Towards Inclusive and Resilient Living Environments for Older Adults: A Methodological Framework for Assessment of Social Sustainability in Nursing Homes

Abstract

The quality of living environments for older adults represents a critical component of social sustainability in an ageing society. Among various housing options, nursing homes are the most institutionalised form of elderly care and demand special attention regarding architectural design. This paper explores the impact of architectural and open space features on social sustainability in living environments for older adults. A comparative analysis of three Slovenian nursing homes is presented. The first two, built in the post-war period, were based on elevated architectural criteria inspired by Swedish human-centred housing design. The third was completed in 2021 in the post-COVID-19 era, which revealed the vulnerability of such housing typologies. An integrated methodological framework was developed by applying two complementary assessment tools: the Safe and Connected, developed by the authors to evaluate the spatial, health, and social resilience of nursing home environments, and the Well-being and Integration, addressing the role of open space with a particular emphasis on the identification of older adults with their environment and the facilitation of social resilience. Both tools evaluate indicators linked to the social dimension of quality of life for older adults. The results show a gradual improvement in architectural quality from the 1960s to the 1980s, followed by a partial decline in the contemporary case. The Swedish example scored highest across both tools. In contrast, the newest Slovenian facility scored surprisingly low in social integration, highlighting critical gaps in current nursing home design. This study demonstrates the value of applying interdisciplinary, tool-based evaluations in identifying design strategies that foster resilient and inclusive LTC environments, and the proposed framework may serve as a decision-making aid for architects, planners, and policymakers. This research highlights the importance of reintroducing human-oriented design principles to support socially sustainable nursing home environments.

1. Introduction

In today’s ageing society, the quality of living environments for older adults is recognised as a critical component of social sustainability. As the process of ageing is understood to be intrinsically linked to the spatial characteristics of a person’s living environment, this environment is not merely a passive backdrop for social life, but rather an active agent that shapes the experiences, identity, and well-being of older individuals [1], rather than merely a passive backdrop to social life. A substantial body of research, including several influential older studies, supports the notion that the design of living environments significantly influences the well-being of residents [2,3,4]. These findings have led to a greater focus in design research on two distinct perspectives: the micro-perspective, encompassing factors such as lighting, orientation, privacy, and access to gardens, and the macro-perspective, considering the broader context of the building, including its spatial placement and connectivity [4,5,6,7,8].

Given the proven impact of spatial design, it is essential to recognise the diversity of residential concepts available to older adults. These environments vary across a range of dimensions, including the level of care, architectural configuration, spatial scale, and degree of institutionalisation. Among the existing concepts, nursing homes represent the most institutionalised form of living environments for older adults in Europe. These facilities encompass a broad spectrum of architectural and operational models, ranging from traditional, hospital-like settings to human-centred environments with a home-like design and greater integration with outdoor open spaces [9]. Considering the substantial quantity of existing nursing home buildings, with a mere 104 such facilities in Slovenia [10], it is evident that these edifices are conceptualised based on disparate models. Consequently, a considerable degree of heterogeneity is observed in their design complexity, thereby giving rise to variations in the quality of the residential environment. In response, it is crucial that architects establish fundamental criteria to analyse, assess, and identify potential improvements to these housing environments. Despite the growing recognition of the role of architecture in shaping the quality of living environments for older adults, there remains a lack of comprehensive, interdisciplinary tools to evaluate their spatial quality. Barnes [7] identified a shortage of adequate and objective instruments for the assessment of design outcomes in residential environments, particularly from the standpoint of everyday life and psychosocial well-being. The prevailing evaluation methodologies tend to prioritise medical or operational efficiency, thereby overlooking the influence of spatial parameters on the autonomy, identity, orientation, social climate, and social integration of residents. Likewise, the research in [11] revealed that the prevailing quality assessment systems for nursing homes predominantly emphasise indicators related to healthcare provision and service quality, while architectural and spatial design elements remain under-explored. Also, an extensive literature review conducted as part of the study by [12] confirmed the lack of comprehensive tools for evaluating the quality of living environments for older adults from an architectural design perspective. Only a small number of the nursing home evaluation tools incorporate a general assessment of architectural design quality [13,14,15].

The study by [12] also emphasises the consideration of the quality architectural design of nursing homes, a matter that has been specifically highlighted by the outbreak of the COVID-19 pandemic. The authors prove that architectural design represents one of the key factors in ensuring safety from infections, as it influences the possibilities of isolation, proper ventilation, and the organisation of the movement of residents and staff. The study also shows that there is an even more pronounced lack of assessment tools that have been adapted to reflect the challenges posed by the spatial and social vulnerabilities of institutional living environments exposed by the pandemic. These discrepancies serve to emphasise the necessity for the development of more comprehensive assessment methodologies that incorporate social and architectural dimensions.

To develop an appropriate tool for assessing the quality of residential environments for older adults, the concept of quality in architectural design must first be identified and defined. Exploring what constitutes quality, how it can be defined, and the elements of quality derived from best practice examples is essential. Historically, Scandinavian countries have been recognised for their high-quality standards in the design of residential environments. For Scandinavians, quality in residential environments is defined by a close relationship with nature, which is reflected in design through the following characteristics: abundant natural light, access to outdoor spaces, and integration with the natural surroundings. Sweden, in particular, achieved one of the highest housing standards globally during the first half of the 20th century [16]. Influenced by modernist principles, Scandinavian nations pioneered methods to elevate general housing quality. These approaches extended beyond the design of individual dwellings, encompassing the urban planning of residential environments as an integrated whole [17]. In Europe and globally, Scandinavian countries have served as a significant role model for a more humanistic approach to housing development, characterised by well-established housing policies and the creation of beautiful yet simple designs for everyday environments.

The influence of Scandinavian, particularly Swedish, architectural practices has been a seminal aspect in the development of post-war Slovenian architecture, particularly regarding the design of living environments for the elderly. A fundamental study in this field was published in [18], which was based on extensive research. This pioneering work laid the foundation for the subsequent development of residential environments tailored to the needs of older adults, thereby establishing core design principles that addressed functionality, accessibility, and psychosocial well-being.

In this context, Scandinavian examples continue to provide not only a reference for architectural excellence but also conceptual grounding for defining quality in residential care environments. Their focus on human-centred design, integration with nature, and adaptability to everyday needs provides an important basis for developing contemporary solutions to current challenges in elderly housing. These principles are particularly relevant when addressing the limitations of existing assessment systems in institutional care contexts. By examining Scandinavian examples, we can not only understand the principles of architectural excellence but also develop a conceptual framework for defining quality in residential care environments. The emphasis placed on human-centred design, integration with nature, and adaptability to everyday needs provides a significant foundation for the development of contemporary tools that respond to current challenges in older adult housing.

These principles are particularly relevant when addressing the limitations of existing assessment systems in contexts of most institutionalised residential environments for older adults, such as nursing homes. Building upon contemporary Scandinavian planning principles, the research in [19] presents the development of an innovative deductive methodology, Residential Environment Liveability (REL), that establishes a set of criteria and parameters for designing liveable residential environments and ensuring healthy, pleasant, and attractive environments. This methodology is presented in more detail in the paper by [16]. The overall framework is based on various aspects of liveability, including key fields and criteria, as well as parameters. The current paper deals only with the sociological aspect entitled Well-being and Integration (WI), published for the first time in its complete form, with each criterion clearly defined by various parameters. The WI assessment translates the methodology developed in [19] by Skalicky (2017) into a practical framework for assessing the social sustainability of nursing home living environments. The WI tool focuses on key spatial and sociological parameters that support the social interaction, personal autonomy, and psychological well-being of older residents in institutional care.

Furthermore, to address the identified gaps in existing assessment tools for the architectural quality of residential environments for older adults, particularly in relation to infection control and emergency preparedness exposed by the pandemic, the study in [12] shows the development of the Safe and Connected assessment tool (SC). The purpose of this tool is to evaluate the spatial, health, and social resilience of nursing home facilities during periods of crisis. It focuses on architectural design features that support infection prevention, spatial adaptability, and the preservation of social contact in emergency situations, such as a respiratory virus epidemic.

With the intention to upgrade the existing assessment practices, the present paper employs both tools, the WI on the urban design scale and the SC on the building design scale, as an integrated framework for a comparative analysis of living environments for older adults. The case studies observed are three Slovenian nursing homes, two of which were designed in the 1960s and late 1970s under the influence of Scandinavian architectural principles, and one of which was recently completed in the post-pandemic era.

