Healthcare: Senior Living - March 2013

By Jessica Chevalier

Caring for America’s increasingly large senior population is a significant challenge. Due to advances in healthcare, Americans are living longer and, as a result, spending more of their late lives needing care. At the same time, the model for how we handle seniors has changed. No longer is it standard protocol that children take care of their aging parents in any sort of hands-on way. People are having kids older, working longer and, often, are simply too engaged in their own lives to take on the daily care of an aging parent. With the baby boomer generation already entering retirement age, the market is preparing for this large influx and readying itself for the changes that this group will bring. Boomers’ expectations differ from those of their parents, and a senior living facility must meet these expectations if they want to win business. 

THE BUSINESS OF SENIOR LIVING
It is important not to forget that senior living is a business—and a thriving one at that. The Assisted Living Federation of America (ALFA), which advocates on behalf of senior living and the residents served by senior living companies, summarizes The 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs findings: “The average cost of assisted living is now $42,600 annually. While the average rate for a private room in a nursing home is now $90,520 annually, a 3.8 percent increase over 2011. The average rate of a semi-private room in a nursing home increased by 3.7 percent over 2011 data to $81,030 annually.” 

Rates for memory care are even higher. The average cost for those with Alzheimer’s or dementia is $57,684 annually, and for facilities that charge a different rate for those with Alzheimer’s or dementia, the average annual rate for a private room is $95,265.

It is estimated that a significant number of people will need senior living services in the years to come. GlynnDevins, an advertising and marketing firm that works with senior living clients, estimates that seven out of ten Americans over the age of 65 will utilize long-term care. According to the U.S. Census Bureau, 13.3% of the population—over 41 million people—were over the age of 65 in 2011, up over 5% from the year 2000.

Also, the percentage of the aged population as it relates to the overall population is growing. The Alliance for Aging reports that starting on January 1, 2011, “as the baby boomers begin to celebrate their 65th birthdays, 10,000 people will turn 65 every day—this will continue for 20 years.” By 2030, the Centers for Disease Control and Prevention estimates that the population of Americans age 65 and older will be 71 million. 

Alzheimer’s rates are expected to rise as well. Findings from a study by the American Academy of Neurology indicate that instances of Alzheimer’s disease are expected to triple by 2050, to an estimated 13.8 million Americans, with 7.0 million of them ages 85 and older.

With lifespans longer and families less equipped to care for their elder members at home, the senior living market is preparing for a record influx of residents. According to LuAnn Thoma-Holec, principal at Thoma-Holec Design based in Mesa, Arizona, “The average age across America today for independent and assisted living environments is 87 years.” So, in roughly 20 years, the first baby boomers will be headed for senior living. Though that is still more than a few years away, the market is preparing for the new approach that they will bring. Says Thoma-Holec, “The baby boomers…are very age conscious and will not go into aging without a fight. Just as they have changed and influenced everything else in their life, they will change the way assisted living and long-term care is handled. We are just not certain how it will change yet.”

What is certain? Baby boomers will not settle for a cookie cutter experience in which they sit in front of a television in a common room, letting their senior years pass them by. Already, senior living communities are collaborating with colleges to offer classes to their residents, incorporating more wellness activities, like yoga, into their programs and offering restaurant-style cuisine.

Several of the designers that with whom we spoke stated that flooring manufacturers are missing an opportunity if they do not create specifically for this market and assume that specifiers will simply choose products from their selection of hospitality or acute healthcare portfolios. A market of this size and with needs as specific as the ones that senior living presents certainly demands its own solutions. 

CHALLENGES OF SENIOR LIVING DESIGN
If you’ve been a patient in a hospital recently, you know that the experience—even if the care is good—generally feels impersonal and, often, institutional. The elimination of germs takes priority, so surfaces are washable and easy to disinfect. Out of necessity, nothing feels truly warm or comforting. There is a hollowness to the design, an aloofness. For a long time, the same approach was taken in senior living. Facilities were created to address physical needs, but the mental health needs—and the benefits to mental health that a vibrant environment can provide—were often overlooked. 

