Episode 15

Senior Living Made Human By Design

Nearly 80 million people will need senior housing in the next 20 years and design models are evolving to impact whole person wellness. In our conversation with senior housing design leader, Leslie Moldow, architectural principle with Perkins Eastman, she shares her experience, her energy and her commitment to developing architecture for senior living that creates a strong sense of community, wellbeing, and a strong social impact.

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Perkins Eastman's motto is "Human by Design". That means that everything that we work on is really focused around the user and the operator, and creating wonderful environments that highlight everyone's everyday experience. And that's what all architecture and design should be. I'm sure that many designers out there strive for that as well. So that's the common root, we're still designing for human beings. They just have had different experiences in their life, and they have different kind of needs than someone might have when they're 20 or going to school. Senior living used to be focused on care exclusively. You'd read descriptions of senior living communities and they talk about how we care for you. And it was very solicitous, and it was very appropriate, I guess, on the former generations. But as baby boomers are aging, we don't want to be cared for. I mean, certainly we'd like to know that if we need care, there's that resource there. But we want our autonomy. We've always wanted our autonomy. Leslie Moldow, FAIA, LEED AP, Principal, Perkins Eastman


CCB: [00:00:00] Welcome to the ONEder podcast. This is CCB your host with a really fascinating conversation, yet another fascinating conversation, with someone in our ecosystem, our design ecosystem. We've been thinking a lot about design for aging, and we actually started thinking about that prior to covid-19. We recognize that the impact of the pandemic has had a remarkably powerful impact on our seniors and senior housing situations. So we were wondering if there was someone in our world who could have a conversation with us about this. And we came across Leslie Moldow, who's a Principal at Perkins Eastman, and she has decades in the industry, I'm going to say, devoted to the study and the exploration of the most effective senior housing, and that's progressed over time. So I'm going to welcome Leslie.

Leslie Moldow (Perkins Eastman): [00:01:02] Hello.

CCB: [00:01:04] Thanks for joining us. And I'd like you to spend a little bit of time and explain your journey to where you are today.

Leslie Moldow (Perkins Eastman): [00:01:13] Ok, well, as inexplicable as it may seem, I became smitten with architecture even before I knew the word for it. In second grade, I was building models of schools and forts. And whatever project the teacher gave, it always turned into something three dimensional. And my family had no idea where that came from. I stole my brother's Legos and built forts out of blankets and tents and learned that this field was called architecture. I read books about Frank Lloyd Wright when I was in fifth grade and I was fortunate enough not to either be dissuaded but encouraged in the field. And as I started to study architecture, I was influenced, I grew up in Washington, D.C., I was influenced by social action, just like we have now. There were anti-war rallies that were going on and there was a sense that something that you did in life, you could have a big impact on how people lived and on making the world better. And so that wove into my desire for architecture. And when I studied first at the University of Maryland and then went to Berkeley, I started to really realize that my interest lied in developing architecture that created a strong sense of community and that really did have a strong social impact. And to that end, I first started working on special needs housing. There was funding when I was living in Boston for special needs housing. And so I worked on housing for people who were quadriplegics, housing for people who had emotional difficulties, of battered women's shelters, housing for pregnant teens who had been formerly incarcerated. And I had an opportunity to work on the first AIDS housing in the United States. And while a lot of those are incredibly significant events in my career, the federal government and other government sources dried the funding up for those still very necessary projects. In the process, I was introduced to some new types of senior housing and realized that that was also a confluence of my interest in creating community and in creating supportive housing. In addition to special needs housing, I started to focus on seniors and senior design. And that was in the mid-80s when it was pretty bad. The design of what people imagine and recall nursing homes are like and there are still nursing homes that are like that out there, could only be made better. So there was a real opportunity to create a huge impact in improving the quality of those environments and affecting the lives of seniors in a positive way.

CCB: [00:04:51] I read the book, Atul Gawande's book…

Leslie Moldow (Perkins Eastman): [00:04:56] One of my favorites.

CCB: [00:04:57] It's such a lovely, lovely book. As our father was older and was becoming more and more dependent on resources and help from others. And the concept…he spoke very clearly about the wellness aspect of human beings when there is a more thoughtful, intentional environment to support them through whatever the disease or the aging process. So we wanted you to talk about your approach to creating senior living, and how is it different from some of those other types of housing? I would say general housing, but then some of those other types of housing projects that you have worked on?

