Category Archives: Senior Living

Senior-Living_Memory-Care-Person-Centered-Care-Design-Strategies_Feature-Image

Residential Memory Care Facility Design – 4 Strategies for Providing Person-Centered Care

By Jim Wallis, AIA, EDAC, NCARB, IIDA
Principal and Senior Living Studio Lead


The U.S. senior population is rising, and so is the projected number of Americans living with Alzheimer’s disease and related dementias.  America’s 65-and-older population is expected to nearly double by the year 2050 to 83.7 million with an estimated 13.8 million living with Alzheimer’s disease.

A recent boom in senior housing construction means senior living providers are facing more competition, especially among the memory care segment. With more choices available to residents, memory care providers need to provide a therapeutic environment to support a person-centered care model unique to this segment of the senior living market.

Each design strategy should support the implementation of person-centered care, providing residents a dignified, comfortable, functioning environment.

But first, it would be helpful to define what person-centered care is.

Defining person-centered care

Person-centered care is a way of thinking about and providing care that places emphasis on the resident experience. Maintaining selfhood is central to this model of care – enabling residents to continue the rhythms of daily life and live as independently as possible as the disease progresses. Person-centered care shifts the environment for those living with cognitive impairments from that of an institutional care setting to a resident-focused care setting.

1. Unique environmental needs of people with dementia

First and foremost, it is key to understand what dementia means and the unique environmental needs of residents with dementia and Alzheimer’s disease.

Dementia is not a specific disease. It is an umbrella term that describes a group of symptoms associated with the loss of cognitive skills – memory, thinking and reasoning – and behavioral abilities severe enough to interfere with that person’s daily life and activities.  There are multiple types of dementias, but the most widely known is Alzheimer’s disease.

Alzheimer’s disease and related dementias do not progress in a linear fashion; therefore, each person experiences Alzheimer’s and related dementias differently.

Therapeutic environments rooted in the person-centered care model of evidence-based design are shown to reduce negative behaviors associated with the disease progression such as wandering, elopement risk, agitation and anxiety.

2. Smaller groups and spaces

Large spaces and groups of people typical of senior living communities can be agitating for residents with cognitive impairment. Reducing spaces to a residential scale and using a household model can alleviate many common agitations.

A household model reflects the familiar elements of a home and includes a living room, residential kitchen, dining room space, private resident rooms with bathrooms, activity areas, and a secured outdoor courtyard. An open plan with clear, familiar room-to-room circulation aids in wayfinding and provides environmental cues as to the intended use for the space.

When Perspectus worked with Brookdale Senior Living at its Atrium Way location in Jacksonville, Florida, we were tasked with renovating an existing assisted living wing into a memory care unit utilizing the household model.

Brookdale Senior Living Atrium Way Memory Care Unit living room

Brookdale Senior Living Atrium Way Memory Care Unit living room

The building was originally designed with a large, two-story central community space that the resident rooms opened up to. The new design reduced the height of the ceilings and defined small spaces within the large existing space to create a more familiar residential scale. 

3. Opportunities for social engagement

It’s important to create a community of the right size. The ideal size of a household is 10 to 14 residents. Smaller groups provide more opportunities for residents to interact with each other and caretakers and participate in familiar daily routines. 

The design strategy should include spaces of multiple scales to allow for different types of activities. This variety of spaces and scales serves multiple purposes: it allows staff more spaces to program activities that cater to the residents’ interests and needs and gives residents control of desired level of social interaction and privacy.

For instance, the design may include smaller alcoves and seating areas for more intimate social interactions and more public spaces such as a living room or a secured outdoor courtyard to accommodate larger group activities. 

Another design feature that promotes social engagement is an open, residential country kitchen located directly adjacent to the dining room. The residential kitchen enhances activities of daily living, creates opportunity for structured programming such as baking or routine household chores, and provides sensory stimulation from cooking aromas which can help stimulate appetite.

 
Brookdale Senior Living Atrium Way Memory Care Unit Country Kitchen

Brookdale Senior Living Atrium Way Memory Care Unit Country Kitchen

Decentralized staff areas maintain a residential environment and encourage more social interaction between staff and residents. Identifiable nurse stations are a necessity in institutional environments, but you wouldn’t want to see a nurse station in your home. Designing the residential kitchen with features that discreetly double as a nurse station facilitates staff interaction without disrupting activities of daily living. 

