The COVID-19 pandemic has given “home” a whole new meaning for older adults. It was always a sanctuary, a place to feel safe and comfortable, but now we know that there also must be ways to keep people connected, engaged, and active when getting out and moving about aren’t options. “Regardless of what is happening in the world around them, older adults — like all of us — want a purpose in life. It is important that community design supports that while keeping them safe and comfortable,” said David Smith, MD, CMD, president of Geriatric Consultants in Brownwood, TX.
Functionality with a Family Flavor
Even without COVID-19, Dr. Smith suggested, “We likely were headed in the direction of more new buildings. According to data I’ve seen, a significant number of nursing homes are in the last years of their architectural life.” However, the pandemic will be influencing facility design moving forward.
Dr. Smith said, “We’ve learned that masking and social distancing is impossible for facilities where 70% of people have dementia. However, we could possibly quarantine people in groups of six to eight. They would be like a family.” As a result, he said, we may see more facilities with a central building for services such as food/meal preparation, laundry, administrative offices, and therapy, surrounded by smaller buildings where the residents are housed in clusters or neighborhoods. Another innovation, he predicts, though not connected to COVID-19, is the use of safety-related innovations such as subflooring that absorbs shock and reduces fall-related injuries.
How the Pandemic Will Shape Design
“There’s no question that the pandemic will impact construction, design, and renovations in the senior living industry, and these will have an impact well beyond the pandemic,” said Greg Hunteman, AIA, president of Austin, TX–based Pi Architects. He suggested a few innovations and changes to watch for.
- •New dining spaces. Indoor dining will involve more spread out seating and dividers, reduced bar and counter seating, and more innovations such as grab-and-go food service. There also is likely to be more of an emphasis on outdoor dining opportunities. Kitchen and food preparation areas also will be designed to avoid possible contamination and limit access to necessary staff. For the foreseeable future, buffets will be gone, but fun features such as golf cart drive-ins and outdoor cafés or coffee shops will be more popular.
- •Hands-off technology. We should expect to see more touch-free technology, suggested Mr. Hunteman, including faucets and other bathroom fixtures, lights, doors/entrances, and hand-sanitizer dispensers. Voice-activated technology also will be more popular on elevators and in living units to enable the residents to control lights, temperature, and other aspects of the environment.
- •Clean air. Increased air filtration is one proven, easy way to reduce the spread of bacteria. This works even better, said Mr. Hunteman, when partnered with needlepoint bipolar ionization, which kills viruses and agglomerates airborne virus-carrying particles. Additionally, bipolar ionization, increased filtration, and ultraviolet (UV) light can be retrofitted to an existing HVAC system or included in a new one.
- •High-tech changes. Before the pandemic, technology came to post-acute and long-term care in dribs and drabs. Lockdowns, quarantines, and the need to limit personal interactions between people have made high-tech a high priority. Wide bandwidth, 5G, and the ability to get and stay online easily and reliably, plus computers, tablets, and other screens that can be used for video chats, teleconferences, and telehealth consultations will be in great demand from now on. More facilities also will feature dedicated rooms for telemedicine visits that are equipped with examination tables, cutting-edge audio and video, comfortable seating, and other features.
- •Easy cleaning. Cleaning innovations such as UV light wands, carts, and door frames can disinfect clothing, shoes, and items such as phones and laptops. Smooth, easy-to-clean surfaces and furniture with sturdy fabrics that hold up with the use of harsh cleaning products also will be necessities moving forward.
- •Store safety. For facilities and communities with retail space, such as a gift shop, coffeehouse, or convenience store, we will see innovations such as translucent shields to separate customers and employees. Kiosks or vestibules for mail and packaging services may be implemented to reduce mailroom traffic and contact between workers and residents.
- •More outdoor access. The great outdoors has been a godsend during the pandemic. Patios, balconies, porches, and courtyards have enabled isolated seniors to connect, meet, and share safely and at a distance. Looking ahead, these features — plus gardens, wide paths, and large windows that open — will be must-have features.
- •Promotion of purpose. Living spaces, suggested Mr. Hunteman, will need to be designed in a way that nurtures a sense of purpose. This may mean fully functioning art studios, business centers and/or office space, and other efforts that enable residents to work, pursue hobbies, volunteer and contribute to various causes, plan social activities and events, and otherwise live lives of purpose.
Melding Safety, Wellness, and Engagement
“The pandemic has changed everything, but innovations that focus on safety, wellness, and engagement will help facilities and communities thrive regardless of what the future brings,” said Mr. Hunteman. Kevin O’Neil, chief medical officer of ALG Senior in Sarasota, FL, added, “One major advantage of senior living settings is the ability for socialization, as well as efforts to maximize quality of life. Moving forward, we will need to look at opportunities to retrofit what we have to promote safe socialization.” He suggested, “We need to look at the spaces we have and consider how we can mitigate the risk for infections.”
Restricting the ability of family and friends to visit residents is intended to keep the residents safe and reduce contamination risks, but many people have found it devastating during lockdowns. Many facilities devised creative alternatives such as video visits, conference calls, outside meetings, and through-the-window conversations. However, looking ahead, better means must be found to enable in-person visits, such as dedicated visitation rooms. Mr. Hunteman said, “Watch for rooms or outdoor areas specially designed and used for residents to visit with friends and family members. These may feature amenities such as separate entrances for residents and their visitors, glass or plexiglass panels or partitions, and dedicated HVAC/air-filtration systems for indoor settings.”
Dr. O’Neil stressed, “These visitation spaces will need to feel like home. This means comfortable furniture, plants, and artwork.” He added, “This also is where technology can play a role. Elements such as advanced air-filtration systems and UV light can create safer spaces for visits and socialization.”
Facilities and communities may adopt innovations from other industries. For instance, Dr. O’Neil suggested, “Many hotels have different areas, with fire pits or other amenities, where small groups of people can gather. We need to design spaces like this that enable safe, comfortable socialization and let residents continue with their routine activities.” Elsewhere, he pointed out, “we might see larger elevators or ways to limit the number of people traveling on them at any given time.”
Of course, safety and innovative design and surroundings aren’t enough. Dr. O’Neil said, “We need communities and facilities where management and staff really understand how essential it is to ensure that social engagement and safety go hand in hand. They need to realize that their responsibility to residents doesn’t stop when they leave the facility.” Toward that end, ALG Senior’s staff sign a “Hero’s Pledge,” stating that they will practice safety measures such as wearing masks and social distancing even when they are not at work.
Infection control will continue to be a priority, Dr. O’Neil said. “The reality is that if we are aggressive about infection control, it makes a difference and can prevent transmission.” The good news, Dr. O’Neil said, is that “there is a real spirit of collaboration and cooperation. People are communicating what they’re learning and sharing best practices.”
Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, PA, and a communications consultant for the Society and other organizations.