This PowerPoint briefly reviews current trends in environments for the elderly and some examples of Crepidoma work.

1. November 6, 2009 University of Wisconsin-Milwaukee Environments for Aging in U.S.

4. I. Introductions

6. II. Seniors By the Numbers

7. Tidal Wave By 2030 20% of the US Population will be over the age of 65 Source: Administration on Aging; U.S. Department of Health and Human Services By the Numbers

8. Age 55 – 64 92 men per 100 women Age 85+ 46 men per 100 women Elderly Women Continue to Outnumber Men By the Numbers Tidal Wave

9. Growing Diversity Members of minority groups projected to increase: 2000 5.7 million (16.5% of elderly pop.) 2010 8.1 million (20.1%) 2020 12.9 million (23.6%) Source: U.S. Census Bureau, 2004b. By the Numbers

11. Where Are They Living? By the Numbers

12. Where Are They Living? Oldest States FL 17.6% PA 15.6% WV 15.3% By the Numbers

13. Where Are They Living? 3 out of 4 Live in a Metropolitan Area Source: U.S. Census Bureau, 2001, Table P12. By the Numbers

14. Income Social Security benefits constitute 90% or more of total income for 1/3 of Americans over 65 Social Security Recipients Aged 65 and Over by Relative Importance of Social Security to Total Money Income: 2001 Source: Social Security Administration, 2003a. (Percent distribution) By the Numbers

15. Income $35,825 median for family households 65+ $15,193 median for people 65+ reporting income Percent Distribution by Income: 2004 Source: U.S. Census Bureau By the Numbers

16. Income 3.6 million elderly were below the poverty level in 2004 Another 2.3 million were classified as “near poor” Source: U.S. Census Bureau By the Numbers

17. By the Numbers 1.6 million people are in 18,000 nursing homes nationwide Nursing Home & Home Care: $111 billion business 2004 Met Life Market Survey Cost of Care

18. Cost of Care By the Numbers 46% of Nursing Home and Home Care Costs are paid by Medicaid 12.4% are paid by Medicare Medicaid 46% Medicare 12.4% Out-of-Pocket 27.9% Private Insurance 7.7% Other 6.1% 2004 Met Life Market Survey

19. Cost of Care By the Numbers $77,380/year National avg rate for private nursing room $68,985/year National avg rate for semi-private nursing room Avg Length of Stay: 2.4 Years 2006 Met Life Market Survey

20. Cost of Care By the Numbers $36,372/year National avg rates for assisted living $51,204/year National avg rates for assisted living Alzheimer’s Care Avg Length of Stay: 21 months 2006 Met Life Market Survey

21. Cost of Care By the Numbers The Alternative: 1.3 million people received home care from 7200 agencies nationwide (2000 data) Average hourly rate for a home health aid: $18.00 per hour

23. III. A Historical Perspective Seniors’ Housing and Care in America

24. Civil War Historical Perspective

25. Nightingale Wards Civil War Historical Perspective

26. Post Civil War Historical Perspective Post Nightingale

35. Historical Perspective 1970s - 1980s

36. Historical Perspective 1985 1932

41. Green House ® Historical Perspective

46. Households - Unconnected Historical Perspective

47. Households - Connected Historical Perspective Gouverneur Healthcare Services New York Health and Hospital Corporation Crepidoma Consulting Architect of record: RMJM Hillier Neighborhood A Neighborhood B Neighborhood C Neighborhood D

48. Households - Connected Historical Perspective

49. Culture Change Historical Perspective Optimizes Quality of Life Maximizes Efficiency Decentralized Centralized Team Oriented Hierarchical Permanent Assignments Rotating Assignments Program Focused Task Oriented Holistic Care Physical Care Resident Centered Nursing Centered Culture Change Traditional Model

51. IV. Top 10 Concerns for Seniors

52. Top 10 Concerns 10. Choice / Flexibility / Freedoms 9. Aging in Place / Aging with Style 8. Health & Wellness 7. Community Connection 6. Affinity Groups 5. Affordability 4. Isolation / Loneliness 3. Health Insurance Options 2. Improving Medicare 1. Financial Security

54. V. Seniors’ Housing Overview

64. VI. Regulatory Challenges

66. Bathroom Design Regulatory Challenges ADA / ANSI Designed Bathroom Meets the Code / Not the Need Does Not Allow for Easy Assistance

67. Regulatory Challenges Bathroom Design ADA / ANSI Designed Bathroom Meets the Code / Not the Need

68. Regulatory Challenges Bathroom Design Mennonite Home Lancaster, PA

71. Sustainability Regulatory Challenges Difficult Devices for a Layman to Operate; Not as Easily Adjusted to Senior Needs Sophisticated HVAC Systems with Control System Design for Engineers Senior Friendly Energy Efficiency

73. VII. Brief Overview of Crepidoma Consulting

75. Forest Side ALF for Dementia, Washington, DC Architect of record: JSA, Inc. Architects

79. Collington Episcopal Life Care Community, Mitchellville, MD

83. House of Hope at Royale Oaks, Omaha, NE Architect of record: Invision

89. Wesley Palms CCRC, San Diego, CA SmithGroup Architects Khoo Teck Puat Healthcare, Singapore RMJM Hilllier Coler-Goldwater Healthcare, New York, NY RMJM Hilllier Felician Village, Manitowoc, WI Eppstein Uhen Architects

91. VIII. Trends for the Future

93. High Rise Urban CCRCs Goodwin House-Bailey’s Crossroads Falls Church, VA DHPY Architects The Mirabella at South Waterfront Portland, OR Ankrom Moisan Associated Architects

94. Akasaki-cho Day Centre in Ofunato-shi, Japan Creative Adaptive Re-use

95. St. Monica Trust-Sanford Station, UK-KWL Architects, Ltd.

97. Meaningful Sustainability Nightingale Care Home-Wandsworth, London, UK-Scurr Architects

98. Adaptive Regulations

99. Adaptive Regulations

100. Research & Evidence Based Design

101. Meaningful Technology

104. Typical Skilled Care Private Room 320 SF Aging in Place Conversion to Apartment 640 SF

106. THANK YOU!