10 Elements of Safe, Functional Bathrooms<p>In a senior living facility, the bathroom is arguably the most important space to providers and their residents. Studies show that most incidents and falls occur in the bathroom. The independence, hygiene, dignity, and safety that occurs in the bathroom is all pivotal. That is why it’s so important to create an environment that supports aging over time and promotes independence for seniors.</p><p><span><img src="/Articles/PublishingImages/740%20x%20740/bathroom.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;250px;height&#58;250px;" /></span>Here are 10 key elements to making a safe, comfortable, and pleasant bathroom environment.&#160;</p><p>1. LIGHTING. The amount of lighting the elderly need increases due to changes in aging eyes. Often, mature adults are most disoriented in the middle of the night. The ability to see clearly, and do so seamlessly, is vital for seniors. Automatic lights and night lighting can aid the sense of security and reduce risks throughout the bathroom. During the day, adequate lighting in the shower and tub increases the ability to see faucets and toiletries, reducing the likelihood of slips and falls. Also, it is important to provide proper lighting around the toilet and within the shower area in the event that staff assistance is necessary.&#160;</p><p>2. FLOORING and FINISHES. Non-slip flooring and textured finishes reduce the risk of falls. Flooring, especially in wet areas, is critical to meet requirements for slipping as the introduction of rugs or mats can be a tripping hazard. Providing flooring that is glare-free and provides for some level of altering color and contrast improves vision clarity. Be very mindful of transitions from carpet to tile or vinyl to ensure that there is little to no elevation change that may increase the likelihood of a fall.&#160;</p><p>3. SHOWERS/TUBS. When it comes to showers, low-threshold showers and collapsible vinyl shower dams are preferred in resident rooms compared to tubs. Weighted shower curtains are key to keeping water where it needs to be along with vinyl collapsible dams that not only assist in keeping water inside the shower but allow for feet and assistive devices to “crush” the dam versus a non-zero entry shower with a fixed 4” lip. Ideally, barrier free entry is the best option. Adequate floor pitch to drains also prevents “ponding” of water, especially if a barrier-free shower area is provided. Moveable shower seating is appropriate for the majority of those in an independent living situation. For all, we must ensure non-slip flooring, and placing grip strips is an optional additional safety measure. However, mats placed on the floor should be avoided in the tub/shower area. Adjustable shower heads and handheld showers, with fixed and multiple docking locations for flexibility allow for staff assisted bathing and ease in resident use. When tubs are desired, specifically designed step-in models with fixed seating are ideal for independent and assisted living and even some skilled care situations.&#160;</p><p>4. NURSE CALL SYSTEMS. Be sure to provide emergency pull cords or buttons, strategically placed near the shower/tub and toilet, with no clutter around them. Be certain the location of the call buttons is paired with proper automatic lighting to ensure they can be found in the most difficult of times.&#160;</p><p>5. TOILETS. There are several factors related to toilets that we need to be aware of to provide safety and comfort. The American with Disabilities Act (ADA) requirement is that toilets are between 17” and 19” from the floor to the top of the seat. The high end is often too high for older women. We suggest setting the height at the mid-end of the ADA range. We must decide about the type of seat. A closed front establishes a more residential sense, but for toileting assistance an open front is better for staff. Another feature that is helpful to aging vision is to provide contrast of the toilet to the wall and flooring. Most toilets are white, and providing a darker wall helps with visibility.</p><p>6. GRAB BARS. There are many types of grab bars, and their function and placement are crucial. Inside the shower, along the bathtub, and beside the toilet area are all important. In the area of the toilet, those that pivot up when not in use are usually preferred by both staff and residents. With the swing-up types, toilets are placed 24” away from the wall versus 18” for a side wall-mounted grab bar. This allows for more area for staff assistance with double transfers. Another advantage of the swing-up type is that those affected by a stroke, where strength is impacted on one side of their body, can use one side or the other. When non-flexible rear bars or just one grab bar is the only type available, it might not serve them adequately. Additionally, properly placed and enforced towel bars (with textured surfaces) that double as grab bars can provide an additional source of security at sink areas and between the shower and toilet.