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Aging in a continuing care retirement environment: A case study of Villa Gardens retirement community

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Aging in a continuing care retirement environment: A case study of Villa Gardens retirement community

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AGING IN A CONTINUING CARE RETIREMENT ENVIRONMENT:
A CASE STUDY OF VILLA GARDENS RETIREMENT COMMUNITY
ty
Myra Myers O'Connell
A Thesis Presented to the
FACULTY OF THE LEONARD DAVIS SCHOOL OF GERONTOLOGY
and the
FACULTY OF THE SCHOOL OF URBAN PLANNING AND DEVELOPMENT
In Partial Fulfillment of the Requirements for the Degrees
MASTER OF SCIENCE IN GERONTOLOGY
MASTER OF SCIENCE IN URBAN PLANNING AND DEVELOPMENT
August 1998
Copyright 1998 Myra Myers O'Connell
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UMI Number: 1393181
Copyright 1998 by
O'Connell, Myra Lynn Myers
All rights reserved.
UMI Microform 1393181
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UNIVERSITY OF SOUTHERN CALIFORNIA
LEONARD DAVIS SCHOOL OF GERONTOLOGY
University Park
Los Angeles, CA 90089
This thesis, written by
Myra O'Connell
under the director of h er Thesis Committee and approved by all its
members, has been presented to and accepted by the Dean of the Leonard
Davis School of Gerontology and the Dean o f:_______________________
School of Urban and Regional Planning
in partial fulfillment of the requirements for the degree of
Master of Science in Gerontology________________________________
3 / /ter
d Dean
Dean
Date
THESIS COMMITTEE
Chairman
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Dedicated to
Michael, my husband, and to the memory of my sister, Marsha Lee
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TABLE OF CONTENTS
Pages
LIST OF TABLES vi
LIST OF FIGURES vi
ABSTRACT vii
THESIS INTRODUCTION 1
Motivation For Research 1
Issues of the aging 1
Existing Design Standards, Physical Barriers to Access 1
Existing Design Standards, Regulatory Barriers to Access 2
HYPOTHESIS 4
Hypothesis 1 5
Hypothesis 2 5
Hypothesis 3 5
Hypothesis 4 6
METHODOLOGY 6
Study Design 7
REVIEW OF THE LITERATURE 9
Why People Choose a CCRC versus Aging in Own Home 9
Increasing Numbers of Older Frail 10
Typical Resident Profiles 10
Trends of the CCRC Industry 11
Aging Trends 12
Change in CCRCs 13
Design Considerations for Elder Housing 15
Physiological Age-related Change and Design Implications 16
Sensory Process and Perception 17
Central Nervous System and Cognitive Functions 17
Muscular and Skeletal Systems 17
Temperature Adaptation 18
Disease 18
Crime and CCRC Settings 18
CCRC Design Practices Evaluation 20
U.S. CCRCs 20
Northern European and British CCRC Examples 21
Best Assisted Living Design Practices 22
Best Planning and Policy Practice 23
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FINDINGS SECTION 24
REVIEW OF ARCHIVAL RECORDS 24
VILLA GARDENS WALK THROUGH ANALYSIS 26
Neighborhood Context 26
Landscape and Building Exterior 28
Issues of Safety and Security 30
Issues of Awareness and Orientation 31
Support of Functional Abilities 31
Social Contact and Interaction 35
Provision of Privacy 37
Personal Control 38
Regulation of Stimulation 38
Quality of Stimulation 38
ANALYSIS OF PLANS 40
Property Zoning 40
Plans Reviewed and Analyzed 40
Neighborhood Context 41
Landscape and Building Exterior 41
Issues of Safety and Security 44
Issues of Awareness and Orientation 44
Support of Functional Abilities 45
Social Contact and Interaction 45
Provision of Privacy 46
INCIDENT AND TRAFFIC REPORTS, ARCHIVAL RECORDS 47
Villa Gardens Incident Report Analysis 47
Traffic Reports 48
SURVEY FINDINGS 48
Villa Gardens Resident Profile 50
Community Demographic Profile 52
Independent Living Data, Survey Findings 52
Neighborhood Context 53
Landscape and Building Exterior 53
Issues of Safety and Security 54
Issues of Awareness and Orientation 55
Support of Functional Abilities 55
Social Contact and Interaction 55
Provision of Privacy 56
Personal Control 56
Regulation of Stimulation 56
Quality of Stimulation 57
Health Center Survey Analysis 57
Neighborhood Context 58
Landscape and Building Exterior 58
Issues of Safety and Security 59
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FINDINGS SECTION, continued Pages
Support of Functional Abilities 60
Social Contact and Interaction 62
Provision of Privacy 62
Personal Control 63
Quality of Stimulation 63
INTERVIEWS 64
Codes From a Planning Perspective 64
Codes From a Developer's Perspective 65
DISCUSSION 67
Hypothesis 1 67
Hypothesis II 72
Hypothesis III 77
Hypothesis IV 79
Survey 79
Walk Through 80
Plan and Archival Record Analysis 81
CONCLUSION 83
RECOMMENDATIONS 84
OPPORTUNITY FOR FURTHER RESEARCH 85
BIBLIOGRAPHY 87
APPENDIX 1 90
APPENDIX 2 106
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LIST OF TABLES Pages
TABLE 1. CHARACTERISTICS OF THE SAMPLE 51
POPULATION
LIST OF FIGURES
FIGURE 1. VILLA GARDENS VICINITY MAP 26
FIGURE 2. VILLA GARDENS SITE AND LANDSCAPE PLAN 42
WITH NEW ADDITION
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ABSTRACT
AGING IN A CONTINUING CARE RETIREMENT ENVIRONMENT:
A CASE STUDY OF VILLA GARDENS RETIREMENT COMMUNITY
Typical building standards do not take into account the anthropomorphic
diversity of the general population or the ability to meet the changing needs
of users as they age. Past design standards have reflected anthropometric data
for "able- bodied" adult males in the prime of life at the discount of the
elderly, children, and people with disabilities. Even with the Americans
With Disabilities Act (ADA) legislation (Federal Register 1990), the minimal
recom m endation is often accepted as the maximal standard. W ith an
increasing number of aged and handicapped persons in the population it is
im perative that buildings maximize the normal functioning for these
populations. Of paramount importance are buildings designed as purpose-
built residential housing for increasingly frail older people whose median age
is over eighty- five years.
A comparative analysis was made of Villa Gardens, an urban continuing
care retirement community, using a case study format with data collected
from two surveys, review of CCRC's, a post-occupancy walk through,
interviews, a review of planning documents and codes. The study found that
present building and safety standards alone in residential facilities are
insufficient to meet the changing needs of the elderly consumer as they age.
W ith increased resident frailty, perception of residential environm ent
support of functional, physical and psychosocial needs will dim inish with
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age. It is the responsiveness of the environment to adapt to these demands
that will determine how successfully people are able to age in such care
communities.
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THESIS INTRODUCTION
Motivation For Research
While the vast majority of older Americans prefer living in single family
detached housing and aging in place, approximately six percent of older
Americans live in housing designed for older adults citing security, provision
of meals, transportation, housekeeping activities, and social activities as
important criteria for alternative housing preferences (AARP). Little research
has been done on continuing care retirement communities (CCRCs) and how
these environments support the changing needs of residents over time.
Issues of The Aging
As people age, competencies change. This includes the ability to adapt to
physiological change and respond to the environment around them. The
built environment communicates and transmits messages about appropriate
behavior and meanings (Hall 16). Those who because of disabilities cannot
participate in the environment, may not receive important information or
may interpret messages differently than the nondisabled. Environmental
adaptation problems can result in inappropriate behavior, confusion, or
negative feelings of self worth and act as barriers to participation in daily
activity.
Existing Design Standards, Physical Barriers to Access
Physical barriers are direct in their influence and explicit in their effect
primarily upon the physically handicapped. They are more easily recognized
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than social barriers and can often be corrected with reasonable and cost
effective accommodation. With the sixth anniversary of the passage of the
Americans With Disability Act legislation, significant progress is being made
in the removal of physical barriers by requiring public and private entities to
be accessible to those with disabilities. Common physical barriers are found
in pedestrian walkways, building entrances, building corridors, stairs,
elevators, toilets and all forms of public transportation.
The design norm is based upon the mobility, size, strength, and mental
capabilities of the average sized healthy thirty year old male (Wilkof 7). Most
of the available anthropometric data commonly used in environmental
design are based upon this norm. Stairs, elevators, door hardware, toilets,
plumbing fixtures, telephone booths, drinking fountains and other facilities
are designed on this basis. Women, children, the aged, the injured or frail,
the visually, hearing, or cognitively impaired, and the physically handicapped
do not fit this norm and even with the new standards, find the environment
unaccom m odating. Only through the developm ent of new kinds of
anthropom etric data can these norms be revised so that environmental
design can become more inclusive of the population that it serves.
Existing Design Standards, Regulatory Barriers to Access
Barriers to access and function also come in the form of rigid and
prescriptive regulation of group living environments in the United States.
These barriers may take the form of high bed rails, heavy fire doors and out of
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reach storage areas. They can also be represented by highly regimented daily
routines (e.g., meals, bathing) and an institutional appearance.
Heavy handed or 'one size fits all' responses to problems of inadequate
nursing home care undermine professionalism and have resulted in codes
that narrow flexibility and limit experimentation with promising therapies or
creative approaches to care management. Punitive actions are emphasized
over positive reinforcement or constructive feedback. The prescriptive
nature of this system often assigns standardized responses to all problems
rather than encouraging a rational and balanced assessment of the situation
as the basis for potential solutions (Regnier 1979 122-124). W ithin the
residential housing market for the elderly a tension is inevitable between
creating environm ents which assume competence and ones which allow
experimentation.
Sacrifices to autonom y, personal choice and self-m aintenance in
activities of daily living are made to ensure standard operating procedure
where state regulations require services in a "one size fits all" approach.
These practices not only undermine self-confidence and create patterns of
dependence, but have also been shown to be more staff intensive (Moore 10-
11,26).
The objective nature of regulations which focus on physical design
considerations often do so at the exclusion of other quality of life factors.
Regulatory reform has historically tended to trail behind technological
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innovation. For example, the rigor of applying fire safety regulation takes
precedence over new fire fighting technology, and can limit the use of
residential materials, open stairs and fireplaces. Codes can also specify overly
wide doors and corridors, and require solid wall separations between
corridors and common rooms. These issues combined with relatively low
construction budgets often lead to stark, inhumane and overly institutional
settings. Regulations are able to address functional considerations such as fire
exiting more easily than character and appearance concerns.
The development of settings which build competence can improve the
adaptive capacity of people over time. The relationship betw een
environment and adaptive capacity can be viewed as a set of interlocking
functions; the adaptation function of the person and the adaptive function of
the environment. The more responsive an environm ent is to meet the
needs of a person, the more opportunities are created for increased
competence and the resulting greater adaptation to the circumstances of
disability. Environments m ust be designed so that they can respond to the
physiological and adaptive responses of the individual person (Steinfield 86).
HYPOTHESIS
With increased resident frailty, perception of residential environment
support of functional, physical and psychosocial needs will diminish with
age. It is the responsiveness of the environment to adapt to these demands
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that will determine how successfully people are able to age in life care
com m unities.
Hypothesis 1. Villa Gardens has adapted over time but falls short of
meeting all the needs of its aging population.
Hypothesis 2. Perception of residential environm ent support of
functional, physical and psychosocial needs will diminish
with age and increased resident frailty.
The problem posed is whether minimal design standards alone reflect
the functional capability of a building and its users over time, and the extent
to which this retirement community has been able to meet the functional,
physical and psychosocial needs of its residents. Problems in the built
environment, over time, manifest themselves in behavioral and functional
problems with an increasingly frail population. Existing conditions will be
analyzed using several methodologies, and recommendations will be made to
support function in Villa Gardens as well as in newly built residential
models.
Hypothesis 3. Present building codes, design and administrative policy
of residential facilities, provide minimal standards, are
not flexible enough to meet the changing and diverse
needs of the elderly consumer as they age, and can actually
create problems for residents.
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Hypothesis 4. Use of multiple m ethodologies will identify unique
problems in the built environment as they relate to the
needs of residents as they age.
The Villa Gardens environment can be improved by performance based ■
codes, which offer greater flexibility to changing resident needs, and by design
that supports the varying abilities of a population as they age in place. Some
design features may be retrofittable in the existing Villa Vista and health
center buildings, while other features can only be realized in the
conceptualization of the assisted living addition. Life care communities
need to be responsive to the changing needs of residents as they age.
METHODOLOGY
This thesis is based on a case study of Villa Gardens which recently
celebrated its 70th anniversary of operation, as a private not for profit facility
in what originally started as a community for retired teachers in Long Beach,
California. Now located in Pasadena, this urban CCRC caters to a highly
educated, middle to upper class population from all parts of North America,
Australia and Europe. This facility represents a stable population with a cross
section of health care needs. Villa Gardens is also representative of a
continuing care building type of the 1970's and is in the process of a building
plan to better meet the changing needs of residents.
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Study Design
Five different methodologies were used to obtain a comprehensive
overview of the existing environment, in terms of :1) how it is perceived by
residents, 2) and how well generic building codes and facility policy have
served an aging population, 3) to documenting successes and failures in
building performance so as to justify new construction or remodeling of
existing buildings, and 4) to generalize methodology findings for the purpose
of updating and improving elder housing state-of-the-art design criteria and
literature for the architectural profession.
A review of the CCRC industry and best practice models of assisted living
and life care communities was undertaken. Examples were taken from
United States and European models to exemplify innovative residential
building design for aging populations. The five methods utilized are listed
below.
1. A walk through of the Villa Gardens independent living unit, health
center, and grounds was conducted. The purpose of this method was to
evaluate how a purpose built environment has served the needs of a
dynamic aging population. In this section Villa Gardens was described
and its design was evaluated.
2. Architectural designs and drawings of both the existing Villa Gardens
Retirement Community buildings and the proposed designs for the new
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buildings were obtained for the purpose of analyzing the built
environment.
3. Additional documents used for analysis of Villa Gardens included
safety and security records, incident and accident reports, remodeling and
repair records, and historical archival data.
4. Individual interviews were conducted with members of the Pasadena
City Planning departm ent to identify the planning process and
application of life safety and accessibility standards as applied to the
existing facility and the new facility.
5. A survey in the form of a semi- structured interview was used with a
sample of facility residents from both the independent living and health
center units. The Survey instrum ents were developed to evaluate
resident perception of Villa Gardens Retirement Community (Preiser
131,132).
Survey instrum ents were adm inistered to 80 residents in the
independent living unit and 11 residents in the health center over a three
week period. At the time of the survey, the number of residents in the
independent living unit was 185. The total number of residents in the health
center were 50. The sample of survey respondents from the independent unit
were recruited by a general announcement at a director's forum meeting and
informational flyers distributed to each resident. A participant sign up sheet
was provided at the front desk with follow up call to schedule survey
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appointments. Administrative personnel provided preliminary screening of
respondents' cognitive status based on recent change in cognitive status or
dementia diagnosis. All independent living unit residents who signed up to
participate met the criteria to participate in the survey.
The survey was administered to groups of five residents at a time. If
assistance was required to fill in survey responses due to visual or fine motor
deficits, the prim ary researcher would make necessary accommodation to
administer survey and record responses individually.
Health center respondents were screened by the director of nursing and
the Villa Garden's medical director for their willingness to participate and
were eliminated from participation by any recent change in cognitive status
or dementia diagnosis. In the health center, surveys were adm inistered at
resident's convenience on an individual basis.
REVIEW OF THE LITERATURE
Why People Choose a CCRC Versus Aging in Own Home
Many individuals choose assisted living, one component of a CCRC, as a
m odel of residential long term care because of its com prehensive
management of minor medical problems within a residential context. This
housing alternative is based on the concept of outfitting a residential
environment with professionally delivered personal care services in a way
that avoids institutionalization and keeps older frail individuals independent
as long as possible. Care can consist of supervision with minor medical
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problems, assistance with bladder or bowel control, an d / or management of
behavioral problems resulting from early stages of dementia. This type of
housing fits between congregate housing and skilled nursing care
(Kane 61, 63).
Increasing Numbers of Older Frail
The literature indicates that demand for assisted living housing by the
over forty age group will increase dramatically in the next 20 years, as a
doubling in the number of individuals in this age group occurs (Special
Committee on Aging 1989). This growth trend will continue to develop into
the year 2030 when the baby-boom generation moves into their 80's.
Although medical advances are allowing the old to live longer, an
increasing number of this oldest age group are unable to live independently
w ithout personal assistance. With extended families living more
geographically distanced the role of caregiver for an older family member
