Acute Care 2025: Acute care flooring must support positive patient outcomes – Oct 2025
By Jessica Chevalier
The acute care sector faces a number of significant challenges, including workforce shortages, overcrowded departments, a high and increasing patient load, and the effects of cuts to Medicaid. The results of these factors are taxing for both providers and patients, but the built environment can assist in alleviating some of that strain with design and flooring solutions that increase comfort, both physical and mental; manage acoustics; and optimize cleanability and infection control.
Flooring's role in the healing environment
While all commercial sectors seek durable flooring specifications, in acute care the need for longwearing flooring has a direct impact on human health. Floors that don’t perform as they should inhibit healthcare providers from optimal performance, and patient health can be negatively impacted.
Consider, for instance, the benefits of reducing travel time between the nurses’ station, the patient room and the tools needed to resuscitate a patient in cardiac arrest. In this scenario, clear paths over supportive flooring can equate to a life saved. Whereas a floor that is slick, uneven or that has a reflecting glare can serve as an obstacle to the caregiver doing their job.
Further, an unfit floor could endanger the caregiver, leading to slip and fall accidents or physical wear-and-tear injuries that result in loss of ability to continue providing healthcare services short- or long-term.
Conversely, flooring can play a direct role in offering respite for both patients and caregivers through sound mitigation, safety and comfort underfoot, healthy material content and aesthetics that support mental wellbeing, such as biophilic looks. A good flooring specification that serves a long useful life contributes to the atmosphere of wellness, whereas one that requires damage mitigation or early replacement brings with it factors that are disruptive and counter to the healing process: commotion from tools and workers, odors from adhesives, not to mention the associated reduced service and/or bed count.
And, as nearly everything comes down to dollars and cents, a floor that lasts supports an acute healthcare system’s bottom line, allowing it to focus on its core duty: care for the sick and injured.
The larger landscape
The acute care space is in a challenging position right now, taxed under the healthcare needs of a growing and aging population yet facing uncertainty due to the $1 trillion of Medicaid cuts in the recently passed One Big Beautiful Bill Act.
The full implications of these cuts have not been totally digested as of yet, but it is clear that they will impact different regions with varied effect. More than 300 rural hospitals are at risk of closing, according to KFF Health News (formerly Kaiser Family Foundation). This loss of full-scale institutions may spur new sorts of acute care in these areas-such as micro-hospitals and urgent care clinics-to fill the gap, though patients are likely to find themselves traveling farther for care and, at times, forgoing care altogether. While a micro-hospital may include inpatient beds, an emergency department and imaging departments, it won’t offer the full range of treatment services that a full hospital would.
Complicating the challenges of acute care today, there is a well-documented care provider shortage at all levels. “Health care workforce shortages are increasing, impacting access to care and slowing patient care,” reports the National Institute for Health Care Management Foundation. “The decline of primary care clinicians entering the field, coupled with hospitals relying on costly labor contracts to fill gaps, is furthering the strain. The Association of American Medical Colleges projects a shortage of over 85,000 physicians by 2036.”
What does this shortage mean in terms of actual outcomes? “A 2015 study published in JAMA Internal Medicine found that adding ten PCPs [primary care physicians] to a population of 100,000 people was associated with a 51.5-day increase in life expectancy,” reports the Society for Women’s Health Research. The shortage of primary care providers is attributed to many factors, including the growth of need due to the aging population; burnout; medical school debt, which drives appeal for higher-paying specialty fields; and the aging workforce and retirement.
The state of affairs in nursing isn’t much rosier. “According to a Health Workforce Analysis published by the Health Resources and Services Administration (HRSA) in November 2022, federal authorities project a shortage of 78,610 full-time RNs in 2025 and a shortage of 63,720 full-time RNs in 2030,” says the American Association of Colleges of Nursing. Nurse burnout is a major factor in this shortage, as is a retiring workforce and increased need for care due to the aging population.
While historically healthcare design focused primarily on patient outcomes, today’s acute care designers understand that well-supported caregivers provide the best care, and the ways in which good design can create a better care-giving environment are numerous, especially considering that burnout is a factor in both physician and nurse shortages.
Supporting caregivers comes in a variety of forms, and, with regard to flooring, the best means of support is the right specification. Flooring should not be something the caregiver ever considers, as it does its job in enabling the provider to do theirs.
Leading priorities
More than ever before, acute healthcare corporations and the designers serving the sector have a commitment to ensuring that flooring selections specified in the acute care space are supportive of healing and wellness at the material level.
Specifiers want flooring choices that check the boxes with regard to material health, and they want access to such information easily. Free of Red List chemicals with an easily available HPD and EPD is a base standard. “We really want to encourage the flooring industry to help us get there in meeting circularity, climate and human health goals,” says Christine Hester Devens, design principal and associate vice president of HGA. Devens is based in Minneapolis, Minnesota.
