Defining Cognitive Care by Meghan Bell

DEFINING COGNITIVE CARE: CAN AN URBAN PROTOTYPE FOR COGNITIVE CARE SPACE BE DEFINED BY VISUAL CONNECTIONS AND SPATIAL ADJACENCIES?

The Boston Architectural College Name of Student:

Meghan E. Bell

Date of Graduating Class:

January 2015

Degree to be Awarded:

Master of Architecture

Final Review:

December 1, 2014

Thesis Instructor:

Marcus Martinez/ Peter Martin

Thesis Director:

Ian F. Taberner, AIA

The Boston Architectural College Name of Student:

Meghan E. Bell

Thesis:

Defining Cognitive Care: Can an urban prototype for cognitive care space be defined by visual connections and spatial adjacencies?

Date of Graduating Class:

January 2015

Degree to be Awarded:

Master of Architecture

Final Review:

December 1, 2014

Thesis Instructor:

Marcus Martinez/ Peter Martin

Thesis Director:

Ian F. Taberner, AIA

Signatures:

__________________________________ Meghan E. Bell Student

__________________________________ Peter Martin Thesis Advisor

__________________________________ Ian F. Taberner, AIA Director, Master of Architecture Thesis

Table of Contents: 3 / Title Page 5 / Table of Contents 7 / Acknowledgements 12 / Executive Summary 15 / Introductory Review 37 / Preliminary Review 63 / Schematic Review 80 / Design Development I Review 104 / Design Development II Review 124 / Final Review 158 / Conclusion 161 / Appendix: Additional References

Acknowledgements: Thank you to all the advisors, critics, friends, and family that have guided and supported me throughout the thesis process. Advisors and critics: Peter Martin Marcus Martinez Ian F. Taberner, AIA, The Boston Architectural College Joe Stromer Amir Mesgar, L.A. Fuess Partners, Inc.- Structural Engineering Advisor Bruce MacRitchie, MacRitchie Engineering, Inc.- Building Systems Advisor David Kelly, Cannon Design Wally Greenhalgh, The Village at Waterman Lake Tim Tobin, Phase Zero Design Sachiko Miyagi Sarah Farrell, Silverman Trykowski Associates Special thanks in particular to my parents, Thomas and Christine Bell, for their unwavering support and encouragement. They have been in my corner each and every day, throughout this project and always. I would not be where I am today without them. In memory and dedication to Edward Sullivan and Evelyn Bell who inspired this thesis exploration and my passion for pursuing the evolution of architecture for memory care.

Modern concept of a healing environment is “... a therapeutic environment that has a positive influence on the healing process and can be achieved by incorporating design elements that provide comfort, security, stimulation, opportunities for privacy and control, positive distractions and access to a patient’s social support network.” - Suite Dreams Project1

“Memories are motionless, and the more securely they are fixed in space, the sounder they are. To localize a memory in time is merely a matter for the biographer and only corresponds to a sort of external history, for external use, to be communicated to others.” -Gaston Bachelard “Poetics of Space”2

“Architecture is a series of successive events...events that the spirit tries to transmute by the creation of relations so precise and so overwhelming that deep physiological sensations result from them, that a real spiritual delectation is felt at reading the solution, that a perception of harmony comes to us from the clear-cut mathematical quality uniting each element of the work.” - Le Corbusier “ Precisions on the Present State of Architecture and City Planning”3

Executive Summary: Title: Defining Cognitive Care: Can an urban prototype for cognitive care be defined by visual connections and spatial adjacencies? Issues: Growing Aging Population- The aging population in the US and around the world is rapidly increasing; given that age is a primary factor in the onset of dementia and related diseases, the need for architecture that supports quality sustained care for the growing demographic is essential. Limited History of Product Type- Spaces designated for dementia and related diseases have only been designed since the early 1980s; there is still a growing field of research that is continuously improving the supporting spatial design. Limited Approaches to Building Type- Over the short history of spaces design for memory care, there have typically been 5 common layout schemes; therefore, there is an opportunity to push the limits of the common solutions. Defining Care Schedules- There are typical schedules for nurses and staff that have been adopted for facilities that require 24-hour staffing; it may be possible to re-imagine staffing and resident schedules. Thesis: My thesis is focused on exploring and defining cognitive care spaces that promote a sustained quality of care for residents, caregivers, and families in an urban environment. I am looking to find a solution that can be a prototype for dementia care as a community hub in an urban setting. I have been focused on using the Daily Living Clock as well as ideas of visual connection and spatial adjacencies to drive the design. By utilizing research-based organizational forces which include exposure to natural sunlight, open sightlines, views and access to nature, visual and spatial movement cues, circular wandering paths, security, and community interaction, the design strives to find a balance between the requirements of institutional care and the benefits of a residential setting enhanced with opportunities for therapeutic activities and experiences. Building Typology and Program: The building program is an assisted living facility with a focus on dementia care. The proposed building is approximately 89,000 SF and provides housing and care for between 37 and 46 residents. There are three proposed resident living floors, each functioning as its own unit; the schematic program layout on each floor is the same with residential rooms and a dining area for morning and evening meals adjacent to each group of rooms. A center atrium provides daylighting and clear sightlines across each floor to a dining area on the opposite side of the living floor for a mid-day meal. This layout provides motivation and opportunity for movement through a variety of spaces, including outdoor terrace space, throughout the residents’ day.

The ground floor of the building functions as a hub for the community and for the building residents and staff. Administrative offices and functional spaces as well as staff break space and outdoor terrace are on this level. The ground floor also provides a café, a daycare center, family dining rooms, a salon/spa, and doctor and physical therapy offices that can be used by residents when chaperoned by a nurse or loved one and by members of the local community. The building functions as a cohesive therapeutic space and the architecture encourages movement and interaction between the various user groups as well as interaction with the outdoors and scenic views. Site: South Huntington Avenue, Jamaica Plain, Boston, MA; 48,625 SF The site was selected because it is located in an urban neighborhood yet also has access to views of the Leverett Pond and surrounding parks in the Emerald Necklace. The site also has significant southern exposure for daylighting needs, ease of access to the site for family, staff, and community members, and lies on the edge of the Mission Hill residential neighborhood and the Veterans Affairs Institutional Subdistrict of Jamaica Plain. The proposed site is a vacant lot on South Huntington Avenue with considerable vegetation and a slope downhill from South Huntington Avenue on the east towards the Jamaicaway to the west. The site is within 1 mile of the Longwood medical campuses and is in the VA Hospital Administration Neighborhood Institutional Overlay. A neighboring property contains long-term stay units for cancer patients receiving treatment at the Longwood hospitals. In terms of zoning, in addition to being in the Neighborhood Institutional Subdistrict the site is also in the Greenbelt Protection Overlay. The zoning allows for both elderly housing and nursing and convalescent homes. The zoning allows for an FAR of 1.0 and a maximum height of 45 feet, both of which will require a variance for the proposed building.