Leslie Moldow (Perkins Eastman): [00:05:40] Well, first, I would say that in many ways it is fundamentally the same, but it just allows you to focus on aspects that you may not normally focus on in housing. Perkins Eastman's motto is "Human by Design". That means that everything that we work on is really focused around the user and the operator and creating wonderful environments that highlight everyone's everyday experience. And that's what all architecture and design should be. I'm sure that many designers out there strive for that as well. So that's the common root, we're still designing for human beings. They just have had different experiences in their life and they have different kind of needs than someone might have when they're 20 or going to school. Senior living used to be focused on care exclusively. You'd read descriptions of senior living communities and they talk about how we care for you. And it was very solicitous, and it was very appropriate, I guess, on the former generations. But as baby boomers are aging, we don't want to be cared for. I mean, certainly we'd like to know that if we need care, there's that resource there. But we want our autonomy. We've always wanted our autonomy. At a base level, all the design really has integration of universal design principles, which means that the design should take into account someone who has arthritic hands and may have a problem picking up a pot of hot water on the stove and bringing it to the sink to drain. Or needs to address people that can't bend over and load a dishwasher the same way that we do, or reach up to a high cabinet or who may be optically affected by certain patterns of a carpet or tile flooring because of that type of vision issues they have.

Leslie Moldow (Perkins Eastman): [00:08:02] And really the type of design that we create needs to, at a minimum, not add a problem to someone. Many people who are living in two story homes and as they age, they just can't drive or even negotiate their house anymore. And we shouldn't be designing anything that creates impediments. And conversely, we should be designing places that empower people to live longer and live well. At a base, what makes it different is it has those design principles baked in. Now, that being said, what makes it special or what's particularly interesting to me is that it's not just the care environment, actually, it's housing and hospitality. It's an environment that focuses on empowerment and creating a place where people can be their best selves. Where they can age gracefully and age in a way that they can still be enlightened and useful and interact with other people and have their third act. It's not a place where people retire and get sent off to. You want to still be in the middle of the action.

CCB: [00:09:26] I came across the Perkins Eastman publication "Design's Impact on Seniors Perceptions of Wellness and the Built Environment" and I thought it was, well, incredibly comprehensive. But the aspects of whole person wellness and then the wellness strategies that you implement to impact, make that impact, or have that influence were comprehensive is the best word, it just keeps coming into my mind because it seems to go across all the physical, emotional, social, intellectual. You've thought about all aspects of that "whole person wellness", could you talk a little bit about the creation of that document?

Leslie Moldow (Perkins Eastman): [00:10:14] Oh, absolutely. As I just spoke about, senior housing communities are about places that people can be the best that they are, their best selves. There's been quite a bit of research about longevity and seniors and about the types of things that impact that longevity. There're people listening to this who want to do some additional research in the Blue Zones. There was research, scientists did on five different locations across the globe. And what was it in common that allowed people in those locations to be very long lived and very active? And what they discovered shouldn't be a surprise in this time of COVID, is that we are social beings. We need to interact with others. We need to be close with others. We need to be physically well. We need to eat well. We need to be mentally stimulated. We need to be engaged in volunteerism. There's a spiritual side to our wellness. So there's a number of dimensions of wellness that we have learned to incorporate in our design. And I think at a minimum, we're designing based on a program of spaces that our clients have. We're designing dining in a certain way. We're designing exercise rooms in a certain way. We're designing spas and salons to have certain activities and wellness. And educational and recreational facilities. But overarching all of that, I think, is the knowledge that as human beings we are biological creatures that come from the greater environment, and we at a very biological level interact with that environment, whether it's how daylight affects our hormonal balance or myriads of other things that we're discovering.

Leslie Moldow (Perkins Eastman): [00:12:46] And so our buildings need to allow us to connect with the environment, both just allowing us to be outside and feeling the breeze, allowing us to perhaps sit by a fireplace and feel the warmth and observe the spontaneity of the flames. But even how we move through space, even creating serendipity in what we expect, even in patterns of interiors, recognizing that our brain perceives certain fractals in a certain way, and that we respond to that kind of stimulation more than we do a type of monotony. So that all of those levels of wellness, we are learning to incorporate those principles into our designs. And that's why we did the paper. And so the last thing I want to leave you with is it's very important at Perkins Eastman to not only include those principles in our design, but to verify at the end, did they have the intended principal effect that we intended? Following up with post-occupancy evaluations and research is very key to what we do at Perkins Eastman. And we believe in sharing that information with other designers. And so I'm really glad you got a chance to read it.

