Enhancing Dementia Nursing Homes in South Korea: Lessons from German Building Standards
Abstract
:1. Introduction
1.1. Background and Objectives
1.2. Research Methods
2. Background Status
2.1. Dementia and the Concept of Dementia-Friendly Built Space
2.1.1. Symptoms of Dementia
2.1.2. Dementia Nursing Homes as Dementia-Friendly Built Spaces
2.2. Dementia Nursing Homes in South Korea
2.3. Dementia Nursing Homes in Germany
3. Current Legislation on Dementia Nursing Homes in South Korea and Germany
3.1. Relevant Laws in South Korea
3.1.1. Superior Law: Welfare of Senior Citizens Act
3.1.2. Inferior Law: The Enforcement Regulations of the Welfare of Senior Citizens Act
3.2. Relevant Laws in Germany
3.2.1. Superior Law: Nursing Homes Act and State Laws
3.2.2. Inferior Law: Regulation on Minimum Standards for Nursing Homes and State Laws
4. A Comparison of Building Standards for Dementia Nursing Homes in South Korea and Germany
4.1. Regulations Regarding Basic Requirements for Dementia Nursing Homes
4.1.1. South Korea
4.1.2. Germany
4.1.3. Summary
4.2. Regulations Regarding the Facility Size of Dementia Nursing Homes
4.2.1. South Korea
4.2.2. Germany
4.2.3. Summary
4.3. Necessary Rooms in Dementia Nursing Homes and Detailed Regulations for Necessary Rooms
4.3.1. Configuration of Necessary Rooms within the Residential Unit
- 1.
- South Korea
- 2.
- Germany
4.3.2. Detailed Regulations for Necessary Rooms
- 1.
- Individual spaces
- a.
- Bedrooms and special bedroomsIn South Korea, detailed regulations focus on various types of bedrooms, including single, multi-person, and couple-shared occupancy types. These regulations primarily emphasize the autonomy design criterion, focusing on aspects such as bed safety, window size, health and safety equipment, anti-slip flooring, wheelchair access, and daylight. There is only a brief mention of personal storage facilities to enhance the sense of familiarity and privacy (Table 17I). Within the same criterion of autonomy, Germany’s building standards pertain to size, accessibility, door control, dimensions, external views, shading, lighting, etc., in bedrooms (Table 17II). Furthermore, they promote familiarity and personal privacy within the criterion of social interaction. This is achieved by arranging diverse furniture, providing adequate personal storage facilities, and ensuring space adaptability, such as allowing the use of a single room as a double room in the case of spousal admission. Both South Korean and German dementia nursing homes require a specific number of special bedrooms to temporarily separate residents in multi-person rooms.
- 2.
- Communal space
- a.
- Common living roomIn South Korea, regulations primarily focus on entry control for dementia units and the provision of space usage programs for program rooms in general units, aiming to support the autonomy of seniors with dementia (Table 18I), albeit with relatively limited requirements. On the other hand, German common living rooms have numerous and detailed requirements within the autonomy criterion, such as size, accessibility, space usage program, treatment integration, bed participation, shading, and reading lights (Table 18II). Furthermore, Germany has specifications on privacy and living space to enhance familiarity and a sense of belonging within the social interaction criterion. Additionally, it provides orientational cues and logical room syntax, such as location, thereby supporting autonomy and legibility criteria.
- b.
- Kitchens, dining rooms, and outdoor spaceIn Korea, kitchen–dining rooms are considered necessary, but kitchens are closed off to patients with dementia, and specific regulations regarding dining rooms are lacking. Between 2016 and 2018, some revisions mandated the installation of a simple kitchenette and dining area within dementia units. However, as of 2019, this requirement is no longer enforced, leaving elderly individuals with dementia in both dementia and general units unable to physically or sensorily engage in kitchen activities.In contrast, in Germany, kitchen and dining rooms are designated as open spaces accessible to patients with dementia and with wheelchair, and there are regulations regarding their size, numbers, storage, and locations. Consequently, these rooms support residents’ independence and enhance the readability of the dining space, aligning with the autonomy and legibility criteria. Moreover, outdoor spaces in Germany are regulated in terms of size, accessibility, location, protection, and shading to address the autonomy, legibility, and sensory stimulation needs of dementia patients.
- 3.
- Therapy and hygiene spaces
- a.
- Physical occupational therapy room and ensuite bathroomIn South Korea, there are no regulations related to physical therapy rooms and ensuite bedrooms in South Korea (Table 19I), with the latter lacking specific mandates for necessary rooms. German regulations address the autonomy criterion in the physical occupational therapy room by specifying numbers, sink usage, and shading. Furthermore, they provide various detailed regulations for ensuite bathroom/toilets, including specific guidelines related to autonomy, familiarity, and legibility criteria (Table 19II), such as numbers, accessibility, entrance space, entrance, door control, sanitary equipment, barrier-free, and home-like configuration.
- b.
- Common toilets and bathroomsSouth Korean regulations for common toilets and bathrooms include features such as anti-slip floors, wheelchair access, night lights, safety handles, bath tubs, and hot water, aiming to enhance the autonomy of patients with dementia. In contrast, German regulations include more detailed provisions such as numbers, door controls, visitor toilets, and mechanical baths, focusing on autonomy and personal privacy within the criterion of social interaction
- 4.
