How do you . . . incorporate innovative design elements into facilities to accommodate aging residents?

Summary: In Design for Aging Post Occupancy Evaluations, a new book evaluating lessons learned from projects featured in the AIA’s last four Design for Aging Facilities Reviews, authors Jeffrey W. Anderzhon, Ingrid L. Fraley, and Mitch Green discuss the consensus planning process necessary for incorporating innovative design elements that will allow people to age in place gracefully.

Innovation in Design for Aging Requires Shared Vision
There is difficulty and danger in drawing general conclusions from the evaluations represented in any review of specific facility designs. The danger would be summary judgment of designs without full engagement in the design, construction, and operations processes that produced the communities evaluated.

The evaluations in Design for Aging Post Occupancy Evaluations were done on structures that were fully vetted, through rigorous processes, by both owner and architect, and with justifiable reasoning behind decisions and compromises made. Still, it is unfair to make broad generalizations on the basis of these evaluations alone.

However, upon review of all of the evaluations, general evidences that were noted in a large number of evaluations can provide some insight as to the success of these projects. In addition, specific issues also merit mention, so that they can be avoided, be summarily included, or at least be fully considered when working on future environments for the aging.

Generalized common evidences
Successful innovation and successful projects are the result of a committed and consistent board of directors, as well as a strong champion for the project within the organization. A clear mission, vision, and purpose must unite all parties involved.

A certain inner strength is necessary within the champion if an innovative project is to come to fruition and be successful. It is far too easy to fall back on traditional solutions that have served well in the past and to take comfort in the belief that such a solution will continue to serve residents in the future. True advancement in care provision programs and environments is the result of thinking beyond traditional limits and embracing a passion to take something that has been done well and make it even better.

It should also be noted that the presence of a strong advocate or champion can also quickly lead a project astray, especially if that person is unwilling to understand fully and systemically the ramifications of a wrong-headed decision. This usually coincides with a reluctance to admit that the approach may indeed have been wrong-headed.

Conclusion 1: Visions of the future are best tested in specific facility situations and, if they pass the test of true and meaningful innovation, become part of a community’s unifying mission and purpose. Moreover, sincere dedication to the mission must also demonstrate flexibility to accommodate bumps in the road and to stay the course.

Consider the implications of innovation
Successful innovation in environments for the aging requires considerable time and effort prior to any construction. Time to consider the ramifications of the innovation, time to consider the resource implications of the innovation, and time to refine the innovation are all required steps to success.

Time is money. Without question, quality and innovation take time to envision and bring to reality. In our economically driven work, time translates quickly to resources, and preparation is the passport for this journey. The innovations highlighted in this book were accomplished with a great deal of preparation time in research and in thought about the correct course of action to ensure full value gained from the committed resources.

This is not to say that successful innovation cannot occur on an accelerated schedule, only that the innovative thoughts should be completely researched, fully formed, and well considered. Within a collaborative environment, this can be accomplished expeditiously, and innovations can be tested by all involved and completed in a timeframe that incorporates a comfortable and affordable build-out schedule.

Conclusion 2: Allocate the time to form fully the vision and collaborate with those who will move that vision into reality. Test the vision, or specific parts of the vision, in an existing environment to discover and address any implementation challenges or unforeseen consequences that arise.

Make innovation sensible
Innovations are by definition new methods of doing something that has been done in a certain way in the past. If we are complacent in our routines, innovation will be stifled. Innovative leadership can produce innovative follow-through by our coworkers.

Care innovations are often overlooked. A partially subsidized lunch for staff goes a long way toward improving morale, for example. Implementing “to the table” service provides an opportunity for residents in assisted living to see, smell, and select menu items, thereby increasing resident satisfaction and caloric intake. The presence of a concierge not only provides additional social service but also by strengthening person-to-person relationships, improves the staff’s ability to see and sense when something is wrong or someone is ill.

Employee relationships can benefit from a department of “people and culture” rather than human resources in which increased ethnic diversity, cultural difference, and communication techniques are recognized and used rather than ignored.

Conclusion 3: Innovations do not have to be expensive, only sensible.

Specific issues
Evidence of many specific issues can be drawn from each site evaluation; as space allowed, these issues were discussed within each chapter. A few, however, transcend site specificity and can be recognized, if not as simple common sense, as a product of experience and examination of environments.

• Building and care provision regulations should not be viewed as standards to meet, but as starting points on which to build. Innovation can take the form of creatively working within restrictive regulations to provide environments that improve the lives of residents, staff, and families.
• Simply because it looks good or is expensive to construct does not mean it works well. Putting a derivative façade on an atrium space will not automatically make that space relate to the intended residents. Know the target market and design to it.
• Pay very close attention to details, both aesthetic and functional. They will make the difference between successful innovation and crude experiment.
• Collaborate. Seek out, listen to, and respect the opinions and suggestions of everyone you can. Some suggestions that seem unusual may have amazing results.
• Don’t stop refining your ideas. Even when the construction is complete, there can be small, easy-to-implement changes that will have profound results.
• Thoughtful and effective environments empower staff in the fulfillment of their jobs. Empowerment of staff improves the quality of care provided to residents.
• Training is critical to staff understanding of how the environment should function. Orientation within that environment should be ongoing if the desired result is higher-functioning staff who will use the environment as it was intended.
• Meals and food service are paramount to resident happiness. The delivery of the dining experience, from the wait to be seated all the way through to dessert and coffee, will reverberate throughout the building, campus, and community.
• Consider the future and how residents will age in place, what they will want to be doing, and how they will perceive their community.

And most importantly:

• Buildings age along with residents. Successful designs withstand years of changes and challenges. Expect that environments must adapt, adjusting their form and function as needs change. Flexible designs will help keep pace with the physical and mental changes in resident populations and the unique demands of future generations.