Introductory Review: The introductory review introduces the thesis panel, thesis advisor, and thesis group to the student’s thesis project, concepts, site, program, and other key components. This review presents the opportunity from the group of critics to analyze the student’s thesis process, address any special concerns with the project that may arise, and to propose strategies appropriate for moving forward with the thesis project. Thesis proposal: A new typology of cognitive care space that will successfully address the needs of this rapidly growing aging population will be defined by integrating residential and institutional spaces through their overlapping edges and investigating architectural interventions specifically for cognitive care. Opportunity: Architecturally, cognitive care spaces are undefined and unsuccessful, despite a limited number of advances and trends over the past 30 years. Argument: The rules that have applied to the design of assisted living spaces do not apply to cognitive care spaces for those with dementia and related cognitive impairments. Historically, the line between assisted living facilities and nursing home facilities has been blurred, usually distinguished by the level of nursing care required for the patients. In designing assisted living facilities, the interiors received the most focus. Natural light, access to the outdoors, private and well-appointed apartments, ease of wayfinding, and community living spaces that have similar design aesthetics to a private residence are the standard for well-designed assisted living facilities. However, cognitive care spaces demand a much higher level of focus and detail including visual connections to multiple points within the resident’s room, within the facility, and within the surrounding site. Attention to the specific levels and gradients of natural light as well as the colors and tactile surfaces within a cognitive care space dictate the comfort of a dementia patient. Also, finding ways to protect resident privacy and security while allowing connection to public spaces, including outdoors spaces, are also paramount in determining successful cognitive care spaces. Position: By focusing on a population who have limitations, dementia suﬀerers, solutions that meet all of their needs should also be able to be applied to a greater population. New spatial understandings can improve wellbeing. This thesis will seek to create an appropriate balance in the physical environment in which individuals’ needs may be met and exceeded, and spatial connections and adjacencies are tested and discovered.

What Defines Dementia?: Dementia is not a specific disease, but rather it is a term that refers to a wide range of symptoms that are related to memory loss and cognitive difficulties that impair an individual’s ability to accomplish everyday tasks and activities. Alzheimer’s disease is the most common form of dementia and is a chronic neurodegenerative brain disease that often begins gradually, but as it progresses over time it leads to memory loss, confusion, changes in personality and behavior, communication difficulties, impaired judgment, and a loss of the ability to maintain personal care. While there are a variety of symptoms for both Alzheimer’s and dementia, according to the Alzheimer’s Association, at least two of the following cognitive issues must show significant impairment for a dementia diagnosis: “memory, communication and language, ability to focus and pay attention, reasoning and judgment, and visual perception.”4 Most forms of dementia are progressive and individuals need a continued increase in care as the disease advances; therefore, their environment will need to anticipate further accommodations needed. The ten most common early symptoms of Alzheimer are as follows: “memory loss that disrupts daily life; challenges in planning or solving problems; difficulty completing familiar tasks at home, at work, or at leisure; confusion with time or place; trouble understanding visual images and spatial relationships; new problems with words in speaking and writing; misplacing things and losing the ability to retrace steps; decreased or poor judgment; withdrawal from work or social activities; and changes in mood or personality.”5 While there is no cure for Alzheimer’s disease or other forms of dementia, these diseases can be treated, and the architecture of the environment can be a major influence in this treatment and can help patients live a rich and dignified life. According to Elizabeth Brawley, an interior designer and a member of the AAHID (American Academy of Healthcare Interior Designers) who focuses specifically on senior housing for memory care, Alzheimer’s patients that are in calm and structured surroundings function better over longer periods of time. A physical environment that directs cognition becomes treatment for an individual that can no longer make or use a cognitive map; this type of environment can increase the safety and security of an individual. Further, privacy and personalization of the bedrooms and other private spaces of individuals with forms of dementia lessen their agitation, while distinctive and varied social spaces reduce the rates of depression, social withdrawal, and confusion. Most clearly stated by Elizabeth Brawley, “The physical environment and therapeutic activities become treatment when they are linked to specific brain dysfunctions such as Alzheimer’s disease when they systematically compensate for the functional losses of dementia. When treated consistently in specially planned environments, even those with Alzheimer’s disease can achieve higher emotional levels, developing both a sense of self and a sense of belonging to a larger community of residents. Improved quality of life, a slowed rate of progression of the disease, delayed institutionalization, and a reduced need for medication are the ultimate measures of success of such a treatment approach.”6 16

History: There has been a distinct evolution of senior healthcare environments (“Eden Alternative”, Greenhouse, and Planetree are the most dominant in schools of thought on care) and all have the common thread of patient-centered care, patient dignity, and small-group “home-like” care. The trend in senior living has focused on a move to smaller facilities designed to be more like a traditional home. Alzheimer’s Disease and other forms of dementia first gained significant attention as a medical condition in the 1980s and early responses to these patients’ needs were to place individuals without immediate family to care for them in hospital-like settings. However, in the early 1990’s a school of thought emerged that began to see aging as a continued stage of development, rather than a period of decline. The Eden Alternative began to bring nature and children into the lives of aging adults and focused on companionship and meaningful activities. This movement began to parallel the work of Planetree, that began in the 1970s related to hospital care, but focused on “patient-centered care” and healing environments, where features of home are incorporated and family and social support are viewed as key components of a healing environment. These two movements inspired the most recent approach (early 2000’s) to care for the aged and suﬀerers from dementia; this is the “Green House” approach. Green House looked at a new way to care for the elderly that centered around small residential homes that could house 10-12 residents with onsite caregivers. By applying this residential model to care for the elderly and patients with dementia, a significant shift from large, institutional facilities to small, specialized facilities began to occur. These smaller facilities allow for greater involvement of families in the lives of their loved one as well as opportunities for meaningful activities and interactions in the lives of the residents. Because of this shift to smaller, specialized facilities, there is an opportunity to re-imagine a small facility in a way that provides healing environments for all parties involved, not only the patient. The residents, workers, families, neighborhood, and greater community can all benefit from a new model that is a healing and meaningful space for everyone. Managing the scale of a facility as well as managing and manipulating the varying edge conditions that exist in a location will dictate the success of the project. Bringing focus specifically to cognitive care spaces as spaces that are unique unto themselves and not a blend of existing typologies will push forward the advancement of these needed facilities.

