Person-Centered Care for Residential Assisted Living Design

Alexandra+Cohl+headshot+2.jpg

By: Alexandra Cohl

Interview with Shernise Richardson: Project Design at JSR Associates, Residential Assisted Living (RAL), and person-centered approach.

0E0A1203_smaller.jpg

This week, I spoke with Shernise Richardson, the Project Designer at JSR Associates. Shernise explained the meaning of Residential Assisted Living and how it differs from larger scale assisted living facilities. Throughout our talk, she also explained how essential it is to take a person-centered approach to design, what one of her favorite projects has been, and the unexpected challenges that happen throughout the design and building process.

 

This interview has been edited for clarity and flow.

 


Shernise, thank you so much for joining me today. I want to jump right in and give our readers a sense of who you are and what the work that you do. Can you describe what your role is at JSR Associates and what a typical week might look like for you?

 

Yeah, no problem at all. Thanks for having me. I am the Project Designer for JSR Associates. So, typically my work week looks like a number of things—I wear a few hats. I’m often producing the drawing sets for any of the projects that we have, whether that’s for new construction or renovations. Sometimes we do a bit of consulting work, as far as reviewing some other projects to make sure they meet certain things that are related to senior living, person-centered care, and things of that nature. So, in my role, I talk a lot with clients. A project  manager is everything, so I’m basically the lead person when it comes to drawing projects and production.

 

Cool. I was just going to say that it sounds like you’re the producer of what goes on.

 

Shernise and Jane working on art install placement.

Shernise and Jane working on art install placement.

Yeah, and we’re a small family firm. When I came to this firm, I was like, “Man, this is awesome,” because it introduces you to a lot of different things that you might not get to experience at larger firms. So, getting to interact with a lot of different people has definitely been a great part of this firm.

That’s awesome. So, one of the things I wanted to ask you about today is the term Residential Assisted Living (RAL). Could you explain that term, for those of us who don’t know what that is, and what it encompasses?

Yeah, so Residential Assisted Living is your typical assisted living but scaled down to a single family-home style. So, basically, taking everything that you would normally see from a facility that’s like 64 units or something like that and fitting it into a single-family home where it’s more of a family-style oriented type of facility. With that, it’s often one main kitchen that everyone shares, not kitchenettes or anything separate, and it’s a home. You have your living room setting, your dining room, people eat together, and have fun in one common living space.

 

Gotcha. So, it’s like a separate home building, not say my grandparents’, for example, who live in an independent living residential space that is an apartment connected to others down a hallway to these other buildings. What you’re explaining is an actual home that’s separated by maybe a yard or something.

 

Right. And within that home, everybody has their own individual rooms and individual spaces. All of the resident rooms that we design have their own bathrooms. We still give the residents that amount of privacy, which is what they prefer. But it’s not apartments, nothing like that. You see all your housemates every single day. It’s literally a house.

 

And are the people who are living in the house blood relatives, or is it sometimes just other people who are living within that home. Or, is it a mix depending on the situation?

 

Typically, it’s all individuals who are not related. Like, if you had an assisted living building and it was separate apartments, instead of it being apartments, it is just people living in individual rooms. You could have a space with maybe somebody related, but they would still have their own individual room.

 

Gotcha. It reminds me a little bit of, say, the fancier suites that some people at college would get. In terms of the work that you do at JSR, how does this term specifically apply to that work and what process do you go through when you’re working with clients on something related to Residential Assisted Living?

 

The way it relates to us is we are very focused on person-centered care, and senior living is almost, I would say, maybe 95% of what we do and what we focus on. The way that Residential Assisted Living fits in is that it’s almost like a household model, and so, we do that when we’re working with other clients on larger assisted living projects. We always recommend a household setting and basically having groupings of just a small amount of maybe eight people (no more than ten) where they all share the same common space. That’s helpful from a staffing perspective, as well as the resident to sometimes have that more focused, smaller grouping of individuals rather than feeling like they’re just in a large grouping.

