10 top design trends in senior living facilities

August 11, 2010

The Point Center for Arts and Education is a 20,000-sf senior activity center at the C.C. Young continuing care retirement community, in Dallas. Its library, classrooms, computer lab, fitness center, performing arts center, and art studios serve both residents and the surrounding community. PHOTO: © CHRIS COOPER
      
      
The surge of silent generation retirees and the impending burst of baby boomers marching toward retirement age are creating a burgeoning market for senior living. What is less widely appreciated is how much creativity is being applied to addressing this critically important part of the b
    
10 trends in senior living

1. Optimizing resident privacy and dignity
2. Creating homelike settings
3. Introducing hospitality design concepts
4. Expanding individual choice
5. Using technology to enhance senior living
6. Filling in the continuum
7. Taking the 'R' out of CCRC
8. Expanding urban options
9. Seeking more sustainable environments
10. Capitalizing on globalization










        
uilt environment. All the old design models are being challenged, serious environmental design research is being done, and a wide range of new models is being planned and built based on this research.
Following are 10 design trends that I believe have the most interesting implications for senior living facilities.
1. Optimizing resident privacy and dignity
The largest, and most disliked, of the available senior living options is the nursing home. Almost all of the existing stock of about 1.9 million beds in skilled-nursing centers, long-term care facilities, and nursing homes was built in accordance with the concept (enforced by state codes) that these were low-tech hospitals. The typical semi-private room with one bed by the window, one by the bathroom, and a curtain in between to separate the two occupants probably is only minimally larger than the code minimum for two inmates in a maximum security prison.

Other activities of daily living also strip privacy and dignity. Bathing, for example, often takes place in a gang shower or tub room down the hall from the residents' rooms. As for disabilities access, many of the bathrooms are too small for wheelchairs.

Nonprofit and for-profit sponsors of senior living are responding to these ignominious conditions with new, less institutional facilities where residents have their own rooms, usually with a three-fixture bath—sink, toilet, and shower. (Tubs are out—most of the elderly frail can't use them and they take up too much room—except in specialized tub rooms or in cases where spa-like facilities are feasible.)

If this sounds expensive, I would agree, but only to a certain extent. I think back to the first all-private home we did some 25 years ago, for the Montefiore Home in Beachwood, Ohio. Most of their reimbursement was coming from Medicaid, but the chairman felt strongly, even back then, that nobody wanted a semiprivate room anymore. Once they went to single occupancy, the other nearby homes also had to convert their rooms to private.            








    
A private room at Copper Ridge, Sykesville, Md. The facility provides a continuum of care specifically for persons with Alzheimer’s disease, with 60 assisted living units, a 66-bed comprehensive care skilled nursing facility, a 25-person adult daycare center, and an assessment clinic run by Johns Hopkins University. The project received an AIA.AAHSA Design for Aging Citation. PHOTO: © CHRIS MARTIN
            

In terms of affordability, the nonprofits are leading the way, through creative project management, especially the faith-based organizations—the Jewish Homes for the Aged, Episcopal Ministries on Aging, Presbyterian Association on Aging, Catholic Charities, etc. They know that the next generation of long-term care residents will not accept a semiprivate.

The high-quality operators in the for-profit sector are increasingly dependent on the high end of the market. To attract private-pay residents, they have to offer all private rooms. In my opinion, however, the for-profits have been under a lot of pressure and are not where the innovation is taking place.

They could take a lesson from a project we're doing in New Rochelle, N.Y., for a nonprofit with very little money. The facility is pretty spartan, but they put the premium on client privacy, and they'll add the amenity touches later if funds become available.
2. Creating homelike settings
A related trend has been the movement toward smaller, more homelike, environments. The Green House movement, which started about five years ago in Tupelo, Miss., is perhaps the most widely publicized form of such environments. Such “small house” senior living revolves around the concept that elderly people don't want to be in an institution; they want a much more houselike setting. Here, skilled nursing care takes place in facilities that are essentially big houses of 8-10 bedrooms with common living rooms and dining rooms, staffed by 24-hour caregivers.

The reality is that when you get into the urban situation, the economies of scale to pay for a rehabilitation staff, or professional dietary staff, or really skilled nursing require that you have facilities with 400-600 beds. But the same idea of homelike settings can be applied by breaking down traditional huge nursing-home complexes into small neighborhoods and houselike settings.
3. Introducing hospitality design concepts
For reasons of market acceptance and operational feasibility, many providers of senior living and their design teams are incorporating hospitality design concepts into their facilities, not only in the interior design but also in the planning and programming.

As I have noted, there has been huge movement to make these facilities look less institutional, although there may be limits to what can be a
          
The pool at Kendal on Hudson overlooking the river and palisades in Sleepy Hollow, N.Y. The continuing care community, founded on Quaker ideals of inclusion and respect for older persons, offers 222 independent-living apartments, 24 enriched housing residences, and 42 skilled nursing units. PHOTO: © CHUCK CHOI
        
ccomplished to make these settings seem truly residential when you have several hundred frail people living there.
At the other end of the spectrum, however, retirement communities and higher-end facilities are taking note of the design sensibility of hotel chains and applying their concepts to long-term care, assisted care, and continuing care.

