Incorporating the Pandemic Experience into Design

From processes to spaces, senior living design and construction are in for a change.

By Drew Roskos

Now in month six of our country’s full-scale reaction to the COVID-19 pandemic, we are all embracing today’s heightened awareness of public health across the board, especially in our field of senior living.  

As of this writing, roughly one-third of COVID-19 cases reported have been in senior living communities. As research continues to teach us more about the spread of the virus who is at the greatest risk, we are also likely all growing in our realization of how this pandemic experience will impact the creation of the senior living facilities of the future. 

Our national housing team at HED is working to layer pandemic-related design thinking in with the accumulated design understanding of best design practices. While certainly our healthcare design colleagues, and many of us working in the housing sector, have already considered traditional germ and disease flow for years, we know this pandemic will increase the expectations of occupants, developers and building visitors for decades to come — as it should. 

What has not changed, though, is our insistence on keeping quality of life and resident happiness as the priority for design success. For both residents and staff, a community is only successful if it serves the needs of the occupants. So, when it comes to both quality of life and health, these groups will always warrant the most important consideration.

What we need to hold on to

Senior living communities that are in dense areas with a strong connection — both physically and programmatically — to the larger, public community will continue to be the most successful and the healthiest environments for older adults. Social connectivity, and its impact on mental and physical health, will continue to be a top priority of this population group, both during the remainder of this pandemic event and long after. It’s an aspect that we can’t lose sight of on the heels of this experience.

We need to continue to actively solve for those needs while also incorporating healthy design responses to today’s research around this virus and other communicable diseases. Our mandate will be to find a balance between helping families be comforted by this new level of care without feeling constricted by it.

Well before we knew of COVID-19, senior living communities would change their operations or increase physical distancing as a result of busy flu seasons, pneumonia outbreaks or otherwise. Programming and scheduled activities changed to account for these concerns, and staff members wore masks, gloves and other personal protective equipment (PPE) in order to do their part in containing these germs. 

But with a heightened consumer awareness of these kinds of health challenges now, we can all expect a more careful eye on the facility itself and its role in disease spread, especially when potential residents are considering their options. 

Additionally, the seniors housing industry was creatively moving to utilize more external resources in fulfilling the care of their patients. From telehealth visits to video-based activity engagement, these systemic changes were already helping to reduce the outside visits from excess people. 

As this shift toward external care providers, and a reduction in onsite staff continues much more on the road ahead, it is my hope that we see a balance on our facilities’ accommodation of family and visits with loved ones, and less on providers. 

How will we adapt?

To start, the first adaptation we need to make is to the design process itself. 

From the onset of a facility’s design effort, we need to be prepared to also design what we are calling a “health management overlay.” This overlay should be crafted with operational leaders to ensure the feasibility of specific ideas in the event of another public health crisis, or even smaller-scale crises that we will now want to be better prepared for. 

Operators must consider everything from the spatial needs of telehealth appointments to where the extra chairs are stored when social distancing; and from the creation of processing spaces to identifying places for the additional location of permanent hand washing stations. This new overlay opportunity will allow a facility to be designed with a typical health condition in mind, while preparing for these kinds of frightening atypical events as well.

When it comes to more permanent physical design changes for future facilities, there are a few that will need to be implemented without a doubt. 

One of those is a greater focus on HVAC design — considering adding zones and increasing air filtration as a result of this pandemic. While mechanical systems have moved toward more efficient choices in an effort to reduce energy consumption, these new lenses of filtration effectiveness and isolation compartmentalization will take a more center-stage role in the years ahead as well. 

We are also confident that outdoor spaces will be significantly re-examined in the years ahead. From the simple mathematical need to increase social distance, to a pent-up desire to be outdoors after initial quarantines evolved, we are now excited to focus on the most effective design of outdoor space for a larger variety of lifestyle needs for our seniors. 

While the importance of active spaces and walking paths remain for the physical health of our seniors, we are now also eager to increase the crafting of intimate spaces where people can passively watch outdoor activities from a safe distance or gather in small groups to connect amidst the fresh outdoor air.

Another noticeable area where we all saw an immediate opportunity was technology. Those facilities that were more technology-enabled had more options when it came time to change their typical operations. From walking into and out of rooms without needing to touch switches, to hosting virtual family hangouts, technology proved to be the greatest gap creator between the haves and the have-nots. We see this continuing to drive the conversation as we create new communities moving forward. 

And in the area of access control, independent living or active adult communities might see an uptick in multiple entrances, creating ways for facilities to lock down individual halls or break resident groups down into smaller groups or neighborhoods. This idea, though, will certainly not shift in the memory care or skilled nursing, where security and safety of resident arrival and departure will continue to take priority. 

No need for overreaction

The most important point on the mind of our team, as we actively work on the design of new senior living facilities, is to not “react” our way into new problems. 

While pandemic woes will certainly weigh heavy on the minds of operators and families for many years to come, we know there are many dimensions to health. The opportunity to learn from this unique viral experience is most certainly great, and it is an important opportunity to seize. We are excited to apply today’s senior living lessons to our design process. 

As always, though, we must all be careful to make long-term decisions for our buildings based on a holistic set of industry knowledge, not just around unique experiences or isolated information garnered from our journeys along the way.

Drew Roskos, AIA, LEED AP, is a housing studio leader with national integrated architecture and engineering firm HED.