This study is mainly framed within the broader Scandinavian tradition, particularly the Swedish approach to residential design for older adults, which has historically influenced post-war Slovenian architecture. These human-centred principles, emphasising functionality, integration with nature, and social inclusiveness, serve as a conceptual benchmark for this analysis. By comparing nursing homes from different periods, the study evaluates whether and how contemporary Slovenian facilities align with or diverge from these established design values.

Against this background, the aim of this study is twofold. First, it examines how Slovenian nursing homes from different historical periods address the challenges of social sustainability and spatial resilience. Second, it demonstrates how the complementary tools Safe and Connected (SC) and Well-being and Integration (WI) can provide a more holistic, interdisciplinary assessment framework than existing healthcare-focused methodologies. By incorporating architectural and socio-spatial parameters, the proposed approach addresses important gaps in current evaluation practices, supporting the planning, renovation, and policy development of inclusive long-term care environments. By applying both tools to case studies, this research introduces evaluation criteria that more accurately capture the architectural quality and social integration capacity of these environments.

Recognising that a comprehensive assessment of quality in institutional living environments requires the consideration of both long-term social well-being and short-term spatial resilience in times of health crisis, this paper advances current methodological approaches by proposing an integrated evaluative framework as a novel methodological approach to address these considerations.

2. Historical Context of the Living Environment for Older Adults

In numerous countries, life expectancy at age 60 has increased by a minimum of one-third since the mid-twentieth century. However, the experiences of later life vary considerably between individuals, largely depending on geographical location and the circumstances experienced during early life. While a considerable proportion of the population now enjoys better health and a higher standard of living than was previously the case, it is estimated that millions still face poor age. In accordance with a United Nations (UN) report, Sweden has been ranked in first position with regard to the treatment of older adults. This report represents the first of its kind to be conducted on a global scale and addresses Sweden as the best place in the world to be old [20]. Sweden has the highest percentage of GDP spent on its older adults of all OECD countries. Over the past 100 years, it has developed a statutory system of elderly care for all [21].

Already in the early 1950s, the development of municipal home care services marked a significant milestone in the establishment of the Swedish welfare state. These services enabled frail older adult individuals to remain in their homes without becoming reliant on their children. In Sweden, the post-World War II political discourse emphasised that only public funding and provision could ensure equitable services for all social groups based on need, rather than purchasing power. It was argued that formal eligibility alone was insufficient; services had to be accessible, affordable, and appealing in order to gain and maintain the support of the middle class. It was further stressed that when the same services are available to all social groups, the overall quality of care improves for everyone [22].

The construction of new nursing homes began slowly. Nursing homes should therefore cease to be homes for the poor and be open to all older adults in need of care, regardless of their private finances [23].

2.1. Architectural Competitions

In Sweden, local authorities are the main providers of primary healthcare, care for older adults, education, infrastructure and adequate housing. Over the past century, several architectural competitions have been organised with a focus on space for dependent and frail older adults. Architectural planning has been integrated into social care reforms for older adults. Architectural competitions in this field are more than just a list of functional and spatial requirements that architects have to consider. Instead, these statements are of a socio-political nature, delineating spatial frameworks within an ideological perspective on the provision of care for dependent and frail older adults within the welfare regime, with the objective of ensuring ethical care practices [24]. The competition, which was first held in 1907, was still based on the starting point of Architecture as an instrument for reforming poor relief aid. In this paper, in more detail, the second competition from 1948 is presented, entitled: The Royal Board of Social Welfare competition concerning the new old people’s homes.

The Social Allowance Committee, a parliamentary commission, recommended the separation of nursing homes from municipal assistance for the impoverished, given that the reform of the public pension system in 1947 had resulted in the provision of a modest but regular monthly income to the majority of older adult individuals. The objective was to construct buildings comprising predominantly single rooms for older adults who were experiencing typical ageing processes and who would have a comfortable home without the characteristics of an institution. This approach diverged from the establishment of institutions for the impoverished, which often accommodated a diverse clientele of healthy and sick older adults. The Committee on Social Benefits has proposed a vision for the future of long-term care in the Netherlands, which would see residents of new nursing homes receiving day care for frailty, with other older adults with long-term health problems, whether functional or cognitive, admitted to special clinics in large hospitals. The Committee on Social Benefits also recognised nursing homes as a viable alternative form of older adult accommodation, which could be integrated into the existing framework of ordinary housing. The primary concern pertained to the optimal number of residents for the proposed nursing home. Consequently, the design challenge entailed the formulation of two distinct plans: either a facility accommodating 30 residents or a more expansive structure designed to house 80 residents. The programme incorporated two innovative requirements that suggested a more refined understanding of the prospective user: floor plans accompanied by symbols for furniture and a minimum of one three-dimensional interior or exterior view. The architect drew parallels between the “new nursing home” and contemporary apartment buildings.

Furthermore, five proposals for a smaller home and two proposals for a larger home were procured. Nevertheless, the jury identified several features that would influence the architecture of the new nursing homes: The layout of the building consists of a series of single rooms, organised around a shared central area. This area incorporates a kitchen and a living room, which are accessible via a neutral passageway from the individual resident rooms. The composition of residents in the building is mixed, with both male and female residents present. The square shape of the resident rooms is designed to promote a comfortable atmosphere and to allow for the adaptation of the space to meet the individual needs of each resident. It is important to avoid overly lengthy corridors, as these have been shown to foster an institutional feel. The proposals in the category of apartments for 80 residents were small-scale in their architectural design, and the jury was cautioned that this would be “a bit too large for a senior citizens’ home”. The integration of a nursing home into the existing residential built environment was also considered, although the jury acknowledged that this option was not foreseen in the competition programme [24].

2.2. Transfer of Knowledge from Sweden to Slovenia

Slovenian architects who had gained experience in Scandinavia emphasised the importance of interdisciplinary cooperation between architects, sociologists, engineers, doctors, educators, traffic experts, etc., when designing living environments. They emphasised quality design criteria, such as the diversity of building typologies and the successful integration of buildings into the natural landscape. They considered the design of public spaces and green areas to be focal points of neighbourhoods, paying particular attention to individual and community needs [25,26]. The architects France and Marta Ivanšek were among the key representatives who worked in Scandinavia and transferred their experience to Slovenia.

The Ivanšeks are often mentioned in Slovenian architectural history as “ambassadors” of Swedish culture, who brought several key models from Scandinavia to the Slovenian space for the advancement of housing standards. Strengthened by their Swedish experiences, they implemented several key developments that were progressive and unique for the Slovenian space at that time [27]. The Swedes’ efforts for a high-living culture made a great impression on them. The frugal attitude towards space, restrained design, and social ideas typical of Scandinavia became the guiding motives of their work. After returning to their homeland in 1959, the Ivanšeks founded the Department for Housing Research at the Urban Planning Institute of the Slovenian Republic, following Swedish models, where they conducted their first research. The Ivanšeks were convinced that quality housing is one of the basic needs of every person, including older adults. The transition to designing a better living environment for older adults was, therefore, an understandable step in their professional path. With previous research, they initially designed equipment adapted to older adults (Tabor nursing home in Ljubljana, 1965) and then planned residential buildings (Kolezija nursing home in Ljubljana, 1979–1982). They received the greatest recognition for their work in 1986, with the international Ikea Foundation Award, one of the most important architectural awards at the time [28].

Architect Ivanšek and his wife encouraged several key developments that were progressive and unique for the Slovenian space. They dealt with housing in a comprehensive way, from research, urban and architectural planning, and interior design to housing education. The goal of their work was to improve the living environment of all people, creating beautiful and comfortable homes for everyone.

In the manual Buildings and equipment for the older adults, published in 1971 [18], architect France Ivanšek outlines the basic principles that residential designers should follow for older adults, who have their own specific requirements alongside those of other people.

