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Three Stage Housing for Old Persons

Clara Ako Yoshida, Kyoei Gakuen Junior College, Japan

International Trends

During the International Year of Disabled Persons in 1981, the United Nations issued international standards with the declaration ’access for all’. These are guidelines for "developing a physical environment without architectural barriers for old and disabled persons and for developing cities where everyone can live without handicap".

In the field of barrier-free design, we cannot ignore the world authorities Dr. T.J.Nugent in the United States and Mr. S.Goldsmith in the United Kingdom. Mention must also be made of the International Center on Technical Aids, Housing and Transportation (ICTA) in Sweden whose main task is to collect and disseminate information on technical aids, environmental and transport facilities for people with disabilities with special regard to mobility impaired persons.

The concept of ’access for all’ became law in the United States where buildings receiving federal subsidies must provide access to all people. In the United Kingdom, the term ’mobility’ used in the sense to improve the mobility for physically disabled persons, also appears in the recommendations for the renovation and renewal of buildings and cities. The United Nations held a world conference on the problems of the aged in 1982, after the International Year of Disabled Persons. At the conference it was proposed that old persons should not be seen as burden but as valuable assets to society. To this end, a resolution was adopted calling for strengthening in-home support services to allow old persons to remain independent and self-reliant in the local community as long as possible. Populations statistics indicate that Japan will turn into an aged society at an unprecedented fast pace, and a call for developing responses to this question has been made recently.

Aging and Physical Functions

Previously, residential facilities specially designated for old and disabled people were built in segregated environments outside our communities. These areas were often called "colonies" and tended to be idealized. However, after the passage of a half century, the shortcomings of this isolation policy have become clear worldwide. As a consequence, today, under the concept of integration, there are an increasing number of plans to make general adaptations in our communities to enable old and disabled citizens to continue to live amongst others in the community.

In adapting architecture to the needs of old persons, the decline in mental and physical functions due to aging is an important factor. Man does not suddenly grow old after reaching the age of 65; the process of decline begins already in the middle 20’s. For example, vision reaches the peak at around the age of 20, and enters the range of far-sightedness by the age of 40. Hearing is best at age 24 and declines at a rate of 1 dB per year. By the time people are 65, they have lost, on the average, about 40 dB. The sense of balance deteriorates; people fall more easily and get more often dizzy while standing as they get older. The time people can stand on one leg with their eyes closed in their 40’s is one-half of the time in their 20’s, and on-third by the time they reach their 60’s. In general, as people grow old, their cells shrink, and their connecting tissues become transformed.

Since a home can only be called a true home, when one can live one’s entire life in it, houses should be easily modifiable as the resident becomes older. In the following, criteria for housing will be developed that can respond to the decline in human mental and physical functions.

Hazards in the Home

When we look at safety in buildings statistics show that common accidents in daily life such as tripping and falling cause far more deaths than emergencies such as fires and earthquakes; to be exact, they cause six times more deaths. While architects’ responsibility for safety in emergencies is under discussion, the question tends to be overlooked as to where the responsibility lies for ordinary accidents such as falls.

In terms of age, an overwhelming number of home accident victims are infants and old persons which leads us to believe that existing dwellings are generally designed for a man (not a woman) in the prime of life and at the peak of his physical fitness. As a consequence, such housing may in many ways be unsuitable for persons whose physical abilities are below those of healthy men.

In this connection the resolution should be recalled which was passed by the United Nations Expert Group Meeting on Barrier Free Design held in 1974. Under the title "The Challenge to Mythical Mr. Average", it stated that "the time has come to reexamine the design of buildings which has been devoted exclusively to the average man up to this point". In Japan, the recommendation has won the support of many persons including architects.

According to a survey on the incident of accidents, they mainly occur on the floor, at entrances and staircases. In these places, accidents involving injuries occur more often in private residences than in office buildings. Accidental injuries can therefore be considered man-made, that is, they are caused, to a significant extent, by a lack of adequate consideration and care on the part of architects.

Focusing on Mobility

Human beings evolve from crawling to walking, from dependence to independence. In order to continue to live into old age with dignity, one of the first requirements is that the old person can go on his own where he wants to and when he wants to. Internationally, this is called ’mobility’. Even though this seems to be simple and self-evident, the design of dwellings, public buildings and mass transportation up to now has allowed only younger and non-disabled persons to enjoy these facilities. For example, while those who can easily lift up their leg walk over a threshold unimpeded, old persons have difficulties in bending their ankles 90 degrees. Thus, even though they may think that they lifted their foot high enough, it gets caught on the threshold, and they trip. They are likely to break a bone in the accident, and require hospitalization.

