LeadingAge Magazine · January-February 2019 • Volume 09 • Number 01

Residential Living and Care: Evolving and Responding

January 18, 2019 | by Debra Wood, R.N.

“Bricks and sticks”—residential options provided by LeadingAge members—aren’t going away, but they will evolve as the needs of older adults change. We asked some providers and design experts for their perspectives.

People’s expectations of retirement living are changing. While most members of the Silent Generation accepted traditional styles for housing and care as they aged, baby boomers have more tailored and sophisticated desires. LeadingAge members and designers are responding.

“It’s fun to be in the driver’s seat and help reshape this field,” says Gregg Scott, a partner at RLPS Architects in Lancaster, PA. “It’s an exciting time.”

We asked LeadingAge members, architects, and a universal design expert a few questions about the future of the residential model for retirement living and long-term care.

Meeting Expectations

What does the next generation of older adults seek in a new community, and what design changes are being made to accommodate that?

“Baby boomers are looking for a home that will accommodate their lifestyle in the future,” says Rosemarie Rossetti, president of the Universal Design Living Laboratory in Columbus, OH, and a motivational speaker. “We have to design for living in place as we age.”

Younger retirees also seek aesthetically pleasing communities with an abundance of plants and natural materials, such as stones, in the landscaping.

“The boomers are clearly interested in quality more than quantity,” says Ric Myers, director of sales at Willow Valley Communities, a life plan community in Lancaster, PA. “They want great experiences and services.”

Among the 65- to 75-year-old population, expectations are broader than for those people’s parents or grandparents, reports Timothy Mueller, president of SFCS Architects in Charlotte, NC. A survey he conducted indicated that this age group wanted enhanced wellness, social engagement, and connectivity. Many people in this group plan to continue working or seek other ways to retain purpose in life.

Promoting Community

How is design changing to promote a sense of belonging?

“We believe people are hard-wired for community,” says Steve Lindsey, CEO of Garden Spot Village, a life plan community in New Holland, PA. “Innate in our being is a desire to be in relationships and connected to one another.”

Garden Spot Village photo
Garden Spot Village’s Sycamore Springs community uses a
“pocket-neighborhood” concept. The homes in 2 neighborhoods
have front porches (which figure heavily in spontaneous
community-building), green areas between homes, and a
community center.

Baby boomers grew up after World War II, when the suburbs came about, and are seeking better opportunities to know their neighbors and develop genuine friendships with fellow residents, Lindsey explains.

Garden Spot Village developed Sycamore Springs, an independent living community using a “pocket-neighborhood concept.” Twenty-seven homes in 2 neighborhoods were constructed with front porches, green areas between homes, rear-entry garages and a community house for get togethers, movie nights or potlucks, arranged by residents, not activity staff.

“It’s spontaneous,” Lindsey says. “It’s an opportunity for people in that neighborhood to live life how they want to live it.”

The front porches play a dominant role in the life of the community, Lindsey explains. People have quickly gotten to know their neighbors.

“There is a deep level of caring,” Lindsey says. “They share life and a sense of authentic community.”

Nearly 1,000 residents call Garden Spot Village home. Before embarking on the pocket neighborhoods, the organization had considered a co-housing initiative, forming a community to share relationships and responsibilities. However, while researching the concept, older adults expressed concern and pushed back.

“One of the things we found was that people loved the physical design of a small neighborhood that lent itself to getting to know the people around you,” Lindsey recalls. “What they did not like was the self-governance and deciding who would mow the grass or clean the gutters. The message was ‘we will pay you to run the community. We just want to live there.’”

Co-housing and front-porch neighborhoods share a common theme of creating intentional communities, reports Mark Hackenburg, principal at RGS Associates in Lancaster, PA.

“These intentional neighborhoods responded to regional influences,” Hackenburg says. “We figured out how to work within zoning codes to adapt these concepts to a new style of living, different than what we were seeing developed in most senior living communities.”

Sycamore Springs’ homes are about 15 feet apart and range from 1,300 to 2,700 square feet. The sidewalk is close to the front porches, yet plants provide a buffer. Although close together, bedrooms in the rear and living space in the front, maintain privacy.

