Designing Senior Living for a New Hospitality, Health Care Paradigm

Senior living communities are beginning to take a new approach to blending hospitality with more robust health care, in a trend sure to influence future developments.

In the past, private-pay senior living providers often set themselves apart from more institutional options by emphasizing a hospitality approach inspired by hotels, and taking a light touch with health care. Now, residents are entering senior living older and frailer; at the same time, health care systems and payers are beginning to appreciate how senior living providers can help them manage high-risk populations, creating new opportunities for business partnerships.

As a result, a number of senior living providers have recently said they intend to offer increasingly robust health care services but want to keep these offerings “invisible” or integrate them seamlessly into the hospitality atmosphere.


This is the inverse of a trend in acute care, where hospitals and doctors’ offices are trying to infuse more hospitality elements to soften what has traditionally been a highly medicalized setting. Architecture firms that serve both hospitals and senior living — such as Perkins Eastman and Hord Coplan Macht — therefore have a valuable perspective on design principles that can accomplish this tricky health care/hospitality balance.

“Perkins Eastman has been talking about convergence in the marketplace and because we do both health care and senior housing, we’ve been seeing it happen,” Perkins Eastman Principal Leslie Moldow told Senior Housing News.

Moldow and leaders with Hord Coplan Macht recently spoke with Senior Housing News, sharing both big-picture and small-scale tips for how to approach the health care/hospitality blend in senior living development or redevelopment projects.


Guiding principles

There are various big-picture frameworks for blending hospitality and health care. Two that are proving successful in both hospitals and senior living are spa-like wellness centers and biophilic designs.

An example of a spa-like design can be found in the work Perkins Eastman did for Memorial Sloan-Kettering Cancer Center Breast and Imaging Center in New York City, as well as White Plains Hospital Cancer Center (see image below).

“Where people are getting treatment, it looks like you’ve entered a spa and feels very comfortable,” Moldow said.

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Photo courtesy Perkins Eastman

Creating a truly spa-like environment in a health care setting has become possible thanks to advances in just the last decade or so, she explained. Fabrics and other materials today have the look and feel of hospitality but are rugged and able to be cleaned with the antiseptic substances necessary in health care.

Architects with Hord Coplan Macht also invoked “spa” as a model for mixing health care and hospitality.

Senior living communities have long had the elements in place — a salon, a therapy gym or exercise space, an office where visiting physicians or other clinicians could conduct exams or provide treatments. However, these areas of a building are often separate from each other, with the health care spaces in out-of-the-way locations. Now, senior living developers and operators are seeing the virtue in bringing these amenities together in a “suite.”

“It’s not necessarily that more square footage is spent on these amenities, but rather it’s being more intentional to group these amenities of wellness and care to create a spa destination,” said Hord Coplan Macht Principal Cindy Shonaiya.

This might entail creating a seating area with a hydration station, upgrading lighting and finishes, and adding sensory elements like water features and aromatherapy misters. It’s also advisable to make the clinical spaces less stark.

“They make some very attractive exam tables that really look like a large recliner,” said Heather Flannery, interior design with Hord Coplan Macht. “Your residents can sit in the chair and it can lay flat, but doesn’t look like your square box exam table.”

Some senior living providers are finding success by branding these spaces. Residents can say that they’re going to “Spice” or whatever the chosen brand might be, which elevates the experience; staff also respond well to this type of branding, Shonaiya observed.

Biophilic design principles are also being incorporated in both hospitals and senior living, Shonaiya and Moldow both said. A biophilic approach calls for incorporating elements of nature in the design, and emerging research is demonstrating that these principles enhance health and wellness while they can also serve to upgrade the look and feel of a space.

“It’s not just adding a green wall or a window out to a courtyard or adding fabrics that have flowers on them,” Moldow said. “We’ve been studying it in a significant and deep way, how it affects people’s psyches.”

Perkins Eastman is preparing to release a post-construction survey of residents at a recently repositioned Rockwood Retirement Communities campus in Spokane, Washington. Layout, materials, furniture selection and other details were all filtered through the lens of biophilic design, and the survey results indicate that this approach has led to higher levels of wellbeing and a variety of more specific positive outcomes, including a 15% increase in social event attendance and 21% increase in dining attendance.

One example of biophilic design in action is the community’s library. The room is designed to be a cozy and sheltered space, with a fireplace and lots of natural materials (see image below). However, the room has large windows offering a view of the community’s drop-off area. This corresponds with a principle known as “prospect and refuge.”

“It recognizes as individuals, we’ve become hard-wired to want to be in spaces where we feel protected and yet have a big view … and see where things are coming from,” Moldow explained. “Perhaps it evolved from living on the savannah, who knows.”

On the post-construction survey, the library ranked among the residents’ favorite new spaces.

Small-scale tips

Having a large-scale vision for how health care and hospitality will coexist is essential, but there are also more specific tips and ideas to consider. Hord Coplan Macht’s Shonaiya and Flannery offered these:

— Rather than a therapy pool, consider a full-size pool with depths and temperatures suitable for rehab, and dress up the space with an appealing aesthetic. This makes the pool both a health care amenity and a draw for visitors, especially grandkids, as at the Wellness Center at Erickson Living, Oak Crest’s Town Center (see image below).

— If a lounge or dining venue includes a bar, explore the option of placing it in a sunken area of the room, so that it is standard height for the bartender but doesn’t require older or frailer residents to get on a full-sized barstool to belly up.

— Instead of having closed-off, coat-check type rooms for diners to store their walkers or other mobility devices, create alcoves or other ways to keep these devices closer to residents, which adds to their sense of security without crowding the walkways.

— Consider “camouflaging” secure medication rooms, such as by using sliding doors to create a panel look and placing artwork along the front, as at Pickersgill Retirement Community (see image below).

— Take advantage of contemporary materials that look identical to high-end wood but without a waxy finish; the appearance of wax can cause residents to tense up to avoid slipping, and in so doing they actually lose their balance and fall.

Moldow echoed some of these ideas and observed that there are many specific ways to keep health care and hospitality in harmony; she also emphasized that designing for hospitality does not mean simply mimicking the look and feel of a hotel.

“We mean the knowledge of the hospitality industry to highlight experiences in people’s lives and creating environments that bring out experiences,” she said. “So when we say we’re bringing hospitality to our senior living projects, we’re thinking about the experiences people are having day-to-day, moment-to-moment in their lives that are significant and meaningful.”

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