Long-Term Living, via our Web site (https://www.iadvanceseniorcare.com) asked readers to nominate and then choose the architects and interior designers who have made a difference in the lives of those residents living in long-term care facilities.

We received many nominations from all over the country and then presented those nominations to readers to vote on. Resoundingly, you, the readers chose architects Gene Guszkowski, AIA, principal, AG Architecture, Milwaukee; J. David Hoglund, FAIA, LEED AP, of Perkins Eastman; and interior designers Rachelle DeGeorge and Mary Inman, both of Studio 121, Nashville, Tennessee.

Guszkowski heads a firm that has been a multiple winner of Long-Term Living‘s annual DESIGN competition. He is known for Saint John’s On The Lake and Highland Gardens, both in Milwaukee; Cypress Glen, Greenville, North Carolina; and Three Crowns Park, Evanston, Illinois.

Hoglund oversaw and directed the design effort for NewBridge on the Charles, outside of Boston. He is also responsible for Copper Ridge, Sykesville, Maryland; Woodside Place, Oakmont, Pennsylvania; and Asbury Place, Mt. Lebanon, Pennsylvania. His designs encourage wellness and the mixing of generations.

DeGeorge and Inman designed the interior for Sojourn Rehabilitation Center, a spa-like rehabilitation center within a skilled nursing facility at Riverside Senior Living, Kankakee, Illinois. It has decentralized nursing stations, private rooms with vibrant colors, natural light, bamboo plantings, and artwork. The space also accommodated wireless technology, TV nooks, and kitchenettes for a hospitality environment supportive of healing.

Long-Term Living would like to congratulate all of our winners and to thank them for their efforts in “making a difference in design” for residents in long-term care.

Readers vote for GuSzkowski, Hoglund, DeGeorge, Inman

Gene Guszkowski, AIA, Principal, AG Architecture

In on the ‘ground floor’ of senior living

By Richard L. Peck, Consulting Editor

There are constants in life, and one seems to be that Milwaukee design firm AG Architecture will win a Citation in Long-Term Living‘s annual DESIGN Showcase. This has happened each of the last four years. It shouldn’t be surprising: AG Architecture has been doing senior facility design for a very long time.

One might say they were present at the creation. As AG Architecture principal and president, Gene Guszkowksi, AIA, notes, “When I started with this firm 42 years ago, skilled nursing facilities were just taking off. There was a boom of construction in the southeast Wisconsin area. The precursor of today’s Lifecare Services, then known as Christian Home Services, wanted to do its prototype for Friendship Village in Milwaukee. Starting as a ‘print boy’ on this project, I got involved on the ground floor of the growth of the senior living industry.”

Back then, Guszkowski recalls, continuing care retirement communities (CCRCs) consisted of a skilled nursing facility on one side, an apartment building on the other, and something called the “ADL building” in between. “It stood for ‘assistance with daily living’ and, over time, that evolved into what we now know as assisted living.” Guszkowski notes that AG Architecture got involved with the Greystone Communities in the late 1980s and then, in the decade of the ′90s, “rode the rocket” of assisted living giant Alterra Healthcare, building 120 facilities in 26 states.

The firm’s work has grown in variety and challenges successfully met over the years, with touchstones being the firm’s four DESIGN Citation winners. Here’s what Guszkowski says he learned from each:

St. John’s On The Lake, Milwaukee. “This was a repositioning for culture change, and one of our first experiences with a client making a real commitment to this. It involved an upgrade of a variety of spaces in a highly restricted building structurally. We learned a lot from that, as well as how to phase a project to get it done while people are still receiving round-the-clock care.”

Highland Gardens, Milwaukee: “This was a public housing upgrade based on the CCRC model. We have a commitment to serving the underserved-everyone should be able to retire with dignity. We applied everything we had learned from the private sector about good planning and applied it to the public sector.”

Cypress Glen, Greenville, North Carolina: “This involved creating a dementia care unit in a very restricted space-literally an island in the middle of a parking lot. It was an exercise in creative space planning and in listening and learning from the nursing staff. We learned, above all, the importance of line of sight in these facilities. In previous facilities we had used the racetrack walking path model, but with the space limitation we provided a collection of spaces for resident activities, all of them under constant monitoring by the nurses.”

Three Crowns Park, Evanston, Illinois: “In combining an addition and a renovation of a skilled nursing facility, we learned a lot about adapting the Green House model from consultant Steve Shields. In learning from the Green House model, though, I get the feeling that not everyone understands its full implications from the management standpoint. It isn’t managing your traditional facility.”

