Senior Housing: Community as an Antidote to Isolation

FRANCIS COLOM: Hello, everyone. My name is Francisco Colom. I am a senior architect at MASS Design Group. And today I'm going to talk about a new model of affordable senior housing.

And I wanted to start with this graph, which tells us that, until very recently, life expectancy was below 35 years all around the world. So it also shows how during the last 150 years or so, modern science altered the course of human life and today we live longer than at any other time in history. And this is, of course, great news.

However, we also age lonelier than ever. In fact, aging has gone from being a shared multigenerational responsibility to something that is experienced mostly alone or with the help from doctors and institutions. Surgeon and public health researcher Atul Gawande talks about how we have allowed aging to be controlled by the imperatives of medicine, technology, and strangers. So over the next 30 minutes or so, I'm going to talk first about how we got here and then about two affordable senior housing projects that are trying to redefine senior living.

So I would like to start with the story of Harry Truman, not the former US president but this 83-year-old man who, in March 1980, refused to leave his home at the foot of the mountain near Olympia in Washington when a volcano began to steam and tremble. He had owned his house for more than 50 years.

Five years earlier, his wife had passed away. So now it was just him and his 16 cats on his property beneath the mountain. So when the authorities told everyone living in the area to clear out because it was not safe, Truman said he was not going anywhere. This home was his life. Some weeks later, the entire lake disappeared under the massive lava flow, burying Truman, and his cats, and his home with it.

Of course, this man had made a pretty risky decision to stay home, perhaps not the wisest. But I think the point of the story is that, at 83, we still expect more from life than safety. However, when we look at the typical alternative to independent living, the nursing home, we find that it's built around safety only.

And so the question is, how did we end up in a world where older adults have to choose between autonomy or safety? It's a fundamental question. And so to understand what happened, we are going to look at the story of how we replaced the poor house with the kinds of places that we have today.

100 years ago, if you were elderly and in need of help but did not have a child or a lot of money, a poor house was your only option to shelter freely. These facilities were designed to house vulnerable people who were unable to support themselves. Here they would sleep in crowded conditions and could be put to work. In the US, for example, the first poor house was built in Boston in 1660. And by the early 20th century, 2/3 of poor house residents were elderly.

In 1935, with the passage of social security, the US created a system of national pensions. And retirement became a mass phenomenon. However, the number of elderly in poor houses didn't drop. Turns out that the reason old people stayed in the poor houses was not just that they didn't have the money to pay for a home. They were there because they had become too frail to take care of themselves. And they had nowhere else to go. They couldn't get the type of attention they needed in an individual home nor anywhere.

After World War II, following multiple medical breakthroughs, Congress provided massive amounts of funds for hospital construction. And as hospitals sprang up, they became a comparatively more attractive place to put seniors. So poor houses started to empty out and hospitals became spaces where elderly went to live out the remainder of their lives.

But hospitals couldn't solve the problems of chronic illness or advancing age. And they were suddenly getting crowded with seniors so hospitals lobbied the government for help. And lawmakers provided funding to enable hospitals to build separate wings for those requiring continuous care. And this was the beginning of the modern nursing home. Later, in 1965, the Medicare and Medicaid Act was signed and nursing homes sprang up all over the country.

The takeaway of this story is that the nursing home is designed as a wing of the hospital, not as a home. So it's designed for illness, not wellness. It's designed as a total institution, a place where all spheres of life are regulated. And they have played an essential role in providing safety for older adults but still most consider them frightening and desolate places to spend the last phase of our lives. So we need and desire something more.

Independent living and nursing homes have become two sides of the same coin and too often translate into a similar experience of loneliness because we don't experience loneliness when we are alone but when we feel alone. And we haven't had the imagination to create anything better. So there is a need and an opportunity here to create an intermediate solution that provides this safe space where seniors can not just survive but also thrive and be the authors of their lives.

At MASS, we are lucky to partner with 2Life Communities. They are a non-profit organization in Massachusetts that is committed to redefining senior living. And they are doing so by creating a unique model for affordable senior housing. So next I'm going to talk about two of the projects that we are developing with them.