With rising living standards, the average life expectancy was increasing year on year in all countries. More and more people were living to a greater age. This fact also highlighted the need for a nationwide study and solution to issues related to ageing and the care of older adults in Slovenia. One of the fundamental issues concerning the care of older adults is the question of their care setting. This encompasses not only the organisation and economics of constructing housing and other buildings for older adults but also the design and planning of these buildings. The latter seeks answers to questions such as where and how to build for older adults. In 1963, the Republican Secretariat for Health and Social Welfare and the Boris Kidrič Fund in Ljubljana jointly financed a study entitled The equipment of housing for the older adults, carried out by the Housing and Furnishing Studio in Ljubljana until the end of 1964. In 1965, the stakeholders, together with the Republican Secretariat for Urban Planning, financed the survey entitled Buildings for older adults. For both studies, architect Ivanšek relied on Swedish and English studies. Finally, in 1971, both studies were published as a manual by Ivanšek [18] on the designing and furnishing of housing for older adults. The manual included a review of the foreign and domestic literature on the topic and a comparison of some of the data. In addition to his research work, Ivanšek was also a member of a special commission of the City of Ljubljana for the construction of nursing homes. In 1969, the Republican Secretariat for Health and Social Welfare asked him to draw up a proposal for norms for the construction and equipping of nursing homes. However, he did not accept the task, as he felt that it was first necessary to clarify the social basis for drawing up the norms, as there was no unanimity on the basic question of what a nursing home was. The norms for the construction and equipment of buildings for older adults were then published in 1972 by Marija Vovk, within the framework of the Urban Planning Institute of the Socialist Republic of Slovenia [29].

In the first section of the manual, Buildings and equipment for the older adults, he introduces apartments for older adults. As individuals, older adults need different types of housing and independent household management, such as ground-floor single-family houses with direct access to the garden, an apartment within multi-apartment buildings (25% of apartments for older adults in Sweden are of this type), and residential buildings for older adults with small rental apartments exclusively for pensioners (2–6 apartments). Such buildings may also have common areas for socialising, etc.

The second part of the manual presents nursing homes, which, unlike apartments for older adults, do not allow residents to care for their own households. Despite their collective nature, the design aims to create a real residential environment where each resident feels “at home”. It is essential that nursing homes do not take on a residential, institutional, or hospital character. One of the first things to be emphasised is the location of the home, which should be close to shops, a library, a cinema, and restaurants. Living in an active environment is paramount, as it strongly encourages physical and mental activity, which is essential for well-being. He also highlights the negative psychological consequences of living in a peripheral and isolated location, however idyllic it may seem (e.g., next to a forest). These consequences are associated with feelings of isolation and inequality. He concludes that a living environment consisting of more small- and medium-sized homes spread out is a better solution for people than fewer large homes—one that is on a scale people are used to. One chapter in the manual summaries the principles for creating a living environment for older adults, such as adapting the architecture of a nursing home to the existing environment (the architectural and urban character of the surroundings, such as scale, choice of materials, overall design, detailing, and subdivision of the building into units closer to the scale of residential buildings); a welcoming entrance (the importance of first contact); an entrance hall (should be small); an intimate entrance (linked to a furnished common living or dining room); small housing department units and short and well-lit corridors (preferably with windows); varying the width of the corridor; positioning the lounge at the end of the corridor; not including doors to alcoves; first-choice materials; and visual and physical contact with green spaces outside the buildings. The small size and self-sufficiency of each housing unit, with its own entrance, tea kitchen, and living room, and, above all, the careful choice of materials, will further contribute to the impression of homeliness. In this context, it recommends single rooms that allow privacy, a large number of windows that serve as a link to the outdoor space, the positioning of beds facing the front door, and, above all, the inclusion of spaces that encourage socialising. Each room should have an individual balcony, as this extends the living space of the occupants, but it should be completely protected from the wind. If a balcony or veranda is provided in the common living room of the housing unit, it is not necessary to have one in each room. The balcony should be 130–140 cm deep to accommodate a sun lounger, and the balustrade should be designed to allow a view even when seated.

Architect Ivanšek is also extremely caring towards nursing homes’ sick residents. He believes that their rooms should be oriented to the south or south-east to maximise light and should have a balcony to allow the bed to be transported to it. Common areas for socialising, reading, and exercise should be easily and quickly accessible from all rooms. It also concludes that nursing homes should be designed from the inside out. In the final chapters, the manual focuses on the technical problems of nursing homes and the furnishing of the living environment for older adults. Lastly, it is concluded in the manual that the design of the living environment for older adults should be addressed through interdisciplinary teamwork, i.e., with architects, doctors, social workers, and other professionals [18].

2.3. Continuity and Contemporary Approach

The global ageing population is a pressing concern that demands innovative and sustainable solutions for elderly care. For almost a century, the development and refinement of positive practices in the planning and comprehensive design of quality residential environments for older adults has been a continuous process in contemporary Swedish practice. Even today, Sweden is actively seeking new and contemporary solutions for creating high-quality living environments for older adults. A variety of living environments for older adults are in place, ranging from models that emphasise independent living in the home as long as possible to those that focus on shared experiences with social innovation perspectives.

Notably, a radical Swedish housing experiment in Helsingborg (Sällbo, 2019) adopts a novel approach to address loneliness. This initiative involves the integration of residents of different ages and backgrounds, with a focus on fostering a sense of community and safety [30]. Sweden’s approach to long-term care is characterised by a combination of home care services and specialised retirement facilities. The country currently has approximately 85,000 available beds in nursing homes, reflecting a commitment to meet the needs of its ageing population. Approximately 80% of these homes are publicly funded, ensuring accessibility, while the private sector accounts for the remaining 20%. Sweden is also at the forefront of incorporating digital tools and remote monitoring to enhance elderly care services. The close collaboration between municipal services and healthcare professionals ensures high-quality care for the ageing population [31]. Creating housing for older adults is an undertaking that encompasses far more than simply the design of the physical structure. The issue necessitates an approach that is holistic in nature, entailing interdisciplinary collaboration, knowledge, empathy, and understanding. It is imperative to conceptualise the implications of inhabiting a diminishing environment, characterised by a significant proportion of one’s time being spent within the confines of one’s residence and its immediate environs. The fundamental purpose of the environment is to address the core needs for maintaining autonomy and good health. These needs are comprised of three key elements: physical activity, social connections, and community participation. The location of a property is of pivotal significance. Proximity to public transport, accessible mobility solutions, nearby services, green spaces, and favourable topography are pivotal factors in the creation of housing that remains attractive and functional over time [32].

In order to provide insight into the aforementioned principles of the quality design of nursing homes, this paper presents a Swedish case study, the Gardens, as an example of good practice. The design of the nursing home is based on a recent study showing that the well-being of older adults is strongly correlated with attractive green outdoor spaces and social interaction [33]. The courtyards feature different landscape arrangements of trees, water features, and vegetation, creating an intimate and subtle atmosphere. The building’s unique shape in an ordinary, everyday context makes its architectural design a symbol of a lively, safe living environment for older adults [34]. The Gardens nursing home has been designed to achieve LEED Gold certification. The nursing home has also received the following awards: Winner of the Sveriges Arkitekter Housing Prize (2017) and Nominee for the Kasper Salin Prize (2017).

The green inner courtyard and the variety of common spaces within the building encourage social interaction among older adults (Figure 1). Large windows provide residents with a view of the courtyard gardens, which increases their sense of security. The outdoor areas differ significantly in design, access, and use. In addition, the small residential units, each housing eight residents in single rooms with spacious bathrooms and their own kitchenettes, offer a high degree of privacy. The Gardens nursing home has an open kitchen where residents can gather and dine together at a large table, creating a home-like environment and sense of belonging [9].

Unlike Sweden, Slovenia has a very poorly developed range of housing options for older adults. The only concept of the living environment is institutionalised settings in the form of nursing homes, which are the most expensive of all types of housing, and to a lesser extent, secured and rental apartments adapted for older adults. There are hardly any other special forms of housing for the elderly in Slovenia. The living conditions for older adults in Slovenia are not suitable for ageing in many respects. There are various obstacles that prevent older adults from living well or pose a serious risk to their future living conditions. In the event of an inability to live independently in their own home, the most widely accepted option among older adults is still to move to a nursing home. At the same time, the study revealed that other, more sustainable forms of housing and care for the elderly in Slovenia would also be acceptable. The problem of population ageing is so pressing that it has become an important political issue, as the state is faced with increasing financial needs to provide adequate housing and services for the elderly [35]. The number of vacant places in nursing homes is lacking, and the quality of the living environment is often poor. Many individuals need help, but unfortunately, the cost of care often exceeds their financial means. A major problem for nursing homes is staffing shortages, as they are chronically understaffed. Some homes are therefore no longer accepting new residents. The homes are repeating the calls for applications, and there is less and less interest in caring for the elderly, or even none at all. There are 14,457 people waiting at the entrance to the homes [36].

