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Another major trend is the shift in senior living away from the continu-
ing care retirement community (CCRC) into a multi-generational setting. In
the current economy, baby boomers are looking for alternatives to physi-
cally moving through the continuum of care. They are looking for person-
centered opportunities to have services and amenities delivered to them,
and to live and thrive in a setting that is reflective of normal daily life—mixed
ages, mixed incomes, and mixed and shared interests.
The three primary types of treatment settings for mental and behavior health
and substance abuse and treatment include hospitals, residential care, and
outpatient. With the onset of technologies, some treatment for mental and
behavioral health is being delivered online and through telecommunication
systems. If a patient requires an inpatient hospital stay, it would typically last
30 days or less. If additional long-term care is required, they would move
into a long-term residential care setting. For outpatient settings, many are
community based, but others are in a hospital-based outpatient clinic or
within a private clinician practice1.
The growth market from a design perspective includes the development
and design of partial hospitalization programs (PHPs). PHPs are day programs
that patients attend for six or more hours a day. The programming could
include group therapy, educational sessions, and individual counseling. There
are hospital-based PHPs, but the largest growth market is new free-standing PHPs. PHPs are similar to some adult daycare settings;
particularly those certified as PACE centers (Programs for All-Inclusive
Care of the Elderly), as the PHP includes the clinical portion for healthcare
but also includes spaces for group therapy, structured activities, and food
Another similar program to PHPs are intensive outpatient programs
(IOPs), which are usually attended for three or four hours—often meeting
during evening hours to accommodate work schedules with a main focus
on substance abuse or mental health issues1. PHPs and IOPs can have a
specific patient type or age focus based upon the services provided.
An example of a successful community-based behavioral health center
is Creative Health Services, which is run by Dr. Andrew Trentacoste, PsyD
MBA, the CEO and clinical director of the center, which is located in
The goal of the program is not only to help people recover from
mental illness and/or substance abuse, but also a subspecialty of healthcare that helps people improve overall health and wellness by changing
behavior. Dr. Trentacoste’s story includes evaluating main design
principles that include removing stigma of mental health perceptions
and define Creative Health Services as a place where critical healthcare
services are provided by the community and are welcoming to all;
ultimately collaborating to create integrated care.
During their design process, there was a focus on understanding and
completing a functional program prior to the physical space program. Dr.
Trentacoste did not know at the time about the functional programming
process outlined within the Facility Guidelines Institute’s Guidelines for
Design and Construction of Outpatient Facilities but realized the importance
• Where does the patient enter, and how do we want them to feel?
• Where are they most likely to head next, with whom, and for what
• Among the staff, which types need the most operational support?
• How can we design spaces that enhance productivity and efficiency?
• How might we leverage the space now and in the future?
• What does the ideal customer want/expect us to look like?
• How can we make our staff welcome and comfortable?
It is believed that a designer’s role is to help organizations like Creative
Health Service understand themselves and their actual workflows. The
“upon entry” experience is felt to be key as a successful starting point for
treatment for a patient.
In evaluating recent multi-family developments, it has become clear that
both millennials and baby boomers have similar desires in selecting housing types. Interestingly, as those working in senior living are
searching for the “next innovation”, multi-family developers are already
By Jane Rohde, AIA, FIIDA, ASID, ACHA, CHID, LEED AP BD+C, GG-EB | Photography courtesy of Ryan Frederick of Smart Living 360
F O R DESIGN
Principal of JSR Associates Jane Rohde sheds light on modern-day design trends
in two long-standing healthcare sectors.