Vision regarding care

The world of care work changes continually, both as to supply and demand. Dutch society is moreover characterized by a wide variety of faiths and lifestyles. The elderly, for example, do not form a single homogeneous group: the category covers multiple generations, with differences in lifestyle, income, ethnic origin and degrees of independence. The aging population, aptly called a grey wave, is rising alarmingly but will fall again. This calls for a flexible, integrated and progressive approach. As the major clients for care architecture, large institutions have long held the upper hand. Standardized schedules of requirements, expressed largely in quantitative terms, as so many square metres, have dictated the shape of many projects. The large scale of the buildings and the organizations makes rationalization imperative. At the same time, there is a lack of visionary ideas; fine ideals for care schemes often end up as predictable, uncontroversial realizations. Just as one fuel station looks very much like any other, regardless of the brand, well-intentioned care institution projects tend to look depressingly similar in their functional and visual design. Perhaps it is time for a quest for a new identity.

The designs of Marlies Rohmer Architects & Urbanists spring from a strong social involvement combined with a research-based approach. Substantive research fathoms the complex issues surrounding a project. Ostensible contradictions, such as large-scale versus small-scale, collectivity versus individuality, dependence versus self-reliance and intimate versus extravert, are spatially integrated. Topics such as safety, orientation, variation and atmosphere are also important, while synergy – being more than the sum of the parts – is a hallmark of the practice’s buildings.
Marlies Rohmer introduces a small-scaled quality into the financially unavoidable large complexes that typify the care sector. The purpose is to help the residents and clients preserve their own identity.
The care buildings of our practice are scrupulously adapted to the various forms of care, to the treatment methods and to the wishes of the care receivers. An open dialogue with clients and users about their wishes is crucial to the fine-tuning of the design and the process. The buildings provide specific spatial answers, through among other things a flexible shell, to the care sector’s need to continue adapting to future changes. The flexibility of the buildings also makes it possible in the long term to assign them to an entirely different purpose.
The care buildings we have realized over recent decades range from relatively sheltered psychiatric institutes to residential care complexes, remodelled old-age homes and small-scale groups of independent dwellings with care amenities.
When designing care buildings, we aim to support the most active possible participation of the residents/users in society. To avoid social isolation, it is important that both the housing and the services for care recipients are integrated into the community. The integration of e.g. a day care facility for mentally handicapped persons, by means of a public bicycle route, an open area with a children’s farm, a vegetable garden or a shop where self-made articles are sold, provides not only for unquestioned participation in the community but for lively surroundings.

The Flemish Government Architect, Peter Swinnen, selected Marlies Rohmer in May 2013 as an expert advisor on the grounds of her office’s many years of experience in the care sector. She will support the Government Architect on one of a series of five pilot care building projects in Flanders. Marlies Rohmer has also been appointed as an adjudicator for the 2014 Hedy d’Ancona Prize for excellence in health care architecture.

Transformation of residential care complexes
Marlies Rohmer Architects & Urbanists (MR A&U) is conducting feasibility studies for the transformation of residential care complexes such as d’Oude Raai (2013) in Ferdinand Bolstraat, Amsterdam. Owing to tendencies in the realm of care provision towards helping elderly persons and other care consumers continue living autonomously for as long as possible (with the aid of family members etc.), purpose-built care complexes need a new purpose. D’Oude Raai is being transformed into small groups of autonomous dwellings linked to an individualized care centre that also serves the neighbourhood community.  The new centre, which includes short stay residential facilities whose use will afford temporary relief to volunteer care providers, forms in turn a new focus for the area. Transformation implies an integrated approach which takes into account the quality of the existing building services, structural problems, insulation etc.

The world of contrasts: collectivity versus individuality, large-scale versus small-scale etc.
The care projects built by MR A&U are intimate, sheltered environments where patients can feel safe and at ease; they are not closed communities cut off from social life. Mutual contact (intimate and extravert) is also important. The Dobbelman residential care complex (2007) is, for example, spatially organized in a way that promotes contact between residents. Each residential storey has a communal garden – an open garden on the ground floor and sheltered winter gardens on each of the three upper floors. These large, well-lit spaces are located centrally with the house kitchens grouped around them.
The “socio houses” project in Amsterdam (1998), a small-scale facility with dwellings which allow elderly incipient dementia patients to continue living independently but with guidance as long as possible, is integrated into a block of social sector apartments. Larger, compact buildings are organizationally more efficient and more sustainable, but they have a drawback: they are inconsistent with the wish to give care work a human scale. To assure privacy and at the same time stimulate social contact, every resident has a private room, but the central circulation footpath and communal garden invite interaction. The apartments are arranged around this circulation footpath, which alternates between an indoor and outdoor climate and offers views out to the street at many points. The complex is not completely locked up, so the residents can go outdoors. It is assumed that residents who “go walkabout” will be brought back home by neighbours or by staff of the nearby police station. Thus the elderly residents can enjoy a measure of liberty despite their impairments.
Integration into the community is also important for carers, family and visitors. The De Joppe day care centre (2001) in The Hague, a special school for children with handicaps, forms part of a primary school. This arrangement makes it easier on parents, who often embarrassed by the thought that their child is going to a special school. The day care centre has the necessary contained character thanks to partition by logical separators and different atmospheres for different groups.

Flexibility
The Dobbelman sheltered housing complex, which accommodates psychogeriatric residents, ethnic minority seniors and persons with handicaps, is a good illustration of the diversity that is possible in one building. The dwellings for persons with mental and physical handicaps are designed to help them live as autonomously as possible. Each has an apartment with an extra large bathroom. The group dwellings respond to the trend in psychogeriatric care towards small-scale living situations.
The flexible internal layout of MR A&U‘s design anticipates the greying of the baby-boom generation. The 50 to 60-year-olds of today are not likely to accept small rooms with standardized facilities in their senior years. They want not only a fully-fledged home with made-to-measure care and living amenities, but also privacy and possibilities for contact.
The flexibility is also relevant to the ongoing changes in the organization of the care sector. For example, De Zeester day care facility for persons with mental handicaps (2007) has a column-supported structure with lightweight dividing walls, so that the interior spaces can be freely reconfigured and repurposed.

A click of a button
Possibilities in the fields of telematics and home automation are being increasingly integrated into architecture. Clicking a button can turn off all the lights, set the curtains to open and close at preset times, electronically regulate the bathwater temperature, activate a vacuum cleaning system as soon as the resident leaves home, and so on. MR A&U is following the technological advances in this area with close attention and fascination.

Residential care centre De Zeester, Noordwijk 

Residential care centre De Zeester, Noordwijk 

Residential care complex Dobbelman Site, Nijmegen 

Residential care complex Dobbelman Site, Nijmegen 

Elderly residents Amerbos, Amsterdam  

Elderly residents Amerbos, Amsterdam  

 
 

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