Design Issues Specific to Senior Living
Senior living facilities have dozens of attributes and requirements that make them different and more complex in regards to development, designing, and construction than other asset classes of real estate. Below are some of the more common differentiators that you, as the development manager, need to keep in mind as you are planning and designing your facilities.
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Proper Drainage for Courtyards
You might assume that your civil engineer will always design adequate area drains and storm drain lines for effective courtyard drainage. However, it's surprisingly common for these area drains, storm lines, and roof drain tie-ins to be either overlooked or undersized by your civil engineer. As the development manager, it's important for you to remind the civil engineer to plan for comprehensive and effective courtyard drainage. There have been instances in senior living developments where storm water drainage was unintentionally omitted from the civil plans for an enclosed courtyard, and not installed by the GC. Not being able to get storm water out of an enclosed courtyard is a huge problem. The solution is usually to incorporate a lift station (pump) to remove the water - a costly and maintenance-sensitive alternative to the preferable gravity-flowing storm water drain lines. If the courtyard isn't properly drained, it poses a flooding risk to the entire building.
Plan for a Leave-Out to Access Enclosed Courtyards with Lifts
When a courtyard is fully enclosed by a multi-story building, ensure your architect, structural engineer, and general contractor (GC) coordinate to install an access point, big enough for a construction lift to drive through, somewhere on the first floor of the building. This will allow the GC to get a sky-lift into and out of the courtyard. This access point is crucial for transporting construction materials into the courtyard and lifting those materials into place on the building exterior facing the courtyard. Creating a leave-out on the first floor that is big enough for a sky-lift to drive through will almost certainly require structural modifications from the structural engineer. Designers and GCs oftentimes overlook this constructability problem, so be sure you remind them of it.
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Art
Given its residential nature, your senior living community will likely have a lot of art on the walls. Collaborate with your interior designer and GC to ensure there are no obstructions placed on walls intended for art. For instance, if a significant painting is planned for a specific wall, and there's a fire alarm device or thermostat where the painting is scheduled to go, you'll face the dilemma of relocating either the device or the artwork. Relocating devices becomes more challenging on walls with tiles or wallpaper. Always plan ahead to avoid such complications.
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Views
Attempt to orient and lay out the building so that the independent living units get the best views. Renting an IL unit is largely a discretionary choice by the resident. A good view of a mountain range, body of water, city scape, etc. will just be another plus to help that IL resident chose your community over another. The need for assisted living and memory care is less of a discretionary choice by the resident (or their adult children), but is more of a service the resident must have just to stay healthy and alive. They are going to be less worried about having a great view to gaze at from their unit. So design your building where you place the IL units facing the great views.
Also, if possible, try to avoid views from your independent and assisted living units, and common areas, from looking into the memory care courtyard. Seeing memory care residents can be depressing to some IL and AL residents. They don't want to be reminded of where they will be headed one day.
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Trash Compactors
If you plan on using large commercial trash compactors at your facility, make sure your architect and civil engineer make room for it on the site plan (likely in the loading dock). Also, make sure your electrical engineer plans to run power to it. Your operator will likely lease the trash compactor from a local sanitation company, so get the compactor electrical requirements from the sanitation company and pass those on to your electrical engineer. You probably will also need traditional dumpsters on the campus for resident use.
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Onsite Resident Storage
A nice revenue generating amenity to offer to your residents are storage cages for their stuff they don’t want to put in (or can’t fit in) their apartments, but they are not ready to part with yet. Usually a resident is downsizing from a house to a small apartment, so they have more stuff than space. These cages can be as small as 3’x3’x3’ or much larger walk-in versions. It would be much more convenient for your residents to store their extra stuff onsite instead of at some off-site storage facility, so it can be a real selling point. Plus the additional rental revenue from the cages enhances your NOI. Tell your architect to program in these storage rooms and cages.

Locking Medicine Cabinets
Locking medicine cabinets are required in memory care (and sometimes assisted living) to store a resident’s medicine, unless your operator programmatically delivers medication to residents via a med-cart. This is something oftentimes overlooked by architects so find out from your operator if they are required, and if so, have your architect add them.
