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REIMAGINING AGING THROUGH CAMPUS COMMUNITIES FINAL YEAR THESIS PROJECT 2017 A REVIEW OF CONTEMPORARY UNIVERSITY OF KANSAS HEALTH AND WELLNESS SENIOR LIVING MODELS
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ACKNOWLEDGEMENTS Partnership between HKS + KU
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Melanie D’Souza MORE ABOUT MELANIE Passionate about international relations and the might of the written word, Melanie delights in creating spaces for a healthy population with the guidance of skilled design professionals in a learning-conducive environment. Originally from Muscat, Oman, Melanie arrived in the United States to pursue her Master of Architecture I (2017) at the University of Kansas with a concentration in Health and Wellness.
My Interests:
UNIVERSITY OF KANSAS MASTER OF ARCHITECTURE, FINAL YEAR
environment
travel
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global relations
writing
dance
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Abbye Torgerson MORE ABOUT ABBYE Fusing a diverse background of hospitality and architecture, Abbye is passionate about designing spaces that leave a lasting impression on people--communities that enhance the way people do life. After graduating from University of Missouri with a Bachelor of Science in Hospitality Management, Abbye came to KU to pursue a Master of Architecture in the M.Arch III program.
My Interests:
UNIVERSITY OF KANSAS MASTER OF ARCHITECTURE, FINAL YEAR
outdoors
travel
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coffee
creating
running
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Project Summary Senior living resources in the U.S. are displaying an evolving definition of aging. The aging culture of baby boomers signifies a marked departure from curative treatment towards socio-cultural growth, especially since they are evidently more active and view life after retirement differently from their parents’ generation. They greatly benefit from a combination of healthcare and hospitality design considerations for a well-rounded and holistic aging process. Hence this calls for devising a senior living community or campus that can strongly benefit the lifestyle of the active baby boomer while remaining adaptable across future generations and changing environments. This project intends to review contemporary trends in environmental design that embrace different approaches to this new model of aging design. Model facilities are analyzed based on four factors of success: (a) a premier Sense of Place, (b) opportunities of Human Development, (c) the Environment of Care and (d) prospects of Innovation, from both (1) human and (2) geographical perspectives. These factors of success exhibit a relationship with campus amenities through provision and proximity. Our research effort manifests itself as threefold: we will uncover key contemporary trends in senior living design through literature review, substantiate chosen precedents with in-depth case study analysis, and conclude with lessons learned and design implications towards a new aging model.
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Our Agenda
Our
Our
Goals +
Research Plan
Team
Vision
Objectives
Overview
Research
Section 1:
Section 2:
Section 3:
Timeline
Inform
Analyze
Educate
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Conclude
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Agenda Cont.
Inform
Analyze
Educate
Industry Overview
4 Models of Senior Living
Lessons Learned
Stakeholder Engagement
Factors of Success
Key Takeaways
Important Definitions
Case Study Questionaire
Expert Opinions
Understanding Baby Boomers
Analysis Summary
Summary + Conclusion
Contemporary Trends
Related Resources
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Research Committee UNIVERSITY OF KANSAS
HKS HEALTH
HKS HOSPITALITY
Jeff Jensen (Dallas)
HKS RESEARCH
Kate Renner (DC)
Prof. Kent Spreckelmeyer
Mason Couvillion (Atlanta)
Prof. Hui Cai
Mindy Goodroe (Atlanta)
Upali Nanda (Houston)
Prof. Frank Zilm
Erin Peavey Hsieh
Giyoung Park (Dallas)
(Knox-Advisors, Phoenix)
Prof. David Ekerdt
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Our Vision 01
CHANGING DEFINITION OF ‘SENIOR LIVING’
Hence this calls for devising a senior living community
Baby Boomers are evidently more active and view life after
that can strongly benefit the lifestyle of the active baby
retirement differently than their parents’ generation.
RELATIONSHIP BETWEEN HOSPITALITY AND HEALTHCARE
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boomer while remaining adaptable across future generations and changing environments.
Boomers are beginning to greatly benefit from a collaboration between hospitality and healthcare design considerations for a well-rounded and holistic aging process.
RESHAPING RETIREMENT
03
A sizeable portion of baby boomers will choose to downsize and move somewhere with less maintenance and more sociability and learning opportunities, while remaining in close
04
proximity to family and familiar socio-economic environments.
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GOALS AND OBJECTIVES 01
INFORM DESIGN AND THE DESIGN PROCESS Suggest design standards for designers of senior living facilities to follow, that are sensitive to the user, staff, and environment.
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IMPROVE COMMUNICATION ● Recognize the importance of cross-disciplinary participation in the design process. ● Demonstrate to the design community the importance of collaboration between healthcare + hospitality.
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TRACK THE DESIGN PROCESS Check the design standards against ‘measures of performance’ post-occupancy.
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RESEARCH PLAN OVERVIEW Senior Living Reimagined
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Topic Importance Distinctive
Significant
Feasible
This approach amalgamates
This will help us fill in gaps in current
This would serve as a persuasive
considerations of both healthcare
design implications for senior citizens
Master’s thesis to pursue and will
and hospitality to actively explore
in their environments of healthcare,
contribute to both KU SADP’s and
effects on the aging process.
residence and hospitality.
HKS’ knowledge repositories.
Relevant
Rigorous
Older Adults will comprise a large
Significant availability of literature
portion of the population - by 2030,
exists on this topic, as well as a need
persons over the age of 55 will
for innovation in design for aging.
compise ⅓ of the US population.
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Benefits to Industry Cultivate
Cultivate a new system of thought towards the paradigm of aging and the processes it entails.
Illustrate
Illustrate the significance of interdisciplinary relationships in developing well-rounded design solutions to support a new aging paradigm.
Educate
Educate designers and policy planners towards the improvement of quality of life of the aging population.
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Benefits to University of Kansas Pioneer
Pioneer a ‘quick research’ study on a highly significant research topic for health and wellness architecture, thus paving the way for development of relevant curriculum.
Contribute
Contribute to developing the realm of aging design within the knowledge repository of the Institute of Health and Wellness Design.
Secure
Secure a knowledge-sharing affiliate relationship with HKS Health and KU Institute of Health and Wellness Design through networking, advisory services, and research engineering.
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Benefits to HKS Capitalize
Capitalize on healthcare design expertise and design for aging knowledge to expand design portfolio and revolutionize healthcare and senior living delivery.
Spearhead
Spearhead an innovation in tourism and hospitality through the consideration of aging specialty populations and intergenerational design.
Understand
Understand the evolving needs of its aging workforce/talent and clients to better cater to their social and professional development.
