Renovation, the budget-friendly way

For an administrator and owner/operator, a long-term care facility in need of renovation is a daunting prospect. The mini-hospital or the 1970s motel look that seemed so appropriate for its day fades badly when compared with the newer facilities on the market. Forget about the sparkling, sometimes ritzy mega-projects that our annual DESIGN issue displays—just some modest improvements would be welcome in most facilities. But are even these beyond current budget realities? No they’re not, not if you approach the challenge sensibly and with a careful eye—at least so says Janet Merutka, a long-time interior merchandiser and vice-president of the Chicago firm Hanna Z. Interiors, Ltd. in Riverwoods, Illinois. Their firm won a Citation of Merit in DESIGN for Senior Environments 08 (Rainbow Hospice Ark, p. 86), a striking facility makeover that featured several relatively low-cost elements—and there are more where those came from, says Merutka in this interview with Long-Term Living Editor-in-Chief Richard L. Peck.

Peck: In thinking about renovation in an economical way, what are some good first steps?

Merutka: Basically, you want to create what I call a master plan for the facility’s environment—an idea of how you want the facility to look when the interior renovation project is totally completed. The first step is to develop a consumer profile of your facility—a demographic of not just current residents, but who the residents are likely to be two, five, ten years from now. One thing I’m finding is that older administrators who are nearing retirement are asking themselves, “Would I want to stay in a facility that looks like this?” The answers they’re coming up with are leading to some new concepts and plans.

When considering a new interior look, it should not be cutesy or trendy. I see the goal as more a resort-type look—comfortable, familiar, relaxing, although the definitions of these might vary depending on the clientele you serve. Some people prefer a Four Seasons Hotel-type look, others would be quite happy with a nice Holiday Inn approach. Administrators know their current and future consumers and their demographics. One thing I do is to visit nursing facilities on weekends to observe the adult children and check out the cars in the parking lot. They are often the next generation of residents. Also, when I get a chance, I ask them how they like to spend Friday and Saturday nights, where they shop, where they go on vacation, and so on. It’s not a focus group, but I do get a pretty good idea of their design preferences and level of sophistication in a short period time. This information is given to our design team who interpret the input in designing cost-effective, dignified residences.

The next key to initial planning is to project renovation expenditures over a period of time and not to be daunted by the prospect of the total cost of the master plan. Rather, think of it in phases. For example, a $1 million project could be done in increments of $250,000 every year for four years. This helps keep it in within the realm of reason.

Peck: What might a typical approach to phasing be?

Merutka: Usually facilities start with the front of the house—lobbies, admissions, dining rooms. Up on the resident floors, often one of the first things is to redesign the nurse’s station (figure 1), making it more like a concierge desk. Many “neighborhood” or “town center” concepts involve reducing the size and presence of the nurse’s station and replacing it with small desks and concealed charting areas. In the next phase you might remodel corridors, physical therapy rooms, the library/computer areas, activities areas, and common areas. In the final phase, many clients begin the redesign of resident rooms, perhaps only three or four at a time, and extending that phase over a period of time.

Nurse’s station is designed to look like a concierge desk

Renovating key areas that create “memories points” for potential residents and their families can be effective in emotionally motivating people to make the decision to select your nursing facility over the competition. These renovated areas set the tone for the campus or facility and subtly indicate to potential residents the level of environmental sophistication and comfort the facility is offering. There was one facility, for example, that converted its 1970s-looking mauve hair salon into an updated spa (figure 2), with zoned areas for massage, pedicures and manicures, and a seating/coffee area, along with new lighting and even a waterfall wall sculpture, all within very limited space. This became one of the facility’s chief marketing tools.

Hair salon was transformed into a spa

Peck: What are some low-cost options for starting within these phases?

Merutka: One way is to start with the architectural features you already have within your building and see if you can accentuate and join that existing architecture. For example, to make a ceiling look higher, we use vertical vs. horizontal details. We do this, for example, by applying full-height corner guards or creating columns of vertical floor-to-ceiling drapery panels. I recall a project with a lovely marble fireplace in an independent living facility (figure 3) that was an interesting architectural focal point but was cold and hard-looking. We simply added some wood columns along the sides and a wooden crossbeam resembling a mantle, and accentuated the fireplace wall with a darker contrasting wall covering. The fireplace was transformed into one with a warmer, more residential feeling and far more attractive to the consumer demographic market.

Marble fireplace is a focal point in the activity room

In general, we, as designers, approach the design process very systematically, addressing the question: What can be done to floors, walls, and ceilings, and how can we get the richest look by balancing all of the materials and design solutions within the limited budget?

Peck: Please elaborate?

Merutka: Start with the floors—this is the surface that is most difficult to redo in the future while census is high, and it’s likely you won’t want to be doing this again before another 10 years. Other areas are less invasive and open to more cosmetic refreshing over the years, such as paint, wall covering, furniture, and drapery which can be changed and refreshed more often—more so than with flooring.