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Water Softeners
Because your senior living facility will have commercial kitchen equipment, and possibly commercial laundry equipment, you want to make sure hard water won’t damage that expensive equipment over time. Hard water is present in the majority of public water system. Hard water has a lot of minerals (mostly calcium and magnesium) and these minerals can build up over time within your equipment and pipes – making them less efficient, creating clogs, and eventual failure and need for replacement.
I wont go into the chemistry of how soft water systems work, but they “filter” out calcium and magnesium from the water and these filters need periodic rinsing with salt water to clean and clear these filters of the minerals. The salt for this cleaning process is usually delivered in bulk, on several pallets, two to four times a year to the facility. To make the receipt of this bulky and heavy salt easier, have your architect place the water softener system in a place where a delivery truck can back up and deliver the salt.
This softer water will also benefit smaller boilers, hot water heaters and residential grade kitchen and laundry equipment to extend its life span. Softer water also cleans clothes more efficient and is more pleasant to shower with. Your plumbing engineer should request a test of the local water to see if you need a water softener.
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Water softener system

ADA Showers
A percentage of your units should have ADA compliant showers, not only to comply with ADA and licensing requirements, but for the real world need of your residents, most of which have a disability or limited mobility. These are showers with a very low threshold (¼” or lower), that a wheelchair can roll over.

ADA shower enclosure
Many prefabricated ADA shower pans are constructed assuming porcelain tile will be on the adjacent bathroom floor, so the threshold on the shower pan is actually 1-1/4” high. Typical porcelain tile is a ½” thick and the mortar bed the tile sits in is a ½” inch thick, only leaving a ¼” net threshold height above the top of the adjacent tile bathroom floor – which is in compliance with ADA standards. You run into a problem if you don’t cover your floor with porcelain tile, but instead use a thinner flooring product like luxury vinyl plank (LVP) flooring. This flooring product is only about ½” thick in total, therefor the shower threshold will stick ¾” above the adjacent flooring, making that shower pan non-ADA compliant. If you are planning to use a flooring product that is thinner than 1” thick in these ADA bathrooms, you will have to float up the sub-floor to bring it within tolerance. LVP is usually cheaper than porcelain tile, but some of that savings will be washed away by having to pay extra for the floor float at these ADA bathrooms. The other way to solve this problem is to recess the shower pans into the concrete slab or wood subfloor, but those options also have costs associated with them and make the construction more complex.
Another inherent problem with these low threshold ADA shower pans is that they don’t do a very good job of keeping water in the shower if you are just using a shower curtain. Oftentimes water flows onto the adjacent bathroom floor. There is not a whole lot you can do about this. Operationally, your staff needs to tell residents to be mindful of spraying water at the shower curtain. You can also install collapsible rubber dams on top of the threshold that wheel chairs can roll over. These dams help to keep water in the shower, but still make the shower ADA compliant.
Finally, ADA showers require grab bars, and sometimes fold down seats. Ensure your design team shows blocking in the walls for those grab bars and fold down seats.
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Pocked Door Hardware
If your project uses pocket doors, be sure to have your architect specify hardware for that door that is easy for your residents to grasp. Many elderly residents have arthritis in their hands and limited grasping ability, and traditional pocket door hardware is difficult for them to grasp. A cheap and easy solution is to just put a big handle on the inside face of the bathroom door near the edge so that residents can easily shut and open that door.
An alternate to pocket doors are barn doors, which typically have hardware that is much easier to grasp. Most people also consider barn doors to be more attractive, easier to operate, easier to install, and easier to maintain than pocket doors. The downside of barn doors is that they are normally more expensive. Also, you need to maintain the wall area next to the barn door clear of fixtures, outlets, switches, furniture and art so the barn door can slide open.