In 1977, the Culture Change movement was launched by a group of stakeholders in the senior industry “to transform long term care homes from institutions to communities where the human spirit can thrive and everyone can have a meaningful voice and choice in the decisions that impact them.” The group represented the entire senior living industry, including elders, direct caregivers, nurses, activity professionals, social workers, administrators and operators, advocates, ombudsmen and state and federal regulators. And the Pioneer Network, an organization focused on bringing the idea of culture change to the senior living community, evolved from that group. Though the movement was initiated 35 years ago, widespread change has been slow. Seeking to bring community to every senior housing resident, the Culture Change movement has impacted not only how care is implemented but also how facilities look. Today’s designs aren’t only focused on function and cleanliness, but they also recognize that senior living facilities are homes, not hospitals, which necessitates a wholly different aesthetic.

Senior living includes many different levels of care (independent living, assisted living, skilled nursing, memory care and rehabilitation) and, therefore, many different housing types. In some of these categories, such as retirement housing, residents are independent and in need of no special care, so retirement housing looks very much like a typical home. However, in a skilled nursing unit, the highest level of care, residents need help performing simple tasks such as eating, going to the bathroom and getting in and out of bed. In addition, rehabilitation and memory care units may not be comprised only of the elderly. Younger individuals who have suffered from traumatic physical or brain injury often reside in these communities as well. As you would expect, design of all these different units varies. 

Complexity is inherent to senior living design. Facilities must feel like a home but function like a healthcare facility. They must appeal to the child’s tastes, since they are often advocating on behalf of the parent, but comfort the parent who resides within them. They must be attractive but safe. They must reflect the area in which they are situated, the beliefs or religious leanings of the residents, and account for the climate. They must appeal to the tastes of those needing them now and also the tastes of those who will need them in ten years, when the styles have changed but the décor has not. 

In terms of flooring, designers of senior living facilities must account for the fact that seniors leak, fall, shuffle and regularly use wheeled transportation, walkers and canes. They must consider that seniors see differently from other adults, and, in the case of dementia, the fact that pattern may actually impact mental health and anxiety levels. They must consider acoustics to create a peaceful, homelike atmosphere in a place where carts, beds and medical equipment are being pushed through the hallways. And they must account for the fact that the maintenance staff will be not only cleaning but also disinfecting due to bodily fluids.

While all sectors come with their own design problems, it is fair to say that senior living design is unique in the scope of its challenges as well as in the serious implications that can come with the wrong specification—a fall for a senior can be a deadly injury.

Flooring that assists in aiding fall prevention is the single most important factor in senior living flooring, according to Thoma-Holec; these include “non-skid vinyls and tile surfaces, smooth transitions between flooring changes, low pile and high density carpet, patterns that do not create vertigo or create challenges with the seniors visibility.”

Thoma-Holec adds, “We specify carpet as often as our clients will let us. We still have many concerns about carpet within acute care areas, but we see carpet offering positive attributes that ultimately benefit the resident and the housekeeping staff.”

Tatyana Lemon, interior designer at Boulder Associates—which has offices in Boulder, Colorado; Dallas, Texas; Sacramento, San Francisco and Irvine, California—reminds manufacturers that a low pile, high density carpet isn’t only important to prevent tripping by the residents who are ambulatory but also in allowing residents who use walkers and wheelchairs ease of movement. In addition, it is important that staff members are able to push heavy wheeled loads over carpets without straining too much and injuring themselves. 

Melinda Avila-Torio, associate at Atlanta-based THW Design, points out that sometimes even replacing old carpet with new can have a significant impact on how the employees work and the level of risk that they are exposed to, “Some facilities haven’t remodeled for 15 years, so the carpet now feels like VCT. Staff members have to push harder when the new carpet is installed, and they can injure themselves that way. Padding and backing systems play a role there too.”

Traditionally, senior living facilities have stuck with broadloom, fearing that the seams in carpet tile will allow liquid through. However, that is no longer the case. Lemon often uses carpet tile in public areas, since it generally features the low pile, high-density profile that is easiest for the seniors maneuvering over it. If needed, an extractor can be used to pull moisture from these areas. In private areas, where liquids and spills may go unnoticed for longer periods of time, Lemon uses broadloom, if she uses soft surface flooring at all. Tandus’ Powerbond is another favorite, since it doesn’t allow moisture to penetrate.

According to Avila-Torio, many of the carpets on the market today have been tested for moisture penetration with a dynamic crush test, which measures the likelihood of penetration when a liquid is rolled over. A few years ago, only a handful of companies employed this test, which is a very important consideration for senior living specifiers. Moisture barrier backing is employed in certain circumstances, though it adds extra cost, which is sometimes a deterrent. 