</p><p>7. FAUCETS. Easy-to-use faucet handles, being mindful of those with arthritic hands, are important. Single-lever faucets are recommended as they are easier to use for arthritic hands with the benefit that residents don’t have to try to blend the two faucets for just the right temperature. Also, the height and distance off the sink ledge is important for infection control. Providing plenty of clearance to properly wash hands is key. Sharper contrast of fixtures, such as contrasting sinks to countertops, provides greater visual clarity to our aging population.&#160;</p><p>8. VANITY AREA. Tilt mirrors allow for shorter persons and those in wheelchairs better coverage and visibility. Mirrors should be lower to the sink/backsplash if not the tilt type. Adequate lighting at the mirror reduces leaning in or to one side to gain a clearer view, providing better lighting at the face. The height of the sink should be no greater than 34”, and under the counter should include 27” of clearance to allow for knee space when operating a wheelchair. </p><p>9. ACCESSORIES. In real estate, it is all about location. That is true for the placement of accessories too. Medicine cabinets should be placed on the side wall and lower for better access. Outlets should be placed closer to the edge of the counter so that cords can hang instead of creating a hazard on the counter and closer to the water source. Towel and soap dispensers may differ depending on if they are used by staff or residents. Staff will use single-use paper towel dispensers, where residents may have their fabric hand towels hanging on the front edge of the sink for easy access. Toilet paper dispensers, soap shelves in the shower, and staff care accessories such as glove box holders, are all part of the overall layout. Maintaining the residential feel of the bathroom can be difficult, but it is possible to place these more institutional accessories in spaces not readily visible.</p><p>10. STORAGE. Be sure to provide adequate storage for both residents’ personal belongings and for staff. Staff often need to have access to such items as incontinence products and personal protective equipment). Also, consider the need for secure storage for such items as medicines or cleaning supplies. Proper storage reduces clutter, keeping the floor space clear for walkers, assistance, and more.</p><p><img src="/Articles/PublishingImages/2024/JulieHeiberger.jpg" alt="Julie Heiberger" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;125px;height&#58;154px;" />Be sure to create a senior-friendly design. As we all age, our vision, mobility, strength, range of motion, and cognitive abilities decline. Increasingly, we’re impacted by glare, less contrast, and eye disease. We have a greater need for assistive devices such as canes, walkers, wheelchairs, and grab bars. Our ability to reach heights or step over barriers changes. We might experience greater weakness on one side of our body. Cognitively, we may have greater confusion, forgetfulness, and less desire for social activities. Being mindful of these 10 elements will provide our residents with the ability to safely age in place, maintaining independence to do their daily tasks. <br><br><em>Julie Heiberger is a senior project architect and the Senior Living Market Leader for <a href="https&#58;//www.hoffman.net/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Hoffman Planning, Design &amp; Construction, Inc</a>. With more than 25 years of experience, she is a member of the American Institute of Architects and the National Council of Architectural Review Boards. She received her Master of Architecture from the University of Wisconsin–Milwaukee. Email Heiberger at <a href="mailto&#58;jheiberger@hoffman.net" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">jheiberger@hoffman.net</a>.</em><br><img src="/Articles/PublishingImages/2024/JonRynish.jpg" alt="Jon Rynish" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;125px;height&#58;154px;" /><br><em>Jon Rynish is a senior project architect with Hoffman and a Leadership in Energy and Environmental Design (LEED) accredited professional. A graduate of the University of Wisconsin-Milwaukee with a Bachelor of Science in Architectural Studies, he has more than 15 years of experience in the design profession. Email Rynish at <a href="mailto&#58;jrynish@hoffman.net" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">jrynish@hoffman.net</a>.</em><br></p>2024-03-19T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/bathroom.jpg" style="BORDER&#58;0px solid;" />Design;CaregivingJulie Heiberger and Jon RynishIn a senior living facility, the bathroom is arguably the most important space to providers and their residents. Studies show that most incidents and falls occur in the bathroom.
