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Senior citizen housing implementing a continuum of care environment Marek, Danna S. 1989

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SENIOR CITIZEN HOUSING IMPLEMENTING A CONTINUUM OF CARE ENVIRONMENT By DANA S. MAREK .M.Sc, The T e c h n i c a l U n i v e r s i t y of Warsaw, 1967 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ADVANCED STUDIES IN ARCHITECTURE THE FACULTY OF (School of i n GRADUATE STUDIES A r c h i t e c t u r e ) We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA September 1989 © Dana Susanne Marek, 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of S c h o o l o f A r c h i t e c t u r e The University of British Columbia Vancouver, Canada Date O c t o b e r , 1 9 8 9 DE-6 (2/88) i i A b s t r a c t In the l a s t twenty f i v e years the h e a l t h of i n d i v i d u a l s worldwide has changed. L i f e expectancy has s u b s t a n t i a l l y i n c r e a s e d and the p r o p o r t i o n of o l d e r c i t i z e n s i s growing c o n s t a n t l y . T h i s growing p o p u l a t i o n of e l d e r l y people w i l l dominate the housing market i n the coming y e a r s . An i n c r e a s e d demand f o r housing and h e a l t h care s e r v i c e s f o r the e l d e r l y c a l l s not o n l y f o r much g r e a t e r supply than we have ever experienced, but a l s o f o r new approaches, one of which i s based on the g r a d u a t i o n of care. P r o v i n c i a l and l o c a l governments are l o o k i n g f o r innova-t i v e o p t i o n s and design s o l u t i o n s which c o u l d meet the needs and e x p e c t a t i o n s of a new wave of s e n i o r s a t the end of t h i s century. I t i s the i n t e n t i o n of t h i s t h e s i s to i d e n t i f y and d e f i n e what are the u n d e r l y i n g p r i n c i p l e s i n p l a n n i n g housing and s e r v i c e s f o r the contemporary e l d e r l y . The T h e s i s has been developed as a r e s e a r c h c y c l e based on a three-phase methodology of a n a l y s i s - s y n t h e s i s - e v a l u a t i o n . A n a l y s i s commences with comprehensive r e s e a r c h i n t o e x i s t i n g f a c i l i t i e s and i n t r o d u c e s the n o t i o n of m u l t i - l e v e l care of the e l d e r l y . I t i n v e s t i g a t e s the r e a l meaning of the q u a l i t y environment w i t h i n the e l d e r l y f a c i l i t y i n terms of a c o n t i n u -um of h i s / h e r l i f e s t y l e . S y n t h e s i s d e f i n e s the phenomenon of the continuum of care environment i n the f u l l s c a l e f a c i l i t y program f o r the proposed Continuum of Care Complex (CCC) i n West P o i n t Grey i n Vancouver, B.C. E v a l u a t i o n i n v e s t i g a t e s i i i the f e a s i b i l i t y of the program implementation on a t e s t s i t e . A b a s i c premise of the t h e s i s i s t h a t a m u l t i - l e v e l care f a c i l i t y i s a v i a b l e way of a c h i e v i n g an environment, which may f u l f i l l a comprehensive a r r a y of needs of the e l d e r l y . I t should i n c l u d e housing a l t e r n a t i v e s f o r the e l d e r l y , both i n terms of tenure and s u p p o r t i v e s e r v i c e s , but above a l l should provide a s p e c i f i c ambiance equal to a home-like environment. The t h e s i s has been s t r u c t u r e d as a h y p o t h e t i c a l model of a programming system based on the p r i n c i p l e of the continuum of care. T h i s model i n c l u d e s f o u r major f u n c t i o n a l components of the proposed complex: r e s i d e n t i a l , long-term care, community s e r v i c e s and outdoor a c t i v i t y spaces t h a t b l e n d i n g t o g e t h e r c r e a t e a q u a l i t y environment. T h i s model has been developed i n the r e a l s i t u a t i o n of the P o i n t Grey Community on the p r i n c i p l e of an a c t i v e i n t e r a c t i o n . Subsequently t h i s model has been t e s t e d on a s e l e c t e d s i t e i n terms of i d e n t i f i c a t i o n of o p p o r t u n i t i e s and c o n s t r a i n t s which may a f f e c t s u c c e s s f u l program implementation. The t h e s i s concludes t h a t a h y p o t h e t i c a l model of the Continuum of Care Complex can be s u c c e s s f u l l y implemented on the s e l e c t e d t e s t s i t e of the P o i n t Grey Community. "Continu-um of Care" environment f o r the e l d e r l y developed i n the model may s a t i s f y a broad range of needs f o r the e l d e r l y : p h y s i c a l , p h y s i o l o g i c a l and s o c i o p s y c h o l o g i c a l . i v TABLE OF CONTENTS A b s t r a c t i i - i i i Table of Contents i v - x i i L i s t of F i g u r e s x i i i - xv L i s t of Tables x v i - x v i i Acknowledgements x v i i i I n t r o d u c t i o n 1 - 1 3 1. The O r i g i n of my Th e s i s 1 2. Problem Statement: B r i t i s h Columbia Background 1 - 3 3. D e f i n i t i o n of Continuum of Care 3 - 4 4. I n t e n t i o n s of the T h e s i s 4 - 6 5. Research Questions 6 - 7 6. O b j e c t i v e s of the T h e s i s 7 - 8 7. Methodology 8 - 1 2 8. Layout of the T h e s i s 12 - 13 Chapter 1 - The Continuum of Care Concept 14 - 42 Chapter Summary 14 1.1 L i t e r a t u r e and P r o j e c t s review: Concepts of M u l t i - L e v e l e l d e r l y housing. 14 - 17 1.1.1 Greater Vancouver Regional D i s t r i c t Area and B r i t i s h Columbia. 17 - 27 1.1.2 Canada 27 - 28 V 1.1.3 Europe 28 - 29 1.1.4 The United S t a t e s of America 29 - 34 1.1.5 C o n c l u s i o n 34 1.2 Review of the C u r r e n t P o l i c i e s of the E l d e r l y Housing 35 - 39 1.2.1 F i n d i n g s , Problem Statement and Summary 40 - 41 1.3. The CCC i n P o i n t Grey as One of the Options and Innovative Approaches to S o l v i n g the E l d e r l y Housing Problem. 41 - 42 1.4 R a t i o n a l e of the T h e s i s 42 Chapter 2 - Supply and Demand: A n a l y s i s of the E l d e r l y Housing Options and S e r v i c e s  i n Vancouver and West P o i n t Grey Area. 43 - 63 Chapter Summary 43 2.1. The Contemporary E l d e r l y : T h e i r Means and E x p e c t a t i o n s 43 - 48 2.1.1 Current Trends 43 - 45 2.1.2 Features C h a r a c t e r i s t i c s of S e n i o r C i t i z e n s - the Future C l i e n t s of the Continuum of Care Complex (C.C.C.) 4 5 - 4 8 2.2 The E l d e r l y i n Vancouver 48 - 55 2.2.1 E l d e r l y P o p u l a t i o n : the People and T h e i r Houses 48 - 53 2.2.2 Reluctance to Move Versus A t t r a c t i v n e s s of a New Place 53 - 54 2. 2. 3 C i t y ' s Housing P o l i c i e s and Market Forces 55 2. 3 The e l d e r l y i n P o i n t Grey 55 - 62 2. 3. 1 Vancouver West S i t e : Trends and P r e f e r e n c e s 55 - 58 2. 3. 2 The E x i s t i n g S e n i o r Housing i n P o i n t Grey 58 - 59 2. 3. 3 The E x i s t i n g Long Term Care F a c i l i t i e s 59 2. 3. 4 A Need f o r Long Term Care F a c i l i t i e s 59 - 60 2. 3. 5 A Need f o r S e n i o r Centre 61 2. 3. 6 P o i n t Grey: D e s t i n a t i o n f o r the E l d e r l y 61 - 62 2. 4 The S i t e of the Continuum of Care Complex at 4th Ave & Highbury S t r e e t . 63 Chapter 3 - The CCC F a c i l i t y O b j e c t i v e s 64 98 Chapter Summary 64 I n t r o d u c t i o n 64 - 65 3. 1 L i v i n g Environment O b j e c t i v e s (L.E.O.) 65 - 73 L.E.O. #1 - Q u a l i t y Environment 65 - 70 #2 - S a f e t y and S e c u r i t y 70 - 71 #3 - V a r i e t y of Environments 71 - 73 3. 2 R e s i d e n t s ' O b j e c t i v e s (R.O.) 73 - 82 R.O. #1 - R e s i d e n t i a l Tenure Choice 74 - 77 #2 - H e a l t h Care Needs 77 - 79 #3 - S o c i a l Needs 80 - 81 3. 3 F a c i l i t y Management O b j e c t i v e s (F.M.O.) 81 - 86 F.M.O. #1 - Autonomy and U s e f u l n e s s of Residents 82 - 83 #2 - Independence 83 v i i #3 - P e r s o n a l i z a t i o n and C o n t r o l 84 #4 - F r i e n d l y P h y s i c a l Environment 84 - 85 #5 - C e n t r a l i z a t i o n of Supportive S e r v i c e s 85 - 86 3.4 Community O b j e c t i v e s (CO.) 86 - 92 C O . #1 - Care f o r the L o c a l E l d e r l y . 86 - 88 #2 - Access to Neighbourhood Resources. 88 - 89 #3 - L i f e S u s t a i n i n g Resources 89 #4 - Community Network 89 - 91 #5 - L i f e E n r i c h i n g Resources 91 - 92 *6 - Business I n t e g r a t i o n 92 Neighbourhood Development O b j e c t i v e s (N.D.O.) 92 - 98 N.D.O.#l - C h a r a c t e r and L i v a b i l i t y 92 - 93 #2 - C o m p a t i b i l i t y 93 #3 - S t r e e t s c a p e 93 - 94 #4 - Views 94 - 95 #5 - Minimize Noise Impact 95 #6 - P r i v a c y 95 - 96 #7 - Secure Environment 96 #8 - V a r i e t y of Open Spaces 96 - 97 #9 - Landscaping 97 3.6 C o n c l u s i o n 97 - 98 Chapter 4 - The CCC F a c i l i t y Components 99 - 123 Chapter Summary 99 I n t r o d u c t i o n 99 - 100 v i i i 4. 0 S i z e of the F a c i l i t y 100 - 101 4. 1 Housing - Independent L i v i n g 101 - 103 4. 1. 1 BCHMC Housing - N o n - P r o f i t Rental Housing 103 - 105 4. 1. 2 Co-Operative Housing 105 - 106 4. 1. 3 S t r a t a - T i t l e Housing (Condominiums) 106 - 107 4. 1. 4 S e r v i c e s i n the Independent L i v i n g Housing 107 - 108 4. 2 Housing f o r Persons R e q u i r i n g Long Term Care 108 - 109 4. 2. 1 Intermediate Care F a c i l i t y 109 - 111 4. 2. 2 Extended Care F a c i l i t y 111 - 112 4. 2. 3 The Number of Long Term Care Beds 112 - 114 4. 3 The Core Centre 114 4. 3. 1 Core Centre Component I - L i f e E n r i c h i n g Resources - C u l t u r a l Centre 115 - 116 4. 3. 2 Core Centre Component I I - L i f e S u s t a i n i n g Resources - Heal t h Centre 117 - 118 4. 3. 3 Core Centre Component I I I - S o c i a l I n t e r a c t i o n and Business I n t e g r a t i o n . 118 4. 3. 4 Core Centre Component IV - Supporting and Maintenance Components. 118 4. 4 Outdoor Spaces 118 - 121 4. 4. 1 Outdoor Space Components 119 - 121 4.5 C o n c l u s i o n 122 - 123 Chapter 5 - General Program Requirements 124 - 229 Chapter Summary 124 i x 5.1 R e s i d e n t i a l Housing - Independent L i v i n g C l u s t e r 124 5.1.1 F u n c t i o n a l Components 124 - 127 5.1.2 Housing P a t t e r n and C r i t i c a l Issues 128 - 132 5.1.2.1 Shape (Layout) of the C l u s t e r 128 - 129 5.1.2.2 C l u s t e r I d e n t i t y 129 - 132 5.1.2.3 R e l a t i o n s h i p with the Core Centre 132 5.1.3 Dw e l l i n g U n i t s 133 - 134 5.1.3.1 F u n c t i o n a l Components 133 5.1.3.2 Category of Users and T h e i r Needs 134 5.1.4 P r i v a t e Outdoor Space - Independent L i v i n g Housing 134 - 139 5.1.4.1 I n t r o d u c t i o n 134 - 135 5.1.4.2 Elements of P r i v a t e Space 135 - 137 5.1.4.3 Issues i n Designing P r i v a t e Outdoor Spaces 137 - 139 5.2 Dependent L i v i n g - Intermediate Care F a c i l i t y 140 - 151 5.2.1 F u n c t i o n a l Components 140 - 142 5.2.2 L i v i n g U n i t s - P a t t e r n and C r i t i c a l I ssues 143 - 151 Issue #1 - Sense of r e s i d e n c y 143 - 146 Issue #2 - F l e x i b i l i t y 146 Issue #3 - L i n k with the Core Centre -Wayfinding w i t h i n the CCC F a c i l i t y 147 - 151 5.3 Dependent L i v i n g - Extended Care F a c i l i t y 152 - 164 5.3.1 F u n c t i o n a l Components 152 5.3.2 L i v i n g U n i t s P a t t e r n and C r i t i c a l Issues 152 - 156 Issue #1 - C l u s t e r Approach 152 - 153 Issue #2 - R e s i d e n t i a l Character 153 - 154 Issue #3 - Home l i k e Environment 154 - 155 Issue #4 - P a t i e n t L i v i n g U n i t -P r i v a c y Issue 155 - 156 5.3.3 P r i v a t e Outdoor Spaces i n the Dependent L i v i n g - Long Term Care F a c i l i t y 156 - 164 5.4 Core Centre 165 - 166 5.4.1 Main Concourse 167 - 171 5.4.2 Food F a i r - D i n i n g 172 - 176 5.4.3 Food S e r v i c e s F a c i l i t y 177 - 181 5.4.4 R e h a b i l i t a t i o n Centre 182 - 186 5.4.5 A r t s and C r a f t s 187 - 190 5.4.6 Auditorium and S p e c i a l Programs 191 - 193 5.4.7 A d m i n i s t r a t i o n 194 - 197 5.4.8 C l i n i c 198 - 201 5.4.9 Pharmacy 202 - 205 5.4.10 L i b r a r y 206 - 208 5.4.11 S t a f f Support F a c i l i t i e s 209 - 211 5.4.12 Laundry S e r v i c e s 212 - 213 5.4.13 P l a n t S e r v i c e s 214 - 215 5.4.14 B u i l d i n g S e r v i c e s 216 - 217 5.4.15 M a t e r i a l S e r v i c e s 218 - 220 5.5 F a c i l i t y Common Outdoor Space 221 - 227 5.6 Parking and Road Network w i t h i n F a c i l i t y 228 229 Chapter 6 - F e a s i b i l i t y of Program Implementation on the S e l e c t e d S i t e : T h e s i s C o n c l u s i o n . 230 _ 273 Chapter Summary 230 E v a l u a t i o n i #1: S i t e L o c a t i o n and S i z e 230 - 236 6.1.1 R a t i o n a l e 230 - 233 6.1.2 L o c a t i o n 233 - 235 6.1.3 O p p o r t u n i t i e s 235 6.1.4 C o n s t r a i n t s 236 6.1.5 C o n c l u s i o n 236 E v a l u a t i o n i #2: Land Use Context 237 - 240 6.2.1 O p p o r t u n i t i e s 237 6.2.2 C o n s t r a i n t s 237 - 239 6.2.3 C o n c l u s i o n 240 E v a l u a t i o n #3: P u b l i c T r a n s p o r t a t i o n , V e h i c u l a r and P e d e s t r i a n Access. 240 - 246 6.3.1 O p p o r t u n i t i e s 240 - 241 6.3.2 C o n s t r a i n t s 241 - 245 6.3.3 C o n c l u s i o n 245 - 246 E v a l u a t i o n #4: S i t e P h y s i c a l C h a r a c t e r i s t i c 246 - 251 6.4.1 O p p o r t u n i t i e s : S i t e N a t u r a l Resources 246 - 250 6.4.2 C o n s t r a i n t s 250 6.4.3 C o n c l u s i o n 250 - 251 E v a l u a t i o n #5: Space Ch a r a c t e r and Views 251 - 254 6.5.1 O p p o r t u n i t i e s 251 - 253 x i i 6.5.2 C o n s t r a i n t s 253 6.5.3 C o n c l u s i o n 253 - 255 E v a l u a t i o n #6: Housing P a t t e r n s 255 6.6.1 R a t i o n a l e 255 6.6.2 P a t t e r n No.l 256 - 261 6.6.3 P a t t e r n No.2 261 6.6.4 P a t t e r n No.3 262 6.6.5 P a t t e r n No.4 262 6.6.6 C o n c l u s i o n 263 - 272 F i n d i n g s and T h e s i s C o n c l u s i o n 273 - 283 References 284 - 288 Appendices 289 - 310 LIST OF FIGURES F i g . 1- 1 H o l l y b u r n House - Main F l o o r 21 F i g . 1- 2 South G r a n v i l l e Park - T y p i c a l F l o o r Lodge 21 F i g . 1- 3 St. M i c h a e l ' s Centre - Main F l o o r 24 F i g . 1- 4 Parkwood Manor - Main F l o o r 24 F i g . 1- 5 A b b e y f i e l d Concept - Main F l o o r 26 F i g . 1- 6 Arbutus Ridge V i l l a g e - S i t e P l a n 26 F i g . 1- 7 H a u s j a r v i Health Care F a c i l i t y - S i t e Plan and R e s i d e n t i a l C l u s t e r Layout 30 F i g . 1- 8 Motion P i c t u r e and T e l e v i s i o n Country House and H o s p i t a l - E x i s t i n g S i t e P l a n and Proposed S i t e Development 32 F i g . 1- 9 Regent P o i n t - S i t e Plan 33 F i g . 2- 1 1981 - S i n g l e Family Households with Member Age 65+ 50 F i g . 2- 2 1991 - S i n g l e Family Households with Member Age 65+ 51 F i g . 2- 3 2001 S i n g l e Family Households with Member Age 65+ 52 F i g . 2- 4 P r o j e c t i o n of Se n i o r Housing Needed by 2001 to Accommodate E l d e r l y Homeowners 53 F i g . 2- 5 Number of C l i e n t s R e c e i v i n g Long Term Care Home Support or F a c i l i t y S e r v i c e s by L e v e l of Care (December 1986) 60 F i g . 2- 6 Number of C l i e n t s W a i t l i s t e d f o r Long Term Care Placement by l e v e l of Care (December 1986) 60 F i g . 4- 1 Access and C o n t r o l Model of the CCC F a c i l i t y 123 F i g . 5- 1 Common Space i n the C l u s t e r as a Garden 130 F i g . 5- 2 Common Space i n the C l u s t e r with Shared Walkway 130 x i v F i g . 5- 3 C l u s t e r I d e n t i t y R e i n f o r c e d by a C e n t r a l S i t t i n g Area and Shared Storage Shed 131 F i g . 5- 4 P e d e s t r i a n C i r c u l a t i o n Developed as a "Feeder" System. 131 F i g . 5- 5 Independent L i v i n g Outdoor Spaces 136 F i g . 5- 6 Long-Term Care F a c i l i t y Access Model 145 F i g . 5- 7 Intermediate Care F a c i l i t y 149 F i g . 5- 8 Intermediate Care C l u s t e r Type 1 150 F i g . 5- 9 Intermediate Care C l u s t e r Support 151 F i g . 5- 10 P r i v a t e Outdoor Spaces i n Nursing Home 158 F i g . 5- 11 Extended Care F a c i l i t y 162 F i g . 5- 12 Extended Care C l u s t e r Type 1 163 F i g . 5- 13 Extended Care C l u s t e r Support 164 F i g . 5- 14 Core Centre 166 F i g . 5- 15 Main Concourse 171 F i g . 5- 16 Food S e r v i c e s 181 F i g . 5- 17 R e h a b i l i t a t i o n Centre 186 F i g . 5- 18 A r t s and C r a f t s 190 F i g . 5- 19 Auditorium and S p e c i a l Programs 193 F i g . 5- 20 A d m i n i s t r a t i o n S u i t e 197 F i g . 5- 21 C l i n i c 201 F i g . 5- 22 Pharmacy 205 F i g . 5- 23 L i b r a r y 208 F i g . 5- 24 Outdoor Common Space 227 F i g . 6-•1 L o c a t i o n and S i z e 234 F i g . 6-2 Land Use Context 238 F i g . 6-•3 P u b l i c T r a n s p o r t a t i o n and V e h i c u l a r Access 242 XV F i g . 6-4 P e d e s t r i a n Access 243 F i g . 6-5 S i t e Topography 247 F i g . 6-6 V e g e t a t i o n and Landscaping 248 F i g . 6-7 P u b l i c and P r i v a t e Views 252 F i g . 6-8 P a t t e r n 1 257 F i g . 6-9 P a t t e r n 2 258 F i g . 6-10 P a t t e r n 3 259 F i g . 6-11 P a t t e r n 4 260 x v i LIST OF TABLES Table 2-1 P r o j e c t i o n s of the E l d e r l y Home owners and the P o t e n t i a l Movers i n Vancouver: (1981 census) 53 Table 4- 1 Housing Choices i n the CCC F a c i l i t y 102 - 103 Table 5- 1 Housing Type #1: Rental Housing Space Program 126 Table 5- 2 Housing Type #2: Co-op Housing, 50 D w e l l i n g U n i t s Space Program 127 Table 5- 3 Housing Type #3: S t r a t a T i t l e , 50 D w e l l i n g U n i t s Space Program 127 Table 5- 4 Intermediate Care C l u s t e r Space Program 142 Table 5- 5 Extended Care C l u s t e r Space Program 160 - 161 Table 5- 6 Main Concourse Space Program 170 Table 5- 7 Food F a i r Space Program 176 Table 5- 8 Food S e r v i c e s F a c i l i t y Space Program 180 Table 5- 9 R e h a b i l i t a t i o n Centre Space Program 185 Table 5- 10 A r t s and C r a f t s Space Program 189 Table 5- 11 Auditorium and S p e c i a l Programs Space Program 192 Table 5- 12 A d m i n i s t r a t i o n Space Program 196 Table 5- 13 C l i n i c Space Program 200 Table 5- 14 Pharmacy and Dispensary Space Program 204 Table 5- 15 L i b r a r y Space Program 207 Table 5- 16 S t a f f Support F a c i l i t i e s Space Program 211 Table 5- 17 Laundry S e r v i c e s Space Program 213 Table 5- 18 P l a n t S e r v i c e s Space Program 215 Table 5- 19 B u i l d i n g S e r v i c e s Space Program 217 x v i i Table 5-20 M a t e r i a l S e r v i c e s Space Program 220 Table 5-21 F a c i l i t y Common Outdoor Area Space Program 226 Table 5-22 Par k i n g Area Program 229 Table 6-1 Use of Resources, T r a v e l Time and D i s t a n c e to Resources 231 x v i i i Acknowledgements I would l i k e to express my g r a t i t u d e to P r o f e s s o r J o e l Shack f o r h i s s u p e r v i s i o n and encouragement. My s i n c e r e thanks are to P r o f e s s o r G l o r i a Gutman and A r c h i t e c t C h a r l o t t e Murray f o r t h e i r c o n s t r u c t i v e c r i t i c i s m and comments. Furthermore, many thanks to P r o f e s s o r Rose Murakami f o r her p a r t i c i p a t i o n i n the d i s c u s s i o n of the t h e s i s . I would l i k e a l s o to thank A r c h i t e c t E m i l Marek, Ph.D., my husband, and M i c h a e l , my son, f o r t h e i r advice and a s s i s t a n c e . F i n a l l y , I am very g r a t e f u l to Canada Mortgage and Housing C o r p o r a t i o n f o r the s c h o l a r s h i p which has made t h i s t h e s i s p o s s i b l e . 1 INTRODUCTION 1. THE ORIGIN OF MY THESIS My p e r s o n a l i n t e r e s t i n f a c i l i t i e s f o r the e l d e r l y began i n 1970 when I was i n v o l v e d i n a number of p r o j e c t s as an a r c h i t e c t i n Poland. While working on an Intermediate Care F a c i l i t y I began to f e e l t h a t the e n t i r e programming and design process i s missing something. I r e a l i z e d t h a t d e s i g n i n g f o r the e l d e r l y i s a unique problem because the needs of those people change almost on a day-to-day b a s i s . Designing a b u i l d i n g which responds to a s p e c i f i c program aimed at a s p e c i f i c group of e l d e r l y seems not to be an e f f e c t i v e approach to the needs of the e l d e r l y . I came to understand t h a t the e n t i r e programming and design process should not be c o n s i d e r e d a t r a d i t i o n a l a r c h i t e c t u r a l three dimen-s i o n a l problem but r a t h e r needs a fo u r dimensional approach. The f o u r t h dimension i s TIME -- the p r i n c i p a l f a c t o r i n under-standing the needs of e l d e r l y people. T h i s i d e a puts the whole p r o j e c t d e l i v e r y system i n a new p e r s p e c t i v e . 2. PROBLEM STATEMENT: BRITISH COLUMBIA BACKGROUND In the l a s t seventy f i v e years worldwide l i f e expectancy has s u b s t a n t i a l l y i n c r e a s e d and the p r o p o r t i o n of o l d e r c i t i z e n s has grown and i s growing c o n s t a n t l y . By the end of t h i s century, i n Canada and p a r t i c u l a r l y i n B r i t i s h Columbia the growing popula-t i o n aged 65 years and over w i l l c r e a t e c h a l l e n g e s i n the way of he a l t h c a r e , housing and p s y c h o - s o c i a l supports. T h i s s i t u a t i o n c a l l s f o r p l a n n i n g f o r housing and h e a l t h care s e r v i c e s f o r the e l d e r l y not o n l y i n much g r e a t e r s c a l e than we have ever e x p e r i -2 enced, but a l s o f o r a new approach based on the g r a d u a t i o n of care. Therefore the Problem, which I am i n v e s t i g a t i n g i n t h i s t h e s i s c o u l d be summarized b r i e f l y as f o l l o w s : "What are the u n d e r l y i n g p r i n c i p l e s i n plan n i n g housing and s e r v i c e s f o r the contemporary e l d e r l y ? " Since the number of o l d e r persons age 75 and over c o n t i n u e s to expand, housing with s u p p o r t i v e s e r v i c e s on s i t e (medical and pe r s o n a l care) w i l l be i n great demand. New housing forms t h a t provide f r e e c h o i c e , maximize independence, s t i m u l a t e the c r e a -t i v e and s e l f - e x p r e s s i v e needs of i n d i v i d u a l s and optimize con-t r o l over the environment are s t r o n g l y needed. The n o t i o n of graduation of care organized and d e l i v e r e d i n one s e t t i n g seems to be the a l t e r n a t i v e approach i n p l a n n i n g f o r the e l d e r l y . That n o t i o n has been s t r o n g l y endorsed by The Canadian Medical A s s o c i a t i o n (1987, p.22). F a c i l i t i e s designed f o r use by e l d e r l y people can be charac-t e r i z e d by t h e i r s p e c i f i c s u p p o r t i v e l i v i n g and s o c i a l e n v i r o n -ments, and by d e l i v e r y of p e r s o n a l , s o c i a l and h e a l t h care s e r -v i c e s . The s e r v i c e s t h a t e l d e r l y people need can range from very low - i n a f u l l y independent person's p r i v a t e home to the high l e v e l of s e r v i c e s provided i n a n u r s i n g home. In B r i t i s h Columbia, the p r o v i n c i a l government c u r r e n t l y uses the f o l l o w i n g terminology (see Appx # 0-1) to d e s c r i b e the range: 1. those e l d e r l y capable of Independent L i v i n g (IL) 2. those r e q u i r i n g P e r s o n a l Care (PC) 3 3. those r e q u i r i n g Intermediate Care (3 l e v e l s : IC1, IC2, IC3) 4. those r e q u i r i n g Extended Care (EC) In the l a s t f o u r decades, the g u i d i n g p h i l o s o p h y i n d e v e l o p i n g housing f o r the e l d e r l y has undergone a r a d i c a l change. At the time when most "homes f o r the aged" where b u i l t , such f a c i l i t i e s were co n s i d e r e d more i n s t i t u t i o n a l than r e s i d e n t i a l b u i l d i n g s . The c r i t i c s of the i n s t i t u t i o n a l model proposed t h a t the b e s t s o l u t i o n was to keep the e l d e r l y i n t h e i r own homes, but the problem could not be so l v e d because of the p r o h i b i t i v e c o s t s i n the p r o v i s i o n of s o c i a l and h e a l t h care s e r v i c e s to p r i v a t e homes. As noted above, i n B r i t i s h Columbia there are f i v e l e v e l s of care f o r the e l d e r l y : Personal Care, Intermediate Care (3 l e v e l s ) and Extended Care. However, there i s no p r a c t i c a l example of a comprehensive f a c i l i t y i n B r i t i s h Columbia which has implemented space f l e x i b i l i t y and program a d a p t a b i l i t y (as t r a n s i t i o n between the "go-go" e l d e r l y and "slow-go" e l d e r l y ) t h a t would p r o v i d e graduation of care f o r a l l l e v e l s i n one p l a c e . 3. DEFINITION OF CONTINUUM OF CARE A Continuum of Care f o r the e l d e r l y p r o v i d e s a l l l e v e l s of care i n one l o c a t i o n . A Continuum of Care f a c i l i t y can p r o v i d e a continuum of housing and care from independent l i v i n g to n u r s i n g care at the Extended Care l e v e l . The r a t i o n a l e behind the Continuum of Care idea i s to develop a new program f o r the e l d e r l y f a c i l i t y which might f u l f i l l e l d e r l y ' s d i v e r s e and 4 changing needs. Groups of people with s i m i l a r needs and r e q u i r e -ments w i l l be accommodated i n c l o s e p r o x i m i t y t o one area w i t h i n p a r t i c u l a r components of a "Continuum of Care Complex" (CCC) which w i l l o f f e r a r e l a t i v e l y f i x e d range of s e r v i c e s . How-ever, they w i l l a l s o have access to a g r e a t e r v a r i e t y of s e r -v i c e s i n the whole Complex. A "Continuum of Care Complex" might a l s o provide a d d i t i o n a l s e r v i c e s f o r the e l d e r l y t h a t l i v e i n the neighbourhood. 4. INTENTIONS OF THE THESIS In t h i s T h e s i s ["Senior C i t i z e n Housing, Implementing a Con-tinuum of Care Environment"], I propose an a l t e r n a t i v e approach to p l a n n i n g housing and s e r v i c e s f o r the e l d e r l y . The t h e s i s has been developed as a h y p o t h e t i c a l model of a planning/programming system based on the p r i n c i p l e of the continuum of care, with the v a r i o u s elements b l e n d i n g together. T h i s h y p o t h e t i c a l model i n terms of a f a c i l i t y program has been developed i n the r e a l s i t u a -t i o n of the P o i n t Grey Community on the s e l e c t e d t e s t s i t e . T h i s t h e s i s i s an " a r c h i t e c t u r a l i n v e s t i g a t i o n " which f o c u s -es on " f a c i l i t y programming" f o r an i n n o v a t i v e approach to a Continuum of Care f a c i l i t y . F a c i l i t y programming i s f i r m l y e s t a b l i s h e d today as an important and necessary i n g r e d i e n t of the design process. According to Palmer (1981), programming i s an a n a l y t i c a l aspect of design. Programming, as an i n f o r m a t i o n -p r o c e s s i n g system, i n v o l v e s a d i s c i p l i n e d methodology of data c o l l e c t i o n , a n a l y s i s , o r g a n i z a t i o n , communication and evalua 5 t i o n . The t h e s i s i s based on the f o l l o w i n g c y c l e : a n a l y s i s -s y n t h e s i s - e v a l u a t i o n : 1. ANALYSIS of the data d i s c o v e r e d i n the process of the a r c h i t e c t u r a l i n v e s t i g a t i o n . 2. SYNTHESIS of the f i n d i n g s i n the form of a CCC f a c i l i t y program. 3. EVALUATION of the p o s s i b i l i t y of the program development on the s e l e c t e d t e s t s i t e . T h i s T h e s i s w i l l t r y to d e f i n e a "continuum of car e " environment f o r the e l d e r l y i n terms of a program of housing as w e l l as p e r s o n a l , s o c i a l and h e a l t h care s e r v i c e s on one s i t e . Generic r e s u l t s w i l l be b a s i c f u n c t i o n a l components (such as Extended Care), but s p e c i f i c w i l l be the a p p l i c a t i o n of compo-nents to a t e s t s i t e as an e v a l u a t i v e p rocess c o n s i s t i n g of i n n o v a t i v e approach i n addressing the needs of the e l d e r l y a t a l l d i f f e r e n t l e v e l s of care and a l s o the way such a f a c i l i t y should respond to i t s s i t e and neighbourhood. In my t h e s i s I w i l l d e f i n e a "Continuum of Care" environment which may s a t i s f y a broad range of needs f o r the e l d e r l y : phy-s i c a l , p h y s i o l o g i c a l and p s y c h o l o g i c a l . On the b a s i s of the p u b l i s h e d r e s e a r c h and my p r i v a t e o b s e r v a t i o n s I w i l l s e t up a Program which w i l l address t h i s p a r t i c u l a r environment and i d e n t i f y the design v a r i a b l e s which may improve q u a l i t y of l i f e f o r the e l d e r l y . My r e s e a r c h study w i l l be a p p l i e d on a s i t e i n P o i n t Grey, Vancouver, B r i t i s h Columbia. The F e d e r a l N a t i o n a l Defence Lands 6 s i t e has a unique s e t t i n g i n Vancouver c l o s e to J e r i c h o Beach and UBC. The s u b j e c t s i t e may serve as a pl a c e f o r f u t u r e development of housing as w e l l as a f a c i l i t y f o r s e n i o r s . The Planning Department recommends th a t F l o o r Space R a t i o be 1.0 to 1.45 and a l s o t h a t new development be compatible with the surrounding area of m u l t i - f a m i l y and s i n g l e f a m i l y housing. However, there are no o f f i c i a l g u i d e l i n e s r e g a r d i n g the s c a l e and scope of proposed development. T h i s t h e s i s w i l l be the f i r s t attempt i n proposing a s e n i o r c i t i z e n s ' housing develop-ment on t h i s s i t e . 5. RESEARCH QUESTIONS Group I -- In terms of d e f i n i n g the e l d e r l y f a c i l i t y as a c o n t i n u a t i o n of the e l d e r l y person's l i f e s t y l e : 1. What o p p o r t u n i t i e s and c o n s t r a i n t s r e s u l t from moving an e l d e r l y person from h i s / h e r home to t h i s proposed CCC f a c i l i t y ? 2. How has the g u i d i n g p h i l o s o p h y i n de v e l o p i n g housing f o r the e l d e r l y changed i n the l a s t four decades? Group I I -- In terms of d e f i n i n g the phenomenon of the "continuum of care environment": 1. How can the CCC f u l f i l l the needs and e x p e c t a t i o n s of e l d e r l y r e s i d e n t s ? 2. How can the CCC respond to the needs of the neighbourhood's e l d e r l y r e s i d e n t s ? 7 3. What are the most important q u a l i t i e s i n c r e a t i o n of the CCC environment? Group I I I -- In terms of the CCC s i t e development p o t e n t i a l : 1. What s i t e development o p p o r t u n i t i e s and c o n s t r a i n t s e x i s t on the t e s t s i t e ? 2. How can the outdoor spaces of the CCC respond to the p r o g r e s s i v e l e v e l s of care and t h e i r c o r r e s p o n d i n g s e r v i c e s ? 6. OBJECTIVES OF THE THESIS The p r i n c i p l e o b j e c t i v e of my r e s e a r c h study i s to f i n d out what can be done: 1. To c r e a t e an o p p o r t u n i t y f o r l i v i n g i n one place as long as p o s s i b l e . The e l d e r l y should be able to continue to l i v e i n the same pl a c e as long as p o s s i b l e and i f a move i s necessary because of d e t e r i o r a t i n g h e a l t h c o n d i t i o n s , i t should be w i t h i n the same f a c i l i t y . 2. To c r e a t e a s p e c i a l home-like environment which would f u l -f i l l a comprehensive a r r a y of e l d e r l y needs such as: eco-nomics ( a f f o r d a b i l i t y ) , s o c i o - p s y c h o l o g i c a l ( s u p p o r t i v e environments, peer groups) and p h y s i c a l (good q u a l i t y ; designed and l o c a t e d to accommodate the e l d e r l y with d i f f e r -ent l e v e l s of dependency). 3. To respond to the above o b j e c t i v e s a t the same time as p r o v i d i n g a way of l i f e f o r the e l d e r l y which w i l l r ecognize t h e i r i n d i v i d u a l r i g h t s , such as p r i v a c y , s e l f - d e t e r m i n a -t i o n , i n t e g r a t i o n and a l s o w i l l p r o v i d e the compensatory 8 resources of the environment i n terms of a b a r r i e r - f r e e d e s ign, v a r i e t y of l i v i n g , a t t r a c t i v e i n t e r i o r s e t t i n g and landscape design. 7. METHODOLOGY The t h e s i s f o l l o w s a resea r c h method c y c l e of a n a l y s i s , s y n t h e s i s and e v a l u a t i o n : 7.1 ANALYSIS of c o l l e c t e d data: A. A n a l y s i s of e x i s t i n g f a c i l i t i e s f o r the e l d e r l y with d i f f e r e n t l e v e l s of dependency. 1. Type of re s e a r c h : a r c h i t e c t u r a l i n v e s t i g a t i o n and design data g a t h e r i n g . I have s e l e c t e d e i g h t e x i s t i n g f a c i l i t i e s (see Appx. #0-2) f o r the e l d e r l y i n the Vancouver area, one i n H a l i f a x , and three i n C a l i f o r n i a , U.S.A. The s e l e c t i o n was based on i n f o r m a t i o n from the l i t e r a t u r e (Gutman 1976; Carstens 1985; CMHC Conference 1988) and p e r s o n a l communications. The p r i n c i p l e c r i t e r i o n i n s e l e c t i n g these examples was t h a t they are f a c i l i t i e s which have implemented a p o l i c y of graduation of c a r e , o r g a n i z e d and d e l i v e r e d i n one s e t t i n g . I was s p e c i f i c a l l y l o o k i n g f o r the f u n c t i o n a l components mix and t h e i r c o n t r i b u t i o n to the q u a l i t y of the continuum of care environment. 2. Research methods: Comparative a n a l y s i s of design p r i n c i p l e s : 9 The purpose of these analyses was to come up with programmatic c r i t e r i a and i n t e n t i o n s f o r a F a c i l i t y Program implementing the Continuum of Care concept. The Research procedures I was u s i n g : 2.1 F i n d i n g out how design d e c i s i o n s were made: a. A n a l y s i n g the a r c h i t e c t s * plans and r e c o r d s . T h i s process provided a b a s i s f o r hypotheses which were explo r e d i n the e v a l u a t i o n of the p r o j e c t s . I t c l a r i f i -ed the goals of both the designer and the c l i e n t i n the e a r l y p l a n n i n g stages of the design. A n a l y s i s of the d e s i g n e r ' s plans over the p e r i o d of design development r e v e a l e d how ideas changed and were e v e n t u a l l y i n c o r p o -r a t e d i n the f i n a l design. b. I n t e r v i e w i n g the A r c h i t e c t s T h i s step allowed f u r t h e r e x p l o r a t i o n of the a r c h i -t e c t ' s design ideas and o b j e c t i v e s , p r o v i d i n g informa-t i o n about how and why s p e c i f i c d e s i g n d e c i s i o n s were made. c. P e r s o n a l Observations i n the e x i s t i n g f a c i l i t i e s : numerous s i t e v i s i t s , watching the behaviour of r e s i d e n t s , i n t e r v i e w i n g r e s i d e n t s and p a t i e n t s , i n t e r v i e w i n g management and s t a f f . B. ANALYSIS of L i t e r a t u r e : 1. Type of r e s e a r c h : i n v e s t i g a t i o n and data g a t h e r i n g on contemporary models of housing f o r the e l d e r l y . 2. Research methods: review of the a v a i l a b l e l i t e r a t u r e d e a l i n g with the s p e c i f i c i s s u e s d i r e c t l y r e l a t i n g to the CC environment: 10 a. L i v i n g environment f o r the e l d e r l y . b. Psychology of aging process. c. S o c i o l o g y i n terms of how the p o s t - i n d u s t r i a l s o c i e t y should take care of i t s e l d e r l y people. d. Plans and l a y o u t s of new and i n n o v a t i v e design s o l u t i o n s implemented i n long-term care f a c i l i t i e s . C. INTERVIEWS 1. Type of r e s e a r c h : S t r u c t u r e d i n t e r v i e w s with p r o f e s s i o n a l s i n v o l v e d i n the s u b j e c t of my t h e s i s (see Appendix #0-3). There i n c l u d e d the f o l l o w i n g : A r c h i t e c t s Long-Term Care F a c i l i t y A d m i n i s t r a t o r s . F a c i l i t y Programmers. Health Care A u t h o r i t i e s O f f i c i a l s Developers Residents C i t y H a l l Planners 2. Research Methods: a l l i n t e r v i e w s have been c a r e f u l l y s t r u c -t u r e d i n order to o b t a i n maximum i n f o r m a t i o n on v a r i o u s sub-j e c t s and f u n c t i o n a l component i s s u e s r e l a t i n g to my t h e s i s ; i n p a r t i c u l a r I was l o o k i n g f o r s p e c i f i c i n f o r m a t i o n con-c e r n i n g : A r c h i t e c t s : p l a n s , l a y o u t s , environment. Developers: market trend s , s e r v i c e p r e f e r e n c e s , f i s c a l aspects of p r o j e c t f i n a n c i n g . 11 C i t y p l a n n e r s : zoning r e g u l a t i o n s and d e sign g u i d e l i n e s . H e a l t h O f f i c i a l s : l o c a l care needs. Residents: t h e i r needs. D. ANALYSIS of e x i s t i n g L e g i s l a t i o n and Design G u i d e l i n e s (see Appendix #0-4). 1. Type of r e s e a r c h : i n v e s t i g a t i o n and comparative a n a l y s i s of the s t a t u t o r y r e g u l a t i o n s r e l a t i n g to the f u n c t i o n a l components developed i n t h i s t h e s i s . 2. Research Methods: i d e n t i f i c a t i o n of e x i s t i n g r e g u l a t i o n s i n terms of: a. area, space requirements. b. s e r v i c e and t e c h n i c a l r e g u l a t i o n . c. user needs and demands. d. program components e. o p e r a t i o n p o l i c y g u i d e l i n e s . 7.2 SYNTHESIS i n the form of the CCC F a c i l i t y program (Chapter 4 & 5) . 1. Type of approach: i n t e r d i s c i p l i n a r y -- a r c h i t e c t u r e , gerontology, s o c i o l o g y . 2. The methods: f u l l programming c y c l e (data o r g a n i z a t i o n and data communication) l e a d i n g to the d e f i n i t i o n of components of a f a c i l i t y program f o r the CCC F a c i l i t y i n the P o i n t Grey Area i n Vancouver. 7.3 EVALUATION i n the form of the f e a s i b i l i t y of CCC program development on the s e l e c t e d t e s t s i t e . 12 1. Type of approach: comprehensive s i t e a n a l y s i s i n terms of a program implementation on the t e s t s i t e . 2. The methods: d e f i n i n g development o p p o r t u n i t i e s and con-s t r a i n t s i n a t e s t s i t e s i t u a t i o n . 8. LAYOUT OF THE THESIS The t h e s i s i s s u b d i v i d e d i n t o an i n t r o d u c t i o n , f i v e chapters which develop the argument of t h e s i s and a c o n c l u d i n g chapter s i x . The s t r u c t u r e of the t h e s i s f o l l o w s the methodology out-l i n e d i n p o i n t 7.1 - Research Cycle and Methods. The s i x chap-t e r s of the t h e s i s are d i v i d e d i n t o a three segment r e s e a r c h c y c l e : a n a l y s i s - s y n t h e s i s - e v a l u a t i o n as f o l l o w s : ANAYLYSIS: T h i s segment i n c l u d e s chapter one and two. I t g i v e s an overview of the e x i s t i n g trends i n contemporary f a c i l i t i e s f o r the e l d e r l y with emphasis on the m u l t i l e v e l approach. T h i s p a r t p r o v i d e s a l s o a review of new p o l i c i e s i n the p l a n n i n g of f u t u r e housing and long-term care f a c i l i t i e s i n the G r e a t e r Vancouver Region a l D i s t r i c t . As w e l l , d i s c u s s i o n of the s o c i a l p r o f i l e of the p o t e n t i a l r e s i d e n t s i n the P o i n t Grey Area, serves as a background f o r the t h e s i s . SYNTHESIS: T h i s segment i n c l u d e s chapter t h r e e , f o u r and f i v e . I t s y n t h e s i z e s the f i n d i n g s of the p r e v i o u s segment i n t o a comprehensive f a c i l i t y program. 13 EVALUATION: the c o n c l u s i o n of my re s e a r c h study t h e s i s i s presented i n chapter s i x . I t c o n t a i n s a comprehensive s i t e a n a l y s i s i n the form of a f e a s i b i l i t y study of development i n a r e a l s i t u a t i o n . 14 CHAPTER 1 - THE CONTINUUM OF CARE CONCEPT Chapter Summary: Chapter 1 i s the beginning of the t h e s i s a n a l y s i s c y c l e and i n t r o d u c e s the n o t i o n of m u l t i - l e v e l of care of the e l d e r l y . On the b a s i s of s e l e c t e d examples, three major trends or approaches to the e l d e r l y f a c i l i t i e s have been i d e n t i f i e d . A n a l y s i s of the l i t e r a t u r e and a c t u a l p r o j e c t s , l e d to s e v e r a l c o n c l u s i o n s about m u l t i - l e v e l care f a c i l i t i e s and c h a r a c t e r i s t i c design f e a t u r e s c o n t r i b u t i n g to a q u a l i t y environment. Many of those f i n d i n g s have been implemented i n the t h e s i s s y n t h e s i s p o r t i o n . Current P r o v i n c i a l and GVRD p o l i c i e s and recommendations r e g a r d i n g housing f o r the e l d e r l y have been analyzed. These f i n d i n g s provided grounds to s t a t e the Problem. The Chapter concludes with the proposed Continuum of Care Complex i n a r e a l s i t u a t i o n and the t h e s i s R a t i o n a l e . 1.1 LITERATURE AND PROJECTS REVIEW: CONCEPTS OF MULTI-LEVEL  ELDERLY HOUSING. I n t r o d u c t i o n : Current trends i n m u l t i - l e v e l care of the e l d e r l y In recent years, a number of d i r e c t i o n s have been explored i n the p l a n n i n g of housing and long-term care f a c i l i t i e s f o r the e l d e r l y . In B r i t i s h Columbia, there are a s m a l l number of pro-j e c t s i n which i n n o v a t i v e approaches to e l d e r l y f a c i l i t i e s are employed. The f o l l o w i n g s e l e c t e d examples i n t r o d u c e three 15 major trends: the f i r s t combines more than one l e v e l of care i n the same f a c i l i t y ; the second pro v i d e s s u p p o r t i v e l i v i n g and congregate housing; and the t h i r d extends the independence of the e l d e r l y through a s s o c i a t i o n with peer groups i n a l u x u r i o u s and s t i m u l a t i n g environment. F i r s t Trend F i r s t , there i s a trend to combine two or three l e v e l s of care i n one f a c i l i t y . While r e c o g n i t i o n has been growing t h a t v a r i o u s forms of a s s i s t a n c e are needed to maintain f r a i l o l d e r people i n the community, there i s a l s o a f e a r t h a t too much support and a s s i s t a n c e i n the form of long-term care can be inap-p r o p r i a t e and may le a d to premature l o s s of f u n c t i o n a l indepen-dence. However, as people age and become more dependent v a r i o u s kinds of support may be needed. To respond to these needs, the m u l t i - l e v e l f a c i l i t y p r o v i d e s p r o g r e s s i v e care f o r the e l d e r l y r e s i d e n t s as w e l l as d i f f e r e n t mixes of s o c i a l s e r v i c e s . Accord-ing to Gutman (1983), there are s e v e r a l advantages i n f a c t , because a m u l t i - l e v e l care f a c i l i t y : 1. may reduce r e l o c a t i o n s t r e e s e f f e c t s . 2. enables couples to remain i n c l o s e p r o x i m i t y when the h e a l t h of one d e t e r i o r a t e s . 3. f a c i l i t a t e s adjustments i n s e r v i c e l e v e l to meet temporary changes i n needs. 4. enables i n d i v i d u a l s r e h a b i l i t a t e d to a hi g h e r l e v e l of f u n c t i o n i n g to remain i n p r o x i m i t y to s t a f f and r e s i d e n t s with whom rapp o r t has been e s t a b l i s h e d . 16 5. enables economies of s c a l e (both c a p i t a l and opera t i n g ) i n b a s i c and s p e c i a l i z e d s e r v i c e s . Second Trend S t u d i e s of trends and consumer p r e f e r e n c e s r e v e a l t h a t congregate housing i s more d e s i r e d by the consumer today than i t was 10 years ago (Gaskie, A r c h i t e c t u r a l Record, 1988). Taking the m i d p o s i t i o n between a n u r s i n g home and independent housing, congregate housing p r o v i d e s an arrangement l e s s s t r i n g e n t than a long-term care f a c i l i t y and more s u p p o r t i v e than c o n v e n t i o n a l e l d e r l y housing. U s u a l l y , the congregate home pr o v i d e s an around-the-clock nonmedical "watch", minimum one or two prepared meals, l i m i t e d p e r s o n a l care and s e v e r a l s o c i a l s e r v i c e s . In congregate l i v i n g , each r e s i d e n t has a p r i v a t e i n d i v i d u a l u n i t , which u s u a l l y i n c l u d e s a small k i t c h e n , bedroom, bathrom and s i t t i n g space; but communal f a c i l i t i e s such as c e n t r a l k i t c h e n , d i n i n g room and lounge are shared. There are f i v e types of congregate s e t t i n g s : the small apartment, the l a r g e apartment, the apartment b u i l d i n g , the congregate house and the r e s i d e n t i a l h o t e l congregate (Welch, Parker and Z e i s e l 1984). Congregate housing i s u s u a l l y owned and operated by a p u b l i c or n o n - p r o f i t agency. Tenants o f t e n accept r e s p o n s i b i l i t i e s f o r a s s i s t i n g s t a f f i n management and maintenance a c t i v i t i e s . Con-gregate l i v i n g p r o v i d e s o p p o r t u n i t i e s f o r mutual awarness and info r m a l s o c i a l support among e l d e r l y r e s i d e n t s and at the same time preserves t h e i r independence. 17 T h i r d t r e n d Retirement v i l l a g e s or l e i s u r e l i f e s t y l e communities provide a l t e r n a t i v e l i v i n g accomodation f o r wealthy s e n i o r s capable of independent l i v i n g . Because B r i t i s h Columbia and e s p e c i a l l y the Lower Mainland, boasts a moderate c l i m a t e , i t i s here t h a t the g r e a t e s t number of r e t i r e m e n t communities have been b u i l t . These developments promote a l e i s u r l y , c a r e f r e e l i f e s t y l e by o f f e r i n g s i n g l e - f a m i l y homes, apartments or townhouses with s p e c i a l f e a t u r e s (eg. wheelchair a c c e s s i b l e , l a c k of s t a i r s ) and s e v e r a l amenities f o r r e c r e a t i o n . Club houses are pr o v i d e d f o r p a r t i e s , b i l l a r d s , cards and other games. Some developments have swimming p o o l s , hot tubs, p u t t i n g greens, g o l f courses and other. S o p h i s t i c a t e d s e c u r i t y systems with video s u r v e i l l a n c e , e l e c t r o n i c a l l y c o n t r o l l e d entry-gates and e l a b o r a t e b u r g l a r alarms are common f e a t u r e s i n many r e t i r e m e n t communities. Although h e a l t h - c a r e i s u s u a l l y not provided i n the r e t i r e m e n t v i l l a g e concept some v i l l a g e s employ a f u l l - t i m e nurse or pro-vide p e r s o n a l and a s s i s t e d l i v i n g care f o r those who might other-wise be c o n f i n e d to n u r s i n g homes. The r e t i r e m e n t communities allow o l d e r people the extended independence through a s s o c i a t i o n with peer groups i n a s t i m u l a t i n g luxury environment. 1.1.1. GREATER VANCOUVER REGIONAL DISTRICT AREA AND BRITISH COLUMBIA. TREND 1 - More than one l e v e l on the same s i t e . 18 Example #1: Seton V i l l a i n North Burnaby, B.C. Seton V i l l a , a m u l t i l e v e l f a c i l i t y run by a n o n - p r o f i t o r g a n i z a t i o n , o f f e r s s e l f - c o n t a i n e d s u i t e s , board-residence and perso n a l care i n one n i n t e e n - s t o r e y b u i l d i n g . The b u i l d i n g i s d i v i d e d i n t o two p a r t s : the r e s i d e n t i a l p a r t and the common f a c i l i t y p a r t . The r e s i d e n t i a l p a r t i s comprised of 77 u n i t s of s e l f contained s u i t e s (one bedroom or bachelor) l o c a t e d on the 12th to 18th f l o o r s , 86 room and board u n i t s on the 6th to 11th f l o o r s and 88 pe r s o n a l care beds on the 2nd to 5th f l o o r . The common f a c i l i t i e s are l o c a t e d on the main f l o o r of the b u i l d i n g , i n the basement and on the top f l o o r . A communal d i n i n g room, k i t c h e n , and the a d m i n i s t r a t i o n area are l o c a t e d on the main f l o o r . A Health spa component c o n t a i n i n g an e x c e r c i s e p o o l , a thermal p o o l , showers and changing rooms as w e l l as an A r t s and C r a f t s component are l o c a t e d i n the basement. On the top f l o o r of the b u i l d i n g , there i s the lounge, which i s used as a m u l t i -purpose room f o r d i f f e r e n t a c t i v e and p a s s i v e a c t i v i t i e s . Adjacent to the lounge there i s a beauty p a r l o u r / b a r b e r shop. The Auditorium component (which can accommodate 200, seated t h e a t r e s t y l e ) i s l o c a t e d i n a separate b u i l d i n g , attached to main b u i l d i n g by a covered ramp. The A d m i n i s t r a t i o n of the f a c i l i t y p r o v i d e s a very warm, home l i k e atmosphere with s e v e r a l a t t r a c t i v e s o c i a l programs and i n v o l v e s r e s i d e n t s i n management of the f a c i l i t y . Seton V i l l a i s a very good example of a f a c i l i t y f o r the e l d e r l y which provides a secure environment with a p r o g r e s s i v e care system from Independent L i v i n g to Personal Care (some Intermediate Care 19 i s a l s o i n f o r m a l l y provided) as w e l l as a s t i m u l a t i n g e n v i r o n -ment with a v a r i e t y of amenities and s e r v i c e s . However, f o r those whose h e a l t h s e v e r l y d e t e r i o r a t e s , i t i s a necessary to move to a Intermediate or Extended Care f a c i l i t y . Example #2: H o l l y b u r n House, West Vancouver, B.C. (see F i g . 1-1) I d e a l l y l o c a t e d 2 blocks from the shops at Ambleside, opposite a L i b r a r y and next to a Se n i o r s A c t i v i t y Centre, Ho l l y b u r n House p r o v i d e s accommodation f o r the a f f l u e n t e l d e r l y . Run by a p r i v a t e , p r o f i t o r i e n t e d o r g a n i z a t i o n , the f a c i l i t y i s designed to provide two l e v e l s of care: r e s i d e n t i a l (personal) and Intermediate Care. The b u i l d i n g i s d i v i d e d i n t o two f u n c t i o n a l p a r t s . P a r t one i s comprised of 66 s e l f - c o n t a i n -ed u nfurnished apartments (bachelor, one-bedroom, two-bedroom s u i t e s ) l o c a t e d i n the second and t h i r d f l o o r s and Reception-A d m i n i s t r a t i o n area as w e l l as s o c i a l and d i n i n g spaces on the Ground F l o o r l e v e l . The south si d e of the b u i l d i n g has been designed as a s o c i a l d i n i n g space with a Conference Room and Bar, while the nort h s i d e c o n t a i n s C r a f t s , Cards, E x e r c i s e Room, small Shop, C l i n i c and Beauty Salon. P a r t two - Care Centre: Intermediate L e v e l 1 and 2 i s l o c a t e d on the Ground f l o o r l e v e l and comprises 36 f u r n i s h e d s i n g l e u n i t s with s o c i a l and d i n i n g space. The k i t c h e n and s t a f f f a c i l i t i e s are l o c a t e d i n the core of the main f l o o r and serve these two p a r t s s i m u l t a n e o u s l y . Although the f a c i l i t y p rovides " Q u a l i t y of L i f e " with choice of s e r v i c e s , programs and l i v i n g arrangement, there i s s t i l l a problem with r e l o c a t i o n s t r e s s f o r those whose h e a l t h c o n d i t i o n s 20 r e q u i r e Extended Care. N e v e r t h e l e s s , the combination of Independent L i v i n g with an Intermediate Care f a c i l i t y p o i n t s out to a new approach to the p r o g r e s s i v e care system. The c r e a t e d o p p o r t u n i t y f o r s o c i a l i n t e g r a t i o n between two groups of r e s i d e n t s may be s t i m u l a t i n g f o r l e s s able e l d e r l y . For independent l i v i n g r e s i d e n t s p o t e n t i a l of f u t u r e care i n the Intermediate Care p o r t i o n of the f a c i l i t y w i l l assure s e c u r i t y when one's h e a l t h d e t e r i o r a t e s . A v a r i e t y of l i v i n g arrangements - s e v e r a l l a y o u t s of one and two-bedroom s u i t e s , b e a u t i f u l l y designed outdoor spaces, f r i e n d l y management and p r o x i m i t y to community s e r v i c e s may c o n t r i b u t e to the w e l l being of r e s i d e n t s . A l l these a t t r i b u t e s should be employed i n the CCC f a c i l i t i e s . Example #3:South G r a n v i l l e Park Lodge,Vancouver BC(see F i g . 1-2) Designed f o r 120 r e s i d e n t s , South G r a n v i l l e Park Lodge provides s e r v i c e s f o r 42 r e s i d e n t s at the P e r s o n a l Care l e v e l and f o r 78 r e s i d e n t s at Intermediate Care l e v e l s 1, 2 and 3. The f a c i l i t y o f f e r s 24-hour n u r s i n g s u p e r v i s i o n , meals i n the common d i n i n g room, housekeeping, and s e v e r a l a t t r a c t i v e s o c i a l programs. The three s t o r e y b u i l d i n g i s d i v i d e d i n t o two wings. On the main f l o o r , there i s the R e c e p t i o n - A d m i n i s t r a t i o n area, spacious lounge, d i n i n g room, multipurpose room and s i x handicapped u n i t s . The two r e s i d e n t i a l f l o o r s comprise Personal or Intermediate Care u n i t s i n each wing with c e n t r a l l y l o c a t e d nursing s t a t i o n and s o c i a l area. 21 F i g . 1-2 South G r a n v i l l e Park Lodge - T y p i c a l F l o o r Source: South G r a n v i l l e Park Lodge 22 The long c o r r i d o r s and anonymous entrances to each s l e e p i n g u n i t as w e l l as l a c k of b a l c o n i e s as p r i v a t e outdoor spaces provide an i n s t i t u t i o n a l c h a r a c t e r to the b u i l d i n g . Although the f a c i l i t y p r o v i d e s two l e v e l s of care, i f t h e i r h e a l t h d e t e r i o r a t e s , r e s i d e n t s s t i l l are f o r c e d to move once again to an Extended Care f a c i l i t y . Example #4: St. Michael's Centre, Burnaby, B.C. (see F i g . 1-3). The most advanced approach i n terms of a m u l t i - l e v e l care f a c i l i t y i n the Vancouver area, was the o r i g i n a l concept of the St. Michael's Centre. Run by a n o n - p r o f i t , r e l i g i o u s o r g a n i z a t i o n , the o r i g i n a l f a c i l i t y program c a l l e d f o r a m u l t i - l e v e l care complex with Day Care and Home Care s e r v i c e s to those s e n i o r s l i v i n g i n the neighbourhood; P e r s o n a l and Intermediate Care f o r those who can no longer remain independent as r e s i d e n t s o u t s i d e the Centre and the Extended Care f o r those r e q u i r i n g 24hour a day p r o f e s s i o n a l s u p e r v i s i o n . At the present time, the f a c i l i t y i s comprised of 40 Intermediate Care beds and 40 Extended Care beds with common spaces: D i n i n g Room, small A c t i v i t y and Therapy areas, Lounge and a u x i l i a r y spaces. Day Care p r e v i o u s l y programmed w i t h i n the f a c i l i t y , i s l o c a t e d across the s t r e e t i n a separate b u i l d i n g . There i s a proposal f o r f u t u r e expansion of the e x i s t i n g f a c i l i t y to accommodate 80 a d d i t i o n a l beds at the Extended Care l e v e l . I t seems t h a t the i n i t i a l i d e a of c r e a t i o n of a m u l t i - l e v e l f a c i l i t y with con t i n u a -t i o n of care i s transformed i n t o i n s t i t u t i o n a l approach -- a 23 g e r i a t r i c complex with the Intermediate and Extended Care l e v e l s only. TREND 2 - Congregate housing Example #5: Parkwood Manor, Coquitlam, B.C. (see F i g . 1-4) Parkwood Manor i s an example of the second t r e n d i n the development of e l d e r l y f a c i l i t i e s i n B r i t i s h Columbia. T h i s congregate house-hotel type was founded by a p r o f i t o r i e n t e d o r g a n i z a t i o n i n the heart of Coquitlam on 5 acres of b e a u t i f u l l y landscaped grounds. The Coquitlam Shopping Centre i s only one block away. Churches, medical o f f i c e s , a l i b r a r y and other community s e r v i c e s are a l s o i n c l o s e p r o x i m i t y to the s i t e . The t h r e e - s t o r y b u i l d i n g i s comprised of f o u r r e s i d e n t i a l wings with 115 one-bedroom and 8 two-bedroom u n i t s and a c e n t r a l p a r t with the main s o c i a l space. On the ground f l o o r l e v e l , i n the core of the b u i l d i n g , there i s an elegant d i n i n g room o v e r l o o k i n g the f r o n t yard, while lounge and s o c i a l a c t i v i t i e s areas overlook a formal garden. The f a c i l i t y p r ovides comfortable accommodation, convenience, s e c u r i t y and o p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n among r e s i d e n t s . However, t h i s l u x u r i o u s environment i s aimed at r e t i r e d , a c t i v e and a f f l u e n t e l d e r l y people. One i n c l u s i v e monthly fee covers r e n t a l of a l l p r i v a t e , spacious apartments, u t i l i t i e s , weekly maid and laundry s e r v i c e s , r e g u l a r d i n i n g room meal s e r v i c e , use of a l l in-house r e c r e a t i o n a l f a c i l i t i e s , p arking and 24 hour emergency c a l l and s e c u r i t y . Since the f a c i l i t y p r o v i d e s only r e s i d e n t i a l (personal) care, when the F i g . 1-4 Parkwood Manor - Main F l o o r Source: Waisman Dewar Grout C a r t e r A r c h i t e c t s 25 h e a l t h of a r e s i d e n t s d e t e r i o r a t e s they have to move to a h e a l t h care f a c i l i t y . That i s the main disadvantage of congregate housing. Example #6: A b b e y f i e l d , Sidney, B.C. (see F i g . 1-5) The A b b e y f i e l d concept i s an example of congregate housing f o r a maximum of 9 people who l i v e with a l i v e - i n housekeeper (CMHC, NHA 6009). O r i g i n a t e d i n England i n 1956, t h i s concept i s u s u a l l y l o c a t e d i n a la r g e house i n which seven to ten people are accommodated, a l l with t h e i r own p r i v a t e spaces. However, r e s i d e n t s share a common d i n i n g room, k i t c h e n and l i v i n g room. To a s s i s t a l l r e s i d e n t s , there i s a l i v e - i n housekeeper who attends to the d a i l y running of the house, the shopping, and prepares and serves meals. The f i r s t Canadian prototype was opened i n September 1987 i n Sidney, B.C. Although t h i s concept c r e a t e s a c l o s e - c i r c l e atmosphere, s u p p o r t i v e l i v i n g and an op p o r t u n i t y f o r s o c i a l i n t e r a c t i o n s , n e v e r t h e l e s s there i s a lac k of s e c u r i t y , when one's h e a l t h s e v e r e l y d e t e r i o r a t e s , n e c e s s i t a t i n g a move to an i n s t i t u t i o n . TREND 3 - Retirement V i l l a g e s Example #7: Arbutus Ridge V i l l a g e , Vancouver I s l a n d , B.C. (see f i g . 