Design tends to be evolutionary, not revolutionary. Progress is typically made in incremental steps, tweaking what “is” to change what “will be.” Occasionally, a revolutionary idea comes along, one that makes us stop and reconsider what we thought we knew. So when I was asked to write about what I feel are the top 10 design innovations from the past decade, I let my mind wander over all the changes we've witnessed. There is now widespread recognition that things will be different as the Baby Boom generation moves, inexorably and generally unwillingly, into that category of citizenship we have, in the past, so easily called senior citizens. This is not a cohort that takes aging (or anything else for that matter) lightly. Many are already helping aging parents cope with later life changes, vowing that things will be different when they get to that stage. We are beginning to see that commitment in changes to nursing homes. It is heartening for those of us who have been in the industry for 25 or more years to see that people are increasingly unsatisfied with what we let nursing homes evolve into-staff-centric institutions that cared more for the body than the soul. I wouldn't yet call the culture change movement a tsunami, but it is certainly a significant groundswell, with enough traction to be more than a passing fad. Whether you refer to it as person-centered care, resident-directed care, or as I prefer, self-directed, relationship-based life, it is here to stay.
But there have been changes in other arenas as well. So let's explore the past decade. Some ideas are big-at the scale of the building or even the community-while other innovations appear in areas such as the small details of a handle grip. All make a difference.
INTENTIONAL ELDER-FRIENDLY COMMUNITIES
Unfortunately, the majority of new homes are still being built with multiple levels, steps at the threshold, and in cul-de-sac suburbs that require a car to go anywhere. Hopefully, in the next decade, we will see more development of intentional elder-friendly communities such as those being spearheaded by groups like the Village to Village Network (www.vtvnetwork.org) and Generations of Hope Communities (www.generationsofhope.org).
THE GREEN HOUSE® PROJECT
Who would have thought, 15 years ago, that you could have a house-a freestanding building-where 10 people lived and loved and laughed and cried, and received nursing level care? There were some smaller household examples, but they were almost always housed under a larger roof, usually with the typical organizational structure, a focus on operational efficiencies, and an institutional culture. There were exceptions-many of the Pioneer Network founders recognized that changing the physical environment was necessary but not sufficient; organizational change was needed to really change the culture from institution to home.
Some care providers thought that if they created a space that looks like a household, it would act and feel like a household. Not true. The Green House project (www.thegreenhouseproject.org) has demonstrated that not only is it possible to live in a home and receive skilled nursing services, the model can be financially viable. The model is spreading and several other organizations are now supporting the small house movement, including the National Alliance of Small Houses (www.smallhousealliance.org) and the Association of Households International (www.ahhi.org).
It's still a young model, and needs more years of experience to demonstrate continued success. A testimony to its radicalism is that a lot of professional caregivers and nursing home administrators still don't believe it can be done. And yet it is. Ask those who live or are employed in a Green House and they will tell you, in no uncertain terms, that it works.