By Stuart Carr, director at Inglis & Carr
The new reality
In a recent trip to Verona, prior to the majority of the population of the UK being placed under house arrest, I found myself looking up at the balcony which was said to have inspired Shakespeare’s ‘Wherefore art thou, Romeo’ scene. Young couples, and some older, were re-enacting the scene for the benefit of their families and friends and any thought of social distancing amongst the tourists in the courtyard below, myself included, could not have been further from our minds. In a sense the crush and inconvenience of it all was part of the fun of the experience. How ironic that just a few short months later the television pictures of Italy would show deserted streets with not a tourist and barely a local in sight.
But people are very innovative and uniquely skilled at turning a necessity into a virtue. Before long the pictures from Italy were showing residents on their balconies, observing the social distancing rules but managing to communicate in amusing and creative ways with their adjacent neighbours and those across the street. It was like the Romeo & Juliet balcony scene on speed as neighbours reached out to each other in a shared quest for companionship and a sense of corporate celebration in the face of a hidden enemy.
There have been other evidences of some positive effects of the shutdown with various support networks forming to help those who are more susceptible to the effects of being shut in alone and others who need help with the practical necessities of life. The UK nation as a whole were taken aback at the overwhelming response to the government request for ordinary citizens to volunteer their time and energy to assist the NHS with all kinds of non-medical tasks.
So, what bearing will all of this have on the design of new communities for older people? Communities that enable residents to rent or own a property and to maintain their privacy and independence, with the reassurance of 24-hour on-site staff, communal facilities, and optional care and support as needed. This is a crucial question for our practice as we are currently designing Future Street’s new mid-market Later Living Villages for rent and part-ownership in various locations throughout England.
How should we design to provide the optimum facilities for our residents against the potential recurrence of this virus or the appearance of another similar challenge?
We have a huge housing gap in the UK and the population is ageing. In August 2019, Property Week declared that Later Living is ‘set to be the next major UK residential asset class’ and ARCO (Associated Retirement Community Operators), the main body representing the sector in the UK, has ambition for 250,000 people to have the opportunity to live in Later Living communities by 2030.
As human beings we also have a fundamental need for a sense of safety and security, particularly as we get older and more vulnerable. Abraham Maslow, the celebrated American psychologist, proposed in his Hierarchy of Human Needs thesis that once our basic physiological needs, such as warmth, shelter and food, have been met the next most pressing need is for a sense of safety and security from any potential harm. It is only once these needs have been taken care of that the more complex aspirations of being human can begin to develop.
Historically, plagues have driven profound changes in our built environment. London’s Victoria Embankment is a case in point. Although it is now part of the cultural fabric of the city and runs for a mile and a quarter along the River Thames it was built in the late 19th Century as a recognition of the desperate need for a modern sanitation system in response to the numerous cholera epidemics which had broken out, including one outbreak in the 1850s which claimed over 10,000 lives.
Covid-19 will also drive changes of various kinds: legal, fiscal, procedural and physical. There is an inevitable tension between the need for densification and future social distancing. The denser a settlement is the more energy efficient it is and the easier access becomes to social and health services. But this is a multi-faceted problem which when tweaked beneficially in one direction creates detrimental effects in another. If we try to spread ourselves out more what effect will this have on our valuable green belt and our dependency on the car to get anywhere in the absence of good, well-connected public transport in more rural areas?
Social distancing or social engagement
We are all familiar with the sense of social isolation which elderly people living alone can feel. The current requirement for social distancing is directly opposed to the ethos of community living. ‘Live in the building, sleep in your flat’ is one of the recent mantras of the Build to Rent Sector.
It is unlikely that the measures adopted to counteract Covid-19 will result in a reconsideration of the HAPPI principles which we adopt in our approach to good design for the elderly. Generous space standards and natural light in the circulation spaces, avoiding an institutional feeling whilst encouraging social interaction, will always be desirable given that pandemics are the exception rather than the rule. The social and psychological benefits of shared facilities and community ‘hubs’, where these are lacking in the neighbourhood, are well-attested. The provision of external spaces, both private and communal, opening onto areas of planting, trees and the natural environment are essential and vehicular circulation should comply with Homezone principles where pedestrian movement is given priority over vehicles.
In such responsibly managed living environments it is likely that health, fitness and wellness will improve, leading to increased longevity. A recent report commissioned by the Extra Care Charitable Trust shows that older people benefit from improved physical and mental health in Later Living Villages, resulting in cost savings to the NHS. The study into healthy ageing was carried out by Aston and Lancaster Universities and demonstrated that residents in such communities:
- are more physically active (75% increase in exercise)
- benefit from a reduced risk of falls (18%)
- are less anxious (23%)
- have an increased walking speed
- were ‘never or hardly ever’ lonely (86.5%)
- have improved autobiographical (24%) and memory (17%) recall
- can delay or reverse the onset of frailty
On the other hand, social distancing is a form of social isolation with potential physical and mental health consequences. Getting the management procedures in place to respond rapidly to any infection will help to ensure that such benefits are maintained. Adding to this the emerging innovations, including telecare and tele-healthcare technologies, will reduce the risk for residents, staff, and visitors alike.
It is the need to be close to family, friends and facilities which attracts older people into the city, often having raised their families in the leafy suburbs. Lock-downs may become more frequent in the future if these are seen by successive governments as the best method of avoiding the worst effects of a pandemic but the fundamental advantages of social integration over social isolation will remain the primary driving force.
Quarantine has been used for centuries as a method of avoiding the spread of infection. I anticipate that at the first hint of a potential pandemic new management protocols will require that all residents go into lock-down until a comprehensive process of testing has been undertaken. Testing will become all-encompassing: Residents, staff, friends and visitors will all have to pass the test to enter the building- this requirement is likely to drive innovation to make this a simple, straightforward and inexpensive process.
