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Well Buildings for Senior Living: Design Making a Big Impact on Healthy Environments

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There is little question that the buildings in which we work, live, shop and play have an impact on many aspects of our existence. This impact can be so subtle as to be unnoticed, but no less impactful, or can be so overt as to force us to a point where we want to exit the structure. What makes a building a “well” building? Simply put, a well building is one that is designed with attention to the quality of building construction such that it enhances or, at minimum, does not detract from an occupant’s physical, mental, social and emotional well-being. In a time of a pandemic this is increasingly on the forefronts of our minds as the design of built environments can also profoundly affect economic well-being by simple virtue of minimizing the spread of disease.

Architects and designers have been cognizant of a movement to more adequately address designs that contribute to a “well” building both as a professional and social mandate. This movement has fostered the initiation in 2014 of the International WELL Building Institute®. This organization provides certification for buildings that meet the criteria established by the Institute. Of course, this process requires a certification fee but also provides a level of accountability for building owners and occupants.

However, in 2011 the book Making Healthy Places (Edited by Dannenberg, A., etal., © 2011, Island Press) posited a strategy not only for providing healthier buildings but healthier communities as well as strategies for accomplishing these goals. The premise of this book is that while the world is becoming increasingly more concerned about what we eat and how we exercise, we tend to ignore the effect the built environment, where we spend much of our lives, has on all aspects of our health.

It can be argued that senior living environments have the most significant effect on their residents’ health because these residents generally spend considerably more time in their homes than other demographic cohorts. It can also be argued that a healthy senior living environment can have a profound effect on the financial health of not only the residents but of the owners and operators of that environment. Keeping residents in a senior living environment holistically healthy also improves economic well-being. 

The WELL Building Institute provides ten strategies to follow to accomplish a wellness program and to provide a well building. These strategies meld together within building design, building operations and facility policies. They include the following:

As can be seen, there are some basic considerations in building design within these recommendations that are traditionally attended to during the design process. But closer attention and more in-depth discussion of these aspects are perhaps in order.

It may seem self-evident that air and water quality, sound and thermal comfort and appropriate material selection are basic, and often code driven, considerations the designer should address. While this may be true, a design that addresses wellness, both in the short and long term, deserves more in-depth consideration. Often the client or the designer provides the least expensive and most expeditious solution to these issues without an eye to the environment’s life span. This approach obviously provides the best immediate return on investment, but does not necessarily contribute to the long-term health, wellness or overall comfort of the occupants or to the sustainability of the environment. Consider again these design items more closely, particularly keeping in mind senior living environments and the potential for the spread of disease or a potential pandemic.

WELL Concept: Air Quality/Thermal Comfort

Air quality becomes paramount in these environments, both the distribution of tempered air and the cleansing of that air to avoid the recirculation of any contaminants or infectious diseases. There are several effective options that are currently available that can be included in design or added to existing systems, but one significant efficacy is increasing the introduction of outside air. There is conclusive scientific evidence that shows increased air quality, in terms of low VOC (from material off-gassing) and low carbon dioxide levels associated with “well” buildings increase the cognitive function of occupants. This can be accomplished in a tempered system simply by adding this air through a heat exchanger.

Of course, air quality and thermal comfort are closely related, particularly within a senior living environment. Older adults have widely varying temperature comfort levels and in a congregate living setting really need to have full control over their living unit thermal preferences. Designing individually controlled systems with programmable thermostats becomes critical in these situations. However, operationally, the residents should be oriented to how that system works as well as how to accurately set the thermostat to their comfort level.

WELL Concept: Water Quality

Designers need to provide potable water that is not harmful. To do this, the design team may not be able to rely fully on simply tapping into the local service lines. Testing the water supply is not difficult and the results may prove that the design needs to include particulate filters or other modifications. The recent debacle in Flint, Michigan is an example where the City provided water was not appropriately safe for its citizens.

But by providing good potable water the over-treatment of that water can have detrimental effects on the larger environment in addition to adverse health effects. Thus, fully understanding the balance between clean potable water and methods of achieving that is critical.

Providing a holistic well environment also means appropriate design approaches to storm water retention and run-off. Doing this in a manner that contributes to a well environment can be effective and contribute to the mental well-being of the occupants through the introduction of exterior areas for contemplation or simply sitting aside a water feature. Being conscious of appropriate storm water treatment is simply a good practice for designers who are aware of their responsibility to the community and the future.

WELL Concept: Movement

It is incontrovertible that exercise contributes to a healthy body, can add energy to a person and increase the mental attitude of that person. Designers of senior living environments must balance the convenience of an individual with limited mobility against how the environmental design might encourage non-assisted mobility and a higher level of well-being. Add to this conundrum the fact that many senior living environments are also a workplace where the efficiency of staff providing care is a significant issue. This balance is not prevalent when designing a workplace environment for example, but with a senior living facility it requires the knowledge and experience that does not fully fall on one side or the other and that fully engages operational stakeholders in the design process.

Oklahoma Methodist Manor Gym

WELL Concept: Community

Creating community is a basic tenant of designers of senior living environments or, for that matter, for any congregate living environment. Without community we are simply individuals living within the shell of our home, neither contributing to the well-being of others or even ourselves. Within a senior living community there are social and amenity spaces that both covertly and overtly bring the occupants, family members and outside visitors together to celebrate their relationships and their larger community. Designing and locating these spaces such that serendipitous socialization as well as active socialization provides a sense of belonging, contributes to independence and ultimately an increased sense of well-being, both physically and mentally.

WELL Concept: Nourishment

While proper nourishment as a contributor to well buildings may seem more in the operational realm than designer’s realm, designers can contribute to this WELL Building principle by first fully understanding the role that proper and balanced nourishment plays in human health. Once that is accomplished a full understanding of how a client intends to deliver food service within a senior living environment, this knowledge can inform not only the design of inviting dining venues and efficient preparatory kitchens, but can lead to the inclusion of campus areas where perhaps kitchen gardens can be located.

Pine Valley Dining

WELL Concept: Mind

Good design touches all the human senses and thus invigorates the mind. The first century BC architect Vitruvius stated in his book De Architectura that a structure must exhibit stability, utility and beauty. Stability and utility can be resolved technically, but beauty is the quality that touches the mind and excites the senses. When that excitement takes place, we are more at ease, we are more communicative, we are more social, and we are happier. And having achieved these qualities we are inarguably healthier.

Addressing through design the well-being of the mind may be more difficult to quantify, it is perhaps the most important aspect of designing a WELL Building because when done well, it encompasses practically all the other strategies.

Your Senior Living Architect should be knowledgeable in providing healthy environments that address occupant wellness and well-being. It should be an innate quality that is brought to the process and one that should encourage others to embrace. Not doing so diminishes the quality of environment and in turn, the quality of life of the individuals occupying that environment.

Charles Robertson, RA, CDT
Project Manager

Charlie is a Project Manager in the Living Environments Studio and a great mentor at EUA. He brings a perspective and a well-informed knowledge of Senior Living Environments as he is a former Certified Nursing Assistant.

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