- Functional auxiliary, household management, and staff duty spaces
4.3.3. Summary
5. Conclusions
6. Discussion
Funding
Data Availability Statement
Conflicts of Interest
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Year | 2015 | 2020 | 2025 | 2030 | 2035 | 2040 | 2045 | 2050 |
---|---|---|---|---|---|---|---|---|
Number of people with dementia (million) | 49.92 | 58.66 | 69.20 | 82.05 | 97.45 | 114.83 | 133.28 | 152.24 |
Year | 1980 | 2022 | 2050 | |||
---|---|---|---|---|---|---|
Ranking | Country | People Aged 65 and Older (%) | Country | People Aged 65 and Older (%) | Country | People Aged 65 and Older (%) |
1 | Sweden | 16.3 | Japan | 29.8 | Hongkong | 40.6 |
2 | Germany | 15.7 | Italy | 23.7 | South Korea | 39.4 |
3 | Austria | 15.4 | Finland | 22.9 | Japan | 37.5 |
4 | UK | 14.9 | Portugal | 22.6 | Italy | 37.1 |
5 | Norway | 14.8 | Greece | 22.5 | Spain | 36.6 |
6 | Belgium | 14.4 | Bulgaria | 22.4 | Taiwan | 35.3 |
7 | Denmark | 14.4 | Puerto Rico | 22.4 | Greece | 34.8 |
8 | France | 14.0 | Germany | 22.2 | Portugal | 34.5 |
Year | I. People Aged 65 or Older | II. Dementia Prevalence Rate among Individuals Aged 65 and Above | ||
---|---|---|---|---|
People Aged 65 or Older (Persons) | Population Ratio (%) | People Aged 65 or Older Living with Dementia (Persons) | Dementia Prevalence Rate among Individuals Aged 65 and Above (%) | |
2050 | - | 37 *4 (c) | 3,026,593 *4 | 16.09 *4 |
2025 | - | 19.9 *4 (b) | 1,083,977 *4 | 10.32 *4 |
2020 | 8,125,000 *1 | 15.7 *1 (b) | 832,795 *3 | 10.24 *3 |
2019 | 7,685,000 *1 | 14.9 *1 (b) | 794,280 *3 | 10.33 *3 |
2018 | 7,381,000 *1 | 14.3 *1 (b) | 750,488 *2 | 10.16 *2 |
2017 | 7,076,000 *1 | 13.8 *1 (a) | 702,436 *2 | 9.94 *2 |
Disorder | Associated Symptoms | |
---|---|---|
Cognitive disorder | Memory disorder, orientation disorder, language disturbance, space–time perceptual disturbance, agnosia, apraxia, prefrontal functional disorders causing judgment disorder | |
Behavior-psychological disorder | Behavior disorder | Aggression, wandering without meaning, inappropriate sexual behavior, screaming, cursing, insomnia, bulimia |
Psychological disorder | Anxiety, agitation, apathy, insensibility, depression, hallucination, delusion | |
Changes in activities of daily living | Changes in P-ADL 1 | Defecating, dressing, bathing, etc. |
Changes in I-ADL 2 | Shopping, money management, household, food preparation, etc. |
Criteria | I. Autonomy | II. Familiarity | III. Sensory Stimulation | IV. Legibility | V. Social Interaction |
---|---|---|---|---|---|
Design principles | Barrier-free, compensatory environment | Biographical reference | Encouragement | Logical room syntax | Privacy |
Safety and security | Homogenous and small groups | Avoidance of overstimulation | Furnishing | Belonging | |
Orientational cues | Noninstitutional character | Fixtures and fittings | Fixtures and fittings | Communication |
South Korea | Germany | ||
---|---|---|---|
Federal Law (Bundesgesetz) | State Law (Landesgesetz) | ||
Superior law | Welfare of Senior Citizens Act | Nursing Homes Act (Heimgesetz: HeimG) | State law for Nursing Home Act * (Länderheimgesetze) |
Inferior law | The Enforcement Regulations of the Welfare of Senior Citizens Act | Regulation on Minimum Standards for Nursing Homes (Heimmindestbauverordnung: HeimMindBauV) | State law for Regulations on Minimum Standards for Nursing Homes * (Heimmindestbauverordnung der Bundesländer) |
Regulation | Legal Provisions | Main Contents | ||
---|---|---|---|---|
I. Welfare of Senior Citizens Act | Art. 31 | Types of elderly welfare facilities | Upper classification: Welfare facilities for the elderly Middle classification: Medical welfare facilities for the elderly Subclassification: Elderly nursing homes | |
Art. 34(1) | Elderly medical welfare facilities | Definition of elderly nursing home: Facility that accommodates seniors with significant mental and physical disabilities arising from conditions such as dementia, stroke, and other geriatric illnesses, and provides meals, care, and other necessities of daily life | ||
II. The Enforcement Regulations of the Welfare of Senior Citizens Act | Art. 22(1) | Building standards of medical welfare facilities for the elderly | Common matters | Facility size, structure, and equipment |
Facility standards | Necessary rooms: Bedroom, kitchen, dining room, washroom, bathroom, program room, physical (occupational) therapy room, medical/nursing room, and other rooms | |||
Facility equipment standards | Facility equipment for necessary rooms |
