Innovation clashes with harsh economic reality in LTC design

Environments for aging are always top of mind here at Long-Term Living, an area of the LTC industry that we cover at our annual conference and in our editorial content, both online and in print. So when a book that addresses architecture and design for an aging population landed on my desk last week, I was eager to review it. Design for Aging: International Case Studies of Building and Program profiles 25 innovative, contemporary examples of aged care facilities from around the world, including Australia, Denmark, England, Japan, the Netherlands, Sweden and the U.S.

The book focuses on integrating architectural considerations within a people-driven (resident-centered) approach. The authors describe how each design has succeeded in addressing the requirements of its residents regardless of wide variations in design, geography, cultural factors, medical needs, capital cost and other factors.

There is so much great work being done in the field that addresses the special needs of our elder community, including those with physical and cognitive limitations who reside in all types of communities including independent living, assisted living and skilled nursing. Here are some of the ideas and specific elements that I found noteworthy and forward-thinking:

• Design that permits people to reside in a positive environment that aesthetically expresses their individuality
• A balance between individuality, privacy and identity of households without the feeling of isolation
• Community engagement—e.g., cafes open to the surrounding neighborhood community
• Creative solutions to issues of security and independence
• Excellent use of space, light levels and staff support layout
• Intergenerational activity with the local community
• Use of landscape, rather than furniture or color, for wayfinding
• Engaging and uplifting gardens, courtyards and water features

However (big emphasis on that word), the positive and hopeful vibe I felt upon closing the book’s cover was tempered by the reality check of resident blogger Kathy Mears’s dispatch from the nursing home in which she resides. Her topic this week: “When a Facility Needs to Be Fixed Up.” In her simple but impactful words, Kathy paints a stark picture of a neglected physical plant and the negative effect this neglect has on its residents and staff.

Torn and discolored wallcoverings, malfunctioning HVAC units and broken window blinds are a few of the issues she details that create not just physical discomfort, but emotional negativity as well.

Kathy doesn’t cast stones at the operator of her facility. If anything, she is pragmatic and understands the economic challenges the LTC industry faces. Sadly, for most U.S. facilities, physical maintenance and updates (forget about enhanced amenities) have been placed on the back burner as federal and state budget cuts stretch LTC owners to the breaking point. It’s a shameful situation with no easy solutions in sight.

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.