A HEALTHCARE LANDSCAPE ADAPTIVE TO THE COURSE OF ALZHEIMER’S DISEASE.
A new typology of architecture for Alzheimer’s care facilities, characterized by an open spatial organization with the greatest possible integration into society in spatial and social terms. I see the potential in such facilities to develop an architecture that responds to the changed spatial perception of Alzheimer's patients. The maxim here is to reduce institutionalized constraints and to offer choices for a self-determined life within the framework of the respective possibilities.
Regional
Italy
South Tyrol
Mainly urban
It refers to a physical transformation of the built environment (hard investment)
Landscape Curativa is an environment that helps Alzheimer‘s patients to lead a self-determined everyday life in the different stages of the disease. The holistic approach includes a variety of offers for those affected and their families, from daycare to in-patient treatment, as well as offers for the neighborhood. The aim is to demonstrate a counter-position to the architectural attitude of isolating a care facility from society and to work out synergy effects. An overview of Alzheimer‘s disease and its spatial implications led to an analysis of the architectural context with different case studies. On this basis, the developed project uses its own design for a new type of care facility as a healthcare landscape.
The potential in such facilities is the development of an architecture that responds to the altered spatial perception of Alzheimer’s patients. By reducing institutionalized constraints and offering choices for a self-determined life within the framework of the respective possibilities. The inner restlessness and urge to move of those affected require an open landscape of movement areas, which integrates routines into a new form of circulation as a walk, where the routes will vary according to the patient’s personality and disposition.
Here the architecture plays with different spatial offerings that invite certain activities and generate intuitive access. In this context, the design responds to the different sensory impressions and does not lead to sensory overload. A conscious interplay of the built environment and natural impressions stimulates the person in a subtle way and helps to slow down the loss of cognitive abilities.
The project elaborates an approach to building for Alzheimer’s patients on several levels, through social and spatial integration and elaborating synergy effects for a neighborhood. At the exemplary location, the neighborhood Firmian in Bolzano, the design strategy is applied and extends it’s necessary social infrastructure.
Loss of spatial perception
Alzheimer care
Women empowerment through new architectural infrastructures
Future healthcare scenario
Synergy with the Peripheries
The construction time is reduced through the extensive use of a drywall structure and prefabricated materials, as well as the 'use of local materials for the interior cladding.
Using a green roof, the project has environmental, economic, and social benefits by allowing the regulation of rainwater flow, purifying the air, reducing the temperature of the outdoor environment, and regulating the temperature inside the building as well as saving energy by encouraging biodiversity in the area. As if that were not enough, the combination of the green roof with the housing units has a very positive effect on the cognitive faculties of the inhabitants.
Through the various patios integrated into the design, rainwater is collected, recovered, and reused for all activities that don’t require the use of potable water within the building such as toilet flushing, laundry washing, and irrigation of the green areas widely present in the structure.
In the large garden, there are various areas where self-catering gardens cared for by the residents and visitors add ecological value and constitute a mental and calming aid for the residents.
Through the spatial and architectural organization of the project, a possible change of use-thereby avoiding demolition-would be possible as a student residence (another service in high demand in the city due to the "young" expanding university).
The increase in infrastructural and social offerings in the neighborhood would result in less traffic to the city center.
The design plays with the relationship between private and common spaces. Based on the analysis of Alzheimer's disease and the typological development of care architectures, the private retreat space is of particular importance. This place becomes a familiar environment for the resident through personal objects from earlier times. The resident is free at any time to withdraw from the community in a self-determined manner and to find peace in their own room. Each unit consists of a main room and vestibule facing a patio in front of the unit, which is an interpretation of a traditional porch and forms the threshold between intimate and communal areas. The circulation system intends to encourage the residents to interact with each other offering a wide range of spatial qualities from intimate to public. The familiar character promotes identification with the community. The many viewing relationships within the group are part of the therapeutic strategy of training the cognitive abilities of those with Alzheimer's disease through subtle stimulation. The communities are integrated into a health landscape with a wide range of offerings from formal therapy rooms to informal activities that arise spontaneously integrating everyday routines into a new form of circulation as a walk. In this way, the respective care is composed of individual care services for every stage, as the course of Alzheimer's disease is very dependent on the person. In addition, there are offers that help to integrate the neighborhood and create synergy effects such as childcare, multifunctional spaces for the neighborhood, etc. The Landscape Curativa surrounds a health garden adjacent to agricultural fields where linear cultivation is incorporated into the design process. Here, four main zones all of which radiate in linear form from the main building into the surrounding area provide a range for sensory stimulation and are open to the neighborhood, and provide a stage for daily stories.
