Insights in Seniors Housing & Care
By: Caroline Clapp | December 20, 2022
COVID-19 | Ideas and Discussion | Senior Housing | Skilled Nursing | healthcare
Loneliness and isolation were health concerns for older adults before the pandemic and have become more so in the aftermath of the worst of the pandemic period partly due to restrictions and protocols that were put in place within seniors housing communities and health care facilities. A search for publications that mentioned “loneliness” or “isolation” and “older adult(s)” or “older people” produced a result of roughly 19,000 publications in 2013. This number climbed to more than 25,000 in 2019 and spiked to more than 40,000 and 45,000 publications in 2020 and 2021, respectively. While down to roughly 32,000 thus far in 2022 (as of December 15), the level of interest and concern remains elevated.
One reason for concern is that neuroscience research has shown that loneliness can speed cognitive decline. For example, one study found that individuals who were age 75 or older and lonely – defined as feeling unseen or unheard within a group – had a 210% increased chance of developing dementia. At the same time, there was a 60% increase in lifespan for individuals of the same age group who had rich social networks1.
Isolation, meanwhile, can result in both physical and mental health issues escalating into major emergencies if they remain unchecked by health care providers, family, friends, or the surrounding community. Developers, operators, and health care providers can take steps to reduce isolation and loneliness among older adults.
Senior housing developers can reduce loneliness and isolation by site selection, location, and design. For example, new development, conversions, or retrofits with a tilt toward urban in-fill locations allow residents to be closer to city centers and population clusters. Indeed, some residents report that even the sound of nearby public transportation helps them feel less isolated from the community. However, from a cost-basis, in-fill locations can be expensive sites in which to build, and as a result, developers could also look to smaller secondary and tertiary cities for urban development where costs may be less prohibitive.
Developing properties near or within multigenerational communities may also help reduce the potential for resident isolation and loneliness. For example, providing senior housing within walking distance of single-family housing helps residents be closer to younger generations or younger families. While age-eligible housing is an attractive lifestyle for many older adults, offering intergenerational developments with a mix of housing, retail, health, and wellness provides another option for those at risk of isolation. Locating senior housing on or near college campuses is another opportunity that allows proximity to walkable and alma mater experiences such as auditing courses or attending sporting events, which has been a popular draw to older adults for many years. Recently, some universities and colleges have begun incorporating non-students into classrooms, housing, and daily life as part of their diversity, equity, and inclusion initiatives and to address loneliness among both older adults and college students.
Regarding design, spaces that encourage positive interactions and socialization between residents, visitors, and the surrounding community help to reduce loneliness and isolation. Rather than fences or walls, use of wide side yards with benches, shade trees, and sidewalks that are wide enough for both wheelchairs and pedestrians help to enhance community integration. Additionally, enlarged thresholds help to draw visitors in and to encourage residents to go out while providing opportunity for those less mobile to observe activities in the immediate surroundings. Inside, bedrooms that face communal space encourage residents to go out and socialize. In the dining area, small and intimate tables provide ease of conversation with other residents, while reconfigurable tables allow for larger gatherings with visitors.
Senior housing operators can reduce loneliness and isolation by leveraging campus resources, affinity groups, pet therapy, and technology. Regarding resources, operators can offer popular campus services such as maintenance, landscaping, meal prep, and housekeeping off-site to engage the surrounding community. Wellness centers with fitness and nutrition amenities that are open to staff, residents, and the surrounding community increase multigenerational integration, particularly if set in a quiet environment that encourages conversation. Providing on-site childcare for staff could also help to increase multigenerational interaction, as well as help with employee hiring and retention. This is not always easy to implement effectively, however. Pet therapy has become popular in both schools and older adult communities for pets’ ability to reduce anxiety and feelings of loneliness, and operators can enlist regular visits from such pets to increase interactions between residents, staff, and visitors.
Affinity groups can reduce loneliness and isolation by increasing opportunities to socialize and connect in a specialized setting. Communities catering to LGBTQ+ older adults and allies have gained interest2, as well as veterans-focused age-eligible communities. Some adult day care operators have had success in target marketing for ethnic backgrounds with newspapers, television programs, and conversation in a particular language. Operators of culturally focused communities can also consider dietary customs, opportunities for meal sharing, and spaces for cultural events in their designs. As a commercial real estate property type, active adult rental properties are a response to the preferences of the baby boomer generation and appeal to a cohort of the older population seeking an option for living in a secure, maintenance-free setting with amenities and opportunities that foster socialization and shared activities with like-minded older adults.
Regarding technology, today’s older adults are more tech savvy than prior generations and are increasingly expanding the use and number of devices employed3. Ensuring regular, private communication between staff, family, and residents and sharing real-time data via apps or wearable devices reduces isolation and the likelihood of physical or mental health issues going unchecked. Wearables can track changes in socialization by reporting “where two or more are together.” Access to traditional social media allows connectedness to friends, family, and daily life.
Skilled nursing properties and hospitals can reduce loneliness and isolation by design and by leveraging technology and campus resources. Inviting use of skilled nursing and hospital campuses for community events, such as farmers markets, or charity events, including cornhole tournaments, could increase community integration with residents, patients, visitors, and staff. Corridors designed as walking paths encourage patients to step out and visitors to come in. Within skilled nursing and hospital rooms, large consultation areas can include both the patient and family bedside with designated space to display family photographs either digitally or physically. Additionally, skilled nursing properties and hospitals can downplay the clinical environment by adding art, appealing lighting, and communal touches such as:
Regarding technology, skilled nursing and hospital rooms can incorporate devices and wearables to communicate with family, friends, and staff. Additionally, the use of robots has increasingly been used to provide socialization in addition to providing entertainment and helping with staffing shortages. For example, some interactive therapeutic robots provide animal therapy in environments where live animals are unable to visit and can stimulate interaction between patients and caregivers4.
While the pandemic brought new restrictions and protocols, strained labor availability, and increased concerns about loneliness and isolation, senior housing developers and operators and health care providers can incorporate social needs into daily life and care. In general, older adults must not feel like a burden to those around them and should not be isolated from family, friends, staff, or the surrounding community. All available resources should be leveraged to encourage socialization, communication, connectedness, and inclusion.
1 “Lifestyle, Social Factors, and Survival After Age 75: Population Based Study”, BMJ, The Advisory Board Company.
2 “Retirement Communities Cater to LGBT Population”, WSJ, November 16, 2022.
3 “Baby Boomers & Tech – How the Pandemic Changed the Relationship”, GWI, July 6, 2021.
4 “How a Robotic Baby Seal Is Revolutionizing Memory Care”, The Front Porch Center for Innovation and Wellbeing, October 20, 2016.
Caroline Clapp is a Senior Principal at the National Investment Center for Seniors Housing & Care (NIC), where she serves as a subject matter expert and supports outreach for the senior housing industry. Prior to joining the staff at NIC, Ms. Clapp was a Vice President at AEW Capital Management. During her 15 years at AEW, Ms. Clapp was a member of the Investor Relations and Research groups, providing client service and real estate research for the firm’s private and public investment strategies. Prior to joining AEW, Ms. Clapp was a Financial Analyst at Entergy Corporation. Ms. Clapp holds a Master of Science in Finance from the Carroll School of Management at Boston College and a Bachelor of Science in Management from Tulane University. Ms. Clapp is a Chartered Financial Analyst® and a member of the CFA Society, Urban Land Institute, Women in Real Estate (WIRE), and CREW Network.
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