The most important milestones in the housing sector in Slovenia after World War II were the result of structural changes in politics and the economy [37]. Housing construction changed according to the socio-economic circumstances during the period of Yugoslavia, with the formation of a new socialist society, and changed significantly in the post-independence period. The development of the socio-economic system between 1945 and 1990, which developed or was supplemented over the decades, significantly influenced the different organisation, characteristics, and quality of housing construction. Housing construction developed in four distinct periods during the socialist social order. During the period of “housing funds”, housing construction was given a distinct opportunity for development, but it still remained in the hands of architects who were inspired by residential architecture mainly from the Scandinavian region [38]. During the period of intensive urbanisation and the associated housing construction after World War II, Slovenian magazines in the 1950s and 1960s presented Scandinavian architecture, design, and lifestyle as a high-quality and transferable model for Slovenia [29].

Slovenia’s independence in the early 1990s and political and economic changes with the transition to capitalism and a market economy represent a new era that has changed the role of the state in the housing sector and the characteristics of housing construction. Newer housing that was created in the period after the formation of the new state in the early 1990s, during the time of political and economic changes and the transition to a market economy, is characterised by being distinctly monofunctional, with no or modest public infrastructure. Open spaces or green areas between buildings in newer residential settlements are severely neglected, or in a reduced state, and in a limited program [39]. The practically complete absence of public housing construction and the dominance of the otherwise legitimate interest of private investors in profit is reflected in the lack of space, the increase in the density of buildings, and the number of apartments. This prevents the appropriate design of green areas and the placement of green and common areas, which would make a key contribution to improving the quality of the residential environment [40].

Swedish architecture and urbanism were the most familiar to our architects in the 1950s [41]. At that time, Sweden was an example for Slovenia, both in its understanding and solving of social issues, and in the central role played by housing construction [42]. By retransferring contemporary Swedish approaches to planning quality residential environments to Slovenia nowadays, we could revive and upgrade the previously established good practice of planning and building residential environments for older adults.

3. Materials and Methods

This section presents the methodological framework applied in this study. This study pursues two primary objectives. The first is to apply an integrated evaluation framework combining two assessment tools used to evaluate the quality of living environments of nursing homes. The second objective is to examine key architectural concepts of nursing homes developed in different historical periods, each reflecting a distinct approach to human-centred design.

3.1. Description of Assessment Tools

The present study proposes the implementation of two assessment tools, i.e., Well-being and Integration and Safe and Connected, with the objective of facilitating a comprehensive evaluation that encompasses both long-term social sustainability and short-term spatial resilience.

The Well-being and Integration tool is derived from the sociological component of the broader REL methodology, which was developed in a Ph.D. thesis titled Contemporary Scandinavian Urban Planning Principles and Criteria for High-Quality Living in Residential Environments by Skalicky Klemenčič [19], which was further refined in [16]. Based on the original deductive methodology, a system of criteria and parameters was developed to assess the liveability of residential environments, drawing upon the experience of Scandinavia as a historically sophisticated housing culture. The original methodology establishes a comprehensive framework for the design of liveable residential environments, incorporating environmental, functional, sociological, and cultural aspects.

When developing this system, not only was the Scandinavian experience considered, but also the implementation of quality Scandinavian practice in Slovenia during the 1950s and 1970s, which ensured the transferability and general validity of the results. During the post-war housing development period, Slovenia successfully implemented the Scandinavian model within socialist Yugoslavia, constructing numerous high-quality residential environments based on Scandinavian principles. This influence is evident in articles and manuals by Slovenian architects active at the time, such as F. Ivanšek, E. Ravnikar, and L. Humek [18,25,26,27]. However, this connection was subsequently lost, resulting in a decline in the quality of living environments, as explained in Section 2.3. In contrast, in Sweden, development is continuously evolving in quality. Therefore, a system of criteria was developed based on contemporary practice.

This research focuses on studying the elements of the built environment that create a stimulating and environmentally sensitive residential environment. The overall framework is based on various aspects of liveability, including key fields and criteria, as well as parameters. The methodology consists of five phases: In Phase 1, the key aspects of the REL were defined by analysing the different models and frameworks used to evaluate sustainable and high-quality urban and housing environments. In Phase 2, twelve specific fields were identified based on a detailed comparative analysis of sources and the literature discussing the development of quality residential environments in Scandinavia and emphasising diverse fields of residential environment design. During Phase 3, a detailed case study of contemporary best-practice residential environments in Scandinavian cities (Hamarby Sjostadt in Stockholm and Pilestredet Park in Oslo) was analysed, and specific, measurable parameters, as well as spatial solutions, were defined. Phase 4 identified the set of criteria for designing and assessing REL. These criteria were defined in detail based on research conducted by numerous experts in various disciplines, ranging from urbanism to environmental psychology [43,44,45,46,47]. These experts have studied urban design and the interactions between the physical form of residential environments and their users. This was followed by the application of the criteria, driving the implementation of individual criteria and the selection of parameters. Each criterion was illustrated with a Scandinavian example of a residential environment, and reference values were presented graphically or as measurable data for the selected case study, alongside the author’s comments. During Phase 5, the REL method was verified using a case study. To verify the functioning of the criteria system and its general validity, an example from outside Scandinavia was selected. The REL criteria were verified using two case studies investigating residential environments in Slovenia during different periods: one dating back to the 1950s, when Swedish architecture and urbanism were close to Slovenian architects (the first example of using a motive from a Swedish living environment design is the residential environment running along Gosposvetska Street in Maribor, Slovenia) [41], and a contemporary one.

The WI tool, presented in the current paper for the first time in its complete form (

Table 1. The main quality assessment fields of the Well-being and Integration assessment tool [19].

Assessment Fields	Explanation
F1: Sense of belonging	The residents’ sense of belonging is one of the essential elements of a humane environment and contributes to the sustainable use of space. It is generally acknowledged that humans instinctively want to define the boundaries of their personal and communal territory. Boundaries within the residential environment need to be defined so that residents can develop their individuality in arranging “their” territory and so that residents, the social community, and the public have a clear idea of what belongs to whom and who takes care of what. Among other things, this contributes to reducing vandalism in the residential environment [48].
F2: Sense of safety	Safety is one of the essential necessities of life. People will accept an environment as their own when it provides them with a sense of safety in their living environment, traffic safety, and security from crime. Physical strategies in spatial design can effectively increase the sense of safety, although they do not in themselves guarantee safety, as explained by [49].
F3: Sense of enjoyment and comfort	It is necessary to create quality spaces between buildings. The spaces between buildings play an important role, as they are not limited only to the amount of open space and usability, but also to the attractiveness and comfort for the user.

and Table 5), translates only the sociological aspect of the REL framework into a practical assessment instrument. It focuses on key spatial and sociological parameters that enhance the quality of institutional living environments for older adults. Specifically, it evaluates how the built environment supports social interaction, personal autonomy, and psychological well-being.

Each field F1–F3 (Table 1) within the WI framework is operationalised through 14 criteria, and each criterion with parameters, allowing for structured and consistent assessments of nursing home environments in terms of their social inclusivity and integrative spatial qualities (Table 5). The total maximum score is 24 points.

The Safe and Connected assessment tool is an original methodology developed by the authors, which was comprehensively introduced in [12], in response to critical shortcomings in existing assessment methodologies, particularly those revealed by the COVID-19 pandemic. The development of the SC tool was informed by a comprehensive review of the extant scientific literature. While the concept is grounded in international research, it was empirically tested and validated through Slovenian case studies. The tool is designed to evaluate the spatial, health, and social resilience of nursing home environments during periods of crisis, such as respiratory virus outbreaks. Focusing on the building design scale, the SC tool assesses architectural features that enable effective infection prevention and control, spatial adaptability in emergency scenarios and maintenance of social contact under restrictive conditions. The SC framework is structured into five fields, F1–F5 (

Table 2. The main quality assessment fields of the Safe and Connected assessment tool [12].

