When it comes to design trends in senior living communities, there are many. But at Monday's Environments for Aging Conference in Baltimore, industry experts took on what they consider the top three: Short-term rehab, downtown CCRCs and, remodeling versus rebuilding.
The experts on the panel included Avanti Senior Living Owner/Operator Lori Alford, consultant Scott Townsley, and architect Eric McRoberts, partner at RLPS Architects.
Below are excerpts from the Q&A session.
Question: In your occupation, what perspectives are you bringing to the table when considering senior living design trends?
McRoberts: I represent and defend the built environment. It's our silent partner. Once built, it does its thing, if it's built right, and has impact on the way people feel when they experience that building.
Alford: It's great to build buildings, but what it really comes down to is caring for our residents. To build well, you have to have a strong operations partner and get input from everyone from the very beginning.
Townsley: I work around the country and get to see a lot of projects and communities on a daily basis. I'm a strategist, and I take a longer-term view of things. I'm also a consumerist trying to see the project from the consumer's eyes.
Question: What are your thoughts on short-term rehab environments?
McRoberts: It's very logical that CCRCs have gotten into the business of short-term rehab. They're filling a gap in the care continuum. Patients are looking for something that's different than spending two to three weeks in a nursing system. And right now, medical insurance is driving people out of the hospital more quickly in search of a lower cost scenario. When we talk about rehab though, people are looking for something different. Nursing home settings are not ideal. Communities will set aside a certain number of beds or a wing for people in rehab, but they're still living with people in those nursing homes. Someone who just had hip or knee replacement wants to be in a healing environment, not a sterile one.
Alford: We don't own any rehab centers, but we refer and hear feedback. We always hear that it's scary looking for a rehab facility. Families say they're sterile and institutional, or "my mom doesn't look like them." A rehab facility designed like a hotel makes it appealing. It's a great marketing differentiator. The design should be more like a medical spa.
Townsley: Medicare has been the cocaine of the senior living field for years. We follow it and we need to design accommodations to what Lori and Eric are saying. But I think we're overestimating the demand for short stay. The ability to provide rehab outside skilled nursing is going to become much more predominant in the next two to three years, and it'll be driven by payers and consumers. But my fear is we'll have a surplus of beds. And then what do you do?
Question: What are your thoughts on downtown CCRCs?
McRoberts: This is something I am very passionate about. I think that CCRCs were built where land was cheap, and the challenge we face is how do we make them connected to larger community? Physically they are isolated, and as much as we try to make common spaces in CCRCs beautiful, they're still separated. I think about myself and living on the edge of a smaller city and everything that is going on downtown — the venues, bars, etc. — that's where I want to be when I retire. So we're finally starting to see a shift that people are thinking about being where the action is. I don't want to be told I have to eat in two dining rooms the rest of my life. I want the city. Why couldn't you make a partnership with some of the downtown venues, like restaurants, and have your residents eat there and choose on their own?
Alford: As owners, we design and create and program based on what we think people want. But if you stop and pause and go to the source, it's massively eye opening to see what the folks who live in our communities want to experience. It is very different than what I thought they'd want to do. We also think they don't want to live downtown, and it's not the case. More feasibility studies should be done. Why would they want to move out of a city environment to live in the boondocks in structured program? If we can build buildings around what they want and take ourselves out of the equation, bring it downtown and use outside world instead of providing one, we can still provide the care and a little more help for a safe environment.
Townsley: I say let consumer decide. We need to do a better job of understanding what the consumer wants. On this topic, Eric and I don't necessarily agree. I wouldn't call this a trend, I would call it a "trendlet." Seniors moving back to the city is a trendlet. The trend is "I want options," and "I may want to be more adventurous," and "I want to try the city." Tying the two together is when we think about urban location and the consumer. They may be younger and more vital. We're trying to apply the same financial models to urban locations and it is a recipe for disaster.
Question: Renovation or new build?
McRoberts: We all have to deal with this at some point. CCRCs have traditionally grown up starting small with a health center and the added different care and housing centers. Pretty typically, the oldest buildings on campus are at the center. So what do we do with it? There's not an answer that's right. The thing that's most important is we have to look at the limitations of the layout of the building. You don't want to do a renovation that you'll hate in a few years. And then if you decided to just tear it down and start fresh, is very difficult to vacate a building.
Alford: You have to look at it in terms of the capital you're going to use for it. Will this capture the market share that you want to provide and the returns you need for today and five to 10 years down the road? A lot of times with remodeling, it's not just changing the color palette. Sometimes I see that's where it's missed. That'll get you through a year. If you're going to do it, do it right. Know your competition. Think through what you can market and what's a differentiator. If you can't figure those out, then don't do it. Why waste the money?
Townsley: To Lori's point: That's exactly the way to look at it. It's more expensive to do new so it's less favorable, but then it turns out to be the better investment. We have all these options and for some people they go for less expensive. The image that comes to mind is a half-finished bridge across a river. And the value of that is about zero, so half of that bridge ends up being totally wasted. The other image that comes to mind is Lucy and Ethel at the chocolate factory where the line is moving and Lucy and Ethel stop to eat and fall behind and the chocolates pile up. If we can't get everything we need to have that market domination, the cost of falling behind is phenomenally high, and the ability to catch up is phenomenally low. Going halfway could have seemed like a good idea, but it didn't get us far enough.
What are your thoughts on these topics? Share them in the comments below.
