Aging safely

COVID-19 spurs senior living industry to consider design changes

In the wake of devastating outbreaks of COVID-19 in numerous nursing homes, operators of senior living facilities along with their architects, engineers and builders are searching for ways to better protect vulnerable populations from highly infectious and potentially deadly diseases.

“There is a huge conversation happening about putting HVAC systems in place to ensure that the spread is minimized as much as possible,” said Maura Richards, Vice President of Business Development for Wohlsen Construction and previously a long-time professional within the senior living industry.

That conversation, however, is complicated by multiple factors. The daily challenges of functioning in the midst of a pandemic have left many senior living operators, especially at skilled nursing facilities, with little time to ponder building renovations. Many nursing facilities which typically operate on narrow margins, are dealing with reduced occupancy either due to fatalities, temporary suspension of admissions or widespread suspension of elective surgeries. Nearly all facilities are shouldering heighted costs due to increased PPE purchases and other expenses related to treating or preventing infection. And many facilities are decades old, making any upgrade to building systems more difficult and costly.

“Budget is a concern, but if the budget and cashflow are available, they want to do this as soon as possible… It has risen to the top of the priority list for most, if not all operators,” Richards said.

Ben Perez, MEP Field Coordinator at Wohlsen, is focusing those initial discussions with senior living clients around how to optimize existing systems.

“The best, first thing to do is talk to your design team about whether you have adequate air movement, adequate makeup air, proper ventilation and pressurization,” Perez said.

That discussion includes determining if systems are being properly maintained and using the best possible filters, and explores possible system upgrades.

“A lot of companies like Trane, Johnson Controls, Daikin, Mitsubishi, are being pretty responsive…and working towards solutions such as adding an extra compartment into ductwork, retrofitting systems with HEPA filters or making other modifications,” Perez said.

Determining the correct HVAC upgrade for a particular facility is not simple and, unfortunately, includes avoiding some new hazards.

“We are seeing a lot of snake oil being peddled… People are pushing products that really aren’t going to fix anything,” said Ed Hubner, Principal at EBL Engineers.

Those include relatively inexpensive ultraviolet light kits to add onto existing air handling units which are ineffective because they either don’t deliver the correct wavelength or exposure time or they place the UV treatment at the wrong point in the system.

Other retrofits could be beneficial, but they need to be properly assessed, Hubner said. Installing filters with higher MERV ratings could improve air quality but, if used incorrectly, could also damage motors and coils.

Installing bipolar ionization units inside air handling units looks “very intriguing and the technology has been around for a while. It has also had some failures,” said Hubner who is reviewing third-party evaluations of the systems. “I would advise anyone before you buy something from a salesman, engage a competent design professional to evaluate what the solution is and whether it is really going to work for you.”

Meanwhile, senior living operators are exploring or already implementing a variety of other changes to their facilities.

To limit access to facilities without completely cutting residents off from their loved ones, some operators have created visiting areas with plexiglass partitions and telephones on each side. Some operators and AEC partners are already designing more permanent and pleasant safe visiting spaces.

Dramatically increased use of online services and mobile devices during the pandemic for everything from Zoom calls with family to online shopping to telemedicine appointments is fueling needs for technology upgrades in nursing centers, assisted and independent living sites, and 55-plus communities.

Developers and designers are looking at options to install touchless technologies to operate doors, faucets and other devices, and options to replace some surface materials with antimicrobial fabrics and paints, and antibacterial solid surfaces, such as copper, brass and Krion (a non-porous, stone-like product). Longer term, the design of senior living facilities could change significantly.

To contain disease spread, senior health experts and design professionals are looking at eliminating multi-resident rooms, wings that might house 60 or more residents, and central dining facilities that could serve hundreds. In their place, facilities could create smaller, more self-sufficient units possibly consisting of 20 residents in private rooms served by a smaller living room, dining room and dedicated workspace for staff.

“Flexibility in the layout of buildings is going to be important,” said Amy Young, Director of Business Development for Wagman Construction and previously a long-time professional in the senior living industry.

That flexibility, she said, could enable residents to safely use and enjoy the entire property when the facility is not facing an infectious disease concern and also enable operators to effectively address an onsite infection by serving residents in smaller groups and creating isolation rooms or wings as needed.

Even in independent living spaces, operators and designers are looking at ways of creating smaller, more contained spaces.

“Potentially, we could see scaled-down amenity space and increased apartment space because people have been quarantined in their apartments and they want to be comfortable,” Richards said.

Many industry leaders, however, have expressed strong desires not to reverse the trend of offering nicer design and improved amenities in all types of senior living communities.

“The biggest area we may have to rethink is how we provide dining services,” Young said.

In addition to eliminating buffets and salad bars and providing expanded table service, senior communities may need to create smaller but uncrowded dining areas, she said. “Fortunately, there has been a trend in some senior living communities to creating more bistros and cafes and even some outdoor dining. We may need to do more of that.”

Young anticipates the AEC industry will need to embrace two other trends for senior living clients in the near future. The first is the WELL Building Standard which aims to create environments that support both physical health and emotional wellbeing – something that could become a higher priority as America continues to contend with the stress of a pandemic.

The other is the “small home” concept in senior living, such as the trademarked Green Houses. The model creates small, stand-alone facilities that resemble houses but provide assisted or nursing care to 12 to 16 residents each.