However, for residents using wheelchairs and walkers, Lemon forgoes soft surface flooring for private areas altogether. To maneuver through a small area like a bedroom, residents must make a lot of left and right turns. The traction caused by soft surface flooring is simply too great for a senior, so Lemon generally uses sheet goods with cushion in these locations. 

Hard surface flooring is becoming more popular in senior living, and Lemon reports that everyone wants the wood look. As with soft surface flooring, Lemon will use vinyl planks, which create a more natural look, in public space areas, but she uses sheet goods in private areas because they do not have seams that can trap moisture.

Obviously, bathrooms are hard surface areas, though ceramic tile, which is often used in residential bathrooms, is not a good choice because it is a danger for fall risks due to its hardness. Lemon likes to use rubber sheet flooring in bathrooms since it is warmer underfoot and provides a slip resistant surface. The product also provides good traction and is softer to stand on, which prevents foot fatigue for staff members who may be standing to assist residents in the bath. 

FLOORING AND THE SENIOR LIVING MARKET
Senior living design is often lumped in with acute care. Other times, it is compared to hospitality. In truth, it is a different animal from both of these because it acts as a home for the seniors who reside there, and it really does deserve its own standing with manufacturers. 

With the ever-increasing size of the senior living market, understanding senior needs and designing products specifically to serve the senior market will certainly pay off for manufacturers. Knowing simple facts about how seniors see—like that their sight yellows and that dark transitions can appear as drop-offs—may mean relatively small differences with regard to how a flooring design is constructed, but significant advantages for the seniors living on them. Seniors look down as they walk, so flooring plays an important role in providing visual cues and wayfinding. A poorly designed floor can make a senior feel hesitant to move, afraid of falling or disoriented. For those with dementia, pattern can cause anxiety, particularly busy or wormy looking patterns. Having these factors in mind while creating a product will lead to a result that is more senior-friendly.

Even spending a few minutes in a wheelchair, navigating over a flooring material, will provide the manufacturer a new perspective on designing for this market.

In senior living, color is especially important in creating a home-like feel, since the flooring materials specified are typically not residential. Thoma-Holec says, “We feel that the flooring industry still does not understand what designers desire for the long-term living industry. Oftentimes flooring is developed for multiple markets, and a carpet pattern or color that might be suitable for an office or a hospital will not create residential appeal in a long-term care setting. Hospitality carpet mills have wonderful patterns and colors, but they are constructed with 32-ounce weight, which is not suitable for heavy traffic areas in a long term living interior. Minimum yardage requirements often prohibit changing the ounce weight for utilization in our interiors.” 

In addition, manufacturers should consider that flooring specified for senior living may be cleaned more often or more vigorously than flooring installed in other sectors. While they can’t control what products a maintenance staff uses, they can consider how to create products that assist in eliminating odor, preventing moisture penetration and standing up to disinfectants. Performing testing, such as the dynamic crush testing mentioned earlier, and offering easy access to the results of this testing, allows specifiers to compare like against like and make an informed decision, which, ultimately, is good for everyone. After all, if a specifier chooses the wrong product and it underperforms, that reflects badly not only on the specifier but also, in some cases, on the company that made the product. A good specification benefits everyone. 

Acoustics play another important role in senior living. To make residents feel truly at home, the noise associated with wheeling carts and beds down the hall as well as the sound of residents must be mitigated. While hard surface flooring is more cleanable, it does not absorb noise as well as soft surface flooring. Helping a specifier to pair the right hard surface flooring and underlayment is a great service.

Most of all, it is important for manufacturers to remember that senior living facilities are homes. Thoma-Holec adds, “If a client asks me to specify a product or design an element for their community, I will always pose the question, ‘Would you put that in your home?’ It is a great barometer to determine if a product fits into a homelike setting. There are many new products on the market that provide the proper specifications for maintenance, life safety, and code issues. It just takes a good professional designer to make the correct specification and marry the residential appeal along with the products.”

Coordinating senior living-suited soft and hard surface product lines and bundling them for the A&D community will go a long way toward making the jobs of specifiers easier and, therefore, winning more of their business. Says Thoma-Holec, “Just as I learned to specialize in this field, manufacturers need to learn that they may not be able to be all things to all industries. They could then provide additional research within the senior living industry for better and more cost-effective products.”

Related Topics:RD Weis, U.S. Census Bureau, Shaw Industries Group, Inc., Interface