becomes more challenging. In addition, more couples are putting off child
rearing and until later and are finding themselves "sandwiched" between
responsibilities of caring for young children and ailing parents.
Typical Resident Profiles
The typical resident of an assisted living environment is often a frail
female in her mid eighties, facing the danger of institutionalization because
of a decline in competency and an inability to organize the necessary network
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of services to live independently. This is reflected in two typical profiles,
neither of which belongs in a nursing home.
The first resident profile is that of an older cognitively alert, physically
frail individual. She will often suffer from one or more debilitating diseases
and will have problems carrying out activities of daily living (Kane 41).
Assistance in bathing, toileting, grooming, ambulation stops short of 24 hour
nursing care.
The second profile is the physically able, but mentally frail individual
experiencing the early stages of dem entia. She often has difficulty
comprehending the environment and may be easily confused or lost, even in
familiar surroundings. As the disease advances, restlessness, irritability and
behavioral problems can develop.
Trends of the CCRC Industiy
The Continuing Care A ccreditation Commission (CCAC) defines
continuing care retirem ent com m unities (CCRC) as " a retirem ent
community offering an older person a contract or contracts that provide
independent living and various health care services for the balance of his or
her life." (AAHSA 1994, 305)
Present day continuing care retirement communities (CCRCs) trace their
ancestral roots to the second half of the 19th century, and many will celebrate
centennial birthdays before the year 2000 (Scruggs 4). The average age of the
CCRCs listed in The Consumers' Directory to Continuing Care Retirement
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Communities of 1993 was 24 and the median age was 19 (AAHA 26). CCRC's
have a history of serving the nation's older adults, often with innovative
approaches to managing the care of the people they serve.
Of the steady evolutionary change over the last 100 years in science,
medicine, technology, economics, sociology and other variables, life span
statistics are the most startling indicator of radical change. Improvements in
health care and disease prevention have resulted in dramatic gains in life
expectancies and a rapid growth in the number of older Americans. In fact,
the elderly population, age 65 and older, has increased more rapidly than the
rest of the population for most of this century. The most significant growth
has been in the proportion of older Americans above age 74: in 1993, the 65-
74 age group (18.7 million) was eight times larger than in 1900, but the 75- 84
group (10.8 million) was 14 times larger and the 85+ group (3.4 million) was
27 times larger (Crimmins 8).
Aging Trends
Examination of actual past and future projected aging population figures
for California indicates that California's growth is expected to continue
through 2020 adding 3.5 to 4 million in population size during each of the
next 3 decades. The expectation is that the older population (65+) will grow
faster than the rest of the population (Crimmins 8) The oldest segment of the
older population (85+) will be the fastest growing age group in the population
in the next 20 years.
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In response to changes over the past 100 years, CCRCs have evolved from
"old folks' hom es" to sophisticated retirem ent com m unities w ith
professional m anagement and complex financial structures. The advent of
M edicare and M edicaid, rising health care costs, shifting consum er
preferences and government regulation have resulted in operational changes,
new amenities packages and a myriad of contractual arrangements with
residents.
Change in CCRCs
Demographic change, economics of aging, and advances in design
technology have all served to define the ever changing continuing care
retirement industry. The earliest residential models for the elderly consisted
of almshouses and hospital based institutional long- term care settings. In the
mid to late 1960's churches answered the call for help to house elderly in
nursing homes. The Hill- Burton Act, originally the Hospital Survey and
Construction Act, was amended to include expansion of nursing homes. This
resulted in design for senior housing that was closely aligned w ith the
medical, rather than residential, model (Christensen 88).
The present group of elderly, born between 1900- 1930, will constitute the
largest group of elderly over the next twenty years. With a strong political
presence, this group has changed the definition of being old from poor and
needy, to well-off and productive. This individual and self-reliant spirit is
reflected in lifestyle choices, age at which individuals choose to enter life care
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communities, and choices of amenities offered w ithin continuing care
retirement communities (Torres 15).
While change has been a constant for CCRCs, the closing years of the 20th
century promise the arrival of new opportunities and challenges at a
frequency and of a magnitude never before experienced. Some of these
opportunities and challenges are already apparent; others are just beginning
to take shape. The changes in health care delivery, health care benefits,
multiple pensions, increases in home equity values created a leisure and
recreation and retirement industry in the western world as had never existed
before. W hile these environm ental changes can be characterized as
nationw ide or universal trends, how they play them selves out in
communities with unique needs and patterns of housing and health care
delivery often is particular to the specific personalities, institutions and
circumstances of a locality. There are no universal or prepackaged responses
to today's opportunities and challenges.
Numerous variables influence the unique character of every CCRC. Each
CCRC has its own particular mission, and philosophy reflecting the sponsor,
board of trustees, residents and staff. Location and facilities, and available
services and amenities also influence the way a community feels and
functions. Locations can range from urban to suburban to rural. Sites may be
on a small piece of land or in a resort (Cassel 6-10).
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Planners of a life care community must not only consider the internal
and external campus facilities but must also consider conditions of the
surrounding neighborhood. The impact of the residential environment is of
particular concern for the many older people who live in group settings.
These settings provide a shared environment, serve a more vulnerable
segment of the older population, and result from intentional efforts on the
part of architects, planners, and administrators (Moos 10, 11). The literature
review considers the market and social forces that have driven this
residential model in light of a ^ spectrum of abilities and needs.
Design Considerations for Elder Housing
Provision of high-quality housing for older people requires a flexible
concept of aging that maximizes choices for older people and pays attention to
all aspects of the housing environment. This includes choices in housing
and service arrangem ents, responsive m anagem ent and activity
programming, as well as ongoing service and design evaluation.
An important concern for those involved in designing outdoor spaces for
older people is the dynamic interaction between design, management and
activity program m ing (Carstens 1, 2). M anagem ent and activity
programming are necessary components of a successful design, particularly
for older people who may be less willing or less able to instigate a new
activity, to change their physical surroundings, or to change management and
programming policy. Research and design technology can be used to re-
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evaluate the impact of services and programs upon older residents and their
use of the designed environment. Also vital is ongoing review of
management, service, and activity programming, as well as reassessment of
the design itself throughout the life span of the project (Carstens 1, 2).
Physiological Age-related Change and Design Implications
To consider supportive design solutions for the elderly is to also consider
physiological changes that come with age and are impacted by the built
environment. The aging process brings both physiological and psychological
changes that affect the functioning of the individual and his or her
interaction with the environment (Ferrini 122-125).
Real aging is determined by the body's loss of reserve or ability to
m aintain its homeostasis or equilibrium. Environmental variables may
hasten this process. To maximize the daily living options for older people,
design can and must respond to changes in sensory processes, perception, the
central nervous system, cognitive functions, and health associated with the
aging process. To better serve diverse populations, planners and architects
will need to have a baseline understanding of the capabilities of these
different groups. This may require the generation of new sets of human
factors data.
Although physiological changes associated with age may be genetically
determ ined and environmentally modulated (Cuyeneking 1995), changes
appear to be universal in the elderly person. The following design solutions
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offer environmental support to modify the affects of age-related physiological
change (Carstens 1-2).
Sensory Process and Perception
Age-related sensory losses occur with vision, hearing, taste, touch, and
smell and can affect an individual's internal equilibrium as well as the ability
to respond to the environment. A practical design response to these losses is
to load the environment with redundant sensory cues. This includes special
attention to the quantity and quality of light, the use of brighter and more
distinguishable colors, contrasts of light and shadows or. advancing and
receding colors as these may distort depth perception. Also important are the
intensity and pitch of sounds (e.g., lower pitched sounds are more easily,
heard) and tactual cues that may be more easily "read".
Central Nervous System and Cognitive Functions
Although many cognitive functions do not change w ith age, concept
formation ability and reaction time may be reduced. To facilitate orientation
and promote safety, special attention must be given to decreased concept
formation ability affecting orientation or way finding, slower reaction time to
stimuli such as elevators or door closings and difficulty in distinguishing and
interpreting background noises from foreground sounds.
Muscular and Skeletal Systems
In the musculoskeletal system, age associated decrements are exacerbated
by the physical inactivity or disability that may accompany age. Elders may
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lose muscular strength, fine-motor control, joint flexibility, and bone strength
and mass. The reduced resiliency of the skeletal system requires attention to
safety, security, and environment negotiability, as injury may be more
devastating for older people. These have special implications for the design
of ground and floor surfaces and facilities requiring fine and gross muscle
movement (e.g., door openings, faucet handles).
Temperature Adaptation
The reduced ability to adapt to changes in temperature requires amenities
and detailing for temperature moderation control.
Disease
Susceptibility to chronic diseases also restrains activity. Special
considerations for health related problems include providing easy access to
nearby restrooms and options for those with various levels of reserve/energy.
There will be limitations on fine motor control and gross movements due to
arthritis.
Crime and CCRC Settings
In urban CCRC settings, especially, crime and victimization against the
elderly can be actualized by certain environmental factors. Gardiner (1977)
has identified environmentally related elements believed to have crime
generating potential:
1. Porosity, which is the presence of parking lots, vacant lots and open
areas. These areas allow access to the neighborhood and easy escape for
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intruders. Residential areas with vacant lots or parking areas adjacent to
commercial strips are considered porous.
2. The presence of commercial gathering spots that attract outsiders who
are potential offenders. For example, schools, supermarkets, or undesirable
retail outlets may attract strangers to the neighborhood. Recognition of the
crime generating potential of these services can lead to design modifications
which create safer physical settings.
3. A neighborhood focal point claimed by outsiders. For example, a
playground or park may become a gathering place or hangout for gangs.
4. A lack of clearly defined boundaries betw een districts and
neighborhoods. When a neighborhood is clearly defined and residents are
familiar with one another, outsiders are readily identified.
5. The lack of transitional zones between different types of land uses can
lead to an inflow of potential offenders and can underm ine community
cohesiveness. For exam ple, in areas where commercial activity is
interspersed with residential use, potential offenders may go undetected.
Although statistically, persons 50 years of age and older have a lower rate
of victimization than persons under 50, it is critical to recognize that the
elderly are the most vulnerable members of our society in the aftermath of
crime (Clemente 16). Findings reported by the Midwest Research Institute (5,
6) Study of Kansas City, Missouri suggests that older people are less prepared
to secure and protect themselves than their younger counterparts. The report
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also suggests that older persons suffer long term consequences of
victimization because they are less resilient physically, economically, and
psychologically. Aging people are also more susceptible to phone and
marketing fraud.
Significant correlations have been found between the fear of crime and
diminished elderly activity and increased isolation (Clemente 207-210). Thus,
fear of crime may be more debilitating than actual victimization because of
the limits it places on mobility. CCRC planning, design and management can
afford resident access to the community while providing a safe residential
environm ent.
CCRC DESIGN PRACTICES EVALUATION
In comparing United States and European residential models for the
elderly, which include assisted living, the following precedents are noted
below. The most innovative of these alternative residential models offer
greater independence, autonomy, and privacy to augm ent and replace the
traditional nursing home (Regnier 1994 1).
U.S. CCRC's
The U.S. models are usually not for profit and are designed to care for
lifetime resident nursing and health care needs, and to avoid premature
institutionalization in the skilled nursing component. The economic and
social structure of the community encourages innovative ideas regarding
therapy and treatment that keep residents as independent as possible. U.S.
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housing stock for frail elderly is characterized by community segregation with
lim ited governm ent agency co-venture and by zoning policies that
discourages mixed land uses.
Northern European and British CCRC Examples
National attitudes in Northern Europe have supported competitions
which have emphasized progressive noninstitutional residential alternatives
for the frail elderly. Older frail people, especially in Scandinavian countries,
live in larger and m ore private residential environm ents than their
counterparts in the United States. Enlightened attitudes about "aging in
place" have allowed for flexible elder care within a range of community
contexts (e.g., housing stock based on vernacular traditions and cultural
differences).
Attitudes reflect a history of residential design innovation through state
sponsored architectural com petition and a com m itm ent to mixed use
planning. As a result, building codes, experimental program s, attitudes
towards independence and financial commitment reflect housing practice
and policy for aging that is 15 - 20 years ahead of the United States. Social
service, health care and housing agencies recognize the influence of new
architectural forms in challenging conventional thinking about social
problems.
Geographical proxim ity and tradition of international research has
provided testing ground for good elder housing within multi-governmental
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and organizational contexts. Also, a European tradition of testing innovative
architecture, has prom oted service planning and caregiving through
architectural competitions.
European housing models for the frail elderly demonstrate community
mixed use. For example, swimming pools, restaurants, health services,
physical therapy equipment, and meeting room space are designed to be used
by residents and older people living in the surrounding neighborhood.
Best Assisted Living Design Practices
Experimental assisted living projects have the potential to serve a rapidly
growing segment of the senior housing market by combining building design
with ideas about caregiving. The following design features exemplify some
best practice examples of assisted living projects throughout Northern Europe
and the United States (Regnier 1994,180-186).
Projects embrace a family lifestyle and a low m anagem ent profile
encourages resident interdependence and self-maintenance. Designs have
supportive features unique to resident population being served. Stand alone
dwellings for Alzheimer residents feature an open plan with transparencies
and half walls between common rooms along w ith a w andering path.
Utilization of services of design behavior consultant can facilitate critical
design review adjustments.
The exterior massing of the buildings, in the selection of art, and
finishing details can be designed to promote a residential rather than
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institutional (Lynch 6,7). Consistency of design theme should be carried
throughout a project. For example bungalows w ith sloping roofs,
overhanging eaves and a large "great" room reflect the concept of a Shaker
commune. Location is considered in respect to proximity of community
services (e.g., medical center, supermarket, golf course).
Atrium design fills center of project with light and facilitates activities on
the first floor as well as creating an enriching view (e.g., tropical landscape
materials, caged birds, filtered light). This design allows dwelling units to
receive light from two sides, exterior walls have floor to ceiling glass that
allows daylight into bedroom and living room.
Living units have a full kitchen, designed to encourage residents in
normal daily helping activities, and bathroom with handicapped access.
Certain rooms are allotted for high care residents and residents requiring
m onitoring (e.g., room features include accessible outdoor entry from
forecourt in front and rear of project).
Best Planning and Policy Practice
The best in current planning and policy practice include the following
concepts.
Projects should reflect community and resident needs in the form of
nursing home assistance, resident and community lecture series or meal
program. Input of community focus groups can be used to provide direction
and revision throughout the design process and architectural program. The
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Dutch commonly have an active community design process in the form of
non-profit housing corporations.
Support services contribute to emotional and physical aging in place such
as home nursing, occupational, physical and speech therapy, podiatry care,
multi-purpose room with warm up kitchen, afternoon bar w ith coffee, tea,
beer and soft drinks. Also, volunteers can manage a grocery store for resident
and community use.
Continuity of care can be achieved with one regularly assigned attendant
who is familiar with the resident's health history, family support, food
preferences and interests.
The best urban sites allow pedestrian access to shops, schools, parks and
churches in a non threatening environment. Residential buildings can
provide base of community senior services such as meals on wheels program,
district home health agency, and emergency response center.
Swimming pool and sauna are open to the community for senior aquatic
