Senior Living Update: Designers must meet requirements while fulfilling design directions - Feb 2018
By Beth Miller
Senior living communities are no longer a place where patients go to wait out their remaining years, but rather a home where every element incorporated into the design of the facility is in place to encourage mobility and foster a sense of vitality and wellness. The current state of senior living design is being driven by the Baby Boomer generation. The amenities they seek are more extensive than previous generations and are more akin to hotel offerings.
Boomers are an active generation that seek a wide variety of services. They desire multiple social spaces and dining venues. This sort of “out with the old and in with the new” mentality has challenged designers, facility owners and product manufacturers to design environments that not only meet healthcare design requirements but also incorporate the wants and desires of the current generation.
It is no secret that the healthcare community has been preparing for the influx of Baby Boomers into hospitals and senior living facilities. In 2000, the number of residents age 65 and older stood at 35 million. In 2016, that number swelled to over 49 million. With such significant growth, senior living design has been forced to evolve to meet requirements that are the result of research, trial-and-error, post-occupancy surveys and roundtable discussions. Evidence-based design (EBD) plays a big role in healthcare design. The Center for Health Design, a non-profit organization made up of healthcare designers, defines evidence-based design as “the deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.”
Jane Rohde, principal and founder of JSR Associates in Catonsville, Maryland, has devoted her career to improving the lives of older adults. Her focus is the de-institutionalization of senior living facilities through consulting, research and advocacy. She works with non-profit and for-profit developers, government agencies and senior living and care providers. According to Rohde, “Using evidence-based design is part of a successful planning and programming process. Research needs to inform decisions, particularly around mobility and transfer, fall risk, and supporting as much independent capability as possible for older adults.”
Currently, the senior living industry is in a state of growth, despite the Great Recession and its slow rebound. Many of the designers interviewed indicated that this did not have an impact on the growth of the segment, as the demands for the communities were high due to the influx of Baby Boomers into retirement; however, many projects were impacted on an individual basis, delaying build schedules for years. It is worth noting that while the projects may have been delayed, other projects in different commercial sectors slated for the same development never came to fruition, but the senior living facility eventually got back on track and was completed-a testament to the demand.
Sustainability is no longer a box to be checked when deciding on the project goals. It is now, through manufacturer product development, an inherent trait in a wide variety of flooring and paint products.
Perkins Eastman has purged its libraries nationally of any unsustainable materials. The firm hosts several in-house experts in material sciences, who ensure that the products specified for projects meet the firm’s high sustainability standards. In the case of the Atria at Foster Square project, Becker says, “All of the materials in the project were sustainable and were chosen so that they cause no harm to the residents.”
Bethany Harris, associate principal with RJTR Design, explains that even if a product is not labeled as a green product, the firm chooses to use the product responsibly, eliminating unnecessary waste. Harris says, “We want to do the right thing. We want to specify products that aren’t going to contribute to a variety of waste. One of our biggest struggles in senior living is the corridor width. What broadloom width is available and appropriate to meet that corridor width?”
Lisa Collins, ASID interior designer with Living Designs, says, “Environmentally friendly products aren’t unusual anymore. They aren’t something you have to search hard for. Most of the [manufacturers] I work with are already environmentally friendly. They are already ahead of the curve with that because that’s been coming for a while. The flooring has no odors from floor finishes. They use 75% post-consumer recycled content and the carpet is 100% recyclable. Even the paints are low VOC.”
SENIOR LIVING MODEL
The Small House model with “households” of ten to 12 residents continues to be the standard for memory care and skilled nursing. Within these households, residents share common living spaces in a residentially designed atmosphere. However, Joyce Polhamus, vice president and office director with SmithGroupJJR in San Francisco, California, says, “The household model is definitely the current preferred model of care and has expanded beyond just memory care. The principles are applied to assisted living and skilled nursing. I don’t see that changing in the future. The linking of households may offer more amenities between households.”
According to Rohde, the household model has endured for ten years without any significant changes to the model. She says, “The hope is to continue to evaluate this household model for not only those with memory care, but also assisted living and independent living. The future model for senior living is multi-generational, non-isolating, and bringing further normal/daily life opportunities to all residents.”