1-6) Arbutus Ridge V i l l a g e i s an example of a l u x u r y r e t i r e m e n t complex aimed a t s e l f - s u f f i c i e n t , a c t i v e and wealthy s e n i o r s . T h i s p r o j e c t has adopted an E n g l i s h - c o u n t r y v i l l a g e theme. 26 F i g . 1-5 A b b e y f i e l d Concept - Main F l o o r Source: Murray, C h a r l o t t e . Supportive Housing f o r S e n i o r s : the Elements and Issues f o r a Canadian Model. 1989, p. 44. F i g . 1-6 Arbutus Ridge V i l l a g e - S i t e Plan Source: Canadian Retirement C o r p o r a t i o n Brochure 27 Located on 218 acre of w a t e r f r o n t land, the v i l l a g e w i l l be comprised, when completed, of 676 s i n g l e f a m i l y detached and attached homes and the c e n t r e . The c e n t r e e i g h t b u i l d i n g s i n c l u d e such amenities as c r a f t and t e a c h i n g room, heated swimming p o o l , J a c u z z i , h e a l t h c l u b , post o f f i c e , banquet and k i t c h e n f a c i l i t y as w e l l as commercial a m e n i t i e s , such as bank, small grocery shop and beauty shop. The v i l l a g e f e a t u r e s s e v e r a l outdoor a c t i v i t i e s : t e n n i s , horseshoes, walking pathways, s h u f f l e b o a r d , year round f i s h i n g and nine-hole g o l f course, which p r o v i d e s a l s o a l u x u r i o u s p a r k - l i k e s e t t i n g f o r a l l r e s i d e n t s . Arbutus Ridge V i l l a g e o f f e r s a s t i m u l a t i n g environment f o r e l d e r l y r e s i d e n t s . They have a choice of s o c i a l and r e c r e a t i o n a l a c t i v i t i e s ; s e c u r i t y and peace of mind by p r o v i d i n g emergency s i g n a l system and the "community f e e l i n g " . In s p i t e of advantages, the v i l l a g e does not p r o v i d e s e c u r i t y i n terms of h e a l t h care. I t can be obtained, however, by purchasing "home care" s e r v i c e s and medical care i n adjacent communities: M i l l Bay or Duncan. N e v e r t h e l e s s , there w i l l be s t i l l a problem f o r more f r a i l e l d e r l y , who r e q u i r e h e a l t h care beyond what can be provided at home. 1.1.2. OTHER PARTS OF CANADA Example #8: Northwoodcare Complex, H a l i f a x , N.S. Founded i n 1960 by Edward L. Roach, P r e s i d e n t of H a l i f a x Senior C i t i z e n s Housing C o r p o r a t i o n , Northwood Care Inc. i s a n o n - p r o f i t o r g a n i z a t i o n which has developed a " s h e l t e r " , "care" 28 and "reachout" f a c i l i t y . Some 859 r e s i d e n t s of Northwood enjoy a v a r i e t y of l i v i n g accommodations from independent l i v i n g to i n s t i t u t i o n a l care, i n a d d i t i o n to the p r o v i s i o n of " h e a l t h maintenance", " h e a l t h promotion", " i l l n e s s p r e v e n t i o n " , and other " l i f e - e n r i c h m e n t " programs through Northwood's M u l t i -purpose Centre. The Centre has been developed i n phases. The f i r s t phase s t a r t e d i n 1966 with a 73-unit s e l f - c o n t a i n e d apartment b u i l d i n g f o r the e l d e r l y . Than, i n 1969 a t e n - s t o r e y high r i s e was b u i l t with p r o g r e s s i v e l e v e l s of care: 146 s e l f - c o n t a i n e d apartments, 84 " s u p e r v i s o r y " care beds and 195 "p e r s o n a l " care beds. In the next phase the complex was i n c r e a s e d by a n i n e - s t o r y , 297 bed "nursing" home which i n c o r p o r a t e d , on the main f l o o r , a " M u l t i -purpose Centre". In 1978, the complex i n t r o d u c e d the f i r s t A d u l t Day Care program i n Nova S c o t i a . In the f o l l o w i n g years other f a c i l i t i e s and s e r v i c e s were i n t r o d u c e d such as a C h i l d Care Centre, Home Support S e r v i c e and Respit e care. Northwood Centre has c r e a t e d , over a twenty f i v e year span, a model of e x c e l l e n c e t h a t has stood the t e s t of time (Rogers 1987). Today, the Northwood Care Complex has implemented a l l the necessary program components to ensure a comprehensive care system f o r i t s r e s i d e n t s . The f a c i l i t y o f f e r s a s t i m u l a t i n g environment i n the Multipurpose c e n t r e . 1.1.3 EUROPE There are other concepts of Care f o r the aging t h a t could be 29 implemented even w i t h i n the e x i s t i n g n u r s i n g homes or other types of f a c i l i t i e s . For example, the B r i t i s h have a system of day and n i g h t care f a c i l i t i e s f o r the aging. I f a person has nowhere to go d u r i n g the day (or l i v e s with someone who works) and needs care, these f a c i l i t i e s may provide care d u r i n g the day (or n i g h t ) . S i m i l a r l y i n Sweden, F i n l a n d , Denmark and a l s o i n the E a s t e r n European c o u n t r i e s , the t r e n d i s to provide a f u l l spectrum of s e r v i c e s i n the r e s i d e n t i a l s e t t i n g (Hogland, 1985). A l l those f a c i l i t i e s t r y to meet a v a r i e t y of needs of the e l d e r l y . Example #9: H a u s j a r v i , F i n l a n d (see F i g . 1-7) In F i n l a n d , there was r e c e n t l y an a r c h i t e c t u r a l c o m p e t i t i o n f o r "more human h e a l t h f a c i l i t i e s " i n H a u s j a r v i , a t y p i c a l r u r a l m u n i c i p a l i t y . The f i r s t p r i z e winner has proposed a primary h e a l t h c e n t r e , an extended care ward of 30 beds, an old-age home designed f o r about 45 r e s i d e n t s and a community centre f o r other e l d e r l y people l i v i n g i n the neighbourhood ( K o t i l a i n e n , 1987). 1.1.4. THE UNITED STATES OF AMERICA Example #10: Motion P i c t u r e and T e l e v i s i o n Country House and  H o s p i t a l , Woodland H i l l s , CA (see F i g . 1-8). Residents of a M u l t i l e v e l Care F a c i l i t y - Motion P i c t u r e and T e l e v i s i o n Country House and H o s p i t a l i n Woodland H i l l s i n C a l i f o r n i a are sponsoring t h e i r own community. A l l r e s i d e n t s 30 A F i g . 1-7 H a u s j a r v i Health Care F a c i l i t y : A - S i t e Plan, B - Re-s i d e n t i a l C l u s t e r Layout Source: H a u s j a r v i Health Centre and Old People's Home Design Competition. A r k k i t e h t u u r i k i l p a i l u j a . 1987, 2,pp.17-18. 31 have worked i n the motion p i c t u r e and t e l e v i s i o n i n d u s t r y and have c o n t r i b u t e d to a fund over a p e r i o d of years to guarantee t h e i r l i f e c are. Founded i n 1942, the Motion P i c t u r e and T e l e v i s i o n Fund p r o v i d e s h e a l t h care and housing f o r r e t i r i n g members of the entertainment i n d u s t r y . On a f o r t y - o n e acre country s i t e the MPTF operates three somewhat d i s t i n c t communi-t i e s : f i r s t , a lodge f o r the Intermediate Care r e s i d e n t s ; second, semiattached country-type cottages f o r semi to f u l l y independent l i v i n g and t h i r d , a modern acute care f a c i l i t y . The n a t u r a l c h a r a c t e r of the s i t e i s preserved by a landscape and waterway system which enhances the e a r l y C a l i f o r n i a v e r n a c u l a r a r c h i t e c t u r e . The c u r r e n t p r o j e c t designed by Bobrow, Thomas and A s s o c i a t e s , an a r c h i t e c t u r a l f i r m i n Los Angeles, i n c l u d e s expansion of the acute care h o s p i t a l , and a d d i t i o n of a s k i l l e d n u r sing f a c i l i t y , and cottages f o r semi-independent l i v i n g . A l s o planned are a new a d m i n i s t r a t i o n b u i l d i n g and the outpa-t i e n t c l i n i c . With these a d d i t i o n s , the MPTF w i l l be able to provide comprehensive care f o r n e a r l y 500 r e s i d e n t s . Example #11: Regent P o i n t , Pasadena, CA (see Fig.1-9) Regent P o i n t , i s a re t i r e m e n t community owned and operated by the Southern C a l i f o r n i a P r e s b y t e r i a n Homes. Designed by Neptun & Thomas A s s o c i a t e s i n Pasadena, the f a c i l i t y has 370 u n i t s : 136 semi-attached l o w - r i s e u n i t s f o r independent l i v i n g , 234 per s o n a l care u n i t s i n a four s t o r y apartment b u i l d i n g , and s k i l l e d n u r s i n g - c a r e u n i t s i n a two-story b u i l d i n g . A c e n t r a l l y 32 Motion P i c t u r e and T e l e v i s i o n Country House and Hos-p i t a l - E x i s t i n g S i t e Plan and Proposed S i t e Develop-ment . Carstens, Diane Y. S i t e P lanning and Design f o r the  E l d e r l y - Issues, G u i d e l i n e s and A l t e r n a t i v e s . 1985, pp. 44-46. F i g . 1-8 Source: 33 F i g . 1-9 Regent P o i n t - S i t e Plan Source: Carsten Diane Y. S i t e Planning and Design f o r the E l d e r l y - Issues, G u i d e l i n e s and A l t e r n a t i v e s . 1985, p. 48. 34 l o c a t e d D i n i n g P a v i l i o n and Re c r e a t i o n Centre i s connected with semi-independent l i v i n g u n i t s . The s i t e has been developed to maximize i t s h i l l t o p view of the a d j o i n i n g r e g i o n a l park. 1.1.5. CONCLUSION A l l of the f o r e g o i n g examples i n c l u d e s e v e r a l m e r i t s i n the c r e a t i o n of a s p e c i f i c environment f o r e l d e r l y people. The m u l t i - l e v e l care f a c i l i t i e s provide p r o g r e s s i v e care and a v a r i e t y of s o c i a l s e r v i c e s . The congregate examples provide supportive l i v i n g i n c l o s e - c i r c l e home-like atmosphere and an op p o r t u n i t y f o r s o c i a l i n t e r a c t i o n . The r e t i r e m e n t v i l l a g e s c r e a t e "community f e e l i n g s " i n s t i m u l a t i n g l e i s u r e o r i e n t e d environment. A l l these approaches may have a gre a t impact on we l l - b e i n g and l i f e s a t i s f a c t i o n of the e l d e r l y . T h i s t h e s i s w i l l propose a CCC f a c i l i t y program which w i l l t r y to implement many of a l l these f e a t u r e s i n order to c r e a t e a q u a l i t y m u l t i -l e v e l care environment. 35 1.2. REVIEW OF THE CURRENT POLICIES OF ELDERLY HOUSING In the l a s t seventy f i v e years, l i f e expectancy has i n c r e a s -ed s u b s t a n t i a l l y and the p r o p o r t i o n of o l d e r c i t i z e n s has grown and i s growing c o n s t a n t l y . In B r i t i s h Columbia, the i n c r e a s e i n the e l d e r p o p u l a t i o n i s s u b s t a n t i a l l y g r e a t e r than f o r Canada as a whole. In 1981, 10.9% of B r i t i s h Columbians were aged 65 and over; 2% were aged 80 and over. P r o j e c t i o n s f o r the year 2001 are 13.5% and 3.6% r e s p e c t i v e l y (Seaton R. and M. Rajan 1987). C e n t r a l S t a t i s t i c s Bureau p r o j e c t i o n s f o r the GVRHD by L o c a l Health Area (LHA) assume an i n c r e a s e i n the aging p o p u l a t i o n f o r Vancouver LHA i n years 1986-2001 as f o l l o w : f o r the t o t a l p o p u l a t i o n 3%, f o r aged 65 and over 10%, and f o r aged 85 and over 54% (GVRHD Report, 1987, Appendix A, Table 2). These trends c r e a t e a demand f o r housing as w e l l as h e a l t h care s e r v i c e s f o r the e l d e r l y i n much g r e a t e r s c a l e than we have ever experienced. However, both u t i l i z a t i o n of s e r v i c e s (demand side) and p r o v i s i o n of s e r v i c e s (supply s i d e ) w i l l be i n f l u e n c e d by e v o l v i n g s o c i e t a l trends and p o l i c y d i r e c t i o n s . The gen e r a l consensus suggests t h a t , o v e r a l l , f a c i l i t y care w i l l d e c l i n e , p a r t i c u l a r l y at the lower care l e v e l s , and demand f o r home support s e r v i c e s w i l l i n c r e a s e (GVRHD Report, 1987, p.6). P r o v i n c i a l L e v e l In B r i t i s h Columbia, there i s evidence of t h i s t r e n d i n the d i f f e r e n t i a l r a t e of the growth of f a c i l i t y care and home based care. There i s a recommendation i n the p r o v i n c i a l government 36 p o l i c y to reduce f a c i l i t y r e f e r r a l s f o r Intermediate Care L e v e l 1 and L e v e l 2 c l i e n t s to the g r e a t e s t extent p o s s i b l e . I t i s u n l i k e l y t h a t the i n c r e a s e d home support s e r v i c e s w i l l reduce the need f o r f a c i l i t y care at the Extended Care L e v e l or even the Intermediate Care L e v e l . However, the Government w i l l not be funding the c o n s t r u c t i o n of long term f a c i l i t i e s a t c u r r e n t l e v e l s of usage (Tate 1987, p.4). The d i s p a r i t y between the supply and demand w i l l l ead to an i n c r e a s i n g number of p r i v a t e market u n s u b s i d i z e d care f a c i l i t i e s ( r e t i r e m e n t or congregate housing, long term care f a c i l i t i e s p r i m a r i l y a t the lower care l e v e l s ) . At the same time when the Government w i l l be c u t t i n g funding of long term f a c i l i t i e s , t h a t are a c c e s s i b l e to a l l , the p r i v a t e market w i l l be p r o v i d i n g luxury u n i t s o n l y to those who can a f f o r d them. Obviously, t h i s w i l l r e s u l t i n the c r e a t i o n of gaps i n the care system f o r the m a j o r i t y of the s e n i o r s popula-t i o n , with some e l d e r l y remaining at home beyond t h e i r a b i l i t y to maintain themselves with homecare. Consequently, there s t i l l w i l l be a n e c e s s i t y f o r the e l d e r l y to move from one f a c i l i t y to another because of l a c k of a f u l l range of s e r v i c e s and expen-s i v e acute h o s p i t a l care w i l l continue to be a s u b s t i t u t e f o r Intermediate and Extended Care. Greater Vancouver Regional D i s t r i c t L e v e l The growing p o p u l a t i o n of o l d e r c i t i z e n s , e s p e c i a l l y the f a s t e s t growing segments of people aged 74 to 85 and o l d e r , increase the demand f o r f a c i l i t i e s f o r the e l d e r l y . Other trends 37 which may i n c r e a s e the demand f o r or u t i l i z a t i o n of s e r v i c e s i n c l u d e : 1. Fewer f a m i l y c a r e - g i v e r s among f a m i l y members due t o : r i s i n g d i v o r c e r a t e s which r e s u l t i n fewer spousal c a r e - g i v e r s ; high m o b i l i t y which r e q u i r e s a d u l t c h i l d r e n to l i v e at some di s t a n c e from t h e i r aging parents; i n c r e a s e d female p a r t i c i p a t i o n i n the workforce which l i m i t s the a b i l i t y of a d u l t daughters (the t r a d i t i o n a l c a r e - g i v e r s ) to care f o r t h e i r aging parents; 2. Higher e x p e c t a t i o n of q u a n t i t y and q u a l i t y of s e r v i c e s : over time, the e l d e r l y w i l l be b e t t e r educated and b e t t e r i n -formed. Consequently, they w i l l demand a d d i t i o n a l home sup-p o r t s e r v i c e s such as: home makers, a d u l t day care, r e s p i t e care, c a r e - g i v e r support. 3 . Expansion of the t r a d i t i o n a l c l i e n t group: the e l d e r l y and the young d i s a b l e d - the t r a d i t i o n a l c l i e n t groups w i l l be enlarged by AIDS p a t i e n t s by whom u t i l i z a t i o n of homemaker s e r v i c e s has been i n c r e a s i n g . However, there are other assumptions and trends t h a t may decrease the p r o v i s i o n of or u t i l i z a t i o n of s e r v i c e s : 1. Lower tax revenues: f i s c a l r e s t r a i n t w i l l continue to squeeze resources f o r a l l s e r v i c e s i n the h e a l t h care s e c t o r (a d e c l i n e i n the percentage of the p o p u l a t i o n i n f a c i l i t i e s at the lower care l e v e l s without concurrent i n c r e a s e i n the number of homemaker hours). 38 Q u a l i t y of l i f e c o n s i d e r a t i o n s : c u r r e n t t h i n k i n g i s t h a t en-a b l i n g the e l d e r l y to remain i n t h e i r own home with support s e r v i c e s , r a t h e r than c a r i n g f o r them i n f a c i l i t i e s , i s b e n e f i c i a l i n terms of t h e i r h e a l t h and l i f e s a t i s f a c t i o n i n a d d i t i o n to the p e r c e i v e d economic b e n e f i t s . Consequently, f a c i l i t y care w i l l be concentrated on very f r a i l e l d e r l y . I n c r e a s i n g emphasis on h e a l t h promotion and p r e v e n t i o n : g r e a t e r r e c o g n i t i o n by i n d i v i d u a l s , h e a l t h care p r o f e s s i o -n a l s , and governments of the importance of p s y c h o l o g i c a l and l i f e s t y l e f a c t o r s i n m a i n t a i n i n g good h e a l t h and i n c r e a s e d r e s e a r c h i n t o and r e g u l a t i o n of o c c u p a t i o n a l and e n v i r o n -mental c o n d i t i o n s w i l l help the e l d e r l y to l i v e longer, be more a c t i v e and a l e r t , and enjoy b e t t e r h e a l t h . I n c r e a s i n g economic independence f o r the e l d e r l y : while the e l d e r l y have t r a d i t i o n a l l y had r e l a t i v e l y low incomes, espe-c i a l l y women, there i s some evidence t h a t t h e i r economic s i t u a t i o n i s improving due to: removal of compulsory r e t i r e -ment i n many s e t t i n g s , government encouragement of p r i v a t e savings (RRSP), insurance and i n c r e a s i n g number of workers with pension p l a n s . The above simply p r o v i d e s another source of r e t i r e m e n t income. Innovative housing o p t i o n s : the p r i v a t e s e c t o r i s responding to the growing e l d e r l y p o p u l a t i o n by s u p p l y i n g v a r i o u s forms of s u p p o r t i v e housing (meal s e r v i c e , caretaker/manager, alarm systems etc) which enable the e l d e r l y to avoid or delay f a c i l i t y care. A l l these trends are l i k e l y to i n f l u 39 ence the p r o v i s i o n and u t i l i z a t i o n of s e r v i c e s (GVRHD Report, 1987, p.3-7). The Extended Care Subcommittee of GVRHD o u t l i n e d s e v e r a l recommendations. F i r s t , there w i l l be a major r e d u c t i o n i n f a c i l i t y r e f e r r a l s at the lower care l e v e l s (PC, IC1 and IC2). However, there w i l l be encouragement of " v a r i o u s forms of a p p r o p r i a t e l y designed, a f f o r d a b l e housing f o r the e l d e r l y i n the community". Moreover, there w i l l be a major i n c r e a s e i n resources f o r home support s e r v i c e s and a con c u r r e n t i n c r e a s e i n a n c i l l a r y s e r v i c e s needed by the e l d e r l y i n the community, e.g. meals-on-wheels, a d u l t day care, r e s p i t e beds, r e h a b i l i t a t i o n s e r v i c e s . In a d d i t i o n , there w i l l be p r o v i s i o n i n f a c i l i t i e s f o r an a d d i t i o n a l 960 Intermediate Care ( l e v e l 3) and 1850 Extended Care c l i e n t s over the next f i f t e e n years. N e v e r t h e l e s s , there w i l l s t i l l be a shortage i n f a c i l i t i e s f o r the e l d e r l y e s p e c i a l l y at the higher l e v e l s of care. Innova-t i v e housing o p t i o n s which were r e c e n t l y b u i l t e.g. congregate housing, A b b e y f i e l d model or m u l t i l e v e l f a c i l i t i e s ( p r a c t i c a l l y o n l y two l e v e l s of care) do not provide a l l kinds of s e r v i c e s needed by aged people. Most of these new op t i o n s are provided by the p r i v a t e s e c t o r which i s p r o f i t o r i e n t e d . T h e r e f o r e , there i s s t i l l a need f o r new, i n n o v a t i v e s o l u t i o n s which w i l l support a l l above mentioned recommendations of GVRHD and br i d g e a gap between s e n i o r s ' housing and a h e a l t h care f a c i l i t y f o r the e l d e r l y . 40 1.2.1. FINDINGS AND PROBLEM STATEMENT  F i n d i n g s : The Extended Care Subcommittee of GVRD has s p e c i f i c a l l y recommended and encouraged "various forms of a p p r o p r i a t e l y designed, a f f o r d a b l e housing f o r the e l d e r l y i n the community". Th i s i s one of most important aspects of the contemporary approach to e l d e r l y housing: s e n i o r s have to st a y w i t h i n the same community they have been l i v i n g i n . T h e r e f o r e , the same subcommittee f u r t h e r recommends an i n c r e a s e i n resources f o r home support s e r v i c e s , meals-on wheels, a d u l t day car e , r e s p i t e beds, r e h a b i l i t a t i o n s e r v i c e s and ot h e r s . Problem Statement: Both the p r o v i n c i a l government and GVRD p r e d i c t t h a t they w i l l not be funding the c o n s t r u c t i o n of long term care f a c i l i -t i e s at c u r r e n t l e v e l s of usage. There w i l l be a d i s p a r i t y between the a c t u a l supply and demand. T h i s w i l l r e s u l t i n the c r e a t i o n of gaps i n the care system f o r the m a j o r i t y of s e n i o r s , e s p e c i a l l y those who can't a f f o r d r e t i r e m e n t or congregate housing provided by the p r i v a t e market. So, i t w i l l be necessary f o r the e l d e r l y to move from one f a c i l i t y to another because of lac k of a f u l l range of s e r v i c e s . T h i s c r e a t e s a problem which has to be addressed. Summary: The s i t u a t i o n i s c l e a r : both, the p r o v i n c i a l Government and GVRD (they both share expenditure f o r e l d e r l y housing) are lo o k i n g f o r i n n o v a t i v e options and design s o l u t i o n s which could 41 meet needs and e x p e c t a t i o n s of a new wave of s e n i o r s a t the end of t h i s century. 1.3. THE CONTINUUM OF CARE COMPLEX IN POINT GREY AS ONE OF THE OPTIONS AND INNOVATIVE APPROACHES TO SOLVE THE  ELDERLY HOUSING PROBLEM. The proposed Continuum of Care Complex i n P o i n t Grey has one major g o a l : to c r e a t e a comprehensive f a c i l i t y f o r the e l d e r l y t h a t p r o v i d e s a l l l e v e l s of care with a wide range of s e r v i c e s t h a t meet a v a r i e t y of r e s i d e n t s ' needs. In the CCC the housing a l t e r n a t i v e s f o r the e l d e r l y w i l l range from Independent L i v i n g u n i t s and Supported Independent L i v i n g U n i t s to Dependent L i v i n g U n i t s . There are i n d i c a t i o n s ( C l u f f 1986), t h a t a Continuum of Care f a c i l i t y may reduce the c a p i t a l and o p e r a t i n g c o s t s of s e r v i c e s and at the same time i n c r e a s e the q u a l i t y of care as w e l l as q u a l i t y of l i f e f o r the e l d e r l y . However, t h i s t h e s i s w i l l not evaluate the c a p i t a l and o p e r a t i n g c o s t s . These i s s u e s would r e q u i r e separate s t u d i e s and they are not the s u b j e c t of t h i s t h e s i s . Moreover, f i n a n c i a l s e c u r i t y of the r e s i d e n t s may be an a d d i t i o n a l advantage of a CCC because there c o u l d be a s t a b l e r e n t payment arrangement c o n t r o l l e d by government agen-c i e s (BCMHC, CMHC, GVRHD, MOH). The CCC f a c i l i t y i s assumed to be a c c e s s i b l e f o r a l l , even f o r those with very l i m i t e d income. The proposed CC Complex w i l l have a more comprehensive program which w i l l provide p e r s o n a l , s o c i a l and h e a l t h care s e r v i c e s not on l y f o r r e s i d e n t s but a l s o f o r the e n t i r e P o i n t 4 2 Grey community. By p r o v i d i n g a f u n c t i o n a l , a t t r a c t i v e and comfor-t a b l e environment f o r the r e s i d e n t s and v i s i t o r s , and by i n v o l v -ing the e l d e r l y i n i t s management, the CCC may c r e a t e a s t r o n g l i n k between the CCC 'community' and the o u t s i d e neighbourhood. 1.4. RATIONALE OF THE THESIS This t h e s i s accepts the hypo t h e s i s , t h a t m u l t i - l e v e l care i s a v i a b l e way of a c h i e v i n g an environment which may f u l f i l l a comprehensive a r r a y of needs of the e l d e r l y . The f a c i l i t y program study of t h i s t h e s i s expands t h a t b a s i c hypothesis arguing, t h a t a CCC should i n c l u d e housing a l t e r n a t i v e s f o r the e l d e r l y both i n terms of tenure and s u p p o r t i n g s e r v i c e s , but above a l l should provide a s p e c i f i c ambiance equal to a home-l i k e environment. The t h e s i s goes on to demonstrate how such a f a c i l i t y may be organized. Examples of p a r t i a l m u l t i - l e v e l care are common i n the USA i n ret i r e m e n t v i l l a g e s . T h i s t h e s i s w i l l attempt to achieve some of those amenities on an urban s i t e . 43 CHAPTER 2 - SUPPLY AND DEMAND: ANALYSIS OF THE ELDERLY HOUSING  OPTIONS AND SERVICES IN VANCOUVER AND WEST POINT  GREY AREA.  Chapter Summary: Chapter 2 c o n c e n t r a t e s on the a n a l y s i s of the contemporary e l d e r l y : t h e i r means, ex p e c t a t i o n s and s o c i a l p r o f i l e . F i n d i n g s have been presented i n the form of the c h a r a c t e r i s t i c f e a t u r e s of the f u t u r e c l i e n t s of the Continuum of Care Complex and a l s o i n c o n c l u s i o n s to be implemented i n the f a c i l i t y program. The e l d e r l y p o p u l a t i o n i n Vancouver i n g e n e r a l and i n P o i n t Grey i n p a r t i c u l a r has been analysed, based on census data, i n terms of f a m i l y households, home ownership and d w e l l i n g c h a r a c t e r i s t i c s . S enior housing r e s o u r c e s , d w e l l i n g u n i t s , long-term care beds and s e n i o r c e n t r e s i n Vancouver's West Side serve as a r e s e a r c h background f o r t h i s chapter's o b j e c t i v e : to i n v e s t i g a t e the need f o r e s t a b l i s h m e n t of a CCC i n P o i n t Grey i n terms of i t s f u t u r e r e s i d e n t s , l o c a t i o n and unique environment. 2.1. THE CONTEMPORARY ELDERLY: THEIR MEANS AND EXPECTATIONS.  2.1.1. CURRENT TRENDS. As Harlow Unger noted i n h i s S t a t e s i d e - Column: U n i v e r s i t y towns show b u i l d i n g boom (Canadian B u i l d i n g , 1988); the b i g g e s t s u r p r i s e a f t e r the October 1987 stock market c r a s h and subse-quent d e c l i n e i n housing s t a r t s , was the f a c t t h a t the United States c o l l e g e towns have been e x p e r i e n c i n g an unprecedented housing c o n s t r u c t i o n boom. The cause of the boom was the 44 exploding p o p u l a t i o n of American r e t i r e e s . Now, they no longer move to the t r a d i t i o n a l r e t irement v i l l a g e s i n the U.S. South and Southwest, but i n s t e a d f a v o r the a c t i v e c u l t u r a l environment of c o l l e g e and u n i v e r s i t y communities. Who are those r e t i r e e s ? F i r s t , they tend to be w e a l t h i e r , more cosmopolitan r e t i r e e s who have found t h e i r e x i s t i n g suburban communities too s t e r i l e and nearby c i t i e s too c o s t l y . What are they l o o k i n g f o r ? T h e i r e x p e c t a t i o n s can e a s i l y be s a t i s f i e d i n c o l l e g e and u n i v e r s i t y towns which o f f e r a l l the c u l t u r a l advantages of major c i t i e s -c o n c e r t s , opera, t h e a t r e , l e c t u r e s , museums, a d u l t education as we l l as safe (low crime) environment. Vancouver's safe environment, i t s s c e n i c c o a s t a l and moun-t a i n beauty, i t s temperate c l i m a t e , i t s impressive c u l t u r a l , academic (the U n i v e r s i t y of B r i t i s h Columbia and Simon F r a s e r U n i v e r s i t y ) and r e c r e a t i o n a l advantages and i t s commercial and business importance, continue to a t t r a c t more and more people, i n c l u d i n g s e n i o r c i t i z e n s , from a l l over Canada and the United S t a t e s . With steady p o p u l a t i o n growth p r o j e c t e d to continue, p a r t i -c u l a r l y the p o p u l a t i o n age 65+ may i n c r e a s e by about 35% between the years 1986-2001 (GVRHD Report, 1987), the p r e s s u r e s on hous-in g supply w i l l grow. Low vacancy r a t e s i n r e n t a l accommodation and at the same time e s c a l a t i n g r e s a l e p r i c e s f o r homes c a l l f o r new, i n n o v a t i v e s o l u t i o n s and housing o p t i o n s s p e c i a l l y f o r the e l d e r l y p o p u l a t i o n . In summary, the "new" emerging group of the e l d e r l y people, 45 who w i l l dominate the housing scene i n the next few decades can be d e s c r i b e d as f o l l o w s : - o l d e r people who value independence more than anything e l s e - they want to stay out of i n s t i t u t i o n s - they don't want to l i v e with t h e i r c h i l d r e n - they p r e f e r to l i v e alone i n more s t i m u l a t i n g communities - they tend to be w e a l t h i e r and more cosmopolitan 2.1.2 FEATURE CHARACTERISTICS OF SENIOR CITIZENS - THE FUTURE CLIENTS OF THE CONTINUUM OF CARE COMPLEX ( C C C )  Feature #1: Housing and Income L e v e l s : M a j o r i t y of S e n i o r C i t i z e n s i n Canada i n g e n e r a l and i n B r i t i s h Columbia i n p a r t i c u l a r own t h e i r homes (see Appx.#2-1). The f i r s t group of more a f f l u e n t s e n i o r homeowners may be w i l l i n g to move to new housing, i f such housing responds to t h e i r s p e c i f i c needs. The most a t t r a c t i v e tenure type w i l l be a s t r a t a t i t l e condominium, where they can i n v e s t a p o r t i o n of any e q u i t y recovered from s e l l i n g t h e i r present home. The second group of s e n i o r s i s made up of those "go-go" r e l a -t i v e l y h e a l t h y i n d i v i d u a l s who are not as w e l l o f f as the p r e v i -ous group, but are a c t i v e , w i l l i n g to p a r t i c i p a t e and e s t a b l i s h c o - o p e r a t i v e housing, based on the CMHC a s s i s t a n c e programs. The t h i r d group w i l l be made up of s e n i o r s l i v i n g on a f i x e d income, with no f i n a n c i a l r esources, who badly need s o c i a l a s s i s t a n c e . The best form of housing f o r t h i s group, would be the BCHMC programs. 46 The f o u r t h group w i l l be those, who need Long Term Care on a continuous b a s i s , and q u a l i f y f o r f a c i l i t y - b a s e d care f i n a n c e d by the P r o v i n c i a l M i n i s t r y of Health. C o n c l u s i o n #1: The CCC should provide a v a r i e t y of housing tenures f o r i t s f u t u r e c l i e n t s . Feature #2: Family and S o c i a l Status The e l d e r l y p o p u l a t i o n i s extremely d i v e r s i f i e d i n terms of fa m i l y s t a t u s , household arrangements and s o c i a l s t a t u s : e l d e r l y couples, those l i v i n g with f a m i l i e s or f r i e n d s , unattached ( l i v i n g alone) i n d i v i d u a l s , more a c t i v e and "no-go's", h e a l t h y and wheelchair handicapped and so on. Conc l u s i o n #2: The CCC should c r e a t e a p h y s i c a l and s o c i a l environment responding to the needs of a broad spectrum of the e l d e r l y p o p u l a t i o n . Feature #3: Health Care Needs. Access to and q u a l i t y of h e a l t h care s e r v i c e s are major elements c o n t r i b u t i n g to the w e l l - b e i n g of most s e n i o r c i t i z e n s . Case study a n a l y s i s (see Appx.#2-1) i n d i c a t e s the whole complex framework of the e x i s t i n g a v a i l a b l e s e r v i c e s i n terms of: gene r a l medicine (doctors; c l i n i c s ) r e h a b i l i t a t i o n ( p h y s i c a l , mental) p e r s o n a l care: home care and home support s e r v i c e s long term-care: intermediate and extended care r e s p i t e care day care 47 s h o r t stay assessment and treatment pharmacy As the C i t y of Vancouver grows i n terms of the economic resour-ces and p o p u l a t i o n , i t w i l l face t r a f f i c c o n g e s t i o n and commu-n i c a t i o n problems as any other m e t r o p o l i t a n area. T h i s of course may a f f e c t s e n i o r s ' easy access to h e a l t h care s e r v i c e s , now s c a t t e r e d a l l over the c i t y . C o n c l u s ion #3: The CCC should provide a l l l e v e l s of h e a l t h care s e r v i c e s (except acute care) i n one p l a c e . Feature #4: L i f e s t y l e and E x p e c t a t i o n s Contemporary s e n i o r s expect more than t h e i r predecessors i n terms of q u a l i t y l i f e s t y l e . They are more educated, h e a l t h y and more s o p h i s t i c a t e d i n t h e i r e x p e c t a t i o n s . They are l o o k i n g f o r an a t t r a c t i v e , n a t u r a l environment, yet c l o s e to the c u l t u r a l c e n t r e s of m e t r o p o l i t a n l i f e where they can enjoy: s p o r t and r e c r e a t i o n secure environment l e i s u r e and r e t r e a t c u l t u r a l a c t i v i t i e s companionship C o n c l u s i o n #4: The CCC should take advantage of the n a t u r a l beauty of the BC environment and be l o c a t e d c l o s e to the U n i v e r s i t y , R e c r e a t i o n a l and C u l t u r a l Centres and major shopping area. Feature #5: S e n i o r s Everywhere. The growing p o p u l a t i o n of s e n i o r c i t i z e n s i n any community 48 across Canada to g e t h e r with the market f o r c e s i n the housing i n d u s t r y , c a l l f o r a general r a t h e r than a s p e c i f i c l o c a l approach to s e n i o r s ' housing problems. Any c o n s i d e r a t i o n f o r a new f a c i l i t y or housing p r o j e c t , should take i n t o account the catchment area f a r beyond the a c t u a l community. Con c l u s i o n #5: The CCC s h a l l be a d e s t i n a t i o n f o r the l o c a l r e s i d e n t s and a l s o f o r those from M e t r o p o l i t a n Vancouver and Canada. Feature #6: F l e x i b i l i t y and C o n t i n u i t y . The only constant and c e r t a i n c h a r a c t e r i s t i c of a l l the e l d e r l y i s t h a t they change c o n t i n u o u s l y . Because of t h i s phenomenon, the p h y s i c a l and s o c i a l environment they are suppose to l i v e i n must be f l e x i b l e . C o n c l u s i o n #6: The CCC should c r e a t e an environment, which should provide f o r : A. F l e x i b i l i t y i n housing options i n terms of: 1. form of tenure 2. types of d w e l l i n g u n i t s 3. a c c e s s i b i l i t y f o r the p h y s i c a l l y handicapped. B. C o n t i n u i t y i n h e a l t h care s e r v i c e s p r o v i d e d i n only one p l a c e : 1. from Independent L i v i n g 2. to Long Term Care. 49 2.2 THE ELDERLY IN VANCOUVER 2.2.1 ELDERLY POPULATION: THE PEOPLE AND THEIR HOUSES. In 1986 the number of people 65 years o l d and over i n the c i t y i n c r e a s e d from 57530 i n 1971 to 64,415 and composed 15 per-cent of the p o p u l a t i o n and 22 per cent of the households. About 35,000 of the e l d e r l y are l i v i n g i n the West Side of the c i t y . H a l f of the e l d e r l y r e n t and h a l f own t h e i r homes. The e l d e r l y are the l e a s t mobile of the c i t y ' s households. Most have l i v e d i n t h e i r present homes f o r at l e a s t f i v e y ears, but 36.6 per cent have l i v e d there f o r ten years and over (McAfee, Donegani 1985). In 1986 the t r a d i t i o n a l two-parent f a m i l y with c h i l d r e n occupied only 1 i n 5 homes. An equal share of homeowners were aged 65 or o l d e r . By the year 2000, the e l d e r l y c o u l d occupy 1 i n 3 s i n g l e f a m i l y houses. The Vancouver Planning Department r e p o r t s : there i s a grow-ing number of s i n g l e f a m i l y households with members age 65 and over. In 1981, there were 14,500 s e n i o r s households (14 per cent of a l l households, see F i g . 2-1). The Vancouver Planning Department p r o j e c t i o n s f o r the same area i n 1991 i s about 20,000 s i n g l e f a m i l y households with member age 65+ (see F i g . 2-2). P o t e n t i a l movers to a l t e r n a t i v e housing w i l l be between 20% minimum and 50% maximum (The Vancouver P l a n n i n g Department data). P r o j e c t i o n s f o r year 2001 assume 22,800 s i n g l e f a m i l y house-holds with member age 65+ (see F i g . 2-3). i n these census t r a c t s F i g . 2-1 1981 - S i n g l e Family Households with Member Aged 65+ Source: C i t y of Vancouver P l a n n i n g Department o Based on 1981 C e n s u s T o t a l - 103,425 h o u s e h o l d s i n t h e s e census t r a c t s F i g . 2-2 1991 - S i n g l e Family Households with Member Aged 65+ Source: C i t y of Vancouver P l a n n i n g Department TOTAL =~22,BOO (22% of a l l h o u s e h o l d s ) POTENTIAL MOVERS = 20% (minimum) - 50* Imaximum) NUmBER = * of s i n g l e f a m i l y h ouseholds w i t h member age 65+ mini mum [households -mov i ng Based on 19B1 Census max imum \ DusehoIds \ moving I TOTAL - 103,425 h o u s e h o l d s i n t h e s e c e n s u s t r a c t s F i g . 2-3 2001 - S i n g l e Family Households with Member Aged 65+ Source: C i t y of Vancouver P l a n n i n g Department 53 Table 2 - 1 . - - P r o j e c t i o n s of the E l d e r l y Homeowners and the p o t e n t i a l movers i n Vancouver: (1981 census) YEAR HOUSEHOLDS ELDERLY HOUSEHOLD POTENTIAL MOVERS TOTAL % | TOTAL MIN | MAX COMPARISON 20% 50% BASE  1981 103,425 14 14,500 2,900 7,252 1991 103,425 19 20,000 4,000 10,000 2001 103,425 22 22,800 4,560 11,400 2.2.2 SENIORS' RELUCTANCE TO MOVE VERSUS ATTRACTIVENESS OF A NEW  PLACE. The C i t y ' s P l a n n i n g Department ( D r a f t 1985) has concluded t h a t the e l d e r l y do not choose to move because of p r e f e r e n c e s which stem from emotional attachment to t h e i r homes or neighbour-hoods : f a m i l i a r i t y with the environment l o c a t i o n of c h i l d r e n and f a m i l y f e a r of debt change i n gen e r a l crime memories of younger years l e n g t h of term of re s i d e n c e the l a c k of v i a b l e a l t e r n a t e housing The Planning Department c l a i m s , t h a t d e c l i n i n g h e a l t h does e v e n t u a l l y f o r c e 10% of e l d e r l y homeowners to move from t h e i r 54 f a m i l y home i n t o long-term care. Another 10% s e l l and move from t h e i r s i n g l e - f a m i l y home to sma l l e r , s e l f - c o n t a i n e d d w e l l i n g . There are c h a r a c t e r i s i t i c s , which ( i n theory) might encourage the e l d e r l y to move from l a r g e r to s m a l l e r housing: t h e i r houses are o f t e n l a r g e r than r e q u i r e d the aging process c r e a t e s p h y s i c a l l i m i t a t i o n s , which i n c r e a s e the d i f f i c u l t y of ma i n t a i n i n g a house and garden, aging i n c r e a s e s the l i k e l i h o o d of i l l n e s s or death of a spouse, which may r e s u l t i n the s u r v i v i n g p a r t n e r seeking a l t e r n a t e housing. most e l d e r l y homeowners own t h e i r home o u t r i g h t ( e q u i t y ) ; a s u b s t a n t i a l a s s e t should they choose to s e l l . S e v e r a l s t u d i e s have found (McAfee, Donegani 1985) t h a t 50% of today's e l d e r l y homeowners would c o n s i d e r moving i f : 1. They could f i n d the type of home they want. 2. At a p r i c e they c o u l d a f f o r d . 3. In the l o c a t i o n of t h e i r c h o i c e . L o c a t i o n , however, becomes of paramount importance i n any d e c i s i o n to move. In general terms, l o c a t i o n s p r e f e r r e d , by the e l d e r l y would be (McAfee, Donegani 1985): i n t h e i r own neighbourhood w i t h i n walking d i s t a n c e of s e r v i c e s , f a m i l i e s and f r i e n d s near p u b l i c t r a n s p o r t a t i o n near c o n c e n t r a t i o n s of e l d e r l y people not too c l o s e to c o n c e n t r a t i o n s of c h i l d r e n . 55 2.2.3. THE CITY'S HOUSING POLICIES AND MARKET FORCES. "The Goals f o r Vancouver" a major p o l i c y g u i d e l i n e document recommended t h a t housing f o r the e l d e r l y i n t h e i r t r a d i t i o n a l neighbourhoods be encouraged and t h a t o p p o r t u n i t i e s f o r f a m i l i e s to l i v e i n the c i t y be expanded. Obviously, there i s a l i n k between these two g o a l s . I t i s a known f a c t t h a t there are l i m i t s to the c i t y ' s e x i s t i n g housing stock and i t s scarce supply of land. Family housing r e q u i r e s l a r g e ground o r i e n t e d u n i t s . However, a l t e r n a t i v e housing f o r the e l d e r l y can be b u i l t at higher d e n s i t y , t h e r e f o r e can help the e l d e r l y remain independent f o r a longer p e r i o d . The key i s s u e to meet these two o b j e c t i v e s i s the zoning by-law. The C i t y c o u l d a s s i s t those who wish to r e l o c a t e near t h e i r present home, by ensuring t h a t zoning allows some choice of housing type. A c t u a l l y , the c i t y can only zone land to permit develop-ment. From t h a t p o i n t , the p r o v i s i o n of new housing depends upon market f o r c e s = the demand of the e l d e r l y who are prepared to move and a supply of a p p r o p r i a t e u n i t s b u i l t by developers. The Vancouver Planning Department's p r o j e c t i o n s of new s e n i o r s housing needed by 2001 to accommodate e l d e r l y homeowners alone amount to 13,700 u n i t s to meet the needs of aging homeowners (see F i g . 2-4). 2.3 THE ELDERLY IN POINT GREY 2.3.1 VANCOUVER WEST SIDE: TRENDS AND PREFERENCES. Demographic s t u d i e s i n Vancouver's West Side ( R e b a l s k i 1988) 2500 2 100 1200 \ - - .—I 2000 1900 2100 Total 13,700 units 1900 F i g . 2-4 Source: P r o j e c t i o n of S e n i o r Housing Needed by 2001 t o Accomodate E l d e r l y Homeowners C i t y of Vancouver P l a n n i n g Department 57 show a need f o r more s e n i o r s housing f o r those who otherwise might f e e l f o r c e d to leave the neighbourhood to f i n d a p p r o p r i a t e accommodation. Current (1988) estimates of the C i t y ' s P lanning Department i n d i c a t e as many as 10,000 Vancouver s e n i o r s who p r e s e n t l y own t h e i r own detached houses might be i n t e r e s t e d i n moving to other forms of housing i f i t was a v a i l a b l e . According to the recent survey of housing p r e f e r e n c e s of West Side r e s i d e n t s c a r r i e d out by Michael G e l l e r & A s s o c i a t e s L t d . "Is Your House G e t t i n g Too Big?" (1987), 71% of those who responded were 55 years of age or over. While the p r e f e r r e d b u i l d i n g type was townhouses, there was i n t e r e s t i n l o w r i s e a-partments as w e l l as apartments 5 s t o r e y s and over. Respondents were l o o k i n g f o r apartment b u i l d i n g s with s e r v i c e s i n c l u d i n g communal d i n i n g f a c i l i t i e s . There were two p r e f e r a b l e l o c a t i o n s : one near 10th and Tolmie and the second near 4th and Alma, which was chosen p a r t i c u l a r l y by those 65 years o l d and over. 2.3.1.1 The E l d e r l y i n West P o i n t Grey Area P a r t i c u l a r l y , i n West P o i n t Grey area, the e l d e r l y compose 15.4 per cent of the t o t a l p o p u l a t i o n of 11,540. E l d e r l y men form 5.76 per cent and women 9.66 per cent. However, the p o p u l a t i o n i n t h e i r f i f t i e s and e a r l y s i x t i e s i s r e l a t i v e l y higher, 9.66% and 10.31% r e s p e c t i v e l y . T h e r e f o r e , we can assume th a t the number of the e l d e r l y i n West P o i n t Grey area w i l l i n c r e a s e . 2.3.1.2 Dwel l i n g C h a r a c t e r i s t i c s There are 4,625 p r i v a t e d w e l l i n g s i n West P o i n t Grey area 58 with 2770 owned (59.9%) and 1850 (40%) rented (Census 1986). We can assume t h a t the o l d e r people l i v i n g i n the rented d w e l l i n g s w i l l be i n the f u t u r e p o t e n t i a l a p p l i c a n t s f o r a l t e r n a t i v e housing or f a c i l i t y f o r the e l d e r l y . 2.3.1.3 Household C h a r a c t e r i s t i c s In West P o i n t Grey 1760 persons 65 years o l d and over l i v e i n p r i v a t e households, 33% of them i s l i v e alone. 2.3.1.4 Census Family C h a r a c t e r i s t i c s The f a m i l y p r o f i l e i n West P o i n t Grey area composes of 50% of f a m i l i e s without any c h i l d r e n or c h i l d r e n no longer at home. Th i s group i s a t high r i s k of going to a n u r s i n g home i f they become i l l . T h e r e f o r e , we can assume t h a t a s i g n i f i c a n t number of the e l d e r l y would seek another l i v i n g arrangement with more s e c u r i t y i n terms of h e a l t h care due to l a c k of f a m i l y s u p e r v i s i o n . 2.3.2 THE EXISITING SENIOR HOUSING IN POINT GREY In Vancouver, i n ge n e r a l , there are l i m i t e d c h o i c e s f o r e l d e r l y s i n g l e f a m i l y homeowners who wish to move to other housing i n t h e i r neighbourhood. P a r t i c u l a r l y , the West P o i n t Grey area i s b u i l t to c a p a c i t y . There i s onl y one S e n i o r s S o c i a l Housing p r o j e c t , Steeves Manor, on Wallace S t r e e t . T h i s p r o j e c t comprises 200 d w e l l i n g u n i t s . Next to the t h e s i s s u b j e c t s i t e on West 4th Avenue, there i s under c o n s t r u c t i o n a 10 s t o r e y r e s i d e n t i a l b u i l d i n g with 45 s e l f - c o n t a i n e d d w e l l i n g u n i t s , which are s e n i o r s o r i e n t e d . In a d d i t i o n , there are two 59 condominuum developments under c o n s t r u c t i o n : "Mayfair House" with 81 u n i t s (one and two bedroom) and the "Cumberland" with 41 one bedroom u n i t s . 2.3.3 THE EXISTING LONG TERM CARE FACILITIES In the West P o i n t Grey area (with 2310 persons 65 years o l d and over) as w e l l as i n the adjacent areas of K i t s i l a n o and Dunbar-Southlands, there are only nine long term care f a c i l i -t i e s , with a t o t a l of 384 beds. There are 56 beds at the E.C. l e v e l , 202 beds at I.C. and 126 beds at P.C. (Vancouver Health Department). Although the P r o v i n c i a l M i n i s t r y of Health's Con-t i n u i n g Care Program arranges f o r treatment and support s e r v i c e s f o r i n d i v i d u a l s who can not f u n c t i o n independently i n homes among t h e i r f a m i l i e s , due to h e a l t h r e l a t e d problems, there i s s t i l l a need f o r a long term care f a c i l i t y e s p e c i a l l y at the Intermediate Care L e v e l . 2.3.4 A NEED FOR LONG TERM CARE FACILITIES According to Vancouver Health Department data there are 13,169 c l i e n t s i n Vancouver r e c e i v i n g long term care s e r v i c e s (see F i g . 2-5): however, there i s s t i l l a s i g n i f i c a n t number of c l i e n t s (see F i g . 2-6) who are w a i t l i s t e d f o r a long term care placement (Annual Report 1986). The growing p o p u l a t i o n of t h i s area may c r e a t e a new problem with the supply of necessary h e a l t h care s e r v i c e s such as Intermediate Care, Extended Care, C l i n i c f o r the e l d e r l y , Respite Care, Day/Night Care or care f o r the s e n i o r s when t h e i r f a m i l i e s are on v a c a t i o n s . 60 F i g . 2-5 Number of C l i e n t s R e c e i v i n g Long Term Care Home Support or F a c i l i t y S e r v i c e s by L e v e l of Care (December 1986) Int.l: 299 (37X) F i g . 2-6 Number of C l i e n t s W a i t l i s t e d f o r Long Term Care Placement by L e v e l of Care (December, 1986) Source: Vancouver Health Department, C o n t i n u i n g Care D i v i s i o n , Annual Report, 1986. 61 2.3.5 A NEED FOR SENIOR CENTRE There i s a need f o r a bi g g e r a c t i v i t y c e n t r e f o r s e n i o r s i n t h i s area. The e x i s t i n g Brock House - S e n i o r s A c t i v i t y Centre on J e r i c h o Beach although p r o v i d i n g a v a r i e t y of c u l t u r a l , educa-t i o n a l and s o c i a l programs, i s simply too s m a l l . Brock House i s a h e r i t a g e b u i l d i n g , which belongs to the C i t y of Vancouver and has been l e a s e d to the Brock House S o c i e t y , a n o n - p r o f i t o r g a n i -z a t i o n , which a d m i n i s t e r s the A c t i v i t y Centre f o r S e n i o r C i t i -zens. S i t u a t e d on two and one h a l f acres of w a t e r f r o n t proper-t y , 20 room Brock House i s i n s u f f i c i e n t f o r 3000 members and can not accomodate a l l d e s i r e d programs and a c t i v i t i e s . There are apparent needs f o r adequate room to accommodate Members f o r a wide range of a c t i v i t i e s : c h o i r , o r c h e s t r a , c o n c e r t s , popular l e c t u r e s , s o c i a l events, dances, br i d g e tournaments, f i t n e s s c l a s s e s , workshops and r e c r e a t i o n a l a c t i v i t i e s . In September 1988 a q u e s t i o n n a i r e on the Annex Concept was sent to a l l members. A t o t a l of 576 r e p l i e s to the q u e s t i o n n a i r e supported the major a d d i t i o n p r o j e c t . The survey documented t h a t there i s a urgent need f o r a S e n i o r C i t i z e n Centre with a more comprehensive program and a wider range of amenities than are provided by Brock House at the present time. 2.3.6 POINT GREY: DESTINATION FOR THE ELDERLY I have s e l e c t e d the P o i n t Grey area as a background f o r my research t h e s i s , because i n general terms, i t o f f e r s a unique environment: 62 F i r s t l y : f o r the s e n i o r c i t i z e n s l i v i n g i n P o i n t Grey at the present moment and who want to stay there. Secondly: f o r those l i v i n g i n adjacent K i t s i l a n o , Dunbar and K e r r i s d a l e areas, who want to move to f a m i l i a r neighbourhood. T h i r d l y ; f o r those l i v i n g i n M e t r o p o l i t a n Vancouver and the Lower Mainland who would l i k e to move there i f p o s s i b l e , and F i n a l l y : f o r a l l those s e n i o r s from a l l over Canada and U.S.A. who are p l a n n i n g to come here, because of these primary reasons: N a t u r a l Beauty of BC, i t s m i l d c l i m a t e and e x c e l l e n t l e v e l of h e a l t h care s e r v i c e s . The proposed Continuum of Care Complex i n West P o i n t Grey area could be one of the options f o r the b a s i c three groups of e l d e r l y : 1. "empty n e s t e r s " , the e l d e r l y and p r e - e l d e r l y i n s i n g l e f a m i l y houses -- these people s e l l an expensive house to get a s m a l l e r one, or a townhouse, f o r convenience and lower p r i c e . They may be l a s t time buyers t h i n k i n g about aging i n t h a t u n i t . 2. " r e n t e r s " , the e l d e r l y l i v i n g i n rented d w e l l i n g s - u s u a l l y the e l d e r l y with a low income, i n t e r e s t e d i n a f f o r d a b l e housing with high l e v e l of amenities and s e c u r i t y . 3. " a l o n e r s " , the e l d e r l y l i v i n g alone without f a m i l i e s -mostly women. Those people w i l l look f o r s e c u r i t y both i n terms of p h y s i c a l l y secure environment and h e a l t h care s e r v i c e s , t r o u b l e f r e e maintenance and companionship. 63 2.4 THE SITE OF THE CONTINUUM OF CARE COMPLEX AT 4TH AVE &  HIGHBURY STREET I have s e l e c t e d f o r my t h e s i s the F e d e r a l N a t i o n a l Defence Lands s i t e f o r the proposed development, because there i s an e x e l l e n t access to s e r v i c e s , a c t i v i t i e s , p u b l i c t r a n s p o r t a t i o n and the U n i v e r i s i t y of B r i t i s h Columbia. The s i t e i s l o c a t e d i n the core of one of Vancouver's d e s i r a b l e r e s i d e n t i a l areas. I t i s c l o s e to J e r i c h o Beach and has neighbourhoods with w e l l - l o v e d atmosphere of s t a b i l i t y and t r a d i t i o n . Although there has been c o n s i d e r a b l e d i s c u s s i o n on a need to preserve Vancouver's s i n g l e f a m i l y neighbourhoods, there i s a l s o a growing need f o r new forms of housing on the West Side of Vancouver. The s u b j e c t s i t e could make an e x c e l l e n t p l a c e f o r the CCC development. The l o c a t i o n and v a r i e t y of s e r v i c e s provided by the Continuum of Care Complex and easy access to community reso u r c e s c o u l d a t t r a c t s e n i o r s not only from the West P o i n t Grey area, but a l s o from Vancouver, the Province of BC and a l l of Canada. 64 CHAPTER 3 - THE CCC FACILITY OBJECTIVES Chapter Summary; Chapter 3 concludes the t h e s i s a n a l y s i s c y c l e and develops the major o b j e c t i v e s f o r the f a c i l i t y program. I t c o n s i s t s of f i v e s e c t i o n s , each d e d i c a t e d to a separate important i s s u e . These i s s u e s are: L i v i n g Environment, R e s i d e n t s , Management, Community and Neighbourhood Development. INTRODUCTION The Continuum of Care Complex c o n s i s t s of independent s e n i o r s ' housing, r e s i d e n t i a l h e a l t h care f a c i l i t i e s and s e n i o r community s e r v i c e s . The complex w i l l provide on s i t e p e r s o n a l , s o c i a l , and h e a l t h care s e r v i c e s to i t s r e s i d e n t s . Since the e l d e r l y r e p r e s e n t a great d i v e r s i t y of p h y s i c a l and mental a b i l i t i e s , l i f e - s t y l e s and p r e f e r e n c e s , d e s i g n i n g f o r them r e q u i r e s s p e c i a l knowledge about the aging process and how t h i s process a f f e c t s t h e i r way of readi n g , i n t e r p r e t i n g or even imaginating t h e i r environment. In g e n e r a l , the aging process i s a s s o c i a t e d with s e v e r a l changes. These changes may be understood as a slow process of l o s s e s such as c h i l d r e n l e a v i n g home, death of spouse or f r i e n d s , l o s s of income, l o s s of sensory a c u i t y , d e t e r i o r a t i n g h e a l t h and diminished independence. T h i s process r e s u l t s i n an i n c r e a s e i n the e l d e r l y ' l e v e l of dependence and a decrease of t h e i r l e v e l of competence. In "Environment and Aging" M. Powell Lawton d i s c u s s e s the i s s u e of the i n t e r a c t i o n 65 between man and environment. He s t a t e s t h a t : The l e s s competent the i n d i v i d u a l , the g r e a t e r the impact of environmental f a c t o r s on t h a t i n d i v i d u a l (Lawton 1986, p.14). A person with average competence can de a l with p h y s i c a l s e t t i n g s through adaptive behavior. Although the aged f o r the most p a r t of t h e i r l i v e s are c h a r a c t e r i z e d by independence and competent behavior, they are v u l n e r a b l e ( e s p e c i a l y the " o l d - o l d " segment -75 years of age and more) to h e a l t h changes and s o c i a l d e p r i v a t i o n s which may lead to r e d u c t i o n s i n competence. Lawton suggest t h a t : ... i f we c o u l d design housing with fewer b a r r i e r s , neighborhoods with more e n r i c h i n g r e s o u r c e s , or i n s t i t u t i o n s with higher s t i m u l a t i n g q u a l i t i e s , we coul d improve the l e v e l of f u n c t i o n i n g of many o l d e r people more than p r o p o r t i o n a t e l y (Lawton 1986, p.15). He l a t e r concludes t h a t by r e c o g n i z i n g the e l d e r l y persons unique needs we can cr e a t e f o r them a more f a v o r a b l e environment and e l e v a t e t h e i r behavior. 3.1. LIVING ENVIRONMENT OBJECTIVES (L.E.O.) In order to s a t i s f y the e l d e r l y ' s unique needs a number of o v e r a l l o b j e c t i v e s have to be poin t e d out. These o b j e c t i v e s recognize the s p e c i a l c h a r a c t e r i s t i c s of the e l d e r l y which a f f e c t the design of the Continuum of Care Complex. L.E.O. # 1 To c r e a t e a q u a l i t y environment which w i l l : 66 1) i n c r e a s e o p p o r t u n i t i e s f o r i n d i v i d u a l choice i n the CCC  p h y s i c a l s e t t i n g ; R a t i o n a l e : the i n d i v i d u a l ' s l i f e s t y l e i n o l d e r age i s a f f e c t e d by a r e d u c t i o n of the number of options open to him. To respond to the p r e f e r e n c e s and a b i l i t i e s among the e l d e r l y v a r i e t y and choice must be o f f e r e d . "Where environmental c h o i c e s are a v a i l -a b l e , o l d e r people g e n e r a l l y tend to choose those t h a t match t h e i r a b i l i t y l e v e l " ( C a r s t e n s 1985). The CCC environment should permit the widest range of pe r s o n a l c h o i c e s by p r o v i d i n g : a v a r i e t y of l i v i n g arrangements (one bedroom u n i t s , two bedroom u n i t s , townhouse, m u l t i p l e d w e l l i n g u n i t s ) a v a r i e t y of amenities and s e r v i c e s (a wide range of s o c i a l , p e r s o n a l and h e a l t h care s e r v i c e s ) a v a r i e t y of outdoor areas (f o r m a l , i n f o r m a l , c h o i c e s i n s c a l e and spaces) a v a r i e t y of common spaces ( s o c i a l i n t e r a c t i o n vs intimacy) a v a r i e t y of tenure 2) minimize dependence and i n s t e a d encourage p e r s o n a l inde-pendence i n use of the CCC f a c i l i t y ; R a t i o n a l e : "The d e s i r e to be independent of ot h e r s i s p a r t i -c u l a r l y s t r o n g among the e l d e r l y . The a b i l i t y to do f o r o n e s e l f c a r r i e s a sense of p r i d e and i n c r e a s e s s e l f - e s t e e m " (Jordan 1978, p.47) P h y s i c a l support f e a t u r e s (as w e l l as management) i n the 67 CCC should be unobtrusive i n order to reduce f e e l i n g of dependency. For example, the design of the p a r k i n g area (15% wider parking spaces or s p e c i a l l y marked spaces f o r handicapp-ed), walks, ramps, l i v i n g u n i t s , a l l f a c i l i t i e s i n the Core Centre should permit use by the handicapped or l e s s mobile e l d e r l y without the a s s i s t a n c e of other s . 