Comfort and joy

Willson Hospice House, Albany, Georgia

Ila Burdette, AIA, LEED AP BD+C, Principal Perkins+Will

Page 42

When Ila Burdette describes her experience designing the Willson Hospice House in Albany, Georgia, one is struck by the gravity of the commission she and her team at Perkins+Will were charged with delivering. People who leave their homes to enter hospice care most likely will experience their final days in the setting. It can be a daunting responsibility, not to be taken lightly. And yet when Burdette, a seasoned senior living design professional, speaks of her involvement with the award-winning community, one senses her joy and peace and a quiet satisfaction in having created a beautiful and life-affirming haven for the terminally ill and their families.

A COMMUNITY NEED

Willson House grew out of a pressing community need: A growing number of terminally ill patients in the area were unable to stay in their homes or were lacking family support. The hospice program originally involved 50 homecare staff who traveled from a modest base building each day to reach patients in the surrounding 11 counties. There wasn't a residential component.

“We were building a home for a program that has so much built-in affection and support,” Burdette says, “because if you help a family's loved ones they'll never forget it and they'll be loyal forever. And many people don't realize that those families are taken care of for up to a year after their loved one has died. So we hear ‘What else can we do for you? What would you like? How can we help?’ And then family members become volunteers and the volunteers become donors.”

Burdette describes a group of stakeholders who brought varying perspectives to the project. “The administration had a goal of being responsive to the community and they were also interested in a distinct architectural style and a sustainable project-those were big-picture goals. (Just prior to going to press Burdette was notified that the project achieved LEED Silver certification.)

“We had a far-sighted CEO, Joel Wernick (President and CEO of Phoebe Putney Memorial Hospital, of which Willson Hospice House belongs) who was interested in something that was a translation of [architect] Frank Lloyd Wright to South Georgia, and Patty Woodall, Willson's executive director, who really focused on patient and staff needs: ‘Let's make a beautiful room that feels like you could live it. Let's think about where these family members are going to spend the night and make sure they're very close,’” says Burdette.

NATURAL TRANSITIONS

The 14-acre site sits on 200 acres of rolling woodland, much of which is wetlands, offering a natural privacy buffer and yet ready access to the outside community. “There's a long approach road that takes you under the Spanish moss and through the oak trees. It gives you a chance to breathe a bit before getting to the front door,” Burdette says. “We wanted something that felt like it was taking advantage of this beautiful site.”

In addition to the administrative component of the building, which serves as a home base for the outreach staff, and a public meeting space, the rest of the community is organized into three pods and associated support areas for 18 patients. Each pod is composed of six private rooms grouped around a family living room with space for dining, reading, and conversation.

Burdette and her team found from earlier projects that these pods or small cottages work best in hospice with family living areas located right outside the door of the patient's room; if the living areas are too far away from the patient families won't use them.

Built-in window-seat beds in each room serve a purpose beyond accommodating guests with a pretty view to the outdoors; they stay put. Says Burdette, “The problem with pullout chairs is those chairs wander around and you don't want them in a place where the nurse will trip over them at 3 in the morning.”

There's plenty of access to the outdoors at Willson Hospice House, exemplifying the community's mission of serenity and stress relief. Patient rooms have views of and access to tranquility gardens and the patient pods are arranged around a central green space courtyard.

Burdette reflects on the rewards of the project: “We had that community support, that affection, and when we visit it's still there and people are so proud of [Willson House] because they made it possible. They really identify with it. You don't just put up a building and walk away from it. It's nice to see folks so excited about a project.”

Merrill Gardens at The University, Seattle, Washington

Brian Runberg, AIA, Principal Runberg Architecture Group PLLC

Page 46

The evolution of Merrill Gardens at The University is a tale of two generations. Set in the established Ravenna neighborhood of Seattle, the 2.5-acre building site, comprising both seniors housing and market-rate apartments, is but a few blocks from the University of Washington's main campus. With the intermingling of such markedly different community residents-both student and aging citizen-already taking place, bridging the generational divide was an unavoidable certainty for this project.

