Unless one has the foresight of Jules Verne, it is impossible to predict the future. One thing is certain, however, when it comes to senior living design: tomorrow’s design approaches will be significantly altered as a result of the COVID-19 pandemic. As designers, it is our duty to seriously consider how the built environment can be in the forefront of infectious disease control and prevention. While acute care environmental designers have long been charged with attention to infection control, many long-term senior living designers have either not considered or have simply ignored elements of building design that can serve to protect one of our most vulnerable population segments from the introduction of disease into their congregate homes.
Why should we even think about adding design measures to congregate long-term senior living environments that diminish the chance of passing on a virus when such an approach would surely raise the cost of construction? If the answer to that question is not obvious, let’s look at the current situation involving the COVID-19 virus. The population segment for whom we are designing for is the most vulnerable for any infection and they are the segment that will have the most devastating reactions to their health. As a result of this current pandemic, almost all long-term senior living campuses have been locked down and visitors, including family members, have been barred from entry. Additionally, trips for residents to the outside community and commercial activities have been halted. These logical reactions to the pandemic only exacerbate the negative resident feelings of solitude, isolation and loneliness. Additionally, as any infection courses through a senior living environment, the staff become vulnerable to that infection and in turn may bring it to their own homes and families. Their absence from providing care to seniors can be devastating to the health of the senior community and to the relationships they have established with residents.
As designers, if we add to all our building programs the preparation for another pandemic, we will almost certainly have designed a senior living environment that will serve to protect the residents and staff from both major and more minor infectious outbreaks. This only makes practical sense and should be strongly advocated to our clients. COVID-19 has changed numerous things about living in the world and it is our duty to pivot, design and build for those changes.
Here are only a few design changes that will emerge to protect our senior residents, but there are many other ideas that will expose themselves as we consider more deeply our charge as designers of safe senior environments.
- Congregate senior living environments will become larger. As social distancing continues to be a significant efficacy to prevent the spread of infectious diseases, larger social areas, such as living and dining areas, will increase in size so that residents may still utilize and converse in those areas, but a bit further away from one another;
- Small house assisted and skilled living residences will become the industry standard. Even prior to the COVID-19 pandemic, small household design was prevalent in new construction. For the myriad of reasons, it made sense then and makes even more sense now. If we provide private rooms with full bathrooms for each resident, it becomes easier to quarantine individual residents if necessary, while allowing them to fully remain in their “home.” Additionally, an operator can more easily quarantine a single household while that household can remain self-sufficient;
- Resident rooms will become larger. Too long it has been the practice of designers and clients to provide only the minimum standard size resident rooms. That minimum can accommodate a bed, bedside table, chair and wardrobe or closet. There is little opportunity for resident owned furniture or a small area for individual socialization or resident study space. If a quarantine is put in place, these rooms become little more than isolation cells. As designers we must always keep in mind that we are creating “homes” and not simply bedrooms.
- More resident rooms will sprout secured balconies or patios. It is always good to provide residents safe and secured access to the outside. Fresh air is an amazing tonic and even more so when confinement to one’s room is mandated. We must be sensible, however, when including these amenities in our design in order to minimize operator liability and, more importantly, to keep residents safe.
- We will see creative ways that allow visitors to socialize with senior living residents. It is crucial for designers to provide environments that create and engage community. When a congregate residence is experiencing a spike in infection among residents, they still need community socialization and interaction. This can be accomplished by providing a small, clean social room that can even have a visual screen safely separating the resident from the visitor. Protected from the weather, these rooms can be designed with easily disinfected furniture and finishes that can be completely cleaned following each visit. In addition, a sort of waiting room adjacent to the main building entry can be included where staff can verify a visitor’s general health prior to admission to the building.
- Technology within the residence will continue at an accelerated rate. Social connection has become ubiquitous and will be more so as senior residents become more familiar and comfortable with it. Technology can not only provide convenient ways for residents to maintain remote connectivity with friends and family, but can also provide ways for them to remain connected to doctors and clinics through telemedicine. Providing a telemedicine room within the campus is relatively inexpensive and the cost can be easily captured from the savings realized by a reduction in transportation costs and can provide operators with early detection of any infectious disease that may warrant physical isolation. Technology can also provide residents with online continuing education courses, cultural events or simply great movie nights. Media rooms are already in many residences but streaming these events directly into resident rooms can help diminish the feeling of isolation during a quarantine.
- Resident room design will include consideration for future versatility. In addition to being larger, resident room design will include consideration for licensure change and perhaps modification for more acute care during a pandemic. If appropriate design is provided, long-term care resident rooms, particularly those within a small house concept, can relieve the strain of a hospital during a pandemic. This approach is community-minded, but could provide additional revenue for a provider experiencing low census. Coordination with local acute care providers would be essential. This approach may also become a mandate for licensure from some authorities having jurisdiction so being prepared may be the watchword.
- More intensive consideration will be given to finishes and furnishings. As designers, we should be advocating finishes and furnishings to our clients that are readily cleanable and easily disinfected. These don’t have to be institutional in nature. There are numerous finishes that are anti-bacterial and even attractive hard, non-porous surfaces are available that can be easily cleaned. Thoughtful attention to the materials we place in our senior living environments is essential.
- Mechanical systems will become more sophisticated and garner more attention. The air quality within senior living residences has always been a critical design factor. In order to prevent the spread of pathogens, it will become even more so. Germicidal ultraviolet air disinfection units and air filters will proliferate in new and remodeling projects for senior living. While not inexpensive, these sorts of mechanical system add-ons can save resources in the long run.
- Design for residents. Even in normal times, we should be designing for how residents live and how staff work within senior living environments. Listening to our clients and fully understanding their operations can allow us to create spaces that will be functional, but also provide “homes” for those occupying them. We can demonstrate to residents, staff and the public, through thoughtful environmental designs, that the residence is safe, secure and prepared for practically any eventuality.
- Create a “clean team.” Senior living care providers are on the front line of infection and disease control, they know the intricacies of how infections are spread and they care deeply about the health of the residents they take care of. Creating a rotating group of staff members who can suggest and review efficacies for a clean environment not only serves to involve them as full stakeholders, but can result in innovative and creative ways to keep the environment safe.
Certainly, none of us can predict the future, but we can prepare for what the future might present based on our past experiences. Hopefully when this pandemic subsides, we will not experience another, but being cognizant that infections and disease can easily spread within a senior living environment should inform our design decisions as we move forward.