Designing Therapeutic Gardens for a Senior Population<p><img src="/Articles/PublishingImages/740%20x%20740/garden.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;250px;height&#58;250px;" />​Therapeutic landscape gardens (TLG) are often designed for elders in nursing homes and senior housing to provide a soothing experience for the resident that brings them outside, closer to nature, and closer to the beauty of a well-designed garden. This senior population may exhibit a series of invisible disabilities (IDs), such as dementia, autism, PTSD, ADHD, sensory processing disorder, blindness, and deafness. These IDs can be found in up to half or more of the typical population and at least 80-90 percent of the elder population.</p><p>There are many articles about the design of these TLGs, but not many deal with the two main challenges in designing these gardens&#58; a lack of instructions and reduced perception.</p><p>The first issue is the lack of an instruction set on how to design an elder therapeutic garden. Most books on TLG show all kinds of images of wonderful gardens, but none of them have an instruction set that will help a designer understand the steps that must be taken in order to design one correctly for elders. By 80, the typical elder has 20 percent of their visual performance range; by 90, it drops to 10 percent. Visual acuity is low, they cannot see clearly with sky brightness, colors are not easily distinguished, adjustment from dark to light takes 10-15 minutes. Vision can be very limited.</p><p>The second issue, which is even more important, relates to aging and sensory deprivation. Elders in nursing and dementia homes are generally coping with very limited ranges of sensory sensitivity. An older resident has perceptual sensitivity dramatically lower than when they were younger. By age 80-90, the sensory sensitivity of an elder is about 10-20 percent of what it was when they were young. Thus, their vision, hearing, tactile sense, thermal and olfactory sensitivity is very low. Their experience of the sensory garden can be limited compared to young designers who design these gardens, because that have a hard time seeing the garden, dealing with sky glare, recognizing color ranges, and smelling the flowers. Audible insensitivity can mean that they cannot hear the sounds of unsteady walking, low level talking of nurse aides, and other sounds over the environmental noise of the site.</p><p>To the elder resident, the gardens look less clear and more out of focus. They see groups of plantings, not individual plants. Colors blend together, as color vision is limited in range, resolution, and sensitivity. The design of the garden must take account of the fact that many elders have visual acuity in the 20&#58;100 or greater (they see at 20 feet what younger folks see at 100 feet).</p><p>If the site is noisy or busy, the sounds of traffic, idling car engines, and people are all of concern. And areas that are light versus dark can cause visual failure due to slow adaptation (visual adjustment from light to dark). These areas can also cause a cognitive load due to complexity that is too great for the elder to process, as too much information is presented in the perceptual and cognitive fields. The experience is often unnerving and overwhelming. Overstimulation of the senses affects our sense of vestibular equilibrium (balance) as well.&#160;</p><p>Well-designed environments can alleviate these problems, via the use of scientific sensory and cognitive design principles. Yet most design schools do not teach about human perception or the science of human-centered building design.</p><p>Design schools believe, as the American Institute of Architects suggests, that expert intuition comes from a design education, and that this alone is adequate training to solve most architectural problems, which is far from correct. Intuition only works when designing for people who are like the designer, and those with disabilities are not often like the designer.</p><h3>Reducing Sensory Noise </h3><p>The experience of disorientation and discomfort are important to avoid when designing for people with invisible disabilities. Unlike physical disabilities, over 70 percent of disabilities cannot be seen or inferred by observers. Cognitive and emotional sensitivities often negatively impact the experience of the garden by masking the experience by causing complexity to take focus away from what we’re looking at.</p><p>Overstimulation in any of the primary senses (hearing, sight, thermal comfort, touch, taste, and smell) creates mental and emotional “noise.” Less sensory stimulation means more clarity in surroundings. Designs should be simpler and more obviously what elders would expect. It is the first priority to understand their sensory and cognitive perceptions.