Spotlight on housing & care

A spotlight has been shone on how we house and care for our older generation in the UK, Anne-Marie Nicholson of Life3A explains more

In our post pandemic world, we have the perfect opportunity to adjust our design approach to our built environment and create excellent buildings that improve our country’s understanding of what the options for later living actually are and how positively ‘life changing’ a move can be.  

Lockdown has taught us what we are grateful for, how to cope with change, and the art of the possible. We have become grateful for a private garden, a balcony, large picture windows and a view, a local park, our community, support from neighbours, technology, internet shopping, online entertainment and exercise classes, mental health apps, environmental awareness, and the importance of seeing our loved ones.    

We are still woefully ignorant as a nation about the sheer range of options available for our later life and we are holding back the chance to give our older generation and the subsequent generations a longer, more independent, and healthy life where they can contribute, hold communities together and have fun. In countries like the USA and Australia people can’t wait to move into retirement villages because they are so great. You don’t go there to die, you go there to live! 

The media has rightly focussed on the tragic loss of life in care homes and the loneliness of those who are isolated by the rules of lockdown and shielding. If anyone was worried about ‘ending up in a care home’ before the pandemic they would be forgiven for being more fearful now. 

Many care homes struggled against national policies and inadequate stocks of PPE to keep the virus at bay, but some also managed with great success and described heart-warming stories of how they were able to provide companionship, safety, and an engaging social life for their residents over the course of the pandemic.  

We have always championed the benefits of good design for those less able and the delight that beautifully designed spaces bring to our lives. We are now sure that design, along with stringently applied operational policies and procedures, can help prevent the spread of infection, which is why we must do all we can to protect the most vulnerable and often wisest members of our society. It is worth noting that many older care homes that struggled in the pandemic are not physically designed to enable their occupants to keep apart or isolate due to outdated facilities that require sharing bathrooms and small, difficult to ventilate lounge areas.   

Modern purpose-built care homes are designed with full en-suites with level access shower rooms along with smart mechanically ventilated shared spaces, separate staff areas and spacious entrance areas and gardens. It is much easier to control infection in such settings and notwithstanding the need for sensible hospital discharge policies and infection control operations, these care homes continue to keep infections to a minimum.  But care home operators are keen design-in further features into the built environment, and we would suggest these include elements that also bring people together safely.

Retirement living, as opposed to a care home model, is housing for older people in self-contained apartments with onsite services and additional amenities. These developments have fared very well during the pandemic. Whole communities of older people have been thrown together in isolation and have come up with innovative ways to socialise, communicate and exercise, whilst keeping apart and keeping Covid-19 at bay.

Self-contained accommodation makes it easier to self-isolate and manage your own environment whilst knowing that help and companions are close by, connected physically and by technology, and community spirit.

The pandemic has encouraged us all to reassess our living arrangements and our lifestyles. We have become adept at living cheek by jowl with our loved ones, but also starkly alone as we protect the vulnerable. 

This period of intense reflection has led many older people to confront decisions that they would otherwise have put off. Negative aspects of our living arrangements that we used to overlook have been magnified during lockdown and have fuelled a desire to see what else is out there and what other options are on offer. This could mean living closer to town centres or community hubs, living closer to relatives, downsizing, making a lifestyle change, and even considering a specialist later living community.

There is also a huge gap in provision between hospital and home, wherever ‘home’ is, be it a care home, a retirement living scheme or your family home. This interface currently is too much like a cliff edge for those no longer needing acute hospital care, but still not well enough to go home. Again, the pandemic highlighted how dangerous this cliff edge can be and how important it is for us to review a new form of step down care that remains closely linked to NHS care. Perhaps this is a model of care that can be explored with government in order to bring health, social care, and housing together.

With viruses able to spread more easily inside, our built environment must respond to the need to socially distance, keep air quality and surfaces clean, but also to enable social interaction. 

So, how do we keep people apart but together all at the same time?

