By Michál Cohen of Walters & Cohen Architects (www.waltersandcohen.com)
Shortly after my mum died in 2018, I read a book that touched me deeply, Being Mortal: Medicine & What Matters in the End, by Atul Gawande. The book covers many subjects around end-of-life care, and the key message I took was that quality of life is more valuable than quantity. This article is about my personal and professional experience of care homes, assisted living and end-of-life care.
When my mum was diagnosed with Alzheimer’s, our priority was that she and my dad should continue to live together in South Africa, where my sister still lives. We settled on a development with 150 bungalows for individuals or couples able to look after themselves for the most part. The site also offered frail care support and more intensive medical care – almost a small hospital – plus some shared facilities, such as a restaurant. I appreciate that South Africa has space and sunshine that are not always available in the UK, but this model of living has transfer- able benefits that are already happening in the UK and elsewhere.
My mum and dad were devoted to each other, and having their own two-bedroom bungalow meant that mum’s last years were as good as they could possibly be. My parents kept their beloved dogs, made friends with their new neighbours, and had friends and family to stay; eventually the second bedroom was used by their wonderful live-in carer.
I visited often and would spend hours cooking up a storm, my mum sitting near me in the kitchen, the two of us talking the whole time as I filled their freezer. What a privilege to have this time with my mum and nourish her and my dad as best I could. What would my experience have been if I’d visited her in a care home where residents are seated in a circle around a too-big room, without her familiar belongings around her, and no kitchen? Where it didn’t feel like her home?
I know there are financial and practical issues around care homes and assisted living, but I also know that good design doesn’t have to be pricey. Best practice around the world can inform our buildings, and conversations about the future of care homes should involve those who live and work in them, those who visit, and local authorities among others. I believe the design response to the variety of needs in a gradually ageing population is rich with possibilities.
Some of the things I’ve been thinking about are materials, layout and facilities. Can we use timber to warm up a space? Can we make a bath- room feel like a sanctuary? How about having a series of smaller living rooms instead of one big space? Would you like to offer visitors a variety of spaces so that they can choose a cosy nook, or hold a family celebration? What scope is there for encouraging birds and other wildlife into the garden, and making sure residents can see? Can we make bet-er use of your outdoor space? What about opportunities for biophilic design, bringing the outdoors to the indoor environment? Would more able residents like to be able to fetch themselves a cup of tea or bake some cookies for their grandchildren? What if we could avoid long, windowless corridors?
These improvements don’t have to be luxuries. Some small interventions can make a big difference, and I am always delighted when our clients tell us they didn’t know just how much they could get for their budget.
I’ve scratched the surface here – I’ve not even talked about the design response to Covid, for example. But I am excited and optimistic about the future. I think there is a lot that can be done to ‘design in’ features that can make care homes excellent places to live and work.
My mum benefitted from the care she experienced in her final years, and this was a comfort to everyone around her. Architects can be part of the movement towards improving quality of life for older people and everyone who cares for them.