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Designing International Aged Care Environments

By Jeffrey Anderzhon, FAIA

The world’s population is aging rapidly in both the developed and developing countries. Most of these societies have undertaken the obligation of providing care for their elders and the environments in which that care can be given, either through private sponsors or with government-funded financial assistance. Combined with the recent economic recession, designers have looked beyond the borders of the United States for opportunities, particularly in the Pacific Rim countries. 

The exportation of both Western models of care environments and care programs has become significant. But are Western models of care and environments appropriate in a Pacific Rim country or, for that matter, anywhere else? While this veneration for our architecture and our care is commendable, it may not be fully deserved as cultural and socioeconomic intricacies of the residents for whom it is intended may be ignored. If we accept this admiration for our design and program talents, we must also accept the responsibility to provide unassailable quality of both environment and care as we export these to foreign shores. 

While the United States is a melting pot of cultures, other countries are more homogenous in both culture and general attitude toward aged care. American designers and care providers cannot simply utilize that which we have found successful in this country, transport it to another and expect it to be either a sustainable aged care community or to even meet the physical and social needs of those for whom it is intended. To achieve success elsewhere we must fully understand how to accomplish the integration of environment and program within a template of local custom, culture and lifestyle. One path to this goal is the study of successful aged care communities elsewhere in the world, learning from their successes and interpreting those efficacies in our own design approaches.

TJILPI PAMPAKU NGURA - SOUTH AUSTRALIA
Located in the remote “outback” center of Australia, Tjilpi Pampaku Ngura is a small aged care community, fully funded by the Australian government. Created in 2000 specifically for an Aboriginal population used to living off the land, the community houses just 16 residents. The design has an integral and direct connection to the outdoors in deference to the residents’ culture. Intended simply for short residential stays when the Aboriginal elder requires some respite assistance until he or she can return to the “land,” the design is simple and uses building materials that are either readily available or that are easily transported to the job site and that are durable under the harsh local weather conditions.

Each of four separate houses accommodates four residents and provides modest sleeping rooms and bathrooms. The houses surround a central community space where meals are served and social activities take place. Residents are free to come and go as their spirit moves them. The most popular structure on the small campus is the “wiltja,” or shade structure, where residents can sleep close to the land as is their custom.

In the end, the designers and care providers discovered that the buildings were not nearly as important as the cultural and spiritual significance of their location and its relationship to the land. In addition, Tjilpi Pampaku Ngura has enabled aged

Aborigines in the surrounding area to remain connected to their traditions and culture.

BELONG WIGANWIGAN, UNITED KINGDOM
Located just outside of Manchester, England, Belong Wigan was built in an economically depressed area predominately populated by blue-collar factory workers. The surrounding community has had few optimistic economic prospects, particularly in the recent worldwide recession. Residents have seen local businesses close, population leave and their community fabric begin to fray. One victim of the recent economic recession was the last privately operated restaurant in town, which closed its doors. It was a natural gathering place for residents of the community and a foundational element in the social activity of the community.

The sponsor and designer had the opportunity to provide not only a much needed new series of affordable apartments and sheltered care for the aged, but also a new center for community activity that includes a bistro-type café open to the public. This solution points to a deep understanding of cultural and community relationships as well as an understanding of community organization. 

By replacing a lost community “asset,” Belong Wigan strengthens the community, reinforces the local culture and, as a result, enhances its own position. The additional community benefit, resulting from creating new housing and care stock, has kept people in the community. The end result is that the wildly popular café attracts residents from both the campus and the town, brings them together in a way which had been lost and provides a rediscovered sense of pride for Wigan and its future.

GOJIKARA MURA VILLAGE - NAGOYA, JAPAN
On the opposite side of the world in Nagoya, Japan, the aged care community Gojikari Mura Village provides a similar deference to culture and community, but with a different twist on the design approach. With its original structures completed around 1987, this aged care community offers an intuitive, if a somewhat arguably disconnected, design vernacular to its resident. This happened, in part, because structures and programs were added over the years and partly because the sponsor has clearly listened to the residents and the community, studied how they live their daily lives and responded with architecture that fulfills the residents’ physical, psychological and social needs. The campus has grown from simply a nursing care center to include dementia care, assisted living, independent retirement living, child daycare, a very active community center and a small nursing school. 

To foster a sense of cultural and physical authenticity, parts of the campus are intentionally designed to be inconvenient and somewhat difficult to access, just as the city of Nagoya is. This approach encourages residents to seek assistance from other residents or staff, which initiates and promotes opportunities for socialization. The buildings are constructed at a scale that echoes a typical and walkable Japanese neighborhood. There is a design diversity among the structures, which provides a visual sense of community and avoids design boredom. While we may not appreciate the architecture, Gojikari Mura Village has been designed with respect to the local culture, and has creatively integrated itself into the larger Nagoya community.

DESIGNING FOR DIVERSITY
If we are charged with being the world’s example of providing aged care and with the environments in which that care is housed, we must immerse ourselves in the cultural nuances of the residents for whom we are designing. We must also understand that as the world continues to shrink, those cultural issues will be influenced by outside forces and we be versatile in our designs and programs to accommodate this. Placing our own template of aged care design and program on other cultures in other countries is neither sustainable nor appropriate and in the end it is simply a bad approach to an issue that needs creativity, sensitivity and empathetic thought leaders.