“There are organizations that understand the importance of sustainability in general because their mission is tied to community health and community health as it is impacted by materials and climate issues-increased asthma, the impacts of extreme heat,” says Devens.. “There has been the perception that sustainable costs more, but I think that’s getting better. There are more products to choose from today, and we are in the position, as a design firm, to set the baseline for transparency with products and the aspirations of the (AIA) American Institute of Architects’ materials pledge.”
As important in a flooring specification, however, is ease of maintenance. With facilities teams experiencing frequent turnover, maintenance protocols can’t be overly complex and variation between material cleaning processes must be minimized.
To that end, designers look to outfit acute care environments with streamlined operations-as few different cleaning protocols as possible. If various types of flooring can be cleaned with the same method, that is acceptable. If not, it’s often preferred to have a single specification across all applicable spaces.
Boston-based Alison Faecher, vice president of interior design for SmithGroup, notes that one of the key learnings from Covid was the importance of a more rigid set of materials to withstand bleach cleaning. “That trended up in the pandemic due to material failures and streamlines the approach to infection prevention,” she says.
These evolving priorities have shuffled the deck with regard to what materials are used most frequently in acute care. And one segment that has been highly impacted is carpet.
Carpet tile is less frequently seen in waiting rooms and other public spaces than it was in the past, and part of that is the practicality of its cleanability in places where bodily fluids are not uncommon. While it’s true that many products feature advanced fibers, cleanable with bleach and other harsh agents and, in addition, the aesthetics of carpet are somewhat unmatched in terms of contributing a feeling of softness and comfort, the material cannot be cleaned in the same way that hard surface materials in the acute care environment are, so due to the fact that they are an added maintenance program, they are often deselected.
The same can be true of hard surface materials that require maintenance outside of the standard. Shutting down a part of an acute care facility to, for instance, buff and wax or otherwise maintain a floor-even annually-is an undesirable prospect. That said, Dallas, Texas-based Nicki Hellem, associate principal at Perkins&Will, always reminds her clients that “there is no maintenance-free floor.”
For both of these reasons, rubber and linoleum were two of the top product categories mentioned by this year’s interviewees, with PVC-free resilient another common choice.
Nurturing mental comfort
Creating an atmosphere of comfort begins with a patient’s first steps into an acute care facility. “It starts with making sure the space is functional for everyone, and then creating an intuitive feeling of safety when you walk in-keeping the space calm and welcoming rather than confusing and overwhelming,” says Hellem. “In acute care facility design, the number one thing we hear from clients is a desire for intuitive wayfinding. In facilities so massive, you don’t want people getting lost.” Using subtle design cues, including in flooring, to help users find their way through a facility with less signage is optimal.
Helping caregivers move through a space efficiently is just as critical. “How do we remove the mental load by making sure everything is in the right location and flows nicely?” asks Ashlee Washington, healthcare studio co-leader at Akrom Moisan, based in Seattle. “By using visual signals with finishes and flooring and, thereby, reducing stress.”
Respite spaces-locations to get out of the hustle and bustle of patient care-are also key in supporting staff wellbeing. These include lactation rooms, break spaces and access to natural light and the outdoors, where possible.
There are also ways to use design to build support amid work. “We are taking a cue from workplace and creating environments that can flex and, through design, encourage communication and collaboration. That’s a big area of focus,” says Faecher.
To achieve any of these goals, designers must, first and foremost, understand how caregivers’ work is done, and, to that end, one of Deven’s first steps on renovation projects is a Gemba Walk, observing exactly how caregivers are utilizing the space as they complete their tasks, with the goal of identifying what works with regard to space and materials and what doesn’t. Devens finds it useful to “engage users in process improvement to identify ideal future state design and develop a response that supports that process.” Improvements often center around identifying travel paths and reducing travel distances, with the ultimate goal of streamlining the workflow.
“For both providers and patients, clear wayfinding is crucial. They shouldn’t have to overthink it,” says Mariah Kiersey, healthcare studio co-leader at Akrom Moisan.
On the other side of the “mental comfort” coin is lowering stress through finishes that generate a sense of peace, most commonly implementing biophilic principles. As the basis for the space, flooring is key to setting the right tone, which can be through replicating natural materials or simply featuring color palettes reflective of the natural environment.
“There is really good research on the impact of biophilic finishes and materials in lowering cortisol and providing peace of mind,” says Washington, who likes to pull from the regional palette in incorporating nature into a space.
Adds Kiersey, “Natural light, calming colors, views of nature-these lower anxiety and make spaces feel less institutional.”
