By popular demand.

Design teams can meet today's market challenges at any price point

In today's competitive long term care market, good design has a lot to do with privacy, homelike design, and dementia care--elements in big demand from prospective residents and their families. If a facility fails in any one regard, there's likely a competitor nearby that makes the grade.

Though design experts differ on long term care ideals--from grandma's house revisited to grand hotel recreated--most agree these top three design concerns can be addressed at any price point. We asked architects around the country to comment on how they had addressed these key design problems given high, moderate, or low budgets.

GOAL: Privacy

The privacy component of senior living design involves several key issues: Are shared rooms marketable in your area? Should residents room together? Can you provide privacy in doubles and still control costs? On the high end, where resident demand increasingly dictates designing large private quarters, just how big should you go? And what amenities matter most?

* Price point: HIGH

Everything in Texas might not be big, but designers of Edgemere in Dallas, a luxury continuing care retirement community (CCRC), aren't skimping on size. When complete, skilled nursing units will run as large as 640 square feet, and apartments for independent living will be as roomy as 2,000 square feet. Project designers from Dallas-based ThreeArchitecture, who are working in conjunction with the Milwaukee-based architectural and engineering firm Aldrian Guszkowski, hope to set a new standard with Edgemere, says ThreeArchitecture principal David Dillard.

In the right market, generous rooms simply pay off, notes Dillard, and more and more markets are becoming ripe for such high-end design. "In all properties, we're meeting tremendous demand for larger units," says Dillard.

Large, private rooms aren't always the way to go on a high budget, however. Flexibility and marketable extras may be a better investment. For a $17-million, 120,000-square-foot, state-of-the-art State Veterans Nursing Home at Fitzsimons in Colorado, Boulder Associates Architecture + Interior Design prescribed two layouts for double rooms: an L-shaped plan that staggers roommates' individual spaces and another plan that keeps the spaces parallel. Both plans have two windows. These options permit more than one location for beds--parallel or perpendicular to windows. Window seats in each space add a residential feel and are popular with residents' visitors. "People are always looking for a little extra space," says Boulder Associates principal Tim Boers.

* Price point: MODERATE

In another ThreeArchitecture project in Dallas, Signature Pointe on the Lake, the budget was a little tighter--$80 per square foot--but designers didn't give up on privacy as an ideal. In fact, through careful planning, they were able to take it a step farther, maximizing it even within small apartments. In the CCRC's one-bedroom assisted living apartments (520 square feet), a simple jog in a wall delineates the living area and defines a vestibule containing a closet and an adjoining bedroom and bath.

In Signature Pointe's semi-private skilled nursing rooms, a four foot high "half wall" and closet are used to separate space visually. As a result, the rooms curtain tracks are rarely used.

* Price point: LOW

In shared rooms, relatively simple tweaking such as toe-to-toe bed placement can help keep a sense of privacy alive, says Victor Regnier, FAIA, professor of architecture and gerontology at the University of Southern California, Los Angeles.

Such an arrangement can also improve roommate relations, staving off fights over the window note designers at Columbus, Ohio-based The InterDesign Group, who achieved heightened privacy for residents in a $66-per-square-foot renovation at Marquette Manor Healthcare Center in Indianapolis.

Other relatively inexpensive fixes: replace a single built-in closet with an armoire or wardrobe for each resident. Place televisions in armoires and install bedside speakers. Used freed space for hallway linen storage or to enlarge bathrooms, changes that can help staff and save operational dollars.

Another strategy is to simplify typically high-cost aspects of a project. By doing so, O'Keefe Architects of Palm Harbor, Florida, were able to complete 88 studio and one-bedroom assisted living units for Merrill Gardens in Orange City, Florida, for just $56 per square foot. Among the cost-savers were two-story wooden construction and resident quarters separated from common space by four-hour-rated fire walls, eliminating the need for costly fire dampers in mechanical systems. Bathrooms were backed up and stacked to keep plumbing costs in line.

GOAL: Homelike design

The homelike atmosphere so sought after in senior care facilities requires particular attention to scale, which is possible on any budget, according to Three-Architecture's David Dillard. "A lot of people think, 'The taller it is, the fancier it is.' I've seen a lot of two-story dining halls but I'd rather have a nine-foot ceiling and a nice finish on the sheetrock plus a higher wood base moulding."

* Price point: HIGH

At the high end, a residential feel may lean toward the features of a luxury, residential-style hotel. "We care greatly what anchors the ends of corridors," says Dillard. "Imagine an art niche with downlighting and a museum-quality icon strategically placed, softly lit."

Fireplaces, nooks, reading areas can also add charm and character.

In the recently completed Homewood Residence at Lakeway, an American Retirement Corporation development near Austin, Texas, Nashville architects Earl Swensson Associates aimed for residential effect in a 77,000-square-foot property containing 81 assisted living and dementia units. The design team created a large staircase inside the main entrance to lend a homelike ambiance. Carved alcoves grace the corndors adjacent living spaces. Both community living rooms and a private dining room are of an intimate scale. Construction totaled $105 per square foot.