Assessment Fields	Explanation
F1: Bubble concept	The concept of social bubbles, defined as small groups of individuals with limited outside contact, has been demonstrated to be an effective strategy for reducing the spread of infectious diseases, such as COVID-19 [50]. Within the context of nursing homes, this approach aligns with the fourth- and fifth-generation European models, which advocate for small household-like units of up to 12 residents with private rooms and bathrooms.
F2: Outdoor space	Access to outdoor space, including balconies, terraces, and green areas, has been demonstrated to enhance the physical and mental well-being of residents, whilst also facilitating safer social interaction during health crises [51]. Visual and physical connections to nature have been demonstrated to support psychological health [52]. The recommended minimum area of green space per resident within 800 m of living environments is 10 m2 [53].
F3: Distancing space	During the COVID-19 pandemic, nursing homes with flexible spatial layouts adapted rooms into red and grey zones to isolate infected residents and control infection spread. The zoning strategy (red/yellow/green) proved effective in reducing the spread of infection [54]. Additionally, visitor rooms divided by transparent barriers allowed safe social contact and helped mitigate the effects of isolation during lockdown periods.
F4: Ventilation	Numerous studies in medicine and epidemiology have confirmed that SARS-CoV-2 spreads via droplets, aerosols, direct contact, and contaminated surfaces. The potential for airborne transmission highlights the essential role of ventilation in reducing indoor viral load [55,56]. The WHO issued specific guidelines to support effective ventilation during the COVID-19 pandemic [57].
F5: Architectural protective measures	Architectural–organisational measures have been shown to play a key role in preventing the introduction and transmission of infections in nursing homes. These include restrictions, such as the implementation of controlled access and visitor tracking systems, a reduction in physical contact using contactless doors and separate entrances, and spatial adaptations for safe socialisation, including the use of flexible or outdoor spaces [51].

), each addressing a specific aspect of resilience in LTC environments. In this context, the term “Safe” refers to spatial and organisational design measures aimed at minimising infection risks and enhancing infection control, while “Connected” encompasses design strategies that foster social inclusion, interaction, and a sense of belonging [12].

These fields are further divided into 20 criteria, each of which is associated with specific parameters (Table 4) that reflect health-protective design strategies, socially supportive design strategies, or both. In general, each criterion is assigned a maximum of one point, with the exception of those within the architectural protective measures field, where measures may be weighted at max. 0.33, or 0.5 point, depending on their significance. This results in a maximum of three points per field. A score of one point indicates full compliance (100%) with the respective criterion. The total maximum score is 15 points, reflecting the highest possible quality of LTC living environments. A more detailed explanation of the scoring system and methodology is provided in [12].

By identifying architectural elements that support both physical safety and relational connectivity in institutional settings, the SC tool provides a robust basis for assessing short-term crisis responsiveness as a core dimension of quality in elderly care environments.

Due to their structured format, parameter-based criteria, and focus on both architectural and sociological dimensions, the SC and WI tools are applicable not only for the post-occupancy evaluation of existing nursing homes but also as practical design instruments. They support the planning and development of both renovation projects and new constructions by identifying spatial and social qualities that enhance the safety, autonomy, and integration of older adults. As such, the tools offer added value for architects, urban planners, and decision-makers aiming to improve the living environments in long-term care facilities through informed and evidence-based design strategies.

3.2. Description of the Case Studies

For the purposes of this study, three Slovenian nursing homes were selected to reflect distinct historical and socio-political contexts. The basic data on the facilities observed are presented in

Table 3. Basic data on the observed LTC living environments.

Case Study	Year	Ownership	Capacity (Inhabitants)
LE_1	1960s	public	321
LE_2	late 1970s	public	192
LE_3	2021	private	150

.

Two of the facilities, designated LE_1 and LE_2, were constructed in the 1960s and late 1970s, respectively, in accordance with post-war modernist architectural principles. The third facility, designated LE_3, was constructed in 2021 during the post-pandemic period.

Table 3 reveals key differences among the analysed case-study facilities.

LE_1 was planned in the early 1960s within the paradigm of post-war modernist architecture, with a focus on the creation of an interior design that prioritised user-friendly environments. The interior furnishings, colours, and lighting were adapted to meet the physical and psychological needs of older users. The facility is located in the city centre and has a capacity for 321 residents.

LE_2 serves as a prime example of modernist design adapted to the needs of older adults. The facility under discussion was constructed in the late 1970s and was designed with a capacity of 192 residents in mind, thus classifying it as an urban facility. This facility was the inaugural Slovenian nursing home to adopt design principles that align with contemporary viewpoints on ageing and quality of life, as outlined in [18].

LE_3 is a privately funded nursing home that opened in 2021. Located in a quiet suburban area, it accommodates up to 150 residents. As a post-pandemic facility, it reflects contemporary standards in elderly care, though with a more compact layout than earlier examples.

3.3. Evaluation Procedure

The evaluation was conducted on three Slovenian nursing homes representing distinct historical periods and architectural approaches: LE_1 (1960s), LE_2 (late 1970s), and LE_3 (2021). These facilities were selected to enable comparison across different design paradigms and socio-political contexts.

The assessment applied two complementary tools, Safe and Connected and Well-being and Integration, to evaluate the spatial resilience and social sustainability of each environment. The evaluation followed a structured process:

Data Collection: For each facility, a combination of architectural documentation, on-site observation, and interviews with the nursing home directors was used.

On-site Evaluation: Field visits were conducted to verify architectural features in situ and to assess the spatial qualities and open space design beyond what was visible in drawings and documentation.

Scoring and Analysis: Each case was scored independently using the criteria and parameters defined within the SC and WI tools.

Comparative Review: The results were presented in tables and figures to enable direct comparison across the three case studies, highlighting differences in spatial resilience and social integration.

Contextual Interpretation: The findings were interpreted with regard to each home’s historical background, planning principles, and broader socio-economic conditions.

This combined approach ensured a consistent and context-sensitive evaluation of both architectural and sociological aspects of long-term care environments.

4. Results

The results of the analysis provide a systematic and detailed review of the criteria and parameters for designing a quality living environment for older adults. These criteria were verified using a case study of living environments for older adults in Slovenia constructed during different periods. It is important to emphasise that this paper is based on two integrated tools (SC and WI) for designing comprehensive living environments for older adults.

As demonstrated in

Table 4. Detailed evaluation results of the Safe and Connected assessment tool [12].

Fields	Criteria	Parameter	S *	LE_1	LE_2	LE_3
Bubble concept	Small household units	Twelve residents = 100% matching the criteria	1	0.71	1	0.75
	Single bedrooms with private bathroom	Share of single bedrooms with private bathroom (%)	1	0.4	0.77	0.97
	Common rooms	Each smaller unit has its own common social space (%)	1	1	1	1
Outdoor space	Open space and green areas	Guideline—at least 10 m2/resident nearby (nursing) home (%)	1	1	1	1
	Rooms with balconies	Share of rooms with balconies (%)	1	0.9	0.53	0
	Common rooms with balconies/terraces or/and visual contact with the outdoor environment	- Each common room (of each unit) has its own balcony or terrace (1 s) - Visual contact with outdoor spaces (0.5 s)?	1	0.5	1	1
Distancing space	“Grey zone”	- Flexible room (1 s). - Outdoor unit (0.75 s). - Common rooms (0.5 s). - Rooms of residents (0.25 s).	1	1	1	0.25
	“Safe room” for visitors	- External access for visitors and prevention of airborne transmission of viruses by transparent (soft) curtain barrier (1 s). - External access for visitors and prevention of airborne transmission of viruses by transparent wall/window barrier (0.75 s). - Internal access for visitors and prevention of airborne transmission of viruses by transparent wall/window barrier (0.5 s). - Internal access for visitors without prevention of airborne transmission of viruses (0.25 s).	1	0.5	0.75	0.75
	“Red zone”	- Flexible room (1 s). - Outdoor unit (0.75 s). - Common rooms (0.5 s). - Rooms of residents (0.25 s).	1	0.5	1	0.25
Ventilation	Bedrooms	(See the explanation in [12])	1	0.5	0.5	0.75
	Common rooms		1	0.5	0.5	0.75
	Corridors and staircases		1	0.5	0.5	0.75
Architectural protective measures	Quarantine of delivered goods	No (0 s) Partially (0.165 s) Yes (0.33 s)	1	0.33	0.165	0.33
	Staff working in bubble	No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33	0	0.33
	Limited movement of visitors	No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33	0.165	0.165
	Contactless door	For each main entrance, bathroom, and room No (0 s) Partially (0.165 s) Yes (0.33 s)	1	0.165	0.165	0.165
	Use of outdoor areas by healthy residents	No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33	0.33	0.33
	Individual entrance	For each employee, resident, and delivery No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33	0.33	0.33
	Common rooms	Reduction in capacity if used or protocol of use or partition of space No (0 s) Partially (0.25 s) Yes (0.5 s)	1	0.5	0.5	0.5
	“Flexible room”	Is there a flexible room in the NH? No (0 s) Partially (0.25 s) Yes (0.5 s)		0.25	0.5	0.25
Scores total			15	10.575	11.705	10.620
Estimated degree (%)			100	71	78	71

* S = max score.

and Figure 2, a marginal discrepancy is observed in the outcomes of the three assessed case studies. The evaluation scores in percentage are the following: 71% for LE_1, 78% for LE_2, and 71% for LE_3. As can be seen in Table 3, only two criteria, “Single bedrooms with private bathroom” and “Rooms with balconies”, show higher variations between the cases analysed.

