Better living by design

by Jeff Shaw

Architects find ways to extend life, increase happiness for seniors.

 By Jeff Shaw

Seniors housing is a complicated sector for architects because it’s a combination of many other types of design. To create a functional and desirable community, architects must use elements of the hospitality, multifamily, healthcare and foodservice sectors.

The design process is further complicated by the varied needs of for-profit operators versus nonprofits, as well as the regional styles required to make a facility that fits into its surrounding community.

“In the for-profit sector, we typically work with developers with different goals in mind. They might look at five to seven years of owning before they sell it,” says Lorraine Enwright, director of design for THW Design. “The nonprofit clients are generally very mission-based. They tend to be very service oriented and they’re looking for the long haul.”

THW began designing seniors housing communities in the 1990s, and the sector now accounts for more than 90 percent of the company’s work. There are teams at THW that service both for-profit and nonprofit clients.

The recent increase in new seniors housing development has drawn the interest of architectural firms in other sectors. Unfortunately, says Enwright, many of them don’t understand the intricacies of designing senior living environments.

“Pretty much across the board everyone wants to get into senior living,” says Enwright. “A lot of those groups don’t understand the complexity of the product and what it takes to do it well.”

Thankfully, the inexperienced don’t often make it far, says James Moyer, principal at SAS Architects and Planners, an Illinois-based architecture firm with over 250 seniors housing projects under its belt. 

Between developers recognizing the importance of experience, cities denying entitlements to inexperienced architects, and failure of architects from other sectors to understand health regulations, designers that don’t know seniors housing often wash out before they ever get a chance to start building. 

“We’ve been hired to take over projects that had trouble getting approvals,” says Moyer. “Usually [inexperienced architecture firms] get vetted out in the selection process or run into problems with government approvals.”

One approach is to work with the owner/operator on how the community will functionally be used, and design on that basis, says Frank Muraca, president of ARCH Consultants Ltd., an Illinois-based firm that has developed over 2,000 seniors housing units in the last five years.

“Before you even put pencil on paper, ask how, operationally, the building is intended to be used,” says Muraca. “It needs to start with a well-defined program. Then the teams can all glean from that and do what we do best — develop a project.”


Extending independence for residents

A good architect is key in seniors housing because decisions made at the design phase can have real, lasting impact on the health and happiness of a community’s residents. 

Within the residential units, all sorts of considerations must be taken into account, such as accommodating a variety of acuity levels. Everything from making sure a wheelchair can clear a turn to putting the stove’s dials on the front so a senior doesn’t have to reach over a hot burner have an impact on livability.

“The goal is to extend independence as long as possible,” says Enwright. “The more design features that allow a resident to operate safely and independently, the longer there’s wellness for them. Its those important features that a less experienced firm often misses.”

The cost of a resident’s healthcare can be minimized by postponing a move to assisted living or skilled nursing, adds Enwright.

Out in the common areas, there are even more issues to consider. Is a long hallway too intimidating, causing residents to stay in their rooms? Is the lighting too dim? Does the design of the hallway make it too loud?

“Background noise can become a big issue; we have acoustical consultants analyze common areas,” says Moyer. “You really have to think about what your residents are experiencing. That’s what makes this sector so different.”

Dallas-based D2 Architecture takes understanding the resident experience so seriously that the firm has employees spend 24 hours in a community, using a wheelchair and wearing earplugs to replicate life as a senior. They then use that data to improve on future designs.


Serving special needs

Memory care is an area where architectural changes are starting to have a serious impact. Many modern memory care communities now focus on smaller groups of 10 to 15 residents, with rooms centered around a living room/dining room area, often with an open kitchen.

“Circulation is important in memory care — not a single corridor with a dead end, but a free-flowing space,” says Moyer. “Memory care residents like to pace and walk around a lot. You don’t want to create a dead end where they stop and reverse.”

Better integration of indoor and outdoor living areas — one of the biggest senior living trends of recent years — is yet another way architectural design can have a positive impact on resident health. Quality outdoor spaces help create social connections and improve overall wellness in all levels of care, including memory care.

