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.

Melissa C. Pritchard
Senior vice president, SFCS Architects, Roanoke, Va.

When Melissa Pritchard was young, her family was always buying and renovating neglected houses. She watched her parents and older brothers take homes that were uninhabitable and create places where people wanted to live. She also watched as her grandparents struggled to remain in their home as they aged, challenged by stairs, narrow doors, and clawfoot bathtubs. Later, when she entered architecture school, these two experiences fueled a passion in her to create better spaces, specifically for seniors. After graduating, she returned to her hometown of Memphis, Tenn., to help her parents care for her grandparents as they aged. By her mid-20s, she began a career at a general design firm, pursuing small senior living projects, while simultaneously experiencing five family members, including her grandparents, live and ultimately die in nursing homes—making her work all the more meaningful. It was during this same time that Pritchard’s firm was pursuing a renovation of an Alzheimer’s day center. To prepare, she dove into heaps of research, scouring medical journals to understand the disease while also realizing that little environmental evidence was available. The firm won the job, and, yet, another passion was ignited. Today, Pritchard works at SFCS, where she continues to champion for better memory care environments. One of her most recent accomplishments is the completion of the Cottages at Cypress Cove in Fort Myers, Fla., an assisted living memory care project that earned an Award of Merit in EFA’s 2017 Design Showcase and was selected as the site for SAGE’s 2018 post-occupancy evaluation project.

Environments for Aging: Most recently you’ve worked on projects to deliver new memory care models to better serve residents. What have you seen in existing communities that you wanted to improve upon?
Melissa C. Pritchard:
While I think that environments overall have gradually been improving across the boards in the senior living industry, what really bothered me the most was that for those suffering from dementia, the entire environmental approach seemed to be to contain, control, and manage those seniors. The big focus was (and, in a lot of instances, still is) on security and safety to the degree that those factors often came well ahead of quality of life and environment. This doesn’t seem right to me, and I feel an obligation to try to do what I can to effect change within the industry.

Another observation that I’ve reacted to was visiting memory care environments that were mainly locked areas that were sterile, clinical, institutional, and devoid of comfort, color, freedom, nature, and familiarity. I started thinking that in an effort to not “overstimulate” this population, many of these environments had become absolutely lacking humanity, verging on being uninhabitable, and that this could actually be making residents’ lives worse rather than better. It’s a direct reaction to this that I (and all of us at SFCS) work hard to build environments that go beyond just providing those things but that also use aspects of the design to actually slow the cognitive decline and to try to preserve function in residents for as long as possible.

You’ve immersed yourself in your work, from overnight stays in communities to using equipment that simulates the lives of a resident with dementia. How has this informed your work?
During my early work with design for dementia, I was struck by the idea that what we don’t understand scares us and we try to control it. That’s just natural human behavior, and we were doing this to elders with cognitive impairments. I felt like we needed to find a way to get past the fear and go deeper into understanding. One of the toughest things about the disease is that, once affected, seniors often lose the ability to communicate to others what’s really happening to them, so we often guess and make assumptions about the resulting behaviors and outcomes that are demonstrated.

One example that’s seared into my memory was during one of my stays with applied virtual dementia, I really wanted to go outside into the secure courtyard to get some fresh air and to feel the sun on my face. As I stood in front of the door that led to the courtyard, I started trying to remember if the alarm would go off and if I was allowed to go out there because there were signs on the door and pieces of equipment that were giving me the message “do not enter.” So to the person observing me, I stood there blankly, in front of the door, staring into space, looking lost and confused. I then “wandered” around and ultimately I sat down in the chair right next to the door and looked outside rather than going through the door. Sounds pretty familiar and pretty typical of dementia behaviors.

When I was able to explain this to my observer, there was a completely different understanding and perception of what I was doing and why I was doing it—it made sense. That experience made us really aware of trying to address what I call “conflicting cues” in the environment that sometimes we completely overlook.  If we want residents to have access to the outdoors, then are we not only saying that but also living up to it in the experience of trying to access the outdoors as a resident? If we want residents to have privacy, then are we really supporting that with our environment, operations, care? I and my team members are much more aware of the subtle and sometimes invisible barriers (to us, care givers, operators) that can be created that send conflicting and confusing messages to residents.

How do you use the knowledge you’ve gained over the years to encourage others to see spaces through residents’ eyes?
I believe in leading by example, sharing knowledge, mentoring, and encouraging others—both within our firm and within life—so I try to share as much as possible. This mainly takes the form of speaking regularly at state and national conferences, as well as writing papers and articles when possible. I fundamentally believe that we can’t think of seniors in an “us (not old and frail) versus them (old and frail)” mindset, and when you experience that firsthand through research, loved ones, personal medical challenges, etc., it changes the way you see and experience the world.

What does it mean to you to champion for appropriate and supportive designs in senior living?
I believe it means challenging the status quo, accepted beliefs, and opinions and not being afraid to be wrong and make mistakes. It means pushing the perceived limits of yourself, your colleagues, and even your clients. It means learning from everything that you can and applying it to the work you’re doing and creating. It means being open and listening to the thoughts and ideas of others and not being stuck on only your ideas. It means striving every day to make a difference.