Trends In Today's Design
The Focus Is On Residents
By Erin P. Hogan
 When
planning a remodeling project, new construction or design update,
assisted-living community developers need to address typical concerns:
regulations, code requirements, cost containment, plus the usual mechanical,
electrical and structural issues. But today's administrators, architects and
designers are looking beyond the "nuts and bolts" issues; they are
focusing more on resident needs--elements such as convenience, services,
appearance and safety.
Competition Spurs Changes
With the supply of assisted-living beds currently exceeding demand, facility
operators find themselves competing for residents. The market has become
increasingly consumer-driven, and operators are looking closely at what current
residents, prospective residents and their families want. "One trend we've
noticed is that consumers want more living space," explains John Nicolay,
executive vice president of Bovis Lend Lease Construction Corp.'s senior-living
group. Many of his remodeling requests include conversion of studio apartments
into two-room living quarters.
"We've also seen more requests for full kitchens instead of the typical
mini-kitchens for those who are still independent," says Nicolay. Other
trends include a demand for health and fitness centers and other amenities
on-site. "Facilities are also including casual dining areas in addition to
traditional formal dining rooms, which seem to fit with the more casual
lifestyle of today's older people."
Flexible Designs
Another issue facing builders is the need for more flexible designs, which
allow operators to modify the facility as demands change. "Developers are
expanding services to offer more levels of care," explains Tom Rousseau,
vice president of business development for Konover Construction Corp. "We
have clients who want to add on to their facility, or convert existing space, to
provide for residents with special needs, such as those with Alzheimer's
disease. This affects not only space allotment, but also how the building is
designed. For example, facilities that house those with Alzheimer's disease or
other forms of dementia may require a higher level of security, or need a
nurse's station," he explains.
Flexible design and expansion of services can also be beneficial for couples
or close friends who want to be in the same facility, but who may require
different levels of care. It also allows individuals to shift from one area to
another as their needs change without having to start over in a new environment.
Safety and Accessibility
Assisted-living and continuing-care facilities are no longer just
"nursing homes with carpet," says Geoffrey Coleman, associate with
Bernardon and Associates, specializing in senior care for nearly 20 years. He
explains the facilities need to look attractive and inviting, but without
forgetting the special needs of the elderly. "Mobility, safety and
accessibility are all issues we need to address," says Coleman.
"Lighting, for example, requires an understanding of the special needs of
elderly residents. We don't need to have the bright-blue fluorescent glow we're
accustomed to in hospitals or nursing homes. We can go with warmer colors and
make it look more residential, but use appropriate indirect lighting to prevent
glare, which can make seeing more difficult for those with cataracts or other
vision problems."
Safe and easy access to food services, social activities and wellness
facilities is essential if residents are to stay active. Some basic necessities
include:
- Handrails, grip bars and door knobs, which are appropriate for arthritic
hands;
- High levels of indirect lighting;
- Floors that minimize the risk of slipping;
- Bacteria-resistant carpeting suitable for environments where incontinence
is a common problem;
- Wide doorways and ramps for those with wheelchairs or walkers;
- Senior-friendly elevators with slow doors, buttons that are easy to push,
and simple labels to identify floors;
- Easy-to-read signs with large, simple, high-contrast lettering; and
- Proper acoustic planning in common areas, such as eating and meeting
rooms.
Conveniences Abound
Jeff Anderzhon, president of Anderzhon Carlson Architects, describes the
increasing emphasis on amenities within a facility and the need to create space
for such services when planning a project. "Many of today's facilities are
being arranged around a 'main-street' concept," he explains. "This may
include gift shops, pharmacies and offices for professionals like doctors,
lawyers and accountants. They can include chapels, places for family gatherings,
or even an ice-cream parlor." On-site retail shops and services are being
added, such as banks, dry cleaners, libraries, beauty and barber shops, and
postal services. Wellness centers, pools and other recreational facilities
continue to grow in popularity. "It's truly a community," says
Anderzhon.
Keeping Residents Healthy and Active
Recreation, entertainment and other social activities on-site or close to
home encourage residents to get out of their rooms, socialize and stay
physically active, promoting physical and mental health. "The trend is to
create more spaces where residents can interact," explains Robert Feller,
senior associate with DLR Group. "That means more than a card room at the
end of the hall. We're creating wider corridors with nooks to create small
sitting areas where friends can meet. They don't have to go 200 yards to a
multipurpose room just to interact," he says.
Feller explains some developers are going beyond the main-street concept,
creating entire "campuses" that incorporate not only housing and
medical services for the elderly, but also churches, schools, shops and other
neighborhood services. Often these communities are church-based.
More Like Home
Assisted-living facility operators recognized long ago that residents and
families alike preferred a homelike atmosphere, and they began shifting away
from the sterile hospital environment by adding plush couches, decorative
wallpaper and soft lighting. But these well-intentioned efforts created a
dilemma for the design industry. "The trend toward creating a homelike
atmosphere can be in conflict with the need to provide an environment that is
safe and accessible for the elderly population who live there," explains
Beth Kuzbek, director of design services for InPro Corp. as well as the
International Interior Design Association's Health Care Forum. "Many
facilities in recent years have created a look that resembles a high-end hotel.
While we don't want an institutional look, we have to remember that people come
to an assisted-living facility because there was something about the home
atmosphere that no longer suited their needs."
She explains that too often these facilities choose incorrect furnishings and
materials based solely on their appearance. "They look nice, but those
puffy couches are the most difficult for an elderly person to get out of."
She also gives the example of brick interiors, which are aesthetically pleasing
but are far too rough on fragile skin. Kuzbek says it is possible to have
products that are decorative and functional. "Wall coverings, for example,
need to be commercial-grade, but we're now creating them with appealing patterns
that looks residential." Her company also produces a functional handrail,
which is broader, flatter and more suitable for arthritic hands, but is made of
wood so it looks less institutional. Such innovations point the way for
designers, manufacturers and builders who want to blend form with function for
the benefit of all residents.
Designing for Alzheimer's Patients
By Erin P. Hogan
While residents with Alzheimer's disease and other forms of dementia face
many of the same challenges as other older people, such as loss of sight,
hearing and reduced mobility, they also have some special needs. Betsy Brawley,
president of Design Concepts Unlimited and author of Designing for
Alzheimer's Disease, suggests starting any design project by first
determining the end use of the space. "Don't just build a big room, paint
it pretty colors, then figure out what to do with it," she explains.
"Know what activities you want to provide to residents, then design the
space to fit your plans. That will determine the types of rooms you need, their
size, lighting, acoustics and all other design considerations."
She also suggests providing sufficient space in residents' rooms where they
can work on hobbies, projects or other activities of daily living. "Often,
the agitation commonly seen with Alzheimer's is the result of simply having
nothing to do. Residents need space where they can do familiar activities and
stay busy."
Architects and designers are exploring concepts such as small
"neighborhoods" for Alzheimer's residents with eight to 10 individuals
sharing common areas on a smaller, more manageable scale. These may require
space for group activities, such as cooperative food preparation and eating
areas.
The design of bathrooms is another major concern for residents with
Alzheimer's disease. "Showering can be a frightening experience for
them," says Brawley. "Everything from the sound of the water to being
told to disrobe can seem threatening. By paying attention to acoustics,
providing safety features and making it look more like a home bathroom, we can
make the residents more comfortable."
The creation of secure, attractive outdoor areas also benefits these
residents. "Exposure to sunshine for as little as 15 to 20 minutes a day
for four to five days a week can significantly impact sleep disorders, which are
prevalent in Alzheimer's patients," explains Brawley. "It also helps
with depression and agitation common with these individuals."
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