4. Color, lighting and materials

Lighting and material selection are critical design elements in senior living and memory care environments. It is very common for elderly persons, especially those with cognitive impairments, to experience several age-related vision issues including difficulties distinguishing colors, depth perception, and sensitivity to contrast and glare.

The most common lighting problem for memory care residents is that the space is not bright enough, causing agitation. Illumination should be increased to improve visibility and offset contrast sensitivity.

Another common light-related agitator is glare. Materials and surfaces that are not glossy and reflective can help eliminate glare.

The use of color and materials should work both to create a calming environment as well as increase contrast. Flooring color should provide complimentary contrast to the wall color. If a pattern is used, it should be kept simple. Too much contrasting pattern can cause confusion, as memory care residents may see certain areas within the pattern as voids and step around them.

Color contrast also aids in visual cueing. For instance, memory care residents can have difficulty recognizing the need to use the bathroom as the disease progresses. Floor and wall colors that contrast with the toilet help it stand out.

 Brookdale Senior Living Westlake Village Memory Care resident room bathroom
Brookdale Senior Living Westlake Village Memory Care resident room bathroom

Thoughtful choice in color, lighting and materials are critical to reducing agitated behaviors and increase resident well-being and autonomy.

Dignified living

Person-centered care design strategies for memory care residents are about facilitating as normal a life as possible in an environment that is truly a home. Through a heightened understanding of the disease and utilizing a holistic, person-centered care approach, memory care facilities can provide residents with a dignified experience that nurtures their mind, body and spirit.


Jim Wallis is Principal and studio lead of Perspectus Architecture’s Senior Living market. Want to make your next senior living project rise above the competition? Let’s work together.

Perspectus-Architecture-Historic-Restoration-Adaptive Reuse-Everts-Hill-Circleville High School-Exterior

Adaptive Reuse: How Preserving Buildings of the Past Helps Preserve the Future

Historic preservation is itself, a practice of sustainability that benefits communities and our environment. The demolition of a building uses a lot of energy and releases large amounts of greenhouse gasses into the atmosphere. Additional energy is expelled during construction of a replacement facility.

On the flipside, according to the National Trust for Historic Preservation’s 2016 report “The Greenest Building,” saving a historic building for adaptive reuse “almost always yields far fewer environmental impacts than new construction when comparing buildings of similar size and functionality.”

We can see sustainable adaptive reuse in action in the renovation of the historic Circleville High School in Circleville, Ohio. Built in 1916, the high school eventually become the Everts Hill Middle School. When Everts Hill Middle School relocated to a new facility in 2016, the century-old school sat empty and was almost torn down.

Photography by Todd Williams
The front exterior of the historic Circleville High School.
Photography by Todd Williams 
The historic high school was rehabilitated into Everts Hill affordable senior living apartments. The new complex is fully ADA accessible.
Photography by Todd Williams 
Detail above the front entrance.
Photography by Todd Williams  
The historic Circleville High School was built in 1916 and would continue to serve students for the next 100 years.
Photography by Todd Williams
The historic auditorium retains the original proscenium arch and now serves as the gathering area for families and parties.
Photography by Todd Williams
The exterior of the restored historic greenhouse original to the property.
Photography by Todd Williams
The interior of the restored historic greenhouse, original to the property.
Photography by Todd Williams
A view down one of the corridors. The original built-in lockers now function as tenant storage. The terrazzo flooring is also original to the corridors.
Photography by Todd Williams
Historic built-ins that were coat/backpack racks and teacher supply storage are now used for tenant storage.
Photography by Todd Williams
View inside a unit living space. Each unit is designed with open living spaces facing the historic windows, which provides ample natural light. The original slate boards were retained in each unit adding to the historic charm of the unit.
Photography by Todd Williams
View inside a unit living space. Each unit is designed with open living spaces facing the historic windows, which provides ample natural light. Plumbing for the kitchens and bathrooms are configured along the corridor wall.
Photography by Todd Williams
View inside a unit living space. Each unit is designed with open living spaces facing the historic windows, which provides ample natural light. Plumbing for the kitchens and bathrooms are configured along the corridor wall.
Photography by Todd Williams
Plumbing for the kitchens and bathrooms are configured along the corridor wall.
Photography by Todd Williams
View inside a unit bedroom.

