Is renovation always a good thing?

Every year a group of multi-disciplinary professionals gather to discuss Design Showcase submissions for Long-Term Living's Environments for Aging review. Inevitably, during the discussion, a common theme appears. This year was no exception: Is renovation always a good thing?

We always consider the SAGE (Society for the Advancement of Gerontological Environments) design principles during the discussions, but one aspect that we sometimes neglect is the entire context of the renovation project. Context is not just the location of the project, it is also a myriad of other factors including financial, cultural, operational, etc. These other factors might mean that a simple and limited renovation project for one community is a complex and challenging endeavor for another community.  

As proponents of good “design for aging” we will always encourage a complete transformation in any renovation project including concurrent changes in the model of care, operations and the built environment. However, the reality is that many communities are faced with restrictions that only allow limited changes, which may not be considered ideal. Regardless of the type of change, if it improves the quality of life of the resident, it is a worthwhile endeavor. Often, when financial factors play a role in the potential scope of renovation, operational and model of care decisions can enrich the final result and help compensate for financial limitations. If your community has completed a renovation project that dealt with challenges (financial, operational, site or others), please consider submitting to the Environments for Aging Remodel/Renovation 2013 competition in April.

As part of the review process the judges answered questions as they reviewed the submissions. For a glimpse into the mindsets of the judges and commentaries on the entirety of the 2013 submissions, read on.

Environments for Aging 2013 Jury Front (left to right): Alec Sithong, Assoc. AIA, Project Manager, Senior Living, VOA Associates Incorporated; Jerry Weisman, Professor of Architecture, University of Wisconsin-Milwaukee; Lorraine G. Hiatt, Ph.D., Environmental Gerontologist—Planning, Research and Design Consultation; Russell R. McLaughlin, AIA, Senior Associate, AG Architecture, Inc.; Amy Carpenter, AIA, LEED BD+C, Principal, Lenhardt Rodgers | Architecture + Interiors; Duane Helwig, AIA, Vice President or Design, Community Living Solutions; David A. Green, Director of Conceptual Planning & Development, China Senior Care; Mark Proffitt, Ph.D Candidate School of Architecture and Urban Planning, University of Milwaukee; Fellow, Institute on Aging and Environment. Back (left to right): Christine Soma, Assoc. AIA, Designer, Horty Elving & Associates; Carolyn BaRoss, IIDA, LEED AP, Principal, Perkins+Will; LuAnn Thoma-Holec, ASID, IIDA, CID, Principal, Thoma-Holec Design, LLC; Melissa C. Pritchard, AIA, LEED, AP, BD+C, Senior Vice President, SFCS; Geoffrey Roehll, Senior Vice President, Hitchcock Design Group; Andrew L. Alden, Studio Director, Eppstein Uhen Architects; Charlie Wilson, Senior Vice President, Buckner Retirement Services; Addie M. Abushousheh, Ph.D EDAC, Assoc. AIA, Executive Director-Association of Households International; Robert C. Pfauth, NCARB, Senior Project Manager, eppstein uhen architects; Larry Schneider, Project Executive, Plunkett Raysich Architects, LLP; Mitchell S. Elliott, AIA, Chief Development Officer, Vetter Health Services. Jurors not pictured: Deborah Breunig; RN BSN MBA EDAC, Vice President Healthcare, KI; Margaret Calkins, Ph.D President, IDEAS Consulting Inc., Board Chair, IDEAS Institute; Carol Reitter Elia, ASID, IIDA, LEED-AP, SAGE, CR DESIGN; Skip Gregory, NCARB, President, Health Facility Consulting; Dr. Susan Rodeik, NCARB, EDAC, Associate Professor of Architecture, Texas A&M University; Kimberley A. Shapiro, IIDA, LEED AP, NCIDQ, Director of Business Development, Southwest, HDR Architecture; John Shoesmith, AIA , LEED AP, Partner, Shoesmith Cox Architects, PLLC; Fred Worley, Architect, Architectural Unit Manager, Texas Department of Aging and Disability Services.

Did you see any outdated design concepts or elements that you would like to see banished?

Addie Abushousheh: First, the language of patients, pods, guests, etc. has to be changed. Our language shapes the way we view others. As a result, we take things for granted by making assumptions. Designers need to spend time in the communities that they are working with so they have the opportunity to get to know residents and staff personally. Second, there has to be a better answer to increasing a building’s capacity other than a seemingly endless double-loaded stark corridor with no orienting cues or access to natural light.

Fred Worley: Identical oversized bathrooms are used again and again because they have met ADA [Americans with Disabilities guidelines] and architects are reluctant to try new designs.

Lorraine Hiatt: We had new buildings with traditional double rooms, both with decent budgets and sponsors/architects supporting central nursing. We also saw evidence of fixed vs. wearable technology.

Skip Gregory: The continued reliance on the nurse station even in otherwise well-designed projects. Some people must cling to their nursing stations.

Margaret Calkins: I struggle a little with the shared bathrooms; most of the designs are better in that each person has their own private sleeping area. I recognize that bathrooms are more expensive to build, but if you take a life-cycle cost perspective, the ultimate cost is probably something like $0.75 – $1 a day to create the space for a private bathroom. If you were checking into a hotel and had the choice of saving one dollar by sharing the bathroom with someone in the next room, would you share? Or, pay the extra dollar?

Alec Sithong: I wouldn’t say banish but tone down on the hospitality/luxury theme.