As demonstrated in

Table 5. Detailed evaluation results of the Well-being and Integration assessment tool [19].

Fields	Criteria	Parameter	S *	LE_1	LE_2	LE_3
Sense of belonging	Distinction between private and public space; hierarchy of open spaces in a residential environment	Appropriate selection of building types and planning of different types of open space (public, semi-public, semi-private, and private = 100% matching the criteria)	3	0.75	1	1
		Different urban design elements mark the demarcation between different types of spaces (level difference or a change in paving or vegetation/water) No (0 s)/Partially (0.5 s)/Yes (1 s)		1	1	0
		Accesses/entrances to the residential environment and urban design elements that clearly define the entrance to the residential environment (architectural element or change in paving or solitaire tree or urban furniture design) No (0 s)/Partially (0.5 s)/Yes (1 s)		1	1	0
	Design of the residential environment, enabling leisure and strengthening social interactions	Variety of experiences and activities, spatial distribution regarding inclusive content (seating area, picnic area, children’s playground, space for social urban games, and walking areas = 100% matching the criteria)	1	0.5	0.4	0.1
	Maintained residential environment	Proportion of maintained areas No (0 s)/Partially (0.5 s)/Yes (1 s)	1	1	1	1
	Involvement of residents in the residential environment	Number of different local services (local shops, cafés, health care, beauty care, day-care, and public transport = 100% matching the criteria)	2	0.4	0.6	0
		Number of different activities for residents included in the maintenance of public spaces (planting flowers, landscaping green areas, renovation of urban equipment = 100% matching the criteria)		0.33	0.33	0.33
	Awareness, participation, and education of residents—active role of residents in the co-design of the residential environment	Information points, volume of lectures and workshops for residents, volume of formal/informal meetings with residents and working groups as forms of resident involvement and the cooperation–participation rate = 100% matching the criteria	1	0.25	0.25	0.25
	Diversity of living unit typologies	Integration of different social groups into the residential environment: secured apartment, household unit, experimental apartment, and low-density houses = 100% matching the criteria	1	0	0	0.25
Sense of safety	Lively and controlled public space	Presence of people in the space (number of people using the space in certain time segments); mixed use of the space (r = 300 m): commercial, education, kindergarten, and recreation = 100% matching the criteria	3	1	1	0.25
		Dominant share of buildings with glazed surfaces of street facades or facades oriented towards public space No (0 s)/Partially (0.5 s)/Yes (1 s)		1	1	1
		Smaller number of apartments arranged in departments and larger number of entrances to the residential building = 100% matching the criteria		0.5	1	0.5
	Protection of private space and interaction with public space	Orientation of entrances towards the street, distance of residential entrances to buildings from the street (front yard), design of the entrance element with a canopy and benches = 100% matching the criteria	1	1	1	0.25
	Design of residential environment, enabling orientation in space	Various elements of open space design in a residential environment (single tree or avenue or platforms levels or sculptures or urban furniture) No (0 s)/Partially (0.5 s)/Yes (1 s)	1	0.50	1	0
	Lighting of open space in the residential environment	Share of adequately illuminated open spaces: building entrances, paths, staircases, and social areas = 100% matching the criteria	1	0.75	0.5	0.25
	Priority for pedestrian and traffic safety	Motorised roads vs. pedestrianised: streets for pedestrians and motorised traffic roads (0 s)/traffic-calmed areas (0.5 s)/streets for pedestrians and cyclists (1 s)	1	1	1	0
Sense of enjoyment and comfort	Human scale of the residential environment	Share of streets that are attractive for walking: urban furniture, pedestrian pavement, shadow, no blank facades, active ground floor No (0 s)/Partially (0.5 s)/Yes (1 s)	5	0.5	1	0
		Spacing between buildings (max = 100 m, min = 2H) and building height (to four floors) No (0 s)/Partially (0.5 s)/Yes (1 s)		0	1	0.5
		Arrangement and articulation of open space: diverse character and connectivity of open spaces No (0 s)/Partially (0.5 s)/Yes (1 s)		0.5	1	0
		A dense network of paths with numerous shortcuts No (0 s)/Partially (0.5 s)/Yes (1 s)		0.5	1	0
		Insolation of open space No (0 s)/Partially (0.5 s)/Yes (1 s)		0.5	1	0
	Creating quiet areas/ reducing noise level and quality of the air	Placing greenery between motor roads and residential areas Noise level (max = 45 dB) No (0 s)/Partially (0.5 s)/Yes (1 s) and pollution of open space; greenhouse gas emissions (daily limit concentration of PM10: 50 µg/m3, permitted exceedance—35 times in a calendar year, annual limit concentration of PM10: 40 µg/m3) No (0 s)/Partially (0.5 s)/Yes (1 s)	1	0.75	1	1
	Design of the residential environment, enabling contact with natural landscapes and reducing the heat island effect	Share of green and water/built-up open areas more than 65% of the area = 1 s, 65–30% = 0.5 s, less than 30% = 1 s, 65–30% = 0.5 s, less than 30% = 0 s	2	0.5	1	0
		Green and water elements: tall vegetation and trees and water elements (natural and urban design elements) The Green Space Factor [58] No (0 s)/Partially (0.5 s)/Yes (1 s)		1	1	0
Scores total			24	15.23	20.08	6.68
Estimated degree (%)				63	84	28

* S = max score.

and Figure 3, a high discrepancy is observed in the outcomes of the three assessed case studies. The evaluation scores in percentage are the following: 63% for LE_1, 84% for LE_2, and only 28% for LE_3.

Because of the more pronounced deviations in the results between the individual nursing homes considered, we present the data that were evaluated in detail in Table 5 in an analytical presentation by individual areas in Figure 4, Figure 5 and Figure 6.

As can be seen in Figure 4, which presents the individual evaluation fields of the WI assessment tool, the most pronounced differences in the evaluation results occur in the SENSE OF SAFETY and SENSE OF ENJOYMENT AND COMFORT fields. In the SENSE OF SAFETY field, the result differs by almost a factor of three (93% for LE_2 and 32% for LE_3), while in the SENSE OF ENJOYMENT AND COMFORT field, the result differs by as much as a factor of five between the best (100% for LE_2) and worst (19% for LE_3) living environment. Because of the significant variation in quality scores within the SENSE OF ENJOYMENT AND COMFORT domain, we conducted a further analysis of these results, which are presented in Figure 5.

In Figure 5, it is evident that the most pronounced differences in the evaluation results occur in the criteria HUMAN SCALE OF THE RESIDENTIAL ENVIRONMENT and DESIGN OF THE RESIDENTIAL ENVIRONMENT, ENABLING CONTACT WITH NATURAL LANDSCAPES AND REDUCING THE HEAT ISLAND EFFECT. In the HUMAN SCALE OF THE RESIDENTIAL ENVIRONMENT criterion, the results differ drastically (100% for LE_2 and 10% for LE_3), while in the DESIGN OF THE RESIDENTIAL ENVIRONMENT, ENABLING CONTACT WITH NATURAL LANDSCAPES AND REDUCING THE HEAT ISLAND EFFECT, LE_3 shows a result of 0%, failing to satisfy even the most basic criteria. Interestingly, all the case studies achieve a high result for CREATING QUIET AREAS/REDUCING NOISE LEVEL AND QUALITY OF THE AIR. Even the nursing home LE_3 achieves the highest score of 100%, the same as LE_2.

Finally, further details of the results for all individual criteria are expressed as parameters with points (Figure 6).

Figure 6 shows that, for all the parameters, LE_2 is scored by one point, while LE_3 is scored by zero, and LE_1 is scored by 0.5 points, except for the SPACING BETWEEN BUILDINGS AND BUILDING HEIGHT parameter, where LE_1 scores 0 points, and for the NOISE LEVEL AND POLLUTION OF THE OPEN SPACE parameter, where LE_3 scores 1 point and LE_1 scores 0.75 point.

