Leaders in the senior living industry continue to look for ways to improve the lives of our ever-growing senior population. As these leaders focus on the future and take note of this specialized demographic, the approach to senior living design continues to evolve. Aspects of hospitality design are being applied in senior living communities in order to elevate the resident experience and infuse a vibrancy that supports an active lifestyle. And in skilled nursing, elements of residential design continue to be explored in order to ensure that residents who need an increasing level of care can receive that care in a comfortable environment that truly feels like home.

Over the years, AG Architecture has received recognition for creating successful person-centered skilled nursing households. In 2009, EFA awarded Three Crowns Park in Evanston, Illinois a Best in Show award in the Design for Senior Environments competition for achieving distinct household separations within an existing structure. This community was committed to achieving culture change and the AG team was by their side every step of the way.

In 2010, this level of excellence was once again achieved with the Best in Show honor for the skilled nursing households at Edgewater in West Des Moines, Iowa. For this new construction project, efficiency of service was a priority in the household design. The result was four, ten-resident households that each have a separate entrance and numerous common spaces to encourage interaction between residents and staff. Service areas such as the spa, physical therapy and a fully equipped kitchen were centralized for maximum efficiencies.

Whether a repositioning or a new construction project, a successful household can take different shapes. From the reuse of existing space to newly constructed freestanding cottages, the end result may look different but there are certain aspects that are essential to achieve a successful person-centered household design.

AG recognizes the key culturally-accepted components of home to be:

  • A place to sleep and keep your belongings – a bedroom to personalize.
  • A place for personal hygiene – a bathroom.
  • A place to cook and sustain yourself – a kitchen.
  • A place to socialize – a living room.

We find the critical components we can manipulate to create a “residential feel” to be:

  • The scale of the spaces.
  • The interconnectivity of spaces.
  • The use of natural light.

We create inviting households by:

  • Organizing resident rooms around a social activity core.
  • Optimizing accessibility by minimizing travel distances.
  • Creating efficient adjacencies to support areas.

The size and scale of the rooms should be similar to those we have become familiar with in a typical single family home.  The interconnectivity of spaces is important as well.  It is critical to easily and clearly get people to a destination, but then to make that space warm and inviting, once they have arrived there.  These destinations, like a small parlor, a family room or a kitchen, provide opportunities for socialization and personal choice. Natural light and abundant availability of exterior windows provide an important tie to nature and can act as an extension of living spaces.

At the same time, the needs of the operational staff must be addressed.  Back-of-the-house components need to be strategically located in order to create efficiencies, reduce staffing costs and minimize disruption to the residents.  Nursing stations can be minimized by providing discreet charting areas that allow for privacy and care planning.  We think that through thoughtful design solutions, these concerns can be creatively balanced to be mutually inclusive, rather than exclusive.

Creating Normalcy

AG continues to explore the topic of culture change in our day to day practice for sponsors throughout the country.  The goal is to create “rampant normalcy” in the life of the residents while facilitating a smooth transition in lifestyle and independence from the home to a new “shared” residential environment.  We will always continue to reference a typical home and examine how best to translate key components of the house into a larger facility.  For example, a typical home has an individual entry.  How can the plan be developed to simulate the entry with details such as the door, doorbell, porch, light and mailbox?  These are some of the clear identifiable features of a home that distinguish normal life.  The task is to creatively replicate these distinct characteristics in a long term care setting.

We can’t forget that “normalcy” implies more than just living in a nice home.  We envision that there will be a need to promote connectivity by striving to create destinations within these environments.  Whether a hair salon, coffee shop or outdoor garden, normal lives are filled with a wide variety of activities and experiences.  Though a long term care or assisted living environment may be a kind of closed loop, there is no reason it should not be stimulating.

More recently completed projects continue to explore these elements and the AG team has worked with providers across the country to develop a household model that makes sense for the specific community’s goals as well as its resident and staff needs.

Edgewood Summit in Charleston, West Virginia is tucked neatly into a steeply sloping site. The second floor of this U-shaped structure is a 20-bed short and long term care skilled nursing environment. In order to create an accessible outdoor space for the residents of this level, the dining areas were carefully placed so that there is direct access to the higher-grade level created by tucking the building into the hillside. A compact, but highly efficient therapy pavilion has also been located in the plan’s upper level. Though very compact in nature, the household has proven to be highly efficient in both layout and function. Yet at the same time the building feels much larger due to the extensive amount of natural light and the amazing views that provide unlimited vistas beyond the stunning natural landscape.

According to Diane Gouhin, executive director at Edgewood Summit, “The residents love the natural light offered in the therapy pavilion as well as the dining room and living room.  High ceilings contribute to the feeling of spaciousness and yet the environment feels cozy and comfortable. The outdoor space is used in good weather. It offers a lovely view of nature and feels like an outdoor patio reminiscent of their own homes.”

In order to improve intimacy, create a more natural sense of scale, and elevate the image and experience in the skilled nursing and memory support at Three Palms Health Center at East Ridge in Cutler Bay, Florida, a household environment was created. In the search for maximum efficiency two households were joined in the center to improve operations. Careful planning allowed many dining and care functions to be centralized. Multiple resident activity spaces positioned directly off the corridors create the intimate feel of a home. The result is an environment which encourages socialization while supporting the staff’s ability to effectively service care needs.

“The new design is such a departure from the long corridors and unbroken sight lines in our old building,” says Troy Hart, president of SantaFe Senior Living. “It has really transformed our care practices from a more institutional approach to a household approach.  The new space has been well received by residents, families and staff.”

The Terraces of Boise is the first senior living community in the state of Idaho to offer household design for skilled nursing. While focused, expert medical attention is the priority – creating an engaging family environment is the cornerstone of this nurturing, social model of care. Designed as three, small homes, each household includes private suites surrounding an open kitchen and comfortable living space. This layout naturally builds more opportunity for social interaction and shared experiences. Personalized plans of care for each resident are used to respect established daily routines.

Choosing to develop a cottage typology posed efficiency challenges, but this determined provider wanted to support resident life by delivering the next dimension of skilled care with standalone buildings. Operational costs did not outweigh the provider’s desire to deliver a new paradigm. The project team worked closely with local authorities to address current regulations and push boundaries to support the long term vision and goals.

“It would have been much easier to proceed with the standard skilled nursing model however with the encouragement of the state of Idaho and the guidance of AG we were able to implement a household model and elevate the standard of care. AG was a great partner and advocate throughout this process,” says Jud Severns, executive director of The Terraces of Boise.

In Conclusion

The word home means different things to different people and in the world of senior living AG Architecture works with providers across the country to define what home means to its specific residents. AG continues to look to the future and is excited to explore more residential influences on household design so we can create skilled nursing environments that offer a distinct sense of place – environments that truly feel like home sweet home.