3) r e i n f o r c e the i n d i v i d u a l s ' l e v e l of competency by p r o v i d i n g  environmental support; R a t i o n a l e ; Environmental support w i t h i n the CCC f a c i l i t y should help the l e s s able to f u n c t i o n at higher l e v e l of competence. In ge n e r a l , more space "around", whether i t w i l l be i n the d w e l l i n g u n i t or i n the common space w i l l help o l d e r people to f u n c t i o n at a higher l e v e l of competence. Some environmental supports may r e i n f o r c e the i n d i v i d u a l s l e v e l of competency and improve q u a l i -t y of l i f e . F or example, wide stairways with g e n t l e r i s e r s and frequent l a n d i n g s w i l l be e a s i e r f o r o l d e r people to use, as w e l l as, wider spacing of rows of auditorium s e a t s , and p r o v i d -ing easy use f u r n i t u r e . 4) compensate f o r sensory and p e r c e p t u a l changes; R a t i o n a l e ; The aging process b r i n g s sensory changes. Sensory l o s s e s occur with v i s i o n , h earing, t a s t e , touch and s m e l l . By adopting a " p r o s t h e t i c approach" to design (Carstens 1985) such changes c o u l d be compensated f o r . A " p r o s t h e t i c environment" o f f e r s a p p r o p r i a t e l e v e l s of c h a l l e n g e or support. 68 I t compensates f o r l o s s e s by, f o r example, use of the b r i g h t e r c o l o r s and those i n the orange-yellow-red spectrum ( e a s i e r to d i s t i n g u i s h ) , u s i n g l o w e r - p i t c h e d sounds (which are more e a s i l y heard), p r o v i d i n g t a c t i l e cues t h a t may be more e a s i l y p e r c e i v e (walking s u r f a c e ) . 5) improve comprehension and o r i e n t a t i o n i n the new e n v i r o n -ment; R a t i o n a l e : "Changes i n mental f u n c t i o n i n g brought about by age can r e s u l t i n behavior t h a t i n c l u d e s memory l o s s , f o r g e t f u l n e s s , d i s o r i e n t a t i o n and incoherence"(Jordan 1978, p.49) To promote wayfinding and o r i e n t a t i o n the c i r c u l a t i o n pat-t e r n of the whole CCC f a c i l i t y should be simple and e a s i l y a c c e s s i b l e . For example, sig n s should be l a r g e enough to be read and l o c a t e d at a he i g h t convenient f o r people with v i s u a l l i m i t a -t i o n ; the b u i l d i n g plans and outdoor areas should promote way-f i n d i n g through v i s u a l c l u e s which emphasize the c h a r a c t e r of any p a r t i c u l a r area. 6) encourage s o c i a l i n t e r a c t i o n between r e s i d e n t s (and  v i s i t o r s ) ; R a t i o n a l e ; With age an o l d e r person's s o c i a l c o n t a c t s are o f t e n reduced by: l o s s of h e a l t h , death of spouse or f r i e n d s and c h i l d r e n moving away. Older people look f o r o p p o r t u n i t i e s to e s t a b l i s h new acquaintances or f r i e n d s h i p (Jordan 1978, p.50) A s p e c i a l l y designed environment which promotes and encour 69 ages the e l d e r l y i n s o c i a l i n t e r a c t i o n can help to e s t a b l i s h new f r i e n d s and acquaintances. For example, the amenity spaces such as lounges, d i n i n g f a c i l i t i e s , w a i t i n g areas should provide an i n t i m a t e atmosphere which promotes p r i v a t e c o n v e r s a t i o n ; game rooms, a r t s and c r a f t s , swimming pool and other components should i n c r e a s e o p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n ; outdoor r e c r e a t i o n a l f a c i l i t i e s may a t t r a c t younger persons and promote a mix of age c o h o r t s . 7) s t i m u l a t e p a r t i c i p a t i o n i n a c t i v i t i e s ; R a t i o n a l e ; With age can come a r e d u c t i o n i n one's s e l f - c o n f i -dence (Lawton 1986). In order to encourage p a r t i c i p a t i o n i n a c t i v i t i e s some design f e a t u r e s should be implemented. For example, the group a c t i v i t i e s i n the amenity areas such as a r t s and c r a f t s should be v i s i b l e f o r passing-by observers by p r o v i d i n g open s t u d i o s ( r a t h e r than c l o s e d - o f f rooms), lounges should be adjacent to "where the a c t i o n i s " , outdoor a c t i v i t y areas should be surround-ed by a s e a t i n g area f o r watching. 8) provide o p p o r t u n i t i e s f o r i n d i v i d u a l p r i v a c y i n c o n t a c t with  o t h e r s ; R a t i o n a l e ; With age many people want more i n t i m a t e c o n t a c t with one or two others (Jordan 1978). Common spaces: p r o v i d i n g q u i e t corners (alcoves) i n lounges or by f u r n i t u r e arrangement (two-person t a b l e i n d i n i n g room) 70 f o r example, may improve p r i v a c y or encourage more i n t i m a t e c o n v e r s a t i o n . Outdoor spaces: should i n c l u d e secluded s e a t i n g areas and r e t r e a t s . The d w e l l i n g u n i t : should provide a space arrangement which may c r e a t e one's own t e r r i t o r y . T h i s i s s u e i s d i s c u s s e d i n g r e a t e r d e t a i l i n Chapter 6. 9) improve the p u b l i c image of the e l d e r l y . R a t i o n a l e : Negative, o b s o l e t e s t e r e o t y p e s about the e l d e r l y are a s s o c i a t e d with d i s a b i l i t y and s i c k n e s s . The f a c i l i t y should be designed to improve the p u b l i c ' s a t t i t u d e s and o p i n i o n s about the e l d e r l y by c r e a t i n g an e n v i r o n -ment i n which the e l d e r l y c o u l d f u n c t i o n e f f e c t i v e l y as a p a r t of the community but not as an i s o l a t e d i n s t i t u t i o n f o r d i s a b l e d or s i c k people. L.E.O. # 2 To provide the s a f e t y and s e c u r i t y . R a t i o n a l e : Older people are e s p e c i a l l y s e n s i t i v e to the need of secure environment because of reduced l e v e l s of p h y s i c a l and mental competence (Lawton 1986). Fear of crime, s t o l e n p r o p e r t y and concern about f a l l i n g or being a t t a c k e d and not being seen or a i d e d are high among o l d e r people. They are more v u l n e r a b l e to long-term d i s a b i l i t i e s caused by a f a l l or an a t t a c k . 1. The f a c i l i t y should be l o c a t e d i n an area where people are reasonably safe from robbery, muggings or p e r s o n a l harassment. 2. The f a c i l i t y should p r o v i d e s e r v i c e s , which may improve 71 f e e l i n g s of s a f e t y f o r example: home support s e r v i c e s , s e c u r i t y p ersonnel. 3. Outdoor areas and main p e d e s t r i a n walkways should be l o c a t e d to a llow f o r v i s u a l s u r v e i l l a n c e by r e s i d e n t s and s t a f f . 4. Outdoor common areas used by r e s i d e n t s should be enclosed w i t h i n c l u s t e r s . 5. A c l e a r t r a n s i t i o n from neighbourhood p u b l i c space to p r i -vate space should be implemented by p r o v i d i n g t r a n s i t i o n a l zones: p u b l i c , s e m i p u b l i c (the CCC community), s e m i p r i v a t e ( c l u s t e r space), p r i v a t e ( p a t i o ) . 6. The s i t e p l a n n i n g should c l e a r l y d e f i n e edge c o n d i t i o n s such as f e n c i n g and gates, which may f o s t e r a sense of s e c u r i t y . 7. The f a c i l i t y should provide p h y s i c a l s a f e t y f e a t u r e s . A l l f a c i l i t y entrances and e x i t s should be v i s u a l l y s u p e r v i s e d by s t a f f ( c l o s e d - c i r c u i t v i d e o / t v system). P u b l i c areas should be p r o t e c t e d by an emergency l i g h t i n g system i n case of power f a i l u r e . Hazards to p e r s o n a l s a f e t y should be minimized by p r o v i d i n g s a f e t y f e a t u r e s such as: h a n d - r a i l s i n c o r r i d o r s , n o n - s l i p f l o o r s , grab bars i n washrooms and bathrooms, emergency c a l l boxes and telephones throughout the b u i l d i n g s and i n the outdoor common areas. L.E.O. # 3 To provide a v a r i e t y of Environments. 1. To provide a s p e c i f i c combination of environments f o r the e l d e r l y which w i l l i n c l u d e : a. a "home-like" environment i n the d w e l l i n g c l u s t e r s at a l l l e v e l s of care. 72 b. a " s o c i a l community" environment i n the amenity areas and outdoor a c t i v i t y c e n t r e . c. environments which w i l l be a e s t h e t i c a l l y a p p e a l i n g to the r e s i d e n t s , t h e i r f a m i l i e s and f r i e n d s , the s t a f f and the community at l a r g e . R a t i o n a l e : The Continuum of Care Complex w i l l be the new pl a c e to l i v e i n but by p r o v i d i n g a r e s i d e n t i a l c h a r a c t e r i t might help the r e s i d e n t s to r e t a i n t h e i r s e l f - i d e n t i t i e s and l i f e - s t y l e s . 2. To d i m i n i s h " o l d - f o l k s home" st e r e o t y p e . R a t i o n a l e : Long term care f a c i l i t i e s are u s u a l l y a s s o c i a t e d with the s t e r e o t y p e of i n s t i t u t i o n a l c h a r a c t e r which consequently c r e a t e s negative p u b l i c o p i n i o n . Older people don't l i k e to move i n because of f e a r of becoming a " p a t i e n t " ; the neighbourhood does not l i k e to have such a f a c i l i t y near by because of i t s negative image. "R e g r e t t a b l y , the p u b l i c image of aging i n our s o c i e t y a s c r i b e s d i s a b i l i t y and s i c k n e s s to the m a j o r i t y of o l d e r people"(Lawton 1986, p.105). G e r o n t o l o g i s t s are unanimous i n f e e l i n g t h a t the i n s t i t u t i o n i s the l e a s t d e s i r a b l e p l a c e f o r o l d e r people and they encourage any attempt to design s e r v i c e s and environments which can prolong r e s i d e n c e i n the community. 3. To c r e a t e an o p p o r t u n i t y f o r a "new s t a r t " . R a t i o n a l e : The f a c i l i t y might a l s o provide o p p o r t u n i t i e s f o r the r e s i d e n t s to make l i f e more enjoyable by e s t a b l i s h i n g a new 73 p a t t e r n of s o c i a l l i f e . The CCC, i n p r i n c i p l e , w i l l a l s o be a p a r t of the neighbourhood by p r o v i d i n g a g r e a t number of s e r -v i c e s and programs f o r r e s i d e n t s and the e n t i r e community. The proposed Core Centre, the i n n o v a t i v e program component, should become an a c t i v e " s o c i a l community" which encourages i n t e r a c t i o n not o n l y among f a c i l i t y r e s i d e n t s but a l s o with f r i e n d s , r e l a -t i v e s and aquaintances from the neighbourhood. A v a r i e t y of f a c i l t i e s open to the p u b l i c such as a swimming po o l , l i b r a r y , auditorium, a r t and c r a f t s , e t c . should b r i n g people together. Moreover, the Core Centre should provide mental and s o c i a l s t i m u l a t i o n . The e l d e r l y should be encouraged to c o n t r i b u t e or p a r t i c i p a t e i n the running of the Centre. They can s t a f f the r e c e p t i o n desk, organize c u l t u r a l events, run the l i b r a r y , take care of the garden e t c . They can j o i n f o r c e s to r a i s e funds f o r a s p e c i a l p r o j e c t and i n t e r a c t with community r e s i d e n t s . They can have the o p p o r t u n i t y to earn e x t r a income by s e r v i n g f o r example as instrument and languages t e a c h e r s , p r e p a r i n g income tax e t c . They can be very c r e a t i v e i n A r t s and C r a f t s and the Core Centre may become a very important p a r t of t h e i r l i v e s . 3.2. RESIDENTS' OBJECTIVES (R.O.) The most important o b j e c t i v e s f o r r e s i d e n t s choosing to l i v e i n the CCC have been agglomerated i n t o three b a s i c groups of needs: r e s i d e n t i a l , h e a l t h care and s o c i a l needs. 74 R.O. # 1 RESIDENTIAL TENURE CHOICE To provide rented accommodation f o r those who are unable to purchase t h e i r d w e l l i n g u n i t s . To provide a l t e r n a t i v e hous-i n g f o r those who wish to r e l i n q u i s h the r e s p o n s i b i l i t y of ownership. R a t i o n a l e : Although the income of e l d e r l y Canadians has i n c r e a s e d substan-t i a l l y over the l a s t few years there i s s t i l l an income gap between the e l d e r l y and the r e s t of the p o p u l a t i o n . The f i n a n c i -a l p o s i t i o n of e l d e r l y men has improved more than t h a t of e l d e r -l y women ( N a t i o n a l C o u n c i l of Welfare,1984). A c c o r d i n g to S t a t i s -t i c s Canada, 1984 the e l d e r l y are h e a v i l y dependent on p u b l i c pension and income s e c u r i t y p l a n s . In 1985, 10% of f a m i l i e s i n which the head of the household was 65 years or over were below the poverty l i n e . C o r r e s p o n d i n g l y , 46.8% of unattached i n d i v i d -u a l s 65 years of age or over were a l s o below the poverty l i n e . In the West P o i n t Grey area, the average household income i s $35,000; however, 39.6% of a l l households income i s onl y $20,000. The worst s i t u a t i o n i s i n adjacent K i t s i l a n o where a household income of $20,000 r e p r e s e n t s 54% of a l l households ( C i t y H a l l data,1986). Although the f i n a n c i a l p o s i t i o n of e l d e r -l y people has improved and the trend toward f i n a n c i a l s e c u r i t y w i l l continue ( N a t i o n a l C o u n c i l of Welfare,1984) a t t e n t i o n must be p a i d to those people who d i d not make pension c o n t r i b u t i o n s or save d u r i n g t h e i r younger years. For example, many women f i n d themselves i n t h i s s i t u a t i o n . A c c o r d i n g to a survey of B.C. 75 Housing Management Commission a p l i c a n t s , the t y p i c a l s e n i o r seek-i n g a s s i s t a n c e was female (70%), aged 65-74 (59%), l i v i n g i n a-partment (87%) and spending 48% of her income on r e n t i n g s h e l t e r . On the other hand, f o r more a f f l u e n t s e n i o r homeowners, the a v a i l a b i l i t y of a l t e r n a t i v e housing which w i l l respond to t h e i r s p e c i f i c needs c o u l d convince them to s e l l t h e i r homes. Accord-i n g to an SFU study of s e n i o r s aged 51-64, 65-74, and 75+ conducted by Gutman (1988), e n t i t l e d "Seniors R e a c t i o n to New V i s t a ' s Community Concept", the p r o p o r t i o n of homeowners who had thought s e r i o u s l y about s e l l i n g t h e i r home i n c r e a s e d with i n -c r e a s i n g age. T h e i r major reasons f o r doing so were p h y s i c a l d i f f i c u l t y m a i n t a i n i n g t h e i r home or garden and the i l l n e s s of themselves or t h e i r spouse. "When asked why they d i d not s e l l , a t h i r d of respondents s a i d i t was because they d i d not want to change t h e i r l i f e -s t y l e , 14.8% s a i d i t was because they c o u l d not f i n d a b e t t e r a l t e r n a t i v e while 11.1% re p o r t e d they were s t i l l c o n s i d e r i n g s e l l i n g " (Gutman,1988 p.20). When homeowners were asked whether, i f they were to s e l l t h e i r home, they would be more l i k e l y to buy or r e n t t h e i r next accommodation, those i n the youngest group (51-64) were about e q u a l l y s p l i t between r e n t i n g and buying another home. The p r o p o r t i o n who would buy decreased with i n c r e a s i n g age. Renting was c l e a r l y the pre f e r e n c e of those i n the o l d e s t (75+) group. Respondents were a t t r a c t e d to the New V i s t a s i t e because New V i s t a was w e l l l o c a t e d , there 76 would be access to the care ce n t r e i f long-term care was needed and there would be medical personnel nearby i n the event of an emergency (Gutman 1988, p.28). The o l d e s t group of respondents were convinced t h a t people who c o u l d a f f o r d to pay market re n t would move to a s i t e where the other b u i l d i n g s housed mainly low income people - as long as those low income people were s e n i o r s . Based on these data, we can assume t h a t there i s the p o s s i b i l i t y of co e x i s t a n c e of r e s i d e n t s with low income and the b e t t e r o f f e l d e r l y people. T h e r e f o r e , a f f o r d a b l e housing f o r the e l d e r l y with low income and a l t e r n a t i v e housing f o r those who wish to s e l l t h e i r home w i l l be an important o b j e c t i v e i n c r e a t i o n of a Continuum of Care Complex i n West P o i n t Grey area. T h i s c o u l d be achieved by: 1. P r o v i d i n g housing through BCHMC programs where housing charges do not exceed 30% of the r e s i d e n t ' s income. According to the C i t y H a l l P l a n n i n g Department (1986) the number of people r e q u i r i n g a s s i s t e d housing was 2,558. 2. P r o v i d i n g Co-operative Housing based on the CMHC a s s i s t a n c e program or a f f o r d a b l e s e n i o r s ' housing without government a s s i s t a n c e . For example, Avondale Cooperative Housing f o r S e n i o r s i n North-Surrey has won the CMHC award i n the f i n a n -c i n g and tenure category. Members bought shares i n the co-op and organized r i g h t s as shareholders i n a c o r p o r a t i o n . By paying o f f the mortgage they i n c r e a s e t h e i r s h a r e h o l d i n g u n t i l they have i n v e s t e d the f u l l value of the u n i t . Then 77 they j u s t pay monthly maintenance f e e s . Since the value of a share does not i n c r e a s e over time, the p r i c e of a u n i t w i l l remain the same. Members who move out r e c e i v e the amount they have i n v e s t e d without making a p r o f i t ( R e b a l s k i 1988). Because the share p r i c e w i l l remain low and, i n f a c t , decrease i n p r o p o r t i o n to the r i s i n g c o s t of other housing, the co-op w i l l have an ever broadening market of people who can a f f o r d shares. 3. Provide s t r a t a t i t l e condominiums f o r those who can i n v e s t a p o r t i o n of e q u i t y recovered from s e l l i n g t h e i r present home and who wish to have a hig h e r standard of housing than may be p r o v i d e d by other forms of housing. For example, more l i v i n g space, more amen i t i e s , b e t t e r f i n i s h m a t e r i a l s . R.O. # 2 HEALTH CARE NEEDS To provide h e a l t h care s e r v i c e s f o r a l l r e s i d e n t s of the CCC f a c i l i t y . To provide h e a l t h care s e r v i c e s f o r the e l d e r l y r e s i d e n t s and i n the e n t i r e neighbourhood. R a t i o n a l e : H e a l t h matters are of d i s t i n c t importance when c o n s i d e r i n g the needs of the e l d e r l y . I l l n e s s and l o n e l i n e s s become r e a l i s t i c f e a r s f o r o l d e r people. Given t h a t t w o - t h i r d s of d i s a b l e d people are a l s o e l d e r l y people, the importance of h e a l t h and s o c i a l s e r v i c e s p r o v i s i o n i s s e l f - e v i d e n t . The e l d e r l y use more medical s e r v i c e s than any other a d u l t age group, the o l d e l d e r l y use more than young e l d e r l y and women use more than men (Gutman 1982). I n c r e a s i n g age among the e l d e r l y i s a s s o c i a t e d with a 78 decrease i n h e a l t h i n the form of c h r o n i c i l l n e s s , p h y s i c a l h e a l t h d y s f u n c t i o n and dependency on o t h e r s . As the l e v e l of dependency of an i n d i v i d u a l i n c r e a s e s , so too does the l e v e l of s e r v i c e s r e q u i r e d to keep t h a t person a t home. I f more e l d e r l y are to remain at home (GVRHD Report 1987), formal s e r v i c e s must be provided. At some p o i n t the c o s t of formal s e r v i c e s i n the home w i l l become high e r than the c o s t of care i n an i n s t i t u t i o n . With i n c r e a s e s i n the p r o p o r t i o n of the e l d e r l y i n the h i g h e r age groups, e s p e c i a l l y 85 years of age and over ( S t a t i s t i c s Canada 1980), home care may no longer be a c o s t - s a v i n g measure. Moreover, there w i l l always be some e l d e r l y f o r whom there i s no a l t e r n a t i v e to i n s t i t u t i o n a l i z a t i o n . In other words i t i s not a q u e s t i o n of f a i l i n g to support d e i n s t i -t u t i o n a l i z a t i o n but r a t h e r of p r o v i d i n g the best p o s s i b l e h e a l t h care to the e l d e r l y i n the most a p p r o p r i a t e s e t t i n g at a c o s t t h a t s o c i e t y can a f f o r d (Canadian M e d i c a l A s s o c i a t i o n 1987). T h e r e f o r e , a f a c i l i t y which w i l l have h e a l t h care s e r v i c e s a t  hand would be i n g r e a t demand by aged people. A c c o r d i n g to r e s e a r c h (Gutman 1988) on r e a c t i o n s of c u r r e n t homeowners to the p o s s i b l i t y of p r o v i d i n g market r e n t a l u n i t s a t the New V i s t a S i t e , the data c l e a r l y show t h a t having h e a l t h care s e r v i c e s on the s i t e would i n c r e a s e New V i s t a ' s a t t r a c t i v n e s s , e s p e c i a l l y f o r those i n the o l d e s t (75+) group. Two-thirds of the two younger groups of respondents and f o u r - f i f t h s of the o l d e s t group f e l t the s e r v i c e s would be used by those i n the surrounding area i f they were of good q u a l i t y , d i d not d u p l i c a t e 79 s e r v i c e s c l o s e by, i f they were handy and/or i f t h e i r c o s t was reasonable. The respondents were a l s o e n t h u s i a s t i c about New V i s t a p r o v i d i n g such t r a d i t i o n a l , long-term support s e r v i c e s as meals-on-wheels, an a d u l t day care c e n t r e , r e s p i t e or n i g h t care. Approximately h a l f (48.1%) of the respondents supported the i d e a i n p r i n c i p l e . An a d d i t i o n a l 14.8% p o i n t e d out t h a t such s e r v i c e s would extend independence, reduce w o r r i e s and/or help c a r e - g i v e r s (Gutman 1988). Resident's h e a l t h care needs may be s a t i s f i e d by: 1. the Continuum of Care Complex p r o v i d i n g a choice of l i v i n g accommodations s u i t a b l e f o r persons at v a r y i n g l e v e l s of dependence and a range of care s e r v i c e s from which they can s e l e c t to meet t h e i r complex needs. In order to s a t i s f y h e a v i e r h e a l t h care needs, the CCC should provide an Intermediate Care F a c i l i t y (three l e v e l s ) and an Extended Care F a c i l i t y . 2. The CCC f a c i l i t y should provide a Health Care C l i n i c with d o c t o r s and d e n t i s t o f f i c e s , a R e h a b i l i t a t i o n Centre and a Pharmacy, which w i l l serve the r e s i d e n t s as w e l l as e l d e r l y people of the whole neighbourhood. 3. The CCC should provide A d u l t Day/Night Care, R e s p i t e Care and H o l i d a y V a c a t i o n Care beds p r o v i d i n g r e l i e f f o r r e l a t i v e s c a r i n g f o r the e l d e r l y at home. 80 R.O. # 3 SOCIAL NEEDS The CCC f a c i l i t y should provide a su p p o r t i v e s o c i a l l i v i n g environment. R a t i o n a l e : In the f u t u r e , there w i l l be fewer f a m i l y members a v a i l a b l e to provide care to the e l d e r l y due to the i n c r e a s i n g number of small f a m i l i e s without any c h i l d r e n and due to r i s i n g d i v o r c e r a t e s . High m o b i l i t y which o f t e n r e q u i r e s a d u l t c h i l d r e n to l i v e a t some d i s t a n c e from t h e i r aging parents w i l l a l s o have an impact on the s o c i a l support r e q u i r e d to be pro v i d e d to o l d e r people. Increased female p a r t i c i p a t i o n i n the workforce w i l l l i m i t the a b i l i t y of a d u l t daughters ( t r a d i t i o n a l c a r e - g i v e r s ) to care f o r t h e i r aging parents. T h e r e f o r e , other a l t e r n a t i v e l i f e s t y l e s which w i l l provide d i f f e r e n t types of s o c i a l support w i l l be sought a f t e r . Moreover, the e l d e r l y and p a r t i c u l a r l y e l d e r l y women are p r e c i s e l y the persons who can become i s o l a t e d i n a s o c i e t y which i s centered around the n u c l e a r f a m i l y of mother, f a t h e r and c h i l d r e n . In the P o i n t Grey area, e l d e r l y women s i g n i f i c a n t l y outnumber e l d e r l y men. Th e r e f o r e , they may be p o t e n t i a l a p p l i c a n t s f o r admission to the CCC, l o o k i n g f o r a su p p o r t i v e l i v i n g environment with peers. The CCC f a c i l i t y should c r e a t e a str o n g community f e e l i n g i n order to s a t i s f y r e s i d e n t s ' s o c i a l needs. For o l d e r people f e e l -i n g t h a t they belong to a community, which they are proud of, i s important f o r se l f - e s t e e m and s a t i s f a c t i o n . In a s o c i e t y where s t a t u s and r o l e are d e f i n e d i n work s i t u a t i o n s , the e l d e r l y are 81 d e p r i v e d of such d i s t i n c t i d e n t i f i c a t i o n (Champagne and Br i n k , 1985). There w i l l be two ways to achieve t h i s o b j e c t i v e : 1. By e s t a b l i s h i n g p o l i c i e s t h a t r e s i d e n t s p l a y a c r i t i c a l r o l e i n the CCC f a c i l i t y ownership, management and development process. For example, r e s i d e n t s w i l l be members of one of three (co-op, s t r a t a - t i t l e , BCHMC s u b s i d i z e d housing) hous-in g s o c i e t i e s r e s p o n s i b l e f o r the management and o p e r a t i o n of t h e i r u n i t s . A l l "community" f a c i l i t i e s (the Core Centre) w i l l be shared and managed by the Boards of D i r e c t o r s of a l l three s o c i e t i e s i n co o p e r a t i o n with a p r o f e s s i o n a l P r o p e r t y Management o r g a n i z a t i o n . Development of the new CCC f a c i l i t y would be the Boards' major r e s p o n s i b i l i t y . 2. By i n t r o d u c i n g s o c i a l s e r v i c e s and by d e s i g n i n g a p h y s i c a l environment which w i l l f a c i l i t a t e s o c i a l i n t e r a c t i o n . The CCC Program c a l l s f o r s e v e r a l s o c i a l s e r v i c e s , which w i l l p r o vide programs of c r e a t i v e ( A r t s and C r a f t ) and r e c r e a -t i o n a l a c t i v i t i e s ( s p o r t s , games) as w e l l as in t r o d u c e E d u c a t i o n a l and C u l t u r a l programs t h a t w i l l be h e l d i n a 200-seat A u d i t i o r i u m f o r both r e s i d e n t s and no n - r e s i d e n t s . The housing c l u s t e r arrangement w i l l c r e a t e o p p o r t u n i t i e s f o r chance meetings so t h a t r e s i d e n t s of the same housing c l u s t e r w i l l at l e a s t recognize each other. 3.3. FACILITY MANAGEMENT OBJECTIVES (F.M.O.) The Management o b j e c t i v e s are somewhat s i m i l a r to design o b j e c t i v e s : both the Management p o l i c i e s and the p h y s i c a l e n v i 82 ronment may e q u a l l y produce i n s t i t u t i o n a l i z a t i o n . The impact of i n s t i t u t i o n a l i z a t i o n i s apathy, withdrawal and disengagement. T h i s o b v i o u s l y i s not the q u a l i t y of l i f e which should be o f f e r -ed to e l d e r l y people. The CCC f a c i l i t y should be d e d i c a t e d to the p r o v i s i o n of a home-like environment emphasizing q u a l i t y of l i f e and encouraging growth of each i n d i v i d u a l member of i t s community. The r e s i d e n t s should be esteemed and e n t i t l e d to the best of r e s t o r a t i v e and su p p o r t i v e care: emotional, i n t e l l e c t u -a l , s p i r i t u a l , p h y s i c a l and s o c i a l . Rules and r e g u l a t i o n s which impose b a r r i e r s t h a t segregate those i n each l e v e l of care should be avoided where p o s s i b l e , to allow development of a sense of community. F.M.O. # 1 Management of the CCC should a l l o w r e s i d e n t s (and v i s i t o r s ) to perform tasks f o r themselves and r e i n f o r c e a sense of autonomy and u s e f u l n e s s . R a t i o n a l e : Some autonomy i s s a c r i f i c e d i n housing p r o j e c t s by p r o v i d i n g group s e r v i c e s and f a c i l i t i e s . Mostly i t i s caused by economic f a c t o r s . In a d d i t i o n , r e t i r e m e n t o f t e n b r i n g s the l o s s of important r o l e s i n s o c i e t y and a sense of u s e l e s s n e s s (Carstens 1985). Management p o l i c i e s should respond to the e l d e r l y ' s needs and all o w r e s i d e n t s to r e i n f o r c e t h e i r sense of autonomy and u s e f u l n e s s by p r o v i d i n g : 1. easy access to a l l CCC f a c i l i t i e s and s e r v i c e s . 2. comfort and ease of use (the Core Centre, outdoor space). 3. o p p o r t u n i t i e s f o r p a r t i c i p a t i o n i n a c t i v i t i e s , a c t i v i t y 83 o r g a n i z i n g and s e r v i c e d e l i v e r y ( s e n i o r s ' c e n t r e ) . 4. o p p o r t u n i t i e s to p a r t i c i p a t e i n outdoor maintenance (gardening committee). F.M.O. # 2 Management p o l i c i e s should encourage independence and use of the CCC f a c i l i t i e s . R a t i o n a l e : Management p o l i c i e s on use of f a c i l i t i e s and a c t i v i t y programming are c r i t i c a l f o r encouraging independence and the optimal f u n c t i o n i n g of the i n d i v i d u a l (Carstens 1985). E l d e r l y people are more l i k e l y than younger people to a d j u s t to e x i s t i n g r u l e s and c o n d i t i o n s although these may not accommodate t h e i r needs and may discourage use and s a t i s f a c t i o n with the surround-ing environment. Management should: 1. Create a forum f o r s o l v i n g problems and d i s c u s s i n g i s s u e s r e l a t e d to the growth and development of the CCC i n promot-in g i n d i v i d u a l and group needs, a b i l i t i e s and a s p i r a t i o n s such as a r e s i d e n t design board which can e v a l u a t e , review and propose changes or a d d i t i o n s to the CCC f a c i l i t i e s . 2. I d e n t i f y common problems, s e r v i c e gaps and areas f o r program and s e r v i c e expansion eg: a r e s i d e n t program board to organize s p e c i a l events which may i n c r e a s e use of f a c i l i t i e s i n the Core Centre and outdoor spaces. 3. Advise on l e a r n i n g experiences, o p p o r t u n i t i e s f o r growth and promotion of freedom of choice to help o l d e r people, e s p e c i a l l y d i s a b l e d , to be more s e l f - s u f f i c i e n t and independent, eg: r e s i d e n t education board and programs. 84 F.M.O. # 3 O b j e c t i v e : Management p o l i c y should encourage r e s i -dents to p e r s o n a l i z e , change and c o n t r o l the CCC environment. R a t i o n a l e : " P e r s o n a l i z a t i o n and c o n t r o l over the environment i s important f o r se l f - e s t e e m and s a t i s f a c t i o n , p a r t i c u l a r l y f o r aging persons who experience a c l o s i n g o f f of l i f e ' s o p t i o n s . Being able to change and p e r s o n a l i z e the environment allows i n d i -v i d u a l needs and pr e f e r e n c e s to be s a t i s f i e d . A sense of c o n t r o l a l s o i n c r e a s e s the f e e l i n g of home and the use of a space while d e c r e a s i n g the i n s t i t u t i o n a l c h a r a c t e r of planned housing" (Carstens 1985, p.16). Mangement p o l i c i e s should: 1. encourage r e s i d e n t s to p e r s o n a l i z e t h e i r own d w e l l i n g u n i t s e s p e c i a l l y i n the long term care c l u s t e r s by p r o v i d i n g o p p o r t u n i t i e s f o r d i s p l a y of t h e i r p e r s o n a l belongings and f u r n i t u r e . 2. accentuate u n i t e n t r y with flowers or other p e r s o n a l items. 3. provide r e s i d e n t s with t h e i r own amenities to take care o f : l i k e aquariums, b i r d s f e e d e r s . 4. f a c i l i t a t e c o n t r o l over placement w i t h i n the CCC environment by p r o v i d i n g , f o r example, movable f u r n i t u r e . F.M.O. # 4 Management should make the pl a c e a p p e a l i n g i n terms of a r e l a x e d atmosphere and f r i e n d l y y et unobstructed s e r v i c e s as w e l l as " f r i e n d l y , p h y s i c a l environment". R a t i o n a l e : The e l d e r l y are more v u l n e r a b l e because of day to day 85 d i f f i c u l t i e s . Contact with a new s t a f f or other r e s i d e n t s may cause a n x i e t y and reduce c o n f i d e n c e . The o l d e r people r e q u i r e time to evaluate and prepare f o r changes i n the environment. Through a r e l a x e d , p o s i t i v e atmosphere and c h e e r f u l ambience management may e l e v a t e r e s i d e n t s mood and s a t i s f a c t i o n . For example: a l l l o u n g e s / d i n i n g rooms should be equipped with home l i k e a c c e s s o r i e s : b r i g h t c o l o u r e d t a b l e c l o t h , f r e s h f l owers on each t a b l e , comfortable f u r n i t u r e . F.M.O. # 5 Management should c e n t r a l i z e a l l s u p p o r t i v e s e r -v i c e s , but r e t a i n home-like environment w i t h i n r e s i d e n t i a l c l u s t e r . R a t i o n a l e : C e n t r a l i z a t i o n of a number of f a c i l i t i e s may co n s i d e -r a b l y reduce the number of s t a f f t h a t i s r e q u i r e d to perform those s e r v i c e s , which consequently may reduce o p e r a t i n g c o s t s of the CCC f a c i l i t y . In a d d i t i o n to t h a t , c e n t r a l i z e d comprehen-s i v e s e r v i c e s i n the f a c i l i t y w i l l a l l o w f o r ease of access f o r r e s i d e n t s and s t a f f . The management of the whole f a c i l i t y may be more e f f e c t i v e and e a s i e r too. The CCC should c e n t r a l i z e a number of s e r v i c e s i n the Core Centre such as: 1) c e n t r a l a d m i n i s t r a t i o n 2) c e n t r a l food s e r v i c e s 3) c e n t r a l laundry 4) c e n t r a l m a t e r i a l s e r v i c e s 5) c e n t r a l b u i l d i n g s e r v i c e s 86 6) c e n t r a l p l a n t s e r v i c e s 7) c e n t r a l personnel s e r v i c e s 8) c e n t r a l s o c i a l s e r v i c e s 9) c e n t r a l h e a l t h care s e r v i c e s . 3.4. COMMUNITY OBJECTIVES (CO.) The neighbourhood environment may be the source of aes-t h e t i c enjoyment, p h y s i c a l s e c u r i t y , sensory v a r i e t y , b a s i c r e s o u r c e s , help i n emergencies, s o c i a l i n t e r a c -t i o n , i n t e r e s t i n g t h i n g s t o do, the f e e l i n g of t e r r i t o -r i a l p r i d e , and many other s a t i s f i e r s of human needs (Lawton 1987, p.38). To provide the e l d e r l y with a l l these a t t r i b u t e s of an " i d e a l environment", i t i s necessary to sense the general community o b j e c t i v e s . These o b j e c t i v e s ( s u b j e c t to the Planning Department and P o i n t Grey neighbourhood groups approval) have s i m i l a r background to the p r e v i o u s two groups of o b j e c t i v e s : to cr e a t e a s p e c i a l Continuum of Care neighbourhood f o r the e l d e r l y w i t h i n the l a r g e r context of the Community Development P l a n . The "mini" CCC community should attempt to recognize both unique needs f o r s p e c i a l s e r v i c e s i t may o f f e r to e l d e r l y people l i v i n g o u t s i d e the CCC, the advantages of l i v i n g c l o s e to age peers, and s i m u l t a n e u s l y the need to r e t a i n some u n i t y with the people and the resources of the P o i n t Grey Community. C O . # 1 To provide the CCC f a c i l i t y i n the P o i n t Grey Area i n order to prevent l o c a l e l d e r l y people from enduring r e l o c a t i o n s t r e s s . 87 R a t i o n a l e : Although i t i s g e n e r a l l y assumed t h a t r e t i r e m e n t con-s t i t u t e s an o c c a s i o n f o r many people to move, the very low m o b i l i t y r a t e of the e l d e r l y a t t e s t s to the f a c t t h a t r e l a t i v e l y few make t h i s type of change. E l d e r l y people need to continue to l i v e i n the same community and to r e t a i n the t i e s of t h e i r p r e v i o u s e x i s t e n c e . The move to an i n s t i t u t i o n i s traumatic enough. A number of s t u d i e s on i n v o l u n t a r y r e l o c a t i o n have documented negative consequences and f o r o l d e r people, p a r t i c u l a r l y , i n c r e a s e i n m o r t a l i t y and m o r b i d i t y r a t e s (Gutman 1983; Lawton 1986). In order to r e t a i n the e l d e r l y w i t h i n the same community the u s a b i l i t y of i t s resources i s of major concern f o r planners and f o r those r e s p o n s i b l e f o r d e l i v e r i n g s e r v i c e s . To achieve t h i s task i t i s necessary: 1. To l o c a t e e l d e r l y people near d e s i r a b l e r e s o u r c e s . The new CCC housing should be l o c a t e d near e x i s t i n g shopping m a l l s , bus stops, banks, parks. 2. To l o c a t e d e s i r a b l e resources near e x i s t i n g c o n c e n t r a t i o n of o l d e r people. The CCC long-term f a c i l i t i e s , A d u l t Day/Night Care, S e n i o r Center, R e c r e a t i o n a l A c t i v i t y Club, C l i n i c should be l o c a t e d i n c l o s e p r o x i m i t y to the e x i s t i n g e l d e r l y h a b i t a t i o n areas. 3. To m o b i l i z e e x i s t i n g resources to t a i l o r programs to the e l d e r l y . For example, l o c a l merchants' i n s t i t u t i n g d i s c o u n t s f o r s e n i o r s - S e n i o r ' s Day i n bank, drugmart, r e s t a u r a n t s or e s t a b l i s h i n g a new program f o r s e n i o r s i n the community c e n t r e . 88 4. To m o b i l i z e i n f o r m a l resources of the neighbourhood which can provide support f o r the e l d e r l y who have g r e a t e r l i m i t a -t i o n s . For example, a v o l u n t e e r network p r o v i d i n g such s e r v i c e s as f r i e n d l y v i s i t o r s , s e c u r i t y c a l l system and pet therapy. C O . # 2 Provide easy access to neighbourhood res o u r c e s . R a t i o n a l e : Access to neighbourhood resources i s important f o r g e n e r a l l i f e s a t i s f a c t i o n , morale and the optimal f u n c t i o n i n g of the i n d i v i d u a l , as w e l l as. f o r a v o i d i n g i s o l a t i o n from the r e s t of the community. Acc o r d i n g to Lawton (1986), p r o x i m i t y to the neighbourhood resources and knowledge of the neighbourhood are two determi-nants which are r e l a t e d to w e l l - b e i n g of the e l d e r l y . S e v e r a l s t u d i e s on the e f f e c t of resources p r o x i m i t y to e l d e r l y housing have proved t h a t there are " c r i t i c a l d i s t a n c e s " beyond which e l d e r l y people d e c l i n e to use f a c i l i t i e s . For example, a laund-romat or s e n i o r s c e n t r e needed to be on the housing s i t e to be used maximally, a post o f f i c e or bus stop w i t h i n three b l o c k s , a g r o c e r y s t o r e , bank or p h y s i c i a n w i t h i n ten b l o c k s . However, other s t u d i e s have found t h a t the amount of use of resources i s not o n l y a s s o c i a t e d with d i s t a n c e to the resources but a l s o with s a t i s f a c t i o n with d i s t a n c e and p e r c e i v e d convenience (Lawton, 1986). Since walking i n c r e a s i n g l y becomes a major mode of t r a n s p o r t a t i o n f o r o l d e r people the new CCC f a c i l i t y should be l o c a t e d : 89 1. Close to the neighbourhood's resources such as r e t a i l o u t l e t s , necessary s e r v i c e s (banks, l a y e r , e a t i n g o u t ) . 2. Close to convenient p u b l i c t r a n s p o r a t i o n stops and safe and convenient walking rou t e s . 3. Located i n an a t t r a c t i v e p l a c e w i t h i n the community, focused on n a t u r a l beauty and views. 4. Within c l o s e or with convenient access to e d u c a t i o n a l c e n t r e s (e.g. UBC). C O . # 3 The CCC f a c i l i t y should provide l i f e s u s t a i n i n g r e s o u r c e s f o r i t s r e s i d e n t s and f o r the e l d e r l y l i v i n g i n the neighbourhood. R a t i o n a l e : Gutman's (1988) study of S e n i o r s ' Reactions to New V i s t a ' s Community Concept found t h a t more than t w o - t h i r d s i n the two younger groups and more than 90% i n the o l d e s t group express-ed enthusiasm f o r the i d e a of h e a l t h care s e r v i c e s (e.g.: doc-t o r s ' and d e n t i s t s ' o f f i c e s , p h y s i o t h e r a p i s t , p o d i a t r i s t , d i a g -n o s t i c lab) on the New V i s t a s i t e . Respondents, e s p e c i a l l y i n the o l d e s t group, were very e n t h u s i a s t i c about the i d e a of New V i s t a p r o v i d i n g such t r a d i t i o n a l long-term care support s e r v i c e s as meal-on-wheels, a d u l t day care, r e s p i t e or n i g h t care. These o b j e c t i v e s have been d i s c u s s e d i n R.O. # 2. C O . # 4 The CCC f a c i l i t y should c r e a t e an i n f o r m a l community network of f r i e n d s and r e l a t i v e s . R a t i o n a l e ; I n the community, r e s i d e n t s mingle with people of a l l 90 age groups. T h e i r f r i e n d s h i p networks i n c l u d e f r i e n d s , r e l a t i v e s and acquaintances from a wide v a r i e t y c o n t e x t s . In a f a c i l i t y , the e l d e r l y are faced with a homogenous community. Resources and programs should encourage p a r t i c i p a t i o n of the CCC r e s i d e n t s and a l s o v i s i t o r s from v a r i o u s s o c i a l groups. A c c o r d i n g to Gutman*s re s e a r c h on New V i s t a (1988) the most p r e f e r a b l e resources a s s o c i a t e d with a s e n i o r s ' housing complex f o r the youngest group of the e l d e r l y respondents was the a v a i l a b i l i t y of r e c r e a -t i o n a l and s o c i a l programs. The o l d e s t group was most a t t r a c t e d by the o p p o r t u n i t y f o r the companionship of age peers i n such complexes. The CCC f a c i l i t y should: 1. Provide r e c r e a t i o n a l f a c i l i t i e s such as: - an outdoor a c t i v i t y c l u b with bowling, m i n i - g o l f , croquet, BBQ - gardening c l u b which w i l l provide the o p p o r t u n i t y not o n l y f o r s o c i a l i n t e g r a t i o n , but a l s o f o r h o r t i c u l t u r e therapy. - indoor a c t i v i t i e s and programs such as a swimming p o o l , f i t n e s s c e n t r e , dancing c l u b , auditorium with multipurpose use. 2. Provide s o c i a l programs, which encourage p a r t i c i p a t i o n of the r e s i d e n t s and v i s i t o r s such as: bingo, b r i d g e drama c l u b , s i n g along, a r t s and c r a f t s toastmaster c l u b , t r a v e l c l u b p i c n i c lunches, t e a and t a l k , shopping t r i p s 91 3. Provide f a c i l i t i e s which w i l l p r ovide the o p p o r t u n i t y f o r s o c i a l c o n t a c t s : r e s t a u r a n t c a f e / b a r winter garden with a r t s e x h i b i t i o n beauty s a l o n and h a i r d r e s s e r bank, smal l r e t a i l o u t l e t C O . # 5 The CCC f a c i l i t y should provide l i f e e n r i c h i n g r e s o u r c e s which w i l l promote mental and s o c i a l i n t e g r a t i o n . R a t i o n a l e : L i f e e n r i c h i n g resources c o n t r i b u t e very much to w e l l being of the e l d e r l y (Lawton 1986). As a p a r t of a comprehen-s i v e community s t r a t e g y to meet the needs of o l d e r people, the CCC f a c i l i t y through a v a r i e t y of s e r v i c e s and a c t i v i t i e s i n such areas as e d u c a t i o n , c r e a t i v e a r t s or l e a d e r s h i p development may support t h e i r independence, enhance d i g n i t y and encourage t h e i r involvements i n l i f e of the CCC community and the whole neighbourhood. With the growing p o p u l a t i o n of more educated e l d e r l y who are seeking l i f e s a t i s f a c t i o n i n more s o p h i s t i c a t e d ways, emphasis should be put on c r e a t i v e a c t i v i t i e s , s p e c i a l c l a s s e s along with other forms of a c t i v e r e c r e a t i o n . The CCC f a c i l i t y should: 1. P r o v i d e a small l i b r a r y with r e a d i n g and l i s t e n i n g rooms (music, languages). 2. An A u d i t i o r i u m and c l a s s e s f o r s p e c i a l e d u c a t i o n a l program 92 such as guest l e c t u r e r s from U.B.C., or S.F.U., t r a v e l experiences and o t h e r s . 3. A r t s and C r a f t s programs because these provide so w e l l f o r the e x p r e s s i v e needs of the e l d e r l y . 4. E x c u r s i o n s to U.B.C. or S.F.U or downtown f o r s p e c i a l l e c t u r e or c u l t u r a l events . C O . # 6 The CCC f a c i l i t y should enhance business i n t e g r a t i o n with the P o i n t Grey Community. R a t i o n a l e ; The CCC environment, which t r i e s to meet a v a r i e t y of e l d e r l y people needs, can be very expensive and does not provide a r e t u r n on the o r i g i n a l investment. The community can share the b e n e f i t i f the f a c i l i t y i s open to the p u b l i c . The CCC f a c i l i t y should: 1. Provide f a c i l i t i e s such as day care, r e h a b i l i t a t i o n c e n t r e , c l i n i c , s t o r e s , r e s t a u r a n t , c a f e / b a r , h a i r d r e s s e r , pharmacy, auditorium, l i b r a r y to be shared by the community at l a r g e . 2. Provide membership cards f o r s p e c i a l r e c r e a t i o n a l a c t i v i t i e s and s o c i a l programs such as: bowling c l u b , croquet c l u b , swimming c l u b , dancing c l u b , gardening c l u b and o t h e r s . 3.5. NEIGHBOURHOOD DEVELOPMENT OBJECTIVES (N.D.O.) For the S e l e c t e d Test S i t e (Please r e f e r to Chapter 2 p.2.4. ) N.D.O. # 1 The design and p l a n n i n g of the CCC f a c i l i t y has to 93 ensure t h a t a new f a c i l i t y maintains l i v a b i l i t y , p r i v a c y and a sense of community: R a t i o n a l e : The new CCC f a c i l i t y has to be a p a r t of the e x i s t -i n g P o i n t Grey Community i n terms of b u i l d i n g p h y s i c a l c h a r a c t e r -i s t i c s as w e l l as s o c i a l i n f r a s t r u c t u r e . Residents should be encouraged to go out i n t o the community but a t the same time the e l d e r l y l i v i n g i n the P o i n t Grey area should be encouraged to p a r t i c i p a t e i n the CCC a c t i v i t i e s . The r e s i d e n t i a l p o r t i o n of the f a c i l i t y should provide b u i l d i n g s i n c l u s t e r s i n order to cr e a t e a mini community p r o v i d i n g p r i v a c y and l i v a b i l i t y to each r e s i d e n t . However, t h i s small CCC community should blend with the P o i n t Grey neighbourhood. N.D.O. # 2 The CCC development should c r e a t e a cohesive neigh-bourhood c h a r a c t e r and achieve v i s u a l c o m p a t i b i l i -t y with the surrounding housing. R a t i o n a l e : The e x i s t i n g apartment b u i l d i n g s along 4th Ave and Highbury S t r e e t are 3 s t o r e y b u i l d i n g s which have no s p e c i a l a r c h i t e c t u r a l m e r i t . Along 8th Avenue there are s i n g l e s t o r e y o l d houses b u i l t as s i n g l e - f a m i l y homes. In terms of o v e r a l l massing a new development should provide a v a r i e t y of space o p t i o n s from s i n g l e f a m i l y housing to the m u l t i p l e - u n i t housing. N.D.O. # 3 The CCC development should c o n t r i b u t e to s t r e e t -scape having i t s d i s t i n c t i v e c h a r a c t e r and v i s u a l i n t e r e s t . 94 R a t i o n a l e : The c h a r a c t e r of s t r e e t s c o n t r i b u t e s s i g n i f i c a n t l y to a neighbourhood's image. I t i s t r a d i t i o n a l l y c r e a t e d by the l a n d s c a p i n g treatment of the f r o n t yard of i n d i v i d u a l s i t e s and the rhythm of b u i l d i n g s and s i d e yards. A v a r i e t y of b u i l d i n g s t y l e s around the s u b j e c t s i t e can c o e x i s t because the s t r e e t s -cape t i e s them together. On 4th Avenue, c l o s e to Alma S t r e e t , a more urban c h a r a c t e r i s e v i d e n t which i s c r e a t e d by the p r o x i m i t y of commercial b u i l d i n g s : new J e r i c h o M a l l and shopping and s e r v i c e s area. On 8th Avenue and Highbury S t r e e t the e x i s t i n g b u i l d i n g s c r e a t e a rhythm of the predominant r e s i d e n t i a l neighbourhood. Along the north s i d e of 4th Avenue, m u l i t i p l e - u n i t housing with minimal f r o n t yard setbacks c r e a t e a more urban s t r e e t c h a r a c t e r . A s t r e e t s c a p e with d i s t i n c t i v e c h a r a c t e r and v i s u a l i n t e r e s t should be achieved by: 1. E n s u r i n g t h a t the CCC p r o v i d e s b u i l d i n g treatment t h a t complements developments on adjacent s i t e s and c r e a t e s v i s u a l rhythm. 2. M a i n t a i n i n g a more urban s t r e e t s c a p e i n the north e a s t p a r t of the s i t e . N.D.O. # 4 The CCC development e s p e c i a l l y the r e s i d e n t i a l p a r t should not block or reduce the e x i s t i n g views. R a t i o n a l e : The major p u b l i c view c o r r i d o r e x i s t s along Highbury S t r e e t , l o o k i n g north. A p r i v a t e view i s a v a i l a b l e i n the 95 southern p a r t of the s i t e and i n the northwest p a r t of the s i t e where there i s a view of the mountains and J e r i c h o Park to the north. N.D.O. # 5 The CCC development should be designed to minimize the p o t e n t i a l noise impact from 4th Avenue. R a t i o n a l e : The C i t y H a l l data i n d i c a t e t h a t the v e h i c u l a r t r a f -f i c has a gre a t impact on the q u a l i t y of l i f e i n the development along 4th Avenue. In order to r e l e a s e the heavy t r a f f i c on 4th Avenue and provide easy access to the s i t e the C i t y recommended an access to the CCC s i t e from Highbury S t r e e t through S i x t h Avenue. N.D.O. # 6 I n d i v i d u a l d w e l l i n g u n i t s should enjoy a high degree of p r i v a c y . R a t i o n a l e ; In e l d e r l y housing p r i v a c y i s h i g h l y valued. I t i s important t h a t the CCC pr o v i d e s p r i v a c y f o r i t s r e s i d e n t s and does not erode the present l e v e l s of p r i v a c y enjoyed by adjacent p r o p e r t i e s e s p e c i a l l y i n the southern p a r t of the s i t e . T h i s should be achieved by: 1. O r i e n t i n g major windows away from the windows of adjacent u n i t s when d i s t a n c e between them i s l e s s than 15 metres. 2. O r i e n t i n g b a l c o n i e s away from adjacent s i t e s ( u n i t s ) , or sc r e e n i n g them to minimize overlook. 3. P r o v i d i n g s c r e e n i n g f o r ground l e v e l u n i t s near a s t r e e t or access route. T h i s s c r e e n i n g should be obtained p r i m a r i l y through l a n d s c a p i n g with f e n c i n g p r o v i d i n g a secondary screen. N.D.O. # 7 The design should accommodate d e f e n s i b l e space methods to ensure a safe and secure environment. R a t i o n a l e : S e c u r i t y and crime p r e v e n t i o n i s an i s s u e i n e l d e r l y housing. Through s i t e p l a n n i n g and b u i l d i n g design, an e n v i r o n -ment t h a t discourag e s crime can be c r e a t e d . T h i s should be achieved by: 1. L o c a t i n g indoor common areas adjacent to outdoor common spaces to improve mutual s e c u r i t y . 2. Grouping d w e l l i n g u n i t s i n c l u s t e r s to enhance entrances s u r v e i l l a n c e of comings and goings. 3. Designing fences and lan d s c a p i n g t h a t a l l o w same views of the c l u s t e r s ( b u i l d i n g s ) and p r i v a t e open spaces from the s t r e e t . N.D.O. # 8 The CCC development should provide a v a r i e t y of open spaces which w i l l serve the p u b l i c , r e s i d e n t s and the neighbourhood as a whole. The treatment of open space should c o n t r i b u t e to the neighbour-hood i d e n t i t y . R a t i o n a l e : The s u b j e c t s i t e i s a "green o a s i s " i n the P o i n t Grey area and can be e a s i l y transformed i n t o medium d e n s i t y deve-lopment with s u f f i c i e n t p r o v i s i o n of open spaces. The northern p o r t i o n of the s i t e i s a l r e a d y an open p u b l i c grass-covered area 97 with t r e e s t h a t c r e a t e an a t t r a c t i v e s t r e e t s c a p e and c o n t r i b u t e to neighbourhood i d e n t i t y . A p l e a s a n t , e a s i l y a c c e s s i b l e outdoor area i s an e s s e n t i a l p a r t of a r e s i d e n t i a l environment f o r the e l d e r l y who are l i k e l y to spend more time i n or near t h e i r homes than younger people. The outdoor area should permit r e s i d e n t s to walk about e a s i l y and c o n v e n i e n t l y and should provide s e v e r a l kinds of space c r e a t e d f o r d i f f e r e n t a c t i v i t i e s . N.D.O. # 9 The CCC development should p r o v i d e l a n d s c a p i n g t h a t c r e a t e s v i s u a l i n t e r e s t and i d e n t i t y . R a t i o n a l e : There i s a s u b s t a n t i a l q u a n t i t y of deciduous t r e e s l o c a t e d i n the western p a r t of s i t e which provide a n a t u r a l b u f f e r zone from the adjacent J e r i c h o H i l l School p r o p e r t y and J u s t i c e I n s t i t u t e . Along 4th Avenue, there i s a green zone with deciduous t r e e s t h a t p r o v i d e s a b a r r i e r from the n o i s y 4th Avenue. Close to the i n t e r s e c t i o n of 4th Ave., and Highbury S t r e e t there i s a b e a u t i f u l a l l e y with many f e a t u r e t r e e s t h a t c r o s s the s i t e d i a g o n a l l y on the east-west a x i s . T h i s a l l e y i s a very important f e a t u r e of the s i t e t h a t should be preserved i n the f u t u r e development. Throughout the whole s i t e , there are s c a t t e r e d c o n i f e r o u s and deciduous t r e e s and rows of t r e e s along e x i s t i n g t r a n s p o r t a t i o n r o u t e s . Along 8th Avenue, there i s a high shrub hedge and a row of deciduous t r e e s . 3.6. CONCLUSION The f a c i l i t y o b j e c t i v e s developed i n t h i s chapter have been 98 e s t a b l i s h e d i n order to guide the program development i n the f o l l o w i n g Chapters 4 and 5. A l l these o b j e c t i v e s are i n s t r u -mental i n terms of s u c c e s s f u l o p e r a t i o n and management of the CCC f a c i l i t y . In summary, there are f i v e groups of o b j e c t i v e s : Group 1 L i v i n g Environmental O b j e c t i v e s which address the i s s u e of a sa f e and q u a l i t y f a c i l i t y environment. Group 2 R e s i d e n t s ' O b j e c t i v e s which concentrate on three b a s i c i s s u e s : tenure c h o i c e , h e a l t h care and s o c i a l needs. Group 3 F a c i l i t y Management O b j e c t i v e s which although emphasiz-in g the importance of c e n t r a l i z a t i o n of su p p o r t i v e s e r -v i c e s , n e v e r t h e l e s s s t r e s s a l s o the need f o r independ-ence, p e r s o n a l i z a t i o n and v a r i e d p h y s i c a l environment. Group 4 Community O b j e c t i v e s e x p l a i n a need f o r s u c c e s s f u l and smooth r e l a t i o n s h i p between the CCC f a c i l i t y and the P o i n t Grey Community. Group 5 Neighbourhood Development O b j e c t i v e s are very important f o r the a r c h i t e c t u r a l concept of the CCC f a c i l i t y and have been presented i n the form of design g u i d e l i n e s . 99 CHAPTER 4 - THE CCC FACILITY COMPONENTS  Chapter Summary: Chapter 4 i s the p a r t of t h e s i s s y n t h e s i s and co n c e n t r a t e s on f o u r major f u n c t i o n a l components of the continuum of care complex: r e s i d e n t i a l , long-term care, community s e r v i c e s and outdoor a c t i v i t y spaces. These components c o n s t i t u t e the e n t i r e spectrum of the CC environment and are i n s t r u m e n t a l to i t s q u a l i t y . INTRODUCTION A q u a l i t y environment, which may c o n t r i b u t e to the e l d e r l y s s a t i s f a c t i o n and w e l l - b e i n g i s the major f a c t o r i n d e s i g n i n g a Continuum of Care Complex. As po i n t e d out i n Chapter 3, there are s e v e r a l p h y s i c a l and s o c i a l c r i t e r i a , which may be used i n e v a l u a t i o n of the environmental q u a l i t y . The o p p o r t u n i t i e s f o r i n d i v i d u a l c h o i c e , an encouragement of s o c i a l i n t e r a c t i o n between r e s i d e n t s , s t i m u l a t i o n and p a r t i c i p a t i o n i n a c t i v i t i e s as w e l l as reinforcement of i n d i v i d u a l independence are j u s t the b a s i c o b j e c t i v e s i n f u l f i l l i n g the CCC r e s i d e n t s s a t i s f a c t i o n . The o p p o r t u n i t y f o r i n d i v i d u a l c h o i c e would be s a t i s f i e d g e n e r a l l y by p r o v i d i n g a v a r i e t y of Environments which would permit the widest range of p e r s o n a l c h o i c e s . The most important c h o i c e would be a ch o i c e i n a v a r i e t y of l i v i n g arrangements. The CCC F a c i l i t y w i l l p r ovide three tenure o p t i o n s . Each o p t i o n would pr o v i d e f u r t h e r c h o i c e s i n terms of the type and s i z e of d w e l l i n g u n i t s . 100 For those s e n i o r r e s i d e n t s who need h e a l t h care s e r v i c e s the Continuum of Care Complex w i l l p r ovide a choice i n a range of l i v i n g accommodations a c c o r d i n g to l e v e l s of dependence and a range of care s e r v i c e s i n the Intermediate Care (three l e v e l s ) and Extended Care F a c i l i t i e s . The Core Centre would be a key component i n the c r e a t i o n of the CCC q u a l i t y environment. The l i f e e n r i c h i n g resources would promote mental and s o c i a l i n t e r g r a t i o n i n the Core Centre -c u l t u r a l component. The l i f e s u s t a i n i n g resources i n the Health Centre would s a t i s f y r e s i d e n t s and the e l d e r l y l i v i n g i n the neighbourhood. However, the Core Centre would a l s o promote the o p p o r t u n i t y f o r s o c i a l c o n t a c t s and would enhance business i n t e g r a t i o n with the P o i n t Grey Community. S e v e r a l s e r v i c e s , programs and amenities would i n c r e a s e o p p o r t u n i t i e s f o r i n d i v i d u a l c h o i c e . The outdoor space program components would be the p r i n c i p a l elements i n the CCC environment. Besides having t h e r a p e u t i c alue the outdoor spaces would c r e a t e a v a r i e t y of outdoor a c t i v i t i e s . T h i s component would a l s o promote p a r t i c i p a t i o n i n a l l i t s a c t i v i t i e s as w e l l as encourage s o c i a l c o n t a c t s between r e s i d e n t s and v i s i t o r s . 