These hazardous level differences are found everywhere, especially in Japanese traditional style houses. The concept of ’partitioning’ (shikiru) is very old and has been important when entering somebody else’s territory. ’Shikii’ (threshold) is the symbol of this concept. In figurative speech, for example, "stepping over the threshold", means to become a member of the family; "the threshold feels high", is used to connote psychological difficulties in visiting somebody. Invariably, there are level differences at entrances to buildings and rooms in Japan.

Furthermore, because the Japanese traditional 3-foot module for the pillar interval has been reduced to ’apartment size’, there are now many narrow passageways and doors. This means that when a person carries another person on the back or when a person uses a wheel chair, there are many entrances that the person cannot pass through on the way to toilet, bathroom, or hallway, all of which are necessary for daily activities.

Thus, even though at first glance existing dwellings appear to be fit for anyone, at closer observation they contain all sorts of dangerous traps which hamper the mobility of infants, old people and disabled persons. They cause tripping, slipping, and falling, leading to injury or even death.

In most Western countries recommendations exist for considerations of mobility to be included in the architectural plans from the very beginning. When the residents acquire a disability, the house can be remodeled at relatively small cost. This measure can be considered the starting point for designing housing in which one can live one’s entire life with a sense of security.

In this connection, S.Goldsmith presented three conditions for mobility planning in a paper entitled ’Mobility Houses’ in 1970. They read as follows:

First condition
A person must be able to pass through the front door without tripping. That is, he or she can enter and leave without having to overcome level differences. If there is a staircase, it should have handrails.

Second condition
Interior hallways and entrances including doors to toilet and bathroom should have an effective width of at least 85 cm. In this way, even when a person has difficulties in moving about and needs assistance, uses a crutch or a wheelchair, he can pass through them.

Third condition
No level differences must exist between different rooms. In Japanese architecture it is common to have level differences or thresholds between hallway and a Japanese-style room, between dressing rooms and bathrooms to facilitate drainage, or to partition different floor finishings. Since such obstacles can be fatal for old persons, ingenuity should be exercised in using appropriate floor materials to eliminate level differences.

The three conditions can be applied to any type of planning. They do not interfere with the freedom of architectural design and can be readily incorporated into all types of dwellings. In dwellings where people can live a whole life long the absence of the three greatest barriers causing accidents in ordinary houses, i.e. staircases, narrow entrances and slippery floors, should be expected.

Life Cycles and Housing Stages

Sociology offers various definition of the onset of old age: the marriage of the oldest child, marriage of the youngest child, or mandatory retirement. Housing design should respond to the life cycles. To this end, we need not only flexibility in space, but also flexibility in housing structure which should even include the eventuality that a resident cannot leave the bed.

The housing plan incorporating these design features is divided into three or four stages in Western countries. In Japan, a 4-level concept was proposed in the Ministry of International Trade and Industry’s New Housing Development Project III entitled "Development of Care System Technology for the Aged and the Disabled" .

Since then, the Osaka Prefecture has developed the MAI 3-Stage Housing Method, and started its construction. Shimane Prefecture with the highest percentage of old people in Japan has adopted this 3-Stage Housing Method applying it not only to a small number of special types of housing but also to standard housing. As a result, "model housing estates for the aging era" were adopted by the Ministry of Construction which, in turn, led to the development of the "Silver House Plan" by the Ministry of Construction. In the 3-Stage Housing Method, the function of care has been added to the housing function by incorporating the possibility of installing equipment and facilities which make independence and care possible.

The 3-Stage Housing Method consists of the following stages:

• The first stage is mobility (M) (housing for everyone)
  
• The second stage is adjustability (A) (equipped to make adjustments possible.)
  
• The third stage is intensive care (I). (equipped with facilities for intensive care.)

Using the initial letters of the key words, it is called housing geared for aging based on the MAI House 3-Stage Housing Method.

Development of Housing Equipment

The New Housing Development Project III "Development of Care System Technology for the Aged and the Disabled" (under the Ministry of International Trade and Industry), has developed over the last six years 12 types of housing components and equipment that correspond to these three stages at an expenditure of Y200 million. The products include door frames without sills and thresholds, bathroom units for the first stage; wash basin and toilet adjustable in height, a kitchen system, and elevator for the second stage. For the third stage, an environmental control system which facilitates care and horizontal transfer equipment.

The first prototype of this housing with special considerations for people with disabilities was built in 1983. After an evaluation period, the second model was built in 1984, and the third in 1985. After step by step improvement, a mass-distribution model is now available for purchase.
The prototypes were evaluated in meetings with disabled consumers, rehabilitation workers, and engineers as well as key media personalities.