Over 40 percent of American deaths attributed to COVID-19 have been nursing home residents. Outdated nursing home designs contributed to the scale of this tragedy in Connecticut. Many design changes that could have prevented the spread of COVID-19 were already needed to improve the well-being of nursing home residents. The pandemic has made these issues impossible to ignore. A generation of seniors will now benefit from resident-centric changes in design thinking that would have been much slower coming without the devastation of COVID-19.
Sunlight and nature – must-haves
Evidence of the clinical benefits of natural light and access to nature for seniors is mounting, and designers and developers have increasingly included these features in recent years. However, they are often viewed as a “nice-to-have.” With residents of senior living communities confined to their buildings, their floor or often their room, COVID-19 showed why this approach was inadequate.
During the height of quarantine last year, I kept thinking about two recently completed senior living renovations my team and I designed in Connecticut. At one memory care community in Bloomfield, a magnificent tree had been visible from the windows of only a few coveted rooms. We changed both sides of the building to provide every resident a view of the tree.
At a senior living community in Southington for residents with varying stages of dementia, we transformed a stark second-floor courtyard into a green, shaded space for wheelchair-accessible gardening. For months, this was the only access to the outdoors for residents of this floor. I felt immensely fortunate that construction was completed just weeks before the first wave of the pandemic hit.
Senior living communities were already in need of becoming more technologically advanced, and the pandemic has catapulted them ahead. Thin profit margins, combined with a resident base that wasn’t exactly clamoring for new tech, meant the transition had been occurring gradually. COVID-19 changed the equation.
With a shortage of personal protective equipment and an overwhelmed staff, one of our senior living clients rushed to deploy a “robot doctor” for telehealth — essentially an iPad on wheels controlled by a provider that can take vitals and talk to residents. Other senior living communities have implemented sensors that track vitals of residents remotely and detect irregular movements to cut down on in-person check-ins from staff and identify issues quicker. These technologies have been in existence for years, but for many senior living communities, the pandemic was the catalyst for taking the leap.
A room of one’s own
While telehealth advances are flashy, simpler technologies like touchless controls for interior doors, lighting and faucets also improve quality of life and infection control. One of the greatest benefits of implementing automatic interior doors is that it saves a great deal of space. An automatic swinging door with a hygienic hand-wave sensor can save roughly 10 square feet of space that a person in a wheelchair no longer needs for maneuvering. This is one way nursing homes are making the switch from traditional double-occupancy rooms to singles.
Residents overwhelmingly prefer single-occupancy rooms, though the greater affordability of double-occupancy rooms made this model more viable before the pandemic. It also made COVID-19 harder to contain and, for many, the restrictions much more unbearable. Smaller, tech-enabled, individual resident rooms are becoming the norm much sooner than they would have otherwise.
Social interaction among residents has tremendous health benefits and has long been a focus of designers. Having one main common area used to be considered sufficient, but living in the COVID-19 era has exposed the need for a wider range of common spaces that accommodate diverse resident needs and experiences. Are there spaces for small gatherings as well as large? Does each floor or wing have a natural space for social contact? Is there an outdoor space where residents can congregate? Does the space help facilitate communal activities — both planned and spontaneous — for residents in wheelchairs?
These are some of the questions designers are increasingly asking. As the hardship of COVID-19 lifts, residents of senior living communities are finding a richer, more nuanced social life available to them. Most nursing home residents have now been vaccinated. Vaccinations for their loved ones can’t come soon enough.
Funding any of these upgrades or the construction of new nursing homes will not be easy. At least the need to do so is no longer in question.
Myles R. Brown is a principal at Amenta Emma Architects in Hartford.