The Legacy Center explores what we term "Legacy Living." At its most fundamental level, Legacy Living is about the timely and the timeless over the typical or the trendy. It has several dimensions, one of which is recognizing needs and abilities across the entire life course and bringing together all ages for mutual support – through trans/multi-generational design.
The place we live becomes part of who we are. Unfortunately, we currently build Peter Pan houses, for people who will never get old. The problem is real people do get old. And when they have to move from a home they know and love, it makes getting old even harder. We need design that promotes the physical and psychosocial well-being of people through the life cycle. We need to plan for a lifetime and design for a lifespan.
Focusing for the moment on elders, not only are older people increasing in number, they're also living longer. As they live longer, there's an inevitable rise in the number of physical and sensory impairments and disabilities. So, design professionals face a growing new challenge.
Research tells us the vast majority of older adults want to "age in place," remaining in their own home, even if that home is no longer a comfortable place to live. We humans develop "place attachment," a socioculturally mediated emotional connection to a particular physical location. In the face of instability and physical changes, illness, and other losses, we engage in an ongoing effort to create and preserve meaning through place-centered activity. We give meaning to places like our home, and our home in turn shapes the meaning available to us as we age.
The meaning derived from place is also important to the young. It's at home that we celebrate special events, connect with parents and grandparents, and engage in the everyday activities of living that give us the skills to become independent adults. Home is where your story begins. The design of that home, and the activity and interaction it encourages, helps form your story. On one side of the coin, some research shows that children who grow up in houses with a large square footage often feel less connected with their parents and siblings simply because the ample space affords too much independent, often self-absorbed, activity. You aren't forced to interact with or even get along with others – important social skills in themselves. On the other side of the coin, "going home" for many is to return to the happy comforts of childhood memories, recall lessons learned from important intergenerational connections, and speaks to the grown-up self you have become.
Trans/multi-generational design facilitates aging in place and makes living better for all ages across the life course, supporting meaning for young and old.
Transgenerational Design
Transgenerational design as a term and concept initially emerged in the mid-1980s by Syracuse University industrial design professor James J. Pirkl. Working with gerontologist Anna L. Babic, Pirkl developed two seminal 1988 publications resulting from the Design for Aging research project. The concept has been developed and expanded by a number of other researchers and practitioners.
Accessibility isn't the same thing as transgenerational design. A house that has, for example, one accessible entrance, one accessible bathroom, and one accessible bedroom constitutes what some term a "ghetto accessibility" approach. Accessible design all too often mindlessly conforms to bureaucratically imposed principles, standards, dimensions, and diagrammatically mandated "solutions." Designs produced from this focus on code compliance usually result in starkly functional, impersonal products and environments that lack human sensitivity, interest, and appeal and have an institutional, medical feel. In short, they don't speak to the human soul.
A transgenerational house, a true lifespan house, opens all the rooms of the house to everyone, regardless of ability. It's good, thoughtful design. Design flaws that impede or annoy the "disabled," "old," or others with reduced ability are often the same things that fully-able people find inconvenient, troublesome, uncomfortable, dumb, ugly, or just plain cheap. And good design has to include aesthetics; it has to be soul-soothing. So transgenerational design is for everyone.
Some interesting research has been done by the L.E.A.D. 2010 project, which stands for the Laboratory for Efficient and Accessible Design for the year 2010 (the year the first Baby Boomers turned 65 years old). The research subjects were people between the ages of 18 and 88 who lived in the community. The purpose of the project was to evaluate how well different people negotiated various living environments and what they thought of various products and architectural features.
According to L.E.A.D. 2010, in terms of physical capabilities, the factors most limiting a person's ability to function in their home, from most common and limiting to least common and limiting are:
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Overall strength
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Bending, stooping and kneeling
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Walking
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Standing
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Maintaining balance
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Using the hands to grasp
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Coordinating movements (e.g. muscles working together to walk, climb stairs, or tie shoelaces)
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Sitting
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Using hands to move objects
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Seeing
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Moving the head right to left and up and down
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Hearing
And according to the Centers for Disease Control and Prevention, falls are the leading cause of injurious death among older adults. Most falls occur in or near the home.
Keeping the above research results in mind, think about the physical challenges posed by hallways that are too narrow to accommodate a walker, wheelchair, or scooter, or by a shower threshold that must be stepped over, or by a toilet so low that standing up from being seated places a great deal of stress on an already sore back, knees, or legs. Imagine that the motion of your fingers is severely restricted by crippling arthritis. If a door or cabinet hardware, like knobs or pulls, has to be gripped, how easy is it to open that door or drawer? Even simple tasks like turning on the kitchen faucet can seem insurmountable. Imagine, too, the psychological impact of such a limiting environment on a person who has been accustomed to being fully able, independent, and useful.