5. Discussion

The results of the detailed analysis of all three nursing homes show obvious deviations between the SC tool and the WI tool. When evaluating nursing homes, only a small difference is noticeable between the homes with the SC tool, which mainly refers to the functional criteria of buildings.

However, when using the WI tool, which is primarily intended for evaluating the placement of nursing homes within urban structures, as well as for carefully and subtly designing open spaces and green areas, significant differences between individual homes become noticeable.

Breaking down each tool more precisely, there has been little design progress between homes built in the late 1960s and those built in the late 1970s within the SC tool. This difference can be attributed to the introduction of new guidelines in the field of home design. Small deviations are also noticeable in the following two criteria: the proportion of single bedrooms with private bathrooms and rooms with balconies. The increase in the number of single rooms with private bathrooms over the decades could be attributed, on the one hand, to the improving economic situation and the new guidelines, but also to the fact that the experience of the impact of the 2019 pandemic on the health and safety of older adults in nursing homes has definitely influenced the preference for single rooms over double rooms. Unfortunately, the opposite trend applies to the placement of balconies in individual rooms. While almost all rooms in a nursing home built 60 years ago had balconies, not a single room in a home built recently does. This can be attributed to the principle of reducing construction costs, but at the expense of residents’ quality of life.

Elaborating on the results of the WI tool, which highlights the importance of the relationship between buildings and open areas, it is evident that there was a rapid positive deviation in the quality of homes built in 1965 and 1979. However, there was then an obvious negative deviation in a nursing home built just a couple of years ago, in 2021. This can certainly be attributed to structural changes in Slovenian politics and the economy: from the socio-economic circumstances of the formation of the new socialist society in the Yugoslav era (1945–1990) to the liberal market society of the post-independence era. The analysis shows that private interests dominate public interests and that quality is subordinated to market laws, as can be seen in the 2021 nursing home case study.

Significant differences are visible in the design of a human-oriented open space, between homes LE_1 and LE_2 and between home LE_3. Figure 7 and Figure 8 show the characteristic features and differences of all three observed living environments in terms of the SENSE OF ENJOYMENT AND COMFORT domain: the human scale of the living environment, as well as the design of the residential environment, enabling contact with natural landscapes (green and water elements).

In LE_1 and LE_2, the open public space design features elements of greenery and water, while in the open public space of LE_3, traffic areas, such as roads and parking spaces, dominate (Figure 7). Because of this, almost the entire entrance area is covered with asphalt, and there are hardly any green areas around the building. The open space is completely unstructured. The entrance is not clearly defined, and there is almost no urban furniture in the public space and not even trees. The design of the semi-private courtyards is similar, where green areas and trees dominate in LE_1 and LE_2, while in LE_3, with the exception of the placement of the drinking fountain, the entire area is designed with asphalted surfaces (Figure 8). The LE_3 semi-private courtyard area is too narrow and claustrophobic, without green areas, without trees, without pedestrian paths, and without any insolation (Figure 8, right). The design of the open space does not inspire a sense of homeliness, belonging, or well-being.

Nevertheless, there is one rare qualitative characteristic of LE_3: the building is located near a forest and among extensive areas of agricultural land and meadows. This allows residents to enjoy quality nature views from their rooms, as only asphalt surfaces for cars dominate the immediate area around the home. Such a placement of the nursing home building also has a positive impact on the design of a quiet area for the older adults and indirectly prevents the open areas from overheating. Based on the municipality’s development plans, this situation will no longer be so idyllic in the future. As shown in Figure 9, agricultural and meadow areas will be restructured into a monotone and dense residential environment with service facilities in 2025 and 2026.

This paper assesses the living environments of older adults in case studies from three different periods in Slovenia. The results of the WI tool clearly demonstrate differences in quality during the period of Swedish influence and afterwards, thus proving the validity of the WI evaluation system. In a manner analogous to the manner in which numerous European countries were inspired by Swedish practices in the aftermath of World War II, it is also possible to adopt principles for the planning of high-quality living environments for older adults from Swedish practices in the present day.

The final review of the integrated SC and WI assessment tool results, depending on the period of construction for all three living environments from Slovenia, is shown in Figure 10 (67% for LE_1, 81% for LE_2, and only 50% for LE_3). For comparison and confirmation of high-quality Swedish practice, an additional evaluation of the Swedish contemporary example of a nursing home, The Gardens, i.e., LE_4, as discussed in Section 2.3 (see

Table A1. Detailed evaluation results of the Safe and Connected assessment tool [12].

Fields	Criteria	Parameter	S *	LE_4
Bubble concept	Small household units	Twelve residents = 100% matching the criteria	1	1
	Single bedrooms with private bathroom	Share of single bedrooms with private bathroom (%)	1	1
	Common rooms	Each smaller unit has its own common social space (%)	1	1
Outdoor space	Open space and green areas	Guideline—at least 10 m2/resident nearby (nursing) home (%)	1	1
	Rooms with balconies	Share of rooms with balconies (%)	1	0.25
	Common rooms with balconies/terraces or/and visual contact with the outdoor environment	- Each common room (of each unit) has its own balcony or terrace (1 s). - Visual contact with outdoor spaces (0.5 s)?	1	1
Distancing space	“Grey zone”	- Flexible room (1 s). - Outdoor unit (0.75 s). Common rooms (0.5 s). - Rooms of residents (0.25 s).	1	1
	“Safe room” for visitors	- External access for visitors and prevention of airborne transmission of viruses by transparent (soft) curtain barrier (1 s). - External access for visitors and prevention of airborne transmission of viruses by transparent wall/window barrier (0.75 s). - Internal access for visitors and prevention of airborne transmission of viruses by transparent wall/window barrier (0.5 s). - Internal access for visitors without prevention of airborne transmission of viruses (0.25 s).	1	0.75
	“Red zone”	- Flexible room (1 s). - Outdoor unit (0.75 s). - Common rooms (0.5 s). - Rooms of residents (0.25 s).	1	1
Ventilation	Bedrooms	(See the explanation in [12])	1	0.75
	Common rooms		1	0.75
	Corridors and staircases		1	0.75
Architectural protective measures	Quarantine of delivered goods	No (0 s) Partially (0.165 s) Yes (0.33 s)	1	0.33
	Staff working in bubble	No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33
	Limited movement of visitors	No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33
	Contactless door	For each main entrance, bathrooms, rooms No (0 s) Partially (0.165 s) Yes (0.33 s)	1	0.165
	Use of outdoor areas by healthy residents	No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33
	Individual entrance	For each employee, resident, and delivery No (0 s) Partially (0.165 s) Yes (0.33 s)		0.33
	Common rooms	Reduction in capacity if used or protocol of use or partition of space No (0 s) Partially (0.25 s) Yes (0.5 s)	1	0.5
	“Flexible room”	Is there a flexible room in the NH? No (0 s) Partially (0.25 s) Yes (0.5 s)		0.5
Scores total			15	13.065
Estimated degree (%)			100	87

* S = max score.

and

Table A2. Detailed evaluation results of the Well-being and Integration assessment tool [19].

