Fifteen or 20 years ago, the conventional wisdom was that assisted living residents would be best served in urban environments in proximity to theaters, museums, restaurants, cafes, and other places where seniors could walk. This was a somewhat romanticized idea, though.

While easy access to services such as doctors, dentists, and hairdressers offers real advantages, the idealized notion of independently ambulatory seniors is often quite different from the physical and mental reality of typical assisted living residents. Those who can independently seek out such amenities don’t generally need assistance with activities of daily living and likely haven’t graduated to an assisted living environment.

So it’s just as well that most assisted living facilities don’t get built as urban infill projects. There are obvious real estate reasons for this. For example, unless the development of an abandoned lot in a blighted area is being pursued, most sites in thriving neighborhoods with the kinds of retail amenities described above are too expensive, and assisted living generally wouldn’t be considered a highest and best use.

Occasionally, however, such a site becomes developable as assisted living due to peculiarities of zoning restrictions, bequests, or other reasons that spare them from narrow economic motivations. And urban-dwelling baby boomers in years to come may very likely grow demand. So it’s important to understand that such sites require a much different form and construction than the relatively sprawling two- and three-story facilities that are typically in suburbs.

The program
The urban assisted living facility tends to be vertical due to site constraints. This may present logistical/staffing issues depending on the size of the typical floor plate and building footprint. Given desired staffing ratios of 1:12 to 1:16 depending on acuity, it’s important to avoid staff/resident ratio inefficiencies in which there are too few residents on a floor to merit two caregivers but too many for a single caregiver.

Many providers create resident floors with multiple “neighborhoods,” each with its own amenity sub-spaces such as a kitchen and lounge. It’s often advantageous to design two such neighborhoods on a floor so that caregivers can provide backup to one another. A very constricted urban site may make that impossible, or may provide more than enough floor area for one neighborhood but not enough for two. One solution for dealing with this second possibility is to create ancillary neighborhoods with fewer units devoted to residents needing higher levels of care.

One advantage of a smaller site, and therefore a smaller floor plate, is in reduced travel distances—both from unit to unit and from unit to common amenities—that would typically be accessed by elevator. Travel distances in a typical non-urban, horizontally designed assisted living facility may easily exceed 200 feet and, depending on the point of departure and destination, may greatly exceed that.

In non-urban, open sites, it’s desirable and often possible to create a memory care subcomponent of the residence with direct access to a secure, enclosed outdoor area. In urban infill sites this is usually not possible and in order to make a tight site work, the first floor is devoted to common amenity and service areas. This generally segregates memory care to an upper floor, where outdoor space is provided via terraces and balconies. While not ideal, such an arrangement is manageable if supplemented by scheduled, guided outings off-site.

The building
For the site itself, the cost of structured parking requires some compromise in an urban project. At $50,000 per space or more, underground parking structures can quickly turn an assisted living pro forma upside down. The complete or partial elimination of a parking component from the program may be justified by greater access to public transportation, for example, though such obligations are commonly dictated by zoning regulations. Parking, when provided, is almost entirely for the benefit of staff and visitors rather than residents who don’t drive.

From a municipal planning perspective, assisted living projects have been recognized as a beneficial addition to an urban neighborhood. For example, the Residences at Watertown Square in Watertown, Mass., which opened in November 2014, was built adjacent to a vibrant retail corridor, but the actual street on which the project was built was almost devoid of activity. However, the project was able to draw pedestrian interest into the block.

This activation was helped, in part, by the inclusion of third-party retail space at the ground floor of the project. The inclusion of such commercial space both lends an additional sense of integration with the community that’s beneficial to the mainly facility-bound residents and supports the viability of the commercial tenants. To be successful, the integration of commercial space requires the kind of retail density only available in an urban environment.

In very dense urban environments, assisted living facilities may be an imbedded component of a larger development. One example of this is the 23-story Metropolitan Tower in Boston’s Chinatown neighborhood. A mixed-use project including multifamily rental apartments, residential condominiums, retail, and 50,000 square feet of commercial office space, the project also includes 60 assisted living units located on the 8th floor. In large metropolitan areas, one may begin to see large towers being broken up into separate master condominium units, some of which may become assisted living.

The future
Within the senior care industry, it’s axiomatic that seniors don’t like to leave the communities and environments to which they’ve become accustomed. So one must ask what happens in 10 or 15 years to the 60-something boomers who have moved back to urban locales. A substantial portion of this newly indigenous urban senior market will need to be accommodated within their community, and that will likely be based on high-rise living.  

The recent trend to develop luxury urban towers housing small studio and one-bedroom apartments paired with generous amenity components and on-site services is typically marketed to young professionals in their late 20s and early 30s. Ironically, such developments begin to resemble assisted living in unit size, amenity space, and emphasis on services. It wouldn’t be hard, with the addition of dining and meal delivery components, to reimagine them for an assisted living demographic. 

As the market for young professionals becomes more competitive, urban assisted living subcomponents may provide market diversity to the urban residential developer.

Michael Liu, AIA, NCARB, is vice president and principal of The Architectural Team (Chelsea, Mass.). He can be reached at mliu@architecturalteam.com.