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Unit Mockups
Mockups are always a good idea. They allow the owner, architect, GC and subcontractors to review a small sample of some constructable component of the building before going into mass production. On many commercial construction projects, the GC creates a mockup of an exterior wall for the whole team to review. This gives the subcontractors a chance to work together and collaborate on how to properly assemble the wall in accordance with the plans. It also gives the GC and architect a chance to review the wall assembly to make sure it is constructed properly. And gives the architect and owner a chance to review the exterior finishes to ensure the building will look good.
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With senior living projects, you can have well in excess of 100 resident rooms. If possible, you want to fully build out one of these unit rooms (or one of each type of room) so that the whole team can see how the room comes together and identify any problems before you go into mass production of the 100+ rooms. Some of the problems you can catch are: door swings conflicting with something; electrical outlets or light switches in the wrong location; flooring transition creating a trip hazard; pocked door issues that I mention above; ADA shower issues that I mention above; overall quality, look and feel of the finishes and layout not turning out like you thought.
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Unit mockups are great in theory, but hard to pull off. Trying to get all of the specified finishes, appliances, and fixtures built into a completed unit early in the construction process is tough. Certain finishes, like solid surface countertops, might have a long lead time so it would be difficult to install them a year+ ahead of schedule. A way around these problems is to use more readily available products for the mockup, but obviously, if you don't use all of the specified products in the mockup, the utility of the mockup becomes less valuable.
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Be sure to tell your architect to include the requirement to build out a mockup in the plans and specs, and highlight this requirement to your GC so he does not overlook it when pricing out the construction.
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Backup Electrical Generator
Although not always required by local code or the state to get your license, you may want to consider providing a backup generator to your facility to provide electrical power if the normal electrical power goes down.
Generators are expensive. Not only do you have to pay for the generator itself, you also have to pay for the generator enclosure, automatic transfer switch and all other supporting wire infrastructure to incorporate your generator into your electrical power system.
You don’t want to buy a generator that could power your whole facility because that would cost a fortune. You should size the generator so that it only powers critical or important building systems if the power goes down. Some examples of critical and important items to place on backup power are:
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elevators
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nurse call
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nurse's office
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access control
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egress lighting
One of the main concerns with not having a backup generator is people getting stuck in the elevator if the power goes down. If you don’t have a generator, you can add a feature to your elevators where a backup battery allows the elevator to lower to the 1st floor and open the doors if there is a power outage.
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Wood Framing Combined with a Steel and Concrete Structure in One Building
Senior living buildings are distinct from other types of buildings in that they usually have an un-licensed independent living building, directly abutting a licensed assisted living and/or memory care building. These licensed and un-licensed buildings are usually only separated by a fire wall, so from the outside, it just looks like one big continuous building.
Since independent living building don’t require a license from the state, they can be built with more relaxed construction standards and at a cheaper cost. For example, IL can usually be built with wood framing and Romex electrical wire, whereas AL and MC usually require steel and concrete structure and electrical wiring in metal conduit. You obviously want to take advantage of the cheaper constriction costs of IL buildings, but combining IL construction standards with AL and MC construction standards in one building provides some challenges.
First of all, it is challenging to find a general contractor that has experience with, and can effectively manage a project that is partially wood framed and partially steel and concrete structure. Usually, general contractors are divided into groups that focus on wood framed apartment buildings, and ones that focus on more commercial type steel and concrete structures, and they rarely mix. These two product types also have a different subcontractor base, and require a different knowledge and experience level of the general contracting staff to manage these projects effectively. It is a small group of general contractors that are willing to do both types of construction in one project.
If possible, it's good to get your general contractor on board early in the design process so that he can give feedback to your structural engineer on how to cost effectively design the structure of the building. A building's structure is a huge cost driver of a project. So even if you can shave only 10% off the structural component cost of the building, it could easily save tens or hundreds of thousands of dollars.
Steel and concrete AL building in front with wood framed IL building connected in the back, but separated with a fire wall.

