<p>The ageing population is growing rapidly in New Zealand, and those with high-care needs are increasing at an even higher rate. Government policy calls for ageing-in-place,staying in their own home as long as possible, without entering residential care. Subsequently, there is a growing need for housing that accommodates the impairments and care requirements that typically correspond with ageing. Recently a reduced quality of life (QoL) was reported in one of the independent living options specifically designed for the elderly with care needs in New Zealand. Without change to housing that offers support and care for the elderly, the reduced QoLof residents is likely to remain a problem. A review of extensive literature onQoL and the role of architecture identifies a number of gaps in existing knowledge about housing design that facilitates the QoL of those elderly with high needs. These gaps include that, while the role of architecture is already established with regard to facilitating independence and control, there have been only limited insights into housing design that facilitates a wider range of aspects of QoL such as facilitating personal identity, important activities, relationships and maintaining high quality of care.Given the absence of design frameworks that are useful for designing housing that improves the QoL of the high-needs elderly in New Zealand,this research develops a holistic framework for housing design that improves the QoLfor this cohort. Two phases of survey are conducted in three types of senior housing complexes: retirement villages, and both public and private rental housing for the elderly. First, data on the current situations regarding these housing types, focusing on the models of care and physical environments as well as residents’ care requirements, are obtained through two types of questionnaires. This preliminary survey is followed by a qualitative, ethnographical investigation for the QoL of residents that relate to physical environments. Through semi-structured interviews and full-day observation of 30 elderly people who receive assistance in daily life and their caregivers, as well as documentation of physical environments, data are gathered on their perceptions and spatial use. Numerous themes for QoL emerge and are categorised into six main headings: Control in daily activities, Meaningful leisure activities, Meaningful relationships, Maintenance of possessions, Comfort and Quality of care. A number of design requirements are then identified and discussed with reference to existing knowledge, which leads to the development of a design framework. Housing that improves QoL needs to accommodate a variety of needs that reflect diverse individual preferences, circumstances and types of impairments. There is a need for reorganisation of space to accommodate caregivers, valuable relationships and personal possessions. The careful design of micro space greatly improves residents’ control. The design of a complex is also influential on QoL, particularly for facilitating activities as well as maintaining both privacy and connection. Finally, the potential to implement the framework is examined through designing example models of housing units and complexes. The design framework developed through this research has great potential to improve a wide range of aspects of QoL for the high-needs elderly in New Zealand, thereby helping them maintain satisfying and independent living longer.</p>
Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults
