Environments for Aging - Fall 2016 - 39

Left: The living room, part of a great room,
is adjacent to an open kitchen and dining
room in one of the small houses on the Sarah
Neuman campus of The New Jewish Home in
Mamaroneck, N.Y. Three skilled nursing small
houses are open; a total of seven houses are
planned as part of a phased renovation, from
2014 to 2017. Below: Each house on the Sarah
Neuman campus has its own dining room, open
kitchen, and living room, all part of a common
area. The homes were designed by Perkins
Eastman.

quality-of-life improvement for elders in longterm care communities.
Today, skilled nursing design is steeped
in person-centered care elements such as
private rooms with private bathrooms, an absence of centralized nurses' stations, smaller
resident wings with dedicated kitchens,
easily accessible and visible outdoor spaces,
and common areas that integrate staff and
resident activities.
Despite this progress being made,
consumer preference remains with avoiding
skilled nursing for as long as possible, which
is influencing the resident populations that
designs must support.
"People are living longer, medical care is
improving, and less expensive alternatives
such as adult day healthcare, home healthcare, assisted living, and supportive housing
are growing," says Tom Gears, principal with
SWBR Architects (Rochester, N.Y.). "The
typical resident entering a skilled nursing
facility is now older and in need of more
medical services." Growth in the sub-acute,
short-term stay market is also affecting
SNFs, Gears says, requiring communities
to support not only different diagnoses but
traditionally younger residents, as well. To
that end, highly flexible environments are
preferred.

THE NEW JEWISH HOME

A household remedy
"Our clients are not focusing on an individual
population. We're designing for multiple
populations and multiple acuity levels," says
Rob Simonetti, senior associate and design
director with SWBR. "When we focus less
on medical diagnosis and more on the whole
person, we see that there is a narrower spectrum of differences between people. Environments that support all domains of wellness
can serve the vast spectrum of needs and

can be supplemented with specific care for
the individual."
One major design solution being implemented across the country to create appropriate
environments for care is the household model.
"The smaller household models offer providers
the flexibility to address different populations,
services, and diagnoses with specialized
needs in controlled, intimate environments,"
says Joseph Hassel, principal with Perkins
Eastman (Chicago). "It also offers the provider
the ability to expand or contract the program
offerings based on market need."
This often translates to "neighborhoods"
broken down into 24 private rooms or fewer,
says Susan Ryan, senior director with The
Green House Project (Baltimore). In comparison, traditional models being renovated
formerly offered 40-, 45-, or even 60-plusbed layouts, she adds. The Green House
Project, founded in 2001, partners with
organizations to realize the design and building of small-scale, community-based licensed

SNFs, emphasizing a household model and
person-directed care. Currently there are
208 Green House homes in 49 communities
across 30 states.
Examples of the household model in action
include The Terraces at San Joaquin Gardens, a community of the American Baptist
Homes of the West (ABHOW) in Fresno,
Calif., which features a replacement SNF that
opened in 2014 and offers three separate
households within a one-story building. The
project was designed by Douglas Pancake
Architects (Irvine, Calif.). The previous site had
88 beds, of which 80 percent were semiprivate; in contrast, the three households
each now feature 15 units with 12 private
bedrooms and three semi-private bedrooms
with two beds.
A similar design sensibility is evident in The
Living Center of Manhattan, a building initiative of The New Jewish Home in New York
City. Groundbreaking for this 376,000-squarefoot SNF is set for summer 2017, with doors
Fall 2016 * EFAmagazine.com

39
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