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Design Framework of Target Population
Although our study targets the aging habits of current baby boomers, it must be kept in mind that aging approaches are evolving with this generation to come, within the United States. Because the process of successful aging incorporates factors that extend beyond medical care, research input must be gathered from groups outside the standard healthcare institution- that contribute to the holistic life development of seniors.
01
CLIENT Retired Persons and family
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03
02
SUPPORTER
DEVELOPER
CAREGIVER
People who contribute to
People who are responsible for
People who form the backbone
human and social development
developing related
for continued health and
infrastructure UNIVERSITY OF KANSAS HEALTH AND WELLNESS
wellness
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METHODS Literature
Case
Surveys &
Physical
Review
Studies
Interviews
Observation
Gaining an in-depth
Studying exemplary
Learning from experts in the
knowledge on current
communities of cutting-edge
field as well as current
industry trends.
senior living.
residents and facility managers.
Observing these environments and recording our unique findings.
OUR PROCESS Our end goal is to understand how the model or paradigm of senior living communities is evolving in our ever-changing present, especially with the onset of the retirement period of the baby boomers.
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Research Methodology - Mixed Method Approach This method assesses the chosen case studies in two ways: (A) Human perception and (B) Geographical perception. Part A: ‘Provision’ employs the survey-research method of a facility assessment questionnaire that was administered to facility managers, residents and researchers to qualitatively evaluate each case study across the four factors of success: (1) Premier Sense of Place, (2) Human Development, (3) Environment of Care, (4) Innovation, using a Likert-type scale. While these factors can exhibit intrinsic key values, they can also be linked to areas of human development that exhibit a direct relationship with different campus amenities, in terms of availability.
Thus, Part B: ‘Proximity’ utilizes Geographic Information Systems (GIS) mapping to perform site analysis of the case study in its environmental context, thus exploring a spatial perspective on its surrounding amenities.
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Research Methodology - Mixed Method Approach For Part A: ‘Provision’ we pulled key ideas within each of the 4 factors from our literature review to help steer our case study investigation.
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Research Methodology - Mixed Method Approach Sense of Place Bus Stops Parks Walking/Biking Trails Bodies of Water
For Part B: ‘Proximity’ we studied key physical
Human Development
Google Maps.
nodes of a community with the help of GIS and
Restaurants Entertainment Schools Environment of Care Churches Grocery Stores Medical Centers Pharmacies Fitness Centers
Note that Factor 4: Innovation is an intangible area of development that cannot be merely studied through geographical mapping. UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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RESEARCH TIMELINE
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SECTION 1 Industry Awareness
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INDUSTRY OVERVIEW
While we attempt to study existing senior living climate in the United States, it is important to recognize the several categories of institutions and organizations in place that support aging concerns. Since this multitude is activated across several disciplines, it calls for the interdisciplinary collaboration of such organizations for the development of any successful support system for aging.
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STAKEHOLDER MANAGEMENT
As postulated earlier, the different disciplines can thus be recognized across clear, large groups of varied stakeholders namely (1) caregiver, (2) client, (3) developer and (4) supporter (clockwise left to right).
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Important Definitions ACTIVE AGING
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Describes the desire and ability of older adults to integrate physical activity into daily routines, such as walking for transportation, exercise, or pleasure. source: “Neighborhood Design and Active Aging” Yvonne L. Michael, Mandy K. Green, Stephanie A. Farquhar. December 27, 2004
SOCIAL CAPITAL
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The resources available to individuals and groups through social connections and social relations with others. source: “Social Capital and Successful Aging: The Role of Senior Housing.” Carolyn Cannuscio, Jason Block, Ichiro Kawachi. Sept. 2, 2003
NEW URBANISM
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Neo-traditional planning, has been promoted as an answer to many of the problems created by sprawl. Such developments are intended to offer a greater diversity of land use within a walkable community. Houses are more densely situated and public open space is easily accessible. source: Physical and Psychological Factors in Sense of Community: New Urbanist Kentlands and Nearby Orchard Village. Envrionment and Behavior. May 2004
ASSISTED LIVING
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A long-term care alternative which involves the delivery of professionally managed personal and health care services, in a group setting that is residential in character and appearance, in ways that optimize the physical and psychological independence of residents. source: Regnier, V.A (1994). Assisted Living Housing for the Elderly. New York: Van Nostrand-Reinhold.
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UNIVERSAL DESIGN A framework for the design of places, things, information, communication and policy to be usable by the widest range of people operating in the widest range of situations without special or separate design. It is human-centered design of everything with everyone in mind. Also called Inclusive Design, Design-for-All and Lifespan Design. source: Institute for Human-centered Design, Website.
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Investigation of Current Senior Housing Climate The term “Baby Boom� is used to describe the high increase in births following WWII. Baby Boomers are those people born worldwide between 1946 and 1964. In 2011, the first boomers reached the accepted retirement age of 65. As of 2016, Boomers range in age from 52-70.
Understanding the needs and concerns of the Baby Boomer generation is the first step in analyzing the current climate of senior living
Understanding Baby Boomers an overview.
1 of 5
There are about 76 million Boomers
in
the
communities.
US,
representing about 29% of the population.
By the year 2030, Baby Boomers will represent 1 of every 5 Americans.
Mobile
Healthy
To live independently with
To remain physically and
regards to mobility.
mentally active and healthy.
Involved
Engaged
To stay involved through
To be engaged in community
volunteerism and part-time or
and social activities and
full-time employment.
participate in a variety of learning opportunities.
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INVESTIGATION OF CURRENT SENIOR HOUSING CLIMATE
How are Boomers aging differently? ● Significantly more active ○ do not see retirement as an end to active life ● Advancement of profession ● Extension of work-life to recover from debt ● Fighting empty-nest syndrome ● Lower reliance on traditional health care ● Storehouse of mentoring potential ● More travel and participation in ‘riskier’ leisure activities than their parents’ generation ● More social than parents’ generation ● Technologically savvy (96% use email) UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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INVESTIGATION OF CURRENT SENIOR HOUSING CLIMATE
How is the approach to aging changing? According to Melissa Piatkowski, M.S., EDAC at the Center for Health Design, Design for Aging presently focuses on problems, using the following approaches:
Physical: prevent Cognitive: Make it
falls
easy to use
Design for Aging
Psychological: Keep it calm and quiet
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Social: Space for family to visit
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INVESTIGATION OF CURRENT SENIOR HOUSING CLIMATE
How is the design approach to aging changing? CHD’s Piatkowski recommends the following paradigm shift: Design for Aging to Design for People shift from a focus on problems to a focus on happiness
Physical: Get Cognitive:
people active!
