Originally Published on efamagazine.com on May 28, 2020

Design Strategies To Prepare For The Next Pandemic

By Duncan Walker | May 28, 2020

Senior communities everywhere are now under stress as they focus on keeping residents and staff safe during the COVID-19 pandemic. The primary tool currently available to curb the spread of the virus is social distancing or self-isolation.

But avoiding isolation is one of the main reasons people choose to live in a retirement community and this is the crux of the problem we now face: How can we safely separate residents from each other, from staff, and the world without causing fundamental harm of a different sort?

Improvised temporary solutions to both protecting residents from the virus and preventing the psychological and physical problems of extended isolation are beginning to emerge. Reducing access to communities and interactions within them are clear first steps that have been adopted almost universally. Done effectively, this should greatly reduce the risk of transmission in independent living, and, to a slightly lesser extent, in assisted living where the care provided requires direct contact. However, memory care and skilled nursing require near constant person-to-person interaction to provide appropriate care, making social distancing in these communities with higher levels of acuity much more challenging.

Several strategies are being put in place now to help navigate this crisis and minimize risk for seniors, including controlled access and limited use of communal spaces. One method for improving outcomes is to limit access to the community to two primary entrances—one for staff and one for residents—to facilitate more consistent and rigorous monitoring of comings and goings from the community.

Additionally, adding entry checkpoints with temperature stations and history questionnaires further supports infection control measures until accurate testing for the virus becomes more readily available. By requiring residents to go through such checkpoints to re-enter the building, they may be less inclined to leave campus for non-urgent issues.

Most communities are also taking steps to reduce resident-to-resident and resident-to-staff contact within their buildings, including closing communal dining and other gathering spaces and encouraging residents to stay in their units as much as possible. Meals are typically being delivered to individual apartments, and public events have been cancelled.


Short-term strategies

Conclusive data is not yet available, but early reports seem to indicate that by implementing these short-term distancing practices measures, independent living is experiencing significantly less infection and death than skilled nursing, with assisted living falling in between the two.

However, an unfortunate side effect is lonely residents, many of whom are not only anxious but also increasingly confused. Even the Centers for Disease Control and Prevention’s interim guidance publication for retirement communities acknowledges the risk that isolation poses to residents’ emotional health. For people in their 80s and 90s, being cut off from their community is not just an unpleasant inconvenience, it can significantly degrade their life and precipitate a serious decline in both mental and physical health.

Current strategies to mitigate the negative consequences of isolation are developing but are less ubiquitous than efforts to create isolation. For residents whose units are at or just above ground level, “visits through the glass” are occurring, usually initiated by family and friends.

The interaction is mainly symbolic and brief, but there is some psychological benefit. However, these visits are not an option for residents on higher floors or with less accessible windows or patios. Visits by family in outdoor spaces with social distancing are a more effective option, even if a parking lot is the only available exterior space.

Other strategies by provider organizations to mitigate isolation include bringing activities, such as books to borrow or craft supplies, to the residents’ doorways on a cart or having staff coordinate corridor bingo games or other group activities where residents remain in their doorways. These group ideas are dependent on the layout of the building and are probably only practical where units are fairly small and doorways are close enough to involve more than one or two residents at once.


Possible long-term design solutions

As more is learned about COVID-19, a more nuanced set of options will no doubt become available, both for controlling the spread and mitigating isolation. However, it’s not too early to begin thinking about how new communities should be designed and how current communities can be modified to be ready for the next crisis. Future contagious disease outbreaks in the foreseeable future are likely, so how can we build resiliency into our retirement communities?

Some preliminary thoughts about future design strategies include:
Building floor plans should be designed to accommodate the logistical issues currently affecting communities. One priority would be creating a screening area at the main entry. Then once people have been screened and allowed access to the community, they should use intentionally designed interior routes that do not pass in proximity to this “triage” area.

• Unit entries could be clustered in groups of four where possible to facilitate “doorway” activities.

• HVAC systems should be designed to allow individual units to be switched to negative pressure without refitting. This would allow safer isolation of sick residents who do not require hospitalization.

• Permanent antiviral coatings should be used on all high-touch public surfaces. This type of coating material is already available and has been used in hospitals for more than a decade. Newer ant-viral products that use nanoparticles are coming to market, and multiple options will likely be available for use soon.

• Exterior gardens should be designed so they can be easily converted to outdoor visiting areas with shelter from the sun and rain. Conceptually, this might look like pairs of benches facing each other across a six-foot-wide, dead-end path.

• Floor plans should include a room adjacent to the front entry that can be converted into an indoor visiting space with a specialized air curtain and exhaust to develop negative pressure on both sides of the room. This will allow residents to safely receive visitors indoors with social distancing and low risk of person-to-person contamination.

• More public-corridor bathrooms should be incorporated into communities to double as hand washing stations for residents and staff . All fixtures in public restrooms should be touchless motion activated.

As we come out of this current crisis, further study, experience, and data will suggest additional recommendations for moving forward. Doing everything we can now to both implement short-term methods and prepare long-term design solutions is critical to keeping seniors, their families, and community staff as safe and healthy as possible.

Duncan Walker, AIA, is a principal at Hord Coplan Macht (Baltimore). He can be reached at dwalker@hcm2.com.

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