Washington points out that incorporating nature isn’t just a function of finishes but “from a high level, working intentionally from an architectural standpoint to make sure we maximize the opportunity for direct contact with nature when we have a chance.” Kiersey points to an Ankrom Moisan-designed pediatric wing at Peace Health Riverbend in Springfield, Oregon, where a playroom with a biophilic design feel opens to a small rooftop garden that allows the young patients easy access to plant life and fresh air.
Physical space
Kiersey doesn’t believe the acute care space is adding a lot of square footage at present but instead is repurposing existing space to accommodate more patients in the same footprint. This results in small remodel projects, with Washington noting, “Long term, we are going to see some of those spaces opened up to full renovation.”
That said, when square footage is added or space reallotted, what types of spaces are growing their footprints? Behavioral health has been a growth area for several years. The Bureau of Labor Statistics reports, “From 2022 to 2032, employment for many mental health-related occupations is projected to grow faster than the 3% average for all occupations. Employment of substance abuse, behavioral disorder and mental health counselors is projected to grow 18% over the period.” With those added providers comes the need for added space-both for short- and long-term treatment.
In addition, “there is a lot of emphasis on imaging and procedural spaces, which have a big impact on the bottom line,” says Devens. “There is a lot of activity around patient unit renovations in older buildings. In the Midwest, we have a lot of older hospital buildings, and there is a need to bring patient units up to date with current expectations. In general, there is a need for more beds and, in particular, infectious isolation units that can accommodate a future pandemic.”
Devens reports seeing “a fair amount of new construction” in her Midwest market. “The healthcare sector hasn’t experienced any sort of slowdown, but we do anticipate more renovation in coming years,” she explains. “And new construction might be an addition rather than a whole new facility.”
The story is different in the Northeast, where Faecher works. “Here, there is still a critical bed shortage,” she notes. “Beds are being brought on board, but it’s hard to keep up with demand. There are still semi-privates in acute care centers. Behavioral health is still exploding. Many of these patients are entering through the emergency department, and this impacts how we approach design of these spaces. Cancer care is also expanding.”
One area where Kiersey and Washington see new development is within spaces adjacent to acute care that have the goal of easing the pressure on acute care institutions. Ankrom Moisan is currently working on a behavioral health facility that will have two outpatient and two inpatient floors. The facility focus is on crisis stabilization and giving patients experiencing mental health issues a safe place to land that isn’t the emergency room. The pair sees similar facilities popping up to assist with the addicted and unhoused, with Kiersey noting that a small issue like a cut can balloon into something large and life-threatening, such as gangrene, if an unhoused person doesn’t have a means for cleaning the wound and access to antibiotics. Providing care that deals with these specific issues lowers populations in acute care environments. It’s also “a way to get funding streams,” explains Kiersey. “One recent project had 26 funding streams
because it gave people a clean, safe place to heal and helped keep them out of the emergency department.”
At the same time, emergency departments are a space in transition, with the newest guidelines including rapid care bays for quick treatment. “Since numbers are unlike what they have ever been before, there is a different format for converting areas of the emergency department to have chairs to treat people who aren’t as acute in ways that are faster,” explains Washington.
The soft story
The use of soft surface flooring in acute care varies from region to region and, to some extent, by organization. When soft surface is used in acute care today, it is almost always carpet tile.
Devens sees carpet tile used in some Midwest projects, particularly in office, administration and lounge spaces, though on a recent acute care project in Florida she worked on, there was no carpet in sight. “I would say overall, across acute care, hard surface has continued to increase,” she says. “When I started in design work, I saw an ICU with carpet in the corridors. Today, we lean on hard surface, especially since the pandemic.”
Faecher reports that the Veteran’s Administration does continue to utilize soft surface flooring, using a “tremendous amount” of carpet in its outpatient centers.
Rubber checks the box
Rubber is another product that the Ankrom Moisan team often utilizes in acute care for its myriad of benefits, including its durability, acoustics, non-reflective nature, comfort underfoot and ease of cleanability. Rubber products can also offer strong sustainable profiles and, while past iterations were sometimes unattractive, their aesthetics have improved greatly in recent years.
The Ankrom Moisan team recently utilized rubber on the pediatric roof deck space, where a labyrinth pattern was created to provide entertainment for the child patients.
Devens often opts for Nora rubber sheet for acute care spaces like imaging and a thicker version of rubber products for spaces like elevator cabs and on stairs.
These thicker versions are also used in places where healthcare providers will be standing for longer periods, such as in operating rooms, says Hellem.
“We try to mitigate physical stress with flooring products that are easier on the hips, for instance-a nice dense rubber flooring underfoot for sound and also for stress on bodies,” says Faecher.
In addition, the material can be used in a sheet form for spaces that require seamless flooring or can be used to create patterns to assist with wayfinding or simply complement the design concept. And rubber tile products offer ease of replacement, just as other modular products do.