Fields	Criteria	Parameter	S *	LE_4
Sense of belonging	Distinction between private and public space; hierarchy of open spaces in a residential environment	Appropriate selection of building types and planning of different types of open spaces (public, semi-public, semi-private, and private = 100% matching the criteria)	3	1
		Different urban design elements mark the demarcation between different types of spaces (level difference or a change in paving or vegetation/water) No (0 s)/Partially (0.5 s)/Yes (1 s)		1
		Accesses/entrances to the residential environment and urban design elements that clearly define the entrance to the residential environment (architectural element or change in paving or solitaire tree or urban furniture design) No (0 s)/Partially (0.5 s)/Yes (1 s)		1
	Design of residential environment, enabling leisure and strengthening social interactions	Variety of experiences and activities; spatial distribution regarding inclusive content (seating area, picnic area, children’s playground, space for social urban games, and walking area = 100% matching the criteria)	1	0.75
	Maintained residential environment	Proportion of maintained areas No (0 s)/Partially (0.5 s)/Yes (1 s)	1	1
	Involvement of residents in the residential environment	Number of different local services (local shops, cafés, health care, beauty care, day-care, and public transport = 100% matching the criteria)	2	1
		Number of different activities for residents included in the maintenance of public spaces (planting flowers, landscaping green areas, renovation of urban equipment = 100% matching the criteria)		1
	Awareness, participation, and education of residents—active role of residents in the co-design of the residential environment	Information points; volume of lectures and workshops for residents; volume of formal/informal meetings with residents and working groups as forms of resident involvement and the cooperation–participation rate = 100% matching the criteria	1	0.5
	Diversity of living unit typologies	Integration of different social groups into the residential environment: secured apartment, household unit, experimental apartment, and low-density houses = 100% matching the criteria	1	0.25
Sense of safety	Lively and controlled public space	Presence of people in the space (number of people using the space in certain time segments); mixed use of the space (r = 300 m) (commercial, education, kindergarten, and recreation = 100% matching the criteria)	3	0.5
		Dominant share of buildings with glazed surfaces of street facades or facades oriented towards public space No (0 s)/Partially (0.5 s)/Yes (1 s)		1
		Smaller number of apartments arranged in departments and larger number of entrances to the residential building = 100% matching the criteria		1
	Protection of private space and interaction with public space	Orientation of entrances towards the street, distance of residential entrances to buildings from the street (front yard), design of the entrance element with a canopy and benches = 100% matching the criteria	1	1
	Design of the residential environment, enabling orientation in space	Various elements of open space design in a residential environment (single tree or avenue or platform levels or sculptures or urban furniture) No (0 s)/Partially (0.5 s)/Yes (1 s)	1	1
	Lighting of open space in the residential environment	Share of adequately illuminated open spaces: building entrances, paths, staircases, and social areas = 100% matching the criteria	1	1
	Priority for pedestrian and traffic safety	Motorised roads vs. pedestrianised: streets for pedestrians and motorised traffic roads (0 s)/traffic-calmed areas (0.5 s)/streets for pedestrians and cyclists (1 s)	1	1
Sense of enjoyment and comfort	Human scale of the residential environment	Share of streets that are attractive for walking: urban furniture, pedestrian pavement, shadow, no blank facades, active ground floor No (0 s)/Partially (0.5 s)/Yes (1 s)	5	1
		Spacing between buildings (max = 100 m, min = 2H) and building height (up to four floors) No (0 s)/Partially (0.5 s)/Yes (1 s)		1
		Arrangement and articulation of open space: diverse character and connectivity of open spaces No (0 s)/Partially (0.5 s)/Yes (1 s)		1
		A dense network of paths with numerous shortcuts No (0 s)/Partially (0.5 s)/Yes (1 s)		1
		Insolation of open space No (0 s)/Partially (0.5 s)/Yes (1 s)		1
	Creating quiet areas/ reducing noise level and quality of the air	Placing greenery between motor roads and residential areas Noise level (max = 45 dB) No (0 s)/Partially (0.5 s)/Yes (1 s) and pollution of open space; greenhouse gas emissions (daily limit concentration of PM10: 50 µg/m3, permitted exceedance—35 times in a calendar year), annual limit concentration of PM10: 40 µg/m3 No (0 s)/Partially (0.5 s)/Yes (1 s)	1	1
	Design of the residential environment, enabling contact with natural landscapes and reducing the heat island effect	Share of green and water/built-up open areas (more than 65% of the area = 1 s, 65–30% = 0.5 s, less than 30% = 0 s)	2	1
		Green and water elements: tall vegetation and trees and water elements (natural and urban design elements) The Green Space Factor No (0 s)/Partially (0.5 s)/Yes (1 s)		1
Scores total			24	22
Estimated degree (%)			100	92

* S = max score.

), with the new integrated tool is also presented in Figure 10 in blue colour (90% for LE_4).

As demonstrated in Figure 10, the Swedish case is assigned the highest rating among the four cases examined, despite the fact that it was not the most recently constructed.

Finally, Figure 11 shows the final review of the integrated SC and WI assessment tools on a coloured five-level scale for all three Slovenian living environments and an additional one from Sweden.

The final evaluation shows that the inclusion of principles for planning quality living environments for older adults in Slovenia increased gradually around 1980, before decreasing again (see Figure 10). While LE_2 is an excellent example of a living environment, LE_3 is average (Figure 11). However, the results should not be misleading; this final evaluation is based on an assessment of two tools. The LE_3 nursing home is evaluated only as 29% for the WI tool, which would otherwise categorise it as a poorly designed living environment for older adults. In contrast, the Swedish case study, LE_4, received the highest combined score, suggesting that the long-standing tradition of human-centred architectural and urban planning in Sweden continues to produce exemplary outcomes in the field of long-term care (Figure 11). The results support earlier findings that well-designed spatial arrangements can simultaneously improve residents’ psychosocial outcomes and reduce caregiver burden [59]. This confirms the relevance of integrating socio-spatial parameters into quality assessments of LTC environments.

6. Conclusions

The current study addresses the need to re-evaluate the architectural and urban design quality of nursing home environments, especially considering an ageing population and the increased awareness that has emerged since the outbreak of the global SARS-CoV-2 pandemic. Meaningful reconsideration of design quality requires a comprehensive evaluation of the current state, effectively achieved through integrated assessment tools consolidating relevant elements, criteria, and parameters of quality in architectural planning. This study’s methodological innovation lies in its combined application of two complementary tools: Safe and Connected, which evaluates crisis-related spatial resilience, and Well-being and Integration, which assesses long-term social sustainability. Together, these tools provide a thorough, interdisciplinary approach to evaluating living environments for older adults, considering physical safety and socio-spatial integration. The WI tool, which was developed primarily for urban design, focuses on spatial and sociological parameters that promote social interaction, autonomy, and psychological well-being. In contrast, the SC tool, applied at the level of building design, addresses architectural features that enhance health-related resilience, spatial adaptability, and social connectivity preservation during emergencies. Integrating both tools enables an analytical framework to be established that allows for a comprehensive comparative evaluation of nursing home environments from multiple design perspectives.

This study applies the integrated tools to three case studies of Slovenian nursing homes representing different historical periods. Through a comparative analysis of these facilities, two designed within the concepts of post-war modernist architecture and one constructed in the contemporary post-pandemic era, this research reveals notable variations in the assessment results, especially in the context of a sociological perspective. The findings suggest that LE_2, a facility from the late 1970s, consistently outperforms LE_3, the most recently built nursing home, across most evaluated parameters. LE_2 achieves superior scores in domains associated with the human scale, integration with the natural environment, and promotion of social interaction. These results highlight the enduring relevance of Scandinavian-inspired, human-centred design principles, which remain a valuable source of guidance for developing supportive and socially sustainable residential care environments. The decline in quality observed in the most recent case study may be attributed, at least in part, to the broader systemic context in Slovenia, where the development of nursing homes has become increasingly market-driven. With private investors assuming a dominant role, the emphasis is frequently placed on economic efficiency rather than on architectural or social quality. As in the wider housing sector, this approach has been shown to marginalise research-based planning, neglecting critical factors such as spatial diversity, green areas, and social infrastructure that are essential for ensuring a high quality of life in residential care settings. However, these factors are not fully mandated by national planning regulations. Consequently, investors frequently perceive them as a mere cost burden, which often results in their omission or inadequate implementation in the final stages of project development due to budget limitations or profit-oriented priorities.

The research presented contributes to the ongoing development of interdisciplinary tools for assessing the social sustainability of institutional living environments for older adults. The dual-tool approach introduced enhances existing evaluation frameworks by integrating short-term spatial resilience with long-term well-being indicators. The framework synthesises the complementary perspectives of the Well-being and Integration and Safe and Connected tools, thereby facilitating a holistic analysis that encompasses the architectural and sociological dimensions of nursing home environments. This enables a more thorough understanding of how architectural and sociological dimensions collectively influence residents’ quality of life. The findings also call into question the assumption that newer facilities inherently ensure higher quality and instead emphasise the enduring value of human-centred design traditions. Consequently, this study provides a pragmatic, evidence-based contribution to the re-evaluation of design strategies in nursing home environments, emphasising the necessity of planning approaches that prioritise care, community, and dignity in conjunction with efficiency. These insights represent a valuable step forward in the ongoing development of interdisciplinary tools for assessing the social sustainability of residential care settings for older adults. In this context, the Swedish case study presented in this paper offers not only a benchmark of good practice but also a valuable lens through which the feasibility of model transfer can be critically assessed. While its success demonstrates the long-term effectiveness of consistent policy, architectural quality, and user-oriented care design, transferring such a model to other national contexts—such as Slovenia—requires careful consideration of legislative, cultural, professional, and spatial conditions. Rather than a direct replication, the Swedish model should be adapted to local realities through incremental innovation, targeted policy updates, and pilot projects that reflect shared principles while respecting contextual differences.