Background

With 1/5 of the world's population, China has entered into an aging society. The huge aging population as well as incomplete social security system has become significant risk for the future development of the nation. At the same time, with inevitable socialization of old-age support, facilities for the aged in China are facing tremendous opportunities as well as challenges. In the past decade, China's residential facilities for the aged have met rapid development. However, in contrast to the significant increasing speed, the definition and classification of the facilities are yet to be clarified. At the same time, without a sound guidance as well as sufficient practical experience, the planning and design work of the facilities also tends to be immature.

Gap in past researches

On the other hand, current architectural researches on the facilities for the aged in China are still limited in both number and topics. Most of the relative researches either discuss the design principles from an abstract theoretical perspective or focus on specific design problems based on case studies in a limited area. In contrast, researches under the specialty of sociology provided benefit results for understanding the overall condition of facilities today. However, since these researches are mainly supposed to serve the social policy making, the results are incapable to offer enough knowledge for the architectural needs. Therefore, there left a gap in current literatures as an essential research about the present condition of the facilities and demands of the users under the subject of architecture.

Objectives

To fill in the blank in past studies, the purposes of this research lie in:

1.Inspect the overall condition of facilities for the aged in China and the internal diversities among them. By describing the overall image of the facilities, the present developing status is supposed to be confirmed. The natural and regional disparities of the facilities are also expected to be clarified to deepen the understanding of the current situation.

2.Figure out the thoughts of the elders as well as their individual differences. By grasping the general concerns and preferences of the elders, as well as the variances in thoughts according to the attributes of the individual, the potential mental demands are supposed to be distinguished.

3.Discuss the primary issues existing today and possible solutions on the base of the present status of the facilities and the concerns of the elders.

Significance

The study is supposed to have both practical and academic values. The practical usage is firstly expected in the classification definition as well as building standard making of the facilities by offering information about their present status. In addition, the thoughts of the elders figured out could be useful references for proposal making in relative projects, and both the condition of the facilities and concerns of the elders could benefit the space design by deepening the understanding of building functionality as well as demands of users.

The academic value, on the other hand, lies in presenting the real condition of facilities in China for the theoretic researches as well as defining the application scope of detail design studies. Furthermore, by clarifying the internal difference of the facilities and elders, the research is supposed to serve the sample selection process and phenomenon explanation in future relative studies.

Procedures

4 surveys including a literature study and 3 field surveys are carried out to approach the research questions. The literature study mainly objected at the international experiences in the development of facilities for the aged from a historical view by studying both general condition of global socialization of old-age support and current facilities design trend in Europe, America and Japan.

The field surveys, on the other hand, are composed of a local questionnaire in Shanghai, a national questionnaire and a case study. The questionnaire in Shanghai intends to grasp a complete and detailed image of the development status of facilities in the most advanced and aged region of China. The questionnaire was carried out with the help of Shanghai Municipal Bureau of Civil Affairs and collected 491 valid facility samples, accounting for 84.4% of the facilities in Shanghai by the end of 2008.

The national questionnaire is able to offer a rougher but wider picture of current top-level facility in different regions of China, but mainly aims at inspecting the thoughts of both elders living in the facilities and living at home. The study is based on spot investigation and during the 4-year survey, information of over a hundred facilities and elders in 98 cities of 29 provinces in China are collected.

Besides, a case study is executed in 3 facilities with significant diversities in Shanghai. In each facility, investigation included building surveying, interview to the administrator and recording of space using condition as well as activity condition of the users. The results illustrated the historical change as well as current status of different types of facilities, and the spatial problems for elders with different health conditions.

Results

1.Facilities with regional and natural diversities

Generally speaking, residential facilities for the aged in China today tend to be large in scale and have no clear distinction in the health condition of the users. As it is found in both the local and national survey, the majority of the sample facilities have capacity over 100 beds although with great diversities. Most facilities have double room as standard bedroom and as the single room rate is very low, most residents of the homes are supposed to be experiencing bedroom-sharing. And on average, about half of homes are located in the suburban area today.

In addition, although most facility are mainly targeting at elders who can accomplish self-care, despite the initial positioning, many facilities are actually providing caring services at the same time and trying to respond to the increasing nursing needs. Currently about half of the staffs are nursing helpers, and the high turnover rate of them due to the low social and financial status of the job is seen as a primary problem in the facility operation.