4.0 SIZE OF THE FACILITY Is there an i d e a l number of e l d e r l y people, t h a t can be main-t a i n e d i n one Continuum of Care Complex? In the United S t a t e s c o n t i n u i n g care r e t i r e m e n t communities house an average of 101 350-500 r e s i d e n t s , a p o p u l a t i o n range t h a t has proven economical-l y v i a b l e (Green, 1985, p.39). Another study suggests t h a t : Although there i s d i v i d e d o p i n i o n as to the number of e l d e r l y who may be c o n c e n t r a t e d i n t h e i r own neighbour-hood, up to 500 housing u n i t s d i v i d e d i n t o c l u s t e r s of 30 to 50 i s a s c a l e to which most r e s i d e n t s can comfor-t a b l y r e l a t e . With l e s s than two persons per house-h o l d , the neighbourhood w i l l house a p o p u l a t i o n under 1000 ( Z e l v e r 1976, p. 200). The s i z e of the CCC f a c i l i t y should be such t h a t i t does not c r e a t e an i s o l a t e d community of the e l d e r l y , but l a r g e enough to provide an economic v i a b i l i t y i n terms of b u i l d i n g s and s e r -v i c e s . However, the problem remains beyond the q u e s t i o n of a number of s e n i o r s i n a given space. A q u a l i t y environment, which c o n t r i b u t e s i n the f i r s t p l a c e to the e l d e r l y * s s a t i s f a c -t i o n and t h e i r w e l l - b e i n g would be another important f a c t o r i n d e s i g n i n g a Continuum of Care Complex. 4.1 HOUSING - INDEPENDENT LIVING The o b j e c t i v e f o r choice of r e s i d e n t i a l tenure i n Indepen-dent L i v i n g Housing c o u l d be f u l f i l l e d by p r o v i d i n g three tenure o p t i o n s . The f i r s t one would be r e n t a l accommodation f o r the e l d e r l y who are unable to own t h e i r d w e l l i n g u n i t s . T h i s type of housing would be a v a i l a b l e to low income s e n i o r s l i v i n g i n r e n t a l apartments i n the West P o i n t Grey area as w e l l as i n K i t s i l a n o , Dunbar and K e r r i s d a l e . However, the program a l s o assumes other c h o i c e s : Cooperative Housing townhouses ( a s s i s t e d by funds from CMHC) f o r those with moderate income, but a c t i v e and w i l l i n g to p a r t i c i p a t e i n the c o o p e r a t i v e management; and 102 a l s o S t r a t a - T i t l e d w e l l i n g u n i t s developed by the p r i v a t e s e c t o r . The l a s t o p t i o n c o u l d be o f f e r e d to more a f f l u e n t r e s i d e n t s of West P o i n t Grey, adjacent Dunbar and K e r r i s d a l e as w e l l as to those from M e t r o p o l i t a n Vancouver and Canada (see Chapter 2). There are advantages and disadvantages of each housing o p t i o n . (Housing Information For Those Approaching Retirement, Centre f o r Co n t i n u i n g E d u c t i o n , U.B.C. 1986; Home S e l e c t i o n Guide, NHA 5179 CMHC, 1983) Each housing type s a t i s f i e s d i f f e r e n t needs of the e l d e r l y : Tabel 4-1.--Housing Choices i n the CCC F a c i l i t y BCHMC CO-OPERATIVE HOUSING STRATA-TITLE DW. UNITS ADVANTAGES Low and moderate income - r e n t s are 30% of gross house-h o l d income. S e c u r i t y of tenure, S e c u r i t y of the ownership. Op p o r t u n i t y to change accomodation. Housing charges are kept a t reasonable l e v e l . O p portunity to p a r t i c i p a t e i n the management of the condo-minium. L i t t l e or no r e s -p o n s i b i l i t y f o r the maintenance. L i v e and s o c i a l i z e i n a community type s e t t i n g . More l i v i n g space s e r v i c e s and f a c i l i t i e s , b e t t e r f i n i s h m a t e r i a l s . No down-payment r e q u i r e d . Occupants c o l l e c t -i v e l y own and manage the housing. Opportunity to recover the in v e s t e d money. 103 Table 4-1.--Housing Choices i n the CCC F a c i l i t y (Cont'd) BCHMC CO-OPERATIVE HOUSING STRATA-TITLE DW. UNITS ADVANTAGES More freedom to be away. Household/occupants purchase share -- money refunded when the occu-pant moves out. Independence and freedom to pur-sue i n d i v i d u a l l i v e s t y l e . Convenience of having f r i e n d s i n the same b u i l d i n g Value has i n -creased over pa s t s e v e r a l years. DISADVANTAGES Long w a i t i n g l i s t . Members must comply with the r e g u l a t i o n s e s t a b l i s h e d by the c o o p e r a t i v e as a group. N e c e s s i t y to comply with con-dominium r e g u l a -t i o n s . No o p p o r t u n i t y to t u r n p a r t of your expenses i n t o i n -vestment. O b l i g a t i o n s to p a r t i -c i p a t e i n c o o p e r a t i v e a d m i n i s t r a t i o n . Maintenance and improvements o u t s i d e the housing u n i t are s u b j e c t to d e c i -s i o n s by the board of d i -r e c t o r s . No s e c u r i t y of the ownership. No o p p o r t u n i t y to b u i l d up investment i n value of property. Costs: h i g h e r than co-ops. 5% wheelchair acces-s i b l e u n i t s only. Higher monthly mortgage payments than f o r r e n t -a l housing Long-term f i n a n -c i a l commitment. Less l i v i n g space amenities than i n co-op and s t r a t a -t i t l e . Long-term f i n a n c i a l commitment or l a r g e downpayment. R e l a t i v e l y l e s s freedom to move than with r e n t a l housing N e c e s s i t y to buy shares. 104 4.1.1 BCHMC HOUSING - NON-PROFIT RENTAL HOUSING To s a t i s f y the needs of the f i r s t group of p o t e n t i a l r e s i -dents the CCC f a c i l i t y c o u l d provide independent l i v i n g u n i t s w i t h i n the N o n - p r o f i t Housing Program of the BCHMC. The o b j e c t i v e of t h a t program i s the development of modest housing p r o j e c t s f o r needy people b u i l t i n accordance with BCHMC s p e c i f i c a t i o n s , a l l a p p l i c a b l e b u i l d i n g codes, m u n i c i p a l by-laws and r e g u l a t i o n s . At present the program covers both s e n i o r c i t i z e n s and f a m i l y housing p r o j e c t s , i n c l u d i n g a s s o c i a t e d u n i t s f o r the d i s a b l e d . The subsidy a v a i l a b l e under the program i s designed to cover the d i f f e r e n c e between the break-even re n t f o r the p r o j e c t and the tenant r e n t c o n t r i b u t i o n based on 30% of household income. A f t e r completion of c o n s t r u c t i o n , the subsidy i s p a i d d i r e c t l y to a sponsoring housing s o c i e t y by the B.C. Housing Management Commission on b e h a l f of the F e d e r a l and P r o v i n c i a l governments. Acco r d i n g to the development c r i t e r i a the sponsor of such a p r o j e c t must be a n o n - p r o f i t housing s o c i e t y , which plans to develop a s o c i a l housing p r o j e c t and make a long term commitment to the e f f i c i e n t management of the f a c i l i t y . BCHMCs data (on J u l y 21th, 1989) i n d i c a t e t h a t there i s a g r e a t demand f o r s u b s i d i z e d housing. In Vancouver, there are 1040 persons 55 years o l d and over on the w a i t i n g l i s t (226 persons i n the West Side of Vancouver). F i v e per cent of them are l i v i n g i n very poor c o n d i t i o n s . Thus, we can assume t h a t the CCC f a c i l i t y might provide up to 100 u n i t s of r e n t a l housing 105 a c c o r d i n g to the BCHMC Design G u i d e l i n e s i n d i c a t i n g t h i s s i z e of development as the most economical from the f i n a n c i a l , p r o p e r t y and management, and maintenance p o i n t of view (BCMHC 1989 P r o p o s a l C a l l - Blue Book, p. 1). 4.1.2. CO-OPERATIVE HOUSING Co-operative housing i s becoming a popular way to s a t i s f y the e l d e r l y * s housing needs. I t p r o v i d e s f o r user p a r t i c i p a t i o n i n s e v e r a l Committees, Board of D i r e c t o r s and permits them to i n f l u e n c e the a f f a i r s of the co-op. In a d d i t i o n i t p r o v i d e s n o n - p r o f i t , c o s t e f f i c i e n t housing. In 1980 there were only s i x co-op housing p r o j e c t s f o r s e n i o r s i n Canada. By 1986 there were 15 and today there are 45, o f f e r i n g 2,000 u n i t s (The C o u r i e r , A p r i l 2, 1989). An a l t e r n a t i v e o p t i o n of Independent L i v i n g Housing c o u l d be a new form of a n o n - p r o f i t housing c o - o p e r a t i v e f o r s e n i o r c i t i z e n s r e c e n t l y developed i n B.C. by the Columbia Housing A d v i s o r y A s s o c i a t i o n . T h i s type of Housing Co-op doesn't r e -q u i r e government s u b s i d i e s (see Chapter 3 - R e s i d e n t i a l O b j e c t i v e s ) . Instead, members purchase shares which amount to a t l e a s t 20% of the c o s t of t h e i r u n i t s . Monthly housing charges are based on the mortgage and o p e r a t i n g c o s t s per u n i t . T h i s o p t i o n c o u l d be o f f e r e d to people who s o l d t h e i r f a m i l y houses and are l o o k i n g f o r s m a l l e r , more manageable d w e l l i n g u n i t s . A c c o r d i n g to t h e i r experience i n management of e x i s t i n g s e n i o r s ' co-ops, Columbia Housing A d v i s o r y A s s o c i a t i o n suggests 106 the number of 50-70 u n i t s as the most a p p r o p r i a t e s i z e of the co-op. In the CCC c o o p e r a t i v e housing, there would be 50 u n i t s grouped i n 4-5 c l u s t e r s , c r e a t i n g the s c a l e of the c l u s t e r to which most e l d e r l y r e s i d e n t s may comfortably r e l a t e (Alexander 1977, p.202). 4.1.3 STRATA-TITLE HOUSING (CONDOMINIUM) The term condominium r e f e r s to e x c l u s i v e ownership of one housing u n i t i n a housing p r o j e c t and co-ownership of a f r a c t i o n of common space and amenities. The monthly payment covers the mortgage, taxes and maintenance c o s t . A c c o r d i n g to the Condo-minium Act, there s h a l l be a c o u n c i l e l e c t e d a n n u a l l y from the members. The C o u n c i l has power to a c t f o r the group as a whole. However, the members are r e l e a s e d from the r e s p o n s i b i -l i t y of management of the p r o j e c t . The c o u n c i l h i r e s the manager. Although the members have c o n t r o l over t h e i r u n i t s they are l e s s i n v o l v e d i n the o p e r a t i o n of the p r o j e c t i n comparison with co-op housing where involvement i n common a f f a i r s i s mandatory. Ac c o r d i n g to the 1985 HOMES N a t i o n a l Survey on housing market c h a r a c t e r i s t i c s and demand, (Berger, Godin, and Harvey 1986) one of f o u r Canadians between 55 and 64 years of age i s a p o t e n t i a l homebuyer. The r e g i o n showing the most a c t i v e market i s B r i t i s h Columbia. There, twenty seven percent of the popula-t i o n i n the 55 plus age group are i n t e r e s t e d i n buying a home. The survey has shown t h a t although the p r e f e r e d housing type by 107 the m a j o r i t y of Canadians (80%) was a s i n g l e detached house, the second p r e f e r e n c e was apartment-condominium (6%) and townhouse condominium ( 2 % ) . Moreover, f o u r percent of respondents s a i d they would s e r i o u s l y c o n s i d e r , and 15% s a i d they would somewhat s e r i o u s l y c o n s i d e r buying a condominium (Berger, Godin and Harvey, 1986, p.62). We can assume t h a t there c o u l d be a demand f o r purchasing condominiums i n the CCC f a c i l i t y . S i m i l a r l y to the c o o p e r a t i v e housing, the Condominium C l u s t e r s w i l l be comprised of 50 d w e l l i n g u n i t s . Since the v a r i e t y of housing o p t i o n s w i l l be addressed to v a r i o u s needs of the e l d e r l y , the p o t e n t i a l r e s i d e n t s of the CCC w i l l have f l e x i b i l i t y of c h o i c e and o p p o r t u n i t y w i t h i n t h e i r means to l i v e as they wish. In a d d i t i o n , a l l three types of housing - s o c i a l housing (standard u n i t s , a f f o r d a b l e r e n t ) , c o o p e r a t i v e housing ( a f f o r d a b l e mortgage, more space) and p r i v a t e housing (higher q u a l i t y , more space) - w i l l adopt a p r o s t h e t i c approach to design by p r o v i d i n g environmental support to encourage independence of s e n i o r r e s i d e n t s (see Chapter 3, L.E.O. #2, 3, 4). 4.1.4 SERVICES IN THE INDEPENDENT LIVING HOUSING The types of s e r v i c e s p r o v i d e d i n e l d e r l y housing w i l l vary, depending on the l e v e l of dependence of r e s i d e n t s . In Indepen-dent L i v i n g , where the l e v e l of dependency i s "very low", the e l d e r l y w i l l l i v e independently with only minimal support. S e r v i c e s such as t r a n s p o r t a t i o n , s o c i a l events, or r e c r e a t i o n a l 108 a c t i v i t i e s c o u l d be mainly a v a i l a b l e i n the c e n t r a l p a r t of CCC Core Centre or Outdoor A c t i v i t y Centre. In the Supported Independent L i v i n g where the l e v e l of dependence i s "moderate low", s o c i a l s e r v i c e s w i l l be mostly r e q u i r e d . The r e s i d e n t s may be l o o k i n g f o r i n f o r m a t i o n , and a p l e a s a n t atmosphere. When the l e v e l of dependence changes to "moderate", p e r s o n a l s e r v i c e s as w e l l as s o c i a l s e r v i c e s w i l l be r e q u i r e d such as: c o u n s e l l i n g , house-keeping ( c l e a n i n g , minor house r e p a i r s ) , meals-on-wheels or wheels-to-meals, s e c u r i t y checks, t e l e c a r e , day care or f r i e n d l y v i s i t i n g and 24-hour s e c u r i t y . T h i s k i n d of s e r v i c e s c o u l d be provided by the Home Support and Home Care from the Core Centre component. A l s o , the s o c i a l p l a n n i n g s t a f f from the Core Centre may provide a v a r i e t y of r e c r e a t i o n a l a c t i v -i t y programs i n the common areas or may organize t r i p s away f o r shopping, d i n i n g or c u l t u r a l events. 4.2 HOUSING FOR PERSONS REQUIRING LONG TERM CARE The second major component of the Continuum of Care Complex co u l d be Long Term Care F a c i l i t i e s i n c l u d i n g Intermediate Care (three l e v e l s ) , and the Extended Care. Long-term care i s the p r o v i s i o n of organized s e r v i c e s to a person with a c h r o n i c d i s a b i l i t y over a prolonged p e r i o d of time. The goal i s to a t t a i n and maintain an optimal l e v e l of f u n c t i o n i n g i n the p a t i e n t . I t i n c l u d e s s e r v i c e s f o r p a t i e n t s i n i n s t i t u t i o n a l and home s e t t i n g s (Report of CMA, 1987). At present, there i s a sharp d i v i s i o n between care i n the community and care i n the i n s t i t u t i o n ; indeed, s e r v i c e s are g e n e r a l l y fragmented. Acc o r d i n g to the Report of the CMA, 1987 "the p r o v i s i o n of a continuum of care, with the v a r i o u s elements b l e n d i n g together, should be the u n d e r l y i n g p r i n c i p l e i n plann-i n g s e r v i c e s f o r the e l d e r l y " . The Continuum of Care Complex w i l l provide a comprehensive and c o o r d i n a t e d system of care ranging from home support and home care to treatment i n I n t e r -mediate Care and Extended Care f a c i l i t i e s . The CCC w i l l be a m u l t i - l e v e l c e n t r e with g r a d u a t i o n of care organized and d e l i v e r -ed i n one s e t t i n g . Moreover, there w i l l be the Day/Night Care, R e s p i t e Care and H o l i d a y / V a c a t i o n Care f o r the e l d e r l y who are l i v i n g i n the neighbourhood. 4.2.1 INTERMEDIATE CARE; The three l e v e l Intermediate Care f a c i l i t y w i l l p r o v i d e s e r v i c e s f o r f r a i l e l d e r l y people who have l i m i t e d m o b i l i t y and whose l e v e l of dependency i s "moderate high". T h e r e f o r e , a l l spaces w i l l be handicap a c c e s s i b l e and a v a r i e t y of s e r v i c e s may be o f f e r e d to i t s r e s i d e n t s . G e n e r a l l y , a l l three l e v e l s c o u l d provide the b a s i c types of s e r v i c e s : p e r s o n a l , s o c i a l , and h e a l t h care s e r v i c e s . Intermediate Care l e v e l I rec o g n i z e s the i n d i v i d u a l who r e q u i r e s moderate a s s i s t a n c e with the a c t i v i t i e s of d a i l y l i v i n g and minimal p r o f e s s i o n a l care and s u p e r v i s i o n . The focus i s on r e a c t i v a t i o n and maintenance program with medical and p r o f e s -s i o n a l n u r s i n g s u p e r v i s i o n . The program c o u l d encourage and 110 m a i n t ain independence i n the a c t i v i t i e s of d a i l y l i v i n g , and a l s o c o u l d meet the p s y c h o - s o c i a l needs of r e s i d e n t s . R e a c t i v a -t i o n i m p l i e s s t i m u l a t i o n of the r e s i d e n t s so t h a t p h y s i c a l , mental and s o c i a l a b i l i t i e s are brought to the optimum l e v e l and maintained. P e r s o n a l s e r v i c e s p r o v i d e d at t h i s l e v e l : s u p e r v i s i o n ; p e r s o n a l care eg: p e r s o n a l grooming, hygiene, p o d i a t r y , housekeeping and p e r s o n a l laundry; three meals per day; c o u n s e l l i n g . S o c i a l s e r v i c e s p r o v i d e d a t t h i s l e v e l : a c t i v a t i o n program; s o c i a l and r e c r e a t i o n a l programs as d e s i r e d ; H ealth care s e r v i c e s : b a s i c n u r s i n g s e r v i c e s approximately 2-6 hours per r e s i d e n t / d a y ; c o n s u l t a t i o n ; three months drug review; annual p h y s i c a l examination; medication a d m i n i s t r a t i o n ; Intermediate Care l e v e l s I I and I I I provide p e r s o n a l and s o c i a l s e r v i c e s s i m i l a r to s e r v i c e s a v a i l a b l e on l e v e l I with added op t i o n s such as: f u l l d i e t a r y s e r v i c e s ; a s s i s t a n c e with f i n a n c i a l matters; I l l needed s u p e r v i s i o n ; emotional or b e h a v i o r a l c o n d i t i o n support; The h e a l t h care s e r v i c e s at t h i s l e v e l s c o u l d i n c l u d e : medications adm i n i s t e r e d by a r e g i s t e r e d nurse; part-time c o n s u l t a n t physiotherapy and o c c u p a t i o n a l therapy, d a i l y o b s e r v a t i o n s ; constant s u p e r v i s i o n r e q u i r e d due to d i s o r i e n t a t i o n of the r e s i d e n t s ; other s e r v i c e s a v a i l a b l e as may be r e q u i r e d ; (Community Care F a c i l i t y Act, 1 9 8 0 ) ( M i n i s t r y of Health Long Term Care Program, P o l i c y Manual, 1983). 4.2.2 EXTENDED CARE Extended Care d i f f e r s from Intermediate Care because p h y s i c a l , mental or emotional c o n d i t i o n s of r e s i d e n t - p a t i e n t r e q u i r e ongoing assessment and i n t e r v e n t i o n by a l l d i s c i p l i n e s (e.g. n u r s i n g , d i e t a r y and m e d i c a l ) . The Extended Care f a c i l i t y c o u l d serve the e l d e r l y with a "high l e v e l " of dependence who r e q u i r e p r o f e s s i o n a l n u r s i n g s e r v i c e s on a twenty-four hour b a s i s and r e g u l a r continuous medical s u p e r v i s i o n . However, Extended Care does not r e q u i r e a l l the resources of an acute care h o s p i t a l (BCHP Extended Care Design G u i d e l i n e s 1988). S e r v i c e s provided i n the Extended Care f a c i l i t y c o u l d i n c l u d e h e a l t h care and p e r s o n a l s e r v i c e s . S o c i a l s e r v i c e s w i l l depend on the p h y s i c a l c o n d i t i o n of r e s i d e n t s . The Extended Care l e v e l c o u l d p r o v i d e : 112 d a i l y help with grooming, t o i l e t i n g , m o b i l i t y ; d a i l y treatments as may be r e q u i r e d ; medication a d m i n i s t e r e d by a r e g i s t e r e d nurse; t h e r a p e u t i c s e r v i c e s : physiotherapy, o c c u p a t i o n a l therapy and speech therapy. s p e c i a l d i e t mechanical a i d s f o r r e s i d e n t care eg: mechanical l i f t s or high-low beds, as w e l l as s p e c i a l i z e d t h e r a p e u t i c a i d s ; help and a s s i s t a n c e i n emotional or b e h a v i o r a l problems; The major program d i f f e r e n c e s among the Long-Term Care f a c i l i -t i e s are s i g n i f i c a n t i n terms of the s p e c i a l requirements and the provided s e r v i c e s . Since the l e v e l of dependence of the e l d e r l y grows a c c o r d i n g to t h e i r gradual p h y s i c a l and emotional l o s s e s , consequently there i s a n e c e s s i t y to provide a v a r i e t y of care l e v e l s . However, most o l d e r people do not f i t n e a t l y i n t o any p a r t i c u l a r order of s e r v i c e s ; o n l y a few r e q u i r e a l l a v a i l a b l e s e r v i c e s . Most e l d e r l y may need one p a r t i c u l a r s e r -v i c e one day and d i f f e r e n t mix of s e r v i c e s the next day. The Continuum of Care Complex may meet these d i v e r s e and changing needs through a network of d i f f e r e n t s e r v i c e s a v a i l a b l e a t a l l times i n one p l a c e . 4.2.3. THE NUMBER OF LONG TERM CARE BEDS At pres e n t there i s no answer to the q u e s t i o n "What i s the r i g h t mix of r e s i d e n t s i n m u l t i - l e v e l care f a c i l i t i e s and Continuum of Care Retirement Communities (CCRCs)?" Researchers 113 do not know the extent to which continued i n t e r a c t i o n s between CCRC n u r s i n g home r e s i d e n t s and independent l i v i n g u n i t r e s i d e n t s a f f e c t the l i f e s a t i s f a c t i o n of each group (Gutman, 1988). For example, i n Seton V i l l a -- a m u l t i - l e v e l care f a c i l i t y i n Burnaby B.C. the " l i g h t " or "heavy" p e r s o n a l care beds (Intermediate Care l e v e l ) represented 25% of r e s i d e n t s only. The remainder l i v e d i n s e l f - c o n t a i n e d and b o a r d - r e s i d e n t s u n i t s and were e s s e n t i a l l y independent. " T h i s mix seemed to work w e l l . " (Gutman 1988, p.10) Another example i s the Northwood Complex i n H a l i f a x , N.S. The f a c i l i t y accomodates 876 o l d e r people i n v a r i o u s l i v i n g arrangement from " s e l f - c o n t a i n e d " apartments through to "Nurs-i n g " c a r e . There are 230 independent s e l f c o n tained apartments o n l y (35% r e s i d e n t s i n 56 one bedroom and 174 b a c h e l o r a p t s . ) . The r e s t (65%) of 576 "care" beds o f f e r p r o g r e s s i v e stages or l e v e l s of care made up of 112 " s u p e r v i s o r y " care beds, 167 " p e r s o n a l " care beds, 297 " n u r s i n g " care beds. Although the Northwood Complex i s very b i g and "there are those who b e l i e v e i t has grown too l a r g e ..", there i n no i n d i c a t i o n t h a t there i s not a r i g h t mix among the l e v e l s of care. On the c o n t r a r y , f o r many, the Complex i s a model of e x c e l l e n c e f o r the Province and the Country (Rogers 1987). Acco r d i n g to Gutman (1988) p o s i t i v e a t t i t u d e s towards mixing between l e v e l s i n m u l t i - l e v e l complexes or CCRCs are dependent a l s o on management p r a c t i c e s , p o l i c i e s and enthusiasm. In Vancouver, there i s a need f o r Long Term Care f a c i l i t i e s 114 (see Chapter 2, F i g 2-5, 2-6). The t o t a l number of w a i t l i s t e d r e s i d e n t s f o r Intermediate Care f a c i l i t i e s i n 1986 was 694 and 69 f o r Extended Care F a c i l i t i e s (Vancouver Health Department Annual Report 1986). Based on the above data t h i s Program assumes t h a t the CCC should provide mainly Intermediate Care (90 beds) with c l u s t e r of Extended Care (42 beds). 4.3 THE CORE CENTRE The Core Centre would c r e a t e a major focus of a c t i v i t i e s w i t h i n the CCC and would serve as l i a s o n between a l l l e v e l s of care w i t h i n the f a c i l i t y and the community at l a r g e . T h i s f a c i l i t y component would c r e a t e an i n f o r m a l community network of f r i e n d s and r e l a t i v e s , would provide l i f e s u s t a i n i n g and l i f e e n r i c h i n g r e s o u r c e s f o r the r e s i d e n t s as w e l l as o l d e r people from the P o i n t Grey neighbourhood and would enhance business i n t e g r a t i o n with the e n t i r e community. For the r e s i d e n t s , the Core Centre w i l l be a p l a c e where they may spend time inexpen-s i v e l y and p r o f i t a b l y . I t may generate f r i e n d s , o p p o r t u n i t i e s f o r p e r s o n a l growth and c o n t a c t with the community and "ongoing-ness" of l i f e . I t may a l s o be a p l a c e j u s t to go and watch when d e c l i n i n g p h y s i c a l v i g o r no longer makes p a r t i c i p a t i o n p o s s i b l e . In keeping with the CCC f a c i l i t y o b j e c t i v e s the Core Centre w i l l c e n t r a l i z e a number of s e r v i c e s . There would be c e n t r a l a d m i n i s t r a t i o n , food s e r v i c e s , laundry s e r v i c e s , m a t e r i a l s , supply b u i l d i n g and p l a n t s e r v i c e s as w e l l as c e n t r a l s o c i a l and h e a l t h s e r v i c e s . However, o n l y a few of the major Core Centre 115 components w i l l e x c l u s i v e l y serve the CCC f a c i l i t y r e s i d e n t s . There w i l l be s e v e r a l components which would provide s e r v i c e s f o r the r e s i d e n t s as w e l l as f o r the v i s i t o r s from the communi-t y . For example, the Core Centre components, which provide s o c i a l and h e a l t h care s e r v i c e s such as the Auditorium and S p e c i a l Programs, A r t s and C r a f t s , L i b r a r y , R e h a b i l i t a t i o n Centre with f i t n e s s c l u b and swimming pool and Food F a i r can be o r g a n i z e d under the auspices of the S e n i o r Centre. The S e n i o r Centre may p l a y i t s unique r o l e i n the P o i n t Grey community by p r o v i d i n g f o r s o c i a l , p h y s i c a l and i n t e l l e c t u a l needs of o l d e r people. I t may s t i m u l a t e , maintain and deepen a "sense of t h a t community" as w e l l as may provide o p p o r t u n i t i e s f o r people to give t h e i r time i n v o l u n t e e r s e r v i c e . The S e n i o r Centre may be run by the CCC r e s i d e n t s and members from the community with support of the p r o f e s s i o n a l s t a f f . We assume a t t h i s stage t h a t a d u l t s 50 years of age and over w i l l be e l i g i b l e f o r membership i n the CCC S e n i o r A s s o c i a t i o n . A membership may e n t i t l e a person to take p a r t i n C o u n c i l sponsored a c t i v i t i e s and to take advantage of other programs and s e r v i c e s o f f e r e d w i t h i n the Core Centre. 4.3.1. CORE CENTRE COMPONENT I - LIFE ENRICHING RESOURCES - CULTURAL CENTRE As a l r e a d y mentioned i n Chapter 2, there i s an urgent need to expand the e x i s t i n g Brock House S e n i o r C i t i z e n Centre with more comprehensive programs and a wider range of amenities. 116 Brock House p l a y s a s i g n i f i c a n t r o l e i n the P o i n t Grey Community by p r o v i d i n g a v a r i e t y of s o c i a l and e d u c a t i o n a l programs f o r 3000 members. However, there i s no adequate space to accom-modate b i g g e r group meetings, c u l t u r a l events, s e v e r a l A r t s & C r a f t s a c t i v i t i e s , outdoor r e c r e a t i o n a l a c t i v i t i e s , h e a l t h and r e h a b i l i t a t i o n programs and h e a l t h s e r v i c e s as w e l l as a Day Care Program. The Core Centre may respond to those needs by p r o v i d i n g v a r i o u s l i f e e n r i c h i n g r e s o u r c e s . The major component would be the Auditorium and Programs, which would i n c l u d e a 200 seat Theatre and a couple of seminar and meeting rooms. L e c t u r e s , movies, c o n c e r t s , s p e c i a l c u l t u r a l events, Music and Drama c l u b , c l a s s e s f o r a d u l t education and other programs would be o f f e r e d to the CCC r e s i d e n t s and to the whole community. T h i s component w i l l c o u l d a l s o provide an o p p o r t u n i t y f o r many s o c i a l a c t i v i t i e s such as: b r i d g e , bingo, t r i p s , s i n g along, t o a s t -masters e t c . Then, there would be the A r t s and C r a f t s component p r o v i d i n g an o p p o r t u n i t y f o r p e r s o n a l e x p r e s s i o n , d e v e l o p i n g c r e a t i v i t y and s o c i a l , i n t e r a c t i o n . Within t h i s component a number of workshops would be o f f e r e d such as: woodwork p a i n t i n g , dyeing, weaving and p o t t e r y . The L i b r a r y , with r e a d i n g and l i s t e n i n g rooms, c o u l d be f o r those who p r e f e r r e a d i n g , l i s t e n i n g to music or l e a r n i n g a new language i n t h e i r l e a s u r e time. For the youngest and more a c t i v e e l d e r l y , the Core Centre w i l l p r o v i d e outdoor r e c r e a t i o n a l a c t i v i t i e s i n the v a r i o u s c l u b s such as bowling, m i n i - g o l f , croquet and gardening. 117 4.3.2. CORE CENTRE COMPONENT I I - LIFE SUSTAINING RESOURCES - HEALTH CENTRE The Core Centre would a l s o provide l i f e s u s t a i n i n g r e s o u r -ces. The most sought component would be the R e h a b i l i t a t i o n Centre which may be i n s t r u m e n t a l i n developing a community s p i r i t and would provide h e a l t h care s e r v i c e s . The R e h a b i l i t a -t i o n Centre would c o n s i s t of Treatment U n i t s p r o v i d i n g physio-therapy and speech pathology s e r v i c e s . F i t n e s s and Dancing Club would provide e x e r c i s e and k i n e s t h e r a p y s e r v i c e s , while a l a r g e swimming pool with sauna c o u l d become the most a t t r a c t i v e p l a c e i n the Core Centre. Another important component would be the M e d i c a l C l i n i c p r o v i d i n g medical, d e n t a l and c o u n s e l i n g s e r -v i c e s . T h i s component may enhance business i n t e g r a t i o n with the P o i n t Grey Community s i n c e i t may serve not o n l y the CCC r e s i d e n t s but a l s o the e l d e r l y from the community. The next component, Pharmacy, would serve the Long-term care f a c i l i t i e s and dispense pharmaceutical s u p p l i e s to t h e i r r e s i d e n t s and the customers from the community. And l a s t , but not l e a s t , a S e n i o r s ' Day Care Program would o f f e r a wide range of a c t i v i t i e s and programs to the r e s i d e n t s and o l d e r a d u l t s l i v i n g i n the community who r e q u i r e support to maintain an independent l i f e s t y l e . 4.3.3. CORE CENTRE COMPONENT I I I - SOCIAL INTERACTION AND  BUSINESS INTEGRATION The t h i r d group of f u n c t i o n a l components i n the Core Centre would c r e a t e an o p p o r t u n i t y f o r i n f o r m a l community network of 118 f r i e n d s and r e l a t i v e s . An o p p o r t u n i t y f o r s o c i a l i n t e g r a t i o n c o u l d be c r e a t e d by p r o v i d i n g f a c i l i t i e s such as: r e s t a u r a n t , c o f f e e - s h o p and bar. Designed as a "Food F a i r " , t h i s component may become a magnet f o r a l l the r e s i d e n t s and t h e i r v i s i t o r s . Other f a c i l i t i e s , which may add to an o p p o r t u n i t y f o r s o c i a l c o n t a c t s and may enhance business i n t e g r a t i o n with the community would be as f o l l o w s : a winter garden with o c c a s i o n a l a r t e x h i b i -t i o n s , a beauty s a l o n and a h a i r d r e s s e r , a bank and s m a l l r e t a i l o u t l e t s . 4.3.4. SUPPORTING AND MAINTENANCE COMPONENTS The f o u r t h group of the Core Centre components w i l l serve the CCC f a c i l i t y only. There w i l l be Laundry, M a t e r i a l S e r v i c e s , B u i l d i n g S e r v i c e s , P l a n t S e r v i c e s as w e l l as A d m i n i s t r a t i o n and S t a f f Support components. 4.4. OUTDOOR SPACES The outdoor landscape should be c o n s i d e r e d as the p r i n c i p a l element i n c r e a t i n g a s u c c e s s f u l environment f o r the e l d e r l y , because i t has great t h e r a p e u t i c value b e s i d e s enjoyment and p l e a s u r e . For most people, nature holds deep meaning: i t i s a p l a c e of refuge, peace and t r a n q u i l i t y , and symbol of l i f e and growth. Research f i n d i n g s support the i d e a t h a t people gain a g r e a t d e a l of p l e a s u r e from c o n t a c t with nature. Moreover, the b e n e f i t s gained from n a t u r a l scenes go beyond simple p l e a s u r e . 119 Recent r e s e a r c h has proved ( R e i n z e n s t e i n Carpman 1986) t h a t the landscape has t h e r a p e u t i c s i g n i f i c a n c e . The s t u d i e s suggest t h a t the a v a i l a b i l i t y of nature, the form of views from windows as w e l l as a c c e s s i b l e outdoor spaces, can be r e s t o r a t i v e . Many e l d e r l y are under s t r e s s . R e i z e n s t e i n s a i d t h a t : A c c o r d i n g to one r e s e a r c h e r , i f an i n d i v i d u a l i s s t r e s s -ed, viewing an a t t r a c t i v e n a t u r a l scene w i l l be sooth-i n g because i t can e l i c i t f e e l i n g s of pl e a s a n t n e s s , h o l d i n t e r e s t , and block or reduce s t r e s s f u l thoughts ( R e i z e n s t e i n Carpman 1987, p.197). Many o l d e r people i n the CCC e i t h e r by ch o i c e or p h y s i c a l l i m i t a -t i o n may spend most of t h e i r time i n t h e i r d w e l l i n g u n i t s . Pro-v i s i o n of outdoor landscaped spaces i n form of p r i v a t e p a t i o s or b a l c o n i e s and a view to outdoor common a c t i v i t y areas c o u l d be very s t i m u l a t i n g and a p p e a l i n g f o r the e l d e r l y . Outdoor spaces provide a change of environment c l o s e a t hand, an area to grow flowers and p e r s o n a l i z e , and they can p e r c e p t u a l l y i n c r e a s e the s i z e of l i v i n g space. They o f f e r immediate access to f r e s h a i r which i s important f o r some tenants with r e s p i r a t o r y problems. In a d d i t i o n , outdoor extensions of p a t i o s can provide secure and p r o t e c t e d environments f o r c a s u a l s o c i a l i z i n g with others ( Z e i s e l 1977, p.44). 4.4.1. OUTDOOR SPACE COMPONENTS The outdoor areas would c o n s i s t of p r i v a t e outdoor spaces and common a c t i v i t y areas. The p r i v a t e outdoor areas would be p a r t of each Independent L i v i n g c l u s t e r , as w e l l as each Long 120 Term Care r e s i d e n t i a l c l u s t e r , i n the form of p r i v a t e yards/ p a t i o s , porches or b a l c o n i e s . These p r i v a t e spaces w i l l : p r o t e c t the d w e l l i n g as a secure t e r r i t o r y , p r o v i d e outdoor extensions f o r expanding l i v i n g spaces i n seasonable weather, and provide an in t e r m e d i a t e zone between p u b l i c and p r i v a t e which allows s o c i a l , n e i g h b o u r l y c o n t a c t s to be c a s u a l l y made (Shack 1977, p.55) . The CCC common outdoor spaces would i n c l u d e two types of areas. F i r s t l y , the common outdoor space would be i n t e r l o c k e d with p r i v a t e outdoor spaces i n the r e s i d e n t i a l c l u s t e r s i n the form of a common garden, c e n t r a l pathway or a "gateway" gazebo. Secondly, f o u r f u n c t i o n a l components, the Country Club, the R e h a b i l i t a t i o n Outdoor Areas, the Garden Centre and Park would cr e a t e the CCC community Outdoor A c t i v i t y Center. That Outdoor A c t i v i t y Centre would be l o c a t e d adjacent to the Core Centre and along the pathway l e a d i n g to the Core Centre. The outdoor common area would be designed to i n c r e a s e o p p o r t u n i t i e s f o r i n d i v i d u a l c h o i ce and to accomodate three types of a c t i v i t i e s : 1. P a s s i v e Areas: p l a c e s which permit s o l i t u d e ( r e t r e a t ) and those p l a c e s which w i l l o f f e r an o p p o r t u n i t y f o r watching the a c t i v i t i e s of ot h e r s . 2. A c t i v e Areas: these areas w i l l o f f e r a range of r e c r e a t i o -n a l a c t i v i t i e s such as m i n i - g o l f , croquet, bowling, v o l l e y -b a l l , gardening, s o c i a l g a t h e r i n g i n the p i c n i c and BBQ areas or i n the outdoor Theatre designed f o r s p e c i a l c u l t u r a l events. 121 3. Connecting Areas such as Park with walkways would l i n k the above noted two groups. For more a c t i v e r e s i d e n t s the e x i s t i n g J e r i c h o Park and a l l i t s amenities c o u l d be a v a i l a b l e through the proposed overpass above 4th Ave. The Outdoor A c t i v i t y centre w i l l p l a y a s i g n i f i c a n t r o l e i n c r e a t i n g the CCC s p e c i a l environment. F i r s t of a l l , i t would be a plac e where the most a c t i v e r e s i d e n t s of the Independent L i v i n g u n i t s c o u l d spend t h e i r l e i s u r e time t a k i n g advantage of Vancouver's m i l d c l i m a t e and garden s e t t i n g . Secondly, i t would be a very s t i m u l a t i n g area f o r those r e s i d e n t s who can not any more take an a c t i v e p a r t i n the r e c r e a t i o n a l a c t i v i t i e s but s t i l l are w i l l i n g to observe games and share enjoyment with t h e i r peers. T h i r d l y , the Country Club component by p r o v i d i n g many play/game c o u r t s , may be a p p e a l i n g to a d u l t s from the whole neighbourhood. Thus, i t may c r e a t e an o p p o r t u n i t y f o r s o c i a l i n t e g r a t i o n with a r e l a t i v e l y younger g e n e r a t i o n . 4.5 CONCLUSION In c o n c l u s i o n , a l l f o u r major f a c i l i t y components: Independ-ent L i v i n g Housing, Long Term Care f a c i l i t i e s , the Core Centre and the Outdoor Spaces w i l l c r e a t e a s p e c i a l , continuum of care enviroment f o r the e l d e r l y . However, the Core Centre and Outdoor Spaces may c o n t r i b u t e to the unique atmosphere of the CCC, which may enhance the r e s i d e n t s d i g n i t y , support t h e i r independence and encourage t h e i r involvement i n community a f f a i r s . 122 The Core Centre w i l l embrace three d i f f e r e n t hubs: 1. The "Health Centre" with the C l i n i c , R e h a b i l i t a t i o n and Pharmacy which would serve the e l d e r l y to support t h e i r p h y s i c a l l o s s e s . 2. The " C u l t u r a l Centre" with the Auditorium, A r t s and C r a f t s , and L i b r a r y which would s a t i s f y t h e i r c u l t u r a l needs and 3. The " L e i s u r e Centre" with the Outdoor A c t i v i t y Centre, Food F a i r , Winter Garden, Swimming Pool, Dancing and F i t n e s s and other s o c i a l c l u b s . The Core Centre with i t s outdoor a c t i v i t y c l u b s may become an a t t r a c t i o n not on l y f o r the whole neighbourhood but a l s o f o r the e l d e r l y from the West Side of Vancouver. 123 ©•••©•••o«ooo • • • UVIN&-CLUSTER.  • . OUTPOOR. SPACES A T o o o o o CARE CLUSTER. 1 OUTDOOR. SPACES Jf«®» CARE -™ CLUSTER. OUTDOOR. SPACES LE&EK1D • •••• MA"30£ PEDESTRIAN CIRCULATION MA^OR. SERVICE ACCESS MAJOR VEHICULAR ACCESS ENVI RON MENTAL OR. SECUfe-UV COKTROL F i g . 4-1 Access and C o n t r o l Model of the CCC F a c i l i t y . 124 CHAPTER 5 -- GENERAL PROGRAM REQUIREMENTS  Chapter Summary Chapter 5 i s the t h e s i s s y n t h e s i s and c o n s i s t s of the CCC f a c i l i t y program. The c l a s s i f i c a t i o n system, which has been adopted to develop the program f o l l o w s a f u n c t i o n a l model. A l l f a c i l i t i e s belong to one of f o u r major f a c i l i t y components de-s c r i b e d i n Chapter 4. The l a r g e s t e n t i t y i s the Continuum of Care Complex. Within i t , there are f o u r major f a c i l i t y compo-nents: R e s i d e n t i a l Independent L i v i n g , R e s i d e n t i a l Dependent L i v i n g , Core Centre and Common Outdoor Spaces. Within each f a c i l i t y component, there are s e v e r a l program components and a c t i v i t y c e n t r e s . 5.1. RESIDENTIAL HOUSING - INDEPENDENT LIVING CLUSTER 5.1.1 F u n c t i o n a l Components In keeping with the o b j e c t i v e s of the p r o j e c t , housing u n i t s w i l l emulate to the g r e a t e s t p o s s i b l e extent a normal, indepen-dent l i v i n g environment. The u n i t s w i l l c o n t a i n spaces s i m i l a r to those found i n other community housing and w i l l conform to the design c r i t e r i a of the BCMHC and CMHC. As po i n t e d out i n Chapter 4, the Independent L i v i n g C l u s t e r w i l l be comprised of three types of housing: Rental Housing (BCMHC Program), Cooperative Housing (CMHC Program) and S t r a t a - t i t l e condominiums (Market Housing). 125 The number, r a t i o and s i z e of u n i t s i n the S o c i a l R e n t a l Housing (BCHMC) w i l l conform to the requirements of the BCMHC Design G u i d e l i n e s f o r S e n i o r s ' Housing. The s i z e and r a t i o of u n i t s i n the co-op housing and s t r a t a t i t l e was d e r i v e d from the a n a l y s i s of comparative data of s e l e c t e d examples of e x i s t i n g e l d e r l y housing developments i n three groups: 1. Co-operative housing f o r the e l d e r l y . 2. Independent l i v i n g d w e l l i n g u n i t s i n the m u l t i - l e v e l f a c i l i t i e s . 3. R e c e n t l y b u i l t condominiuums f o r the e l d e r l y people i n the P o i n t Grey Area (see Appx. 5-1). I t was a l s o acknowledged t h a t c u r r e n t housing demands and p r e f e r -ences of middle to h i g h e r income o l d e r persons d i f f e r from expec-t a t i o n s of e l d e r l y i n the 1970's. For example, evidence gathered by L a v e n t h a l and Horwath (1983) i n l o n g i t u d i n a l and c r o s s - s e c t i o n a l analyses of Con-t i n u i n g Care Retirement Communities (CCRC) shows an i n c r e a s e i n the p o p u l a r i t y of l a r g e r s i z e u n i t s . While the s t u d i o or one-bedroom u n i t has been the most popular u n i t choice i n the l a s t 10 years, two-bedroom and even three bedroom u n i t s are becoming i n c r e a s i n g l y popular f o r a f f l u e n t r e t i r e e s over the age of 75 (Regnier, Pynoos 1987, p.16). T h e r e f o r e , i n the co-op housing and s t r a t a t i t l e c l u s t e r b i g g e r d w e l l i n g u n i t s would be programmed to respond to the demand of the market. 126 Table 5-1.--Housing Type #1 Re n t a l Housing Space Program Component Q-ty U n i t Net Area T o t a l Net Area Remarks 100 d w e l l i n g u n i t s ; 3 s t o r e y apartment t o t a l number of b u i l d i n g . r e s i d e n t s : 110 1 BR S i n g l e 86 46 m2 3956 m2 1 BR Double 9 52 m2 468 m2 1 BR Handicapped 5 52 m2 260 m2 F l o o r Lounge 2 30 m2 60 m2 Main Lounge 1 60 m2 60 m2 Adm. O f f i c e 1 10 m2 10 m2 Maint. Storage 1 10 m2 10 m2 Common Laundry Communal Storage 3 1 15 23 m2 m2 45 m2 23 m2 2 Washers & Dryers/each H . T o i l e t at Lounge 3 Garbage(chute)rm. 3 S e r v i c e Rms (M&E) 1 Approx. 82 m2 Design Space M a i l Room 1 E l e v . Mech. Room 1 TOTAL 4974 m2 GROSS AREA: 4974 X 1.3 = 6466.2 m2 P r i v . o u t d o o r spaces 100 x 5 m2 = 500 m2 P a t i o s / b a l c o n P a r k i n g : 1 space per 4 u n i t s , 25 spaces x 26.5 m2 = 662.5 m2 on ground ( i n c l u d . a i s l e s ) References: EM A r c h i t e c t u r e Inc., 768 P r i o r S t . , S e n i o r C i t i z e n ' s Complex -Chinese Freemason's S o c i e t y (BCMHC Housing) 1989. 127 Table 5-2.--Housing Type #2 Co-op Housing 50 Dwelling U n i t Space Program Component Q-ty U n i t Net Area T o t a l Net Area Remarks 1 BR+Den(30%) 15 2 BR (35%) 35 Communal Stg. 1 Communal Laun. 1 O f f i c e 1 84 m2 87 m2 25 m2 15 m2 10 m2 1260 m2 3045 m2 25 m2 15 m2 10 m2 2 Washers & 2 Dryers TOTAL 4355 m2 GROSS AREA: 4355 x 1.3 = 5661.5 m2 P r i v a t e outdoor spaces: 50 x 12 m2 = 600 m2 Parking: 1 space per u n i t 50 spaces x 26.5 m2 = 1325 m2 Table 5-3.--Type #3 S t r a t a T i t l e 50 Dwel l i n g U n i t s Space Program Component Q-ty U n i t Net Area T o t a l Net Area Remarks 1 BR (10%) 25 70 m2 350 m2 1 BR + den (20%) 10 84 m2 840 m2 2 BR (70%) 35 96 m2 3360 m2 Lobby lounge 1 30 m2 30 m2 TOTAL 4580 m2 GROSS AREA: 4580 X 1. 3 = 5954 m2 P r i v a t e outdoor spaces: 50 x 12 m2 = 600 m2 Parking: 1.5 space per u n i t , 75 spaces x 26.5 m2 = 1987 m2 References: Outdoor p r i v a t e spaces comply with requirements of BCHMC Design G u i d e l i n e s f o r S e n i o r s ' Housing; Green 1974, p. 14; Carstens 1985, p.105. 128 5.1.2. Housing P a t t e r n and C r i t i c a l Issues: People need to i d e n t i f y with the neighbourhood and f e e l c omfortable i n t h e i r houses. T h e r e f o r e , i t i s necessary to p r o v i d e an adequate type of housing arrangement t h a t w i l l e v e n t u a l l y f u l f i l l t h e i r needs. Research s t u d i e s on housing (Alexander 1977) have i n d i c a t e d t h a t the most a p p r o p r i a t e p a t t e r n i s the c l u s t e r of l a n d and homes immediately around one's own home. That p a t t e r n can be implemented u s i n g Row Houses. A v i t a l f u n c t i o n of such a c l u s t e r i s n e i g h b o u r l y c o n t a c t which becomes one of the most important o b j e c t i v e s i n the c r e a t i o n of e l d e r l y housing. The same r e s e a r c h study says t h a t the most a p p r o p r i a t e s i z e of the c l u s t e r i s 10 or 12 housing u n i t s because: t h i s i s a number of people t h a t can s i t round a common meeting t a b l e , can t a l k to each other d i r e c t l y , face to f a c e . With 8 or 10 housholds, people can meet over a k i t c h e n t a b l e , exchange news on the s t r e e t and i n the gardens, and g e n e r a l l y , w i t h o u t much s p e c i a l a t t e n t i o n , keep i n touch with the whole of the group. When there are more than 10 or 12 homes forming a c l u s t e r , t h i s balance i s s t r a i n e d . We t h e r e f o r e s e t an upper l i m i t of around 12 on the number of housholds t h a t can be n a t u r a l l y drawn i n t o a c l u s t e r (Alexander 1977, p.200). The CCC housing w i l l comprise s e v e r a l c l u s t e r s with the average number of 12 d w e l l i n g u n i t s i n each c l u s t e r . The c r i t i c a l i s s u e s w i t h i n t h i s p a t t e r n are: shape (l a y o u t ) of the c l u s t e r , c l u s t e r i d e n t i t y and l i n k with the Core Centre. 5.1.2.1 Shape ( l a y o u t ) of the c l u s t e r The shape of the c l u s t e r a f f e c t s o p p o r t u n i t i e s f o r s o c i a l 129 i n t e r a c t i o n . I t i s necessary to c r e a t e a common land -- open shared space which w i l l p l a y a double r o l e : as a se m i - p u b l i c outdoor p l a c e where the e l d e r l y gather s o c i a l l y and as a c l u s t e r ' s garden with s e m i - p r i v a t e or even p r i v a t e areas i n f r o n t of the d w e l l i n g u n i t s (see F i g . 5-1). Equal access from the u n i t s and v i s i b i l i t y from p r i v a t e p a t i o s w i l l promote a sense of ownership and c o n t r o l over common space. Other design g u i d e l i n e s suggests p l a c i n g the u n i t e n t r i e s towards common space. Access walks l e a d i n g to u n i t s should be separate from the common access walks to the f a c i l i t y . T h i s arrangement w i l l enhance c l u s t e r i d e n t i t y and i n c r e a s e s r e s i d e n t s ' c o n t r o l over access. A shared walkway and a common laundry i n the centre w i l l p r o v i d e o p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n . P r i v a t e u n i t walkways w i l l p r ovide a t r a n s i t i o n zone from s e m i - p u b l i c area to sem i - p r i v a t e space. Small p a r k i n g areas adjacent to u n i t s w i l l enhance the sense of community (see F i g . 5-2). 5.1.2.2 C l u s t e r I d e n t i t y Each c l u s t e r should be arranged as an i d e n t i f i a b l e p a r t of the l a r g e r p r o j e c t to promote wayfinding and to i d e n t i f y with i t . N a t u r a l s i t e elements as w e l l as b u i l t form elements l i k e c o l o u r , s c a l e and m a t e r i a l s w i l l u n i f y c l u s t e r v i s u a l l y . T h i s allows people to r e a l i z e t h a t a l l u n i t s i n one c l u s t e r r e l a t e to one another. Furthermore, c l u s t e r i d e n t i t y can be r e i n f o r c e d by grouping the s i t t i n g area with communal f a c i l i t i e s such as laundry o r storage (see F i g . 5-3). 130 F i g . 5-1 Common Space i n the C l u s t e r as a Garden C O M M O N L A U N D R Y S H A R E D WALKWAY P R I V A T E U N I T W A L K WAV P A C K I N G -F i g . 5-2 Common Space i n the C l u s t e r with Shared Walkway 131 F i g . 5-3 C l u s t e r I d e n t i t y R e i n f o r c e d by a C e n t r a l S i t t i n g Area and Shared Storage Shed. F i g . 5-4 P e d e s t r i a n C i r c u l a t i o n Developed as a "Feeder" System. Source: Based on Carstens, D. S i t e P l anning and Design  f o r the E l d e r l y - Issues, G u i d e l i n e s and A l t e r n a -t i v e s . 1985, p.39. 132 5.1.2.3 R e l a t i o n s h i p with the Core Centre I t i s necessary to provide d i r e c t , easy access to the Core Centre where a l l major s e r v i c e s are l o c a t e d . The l a y o u t of p e d e s t r i a n and v e h i c u l a r c i r c u l a t i o n systems w i t h i n the o v e r a l l s i t e p l a n should be easy to recognize and i d e n t i f y . The general l a y o u t of the p e d e s t r i a n c i r c u l a t i o n system may be developed as a "feeder" system (Carstens 1985). Walkways l e a d i n g from u n i t s may converge on a c l u s t e r walkway and c l u s t e r walkways converge on a major access route which leads to the Core Centre. A h i e r a r c h y of r o u t e s , from p r i v a t e u n i t access walks to primary r o u t e s , w i l l enhance p r i v a c y w i t h i n the c l u s t e r s and a sense of community w i t h i n the o v e r a l l s i t e p l a n . I t w i l l a l s o promote wayfinding (See F i g . 5-4) and subsequently w i l l add to o l d e r r e s i d e n t s ' sense of s e c u r i t y . The "shared c i r c u l a t i o n " p a t t e r n w i l l g i v e r e s i d e n t s the maximum chance of meeting one another c a s u a l l y so t h a t i t w i l l enhance o p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n . In order to provide s a f e t y and s e c u r i t y the p e d e s t r i a n path system should not c r o s s with the v e h i c u l a r routes system. The major access walkway should not pass d i r e c t l y through the a c t i v i t y area; however, i t should a l l o w f o r s u r v e i l a n c e from those areas. In order t o pro v i d e maximum comfort f o r r e s i d e n t s the main access walkways should be p r o t e c t e d from r a i n or sun g l a r e by a t r e l l i s or canopy. 133 5.1.3 DWELLING UNITS  5.1.3.1 F u n c t i o n a l Components The p r i n c i p a l form of s h e l t e r i n the Independent L i v i n g Com-ponent of the CCC w i l l be a d w e l l i n g u n i t . Spaces i n a d w e l l i n g u n i t w i l l embody the b a s i c a c t i v i t i e s of everyday l i v i n g such as: s l e e p i n g , l e i s u r e , p e r s o n a l hygiene, food p r e p a r a t i o n and d i n i n g . These a c t i v i t i e s are common to a l l r e s i d e n t s and they determine the r e l a t i o n s h i p between spaces as w e l l as the s i z e , shape, equipment and c h a r a c t e r of the space. Each u n i t w i l l i n c l u d e components such as an e n t r y area, d i n i n g / l i v i n g room, k i t c h e n , bathroom, bedroom(s), storage space, and balcony or p a t i o . 5.1.3.2. Category of users and t h e i r needs G e n e r a l l y the users w i l l f a l l i n t o three c a t e g o r i e s : the e l d e r l y couple, the s i n g l e e l d e r l y person ( u s u a l l y women) and two e l d e r l y r e l a t i v e s or f r i e n d s s h a r i n g a u n i t . S i n g l e s u s u a l l y w i l l l i v e i n the one-bedroom u n i t s while couples i n one-bedroom or two-bedroom s u i t e s with enough space i n the bedroom f o r double or twin beds. However, each of the 3 Types of housing development d e s c r i b e d e a r l i e r should o f f e r v a r i o u s forms of one and two bedroom d w e l l i n g u n i t s i n order to accommodate a wider range of housing needs and l i f e - s t y l e s . These needs can i n c l u d e ease of maintenance, f l e x i b i l i -t y i n f u r n i t u r e arrangements f o r hobbies, space f o r en-t e r t a i n i n g l a r g e groups of f a m i l y and f r i e n d s , o p t i o n s f o r e a t i n g , adequate storage f o r valued p o s s e s s i o n s and convenient and safe access between rooms without s a c r i -f i c i n g p r i v a c y ( Z e i s e l 1987, p.20). 134 S t u d i e s have shown c o n s i d e r a b l e d i f f e r e n c e s i n need between c o n v e n t i o n a l housing p r o v i s i o n s and the requirements of d i s a b l e d people. In keeping with the L i v i n g Environment o b j e c t i v e s (Chapter 3). each of the u n i t s should be adaptable f o r use by handicapped persons. The Co-op and S t r a t a - t i t l e townhouses should be designed as o n e - l e v e l u n i t s to f a c i l i t a t e a c c e s s i b i -l i t y . The d w e l l i n g u n i t s p r o v i d e d by the BCHMC Program have t o comply with the BCHMC Design G u i d e l i n e s (5% of u n i t s wheelchair a c c e s s i b l e ) . One of the most c r i t i c a l , y et overlooked, aspects of the p h y s i c a l environment i s the matching of equipment, f u r n i s h i n g and design d e t a i l s to the s p e c i a l p h y s i o l o g i c a l needs of the o l d e r person. S a f e t y f e a t u r e s and design s o l u t i o n s t h a t support independence and reduce p h y s i c a l and sensory b a r r i e r s f o r o l d e r persons should be implemented. The k i t c h e n and bathroom are e x p e c i a l l y c r i t i c a l , because design mistakes i n the k i t c h e n o r bathroom l a y o u t can p o t e n t i a l l y t h r e a t e n s a f e t y or endanger the l i f e of o l d e r persons (Regnier and Pynoos 1987). The k i t c h e n design should r e s p e c t the anthropometric c h a r a c t e r i s t i c s of the e l d e r l y . Bathroom design should emphasize convenience and s a f e t y ( p r o v i s i o n of grab bars, adequate l i g h t l e v e l s and f i x t u r e s , c a l l b u t t o n s ) . 5.1.4 PRIVATE OUTDOOR SPACES - INDEPENDENT LIVING HOUSING  5.1.4.1 I n t r o d u c t i o n Landscape design, although only one of many aspects of a housing p r o j e c t , p l a y s a s u b s t a n t i a l r o l e i n c r e a t i n g h i g h - q u a l i 135 t y housing f o r the o l d e r people. Designing outdoor spaces f o r the e l d e r l y demands s p e c i a l a t t e n t i o n f o r s e v e r a l reasons. F i r s t l y , an a p p r o p r i a t e l y designed environment t h a t meets e l d e r l y needs may e n r i c h t h e i r l i v e s and improve t h e i r independence. Secondly, " f u n c t i o n a l " landscape t h a t encourages p a r t i c i p a t i o n of the e l d e r l y i n i t s c r e a t i o n / c u l t i v a t i o n p l a y s a t h e r a p e u t i c r o l e . In the Independent L i v i n g c l u s t e r s a l l d w e l l i n g u n i t s w i l l have p r i v a t e outdoor spaces (see F i g . 5-5). In the r e n t a l apartment b u i l d i n g each d w e l l i n g u n i t w i l l have balcony or p a t i o . 5.1.4.2 Elements of P r i v a t e Spaces a. The f r o n t yard should not o n l y be an a t t r a c t i v e , person-able s i d e of a d w e l l i n g u n i t , but a l s o a t r a n s i t i o n zone between a very p r i v a t e d w e l l i n g u n i t and a v ery p u b l i c s t r e e t or access route. T h i s s e m i - p r i v a t e space may encourage s o c i a l i n t e r a c t i o n between neighbours and p rovide an o p p o r t u n i t y f o r s e l f - e x p r e s -s i o n . The r e s i d e n t s ' gardens may serve f o r t h e r a p e u t i c a c t i v i -t i e s . b. The f r o n t porch, a s m a l l outdoor space with a roof s h e l -t e r , may p r o v i d e r e s i d e n t s with an easy h a l f step between s o l i -tude and s o c i a b i l i t y . T h i s p l a c e may serve as a comfortable s i t t i n g spot i n one's own t e r r i t o r y to watch outdoor a c t i v i t i e s or to chat with the neighbours. In many r e c e n t developments f o r the e l d e r l y , the f r o n t porch becomes one of the most d e s i r a b l e a r c h i t e c t u r a l f e a t u r e s ( A r c h i t e c t u r a l Record 1988.Nov., p.120). PUF3LIC FRONT YAfc£> n?ONT T-ORCH L»l 2 > I I < ^ I _J LU I fcESI&EVlTIAL CLUSTER II BACK YAfct? COMMON! S P A C ^ COMMUNITY I OUTPOOR | S P A C E S J F i g . 5-5 Independent L i v i n g Outdoor Spaces. 137 because people l i k e to watch common area a c t i v i t y . In F i n l a n d , i n the co m p e t i t i o n f o r an old-age home, the i n s t i t u t i o n a l atmosphere was e l i m i n a t e d by u s i n g v a r i o u s homelike u n i t models with i n d i v i d u a l i t y and o r i e n t a t i o n supported by the f r o n t porch f o r every room-unit ( K o t i l a i n e n 1987, pp. 52-56). c_. The back y a r d / p a t i o i s the i n f o r m a l p r i v a t e s i d e of a d w e l l i n g . T h i s space may be used i n many ways: as a summer d i n i n g room, or as a place to r e s t , read, e n t e r t a i n guests or simply grow p l a n t s . However, t h i s p l a c e r e q u i r e s p e c i a l c o n s i -d e r a t i o n i n terms of a c c e s s i b i l i t y , s e c u r i t y and p r i v a c y . d_. The Balcony may serve s i m i l a r i l y as p r i v a t e outdoor spaces f o r growing p l a n t s , having s o c i a l g a t h e r i n g or simply e n j o y i n g a view and a l s o A balcony which i s not too f a r removed from the ground (one i s able to gr e e t a f r i e n d ) and which i s not ex-tremely enclosed, can c r e a t e a sense of "connectedness" to the o u t s i d e world (Shack 1977, p.61). 