The memory care market is booming for plenty of reasons. More than 5 million Americans are estimated to have Alzheimer’s disease, according to the National Institute on Aging—a number that will continue to grow (along with other types of dementia and memory-affecting conditions) as the baby boomer generation ages.
As a result, many operators are entering the sector as a way to expand their continuum of care and increase revenue. According to a 2015 survey by Perkins Eastman, “An Industry Poised for Change,” 50 percent of respondents said they were planning an expansion and/or renovation at their community, with improving memory care among the top three goals reported for projects.
For those already providing memory care services, there’s also been a wake-up call to upgrade and update. “They’re recognizing that they need to step up their game and provide something that is competitive and appropriate to [meet the] needs and demands of the marketplace,” says David Hoglund, president of Perkins Eastman (New York).
Some of this response relates to the fact that more seniors and their families are demanding additional amenities and homelike settings. There’s also been a movement away from the secluded, locked-down memory care wing within a community to more purpose-built environments that support the emotional needs of residents and foster independence and cognitive stimulation. “We’ve come so far as it relates to creating a dignified setting that supports individuals where they are,” says Eileen Duggan, executive director of Maplewood at Stony Hill, a freestanding memory care community in Bethel, Conn.
But that doesn’t mean the industry has settled on one memory care design that’s right for every community. In fact, a variety of memory care solutions are dotting the senior living landscape to meet different operators’ needs and budgets, from standalone buildings on existing campuses to additions to assisted living buildings or continuing care retirement communities (CCRCs).
A difficult balance
Todd Wiltse, a partner at Worn Jerabek Wiltse Architects PC (Chicago), says many of his memory care clients are new to the market and choosing to add on to an existing building or create a hybrid building where two-thirds is dedicated to traditional assisted living and one-third to memory care. The two models are spatially separate but can share services, such as a central kitchen, laundry, and office support, to cut down on operating costs. “It’s the best of both worlds,” he says.
Others, such as Maplewood Senior Living, an owner and operator of assisted living and memory care communities based in Westport, Conn., are expanding services. Maplewood at Stony Hill opened in December 2014 with 74 units and several levels of care to address the specific needs of memory care residents throughout progression of the disease. The first floor of the three-story building, designed by Perkins Eastman, houses 24 apartments for residents in the early stages of memory loss who can manage independently most of the time. The second floor is for residents with more progressive stages, while the third floor serves as a bridge for those between the two stages. “It allows us to put residents in the right neighborhood to support them,” Duggan says.
Wiltse says operators are also weighing the pros and cons of using a household model, which typically has bedrooms situated off a main living area with a shared kitchen and dining room, versus private units with kitchenettes. “We hear from some operators that [the latter] is much more marketable. People want or expect their own private space, and they’re leaving home for the first time, so it still somewhat feels like home,” he says.
On the other hand, operators also recognize the added cost and square footage required as well as safety concerns. “We’re constantly talking about this balance of autonomy and independence and safety, and where do we draw the line,” says Heidi Dahle, an associate principal at Worn Jerabek Wiltse Architects.
Inside and out
Within these different memory care settings, the same design principles applied to many senior living communities are being used, including access to natural and ambient light sources, residential furnishings and color palettes, and an abundance of activity spaces.
However, there’s an added emphasis on using design to help reduce confusion and anxiety, which is common among cognitively impaired residents, and maximize independence and safety. For example, Duggan says Maplewood Stony Hill houses smaller activity spaces, which aren’t as overstimulating as a larger area and feel more natural and homelike. Designers used the building’s vertical configuration to create shorter hallways on each floor and place destination areas at the ends, including living rooms, sunrooms, and dining areas. The layout helps encourage movement and also places stimulating activities within close reach of residents, keeping them engaged and occupied and less likely to look for the exit doors, Duggan says.
Dahle says she employs large-scale cues to help residents navigate communities. For example, she might design an expansive activity space on one side of a residential neighborhood and then a more intimate setting with a fireplace on the other side to look fundamentally different. “Those things tend to resonate more with people to remember where they’ve been,” she says.
Another way memory care providers are improving their environments is designing outdoor areas that residents can not only see from various rooms but also freely access. “Some facilities have lovely garden spaces, but because there’s no visual control back into the space, the staff won’t let the people go outside unescorted because they don’t feel like it’s safe for them to be there,” Wiltse says.
He says one solution is to use single-loaded corridors with common areas centered on an internal courtyard, keeping sightlines open to both indoor and outdoor environments.
Shannon Remaley, a senior designer at architecture and interior design firm Meyer (Ardmore, Pa.), says it’s also important to recognize that residents in varying stages of memory loss will interact with common areas differently. Therefore, it’s important to design gathering spaces with multiple activity areas. “This creates the opportunity for each resident to make a choice of where they would like to be and what they would like to be doing,” she says. “It encourages individuality and dignity for the residents.”
For dining environments, Dean Maddalena, founder and president of StudioSix5 (Austin, Texas), says he uses smaller settings with table arrangements that can flex to different seating needs, such as a bigger table for residents who want to congregate and smaller tables for those who prefer to sit by themselves. “The focus is providing that flexibility and service to the resident,” he says, rather than thinking from the staff’s perspective first.
Inclusive design
One area where some say there’s still room for improvement is making memory care less segregated from other residents. “There’s an attitude that if we design a building or program that we have to design it for the worst case,” Perkins Eastman’s Hoglund says. “What it does is limits everyone else in the building to a set of experiences that can become boring and mundane because they’re not challenged in any way.”
Dahle suggests applying design concepts used in memory care, such as smaller activity and dining rooms, to assisted living spaces, for example, to improve housing for all. “Why can’t we start to break down the scale and have people live more residentially versus in these larger institutions, and then we can begin to mix the populations again so people aren’t quite so isolated,” she says.
Anne DiNardo is senior editor of Environments for Aging. She can be reached at [email protected].