</p><p>Therapeutic gardens should be designed to produce calm, clarity, and the feeling of beauty. The places in the garden must be symbolic and familiar. The framework of a garden needs to be clear, predictable, intuitive, safe, and secure with a perceived sense of balance of freedom and enclosure.</p><p>A quiet perceptual sensory environment is needed for people to experience the environment with less anxiety and more clarity. And the garden must be a stronger and simpler stimulus than would be designed for younger visitors.</p><h3>Integrating Research into Designs</h3><p>Designers who incorporate scientific design information in ways that are perceptually and cognitively much clearer are more successful. Research-based design (RBD) is about applying research methods to determine the definition of what the design should accomplish and to measure and confirm that the final project actually achieves that goal.</p><p>The first step in RBD is to identify the problem and to develop a hypothesis for solving it through the limits of the person with dementia or other disability. People with dementia must be asked to rate their perception based on comfort and pleasure. Landscapes focused on the elderly must take into consideration perceptual performance. Design research has produced lots of data on sensory and cognitive perception of elders.</p><p><img src="/Articles/PublishingImages/2023/SteveOrfield.jpg" alt="Steve Orfield" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;167px;height&#58;189px;" />Consider the model of a monastery garden, as it evokes calm and peaceful emotions. A cloister garden is surrounded by walls that create an enclosure separated from outside distractions and uncomfortable sounds. The layout is simple and allows for walking around the edges of the garden space. Typically, central landmarks and clarified entrances can help with finding the way back to the entry. Visually it can be a simple structure with vegetation and greenery. Areas must be set aside for gardening and harvesting of flowers, herbs, and vegetables.&#160;</p><p>To achieve acoustic comfort, designers may create sound barriers, soft music, white noise, or birdsong. Olfactory comfort may be pleasant fragrances of the plantings, clean air, and limits on odors. Thermal comfort may include places that are sunny in cold weather and shady in hot weather, protected from wind but open to breezes. Visual comfort may be creating large plantings of color, familiar furnishings and plants, clear surroundings, and pathways, with control of bright light.</p><p><img src="/Articles/PublishingImages/2023/MarthaTyson.jpg" alt="Martha Tyson" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;167px;height&#58;190px;" />The end result of this therapeutic garden design process is a very simple, very clear garden that is uncomplicated, has little perceptual noise, and whose simplicity allows the elders to relax and clearly experience this simpler form of garden.</p><p><em>Steven J. Orfield is the founder of Orfield Laboratories, a multi-sensory design research lab in architecture and product development.</em></p><p><em>Martha M. Tyson is the author of the book The Healing Landscape&#58; Therapeutic Outdoor Environments and numerous articles about garden design for seniors and people with compromised cognitive functioning. She is a landscape architect with over 30 years of experience in site design and campus planning.</em><br></p>2023-10-03T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/garden.jpg" style="BORDER&#58;0px solid;" />DesignSteven Orfield and Martha TysonTherapeutic landscape gardens are often designed for elders in nursing homes and senior housing to provide a soothing experience for the resident that brings them outside, closer to nature, and closer to the beauty of a well-designed garden.
Innovation in Senior Living Facilities Design<p>The pandemic shone a light on senior living infrastructure that has leaders and staff of assisted living and skilled nursing facilities looking for progressive and innovative design concepts. As such, senior housing providers from around the world are looking to learn from the successes and challenges that various models faced at the height of the pandemic. </p><h3>Early Adopters of the Green House Model in Rochester, NY</h3><p>Founded in Rochester in 1997 by a group of forward thinkers, the Pioneer Network has since evolved through a partnership with The Green House Project (GHP) into the Center for Innovation. The new alliance focuses on supporting eldercare reform initiatives and educating and advising eldercare organizations that seek to initiate changes to the cultural, organizational, and physical structures of the traditional nursing home. </p><p>Upstate New York is home to early adopters of the Green House model, giving the region two decades of experience with a model that others are now beginning to recognize, due to exceptional outcomes during the pandemic. <br></p><h3>Design Tenets of the Green House Model</h3><p><span><img src="/Articles/PublishingImages/740%20x%20740/innovation.jpg" class="ms-rtePosition-1" alt="RPH Creekstone Memory Care Small Homes in Perinton, New York" style="margin&#58;5px;width&#58;200px;height&#58;200px;" /></span>The primary objective of the Green House model is to provide a culture and environment where seniors can continue to grow and thrive in a period when they may be experiencing physical or cognitive decline. The model strives to create meaningful life and purpose for both residents and staff, leading to enhanced quality of living and improved clinical outcomes for residents, higher levels of satisfaction among residents and their family members<sup>1</sup>, and greater workplace satisfaction and lower levels of stress for frontline caregivers.