5.1.4.3 Issues i n Designing P r i v a t e Outdoor Spaces The most important design i s s u e s i n c r e a t i n g p r i v a t e outdoor spaces are: a c c e s s i b i l i t y , s e c u r i t y and p r i v a c y . The p r i v a t e outdoor spaces should be d i r e c t l y a c c e s s i b l e to the L i v i n g Room of the d w e l l i n g u n i t . There may a l s o be d i r e c t access to the s l e e p i n g area (Green 1974). The p a t i o or garden should be planned so i t can be e a s i l y maintained by the r e s i d e n t . In order t o pro v i d e a c c e s s i b i l i t y and s e c u r i t y and to p r o t e c t the p r i v a c y of p r i v a t e outdoor areas the f o l l o w i n g g u i d e l i n e s have to be developed: 138 a. P r i v a t e outdoor spaces on the ground f l o o r l e v e l : these area should be a c c e s s i b l e to wheelchair r e s i d e n t s , to those u s i n g walkers and o c c a s i o n a l l y to bedridden r e s i d e n t s . d i r e c t access from the p u b l i c outdoor area should be avoided by c r e a t i n g an i d e n t i t y f o r the outdoor p r i v a t e areas. there should be no d i r e c t a c c e s s i b i l i t y between the p r i v a t e outdoor areas of separate d w e l l i n g u n i t s , i n s p e c i a l l o c a t i o n s design should provide f o r p r i v a c y from adjacent walks or d r i v e s by p r o v i d i n g berms and screens. views on and o f f the s i t e should be maximized, while a t the same time l o s s of p r i v a c y should be minimized, v i s u a l a c c e s s i b i l i t y between the l i v i n g room and the g e n e r a l outdoor area should not be impaired by the design of the p r i v a t e outdoor area. b. p r i v a t e outdoor spaces above grade - r a i s e d t e r r a c e s and  b a l c o n i e s : b a l c o n i e s must not o n l y be s a f e , but they must a l s o f e e l s a f e . whenever p o s s i b l e b a l c o n i e s should be r e c e s s e d behind the main face of the b u i l d i n g to provide a s t r o n g sense of e n c l o s u r e , p r i v a c y and s e c u r i t y . b a l c o n i e s should be p r o t e c t e d from p r e v a i l i n g c o l d autumn and s p r i n g winds, and a l l o w maximum sun p e n e t r a t i o n . 139 provide f o r p l a n t e r boxes or pots. be of a rough t e x t u r e on the underside to d i s p e r s e i n c i d e n t sounds. have a minimum t h r e s h o l d h e i g h t to al l o w easy access from the u n i t . On grade p r i v a t e space w i l l have a paved p a t i o of a t l e a s t 100 square f e e t (9.2 m2). The remaining area should be designed f o r lawn or p l a n t i n g beds. B a l c o n i e s w i l l have a t l e a s t c l e a r d i -mension of no l e s s than 5m2 f o r one-bedroom u n i t s (BCMHC Design G u i d e l i n e s ) or be of a minimum width of 1500 mm c l e a r to provide space f o r s e v e r a l c h a i r s and access to the wheelchair and i t s t u r n around (CMHC 1983). 140 5.2 DEPENDENT LIVING - INTERMEDIATE CARE FACILITY 5.2.1 F u n c t i o n a l Components The Intermediate Care f a c i l i t y w i l l be developed i n the form of r e s i d e n t i a l c l u s t e r s f o r the e l d e r l y who can not l i v e on t h e i r own. Three l e v e l s of i n t e r m e d i a t e care w i l l be o f f e r e d : l e v e l 1, 2 and 3 (Appx.#0-1). A c c o r d i n g to the Vancouver Health Department, Report 1986 (Chapter 2, F i g . 2-6) there i s a g r e a t demand i n the C i t y of Vancouver f o r long term care f a c i l i t i e s , e s p e c i a l l y a t the Intermediate Care l e v e l s (694 c l i e n t s on the w a i t i n g l i s t with a r a t i o of 37% f o r l e v e l 1, 29% f o r l e v e l 2, 20% f o r l e v e l 3 and remaining 14% f o r p e r s o n a l and extended c a r e ) . Research has shown ( P r i e s t 1985, p.7; C i t y P l a n n i n g Department data 1986) t h a t 10% of the e l d e r l y p o p u l a t i o n i s e v e n t u a l l y f o r c e d to move i n t o long-term care f a c i l i t i e s when t h e i r h e a l t h d e c l i n e . For the purpose of t h i s t h e s i s we can assume t h a t about 10% (231 persons) of the e l d e r l y p o p u l a t i o n i n the P o i n t Grey Area w i l l be seeking such long-term care. However, there w i l l be a l s o e l d e r l y r e s i d e n t s l i v i n g i n K e r r i s d a l e , K i t s i l a n o and Dunbar who e v e n t u a l l y w i l l be t r a n s f e r r e d to long-term care f a c i l i t i e s . With the e x i s t i n g 202 beds of Intermediate Care i n the West Side of Vancouver we can assume t h a t a " t y p i c a l " three l e v e l care f a c i l i t y with an average of 30 beds per l e v e l would be s u f f i c i e n t to meet the c u r r e n t needs. Intermediate Care F a c i l i t y r e s i d e n t s w i l l be u s i n g common f a c i l i t i e s i n the Core Centre such as: R e h a b i l i t a t i o n Centre, 141 C l i n i c , Auditorium and Programs, A r t s & C r a f t s , L i b r a r y and the Main Concourse with i t s s e r v i c e s . The l i v i n g q u a r t e r s of the IC w i l l be i n the form of separate r e s i d e n t i a l c l u s t e r s with b a s i c care and treatment rooms p l u s c l u s t e r support a c c e s s o r y spaces (Nurses S t a t i o n with M e d i c a t i o n Room, Wheelchair Shower, Lin e n Storage, J a n i t o r Room, Residents'Laundry, S t a f f Washroom, Wheel-c h a i r S t o r a g e ) . L i v i n g u n i t s are s i m i l a r i n a l l l e v e l s of int e r m e d i a t e care and are e i t h e r p r i v a t e or s e m i - p r i v a t e , each with a washroom (which i n c l u d e s wash-basin i n a v a n i t y and t o i l e t but no bath-tub), entrance h a l l , c l o t h e s c l o s e t . I n t e r -mediate Care Components w i l l be su b - d i v i d e d i n t o three n u r s i n g s e c t i o n s each comprising of 28 rooms. The 84 u n i t c l u s t e r (90 r e s i d e n t s ) w i l l comprise the f u n c t i o n a l components as shown i n t a b l e 5-4. The l i v i n g u n i t s i n the IC f a c i l i t y w i l l be arranged i n c l u s t e r s of 9-10 u n i t s around common area. Each c l u s t e r , i n a s o c i a l sense, w i l l c r e a t e a l a r g e " v o l u n t a r y f a m i l y " . The common area w i l l be comprised of a lounge which w i l l serve a l s o as a d i n i n g room l i n k e d t o the r e s i d e n t k i t c h e n and s e r v i n g area. The outdoor a c t i v i t y area - open shared space w i l l be i n c o r p o r a t e d i n t o each c l u s t e r by d i r e c t access from the l i v i n g u n i t s and lo u n g e / d i n i n g area. T h i s arrangement w i l l p r o vide a s m a l l e r , human s c a l e to the whole f a c i l i t y and w i l l c r e a t e a " r e s i d e n t i a l neighbourhood" w i t h i n the f a c i l i t y . T h i s arrangement w i l l a l s o promote s o c i a l i n t e r a c t i o n and op p o r t u n i -t i e s f o r mutual awarness. The IC Component w i l l comprise 9 l i v i n g c l u s t e r s and 3 support areas. Table 5-4.--Intermediate Care C l u s t e r Space Program 142 Component Q-ty Net Area T o t a l Net Area Remarks: C l u s t e r Type I T o t a l number of r e s i d e n t s : 10 1 BR S i n g l e 8 18.0 m2 144. 0 m2 1 BR Double 1 25.0 m2 25. 0 m2 Loung/Dining 1 30.0 m2 30. 0 m2 3 m2/ person S.Kitch./Serv. 1 10.0 m2 10. 0 m2 Bathing Room 1 8.4 m2 8. 4 m2 T o t a l : 217. 4 m2 TOTAL NUMBER OF CLUSTERS: 6 1,304. 4 m2 C l u s t e r Type I I T o t a l number of r e s i d e n t s : 10 1 BR S i n g l e 10 18.0 m2 180. 0 m2 Lounge/Dining 1 30.0 m2 30. 0 m2 S.Kitch./Serv. 1 10.0 m2 10. 0 m2 Bathing Rm. 1 10.0 m2 10. 0 m2 Therap. Bath T o t a l : 230. 0 m2 TOTAL NUMBER OF CLUSTERS: 3 690. 0 m2 C l u s t e r Support : Nurse S t a t i o n 1 10.0 m2 10. 0 m2 Med. Room 1 5.6 m2 5. 6 m2 W.chair shower 1 3.3 m2 3. 3 m2 Line n Storage 1 5.6 m2 5. 6 m2 S o i l e d U t i l i t y 1 11.0 m2 11. 0 m2 J a n i t o r Rm/St. 1 3.0 m2 3. 0 m2 Res. Laundry 1 10.0 m2 10. 0 m2 S t a f f Washroom 1 3.0 m2 3. 0 m2 W.chair storage 1 12.0 m2 12. 0 m2 T o t a l : 63. 5 m2 TOTAL NUMBER OF CLUSTER SUPPORT: 3 190. 5 m2 TOTAL AREA: 2,184. 9 m2 GROSS AREA (40 m2 x 90 r e s i d e n t s ) 3,600. 0 m2 P i r v a t e outdoor spaces: 84 x 6 m2 504. 0 m2 References: B.C. Reg. 536/80. Community Care F a c i l i t y Act. 1980. CMHC. Nursing Homes and H o s t e l s : Design G u i d e l i n e s . 1979. 143 5.2.2 LIVING UNITS -- PATTERN AND CRITICAL ISSUES  Issue #1 Sense of r e s i d e n c y The general o b j e c t i v e i n d e s i g n i n g long term f a c i l i t i e s i s to c r e a t e a " r e s i d e n t i a l " q u a l i t y and adequate space f o r s o c i a l i z a t i o n on a spontaneous b a s i s . In most of the e x i s t i n g f a c i l i t i e s the l i v i n g u n i t s have a form of h o t e l - l i k e rooms d e s p i t e the dramatic attempts of many de s i g n e r s to achieve a "home-like" q u a l i t y and atmosphere. Indeed, those attempts were o f t e n addressed i n main lounges, e n t r y areas and common d i n i n g spaces. However, those f e a t u r e do not pr o v i d e a sense of re s i d e n c y , because they are not w i t h i n the c o n t r o l of the p a t i e n t s - r e s i d e n t s . A c c o r d i n g to K o n c e l i k (1976) c o n t r o l over one's own p h y s i c a l environment i n a long-term care f a c i l i t y depends l a r g e l y upon f i v e f a c t o r s : 1. M o b i l i t y s t a t u s . Four d i s t i n c t l e v e l s of m o b i l i t y are found i n the long-term care s e t t i n g : f u l l ambulatory, d i s a b l e d ambulatory (walk with canes and w a l k e r s ) , semiambulatory (wheelchair bound), and nonambulatory (bedridden). 2. P e r s o n a l i z a t i o n . The a b i l i t y of the r e s i d e n t to manipulate a r t i f a c t s w i t h i n h i s p h y s i c a l environment, to b r i n g i n pe r s o n a l o b j e c t s , to a f f e c t the c h a r a c t e r of h i s or her surroundings i n a way t h a t i s sympathetic to p e r s o n a l p r e f e r e n c e . 3. S o c i a l i z a t i o n . The a b i l i t y to communicate with others both i n p u b l i c areas i n groups and i n p r i v a c y , without r e g u l a t i o n , t h r e a t or i n t e r f e r e n c e . 144 4. P r i v a c y . There must be a p l a c e where every r e s i d e n t can go to or r e t r e a t t o , t h a t w i l l permit s e c l u s i o n f o r m e d i t a t i o n , c o n s u l t a t i o n , i n t i m a t e d i s c u s s i o n , p e r s o n a l a c t i v i t i e s and r e s t . The most l o g i c a l p l a c e f o r t h i s c a p a b i l i t y i s the r e s i d e n t room. 5. I d e n t i f i c a t i o n . The r e s i d e n t must f e e l t h a t he or she belongs i n the f a c i l i t y and the f a c i l i t y belongs to him/her. T h i s can not o n l y be aided through d e v i c e s i n the p h y s i c a l environment i t s e l f , but a l s o by i n c l u d i n g the r e s i d e n t i n p l a n n i n g and d e c i s i o n making at the s t a f f and a d m i n i s t r a t i v e l e v e l . M o b i l i t y s t a t u s , however, i s the most important determining f a c t o r i n c o n t r o l l i n g the p e r s o n a l surroundings and the o v e r a l l f a c i l i t y . M o b i l i t y s t a t u s i s o f t e n the f a c t o r used i n determin-i n g the v a r i o u s s e g r e g a t i o n s of people w i t h i n the f a c i l i t y . In "Designing the Open Nursing Home" K o n c e l i k makes r e f e r e n c e to a study done by P a s t a l a n (1974) which d i s c u s s e s the a c c e s s i b i l i t y model i n a t y p i c a l n u r s i n g home (see diagram: F i g . 5-6). The space i n a f a c i l i t y i s d i v i d e d i n t o two groups a c c o r d i n g to r e s i d e n t access. The f i r s t one, i s a Primary Access Group which comprises of the " c o r r i d o r neighbourhood": Resident Rooms, Lounges, Bathroom, D i n i n g Room and C o r r i d o r s . The second, i s a Secondary Access Group with T h e r a p e u t i c areas. In order to c r e a t e a r e s i d e n t i a l surrounding and a home-like atmosphere, the p h y s i c a l arrangement of the Primary Access Group spaces should be c o n s i d e r e d as the most important i s s u e . 145 F i g . 5-6 Long Term Care F a c i l i t y Access Model Source: K o n c e l i k , Joseph. Designing the Open Nursing Home. 1976, p. 46. 146 The CCC Intermediate Care r e s i d e n t i a l c l u s t e r s w i l l c r e a t e a primary access group space i n the form of "homes" f o r ten r e s i d e n t s . Each u n i t w i l l open onto a shared l o u n g e / d i n i n g room and not onto a c o r r i d o r , which i s t y p i c a l of i n s t i t u t i o n a l s o l u -t i o n s . T h e i r s p a t i a l h i e r a r c h y w i l l resemble a normal home with p r i v a t e space i n the r e s i d e n t ' s room and washroom and s e m i - p r i -vate area i n the shared " l i v i n g / d i n i n g " room. The i n d i v i d u a l i t y and o r i e n t a t i o n w i l l be supported by g i v i n g i d e n t i t i e s to the entrance of one's room, f o r example, by small porches, and by making rooms of d i f f e r e n t shape. The i n d i v i d u a l p r i v a t e outdoor p a t i o s w i l l be another f e a t u r e of t h i s "home-like" environment (See F i g . 5-8) . Issue #2 F l e x i b i l i t y The p r i n c i p l e of space f l e x i b i l i t y has been implemented by a c l u s t e r approach to the f a c i l i t y programming. R e s i d e n t i a l c l u s t e r s of 9-10 u n i t s around common areas, a l l o w f o r change of use i n terms of r e q u i r e d l e v e l of care (3 l e v e l s ) depending on the a c t u a l needs. The management has the o p t i o n a t any given time to decide on the number of beds and c l u s t e r s i n any l e v e l of c a r e , without any need of change i n the p h y s i c a l i n f r a s t r u c -t u r e of the b u i l d i n g s . T h i s p r i n c i p l e f o l l o w s the o v e r a l l p o l i c y of the CCC f a c i l i t y , which i s based on a smooth t r a n s i t i o n of p a t i e n t s from one l e v e l of care to another. A change i n the r e s i d e n t s c o n d i t i o n w i l l not r e q u i r e moving them from t h e i r u n i t s , so long as the necessary care can be provided. 147 Issue #3 L i n k with the Core Centre -- Way f i n d i n g w i t h i n the  CCC f a c i l i t y . The f u n c t i o n a l connection with the Core Centre, p a r t i c u l a r l y with the R e h a b i l i t a t i o n Centre, C l i n i c and Main Concourse, w i l l be very important. S e v e r a l s t u d i e s (Regnier and Pynoss 1987) of e l d e r l y people's environments have shown t h a t beside c r e a t i o n of a b a r r i e r - f r e e a c c e s s i b l e environment, the l e g i b i l i t y of s e t t i n g s has an impact on goal s a t i s f a c t i o n , sense of c o n t r o l , s t r e s s and s a f e t y . S t u d i e s have shown t h a t the problem of d i s o r i e n t a t i o n i n c r e a s e s among r e s i d e n t s of long-term care f a c i l i t i e s , because of the e l d e r l y ' s reduced l e v e l of competence and c o g n i t i v e f u n c t i o n i n g as w e l l as the new u n f a m i l i a r s e t t i n g of n u r s i n g homes. The post-occupancy e v a l u a t i o n of s e v e r a l e l d e r l y f a c i l i t i e s assessed the e f f i c i e n c y of design f e a t u r e s to f a c i l i t a t e wayfinding among r e s i d e n t s . There are f o u r c l a s s e s of environmental v a r i a b l e s , which have p o t e n t i a l impact upon o r i e n t a t i o n and wayfinding i n the e l d e r l y environment: s i g n s , p e r c e p t u a l access, a r c h i t e c t u r a l d i f f e r e n t i a t i o n and p l a n c o n f i g u a r a t i o n (Regnier and Pynoos 1987, p.445). The use of si g n s can impact the l e g i b i l i t y of a s e t t i n g by p r o v i d i n g d i r e c t i o n a l i n f o r m a t i o n . In the CCC f a c i l i t y there w i l l be l a r g e g r a p h i c s i g n s i n a l l f u n c t i o n a l components as w e l l as i n the open spaces. The p e r c e p t u a l access to the long term care c l u s t e r s as w e l l as to the Core Centre w i l l be enhanced by p r o v i d i n g views to f a m i l i a r e x t e r i o r landmarks or views to other l o c a t i o n s w i t h i n the b u i l d i n g such as a c e n t r a l atrium (Winter 148 Garden) or a common lou n g e / d i n i n g area w i t h i n r e s i d e n t i a l c l u s t e r s . S ince the a r c h i t e c t u r a l c h a r a c t e r of each f u n c t i o n a l component w i l l be d i f f e r e n t i t can a l s o c o n t r i b u t e to e f f e c t i v e way-finding. F i n a l l y , the o v e r a l l plan c o n f i g u r a t i o n of b u i l d i n g s , t h e i r shape or l a y o u t may i n f l u e n c e the ease of way-finding. The long-term care f a c i l i t i e s w i l l be designed i n the form of r e s i d e n t i a l c l u s t e r s connected to the main walkways, which w i l l l e a d to the Core Centre. T h i s "feeder system" of the c i r c u l a t i o n p a t t e r n w i l l promote way-finding. The "promanade" as a main walkway with a g l a s s w a l l i n s t e a d of the s t e r o t y p e i n s t i t u t i o n a l c o r r i d o r w i l l p r ovide views to e x t e r i o r landmarks ( t r e e s or surrounding a c t i v i t y a r e a s ) , which w i l l help r e s i d e n t s i n o r i e n t i n g . The l a y o u t of the r e s i d e n t i a l areas, c l u s t e r i n g s l e e p i n g u n i t s around common shared l o u n g e / d i n i n g areas, w i l l a l s o promote way-finding. These open s o c i a l areas w i l l i n c r e a s e r e s i d e n t s ' s p a t i a l p e r c e p t i o n . The v i s u a l access to the open c e n t r a l area w i l l d i m i n i s h the e f f e c t s of d i s o r i e n t a t i o n and may le a d t o a d e s i r e to explore f u r t h e r p a r t s of the f a c i l i t y . At the entrance to each r e s i d e n t i a l c l u s t e r , there w i l l be l a t e n t cues such as p l a n t s , d i f f e r e n t c o l o u r scheme i n f u r n i t u r e and on the w a l l , which w i l l a l s o c o n t r i b u t e to the l e g i b i l i t y of s e t t i n g s . TO CORE CENTRE LEGEND-cs - C L U S T E R . supporeT CT1 - CLUSTER T Y P E 1 CT2 - CLUSTER T Y P E Z O S - OUTDOOR SPACES F i g . 5-7 Intermediate Care F a c i l i t y 150 TO CLUSTER. SUPPORT LEGEND--1 & 1 BEDROOM ZB Z BEDROOM BTH BATHROOM D/L DINING/LI VI NO K K-lTCHEN/SERVlrAGr OS OUTDOOR. SPACES P PATIO F i g . 5-8 Intermediate Care C l u s t e r Type 1 151 TO CORE C E N T R E WC MP N O CU CH NS VJ/6 L S RL C T 1 CT1 C T 2 L E G E N D : C-H MEDITATION QVCMAPEL NS NUfeSE 5TAT10H KIO HEAbM.OH=ICE HP MEMCJIME PfcEPAKATiOVi WC STAFF WASHfcOOH CU CLEAN UTILITY Vv/S WHEELCHAIR. STORAGE L5 UN EH SUPPLY 3 lANlTOt? ROOM RL *E£\D£U LAUNDRY CT1 CLUSTER- TYPE 1 CTZ CLUSTEe TYPE 2 F i g . 5-9 Intermediate Care C l u s t e r Support 152 5.3 DEPENDENT LIVING - EXTENDED CARE FACILITY 5.3.1. F u n c t i o n a l Components The Extended Care F a c i l i t y Program has been based on the Design G u i d e l i n e s of the M i n i s t r y of Health ( H o s p i t a l Programs). The Extended Care F a c i l i t y has been programmed f o r 36 p a t i e n t s p l u s 6 beds i n the o b s e r v a t i o n u n i t s . The Extended Care component d i f f e r s from the Intermediate Care component because of the f a c t t h a t the p h y s i c a l , mental or emotional c o n d i t i o n s of the E.C. r e s i d e n t s r e q u i r e ongoing assesment and i n t e r v e n t i o n by many d i s c i p l i n e s e.g.: n u r s i n g , d i e t a r y , and medical (Appx. # 0-1). The Extended Care f a c i l i t y w i l l serve the e l d e r l y with a "high l e v e l " of dependence who r e q u i r e p r o f e s s i o n a l n u r s i n g s e r v i c e s on a twenty-four hour b a s i s and r e g u l a r continuous medical s u p e r v i s i o n (Appx. #0-1). The Extended Care component w i l l p r o vide p r i v a t e or s e m i p r i v a t e l i v i n g u n i t s , each with washroom. There w i l l be one, two and four-bedroom wards. However, accommodation f o r a s i n g l e occupant w i l l be a minimum of 60% of a l l r e s i d e n t s . The L i v i n g u n i t s w i l l be comprised of an e n t r y area, l i v i n g - s l e e p i n g area, washroom and a c l o s e t f o r the r e s i d e n t ' s c l o t h i n g and p e r s o n a l belongings. 5.3.2. L i v i n g U n i t s P a t t e r n and C r i t i c a l Issues. Issue #1 - C l u s t e r approach Groups of 9 - 10 rooms w i l l be c l u s t e r e d with a lounge space and d i n i n g area, thus c r e a t i n g a "neighbourhood of 12 r e s i d e n t s " . 153 There w i l l be three c l u s t e r s with one Support Area. That area w i l l i n c l u d e a Nurses S t a t i o n with M e d i c a t i o n P r e p a r a t i o n and Storage Room; Head Nurse's O f f i c e ; S t a f f Washroom; Clean U t i l i t y Rooms; Linen Storage; J a n i t o r Room; Res i d e n t s ' Laundry; and F u r n i t u r e / w h e e l c h a i r Storage (see F i g s . 5-11, 5-12, 5-13). Issue #2 - R e s i d e n t i a l c h a r a c t e r In a c h i e v i n g a r e s i d e n t i a l c h a r a c t e r f o r the EC there are two important f u n c t i o n a l elements: a l i v i n g - u n i t and the c l u s t e r ' s lounge. Older people d e s i r e a choice i n l i v i n g accommodations. T h e r e f o r e , the design has to provide a v a r i e t y of l i v i n g - u n i t c o n f i g u r a t i o n s . Furtheremore, the e l d e r l y look f o r a sense of autonomy and they need an environment t h a t extends and enhances t h e i r independence. Th e r e f o r e , i n each l i v i n g - u n i t as w e l l as i n the whole f a c i l i t y s p e c i a l design f e a t u r e s and d e t a i l s w i l l be provided i n order to improve t h e i r independence, e.g.: supplementary l i g h t sources, h a n d - r a i l s , " f r i e n d l y " f u r n i t u r e . The r e s i d e n t s w i l l be a b l e , to some extent, to p e r s o n a l i z e t h e i r l i v i n g - u n i t s with t h e i r own f u r n i t u r e and other p e r s o n a l belongings. However, the most important f a c t o r a f f e c t i n g the e l d e r l y i s t h e i r l i m i t e d m o b i l i t y . The Extended Care F a c i l i t y w i l l be wheelchair a c c e s s i b l e throughout. One of the most important spaces w i l l be the c l u s t e r ' s main lounge. T h i s area w i l l p l a y a m u l t i f u n c t i o n a l r o l e : as a d i n i n g , l e i s u r e and a c t i v i t y area. As re s e a r c h has shown ( K o n c e l i k 1976) many r e s i d e n t s of the EC w i l l s t ay i n t h e i r rooms without being 154 w i l l i n g to p a r t i c i p a t e i n any common a c t i v i t i e s . Approximately 20% of the p a t i e n t s i n an Extended Care f a c i l i t y are expected to be unable to p a r t i c i p a t e i n any type of a c t i v e program. The remaining 80% of p a t i e n t s w i l l be capable of p a r t i c i p a t i n g i n the programs developed f o r them. I t should be recognized t h a t the m a j o r i t y of the p a t i e n t s w i l l r e q u i r e a s s i s t a n c e i n g e t t i n g to the main lounge (BCHP EC Design G u i d e l i n e s 1988). Th e r e f o r e , i t i s important to encourage r e s i d e n t s to get up, get dressed and proceed i n t o the lounge a c t i v i t y area each day. The more approachable the lounge area the more f r e q u e n t l y i t w i l l be used. T h i s area should a c t as a s u b s t i t u t e l i v i n g room of a normal f a m i l y house. I t should provide a normal, i n v i t i n g ambience which w i l l appeal to r e s i d e n t s . There are s e v e r a l c r i t i c a l i s s u e s i n d e s i g n i n g such space. Although the main t h e r a p e u t i c s e r v i c e s w i l l be a v a i l a b l e i n the Core Centre i t w i l l a l s o be necessary to provide a supplementary space i n the c l u s t e r ' s lounges. T h i s space w i l l be used not o n l y as a l e i s u r e / d i n i n g space but a l s o as P h y s i c a l E x e r c i s e and O c c u p a t i o n a l Therapy Area f o r a very small group of r e s i d e n t s ( b a s i c a l l y f o r those who don't l i k e to mingle with the r e s t of the EC community). Issue #3 Home l i k e environment C r i t i c a l d esign i s s u e s f o r c r e a t i n g a home-like environment i n the r e s i d e n t i a l c l u s t e r s : 1. S c a l e of the c l u s t e r The way space i s enclosed, i t s s i z e and shape, the h e i g h t of 155 the room, p l a y s an important p a r t i n c r e a t i n g a home-like environment i n the EC f a c i l i t y . S c a l e can give a f a c i l i t y a r e s i d e n t i a l or i n s t i t u t i o n a l atmosphere. Proper s c a l e i n the r e s i d e n t i a l c l u s t e r can be achieved by: a. p r o v i d i n g the l o u n g e / d i n i n g area d i v i d e d i n t o f u n c t i o n a l a l c o v e s f o r v a r i o u s a c t i v i t i e s . b. the space w i l l have v a r i e t y of c e i l i n g h e i g h t s by p r o v i d i n g sky l i g h t s i n the l o u n g e / d i n i n g area and lower c e i l i n g i n the r e s t , p a r t of the c l u s t e r . c. the s i z e and shape of f u r n i t u r e , equipment, r a i l i n g s , e l e c t r i c a l switches and other d e t a i l s w i l l be designed i n accordance with the e l d e r l y ' s antropometrics. 2. P r o x i m i t y to l i v i n g u n i t s A l l l i v i n g u n i t s w i l l have d i r e c t access to the l o u n g e / d i n i n g area. 3. Connection with the outdoor a c t i v i t i e s A l l l i v i n g u n i t s w i l l have d i r e c t access to p r i v a t e outdoor space. The l o u n g e / d i n i n g area w i l l have connection to the shared outdoor space. Issue #4 Resident L i v i n g U n i t . C r i t i c a l design i s s u e s i n the r e s i d e n t u n i t : 1. p r i v a c y i n two and f o u r bed rooms ( s e t t i n g up one's t e r r i t o r y ) . A l l two and f o u r bed rooms w i l l be designed to p r o v i d e one's r e s i d e n t t e r r i t o r y by b i a x a l ownership arrangement. 2. view from the bed: windows and c e i l i n g become important 156 space elements of bedridden r e s i d e n t ' s environment. Windows i n the r e s i d e n t s ' rooms w i l l have a s i l l h e i g h t which w i l l a l low a view through the window to the o u t s i d e world (see p r i v a t e out-door space). C e i l i n g s w i l l be enhanced by p r o v i d i n g s t i m u l a t i n g i n t e r i o r design f e a t u r e s such as p a i n t i n g s or s c u l p t u r e d sus-pended c e i l i n g s . 5.3.3 P r i v a t e outdoor spaces i n the Dependent L i v i n g - Long  Term Care F a c i l i t y At the time of w r i t i n g t h i s t h e s i s t here i s no s p e c i f i c l e g i s l a t i o n i n B r i t i s h Columbia nor any g u i d e l i n e s , which s p e c i -f i c a l l y determine the landscape requirements f o r each l e v e l of care. There i s b a s i c i n f o r m a t i o n and common requirments i n the Community Care F a c i l i t y Act, Extended Care Design G u i d e l i n e s and CMHC Design G u i d e l i n e s i n terms of v a r i e t y of outdoor spaces, p r i v a c y and some p h y s i c a l c o n d i t i o n s . However, there i s r e l a -t i v e l y l i t t l e i n f o r m a t i o n r e g a r d i n g s p e c i f i c approaches to the design f o r e l d e r l y r e s i d e n t s i n the h i g h e r l e v e l s of dependency. In the a n a l y s i s of outdoor spaces i n the case s t u d i e s of three d i f f e r e n t l e v e l s of care (Appx. #5-2) I found t h a t o n l y Parkwood Manor, congregate housing i n Coquitlam, B.C. p r o v i d e s d w e l l i n g u n i t s with p r i v a t e b a l c o n i e s or p a t i o s . In the Intermediate Care f a c i l i t y i n H o l l y b u r n House and i n the U n i v e r s i t y H o s p i t a l , UBC S i t e Extended Care U n i t there i s no d i r e c t access from i n d i v i d u a l s l e e p i n g u n i t s to open outdoor spaces. Although a l l Intermediate Care u n i t s i n H o l l y b u r n House 157 are l o c a t e d on the ground f l o o r l e v e l the o n l y access to the shared p a t i o i s through the e x i t of the f a c i l i t y . The UBC S i t e Extended Care U n i t i s a s i x s t o r e y b u i l d i n g without any p r i v a t e b a l c o n i e s . The only small (too small f o r a l l r e s i d e n t s ) outdoor p a t i o i s adjacent to the common spaces on the ground f l o o r l e v e l and not e a s i l y a c c e s s i b l e to the r e s i d e n t s . T h e r e f o r e , t h i s p a t i o i s u n d e r u t i l i z e d . The n u r s i n g home i n the Motion P i c t u r e Country House i n Woodland H i l l s C a l i f o r n i a i s an i n t e r e s t i n g example of a new approach to the design of outdoor p r i v a t e spaces i n a long-term care f a c i l i t y a t the extended care l e v e l . The c l u s t e r i n g of fo u r p a t i e n t rooms around an i n t e r i o r v e s t i b u l e c r e a t e s a geometry t h a t accommodates shared b a l c o n i e s l i n k e d to each u n i t (see F i g . 5-10). While having p r i v a t e rooms the r e s i d e n t s have an o p p o r t u n i t y f o r s o c i a l i n t e r a c t i o n i n an adjacent s e m i - p r i v a t e outdoor space. Since e l d e r l y people i n Long Term Care f a c i l i t i e s are l e s s mobile, d i r e c t access from t h e i r s l e e p i n g u n i t s to the outdoor spaces as w e l l as views from t h e i r u n i t w i l l keep them i n touch with the o u t s i d e world. In the CCC long term r e s i d e n t i a l c l u s t e r s a l l s l e e p i n g u n i t s w i l l have d i r e c t access to the outdoor spaces. A p l a n t i n g area o u t s i d e each u n i t w i l l d e f i n e p e r s o n a l t e r r i t o r y and minimize chance f o r p r i v a c y i n v a s i o n . However, a l l r e s i d e n t s w i l l share a l s o common outdoor space, which may be claimed by s e v e r a l r e s i d e n t s . These arrangement w i l l g i v e the r e s i d e n t s a choice 158 F i g . 5-10 P r i v a t e Outdoor Spaces i n Nursing Home Source: Bobrow/Thomas A r c h i t e c t s , Motion P i c t u r e Country House Woodland, C a l i f o r n i a . 159 to be i n p r i v a t e t e r r i t o r y , or have an o p p o r t u n i t y to meet other r e s i d e n t s and to watch an a c t i v i t y i n the nearest common open areas. For those who are unable to go o u t s i d e views of a t t r a c t i v e outdoor spaces w i l l be e s p e c i a l l y important ( K o n c e l i k 1976). Views from the windows are important ways f o r r e s i d e n t s to f e e l connected with the r e s t of the world. A t t r a c t i v e views provide r e l i e f and p l e a s u r e . There i s evidence i n r e s e a r c h ( R e i z e n s t e i n Carpman et a l . 1986) t h a t p l e a s a n t views can i n c r e a s e the r e s i ^ dent's sense of w e l l - b e i n g and decrease recovery time and need f o r p a i n - r e l i e f medication. Outdoor views remind the e l d e r l y of the season, time of a day and weather. These are important " r e a l i t y cues" f o r long-term, c r i t i c a l l y i l l r e s i d e n t s ( R e i z e n s t e i n Carpman et a l . 1986, p. 211). The flow of time i s the most b a s i c and continuous of n a t u r a l phenomena. The r e p e t i t i v e rhythm of dawn, daytime, evening, sunset and n i g h t has marked t h e r a p e u t i c a l value. Confined to bed a r e s i d e n t can l o s e t h i s rhythm of moving on, of p r o g r e s s -i n g . T h e r e f o r e , i t should be e s s e n t i a l i n the new development to provide t r e e s and p l a n t s which b r i n g out t h i s rhythm through the e f f e c t of changing shadows, and c o l o u r s i n the v a r i o u s seasons of the year. T h e r e f o r e , the CCC open spaces w i l l be v i s u a l l y s t i m u l a t i n g with a view of a c t i v i t y i n the surrounding areas. A l l s l e e p i n g u n i t s w i l l have window s i l l h e i g h t s which allow bedridden r e s i d e n t s see out the window e a s i l y . 160 Table 5-5.--Extended Care C l u s t e r Space Program Component Q-ty U n i t Net Area T o t a l Net Area Remarks: C l u s t e r Type I T o t a l number of r e s i d e n t s : 12 1 - Bedroom 8 18 m2 144 m2 4 - Bedroom 1 47 m2 47 m2 Lounge/dining 1 48 m2 48 m2 4 m2 per bed S a t e l l i t e k i t c h e n 1 10 m2 10 m2 Bathing f a c i l i t i e s 1 26 m2 26 m2 3 bath f i x . S o i l e d u t i l i t y 1 11 m2 11 m2 T o t a l : 286 m2 T o t a l number of c l u s t e r s : 2 572 m2 C l u s t e r Type I I T o t a l number of r e s i d e n t s • 12 1 Bedroom 8 18 m2 144 m2 2 Bedroom 2 30 m2 60 m2 Lounge/dining 1 48 m2 48 m2 S a t e l l i t e K i t c h e n 1 10 m2 10 m2 Bathing f a c i l i t i e s 1 26 m2 26 m2 3 bath f i x . S o i l e d u t i l i t y 1 11 m2 11 m2 T o t a l : C l u s t e r Support Nurses s t a t i o n : C o n t r o l Clean u t i l i t y & Medicine prep. Head N. O f f i c e Staff'washroom Medit.Rm/Chapel Linen Supply J a n i t o r Rm Resid. Laundry W.chair Store 299 m2 38 m2 38 m2 30 m2 14 m2 6 m2 6 m2 22 m2 30 m2 14 m2 6 m2 6 m2 22 m2 T o t a l : 112 m2 Table 5-5.--Extended Care C l u s t e r (Cont'd) Space Program 161 Component Q-ty U n i t Net T o t a l Net Remarks: Area Area Observation U n i t f o r 6 beds 1 Bedroom 4 18 m2 72 m2 2 Bedroom 1 30 m2 30 m2 Lounge/Dining 1 24 m2 24 m2 Linen Supply 1 10 m2 10 m2 S o i l e d U t i l i t y 1 11 m2 11 m2 Bathing f a c i l i t y 1 23 m2 23 m2 2 f i x . Storage 1 10 m2 10 m2 T o t a l : 180 m2 Grand T o t a l : 1, 153 m2 Gross Area: 36 m2 x 42 beds = 1,512 m2 References: BCHP. Extended Care Design G u i d e l i n e s . 1988. CJP A r c h i t e c t s Calberg Jackson P a r t n e r s . St. V i n c e n t ' s Extended  Care H o s p i t a l - Space Program. 1987. Gardiner Thornton P a r t n e r s h i p . St. Michael's Centre - F u n c t i o n a l and Space Program. 1977. 162 LEGEND • CS CTi CT2 OS CLUSTER SUPPORT CLUSTER TYPE 1 CLUSTER. TYPE 2 OUTDOOR. SPACES OBSERVATION UNIT SECURITY CONTROL F i g . 5-11 Extended Care F a c i l i t y 163 LEGEND: 1B 1BEDROOM 4B 4 BEDROOM T y L DINING/LIVING K S.KlTC^r^/SERVIUG-BTH BATHING feOOH SU SOILED UTILITY P PATIO OS OUTDOOR SPACES F i g . 5-12 Extended Care C l u s t e r Type 1 164 TO C O R E C E N T R E RL LS W5 SU C T 1 CT1 C T 2 LEGEND • CT1 CLUSTER TVPE1 CTZ CLUSTER TYPE2. W/6 WHEELCHAIR STORAGE NS NURSE STATION MR MEDICATION PJDOM WC STAFF WASHROOM RL RESIDENTS' LAUNDRY LS LINEN STORAGE WS WHEELCHAIR SHOWER 3 JANITOR ROOV1 SU SOILED UTILITY F i g . 5-13 Extended Care C l u s t e r Support 165 5.4 CORE CENTRE In keeping with the o b j e c t i v e s of the CCC, the Core Centre w i l l p rovide s e r v i c e s f o r the r e s i d e n t s of the f a c i l i t y and to some extent f o r the e l d e r l y from the Community of the West P o i n t Grey area. The Core Centre w i l l be comprised of 15 major f u n c t i o n a l components and each of them w i l l i n c l u d e s e v e r a l a c t i v i t y c e n t r e s . There w i l l be two types of components: 1. Components s e r v i n g the CCC f a c i l i t y o n l y e.g.: M a t e r i a l S e r v i c e s , Maintenance S e r v i c e s , P l a n t S e r v i c e s , S t a f f Support and Laundry; 2. Components which w i l l serve the r e s i d e n t s of the CCC and the e n t i r e community: R e h a b i l i t a t i o n Centre, C l i n i c , Pharmacy, A d m i n i s t r a t i o n , Main Concourse, Food S e r v i c e s , Food F a i r , A r t s and C r a f t s , L i b r a r y , Auditorium and Indoor R e c r e a t i o n Programs; The Core Centre w i l l r e q u i r e l a r g e open spaces f o r a v a r i e t y of group a c t i v i t i e s . There w i l l have to be a l s o ample grounds around the b u i l d i n g f o r important supplementary f u n c t i o n s l i k e : p a r k i n g , s e r v i c e & d e l i v e r y and r e c r e a t i o n . 166 ^ E f e V E CCC ONLY I— < a o > U ui MATERIAL SERVICES .FOR CCC R E S I D E N T S -AND COMMUNITY OUTLOOK. ACTIVITY A R E A 0 /It z _j o P H A £ N \ A C Y FOOD SE R V I C E S FOOD FAIR MAIN coNcouesa-r STAFF SUPPORT APMlNlST. _ "PARKIN& LEGE ISP-MAlOfc PEbESTRlAN CIRCULATION MAJOfc VEHICULAR ACCESS MA30R SERVICE ACCESS F i g . 5-14 Core Centre 167 5.4.1. MAIM CONCOURSE A complex of b u i l d i n g s with no ce n t e r i s l i k e a man without a head. Alexander, A P a t t e r n Language 1) Purpose One of the major f u n c t i o n a l components of the Core Centre w i l l be the Main Concourse, which w i l l c r e a t e a c e n t r a l forum ( P u b l i c Place) f o r the f a c i l i t y . There o l d e r people may come to meet each other, to chat with c l o s e f r i e n d or c a s u a l l y t a l k with new acquaitances i n an a t t r a c t i v e , comfortable s e t t i n g . I t w i l l a l s o be a place f o r b a s i c commercial s e r v i c e s . 2) F u n c t i o n a l D e s c r i p t i o n a. Winter Garden - Conservatory The landscape may be brought i n s i d e the b u i l d i n g so t h a t i t can be enjoyed d u r i n g the winter months and durin g the time of bad weather (Gruffydd 1967). Although i t may be very c o s t l y to b u i l d a landscaped i n t e r i o r atrium, i t would be worthwhile to compare the b e n e f i t s i t b r i n g s f o r r e s i d e n t s i n terms of t h e i r human needs, a g a i n s t the i n i t i a l c a p i t a l c o s t . The i n s t i t u -t i o n a l f e e l i n g would be decreased, because the p l a n t s provide a "home l i k e " atmoshpere. B r i n g i n g nature indoors may hold s i m i l a r p s y c h o l o g i c a l b e n e f i t s to a c c e s s i n g nature outdoors. P l a n t s are soot h i n g and r e s t f u l , e s p e c i a l l y f l o w e r i n g ones. They r e p r e s e n t l i f e , hope and growth. Th e r e f o r e , a green i n t e r i 168 or may become a key element i n the environment f o r the e l d e r l y . In the Core Centre, i n the heart of the Main Concourse, the Conservatory w i l l be one of the most a t t r a c t i v e components. During many r a i n y days i n Vancouver, there w i l l be a c h e e r f u l , p l e a s a n t atmosphere c r e a t e d by p l e n t y of p l a n t s , (some of the e x i s t i n g b e a u t i f u l t r e e s can be i n c o r p o r a t e d w i t h i n t h i s p l a c e ) , water f e a t u r e and l i v e f i s h and b i r d s . E s p e c i a l l y a l i v e fauna w i l l p l a y a s i g n i f i c a n t r o l e i n t h i s environment. Recent s t u d i e s have shown t h a t the bond with animal com-panions i s s t r o n g e r and more profound a t o l d e r age (Bustad 1983; S a v i s h i n s k y 1985). T h e r e f o r e , i n many f a c i l i t i e s f o r the e l d e r l y a new program c a l l e d "Pet Therapy" has been i n t r o d u c e d . T h i s program has confirmed the p o s i t i v e e f f e c t s of pets therapy on the e l d e r l y ' s mental and p h y s i c a l h e a l t h . Although i n the CCC Conservatory o n l y b i r d s and f i s h are planned they w i l l n e v e r t h e l e s s provide s t r o n g v i s u a l s t i m u l a t i o n and o p p o r t u n i t i e s to s t a r t a c o n v e r s a t i o n with another observer. L o n e l i n e s s i s a problem f o r many o l d e r people. Nonverbal communication can decrease the e l d e r l y ' s sensory d e p r i v a t i o n . The idea of c r e a t i n g the winter garden i n the Core Centre was not only to provide green area i n s i d e the f a c i l i t y to enjoy i t d u r i n g the r a i n , but a l s o to c r e a t e a " f r i e n d l y environment" with as much as p o s s i b l e o p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n . b. M a i l Boxes The Main Concourse, being l o c a t e d on a busy c i r c u l a t i o n route, r i g h t i n the heart of the f a c i l i t y , w i l l be an i d e a l 169 l o c a t i o n f o r the M a i l Boxes f o r f a c i l i t y r e s i d e n t s . I t w i l l be a d a i l y d e s t i n a t i o n f o r almost every h a b i t a n t . c. Commercial Components Commercial components such as Beauty and H a i r Salon, Royal Bank Annex f o r example and General Store w i l l c r e a t e an environment of "an a c t i o n t a k i n g p l a c e " as w e l l as w i l l enhance business i n t e g r a t i o n with the P o i n t Grey Community. d. S e n i o r s ' Day Care For S e n i o r s l i v i n g i n the neighbourhood, the Main Concourse w i l l provide a S e n i o r s ' Day Care Centre with easy access to D i n i n g areas, Food F a i r component, s p e c i a l programs, R e h a b i l i -t a t i o n Centre, C l i n i c and outdoor a c t i v i t i e s areas. Table 5-6.--Main Concourse Space Program COMPONENTS: NET AREA REMARKS: 1. Main Entrance 10. 0 m2 2. Coat Room 26. 0 m2 3. Conservatory 100. 0 m2 4. A r t s E x i b i t i o n 30. 0 m2 5. Bank 20. 0 m2 6. Beauty Salon 26. 0 m2 4 c h a i r s , 3 s i n k s with counters, h a i r d r y e r s . 7. Day Care 60. 0 m2 f o r p a r t i c i p a n t s who r e q u i r e r e s t p e r i o d dur i n g the day 8. Washrooms M&F&Hand'd 40. 0 m2 9. Storage/Maintenance 6. 0 m2 10. M a i l Boxes Rm f o r EC,IC, RC 12. 0 m2 f o r 152 r e s i d e n t s 11. General S t o r e : 24 Hrs 20. 0 m2 "Max" or "7&11" TOTAL: 350. 0 m2 GROSS AREA: 350 x 1.3 = 455. 0 m2 References: APRA. F a c i l i t i e s Program f o r the George Derby Long Term Care  S o c i e t y . 1982, p.G41. Gar d i n e r Thornton P a r t n e r s h i p . St. Michael's Centre F u n c t i o n a l  and Space Program. 1975, p.8.1. Northwood Multi-Purpose Centre, P h y s i c a l F a c i l i t i e s Data L i s t . 171 r""] r ^ ^ l nr-.l i — i I 2 I f ^ h L i i I $ S I I 1 IS*, i 1 j PHARMACY [ I 1 A P M I N I S T R - PARKINGr P i g . 5-15 Main Concourse 172 5.4.2. FOOD FAIR - DINING Without communal e a t i n g , no human group can ho l d together. Alexander, A P a t t e r n Language Purpose In keeping with the o b j e c t i v e s of c r e a t i n g an i n f o r m a l community network of f r i e n d s and r e l a t i v e s , the CCC Food F a i r component w i l l become an a t t r a c t i v e and u s e f u l p l a c e f o r the e l d e r l y . Four p r i n c i p a l components make up the scheduled group a c t i v i t y programs at most S e n i o r Centres: d i n i n g , s p e c i a l programs, meeting/classes and a r t s / c r a f t s . The D i n i n g component pr o v i d e s o p p o r t u n i t i e s to meet new people and to share p l e a s a n t experience. Lunch o f t e n becomes one of the major programs of the day, with other a c t i v i t i e s scheduled around i t . I t can be a f e s t i v e o c c a s i o n so the d i n i n g area should r e f l e c t i t s impor-tance. (Jordan 1978, pp.62-63). While most Centres c o n f i n e t h e i r d i n i n g a c t i v i t i e s to a r e g u l a r luncheon program, i n the case of the CCC Food F a i r b r e a k f a s t s , d i n n e r s and even snacks w i l l a l s o be a v a i l a b l e . Annual banquets and s p e c i a l h o l i d a y d i n n e r s , such as Thanks-g i v i n g or Christmas, may b r i n g a l a r g e turnout of p a r t i c i p a n t s . Such meals are o f t e n served banquet-style and need a room l a r g e enough to h o l d a l l of the p a r t i c i p a n t s . Monthly meetings of a c i v i c group or the CCC Board of D i r e c t o r s may be h e l d there i n c l u d i n g a luncheon or dinner. 173 For the purpose of t h i s t h e s i s I assume t h a t up to 50% (100) of r e s i d e n t s i n the Independent L i v i n g C l u s t e r s and t h e i r o c c a s i o n a l guests w i l l be i n t e r e s t e d i n the Food S e r v i c e s . Beside t h a t number, there w i l l a l s o be Day Care p a r t i c i p a n t s and v i s i t o r s from the community. Accor d i n g to a study conducted by p r o f e s s o r F r a n c i s Carp on l i f e s a t i s f a c t i o n of V i c t o r i a P l a z a r e s i d e n t s ( h i g h - r i s e s e n i o r s apartment b u i l d i n g i n San Antonio, Texas with S e n i o r Centre on the ground f l o o r ) , 83 per cent of respondents " s t r o n g l y and p e r s u a s i v e l y d e s i r e d " i n c l u s i o n of some pl a c e they c o u l d buy meals at reasonable c o s t . The most common improvement suggested f o r the S e n i o r Centre was a d d i t i o n of c a f e t e r i a , c o f f e e shop or c a f e . The p r o v i s i o n of a p l a c e to buy meals was suggested by 49 per cent of respondents while a d d i t i o n of food s e r -v i c e s was recommended by about 90 per cent (Carp 1987, P.74) . 2) F u n c t i o n a l D e s c r i p t i o n The Food F a i r w i l l be l o c a t e d i n the Core Centre area c l o s e to the Food S e r v i c e s component and adjacent to the Main Con-course. There w i l l be easy access from the v i s i t o r s p a r k i n g s i n c e i t w i l l be a d e s t i n a t i o n f o r people from the P o i n t Grey neighbourhood. In most s e n i o r s ' f a c i l i t i e s there i s a problem of a premeal l i n u p . For the CCC r e s i d e n t s and t h e i r guests who may come before the doors of the r e s t a u r a n t are open, there w i l l be p l e n t y of room w i t h i n the Main P l a z a Conservatory f o r w a i t i n g . 174 a. Restaurant The Food F a i r w i l l i n c l u d e a r e s t a u r a n t with w a i t r e s s s e r v i -ces. A study of Seton V i l l a r e s i d e n t s p r e f e r e n c e s (Gutman 1983, p.141) showed t h a t about h a l f (55.6 per cent) expressed a c l e a r p r e f e r ence f o r w a i t r e s s s e r v i c e , while 33.3 per cent chose c a f e t e r i a s e l f - s e r v i c e and 11.1 per cent chose c a f e t e r i a with t r a y s e r v i c e . The r e s t a u r a n t w i l l accommodate 125 guests i n a comfortable environment f o r d i n i n g . Table spacing w i l l be generous enough to avoid crowding (1.5 m2 to 1.6 m2 per person). There w i l l be wide gangways to accommodate wheel-chairs. A v a r i e t y of s e a t i n g arrangements, which w i l l permit groupings of two, f o u r , s i x or more at <a t a b l e w i l l c r e a t e p r i v a c y , encourage i n t e r a c t i o n or even provide anonymity f o r those who p r e f e r i s o l a t i o n . Some d i n -i n g t a b l e s w i l l be r e c t a n g u l a r ; others round and w i l l i n c l u d e t a b l e s a c c e s s i b l e to wheelchair users. For l a r g e r groups, there w i l l be banquet t a b l e s i n the a l c o v e s . On the t a b l e s , there w i l l be c o l o u r f u l l i n e n c l o t h s and f r e s h f l o w e r s . A p l e a s a n t , c h e e r f u l ambience i n the r e s t a u r a n t w i l l a l s o be c r e a t e d by having a b r i g h t c o l o u r and p i c t u r e s on the w a l l s . The r e s t a u r a n t w i l l have l a r g e windows f o r d i n e r s to see the o u t s i d e while they are e a t i n g . During good weather, there w i l l be an o p p o r t u n i t y to eat outdoor on the t e r r a c e and enjoy a view at the outdoor a c t i v i t i e s . b. Coffee-shop For those who l i k e to drop i n j u s t f o r a cup of c o f f e e or 175 t e a , there w i l l be an adjacent coffee-shop with 30 seats over-l o o k i n g the main a c t i v i t i e s w i t h i n the Main Concourse. People w i l l have an o p p o r t u n i t y to " s i t s t i l l , r e l a x , be on view and watch the world go by". T h i s place may help to i n c r e a s e the i d e n t i t y of a community. I t w i l l be one of the p l a c e s where newcomer to the CCC may s t a r t meeting the people who have been there many years. c. Bar/Pub The Bar/Pub w i l l provide y e t another o p p o r t u n i t y f o r the CCC e l d e r l y , as w e l l as, v i s i t o r s from the community to be i n a p u b l i c p l a c e and to f i n d companionship. The 14 seat Pub w i l l p rovide s e a t i n g f o r f o u r to s i x people i n a s e t i n open a l c o v e s o v e r l o o k i n g a c t i v i t i e s i n the c e n t r a l p l a z a . 176 Table 5-7.--Food F a i r Space Program: COMPONENTS NET AREA REMARKS: 1. Restaurant: 125 seats 200 m2 min. 1.5 m2 per seat 2. S e r v i c e area 35 m2 3. Cafe-shop: 30 seats 30 m2 min. 0.75 m2 per seat 4. S e r v i c e area 10 m2 5. Pub: 14 seats 24 m2 TOTAL 299 m2 Parking requirements: A minimum of one space f o r the f i r s t 111 m2 and one e x t r a f o r each a d d i t i o n a l 37 m2 of gross f l o o r area ( C i t y of Vancouver Parking BY-law,1987) . Thus, 18 spaces. However, most of the s e n i o r s w i l l walk to the CCC t h e r e f o r e we can reduce i t to 5 spaces = 25% of c l i e n t s may d r i v e . References: De C h i a r a , J and C a l l a n d e r , J . Time-Saver Standards f o r  B u i l d i n g Types. 1980. Jordan, Joe. S e n i o r Centre Design. 1978, p.62. Northwood Multi-Purpose Centre, P h y s i c a l F a c i l i t i e s Data. 177 5.4.3. FOOD SERVICES FACILITY  O b j e c t i v e s The o b j e c t i v e of the Food S e r v i c e s f a c i l i t y w i l l be to prepare wholesome a p p e t i z i n g food. Residents w i l l be provided with s a f e , n u t r i t i o u s and a t t r a c t i v e food which w i l l accommodate s p e c i a l d i e t s (e.g.: s a l t f r e e ; sugar f r e e ; low c h o l e s t e r o l ) . General Concept One c e n t r a l k i t c h e n w i l l serve the whole CCC. In terms of t e c h n i c a l requirements i t w i l l be necessary i n the Design Stage to c o n s u l t Food S e r v i c e s and D i e t a r y S p e c i a l i s t s i n order to e s t a b l i s h exact space and equipment needs. Feeding Requirements: Number of Res i d e n t s : 1 Extended Care Residents 42 3 6 + 6 2. Intermediate Care 90 3. Day Care 20 4. Respi t e Care 10 5. V i s i t o r s , Independent L i v . 150 f l e x i b l e 6. S t a f f & v o l u n t e e r s 80 f l e x i b l e TOTAL approximately 392 ...and a l s o : 7. Ther a p e u t i c d i e t s as needed by the Extended and Intermediate Care r e s i d e n t s 8. D i e t a r y c o u n s e l l i n g as r e q u i r e d f o r those on t h e r a p e u t i c d i e t s , such as d i a b e t i c s , p l u s g e n e r a l n u t r i t i o n a l c o u n s e l -l i n g f o r the r e s i d e n t s , day care c l i e n t s and v i s i t o r s . 178 F u n c t i o n a l D e s c r i p t i o n The K i t c h e n b u i l d i n g w i l l c o n s i s t of one c e n t r a l p r e p a r a t i o n area which w i l l serve the Intermediate and Extended Care f a c i l i -t i e s and the Food F a i r i n the Core Centre area. Meals w i l l be served at s a t e l l i t e d i n i n g areas i n the E.C and I.C. and i n the r e s t a u r a n t w i t h i n the Food F a i r . R e c e i v i n g , Storage, P r e p a r a t i o n Goods w i l l be r e c e i v e d a t the r e c e i v i n g p l a t f o r m and s t o r e d i n the day s t o r e s , f r e e z e r s , c o o l e r s , and i f r e q u i r e d i n the c e n t r a l s t o r e room. Soups, en t r e e s , v e g e t a b l e s , s a l a d s , baked goods, d e s s e r t s w i l l be prepared i n the p r o d u c t i o n area of the k i t c h e n f o r d i s p a t c h i n g to the s a t e l l i t e s e r v e r i e s i n food c a r t s or d i r e c t l y to the r e s t a u r a n t s e r v e r y or coffee-shop ( d e s s e r t s and baked goods). A f t e r meals, c o n t a i n e r s , d i s h e s and u t e n s i l s w i l l be r e t u r n e d to the k i t c h e n area f o r c l e a n i n g and h o l d i n g before being r e t u r n e d to the s a t e l l i t e areas. Intermediate Care D i n i n g In the c l u s t e r , l o u n g e / d i n i n g areas t a b l e s w i l l be prepared with c h i n a , s i l v e r w a r e , l i n e n c l o t h s and f r e s h f l o w e r s . Meals w i l l be d e l i v e r e d by food c a r t s and served from steam t a b l e s i n the s a t e l l i t e s e r v e r y / k i t c h e n . Dishes w i l l be c o l l e c t e d i n t o s o i l e d d i s h c a r t s and washed i n dishwashers i n the c e n t r a l k i t c h e n , and then re t u r n e d to the Tray P r e p a r a t i o n / C a r t Loading area. There w i l l be an emergency n i g h t nourishment s e r v i c e f o r r e -s i d e n t s i n one of the s a t e l l i t e k i t c h e n s . The d i n i n g area w i l l 179 be of s u f f i c i e n t s i z e to accommodate 6 wheel-chair r e s i d e n t s a t the same time. Extended Care D i n i n g P a t i e n t s w i l l be fed i n the c l u s t e r l o u n g e / d i n i n g areas s i m i l a r to the I.e. or by u s i n g i n d i v i d u a l t r a y s f o r bedside f e e d i n g where r e q u i r e d . R e s p i t e Care As i n the I.C. and E.C. f a c i l i t i e s . S t a f f Meals Meals f o r s t a f f w i l l be served i n the area adjacent to the c e n t r a l k i t c h e n on a s e l f - s e r v e b a s i s , but with s t a f f on duty. Day Care Since the Day Care component belongs to the Main Concourse and w i l l be l o c a t e d c l o s e to the Food F a i r , d i n i n g f o r Day Care w i l l take p l a c e i n the Restaurant's s p e c i a l l y a l l o c a t e d a l c o v e s . 180 Table 5-8.--Food S e r v i c e s F a c i l i t y Space Program COMPONENTS NET AREA REMARKS: 1. Manager O f f i c e 11.0 m2 2. D i e t i c i a n , C l e r k O f f i c e 9.5 m2 3. S t a f f Changing Rms F&M 12.0 m2 1 m2/person 4. S t a f f Lounge/Dining 50.0 m2 E.C. and I.C. 5. P r e p a r a t i o n 25.0 m2 6. Pro d u c t i o n 134. 0 m2 7. Tray Prep/Cart Loading 44. 5 m2 8. Dishwashing 30. 0 m2 9. Pot Washing 6.0 m2 10. C a r t Washing 4.5 m2 11. C a r t Storage 19.0 m2 12. Waste 2.0 m2 13. C o o l i n g Storage 46. 0 m2 14. F r e e z e r Storage 46.0 m2 15. Dry Storage 25.0 m2 16. Day Storage 9.0 m2 TOTAL 473. 5 m2 Comparison: BCHP Extended Care Design G u i d e l i n e s - f o r 75 beds: 140 m2 St. M i c h a e l ' s Centre - f o r 120 people: 168 m2 George Derby L.Term Care - f o r 300 people: 412 m2 Jordan, S e n i o r Centre Design - 500 meals a day:198 m2 181 DRY eooi>s STOrX-REFR. STOR.. STOR. DELIVERY STAFF CHANG. W A S H R 0 0 V 6 I S T A F F CAFET. TlOU FOT W A S H tRAY PREP CARTS — ^ SUFPOfl PISH WASH CART S T O R . £ ' WASTE Dispe-ll SAL BUD. S CART WAs.fi A V RESTAURANT MAIN COMC. SOILED PISHES C > F i g . 5-16 Food S e r v i c e s 182 5.4.4. REHABILITATION CENTRE 1) Purpose One of the most a t t r a c t i v e and unique f e a t u r e s of the CCC w i l l be the R e h a b i l i t a t i o n Centre. T h i s Centre w i l l c o n s i s t of c e n t r a l i z e d f a c i l i t i e s f o r r e h a b i l i t a t i o n s e r v i c e s which are not o f f e r e d a t the C l u s t e r Support l e v e l . I t w i l l serve both the r e s i d e n t s of the CCC and r e s i d e n t s of the P o i n t Grey neighbour-hood. T h i s Centre w i l l operate w i t h i n the Core Centre h e a l t h s e r v i c e s programs. However, i t may be simply used as a r e c r e a -t i o n a l area without any s p e c i a l medical s u p e r v i s i o n . 2) F u n c t i o n a l D e s c r i p t i o n The R e h a b i l i t a t i o n Centre w i l l be l i n k e d with the C l i n i c and Main Concourse of the Core Centre. There i s a l s o an easy access f o r the r e s i d e n t s of the IC and EC f a c i l i t i e s . The Centre w i l l be connected with outdoor a c t i v i t i e s areas (bowling, m i n i - g o l f , croquet and o t h e r s ) . a. Swimming Pool F a c i l i t i e s The main f e a t u r e of t h i s Centre w i l l be a swimming pool with an adjacent sauna. The swimming pool w i l l be planned as a b r i g h t area with a major s k y l i g h t , evergreen p l a n t s i n s i d e and c o l o r f u l comfortable "beach" f u r n i t u r e . Large wall-windows with a view to the o u t s i d e w i l l p l e a s a n t l y l i n k the outdoor and the indoor environments and give many an o p p o r t u n i t y to watch people walking around, while e n j o y i n g the warm water. The swimming pool w i l l be shaped purposely to allow the e l d e r l y to move slo w l y 183 from shallow to deeper zones. Even person u s i n g a wheel-chair w i l l be able to enter the pool without s p e c i a l a s s i s t a n c e . There w i l l be no d i v i n g boards which may c r e a t e hazards. Underwater l i g h t i n g w i l l improve the ambience of the pool and w i l l encourage the t i m i d to a c t i v e l y p a r t i c i p a t e . Close to the p o o l , there w i l l be a whirpool with adjacent "Bar" which w i l l serve non- a l c o h o l i c d r i n k s . W ithin the same f a c i l i t i e s , one can go to a sauna or gymnasium or even go o u t s i d e to e x e r c i s e and take the f r e s h a i r . b. F i t n e s s and Dancing Club The F i t n e s s and Dancing Club w i l l provide p h y s i c a l e x e r c i s e s and therapy f o r the r e s i d e n t s and v i s i t o r s . The Club w i l l be l i n k e d with outdoor a c t i v i t y areas to promote f i t n e s s a c t i v i t i e s d u r i n g sunny days. The r e s i d e n t s w i l l come here f o r p a r t of t h e i r d a i l y program which may be expanded by physiotherapy i n the Centre's Treatment Area. However, f o r the more a c t i v e e l d e r l y dancing w i l l be e s p e c i a l l y popular. "While ballroom dancing i s o f t e n the f a v o r i t e , square dancing and f o l k dancing a l s o have t h e i r fans" (Jordan 1978). The Changing Rooms w i l l serve both the swimming pool f a c i l i t i e s and F i t n e s s Club. An O f f i c e f o r the a d m i n i s t r a t i v e work r e l a t e d to the a c t i v i t y programs w i l l accommodate spaces f o r the t h e r a p i s t s and program workers. I t w i l l have v i s u a l access to the treatment area. c. The Treatment U n i t The Treatment U n i t , p r o v i d e s physiotherapy and speech pathology treatment f o r the r e s i d e n t s and the Day Care c l i e n t s . 184 Wheel-chair a c c e s s i b l e washroom w i l l be l o c a t e d adjacent to t h i s area. O c c u p a t i o n a l therapy f o r more f r a g i l e r e s i d e n t s of the IC and EC f a c i l i t i e s w i l l be provided i n t h e i r r e s p e c t e d lounges, while f o r more a c t i v e r e s i d e n t s and v i s i t o r s the Core Centre programs and s e r v i c e s (e.g.: A r t s and C r a f t s , games, l i b r a r y ) w i l l be a v a i l a b l e . 