With some advance planning, it's possible to make significant design improvements without breaking the bank. Subtle changes can make a big difference, experts say

Design on a dime

McKnight's Assisted Living/June 2012
By Julie E. Williamson

In today's competitive assisted living market, more and more operators are finding that eye-catching, well-functioning environments are one of the best routes to attracting and maintaining residents. Fortunately, many operators also have discovered that successful design projects needn't break the budget.

Whether a community is in line for a modest revamp or a broad-scale overhaul — or something in-between — design experts agree that some advance planning and prioritizing can get the most bang from design budget dollars. Well-executed designs also can pay big dividends in the long-term by boosting resident satisfaction and drawing new residents to the facility.

"Every homebuilder in America knows that buyers make buying decisions based on first impressions and appearance. In an assisted living community, the buyers are often the extended family who will make the mental judgment about the community based on its appeal," said Judith Sisler Johnston, president of Sisler Johnston Interior Design.

Depending on budget and need, that appeal can come in many forms. Simply replacing worn, stained or malodorous flooring, reupholstering existing furniture with more durable, commercial- grade fabrics or giving window dressings and walls a modern facelift can go a long way. Creating more multipurpose areas through creative furniture placement and other design cues also can elevate a community's appeal. And if budgets are really tight, operators shouldn't overlook the value of a new paint color for breathing new life into an otherwise dated space.

"I've learned through experience that you don't have to spend a lot of money to make a good impression on residents and their families. You just need to spend the dollars that you do have wisely, so you can make the biggest impact," assured Donald Sapaugh, the president of University General Health System and founder of TrinityCare Senior Living LLC.

Rein in the plan

Before a design even makes it to the drawing table, operators should carefully determine which area or areas warrant the most attention.

"Often, we see operators try to spread the capital too far and it ends up where you don't notice the dollars spent," said Sarah Carney,regional project consultant for Aptura, a division of Direct Supply Inc.

Focusing on a few key areas is the best approach, added Aptura interior designer Meg Sutton.

"Make a big impact by using the entire budget to do one or two spaces completely and well," she advised. Designers largely agree that common areas offer the biggest bang for the buck.

"First impressions are often lasting impressions, so it does often make sense to spend more in the common areas that are most visible," reasoned Chez Eider, president and CEO of Eidco Construction. Taking an "outside in" approach, where lobbies and reception areas are a top design priority, will offer immediate rewards, he said.

"These are the first areas visitors and prospective residents see, so they need to be warm and inviting. If they're outdated and unappealing that will, unfortunately, set the tone for the rest of the building," Eider continued.

When designing for one 15-year-old assisted living community, Sisler Johnston did a budget-friendly overhaul of the entry area by installing walnut wood grain acoustical tiles in the ceiling coffers and color "banding" the surrounding drywall in a fresh and lively green hue. The peach-colored laminate-clad entry reception desk was covered with wood panels and a granite top.

"It is more cost-effective to clad over than to replace," she noted.

Softening automatic sliding commercial entry doors with standing side-entry drapery panels and decorative rods was another inexpensive, high-impact change that offered more residential appeal, she said.

"Using tile to accent behind a reception desk can also give a quick and refreshed look," added Lissa Rolenc, senior lead interior designer for Aptura.

Regardless of the size and configuration, the best common areas are versatile, multifunctional and, above all, easy to navigate. According to Carla Jaspers, a practicing occupational therapist and interior designer, spaces can get a boost simply from strategic furniture placement that promotes social interaction.

"Very large common areas can serve many different purposes — from yoga to educational classes and parties. But when that big, wide open space isn't needed, you can still create intimacy by simply rearranging furniture," she said. Bringing the outdoors in with functional windows and the use of live plants, stone, wood and other natural elements is another good design strategy, she added.

Patterns and hues also should be a top design consideration. Dark-colored rugs and busy floor patterns can appear as holes in the ground to those with impaired vision, explained Mitch Warren, president of LaSalle Group. On walls and fabrics, warm tones, such as shades of blue, green, deep plum, and soft neutrals, create a soothing atmosphere. "It is important to avoid reds and oranges. They can represent fire in the eyes of someone with dementia. Yellow can cause disorientation," he warned.