Vinyl composition tile (VCT) is the least expensive flooring material and can be interesting if colors and details are incorporated into the total design, but it requires high maintenance. Vinyl is a bit more expensive flooring solution but has less maintenance than VCT. You can do vinyl patterns and add a lot of interest and texture to an otherwise bland floor surface. We have designed and installed very rich-looking designs in “first impression” areas by creating patterns that resemble far more expensive wood parquet flooring (figure 4) and have only a small extra one-time cost for installation.

Lobby was designed with vinyl flooring that resembles wood parquet

However, carpet with moisture barrier is even better than vinyl because it has no crevices for urine to accumulate, and it can be cleaned with water, without need for cleaning chemicals. Carpet tiles are a wonderful solution in allowing development of attractive patterns and textures with the added benefit of ease of replacement if one tile is badly stained.

Next, look at the walls. Painting is no doubt the least-expensive renovation option, but even with this I strongly recommend people get expert guidance on color selection. You want to know how the color envisioned interplays with room lighting, natural light, and the limitations of vision in the elderly? Wall covering is the next obvious option, and the good news is that you can use it on a limited basis—applying it, for example, as a panel along a long corridor wall to break it up, or as a headboard definition in a skilled nursing resident’s room. You don’t have to wallpaper everything.

Next, look up to the ceiling. Make sure that all light bulbs are the same color—you’d be amazed at how often this doesn’t happen and results in a subtly uneven light level. Keeping 2×4 existing fixtures but perhaps adding a few decorative ceiling fixtures will enhance the light level and create a simple new look. Or with a little bit more money, replace some of the fixtures with newer indirect/direct lay-in fluorescent fixtures, which give an upgraded look and better light source. In lobby or key areas the addition of recessed cans will soften and update the look.

A couple more points on lighting of landscaped exterior gardens: Interior/exterior relationships are a wonderful opportunity to expand your visual space. You can use exterior lighting to draw people outside in the warmer weather and to sit closer to the windows in cooler weather. We all know how important natural sunlight is for our seniors. This can make the indoor square footage seem larger than it really is. Of course, you need good landscape design and adequately sized windows to pull this off.

Natural light is like gold to seniors. You should design for the maximum exposure of windows to natural light. You can control glare with adjustable wood-like slatted blinds. If the structure and budget allows the addition of skylights on one-story structures, we will pop a hole in the ceiling (figure 5) and capture natural light in darker interior areas. This will also add architectural interest, break up the space, and give it a new personality. If the budget and structure are more limited, you can create a ceiling detail that feels like an outdoor sky (figure 6) in closed-in interior areas.

Skylights increase natural light

Ceiling detail in a windowless room creates the feeling of an indoor sky

Peck: What about renovating bathrooms?

Merutka: With bathrooms there are institutional requirements you must meet, particularly in skilled nursing. However, that institutional look can be minimized with the use of various upgraded materials. For example, rather than using ceramic tiles on the floor, which are never really clean and retain smells, sheet vinyl with a flash base works great and looks good. On the walls ceramic tiles work well, going at least four feet up. With today’s vast selection of tiles, upgraded-looking patterns and textures can easily be designed without huge increases in budgets. We recommend that facilities retain their sinks if they are in good shape, but we do replace the faucets to refresh the design. We also replace those old institutional mirrors and light fixtures with character mirrors and interesting appropriate lighting. We even hang artwork. In all, these bathrooms have the elements of a four- or five-star hotel.

The nice thing, from a business standpoint, in redoing bedrooms and bathrooms in this way is that you can often charge more for daily room rates with private-pay clientele.

Peck: Would you elaborate on how you manipulate spaces to create different-sized and different-looking zones within them?

Merutka: You can explode space, removing walls and dividers and, in general, opening it up so that seniors can interact and socialize more effectively. Not all residents want to join in, but they can at least watch what’s going on around them. As residents become more involved with people and activities outside themselves, they think less about their own problems and become happier people. Opening up space in this way can admit more natural light, too. Dividing large spaces into smaller ones, or zones, is guided not only by the structural limitations but with input from your staff and activities directors. Do you want a library, a card-playing area, a TV area, a family gathering place? What fits your facility’s current and future programming needs?

Another overall tip: To create a residential feel, I’d recommend using furniture and furnishings from several manufacturers, not a “complete package” from just one source. Adding the final design layer of carefully selected existing and new artwork and accessories completes the interiors with that residential, warm, dignified homelike environment. This is the attitude we are all trying to achieve. Using the old package approach is one of the major contributors to the institutional feel you are trying to eliminate in your facilities.

For further information contact Janet Merutka at (847) 729-1199, e-mail, or visit To send your comments to the editors, e-mail


The first step is to develop a consumer profile of your facility—a demographic of not just current residents, but who the residents are likely to be two, five, ten years from now.

Topics: Articles , Design , Facility management