185 Table 5 - 9 . - - R e h a b i l i t a t i o n Centre Space Program COMPONENTS NET AREA REMARKS: 1. Physiotherapy 30.0 m2 6 s t a t i o n s 2. Washroom 2.8 m2 3. O f f i c e 14. 0 m2 4. F i t n e s s and Dancing 60.0 m2 Ballroom 5. Changing Room F 40.0 m2 6. Changing Room M 40. 0 m2 7. Swimming Pool 12.5 x 25 = 2.5 x 12.5 + 3.0 m x 25 = 312. 5 106. 2 m2 m2 + pool-surround 8. Equipment Storage 10. 0 m2 9. Sauna 17.0 m2 10. Gymnasium 20. 0 m2 11. S t a f f Room 10. 0 m2 TOTAL 662. 5 m2 Parking requirements: A minimum of one space f o r each 18.6 m2 of Gross F l o o r Area ( C i t y of Vancouver, Parking BY-law, 1987). 36 pa r k i n g spaces x 26.5 m2 = 954.0 m2 References: De C h i a r a , J . and C a l l e n d e r , J . Time-Saver Standards f o r B u i l d i n g Types. 1980. APRA. F a c i l i t i e s Program f o r the George Derby Long Term Care  S o c i e t y . 1982, p.G58-63. P a t r i c , Thomas. S e l e c t e d R e h a b i l i t a t i o n F a c i l i t i e s i n the United  S t a t e s . 1971, p.53. CMHC. Nursing Home and H o s t e l s with Care S e r v i c e s f o r the E l d e r l y Design G u i d e l i n e s . 1979. 186 |440RnCULj I THERAPY I J MAl N I I CONCOORSEl I 1 F i g . 5-17 R e h a b i l i t a t i o n Centre 187 5.4.5. ARTS AND CRAFTS 1) Purpose A need of some o l d e r people f o r p e r s o n a l e x p r e s s i o n may be s a t i s f i e d by a v a r i e t y of programs i n the A r t s and C r a f t s Rooms. Faced with the r e a l i t y of d e c l i n i n g p h y s i c a l s t r e n g t h , l o s s of job, income and perhaps death of a spouse or f r i e n d s , many o l d e r people t u r n to new p u r s u i t s i n order to r e i n f o r c e t h e i r s e l f - i m a g e . A r t s and C r a f t s programs g i v e t h e i r p a r t i c i -pants a chance to engage i n a group e f f o r t , develop c r e a t i v i t y , cooperate and compete with o t h e r s . 2) F u n c t i o n a l D e s c r i p t i o n The CCC A r t s and C r a f t s a c t i v i t i e s w i l l be i n c l u d e d i n the a d u l t e d u c a t i o n programs i n the Core Centre. Those programs w i l l be o f f e r e d on a r e g u l a r b a s i s . Thus, r e s i d e n t s and v i s i t o r s w i l l be able to spend a g r e a t d e a l of time i n an environment t h a t i s s u p p o r t i v e and rewarding. C l a s s e s w i l l tend to range from 10 to 25 p a r t i c i p a n t s , t h e r e f o r e a l l rooms w i l l be s i z e a b l e , b r i g h t and c h e e r f u l . C r a f t s rooms w i l l be grouped tog e t h e r to p r o v i d e f l e x i b i l i t y i n case of changing c l a s s s i z e s and d i f f e r e n t c r a f t uses. T h i s p a r t i c u l a r program component w i l l be l o c a t e d a s i d e to p r o t e c t the r e s t of the Core Centre from n o i s e , or dust which may be generated by c r a f t s rooms. The rooms w i l l be workshops r a t h e r than showplaces. However, there w i l l be a v i s u a l c o n n e c t i o n with the hallway i n the Main Concourse. 188 T h i s f e a t u r e w i l l a llow p o t e n t i a l p a r t i c i p a n t s to observe o t h e r s a t work u n t i l they decide to take p a r t themselves. F i n i s h e d works of the p a r t i c i p a n t s w i l l be e x i b i t e d i n the main p l a z a -A r t s E x i b i t i o n area. The A r t s and C r a f t s area c o n s i s t s of s i x rooms: woodwork, dyeing, weaving, p o t t e r y , work t a b l e s t h a t i n c l u d e needlework, c r e a t i v e a r t s and h a n d c r a f t s , as w e l l as, p a i n t i n g / s k e t c h i n g . However, some of the rooms can be converted to other c r a f t s such as photography, ceramics or c h i n a p a i n t i n g . M a t e r i a l s and equipment w i l l be s t o r e d on open s h e l v e s , i n an adjacent storage room, to pr o v i d e a c c e s s i b i l i t y . Table 5 - 1 0 . — A r t s and C r a f t s Space Program COMPONENTS UNIT AREA m2 REMARKS: 1. O f f i c e 10.0 m2 2. S t a f f Washroom & Chg. rm. 12. 5 m2 3. Dyeing 35.0 m2 4. Weaving 40. 0 m2 5. P o t t e r y 50.0 m2 6. Worktables 40.0 m2 7. Woodwork 30.0 m2 8. P a i n t i n g & Ske t c h i n g 30.0 m2 9. Storage 34.0 m2 TOTAL: 281. 5 m2 GROSS AREA: 281.5 X 1.4 = 393.0 m2 References: Jordan, Joe. S e n i o r Centre Design. 1978, p.64. APRA. F a c i l i t i e s Program f o r the George Derby Long Term Care  S o c i e t y . 1982, p. G75-87. Northwood Multi-Purpose Centre, P h y s i c a l F a c i l i t i e s Data. Seton V i l l a , M u l t i - l e v e l Care F a c i l i t y i n Burnaby, B.C. 190 WOOD-w o r k s t o r . POTTE-RY PAINT 5TU01O T WEAV 1 NET-STOR. WORK TABLES TMAIKI , I C O N C O U R S E I VISUAL ACCESS TO PEDESTRIAN CIRCULATION I F i g . 5-18 A r t s and C r a f t s 5.4.6. AUDITORIUM AND SPECIAL PROGRAMS 1) Purpose The Auditorium with S p e c i a l Programs w i l l p r o v i d e e d u c a t i o n , i n f o r m a t i o n and entertainment to a l l users of the CCC f a c i l i t y . T h i s embraces a d i v e r s e group of a u d i e n c e - r e l a t e d a c t i v i t i e s , i n c l u d i n g l e c t u r e s , movies, c o n c e r t s , and programs f o r group a c t i v i t i e s such as brid g e c l a s s e s , c a r d p a r t i e s , bingo and ot h e r s . C l a s s e s and meetings w i l l p r ovide a d u l t education and w i l l develop d i v e r s e i n t e r e s t s and p r e f e r e n c e s , f o r example: Poetry w r i t i n g , S i n g - a - l o n g , C h o r a l group, Typing, L o c a l H i s t o r y , Greenhouse workshop and many o t h e r s . 2) F u n c t i o n a l D e s c r i p t i o n The Auditorium w i l l be l o c a t e d i n the Core Centre with an easy access from the Main Concourse. The p r i n c i p a l component w i l l be the Assembly H a l l which w i l l accommodate approximately 200 people. T h i s T h e s i s assumes t h a t there w i l l be frequent p a r t i c i p a t i o n drawn from the P o i n t Grey community. T h e r e f o r e , an Auditorium with a stage, back stage and p r o j e c t o r booth w i l l be w e l l equipped to c r e a t e the best environment f o r s e n i o r s i n terms of seein g as w e l l as f o r h e a r i n g . Furthermore, the Audi-torium w i l l be designed as f u l l y a c c e s s i b l e space f o r wheel-c h a i r r e s i d e n t s . Here, a l l a c t i v i t i e s as l i s t e d e a r l i e r , w i l l take p l a c e . In f r e e time, between the scheduled events, the Auditorium w i l l be used by r e s i d e n t s f o r r e h e a r s a l s of the i n -strumental, t h e a t r e and c h o r a l groups. Close to the Auditorium, 192 there w i l l be l o c a t e d a number of classrooms with a view and access to outdoor a c t i v i t i e s . Storage f o r f u r n i t u r e and equipment w i l l be l o c a t e d c o n v e n i e n t l y a l s o near t h a t area. Washroom f a c i l i t i e s f o r men and women and a cloak-room w i l l be c l o s e i n the Main Concourse. The Auditorium w i l l be lea s e d to other o r g a n i z a t i o n s as w e l l i n order to keep t h i s f a c i l i t y f i n a n c i a l l y f e a s i b l e . T h i s may be an a d d i t i o n a l f a c t o r i n the r e l a t i o n s h i p between the CCC and the business community. Table 5-11.--Auditorium and S p e c i a l Programs Space Program COMPONENT NET UNIT AREA m2 REMARKS 1. Auditorium 224. 0 m2 1.12 m2/person 2. Stage 24. 0 m2 3. Backstage 32. 0 m2 4. Storage 30. 0 m2 5. P r o j e c t i o n Booth 6.0 m2 6. Classroom 25.0 m2 5-10 persons 7. Classroom 40. 0 m2 10-20 persons 8. Meeting Rm/Game Rm 60.0 m2 20-40 persons TOTAL: 441. 0 m2 References: Jordan, Joe. S e n i o r Center Design. 1978, p.60. Burris-Mayer, Harold and E. Cole. Theatres and Auditoriums. 1975. BACK STA&E STAGE PROX E.O0TH AUDl-1 T O R I U M ^ 1 ™ 1 ^ " STOR. CLASS RM. MEET. GAME RM. PRO&. JDIR. T MAIN ~j [CONCOURSEj F i g . 5-19 Auditorium and S p e c i a l Programs 194 5.4.7. ADMINISTRATION  1. O b j e c t i v e s The main o b j e c t i v e of the A d m i n i s t r a t i o n S u i t e i s to provide f o r the o v e r a l l m o nitoring and c o n t r o l of the CCC f a c i l i t y . T h i s u n i t w i l l be r e s p o n s i b l e f o r the g e n e r a l s u p e r v i s i o n of the s t a f f , management of f i n a n c e s , l i a i s o n with the p u b l i c and c o o r d i n a t i o n among a l l major u n i t s of the CCC. The s t a f f w i l l need numerous o f f i c e s to c a r r y out t h e i r d u t i e s e f f i c i e n t l y . At t h i s stage of the program I assume o n l y g e n e r a l g u i d e l i n e s i n terms of the f u n c t i o n and q u a n t i t y . 2) F u n c t i o n a l D e s c r i p t i o n  a. Access The A d m i n i s t r a t i v e S u i t e w i l l be l o c a t e d i n the Core Centre, c l o s e to the main entrance and adjacent to the Main Concourse. The g e n e r a l a d m i n i s t r a t i o n o f f i c e s need l i t t l e c o n t a c t with the day-to-day a c t i v i t i e s of the f a c i l i t y , n e v e r t h e l e s s d i r e c t r e l a -t i o n s h i p s are necessary f o r the e x e c u t i v e s . The E x e c u t i v e D i r e c t o r - C o o r d i n a t o r w i l l need an easy access to the g e n e r a l p u b l i c and to the s e n i o r s t a f f . The Programs D i r e c t o r w i l l need to be c l o s e to the hub of a l l d a i l y a c t i v i t i e s , s t a f f , p a r t i c i -pants and v o l u n t e e r s . The C l i n i c and R e h a b i l i t a t i o n Centre D i r e c t o r w i l l have an access to Programs D i r e c t o r and to C l i n i c . The D i r e c t o r of Home Care and Support w i l l have an access to the D i r e c t o r of the Long Term F a c i l i t y and D i r e c t o r of S o c i a l Programs. The Long Term Care D i r e c t o r w i l l have an easy access 195 to the Intermediate, Extended and Respit e Care f a c i l i t i e s . The Food D i r e c t o r w i l l have access to the Food S e r v i c e s and Food F a i r u n i t s . The A d m i n i s t r a t i v e S u p e r v i s o r w i l l be l o c a t e d c l o s e to the General O f f i c e and Co o r d i n a t o r . Waiting space w i l l be s u f f i c i e n t enough, with a d i r e c t access to the v i s i t o r s washrooms, and l o c a t e d c l o s e to the main entrance. b. P r i v a c y The A d m i n i s t r a t i v e S u i t e w i l l be d i v i d e d i n t o three p a r t s i n terms of p r i v a c y . Planned as P r i v a t e O f f i c e s are those of the: E x e c u t i v e D i r e c t o r , Long Term Care D i r e c t o r , Programs D i r e c t o r , Home Care and Support D i r e c t o r , Accountant, C l i n i c and R e h a b i l i t a t i o n Centre D i r e c t o r , Food S e r v i c e s D i r e c t o r . Planned as Semiprivate O f f i c e s are those of the: A d m i n i s t r a t i v e A s s i s t a n t , Program S u p e r v i s o r s , N u t r i t i o n i s t , Bookkeepers, Custodians, Home Care S u p e r v i s o r s , Home Support S u p e r v i s o r s , M a i l Room-Newsletter O f f i c e , D i r e c t o r of V o l u n t e e r s . General Open O f f i c e Space: S e c r e t a r i e s , C l e r i c a l A s s i s t a n t s , R e c e p t i o n i s t , V o l u n t e e r s . 196 Table 5-12.--Administration Space Program ACTIVITY CENTRE NET AREA m2 REMARKS 1. Co o r d i n a t o r 15.0 m2 2. Ex e c u t i v e S e c r e t a r y 12.0 m2 3. A d m i n i s t r a t i v e s u p e r v i s o r 12.0 m2 4. Long Term Care D i r e c t o r 12. 0 m2 5. Programs D i r e c t o r 12.0 m2 6. Home Care and Support D i r . 12.0 m2 7. Reception and Waiting 20. 0 m2 8. General O f f i c e 36. 0 m2 3 x 12. 0 m2 9, Accounting and Personnel 19.0 m2 2 x9.5 m2 10. Records 8.5 m2 11. C l i n i c & Rehab.Centre D i r . 12.0 m2 12. M a i l Room 12.0 m2 13. V o l u n t e e r s ' C o o r d i n a t o r 8.0 m2 14. Volunteers* Room 12.0 m2 15. V o l u n t e e r C l e r k 8.0 m2 16. S t a f f Lounge 22.0 m2 17. S t a f f Washrooms 5.0 m2 18 V i s i t o r s Washrooms 5.0 m2 19. Board Room 20.0 m2 TOTAL: 262.5 m2 References: Jordan, Joe. S e n i o r Center Design. 1978, p.68; Gard i n e r Thornton P a r t n e r s h i p 1970, p. 43. 197 ADMIW. SUPERVf EXEC. SECRE COORD RM. STAFF LOUNGE S T A F F WASH. MAIL RM BOARD RM. DIR.. L.T C A R E DIR. h i .SEN • CEHTR. VOLUN VOL. VOL. RfA. COORD CLERK F i g . 5-20 A d m i n i s t r a t i o n S u i t e 198 5.4.8 CLINIC 1) Purpose An ambulatory care centre i n the CCC w i l l provide medical, d e n t a l and c o u n s e l i n g s e r v i c e s f o r the r e s i d e n t s and the e l d e r l y from the P o i n t Grey community. The p r i n c i p a l o b j e c t i v e i s to provide h e a l t h maintenance and h e a l t h promotion. T h i s u n i t f u n c t i o n s w i t h i n the Core Centre a c t i v i t i e s . R e s i d e nts or p a r t i c i p a n t s i n the CCC programs w i l l be making appointments to come here f o r medical examination, c o u n s e l i n g , and d e n t a l work. Other s p e c i a l i s t s such as an o p t o m e t r i s t and d i e t i c i a n w i l l a l s o be a v a i l a b l e by scheduled appointments. 2) F u n c t i o n a l D e s c r i p t i o n A c t i v i t i e s i n the C l i n i c w i l l i n c l u d e : r e c e p t i o n of pa-t i e n t s , d o c t o r s ' c o n s u l t a t i o n , u n d r e s s i n g , p h y s i c a l examination, d i a g n o s t i c t e s t s , minor procedures, d r e s s i n g , g i v i n g advice and i n s t r u c t i o n s . The main a c t i v i t y sequences w i l l i n v o l v e p r o f e s -s i o n a l and n o n - p r o f e s s i o n a l s t a f f . In any of these a c t i v i t i e s the C l i n i c w i l l be planned to achieve the f o l l o w i n g o b j e c t i v e s : an easy access f o r the CCC p a t i e n t s or those from the Community a r r i v i n g by p r i v a t e or p u b l i c t r a n s p o r t a t i o n . to r e s p e c t the d i g n i t y and p r i v a c y of the p a t i e n t . to s a t i s f y the needs of handicapped p a t i e n t s . the p o s s i b i l i t y of regrouping of f u n c t i o n s w i t h i n the c l i n i c thus to provide space f l e x i b i l i t y . 199 to make sure t h a t the b u i l d i n g be of n o n - i n s t i t u t i o n a l c h a r a c t e r . a. Access The r e c e p t i o n i s t ' s counter w i l l be e a s i l y a c c e s s i b l e from the Main Concourse as w e l l as from the Intermediate and Extended Care f a c i l i t i e s . I t w i l l be connected with the R e h a b i l i t a t i o n Centre and Pharmacy U n i t s , thus c r e a t i n g one h e a l t h care block. The s o c i a l w e l f a r e and c o u n s e l i n g o f f i c e w i l l have a convenient access to p a t i e n t s from the w a i t i n g / r e c e p t i o n area, but w i l l be l o c a t e d away from other a c t i v i t i e s . There w i l l be separate entrances f o r the s t a f f and p u b l i c . G e n e r a l l y , three f u n c t i o n a l zones i n t h i s U n i t w i l l be d i s t i n g u i s h e d : p u b l i c zone - the entrance lobby, w a i t i n g area, p u b l i c washrooms, shared use zone - the r e c e p t i o n area, examination rooms, s t a f f zone - s t a f f washrooms, workrooms, storages b. P r i v a c y Doctor o f f i c e s and examination room w i l l be grouped around the w a i t i n g area. P a t i e n t s ' routes w i t h i n the c l i n i c w i l l not c r o s s s t a f f r o u tes and w i l l not allow f o r views i n t o o f f i c e s , s t o r e s and s t a f f rooms. Documents f o r f i l i n g , blood and u r i n e samples; instruments and s t e r i l i z e r s w i l l remain concealed from the p u b l i c view. There w i l l be a s e p a r a t i o n of incompatible types of p a t i e n t s . The w a i t i n g area w i l l be screened v i s u a l l y and a c o u s t i c a l l y . 200 Table 5 - 1 3 . - - C l i n i c Space Program ACTIVITY CENTRE NET UNIT AREA m2 REMARKS 1. W a i t i n g / r e c e p t i o n 25 m2 2. Doctor o f f i c e s 56 m2 4 x 14 m2 3. Examination/treatment room 18 m2 4. D e n t i s t room 18 m2 5. Dental l a b o r a t o r y 8 m2 6. S o c i a l worker o f f i c e 14 m2 7. C o u n s e l l i n g o f f i c e 12 m2 8. P u b l i c washrooms F&M 10 m2 2 x 5 m2 t o i l e t s each 9. 10. S t a f f washroom F&M L i n e n supply 5 3 m2 m2 2 t o i l e t s wash-basin wit: 11. Clean u t i l i t y 12 m2 12. S o i l e d u t i l i t y 12 m2 13. Equipment storage 10 m2 TOTAL: 203 m2 GROSS AREA: 203 m2 X 1 .4 = 284 m2 References: Putsep, E r v i n . Modern H o s p i t a l - I n e r n a t i o n a l P l a n n i n g Prac-t i c e s . 1979, pp. 606-630; APRA. F a c i l i t i e s Program f o r the George Derby Long Term Care  S o c i e t y " 1982, pp. G66-74. DEWT. LABOL DEtfT. OPER. CLEAW UTILITY RECEf i WAIT. WASH 50ILED RMS. UTILITY EXAM £ FIRST AID II DOCT OTP 1 — ^ — I MAIN JCONCOURS^  F i g . 5-21 C l i n i c 202 5.4.9 PHARMACY 1) Purpose To provide pharmaceutical s e r v i c e s f o r the CCC r e s i d e n t s and the P o i n t Grey area r e s i d e n t s . T h i s f u n c t i o n a l component w i l l be r e s p o n s i b l e f o r ens u r i n g t h a t medications p r e s c r i b e d by p h y s i c i a n s are a v a i l a b l e to the r e s i d e n t s / p a t i e n t s i n a t i m e l y and e f f i c i e n t manner. The b a s i c f u n c t i o n of the Pharmacy w i l l be: to c o n t r o l medications i n a l l M e d i c a t i o n Rooms of the Long Term Care f a c i l i t i e s : from r e c e i v i n g through storage and d i s t r i b u t i o n ; the r e q u i s i t i o n , storage, compounding, packaging, l a b e l l i n g and d i s p e n s i n g of pharmaceutical items to the r e s i d e n t s and the customers from the Community. 2) F u n c t i o n a l D e s c r i p t i o n The CCC Pharmacy system w i l l be d i v i d e d i n t o two sub-systems. The f i r s t one w i l l c o n s i s t of medication rooms i n the Long Term Care f a c i l i t i e s - - i n C l u s t e r Support areas. A monitored usage system f o r d i s p e n s i n g and d i s t r i b u t i n g medications w i l l be used. D a i l y d e l i v e r y to medication rooms w i l l ensure t h a t n ecessary medications are a v a i l a b l e . However, a l i m i t e d amount of ward stock w i l l be kept i n medication rooms. The r e f o r e , the Pharmacist's o f f i c e i n the Core Centre w i l l c a r r y out o r d e r i n g and s u p p l y i n g of the medications. The second one, w i l l c o n s i s t 203 of the Pharmacy and Di s p e n s i n g i n the Core Centre a v a i l a b l e to a l l : the CCC r e s i d e n t s and Community customers. T h i s component w i l l i n c l u d e : r e t a i l space, s m a l l l a b o r a t o r y and storage. a. Access The Pharmacy must be c o n v e n i e n t l y l o c a t e d to C e n t r a l Receiv-i n g , the C l i n i c , the r e s i d e n t s and v i s i t o r s , and the C e n t r a l Supply - M a t e r i a l S e r v i c e s . To accommodate t h i s , a l o c a t i o n c l o s e to the Main Concourse, adjacent to the C l i n i c and with easy access to M a t e r i a l S e r v i c e s i s necessary. b. F u n c t i o n The Pharmacy i s going to be d i v i d e d i n t o f o u r main f u n c t i o n -a l areas: a d m i n s t r a t i o n , d i s p e n s i n g , p r o d u c t i o n and storage. 1. The ADMINISTRATIVE area w i l l c o n s i s t o f : C h i e f P h a r m a c i s t ' O f f i c e , away from the stream of a c t i v i t y but w i t h i n s i g h t of the the p r o d u c t i o n area R e t a i l - c o n t r o l - r e c e p t i o n , f o r r e c e i p t of r e q u i s i t i o n s , v i s i t o r s t o the component and c o n t r o l of w a i t i n g area Waiting area, designed f o r employees w a i t i n g f o r drugs and f o r r e s i d e n t s and v i s i t o r s Employee's washrooms 2. The PRODUCTION area w i l l be designed to a l l o w a f r e e flow of r e c e i v i n g , p r e p a r i n g , l a b e l l i n g , r e c o r d i n g , and d i s t r i b u t i n g of r e q u i r e d orders or p r e s c r i p t i o n s . 3. The STORAGE area w i l l be l a r g e enough to accommodate pharma-c e u t i c a l s i n a volume t h a t i s economical to buy and dispense w i t h i n a gi v e n p e r i o d of time. I t w i l l be open d i r e c t l y i n t o 204 the working area and c o n t a i n a walk-in r e f r i g e r a t o r with storage and drawers f o r i n s i d e l o a d i n g , storage and a v a u l t f o r n a r c o t i c s and other c o n t r o l l e d substances. Table 5-14.—Pharmacy and Dispensary Space Program COMPONENT NET UNIT AREA m2 REMARKS 1. Pr o d u c t i o n 18 m2 2. Storage 30 m2 3. R e t a i l Space 8 m2 4. Pharmacist's O f f i c e 12 m2 5. Waiting Area 15 m2 6. S t a f f Washroom 3 m2 TOTAL: 86 m2 GROSS AREA: 86 m2 x 1.3 = 112 m2 7. Medic a t i o n Room * 37 m2 5 x 7.4 m2 * Area accommodated i n C l u s t e r Support components. References: G a r d i n e r Thornton P a r t n e r s h i p . Burnaby General H o s p i t a l Program  f o r Expansion. 1970, v o l . 2 . APRA. F a c i l i t i e s Program f o r the George Derby Long Term Care  S o c i e t y . 1982. D i s c u s s i o n s with Pharmacy S t a f f i n London Drugs Store; 600 W. Broadway St. 205 MEDIC. , RM |XC$.ECj T DELIVERY MATERIAL SERVICES —I I I 5T0R. : i I PUAfc. OFF. LABOL CERY . , IW>EF UVIKI6 MAIN DESPENMCONCOURSE i I J PUBLIC F i g . 5-22 Pharmacy 5.9.10. LIBRARY 1) Purpose Reading i s an important l e i s u r e - t i m e a c t i v i t y f o r the e l d e r -l y . Current magazines may be kept i n the c l u s t e r s ' lounges or i n the Main Concourse s i t t i n g area. More s e r i o u s r e a d i n g needs a separate l i b r a r y . Only a few r e s i d e n t s w i l l use t h i s space a t one time, so i t does not need be l a r g e . For those who are s e r i o u s l y i n t e r e s t e d i n music there w i l l be an o p p o r t u n i t y to l i s t e n to music c a s s e t t e s (headphone l i s t e n i n g ) i n a s p e c i a l l y designed R e a d i n g / L i s t e n i n g space i n the L i b r a r y . 2) F u n c t i o n a l D e s c r i p t i o n The L i b r a r y w i l l be comprised of 3 a c t i v i t y c e n t r e s : L i b r a r y Stacks, R e a d i n g / L i s t e n i n g Space and Work Area. 1. L i b r a r y Stacks w i l l be a s e m i - p u b l i c space f o r storage of books or c a s s e t t e tapes. T h i s space w i l l p r ovide wheelchair access between s h e l v e s . The l i g h t i n g system w i l l be designed to minimize shadows and to a l l o w f l e x i b i l i t y i n l a y o u t . 2. R e a d i n g / L i s t e n i n g space w i l l be spacious enough to accom-modate t a b l e s with power sources f o r tape decks. Room w i l l have a c o u s t i c i n s u l a t i o n , wheelchair access and a view to the outdoor r e c r e a t i o n a l areas. 3. The Work Area w i l l be the s t a f f w o r k s t a t i o n f o r s i g n i n g out, r e c e i v i n g , r e p a i r s and monitoring of a c t i v i t i e s . I t w i l l have v i s u a l access to the R e a d i n g / L i s t e n i n g Space and L i b r a r y Stacks. 207 a. Access The L i b r a r y w i l l be s i t u a t e d c l o s e to the main a c t i v i t y area i n the Core Centre. There w i l l be an easy access from the Conser-v a t o r y as w e l l as from other Main Concourse components. Table 5-15.--Library Space Program COMPONENT NET UNIT AREA m2 REMARKS 1. L i b r a r y Stacks 55 m2 2. R e a d i n g / L i s t e n i n g Area 20 m2 3. Work Area 12 m2 TOTAL 87 m2 GROSS AREA: 87 m2 x 1.3 = 113 m2 References: APRA. F a c i l i t i e s Program f o r the George Derby Long Term Care  S o c i e t y . 1982. D i s c u s s i o n s with the Woodwards' L i b r a r y S t a f f , UBC. i r i o u r DOOR i ] AREA j ^ READ/ h-rUSTEU A R E A L I B R -S T A C K MAIM ICONCOURSEJ F i g . 5-23 L i b r a r y 209 5.4.11. STAFF SUPPORT FACILITIES 1) Purpose To provide f a c i l i t i e s ( l o c k e r s , washrooms and lounges) to be used by the s t a f f f o r changing, s t o r i n g c l o t h e s and as a r e s p i t e from r e s i d e n t s , v i s i t o r s and o t h e r s t a f f d u r i n g breaks i n work-i n g hours. 2) F u n c t i o n a l D e s c r i p t i o n The S t a f f Support f u n c t i o n a l component w i l l p r ovide f a c i l i t i e s f o r the M e d i c a l S t a f f , P r o f e s s i o n a l Female and Male S t a f f , N o n - p r o f e s s i o n a l Female and Male S t a f f . Lockers w i l l be c e n t r a l i z e d f o r the m a j o r i t y of s t a f f but d e c e n t r a l i z e d f o r the f o l l o w i n g program components: - M a t e r i a l S e r v i c e s - B u i l d i n g S e r v i c e s - P l a n t S e r v i c e s A. In the Intermediate Care f a c i l i t y , there w i l l be approxima-t e l y 55 f u l l time s t a f f with the f o l l o w i n g s u b d i v i s i o n : 30% - l e v e l 1 40% - l e v e l 2 30% - l e v e l 3 T o t a l p r o f e s s i o n a l s t a f f = 5 (9% of the e n t i r e s t a f f ) . Data from Mrs. Barbara Parson, R e h a b i l i t a t i o n C o n s u l t a n t , Vancouver Health Department). B. In the Extended Care f a c i l i t y , t here w i l l be aproximately 22 s t a f f (data from Ms. June Nakamoto, D i r e c t o r Nursing 210 S e r v i c e s , Long Term Care, U n i v e r s i t y H o s p i t a l , UBC S i t e ) Note: a t the present time there are no o f f i c i a l g u i d e l i n e s f o r s t a f f i n g Extended Care U n i t s ( i n f o r m a t i o n from Ms. Leah H o l l i n s , Nursing C o n s u l t a n t , M i n i s t r y of Health, V i c t o r i a ) . a. Access The S t a f f Support f u n c t i o n a l component w i l l be l o c a t e d convenient to s t a f f p a r k i n g and to p u b l i c t r a n s p o r t a t i o n . I t w i l l have an easy access to a l l work areas. b. F a c i l i t i e s A. P r o f e s s i o n a l Male S t a f f Locker Room, Shower/Washroom and Lounge w i l l be l o c a t e d i n c l o s e to the C l i n i c , Pharmacy and R e h a b i l i t a t i o n Centre, as w e l l as, to the Intermediate and Extended Care f a c i l i t i e s . B. P r o f e s s i o n a l Female S t a f f Locker Room, Shower/Washroom and Lounge f o r the r e g i s t e r e d n u r s i n g s t a f f ; a l l are p a r t of the c e n t r a l i z e d s t a f f f a c i l i t i e s , w i l l be l o c a t e d i n c l o s e p r o x i m i t y to the Intermediate and Extended Care f a c i l i t i e s , as w e l l as, to the C l i n i c and R e h a b i l i t a t i o n Centre. C. N o n - p r o f e s s i o n a l Female S t a f f f a c i l i t i e s f o r Nursing support s t a f f w i l l be l o c a t e d as i n p o i n t B. D. N o n - p r o f e s s i o n a l Male S t a f f f a c i l i t i e s f o r Nursing support s t a f f and oth e r male personnel w i l l be l o c a t e d as i n p o i n t B. G e n e r a l l y , l o c k e r rooms w i l l be designed as open areas d i v i d e d by arrangements of banks of l o c k e r s . Lockers to be 12"x 21"x 72" high with space between f o r a bench f o r changing shoes. 211 Table 5 - 1 6 . — S t a f f Support F a c i l i t i e s Space Program COMPONENTS NET AREA m2 REMARKS P r o f e s s i o n a l Male: Locker Room 10. 0 Shower/Washroom 12. 0 1 shower, 2 l a v a t o r i e s + t o i l e t s . Lounge 20. 0 P r o f e s s i o n a l Female S t a f f : Locker Room 10. 0 Shower/Washroom 12. 0 2 showers + 2 l a v a t o r i e s + 2 t o i l e t s Lounge 20. 0 Common. No n - p r o f e s s i o n a l Female S t a f f : Locker Room 10. 0 Shower/Washroom 12. 0 Lounge 20. 0 N o n - p r o f e s s i o n a l Male S t a f f Locker Room 10. 0 Shower/Washroom 12. 0 2 showers, 2 l a v a t o r i e s + 2 t o i l e t s Lounge 20. 0 Common f o r a l s t a f f . TOTAL: 168. 0 m2 GROSS AREA: 168.0 X 1.2 201. 6 m2 References: APRA. F a c i l i t y Program f o r the George Derby Long Term Care  S o c i e t y . 1982. Ga r d i n e r Thornton P a r t n e r s h i p . Burnaby General H o s p i t a l Program f o r Expansion. 1970, v o l . 2 . 5.4.12 LAUNDRY SERVICES 1) Purpose To p r o v i d e f o r Laundry S e r v i c e s f o r the Intermediate and Extended Care c l u s t e r s by r e c e i v i n g , c l e a n i n g and d i s t r i b u t i n g of r e s i d e n t s ' p e r s o n a l c l o t h i n g . Laundry s e r v i c e s w i l l a l s o monitor the c o l l e c t i o n and d i s t r i b u t i o n of ward l i n e n s , the p r o c e s s i n g of which w i l l be c o n t r a c t e d out to other Commercial Laundry s e r v i c e s and w i l l u t i l i z e a l i n e n c a r t system. 2) F u n c t i o n a l D e s c r i p t i o n Clean l i n e n c a r t s from the Loading Dock w i l l be h e l d i n the Clean L i n e n Area a w a i t i n g d i s t r i b u t i o n to the Clean Supply Rooms. S o i l e d l i n e n w i l l be c o l l e c t e d i n designated S o i l e d U t i l i t y Rooms f o r pick-up and d e l i v e r e d to the S o i l e d H o l d i n g Area i n the Main Laundry near the Loading Dock. Re s i d e n t s ' items w i l l be p i c k e d up from the r e s i d e n t c l u s t e r s , s o r t e d f o r p r o c e s s i n g and minor r e p a i r s , then w i l l be washed and d r i e d i n the laundry f a c i l i t i e s on s i t e . However, f o r the Intermediate Care r e s i d e n t s there w i l l be an a d d i t i o n a l p e r s o n a l laundry f a c i l i t i e s a v a i l a b l e (1 washer and 1 dryer) i n each C l u s t e r Support to pro v i d e an o p p o r t u n i t y f o r r e s i d e n t s to wash t h e i r p e r s o n a l c l o t h i n g by themselves. a. Access The Laundry S e r v i c e s f a c i l i t y w i l l be l o c a t e d i n the Core Centre with an easy access to a l l Intermediate and Extended Care 213 c l u s t e r s as w e l l to M a t e r i a l S e r v i c e s with S h i p p i n g and Receiv-i n g Area. Table 5-17.--Laundry S e r v i c e s Space Program COMPONENT NET UNIT AREA m2 REMARKS 1. Clean L i n e n H o l d i n g 32. 5 ra2 2. S o i l e d L i n e n H o l d i n g 16. 5 m2 3. Resident Laundry 65.0 m2 4. Car t C l e a n i n g 10. 0 ra2 TOTAL 124. 0 m2 GROSS AREA: 124 m2 X 1.3 = 161.0 m2 References: APRA. F a c i l i t i e s Program f o r the George Derby Long Term Care S o c i e t y . 1982. 214 5.4.13 PLANT SERVICES 1) O b j e c t i v e s ; 1. To provide f a c i l i t i e s r e q u i r e d f o r the maintenance, o p e r a t i o n and s e c u r i t y of the whole CCC: 2. R e s p o n s i b l i t y to maintain a l l b u i l d i n g s and equipment i n good c o n d i t i o n and f u n c t i o n i n g ; 3. R e s p o n s i b l i t y f o r the o p e r a t i o n of b o i l e r s , pumps, fans, e l e v a t o r s and other mechanical equipment; 4. R e s p o n s i b l i t y f o r the ground-maintenance, p a r k i n g c o n t r o l , f i r e s a f e t y and watchman s e r v i c e ; 2) F u n c t i o n a l d e s c r i p t i o n B a s i c a l l y the f u n c t i o n s may be s u b d i v i d e d i n t o two groups: 1. P l a n t Maintenance 2. P l a n t O p e r a t i o n In t h i s s e c t i o n the P l a n t Maintenance F a c i l i t i e s are d e s c r i b e d o n l y ( o f f i c e space and workshops). For the P l a n t Operation please r e f e r to the B u i l d i n g and M a t e r i a l S e r v i c e s S e c t i o n s r e s p e c t i v e l y . b. Access The P l a n t S e r v i c e s f a c i l i t y w i l l be l o c a t e d i n the Core Centre i n c l o s e p r o x i m i t y to the M a t e r i a l and B u i l d i n g S e r v i c e s f a c i l i t i e s . I t w i l l p r ovide an o f f i c e f o r the P l a n t - S u p e r i n t e n d -ent who w i l l be r e s p o n s i b l e f o r the Maintenance Department; r e p o r t s to and works with the A d m i n i s t r a t i o n Department to main-t a i n p l a n t e f f i c i e n c y . T h i s o f f i c e w i l l be adjacent to the work-shops. Lockers, Lounge and Washroom F a c i l i t i e s which w i l l serve 215 a l l maintenance personnel. M a t e r i a l Storage w i l l accommodate space f o r lumber, e l e c t r i c a l s u p p l i e s , plumbing s u p p l i e s and p a i n t , while the general workshop w i l l p r ovide space f o r a l l maintenance t a s k s . S t a f f w i l l a l s o be i n v o l v e d i n the grounds care and maintenance, with a l l necessary equipment and m a t e r i a l s being s t o r e d i n Grounds Maintenance Storage. The V e h i c l e Holding area f o r the enclosed storage and washing of v e h i c l e s w i l l a l s o be provided w i t h i n t h i s f u n c t i o n a l component. Table 5-18.--Plant S e r v i c e s Space Program COMPONENT NET UNIT AREA m2 REMARKS 1. Pla n t - S u p e r i n t e n d e n t O f f i c e 12.0 m2 2. Lockers 10.0 m2 up to 10 l o c k e r s 3. Washroom/Shower 12.0 m2 2 T, 2 S, 2 W6 4. General Workshop 46. 0 m2 5. M a t e r i a l Storage 28. 0 m2 6. Grounds Mainten.Storage 35. 0 m2 7. V e h i c l e H o l d i n g 46. 0 m2 TOTAL 189. 0 m2 References: APRA. F a c i l i t i e s Program f o r the George D e r b y L o n g Term Care S o c i e t y . 1982. 216 5.4.14 BUILDING SERVICES 1) Purpose To maintain c l e a n and s a n i t a r y c o n d i t i o n s throughout the Continuum of Care Complex. (The Independent L i v i n g c l u s t e r s are served s e p a r a t e l y ) . A l s o , to c o l l e c t and dispose of a l l r e f u s e . 2) F u n c t i o n a l D e s c r i p t i o n The B u i l d i n g S e r v i c e s f a c i l i t y w i l l u t i l i z e the c e n t r a l i z e d f a c i l i t i e s f o r storage and c l e a n i n g equipment with s a t e l l i t e J a n i t o r s Rooms throughout the f a c i l i t y . a. Access T h i s f a c i l i t y w i l l be l o c a t e d i n the Core Centre c e n t r a l area ( i n the basement) with an easy access to the M a t e r i a l S e r v i c e s f a c i l i t y . S t a f f w i l l r e p o r t at the beginning of each s h i f t to a c e n t r a l area to r e c e i v e i n s t r u c t i o n s and p i c k up equipment as may be r e q u i r e d . There w i l l be s t o r e s f o r supply and the housekeeping u t i l i t y c a r t s . The E x e c u t i v e Housekeeper's O f f i c e w i l l d i r e c t and c o - o r d i n a t e the housekeeping program. I t w i l l be l o c a t e d adjacent to the A s s i s t a n t and C l e r i c a l O f f i c e which i n t u r n w i l l prepare work schedules, time schedules and r e p o r t s . In the v i c i n i t y , there w i l l be Mattress and Bed Storage Room to s t o r e spare or broken mattresses and beds. Housekeeper w i l l arrange r e p a i r s . Garbage w i l l be c o l l e c t e d by j a n i t o r s a t r e s i d e n t s c l u s t e r s and t r a n s p o r t e d by c a r t s to I n c i n e r a t o r Room. I t w i l l be l o c a t e d adjacent to the maintenance workshops and 217 c o n v e n i e n t l y f o r garbage c o l l e c t i o n . Throughout the Core Centre area, there w i l l be J a n i t o r Rooms at the ra t e of one per 550 m2 of f l o o r area minimum. In the Intermediate and Extended Care f a c i l i t i e s , there w i l l be a J a n i t o r Room i n each C l u s t e r Support. Table 5 - 1 9 . — B u i l d i n g S e r v i c e s Space Program COMPONENT NET UNIT AREA m2 REMARKS 1. E x e c u t i v e Housekeeper's O f f i c e 10. 0 m2 2. A s s i s t a n t and C l e r i c a l O f f i c e 15. 0 in 2 3. Housekeeping Supply Room 10. 0 m2 4. Housekeeping Equipment Room 20. 0 m2 5. Mattress and Bed Stg. Room 20. 0 m2 6. I n c i n e r a t o r Room 20. 0 m2 TOTAL: 95. 0 m2 GROSS AREA: 95 m2 X 1.3 = 123. 0 m2 References: G a r d i n e r Thornton P a r t n e r s h i p . Burnaby General H o s p i t a l Program  f o r Expansion. 1970, v o l . 2 . 218 5.4.15. MATERIAL SERVICES 1) Purpose G e n e r a l l y to provide f o r the r e c e i p t , d i s t r i b u t i o n and d i s p o s a l of a l l s u p p l i e s , equipment and s e r v i c e s f o r the e n t i r e CCC f a c i l i t y . S p e c i f i c a l l y : to review, approve, buy and d e l i v e r a l l s u p p l i e s ordered by a l l f a c i l i t i e s ; to r e c e i v e , s o r t , weigh, and uncrate a l l goods d e l i v e r e d ; to s t o r e new and o b s o l e t e goods and dispose of the l a t t e r ; to arrange f o r r e p a i r s which can not be done by the CCC maintenance; to maintain an i n v e n t o r y of equipment and s u p p l i e s i n s t o r e s ; to d i s t r i b u t e goods to a l l f u n c t i o n a l components. 2) F u n c t i o n a l D e s c r i p t i o n A l l d e l i v e r i e s and pick-up of s u p p l i e s and equipment w i l l be through the M a t e r i a l S e r v i c e s f a c i l i t y . The M a t e r i a l s Management Manager w i l l be r e s p o n s i b l e f o r c o - o r d i n a t i o n and c o n t r o l of a l l s u p p l i e s , p urchasing and storage. As a supply s e r v i c e , t h i s Department w i l l m aintain c l o s e a r e l a t i o n s h i p with the Pharmacy, General S t o r e , and L i n e n S e r v i c e s . A l l goods w i l l pass through C e n t r a l R e c e i v i n g and S h i p p i n g with the e x c e p t i o n of Food Ser-v i c e s and Pharmacy. In the S h i p p i n g Counter incoming shipments w i l l be opened and checked before d i s t r i b u t i o n . I t w i l l have m o n i t o r i n g and c o n t r o l l i n g access to and from the Loading Dock, C e n t r a l S t o r e s with S h i p p i n g and R e c e i v i n g . C e n t r a l General S t o r e s w i l l p r ovide storage f o r a l l n o n - d i e t a r y s u p p l i e s 219 goods. In p r o x i m i t y to r e c e i v i n g and adjacent to the Food S e r v i c e s F a c i l i t y , there w i l l be the Bulk Food Storage. P e r i s h a b l e s w i l l be s t o r e d w i t h i n the Food S e r v i c e s F a c i l i t y . Used Equipment Storage w i l l p r o v i d e space f o r used f u r n i t u r e and equipment p r i m a r i l y from the Core Centre f u n c t i o n a l components. There w i l l a l s o be the V o l a t i l e L i q u i d Storage used by the Pharmacy and Flammable Store f o r flammable m a t e r i a l s . L o c a t i o n of these w i l l have to comply with the B u i l d i n g and F i r e Code R e g u l a t i o n s . The Resident S t o r e s ( a c c e s s i b l e to r e s i d e n t s ) w i l l p r o vide storage space f o r the IC and EC r e s i d e n t s ' p e r s o n a l belongings such as l a r g e s u i t c a s e s , f u r n i t u r e which can't be kept or s t o r e d i n the long term care r e s i d e n t i a l c l u s t e r s . 220 Table 5-20.--Material S e r v i c e s Space Program COMPONENTS NET UNIT AREA m2 1. M a t e r i a l Management Manager's O f f i c e 15.0 m2 2. Purchasing Agent's O f f i c e 15.0 m2 3. C l e r k O f f i c e 15.0 m2 4. Storekeepers O f f i c e 8.0 m2 5. D i s p a t c h e r s O f f i c e 8.0 m2 6. R e c e i v i n g Area 28.0 m2 7. Shi p p i n g Counter 9.0 m2 8. General S t o r e s 180.0 m2 9. Bulk Food S t o r e 95.0 m2 10 .Used Equipment Storage 90.0 m2 11 . V o l i t i l e L i q u i d Storage 27. 0 m2 12 .Flammable Store 9.0 m2 TOTAL 499. 0 m2 GROSS AREA: 499.0 m2 x 1.3 648.0 m2 References: G a r d i n e r Thornton P a r t n e r s h i p . Burnaby General H o s p i t a l Program  f o r Expansion. 1970, v o l . 2 . 5.5. FACILITY COMMON OUTDOOR SPACE 1) Purpose In n i c e weather many o l d e r people take advantage of o p p o r t u n i t i e s f o r outdoor a c t i v i t i e s p r o v i d i n g them with f r e s h a i r , e x e r c i s e , and change of environment. These a c t i v i t i e s i n c l u d e s o c i a l i z i n g , game p l a y i n g , and being seen ( Z e i s e l 1977, p.76). More h e a l t h y l i f e - s t y l e s and improved medical care have c o n t r i b u t e d to the c r e a t i o n of a new g e n e r a t i o n of a c t i v e and more mobile e l d e r l y . For them, r e c r e a t i o n a l and s o c i a l a c t i v i t i e s are a p p e a l i n g . The CC Complex w i l l p r ovide a v a r i e t y of outdoor a c t i v i t i e s responding to the p r e f e r e n c e s and a b i l i t i e s of the CCC r e s i d e n t s . For a c t i v e "go-go" r e s i d e n t s and v i s i t o r s , there w i l l be f a c i l i t i e s s i m i l a r to those i n the e x i s t i n g r e t i r e m e n t communities. These f a c i l i t i e s w i l l p r o v i d e s t i m u l a t i o n , enhance r e s i d e n t s ' s e l f - e s t e e m and c r e a t e an o p p o r t u n i t y f o r s o c i a l i n t e r a c t i o n and i n t e g r a t i o n with the P o i n t Grey community. For l e s s mobile e l d e r l y , there w i l l be a " t h e r a p e u t i c park" designed to meet the needs of the p h y s i c a l l y f r a i l . F or those who are i n t e r e s t e d i n h o r t i c u l t u r e the garden p l o t s area w i l l p r o v i d e e x e r c i s e , c o n t a c t with nature and p e r s o n a l reward and s a t i s f a c t i o n . 2) F u n c t i o n a l D e s c r i p t i o n The f a c i l i t y common space w i l l be comprised of f o u r f u n c t i o n a l components: the Country Club, the R e h a b i l i t a t i o n 222 Outdoor Areas, the Garden Centre and Park. A l l these components w i l l form a continuous open space with v a r i e t y of f l o w e r i n g shrubs, p e r e n n i a l s , t r e e s and water f e a t u r e s to ensure v i s u a l d i v e r s i t y at a l l times of the year. a. The Country Club Along the main p e d e s t r i a n walkway, with an easy access to Auditorium and S p e c i a l Programs Component, v a r i o u s games w i l l be l o c a t e d : ( a c t i v e areas) croquet, bowling lawn, m i n i - g o l f , horseshoes, v o l l e y b a l l , badminton c o u r t s and s h u f f l e b o a r d . Those areas w i l l be supplemented with shaded s p e c t a t o r benches (passive a r e a s ) . Storage sheds f o r outdoor r e c r e a t i o n a l equipment w i l l be provided nearby. b. R e h a b i l i t a t i o n Outdoor Areas There w i l l be two components. The F i r s t - gymnastic lawn w i l l be a component of the R e h a b i l i t a t i o n Centre (the Core Centre) designed as an outdoor e x t e n s i o n of the f i t n e s s and gymnasium space. The Second component w i l l be s p e c i a l l y designed rose and herb gardens with r a i s e d p l a n t e r s . These gardens w i l l be developed w i t h i n the t h e r a p e u t i c park and w i l l help to organize h o r t i c u l t u r e therapy s e s s i o n s . Both w i l l be l o c a t e d near the Long Term Care r e s i d e n t i a l c l u s t e r s . Research has shown ( T a y l o r 1978) t h a t h o r t i c u l t u r e therapy g i v e s p a t i e n t s a l i n k with l i f e and a sense of being needed. I t a l s o p r o v i d e s an o p p o r t u n i t y f o r p h y s i c a l a c t i v i t i e s and s o c i a l i n t e r a c t i o n . For those with v i s u a l impairments, i t p r o v i d e s an absorbing a c t i v i t y t h a t does not s t r a i n t h e i r eyes. Although some of the e l d e r l y need a s s i s t a n c e i n working with p l a n t s , the 223 p l e a s u r e of working with p l a n t s i s not lessened by a d i s a b i l i t y . F or example, i n the Extended Care U n i t at the UBC S i t e H o s p i t a l h o r t i c u l t u r e therapy has proved to be very s u c c e s s f u l . The i n t e r e s t i n gardening does not end when c l a s s i s over. People have p l a n t s on t h e i r window s i l l s and bedside t a b l e s and of course the care of them i s ongoing. P l a n t s do c r e a t e a homelike touch i n an i n s t i t u t i o n a l - h o s p i t a l s e t t i n g . Moreover, the i n t e r e s t i n gardening i s mentally s t i m u l a t i n g and the l e a r n i n g experience can be shared with others ( T a y l o r 1978). c. The Garden Centre For more a c t i v e r e s i d e n t s and v i s i t o r s i n t e r e s t e d i n gardening there w i l l be an o p p o r t u n i t y to maintain a "working" atmosphere i n the garden c e n t r e . Research has shown (Carstens 85, p.113), t h a t there i s a growing i n t e r e s t i n gardening among e l d e r l y people. For example, i n L e i s u r e World - Laguna H i l l s i n C a l i f o r n i a , the a c t i v e r e t i r e m e n t community has two garden c e n t r e s . "The more recent one, approximately f i v e a c r e s , p r o v i d e s 500 garden p l o t s i n a d d i t i o n to p o t t i n g sheds, green-houses and restrooms." The CCC garden centre w i l l be l o c a t e d some d i s t a n c e from the main a c t i v i t i e s to allow f o r easy v e h i c u l a r access f o r dropping o f f m a t e r i a l s and b e t t e r sun exposure. I t i s not the o b j e c t i v e of t h i s t h e s i s at t h i s stage of the Program develop-ment to decide on the s i z e of the Garden Centre. We can assume however, t h a t 50 garden p l o t s 10'xl5' with a p o s s i b i l i t y f o r f u t u r e expansion w i l l be s u f f i c i e n t at the beginning. T h i s centre w i l l g i ve the r e s i d e n t s an o p p o r t u n i t y to manage i t s 224 a f f a i r s by themselves. Minimal r e n t a l f e e s f o r the use of garden p l o t s may be charged to purchase community t o o l s and to cover maintenance c o s t s . d. Park A Park w i l l l i n k o ther a c t i v i t i e s t o gether, but a t the same time w i l l p r o v i d e a d d i t i o n a l c h o i c e s f o r the r e s i d e n t s . During n i c e weather s p e c i a l c u l t u r a l events such as c o n c e r t s , drama performances or meetings w i l l take p l a c e i n the outdoor t h e a t r e designed f o r 100 s p e c t a t o r s . The park w i l l a l s o be a r e t r e a t f o r those who need more q u i e t and secluded areas. They o c c a s i o n a l l y r e t r e a t t o these areas when they are i n a contemplative mood, want to take a walk without meeting o t h e r s , or need a change of scenery from t h e i r s m a l l apartment u n i t . An important aspect of r e t r e a t s i s t h a t they o f f e r a d d i t i o n a l c h o i c e s to o l d e r r e s i -dents. While the goal of r e t r e a t may be a q u i e t n i c e p l a c e , the process of g e t t i n g there may be j u s t as important to o l d e r r e s i d e n t s ( Z e i s e l 1977, p. 90). The CCC s i t e o f f e r s a v a r i e t y of o p p o r t u n i t i e s f o r r e s i d e n t s who want j u s t to walk on the grounds a t some d i s t a n c e from the housing, somewhat removed from s i g h t , who would l i k e to enjoy a n a t u r a l v i s t a to the North Shore Mountains. The program r a t i o -nale i s t h a t the park be designed as a t h e r a p e u t i c park. In order to meet the s o c i a l , p s y c h o l o g i c a l and environmental needs of the r e s i d e n t s the park: 1. w i l l o f f e r a v a r i e t y of nature environments such as rose garden, herb garden, p i c n i c areas with gazebo, ponds with water f e a t u r e s , ducks and geese. 225 2. w i l l maximize, p h y s i c a l and mental s t i m u l a t i o n by p r o v i d i n g v a r i e t y of walkway s u r f a c e s ( p r o s t h e t i c d e s i g n ) . For example, w e l l - t e x t u r e d s u r f a c e s allow r e s i d e n t s to f e e l the concrete under f o o t while reducing the p o s s i b i l i t y of s l i p p i n g . A wooden brid g e may heighten the a c c o u s t i c a l s t i m u l a t i o n of walking (Carsten 1985, p.110). 3. w i l l p r ovide f o r freedom of p h y s i c a l movement and at the same time w i l l secure p r o t e c t i o n . The Park w i l l be b a s i c a l -l y w i t h i n the CCC f a c i l i t y , but there w i l l be a connection with the e x i s t i n g J e r i c h o Park. A supplementary i s s u e I would l i k e to review b r i e f l y i s pet therapy. Recent s t u d i e s draw a t t e n t i o n to the b e n e f i t s of the simple presence of companion animals without any d i r e c t c o n t a c t (watching)(Katchner 1982). In my re s e a r c h paper on "Pet Therapy: P r e l i m i n a r y Research Study on E f f e c t i v e n e s s of Use of Animal L i v i n g outdoors w i t h i n I n s t i t u t i o n a l Environments", I found t h a t i n s p i t e of management d i f f i c u l t i e s , there was an i n t e r e s t among e l d e r l y r e s i d e n t s i n the model "zoo i d e a " on the grounds of a Long Term Care f a c i l i t y . One r e s i d e n t suggested roe-deer, peacocks or r a b b i t s as companions of the e l d e r l y r e s i d e n t s . At t h i s stage of program development I can onl y suggest a need i n the next phase to review the p o s s i b i l i t y of p r o v i d i n g c o n t a c t with animals. A design response to t h i s o b j e c t i v e could be, f o r example, a pond with f i s h and b i r d s such as ducks or geese. The area requirements f o r the CCC F a c i l i t y Common Areas are summarized i n the t a b l e 5-21. 226 Table 5 - 2 1 . - - F a c i l i t y Common Space Space Program TYPE OF ACTIVITY DIMENSIONS IN FT. FT.SQ. m2 AVERAGE No.OF PARTICIPANTS 1. Country Club -Bowling lawn ( e i g h t a l l e y s ) 120 X 120 14,400 1,234 32-64 Clock g o l f 30' ( c i r c l e ) 706 65 2-8 M i n i g o l f 87,120 8,015 2-8 Croquet 30 x 60 1,800 165 2-8 Horseshoes 12 x 50 (x2) 1,200 110 2-4 V o l l e y b a l l 50 x 80 (x2) 8,000 736 12-16 S h u f f l e b o a r d 10 x 54 (x3) 1,620 58 2 or 4 Badminton 25 x 60 1, 500 149 2 2. R e h a b i l i t a t i o n Herbs garden 1,600 150 Rose garden 1,600 150 Gymnastic lawn 1,600 150 3. Garden Centre Garden p l o t s 10 x 15 10,000 920 f o r 50 r e s . 4. Park Picnics-BBQ 3 acres 130,680 150 s e v e r a l r e t r e a t s . w i t h i n park Outdoor t h e a t r e 1,600 150 1.5 m2/ pers TOTAL: 260,300 = 6 acres References: Carstens 1985, p.113 De C h i a r a , Joseph and Lee E. Koppelman. S i t e Planning Standards. 1978. 227 3. GARDEN CENTRE P I C K BBQ. EXPL. RETR. 2. fcEHABIL TATION GYN\. GARD4 LAWN HORT-THER. OUTbOOt THEATRE 4.PARK ; = L -IREHAB1UT-I CENTRE I I T I N D E P LIVING* X N T E R M . C A R E E X T E N D C A R E I h j A U D I T O R , I - {PROGRAMS j I MAIN I CON COURSE i -t 1 PUBLIC caoa. BOWL. MINI VOLLEY BA>M. GOLF BALL 1. C O U N T R Y C L U B F i g . 5-24 Common Outdoor Space 228 5.6. PARKING AND ROAD NETWORK WITHIN THE FACILITY  Purpose To provide an organized and c o n t r o l l e d system f o r accommo-d a t i n g the v e h i c u l a r movement and pa r k i n g demands of the housing and long term care c l u s t e r s s t a f f and v i s i t o r s . Short term s e r v i c e p a r k i n g f o r c a r s , vans, t r u c k s making d e l i v e r y to the f a c i l i t y . F u n c t i o n a l D e s c r i p t i o n : A l l p a r k i n g areas w i l l be c l e a r l y i d e n t i f i e d f o r designated use and ease of access. R e s i d e n t i a l p a r k i n g w i l l be i n c o r p o r a t e d i n t o the Independent L i v i n g c l u s t e r area. S t a f f p a r k i n g w i l l be separated and l o c a t e d c l o s e t o a s t a f f main e n t r y . P u b l i c Park-in g w i l l p r o v i d e a d i r e c t access to the Core Centre. S e r v i c e p a r k i n g w i l l p r ovide a d i r e c t access to the s h i p p i n g / r e c e i v i n g area i n the Core Centre. 229 Table 5 - 2 2 . — P a r k i n g Areas Program COMPONENT NO OF PARKING SPACES AREA REMARKS Ind. L i v i n g Housing a. R e n t a l Housing b. Co-op Housing c. S t r a t a - T i t l e V i s i t o r s I.C. F a c i l i t y B.C. F a c i l i t y Core Centre S t a f f Approximately 16 50 75 50 19 18 50 424.0 m2 1,325.0 m2 1,987.0 m2 1,325.0 m2 503.5 m2 477.0 m2 1,325.0 m2 1 space each 6 u n i t s 1 space each dw. u n i t 1.5 space each dw. u n i t 25% of r e q u i r e d number of spaces TOTAL: 253 7,366.5 m2 References: C i t y of Vancouver Pa r k i n g By-Law: 1 space per 6 u n i t s i n BCMHC Housing. 1 space per 1 S t r a t a T i t l e or Co-op Houisng 1 space per 37 m2 s l e e p i n g area i n the IC f a c i l i t y 1 space per 2 beds or f o r each 93 m2 gross area i n the EC f a c i l i t y . 1 space f o r each 18.6 m2 of assembly area i n the Core Centre. 230 CHAPTER 6 - FEASIBILITY OF PROGRAM IMPLEMENTATION ON THE  SELECTED SITE: THESIS CONCLUSION: Chapter Summary: Chapter 6 c o n c e n t r a t e s on the f e a s i b i l i t y of implementing the F a c i l i t y Program on the s e l e c t e d t e s t s i t e . The e v a l u a t i o n has been based on o p p o r t u n i t i e s and c o n s t r a i n t s a s s o c i a t e d with the t e s t s i t e and how they a f f e c t program implementation. Guide-l i n e s and recommmendations are l i s t e d as to how the program o b j e c t i v e s c o u l d be met. The housing development o p t i o n s have been presented i n the form of f o u r p a t t e r n s . The Chapter concludes with f i n d i n g s and the T h e s i s C o n c l u s i o n . EVALUATION #1: S i t e L o c a t i o n and S i z e . 6.1.1 RATIONALE St u d i e s have shown t h a t the l o c a t i o n of f a c i l i t i e s a f f e c t s the e l d e r l y ' s happiness, mental w e l l - b e i n g and even h e a l t h . For o l d e r people the a v a i l a b i l i t y of neighbourhood s u p p o r t i v e s e r v i c e s may make the d i f f e r e n c e between a p o s i t i v e and negative outcome or even between remaining i n the community and becoming i n s t i t u t i o n a l i z e d (Lawton 1986, p.51). In order to s a t i s f y the e l d e r l y ' s p s y c h o l o g i c a l and p h y s i c a l needs the most important c r i t e r i o n f o r e v a l u a t i n g a s i t e i s a c c e s s i b i l i t y to d e s i r e d s e r v i c e s and f a c i l i t i e s . Table 6-1 p r o v i d e s data from s e v e r a l s t u d i e s (Lawton 1986) and i n d i c a t e s the v a r i e t y of l i f e Table 6-1 Uses of Resources, T r a v e l Time and Di s t a n c e t o Resources. Resource Median % using Modal frequency of use (users) Modal frequency of use (all) Modal travel time (users) Modal use distance1" Modal nearest distance" Grocery 87 2/week 1 or 2/week 7 min. 1-3 blocks 1-3 blocks Physician 86 several/year several/year IS min. >20 blocks 4-10 blocks Visit one or more children 98- 1/week 1/week to never 20 min. < 10 blocks Shopping other than grocery 70 1 or 2/month never Church 67 1/week 1/week 12 min. 4-6 blocks Bank 64 1/month 4-6 blocks 4-10 blocks Visit friends 61 2 or 3/weck never 7 min. 4-6 blocks Visit relatives other than children 57 several/year never 35 min. Beauty/barber shop 40 1-3 blocks Restaurant 31 several/year >20 blocks 1-3 blocks Park 30 1-3 blocks Clubs, meetings 29 1/month never 15 min. >20 blocks Entertainment 19 1/month never 20 min. >20 blocks > 11 blocks Library 18 > 11 blocks •Data derived from estimates by Bourg (1975), Cantor (1975). Carp( 1974,1975c). Lawton and Nahemow( 1975), and Nahemow and Kogan (1971) unless otherwise noted. •"Cantor (in press). New York City poverty-area residents. 'Newcomer (1976), public housing tenants. From Handbook of the Psychology of Aging, edited by James E. Birren and K. Warner Schaie. O 1977 by Litton Educational Publishing, Inc. Reprinted by permission of Van Nostrand Reinhold Company. Source: Lawton, Powell M. Environment and Aging. 1986, Table 2-6. p. 41. 232 s u p p o r t i n g , l i f e e n r i c h i n g and s o c i a l r esources used by the m a j o r i t y of independent o l d e r people. I t can be seen t h a t t w o - t h i r d s or more shop a t a grocery s t o r e , do r e g u l a r shopping, v i s i t c h i l d r e n and atte n d church. Almost a l l v i s i t a p h y s i c i a n and over 40% never v i s i t f r i e n d s , but those who do, v i s i t very f r e q u e n t l y . For most of these resources frequency of use was a s s o c i a t e d with d i s t a n c e . Since many e l d e r l y people may no longer own a car or can not d r i v e one, walking i s the e a s i e s t and l e a s t expensive means of t r a n s p o r t a t i o n . Distance i s t h e r e f o r e a c r i t i c a l f a c t o r . A c c o r d i n g to data p r o v i d e d by CMHC "Housing the E l d e r l y " 1983, p.32 there i s a s c a l e of importance f o r community f a c i l i t i e s and c r i t i c a l d i s t a n c e s p e r c e i v e d by o l d e r people: 1. Grocery Store - 2-3 b l o c k s (240-360 m) 2. Bus Stop - 1-2 b l o c k s (120-240 m) 3. Church - 400-800 m 4. Drug Store - 3 b l o c k s (360 m) 5. C l i n i c or H o s p i t a l - 400-800 m 6. Bank - 400 m 7. S o c i a l Center - 360 m 8. L i b r a r y -1600 m St u d i e s have shown (Lawton 1988; CMHC 1988) t h a t the best l o c a t i o n f o r e l d e r l y l i v i n g i s a c e n t r a l urban s i t e t h a t i s con-v e n i e n t to community s e r v i c e s and amenities and a l s o has a low l e v e l of t r a f f i c and c i t y n o i s e . The main f a c t o r i n l o c a t i o n of 233 housing f o r the e l d e r l y i s p r o x i m i t y to "where the a c t i o n i s " : shops, h e a l t h and s o c i a l s e r v i c e s and areas of i n t e r e s t . I d e a l -l y , the e l d e r l y r e s i d e n t s should l i v e w i t h i n two block walking d i s t a n c e of a c t i v i t y c e n t e r s and p u b l i c t r a n s p o r t a t i o n . A good l o c a t i o n f e a t u r e s the f u r t h e r advantage of being a c c e s s i b l e to v i s i t i n g f r i e n d s and r e l a t i v e s . Easy access to p u b l i c t r a n s -p o r t a t i o n and downtown amenities allows r e s i d e n t s to continue being a c t i v e members of the community. 6.1.2 LOCATION (see F i g . 6-1) The " F e d e r a l N a t i o n a l Defence Lands" s i t e comprises 51.47 acres of land and i s l o c a t e d w i t h i n the West P o i n t Grey area and has an unique s e t t i n g i n Vancouver c l o s e to J e r i c h o Beach. The s i t e i s bounded to the north by 4th Avenue; to the south by 8th Avenue; to the east by Highbury S t r e e t and to the west by J e r i c h o H i l l School. While zoned at present RS-1, the s i t e i s a s u b j e c t of many ideas f o r p o t e n t i a l f u t u r e development. The Vancouver P l a n n i n g Department, however, recommended t h i s s i t e as an i d e a l background f o r my t h e s i s becouse i t has a p o t e n t i a l f o r an e l d e r l y f a c i l i t y which can maintain l i v a b i l i t y , p r i v a c y and a sense of community by: 1. r e d u c i n g s i t e coverage when an o p p o r t u n i t y e x i s t s to provide more useable and v i s u a l l y i n t e r e s t i n g open space or to open up q u a l i t y views from the CCC Community. 