 

Evermore Senior Living– Woodbridge, Virginia Small Household living room

Evermore Senior Living– Woodbridge, Virginia
Small Household living room

Where that fits in for us is that we do household design for a common space with a significantly smaller staffing to resident ratio. We take all of that knowledge, and we just pack it into Residential Assisted Living based on our knowledge, the materials, spacing requirements, spacing recommendations, and getting a better understanding of how the residents would like to experience their space. With a project, since you asked about the process, we typically do programming for a project before even starting with drawings. So, we’ll meet with the client, discuss their wants and needs and what they require. If it’s a new build, of course, they are not going to have any residents yet. Meeting with the residents is not always an option. That’s when our knowledge has to come into play to let that client know, from other projects, what we’ve experienced with other residents from other facilities.

 

If it’s a renovation of one, then we will meet with the actual residents and speak with them without staffing present or their children. It’s just the residents by themselves speaking their mind about how they feel about their space: what they need, what they like, what they don’t like. We take all that into account, and a lot of projects can be made better if we just simply talk to the people who are using the space, instead of relying totally on what we’ve learned through books or something like that. When you just talk to people, it makes a big difference.

 

So, we do the programming process, talk to the client, listen to their needs, their wants, and then we basically let them know based on our knowledge level, what we think would best benefit them for their project as far as staffing or anything operational. We’ll start there, and then we’ll go into some of the design process, schematics, and space requirements. When you start to put pencil to paper, that’s the fun part. When you’re starting to really flesh out your ideas. From that process, we go from making sure that the client is happy about what they’re looking at: “Does this meet all of your needs?” Sometimes the understanding of what may be needed for a resident is not always understood. But, we sit down and talk to the client about why we made this decision or why we recommend laying a space out the way that we do. A lot of them say, “Well, I never thought about it that way.”

 

Thinking about something as simple as a nightlight. One thing I would definitely include in their rooms is a through-wall nightlight that directs you to the bathroom. It is a light fixture, and it’s recessed into the wall—it’s essentially a nightlight. We place it on the same wall or near the opening where the bathroom is. That way, if they wake up in the middle of the night, and it’s dark, they see the light and they’re like, oh, the bathroom’s that way. Sometimes that can cause a lot of issues and that helps with less incontinence issues. So, something as small as that that the client never thought about before.

 

Oh, I like that. The nightlight reminds me of the lights you would find on the outside of a front door so people can see where to enter. The person-centered approach is just so, so important. I love that you gave the simplest example because it shows how much the needs of these people can easily be missed. And so, I’m curious, out of the many projects that you’ve worked on, are there any specific ones that come to mind that stand out for whatever reason, whether it was just a certain part of the process or the end result or anything outside or in-between that?

 

I would say of all the projects—every project in itself has something within it that I’ve learned that’s helped me prepare for the next one. It’s something as simple as a small detail. As far as a specific project, I would say Evermore Senior Living. That’s one that we’ve just recently completed and the first house is actually built already in Virginia and they started getting residents in. That process was very interesting to me. I love construction site visits. You get to see the thing that you put on paper actually come to life. And so, as I was doing the construction site visits, it would just be small things that come up that you have to think about right there on the spot. Like, okay, what is the way that we can fix this? Or, what is the best way to go about this? Even though it might deviate a little bit from the drawings, like something as far as spacing might come up, I may ask myself, “How do we change this to where it won’t affect the resident that much but will essentially give us what we need?” A couple of things like that came up with that project and it allows you to go back to the drawing board and basically think about your next one. Like, let me put that in my brain bank and that’s what Evermore did for me as I continue to do those site visits. It was the most site visits I’ve ever done for a project. So, getting to experience that was very rewarding and that’s why that one sticks out the most to me.

Evermore Senior Living– Woodbridge, Virginia Construction site visit

Evermore Senior Living– Woodbridge, Virginia
Construction site visit

A rendering of a resident room. Rendering by Shernise Richardson

A rendering of a resident room. Rendering by Shernise Richardson

The completed resident room. Photo by Nicole Lowder

The completed resident room. Photo by Nicole Lowder

 

I love that you mentioned a little bit just now about particular challenges and what they have taught you for future projects down the road. Can you expand on that just a bit? If there’s any other challenges that you’ve specifically gone through while you’ve been doing this type of work, and how you overcame those challenges.

