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Health, Wellness, and Designing for Senior Living

This program is registered with the AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.

Questions related to specific materials, methods and services will be addressed after the conclusion of this presentation.

Thank you!

AIA Approved – 1 AIA LU/HSW credit

Health, Wellness, and Designing for Senior Living

This CEU is registered with Interior Design Continuing Education Council (IDCEC) for continuing education credits. This credit will be accepted by the American Society of Interior Designers (ASID), International Interior Designers Association (IIDA), and Interior Designers of Canada (IDC).

The content included is not deemed or construed to be an approval or endorsement by IDCEC of any material or construction or any method or manner of handling, using, distributing, or dealing in any material or product.

Questions related to specific materials, methods, and services should be directed to the instructor or provider of this CEU.

This program is registered for 1 CEU value.

This CEU will be reported on your behalf to IDCEC and you will receive an email notification. Please log in and complete the electronic survey for this CEU. Certificates of completion will be automatically issued once you have submitted the online survey for this CEU.

Attendees who do not belong to ASID, IIDA, or IDC and do not have a unique IDCEC number will be provided with a Certificate of Completion after this CEU.

Health, Wellness, and Designing for Senior Living

This course is approved by GBCI for 1.0 continuing education hour and WELL-specific. Approval for this course indicates it will be monitored by GBCI to ensure that it upholds the quality, relevance and rigor necessary to contribute to ongoing learning in knowledge areas relevant to the green building industry.

Health, Wellness, and Designing for Senior Living

Amy Costello, P.E., LEED AP, WELL APSustainability Manager

Learning ObjectivesAfter completing this course, you should be able to:

• Identify key considerations for designing senior living spaces.

• Describe how biophilia is addressed in LEEDv4 and WELL v1 Feature 88 – Biophilia I Qualitative.

• Explain how WELL v1 Feature 72 ADA Accessibility applies to senior living.

• Discuss how WELLv1 Feature 64 – Interior Fitness and Circulation applies to senior living.

• Key Design Considerations

• Health & Wellness

• Universal Design

• Codes & Standards

Agenda

Senior Demographics

For the first time in U.S. history, older adults are projected to outnumber children by 2035.

Senior DemographicsBy 2038, 80+ households will be the fastest-growing age group.

Source: 2018 JCHS Household Projects, Harvard University

10.69

17.54

0

2

4

6

8

10

12

14

16

18

50–54 55–59 60–64 65–69 70–74 75–79 80 and Over

Households (Millions)

2018 2028 2038

Senior Demographics

In Canada, by 2030, seniors will number over 9.5 million and make up 18 percent of population.

Source: Statistics Canada (1971-2010) and Office of the Superintendent of Financial Institutions (2020-2080)

Senior Demographics

Source: National Center for Health Statistics (NCHS), National Study of Long-Term Care Providers, 2018

Distribution of long-term care services by age(United States 2015-2016)

Senior Living SpectrumContinuing Care Retirement Community

Retirement Community

SeniorApartments

Adult Daycare

IndependentLiving

In-HomeSenior Care

Assisted Living

Personal Home Care

DementiaAlzheimer

Memory Care

Nursing HomeRehab

Hospice

Respite Care

Level of Care & Supervision HighLow

Cos

t

High

Low

Base

d on

Mod

el b

y Se

nior

Livi

ng.c

om

Identifying the Care Population

Who are you designing for?

Senior Living Stages for DesignProject

InitiationFunctional Program

Development

Detailed Design, Planning and Scheduling

Execution Monitor & Control

A functional program is an initial planning document that records the project’s purpose & key requirements.

• Ask questions to discover the operational components that impact the design of the physical environment.

• Conduct workshops, focus groups, surveys, staff shadowing, etc. to gather operational process input from staff and administration

• Document the physical space. (e.g., sizes, adjacencies).

• Evaluate operational flows (e.g., environmental services, nursing care, dining services, deliveries, facilities management).

• Learn how building/space will be used to maximize outcomes, increase safety, reduce risk, and improve quality of life.