Some of these innovations are fairly simple to implement and rely on the use of conventional products—for example, shifting from vinyl composition tile to carpet, or from painted gypsum board to wall coverings. Others are more substantial: additional dining options, separating “back of house” operations from residential areas, and concierge-like services.

Then there are many new products that have been developed to meet more stringent healthcare codes or owner/designer specifications, but which are much more attractive than yesterday's offerings.

These include wall coverings that meet infection control requirements, and solution-dyed carpets with moisture backings that can be cleaned with industrial-strength cleaners. There's new furniture that's been designed specifically with the frail elderly in mind—as basic as removable seat cushions for cleaning, arms on the chair to assist lifting, all these little details. So much of senior living is about detail: what the clients can see, what they can do, even when they're very frail.

And in extreme cases, such as the eight projects we have done in Japan for the senior living operator Half Century More, the amenities and finishes, not to mention the dining facilities, are such that your first impression is that you've walked into a five-star hotel.






















            
The arts activity space at Fairhaven Retirement Community, Sykesville, Md., which also features crafts, ceramics, a photography studio, a woodshop, exercise room, and computer center. A 99-bed healthcare center was converted into 33 assisted living units and 66 nursing care beds—all private rooms.PHOTO: © BRYSON LEIDICH PHOTOGRAPHY
        
4. Expanding individual choice
All three of the above trends, as well as others, are about the market's desire for choice. The individuals considering retirement options for themselves or a family member have not been satisfied with the limited options of the past and are demanding new choices. This can be seen in new ownership options—“condo for life,” a wide variety of entry-fee options, rentals, time shares, etc.—all catering to niche markets and offering alternative delivery options for skilled care, richer programs, and other benefits.
5. Using technology to enhance senior living
Technology is finally beginning to have a significant impact on seniors' choices. There are wireless pendants that activate a phone in case a client falls; health-monitoring devices that can be applied to a parent's unit, as a motion-detector; devices that monitor vital signs, or even manage
      
A photovoltaic array at Felician Sisters Convent, Coraopolis, Pa. The Franciscan nuns converted their 70-year-old provincial house into 10 household clusters of individual rooms with private baths. The renovation earned LEED-NC Gold certification. PHOTO: © ALEXANDER DENMARSH
      
medications. There's a growing array of technologies that are making it possible for people to live longer, in less restrictive facilities. Given the growth in the senior market, it is likely to expect technology to have an accelerating impact in the field. 6. Filling in the continuum
Twenty years ago most sponsors of senior living facilities had only one or two options to offer—a nursing home or traditional old-age home for the frail elderly—and many of the new sponsors came in with facilities that addressed only one part of the need. Now they are faced with the problem that, as their residents get older and frailer, sponsors do not want to discharge people who need more care than they normally provide, in part to keep their facilities full.

Thus, a growing part of the market wants to choose an option that gives them security for the remainder of their lives—long-term care (i.e., 24-hour nursing homes), assisted living for the frail who do not need 24-hour care, independent living (“senior housing” for those who are ambulatory), and continuing care retirement communities, or CCRCs, which offer all three options.

Nursing home operators are adding housing and other options, while assisted-living operators are moving into full-scale retirement communities. This move to offer a fuller array of options is producing some of the most interesting projects.
7. Taking the 'R' out of CCRC
As noted above, “CCRC” stands for “continuing care retirement community.” In today's climate, many seniors looking at their options do not see moving into a senior living facility as a decision to drop out of life. Instead, they want to continue their lives and interests long after age 75.

One of the more progressive manifestations of this change in attitude is the development of senior living facilities built either directly in association with universities or near academic campuses.

For example, Kendal at Oberlin, a continuing care community serving seniors “in the Quaker tradition,” is a short van ride from the Oberlin College campus in Ohio. More than a third of its residents are retired Oberlin faculty, alumni, or staff. Similar Quaker tradition centers have been established by Kendal Corporation at Cornell University, Ithaca, N.Y.; Dartmouth College, Hanover, N.H.; and Denison University, Granville, Ohio. The Kendal at Lexington, Va., offers a two-fer: it is near the Virginia Military Institute and Washington and Lee University. And Kendal's two facilities in western Massachusetts are within a 10-mile radius of five colleges and universities.














   
A resident of the Kendal at Granville (Ohio) retirement community participates in a class at nearby Denison University. Kendal Corporation has several facilities located near colleges and universities, including Cornell, Dartmouth, and Oberlin. PHOTO: COURTESY THE KENDAL CORPORATION
             

At the high end of such facilities is the Classic Residence by Hyatt, in Palo Alto, Calif. Opened in 2005 at a cost of $370 million on land leased from Stanford University, it offers 388 independent living residences, 38 assisted-living units, 24 memory-support suites, and 44 skilled nursing suites. Amenities include a pool, fitness center and spa, library, computer center, art studio, beauty salon/barbershop, and meals at three dining locales. There are more than 20 such Classic Residences today, although not all are on college campuses.