Carpet
Most operators and owners would prefer to have no carpet in their senior living facilities. Carpet can get dirty easily, is difficult to clean, can become worn out quickly, and is expensive to replace. Other flooring products, like luxury vinyl plank tiles, are durable, easy to clean, inexpensive, and look good. However, carpet is able to soften a space and absorb sound better than any hard surface flooring. Likewise, too much hard surface flooring in your building can make it feel cold and institutional. Not the feel you are going for in a residence.
You may be thinking that you can just put a bunch or rugs in the units and common areas with hard flooring to soften the space and absorb sound. But unfortunately, rugs become trip hazards for our senior living residents.
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If your corridors are carpeted, your interior designer will likely chose a broadloom carpet with an elaborate pattern. This is to give interest to the corridors, and patterns hide wear and stains well - something that high traffic corridors are susceptible to. When using patterned carpet, especially a carpet with a pattern that does not repeat frequently, installation is challenging. Lining up the patterns at the seams is tricky and if the pattern is elaborate, it will lead to a lot of waste, and higher price. Ensure your GC carries the appropriate allowance for waste in his carpet order (and pricing) to accommodate lining up the patterns at the seams.
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Not only is there waste on the install, there is also waste caused by the minimum run length from the manufacturer. The manufacturer has to fabricate his manufacturing runs so that each run has a complete a pattern. If running that complete pattern takes 320 square yards, but the flooring subcontractor only needs 300 cubic yards, there will be 20 square yards of carpet waste you have to pay for.
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An alternate to broadloom are carpet tiles. They are cheaper to install, have less waste, but usually have a higher material cost. Other benefits are that attic stock is easier to store, and if a section of carpet is stained/damaged, the maintenance manager can switch out that stained/damaged tile.
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Finally, don't pick a carpet with a leaf pattern for your carpets that will go in memory care. Some of your MC residents will spend time trying to pick up the leaves, and that is not a situation we want to put them in.
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Gypcrete
Gypcrete is a flooring underlayment mostly used for sound attenuation, and commonly used in multi-story wood frame construction. It is similar to concrete, but much lighter and not nearly as durable. It really deadens the sound transmission from upper floors to lower floors. If you have lived in an apartment without good sound attenuation between floors, it gets very annoying hearing your neighbor above you walking, running or jumping around. Gypcrete is not unique to senior living, but also commonly used in normal multi-family and hotel projects. Gypcrete is basically a slurry mixture of gypsum plaster, Portland cement and sand that you pour onto a wood subfloor. It is self-leveling, but very messy. In addition to sound attenuation, it is fire resistant and can be used in an UL fire rated flooring assembly. Also, because it is self-leveling, it creates a smooth and level surface for your finish flooring. Gypcrete does cost extra money, but it is relatively cost effective and usually well worth all the benefits it creates.

IT Closet Cooling and Placement
If your senior living building is large, you are going to have several information technology (IT) equipment closets throughout the facility. The IT equipment in these closets gets hot, and that equipment needs a dedicated cooling system to operate effectively. So that your mechanical engineer can specify the correctly sized cooling system (typically a split unit) for each IT closet, have your low voltage consultant estimate what IT equipment will go in each closet, so your mechanical engineer can estimate the heat load created by that equipment, and counter it with an appropriately sized cooling unit.
As for quantity and placement of the IT closets, the cabling used to transmit data for computers, phones, TVs, etc. has a limited length that it can effectively travel to transmit data – approximately 250’. If you have to run a data wire from your main IT equipment room, referred to as your DMARK or main distribution facility (MDF), to a computer that is more than 250’ away, the data line has to stop at an intermediate distribution facilities (IDF) to have the data signal boosted every 250’. Ensure your low voltage consultant, electrical engineer, and architect all work together to plan for and place these IDF closets throughout the facility to be under the maximum data line run of 250’.
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Access Control
Access control is a term to describe the security system that locks and unlocks doors, and usually includes electrified door hardware. This electrified hardware enables a door to stay locked until someone swipes a card or FOB in front of a card/credential reader, or types in a code, to allow the door to open. Electrified hardware usually comes in the format of an electrified strike, an electrified handset, or a magnetic lock.