2. p r o v i d i n g e n c l o s u r e elements such as w a l l s and p l a n t i n g f o r the p o r t i o n of the s u b j e c t s i t e with lower s i t e coverage 234 F i g . 6-1 L o c a t i o n and S i z e 235 where there i s a need f o r continuous w a l l s and s t r e e t d e f i n i -t i o n , f o r example along 8th Avenue. 3. emphasizing the main entrance to the Core Centre. 4. p r o v i d i n g b u i l d i n g s i n c l u s t e r s , t h a t are compatible with the o v e r a l l neighbourhood c h a r a c t e r , maintain s t r e e t rhythm and c r e a t e useable open space. Although there has been c o n s i d e r a b l e d i s c u s s i o n s on a need to preserve Vancouver's s i n g l e f a m i l y neighbourhoods, there i s a growing need f o r new forms of housing on the West Side of Vancouver, which would allow people to s t a y i n t h e i r own neighbourhoods, when t h e i r s i n g l e f a m i l y houses are no longer s u i t a b l e . Moreover, the p o p u l a t i o n of t h i s area i s growing o l d e r and c r e a t e s a new need f o r a supply of necessary h e a l t h care s e r v i c e s . 6.1.3 OPPORTUNITIES The s u b j e c t s i t e would make a p e r f e c t p l a c e f o r the f u t u r e development of m u l t i - f a m i l y housing as w e l l as a f a c i l i t y f o r s e n i o r s . The P l a n n i n g Department suggests F.S.R. = 1.00 and r e q u i r e s t h a t new development be compatible with the surrounding area i n f l u e n c e d b a s i c a l l y by apartment developments and s i n g l e f a m i l y housing. T h i s s i t e o f f e r s s e v e r a l advantages such as l o c a t i o n i n the core of the P o i n t Grey r e s i d e n t i a l area, easy access to shopping and community s e r v i c e s , walking d i s t a n c e to park and p u b l i c r e c r e a t i o n a l f a c i l i t i e s as w e l l as p r o x i m i t y to U.B.C. 236 6.1.4 CONSTRAINTS E x i s t i n g heavy t r a f f i c on 4th Avenue causes noise and p o l l u t i o n . S e v e r a l measures may be recommended at t h i s stage of program development i n order to minimize the p o t e n t i a l noise impact from 4th Avenue, as f o l l o w s : 1. L o c a t i n g r e s i d e n t i a l p a r t of CCC away from the noise source. 2. Using landscape treatment to help m i t i g a t e noise impacts-green b u f f e r zone. 3. Using m a t e r i a l c o n s t r u c t i o n methods t h a t l i m i t noise t r a n s m i s s i o n such as laminated double g l a z i n g . 4. L o c a t i n g areas not a f f e c t e d by noise such as c o r r i d o r s -"promenades" to c r e a t e noise b u f f e r . 6.1.5 CONCLUSION The b e a u t i f u l s e t t i n g and vast land ensures t h a t the CCC f a c i l i t y may maintain l i v a b i l i t y and p r i v a c y by p r o v i d i n g a v a r i e t y of space o p t i o n s from s i n g l e f a m i l y housing to the m u l t i p l e - u n i t housing and commensurate s u f f i c i e n t , v i s u a l l y i n t e r e s t i n g open outdoor areas. The s i z e of the s i t e and type of development a f f e c t the s i t e - p l a n n i n g p a t t e r n . In keeping with the recommendations of the C i t y P lanning Department, the CCC should be a l o w - r i s e development compatible with the surrounding neighbourhoods (see F i g . 6-1) (RSI - on the South; RM - on the East and North). 237 EVALUATION #2: Land Use Context (see F i g . 6-2) 6.2.1 OPORTUNITIES a. A v a i l a b l e s e r v i c e s On the c o rner of 4th Avenue and Highbury S t r e e t , there i s r e c e n t l y b u i l t commercial complex - J e r i c h o M a l l with l a r g e Grocery, Drug Mart and other r e t a i l and s e r v i c e o u t l e t s . Beside t h a t , i n c l o s e p r o x i m i t y , there are two shopping and s e r v i c e s areas. The f i r s t : on 4th Avenue to the e a s t of Alma S t r e e t which i s comprised of the Bank of Montreal, r e s t a u r a n t s , s e v e r a l boutiques and shops. The second: developed around the i n t e r -s e c t i o n s of Alma S t r e e t and Broadway and 10th Avenue. I t i n c l u -des a new r e t a i l m a l l and a v a r i e t y of r e t a i l o u t l e t s i n c l u d i n g the Bank of Nova S c o t i a and a post o f f i c e . Near the c o rner of Broadway and Alma S t r e e t , there i s the Canadian Legion B u i l d i n g which serves many of s e n i o r s c u r r e n t l y l i v i n g i n t h a t area. b. R e c r e a t i o n a l Amenities F u r t h e r to the n o r t h , there i s J e r i c h o Beach Park and a v a r i e t y of r e c r e a t i o n a l amenities i n c l u d i n g J e r i c h o Beach, the J e r i c h o Tennis Club, the Royal Vancouver Yacht Club, Museum, and Brock House S e n i o r s Centre, which serves the growing s e n i o r s ' p o p u l a t i o n w i t h i n the P o i n t Grey communities and those l i v i n g i n the Vancouver West Side. 6.2.2 CONSTRAINTS Although the F a c i l i t y Program p r o v i d e s f o r e x t e n s i v e , s p e c i a l l y designed Outdoor Spaces w i t h i n the s u b j e c t s i t e , 238 »•»/»«« f^aprm: D G O D O O O O 4th A v e . 3 D O D D D Q D C D D O D ' h b D O D o b b b a D ' a b l * > i . . * : "iSCHCW ! \S F i g . 6-2 Land Use Context 239 n e v e r t h e l e s s the p r o x i m i t y of J e r i c h o Beach Park and J e r i c h o Beach would a f f e c t the p h y s i c a l and p s y c h o l o g i c a l need of the CCC r e s i d e n t s . T h i s i s a very important f e a t u r e , s p e c i a l l y f o r the independently l i v i n g s e n i o r s , able and w i l l i n g to purchase t h e i r u n i t s . T h e r e f o r e , a l i n k should be p r o v i d e d between the new f a c i l i t y and the r e c r e a t i o n a l area on J e r i c h o Beach. T h i s l i n k c o u l d be a wide bridge o n l y f o r p e d e s t r i a n s or a tunnel (both of course handicapped a c c e s s i b l e ) . Option #1; Wide bridge with landscaping 1. I t most s u c c e s s f u l l y extends the v i s u a l c o n t i n u i t y of the CCC to J e r i c h o Beach. 2. I t appears, from the road, to be a s u b s t a n t i a l l i n k to the two p a r t s . 3. I t allows f o r viewing the mountains on the North Shore. 4. I t i s a safe and convenient p e d e s t r i a n connection. 5. T r a f f i c volumes on 4th Avenue are u n a f f e c t e d . Option #2: Tunnel 1. The tunnel c o u l d c r e a t e a s e c u r i t y problem. 2. There would be an i n t e r r u p t i o n to t r a f f i c , while the tunnel was being c o n s t r u c t e d . 3. The f e e l i n g of connection between two p a r t s would not be so apparent. 4. Viewing p o t e n t i a l s while walking are e l i m i n a t e d . The l e s s expensive s o l u t i o n would be a p e d e s t r i a n c r o s s i n g , but 240 very i n c o n v e n i e n t f o r the e l d e r l y i n wheelchairs and handicapped persons. 6.2.3. CONCLUSION A v a i l a b i l i t y of s e v e r a l b a s i c s e r v i c e s w i t h i n the walking d i s t a n c e and p r o x i m i t y to the r e c r e a t i o n a l amenities on J e r i c h o Beach w i l l s a t i s f y p s y c h o l o g i c a l and p h y s i c a l needs of the CCC r e s i d e n t s l i v i n g independently. P r o x i m i t y to U n i v e r s i t y H o s p i t a l UBC S i t e , acute care f a c i l i t y , w i l l be an a s s e t f o r the CCC long term care r e s i d e n t s . T r a n s f e r to t h i s f a c i l i t y by ambulance or other form of t r a n s p o r t a t i o n w i l l a l s o be r e q u i r e d f o r such s e r v i c e s as r a d i o l o g i c a l examinations and l a b o r a t o r y procedures as w e l l as f o r p a t i e n t admissions f o r acute medical, s u r g i c a l or p s y c h i a t r i c c o n d i t i o n s . The CCC f a c i l i t y l o c a t i o n w i t h i n walking d i s t a n c e to neighbourhood r e s i d e n t i a l areas, s p e c i a l l y to the surrounding housing o r i e n t e d to the e l d e r l y , w i l l encourage p o t e n t i a l v i s i t o r s to p a r t i c i p a t e i n the Core Centre programs and a c t i v i t i e s . The long term care f a c i l i t y , Day Care and Re s p i t e Care w i l l be very convenient f o r the f u t u r e r e s i d e n t s , p a r t i c i p a n t s and t h e i r f a m i l i e s . EVALUATION #3: P u b l i c T r a n s p o r t a t i o n , V e h i c u l a r and P e d e s t r i a n Access. 6.3.1 OPPORTUNITIES a. P u b l i c T r a n s p o r t a t i o n (see F i g . 6-3) There are two easy accesses to p u b l i c t r a n s p o r t a t i o n , which 241 provide connection with the surrounding areas, K i t s i l a n o , Dunbar, K e r r i s d a l e , Downtown and UBC. The f i r s t i s on 4th Avenue with a bus stop on the north boundary of the s i t e . The second access i s l o c a t e d f u r t h e r to the south, on Broadway S t r e e t . b. V e h i c u l a r Access: (see F i g . 6-3) The present v e h i c u l a r access to the s u b j e c t s i t e i s provided from Highbury S t r e e t (three e n t r a n c e s ) , from 8th Avenue (one en t r a n c e ) , and from 4th Avenue, i n the western p a r t of the s i t e (two e n t r a n c e s ) . c. P e d e s t r i a n Access: (see F i g . 6-4) P e d e s t r i a n movement from the s u b j e c t s i t e w i l l be i n two d i r e c t i o n s : the f i r s t , to the 4th Avenue and s e r v i c e area, bus stops and J e r i c h o r e c r e a t i o n a l amenities and the second, to the Broadway shopping area and bus stops. P e d e s t r i a n access to the s i t e should be provided from 4th Avenue (The Core Centre) and 8th Avenue. Since the e x i s t i n g v e h i c u l a r t r a f f i c on 4th Avenue w i l l o b s t r u c t p e d e s t r i a n movement to J e r i c h o Park a l i n k (pedes-t r i a n overpass) between the new f a c i l i t y and the r e c r e a t i o n a l area should be provided as i n d i c a t e d i n E v a l u a t i o n #2. P u b l i c access to the Core Centre should be e a s i l y i d e n t i f i e d from 4th Avenue. 6.3.2. CONSTRAINTS: HEAVY VEHICULAR TRAFFIC The s u b j e c t s i t e i s bounded by a major a r t e r i a l route 4th Avenue with very heavy t r a f f i c and l o c a l d i s t r i b u t o r s Highbury tjoJTTinrinrTai p MOULD DDTjxnpong . QLIGOLTjq <l i i : . ! • IrPI ; LQ_ I'll I ILLMLLU |J|TinT I I I I I I I I I 1 ' I I I I i i I I I ! ' 1 i I—1 I i-J_'_!_l_L.I 1 1 1 1 LLLUO K F i g . 6-3 P u b l i c T r a n s p o r t a t i o n and V e h i c u l a r Access 243 ''ttEJoOpa d=- • i: i M F H , ; i n ' . ! » 4 W T ; !11 11 » I I I I I I I I I » I I I I ' I I I ! i I : I 1 I ~ l ' 1 I I I " I I ' I I I T l h ^ J ^ J j P in rnoDonrCxn F i g . 6-4 P e d e s t r i a n Access 244 S t r e e t and 8th Avenue. The C i t y E n g i n e e r i n g Department does not have re c e n t t r a f f i c data on 4th Avenue; however, the a v a i l a b l e 1981 and 1982 data i n d i c a t e d t h a t the v e h i c u l a r t r a f f i c has a grea t impact on the q u a l i t y of l i f e i n the development along 4th Avenue. In the rush hours, f o r example, between 4 P.M. and 6 P.M. outbound volumes away from the c i t y c e n t r e comprised 1000 v e h i c l e s and i n the morning between 7 A.M. and 9 A.M. inbound volumes towards the c i t y centre comprised 800 v e h i c l e s . Other i n f o r m a t i o n from Automatic T r a f f i c Counts: 1976-1985 ( s e a s o n a l l y & d a i l y a d j u s t e d data) p r o v i d e s even more dramatic data. For example, i n rush hours between 7-9 A.M. outbound volumes away from the c i t y centre towards UBC amounted to a maximum of 2095 v e h i c l e s , while i n rush hours between 4-6 P.M on l y maximum 1045 v e h i c l e s . On the other hand, the inbound volumes towards the c i t y c e n t r e between 7-9 A.M. amounted to a maximum of 808 v e h i c l e s , while i n rush hours between 4-6 P.M. i t amounted to maximum of 2380 v e h i c l e s . These data i n d i c a t e tremendous t r a f f i c flow i n the d i r e c t i o n of UBC Campus. Other data from the C i t y ' s E n g i n e e r i n g Department i n d i c a t e a s e r i o u s problem with the number of l e f t turns made from Alma S t r e e t to West 4th Avenue. T h i s i n t e r s e c t i o n i s extremely congested ( e s p e c i a l l y i n summer time), because of i t s access to the beach as w e l l as to the UBC. The problem with l e f t t u r n can a l s o appear on the i n t e r s e c t i o n of 4th Avenue and Highbury S t r e e t . In order to reduce the heavy t r a f f i c on 4th Avenue and provide easy access to the s i t e the C i t y has recommended an access to the s u b j e c t s i t e from Highbury S t r e e t through S i x t h 245 Avenue. Moreover, i n g r e s s and egress to the p a r k i n g area must balance the impact on a r t e r i a l volumes and a b u t t i n g r e s i d e n t i a l p r o p e r t i e s . A l l e x i s t i n g p a r k i n g i n the neighbourhood occurs e i t h e r on the s t r e e t s , i n the f r o n t yards, or garages l o c a t e d on the s i d e , or r e a r yards. When c o n s i d e r i n g s e n i o r s o r i e n t e d housing, the i s s u e of p a r k i n g o f t e n a r i s e s . 6.3.3 CONCLUSION Easy access to p u b l i c t r a n s p o r t a t i o n w i l l a llow the CCC r e s i -dents to continue to take an a c t i v e p a r t i n the community. S t a f f and s e n i o r s l i v i n g i n the community, but a t t e n d i n g o n - s i t e program may be u s i n g p u b l i c t r a n s p o r a t i o n , t h e r e f o r e an easy access to t h i s s e r v i c e w i l l be an a s s e t . I t i s l i k e l y t h a t v i s i t o r s to the e l d e r l y r e s i d e n t s w i l l r e l y on p u b l i c t r a n s p o r t a -t i o n as w e l l . V e h i c u l a r Access - Each major component of the CCC w i l l have i t s own e x t e r n a l access. In order to reduce the heavy t r a f f i c on 4th Avenue and a v o i d congestion of t r a f f i c on the i n t e r s e c -t i o n of 4th Avenue and Highbury ( l e f t t u r n ) , the main v e h i c u l a r access to the s i t e should be provided from Highbury S t r e e t through S i x Avenue a c c o r d i n g to recommendation of the C i t y E n g i n e e r i n g Department. T h i s access should be provided as a s e r v i c e access to the Core Centre f a c i l i t i e s i n c o n j u n c t i o n with p a r k i n g f o r v i s i t o r s . P a r k i n g should be s i t u a t e d c l o s e to the main entrance to pre-clude v i s i t o r s from e n t e r i n g the f a c i l i t y through unauthorized 246 ro u t e s . Space p r o v i s i o n should be provided f o r the f u t u r e expansion of the parking area. The CCC development should employ a l s o e x i s t i n g v e h i c u l a r access from 8th Avenue to the independent housing r e s i d e n t i a l c l u s t e r s . The e x i s t i n g access from 4th Avenue should remain as an access to the long term care f a c i l i t i e s keeping i n mind the e a s i e s t c o n n e c t i o n with the H o s p i t a l and the UBC Campus. EVALUATION #4: S i t e P h y s i c a l C h a r a c t e r i s t i c . 6.4.1. OPPORTUNITIES: SITE NATURAL RESOURCES a. Topography (see F i g . 6-5) The s i t e s l o p e s from the southwest to the n o r t h e a s t . There i s approximately a 120 f o o t change i n e l e v a t i o n across the sub-j e c t s i t e . The e l e v a t i o n r i s e s from 110 f e e t to 230 f e e t . How-ever, the s t e e p e s t p a r t of the s i t e i s l o c a t e d i n the southwest, where there i s almost an 8% slope. The n o r t h e a s t p a r t of the s i t e i s almost f l a t where the e l e v a t i o n r i s e s approximately 20' and the slope doesn't exceed 2%. b. V e g e t a t i o n and Landscaping: (see F i g . 6-6) The s u b j e c t s i t e i s a v a s t , green area i n P o i n t Grey. In the western p a r t of the s i t e , there i s a s u b s t a n t i a l q u a n t i t y of deciduous t r e e s , which provide a n a t u r a l b u f f e r zone from the adjacent J e r i c h o H i l l School and J u s t i c e I n s t i t u t e . Along 4th Avenue, there i s an e x i s t i n g green b u f f e r with deciduous t r e e s t h a t p r o v i d e s a b a r r i e r from the n o i s y 4th Avenue. Close to the i n t e r s e c t i o n of 4th Avenue and Highbury S t r e e t , there i s a beau 247 •B*ACH PARK i WEST PART • i i i i i i i i i • L. DOULIULIDp I > I I I I I I I ! ! I • Q D D ' D D • D O ' O D D ' E U I A 1 1 U C O O * 3 /Vo'obbbbb I ' 1 i i I I 4th A v e . M 1 » • I I I I « I ! J C b G D O D O C O D D O O D J D D U D O r-r-. • ! i i i . i i [^•^•.••OCJDpOD I i t I I i i •JLTODci 1 H ^ o c f a b D q g ^ ' i [i—innr. M v . i t rouunt AV •b|Dlp|p|D|ab|irj| j C IC HT M AVI i • c EEEEB . TTJ • T W O * tnrn* trvn* , T f»T» ^ » : u ^ r . i t u - u _ i i . . ' j - m . i j . u _ ' i.u J i l l i 11111 i i i H I 111 L.-i. i I L I i : I U.JT'l ' l F i g . 6-5 S i t e Topography V A. 248 & n ^ BEACH PARK U spaoppapa ^ era. o| [opoauiaoq lumrmrmai pcodii ' I ' l l »*t ( k l / O I I tICCMC * v t •CDDDDOD! s imo^ cSoCT : fctcraQpa: O D D O D D D D D D D O D [ * • D D D o p r j D f • • • • • • U U L 4th Ave ' SCHCJ i M 1 o o j r J d Q d ^ jggrjJrJL^U! S3 DCTJQOC3, I I I I I . FTL , . . . lDXDDtlrCDOQ TTTTT "1 ( I I I I I I I : I mm Hi nl 1 i 1 1 I 1 ' t i LLLLL L l-l I r a ' o i a o c n ! mt ^TTTl i n II. ,!HI1!! X O D D D : ~ ^ j P C O in mrtrrml F i g . 6-6 Ve g e t a t i o n and Landscaping 249 t i f u l a l l e y with many f e a t u r e t r e e s t h a t c r o s s the s i t e d i a g o n a l -l y on the east-west a x i s . The new CCC development has a p o t e n t i a l to emphasize n a t u r a l beauty of the s i t e through la n d s c a p i n g t h a t c r e a t e s v i s u a l i n t e r e s t and i d e n t i t y . T h i s can be achieved by: 1. R e i n f o r c i n g and i n t e g r a t i n g with the p a t t e r n and c h a r a c t e r of the e x i s t i n g l a n d s c a p i n g . 2. Provide l a n d s c a p i n g with a v a r i e t y of f l o w e r i n g shrubs, p e r e n n i a l s and t r e e s ; to be a t t r a c t i v e i n a l l f o u r seasons of the year. 3. R e t a i n i n g e x i s t i n g mature t r e e s e s p e c i a l l y i n the a l l e y a t the i n t e r s e c t i o n of 4th Avenue and Highbury S t r e e t . 4. I n c o r p o r a t i n g s p e c i a l open space f e a t u r e s such as ponds, f o u n t a i n s , arches, arbours to c r e a t e v i s u a l i n t e r e s t along the s t r e e t edge. 5. I n c o r p o r a t i n g l i g h t i n g i n t o l a n d s c a p i n g to c r e a t e an a t t r a c t i v e n i g h t - t i m e appearance and i l l u m i n a t i n g a l l major walkways to allow safe use a t n i g h t . c. "Green O a s i s " i n the P o i n t Grey Area The F e d e r a l N a t i o n a l Defence Lands s i t e as can be seen now i s a l a r g e green open space i n the Community. The proposed CCC f a c i l i -t y w i l l t ransform the land i n t o a medium d e n s i t y development but with an abundance of open spaces a c c e s s i b l e to a l l : r e s i d e n t s of the f a c i l i t y , the neighbourhood as a whole and the general p u b l i c . The proposed open spaces s h a l l c o n t r i b u t e to the neigh-bourhood i d e n t i t y by: 250 1. C r e a t i n g l a r g e continous open space r a t h e r than a s e r i e s of s m a l l e r i s o l a t e d spaces. 2. L i n k i n g the open spaces with J e r i c h o Park. 3. C r e a t i n g a gradual t r a n s i t i o n from the p u b l i c realm of the s t r e e t to the p r i v a t e realm of the i n d i v i d u a l u n i t . 4. P r o v i d i n g common (shared by r e s i d e n t s ) open space i n the form of c o u r t yards. 5. M i n i m i z i n g the use of high, s o l i d fences along the s t r e e t edge. P r i v a c y f e n c i n g or l a n d s c a p i n g s c r e e n i n g should allow c o n t i n u i t y of open spaces between c l u s t e r s . 6. P r i v a t e open spaces s h a l l be d i r e c t l y a c c e s s i b l e from each u n i t i n the form of a p a t i o or balcony. Ground l e v e l p r i v a t e open space s h a l l be d e f i n e d by s c r e e n i n g or l a n d s c a p i n g . 7. On the sloped p a r t of the s i t e along 8th Avenue open space should be t e r r a c e d to complement e x i s t i n g topography and landscape. 6.4.2 CONSTRAINTS The south-west p o r t i o n of the s i t e along 8th Avenue shows a very steep slope approx. 8%, which a f f e c t s any r e s i d e n t i a l , b a r r i e r - f r e e design f o r the e l d e r l y . The CCC development should concentrate i n the north e a s t e r n p o r t i o n of the s i t e to f a c i l i -t a t e r e s i d e n t s walking without hazards. 6.4.3 CONCLUSION The s i t e p r o v i d e s an o p p o r t u n i t y to c r e a t e a l a r g e c o n t i n 251 uous open space, which can be l i n k e d with J e r i c h o Park. T h i s c e n t r a l open space should be designed f o r the Country Club f a c i l i t i e s and Park. The e x i s t i n g t r e e s , e s p e c i a l l y i n the a l l e y , important f e a t u r e of the s i t e , should be preserved i n the f u t u r e development to cr e a t e v i s u a l i n t e r e s t and enhance q u a l i t y of the CCC p r i v a t e and common open space. EVALUATION #5: Space Character and Views 6.5.1 OPPORTUNITIES a. Massing S c a l e and Housing Character In keeping with the recommendations of the C i t y P lanning Department, the CCC should be a l o w - r i s e development compatible with the surrounding neighbourhoods (RS-on the South; RM-on the east and n o r t h ) . South of 8th Avenue and west of Highbury i s the edge of the West P o i n t Grey s i n g l e f a m i l y neighbourhood. To the east of Highbury S t r e e t , there i s a m u l t i - f a m i l y housing zoned RM-3A1, which i n c l u d e s a new development of condominiums f o r o l d e r a d u l t s . On the corner of 4th Avenue and Highbury S t r e e t , there i s an 11-storey r e s i d e n t i a l b u i l d i n g under c o n s t r u c t i o n ( a d u l t o r i e n t e d ) . To the nor t h , there i s m u l t i - f a m i l y housing zoned RM-3A, which comprises a l s o the r e n t a l housing f o r the e l d e r l y : b. P u b l i c and P r i v a t e Views; (see F i g . 6-7) There are onl y l i m i t e d p u b l i c and p r i v a t e views i n the area due to the topography and e x i s t i n g t r e e s on the s i t e . The p r i v a t e view on the s u b j e c t s i t e i s only a v a i l a b l e i n the 252 piqirimj.Di pcorfuu rr*v —n „ ————— C=PLT: i d ! - T T T T T .pnxiai • , _ . 1 1 1 ! 1 1 1 1 scna i ! 1 • PublliCr V I •XrVLrj i i - • . , — 3 , OqXP= 11 i 11 i i 11' m ' I I I I . . . , D a D t ± t t E D Q D c n l . i 3 : : : E B y • T T T . oocrDC "nxiJ * !1111 ' I roan ~i i l i i i i i i ' i T n — I ( 1 ! i I I' n i i m t-,, • • J J P J I in r r o c t r r c a l F i g . 6-7 P u b l i c and P r i v a t e Views 253 the southern p a r t of the s i t e (the h i g h e s t p o i n t ) and i n the northwest p a r t of the s i t e where i s a view of the mountains and J e r i c h o Park. The major p u b l i c view c o r r i d o r e x i s t s along Highbury S t r e e t , l o o k i n g n o r t h . The CCC development should ensure t h a t these views are preserved. T h i s can be achieved by: 1. S i t i n g the b u i l d i n g mass away from the p o t e n t i a l view c o r r i d o r s . 2. L i m i t i n g b u i l d i n g mass where i t blocks s i g n i f i c a n t views from adjacent b u i l d i n g s - e s p e c i a l l y i n the south p a r t of the s i t e . 3. L i n k i n g open spaces to extend the new depth. 4. L o c a t i n g landscaped open spaces c l o s e to windows i n u n i t s with l i m i t e d o p p o r t u n i t i e s f o r d i s t a n c e views. 6.5.2 CONSTRAINTS: COMPATIBILITY WITH NEIGHBOURHOOD The e x i s t i n g apartment b u i l d i n g s along 4th Avenue and Highbury S t r e e t are 3 s t o r e y b u i l d i n g s , which have no s p e c i a l a r c h i t e c t u r a l merit. Along 8th Avenue, there are one or two st o r e y o l d e r houses b u i l t as s i n g l e f a m i l y homes. 6.5.3 CONCLUSION In keeping with the community o b j e c t i v e (Chapter 3), N.D.O. #2, the new development on the s u b j e c t s i t e should achieve v i s u a l c o m p a t i b i l i t y with the surrounding housing. In terms of o v e r a l l massing, a new development should provide massing o p t i o n s from s i n g l e f a m i l y homes to m u l t i p l e - u n i t housing. The 254 f o l l o w i n g g u i d e l i n e s are recommended: 1. S i n g l e f a m i l y housing forms i n the area adjacent to one f a m i l y detached houses, 1-2 s t o r e y high. 2. Apartment b u i l d i n g forms along Highbury S t r e e t compatible with the new apartment b u i l d i n g s now under c o n s t r u c t i o n . While some f l a t r o o f s a l r e a d y e x i s t i n the apartment b u i l d -i n g s , the new b u i l d i n g s should r e i n f o r c e the " h o u s e - l i k e " c h a r a c t e r by p r o v i d i n g p i t c h e d r o o f s , dormers, chimneys and porches. 3. Emphasizing the c o n t i n u i t y of the commercial c h a r a c t e r of Alma S t r e e t and the 4th Avenue corner. The h e i g h t s should vary from 3 s t o r e y b u i l d i n g s along Highbury S t r e e t and 4th Avenue to 2-1 s t o r e y b u i l d i n g s along 8th Avenue. The CCC Independent L i v i n g r e n t a l (BCHMC) housing apartment b u i l d i n g , 3 s t o r e y height should be l o c a t e d along Highbury S t r e e t . One s t o r y h e i g h t co-op and s t r a t a t i t l e townhouses should be l o c a t e d along 8th Avenue. In keeping with the o b j e c t i v e N.D.O. #3, the Core Centre should be l o c a t e d on 4th Avenue c l o s e to Highbury S t r e e t i n order to maintain a more urban s t r e e t s c a p e c h a r a c t e r i n the north east p a r t of the s i t e . C o n s i d e r a t i o n should be given to the views from the new development. In keeping with o b j e c t i v e N.D.O. #4, the CCC development should p l a c e r e s i d e n t i a l long term care c l u s t e r i n the north-west p a r t of the s i t e to take advantage of a wonderful view of the North Shore Mountains and J e r i c h o Beach. In the southern p a r t of the s i t e the Independent L i v i n g c l u s t e r s should 255 permit b u i l d i n g mass to preserve the p r i v a t e view. EVALUATION #6: Housing P a t t e r n s (see F i g . 6-8, 6-9, 6-10, 6-11) 6.6.1 RATIONALE: Pa t t e r n s of Housing w i t h i n the Continuum of Care Complex may be based on e i t h e r s e p a r a t i o n of the o n - s i t e f a c i l i t i e s f o r r e s i d e n t s with d i f f e r e n t a b i l i t y l e v e l or i n t e g r a t i o n of such f a c i l i t i e s . Both s o l u t i o n s have advantages and disadvantages. A c c o r d i n g to Carstens (1985) s e v e r a l p o i n t s can be noted i n f a v o r of the s e p a r a t i o n p a t t e r n : 1. People tend n a t u r a l l y to group themselves. More able r e s i -dents p r e f e r not to mingle with the l e s s competent. 2. I n t e g r a t i o n of care f a c i l i t i e s with more independent l i v i n g may promote an " i n s t i t u t i o n a l " image r a t h e r than " r e s i d e n -t i a l " . 3. The s o c i a l c o s t of s e p a r a t i o n may be reduced by management p o l i c i e s t h a t encourage v o l u n t e e r i n t e r a c t i o n . In f a v o r of i n t e g r a t i o n p a t t e r n there are some su p p o r t i v e f a c t o r s : 1. A f i n a n c i a l r a t i o n a l e f a v o r s shared s e r v i c e s and f a c i l i t i e s . 2. I n t e g r a t i o n promotes s h a r i n g , mutual a s s i s t a n c e , s e l f - h e l p and a l s o p r o v i d e s a powerful o p p o r t u n i t y f o r s o c i a l l e a r n i n g . 3. Segregate f a c i l i t i e s o f t e n r e q u i r e the eventual movement of r e s i d e n t s and the s e p a r a t i o n of spouses and f r i e n d s . Such a move can have a very negative e f f e c t upon the r e s i d e n t s ' h e a l t h . 256 T h e r e f o r e , the d e c i s i o n to c r e a t e a separate or i n t e g r a t e d care f a c i l i t y must be c a r e f u l l y weighed. P a t t e r n o p t i o n s f o r housing arrangements (based on Carstens 1985) i n c l u d e the f o l l o w i n g : P a t t e r n No. 1: S e p a r a t i n g l i v i n g zones f o r independent, i n t e r m e d i a t e and dependent l i v i n g - n u r s i n g care (see F i g . 6-8). P a t t e r n No. 2: C l u s t e r i n g i n t e r m e d i a t e and extended care f a c i l i t i e s and a l s o support s e r v i c e s together while p r o v i d i n g a separate zone f o r independent l i v i n g r e s i d e n t s (see F i g . 6-9). P a t t e r n No. 3: Shared meeting and common spaces, but separate r e s i d e n t i a l areas and f a c i l i t i e s s u i t a b l e f o r each l e v e l of care (see F i g . 6-10). P a t t e r n No. 4: A r a d i a l arrangement with common f a c i l i t i e s and s o c i a l areas as the c e n t r a l core element. S e r v i c e s and f a c i l i t i e s common to v a r i o u s l e v e l s of care c r e a t e separate housing zones (see F i g . 6-11). 6.6.2 PATTERN No. 1: OBJECTIVES: 1. Separate i d e n t i t i e s and independent f u n c t i o n i n g f o r each l e v e l of care. 2. Complete s e p a r a t i o n of the extended care f a c i l i t y and i t s j u x t a p o s i t i o n to Independent housing attempts to reduce p s y c h o l o g i c a l a s s o c i a t i o n s of p h y s i c a l p r o x i m i t y to more i n t e n s i v e care f a c i l i t i e s a s s o c i a t e d with a pe r s o n a l nearness to death and dying. 257 F i g . 6-8 P a t t e r n No. 1 E x i s t i n g S i t e at the Motion P i c t u r e and T e l e v i s i o n I n d u s t r y Fund Country House and H o s p i t a l , C a l i f o r n i a . Carstens, D. S i t e P lanning and Design f o r the E l d e r l y - I s s u e s, G u i d e l i n e s and A l t e r n a t i v e s . 1985, p~. 44~! Example -Source: 258 F i g . 6-9 P a t t e r n No. 2 Maple K n o l l V i l l a g e , Ohio. The Gruzen P a r t n e r s h i p A r c h i t e c t s and Planners, New York. Carstens, D. S i t e P lanning and Design f o r the E l d e r l y - Issues, G u i d e l i n e s and A l t e r n a t i v e s . 1985, pT 3&~. Example -Source: F i g . 6-10 P a t t e r n No. 3 Example - Prototype of the E l d e r l y Housing. Oskar Newman A r c h i t e c t / P l a n n e r , New York. Source: Rush, R. The Age of the Aging. P r o g r e s s i v e A r c h i t e c t u r e . 1981, No. 8, p. 60. 260 F i g . 6-11 P a t t e r n No. 4 Example - Regents P o i n t . Neptun and Thomas A s s o c i a t e s A r c h i t e c t s , Pasadena, C a l i f o r n i a . Source: Carstens, D. S i t e Planning and Design f o r E l d e r l y -Issues, G u i d e l i n e s and A l t e r n a t i v e s . 1985, p. 48. 261 3. Shared a c t i v i t y space (the Core Centre) a f f o r d s some i n t e r a c t i o n between in t e r m e d i a t e and independent l i v i n g . T h i s p a t t e r n was employed i n the proposed master p l a n f o r the Motion P i c t u r e and T e l e v i s i o n Fund Country House and H o s p i t a l , Los Angeles i n C a l i f o r n i a (see Chapter 1). 6.6.3 PATTERN No. 2: OBJECTIVES 1. Promote the image of independent l i v i n g i n a separate complex of the Independent r e s i d e n t i a l c l u s t e r . 2. Provide o p p o r t u n i t i e s f o r i n t e r a c t i o n f o r the Intermediate and Extended Care r e s i d e n t s with independent l i v i n g r e s i d e n t s i n common shared space (the Core C e n t r e ) . 3. Separate the Extended Care from the Intermediate Care by shared space - the Core Centre to reduce p s y c h o l o g i c a l a s s o c i a t i o n with nearness to death and dying i n the Extended Care f a c i l i t y . T h i s p a t t e r n was employed i n Maple K n o l l V i l l a g e , Ohio (Carstens 1985, p.38) and i n St. Michael's Centre, Burnaby, B.C. As an a l t e r n a t i v e arrangement the Independent L i v i n g and Intermediate Care can be c l u s t e r e d t o gether with the common shared spaces i n the Core Centre, while Extended Care C l u s t e r may remain as a separate e n t i t y . For example, Independent L i v i n g Housing and Intermediate Care F a c i l i t y are c l u s t e r e d i n H o l l y b u r n House i n North Vancouver B.C. and South G r a n v i l l e Park Lounge, Vancouver, B.C. (see Chapter 1). 262 6.6.4 PATTERN No. 3: OBJECTIVES 1. I n t e g r a t e a l l l e v e l s of care and shared common space - The Core Centre - i n one b u i l d i n g t ogether to promote d i r e c t access to s e r v i c e s and a sense of s e c u r i t y among r e s i d e n t s . 2. Promote a sense of s a f e t y and s e c u r i t y f o r more f r a i l r e s i d e n t s by l o c a t i n g independent l i v i n g c l o s e to dependent l i v i n g . 3. Reduce s t r e s s of r e l o c a t i o n to separate zone on the s i t e when one's h e a l t h d e t e r i o r a t e s . Within the same b u i l d i n g s e r v i c e s can move e a s i l y to the r e s i d e n t s and while they can s t a y i n t h e i r d w e l l i n g u n i t s . 4. Reduce s t r e s s of the s e p a r a t i o n of spouse and f r i e n d s i f movement would be necessary. T h i s p a t t e r n was employed i n Seton V i l l a i n Burnaby, B.C. ( m u l t i - l e v e l f a c i l i t y ) ( S e e Chapter 1). D i f f e r e n t f l o o r s of t h i s h i g h r i s e d i f f e r e n t i a t e l e v e l of care (seven top f l o o r s - Indepen-dent L i v i n g , next s i x f l o o r s - board r e s i d e n t s , the bottom f o u r f l o o r s accommodate PC-IC r e s i d e n t s ) . 6.6.5 PATTERN No. 4: OBJECTIVES 1. Maximize access to the common f a c i l i t y from each l e v e l of care i n r e s i d e n t i a l areas. 2. Create a separate e n t i t y of each l e v e l of care i n separate r e s i d e n t i a l c l u s t e r s to promote "mini community f e e l i n g " . T h i s p a t t e r n was p a r t i a l l y employed i n the Regents P o i n t continuum of care environment community (see Chapter 1). I t can p r ovide an a l t e r n a t i v e arrangement by lengthening f o r example 263 j u x t a p o s i t i o n of the Extended Care f a c i l i t y i n order to reduce p h y s i c a l p r o x i m i t y to more i n t e n s i v e care as w e l l as by prolong-i n g a d i s t a n c e form Independent L i v i n g u n i t s to promote image of independent l i v i n g . 6.6.6 CONCLUSION Housing P a t t e r n s have been presented i n E v a l u a t i o n #6 f o r the purpose of a general overview and comparison. I f i t was a r e a l - l i f e s i t u a t i o n , i t would be the moment when the major d e c i s i o n s r e g a r d i n g p r o j e c t development would have to be made. Th i s would be a t r a n s i t i o n a l phase from the f a c i l i t y program to the f e a s i b i l i t y study u s u a l l y undertaken by the B u i l d i n g Committee ( i n case of N o n - P r o f i t S o c i e t y ) or the Developer ( i n case of Market Housing) and then the A r c h i t e c t would be s t a r t i n g o f f with the Schematic Design and Design Development. Another i s s u e , which would have to be r e s o l v e d at t h a t time, i s the a c t u a l C i t y of Vancouver zoning, probably CD-Comprehensive Development D i s t r i c t , u s u a l l y developed and approved a f t e r a long process of the c i t y p lanners involvement and p u b l i c hear-ings h e l d i n the s u b j e c t neighbourhood. For the purpose of t h i s t h e s i s , I would l i k e to present my own p e r s o n a l p o i n t of view on how the housing p a t t e r n s should be evaluated, which p a t t e r n I would p r e f e r myself and a l s o how I see the next step i n terms of a design a r c h i t e c t involvement three i s s u e s : Issue #1 - Steps f o r housing p a t t e r n s e v a l u a t i o n . 264 Issue #2 - Housing p a t t e r n s e l e c t i o n , my own c h o i c e . Issue #3 - Next steps to be taken by the Design A r c h i t e c t . Issue #1: Steps f o r Housing P a t t e r n s E v a l u a t i o n . P a t t e r n s e l e c t i o n would be the most important d e c i s i o n i n the e n t i r e f u t u r e p r o j e c t development. I t i s my understanding t h a t the e v a l u a t i o n process would have to be based on c l e a r l y s t r u c t u r e d methodology, aimed at the e v a l u a t i n g team r e p r e s e n t -i n g a l l i n v o l v e d i n the s u b j e c t p r o j e c t : users of the f a c i l i t y ( r e s i d e n t s , s t a f f , management); f i n a n c i n g i n s t i t u t i o n s ; develop-e r s ; c i t y planners; governmental agencies (Long-Term Care) and a l s o l o c a l Community Leaders. E v a l u a t i o n should be based on r a t i n g so the f i n a l c o n c l u s i o n c o u l d be e a s i l y a r r i v e d a t . The development of c i t e r i a to be used i n the e v a l u a t i o n process, has to be based on Chapter 3 of t h i s t h e s i s - the CCC F a c i l t y O b j e c t i v e s ( f i v e groups). I t i s not the i n t e n t i o n of t h i s t h e s i s to develop d e t a i l e d e v a l u a t i o n c i r t e r i a of housing p a t t e r n s but o n l y to i n d i c a t e the process, which may be used by the e v a l u a t i n g team. One of the most important c i t e r i o n i n the e v a l u a t i o n of CCC F a c i l i t y Housing P a t t e r n s i s the Q u a l i t y Environment. I would recommend the f o l l o w i n g e v a l u a t i o n steps which would appraise the f o l l o w i n g c r i t i c a l i s s u e s : Step #1: A Q u a l i t y Environment i n terms of: 1. Increased o p p o r t u n i t i e s f o r i n d i v i d u a l choice i n the CCC p h y s i c a l s e t t i n g . 265 2. Improved comprehension and o r i e n t a t i o n i n the new environment - wayfinding has been promoted. 3. Encouraged s o c i a l i n t e r a c t i o n . 4. Provided o p p o r t u n i t i e s f o r i n d i v i d u a l p r i v a c y . Step #2: S a f e t y and S e c u r i t y 1. L e v e l to which outdoor common areas used by r e s i d e n t s have been enclosed w i t h i n c l u s t e r s . 2. How s u c c e s s f u l a c l e a r t r a n s i t i o n from neighbourhood p u b l i c space to p r i v a t e space has been achieved. 3. How e f f e c t i v e i s the s i t e p l a n n i n g i n terms of c l e a r l y d e f i n e d edge c o n d i t i o n s such as fences. Step #3: A V a r i e t y of Environments A combination of d i f f e r e n t environments f o r the e l d e r l y should i n c l u d e : 1. A 'home-like' environment i n the d w e l l i n g c l u s t e r s at a l l l e v e l s of care. 2. A ' s o c i a l community* environment i n the amenity areas and outdoor a c t i v i t y c e n t r e . Step #4: S o c i a l Needs The p o t e n t i a l of a p a t t e r n to c r e a t e a st r o n g community f e e l i n g by p r o v i d i n g a p h y s i c a l environment which w i l l f a c i l i t a t e s o c i a l i n t e r a c t i o n . 266 Issue #2: Housing P a t t e r n S e l e c t i o n - my own c h o i c e . I t i s my p e r s o n a l b e l i e f , t h a t P a t t e r n #2 r e p r e s e n t i n g s e p a r a t i o n of the independent l i v i n g q u a r t e r s and i n t e g r a t i o n of the Intermediate and Extended Care q u a r t e r s , should be implement-ed i n the proposed Continuum of Care Complex i n P o i n t Grey. In making my own e v a l u a t i o n (note: t h i s i s on l y a r c h i t e c t ' s p o i n t of view) I used the f o l l o w i n g c r i t e r i a ( C = C r i t e r i o n ) l i s t -ed below as the c r i t i c a l i s s u e s : C#l T h i s p a t t e r n has the g r e a t e s t p o t e n t i a l to c r e a t e a q u a l i t y environment by: 1. I n c r e a s i n g o p p o r t u n i t i e s f o r i n d i v i d u a l choice i n the CCC p h y s i c a l s e t t i n g . For example, a separate Independent L i v i n g zone would provide o p p o r t u n i t i e s to c r e a t e a choice i n l i v i n g arrangements such as townhouses or m u l t i p l e d w e l l i n g u n i t s . The c l u s t e r e d Interme-d i a t e and Extended Care f a c i l i t y with the Core Centre would i n c r e a s e a l s o o p p o r t u n i t i e s f o r i n d i v i d u a l c h o i c e . I t s r e s i d e n t s would change very e a s i l y (a r e l a t i v e l y s h o r t d i s t a n c e to the Core Centre) t h e i r "home-like" environment f o r a " s o c i a l community" environment. 2. Improving comprehension and o r i e n t a t i o n (to promote w a y f i n d i n g ) . The separate Independent L i v i n g zone would allow to imple-ment a c l u s t e r p a t t e r n which promotes a wayfinding. S i m i l a r l y , the c l u s t e r e d long-term care f a c i l i t i e s with the Core Centre 267 may s i g n i f i c a n t l y improve comrehension and o r i e n t a t i o n i n the environment. A d i r e c t connection with the Core Centre would f a c i l i t a t e a wayfinding not onl y f o r long-term care f a c i l i t y r e s i d e n t s , but a l s o f o r Independent L i v i n g r e s i d e n t s , as t h i s p a t t e r n may c l e a r l y absorb a 'feeder system'-the CCC c i r c u l a t i o n network. 3. Encouraging s o c i a l i n t e r a c t i o n between r e s i d e n t s and v i s i t o r s . T h i s housing o p t i o n , by p r o v i d i n g p o s s i b l i t y f o r r e s i d e n t i a l c l u s t e r p a t t e r n , would promote s o c i a l i n t e r a c t i o n between r e s i d e n t s . I t would a l s o c r e a t e an o p p o r t u n i t y f o r d e s i g n i n g outdoor common areas i n c l o s e p r o x i m i t y to the r e s i d e n t i a l zones and consequently provide f u r t h e r o p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n . 4. P r o v i d i n g o p p o r t u n i t i e s f o r i n d i v i d u a l p r i v a c y : The c l u s t e r p a t t e r n would provide o p p o r u n i t i e s f o r i n d i v i d u -a l p r i v a c y e.g. p r i v a t e outdoor spaces. 5. P r o v i d i n g s a f e t y and s e c u r i t y . The outdoor common areas used by r e s i d e n t s would be enclosed w i t h i n safe r e s i d e n t i a l c l u s t e r s . The main p e d e s t r i a n walkways co u l d be e a s i l y l a i d out to allow f o r v i s u a l s u r v e i l l a n c e by r e s i d e n t s and s t a f f (feeder system). C#2 T h i s p a t t e r n would e a s i l y achieve one of the major t h e s i s o b j e c t i v e s to c r e a t e a str o n g community f e e l i n g . 268 1. The s i t e p l a n implementing t h i s housing p a t t e r n would f o s t e r community f e e l i n g . The p r o x i m i t y to the Core Centre from long-term care r e s i d e n t i a l c l u s t e r s , may provide o l d e r people with the f e e l i n g of belonging to the CCC community. 2. The c l u s t e r e d r e s i d e n t i a l components may be e a s i l y designed to f a c i l i t a t e s o c i a l i n t e r a c t i o n and a l s o to d i m i n i s h the stereotype of " o l d - f o l k s home" i n s t i t u t i o n a l c h a r a c t e r . 3. The Core Centre with the Main Concourse component, co u l d be designed as a very a t t r a c t i v e a r c h i t e c t u r a l environment. A pla c e which may be app e a l i n g f o r many r e s i d e n t s from the P o i n t Grey community. C#3 T h i s p a t t e r n may e a s i l y c e n t r a l i z e a l l s u p p o r t i v e s e r v i c e s , but a t the same time, maintain home-like environment i n the e n t i r e CCC f a c i l i t y . 1. By c l u s t e r i n g the long-term care f a c i l i t i e s , and the Core Centre, a r e d u c t i o n i n su p p o r t i v e s e r v i c e s , s t a f f , and s e r v i c e s may be expected. T h i s i n t u r n , would l e a d to the o p e r a t i n g c o s t r e d u c t i o n of the e n t i r e CCC f a c i l i t y . 2. T h i s p a t t e r n would allow f o r easy access f o r the long-term care r e s i d e n t s , as w e l l as s t a f f , to a l l c e n t r a l i z e d s e r v i c e s i n the Core Centre. C#4 Neighbourhood Development O b j e c t i v e s as d i s c u s s e d i n Chapter 3, of t h i s t h e s i s , c o u l d be achieved i n the most s a t i s f a c t o r y manner. 1. P a t t e r n #2 would allow to maintain l i v a b i l i t y , p r i v a c y and a 269 sense of community. The Independent L i v i n g r e s i d e n t i a l c l u s t e r s , as w e l l as the long-term care f a c i l i t i e s , would provide high l e v e l s of l i v a b i l i t y . The long-term care f a c i l i t i e s , combined with the Core Centre, would r e i n f o r c e a sense of community. 2. T h i s p a t t e r n would e a s i l y allow f o r c r e a t i o n of a cohesive neighbourhood c h a r a c t e r and achieve v i s u a l c o m p a t i b i l i t y with the surrounding housing. The Independent L i v i n g zone, with one s t o r e y townhouses may be l o c a t e d along 8th Avenue to comply with s i n g l e - f a m i l y homes, while BCMHC r e n t a l housing may be l o c a t e d along Highbury S t r e e t , where m u l t i p l e - u n i t housing i s dominat. The c l u s t e r e d long-term care f a c i l i t y , with the Core Centre, would provide v i s u a l c o m p a t a b i l i t y with e x i s t i n g housing l o c a t e d along 4th Avenue. 3. T h i s p a t t e r n would c o n t r i b u t e b e t t e r to s t r e e t s c a p e c h a r a c t e r than o t h e r s . The Core Centre which may be l o c a t e d at the corner of 4th Avenue and Highbury S t r e e t , would c r e a t e an e x t e n s i o n of an e x i s t i n g commercial shopping and s e r v i c e development, while long-term care f a c i l i t i e s may c r e a t e r e s i d e n t i a l c h a r a c t e r f u r t h e r to the West, along 4th Avenue or on Highbury S t r e e t . The Independent L i v i n g would very e a s i l y provide b u i l d i n g treatment t h a t complements development on adjacent s i t e s and would c r e a t e v i s u a l rhythm. 4. T h i s housing p a t t e r n would take the b i g g e s t advantage of the e x i s t i n g views. For example, the Independent L i v i n g c l u s t e r s 270 l o c a t e d on the southern p a r t of the s i t e would have a p r i v a t e view of the mountains and Downtown while long-term care f a c i l i t y , as w e l l as outdoor common spaces, l o c a t e d i n the n o r t h ern p a r t of the s i t e may have a view of the mountains and J e r i c h o Beach Park. 5. T h i s housing p a t t e r n would allow f o r development of the p r o j e c t i n stages, as w e l l as, would allow f o r an easy f u t u r e e x t e n s i o n . In a d d i t i o n , t h i s p a t t e r n would allow f o r space f l e x i b i l i t y w i t h i n long-term care c l u s t e r s and the Core Centre. Issue #3: Next steps to be taken by the Design A r c h i t e c t . The f a c i l i t y program developed i n t h i s t h e s i s has been presented as a H y p o t h e t i c a l Model of a programming system. Although t h i s Model has been developed i n the r e a l s i t u a t i o n of the P o i n t Grey Community, on a s e l e c t e d s i t e , n e v e r t h e l e s s , i t s purpose i s t h e o r e t i c a l . The major P a r t i n any development process - The C l i e n t / S p o n s o r i s missing. T h e r e f o r e , i n order to suggest any steps to be taken by the Design A r c h i t e c t , a number of assumptions have to be made. These assumptions are necessary, because i t ' s not the A r c h i t e c t , but the C l i e n t , who makes the p r o j e c t r e a l i t y . Assumptions: 1. The C l i e n t ' s o r g a n i z a t i o n e.g.: "The CCC of P o i n t Grey S o c i e t y " has been e s t a b l i s h e d , by c o n s i s t i n g of the Board of D i r e c t o r s , B u i l d i n g Committee, and C l i e n t s ' R e p r e s e n t a t i v e . The C l i e n t has arranged f o r the f i n a n c i n g of the e n t i r e p r o j e c t which i n c l u d e s purchase of p r o p e r t y and arrangement f o r f i n a n c e s . The C l i e n t has obtained the Housing P a t t e r n s E v a l u a t i n g Team, made-up of d i v e r s e users and p r o f e s s i o n a l s (see Issue #1) . The C l i e n t has arranged f o r the f e a s i b i l i t y study with the major o b j e c t i v e s : to determine and confirm the a c t u a l demand (at the time  of a p r o j e c t c o n s t r u c t i o n and u n t i l the year 2000) and need f o r the s p e c i f i c range of f a c i l i t i e s and s e r v i c e s s t i p u l a t e d i n the CCC f a c i l i t y program. to i d e n t i f y c l e a r l y the t a r g e t p o p u l a t i o n , l e v e l of s e r v i c e s and b u i l d i n g forms f o r each type of e l d e r l y group. to analyze o p t i o n s of a p r o j e c t d e l i v e r y methods (phased c o n s t r u c t i o n ; p r o j e c t or c o n s t r u c t i o n management and b u i l d i n g forms). to analyze the a c t u a l (at the time of a p r o j e c t c o n s t r u c t i o n ) socio-economic and h e a l t h care c h a r a c t e r i s t i c s of e l d e r l y p o p u l a t i o n and t h e i r preferences/needs r e g a r d i n g combination of tenure, b u i l d i n g forms and on s i t e s e r v i c e s . to c o n s o l i d a t e a c t u a l demographic i n f o r m a t i o n on the s i z e and growth of the t a r g e t p o p u l a t i o n of P o i n t Grey, Vancouver and province wide. 272 to i d e n t i f y and determine the s i z e of the gap between independent l i v i n g and long-term care f a c i l i t i e s (see Chapter 1 - 1.2.1) with the t a r g e t p o p u l a t i o n , to provide a c o s t e f f e c t i v e n e s s a n a l y s i s of the c a p i t a l and o p e r a t i n g c o s t s of the proposed f a c i l i t i e s and the housing p a t t e r n s , comparing c o s t s to the e x i s t i n g s e n i o r s ' housing, BCHMC r e n t a l housing, and long-term i n s t i t u t i o n a l care. to compare s t a f f i n g f e a s i b i l i t y of each o p t i o n , to make d e t a i l e d recommendations f o r the F a c i l i t y Program implementation, i n c l u d i n g funding arrangements. 5. The Housing P a t t e r n has been s e l e c t e d and the Design A r c h i t e c t (or A r c h i t e c t u r a l Firm) has been appointed. Assuming t h a t the above l i s t e d major o r g a n i z a t i o n a l s t r u c t u r e s have been e s t a b l i s h e d , and major executive d e c i s i o n s reached, i t would be proper at t h i s time, f o r a Design A r c h i t e c t and h i s C o n s u l t a n t s to s t a r t work i n the f o l l o w i n g sequence: Step 1 - Predesign Stage Step 2 - Schematic Design Step 3 - Design Development Step 4 - C o n s t r u c t i o n Documents: Working Drawings and S p e c i f i c a -t i o n s . Step 5 - B i d d i n g or N e g o t i a t i o n Step 6 - C o n t r a c t A d m i n i s t r a t i o n on b e h a l f of the C l i e n t at the a c t u a l C o n s t r u c t i o n Step 7 - Post C o n s t r u c t i o n P r o j e c t I n s p e c t i o n s 273 FINDINGS AND THESIS CONCLUSION T h i s t h e s i s has been developed as a r e s e a r c h c y c l e based on 3-phase s c i e n t i f i c methodology of a n a l y s i s , s y n t h e s i s and e v a l u a t i o n ( I n t r o d u c t i o n , p. 7). Phase 1 of the T h e s i s - A n a l y s i s  Scope of Research: Research at t h i s phase was c a r r i e d out i n two d i s t i n c t i v e d i r e c t i o n s . F i r s t l y , an overview of the e x i s t i n g trends i n contemporary f a c i l i t i e s f o r the e l d e r l y with emphasis on the m u l t i l e v e l approach (General Background of the T h e s i s ) . Second-l y , an a n a l y s i s of e l d e r l y housing options and s e r v i c e s i n Vancouver West s i d e i n general and West P o i n t Grey i n p a r t i c u l a r ( S p e c i f i c Background of the T h e s i s ) . F i n d i n g #A1: "Time" becomes the paramount f a c t o r i n the e n t i r e programm-ing and design process f o r the e l d e r l y . Time means t h a t every-t h i n g i n t h i s process i s dynamic, not s t a t i c and the, program should r e f l e c t t h i s phenomenon. The A r c h i t e c t should plan and design not f o r a s p e c i f i c group of people, but f o r the e l d e r l y who w i l l have a v a r i e t y of needs d i f f i c u l t to c l a s s i f y at one p o i n t of time. T h e r e f o r e , the "time" f a c t o r must be addressed on the p r i n c i p l e of f l e x i b i l i t y , a d a p t a b i l i t y and the continuum of care. 274 F i n d i n g #A2: The n o t i o n of m u l t i - l e v e l of care of the e l d e r l y continues to g ain momentum. According to the Canadian M e d i c a l A s s o c i a t i o n , the p r o v i s i o n of a continuum of care, with the v a r i o u s elements b l e n d i n g together, should be the u n d e r l y i n g p r i n c i p l e i n pl a n n i n g s e r v i c e s f o r the e l d e r l y (Ch. 4, 4.2.). F i n d i n g #A3: There i s a r e a l need i n West P o i n t Grey area f o r a m u l t i - l e v e l f a c i l i t y with graduation of care organized and d e l i v e r e d i n one s e t t i n g (Ch.2, 2.3.6). F i n d i n g #A4: Contemporary s e n i o r s expect more than t h e i r predecessors i n terms of q u a l i t y l i f e s t y l e . They are more educated, h e a l t h y and more s o p h i s t i c a t e d i n t h e i r e x p e c t a t i o n s . They are l o o k i n g f o r an a t t r a c t i v e , n a t u r a l environment where they can enjoy: r e c r e a t i o n , h e a l t h p r o t e c t i o n , s e c u r i t y , l e i s u r e and r e t r e a t , c u l t u r a l a c t i v i t i e s and companionship (Ch.2, 2.1.5. Feature #4). F i n d i n g #A5: The major c o n s t r a i n t r e s u l t i n g i n moving the e l d e r l y person from h i s / h e r home to the f a c i l i t y i s r e l o c a t i o n s t r e s s . Moving i s a traumatic experience and i f done i n v o l u n t a r l y , may have negative p s y c h o s o c i a l consequences and decrease p h y s i c a l h e a l t h (Ch.3, C O . #1). 275 F i n d i n g #A6: S e n i o r s would be w i l l i n g to move to the f a c i l i t y i f such a f a c i l i t y c o uld provide them with the p o s s i b i l i t y of c o n t i n u a t i o n of t h e i r l i f e s t y l e i n terms of r e s i d e n t i a l q u a l i t y , h e a l t h care s e r v i c e s and a s o c i a l network of t h e i r c h o ice (Ch.2, 2.2.2.). The a n a l y s i s p a r t of t h i s t h e s i s concludes i n Chapter 3 by developing the major o b j e c t i v e s f o r the f a c i l i t y program. They have been based on f i n d i n g s and s t r u c t u r e d to the H y p o t h e t i c a l Model of the f a c i l i t y program. The CCC F a c i l i t y O b j e c t i v e s have been c o n s o l i d a t e d i n t o f i v e groups: Group 1 - L i v i n g Environment O b j e c t i v e s which address the i s s u e of a safe and q u a l i t y environment. Group 2 - R e s i d e n t s ' O b j e c t i v e s which concentrate on three b a s i c i s s u e s : tenure c h o i c e , h e a l t h care and s o c i a l needs. Group 3 - F a c i l i t y Management O b j e c t i v e s which although emphasizing the importance of c e n t r a l i z a t i o n of s u p p o r t i v e s e r v i c e s , n e v e r t h e l e s s s t r e s s a l s o the need f o r independence, p e r s o n a l i z a t i o n and v a r i e d p h y s i c a l environment. Group 4 - Community O b j e c t i v e s e x p l a i n a need f o r s u c c e s s f u l and smooth r e l a t i o n s h i p s between the CCC f a c i l i t y and the P o i n t Grey Community. Group 5 - Neighbourhood Development O b j e c t i v e s are very important f o r the a r c h i t e c t u r a l concept of the CCC 276 f a c i l i t y and have been presented i n the form of design q u i d e l i n e s . Research and f i n d i n g s i n t h i s Phase gave grounds to the f o l l o w -i n g major c o n c l u s i o n s : C o n c l u s i o n #A1: In order to s a t i s f y the e l d e r l y ' s unique needs the CCC f a c i l i t y has to c r e a t e a q u a l i t y environment which w i l l : 1. Increase o p p o r t u n i t i e s f o r i n d i v i d u a l choice i n the CCC p h y s i c a l s e t t i n g . 2. Minimize dependence and i n s t e a d encourage p e r s o n a l independence i n use of the CCC f a c i l i t y . 3. R e i n f o r c e the i n d i v i d u a l l e v e l of competency by p r o v i d i n g environmental support. 4. Compensate f o r sensory and p e r c e p t u a l changes. 5. F o s t e r comprehension and o r i e n t a t i o n i n the new environment. 6. Encourage s o c i a l i n t e r a c t i o n between r e s i d e n t s (and v i s i t o r s ) . 7. S t i m u l a t e p a r t i c i p a t i o n i n a c t i v i t i e s . 8. Provide o p p o r t u n i t i e s f o r i n d i v i d u a l p r i v a c y . 9. Improve the p u b l i c image of the e l d e r l y . C o n c l u s i o n #A2: In terms of c o n t i n u a t i o n of the e l d e r l y person's l i f e s t y l e , the r e s i d e n t s have to be p r o v i d e d with choice to s a t i s f y t h e i r needs: r e s i d e n t i a l , h e a l t h care and s o c i a l . 277 C o n c l u s i o n #A3: The CCC f a c i l i t y has to be programmed as being a p a r t of the P o i n t Grey Community but not as an i s o l a t e d i s l a n d f o r i t s r e s i d e n t s only. Phase 2 of the T h e s i s - S y n t h e s i s  Scope of F a c i l i t y Programming In t h i s phase I continued an " a r c h i t e c t u r a l i n v e s t i g a t i o n " which focused on " f a c i l i t y programming" f o r an i n n o v a t i v e approach to a Continuum of Care F a c i l i t y (Ch.4 & 5). The approach I have assumed had two d i s t i n c t i v e f e a t u r e s : A l t e r n a t i v e Approach: 1. which means t h a t the CCC p r o v i d e s p r o g r e s s i v e care: a. continuum of care system from Independent L i v i n g to Extended Care, b. continuum of l i v i n g environment ("home l i k e " ) . 2. provide an o p p o r t u n i t y f o r a choice i n terms of: a. l i v i n g arrangements - tenure, p h y s i c a l environment b. p e r s o n a l s e r v i c e s - the Core Centre c. s o c i a l s e r v i c e s - the Core Centre d. h e a l t h care s e r v i c e s - the Core Centre 3. s e n s i t i v e design i . e . : l i v i n g u n i t s i n the Long Term Care C l u s t e r s , i s s u e s : wayfinding, community f e e l i n g . 