Household Model: Part One - Living Areas

Household Living Model: The New Wave of Resident Centered Care

Design impacting residents’ well-being and quality of life, and organization’s success.

Frank W. Rees Jr. and Ronald C. M. Bergstrom

Part One: Household Living Areas

The attributes and benefits of the household model of design are reflected in the designs of three distinctive nursing homes, with households ranging from 10 to 16 residents, developed for unique life-enriching senior living communities in Tyler, San Antonio, and Farmers Branch, Texas.

In each case, the vibrant living structure created combines with a resident-centered environment to form a whole, life-enriching home. The designs advance residents’ peace of mind, well-being, and quality of life. These were evidenced anecdotally in resident’s pleasant countenance, good energy levels, active participation in life-enriching opportunities, and positive engagement with other residents and staff. A general absence of resident disruptive behavior and elopement attempts also existed. Resident survey results included high levels of satisfaction overall and with regard to the living environment.

Additionally, they contribute to the success of both the nursing homes and their respective senior living communities with regard to:

Market positioning, by addressing older adults’ needs and desires
Marketing, through positive outcomes, including resident and family satisfaction
Operations, through admissions, efficiencies, and staff performance and satisfaction

While each home is distinctive in shape, size, and appearance, all share the multiple integrated elements common to the household design model. One of those elements, the Household Living Unit, is addressed here. Two others – Life-enriching Social Spaces and Positive Outdoor Space – are addressed in articles two and three.

Wellington International Senior Living, San Antonio, TX

Purpose and Outcomes Achieved
The nursing home based on a household design model is comprised of multiple household living areas with elements that mirror a traditional private residence. These residences allow:

Older adults who make it their home to experience the enjoyment, pleasure, and health benefits of living in a household; with its pleasant living areas, engaging daily life activities, and enjoyable relationships and interactions with others, and

Associates who work in the home to experience the satisfaction and enjoyment of working in a home setting, versus tolerating the burdens and frustrations common with a traditional institutional nursing home.

Design Elements/Attributes
The positive impacts of these homes are largely the product of the integrated elements of the household living areas of the design model, including:

A building with a shape and form that is a desirable, visible manifestation of a home, easily recognizable as a home by the older adult social group it serves
A resident personal living space of one’s own, in an individual room or a companion suite
Building spaces laid out in a sequence corresponding to degree of privacy, from the entrance through public and semi-public parts to private spaces (e.g. resident rooms)
Area with a shape and boundaries that creates a readily identifiable household living area
Household unit with cluster configuration of ten to sixteen personal resident living spaces
Life-enriching household social spaces (e.g. family room, sitting spaces, dining area) that are readily visible and easily accessible by residents, and also serve as "destinations”
Short hallways with visible "destinations” and seating, fostering resident mobility
Windows in living areas and public spaces provide maximum natural light and outside views
Separation and protection of the household living areas from major circulation corridors
Natural light in corridors and living areas wherever possible
Positive outdoor spaces which are easily visible and accessible from the households
Variable ceiling heights and pleasant lighting levels throughout the households
Unobtrusive staff support and care work spaces with a residential character
Sound attenuating design elements and materials, and furnishings of a residential nature

Right: Meadow Lake Continuing Care Community, Tyler, TX

Benefits
The multiple benefits to residents attributable to the households include:

Personal living spaces (rooms) that:

o Reduce potential for embarrassment and preserve dignity
o Facilitate quality sleep, free of noise and disruptions
o Meet residents’ privacy and territoriality needs

Living and work environments that:

o Engender positive emotions: pleasure, joy, contentment, happiness, interest, and curiosity in both residents and staff
o Foster residents’ independence, and staff’s embracement of their responsibilities
o Produce pleasant resident and staff social interactions and friendships
o Provide residents a sense of security that comes with being "home”

Physical settings that offer:

o Peace and quiet, absent the disruptions, corridor traffic and other noise, and disruptive
behaviors often present in traditional nursing homes
o Desirable accessible living, toileting/bathing, and social activity spaces
o Spaces with varying levels of relative intimacy (e.g. public, private spaces)
o Unobtrusive preservation of personal safety

Support a healthy lifestyle and personal wellness through:

o Fostering in individuals a sense of physical, mental, and social well-being
o Fullness of life from life-enrichment opportunities facilitated by social spaces
o Resident mobility fostered through visible, easily accessible social destinations
o Reduction of contributors of stress, depression, and negative emotions

Take-Away Message Metrocrest

The best practice nature of the household model of design in the development of nursing homes by three senior living communities is validated by the: clear attributes of the design approach; organizational market positioning, marketing, and operational pluses; and the array of positive impacts it produces for residents, their families, and staff.

Right: Metrocrest - a Wellington Intergenerational Village, Farmers Branch, TX

Frank W. Rees Jr., is Chairman and CEO of Rees Associates, Inc. Ronald C. M. Bergstrom is President of Senior Living, American University Health Care.