The purpose of household models is to take a person-centered approach that impacts the physical environment, which, for senior care, means eliminating corridors to foster movement throughout the facility. But there is more to it than simply removing corridors. Older adults with physical and cognitive impairments struggle with traveling down connecting corridors that extend for long distances. Instead, residents are encouraged to walk shorter distances or do a loop with clear landmarks. The landmarks can be anything from a piece of artwork, a sculpture or another feature that is easy to remember. Rohde says, “Signage that is consistent-this includes contrast in the typeface and lettering that is large enough to easily read-is important.”
Corridors do serve a purpose. They give the resident bedrooms both a sense of entry and privacy. Polhamus adds, “Sitting alcoves, decorative niches for display and casework can all line the corridors to make them more interesting and assist with wayfinding. For seniors, the journey is important, and elements of support or interest or casual interaction can be important to enhance their well-being. The goal is to keep residents moving as much as possible, and making the corridors interesting and accessible will help.”
A common thread running through the case studies that follow is the use of artwork throughout the project. The artwork offers residents a method of stress relief in the form of a creative outlet. Art installations also serve as wayfinding devices, landmarks, as Rohde puts it, to help residents navigate through the space.
Wayfinding elements, including the use of color and pattern, vary depending upon the senior living setting. Rohde says, “For memory care, it is appropriate to use contrast between walls and floors, but floors need to be tonal to avoid confusion, create a fall hazard and even invoke vertigo.”
But how far is too far with color, contrast and pattern? Polhamus says, “Sharp contrasts have always been an issue and an opportunity. Edges defined by contrasts are important and the blending of colors and textures (not patterns) can ease transitions into spaces and aid in wayfinding.”
High contrast can create fall risk opportunities for residents. The drastic variation in light and dark colors can cause a false step or perception of a hole that can cause a fall. Rohde says, “The use of neutrals without color will all blend as a grey tone for aging eyes. Using contrast and color in the right way can improve the quality of life for a resident.”
Flooring choice takes into consideration infection control, durability, desired service life, cost, lifecycle costing, sustainability and safety. Rohde says, “Inexperienced designers have a tendency of focusing on aesthetics, which are enormously important but are not the only characteristic for selecting and specifying flooring.”
Carpet is preferred to help with a number of issues. It helps prevent falls, creates a softer surface if a fall does occur and helps with sound control. Polhamus says, “The key is a low pile that will not grab the sole and precipitate a stumble. The density of the carpet is extremely important in allowing rolling traffic to move easily.”
However, the primary issue with carpet is cleanability. In a senior living environment, incontinence is a concern, which leads to cleaning issues that can result in the premature failure of a soft surface product. Rohde says, “A community has to have the capacity to learn how [to properly clean carpet] and update training and educational processes on cleaning-if you can’t clean and disinfect, then a product will fail. However, if a facility’s maintenance team is committed to soft surface and works with the design team to come up with a product solution, they can be very successful.” As for life expectancy, resident areas often require that the soft surface flooring be changed out when the tenant leaves, loosening the requirements on the product due to the shorter life expectancy.
Hard surface has certainly taken a great deal of profit share from soft in the past few years. However, senior living is one segment where soft surface is often preferable. According to Rohde, “Hard surface flooring, aesthetically speaking, is light-years from where we were even five years ago. The wood plank has been the go-to, but now we are seeing linens, stones and other types of interesting patterning with the digital capabilities that are available.” Of all the hard surface products offered, LVT is growing the fastest. It offers durability and a waterproofing quality that makes it an ideal product for healthcare. Rohde adds, “The technology that has allowed for the development of LVT and products that extend beyond the ‘wood plank’ aesthetic have provided the tools for designers to expand creative design solutions for senior living settings.”
Dr. Lorraine Hiatt, an environmental gerontologist who specializes in planning, research and design for aging, based in New York, New York, contends that there is more work to be done in the research surrounding flooring choice in senior living. As a patient advocate, Hiatt says, “We are not utilizing flooring as a major stepping stone into maintaining mobility because if the floor is perceived as slippery or a falls risk, the individual is more likely to be sedentary-and sedentary behavior is really anathema to what vitality and aging is all about. It is critical to the good life and old age that we take on these challenges.” According to Hiatt, the ability to address these issues is there. She says, “We have all of these issues of falls and the cost of falls, and we’re not addressing them with handsome-looking, easy to maintain, easy to walk on, inviting flooring.”