* Price point: MODERATE

For moderate-budget projects, props can go a long way, says Martha Child, principal of Sterling, Virginia-based Martha Child Interiors, the design division of Sunrise Assisted Living. "I try to recreate the wonderful times I had in my grandmother's home. I use lots of props and pay incredible attention to detail," says Child. Her residential trademarks include "tons of artwork and accessories" appropriate to a particular region.

It is the finishing touches that create the polished interior of Saint Francis Center at Our Lady of the Snows assisted living facility, a 24,800-square-foot addition to a CCRC in Belleville, Illinois. Though overall construction costs were high--$113 per square foot--interior designer Margaret J. (Peg) Cervantes, AIA, IIDA, of Chicago's O'Donnell Wicklund Pigozzi Peterson Architects (OWP&P) helped keep interior costs in the moderate range.

The firm's new procurement management program, which helps owners and developers manage the donation process, was instrumental in staying on budget. Cuffing donations and accepting those appropriate to the mix can free furnishings budgets for other priorities. One caveat: Donations from families can create a jumble that frequently creates "a lot of pianos and furniture that doesn't fit" in apartments and rooms, says Cervantes. So accept donations judiciously.

* Price point: LOW

In some cases, it is possible to down-size big ideas from upscale projects. Consider a 6-by-10-foot seating nook. "Even at $100 per square foot in construction costs, you'll spend just $6,000 to create something of character that breaks up a straight run corridor," says ThreeArchitecture's Dullard.

The residential scale that characterizes Southern Assisted Living in Chapel Hill, North Carolina, is thanks to budget-friendly, single-story wood-frame construction. "We look, feel, and operate like a big house, not a small hotel," says Roger Harper, senior vice president of development. He estimates Southern's average construction costs at about $62 per square foot.

With North Carolina architects Cline Davis and David Ripperton of Raleigh, in conjunction with Aldrian Guszkowski of Milwaukee, Southern Assisted Living planned its prototype vinyl-sided, shuttered, fully sprinklered residence to resemble a rambling, old Carolina plantation house. Each wing creates an interior neighborhood adapted to light, intermediate, or dementia care.

GOAL: Designs for dementia

In assisted living or skilled nursing, chances today are that a facility will have its share of residents with dementia. Reality, says J. David Hoglund, AIA, principal of Perkins Eastman Architects in Pittsburgh, is that a higher percentage of new residents have cognitive impairments, and many others will eventually decline. Mature retirement communities are adding dementia services and living spaces where none previously existed. "Everyone is struggling to balance aging in place," says Hoglund.

* Price point: HIGH

To meet a growing need for mild to mid-stage dementia care, Oakwood Village, a CCRC in Madison, Wisconsin, commissioned OWP&P to plan its new Covenant Oaks licensed community-based residential facility. Given the ample budget, the firm decided to decentralize services such as meal prep and laundry One structure houses all 40 units, but the space is divided into four "houses," each with its own services as well as dining and living areas. Each also opens onto secure garden courtyards with wandering path linking the four areas. Construction costs ran $117 per square foot.

Even on upper floors, outdoor spaces have become essential in dementia care settings. At Sunrise of Rockville in Maryland, designer Martha Child fashioned an outdoor terrace in residential style for the fourth-floor dementia unit at a construction/furniture, fixtures equipment cost of $95 per square foot.

* Price point: MODERATE

When designing for dementia, money set aside for ambitious outdoor spaces is money well spent. At the new dementia assisted living center at Parkcliffe Eldercare Community in Toledo, Ohio, architects placed the "front door" on an enclosed courtyard for residents--their "front yard." A "back door" provides a discreet entrance for visitors and staff. The innovation by Cleveland's Dorsky Hodgson + Partners has big impact without a big budget. "Every building has a front door and a back door anyway," says Cornelia C. Hodgson, AIA, partner in charge and project director.

Parkcliffe's new single-story wood-frame building houses 24 residents in two 12-bedroom homes. Not all services were decentralized, but each wing has its own living, laundry, and bathing spaces. "Instead of saying homelike design, we said 'home,' "says Hodgson. "We found economical ways to house a family of 12." Construction costs were $89 per square foot.

* Price point: LOW

Porches can be grand and expensive but they don't have to be. "A simple, screened porch is like a permanent picnic," says Regnier, citing social possibilities involving ice cream, watermelon, and lemonade.

Visual cues in design can be accomplished at low price points as well. Take waist-high planters or designer Martha Child's Sunrise kitchen without cupboard doors; both tend to help keep dementia wanderers busy and content.

Props and other final interior details can enhance the environment as well. A basket of laundry to fold, a wedding album, a doll, or music collections may spark interest among dementia residents. Such ideas can be adapted to the smallest of budgets.