exercise program. Also, adequate parking should be provided for neighbors
and visitors.
FINDINGS SECTION
R eview of Archival Records
In 1926 the Teachers' Welfare Committee was established as a
subcommittee of the California Teachers Association (CTA) out of growing
concern for retired teachers living in poverty. Shortly thereafter a Bureau of
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Welfare was established and a 5-room house was rented in Inglewood by the
CTA. A location search was made for a permanent retirement residence
which resulted in the 1933 purchase of a 100'x250' lot (which later housed six
retired teachers) at 842 East Villa Street in Pasadena.
In 1948, an expansion campaign was orchestrated under the leadership of
Dr. Ethel Percy Andrus, who subsequently went on to found the National
Retired Teachers Association (NRTA) and the American Association of
Retired Persons (AARP). New buildings were financed by a $10 contribution
of each teacher in CTA. By 1969, Villa West was built to provide a "Protective
Care Unit" similar to the concept of today's "Assisted Living Facilities."At this
point Villa Gardens encompassed about 4 acres of ground and about 17
buildings. Planning by "Foundation to Assist California Teachers" (formerly
Bureau of Welfare) was initiated in 1980 for a new Villa Gardens building and
54 bed health center. In December, 1995, Villa Gardens received National
A ccreditation by the Continuing Care Commission of the American
Association of Housing and Services for the Aging (AAHA 1993, 26).
In February 1996 a ground breaking ceremony was observed for the
addition to Villa Gardens building of 22 residential and 40 residential units.
Also part of the plan is for a redesigned courtyard, new exercise room and
other recreational facilities, redecorated and expanded dining space with
lower level conference space, and redesigned Health Center courtyard.
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VILLA GARDENS WALK THROUGH ANALYSIS
An analysis of the existing grounds and buildings of the Villa Gardens
Retirem ent community was m ade to assess perception of the built
environment. As part of a comprehensive analysis, a physical walk through
and review of incident reports was made of the Villa Gardens buildings and
grounds, in February 1997, using criteria defined in the survey instruments.
Neighborhood Context
The Villa Gardens Retirement Community sits two doors west of the
Lake Avenue corridor and one block north of the 210 freeway in Pasadena,
Figure 1.
Orange Grove Blvd
SITE
Villa Ave
Maple St
210 Freeway
Colorado Blvd
FIGURE 1. VILLA GARDENS VICINITY MAP (not to scale)
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Looking south to the facility from Villa Street, the landscaping of Villa
Gardens is secondary visually to the built environment. On approach to the
Villa Gardens Retirement Community from the east, the transition from
urban to residential becomes very apparent. The setting is urban business to
the immediate east and south, with single family residences to the west. The
West Villa branch of the Pasadena Fire department is located directly across
the street. Restaurants, churches, dry cleaner, florist, and small grocery store
are located within easy walking distance from the Villa Gardens community.
The Villa Gardens Health Center, or skilled nursing facility, is located
directly south east of the main building. The main north public entry to the
Health Center is by unmarked manually operated doors. The west entry by.
walkway allows Villa Garden residents more direct access to the Health
Center by connecting cement pathway, where they do not have to go around
the building through the parking lot.
From a community perspective, Villa Gardens' Independent Living Unit
appears to be a moderate sized apartment complex. The Health Center
resembles a utility building from the street. Thus, neither building's
appearance reflects its actual use in the community as it might (Christopher
806). Signage for both buildings is modest and out of scale with the rest of the
building. A flag pole flying the American and California flags, along with
residential vans, are some of the few distinguishing landmarks of this
retirement community.
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Landscape and Building Exterior
The five story independent living building is the focal point of Villa
Gardens. From street level this building gives the appearance of a traditional
apartm ent complex. Residents on the north side of the building have private
balconies with views of the San Gabriel mountains. All residents have
exterior private balconies which afford an opportunity to personalize their
environments with plants and furniture. North facing green strips of grass
border the sidewalk and are not used by residents or the community.
On the north end, grass, flower borders, shrubs and signage provide a
visual break between Villa Gardens Retirement Community and the street.
Low bedding plants at the front entry provide annual color. Cement walls
provide breaks on the east and south sides of Villa Garden property, with ten
foot gates bordering the west side.
On the north side of the Villa Vista building, from the benches under the
porte cochere entry, green space of the north west lawn, bedding plants, trees,
and shrubs are within view. This protected area sits at a 10 degree grade from
the sidewalk and allows for easy surveillance of the street and incoming
traffic. Although this location is close to foot and vehicle traffic and the
urban community at large, it was rated quite favorably in regard to outdoor
seating.
A paved patio with tables, umbrellas and chairs sits adjacent to the
activity room on the north west side of the building. This enclosed area
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provides the most appealing landscaping on the entire premise at this time,
with numerous varieties of trees, bougainvillea, shrubs and bedding plants.
Although observations of the patio area were made on several occasions, no
residents or staff were seen to be using this area during the course of the
research study. Residents complain that this west facing patio as being "too
bright" (sun glare) in spite of trellises and potted trees, and umbrella tables.
The facade of the health center entry has been enhanced with potted trees and
container gardens.
A low lying health center building is recessed from the street and could
be mistaken for a utility or storage facility. Paved sidewalks provide a
walking path and patio which connect the independent living unit with the
health center. The topography of the landscape is sloped one story from the
north to south of the property. At the time of this study, the landscaped areas
for resident use were limited to the east lawn, health center and independent
living patios and rose garden area due to construction of the west section. At
the time of the walk through no residents from the Health Center were using
the patio, and according to management, this outdoor section of Villa
Gardens and the Health Center is in the process of re-design.
Since February ground breaking, paths and nodes have been restricted on
the grounds of Villa Gardens. Those that do exist are in transition due to
proposed re-landscaping plans. The most readily identifiable outside nodes of
activity are the pool side area and front entry to the independent living unit.
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Landscaped paths and patio areas exist between the east dining room balcony
of the independent living unit and the health center building but do not
appear to generate much traffic or use.
Issues of Safety and Security
A receptionist or security guard is positioned at the independent living
unit front entry on a twenty four hour basis to provide surveillance, and
assistance to residents and visitors. Visitor entry is monitored and facilitated
by the receptionist on duty. Camera monitoring is also used to survey the
building premises in addition to visual surveillance of the street, front
parking lot and serves to deter crime.
Issues have also been raised about emergency evacuation of guests and,
residents from the fifth floor where persons would be required to walk across
a portion of the roof to reach the outside stairwell.
Paved drives and parking spaces with vans and automobiles dominate
the open space. On a pedestrian scale, vehicles move in multidirectional and
sometimes random patterns (e.g., service and delivery vehicles by health
center entrance) creating a somewhat stressful and unsafe environment for
persons with mobility or visual impairments. On the north side of the health
center pedestrian and vehicle right of way is not clearly indicated. Cars and
delivery vehicles often park in random configuration, causing ambiguity for
pedestrian workers, residents, or visitors.
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Driving and pedestrian activity is very important to independent living
residents as 96% of residents surveyed use their own vehicles as their main
source of transportation. An upgraded traffic study of Lake Avenue and Villa
would be recommended to possibly add left turn arrows and consider adding
a crosswalk with more visible signage in front of Villa Gardens to the north
side of Villa and the parking lot. Residents and administration have reported
regular incidence of traffic related accidents at the intersection of Lake
Avenue and Villa, and in the course of this research project, the author was
the victim of a collision at this intersection while turning left onto Villa
Street from Lake Avenue.
Issues of Awareness and Orientation
Exterior signage is kept to a minimum and is small in scale compared to
the buildings. The only indication of an age segregated community is
residents returning from a walk in the neighborhood or waiting under the
porte cochere for rides.
The independent living building L-shaped building design conforms to
traditional institutional themes w ith two double loaded corridors.
Residential corridors are long and double loaded with hand rails lining both
walls throughout the building.
Support of Functional Abilities
Public access to Villa Gardens Independent Living Building and Health
Center is from the main north entrance through automatic doors. Residents
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are able to mail and receive packages at the front desk, arrange for Villa van
transportation, and perform banking functions on certain days of the week.
Adjacent to the main lobby is the library. Staffed by residents on a daily basis
it houses a collection of over 1,000 titles, and in fact donates books to the local
public library. The top two shelves are beyond the reach of persons in
wheelchairs.
In addition to meeting space, the Independent living unit fifth floor has
private residential housing. This causes competition for the elevators
especially during mealtimes. Elevators for residents in the south east section
of the building are also used for freight purposes. Mobility impaired
residents complain that elevators frequently being used for freight transport
force them to walk to the other side of the building for another elevator.
Adjacent to the lobby is the main dining room. Pressure measured on
double entry doors was eight pounds, which is in excess of the five pound
standard. This could also make the room difficult to access for persons with
arthritic conditions or strength deficits. The length of the dining room is
ninety five feet making this a long distance for some residents.
Residents in the independent living unit are able to add supportive aids
to their apartm ent units such as grab bars, commode elevations, upgraded
lighting and floor covering to enhance function, but at their own expense.
In the Villa Gardens independent living unit, a significant concentration
of nodes and pathways converge on the first and fifth floors. Long residential
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section hallways are broken up with clusters of seating arrangements. The
corridor narrows on the ground floor by the mail room creating a sense of
congestion at times when wheel chairs go through. Traffic patterns ebb and
flow with varying activities throughout the day and week. In the north
corridor of the first floor is the health clinic (infirmary) which offers care by a
licensed vocational nurse on a 24 hour basis. It is equipped with an
examination table which is used by the Villa Gardens medical director for
checkups and screenings. Residents from the health center are also brought
to the health clinic for periodic evaluation.
The Villa Mart is located across the hall from the health clinic. Staffed by
residents, it has a steady stream of customers purchasing staple items (e.g.,
eggs, bread, juice, soup, paper goods) during weekday hours, 9:30-11:30 am.
Recently, delivery arrangements were modified to allow for direct delivery of
staple items to the main kitchen, thus eliminating transport of items from
the grocery store by Villa Gardens residents.
Located in the south west corner of the first floor, the Villa Hair Salon
offers weekday hair, manicure, and pedicure services to both the Health
Center and independent living residents. Expansion plans are underway to
also provide services to future residents of the assisted living unit. Protected
outside entry with elevator access facilitates transit of mobility impaired
health center residents to the salon.
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The east lawn is used for dinner functions and other large formal events.
At the Villa Gardens 70 year commemoration ceremony, only 25 residents
were in attendance. Many of those residents who observed from their
balconies or did not attend, complained of difficulty in walking on the grass.
Also, folding chairs are used for most east lawn events which residents state
are difficult to transfer in and out of.
Health center and independent living residents indicated a preference for
the older and heavier cast iron seating in the east lawn and stated that the
newer chairs with sloping backs are "difficult to get out of." Cushions were
also recommended to make the wooden benches more comfortable.
Two Health Center areas are designated for dining. The larger dining
room in the north wing is for residents who are independent in feeding
themselves and has inviting views and access to the interior yard. However,
at the time of the walk through the resident dining room was closed for
remodeling. The west wing dining room is also used as a multi-purpose
room. Residents who have difficulty feeding themselves are given assistance
here by nursing staff for noon and evening meals. A service kitchen is
available for light meal preparation and heating of meals brought over from
the independent living unit.
Public rooms, including the activity room and dining room, are used
prim arily for structured activities. A library in the lobby provides an
intellectual outlet in an attractive setting. An infrequently used therapy
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room is located at the end of the west hallway. Administrative, nursing
offices and staff lounge are located along both hallways.
A therapy room with a mat, scale, floor weights, stairs and private office
is open during daytime hours and is used primarily for activity under the
direction of a licensed or registered therapist.
Visitor parking on premises is limited, with 10 regular visitor spaces and
2 handicapped parking spaces on the north side of the Villa Vista building,
and 13 regular spaces and 1 handicapped parking space on the east side of the
building. A 10 year parking lease agreement has been made to allow Villa
Gardens use of the Pasadena Covenant Church between Villa and Santa
Barbara Streets.
Social Contact and Interaction
The Independent living unit lobby area is a node of transient activity
throughout the daytime hours. Residents wait inside or sit under the awning
of the porte cochere for rides. Guests and community visitors pass through
en route to fifth floor public meeting rooms. Clustered seating is arranged so
that residents can be in full view of approaching transportation or visitors.
Prospective job applicants also use this area for completing paperwork.
Independent living unit couches and armchairs are located adjacent to
the front entry but appear to be used on a brief interim basis, as a point of
meeting or departure. A library room with good lighting and residential
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detailing, such as wood paneling and shelves, is a popular gathering place
adjacent to the main lobby.
Arm chairs are available for waiting customers outside the salon and
health clinic but are seldom used. On each floor of the independent living
unit long corridors are broken up with clustered seating arrangements (e.g.,
love seats, arm chairs, coffee tables with magazines) as well as seating by
south elevators. Little evidence is noted of residents using this available
seating, although one table remains set up with ongoing jigsaw puzzles.
Hall space adjacent to the dining room entrance is a natural point of
social gathering and could be enhanced w ith some additional seating
arrangement. A very heavily used corridor is north and south running on
the first floor. This connects residents with the main lobby and the dining
room. Locked mail boxes and resident cubbie holes and bulletin boards are
also located here. This area is a social gathering point prior to and following
noon and evening meals, and in the afternoon, prior to mail delivery.
Adjacent to this area is a recessed room with chairs, table, and wall display of
resident art work. This area opens onto the north south corridor and is
referred to as the Saturday Morning Chit Chat Room.
Across the corridor from the resident mail boxes and Chit Chat Room,
french doors open to a balcony with umbrellas, tables and chairs, which
overlook the ground level pool area. This also seems to be an under utilized
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area by Villa Garden residents, although it is one of the only designated
smoking areas on the premises.
Independent living dining room seating is at individual tables for two to
four people with choice of restaurant and buffet service. West facing wall of
the dining room is windowed with views to an outdoor patio. The health
center patio and east lawn get full sun until the late afternoon. Regularly
occurring social activities here include cocktail parties and barbecues. Doors
open to tables with umbrellas and chairs where residents can choose to eat or
entertain guests, as weather permits.
Some 'neighboring' goes on, especially betw een Villa G ardens
independent living residents and health center residents. This takes place,
primarily, for very short intervals in resident rooms.
Provision of Privacy
Health center resident rooms typically accommodate two residents with
one shared bath. Hand drawn track curtains can be pulled for privacy but
require nursing assistance. The fire and safety code require that resident
doors remain open, and drywall, which meets minimal standards but fails to
dampen sounds from housekeeping staff and other residents. One resident
noted that placement of vertical facing mirrors on opposite wall reflect
images of residents in neighboring beds. Residents complain of cold showers
and lack of privacy in a communal shower room.
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The health center administrative office adjacent to the nursing station is
available to residents, family members and health care professionals for
private conferences and meetings.
Personal Control
Some independent living unit apartment doors are personalized with
knockers, wreaths, seasonal decorations and nameplates. H ealth center
residents are "allowed" their own furnishings but with space being at such a
prem ium , book cases, arm oires or dressers create a very cluttered
environment. Height of overhead storage areas also raises questions of safe
and ready access to stored items.
Regulation of Stimulation
Interior north facing units do not receive as much natural light as other
independent living units. Residents complain that their units are darker and
they need to be supplemented with artificial lighting. Health center beds are
double railed electric hospital style and the lighting at the head of each bed is
standard institutional track lighting.
Quality of Stimulation
The main lobby of the independent living unit has a warm elegance and
openness at a residential scale. Varied lighting and seating arrangements are
available to make the main lobby and library an inviting space. Residents
design stunning and seasonal floral displays and decorations on a weekly
basis.
