April 1, 2010 | by I Advance Senior Care

“Small house” design rules in DESIGN 2010

Every year, as part of our DESIGN coverage, our jurors participate in a roundtable discussion. This year, they met with DESIGN Editor Maureen Hrehocik to comment on the submissions and discuss trends, innovations, and problem areas noticed in the entries.

Our panel did an extremely conscientious job judging the entries over two full days in Dallas. All of this year's Citation of Merit winners should be very proud their work passed the jurors' exacting standards.

Design 2010 Jury

Jack L. Bowersox, manager, Life Wellness Communities Development Company LLC; Kaye Brown, PhD, adjunct associate professor, Evolutionary Anthropology, Duke University and Anthropology, Boston University; David A. Dillard, AIA, president, D2 Architecture LLC; Greg Hunteman, president, Pi Architects; Kristina L. Kuntz, healthcare administrator, Querencia at Barton Creek; D. Samantha McAskill, ASID, principal, DSM Design Concepts; Alan Moore, AIA, principal, CJMW Architects; Dr. Debajyoti Pati, vice president, director of research, HKS, Inc.; Dr. Frank Rees, AIA, IIDA, LEED AP, chairman/CEO, Rees Associates, Inc.; JoAnn Leavey Shroyer, PhD, endowed Rockwell Professor, director of environmental design graduate programs, Texas Tech University, College of Human Sciences, Department of Design; Donna Vining, FASID, IIDA, RID, CAPS, president, Vining Design Associates, Inc.; Teresa Whittington, RN, BSN, vice president of Quality and Program Development, Presbyterian Communities & Services; Charlie Wilson, vice president of operations, Buckner Retirement Services; Fred Worley, architectural unit manager, Texas Department of Aging and Disability Services.

What trends did you identify in this year's entries? Any improvements or regressions compared to previous competitions you've judged?

Dillard: I noticed progressive designs: ubiquity of the small home or neighborhood model, more private beds, more HUD/affordable projects, more distinctive regional architecture and interiors.

Brown: In the larger projects, there was a concerted focus on developing a sense of place. The site became a set of opportunities rather than construction obstacles and many projects benefited from great interior designs. Hopefully, we will see this next year in the small house projects as well. With regard to regressions, we witnessed once again side-by-side beds in dementia care settings.

Wilson: We had a large number of small house/neighborhood models submitted again this year. It is encouraging to see all the new and creative ways to organize a neighborhood.

McAskill: More focus on small homes and use of natural light which is an improvement over past years. Making sure outside views were accessible in multiple public use areas was another aspect I noted.

Moore: Owners and architects are experimenting with variations on the small house model, in many cases interconnecting “neighborhoods” to achieve staffing efficiency and to give residents some options for activities beyond the neighborhood. At the same time, they are preserving the core concepts of the small house: easy access to common space, opportunities for close relationships between residents and caregivers, and residential scale.

Hunteman: I noticed more focus on small house and neighborhood models in nursing and assisted living with less differences between nursing and assisted living. The interiors were improved.

Is sustainable green design more noticeable in this year's entries than last? If so, in what way?

Dillard: Absolutely. Finally!

Brown: Designers are diverting runoff to ponds, filtering water to replenish wetlands and feed new roof gardens; all acts demonstrating stewardship for the larger physical environment. To build the projects, many designers specified the use of green and reclaimed materials as well as some solar siting. But we have yet to see a project try to generate its own energy or give back to the grid.

Vining: Definitely. I was thrilled to see it. All should be incorporating universal design principles as well as green and sustainable. I would like to see recycling and indoor air quality addressed more. The smell in these types of facilities is huge.

Moore: We are not talking windmills and solar panels here. The green features we saw include daylighting, sustainable landscaping, low-VOC materials, and better indoor air quality (which is a big issue for many senior consumers.)

What features did you see that were particularly encouraging of resident independence? Of staff support and efficiency?

Dillard: Slight (not enough) increase in the capability of residents and staff to move between levels of care indoors. I also found encouraging the deliberate ambiguity of unit rooms and layouts that defied specific level-of-care classification, i.e., many designs could be used for any level of care, or change over time, or accommodate a mixture.

Brown: Resident self-care trends were shorter distances between rooms and essential services, smaller neighborhoods that were familiar and easier to read without signage, increased choices for resident furniture placement, and more glazing in their rooms to encourage visual participation in the outdoor spaces. In small houses, staff space was ubiquitous and supplies were often located near the point of service. The jury liked that most small houses were linked to increase efficiency (i.e., use of float staff as resident acuity changes) and to prevent staff isolation.

Wilson: Some of the small things, such as the layout of the bathrooms with pull-down grab bars, enable ease of staff or resident use.

McAskill: The use of smaller homes encourages staff support and involvement of residents with activities.

