The weeks and months following the COVID-19 outbreak, including its devastating spread across skilled nursing communities, has presented the senior living design industry not just with the necessity to respond to the crisis but to learn from the experience and apply lessons to future projects. In a keynote panel that kicked off the Environments for Aging Virtual Conference held June 1-2, industry leaders explored topics tied to this current landscape, including ways to safely reopen and balance clinical solutions in residential environments as well as how senior living design might change for good.
“Aftermath of COVID-19: New Approaches to Senior Living Design” included panelists Vassar Byrd, CEO of Rose Villa Senior Living; Andy Coelho, senior vice president, facilities, design, and development at Sunrise Senior Living; Eric McRoberts, partner at RLPS Architects; and Jill Schroeder, senior planner and senior interior designer at Pope Architects. The panel was moderated by Environments for Aging magazine Editor-in-Chief Jennifer Kovacs Silvis.
Speakers first shared insight on how, from the owner side, communities are progressing from wholesale shutdowns (residents restricted to units, no-visitation policies) to easing into a reopening. Rose Villa, an outdoor-oriented continuing care retirement community in Portland, Ore., has been set up well to control the risk of virus spread, Byrd said, thanks to no resident units connected via long corridors nor a lot of recirculating air. And, now, the community is launching its “re-entry” program. For example, residents will be permitted to use fitness, restaurant, and salon facilities—by appointment only; serendipitous social encounters indoors would not be allowed. “Honestly, that’s really kind of horrible, as the essence of community is being together,” she said. The solution, so far, is encouraging residents to use the prevalent outdoor spaces to safely socialize from a distance and leveraging technology to keep people connected.
Alternatively, at Sunrise Senior Living communities (325 across the U.S., Canada, and United Kingdom), residents tend to be frailer, many residing in assisted living and memory care environments, requiring a bit more strategy in terms of safe indoor interaction. Coelho said dining is a first area of focus, with fewer residents seated at one time, each at a separate table but facing another resident at the next table to permit interaction. “This is our walk before we run … we’ll do this for a while until conditions allow us to move on to a future phase,” he said.
However, the panel also addressed how skilled nursing has specifically been hit hard by the wave of COVID-19, with reports showing as many as one-third of deaths occurring in nursing settings. McRoberts said that the industry has made great strides over the past 10-15 years in introducing smaller neighborhood models and private bathing that have proven to be more successful in weathering the virus. “Those types of communities have fared much better during this pandemic than some of the older institutional settings,” he said, while environments with two to four residents sharing a space is where many problems occurred.
And while the neighborhood model appears to be one solution, the cost of pursuing such a project is still out of reach for many. “How do we take some of those older communities and make them safer for residents during a pandemic?” McRoberts said. To spur change, Schroeder suggested that data will be a useful tool, capturing the effectiveness of these environments during the pandemic to inspire investment. McRoberts also added that the crisis may spur state and federal organizations to brainstorm how to move away from semiprivate layouts.
Overall, regardless of setting, the panel agreed that the social isolation resulting from the COVID-19 crisis is one that must be addressed thoughtfully through design. One component of that is better controlling who is entering a community, as visitors and staff were likely the cause of spreads seen in skilled nursing. One solution Coelho is considering deeply is technology used in the entry sequence such as health screening devices, even portals built into the architecture, to ensure safety.
The panel also discussed ways to support visits from family and friends, even in a pandemic response scenario. For example, Schroeder shared ideas for family visitation areas, as providers have already converted spaces like libraries and conference spaces for that purpose. In a small house model, she added, the entire household could be considered a safe unit, with full-height glass visiting units erected, possibly against or even in a garage space adjacent to the household, to permit visitation.
And in terms of achieving necessary safety standards, from cleanable fabrics and surfaces to handwashing sinks and hand sanitizer stations, the panel sent out a call to manufacturers to be partners in the process so that the arguably clinical elements likely to be introduced won’t detract from the residential settings the industry has worked so hard to achieve. For example, touchless technology in faucets and fixtures that look elegant and high-end. “We should be looking for things that are beautiful and useful, that people can be proud of,” Coelho said.
Going forward, the panel expects senior living design to be changed in several ways. On the design side, McRoberts looks toward a future where dining will now fully shift away from buffets and salad bars to rethink food delivery, in addition to deeper adoption of small neighborhood models. Schroeder said her focus is on staff retention and celebrating the efforts of senior living community workers for their efforts throughout this crisis, hopefully resulting in more design solutions to provide respite and safety.
For the owners, recognizing a major design change will likely be increased institutionalization due to safety measures, Byrd urged design professionals to collaborate and turn to colleagues across design sectors to share ideas and innovate. Coelho similarly worries about a shift in how communities feel, particularly in terms of social isolation and reducing the chance encounters so critical in senior living. “My concern is that we bend too far backwards, and I hope we come out of this with the ability to have those interactions,” he said. “I hope we are constantly watching that balance.”
Missed the live EFA Virtual Conference event? On-demand access to the conference, including 11 CEU sessions, is available at efamagazine.com/efa-virtual-conference.
