Designing inclusive and accessible healthcare spaces can be a challenging experience, especially when architects and planners must heed guidelines that don’t always comprehensively address the needs of residents, patients and staff. This challenge is especially prevalent when designing living spaces for older adults in long-term care.

Many seniors experience some form of sensory impairment as they age, from loss of sight to arthritis. In the long-term care community, the Americans with Disabilities Act (ADA) sets the standard for accessibility design, but these guidelines do not always thoroughly address the needs of older citizens. The ADA guidelines for accessibility were adopted in 2021 and written to address all disabilities, but we often find that many vulnerable adults are left out of the conversation and lack the daily support and assistance they need.

To create environments that enhance residents’ quality of life, long-term care spaces must go above and beyond accessibility guidelines so seniors can thrive and staff can assist with daily activities when needed. As long-term care planners, we believe the best designs must create environments that not only meet code, but push boundaries, thus promoting the success of both residents and staff. We make it a priority to understand the limitations of guidelines and address each of the five senses in nursing home environment designs.

Understanding ADA requirements

Each state has different guidelines regarding ADA compliance for older adult spaces. In some states, like Minnesota, facilities do not have to abide by ADA standards if owners can prove there are safety and protection elements in place for residents. In Wisconsin, however, 10% of all rooms must be compliant with ADA guidelines, but owners and architects are free to incorporate other designs that support seniors’ abilities and safety in the other 90% of rooms.

Additionally, some veterans’ homes are exempt from ADA requirements because they must follow more in-depth guidelines, like the Barrier Free Design Standard. This is because the percentage of disabled people at Veterans Affairs (VA) hospitals and housing is much higher than the percentage of disabled people in the general population. The guidelines ensure all VA buildings are designed and constructed to be accessible to everyone, and many of the requirements mirror the recommendations our team makes for nursing home environments.

Designing with empathy for the senses

According to Mordor Intelligence, the United States is seeing an increase in long-term care needs due to a longer-living population and a growing aging population, especially among baby boomers. To better advocate for and support residents’ needs, long-term care spaces must be designed with empathy and consideration for the disabilities and sensory challenges many older adults experience. 

Our team always aims to work closely with residents, staff and owners to create a comprehensive strategy that exceeds ADA requirements and focuses design elements around the five senses.


Hearing loss is a common sensory challenge for older adults, but there are many ways to help design spaces that support acoustics. A recent study from the JAMA Network reported that 80% of all people over age 85 will experience noticeable hearing loss. 

Soothing music and nature sounds can promote relaxation and improve residents’ moods. Reducing unnecessary background noise and enhancing resident privacy also helps minimize distractions and disruptive noise. This may include adding acoustic “masking” to certain areas or making changes to housekeeping schedules to reduce noise.


As older adults age, use of their hands can decrease due to arthritis, thus dulling their sense of touch. Swapping doorknobs for more accessible handles is a small but powerful change that can make rooms easier to enter and exit. Grab bars at the bedside aid in helping an older adult climb into and out of bed. The grab bar should be installed for use by the resident’s stronger or more dominant hand. 

Lastly, residents with diabetes or Parkinson’s may have a dulled sense of touch and require extra care and consideration. For example, furniture should be comfortable and easy to grasp, and rough fabrics, sharp edges and hard metals should be avoided.


Although vision may diminish as we age, there are many opportunities to use color and design features to create safe and supportive environments. Earth tones can help an environment feel calm and therapeutic and even promote healing. Artwork and photography of nature or historic photos can create a calming space and encourage memory recall for older adults.

Well-lit spaces can also increase independence for older adults. Light helps reduce falls, increases socialization and stimulates positive physical and mental health. Lighting should provide even illumination, avoid black spots on floors or walls and eliminate glare to help reduce headaches and agitation. Facilities should consider including slider dimmers or push buttons to provide residents with more manageable lighting options.


Most people know that our sense of taste changes over time, but when it comes to designing long-term care facilities, considerations for older adults with a loss of taste are often left off the planning plate. A dulled sense of taste can lead to a lack of appetite and energy. When designing facilities, it’s important to provide spaces that can accommodate a variety of menu options. This may include everything from pub and restaurant-type meals to cafe and bakery options, so residents have the freedom to choose. With loss of taste, offering more options can stimulate a better appetite.


One in two people over 60 deal with a loss of smell, but many are unaware of the loss until it’s tested. Further, some seniors suffer from diseases like Parkinson’s, which often results in a dulled sense of smell that can impact taste. Introducing strong, pleasant smells can help increase patients’ appetites. A person’s sense of smell also commonly triggers memories that can evoke behaviors. For example, lavender, fresh linen, and baked bread are known to induce feelings of relaxation, and the smell of coffee brings feelings of comfort. 

Although older adults may have a diminished sense of smell, designing with scents in mind can create a more positive, upbeat environment. Consider where laundry, storage and waste areas are placed within facilities to eliminate unwanted smells adjacent to rooms or common areas and design opportunities to introduce good smells.

As the baby boomer generation enters retirement age, thoughtful long-term care spaces are more important than ever. By conducting virtual simulations and creating physical mock-ups, we routinely put ourselves in the shoes of residents to fully understand their experiences and the ways our team can use our expertise to create comforting and functional living spaces. Well-designed environments meet operational needs and create better living conditions and quality of life for all.

Tu-Anh Bui Johnson, AAIA, NOMA, LEED AP, BD+C, is an associate and healthcare/senior living principal planner at Wold Architects and Engineers and can be reached here.

Ron Franks, AIA, NCARB, RID, is a principal at Wold Architects and Engineers and can be reached here.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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