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Design HEALS: Investigating Design Guidelines for Healthy Assisted Living Settings

Final Report Summary - DESIGN HEALS (Design HEALS: Investigating Design Guidelines for Healthy Assisted Living Settings)

Recent European Commission (2012) report on aging projected life expectancy at age 65 as 22.4 years for males and 25.6 for females in 2060, adding more emphasis to the planning for the rising need of long-term care services that was also previously stated in the Commission’s 2008 dated report on Long-term Care in the European Union. There are large number of components of long-term care to be considered for planning including the type of setting where the care will be provided. European Union promotes providing care to those with limitations in activities (eg. dressing, bathing) and instrumental activities of daily living (e.g. shopping) but without chronic health conditions at home and in community-based facilities instead of nursing homes. As current models for healthy ageing define institutional care as the last resort, assisted living settings fill a big gap between home and institutions. Varying in scale and design, the overall concept of assisted living facilities is to provide home-like physical environment and social support in community for those who require help in performing their activities of daily living. With the rising cost of care at home due expected increase in demand and challenging economic conditions due to declining demographics in the work-force, assisted living facilities will be an important alternative to the care services provided at home. Yet, given their promise of providing an alternative to home, there are no established criteria to assess if those facilities can really contribute to health and well-being to their occupants’ daily lives.

The aim of this research is to study the link between environmental qualities of assisted living facilities and well-being of cognitively intact elderly. Multiple case study methodology was followed by selecting facilities varying in size and plan layout configurations. The size of facility, plan layout configuration, walking distances between resident’s room and common areas, accessibility and presence of neighborhood amenities will be the independent variables of this study. Well-being outcomes (dependent variables) were collected by structured observation of resident’s use of common spaces and their social interactions. Tablet devices that run geographical information software were used to record location and behaviors of residents in social areas. Residents were be asked about their perceptions of facility and neighborhood in an interview. Caregivers were asked to provide non-medical information and make behavioral assessments about each resident. 180 surveys and 432 behavior maps were collected from 18 facilities, where each size of assisted living facilities with distinct plan layouts and sizes.

When case categories were individually considered, there were facilities in each category of buildings (small, medium, large) with significantly better outcomes of residents, underlining each scale of assisted living has its own potential to be explored and improved. Residents’ use of social areas, outdoors, social activity levels found to be significantly higher in small and medium sized facilities compared to residents of large facilities. Walking distances between social areas (including outdoors) and bedrooms found to play an important role on residents’ daily uses of spaces, social interactions and moods. Residents with roommates found to be more active in and around the facility, yet residents staying in single rooms choose to spend more time in their room. Although initially proposed, neighborhood level assessment for amenities were found to be in applicable in the studied context due to accessibility problems in the city. Study proposed evidence based design guidelines to be followed for modification or initial design stages to provide supportive environment for elderly. Instruments that are piloted, tested and used in this study found to be effective in assessing assisted living environment and proposed as an accompanying assessment instrument to have better understanding of the existing cases. The usability tests of this assessment instrument were completed with caregivers and residents and found to be easily applicable. A short version of the assessment instrument was also developed and found to be reliable in small and medium scale facilities.

The results of this project are important in providing research based design guidelines and an assessment instrument to first understand through analysis and then act-on making changes in assisted living environments to promote well-being of residents. Multi-disciplinary background of this research enabled interests of diverse audience including designers (architects, interior architects, landscape architects and planners), senior citizens, their adult children and relative, caregivers, stakeholders inluding policy makers and scholars.


European Commission 2008. Long-term Care in the European Union. Retrieved from http://ec.europa.eu/employment_social/news/2008/apr/long_term_care_en.pdf January 09
European Commission 2011.
The 2012 Ageing Report: Underlying Assumptions and Projection Methodologies. Retrieved from http://ec.europa.eu/economy_finance/publications/european_economy/2011/pdf/ee-2011-4_en.pdf November 2012.