Common spaces in long-term care communities have received renewed interest in recent years, being viewed in some design circles as the “heart,” or core, of senior communities. This holds true even in the most clinical of all long-term care settings.
Common areas in nursing homes provide the ideal place for socialization, something that is increasingly important in buildings where individuals can easily lapse into self-imposed isolation and withdrawal.
In some respects, the common area in a skilled nursing facility is not much different from the family room at home — a place where everyone gathers to talk or join in communal activities. The forms these rooms take can vary from one large expanse to a collection of spaces, both inside and out.
It fits right in with the trend toward creating more homelike environments.
One of the guiding principles in long-term care design today is to create a residential, non-institutional environment in layout, scale and architectural language, as Robert Wrublowsky, principal of MMP Architects, pointed out in a 2018 update to his “Design Guide for Long-Term Care Homes.”
In fact, Wrublowsky asserts that the institutional-based environment that care architects and planners have been designing for seniors has contributed to agitation and restlessness.
“It appears that our current priority is to provide the operational efficiency of a hospital,” he laments, citing the tight spaces of nurse stations, central dining rooms, commercial kitchens, central laundry facilities and supply rooms.
The “small house” movement of the past few decades attempts to combine all of the “positives” of communal living and around-the-clock medical care for seniors.
It has succeeded in various pockets across the world. Scalability created limitations among skilled nursing facility builders since the concept seems to work best with smaller numbers of cohabitating seniors.
Still, the core elements of the Green House movement — open kitchens, family-style dining and communal “hearths” — have left an indelible mark on today’s nursing home designers and architects.
Sweating the details
Most nursing home visitors might look at a typical common area and see nothing but chairs and couches, lamps and side tables. Non-discerning observers might mistake quirky, or even common, elements of common spaces as accidental. Virtually no detail, however, is unplanned.
Designers sweat all of the so-called “small stuff,” the most important of which is that which creates first impressions.
As RAND Corp. discovered a few years ago in a sweeping nursing home study commissioned by the U.S. Department of Health and Human Services, seniors and their families generally felt a prospective nursing home provided quality care if it “looked nice, smelled nice, and had nice amenities,” much like the homes they were leaving behind.
“Creating more home-like environments is key to helping residents feel comfortable in the common areas,” says Stacy Rubenstein, Medline’s public relations manager.
“Furniture should be similar to what they are used to having in their own homes with fabrics that remind them of home — loveseats, chairs, coffee tables, end tables, lamps, and the like.”
Many facilities struggle with their multiple and often competing personalities as a healthcare space, a hospitality space and a residential space, observes Laura Holzer, segment design manager, healthcare and education for J+J Flooring Group.
Designers today are challenged to create public spaces that not only appeal to residents, but also the family influencers who hold so much sway over which facility to choose, says Andrew Christmann, marketing manager for Hekman Contract.
Both want to get away from the classic nursing home “feel and look. Something that is warm and inviting in the lobby, not unlike what you’d see in a hotel,” Christmann adds. “A nice, welcoming reception area and open environments with some basic lounge seating would seem to be the best fit for both audiences.”
While the physical space is important, what’s happening inside them is even more notable, says Jeanna Swiatkowski, interior design team lead for Direct Supply Aptura.
“What’s really going to get residents out of their rooms are the activities and programming the community provides,” she says. “We design the space based on the types of activities. If residents are into completing puzzles, we’ll design the area to support that.”
Swiatkowski says the company’s designers seek feedback from the residents themselves when creating or re-imagining common spaces, then follow with furnishings that support those activities.
“Based on the resident mix and interests, we’ll design the space so they can actually use it, so it’s not just a sitting area,” she says. “The more interesting and exciting the space is, the more the residents will want to come out and engage.”
Still, luring residents from their private spaces to public areas entails selling them on an inviting space that allows them the ability to retreat to enclaves away from the madding crowd.
Enticing seniors to engage in common areas also involves imbuing confidence they will be safe and able to ambulate freely with or without assistance.
For example, Garnet Sofillas, marketing manager for Ecore International, believes an important consideration that encourages mobility in common areas includes “providing a surface that supports the residents’ sense of comfort and safety without compromising balance. A too-soft floor can have a detrimental effect on balance, which is a challenge with senior residents and inhibits their confidence to ambulate.”
Jodi Fazio, marketing director for Kwalu, advises facilities to provide rest stops en route to common areas.
“Particularly in skilled facilities, the use of benches is very important to get the residents out of their rooms,” Fazio says. “They can sit down and rest on their way out to a common area to participate in activities. Most residents who don’t leave their rooms are worried they will run out of steam before they get to their destination.”
Randy Schellenberg, president of Comfortek, acknowledges common spaces can provide a great way for seniors to engage with one another and their families, but not for the mobility-challenged individuals among them. Much of the problem might center around available hands. People must buttress common-area goals.
“There simply is not enough staff available to meaningfully move and interact with mobility-challenged persons in a common room,” Schellenberg says. “In a world where the mobility limitations of each resident increase daily, I do not think the design of a common space alone will attract greater use.”
Schellenberg believes mobility-challenged seniors would make greater use of common areas “if adequate levels of staff could accommodate them with dignity and respect so they don’t feel awkward in these public spaces.”
No other space within a nursing home undergoes more change than the common area — a must in order to accommodate growing kinds of activities in a fixed place.
“Sectioning off spaces within the larger room helps foster intimacy,” says Swiatkowski.
Seating arrangements, casegoods or even window treatments also work as effective and easy demarcations of spaces within spaces, she adds.
With so many stakeholders competing for valuable internal real estate, nursing homes rely on designers to create common spaces that can easily be transformed from a calming lounge to party room at a moment’s notice.
Flexible furnishings — chairs and tables and floor coverings that are as neutral as they are multifunctional — assist greatly. They can transform numerous areas.
“Multifunctional spaces can incorporate a wide variety of ideas to benefit communities with limited space. Rooms that are used for crafts can be used to play cards and run bingo,” Fazio says. “By moving furnishings around, the same space can be used as a yoga room with soft mats, aromatherapy and lighting that can be dimmed to create the effect of calm.”
The ‘biophilic’ touch
Until recently, natural elements like sunlight and landscapes played a very minor role in creating common spaces in long-term care. Today, designers draw heavily from a natural palette to create calming places for people to gather.
“Natural lighting through the entry of such architectural elements as clerestory or large window expanses have been known to positively support the program spaces within a nursing home,” says Melinda Ávila-Torio, senior associate, project manager for THW Design. Anecdotally, residents and staff have told her that such techniques result in less emotional strain and stress.
Jeanna Swiatkowski, interior design team lead for Direct Supply Aptura, uses generous amounts of large windows and natural views when creating common spaces, and when appropriate, uses fixtures that mimic natural light.
“In the morning, we start with ambient light. At midday, we’ll have brighter light, and then we’ll start dimming it again at the end of the day to coordinate with the circadian rhythm,” she says. “This helps keep residents active and vibrant.”
“Biophilic [life-loving] design” is the term designers employ when describing their use of natural elements and hues, an evidence-based effort that brings a host of positives to nursing home life — including lowered blood pressure.
Laura Holzer, segment design manager, healthcare and education for J+J Flooring Group, says biophilic design influences many of her company’s floorcoverings with “soft, calm blues and greens, clean and clear neutral shades, from warm beige to cooler greys, with small flashes of color.”
“Having durable furniture that looks like wood and evokes nature has been shown to cut down on stress,” adds Jodi Fazio, marketing director for Kwalu. “Natural colors and light are known to positively affect people who have to spend a lot of time indoors.”