Alzheimer's is a very spatial disease and progresses in several phases, leading to varying degrees of cognitive and physical impairment. The person with Alzheimer's reacts very sensitively to changes and so the move to a home can additionally aggravate the respective situation. The transition from home to an unfamiliar accommodation could be made easier through inclusive architecture that responds to the altered spatial perception of Alzheimer's patients reducing institutionalized constraints and offering choices for a self-determined life within the framework of the respective possibilities. To put it bluntly, the inner restlessness and urge to move of those affected requires an open landscape of movement areas rather than long corridors that end in dead ends. The daily routine in this Alzheimer's care facility integrates routines into a new form of circulation as a walk varying its routes according to the patient's personality and disposition. In this scenario, the architecture plays on this landscape with different spatial offerings that invite certain activities and generate intuitive access and inclusion. In this context, the design responds to the different sensory impressions. A conscious interplay of the built environment and natural impressions stimulates the patient in a subtle way and helps to playfully slow down the loss of cognitive abilities.
A central task is the development of an attitude towards the degree of privacy in a community shelter including integration in social and spatial terms, elaborating synergy effects for the neighborhood. At an exemplary location in Bolzano, the developed design strategy is applied and thus the newly built district Firmian is expanded by a necessary social infrastructure, which also offers new forms of use and offers for the neighborhood beyond the care services for Alzheimer's patients.
This project represents a contribution to the current discussion about the integration of a care facility into society and elaborates on possible synergy effects, in which a care home gives an infrastructure for a whole neighborhood, a location at the border to the periphery of Bolzano has offered itself as a location for this draft. The border of the city to the periphery has potential from the point of view of urban expansion because here a great demand for basic social services such as medical care and social services will arise in the foreseen future. The Firmian area is located in the south of Bolzano and is one of the most recent urban developments. Between 2006 and 2016, intensive residential construction was carried out here and attractive apartments were created however with a big flaw, as a broad offer for the new residents is missing in terms of jobs, leisure activities, and gastronomy, leading to the fact that a mere “dormitory suburb” was created where inhabitants are in those areas only to sleep. Integral urban planning has to respond adequately to this phenomenon and create incentives that revitalize the place.
As the core concept of this healing landscape plays with the relationship between private spaces and common spaces, the integration in social and spatial terms of the neighborhood was a central task. It would result in a synergy effect for the whole area by expanding its (needed) social infrastructure, generating new forms of use and offers for the neighborhood beyond the care services for Alzheimer's patients such as childcare, restaurant, local amenities, and multifunctional spaces for the neighborhood.
In the initial part dealing with research, interviews were conducted with representatives of the social services company of the city of Bolzano, with the head of the Alzheimer's department of the Don Bosco nursing home in Bolzano in order to understand the opinions, needs, and state of the art of elderly care in the regional health care system.
Through these exchanges, the importance of integrating into the design of a space without architectural limitations and obstacles for patients was highlighted.
Taking into account the various levels of privacy to be integrated yet maintaining an architectural character that is open to the outside world so as to combat the isolation that often results from the lack of adequate facilities for Alzheimer's patients.
Through interviews and exchanges during the design phase with relatives of Alzheimer's patients and the feminist association SeNonOraQuando, the experience from informal caregivers was gathered, and how the increase of elderly care facilities could also benefit women's empowerment.
A sociological study of the South Tyrolean population and the national health care system highlighted the central problem of the increased need for facilities for diseases of age and the need for an architectural model that could cover all three stages of the disease to support the patients and the families.
