(Re)designing the Continuum of Care for Older Adults: The Future of Long-Term Care Settings

Foreword
Preface
Continuum of Care Environments in the Post-COVID-19 Era
Part I: Home and Community-Based Care
Part II: Facility-Based Care
Part III: Memory Care and End-of-Life Care
Part IV: Evidence-Based Applied Projects and Next Steps
References
Contents
About the Editors and Contributors
Editors
Contributors
Part I: Home and Community-Based Care
Bridging the Digital Divide: Smart Aging in Place and the Future of Gerontechnology
1 Introduction
2 Social Robotics for Aging in Place
3 Technology Literacy and Health
4 Interface Usability, Design, and Accessibility
5 Technology Acceptance, Use, and Privacy
6 Conclusion and Future Directions
References
How Environmentally Embedded In-Home Sensors Are Revolutionizing Independent Living and Family Caregiving: A Literature Review
1 Introduction
2 Embedded Activity Sensors
2.1 Embedded Sensors for Activity Pattern Recognition
2.1.1 Identifying Behaviors Related to Diabetes
2.1.2 Identifying Behaviors Associated with Cognitive Impairment
2.1.3 Driving Patterns
2.1.4 Mental Health
2.2 Embedded Sensors for Fall Risk and Fall Detection
2.3 Embedded Sensors for Chronic Illness Detection
3 Living with Sensors and Privacy Implications
4 Conclusion
References
The Home as a Place for Rehabilitation After Stroke: Emerging Empirical Findings
1 Introduction
1.1 Stroke and the Recovery Process
1.2 The Rehabilitation Pathway
1.3 Care and Rehabilitation Move from Hospitals to People’s Homes
1.4 Person-Centered Care and the Environment
2 Rehabilitation and Architecture: REARCH
2.1 Overarching Aims, Methods, and Participants
2.2 Theoretical Underpinnings
3 Emerging Findings
3.1 Characteristics of the Rehabilitation at Home
3.2 Shared Decision-Making
3.3 The Environment
3.4 A Home Is a Social Place
3.5 Adaptation to Life After Stroke in Light of the Coronavirus Pandemic
4 Conclusions
References
Adult Family Care: A Homelike Environment for Community-Based Care
1 History and National Scope of AFC
2 North Carolina AFC Study Methods
2.1 Sample
2.2 Procedures and Analysis
3 Results
3.1 Motivations to Create an AFC Home
3.2 Adept Applications of a Broad Skill Base
3.3 Supporting Family-Like Relational Ties and Resident Empowerment
3.4 Community Support for Providers
4 Discussion
5 Implications for Practice
References
Part II: Facility-Based Care
A Theory of Creating At-Homeness Across the Long-Term Care Continuum
1 Introduction
2 Key Concepts and Models
2.1 Deinstitutionalization
2.2 Pattern Language
2.3 Person-Centered Care
2.4 At-Homeness
3 Theories
3.1 Caring Theories
3.2 Theory of Thriving
4 Synthesis: The Theory of Caring Environments
5 Application in Practice
5.1 Caring Environment
5.2 Caring Intentions
5.3 Caring Actions
5.4 Resources for Theory Application
5.4.1 Evidence-Based Design Meaningful Environments
5.4.2 Resources for Enabling At-Homeness During Transition
6 Theory in Action
7 Future Research and Policy Implications
7.1 Hypothesis Testing
7.2 Overcoming Barriers
8 Conclusion
References
The Evolution and Rise of Robotic Health Assistants: The New Human-Machine Frontier of Geriatric Home Care
1 Introduction
1.1 Transforming the Home Care Environment
1.2 Technifying Later Life
1.3 Core Barriers of Technology Use in Geriatric Home Health
1.3.1 Privacy
1.3.2 Human-Machine Interface Design
1.3.3 Workforce Training and Education
1.4 Evolution of Socially Assistive Robots in Geriatric Care
2 Research Objectives
3 Methods
4 Results
4.1 Focus Group Results
4.1.1 Theme 1: Vital Functions
4.1.2 Theme 2: Mental Health
4.1.3 Theme 3: Privacy
4.1.4 Theme 4: Monitoring
4.1.5 Theme 5: Telehealth Accessibility
4.1.6 Theme 6: Communication
5 Discussion
5.1 Privacy Concerns
5.2 Intervening Robotic Care Benefits
5.3 Telehealth Communication
5.4 Limitations
6 Conclusions
6.1 Future Directions of Robotics in Geriatric Home Healthcare
References
Rehabilitation Clinics that Enhance Stroke Recovery: Rethinking the Same-for-All Design Approach
1 Introduction
1.1 Aging and Stroke
1.2 Rehabilitation Clinics as Facilities
1.3 Stroke Patients’ Experiences of Rehabilitation