The first one is the JJ Carroll project in Brighton neighborhood in Boston. It started with this kind of provocation. On the one hand, we read in reports by the city that the senior population in Boston is growing and that the number of senior households will increase by 53% between 2010 and 2030. And on the other hand, we read that Massachusetts had the second largest gap between senior median income and the amount of money needed for a basic standard of living. In fact, 62% of seniors living alone in Massachusetts cannot cover basic expenses. And this is according to the Center for Social and Demographic Research on Aging.

So there is a huge need for affordable senior housing. And often this translates into designs that prioritize efficiency, meaning designs that maximize the amount of apartments in the building and reduce nonrentable area to the minimum, which sometimes leads to very long double loaded corridors without access to natural light, views to outside, wayfinding cues, or fresh air, a very unhealthy scheme that perpetuates the social isolation of residents and makes them sick because experts have identified isolation and loneliness as a great public health risk, worse than smoking and worse than obesity, which ends up costing more money than a healthier building.

So we need to move away from the false dichotomy that tells us that we have to choose between efficiency or health. In reality, in the long term, a building will only be efficient if it's healthy in the first place. So how can we design efficient buildings that also are healthy and combat isolation and loneliness?

If we look again at what public health experts say, if research shows that living in community, sharing our life with others, can dramatically improve our health and quality of life. So our strategy to improve senior lives, what we call the method of the project, is to create a model of housing that prioritizes community.

Community can mean many things and can happen in many ways. So we wanted to create meaningful ways for the future residents of the building to shape their home and their idea of community. And we have a unique opportunity here to do that because many of the future residents were already living in the site. They were living in existing buildings that had become obsolete and had to be demolished.

So we set up a series of workshops with them, went through different exercises like these collages that ask them to co-create and design their future home using inspiration images and kind of describing what about those images resonated with them. But another exercise where we ask the residents to help identify where they found community in their current building, they mentioned the laundry room, the parking lot, front doors.

And they described how much they appreciated the small scale of the existing building, like how they shared a front door with only three or four other residents and how they all knew their neighbors well. And we realized this was key because the project was seeking to more than double the number of residents from 60 to 142 apartments. And this shift in scale was going to be a big change for residents so we had to find a way to basically break down the building.

We started from the most efficient scheme that, as we've seen, depends on long, double loaded corridors that result in poor health conditions and an institutional look. We broke it down to create these smaller clusters of apartments that we call the neighborhoods. And this allowed us to reduce the length of the corridors and improve access to natural light and views to outside.

Next, we connected all the residential volumes or the neighborhoods through this central shared space for different types of events, activities, interactions. And we connected this community space to three corridors that provide opportunities for outdoor living and access to nature.

Finally, we responded to the context by further breaking down the scale of the building, lowering, protecting some of the neighborhoods, pushing the building back from the street to create this kind of park at the front. In this way, the mission of improving seniors' lives informed the method, which is community. And this informed the diagram and the massing generation. And the challenge is to keep this diagram alive throughout the development of the project until it's built.

This is the floor plan of the second level of the building. Shown in blue, the residential volumes, the neighborhoods, which plug into the central show of community program, which is shown in grid. It's the central kind of common spine that connects the residential volumes and connects as well to another building owned by 2Life and to their existing campus dedicated to seniors. It connects through this bridge here. And this central area connects as well to the three cottages which are shown in green here.

Something that we paid special attention to was this concept of the scales of community and what are the ideal sizes and spatial attributes to accommodate different scales of interaction from the living room shared by one to four people to common rooms of different sizes, including computer nook, reading room, fitness area, sitting areas, TV lounge, laundry room, or the corridors, which have different sizes, attributes, and programs. So it's all about choice and providing options.

Or in the first level, the most public community area that 2Life calls the village center, which includes the lobby, multipurpose spaces, salon, resale store, and open areas that support social interaction and that connect to the front park, the open space that kind of welcomes the neighborhood with an intergenerational play area, small plazas, seating areas, and so on. So different types of interaction require different dimensions and also different degrees of privacy, natural light, acoustics, and so on.

