Architect David Minnigan has been involved in an extensive number of these projects and has seen different trends emerge over the years. Although not new, one concept that has gained a lot of traction in recent years is prototype design for replication across multiple projects.

As design principal at ESa Architecture, Minnigan has been asked to produce prototype designs that fit the client’s expectations of uniformity in structure, operation and philosophy. This approach certainly has merit, he says, but he cautions against what he calls “false expectations.”

So to give operators some guidance on prototype design, Minnigan has put together some pros and cons for their consideration.

“We have come to understand what prototype design is and what it isn’t,” he says. “One of the pros is that it usually starts with a philosophy of getting the right people in the room to create a new operational model, cost model and market model for a specific segment of the population. To some degree, you design in a vacuum without distractions like site, climate and regulations of jurisdiction, so you focus on what you want to create for the population. That’s a great way to start — with a blank sheet of paper.”

The down side, Minnigan says, is “you take what you do in that work session and stamp it out in every location. Even the best prototype design has to be analyzed by region — climate, rainfall, snowfall, humidity and heat index. Humidity is a glaring thing. If you take the same design and put in Tucson, where the air is dry, and then in humid South Florida, there will be a myriad of issues if not addressed properly.”

Prototype design offers a big advantage in speed to market, Minnigan says, because it provides a major head start to the construction process as opposed to starting from scratch.

“However, if the building needs adaption to climate or site-specific considerations, those types of things do take some time and need to be accounted for in the schedule,” he says.

Speed to market is integral to Sand Hill Development Group’s plan to develop 24 freestanding memory care communities within the next five years. The ambitious schedule wouldn’t be feasible without some kind of prototype design, CEO Rick Gould says.

Starting with the first facility in Gainesville, VA, and planned for “the best markets in the United States,” the prototype design is fairly basic: a 40,000 square-foot rectangle-shaped building with outside courtyard, all-private bedrooms and baths.

“Glitz is not important to our audience,” Gould says. “They want specialized care for their family members with Alzheimer’s and dementia.”

It is an integral, organic part of every room, and understanding how it creates the best environment possible for residents is paramount for every community operator. Furniture is much more than just sticks and pieces that fill interior space.

“Furnishings set the stage for an environment,” says Jadi Endl, senior product consultant, furnishings, for Direct Supply. “The style, the fabrics, the way furniture is arranged — it all plays a role in making a space inviting and home-like. Furniture can tie in design elements from the building to complete a look, bring in fun patterns and colors or make a space feel more ‘lived-in’ and like home.”

Furniture’s first impression is essential, with residents and their families typically assessing the environment from the lobby and surrounding common areas. It is a pivotal moment in deciding the livability of a community, says Mike Schwarzwalder, director of long-term care product strategy for Drive Medical. 

“The look, the style, the smell, and, yes, the feeling they get experiencing a major life change,” he says. “Is that area welcoming or is it confusing, worn and outdated? Furniture plays an important role because it is a point of contact and daily interaction.”

Aesthetically, furniture design creates an eye-pleasing environment when it fits within a design scheme and complements the rest of the property, Schwarzwalder says.

“It must not only be functional but support the mood or feeling, and to a certain degree, showcase the personality of the property,” he says. “If you are unsure or a novice in the field, try working with a designer, especially one who focuses specifically in long-term care.”

Upholstered pieces such as sofas, loveseats and lounge chairs add color and patterns for a textured look, says Linda Nash at Invacare Interior Design.

“Furniture can soften the room if there are a lot of hard surfaces,” she says. “A variety of styles can add interest and make the room homier. An example of this would be using club chairs with high backs. The chairs are different heights and break up the space.”

As owners and developers decide to build new or renovate existing facilities, there are several important trends to keep in mind, says Natalie Faulkner, director of marketing communications for J&J Flooring. Each trend “speaks to the power of design to attract residents and help them to be happy and healthy in their new home,” she says.