Jerry Weisman: I was surprised to see the return of the double-loaded corridor without any design strategies to minimize the problems associated with it. We would like to see, among other things, access to exterior views and natural light, destinations along the corridor for seating, and limiting the length of the corridors. American psychologist George Miller promoted the concept of “seven plus or minus two,” which could be applied to limit the number of entries on a corridor to promote way-finding and orientation.

Kimberley Shapiro: The Concept of wellness should be addressed in every aspect of Healthy Aging facilities. Residents want the feeling of home, but we must not design with the institutional mindset of what has been done in the past. Residents and families are looking to new ways and opportunities in these facilities to be in an environment that encourages active family involvement, connection to the community and individual empowerment.

Were there any common threads identifiable in the submissions?

Carol Elia: I liked the attention to outdoor spaces that were clean, and easy to get to and see from the indoor areas. Those who pointed out these outdoor spaces in their designs did well in creating screened-in porches, raised gardens, private balconies and multiple opportunities to reach the outdoors by residents without the aid of others. 

Geoffrey Roehll: I really love the attention to the indoor/outdoor relationship of most of the designs as well as attention to natural light.

Charlie Wilson: Designs with superb connections to the outdoors seemed plentiful this year indicating a raised awareness of the therapeutic impact of the environment. We also saw many variations of private rooms with shared baths versus semi-private. This tells me that providers and designers understand the market wants privacy and they are trying to do this in an economically feasible manner.

Robert Pfauth: There seems to be an overall trend toward creating hospitality–inspired projects, although a few more residentially-scaled projects were included. These two divergent approaches to designing environments for elders generally seem to be more indicative of the bias of the sponsor or developer than the preferences of the eventual residents. Although not necessarily true as a rule, the former [hospitality] category seems more focused on providing curb appeal and “wow factor” with less concern for ensuring that the environment supports the delivery of person-centered care. By contrast, the latter [homelike] category may scrimp on the building exterior in order to deliver more operational and experiential benefits on the interior.

Carolyn BaRoss:The prevalent aesthetic of the current “elderly home” in exterior and interior design strikes me as formulaic and nostalgic that strives for an “average” and a “hospitality generic” that causes in me a visceral response of dread of aging. There’s a widely-used but narrow range of style, color palette and motif that seems a caricature or an impression of the elderly that is not suited to the independent, intelligent people I know who happen to need some assistance as their bodies age. Is this truly market driven or a safe response? I’d love to see authentic architectural expressions inside and out that convey honesty in form and style, oriented to the natural world, and with a balance of detail and simplicity that respond to the elderly or incapacitated as people like the rest of us, engaged in life, independent of budget. How to redefine this typology?

Russell McLaughlin: A lot of the projects were focused on the skilled/rehabilitation market or incorporated a fitness/wellness component [especially with warm water pools]. We are seeing more of the interiors with a contemporary or transitional look.

Melissa Pritchard: This year many of the submissions seemed to have much more contemporary design elements than last year, more modern materials, colors, furniture and artwork. In general it did seem that common spaces were also more upscale and modern. Most submissions mentioned natural light, but very few actually seemed to live up to that goal/promise.

Duane Helwig: Most submissions I reviewed made attempts to shape their architecture and interiors around the styles appropriate to their regions [Mountain West, Carolinas, Floridian, etc.]. In several cases, neighborhoods were differentiated by distinct styles originating from their respective region. 

Christine Soma: It seems like submissions were attempting to move toward a small house model and reduce the length of a double-loaded corridor. However, some projects were more successful than others.

Mitchell Elliott: The household or neighborhood concept continues to be prevalent, but only in memory support and skilled nursing. I think there is value in creating smaller environments for the more independent environments as well.

LuAnn Thoma-Holec: Many of the communities include “open kitchen” concepts within the resident neighborhoods. In the past this has been a very challenging task, due to life safety and fire codes.

Susan Rodeik: Several of the projects introduced features that supported enhanced resident independence. Although many of the projects were tight on space and designed for low-income elders, they were able to increase levels of privacy in the resident rooms.

John Shoesmith: A memory cabinet does not an Alzheimer’s residence make. I wish that some of the designers spent as much time thinking about providing activity along the corridor, eliminating dead-ends or undesirable points of focus at the end of corridors, or increasing the availability to natural light and quality outdoor environments as they did in detailing the memory cabinets.

Larry Schneider: We need to move away from thinking that memory boxes will solve all our resident’s orientation issues. Memory boxes are just one element of a much larger strategy.

Amy Carpenter: I am seeing more hospital-like submissions which I am concerned about in some cases. Designing for senior living is very different from designing for acute care. Hospital designers have expertise in acute-care environments. But not all hospital designers can jump in to senior design. It’s vital that those involved from both the facility and the design team have the most up-to-date knowledge of senior design, and if they don’t, they should pull someone in that does. I do believe a residential architect tends to have a much better grasp on senior living design.

David Green: Few providers do much with pre-architectural programming. They leave it up to the architect to hold some meetings to obtain input, and often the input is a reaction to schematic drawings rather than basic desires.

Deborah Breunig: It was positive to see references to natural light, amenities and supporting the autonomy of the resident. I would have liked to see more reference into the initiatives to support sustainability, i.e. materials used, healthy indoor air environment, etc.

Mark Proffitt: There is a trend to focus on breaking down the scale of these large institutions into smaller separate living spaces for residents. This often results in buildings being pulled apart into separate pavilions with small connectors. Sometimes the designers effectively use this strategy, but occasionally we are seeing designs that suffer from unnecessary longer walking distances, staffing in-efficiencies, lack of views to the exterior and other problems that overshadow any benefit that the perception of separateness provides.  

Andrew Lee Alden is a Studio Director 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.