Inevitably, there will always be a trade-off between performance and aesthetics when it comes to flooring choices. Hiatt recognizes that flooring choice is more complicated than simply ticking off a list of flooring criteria for older adults. According to Hiatt, designers and facility owners, in order to be marketable, may have to accept a high quality, high maintenance product “in one market and not in another, and yet both are subtly user-friendly to people who are older.” However, she believes there is a way to keep the criteria on the forefront but to award the successes when designers try out a product they have never used and discover that residents respond positively.
ATRIA AT FOSTER SQUARE
Atria at Foster Square is a senior living community that offers 131 assisted and independent living units, with 24 designed specifically for memory care. Located in Foster City, California, Atria is a new construction project in a public plaza, right next door to the town hall. Matthew Becker, Michael Dungca and Olivia Munoz of Perkins Eastman’s San Francisco office led the interior design on this project.
The 194,000-square-foot, six-story facility focused its design efforts on biophilia due to the number of natural elements that surround the area. Situated between San Francisco and Silicon Valley along an estuary, Atria at Foster Square caters to an upscale clientele. Originally filled with orchards, Silicon Valley, despite its many developments, continues to harbor the essence of its surrounding beauty, which Perkins Eastman used to select the color palette. Fabrics and flooring were chosen to mimic the color and texture of the surrounding trees and bodies of water.
The first feature that greets guests is Atria’s hotel-like porte-cochère, which communicates the upscale feel that Atria exudes as well as offers a safe drop-off point for both residents and guests in the midst of a bustling urban setting. Once inside, a large commissioned painting of an aerial view of Foster City adorns the wall behind the lobby’s reception desk. To the right of the entrance is Poppies Bistro, one of three dining areas available throughout the facility.
Perkins Eastman is increasingly incorporating strong visual imagery into its projects. Large pieces of art were used primarily on the second floor, considered the main level, to enhance the visual character within Atria’s walls. The main level hosts the majority of the social spaces and amenities, such as a theater, salon, fitness center and wellness center.
The combination living room and library located on the main level uses Shaw Contract’s EcoWorx performance broadloom to add warmth to the home-like space. Choosing to use the same flooring throughout both zones adds to the openness of the space and fosters movement between the two. “Even in a very open floor plan where spaces flow to spaces, you get a visual cue from the flooring of the main track through-so there’s embedded wayfinding via the materials,” explains Becker. Flowing from the living room/library area is the elevator lobby and the 707 Lounge.
Located on the backside of the 707 Lounge is the theater, installed with Tandus Centiva’s Powerbond six-foot carpet, a solution-dyed product with a waterproof PVC backing that is 100% recyclable through Tandus’ ReStart recycling program. Next to the theater is the Bayview Restaurant, where the menu rotates through the seasons. The northeast wall of the restaurant is lined with glass windows as well as a terrace for dining outside, further enforcing the biophilic design that Atria seeks to provide for its inhabitants.
Various colors and patterns of Powerbond carpet were used in all of the corridors, while the resident apartments were specified with Shaw Contract EcoWorx performance broadloom. The fitness center continues with the Shaw Contract products but in a carpet tile with EcoWorx backing.
Located in Franklin, Tennessee, just outside of Nashville, the Somerby senior living community was completed in the summer of 2017. Drawings for the facility, which includes 136 independent living units, 48 assisted living units and 24 memory care units, began in January 2015. Bethany Harris, associate principal with RJTR Design out of Atlanta, Georgia, led the design charge on the project. The focus of RJTR Design was to bring hospitality-like elements into the project.
The overarching goal for the project was to create a floor plan to connect the independent living building and assisted living building, which includes the memory care units, via a commons building. The dining area, medical clinic, swimming pool and fitness facility are contained within the commons building.
Entering the four-story independent living side of the facility, the reception area welcomes residents and guests with an installation of Florim USA’s Layers stone-look ceramic tile along with Mannington’s Nature’s Paths wood-look LVT plank. However, the bistro is the focal point of the reception area. As the social hub of the community, the bistro was strategically placed in this central location to allow residents a space to gather where others, including staff and visitors, are coming and going. Harris admits this was a huge design shift from previous projects, but it is a change that has proven to be successful. Ceramic Technics’ Pavimenti wood-look porcelain tile was used in the bistro.