“As the ownership and developers started putting the project together, more and more parcels became available,” says Brian Runberg. “The program grew and was redefined a number of times to the point where there were nearly an equal amount of market-rate apartments as there were senior housing units.”

A true multigenerational complex, Merrill Gardens at The University combines 123 independent and assisted living units with 103 market-rate apartments, which are inhabited by a significant number of University of Washington students. In addition, the ground level houses 24,000 sq. ft. devoted to restaurants and specialty retail shops. While it may seem like a bold, perhaps adventurous mixture of occupants, Runberg says consolidating these two ends of the aging spectrum is actually quite complementary. “Knowing how students socialize and live, they can often feel equally as isolated as seniors do,” he says. “So one half of this project has people in their first independent type of living experience. And on the other side, literally across the courtyard, has senior citizens who are in their more reflective sunset years.”

The courtyard itself serves as a versatile space-a “mixing chamber,” as Runberg's team calls it-for both generations to engage one another. Residents play bocce, hold outdoor movie nights, and even invite the University of Washington band to play music. Inside the complex, a wine bar serves coffee in the morning and holds happy hour in the late afternoon, which graduate students and seniors enjoy with one another. Students also purchase meal plans through Merrill Gardens to use in the dining area, which is more like a restaurant with full-scale menus. “They even have these Nintendo Wii bowling contests. They're very competitive about it and the seniors are more competitive than the students,” Runberg says lightheartedly.

While it is easy for student and senior to regularly interact, the layout of Merrill Gardens at The University thoughtfully separates all occupants into specific locations. For instance, the retail shops and apartments line the active, commercialized main street. Because the western half of the block faces a quiet residentially zoned property, it made sense to place “the more passive” seniors housing units there, Runberg says. Everyone is then linked one way or another by the central courtyard, which is critical to the paradigm shift inherent to this multigenerational campus.

“Eighty is the new 70,” Runberg says. “Seniors are living longer not just based on modern medicine but on how people are being more active. I think living in the right environment helps lend to that.” And for the students? Well, being exposed to their elders must certainly be valuable. Access to that kind of wisdom can't be found in any classroom.

Penick Village Garden Cottage, Southern Pines, North Carolina

Alan Moore, AIA, Principal CJMW

Page 48

It was a long process. Alan Moore emphasizes this again and again when describing the project origins of Penick Village Garden Cottage. With a resident capacity of only 10, and a square footage of just 7,000, this single-family type of residence, run as an assisted living facility, does not immediately inspire images of prolonged design.

But Moore assures, don't let the project's size fool you. Those details are deceptive. “Every aspect of design was measured by a simple question: ‘Would you have this in your home?’” Moore says. “Nurse call systems, med carts-we weren't having any of those.”

These are utterly precise standards, born from collaboration with an unwavering client. Moore says once Penick Village heard of the Green House movement, and the notion of freestanding buildings that house a small number of elders, it was all over. Despite criticisms that the concept is too expensive to operate, too financially unsound to take seriously, Penick Village assimilated the philosophy of resident independence into its organizational mission. “Deinstitutionalized healthcare” was the aim of the Garden Cottage, and nothing else would be acceptable. Then again, Moore felt the same way.

“It's wonderful for people like me who have been doing this for a long time to see owners and operators ready to make the changes that I think a lot of designers have known need to be made,” says Moore, a design veteran with more than 30 years of experience. Penick Village certainly aimed high, desiring LEED Silver certification and favoring the principals of environmental sustainability. Beyond that, however, the provider hopes this prototype is also sustainable as a model for care delivery, the success of which will not only have implications for the future of its business, but for the outlook of its neighboring communities as well.

Located in the Sandhills of North Carolina, the Garden Cottage-part of the larger Penick Village retirement community-is being monitored by the state Division of Health Services Regulation as a “test case” to establish criteria for future cottages of similar deinstitutionalized makeup. This regulator had previously not permitted licensure of small homes unless they contained the institutional requirements of larger long-term care facilities. Luckily, the Garden Cottage had an allure they could not deny.