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No fireplaces were noted throughout the Villa Garden buildings.
However, attention has been given to wood detail and finishes in the first
floor dining room and library. Standard flooring in residential units is carpet
(unpadded to better accommodate use of walker) and vinyl.
The main entrance to the health center is abrupt and awkward, from a
black asphalt parking lot through tinted double manually powered doors.
One is immediately confronted with residents facing them in wheelchairs
from down the sixty foot corridor. Utility carts are commonly seen on both
sides of the six foot wide hallway throughout the day.
An aviary on the health center west wing is a unique building feature,
where residents sit in parallel fashion against the wall to observe the birds.
This generated strong and consistent interest in a large number of residents.
This glass and wood trimmed structure appears to promote a calming state as
well as active observation in the Health Center residents who daily gather in
parallel seating arrangement. This researcher noted that although social
interchange seems lim ited between fellow observing residents, a few
knowledgeable residents were very interested in providing information about
the birds and company responsible for the aviary.
Another interesting feature is a Persian rug design motif which has been
woven into the wall to wall carpeting in the main hallways which provides a
residential image throughout the building.
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An activity room measuring 27'x 10'x 20' has a full length window and
access to an outside patio. It also has an aquarium with tropical fish. No
evidence of reading materials, games or craft supplies was visible, and at the
time of the walk through, arm chairs were stacked together in one corner of
the room.
ANALYSIS OF PLANS
Property Zoning
The zoning for property bordering Villa Gardens on the southwest block
of Lake Ave and Villa shows a pattern of mixed use. Storefront properties on
north Lake Avenue are zoned for general commercial use. Properties three
doors west of Lake Avenue on Villa Street are residentially zoned, with the
exception of Villa Gardens Retirement community, with between 12 to 48
units. On the south border of Villa Gardens extending south to Maple Street,
the Lake Avenue Congregational Church is zoned as a public/semi-public
space.
Plans Reviewed and Analyzed
Plans were reviewed and analyzed with principal landscape architect,
Nord Erikkson, of EPT architects, and John Piccari, senior associate of business
administration for the Lake Avenue Congregational Church, Villa Gardens
landscape plans were discussed including the land and streetscape of the
Hudson Street vacation. The following is a summary of that analysis.
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Neighborhood Context
On the west side of Villa Gardens an easement has been granted by the
city of Pasadena to extend the west edge of the assisted living building to
Hudson Street. Originally, Hudson Street went south across, what is now, the
210 freeway. Since the opening of the 210 freeway, the only people using the
street have been Lake Avenue Congregational Church (LACC) and Villa
Gardens. The city originally approached Lake Avenue Church ten years ago
with the idea of a street vacation secondary to the high costs to upgrade and
repair Hudson Street. Villa Gardens joined LACC later on in the process with
a joint commitment to community safety and beautification, and at no cost to
the city of Pasadena. The Villa Gardens purchase of the north east portion of
H udson Street was used to offset the cost of street repair, landscape, and
replacem ent of storm drains. This continues a m utually beneficial and
cooperative tradition of mixed use planning. Streetscape plans include
landscaped walking paths, street lighting, and a pedestrian gate from Hudson
Street to Villa Gardens (refer to figure 2).
Landscape and Building Exterior
Existing Villa Gardens landscaped features will be extended by 25% with
the proposed plans. Landscape plans on the south west side of Villa Gardens
will include a subterranean solarium garden with looped walkways (4'7"
average width), variegated walking surfaces (e.g., smooth, flat limestone,
wood, scored concrete). Plans include a gazebo, water and rock treatments,
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N EW ASSISTED-L1V1NG &
SEN IO R RESID EN TIA L
A P A R T M E N T BU ILD IN G
BUM.DING LEGEND
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KOELREUIERIA BIPINNA I A, Cl IINESE FLAME TREE
T CLYTOSTOMA CALISTEGIOIDES, LAVENDER TRUMPEL VINE •
I’INUS CANARIENSIS. CANARY ISLAND I’lNF.
▲ CINNAMOMUM CAMPORA. CAMPHOR TREE
♦ LIQUID AMBER ROTUND1LOBA, SEEDLESS SWEET CUM
FIGURE 2. V IL L A GARDENS SITE A N D LANDSCAPE P LA N W IT H NEW A D D IT IO N
benches, and grade plant materials. Plants will be graded to height, shade,
drought resistance and perennial colors. Lighting will include pole lights,
and fixture lighting on the gazebo. The intent of the planting is to make the
landscape more residential and less institutional. This will include
'grandmother' plants such as gardenia, sweet olive and star jasmine as well as
flowering perennials which will be spaced throughout the grounds, figure 2.
Arrangements have been made between the landscape contractor and
Villa Gardens to relocate existing trees ranging from 6' to 20' in height.
Container landscaping in pots and boxes will be used to soften the harsh
concrete appearance of the pool and spa area.
Landscaping plans on the health center side and east lawn include
enlarging the health center patio by a third, adding a small gazebo, and
benches near the conference room. Ground treatments will include scored
concrete, flat limestone and flat stones (through grass). More perennials will
be added to the flowering landscape with graded shrubs and trees including a
variety of liquid amber (i.e. Liquid amber rotundabola) which does not drop
balls. The west health center patio and benches are rarely used because of
minimal shade and glare from west facing exposure.
Landscape plans on the south west side of Villa Gardens will include a
subterranean solarium garden with looped walkways (4'7" average width),
variegated walking surfaces (e.g., smooth, flat, limestone, wood, scored
concrete). Plans include a gazebo, water and rock elements. Lighting will
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include pole lights, and fixture lighting on gazebo. The intent of the planting
is to make the landscape more residential and less institutional. This will
include 'grandmother' plants such as gardenia, sweet olive and star jasmine
as well as flowering perennials which will be spaced throughout the grounds.
Issues of Safety and Security
Traffic and utility vehicle delivery patterns at front entry impede
convenient access to this area by residents, visitors and staff. Black tile
flooring in shower room does not create enough visual contrast to enable
residents to feel safe on their feet.
Issues of Awareness and Orientation
Long narrow halls without breaks in the independent living unit and
health center are not conducive to spontaneous social interaction or
unassisted ambulation. The north west section of health center will be
expanded to accommodate a new dining room and conference room
extension.
The Villa Gardens West Wing addition, on south west corner of
property, will add 74,000 square feet to existing residential space. The first two
floors will be designated for assisted living apartments, with third through
fifth floors designated for independent living apartments. Like the Villa
Vista building and health center, the West Wing Addition features a L-shape
design. The Villa Vista building will connect to the West Wing addition on
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all floors. Allowable square footage by room was not specified in the building
plans.
Support of Functional Abilities
Independent living expansion and remodeling plans call for expanding
the existing first floor beauty parlor and adding a bathroom facility with toilet
and wash basin. In this same south east section of the building a massage
room, for resident use, will be added. On the ground level adjacent to pool, a
new exercise room will be added.
The existing independent living exercise room on the second floor is
infrequently used and by few residents. It is long and narrow, measuring 30 1
by 7' and is equipped with one Nordic Track exerciser, one treadmill, five
stationary bikes, and weights. Independent living unit and health center
counter top and accessible storage space is lacking in resident bathrooms.
West wing addition plan features include a winding stairway inside
ground floor entry with first floor observation landing. The first floor of the
assisted living section features a health care area with examination, wellness
and observation rooms. Apartments on the assisted living floors are
clustered and have communal living rooms with electric fireplaces adjacent
to dining rooms on the first and second floors.
Social Contact and Interaction
The fifth floor of Villa Gardens is divided between residential and public
space. The area on the north side of the fifth floor is divided into various
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meeting and activity rooms which are shared between the public and private
sector. The Villa Vista room (40 feet x 50 feet) is the largest public meeting
room at Villa Gardens. A room divider allows multiple events to take place
at the same time. The room is equipped with a large screen television, a
grand piano and organ. Concerts and church services are regularly held here,
in addition to Tai Chi classes, bi-weekly senior curriculum series, league of
women voters forum and resident council, and adm inistrator forum
meetings. The Club room hosts a community music society meeting,
Pasadena Kiwanis, Junior Jay Cees, and California Retired Teachers
Association Meetings.
Provision of Privacy
Sound insulation w ithin shared rooms and between rooms and
hallways seems to be lacking, as evidenced by post occupancy evaluation and
survey responses. Wood framing was used with single layers of drywall in
health center walls between resident rooms and hallway, which according to
Gregg Wilson, general contractor, is noisier and not as conducive as metal
studs and multiple layers of drywall for soundproofing.
W est wing addition sound proofing features in the W est Wing will
include concrete interior walls with metal studs and double layers of drywall.
Analysis of walk through, data survey responses and landscape plans
indicate, at the present time, a lack of a strong landscaping theme on the
Villa Gardens' grounds. Existing plans and Survey responses revealed small
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pockets of the grounds which supported outside activity (e.g., Rose garden
with glider swing, east lawn dinners and barbecues). They also revealed
limitations in terms of shade, adequate seating, level surfaces, w idth of
walking surfaces, and percent of non-vehicular designated walking area.
Approved landscape plans and interviews with Nord Erikkson of EPT
Landscape Architects shows a commitment to a comprehensive landscape
plan and needs of Villa Gardens residents. An example of this is seen in
design revision of seating plans after reviewing resident qualitative
comments on seating.
INCIDENT AND TRAFFIC REPORTS, ARCHIVAL RECORDS
Villa Gardens Incident Report Analysis
From quarterly reports between the period of 10/01/94 and 1/3/97,
resident fall related incidents were reviewed. The total number of incidents
were greater in the independent living unit as compared to the health center
unit with 197:144 incidents. Based on the number of residents in each
building, this data w ould indicate there were three times as many fall
incidents in the health center, per resident, as compared to the independent
living center. This data was consistent with walk through, survey, building
plan and literature review findings (Ferrini 187) that show the
supportiveness of an environment is directly related to resident risk-taking
behavior, and frailer residents have the greater risk of accident or injury.
The majority of falls in both the health center and independent living unit
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were attributed to loss of balance. In the independent living unit 5 fall
incidents, attributed to the same resident in one quarter, were said to be the
result of intoxication. Another fall resulted from a resident being bumped by
the security gate.
Traffic Reports
Traffic patterns from Lake Avenue at Villa Street are very congested with
a main interchange to the 210 freeway located one block from the facility. A
1995 Pasadena traffic engineering report stated that northbound traffic
averaged 19,673 in a 24 hour period on Lake Avenue. Traffic westbound on
Villa averaged 3,546 vehicles in a 24 hour period. A report from the Pasadena
Traffic and Transportation Engineering Division showed a number of speed
related accidents at the intersection of Lake Avenue and Villa Street. On
observation, Villa Gardens' visitors and residents routinely cut across Villa
Street at mid- intersection to get to Villa Gardens.
SURVEY FINDINGS
To evaluate resident perception of Villa G ardens R etirem ent
Community two Survey instruments were developed and administered to
residents in the independent living unit and health center. These
instruments evaluated the Villa Gardens environment within the following
realms:
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- Neighborhood context: location of CCRC within the context
of the community at large, with consideration of safety, proximity to
services, stores, transportation
- Landscape and building exterior: Considers adequacy of seating,
privacy, recreational facilities, landscape, shade and pathways and
accessibility of building entrances
- Issues of Safety and Security: Staff availability and responsiveness,
support of the physical environment including attention to placement
of furniture and floor treatments in the public space
- Issues of A w areness and O rientation: How hospitable is the
environment in terms of signage, visual and auditory cues?
- Support of Functional Abilities: Considers features of the built and
non-built environment which facilitate performance of meaningful
daily activity including laundry facilities, elevators, meal service
- Social Contact and Interaction: Considers purpose-built features of the
environment which promote intentional and spontaneous activity as
well as resident voice in decision-making
- Provision of Privacy: Respect of residents rights as to issues of privacy
and confidentiality
- Personal Control: Considers opportunities for resident choice
in programming, food, decor and environmental (e.g., thermostatic)
control
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- Regulation of Stim ulation: Considers the range of stim ulating
elements, including visual, auditory and olfactory, in the environment
- Q uality of Stim ulation: Considers the overall ambience of the
environment in regard to function and aesthetics
Villa Gardens Resident Profile
Characteristics of the sample population are summarized in Table 1.
Not all residents responded to every question. Therefore, the percentages in
Table 1 may not add up to 100 percent.
The majority of respondents in the independent living unit were female
(81%), with a mean age of 84 years, Table 1. Nearly all of the sample, 95 %,
were Caucasian/anglo and 73% of the respondents were college graduates with
9% of that group having advanced degrees such as Ph.D's, M.D.'s, or J.D.'s.
Most of the of residents, 57%, were widowed and m ean duration residents
had lived at Villa Gardens was 5.4 years and 11% had resided there for more
than 10 years. A sizable minority, 42%, of residents rated their current
financial condition as 'comfortable' (with no ratings of 'very uncomfortable').
More than half, 56%, of respondents rated their overall health as 'good.' 57%
of Survey respondents live in a one bedroom apartment, with 31% rating a
two bedroom as the second most popular choice.
The majority of respondents in the health center were female (89%), with
a mean age of 90 years, Table 1. All of the sample were Caucasian/anglo and
56% of the respondents were college graduates. Most of the of residents, 78%,
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were widowed and mean stay of residents at the Villa Gardens health center
was 1.5 years.
TABLE 1. CHARACTERISTICS OF THE SAMPLE POPULATION
Variable Independent Living
Center
Health Center
Age
Mean 84 years 90 years
Range 70 - 98 years 81-102 years
Sex
Male 16% 11%
Female 81% 89%
Race
Caucasian 95% 100%
African American 1% 0%
Marital Status
Single 25% 11%
Married 17% 11%
W idowed 57% 78%
Education
Grades 1-11 0% 11%
High School Grad 4% 33%
Some College 22% 0%
College Grad 33% 0%
Post Grad 31% 56%
Ph. D, M. D., J. D. 9% 0%
Length of Residency
Mean 5.4 years 1.3 years in HC
2.5 years at VG
Range .1 -10+ years .1 -4 years in HC
.1 -9 years at VG
A volunteer survey of independent living residents (27% or 68 residents)
revealed that Villa Gardens residents contributed 17,083 volunteer hours in
1996 between in facility (e.g., Villa committees, health center services, menus,
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mail) and community (e.g., Red Cross, meals on wheels, H untington
Hospital) service.
Community Demographic Profile
Demographic trends as reflected in 1980 census data and 1996 projections •
w ithin a one mile radius of Villa Gardens revealed the following community
profile. Population density for this neighborhood in 1990 was 11,982 with an
increase of 21.8% from the 1980 census. A projected 2.2% increase from 1996
w ould place the population per square mile at 13,561. The breakdown of
population by race from 1990 census show 39.6% of the population being
white (Non hispanic) with a projected 1996 increase to 36.9%. African
Americans (Non-Hispanic) represented 16.5% of the population by 1990 with
a projected drop to 16.4% by 1996. The Hispanic and Latino population
accounted for 34.8% of the total population in 1980 with a projected increase
to 37.1% by 1996. Asian and other (Non-Hispanic) races accounted from 9.1%
of the population in 1990 with a projected increase to 9.6% of the population
by 1996.
INDEPENDENT LIVING SURVEY FINDINGS: (REFER TO APPENDIX 1)
Response to the written Survey in the independent living unit was
strong, w ith a 50% participation rate, which according to administration was
the highest degree of resident survey participation in Villa Garden history. A
high level of resident interest and motivation towards this study is
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also reflected in the thoughtful and carefully articulated written and verbal
qualitative responses.
Neighborhood Context
Although 96% of respondents use their own vehicle as a mode of
transportation, 93% also used the Villa Gardens van, and 88% included
'other' forms of transportation (including taxis, private drivers, and family or
friends).
A lthough 46% of independent living respondents rated the
neighborhood surrounding Villa Gardens as unsafe to walk in, 82% of
survey respondents take walks outside Villa Gardens into the neighboring
community at least once a week (36%), with 31% taking walks to local stores,
restaurants, churches, etc. more than 3 times per week. A lthough
respondents were able to clearly identify issues of neighborhood concern, 50%
of these rated high satisfaction to extreme satisfaction with the location of
Villa Gardens within the context of the surrounding neighborhood.
Some survey com m ents reflected concerns ranging from the
"transitional" nature of the community bordering Villa Gardens (e.g., zoned
for retail one door east, and residential to the west), to anxiety over the daily
presence of male Hispanic day laborers just one block to the west.
Landscape and Building Exterior
Most independent living respondents, 58%, indicated that they only use
the Villa Gardens grounds and building exterior as a point of transit passage
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to other destinations, and do not engage in activities specifically on the Villa
Gardens grounds. Just under half of the respondents, 49%, were able to
positively identify quiet outside areas where they can be alone or engage in
private conversation. Only 11% of survey respondents indicated the adequacy
of outside seating, and only 40% of these respondents indicated feeling free to
initiate or recommend alternate seating arrangements. Fewer than half of
residents, 43%, rated the outside pathways as inadequate. About half of the
respondents, 49%, indicated that the landscape of the grounds surrounding
Villa Gardens was very adequate, while 35% of respondents rated the outdoor
recreational facilities as inadequate.
Issues of Safety and Security
Most of the survey respondents, 89%, indicated that the staff were readily
available to offer assistance on a 24 hour basis. Nearly all, 99%, indicated that
they would feel free to ask help from staff, if needed. A significant portion of
independent living respondents, 19%, indicated that housekeeping
equipment frequently impedes the use of handrails in the hallways and 12%
of respondents indicated that they had been bruised or injured on furniture
w ith hard or sharp edges within the common areas (qualitative comments
specified injuries on fire door handles).
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Issues of Awareness and Orientation
Most independent living respondents, 84%, rated emergency and
informational signs as adequate, and were able to find their way around
building.
Support of Functional Abilities
At the time of the survey, 12% of independent living respondents were
receiving assistance from the staff in activities of daily living, the most
common type of which was homemaking (e.g., making bed) with primary
support being in homemaker assist (e.g., bed making). More than half of
respondents, 52%, indicated difficulty in using the elevators at Villa Gardens.
Most of the respondents, 67%, do light housekeeping in between weekly
housekeeping visits. Many respondents, 33%, rated apartment storage space
as inadequate and 57% of respondents indicated lack of opportunity to have
their own gardens.
At this point of time it is unclear as to how Villa Gardens will deal with
residents having progressive dementia in the future. Both staff and residents
of the independent living and health center units expressed concern over this
issue and a comprehensive facility policy did not seem to be in place to
address the specific needs of this population at the time of this study.
Social Contact and Interaction
Most residents, 80%, indicated that the placement of furniture allows for
spontaneous social interaction. Just under half (49%) of residents felt that
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social activities are arranged by both staff and residents while 48% of residents
felt that activities are arranged primarily by the Villa Gardens staff.
Provision of Privacy
Almost all respondents, 98%, felt that their rights to privacy are respected
and 68% of respondents were able to identify private spaces where they could
be by themselves or with just one or two others. Again, nearly all of the
respondents, 95%, indicated that they have ready and confidential access to
Villa Gardens staff, management, or health care personnel. Only just over
half of the respondents, 53%, were able to identify a room used on a regular
basis for worship services.
Personal Control
More than one third, 38%, of respondents indicated having limited
control in issues of staffing and voiced concern over dismissal and frequent
turnover of favorite staff. About the same proportion, 36%, of respondents
indicated limited control over space usage, and 39% over food service. About
two thirds, 69%, of respondents identified a choice of rooms or public spaces
available to them. Most respondents, 88%, felt it was easy to regulate the
temperature, 84% the lighting, and 67% the noise in their private apartments.
Regulation of Stimulation
Most respondents, 95%, said the amount of informational and directional
signage is 'adequate.' 87% of residents surveyed indicated that the facility
decor and amount of artifacts (e.g., paintings, photos, floral arrangements)
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was 'adequate,' 40% said it was 'excessive,' and 8% said 'inadequate.'
Residents specifically identified floral arrangements in the main lobby as
excessive. Awareness of 'occasional' odors was noted by 21% of the
respondents.which were characterized as 'soiled diapers in laundry room,'
'cigarette smoke from neighbors apartments,' and 'the smell of paint.
Q uality of Stimulation
Only 10% of respondents indicated that they are frequently aware of
competing sounds occurring at the same time, specifically noise in the dining
room area, traffic sounds of the 210 freeway for south facing apartments, and
fire sirens on the north side of the building. Most respondents, 86%, were
pleased with the facility decor.
In conclusion, there was generally a high level of satisfaction among
residents as 93% of the independent living respondents indicated they would
choose to come to Villa Gardens again if they had it to do over again.
HEALTH CENTER SURVEY ANALYSIS: (REFER TO APPENDIX 2)
Most of the Villa Gardens health center respondents, 89%, were female
and had lived in the health center for at least one year. Only 25% of the
respondents had never lived in the Villa Gardens Retirement Community
before coming to the Health Center. Most respondents, 78%, lived in their
own home before moving to the health center.
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Neighborhood Context
Less than half, 44%, of the health center respondents leave the health
center one to four times per week, with 89% of these feeling safe to go for
wheelchair rides in the neighborhood. Most respondents, 89%, also felt their
sense of privacy is retained, in spite of the urban noises at Villa Gardens.
When asked about interest in joint activity with the Lake Avenue Church
preschool, located directly south of the health center, only 33% expressed a
strong interest in viewing a Christmas performance by the children. Most of
the residents, 67%, identified their families as the prim ary mode of
transportation while 33% used the Villa Gardens van.
Landscape and Building Exterior
The majority of health center respondents, 56%, used the outside
grounds only as an area of transit passage and 33% used the outside for only
one hour or less per day. However, 75% of survey respondents feel
comfortable spending time outside the health center. Only 40% of survey
respondents indicated any areas outside the health center used for informal
social gatherings on a regular basis and 26% of respondents rated the outdoor
space of the health center as inadequate in regard to recreational facilities and
shade. About two thirds, 63%, of respondents use the outside grounds only in
the afternoon. A few respondents, 17%, indicated difficulty in getting around
the grounds and outside of the building by foot or in a wheelchair.
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Many respondents, 33%, indicated no quiet or protected areas where they
can be alone or engage in private conversation and 30% of respondents
indicated a lack of adequate outdoor seating. A large minority of the
respondents, 38%, indicated that they were not encouraged by staff to suggest
outside activities.
Issues of Safety and Security
Although 11% of the health center survey respondents indicated that the
staff was not readily available to offer assistance on a 24 hour basis and did not
respond to requests in a timely manner, 100% of those surveyed indicated
that they would feel free to ask staff for help when needed. Some of the
respondents, 25%, felt that housekeeping equipment impeded the use of
handrails in the hallways and 11% indicated that they had been bruised or
injured on furniture with hard or sharp edges within the common areas of
the health center. A few of the survey respondents, 13%, indicated that they
were not able to personalize the doors to their room.
Some survey respondents, 13%, indicated that they have found it, on
occasion, difficult to find their way around the facility or gotten lost, and 22%
said there were no landmarks in the building to help find the way to their
room. Most of the respondents, 89%, felt that there were enough windows in
the facility to allow for orientation to the outside.
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Support of Functional Abilities
All of the survey respondents, 100%, felt that there was adequate room
in the bathrooms for staff to assist with toileting functions. Most of the
health center residents surveyed, 78%, rated taking a bath as a 'routine
experience/ as compared with 22% who rated it as 'highly stressful,' and 0% as
an enjoyable experience. Qualitative comments regarding toileting and
bathing focused on lack of counter space in bathrooms, air and water
temperature in the shower room ("too cold"), and difficulty seeing the floor
secondary to "poor lighting" and dark colored floor material.
Although 67% of residents surveyed indicated being able to transfer in
and out of bed on their own, 33% of these stated that they are not able to get
out of bed at night to use the bathroom. Qualitative statements indicating
that raised bed rails prevented them from using bedside commodes. A
significant portion of the respondents, 38%, indicated that no other bathroom
facilities were available to them besides those in their room.
Only 50% of survey respondents felt that counter space was adequate in
resident bathrooms. Positive response was unanimous (100%) regarding
accessibility of sink, faucet controls, soap and towel dispensers. Almost half,
44%, of respondents indicated that storage and counter space was inadequate
in their room, with 33% indicating a lack of display space for personal art,
curios, and decorations. The percentage of residents who indicated
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inadequate lighting in their room and an inadequate number of mirrors
throughout the facility was 33%.
At the time of this survey, 33% of survey respondents were receiving
occupational or physical therapy services. Some of the respondents, 11%, felt
that the facility did not provide them with assistive equipment or help to care
for themselves in regard to eating, dressing, toileting, or bathing functions.
Some of the health center residents surveyed, 33%, felt that meals were
rushed and not served in a dignified manner. One resident noted, "If you
don't want to be rushed you need to get to the dining room early.".
Only 11% of respondents indicated interest in participating in gardening
activities, 44% of these felt that there was no space allotted to resident
gardening space even if they so desired. Exactly one half of the respondents
do light housecleaning in between housekeeping visits but 89% of
respondents said they did not have access to a washer or dryer. Some
respondents, 11%, stated they would be allowed to have a small refrigerator in
their room (56% indicated they would not be able to).
One half of the respondents had phones in their rooms, although 29% of
these could not use the phone in their room without being distracted. Only
67% of respondents were able to identify a public phone available for resident
use. All of the respondents indicated that there was no public space available
in the health center where they could get snacks, coffee, or have use of a
microwave oven.
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One half of the of respondents indicated having free access to activity
supply and storage areas between scheduled sessions. But, more than half,
56%, of respondents indicated that they did not have access to the Villa
Gardens gift shop (Villa Mart), with comments stating morning store hours
and need for someone to push them over in a wheelchair limited their access
to the Villa Mart. Most respondents, 78%, indicated that they are not able to
make transactions with money at Villa Gardens (facility policy does not allow
residents to keep money on the premises).
Social Contact and Interaction
Exactly one half of the respondents felt that the placement of furniture in
the public spaces of the health center did not encourage spontaneous social
interaction. Main areas to socialize, as identified by respondents, the bird
aviary, the dining room, and the activity room.
Provision of Privacy
Most residents, 89%, surveyed felt their rights to privacy were respected,
but 56% indicated a lack of semi-private spaces available where they could be
by themselves or with just one or two others. Qualitative comments focused
on lack of choice in roommate selection or having a private room. Many
residents, 44%, indicated they did not have enough privacy in a shared room,
and 22% indicated that staff does not always knock before entering their room
or bathroom. Although worship services are held on a regular basis, only
56% of residents identified a location in the facility used for this.
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Personal Control
Several residents, 44%, indicated that there was not a multi purpose
room or space (including outdoors) available for their use or simultaneously
occurring activities from which they are able to choose. All of the health
center residents surveyed indicated that they do not have a choice of a bath or
shower. More than half, 56%, of residents surveyed indicated that they do
not have a choice in eating at times other than scheduled meal times. Most
residents, 89%, indicated that they did have a choice of food and that they are
able to eat in areas other than the dining room or their room. More than half
of the respondents, 56%, indicated that temperature was difficult to control,
and 33% indicated that noise was difficult to control. Some of the
respondents, 22%, stated that they avoid certain areas in the facility because of
glare from windows, lights, wall or floor surfaces. All of the of residents
indicated that they are 'rarely' aware of regularly occurring and excessive
odors.
Quality of Stimulation
Just over half of the respondents, 56%, indicated that they are frequently
aware of many competing sounds occurring at the same time, specifically
'yelling residents,' voices of housekeepers, and loud television sets. Most of
the respondents, 89%, indicated being pleased with the facility decor, and 79%
of residents surveyed said they would still choose to come to Villa Gardens if
they had to do it over again.
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INTERVIEWS
Codes From a Planning Perspective
In the existing health center and Villa Vista buildings, codes have been
applied to comply with department of health and department of social service
guidelines.
In interviews with the Pasadena Planning Department it was emphasized
that the Pasadena Planning Department speaks to the intent versus the letter
of the code. The priorities of the planning departm ent in evaluating new
building construction is to; 1. make it comply with the code and 2. to
maximize usable space.
As Jerry Wood, Pasadena Program Manager for Plan Review Section
stated in regard to the scope of the planner's function: "All planners can
check for are compliance of minimal code requirements. They don't have the
luxury of having an opinion or im posing w hat is 'best.' In general,
constraints p u t on architects limit the focus of function regarding residents
who will occupy a given building."
Bob Fowler is a Building Official with the City of Pasadena and a leading
spokesm an for a universal and performance based code, as opposed to
prescriptive, in the building industry. A vision he shares w ith other
proponents of code reform is that by the year 2000 a uniform family of single
performance based standard codes will be developed which can be applied on
a national and international scale. Performance based criteria is already
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becoming prevalent in other industry (e.g., car, airplane, computer).
Current codes have been empirically derived to address disaster, safety,
fire, ingress and egress issues. They have looked at broad based need rather
than specific groups of needs. Some specific ways a universal code can
facilitate innovative design is by:
1. Looking at the needs of a specific population
2. Looking at building risk and combustibility
3. Providing flexibility to meet the needs of the facility
4. Encouraging tailoring of design to each project
Codes From a Developer's Perspective
In regard to specific application of building codes, Gregg Wilson, General
Contractor for the Villa Gardens Addition, offered the following perspectives:
Would you say the Pasadena Planning Department functions to apply the
intent rather than the letter of the law in code interpretation?
"Pasadena follows the letter of the law. Building inspectors may vary in
their personalities and interpretation of the code but it is always a challenge to
meet city standards (e.g., infrastructure issues, public works, and liability
issues). Another challenge in this project was to meet the maximal allowable
square footage for the lot and height requirement."
How have the design standards and building codes been applied, to the
benefit or detriment, of this project?
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"Handicapped accessibility and the Americans With Disabilities standard
is a difficult issue for a builder (e.g., requires rigid interpretation of the code in
regard to ramps, ingress and egress). In the Villa Gardens assisted living
project we saw a good demonstration of the standard. The code was applied
in a broader application to where all aspects of the facility, including resident
apartments and public areas are handicapped accessible."
What are your thoughts on a universal building code?
"It all depends on the interpretation of the code. The interpretation of
the code will continue to be dependent on the way it is interpreted by each
building inspector.
A latter interview with Tim Dittman, Villa Gardens CEO, yielded the
following insights on delays in the new assisted living building and current
building codes."
Were delays in designing the new assisted living building caused by current
building code?
According to Mr. Tim Dittman, Villa Gardens CEO, the Pasadena
planning department was cooperative in moving the new addition forward.
"Delays in the completion of the assisted living building resulted from design
related issues. These changes included the set back of Villa Gardens property
line on H udson Street and revision to the second floor activity areas in the
assisted living building."
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The second floor of the assisted living building has been designed for care
of residents with dementia. Originally the design for a resident activity area
on this floor was at the midway point of the hallway, centrally located for
resident access. Subsequent recommendations by architect consultant, Victor
Regnier led to a design modification to include two resident activity areas at
opposite ends of the hallway. This was referred to as a 'bar bell' configuration
because of concentrated activity nodes at each end of the corridor. This type of
residential design feature will provide greater orientation and improved
traffic flow for persons with dementia.
DISCUSSION
Hypothesis 1: Villa Gardens has adapted over time but falls short of meeting
all the needs of its aging population.
Residential facilities for the elderly are unique in that they serve a
dynamically changing population over time, often on a continuum from
robustness to frailty. Only in recent years has the industry as a whole realized,
in hindsight, which environmental supports and services are essential to an
aging population. Many prototypes of senior residential housing built in the
1960's did not consider design solutions which w ould allow smooth
transition for residents from wellness to disability. Residents choose life care
comm unities for varied reasons, as reflected in diverse amenities and
services offered. But what is considered an important amenity to a healthy 70
year old might not hold the same value to a frail mobility impaired 85 year
old resident.
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For instance, the long- range plan for Villa Gardens did not initially
include assisted living provision. The concept of life care was reflected in the
independent living apartments, the health center, and limited home care
services. Some residents in the independent living center have become
marginalized to the extent that they are not frail enough to be admitted to the
health center but require a greater level of care than they are willing to pay for
through home care fee for service. This situation can result in greater health
risk and social isolation. Currently, the average age of independent living
residents is 84.
According to the Home Care director, records of independent living
residents using home care services have only been kept for the past year and a
half. For research purposes it becomes difficult to accurately portray the scope
of independent living residents receiving outside assistance in activities of
daily living (ADL) when some residents contract services outside of Villa
Gardens to assist them with instrumental and activities of daily living. At
