If you have friends or relatives in a nursing home, or live in one yourself, you may be familiar with the often standard offer. Residents are kept behind closed doors, rarely given the opportunity to step outside, instead sitting in armchairs in front of blaring televisions, surrounded by equipment more reminiscent of medical than domestic spaces, without the ability to make decisions about almost anything. A care home can be a large old house that has been clumsily converted, or a new build that is as ruthlessly cost-efficient as a distribution center or a budget hotel. Even if the staff and management are genuinely committed to the well-being of the residents (and there have been reported cases where this is not the case), it seems difficult to escape the ubiquitous numbing formula.
This is something you should be concerned about even if you are not yet old and do not suffer from dementia, as the above is a future that lies ahead for you. It is a problem for society in general, because the population is aging. It is also an area where architecture plays a role, because the physical environment can demonstrably improve or harm the well-being of residents. When done right, design can make caring for the elderly less stressful and more effective. It can reduce the need for expensive medical and other interventions.
For architects, who generally want to do more with their skills than add some style to an office building or a residential home, designing for the elderly and those with age-related diseases such as dementia gives them the opportunity to contribute to something social. value. And so you get works like the John Morden Center in Blackheath, south-east London – a daycare center for care home residents by MAE Architects, winner of last year’s Stirling Prize – and Appleby Blue in nearby Bermondsey, a ’21st-century almshouse” by Witherford Watson Mann. In both projects, the architects have made a lot of extra effort to achieve good daylight, among other things; strong feelings of connection with the outside and between different parts of the building; materials that are natural and enjoyable; and corridors that, rather than being functional passageways, are pleasant places to be.
The Village Landais Alzheimer, on the outskirts of the town of Dax in southwestern France, is a comprehensive effort to “give real life back” to people with Alzheimer’s, as one employee puts it, to “create conditions where they don’t.” Don’t just sit in a room waiting to die.” It is modeled after the Hogeweyk dementia village in the Netherlands, a celebrated 14-year-old facility with the appearance and layout of a village. The Dax project is similarly designed to have the life and appearance of a traditional community, with familiar and legible architecture based on features common to the region, albeit in simplified modern forms. There is a “bastide” – an arcaded square with a restaurant, library and other facilities – plus four clusters of houses, their roofs shallow and covered with clay tiles, surrounding a pleasant green space, with a pond and trees in the middle.
The project is a self-proclaimed experiment to test how its principles work in practice. It was initiated by the local government of the area, the département des Landes, and its budget of 28 million euros was largely financed by them with some help from regional and national governments. It serves 108 residents (who pay €2,000 per month and can receive assistance if they cannot afford this amount) plus 12 day care patients, with more than 120 staff and 80 volunteers. It pays particular attention to the needs of people with early-onset dementia, which means the ages of the current population range from 42 to 104 years. It was designed by the Danish practice Nord and local architects Champagnat & Grégoire.
Village Landais, which opened in 2020 and was recently highly praised at Dezeen’s annual design awards, aims to give the villagers, as the staff call them, as much choice and freedom, real and visible, as possible. The five-hectare complex is fenced, as it should be for the safety of vulnerable residents, but within its boundaries people can come and go, more or less as they please. They can walk through the open spaces (or run or cycle, because people with Alzheimer’s can also be physically fit), visit their neighbors, go to the restaurant or to a show in the village auditorium, take care of animals and plants in a mini – -farm and a vegetable garden.
Within each cluster of buildings, or neighbourhood, are individual ‘houses’, each with private bedrooms and a shared sitting and dining area, and a kitchen run by staff. These in turn look through glass walls into informal courtyards, to create the possibility of community with the other houses. The lanes are both sheltered and partly open, which gives a feeling of flow from one to the other. The paths around the village are laid out in loops, because people with Alzheimer’s sometimes get confused by dead ends. They also return walking routes towards the center and away from the border fence, which you hardly notice. The idea is to create an “impression of freedom,” says Mathilde Charon-Burnel, who manages social care projects for the department.
There are other details designed to soften the effects of the disease. The paving is uniformly beige in color everywhere, because strong contrasts can be disturbing for people with Alzheimer’s. Mirrors, which are also potentially disturbing, can be hidden by shutters. Light and dark are used to draw attention to where it should go, and to distract it from where it should not go. Light door handles are placed against a dark background and doors to service areas are barely noticeable in boarded walls. People with Alzheimer’s are “more curious than other people because they’re lost all the time,” says Charon-Burnel, so “if you put up a ‘no entry’ or ‘staff only’ sign somewhere, that’s where they go” . It is better to make the forbidden zones inconspicuous. “There is as little signage as possible,” says Morten Rask Gregersen of Nord. “People can see where they need to go instead of being shown.”
There is also a fantasy shop, where villagers can ‘buy’ products they don’t actually pay for, and a fantasy compartment of an old-fashioned train carriage, containing a screen on which the countryside scrolls by. Therapists use these to trick patients into thinking they have really been on a trip. You might think that such tricks would only add to their bewilderment, but I’m told they calm and reassure the residents.
The Dax project and those in Blackheath and Bermondsey serve different levels and types of needs. Appleby Blue is sheltered housing that offers residents more independence than is possible in an Alzheimer’s village. But the projects share a desire to respect the individuality and dignity of the people who live there, a recognition that you are still the person you were when you were younger. Also in this category is Bankhouse in Vauxhall, south London, run by housing association Tonic, a retirement community for LGBTQ+ people in a riverside tower designed by Foster + Partners. Here, residents receive not only housing units, but also shared facilities – art classes, a bar, a roof garden – that help create a community.
Dignity includes visibility. It is a strange feature of many care homes that passers-by almost never see the residents through their hermetic exteriors or in their deserted gardens, as if aging is something to be hidden from view. In Appleby Blue, the communal areas are located right next to a street and a bus stop, with the upper floor being on the same level as the upper deck of a double-decker, with generous windows allowing cozy views in both directions. The village of Dax is more remote, but the auditorium and library are open to the local community.
Most importantly, these projects seem to be working. In Dax the villagers seem cheerful, involved and relaxed. I meet a couple who got together after moving there, and who urge me to come back when the weather is better and the flowers are blooming. Charon-Burnel tells me that lower levels of anxiety cause fewer “behavioral problems,” which makes the caregivers’ jobs easier. More scientifically, independent research recently found that markers for things like cognitive decline and depression were significantly better in Dax village than in other care homes.
The most obvious challenge is that of scale. The number of people with Alzheimer’s disease in France is around 1 million, not to mention other forms of dementia. So it takes many projects like Village Landais to have an impact. But the principles of freedom of choice and respect are at least exportable to less special situations. The alternative is not only avoidable misery for the elderly, but also higher costs for the health problems that come with it. Why wouldn’t any of us want happier, healthier places for people nearing the end of our lives, especially since many of us will end up there ourselves?