Designing for Senior Living

Codes & Regulations

• Building Codes

• Licensing Codes

• Federal Regulations

Design Guidelines

• FGI Guidelines

• Universal Design

• Aging in Place

Building Standards

• WELL Building Standard

• LEED

• Green Globes

Driven by mandatory & voluntary requirements

These requirements are not unique – they overlap.

Designing for Senior Living

So they look more like this.

Safety, Health & Wellness

EVIDENCED-BASED DESIGN

Universal Design

A design process that enables and empowers a diverse population by improving human performance, health and wellness, and social participation.

7 Principles of Universal Design1.Equitable use

2.Flexibility in use

3.Simple and intuitive use

4.Perceptible information

5.Tolerance for error

6.Low physical effort

7.Size and space for approach and use

Universal Design ExamplesEquitable Use Inclusive

Perceptible Information Signage

Universal Design ExamplesSimple & Intuitive: WayfindingLow Physical Effort: Automatic Doors

Universal Design ExamplesSimple & Intuitive: Wayfinding

St. Thomas Hospital, OntarioKahler Slater

Universal Design ExamplesFlexibility and Use: Accessibility/Choices

Designing for Senior Living

Designing for Senior LivingSilver Meet all preconditions

GoldMeet preconditions + 40% of optimizations

PlatinumMeet preconditions + 80% of optimizations

5 Points for Preconditions

5 PointsOptimization

Optimizations Approved

Total Optimizations

WELL Building Standard

Feature 64 – Interior Fitness and CirculationPart 1 – Stair AccessibilityAt every major building entrance:Wayfinding signage and point-of-decision prompts to encourage stair use. At least one sign per elevator bank and one per building entrance.

Feature 99 Beauty and Design IIPart 3 – Spatial FamiliarityArtwork can be used to establish wayfinding, aid in orientation, and provide spatial familiarity.

Examples of WELL Features related to Universal Design:

Building CodesInternational Construction Code (ICC)• All 50 States have adopted some

version of the ICC Building Code.• Assisted living facilities are classified as

I-1 occupancy, and nursing homes & hospitals are classified as I-2 occupancy

• States may classified differently (e.g., Massachusetts classifies assisted living facilities as R-2).

• States can adopt additional requirements.

Building Codes & FlooringChapter 8 Interior Finishes

804 Interior Floor Finishes804.1 General

804.2 Classification804.3 Testing and Identification804.4 Interior Finish Floor Requirements

804.1 GeneralInterior floor finish and floor covering materials shall comply with Sections 804.2 through 804.4.2.

Exception: Floor finishes and coverings of a traditional type, such as wood, vinyl, linoleum, or terrazzo, and resilient floor covering materials that are not comprised of fibers.

IIC and STC of 50

FIIC and FSTC of 45

Fire

Chapter 12 Interior Environments1207 Sound Transmission

Building Code – Sound Transmission

What is Airborne (Transmitted) Sound?

Any sound that is transmitted through the air, like the sound of someone speaking.

What is Vibration Sound?

Structure-borne noise is generated by sound sources in direct contact with the building structure, like impact from a rolling cart.

Building Code – Sound Transmission

STC & IIC are for the entire structure.

To compare values, structures must be the same!

Building Code – Sound Transmission

IIC: ASTM E-492 STC: ASTM E-413 & E-90

RegulationsSocial Security Act• Mandates the establishment of minimum health

and safety standards that must be met by providers and suppliers participating in the Medicare and Medicaid programs.

• Title 42 – Public Health

• Mandates NFPA 101

Chapter 10: Interior Finish, Contents, and Furnishings

10.1 General.

10.1.1 Application. The interior finish, contents, and furnishings provisions set forth in this chapter shall apply to new construction and existing buildings.

NFPA 101 (2012) Life Safety CodeFlooring Fire Testing

• NFPA 101 Life Safety Code: A set of fire protection requirements designed to provide a reasonable degree of safety from fire.