I. Nursing Homes Act (HeimG) | Legal Provisions | Main Contents | |||
Art. 1 | Scope of application | Nursing homes (Heime) that provide a residential space, medical care, and meals to the elderly or adults who need care or are disabled | |||
Art. 3(2) | Performance | Necessary rooms: Residential space, treatment spaces, household management spaces, corridor, bathrooms and toilets/Sanitary and technical equipment | |||
II. State laws for the Nursing Homes Act | |||||
State | State law | Legal provisions | Scope of application | ||
1 | BW | WTPG [60] | Art. 2–6 | For adults in need of care or with disabilities: Nursing home (1), ambulatory assisted living community (3A) | |
2 | Bay | PfleWoqG [61] | Art. 2 | For seniors or adults in need of care: Nursing home (1), ambulatory assisted living community (3A), special housing form (6C), assisted living group (5A) | |
3 | Berl | WTG [62] | Art. 2–7 | For adults in need of care or with disabilities: Nursing home (1), care facility (2A), assisted living community (5B), special housing form (6C) | |
4 | Ham | HmbWBG [63] | Art. 2 | For seniors or adults in need of care or with disabilities: Service housing facility (7A), living community (8), assisted living community (5C), residential facility (9), guest facility (10), ambulatory services (4E) | |
5 | Hess | HGBP [64] | Art. 2 | For seniors or adults in need of care or with disabilities: Ambulatory care and nursing services (4D) | |
6 | MV | EQG [65] | Art. 2 | For seniors or adults in need of care, as well as those with mental health issues or disabilities: Day and night care (11), ambulatory assisted living community (3A), training living groups for individuals with mental health challenges (12) | |
7 | NW | WTGNW [66] | Art. 2–5 | For seniors or adults in need of care or with disabilities: Facility with comprehensive service offerings (13B), residential community with care services (5D), serviced living (7B), ambulatory services (4E), guest facility (10) | |
8 | RP | LWTG [67] | Art. 3–6 | For seniors or adults in need of care or with disabilities: Facility with increased self-determination and participation (13A), facility with comprehensive service offerings (13B), self-determined living community (5F) | |
9 | Sach | SächsBeWoG [68] | Art. 2 | For seniors or adults in need of care, as well as those with mental health issues or disabilities: Nursing home (1), ambulatory assisted living community (3A), assisted living group (5A) | |
10 | SH | SbStG [69] | Art. 6–10 | For adults in need of care or with disabilities: Nursing home (1), special forms of housing, care, and support (14), assisted living (6A), ambulatory supported residential and house community (3B) | |
11 | BB | BbgPBWoG [70] | Art. 1, 4, 5 | For adults in need of care or with disabilities: Supported housing (6B), housing with limited self-responsibility (6D) | |
12 | BR | BremWoBeG [71] | Art. 2, 5, 7–9 | For seniors or adults in need of care or with disabilities: Guest facility (10), mobile support services (4F), serviced living (7B), living community with support services (5G), care and support facility (2B) | |
13 | NS | NHeimG [72] | Art. 1 | For seniors or adults in need of care or with disabilities: Non-self-determined living communities (5E), assisted living (6A) | |
14 | Sar | LHeimGS [73] | Art. 1 | For adults in need of care or with disabilities: Nursing home (1), ambulatory assisted living (4A), ambulatory care services (4C) | |
15 | SA | WTG-LSA [74] | Art. 2–4 | For seniors or adults in need of care or with disabilities: Nursing home (1), non-self-organized housing forms (6E) | |
16 | Tuer | ThürWTG [75] | Art. 1–3 | For seniors or adults in need of care or with disabilities: Nursing home (1), ambulatory care housing forms (4B) |
Regulation | Legal Provisions | Main Contents | |||||
---|---|---|---|---|---|---|---|
I. Regulation on Minimum Standards for Nursing Homes (HeimMindBauV) | Art. 1–18 | Minimum requirements | Common regulations | Scope of application | Art. 1 | ||
Residential rooms, care rooms | Art. 2 | ||||||
Corridors, stairs, elevators, floor, lighting | Art. 3–6 | ||||||
Emergency alarm devices, phones, exits | Art. 7–9 | ||||||
Sanitary equipment, household space | Art. 10–11 | ||||||
Heating, building entrance | Art. 12–13 | ||||||
Special regulations | Residential room, functional auxiliary room | Art. 14–15 | |||||
Common areas, treatment room | Art. 16–17 | ||||||
Sanitary equipment | Art. 18 | ||||||
II. State laws for Regulation on Minimum Standards for Nursing Homes | |||||||
