Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Hyung Jin Kim / The senior population within the United States has increased by 1.5% from 2010-2014, whereas other demographics have either stayed the same or have decreased (US Census Bureau, 2014). Assisted living facilities focus on sustaining and enhancing the quality of life for the residents, and their physical and social environments should be modified to stimulate this focus. Studies have shown that is can be accomplished by increasing access to nature. Additionally, a diminished physical activity level among senior citizens is an additional research problem as it contributes to their quality of life. With these research problems in mind, the two research question being addresses are: How does access to nature affect physical activity levels of senior citizens living within assisted living facilities; and how can indoor and outdoor landscapes assist in promoting physical activity? To answer the research questions, the following aims were established in support of the research and design objectives of this study: (1) identify barriers limiting use, and (2) idenify how access to nature affects phyisical activity levels in senior citizens within assisted living facilities, (3) to improve access to nature, (4) to improve quality of outdoor spaces, and (5) to encourage outdoor activity. Research Methods include (a) focus group interviews and (b)an environmental audit to investigate user’s preferences of activities, existing access to nature, and barriers prohibiting the use of the natural environments, (c) literature analysis and research to identify relevant design strategies that have been used in similar studies, and in the design phase,this study synthesizes how design principals can be utilized to solve the identified issues. The findings were then used to create a matrix for design and to also develop design goals and solutions for Homestead. The result of this study identifies strategies used to overcome barriers limiting outdoor use. The focus group and staff interviews along with the environmental audit and the literature analysis findings were used for developing a framework for design. The design framework and research methods this study used could be applied at similar facilities based on the ability ranges of the residents to produce a design solution that encourages outdoor use and physical activity, and thus, enhance the quality of life of the residents in the assisted living facilities.

While play therapy is primarily used with children, recent research has begun to explore the use of this approach with adults and the elderly. The purpose of this study was to explore and describe in detail the process of Client Centered Play Therapy (CCPT) with an elderly assisted living facility resident through use of a qualitative case study. A single elderly resident participated in 12 CCPT sessions over a period of six weeks. Qualitative data were obtained through observational session notes, pre- and post-treatment interviews with the resident and the facility’s Licensed Practical Nurse, pre- and post-treatment administrations of the Geriatric Depression Scale, and review of the resident’s case file in order to gain insight into the process of CCPT with one elderly assisted living facility resident. Data collected were examined in relation to the play behaviors exhibited by the resident, typical stages of play therapy, potential therapeutic benefits, and the resident’s view of the CCPT approach. Results indicate that the play behaviors of one elderly resident were markedly similar to those of children participating in CCPT and that this may be an appropriate and enjoyable method for addressing mental health needs of the elderly. Implications and recommendations for future research are discussed.

Master of Science / Department of Hotel, Restaurant, Institution Management and Dietetics / Carol W. Shanklin / The purposes of this study were to explore factors associated with residents’ dining experience in assisted living facilities and to investigate the influence that these factors had on perceived quality and residents’ satisfaction with their dining experience. Food quality, service quality, mealtime customization, and dining room environment were the four constructs explored. Focus groups were conducted with residents of three assisted living facilities to determine attributes of the constructs that were important to them. A total of 22 residents participated in the three focus groups. A questionnaire developed by Huang was revised to include measurement items identified in the focus groups. The questionnaire was distributed to residents of 16 randomly selected assisted living facilities within a 110 mile radius of the research institution. Of the 492 residents in 16 facilities, 246 completed the questionnaire for a response rate of 50%. Residents evaluated the attributes on a 5-point likert scale (1-strongly disagree; 5-strongly agree). Service quality (4.03) and dining room environment (3.97) attributes were rated significantly higher than food quality (3.64) and customization attributes (3.42). Resident satisfaction also was evaluated on a 5-point scale (1-very dissatisfied; 5-very satisfied). Residents were satisfied with the overall dining experience (3.94) and the overall facility (3.97). Residents were less satisfied with food served (3.67) or the amount of choices they had at meals (3.58). Residents were satisfied with services (3.95) and the dining room atmosphere (3.98). Satisfaction with services and the dining room atmosphere were significantly higher than food served and amount of choices at mealtimes. Residents’ perceptions of food quality, service quality, level of customization, and dining room environment had a positive influence on their satisfaction with the overall dining experience. Residents’ perceptions of food quality had a positive influence on satisfaction with the food served, service quality impacted satisfaction with services, level of customization effected satisfaction with the amount of choices, and dining room environment influenced satisfaction with the dining room atmosphere. Administrators, foodservice directors, and dietitians employed in assisted living facilities can use the results to improve the dining experience for residents and ultimately improve residents’ quality of life.

