Trends in Senior Living: The changes wrought by Covid will alter senior living design and flooring – March 2022
By Jessica Chevalier
Senior living facilities and their residents and staff were hard hit by the Covid-19 pandemic. There are nearly one million senior living care beds in the U.S., and, according to the Kaiser Family Foundation counts, more than 201,000 senior living residents died from Covid-around 20% of the senior living population. As a result of this devastating event, the design of senior living facilities is being reconsidered and tweaked in an effort to minimize loss and increase flexibility, with the goal of creating safer and more functional spaces should another Covid variant wreak havoc or a similar healthcare event occur in the future.
Creating more pandemic-safe spaces impacts a range of considerations, including the way in which residents are housed, the way that community space is divvied up, the changeability of all spaces to meet the needs at hand and the finishes used, flooring included.
“Senior living is an environment of care,” says Allison Wolff, director of healthcare and senior living markets for Shaw Contract. “And if there is anything the pandemic has taught senior living, it’s that it must provide care to residents in the most terrible of situations, so any product that goes in has to protect residents.
“This parallels with acute care. So, if we have a situation where people are in quarantine, what parts of the space can operate like acute care? We are seeing a transformation around huge dining halls, which could not be used in Covid. In these types of events, the space has to be utilized in other ways, and there are certainly some flooring products that will lend themselves more to that type of transition than others.” Shaw has a full suite of hard and soft flooring products for senior living clients, including turf, which is being used more frequently due to the trend toward creating outdoor socialization zones.
The need for mutable space impacts the type of flooring chosen. “We see some senior living providers deliberately designing communal areas with the ability to flex into healing spaces,” says Kathy Griffel, senior director of healthcare sales for Mannington. “A multipurpose area that may have previously used LVT now might be designed with sheet vinyl, so the space can convert quickly into a more sanitary environment.”
In many ways, according to Margaret Bartholomew, segment manager of healthcare for Tarkett, today’s senior living A&D teams are designing for the next potential pandemic or global disaster, hoping to mitigate adversities for both residents and staff with forethought and planning. Tarkett offers carpet and carpet tile, sheet vinyl, LVT, rubber and linoleum for senior living specification.
At present, senior living is active with both new construction and renovation projects. “According to some sources, the overall growth projections for the senior living category are estimated to be around 5.3% [compound annual growth rate] from 2021 to 2027,” reports Laura Holzer, design manager for carpet at J+J Flooring Group. J+J, a division of Engineered Floors, provides broadloom, carpet tile, Kinetex textile composite flooring and LVT products for the senior living sector.
Adds Mannington’s Steve Hadrych, senior director of healthcare sales, “With Covid’s influence on living and construction schedules, remodel work and updates of existing facilities will drive a substantial amount of our clients’ demands. Many of these projects have been delayed to keep the safety of residents and caregivers front and center. We see the assisted living sector most active with bed count and project value in planning. Tied to this sector is memory care, as these often co-exist on the same property.”
Shaw and Patcraft’s Sole with SensFloor Technology, installed beneath a floorcovering, enables senior living staff to remotely monitor activity within the space. In a senior living environment, this is useful in a number of ways: it can signal when a fall-risk patient is out of bed so that they can react and prevent a fall; it can signal an actual fall, enabling staff to react immediately; it can alert staff when a patient is in a location of greater risk, such as the shower; and it can monitor movement or visitors within a space.
And for staff, it provides a peace of mind knowing that they can, in fact, be in more places than one, virtually, to greater care for and protect those in their charge.
TRENDS IN FLOORING
The flooring specified for senior living is largely driven by the type of care being provided in the space. In independent living facilities, the flooring is residential products with a standard residential look. These spaces are homes, and the design intention is to make them as warm and familiar-feeling as possible. Broadloom and LVT are common choices for these zones.
While independent living residents are mobile and able to care for themselves, the goal, of course, is to remove any risk of them becoming less so, and tripping hazards can be both a barrier to independence and a danger. In the last couple of years, many flooring manufacturers have rolled out complementary soft surface and 5mm LVT collections that abut without the need for a transition strip, and the value these offer is greatly appreciated by designers in senior living. Another major concern for flooring is slip-and-fall hazard, which can be remediated by products with a higher coefficient of friction.
As the level of care increases, flooring specifications must offer greater performance as related to moisture resistance, cleanability, rollability and infection control, so vinyl and linoleum sheet products become standard choices. While sheet linoleum isn’t considered truly seamless-meaning that it won’t be used in a highly clinical space-it is a good choice for senior living facilities seeking PVC-free materials.
Antibiotic-resistant infections, such as MRSA, and hospital-acquired infections like C. difficile are a significant concern in senior living facilities, so skilled nursing facilities often opt for products that can be fully seamed and therefore fully disinfected.
