Architecture for the elderly

To architects, nursing homes are a tough nut to crack. Somewhere midway between homes and hospitals, they have to stimulate social contact and provide privacy, be wheelchair and stretcher compatible yet cozy – and all that on a limited budget. Under a mandate by the canton’s Public Health Department, Bruno Marchand and Marielle Savoyat analyzed, through the eyes of an architect, a dozen nursing homes recently erected in the Swiss canton of Vaud. Their results, published in a book that came out in early 2014, give an overview of the history and current trends in the field of nursing home architecture. We sat down with Bruno Marchand to talk about some of the insights gained while writing the book.

Is architecture really that important for the quality of a nursing home?
Yes, obviously! We can safely assume that architecture is closely related to human behavior – even if there are contradicting theories on the subject. There are a number of issues that are inherent to architecture of nursing homes: comfort, atmosphere and accessibility are fundamental to the wellbeing of elderly people, who are often in a fragile state of health.

What types of challenges do architects face when they design nursing homes?
Nursing homes are complex hybrid organisms, where areas for medical care are intimately linked to residential areas. A major challenge is to give them a strongly humane character. Over the past years, those in charge of nursing homes have endeavored to make the medical component of the facilities as discreet as possible. The residents should feel like they are at home, not in a hospital.

Tell us about the book you just published.
Our mandate was to analyze a set of nursing homes that opened recently in the canton of Vaud from an architectural perspective. We compared the conception of each project to its ultimate realization and tried to derive lessons in the process. Additionally, we analyzed hundreds of entries submitted to recent architectural competitions in order to uncover the breadth of possible approaches and thus provide architects with both extensive documentation and a foundation upon which they can build when thinking on the subject. We also dedicated a chapter to a historical overview of nursing home architecture.

Personeni Raffaele Schärer Architectes, EMS La Clairière, Mies, 2003-2007, view onto the living room, © Michel Bonvin

What makes a nursing home a good nursing home?
Basically, anything that conceals the institutional character of the establishment. The long hallways are being increasingly replaced by circular ones to minimize a resemblance to hospitals. The rooms and associated elements, such as doors and windows, are given extra care. The entrance to rooms, which marks the transition between private and public – or intimate and collective – spaces, is another essential component. Location is crucial as well: we have to avoid building “secluded oases in the countryside” and instead integrate nursing homes into bustling neighborhoods that are well serviced by public transport and located near shops and restaurants. However, land at such prime locations is unfortunately hard to come by.

What are the most prevalent ways of designing nursing homes today?
When we analyzed the submissions for nursing home competitions, one theme that came out was that of a large house – about the size of a townhouse. Sometimes two rooms share a single window, and the windows are staggered to attenuate the institutional, regular nature of the building. Large establishments are often fragmented into several smaller structures.

Do other models exist?
In Basel, Herzog and de Meuron built a nursing home in a football stadium, provocatively stating that their residents like to watch football… There is no single model, which is what makes this book interesting. Despite these differences, the humanist discourse is becoming more and more prevalent, adapted each time to local cultural and financial circumstances.

How are things in Switzerland and particularly in Vaud?
Historically, Switzerland has been very mindful of the wellbeing of its elderly population and has therefore become one of the most advanced countries in this area. As is often the case, Switzerland stands out for its very high quality of living and its high quality infrastructure; the same is true for its nursing homes. On top of that, there is a constant sense of progress, with each project bringing a new set of lessons. The members of the canton’s Public Health Department play an important role in guiding these projects and making sure that they keep up with developments in the field.

P. de Benoit M. Wagner Architectes, EMS Silo, Echichens, 2003-2012, picture of a room

Did you experience anything particularly fascinating during your research?
Moving into a nursing home is a difficult step in life, and it is fascinating to see how different people deal with this transition. Some leave behind their past and bring along nothing but their toothbrush. Others try to take their entire lives with them. Because space is limited, this can sometimes be challenging. But what I saw and heard when visiting the homes was generally very positive. Even in a small space, it is perfectly possible to live well.