the time of this research 25 out of 200 independent living residents are
receiving services from Villa Gardens Home Care. The three home care
services most frequently rendered are: 1.) bathing, 2.) dressing, and 3.)
medication management. The contracting of outside assistance for personal
care may reflect an underlying concern by frailer residents over premature
institutionalization and loss of independent apartment living.
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There has been a great deal of stability in the Villa Gardens' resident
population w ith over 40% of health center and independent living
respondents residing at Villa Gardens between 6- 9 years. Although 93% of
independent living and 78% of skilled nursing respondents indicated that
they would still choose to come to Villa Gardens, approximately 75% of
combined respondents had extensive recommendations for improvements to
the Villa Gardens' environment.
Complaints ranged from lack of privacy in health center rooms to
interrupted south elevator use and cigarette fumes in residential area of
independent living area. Survey data from Health center, and to a lesser
degree, independent living respondents, indicated that residents are reticent
to approach the adm inistration with complaints, because of concern over
being identified as a 'trouble m aker/ or the unapproachability of staff.
At Villa Gardens, the resident council has proven to be an effective and
confidential vehicle for change or lodging complaints for those residents
willing to use it. One respondent, active in resident council leadership,
indicated that changes in the original building plans for the assisted living
building were a direct result of resident input.
Residents who expressed the greatest degree of dissatisfaction with the
facility seemed to be those who were not involved in the resident council
process, or who had not met with a receptive administrative response when
lodging a complaint. As in many large institutions, the political and social
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leadership often falls on the same group of people while others complain. At
the same time, the size of a residential institution might have an influence
on a person's level of involvement.
It was the newest residents of Villa Gardens who expressed the highest
degree of satisfaction with Villa Gardens and its surrounding environment.
Residents expressing the most dissatisfaction with the environment were
those with multiple disabilities (e.g., vision, mobility deficits). These were
the 'younger' residents in the 75- 85 year range who were independent with
all ADL, and without physical or mental disabilities which might limit their
ability to perform ADL.
The new building addition and renovation plans to existing Villa
Gardens buildings and landscape are a combined result of changing resident
needs and planning. These plans not only include those which physically
relate to the built and landscaped environment, but also administrative plans
which provide ongoing support to an aging resident population while
managing the demands on home care services.
O ther environm ental m odifications have resulted from changes
stemming from resident incidents (e.g., falls, robberies). These modifications
have included additions of closed circuit television surveillance throughout
the independent living building and parking structure, a 24 hour security
guard, a locking security gate, lighting, and adding window inserts to some
interior doors. Residents in the independent living unit, at their own
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expense, are able to add supportive aids to their apartment units such as grab
bars, raised commodes, upgraded lighting and floor covering to enhance
function.
In spite of changing residential mental and physical profiles, Villa
Gardens has tried to foster an environment where residents can maintain
optimal independence. The transition from complete independence to
greater assistance will be more gradual with the new assisted living addition.
Environmental supports including new exercise facilities, public lounges,
clear signage, use of ambient light, additional staff, and supportive bathroom
features will allow residents to function autonom ously within private
dwelling units while making help available as the need arises.
In conclusion, just as resident populations are dynamic, so are the
environments within which they reside and function. When this not for
profit facility was built, originally as a set of bungalows to house retired
teachers, current issues such as noise control and weight of fire doors likely
would have been non-issues.
Villa Gardens has expanded and adapted, often in piecemeal fashion, to
meet resident market, and regulatory demands. As seems typical of other
residential care facilities for the elderly, changes more often have resulted
from internal demographic market demands than from carefully laid long
term plans. This situation has led to the problems discussed herein, indeed
many of these problems are common to institutional homes. Still, Villa
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Gardens residents' general satisfaction and accreditation show that Villa
Gardens has gone beyond minimal compliance of industry standards and
market trends.
The challenge to Villa Gardens is to show creativity and accessibility in •
the built and landscaped environment within urban geographic and space
limitations. In order to foster this goal all residents must be mobilized to take
some ownership of their environment and to have a voice no matter how
small in voicing issues of concern. Only then will residents not feel
disenfranchised from the facility, and the discrepancy between overall
satisfaction with the facility and specific issues of concern can be narrowed.
A short and long range strategic facility plan is essential, not only for
actuary and marketing purposes in the senior housing industry, but also to
anticipate the continuum of changes age brings in a proactive rather than
reactive way. Piecem eal and reactive structural, landscape, and
adm inistrative design reflects a short-term planning response at Villa
Gardens. A comprehensive plan only goes back to 1994, as indicated by
facility records made available for this research.
HYPOTHESIS II: Perception of the residential environment, which includes
support of functional, physical and psychosocial needs will dim inish with age
and increased resident frailty.
Data presented in this study indicated that older Villa Gardens residents
have greater personal care needs. The mean age of Villa Gardens
independent living unit residents was 84 years and the mean in the health
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care unit was 90 years. This follows industry and market trends (AAHA &
Ernst 29).
Over 90 percent of Villa Gardens residents entering the independent
living section are 80 to 85 years of age and independent with all ADLs. Issues
of wayfinding and orientation to facility and social activities were primary
issues of concern to newest residents of Villa Gardens. These issues may be
temporary in regard to adjustment of new residents to the facility. With the
onset of physical or cognitive changes long time residents of Villa Gardens
may require an environment that is supportive but allows for some risk-
taking behavior as well as stimulating without being overwhelming to the
senses. The resident council process in continuing care retirem ent
communities such as Villa Gardens, needs to reflect the issues of these
differing groups of residents.
Some of the oldest independent living residents who had resided at Villa
Gardens for five or more years were also some of the m ost vocal in
identifying problems which ranged from south elevators being frequently out
of commission to limited shade and walking paths on grounds. These same
residents who seem to dem onstrate ow nership and control of their
residential environment, were also involved in the resident council process
and actively participated in facility social activities.
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Physical disability or advanced age as indicators of resident frailty did not
influence the level of involvement in Villa Gardens' social activity. Physical
disabilities, especially related to mobility, visual or auditory deficits did
influence the type of activities in which residents chose to participate.
Residents with mobility deficits chose to limit their activity at Villa Gardens
to inside activities and refrained from using the grounds due to narrow
pathways, low seating, uneven surfaces, lack of shade, and vehicular traffic.
At the Villa Gardens' 70th anniversary celebration it was noted that many
residents observed the celebration from balconies due to difficulty walking on
sloping grass surfaces. Independent living residents also indicated preference
for off ground escorted activity (e.g., via family or Villa Gardens van
transport).
Residents with visual and auditory deficits indicated a preference for
activities involving small versus large groups of people. A frequently
repeated narrative response focused on the poor acoustics in the dining room
which, according to residents, has created an environment of competing
sound and made resident conversation difficult. The noon and evening
mealtimes in the dining room are considered im portant social times for
independent living residents, so dining in a audibly distracting environment
creates additional frustration for residents.
In observing some residents with visual and cognitive deficits, it was
noted that there was a point of care where the Villa Gardens fee for home care
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service and the residential environm ent was not able to provide a
transitional safety net to a higher level of care. This was evidenced by some
residents not getting dressed and staying in their rooms all day between visits
from home care, or a significant and growing group of other residents who
have resorted to hiring outside help to assist them with activities of daily
living.
Building standards have not been flexible enough to meet the changing
needs of frail residents. This is evidenced by lower resident satisfaction
responses in the health center (e.g., issues of privacy, noise, willingness to
come to Villa Gardens again if given the choice), and by the overwhelming
positive response to the new assisted living addition. By June 1997, all 22
residential apartments in the new building have been filled, and within one
month of anticipated completion, the assisted living section is expected to be
filled to capacity.
Present Fire and Safety codes seem to focus on emergency egress for
disaster related function as opposed to addressing daily operational needs of a
particular building and clientele. This is especially evident w ith door
pressures in some of the public spaces which were in excess of the minimum
requirement (e.g., laundry rooms, rest rooms, Villa Vista room, parking lot)
and w ith the long double loaded corridors which contribute to a more
institutional look in both the independent living building and the health
center. Energy demands on persons with mobility limitations were also cited
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as problems when out of commission elevators force residents to negotiate
the length of long corridors to find alternate exits.
In conclusion, at one end of the continuum Villa Gardens supports an
active and healthy elderly lifestyle, especially in regard to cultural and
educational opportunities. These are the residents who are involved in the
resident council process, on the building committee, and advocating for a
resident technology center and improvements to grounds.
On the other end, frail residents in both the health center and
independent living center, for whatever reasons, are not able to draw on the
support or resources they need to negotiate or function autonomously within
their environment. These are residents who express resignation to their
circum stances and are am bivalent to bring issues of concern to
administration for fear of retaliation.
Research findings from m ultidim ensional analysis supported the
hypothesis that it is the frailer and older Villa Gardens resident who perceive
the residential environment as less supportive. It is the residents who have
lived at Villa Gardens the longest and those with the highest num ber of
physical disabilities who express the most dissatisfaction with Villa Gardens.
W hat is less clear is to what degree the environment has influenced
resident satisfaction and optim ized function. Each group of incoming
residents will assimilate to the built and administrative environment of Villa
G ardens from their own unique set of perceptions and life experience.
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Residents who will enter the completed assisted living section will be older by
at least 10 years than the retired teachers who first came to the Pasadena
residential community. Greater attention to acoustics, door pressure, and
other sensory detail within the newly built and landscaped environments
will create a richer and more supportive residential setting in which to age.
HYPOTHESIS III: Present building codes, design and administrative policy of
residential facilities, which provide minimal standards, are insufficient to
meet the changing and diverse needs of the elderly consumer as they age, and
can actually create problems for residents.
In the United States market forces combined with regulatory considerations,
continue to be the driving factor in building design and prototype for senior
housing. At Villa Gardens this is evidenced by safety codes which have
resulted in double- loaded lengthy corridors and door pressure which
routinely measures in excess of the minimum standard.
Interviews with Pasadena planning officials indicated that the priority of
the planning departm ent is to make buildings comply with code and to
maximize usable space. The current process focuses architects' attention on
meeting code regulations often at the expense of what would be considered
best practice. A performance-based code could allow designers to look at
safety issues and encourages tailoring of design to each project.
In the opinion of the contractor for the Villa Gardens addition, the
project has been constrained to the letter of the law, although interpretation
varies from inspector to inspector. It is believed that the Americans with
Disabilities Act standard is a difficult issue for designers but the Villa Gardens
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project has even exceeded the standard in some instances (e.g., width of
corridors, front entry of independent living unit).
N evertheless, a num ber of issues im portant to the elderly were
unaddressed. For example, the health center building could have an
accessible entry for residents, employees and guests with a protected or
covered overhang with more clearly defined loading zone and a pedestrian
right of way. At the present time, independent living residents use the back
(or west) entrance to visit health center residents. At the north entrance,
visitors m ust enter through a heavy fire safety door and frequently dodge
delivery trucks and moving vehicles from the adjacent parking lot.
In conclusion, code driven design solutions did not result in optimal
utility for an aging population and actually created problems for residents in
the instances of way finding and high door pressures.
Codes have ensured that a minimal standard of safety is adhered to, albeit
in a rigid application. The city of Pasadena does not currently have codes for
residential assisted living, which may have resulted in some of the
numerous delays in the completion of this project. In spite of trends towards
code revision with the Nursing Home Reform Act, the American With
Disabilities Act of 1990 and a Universal Code creative thought and innovative
application of safety and operational codes are frequently sacrificed for the
sake of cost containment. The lack of risk-taking in residential design and
building for the most frail elderly is reflected in monotonous and redundant
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environments which serve to imprison more than inspire, and which
definitely preclude opportunity for risk-taking behavior.
HYPOTHESIS IV: Use of m ultiple m ethodologies will identify unique
problems in the built environment as they relate to the needs of residents as
they age.
The use of multi-dimensional analysis, including resident surveys, walk
through and plan analysis, and comparative analysis of best residential
planning and practice models to look at the environment of an urban
residential care community allowed for a more complete analysis and
problem identification than relying on a simple method.
Survey
Inform ation from surveys and interviews provided an independent
source of review to compare to observations from the building plans, walk
through analysis and literature review of best practice models. The survey
process provides a qualitative dimension of analysis that is otherwise
overlooked in the highly regulated and cost driven development process, but
which in the long run can serve to produce a better product.
Resident survey results identified facility and grounds accessibility and
useability issues of concern as well as issues stemming from the context of
Villa Gardens within the community at large. Resident concerns ranged
from issues of uneven walkways, limited seating, shade and landscape to
need for greater surveillance in the main lobby. Problems in the built
environment related to auditory and visual cuing were a repeated theme in
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resident responses. Residents felt their privacy rights were frequently
interrupted by fire and safety code open door policy, nursing protocol, and by
other resident's preferences. Respondents expressed reluctance to go to
administration with suggestions or complaints because they expected a lack of
responsiveness or had a fear of staff retaliation. The majority of respondents
from both facilities did not reflect familiarity or involvement with the
resident council process. Some residents in the independent living section
expressed frustration over unexplained discharge of favorite staff members.
At this point of time it is unclear as to how Villa Gardens will deal with
residents having progressive dementia in the future. Both staff and residents
of the independent living and health center units expressed concern over this
issue and a comprehensive facility policy did not seem to be in place to
address the specific needs of this population at the time of this study.
W alk Through
A walk through of the Villa Gardens Retirement Community provided a
visual perception as well as a functional image of the facility. The walk
through process added focus to survey responses and allowed for issues to be
addressed within the context of safety code and administrative policy. This
was evident in issues of excessive door pressures in public areas of the health
center and independent living unit hallways, noise control in dining areas
and health center hallways, and issues of resident privacy in the health
center.
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The independent living unit walk through revealed' the impact long
corridors have on mobility impaired residents. In the health center an issue
of hallway noise in resident rooms was noted during a walk through of the
facility.
Plan and Archival Record Analysis
Review of existing and proposed building and landscape plans and
archival records provided not only an historical perspective of the Villa
Gardens community, but also provided information about the intent of each
building project. The health center provides skilled rehabilitation and
nursing services to residents of Villa Gardens and the community at large.
In the health center an issue of hallway noise in resident rooms was
correlated with the building materials used in the original plans.
No longer distinguished as a residential community exclusively for
retired teachers, Villa Gardens attracts a professionally diverse middle to
upper class clientele from the United States and other parts of the world. Just
as there is functional and physical diversity in the independent living center,
there is also diversity of ability in the health center setting. In the
independent living center, some residents own second homes in which they
spend extended months during the year, while others travel extensively.
Other independent living residents in adjacent apartments have difficulty
getting dressed and out of bed without assistance from home care or other