<sup><a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">2</a></sup> <br></p><p>There are multiple design elements that contribute to these results, including a small-scale environment, private bedrooms with private bathrooms, living rooms and other open public spaces, communal dining areas, access to outdoor spaces, and consistent staffing.</p><h3>Green House Model Benefits</h3><p>The pandemic in particular brought more attention to the benefits of the small-house/Green House model. According to a study published in the Journal of Post-Acute and Long-Term Care Medicine, the small-scale environments of Green House and other nontraditional nursing home models proved advantageous, experiencing significantly lower levels of infections and mortality when compared to traditional nursing homes with larger bed counts.<sup><a href="https&#58;//www.jamda.com/article/S1525-8610%2821%2900120-1/fulltext" target="_blank">3</a><br></sup></p><p>In addition to better clinical outcomes for residents, the Green House model offers many other benefits, including flexibility that allows for modification of occupancies as needs change (e.g., skilled nursing, memory care, rehabilitation, hospice), more private pay residents, daily costs that are lower than the traditional nursing home model<sup><a href="http&#58;//www.greenhouseproject.org/" target="_blank">4</a></sup>, and greater staff retention. Moreover, data collected by GHP reveals that even after the pandemic, Green House homes have reported significantly lower turnover rates for CNAs, LPNs, and RNs.<sup><a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">5</a></sup> This is particularly notable as staffing continues to be a critical concern and maintaining staff with a lower turnover rate may offer a competitive advantage.</p><p><img src="/Articles/PublishingImages/2023/RobertSimonetti.jpg" alt="Robert Simonetti" class="ms-rtePosition-2" style="margin&#58;5px;" />Green House living represents a set of design criteria that reconfigures the operations and environments of a traditional nursing facility into an “intentional community” that offers person-centered care focused on relationships and people. Data is mounting that suggests this design initiative also provides several benefits, including better quality of living for residents, lower levels of infections and mortality, lower staff turnover rates, and lower daily costs. New programs and funding opportunities may encourage, require, and facilitate these innovative models further. </p><p><em>Rob Simonetti is senior living leader at LaBella Associates. He has focused the last 15 years of his career on small house models of care for skilled nursing occupancies. </em><br><br><span class="ms-rteStyle-Normal">References</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">1.&#160;&#160;&#160; &quot;Effects of Green House Nursing Homes on Residents’ Families&quot; by Terry Y. Lum, M.S.W., Ph.D., Rosalie A. Kane, M.S.W., Ph.D., Lois J. Cutler, Ph.D., and Tzy-Chyi Yu, M.H.A., Ph.D.</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">2.&#160;&#160;&#160; &quot;The Green House Difference&#58; By The Numbers,&quot; <a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf </a></span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">3.&#160;&#160; &#160;&quot;Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths,&quot; Journal of Post-Acute and Long-Term Care Medicine, <a href="https&#58;//www.jamda.com/article/S1525-8610%2821%2900120-1/fulltext" target="_blank">https&#58;//www.jamda.com/article/S1525-8610(21)00120-1/fulltext</a></span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">4.&#160;&#160; &#160;&quot;Pilot Study Finds Meaningful Savings in THE GREEN HOUSE<sup>®</sup> Model for Eldercare,&quot; <a href="https&#58;//www.greenhouseproject.org/" target="_blank">www.greenhouseproject.org</a> </span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">5.&#160;&#160; &#160;&quot;The Green House Difference&#58; By The Numbers,&quot; <a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf</a> </span><br><br></p>2023-05-16T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/innovation.jpg" style="BORDER&#58;0px solid;" />DesignRobert SimonettiThe pandemic shone a light on senior living infrastructure that has leaders and staff of assisted living and skilled nursing facilities looking for progressive and innovative design concepts.
