When the COVID-19 pandemic began spreading across the U.S. in spring, new protocols and building solutions for senior living were immediately put in place to support social distancing and infection control measures. More specifically, providers closed their dining venues, cocktail bars, gyms, swimming pools, art studios, libraries, and activity rooms. Visits from family members and friends were prohibited for residents in skilled nursing and assisted living communities, with exceptions made for end-of-life situations. Staff looked for new ways to deliver meals to resident rooms or utilize space in new ways—for example, hallways used for game nights, with residents sitting in their doorways to play bingo or trivia.
These drastic measures were a necessary response to contain the spread of the virus and help protect vulnerable senior populations, but they came with a heavy side effect: increased isolation and lack of socialization. “It’s had a negative impact on everyone,” says CC Andrews, president and chief strategist at Quantum Age Collaborative (Cleveland). “The psychosocial and emotional well-being, that’s what they’re struggling with more every single day.”
But as eager as communities may be to return to a sense of normalcy with once-again bustling activity rooms and dining spaces, they’re facing a minefield of regulations and guidelines that not only vary by state or county but are constantly being updated as more is learned about how COVID-19 spreads or as new hot spots emerge. For example, over the summer, South Carolina Gov. Henry McMaster asked the South Carolina Department of Health and Environmental Control to develop guidelines to allow limited in-person visitation in nursing and assisted living communities, only to then ask the department a few weeks later to delay those guidelines after the state had a spike in infection rates and hospitalizations. In June, Ohio Gov. Mike DeWine permitted outdoor visitations to resume in properly prepared assisted living facilities but not at skilled nursing communities. “It’s such a moving target every day, with regulations changing in each of the 50 states,” says Rob Simonetti, architect and senior associate at SWBR (Rochester, N.Y.) and president of SAGE (Society for the Advancement of Gerontological Environments).
Now, more than six months into this pandemic, most senior living communities are still dealing with the day-to-day impacts of COVID-19 and implementing operational or programming changes that balance safety measures with socialization. Simonetti says many providers are in “survival mode,” making some short-term modifications to the built environment but not looking long term just yet. “The idea of planning a physical change in reaction to something that could go away in six months or a year may be too much for providers, as they contend with today’s pandemic,” he says.
Andrews agrees: “So far, there hasn’t been a lot happening [to senior living design], but there’s been a lot of discussion on what could be done.”
As Brookdale Senior Living begins to discuss “reopening” plans for its more than 700 senior living communities in states including Vermont, New Jersey, Connecticut, New Hampshire, and Massachusetts, Laura Busalacchi, senior director of interior services at Brookdale Senior Living (Milwaukee), says her department is developing plans that offer communities different options to accommodate social distancing and other regulations within various spaces. Ideas range from setting up two empty tables between seated residents in a dining room to establish proper distancing and help resume limited food service to using plexiglass structures to allow a resident and family members to visit in a designated outdoor space. “There are different options depending on what works best for that community and what restrictions there may be within that municipality,” she says.
As similar discussions about a return to socialization in dining, activities, and visiting are held in communities and firms, specific strategies for each are beginning to emerge.
Dining
When the pandemic began, most seniors in independent living, assisted living, and memory care communities were quarantined to their rooms or units and dining rooms were shut down, meaning meals had to be organized and delivered to residents in their rooms. “We were scrambling to find additional associates to help get food to residents in hot boxes or on carts,” Busalacchi says.
This solution temporarily solved the issue of providing a safer food service experience but exacerbated resident isolation and contributed to menu fatigue, which was already an issue in senior living prior to COVID-19, says Matt Schuler, director of culinary development at Scopos Hospitality Group (Ephrata, Pa.). This past spring, the firm developed a guidebook with design strategies in response to COVID-19, with some short-term solutions including reconfiguring layouts and removing furniture in main dining rooms to provide more distance between seating areas, installing temporary structures between diners, implementing traffic flows in and out of the space to prevent clustering among residents and staff, and replacing menus with movable boards or technology options to reduce the number of shared surfaces.
One common question he’s being asked is if salad bars, or anything self-serve, need to go away as part of increased infection control measures. While he says he doesn’t see the salad bar “making a comeback” in senior living, there are ways to offer self-service via set-ups similar to what’s used in the restaurant industry, like at Chipotle or Subway. “So residents still have a choice of what they want on their salad or sandwich but someone else with clean hands and gloves is safely producing the food,” he says.