These near-campus locations offer residents access to public lectures, beautiful campus settings, high-level medical facilities, and athletic and cultural events; for example, Oberlin's Conservatory of Music holds 400 concerts a year.

Senior living facilities like these represent a redefinition of retirement. They are not warehouses, but represent a lifestyle change. Their common spaces are a long way from the arts-and-crafts and woodworking shops of y
       
The 12-story Jewish Home & Hospital, Bronx, N.Y., provides an 816-bed skilled nursing facility in an urban setting for persons who are no longer ambulatory or suffer from various forms of dementia. PHOTO: © CHUCK CHOI
    
esteryear, to theater and conference facilities, business centers, spas, and wellness centers that allow people to be active and fit and to live longer.
There have also been a number of efforts to develop “intergenerational” campuses. Hebrew SeniorLife's new CCRC, Newbridge on the Charles, in Dedham, Mass., shares a campus with a day school. Lasell College in Newton, Mass., 10 miles west of Boston, has a CCRC on its own 13-acre site on the college grounds. Lasell Village features a formal continuing education program for senior residents to attend classes at the college.
8. Expanding urban options
Urban options have been harder to develop for a variety of reasons, among them the ability of people in high-density apartment neighborhoods to have services and food brought in and the combination of the cost of land and the cost of living in cities.

Nevertheless, a lot of empty nesters and seniors want to move back into city centers to enjoy the richness of an urban lifestyle and amenities such as having a doorman and home meal deliveries. This phenomenon is stimulating a variety of interesting new projects, such as The Clare at Water Tower Place in Chicago, a full CCRC in an urban high-rise setting.
9. Seeking more sustainable environments
Sustainable design concerns have come to senior living and are an increasingly important factor in the design and operational goals of new projects. The kinds of green design concepts that are being applied to office buildings and schools— daylighting, improved indoor air quality, energy and water conservation, views of nature, gardens and water
           
Sun City Takatsuki combines Western design concepts and insights with Japanese culture to create a continuing care community in a country with no tradition of senior living. PHOTOS: © CHUCK CHOI
    
features, efficient lighting and lighting controls—are also being applied to senior living.
Another sustainability concept that we're seeing is adaptive reuse of existing buildings. One of the more interesting of these has been the conversion of monasteries and convents—some of which sit on very prime real estate—into senior living facilities. With the decline in religious vocations, these buildings are being converted initially for the older nuns and priests; sadly, as these religious die off and are not replaced, the buildings are converted into senior facilities for the public.

For example, the new facility for Dominican Sisters in Grand Rapids, Mich., is designed to serve the sisters and later the surrounding community.
10. Capitalizing on globalization
These trends are not confined to the United States. Many other countries, particularly in Asia, have ballooning senior populations and are looking to stimulate new senior living options—some of which are heavily influenced by American prototypes.

What's driving this? We've done a whole series of high-end senior projects in Japan, and we're working on several in China and Korea. These societies all have millennia-long traditions of families taking care of their elderly, but conditions are changing: in many extended families, the adult children, both men and women, are now working, as often as not in different cities from their parents. Thanks to better healthcare, the parents are living longer, and need more care than their children can give them. Moreover, in societies like Korea and Japan, there is greater acceptance of aging parents not necessarily wanting to live with their grown children.

There's a big potential market in every country, but it's happening all around the world. Although Europe dealt with the aging population issue awhile back, and their models are not easily transferable, the U.S. model, the best of it, is being copied by other countries, particularly in Asia. We're looking to Asia for ideas, and Asia is looking to us for models.

As I approach the end of nearly three decades of designing senior living facilities, I think I can safely say that there is no building type where you can see a more direct correlation between doing something right and its impact on people's lives. You can build an environment for the aging that is confusing, imprisoning, and depressing, or you can build one that frees them, encourages them, and enhances their quality of life. This is a building type where you don't have to look very hard to see what difference you've made in people's lives.
























      
Daylighting floods a room at Childers Place, Amarillo, Texas. A project of the Bivins Foundation, the 60-unit facility combines a high-quality resident experience with a supportive environment for families. Each 350-sf private room features wireless networking to connect family members with the outside world; window seats provide sleeping spaces for overnight visits. Resident beds can be wheeled outdoors onto terraces. PHOTO: © CHRIS COOPER
          
Author Information
Bradford Perkins, FAIA, MRAIC, AICP, is the founder of Perkins Eastman Architects, a New York-based architectural, interior design, and planning firm with a national practice and branch offices in Charlotte (N.C.), Chicago, Pittsburgh, San Francisco, Stamford (Conn.), and Toronto. He is the principal author of Building Type Basics for Senior Living (Wiley). 
   

         
 

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