Architect, environmental gerontologist and GBHI Fellow, Emi Kiyota, led us in a journal club discussion about her paper, “Co-creating Environments: Empowering Elders and Strengthening Communities through Design” (Hastings Center Report, 2018) and Diana Anderson’s 2019 Architecture Ireland article, “The Ethics of Healthcare Architecture.”. We examined several architectural approaches to institutional housing for elders with dementia in the U.S. and abroad, and discussed the ethical implications of these designs for facility inhabitants and society at large.
Emi began by framing architecture as a human rights issue, emphasizing its potential to liberate or confine those whom it engages. We compared the impact of different design elements on residents in several assisted-living homes, from sprawling outdoor walkways that foster socialization in Dementia Villages to murals of halcyon landscapes disguising doors to artificially preserve familiar settings and prevent attempted exits. We discussed the importance of creating dynamic environments that challenge residents’ cognitive and physical skills through environmental press; for example, by erecting a staircase or offering alternative routes to a singular destination. Efforts to balance safety and freedom, and stability and spontaneity within nursing homes encouraged rich dialogue about paternalism, elder dignity, and environmental restraint. We also explored culturally-driven views toward nursing homes and elder care, with members of our group sharing their experiences with widespread stigma in rural parts of Mexico, elder abuse in Peruvian facilities, and inclusion of adults with dementia as restaurant employees in Japan.
We questioned the moral permissibility of the nursing home as a concept: At its best, it serves as a place for elders to thrive among one another with special services to accommodate their diminished competencies. At its worst, it operates as place for corralling individuals deemed burdensome and incapable of functioning in society. Some discussants instead advocated for integration of persons with dementia within their existing communities through litigation, education efforts, and clever design solutions, for instance, printing cards for caregivers to subtly notify strangers of their care-recipient’s cognitive status. Throughout our conversation, we acknowledged the tension surrounding architecture for persons with dementia produced by an amalgamation of conflicting factors, from the challenge of creating an enjoyable living place with limited funds to the desire to grant elders privacy while also avoiding injury and isolation.