In addition, cleanability is increasingly important as the level of care rises; while incontinence plays a role here, residents with shaky hands or unsteady feel are more likely to spill drinks or drop food. In these times, clean-up must be both effective and simple. Understaffed facilities simply don’t have the time or hands to devote more than a few minutes to a clean-up. And fragrant or chemical-scented cleaners may irritate residents. For these reasons and others, hard surface flooring is taking greater share in senior living.
“The biggest change that we have seen as a result of the pandemic is in how facilities evaluate the cleanability of their surfaces,” says Keith Richardson, Patcraft’s director of performance markets. “We have been very intentional on the front-end, educating clients on the right processes and products to maintain both hard and soft surfaces. The pandemic caused many facilities to rush to harsh cleaners and chemicals to try to kill the virus but ultimately ended up damaging their fabrics and surfaces. The staffing shortages have also placed a major strain on communities. The square footage to maintain has remained the same, but the amount of staff to care for the space has been drastically reduced.” Patcraft has carpet tile, broadloom, sheet goods and LVT products for use in senior living.
At the same time, however, elders often face auditory challenges, so the environments in which they are living must include acoustic mitigation tools in order to ensure that they are able to communicate with and stay connected to others.
“We see senior living products as a hybrid of the best-performing commercial floor with the most beautiful residential floor,” says Griffel. “Senior living products must seamlessly work within their care space. Many high-end independent living communities have an initial buy-in of close to a million dollars. Designers for these spaces must meet the prospective residents’ expectations. Then you have adult children selecting a place where Mom can live with dignity as she deals with the onset of dementia. Two different properties, two different goals: a multitude of emotions and demands on design and products.” Mannington manufactures broadloom, LVT and rubber flooring products for use in the senior living market, as well as accessories.
HMTX offers a host of LVT products for senior living in a wide range of price points and with a variety of wearlayers. One newer product the company has added to its senior living portfolio is its Déjà New with Attraxion, a product that installs via magnetic attraction rather than with adhesives. The company reports that this combats a number of challenges for senior living facilities, including elimination of the use of messy and potentially odorous adhesives and easy replacement of damaged tiles without the need for a professional installer, as well as offering changeability with regard to wayfinding cues and signage.
As a strictly resilient manufacturer, Gerflor offers vinyl and linoleum products that are most often utilized in skilled nursing or rehabilitation areas of senior living. In addition, some of its sports products are utilized in rehabilitation spaces.
Shaw Contract’s Wolff reports that senior living designers have a particularly difficult line to walk with regard to design, as they must follow not late-breaking design trends but those that make the resident feel comfortable, while also creating a look that will remain appealing for years to come. Essentially, this equates to taking cues from trends approximately seven years old and also creating looks that will still read as fresh seven years in the future.
HMTX’s Natalia Smith, director of design for Metroflor, notes that design demands vary by subsector. “Independent living will have more liberties with color and pattern,” says Smith. “Then you will see assisted living needing more of a traditional visual. For memory care, skilled nursing and rehabilitation, there is much more to think about, as you design product for the aging community-slip-fall concerns, visual acuity and ease of mobility with wheelchairs and scooters have to be top priorities.”
Key trends include:
• Regional décor: Similar to the location-based design push in the hospitality market that celebrates local nature and culture.
• Pops of color: Gone are the antiseptic whites and dull beiges of yesterday; senior facilities are appealing to Baby Boomers with brighter, bolder design.
• High-end hospitality aesthetics in amenities areas: Following in hospitality’s footsteps, senior living facilities strive to offer top-notch amenities that appeal both to residents and even community members with their looks and offerings.
• Designing for dogs (and cats): More senior living facilities are going pet friendly, allowing residents to bring their pet with them rather than having to rehome them or delay the senior’s move into a facility until their pet passes, and this means the flooring must accommodate pets as well.
A CARE CRISIS
While the pandemic has been a trying event for seniors and their families, staff have also suffered, and many are leaving the profession. According to the National Center for Assisted Living, “Caregivers in long-term care facilities continue to exit the profession, resulting in a worsening labor crisis. According to data from the Bureau of Labor, nursing homes have lost more than 380,000 employees because of the pandemic. A recent American Health Care Association and National Center for Assisted Living (AHCA/NCAL) survey found that nearly every nursing home and assisted living community is currently facing a workforce crisis.
“Reports indicate that the staffing shortages show no signs of slowing. McKnight’s Senior Living reports that nearly 49% of nurses are likely to exit the profession over the next two years, according to a ShiftMed survey of 250 nurses. Among respondents who said they may leave, 38% intend to pursue non-patient-facing roles in healthcare, while 31% plan to leave the healthcare industry completely. Higher pay, better shifts and more flexible scheduling were among some of the factors that respondents said might convince more nurses to stay in the field.”
