Kenneth Caldwell, a writer and communications consultant based in San Francisco, interviews Joyce Polhamus, AIA, LEED AP, a vice president and director of SmithGroup’s Senior Living Practice in San Francisco. With over twenty years of experience, Polhamus has led the architecture, planning, and design process for assisted living, skilled nursing, dementia care, wellness, and ambulatory care facilities. She is a director of the AIA’s Design for Aging Knowledge Community and a member of the American Society on Aging, the Society for the Advancement of Gerontological Environments, the American Association of Homes and Services for the Aging (AAHSA), the California Assisted Living Association, and Aging Services of California.
This interview was originally published 2nd quarter 2009, in arcCA 09.2, “Design for Aging,” accompanied by a portfolio of projects by several architects, which you can find here.
arcCA: This area of architecture, senior living, has negative connotations for a lot of people, including architects.
Joyce Polhamus: It could be associated with bad memories of having to put a parent or a grandparent into a nursing home. Yet, there is incredible potential in the project type, and I want to encourage more architects to pay attention to it. It is a growing area, because our overall population is aging, and we need thoughtful architects contributing their ideas. The care providers are already focused and committed to offering a high quality of life.
arcCA: What is a recent example?
Polhamus: Florida Presbyterian Homes wants to develop a unit that is flexible enough so that residents who need memory-care services or a secure environment and those who need assisted living can be accommodated together. The idea comes from the commitment to serve more people, including couples with differing needs, and to keep people together regardless of a resident’s level of need.
arcCA: Talk about your optimism. Why have you embraced this sector of the market? Is it because you see that there’s so much room for improvement?
Polhamus: We’re on the cusp of an enormous change. This is one of the only architectural product types that hasn’t evolved much in the last fifty years. The care providers/operators themselves are making their own changes. We should be partnering with them to facilitate the changes through the built environment and to create a variety of architectural styles for users. The consumer/users are typically need-driven and often have to settle for the environment the care providers have. Why can’t we help by making the architectural environment one more attraction and option for the consumer resident?
The care providers have initiated a “cultural change” movement that is going back to household models and neighborhoods with “cottage-style” living, where everybody lives and dines together in groups of nine to twelve. That’s not the right living model for everybody, but it has been proven effective. For many, it sparks the desire to “live” within a home, rather than being cared for in a bed.
At the beginning when this industry was starting, it was based on medical models. It was very restrictive—what you can do, what you can’t do. Many in the architectural profession didn’t get involved, because it was so prescribed. But it doesn’t have to be. For example, there was this idea that you can’t put windows at the ends of the corridors because it creates glare. But people prefer daylight to mark their journey down a hallway. If done properly, it can be a huge benefit.
arcCA: Can you explain the basic types of senior housing?
Polhamus: At one end of the needs scale, there is independent living. Seniors in this category don’t need constant care and are able to enjoy recreational and social activities with other seniors, family, and friends. Then there is assisted living, in which a wide variety of programs to assist and supervise residents are paired with the activities of daily living. Memory care is often served in this setting. Skilled nursing facilities are designed for seniors who need care around the clock. Continuing Care Retirement Communities (CCRC) combine all of the aspects I just mentioned into one mega-facility, providing all realms of care.
arcCA: These are all very distinct categories, though?
Polhamus: Yes. Code requirements are different for a skilled nursing facility as opposed to independent living. Materials in skilled nursing tend to lean toward those found in the healthcare sector. Recently, we have seen those materials advance in aesthetics and function, making it easier to blur the line between constant and independent care.
The trend has been to make the interior décor “home-like.” But “home-like” is different for everyone. The real opportunity is to go beyond the décor and make the architecture characteristic of residential design by providing a variety of styles, like in our own homes, with detail and interest.
arcCA: Which of the facilities is seeing the most change or the potential for it?
Polhamus: Skilled nursing “facilities.” They shouldn’t be “facilities,” but places where people who are frail and ill continue to live. The household model is really trying to address that and deinstitutionalize the skilled nursing aspect of senior living care. This is where architects can assist in bringing the most benefit.
arcCA: Interestingly enough, we have seen some award-winning design with subsidized independent living.
Polhamus: Locally, I think we have a lot of innovative architects working in the affordable multifamily housing arena, and it’s not much of a stretch for them to do work for seniors, especially with independent living.
arcCA: And why don’t more of them go beyond independent living into the other forms of senior housing?
