Site Design

Fleming and Bennett (2014) observe that higher quality of life is associated with buildings that facilitate engagement with a variety of activities both inside and outside amenities that encourage links to the community.

In RLTC settings, this casual interaction with the community is often provided by way of balconies, porches, and verandas. Granger (2020) refers to these as transitional spaces and argues that they provide visual stimulus through purposeful design, critical for physical and mental health:

”Even in old age, there is joy, companionship, and spontaneity which, I would add, is facilitated by the material context – the places and porches – that allow the elderly to touch the world beyond.
(Granger, 2020)

The site layout and design determine many key aspects of a RLTC settings such as onsite pedestrian, cycling and vehicle movement, and parking. Universal Design guidance such as ‘Building for Everyone’ (CEUD, 2014) and the Universal Design Guidelines for Homes for Ireland (CEUD, 2015) provide detailed guidance to make site design accessible, easy to understand, and easy to use for a wide range of users.

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Having rooms on ground level enabled window visits which was positive.
- Family member

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Bright rooms, well ventilated […] a place where residents can mix and create friendships. Allowing visitations/residents to go out. Having a large and safe place to sit outdoors.
- Staff

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General layout of the building makes it easy for everyone to use and is wheelchair accessible.
– Resident

Key Findings

Quality
of life

A site design which is large enough to allow for daily walks is important for resident quality of life.

Amenity
access

Site designs which enable visiting, even during pandemic restrictions are preferable i.e., ground floor windows, day room/internal courtyard access without passing through the setting.

Communal
spaces

The ability to break a larger setting down into smaller units is beneficial in terms of infection control. Having numerous communal spaces and outdoor spaces/gardens/terraces on every floor of a setting is beneficial in terms of both infection control and quality of life.

Recommendations

Community Interface

Providing a positive community interface with a welcoming and visually open/permeable boundary with the community can help create a greater sense of ease and encourage community interaction.

While the boundary should be welcoming, it should also maintain privacy to protect residential amenity, as this supports the sense of security experienced by people in the setting.

Visual Connection with Community

While residents in RLTC may need to quarantine or shelter in place during a pandemic, visual access from the setting or from resident bedrooms to the community, the outside word, and nature can help alleviate loneliness and isolation.

Good visual connection to the community can provide a sense of familiarity, sense of place and belonging. It can also help with spatial orientation as people can use familiar external landmarks to orientate themselves within a setting.

Site Design

Create a memorable and distinctive layout that creates a strong sense of place.

Create a pleasant, homelike, and accessible site design that encourages residents to go out and about on the grounds (walking, sitting, reading etc.), while also providing a restful and welcoming environment for staff and visitors.

To facilitate enhanced infection control when required, consider how permanent and temporary site measures can be used to create site zoning to separate activities with high infection risk (e.g., removal of materials associated with infection cases) and other activities (e.g., resident movement, visitor access, etc.). It may be more appropriate that site flexibility can temporarily facilitate these measures only when required.

Employ a Universal Design approach, including dementia-friendly design measures to ensure the site can be accessed, understood, and used by all residents, visitors, and staff.

Environmental Conditions

The site design should create good environmental site conditions that provide a healthful, calm, and relaxing setting in terms of air quality, acoustics, views and contact with nature.

Due to the low infection risk association with the outdoors, as well as the positive impact of access to nature on quality of life; creation of outdoor spaces for activity, exercise, and social interaction becomes a critical part of site design in RLTC settings (for more information see Outdoor Space in 4.3.5 (f)).
Site design also needs to consider local and onsite air quality, not just to provide high quality outdoor areas, but also to protect against the damaging effects of poor air quality and pollution. In a building layout that locates key indoor habitable spaces away from areas of poor air quality, the appropriate placement of key outdoor areas, and the use of site micro-climates to create air flow and ventilation, are all ways to maximise air quality on the site.
Air quality can also be improved by limiting onsite vehicle emissions, controlling harmful onsite emissions, and by planting trees or other appropriate vegetation in strategic locations.