State | State law | State | State law | State | State law | State | State law |
BW | LHeimBauVO [76] | Bay | APfleWoqG [77] | Berl | WTG-BauV [78] | Ham | WBBauVO [79] |
Hess | HGBPAV [80] | MV | EMindBauVOMV [81] | NW | WTGDVO [82] | RP | LWTGDVO [83] |
Sach | SächBeWoGDVO [84] | SH | SbStG-DVO [85] | BB | - | BR | - |
NS | - | Sar | - | SA | - | Tuer | - |
Basic Requirements | (A) Barrier-Free Environment | (B) Safety Lock Device | (C) Light | (D) Thermal Heating System | (E) Indoor Ventilation | (F) Spatial Orientation | (G) Home-like Environment | (H) Personal Belongings and Furniture | (I) Emergency Alarm Communication Device | (J) Protected Outdoor Space | (K) Community Interaction | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Daylight | Lighting | |||||||||||
I. South Korea | ○ | ○ | ○ | ○ | ○ | ○ | - | - | - | - | - | ○ |
II. Germany | ||||||||||||
HeimMindBauV (federal law) | ○ | ○ | - | ○ | ○ | - | - | - | - | ○ | - | - |
BW | ○ | - | ○ | ○ | ○ | ○ | ○ | ○ | ○ | - | ○ | - |
Bay | ○ | - | - | - | - | - | - | - | - | ○ | - | - |
Berl | ○ | ○ | - | ○ | ○ | - | - | - | - | ○ | - | - |
Ham | ○ | - | ○ | ○ | - | - | ○ | ○ | - | ○ | ○ | - |
Hess | ○ | ○ | ○ | ○ | ○ | - | - | - | ○ | ○ | ○ | - |
MV | ○ | - | - | - | - | - | - | - | - | ○ | - | - |
NW | - | - | ○ | - | ○ | - | - | - | - | ○ | ○ | - |
RP | - | - | - | - | ○ | - | ○ | - | ○ | ○ | ○ | - |
Sach | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | - |
SH | ○ | - | - | - | ○ | - | - | ○ | ○ | ○ | ○ | - |
Basic Requirements | I. South Korea | II. Germany | |
---|---|---|---|
A-1 | Stairs, steps |
|
|
A-2 | Corridor width |
| |
A-3 | Anti-slip floor |
|
|
A-4 | Elevator |
|
|
A-5 | Wheelchair usability |
|
|
A-6 | Safety handle |
|
|
A-7 | Barrier-free standard specification |
| |
B-1 | Outside entrance |
| |
B-2 | Stairs |
| |
B-3 | Living room, bedroom, and bathroom |
| |
B-4 | Dementia unit |
| |
B-5 | Kitchen |
| |
C-1 | Daylight |
|
|
C-2 | Lighting |
|
|
D-1 | Heating system |
|
|
E-1 | Ventilation |
|
|
F-1 | Space arrangement | - |
|
F-2 | Orientation element | - |
|
G-1 | Size of the space |
| |
G-2 | An atmosphere like home |
| |
H-1 | Past personal belongings |
| |
I-1 | Alarm device |
| |
I-2 | Communication device |
| |
J-1 | Outdoor space Access |
| |
J-2 | Outdoor space safety |
| |
J-3 | Self-use of outdoor spaces |
| |
J-4 | Adequate outdoor space |
| |
J-5 | Solar control device in outdoor spaces |
| |
K-1 | Additional cultural and sports facilities |
| |
K-2 | Day and night care facility |
|
Design Criteria | I. Autonomy | II. Familiarity | III. Sensory Stimulation | IV. Legibility | V. Social Interaction | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
I-1 | I-2 | I-3 | II-1 | II-2 | II-3 | III-1 | III-2 | III-3 | IV-1 | IV-2 | IV-3 | V-1 | V-2 | V-3 | |
Barrier-Free and Compensatory Environment | Safety and Security | Orientational Cues | Biographical Reference | Small Groups | Noninstitutional Character | Encouragement | Avoidance of Overstimulation | Access to the Outdoors | Logical Room Syntax | Furnishing | Fixtures and Fittings | Privacy | Belonging | Communication | |
(A) | ◯ 1,2 | ◯ 1,2 | - | - | - | - | - | - | - | - | - | - | - | - | - |
(B) | - | ◯ 1,2 | - | - | - | - | - | - | - | - | - | - | - | - | - |
(C) | ◯ 1,2 | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(D) | ◯ 1,2 | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(E) | ◯ 1,2 | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(F) | - | - | ◯ 2 | - | - | - | - | - | - | ◯ 2 | - | - | - | - | |
(G) | - | - | - | - | ◯ 2 | ◯ 2 | - | - | - | - | - | - | ◯ 2 | ◯ 2 | - |
(H) | - | - | - | ◯ 2 | - | ◯ 2 | - | - | - | - | ◯ 2 | - | ◯ 2 | - | - |
(I) | ◯ 2 | ◯ 2 | - | - | - | - | - | - | - | - | - | - | - | - | |
(J) | ◯ 2 | ◯ 2 | - | - | - | - | - | ◯ 2 | ◯ 2 | - | - | - | - | ||
(K) | - | - | - | - | - | - | - | - | - | - | - | - | - | - | ◯ 1 |
Facility Sizes | The Entire Facility | Residential Unit | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
General Unit | Dementia Unit | ||||||||||||
Resident‘s Bedroom | Common Living Room | The Unit | Resident‘s Bedroom | Com. Living Room | |||||||||
A–B | C | D | E | F | G | H | I | B | D | F | I | ||
Capacity (p.) | Min. Floor Area (m2/p.) | Capacity (p.) | Single-Bedroom Ratio (%) | Min. Net Floor Area (m2) | Min. Width (m) | Capacity (p.) | Min. Net Floor Area (m2/p.) | Capacity (p.) | Capacity (p.) | Min. Net Floor Area (m2) | Min. Net Floor Area (m2/p.) | ||
Min. | Max. | Max. | Max. | Max. | Max. | ||||||||
I. South Korea | |||||||||||||