The design of an environment is a major impediment to many people. In the L.E.A.D. 2010 project research, what many participants could accomplish in a few seconds or a single trip from one room to another required minutes and many trips for others. In most instances, the barrier could be identified, and therefore easily eliminated through better design. Two other key points emerged from the research. First, age alone is not a good indicator of a person's ability to use a product or negotiate an environment. Second, there is no clear distinction between able-bodied and disabled. Humans represent a continuum of abilities, not a dichotomy of abled and disabled.
Transgenerational design promotes independence and livability no matter what the age or level of ability. It is, to repeat, good design. And transgenerational design doesn't have to be ugly. Spaces should nurture the human spirit while facilitating the functions of everyday living. You can have form and function – it just takes a thoughtful approach.
Transgenerational design can also include a therapeutic approach to supporting those with Alzheimer's and other forms of dementia. People with dementia face many real frustrations and experience real losses. In addition to physical and cognitive losses, they progressively lose their coping abilities and often perceive their environment as more and more stressful. They have a lower threshold for dealing with stress, resulting in anxiety and inappropriate behavior when the environment becomes too confusing and overwhelming. In short, people with dementia are more susceptible to environmental factors; they are particularly vulnerable when they perceive normal levels of sensory stimulation (e.g. colors or shapes around them) as over-stimulation.
You can view the environment as part of a treatment for dementia. Research shows that thoughtful psychosocial, behavioral, and environmental approaches combined often have a faster, safer, and more effective impact than pharmacological interventions in treating a range of secondary symptoms for people with dementia. While there is currently no cure for conditions like Alzheimer's, don't lose sight of the fact that incurable doesn't mean untreatable. Alzheimer's has been labeled as hopeless for too long. Complex challenges can be addressed by the partnering of neuroscience with architecture and design. The goal of using good design in the environment for someone with dementia is to support function and encourage positive emotions for as long as possible.
Narcotics and antipsychotics are too frequently prescribed to deal with the secondary symptoms of conditions like Alzheimer's. These drugs further compromise cognitive function that is already muddled, and have been shown to increase mortality. Often the greatest barrier to environmental, nonpharmacological interventions is the lack of financial resources, or more specifically the lack of reimbursement. Drugs are generally directly reimbursed; retrofitting the environment is not. So, we need some changes in thinking and policies to promote a more progressive approach to the treatment of dementia.
There are a wide range of design features for treating dementia. For example: ensuring plenty of nonglare lighting, with an emphasis on natural light; working in grab points and bars for intuitive navigability; integrating in landmarks for navigability; using contrast to overcome perceptual limitations; installing nonskid flooring to reduce the risk of falls; using flooring and wall materials that temper noises and echoes to allow better task focus. Structured, calm, soul-satisfying surroundings can go a long way to helping someone with dementia function at a reasonable level for as long as possible and have a good quality of life.
To summarize, transgenerational design serves the widest range of ages and abilities, bridges the transitions across life stages, responds to the widest range of individual differences and abilities, offers a variety of means to accomplish the activities of daily living, facilitates a sense of dignity and self-worth, and speaks to aesthetic sensibilities. Transgenerational design emphasizes safety, comfort, convenience, beauty, accessibility, cleanability, adjustability, ease-of-use, and ergonomic bodily fit.
If something works well for people at the edges of the spectrum of functional ability, it works better for everyone. That's why transgenerational design makes sense.
Multigenerational Design
When the Obamas moved into the White House, they not only brought with them their two young daughters, but also Michelle Obama's mother, Marian Robinson. In the case of the Obama family, Grandma Robinson helped smooth the transition for the young girls and was someone the girls could count on if their parents were otherwise obligated.
More and more households are multigenerational as the population ages. Humans are social creatures, and yet our current residential design often fails to accommodate this most fundamental need as we age.
There are four quality-of-life basics that should become a part of every house design: sense of control; safety and security; privacy; and sense of belonging. The first two relate strongly to transgenerational design. The second two relate strongly to multigenerational design.