Americans with Disabilities, 2005

Top Ten Chronic Conditions of Assisted Living Resident: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

High Blood Pressure: Alzheimerâ&#x20AC;&#x2122;s disease and other dementias: Heart Disease: Depression: Arthritis: Osteoporosis: Diabetes: COPD and allied conditions: Cancer: Stroke:

(www.ahcancal.org)

57% 42% 34% 28% 27% 21% 17% 15% 11% 11%

Demographics/ What Defines the Aging Population?: • The aging or elder population is defined as that segment of the population over the age of 65 • 13.1% or 1/8 of the US population is 65 or older • Of this elder population, 72% of men are married, where only 42% of women are married • Of all women over the age of 65, 40% of women are widows • Of women over the age of 75, 47% of women live alone • In assisted living facilities, 74% of the residents are female, where only 26% of the residents are male.

Issues/ Growing Aging Population: The aging population in the US and around the world is rapidly increasing. Given that age is a primary factor in the onset of dementia and related diseases, the need for quality sustained care for suďŹ&#x20AC;erers is also growing. 1 in 9 of elder adults will die of Alzheimers, 1 in 3 over 65 will die with some form of dementia, and by 2050, 13.8M people will have dementia (up from 4.7M in 2010).

www.alz.org

Issues/ Limited History of Product Type: Alzheimers and dementia were first solidified and new care options looked at in the late 1970s/ early 1980s. The real beginnings of the progression of design for these conditions began in the mid-1990s, so this is still a new and changing field of study. There are 5 typically used schemes for building layouts used for these types of projects and many programs of care follow a few similar paths such as the traditional care strategy or the Green House strategy. Alzheimer’s Disease discovered- 1906 Link between cognitive decline and number of plaques and tangles in the brain solidiﬁed- 1960’s

1975 Shift from housing dementia patients in nursing homes instead of mental institutions

Philadelphia Geriatric Center- ﬁrst nursing home specialized for dementia care (mid 1970s)

Alzheimer’s Disease deﬁnition solidiﬁed- 1977 Planetree movement founded- focused on patientcentered care (1978) Alzheimer’s Association formed in 1980

1980

Emergence of Assisted Living model Dementia recognized as a group of symptoms related to cognitive decline- Alzheimers Disease is just one cause of dementia symptoms

1985 Alois Alzheimers Center, Cincinnati, OH- early assisted living with dementia care (1987) Design for Dementia: Planning Environments for the Elderly and the Confused- ﬁrst comprehensive design guide for dementia care published in 1988.

Alzheimers Care Center of Gardner, ME- early assisted living with dementia care (1988) Corinne Dolan Alzheimers Center, Chardon, OH- early assisted living with dementia care (1989)

1990 Eden Alternative founded- focused on improving nursing home care by introducing opportunities for patients to provide meaningful care to other living things (1991)

Number of assisted living facilities with dementia care increased dramatically

Homes for Senior Citizens by Peter Zumthor, Chur, Switzerland- 1993

1995 Montgomery Place, Chicago, ILbuilt in early 1990s, repostioned in 2009.

2000 Green House Project ﬁrst developed- shifting from institutional model to residential homes of 10-12 elders (2003) The Competence Centre for People with Dementia in Nuremberg, Germany, (2006)

Leonard Florence Center for Living, Chelsea, MA- Urban Green House project (2010)

Still very few ﬁrms focused on dementia care as a project type. Cognitive care spaces are still termed either residential or institutional

present

Issues/ Limited Approaches to Building Type: Over the short history of design of facilities for dementia care and senior living, five common layout plans tend to repeat in a variety of iterations. These five common layouts are as follows: 1. Traditional Long Corridor: Provides space for larger groups of residents (40-60) and centralizes spaces for both residents and staﬀ. Sight lines and circulation patterns are restricted.

2. Clusters: Units are broken down into smaller groupings to allow centralization of care by staﬀ to smaller groups of residents. Staﬀ and resident spaces are all contained within the smaller grouping.

3. Neighborhoods: Centralizes staﬃng resources and resident amenities while decentralizing small-scale clusters of units (typically 10-20 residents).

4. Internal Garden/ Courtyard: Self-contained living and staﬃng environment typically focused on central (outdoor) secure gathering space. The number of units in the grouping is usually for 10-20 residents.

5. Houses (Green House): The units are freestanding operationally and physically and typically serve 10-12 residents. All services are provided within the freestanding home, most importantly, cooking.

Issues/ Defining Care Schedules: Per the NHRA, or Nursing Home Reform Act, of 1987, facilities that provide 24-hour care for elder adults are required to be staffed at minimum levels based on qualifications of staff and recommended care hours per resident. A Registered Nurse, or RN, is to be the Director of Nursing, and at least one RN will be on site for 8 hours a day, 7 days a week. The remainder of the 24-hour shift each day will be staffed by a licensed nurse in charge and this nurse shall be either an RN or an LPN/LVA (Licensed Practical Nurse/ Licensed Vocational Nurse). There will be sufficient CNAs, or Certified Nursing Assistant, on staff 24 hours a day, 7 days a week. It is recommended that a member of the nursing staff spends at least 4.55 hours with each resident every day. For context, typically a resident needs assistance with an Activity of Daily Living, or ADL, for at least 2.88 hours each day. Typically in the elder care setting, nursing staff works three shifts in a 24 hour period; these shifts are from 7 AM to 3 PM, 3 PM to 11 PM, and 11 PM to 7 AM.

Strategy/ Reimagining the Daily Living Clock: Given that typical nursing staff hours are 7 AM to 3 PM, 3 PM to 11 PM, and 11 PM to 7 AM, for a 24-hour staffed facility, overlaying residents’ daily schedules with that of staffing needs is a critical component of maintaining quality care. While typically there are three meals per day, eaten in the morning, afternoon, and evening, and these meals are bookended by ADLs and entertainment activities, not all dementia patients run on a fixed schedule. Routine and consistency are helpful for residents, as is allowing a resident to move at his or her own pace. Re-imagining the typically “fixed” daily living clock with one that is more flexible and allows for patient variation is the proposed alternative strategy. The key to the success of this strategy is providing spaces that support this flexibility. Further, allowing some flexibility in staff schedules can improve conditions for both staff and residents. For example, alternate shift schedules could be 6 AM to 2 PM, 2 PM to 10 PM, and 10 PM to 6 AM. Allowing these varying shift schedules to overlap with existing schedules could provide extra staff in the morning when residents are awakening and need assistance with tasks of daily living and also allow staff to be home earlier in the afternoon for childcare or other home life needs.

