Senior Living Report: As perceptions on aging change, so do the facilities that serve aging - Feb 2019
By Jessica Chevalier
Whiskey parlors and craft beer bars, yoga studios and wellness centers, Starbucks cafes and artisanal pizza pubs: in addition to constructing the fabric of any lively urban center, today you may find this range of offerings in a contemporary senior living community.
The ways in which the concept of the “nursing home” has changed over the last decades cannot be overstated. The senior living communities being established today are not long-term hospice facilities but villages where individuals may choose to forego the burden of keeping up a house and yard and enjoy their senior years in a community of people their own age, moving through the levels of care as needed.
Furthermore, senior care today isn’t about simply tending to the physical needs but caring for the emotional, mental and spiritual as well. The difference in this mindset is stark in comparison to even a few decades ago. “This is really a human rights issue,” Max Winters, planner, designer and strategist with Perkins Eastman, says. “Thirty years ago, we were using physical restraints on dementia patients.”
One of the most impressive parts of this thought development is the fact that interior design is one tool that is being used to eradicate practices that pose danger-physical and mental-to the residents, with flooring playing, perhaps, the most crucial role in that effort.
CHANGING DYNAMICS
The generations impacted by and impacting senior living today are primarily the Silent Generation and the Baby Boomers-the youngest of the Greatest Generation, which came before the Silent Generation, are now 95-and it’s important to remember that while generational traits are good basic guidelines for understanding groups, they can also be reductive.
The fact is, the term Silent Generation-individuals ranging from 74 to early-90s today-calls to mind a group of people content to let the world go by, and that’s how it is typically characterized: as a group focused on their career and generally indifferent to activism, unwilling to stand up and make things happen. Do those traits sound fitting of Martin Luther King Jr., Bob Dylan, Gloria Steinem, Andy Warhol, Sylvia Plath, Malcolm X and Bernie Sanders to you?
In fact, some suggest that the “Silent Generation” term isn’t a characterization of the group’s temperament at all but of its standing among the generations. At an estimated 20 million, the Silent Generation was the first in America to be smaller than its predecessor-the Greatest Generation, estimated at 56 million-though it was partially responsible for producing the large Boomer generation, which peaked at over 78 million. The nature of its relatively small size, and consequently its smaller voice, is thought to be the reason for it earning the “silent” nomenclature. Regardless, according to Neil Howe of Forbes, the Silent Generation “...spearheaded the divorce revolution and popularized (thanks, Gail Sheehy) the term ‘midlife crisis’,” so the group clearly isn’t as laissez-faire as it is sometimes portrayed.
And Baby Boomers, of course, have been the subject of significant attention, a group largely identified as hippie kids who settled down in search of the American dream, putting work-life at the forefront-a generation that out-earned their parents and, consequently, bought what they wanted. Again, a diminishing summary, especially as you consider that a good number of Boomers were not protesting hippies at all, but those fighting and dying in the Vietnam trenches.
While senior living is transforming itself to cater to these dynamic populations, it is also repositioning itself from a late-in-life, last-ditch option for those who cannot care for themselves to desirable and well-appointed human-centered residential communities, actively recruiting seniors by marketing their amenities-much as colleges do.
Says Winters, “The Baby Boomers basically invented consumer culture, and when it comes to senior living, they are shopping around. They have higher expectations. They saw their parents in nursing homes, and they don’t want that for themselves.”
In addition, the generations have increasingly produced fewer children per capita. In 1960, the birth rate was 3.65 per woman; in 2017, it fell to 1.76, which means that people have fewer children to assist with their care as they age. Add to that the fact that families today are more far flung-making it harder for seniors to age in place with progeny help or, indeed, to move in with adult children. And, of course, the fact that the Silent Generation and Baby Boomers earned more than prior generations also means that they have more financial liquidity to make choices; they may not want to rely on their children to care for them as they age, and they have the financial power to choose otherwise.
