Healthcare facilities face a profound demographic shift as the baby boomer generation, born between 1946 and 19 64, ages at unprecedented rates. By 2030, the youngest boomers will turn 65 as the oldest will be in their early 80s—accounting for one in every five Americans.
This surge brings staggering implications for acute care facilities. Older adults already make up a disproportionate share of healthcare utilization, with hospitalization rates three times higher than younger patients, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. As people live longer despite multiple chronic conditions, aging patients will require extended hospital stays and more complex recoveries at overwhelming volumes. “These boomers are going to need more acute care than senior living will be able to provide, so healthcare facilities are going to be inundated with older adults,” says Grant Warner, senior living practice leader and associate partner at BKV Group (Dallas). “Start preparing for this flood of baby boomers now.”
As healthcare organizations and design teams proactively prepare to meet the evolving needs of aging patients, the senior living design sector can be a source of inspiration—offering valuable design lessons for acute care settings to create spaces that serve aging patients more effectively. To stay ahead of this surge, Healthcare Design spoke with senior living design experts to gather some best practices to help project teams address these changing demographics.
Accessibility beyond codes
Healthcare designers can take a cue from senior living by recognizing that strict adherence to the Americans with Disabilities Act (ADA) guidelines often falls short for aging patients dealing with vision loss, mobility challenges, and other disabilities. “While the ADA guidelines are important, they don’t always apply to older adults because the ADA code was essentially developed for soldiers coming back from war, who were mentally and physically strong,” explains Steve Leone, principal at Spiezle Architectural Group, Inc. (Hamilton, N.J.), who oversees the firm’s healthcare and senior living practices.
For example, he says even the smallest threshold allowed by ADA guidelines can be difficult for a senior with limited upper body strength to cross in a wheelchair, so zero-transition flooring materials are a key consideration. To avoid tripping hazards and mobility obstacles like thresholds, Tiana Lemons, partner and interior design studio leader at Grace Design Studios (Nashville, Tenn.), recommends floating floors where possible, which involves leveling the surface to create smooth transitions by gradually adjusting the grade of the floor to seamlessly meet another material. Morgen Woodford, a designer in the senior living studio at Grace Design (Phoenix), also suggests avoiding terrazzo flooring or bold patterns that might look like holes or items scattered on the ground to aging patients with vision challenges.
Designers at Grace and BKV utilize glasses that simulate visual impairments to understand how aging patients might perceive their environment. “It’s an eye-opening way to provide empathy by seeing what some of these conditions are like,” Warner says.
When wearing these simulators, for example, he found himself looking at the floor as he walked around, rather than looking straight ahead. For that reason, he realized, “It’s really important to have a contrast between the floor and the wall, like a darker-colored base trim, so patients can see that edge and not run into it.” Likewise, he says, “contrasting the seat and arms of chairs with a different color and pattern from the floor helped me see the chair as I was trying to sit down, because sometimes you lose depth perception, and simply sitting can be terrifying if you can’t see the chair against the floor.”
Lighting is another important consideration for an aging population, design leaders say. “The glare from harsh light can have a severe impact on people with certain vision conditions,” Warner says. To address the issue, Warner suggests indirect lighting fixtures like coves that shine upward to reflect off the ceiling, as well as choosing semimatte or matte finishes on walls and floors instead of high-gloss treatments. Additionally, Woodford recommends consistent lighting color temperature throughout a building to avoid “visual disruptions where some lighting might be warmer, and then some of it is glaring blue,” she says.
Designing for flexibility
While many healthcare facilities already embrace adaptable design strategies that allow rooms to flex up or down to accommodate different acuities of care, senior living designers advise additional steps to ensure spaces can evolve to meet seniors’ changing needs.
For example, practical precautions such as installing ceiling lift tracks between beds and bathrooms can make rooms adaptable for patients with mobility challenges. “We may not put a lift in every room, but at least we’ll put in the tracks so you can hook them up when you need them,” Lemons says.
