Providers Try to Anticipate Change with Flexible Design

The coming “silver tsunami” is a concept that continues to inspire optimism in the skilled nursing and senior care space, but the health needs of that population are still murky.

Flexible design is a tool that can help skilled nursing providers and others be prepared for these unknowns, and one Virginia continuing care retirement community (CCRC) made it a core part of their design from the beginning.

The Culpeper, located in Culpeper, Va., includes 47 skilled nursing beds and 36 memory care beds.


The project initially had been planned with an eye toward eventually converting the memory care beds to skilled ones. But in the end, due to different licensure needs the pattern flipped, and skilled care units were designed so that they could be converted to memory care ones. This was due to an expected uptick in demand for the latter services, Sarah Gregory, project manager at THW Design, told Skilled Nursing News.

That kind of flexibility was a key goal for LifeSpire of Virginia, which runs the CCRC, from the start of the project, Gregory explained.

“They’re really seeing the industry change a lot, and with the baby boomers, we don’t know what we’re getting,” she said. “But we know we’re getting a lot of them.”


Versatile inside and out

The Culpeper is preparing to have its residents age in place.

The five-story facility will cost a total of $33 million to build, with a planned completion timeframe of early 2019. The designers took advantage of the landscape by building into the side of a hill, Gregory explained, allowing for three of the stories to technically be at ground level — so memory care units can be easily arranged to meet future needs.

The top three stories of the building have been designated for assisted living. However, all of the people initially coming into those levels will start out with an independent living level of service.

“Because we’re setting it up for assisted, all of the facilities will be in place to be able to let them age in place,” Gregory said.

These considerations are likely to become more widespread; THW has clients with independent and assisted living needs in Georgia that are actively including flexibility. Though there will be different licensure considerations — skilled care typically requires a separate license than assisted living — in most states, the codes allow for this elasticity of design, Gregory said.

Disputed future

Gregory and Culpeper executive director Jim Jacobsen both referred to the coming wave of seniors as a consideration for the facility’s design.

There is some debate, however, about the timing and makeup of that projected influx of elders, at least among two major real estate investment trusts (REITs). Omega Healthcare Investors (NYSE: OHI) recently completed an analysis of the demographics expected to drive skilled nursing demand over the next 10 years, and predicts that the demand wave will be felt heading into 2019, according to the REIT’s most recent earnings call.

On the other hand, Rick Matros, CEO of Sabra Health Care REIT (NASDAQ: SBRA), expressed doubts the tsunami would even make landfall.

“[T]here is no big wave coming in,” he said in the fourth-quarter earnings call. “It’s just going to start trickling in.”

The polar-opposite prognostications highlight the difficulty of planning for the future, but by incorporating flexibility into the design, new SNFs can position themselves for any changes or unexpected trends.

In the Culpeper’s case, 16 of the 47 SNF beds have been designated for short-term rehab, Jacobsen told SNN. These can be converted to long-term skilled nursing beds as needed, since all the units are designed identically with private bathrooms and the same access points. The rehab units are also in different “neighborhoods,” or wings, so they can be adjusted for the residents in a certain area of the building.

“To maybe be able to take some of the memory care residences and convert them later, and the same for skilled nursing and the short-term rehab… to have that flexibility was something that was very important to all of us based on the future population and the needs of our seniors down the road,” Jacobsen said.

Written by Maggie Flynn

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