Looking at other long-term changes, Busalacchi says she expects large dining rooms to be designed with the ability to be sectioned off into smaller spaces using movable walls or structures, which would allow communities to flex to varying capacity or spacing needs while remaining open. Where possible, Schuler says he anticipates communities will add more decentralized dining services and multiple options including bistros, coffee counters, and smaller venues. These solutions would not only appeal to residents’ desire for choice and variety but also could flex to other operational needs, such as a coffee shop becoming a takeout venue, during a pandemic or other crisis.
Amenity spaces
As the senior living industry has shifted away from institutional models to deliver more homelike aesthetics and settings, activity spaces have become more intimate and specialized, Andrews says. “What that means is when something like COVID-19 comes along, those spaces become unusable because you can’t space people out far enough to do anything meaningful.”
This past spring, many communities canceled programming as they operated in lockdown mode with residents remaining in their bedrooms most of the time. Looking to improve the situation, “even just for the short-term,” Andrews says she saw great examples of staff creatively applying new ideas to support some programming, such as walking an ice cream cart down resident hallways for an ice cream social or inviting residents to sit in doorways to sing, play bingo, or have remote-controlled car races.
While communities continue to make short-term adjustments to programming, there’s an opportunity in the future to rethink activity areas to support new distanced seating and air circulation or make them larger to accommodate different space or program needs, designers say. In addition to space planning changes, Busalacchi says operators should also reconsider furnishings to support different activity types. “Are the chairs nice so you can sit in them longer than just 30-40 minutes to do an activity but also to sit at a dining table for longer, depending on how much time it takes to serve and eat,” she says.
Family visits
Some of the most vivid images from the pandemic have been family members “touching hands” with loved ones through window panes or sharing screenshots of Face Time sessions, further illustrating the importance of reconnecting residents with family and friends, many of whom have been restricted from visiting for months. And while some states are beginning to allow limited visitations at certain communities, the industry is nowhere close to normal. “Aside from the risk factor, there’s not a senior care community around that doesn’t want residents to see their loved ones,” Andrews says.
Technology, including tablets and video conferencing programs, has played a big role in giving families some much-needed face time, but it’s not a solution for all residents, including those with cognitive issues. While plexiglass dividers have served as a short-term solution, some states require more than just 6 feet of distance between people, affecting the overall experience as well as some seniors’ ability to hear conversations and interact. Others states mandate that a staff member accompany residents on visits, impacting staffing and operations.
Beyond these temporary measures, design professionals are starting to look further down the road to consider how existing spaces within a community might be repurposed to accommodate in-person visits. For example, Andrews says many communities have a conference room or family dining space near the entrance, which could be reconfigured to allow for visits within social distancing guidelines.
One anticipated bright spot in the industry’s COVID-19 response is the renewed attention to planning and design of outdoor spaces, as these areas play an integral role in safely accommodating visits and activities. Patricia Gruits, senior principal and managing director at MASS Design Group (Boston), says one of the biggest shifts she’s seen, especially in urban environments, is older adults’ reliance on passive landscape. “We’ve seen more residents looking for loops and trails that are easily accessible,” she says.
The firm recently released a report, “Designing Senior Housing for Safe Interaction: The Role of Architecture in Fighting COVID-19,” focusing specifically on multifamily affordable housing for older adults and providing ideas on how to allow people to safely come together. Addressing outdoor spaces, the recommendations include giving definition and variety, such as activity areas, porches, or meditation spaces, to meet a variety of residents’ needs. Having multiple options also helps reduce the traffic load on any one area.
Looking forward
While there’s much still left to address before socialization in communities can safely return to pre-COVID-19 levels, Simonetti says he’s glad to see his clients aren’t knee-jerk reacting to the pandemic and starting to plan for physical changes that they’ll have to live with for decades to come. “I’d rather see people wait until the immediate crisis is past,” he says.
Several architecture firms as well as industry organizations are developing toolkits and reports, such the American Institute of Architects’ “Strategies for Safer Senior Living Communities,” to help guide conversations between design teams and communities—when the time is right. Meanwhile, the industry will remain focused on “getting through this.” Simonetti says. “And then we can think about where we go from here.”
Anne DiNardo is executive editor of Environments for Aging. She can be reached at [email protected].