contracted help. An increasing number of residents from the health center
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retain their apartment while recuperating and receiving therapy services on a
short term basis. At the same time other frailer health center residents
remain in bed for extended periods due the staff required to perform transfers.
This not only serves to socially isolate frailer residents w ithin the
community, but also creates a potential health risk from inactivity.
In conclusion, the different methodologies identified unique problems in
the built environm ent of Villa Gardens. The resident survey identified
narrative and quantitative issues dealing with accessibility, safety, and the
facility setting within the neighborhood context. Walk through data
highlighted problems in the landscaped environm ent of Villa Gardens,
excessive door pressures, and issues dealing with noise and signage. Building
plan and archival record analysis revealed issues of long range planning,
building design and issues of ingress and egress.
Although each of the methodologies provided useful information as to
the impact of the built environment on an aging population, in the interest
of professional planning, a streamlined approach to data gathering would be
preferable when performing an evaluation in the field. To maximize time
and financial resources, a modified approach using limited resident random
survey w ith analysis of plans and a walk through analysis of the given
environm ent would yield quantitative and qualitative information in a cost
effective manner.
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CONCLUSION
The United States is an aging society. Over the next 20 years there will
unprecedented demand for aging services and housing by a cohort that
includes an unprecedented group of affluent, educated, and politically vocal
seniors. Demographics also show that the fastest growing segment of our
population is the oldest and most frail.
In this case study of an urban continuing care retirement community,
data reveals that geographical constraints such as high density housing,
crime, and limited space do not necessarily adversely affect overall resident
satisfaction of a facility. However, no matter how proactive and adaptive a
CCRC is, it will always fall short of meeting the needs of all residents. Just as
resident populations are dynamic, so are the environments w ithin which
they reside and function. When this non-profit facility was built as a set of
bungalows to house retired teachers current issues of noise control and
weight of fire doors would likely have been non-issues.
Villa Gardens has expanded and adapted often in piecemeal fashion to
meet resident market and regulatory demands. As seems typical within the
CCRC industry, changes within residential care facilities for the elderly have
more often resulted from internal demographic market demands than from
carefully laid long-term plans. In spite of this lack of foresight, Villa Gardens'
resident general satisfaction and the accreditation of the CCRC indicate that
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the facility has still been able to go beyond minimal compliance of industry
standards.
The challenge for Villa Gardens and other urban CCRCs is to
dem onstrate creativity and accessibility in the built and landscaped
environment within urban geographic and space limitations. Also, with an
increasingly educated and vocal residential pool, CCRC residents must be
mobilized to take ownership of their environment and voice issues of
concern through the resident council process and other proper administrative
channels. Lastly, short and long range planning are essential to evaluate the
efficacy of what has or has not worked in the past and to anticipate the
changes age brings in a proactive rather than a reactive way.
RECOMMENDATIONS
With projected demand for senior housing expected to continue into the
next century it will be necessary to educate developers and architects to the
scope of consumer needs in this specific market. Complex social and design
issues associated with life care developments offering a range of housing
types and services for older people of varying competencies that will need to
be addressed. Design response to the location of housing and facilities for the
more dependent resident, and the relationship of this housing and facilities
to those for the more competent must be evaluated for each individual
project and group of residents.
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With continuously aging populations, CCRC planners will be needed to
estimate the number of health care beds a CCRC will need at maturity. The
utilization of health care beds is influenced by the age and health of residents,
the philosophy of the CCRC and market conditions such as managed care. A
comprehensive plan for dealing with residents with progressive dementia
should by developed in the future.
The timing as well as the quantitative and qualitative responses of this
post occupancy study was opportune. It allowed for primary research of a well
established urban CCRC and relatively stable population, as well as study of
the design process and community transition with the new building addition.
Opportunity for dialogue and design recommendation presented itself with
the Villa Gardens principal landscape architect, who was able to incorporate
some qualitative responses into his plans.
OPPORTUNITY FOR FURTHER RESEARCH
A comparative analysis of urban CCRCs could expand the limited
knowledge base in this field. In establishing long-range planning for CCRC
populations, periodic review of resident and staff psychosocial, functional and
program needs should be surveyed. This would serve not only to determine
under or over utilized services but to also provide the right mix of services
and environmental support for a dynamic population.
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Studies should be devised to provide comprehensive plans for dealing
with residents with progressive dementia. Other studies might evaluate the
environm ental competency of Villa Gardens as it relates to staff and
adm inistrative function. Policy research might focus on flexibility in
standard interpretation and the industry shift to universal code. A study of
pedestrian and vehicular traffic patterns at Villa and Lake Street would be
indicated to facilitate Villa Gardens' pedestrian and motorist safety.
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BIBLIOGRAPHY
American Association of Homes and Services for the Aging. Continuing
Care Accreditation Commission Accreditation Handbook. Washington, D.C.:
AAHSA, 1994:305.
American Association of Homes for the Aging, and Ernst & Young. •
C ontinuing Care Retirem ent Communities: An Industry In A ction.
Washington, D.C.: AAHA, 1991: 29, 35.
American Association of Homes for the Aging. The Consumers' Directory iQ
Continuing Care Retirement Communities. Washington, D.C.: AAHA, 1993:
26.
American Association of Homes and Services for the Aging. Dare to
Discover: The Future of Continuing Care Retirem ent C om m unities.
Washington, D.C.: AAHSA, 1995: 1.
American Association of Retired Persons. A Profile of Older Americans: 1990.
Washington, D.C.: AARP, 1990.
Carstens, Diane Y. Site Planning and Design for the Elderly. New York: Van
Nostrand Reinhold Company, 1985: 1-2.
Cassel. The Continuing Care Retirement Community: A Guidebook for
C o n su m ers. W ashington D.C.: American Association of Homes for the
Aging, 1990: 6-10.
Christensen, Margaret. Aging In The Designed Environment. New York:
The Haworth Press, 1990: 88.
Christopher, Alexander, et al. A Pattern Language. New York: Oxford
University Press, 1977: 806.
Clemente, F., & Kleiman, M.B. Fear of Crime Among The A ged.
Gerontologist, 1976: 16 (3), 207- 210.
Crimmins, Eileen. "Implications of Demographic and Epidemiological
Trends for California's Long-Term Care Policies": 2, 8 and 9. California Policy
Choices for Long Term Care. Ed. Phoebe S. Liebig, and William W.
Lammers. Los Angeles, California: WSC Ethel Percy Andrus Gerontology
Center, 1990.
Cuyeneking, Timothy. USC lecture attended by author. 1995.
87
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Dittman, Tim. Interview by author with Villa Gardens CEO. July 31, 1998.
Eriksson, Nord. Interview by author with landscape architect regarding Villa
Gardens landscape plans. Pasadena, California. 18 March, 1997.
Federal Register. Fair Housing accessibility guidelines: proposed rule.
Washington, D.C.: Department of Housing and Urban Development, Friday,
June 15, 1990.
Ferrini, Armeda F., and Ferrini, Rebecca L. Health In The Later Years. 2nd ed.
Madison, Wisconsin: WCB Brown & Benchmark, 1993: 122-125, 187.
Fowler, Robert J. Interview by author with Pasadena planner regarding
universal code revision. Pasadena, California. 25 April, 1997.
Gardiner, R. A. The Environmental Security Planning Process. Boston,
Mass.: Gardiner & Associates, 1977.
Kane, Robert L., Joseph Ouslander, and Itamar Abrass. Essentials of Clinical
Geriatrics. New York: McGraw-Hill, 1989: 41, 61 and 63.
Lynch, Kevin. The Image of The Citv. Cambridge, Massachusetts: The MIT
Press, 1993: 6, 7.
Midwest Research Institute. Crimes Against The Aging: Patterns And
Prevention. Kansas City, Mo.: Midwest Research Institute, 1977: 5, 6.
Moore, Jim. Assisted Living: Pure and Simple Development and Operating
Strategies. Westridge, Connecticut: Westridge Publishing, 1996: 10-11, 26.
Moos, Rudolf H., and Sonne Lemke. Group Residences For Older Adults:
Physical Features. Policies, and Social Climate. New York: Oxford University
Press, 1994:10,11.
Preiser, Wolfgang F. E., Rabinowitz, Harvey Z., and White, Edward T. Post
Occupancy Evaluation. New York: Van Nostrand Reinhold company, 1998:
131,132.
Regnier, Victor. Assisted Living For The Elderly: Design Innovations from
the United States and Europe. New York: Van Nostrand Reinhold, 1994: 1,
180-186.
88
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Regnier, Victor. Planning For The Elderly: Alternative Analysis Techniques.
Los Angeles: The University of Southern California Press, 1979: 122-124.
Scruggs, David W. The CCRC Industry 1996 Profile. W ashington, D.C.:
AAHSA, 1996: 4.
Steinfield, Edward, and Cardel. "Developing Standards for Accessibility."
Barrier Free Environments. Ed. Bednar, Michael J. Stroidsburg, Pa.: Dowden,
Hutchinson & Ross, 1977: 86.
Torres, Deborah, and Gill, Fernando. The New Aging: Politics and Change in
America. Westport, CT.: Auburn House, 1992: 15.
Wilkof, Abed. Universal Design: An Interpretation of the ADA. New York:
Van Nostrand Reinhold, 1994: 7.
Wilson, Gregg. Interview by author with building contractor regarding Villa
Gardens plans. Pasadena, California. 1 May, 1997.
Wood, Jerry S. Interview by author with program manager Plan Review
Section regarding fire and safety code. Pasadena, California. 4 April 1997.
89
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A P P E N D IX 1
VILLA GARDENS ENVIRONMENTAL ASSESSMENT SURVEY
(RESIDENT)
Neighborhood Context:
How safe is it to walk in this neighborhood? (check V one)
4% Very safe
49% Safe
46% Not safe(please specify)
How many times per week do you walk outside Villa Gardens ( e.g. to a local
store, restaurant, church, etc.)? (check V one)
36% Once a week
15% 2 to 3 times a week
31% More than 3 times per week
How satisfied are you with the location of Villa Gardens within this
neighborhood? (circle one)
Extremely Extremely
Satisfied Dissatisfied
1 17% 2 33% 3 28% 4 14% 5 5%
(if dissatisfied, please specify)
Would you feel safer if there was a secured gate around the Villa Gardens
Retirement community? (check V one)
Yes 14% No 78% (if yes, in what way?)
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N eighborhood Context: (continued)
Does the location of Villa Gardens have any impact upon your privacy?
(check V one)
Yes 6 % N o 90% (if yes, in what way?)
Is noise a problem at Villa Gardens? (check V one)
Yes 2 6 % No 72% (if yes, in what way?)
What mode of transportation do you use to get around? (check V one)
Own vehicle 96% Villa Gardens
Van 9.3% O ther 88%
Landscape and Building Exterior:
Do you feel comfortable spending time outside on the grounds of Villa
Gardens?
(check V one)
53% Extremely
30% Som ew hat
12% Do not feel comfortable(please specify)
How much time do you spend outside on the Villa Garden grounds per day?
(check V one)
58% Only to pass through
25% Less than 1/2 hour
6% 1/2 hour to less than one hour
11% An hour or more
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Landscape and Building Exterior: (continued)
At what time of the day are you usually outside? (check V one)
52% Before noon
32% A fternoon
1% Evening
Do you find it difficult, in any way, to get around the Villa Garden grounds
the outside of the building (e.g., uneven walkways, no place to rest, no
support rails)? (check V one)
Yes 1 4 % Mo 84% fif yes, what makes it difficult?)
Do you regularly engage in any activities when outside? (check V one)
Yes 1 4 % No 56% (if yes, please specify activities)
Where do you like to spend time when outside on the grounds?
Is there anything or any feature that makes this (outside) area special?
Please, describe the Villa Gardens' outdoor seating you prefer and why?
Now describe your least preferred outside seating.
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Landscape and Building Exterior: (continued)
Are there quiet areas outside where you can be alone or engage in private
conversation? (check V one)
Yes 49% fif yes, indicate where) N o 30% 20% no response
Are you ever reluctant to use an outside area due to limited access to the
building (e.g., locked doors)? (check V one)
Yes 4% No 81%
What do you think is the single most successful activity which was held on
the grounds of Villa Gardens in the past year?
What would you say are the most used outdoor recreational areas and please
indicate why?
What are the least used recreational areas and why?
Do you feel for safety and surveillance purposes that outside benches could be
better placed to observe people coming and going? (check V one)
Yes 1 0 % No 63% (if yes, how so?) 24% no response
Would you feel free to initiate or recommend alternate seating arrangements
outside? (check V one)
Yes 3 9 % N o 3 8 % ___ 23% no response
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Landscape and Building Exterior: (continued)
Are any outside areas currently used for informal social gatherings on a
regular basis? (check V one)
Yes 3 9 % No 38% (if yes, specify location) 23% no response
If you could change one feature of the outside landscape of Villa Gardens,
what would
that be?
Now I would like to have you rate the adequacy of the Villa Garden outdoor
space and grounds in the following areas: (circle one)
very
adequate inadequate
• Seating 1 11% 2 11% 3 16% 4 20% 5 19%
• Privacy 1 14% 2 9% 3 20% 4 11% 5 23%
• Recreational facilities 1 6% 2 15% 3 20% 4 19% 5 16%
• Shade 1 9% 2 15% 3 20% 4 20% 5 15%
• Landscape 1 25% 2 24% 3 15% 4 6% 5 10%
• Pathways 1 10% 2 9% 3 15% 4 19% 5 24%
Villa Gardens' Internal Space; Issues of Safety and Security
How safe do you feel safe living at Villa Gardens? (circle one)
very safe unsafe
1 78% 2 14% 3 4% 4 0% 5 4%
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Villa Gardens' Internal Space: Issues of Safety and Security , (continued)
Do you feel that the staff are readily available to offer assistance if needed on a
24 hour basis? (check V one)
Yes _8 9 % No 11% (if no, why not?)
Would you feel free to ask staff for help if needed? (check V one)
Yes _9 9 % N o_____1% fif no, why not?)
Does the management make it clear about which doors are unlocked/ locked
during day and how to gain access to the facility after hours? (check V one)
Yes 90% N o 4 % _ _
Are you able to easily get from your room to the dining room? (check V one)
Yes 99% No 1%
Does housekeeping equipment frequently impede use of handrails in
hallways, (check V one)
Yes_19% No 81%
Are floor surfaces throughout the building easy to walk over, even when
using an assistive walking device? (check V one)
Yes__95% N o 2%
Have you ever been bruised or injured on furniture with hard or sharp edges
within the common areas of Villa Gardens? (check V one)
Yes 1 2 % N o 86%
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Issues of Awareness and Orientation:
How adequate are emergency and other informational signs? (circle one)
very adequate inadequate
1 64% 2 20% 3 5% 4 4% 5 4%
How easy is it to find your way around the building? (circle one)
very easy difficult
1 64% 2 21% 3 7% 4 0% 5 5%
Are there distinguishing features on each floor and throughout facility (e.g.,
furniture, art work) to help a person identify their location? (check V one)
Yes 89% N o 7%
In the public corridors of Villa Gardens, are there views to the outside which
help you to orient yourself?(check V one)
Yes 90% N o 5%
Can you think of any locations in Villa Gardens that offer views of
simultaneous resident, staff or visitor activity? (check V one)
Yes__50% No 40% (if yes, please specify)
Support of Functional Abilities:
Are you currently receiving assistance from staff for any daily activities (e.g.,
bathing, dressing, eating)? (check V one)
Yes 1 2 % No 85% (if yes, please specify)
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Support of Functional Abilities: (continued)
Are restroom facilities adequately spaced throughout the public area?
(check V one)
Yes 89% N o_____ 9 % _____
Are faucets easy to use? (check V one)
Yes 94% N o_____ 2 % _____
Is the lighting adequate in your apartment? (check V one)
Yes 89% N o 7 % _____
Are meals served in a dignified manner and not rushed? (check V one)
Yes 96% N o 2%
Do you currently do any light cleaning of your apartment between
housekeeping visits? (check V one)
Yes_67% No 31% (if no, specify why not)
Have you ever experienced any difficulty in using the elevators at Villa
Gardens? (check V one)
Yes 52% No 46% (if yes, specify difficulty and elevator location)
97
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Support of Functional Abilities; (continued)
Do you encounter any difficulty in transporting your laundry between your
apartment unit and the laundry room? (check V one)
Yes _9 % No 90% (if yes, specify)
Is counter and storage space adequate in your apartment? (check V one)
Yes 63% N o 3 3 % _ _
Would you like to have your own garden? (check V one)
Yes 11% N o 8 6 % _ _
Are there opportunities for you to have your own garden? (check V one)
Yes _3 0 % No 57% (if yes,specify)
Social Contact and Interaction:
Can you identify 3 areas (in addition to dining room and apartment unit)
where people informally gather to socialize?
Does the placement of furniture allow for spontaneous social
interaction?(e.g., small clusters of chairs, seating near high activity centers
and in corridors).
(check V one)
Yes 8 0 % _____ No 9% (please explain)
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Social Contact and Interaction: (continued)
Are most of the social activities at Villa Gardens initiated and arranged by the
staff or by residents? (check V one)
Staff 48%______ R esidents _0 % ___ Both__4 9 % __
Provision of Privacy:
Do you feel your rights to privacy are respected? (check V one)
Yes 98% N o__0% (If no, explain)
Are there private spaces available (besides your room) at Villa Gardens where
you can be by yourself or with just one or two others? (check V one)
Yes 68% No 2 3 % __
Is any room in the facility available for resident worship services or personal
meditation on a regular basis?
Yes 5 3 % No 3 3 % __
If no, how important would it be to designate a space for this purpose?
very important not important
1 2% 2 0% 3 12% 4 6% 5 40% 40% no response
Do you have ready and confidential access to Villa Gardens staff,
management, or health care personnel (e.g., within the privacy of a staff
office)? (check V one)
Yes 95% No 2%
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Personal Control:
To what extent does the resident council have control concerning decision in
the following areas? (circle one)
extensive very limited don't
control control know
•
program m ing 1 10% 2 10% 3 23% 4 11% 5 12% 6 5%
•
staffing 1 2% 2 4% 3 7% 4 10% 5 38% 6 5%
•
food service 1 4% 2 9% 3 21% 4 19% 5 20% 6 5%
•
space usage 1 7% 2 2% 3 14% 4 11% 5 25% 6 5%
Do you have a choice of rooms or spaces (including outdoor spaces) available
to you at Villa Gardens? (check V one)
Yes 69% No 13%
Are there an adequate number of chairs and seating arrangements
throughout the facility?(check V one)
Yes 89%No 6% (if no, identify areas where more seating is needed)
How easy is it to control the temperature, lighting, and noise in your own
room ? (circle one)
easy difficult
• tem perature 1 74% 2 14% 3 2% 4 2% 5 2%
• lighting 178% 2 6% 3 4% 4 0% 5 4%
• noise 1 53% 2 14% 3 10% 4 4% 5 6%
