Everyone knew it was a problem that could get bigger. Reports and education covered it, many discussed it, and nearly everyone in senior living made it part of their mission to address it. But when the pandemic hit, another epidemic was revealed: Loneliness and social isolation.
It affects health—reports put it at more dangerous than smoking—not only of seniors, but often of their families and loved ones during times of limited visitation. It affects quality of life. It affects even older adults living in communities, with activities and neighbors built into their living experience.
And it’s not a new problem: It affected older adults even before the pandemic started.
An Argentum survey of Certified Directors of Assisted Living showed prevention social isolation and loneliness was the top challenge for 2020 and 2021, and the second most important in influencing move-ins, just behind safety and infection control.
A survey from industry provider iN2L showed that during the pandemic, there was an alarming 230 percent leap in the number of residents who reported they felt “always” lonely.
“The pandemic has changed so much about our daily lives,” writes Lisa Taylor, iN2L CEO. “But for residents and their communities, we suspected they were struggling with the same issues as before the pandemic but multiplied a hundred-fold.
“Preventing loneliness, making social connections, engaging residents with things that are personalized and purposeful—these are much harder now than they were before.”
The data iN2L presents in its report “Bridging the Loneliness Gap,” she writes, reveals “there are many challenges that are being exacerbated by the pandemic, but also some key opportunities.”
Moving toward solutions
As with other challenges in senior living, such as infection prevention and control, solving the loneliness challenge demands a multi-faceted approach that changes all aspects of daily life, from culinary to administration. But during the pandemic, two areas showed hope and promise: Design and activities, particularly design and activities that integrated technology.
“We believe that moving forward calls for change, fearlessness, and the desire to more broadly serve older adults with supportive, caring, and inspiring environments to call home,” says the introduction to Perkins Eastman’s “State of Senior Living Development: Moving Forward” report, available at perkinseastman.com/white-papers. It outlines developer and provider perspective on the market and finds there’s optimism and willingness to innovate and change.
The Perkins Eastman team itself changed its approach this year to its report—it interviewed for-profit developers, when it usually surveys nonprofits.
“The biggest thing that I extracted from it is that people in this industry have a lot of heart and they have a major positive outlook,” says report contributor Hillary DeGroff, IIDA, LEED AP, ID+C and associate principal. “Despite everything that’s happened this past year, they are planning ahead. They’re looking forward and they’re going to come out on top, with new innovations.”
Some providers reported making physical building changes and changing activities processes to make socialization possible in pandemic conditions—from installing Plexiglas barriers to creating outdoor visiting spaces to instituting all-day dining.
Providers are taking a more holistic view of health, says report contributor Leslie Moldow, FAIA, LEED AP. “And there’s Medicare Advantage also, where you’re starting to see the medical models bridge into the social model. Care isn’t only about your body, but about the environment in which it’s cared for, and what supports you can get socially—which is even more poignant and more important after the COVID experience.”
“We’re all realizing, whether we’re in a senior living environment or not, how much our wellness is supported by social interaction,” says DeGroff. “Health starts to deteriorate in isolation. It’s interesting to think about new models and how they may be propelled forward because of this era.”
Technological solutions?
Activities, the other big factor in socialization, had senior living community leaders thinking creatively and innovatively as well. Some activities had to be adapted to be brought to individual residents, and some relied on technology.
iN2L was connecting senior living residents through technology and personalized content well before the pandemic. It provides the ability to create a personalized profile for each resident, which provides easy access to their favorite content, personal photos, messages, and contacts. The company also does research to determine the value of its offerings and to uncover opportunities and challenges in senior living.
“Technology enables a resident and a community staff member to play checkers together every Friday, a group of residents to worship together with spiritual or religious content writes Taylor, the company CEO.
“Communities should look at technology as a conduit for social connection, not a replacement for it.”