Controlling what people can open what doors in a building is not unique to senior living, but you do need to pay particular attention to the access control into and out of your memory care facility. It is not uncommon for a memory care resident to accidentally or deliberately wander out of the memory care facility and get lost, injured, and even die. The industry term for an MC resident getting out of the secured MC area is "elopement." Because of this threat, most states require access control at the MC facility to get your license.
Your architect should work with your operator to determine what doors should get access control, both from a regulatory standpoint and a functionality standpoint. After getting your functional requirement from the operator, your architect will usually hire a hardware consultant to specify all the door hardware, to include electrified hardware.
Getting your access control right is tough to figure out. Take it seriously and dig into the details as the development manager. Ensure your architect hires an experienced access control consultant that knows both the local code (to include the local fire marshal's requirements) and the state licensing requirements pertaining to access control. You don’t want to get to your state licensing inspection and fail because the incorrect access control was installed. Fixing access control is not going to be a quick, cheap or easy. The lead time on access control equipment is long. You will be losing revenue waiting for your license and paying your cost of capital during this dead time.
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Some development managers use the low voltage consultant to help select, furnish and install the access control system, and some simply use the GC. I've done it both ways, and think it is simpler and cleaner to just have the GC furnish and install the access control. If you use electrified strikes, your GC's doors/frames/hardware subcontractor will have to prepare the door frames to receive those strikes. And if you use electrified handsets, the sub will have to prepare the door, and provide an electrified hinge to allow the handset to work. It is simpler to just leave all of this coordination and responsibility with one party - the GC.
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Door Auto Openers
Opening a heavy exterior door can be challenging for a senior resident, so it may make sense for the owner to install auto openers at frequently used exterior doors. The facility main entrance door and the doors to the courtyards are good examples of doors where it would be good to install auto openers.
You may have some type of access control on the doors with auto openers, so be sure to coordinate that tightly between the subcontractor providing your access control and the subcontractor providing your auto opener. Doors with access control and an auto opener are notorious for having problems. Try to limit the doors with both. Since your main entrance door will likely have an auto opener and access control, and because it will get a lot of traffic, and it is one of the first impressions a potential new resident will see, you don't want it to have many problems. So coordinate its installation tightly to make sure it does not have problems.
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Employee Breakroom
​Working with senior living residents all day can be taxing mentally and emotionally for your staff. The break room is a place where they can get away for a little while, recover, have a quick meal, then get back to work a little more recharged. Make the breakroom nice. Get some natural light in there. Furnish it well with a couch and tables and chairs for meals. Have an ice dispenser and filtered water to refill drinking bottles.
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Gym
Most senior living facilities have a gym for residents to exercise in and sometimes for physical therapy. There is not much that is complex about these gyms from a development perspective. Your operator should help select the type and quantity of exercise equipment for the gym based on the quantity and acuity levels of the future residents. Once your operator selects the type and quantity of exercise equipment, your architect can then layout the gym equipment onto the gym floor plan. Since most gym cardio equipment needs to be plugged into an electrical outlet, have your electrical engineer place the outlets near that equipment. This may require installing floor outlets.
Salon
Your senior residents are going to need haircuts. And some residents want other salon services like hair styling, manicures, pedicures, makeup application, facials and messages. It is certainly convenient for your residents, and the operator, if these services are offered right at the community.
If you have the budget for it, it is a good idea to offer a separate salon/barber shop for the different types of residents you have. If your community offers residences for IL, AL, and MC, you should have separate IL, AL and MC salons. At minimum, you should have a separate salon for memory care residents.
You may want to consider having an area or chair in the salon that is more masculine and barbershop-like for male residents. Some males have a problem going into a feminine looking salon to get their haircut.
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Dog Park
Many of your senior living residents will have a companion dog or dogs. Since walking those dogs will likely be difficult for most residents, it is good to offer them a fenced in dog park so the dogs can run around outside, get some exercise, and go poddy. Facilities without a dog park will be a major shortcoming to dog owning potential residents.
