EFA Review: A 15-year retrospective

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.

Margaret Christenson, MPH, OTR/L FAOTA

Lifease, Inc.

I think it's helpful for current practitioners to understand where "what we still battle with today" came from. In the middle of the 20th century, the country found itself with a lack of hospital beds. Congress acted on this shortage and passed the Hill-Burton Act. Later the original law was amended to include expansion of hospitals, nursing homes, treatment centers and rehabilitation facilities. These Hill-Burton funds and the following Certificate of Need were granted on a competitive basis and the projects selected were the projects that cost the least. In the mid-1960s, Medicare and Medicaid were established. Due to reimbursement from these federal funds, the medical model minimum design requirements became the maximum that was designed and a proliferation of nursing homes with side-by-side beds in a room and a single bathroom, double-loaded corridors, nursing stations with high counters, room signage placed too high and poor lighting occurred.

Lorraine G. Hiatt, PhD

Planning, Research & Design Consultation

In 1997, we were seven years into the implications of the Americans with Disability Act (ADA). For many providers and designers, this meant incorporating concessions to seniors’ mobility, agility, balance, vision and hearing. By 2012, we not only have years of examples, but they are more frequently emerging not from popularized stylistic themes, but great looking, more functionally based results. In addition to more design competitions and shows, we also see regulations providing tools for innovations, reducing risks and encouraging even those least likely to improvise. We’re beginning to accept design as more than a cosmetic or attribute of the upscale community.

Beyond lobbies, sound design thinking is working at the core of aging itself: evoking capabilities, cueing memory, captivating our innate desires to move, to nest. The environment is less often an obstacle and more aptly recognized as a partner in wellness, personal choice and independence.

Russell R. McLaughlin, AIA

AG Architecture, Inc.

Over the past 15 years, the one constant we have seen is the continued development and refinement of household design in both skilled nursing and memory support environments. The emphasis has been primarily towards private rooms and, where used, shared rooms that afford residents more privacy than that of the traditional side-by-side room. Much of what has and is being built is designed beyond code minimums to better accommodate personal items and equipment needed for resident care. The dining, living and activity spaces are also being designed larger to better accommodate resident mobility devices.

Many providers try to incorporate public venues that are not only shared by residents and staff, but are open to the community at large. In all of these scenarios, the focus is on the creation of resident-centered environments that provide a sense of community—not separation. 

Jeff Bogart, ASID

Eppstein Uhen Architects

The dramatic culture change resulting from fully embracing the household model has been a major achievement. Increasingly, senior living environments have abandoned the large-scale institutional models in favor of home-scaled, resident-focused models. Private rooms with accessible baths, country kitchens, family dining rooms, living rooms and dens have now become the norm in terms of consumer expectations.

The array of amenities in the common areas reflects a greater emphasis on supporting wellness of mind, body and spirit. There is increasing emphasis on fostering a sense of community and encouraging greater family involvement. The warm, welcoming environments now create an atmosphere of hospitality. Advancements in the aesthetics and performance of furnishings and finish materials have enabled designers to create environments that are not only beautiful, but appropriate, and maintainable as well.

Stylistically, there is also an emerging trend of a more transitional design aesthetic. While there will always be a place for classic traditional style, the increasing influence of the Baby Boomers will see a greater acceptance of a more sophisticated and contemporary look reflective of our times. 

Andrew Lee Alden is a Living Environment Market Leader at Eppstein Uhen Architects (www.eua.com) in Milwaukee, Wisc. He is a member of the Society for the Advancement of Gerontological Environments(SAGE). For more information on SAGE, visit www.sagefederation.org.

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