Connecting to the independent building is the commons building, where residents can indulge in a variety of amenities. Another strategic design element, the commons building encapsulates all of these services essentially just down the hall from the bistro. This straight shot approach is inherently a wayfinding device that keeps residents moving between the two areas. They can go down the hall and participate in a yoga class and afterward head back up the corridor to the bistro for a smoothie.
Flooring choice is a critical element in senior living design. Harris says, “It’s the one surface everybody touches. That’s where I start when I design an interior because we have to check all of these boxes. From there we can choose any paint color in the universe-we can create a custom wallpaper pattern if we need to-but the flooring is the keystone to it all.”
One of the critical components Harris always looks for in carpet is 100% solution-dyed fiber, because of its cleanability and longevity. She says, “To find something that is 100% solution dyed in a pleasing color palette can sometimes be difficult, and then the next step to that is the backing. Typically, we want moisture barrier backing, and then, on top of that, we like to find a product that is going to be economically mindful.” According to Harris, one of the biggest selection issues is locating a broadloom product that is an appropriate width to accommodate the corridors. Most products are much wider than is necessary, creating a great deal of product waste. Harris believes that carpet tile is the obvious remedy to the problem. Tile can easily be changed out if it gets stained, and it minimizes product waste at the time of installation. However, in most cases, carpet tile still has a corporate look, making it unappealing to place in a residence space.
Chosen for its hospitality feel, Bolyu’s Loft broadloom with Puralex odor eliminator was placed in the resident rooms. While a hard surface product would seem the obvious choice for a dining area due to its ease of maintenance and durability, RJTR went with Tandus Centiva’s Powerbond for its acoustical properties and its built-in moisture barrier backing. Harris had to take into consideration the impact of rolling carts, heavy traffic and spills. If a spot does stain, the section can be cut out and replaced.
One of the products Harris is most impressed with is Mannington’s broadloom carpet with Integra HP moisture-barrier backing. What is unique about this product is that the broadloom can be chemically welded to the Mannington LVT products, eliminating the need for transition strips. Based on resident feedback from post-occupancy surveys, the transition strips were problematic. Residents indicated that the strips were often aesthetically unpleasing, installed improperly or a trip hazard, or they failed in some other way. So the welding remedied those issues. The hubs connecting to the corridors used LVT while the broadloom was installed in the corridors.
Harris sees that the younger generations coming into senior living want more color. And the current trend toward more subdued color palettes with pops of color present in the furnishings may become a thing of the past. According to Harris, the residents are controlling the design trends. “What the residents are expecting and what they are gravitating towards and willing to spend their money for is a concierge service,” she says. “It’s just a different level of service. I think, coupled with that, people are expecting a different level of design as well.”
THE VIEW AT PINE RIDGE
The View at Pine Ridge, located in Oconomowoc, Wisconsin, is a new construction project that was completed in two phases. The first phase of the build was a 26-bed community, and phase two added another 46-bed community and divided up the units based on the needs of the individuals in the area. It is a combination assisted living and memory care facility.
For the collaborative project, Living Design’s Collins, located in Waterford, Wisconsin, worked alongside Kimberly Otte-May, operations consultant for The View at Pine Ridge. In addition, the kitchen, maintenance and other staff members were consulted to help choose the design elements within their respective areas.
Included in the design are spaces that support a Creative Expressions program, a bistro, couple’s suites and on-site therapy. The View also offers highly trained dementia specialists to assist the memory care patients. Collins says, “The whole building is designed to support the [residents] creative expressions, physical activities, social activities. The entire building supports a full purposeful lifestyle. Who is going to be active, and what areas were going to be needed by those who require the 24-hour care? Now, we focus more on the person and design spaces that offer real choices based on wants and desires. We call it a therapeutic environment.”