J. David Hoglund, FAIA, LEED AP, Perkins Eastman

Lifelong interest between seniors and built environment

By Maureen Hrehocik, Editor

J David Hoglund, FAIA, LEED AP, has come a long way from cardboard and popsicle-stick buildings. He relates as a five-year-old while his friends were out making roads for toy trucks, he was running home to find cardboard and sticks for the buildings. That’s how early the principal and director at Perkins Eastman knew he would be an architect. He is now nationally known for his long-term care facilities in the United States (Woodside Place, Copper Ridge, Asbury Place, NewBridge); has designed for clients in Japan; and is now in discussions with clients from China and India.

Hoglund was drawn to long-term care because of his lifelong interest in seniors. “I’m motivated by how much impact the built environment has on seniors and the relationship between the two,” he says. “That relationship can lead to very rich and new solutions when one begins to look at how much impact on the quality of life we can have.” Hoglund’s interest in the interface between people and buildings started in architecture school. Over the years that interest evolved into working with populations with special needs where the physical environment creates challenges or the built environment is not being as supportive as it could be. He has designed buildings for the emotionally disturbed, for substance abuse patients, and homeless shelters.

Innovation abroad

During the early ′80s, a fellowship took Hoglund to Scandinavia. “I chose Northern Europe because it had already gone through the deinstitutionalization of environments that was just starting to happen in the United States,” Hoglund explains. “They had already created a group home care model similar to The Green House. They were very innovative and ahead of the U.S. in long-term care design.” Hoglund was able to put what he learned abroad to quick use a couple of years later with Woodside Place, Oakmont, Pennsylvania, a dementia-specific assisted living space. It was based on creating households for residents. “That project was the beginning for me of creating new ideas and new models of care for seniors,” Hoglund says. “Woodside was starting to transform the way we thought about people with dementia. What we learned very quickly out of our research for that building was many of the design principles of small group homes and paying close attention to finishes and acoustics, the visual field of what people saw, and creating landmarks and an easily navigable building were good design principles for all seniors. All of those ideas that were focused around dementia were really things that helped us create new models in this industry for what long-term care will become in the future.”

Last year, the AIA and AAHSA awarded Woodside the 10-Year Design Award because of its lasting impact on the industry. “That got a lot of people thinking,” Hoglund says. “I feel fortunate in my career to be able to take lessons learned from Woodside and go on to do Copper Ridge and Asbury Place and 30 or 40 other lineages of that idea and transforming them with forward-thinking clients.”

Most rewarding

But the most rewarding aspect, Hoglund says, is seeing how other architects, designers, and clients have taken those ideas and interpreted them in their own ways and applied them to their own projects. “That’s the lasting impact of ideas and no pride of ownership,” he says. “It’s just a great thing to see the industry embrace new thinking, and obviously a lot of other people had an impact on this industry. It’s rewarding when you see your ideas being talked about.”

While Hoglund is very proud of Woodside and says that each project he does has a “unique fascination and a unique angle” that makes him proud of all of them, it is NewBridge on the Charles, nine miles from Boston, that gives him “extraordinary” pride. The first independent living residents will arrive this month with the assisted living and health center opening in late September.

Nestled on the banks of the Charles River on what was a polo field in the 1940s, NewBridge sits on 150 acres, 80 of them buildable. It has a million square feet of enclosed space, one of the country’s largest geothermal systems, five different layers of housing types from cottages to small apartment buildings to large apartment buildings, to units built over the clubhouse. It includes a 268-bed long-term care facility, 51 assisted living apartments, 182 independent-living entry fee apartments, 24 villas, and 50 cottages. The campus also includes a 100-pupil children’s day care center; a Jewish K-8 day school for 450 students; and a summer camp. Hoglund is quick to give credit to his entire Perkins Eastman team-from civil, mechanical, and structural engineers, to office staff, to landscape architects, and especially the client-for the success of NewBridge.

According to Hoglund, NewBridge, operated by Hebrew SeniorLife, brings together a lot of things that are currently going on in the industry. It offers a full continuum of care. Hoglund terms it a “porous” CCRC in that there are various housing options and residents can come in anywhere on the continuum.

The new health center integrates the household model from Woodside and the Green House model and combines them into unique households, neighborhoods, and communities. Rehabilitation and recreation therapy were decentralized. There are private rooms with private showers. The independent living areas follow an aging-in-place model that will allow residents to have services come into their apartment for life. “The assisted living has a dementia program that builds on some of the best ideas out there,” Hoglund says.

The facility will not be LEED-certified because the client elected not to, however he says it would at least earn LEED silver certification. From start to finish, the project took six years.