Challenge the mind!
Design for People
Psychological: Have some fun!
This thus enables us to
Social: Get people
think about the
together!
holistic benefits of universal design. UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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INVESTIGATION OF CURRENT SENIOR HOUSING CLIMATE
How can we help the aging process become less institutionalized? Shifting the focus from the problems of aging to advancing the quotient of happiness and wellbeing of the residents within environments with which they are familiar.
Focus on
Understand
Provide plentiful
People
Adaptability
green spaces
Provide
Provide
Provide continuing
sociability
educational
care
opportunities
opportunities
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INVESTIGATION OF CURRENT SENIOR HOUSING CLIMATE
How can the collaboration of Hospitality and Healthcare benefit senior living? Understanding what draws people to hospitality destinations for holistic health can bring significant quality to overall wellness.
Comfort
Day Light
Rest
Tranquility
Amenities
Services
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INVESTIGATION OF CURRENT SENIOR HOUSING CLIMATE
How are urban campuses successful? Bringing together various components of healthy living and all-round development across all ages and within easy access, helps all residents feel welcome and integrated in such an environment.
Neighbor
Resources
Social Opportunities
Support
Mobility
Entertainment &
Medicine
Food UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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Evolving Senior Living + Retirement Considerations Independence
Familiarity
Age Integration
Mobility
Personalization
New Urbanism
Universal Design
Social Capital
Continuum of Care
Thus, as we investigate various schools of thought around the evolving senior living paradigm, as well as current design trends in senior living communities, the following considerations are prioritized for effective aging design. These priorities bring us closer to our multi-faceted research question.
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INVESTIGATION OF CURRENT SENIOR HOUSING CLIMATE
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Research Question How is the model or paradigm of senior housing evolving in our ever changing present, especially with the onset of the retirement period of baby boomers?
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SECTION 2 CASE STUDY INVESTIGATION
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4 Models of Contemporary Communities
Luxury Resort Model
UBRC
Apartments 4 Life
Co - Housing
Destination living, health and
University-Based Retirement
Modular, intergenerational,
Cooperative housing, may be
wellness enthusiasts
Community
age-proof continuum of care
intergenerational or age-targeted
DESCRIPTION ANALYSIS
When investigating cutting edge senior living facilities both foreign and domestic, we discovered four models to further study and assess using our four factors of success.
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LUXURY RESORT MODEL
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Luxury Resort Model About Us LEADERSHIP The activities of a company associated with buying and selling a product.
ENTREPRENEURSHIP The activities of a company associated with buying and selling a product.
MARKETING
Tailoring a maintenance-free lifestyle that meets one’s personal interests in an environment that’s more like a luxury resort than a retirement community. With the peace of mind that comes only with the guarantee of continued care.
The activities of a company associated with buying and selling a product.
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Luxury Resort Model Key Attributes ● Social learning; classes and clubs to maintain relationships and hobbies ● Amenities and resources to foster a holistic sense of health and wellbeing ● Continuing care for medical needs ● Caters to those seeking an active lifestyle, coupled with five-star services ● Reinventing the dining experience; emphasis placed on health and nutrition. ● High-end residence living; all services provided for residents
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Luxury Resort Model Some local precedents
Edgemere
Sarasota Bay Club
Sun City
Dallas, TX
Sarasota, FL
Phoenix, AZ
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Luxury Resort Model Case Study - The Villages, FL
“Florida’s Friendliest Hometown” “The Morse family founded the Villages over 30 years ago, with the vision to create a warm, secure and friendly hometown, where all your retirement dreams come true.” http://www.thevillages.com/ UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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COMMUNITY CHARACTERISTICS “SMALL-TOWN METROPOLITANISM”
01
Small town charm coupled with metropolitan amenities, activities, entertainment, and resources.
A “FAUX” HISTORY OF THE VILLAGES
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Historical fiction designed as a ‘theme-park’ for seniors.
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FAMILY OWNED AND OPERATED
FAST GROWING
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Population: 157,000 in 2016 - The Villages area was the fastest-growing U.S metropolitan area for the second year in a row. Over 2000 clubs and classes to join.
3 TOWN SQUARES
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Designed as the ‘hub’ of each neighborhood with nightly entertainment and activities. Also with restaurants, shopping, and recreation opportunities. Spanish Springs, Lake Sumpter Landing, Brownwood Paddock Square. Secured by neighborhood watch and gated communities.
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COMMUNITY CHARACTERISTICS NEIGHBORHOOD CENTERS (32)
01
These centers offer local adult-only pools as well as bocce, horseshoe, and shuffleboard courts.
VILLAGE CENTERS (17)
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These centers offer family pools (except for Silverlake) facilities with billiard meeting rooms and full kitchens, bocce, horseshoe, and shuffleboard courts, plus tennis and pickleball courts.
REGIONAL CENTERS (8)
03
These centers offer resident-only sports pools (except for Paradise, which offers a family pool), larger venues with stages for theatrical and musical productions, and many of the same features as the village centers; all but two operate fitness centers for which a membership must be purchased.
PARKS
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The Villages operates 11 parks, dog parks, and fitness trails, which are separate from the recreation centers. Team and individual sports offered.
HEALTH CENTERS
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6 Neighborhood care centers for primary care and a specialty care center with specialists doctors. Available care includes primary geriatric care, residential-style assisted living, skilled nursing, and memory support.
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RESIDENT CHARACTERISTICS 01
AVERAGE AGE ~68 YEARS OLD
02
98.2% CAUCASIAN, 0.6% AFRICAN AMERICAN, 0.7% ASIAN, 0.1% AMERICAN INDIAN
03
16,069 VETERANS
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UNIVERSITY-BASED RETIREMENT COMMUNITY
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University Based Retirement Communities About Us LEADERSHIP The activities of a company associated with buying and selling a product.
ENTREPRENEURSHIP The activities of a company associated with
Retirement communities that enjoy a formal or informal relationship with universities by virtue of their physical location of a campus as well as academic benefits.
buying and selling a product.
MARKETING The activities of a company associated with buying and selling a product.
