Design with people with dementia

Front cover of the thesis. Design with people with dementia.It’s not often that people diagnosed with dementia get asked what works for them in terms of home design. People with dementia want to age in place in the same way as others. However, this requires integrated and diverse living solutions. The only way to do this is to design with people with dementia.

In a master’s thesis, Kembhavi explains the background to her research and the research objectives. Using a co-design process she identified three key concepts important to people with dementia: choice, integration, and service support. The process was not linear – many modifications and iterations were required to arrive at the final result.

To begin, the idea of aging in place was investigated. This inquiry created the first design challenge. That is, factors that make aging in place difficult. This resulted in the adoption of a user-centered design philosophy.  User-centred design focuses on the requirements and desires of users throughout the concept development process.

This paved the path for the second research topic: ‘how can people with dementia be involved in developing living solutions for themselves?’ 

Title of the thesis is, Integrated living environment for people with memory decline. Author Shreya Kembhavi, Aalto University. Helsinki city housing company housing was the context for the research.

This masters thesis covers a literature review, design methods, and an implementation strategy.  It includes case studies with images and explanatory graphics. The conclusion explains the background to the research, and how the research was done.

From the abstract

Giving people the ability to choose their way of life is an effective way of developing living alternatives for people with dementia. Residential services and spaces, engagement services and spaces, and support services and spaces must be addressed through service and space provision to enable aging in a place of choice. A strong network of these elements in the area could potentially allow a greater population to age in place.

By integrating the serviced housing with the housing for other user groups, the thesis proposes a strategy that incorporates serviced housing as a component of the standard housing stock. The serviced housing is built on the principles of residency, engagement, and support. As part of this approach, new services such as drop-in consultations for persons seeking advice, social spaces such as a cafés, and residential services such as a dementia hotel are proposed.

A branding strategy is advised to de-stigmatize and incorporate people with memory decline. This is an attempt to change an image associated with such spaces, into one that is inclusive and open to the community. The thesis with demonstration of the concept’s scaling and its benefits in the realm of living solutions for people with dementia.

Ageing well in suburbia

A single story home viewed from the back yard. A woman reaches up into a small tree and dog sits nearby. Ageing well in the bluefields.
Image by Damian Madigan

In a previous post Guy Luscombe alerted us to some forthcoming articles in ArchitectureAu. The first is by Damian Madigan and is titled, Ageing well in the Bluefields.  The context is suburban infill sites. The problem is how to increase housing supply and diversity while maintaining the existing character of the area. Madigan comes up with models based on the Livable Housing Design Guidelines. 

The overall aim is to support ageing in place and multi-generational living.

Madigan describes suburbs that have an established character and high financial values as ‘blue’. They are often exempt from density increases and also housing diversity. 

Madigan explains a collaborative design research project that developed ‘bluefield housing models’. The models are based on four different allotment sizes, small, medium, large and extra large. They are also based on Livable Housing Australia gold or platinum levels. Floor plans are included in the article. Madigan explains:

“Underpinning the designs is what I call the “bluefield housing model,” which:

        1. denies subdivision of the block, instead creating a design-led whole-of-site approach
        2. retains and adapts original housing into smaller accommodation
        3. creates new housing through leveraging the existing pattern of alterations and additions
        4. creates all housing in a flat hierarchy rather than as “accessory” dwelling units
        5. arranges the housing around shared landscape capable of retaining or developing large trees.

Ageing well in the bluefields is on the ArchitectureAU website and will be of interest to building designers and smaller developers. 

Universal design in housing: is cost the real issue?

A spacious kitchen with white cabinetry. Is cost the real issue?
Image by Taylor’d Distinction

After twenty years of citizen advocacy for access features in new housing, the Australian Building Codes Board  commissioned a cost benefit analysis which informed the Building Ministers’ decision to say yes, let’s do it. But is cost the real issue? And are those costs real?

An article in The Fifth Estate discusses the way various facts and figures go unquestioned. Figures plucked from the air appear to carry more weight in NSW, SA and WA than actual evidence presented to the Building Ministers Meeting. Victoria, Queensland, Tasmania, ACT, and NT are ready to roll with the new features. However they have delayed adoption due to industry lobbying. That will leave mass market developers with different rules in different states. 

