Sustaining lifelong connections

Humans are relational beings. We have connections with one another and the natural environment. When we think about how we can nurture and sustain these connections, we can improve our built environments and the quality of our lives, including those of seniors.

Thus, a broad vision for a sustainable long-term care facility goes beyond environmental design and LEED® certification-it seeks to nurture seniors’ connections with their environment, community, and humanity. This vision can be realized through a variety of means: design, construction, operations, and maintenance of a facility that:

  • helps sustain the environment;

  • fosters seniors’ engagement in the social, cultural, and economic life of the larger community; and

  • provides seniors with opportunities for continuing education and intergenerational learning.

Through creative space planning and design strategies, designers can create a built environment that enables these connections to be made. And, through development of partnerships with the larger community, long-term care leaders can identify mutual needs that help them overcome financial challenges to realizing this vision.

Beyond environmental sustainability

Much has been written over the last several years about ways to design and construct an environmentally sustainable healthcare facility. The U.S. Green Building Council (USGBC) (, in developing the LEED Rating Systems, has made a great contribution to the transformation of the design and construction industry. The USGBC Website states: “The LEED for Existing Buildings Rating System helps building owners and operators measure operations, improvements, and maintenance on a consistent scale, with the goal of maximizing operational efficiency while minimizing environmental impacts. LEED for Existing Buildings addresses whole-building cleaning and maintenance issues (including chemical use), recycling programs, exterior maintenance programs, and systems upgrades. It can be applied both to existing buildings seeking LEED certification for the first time and to projects previously certified under LEED for New Construction, Schools, or Core & Shell.” Designing and building a LEED-certified facility that integrates high-efficiency mechanical/electrical/plumbing systems, renewable, low-VOC building materials and finishes, and other components is a worthwhile environmental goal. It also offers a return on investment in the form of a high-performance building that lowers operating costs over its own life cycle, and contributes to its users’ quality of life. It is a healthier building to live and work in.

Completing checklist

Many people-including designers, builders, and owners-equate sustainability with completing a rating checklist and cutting the ribbon on a certified “green” facility.

Achieving certification under any rating system becomes a “snapshot” in time. The challenge to any facility owner is to maintain a sustainable facility. After the ribbon-cutting comes the ongoing process of operations and maintenance-activities in themselves that must be sustainable.

However worthwhile these goals and practices are, LEED certification is intended only as a starting point. To achieve true long-term sustainability, owners must periodically reassess their Operations & Maintenance (O&M) standards and practices in light of sustainability goals. They must ensure they are optimizing the productivity and efficiency of their facilities and personnel.

The challenge, whether certifying your facility or using environmental rating systems as a guide, is to broaden an understanding of sustainability beyond the checklist. Special considerations are required for specific healthcare needs, integration with the community, and developing a view of how to restore, or enhance, the quality of the natural environment around your facility.

The Green Guide for Health Care (GGHC) ( has developed a “tool kit” that broadens the definition of sustainability for healthcare facilities. For example, it recommends establishing connections with the natural environment for patients, residents, visitors, and staff through creation of landscaped outdoor spaces and gardens. To develop a relationship between food service and sustainability, the GGHC suggests offering space on the grounds to host a local farmer’s market-establishing an important connection with the larger community, and other alternatives that focus on food production. The USGBC is in the processs of developing LEED for Healthcare, another companion tool that can address specific healthcare issues. While both are rooted in acute care settings, there can be beneficial elements that can be applied to any healthcare setting.

Another example of a broader definition of sustainability is the concept of regenerative design; that is, designing a built environment that is not only compatible with, but also helps to restore the indigenous natural environment. Applied to healthcare, a long-term care community is an ideal place to practice regenerative design; it makes a place that regenerates the seniors’ knowledge and wisdom by infusing it into the larger community. In fact, long-term care leaders are passionate about developing a supportive environment that helps seniors realize their individual potential as continuing contributing members of society. A long-term care community can and should be a place that enables seniors to remain active, increase their knowledge, and share their wisdom and talents with others.

Figure. Layout for intergenerational activities and programming.

Engaging seniors

One way to nurture and sustain connections between seniors and the social, cultural, and economic life of the larger community is to identify mutual needs and develop facilities that meet them. For example, hospitals and schools have recently discovered the value of sharing meeting rooms, multipurpose rooms, and fitness facilities with the community. Applied to a long-term care facility, this kind of community partnership might mean a multipurpose space with separate entrances for residents and community members, as well as expanded visitor parking.

Of course, entrances must be monitored to ensure the safety and security of both communities. For example, it would be important to ensure that visitors from the larger community could not gain unauthorized access to the long-term care facility. But to promote cross-generational interaction, programming could include both private and shared events and activities.

Similarly, outdoor landscaping could be designed to permit development of a therapeutic garden, including native ornamental plants, herbs, and vegetables, that could engage residents in gardening to the extent that they are able and interested. By partnering with the community and identifying mutual needs, social service agencies and community gardeners may participate in funding and managing the garden.

The fruits of their combined efforts might supply some of the food needs of the facility itself, as well as outlets in the community; for example, a soup kitchen for the needy.

Intergenerational learning

A shared multipurpose space can also function as a place for intergenerational learning if it is designed with a school bus drop-off zone, bicycle racks, perhaps an outdoor play area, and appropriate coat room and toilet facilities for children and teens (see figure above). The long-term care facility and local schools could partner in development of appropriate after-school intergenerational learning programs that would benefit both residents and students.

This type of partnership could include other entities that have a similar mission, benefiting community-based YMCA/YWCA, Head Start MRDD, and other private care organizations that find it challenging to go it alone. These community-based organizations can bring the skill sets and additional funding to the partnership. In one urban area, a not-for-profit organization that participated in this type of partnership, engaged in a monitored-shared parenting program, as well as in special programs designed for students who were removed from the mainstream classroom environment.

A long-term care community can and should be a place that enables seniors to remain active, increase their knowledge, and share their wisdom and talents with others.

Similarly, a partnership with a local community college or university could result in use of the multipurpose room for on-site lectures and other programs-perhaps even a distance-learning component-to benefit residents as well as the larger community. Depending on the nature of these programs, designers can incorporate Internet access, audio-visual presentation systems, conferencing systems, etc., into the multipurpose room.

Many long-term care facilities include spaces for small lending libraries, along with arts and crafts activities. Depending on residents’ functional level, facility leaders may be able to broaden educational programming for their residents to include new challenges: for example, computer skills and Internet use. Here is another opportunity to engage community resources to make it happen.

Larger context

At the heart of sustainability is understanding the larger context for a long-term care facility. Is it connected with other people and the community beyond its walls? Moreover, by reaching out to the larger community, long-term care leaders can identify mutual needs that help them share the costs and the benefits.

Bob Siebenaller, AIA, NCARB, LEED AP BD+C, ACHE, is a Healthcare Division Manager at SSOE Group (, an international engineering, procurement, and construction management firm. With 26 years of experience, Mr. Siebenaller specializes in healthcare, education, and early childhood design. He can be reached in SSOE’s Toledo, Ohio office at (419) 255-3830 or Long-Term Living 2010 September;59(9):28-31

Topics: Articles