There are a number of challenges when it comes to the renovation of an entire wing within a fully occupied seniors housing community.
How does one completely renovate a space while minimizing the disruption to daily living of both the facility’s staff and a mix of elderly and infirm people? Rarely is the work itself to be considered a typical renovation.
Demolition, framing, plumbing, electrical, finishes, and so on all have to be completed in the midst of a functioning facility. One analogy that has been used to describe construction in an occupied senior environment is that it is “like trying to paint the lines on the highway while the road is open.”

A Case Study

To give an an example of construction within an occupied and operational environment, an assisted living community recently completed construction on a memory care neighborhood in West Barrington, R.I. The neighborhood was designed to help individuals with dementia achieve a better quality of life.   
The operator’s goal was to create more memory care units to meet increasing demand within its assisted living facility. Preconstruction services, including preliminary designs and budget, were provided to the operator.
The overall project was innovative in its use of existing space, which involved the conversion of 13 existing apartments into a new 11-unit, 15-bed dementia care neighborhood with a separate secure outdoor garden area.
Two apartments were converted into an open kitchen, dining room, and living room.
There were significant challenges: meeting the regulations for a memory care unit in terms of space and usage, while maintaining a construction budget that made the project feasible. Additionally, the project had to be completed while the residence was occupied.

Partner With The General Contractor

The general contractor should always act as a partner with the senior care facility in the renovation and seek valuable input from the entire project team—owner, architect, engineers, subcontractors, and designers.
Renovation and construction in an occupied and operational environment is always extremely complicated. It’s of utmost importance to ensure that the renovated senior care facility exceed rigorous state and federal quality standards.   

The primary consideration during renovation and construction is always the safety of the senior residents and patients and what needs to be done to keep them out of harm’s way. Temporary walls are erected where possible, as well as fireproof zip walls (plastic walls), cones, and yellow caution tape.

A “traffic cop” or two (literally, crew members) stand and direct floor traffic. It’s imperative to evaluate high traffic times, such as mealtime with the migration to the dining room, as a time when all hall construction must be halted.
Contractors are prohibited from leaving ladders or tools unattended at any time. Noisy activities such as trenching or core drilling concrete and shooting fasteners into concrete obviously cannot be done in the evenings. There are also other times during the day that are not ideal for noisy activity, such as during patient medication administration or patient quiet/rest time.
Tremendous effort must be made to maintain continuous communication with staff so that disruptions are minimized whenever possible.

Use ICRA Principles

The Infection Control Risk Assessment (ICRA) Matrix of Precautions for Construction and Renovation (see box, right), which was developed primarily for the hospital setting, should be utilized in the construction and renovation of long term, short-term, and senior care facilities, because senior care facilities share many characteristics similar to the traditional hospital.

By utilizing the ICRA matrix in long and short-term care and senior living environments, the general contractor can provide maximum protection against infection to sensitive clientele.
The memory care neighborhood in West Barrington now consists of thoughtfully designed spaces that flow well and provide an intimate environment, but also an environment that is structured. The conversion of the traditional assisted living space into memory care apartments was successfully completed in the contracted 24 months.
Experience and knowledge of sensitive, occupied environments are critical in renovation and construction.

The general contractor must work with facility staff to create a plan and a phasing schedule to ensure the project is completed on time and within budget, while also ensuring the safety and health of the facility’s population.
Tom Quinlan is president of South Coast Improvement Co., an expert in complex renovation projects within occupied and operational environments. The company’s diverse project portfolio spans throughout New England and the MidAtlantic. For more information, visit

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