Traditional Timeframes of Daily Activities

Traditional Daily Living Clock

Daily Living Clock Re-imagined 26

Solution/ Cognitive Care Environments Focused on the Re-imagined Daily Living Clock and Visually Connected Spaces: Spaces that support flexibility while working with caretaker and family schedules will be the most successful for dementia care. By providing a guided day on a continuous pathway, allowing for family and community interaction, and designing a streamlined flow of work for staff as well as personal flexibility, cognitive care spaces can provide sustained quality care for its residents. Additonally, providing visual connections between spaces encourages resident movement. Often as part of the memory loss associated with dementia, sufferers will be apt to forget what is behind a solid wall since they can’t see the space; without knowing what the space is behind the wall, the person will be unlikely to explore the unknown area. By providing open sightlines, residents will be encouraged to move as they will be able to see spaces and activities that they would like to inhabit or in which they would like to participate. This movement throughout the day provides opportunities for physical exercise, socialization, access to therapeutic spaces, and engagement with activities; each of these opportunities provide stimulation that can ease tension, aggression, confusion, and agitation in dementia sufferers.

Methods of Inquiry: • Research and compile a thorough understanding of the short history of memory care design. • Examine case studies of unique program precedents and strategies for the program type. • Research and understand the cognitive and physical limitations and symptoms of aging individuals living with dementia • Research current design strategies for senior living and dementia care. Categorize types of interventions and the success/failure as related to the limitations of individuals with dementia. • Actively pursue new design strategies and architectural interventions to define cognitive care spaces in a spatial manner. Look to existing housing and healthcare facilities in urban settings for strategies to employ on a constrained site. Look to alternate program types for spatial solutions to visual connections, indoor and outdoor connections, architectural wayfinding strategies, and multifamily housing.

Terms of Criticism: • Were new spatial connections and strategies discovered to accommodate individuals with dementia? • Was the design solution sensitive to the internal needs of the occupants as well as the urban constraints of the site? • How does the proposed design solution continue or redirect the current trend of memory care design? • Can the proposed design be used as a prototype for urban memory care? • Does the proposed design provide connection to the community through the site?

Case Studies/ Inspiration: Several case studies, of similar and diďŹ&#x20AC;erent programs to the proposed program, were studied for inspiration as to how circulation and public space can also be flexible and personalized.

(Google Images) Peter Zumthor: Homes for Senior Citizens

TakeawayThe public circulation runs through more private individualized spaces to create points of connection and interaction.

Lewis Tsurumaki Lewis: Bornhuetter Hall 7

TakeawayPrivate spaces are separated from public spaces yet each type of space can be seen from the other, creating a visual connection instead of a shared physical space. 31

Site/ Location: Region:

City:

Site:

Context:

Site/ South Huntington Avenue, Jamaica Plain, MA: The site on South Huntington Avenue exists at the edge of residential and institutional districts as it crosses the boundary between the dense residential neighborhood in this section of Mission Hill as well as the institutional district of Jamaica Plain. The site is approximately 48k SF, has an FAR of 1, and slopes about 12 feet from South Huntington Avenue to the Jamaicaway. Excellent views of the Emerald Necklace and Leverett Pond are available from the site. The site is located within close proximity to the VA Hospital and to the Longwood area hospitals; a neighboring site is a center for patients and their families receiving long-term treatment at these area hospitals. Public transit (both train and bus routes), pedestrian access, and vehicle access are all readily available at the site.

Introductory Review/ Reviewer Feedback: The reviewer feedback at the introductory review was constructive and positive. The following key items were brought up to pursue for the next review: â&#x20AC;˘ be sure to graphically illustrate key issues, facts and figures â&#x20AC;˘ focus on the program and site driving forces to reinforce concept

Preliminary Review: The preliminary review allows the student to present the full scope of the thesis and all work to date for feedback and guidance for future direction and investigation. This review encompasses a deeper illustration and evidence of research relating to thesis concept, site analysis relating to concept, programmatic concepts and proposals, and a number of conceptual schemes illustrating conceptually distinct approaches to the project. Thesis: My thesis is focused on exploring and defining cognitive care spaces that are focused on sustained quality of care for residents, caregivers, and their families in an urban environment. Opportunity: Given that the number of people with some form of dementia is rapidly increasing, developing a solid model for quality sustained care for suďŹ&#x20AC;erers is necessary. By focusing on a re-imagined daily living clock and working with the flow of residents, staďŹ&#x20AC;, and the community life at the site and in the surrounding neighborhood, a new strategy for the architecture for these care facilities can be developed. Site: I am focused on developing this program in an urban constrained site. As the aging population is moving to urban centers and is choosing to stay in these centers as they age because of the ease of access to extended families, amenities, and healthcare, developing this project on an urban site is key. The chosen site is on South Huntington Ave. in Jamaica Plain and sits between South Huntington and the Jamaicaway on the edge of the Mission Hill neighborhood overlooking a portion of the Emerald Necklace. The site is currently vacant, is approximately 48k SF, slopes about 12 feet in a sharp incline to the Jamaicaway, lies in an institutional overlay zoning district, and has an FAR of 1. Senior living and nursing home facilities are allowed uses per the current codes. Position: The architecture of cognitive care space should enhance the quality of sustained care and provide spaces where people want to live.

Public transit:

TraďŹ&#x192;c:

Pedestrians: 38

Site/ South Huntington Avenue, Jamaica Plain, Boston, MA:

Site section:

Site axonometric: 39

5 and 10 minute walking radius:

Wind:

Green space: 40

Program/ Senior Housing for Dementia Care: The chosen program is senior living focused on dementia care. Key ideas that are the focus of programming the space are limiting circulation spaces to allow for visual contact between spaces and allowing for more flexible spaces that create a therapeutic environment and redefine behavioral care, or cognitive care space.