And the last thing to mention here is that the darker area between the village center and the parking is a base health center for seniors. This means an entire team of clinical and social service providers located right in the ground floor of the building. This key for the resiliency of this model of housing that wants to look at the health of the residents holistically, to basically take care of the whole person considering all the social determinants of health.

This is a view of the front park. Something that we learned during the workshops with the residents, for example, is that while some of them enjoyed actively engaging in the action, others preferred the more passive engagement like watching the action while feeling protected or not feeling too exposed. So that's the experience that these front porches in the left are hoping to provide. Again, the idea is to create a diversity of situations that can accommodate multiple ways and scales of interaction and engagement with the broader goal of empowering seniors through aging community so that they can live longer and better.

So in March 2020 when we were halfway through the design of this project, the COVID-19 pandemic added even more complexity to the challenges that senior affordable housing was trying to address. We realized we were working at the intersection of two crises. On the one hand, we had people 65 years or older representing 80% of all deaths from COVID-19. On the other hand, older adults need to fight social isolation, another public health risk, as we've seen. So the question became, how do we design for safe interaction instead of social isolation?

During the spring that year, MASS partnered with the Joint Center for Housing Studies and other senior housing experts to develop this document, Designing Senior Housing For Safe Interaction, which talks about design principles aligned with infection control strategies and how they can help us preserve healthy social interaction. Not rocket science. Basic things like providing access to fresh air or encouraging people to spend time outdoors.

We were at that time about to start working on a new affordable housing project with our partner 2Life, which we found was the perfect opportunity to put all this into practice. It's the 500 Lynnfield Street Project located in Lynn, Massachusetts. As the animation in the left shows, Lynn has been a center of COVID-19 in Massachusetts throughout the pandemic, which is not surprising. Right. Working class, low income, high immigrant population.

We know that COVID-19 is affecting lower income and communities of color more than others because of structural issues. I won't stop much here but other infectious disease rates have been disproportionately high in Lynn as well. And we also find higher rates of mental health conditions, which we learned many times have to do with traumas related to housing insecurity.

And it's not only people that are traumatized. When we look at the site of the project, we find that the previous building was brutal in how it interfaced with the land. Two-story deep basements that had disrupted the hydrology, radiology, and the overall ecology of the site. Also, the building was surrounded by asphalt and overall just a very car-centric development. So the question became, how can we heal the site and, by doing so, support traumatized seniors?

When we zoom out of the site a bit, we find that it was once connected to the Lynn Woods reservation, this amazing forest that inspired the opportunity of this project. What if we could bring the forest back into the site? Research shows that access to nature makes us healthier, more creative, more empathetic, and more apt to engage with the world and with each other.

In fact, health experts talk about forests as therapeutic landscapes. So if the mission of the project is that seniors in Lynn thrive, the way to get there, the method of the project, is to create an environment that brings them out of the woods and into the light of the clearing. And this is just a metaphor for no longer being in a state of danger or difficulty. The idea here is that we can support people by bringing the forest back into the site.

So how do we do that? These are the existing conditions, which include a bigger north building that had become obsolete and had to be demolished and a smaller south building that we are able to keep and then a lot of parking and asphalt surrounding these buildings.

This is the proposed site plan. The senior housing building in the north creates a central courtyard, like the clearing in the forest. The south building transforms into a base health center for seniors which will be connected to the housing through a bridge. And then we have the restored landscape area that is open for residents and the general public. Right. Within that, the space for cars is just reduced to the minimum. And this allows us to transform a site with a footprint of almost 70% concrete and asphalt to a site that is 70% green and prioritizes people over vehicles.

As I said, one of the key goals of this project is to provide opportunities for healthy social interaction. And the open courtyard and other outdoor areas provide multiple opportunities for that. However, they are not enough for the senior population of the building, mainly for two reasons. First, some seniors spend most of their time inside the building and don't feel comfortable going to far from their apartments, especially as they get older, so we need to bring fresh air and opportunities for other living closer to the apartments.

