start with the same knowledge about the methodology, but by going to different nursing homes, each couple uses different ways to get into contact and generate information. For example, students make big posters to let the inhabitants “speak” by posting them and asking two questions: ‘What do you like here?’ and ‘What would you like to improve?’ By doing this, they get first-hand information about the place and the wishes of the elderly. The students study the apartments and identify different elements on a day-to-day basis, like the appropriation of space and identity. They observe the activities in different rooms to see if and how the room changes during the day according to the people who use and adapt it. Furniture moves according to wheelchair or walker usage, and some places are not used at all. These observations help the students understand the daily lives of the elderly. The on-site explorations have shown that the students develop different strategies to get in touch with the residents: informal conversations, formal interviews, surveys, and attending and organising activities. The scale levels the environment, the building, and the private room.

Phase 3: Analysis and in-depth research

Data from the fieldwork is organised and analyzed. Photo series often tell a lot about the usage of spaces, leading to new questions about topics that were touched upon during the visit. As a result, the research takes the form of an individual follow-up journey. The student chooses to shed light on one topic. This requires further observations and interviews, as well as a literature study. It often comes to a return day in the senior home. After 10 weeks, the work is presented as draft research.

 Phase 4: From data to evaluation and conclusion

From now on, the student tries to reach conclusions through the research that supports his design practice. Information is transformed into material and spatial solutions. The main question now is: what does a conclusion drawn from the fieldwork mean for architecture? In the eight to ten weeks that follow, step-by-step, a translation is made into architectural answers, and these are gradually introduced into a concrete design location. The design starts with the neighbourhood scale and ends with a detailed design of the building(s).

3. Results

3.1. Results of the fieldwork

The five topics listed below are what all students work through.

The organization of the building
This entails understanding the building's accessibility and organization, as well as its immediate living environment, including the apartments and rooms. All buildings visited are owned by Habion. The accessibility is generally good, but in a few exceptions, there is a second entrance not suitable for wheelchairs (Huis Assendorp in Zwolle) that could cause problems. In Huis Assendorp, several wings are linked together. Observation showed that there is little social interaction between the residents of one wing and the other. After several conversations, it became clear that the reason was a lack of clarity and therefore a psychological barrier to entering the other wing (Huis Assendorp). In the ‘Liv-inn’ in Hilversum, the socio-economic difference (rental versus privately owned apartments) seems to be the reason. The 'traffic flow' drawing makes clear where 'traffic jams' occur, for example, at the entrance or at the elevator (fig. 1).

Figure 1: traffic flows and traffic jam at Huis Assendorp in Zwolle. (Alkema, R., 2019, research book p.51).

The residents and the neighbourhood

The students researched the outside activities in their daily lives. A walk through the garden or to the supermarket is often the only daily activity for an elderly person.“ The overall conclusion is that the interruption of their path, the sidewalk, is the biggest problem for the elderly in the city. Most of the time, the sidewalks are interrupted by big, busy streets. These fast traffic flows are overwhelming, and elderly people get anxious because of the pace difference between them and the cars. Another problem with the sidewalks around Huis Assendorp is that they are not even accessible for wheelchairs. The sidewalks are either too small or have obstacles that obstruct the path. The traffic lights also pose a problem. They turn from green to red too fast for less mobile people, so they end up in a dangerous situation.” (Rosanne Alkema, 2019, research p. 31).

Figure 2: accompanying and observing an elderly person walking with a walker. (Alkema, R. 2019, research book, p.24, 25).

Usage of spaces in the building

Students especially look at the patterns of use within the different spaces, like the collective garden, the collective rooms inside, the circulation spaces, the entrance of the apartments, and the apartments.

The entrance doors of the apartments seem to be important to personalize. This makes recognition much easier.

Figure 3: personalization at the entrances (Borgdorff, S., 2021, research book, p.48-51)

Within the apartments, several students realised that the door from the living room to the bedroom is often blocked by furniture. The residents frequently told the students that they didn't want to see the bed during the day. Next, the furniture in the bedroom blocked the window. This did not seem to be a satisfied design.

Figure 4: in grey the places of the furniture of several apartments in Huis Assendorp in Zwolle. The right floorplan shows the blocked door. (Alkema, R., 2019, research book p.89,99).

The residents themselves

Residents are as different as they could be. What do they have in common? Meanwhile, a talk during the daily round gives them information about their daily activities. In the analysis drawings, they compare the residents’ activities and moments of encounter. One resident, for example (Fig. 5), walks four times a day with her dog. The moments of encountering neighbours are frequent, both inside and outside the building. This resident has also blocked the doorway between the living room and bedroom. Now, another residents meets others for coffee but asks for a taxi twice a week to meet friends outside. The various schematics of the elderly show their level of activity and how they use their apartments. The layout of the apartments and the appropriation of the spaces often show similarities in a way of furnishing that repeats itself.

