How do senior living facilities adopt a household model? Retrofit care around the resident

February 19, 2020 Thomas Grden

Older—and larger—senior living facilities can adopt “small house” principles and provide care that doesn’t feel institutional


Person-centered care has been the focus of much of the thinking and preparation for caregivers and organizations in long-term senior care for some time. But some care providers look at the “small house” version of senior care and believe they can’t achieve it. They don’t think of themselves running small houses.

But there are ways to make “small” work on a larger scale.


The household model

A decade ago, the household model arose as a way of administering that person-centered care, building upon a model that emerged in the 1990s, the Eden Alternative®, which emphasized quality of life and caregiving culture.

The household model was originally conceived at the scale of 8 to 12 to 15 beds with shared spaces like a kitchen, dining room, living room, den, and front porch. In this small-house model, each resident lives in a private bedroom with its own full bath, organized as part of the household. This model strives to enhance quality of life and give residents more control over their lives, ultimately enhancing well-being while empowering staff. The household model has been put into practice through specific franchises and new facilities.


What makes a senior-living facility feel like "home?" Five elements are important.


Feeling left out?

But what about caregiving clients that have older facilities? Are they left out? Whether it’s to stay at the forefront of their industry, achieve their mission, or better their reputation in the marketplace, many clients have good reason to embrace the household model.

An older and larger facility presents several obstacles toward creating person-centered care. The physical plant for a facility built between the 1970s and ’90s typically includes features that one might call institutional—double-loaded corridors, shared semi-private rooms, shared bathrooms, and a congregate eating model. Clients will find it difficult to apply the household model in these environments without modification. A traditional “nursing home” facility like this appears anything but homelike in every way, and that goes for its operations, too. It’s all too easy for an owner/operator to conclude that its outdated facility is a bad fit for the house model. Why even try?

One can, however, implement this progressive household idea while retrofitting an older building, but it requires us to think about the big picture first and make some intelligent compromises. In the last few years, my team has been engaged to do several studies and renovations to overcome physical plant limitations and reboot tired facilities around the principles of the household model.


What makes a home

How did we do this?

First, we looked at what makes something feel like “home.” What makes a household? What does it consist of? We boiled it down to five elements that create that feeling of home.

  1. Private space: Bedroom and bath
  2. Personal belongings
  3. Residential scale and familiar materials
  4. Familiar living space: Living room, dining room, and kitchen
  5. Outdoor spaces and location

Elements such as a front door, sense of ownership, sense of place, and optional privacy also contribute to creating a homelike setting. Then there are the materials and textures we associate with home, our personal belongings, memorabilia, and places of significance like dining rooms, the hearth, and fireplace. We compared the institutional version of a room—say one with a central bathing room—with that of a home and a private bath. We began to think about how institutional features like nurses’ stations and those double-loaded corridors could be made more like something we’d see in a private residence.


Model for a home-inspired dining room.


So what else makes a home?

Is it a place? The people? Residents? Both? Resident plus the caregivers?

We researched various models of collective living for insight on how to create community, drawing on models from Europe and elsewhere, such as a rural group farm, a residential community with its own grocery, and the Collective—a co-living quarters for young professionals in the UK who are looking for social interaction in common areas rather than copious private spaces.

_q_tweetable:We found that the young professional model has a lot in common with what residents want in senior living. Both have social needs, medical needs, day-to-day needs, etc. _q_We found that the young professional model has a lot in common with what residents want in senior living. Both have social needs, medical needs, day-to-day needs, etc. We also drew on the U.S. Department of Veterans Affairs work on scaling up the small house model with its Small House Design Guide and projects such as Perry Point in Maryland. If the VA is adopting the household model, many senior-care providers are more likely to see it as attainable.


A broader definition

As we thought about what makes a place homelike, we began to expand our thinking about the definition of a household. This expanded definition helps us empower our clients, so they don’t feel boxed-in to the specifics of the household model. They see a continuum of options that are more homelike.


The challenges of the existing physical plant and building design

What are some of the design strategies that can create that sense of home in decades-old facilities? It’s important to create circulation and do away with dead-end corridors through corner additions, for example.

We create private and semi-private rooms wherever possible. In reconfiguring the buildings, we look at ways to create a dining room, a lounge, make the nurse’s station more like a concierge’s desk at the center of a town square, and create courtyards and green space. We even develop some curb appeal and residential architectural character on the exterior.


Sizes may vary

Eden Alternative and the Green House model recommend specific sizes. But we have had success doing two 15-bed households sharing a country kitchen and dining space. Since then, we’ve worked on a variety of facilities with households of varying sizes that can exemplify the household model at a more robust scale and reach a staffing economy. In future blogs, we will look at different possible sizes of the household model.


A “flexible” household

Living environments for seniors can look bleak. The big message here is that compromise can work, and by embracing a flexible notion of the household model we can meet the challenge of senior care and enhance quality of life.

The good news is that the culture of aging is changing, as are care attitudes. But living environments must change as well. When they do, aging looks and feels a whole lot better.

About the Author

Thomas Grden

Tom Grden has more than 30 years of experience in architecture, and has served as principal, project manager, and lead architect on a variety of projects. His experience encompasses a wide spectrum of building types and construction systems including commercial, residential, institutional, higher education, and renovation projects.

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