“As much as we complain about the state regulatory authorities,” Moore says, “in this case I really couldn't have asked for them to have done more. They saw this as an opportunity to adapt to the changes that are taking place in long-term care.” The regulatory body met with both Penick Village and CJMW during design development to come up with acceptable equivalency measures-“a technical term in building code language that meant coming up with design solutions that they felt provided the safety that they expected but without all the institutional features of a typical nursing home,” Moore explains. A good example is the open dining area, directly connected to corridors and bedrooms. Because the structure has a high ceiling, the regulator deemed that if a fire were to occur, smoke would rise within that space and allow residents sufficient time to evacuate. This allowed the designers to abstain from installing fire shutters and doors “that would have given the place an institutional feel,” he says.

Though the Garden Cottage itself is small in size, Moore says its completion helps in combating the “enormous” regulatory challenges that plague good design every day. “Winning the battle of the codes is going to be a long process,” he says. But much like good design, he knows that investment in time comes with the job.

Casitas on East Broadway, Tucson, Arizona

Tom McQuillen, AIA, LEED AP, Principal Lizard Rock Designs, LLC

Page 50

Casitas on East Broadway provides affordable, safe housing to low-income seniors who qualify for HUD low-rent subsidies. During its construction, tenants had already submitted their applications and, upon its completion in August 2010, it was immediately occupied, according to Tom McQuillen, AIA, LEED AP, and principal of Lizard Rock Designs, LLC. “This is a compliment to the Tucson Housing Foundation and the Catholic Community Services of Southern Arizona, who partnered with us on this project,” he says.

The historic Sam Hughes neighborhood, an area with a unique character, is located east of the University of Arizona. “It is an area of charming bungalows, where many professors live. Many of the area's homes were built around the time the railroads were being established in Arizona,” says McQuillen. A number of these homes are wood-frame construction. “Since there aren't a lot of trees in Arizona, the lumber arrived by rail,” he explains.

From a neighborhood perspective, there is a strong block culture. A typical home has a front porch and maybe a garage or one that's been converted to a studio off of an alleyway. Casitas borders this neighborhood. “Shopping is very convenient and walkable for the Casitas residents,” says McQuillen.

As the building became occupied, the new residents of Casitas were welcomed into the greater community. “There is a Safeway [supermarket] within 200 yards of the building. Its manager is on the Casitas board and the store offers special promotions to encourage the residents to stop by,” McQuillen says. Businesses continue to establish ties with these senior apartment dwellers.

Safety is always a concern for seniors living on their own, but Casitas is staffed with two full-time employees from Catholic Community Services, and a live-in manager is in the works, so there will always be someone a resident can contact. The apartments are also well-lit from the abundance of natural daylight from either a corner or bay window.

Apartments are arranged around small courtyards that foster a sense of community. The various “neighborhoods” designed throughout the complex promote a sense of neighborliness between the Casitas residents. The main lobby also serves as an area of spontaneous socialization.

McQuillen credits the project's location as a big plus in attaining its LEED Gold certification. “Points are awarded for how close a project is to shopping, transportation, and public parks.” Casitas on East Broadway was constructed on a lot previously occupied by a closed-down car dealership, which became an “attractive nuisance” in the neighborhood. With Casitas in its place, the neighborhood is now a positive, active asset to the community.

Krista Ziemba, the project architect, worked incredibly hard sorting through and evaluating all of the LEED points that could be pursued including those that added no cost to the project as well as those that gave residents the most value in creating a positive environment to live in. “That was a satisfying aspect of the project,” admits McQuillen, “and Krista is responsible for pulling it all together and spearheading the LEED certification process.” She is also credited with keeping the project on track and on budget.

Although sustainable design is not prohibitively expensive, you have to pick and choose the elements to incorporate. “In building Casitas on East Broadway, we didn't have much choice,” says McQuillen, “because the money we got from the HUD grant was the money we had to work with.” For instance, the architects would have loved to include a huge solar array on top of the building, but it was cost prohibitive.