CCB: [00:14:18] It was quite impressive. It certainly gives a massive amount of information to process and absorb. In such a broad sense, when I think about not only design, but just living today, especially for our seniors, but life in general, how to incorporate all those things. And it was to me an aspect of beyond LEED, beyond Well Building, the International Living Future Institute, it's incorporating much of that type of methodology and more. So I give you great kudos for that particular bit. I did want to ask a question about the research component at Perkins Eastman, because you have principal researchers as well as the designers. Could you tell us a little bit more about that?

Leslie Moldow (Perkins Eastman): [00:15:14] The idea for researching started in senior living design. We're very proud of that. But now it's very pervasive throughout our whole firm and other areas like education and work-related environments, et cetera, do their own research. We started by calling it Perkin's Eastman Research Collaborative and one of our first senior buildings in the mid-80s got together some social scientists and psychologists. It was to design one of the first memory care buildings in the United States. We researched some buildings in England. We brought some of those principles over. We invited these social scientists to be part of our team. And we developed some core principles that we wanted to imbue in the project that had to do with neighborhoods and wayfinding and orientation and recognizing perception and what caused that agitation and trying to minimize education in people living with Alzheimer's. That project won the AIA 10 year award, it was very influential. It was one of the first that used the idea of "memory boxes" that is just all pervasive in the industry. And since then, we frequently do post-occupancy evaluations on our projects, testing them against what we were hoping we were achieving and then share that. We let our researchers know early on in our projects, these are the intended principles that we're including. They're very mapped out, very intentional at the beginning. We keep those principles all the way through the project. We tell our clients; this is what we've heard from you. This is what we've learned. This is what we're trying to achieve. And all of our designers literally have it posted over their desks. And when we talk to the contractors during value engineering, those are those sacrosanct elements that we keep in the design. And then in the end, we're able to verify, did they have the impact that we hoped they did?

CCB: [00:17:53] The holistic approach to your designing for humans is very apparent. Now I want to move to a more specific project questions. There was another article, recent article, about senior living, and it talked about the pocket neighborhood and a couple of the projects that Perkins Eastman has worked on that incorporated that design concept, if you will. Could you speak a little bit more about that, how you came to that and the values and benefits that have been derived from that?

Leslie Moldow (Perkins Eastman): [00:18:39] Sure. And just to be clear on the language, because I think "pocket neighborhoods" refer to a number of things. It can refer to, in housing, a courtyard of small homes around a green space. But are you referring more to clustering units in a multifamily configuration?

CCB: [00:18:59] Yes.

Leslie Moldow (Perkins Eastman): [00:19:00] Particularly in care environments, the more that we can make an environment feel like home, we're finding that the evidence is the better that environment is. We want to definitely move from an institutional model where something feels like a hospital, which is a corridor with bedrooms off each side, and straight corridor where the nurse can see everybody, and what's paramount is the operation being as efficient as possible. To move to a more spontaneous environment like you would have at home where you have a household, and that's often a frequently used term for "neighborhood" - "a household". The number of people, that might be 10 to 14, that feel more like a family that share a living room, the common area, that dine at the same long dining table, who can operationally have input on what their meals are going to be. Again, it's going back to that we all want, autonomy. We all want that sense of not having lost ourselves and our ability to direct decisions in our lives. So that idea is becoming more and more accepted in care environments. And with Covid, we're actually finding, the "Green House" is a trademark of that kind of neighborhood household model, where it's literally a house or floor of a house like an apartment with 10 to 12 people in it. And they're finding anecdotally that those households are staying much healthier than the institutional model where you have staff that's dedicated. It is more like a house mother, if you will, with staff. They become almost like a bubble. Everybody knows who's coming and going. They have each other to keep each other company. They're not just locked in their rooms on the corridors. So I think coming out of this Covid experience, we're going to be seeing the next generation of care environments taking on that household model.

CCB: [00:21:29] There's kind of two questions that follow this. One is, are these concepts and approaches more expensive or less expensive to implement? What's the cost factor there? And then, how does that translate to low income?

Leslie Moldow (Perkins Eastman): [00:21:51] So do you mean do you mean the household model or just even the model?

CCB: [00:21:56] The household model.