The title of the article is, States disagree on access features for new housing

The Guardian also has a good article with a similar message. 

But Gold is more cost effective

Front cover of the Accessible Housing report.
The Melbourne Disability Institute and Summer Foundation submitted a response to the Consultation RIS for accessible housing with the recommendation that, based on the independent assessments and research they commissioned, Governments adopt Option 2, that is to regulate to Livable Housing Gold Level in the National Construction Code, as the benefits clearly outweigh the costs.
The Melbourne Disability Institute critiques the final cost benefit analysis by the Australian Building Codes Board as being incomplete. It goes as far as saying the report “contains and inherent and under-acknowledged bias against building code reform”. It was prepared by Professors Andrew Dalton and Rob Carter.

The independent assessments and research are:

    • REVIEW OF THE ECONOMIC REPORT
      The review identified four key issues that individually have a large impact on the benefit-cost ratios reported. Taken together, they totally reverse the economic credentials of the regulation. 
    • Please note: The issues raised in the analysis are highly technical. The researchers provided more concise executive summary to improve accessibility. If you have particular questions, please contact md-i@unimelb.edu.au.
    • SURVEY OF PEOPLE WITH DISABILITY
      This extra data aligns with the advice from the Office of Best Practice Regulation to include qualitative analysis in all Regulatory Impact Statements, particularly when important elements cannot be quantified or monetised.
    • AUDIT OF ACCESSIBLE FEATURES
      This study found that many accessibility features are already incorporated into the most popular house designs being built in Australia, but not in a systematic way. It also demonstrates that accessible features are basic elements of good house design for the general population, and indicates that the likely cost of including further accessible features to be fully consistent with the accessibility standards in new builds is very low.
    • SUPPLEMENTARY REPORT
      MDI and the Summer Foundation prepared further information for the ABCB on 6 October 2020 to substantiate their position that that governments should adopt Option 2, which would set minimum mandatory standards for accessible housing at the Gold (LHDG) standard.

Home Truths: Dispelling Myths

Front cover showing an older woman wearing glasses and a headscarf. She is sitting in an armchair.Across the globe, advocates for universal design in housing find themselves faced with the same myths. And these myths prevail in spite of hard evidence. AgeUK and Habinteg have put together a fact sheet, Home Truths – rebutting the 10 myths about building accessible housing. They challenge the ideas that it is too costly, difficult or undesirable. And also why the solution is not in building more age-segregated developments. 

Note: In the UK, Part M4 (1) of the building code mandates some basic access features. There are two other sections; one is to include adaptability, and the other is to be wheelchair accessible. However, these are optional unless it is set down in the local government plan because there is a community need. Developers challenge these plans asserting that the local authority has failed to prove the need. This indicates that industry will continue to fight for what suits them rather than occupants of the home.  

 

The value of home modifications

A white Labrador dog sleeps behind the couch with a view to an alfresco with level access. Value of home modifications.Quantifying the value of home modifications is a tricky business. It depends on who is doing the valuing. Governments look immediately to costs and benefits while home occupants look at their quality of life. Research findings of cost benefits and improved quality of life have done little to change either policy or home design. So we have yet another research article. 

Jesse Abraham’s paper points to our ageing population and the lack of suitable housing for later life. It’s time for America’s existing housing to be made safe and accessible for ageing in place, says Abraham. The healthcare cost of falls is over $50 billion a year in the US. And that doesn’t count the quality of life costs to individuals and the inconvenience to families. 

Abraham looks at the current evidence and takes an economic approach to the issues. That means there are a few equations and tables in his paper. His key argument is that there are cost efficiencies for society and for the government to provide subsidies for home modifications. 

Abraham is curious that so few older people think about modifying their home in preparation for ageing. Usually it’s done as a reaction to a medical event and then done last minute. This is when the family is already coping with other healthcare needs. 

Australian research by Carnemolla and Bridge underpins much of the work in this paper. Abraham cites three of their papers using their map of the evidence. He acknowledges that there are other quantifiable benefits such as improvements in physical and mental wellbeing. 