The places in which we live have a direct influence on our health and wellbeing. The interest in human health and experience of a space was apparent in the work of 20th century architects such as Le-Corbusier and Alvar Aalto during the tuberculosis epidemic. The Paimio Sanatorium, which was a collaboration between doctors and architect by Alvar Aalto in 1929-33, was one of the most famous projects that shows the tuberculosis influence on architecture. Therefore, the need to redesign spaces in order to live a happier and healthier life began to influence modern architecture from the early 20th century. The change of body perception because of disease impacted architecture, reconfiguring it in a way that the building could function as a medical tool. However, after years of living in a world without pandemics, designers just about to forget the importance of the design and its influence on human health. Although, the new restrictions placed on society due to Covid-19 outbreak, played an important role to reconsider the functional connection between the built environment and human wellness. This thesis explores the ways that the built environment and its surroundings can affect human physical and mental wellbeing by examining the ways that the world has adapted to the new trends and strategies through the design of an assisted living facility in Oldtown, Alexandria, Virginia. / Master of Architecture / In the early months of 2020, the World Health Organization announced a pandemic due to Covid-19 which was first reported in China. Following the WHO declaration, people were forced to be quarantined for months. The fear of the contagious airborne disease became the most important factor in determining which spaces people can safely frequent. Therefore, space became an essential component of concern during the Covid-19 pandemic and will continue to play a role in architecture thereafter. These issues are examined through the design of an assisted living facility in Oldtown Alexandria, Virginia.

