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'Nursing homes' in transition.

Health Care Reform, Lifestyle Trends Drive Internal, Aesthetic Changes in Health Care Facilities

THE "OLD FOLKS HOME" is changing not only its look, but its focus.

It's not just for old folks anymore.

In states at the vanguard of health care reform, the so-called "nursing home" is quickly becoming extinct. Taking its place are "specialized health care facilities" offering a combination of short-term and long-term medical help to patients who vary widely in age and ailment.

"Strictly nursing homes like you may find here in Arkansas are really not going to exist anymore because the nursing home is going to become more," says architect Dwayne Wilson of The Fletcher Firm Inc. of Little Rock.

"With the health care system we have, we're fixing to find a big shift ... Nursing home care is not only going to be for the elderly or |those needing~ skilled care. They're trying to provide sub-acute care and rehab care and so forth. The whole spectrum is trying to shift right now."

The Fletcher Firm has become nationally known through its association with Fort Smith-based Beverly Enterprises Inc., for which it has designed many health care facilities. Beverly Enterprises is the largest operator of nursing homes in the country.

As a result, much of The Fletcher Firm's work is in states with high elderly populations such as Florida, California and New Jersey. Two Arkansas examples of the firm's work are the Jonesboro Villa and Hot Springs Villa retirement centers.

Wilson attributes changes in the operation and appearance of health care facilities to the health care reform movement and the aging of the baby-boom generation, which has grown accustomed to a higher quality of life than its elders.

"They want to be served better than the lower population was 25-30 years ago," Wilson says. "They're demanding more."

Reflecting Today's Concerns

Designs in elderly housing closely parallel societal and health care trends.

On the whole, elderly housing has moved away from institutional-looking buildings toward ones "more residential in form and feeling," says John Fletcher, the principal of The Fletcher Firm, which specializes in the design of nursing, rehabilitation and retirement facilities.

A project the firm has under way in Sarasota, Fla., could be considered the future of assisted-living health care. Known as Oak Pointe Manor, it is the antithesis of sterile, hospital-like nursing homes.

As its name suggests, Oak Pointe Manor is upscale, designed in a Spanish mission style that emulates the mansions of Palm Beach, Fla. Inside, decorative touches such as arched doorways, columns, arcades and moulding reinforce the building's architectural character. Lush regional vegetation accents the building's interior and exterior.

The facility operates differently, too.

It will house elderly people needing help on a daily basis and other patients who are ventilator-dependent, in need of physical therapy or respite care. The function of a facility serving a varied patient base should dictate its form, Wilson says, just as a physical site would influence whether a building is sprawling or a high-rise.

"If you've got three separate specialties going on in the building, the building should reflect that," Wilson says. "They shouldn't intertwine with each other."

Architect Steve Warnock of The Fletcher Firm says a variety of design elements are being used by architects to "de-institutionalize" health care facilities. For example, narrow, nondescript corridors are becoming a thing of the past.

"Instead of having a double-loaded corridor with rooms on each side, we go down to a pod where we have four private apartments or rooms around a sitting area," Warnock says.

Corridors also are getting increased attention with sitting areas and other design elements breaking up their monotony.

Integrating Outside and Inside

Another design trend being used more today in health care facilities is bringing the outdoors in through the use of skylights, atriums and oversized windows.

"We're doing a much better job these days at integrating outside and inside -- giving these people daylight, views to the exterior and places to sit outside," Warnock says.

Wilson says the goal of most of The Fletcher Firm's clients is to shift the emphasis from long-term care to a short-duration, rehabilitative care.

Aesthetic changes in health care buildings are mirroring that broader purpose and audience. And, if architects and health care operators succeed in their transformation efforts, perhaps they'll undo the stereotype of nursing homes as an institutional, languishing ground only for dependent elderly.

"It's nursing care while you're there, but you're there to be rehabilitated," Wilson says. "That's the target of our clients."

Amenities Provide Key to Modern Retirement Living

RISING ABOVE THE wooded hillside along Little Rock's Interstate 630 is Woodland Heights, an example of the new breed of retirement homes.

It could easily be mistaken for an exclusive high-rise luxury apartment home, which it is, but it admits only active retirees 62 and over who live independently.

Architects say retirement homes and assisted-living facilities are borrowing many design elements from the hospitality industry, which is an evident influence at Woodland Heights, built in 1985. Amenities such as a plant-filled atrium, eating areas tailored to different meals, a swimming pool and hot tub, daily continental breakfast and plush decor are all reminiscent of nice hotels.

These offerings are necessary to entice people to sell their homes and experience retirement living, says Pat M. Riley Sr., board chairman of the Riley Co., the holding company for Riley's Inc., which operates Woodland Heights and two area nursing homes.

"If you don't make it really plush, then you don't attract," Riley says.

He points to carpeting as an example of the extra detail involved in decorating up-scale retirement homes. For example, when Riley bought carpet in Woodland Heights about 10 years ago, he installed corridor carpet that cost $18 a yard. Carpet for the dining room and main floors cost a premium $48 a yard, he says.

Riley says these are all touches that are expected in a facility that requires monthly service fees from about $700 to $900, in addition to a partially refundable resident's fee that tops out around $100,000.

After all, the goal is not just retirement living, but luxury living.
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Title Annotation:includes related article
Author:Walters, Dixie
Publication:Arkansas Business
Date:Jun 28, 1993
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