As architects specializing in senior living, we increasingly hear from eldercare housing providers that are looking to convert units in existing facilities into spaces that provide specialized support and care. Most common is the desire to transform independent or assisted living apartments into ones that offer memory support or dementia care. Occasionally, the goal is to turn previously underutilized areas within a senior housing community to areas that offer more specialized care.
A GROWING TREND
Several factors drive the conversion trend. One is the increasing need for dementia care and memory support services. According to the Alzheimer’s Association, the number of Americans suffering from Alzheimer’s—a disease with no cure or form of prevention—is expected to quadruple to 13.5 million by 2050.
At the same time, the declining real estate market has made it tougher for older adults to finalize the home sales necessary to fund a move to a senior living community.
Turning some units into higher acuity care makes senior living communities more attractive to residents who want to remain in the same place—where they know the facility and the staff—as they require higher levels of care. This is especially important to couples who want to remain together, since they likely will require different levels of care at different times.
Indeed, many communities that have converted selected units to more specialized care have reported higher occupancy rates and revenues. And, reusing or remodeling an existing facility may cost less and is more sustainable than demolishing and building a new facility, or even an addition.
Depending on a building’s age and configuration, converting existing senior living real estate involves certain design considerations. Here are a few issues we frequently encounter.
Challenge # 1: Creating public spaces in the right configuration. In particular, memory support and dementia care requires common spaces or “neighborhoods” that will entice individuals to leave their individual apartments and socialize with other residents and staff. These common spaces often include group activity, living, dining and therapy areas. Access to an outside garden or terrace also is desirable and therapeutic for the residents. To develop these, we typically must creatively deal with factors such as the building’s footprint, circulation, space adjacencies, natural light, views and outside access, as well as infrastructure obstacles such as vertical plumbing/mechanical risers and the building’s structure itself.
Challenge #2: Maximizing space. Many older buildings have inefficient interior floor space with long corridors and groups of apartments on either side. We frequently find opportunities for usable space in the building’s corners or intersections that can be adapted to meet the needs of the resident and the level of care to be provided. For example, a typical one-bedroom independent or assisted living apartment contains a lot of wasted space for a resident with dementia, including a kitchen that would actually make the unit unsafe for them to occupy.
Challenge #3: Overcoming a long, double-loaded corridor. Redesigning dead-end corridors with circulation loops and destination points (seating alcoves, reading/desk areas) breaks up the long visual length of the corridor, and enlivens the neighborhood environment. The new design also encourages residents to explore the area and interact with others, bringing many therapeutic benefits.
Challenge #4: Creating a functional, safe and secure progression of space. Depending on the level of care, a neighborhood concept requires a secure progression of space (from public to private) from the entry to the common neighborhood areas and eventually to the private resident apartment. Entry should be to a secure supervised area—not into an apartment corridor. Room relationships and service areas are important. For example, we try to create transitions from a secured entry to a supervised dining, living and activity space.
We overcame many design challenges during a recent conversion of a 16,000-square-foot assisted living facility wing into a memory support “neighborhood.”
Isolated within the facility’s third floor, the wing had no public space whatsoever. We created such a space by converting two adjacent one-bedroom apartments, located on an inside corner in an L configuration, into a large activity area for residents. Because there were no structural bearing walls or mechanical shafts to deal with, eliminating the apartments created a clear, unobstructed common area large enough for the neighborhood population. By connecting the apartments’ balconies, we also created a generous outdoor space for residents’ use.
Next, we opened up the building’s corridor so that it flowed into the newly created activity space. This not only helped visually to break up the long corridor, but it brought more natural light to the building’s interior and encouraged residents to move about. Now, residents enjoy the new built-in seating and reading alcoves along the corridor where they can read, use the computers, or just relax.
We designed a new secure elevator entrance lobby that opens directly into the activity space, providing security and the desired sequence of space.
Finally, our plan called for removing kitchens and bedrooms from the wing’s 21 one-bedroom apartments so that they could easily be converted into 36 studio apartments and associated common/support space.