10 | - | 23.6 | 4 | - | 6.6 per person | - | - | - | 16 | 4 | 9.9 (1p.) | 1.65 | |
16.5 (2p.) | |||||||||||||
23.1 (3p.) | |||||||||||||
29.7 (4p.) | |||||||||||||
II. Germany | |||||||||||||
HeimMindBauV | 6 | - | - | 2 4 | - | 12 (1p.) | - | - | (20 + 1) 1 | ||||
18 (2p.) | |||||||||||||
24 (3p.) | |||||||||||||
30 (4p.) | |||||||||||||
BW | - | 100 | - | 1 | 100 | 14 (1p.) 2 | 3.2 | 15 | 5 | ||||
Bay | 6 | - | - | 1, 2 | - | 14 (1p.) 2 | - | - | (20 + 1.5) 1,3 | ||||
20 (2p.) 2 | |||||||||||||
Berl | - | - | - | 1, 2 | 60 | 14 (1p.) 2 | - | - | 5 3 | ||||
22 (2p.) 2 | |||||||||||||
Ham | - | - | - | 1 | - | 14 (1p.) 2 | 3.2 | 12 | (18 + 1) 1 | ||||
Hess | 6 | - | - | 1, 2 | - | 14 (1p.) 2 | 3.2 | - | (20 + 2.5) 1 | ||||
24 (2p.) 2 | |||||||||||||
MV | - | - | - | 1, 2 | - | 12 (1p.) | - | - | - | ||||
18 (2p.) | |||||||||||||
NW | - | 36 | 45 | 1, 2 | 80–100 | 14 (1p.) 2 | - | - | 5 | ||||
24 (2p.) 2 | |||||||||||||
RP | - | - | - | 1, 2 | - | 14 (1p.) | - | - | 3 | ||||
20 (2p.) | |||||||||||||
Sach | 9 | - | - | 1, 2 | - | 12 (1p.) 2 | - | - | (20 + 0.75) 1,3 | ||||
18 (2p.) 2 | |||||||||||||
SH | - | - | - | 1, 2 | 75 | 14 (1p.) | - | - | - | ||||
20 (2p.) |
Design Criteria | I. Autonomy | II. Familiarity | III. Sensory Stimulation | IV. Legibility | V. Social Interaction | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
I-1 | I-2 | I-3 | II-1 | II-2 | II-3 | III-1 | III-2 | III-3 | IV-1 | IV-2 | IV-3 | V-1 | V-2 | V-3 | |
Barrier-Free and Compensatory Environment | Safety and Security | Orientational Cues | Biographical Reference | Small Groups | Noninstitutional Character | Encouragement | Avoidance of Overstimulation | Access to the Outdoors | Logical Room Syntax | Furnishing | Fixtures and Fittings | Privacy | Belonging | Communication | |
(A) | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(B) | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(C) | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(D) | ◯ 1,2 | ◯ 1,2 | - | - | ◯ 1,2 | ◯ 1,2 | - | - | - | - | - | - | ◯ 1,2 | - | - |
(E) | ◯ 2 | ◯ 2 | - | - | ◯ 2 | ◯ 2 | - | - | - | - | ◯ 2 | - | ◯ 2 | - | - |
(F) | ◯ 1,2 | ◯ 1,2 | - | - | - | ◯ 2 | - | - | - | - | - | - | ◯ 2 | - | - |
(G) | ◯ 2 | ◯ 2 | ◯ 2 | ◯ 2 | - | ◯ 2 | - | - | - | - | ◯ 2 | - | ◯ 2 | - | - |
(H) | ◯ 2 | ◯ 2 | - | - | ◯ 2 | ◯ 2 | - | ◯ 2 | - | - | - | - | ◯ 2 | ◯ 2 | ◯ 2 |
(I) * | ◯ 1,2 | ◯ 1,2 | - | - | - | - | - | - | ◯ 2 | - | - | - | - | ◯ 2 | ◯ 2 |
A. Individual Spaces | B. Communal s. | C. Therapy s. | D. Hygiene s. | E. Functional Auxiliary s. | F. Household Management s. | G. Staff Duty s. | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Bedroom | ◯ 1,2 | Common living room/pro-gram room | ◯ 1,2 | Physical occupational therapy room | ◯ 1,2 | Ensuite bathroom/toilet | ◯ 2 | Waste disposal room | ◯ 2 | Storage room | ◯ 2 | Nursing station | ◯ 1,2 |
Special bedroom | ◯ 1,2 | Kitchen/cooking room | ◯ 1,2 | - | - | Common toilet | ◯ 1,2 | Morgue | ◯ 2 | Laundry room | ◯ 1,2 | Staff office | ◯ 1,2 |
- | - | Dining room | ◯ 1,2 | - | - | Common washbasins/bathrooms | ◯ 1,2 | - | - | Drying room | ◯ 1,2 | Staff room | ◯ 1,2 |
Outdoor space *2 | Volunteer room | ◯ 1 |
Spatial Areas | A. Individual Spaces | B. Communal s. | C. Therapy s. | E. Functional Auxiliary s. | D. Hygiene s. | F. Household Management s. | G. Staff Duty s. | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Necessary Room | B | SB | LR | PR | KD | OS | PT | WD | M | EB | CT | CB | LD | SR | SO | SR | VR | NS |
I. South Korea | ||||||||||||||||||
>30 | ◯ 1 | ◯ 1 | - | ◯ 1 | ◯ 1 | - | ◯ 1 | - | - | - | ◯ 1 | ◯ 2 | ◯ 2 | - | ◯ 2 | ◯ 2 | ◯ 2 | ◯ 1 |
10–30 | ◯ 1 | ◯ 1 | - | ◯ 1 | ◯ 1 | - | ◯ 1 | - | - | - | ◯ 1 | ◯ 2 | - | ◯ 2 | ◯ 1 | |||
Dementia units | ◯ | ◯ | - | ◯ | - | - | - | - | - | ◯ | ◯ | - | - | |||||
II. Germany | ||||||||||||||||||
HeimMindBauV | ◯ | ◯ | ◯ | - | - | ◯ 5 | ◯ | - | ◯ | - | ◯ | ◯ 4(A) | - | ◯ | - | |||
◯ 7 | ||||||||||||||||||
BW | ◯ | - | ◯ | - | ◯ | ◯ 6 | - | - | ◯ 3 | - | ◯ 4(A) | - | ◯ 7 | - | ||||
◯ 7 | ◯ 7 | |||||||||||||||||
Bay | ◯ | ◯ | ◯ | - | - | - | ◯ 7 | - | ◯ | ◯ 3 | - | ◯ 4(B) | - | - | ||||
Ber | ◯ | ◯ | ◯ | - | - | - | ◯ 7 | ◯ | - | ◯ 3 | ◯ | ◯ 4(C) | ◯ 7 | ◯ | ||||
◯ 7 | ||||||||||||||||||
Ham | ◯ | - | ◯ | - | ◯ | ◯ 6 | - | - | ◯ 3 | ◯ | ◯ 4(B) | - | ◯ 7 | ◯ 7 | ||||
◯ 7 | ◯ 7 | |||||||||||||||||
Hess | ◯ | ◯ | ◯ | - | - | - | ◯ 7 | ◯ | ◯ | ◯ 3 | - | ◯ 4 | - | ◯ | ◯ 7 | |||
◯ 7 | ◯ 7 | |||||||||||||||||
MV | ◯ | ◯ | ◯ | - | - | ◯ 6 | ◯ | ◯ | - | ◯ 3 | ◯ | ◯ 4(D) | ◯ 7 | ◯ 7 | ||||
◯ 7 | ||||||||||||||||||
NW | ◯ | ◯ | ◯ | - | ◯ | ◯ 6 | - | - | ◯ 3 | ◯ | ◯ 4(E) | - | ◯ | - | ||||