“We want to create spaces you can gather in — spaces that are not just curb appeal, but actually usable,” says Enwright. “We want to encourage residents to socialize and congregate, to get out of their rooms and exercise.”

There’s a stereotype in the seniors housing industry, though, that residents simply don’t use the outside spaces. This misconception can be dispelled by considering why the spaces don’t get used, according to Daniel Cinelli, principal and executive director at Perkins Eastman, an international architecture firm with over 30 years of designing seniors housing communities.

“You hear, ‘Seniors don’t use balconies, they just store things out there,’” says Cinelli. “Well, they won’t use a balcony if it’s like a tongue sticking out of the building. If they have a hearing device and there’s wind, you can’t have a conversation. You have vertigo issues. If you recess the balcony into the building, you don’t have wind and you don’t have glare.”

“What makes sense for a 30-year-old doesn’t make sense for a senior,” he adds. “Just make balconies that fit their lifestyle.”

Other considerations for outdoor spaces are making sure there is enough shade to make the areas comfortable, and to make outdoor living areas visible from inside to entice residents into them.

David Dillard, president of D2 Architecture, says that even if seniors don’t use the outside space, it’s still an important psychological benefit.

“We work tirelessly with our clients and landscape architects to maximize beautiful outdoor spaces because, psychologically, residents are out there. They look out the window and know they could go out there, even if they don’t.”

Dan King, principal with Pennsylvania-based architecture firm Meyer, encourages developers not to cut corners in the interest of economy and efficiency. He cites an example of putting a washer/dryer in the bathroom because the plumbing is in there, only to find the bathroom becomes cramped and difficult to navigate.

“It’s a lot of the minutiae, the little things you don’t think about until you walk the space and realize they weren’t the best way to handle,” says King. “Developers love spa tubs, so they’ll place it on a platform and surround it with stone. It’s very elegant, but the senior can’t get into or get out of it.”


Boomers accelerate change

Even though the Baby Boom generation is over a decade away from needing seniors housing, the industry is preparing for their arrival. One reason is that the adult children of today’s resident base are largely Boomers, and they have a strong say in where today’s seniors end up living.

“The power of the 55-year-old daughter and what she wants for mom is driving development more than ever,” says Dillard. “That has a lot to do with why the look, tone and ambiance are a lot fresher than they were a few years ago.”

Although the designs are meant to please the younger Boomers, that doesn’t mean it doesn’t serve the older prospective residents, according to Rocky Berg, principal at three: living architecture, a Dallas-based architecture firm specializing in seniors housing.

“The Greatest Generation sees what we’re doing for the Boomers, and they love it,” says Berg. “It’s a great sector to design in right now. Change is a good thing. It gives us opportunity.”

The average room size shrank during the recession, but the rooms are getting bigger again to meet resident demands. The studio apartment for independent living has disappeared in new developments, says Berg, and even one-bedroom layouts are largely being replaced by one bedroom with a den or office. This gives space for friends to visit or grandchildren to stay over.

Additionally, more residents are choosing to live in urban environments rather than the stereotypical isolated, suburban campuses. 

“There are more inclusive, urban-infill projects. So, instead of having a community with a wall and a gate and a moat, the walls are tending to come down,” says Berg. “Security is still important, but the idea that the broader community can come in and use the resources of the senior living community, that’s where people want to move to. It encourages multi-generational experiences within the community.”

Environmental sustainability remains a major selling point for communities, but actual LEED certification is becoming less common in favor of simply advertising the sustainability initiatives that the development incorporates.

“A few years ago, many of our clients wanted to get LEED certified and were willing to spend the time and money to do that,” says THW’s Enwright. “Now, while many still want sustainable features built into their communities, they are not always looking to pursue LEED certification. For those clients, we ensure that sustainability is part of the design solutions.”


Breaking with dining traditions

The biggest trend in recent years has been the emergence of multiple dining venues. Nearly every new community requires several places to eat — often a bistro or coffee shop in addition to a sit-down restaurant and even bars and marketplaces.