A historical study of the architectural types of nursing homes has revealed difficulties given by the use of hospital-like facilities for a clientele with needs of everyday life. This prevailing attitude in elderly care architecture evolved in the course of the 20th century from a landmark of the welfare state coming to the nowadays reintegration of care facilities into society on a sociological as well as architectural level.
A study of the symptomatology was crucial for design strategy, with Alzheimer being a disease with deep impact on the perception of space as each person develops their own communication strategies that are difficult to decipher and reacts individually to stimuli. Architecture has a special role to play in meeting the new needs of the person. The remaining relationship with the social environment and the built environment must be preserved and promoted but special care needs must be addressed in order to minimize dangers for the person. Integrating new methods of communication into the daily lives of those affected through spatial configurations, the influence of architecture can maintain the remaining understanding of relationships with places, people, and objects for as long as possible reflecting the core of needs. In addition to the social environment, the built environment takes on a compensatory role in everyday life and emotions can be better processed through familiar spaces of retreat and create a sense of grounding. Through a stable and empathic architectural environment, the progression of Alzheimer's disease cannot stop, but it can reduce behavioral problems and the decline of the abilities necessary for an independent life.
This project examines the potential of a new typology of architecture for an elderly-care center, which is characterized by an open spatial organization with the greatest possible integration into society in terms of space and social aspects, by specifically addressing the wandering behavior and the impairment of the spatial perception that Alzheimer’s patients go through every day. Through an intuitive architecture the daily “stroll” is empowered through different circulation loops, where no constant reorientation is needed, which results in less stress for the patient, as opposed to many conventional elderly care centers which are developed through a linear architecture.
This Landscape Curativa is an environment that helps Alzheimer‘s sufferers to self-determine everyday life in the various stages of the disease. The holistic approach includes a wide range of services for affected persons and their families, from daycare to inpatient treatment, as well as offers for the neighborhood such as childcare, medical care, and shopping facilities. The aim of the Landscape Curativa is to show a new strategy in contrast to the conventional architecture of isolating care facilities from society and to merge synergy effects through a radical crosslinking of the center in the environment way before the worsening of the disease.
The main qualities of the Landscape Curativa are the stimulation through space and the possibility of activities in order to allow the person the chance of individuality until the very last day.
The spatial methodology sees the rejection of the conventional linear model of nursing homes through the model of a miniature safe city where residents can live the day with maximum individuality through the loop walking approach where a free development of their own everyday routine is made possible individuality come to the foreground.
While the social methodology wants to engage with the different levels of belongingness through micro (the living communities) and macro neighborhoods, which is allowed through the use of an intuitive, open, and safe architecture.
Since Landscape Curativa it is an architectural model, the model, and its qualities could be replicated in all those areas that suffer from a lack of social infrastructure and at the same time need facilities for the care of the elderly.
The generation pyramid is increasingly reversing. With declining birth rates and the resulting increase in small households, the challenges for the current care system will grow enormously. This results in the urgent need to think about the future ways of the entire care management, because care can no longer be burdened almost exclusively on families, especially those of the elderly. According to the evaluation forms of the 2016 AFI, 84.2 % of the main caregivers in the family environment are still women. This role is still compared to the housework and both culturally and socially there is a tendency to replicate the model of the last century, in which the man performed the productive role and the woman the reproductive one, becoming one of the many obstacles to achieving equal opportunities and equality.
The crisis of the current care system, highlighted by the pandemic, has revealed an urgent need for modernization and adaptation to contemporary social roles. Informal family caregivers play an important role in the South Tyrolean care system, but this leads to the conclusion that it is not a sustainable economic system in the long run:
The interviews with the coordinators of the self-help groups for family caregivers showed that care at home is not the optimal solution but is made necessary by the lack of places in inpatient facilities or by long waiting lists for a place.
Having facilities designed for the elderly, starting from a female point of view, from a baggage of experience that often women in particular carry with them through a narrative "from mother to mother", would lead to invalidating women's sense of guilt and duty to take care. Such facilities, would encourage the inclusion of older people who can no longer care for themselves can, in environments that are comfortable, bearers of aesthetics, efficiency, warmth, and to this end allow positive social interaction between people.
