Life is painted on a canvas that expresses many similarities and differences. As creators of environments we struggle to acknowledge what will accommodate the masses while not excluding the exceptions. The exceptions in health design have to do with the level of disability, health acuity, and age our building occupants possess.

In most design solutions (private residential excluded) we have integrated the needs of those with a disability with those without through the American with Disabilities Act. I know I welcome many of those design interventions as I move through public facilities. So much so, that when I built my house I planned many American with Disabilities Act (ADA) requirements into its scheme. It has made moving my 80-year-old mom into our home that much easier, even though she is without disability. If these features were to disappear off the American landscape, I think all ability levels would notice.

In acute healthcare design work we struggle with understanding how best to integrate all levels of health acuity into the design of patient rooms/medical care units. At this time the jury is out on the benefit of this feature. It is in this struggle between adjusting a difficult-to-staff care model for the desired healing benefit of patients that stalls the move to more acuity-adaptable rooms. Several of our Pebble Partners are measuring the results of their built acuity-adaptable rooms to see if in fact this design intervention speeds the healing process. Stay tuned!

In designing for various age groups, however, we still discriminate. Facilities for children are much more sensitive to size and developmental differences, for seniors to degenerating senses and mobility. As with disability and acuity level, I wonder why we cannot explore and one day embrace a universal approach to designing for all ages. There will always be as much difference in the needs of a two year old from that of a 30 year old, as there will be between a 30 year old and a 90 year old.

I struggle with this last age group because I know many active seniors who have maintained their health and mobility, but so many more have become shut-ins because of the fear of injury. In the design of children’s facilities there is a strong tendency to not design down to the toddler mindset, but to recognize that their environments are to accommodate an infant, as well as an adolescent and young adult, not to forget the family in tow. Similarly, designing for the elderly should recognize the need to adjust for dulled senses and mobility challenges to varied levels of cognitive challenges. Is this different than for the very young? Or how about for the rest of us caught in the middle of life with varied interruptions to our health and well-being? How do we study the ends of life’s spectrum to see the universality of the human condition and design for the ease of all?

It is clear that the way to mature to an awareness of the need for universality is to talk about it and find common solutions for all so that the most public of environments will not discriminate. As we get to the extreme of each of these populations then we need special environments, but our most accessible public facilities will need to understand the special requirements in order to create accessibility for all.

This is exactly the topic at the Environments for Aging 2008 Conference, taking place March 17-19 at the JW Marriott Starr Pass Resort in Tuscon, Arizona (for more information, visit The extreme needs of the far spectrum of life will be explored but the push will be for all of us who design to see how easily we can remove encumbrances to make living more accessible.

I’d love to hear your comments about Universal Design and the creation of “Environments for Living.” HD

The Center for Health Design is located in Concord, California. For more information, visit