“It used to be it was one big dining venue, it was very fancy and there was a set time to eat three times a day,” says Meyer’s King. “That’s going by the wayside. You might have a bistro on one side then a country kitchen on the other side, then a sports lounge somewhere else. If you don’t want to get dressed up or you want to eat at 3 p.m., operators are providing that.”

From an architectural perspec-tive, this trend creates a functional challenge. Does each venue get its own kitchen, or is everything serviced from one central area?

King says many of Meyer’s clients have a central kitchen that services assisted living dining on one side and independent living on the other. There may be secondary kitchens elsewhere to serve satellite venues.

Modern dining concepts can even help improve resident health by encouraging them to eat.

“I love open-kitchen concepts,” says King. “Seniors are starting to lose some senses; eating is not as exciting so they eat less. Open kitchens stimulate their olfactory sense, which makes them want to eat. They get the nutrition they need and they get a healthy diet.”

The kitchen concept and other amenities are also another way to involve the surrounding community. If a restaurant is visible from the outside, or a salon is open to people who don’t live there, these amenities can become a strong marketing tool, notes Cinelli of Perkins Eastman.

If people from the community know and enjoy the amenities, they’re more likely to become residents or encourage others to do so.

“If you’ve got dining venues, make them look like restaurants visible from the outside, with umbrellas and a bar music playing on the patio,” says Cinelli. “Don’t bury it in the bowels of the building. Invite people into your space, even though they might never move in.”


Building for an uncertain future

Of course, designing for today’s trends might not help tomorrow. If it’s so hard to predict the needs of future seniors, how can architects make designs that will last?

Buildings need to be flexible, both in use as well as in infrastructure, allowing buildings to change structurally to fit an ever-changing industry’s needs and regulations.

For instance, memory care is growing now, but advancements in research to Alzheimer’s disease and dementia could theoretically cause a drop in demand.

“You don’t want to just jump on a bandwagon if it doesn’t make sense for your particular development,” says Arch’s Muraca. “The trend we’re a firm believer in is making sure to build environments as flexibly as possible.”

To keep assisted living infrastructure flexible, THW often designs hallways 8 feet wide, the minimum requirement for skilled nursing, rather than the 6 feet required for assisted living. This means that, should the community ever need to implement skilled nursing, it already meets one of the main requirements without renovations.

“We don’t know what the realities are going to be in 10 years,” says Enwright. “If we give them the ability to convert at minimal cost, that’s a really nice feature.”

Also, THW designs doors that look like standard residential entryways for assisted levels of care, but with an extra hinged panel that allows the doors to become wider for stretchers if needed in a more acute situation.

Plumbing and electrical can also be carefully planned so that it matches up across various floors and levels of care. For example, if rooms need to be converted from independent living to assisted living there is less infrastructure work to replace, says Enwright.

SAS advises developers to build to a higher fire rating to ease any future transitions to skilled nursing, which has more stringent requirements.

“It’s not that big of a cost in a smaller facility to have a higher occupancy type or fire rating,” says Moyer. “A lot of the South uses wood construction. That’s fine for independent living, but if you want to go to skilled nursing that type wouldn’t be allowed.“

Berg of Three plans load-bearing walls strategically so that more walls can be knocked out to reshape or repurpose rooms inexpensively. Although it can increase upfront costs, the savings in the future could be huge.

“Load-bearing walls often cut up the common spaces. But if you can structurally transfer those loads and open up the ground floor, it gives you flexibility,” says Berg. 

“This also helps to create combo units. How does a unit work if you take out that second kitchen and have the master bath in there? Planning that out can give you flexibility in the living units,” adds Berg. “Making rooms smarter with better lighting, acoustics and web-based technologies also improves their ability to flex.”

This is especially important to consider as Meyer’s King predicts the industry will even see the definitions of the continuum of care change in years to come.

“In the future, you’re going to see units that are memory care but specialized more toward specific groups such as military veterans,” says King. 

“You’ll see units specialized for Parkinson’s disease. You’ll see independent living geared toward the younger, more active adult. You’re going to see assisted living with more concierge-type services,” predicts King.

“Senior living is such a growing industry, there are all kinds of entrepreneurs inventing services just for this market,” concludes King. “It might look totally different in 10 to 15 years.”

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