Older people are as diverse a group as they were as younger people. Home environments should reflect these diverse individuals' varying interests, preferences, and needs. In spite of efforts to remain independent and at home, some elderly people have to leave conventional housing and move into long-term care facilities because of factors such as mental or physical health problems or the loss of family members. Most elderly people who move into these facilities do not feel "at home" in their new living arrangements. Assisted living facilities (ALFs) have been developed as a response to these issues. The major goal of assisted living is to create a supportive social setting that elderly residents can call home. Although assisted living is the fastest growing long-term care alternative, it still needs to continually change in response to the needs of older residents and the desires and interests of family members. The purpose of this study was to examine the features that make residents feel "at home" in ALFs in Southwest Virginia and to suggest further policy and design guidelines for better quality of ALFs as a "home." For this purpose, residents' needs, experiences, and opinions of the physical environment, the social environment, and the organizational environments such as policies and programs of ALFs were identified. As a multi-site case study, I studied five ALFs in Southwest Virginia and did a cross-case analysis. In addition to face-to-face interviews with 25 residents and five administrators of five ALFs, I also conducted observations and recorded my feelings in a personal journal with document review. To analyze the data gathered in this study, I used the constant comparative method of data analysis. The respondents' age range was between 64 and 95 and the average age was 82. There were 6 males and 19 females among the respondents and most of them were widowed. They came from a wide geographic area, and most of them have lived in single-family homes for a long time. Many had children or family members nearby. Overall, the five sites selected presented homelike features showing the philosophy of assisted living which combines housing and services. Each facility was designed to be a single-family house or multi-family dwelling in outside appearance. However, the older the structure, the fewer homelike features were provided. As a whole, residents felt isolation and loneliness and they did not have active interaction with other residents because of diverse background among the residents. During meals, people had active interaction with one or two residents. However, all of them had close relationships with the staff. The staff's attitude and behavior seemed to influence greatly the residents' feeling "at home." Friends and family members also provided an important role for the residents to adjust to their new environment. Despite the provision of diverse activities by the facilities, many residents did not participate in the programs. Among the services provided, there were only a few complaints about food and mealtimes. Most of the residents agreed that the rules and regulations were fair; however, one person disagreed with the smoking rules. For the meaning of "home," many residents talked about love, fellowship, privilege, stability, and security. The administrators tried to make the residents feel "at home;" however, they mentioned the limitation of providing a real "home" for the residents due to the residents' diversity. Some categories which could contribute to the perception of ALFs as a "home" were classified by the researcher: safety and security, services and care, autonomy/privacy, independence, social life/friendship, family support, daily routine, personalization, physical environment, and management. Regardless of the type of facilities and the residents' characteristics, most of the respondents were satisfied with their current dwelling. In spite of high satisfaction with the facility, many people did not think of their current dwelling as a real "home." As the biggest difference between living in their own homes and living in the ALF, people pointed out a lack of independence, freedom, and autonomy. Moreover, they talked about the loneliness stemming from living with strangers who are not their family or friends. Residents of ALFs may have reordered their priorities in their current life situation so that safety, security, and care were more important to them than feeling "at home." Among the four factors --personal, physical, social, and organizational-- that affect the residents' perception of ALFs as a "home," many emphasized the importance of social factors such as relationships with the staff and residents, and social support from their family or friends. / Ph. D.

Within Assisted Living Facilities (ALFs), high staff turnover and the foreseeable future shortage in the workforce population have created a growing urgency to increase the retention of workers in this field. This study examines the experiences of care workers in the dementia care units (DCUs) of ALFs. The specific aims are to learn: 1) what these workers find frustrating and satisfying about their job; and 2) what are the individual-level (e.g., race, education, employment history) and facility-level (e.g., size of unit, workload) factors that affect how they feel about their job. We used qualitative data from interviews with 45 staff and observations gathered in DCUs in five ALFs that varied in size, location, and race of staff. Findings show that workers' sources of dissatisfaction included heavy workloads, lack of teamwork, and residents' racist remarks and other problem behaviors. Positive relationships with residents were a primary source of satisfaction.

The population within the age group 80+ is increasing. At the same time retirement housing are limited. Which entails that a large portion of the elderly are in the main housing market, where there is a shortage of housing. An option to ease the problematic housing situation could be assisted living facilities. The problem with the assisted living facilities of today, is that they are often located within the city. The result of this is that many elderly people choose to remain in their current houses due to a fear of leaving the countryside and their social network behind.  The purpose of this thesis is to investigate the conditions of an assisted living facility on the countryside, define which aspects that the elderly appreciate in their home and everyday life, and finally design a visual suggestion of an assisted living facility. The applied methods were (i) literature study, (ii) area analysis and (iii) modeling of the assisted living facilities. The following questions were addressed:  -  What are the conditions for assisted living facilities? -  How do these conditions differ between urban and rural areas? -  What aspects create quality/well-being in their own home for elderly  people? -  How can these conditions and aspects be considered when designing  assisted living facilities on the countryside?  Based on the work's theoretical starting points and results, some conclusions could be made. An assisted living facility on the countryside would combine a harmonious environment and a quiet neighborhood. The form of housing would open housing opportunities for the younger generation on the countryside. Health, physical activities, and social interactions were deemed to give more well-being to the individual than the home's design. The main values of the design lay in its ability to allow the individual to live out their personality, and at the same time make the individual feel safe and secure in their home. The final result was a visual proposal for ten condominiums inspired by, among other things, Sweden's traditional one-room cottage.