 

I don’t think a lot of people think about this, but bathrooms and kitchens are some of the most difficult things to design. If you haven’t realized in those two spaces we do so many things. So, just being able to design for a space that anything possible could happen: you know with a bedroom, you’re sleeping or you may have a desk in there, but with bathrooms, especially for senior living, we have to take into account grab bars. But not just your traditional setup of grab bars. We typically go with the drop-downs, and with the drop-downs, that allows the user to push themselves up rather than the traditional setup that’s on the side or the back wall. So the drop-downs and the grab bars that can be used by different individuals.

 

So, with grab bars, we have the ones that adjust up and down, to the side. You have to think about counters, storage, things like that. Showers! Just something as simple as the entry to a shower and making sure it is a level transition with no bumps or anything like that. You wouldn’t think about how much just that little spacing, that little bump, can cause a tripping hazard. So making sure there’s no level change or transition, but the detail of how the floor meets the shower insert. Sometimes we have one-piece showers, and your flooring has to meet right up so that water doesn’t escape into the bottom. That detail is very delicate. It has to be so specific. Especially if it’s slab on grade—that’s basically your concrete. They had to cut into the concrete in order to set the shower inserts inside the concrete and make sure it is level with the floor. It was like me, sitting at the drawing table for hours, pulling my hair out. So, that was one of the things that I experienced with one of the projects.

 

It takes a good amount of your time. Something just that finite, even if it’s off by a 16th of an inch. It can really cause an issue. So, we sat there for hours and finally figured it out. Then we just decided to put an extra detail, almost like a collapsible dam that is rubber. So, if you step on it, it flexes with your foot and doesn’t cause you to trip. You can also wheel over it. It gave a way to also keep more of the water in. We had to figure out solutions to something that small, and it can take a good amount of time just to make sure that we’re getting it right for the resident. You want them to be comfortable and also make sure it meets their needs. But also, design-wise and structure-wise, we didn’t want water getting into the flooring and things like that because that can cause issues down the line (as far as replacing materials). When it comes to bathrooms and kitchens, those are the spaces where you learn the most.

 

It’s very much clear to me, as someone who has no idea how the intricacies of this work works, how creative and innovative you have to be while you’re considering how to make this space work for the actual humans that are going to be using it day in and day out.

 

Yes, yes. When we’re thinking about the single family, we’re not just designing this space for a single family. It’s a project for a client that’s going to have multiple tenants. And, sometimes there’s going to be some changeovers. So, that’s a different person coming into that space. And, we have to make sure that that space serves everyone—not just the typical, single family.


Listen to the Podcast!

Innovation, Design, and the Impact on Community Building

Alexandra+Cohl+headshot+2.jpg

By: Alexandra Cohl

Interview with David DeLuca: Innovation, Design, and the Impact on Community Building

This week, I spoke with David DeLuca, the Director of Real Estate at Liberty Lutheran, a non-profit organization dedicated to serving older adults and their families. We spoke about his role at Liberty Lutheran, how his work has shifted since the start of COVID, and about the development process of The Village at Penn State’s newly-completed Palmer Park. The Village at Penn State is a retirement community in State College, Centre County, Pennsylvania. Specifically, in our conversation around The Village, David explains the aspects of “universal design” that went into this project and how the park is currently used and how it might be used in the future.

 

This interview has been edited for clarity and flow.

 


David, thank you so much for joining me to talk about some of the work that you are doing with Liberty Lutheran. I’d love to start there. Can you tell me a little bit about the work that you do with Liberty Lutheran and what a day (or week or month) in the life looks like for you?


You’re more than welcome. So, with my current title as Director of Real Estate, it has many facets beyond real estate, but my primary responsibility is for the real estate that we own and that we currently develop or develop further–all the way through the ongoing capital planning pieces and the master planning pieces. Any major projects that we do, I shepherd those as best I can along with our operations teams and with a team of strong consultants that we put together for each project.