Keep in mind as well that medicine has increased life expectancies, so the senior citizen population is growing at a good clip, and that is expected to continue. According to the University of Southern California Leonard Davis School of Gerontology, “The average life expectancy in America today is higher than in any other period in history. More specifically, data from a United Nations report shows that the number of people 65 years and older rose from 8% to 12% of the total population between 1950 and 2000. What’s more, this figure will rise to 20% by 2050 and is likely to continue rising steadily thereafter.”
Modern medicine and practice have also enabled people to remain more active as they age. Says LuAnn Thoma-Holec, founder of Thoma-Holec Design, which focuses exclusively on senior living, “A person at 65 today is much younger physically and mentally than previous generations. They are much more active, involved and purposeful in all aspects of living. Because of the more dynamic lifestyle required, senior living design must provide the opportunities that residents today are seeking. This includes purposeful activities. The days of bingo are gone.”
With senior care sloughing off its “hospice” image, incoming residents today have the opportunity to look at entering senior care as a positive transition rather than a dreaded end, and with that comes a change in spirit about the change in surroundings. “I believe it is a misconception that residents want to live with furnishings from their past,” Thoma-Holec says. “Moving to a new community is an opportunity for a change and provides them with an opportunity to create a beautiful new space to enjoy. Certainly, well-loved pieces of furniture are brought to the new environment, but oftentimes I see residents purchasing all new furniture. In memory care, it is important to bring the familiar items, but in independent living, it is a new opportunity.”
The design of senior living centers is a unique and locally focused endeavor that hones-in on the location of the facility as well as the general interests, experience and tastes of the individuals who will be residing there, explains Thoma-Holec. “Just as we have seen hospitality environments tap into local flavor in their aesthetics, so has the senior living industry. Our first step is to determine the demographic and socioeconomic background of the potential residents. It is important that we have a thorough understanding of who the resident is, where they are coming from, if they are well-traveled, [whether there] is a specific occupation in the region or area where they may have worked, etc. Then we can begin to pull our inspiration for the interior design.”
HOME, NOT HOSPITAL
If there is one trend transcending all others in senior living design today, it is designing these communities as homes, not hospitals. Consider the old nursing home model: a central nurses’ station around which were long corridors lined with hospital-esque rooms. Today, a facility such as the Jewish Senior Life’s Green House Cottage Homes is an alternative that offers greater mental and physical comfort for the resident. The Rochester, New York-based facility, designed by Perkins Eastman, features a communal kitchen area with a large dining table as a central hub, off of which ten to 12 private bedrooms and bathrooms extend. Medicines and nursing supplies are kept in locked built-in cabinets within each resident room; these simply read as residential cabinetry. The whole facility reads like a home because it is a home.
“One thing to remember is that senior living as a solidified idea isn’t really that old,” says Winters. “We have had nursing homes for a long time, dating back to Roman times, but the idea that this is a residential experience, and that not everyone over the age of 65 is the same, is relatively new.”
The Green House Project was formulated by pediatrician Bill Thomas in 2001, based on the idea of providing “a radically simple alternative to the traditional nursing home,” which was largely considered a last resort by anyone who had ever visited one. “In subsequent years, with support from the Robert Wood Johnson Foundation, the concept evolved into The Green House Project: small homes that return control, dignity and a sense of well-being to elders, while providing high-quality, personalized care,” the website explains. “A Green House home differs from a traditional nursing home in terms of facility size, interior design, organizational structure, staffing patterns, and methods of delivering skilled professional services. It is designed from the ground up, to look and feel like a real home. Food is cooked on premises, and medical equipment is often tucked away in wall closets. Skilled nursing assistants manage residents’ care, with support from nurses and therapists but minus the extra supervisory and administrative layers-a reversal of the traditional nursing home model.”
“This is a culture change for the industry,” says Winters, “We realized that the way we were doing nursing homes wasn’t working for many reasons. And we asked ourselves, ‘What if it was more like a house?’” In fact, at the Jewish Senior Life’s Green House cottage homes, each residence has a private entry that creates the “experience of entering a home,” says Lori Miller, senior associate, marketing manager with Perkins Eastman.
Though Thoma-Holec reports that the senior living sector may experience a slowdown in the next few years as a result of the high cost of building materials and labor, due to the high demand expected to be created by Baby Boomers over the coming decades there is little question as to whether the sector will continue to expand.