Technology from virtual reality to video conferencing have been helping fight loneliness during the pandemic. In fact, iN2L thinks of its services as a “non-clinical solution…[T]echnology-enabled engagement is an intervention that can combat negative health outcomes, such as the anxiety and symptoms of depression that go along with loneliness,” Taylor writes.
“We know that by engaging elders meaningfully and connecting them to others around them, we create higher levels of camaraderie and engagement, as well as a greater sense of purpose.
The loneliness report data shows several opportunities for increasing socialization, such as making it easier to gather information about residents’ likes and dislikes, to make it easier for all staff to get to know residents, as well as greater personalization of activities so residents will find them more meaningful.
We’re all realizing, whether we’re in a senior living environment or not, how much our wellness is supported by social interaction,” says Hillary DeGroff, of Perkins Eastman architecture. “Health starts to deteriorate in isolation. It’s interesting to think about new models and how they may be propelled forward because of this era.”
The future, today
Already integrating some of these factors is Atria Newport Beach—the provider’s 85-residence “community of the future”, in California’s Orange County.
It offers multiple design features and amenities for safety and infection prevention and control. But it’s also keeping socialization in mind by including:
- Large apartments with full-size kitchens and full-size refrigerators, making it easier to host
- Juliet balconies, which provide both fresh air and a place to watch the world
- A breadth of covered terrace space outdoors that is large enough to hold four socially distanced family gatherings at a time
- Other visiting spaces that allow social distancing
- A space for visiting children to hang out and play video games
- Dining areas optimizing space and distancing, so communal dining may not have to be shut down
Even with vaccines being delivered and families and friends being able to have contact once again, basic design features that emphasize light, fresh air, and lots of personal space, and activities that are meaningful and personalized are likely to be features of senior living communities as soon as possible—if they’re not there already.
Innovative concepts
The relevance—and, it turns out, prescience—of Perkins’ Eastman’s Clean Slate project (perkinseastman.com/white-papers) proposed many innovations to address socialization, explicitly and by association.
Published in June 2019, it’s still a fascinating look at possible future models of senior living—some which are coming through faster than others. Intergenerational models, communities integrated into educational opportunities, and a scenario in which older adults work in tech as part of their community life are all ideas that could give a sense of collaboration, purpose, and being part of something.
There has also been an uptick in attention to the Green House® model—or the “small house” model, in which a community is not a trademarked Green House but uses many of the organization’s principles and findings.
The Green House® Project (GHP) not-for-profit has been active with its model for about 17 years. Green House homes are “small-scale, self-contained, and self-sufficient nursing home and assisted living settings that put elders at the center. Each home includes private rooms and bathrooms for each elder, a living room with a fireplace, and outdoor spaces that are easy to access and navigate.”
About 300 homes have been built in 32 states. The group also provides guidance for culture change and has a memory care approach.
The interest comes because Green House and small house residences reported lower COVID-19 rates—a case rate 3.8 times lower than in traditional skilled nursing, according to the Green House Project. Solo isolation is also less of a problem: Fewer residents overall makes for a “pod” affect, where risks are reduced for small groups.
It’s much like the “friend pods” of screened friends or relatives in groups of six that many people of all ages have adopted during the pandemic, or the “bubbles” created for child care or sports, but on a smaller scale.
The Great Recession served to slow adoption of this model, but some of its qualities, culture, and design features could lead to further innovation to tackle the isolation/safety paradox. Some traditionally designed communities are planning design changes, shifting wings, and combining living areas to avoid having single residents isolated for full days in single rooms whenever possible while maintaining safety is the goal.
New solutions ahead
While the concern over present and future pandemics and other health issues such as chronic conditions could clip the wings of some visions for the future, the report contributors don’t see this as an insurmountable obstacle.
“The fundamentals in the senior living business are still there. The things that define a generation and their life experience are still there,” Moldow says.
“People living longer and having a ‘third act’—these things are going to start generating new solutions. These will partially come from senior living providers, but they could come from left field—Google, for instance, or other outside actors. If people aren’t staying up to date, creating those new models, they’re going to fall behind.”