Free movement of staff will be curtailed – at present staff sometimes move between operators which increases the risk of cross infection. In effect, the village operators will have built a virtual wall around their premises. But this will not preclude the strategic coordination of non-human resources and the sharing of information amongst operators. Alongside this, village operators will ensure that they have an abundance of PPE and clinical on-site facilities which will enable residents to be properly cared for on-site rather than having to be transferred to hospital, wherever possible. Given that some PPE has a limited shelf life this will also call for further development and innovation.
It is alarming to see the difficulties which nursing homes are experiencing at present where a high degree of close-contact care is provided. Care homes have complained that they cannot get hold of the necessary PPE as it has mostly been acquired by the NHS. This oversight is concerning considering that there are three times as many beds provided within care homes compared to hospital beds in the UK. The fact is that no public or private sector organisation has been fully prepared for the speed of onset of the lock-down. No astute organisation will be caught out twice.
Later Living Villages, unlike care homes, have experienced a much lower rate of infection – largely because of the relatively low levels of hands-on care provided and the compartmentalisation of the village into individual homes, whether flats or houses. Residents also tend to be younger, fitter and more able to resist infection. Depriving people of the right to visit nearby parks and open spaces has been perceived as a particularly oppressive measure by some and will need to be given more consideration in any future pandemic. It should not be beyond our wit, as a civilised society, to introduce procedures and protective measures which enable us to continue to enjoy the benefits of such spaces.
The pandemic will require Later Living to enter the digital age and will act as the catalyst that ignites the need for tech innovation to enable better care, communications, and management: from video platforms to keep residents connected to deployed robots to interact with residents.
New technological methods of tracking the progress of a virus will be introduced which governments will seek to impose on the population as a whole. Whilst there will be inevitable resistance to the potential misuse of this technology it is undeniable that some countries, most notably South Korea, kept their casualty numbers to a very low minimum by mapping and publicising the movements of infected patients.
I would also expect such tracking to become commonplace on the micro scale within all Later Living Villages as potential residents look for complete reassurance that everything possible is being done to protect the health and safety of the residents before they agree to take up residence. If plagues do indeed drive innovation and invention then this one should be no different. New technologies will inevitably emerge which are not yet within the collective public consciousness.
Other construction technologies which are better known, but not yet widespread, will come to the fore. Offsite manufacturing, particularly modular construction, will increasingly demonstrate its ability to comply with social distancing requirements. In this form of construction prefabricated structural boxes fully finished internally are manufactured in factories remote from the site and then craned into position onto a foundation or podium which is constructed on site. This form of construction reduces the time spent on site overall very substantially. In this process quality control and health and safety issues can be effectively managed within a well-lit and well-regulated, heated factory environment.
Consider the innovate Japanese ‘Just in Time’ process which has been employed at the Mini Cooper production line in Cowley. Bringing this kind of innovation to the construction industry is difficult but perhaps now even more imperative. There have been a few enthusiastic attempts by major national companies to introduce this degree of industrialisation to the off-site manufacturing process, with varying degrees of success.
Robotics will play an important part but, like the Mini Cooper factory in Cowley, relatively unskilled people can be trained easily to carry out a limited number of tasks to a high standard. The climatic and quality control advantages of manufacturing in controlled factory conditions are well established. Health and safety issues can be better managed within a factory environment and when social distancing is required this can also be more easily implemented without having to shut down the factory. Covid-19 may turn out to be the impetus which modular manufacturing needs to get it over the tipping point, where it has been hovering uncertainly in recent years.
The courtyard, the balcony, the winter garden and micro-gardening
In possible future outbreaks, the ability of residents to interact with others in a safe environment will be of paramount importance. The provision of balconies, either within a courtyard setting or facing the street, provides an opportunity most of the year round for safe social interaction, Verona style, for the residents.
The courtyard will often be a space that is used for various activities, whether recreational or educational or just for relaxation and talking to friends. During the lockdown in Verona the residents compensated for the lack of any street activity by creating their own. I would expect the same phenomenon to occur on an impromptu basis within the courtyards we are creating for Future Street. When it is too cold to sit out on a balcony there will be an option to sit in the rooftop winter garden in an attractive landscape setting. This facility will be reserved for those who have tested negative or who have developed a resistance to the virus, either through exposure and recovery or through vaccination. If the testing protocol previously suggested is implemented we would anticipate that very few residents would need to self-isolate and most will be able to continue to stay alert.
Our immune system is bolstered by healthy eating and micro-gardening, the intensive cultivation of a wide range of vegetables and herbs in small spaces such as balconies, courtyards, and surrounding landscaping, are highly productive. Studies show that a just one square metre can produce around 200 tomatoes a year, 100 onions every 120 days and 10 cabbages every 90 days. Such contributions by residents towards their own cooking ingredients or village restaurant dishes are valuable.
Extending this wellness philosophy further to the boundaries of the plot and we could see small allotments, summer fruit trees and bushes, wildlife gardens, natural wildflower areas ; initiatives that create a purpose for all outdoor areas to promote and enhance wellness for village residents.
In conclusion, it seems unlikely to me that the basics of good design for the elderly will change significantly. I believe that the balcony, the courtyard, the winter garden and wellness philosophy will become essential features rather than being seen as optional luxuries. Management procedures will change in response to the devastating wake-up call that nursing homes throughout the country have experienced of late and there will be a renewed interest in off-site manufacturing to enable construction work to continue during a future period of social distancing. We have an opportunity to respond in a positive and creative way and I look forward to seeing the innovative ideas which the current crisis will generate.