Healthcare: Senior Living Market - March 2011
By Jessica Chevalier
Healthcare accounts for just under 6% of the flooring industry’s annual $4 billion in commercial revenue, making it the smallest market segment. As the current and forthcoming growth of the healthcare sector is well documented, this may come as a surprise. However, flooring in the sector is expected to last and is often used ten or more years before it is replaced. Therefore, while the number of healthcare facilities may be increasing, replacement needs are low. Over the next years, however, significant growth is expected, from 249 million square feet of consumption in 2010 to an anticipated 355 million square feet in 2014, according to Market Insights/Torcivia.
The healthcare sector is divided into two segments: the acute care market and the long-term care or senior living market. The senior living market is a complex system, composed of many different types of care facilities: retirement housing, assisted living, skilled nursing, memory care and rehabilitation. Though not all residents in this market are necessarily senior, the phrase “senior living” is used as a blanket term for the segment. Younger individuals with brain trauma or physical needs that require long-term care may live in the rehabilitation wings. In the past, much of the design budget for the senior living market was spent on the independent living units. Today, people expect all levels of care to have a polished residential or hospitality feel.
The days of the “nursing home,” those dingy facilities overflowing with patient beds and residents strapped in their wheelchairs, are coming to a close. The new face of senior living is the Continuing Care Retirement Community (CCRC), a concept developed by the Quakers in the early 1900s. These communities, most popular in Pennsylvania and Ohio (where the Quakers settled) as well as Maryland and California, focus on mind, body and spirit wellness care. And they look more like upscale communities or resorts than hospitals or nursing homes. CCRC residents pay a substantial sum to the organization in return for care for the remainder of their lives, which makes competition for future residents stiff and heightens the importance of having a well-designed and marketable facility. Obviously, not all senior living facilities are CCRCs, but the CCRC is setting a standard for care that is trickling down to other types of senior living.
The mass transition from “facilities” to “communities” began with a few enlightened developers in the late ’90s, but, according to Lea von Kaenel and Dean Maddalena, partners at StudioSix5—a firm that designs only in the senior living market—in the last five years it has really become the way business is done.
“It’s all demographically driven,” says von Kaenel. “You have a wellness-focused population making demands that they have a non-institutional environment.” Many of these communities go far beyond simply being “non-institutional,” offering concierge services, cafés, spas, viewing rooms for watching films, exercise facilities with trainers, opportunities for continuing education and brain fitness. According to von Kaenel, “People think of retirement differently; it’s a chance to reinvent yourself. You can go back to school, get involved with charity work or travel.”
Though most baby boomers won’t start entering retirement housing for 15 to 20 years, their impact is already being felt within these communities in several ways. To start, the average age of individuals entering senior living is between 75 and 80, so many baby boomers are currently assisting their parents—members of the “silent generation” born between 1925 and 1945—in choosing a community, and their likes, dislikes and values are influencing their parents’ choices. And, as they assist their parents, baby boomers are beginning to consider what they want for themselves in senior living. Many baby boomers reject a “one size fits all” lifestyle, so senior living facilities have to customize their offerings, basically competing for residents as colleges compete for students. Lastly, with so many baby boomers expected to enter the senior living market at once, communities have to start preparing for this influx now.
Thanks in part to this expected surge, the future of senior living as a business is bright. There is continued and unparalleled growth of those entering retirement until 2030, according to Maddalena. Still, over the last years, the recession did impact the category. Large CCRC projects cost between $110 and $190 million on average. As banks tightened their lending, many of these facilities were put on hold or scaled back versions of the communities were developed instead. According to StudioSix5, many existing communities took the opportunity to complete renovations, which are generally financed out of maintenance capital, positioning for the rebound. In fact, remodeling projects accounted for roughly 25% of the firm’s work last year.
Though the abilities and physical needs of senior living residents are varied, the flooring requirements are similar between the residence types. No matter how able-bodied the residents are, safety and accessibility are the primary concerns. Safety encompasses accommodations for visual impairment, slip hazards, transition hazards (between materials) and flammability. Durability, ease of maintenance and sustainability are significant considerations as well.
