長期照護機構建築之歷史演進

The roots of care for the aged in Western culture can be traced as far back as gerocomia, the buildings in ancient Rome that housed the elderly. In medieval times, many monasteries created separate dormitory ward for the aged and infirm. At the same time, many almshouses, which were funded by the church, were constructed throughout the England. Almshouses were freestanding residences typically configured around a central courtyard and adjacent to church structure. After the World War Ⅱ, many obsolete acute-care hospitals in Western countries, which had typically been used for the treatment of smallpox and tuberculosis, were given over to geriatric medical care. However, the standard template of these facilities is a modified version of the Nightingale open ward with communal lavatories and bathing facilities. From today's viewpoints, these facilities were very primitive. From 1940s to 1960s, the first wave of newly built long-term care institutions was nursing home. Architecturally, the aesthetic and functional vocabulary of the International Style was sweeping through developed and developing nations alike. The design concept of nursing home at this period was to follow the modernist zeitgeist enlightened by Le Corbusier and Mies van der Rohe. After 1960s, due to the influence of Scandinavian residentialism, design of nursing home began to express ”non-hospital” image and ambiance. By the early 1980s, the modernist hospital-based nursing home had been rejected by a growing number of architects and long-term care administrators as inappropriate and antithetical to the call for more homelike settings. Owing to the concepts of aging-in-place and continuity of care, many new types of long-term care facilities, such as the continuing care retirement communities (CCRC5) and assisted-living units, had emerged in the 1980s. There are three major zeitgeists can be derived from the contemporary long-term care facilities evolution. First of all, from the perspective of architectural concepts, the design of modern long-term care facilities should consider humanity in addition to medical functions. Accordingly, modern long-term care facilities should get rid of its traditional image of hospital and transform to homelike settings gradually. Secondly, from the perspective of architectural function, the design of contemporary long- term care organizations should be flexible enough in order to satisfy different stages of need when residents' health deteriorated. Thus, the institution-based care for the elderly can gradually de-institutionalized under the concept of aging-in-place. Finally, from the perspective of spatial arrangement, the design of long-term care organizations should be rehabilitation oriented instead of custody oriented. Hence, living clusters should be constructed rather than traditional hospital-like wards in long-term care facilities.