“Design details matter to seniors and their adult children who are looking for a senior living residence or community — particularly at the mid-to-high price range,” Faulkner says. “Most of these prospects are design-savvy and well-educated. They know what they like and what they don’t like in terms of décor, materials, color, pattern, lighting, flooring and accessories. And many understand the basic principles of senior living design when it comes to contrast-color, slipping-falling and mobility. Floor patterns should complement the other interior finishes while keeping safety at the forefront.”

Versatility, durability

Today’s senior living residents are more active than previous generations, and furnishings can assist them in their pursuits.

Kwalu CEO Michael Zusman believes furniture for outdoor spaces is just as important as it is for the interior setting and can play a key role in encouraging activity.

“It is very nice to sit in a shaded area in a comfortable rocking chair, but with the addition of potting benches and planting tables outside or in a screened-in porch, residents can experience the joy of gardening,” he says. “Make sure the planting tables accommodate those in wheelchairs and have lots of storage for seeds, pots, soil and tools. This provides an opportunity for staff to assist in an activity, the benefits of which everyone can enjoy.” 

Anna Chaney, lead contract designer for Flexsteel, has seen an increased demand for tablet chairs because residents can easily be a part of the property’s social scene while still working on individual projects.

“These likely help staff in their jobs as well, since the versatility is limitless,” she says. “They can be used in common areas or theaters but also in libraries and resident rooms. They are mobile, cleanable and bring a huge amount of options where needed.”

As important as the furnishings themselves is the layout of each room, which should account for residents’ special needs, Endl says. “Consider how residents will move throughout the space — especially those with walkers or wheelchairs,” she says. “Make sure to keep pathways clear, and add stable, arm-height furniture that can be grasped for added balance. It helps the staff by keeping residents safer and preventing falls, giving them more time to focus on activities of daily living.”

Overlooked pieces

Every community has the basic furniture components to enhance each room, but industry specialists say some selections tend to get overlooked. For instance, the utility and versatility of benches should draw operators’ attention, Chaney says.

But wounds are a real danger for all seniors, whose skin becomes more fragile with the passing years, a range of health conditions and dehydration or poor nutrition.

The susceptible include fully independent or highly mobile residents in assisted living and memory care settings.

“They may not be at risk for pressure ulcers as much, but they’re at risk for things like diabetic ulcers or venous ulcers,” says Renee Cordrey, PT, MSPT, MPH, CWS, a former board member of the Association for the Advancement of Wound Care. “If we can address risk factors, then we reduce the odds of wounds happening. And if they do have an ulcer, the quicker we can treat it, the more likely it is to close.”

New options and guidance seeks to help communities provide ongoing skin integrity, even as residents’ needs evolve.

A holistic approach that coordinates the efforts of direct and indirect caregivers, nutrition teams, rehab and primary care clinicians is ideal in continuing care retirement communities, according to Michelle Christiansen, vice president of clinical sales and marketing for Medline.

“Taking proactive care of the resident’s skin is an extra challenge for elders residing in CCRCs since a lot of residents are independent,” Christiansen says. “Everything from chair padding to diet, to skin care and bathing products, to bedding fabrics can play a role in skin breakdown.”

A staff educated on signs of potential skin damage — even among residents who may try to hide it — and preventive care can be critical to facility-wide success. 

Tracey Yap, associate professor at the Duke University School of Nursing, is a board member of the National Pressure Ulcer Advisory Panel.

She designs and tests interventions for wound prevention and management, with a focus on cueing staff and residents to move regularly.

“Even a medication change that leads someone to sleep more, a fall or a bump could cause a deep tissue injury,” Yap says. “With the emphasis on aging in place … it’s important to have staff really understand the implications.”

A closer look

Added regulatory oversight and a link to reimbursement spur some of the extra attention paid to residents, Cordrey says.

But plenty of opportunities exist to increase vigilance and improve health outcomes in less intense care settings.

“People with a chronic wound try to hide it,” Cordrey says, noting that a pressure ulcer doesn’t necessarily draw the same kind of sympathy as other diagnoses. “Sometimes there’s a stigma.”

