Senior Housing Design for the Future Involves “As Much Flexibility As Possible”

When designing new (or renovating existing) senior housing projects, there needs to be an emphasis on the ability to transition or convert between different kinds of care units, a panel of senior living industry executives agreed at a session during ALFA’s Community 2012 event, held last week in Dallas, Tex.

“Build with as much flexibility as possible,” advised Stephanie Handelson, New England-based Benchmark Senior Living’s president and COO, during the session.

In many Benchmark communities, independent living residents are “basically the same” as assisted living residents in terms of age and even acuity, she said. In fact, the average age for assisted living residents is 83—compared to 85 for independent living residents.

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Blurred lines between independent and assisted living

What’s happening is that many of the independent living residents are using home health services so they can stay in their larger apartments. “[The IL residents] aren’t as physically frail, but they’re still medically complex,” she said. “In our new buildings, we’ve put in every opportunity to be able to switch gears at any time—add more assisted living, more Alzheimer’s care… We’re putting in a lot of flexibility, because we’re going to need that.”

There’s no longer a clear differentiation in terms of residents’ ages in independent versus assisted living, said Patricia Will, CEO of Houston, Tex.-headquartered Belmont Village Senior Living, and that needs to be reflected in the way operators provide their products.

“We have to have flexibility in the way we see residents and the products we’re offering them,” she said during the session.

Independent living used to be ‘lifestyle of the rich and famous,’ and skilled nursing was ‘all the old people in wheelchairs,’ she said, while assisted living inhabited the middle ground of ‘older people doing fun stuff.’

“But [now] the lines are blurred. They’re all more or less the same age,” Will said.

It’s getting harder and harder—with the exception of secured memory care units—to segregate residents according to unit type, she continued. There could be a couple where the wife needs skilled nursing after fracturing her hip, while the husband, who may be physically healthy, is cognitively frail; they’re together, but belong in different levels of care.

“Do you send them to separate dining rooms?” Will asked. “The difficulty of segregating among products and services when you basically have the same age cohort is upon us. We need to figure out how to address that age cohort.”

Designing for “flex”

In terms of designing for a lines-blurred resident demographic, the ability to convert units along the care continuum is important, said Paul Donaldson, AIA, LEED AP, a principal at international design firm Perkins+Will.

“The flexibility is something we’re constantly facing; we have to deal with the desires of operators facing aging in place,” Donaldson said. “We’re definitely seeing a trend for neighborhood-oriented residential scale projects—it’s a lot more humane way to deliver that care.”

However, there can be code issues, he warned.

“You generally have to ‘design up’ in code,” he said. Many communities are being built with “flex” standards that can see independent living convert to assisted living, or assisted living to memory care. And renovating older buildings to be able to do the same will become increasingly necessary as existing buildings age.

“Most buildings [which are now about 20 years old] are going through very significant renovations to address rising acuity,” said Chuck Herman, executive vice president and CIO of Toledo, Ohio-based Health Care REIT. “Those that do [renovate] can continue to perform well.”

He said he’s also seeing new product coming to market, along with additions being added to existing communities.

“There’s a dramatic difference between folks willing to address acuity needs, whether [it’s seen] in occupancy levels or revenue per unit, and those who aren’t,” Herman said, adding that the operators who are keeping up with the times are “generally performing better.”

Written by Alyssa Gerace

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