January 25, 2011
By Gary Prager, AIA, LEED AP, NCARB, CDT
The most difficult part of moving to a senior healthcare community is making the decision to live there. When designing for the wellness and health of seniors, you need to appeal to not only the seniors, but to their adult children. Adult children may have to drag their parents kicking and screaming just to visit the facility. The question is, “How do you combine the concepts to work for both of them?”
No facility can help you make that decision – they can only make it easier by appealing to the preferred lifestyle rather than the healthcare needs. The draw has to be not only what's in the building, but also what the community has to offer. Generally, one-half of the residents in a facility have been in the community for a long period of time. The remaining residents are “out-of-towners” brought in by adult children to be close to them. They may also be people who have always wanted to live in that type of community. Therefore, how do you appeal to the transplant?
My dad was 85 years old when my mom suddenly died. My siblings and I lived halfway across the country and were concerned about him living alone. He refused to move in with any of us because he still had many of his friends that he and Mom grew up with and felt like he still had his life there.
We began our search throughout the area for a senior living environment that he might consider moving into. Nothing was appealing to him, including communities that his friends lived in, and he was just as content to remain living in his apartment. Because of his independent lifestyle, we left him where he was happiest and visited him often.
Designing for ourselves
Other families might not be as fortunate to have an elderly parent still as active and healthy and able to live alone safely. This made me realize that the design of senior care communities needs to be updated to appeal to this growing faction of people.
The average age today for someone entering these facilities is approximately 84. Statistics say that one million boomers (born between 1946 and 1964) will live past 100 years. This generation is still 20 years from entering these facilities, based on current average entry age.
With the advances in healthcare, it is possible that the entry age could reach 90 in the future. As an architect who designs senior communities, I have the opportunity to design a facility that I would like to live in when the time is right.
Occasionally, when I see one, I think to myself, “Hmmm, this wouldn't be bad in my golden years.” (I really dislike that terminology.) I'm in my mid-50s and still extremely healthy and active and have not found one that appeals to my healthy lifestyle. If I'm feeling disappointed with the choices, how would potential residents feel? When the time comes and I want to retain my independence and lifestyle but no longer want the responsibility of homeownership, I want a facility that appeals to my standard of living.
Keeping active, in multiple ways
Let's talk about social spaces. These are probably one of the most important factors when you are trying to attract residents. The design of the building and the programs need to accommodate various social activities of residents without forcing them to participate. The idea of the residents staying in their rooms as recluses is detrimental to both their mental and physical wellbeing, and also is a strain on staffing. Offering enough activities to keep them involved in the events, or better yet in organizing them, will keep them socially active.
On the facility side, incorporating spaces that cater to specific activities can be expensive and underutilizes the building. Spaces needed to be designed to accommodate multiple activities. Therefore the design should have the capacity for adequate storage, proper infrastructure, and creative layouts. Even food service needs to provide choice of menu and venue. An alternate solution could be providing transportation to locations that allow access to certain activities and services. The issue here is the facility needs to own and maintain a vehicle that accommodates this amenity. The idea is to provide a variety of options with a limited budget.
Access to the outdoors for everyday life, such as dining, relaxing, gardening, taking a walk, or just sitting on the porch, is an element that shouldn't be ignored. In their own homes, individuals experienced these pleasures daily. No matter where you are building your facility, outdoor life should be an important part of your program and reflected in the design.
Equally important is the design of the personal living spaces based on the type of service provided for various acuity levels. For instance, independent living units will have far more personal space than skilled nursing rooms. Units should be generous enough to allow for residents to have private social interaction, which also promotes wellness. The character of the interior design needs to be consistent to ease the individual's journey through the levels of care. However, the interior finishes need to meet the intent of health codes as well as meet the needs of maintenance and housekeeping at the various levels of care.
Does a destination hotel come to mind at this point? The more successful facilities feel like a resort rather than a utilitarian facility. This is especially true where choice is abundant. What message are you sending to the community by sacrificing the quality and lifestyle elements of senior environments in rural areas? Through attrition, you still need to market the facility, which is even more difficult in less populated areas.
After the flash, then what?
After walking through many senior care facilities and observing the different levels of care, I noticed that they are designed for the initial “Wow” factor, but it is not carried through the entire facility.
As an adult child or active senior looking into moving to one of these, it may be exciting in front, but going through different levels of care it gets more and more institutional. So, I walked out depressed, thinking, “I don't like that place.” Therefore, the first impression must also be the last impression. As you walk into a facility and meander around, you need to feel that you won't end up in an institution. There is a line you cross when going through a facility from residential to institutional. The entry of the building can appear to be a resort and then downgrade to residential but should never cross the line to institutional.
Wellness as the component of the design without being institutional would include:
1. Unit design allowing adequate space for comfortable living
2. Multi-purpose rooms that are flexible
3. Space/volume of building, but not cavernous
4. Natural or subtle interiors – comfortable, soothing, tasteful, but not gaudy
(There are plenty of buses going to casinos if you admire that type of atmosphere.)
5. Stairs that are inviting and easily accessed
6. Therapy pools
7. Restaurants or alternate dining venues and styles
8. Adequate ventilation – controlling offensive odors
9. Exterior sidewalks with activity nodes
10. Connectivity to community/integration into community
11. Facility should be within the town, not on the outskirts
12. Freedom of movement throughout interior and exterior
13. Move staff out of their offices and into the facility
14. Keep staff engaged with each other and their charges
A quality staff is vital to the success of the facility. They are your most important and most expensive asset. The facility needs to support their efforts without too much redundancy of space that can break the budget. A comfortable, quiet break room should be provided away from their charges. The break room should include lockers, bathrooms, a shower, and a small kitchenette, with access to the outdoors. If the site allows, place staff parking near a separate entrance. A building design that also shows concern for the staff will result in success for everyone.
Know the neighborhood
Many providers have facilities in multiple communities throughout the country. While achieving the goals of a home-like facility, a designer must be cognizant of the different codes in various jurisdictions. It is important to work with the owner/operator to understand the licensing requirements of the facilities, which could be more stringent than the building codes.
A knowledgeable design team is important for the success of the project. The design team must be creative, flexible, and listen to understand the services and programs that the owner/operator is providing without injecting their design signature into the project. Lifestyles change, programs change, and the design of buildings must accommodate this maturing generation with choices and dignity.
Gary Prager has more than 34 years of experience in the field and is the partner-in-charge of VTBS's Denver Architectural firm. He has been involved in the design of senior healthcare facilities throughout the country for more than 20 years.