Similarly, Warner recommends fold-down grab bars to create ambulatory accessible toilet stalls, offering additional support if needed.
He also champions the concept of “flexible small households,” a senior living model that houses 10-20 residents per unit with shared common areas. These neighborhoods can be stacked into a high-rise, as demonstrated by The Vista at CC Young, a senior living community in Dallas designed to the highest licensing standards—including 8-foot corridors, instead of 6-foot—so it can easily convert from assisted living to skilled nursing care as residents’ needs shift.
These neighborhood-inspired floor plans divide large wings into smaller units based on staffing ratios, which can be more efficient for acute care staff as patient volumes increase in hospitals. For example, “Instead of long corridors with dead ends, we are moving toward looped arrangements,” Warner says. “And instead of having one huge clean linen room, we distribute supplies into smaller closets on each side of the loop,” which supports staff efficiencies by bringing supplies closer to caregivers, reducing steps so they can spend more time with patients.
Within these household models, Warner says design strategies aim to disguise nurses’ stations. “When you see a nurse station with all the phones ringing, bells and alarms blaring, and lighting at full intensity, it reeks of institutional care, so in senior living we hide them in residential-style kitchens,” he says. In acute care settings, Warner says this concept could feature staff areas designed with cozy cabinetry to hide the call systems, fire alarm pulls, and other emergency services “to make the setting more residential so residents feel more at home.”
Supporting longer patient stays
As healthcare designers seek to design a more comfortable experience for patients who require extended care, they can learn from the residential approach of senior living interiors, designers say. “Senior living reminds us that these environments can be clinically robust while still feeling personal and patient-centered,” says Damian Huneycutt, associate principal at Spiezle Architectural Group, Inc. (Charlotte, N.C.) who specializes in acute care design. Still, designers recognize that “acute care environments have much more stringent requirements,” which can present challenges when trying to deliver care spaces that “feel warmer, more familiar, and more accommodating,” Leone says.
For example, natural daylight is essential to making settings more comfortable. “In your home, every room has windows,” Leone says, “but in large institutional buildings, you have to work a little harder to incorporate daylighting.” If expansive windows aren’t possible in every room, Huneycutt suggests using warm, yellow lighting versus bright white lighting, and bringing in biophilic elements, like nature-inspired artwork and natural materials.
“Metal products can look cold and sterile,” Leone says, but “wood in almost any form feels warmer and more tactile.” Today, many finishes made of metal, ceramic tile, or vinyl are increasingly made to mimic woodgrain patterns and textures. Plus, Lemons adds, the durability and cleanability of these materials are critical for healthcare settings.
Pulling inspiration directly from the landscapes surrounding a facility is key, too, because “familiar things provide comfort,” Lemons says. When designing the West Tennessee State Veterans Home in Arlington, Va., Lemons looked to local lakes to create a blue color palette for the interior, which features pictures of nearby scenery. For another senior living project in Kentucky, she named each neighborhood with themes based on the surrounding community, such as “Whiskey Trail” and “Derby Lane,” a strategy that hospitals could incorporate into their wayfinding programs, she adds.
Breaking down silos
As the population continues to advance in age, it’s more important than ever for healthcare designers to collaborate with senior living peers. “Whether you’re designing for acute care or senior living, we’re increasingly serving the same aging population,” Huneycutt notes. “They’re just in different points of their healthcare journey, so sharing ideas helps deliver a continuity of experience.”
Leone agrees. “Working in silos offers the greatest degree for a miss,” he says. In some firms, such as Spiezle, healthcare designers work on various project types, from acute care to senior living, to cross-pollinate the design thought process from different environments. Even if some senior living design concepts can’t be fully incorporated into acute care settings because of codes or operational issues, Leone says, “exploring new ideas to make patients feel more at home can lead to innovation, making the environment more healing.”
Brooke Bilyj is a freelance writer and owner of Bantamedia (Cleveland) and can be reached at [email protected].