RP | ◯ | ◯ | ◯ | - | - | ◯ 6 | ◯ | ◯ | - | ◯ 3 | ◯ | ◯ 4 | - | ◯ | - | |||
◯ | ||||||||||||||||||
Sachs | ◯ | ◯ | ◯ | - | - | - | - | ◯ 7 | ◯ 3 | - | - | - | ◯ 7 | |||||
SH | ◯ | ◯ | ◯ | - | ◯ | ◯ | ◯ | ◯ | - | ◯ 3 | ◯ | ◯ 4 | - | ◯ 7 | - | |||
◯ 7 | ◯ 7 |
Regulation | I. South Korea | II. Germany | |
---|---|---|---|
(A-1) Bedroom | |||
Autonomy | Barrier-free and compensatory environment | Room type: Single, multi-person, and couple-shared bedrooms. Bed safety: Adjustable height. Window size: 1/7 or more of bedroom floor area. Health equipment: Adequate heating, ventilation, lighting, and moisture-proofing. Safety equipment. Safety handle: Move freely on and off the bed. Anti-slip floor. Wheelchair access: No thresholds. Daylight. | Size: Spacious for wheelchair movement (4). Accessibility: Easy access from corridor or communal spaces (1, 3, 6, 8). Room type: Avoid designs requiring crossing through bedroom (4, 6, 8, 10). Door control: Lockable from inside and unlockable from outside in an emergency (1, 3, 4, 6, 10). Basement bedroom: Prohibited (6). Outside view: Bed should offer outside view (8). Direction: Avoid facing north (8). Shading device: For indoor temperature control (4). Lighting: Bedside reading stand (1, 6). Night lights installed (6). |
Safety and security | |||
Familiarity | Biographical reference | Personal storage: Separate storage by multi-person type. | Furniture: Bed, bedside table, closet, TV, chair, and table arranged for sleep and daily use (4). Spatial variability: Combining single rooms into doubles (5, 6, 2). Personal storage: Ensure at least one location on each floor (6, 9), tailored to resident count (9). Adequate space (1, 2, 10). At least 1 m2 per person near or within private living space, like a closet or shelf, with lockable options (1,5). |
Noninstitutional character | |||
Social interaction | Privacy | ||
(A-2) Special bedroom | |||
Size: Less than 5% of total capacity. | Numbers: Single room for temporary use by multi-person room residents (1, 3, 6, 7, 8, 9, 10, 11). At least one single room designated as special for every 30 residents in a double bedroom (8). |
Regulation | I. South Korea | II. Germany | |
---|---|---|---|
(B-1) Common living room | |||
Autonomy | Barrier-free and compensatory environment | Dementia unit: Entrance door ensures space separation and emergency access. Program room: Cultural and entertainment facilities available for free use. | Size: Consider facility concept, resident count, wheelchair use (11). Accessibility: Good access from bedrooms (3, 4, 6, 10). Single-story layout: (4). Space usage program Functions as living, dining, group activity, socializing, and play areas (4, 7, 9). Treatment integration: Doubles as therapy space (1), ensuring resident privacy (3, 4, 6, 7). Participation from bed: All residents participate (3, 4, 6, 7, 11), even from bed (4, 10). Shading device: (4). Reading lights: (1). |
Safety and security | |||
Orientational cues | - | Location: Centrally located within units (5). | |
Legibility | Logical room syntax | ||
Familiarity | Noninstitutional character | - | Privacy: Residence units emphasize individuality (5). |
Social interaction | Belonging | Living space: Living area corridor and greenhouse (11). | |
(B-2) Kitchen/dining room | |||
Autonomy | Barrier-free and compensatory environment | Kitchen flooring: Water-resistant. Kitchen cleaning and drainage: Structured for easy cleaning and drainage. Kitchen door lock: Door locks installed for dementia patients. | Size: Adequate for meal prep and resident participation, considering furniture (5). Numbers: At least one kitchen, based on facility needs (1, 2, 8). The location, size, and furniture layout based on resident count (9). Storage: Sufficient for prep and food, with extra per facility needs (4, 8). Wheelchair users: Sink height adjustable for wheelchair access, promoting kitchen participation (5). |
Safety and security | |||
Orientational cues | - | Location: Centrally located within units (5). | |
Legibility | Logical room syntax | ||
(B-3) Outdoor space | |||
Sensory stimulation | Access to the outdoors | - | Size: Adequate (2, 8, 9). Accessibility: Safe and unrestricted resident access (5), even for wheelchair users (2, 8, 9). Location: Proximity to central communal area (5). Protection: Design to ensure protection (2, 8, 11). Shading device: (5). |
Regulation | I. South Korea | II. Germany | |
---|---|---|---|
(C-1) Physical occupational therapy room | |||
