Trading spaces

[Editor's note: This is part two of a two-part article. Read part one here: Designing memory care]

For long-term care (LTC) organizations, catching the golden train of memory care services often means revamping current spaces for new uses. Right now, especially for organizations already involved in the assisted living (AL) market, no service market trend is bigger or more lucrative than memory care.

Epworth Villa, a continuing care retirement community in Oklahoma City, is an example of how one organization realized the need to revamp its service delivery models and its campus—built a mere 20 years ago—to re-tailor its service offerings to memory care and greater AL options.

“We had been providing long-term care memory care, but it was within an institutional model nursing home—a medical model, with long hallways and big nurse’s stations,” says John Harned, president and CEO of Epworth Living, the site’s parent company. In Epworth Villa’s previous layout, two-thirds of the AL quarters had no showers. While a third of the units had toilets and sinks, they were basically semi-private rooms, Harned noted. Not at all the expectations of today’s fast-changing consumer views of assisted living units, let alone those dedicated to memory care.


The organization went through a transformation to the household model, a three-year planning project that deliberately included the care managers and residents at every step. Involving the residents in the early financial and design discussions worked well, Harned says. “At first, residents said, ‘We want a balcony for every assisted living apartment.’ Then, we talked about cost per square foot and the residents were in the room when we said, ‘Well, we need to cut about $8 million.’ One of the first things that got cut was those balconies, but because we had involved the residents in that decision, they said, ‘Yeah, balconies would have been nice, but [the cuts] make sense.’” 

The campus renovations began in 2013, restructuring 32 former AL or LTC units into private apartments and building 40 new private memory care apartments. The restructuring part of the campus for dedicated memory care services was not just to improve bed-census, but was a nimble course correction amid a quickly changing market, Harned says.

“We expanded the assisted living [section] and turned it into long-term care. Then we gutted the nursing home and turned it into a town center with multiple restaurants, a convenience store, a fitness center, a salon and day spa, movie theater, a clinic with a hospital, and a pharmacy. Now everything is connected. The town center is literally the center of the campus, where if your spouse lives in another level of care, you never have to go outside [to visit.]”


The interior design for the new memory care spaces needed to match the new care missions, explains Melissa Beck, who served as design firm Spellman Brady’s lead designer on the project. “For everyone from the director of nursing down to housekeeping, it’s the interior design that the staff and the residents interface with every day. So the way those spaces were being repurposed really had to be taken into consideration in terms of how the interior design was planned.”

The old traditional nurses’ station is now cozied into a cabinet-based nook, much like someone would have in their home, adds Kelley Hoffman, vice president of senior living at St. Louis, Mo.-based Spellman Brady. “The institutional part is gone and the work station is based on residential cabinetry set off to the side, like you might have built into your own kitchen. It’s not a place where people go and hide behind a big desk.”

Unique tactile surfaces and color palettes for each floor and dementia-friendly cues for wayfinding all add to the interior design for Epworth Villa’s new memory care units. Patterns on fabrics and flooring are minimized in the memory care spaces to reduce agitation and confusion, while high-contrast decorations clearly show the difference between shelving and decorations, an aid to the aging eye.

Epworth Villa’s new memory care units also are deliberately placed on the ground floor, to give residents freedom to access the securely enclosed, yet highly visible, outdoor garden. “The residents can go outside during the day and we can see everybody in that garden area,” Harned says.

The repositioning to memory care services demanded a change in everything from spaces to viewpoint, says Epworth’s Harned: “What I have been trying to do for years is really raise the level of long-term care and assisted living and memory care. It’s just as important as independent living, and for years it has always been unattached or across the road or at the back of a campus. We wanted to give it spaces and amenities that everybody can be just as proud of as they are in independent living.”

Related article: Designing memory care

Topics: Alzheimer's/Dementia , Articles , Executive Leadership