A government incentive

The key point in the paper is that the cost of updating homes with accessibility features is a cost effective healthcare prevention. Given that older people are reluctant to take steps for their own wellbeing there is much to gain by providing a financial incentive. If governments were to pay half they would still be saving healthcare costs. 

Abraham says that this is a difficult argument to prosecute because there will be costs for those who may never benefit. Perhaps if he had taken a universal design perspective he would see that benefits go beyond older people.

The title of the article is, The Cost Efficiency of Home Modifications to Reduce Healthcare Costs. If you skip the technical bits, this is a relatively easy read. It has a lot of useful information on this topic and good references. 

Home adaptations for people with dementia

A kitchen in the middle of renovations. Home adaptations for people with dementia.Most people with dementia live in their own homes within the community. A group of researchers in the UK wanted to find out the role of home adaptations in supporting people with dementia. They wanted to know what works, what doesn’t, and what more needs to be done. There were four key questions in their literature review:

    1. Which housing adaptations are being implemented and used by people with dementia and their carers on an everyday basis?
    2. How are decisions made to implement and use housing adaptations, or otherwise?
    3. What are the barriers and enablers to housing adaptation and use?
    4. What is the impact of housing adaptations on everyday life?

Results of the review

The review found that the most common adaptations were about physical limitations. The emphasis was on preventing falls. Clinical trials found that home adaptations have the potential to minimise falls. Safety relies on predictability of the environment for people with dementia. Nevertheless, this is the one area that is most lacking for people living in the community. 

Professionals and family members were good at coming up with ideas for adaptations. The study also found that carers were often inventive with novel solutions. However, some carers preferred their own trial and error methods when they thought professionals would not be helpful. A key issue here is that most useful information for families is online and not everyone has the ability to access this information.

“I’ll wait until the time comes” was evident in some of the literature. Some families were in favour of adaptations prior to need, whereas others wanted to wait until it was necessary. The type of housing also had an impact on this aspect.

Carers felt the adaptations made their caring tasks easier. They spent less time supervising and resulted in less burden and more sleep. The health and wellbeing of carers was the main gap in the literature. 

There’s a lot more information in this scoping review. The title is, Exploring the contribution of housing adaptations in supporting everyday life for people with dementia: a scoping review.

You can read more on home modifications and renovations

OECD housing report: A crisis on the horizon

Brightly coloured graphic of little houses clustered togetherA new OECD working paper says there is a housing crisis on the horizon for people with disability and older people. Most jurisdictions in Australia are signing up to some basic universal design features in all new homes. But will it be enough?  In the UK, their home access regulations are being reviewed because they don’t go far enough. So partial access solutions are no solution, but for policy-makers it looks like they are doing something. 

Front cover of the OECD working paper on the housing crisis on the horizon.The OECD working paper says there is talk about housing for people with disability, but no real action. The shortage of suitable accessible housing is still lacking. And it will get worse. By 2050 more than one quarter of the population will be over 65 years – it’s 18% now. Major modifications will be needed if people are to age in place. 

Social housing is a help provided it is accessible, but it is not the best option for everyone or every family. Grants and loans for home modifications can help too. People with complex needs might need specialised accommodation. Briefly, the working paper suggests the following policy actions:

    • Finding out what people with disability need from their housing and what supports are available. An evidence base is important.
    • Developing tools to match available stock with people needing it.
    • Strengthening access standards for new residential construction.
    • Providing financial incentives such as loans and income-tested grants for upgrading existing stock. 
    • Ensuring people with disability benefit from increased accessible, affordable and social housing. 

The document concludes with ways that governments can improve housing support for people with disability. It also has examples from different countries. The title of the report is, A crisis on the horizon: Ensuring affordable, accessible housing for people with disabilitiesThe writing style makes this type of document relatively easy to read. 

Abstract

This paper discusses housing challenges facing people with disabilities in OECD and EU countries, and policy supports to make housing more affordable, accessible and adapted to their needs. It focuses on the adult population with disabilities living outside institutions, drawing on data from the European Union Survey of Income and Living Conditions (EU-SILC), household surveys, national population census and disability surveys, and country responses to the 2021 OECD Questionnaire on Affordable and Social Housing. The paper summarises housing outcomes; discusses policy supports to ensure that people with disabilities can be safely, affordably and independently housed; and outlines actions for policy makers.