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Dog Wash/Grooming Room and Station
If you have a dog, you are going to have to periodically bathe him. It is difficult for a senior to bend over or get on their knees at the bath tub or shower to bathe their dog, so make it easy for them and provide a dog bathing room and station with elevated tub that they can place their dog into for convenient bathing.
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Resident Garages and Carports
Resident garages and/or carports are a great amenity to offer your residents. Also the incremental rent revenue from these structures has a short payback period and can really boost your Net Operating Income and eventual sale price.
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Golf Cart Parking & Charging
If you are adjacent to a golf course, or simply in a community where people use golf carts as a mode of transportation, some of your residents my have their own personal golf cart and will want parking and charging for those golf carts.
Also, your staff will likely use golf carts for tours, grounds maintenance, and possibly food delivery from the main kitchen to the memory care warming kitchen. Ensure you plan for parking and charging for these staff golf carts.
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Rooftop Equipment Screening
City requirements to screen ugly roof top equipment is not unique to senior living buildings. However, many senior living communities also have a Direct Outside Air Supply (DOAS) units. DOAS units bring in fresh air from the outside so that stale interior air does not continue to be recycled within the facility. This introduction of outside air is required by some codes and/or senior living licensing authorities.
Before that outside air can be introduced, it usually has to be conditioned – cooled, heated, and de-humidified. I won’t go into the details of why, but to perform these functions, DOAS units tend to be very tall. They are usually in the 8’ range, and they sit on a curb that is more than a foot tall so the total unit height can be almost 10’ on some units. Screening something that tall is difficult and expensive because of the wind loads the screen is subject to. Ensure your architect knows early what the city requirements are for screening roof top equipment, and he incorporates that into his design, so that your GC can incorporate that into their price. ​
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Lighting Requirements in AL and MC
Since assisted living and memory care facilities are licensed by the state, the state typically requires they have a minimum level of lighting throughout the AL and MC portions of the community. The purpose of this regulation is to ensure there is sufficient light for senior residents, who may have deteriorated eyesight, and need well lit areas to safely get around. The regulation may also require certain staff areas to have a minimum amount of light so the staff can perform their job, like preparing medication for residents. These illumination standards usually require a certain amount foot candles at specific areas of the building and at a specific height above the finish floor.
To achieve these illumination standards, your electrical engineer will need to run a photometric model on the floor plans so he knows where to put the light fixtures and how bright those light fixtures need to be. Photometric models are notoriously inaccurate because many factors affect how much light is in a certain area, like the reflectivity of the surfaces around the light.
Also, decorative light fixtures, which are common in senior living facilities, are usually not counted in your photometric study because they do not typically come with Illumination Engineering Society (IES) files. Therefore, your electrical engineer can’t input them into his photometric model. IES files describe how light from a lamp is distributed in a room. Manufactures of lights test this light distribution and include IES files with the light fixture specifications. However, decorative lights are specifically designed more for decoration and ambiance, not primarily for illumination, so most manufactures do not provide IES files for their decorative light fixtures. This includes chandeliers, and sconce lights, which are common in corridors and public areas.
The state licensing inspector may walk around the facility with a light meter and measure the amount of foot candles in certain areas of the building to ensure they meet the requirements. Before your actual licensing inspection, your electrical engineer should walk the building with a light meter to ensure all areas of your building will pass the illumination standards. If not, add more or brighter lights.
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An important thing to coordinate between your electrical engineer and your interior designer is a consistent color temperature between the architectural lighting and the decorative lighting. You don't want to see a mix-match of bright white architectural lights and warm light decorative lights in the same room. 3000k is a widely accepted color temperature for a soft white light and the best color rendition.
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Fire Walls
​Senior living communities usually have several fire walls in them – more than your typical commercial building. Be sure to minimize or eliminate any windows that might be in fire walls. If there is a window in a fire wall, the glass and frame have to be fire rated and those windows can get very expensive. Make sure your GC uses a drywall contractor that is experienced with senior living so they know how to construct the complex smoke barriers, and how to properly seal any penetrations through fire walls.