Along with those “perks,” improving on-the-job quality of life for senior living caregivers may also provide some respite and stave off burn-out, so space designs, concepts and products that make their work lives easier are greatly needed. This could range from designing care settings in smaller groups so that caregivers have fewer patients to oversee in a shift and, therefore, reduced exposure to viral illnesses to offering flooring products that ease the cleaning process when spills or accidents occur.
Says Bartholomew, “[Senior living staff] put their lives on the line amid Covid. Even before the pandemic, staffing shortages were growing. Senior living staff make 30% less than acute care workers. A certified CNA makes as much as a barista at Starbucks. Anything owners can offer to help staff de-stress is warranted-cool respite spaces, free food, gyms with a stationary bike studio or yoga, pods where they can put their feet up and read or nap. Senior living staff generally work 12-hour shifts; those are long shifts, and they can’t ‘shut down’ when they are taking care of patients, so we are seeing staff lounges increasing in importance and many included in renovations.”
Wolff recalls the commitment of staff in the early days of the pandemic when some slept and lived onsite with senior living community members in order to avoid bringing the virus in from the outside world.
According to Rohde, spread of infection is a staffing disaster that can lead to major crises for a senior living operation. She notes, “If you have consistent staff and are paying them a living wage, and they have access to transportation to and from work, and housing, and enough money that they don’t have to work multiple jobs, you have a much greater chance of reducing spread of a virus.”
Rohde reports that smaller, community-based models have lower turnover because the relationships with patients are stronger, risk is lower and work conditions are better. Another key to improving work conditions is establishing communication between the care teams. “Right now, the disciplines are too siloed,” says Rohde, explaining that if environmental services notices an increase in accidents in a particular patient room, that should be communicated to the care staff, as it could indicate a change in patient health.
Within senior living, customization is much more prevalent on the soft surface side, though pricing limitations and tight timelines frequently dictate that designers choose off-the-rack.
However, the design demands of the sector have made customization more frequent. “Today’s senior living [facilities] can be as sophisticated as a five-star luxury hotel brand,” says Griffel. “Their identity and the identity of the residents within these properties often demands visuals that must meet color guidance, regional architectural influences and the emotional demands associated with senior living communities. Custom products and solutions are always in play. One key item to remember is that many ‘customs’ may become a standard for a specific client and repeated in multiple locations, at that point making it a running-line solution.”
SERVING THE SECTOR
As technology enables manufacturers to create products with honed detail, it is imperative that they communicate the breadth of this offering to the designers seeking senior living products. “We want to make sure they understand that the world is their oyster but also that the attributes to aid mobility are maintained,” says Wolff. “Designers may want a hospitality look,” but the product may need to be tweaked in order to create a pile height differential that better accommodates the gait of seniors or a color palette that better suits the aging eye. Wolff adds, “We bake all of these [factors] into the product so that the resident doesn’t feel that the environment is different.” As an example, Patcraft’s new Inspired Connection line of carpet tile and broadloom was developed with extensive market research and considerations for the aging eye and studies of light reflectance values for pattern and color.
Rohde believes that LVT manufacturers have done a great job over the last several years in using digital imaging to create aesthetics that feel warm and residential while also providing greater cleanability. She and her team continue to seek better options with regard to shower systems, desiring aesthetics that work through the entire bathroom space; sheet vinyl products that are warrantied for use with a trench drain; and vinyl products that can tuck under the shower pan rather than butt against it, as seam sealers eventually break down and allow the vinyl edge to roll up, becoming a hazard. On the soft surface side, Rohde is issuing a call for more color in loop products; she avoids cut and loop products because the textural variation can create a falling hazard.
It is standard practice that flooring is replaced between residents, and because quick turnovers are needed, it is important that facilities have access to local stock. For this reason, the product is generally standardized, though residents may, in some cases, have the opportunity to choose between, say, four colorways.
Operating budgets were hit hard in the pandemic, reports Joe Martere, senior director of strategy for healthcare in senior living for Mohawk Group, who notes that, for years, he has tried to convince senior living facilities to invest in better quality flooring that could be cleaned between residents, rather than ripping it out. “But that just doesn’t resonate for many,” he reports. “It isn’t the mindset. They want new flooring and paint between each resident.”
On the other hand, he’s met a handful of clients who practice the we-can’t-afford-to-buy-cheap strategy and are willing to invest in better product, knowing that it will bring them long-term value.
Mohawk Group offers a full suite of flooring materials for use in senior living and has a design team specifically focused on creating product for the sector.
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