Design considerations:

Natural light and ventilation
Maximising and controlling natural light and ventilation is one of the most critical things to focus on in terms of health benefits. Getting this right means considering the fabric and construction elements of the building at the outset to a project. Consider providing large windows with stylish safety screens fixed to opening panels to allow them to fully open to increase air supply and the chance to cool internal spaces naturally. Secure screens are preferable to relying solely on restrictors that only allow a 20mm gap for air to circulate. Maximise views and lay-out rooms considering their orientation and what can be seen from the window.  Make the most of dual aspect opportunities for apartments and shared lounges or consider open plan living as this gives a sense of space and views out from all areas.

Private external spaces such as balconies and terraces are essential and communal spaces linked to outdoor amenity brings the outdoors in. Communal areas don’t always need to be south facing as these often remain closed off with blinds and curtains to control the sunlight so consider a range of orientations or outdoor awnings. Roof terraces offer spectacular views and areas which are often not overlooked and give another exciting opportunity to socialise outdoors. Open-air circulation areas such as deck access or corridors with openable screens are ideal and create interest, character and prevent overheating. Spontaneous interaction from balconies and open decks keep people connected.  Opening roof lights in circulation areas and lightwells or atria are great to purge stale air and to help cool in the hotter months.

Gardens and external amenity are of great importance and should be provided wherever possible.  Designing gardens as a series of rooms and spaces with activity lawns for flexible uses. Sheltered seating areas enable residents to socialise outside and potentially to have visitors without risking spread of infection. Being able to enjoy outdoor projects such as horticultural or keeping pets (communally or privately) will encourage more meaningful time outside.

The use of technology has increased exponentially during the pandemic and this will become the norm for us as a means to improve communication, entertainment, personal healthcare, remote monitoring, online shopping and automated window and door openings to reduce touch points.   Building management systems can control systems that respond to changes in temperature or occupancy to create comfort and good ventilation. 

Entrances, exits and movement
It would be prudent to provide permanent or at least temporary handwashing stations close to highly trafficked entrances, washing is proven to be more effective than hand sanitiser. The ability to have separate staff entrances will enable staff to change their clothing prior to entry and exit to avoid cross contamination during a period of infection alert. Similarly, providing holding areas for deliveries and consideration given to an undercover holding / waiting area for visitors prior to entry into the building.  A dedicated visiting space with dual access entrance and separating glass screens for relatives or professionals to meet with residents safely and in the warm during lock down scenarios.

Zoning within buildings
Designating the building into zones can help to control spread of infection at any time, provide sanitation stations at entry to each zone or floor or within lift and stairs lobbies, provide dedicated cleaning stores and equipment for each zone/floor and consider alternative routes out or access to garden areas to reduce interaction with others when necessary.

Mechanical ventilation
Another critical area to get right is mechanical ventilation with consideration for good fresh air supply with flow to avoid spreading or recirculating contaminated air. Controlling humidity levels has proven benefits to health and the spread of airborne pathogens. HEPA Filters and UVC light air purification can be considered for use in high occupancy areas. Consulting an experienced engineer early on in the design stage is important.

Storage and flexibility
Designing-in flexible communal spaces by using moveable walls and screens to open up or close down spaces. Flexibility often requires more storage for different furniture to suit activities. Storage for bulky items such as PPE, testing kits and possibly vaccination equipment for annual programmes.  Space for use as health and wellbeing training spaces to educate regarding how to stay safe.

Surfaces, materials and fittings
Specify easy to clean designs e.g., wall mounted cupboards and WC pans along with microbial materials particularly for high touch areas. Copper also has amazing anti-viral properties and can be impregnated into other materials.

Location and place making
Being isolated and lonely can be as detrimental to health as being ill. Care homes and later living apartments should be located within communities, close to facilities. Central locations work well when adjacent to vibrant public spaces as they provide opportunities for intergenerational interaction or just a chance to experience activity as a passive participant.

This is a global issue and one we are working closely on with our colleagues in Spain, Australia, New Zealand, and Malaysia to understand how we can all benefit from the lessons of the last 12 months.  

Whilst design is important to us, we focus on more than just that to offer strategic advice and research for the benefit of our clients in order to improve lives.

Anne-Marie Nicholson is principal at Life3A