What providers are doing about wellness: the National Whole-Person Wellness Survey looks at the state of wellness programs in CCRCs--what's "hot," what's warming up.

As continuing care retirement communities (CCRCs) strive to incorporate whole-person wellness programs into their campus cultures, a recent national survey asked participants to gauge their level of success. The National Whole-Person Wellness Survey is an interdisciplinary effort to identify the effects of wellness programs on residents. "A major goal for the survey was to assess how CCRCs are incorporating the elements of whole-person wellness from a philosophical, staffing, programmatic, physical, and financial standpoint," says Perry Edelman, director of Outcomes Research at Mather LifeWays Institute on Aging and the survey's principal investigator.

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The National Whole-Person Wellness Survey, sponsored by Mather LifeWays, architectural firm Dorsky Hodgson Parrish Yue, and Ziegler Capital Markets Group, was completed by 61 presidents, CEOs, executive directors, and wellness program directors of CCRCs, as well as representatives of 11 active adult communities (AACs). Survey investigators identified participants through an existing database, e-newsletter promotion, and personal contacts. "This survey really represents a slice of the industry today, creating a baseline for evidence-based designs in the future," notes Cornelia Hodgson, head of Dorsky Hodgson Parrish Yue's Senior Living Studio and a coprincipal investigator on the survey. The final report will be released on March 7 to coincide with the American Society of Aging and National Council on Aging conference in Chicago.

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Addressing Aspects of Wellness

All the participants accept the philosophy of wellness as a lifestyle, not just an exercise program. Whole-person wellness programs "promote successful living through the six dimensions of wellness," note the survey authors. The six wellness dimensions are:

* Physical

* Social

* Emotional

* Spiritual

* Intellectual

* Vocational

Respondents reported that the most opportunities for residents to achieve wellness existed in the social, physical, and spiritual dimensions. "The emotional and vocational dimensions had provided the fewest opportunities, which was not surprising," Edelman says, "but I was pleasantly surprised to see that they were also the areas in which respondents expected the greatest increase in opportunities in the future." Support groups--including caregiver support groups and grief support groups--are a popular activity component within the emotional dimension. Respondents also noted the importance of counseling programs--either peer counseling or staff counseling. Vocational opportunities mentioned include volunteer activities and resident committee participation, as well as computer access and computer classes.

Measuring Success

Facilities measured success in a variety of ways. To assess their wellness programs, more than half of respondents indicated they used the following methods:

* Resident satisfaction questionnaires

* Records of program participation/attendance

* Health screening (e.g., blood pressure, cholesterol, bone density)

* Resident committee feedback

* Physical fitness assessment (flexibility, strength, endurance, body composition)

* A suggestion box

Respondents assessed the impact of wellness programs on residents using a 7-point scale (1 = none or no impact, and 7 = a great deal of impact). The greatest areas of resident impact were on regular exercise, participation in meaningful activities, socializing with others, and overall quality of life. "It's a progressive concept for communities to be embracing wellness rather than illness," Hodgson explains. "People are more satisfied with a community that supports residents making decisions themselves through whole-person wellness."

When asked about the importance of wellness programs to residents' satisfaction, 88% of respondents rated the programs at five or better; 72% gave a score of five or better regarding the importance of wellness programs to family members' satisfaction. "The survey indicates that the inclusion of a wellness program does in fact elevate the reputation of your community by the residents, as well as family members," Hodgson says. Edelman adds, "It's probably easier for the respondents to estimate resident satisfaction because they're around the residents and may have limited contact with family members." In any event, he stresses that the respondents estimated a high level of satisfaction for both groups.

Respondents also noted the five most essential factors for a successful wellness program--in order: organizational commitment (74%), trained/experienced staff (61%), programs appropriate to resident abilities (56%), variety of programs/activities (56%), and financial resources (51%).

Designing for Wellness

The physical layout and design of a facility are important to creating a wellness atmosphere. Three-quarters of the communities have exercise rooms, activity/game rooms, and libraries. More than 25% have a large chapel and a formal dining room--although these areas were not considered part of their wellness programs, reflecting a somewhat less holistic view of wellness. "How does a facility get a more holistic view? Respond to what's going on in society already," Hodgson says. "More and more you see a focus in society on the concepts of wellness and successful aging being tied together. The boomers are redefining retirement with a focus on engagement in life. Design must support this wellness philosophy."

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More than 20% of those surveyed are planning to add a spa treatment area, cafe/refreshment area, or pool in the next five years. In the past five years, 59% of facilities renovated existing spaces; 62% believe they will need to add square footage or unspecified new construction. "Space doesn't have to be large to be effective," Hodgson notes. But these spaces--regardless of size--must be prominent. "The more people pass by these spaces, the more encouraged they are to actually begin participating in the wellness programs," she adds. Spaces must be accessible to all residents, including those who use walkers or wheelchairs, and must be open to natural light. Most respondents are also planning to add and/or replace equipment, hire additional staff, and redo marketing materials.

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Respondents ranked the importance of 35 possible wellness spaces/features as perceived 10 years from now. Exercise spaces and computer rooms were listed as very important by 88% and 79% of respondents, respectively. Deemed less important are steam rooms, saunas, and outdoor pools. The study's authors believe this may be because of concerns for safety or climatic concerns with outdoor pools.

Culture of Wellness

"The investment that communities are making in designing, building, and incorporating wellness-oriented spaces within their communities is itself a statement of their culture," Hodgson says. "That alone is contributing to a culture of wellness." The study identified three culture of wellness profiles based on eight characteristics of communities' wellness programs: Tenderfeet (have barely begun creating a culture of wellness); Travelers (vary on the extent to which they have developed a culture of wellness); and Trailblazers (exhibit most of the characteristics of a culture of wellness). "When we looked at these three profiles of communities, in terms of where they are on the road to a culture of wellness, they all had the potential to be a Trailblazer," Edelman notes.

Future Investigations

The National Whole-Person Wellness Survey investigators are looking to the survey's future implications. Hodgson is interested in examining design features in greater depth through on-site visits. "We'd like to get better data on the actual spaces to create the evidence that validates our design approach, and there's no shortcut to having architects literally visit the spaces," she says.

Dementia-specific wellness programs are also an area of potential future research. "We're starting to talk with some of our clients about the design implications in creating fitness programs that work well with people with dementia who can't necessarily retain or follow directions," Hodgson says. "An example of design supporting therapeutic goals is an aquatic center with its many environmental cues."

Edelman hopes to hear from more than communities' administrative and managerial staff. "This comingyear, I hope to complete a project in which we actually talk to residents and staff in general, not just one or two people from the organization," he says.

The National Whole-Person Wellness Survey Summary of Findings is available at www.matherlifeways.com/re_nationalwellnesssurvey.asp. For more information, contact Perry Edelman, Director of Outcomes Research, Mather LifeWays Institute on Aging, [phone]; Cornelia Hodgson, President, Dorsky Hodgson Parrish Yue, [phone]; or Kathryn Brod, Senior Vice-President, Director of Senior Living Research, Ziegler Capital Markets Group, [phone]. To send your comments to the author and editors, e-mail [e-mail].

BY MICHAEL PELTIER, ASSISTANT EDITOR

Achitecture by Dorsky Hodgson Parrish Yue