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EFA Review: A 15-year retrospective

March 2, 2012
by Andrew Lee Alden
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Although the competition and publication name has changed, this juried event continues to gain relevance with each new generation of older adults

Over the past 15 years, DESIGN/EFA has chronicled the evolution of senior living design. From eliminating central nursing stations to incorporating them in household models and from providing institutional services to offering hospitality-styled amenities, senior design has developed inviting, safe and person-centered environments that provides residents with an energetic, individualized quality of life.

I am intrigued by the evolving composition of jury members and the jury process. During the first few years of the review jurors scrutinizing the paper submissions were limited in number and specialty. In contrast, this year we had 19 individuals with a wide variety of expertise who reviewed the submissions electronically before our January meeting at the Devonshire at PGA National in Palms Beach Gardens, Fla.

Technology has changed and we have seen a substantial increase in the number of professionals who choose a facet of design for aging as a career choice. This year’s multidisciplinary panel of reviewers is a testament to the evolving wide-reaching influence of the design for aging field. 

This year’s jury reflected on the changes they’ve observed. Listed below are comments from the 2012 Environments for Aging review panel. 

David R. Soens

Wisconsin Department of Health Services

I’ve appreciated the overall perspective of the review and that design is not only about the exterior of the building. The primary emphasis is on the interior or resident spaces, quite the game changer from a typical modern architectural emphasis.

Carol Reitter Elia, ASID, LEED AP

CR Design

I think the biggest impact for interior design has been the numerous products that have been created to be more appropriate for seniors. The variety of synthetic fabrics is just breathtaking and even if a fabric does not have a moisture barrier, it can usually be added. There is such a variety of carpet patterns and backings for our use in creating functional, yet beautiful, interiors. Other products like enhanced chair rails, palm rails and profile wood-look rubber bases are more durable and maintenance-free than wood. Overall, designers have so many more options now than we did 15 years ago. 

Mary Bamborough, IIDA


For me, I have four words: "The Joy of Life." I truly believe that these are places people now go to live and enjoy the last stage of their life, not to die. How many building "types" operate 24/7/365? There are hospitals, prisons and some casinos, but for the most part a building that is always open is not a typical building type. Therefore, it takes a lot of abuse. Our challenge as interior designers is to make the environment able to withstand constant use and still feel like home.

We have seen tremendous growth over the past 15 years in finishes and materials able to withstand heavy use and not look institutional. We have designed around our senses to support life and healing. The environment definitely plays a role in the resident’s experience. The joy is seeing the residents happy and leading fulfilled lives. 

Jack L. Bowersox

Life Wellness Communities Development Co., LLC

We are finally seeing the consistent development of “household” designs with 10–20 resident bedrooms wrap around an open kitchen, which is also the “staff station,” a dining/living room and the activity area. The household approach eliminates most, if not all, of the hallways, double-loaded corridors and central nursing stations. Studies show that the functioning levels of older people can actually increase and the number of heavy-care residents is actually reduced because of the reduced horizontal distances from the bedroom to dining and activities.

Wheelchair dependency is also reduced. Although the household design has a similar impact on those living in assisted living, the sad reality is that most of the assisted living facilities built to date are designed on the independent living model with living units on double-loaded corridors with central dining and activities on the first floor. In many cases, assisted living residents on a second or third floor are expected to traverse double-loaded corridors to an elevator to access large central dining rooms at least three times a day. The lessons that have been learned in the long-term care environments must now be routinely applied to assisted living facilities. 

Kaye Brown, PhD

Boston University

In an industry that never stops changing, it can be a bit hard to distinguish lasting design trends from the trends of the day.  However, in the past 15 years I believe we can discern the following directions in many—if not most—congregate designs for aging:

●  A reduction in scale by way of grouping resident rooms into households, neighborhoods

    and pods.

●  The conversion of site “obstacles” into thoughtful site “opportunities.”

●  Inclusive design teams (more voices) and the routine use of pre-design research.

●  A broader search for an appropriate and customized vernacular.

●  A shift from the delivery of healthcare services toward resident-driven wellness.

●  A move away from the adoption of “one size fits all” national prescriptions for

    environmental enhancements to operating philosophies that are thoroughly grounded in      

    the uniqueness of a given care community.