WHAT
IS 'HOMELIKE'?
CONSUMERS ASSESS
ASSISTED LIVING DESIGNS
By JOHN P. MARSDEN
Assisted living has been promoted as a residential or homelike living arrangement, but determining what makes the building itself homelike has been left largely to the discretion of developers, architects and marketing departments. There has been very little effort to determine what constitutes a "homelike" residence that would appeal to prospective elderly occupants or to influential members of their families.
In a study to find out more about consumer perceptions, I focused on the exterior physical features that help make housing options such as assisted living and nursing homes appear more homelike to potential residents and their family members and visitors. Potential clients may avoid facilities that provide excellent services, personnel, policies and even interior design simply because the buildings are perceived as too "institutional" or inappropriate in some other way.
PHOTOGRAPHS
I presented photographs of assisted living facilities for comment and discussion to groups of consumers. From a very large collection of examples of what is being designed and built in the assisted living industry, I selected 34 photographs of facilities in Michigan, Massachusetts and Florida. These were either free-standing structures remodeled or specifically designed and constructed to incorporate the assisted living philosophy or buildings that were part of a continuing care retirement community (CCRC); buildings of three stories or less; and buildings that appeared to be in good condition and were devoid of signs of construction or renovation. Single-family houses designated as assisted living for elders were not included.
The facilities were photographed from the street or a parking lot, and all of the images were taken under sunny conditions with the vegetation in bloom. Scenes typically focused on either main entries or an expanse of the building near the main entry. The photos did not include the entire building, but rather focused on particular features such as entries, building materials, roof articulations, window treatments, massing and landscaping.
The photographs were evaluated by two groups of participants: elderly retirement housing residents and family members who could be involved in making decisions about the older person's relocation. Each group consisted of 100 individuals who lived in Michigan or New York.
The sample of elders included people of ages 6898. Although all were residents of retirement housing, such as assisted living, they were unfamiliar with the buildings depicted in the photographs. The second group consisted of family members with a relative over the age of 65 who currently resided in or might be a candidate for assisted living. I interviewed each of the study participants individually, usually at their place of residence.
Using a face-to-face interview format, I asked participants to imagine they were helping a close friend or relative select a "homelike" housing arrangement for an older person. They were instructed to sort the photographed scenes into five piles ranging from "not at all homelike" to "very homelike." In addition, participants were asked to explain, in an open-ended format, what led them to include photographs in the "very homelike" and "not at all homelike" piles.
GROUPS AGREED--
AND DISAGREED
There were strong areas of agreement--and disagreement--between the elders and family members. The groups' responses related to five major areas:
* Familiar Housing Cues. For both groups, familiar housing cues--memory-jogging symbols--were associated with "homelike." Porches and porticos customary in home design are examples. Symbols such as these might help make an assisted living facility more familiar.
In contrast, there were unfamiliar housing cues that were received less favorably. For example, the long driveway through the porte cochere--an entry feature common to many assisted living residences--suggested to the majority of respondents that a bellhop would be waiting at the entrance. The large size of the porte cochere, the width of the driveway, and signs indicating clearance heights also suggested that the entry could accommodate a truck or an ambulance. Needless to say, this evoked images of institutional buildings such as hospitals, hotels and funeral homes.
* Enclosing Elements. Enclosure has to do with the feeling of being sheltered and protected. Several exterior physical features that provide either actual sheltered covering or a transitional layer of enclosure evoked positive reactions among the elderly. Supportive protection, as evidenced by enclosing elements, may be particularly important to more vulnerable populations. For instance, elders tended to favor portico entries, a familiar housing cue, as well as small pedestrian covered entries, as opposed to large and open hotel-like porte cocheres.
Family members, in contrast, viewed all types of sheltered entries, including drive-up porte cocheres and pedestrian covered entries, much less favorably.
* Caring Attitude. A caring attitude, as demonstrated by signs of occupancy and attention to details and maintenance, suggests human presence and support nearby. For example, seating and picnic tables were often noted favorably by both the elderly and family members as features that imply human occupancy and a homelike quality. The two groups differed, however, with respect to building maintenance. For older people, the issue of maintenance was often linked to the age of buildings. Older buildings were associated with potential maintenance problems and were therefore viewed negatively. Family members, on the other hand, felt that elders would be able to identify with older buildings. Few of them addressed the issue of maintenance.
* Human Scale. Human scale, the idea that the size of something relates to the size of a human being, is particularly important when dealing with a housing type like assisted living. Facilities are typically larger than the single-family homes with which most older adults have identified over a lifetime. This would clearly be important, as well, when dealing with an often vulnerable population, such as elders. A sense of human scale helps to make an environment seem more graspable and manageable; it may instill a sense of power and competence in older residents. A smaller entryway, such as a portico, for example, was favored as homelike, while entries that were large and overpowering (the porte cocheres) evoked negative reactions from both the elders and family members.
In addition, older respondents stressed the need for one-story, relatively low structures to a greater degree than did family members. One-story buildings not only provided a sense of human scale and a "bungalow" feel, they were also viewed as more convenient and accessible than two- and three-story ones.
* Naturalness. Naturalness can be interpreted as a connection to landscape elements and the use of "authentic" building materials and colors. Landscape elements such as shrubs along the building's foundation form a direct connection to the outdoors. They were considered to be homey features by both groups of respondents. In addition, certain natural building materials, such as wood, alone or in combination with brick, were identified as predictors of a homelike atmosphere by both samples. Synthetic modern materials such as stucco were viewed negatively.
IMPLICATIONS
The study sheds light on an area that has received very little if any attention from the research community. Although assisted living has been promoted as a residential or homelike housing choice for older individuals, few researchers have examined how this living arrangement is actually perceived. The question of what "home" means to elders is rarely raised in the context of the exterior of the building. Yet the exterior renders the first impression one receives. Each of the major themes identified by the study--familiar housing cues, enclosing elements, a caring attitude, human scale and naturalness--has direct implications for design and policy, applicable to both assisted living facilities and nursing homes.
A key example popular with designers--the porte cochere--brought a negative response from consumers. Despite the protection from inclement weather this structural element affords, designers might think instead of positioning the front door close to the entry drive to reduce the distance that an elder needs to traverse. To enhance the homelike effect, they could provide a pedestrian-oriented covered walkway on a smaller, more human scale.
Elders' unfavorable views of older structures suggest that designers should regard expensive remodeling of older buildings with caution. Alternatively, family members' assumptions that older people would identify with historic architecture suggests that use of older buildings should be considered on a case-by-case basis, depending on the marketing realities of individual communities.
These are only a few of the issues that can be taken into account when designing homelike exteriors for facilities for older residents. This study also highlights the importance of public input into the design for places that many may come to call home in the future. More research will demonstrate that the architectural choices are not as easily determined as many professionals might think.
John P. Marsden, based in Cleveland Heights, Ohio, is with ideas Inc. (Innovative Designs in Environments for an Aging Society), a research, education and consulting firm. This article is based on the author's doctoral work at the College of Architecture and Urban Planning, University of Michigan. For additional information, contact Marsden at (216) 932-2419 or MarsdenJP@aol.com. Adapted with permission from an article that appeared in Design '98 (March 1998), a publication of Nursing Homes Long Term Care Management.
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