A century ago, children, parents, and grandparents commonly shared homes out of economic necessity. As Western society became more affluent and our cultural values shifted toward independence over connection, multigenerational habitation became less common. We lost something. We lost children learning from their elders, parents getting the physical and emotional support of their parents, and elders feeling useful and connected to their families. We also lost the opportunity to use the family as a testing-ground for one of the biggest human challenges we face: how to get along with other people. Many of the negatives associated with multigenerational co-habitation, like a loss of privacy and independence, are often the fault of poor design. Good multigenerational design supports the positives of living together and minimizes the negatives.
Multigenerational design can address the economic realities facing many families today. Living together is cheaper than living apart. It also speaks to the fact that relationships become increasingly important as we age. Individuals who have more actual and potential sources of social support have greater physical and psychosocial well-being, and greater resilience in response to illness and other life stressors. Further, as we get older and ever closer to the end of our lives, maintaining social connectedness and deepening existing relationships becomes a priority.
Most elders don't want to be sequestered in nursing homes, assisted living residences, or continuum-of-care retirement communities. Rather, they want to remain engaged in community and cultural life and live in mixed-use, multigenerational settings. Intergenerational contact makes life rich and textured.
San Francisco resident Anne Leitch shared this viewpoint in the Summer, 2009 issue of Generations, the American Society on Aging journal:
I live in a gated seniors community with all the amenities one could dream of – workshops, handicrafts, exercise. You name it, we have it. And yet I am longing, longing to walk to the corner coffee shop, to hear the sound of children playing, dogs barking. I want to see young people in love, watch mothers with their children in the park, young families, teens in the latest wild outfits. Yes, I'm lucky to have what I do, and I never forget that. But I am excluded from the mainstream of life. I am not elderly and never will be; my mother never was and she died at 92. Many of us don't want to be maintained and monitored. We want to belong, not only to each other, with whom we may have only one common denominator, age, but to society in general. We want to be 'just like everyone else.' Think up something daring, something challenging, something creative. Segregation by race has come to an end. Now we can put an end to segregation by age. We need each other at every age.
So many parents and grandparents just want to be with their children and grandchildren, to be a daily part of their lives. A morning hello, snippets of conversation and banter throughout the day, a hug before you head off to sleep, those are the things that make a day rich and comforting, especially as you face your own physical and emotional losses. The little things keep you connected to the spirit of life. Don't underestimate the power of where and how you live to sustain you.
We need homes and communities that are multigenerational. They cannot be fragmented, with youths, adults, and elders going their separate ways. Rather, they should be age-inclusive, with different generations recognizing – and acting upon – their mutual interests in building family and community.
We need to plan for our parents and grandparents as much as we do for our children. There are a lot of products and services out there to help prepare a nursery space for the arrival of a new infant. There are electrical socket plugs and cabinet fasteners, baby gates and, for the really fastidious, professional "babyproofers" who will come and overhaul your home. There are far fewer options when it comes to preparing and retrofitting your home for a grandparent or parent. We don't seem to want to think that far ahead. But to ignore the inevitable is to set everyone up for heartache and stress, and miss opportunities for enriching relationships.
Multigenerational homes should be designed with more open areas on one level. They should have flexible spaces that can be reconfigured as needs change. For example, a bedroom and bathroom in a corner of the house separated by a door for privacy and used by a teenager in a younger family, can later be used for a grandparent or parent or even a live-in caregiver. A room initially used as a den or office can later become a bedroom with or near a bathroom.
A few architects and developers now do offer multigenerational designs for new homes. The main unit is generally larger, offering three and even four bedrooms to accommodate a young family with children, while the subunit offers all the comforts of a full apartment with one bedroom, a kitchen, dining/living room, as well as a full bathroom and laundry facilities. For security purposes, both parts of the house are usually accessible to one another from inside the home, but also have their own individual/independent access to and from the outside.
A house doesn't have to be large and expensive to accommodate multigenerational living. And you can often retrofit an existing house. It's very much about good, smart design.
Multigenerational design includes aesthetic base choices for walls, floors, cabinets, etc. that allow for traditional and modern décors to coexist and complement each other. A grandparent or parent will want to bring their own furnishings into their space. And part of Legacy Living includes cherishing, using, and reusing furniture that has been handed down from generation to generation.
Multigenerational living can also be an important part of the environmental treatment for people with Alzheimer's and other dementias. At one of the top Alzheimer's research facilities in the US, there are no waiting rooms because the person whose charitable contribution made the building possible did not want early-stage people to sit across from late-stage people, as his mother had when she began developing dementia. Imagine living every day in a building like a nursing home filled only with people with dementia and a range of physical disabilities, facing so much loss on a constant basis. It can be overwhelming and debilitating in itself for residents, as it often is for some of the staff. There's little to lift you up. But introduce one baby, and the entire dynamic changes. A room lights up, as do the people with dementia in it. All the activities a program director can dream up can never replace the power of that one tiny human presence.