A good reference document for people working in the housing policy space. 

 

Ageing in Place: Not there yet

A suburban house in UK showing before and after the ramp. The ramp makes several zig-zags up the front of the house. It looks ugly.What home modifications are needed most and how much are they needed? Mary Ann Jackson analysed 50 home modification reports in Victoria to get an answer. She found that when it comes to ageing in place we are not there yet. 

The homes visited all had a doorsill or step at the front door and tight spaces. A screen door complicated matters, and meter boxes also intruded on entry space. Many of the fittings, such as taps and handles were poorly designed to suit ageing in place. 

Jackson advises that accessibility issues are endemic to Australia’s existing housing stock. This is a big problem when 39.5% of households include a person with disability. 

Architect and Planner Jackson says, “Cooperation, collaboration, and a clear recognition of the emotional, physical, and economic cost-benefit of ageing in place will be needed to rebuild Australia’s housing stock to better accommodate all inhabitants throughout life.” The title of the newsletter article is Ageing in place – are we there yet?  

The picture above is famous for its technical compliance, but not usability, and definitely not aesthetics.

Older people and perception of home

Within the findings of an AHURI report is a section on the qualitative research on older people and the perceptions of their homes in terms of ageing in place. The report is titled, “The role of home maintenance and modification services in achieving health community care and housing outcomes in later life”, and is by Andrew Jones, Desleigh de Jonge and Rhonda Phillips for the Australian Housing and Urban Research Institute, 2008. 

A man in a bright yellow T shirt is painting and archway in a wall inside a home. The wall is grey and there are tools on the floor.Phillippa Carnemolla’s conference paper expands on some of these ideas for ageing well at home. She found that home modifications address both social and individual needs. The title of the paper is,  The potential of a home modification strategy – a universal design approach to existing housing

 

Universal Design in Architectural Education

Two student models of a housing development incorporating universal design.
Two examples of student designs

Ageing is a fact of life. It’s something we know happens but don’t want to think about. But policy-makers and designers need to think about it as many of us live longer. Yes, it is a good thing, but also a challenge. Two things need to change – designer attitudes and skills, and building codes. So what are architects doing about it? We need universal design in architectural education if we are to leave behind the age-unfriendly designs of last century.

A paper from Ireland discusses many of the housing issues faced across the world. That is, homelessness, affordability, social housing, and ageing safely at home. The crisis in homelessness led to more funding for local authorities to tackle the issues. Hence, an opportunity to try something different. 

The Cork Centre for Architectural Education (CCAE) embarked on a “Live Project” for architecture students. This type of learning allows creativity to meet the real world. It also encourages students to take a moral and social approach to design. 

The authors discuss the real life project which was to design a housing development for older adults. It covers the site and the teaching methods related to universal design. Working with the local authority gave students awareness of different housing provisions. It also changed their perceptions of families similar to their own experience. 

One of the outcomes was that students found it harder to combine both the effective overall site strategy with an equally well-considered scheme for the interior of the houses. However, this was likely due to the limited time frame they were working with. But there is much more in this paper. 

The title is, Universal Design in Architectural Education: Community Liaison on ‘Live Projects’.  The paper is from the 2018 Universal Design Conference held in Dublin.    

Abstract

The infusion of Universal Design principles into existing courses in
architecture should become evident in any project work undertaken. ‘Live project’ is a term used to describe projects that engage the academic world with real-world groups/organizations.

CCAE sees such projects as valuable exercises in a student’s education, particularly, the practical experience of interaction with ‘user-experts’. In 2016 Cork County Council approached CCAE with a proposal to promote age friendly housing as part of their age-friendly initiative.

CCAE developed this into a ‘live project’ for Year 2 architecture students, continuing the integration of UD into the curriculum. This helps students to identify the negative disabling aspects of ageing and show UD principles can be seen as commonplace. For their part, the County Council were able to expand their own thinking, availing of the less constrained ideas that students brought to their schemes.

