Design of the times

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Design of the times
Design of the times
In today's senior housing market, many long-term care operators are challenged to create attention-grabbing, residential-inspired communities that satisfy residents' desire for comfortable, functional and aesthetically pleasing surroundings. At the same time, limited capital and a lingering poor economy require operators to spend their renovation and design dollars with extra caution.

Seamlessly blending appealing, functional, yet budget-friendly, designs isn't always easy. But some prominent — and even surprising  — renovation trends are emerging that are helping long-term care operators effectively merge those two goals and stay one step ahead of the competition.

Existing facilities are being revamped, as opposed to undergoing sweeping tear-downs and new construction, according to architect Randy Bremhorst, project principal and senior living team leader for the planning, architecture and construction firm Hoffman LLC in Appleton, WI.

“Our current economic environment requires everyone to be good stewards of bricks and mortar,” he says. “For many, the limitations on capital make it difficult to entertain the idea of all-new construction, so providers are really looking at renovating existing spaces to remain competitive. And the great thing about that is, when done correctly, even smaller renovations can have a very big effect.”

Doing a renovation poses the difficult dilemma of determining just where and how improvement dollars are best spent. It's a question frequently fielded by architects and designers, and one whose answers are as varied as the communities themselves.

In the past, design experts — and even long-term care operators — seemed divided into two camps: those who focused most of their attention on common areas and those who dedicated the lion's share of their renovation dollars to resident rooms. Today, though, there's a growing trend to judiciously upgrade both.

Some say divvying up the capital and spending it on some high-impact improvements can offer the biggest return on investment unless there's a fundamental design flaw that would dictate a more widespread redo, such as spaces that jeopardize resident safety or significantly limit one's ability to properly use a room. High-traffic, high-visibility spaces, such as lobbies, dining rooms and entertainment areas, are drawing more focused attention, says one design professional.

The right renovated look
“First impressions are critical, and a refreshed lobby area with new fabrics, flooring and furniture invite potential residents, guests and current residents alike,” says Michael Zusman, CEO of Kwalu, an Atlanta-based manufacturer of furniture and wall covering products. He pointed out that “transitional” spaces can have a positive impact on residents, families, visitors and staff. “Thinking about the front garden as guests walk from the car or maybe providing a café in the front area where guests can feel comfortable waiting — or an employee lounge where staff can respite between projects — is critical in overall design.”

Experts generally agree that common areas are getting cozier, with large, sprawling and soaring spaces giving way to more intimate, defined areas that support both socialization and privacy. If budgets don't allow architectural separation of large areas through the construction of walls or partitions, thoughtfully arranged seating areas are often the answer. Attractive, durable and well-lit residential-style furnishings can create a similar effect, while making residents and visitors want to take a seat and enjoy the space.

Color also can work wonders for visually constricting an overly large area. Richer hues on walls can instantly convey coziness, and a strategically painted ceiling can visually raise or lower its dimensions (darker colors will shrink a room; lighter shades give illusion of height). Full, layered drapes are playing a role in budget-friendly renovations and can instantly transform the appearance of dated or poorly positioned windows. Older buildings with small windows can appear larger by placing curtain rods higher and flanking the windows in floor-length drapes.

Furniture arrangement also has a significant impact. Because not all residents want to sit in front of a television, a room that offers multiple gathering areas creates more intimate conversation or resting spots — an increasingly important offering for residents who want some solitude outside their own room, says Bremhorst. Maneuverability is also key. Regardless of how furniture is arranged, it should allow for easy relocation.


Going big, going small

If an existing facility has many small or partitioned rooms, removal of some of its walls can be beneficial.
“Whether it's a smaller room or a large one, it's about creating flexible spaces that feel more homelike and comfortable, and can serve more than one purpose,” reasons Melinda Avila-Torio, IIDA, RID, LEED AP, of THW Design in Atlanta.

Dining areas are a perfect example. More facilities are abandoning the dated cafeteria-like dining model, and searching for wasted square footage that can be turned into more intimate café and bistro dining areas.
Levindale Hebrew Geriatric Hospital and Nursing Center in Baltimore, for example, is undergoing a massive renovation and construction project that will incorporate a café and pub in the skilled nursing center's “town center” to provide residents with more personalized dining and entertainment options. As an Eden Alternative facility, Levindale is constructing neighborhood kitchens — each shared by only 14 residents — with varying counter heights to accommodate wheelchair-bound residents, as well as those who prefer to perch on a stool.

“It's about looking through the eyes of our residents and designing spaces and options that really support our culture and provide the best quality care and service for our residents,” says Levindale President and COO Aric Spitulnik.

Well-grounded advice
Paying attention to what's overhead and underfoot can pay big dividends. Worn, dingy or dated floors and large, rectangular panels of fluorescent lights that convey more “hospital” than “inviting home” can throw a wrench in an otherwise residentially inspired renovation, sources warned.

