Many trends are clear in the development of continuing care retirement communities (CCRC), from the rethinking of communal spaces as something closer to retail environments to more homelike living spaces. If building a CCRC from the ground up today, that’s the starting point.
But for owners of the many CCRCs that date from a previous generation (or even two), things are seldom so simple.
New buildings have to mesh within the existing campus plan, with a certain synergy maintained between old and new. Site limitations might be a barrier to creating the buildings as visualized by current residents, and the potential disruptions associated with new construction can be particularly problematic.
In short, undertaking an expansion of or addition to existing senior living communities has to be managed with extreme care and sensitivity.
Incremental change
It’s customary for administrators and their architects to meet with resident councils or perform a more formal survey to gauge residents’ desires for a new project. However, administrators’ viewpoints are often given the most weight, due to the importance of creating spaces that can be marketed successfully in the future.
This is the primary reason that changes made in each successive expansion tend to seem incremental—the creation of a Taj Mahal on one part of the site might make the rest of the campus less desirable by comparison.
Elim Park in Cheshire, Conn., bears this out. The community, which dates from 1907 and moved to its current location in 1959, has expanded over the years through the addition of four residential buildings, a physical therapy wing, a wellness center with pool, skilled nursing and rehab renovations, dining rooms and bistros, administrative suites and even a car barn.
In each new residence, apartments have grown slightly more lavish and comparatively larger—a shift toward two-bedroom layouts from one-bedroom layouts and a square footage that inches up by between 5 and 10 percent in each successive iteration—and have offered prospective residents a bit more variety.
Public spaces, meanwhile, have moved in the opposite direction. Staff work spaces, as in most healthcare environments, have become smaller and decentralized, and something similar is happening in food service (smaller bistros and coffee shops in place of larger, more institutional dining halls) and entertainment (activity-specific spaces in place of larger, sub-dividable multipurpose rooms).
Fortunately, from a space planning standpoint, this big-to-small trend in communal areas is the easiest to accommodate with targeted renovations.
Fitting In
While Elim Park administrators were working off a master plan that accounted for future expansion, the community had long since outgrown that plan by the time its latest project was completed in 2012.
The experience brought to light three things to consider when a team begins planning a new building on an existing senior-living campus.
Adjacencies. While the most space-efficient CCRC would resemble a wheel—with larger administrative and communal spaces serving as the hub, various living environments as the spokes, and vehicular traffic kept largely to the outside—a spider web is a more apt metaphor, given that all buildings are linked.
The interconnection of spaces and their proximity to each other are vital to ease of operation and access for healthcare staff, particularly when all apartments are licensed as assisted living.
As such, CCRCs tend to grow from the inside toward the perimeter, as has been the case with the last two buildings completed at Elim Park. Even then, building placement wasn’t simple.
For example, space constraints kept the 12,000-square-foot wellness center that opened in 2008 from the facility’s core, and psychological constraints—some people in the independent living area don’t feel comfortable walking through the skilled nursing area—kept it from a logical arrangement in the physical therapy wing of the health center.
Instead, the wellness center is designed to be close enough to the skilled nursing building that a future renovation might include a connecting bridge, but access to it is through a residence rather than the health center.
The 2012 addition to Elim Park, a 97,000-square-foot Riverbend independent living apartment builiding, took the place of perimeter parking lots (it was designed with underground parking as a result), making it among the least central of the complex’s linked living spaces. Riverbend is the second Elim Park apartment building to require residents to travel through an adjacent residence to reach its dining establishments and chapel.
Aesthetics. A CCRC’s exterior is important to prospective residents as well as to current residents. For example, its Elim Park Place is marketed as “a collection of seven New England-style neighborhoods in a country setting,” all of which have a slightly different identity achieved through the use of slightly different finishes, as well as different building shapes that give each interior layout of apartments a distinct character.
Where expansions and additions might complicate the community’s overall look is in the areas of size and scale: With each building getting progressively larger, both in footprint and in floor-to-floor ratio, some effort must be expended to keep the new building in line with its neighbors.
At Elim Park, the “New England” setting and the surrounding residential neighborhoods set the materials palette of brick and siding, and bays and decks on each apartment bring variety to building exteriors.
Where a three-story structure is appended to a two-story structure (or where a new building’s more-vaulted ceilings result in a taller structure), roofs are brought lower so that the building’s ends appear to be two stories tall, keeping the relative scale together.
Environments. Healthcare architects want to create environments that are unique, but most aren’t fanciful. Typically, the site will dictate the building form (fully or to a degree), and then the designer will work within those parameters to create interesting spaces.
The Riverbend project’s elbow shape was site-determined, for example, and then 11 different apartment layouts were selected by administrators. The benefit of more choices is obvious, but there was concern that layouts producing certain shapes and sizes might be more difficult to sell. However, the three apartments located on the building’s 130-degree obtuse angle proved administrators’ concerns to be misplaced, with those apartments among the first sold.
Riverbend serves as a standard for many modern design choices for CCRCs, such as one or more decks on each apartment, all of which are generous enough for full wheelchair accessibility; pocket doors in closets and bathrooms to reduce the inconvenience caused by the sweep of standard doors; oversize door widths and 3-by-5-foot roll-in showers; and both lower-mounted upper kitchen cabinets and drawer-equipped lower kitchen cabinets.
It also has amenities that make it desirable—underground parking; ceilings measuring 9-foot-8 to 9-foot-11, depending on the floor; arch-top windows; and stainless steel fixtures—and the new building’s apartments are priced accordingly. However, a great deal of care was taken to introduce these amenities within a framework of incremental improvement: slightly larger and more spacious interiors within a building that is more similar to its predecessors than visually different. Elim Park markets its new buildings as “luxury” apartments, but they are designed to feel more comfortable than luxurious.
Added vitality
While CCRCs are marketed to people 60 and older, the average age of new residents nationally has risen to 80, making sensitivity to residents and their families who have mobility or sight issues even more paramount. Integration of old and new structures must therefore incorporate all current knowledge about materials, color, and signage specification for ease of wayfinding and safety, and care must be taken to ensure elevation changes are minimized or mitigated through the use of gently sloped ramps.
When properly handled, improvements to facilities bring new life and vitality to senior living communities, and allow administrators to cast a wider net when looking to market their senior care services.
Dan Tuttle ([email protected]) is a partner with Wethersfield, Conn.-based Moser Pilon Nelson Architects.
