Most skilled nursing facilities were not initially designed to deal with crises like the coronavirus pandemic, though changes were made on the fly as the outbreak unfolded, and more will no doubt follow in the years to come.
It seems certain, in fact, that this crisis will profoundly impact the design of SNFs and senior living communities for decades. While some experts warn that redesigns might result in overcorrections, the pandemic revealed acute needs in infection prevention, technology and general operations that intended to safeguard residents and staff. Meeting future challenges and being prepared for other crises requires carrying out focused approaches.
Sanitation improvements and infection prevention
Even absent a pandemic, surface sanitation, air quality and infection prevention can be a matter of life and death for SNF residents and staff. Given the relatively rapid spread of coronavirus and the likely toughening of air quality codes, air purification will become increasingly important. Also, many redesigns might incorporate cabinets, countertops, flooring and handrails that consist of antimicrobial materials that are easy to clean.
Some newly built SNFs might also include a dedicated “clean room” that could allow for in-person visits when an airborne pathogen is likely to spread. Such rooms would be adjacent to another one and equipped with separation glass and an intercom system that allows family visits.
Companies making renovations in the middle of the pandemic are rethinking their design strategies to accommodate COVID-19-related health mandates and protect the people under their care. For example, The Allure Group had to make changes when renovating our King David Center by incorporating enough social distancing space in common areas like the café.
Technology is another factor shaping future SNF designs and renovations. Virtually every department in a facility can benefit from IT adoption. For instance, healthcare professionals working SNFs can use electronic health records to share information with other providers, review patient records and keep family members informed.
When facilities have to suspend visitation and cancel group activities, technology can counteract the negative effects of isolation by remotely connecting residents with healthcare providers. The Allure Group’s use of telehealth allows offsite doctors to use virtual stethoscopes, ECGs and other tools to perform remote examinations and make diagnoses. The Allure Group also uses advanced entry kiosks at each of its six facilities, which automatically take the temperatures of staff and visitors seeking entry, while also asking key questions of them. And Allure provides recently discharged patients with hand-held remote monitors so that each patient can receive appropriate transitional care.
Residents can also use communication technologies like teleconferencing to stay in touch with family and friends while under lockdown. That is the case with the PadInMotion technology installed at all 1,400 bedsides in The Allure Group’s six facilities. These Samsung tablets, placed well before the pandemic, were first used almost solely for entertainment and relaxation. When the outbreak occurred and government-mandated lockdowns were put in place, they became a crucial lifeline to loved ones.
Given seniors’ increased embrace of technology, incorporating such innovations will likely continue at facilities throughout the country.
As nursing home companies continue to plan for the future, some of their ideas include designing more small-home models and other intimate forms of housing. One such concept is the pocket neighborhood, such as Sycamore Springs at Garden Spot Village in New Holland, Pennsylvania. Pocket neighborhoods consist of small prefabricated homes organized on a focused and centralized layout distinct from surrounding zones.
These separate “villages” provide a campus setting where nursing residents can socialize and share meals in small groups. If and when another epidemic emerges, a pocket neighborhood can isolate itself from the larger community when infection prevention is necessary. An urban high-rise can also adopt this model, with the ability to section off one floor instead of locking down the whole building during infection control.
Preventing industry overcorrections
While the factors above can potentially revitalize SNFs and help them prepare for future health crises, architect David Dillard has warned against radical changes that might lead to overcorrecting, thus downgrading nursing care. Dillard cautions designers against undoing what he calls the “healthy evolution” of nursing home life.
This concern addresses redesigning facilities so that they become unnecessarily “institutional.” For instance, constructing an SNF to facilitate in-room isolation should not overlook residents’ needs for continuing socialization and connectivity to the outer world. Creating quarantine-ready rooms with balconies that allow for spending time outside and talking with visitors at a distance might minimize the kind of “downgrading” against which Dillard cautions.
Whether preparing for the next global pandemic or the yearly flu season, SNFs are embracing new design concepts to meet the needs of current and future nursing residents. In the years following COVID-19, nursing homes might increasingly incorporate models like pocket neighborhoods to employ isolation without diminishing quality of life. The key will be to plan for future scenarios while simultaneously supporting quality care while minimizing disruptions.
Melissa Powell is COO of The Allure Group, a network of six New York City-based skilled nursing facilities.