Autonomy | Barrier-free and compensatory environment | - | Numbers: Minimum of one per facility (1, 7, 11), with sufficient size and location determined by resident count and specific needs (3, 4, 6, 7, 9). Sink: At least one sink (4, 6). Shading device: (4). |
Safety and security | |||
(D-1) Ensuite bathroom/toilets | |||
Autonomy | Barrier-free and compensatory environment | Numbers: Required for 100% single-bedroom ratio (2).Accessibility: Direct connection from bedroom or adjacent room (3, 10, 7). Entrance space: Connecting two bedrooms and one ensuite between a common space and a private space (2). In front of the ensuite (2). Entrance: Avoid two entrances (5, 8). Exceptionally, one ensuite may serve two single rooms (11). Door control: Lockable door, emergency openable (1, 10, 4). Sanitary equipment: Double bedroom requires two sinks (1). At least one of each item: washbasin, shower, and toilet (2–11). Barrier-free: Safety handles in all sanitary facilities (3, 4, 6, 10). Anti-burn devices in washbasins, showers, and bathtubs (3, 6). | |
Safety and security | |||
Familiarity | Noninstitutional character | - | Home-like configuration: Arrangement of bathroom, sanitary equipment, and openings to resemble those found at home (5). |
Legibility | Logical room syntax | ||
(D-2) Common toilet | |||
Autonomy | Barrier-free and compensatory environment | Anti-slip floor: Non-slip floors. Wheelchair access. Night lights. | Numbers: At least one per eight individuals on the same floor (1). Adequate number near common bathroom (4). Wheelchair user: Enough for wheelchair users (1). Safety handle: (4). Door control: Emergency door opening (1). Visitor toilet: Sufficient for visitors (4). At least one installation place (5), up to 40 people (8). |
Safety and security | |||
(D-3) Common bathroom | |||
Autonomy | Barrier-free and compensatory environment | Anti-slip floor: Non-slip floors. Wheelchair access. Safety handle. Bathtub: Shallow with at least one grip rail and vertical handle lights Hot water: Temperature under 40 degrees Celsius with automatic thermostat use. Night lights. | Numbers: One facility per 20 residents (8), 30 or 32 people (4, 7), and 40 residents (3, 5, 7). One bathtub or shower per 20 people (1) and consider resident count (9). Wheelchair user: Available (6), sufficient quantities (1). Door control: Emergency door opening (1). Sanitary equipment: At least one tub, shower, and sink. Bathtub: Safe entry and exit (1, 4). Safety handle: In the bathtub, shower, and toilet (1, 4, 6). Mechanical bath: For medical use (6), tailored to individual needs (9). |
Safety and security | |||
Social interaction | Privacy | Privacy: Modesty protection (1,6) with curtains around tub and shower (4) |
Regulation | I. South Korea | II. Germany |
---|---|---|
(F) Functional auxiliary spaces | ||
Waste disposal room | Numbers: Installed on each floor (6). | |
Morgue | Morgue: Required if quick body transport is not ensured in double-bedroom facilities (1, 3, 6). | |
(G) Household management spaces | ||
Storage room | Numbers: At least one in-house management space (2). If unable to outsource external household services, provide adequate facilities internally (1, 4, 6, 7). Storage: Accommodate machinery, appliances, in-house items, wheelchairs, beds, and medical devices (9, 4). Include a warehouse for household goods, laundry, and medicines (4, 5). | |
Laundry room, drying room | ||
(H) Staff duty spaces | ||
Nursing station | Medical supplies and devices: Installation of necessary medical equipment and pharmaceutical hygiene materials. | Numbers: As many locations and sizes as necessary (2, 5, 6, 7, 10). Location: Essential for resident care (5, 7), positioned in a common area within the residential unit (5). |
Staff offices | ||
Staff changing room, staff break room | Location: Place outside the residential unit (5). | |
Caregiver’s room | ||
Volunteer room |
Design Criteria | I. Autonomy | II. Familiarity | III. Sensory Stimulation | IV. Legibility | V. Social Interaction | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
I-1 | I-2 | I-3 | II-1 | II-2 | II-3 | III-1 | III-2 | III-3 | IV-1 | IV-2 | IV-3 | V-1 | V-2 | V-3 | |
Barrier-Free and Compensatory Environment | Safety and Security | Orientational Cues | Biographical Reference | Small Groups | Noninstitutional Character | Encouragement | Avoidance of Overstimulation | Access to the Outdoors | Logical Room Syntax | Furnishing | Fixtures and Fittings | Privacy | Belonging | Communication | |
(A) Individual spaces | |||||||||||||||