Polhamus: Then you have to start thinking about a building type that can serve a wide variety of people, and you get closer to a medical model.
We tend to build four- or five-story apartment buildings for most independent living units, but people don’t fit neatly in those categories. People want more choice.
I think the more-independent-living environments fall back on the models that have worked in the past, as they are often driven by financing and marketing. The banks want to know that the developer has this mix of one-bedroom units, two-bedroom units, two-bedroom units with a den. The demographics drive the product type, and focus groups influence the size and amenities. The price point’s got to be this, and you’ve got to offer these amenities; there’s basically a pro forma.
This is fine for senior housing and independent living for the middle-class market that goes there as a lifestyle choice. But there is still a market—and a need—for people who are looking for more services further down the line. There are limited residential options architecturally when housing is combined with services.
arcCA: Is this changing some?
Polhamus: Yes. We (SmithGroup) are working with Life Care Services on a project in Roseville. They are committed to making their development a place that people want to go to, not a place to avoid.
There is also no reason that housing for seniors can’t be a visible and desirable part of the neighborhood fabric. Often, CCRC developments are like the corporate office park with the big cafeteria. This is one of the opportunities for architects. They can shift the consciousness about the design of these buildings into creating places that generate interest from surrounding communities, rather than looking like modified hospital/hotels.
arcCA: Where would you want to go?
Polhamus: Personally? I want to move into an upscale, modern high-rise building downtown. I want expanded concierge services in the middle of the city that would support a range of my everyday living needs. That’s different from the options offered out there right now. But I suspect I am not alone.
The consumer base is growing, and they want all kinds of options and styles. We are working with the Sisters of Carmelite on an assisted living project. Because of the recession, we were able to hire a talented architect experienced in high-end hospitality and residential design. He has brought a new energy to our design team and another dimension and style. That’s an example of the change I am talking about.
arcCA: The recent downturn may mean troubles ahead. Some people won’t have hundreds of thousands of dollars to buy into retirement communities or be able to pay over five thousand dollars a month to live in assisted living. How is the market going to accommodate this?
Polhamus: For some time, there has been a range of product types in the senior-living industry. As I mentioned, some of the best projects have been in affordable senior housing. It’s the middle class where we might see some changes in the way services are delivered. For example, people may live in apartments and select from a menu of services. Part of the problem is that people are paying for services they don’t need. Why can’t we separate the housing from the operations and bring more services to the client, a la carte? Let’s just offer services as people need them.
arcCA: Where are we going to find these models?
Polhamus: We may find them in social service providers like San Francisco-based On Lok (www.onlok.org). Seniors are offered all kinds of services, adult daycare or medical, but they continue to live independently in their own apartments and are picked up in vans. In some cases, there might be a medically trained person onsite to help people with medications while they remain in their own homes. They use services as they need them.
arcCA: So you’re suggesting that the economic downturn will push us to find new ways of delivering services?
Polhamus: Or adapt existing methods for new audiences.
arcCA: What about style? There has been a prevalence of Cape Cod, it seems.
Polhamus: To think that there is one style that older people want is condescending. When we designed different phases of Stark Villa for the Motion Picture Television Fund in Southern California, they wanted something contemporary. In West Los Angeles, we also brought a different, contemporary style to a skilled nursing facility for the Veterans Health Administration. There’s room to bring different styles in. Consumers want variety.
arcCA: What about the smaller complexes? What’s the architectural challenge there?
Polhamus: These complexes cluster houses with everything in a single story and a big, spread-out footprint. They end up looking like a giant ranch house, and they’re not architecturally interesting. But they could be. They don’t have to look like suburban houses.
arcCA: So you have more flexibility with large institutions?
Polhamus: Sometimes, yes. The Veterans Health Administration, for example, puts a lot of resources into research. They are focused on state-of-the-art care. Their image isn’t one of an oversized house. And yet they are sensitive to making the campus not feel like an institution.
arcCA: And we’re not just talking about being medically state-of-the-art. We’re talking about the living patterns and social patterns?
Polhamus: The connections to the outdoors, the sequencing of spaces, the social interaction. In the future there is going to be a lot more dialogue among the operators, because these baby boomers are going to continue to be a demanding and vocal demographic.
Originally published 2nd quarter 2009, in arcCA 09.2, “Design for Aging.”