People with dementia often retain much more function, both physical and cognitive, and are happier not only when they are at home, but in an intergenerational, family environment. The high functioning of those around them lifts up people with dementia. You often become what you see around you, and if you see life and vitality, you are drawn to it. At the other end, the young in a multigenerational home learn firsthand about the entire course of life, and learn life skills like patience and empathy when they are involved in the care of a frail elder.
When you're planning for multigenerational living, it's important to discuss the arrangements ahead of time. Talk about boundaries for privacy and independence, while balancing recognized or unrecognized needs and limitations. Talk about expectations, responsibilities, and assumptions. Some tips to keep in mind:
Familiarize yourself with each person's preferences (e.g. music, colors, food). Make accommodations so that everyone's needs are respected. For example, if you're young, learning about the kind of music your grandparents grew up with is a way to show respect and interest in them. Show consideration. Older family members normally need more sleep. This means that teens may need to turn down their music or television. If you're older, you may need to be more tolerant and remember when you were young. Different generations have different schedules. Make sure everyone knows the various schedules, when to expect people to be present, coming and going. If an elder requires constant supervision or care, family members should coordinate their schedules to trade-off the care so that no single person carries too much responsibility. Elders should share their wealth of information and experience with younger generations, but also allow them room for growth. Everyone learns through experience. If no one is being hurt, allow younger family members to learn from their own mistakes. Finally, make sure you address any problems or issues promptly to maintain family peace and unity. If you don't, your relationship becomes strained and eventually you'll face an explosion of repressed feelings.
As you explore multigenerational living, remember Anne Leitch's call to action: "Think up something daring, something challenging, something creative. We need each other at every age."
Legacy Center Retrofit
Part of the Legacy Center's mandate is to serve as a real-world, working demonstration project of Legacy Living. Because it combines an existing building with a new addition, the Legacy Center speaks to the widest possible audience – those looking at a retrofit and those looking at new construction.
Retrofit work has already been done to create real-life trans/multi-generational designed spaces.
Many trans/multi-generational design retrofits are common sense. For example, a removable ramp at the front entrance, nonslip floors, and handrails on both sides of stairs to provide security. All doorways should be
32-36 inches wide, and every room should include a
five-foot turning radius in which to turn a wheelchair or walker. Doorsills between rooms that impede mobility should be removed, and door knobs replaced with ergonomic door levers. Natural lighting in each room is maximized and supplemented with nonglare general and task lighting.
In general, as retrofits have been done at the Legacy Center, we apply a "minimal effort" test to anything that requires manual operation or physical exertion.
A big part of the challenge of the retrofits in the Legacy Center's existing building was the small spaces. This is an issue shared by many homeowners. As well, the original architecture of the building had to be preserved (like the custom woodwork on the walls) and designed around (like the often unusually-shaped curved spaces in the round building). So, the design had to be particularly clever.
An existing bathroom was far too small for wheelchair access and made even fully-able people uncomfortable as they used the toilet. The toilet was very low to the floor, which made it difficult for an older person to get up. There were no grab bars.
An existing vanity wasn't wheelchair accessible, and the cabinet knobs and sink faucet did not pass the "minimal effort" test.
To increase the available space for the renovated bathroom, a wall to an adjoining closet was removed. The total space available was still small, but we were able to ensure the minimum five-foot turning radius for a wheelchair.
A key goal for the new bathroom was the perfect balance between form and function so that the bathroom didn't look "ugly" or institutional. It still needed to be a relaxing, comfortable space, especially if you're looking to encourage an elder with physical or cognitive limitations to take a shower, for example. Discomfort with and fear of bathing is often a major issue for people with dementia.
The new toilet is higher, with a grab bar that doubles as a toilet paper holder. Ceramic tile on the walls makes it easier to maintain a sanitized environment for elders with weakened immune systems. The floor tiles were specially chosen so they aren't slippery when wet, and are heated to make the floor comfortable and inviting for delicate bare feet. The specialized toilet seat can be added to most existing toilets; it requires an electrical outlet and plumbing attachment. It's heated, which makes toileting a comforting and comfortable experience for a person with dementia who may be anxious. It also has a bidet feature which is extremely valuable in maintaining hygiene; older women, in particular, are highly susceptible to urinary tract infections. The bidet feature – which includes a water spout with various water temperature and pressure settings and a dryer – also allows someone with arthritis or partial paralysis from a stroke to toilet as independently as possible. The toilet lid raises automatically when a person approaches, the toilet flushes automatically as soon as a person stands up, and then the toilet lid closes again.
