Hired by HCM Sun City Japan, San Francisco interior design firm Yokomizo Associates, in collaboration with BAR Architects of San Francisco, spent five years envisioning a new potential for senior living healthcare. The result is a six-story, 200-unit nursing facility that comprises five residential floors, including one exclusively dedicated to residents with Alzheimer's disease.

Charged with creating a sophisticated, home-like sanctuary that enhances resident healing and inspires guest visits, the design team went against convention with generous spaces and elegant finishes and simultaneously satisfied the practical and functional requirements of a medical facility. The result: institutional care that in no way feels institutional.

Answering a new imperative for elder care, Japan looks to the West for vision.

Still in its infancy, institutional senior care in Japan reflects a radical social and cultural shift away from a long-standing and rich tradition of elder veneration and family unity. Historically cared for at home by family, the aging Japanese population must seek new alternatives as their own numbers exponentially outpace the growth rate of younger generations, leaving a significant gap between those needing care and those able to provide it. Seniors ages 65 and older stand to comprise as much as 40% of the total citizenry in Japan by 2055. In the meantime, the country's increasingly mobile youth continue to choose to defer, and even refuse, marriage and children, accelerating the country's population decline.

Faced with this new imperative, HCM Sun City Japan came to the United States looking for insight and inspiration. Just as each generation learns from and builds upon the wisdom of the previous generation-bringing fresh ideas to seasoned experience-the client returned to Japan richer in appreciation for the particulars of the project, while inspired to create a healthier, stronger model more closely aligned with the Japanese culture's prominent tradition of dignity.

Choosing an American design team reflected both a tactical concern and an aesthetic preference. Desiring a contemporary Amerasian look and feel, the client also needed a team with experience working on projects of this scale and that possessed the technical background in institutional requirements-a vast body of knowledge not easily acquired.

Blending perspectives: A collaborative exchange produces a superior process and project

With the foresight to recognize that bringing all the teams together from the beginning to work in concert would result in a better project, the client engaged the architects, landscape architects, and Yokomizo Associates from the outset, fostering an environment of collaboration. Producing a unified effect, each team brought its unique expertise and strengths to a forum of respectful and creative deliberation that challenged assumptions and conventional solutions to continually raise the bar.

For Yokomizo Associates, the client's sophisticated appreciation for the design process represented a refreshing and welcome change from the typical project experience. Misunderstanding and underutilizing the value of interior design talent, more often than not, clients engage an interiors team at the conclusion of construction, when solutions become fixes rather than part of the project planning. While architects focus on how a building relates to its environment, Yokomizo Associates specializes in the nitty-gritty of organization and flow-the human-scale perspective of who uses what and how it gets used. Experts in function and spatial relationships, the team also has mastered the plethora of technical requirements and specific materials related to particular industries, such as nursing.

These are details that on the Sun City Tsukaguchi Royal Care project, Yokomizo Associates not only coordinated with the architect's building concept, but harmonized with the proposed garden vistas designed by the landscape architect team, relating interior and exterior environments for a cumulative effect.

The elements of style

Adhering to the client's vision for a refined sanctuary that was residential in feel, the elements of the building design incorporate uncommonly spacious hallways, multiple and varied settings for visits and relaxing, framed garden views, and abundant use of natural light.

Each of the five residential floors feature common areas with garden vistas, and comfortable lounges and dining areas intended for entertaining family and friends. Carefully planned around access to natural light, private rooms seek to bring a sense of the outdoors in with contemplative garden perspectives-a direct connection with nature that not only provides a tranquil aesthetic but serves as a visual reminder of the time of year. Addressing functional concerns, rooms and baths all account for wheelchair and walker accessibility, along with easy access to staff and the personal amenities of ample storage. With space planned to provide direct lines of sight from a central nurses' station, staff members are able to easily monitor common areas, corridors, and visitor access points concurrently for the safety and security of residents.

The main floor integrates all the functional requirements of a medical facility, including rehabilitation areas and conference rooms, while evoking the intimacy and sophistication of a private home. Public spaces include a multipurpose salon, a larger “relaxing” parlor, a library, a tea room, and an aviary lounge. A grand aquarium and large aviary provide interactive features that offer playful diversions for residents and their young visitors.

Emphasizing the importance of a natural environment, all ground floor spaces lead to a central garden with wide pathways for supervised exercise, as well as personal gardening and planting areas for residents to enjoy.

Designing the institutional details to disappear

Finishing strong, all the materials and furnishings used throughout the facility seamlessly blend practical, high-performance quality with sumptuous elegance. So as not to compromise appearances or function, Yokomizo Associates sourced custom solutions and innovative materials, always taking the next step to make unattractive hospital necessities blend into their environment and disappear. Advocates for the details and decisions that elevate a finished project from acceptable to exceptional, Yokomizo Associates considers client education part of its purpose and value, and willingly invests the time and effort to demonstrate why an obvious solution may not be the best one.

Considering the maintenance needs of the elderly, the firm selected textiles, flooring and wall materials for durability, moisture resistance, antimicrobial qualities, and easy-to-clean surfaces. Safety considerations required Yokomizo Associates to choose nonslip, low-glare flooring in appropriate colors and patterns, with adequate contrast between wall-to-floor materials to assist the visually impaired. Transitions needed to be smooth and level, and features such as corner guards had to be durable and resistant to the constant impact of wheelchairs and walkers. Balancing soothing and serene with fresh and current, color choices along with lighting needed to be carefully considered to account for the loss of visual acuity that occurs with age. A combination of pendant and indirect light sources reduce the potential for glare.

In an example of customized innovation, handrails exist as an integrated feature of a practical yet handsome wainscot, providing both assistance for mobile residents and protection for the walls, while lending a tasteful residential feel to the corridors. Individualized “memory boxes” personalize the entrance to each room by providing a place for residents to display treasured photos or belongings that stimulate memories and act as wayfinding cues for locating one's room. Bypassing prefabricated options for a coordinated custom solution kept residential hallways clean and elegant in appearance without foregoing this useful resource. Handrail heights and furniture dimensions also needed special consideration and custom manufacturing to accommodate the specific physical needs of the aging Japanese population.

Rehabilitating dignity and respect

More concerned with satisfied residents than photo finishes, Yokomizo Associates designs for feel and measures its success through the comments of guests, residents, and colleagues who remark, “You know, it just feels really good.”

Everything about this project felt right, from the client's vision, to the collaborative process, to the working alliance of a cross-cultural team. Impressed with the thoroughness and ethic of respect that defined the contributions of everyone involved-from the client, to the local architects on through to the last subcontractor-the spirit of cooperation and mutual appreciation made for an exceptionally pleasant working environment and a better project, a professional experience Yokomizo Associates looks forward to repeating. Engaged to design two additional senior healthcare centers for HCM Sun City Japan, the firm also intends to continue championing both aging-and designing-with dignity at home and abroad.

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Healthcare Design 2010 October;10(10):34-42