Figure 5: Resident 1 and resident 2 and their pattern of daily life (Kieft, E., 2020, research book, p.20,21)

Residents’ wishes and preferences
Student 1 made little room models and used them to discuss the willingness to share the room and help others in their own living environment (family, neighbours, students, friends). Her findings show that people do not want to share the bedroom or bathroom. Only half of them would share the dining room, and a bit more would share the living room. Functional rooms and gardens are no problem to share. Most people are willing to help with a household task or walk together, but more private actions like dressing are problematic.

It must be clear that this work is very individual. The relationship between a student and the elderly may foster very different dialogues. Nevertheless, certain aspects pop up regularly. They are therefore often themes for further research.

• From passive behaviour to self-reliance

• From dependence to independence

• Loneliness

• Social meetings

• Meaning of life

• distance between residents and the neighbourhood

• feeling that you do not belong anymore

• Homesickness

• Dementia: Will you be able to stay where you are?

• Reciprocity between the elderly and other age groups

• Resilient housing enables elderly people to stay at home as long as possible.

Table 1: The willingness to share a room and to help with certain activities (Bouwman, M., 2019, research book, p.54, 56)

3.2. First translations into architectural results

The daily walks inspired student 2 to design an ensemble of buildings that form one large courtyard, open to the neighbourhood. Walking routes through and around the building provide residents with a variety of options for a safe daily walk. There is an extravert and an introvert walking through the building ensemble with stimuli and places, inside and outside, to rest and to meet others. As almost all students heard from the seniors, it is not normal to live exclusively with 80+. To the south of this ensemble, a children's daycare is placed, together with family houses. Due to the observations during her fieldwork, the student realised that the residents do not want to see the bed during the day, but once they get sick, it’s nice to give the bed a good place. Therefore, she designed an apartment in which the bed can move to three different places, depending on the situation.

Figure 6: on the left the ensemble of four buildings and the walking paths outside, on the right, three positions for the bed with sliding doors to close the place or the room. (Alkema, R., 2019, book of drawings, p.1 and presentation slide 59).

Student 1's interviews with the elderly and their families regarding their willingness to share rooms and assist each other revealed that while some private tasks, such as washing someone, require professional assistance, most individuals are open to sharing meals and cooking together. This information resulted in dwelling clusters with collective living for the elderly and family living in-between. Because of the need for professional care, six co-living areas with a total of 30 seniors would also have one care office. Her fieldwork showed that not everybody likes to sit in the collective kitchen with the others. Therefore, each apartment has a little pantry as well as a good view towards the common room to see who is sitting there. 

Figure 7: on the left one cluster of collective living apartments for the elderly and family living in-between; on the right, one collective living apartment group for five elderly on the ground floor and one group on the first floor (Marijn Bouwman, 2019, design book, p.15,19).

Figure 8: one elderly’s apartment and the cluster of co-living. During the day the bed will be hidden behind a sliding door. Each apartment has its own pantry and enough closets. There is a bench combined with the window to sit in front of the house. The cluster of co-living (one story high or two stories) and family houses are combined with a winter garden. (Marijn Bouman, 2019, design booklet, p.13,27)

4. Discussion

In the near future, one out of four inhabitants will be over 65 years old. These elderly will be better educated, healthier, and richer than in the present. The existing housing stock is based on past experiences and mainly designed for families. Furthermore, there will be a shortage of professional staff and informal support. This makes it necessary that the elderly support each other and stay as self-reliant as possible. To anticipate this transition in society, more research and work in other scientific fields like anthropology, mobility, and preventive health needs to be done by architects and urban planners to understand the needs of the elderly today and in the near future because traditional design will not provide the solutions.

5. Conclusions

We have never experienced an ageing society before. New research methods, such as combining anthropological and architectural research, provide the necessary insight into the daily lives of the elderly. Lots of elderly people, but also younger people like neighbours and family, provided us with information. After four years of work with the master students, we can conclude that the method brought us new insides into the daily lives of the elderly who need care, as well as insides into the willingness and limits of others to help. We saw lots of translations of design proposals; not all of them could be shown in the limited context of this text.

Using this method, the students designed innovative living concepts in which the elderly could get old by their own standards, as independently and self-reliantly as possible. The cooperation between TU Delft and Habion not only gives the students the opportunity to observe the daily lives of elderly people but also provides a living lab to test innovative ideas.

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