Furthermore, natural diversities and regional difference of the facilities are found in the surveys. Through primary component analysis to the facilities in Shanghai, it is shown that the diversity in attributes of current homes is most significant in the respects of scale, space amenity, nature of service and aging degree of the residents. And by classifying the facilities through clustering analysis and comparing the attribute values, the features of different types of facilities are identified. Results suggest that the majority of the facilities today are with residents of mixed health conditions. At the same time, the early form of nursing form and rental apartment for the elders can also be distinguished. In addition, a special facility with notable large scale and strong support from the municipal government is seen and considered as the model facility in Shanghai.

What's more, the regional difference is most significantly shown in the gap of economic status-facilities in more advanced regions are seen as more commodious in space and more likely to be located in the suburb area than those in less developed regions. On the other hand, facilities in regions with higher aging rate tend to build more rental apartments for the aged, which indicates larger share of elders who would choose to live in facilities.

2.Elders with different backgrounds and disparate preferences

The surveys about the thoughts of the elders firstly suggest a close relationship between parent and children generation in China. The preference in life style for elders living at home now suggests that most of the elders want to live separately but close to their children's family. Over 60% of the elders meet their children once a week or even more frequently, and for elders living in the facilities, the rate is lower but still over 40%.

At the same time, both elders living in the facilities and at home showed great concern about nursing service of the facility. Over half of the current facility residents state they moved to the facility as they cannot be cared at home or want to lighten the burden of their family members. And the elders living at home showed similar concerns as they consider the in time medical support and nursing service as the main merits of facility life.

For the attitude toward the facility life, it is interesting to notice the great difference between elders living in facilities and at home. Elders already experienced facility life have very high satisfactory rate toward the facility, while those haven't lived in such facilities show strong defensive attitude. Many elders also value the public view as been abandoned by their family as a primary demerit of the facility life, which suggests general low acceptability of the facilities and the dominance of traditional oriental family values in elder's thoughts.

Moreover, the thoughts of the elders are also found as influenced greatly by their personal experience especially their education level and former occupation. Generally speaking, elders with higher education level are seen as more independent-they have more variant financial sources, place more emphasis upon personal feelings, value more the freedom in daily life, and are keeping a more open mind to live in a facility. People's former occupancy also affects their preferences in a similar way as people engaged in intellectual works tend to be more independent both financially and mentally.

3.Primary issues today and suggestion for solution

From the survey results, the primary issues for today's facilities are discussed and suggestions are made for the relative standard making, project planning and space design. For the building standard making, firstly, to ameliorate the demerits of current large scale facilities, making the construction of facilities for the aged as a part of the community construction and the introduction of living/nursing unit in building design is recommended. In addition, as the mixed nature homes are the majority today, it is necessary to make regulations to distinguish the space for active and dependent elders to suit the distinct demands. On the other hand, as the current space composition in the facilities tends to be incomplete for the nursing service provision, the standardization of space is recommended. Furthermore, considering the future increase in labor shortage, the building standard of the facilities should also emphasize the importance of concerning the demands of the nursing helpers and manpower saving strategies.

In addition, for the positioning of facilities and demands of the elders, the survey found that the nursing service is the primary concern for elders to choose facilities today although the majority of facilities today are still initially objected at active elders. To fulfill the large nursing demands, both the concept change from the private sectors and support from the public sectors are expected. What's more, as the regional disparity of the facility demands is identified, the project planning is expected to take the differences into consideration. On the other hand, the survey result suggested that the traditional oriental family values are still the dominate factor in the concerns of the elders. So the facility planning is supposed to take the features of the concerns into consideration and the spatial preparation for communing space as well as family visiting space could be practical ways to relieve the disturbance of the elders. In addition, although the oriental traditional family value is dominant, the contrary demands of elders with strong individualism could also be distinguished. Therefore, the facilities are supposed to make distinction to the demands of the two types of residents, especially the different activity preferences for the independent elders.

On the other hand, for the space design of the facilities, as the current users of the facilities have separated preference for single and double bedroom, semi-private rooms or private rooms with spear space to suit both the double or single demands is considered to be practical compromises. At the same time, as the current public space for the residents tend to be monotonous and all activities are usually set to carry out in one large space, considering the various demands, space distinguishes between activities in unruffled environment and with noises are supposed to be made and adding semi-public living room to the bedroom to suit the distinct demands of the users can be considerable. While for elders with nursing demands, as the "cohabit nursing" is identified as a common while questionable phenomenon today, consideration of nursing route in the floor plan for new buildings and bedroom reform to offer space for nursing helpers in existing buildings are suggested as improvement measures to lighten the mental burden of both the nursing helpers and the elders.

Conclusion

To be brief, the research attempts to clarify both the general conditions and internal diversities of current status of China's facilities for the aged and thoughts of the elders, as well as discuss the primary problems and possible solutions. With the abovementioned findings, this research is supposed to provide the essential knowledge on the demands of the facilities and elders, as well as focal points in the standard making and design work. The results are also expected to serve as a basis for future relative studies.