Would you like to re-arrange furniture in your room? (check V one)
Yes 15% No 8 1 % ___
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Personal Control: (continued)
Are you allowed to do so? (check V one)
Yes 94% N o 1 % ___
Are you free to personalize the hallway entry to your apartment if you so
choose (e.g., light fixtures, doorbells, name placard)? (check V one)
Yes 8 4 % ___ No 1 2 % ___
If yes, have you chosen to do so?
Yes 63%____ No 22% (If yes, in what way and why?)
Regulation of Stimulation:
Would you say the amount of informational and directional signage is
(check v one)
inadequate 3% adequate 95% excessive 0%
Would you say the facility decor and amount of artifacts (e.g., paintings,
photos, floral arrangements) is (check V one)
inadequate 8% adequate 87% excessive 40%
Are you aware of regularly occurring and excessive odors (e.g., food, cleaning
solvents, untidy residents)? (check V one)
regularly 40% occasionally 21% rarely 74%
(identify source if regularly or occasionally)
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Quality of Stimulation:
Are you frequently aware of many competing sounds occurring at the same
time (e.g., clinking dishes, loud music, voices, air conditioning system)
(check V one)
Yes 10% No 84% (if yes, what would you change?)
Are you generally pleased with the facility decor
(check V one)
Yes 86% No 7% (if no, what would you change?)
Do you like the overall design of Villa Gardens?
(check V one)
Yes 93% No 2 % __
Summary:
Now I would like to ask you some final questions about your background,
health, money and insurance to help me get a profile of residents at Villa
Gardens. All your answers to these questions will be kept completely
anonymous and confidential.
Background Information:
Sex: (check V one)
1 [ 16% ] MALE
2 [ 81% ] FEMALE
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Background Information:
Please indicate your age group: (check V one)
1 [ 0% ] 62- 69
2 [ 20% ] 70- 79
3 [38% ] 80- 85
4 [ 31% ] 86- 91
5 [9% ] 92-98
What is your ethnicity?: (check V one)
1 [ 1% ] AFRICAN AMERICAN
2 [ 0% ] ASIAN
3 [ 95% ] CAUCASIAN/ ANGLO
4 [ 0% ] LATINO/HISPANIC
5 [ 0% ] MIXED RACE
6 [ 0% ] OTHER, s p e c i f y ______
Where were you born?(Please indicate country and state)
What is the highest grade of education you have completed? (check V one)
0% GRADE 1-11
4% HIGH SCHOOL GRADUATE
22% SOME COLLEGE
33% COLLEGE GRADUATE
31% POST GRADUATE
9% Ph.D, M.D., J.D.
What is your marital status? (check V one)
1 [17% ] MARRIED
2 [57% ] WIDOWED
3 [ 9% ] DIVORCED
4 [ 1% ] SEPARATED
5 [ 15% ] SINGLE, NEVER MARRIED
6 [ 0% ] LIVING WITH A PARTNER
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Background Information: (continued)
How long have you lived at Villa Gardens? (check V one)
10% LESS THAN 1 YEAR
11% 1 TO 2 YEARS
27% 3 TO 5 YEARS
40% 6 TO 9 YEARS
11% 10 YEARS AND OVER (please indicate if you are one of the
o rig in al resid en ts)____________________________
How would you evaluate your current financial condition? Would you say
that you are: (check V one)
1. [ 33% ] VERY COMFORTABLE FINANCIALLY
2. [ 20% ] SOMEWHAT COMFORTABLE
3. [ 42% ] COMFORTABLE
4. [ 4% ] SOMEWHAT UNCOMFORTABLE
5. [ 0% ] VERY UNCOMFORTABLE
6. [ 0% ] DON'T KNOW
Compared to people your own age, how would you rate your overall physical
health at the present time? (checkV one)
1. [ 25% ] Excellent
2. [ 56% ] Good
3. [ 16% ] Fair
4. [ 0% ] Poor
What type of room do you have?: (check V one)
1. [ 5% ] STUDIO
2. [ 57% ] ONE BEDROOM
3. [ 31% ] TWO BEDROOM
4. [ 1% ] SUITE
5. [ 4% ] HUSBAND AND WIFE SHARE AN APARTMENT
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Background Information: (continued)
Would you still choose to come to Villa Gardens if you had it to do over
again?
Yes 93% N o 4% C if no, why not)
If you had the power to change one thing about the environment at Villa
Gardens, what would that be? (Please write in your response)
Please include any recommendations you may have that you feel would
improve the facility. Feel free to write as much as you feel would be necessary
to clearly explain your suggestions (continue writing on the back of the
Survey if needed).
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APPENDIX 2
VILLA GARDENS ENVIRONMENTAL ASSESSMENT SURVEY
(Skilled Nursing Unit Residents)
BACKGROUND INFORMATION:
How long have you lived here?
11 %Less than 2 months 33% 2 to 12 months 44% Over 1 year
Sex: 1 [11% ] MALE
2 [89% [FEMALE
What is your age?: 81, 83, 86, 87,88,89, 89, 90, 96, 97,102
What is your ethnicity?: (check one)
1 [ 0% ] AFRICAN AMERICAN
2 [ 0% ] ASIAN
3 [100% ] CAUCASIAN/ANGLO
4 [ 0% ] LATIN HISPANIC
5 [ 0% ] MIXED RACE
6 [ ] OTHER, specify_______
What is the highest grade of education you have completed? (Check one)
11% GRADE 1-11
33% HIGH SCHOOL GRADUATE
0% SOME COLLEGE
0% COLLEGE GRADUATE
56% POST GRADUATE
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Background Information; (continued)
What is your marital status?
1 [ 11% ] MARRIED
2 [78% ] WIDOWED
3 [0% ] DIVORCED
4 [0% ] SEPARATED
5 [11% ] SINGLE, NEVER MARRIED
6 [0% ] LIVING WITH A PARTNER
How long have you lived at Villa Gardens?
25% I never lived in a Villa Gardens residence before coming to health unit
13% Less than 1 year 13% 1 to 3 years 0% 4 to 5 years
0% 6to 7 years 50% 8 to 10 years (are you one of the original residents)
Where were you living before coming to Villa Gardens?
78% In own home 22% Renting apartm ent 0% Living with children
_0% O ther (Please specify)__________________________
How many times per week do you get out of the skilled nursing unit to go to
a restaurant, church, for a walk, ride or any other kind of outing?
4 4 % __0 44% 1 to 4 times 1 1 % ___ Daily
Do you feel safe to go for a ride in a wheelchair in this neighborhood?
89% Yes 11% No (if no, please explain)
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N eighborhood Context:
Are you often bothered by close proximity to the Lake Avenue Church, the
fire station, or Lake Avenue?
11 % Yes 89% No (if yes, please explain)
Have you ever had any contact with the Lake Ave Church pre- school since
you have been here at the Health Center?
11% Yes 89% No (if yes, please explain)
If yes, was it an enjoyable experience and would you be agreeable to have
visits from the pre- school on a regular basis?
13% Yes 13% No (if no, please explain)
Now I would like you to rate your preferences for involvement with the Lake
Avenue pre-school in the following areas:(circle response in each category)
strong interest no interest
1 11% 2 0% 3 0% 4 22% 5 67%
1 0% 2 11% 3 11% 4 0% 5 78%
1 11% 2 22% 3 22% 4 0% 5 44%
1 0% 2 11% 3 0% 4 0% 5 89%
• reading to children
• observing children at the
playground
• viewing a Christmas play
• participating in a shared
gardening activity
Do you feel a sense of privacy even though Villa Gardens is located next to a
busy intersection?
89% Yes 0% No (if no, please explain)
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Neighborhood Context: (continued)
What mode of transportation do you use to go on outings from this facility?
67% Family d r i v e s 33% Villa Garden's Van ___ 0% O ther
(P lease sp ec ify )___________________________________________
Landscape and Building Exterior:
How much time do you spend outside of the Health Center, on the Villa
Gardens grounds per day?
56% Only to pass through
11% Less than 1/2 hour
33% 1/2 hour to less than one hour
0% An hour or more
In what activities, if any, do you engage in when outside?
At w h a t t i m e o f d a y a r e y o u u s u a l l y o u t s i d e ? ( c h e c k V o n e )
38% Before noon
63% A fternoon
0% Evening
Do you feel comfortable spending time outside the building?
75% Yes 25% No (if no, please explain why not)
Where do you like to spend time when outside on the grounds?
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Landscape and Building Exterior; (continued)
What makes this area special?
If you are not currently using a wheelchair, please describe the outside seating
you prefer and why?
Is there any outside seating that you avoid?
0% Yes 80% No (if yes, please explain)
20% no response____________________________________________
Are you able to get around the grounds and outside of the building by foot or
in a wheelchair without difficulty?
83% Yes 17% No (if no, what makes it difficult?)
Are there quiet protected areas outside where you can be alone or engage in
private conversation?
67% Yes 33% No
Are you ever reluctant to use an outside area due to limited access to the
building (e.g., locked doors)?
0% Yes 100% No
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Landscape and Building Exterior: (continued)
Can you think of one or more successful activities which were held on the
grounds of Villa Gardens in the past year?
38% Yes 68% No ( if yes, please specify)
Are residents encouraged by the staff to suggest outside activities?
63% Yes 38% No
Is outdoor seating adequate?
71% Yes 29% No (if no, please explain why not)
Would you feel free to recommend alternate seating arrangements outside?
71% Yes 29% No
Are any areas outside the skilled nursing unit currently used for informal
social gatherings on a regular basis?
60% Yes 40% No ( if yes, specify location)
If you could improve or change one feature of the outside landscape of Villa
Gardens, what would that be?
I ll
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Landscape and Building Exterior; (continued)
Now I would like to have you rate the adequacy of the Villa Garden outdoor
space and grounds in the following areas: (circle one in each category)
very
adequate inadequate
Seating 1 13% 2 25% 3 50% 4 13% 5 0%
Privacy 1 25% 2 0% 3 63% 4 0% 5 0%
Recreational facilities 1 13% 2 13% 3 50% 4 13% 5 13%
Shade 1 38% 2 13% 3 25% 4 13% 5 13%
Landscape 1 50% 2 13% 3 25% 4 0% 5 13%
Pathways 1 38% 2 25% 3 25% 4 13% 5 0%
Issues of Safety and Security: .
Do you feel that the staff are readily available to offer assistance if needed on a
24 hour basis?
78% Yes 11 % No (if no, please explain why not)
Do you feel free to ask staff for help when needed?
100% Yes 0 No (if no, please explain why not)
Does staff respond to your requests in a timely manner?
89% Yes 11% N o
Can you identify at least one exit from this facility?
89% Yes 11% N o
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Issues of Safety and Security: (continued)
Does housekeeping equipment frequently impede the use of handrails in
hallways?
25% Yes ___ 75% No
Are floor surfaces throughout the building easy to walk or move over,
whether a person is in a wheelchair or using a walker?
89% Yes 0% No (if no, please explain why not)
11% no response_______________________________________
Have you ever been bruised or injured on furniture with hard or sharp edges
within the common areas of the Villa Gardens skilled nursing unit?
11% Yes 89%No (If yes, please identify type and location of that
furniture)
___________11% no response________________________________________
Have you had any fall or other type of injury since living here?
0% Yes 89% No (if yes, please explain)
___________11% no response____________________________________
Are emergency and other informational signs clearly visible to you?
89% Yes _0 % N o 11% no response
Are you allowed to have personalized signs on the doors to indicate your
room ?
75% Yes 13% No
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Issues of Safety and Security: (continued)
Could you identify 2 areas (excluding bedroom and dining areas) in this
facility where specific activities take place?
Have you ever found it difficult to find your way around the facility or gotten
lost?
13% Yes ___88% N o
Are there certain landmarks which help you to find your room?
67% Yes 22% NoCIf yes, please specify)
Do you find it difficult to walk in certain sections of the facility due to glare
from flooring or confusing wallpaper patterns?
13% Yes 88% No (if yes, specify where)
Are there features you could name which distinguish your room from other
resident rooms?
Are there enough windows to allow you to orient yourself throughout the
facility to the outside?
89% Yes 11% N o
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Issues of Safety and Security: (continued)
Are you able to easily identify resident rooms, or your direction in halls and
corridors?
100% Yes 0% No (if no, please explain why not)
Support of Functional Abilities:
Is there enough room in your bathroom for staff to assist you with toileting
functions if needed?
100% Yes 0% No (if no, please explain why not)
How would you rate taking a bath at this facility?
0% An enjoyable experience 78% A routine experience
22% Highly stressful
If highly stressful, please explain
Are you able to get out of bed at night to use the bathroom?
56% Yes 33% No (if no, please explain why not)
_________ 11% no response________________________________________
How do you summon help?
Are any restroom facilities available for your use besides that in your room?
63% Yes ___38% N o
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Support of Functional Abilities: (continued)
Is counter space adequate in your bathroom?
50% Yes ___50% No
If using a wheelchair are you easily able to reach faucet controls and sink?
100% Yes 0% No (if no, please explain why not)
Are faucets, soap and towel dispensers easy to use?
100% Yes 0% No (if no, please explain why not)
Is there space in your room to display personal art, curios, and decorations?
67% Yes ___ 33% N o
Do you feel storage and counter space is adequate in your room?
56% Yes 44% Noflf no, please indicate how this might be improved)
Is the lighting adequate in your room?
67% Yes 33% Noflf no, please indicate how this might be improved)
Are you able to get things in/out of your storage areas and wardrobe without
asking for assistance?
89% Yes 11% No
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Support of Functional Abilities: (continued)
Does this facility have enough mirrors for resident use?
67% Yes _33% N o
Does the facility provide you with the assistive equipment or help you need
to care for yourself (including eating, dressing, toileting and bathing
functions)?
89% Yes 1 1 % ___ No
What assistive equipment, if any are you currently using?
Are you able to transfer in and out of bed on your own?
67% Yes ___ 33% N o
(if no, please explain why not and indicate amount of assistance required)
Are you currently receiving OT or PT to help you maintain your
independence?
33% Yes ___ 67% No
Are meals served in a dignified manner and not rushed?
67% Yes 33% No (if no, explain with suggestions for improvement)
Would you be interested in participating in any gardening activities at this
tim e?
11% Yes ___89% No
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Support of Functional Abilities: (continued)
Would you be able to have a garden space if you so desired?
22% Yes ____ 44% N o D on't know
Are you able to easily do any light cleaning of your room between
housekeeping visits if you so wish?
50% Yes 50% No (If no, please explain)
Do you have access to a washer or dryer?
11% Yes ____89% N o
Are you allowed to have a small refrigerator in your room?
11% Yes ____56% No 33% NA
Do you have a phone in your room?
50% Yes 50% No (if no, indicate why not)
If yes, are you able to use it without distraction?
71% Yes ______ N o 29% no response
Are public phones available in the facility?
67% Yes ____22% N o
118
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Support of Functional Abilities;
Is there an area where residents can get snacks, coffee, or have use of a
microwave oven?
Yes ___ 100% N o
Are activity supply storage areas available and accessible for residents
independent use?
50% Yes 2 5 % _ _ No
Do you have access to the Villa Gardens gift shop/store?
44% Yes 56% No (if no, indicate why not)
Are you ever able to make transactions using money at Villa Gardens?
22% Yes 78% No (if no, indicate why not)
Social Contact and Interaction:
Can you identify 2 areas (in addition to dining room and resident units)
where people can informally gather to socialize?
Does the placement of furniture encourage spontaneous social interaction?
38% Yes 50% No (please explain) 13% NA
119
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Provision of Privacy:
Do you feel your rights to privacy are respected here?
89% Yes 11 % No (please explain)
Are there semi- private spaces available (besides your room) where you can be
by yourself or with just one or two others?
44% Yes 56% No (if yes, please identify)
Do you have ready and confidential access to Villa Gardens' staff,
management or health care personnel (e.g., places where you can discuss
matters in private)?
88% Yes ______13% No
Have you ever had a choice in selecting a roomate since you have been here?
22% Yes ______78% No
Did you have a choice in having your own room or sharing it?
44% Yes ______56%__ No
If in a shared room, do you feel that you have enough privacy?
56% Yes 44% No (if no, please explain)
Does staff always knock before they enter your room or bathroom?
78% Yes ______22% No
120
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Provision of Privacy: (continued)
Is any room in the facility available for resident worship services or personal
meditation on a regular basis?
33% Yes ___56% No
Personal Control:
Do you have a choice of multiple rooms or spaces (including outdoor spaces)
available for your use?
56% Yes ___44% No
Do numerous activities occur simultaneously from which you are able to
choose?
44% Yes ____ 33% N o 22% no response
Do you have a choice of bath or shower?
( 2 Yes ____ 100% N o
Are there an adequate number of chairs throughout the facility?
89% Yes 11% No (if no, identify areas where more chairs are needed)
Do you have a choice of food?
89% Yes 11% No
Are you able to eat in areas other than in the dining room or have food in
your room?
89% Yes 11% No
121
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Personal Control: (continued)
Are you able to eat at times other than regular meal times?
22% Yes ___ 56% No
How easy is it to control the temperature, lighting, and noise in your own
room ? (circle one)
easy difficult
• tem perature 1 11% 2 11% 3 22% 4 0% 5 56%
• lighting 1 33% 2 11% 3 44% 4 11% 5 0%
• noise 1 11% 2 0% 3 44% 4 11% 5 33%
Regulation of Stimulation;
How would you rate the indoor temperature in this facility?
Comfortable 44% Too cold 22% Too warm 22%
Tends to fluctuate all the time 11%
Do you avoid certain areas because of glare (e.g., from windows, lights, wall or
floor surfaces)
22% Yes 67% No (if yes, specify)
Would you say the amount of informational and directional signage is:
0% Inadequate 100% A dequate 0% Excessive
Would you say the facility decor and amount of artifacts (e.g., paintings,
photos, and floral arrangements) is:
0% Inadequate 100% A dequate 0% Excessive
122
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Regulation of Stimulation: (continued)
Are you aware of regularly occurring and excessive odors (e.g., food, cleaning
solvents, human waste)?
0% Regularly 0% Occasionally 100% Rarely
Quality of Stimulation:
Are you frequently aware of many competing sounds occurring at the same
time (e.g., clinking dishes, paging system, loud music, air conditioning)?
56% Yes 44% No (if yes, indicate source)
Are informational signs and brochures geared more to the benefit of residents
or staff?
78% R esidents __0% Staff
Are you generally pleased with the facility decor
89% Yes 0% No (if no, what would you change)
Conclusion;
Would you still choose to come to Villa Gardens if you had to do it over
again?
78% Yes 11 % No (if no, why not?)
If you had the power to make one improvement or change to the Villa
Gardens' Health Center, what would that be?
123
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IMAGE EVALUATION
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1653 East Main Street
Rochester, NY 14609 USA
Phone: 716/482-0300
Fax: 716/288-5989
Q 1 9 9 3 , A pplied Im a g e , Inc.. Ail R ig h ts R e s e rv e d
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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Asset Metadata

Creator O'Connell, Myra Lynn Myers (author)

Core Title Aging in a continuing care retirement environment: A case study of Villa Gardens retirement community

School Leonard Davis School of Gerontology

Degree Master of Planning

Degree Program Gerontology,Urban Planning and Development

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Architecture,Gerontology,OAI-PMH Harvest,Social work

Language English

Contributor Digitized by ProQuest (provenance)

Advisor [illegible] (committee chair), [illegible] (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-25703

Unique identifier UC11337821

Identifier 1393181.pdf (filename),usctheses-c16-25703 (legacy record id)

Legacy Identifier 1393181.pdf

Dmrecord 25703

Document Type Thesis

Rights O'Connell, Myra Lynn Myers

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA