A common clothesline can make a difference in preserving the dignity and self identity of Alzheimer’s patients, says Keith Diaz Moore, Washington State University professor of architecture and landscape architecture.
At Sedgewood Commons in Falmouth, Maine, a backyard clothesline engages residents of the 96-bed care facility in daily household tasks. It also represents how designers now are considering cultural aspects in building new and remodeled assisted-living facilities, explains Diaz Moore. “An outdoor yard, including a clothesline, historically has been an important part of New England family culture. Here it helps promote resident autonomy, and the ritual of maintaining the landscape encourages awareness and orientation.”
Diaz Moore directs teaching and research at WSU Spokane’s Interdisciplinary Design Institute (IDI) in design issues related to dementia. The IDI is one of only a handful of architectural schools in the country with a concentration in the area.
Diaz Moore says while physical, social, and organizational environments do not determine an individual’s quality of life, together they certainly have a substantial impact upon people, particularly upon those with reduced competence. Culture provides untapped resources for creating activities and environments that address age-related cognitive issues.
Tribal longhouses, Jewish and Catholic religious traditions, and customs of the Pennsylvania Dutch have all been incorporated in assisted living facilities built recently in this country, representing attempts to improve the quality of life of Alzheimer’s victims.
Unfortunately, says Diaz Moore, only a small percentage of our four million Alzheimer’s sufferers live in these innovative facilities. “The vast majority of institutionalized dementia victims are still housed in traditional nursing home environments.”
In a way they are captives of well-intended social policies. Although the Hill-Burton Act, which provided federal funding for hospital construction, was extended in 1954 to include nursing homes, the standards for construction, facility design, and staffing patterns it originally set forth remained unchanged. As a result, nursing homes resemble hospitals, with narrow rooms arranged along a corridor near a nursing station. Like hospitals, they are designed for a few days of acute treatment, not for the years to which many elderly are sentenced, says Diaz Moore.
But by the mid-80s, the view of dementia as a national tragedy began to take center stage, along with discussions of how environments might be changed to improve the quality of life for those afflicted.
Change has been slow because of limited financial resources and limited design research, says Diaz Moore. However, he hopes that a project he’s directing will accelerate the application of successful innovation in design. For the past three years, he has headed a study involving six facilities across the country, including one in Spokane, to assess the effects of design elements on residents, staff, and operations. Funding by the Extendicare Foundation, operator of long-term care facilities, will support the maintenance and updating of a Web site to include the research assessment and information available to designers and researchers in the field.
In the long term, Diaz Moore is optimistic about improving the prospects for elders committed to extended care. It is estimated that by the middle of the century 14 million Americans will be ravaged by Alzheimer’s disease. Other dementias will raise the total. When their friends start becoming dementia victims, baby boomers will have the political clout to really change public policy, he says. “Until then we must invest designers with the best information and tools possible to replace the Old Folks Home.”