本論文は、中国高齢者居住施設の全体像と多様性を調査し把握すること、高齢者の意識について個々の多様性も含め明らかにすること、施設と高齢者の現在の主要な問題と現状に基づいた解決策についての検討をすることを目的として、文献調査と3つの実態調査を行った。

中国は高齢社会に入り、高齢者居住施設はここ10年の間に急増したが、高齢者居住施設の種類や定義ははっきりせず、十分な経験もなく未熟な計画・設計が行われているのが現状である。一方、現在の中国高齢者居住施設の研究は、限られた地域の一施設のケーススタディに基づく特定の問題についてのデザイン原理に関するものが多く、現在の施設の状況と利用者の要求に基づく基本的な研究は行われていないことが背景にある。

文献調査では主に先進的な諸外国での高齢者施設の発展の経験について調査した。

実態調査は、上海における質問紙調査、全国的な質問紙調査、およびケーススタディを行った。

上海における質問紙調査は中国において最も先進的で高齢化の進んでいる地域における施設の発展状況の全体像と詳細なイメージを把握することを目的とした。

全国的な質問紙調査は、より広範に施設の地域による違いと、施設に入居する高齢者と自宅に住む高齢者の意識を探ることを目的とした。

ケーススタディは上海の特徴的な3施設について行った。

施設の地域性と多様性として、一般的に、現在の中国の高齢者居住施設は規模が大きくなる傾向にあり、利用者の健康状況に明確な区別はない。多くの施設は2床室が標準的で、個室は非常に少ない。加えて、多くの施設がはじめから自立できる高齢者を対象としているが、多くは同時に実際に介護サービスを提供している。現在、スタッフのおよそ半数が介護ヘルパーであり、異動の率が高いことが施設運営上の大きな問題となっている。

さらに、施設の多様性と地域差について明らかにした。現状の施設の多様性は、規模、空間の快適性、サービス、居住者の年齢によるところが大きい。現在の多くの施設は居住者の健康状況が混在する。さらに、施設の多くが様々な健康状態の混在した居住者を持ちながら、早期の介護施設、高齢者向き賃貸アパートの形であることが明らかになった。

高齢者の意識の調査からは、異なる背景と異なる好みをもつ高齢者の状況が明らかになった。第一に、中国の親と子世代の間の密接な関係が示唆された。同時に、施設に入居する高齢者も在宅の高齢者も施設の介護サービスに大きな関心を持っている。施設での生活に対する態度は、施設入居経験のある高齢者にとって多くは施設に高い満足度を示し、在宅者は強い防御的姿勢を示した。高齢者には伝統的東洋的家族観が支配的とみられ、多くの高齢者は施設での生活の大きなデメリットとして家族に見捨てられたと世間に見られることも重要視している。

さらに、高齢者の考えは、特に学歴や前職などの個人的な経歴による影響が大きい。一般的に、高学歴な人は、いろいろな財産もあり、より独立しようとし、個人の感覚により重きを置き、施設での生活に心を開き続けている。前職も同じように好みに影響し、頭脳労働の職歴のある人は経済的にも精神的にもより独立しようとする。

現状の主な問題点と解決へ向けた提案として、調査の結果、今日の施設の主な問題点が検討され改善への提案がなされた。第一に、現在の大規模施設のデメリットを改善することを評価し、いくつかの性格のホームが複合した空間が推奨できる。加えて、介護への強い要求を満たすため、公共のサポートへの考え方の変化が期待される。

さらに、調査から施設の要求の地域格差と伝統的東洋的家族観と強い個人主義をもった高齢者の要求も明らかになり、これらを計画において考慮しなければならない。

一方で、施設の空間デザインのために、個室・2床室両者の要求にも適し、活動のための空間を持つセミプライベート室あるいは予備的な空間をもつ個室が提案された。介護の必要な高齢者にとって、今日、「同居介護」は問題ある現象であるが、よくあることととらえられ、新築の平面では介護ルートを配慮し既存の建物では介護ヘルパーのための空間をとれるように改修することが改善点と評価される。

本論文は、現在の中国高齢者居住施設と高齢者の意識について全般的状況と多様性を明らかにし、主要な問題点と可能な改善案を検討した。この成果は、施設と高齢者の要求に基づいた基礎的な知見となるものであり、基準策定やデザインにおける観点を示すものとなる。この成果は今後の比較研究の基礎ともなるものであり、建築計画学の発展に大いなる寄与となりうるものである。

よって本論文は博士(工学)の学位請求論文として合格と認められる。