The City of Circleville had a demolition contract for the property in place when our historic architecture team put them in contact with the developer, Woda Cooper Companies. Perspectus Historic Architecture, Chambers, Murphy & Burge Studio and Woda Cooper Companies worked together with the city to save the historic high school and rehabilitate it into an affordable senior living community by creative use of the land and existing facilities. The property is now known as Everts Hill Apartments.

“We’re able to place tenants into a building that was about to be torn down, that’s pretty amazing,” says Principal Elizabeth Corbin Murphy, FAIA, Perspectus Historic Architecture, Chambers, Murphy & Burge Studio. “That’s a victory for the city as well as for the developers.” Murphy also stresses that by saving the building from demolition, we have a measurably reduced carbon footprint.

Meeting Green Standards

The project was primarily funded by the developer’s private funding and through federal and state historic preservation tax credits. One of the chief funding sources comes from the Ohio Housing Finance Agency, which will reward restoration housing projects that meet the sustainability standards outlined by the Enterprise Green Community program. The Enterprise Green Community program aligns “affordable housing project investment strategies with environmentally responsive building practices.” To qualify, the sustainable restoration must meet a certain number of points in a required and optional set of standards for certification.

Perspectus Historic Architecture, Chambers, Murphy & Burge Studio and Woda Cooper Companies worked closely to ensure the design of the new Everts Hill senior living community met all Enterprise Green Community certification requirements, even going above and beyond in certain areas, as a sustainable building. Some of the measures taken to meet green living standards include recycling above the required amount of post-industrial waste, using materials that are manufactured and transported from within 500 miles to reduce CO2 emissions associated with transportation, using low VOC materials, as well as efficient heating and cooling systems.

Everts Hill must additionally meet requirements that holistically benefit the health of the tenant through implementing universal design in which the design decision was made to make the building accessible and visitable, a completely non-smoking environment, connected to the community, and available to open space. Residents have access to half the original football field for outdoor leisure and the restoration preserved the historic configuration of the site.

Ultimately, earning Enterprise Green Community certification means the building will cost less to operate and maintain, use fewer resources and contain fewer toxic materials.

Cultural Sustainability

Historic restoration projects also achieve sustainability from a cultural perspective. The buildings are given a new use while the design must respect its past and its emotional ties with community members. The new Everts Hill complex is tied to the community, especially among the older community because they remember going to school there.

Many of the building’s unique features were restored and creatively incorporated to serve the building’s new function while also created to be distinctly reminiscent of the building’s original purpose.  Murphy explains that for a restoration architect, “the biggest challenge in these types of projects is that you want to save everything, and you want to restore everything. But you must remember that people are the clients, not the buildings. And that to make affordable housing, we have to be careful not to go overboard.”

The goal of the design was to maintain the charm of the historic high school, says Dalton Kline, Interior Designer, Perspectus Historic Architecture, Chambers, Murphy & Burge Studio. “We have design stylistically compatible apartments in this historic building.”

Old classrooms are now apartment units, complete with the original slate boards. New unit entry doors were reconstructed to resemble the classroom’s original doors. Plumbing and other apartment amenities were configured along the corridor wall with the living space along the windows, which were restored to their original size allowing for more natural light in the units.

The building features the original corridors and flooring. The historic auditorium retains the original proscenium arch and is now home to the complex’s gathering area for families and parties. At the rear of the historic high school, the original greenhouse that was converted to a fieldhouse has been reborn as a greenhouse for tenants. Also remaining are the corridors built-in lockers that currently serve as tenant storage.

Previously hidden by drop ceilings, contractors discovered the original skylights, that once again provide another source of natural light.

The existing cafeteria is reimagined as a café open to the public. Creating this space increases the quality of life and provides a community connection between the senior residents and the public.

