Emerging trends in assisted living - assisted living facilities

Nursing Homes, August, 1999 by Gregory J. Scott, Mary Kender, Scott E. Townsley

It could be argued that the assisted living field has come a long way in defining itself. What assisted living offers, what makes it different from any other sector in long-term care - there seems to be growing agreement on this among owners and investors. But what does the purchasing public think? When people make an appointment to visit and tour an "assisted living" facility, what do they expect to see? Or, more to the point, what do they want to see?

The answers have been changing over the years, and will continue to change. From our perspectives as an architect (Scott), administrator (Kender) and consultant (Townsley), we have perceived several trends that might be important in the future marketing of these facilities:

Larger Units

Across the board, residents are expecting more spacious living accommodations. Historically, assisted living residents would be content with a 300-sq.-ft. studio or a 350-sq.-ft. alcove unit. Today, studios are the exceptions, alcove units of 400 sq. ft. are considered acceptable, while 1-bedroom units of 450 to 500 sq. ft. are seen as the emerging standard.

The larger units, in addition to providing more room for personal possessions, also offer walk-in closets, kitchenettes, fully accessible three-fixture bathrooms and, in many cases, patios or walk-out balconies. The new generation of assisted living models often features expansive window openings and 9[feet] ceiling heights to further accentuate spaciousness.

The larger units equate to higher allocations of square footage per resident, higher cost per dwelling unit and, finally, higher per-diem rates for the consumer. Balancing market demand for larger units against the need for affordability remains one of the greatest challenges facing providers.

An alternative to larger individual units is providing smaller private accommodations but larger public areas. The concept assumes that residents will be less inclined to stay in their modestly sized personal accommodations and therefore seek variety and "elbow room" in the more spacious public areas of the facility. This concept can reduce overall building square footage and, ultimately, construction costs.

Increased Amenities

Individual: Increasingly popular are kitchenettes, fully accessible three-fixture bathrooms with shower, dedicated computer lines, wireless paging, private patio or balcony, central ducted air, walk-in closets with closet organizers, linen closets, built-in window seats and/or shelves, flooring options, wood trim and molding options. Of these, one of the "hot tickets" today is the walk-in closet. Tomorrow's hot ticket will be space for a desk and personal computer; today's "computer labs," offering computers for use on a shared basis, will become outmoded space and an actual detriment to marketing.

Public: Assisted living environments are beginning to adapt the offerings and characteristics once associated only with independent living accommodations: cafes, bistros, communication centers, libraries, mini-theaters, pharmacies, banks, computer centers, club rooms, horticulture centers and medical suites, to mention a few. Some of these amenities can be shared with the broader CCRC community to defray operational costs (i.e., pharmacy, banking and bistros). Stand-alone provision of these amenities becomes much more difficult to justify and support without per-diem rates rising above market affordability. Many facilities are requiring a once-and-done entrance fee to help offset the additional financial obligations associated with these offerings.

Special Care

The integration of dementia assisted living components within mainstream assisted living accommodations - a trend that is well under way - creates its own set of challenges. Dementia residents benefit from easy and spontaneous access to the outdoors. This would logically place a special care component on the ground floor of the facility but potentially create an "image issue" regarding first impressions and territorial access to outdoor gardens and amenities. Conversely, placing special care units on any floor other than the ground floor will necessitate either staff-assisted access to grade-level gardens, thereby compromising spontaneity, or developing rooftop gardens that raise immediate concerns with safety and weathertightness. The point is, several factors must be weighed in making this decision.

Another challenge centers around structural and mechanical issues. The traditional special care unit accommodation is approximately one-half the square footage required for a traditional one-bedroom assisted living accommodation. The challenge of economically stacking the required mechanical and plumbing apparatus increases because of the disparity in room sizes, locations and structural-bearing considerations. With careful planning, though, these issues can be minimized.

Finally, it is conceivable that, within the near future, special care for assisted living residents will go beyond dementia care to encompass IV therapies, respiratory therapies and rehabilitation.