The immediate reasons for providing access to outdoor space at a skilled nursing facility (SNF) are familiar: fresh air, exercise, stimulation, and simply pursuing another destination option. Other compelling reasons include exposure to natural light that reaffirms the body’s circadian rhythms, opportunities for tactile experiences with water or auditory stimulation from rustling leaves, and engagement with an outside community.
Quite simply, being outside is consistent with what people are used to doing.
The Terraces at San Joaquin Gardens, a community of the American Baptist Homes of the West (ABHOW) in Fresno, Calif., has a dedicated courtyard area, featuring a fountain, separate from the outdoor patio spaces of three adjacent households. Those three patio spaces open into and tie together around this fountain plaza and garden. “It’s big enough to feel outside and small enough to feel controlled,” says Douglas Pancake, president of Douglas Pancake Architects, the design firm for the project.
A primary concrete walking path is configured into a manageable 100-foot loop around that secured courtyard. Other concrete paths are wide enough for physical therapy or moving side-by-side with a family member, solo by wheelchair, or on foot. The paths link to access points on the community’s grounds; via a gated exit, those paths then tie into sidewalks that run throughout the rest of the community.
The Terraces offers residents several choices regarding which outdoor destination to pursue: Starting with sitting next to a window or being in proximity of a window on days when venturing outside isn’t an option. “All windows in resident rooms or common spaces are oriented toward pleasing views,” says Russell Mauk, ABHOW’s vice president of design and construction. “Window sills were kept low so that people lying in bed could still see a nice view outside.” And all three common areas of the three households feature windows that respectively overlook a dedicated exterior courtyard.
“The exterior area, adjacent to each of the households and opening up on to the courtyard, is covered by a roof. Residents may want to venture outdoors, but may not want full exposure to the sun or sky. The covered patio provides this opportunity,” Pancake says. “If you create different viewing areas, you create a hierarchy that offers choice in which they can gratify their needs.”
At The Green House Homes at Saint Elizabeth, which broke ground in East Greenwich, R.I., in 2015 and will open early 2017, residents will reach exterior spaces by exiting via the dining room of each home’s common area; each household’s kitchen, den, dining room, and resident rooms will have views overlooking an outside space, encouraging outdoor inter-building interactions.
“The exterior space becomes the heart of the [household], the gathering space. The area ties to the residents in the community. The exterior becomes the true community,” says Thomas Gears, principal with SWBR Architects. SWBR Architects is the design firm and architect of record for the project.
At Saint Elizabeth, four freestanding 12-bed SNF homes will be organized along a campus-based street front with the streetscape and central green space acting as the community gathering space. The Green House homes are an addition to an existing skilled nursing building, which serves 120 residents—12 of those 120 beds are private; 108 are semi-private.
An outdoor focal point of The Living Center of Manhattan, a building initiative of The New Jewish Home, will be the first-floor exterior gardens, encompassing 8,400 square feet. The gardens will be accessible to children, parents, and staff of a next-door school and to tenants of three nearby buildings in a neighboring apartment complex, says Audrey Weiner, president and CEO of The New Jewish Home. And with a nod toward a New York City way of life, a 4,000-square-foot rooftop space will offer additional outdoor landscaped getaways intended for gathering; private repose; and views of the East River, the Hudson River, and Central Park. The building, designed by Perkins Eastman, is expected to open in 2020.
Being outside offers yet another setting for carrying out meaningful activities, too, such as dining, exercise, gardening, and socializing, but it also fortifies a sense of independence and autonomy. Outdoor spaces maintain and continue the residents’ “normalized connections” with the outside world, says Susan Ryan, senior director of The Green House Project. “We call it ‘the power of normal.’ It just feels normal.”
Sharon Schnall is a writer based in Ohio. She can be reached at [email protected].
For more on skilled nursing design, see “Focusing on Peson-centered Care.”