Leslie Moldow (Perkins Eastman): [00:21:58] There have been studies on the costs of the household model. And when you look holistically, and you take into account the fact that this next generation wants those environments. So from a marketing perspective, they stay more formal because people have private rooms, there's less sharing of infection. So the cost is much better because you're not having to fight infections. From a housekeeping point of view, because someone has their own private space and they feel ownership about that space, they take care of their room more so the housekeeping costs go down. There's less food waste because people are selecting what they want to eat together. So there's all these kind of built in savings. And operationally, you have less of a hierarchy. Operationally you can take the same type of, number people, distribute them in different ways where someone, instead of being a specialist in delivering the food from the main kitchen, pushing the food down the corridor to where it get served. That person has more of a universal job description. They might be in the small kitchen in the household. They might help plate for somebody. They might spend more time sitting next to somebody. The number of hours ends up being the same, but the amount of personal touch time increases. The person is no longer wheeling things back and forth. They're able to sit next to Marge and say, "How is your day to day? How are you feeling today?" That makes a huge difference.

CCB: [00:23:51] Makes a huge difference, indeed. There's been a question about repurposing vacant high rises that might have been office space prior to, for senior living. Have you run into that question, that conversation, and do you have any thoughts on it?

Leslie Moldow (Perkins Eastman): [00:24:12] We're constantly thinking about, how do you create affordable models or what's happening in the general built environment that we should be aware of, that will radically change the future of senior living? We did a study called "Clean Slate" where we researched all of these. It's on our website, Perkins Eastman. We researched all of these outside influencers to see how that might change senior living. We see with Covid, certainly, that the hospitality industry is being affected, that retail industry is being affected, and that the office environments are being affected. Now, it's very natural to convert most hotels into senior living. It has a main kitchen, has a dining room, typically has some meeting rooms. There's a sense of entry. That hospitality feeling is there. While you might be limited to a single room, there are ways of renovating and joining rooms and converting spaces that that are a cost but not a huge impact. Next would be repurposing of retail environments. There are a lot of shopping malls that have retail spaces that are going out of business and the idea of potentially injecting a senior living community on what is a huge parking lot and maybe taking away some of those retail units and putting a place where people can live, where they can walk inside, where they can use the gym, go to the movie, use the eatery. Leverage off of some of those common areas in a shopping mall is something that we've started talking to mall operators about. They should be looking at this new kind of model as a way of solving some of the real estate issues. As for office buildings, in particular, especially high rise office buildings, I think there's difficulty with both the depth of typical office structures so that you don't have enough space that's adjacent to a window for a unit, and then many of them frequently don't have operable windows. That idea of having fresh air or being able to walk out onto a balcony, particularly with what we've learned with Covid, is going to be increasingly important. So I'm not saying it's not possible, in fact, we're looking at a project in Arizona where we're repurposing a medical office building, potentially, but it's not cheap. It's not the low hanging fruit. It's going to be expensive.

CCB: [00:27:16] Well, I have to say, Leslie, this half hour has gone by so quickly. I have millions more questions for you. And unfortunately, we don't have enough time. But I would like to ask you if there's any one final thought you'd like to share with our listeners. And I'm going to preface this by saying, listeners, there will be on the podcast page links to all of the references that Leslie has shared with us. So you'll be able to catch those. But is there anything else, Leslie, that you'd like to leave us as a final thought?

Leslie Moldow (Perkins Eastman): [00:27:47] Yes, I think as anybody is approaching senior living design, I think sometimes there's an idea that seniors are them. They're old, frail, there's a lot of misconceptions about what seniors are. My mom, who's eighty-three, even has misconceptions about what seniors are because she's certainly not old. And I agree with her. She's not. I think we need to adjust the dial on our perception of seniors, how we design for them, who they are, how we include them in society. I think that society, particularly with covid, with senior environments as they are, and seniors dying at much higher rate, it is finally time that from a society, we need to consider our elders and give them the respect they deserve and create environments for them that uplift them and their spirit in their lives.

CCB: [00:29:01] That's a beautiful final ending from our guest, Leslie Muldrow, principal at Perkins Eastman talking about senior living. We are very, very grateful for your time with us today Leslie.

[00:29:12] This is fun, thanks.

[00:29:14] Thank you so much. And for all our listeners, this will be available on all the podcast channels that you search Spotify, iTunes, etc, etc, etc.. We will look forward to speaking with you again sometime soon. Bye bye.