“A lot of attention was given to sight lines, organization of spaces and proximity of homes to one another and their broader orientation within each neighborhood,” Hackenburg says.

Sycamore Springs is attracting people in their 60s and early 70s. As they age and need services, they can move to assisted living or skilled nursing units on the campus.

Evolution of Life Plan Communities

How is the concept of the life plan community and its design elements changing?

Life plan communities exist in cities as well as suburbs. City communities are “huge,” Myers and Scott report. Cities are more diverse and already enjoy vibrant neighborhoods.

“We have to stop building these communities in cotton or corn fields,” Mueller says. “That is not what this generation is looking for.”

However, Mueller indicates urban environments present challenges for nonprofit organizations trying to make the financials work due to high land and building costs.

Often, these urban life plan communities feature relatively small units. Myers explains that a city dweller’s “home” is their bedroom and the “rest of the house” is the city—its restaurants, museums and theaters. It becomes a change of mindset. He explains that people spend 90% of their time in 30% of their living space.

“We try to help people think about how they live in spaces and how much they need,” Myers says. “There are so many benefits, such as having less to clean and less to operate with heating or cooling.”

Willow Valley
Willow Valley Communities has residences from 400 to 3,500
square feet. Moving walls, bringing in more outside light,
and even using the same flooring throughout the apartment
can make smaller units seem larger.

Willow Valley Communities has residences from 400 to 3,500 square feet, with the smaller units being more challenging to sell.

Scott says that during the recession of 2008, many communities had unsold smaller units, and he was hired to make them appealing.

“I had an ‘ah-ha moment’ that you do not need large spaces to make them cool,” Scott says. “You can make something feel big and sell well. It has taken off like a rocket ship.”

Changes might include removing walls to create a great room and bring more natural light and outdoor views into the unit. Scott recommends not including square footage on project plans for prospective residents.

“As people age, they need more lighting for safety,” Rossetti says. “Look at lights coming on with motion. Safety is paramount.”

Large windows at Sycamore Springs bring in natural light, which helps with mood and circadian rhythm. Light fixtures create additional illumination to brighten spaces, which can improve safety.

Each unit must include a washer and dryer, and bathrooms must become accessible and appealing, Scott says.

Myers recommends keeping the same color and flooring throughout the unit to make it appear bigger.

“The whole space should flow from one place to the next,” Scott adds.

Evolution in Health and Long-Term Care

What design changes are developing in memory care and skilled nursing?

People are expecting and want private rooms, Myers says. Willow Valley has redesigned semi-private rooms into 2 studios with a shared bathroom.

“Private rooms give a sense of privacy and dignity,” says Mueller, who reports private rooms are more common on the coasts, but organizations in the middle of the country struggle financially to provide private rooms, especially for Medicaid patients.

Residents also want their own showers, as common bathing rooms go out of style. Bathrooms should contain storage for towels and other supplies, he says.

Additionally, Scott indicates that skilled communities and memory care are moving away from a medical-style environment to a more residential or hospitality design.

“It goes a long way in reducing anxiety in health care,” Scott says.

Food services are shifting from formal dining rooms and delivered trays to casual dining.

Cypress Cove
The Cottage at Cypress Cove features a 200-foot-long tropical
garden with multiple water elements: a rain chain waterfall,
dancing water jets and other quieting water fountains. The garden
is accessible from any of the 4 memory care households. Photo
courtesy of Cypress Cove at HealthPark Florida.

Household models are attractive. These buildings have kitchens, in a home-like environment. Assisted living also is moving toward household models, Mueller reports. The Cottage at Cypress Cove, in Fort Myers, FL, offers memory care assisted living in a household model, with 4 households of 11 units, each with a country kitchen residents and staff can use, along with sitting areas.

“It gives residents a feeling of being at home,” says Ed Stransenback, public relations coordinator for Cypress Cove.

The challenges, Mueller explains, are making the household model function for frail older adults and people in wheelchairs, and including enough integrated living spaces to make the finances work. He suggested connecting 2 or more “houses” together to share nighttime staffing and guest entertainment.