1.4 Strategies for Increasing Patient Activity
2 How Stroke Patients Interact with the Built Environment: An Empirical Study
2.1 Research Methods, Settings, and Participants
2.2 Results
2.2.1 Barriers in the Built Environment
2.2.2 Facilitators in the Built Environment
2.2.3 Differences Between Patients with Different Mobility Levels
3 Discussion
3.1 Physical Aspects of the Built Environment
3.2 A New Perspective to Rehabilitation Clinic Design
3.3 Limitations
4 Conclusion
References
Exploring the Role of the Built Environment in Person-Centered Care During Mealtimes in an Ethno-specific Long-Term Care Home
1 Ethnic Minority Aging Population and Long-Term Care
1.1 Built Environment and Person-Centered Care During Mealtimes
2 Objectives
3 Theoretical Context
4 Ethnographic Observations
4.1 Setting and Sample
4.2 Data Collection and Analysis
5 Findings
5.1 Space as the Stage for Mealtime
5.2 Mealtime Routines as a Primer for Dining Experience
5.3 Teamwork for Institutional Efficiency
5.4 Varied Assistance
5.5 The Lost Meaning in Interaction
6 Discussion and Conclusion
References
Part III: Memory Care and End-of-Life Care
Designing for Dementia: An Approach that Works for Everyone
1 Introduction
1.1 A Design Vocabulary for Those with Dementia
2 Translating Research into Reality
2.1 The Small House Concept
2.2 Adding to Community
2.3 Extending Community
2.4 Replicating Community
2.5 Creating a New Community
3 Conclusion
References
Communication and Environmental Positioning in Dementia Care Units: Dialogues Through Space and Place
1 Introduction
1.1 Communication and Dementia
1.2 Residential Long-Term Care
1.3 Environmental Positioning
2 Research Objective
3 Methods
4 Results
4.1 The Notebook
4.2 Where Am I?
4.3 The Easter Card
4.4 The Kitchen Remodel
4.5 Rosie Is Transferred
5 Discussion
6 Conclusion
References
Adaptive Reuse of Closed Malls for Dementia Programs and Services: Community Focus Group Feedback
1 Introduction
1.1 Supporting Autonomy in Dementia Care
1.1.1 The Netherlands Dementia Village
2 Adaptive Reuse for Community Healthcare Needs
2.1 Mall Adaptations
2.2 Example Mall Conversion Sites
3 The Dementia-Friendly City Center
3.1 A Convergence of Factors
3.2 The DFCC Case Study Site
4 Methods
4.1 Architect/Developer Focus Group
5 Results
5.1 Mixed-Use Precedents
5.1.1 Mixed-Use Development for Dementia Programs and Services
5.2 Sustainable Building Practices
5.3 Linking the Old with the New
5.4 Financial Implications
5.5 Development Partnerships
6 Discussion
7 Conclusion
References
Extending the Continuum of Care for People with Dementia: Building Resilience
1 Dementia-Friendly Architecture
1.1 Research Findings on Supportive Nursing Care Environments
1.2 Dementia-Friendly Design Criteria to Transfer Research Results into Architectural Practice
1.2.1 Floor Plan Structure
1.2.2 Floor Space Requirements
1.2.3 Safety
1.2.4 Orientation
1.2.5 Guidance and Orientation Systems
1.2.6 Lighting
1.2.7 Colors and Contrast
1.2.8 Atmosphere
1.2.9 Activation Concepts
1.2.10 Stimulus Densities
2 Current State of Dementia-Friendly Architectural Design in Long-Term Care Settings
3 Continuing Dementia-Friendly Care in Hospital Environments
3.1 Architectural Properties of Dementia-Friendly Hospitals
3.2 Quasi-Experimental Study: Results of a Dementia-Friendly Redesign of a Hospital Ward
4 Discussion
4.1 Dementia-Friendly Design as a Driver for Human-Centered Design
4.2 Potential of Dementia-Friendly Design in Building Resilient Structures in the Future
5 Conclusion
References
Designing the Post-Pandemic Hospice Environment: “The Last Place”
1 Introduction
2 The Hospice Environment
3 COVID-19 and the Hospice Environment
3.1 Improve Infection Control
3.2 Accommodate COVID-19 Patients Along with Regular Patients
3.3 Accommodate Patients’ Families in the Facilities
3.4 Create a Safe and Supportive Place for Healthcare Workers
3.5 Provide Palliative Therapies and Spiritual or Grief Support
3.6 Increase in-House Surge Capacity
4 Therapeutic Goals of Hospice Environments
4.1 Goal 1: Provide Continuity of Self
4.2 Goal 2: Provide Access to Nature
4.3 Goal 3: Provide Privacy
4.4 Goal 4: Facilitate Social Interaction