Because of the tight building envelope and efficiently designed air filtration, the environment is healthier for seniors. In addition, McQuillen notes that Tucson Electric Power recently proposed to donate and install solar hot water heaters. “It was on our wish list, but was too costly. Now we're going to go back and retrofit the building to install them in the near future,” he says.

McQuillen remembers when ground was first broken for Casitas. “Prospective tenants would come by the construction site to watch the activity. They wanted to know when it would be done because not only was it an affordable option, but they knew that the involvement of Catholic Community Services and Tucson Housing Foundation meant that these independent living apartments would be well-run and maintained.” Now the community of seniors at Casitas on East Broadway is thriving.

Eden Rehabilitation Suites and Eden Green House® Homes, Oshkosh, Wisconsin

Julie Heiberger, Project Architect Hoffman, LLC

Page 52

The new Eden Meadows campus is the culmination of in-depth planning, design, construction, and organizational strategies between Lutheran Homes of Oshkosh (LHO) stakeholders and its architectural and construction management partner, Hoffman, LLC. A Wisconsin leader in senior care looking to expand its existing services, LHO acquired 77 additional acres just a few miles from its original campus. According to Julie Heiberger, project architect, LHO now provides person-centered care on its Eden Meadows campus-Eden Rehabilitation Suites and two Eden Green House® Homes, the first facilities of their kind in Wisconsin.

“Eden Rehabilitation Suites offers short-stay therapy in a pleasant and healing-oriented environment,” says Heiberger. A state-of-the-art facility, the Rehabilitation Suites provide the latest in therapy services in a convenient, comfortable, and healing atmosphere for up to 30 residents. “Whether recovering from surgery, illness, or accident, care is provided within a homelike atmosphere,” explains Heiberger. She adds that the facility was designed to provide private rooms that include European (barrier-free) bathrooms in their design. “To conserve water, bathrooms were fitted with low-flow plumbing fixtures and dual-flush toilets here and in the Green House Homes” she adds.

Heiberger reflects that since short-stay residents are on their way to recovery and back into their daily lives, amenities like a bistro with outdoor patio seating and a fireplace in each household dining room offer residents, their guests, and staff an area to socialize, relax, and recover from a therapeutic workout. A courtyard garden area also offers clients refreshing and rehabilitating connection to nature and the outdoors.

“Of course,” says Heiberger, “the primary purpose is providing therapy to Eden Rehabilitation's residents, out-patient clients and, in some cases, the Green House residents. The facility's main therapy room, which is bright and energetic due to the natural light from coming in through the skylight above, offers the latest in rehab equipment and programming. “We worked closely with LHO's rehab service provider to arrive at the many program needs; from access to the outdoors, how to accommodate therapy space for getting in and out of resident's own car, bathing and cooking accommodations, to staff space and storage. The layout of Eden Rehabilitation provides for access directly from the two households in addition to the entry directly off the main lobby. The direct household access allows staff to use the serving kitchens as program space for occupational therapy.”

Being first to achieve a goal is a wonderful feeling, especially when your accomplishment provides a response to the ever-evolving needs of seniors and their families. In 2008, Wisconsin's Department of Health Services created a Property Incentive Program for new skilled nursing construction. The fiscal incentive is to encourage nursing home providers to replace their old facilities with new building environments that embrace innovative design strategies, have 50 beds or fewer, and support a person-centered care model. LHO's Eden Meadows Campus was the first new skilled nursing facility in Wisconsin to open under this program and receive the incentive.

“Since 1966, Lutheran Homes of Oshkosh has been providing quality care to seniors in a Christian environment in the Oshkosh area,” says Heiberger, “and this project is a great achievement for them to continue to be on the forefront of senior care. LHO worked with representatives from the The Green House Project to bring the first Green House Home model to Wisconsin.” Today, two 10-room homes offer person-centered care in an enriching, deinstitutionalized atmosphere. “Resident rooms radiate from a central area that includes a hearth, an open kitchen, and a dining area,” she explains. In addition, each home has a den and a beauty/spa. “All of these amenities and residential feel were accomplished while adhering to regulations covering skilled nursing facilities,” she says. Adjacent to the spa, there is a wellness area which allows residents to receive therapy in the home. “The team really focused on creating a sense of home, both in scale and with the materials and details incorporated into the design. We used many craftsman details throughout to enhance the residential qualities of the home.”

