Design feature: Surface appeal

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Providers who haven't shopped for a while soon will find that flooring designs and performance are better than ever.

Remember the simpler times of flooring? Only a few years ago, carpet might have implied a dark, unassuming covering available in three or four basic colors and patterns.
And if you didn't want carpet, there were harder surfaces, usually vinyl composition tile. It wasn't fetching, but it did the job of keeping moisture from seeping through and was easy to mop.
Like many things in long-term care, though, choices are not quite so basic (or boring) anymore. Carpeting is more sophisticated, with colors, patterns and materials that combine comfort and sound-absorption with aesthetics. Meanwhile, resilient surfaces have progressed with regard to appearance and safety, making them more viable options for facilities.
To state it simply, the humdrum days of flooring have vanished and a red-hot market has emerged.
"More and more companies are getting on the bandwagon and seeing that it is a profitable thing to do, and the marketplace has responded with more products," said Kareyn Davies, a senior care facility designer in Vancouver, British Columbia.
The diversity of coverings means flooring is no longer an afterthought in the design of buildings, she and other designers say. By contrast, flooring often is the first element a designer considers when creating the look of a space. And with the current pace of facility expansions and renovations, knowledge about flooring has become a necessity among healthcare facility designers.

Getting down to it

More than ever, facilities and designers find themselves looking down, experts say.
"Before, it was, 'Let's put something down on the floor,'" explains Jennie Selden Griggs of Bentley Prince Street, a carpet manufacturer. "They'd be aware of shuffling or rolling loads. But as far as the visual and backing system and color appropriate for the need, it wasn't even suggested."
This heightened awareness is due in part to innovations in performance technology that have allowed manufacturers to do more for the healthcare setting. The construction of carpeting has become denser and lower to the ground so wheelchairs can roll across without getting stuck. The creation of vinyl-cushion, moisture impermeable backings, which reduce odor, has helped to expand the use of carpeting in a facility.
"When you walk in the door, you're going to form in the first five seconds an opinion or perception based on the look, smell and sound of the facility." said Ridley Kinsey, general manager of healthcare products for carpet maker Tandus.
Other carpeting advances include cushioning that helps insulate the room, reduce noise and cut the risk of slips and falls, major concerns in nursing homes. (See "Trouble afoot," page 41, for more.)
Hard flooring surfaces also have changed. Safety flooring used to be confined to the back of the building because of its industrial appearance, said Dawn Fisher, strategic marketing manager for Altro, which makes safety floors. Trends in the United States have generally favored form over function, she said.
"People would rather risk getting sued than have an ugly floor," she said.
But about two years ago, Altro introduced safety flooring with a more upscale appearance. One of the products, Supremaâ„¢, maintains slip resistance and also offers a look that is pleasing to facility workers and residents. Later this year, the company will offer the vinyl product with a wood-like appearance.
"We expect this to be huge in healthcare because a lot of healthcare facilities today want to have a home look and feel," Fisher said.
"The wood has the warmth of the environment yet is still a safety flooring product with slip resistance."

