By Paul Saks
Maybe I am slowly becoming a grumpy old man. As I have gotten older, I have become more vocal about everything, like stores that offer poor customer service, restaurants that serve cold food and even drivers who text while the light is green.
Moreover, when it comes to work, there are things that I encounter daily that are also causing me to speak up. I am constantly seeing the design of senior housing communities not meeting the needs of the staff or residents. These design issues not only affect the functionality of the community, but also the satisfaction level of the residents. Like a puzzle, these issues arise because there is a key piece missing in the design process, an operational component.
There is intrinsic knowledge of the senior housing industry only obtained by working directly in a community—seeing staff and resident challenges with mobility, logistics and legal rights. I personally know many senior housing architects, designers, developers and investors who have never been in, worked in, or spent significant time in an actual operating community. Yes, it can be chaotic, unpleasant and heartbreaking, but it can also be enlightening and rewarding. This insider knowledge is key to developing a great design.
So why is insider knowledge lacking?
If the architects, designers, developers and investors do not have this knowledge or experience, the only party left is the operator. Often, the developer and the operator are one in the same, but typically, the operator of the community is a third party who is leasing the building from the developer. In many cases, however, the operator is not involved in the design process. Contractual obligations for community operations are commonly not in place until after design completion and ground has been broken.
Even when an operator is involved early in the design, it usually has minimal input. There can be a disconnect between their interpretation of the blueprints and the final constructed product, as the operator is not a design or real estate professional skilled at reviewing plans and building specifications. In addition, due to time constraints and the need to push projects rapidly, this part of the process is frequently rushed. The operator may only have time for a cursory review of the plans and limited comments.
So, before I touch on some design issues, let me bring up one key point to remember: You are designing a community for residents who are seniors, many of whom have senior issues, like bunions, arthritis, heart disease, diabetes and the need to play bingo. This seems like common sense, but you would be surprised how many new communities do not reflect the needs of the end-user.
The design created for a project full of Millennials is not going to work for a project full of AARP members.
I recently talked with a development company out of Virginia who builds senior living communities in the Southeast. They told me the average age of their assisted living residents was 84 years old. Their memory care residents were older. Even their independent living residents were in their late 70s and early 80s. Age produces a completely new level of design complexity.
Here are a few of the design issues that I encounter:
Mobility—Senior living facilities are getting larger. Many projects are combining assisted living with memory care. Some also have an independent living component, and a few of the newest ones are adding respite care, hospice and elderly daycare in their mix. This means that new buildings will often exceed 200,000 square feet. In design plans that I have reviewed, it is common to see long hallways that a resident has to traverse to get to a dining room or an amenity area. If the average age in your community is 84 years old, this can challenge residents.
I know instances where residents have skipped breakfast and lunch because they could not walk the long distance to the community dining facility. Asking for help or a wheelchair means loss of independence. To remedy this design issue, add some “pit stops” along the way. A pit stop can be a mini living room in the hallway with a sofa and chairs, or just a little bump out in the wall with a bench. Give residents a place to stop and rest.
Another option would be to revise the placement of the elevators. Most often, elevators banks are located at the center in the building. Pulling an elevator closer to the units can help break up walking distance.
Finally, it is common to see dining and amenities all relegated to the first floor. Challenge the norm. Instead of bringing residents to the amenity, bring the amenity closer to the residents and their living quarters.
Service Logistics—Larger buildings also mean you may have two or three (or even four) dining areas served by one kitchen. In a restaurant, an employee typically moves food from the line area out a service door into the dining room and directly to the customer. In a senior community with multiple dining areas, you may have one dining room with direct access to the kitchen, but others more remote in the building. Food may now have to be placed on a cart and trucked down a hallway, or even outside to an adjoining building. This is a huge liability.
Pushing a heavy cart down a hallway crowded with senior citizens is an accident waiting to happen. I have seen residents hit by carts, improperly stacked food trays fall on residents and even staff injured (I remember a traumatic big toe episode), not to mention walls, furniture and doors damaged by careless cart drivers. Food can also arrive cold, or worse, be accidently contaminated along the way to a dining room. While cold food is a bad customer service issue, a food–borne illness can elicit the wrath of state regulators.