An approach to achieving the adoption of UD is to consider the Vitruvian definition of architecture as having ‘commodity, firmness and delight’. From this, the aesthetic integration of features to benefit users of limited ability can be achieved without stigmatising anyone as being old or disabled. Now in its second year the project is being run in West Cork.

The chosen site in Bantry town centre, has interesting challenges for the students to incorporate UD principles. This paper will present imaginative but viable projects as examples of student’ responses to the challenges of designing housing solutions and will report on their ability to integrate age-friendly features at different scales.

The Good Home Dialogue

A row of brick houses in UK. From Good Home Inquiry.When homeowners get used to their home being substandard, and even unsafe, they are reluctant to do anything about it. There are several reasons for this as discussed in the The Good Home Dialogue from the UK. Homeowners take pride in their homes regardless of their condition. They solve the issues with work-arounds which they just get used to. In Australia, these findings provide insights into why older people are resistant to home modifications.

The Good Home Dialogue executive summary is interesting reading. It tells the story of homeowners and renters and their relationship to their home. The research project asked people with low incomes living in poor quality homes what they thought would help.

Although half the participants expressed problems, they remained satisfied with their home. This is because they thought work-arounds were normal. Others preferred not to think about it or didn’t know where to start to make things better.

Participants understood the connection between health and quality of their home. However, this was not enough to motivate them to seek improvements. In the UK around half of ‘non-decent’ homes are lived in by someone over 55 years. 

The barriers

The barriers to making improvements were largely due to people getting used to the conditions. As homeowners they valued their home for what it means to them. And that meant leaving things as they are unless there was a critical need. Finding and working with reputable tradespeople was a common theme. This did not encourage those who felt they lacked the capability to commission work. Overall, there was a sense of feeling overwhelmed by the issues, especially renters.

The housing supply system in the UK is not the same as in Australia. However, there are useful insights as to why people are reticent to make changes to their homes. This is especially the case for older people and people with disability who would likely benefit most. 

The document is easy to read and well set out with recommendations for the Good Home Inquiry at the the end. The first of which is finding ways to motivate people to take action. The last point is improving access to a pool of trusted tradespeople. Funding, regulation and information are the basis of other recommendations. 

The Centre for Ageing Better webpage has more detail about the Good Home Inquiry and the full report of the research. The key issue in the UK is that more than 4 million older people live in homes that threaten their health.

There are more housing reports on the Centre for Ageing Better website, including accessibility and adaptations.

 

Universal design in the kitchen

Picture shows a kitchen in timber tones. There is an island bench with an induction cooktop. Drawers replace cupboards. Universal design in the kitchen.
Universal design in the kitchen

The Center for Real Life Design at Virginia Tech renovated two kitchens to incorporate many universal design features. One was designed for a multi-generational family, including an older grandparent and a child with autism spectrum disorder. The other was planned as a multifamily kitchen. These examples show how to do universal design in the kitchen.

The Center’s webpage has an article that explains the design features, and several pictures illustrate the outcomes. The first part of the article is about the Centre, and the second part has detailed explanations.

Julia Beamish also published an academic article on this project that can be accessed from Ingenta Connect: Real Life Design: A Case Study in Universal Design. You can also access on ResearchGate and ask for a copy.

A related article by Sandra Hartje, also available through Ingenta Connect, is Universal Design Improves the Quality of Life for Individuals, Families and Communities. It’s about why it is important for families and communities to design universally rather than how to design.  

Kitchen lighting

A modern kitchen with a bowl of fruit in the foreground and a stove and microwave in the backgroundLighting is of particular importance to anyone with low vision. And people who wear glasses also need good light to see what they are doing. And more light isn’t always better if it produces glare.

Doug Walter writes in ProRemodeller magazine about research in kitchen lighting. He says, “Most kitchens are woefully underlit. Lighting is often an afterthought, yet even when it’s carefully planned, designers and lighting experts often don’t agree on which lamps work best in particular fixtures and where those fixtures should be located.”

In the absence of any standards, the kitchen designer or the homeowner to have to work it out for themselves. The article offers practical and technical advice about lighting the kitchen. 

The title of the article is Recessed Kitchen Lighting Reconsidered. Doug Walter also wrote The Right Way to Light a Kitchen

 

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