Hunteman: I saw integration of technologies that allow residents to stay in their apartments longer. It would have been nice to see more use of spaces for community outreach and early integration of seniors into wellness programs.

Were there any common threads identifiable in the submissions, such as more attention to room sizes or natural light, to name a few?

Dillard: Indeed, more natural light due to the influence of the small home model and increased awareness of sustainability criteria were noted. In most cases, the room sizes were surprisingly small, especially in independent living.

Brown: Most projects of any size developed wellness programs as the core of the enhanced amenity base. On average, the projects also tried to convey a sense of place by contrast to a local version of a successful generic type. Many jurors liked the fact that we knew at once where the project was before we read its location. Good job!

Vining: I was pleasantly surprised to see projects using daylighting which is as it should be.

Moore: The smaller independent living room sizes may represent a response to the recession. We are hearing anecdotal evidence that small apartments are suddenly marketable again, after years of increasing unit sizes. One concern about the smaller units that we saw: Many were planned with little regard to furniture placement. Architects need to design around furniture placement in ways that reflect typical resident activities-watching TV, dining, entertaining guests, paying the bills, etc.

Hunteman: Utilization of household models and creative ways of putting them together to improve staffing efficiencies.

What evidence did you see of staff, family, and resident involvement in design?

Dillard: There were great stories in the text of the submittals, but honestly, I can't name any features per se that were direct derivatives. The best benefits, though, are resident dignity, empowerment, and buy-in to the project itself, even if the physical results come out much the same.

Brown: Involving all stakeholders was most notable in the predesign programming phase. Many (but not all) projects consulted all user groups during this phase. We encourage even more formal participation during predesign. We also saw one project focus on the family as the user group and designed the entire project around meeting their needs. Awesome trend.

Vining: Definitely. Loved the project that mentioned how they involved the tenants from beginning to end as their facility received its facelift. Bringing the tenants in at the beginning makes dealing with construction issues bearable as they know the end result will be better for them.

McAskill: In the projects I reviewed, I can't say it was possible to identify if all these partners were involved in the project. One in particular was a co-op with the residents' committee as the client so their involvement was total.

Wilson: Several of the projects were over the top in involving residents in the initial planning and then keeping them involved through the construction process. These project teams should be applauded.

Moore: We saw implementation of some practical suggestions from staff. For example, in nursing and assisted living units, cabinets for storage of linens and medications were within the resident apartment.

Hunteman: I would have liked to have seen more text in regard to staff involvement. Most texts focused on residents, but not the “in the trenches” great ideas that often come from frontline staff.

Were there any surprises or especially unique uses of space or features in this year's entries?

Dillard: Many owners seem to have found a way to make the 12- or 14- or 16-unit neighborhoods work. That is a surprise. If the small house concept really does work, it needs to go viral (in a good way!). I was also surprised at the number of suburban or even rural locations, contradicting the trend of moving back into the cities about which we hear so much. Could be a fluke in my observation.

Brown: I was struck by the absence of multigenerational features within the projects as well as space for pets and horticultural therapy activities. In the past, we have seen more attention to these features as well as integration with the larger surrounding community. However, I wish to commend one client who created an on-site, lifelong learning center for the whole community. Thank you.

Vining: I would like to see assisted living [AL] and independent living [IL] with 3-ft. doors swinging out in bathrooms as they should be-this was a real disappointment for me. I see AL/IL as aging in place and if that is truly going to happen, then they need to design the spaces that way. I also think the projects that showed a choice of floor plans for IL/AL are way ahead of the others. I was also surprised to see only one closet in IL. Yes, these people are definitely downsizing, but try to put yourself in a space with one closet. IL residents are still living active lives. Another item that should be addressed is how they plan for scooters (where do they charge them), wheelchairs, walkers, etc.

Wilson: The varying neighborhood designs and particularly the kitchen layouts, sparked my imagination.

McAskill: I noticed the number of submittals that focused on the small home. Hoping this means it's a design that is now naturally being incorporated into projects rather than just a trend.

Moore: I think there are several factors at work here. Although a significant number (but still a small percentage) of Baby Boomers have been moving back into the cities, the CCRC market is mostly affluent 75- to 80-year-olds who have lived in the suburbs most of their lives. They are not interested in being urban pioneers. When Baby Boomers who have already moved to urban lofts reach 80, they may like the idea of an urban CCRC. More likely, however, the close proximity of services and amenities in an urban environment will allow them to live in their homes longer with community-based services.

Hunteman: The most successful submissions integrated the interior and exterior environments for a more cohesive living environment. Quality of life can be significantly improved by encouraging residents, families and staff to use outside spaces on a daily basis. D

To send your comment to the editor, e-mail mhrehocik@iadvanceseniorcare.com.

Design Environments for Aging 2010 2010 March;():8-12

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