While reducing beds has been proven to keep residents safe across various metrics, the financial implications threaten providers’ health.

Private room conversions remain limited as economic, reimbursement and workforce challenges take center stage, even while evidence against shared rooms mounts.

“Long-term care or congregate care settings are pretty much at the same crossroads acute-care facilities were 30-plus years ago, when hospitals had four-bed wards,” said Evelyn Cook, associate director, Statewide Program for Infection Control and Epidemiology at the University of North Carolina at Chapel Hill. She called a private room an infection preventionist’s “best friend.”

Single-occupancy rooms are associated with decreased risks of medication errors, healthcare-associated infections, resident anxiety, aggressive behavior, and poor sleep patterns, added Amanda Thornton, RN, clinical science liaison for PDI Healthcare.

With that kind of endorsement, it’s no wonder private rooms dominate development talk. According to Cass Gottlieb, AIA, LEED AP/BD+C, principal at Waldon Studio Architects, a Michael Graves affiliate, some operators are planning expansions to accommodate singles. Others are looking to repurpose existing interior spaces, such as outdated nurses stations or old storage rooms.Some designers report dwindling staffs and reduced admissions have presented another option.

Martin Siefering, principal and senior living practice leader at Perkins Eastman, said many providers are simply removing one bed from some of their semi-private rooms. It’s an inexpensive solution from a capital perspective. Still, the obstacles are ubiquitous.

“Maintaining bed count is the biggest challenge to increasing the number of private rooms, especially where space is at a premium,” added Gottlieb.

Ultimately, “the financials of reducing bed counts almost never pencil out. Therefore, we very rarely see this being implemented in SNF settings,” said Gaurie Rodman, director of development services for Aptura. As former NIC analyst Liz Liberman portended in 2018, demographics will keep the pressure on older buildings.

“It is likely that many facilities will consider making these upgrades — or risk losing out on young residents and their high Medicare reimbursement rates,” she wrote.