New skilled nursing facilities (SNFs) are expected to last 50 to 70 years. “The next model of care arrives in 15 to 20 years; renovation occurs every 15 to 20 years,” says Joseph Hassel, principal of Perkins Eastman (Chicago).

In order to provide an environment that’s flexible aesthetically, both in the short- and long-term, skilled nursing design follows best practices used in healthcare overall, introducing timeless materials such as wood or wood tones and stone, says Jennifer McDermott, associate principal of Perkins Eastman.

Providers urged on by the baby boomer community will go beyond past design models, particularly ones with any vestiges of the medical model. The emphasis will be upon maximizing abilities. “Creating wellness environments that use space for healing and living will become the norm,” says Susan Ryan, RN, senior director with The Green House Project (Baltimore).  “The consumer is and will continue to drive a smaller and more residential style in skilled and long-term care, going beyond person-centered care approaches to person-directed living.”

Additionally, design is responding to prospective residents’ exploits: travel with stays in well-appointed hotels, frequent dining out, and owning homes that were upgraded and updated—each creating expectations for a SNF community with amenities. This preference is reflected in residential models as well as hospitality models, the latter favoring a luxurious aesthetic and concierge-style living philosophy; when pursued, some clients see the hospitality model as a marketing benefit.


“In a true hospitality model, you might, for instance, have the kitchen less visible,” says Maggie Calkins, behavior researcher, consultant, and executive director of The Mayer-Rothschild Foundation (Chicago). “Whereas in a household model, food is a major part of the day. The household model’s open kitchen gives residents the option to help prepare food or simply sit back and observe food preparation. There is still a segment that believes a hospitality approach is what some older adults want. Different people want different things … Some people get pleasure from contributing to the household; other people are not interested in cooking.”

Additionally, a Perkins Eastman focus group determined that the SNF environment needs to offer multiple destination spaces. In fact, destination spaces are increasing in popularity. “We are realizing the importance of having things to do that aren’t just programmed activities—who doesn’t want to go get a cup of coffee or ice cream on a regular basis?” Calkins says. “Many of these destination locations are food-related, serving to increase hydration and intake in a way that’s more fun. This is also a consequence of the movement to make nursing-level care more like assisted living, to be less restrictive and more accommodating of individual preference.”

Hassel recalls how a resident’s daughter said, “I want to be out of the bedroom; I need environments to take my mom to in this community.” The daughter envisioned a salon, where seated side by side, mother and daughter could together enjoy a manicure. This space recommendation, Hassel says, will be designed by Perkins Eastman for a skilled nursing client; it will have the look of a day spa including a styling station, manicure area, and make-up counter.

“(Destination spaces) allow for flexible interaction and replicate what happens at home,” McDermott says. “It’s thinking about ways family members can engage together other than engaging in the room… It looks familiar. It mirrors the life people lead.”

Sharon Schnall is a writer based in Ohio. She can be reached at schnallwritng@yahoo.com.