“While flooring is often overlooked, it can be one of the most important things to consider when designing or renovating a facility,” says Ridley Kinsey, vice president of sales for the healthcare division of Dalton, GA-based Tandus Flooring. He adds that flooring can influence safety, comfort, hygiene and maintenance, as well as sustainability, marketability, and financial performance.

While some operators shied away from carpet in the past because of moisture, stains and odor, advancements have led to a resurgence in its popularity.

“Today's carpet technology advances in fiber, stain resistance, construction and moisture barriers have elevated carpet's overall acceptance in long-term care,” notes Paul Young, director of healthcare markets for Shaw Contract Group, Dalton, GA.

A dense, well-maintained broadloom carpet with a good face weight and moisture barrier can easily last eight to 10 years, assures Clarence Porch, market manager for Milliken, of LaGrange, GA. While broadloom remains a top long-term care carpet choice, carpet tiles, which can be individually removed and replaced, also are gaining in popularity.

“The tiles offer flexibility and the cost is now becoming more in line with broadloom. If it's installed properly, the seams will be tight, so moisture shouldn't be a problem,” says Porch.

At Pleasant View, an Ottawa, IL, skilled nursing facility originally constructed in 1975, recessed ceiling lights and wall sconces replaced outdated lighting panels. It's a relatively simple fix that has made an immediate impact on the community's new residential design focus, according to Bremhorst.

An unwelcoming resident seating area gave way to a thoughtfully renovated space —  now known as the “front porch” — complete with upscale color palettes and the addition of high-impact architectural elements, such as trim work, pillars and gentle arches to define the space. Worn carpet was upgraded with wood planks in the newly defined seating area and neutral carpet was installed adjacent to provide a more homelike environment. Another key renovation involved turning a once sprawling, obtrusive nurses' station into a less prominent “care base” that blends seamlessly with the surroundings.

 “The new paradigm should [involve an understanding] that we are guests in residents' homes, as opposed to them being guests in our office,” says Bremhurst, who led the renovation.

Resident room facelift
Common areas may be responsible for first impressions, but lackluster resident rooms easily can cause facilities to lose census to competitors.

“Beautiful common areas give you that ‘wow' factor, but if it's apparent that the resident rooms are an afterthought, you're going to lose out,” says Avila-Torio. “Today, we're seeing a stronger allegiance by [operators] to protect funds to allow resident rooms to be renovated.”

There's no question that non-institutional resident rooms are in demand, and operators are seeking durable, complementary furniture sets, such as bedside tables and bureaus, that artfully blend form with function. Even low beds are getting facelifts, thanks to the availability of traditional-looking headboards and footboards that slip over existing bed frames.

“Beds have always been the one thing in the room that really screamed ‘hospital,'” says Susan Verlander, marketing manager of Alpharetta, GA-based Tendercare Beds. “Now, these beds can actually look like ones that would be found in a person's home, as opposed to an [institution].”

Residential-inspired bedding and improved mattresses that fold and bend to accommodate electronic beds also can have a big impact on resident satisfaction, she says. The construction of walls between residents that double as desks and storage systems (instead of simple divider curtains) also are helpful.

“We also see wall shelves where personal belongings can be displayed on the wall and out of the way,” continues Verlander. “This eliminates clutter and allows the resident to enjoy items that make them feel like they're at home.”

Closets, which were largely ignored in the past, also are getting a closer look as operators begin to recognize their impact on resident satisfaction, safety and even activities of daily living. There's a growing trend to reconfigure basic single-rod closets with millwork cabinetry that divides closets and allows even wheelchair-bound residents to easily organize and locate personal items.

“Creating customizable organization isn't cheap, but it can be a good [investment],” says Avila-Torio. “Organized garments, shoes and accessories let residents easily see what they have and take a more active role in their ADLs.” Access to belongings helps make the most of available staff, while also reducing resident frustration and the likelihood of injuries resulting from reaching or digging for buried items, she explains.

Single-minded focus
More operators are finding that parlaying renovation dollars into the development of private rooms also is a smart investment. Levindale, for example, is in the process of adding 84 new nursing home beds to its current 172, and upping the availability of private rooms from 24 to between 130 and 150. Spitulnik says the ultimate vision is to transition to entirely private residences. 

Even smaller facilities may benefit from such an approach, particularly in short-term rehabilitation where residents—many of whom are younger—cherish their privacy over socialization in common areas.

“If a provider is still trying to operate a 150-or-more bed facility in a small-to-medium market, they may want to focus on downsizing to private resident rooms,” Bremhorst says, adding that well-designed private rooms, coupled with technology, make it easier to bring therapy services directly to resident rooms.

Often, a facility is better off downsizing the number of beds and creating private rooms with flat-screen TVs, nice furnishings and a chest of drawers that make residents feel more at home, he says. Creating private bathrooms can be another added bonus, although they often require wall and plumbing reconfigurations. For this reason, “providers may be able to offer more privacy at less cost by converting three rooms into two.”
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