As the way memory care operators care for residents grows more sophisticated, so too does how such communities are designed.
Design trends within senior housing are evolving to include specific spaces designed for memory care residents, with operators taking a serious step to offer purposeful living spaces for those receiving dementia care. From creating new spaces with physical infrastructure to providing higher-quality memory care services, operators are not only building anew but also adapting spaces with higher-acuity residents in mind.
For operators in memory care, the premise is simple: Designing spaces where memory care residents can thrive. But the execution of these cutting-edge spaces requires in-depth analysis and collaboration with researchers and a commitment to specific design standards.
Companies at the cutting edge of memory care design include RLPS Architects, which is innovating memory care layouts; design firm HKS, which is informing its design with brain health research; and Epoch Senior Living, which has nearly a dozen memory care communities after growing its footprint in the sector to capitalize on demand.
‘Hybrid’ model for memory support
At Lancaster, Penn.-based RLPS, the company has used its “hybrid home” model for senior living following the Great Recession as operators were looking to add IL units. Hybrid homes, as defined by RLPS, is a senior housing model that allows providers to add IL in higher-density markets compared to stand-alone development.
These hybrid units are similar to cottage-style living residences with in-ground parking, small unit mixes per-floor and offers residents ample natural lighting. But that concept evolved out of only being IL-specific to include memory care, according to RLPS Partner Eric McRoberts.
“It became a very attractive thing and I think the reason it has matriculated into the memory care industry is that it’s a wonderful quality of life,” McRoberts said during BRAIN, an event held by SHN in Washington last month.
That led operators to consider building ‘hybrid’ home models for AL and early-stage memory care residents, targeting those with the first diagnosis of dementia. The small units are designed for couples, and couples can remain in memory care together.
The homes allow residents to come and go as they please, with security measures in place for evening hours, McRobert said.
In general, memory care design should be informed by research-based concepts, including creating enriched environments using evidence-based approaches, according to Dr. Upali Nanda, who is the global practice director of research and partner at HKS.
Operators need to incorporate physical activity, socialization and play into the lives of memory care residents based on research, Nanda said, and the concepts of enriched environments are based on motor function, physical stimuli, sensory stimuli and cognitive engagement.
This emphasis on neurogenesis led HKS to pivot its view on dementia care from memory care to cognitive fitness, similar to how health care has shifted to preventative medicine.
“The framework of enriched environments is how environmental enrichment can create neurogenesis, and stave off cognitive decline,” Nanda said during the panel. “The argument we’re making is with environments to stave off cognitive decline.”
Nanda added that she felt the senior living industry was “in the beginning” of a paradigm shift on memory care and brain health.
McRoberts said that the evolution of memory care, from medical-based settings to an emphasis on residential living, creating social spaces for interaction has remained a driver in how providers are creating memory care communities with keeping social interaction top-of-mind.
That’s led designers to focus on “zoning” within memory care units, or creating spaces where social interactions can take place while creating quiet retreats for residents who might need a break from group living.
“The way we like to always approach things is to design a space that we would like to live in, whether we have dementia or not,” McRoberts said. “We want to design spaces that are universally beautiful and functional that people want to live in.”
Epoch’s memory care journey
Waltham, Mass.-based Epoch Senior Living started its Bridges assisted living and memory care program in 2012, and that standalone communities for AL and memory support now include 11 communities in the greater Boston, Mass. and coastal Connecticut areas.
The focus on memory care emerged after Epoch reviewed memory care options for older adults across the state and found that many operators had made memory support “an afterthought” in how buildings were designed, according to Michael Gordon, the company’s chief investment officer (CIO).
“We thought that if we offered a more robust, larger and dedicated building for it we could include elements that support memory care residents specifically,” Gordon said.
Epoch designed a “household model” prototype with three or four households of 16 units. Corridors are eliminated and each bedroom opens up to a living area. The living area, due to its size, requires a large, wide building footprint, at minimum a four-to-five-acre site.
“It’s much larger than your typical memory care unit,” Gordon added. “We were able to find sites that could fit our building in an economical way that we could lay out in single-floor living.”
With the wide footprint, it leaves ample space for country kitchens, vaulted ceilings and overlooks of the enclosed courtyard space.
The key component of Epoch’s Bridges memory care buildings is something not part of the brick-and-mortar at all, it’s the outdoor, secured courtyard for residents to enjoy nature and soak in some sun. Add in programming likey daily meal preparation akin to restaurant dining and activities, residents at Epoch’s memory support communities are primed for well-being, Gordon said.
“There are different levels where people thrive,” Gordon added.
Future of memory care design
Nanda said that a key component for conducting research-based design is understanding the “power of perception.”
“When all our faculties are working, we recognize social spaces or recognize things by visual queues,” Nanda said. “We’re really trying to understand that threshold to give affordances in design that make good design and understand the cognitive threshold.”
McRoberts said two memory care designs that are flourishing are small-home units, known as greenhouses that are as small as 10-beds, or memory care villages that can include up to 200 residents. That’s left operators in a position to evolve programming over time as cognitive levels change for residents.
“I think making sure that you remain flexible is very important,” McRoberts said.
Creating flexible programming helps operators create versatility and modifiability within their spaces of memory care units, Nanda said, but that is a delicate balance because memory care residents often rely on routine and recognition of spaces to participate in activities.
“Consistency is still a design need that you have to create recognizability and familiarity,” Nanda said.
Epoch is currently in a pilot program for telemedicine urgent care visits and running a pilot on fall sensing technology in Bridges units, with two cameras in each room to use artificial intelligence (AI) to detect falls in a non-invasive manner. Once an alert is sent to care staff, residents are checked on.
Installing technology-based improvements to a memory care unit can come with a hefty price tag, McRoberts conceded, but he urged operators to consider tech partnerships to ensure that technology installed in units is easy to use and affordable. All three said they believe that technology will help senior living get to a point in the future where memory care units do not need to be locked at night.
But tech-based enhancements aren’t a magic bullet to the industry’s problem of rising costs or any one community’s problems.
“If you use technology as a panacea, it doesn’t work,” Nanda said. “If it’s an integrated system solution within the built-in environment, it does.”
Looking toward the future of memory care design, Gordon said breakthroughs in brain research and cognitive health could help ease an operator’s bottom line burden as therapeutic care for those with dementia grows as therapies and practices evolve.
Nanda speculated that memory care would shift to “cognitive fitness” and not just care support.
“It’s kind of this turning point where we have to marry a lot of disciplines that have not talked together, and that will change the entire paradigm,” Nanda said.
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