Preliminary Program Components: (in SF) Type of Space Apartments Kitchen Dining Cognitive Care Nursing/ PT Day Care Exercise Space Administrative Outdoor Space Parking

Total

SF of each Unit

9600 800 850 3000 2000 1500 1200 2000

400 800 850 3000 2000 1500 1200 2000

# of Units 24 1 1 1 1 1 1 1

25 spaces

Net Building Area

20,950

Restrooms Mechanical/Circulation/Storage Total

1,000 5,000 6,000

Gross Building Area

26,950

Typical Daily Timeline and Program:

Program Adjacencies:

Program Requirements:

Program Timeline: 44

Re-imagined Daily Timeline and Program:

Program Adjacencies:

Program Requirements:

Program Timeline: 45

Re-imagined Daily Timeline and Program:

Program Adjacencies:

Program Requirements:

Program Timeline: 46

Re-imagined Daily Timeline and Program:

Program Adjacencies:

Program Requirements:

Program Timeline: 47

Program Precedents: PSY / Psychiatric hospital in Helsingor, DK BIG / Competition TAKE AWAY: Allows freedom and autonomy while providing a secure and protected environment. Engages the interior of the building with protected outdoor spaces.

Leonard Florence Center for Living / “Green House” style long-term care and skilled nursing facility in Chelsea, MA. First implementation of Green House in urban setting. 100 beds. DiMella Shaﬀer / 2010 TAKE AWAY: Deploys a residential organizational strategy for long-term care (Green House) in an urban setting. Utilizes large floor plates as individual “houses”.

Hogeway â&#x20AC;&#x153;Dementia Villageâ&#x20AC;? / Village-style, self-contained, residential complex for dementia patients in Weesp, NL. 152 current residents. Molenaar & Bol & VanDillen / 2009 TAKE AWAY: Allows freedom and autonomy while providing a secure and protected environment. Engages the interior of the building with protected outdoor spaces.

THE STAIRCASE

KEY CONCEPT: RESIDENT ROOMS GET PRIORITY VIEW OVER LAKE AND PARK

THE CLOCK

KEY CONCEPT: SPACE ALLOWS FOR SEQUENTIAL ADJACENCIES BASED ON FLOW AND TIME OF USE

THE VILLAGE

KEY CONCEPT: PROGRAM DIVIDED INTO DISTINCT PODS TO DISTINGUISH USE AND HIERARCHY

THE EDGE

KEY CONCEPT: PROGRAM LOCATION ON SITE RESPONDS TO PROGRAM ON ADJACENT SITES

THE CORE

KEY CONCEPT:

PROGRAM IS CENTRALIZED. KEY MOMENTS ARE CUTAWAY FOR VIEWS.

Conceptual Schemes: Five possible building schemes were generated from key researched concepts.

SCHEME PLAN:

SCHEME SECTION:

Scheme 1/ The Staircase: This scheme prioritizes resident rooms, allows for views from much of the building to the neighboring park, connects the building visually to the outdoors, allows for continous internal circulation, and plays to the site topography.

STRATEGY DIAGRAM:

KEY MOMENTS: View to Park

PRECEDENTS:

The Habitat and Renzo Pianoâ&#x20AC;&#x2122;s Studio (Google Images) 55

SCHEME PLAN:

SCHEME SECTION:

Scheme 2/ The Clock: This scheme considers the flow of activities on a timeline, allows for both views and protected exterior spaces; there is continous circulation within the building, and significant natural light is available to the interior spaces.

STRATEGY DIAGRAM:

KEY MOMENT: Courtyard

PRECEDENTS:

Exeter Library and Basque Culinary Center (Google Images) 57

SCHEME PLAN:

SCHEME SECTION:

Scheme 3/ The Core: This scheme allows for adjacencies, timeflow, and internal circulation, allows for visual connections between the exterior and interior spaces of the building, and prioritizes cognitive care spaces within the building.

STRATEGY DIAGRAM:

KEY MOMENTS:

PRECEDENTS:

Open Interior Nordic Pavilion- Venice Biennale 2012 (Google Images)

Huski Apartments (Google Images)

Site Model:

Preliminary Review/ Reviewer Feedback: The reviewer feedback at the preliminary review was constructive and positive. The following key items were brought up for further consideration: • be sure to address all user groups in the scheme that will be chosen to be developed further • critically explain and illustrate why the site works for cognitive care • focus on the “hidden reality” that staﬀ members work under to keep the residents calm and undisturbed • look carefully at how residents’ rooms connect to the outdoors; how does circulation work in this area of the project and how is it functional • research the benefits of the daycare component and re-examine the adjacencies to the daycare within the building • spaces within the building should be flexible and should easily accommodate a variety of uses • clarify the resident mix based on population demographics

Schematic Program Requirements and Adjacencies:

Program Adjacencies:

Program Requirements:

Program Timeline: 62

Schematic Review: The schematic review is where the student presents a single scheme for addressing the thesis concept and for resolving basic site and program relationships for the first time. This review emphasizes concept development from the previous review and demonstrates how the concept will be realized architecturally. Areas that must be addressed in the schematic review include further thesis concept development, site plan and organization, building organization, architectural character, and building systems. Thesis: My thesis is focused on exploring and defining cognitive care spaces that promote a sustained quality of care for residents, caregivers, and their families in an urban environment. Over the short history of senior living for memory care, these spaces have been viewed as a mix of residential and institutional spaces with one of these typologies dominating the design scheme. Specialization for memory care has most often been attempted by adapting interior design features (such as color and signage) instead of looking at a new type of architectural space to accommodate the needs of this rapidly growing population. I will look to find a new solution that re-imagines cognitive care space for the elderly by using the daily living clock and visual connections to drive the organization and design. Each of the three primary user groups of the facility, residents, staﬀ, and the community, function along a normalized daily living clock. I imagined a common daily timeline based on typical nurse shifts and daily activities, and then re-imagined this timeline with the activities flowing over the course of the day based on individuals’ unique internal time clocks. I also looked at the orientation of the site and the alignment of the building on the site using shadow studies to tie the activities of daily living on the clock to the movement of light and shadows on the site. I looked to combine the cycle of the function of the building and site with the movement of the sun. The normal daily pattern that the residents will follow, follows the sun and leads the residents in a continous path of activity to keep them calm and engaged. The layout of the building also allows for continuous connecting sightlines between hubs of activity. Once this alignment with the daily clock was determined, I set 4 major points as “anchors” or “signposts” for the basis of form generation. The 4 points align with the three daily meals and the nurses station. By designating a new location for each meal of the day, circulation through the space is facilitated. Sightlines between these hubs connect across usable, flexible spaces with limited hallways in the facility. The nurses’ hub is central to the residents’ private rooms which is where residents will be most likely all gathered in one place at the same time. This circulation carries through to the alignment of the building on the site with views from the building “anchors” and adjacencies to the edges of the residential and institutional districts in the Jamaica Plain neighborhood. 63