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Pavers
Pavers on hardscape walkways look great, but hey are a trip hazard to senior living residents, and are a difficult surface for a walker to travel over. Minimize or eliminate their use on your campus. The same goes for stamped concrete made to look like pavers.
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Hot Water Circulating Pump
Hot water circulating pumps are not unique to senior living, they are also common in multi-family and hospitality. You not only don't want your residents to be inconvenienced by waiting a long time for the water to get hot from their faucet, you as the owner don't want to pay for all that waisted water. Be sure your plumbing engineer includes these circulation pumps.
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Limiting the Amount of TVs in Memory Care
In your memory care building, you want to limit the number of TVs for the residents to watch. Memory care residents may want to watch TV all day, but when families are paying $4000 - $6000/month in rent, they probably wont be happy to learn they are paying that much to have mom or dad sit in front of a TV all day. If a MC resident is sitting in front of the TV all day, that probably means your operator is not planning enough activities for them.
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Theater Room
Seniors sometimes enjoy watching a moving in a group setting, as opposed watching it alone, so theaters are common in senior living communities. They don't have to be fancy, just a large room with a big TV, good speakers and plenty of comfortable chairs. Pick a room without windows in your facility to improve the viewing experience.
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Memory Boxes
Some memory care facilities place “memory boxes” outside of a resident’s unit to help them recognize their unit. If your operator thinks these are a good idea, have your architect incorporate them into the design.
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Post-Tension Slabs
Post-tension slab can usually be a cost effective way to provide a slab for a senior living community. However, one of the problems with post-tension slabs is that if you have to cut into the slab to run a drain, water or electrical line, you are very limited in what areas you can cut into the slab so as not to cut a post-tension cable.
The design team can’t plan perfectly for everything, and you are likely going to need to cut into the slab for one reason or another. Emphasis to your design team that they need to nail all the under slab MEP during the design phase to minimize the need to cut into a post-tension slab later.
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Balconies
Balconies are one of the main potential sources of water infiltration in a multi-family project, to include high density senior living buildings. Water can infiltrate the balcony structural members that penetrate the waterproofing membrane, which are difficult to flash. Also, balcony doors are usually double doors, which are inherently more difficult to keep watertight and airtight, as opposed to single leaf doors. Here are a few tips on keeping water leaks from happening at your balconies:
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Balconies are usually stacked on top of one another, so put a roof on the top balcony. This will keep the majority of rainwater off the balconies in that column of balconies.

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Use an impervious decking for your balcony floor, like light-weight concrete. Permeable decking boards are a good amount cheaper, but by allowing water to permeate your balcony decking, you are exposing yourself to a much greater risk of leaks getting into the building.
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Ensure your GC does a thorough pre-construction meeting with his subs on how the balcony's waterproofing system will be assembled. Install the flashing and waterproofing on a mockup balcony and review it in detail with your designer (and maybe a waterproofing consultant) before approving the waterproofing system for mass production.
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For the balcony doors, possibly select a single leaf door, or a glass sliding door as opposed to a double leaf door. A single leaf door and slider won't look as good as a double door, so you will have to balance that aesthetic with more certainty in the door being able to keep water out. Some French doors look like double doors, but one of the door leaves is in-active. This gives you the look of a double French door, but provides the water-tightness of a single leaf door.
Example of a balcony door that looks like a double French door, but the left leaf is in-operable, making the overall opening more water-tight.

2nd Deadbolt That Can Only be Unlocked From Inside the Unit
Because a senior resident might have a medical emergency in their unit that the operations staff will need to respond to immediately, you don't want residents to be able to lock there door, and the operations staff not have a way to open that door. The operations staff will have a mater key that will unlock all unit doors, but you do not want to equip the until doors with a second deadbolt, that can only be unlocked from the inside, as shown circled in red in the picture below. If a resident had a medical emergency in the unit, and that second top deadbolt was locked, the only way to get in would be to break down the door. Only install one deadbolt on each unit door, and make sure it can be opened from the outside with a master key.

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