Bedrooms | ◯ 1,2 | ◯ 1,2 | - | ◯ 2 | - | ◯ 2 | - | - | - | - | - | - | ◯ 2 | - | - |
Special bedrooms | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(B) Communal s. | |||||||||||||||
Common living rooms | ◯ 1,2 | ◯ 1,2 | ◯ 2 | ◯ 2 | - | ◯ 2 | - | - | - | ◯ 2 | - | - | - | ◯ 2 | - |
Kitchens/dining rooms | ◯ 1,2 | ◯ 1,2 | ◯ 2 | - | - | - | - | - | - | ◯ 2 | - | - | - | - | - |
Outdoor spaces | ◯ 2 | ◯ 2 | ◯ 2 | - | - | - | - | - | ◯ 2 | - | - | - | - | - | - |
(C) Therapy s. | |||||||||||||||
Physical occupational therapy rooms | ◯ 2 | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
(D) Hygiene s. | |||||||||||||||
Ensuite bathroom/toilets | ◯ 1,2 | ◯ 1,2 | - | - | - | ◯ 2 | - | - | - | ◯ 2 | - | - | - | - | - |
Common toilet | ◯ 1,2 | ◯ 1,2 | - | - | - | - | - | - | - | - | - | - | - | - | - |
Common bathrooms | ◯ 1,2 | ◯ 1,2 | - | - | - | - | - | - | - | - | - | - | ◯ 2 | - | - |
Design Criteria | I. Autonomy | II. Familiarity | III. Sensory Stimulation | IV. Legibility | V. Social Interaction | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Barrier-Free and Compensatory Environment | Safety and Security | Orientational Cues | Biographical Reference | Small Groups | Noninstitutional Character | Encouragement | Avoidance of Overstimulation | Access to the Outdoors | Logical Room Syntax | Furnishing | Fixtures and Fittings | Privacy | Belonging | Communication | |
(1) Basic requirements | |||||||||||||||
South Korea | ◯ | ◯ | ◯ 1 | ||||||||||||
Germany | ● | ● | ◯ | ◯ | ◯ | ◯ | ◯ | ◯ | ◯ | ◯ | |||||
(2) Facility sizes | |||||||||||||||
South Korea | ◯ | ◯ | ◯ | ◯ | ◯ | ||||||||||
Germany | ● | ● | ◯ | ◯ | ● | ● | ◯ | ◯ | ◯ | ◯ | ◯ | ◯ | |||
(3) Necessary rooms | |||||||||||||||
South Korea | ◯ | ||||||||||||||
Germany | ◯ 2 | ◯ 3 | |||||||||||||
(4) Detailed regulations of necessary rooms | |||||||||||||||
South Korea | ◯ | ◯ | |||||||||||||
Germany | ● | ● | ◯ | ◯ | ◯ | ◯ | ◯ | ◯ | ◯ |
Design Criteria | Implications | ||||||
---|---|---|---|---|---|---|---|
I | II | III | IV | V | |||
(1) Basic requirements | ◯ |
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◯ |
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[90] [91] | |||||||
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◯ |
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[92] [93] | |||||||
◯ |
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◯ | ◯ |
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[94] [95] [96] [94] | |||||||
◯ | ◯ |
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[96] [97] | |||||||
◯ |
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[98] [99] | |||||||
(2) Facility sizes | ◯ | ◯ | ◯ | ◯ |
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◯ | ◯ | ◯ |
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◯ | ◯ | ◯ | ◯ |
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◯ | ◯ | ◯ | ◯ |
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◯ | ◯ | ◯ |
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◯ | ◯ | ◯ | ◯ |
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(3) Necessary rooms | ◯ |
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[96] [100] | |||||||
◯ | ◯ | ◯ |
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[91] [94] | |||||||
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(4) Detailed regulations of necessary rooms | ◯ | ◯ | ◯ | Bedrooms |
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◯ | ◯ | ◯ | ◯ | Common living room |
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◯ | ◯ | Kitchen and dining room |
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◯ | ◯ | ◯ | Outdoor spaces |
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◯ | Physical occupational therapy room |
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◯ | ◯ | ◯ | Ensuite bathrooms |
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◯ | Common toilets |
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◯ | ◯ | Common bathrooms |
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© 2024 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Jee, S.I. Enhancing Dementia Nursing Homes in South Korea: Lessons from German Building Standards. Buildings 2024, 14, 1427. https://doi.org/10.3390/buildings14051427
Jee SI. Enhancing Dementia Nursing Homes in South Korea: Lessons from German Building Standards. Buildings. 2024; 14(5):1427. https://doi.org/10.3390/buildings14051427
Chicago/Turabian StyleJee, Soo In. 2024. "Enhancing Dementia Nursing Homes in South Korea: Lessons from German Building Standards" Buildings 14, no. 5: 1427. https://doi.org/10.3390/buildings14051427