長期照護機構建築之歷史演進

Architectural Evolution of Long-term Care Facilities

王佳惠(Chia-Hui Wang) ； 郭乃文(Nai-Wen Kuo)

《北市醫學雜誌》 2卷4期 (2005/04) Pp. 311-319

https://doi.org/10.6200/TCMJ.2005.2.4.01

摘要

本研究以文獻探討之方式，從「長期照護機構建築演進歷程」初入，探討長期照護機構建築歷史演進，並歸納現代長期照護機構設計之趨勢。回顧西方文明中，對老人之照護可追溯自古羅馬時期一種名為「gerocomia」之建築類型，其主要機能為供老人居住。中世紀時期，許多修道院醫院均有分別設立、收容老人之房舍；在此期間之英國，在教會贊助下亦廣設「almshouse」之老人安養院，其典型之平面配置為圍繞一中央庭院且鄰接教堂之建築量體，其僅只於提供居住安養，並不提供醫療照護。二次大戰之後，許多國家逐漸將廢棄之急性醫院，其原是用於治療天花與肺結核等傳染性疾病，而轉變為專責提供老人醫療照護之醫院。此類醫院其病房層之標準模板幾乎全為改良式之南丁格爾式開放式病房與公用之衛浴設備；即使是單人房亦無專供個人使用之衛浴設備，依今日之標準，其設施標準顯然簡窳許多。西元1945至1960年代，「護理之家」成為首波專為長期照護所設計之新建機構，國際式樣之美學樣式與功能語彙席捲了當時之已開發或開發中國家。該時期護理之家建築設計之概念大體遵循勒•柯布與密斯•凡德羅兩位建築大師之現代主義思潮。西元1960年代以後，護理之家之規劃設計受到居家主義影響，逐漸脫離極簡主義醫院之面貌，展現非醫院之形象與氛圍。西元1980年代初期，現代主義醫院式護理之家的設計因其不符美學要件及居家氛圍之需要而遭揚棄。在「在地安老」與持續性照護等觀念之影響下，持續性照護退休社區與輔助生活照護單元等長期照護機構遂逐漸衍生而出。綜觀長期照護機構之設計思潮，可歸納出下列三大趨勢：1.在建築理念展現上，除醫療機能取向之考量外，加入居家概念之營造及人性化尺度等規劃概念。2.於建築機能演進方面，由照護機構之單一性設計概念轉化為滿足使用者不同階段體能及健康狀況之多元性設計。3.在建築空間型態配置概念上，由單向監管式病床單元轉化為互動式居住交誼空間。

關鍵字

長期照護 ； 長期照護機構規劃設計 ； 醫療機構建築

並列摘要

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.

並列關鍵字

Long-term care ； long-term care facility design ； healthcare architecture