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UBRC Key Attributes ● Programming between UBRC and university ● Proximity (within 1 mile) of the campus ● Senior housing + health services with full continuum of care ● Alumni base (at least 10% alums or retired staff) ● Sound financial planning ● Academic learning: residents can audit university classes doing wonders for mental exercise ● Social learning: clubs + organizations to enter passions and hobbies ● Self-sufficiency & diversity of residents - both students and seniors co-existing
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UBRC Some local and international precedents
Kendal at Dartmouth College Hanover, NH
Old Hammock at the
“One Roof, Two
University of Florida
Generations”
Sarasota, FL
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Lyon, France
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UBRC Model Case Study - The Forest at Duke
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“The Forest, Your Place to Grow” More than a community, a celebration. ● Location: Durham, North Carolina ● James & Kathy Capo ● Age: Opened in 1992 ● Population: 400 Residents ● Architects: Alan Moore, Leslie Jarema (Interiors), Charles Burkhead (Landscape) ● Partners: Osher Lifelong Learning Institute, Duke University, Duke Center for Study of Aging and Human Development
http://www.forestduke.org/
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COMMUNITY CHARACTERISTICS HISTORICAL FICTION
01
Designed as ‘nostalgia town’ with ‘Main street’ aesthetic to help residents feel more at home and help with memory retention.
COMMUNITY CENTER
02
~40,000 SF with a permanent woodworking shop and art studio with kiln, as well as a library and media center.
COMMUNITY ENGAGEMENT
03
Regular volunteering opportunities for residents at nearby Duke hospitals, the Sarah P. Duke Gardens, The Boys and Girls Club of Greater Durham, the Nasher Museum, the Rare Book Room, the Caring House among other Duke campus sites and local North Carolina sites.
BRINGS IN YOUNG PEOPLE FOR TRAINING
04
Serves as a training site for residents at various nearby universities in the disciplines of internal medicine, psychiatry, nursing, leadership in aging, public health administration, and therapeutic recreation.
IDEAL LOCATION FOR SENIORS
05
2 miles away from Duke University and 2 university Medical Centers. 3 secured gardens with walking trails with an award-winning neighbourhood design with regular bus transportation to events and shopping. Close proximity to Duke provides exposure to cultural enrichments of music, dance, and film events.
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BUILDING CHARACTERISTICS 154 APARTMENTS
01
5 different floor plans with bathroom safety.
80 DUPLEX COTTAGES
02
3 different floor plans with sound-proof construction.
15 SINGLE FAMILY HOMES
03
Fountain View Lane Homes with 3 options
HEALTH CENTER
04
6 assisted living neighborhoods include - 2 secured for memory support, 2 skilled nursing
ACCESS TO GREEN SPACES
05
Living spaces open to 3 secured gardens for residents to enjoy the outdoors safely, without direct staff supervision. Animal-friendly community encouraging long walks with pets.
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RESIDENT CHARACTERISTICS 01
CURRENT NUMBER OF RESIDENTS: 400
02
AVERAGE AGE OF RESIDENT: 84
03
AVERAGE AGE OF ENTRY: 77
04
CURRENT NUMBER OF STAFF MEMBERS: 275
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APARTMENTS FOR LIFE
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Key Attributes
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A4L
● Four points of the A4L philosophy: ○ Autonomy/being your own boss: residents are in charge of their own health choices and are entitled to be the bosses of their own lives. ○ Op maat/’Use it or lose it’: residents and their respective families and staff are encouraged to respect ‘personal strength’, retaining focus of overcoming limitations to pursue any new experience and skills, no matter the challenge. ○ Extended family: residents’ volunteer time is highly appreciated and rewarded as they can contribute to a larger social and professional network to enrich other residents and staff, through their years of life experience. ○ A “Yes” Culture: Residents’ preferences are prioritized by staff within a ‘yes’ culture that both challenges and positively stimulates their quality of life through the simple pleasure of life that can be anywhere from jacuzzi time to drinking at a bar. ● Flexibility of care: the three types of resident categories are not segregated but are scattered across the floor. Built with modifiable elements that adapt to the resident’s needs, each Apartment for Life unit, although larger than a typical nursing unit, has a significantly less cost of 35%. ● Volunteer rewards: Humanitas rewards resident volunteers (which exceed staff in number) with a monthly tax-free stipend of about 100 euros thus encouraging a greater sense of community ownership while fostering social activity. ● Self-sufficiency and independence: through the op maat philosophy, residents exercise greater control of their lives and this is expressed in their social choices in a fight against ‘health and diet dictatorship’. UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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Apartments for Life This innovative approach towards senior housing illustrates that various efforts towards integration of older adults into community can be successful, despite aging-related physical and cognitive challenges. Originating in the Netherlands, since after World War II when older residents were placed in relatively small service flats, Apartments for Life, or ‘A4L’ follows the Dutch philosophy of op maat, where care is tailored to fit the individual’s needs rather than being determined by staffing requirements. In an A4L community, ‘age-proof’ dwellings are designed to enable the residents to inhabit their apartment (which they typically enter while still independent) and remain until death. These apartments accommodate patient lift equipment, oxygen, wheelchairs, etc., not forgetting modifiable home components that can be adjusted to the residents’ needs. This approach is appealing even so to couples where one partner is chronically ill and they would still prefer to live together.
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A4L Some local and international precedents
Condos for Life
Jewish Community
Project Rundgraafpark
Housing for the Elderly The Woodlands, TX Boston, MA
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Veldhoven, the Netherlands
REIMAGINING AGING
A4L CASE STUDY - HURMANITAS BERGWEG
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“Too much care is worse than too little… people must be allowed to be the ‘boss of their lives’, with care avoiding ‘health and diet dictatorship’.” - Dr. Hans Becker, Founder + CEO ● Location: Rotterdam, the Netherlands ● Founders: Humanitas, non-profit Rotterdam foundation ● About the owner/manager: One of the divisions of Humanitas Academie trains and provides volunteer support. Dr. Hans Becker, Professor of Humanising Care, Utrecht University founded Humanitas Bergweg ● Age: opened in 1996 ● Population (2002): 250 Residents ● Architect: EGM Architecten ● Partners: Stichting Humanitas Foundation ● Current facility director: Gijsbert van Herck
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COMMUNITY CHARACTERISTICS URBAN LANDSCAPE
01
The development, completed in April 1996 occupies an urban block in Rotterdam, replacing a hospital to wrap an atrium between a four-story apartment building and 12-story landmark building.
AVAILABLE CARE
02
Clinic, therapy office, day-care center
VIBRANT NATURE AMENITIES
03
Small zoo, koi pond, and sculpture gardens.
MEMORIES OF YOUTH
04
Reminiscence museums where they re-create rooms of the resident’s youth--a 1940’s kitchen, a 1930s bathroom, an early 20th century grocery store, and invite guests to share their memories. Each one has a unique story and these artifacts are meant to spur memories and particularly the sharing of them.
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BUILDING CHARACTERISTICS 195 ONE-BEDROOM APARTMENTS
01
Average size 750 SF.
