The EFA Design Champions awards program was launched this spring to recognize the individuals who are advancing the design of senior living environments, those who have fought for design solutions that make a meaningful improvement in the lives of residents, staff, or the greater community. The winners will be recognized during an awards luncheon at the 2019 EFA Expo & Conference in Salt Lake City. Read more about them in the Summer 2018 issue of Environments for Aging and here online in extended interviews.

Renee Anderson
President and CEO, Saint John’s On The Lake, Milwaukee

A certified public accountant by trade, Renee Anderson took a different turn in 1990 when she joined the corporate office of a large national senior living provider and later landed at Saint John’s On the Lake in 1996 as director of finance. It was then that she says she found what had been missing in her career: a connection to the people she serves. Now president and CEO, she spends her days focused on strategy and visioning as well as walking the campus to talk to residents and team members (she knows them all by name, to boot). The 5-acre continuing care retirement community (CCRC) sits on a bluff overlooking Lake Michigan and comprises 90 independent living (IL) apartments in the 21-story South Tower that opened in 2011 (an expansion she helped lead), 110 IL apartments in the 10-story Central Tower built in 1979, and 24 assisted living and 50 skilled nursing suites in a three-story structure also built in 1979. All three buildings are connected by a first-floor Town Center, home to most of the CCRC’s amenity spaces. Anderson is currently at the helm of a new undertaking: a North Tower that will be home to 79 IL apartments as well as a reimagined skilled nursing setting. Despite efforts to remodel over time, the current care neighborhoods still have double-loaded corridors and little access to natural light on the interiors, among other challenges. Anderson is on a mission to fix that, pushing the limits of traditional design solutions and tasking the project team to innovate everything from unit layout and room design to furniture and views.

EFA: Tell us about this new project and what’s driving it.
Renee Anderson: Our goal is to recreate skilled nursing in a way that respects resident needs and wants, incorporates best practices, supports ongoing innovation, and responds to the desire to provide employees the opportunity to deliver excellence.


We’ve designed the assisted living and skilled care to be identical, affording maximum flexibility of license and helping overcome barriers to transfers between levels of care. Residents will enjoy private rooms ranging in size from 350 to 450 square feet with full bathrooms. Each room has multiple large windows and plenty of space for personalization.

Resident rooms are positioned around centralized open common space so that when residents leave their suites, they see, hear, and smell familiar things that draw them out. The living space has natural light from all directions, an open kitchen where meals are prepared to order, and a terrace overlooking Lake Michigan. The caregiving team spent hours poring over plans and analyzing tasks to design right-sized, appropriately placed support and back-of-house space.

Why was it so important to you to get the skilled nursing design right?
As we age, we lose so much: We retire from our life’s work; we move from our family home; our spouse, siblings, and friends die. And when our own health changes, well-meaning children and medical professionals trundle us off to a nursing home where regulation, under the guise of safety, dictates what we can and cannot do any longer. No wonder nursing homes are recognized as the place you go to die—who wants to live like that? We want to create a home where residents with advanced medical and cognitive needs can live with dignity, exercising the fullest of their capabilities.

You invited in design firms Blitch Knevel Architects and Eppstein Uhen Architects and consultant Lori Hiatt and spent a great deal of time in predesign efforts. Why was this so important to you and what, specifically, did you learn?
I hear lots about what doesn’t work and why, but as a recovering CPA, I’m a data-driven person. Lori has this exhaustive spreadsheet, a point-in-time analysis of the resident population, which confirmed who we serve and their needs. It helped us understand how the physical environment was placing constraints on their ability to act independently. We listened to residents, families, and staff; took what we thought we heard them say; and drew it. We took it back to them for a reaction, and then we made modifications.

Much of our work focused around the bathroom. Bathing and toileting are so personal, and the source of much concern for both those who live and work in these environments. Not everyone is able to interpret a drawing, and we wanted to test the theories, so in our garage we built a full-scale furnished mock-up of a resident room with bathroom. Staff toured and residents visited and tested the mock-up, navigating doorways, transferring to the toilet, using the shower and the vanity. We talked to nursing, of course, but also to housekeeping and maintenance who helped evaluate the choice of toilet, for example.

We knew what the shape of the shower and position of the shower control and toilet did not meet code, so the mock-up helped us prove to the authorities that we were proposing a better solution for safety and functionality. Lori and Ron Blitch were also very helpful in providing examples of comparable designs built in other states, so we were able to use those precedents and ask for similar consideration for older adults in Wisconsin.

Why is it important to champion for appropriate and supportive designs in senior living?
Residents of skilled care are our oldest and frailest, and they deserve the best design money can buy. Skilled care is much maligned, generally misunderstood, and, consequently, seriously over-regulated. We’ve made it so much more difficult than it needs to be from both a physical plant and an operational point of view. As a result, we’re directing our precious resources to compliance, not care, and replicating bad design—it’s maddening!

All older adults should live in a dignified environment where they’re allowed to exercise choice. I feel an obligation to push toward better solutions challenging the status quo. I hope demonstrating successful alternatives paves the way for reforms and helps other providers make better choices for those they serve.