The Skilled Nursing Development Opportunity – Aspiring to Something More

By / Posted on July 31st, 2014

I read with interest a recent article in Senior Housing News- Developers See Opportunity as Old Nursing Homes Become Obsolete. It’s great to see not only that people recognize that the stock of 40+ year old nursing homes is not going to cut it, but to hear the sentiment that the replacement of old nursing homes is an opportunity. But when we think about replacing nursing homes, what are the key considerations? Are we making the most of this opportunity by re-thinking them, or are we simply sprucing up the same institutional approach?

For nursing home providers considering a significant renovation, the article makes the point to do your homework. “Given the relative aging of the post-acute care facilities, some providers are finding that it’s more cost-effective to develop new facilities rather than redesign multiple decades-old properties.”

Also think about the long-term value of your renovation investment – a renovated facility will look good today compared to what’s available, but how will it look against the competition in 20 years? How will it fare as consumer demands continue to evolve?

What I love about the nursing home model discussed in this article is that it’s designed to be a community gathering place. Most current designs and locations segregate their older population from everyone else. This is bad for everybody – Elders don’t get to interact with anyone other than other older people. And younger people don’t have the opportunity to appreciate Elders and to benefit from everything they have to offer. Creating a space that is inviting to the surrounding community, families and friends is a great idea.

On the other hand, I got the sense that at their heart, these facilities are potentially the same old institutional nursing home in a prettier box. In addition to community space, this design will have examination rooms, because that’s what physicians want. As I hear providers embrace the “hospitality” model, with cafes, wireless and flat screen TVs, I wonder if anyone has asked Elders what they want.

I’m also wondering about how these new nursing homes will actually work. Will the design make it easier for people to get around or will it still have long hallways filled with workers hurrying from place to place (albeit on nice carpet)? Will the culture put people first, or will it simply be the same institutional approach? Will the people who work there develop real relationships with the Elders who live there? Is it designed to maintain dignity and create meaningful lives?

There’s no doubt that these new nursing homes will be a huge upgrade over what’s currently available to most people. They’ll be more attractive, and more comfortable than facilities built in the 1960’s, but will the experience really be that different?

If you ask people where they want to spend their last years, they’ll tell you “home.” When Elders are admitted into institutional skilled nursing facilities, they want to go “home.” If an Elder is in long term care, being physically at home is no longer an option. So what can “home” mean in that context? First off, I’m pretty confident it doesn’t mean something that looks like a hotel. I think it means a place that is comfortable and is familiar, and allows them to continue to live their lives as they would if they were living independently. It means having opportunities to make the choices we all expect as adults – when to get up, when to have meals and what to eat, how we spend our time. It means being able to do the things that make life meaningful, and to be respected and known as individuals.

So when we invest in new skilled nursing development, don’t redesign something based on today’s nursing homes. Start with the mission and important values. Think about a design that will work better for Elders and the people who work there. Let’s not squander the opportunity to create something new. Let’s aspire to something better than more attractive institutions.