FACILITY AMENITIES
02
Restaurant bar and smoking room are primary spots of socialization as true for European culture, hairdresser, grocery store, fancy clothes and homeware boutique, and beauty salon. Amenities catered towards personal care. Most vibrant element - a sun-filled public atrium.
CELEBRATING CULTURE
03
To reflect their multi-cultural clientele, they have museums for each of the cultures, a Moroccan museum, a Surinamese, and a Turkish museum.
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RESIDENT CHARACTERISTICS CURRENT NUMBER OF RESIDENTS: 250 (2002)
01
42 men, 98 women, 55 couples
02
AVERAGE AGE OF RESIDENT: ~80
03
AGE RANGE: 55-96
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REIMAGINING AGING
COHOUSING
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Cohousing An intentional community of private homes clustered around shared space. Each attached or single family home has traditional amenities, including a private kitchen. Shared spaces typically feature a common house, which may
About Us
include a large kitchen and dining area, laundry, and recreational spaces. Shared outdoor space may include parking, walkways, open space, and
LEADERSHIP The activities of a company associated with
gardens. Neighbors also share resources like tools and lawnmowers.
buying and selling a product.
Households have independent incomes and private lives, but neighbors ENTREPRENEURSHIP
collaboratively plan and manage community activities and shared spaces. The
The activities of a company associated with buying and selling a product.
legal structure is typically an HOA, Condo Association, or Housing Cooperative. Community activities feature regularly-scheduled shared meals,
MARKETING
meetings, and workdays. Neighbors gather for parties, games, movies or other
The activities of a company associated with
events. Cohousing makes it easy to form clubs, organize child and elder care,
buying and selling a product.
and carpool. http://www.cohousing.org/ UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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Key Features
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Cohousing
● Relationships ○ Neighbors commit to being part of a community for everyone’s mutual benefit. ○ Cohousing cultivates a culture of sharing and caring. ○ Design features and neighborhood size (typically 20-40 homes) promote frequent interaction and close relationships. ● Balancing privacy and community ○ Cohousing neighborhoods are designed for privacy as well as community. ○ Residents balance privacy and community by choosing their own level of engagement. ● Participation ○ Decision-making is participatory and often based on consensus. ○ Self-management empowers residents, builds community, and saves money. ○ Shared common spaces such as kitchens, guest homes, gardens, workshops, fitness rooms, etc. ● Shared values ○ Cohousing communities support residents in actualizing shared values ○ Cohousing communities typically adopt green approaches to living ● Sociability: cultivates a culture of sharing and taking care of one another - all have a common goal of building a successful community. ● Self-sufficiency and diversity of residents: both families and seniors may live together and sustain the community through shared knowledge and shared activities. http://www.cohousing.org/
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COHOUSING Some national precedents
Wolf Creek Lodge
Heartwood Cohousing
Grass Valley, CA Bayfield, CO
UNIVERSITY OF KANSAS HEALTH AND WELLNESS
Milagro Cohousing Tucson, AZ
REIMAGINING AGING
Cohousing Case Study - Silver Sage Village
“‘Sagers’ sharing a commitment to life together” “Our Silver Sage Village vision is to be a strong community, one that nourishes the body and soul, and celebrates and harvest our diversities and life experience. We embrace living sustainably on the earth, creating a beautiful place to live, continuing to grow, aging in community, and responsibly honoring our commitment to one another. We are committed to establishing a workable balance between having our own private lives, doing our share for Silver Sage Village, and reaching out to the wider community.” http://silversagevillage.com/
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BUILDING + COMMUNITY CHARACTERISTICS COMMON HOUSE
01
5000 SF common house with industrial kitchen, dining room, meditation room, guest room, storage spaces, laundry room, exercise room, craft room, media room, two bathrooms, and spaces used by local artists.
SIZE
02
16 units ranging from 850 SF - 2200 SF with solar hot water heating, energy efficient appliances
NOBO COMMUNITY
03
Nestled within the “NOBO” (North Boulder Art District) has become a national model for new urbanist living. 300 miles of bike/walking trails, 60 urban parks, Pearl Street Mall, walking distance of urban mixed-use development.
PRICE DIVERSITY
04
16 total units, 6 units designed as affordable housing (designated permanently affordable)
DESIGNED AROUND GREEN SPACE
05
Organized around landscaped central courtyard, with raised garden beds, outdoor seating, and eating areas.
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RESIDENT CHARACTERISTICS 01
CURRENT NUMBER OF RESIDENTS: 24
02
AVERAGE AGE OF RESIDENT: 60-70
03
AGE RANGE OF MEMBERS: 50-LATE 80S
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MESSAGE FROM THE DEVELOPER* “Both the successes and weaknesses are “Boulder is a great place to live and retire in
related to the deeper level of connection
and there is a strong housing market. Our
and community that can be generated in a
location in the Holiday Neighborhood has
cohousing community. The most effective
several advantages for seniors. It is very
solutions are related to building the social
walk-able with a small neighborhood park,
and cultural connections that generate
coffee shops, and restaurants nearby, and
“Cohousing seems to be a solidly
community among neighbors, often not an
good bus service to downtown and the
established in the US as a small specialty
easy task in our independent American
University of Colorado. There is a lot of
housing choice for seniors, but it is unlikely
culture, even among seniors who need
interesting diversity of housing types and
to grow rapidly in the future unless
community the most.”
households in the neighborhood with many
someone finds a way to produce and
young families and children.”
market it more efficiently. Its nature as a small neighborhood makes it more challenging to develop and is more costly than the large scale senior housing that is typical in the US.”
*James Leach is the president for Wonderland Hill Development Company and also a resident of Silver Sage Village.
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FACTORS OF SUCCESS
PREMIER SENSE OF LOCATION
ENVRIONMENT OF HUMAN CARE DEVELOPMENT UNIVERSITY OF KANSAS HEALTH AND WELLNESS
INNOVATION
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Premier Sense of Location Residents tend to prefer familiarity of routine, no matter the unfamiliarity of location. Evidence-based design outcomes indicate that overall population health improves with greater connection to natural surroundings that increase Connectivity
opportunities for community wellness and prosperity. Moreover, it is imperative that residents experience a sense of pride and comfort in their home environments. KEY VALUES
Walkability
Destination quality UNIVERSITY OF KANSAS HEALTH AND WELLNESS
Connected to nature
Sense of home
REIMAGINING AGING
Premier Sense of Location CASE STUDY QUESTIONNAIRE QUESTIONS 1. Is the facility in close proximity (within 10 miles) to a larger community and its resources? 2. How accessible is the community via public transporation? 3. Is there adequate pedestrian infrastructure within the facility’s campus? 4. Is there adequate pedestrian infrastructure between the facility and its surrounding community? 5. Is the community visually appealing? 6. Is the community connected to nature? (e.g. green belt, gardens, walking trails?) 7. Do you feel this community ‘home-like’? 8. Are residents experiencing a sense of belonging? 9. Do the residents feel safe and secure at this community? 10. How many hours per week do you spend outside your home each week? 11. Any additional comments regarding the overall sense of place at your community?
