10/12/2015. Culture Change Through the Physical Environment: Trends in Senior Living Design

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1 Culture Change Through the Physical Environment: Trends in Senior Living Design As the SNF industry evolves, so must the SNF physical plant. As we are in an era of wellness and rehabilitation, this means that the physical plant must similarly evolve to allow the SNF provider to deliver the services that the market demands. It is no longer a matter of hypothesis or conjecture; it is a fact that the physical environment influences the healing process. -William Nicholson, CEO of the Congress Companies Rethinking Skilled Nursing and SNF Construction 5/14/15 Culture Change can occur in homes that serve residents of all income levels and applies to much more than just the physical environment. However, the physical appearance of the senior living community is the most visible aspect of culture change to the casual observer. 1

2 -Baby boomers are aging, and the qualities and amenities they want in a senior living community are different from their parents desires -Physical design is the first impression of a potential resident and/or their families -Design becomes a marketing tool Trends in Senior Living Design 1. Optimize resident privacy and dignity. 2. Employ the household design model. 3. Introduce hospitality design concepts. 4. Include sustainable design elements. 5. Provide memory care and short-term rehabilitation services. Optimize Resident Privacy & Dignity Almost all of the existing stock of about 1.9 million beds in skilled nursing centers, long term care facilities and nursing homes were built in accordance with the concept (enforced by state codes) that these were low-tech hospitals. Bradford Perkins 2

3 Optimize Resident Privacy & Dignity Traditional Semi-Private Room Optimize Resident Privacy & Dignity Better Semi-Private Room Plans Optimize Resident Privacy & Dignity Private Room Plans w/semi-private Bath 3

4 Optimize Resident Privacy & Dignity Private Room Plans w/private Baths Optimize Resident Privacy & Dignity Private Baths Helpful Features Optimize Resident Privacy & Dignity Spa Bathing 4

5 The Green House Movement - Movement began in 2003 and brought attention to the importance of creating homelike settings; most widely publicized form - Project based on a philosophy seeking to reverse enforced dependency of life in a traditional nursing home by creating small, intentional communities of 7-10 elders to foster late-life development and growth - As of February, 2015, there are 174 open Green House homes on 40 campuses in 27 states with another 186 in development The Green House Movement Elements and Spaces - Small Neighborhood Size no more than 15 residents. Ideally 12 or less per household - Private Units with Private Bath & Shower - Great room space includes living, dining room and residential kitchen - Direct access to the outdoors 5

6 St. Louis Altenheim St. Louis, MO 6

7 Meridian Village Glen Carbon, IL 7

8 Introduce Hospitality Design Concepts - Concepts learned from the global hotel market and that appeal to baby boomers and their families - Rooted in a culture of service - Achieving i this kind of feel in a senior living i community largely l revolves around the services and amenities provided to residents, but the physical design is key as well Introduce Hospitality Design Concepts 8

9 Introduce Hospitality Design Concepts - Hidden Circulation Paths Services should be hidden from view. No central nurse stations. Utility, laundry rooms, etc should be in a back of house area Introduce Hospitality Design Concepts - Finishes Consider wall coverings, carpeting and luxury vinyl tile (wood look, etc). Many manufacturers make hospitality lines that are also rated for use in skilled nursing communities Introduce Hospitality Design Concepts - Services & Amenities Offer concierge services (dry cleaning, restaurant reservations, etc) and multiple dining options (bar, café, sit-down restaurant, quick serve sandwiches, etc). Include amenities like libraries, computer labs, fitness rooms. Offer wifi throughout the entire community, include playgrounds or other spaces that appeal to children. 9

10 Include Sustainable Design Elements - More residents and especially their families are becoming interested in green buildings and communities. Green features can become a marketing tool. - Important to investigate both up-front costs and life cycle costs for green elements. - Many green elements are not only good for the environment, but also save money over the long term as well as benefitting the health of residents and staff. Include Sustainable Design Elements - When considering Green Design features, it is important to consider the life cycle cost in addition to the up-front cost. - Life Cycle Cost - the total cost of the asset over the life of the asset. Include Sustainable Design Elements - It is important to talk about Green features during the design process for new construction or large remodel projects: - Daylighting- Try to maximize access to natural light. Not only can this reduce energy costs if done properly, studies have shown that exposure to natural light reduces depression and fatigue and increases alertness. Other studies have shown natural light exposure decreases the length of patient stays, lessens the need for analgesics and decreases agitation among residents suffering from Alzheimers disease. - Be mindful of glare and too much heat gain when designing new spaces. Shading devices can help. 10

11 Include Sustainable Design Elements - It is important to talk about Green features during the design process for new construction or large remodel projects: - Additional Green Features More efficient HVAC systems, LED Lighting & Efficient Controls, Energy & Water Conserving Fixtures, Natural Plantings, Rain Gardens, Etc. Include Sustainable Design Elements - It s possible to make smaller green changes to existing buildings and communities - Change lamps & bulbs to more efficient products, like LEDs - Add sensors to conserve light and water -Evaluate cleaning products and practices (benefits indoor air quality) Include Sustainable Design Elements - Educating your Residents and Staff is very important. Some Green features may look odd (example: natural planting = weeds) 11

12 - Memory Care Units - offer specialized treatment for seniors with dementia - According to the Alzheimer s Association, there are 5.4 million Americans currently living with Alzheimer s, and that statistic is expected to more than double in the next forty years. - Senior Housing News reports that Development for memory care is far outpacing that of other senior living sectors, but oversupply isn t a concern considering the concentration of projects of a few hot markets and staggering upcoming demand. - Memory Care Units A well-functioning Memory Care unit reports many positive outcomes, including the following: reduction in medications and related side effects, increased nutrition, increased independence and social interaction, increased happiness as residents are functioning at a higher level, improved or maintained mental functioning in 50-75% of residents over a six month period. - Memory Care Units Often include the following design features - 1. A secure environment to reduce elopement - 2. A low staff-to-resident ratio -3. Sensory based programming g - 4. Design features to facilitate easy navigation and reduce anxiety 12

13 - Short-Term Rehabilitation Units offer skilled nursing care augmented with therapy for residents recovering from an injury, surgery, or medical incident - If a CCRC SNF doesn t maintain an active short stay Medicare practice of at least on-going short stay beds, it runs the risk of becoming irrelevant to the health care system. Cain Brothers Industry Insights, 4/23/12 - A short-term rehab unit is an important marketing tool for a community. If a resident has a good experience, they will recommend it to friends and family once they re home. 13

14 - Short-Term Rehabilitation Units Residents in short-term rehab units don t like to mix with long term SNF residents. Therefore, separate short-term rehab household with a designated therapy area is ideal - Short-term residents also prefer private units with a private bath and shower Good Samaritan Care Center Cole Camp, MO 14

15 Oak Hill Waterloo, IL 15

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