Modern Factors in Senior Living Campus and Facility Planning<p>​Increasingly, senior living organizations are seeking to provide a combination of uses for a continuum of ages and care that is specific to each resident’s needs. While these aren’t new concepts, we’re seeing them rise higher on priority lists than ever before.<br></p><p>Modern care communities are being created to blend care efficiency with more nuanced treatment levels. While care options are becoming more specialized, we need to foster meaningful connections between those levels of community.​<br></p><h3>Mixed-Use, Multi-Generational Lifestyle Developments</h3><p>A prime example can be found with the Franciscan Sisters of Perpetual Adoration (FSPA) in La Crosse, Wisconsin. This continuing care retirement community includes 45 skilled/memory care units along with 35 assisted living, 11 independent living/guest spaces, and 32 guest rooms for retreat center participants.<br></p><p><img src="/Articles/PublishingImages/2023/FranciscanSistersPerpetualAdoration.jpg" alt="Franciscan Sisters of Perpetual Adoration" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;535px;height&#58;283px;" />The facility addresses the Franciscan Sisters’ vision of bringing sisters, spread across a wide continuum of care spectrum, together on one campus. Following a comprehensive planning effort, they decided to renovate St. Rose Motherhouse to accommodate all care levels and move those living off-site into the Motherhouse. The existing configuration was not readily suited to incorporate each of the needed levels of care, which presented a great renovation challenge and required a strong commitment from the sisters to bring their vision to life.&#160;<br></p><p>Reflecting on why this renovation project was so important to FSPA, one of the sisters in leadership shared that it was part of how they enacted their assembly mandate to right-size their facilities, and it is vital to their future planning. She explained that they looked at their trends data knowing that they had two large buildings that were less than half full.&#160;<br></p><p>“We knew that as we moved forward, we would have fewer members and would not need both spaces,” she explained. “We realized it was not the best use of the assets we are stewarding to not use the buildings to their capacity. We discerned, as a congregation, that we wanted all of our senior members going forward—as space would permit—to be at our Motherhouse. That is where our adoration chapel is located, which is key to our charism of perpetual adoration.”​<br></p><h3>Res​ponding to Changes in Health Care and Life Safety</h3><p>In recent years, there has been a paradigm shift in care models, including a significant move to assisted living communities. Considering this swing, the solutions are not the same as they have historically been. Innovative design solutions are necessary to best meet the various care community being served. At times, regulations have not kept up with those needs, nor the research, best practices, new products, and special exceptions that will best serve the community.&#160;<br></p><p>Architectural and construction consultants must explore new ways to meet the intent of the code, even when those solutions are not explicitly permitted in the code. Existing codes can sometimes be years behind the continuum of care needs and solutions, so a Petition for Variance is requested in those situations.<br></p><p><img src="/Articles/PublishingImages/2023/177Hoff17.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;365px;height&#58;251px;" />An example is the grab bar variance. Experience and research data is showing that swing-down grab bars can be more effective for residents and staff in assisted care environments. Unlike current code standards, swing-down grab bars are non-handed (correct for left or right-handed people), provide flexibility for residents with unbalanced upper body strength due to injuries or stroke, and permit additional flexibility for assistance.&#160;</p><p>Petitions are sometimes the best way to provide effective design solutions, especially when repurposing existing buildings. Although a useful tool, petitions should not be taken lightly and always pursued in collaboration with all involved parties (owner, operator, care staff, plan reviewers, inspectors, state officials, etc.) to ensure the intended outcome is achieved.&#160;​<br></p><h3>Elevating the Staff Experience&#160;</h3><p>Staff efficiency is at the top of the priority list for our senior living clients. Considering the staffing challenges that most organizations are facing, helping staff be more productive is a critical desired outcome.