It's important that furniture look good and be resilient to the rigors of hard use, according to Kwalu. The modular construction of its products enables customers to mix and match frame styles, finishes, and upholstery choices to create unique furnishings.

Value of versatility

Dining rooms also should serve up good design flavor. Experts say the best ones not only look appealing, but are large enough and able to accommodate residents with walkers and wheelchairs.

"Having a dining room look and function well helps keep census up," said Dennis Boren, sales manager of Space Tables. "The dining room is a big part of the image the facility presents to the outside world."

Adjustable-height tables, round tables and larger table tops to accommodate wheelchair undercarriages are wise investments, he said. Between meals, larger dining areas also can be repurposed for other activities.

Trinity SeniorCare facilities all feature expansive dining rooms that back to a large great room. "Both of these areas really are the cornerstone of the facility," said Sapaugh.

Standardizing furnishings across all communities helps ensure design symmetry; fabrics, colors and patterns differ according to facility and region. Standardizing furnishings also helps keep costs down. Trinity SeniorCare splurges on luxury design touches like granite and marble thresholds. The products' durability helps save on replacement costs, while pleasing new and prospective residents, said Sapaugh.

Facilities with many small community areas don't need to spend big bucks knocking down walls. In fact, smaller, more intimate spaces can be popular destinations, as long as they serve a unique and dedicated purpose.

"Rather than six living rooms, give each space a specific purpose so folks know exactly why they might go there," recommended Sutton. Turning those living rooms into a library, media center, theater, café, billiards parlor, or ice cream shop are just a few of her suggestions.

Common areas also can be constructed, renovated or redesigned as a "blank slate." These spaces then can be outsourced to tenants who will operate a specific business, such as a spa, salon, market, bank or even a concierge service. "This gives added value to residents, but without the operator having to [take on the responsibility] of managing the service," said Eider.

Clearthe clutter

Just because common areas are a priority doesn't mean operators should neglect resident rooms, however. Fortunately, rooms can be significantly improved on even a shoestring budget. One of the most immediate fixes, according to Jaspers, is opening up cramped quarters through scaled-down furnishings, improved furniture layout and better use of vertical space.

"As a therapist, I see a lot of rooms that just aren't functional, and I'm always trying to move things out of the way," she said.

In her designs, she favors more streamlined furniture over bulky, Colonial-style versions — a trend she said is being driven by the next generation of seniors with more modern design taste. She also likes wall-mounted shelves to free up space and allow residents to display photos and other memorable objects that personalize the room.

In-room bathrooms also deserve attention. "Facilities retrofit often and bathroom considerations are sometimes an afterthought, with difficult-to-reach faucets, too high counters and so on," Jasper added. "If the resident can't use them easily, the design doesn't work. And that's definitely going to impact satisfaction."

And don't forget the beds. With sleep comprising at least one-third of the day, the value of resident comfort cannot be overestimated, stressed Susan English, marketing executive for SleepSafe Beds. Adjustable beds are gaining popularity in the consumer market, she said, including in the seniors housing segment where operators are seeking a competitive advantage and residents are looking for beds and furnishings that blend comfort and wellness with residential appeal.

"Operators that show the option of having the modern convenience of a beautiful, customizable adjustable bed in residents' personal space will benefit. If they don't embrace this as a recommendation or option, they're going to be missing out on profit margin," she reasoned. American-made SleepSafe Beds feature memory foam mattresses, aluminum frames that have been "over-engineered for safety," and headboards and footboards in a broad range of styles to match any décor (including solid wood in various finishes and upholstered headboards). If preferred, the bed frames can even work with a resident's existing headboards.

Lighting is also critical. "Instant on" fluorescent lighting in bathrooms is one easy way to improve safety and satisfaction, according to Warren. "Dimly lit areas can produce confusing shadows or make it difficult to interpret everyday objects." For added safety, Autumn Leaves assisted living communities, operated by LaSalle Group's parent company Constant Care Family Management, are designed with bathrooms outside the living quarters. "These community bathroom facilities allow for a great deal of privacy, while also allowing for staff supervision."