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According to the US Census Bureau, the number of Americans over the age of 65 has reached 33 million, a figure that will more than double within 50 years. Of this group — the nation's fastest-growing population segment — 87 percent are choosing to remain in their own homes for as long as possible. As a result, today's retirees are entering the senior housing market at a later age. And when they do, they are much more likely to require care. by: Renee Young

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Two types of senior housing designed to provide autonomy for active retirees are losing ground in the current senior climate: independent living apartments dedicated to senior couples and congregate housing facilities with shared dining and community spaces for singles. Assisted-living facilities that provide more comprehensive services are taking their place. In fact, more than two-thirds of all new senior housing construction last year included an assisted-living component.

Serving seniors 70 years of age or older, assisted-living facilities typically consist of single-occupancy resident rooms that are grouped into units according to the level of assistance needed. Depending on individual states' licensing regulations, these facilities can provide a wide range of care, from assistance with daily grooming to rehabilitation treatments administered by a medical nurse. In addition, an increasing number of facilities are incorporating units dedicated to memory disorders.

According to David Schless, executive director of the American Seniors Housing Association in Washington, D.C., the move into such a facility is usually precipitated by a change in life situation, such as the death of a spouse or a physical condition that limits a person's ability to live alone. While the latter may make the person dependent on others for some daily life activities, it may not necessitate medical care. "Oftentimes these seniors simply need help getting dressed in the morning, not extensive medical attention," said Schless.

Recognizing the increased demand for assisted living, 55 percent of all congregate facilities under construction last year include an assisted-living component. And picking up on the trend, existing senior housing developments across the nation are adding assisted-living facilities to their retirement campuses.

Just as seniors have created an assisted-living boom with their lifestyle choices, so too have they influenced the design of senior facilities from institutional to residential. Recently, three existing retirement communities in Pasadena, Calif., Chenoa, Ill., and Tucson, Ariz., expanded to reflect the current trends in senior housing. With distinctly residential designs that challenge the traditional institutional concept and new amenities to attract occupants, these facilities are setting a new standard for senior housing.

Urban approach
"Assisted living has become a consumer-driven phenomenon. Seniors are looking for non-institutional facilities that provide both assistance and independence," said Armando Gonzolez, founder and principal with Pasadena-based CHCG Architects. Project architect for the new, five-story, $14 million wing of Villa Gardens retirement complex in Pasadena, CHCG was faced with the challenge of creating the feel of a campus environment on a tight urban site.


Previously, Villa Gardens included only independent-living and medical facilities. The 67,000-sq.-ft., L-shaped wing expands its range of care with 40 assisted-living units, half of which are dedicated to dementia care. In addition, the wing includes 22 independent-living apartments, a fitness center, dining room, and education center.

While some communities keep diverse populations separated, at Villa Gardens interaction is encouraged. Even though floors are assigned a specific level of care, common areas such as patios, a bird aviary, and a potting garden are located at the ends of each floor for use by all residents. "These rooms function as magnets, with seniors from all levels using the common spaces as destinations for their daily walks," said Laura Serdar, project architect with CHCG.

To create a sense of openness, a central courtyard provides outside recreational space, and patios and activity rooms at the ends of the hallways bring daylight into the building. The independent-living units, located on the top floors, range from 700 square feet to 2000 square feet, and feature walkout balconies. All rooms on the assisted-living floors are equipped with sliding glass doors and false balconies, with glass safety panels, that overlook either the front gardens or the courtyard.

The single-occupancy, general assistance studios are clustered on two floors and feature recessed entries. "Although the rooms line each side of the corridor, we pushed back the entries to create a neighborhood feel," said Serdar. "That way, when you look down the corridor you don't see an institutional lineup of doors." Because the populations intermingle, a nurses' station is located at the intersection of the corridors, providing clear views of the floor.

Even though the facility promotes socializing, residents of the dementia unit are more restricted. "Usually for dementia patients, you want to incorporate loops into the floor plan so they can walk without getting lost, but here we were faced with an L-shaped design and double-loaded corridors," said Serdar. As a result, a "barbell" concept was used in which activity rooms are located at each end of a hallway instead of an exit door or window. "Often dementia patients will become confused or agitated when they hit a dead end, so here they are welcomed into an active space," she said. To further protect residents from wandering, a sensor system is installed at all exit and elevator doors that sets off an alarm when those residents, who are equipped with a sensor bracelet or anklet, pass through.