Betsy Brawley, president of Design Concepts Unlimited and author of “Design Innovations for Aging and Alzheimer’s” and “Designing for Alzheimer’s Disease,” emphasizes that design mistakes in senior living can be downright dangerous and even deadly for the residents. “Using wild patterns,” she says in regard to flooring, “is asking for hip fractures,” and, for many seniors, the downward spiral of health and lack of mobility resulting from a hip fracture leads to death within six months. “You can’t assume that patients see as you do or that they have good depth perception. You don’t want them to feel that they can’t move.”
Designers of senior living facilities are faced with a significant dilemma then: the challenge of creating a space that appeals to younger eyes while also providing a safe environment for older eyes, of creating a marketable space that is functional for its residents. Brawley points out that design for senior living is rarely taught as part of the interior design curriculum in universities, so many designers don’t even realize the significance of considering eyesight (or lack thereof) when specifying flooring products.
SOFT OR HARD SURFACE?
Victor Regnier is one academic who does explore the implications of aging on design with his students. Regnier, who holds a joint professorship between the University of Southern California School of Architecture and the Leonard David School of Gerontology, notes that the decision about whether to use hard or soft surface products in senior living facilities is an ongoing debate, as both hard and soft surface flooring choices have significant advantages and disadvantages for seniors.
Carpet is a benefit acoustically, since there is a need to mitigate sound due to walker and wheelchair use, machinery noise, conversation and the like. Carpet is also a much more forgiving surface for residents who fall, a common problem in senior living. However, carpet also absorbs fluids and odor—a very undesirable quality in locations where the residents are sometimes incontinent. Hard surfaces products, on the other hand, do not absorb spills or smells, but also don’t mitigate noise or gently break a fall. With the addition of a resilient backing for hard surface products and a moisture resistant backing and antimicrobial treatment for soft surface products, both categories can improve their profile for use in senior living.
When soft surface products are called for, StudioSix5 considers solution dyed 6,6 nylon broadloom with a low pile a good choice for senior living. The firm also uses berbers and friezes, especially for independent living units, where the largest amount of yardage goes. The products that the firm specifies for these projects are usually in the $7 to $9 square yard range. They also use six-foot goods for corridors. The firm makes sure to avoid carpet that features fibers with two different heights within its design, as this can cause difficulty for ambulation.
Since senior living facilities don’t have the funds to replace carpet frequently, Brawley recommends that designers for senior living products choose a good quality, dense, low pile carpet for common areas. For resident rooms, she chooses a more residential carpet because this flooring is often replaced between tenants and the product creates a home-like feel. Brawley uses soft surface products throughout senior living communities, even within the dining areas and in skilled nursing units. “With the number of products certified for healthcare use, there is no reason that you can’t use a soft surface,” she says. “They are going to be cleanable.” Brawley notes that Tandus and Shaw are two soft surface manufacturers that are providing good choices for the senior living market.
Regnier, who generally uses carpet in resident rooms, notes that soft surface products should always be double-backed and treated, but also says that smells within patient rooms are less problematic because, unlike odors in hallways and public spaces, they belong primarily to those smelling them. He points out that it’s rare to find a resident room that is not carpeted. Regnier doesn’t consider carpet tile a good choice for senior living because it has so many seams (where food and liquid can be trapped) and backing that he considers inferior to broadloom’s for these applications. In Regnier’s opinion, dark or patterned choices are the best bet for senior living facilities since they hide stains most effectively.
It is important to consider the transitions between flooring materials; because senior living residents sometimes shuffle, these can pose a tripping hazard due to differences in height or surface friction. For this reason, Regnier often carpets the corridor as well.
If he is using a hard surface product, Regnier prefers a resilient type such as a wood look vinyl with a resilient underlayment—Toli is a brand that he likes. StudioSix5 likes wood look vinyl plank flooring as well. The firm also uses vinyl tile, in part because it has a hospitality look and solid durability; sheet vinyl in medicine or linen rooms; linoleum because it has a sustainable profile; and ceramic tile in wet areas. The firm does not use VCT, not only because of the long term cost and maintenance associated with it but also because it has an institutional look.