In addition, the experts with whom we spoke report that many existing facilities are being repositioned and remodeled to align with contemporary concepts on senior care, so remodel work is expected to remain steady as well.
Wilson points out that the industry is still grappling with the question of what level of care will be most needed in the coming years. “During the end of the recession, skilled nursing and memory care facilities were in greater demand because people were operating more on a have-to basis, whereas independent and assisted living were more of a luxury. We’re seeing a shift there, as all levels of care are being utilized and facilities are morphing to align with current needs.”
FLOORING AND DESIGN
While it would be nice to offer a clear blueprint for what flooring is used in what applications across the senior living spectrum, that sort of standard format is just not how things are done today. As in single-family homes, finishes vary by taste, location and application, and residential styling plays a very important role.
Ultimately, however, flooring is one of the most important considerations in senior care design. “Flooring is a first and foremost concern because it can be the biggest hurdle in senior living” says Leslie Ann Wilson, interior designer with ESa. “We have the aesthetic concerns-making the space warm, residential, inviting and a place that residents are proud to call home-but we must also take into consideration mobility issues, visual issues and other similar hurdles that make flooring selection very important. We have to use flooring to create opportunities for residents, not obstacles.” While the aesthetics senior living designers seek are often residential-inspired, commercial grade materials are the norm. Wilson reports that manufacturers must meet ESa’s criteria for slip resistance “prior to even getting their books on our shelves.”
One factor that is highly important to designers in this realm, however, is transitions. Strips trip-that is an even more significant danger with seniors, who are more likely to shuffle their feet, so avoiding transition strips of every sort is key.
But transitions from material to material can also be problematic, so they must, upon installation, end up the same height with, as much as is possible, similar coefficients of friction. Carpets piles must be low and tight, and hard surface materials must not be slick. “We have also learned that those transitions from one flooring type to another, soft to hard, can be an issue if there is any kind of height change or severe contrast in color,” Wilson notes. “We pay really close attention to contrast, thickness and slip resistance, and use vertical surfaces to keep the eye up, even as the posture starts to angle down. Keeping the eye up helps people to pick their feet up.”
Samantha Belfoure, senior associate with Perkins Eastman, agrees that flooring is part of the conversation up front. “One of the biggest challenges is making spaces open to each other while limiting the transitions between flooring types and making sure transitions between colors are correct,” says Belfoure. “Perceptions of change are a big deal in memory support and skilled nursing spaces.” The Perkins Eastman interiors team works closely with its architecture team from the initial stages of the design process to find best practice solutions.
Adds Winters, “We can create a master plan for a project and say that we are changing the culture of the nursing home, building a residential-style building, but if there is a flooring transition that residents can’t navigate, we have taken away all their independence.”
Even with such significant primary concerns, there are secondary factors that must be considered as well. “Cost is critical, especially with the rising costs of construction,” says Thoma-Holec. “We always seek a unique pattern with beautiful colors and aesthetics that will be easy to maintain and last a minimum of five to seven years. The flooring material must be appropriate for the residents and the space. This includes low pile, patterns without too much movement, and colors that will not become dated, while also being interesting and intriguing. Cost and aesthetics are our clients’ number one and two concerns.”
Though acoustics are a big concern in senior living, designers don’t typically look to flooring to control sound. “We use ceiling treatments and non-flooring for that,” says Wilson. “I know that LVT is getting thicker and that new products are being shown to contribute to acoustic value. I don’t think they would be the only assistance for acoustics, but every little bit helps.”
In memory care design, these concerns are even more heightened. “In memory care we’re very sensitive with most finishes, but especially flooring,” Wilson adds. “We still have the same concerns as with every level of care, but because of the cognitive issues and often visual impairment, we have to be even more careful with patterns, color changes, thicknesses and height changes. Basically, the less patterning the better. We’ve all heard horror stories about memory care residents trying to rake up the leaf patterning on a carpet or misinterpreting changes in color as steps.”