&#160;<br></p><p>Survey findings demonstrate that staff are one of the most important factors in environmental and care quality. Getting the most out of your staff is accomplished by improving their experience and creating a facility that allows them to work like they want to—smoother and easier.<br></p><p>This is accomplished by involving care givers, culinary staff, and other key stakeholders in early discussions to uncover the intricate details that will ultimately lead them to be fully successful in supporting patient care and independence.​<br></p><h3>We​llness Models for Active Older Adults</h3><p>Never has wellness been as critical in senior living as it is today. Wellness encompasses many themes from physical fitness to social engagement. As providers navigate the wellness landscape in 2023, they are well served to take note of several trends and consider them as they are planning and making improvements to current wellness programs and paradigms.&#160;<br></p><p>We recommend the expansion of wellness programs to create deeper connections, higher levels of engagement, and more fulfilling experiences for residents and associates alike.&#160;<br></p><p>We have found that the expansion of wellness programs across the industry has enabled operators to offer more program customization without overwhelming their operations. One strategy for accomplishing this is to frontload the resident onboarding process with thorough evaluations that focus on lifestyle, preference, and resident history. It empowers operators and associates to create a more personalized experience for each resident. It also drives whole-person wellness by helping residents maintain physical activity, sense of purpose, and a feeling of connection.&#160;<br></p><p>We believe that every operator’s goal should be to create a greater sense of community. True communities are integrated and alive, providing residents with a greater sense of purpose, connection, and togetherness, and built around social engagement models. When the sense of community is the result of empowering residents, they become free to choose how they want to participate and contribute, instead of assuming the associates will do everything for them.&#160;​<br></p><h3>Use of Technology to Maintain Independence and Support Care Operations</h3><p>We have had many conversations with clients about the increased and proper use of technology to make their work easier. You are likely very familiar with such applications as smart vital monitoring, fall detection, and social connectivity tools. These are still very proprietary, and interconnectivity with higher level systems like nurse call and security systems is sometimes limited.<br></p><p>The next shift and latest technology are happening more on the vendor level, versus the industry or system level. With that in mind, operators and administrators wishing to be on the forefront of technology advancement should engage with vendors that are on the cutting edge of specific systems. Then, they should seek to participate in beta tests to be a part of creating the end solutions that will serve residents and staff most effectively.<br></p><p>A crucial decision that we strongly encourage every client to make in a building project is to create a robust wired and wireless infrastructure. This will allow easier “plug and play” for the latest technological advancements, for emerging technologies, and most importantly, for future technologies yet to be developed.&#160;​<br></p><h3>Now and Then</h3><p>Making decisions that allow for flexibility of care, staff efficiency, and wise use of technology will set you up for success. Your staff and residents will be the benefactors and the efficiency and productivity of your facilities will greatly benefit as well.&#160;<br></p><img src="/Articles/PublishingImages/2023/JulieHeiberger.jpg" alt="Julie Heiberger" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;115px;height&#58;145px;" /><p><em>Julie Heiberger is a senior project architect and the Senior Living Market Leader for Hoffman Planning, Design &amp; Construction, Inc. A member of the American Institute of Architects and the National Council of Architectural Review Boards, she received her Master of Architecture from the University of Wisconsin–Milwaukee.&#160;​</em></p><p><em><img src="/Articles/PublishingImages/2023/RandyBremhorst.jpg" alt="Randy Bremhorst" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;115px;height&#58;144px;" />Randy Bremhorst is Vice President of Design at Hoffman Planning, Design &amp; Construction, Inc. A graduate of the University of Notre Dame’s School of Architecture, he has more than 30 years of experience in the design and construction profession.&#160;</em></p>2023-02-14T05:00:00Z<img alt="" src="/Articles/PublishingImages/2023/design.jpg" style="BORDER&#58;0px solid;" />DesignJulie Heiberger and Randy BremhorstModern care communities are being created to blend care efficiency with more nuanced treatment levels.