Brawley mainly specifies good quality sheet vinyl for hard surface areas. She too likes Toli products for this use. She often chooses wood grain sheet vinyl but avoids vinyl planks due to the number of joints, which may trap food and liquid. Regarding hard surface products, in particular, Brawley believes that it’s very important for designers to communicate maintenance needs clearly to the maintenance staff. Often when maintenance personnel encounter a hard surface product, they will simply do what they have always done: wax and buff. In order to ensure a successful installation long-term and to create the safest environment for patients, maintenance staff must be instructed on how to care for whatever flooring is chosen.
DESIGN: COLORS AND PATTERNS
In terms of flooring design, StudioSix5 says, “The world is going transitional.” Generally, a soft modern or updated traditional look with global influences is most suitable for senior living. But the entire facility doesn’t have to have a single motif. The café can have a modern influence, while the dining room features a traditional look.
Organic patterns are popular, reports StudioSix5’s von Kaenel. And modern geometrics, which can be used with both classic and modern furniture, are gathering steam. Currently, larger patterns or a variety of pattern sizes is considered attractive. Ultimately, the firm strives to create a seamless visual interface that will be effortless for residents to navigate.
In carpet, subtle, complex combinations of colors offer strong appeal. In large part, color preferences are geographically oriented, but senior living style does follow national trends too. Von Kaenel notes that it is important not to choose anything too trendy for senior living design, since flooring in the healthcare sector has such a long anticipated life. These materials must also meet tight budget goals; von Kaenel generally only considers products in the $20 a yard and under range.
For all senior living flooring, soft or hard surface, Brawley chooses products with medium color values. And she restricts patterns to tone-on-tone designs, which often appear monochromatic to those with poor eyesight, yet provide relief, design-wise, to the healthy eye. Carpets with dark borders are terrible for residents with bad depth perception, since they make it appear that there is a step downward.
For memory care, the design standards are slightly different, as a soothing environment is the ultimate goal. To this end, contrast between the floor and walls as well as between flooring materials is kept to a minimum, since some memory residents fear crossing a distinct line. The use of pattern is reduced as well, and organic patterns that can appear to move and look wormy are avoided. Ultimately, designers strive to remove anything that is optically confusing in memory care facilities. Vinyl tile and plank is a good choice for these areas, according to von Kaenel, because residents won’t experience too much anxiety if they spill on these easily cleaned materials.
StudioSix5 believes in always designing for the future, looking ahead to attract even those who are not yet ready for senior living. The firm notes that it is always important to consider whether the facility is located in an urban or rural environment before choosing a look. “If you mismatch design and market, the units won’t sell,” says von Kaenel.
In 2008, StudioSix5 designed the country’s first LEED Silver CCRC facility outside Seattle, Washington. The firm considers sustainability a necessary element of senior living design, noting that senior citizens are concerned about what kind of world they are leaving for their children and grandchildren. If possible, StudioSix5 chooses local products, from West Coast manufacturers in the West and East Coast manufacturers in the East.
Offgassing from flooring is another significant concern within senior living, since residents may have respiratory difficulties. The issue is compounded by the fact that much of the flooring replacement must be completed while the facility is occupied, so the adhesives and installation process must also produce no noxious gases. Zero or low VOC flooring products are a must for these reasons.
While in the past specifiers had to choose between hospitality products (for looks) or healthcare products (for functionality), von Kaenel reports that some manufacturers are in the process of creating flooring products specifically for the senior living market—seeing what lucrative potential the sector holds. StudioSix5 has been approached by some flooring manufacturers to help develop these products, so they are keeping the names of these firms under wraps.
Brawley advises that these manufacturers imagine themselves in the shoes of a senior living resident as they develop products for the market. One big mistake manufacturers make, she notes, is their choice of color palettes for senior living. Since the lens of humans’ eyes yellows with age, it is imperative that manufacturers view their palettes with a yellow cast. The color purple, which she sees used frequently, is particularly bad through this lens. View products through yellow-tinted glasses, she advises, to see what the residents will be seeing.
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