She continues, “The products also have to be very durable. Memory care residents are more likely to have spills, so soil- and stain-resistance is a component as well. Memory care has grown over the years and has become something that we find we are adding to campuses.”
It is no secret that senior care is expensive. And many assume that beautiful, design-forward options often come with a hefty price tag, but that isn’t always the case. In fact, the design team plays an important role in finding the right cost-value balance.
“Sometimes, just due to the expertise of designers, communities may look super high end but be an affordable model,” says Samantha Belfoure of Perkins Eastman. “As designers, we know which elements we can incorporate to save cost upfront and get the budget down. You can make a building look expensive without spending a lot; you just have to be creative about where you utilize resources.”
Specific to flooring, the designer comments, “In general, the cost of flooring has come down so much. It has become affordable to do higher-end looking finishes.” In the design process, the Perkins Eastman design team chooses areas that will be seen more often, budgeting higher cost materials to these. For resident rooms, back of house operations and corridors, the design team often opts for a lower price point product, also factoring rate of replacement in these equations.
Says Wilson, “We have definitely run into facilities that are too nice to be sellable. You have to cater to the area and the clientele, to know who the neighbors are. This is a critical component in senior living design versus hospitality design. Even if residents are not from the area-having moved to be closer to adult children, perhaps-they want the residence to represent them and the area they are living in. I think that’s very important, not just to create something cool but something representative of the community.”
Perkins Eastman is currently working with an organization in the Boston area that provides senior housing for populations at the most risk, like the homeless. “We’re figuring out that model right now, trying to make all the parts and pieces come together and make it operationally affordable,” says Miller. “It will happen, and it will be really interesting when it does."
WHERE THE FLOORING INDUSTRY CAN IMPROVE
Though Wilson believes that the flooring industry is largely doing well at serving the senior living sector-especially the industry’s larger manufacturers-she does feel overwhelmed by the quantity of LVT offerings in the market. In addition, she notes that, “I just want to make sure that we continue to have new offerings geared towards senior spaces. Once a manufacturer has one book with a nice collection, they can’t just ignore the sector for seven years.”
Thoma-Holec believes there’s some work to be done. “I feel that the flooring industry could better understand this market,” the designer says. “Every flooring company has come out with wood grain vinyls, with the assumption that is what designers want to use-it seems like every skilled nursing community and memory care has wood grain vinyl flooring. We want new patterns, varying colors, and carpet that is a custom look without the custom price point. Carpet mills attempt to play it safe with their colors, trying to introduce patterns and colors that will appeal to all segments of the flooring industry. The hospitality carpet mills do not understand that senior housing desires those patterns but in low pile dense products. We cannot use a 32-ounce weight hospitality carpet that is used in hotel rooms for corridors and common areas, yet the patterns and colors are often very desirable for our use. Even with some adaptations of existing products, the flooring industry could play a more significant role in the design process.”
LIVGENERATIONS AHWATUKEE
LivGenerations Ahwatukee is a Phoenix, Arizona-based community that offers independent living, assisted living and memory care accommodations. LivGenerations Ahwatukee features a number of amenities, including a salon, wine cellar, tea room, theater, fitness center, pool and spa.
Thoma-Holec reports that the many varied locations within LivGenerations made flooring specification a fun process. The lobby opens with a neutral, soft patterned carpet that complements the millwork and architectural details. “There is so much beauty in the finishes and the volume that we did not want a bold and trendy carpet,” explains Thoma-Holec.
For the heart of the three-story building, the design team specified the same patterned carpet for each level, but each in a different color to assist residents with wayfinding.
The wine cellar and bistro are wood plank porcelain, while for the Tuk Café, which is open to both the public and residents, Thoma-Holec specified a large-format porcelain with a concrete look. The Tuk Café features garage doors that open to outdoor seating; the cement-look porcelain connects the indoors to the outdoors and is accented with a coin mosaic at the serving bar.
The broadloom in the main dining area is a bold pattern that creates a restaurant vibe. “It is conducive to the function of the restaurant and allows the residents to enjoy the open view kitchen in multiple seating venues,” Thoma-Holec comments.