When asked how the Everts Hill was received by the Circleville community, Murphy explained that during the construction phase of these historic adaptive reuse projects, people tend to be unsure since they’ve grown used to the building as part of the city’s landscape. “But once it opens and has a little life pumped back into it, everyone is thrilled.”

Historic preservation provides sustainability for our environment and our communities. Projects like Everts Hill Apartments at the historic Circleville High School demonstrate that preserving the past can go a long way towards preserving the future.

Senior Living Architect Eileen Nacht joins Perspectus Architecture

Perspectus Architecture is pleased to announce that Eileen Nacht, AIA, LEED AP, EDAC, one of the region’s leading senior living architects, has joined the full-service architectural firm as Senior Project Director.

Senior Project Director Eileen Nacht

With more than 25 years of experience, Eileen is a seasoned architectural professional who manages concept, design, budgeting and development for multi-million dollar clients. Her portfolio includes complex, multifaceted projects specific to senior living, encompassing the full continuum of care, including master planning for new construction and renovation of existing communities. Eileen has worked with senior living communities in Ohio, Illinois, Michigan, Virginia, Pennsylvania and Florida as well as several VA Medical Center Community Living Centers.

Supervising projects from concept design through post occupancy, Eileen is committed to expanding Perspectus’ capabilities and applying an evidence-based process to the design and development of healing environments for senior living and healthcare.

“We continually strive to attract the best talent, and Eileen excels in leading architectural and engineering project teams,” said Jim Wallis, AIA, IIDA, NCARB, Principal of Perspectus Architecture. “We’re thrilled to have her on board to elevate our programming process for all project types, especially those focused on person-centered care.”

A resident of Pepper Pike, Ohio, Eileen earned a Bachelor of Architecture degree from University of Cincinnati and is a registered architect in the State of Ohio. A member of AIA, Eileen is a LEED Accredited Professional and holds Evidence Based Design Accreditation Certification (EDAC).

Opening of CDC at Eliza Bryant Village

Over the past few years, Perspectus has enjoyed a successful partnership providing architectural and interior design services for Centers for Dialysis Care, an independent provider of dialysis and related health services to individuals with kidney failure. It’s the largest outpatient dialysis provider in Northeast Ohio with 18 locations.

CDC’s newest facility is on the campus of Eliza Bryant Village in Cleveland. Founded in 1896, Eliza Bryant is the oldest operating African American long-term care facility in the country. A ribbon cutting ceremony took place on April 29 for the one-story, 10,462 sf building.

{CLICK HERE to read the Properties Magazine feature story about the project in the May 2015 issue.}

CDC at Eliza Bryant Village Ribbon Cutting Ceremony

Perspectus Project Director David Thompson, AIA, LEED AP BD+C said, “The design intent was to create an environment that instills confidence in patients and family members walking through the front door and supports the CDC’s message of quality care.”

Interior Designer Jennifer Gibson, IIDA, NCIDQ, LEED AP ID+C added, “When we first began working with CDC, they were interested in refreshing some of their existing facilities as well as building new ones. So we developed a whole new palette of materials that was in sync with their re-branding efforts. We work hard to make each facility recognizable as Centers for Dialysis Care but they’re not all the same.”

In addition to the Eliza Bryant Village project, Perspectus has completed renovations to a number of CDC’s outpatient hemodialysis units as well as its corporate office in Shaker Heights. The projects have upgraded patient experience, improved caregiver workflow / workstation configurations and developed a recognizable brand that conveys the CDC mission.

 

 

Brookdale Senior Living’s Westlake Village Renovation

brookdale_westlake3Perspectus was selected to create a new 32-bed Memory Care Facility for Westlake Village. Located on a tight site with views in all directions, this facility is the prototype for the owner/operator.

The concept features resident rooms surrounding a core of large open activity, dining and living rooms and wide corridors that define clear circulation paths and good sight lines.

brookdale_westlake4At the heart of the building is a Country Kitchen that serves as an informal gathering area for residents and staff.

Natural light is brought into the interior through an outdoor courtyard and clerestory windows.

The resident rooms are designed to allow maximum visibility for staff to see residents by shifting the resident toilet rooms to the rear of the unit.