And second, we need to be mindful of the weather. Outdoor spaces will only be comfortable during a limited time of the year. And they will be too cold during the rest of the year. And then again the only alternative for residents could be to stay indoors. So the challenge is how do we provide more access to fresh air throughout the year.

And this is not a new challenge. So we look at some traditional typologies to see how this had been addressed in New England. And we found out that this is exactly what the traditional three-season porch was designed for. Its goal is to expand opportunities for outdoor living.

These are sunrooms attached to the home that are not insulated nor conditioned. They can be open or closed. And this makes them an intermediate flexible space between the inside and the outside. This is exactly what we need to extend access to fresh air during the colder seasons to create opportunities for healthy interaction and to make our model housing healthier and more resilient.

Now there are some challenges associated with designing this type of intermediate spaces today. These are typical building sections with four residential stories above parking and back of house podium. And because this is a Passive House Certified building, we are pushed to create a very thick, a very rigid envelope between the inside and the outside. Passive house aims to completely isolate the building from its surroundings, to have full control over what's happening inside. But what we're proposing looks more like this, a dynamic building that changes depending on the climate.

We want to break the pure extrusion of a typical floorplan and introduce these three-season porches and balconies that can provide access to fresh air and outdoor living at every floor of the building. And we realized these spaces need to be outside the passive house boundary because otherwise they would need to be conditioned and they would need to perform less flexibly.

These two graphics represent the temperature throughout the year. The graphic above represents the outside temperature. And the graphic below represents the temperature inside the three-season porches, each dot representing one hour of the year and the color of the dot representing how comfortable that space is, blue tones being colder than ideal, yellow and red mean hotter than ideal, and the two tones of green mean the space is comfortable.

So we see how the graphic below expands the area of green dots, which means the three-season porches will be comfortable from March to June and from October to mid-December when it's too cold outside. Again, three-season porch acts as a buffer between the inside and the outside of the building.

We are more than duplicating the months during which residents will be able to access a comfortable outdoor space without leaving their floor. This is a rendering of the interior of one of those spaces when there is good weather outside so the glass door is open. And this is the basic diagram of that floor plan.

We have five clusters with eight to 11 apartments each cluster. These are represented in blue. And these are connected by common areas represented by the red arrows. And we have three-season porch and the balcony on each floor, represented in green. In this way, the floor plan is trying to achieve this healthiest balance between efficiency and a positive user experience, creating a place where residents can eat healthy and in community.

So this is a typical upper floor with 40 apartments plus some small and medium common areas. And this is the ground floor where we have removed 10 apartments at the front of the building to accommodate this most public common areas, connecting the front garden to the interior courtyard and aiming to welcome the neighborhood and support the interaction between the residents and the surrounding community.

In terms of the urban image of the project, the goal is to achieve that this image is rooted in the neighborhood but also that it provides a unique identity that helps us remove this stigma around affordable housing. This is a view of the front of the building from across the street and a closer view of the main entry to the building marked by the double height front porch.

And in this image, we see the interior courtyard, which aims to bring the forest back into the site to provide access to nature and opportunities for outdoor living and overall to create this environment where seniors can thrive. Both this project and the previous project are born as a reaction to the institutionalized version of aging.

They are aiming to establish a new model, one that is about healing ourselves by healing our environment, about designing for wellness, not for illness, one that recognizes that design is not neutral. As we see in this aerial representation of our project and the car-centric development next door, design can either heal or hurt. And while we all try to create this new model or this new norm, the need is huge.

In our last meeting with the Lynn City Council after we presented the project, Kathy Lowry, 73, stood up to share her experience with housing insecurity and instability, couch surfing and the big uncertainty that comes with constantly moving from one place to another. She also shared how she got lucky enough to win the lottery for affordable housing and how life-changing that was for her.

Affordable housing is many times thought of as numbers and units in a way that dehumanizes residents, treating them as a faceless number. Kathy reminded us all that we cannot forget the human experiences that are behind all these numbers. Kathy is now a strong advocate for affordable senior housing. She, as so many other older adults, demands that we build more spaces where seniors can eat healthy and in community. Thank you.