For the salon, the design team selected vinyl sheet goods in two patterns. The vinyl was custom designed by the firm to create sweeping arcs that add a great deal of variation and texture.
The fitness center features carpet tile in an active color and pattern to set the mood for activities in the space.
“Because of all the amenities and opportunities and with infinite flooring choices, it was critical that all floors transition from space to space without any thresholds, and with patterns and colors that do not conflict,” notes Thoma-Holec.
Thoma-Holec Design reports that it uses a lot of carpet, both broadloom and carpet tile, across the spectrum of senior living. In independent living, it leans toward the hospitality-based colors and patterns; porcelain tiles, natural stone, and luxury vinyl tiles are also go-to products for independent living.
For assisted living, the team seeks less pattern but still typically utilizes carpet in the main dining areas, corridors and common areas.
Memory support calls for porcelain wood-look tile or luxury vinyl tile in dining areas, with carpet in the corridors and living rooms.
“Our number one concern with any flooring choice is to eliminate fall risks,” says Thoma-Holec. “Transitions from materials must be smooth, not just ADA compliant. We don’t like hard surface flooring in apartment living rooms because the families and residents will introduce area rugs, which will result in a fall.”
JEWISH SENIOR LIFE GREEN HOUSE COTTAGE HOMES
The Jewish Senior Life Green House Cottage Homes are part of a large campus that offers all levels of senior care. Winters reports that Jewish Senior Life “looked at what it had in its community; considered the next set of consumers, the Baby Boomers; and realized that it needed to make some changes. It started with a master plan and, among many things, decided it needed to change the culture around skilled nursing. This is a big question in our industry, as people see skilled as ‘nursing home’ and have negative experiences and stigmas around the concept. So Jewish Senior Life embraced The Green House philosophy.”
The format of the homes allows each resident to have a private bedroom and bathroom, opening onto a communal space that features a kitchen and dining area.
For flooring specifications across the space, the Perkins Eastman team chose a neutral palette to create and reinforce a home-like feel and create a base upon which to develop the finish applications.
Belfoure prefers carpet tile to broadloom for senior living projects primarily due to ease of maintenance. “The maintenance staff can pop out tiles and replace on an as-needed basis without having to worry about color or patterning,” she explains. “It’s a lot less time-intensive than coming in with a carpet extractor. We have been using carpet tile in senior living for more than a decade.” Because maintenance staffs sometimes overlook the “easy fix” of replacing tile, Belfoure likes to have mill reps offer tutorials frequently.
“Most of the time,” notes Belfoure, “we use soft surface in spaces that are open to one another, and carpet tile is a great option because you can use a variety of looks but maintain the ease of achieving transitions. We also like to use carpet tile in corridors, sometimes with multiple patterns or colors to break up the space or signal an entry.”
Belfoure reports that some clients do request broadloom for the hospitality look, but, regardless of which format is chosen, she always opts for solution-dyed fiber, so that cleaning with bleach is possible. For the Jewish Senior Life project, the design team chose Interface carpet tile.
LVT is another material that Perkins Eastman utilizes frequently in senior living and chose for the Jewish Senior Life cottages. “We are seeing LVT more often requested,” notes Belfoure. “It has come a long way to look more realistic. We strive for no transition strips at all, so often the contractors are having to feather the floors up so that they are seamless between materials. We think the trend we’re seeing towards manufacturers thickening vinyl plank to align them with carpet is great.” For the cottages, Perkins Eastman selected two Mannington Amtico looks-Classic Walnut and Quill Sable-one for each of its two color schemes.
The team also appreciates the improving durability story for vinyl plank. With wearlayers as high as 30 mil today, the product is much harder to scratch under wheelchairs and such, and the color and patterning makes any scratching that does occur harder to see.
Ceramic was specified for the bathrooms in the cottages, and the product extends, with no transitions, into an open shower. “We use smaller format tile, so there is more grout, and it’s easier for the foot to grip,” explains Belfoure. Perkins Eastman used DalTile, Trinity Tile and American Olean products in the cottages.