“I love my career,” Hoglund says. “I feel very fortunate to work with clients and in a company where one gets to do things that make a difference in peoples’ lives.” Hoglund sees challenges and changes coming in design as people’s expectations change and they demand more metrics, research, and cold, hard facts about their retirement living choice. “We use words like ‘compassionate,’ ‘caring,’ ‘improving quality of life,’ but we really don’t have measurements on how we deliver those. The next generation is going to be asking ‘How will you improve my quality of life?’ ‘How will I be more active?’ ‘How will I be more spiritual?’ ‘What kind of opportunities will I have for wellness?’ I’m just excited about the things that are ahead of us.”

Rachelle DeGeorge and Mary Inman, Studio 121

Designers pushed to be unique

By Kevin Kolus, Associate Editor

When the interior designers of Studio 121 first sat down with Judy Amiano of Riverside Medical Center to propose their ideas for her facility’s newest addition, they didn’t receive the type of reaction most people would anticipate. Amiano, Riverside’s vice president of senior services, grabbed the color palettes and designs in front of her, folded them up, and slid them back toward the designers from Nashville, stating, “You know, I just want something different.” Luckily for everyone involved, that was precisely the response this design team had hoped to hear.

“We started Studio 121 on the foundation that we wanted to work with clients who were willing to give, to push, and to pull with us so we could collaborate on every element and detail within the project,” says Studio 121 designer Rachelle DeGeorge. “We have been lucky in that those are exactly the type of clients we have been able to work with, and this time was no different.”

And so they went to work. Studio 121-composed of three women with 30 combined years of senior living design experience-was asked many times by Amiano to “push the envelope,” DeGeorge says. The addition to Illinois-based Riverside would become the Sojourn Rehabilitation Center, a facility that restores 90% of its clientele to a health level sufficient for discharge to home.

AG Architecture, Inc., had spent years on the design of the building before Studio 121 was summoned, DeGeorge says, and created a structure “atypical for skilled nursing.” The square footage of the building reached more than 34,000, with a capacity of 40 beds, including individual patient suites fitted with full bathrooms. The oversized spacing for individuals to live in, while ideal for comfortable healing, presented a budgetary challenge before Studio 121 had even been contacted.

Reminiscing, DeGeorge explains, “We were brought on board and were basically told, ‘We’ve got this great building and we’ve priced it out with the general contractor we have on board. We’re about $3 million over budget, but we don’t have interiors included yet, so what can you do?’” Undaunted, Studio 121 immediately started working with the architect and general contractor to obtain pricing information, turning around to rework the lighting design, the ceiling design, and other key elements that were in resident rooms. “We brought the project under budget with the things that we were able to provide for them in the design,” DeGeorge says. Vital to this process was Studio 121 learning Riverside’s program, what its goals were for resident rehabilitation, and how it wanted to portray this vision aesthetically.

The result is a spa-like environment accentuated by soothing color palettes and earthy textures brightened by a natural glow pouring in through assorted skylights. Corridors containing resident areas are lined with synthetic stone wall sections and 12-foot long bamboo planters that are growing straight through the ground-as there is no subfloor-creating what DeGeorge calls a “truly ‘live’ environment.” And for the importance of learning the facility’s program? The designers ensured that as part of rehabilitation, residents can shear the bamboo when it becomes overgrown.

Such innovative design did not come without obstacles, DeGeorge assures. The Illinois Department of Public Health was wary of the control lighting, which is divided into different sets for cost efficiency during the day and resident comfort at night. Sojourn’s expansive square footage was being questioned as well since regulatory code insists a much smaller space is adequate for skilled nursing, DeGeorge says. But Riverside would not budge.

“I’ve learned that over the course of time that I have designed for seniors that a lot of people who are not directly involved with seniors on a day-by-day basis have a very distinct impression of what senior design should be, and it is almost elementary,” DeGeorge says. “It’s a really good thing when a client is willing to not be so safe in terms of approaching what current codes are requiring them for space planning, for materials that are used, and overall aesthetics and functionality of a project.”

Toward the end of construction, when furniture and fixtures were installed, DeGeorge and fellow Studio 121 designer Mary Inman toured the facility with Amiano. It was the moment of judgment, and this time Riverside’s chief administrator couldn’t crumple up the designers’ hard work. As they finished, Amiano stopped and exclaimed, “You took our vision and made it a million times more than what we envisioned.”

As DeGeorge says, design can make a difference. All it takes is a push.

I Advance Senior Care

I Advance Senior Care is the industry-leading source for practical, in-depth, business-building, and resident care information for owners, executives, administrators, and directors of nursing at assisted living communities, skilled nursing facilities, post-acute facilities, and continuing care retirement communities. The I Advance Senior Care editorial team and industry experts provide market analysis, strategic direction, policy commentary, clinical best-practices, business management, and technology breakthroughs.

I Advance Senior Care is part of the Institute for the Advancement of Senior Care and published by Plain-English Health Care.