“Acoustics is a huge element where rubber offers benefits, especially for inpatient, ICUs or NICUs or med-surg,” explains Washington. “We tend to assume that flooring won’t have a huge impact on acoustics so whatever material ends up there will be okay. But if we get something absorbent, like rubber, it adds to that level of quiet.
“Once a facility buys into rubber and understands its cleaning, they get it. While sheet vinyl requires waxing and polishing, you don’t have to do that with rubber. It’s pretty low maintenance. You do have to carefully choose colors in place like the operating rooms, corridors and any places where betadine is used. As long as it’s not too light, it looks great long term.”
Devens concurs, adding, “Assuming a healthcare organization is set up for maintenance of rubber, which isn’t more than other flooring products but is different, and presuming there are contractors in the area that can install it, it’s really a successful solution for acoustics, low sheen, carts being rolled across it.”
She continues, “First cost is a factor, but in acute care, where function is so demanding, lifecycle cost is more important. Taking down a space to address a flooring failure is very costly and really undesirable.”
Linoleum: Longwearing & sustainable
Linoleum is another great acute care solution if a facility is willing to consider its lifecycle cost and invest in it. “We often use Forbo’s Marmoleum if a facility is looking to be sustainable,” says Kiersey, who notes that she has recently had several projects with one or more funding sources linked to sustainability.
“On a recent behavioral health project, we used a linoleum through all the spaces,” adds Washington. In addition to its sustainable profile, linoleum is long-wearing, easy to clean and highly durable.
Faecher recently specified a facility’s worth of linoleum in a location where the prior linoleum had been in place and performing well for 20 years.
Devens recalls that linoleum has resurged at different points throughout her career. She says, “I did a whole hospital in it 20 years ago, then the industry moved away from it, though some clients have been standardized on it for years.” Devens says that Forbo’s ArmorCove flash coving has been a boon, noting that previously,“clients would complain about the crack where the floor met the wall. ArmorCove addresses that. It makes linoleum, which is less expensive than rubber, easier to use in some installations.”
Similarly, Devens points to Nora’s Sanitary Base as a solution in rural regions where there may not be installers as adept at installing integral cove base. Devens adds, “It’s costly but solves installation challenges.”
Reformatted resilient
Vinyl products are go-tos for acute care, both in sheet and modular formats, although the designers we interviewed report that they seek PVC-free and phthalate-free solutions with biobased plasticizers for acute care specification. “We want to make sure we balance that with long-term durability,” says Washington. “We are looking for low-VOC and products with good FloorScore ratings. We want to put in the healthiest product that we can.”
That said, “healthy” is not enough. “We are going to look at wearlayers, durability ratings,” Washington continues. “You can’t just choose a product because it’s PVC-free. That’s one of many factors. And there are times when it just isn’t the right fit.”
In her acute care work, Faecher leads discussions with the suggestion of PVC-free vinyl products, even if particular systems don’t have those standards in place.
None of the designers report having any performance issues around their PVC-free specifications.
Of the product formats, LVT is the go-to for spaces that don’t require deep cleaning, while sheet vinyl is used for spaces that require a seamless format and stringent maintenance protocols.
In lieu of soft surface, the Ankrom Moisan team like to specify materials that have a textile-like quality in order to create a more hospitable-less clinical-environment. Washington reports that woven-look resilients allow her to maintain a softer aesthetic, as do hybrid materials like J+J’s Kinetex textile flooring, which is also highly durable.
Poured in place
Devens will often look to resinous flooring for locations like pharmacy clean rooms with strict code requirements around cleaning and seamless installation. One of her clients prefers Sherwin William’s Dur-A-Flex. Another product she’s interested in is Sika’s Comfortfloor, a poured epoxy that offers strong acoustic properties and underfoot comfort.
Terrazzo is a great option for lobbies, says Devens, due to the fact that it is long-wearing and aggregate can be sourced regionally.
Relationships matter the most
As a specifier, one of the greatest priorities for Hellem is supplier responsiveness-from prior to product installation to post-installation: being accurate on lead time, providing information around material content and performance, and, most importantly, resolving any arising issues-regardless of their origin-in a timely manner.
Hellem agrees, noting that what’s most important to her with regard to a specification is how manufacturers respond when issues do arise, even if their product wasn’t the origin of the problem.
“We have some amazing reps, who are so strong technically, responsive, and it would be great to have that consistently for every product,” says Faecher. “We have failures regularly. It’s not always the product-it can be maintenance-but, regardless, we need a response quickly. We have had manufacturers replace a failure that may not have been their fault; that is part of maintaining longstanding relationships. Having that level of trust is super important and tends to drive decision making. There are a lot of good products to choose from; we need to know that we will be well supported.”