Designing for End-of-Life Care: Architectural Insights for Resilient Housing

This blog distils research insights shared at the Housing LIN Cymru Symposium in Welshpool which explored the theme of “Making Wales a great place to grow old.” At that moment, our work sat at a productive threshold between research recently completed and new research just beginning. Together, these projects are connected by a shared concern with the place of ageing: particularly where the desire is to remain in a familiar home and neighbourhood for as long as possible, and the potential of architectural design to support that ambition.

The first strand of research resulted a book chapter, “Getting in Place: Ethnographic Observations of Homemaking in New-Build Almshousing in Central London,” published in Architectures of Ageing in Place (opens new window). The second had been newly launched as interdisciplinary study, Designing Dying-in-Place (opens new window), which seeks to understand the qualities of place that matter when older people receive end-of-life care. This blog brings together key insights and emerging directions from both.

Getting in place

Our book chapter draws on research undertaken through a series of research residencies at United St Saviour’s Charity (USSC), focused on Appleby Blue almshouse in South London, designed by Witherford Watson Mann Architects. The residencies were intended to explore the process of “getting in place”: how residents adjust to and begin to realise the potential of new housing designed to balance independence and support in later life.

The research took place at an early stage in the building’s life, while snagging works were ongoing, residents were settling into their new homes, and staff were learning to manage a new-build almshouse. We aligned our observations with the HAPPI (2009) recommendations to develop an initial assessment of the design, while recognising that both the building and its community would need time to settle and co-evolve.

It quickly became clear that a model of independent living with support does not establish itself instantly. Newly arrived residents were often reliant on managers for practical help, conversation, reassurance, and orientation because surroundings were still unfamiliar; in time, as routines establish, independence would grow. However carefully design cues are embedded, buildings must be learned: from understanding door locks and security systems to working out how best to manage heating or cooling. In turn, homemaking, as a set of practices undertaken by residents themselves in living independently relies on the degree of agency they can exercise in appropriating space: positioning furniture, adding planters, or leaving personal traces within shared areas. Observing these practices raised questions around control, curation, and custodianship – issues that will shape both the social and physical character of the building over time, and the degree to which is personalised or institutional.

Appleby Blue represents a compelling model for thinking about ageing in place across multiple scales, from the dwelling to the building, the street, and the wider social context. Through this case study we have witnessed individual and collective practices of homemaking that layer onto a housing scheme with a distinct architectural identity, rooted in placemaking and providing new homes to support independent living that can help sustain attachments to place and people.

Placemaking (Wales)

At the symposium, we contrasted findings from Appleby Blue with principles set out in the Placemaking Wales Charter (2020), focusing on the relationship between interior and exterior life – the from being at home to feeling part of the wider city.

The design process for Appleby Blue included innovative approaches to engagement, such as filmed recordings of residents in their previous homes. Equally important was the decision to locate the almshouse on a London high street. This ensures proximity to local services, supports active travel and independence, and makes the almshouse visible as part of everyday urban life. The scheme combines housing with community spaces, bringing activity to the street and offering a strong architectural identity rooted in its context.

The building encourages mobility and active living, both internally and through its location. At the same time, the condition of the surrounding streets – uneven paving and fragmented management – raises questions about access to high-quality public realm that lie beyond the control of designers and commissioners. Within the building, however, shared walkways function as internal streets, furnished with benches and planters, and carefully designed windows offer strong visual connections to landscaping and the outdoors. These spaces depart from conventional models of age-specific landscapes and support everyday encounters, informal homemaking, and psychological connections to the city – especially important for residents who may be less mobile or unwell.

Designing dying-in-place

Building on this work, we have turned our attention to the final stages of the life course. If ageing in place is to succeed, it must also accommodate end-of-life care at home. Our AHRC-funded project, Designing Dying-in-Place, seeks to translate existing understandings of the “place of care” into architectural knowledge and design strategies for housing.

The project aims to review research and cultural attitudes around dying at home; gather experiences from carers and families across diverse cultural contexts in Wales; and develop insights for architects designing homes that better support end-of-life care. Central questions include: What do people want from the place where they die? What environmental barriers make dying at home difficult? And how might architectural design help address them?

Together, these strands of research underline the importance of thinking about housing not just as shelter, but as a setting for care, attachment, and dignity across the later life course – from moving in, to settling, and ultimately, to dying in place.

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Sam is a Reader (Associate Professor) at the Welsh School of Architecture, Cardiff University. He now co-leading the AHRC-funded project Designing Dying-in-Place (opens new window), examining the role of home in end-of-life care. Juliet Davis is a Professor of Architecture and Urbanism and Head of the Welsh School of Architecture, Cardiff University, as well as a registered architect and Chartered Member of Royal Institute of British Architects (RIBA).

Sam was a keynote speaker at the Housing LIN Cymru Symposium, Making Wales a Great Place to Grow Old, on 4 November 2025 at Clwyd Alyn Housing Association’s extra care scheme, Neuadd Maldwyn, in Welshpool. His presentation and further information about the event can be found here.

And for details about Housing LIN Cymru, click here.