Some organizations are building structures that can flex from one level of care to another.

“Our owners are demanding the ability to flex the design based on the market,” Mueller says.

Mueller also recommends installing amber lights in the bathrooms and finding ways to bring daylight into the building, which helps residents connect to the rhythms of the day. Cypress Cove installed a computerized indoor lighting system that mimics the outdoor lighting for each day.

Mueller suggests creating indoor-outdoor spaces, with easy access to a dynamic and interactive garden with water features, which SFCS developed at Cypress Cove. The 200-foot long tropical garden is accessible from any of the 4 households, upstairs and down.

“It’s very quiet and used for several functions, to go out and sit, to enjoy discussions with family or for activities for residents,” Stransenback explains. “We have found the environment and freedom it provides has helped residents as they move through the journey of dementia.”

Rossetti adds that gardens and walking or biking trails should have a solid surface and be able to accommodate walkers and wheelchairs, with smooth surfaces and shallow slopes. Forty-eight inches wide is ideal, she says, so 2 people can walk side-by-side.

City Living for Older Adults: Why Urban Retirement Living is Gaining Popularity

In this podcast, you’ll hear from 3 advocates for city living: Susan Brecht of Brecht Associates, Inc., Ted Reed of Friends in the City, and Jennifer Tapner of The Watermark at Logan Square. They discuss the physical and programmatic aspects that enhance the experience of urban living, and who is attracted to it. Recorded in October 2018, at the LeadingAge Annual Meeting & Expo in Philadelphia.

Find more LeadingAge magazine podcasts here, along with podcasts in the LeadingAge Workforce Solutions series and the Aging Unmasked series.

Accommodating All Abilities

How can design contribute to ease of living?

Kendal at Home, a life plan at home program in Westlake, OH, lets people stay in their homes and function independently for as long as possible.

Universal design is a framework to be usable by people of all abilities and does not stand out as stigmatized, Rossetti says.

It features architectural adjustments that make living easier, safer and more comfortable for all people, adds Lynne Giacobbe, executive director of Kendal at Home. Even so, members often resist making those changes until absolutely necessary due to a disability.

“As we become more aware, I ask ‘why isn’t this a standard builders are using?’” Giacobbe says.

Accessible design includes a step-free main entry and interior and exterior doors at least 36-inches wide, says Rossetti, adding that people often overlook entryways. The bathroom also presents challenges for people, including pathways from the bedroom, and curbless showers with seating, a hand-held shower and room for a caregiver.

“My biggest concerns are getting into the house and getting into the bathroom safely,” Rossetti says.

Homes and the community houses at Sycamore Springs incorporate universal design, Lindsey says. Entrances are at grade with no steps. Some models have elevators to allow easy movement between floors.

“Everything is accessible to people, whether they are ambulating or in a wheelchair,” Lindsey says. “It creates a space people can age in.”

Floors should feature hardwood, tile and laminates for ease of movement, Rossetti says. Throw rugs can result in falls. Circulation patterns should allow access for dining and preparing meals. At least half of the storage should be reachable for a seated person and countertops ergonomic. Refrigerators should open flat—in other words, with doors that open a full 180 degrees to allow easy access to someone in a wheelchair. Side by side units make it easier to use the fridge. Microwaves above the stove present safety risks, she adds

“Most falls occur in the bathroom,” Rossetti says. Grab bars should be installed to fit the person. Some grab bars are attractive and may be incorporated into towel racks or toilet paper holders. Two grab bars may be needed. Yet people often resist installing even attractive grab bars.

“Grab bars need to be there before there is a fall or stumble,” Rossetti adds. “No one is immune. It just happens.”

Scott reports a negative recoil to anything that speaks or looks like ‘accessibility,’ such as institutional-looking handrails or anything that looks medical, because it reminds them, they are aging.

“We are working hard to be more creative and artistic with accessibility,” Scott says. “When it works, it is magic.”

Debra Wood, R.N., is a writer living in Orlando, FL.