WELL Building Standard – Air Feature 25 – Toxic Material Reduction (Optimization)Part 2: Flame Retardant Limitation

Halogenated flame retardants are limited in the following components to 0.01% (100 ppm)

Flooring, ceiling tiles, and wall coverings

These halogenated

flame retardants are not used in vinyl flooring

RegulationsAmericans with Disabilities Act (ADA)

• Enforceable accessibility standards

• Minimum requirements for newly designed and constructed or altered public facilities

• Must be readily accessible to and usable by individuals with disabilities.

WELL Building StandardFeature 72 – ADA Accessibility (Precondition)

Part 1: ADA Regulations

Buildings must comply with ADA Standards for Assessable Design.

Per ADA Standard Section 302Floor and ground surfaces shall be stable, firm, and slip resistant.

Facility Guideline InstituteFGI Guidelines

• Basic information on planning, design, construction, and commissioning

• Minimum design requirements

• Allow flexibility in design to support development of facilities that will meet the needs of owners and their communities over the long term

• 42 states have adopted some edition of the Guidelines

FGI GuidelinesAdoption by State

Source: https://fgiguidelines.org/guidelines/state-adoption-fgi-guidelines/

FGI Guidelines

Source: https://fgiguidelines.org/guidelines/state-adoption-fgi-guidelines/

Nebraska has adopted the 2018 Guidelines for Design and Construction documents to be applied to any facility currently licensed under the Nebraska Healthcare Facility Licensure Act or that will be licensed under the act once construction has been completed. Construction means a facility or distinct part of a facility in which services are to be provided which is enlarged, remodeled, or altered in any fashion, or is built from the group up. Minor projects such as repairing or replacing existing material do not fall under these requirements. These requirements apply to ambulatory surgery centers, critical access hospitals, general acute hospitals, and other hospitals. For assisted living facilities, long-term care hospitals, nursing facilities, and skilled nursing facilities, the 2018 Guidelines apply to new construction projects beginning September 1, 2019. (7/30/19)

FGI Guidelines for FlooringFloor Pattern

Studies suggest that flooring with a medium-sized pattern (1–6” wide) were associated with more falls

than floors with no pattern, a small pattern (< 1” wide), or a large

pattern (wider than 6”).

Smooth Transitions Stable & Slip Resistant

Transitions should be smooth between different flooring materials.

Surfaces, including those on stairways, shall be stable, firm, and

slip-resistant.

Color Contrast

Consider color contrast between walls and floors and minimized

transitionsto different types of flooring

may reduce falling risk.

Cleanable & Wear Resistant Floor Reflectivity

Floors should be easy to clean and resistant wear in each location.

High gloss value finished floors cause glare that may compromise patient vision, disrupting balance.

FGI Guidelines for FlooringSmooth Transitions• Floor transitions can

be a fall risk hazard.

• Using smooth transitions may reduce falls.

Source: Theodos, P. (2003). Fall prevention in frail elderly nursing home residents: A challenge to case management: Part I. Lippincott’s Case Management, 8(6), 246–251.

Example: Bad transition with a high threshold and high color contrast that can be perceived as level changes.

Example: Good transition with a low-contrast floor and level threshold.

FGI Guidelines for FlooringColor ContrastConsider that color contrast between walls and floors and minimized transitions to different types of flooring may reduce falling risk.

FGI Guidelines for FlooringFloor PatternSelecting flooring with small motifs and low contrast as a resident fall risk-prevention measure.

Studies suggest that flooring with a medium-sized pattern (1–6” wide) are associated with more falls than floors with no pattern or small pattern.

Source: Calkins, Biddle, & Biesan, 2012

FGI Guidelines for FlooringFloor ReflectivityHigh gloss value finished floors cause glare that may compromise patient vision, disrupting balance.

• Flooring surfaces shall be cleanable and wear-resistant for the location.

• Surfaces shall be non-absorptive, nonporous, and smooth.

• Manufacturer-recommended cleaning and disinfection protocols ensure durability and effectiveness.