The main dining areas need to close to the kitchen. If this is not feasible due to building constraints, then one option is to put a small prep area off each dining room.
Instead of staff pushing multiple carts full of plated food down a crowded hallway, a few sealed trays of pre–made food now go directly to the prep area for plating. If the food needs be kept warm, ditch the old steam table and install a warming drawer, or reheat quickly with a small ventless convection oven. There is always the option of a service hallway, like those found in hotels. While this is the best route for delivery, service hallways will add thousands in cost to a project. You are also adding more square footage to your building, and this space does not create any inherent value in terms of marketing benefit or increased rental income.
Another more creative option is to stack dining areas. The assisted-living dining room may be on the first floor while the independent living dining room is on the second floor, with staff access via a service elevator or dumbwaiter.
Storage—In my past life as an administrator, I had hundreds of residents pass through my community. Downsizing for them was difficult, and every one of them came with chachkies, bric–a–bracs and knickknacks. Some rooms became trip and fire hazards. The minute you politely asked a resident to remove some of these items, you received a visit from the ombudsman claiming you were impeding resident rights. Residents come with stuff, so plan for it.
Give residents a large walk-in closet. If there are porches or patios, provide a locked storage area at one end like those found in many traditional apartment units. You can even provide some storage lockers. There is always dead space in the community (like under stairs) that can be utilized. A small rental fee can also add a little miscellaneous income to the bottom line or the resident bingo fund.
Outdoor Space—There was an administrator for a community in North Carolina that always got into trouble. When his regional vice president would show up for inspection. The residents sitting in front of the building would infuriate the vice president. He believed that “old people” sitting or sleeping at the entry hurt the marketing program and he wanted them relegated to the back of the building to an unkempt greenspace area (with the view of a wall).
Do not hide your residents from society; put them where the action is happening. Many of the new projects today promote walking trails, Jacuzzis and putting greens. Unless your community targets younger, more active adults, only a handful of your residents will use these services. They are great marketing tools to show the family, but not purposeful. Residents want to get outside, but often have mobility challenges.
Give them a purposeful place to go and sit, socialize and watch the world around them. There is a project in Columbia, S.C., that has a beautiful outdoor patio, but most of the time it is vacant. The designer, who was not from South Carolina, did not know that Columbia was a hot, humid and sweaty town. The positioning of the patio caused it to get beat by the sun all day with limited shade. Moreover, the view from the patio included the back of buildings and air-conditioning units.
Know your customer, know your site and know your market. One of the most successful communities I saw recently was an infill project that backed up to railroad tracks. The developer, instead of downplaying or trying to hide the railroad tracks, made them an amenity. He built a handicapped accessible train-viewing platform. The residents loved it.
Give residents a purposeful place to sit outside (it does not have to be at the front entry) with a view of planes, trains, automobiles and people—not walls and air conditioners.
In summary, you must have some insider knowledge to understand how a senior living building will truly operate when opened, and you must have some insider knowledge to understand the needs of your ultimate clients, the residents of the community.
You are not designing for yourself or a developer; you are really designing for residents like your parents, grandparents, or even great grandparents. They need to be able to navigate the community easily, they expect hot food and great service (and safety), they demand to keep personal stuff and will need storage, and they do not want to be isolated. They want to maintain some resemblance of a connection to the outside world.
I believe that you will begin to see resident satisfaction increase as these issues are addressed, and higher resident satisfaction can have the effect of creating higher staff satisfaction. Please keep all of this in mind when designing your next community.
Paul Saks is director of development for LandSouth Construction – Senior Living Division in Jacksonville, Fla. He has been in the real estate industry for 30 years, and has entitled, developed and constructed senior living, multifamily and master-planned mixed-use communities throughout the U.S. He is also a licensed assisted living and skilled nursing administrator and previously ran a 180-bed community.