The color palette is based on the natural elements that surround the facility, and Otte-May says that they get lots of compliments on the therapeutic feel that the color palette imparts. Collins says, “We want the building to feel one with nature with its screened-in porches, courtyards, visual access to outdoor spaces, natural light and big windows.” The abundance of large windows helps keep lighting levels consistent when moving between the outside and the inside, since seniors have trouble with their eyes adjusting to changes in lighting. Seniors also experience a reduction in visual contrast as they age, so the specific items residents need to see, such as handrails and chairs, are highly contrasted against the other elements in the room.
A bronze waterfall sculpture is the focal point as guests and residents enter the front doors and step onto the Teknoflor wood-look luxury vinyl plank. High ceilings with windows let in a lot of natural light as they make their way to the bistro directly ahead. The luxury vinyl plank transitions to Mannington Commercial vinyl tile in the bistro area. And the bistro opens up to an interior garden area where outside seating is available.
Beyond the bistro and garden area, the facility opens up into two different sides, one for assisted living and the other for memory care. Upon entering the assisted living side, artwork created by the residents adorns the walls. According to Otte-May, art classes provide the residents with a continued purpose that she feels is certainly important.
In the assisted living dining room, Collins incorporated a fireplace surrounded by a sitting area, providing residents with a social space in which to gather. This space has proven to be a successful design element. According to Otte-May, the early risers make their way to the comfortable chairs, enjoy a cup of coffee and a piece of toast, read the newspaper or watch the news on the TV while they wait on breakfast to be served. Teknoflor wood-look luxury vinyl plank was also used in the dining area.
A great room off of the dining room offers more high ceilings and lots of windows over J+J Flooring’s Tussah carpet tile. Screened-in porches are located just behind this room where residents can sit and overlook the surrounding landscape.
To foster a built-in wayfinding element, each half of the building is purposefully shaped like a rectangle. This design leads residents back to the common space. All corridors and resident rooms use J+J’s Sidestreet carpet tile. Using the same product in both spaces prevents the appearance of a change in flooring height. The choice to use firm, dense carpeting was purposeful in that it helps to facilitate balance.
Flooring was specifically chosen to protect residents in the memory care building. Just before the exit doors, black carpet tiles are used to signify a shift in location. “It is known that memory care [patients] won’t step on black areas because they feel it is a hole,” says Otte-May. “That prevents elopement risk.” Carpet tile was also chosen for its ability to easily be removed and replaced to help remedy incontinence issues.
Commenting on the evolution in design over the last 20 years. Otte-May says, “We started with small rooms, shared baths and small common spaces. Now, we moved to a more innovative footprint where you basically have larger, more spacious apartment-style units, and more flexible common areas for multi-purpose use so that those can be used to focus on the individual. And, of course, a huge focus on preventative healthcare, fitness and wellness.”
THE CARDINAL AT NORTH HILLS
The Cardinal at North Hills is a new continuing care retirement community (CCRC) in Raleigh, North Carolina. CCRCs are retirement communities with accommodations for independent living, assisted living and nursing home care, offering residents a continuum of care. The six-acre community includes four living options: independent living, assisted living, memory care and skilled nursing care. The Cardinal is a private-pay community that houses 165 independent living units, 27 assisted living units, 18 memory care units and 15 Medicare-certified nursing units. Nancy Borum, principal, and Warren Kestler, project manager, with ID Collaborative, located in Greensboro, North Carolina, were in charge of design.
A first for both the design firm and the facility owner, The Cardinal is located in a downtown urban setting right in the heart of a shopping area-both the design firm and the facility owner typically build in the suburbs. The design focus for the project was a hospitality-concierge philosophy combined with health and wellness, building on the six dimensions of wellness: emotional, physical, social, occupational, intellectual and spiritual.
The Cardinal’s overall design is a contemporary modern look in a two-tower construction with a centralized clubhouse. The 35,000-square-foot clubhouse boasts a selection of high-end amenities, including an indoor heated pool and spa, fitness center, salon, library, art studio, game room, theater and woodworking shop. Located on the first two levels, nursing care and memory care are designed as households, providing the residents with a relaxing atmosphere that promotes independence and reduces anxiety.
The goals for the project were, first and foremost, to break the norm of what constitutes senior living with its traditional furnishings by incorporating contemporary design elements, keeping senior needs in mind. Secondly, Borum explains, “Something that we strive for and wanted to really focus on here is that you walk into this high-end independent living lobby and your apartment quarters are nice and elegant, but you don’t trade down when you go to assisted or skilled. The look of the facility and the upscale feel and the promotion of wellness is maintained throughout the levels of care.”