A wound left untreated for too long also could force a resident into a more intense care setting and out of the place they call home, especially in facilities or states that require advanced wound stages to be treated.

Skin breakdown associated with incontinence, or incontinence-associated dermatitis, is the most common form of injury within the broader category of moisture- associated skin damage.

IAD is caused by chronic exposure to urine and/or stool, particularly liquid stool, and manifests as inflammation and sometimes erosion or denudation of the perianal or perigenital skin, explains Julia Melendez, RN, BSN, JD, CWOCN, national clinical director for Joerns Healthcare.

Christiansen says staff should take note of residents who begin wearing dark clothing routinely, refuse to drink liquids or wear fragrances to conceal odor.

Others, she says, might try to double up on disposable absorbent products, so staff should watch for unexpected product loss.

“Caregivers might notice the resident increasingly depends on them for activities of daily life or the resident entirely stops doing things they used to enjoy out of fear of putting pressure on their bladder while moving,” Christiansen says. “Once they stop moving, more problems start.”

Skin care providers constantly are improving products to offer better protection — and ensure better compliance — among people of varying ages and abilities in all corners of healthcare.

Melendez says disposable incontinence garments and products with superabsorbent polymers should be used to absorb urine and stool and wick moisture away from the skin.

“When the patient is in bed, absorptive products should be left open underneath the patient to avoid creating an occlusive environment that increases skin temperature and humidity, which is a significant risk factor for IAD,” Melendez explains. 

For residents with pressure injury in the sacral and/or ischial areas and IAD, Melendez recommends a therapeutic support surface that provides microclimate management to help maintain normal skin temperature, inhibit sweating and reduce excessive skin moisture.

But there’s no one-size-fits-all solution.

Though some facilities invest in support mattresses for every resident, Melendez cautions careful observation. It’s all about achieving a balance between support and overly dry skin, which can be caused by some high air-loss surfaces.

Likewise for briefs or other garments needed to protect against leaks, says Michele Mongillo, RN, BSN, MSN, RAC-CT, senior clinical director for FirstQuality Healthcare.

Only residents who are completely dependent should wear briefs all day, she says. Otherwise, use the least restrictive product possible. Protective underwear can help residents who are active and toileting on their own but report occasional accidents. Activity-induced leaks — for instance, from a sneeze or deep cough — can be countered with bladder control pads.

“You want to promote as much socialization and dignity as possible,” Mongillo says.

Q: What practical options are available to enhance the flexibility of my service offering to be more competitive and financially viable without significant modification to my community?

A: Offer a unique and more flexible living arrangement for some of your independent living residents who obviously want to continue to maximize their independence but may now need some moderate additional assistance in living. They may not currently require more extensive and structured assisted living. But they could benefit from accessing additional a la carte priced assistance. I call it “catered living.”

What this means is that your residents can live as independently as their situation allows while having access
to appropriate assistance.

As with every strategic opportunity, there are challenges and cautions. Here are two: 

1. Make sure regulations and licensing allow you to deliver catered living services. 
2. Have a clearly documented policy as to when a resident must move to a more structured, formal assisted living setting.

If interested in additional details, send your request to jimmoore@m-d-s.com or (817) 731-4266. Jim Moore is president of Moore Diversified Services, Inc., a national senior housing and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for 46 years. He has authored five books about senior living and healthcare, including Assisted Living Strategies for Changing Markets and Independent Living and CCRCs.

Most vendors and their designers and engineers wish the adoption rate for resident security technology would accelerate. Laura Wasson, director of healthcare for Tech Electronics, for example, notes how “perceived high costs” are squeezing the flow of now plentiful — even disruptive — technologies today.

But there are a few things they simply cannot afford to skimp on, and resident security tech is one. New products and services are making it easier than ever to keep residents safe — while also making many existing options obsolete.