Conceptual Scheme/ Daily Living Flow Diagrams:

Daily Living Flow Diagrams:

“Activity Options”

“Decision Tree”

Resident Activity Flow: consistent yet diﬀerent exterior views with each meal

StaďŹ&#x20AC; (Nurse) Activity Flow:

Community Member Activity Flow:

Scheme Generation:

1. Plinth

2. Site adjacencies and orientation points:

3. Daily Living Clock on Site 66

4. Four Anchors Sited

5. Courtyard

6. Living spaces added 67

Schematic Floor Plans:

Floor 1:

Floor 2: 68

Prototype Typical Floor Use Pattern

Resident Rooms

Dinner

Breakfast

Lunch

Site Strategy/ Shadows and Outdoor Space: Shadow Studies:

MARCH 21, 8 AM

JUNE 21, 8 AM

SEPTEMBER 21, 8 AM

DECEMBER 21, 8 AM

MARCH 21, 12 PM

JUNE 21, 12 PM

SEPTEMBER 21, 12 PM

DECEMBER 21, 12 PM

MARCH 21, 4 PM

JUNE 21, 4 PM

SEPTEMBER 21, 4 PM

DECEMBER 21, 4 PM

Site section facing southeast

DINING SPACE

COURTYARD

ACTIVITY SPACE

Architectural Character/ Form and Materiality:

Proposed Materials:

Glass facade by Steven Holl:

Fibre C facade material by Rieder:

Elevation View from Jamaicaway:

Program and Form/ The Daily Living Clock:

Resident Rooms, Nursing Station, Courtyard

Afternoon gathering space, Dinner space

Technical Considerations: Structural grid:

Wandering Gardens:

(www.portlandmemorygarden.org)

Color Schemes: Aging eyes need both contrast and colors sensitive to the yellow hue that most aging eyes add to all viewed colors.

(www.sherwin-williams.com)

Model in Context:

Schematic Review/ Reviewer Feedback: The reviewer feedback at the preliminary review was constructive and positive. The following key items were brought up for further consideration: • develop one diagram for all points of argument • focus on flexible uses for the meal spaces- what is being done with these spaces when they are not being used for meals? • develop specific threshold moments between spaces • research the pathways and uses of space that are critical to the nursing staﬀ daily activities • develop detailed interior vignettes that include color schemes for the interior spaces.

Design Development I Review: The first design development review is focused on integrating disparate areas of inquiry into a holistic architectural response; conceptual ideas are beginning to be expressed directly in the architecture. Areas that must be addressed in the first design development review include further thesis concept development, site plan and organization, architectural design, building systems, and other technical issues specific to the thesis. Progress: The summer months gave me time to reflect on the thesis progress to date and I realized that several major aspects of the developing building needed to be re-focused. While the conceptual design of the program adjacencies were in touch with my overall thesis of movement and working with individuals’ daily living clocks, the scale of the building spaces were not functional or in touch with the human scale of the multiple user groups and the spaces designated for dining activities were far too large given the number of residents projected for each level of the building. Further, while the central courtyard accomplished the goal of providing secure outdoor spaces and daylighting to the interior of the building, the usability of this internal courtyard on multiple floors was not workable. I am seeking a solution to dementia care in an urban setting, which means finding workable ways to develop vertically instead of horizontally. Incorporating daylight as well as usable courtyards into the movement of the daily travel of the residents on each level is critical and I looked to develop a new solution. Also, spaces for staff and a for a true community connection have not yet been established. Further, code issues and zoning requirement such as parking have not yet been considered and these necessary aspects will inform access and footprint that may be required on the site. Additionally, I felt that further research and discussion with current users and staff of existing facilities was needed to help me solve the large scale issues that I believed existed in my thesis. As a result, I took a step back and went to interview first hand administration and staff of a memory care and skilled nursing facility, The Village at Waterman Lake, in Smithfield, RI. Thesis: My thesis is focused on exploring and defining cognitive care spaces that promote a sustained quality of care for residents, caregivers, and families in an urban environment. I am looking to find a solution that can be a prototype for dementia care as a community hub in an urban setting. I have been focused on using the Daily Living Clock as I have re-imagined it to drive the design; however, based on further research on typical symptoms of dementia I am returning to my initial ideas of visual connection and spatial adjacencies in addition to the Daily Living Clock. Because dementia sufferers often forget what is out of sight, this includes what is is beyond solid walls, sightlines between spaces to facilitate movement through the building will be essential.

Design Development I Review: Organization: A new site organization is proposed for the building. Considering the amount of required parking for the building, as well as required loading access, a base for the building will be built into the slope of the site. These required functions also informed a base column grid and building footprint on top of which user levels are stacked vertically. A level for staﬀ and community is provided at ground level for ease of street access from South Huntington Avenue. Three resident levels are located above this community and staﬀ level and are oriented on the site to allow for maximum daylight and views to the Emerald Necklace for the residents. All resident rooms are organized into “pods” of 6 private rooms, with 2 of these pods per floor. Smaller dining spaces for breakfast and dinner are located directly adjacent to these pods. Keeping with the motivation to facilitate movement, a secondary dining space is located on the other side of the floor from these pods for the mid-day meal. The space that was formerly a center courtyard is now a large atrium space that allows for views across each floor and for daylighting to the interior of the building. Accessible terraces have been moved to the building exterior and are beginning to flow with the continuous circulation path being developed on each resident level.

User Interview/ The Village at Waterman Lake: I sat down with Wally Greenhalgh, head of administration at The Village at Waterman Lake in Smithfield, RI in September of 2014. Key points from the interview are as follows: • The Village at Waterman Lake memory care building has 4 wings, 3 designated to memory care and one designated for skilled nursing services. • The memory care wings accommodate a maximum of 18 residents each • The skilled nursing wing accommodates 30 residents • Consistent teams for patient care are critical; it is ideal that a resident see no more than 6 different nursing staff members in a week • Staff hours are typically 7 AM to 3 PM, 3 PM to 11 PM, and 11 PM to 7 AM although the facility is leaning towards more flexible hours for both staff and resident benefits. • There are 2 full time nurses, a 0.5 time nurse, 1 nursing aid, and 1 nursing assistant on staff in each wing during the first 2 shifts of the day; 2 people are on staff for the third shift • Residents are bathed twice a week in the mornings and evenings; most prefer showers and the facility is moving away from a central shower room to use of private resident bathrooms for this purpose. • 8 to 10 residents per staff member is common; when residents are in the enclosed outdoor spaces a lower staff ratio is needed • rooms at The Village at Waterman Lake are shared rooms primarily due to cost constraints; private rooms are ideal to reduce spread of infection, lower noise, and individual bathroom needs. • Nurses stations are being eliminated as all files are now stored digitally • Wandering and security are a key concern and consideration • Storage is the most underaccommodated need as 1 month of all supplies must be kept on hand. • Ambulance access is through the main entrance as is the path of travel for deceased residents.