According to Borum and Kestler, the project was slated to go up ten years ago. But following The Great Recession, people couldn’t sell their primary residences. It wasn’t until the economy picked back up that the project got underway. Something to consider is that in that amount of time, the design elements can go out of style, and the technology within the communities can change dramatically. With Raleigh being a huge technology hub with the likes of IBM and Northern Telecom, the technology incorporated into the senior living communities is important to the tech-savvy generation of younger Baby Boomers now entering the facilities.
In terms of the hospitality-concierge approach, Kestler says, “The amenities blended in with how the design worked. The front desk is a reception desk and a concierge desk. That’s why there’s two. We are also always thinking of flooring transitions.” Borum adds, “We are big about elevation heights staying the same. No transitions for wheelchairs or walkers.” The same goes for the resident unit bathrooms.
On ID Collaborative’s soft surface list was Brintons’ custom wool broadloom, which was used throughout the project in the independent living dining room and living room, reception, entryway and staircases. Brintons is a British manufacturer of Axminster broadloom products with multiple locations all over the world, including the U.S. However, the wool products could not be used in skilled nursing areas where a solution-dyed fiber was required due to the greater flexibility in cleaning. Two Masland broadloom options were available to the residents for the apartment units. The assisted living library and multi-purpose rooms used Mannington broadloom with moisture backing.
On the hard surface side, Ecore recycled rubber flooring was specified for the fitness center, and Ecore’s Forest RX was installed in the yoga room. Mannington LVT was used in the spa lobby, while the salon, bistro and assisted living dining room used Shaw Contract LVT. “One thing that’s so wonderful about the LVT flooring is that we went down a main corridor, and we separated from the hospitality carpet in the lobby to a nice grey LVT flooring, which was elegant and worked with the color scheme and then carried you right into healthcare. Then we picked back up with a moisture-backed Mannington product, but all in the same color scheme, so the residents don’t sense [the product shift] when turning the corner to go to assisted living,” explains Borum.
Each designer indicated that there are significant differences in the needs and desires of the various generations that now reside in the senior living communities. The Silent Generation, aptly named for their conformity, were born between 1925 and 1945. They prefer simplicity and consistency while the Baby Boomers are proving to be demanding when it comes to all aspects of senior living design, services and amenities.
According to Matthew Becker with Perkins Eastman, the Silent Generation does not want multiple dining options but rather a communal dining hall where they can be together, similar to a mess hall with no difference in food service. They need the daily staff operations to remain the same. On the other hand, the Baby Boomers prefer a boutique approach. They want multiple food venues and a variety of social spaces. They’re used to being catered to and enjoy all of the perks that come with that level of service.
Kimberly Otte-May, operations consultant at The View at Pine Ridge, says, “When you compare the Baby Boomers to the Silent Generation, I think [the name] says it all. The Silent Generation was accepting of everything. They were thankful for everything. They didn’t want to complain, and so they were more complacent. They felt blessed to have heat, electricity, a light over their head and food. The Baby Boomers are demanding. They have high expectations. They are definitely individualists where one size does not fit all. So you have to be very mindful of providing or addressing the wants and needs-and they are so varied now. It’s definitely more challenging.”
Living Design’s Collins says, “The Baby Boomers are focused on health and wellness, lifelong learning, a full and rich lifestyle. The Silent Generation were happy with the simple things. They never complained.”
According to RJTR’s Harris, “The Silent Generation’s daily work was very physical. Now that they are retired, they want somewhere to rest. Whereas the Boomers, now that they are retired and done working, they want somewhere to be active-fitness facilities, swimming pools.” As for dining, Harris adds, “The older generation had a favorite restaurant where they had the same waitress and ordered ‘the usual’ every time. Boomers want variety. They don’t want to eat at the same dining room. They don’t want the same menu.”
Nancy Borum, principal with ID Collaborative, says, “The Eisenhower generation was ‘That’s fine if that’s what you want us to have. I can accept that. That’s just fine.’ The next crowd is very demanding with a high expectation level.”