Yet with all the competitive, financial, legal and regulatory pressures to keep communities safe, residents aren’t the only things aging in place. Even well-established, stalwart tech is in need of serious facelifts in many senior living communities. Like everything, it’s a juggling act. Acquisition cost may be the biggest hurdle, made even more dicey to navigate by the political chaos in Washington. As Brad Hyder, marketing director for TekTone Sound & Signal Manufacturing, observes, “Changes to the healthcare structure are leading to a level of uncertainty. With drastic changes to the market over the last few years and uncertainty for the future, a lot of facilities are hesitant to make any big changes.”

Just a few years back, few owner- operators knew little of things such as real-time location services or predictive analytics. Yet these and other emerging technologies are transforming and expanding the capabilities of resident security in long-term care. Legacy technologies like Wi-Fi, along with an explosion of mobile smartphone applications and electronic health records are making it more possible than ever to integrate resident security into the larger realm of resident care and quality.

“Resident security technology is increasing as we see operators looking for advanced ways to provide a safe environment converge with manufacturers’ growing interest in the senior living marketplace,” observes James Jansen, product manager for Direct Supply. “Technology that was traditionally only within reach for hospitals, education and government is becoming realistic for the senior living space.

Hyder believes resident security is in a period of rapid growth. “With more companies developing time to R&D, new technologies are altering the canvas for resident security standards across the globe,” he says. In addition, he sees newer medical technologies and an increased need for wireless networks pushing the desire for more facilities to want integration and interconnectedness across all platforms.

Only recently has the awareness of new resident security tech been this palpable.

“Resident security technology is evolving. It was stagnant for the last 10 years, but over the past five years, new technologies, feature functionalities and integrations have been developed,” Wasson says. Around the corner: a major impetus thanks to healthcare reform. Wasson contends those efforts are driving change.

“I believe that accountable care organizations and the Centers for Medicare & Medicaid Services initiatives may force communities to adopt these new technologies,” she adds. “It will be hard for the communities that do not adopt new technology to stay competitive.”

To understand how CMS now is driving interest, look no further than changes in long-entrenched systems, according to Tim Fischer, vice president of sales at RF Technologies. “The CMS guidelines requiring Quality Assurance Performance Improvement plans by the end of this year are spurring a lot of activity in nurse call systems,” he says.

Few evolving technologies are changing and improving resident security more than sensors, which play key roles in everything from resident fall management to elopement, as Maayan Wenderow, director of marketing for EarlySense, notes.

“I do see an increasing trend to make investments in technology and market it to all stakeholders,” she says. “From what I see, skilled nursing facilities are in the process of adopting technology and innovative sensor technologies to increase residents’ safety and stay current with CMS trends such as the Five-Star rating, [as well as] pressure from referring hospitals and family members concerned about their loved ones.”

Tech adoption drivers

Several factors are driving resident security tech adoption.

Particularly with non-skilled senior living, competitive pressures to have the latest innovations are peaking. Says Fischer: “A lot of communities are implementing new systems so they can be more competitive in their local markets.” That competition also is coming from employees, more and more of whom are immersed in mobile tech. As Fischer explains, an increasingly number of facilities are replacing pagers with smartphones and call-system apps.

“In today’s environment, two must-haves are mobility and reporting,” Wasson adds. “Mobility solutions allow for a quicker response to a resident’s call and enhance communication between staff for assistance.” Myriad mobile apps now greatly enhance areas such as resident wander management, HVAC, resident entertainment, fire alarm, and fall technology, she adds.

And the ubiquity of Wi-Fi now makes wireless security essential.

“UL 2560-listed wireless emergency call system solutions in assisted and independent living settings offer reliability and durability, plus ease of installation, flexibility and scalability,” says Todd Stanley, senior product manager at Inovonics. They also greatly facilitate faster response times.

The pace of new products flooding the market almost demands frequent upgrades, as Jeff Moore, U.S. director of senior living for Philips’ Home Monitoring division observes. “Technology is constantly evolving everywhere we look in healthcare,” he says.

Q: First of all, does this mean that there is no such thing as the LeadingAge Center for Applied Research anymore?

A: Yes. We are in the process of getting everybody to start using LeadingAge LTSS Center @UMass Boston as the formal title. That’s a mouthful, so it probably will get reduced at some point, but I don’t think the title is as important as the fact that we’ll still be here at LeadingAge.

