Margaret Calkins

For more than two decades, designers, providers, and advocates have promoted household model nursing homes as alternatives to institutional long-term care environments. Yet implementation across the United States remains uneven, with some states advancing household model development while others continue to reinforce traditional institutional configurations. Drawing upon a national multi-phase policy analysis conducted through the Moving Forward Coalition's Financing Household Models & Physical Plant Improvements Workgroup, presenters will explore how often-overlooked policy, financing, regulatory, and planning frameworks influence the feasibility, scalability, and operational realities of household model environments. Using comparative state examples and a Household Model Environmental Taxonomy, the session will translate complex policy and regulatory systems into actionable insights for architects, designers, providers, and development teams. Attendees will gain practical strategies for recognizing how the alignment, or misalignment, of financing structures, licensure pathways, occupancy policies, and emerging planning and design standards can either constrain or accelerate residential, person-centered, and relationship-based care environments. The session will also examine how emerging FGI planning and design standards may create new opportunities for aligning environmental expectations with evolving operational, regulatory, and resident-centered goals across senior living and long-term care settings.

Wayfinding in older adults has been recognized as an essential yet challenging aspect of daily functioning due to age-related cognitive decline. As such, the design of LTC facilities plays a critical role in supporting wayfinding, facilitating essential activities, and promoting residents’ independence. Therefore, this session aims to examine how spatial qualities of LTC facilities can predict residents’ wayfinding performance. Fifteen LTC facilities in the U.S. were selected, and the wayfinding performance of a total of 125 older adult residents was evaluated through predefined navigation tasks of three levels of complexity. The design typology was identified based on corridor structure (linear, branched, and courtyard). In addition to typical route characteristics (i.e., length, turns, floors visited), key spatial metrics of the floor plans were analyzed using Space Syntax methods. Stepwise regression models and Kruskal-Wallis test were used to analyze the relationship between the spatial characteristics of the floor plans, typologies, and route features on wayfinding performance. Findings show that spatial layout impacts wayfinding performance, even when residents’ individual health and cognitive conditions are considered. The LTC facility typology has also played a role in residents’ wayfinding performance. The findings can inform the architectural design of LTC facilities, ultimately enhancing residents’ autonomy and quality of life.