Parking, Access, and Fire Protection Requirements: The projected parking needs at the site are estimated as follows: Staﬃng Estimate (at minimum): 12 residents per floor x 3 floors = 3 nurses per floor at minimum x 3 floors = Dining services Director of Nursing Administration Daycare Reception Sales Activities Coordinators

36 residents 9 nurses 4 employees 1 employee 1 employee 2 employees 1 employee 1 employee 3 employees

Estimated

22 employees per shift

Parking requirements32 to 35 spaces including 2 ADA spaces (including 1 van space) Ambulance access to the main entry requires a 12’ wide aisle and a 25’ turning radius 1 loading bay is required per code All entrances and 100% of the dwelling units must be ADA accessible Fire Protection: Per the 2009 IBC, the project falls under type I-2: • automatic smoke and fire protection systems are required • the building must be fully sprinklered • smoke detectors must be located in all resident rooms • maximum egress travel distance is 200 feet • there must be a minimum of 2 exits per floor • Resident rooms will be “shelter-in-place”, this must include the entire “pod” because they must have stairway access and a 2-way communication system • fire-retardant wood framing is allowed • all fire walls must have a 2-hour rating Variance required for height and FAR- allowed FAR is 1 and allowed height is 45’, both of which will be exceeded by the proposed building. (IBC 2009)

Site Strategy/ Shadows and Outdoor Space:

MARCH 21 10 AM:

JUNE 21 10 AM:

SEPTEMBER 21 10 AM:

DECEMBER 21 10 AM:

MARCH 21 2 PM:

JUNE21 2 PM:

SEPTEMBER 21 2 PM:

DECEMBER 21 2 PM:

Atrium Shadows in Plan:

MARCH 21 8 AM:

JUNE 21 8 AM:

SEPTEMBER 21 8 AM:

DECEMBER 21 8 AM:

MARCH 21 12 PM:

JUNE 21 12 PM:

SEPTEMBER 21 12 PM:

DECEMBER 21 12 PM:

MARCH 21 4 PM:

JUNE 21 4 PM:

SEPTEMBER 21 4 PM:

DECEMBER 21 4 PM:

Atrium Shadows in Section: 86

Jamaicaway

South Huntington Avenue

Site Access:

Program Components:

Program Adjacencies:

Program Requirements: Program Timeline:

Site Plan with parking:

Ground Floor:

Administration

Entry

Daycare

Second Floor:

Resident Rooms

Breakfast/ Dinner

Mid-Day Meal

Resident Rooms

Breakfast/ Dinner

Building Layout:

Third Floor:

Resident Rooms

Breakfast/ Dinner

Resident Rooms

Breakfast/ Dinner

Mid-Day Meal

Fourth Floor:

Mid-Day Meal

Resident Rooms

Breakfast/ Dinner

Resident Rooms

Breakfast/ Dinner

Program and Form/ The Daily Living Clock:

Building Axonometric:

Resident Floor Schematic Plan: Concept of moving from resident room to breakfast around atrium to mid-day meal and back to dining near private room for dinner

View Across Atrium:

View From Resident â&#x20AC;&#x153;Podâ&#x20AC;?: 95

View from Jamaicaway:

Exterior Concept Views:

View from South Huntington Avenue:

Form and Materiality:

(www.bullittcenter.org)

Interior Structure Inspiration: Wood beam, exposed underside of wood deck above to give a warm feeling (Google Images)

Exterior Materials Inspiration: (Google Images)

Sensitivity to local materials and surrounding context

Structural System Inspiration Details:

(Google Images)

Parking Level Plan with Column Grid:

Isometric Column Grid, Floor Plates, and Atrium:

100

Schematic Building Systems:

Schematic Plumbing Diagram:

Structure and Ceiling Height Section Diagram:

101

102

Design Development I Review/ Reviewer Feedback: The following key points were raised for further exploration: • • • • •

Refine the structural grid to work better with the program layout Clearly show sightlines and ceiling heights as they related to circulation Re-think the location of the service elevator Consider screens or low-walls on resident floors along the atrium to moderate views Will the atrium space be occupiable on the ground floor?

103

Design Development II Review: The second design development review is focused on further integrating disparate areas of inquiry into a holistic architectural response; conceptual ideas are to be expressed directly in the architecture. Areas that must be addressed in the second design development review include further thesis concept development, site plan and organization, architectural design, building systems, and other technical issues specific to the thesis. Thesis: My thesis is focused on exploring and defining cognitive care spaces that promote a sustained quality of care for residents, caregivers, and families in an urban environment. I am looking to find a solution that can be a prototype for dementia care as a community hub in an urban setting. I have been focused on using the Daily Living Clock as well as ideas of visual connection and spatial adjacencies to drive the design. Organization: As my proposed building evolves and as I continue to research concepts related to dementia, cognitive care, and residential spaces, I have compiled a set of driving key organizational forces. While there are a wide variety of causes of dementia, each affecting different parts of the brain, there are commonalities in symptoms which allow for specific design solutions to have positive effects on this demographic group. 1. Exposure to natural sunlight• provides Vitamin D • assists in the management of sleep patterns • has a positive effect on mood 2. Open sightlines• relieve anxiety in dementia sufferers • encourage movement between spaces • allow for ease of monitoring by staff 3. Views and access to nature• have a positive effect on mood • slow the rate of patient decline • relieve anxiety • decrease pain 4. Visual and spatial movement cues• improve solution to color coding/ signage for direction • encourage movement

104

Design Development II Review: 5. Circular wandering paths• facilitate movement • relieve anxiety and provide comfort • direct resident to where they should be organically 6. Security• contains wandering • monitors visitor access • allows for ease of supervision 7. Community interaction• has a positive effect on mood • slows the rate of patient decline To address each of these key points each floor plate of living units is planned as an individual unit. Each resident floor is centered on the atrium space which allows in daylight and provides sightlines across the floor plate. Small residential groups of rooms provide a feeling of home and two designated meal areas for all residents encourage movement and socialization. The terraces on each resident level provide a variety of outdoor spaces that are easily accessible and provide a connection with nature. There is a change to a higher ceiling height in the zone around the atrium space on each resident floor to signal circulation. The entry level contributes important elements for the other important user groups of the building, the staff and the visitors. The ground level allows for ease of security, grouping of amenities, and staff break space and outdoor space which is equally as important as the resident outdoor space.

105

Program Components:

Program Adjacencies:

Program Requirements:

106

Program Timeline:

Pedestrian (red) and vehicle (blue) access:

Site Access:

107

Building Section A-A:

108

Legend:

Building Parking Level:

Resident StaďŹ&#x20AC; Visitor

109

110

Ground Floor:

Second Floor:

Schematic Floor Plans:

111

112

Third Floor:

113

Fourth Floor:

114

Roof Plan:

Building Systems: Structure Diagram:

Notes from meeting with Structural Engineer, Amir Mesgar: • for lateral bracing CMU shear walls in stairwells and elevator cores sufficient • additional columns around atrium do not need to run to garage level; a 4’ transfer beam in garage can carry this load • timber columns not ideal, instead use steel columns wrapped in wood for same effect visually • 12’ from floor to floor is sufficient • beams estimated at 24” and spaced 6’ o.c. between girders • a 3” sheathing material in composite floor plate will allow for timber effect on underside of floor plate and the 6’ beam spacing • 18” columns assumed for grid Heating Diagram:

Chiller Diagram:

Notes from meeting with MEP Engineer, Bruce MacRitchie: • will need exhaust vents from kitchen and dining areas for odor control • for size of building, 2 rooftop package chillers will be suﬃcient each at 125 tons (8’ x 8’ x 30’) • boiler room can be placed on the roof and for the estimated 25 BTU/ SF condensing boiler will be needed (boiler room at 30’ x 20’) • a backup generator that can operate for a minimum of 90 minutes will be required • vent fans in the atrium will be required for smoke evacuation • water-sourced heat pumps can be installed in the exterior wall of each resident room for localized temperature control (4-pipe fan coil system) 115

116

Front Elevation:

Right Side Elevation:

Elevations:

117

Back Elevation:

Left Side Elevation:

Perspectives and Materials: Structure:

Terrace Walls:

Atrium Perspective: Terrace Wall Exterior:

Exterior Paneling:

Terrace Perspective:

(Google Images)

118

Wall Section: Section B-B:

119

Wall and Terrace Details:

Floor Plate Detail:

Terrace Floor Detail:

Terrace Edge Detail:

120

Model in Context:

121

122

Design Development II Review/ Reviewer Feedback: The following key items were brought up for further consideration: • further develop the circulation drivers in perspective. Perhaps illustrate “A Day in the Life” • examine planting on the exterior of the building and the terraces • further develop the language of the atrium walls both from the ground floor looking up and from the resident floors looking inward • focus on the flow of the first floor to really work as a community/hub space • illustrate daylighting and shadows on the exterior terraces • be specific about the elevator type and clearances required

123

Final Review/ Defining Memory Care: The final review is a demonstration of the entire project. Conceptual clarity and formal spatial presentation is critical. Completion of the integration of agendas and alternatives begun in the research and schematic reviews as well as demonstration of the final resolution of the underlying ideas carried through from the beginning of the thesis must be achieved. The final review must demonstrate the translation and integration of the elements of architecture into a coherent proposal which embodies the idea basis of the thesis. Thesis: Can an urban prototype for cognitive care space be defined by utilizing visual connections and spatial adjacencies? This thesis has been a typological investigation of cognitive care space and has redefined what memory care in an urban environment can be. Historically, senior living facilities for memory care have been viewed as a cross between residential and institutional space, with one or the other of these typologies dominating the design scheme. I have examined a new way to use the Daily Living Clock and visual connection to develop a dementia care facility that is a community hub in an urban neighborhood. While there are a wide variety of causes of dementia, each affecting different parts of the brain, there are commonalities in key symptoms; therefore, it has been possible to arrive at a design that can have positive effects for the whole of this demographic group. Within the Daily Living Clock organization of space, I have also included accommodation for research driven organizational factors including exposure to natural sunlight, open sightlines, views and access to nature, visual cues for movement, wandering paths, security, and access to community. These factors are not only critical to resident health, but also to quality of work life for staff and a positive visitor experience. To address each of these key points each floor plate of living units is planned as an individual unit. Each resident floor is centered on the atrium space which allows in daylight and provides sightlines across the floor plate. Small residential groups of rooms provide a feeling of home and two designated meal areas for all residents encourage movement and socialization. The terraces on each resident level provide a variety of outdoor spaces that are easily accessible and provide a connection with nature. There is a change to a higher ceiling height in the zone around the atrium space on each resident floor to signal circulation. The entry level contributes important features for the other important user groups of the building, the staff and the visitors. The ground level allows for ease of security, grouping of amenities, and staff break space and outdoor space which is equally as important as the resident outdoor space. 124

Final Review/ Defining Memory Care: Parking and ground level entry are organized to maintain security while providing a community hub and a flow that provides ease of care for staff and a welcoming visitor experience. Visitors to the building have access to all forms of transportation including public transit, bicycle, on foot, and by car. Designated visitor passenger elevators provide access to the resident floors and terminate on the first floor for security reasons. Support spaces such as laundry, the kitchen, storage, and administration are grouped on the ground level to provide organization and ease of access with a designated freight elevator to access resident floors. The lower atrium is a community center with doctor and physical therapy offices, a spa/salon, a cafe, and a daycare facility. These amenities service the residents of the building as well as visitors and staff. Additionally, there are flexible spaces adjacent to the lower atrium that can be used as family dining facilities for intimate gatherings of families when a resident finds it difficult to leave the comfort of the building. These services are not only convenient but also provide supplemental income to the project, a space for community gathering, and a place for unique visitor interaction. Visual and supervised interaction of residents with the children in daycare is a unique therapeutic experience. Staff space separate from the rest of the building with its own outdoor space has been provided to improve staff experience and morale. While this project is a facility that provides medical care, it is first and foremost a home to its residents in the Jamaica Plain neighborhood of Boston and the materials and systems incorporated into the building are sensitive to these uses and identity.

125

History:

Alzheimer’s Disease discovered- 1906

Link between cognitive decline and number of plaques and tangles in the brain solidiﬁed- 1960’s