From Institutional to Homelike: Inside Nursing Home Renovations That Impact Recruiting, Retention, Resident Wellbeing

Renovating nursing homes to uplift the resident experience can improve not only property value and overall quality of care, but also regulatory compliance.

Staffing and retention are ever-present roadblocks at nursing facilities, and upgrading the overall atmosphere can actually help alleviate some of these roadblocks, with caregivers wanting to be in a building that’s easier to navigate and is the type of space that reminds them of home.

For operators with a lot of traditional, institutional floor plans, there’s still a lot that can be done to improve the environment in small, incremental ways, according to architects renovating such spaces. Therefore, changes, regardless of size, should be focused on shifting from an institutional feel to one that’s more residential in nature.


Meanwhile, introducing natural light or circadian lighting is a good place to start, and makes it easier for residents to access common spaces, getting them out of their rooms.

“Our environments matter. They matter not only to older adults, they matter to all of us, they have a direct impact on our behavior, our quality of life and enjoyment and engagement, and ultimately, our health,” said Alexis Denton, principal for Resilient Environment and gerontologist.

Denton spoke at a panel for LeadingAge California, along with Darla Esnard and Christopher Ebert, principals at Ankrom Moisan Architects.


A safe and engaging environment

In renovating, operators can send the right messages to residents and staff – engagement for residents, specifically, and work efficiency for staff, she said. More practically, nursing home spaces must help residents maintain the abilities they have, and be consistent and predictable while also being stimulating and engaging.

Support is the most important when it comes to renovations, Denton said, and that doesn’t just mean adding grab bars to rooms.

“It’s really important to match your residents’ abilities with the environment. A level of press is what the environment puts on you that you have to overcome. Stairs, going up to a front entry is probably the easiest example of a level of press; many of us can navigate those stairs easily without needing to overcome something,” said Denton. “But if someone has any kind of physical impairment, getting over those stairs becomes that much more difficult.”

Renovations must find the sweet spot between a stimulating environment and one that’s supportive and safe, she added.

For memory care patients, certain environments, like a dark spot on a carpet, can contribute to agitation. If a resident is withdrawn and it’s difficult to get to a common space like a living room or dining room, they are likely to just stay in their own rooms.

“The environment can even affect medication use. There’s research that residents that are agitated because of the environment, they need more medication. Again, there’s that direct effect on quality of life,” said Denton.

Initial fixes from the architectural panel involved adding circadian lighting for residents to more easily fall asleep and wake up at the right times, and comfortable furniture can make a huge difference. It’s all part of having a “biophilic design” to connect residents and staff to nature through architectural choices, said Ebert.

Circadian lighting changes the color of the lights throughout the day so that it matches more closely with what the natural sun cycle is, he said. In the morning, the lighting would have a blue tint to it, and as the day progresses toward evening, it becomes warmer with more orange and yellow.

“It’s been found that that process impacts our psychology and our body. It’s especially impactful for memory care residents,” said Ebert. “The research really does show and has shown for years, the impacts of access to the natural environment, whether physical access with your windows, even art, has shown to be able to improve the health and well being of residents.”

A fix can be as simple as moving away from more institutional fluorescent lighting, toward a warmer light bulb found in the home, he said.

Renovations and workflow

In terms of the environmental impact on staff, Denton said that if the environment doesn’t match the operational model, staff are working that much harder, going farther and there’s going to be physical impacts on them.

If it’s harder for staff, physically, to perform their day to day tasks due to their environment, that’s going to have a negative impact on recruiting and retention, she said.

Ensuring every piece of equipment has a place and is either hidden or has nice “framing” helps an environment feel more residential, Denton said. If a mop and bucket is just out in a hallway where residents and staff can see it, it “flips the switch” in that person’s mind that they’re in an institutional environment.

Denton said equipment placement is a good example of matching the environment with operations.

And as technology has reduced the number of binders, fax machines and other bulky administrative items for charting, the nurse’s station has gotten smaller as well. It’s actually happening in some instances at the point of care, said Esnard.

“It’s happening in your living rooms, and it’s happening in your other social spaces, where nurses and staff can connect with residents, but not necessarily sitting at one large nurse station,” said Esnard. “I know that’s controversial, it’s something that can be difficult to change, the way people are working. But we’re seeing more of that hybrid of one smaller station, and then point of care stations throughout the community.”

If a large, central nurse’s station is still needed, Denton said operators can get creative with how it’s laid out.

“We so often see residents congregating at the nurse’s station because that’s where the activity is. That’s where the people are, that’s where they want to interact,” said Denton. “Why not own that? Let’s put the nurse’s station in the center, let’s make it big, let’s make it look and feel residential. Let’s put it adjacent to a serving kitchen. We’re going to invite residents into the nurse’s station.”

Companies featured in this article:

, ,