Current trends in assisted living from the design perspective Residential is the theme - social is the model. Assisted living is not healthcare with residential finishes even though it is an economical replacement for elderly nursing environments. Assisted living environments are designed social environments that encourage wellness. Facility designs must create environments that are comfortable, familiar, secure and durable that offer support in a community atmosphere. Assisted living facilities (ALF) neighborhoods consist of apartments in clusters of eight to 10 units. The concept of "neighborhoods" is an underlying residential theme simulated in ALF because neighborhoods encourage socialization. In addition to a residential and neighborhood feel, units offer choice. Choice is an important decision-making factor because consumers are accustomed to options. Varieties in unit types, sizes, layouts and amenities are some of the alternatives we build into our programs.

SUPPORT In addition to a residential environment and the options one has to chose from, the facility must resonate with subtle support. Depending on the age and faculty level of residents, the services provided may lean more toward healthcare or more toward hospitality. Consequently, a concierge desk offers help and support in place of the nursing station, and life safety appliances exist but are disguised. Accommodating our seniors in a service-oriented manner, regardless of the service, is paramount toward designing an ALF more reminiscent of a hotel vs. an institutional healthcare facility.

COMPETITION Competition amongst ALF providers has become increasingly intense. Clearly, we are in the midst of a fast paced building environment in an industry that is continually growing and evolving. To be successful, we must meet both the market trends and residents' expectations. The type of facility we design must depend on what the target market desires. Targeting prospective residents means creating an environment that is familiar to that populace. Market feasibility studies should include an analysis of the needs and expectations of your target residents. With a clear idea of what residents are looking for, designers can create the appropriate atmosphere for that market segment.

RETROFIT OR NEW STRUCTURES? Location is a core element to the success of an ALF. The question therefore is how to select a site--renovation or new construction? If vacant property is unavailable, should you renovate an existing property in a good location? What are the zoning and land planning issues if you build new? What is the competition doing? Are they finding success? If cost is a major consideration, building new may be less costly. Converting a skilled nursing facility (SNF) that has a good reputation and prime location may be a viable alternative since code, zoning and land planning issues may be minimized. However, the existing footprint may be difficult to convert into a residential-style facility. One may also find it challenging to convert a clinical environment into a non-clinical one. Long straight halls are very institutional and not conducive to sight distances and ease of movement. Central nursing stations are not suggestive of a social environment. It is more cost effective to address these issues in a new facility than in a conversion of an existing structure. Consequently, conversions require a great deal of creativity and offer additional challenges to the designer.

ACCESSIBILITY Accessibility issues in ALF often go beyond the requirements of ADA. Understanding the elderly, their particular frailties and where the ADA diverges from their needs is important in the design of ALF. For instance, the designer must be conscious that raised toilets may not be advisable for people of small stature, shower grab bars may require enhancement to provide stability, ADA sloped ramps are generally too steep for elderly individuals with decreased mobility and, finally, ADA guidelines accept a 1/2 level of floor change, which can be a tripping hazard for the elderly.

CONCLUSION ALF environments that create a residential feel, promote wellness, provide individual support and exude accessibility will be the ones most sought after by today's discerning residents. As designers we must not only, design with the residents in mind, we must also design around the needs and expectations of the community and the facility owner. Clearly, ALF design requires the ability for architects to provide multiple masters with thoughtful design concepts, tactful diplomacy and compassion.Arthur A. Bernardon is president of Bernardon & Associates Architects, P.C., a land planning, architectural and interior design firm in Kennett Square, Pa., and Wilmington, Del.

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