Gary Prager, AIA, NCARB, LEED AP, CDT
Principal, Hord Coplan Macht, Denver
How can we better understand the needs of those living and working in senior living communities to improve their overall experience?
That was the challenge I undertook recently in a career-changing mission. It began with a unique opportunity to transition into a different individual, with a new identity, to see the world through a unique lens.
For 24 hours, I became a wheelchair-bound individual with the following health conditions: mild dementia, chronic obstructive pulmonary disease and a fractured hip, and I was to become a resident at a local senior living facility – a project I had designed five years prior.
My undercover experience provided a glimpse into “a day in the life” as I was admitted as a resident into the skilled nursing community. I was able to witness firsthand if the community design was as functional in real life as it has been designed on paper and, more importantly, to experience how the design impacted the residents, staff and visitors on a daily basis.
The purpose for my investigation was four-fold:
1) To realize how the design of a community affects the emotional experience of residents and their ability to traverse the community.
2) To understand the difference in how building codes and accessibility requirements impact daily living for not only able-bodied residents but also those wheelchair bound.
3) To understand the engagement aspect for residents at the community for activities and spontaneous socialization.
4) To discover if the design fulfilled the specific needs of the medical and administrative staff. Did the community make their work easier or more difficult, and how?
A day in the life
During my drive from Denver to the community, my mind was filled with nervous anticipation, as I didn’t know what to expect for the next 24 hours. My mind also raced with emotion imagining how a genuine resident might feel in this moment about the enormous change at hand.
I arrived at the community with a co-worker who would document my experiences but from a different perspective – as an “able” participant. We were greeted by the director of nursing, who described my “symptoms” to me and ushered me into my wheelchair. Immediately, I became keenly aware of people and the building from a very different viewpoint – sitting in a wheelchair.
I was guided to my new home and given a walker to assist in standing for my initial weigh-in before having my vitals documented.
During my initial intake, I met with the lifestyle coordinator, who asked me a series of questions, including what I like to eat, hobbies and how I like to begin my day. This all began to stir my emotions, and I realized I could no longer do what I like to do on my own. I’m no longer in control of my own independence in a meaningful way, and they will do the best they can for me with the resources available to the community.
After getting settled, I was scheduled for “therapy” in the afternoon, but did not actually receive treatment as the staff was occupied with residents of the community. I had a significant amount of downtime throughout the afternoon to experience other areas of the building in my wheelchair. I realized that a resident of the skilled nursing wing is not able to access the exterior without an escort due to the terrain. I was able to get around the building, but I had dementia so it had to be with my escort. I found several barriers that were code compliant but a bit difficult to overcome for even an able-bodied person and wondered what a frail resident does in these circumstances.
About an hour prior to dinner, residents were gathered in the dining area waiting to eat. The dining room was originally designed for 60 percent of the residents but they were all there and left no room for me. Instead, I went to the independent living dining room and enjoyed a wonderful meal. There, I was able to speak with several independent living residents and learned quite a bit about the independent unit designs.
By 9 p.m., I was seated alone in the lounge trying to work the multiple remote controls for the TV. As I was unable to work any of the five remotes, I watched what was on aimlessly, and became increasingly lonely and reflective.
From the initial feeling of nervous anticipation and mixture of emotions to the constant learning moments throughout the day, my stay provided immeasurable opportunities for positive change in my work as an architect. The following are the key points of interest from my experience.
Top 10 takeaways
1) More natural light (skylights or solar tubes in central areas) and additional attention to artificial lighting.
2) Larger bathrooms in the units:
• Improved shower accessibility;
• Grab bar locations in shower/tub rooms;
• Showers in all resident rooms; and
• Deeper leg room under the vanities and move the lavatory closer to the edge.
3) More room to maneuver in the units and higher toe kick space at bathroom casework.
4) Storage, storage, storage – with deeper alcoves to store equipment in the corridors.
5) Improved access and access control between building areas for residents and staff.
6) Enhanced wayfinding throughout the community.
7) Increased and improved access to outdoors, including a secure courtyard.
8) Increased awareness of sharp corners at handrails.
9) Better quality transition strips and carpet selection.
10) Gathering spaces and engagement areas:
• Large, flexible, multipurpose community space(s) for residents to gather and interact;
• Staggered dining or two to three spaces that double as dining and gathering areas; and
• Space for staff to meet, especially during shift changes.
My “day in the life” experience was enlightening, eye-opening, emotional, humbling and gratifying. It showed me that an amazing staff of caregivers and an exceptional operator can make any building work for the residents’ well-being and comfort. At the same time, my experience emphasized the incredible importance of creating a setting that responds to the needs of staff and residents. My responsibility as an architect is to work with the developer and/or operator team to find design solutions that make the staff’s job easier and create an environment of comfort, access and engagement for all residents. The lessons learned and key takeaways undoubtedly will come in to play and help inform the design of future senior living projects.
The article is part of the Health Care Properties Quarterly “Question of the Quarter” feature.
Hayden Behnke
This quarter’s article was moderated by Hayden D. Behnke, broker associate, Pyms Capital Resources.
“Gary Prager, one of our local architects who has a significant track record in the senior space, recently had the unique experience of spending time in a senior community as a ‘resident.'”
“This month he is sharing his ‘day in the life’ adventure with us, including the insights he gained as an individual and an architect. Thank you Gary!”
