Rethinking elder care: Real estate pros are examining what changes must be made in design of facilities in post-COVID world

New Jersey’s real estate industry is beginning to imagine what building design will look like after the ravages of COVID-19.

And that reevaluation has started where nearly half of people are dying from the disease: long-term care facilities.

In the Garden State alone, more than 10,000 confirmed COVID-19 cases and 4,377 related deaths have been reported among elder care residents and staff, according to data from the state’s Department of Health. That death toll amounted to more than 40% of New Jersey’s COVID-19 deaths at the time the figure was published.

Photos courtesy T&M Associates
Gene March.

New Jersey health officials have been divulging the particulars of where those deaths occurred in the state’s more than 400 long-term care facilities, revealing that some individual facilities have had more than 30 reported deaths.

Those that have been involved with development projects for retirement and nursing homes are now asking how architectural design and building operations might better protect a population that has proved especially vulnerable to this respiratory disease.

Leaders at T&M Associates, a Middletown firm that provides engineering and construction services for the health care sector and other industries, had to start that conversation not long after the nation’s first reported outbreaks were in elder care facilities teeming with infection.

Gene March, client manager at the firm, doesn’t shy away from talking about how grim the situation has gotten since.

“Nursing homes are losing people faster than they can process them out,” he said. “It’s really morbid. … But one of the changes needed at these facilities is that their morgues store two bodies at a time. Now, they have to account for much larger amounts of people who are passing away there.”

Architects agree: The unprecedented situation needs to be answered by an equally unprecedented reimagining in the design of elder care facilities.

They’re talking about the need to change everything from the air conditioning units that might be recirculating virus particles to the carpet and soft wall coverings that were meant to be inviting, but might also be harboring germs.

When it comes to nursing homes, in particular, the local engineering firm executives explained that, as they’ve worked with nursing homes over the past 25-some years, the number of beds within each room has been on the decline.

Michael Regan.

But the senior citizens that live in these buildings don’t usually get rooms to themselves, even now.

“Given where we are with COVID, I would think there would be a push to make these rooms totally private now,” March said. “Private is the name of the game. It solves a lot of problems.”

Everything’s still speculative at this point, said Michael Regan, senior vice president and operations manager for T&M Associates.

And ideas for major overhauls are facing a conundrum. Namely, given that long-term care facilities tend to survive on razor-thin profit margins, there might not be capital on hand for such investments.

“Nursing homes need to be full to be profitable,” Regan said. “This hasn’t put more people in nursing homes; it has taken them out. So, I don’t think, overall economically, it’s going to be a help to the bottom line of these business.”

The firm’s project executive, Robert Koochagian, said one of the aspects of these facilities that’s being revisited for the time being is how they are run from a programmatic perspective.

“In these homes, you have an emphasis on group activities that keep people out of their rooms and engaged with the community,” he said. “Now, things are moving in the opposite direction.”

There’s already a degree of separation built into something like a nursing home, given that those with dementia are separated within the facility.

Using those features of facilities for quarantine efforts and pulling back on regular mingling of residents are administrative steps already taken at many long-term care facilities. But, depending on how long-lasting those measures are, there could be downsides.

Robert Koochagian.

“If it’s too much of a cold, isolated environment, families are only going to be having people go there as a last choice — after we’ve seen over the past few years assisted living that is more often being made as a choice,” Koochagian said.

Whether families might already choose in the future to keep people home longer because of the news that’s already come out about infections in these facilities is another of the many unknowns that have these real estate executives feeling like they’re flying blind.

But they are certain about one thing: If the world is going to change to adapt to pandemics, that change is going to happen in elder care facilities.

Rethinking medical office space

At the end of April, Darren Lizzack was asked by a real estate client, an optometrist, how he should design the waiting room at a new office the client would be relocating to.

Lizzack, who leads commercial real estate firm NAI James E. Hanson’s medical office team, said it’s eye-opening how often he’s now fielding questions no one quite has the answer to.

“I said, ‘Look, you’re going to be one of the first offices to open up for business that took into consideration what was going on during the COVID-19 epidemic,’” he said.

Those in real estate who handle the physical footprint of specialized doctors and surgeons say they have some quandaries to sort out. For one, these health care professionals are often tenants in multistory office buildings with heavily trafficked entrances and tightly confined elevators. In other words, not perfect environments during a pandemic.

Bob Atkins, managing partner for Atkins Properties, said that means these professionals have had to think about how they can immediately step up the sanitation of their spaces. Atkins believes that trend of dentists, eye doctors and other specialists moving into single-story, retail-type buildings with dedicated parking structures will be accelerated in the long term.

These professionals have also taken more of a financial hit during the attempt to slow the transmission of COVID-19 than other segments of the health care industry.

The real estate experts working with them to figure out the best way forward haven’t turned a blind eye to that. But they do expect this part of the real estate market to rebound quickly.

“For us, we’re very happy to be in this asset class,” Atkins said. “These practices are not immune to feeling some pain like everyone is, with the postponement of elective surgeries and a significant drop in patient load, but I don’t expect it will hurt for as long as something like the retail sector.”

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