Operators place more emphasis on socialization, programming and flexible common areas based on the latest research.
By Jane Adler
The business of housing older people with dementia and Alzheimer’s disease has changed dramatically in the last 100 years. Elders in the 1900s with failing memories were often institutionalized in mental hospitals, but by the 1960s nursing homes became the place where those with the disease went to live.
Nursing homes, and later assisted living facilities, often created locked wings just for those with memory loss, but that changed in the 1990s with the debut of specialized care centers focused on the residents’ needs.
Based on the principles of the so-called Culture Change Movement and new research showing the advantages of person-centered care, building designs began to feature small wings or neighborhoods of 10 to 12 residents. Common areas such as kitchens and living rooms gave the building a homelike feel. The idea was to allow residents to function together like a household with staffers to help.
While many memory care facilities adopted the basic household or neighborhood model, some important new design lessons have been learned over the last decade.
For example, the latest building designs feature clear sight lines so staffers can monitor residents more closely. Open kitchens are less common in an effort to streamline service. And more attention is being given to the need for extra space to accommodate wheel chairs and walkers as residents age in place.
“There’s been a big shift in the industry in the last 30 years,” says Emily Chmielewski, author of a research study of design elements for dementia care facilities, and associate at architectural firm Perkins Eastman, in the company’s Pittsburgh office. “The concept of dementia care is being reinvented.”
The shift comes at a critical time for the industry. According to estimates from the Alzheimer’s Association, the number of people age 65 and older with the disease may nearly triple by 2050, rising from 5 million to as many as 16 million, barring the development of medical breakthroughs to prevent, slow or stop the disease.
Anticipating a wave of demand, construction of memory care units is on the rise. During the first quarter of 2014, assisted living and memory care accounted for 73 percent of all units under construction. Some 30 percent of that segment consisted of standalone memory care construction, according to the National Investment Center for the Seniors Housing & Care Industry (NIC). At the end of the third quarter, 2014, about 4,400 memory care units were under construction nationwide.
The design of dementia care buildings continues to evolve based on past experience and new findings. The Perkins Eastman research compared the design of an early 1990s dementia facility — Woodside Place in Oakmont, Pa. — to three other facilities. Two of the buildings were designed 20 years after Woodside Place opened. The designs were based on lessons learned from that original look.
Perkins Eastman designed all of the facilities in the study.
The lessons learned are being put into practice. Moorings Park is an 83-acre continuing care retirement community in Naples, Fla., that is being repositioned. Perkins Eastman is handling the overall design.
The revamped community includes a new satellite campus called Moorings Park at Grey Oaks that will be built about a mile from the original campus. Expected to open in late 2016, Grey Oaks will include independent living apartments, and assisted living and dementia care units along with a new health center.
Two new dementia care households are connected by common space that can be opened or closed off depending on residents’ needs. That way staffers can bring together different groups.
Outdoor features include paths that allow residents “to walk with purpose,” according to Dan Cinelli, principal and executive director at Perkins Eastman based in the firm’s Washington, D.C. office. “Staffers and relatives don’t have to worry about residents being outside,” says Cinelli.
Design innovations
The Bright Oaks Group is trying a new type of resident room in its memory care sections. The Chicago-based company is developing 11 new combination assisted living/memory care properties in Florida and Illinois. A typical building includes approximately 100 units.
One of the first buildings, Bright Oaks of Aurora, will open in the winter of 2015 in Aurora, a western suburb of Chicago. The project will include 24 memory care units and 36 assisted living units.
The Bright Oaks buildings will feature about eight or nine apartments called “bridge” units, according to Nader Kameli, CEO at Bright Oaks. These two-bedroom apartments will be available for couples, only one of which has dementia.
The bridge units are attached to the dementia care section of the building so the spouse with a failing memory can easily access services. The independent spouse has the option to take his or her partner outside the building.
The concept was tested on focus groups in Florida, and the response was 100 percent positive, says Kameli. “This is not rocket science. Why would you want to take couples and separate them?”
The Autumn Leaves memory care buildings developed by Irving, Texas-based The LaSalle Group are based on the neighborhood model, but the sections are not closed off so residents have access to all areas of the building.
“It’s an open concept,” says Jim Moyer, partner and vice president at SAS Architects and Planners, a Northbrook, Ill.-based firm. SAS has designed a number of the Autumn Leaves buildings.
Buildings are configured in an “H” pattern. The center of the building includes common areas such as the dining room, game room, and a green house. A courtyard contains a wandering garden.
A new community planned in San Antonio, Autumn Leaves of Westover Hills, will feature two themed courtyards. The active courtyard will include a putting green, walking path and musical playground. The relaxation courtyard will have resting spots, comfortable motion seating, a shaded area and a water feature.
Moyer notes that common dining areas in dementia care buildings are becoming larger to accommodate more helpers as residents age in place. “People want to put off going to a nursing home,” says Moyer. Showers and bathrooms are also growing in size so there’s space for aides and often a wheelchair or walker.
Owners and operators are also looking to improve building efficiency, which could reduce labor costs. When the neighborhood concept was first rolled out, universal workers were often employed to handle all the tasks for a household, including resident care, cooking and cleaning.
Operators have found this to be a clumsy model, however, according to Greg Irwin, partner at Irwin Partner Architects headquartered in Costa Mesa, Calif.
Qualified universal workers are difficult to find making it necessary to cross train employees to handle a variety of duties. Instead, owners and operators are reverting to the old model where, for instance, one cook handles all the kitchen work.
In another effort to improve efficiency, activity areas are being combined so one staffer can supervise a group of residents instead of having two activity areas that each require a staffer. “We’re taking a closer look at how many people one staffer can manage,” says Irwin.
Creating a social environment
Life skill stations where residents can engage in simple activities are growing in popularity. A station might feature locks and faucets for a resident to use and manipulate. Kitchen cabinets allow residents to stock shelves and enjoy an everyday activity.
Building designs include more space for socializing and enjoyment. Pi Architects designs dementia care buildings for Dallas-based developer Meridian Realty Advisors. Pi has two new projects in the Austin area managed by Silverado Senior Living: Silverado at Onion Creek and Silverado at Bee Cave.
The new buildings include three neighborhoods connected to the common areas to encourage freedom of movement. Each neighborhood and the community spaces open to a covered porch that joins several winding paths in the courtyard. Residents can garden in raised beds that are at wheel-chair height.
The common area includes a beauty salon, private dining room, art studio, country store and other activity rooms. Small spaces are available for sensory activities such as aroma therapy and working with clay.
Agitated residents can be taken to a sun room with plenty of windows so the resident can focus on the outside — a better alternative to putting a resident in an enclosed space, says Greg Hunteman, president of Pi Architects, Austin, Texas.
Common areas provide space for families, including a reception area and a bistro that serves snacks and coffee. An outdoor playscape is situated outside at the front of the building where children can enjoy themselves during a family visit. “We want to encourage families to stay,” says Hunteman.
Building owners recognize the importance of keeping families engaged. The Franklin Companies is a multifamily and seniors housing developer based in San Antonio, Texas. The company owns and operates five seniors housing communities and has a sixth property under construction. The projects — all in Texas — offer independent, assisted living and memory care.
While some communities offer space, such as living rooms, where families can gather, the Franklin projects also provide programming. For example, grandkids can sit with their grandparents and do paint-by-number projects.
“We want to give families something to do rather than just sitting in a room and looking at each other,” says Luke Classen, president and COO at the Franklin Companies. “We create environments where people can interact.”