Specialized assistance
As retirement communities look to expand their services, assisted living dedicated to Alzheimer and dementia care is becoming an increasingly popular component. While operating license requirements vary by state depending on the level of assisted care and the distribution of medications, there are emerging characteristics common to this type of facility.

Located in Chenoa, Ill., the Meadows Mennonite Retirement Community recently built a 22-bed Alzheimer's wing to complement its independent living unit. "There is an increasing demand for dedicated Alzheimer facilities that incorporate a residential feel," said Dan Cinelli, director of life care marketing with the project architect, Chicago-based O'Donnell Wicklund Pigozzi and Peterson (OWP&P). The new Alzheimer's wing includes amenities such as a spa room and a beauty/barber shop.

The facility is organized around a looped corridor with eight double-occupancy and six single-occupancy bed units situated along perimeter walls with nursing services, kitchen, and dining area in the center. According to Cinelli, the loop configuration keeps walking distances to a minimum and allows residents to more easily find their way. And by placing the nurses' station at the center, they are provided clear sightlines to the entire facility. In addition, limiting the number of beds helps keep residents calm, as many become disoriented in large groups.

While the facility does include a terrace and an enclosed garden located off the common living room, residents' interaction with the outside is limited. Therefore, the looped corridor is designed to create a streetscape effect, with a suspended wood ceiling that mimics a trellis and a carpet that features a paved pattern. In addition, the kitchen is designed to resemble a house, with paneled wood siding. And to remind residents of the time of day, clerestory windows located at the center of the structure above the dining area bring natural light into the facility.

To help residents identify their rooms, "memory" cabinets, which resemble windows and contain photos and other memorabilia, are located at the room entrances. In shared rooms, each wall is painted a different color to help residents recognize their space.

In the near future, Meadows Mennonite will add assisted-living apartments with varying levels of care and renovate its existing buildings to accommodate the ever-changing demands and the increasing number of seniors. "The first of America's 75 million baby boomers will begin to turn 60 by the end of 2005," said Cinelli. "We want to be ready for them."

Combined care
Located below the foothills of the Santa Catalina Mountains in Tuscon, the new 98,000-sq.-ft. Santa Catalina Assisted Living Health Care Center provides a much-needed alternative for seniors who are no longer able to live in an adjacent independent-living facility. "The center was added to the independent-living campus to give residents a place to move on site, where they can receive the necessary assistance while remaining close to friends," said Sam Burnette, senior designer with project architect Earl Swensson Associates Inc. (ESA), Nashville, Tenn.

The three-story facility includes 127 resident rooms broken into three units serving three distinct populations ? 15 memory-impaired suites, 42 skilled-nursing rooms, and 70 apartments dedicated to residents requiring assistance with general activities of daily life.

The site's extreme 35-ft. slope provided ESA the opportunity to fit the grade level of the building into the hill, thus keeping with the owner's desire for a low-profile, residential facility. Further, the design enabled ESA to incorporate separate entrances for the nursing unit and general-assistance apartments at two levels at opposite ends of the structure.

The skilled-nursing unit located at grade level has its own entrance. At the opposite side of the structure (at the top of the slope) is the entrance to the general living unit, which is located on the first and second levels. The memory-impaired unit is also located on the second floor, separate from the general living unit. "Sometimes mixing communities in facilities that have either a memory-impaired or a skilled-nursing component can be a problem, because residents with daily living needs are often disturbed by severe medical and physical conditions. It reminds them of the possible next step," said David Minnigan, ESA senior design architect. According to Minnigan, the three populations have limited contact except for general service areas.

The general living unit features a common area that includes a sun room, arts and crafts room, dining area, and beauty/barber shop. Residents' rooms are located off the common area in five U-shaped pods, or neighborhoods, that each contain 6 to 12 apartments. To create a residential feel, the pods have a central foyer and each apartment has a recessed entrance. Grouping rooms in pods reduces overall corridor length, thereby shortening walking distances. To help with wayfinding, each pod is uniquely colored and common areas are no more than two turns from any resident's room.

According to Burnette, to enhance the residential feel of the living areas, the staff rooms are integrated, and not located at the intersections of the corridors as they are in the memory-impaired or nursing units. "Direct sightlines are not needed in this environment; therefore we were able to keep the staff out of view," he said. With an eye toward the future, each resident room is designed to accommodate residents who may become disabled, and can be retrofitted with grab bars and other accessibility features.

From Building Design and Construction Magazine, 1999