The COVID-19 pandemic has created design challenges for the seniors housing and care sector that need to be articulated, addressed and navigated. Achieving the right balance between social connectivity and coronavirus exposure has now become one of the key trials facing seniors housing operators. And with colder weather approaching, move-in restrictions easing, more visitation being allowed, and communal dining returning (albeit with physical distancing and other precautions being observed), operators need to think about design principles that help minimize risks to their residents. This blog post highlights a number of design principles operators may want to consider.
Creating Resident ‘Cohorts’ or ‘Pods’
Socialization has long been an established value proposition for seniors housing. Since the onset of the pandemic in March 2020, delivering on this goal has become more difficult due to the risk of infection transmission. Some operators have found success by forming small group ‘pods’ of residents, usually formed with resident rooms or apartments that are clustered near one another. Although this strategy is limited to certain building designs, these small cohorts of neighbors – usually between eight and ten units – can offer residents a familiar sense of community in addition to serving as a peer support group.
Within each group, residents dine together and visit with each other but avoid mixing with the entire community. Common amenities like kitchens and living rooms can be shared within each of these clusters to avoid relying on higher risk multi-purpose rooms or large shared dining spaces. This strategy helps maintain a degree of the community lifestyle that residents have grown accustomed to.
For this strategy to be effective, however, a well-thought out staffing plan needs to be implemented. Ideally, staff should be assigned to specific cohorts and avoid going into other parts of the building. To aid with this, PPE donning and doffing areas should be established outside of each resident cohort area and staff should exit directly to the exterior whenever possible. In some cases, early in the pandemic, these cohorts were made even tighter with staff living in on-site RVs or unoccupied units to further restrict exposure to residents and the community. It should be noted, however, that this plan may contribute to additional staffing costs, boosting what is already the largest operating expenses line item. Where regulations allow, adopting universal staffing patterns, where staff take on multiple tasks, can mitigate some of these additional staffing costs.
Improve Air Flow Through Spaces
A CDC study conducted in the early stages of the pandemic indicated that HVAC systems can be responsible for transmission of the virus. As such, certain mechanical considerations may need to be undertaken to prevent the spread of infection. For example, HVAC systems may need to be ‘zoned’ so that air ducts are not serving multiple pods or established resident cohorts. Other considerations include replacing HEPA filters, increasing maintenance frequency, and adding air exchanges to direct more fresh air into buildings.
In the Joint Center for Housing Studies’ webinar, Designing Senior Housing for Safe Interaction in the Age of COVID-19, balconies were referred to as ‘design heroes’ as they allow residents access to fresh air and a space to interact with others from a safe distance. Unfortunately, adding balconies to existing buildings can neither be done quickly or inexpensively, and in most cases is simply not feasible with residents in place. A more near-term solution is the use of fans to help create negative air pressure environments. Putting an outward facing fan in a window can achieve the desired directional flow of air, especially in high-risk locations such as those with a great degree of shared use or where residents are suspected of being ill.
Design Outdoor Space and Programming to Encourage Use
Most scientists agree that access to outdoor air reduces the risk of infection transmission. Designing outdoor spaces in such a way that encourages outdoor activity gives residents increased opportunity to get both fresh air and exercise. Incorporating frequent points of interest – fountains, flower gardens, picnic areas, and gazebos – along walking paths promotes their recurring use. A NIC Talk being presented at the 2020 NIC Fall Conference, How Will Disruptive Forces like COVID-19 Impact the Design of Senior Living, dives deeper into ways to extend the usefulness and comfortability of outdoor space.
Programming is increasingly moving outdoors as well. Prior to the pandemic, outdoor courtyard spaces may have been underutilized. These spaces are now of the utmost importance and can be reactivated for programming opportunities like outdoor exercise classes. Residents with the option to do so can join from their balcony, while others can participate from a safe distance outdoors.
Sequence Flows Through Buildings to Reduce Pressure on High Traffic Areas
To avoid unnecessary mixing between visitors, staff, and service providers, strong way-finding protocols are an option that can be implemented throughout all parts of a property. A basic strategy is to create one-directional hallways, as is often the case now in grocery stores and retail outlets. In the absence of one-way hallways, and especially for hallways less than six feet wide, an option of recessed pause points may be considered. These can create room for residents to pass each other safely and can also double as rest points along longer corridors. Where possible though, best practice dictates that hallways should be widened to allow two individuals to pass each other while maintaining six feet of distance, although this a challenging proposition, especially in older properties.
High traffic spaces like elevators and common areas should be well thought out as well. Encouraging staff to use stairs instead of elevators helps reduce traffic and leave them available for residents. Improving lighting and even adding music to stairwells can make them more pleasant to use. Other considerations for improving safety of elevator use are to set limits on the number of people who can use the elevator at the same time, creating buffer zones where people can safely queue while waiting, and eliminating the use of buttons altogether by using key cards that can select a rider’s destination.
COVID-19 is causing the industry to rethink senior housing and nursing building design and consider innovative ideas to balance social connectivity and infection exposure. Unfortunately, the upcoming winter months, combined with the easing of move-in restrictions and visitation policies, will bring a renewed threat. This will further prod operators, architects and developers to bring another round of thoughtful implementation of design elements. To hear more on this topic, join David Segmiller, FAIA, Principal, Hord Coplan Macht and myself at the 2020 NIC Fall Conference as we discuss how to balance community, safety, and lifestyle needs for the next generation consumer.
About Ryan Brooks
Senior Principal Ryan Brooks works with the research team in providing research, analysis, and contributions in the areas of healthcare collaboration and partnerships, telemedicine implementation, EHR optimization, and value-based care transition. Prior to joining NIC, he served as Clinical Administrator for multiple service lines within the Johns Hopkins Health System, where he focused on patient throughput strategies, regulatory compliance, and lean deployment throughout the organization. Brooks received his Bachelor’s in Health Services Administration from James Madison University and his Master’s in Business Administration from the University of Maryland.
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