Putting People First

We all need and love fresh air, sunlight and green space to thrive, which is what the late, great Harvard naturalist E.O. Wilson called "biophilia." Countless academic studies have shown that natural amenities are good for our physical/mental health and wellbeing. Human-centered design (HCD) places nature, people and their needs front and center.

In the wake of the COVID pandemic, architects, interior designers and others have broadly reconsidered how to provide higher-quality long-term care in various settings. HCD is a concept that is slowly triggering changes in how such facilities are designed.

"Human-centered design (HCD), with its systemic humane approach and creativity toward change, can play an essential role in dealing with today's complex care challenges," three academic researchers stated in an article in the International Journal of Quality Health Care.

Still, you could easily argue that the status quo in most memory care or assisted-living facilities ranges from drab to dreary. For the most part, they all have an institutional sameness that mimics slightly enhanced hospital wards. What if builders of these facilities designed them based on what people needed to feel human and not warehoused patients?

As a comprehensive approach, HCD focuses on the humane sum of its parts. How can improving and greening the built environment lead to better overall experience? For planners of spaces that cater to older Americans, HCD can offer added value, meaning designing "our care delivery system to fit people where they live, work, learn, play and receive health care," according to researchers Kim Erwin and Jerry Krishnan.

Architects employing HCD are increasingly making spaces more biophilic, that is, incorporating more natural elements such as light, plants and green space to complement a love — and need — for nature.

Some human-centered design considerations can be relatively straightforward. The Burnham Family Memory Care Residence at Avery Heights in Hartford, Connecticut, for example, incorporates light-filled rooms, casual sitting areas and garden access in a 10,000 square-foot space. The 20-unit assisted living "neighborhood" was remodeled and designed for residents with dementia.

Instead of cold, nondescript institutional interiors, designers wanted to provide a sense of home "while compensating for deteriorating eyesight in older adults with higher controllable levels of light and contrasting floor-to-wall surfaces," according to Myles Brown, an architect involved in designing and updating the facility.

The newer area includes an outdoor space with a patio for socializing, a walking/exercise path and garden gazebo. A selected mixture of native plants provides a variety of textures, colors and scents.

Do these changes make a difference in the quality of the residents' experience? Brown, from Amenta Emma Architects in Hartford, says "there's an important connection between biophilia and human-centered design, especially for older adults who typically spend more than 90% of their time indoors" in the memory care spaces he's designed. "They all have 'memory gardens' with direct and easy access from the indoors," he adds. "On the interior, they have maximum exposure to daylight."

Indeed, "daylighting" interior spaces can have a positive impact on the mental state of dementia patients. According to an article in the journal Clinical Interventions in Aging, "increased exposure to daylight can reduce depression in people living with dementia."

Many core elements of HCD also include what architects call "universal" design. This involves making subtle alterations to make every space safer and more accessible. Cabinets and drawers are located so that users don't need to bend over. Bathrooms and other rooms are fully accessible by people in wheelchairs or walkers. Area rugs are recessed into the floor to prevent falls.

Pantea Khoshnevis, a senior project manager with DAHLIN Architecture Planning Interiors in Pleasanton, California, notes that HCD and universal design employ "a deep understanding of who we're designing for," which often involves discussions with residents and other stakeholders. It can even embrace local history. Aegis Living Ballard in Seattle, a project that her firm designed for the assisted living and memory care developer and operator Aegis Living, is a five-story, 88,000-square-foot building featuring 92 assisted-living apartments and memory care.

"We studied the local heritage of this [predominantly] Scandinavian neighborhood," Khoshnevis said. While primarily focused on health and wellness, the community also features art installations and "green" walls of plants. The design is geared toward giving the residences a "homey" feel.

Using HCD principles, Ballard's designers strove to convey a sense of "belonging and safety, which helps dementia residents feel connected to the space and associate it with their home," she adds. "Throughout the interior, the Danish concept of hygge — a quality of coziness and comfort that fosters a feeling of community, contentment and wellbeing — is pervasive."

Interior details reflect and complement the neighborhood's canopy of oak trees and its proximity to water. Materials such as wood and leather, along with soft colors like "coastal blue," incorporate biophilic elements and are enhanced by the sound of water. This sensory calming is intended to "help minimize overstimulation and stress in dementia residents — a vital factor in the design for such a space."

While there is little research on how HCD buffers the impact of dementia-related conditions — if it has any meaningful effect at all — its more humane focus can provide more comfortable and dignified surroundings.

Many of these design-driven changes are occurring in unusual places such as shopping malls, where millions of square feet of commercial, office and retail space is being repurposed for older Americans.

How do you find a community that employs HCD? There's no single search engine keyword that consistently works, although you can try "evidence-based or people-centered design." Better yet, tour prospective facilities and take notes. Do they have ample natural light? Can residents safely access all spaces and go outside? Does it have a garden or green space?

A key resource that takes a deep dive into HCD is the Sage Federation, which illuminates design principles that are most essential in human senior communities.

The most humane communities try to make spaces more like homes with access to the environment. While HCD will not alleviate the heartbreaking conditions of dementia and long-term disability, they generally embrace a love of nature — rather than shutting it out.