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Human Development There is strength in a community- that respects its aged as a seat of wisdom promoting continual educational and professional resources for all within it. This also extends to ensuring positive partnerships and friendships between Learning
people across various demographic backgrounds to provide
Sociability
support for daily activities and a healthy social life. KEY VALUES Educating
Mentorship
UNIVERSITY OF KANSAS HEALTH AND WELLNESS
Encouragement to expand horizons
Community engagement
REIMAGINING AGING
Human Development CASE STUDY QUESTIONNAIRE QUESTIONS 1. Is the facility engaging residents in learning opportunities? 2. Is the social climate cohesive in that the staff make a strong contribution to the quality of life? 3. Does the facility offer an adequate amount of amenities and programming towards recreation? (e.g. pickleball, golf, dance glasses, etc.) 4. Does the facility offer an adequate amount of amenities and programming towards entertainment? (e.g. card games, film theaters, clubs to join, cocktail hours, restaurants, etc.) 5. Does such an environment foster the healthy growth of personal relationships? 6. Does such an environment help cultivate community partnerships? (e.g. volunteering opportunities, tie-ups with research centers, service programs, etc.) 7. Are residents engaging in skill transfer for mutual benefit? 8. How many hours per week do you spend doing entertainment or recreation activities? 9. How many hours per week do you spend engaging in learning activities -- whether that is you, yourself, learning or teaching others? 10. Any additional comments regarding social well-being at your community?
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Envrionment of Care While residents continue to grow and thrive in their communities, their holistic sense of health and wellness must be nurtured in terms of quality medical care, as well as through opportunities of community wellness that ensure a healthy aging process. These prospects must remain easily
Technologically advanced
Ease of mind and body
accessible, affordable, streamlined, stess-free and up-to-date while serving a variety of needs. KEY VALUES
Health & Wellness
Fitness UNIVERSITY OF KANSAS HEALTH AND WELLNESS
Acuity adaptable medical care & retail
Environmental health
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Environment of Care CASE STUDY QUESTIONNAIRE QUESTIONS 1. Is the facility being cognizant of aging-sensitive lifestyles? 2. Does the community recognize the need for healthy eating while incorporating active and positive attitudes towards nutrition? 3. Is the facility able to reach different levels of health needs? (i.e. independent living, assisted living, memory care, skilled-nursing, etc.) 4. Are there medical services on site? 5. Are there sufficient provisions for promoting mental health? 6. Are there sufficient provisions for promoting spiritual health? 7. Does the care provided also include the essential levels of prevention as basic to any public health service? (such as health education, immunization, social marketing, to prevent or stop smoking, etc.) 8. Does the care provided achieve a high standard? 9. Are the services cutting-edge and technologically advanced? 10. Is staff care and wellness being considered? 11. How many hours per week do you spend engaging in faith or spiritual activities? 12. How many hours per week do you spend accessing medical care and/or daily medical activities? 13. Any additional comments regarding health and wellness at your community? UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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Innovation With continual advancements in technology and demands for integration with housing, health and hospitality, facilities can address such changes in a manner that enriches quality of living and work for residents and staff alike. Such an
Strategic planning
environment should accommodate continual research and development within its infrastructural and organizational function. KEY VALUES
Flexibility of function
Change ready UNIVERSITY OF KANSAS HEALTH AND WELLNESS
Adaptability
Futuristic thinking
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Innovation CASE STUDY QUESTIONNAIRE QUESTIONS 1. Is the facility preparing for needs and wants of the future generations? (i.e. through changes in infrastructure and/or organizational culture?) 2. Are they using cutting-edge technology for enhanced user experience, without compromising on quality of service? 3. Does this technology advance access and independence towards medical care? 4. Is there provision for a variety of health options alongside changes in ambitions and passions? 5. Is there provision for a variety of residential options alongside changes in ambitions and passions? 6. Does the facility exhibit unique design strategies that derive from evidence-based and experience-based research towards significant outcomes? 7. How many hours per week do you spend using technology? (i.e phone, internet, email, etc.) 8. Any additional comments regarding innovation and flexibility for the future?
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Online Questionnaire Snippet of our online quesionnaire
This was used to both rate our case studies, as well as survey residents and staff from our case studies. See our questionnaire here. UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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Case Study Analysis We analyzed the case study of Silver Sage Cohousing in Boulder, CO for both human and geographic perception of quality of amenities. For Part A: Human Perception, as previously stated, participants were tested on different values of each success factor, through corresponding questions regarding facility’s amenities. A. Overall Human Perception results (Questionnaire response from facility manager)
Factor 1 : Sense of PLACE
78%
As one may notice, there exists some discrepancies in different levels of positive perception of the facility. This can
Factor 2: HUMAN Development Factor 3: Environment of CARE Factor 4: INNOVATION
60%
be substantiated by the geographic analysis, as the facility’s amenities are supported by the neighbourhood’s amenities.
25% 71%
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Discussion: Human Perception Key Value Breakdown (Percentage): Connectivity 0.95
a b
Biophilic Design 0.7 Sense of Home 0.5
Key Observations: Healthy Lifestyle 0.35
The response to each value can be explained by the following
Mental Health 0
comments of the facility manager:
Spiritual Health 0
Safety + Security 0.8
a + b. Holiday neighbourhood location in Boulder with abundance
Medical Care 0.28
e
of walking & biking trails, green spaces and diversity of age groups c. Individualistic-minded American culture hinders collaborative
Staff Support 0.6
Evidence-Based Results 0.8
Learning Climate 0.6
Tech Advancement 0.6
Community Partnerships 0.5 Social Climate 0.8
c d
f g
learning d. Community of like-minded individuals boosts social capital
Adaptive Function 0.6
e. Self-managed independent community lacks on-site medical
Strategic Planning 0.8
care
Summary:
h
f + h. Co-housers took ownership in design programming of units & amenities g. Rising concerns regarding endurance of community with age
78% Place
71%
25%
Human
Care
60% Innovation UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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Discussion: Geographic Perception B. Geographical perception results (Compilation of data from GIS and Google Maps) The typical urban core is ~3 mi radius; we looked at 1 mi, 1/2 mi density of campus amenities to study the surrounding context of Silver Sage Village across our success factors. We can thus see how some highs and lows of human perception results can be explained with the geographic mapping, as the close presence of town amenities support lack of facility amenities.
