How Household Model of Design Could Meet Senior Living’s New Care Paradigm

The debate over whether senior housing is a hospitality or health care model has raged for years.

In higher care segments, however, a growing number of providers are embracing a model that puts hospitality at the forefront while blending the clinical component to the background. This prioritizes the needs, comfort and attitude of residents, without sacrificing the convenience and efficiency for care providers.

McMillan Pazdan Smith, an architecture and design firm with six offices in Georgia, North Carolina and South Carolina, believes this design model will gain in popularity in response to Covid-19, and is tailor-made to handle infection control protocols already in place across the industry, Associate Principal Stuart Barber told Senior Housing News. He directs the firm’s senior housing practice.

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McMillan Pazdan Smith has created an approach to the “household model” and is advocating to its senior housing clients to consider the benefits. The household model follows several design principles, it emphasizes private and semi-private living quarters, thereby keeping a resident’s bed and bathroom as their private sanctuary, to be entered only with consent.

Barber sees the household model as an extension of residential design. McMillan takes the recognizable features of a home — porches, living rooms that can be seen from an entryway, dining rooms with adjacent kitchens — and applies them in the layout of an assisted living or memory care facility.

“A home is familiar and is recognizable to most people, especially residents that are moving into these facilities,” he said. “How can we make this something that the resident is going to recognize as a home versus a place where care is delivered?”

Designing an assisted living facility from a residential perspective shifts how care is provided. In the household model, it does not serve as the design focal point from a resident’s perspective.

Instead, classic design features such as nursing stations are concealed in the background, allowing caregivers free rein to roam about the facility at all times, interacting with residents while still able to attend to their needs and emergencies.

One concept that Smith and his team have developed is a “double household model,” which takes two households with their own separate amenities and resident populations, and links those with a nurse’s station that is hidden from view. Staff corridors connect the station with the two households.

Common spaces such as lounges and dining rooms, meanwhile, are designed with a mix of communal gathering and smaller groups in mind — in line with another safety procedure implemented during Covid-19. Kitchens, in particular, are built so they meet commercial building requirements, yet retain a residential feel, and can be used by staff and residents alike.

The household model is designed to be scalable because it breaks down the total population of a campus. Most of the projects McMillan builds include between 16 and 22 units in one household. This is a sweet spot for care and staffing ratios, and gives residents more autonomy in their daily routines.

Barber believes the household model can help providers address staffing concerns by providing efficiencies in sight lines and flow, allowing fewer frontline workers to tend to a larger population while still maintaining access to their stations. Although the model is gaining traction in McMillan’s markets, some providers remain hesitant to explore the concept, believing that it might be unobtainable from a cost perspective.

“The most important thing is getting the operator to buy into that change,” he said. “We listen to the operators about what is important to them and incorporate those things, pushing them if needed into a new realm.”

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