The original wood folding doors from the closet were reclaimed for the new bathroom to allow a wide, flexible entrance.
The sink is wheelchair accessible; it has an easy-to-use faucet lever with an anti-scald feature, and a push-down sink drain. The natural stone counter is made up of a thick slab of quartz, very sturdy for leaning or as a transfer grab point, with a durable, nonporous, easy-to-clean surface to ensure proper sanitation. A tri-view mirror medicine cabinet with adjustable shelves over the counter is at the right height for someone in a wheelchair to see themselves, and there's a deep drawer under the counter for storing cleaning and hygiene supplies.
All parts of the small bathroom space are used efficiently, with storage cabinets over the toilet for towels, toilet paper, etc. Soft, warm colors and a low-noise ventilation fan contribute to the bathroom's calming mood. An energy-saving, safety night light provides cozy yet sufficient night-time lighting without having to turn on glaring overhead lights.
The new bathroom is divided into two areas, each of which has its own door to the hall and can be used independently. Painted glass doors separate the toilet area from the shower area. The painted glass doors are durable for the water and steam from the shower, and ensure complete privacy between the two areas. The areas are separately vented and a narrow gap above and below the glass doors allows air flow to reduce a build-up of moisture and, long term, prevent mold. When both glass doors are open – they swing either way – a wheelchair can easily access the shower area.
As mentioned, the mosaic tiles on the floor are heated and were carefully chosen for a high friction coefficient so that they don't get dangerously slippery when wet (check with the manufacturer; some tiles get surprisingly slippery when wet).
The shower and toilet areas have separate lighting controls – easy-to-use rocker switches with dimmer feature.
The shower area is large enough for a full-tilt shower commode wheelchair and has no sill, which allows for easy access. The slightly sloped floor ensures water flows into the drain. Grab bars are both functional and attractive. A hand-held shower allows the shower to be used by someone standing or sitting (a bath chair tucks neatly into the corner opposite the shower head). A floor-to-ceiling shower curtain can be pushed to either side to enable a caregiver to assist with showering. The space is very easy to clean with a soft-bristle cleaning brush.
The Legacy Center retrofit includes accommodations for multigenerational living. A separate suite has been designed especially for a person with dementia. It has
a sitting area, a bed, a small dining table with task lighting for
eating and other activities, a private washroom, and a kitchenette. The washroom door has a frosted glass insert to allow for privacy while at the same time enabling a family member or caregiver to monitor someone who is frail or ill. The kitchenette is filled with natural light and features a long, low, ergonomic counter. The kitchenette has a sink, microwave, and fridge to encourage as much function as possible by allowing some independence in the activities of daily living, such as making tea or toast. The linoleum floor is environmentally-friendly, durable, easy to clean, and "soft" and warm on delicate feet.
An induction cooktop is an important appliance for a person with dementia. It's easy to use and clean, and very safe. The model used in the Legacy Center kitchenette is portable. An induction cooktop works only with special induction cookware. Unlike other forms of cooking, heat is generated directly in the pot or pan, as opposed to being generated in the cooktop by electrical coils or burning gas. So, even if you turn on the knob, the induction cooktop won't heat; heat is generated only when the special cookware is on the induction ring. The cooktop remains cool in all areas surrounding the induction ring (though some heat may be transferred from the pot as it heats), and heating immediately stops when the cookware is removed.
Smart design includes integrating in specialized equipment as strategically as possible. For example, instead of using a Hoyer Lift to move someone in and out of bed who cannot move on their own, a ceiling lift has been installed. The ceiling lift doesn't take up valuable floor space and is powered by a rechargeable battery. It's much easier for a caregiver, particularly one who may not have a lot of strength themselves. Design of the space should include considerations not only for the person being cared for, but also for the caregiver. Even something as simple as making sure there's a comfortable chair somewhere in which a caregiver can relax for a few minutes can go a long way to getting through a day's routine.
This introduction outlines some of the trans/multi-generational design features of the Legacy Center. If you'd like to visit the Legacy Center to tour the trans/multi-generational designed spaces and get a complete listing of ideas and resources, e-mail or call
1-800-772-7765. The onsite examples of trans/multi-generational design are also part of our caregiver workshops. |