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Research Limitations Through the course of the study so far, we have experienced the following limitations, that must be kept in mind, while considering results: 1. Self-reported data: The questionnaire is a qualitative assessment tool that may potentially reflect personal bias. 2. Lack of available data: Some case studies have yet to report their participation and assessment results, therefore some key values are difficult to measure due to incomplete information. Additionally, there aren’t sufficiently reputable/ accurate sources or data sets for geographical information on certain types of campus amenities. This could be resolved to a certain extent by reaching out to multiple case studies within the same model type and pursuing in-depth research of those that submitted responses. 3. Access to information: It must be noted that the quality and quantity of amenities are subject to change which makes it hard to measure. Moreover, complexity of GIS data cannot completely resolve the variance of this information. For example, the definition of grocery stores that promote healthy eating can vary from ‘Quik Trip’ to ‘Whole Foods’. Similarly, not all faiths can be considered represented in the provision of support for ‘faith and spirituality’ as an area of development. 4. Sample size: Questionnaire results represent data from a singular case study that was considered the prototype of a senior living community model. This could be resolved by applying the questionnaire to a larger number of case studies that fit a model type.
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SECTION 3 LESSONS & CONCLUSION
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Review of Contemporary Models Evaluating Model approaches for varying site contexts
The various contemporary aging models observed through design and construction in the current commercial senior living industry have been reviewed through four distinct categories in this project. However, it is important to note that such facilities, or urban campuses could exist in a combination of these models or philosophies. For example, a senior living community being developed by NYU in late 2016, is part of a ‘homestay’ program being planned. This shall incorporate intergenerational housing as a two-pronged solution- to rising housing costs in New York City and to the shared problem of social isolation between the two age groups on either side of the regular work life spectrum: college-going youth and senior citizens. Such a model thus not only follows model (3) as a University-Based Retirement Community on account of its affiliation with a state university, but also empowers the independence of senior citizens on a long-term basis through the ‘op maat’ philosophy expressed in model (2) Apartments for Life. Hence, this section investigates significant summative observations of the successes and failures of each model that can be taken into consideration while selecting a suitable model or combination of models for any given urban or rural context of a site campus for a project.
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Luxury Resort Model LONGEVITY FOCUS
01
The luxury resort model incorporates special programs that pamper residents with anti-ageing treatment priorities and promotes their wellness education as well as long-term relaxation.
02
TEMPORARY ENTERTAINMENT This model may not be seen as one to foster independence since several amenities aren’t very affordable and are fee-based and, thus such campuses are best seen as wellness holiday destinations, rather than a continual living situation.
POCKET-HEAVY
ATRIA AT VILLAGES OF WINDSOR, PALM COUNTY BEACH, FLORIDA (Seniors bask in a luxury senior living rental resort). Courtesy: Atria Senior Living; Senior Housing News
03
As stated before, this results in low economic diversity of residents- thus restricting aging and life priorities to a certain class of taste and extra-curricular activities.
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University-Based Retirement Communities CONTINUING EDUCATION FOCUS
01
In contrast to the luxury resort model, this model appeals specifically to senior desiring an active and continued relationship of absorption and contribution of intellectual engagement with the host campus: a university.
02
INTERGENERATIONAL LIFESTYLE Residents develop a significant sense of comfort with other groups of people significantly different from them in age- thus this encourages and compels the willingness to co-exist with folks of different mindsets and social priorities.
COMMUNITY GRANDPARENTING
OAK HAMMOCK, UNIVERSITY OF FLORIDA (The Goldwires reside close to their alma mater as part of a UBRC). http://www.pbs.org/newshour/updates/why-boomers-are-retiring-to-college/
03
Senior citizens are treated with a great amount of respect because they are seen as experienced stewards of the larger context of the university campus, be it a college town or university neighbourhood.
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Apartments for Life SIGNIFICANT INDEPENDENCE
01
The urban context that this model requires automatically forms a basis of greater connectivity to site in terms of access to essential amenities and transportation thus encouraging active lifestyles.
02
POTENTIAL ISOLATION Urban apartment complexes can be hazardous for senior residents in terms of health needs and social isolation, but when supported by people of other ages and competence, can be designed to incorporate a stronger sense of safety.
TRANSITIONAL AMENITIES
03
This model demands a high level of compactness and flexibility,
URBAN RETIREMENT VILLAGE FLOOR PLAN, STOCKTON, U.K.
not only to adapt to the care continuum of the aging senior, but
https://www.slideshare.net/HCA_UK/urban-retirement-village-stockton
also to accommodate changing approaches to aging and the uniqueness of each resident.
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Cohousing NEIGHBOURHOOD CULTURE
01
Through the interesting arrangement of ‘microunits’ that share common ‘umbrella’ amenities, combating social exclusion can be successful for like-minded folks that can overcome individualism for a step towards communitarianism.
02
COMMUNITY INNOVATION Residents celebrate the uniqueness of their community through a variety of site design strategies that require continued responsibility and accountability across members. These prioritize environmental sustainability and energy efficiency.
SOCIO-ECONOMIC EMPOWERMENT
03
This intentional community requires a resident-led agenda, a strong sense of social entrepreneurship and unique economic model with any relevant charitable or government support.
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Key Design Takeaways Distinct design strategies of a senior living campus incorporate various aging priorities in different innovative ways across the models, but must be recognised all the same.
01
MICRO-UNIT: Compact, modular units create affordable space for those with
04
greater flexibility and minimal belongings.
INCLUSIVITY: Familiar site location accommodates easy resident and
RESIDENT EMPOWERMENT: Flexible design and amenities
07
both at local unit level and larger site level that result from residents’ changing intent, support the evidence-based design
visitor access across all demographics.
process
02
NEIGHBOURHOOD SUPPORT: Sharing of amenities reduces social
05
isolation and increases affordability.
03
ACTIVE LIFESTYLE: Programming of amenities and site design recognizes healthy lifestyles as well as social entertainment needs.
06
UNIVERSAL DESIGN: Promoting social, educational, physical needs for all ages
08
SUSTAINABILITY STEWARDSHIP: Green design that recognises a holistic sense of grandparenting responsibility
through age-proof inclusive design.
over the larger environment of the seniors in the community
SOCIAL REVENUE: ‘Main Street’ quality
TECH REVOLUTION: Physical design acknowledges
09
supports clear site access, social activity
technological advantages of empowering residents in terms
and mixed-use corridor for continued
of flexibility, access to quality healthcare as well as regular
economic involvement.
monitoring and communication.