We also investigate and complete acquisition and sales of properties that we continue to develop over the years. The sort of the day-to-day pieces are those of the Administration and Facilities Directors who handle the properties that we own; and as they have major building or property issues that come up, they often contact me. So, I could get all kinds of calls any given day, from something that’s long term to something that’s an emergency, such as, all of a sudden, one of our facilities has no heat. So, it could be that wide of a variety. I’m fortunate enough to have that variety because it keeps me really interested and challenged, and it has been for the last 11 or 12 years. It’s actually a lot of fun.




Awesome. You took the words out of my mouth. I was going to say it sounds like that keeps it really interesting.


Yes, it does, especially in these times. The last eight months or so, have been quite interesting and challenging. Probably the biggest news right now for folks in our industry, as well as all industries, is how you can make it out, you know? Fortunately, though we’ve had our challenges, there’s no doubt about it, we’ve come through it reasonably well. We’re fortunate enough to be very strong fiscally. We’ve had a lot a rainy-day, or pandemic-day planning—whatever you want to call it—but, basically rainy-day type fiscal planning that’s paid off in these times. We’ll not only make it through but we’ll make it through very well.




Do you feel like you’ve been able to pivot in a way that has allowed for more creativity in terms of the way that you’re approaching projects? Has it changed the type of projects that have been coming up or have they essentially remained the same?


There’s a little of both. There’re certain projects that will continue. They just had to be put on hold for a little while. But, we’re looking at them again because the dynamics of the population and the demographics are still there. We’ve got a large chunk of population coming through that needs more and more senior care. That doesn’t go away with a pandemic. It does temporarily make you pivot, as you said, so we’ve had to pivot a few times over the past six to eight months, which has changed the dynamic of some of the projects we’re doing, delayed some, changed how we’re looking at some of them and so on, but we’re moving ahead with a lot.


For example, we have one of our communities in Philadelphia. Very, very active and vibrant community of a few hundred seniors in north-east Philadelphia, and we’ve had our challenges through COVID, but it’s something that we’re managing, I think quite well. The projects there vary from creating a new memory unit to a new bistro, and things like that. What we’ve done is we’ve now focused on what that whole bistro means in terms of social gathering. Now we’ve kind of expanded that design work to include a bigger area so that we can allow folks to social distance in a better way. Families, when they come in, have more room to spread out. Those kinds of things. So, yeah, there’s a few pivots.



Yeah, that’s great, though. That’s how you keep it going. I know that you collaborated with JSR Associates on some universal design aspects of The Village at Penn State Palmer Park, which is a retirement community in Centre County, Pennsylvania. Can you tell me first a little bit about universal design and how that came into play in the work that you were doing, and then what the initial reason was for developing that space?


Sure. Well, the universal design piece really came from my conversations with Jane and JSR. We discussed the cottages that we were building that overlooked Palmer Park, what kind of nuances we can incorporate into those cottages (which turned out great!). The universal design perspective, to us in this case, means how can we take our residents that are in their cottages and envision their everyday life and connect it to Palmar Park.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


Connect it meaning: how can you take universal design aspects of people who are in their seventies, eighties, and nineties and be able to let them connect with everyday activities that otherwise maybe they couldn’t do. So, you’re designing for someone who’s eighty-five, just like you design if they’re sixty-five, but you’re keeping that eight-five-year-old in mind when you’re connecting paths and thinking about how they may want to be able to walk from the back of their cottage patio right down into the park rather than waiting for a ride.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


Jane was good to point that out. It took a little extra to figure out how to meander some very informal but specially graded pathways for people to be able to make their way down into the park, right out of their backyard, just like if they were forty-five. That was a big piece.


And, also to incorporate the design of our landscape—a different version of universal design is to say: well, instead of buffering Palmar Park so that the cottages wouldn’t be, let’s say, bothered by the activity of Palmer Park, we embraced that connection. We want the universal aspects—meaning the “connectability,” connectivity, whatever you want to call it—of that social interaction of people on their decks at their cottages to really be able to wave and talk to the people walking the trails in Palmer Park.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


And then be able to walk down and join and sit next to one of the fountains or other features of the Park, casually without having to wait for a ride. You know, those kinds of things really came into play, and we adapted those nuances into the areas in back of the cottages—which have these beautiful decks and patios—and really made it connected to Palmer Park. As opposed to buffering it, which would have felt separate. So, they are really together. It turned out great.

