Staff Writer Tim Mullaney
Staff Writer Tim Mullaney

When talking to long-term care leaders about new construction or facility renovations, I hear the word “residential” spoken often, and with great excitement and pride. And I’ve accepted that a less institutional, more homelike building is indeed something to celebrate. But two things — a recent experience and a conversation — have gotten me thinking.

First, I was visiting my old graduate school stomping grounds in St. Louis. Driving through my former neighborhood with a friend, we passed a skilled nursing facility that had new signage. “That sign is ugly,” my friend said. I was too surprised to comment. In four years of living right down the block, I had never realized the building was a SNF.

I had never paid much attention at all — the SNF looked like just another apartment building in a neighborhood full of them. I’m sure I saw a sign on the building before, but ignored it. 

Well, I thought, that’s certainly a residential facility, at least on the outside. Not a beautiful, newly constructed one, but one that blends in with the neighborhood.

I didn’t give the matter another thought until yesterday, when I talked with Roger W. Paulsberg, CEO and president of Lutheran Life Communities. We were discussing an intergenerational childcare program at the Lutheran Home in Arlington Heights, IL (Teaser: Look for more on this program in the October issue of McKnight’s). He mentioned a possible plan to put a playground in front of the Lutheran Home, so that passersby would see children and seniors interacting, and know that something special was happening at the facility.

His reasons are both idealistic and business-minded.

“I’ve been in the business for 30-plus years,” he said. “I’ve seen the negative perception of the nursing home, and my goal has always been to create a positive image of the nursing home. A playground would create that positive image.”

But, he added, the playground might also be a way of piquing people’s interest in the home, an organic way of advertising the services provided there, for both children and elders.

His comments reminded me of my experience in St. Louis. I probably hadn’t been the only person oblivious to the services being provided in that building that looked like another apartment block. But could it have done something more creative than put up a bigger sign, something to spark interest and draw people in? A playground might not fit in with its services and mission (or its zoning allowance) but how about a sculpture? A fountain? A patio or some landscaping or a bench?

I also considered the other issue Paulsberg raised, of how people’s perceptions of nursing homes — and aging in general — is influenced by the appearance of facilities.

A nursing home so camouflaged it becomes invisible might not create a negative impression, but it doesn’t help the larger issue of seniors’ feeling and being treated as invisible in a youth-oriented society.

I compared that St. Louis SNF to the nursing home and rehabilitation center down the street from my current apartment, in Chicago. This is a large facility in an impressive pre-war building. It stands out and makes people curious. I’ve seen people walking past slow down to look in the windows, glimpsing some of the well-appointed common areas, even sharing a nod or wave with a resident.

Although it has some homelike interior spaces, I wouldn’t think of this as a “residential” facility — it is obviously an institution — but that might actually be a selling point. It is an attractive building that is highly visible in, I think, a positive way. Rather than blending into the community, it stands out within the community, and perhaps serves a valuable civic purpose, reminding all of us in the neighborhood that seniors live among us in large numbers, and we are all aging ourselves.

Thinking about being a senior myself leads me to the question: Would I rather live in the Chicago or the St. Louis facility? It’s easy for me to extol the virtues of the Chicago building, but I can see how I would prefer to move into a more modest building that fits my idea of “home” more closely, even if I don’t want to disappear within it and become invisible.

Yet, by the time I’m considering my senior living options, my choices might look quite different. Expansive continuing care retirement communities and Green House homes have already changed the nature of this conversation about what a nursing home can and should look like, and will continue to do so.

In the meantime, I’m going to try to be a bit more discerning about the benefits and pitfalls of a “residential” facility, and question how they stand out from their surroundings, as well as how they blend in.