4.5 Goal 5: Maximize Safety and Security
4.6 Goal 6: Provide Autonomy
4.7 Goal 7: Regulate Stimulation and Support Sensory Therapies
4.8 Goal 8: Support for Spiritual Care
4.9 Goal 9: Provide Family Accommodation
4.10 Goal 10: Provide Support After Death
4.11 Goal 11: Maximize Support for Staff
5 Prospective Design Considerations for COVID-19
5.1 Planning and Programming
5.2 Building Configurations
5.3 Overall Interior Design
5.4 Staff Area
5.5 Patient Rooms
5.6 Social/Family Spaces
5.7 Outdoor Spaces and Gardens
6 Conclusions
References
Part IV: Evidence-Based Applied Projects and Next Steps
Autonomy, Identity, and Design in the COVID-19 Era
1 Framework of Person-Environment Exchange
1.1 Autonomy, Identity, and the Integrated Development Model
2 The Continuum of Care: Independent Housing to Skilled Nursing
2.1 Independent Housing
2.1.1 COVID Issues in Independent Housing
Autonomy and Independent Housing: Compensation, Control, Challenge
Identity and Independent Housing: Connection, Continuity, Contribution
2.1.2 Design Opportunities in Independent Housing: Digital Technology
2.1.3 Design Opportunities in Independent Housing: Physical Environment
2.2 Skilled Nursing Facilities
2.2.1 COVID Issues in Skilled Nursing Facilities
Autonomy and Skilled Care: Compensation, Control, Challenge
Identity and Skilled Care: Connection, Continuity, Contribution
2.2.2 Design Opportunities in Skilled Nursing Facilities: Digital Technology
2.2.3 Design Opportunities in Skilled Nursing Facilities: Physical Environment
3 Conclusion
References
Creating a Tailored Approach: The Transformation of Jewish Senior Life
1 Introduction
2 Project Premise
3 Design Process
4 Adopting the Green House Model
5 The Cottages: Breaking the Mold
6 The Tower: Further Adaptations
7 Project Impact
7.1 Interior Aesthetics
7.2 Independence
7.3 Privacy
7.4 Sense of Community
7.5 Well-being
7.6 Staffing
8 Conclusion
References
Flexible and Enriched Environments for Senior Living and Aging-in-Place in Dense Urban Environments
1 Outline
1.1 Countering Ageism and Promoting Brain Health
2 Enriched Environments
3 Flexible Environments
4 A Case Study of an Enriched and Flexible Environment Allowing Aging-in-Place
5 Institution to Home
6 Summary and Key Takeaways
7 Conclusion
References
Envisioning Innovative Post-COVID Approaches Toward LTCF Design in Dense Urban Areas: Exploring an Evidence-Based Design Prototype
1 Introduction
1.1 Unique Challenges of LTCFs in Dense Urban Environments
2 Research Objectives
3 Literature Review
3.1 The Impacts of COVID-19 on LTC Residents’ Physical Health and Safety
3.2 The Impacts of COVID-19 on LTC Residents’ Psychological Well-being
3.3 The Impact of COVID-19 on Families and Visitors of LTCF Residents
3.4 The Impact of COVID-19 on LTC Healthcare Workers
3.5 Infection Control
3.6 The Physical Environment of LTC and Residents’ Quality of Life (QoL) and Safety During and After the COVID-19 Pandemic
4 Design Principles for LTCFS During and After the COVID-19 Pandemic
5 Lessons Learned From Recent LTCF Design Trends
5.1 Intergenerational Community
5.2 Small Household Model for the Home-Like Environment and Person-Centered Care
5.3 Biophilic Design
6 Translating Research to Design: An Urban Vertical Continuous Care Intergenerational Community Prototype Design
6.1 Macro-level (Overall Urban Setting)
6.2 Meso-level (Neighborhoods and Districts)
6.3 Micro-level (Site/Building)
6.3.1 Intergenerational Programs and Amenities
6.3.2 Biophilic Design
6.3.3 Small Household Model
6.3.4 Multi-tier Infection Control and Pandemic-Resilient Design
7 Conclusions
References
Realizing the Future of Intergenerational Environments for Aging Through Design Research
1 Introduction
2 The Boomtown Framework
2.1 The Creation of the Boomtown Framework
2.2 The Elements of the Boomtown Framework
2.3 The Subareas of the Boomtown Framework
2.4 Processes and Partnerships
3 Testing the Boomtown Framework
3.1 Results for Mixed-Use Convenience
4 Applied Case Studies of the Boomtown Framework
4.1 Mosaic via Willow Valley
4.2 MacArthur Park
4.3 Ivy City
5 Conclusion
References
Epilogue
Place-Type Diversification
Placemaking as Process
References
Index