by If you have friends or relatives in care homes, or if you live in one, you may often be familiar with the standard offer. Residents are kept behind locked doors, rarely allowed to walk outside, instead stuck in armchairs in front of blaring televisions, surrounded by equipment that resembles medical spaces other than home, lacking the ability to make decisions about almost nothing. A care home could be a large old house converted very awkwardly, or a new building that is as ruthlessly cost-effective as a decent distribution center or hotel. Even where the staff and management are truly committed to the welfare of the residents (and there are reported cases where this is not the case), it seems difficult to escape the pervasive formula of death.
This, even if you are not yet old and do not suffer from dementia, is something you should be careful about, because the above is a possible future for you. It is an issue for society in general, as the population ages. It is also an area where architecture plays a role, as the physical environment can enhance or harm the well-being of residents. Done right, design can make elder care less stressful and more efficient. It can reduce the need for expensive medical and other interventions.
For architects, who generally want to do more with their skills than add some style to an office block or private home, design for the elderly and those living with age-related diseases such as dementia gives an opportunity for them to contribute to something social. value. And so you find works such as the John Morden Center in Blackheath, south-east London – a day care center for retirement community residents by MAE Architects, winner of last year’s Stirling prize – and Appleby Blue in nearby Bermondsey, “21st. -almshouse of the century” by Witherford Watson Mann. With both projects, the architects went the extra mile to achieve things like good daylight; strong feelings of connection with the outside and between different parts of the building; materials that are natural and pleasant; and trails that, rather than functional routes, are pleasant places to stay.
The Village Landais Alzheimer, on the outskirts of the town of Dax in south-west France, is a comprehensive effort to “give real life back” to people with Alzheimer’s, as one staff member puts it, to “create conditions in which they live”. t stay in a room waiting to die”. It is based on the dementia village of Hogeweyk in the Netherlands, a celebrated 14-year-old facility with the look and feel of a village. The Dax project is similarly designed to have the life and appearance of a traditional community, with a familiar and legible architecture based on common features in the region, albeit in simplified modern forms. There is a “bastide” – an arcaded square with a restaurant, library and other facilities – as well as four clusters of houses, with their shallow pitched roofs and clay tiles, surrounding a pleasant green space, with a pond and trees in the middle.
The project is a self-affirming experiment to test how its principles work in practice. The budget was initiated by the area’s local authority, the département des Landes, and its €28m budget is largely funded by them with some assistance from regional and national governments. It serves 108 residents (who pay €2,000 a month and can get help if they can’t afford this) plus 12 day care patients, with more than 120 staff and 80 volunteers. It pays particular attention to the needs of people with early-onset dementia, meaning the current population ages from 42 to 104. It was designed by Danish practice Nord and local architects Champagnat & Grégoire.
Village Landais, which opened in 2020 and recently received high praise in Dezeen’s annual design awards, aims to give villagers, as the team call them, as much agency and freedom, real and apparent, as can. The five-hectare complex has a fence around it, as it must for the safety of vulnerable residents, but within its boundary people can come and go, more or less as they please. They can walk around the open spaces (or run, or cycle, as people with Alzheimer’s can be physically active too), visit their neighbours, go to the restaurant or a show in the village hall , serve animals and plants in minutes. -farm and kitchen garden.
Within each cluster of buildings, or fourth, are “individual houses”, each with private bedrooms and a shared living and dining area, with a staff-run kitchen. These then look through glass walls into informal courtyards, to create the possibility of community with the other houses. The courts are partly sheltered and partly open, giving a feeling of flow from one person to another. The paths around the village are designed in loops, as people with Alzheimer’s sometimes get confused when there are dead ends. They also return walkways back towards the center and away from the border fence, which you barely notice. The idea is to create “the expression of freedom”, says Mathilde Charon-Burnel, who manages social care projects for the département.
There are other details designed to mitigate the effects of the disease. The pavement is a uniform beige color throughout, as strong contrasts can affect people with Alzheimer’s. Mirrors, which can also be annoying, can be hidden with shutters. Light and darkness are used to draw attention to where it should go, and deflect it from where it should not. Green door handles are set against darker backgrounds, and doors to service areas are barely visible in paneled walls. People with Alzheimer’s are “more curious than other people, because they’re lost all the time”, says Charon-Burnel, so “if you put a ‘no entry’ or ‘teams only’ sign on something they will go there”. It is best to make the out-of-bounds zones inconspicuous. “There is as little signage as possible,” says Morten Rask Gregersen of Nord. “People can see where they need to go instead of being shown.”
There’s also a make-up shop, where townspeople can “buy” products they don’t actually pay for, and a believable compartment of an old-fashioned railway carriage, with a screen inside that shows scrolling countryside. Therapists use these to make patients think they are really on a journey. You might think that such an artifact would only add to their anxiety, but I am told that they calm and relax the residents.
The Dax project and those in Blackheath and Bermondsey cater for different levels and types of need. Appleby Blue is sheltered housing, giving residents more independence than is possible in an Alzheimer’s village. But the projects are keen to show respect for the individuality and dignity of the people who live in them, a recognition that you continue to be the person you were when you were younger. Also in this category is Bankhouse in Vauxhall, South London, run by housing association Tonic, a retirement community for LGBTQ+ people in a riverside tower designed by Foster + Partners. Here, residents are provided with not only residential units but shared facilities – art classes, a bar, a roof garden – that help create a community.
Dignity includes visibility. A curious feature of many care homes is that passers-by do not see the residents through their hermetic exteriors or abandoned gardens, as if aging is something that should be kept out of sight. In Appleby Blue the common areas are right next to a street and a bus stop, their upper floor on a level with a two-storey upper deck, with generous windows allowing for positive views in both directions. The village of Dax is more remote, but the local community has access to its auditorium and library.
More importantly, these projects seem to work. In Dax, the townspeople seem cheerful, engaged, relaxed. I meet a couple who got together after moving there, who beg me to come back when the weather is better and the flowers are out. Charon-Burnel tells me that lower levels of anxiety create fewer “behavior issues,” making caregivers’ jobs easier. More scientifically, independent research recently found that markers for things like cognitive decline and depression were significantly better in Dax village than in other care homes.
The most obvious challenge is scale. There are around 1 million people with Alzheimer’s in France, not to mention other forms of dementia, so it would take a lot of projects like Village Landais to make an impact. But the principles of agency and respect can be exported to at least less singular situations. The alternative is not avoidable misery for the elderly but also increased spending on the health problems that come with it. Why wouldn’t any of us want happier and healthier places for people nearing the end of their lives, especially since many of us will be in our own?