Looking good

Aesthetically speaking, both carpeting and hard surfaces have made key improvements in recent years.
The introduction of color and pattern collections in carpeting have allowed facilities to coordinate rooms and create a theme.
"I think a more coordinated approach to interior design not only is affecting floor coverings but everything else," Tandus's Kinsey said.
Today, carpets are showing organic patterns such as leaves with the subtlety of two or three colors rather than seven or eight, said Paul Cleary, vice president of the healthcare segment for Lees Carpets.
Cleary attributes this design to the "spa influence."
"The spa look is kind of the look where you're going somewhere for a day to have your nails done. When you're going to a spa, it's about how this place looks. It tends to be earth tones, a lot of organics, and just something that looks like it was designed as a single environment."
Materials also have grown more diverse, combining aesthetics with function. (See related sidebar, page 40.)
Design and performance advances in long-term care flooring cannot be understated.
The Cedars at JCA, a mostly skilled retirement community based in Chesterfield, MO, completed work on its new $62 million facility in 2003. Carpeting comprises more than 90% of the 262,000-square-foot space, including resident rooms, which are mostly singles.
"We wanted people to feel like they were going to a five-star hotel," CEO Randy Delkus said. "We wanted people to be very comfortable and have that residential feel."
Besides creating a warm, inviting look, the carpeting also provides cushion and because it has a low pile, residents can walk on it easily, Delkus said.
Caregivers, who stand during most of their shifts, also enjoy the comfort of the carpet underfoot and the homey tone it projects, he said.
Workers at Westminster-Canterbury in Richmond, VA, a continuing care retirement community, might say the same of their new facility.
A 750,000-square-foot expansion, which is scheduled for completion this month, includes new independent living and assisted living apartments, a memory support center for Alzheimer's residents, and its new Center for Creative Living. It also has a large common area, which includes a billiards room, a classroom, and lounge area. All residents, including skilled residents, have access to these areas.
Bob Cox, vice president of support services, admits that the center, with its chandeliers and mahogany bar, offers a "wow effect." But the carpeting, which covers all common areas, also is functional, Cox said.
The carpeting has a shorter pile that will wear well with walkers, and will enhance their balance.
Picking the right color and patterns were key, Cox noted. Before making final decisions, the manager of the therapy department reviewed the architect's recommendations. Carpeting in the lounge area had to be revised several times to get the appropriate color contrast.

Knowledge boom

As facilities have been renovating their floors, designers have been forced to keep pace.
Two years ago, an accreditation organization called the American Academy of Healthcare Interior Design was formed. Designers noticed that their peers from hospitality were designing for a market of which they had no knowledge.
In April, the organization offered its first exam. About 25% of the questions were related to seniors and long-term care.
"Knowing the differences in flooring and their impact is one of the most important things for a senior designer to know," according to Jane Daley, senior living director for the new academy of design.

A material world

The variety of flooring available today is almost dizzying.
Want a carpet that resembles stone, wood or water? Lees Carpets offers NeoFloorâ„¢, a combination of carpeting and resilient surfaces. It recently introduced 12 wood and six stone visuals that provide the look and feel of those natural elements on a material that feels like carpet and provides slip resistance and minimizes acoustics.
LG Floors recently has unveiled the Rustic Collection from Naturelifeâ„¢, a vinyl sheet flooring that recreates the look of aged hardwood floors.
Thanks to flooring technology, carpeting and vinyl can create a variety of looks, including natural wood. Other materials also enhance the look and safety of facilities. Rubber works well in a bathing setting because of its slip resistance, and ceramic has its place in day rooms and other locations.
Laminate also is an option for facility flooring, but it can be 25% more expensive than carpeting, said Mark Taylor, director of the healthcare division for Shaw Industries, a carpeting and hard surface manufacturer.
Some old flooring materials are making a comeback, like cork, which is also pricey, according to designer Jane Daley. But other seasoned products are considered passé, including vinyl composition tile, which used to line nursing home corridors.
The key to a good floor is to combine looks with lasting power, flooring experts say.
"If you can build things that look good and last a long time, that's pretty much winning the game," said Ridley Kinsey, general manager of healthcare products for Tandus.

Trouble afoot

The risk of falls should be a major consideration when it comes to choosing flooring. Here's why:
- People 75 and older account for 82% of fall-related deaths among older adults.
- People 85 or older are 10 to 15 times more likely to experience hip fractures than are people between the ages of 60 and 65.
- Each year, 350,000 hospital admissions and 60,000 nursing home admissions are due to hip fractures — many of them caused by falls.
- Approximately 10% to 20% of nursing home falls result in serious injuries, and 2% to 6% result in fractures.
- By 2020, the cost of fall injuries is expected to reach $32.4 billion.

Sources: Centers for Disease Control and Prevention, American Academy of Orthopaedic Surgeons, 2006.