Due to consumer demand, Perkins Eastman has seen the renovation cycle on senior care facilities shortened but reports that timelines of ten to 15 years are the standard. Today, a community might see that consumers want X, so they make changes to provide that.
While the senior living industry has been moving away from an institutional approach, it also has to walk a line regarding hospitality influence, because, though there is overlap, there is a distinct difference between home and hotel as well. “Initially, when the industry was working to differentiate between the nursing home and assisted living, floor plans were based on the hotel model,” explains Wilson. “The finishes were hospitality oriented, and although it is critical to incorporate a hospitality feel into these communities, it’s not always applicable in every sense. The apartment can’t be quite as efficient as the hotel room; however, you do want to encourage residents to be active with their neighbors.”
Thoma-Holec pulls significant inspiration from hospitality trends. “Senior communities must function in many specialties. It is a social model for residents, consisting of hospitality amenities, with medical services provided, with apartments and locations within that are homelike,” explains Thoma-Holec. “The majority of our designs in the past ten years are very hospitality oriented, with amenities similar to a fine hotel. We create pockets of areas that are residential; it may be certain lounges and areas that are quiet and provide residents purposeful quiet activities.”
The designer adds, “Memory support areas are always designed more residential and homelike. Purposeful activity areas are designed within that homelike setting. We design dedicated spaces for charts, storage for medication and supplies that match the residential décor, bathing rooms with carefully chosen colors and themes that reflect a spa setting, and spaces for work areas that blend with the residential design.”
So what’s to come activity-wise for this evolving sector? “Demand will be strong in 2025 or 2030, which is when the youngest Boomer turns 65,” says Winters. “We’re at the tip of the iceberg now. At Perkins Eastman, the research division is working on The Clean Slate Project, which is rolling out in February. The premise is that we know Boomers are coming and have different expectations, so we are looking to precedents outside senior living. We are looking for hospitality experience and high-quality healthcare. By looking outside senior living, we can learn many lessons. That’s really the biggest mega-trend in senior living. It’s not just senior living anymore-a separate silo-but integrated into communities and overlapping with hospitality, healthcare, mixed use and multifamily. We talk a lot about how long the term ‘senior living’ will even be around.”
BROOKDALE SARASOTA MIDTOWN
ESa was hired by Brookdale to renovate its three-story assisted living Sarasota Midtown residence and convert one floor (the third) into a memory care program, which it previously lacked. For the second and third floors, the firm was tasked with updating the common areas and corridors, but the third flooring memory care suite was a full renovation.
Wilson points out that, in addition to its many considerations in senior living design, it must also consider marketability in this highly competitive sector. For that reason, the firm tends to lean toward transitional designs that appeal to both the potential resident and the adult children who are assisting them in the selection process. “The days of wingback chairs in rose patterned fabric are gone, thankfully, “ says Wilson, “but you can’t push the design so far that it feels foreign to the residents.”
Though each community is unique, Wilson reports that the senior living locations she designs typically follow the following footprint: “For dining and arts and craft, we typically do resilient. We select carpet for its residential feel and acoustics in living rooms and in corridors. But, ultimately, each community is unique, and you have to determine how spaces interact.”
In consideration of Brookdale’s Florida location and the traditional aesthetic of the region, Wilson sought out a terracotta-toned vinyl tile to use across several common spaces in the community, including the living room and the café in the assisted living area. For the country kitchen on the memory care floor, the design team selected a wood-look vinyl plank with deep tonal variation. And for a casual gathering niche on the memory care floor, the team continued the terracotta vinyl with an inset custom CYP broadloom under the seating area.
Wilson reports that she often opts for broadloom rather than carpet tile for several reasons. First of all, she typically includes a moisture backing. Secondly, senior living operators have reported to her that maintenance teams rarely change out tiles, reverting instead to familiar cleaning methods, so an upgrade to carpet tile is not typically worth the cost. Thirdly, the firm has completed focus group studies and found that residents prefer the look of broadloom to carpet tile, as they believe the former is more residential in feel.
“Ultimately, our goal is to make sure everyone feels at home and isn’t hindered,” says Wilson.
Copyright 2019 Floor Focus
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