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Summary : The Urban Campus approach To recap, various design strategies can address different socio-economic priorities of the contemporary aging model. The contemporary aging model
Connectivity
as evident, best utilises the urban campus approach, irrespective of its location or its combination of philosophies as it fights against social
Destination quality
isolation, dependence, stunted holistic growth and lifestyles towards the four requisite success factors of sense of place, human development, environment of care and innovation.
Learning
Modularity Mixed Revenue
Social Climate
Affordability
SILVER SAGE URBAN CAMPUS, BOULDER, CO
Mentorship
Strategic planning
Intergene-r ational quality
Community Engagement
Flexibility of function
Sustainability
UNIVERSITY OF KANSAS HEALTH AND WELLNESS
Adaptability
Active Lifestyle
Futuristic thinking
Fitness
Sense of home
Biophilic design
Entrepreneurship
Tech Advancement Medical Care
Environmental health
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Expert Opinions Planning for a senior living community that utilises an urban campus approach, undeniably entails the consulting of notable experts across various disciplines of medical care, sociology, research, design and economics. Here are some such valuable testimonies from stakeholders and advisors. UPALI NANDA, AIA, EDAC, DIRECTOR OF RESEARCH, HKS INC. Houston, TX
DR. ERNESTO CHIOCO, P.M.D, GERIATRICS AND LONG-TERM CARE MEDICINE Humboldt, TN
“Design for aging in place, and end of life management, will be the most prominent concerns in
“A facility for the elderly should be in a
the next couple of decades given the needs of the
safe environment, (be) efficient,
largest age cohort- the baby boomers.
accommodate disabled persons, (be)
This research is timely, and much needed, to advance
affordable and beautiful just like their
the field of architecture and design”.
own homes”.
UNIVERSITY OF KANSAS HEALTH AND WELLNESS
REIMAGINING AGING - EXPERT OPINIONS CONT.
ALICE ALEXANDER, EXECUTIVE DIRECTOR, COHOUSING ASSOCIATION OF THE UNITED STATES
CHUCK DURRETT, ARCHITECT AND PIONEER OF SENIOR COHOUSING IN NORTH AMERICA “College-based alumni senior cohousing is a trend in
“Cohousing can provide economic advantages over
retirement communities that allows retired alumni to engage
other retirement care. Smaller, more energy-efficient,
in a lifelong exchange with their alma mater that significantly
well-designed homes translate to lower cost of living
enhances the college community and the quality of life in
expenses. So does sharing resources. A strong social
higher learning institutions. It enables seniors to live
environment may contribute to better health and lower
independently, in an active community, with access to
medical costs. And cooperatively hiring outside
resources. Just as matured salmon return to their place of
caregivers may be far more cost efficient”.
origin, it makes sense for retirees to return to their college communities” UNIVERSITY OF KANSAS HEALTH AND WELLNESS
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DAVID BARRETT GRAVER, SENIOR EDITOR, COOL HUNTING, NYC, NY “The new aging concept is direct: integrate rather than segregrate. But it’s the sociological and spatial depths that Hollowich (architect and the author of the book New Aging: Live Smarter Now to Live Better Forever) traverses, that make it a guide worth looking at now- for all age groups”.
REIMAGINING AGING
Conclusion
From our preliminary inferences of both the human and geographical perception of the current climate of senior living in the U.S., we understand that there are both opportunities and barriers to promoting the urban campus approach to healthy retirement. For eg., in the singular case of Silver Sage, a senior co-housing community in Boulder, CO, while medical services on-site are absent, the Environment of Care (Factor 3) is remedied by the density of medical services in the area. Therefore, designers and developers must consider both high proximity and provision of campus amenities to maximize senior living comfort for the active boomer. Interdisciplinary considerations must be taken into account towards developing urban campuses that satisfy comfort and integration for senior citizens, while continually fostering their sense of place, human development, environment of care and innovation.
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BIBLIOGRAPHY ❖ -Birkbeck, David. “‘Happy Meals’: Finding Happiness with Hans Becker and the Humanitas Care Model.” Architectural Design 84.2 (2014): 94-101. ❖ Chaudhury, Habib. “V. Regnier. Design for Assisted Living: Guidelines for Housing the Physically and Mentally Frail. New York: John Wiley, 2002.” Canadian Journal on Aging/La Revue canadienne du vieillissement 25.04 (2006): 415-416. ❖ ”Florida’s Friendliest Active 55 Retirement Community.” Florida’s Friendliest Active 55 Retirement Community. N.p., n.d. Web. 04 Apr. 2017. <http:// ❖ www.thevillages.com/>. ❖ ”Latest News.” The Forest at Duke in Durham, North Carolina. N.p., n.d. Web. 06 Apr. 2017. <http://www.forestduke.org/>. ❖ Perkins, Bradford. “10 top design trends in senior living facilities.” Building Design Construction. N.p., 19 Jan. 2009. Web. 15 Mar. 2017. <https://www.bdcnetwork.com/10-top-design-trends-senior%C2%A0living-facilities>. ❖ Piatkowski, M. (2017, March 31). To Age is Human: Universal Design Research and Trends. [Webinar]. The Center for Health Design Webinar Series. Retrieved from https://www.healthdesign.org/events/76. ❖ ”Population estimates, July 1, 2016, (V2016).” UNITED STATES QuickFacts from the US Census Bureau. N.p., n.d. Web. 06 Feb. 2017. <https://www.census.gov/quickfacts/table>. ❖ Rolfes, Ellen. “Why boomers are retiring to college.” PBS. Public Broadcasting Service, 29 Apr. 2014. Web. 06 Apr. 2017. <http://www.pbs.org/newshour/updates/why-boomers-are-retiring-to-college/>. ❖ Services, Tribune News. “The Villages, Florida, is fastest growing metro area in U.S.” Chicagotribune.com. N.p., 24 Mar. 2016. Web. 01 Apr. 2017. <http://www.chicagotribune.com/news/local/breaking/ct-census-fastest-growing-metro-area-20160324-story.html>. ❖ ”Silver Sage Village Cohousing Home Page.” Silver Sage Village. N.p., n.d. Web. 03 Apr. 2017. <http://silversagevillage.com/>. ❖ Del Nord, Romano. Architecture for alzheimer disease. Alinea Editrice, 2003. ❖ ”The Villages Health | America’s Healthiest Hometown.” The Villages Health | America’s Healthiest Hometown. N.p., n.d. Web. 06 Mar. 2017. <http://www.thevillageshealth.com/>.
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