NURSING-HOME DESIGN - A MISGUIDED ARCHITECTURAL MODEL

The systemic difficulties and ideological contradictions of nursing ho me design in the United States suggest that a misguided architectural model is being followed The scientific management of aging encourages the persistent uses of medical models for long-term care. This practic e clashes with efforts to satisfy non-medical needs of the frail elder ly and forces compromises in the design process of nursing homes Quali tative analysis of three cases is presented leading to conclusions tha t philosophical as well as a political shifts are needed The necessary changes should reflect the notion that growing old is part of the hum an condition and not a medical problem Nursing homes are the last refu ge in our society's long-term care for the elderly, the frail and thos e with chronic illness and disability. It has been said that a society can be judged by how well it provides for its vulnerable populations. If the depressing and frightening setting of the American nursing hom e reflects our collective moral heart - it is fairly grim. This articl e follows two fines of inquiry in the attempt to explain why it seems that in the design of the nursing home environment we have achieved th e worst of both worlds: an institutional setting that goes too far whi le it also does too little for its residents. The first line a philoso phical one, suggests that the medical perspective of aging as a manage able problem has significant implications on the way our society has c onstructed settings for provision of long-term care. The second course , the political explanation focuses on the systemic difficulties and t he ideological contradictions of nursing home design. Along this fine, the article reviews the background of the misguided architectural mod el of nursing homes and the wicked compromises which are made in the d esign process. The design process is depicted through three case studi es which are analyzed with the intent to demonstrate that unsuitable r egulations and an arduous reimbursement system constrain the design pr ocess of nursing homes. Furthermore, the analysis of the cases shows t he need for a change in the design process of long-term care facilitie s so that architectural models for these settings may be improved to m eet both the needs and the wants of older Americans.