278 Innovative Approach: A new methodology has been i n t r o d u c e d i n t o the programming process: 1. space f l e x i b i l i t y : a dynamic not s t a t i c model i n the I n t e r -mediate and Extended Care p o r t i o n by assuming a c l u s t e r arrangement. 2. the Core Centre with i t s program components can be e a s i l y changed a c c o r d i n g to the a c t u a l needs of the e l d e r l y , i . e . : A r t s & C r a f t s ( d i f f e r e n t a c t i v i t i e s ) , Auditorium and Programs or C l i n i c may be expanded. 3. the Long Term Care F a c i l i t y may be expanded by p r o v i d i n g a new c l u s t e r f o r a d d i t i o n a l p a t i e n t s or by p r o v i d i n g s p e c i a l Care f o r Alzheimer's p a t i e n t s . C o n c l u s i o n #S1: The CCC f a c i l i t y may c r e a t e a q u a l i t y environment through f o u r major f u n c t i o n a l components: r e s i d e n t i a l , long-term care, community-services and outdoor a c t i v i t y spaces. C o n c l u s i o n #S2: The u n d e r l y i n g p r i n c i p l e i n p l a n n i n g housing and s e r v i c e s f o r the contemporary e l d e r l y has to be based on the continuum of care i n c l u d i n g the f o l l o w i n g f e a t u r e s : 1. R e s i d e n t i a l c l u s t e r p a t t e r n (Ch.5, 5.1.2.). 2. C l u s t e r i d e n t i t y (Ch.5, 5.1.2.2.). 3. Sense of s e c u r i t y (Ch.5, 5.1.2.3.). 279 4. O p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n (Ch.5, 5.1.2.3.). 5. A c c e s s i b i l i t y to a l l f a c i l i t i e s . 6. P r i v a c y (Ch.5, 5.1.4.3.). 7. Home-like atmposphere i n a l l types of f a c i l i t i e s : Independent L i v i n g (Ch.4, I n t r o d u c t i o n ) . Intermediate Care (Ch.5, 5.2.2.) Extended Care (Ch.5, 5.3.2., Issue #3). 8. Sense of r e s i d e n c y (Ch.5, 5.2.2., Issue #1). 9. Space F l e x i b i l i t y (Ch.5, 5.2.2., Issue #2). 10. Wayfinding (Ch.5, 5.1.2.3., 5.2.2., Issue #3). The above noted u n d e r l y i n g p r i n c i p l e f o r housing the e l d e r l y can be summarized b r i e f l y : to provide a q u a l i t y environment f o r the , e l d e r l y which w i l l be a c o n t i n u a t i o n of the environment they were l i v i n g i n so f a r and which w i l l p r ovide a l l necessary s u p p o r t i v e f a c i l i t i e s i n terms of s o c i a l , emotional and h e a l t h care need. C o n c l u s i o n #S3: The Core Centre with i t s s e r v i c e s becomes the paramount f u n c t i o n a l component i n c r e a t i o n of the q u a l i t y environment f o r the e l d e r l y and a l s o an important and necessary l i n k with the r e s t of the community. I t i s the Core Centre, which p l a y s the s i g n i f i c a n t r o l e i n the c r e a t i o n of a c h e e r f u l , p l e a s a n t , secure and f r i e n d l y atmosphere i n the CCC environment. A l s o , i t i s Core Centre which has to serve the r e s i d e n t s of the CCC and the 280 e n t i r e community: R e h a b i l i t a t i o n Centre, C l i n i c , Pharmacy, Main Concourse, Food S e r v i c e s , Food F a i r , A r t s and C r a f t s , L i b r a r y , Auditorium and Indoor R e c r e a t i o n Programs. The Core Centre comprised of 15 major f u n c t i o n a l components, each of them i n c l u d i n g s e v e r a l a c t i v i t y c e n t r e s , has to respond e f f e c t i v e l y to e l d e r l y ' s needs by c r e a t i n g s p e c i f i c ambiance. Some of the program f e a t u r e s s p e c i a l l y important to achieve t h i s o b j e c t i v e are: 1. Winter Garden - Conservatory (5.4.1.2.a) 2. L o c a t i o n of M a i l Boxes (5.4.1.2.b) 3. Food F a i r - D i n i n g (5.4.2) 4. R e h a b i l i t a t i o n Centre with Swimming Pool, Sauna, Whirpool, Bar, F i t n e s s & Dancing Club (5.4.4) 5. A r t s and C r a f t s (5.4.5) 6. Auditorium and S p e c i a l Programs (5.4.5) 7. L i b r a r y (5.9.10) Co n c l u s i o n #S4: The s p e c i a l l y designed F a c i l i t y Common Outdoor Space b r i n g s a s i g n i f i c a n t c o n t r i b u t i o n to the w e l l - b e i n g of the e l d e r l y . T h i s program component p r o v i d e s s t i m u l a t i o n , enhances r e s i d e n t s " s e l f - e s t e e m and c r e a t e s an o p p o r t u n i t y f o r s o c i a l i n t e r a c t i o n and i n t e g r a t i o n with the P o i n t Grey Community. I t pro v i d e s f o r a " t h e r a p e u t i c park" designed to meet the needs of the p h y s i c a l -l y f r a i l and garden p l o t s f o r those i n t e r e s t e d i n h o r t i c u l t u r e . 281 Phase 3 of the T h e s i s - E v a l u a t i o n  Scope of I n v e s t i g a t i o n In the l a s t and f i n a l phase I have i n v e s t i g a t e d how success-f u l l y the Program can be implementated on the t e s t s i t e and what o p p o r t u n i t i e s and c o n s t r a i n t s e x i s t s . Furthermore, I have e l a b o r a t e d Design G u i d e l i n e s and Recommendations on how the Program O b j e c t i v e c o u l d be met i n a given r e a l s i t u a t i o n . I have concluded by p r o v i d i n g a l t e r n a t i v e Housing Development Options i n f o u r p a t t e r n s . F i n d i n g s r e f e r to the S i t e A n a l y s i s . C o n c l u s i o n s r e f e r to the f e a s i b i l i t y of Program implementation. F i n d i n g #E1: The " F e d e r a l N a t i o n a l Defence Lands", the t e s t s i t e , p r o v i d e s a number of o p p o r t u n i t i e s f o r s u c c e s s f u l program implementation: 1. Complies with the area p l a n p o l i c y of the Vancouver Pl a n n i n g Department. 2. Ensures a b e a u t i f u l s e t t i n g and v a s t land. 3. Is l o c a t e d c l o s e to commercial o u t l e t s : 4th Avenue, Alma & Broadway. 4. Is l o c a t e d c l o s e to r e c r e a t i o n a l amenities: J e r i c h o Beach, J e r i c h o Tennis Club, Royal Vancouver Yacht Club. 5. Is i n p r o x i m i t y to the U n i v e r s i t y H o s p i t a l , UBC S i t e . 6. Is c l o s e to p u b l i c bus t r a n s p o r t a t i o n . 7. Has a v a r i e d topography p r o v i d i n g m a g n i f i c e n t views. 282 8. Is a "green o a s i s " i n the P o i n t Grey Area with s u b s t a n t i a l q u a n t i t i e s of t r e e s and shrubs. F i n d i n g #E2: The t e s t s i t e poses some c o n s t r a i n t s which have to be overcome i n order to implement the program s u c c e s s f u l l y : 1. Heavy t r a f f i c and noise from 4th Avenue. 2. Steep slope of the s i t e i n the southwest area. 3. Need f o r a p e d e s t r i a n overpass to J e r i c h o Beach Park. C o n c l u s i o n #E1: The s u b j e c t s i t e would make a p e r f e c t p l a c e f o r the f u t u r e development of a f a c i l i t y f o r s e n i o r s . T h i s s i t e o f f e r s s e v e r a l advantages such as a l o c a t i o n i n the core of the P o i n t Grey r e s i -d e n t i a l area, easy access to shopping and community s e r v i c e s , walking d i s t a n c e to park and p u b l i c r e c r e a t i o n a l f a c i l i t i e s as w e l l as p r o x i m i t y to U.B.C. Co n c l u s i o n #E2: The s i t e area (51.47 acres) i s an s u c c e s s f u l program implementation now expansion. C o n c l u s i o n #E3: The s i t e and i t s l o c a t i o n has a gre a t p o t e n t i a l f o r easy to achieve a r c h i t e c t u r a l c h a r a c t e r compatible with the surrounding neighbourhood. e x c e l l e n t p l a c e f o r and f o r the f u t u r e 283 General T h e s i s C o n c l u s i o n T h i s T h e s i s has developed a h y p o t h e t i c a l model of the Continuum of Care Complex i n terms of a f a c i l i t y program i n the r e a l s i t u a t i o n of the P o i n t Grey Community on the s e l e c t e d t e s t s i t e . A "Continuum of Care" environment f o r the e l d e r l y has been d e f i n e d i n terms of a program of housing as w e l l as p e r s o n a l , s o c i a l and h e a l t h care s e r v i c e s a v a i l a b l e on one s i t e . That environment, which c o u l d be s u c c e s s f u l l y developed and implement-ed on the s u b j e c t s i t e , may s a t i s f y a broad range of needs f o r the e l d e r l y : p h y s i c a l , p h y s i o l o g i c a l and s o c i o p s y c h o l o g i c a l . 284 REFERENCES A Gentle Echo. A r c h i t e c t u r a l Record. 1980, Nov., p.120. Advance P l a n n i n g and Research f o r A r c h i t e c t u r e , APRA. 1982. F a c i l i t i e s Program f o r the George Derby Long Term Care  Society!! Vancouver, B.C. Aging P o p u l a t i o n Increases Housing Pressure. The C o u r i e r . Vancouver: A p r i l 2, 1989. Alexander, C h r i s t o p h e r et a l . 1977. A P a t t e r n Language. New York: Oxford U n i v e r s i t y Press. B.C. H o s p i t a l Program. 1988. Extended Care Design Guide-l i n e s . V i c t o r i a , B.C.. B.C. R e g u l a t i o n 536/80. 1980. Community Care F a c i l i t y Act. Berger, E., R. Godin, and A.C. Harvey. 1986. 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GVRHD, Extended Care Subcommittee. June 1987. Regional G e r i a t r i c Care Planning Model f o r the Greater Vancouver  Regional H o s p i t a l D i s t r i c t " ! H a u s j a r v i H e a l t h Centre and Old People's Home Design Competition. A r k k i t e h t u u r i k i l p a i l u j a . 1987, 2, pp. 17-18. Hogland, David J . 1985. Housing f o r the E l d e r l y : P r i v a c y  and Independence i n Environments f o r the Aging. New York: Van Nostrand Reinhold Co. Jordan, Joe. 1978. S e n i o r Center Design. Washington D.C.: The N a t i o n a l C o u n c i l on the Aging. Katchner, Aaron H. 1982. Are Companion Animals Good f o r Your H e a l t h . Aging, (Sept.-Oct.), Nos 331—332, 2-8. 287 K o n c e l i k , Joseph A. 1976. Designing the Open Nursing Home. Stroudsburg, Pennsylvania: Dowden, Hutchinson & Ross Inc. K o t i l a i n e n , H e l i . 1987. More Human Health F a c i l i t i e s . R e s u l t s of an A r c h i t e c t u r a l Competition. 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Housing the Aged: Design D i r e c t i v e s and P o l i c y C o n s i d e r a t i o n s . New York: E l s e r v i e r Science P u b l i s h i n g Co. R e i z e n s t e i n Carpman, Janet e t a l . 1986. Design t h a t Cares. American H o s p i t a l A s s o c i a t i o n . Rogers, Maureen H. 1987. Northwood Incorporated A Case  Study i n Community Development. Research Paper -Education 7974B. Dalhousie U n i v e r s i t y , March. Rush, Ri c h a r d . The Age of the Aging. P r o g r e s s i v e A r c h i -t e c t u r e , No. 8, 1981, pp. 59-63. Seaton, R i c h a r d W. and M i r u n l i n i Rajan. 1987. Review of  age - sex - s p e c i f i c c h a r a c t e r i s t i c s of the Canadian  p o p u l a t i o n . Unpublished d r a f t . Shack, J o e l and G. Friedman. 1977. R e s i d e n t i a l Open Space  Design Manual. Prepared f o r the C i t y of Toronto Housing Department, November. Tate, Jeremy. 1987. Long Term Care F a c i l i t i e s Overview and  Trends. Prepared f o r Retirement Housing Course Held October 29,1987. The U n i v e r s i t y of B r i t i s h Columbia, Centre f o r C o n t i n u i n g Education. T a y l o r , S y l v i a , ed. 1978. H o r t i c u l t u r e as Therapy. T e c h n i c a l B i u l e t y n No. 9, October. The B o t a n i c a l Garden: The U n i v e r s i t y of B r i t i s h Columbia. Unger, Harlow. 1988. U n i v e r s i t y towns show b u i l d i n g boom. Canadian B u i l d i n g , January-February, p. 3. Welch, P o l l y , V. Parker and J . Z e i s e l . 1984. Independence  Through Interdependence Congregate L i v i n g f o r Older  People. Bostolil Department of E l d e r A f f a i r s . Vancouver H e a l t h Department, C o n t i n u i n g Care D i v i s o n . 1986. Annual Report. Vancouver C i t y H a l l . Z e i s e l , John. 1977. Low Rise Housing For Older People. Washington D.C.: U.S. Government P r i n t i n g O f f i c e . Z e l v e r , A l v i n . 1976. Model f o r Planning a S p e c i a l Neighbour hood. In Lawton, Powell ed. Community Pl a n n i n g f o r an  Aging S o c i e t y . Pennsylvania: Dowden, Hutchinson & Ross Inc. pp. 200-220. 289 APPENDIX #0-1 Province of B r i t i s h Columbia, M i n i s t r y of Health C o n t i n u i n g Care D i v i s i o n Long-Term Care Program Care L e v e l D e f i n i t i o n s L e v e l s of Care The c l a s s i f i c a t i o n system used by the Long-Term Care program to d e s c r i b e i n d i v i d u a l s with s i m i l a r types of h e a l t h care needs c o n s i s t s of three major groupings - Pe r s o n a l Care, Intermediate Care, and Extended Care. W i t h i n these groupings, Intermediate Care has been f u r t h e r d i v i d e d i n t o l e v e l s I, I I , and I I I . These care l e v e l s move i n a p r o g r e s s i o n from l i g h t e r care r e q u i r e -ments of Per s o n a l Care, through the Intermediate Care l e v e l s to the h e a v i e r care requirements of Extended Care. B r i e f l y summarized, the care l e v e l s are: Pers o n a l Care T h i s l e v e l of care r e c o g n i z e the i n d i v i d u a l who i s independent-l y mobile, with or without mechanical a i d s , and whose primary need i s f o r minimal n o n - p r o f e s s i o n a l s u p e r v i s i o n and /or a s s i s t a n c e with the a c t i v i t i e s of d a i l y l i v i n g f o r the purpose of a c h i e v i n g or m a i n t a i n i n g maximum p e r s o n a l independence i n everyday a c t i v i t i e s . Intermediate Care The three Intermediate Care l e v e l s b u i l d on the Per s o n a l Care l e v e l and recog n i z e a need f o r care p l a n n i n g and s u p e r v i s i o n under the d i r e c t i o n of a h e a l t h care p r o f e s s i o n a l by i n t r o d u c -i n g a combination of p r o f e s s i o n a l and n o n - p r o f e s s i o n a l ( l a y ) s u p e r v i s i o n . T h i s p r o f e s s i o n a l s u p e r v i s i o n i s r e q u i r e d on a d a i l y r a t h e r than a twenty-four hour b a s i s . I n d i v i d u a l s a t the Intermediate Care l e v e l s are ambulant with or without mechanical a i d s . Intermediate Care I T h i s l e v e l of care r e c o g n i z e s the i n d i v i d u a l who i s independent-l y mobile with or without mechanical a i d s , r e q u i r e s moderate a s s i s t a n c e with the a c t i v i t i e s of d a i l y l i v i n g , and who r e q u i r e s d a i l y p r o f e s s i o n a l care and/or s u p e r v i s i o n . Intermediate Care I I T h i s l e v e l o l care r e c o g n i z e s h e a v i e r care and/or s u p e r v i s i o n r e q u i r i n g a d d i t i o n a l care time. Intermediate Care I I I Th i s l e v e l of care p r i m a r i l y recognize the i n d i v i d u a l who e x h i b i t s severe b e h a v i o u r a l d i s t u r b a n c e s on a c o n t i n u i n g b a s i s 290 and who prese n t s a s i g n i f i c a n t mangement problem. T h i s l e v e l a l s o recognize the i n d i v i d u a l who has very heavy care requirements which r e q i r e s i g n i f i c a n t s t a f f time to manage. In both i n s t a n c e s , t h i s l e v e l of care r e q u i r e s c o n s i d e r a b l e s u p e r v i s i o n and/or a s s i s t a n c e under the d i r e c t i o n of a h e a l t h care p r o f e s s i o n a l . Extended Care T h i s l e v e l of care recognize the person with a severe c h r o n i c d i s a b i l i t y which has u s u a l l y produced a f u n c t i o n a l d e f i c i t which r e q u i r e s twenty-four hour a day p r o f e s s i o n a l n u r s i n g s e r v i c e s and c o n t i n u i n g medical s u p e r v i s i o n , but does not r e q u i r e a l l the resources of an acute care h o s p i t a l . Most persons at t h i s l e v e l of care have a l i m i t e d p o t e n t i a l f o r r e h a b i l i t a t i o n and o f t e n r e q u i r e i n s t i t u t i o n a l care on a permanent b a s i s . 291 APPENDIX #0-2 A n a l y s i s of the e x i s t i n g f a c i l i t i e s f o r the e l d e r l y with d i f f e r e n t l e v e l s of dependency. The f a c i l i t i e s are: 1. PARKWOOD MANOR - Congregate House (Hotel Type) - Per s o n a l Care, Coquitlam, B.C. - case study. 2. HOLLYBURN HOUSE - Per s o n a l Care and Intermediate Care F a c i l i t y , North Vancovuer, B.C. - case study. 3. EXTENDED CARE UNIT OF UNIVERSITY HOSPITAL, UBC SITE, Vancouver, B.C. - case study. 4. SOUTH GRANVILLE PARK LODGE, Vancouver, B.C. - Per s o n a l and Intermediate Care F a c i l i t y - case study. 5. MOTION PICTURE AND TELEVISION COUNTRY HOUSE AND HOSPITAL i n Woodland H i l l s , C a l i f o r n i a - M u l t i l e v e l Care F a c i l i t y . 6. REGENTS POINT, Southern C a l i f o r n i a P r e s b y t e r i a n Homes -M u l t i l e v e l Care F a c i l i t i e s . 7. SAN RAPHAEL COMMONS, San Raphael, C a l i f o r n i a - the Independent L i v i n g Housing. 8. ST. MICHAEL'S CENTRE, Burnaby, B.C. - Intermediate and Extended Care F a c i l i t i e s . 9. NORTHWOOD MULTI-PURPOSE COMPLEX, H a l i f a x , Nova S c o t i a . 10. KOPERNIK LODGE - Per s o n a l and Intermediate Care, Vancouver, B.C. 11. SETON VILLA, North Burnaby, B.C. - Independent L i v i n g and Pers o n a l Care. 12. SUNNY MANOR, White Rock, B.C. - Independent L i v i n g and I n t e r -mediate Care. 292 APPENDIX #0-3 L i s t of people Interviewed on the s u b j e c t of my t h e s i s : 1. C i t y of Vancouver, Vancouver Health Department: Mrs. Barbara Parson, R e h a b i l i t a t i o n C o n s u l t a n t C o n t i n u i n g Care D i v i s i o n . 2. C i t y of Vancouver, P l a n n i n g Department: Mr. K e r i Huhtala, S e n i o r Planner Mr. John Winsor, S e n i o r Planner. 3. C i t y of Vancouver, T r a n s p o r t a t i o n Branch, E n g i n e e r i n g Dept.: Mr. Ron S l e t t , 4. I n t e r n a t i o n a l Care C o r p o r a t i o n - I n t e r c a r e Mr. Walter S t e i n i n g e r , V i c e P r e s i d e n t . 5. BC Long Term Care A s s o c i a t i o n : Mrs. L i l i a n Moreton, E x e c u t i v e D i r e c t o r . 6. Vancouver West Side Health Department: Ms. L e s l i e T y l o r , C o o r d i n a t o r . 7. West End H e a l t h S e r v i c e Centre: Ms. Bev M a r s h a l l , Nurse i n r e s i d e n t i a l care f a c i l i t y (Sunset Towers, 1655 B a r c l a y S t r e e t ) . 8. South G r a n v i l l e Park Lodge - PC and IC F A c i l i t y i n Vancovuer: Mr. Ed Z i n k e v i c h , A d m i n i s t r a t o r . 9. St. M i c h a e l ' s Centre - IC and EC F a c i l i t y i n Burnaby: Mr. G e r a l d H e r k e l , E x e c u t i v e D i r e c t o r . Mr. Michael G a r r e t t , A r c h i t e c t - Gardiner Thornton A r c h i t e c t s . 10. Brock House S o c i e t y - Day-time A c t i v i t y Centre f o r S e n i o r s i n P o i n t Grey: Mrs. Irene Ovenden, E x e c u t i v e C o o r d i n a t o r . 11. H o l l y b u r n House - PC and IC F a c i l i t y i n North Vancouver: Mr. Alex Coruth - L a i n g P r o p e r t y L t d . , Mr. J . D o l l , A r c h i t e c t - Neale, S t a n i s z k i s , D o l l A r c h i t e c t s Mr. Kim P e r r y , Landscape A r c h i t e c t . 12. Parkwood Manor - Congregate House i n Coquitlam: Mr. Stu Lyon, A r c h i t e c t - Waisman Dewar Grout C a r t e r A r c h i t e c t s . Mr. R a n d a l l Sharp, Landscape A r c h i t e c t . 13. Kopernik Lodge: Ms. Irena Donlon, A d m i n i s t r a t o r . Mrs. Hanna Freyman, Resident. 293 APPENDIX #0-3 14. U n i v e r s i t y H o s p i t a l , UBC S i t e , Extended Care U n i t : Ms. Rose Murakami, A s s i s t a n t A d m i n i s t r a t o r and C h i e f Nursing O f f i c e r . Ms. June Nakamoto, D i r e c t o r Nursing S e r v i c e s . Mrs. Karen Va g e l a t o s , Landscape A r c h i t e c t . 15. Seton V i l l a - PC and IL F a c i l i t y i n North Burnaby: Mrs. Donna Kerr, A d m i n i s t r a t o r . 16. Sunnyside Manor - IC and IL F a c i l i t y White Rock: Mr. J . White, Owner. 17. Mr. & Mrs. Leon and Diane Kowalczyk - s e n i o r r e s i d e n t s i n the P o i n t Grey area and s e v e r a l s e n i o r c i t i z e n s i n Vancouver. 18. B r i t i s h Columbia Housing Management Commission Mrs. Donna M c R i r i c k , C o o r d i n a t o r . 294 APPENDIX #0-4 E x i s t i n g L e g i s l a t i o n and G u i d e l i n e s : 1. B.C. Reg. 536/80 Community Care F a c i l i t y Act. 2. H o s p i t a l f o r Extended Care: A Program and Design Guide, H o s p i t a l Programs, M i n i s t r y of H e a l t h , V i c t o r i a , B.C., 1989 3. O c c u p a t i o n a l Environment R e g u l a t i o n s , Workers' Compensation Board of B r i t i s h Columbia, Richmond, B.C. 1974. 4. Housing the E l d e r l y , Canada Mortgage and Housing Corpora-t i o n , 1983. 5. Nursing Homes and H o s t e l s with Care S e r v i c e s f o r the E l d e r l y Design g u i d e l i n e s , Canada Mortgage and Housing Corpora-t i o n , 1979. 6. Housing an Aging P o p u l a t i o n , Government of Canada, N a t i o n a l A d v i s o r y C o u n c i l on Aging, 1987. 7. Housing f o r E l d e r l y People, Canada Mortgage and Housing C o r p o r a t i o n , 1987. 8. BCMHC Design G u i d e l i n e s f o r Family and Se n i o r Housing Appendix 2. APPENDIX #2-1 1. HOUSING CONDITIONS The s t a t i s t i c a l data r e p o r t e d below i s based on the re s e a r c h paper "Review of age - sex - s p e c i f i c c h a r a c t e r i s t i c of the Canadian p o p u l a t i o n " R.W. Seaton and M.Rajan, 1987 (unpublished d r a f t ) . CANADA (1982) A. S e n i o r Canadians are homeowners: 65% of the households heads aged 65 and over own t h e i r homes 75% of a l l men aged 65 and over own t h e i r homes 50% of a l l women aged 65 and over own t h e i r homes As the age i n c r e a s e s past 65 homeownership drops: 56% of s e n i o r s aged 80 and over own t h e i r homes But a mortgage d e c l i n e s as age advances: 95% of heads aged 80 and over had p a i d o f f t h e i r mortgages. B. Dwe l l i n g Types: 75% of a l l homeowners have a s i n g l e f a m i l y detached home. 60% of a l l s e n i o r s l i v e i n such above noted homes 12% of the e l d e r l y l i v e i n apartments (5 s t o r e y s and more) 25% of the e l d e r l y l i v e i n m u l t i p l e d w e l l i n g s 3% as above i n mobile homes C. C o l l e c t i v e Housing: (1981) 20% of" women aged 75 and over: s i n g l e women the l a r g e s t group 13% of the men as above Past the age 65: 79% of women and 73% of men l i v i n g i n c o l l e c t i v e d w e l l i n g s l i v e d i n n u r s i n g homes Past the age 75: 80% of both sexes l i v i n g i n c o l l e c t i v e d w e l l i n g s l i v e d i n nu r s i n g homes BRITISH COLUMBIA: (1981) A. Home Ownership: 66% of the e l d e r l y owned t h e i r homes As the age i n c r e a s e s past 65 - home ownership drops but even then 56.5% of s e n i o r s 75 and over own t h e i r homes. B. D w e l l i n g Types: 56% of household headed by person aged 65 and over have a s i n g l e f a m i l y detached d w e l l i n g 22% as above l i v e i n apartment bldg ( l e s s than 5 storey) 11% as above l i v e i n apartment bldg (high r i s e ) 5.5% as above: i n m u l t i p l e housing 5.5% as above: i n mobile homes Note: i n the p e r i o d 1971 to 1981: the % of BC e l d e r l y p o p u l a t i o n 65 and over l i v i n g i n s i n g l e detached d w e l l i n g s decreased from 64.6% to 56.2%. One of the reasons was the i n c r e a s e i n the stock of m u l t i p l e and attached d w e l l i n g s (condominiums). 2. INCOME LEVELS 296 CANADA (1980) A. V a r i a t i o n of income l e v e l s between males and females: 65-69 age group: the median income f o r males was more than twice t h a t f o r females 70 and over: medium income f o r males: $ 3,792 as above f o r females: $ 2,659 However, c o n s i d e r i n g the flow of non-cash b e n e f i t s per person (e.g. housing) i t i s much g r e a t e r to females than males. R e s u l t : money income alone do not provide an adequate b a s i s f o r comparison. B. Family Incomes: (1981) 50% of f a m i l i e s headed by person aged 65 and over had income under $ 15,000 (median income f o r t h i s group) Non-cash b e n e f i t s , such as s e n i o r c i t i z e n d i s c o n t s and s u b s i d i z e d housing and h e a l t h c a r e , c o n t r i b u t e to the economic w e l l - b e i n g of many s e n i o r c i t i z e n s , however o l d e r unattached i n d i v i d u a l s (those l i v i n g alone) are e s p e c i a l l y i n d i f f i c u l t f i n a n c i a l p o s i t i o n : 57%of them had income l e s s than $ 7,000. BRITISH COLUMBIA: (1980) 54% of f a m i l i e s headed by person aged 65 and over had incomes under $ 15,000 69.3% of o l d e r unattached persons had incomes l e s s than $ 8,000 75% of above group are females 3. RESOURCES AND SERVICES AVAILABLE TO THE SENIORS. In" order to d e p i c t the f u l l p i c t u r e of the contemporary e l d e r l y , i t i s necessry to review b r i e f l y the a v a i l a b l e resources and s e r v i c e s as a suplement to the p r e v i o u s l y d e s c r i b e d : Housing c o n d i t i o n s and income l e v e l s . As an example, I have s e l e c t e d the e x i s t i n g s e n i o r programs, a v a i l a b l e to those l i v i n g i n West Side Vancouver (Community Resource D i r e c t o r y f o r S e n i o r s , Summer 1988-1989). A. H e a l t h Resources and H e a l t h A s s i s t a n c e : T~. M e d i c a l S e r v i c e s Plan of BC: covers most medical, s u r g i c a l and d i a g n o s t i c s e r v i c e s 2. H o s p i t a l Care: i n - p a t i e n t , o u t - p a t i e n t , day and emergency treatment 3. Pharmacare: s e n i o r s pay 75% of d i s p e n s i n g fees; Pharmacare card i s used to o b t a i n : p r e s c r i p t i o n drugs, ostomy s u p p l i e s , i n s u l i n , permanent p r o s t h e t i c a p p l i a n c e s 4. - Long-Term Care Program: p r o v i d e s f o r care i n : - own home - i n t e r m e d i a t e care u n i t - a d u l t day care c e n t r e - extended care u n i t s e r v i c e i n c l u d e : Homemaker S e r v i c e : i n s e n i o r ' s own home ( a s s i s t a n c e with d a i l y a c t i v i t i e s ) R e s p i t e Care: r e l i e f s e r v i c e f o r care g i v e r A d u l t day C a r e : s u p e r v i s i o n of h e a l t h needs r e s i d e n t i a l Care S e r v i c e s : care f a c i l i t i e s 297 5. Home Care: Nursing S e r v i c e s - p r o f e s s i o n a l n u r s i n g care P hysiotherapy S e r v i c e s : due to c h r o n i c h e a l t h c o n d i t i o n Other e.g. : Speech Therapy 6. Home Support S e r v i c e s : Meals-on-wheels 7. Short Stay Assessment and Treatment Centres 8. Veterans Independent Program B. Housing Resources: T~. S o c i a l Housing r e s o u r c e s : (average r e n t s l e s s than 30% of gross household income) A f f o r d a b l e Housing A d v i s o r y A s s o c i a t i o n B.C. Housing Foundation B.C. Housing Management Commission Canada Mortgage and Housing C o r p o r a t i o n 2. Co-operative Housing: members owing share of t o t a l p r o j e c t not i n d i v i d u a l u n i t s Access B u i l d i n g A s s o c i a t i o n A f f o r d a b l e Housing A d v i s o r y A s s o c i a t i o n Canada Mortgage and Housing C o r p o r a t i o n Columbia Housing A d v i s o r y A s s o c i a t i o n Inner C i t y Housing S o c i e t y 3. Lowermainland Community Housing R e g i s t r y S o c i e t y n o n - p r o f i t s o c i e t y h e l p i n g people f i n d reasonable accomodation 4. R e s i d e n t i a l Tenancy Branch - P r o v i n c i a l agency housing p r o v i n c i a l j u r i s d i c t i o n over rented r e s i d e n t i a l premises i n B.C. 5. S h e l t e r A i d f o r E l d e r l y Renters - to a s s i s t e l i g i b l e s e n i o r s with high r e n t s 6. Programs h e l p i n g s e n i o r t s to stay i n t h e i r own homes: a. Home E q u i t y Plans: homeowners can r e c e i v e monthly income based on assessed value of t h e i r house b. P r o p e r t y Tax D e f e r r a l : u n t i l p r o p e r t y i s t r a n s f e r r e d or s o l d c. RRAP ( R e s i d e n t i a l R e h a b i l i t a t i o n A s s i s t a n c e ) : grants or loans to low income s e n i o r s r e q u i r i n g r e s i d e n t i a l r e p a i r s d. Home Support S e r v i c e s 7. S e n i o r C i t i z e n ' s Repair S e r v i c e s : Low-cost minor home r e p a i r s C. F e d e r a l Government Income Resources: T"! Old Age S e c u r i t y Pension: a l l Canadians over 65 2. Guaranteed Income Supplement: i n a d d i t i o n to (1). 3. Spouse's Allowance to Old Age S e c u r i t y Pension 4. Canada Pension Plan: f o r those who c o n t r i b u t e d to the Plan. 5. Unemployment Insurance. Government of BC: 6. G.A.I.N. - Guarnateed A v a i l a b l e Income f o r Need: age b e n e f i t s to s e n i o r s l i v i n g i n BC (age 60 & o v e r ) . 7. S.A.F.E.R. - S h e l t e r A i d f o r E l d e r l y Renters (see 13.5). D. O r g a n i z a t i o n s f o r S e n i o r s : T~. B.C. S e n i o r s ' Games: o r g a n i z i n g the s e n i o r s ' games on an annual b a s i s . 298 2. B.C. Old Age Pensioners O r g a n i z a t i o n : p o l i t i c a l and s o c i a l a c t i v i t i e s . 3. B r i t i s h Pensioners A s s o c i a t i o n (Canada): B r i t i s h pensioners r e s i d e n t i n Canada. 4. C o u n c i l of S e n i o r C i t i z e n O r g a n i z a t i o n s (COSCO). 5. S e n i o r C i t i z e n s A s s o c i a t i o n of B.C.: s o c i a l & b u s i n e s s . 6. Royal Canadian Legion: a c t i v e i n the welfare of i t s s e n i o r members. E. S e n i o r Centres: 1. 411 S e n i o r ' s Centre S o c i e t y ; 411 Dunsmuir St . 2. The Brock House S o c i e t y : 3875 P o i n t Grey Rd. 3. DERA Seni o r C i t i z e n Club: 9 E. Hastings St. 4. The E l d e r s ' Network: #105-2182 W. 12th Ave. 5. K i t s i l a n o Neighbourhood House: 2325 W. 7th Ave. 6. South G r a n v i l l e S e n i o r s F r i e n d s i p Centre S o c i e t y : 1420 W. 12th Ave. 7. West P o i n t Grey Community Centre a t Aberthan: 4397 W. 2nd Ave. 299 APPENDIX #5-1 Table 5-1A Independent L i v i n g Housing -- Comperative A n a l y s i s Type of U n i t s NAME OF HOUSING | No. OF | UNIT TYPES ,NUMBER AND MIX PER CENTAGE 1 1 UNIT TOTAL 1 1 j BACHELOR j 1 1 BED | 1 BED+DEN 1 | 2 BED Group 1: AVONDALE CO-OP /SURREY/ 70 -- 18 (25%) 52(75%) CEDAR CO-OP /SURREY/ 84 34 (405) 50(60%) Group 2: REGENT POINT /CALIFORNIA/ 136 36(26%) a 58(43%) b 42(31%) HOLLYBURN HOUSE /WEST VANCOUVER/ 66 8(12.2%) 42(63.6%) 8(12.2% ) — SUNNYSIDE MANOR /WHITE ROCK/ 74 31(41.9%) 27(36.5% 16(21.6% )a — )b — PARKWOOD MANOR /COQUITLAM/ 123 115(93%) 8(7%) SAN RAFAEL COMMONS /CALIF./ 81 36(44.4%) 45(55.6%) SETON VILLA /BURNABY/ 77 14(18%)a 28(36% )b 7(10% )c 14(18%)a 14(18%)b Group 3: MAYFAIR HOUSE 81 CONDO /P.GREY AREA/ -- 35(44%) -- 46(56%) THE CUMBERLAND 50 CONDO /P.GREY AREA/ 50(100%) 300 APPENDIX #5-1 Table 5-1B Independent L i v i n g Housing -- Comparative A n a l y s i s S i z e of U n i t s 1 SIZE OF UNITS NAME OF HOUSING | 1 | BACHELOR | m2 | 1 BED m2 | 1 BED+DEN | 1 m2 | 2 BED m2 AVOHDALE CO-OP 84 87 CEDAR CO-OP — — 83 84 Group 2 REGENT POINT 48 57 a b 86 HOLLYBURN HOUSE 49 58 62 80 SUNNYSIDE MANOR 45 64 a 60 b "*** "~~ PARKWOOD MANOR 57 58 55 a b c 61 SAN RAFAEL 46. 5 54 60 a b SETON VILLA 33 a 36 b 44.5 c 50 63 a b Group 3 MAYFAIR HOUSE 71 106 a 144 b THE CUMBERLAND 108 a 133 b 156 c 301 APPENDIX #5-2 The Extended Care U n i t of UBC Health Science H o s p i t a l A r c h i t e c t - Paul Smith A s s o c i a t e s Landscape A r c h i t e c t - Torrence/Vagelatos L t d . and Paul Smith A s s o c i a t e s . 1. S i t e context The Extended Care U n i t i s l o c a t e d i n the group of medical b u i l d i n g s i n the c e n t r a l p a r t of the UBC Campus. The medical f a c i l i t i e s are bounded from East by Westbroook M a l l and from North by the main entrance route - U n i v e r s i t y Boulevard. The f a c i l i t y i s l o c a t e d i n the southern p a r t of the complex and to the n o r t h there i s an adjacent Acute Care U n i t , to the E a s t there i s a n e i g h b o r i n g P s y c h i a t r i c U n i t . To the South the f a c i -l i t y looks to a huge open space while to the West there i s a Health Science M a l l . 2. General Space Concept The f i v e s t o r e y b u i l d i n g comprises three ward wings and the c e n t r a l p a r t with the main common space i n c l u d i n g n u r s i n g s t a -t i o n , lounges, and the a u x i l i a r y f a c i l i t i e s . On the Ground f l o o r l e v e l there are lounges and a space f o r p h y s i o t h e r a p y which overlook a small but a very p l e a s a n t garden to the South. Between Extended Care and Acute Care b u i l d i n g s there i s a 1.3 acre park which was o r i g i n a l l y c r e a t e d f o r the p a t i e n t s of both f a c i l i t i e s by two d i f f e r e n t a r c h i t e c t u r a l and landscape a r c h i t e c -t u r a l f i r m s . The P a t i e n t Park was designed by Landscape A r c h i -t e c t Karen Vagelatos while the small South Garden - p a t i o was de-signed by A r c h i t e c t s Paul Smith A s s o c i a t e s . South Garden - P a t i o 3. Design D e c i s i o n and O b j e c t i v e s a. provide a s m a l l but a t t r a c t i v e outdoor open space f o r p a t i e n t s (wheelchair a c c e s s i b l e ) b. provide s p e c i a l f e a t u r e s f o r the a c t i v i t i e s of the e l d e r l y such as r a i s e d p l a n t e r s , sunny group a c t i v i t i e s area - checkerboard and s h u f f l e b o a r d c. c r e a t e garden on a slope r i c h i n p l a n t m a t e r i a l 4. A n a l y s i s of F i n d i n g s The A r c h i t e c t has c r e a t e d on aprox 16000 s . f . area a very p l e a s a n t open space - p a t i o f o r the p a t i e n t s from Extended Care U n i t . 302 In s p i t e of a d i f f i c u l t l o t c o n f i g u r a t i o n and a c l i f f - - l i k e steep s l o p e , the a r c h i t e c t has provided a p a t i o - garden which i s an e x t e n t i o n of the b u i l d i n g ' s ground f l o o r area. The south-ern exposure and s y n c l i n e c h a r a c t e r of the slope c r e a t e a micro-c l i m a t e which helps to provide outdoor a c t i v i t i e s f o r the pa-t i e n t s even d u r i n g the winter. The space i s s m a l l , bounded by two f o o t high wood r e t a i n i n g w a l l s which at the same time serve as r a i s e d p l a n t e r s . The p a t i o area i s f i n i s h e d with 12" x 12" concrete p a t i o pavers. In the c e n t r a l p a r t of the p a t i o , there i s a checker-board. Close to the entrance, there are s e v e r a l s m a l l r a i s e d wood p l a n t e r s . Each of them i s two f o o t high and 4'x 6' i n s i z e . However, the recommended width i s 3"4" i n order f o r people to reach the c e n t e r of the bed. The a r c h i t e c t s ' i d e a was to provide a p l e a s a n t environment as w e l l as outdoor a c t i v i t i e s f o r the e l d e r l y . U n f o r t u n a t e l l y , there i s not much space f o r s h u f f l e b o a r d but a number of the e l d e r l y p a t i e n t s who are c o n f i n e d to wheelchairs can p a r t i c i p a t e i n a h o r t i c u l t u r e therapy program. Besides the r a i s e d beds, the p a t i o has been r e c e n t l y e n r i c h e d by a c i r c u l a r greenhouse, spe-c i a l l y designed f o r the wheelchair p a t i e n t s . The p l a n t m a t e r i a l on the slope i s designed f o r the f o u r - s e a -son c y c l e ; however, the most a t t r a c t i v e p l a n t s are annuals p l a n t -ed by the r e s i d e n t s themselves. The P a t i e n t Park 5. Design D e c i s i o n and O b j e c t i v e s a. c r e a t e outdoor open space f o r p a t i e n t s of the Extended Care U n i t and Acute Care U n i t b. provide many s e m i - p r i v a t e spaces connected to the com-mon open space c. c r e a t e a water f e a t u r e as v i s u a l i n t e r e s t d. provide a loop around the w a t e r f a l l e. u t i l i z e an area of the park i n t e n s e l y f. p rovide b a r r i e r - f r e e design throughout g. reduce impact of v e h i c u l a r t r a f f i c on Health Science M a l l h. connect the Park area with the Extended Care U n i t and Acute Care U n i t i . p r o vide p l a n t e r s with r a i s e d beds 303 6. A n a l y s i s of F i n d i n g s The P a t i e n t Park i s l o c a t e d on 1.3 acres adjacent to the west e l e v a t i o n of the Acute Care U n i t and the north p a r t of the Extended Care f a c i l i t y . To the west, the park i s bounded by Health Science Road. The landscape a r c h i t e c t s ' o b j e c t i v e s have been implemented, except f o r the loop around the w a t e r f a l l . P a t i e n t Park i s one of the most p l e a s a n t p l a c e s to enjoy outdoor environment at the U.B.C. Campus. The task f o r the landscape a r c h i t e c t was c h a l l e n g i n g because of the small area, sloped grounds and v a r i e t y of u s e r s . The r e -s u l t i s impressive, s i n c e the park i s a wonderful r e t r e a t , not o n l y f o r the p a t i e n t s and t h e i r v i s i t o r s , but a l s o f o r the s t a f f and passerby. The whole open area s t r e t c h e s along the North--South a x i s with the water f a l l on the c l o s u r e of the long v i s t a . The general i d e a of the landscape a r c h i t e c t was to c r e a t e maximum o p p o r t u n i t i e s f o r s o c i a l i n t e r a c t i o n as w e l l as f o r p r i v a c y w i t h i n a s a l u t a r y environment. T h e r e f o r e , the landscape a r c h i t e c t has c r e a t e d a park which serves both: as a common space f o r p a t i e n t - r e s i d e n t group a c t i v i t i e s and as s e m i - p r i v a t e spaces f o r i n t i m a t e g a t h e r i n g with f r i e n d s and f a m i l i e s . However, the p r i n c i p a l theme of a whole composition was a water f e a t u r e . The landscape a r c h i t e c t has provided a movement to e n l i v e n s t a t i c elements of the design and thus provide stimu-l a t i o n f o r the p a t i e n t s . By the same token she has c r e a t e d a sym-b o l i c p l a c e where a water f e a t u r e symbolizes " l i f e " . The water-f a l l , designed as a s c u l p t u r e d w a l l which g l i t t e r s i n s u n l i g h t , p r o v i d e s a v i s u a l magnet as w e l l as t r a n q u i l i t y to the park and r e l a t e s harmoniously with the t o t a l space. Above the w a t e r f a l l there i s a s m a l l p l a t e a u with evergreen shrubs which a l s o sym-b o l i z e c o n t i n u i t y of l i f e . The open space comprises f o u r small s e m i - p r i v a t e enclaves with sunny exposure which are surrounded by t r e e s , r a i s e d p l a n -t e r s and a c e n t r a l p l a z a . The f l o o r of the open space i s paved with exposed aggregate. The a i s e d bed p l a n t e r s are a l s o i n c o n c r e t e . During the summer time there i s white garden f u r n i t u r e which p r o v i d e s a very r e c r e a t i o n a l c h a r a c t e r to the p l a c e . Above the w a t e r f a l l as w e l l as around the whole p l a z a , there are p l a n t -ed s l o p e s with ( f o u r season) evergreen t r e e s and shrubs. In the southern p a r t of the park, there i s a cul-de sac f o r the Extend-ed Care U n i t p a t i e n t s f o r p i c k up and drop o f f which i s very gen-t l y emphasized by the arrangement of t r e e s . The c o n n e c t i o n between the park and two h e a l t h care f a c i l i -t i e s , a d i f f i c u l t problem, was s o l v e d by p r o v i d i n g a covered, paved walkway and hedges of s i m i l a r p l a n t m a t e r i a l . Since the 304 park i s aj a c e n t to Hea l t h Science Road, the landscape a r c h i t e c t reduced the impact of noise by c r e a t i n g a pl a n t e d mound and p u t t i n g a row of t r e e s along the road. The r a i s e d p l a n t e r s are very important f e a t u r e s f o r the e l d e r l y and are u t i l i z e d f u l l y by a h o r t i c u l t u r e therapy program. Summary Both outdoor open spaces, the P a t i e n t Park and the South P a t i o , provide a t t r a c t i v e and u s e f u l environments f o r the e l d e r -l y p a t i e n t s . The o r g i n a l ideas of the a r c h i t e c t s and landscape a r c h i t e c t have been almost f u l l y implemented and have emphasized the f u n c t i o n of the spaces i n which c e r t a i n a c t i v i t i e s can take place c o m fortably and e f f i c i e n t l y . Moreover, the P a t i e n t Park f u l f i l l s a s t r o n g need f o r beauty and a e s t h e t i c experience by p r o v i d i n g s c e n i c , b e a u t i f u l landscape with the w a t e r f a l l as a main f e a t u r e . 305 PARKWOOD MANOR - Congregate House A r c h i t e c t : Waisman, Dewar, Grout, C a r t e r A r c h i t e c t s Landscape A r c h i t e c t : R a n d a l l Sharp l . S i t e Context The s i t e of Parkwood Manor i s l o c a t e d i n h e a r t of Coquitlam on 5 acres of the b e a u t i f u l l y landscaped grounds adjacent to a we l l - p r e s e r v e d n a t u r a l park. The f a c i l i t y i s e a s i l y a c c e s s i b l e from a l l p a r t s of the Lower Mainland and the F r a s e r V a l l e y by the Barnet and Lougheed Highways. The Coquitlam Shopping Centre i s o n l y one block away. Churches, medical, l i b r a r y , and other community s e r v i c e s are a l s o i n c l o s e p r o x i m i t y to the s i t e . 2. General Space Concept The b u i l d i n g i s s i t u a t e d i n Coquitlam on the cul - d e - s a c of Pacard Avenue, p a r a l l e l to D u f f e r i n S t r e e t . The t h r e e - s t o r e y b u i l d i n g comprises f o u r r e s i d e n t i a l wings and a c e n t r a l p a r t with the main s o c i a l space. The main entrance, with ceremonial driveway and two a d j o i n g p a r k i n g l o t s with separete s e r v i c e access to the k i t c h e n f a c i l i t i e s , face D u f f e r i n S t r e e t . On the ground f l o o r l e v e l , i n the core of the b u i l d i n g , there are: d i n i n g room o v e r l o o k i n g the f r o n t yard, lounge and s o c i a l a c t i v i t i e s area o v e r l o o k i n g formal garden. The lounge area i s connected with the garden by a huge t e r r a c e . The ground f l o o r l e v e l d w e l l i n g u n i t s i n each of the f o u r r e s i d e n t i a l wings have d i r e c t e x i t to the grounds. 3. Design D e c i s i o n and O b j e c t i v e s a. Create a walkway loop around the whole f a c i l i t y with a r e t r e a t p l a c e c l o s e to Holy Creek area. b. Create a formal garden on the r e a r yard c. Provide b a r r i e r - f r e e access d. Create f l a t game areas on grass such as croquet, pad f o r s h u f f l e - b o a r d e. Provide s p e c i a l f e a t u r e f o r the a c t i v i t i e s f o r the e l d e r l y such as r a i s e d p l a n t e r s - h o r t i c u l t u r e therapy, sunny group a c t i v i t i e s area - B.B.Q. f. P r o v i d e screened p a t i o f o r each u n i t on the ground l e v e l , w h e elchair a c c e s s i b l e from perimeter walk g. Pr o v i d e o r i e n t a t i o n - signage along path f o r the v i s u a l l y impaired r e s i d e n t s 306 4. A n a l y s i s of F i n d i n g s The Landscape a r c h i t e c t has c r e a t e d an a t t r a c t i v e e n v i r o n -ment f o r the e l d e r l y r e s i d e n t s of Parkwood Manor by p r o v i d i n g spaces f o r s o c i a l i n t e r a c t i o n , sensory s t i m u l a t i o n as w e l l as s a f e t y and s e c u r i t y . Although not a l l h i s ideas were implemented, the main con-cept of a looped walkway around the whole f a c i l i t y was c a r r i e d out. The developer r e j e c t e d the o r g i n a l i d e a to connect the main walkway with the Holy Creek area which c o u l d have been an a t t r a c -t i v e r e t r e a t d e s t i n a t i o n f o r r e s i d e n t s . Moreover, the l o c a l r e s t areas along the walkway with benches (thought to serve as s o c i a l outdoor spaces) were a l s o d e l e t e d . O r g i n a l l y , the formal garden was designed as two d i f f e r e n t t e r r a c e s : the upper one with smooth t e r r a c o t t a paving overlooked a lower grass t e r r a c e . Along the bank, at the end of the upper t e r r a c e a b a l u s t r a d e was planned and below i t benches o v e r l o o k i n g rose beds f l a n k e d the grass m a l l . F a r behind there supposed to be a gazebo w i t h i n a r i n g of c h e r r i e s b u f f e r e d by e x i s t i n g hemlocks. U n f o r t u n a t e l l y , the whole i d e a was given up and now there i s o n l y a p l a i n upper t e r r a c e with benches on i t and huge grass space with some rose beds. There are n e i t h e r r a i s e d p l a n t e r s s c r e e n i n g the p r i v a t e p a r t of the open space, nor the gazebo. A l l a t t r a c t i v e and very important f e a t u r e such as a c t i v i t i e s areas with s p e c i a l game c o n s t r u c t i o n s : chess/checkers t a b l e s , sand of horseshoes, paved p a i n t e d s h u f f b o a r d , lawn's area f o r c r o q u e t t e , b a c i b a l l and others which c o u l d encourage c a s u a l p a r t i c i p a t i o n were abandoned a l s o . However, the e x i s t i n g t e r r a c e p l a y s an important r o l e as an indoor-outdoor t r a n s i t i o n area which o f f e r b e a u t i f u l garden view, comfortable s e a t i n g , easy and d i r e c t access and sense of human s c a l e . Moreover, t h i s area allows v i s u a l s u r v e i l l a n c e by r e s i d e n t s and s t a f f . Although the designed outdoor spaces promote s e c u r i t y and s a f e t y , as w e l l as n e g o t i a b i l i t y , the p r i v a c y i s s u e i s s t i l l c r i t i c a l one. The p r i v a t e p a t i o s were not c a r r i e d out as planned. The wooden decks has been eleminated and o n l y small concrete pads adjacent to p a t i o doors were provided. The l a c k of f e n c i n g or the other b a r r i e r i . e . shrubs and p a t i o - d e c k s on ground f l o o r yards have dim i n i s h e d p r i v a c y and excluded the p o s s i b i l i t y t h a t r e s i d e n t s c o u l d c r e a t e t h e i r own p r i v a t e t e r r i t o r i e s and use them as such. In f a c t , these p l a c e s become u s e l e s s . Moreover, l a c k of shrubs has c r e a t e d monotony of e x t e n s i v e area of grass s u r f a c e i n f r o n t of the b u i l d i n g . H o r t i c u l t u r e therapy i s another important aspect of appro-p r i a t e landscape f o r the e l d e r l y . Altough the southern p a r t of the garden was the p o t e n t i a l space f o r garden p l o t s or r a i s e d p l a n t e r s f o r h o r t i c u l t u r e therapy the developer r e j e c t e d t h i s i d e a . There are many proofs t h a t gardening p l a y s b e n e f i c i a l 307 r o l e i n therapy f o r the e l d e r l y . Moreover, a g r e a t e r l e v e l of d e t a i l i n g i n outdoor spaces may be p r e f e r e d by many o l d e r people to open spaces l a c k i n g d e t a i l . Raised garden p l a n t e r s f o r use by people i n wheelchairs or garden p l o t s c o u l d have d i v e r s i f i e d the a c t i v i t i e s f o r the e l d e r l y by c r e a t i n g a d d i t i o n a l space f o r s o c i a l i n t e r a c t i o n as w e l l as c r e a t i n g v a r i e t y i n type and l o c a t i o n of garden areas. U n f o r t u n a t e l l y , even the BBQ area has not been approved by the developer. Parkwood Manor i s s p e c i f i c a l l y designed f o r the e l d e r l y . T h e r e f o r e , any s o l u t i o n to provide a t t r a c t i v e and u s e f u l environment i n terms of a landscape i s very d e s i r a b l e . The o r g i n a l design s o l u t i o n s presented by the Landscape a r c h i t e c t c o u l d have enhanced the l i v e s of the e l d e r l y a t the Parkwood Manor f a c i l i t y i f they were f u l l y implemented. 308 HOLLYBURN HOUSE -Intermediate Care and P e r s o n a l Care F a c i l i t y A r c h i t e c t : Neale, S t a n i s z k i s , D o l l A r c h i t e c t s Landscape A r c h i t e c t : Kim Perry 1. S i t e Context The s i t e of H o l l y b u r n House i s l o c a t e d i n an upper-middle c l a s s neighbourhood i n West Vancouver on a sloped 53,777 s . f . l o t . H o l l y b u r n House i s p e r f e c t l y l o c a t e d as i t complies with a l l requirements f o r s i t i n g a f a c i l i t y f o r the e l d e r l y . The s i t e borders the major p u b l i c thoroughfare of Marine D r i v e and two l o c a l r e s i d e n t i a l s t r e e t s , 21st and 20th. The p u b l i c bus stop i s i n f r o n t of the b u i l d i n g . Across the s t r e e t there i s a P u b l i c L i b r a r y . Close to the s i t e , to the West, there i s a S e n i o r s ' A c t i v i t y Centre and R e c r e a t i o n a l Centre with A q u a t i c f a c i l i t i e s , Ice Arena and t e n n i s c o u r t s . To the E a s t , there i s a Memorial Park with the Lawn Bowling Green. To the North, the lane separates the H o l l y b u r n House and A n g l i c a n Church. The shopping c e n t r e a t Ambleside i s w i t h i n 2 b l o c k s ; however, across the s t r e e t the new shopping complex i s under c o n s t r a c t i o n at present. To the South, w i t h i n 2 b l o c k s , there i s a C e n t e n n i a l Seawalk and r e c r e a t i o n a l area. 2. General Space Concept The b u i l d i n g i s d i v i d e d i n t o two f u n c t i o n a l p a r t s : P a r t one comprises P e r s o n a l Care with 66 s e l f - c o n t a i n e d u n i t s on the second and t h i r d f l o o r s and Reception- A d m i n i s t r a t i o n area as w e l l as s o c i a l and d i n i n g spaces on the Ground f l o o r l e v e l . P a r t Two - Intermediate Care I and I I i s l o c a t e d on the Ground f l o o r l e v e l and comprises 36 s i n g l e u n i t s with a s o c i a l and d i n i n g space. The k i t c h e n and s t a f f f a c i l i t i e s are l o c a t e d i n the core of the main f l o o r l e v e l and serve these two p a r t s simutaneusly. 3. Design D e c i s i o n and O b j e c t i v e s a. Create a c c e s s i b l e ground f l o o r l e v e l i n s p i t e of a sloped s i t e b. Provide as many outdoor spaces as p o s s i b l e c. U t i l i z e s m a l l spaces i n t e n s i v e l y . d. Reduce impact of the p r o x i m i t y to lane and church e. P r o v i d e West Vancouver v e r n a c u l a r f. P r o v i d e b a r r i e r - f r e e design throughout g. Reduce impact of v e h i c u l a r t r a f f i c on Marina D r i v e h. Create A c t i v e Garden i . Create V i s u a l Garden j . Implement four-season p l a n t i n g m a t e r i a l 309 4. A n a l y s i s of F i n d i n g s The task f o r the Landscape A r c h i t e c t was extremely d i f f i c u l t because of l i m i t a t i o n s : s m a l l area and sloped grounds. N e v e r t h e l e s s , the r e s u l t i s impressive because a l l open spaces support s o c i a l i n t e r a c t i o n , p rovide sensory s t i m u l a t i o n , promote s e c u r i t y and s a f e t y , u t i l z e s m a l l spaces i n t e n s i v e l y and are compatible with H o l l y b u r n House a r c h i t e c t u r e as w e l l as with the whole neighbourhood. To reduce the impact of v e h i c u l a r t r a f f i c on Marina Drive a sloped green zone with t r e e s and shrubs was c r e a t e d to p r o t e c t the r e s i d e n t s from noise and p o l l u t i o n . Two separate entrances to P a r t One and P a r t Two are designed as e n t r y c o u r t s with shrub hedges, t r e e s and p l a n t e r s with annuals and p e r e n n i a l s . There are three main patio-gardens which are i n c o r p o r a t e d i n t o the main f u n c t i o n s of the f a c i l i t y at a Ground f l o o r l e v e l . T o the West, (Part One) there i s a Patio-Garden adjacent to the lobby, lounge and d i n i n g area. T h i s p a t i o was c r e a t e d as a paved p l a t e a u surrounded by stone w a l l s as an "embankment" with t r e e s and shrub hedges along the w a l l s . The entrance to the lounge i s emphasized s p a t i a l l y by the round shape of the garden. The main o b j e c t i v e of t h i s p a t i o was to cr e a t e an open space as an e x t e n t i o n of a s o c i a l space i n the f a c i l i t y and a t the same time to provide a summer d i n i n g or outdoor room f o r the r e s i d e n t s of Personal Care l e v e l . To the West, of the p a t i o , there i s a v i s u a l f e a t u r e designed as a water f e a t u r e surronded by annual f l o w e r beds, c h e r r y t r e e s and shrubs. The water f e a t u r e i n c l u d e s a water j e t and water f a l l , a l l done i n a stone w a l l , the same p a t t e r n which embraces the whole s i t e . T h i s f e a t u r e i s v i s i b l e from the entrance area because i t i s s i t u a t e d on the a x i s of a c i r c u l a t i o n area on the main f l o o r of the f a c i l i t y . To the North of the b u i l d i n g , there i s an unobtrusive access to the par k i n g area i n the basement and l o a d i n g area a c c e s s i b l e from the lane. The second P a r t of f a c i l i t y - Intermediate Care has a separate entrance with an e n t r y c o u r t a t the 20th s t r e e t . There are two l a r g e open s p a c e s - p a t i o s which are adjacent to a d i n i n g room and lounge. The northern p a t i o i s designed as a V i s u a l Garden. Since i t i s adjacent to the lane, the landscape a r c h i t e c t reduced the impact of unpleasant surrounding by p r o v i d i n g an arbor with c l i m b i n g p l a n t s as a s e p a r a t i o n and a f o u n t a i n as a focus p o i n t . The f l o o r i s paved with exposed aggregate concrete f i n i s h and surrounded by n a t i v e p l a n t m a t e r i a l . Although the p a t i o i s s i t u a t e d on the nor t h s i d e of the b u i l d i n g there i s a very p l e a s a n t "home l i k e " atmosphere c r e a t e d by smal l human s c a l e , wooden f u r n i t u r e , v i s u a l f e a t u r e s a f o u n t a i n , an arbor and p l a n t s . T h i s V i s u a l - P a t i o encourages r e s i d e n t s to use i t as an outdoor d i n i n g area. 310 The second p a t i o on the south s i d e of the f a c i l i t y i s c a l l e d the A c t i v e Garden. There i s a lawn with a gazebo. The landscape a r c h i t e c t ' s i d e a was to c r e a t e an a c t i v e space f o r the e l d e r l y with s h u f f l e - b o a r d on a lawn as w e l l as r a i s e d beds f o r c u l t i v a t i n g e a t i n g p l a n t s . However, the developer decided on a c a s u a l landscape, easy to maintain by the a d m i n i s t r a t i o n of the f a c i l i t y . As a r e s u l t , there i s o n l y one f e a t u r e - a gazebo which p l a y s a r o l e as an covered outdoor space f o r meeting purposes. A l l three patio-gardens are b a r r i e r - f r e e ; u n f o r t u n a t e l y , there i s no p h y s i c a l connection between them. The e l d e r l y , t h e r e f o r e , can not walk around and penetrate t h e i r t e r r i t o r y . Lack of r e l a t i o n s h i p between two p a r t s of f a c i l i t y negate the whole i d e a of m u l t i l e v e l care f a c i l i t y . Moreover, there i s no access from Intermediate Care u n i t s to the open space which c o u l d serve as s e m i - p r i v a t e areas of the d w e l l i n g u n i t which i s one of the most d e s i r a b l e f e a t u r e i n the e l d e r l y housing. G e n e r a l l y , H o l l y b u r n House Landscape i s a good example of a s i t e c o n t i n u i t y and c o m p a t i b i l i t y with the neighbourhood. By s e n s i t i v e design the landscape a r c h i t e c t has c r e a t e d three v a l u a b l e p a t i o s f o r the e l d e r l y r e s i d e n t s . The i d e a of p r o v i d i n g s p e c i a l garden f e a t u r e s f o r the e l d e r l y such as r a i s i n g beds, s h u f f l e - b o a r d s and implement h o r t i c u l t u r e as therapy i n the f a c i l i t y was an i n n o v a t i v e s o l u t i o n and of g r e a t value. A S E M A P I I R R O S 1 / 5 0 0 Mkannukaan ylaiiluontaan wowutui in i " on "aikut-tanut a lmni t iHt i uueiuluva i t m y i noltoiyttn ltt»nt«Mta )a • l * » * a r l * t l . *HJ»MHIO }• * « * * , » • -ahkltasv* tioito adatlyttivat t*tvayat«t*uka*lea a-uoiaauutta }a luontevmitta. Tarvaydanlwlto on oaa 1 Italian noraa*ll«ti catvltaaaia palvaluita, naktl palvalulta t > l ) » v n la itoata fiat • f l « t l t audita yhdyaliunnaita. vaan lan tulaa aakl a ia l l -ISlUaaati alt) arkkltafttooniian ilaiaaunaa kaut-ta totali yaplnatdnaa ooait l iviaana 2lain*. HauB]«fVBfi taivayakaaku* on ohjalaaliaan auun auntaaaaa yaHrittonaa ratannuaktntaan. T»aa on lontanut H 4 i i H u n halollatluun rattailuun, joka aiitakaavaltaan )• Buotowlaltlln hat** auialuaia p«fintalaaata ly l ia l l )66*t*. ToiaaaUa aan tahta** on M l * * " * laaiaapaa aiuatta, aikH kohottaa aan Hi l i iy tHlc I In lahlyaaatntona* kotoa*a«ai doai-nantikai am Qttin >)ll<i aiaataan l i n i i i i i u . "yd* t M i taklUn on annattu loiaiai ni.niiuinii I I M on yatavimnan. autt* ayoi arvokaa. KLaaataoivat f i i t t « * ( xlinaavat II I««(iB«**n pickain akataaai-aaan par mtaaaaan, inmailllnan slotauua kartoo aodarntn ftoitotyttn luontaaata. •akannutaan HJlM.ti piloiaata vantiainkoti on n -Joitattu tonun itlpllhan, ]• nakamuu kanti i l t*-»urinkoa, Ylaiatan paWaluatan oaa )* tacvay*-kaakukaan vuodaaaaato tyttntyva't torn in pohjota-raunaan latcian ataltpuolall* l**)an v«pa*-alu**n. Natannukaan all lan ksikiuaihailt* kulka* ylainan kavyan U l l m t i . n vayla, )ok* H t t t i * earvayakaa-kukean la Ottin *y l i« afiiakaaan toianni* . 5s pytfcli •uojautuaaan t]ontuvoliii*ntnn naitoilta. •utta kavyan l i lk intnn t m i i i l u n ottaa n -kaatuctaaaan hoidokkiana* (okapuaoiit it. Siaatilolan catkaiaut luovai kodtkaac* ]• nialan-vaiaiaavac auurat katiolyndyt, i i [ v i ) i i i i i g l i i n puolalla n« euovat valo* atyda alaman katcokaan adotuatiloihi*. «*yt»vl- , o l « i » U - ]« odotuati-lout * avautuv naayaia vuorotn itJKn j* scaiaan, kaavaiaan katutiLan tavoin. Potilaanuonaiaaa ton -nUkyaaauunti* ayda vuotaaaaa ol.valla. nut.ka-ikkunat avaavat u i i i i i n panoraaaana. Ehdotni (oroataa tatvaydan- ]a vannuacannoidon lahaiatl autidatt* yaparaivaln allaaani aikialaaa vapatol takannuat* 1* ] . t . u u lucntaMaad a*« tx-•11U, aaaoln hum luopm lit kit laavtantaan i.n laiianaa lydkamt, l*ncina]oi><*. 

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