If you have friends or relatives in a care home, or if you live in one yourself, you may know what the standard offer is usually. Residents are kept behind locked doors, rarely allowed to walk outside, instead confined to armchairs in front of loud televisions, surrounded by equipment that resembles medical spaces rather than domestic spaces, and deprived of the ability to make decisions on nearly every issue. A care home can be a large, old house that has been clumsily converted, or a newly built home that is as brutally affordable as a distribution center or budget hotel. Even in cases where staff and management are truly committed to the well-being of residents (and there are reported cases where this is not the case), it seems difficult to escape the pervasive lethal formula.
This is something you should care about even if you are not yet old and do not have dementia, because the above is a future that may come for you. This is an issue that concerns society in general as the population ages. This is also an area where architecture will also play a role; because the physical environment can markedly improve or harm the well-being of residents. When done right, design can make caring for older people less stressful and more effective. It may reduce the need for expensive medical and other interventions.
For architects who often want to do more with their skills rather than simply add style to an office block or private home, designing for the elderly and those living with age-related diseases such as dementia gives them the chance to contribute to something social. value. And so there are the John Morden Center in Blackheath, south-east London (a day care center for retirement community residents by MAE Architects, which won last year’s Stirling prize) and the “21st Century” in nearby Bermondsey. Witherford Watson Mann’s “Century Almshouse”. In both projects, architects went the extra mile to achieve things like good daylight; a strong sense of connection between the outside and different parts of the building; natural and tasteful materials; and corridors that are pleasant places to linger rather than functional streets.
Located on the edge of the town of Dax in southwestern France, the Landais Alzheimer Village is a comprehensive initiative to “give real life back” to Alzheimer’s patients and “create conditions where they cannot,” as one employee puts it. “It’s not just staying in a room waiting to die.” A 14-year-old facility is modeled on the dementia village of Hogeweyk in the Netherlands, famous for its village appearance and layout. The Dax project was similarly designed to have the life and appearance of a traditional community, with familiar and legible architecture based on common features in the area, albeit in simplified modern forms. There are four groups of houses with shallow-pitched and clay-tiled roofs around a “bastide”, an arched square with a restaurant, library and other facilities, plus a pleasant green area with a pond and trees in the middle.
The project is a self-declared experiment to test how its principles work in practice. The local administration of the region was initiated by the département des Landes, and its 28 million euro budget was largely financed by them with the help of regional and national governments. It serves 108 residents (who pay €2,000 a month and can get help if they cannot afford this amount) plus 12 day care patients, more than 120 staff and 80 volunteers. He pays particular attention to the needs of patients with early-onset dementia; This means that the ages of its current population range from 42 to 104 years old. It was designed by Danish practice Nord and local architects Champagnat & Grégoire.
Village Landais, which opened in 2020 and was recently critically acclaimed at Dezeen’s annual design awards, aims to offer villagers as much real and visible freedom as staff can. The five-hectare complex is properly fenced for the safety of vulnerable residents, but within this boundary people can come and go more or less as they please. They can walk around open spaces (or run or bike, because Alzheimer’s patients can also be physically healthy), visit neighbors, go to a restaurant or a show in the village auditorium, take care of animals and plants in a mini area. -farm and kitchen garden.
In each cluster of buildings or neighbourhood, are individual “houses,” each with private bedrooms, a shared living and dining area, and a staff-run kitchen. These also look out through glass walls onto informal courtyards to create the possibility of community with other houses. The courts are both sheltered and partially open, giving a sense of flow from one to the other. The roads around the village are designed in loops, because sometimes Alzheimer’s patients get confused by dead-end streets. They also rotate their walking routes towards the center and away from the border fence, which you barely notice. The aim was to create an “impression of freedom”, says Mathilde Charon-Burnel, who manages social care projects for the Département.
There are other details designed to alleviate the effects of the disease. The entire flooring is a uniform beige color, as strong contrasts can be disturbing for Alzheimer’s patients. Mirrors can also be distracting and can be hidden by blinds. Light and darkness are used to draw attention to where it should go and to divert attention from where it should not go. Faded door handles are set against dark backgrounds, and doors leading to service areas are barely noticeable against the wooden walls. Charon-Burnel says Alzheimer’s patients are “more curious than other people because they get lost all the time,” so “if you put a ‘no trespassing’ or ‘personnel only’ sign on something, they’ll go there.” It is better to make out-of-bounds areas inconspicuous. “There is as little signage as possible,” says Morten Rask Gregersen from Nord. “People can see where they need to go instead of being shown.”
There is also an imaginary shop where villagers can “buy” items they haven’t actually paid for, and an imaginary compartment of an old-fashioned railway carriage; inside is a screen showing the countryside passing by. Therapists use these to make patients think they are truly going on a journey. You might think such tricks would only increase their confusion, but I’m told they calm residents down and reassure them.
The Dax project and projects in Blackheath and Bermondsey serve varying degrees and types of needs. Appleby Blue is sheltered housing that offers residents more independence than is possible in an Alzheimer’s village. But the projects share the desire to respect the individuality and dignity of the people living in them; an acknowledgment that you continue to be the same person you were when you were younger. Also in this category is Bankhouse in Vauxhall, South London, managed by Tonic housing association, a retirement community for LGBTQ+ people in a riverside tower designed by Foster + Partners. Here, residents are offered not just residential units but also shared facilities (art classes, bar, rooftop garden) that help create a community.
Dignity includes visibility. A curious feature of many care homes is that passers-by barely see their residents through their airtight exteriors or deserted gardens, as if aging were something to be ignored. At Appleby Blue, common areas are right next to a street and a bus stop; The upper floors are level with the top floor of a double-storey building and have generous windows providing delightful views in both directions. Dax village is more secluded, but its auditorium and library are accessible to locals.
Most importantly, these projects appear to be working. In Dax, the villagers seem cheerful, caring and relaxed. After moving there I met a couple who got together and encouraged me to return when the weather was better and the flowers were in bloom. Charon-Burnel told me that lower anxiety levels create fewer “behavior problems,” which makes caregivers’ jobs easier. More scientifically, independent studies have recently found that symptoms such as cognitive decline and depression are significantly better in Dax village than in other nursing homes.
The most obvious challenge is the issue of scale. The number of Alzheimer’s patients in France is around 1 million, not to mention other types of dementia, so many projects like Village Landais need to make an impact. But the principles of agency and respect can at least be exported to less singular situations. The alternative is not only avoidable misery for older people, but also increased spending on the health problems that come with it. Why don’t any of us want happier, healthier places for people nearing the end of their lives, especially since most of us will encounter such a place ourselves?