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Small design projects, big impact on culture change

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The culture change movement is driving design and operations of our environments for aging. Evolving trends and demographic forces challenge senior living owners, operators and designers to implement these trends in a way that best serves our elders. But a real challenge is fostering culture change in the thousands of aging physical plants that were built decades ago in the U.S. as institutional “facilities.”

Couple that challenge with tight budgets and a LTC operator is apt to throw up his or her hands in frustration. But there are solutions. A recent Environments for Aging conference session challenged attendees to consider small renovation projects that support culture change in a skilled nursing community. The group of architects, designers and LTC providers jumped right in—bringing their diverse viewpoints and experiences to create inspiring solutions.

Rick Moore, AIA, ACHA, principal, Horty Elving, and his colleague Christine Soma, project designer, guided the group to focus on financially feasible ways to create changes that facilitate resident choice. From there the ideas flowed forth—everything from creating gathering spaces to foster community, eliminating the central nurses station (or “mothership” as Moore called it), renovating residents’ rooms, downsizing large dining rooms and breaking up long “bowling alley” corridors with recessed spaces to foster socializing or activities.

The group ultimately concluded that the most bang for the buck would come from changes that impacted the total community—changes to common spaces. They talked about the importance of people watching and fostering connections and how that could be achieved, for example, by converting a big, impersonal lobby into smaller spaces—perhaps creating coffee shops or a small game room.

“These changes facilitate resident choice and the ability for residents to be who they are,” Moore said. And that’s what culture change is ultimately all about, right? Choice, dignity and self-determination.

Patricia Sheehan

Patricia Sheehan


Patricia Sheehan wrote for Long-Term Living when she was editor-in-chief. She left that...




Indeed, LTC operators are challenged with decreasing reimbursement issues and thus, as you point out, tightening budgets. Plus, the inventory of many LTC facilities is aged some forty years or more and the design is institutional and outdated. I agree that small renovations are a more economical way to start the process and the best "bang for the buck" may indeed be in the common spaces. I like the concept of reducing the large spaces into smaller, more intimate ones. I would add that providers should design flexibility into these spaces so that the use can be changed to meet the needs. Flexibility helps to keep spaces relevant and useful.

I agree with the small design option as a start point. I thing that option should also confront LTC facilities with the need to review and define what is the role of the resident, the family and the community in long term care settings. It is not just about designing spaces is also about having LTC facilities embracing the concept behind the change.