 


Very cool. So, the Village is the name of the retirement community, and is Palmer Park connected to it or is it all just a part of the retirement community?


Right. It’s completely enclosed within the Village of Penn State. The vision, if you can think of this, is the Village of Penn State was mostly built out when we bought it about eight years ago or so, but they had no outdoor amenities other than a really, tiny, little flat putting green—kind of had its better days. It had a big open, grassy field in the middle of the place that had nothing in it, other than groundhogs. They never had really built it out because 2008 and 2009 came with the economic downturn and the canyon of real estate demise that happened in that time stopped the Village from really doing and finishing a lot of things that originally were planned.


So when we bought it, we sort of said, let’s start from scratch: “What do you need here?” Well, we needed an upbeat, new life brought in to the Village at Penn State. If we could associate The Village with a Pennsylvania, Penn State kind of hero (such as Arnold Palmer), that’d be great. So, there was that personality side that needed a boost. At that time, Penn State University was going through some real big challenges, to say the least, and the Village had just been acquired by us (Liberty Lutheran) with an exciting future ahead.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


Imagine this big, giant field in the middle of senior apartment buildings, multiple buildings, and there’s big grass field in the middle of it. On top of that, the originally-planned front door to the main common areas of the building, was never really built essentially, no main entrance. So, what we did is we said: Let’s take our thoughts of wanting to create a grand entrance for The Village at Penn State that incorporates a big Nittany Lion monument sign out front, and all that kind of stuff, and team it up with the golf aspects that Arnold Palmer’s Design Company can bring to it. Let’s integrate them with all kinds of different landscape features that would incorporate features like a Village Green for common activities, a real walkable trail for people of all ages, lots of landscape features and fountains for passive recreation and some more active recreation—like, we also built some bocce courts. We’ve actually seen our residents enjoying anything from croquet to Tai chi to outdoor yoga on our new Village Green.


We even have a picture of these folks in their seventies, eighties, nineties on the Village Green this past Spring as I recall, with masks on and distancing, doing various fitness routines on the Green because the Green was built to golf Tee specs. So, it’s very firm, very flat, and you can cut the grass really short, so even walkers can go on it. That was part of the collaboration with Arnold Palmer’s Design folks. We wanted a Village Green, but not just like your average park lawn which would not be as accommodating for our residents’ activities. Here on our Village Green our residents can feel comfortable.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


So, we did all that in collaboration with Palmer and the specs were designed for that. Plus, we took Jane’s collaboration with JSR and integrating the cottages into the park, and turned this whole vacant field that was just begging for something to be done to it into this now burgeoning thing. People love it. They’re always out there.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


We also designed an indoor-outdoor dining terrace. We built an indoor bistro as part of this building project and then built a terrace overlooking Palmer Park. We integrated food service into this whole outdoor experience, “al fresco dining,” and so, if you can’t really get around the park too well, you can at least get to the terrace and sit out there or walk out there and watch your grandkids having fun on the Village Green, playing bocce or putting or chipping, or you can see your neighbors come down from the cottages. That vacant field became all of this.  Hopefully that answers your question.

 


Yeah, you actually answered a lot of my questions. I also want to make sure I’m clear on this: is the Arnold Palmer concept something that is normally for creating golf courses or something else?


I have to tell you the history for you to understand it. I had known Arnold Palmer from some golf course work I had done in the past. I hadn’t seen him for a while, so I wrote him a letter. I then wrote him a second letter and said, “Look, would you ever be interested in collaborating with me on something? I don’t know what we’re going to do at Penn State but we have some piece of golf that we could connect you to, because you’re sort of like a Pennsylvania hero.” His brother went to Penn State and his father was one of the first graduates of Penn State Agronomy School. So, his family has strong connections to Penn State, and of course, he’s a native of La Trobe.