The partnership is virtual and builds on our collective skills, expertise and knowledge. It strengthens our footprint in trying to do applied research that’s translational.

Q: How did the new center come about?

A: It’s been in the works for about a year, having evolved through a series of conversations that began with Len Fishman.

Len was the CEO of LeadingAge in the late 1990s and now is the director of the Gerontology Institute at UMass Boston, which is the overarching entity at UMass within which this center, with Marc Cohen at its head, has been established. Len and I have a long history together. When he was at LeadingAge, he encouraged me to come and start an applied research group.

At UMass, Len was working with Community Catalyst, a consumer advocacy organization that had a legacy grant from The Atlantic Philanthropies to support a center that was focused on applied research that would influence policy around LTSS. As we discussed the evolution of that center, it occurred to Len and me that maybe there would be a way to think about how we brought UMass Boston and their academic orientation together with our group to form one larger group that would focus on LTSS very broadly.

Community Catalyst has quite a few state affiliates or folks out in the fields who are working on a number of consumer-oriented issues around health. We’ve worked with them before, but now our relationship is becoming more formalized.

Q: Where do things stand with the center?

A: Our members have been very excited about it, we’ve received some good feedback and the external research community also has been really excited about it.

It’s a work in progress. It’s not a financial merger but a joint venture of staff and philosophy and goals. It’s an interesting experiment.

We’ve set up a steering committee. We had a retreat in Boston where we brought both of our staffs together to start thinking about joint cultures and joint projects and that kind of thing. We’re working on a new joint website. It will include an interview with Marc Cohen and me talking about the merger and how it benefits each of our institutions.

The focus here is on bringing our groups together to do joint applied research work, then aggressively trying to influence the policy process. We will be doing more work jointly in terms of getting money for projects.

We’re exploring a couple of projects around home care — trying to understand the future of the home care evolution in terms of the different business models and what that means for the workplace and the workforce — and we’re also looking at housing with services in Massachusetts. We’re also looking at issues around culture change and quality improvement in nursing homes because we have some joint interests in that area. Then, of course, the whole area of LTSS financing. Marc Cohen has tremendous expertise in that area and actually was working with LeadingAge on some of those issues even before he moved over to UMass Boston.

The relationship and the partnership is going to grow as we get more joint projects together. That’s one of our major aims.

LeadingAge has two administrative people and seven researchers as part of the center. We now are fellows at UMass Boston, and we’re going to be doing some adjunct teaching there. We now have full access to a lot of university resources, including the library, which extends our reach in terms of getting access to materials.

We’re also hoping to have opportunities for graduate students to do internships here, to give them more experience in the applied environment.

Those kinds of things don’t typically happen when you’re simply partnering with a university on a particular project.

Silver Lake, based in Menlo Park, CA, and General Atlantic, in New York City, will own equal stakes in A Place for Mom and will add two representatives to the senior living referral service’s board of directors. A Place for Mom will continue to be led by CEO Sean Kell and the company’s management team members, who will remain shareholders in the business.

Other details of the transaction were not disclosed.

“We are proud of the progress we have achieved together with our valued network of senior living community partners and through our partnership with Warburg Pincus,” Kell said in a statement. “General Atlantic and Silver Lake both have proven track records of partnering with high-growth companies and will add considerable strategic value as we aim to expand our capabilities to serve the needs of both our families and network of senior living providers.”

The 17-year-old company said it hopes to expand its service offering across the senior living continuum to provide better access, coordination and quality of care for the families it serves. In addition, A Place for Mom said it expects to make additional investments in its technology platform, including in cloud-based initiatives and advanced data collection and analytics.

A Place for Mom said it currently works with more than 18,500 U.S. and Canadian senior living communities, although some operators are trying to rely more on referrals from residents and their websites in an effort to save on fees paid to referral services.

For instance, Five Star Senior Living Chief Operating Officer Scott Herzig told participants in an earnings call earlier this year that the company’s website now accounts for almost 17% of move-ins, up 29% year-over-year. “Conversely, move-ins from A Place for Mom are down to less than 5% of our total move-ins, which is down 47% from the year ago,” he added.