Both projects took full advantage of sustainable design strategies. “We used LEED® guidelines in planning the entire project,” comments Heiberger. Among the sustainable features, she notes the project's specification of high-performance glazed windows that provide generous non-glare day lighting, offer beautiful campus views, and help control seasonal heat gain or loss. A man-made pond used as a storm water detention basin also serves as a geothermal system to provide heating and cooling throughout the buildings. “Along with the windows, a light-colored membrane roof at flat areas of the Rehabilitation building, the use of energy recovery units, and the incorporation of heat pumps help to make Eden Meadows a very energy-efficient campus.

Residents-both long- and short-term-enjoy and appreciate the environment LHO has created for them. From ponds, landscaped courtyards, adjacent wetlands and woodlands to the warmth and style of their rooms, the Eden Rehabilitation Suites and Eden Green House Homes provide the optimum environment for LHO to continue its tradition of person-centered care. “The design of this campus would not have been possible without LHO's diverse team of individuals who we worked with throughout the entire process. The result is an environment that enhances the daily living of the residents while supporting the needs of the staff,” reflects Heiberger.

Azura of Lakewood

Lantz-Boggio Architects, PC

“This project provides great separation of services from public and resident spaces. Nicely scaled and well-appointed interiors.”

“I like the small clusters of eight combined with the ‘café’ for 24.”

California Veterans Home

SFCS Inc.

“Design incorporates resident room innovations including window seating, corner windows, and an area at the door for scooter storage.”

“The designers spent time thinking of ways to increase contact time of staff to members-staff touchdowns and decentralized systems.”

Casitas on East Broadway

Lizard Rock Designs, LLC

“Wins the financial challenge by making LEED Gold work on a HUD 202 budget. This raises the bar for the rest of the industry.”

“Good use of outdoor courtyards to bring in more natural daylight and to break up what could have been a long, narrow corridor.”

Ginger Cove

CR Goodman Associates

“The stakeholder involvement in pre-design was one of the strongest elements of this project. The design solutions have a direct correlation to measurable stakeholder goals that were established early in the process.”

“Large resident rooms and nice bathrooms.”

Grancare Gardens

Community Living Solutions, LLC

“This project presents a creative solution for adaptive reuse, converting an old medical office building into a small assisted living residence. This low-cost project took advantage of an underutilized resource that can be found in almost every community.”

“The gazebo provides a successful integration of interior and exterior environments.”

Landis Homes Retirement Community

RLPS Architects

“A unique hybrid concept incorporating shared common areas in a small independent living apartment building. The plan allows each apartment to be a corner unit.”

“Adding a common space to a small apartment building for seniors offers the possibility for more congregate activity.”

Immanuel Lutheran Senior Living Community

AG Architecture, Inc.

“The Therapy Pavilion exceeds the standard design of what we typically see in therapy areas by incorporating design concepts indicative of the mountainous region.”

“All private rooms with ceiling lifts are located in proximity to the Therapy Pavilion.”

Rockwood Retirement Community: The Summit + The Ridge

Perkins Eastman and NAC | Architecture

“Riverwalk present a mind/body concept. Exceptional guiding principle and design concept create the connection between operational philosophy and built environment.”

“The windows, clerestory light, balconies, and landscaping all add up to a community for outdoor lovers.”

The Sagewood Continuing Care Community

Rosecrest Communities

“There was outstanding inclusive pre-design programming that resulted in moving regulations to support household designs.”

“The Main Street is accessible for the residents from their respective households.”

Vi at Silverstone

Vi Living and Plaza Companies

“The Palazzo Living Room connects the interior to the exterior and outdoor living opportunities.”

“Successful use of interior color and light set the appropriate mood.”

Design Environments for Aging 2011 2011 March;():32-40

Patricia Sheehan

Patricia Sheehan was Editor in Chief of I Advance Senior Care / Long Term Living from 2010-2013. She is now manager, communications at Nestlé USA.