So, after a couple of letters, his office finally called me and said, “Mister Palmer would like to talk to you. He thinks the idea has some merit.” So, we got on a call. One thing turned into another, and, we basically took what was a very simple concept and created a two-page agreement between Liberty Lutheran and Arnold Palmer Golf Course Design. We created Palmer Park together and Palmer Enterprises created the logo for Palmer Park. With Palmer having passed on, they certainly don’t have the patriarch of their company, but they still do a lot of golf course work, rebuilding work, consultant work, and the like for different development properties including golf.


So the idea was to incorporate small golf with senior living and integrate it into a park-like setting. We jointly came up with the name Palmer Park, and this is the first and only one, initially. The Palmer organization had a lot of inquiries from around the world and just this past winter, we started to collaborate with some of their principals there to come up with some ways to present this to different places and share this. That’s really it. It’s a collaboration between the two of us.


The Village of Penn State Palmar Park is not closed to the public, but it’s not a part of a public space. It’s private property and primarily for the residents; we don’t necessarily encourage people from the adjoining neighborhood to walk through it. Any activities there are primarily for the residents and their families, but there can be events that involve the community. That’s the beauty of it. It’s got some flexibility.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran

 


That’s great. I love hearing about all of the different activities that currently take place in the park and how much it allows for the residents to be able to interact with each other and maybe try some new things. I’m curious: Do you see any other type of evolution for how this park is used in the future versus how it is already used now? Do you see it changing or shifting into something else for the residents or the community at large?


One of the best elements of the Park is the Village Green and the fact that you can have indoor-outdoor events there and you can put up a pretty good-sized tent. And, the food service that the Village has is just phenomenal. I mean, we have a Penn State Culinary Institute graduate that is our food service director. He has a lot of connections in the state college area. You can have things like a culinary type piece that winds up on the Village Green in a tent for a special event with some folks in the community or from the university.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran

For example, a number of times before COVID, different athletic teams, choirs, and musical groups would visit the village. I could certainly envision them having an event in the tent or even outside with the backdrop of the waterfall and the terrace there. We’re talking about more boutique-type intimate events that are shared by friends and family of the university and the community to come into this beautiful, little park. All kinds of stuff can happen and all kinds of neat little nuances that you can do there.

 


Yeah, definitely. I think it’s so beautiful that it’s not so much an isolated retirement community, which I feel like I’ve witnessed a lot in different spaces—cities, suburbs, etc.—but it’s really placed in a space that invites the community to be a part of it and engage with it and have people interact cross generationally.

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


We’ve actually had dialogue with the University Department of Agronomy—now they call it Turf Management. We invited some of the professors from Penn State, from the agronomy, or turf management department to our event with Mr. Palmer a few years ago, because Arnold Palmer was really keen, as you can imagine, on golf courses and their grasses. They seemed to enjoy talking with him about all that. We’ve asked them if they would want to come up and have some of their turf management classes at our Village Green and Palmer Park. We actually made the putting green synthetic because, as you may know, the full growing season in this area isn’t very predictable, and the winter lasts pretty long. The rest of the park is all natural, but the putting green and some of the chipping areas around it are synthetic, so it’s there for our residents year-round.


So, the weather might not be great in April for the grass often gets pretty muddy, but if they have a nice day in April, even though the golf courses are still full of mud, they can walk right out from their patios onto this synthetic turf and enjoy some putting and chipping. It is a beautiful shade of realistic, green, not that old, lime-color stuff from the seventies. Arnold Palmer Golf Course design has only one synthetic that they’ll endorse as far as I know, and it’s the one we use. It’s so realistic and with it you play almost year-round.

 


It is really interesting to find out how that space has come together and how it continues to be really useful and just inviting to the community.


It’s been a blessing. Without Liberty Lutheran’s commitment, as well as their understanding and flexibility about how we could integrate Arnold Palmer Golf Design elements with upscale park-like landscape amenities and architectural design, we couldn’t have done it. I’m so thankful for their buy-in to the vision to meld all of these things together, along with Penn State University.

 

Photo courtesy of Liberty Lutheran

Photo courtesy of Liberty Lutheran


It is truly a community effort.


Yes, The Village at Penn State Community.