A Place for Mom, which offers its services at no charge to families, said it helped more than 275,000 families last year.

Sixty-seven percent of Americans aged 65 or more years now access news on mobile devices, according to center interviews with more than 4,100 adults between March 13 and 27. That’s a 24-percentage-point increase over the past year and approximately three times the share of four years ago, when 22% of those in this age group said they accessed news on mobile devices, Pew said.

For those older adults who access news on mobile devices and computers, only 44% of them said they prefer to access news on mobile devices, however. Fifty-one percent said they prefer to access it via a desktop or laptop computer.

Of all age groups surveyed by Pew, this one was the only one that didn’t prefer mobile devices. The other age groups into which study participants were divided were 50 to 64, 30 to 49 and 18 to 29. The younger the group, the more its members said they preferred mobile devices over computers.

“We love being part of the continued development in Louisville, and we’re excited that the LouVelo bike-share program will give our employees more access to what the downtown area has to offer,” Regan Atkinson, Atria Senior Living’s senior vice president for creative, marketing and communications, told McKnight’s Senior Living.

The LouVelo program offers people short-term bike use via 305 bikes positioned at 27 stations around the city. The bikes can be picked up at one station and returned to any other station in the system. The city is planning to expand the network around the city and out to the suburbs.

In addition to Atria, LouVelo sponsors include Computershare, Norton Healthcare, JP Morgan Chase & Co., UPS, Main & Clay, Genscape Inc., The Brown Hotel, KentuckyOne Health and The Eye Care Institute.

“These great community partners know that quality of life is a critical factor in maintaining and growing a talented workforce in Louisville,” Louisville Mayor Greg Fischer said May 25 in announcing the program’s availability.

The most recent list compiled by Argentum lists Atria as the seventh largest senior living company in the country. According to its website, Atria has more than 14,500 employees who work at 190 communities over 28 states and seven Canadian provinces, where they serve more than 21,000 independent living, assisted living and memory care residents.

The Obama-era overtime rule would have doubled the salary threshold — from $23,660 to $47,476 per year — under which most salaried workers would be guaranteed overtime pay when they work more than 40 hours per week. It was opposed by several associations representing senior living operators.

The rule, finalized in May 2016, was set to take effect Dec. 1, but the U.S. Chamber of Commerce, several states’ attorneys general and other national and state business groups filed legal challenges. A judge issued a preliminary injunction in November, and soon after, the Labor Department filed an appeal.

In Friday’s brief, however, government attorneys said: “The Department has decided not to advocate for the specific salary level ($913 per week) set in the final rule at this time and intends to undertake further rulemaking to determine what the salary level should be. Accordingly, the Department requests that this Court address only the threshold legal question of the Department’s statutory authority to set a salary level, without addressing the specific  salary level set by the 2016 final rule.”

In a June 27 press release, the Department of Labor said it already has a request for information related to the overtime rule to the Office of Management and Budget for its review. “When published, the RFI offers the opportunity for the public to comment,” the department said.

Chamber: Some employers can’t pass along increases

An addendum to Friday’s brief included a Sept. 4, 2015, letter that the U.S. Chamber of Commerce had sent to the Labor Department arguing that healthcare companies would not simply be able to raise prices should the overtime rule go into effect, as companies in some other industries might be able to do.

“Many employers in the healthcare industry depend on reimbursements from Medicaid, Medicare and private insurance — which will not increase just because the department raises the salary level for exempt employees,” the letter stated, later adding: “The only option for non-profit, government and healthcare employers is to reduce services by decreasing headcount and hours worked. For healthcare employers, however, reducing services often is not an option either because of laws requiring a minimum level of service. Thus, employers in these sectors will face significant hardships, and the people who rely on their operations will be forced to go without these services.”

At the time the comments were made, the U.S. Chamber listed among the members of its board of directors Paul Klaassen, founder of Sunrise Senior Living.