WELL Feature 28 – Antimicrobial Surfaces (Optimization)

Nonporous high-touch only Flooring is not included

FGI Cleanable & Wear Resistant

Licensing Regulations• Vary by state

• Typically overseen by State Health Agencies

• Maintain facility standards

• License health-care facilities and agencies including hospitals, nursing homes, residential/assisted Living and other facilities

• Inspect periodically to ensure citizens receive safe, high-quality care

Source: https://aspe.hhs.gov/

Codes & RegulationsSummary Example

IBC Adoption Occupancy None Moderate Full General MinorGroup Assisted Living Community NFPA 101, 2000 ed. I-2Congregate Assisted Living Community NFPA 101, 2000 ed. I-3

Alaska Assisted Living Center: Direct Care Services n/a 2012 IBC Statewide (SW) I-4 X XAssisted Living Center: Personal Care Services I-1/R-4Residential Care Community for Elderly I-2Assisted Living Community - Level I NFPA 101, 2015 ed. 2012 IBC SW I-1/R-4Assisted Living Community - Level II NFPA 101, 2015 ed. I-2

California Residential Care Community for Elderly n/a 2018 IBC SWR-2: I-1

amendedX X

X

NFPA Referenced

Alabama

Arizona n/a

X

X

State Type of Community

Arkansas

2015 IBC Limited Statewide (LS)

2012 IBC LS

Licensing Regulation & Enforcement

Statewide Regulation Coordination

Referenced IBC

X

X

X

Designing for Senior Living

EVIDENCE-BASED DESIGN

Safety, Health & Wellness

Evidenced-Based Design

The process of basing decisions about the built environment on credible research to achieve the best possible outcomes.

The Center for Health Design

Biophilic Design

Emerging field that recognizes our psychological need to be around life and life-like processes.

Interior environments that are cold, sterile and devoid of life diminish our experience, mood and happiness and can reduce creativity and cognitive function.

Why Biophilic Design?

• Improve cognitive function and creativity

• Improve our well-being

• Fewer ailments

• Expedite healing

• Reduce stress

Experiencing nature can elicit a restorative response.

Patterns of Biophilic Design?

Nature in the Space: Visual or non-visual (sensory, airflow, water light)Natural Equivalents: Objects, materials, and patterns that evoke natureNature of the Space: Differing spatial configuration of the built environment

Connection with Natural Systems

Source: Assistant Secretary for Planning and Evaluation (ASPE), 2015

WELL Building Standard

• Recognizes the importance of creating an interior environment that nurtures the innate human-nature connection.

• The nervous system is the main control center of the body; it controls every internal function of the body and interacts with the external world.

• Develop a three-part Biophilia PlanPart 1: Nature IncorporationPart 2: Pattern IncorporationPart 3: Nature Interaction

Feature 88 Biophilia – Qualitative (Optimization)

LEED & Biophilic Design

• To connect building occupants with the outdoors,

• Reinforce circadian rhythms, and

• Reduce the use of electrical lighting by introducing daylight and views into the space.

Daylight & Quality Views Credit

Kaleida Health Buffalo, New York

Option 1. Daylight Measurement (2 points) – 50% of regular occupants have access to daylightand/or

Option 2. Quality Views (2 points) – 50% have access to views

Biophilic – Light Exposure to light can impact mood & cognition.

Source: Nature Reviews Neuroscience 15, 443–454 (2014)

Figure:Model of the direct and indirect influences of light on mood and cognition.

Biophilic – Light Impacts mood & sleep in dementia patients

Lighting intervention, tailored to increase daytime circadian stimulation, can be used

to increase sleep quality and improve behavior in patients with Alzheimer’s

disease and related dementias. (Figueiroet al., 2014)

Evidence that a higher daily light exposure has beneficial effects on emotions and

thus improved quality of life in a severely demented patient group(Schmieder et al., 2017)

Summary

You should now be able to:• Identify key considerations for designing senior living

spaces.

• Describe how biophilia is addressed in LEEDv4 and WELL v1 Feature 88 – biophilia I Qualitative.

• Explain how WELL v1 Feature 72 ADA Accessibility applies to senior living.

• Discuss how WELLv1 Feature 64 – Interior Fitness and Circulation applies to senior living.

Thank you for your time.This concludes The American Institute of Architects

Continuing Education Systems Course.