A Guide to Flooring in Senior Living

Important Design Considerations for Senior Living

Designing for an ever-present and verbal aging target population has never been more dynamic and complicated. By now, many are aware there is a growing gestalt shift ever since the millennium change (and even earlier) when initially the trends from a more medical-focused product to a residential model redefined the field. “Senior Living” design became a dedicated focus separate from both medical and multi-family residential precepts. With the presence of the Continuing Care Retirement Communities (CCRC) nationally since the 1990s and the various independent forms and offerings of the continuum in both the non-profit and for-profit sectors, design and philosophy experts have sprung up professing innovative approaches to bring the latest to the marketplace. This is due, in part, to growing demand from affected influential populations expecting intellectual cutting-edge responses, not yet for themselves, but for their parents, with the full presumption that initial investigations therein would be worked out sufficiently by the time they themselves had the need for this product.

Let’s not presume that this trend to design and build suitable senior living environments is entirely a new focus. On the contrary, people worldwide have been engaged in personal efforts that respond to individuals. That is not to diminish the valid contributions studied and analyzed approaches the design community provides. 

Tried-and-true methods marry sage advice to offer both the expanding design professional and everyday consumer guidance that is practical and attractive. Now the general population can be informed with logical selection criteria to best suit their needs and preferences while feeling that their solutions will provide their loved ones’ optimal results.

Even more so during and (supposed) after the pandemic. Specific and prudent selection of finish materials can make a difference for successful professional or DIY projects. Herein we will discuss some of the reasons why and how to select the proper tile for Senior Living applications, whether it be standard ceramic, glass, quarry, porcelain, or other offerings.

Bathroom at Mercy Ridge Retirement Center, designed by Peter Wilson of the ateri group featuring SHALE and BRIGHTON. 

In short, people these days want what they want when they want it and at a reasonable price: led by the American post-war(s) mindset, we are no longer willing to accept the conventional. Case in point, the old school cafeteria-style of a forced set of offerings and the sage life lesson “ya get whatcha get and ya don’t get upset”; these are not accepted anymore. That permeates expectations and experiences for the built environment. 

But where does this all come from?

We see it in everyday life, at least in Western-developed societies. The popularity (or even presumption of easy access) to a vast array of offerings, manifested in an urban or rural stand-alone “mall” setting, exposes most of the population to a panacea of style, opportunities, and perceptions of value or luxury. 

For a while, many design entities and groups have promoted Health, Safety & Welfare (HSW) for all. 

The general public presumes that we primarily think of aesthetics foremost, which is, truth be told, an important feature but not a critical one. Whether in the commercial, public or private residential realm, everyone hopes to feel that their personal well-being is paramount everyday and in emergencies. Quick to mind about flooring HSW includes slip resistance. But what defines that and is that all? No. Additional selection considerations include durability, hygiene, maintenance & upkeep, along with visual aspects such as colors, patterning, and texture. Not all of these factors are to be born on the shoulders of manufactured materials alone.  

Tile suppliers offer a gambit of products that allow others to customize their spaces. Sometimes proper design selections and manipulation extend to placement, contrasts with adjacent surfaces, and appropriate use in the first place. Regards to prudent and appropriate tile selection relies also on lighting, sub-surface treatment, and how surfaces interface with each other.

This cannot be underscored enough when it comes to flooring. I would like to believe that more people understand what health, safety, and aesthetics mean, and fewer truly understand what “wellness/welfare” means and how it relates to them and translates to our built world.

Image courtesy of PennWest Clarion.

7 Dimensions of Wellness – a brief aside about what this means

Wellness is an intentional and active state of mind, body, and soul. Instead of life being handed to us and washing over us (so to speak), current definitions of successful living can be defined as “thriving” instead of merely existing. Wellness is a newish paradigm and has recently been synthesized down to 7 aspects: mental, physical, social, financial, spiritual, environmental, and vocational as initially coined by Dr. Bill Hettler from Wisconsin. This stems from the immediate and conspicuous consumption mindset rooted in and sparked by the Baby Boomer Generation in the last decades of the 20th Century. A la carte living has become the norm for many and has not diminished in younger generations. Privilege is aspirational, which is not a new concept. However, with the blossoming middle and affluent classes worldwide, those tangible nuggets of the built environment are more attainable than for many of our predecessors. Expectations of what we “want” as opposed to “what will be offered” to us or “provided” on our behalf is the cultural change between the 20th & 21st centuries. 

These dimensions affect each other and are not only intra- but inter-dependent. Like when we lose one of our bodily 5 senses, the other senses are bolstered to bridge the void. The same occurs with wellness and design.

It is not surprising that we are seeing an increase in popularity regarding mind-body and holistic wellness across the world. This concept is certainly NOT new to many world cultures, rather it is just “new” to conventional Western society, including medicines, yoga, spiritual connections, diet, and other acceptances. Actually, there are schools of thought claiming 6 vs 7 categories; financial dynamics being the argued divide, which speaks volumes itself.

 Image courtesy of Manna Project International.

But let’s not get too esoteric nor academic for the moment…

When it comes to the built environment, especially when selecting interior surfaces, forms, and finishes, all of the debates can be put aside and boiled down to (4) basic factors or considerations:

• aesthetic appeal
• ease of installation
• penultimately convenience of maintenance and durability
• cost/ availability

While there are several readily accessible options to cover and finish surfaces, some universally used products for flooring and vertical surfaces can be separated into public, private and support Back-of-House (BOH) zones – not exclusive to Senior Living venues.

The fundamental question arises: Why select tile, to begin with? 

Some answers come to mind.

1. Tile is a convenient, flexible & familiar solution

It also has a long history of worldwide tradition, which makes it culturally acceptable. We frequently use tile in spaces that cannot use other flooring or wall materials. Also, it is common to see people placing a mat or area rug on top of tile for various reasons; however, regarding senior living design factors, adding something on top of tile can promote a trip hazard, since older adults frequently shuffle and can catch their footfall and footing on floor surfaces. There is an array of design remedies for those situations.

2. Tile can be affordable

There are multiple ways to achieve a desired result that fits a budget or offerings that run the cost spectrum. It depends on you! More recently, many tile shops, contractors, and suppliers have discontinued or returned material that they sell at a discount. Check out your local stores and suppliers for the best deals.

3. Tile can be popular, look “pretty & cool” and “appear’ at times expensive when actually it can be affordable

Quite true. Well-designed and installed applications are a proven marketability plus in the real-estate realms. Specifically for senior living situations, there are many other factors to consider that surpass those aspects to honor health, safety, and welfare.

4. Tile is a durable, easily cleaned, and practical solution

5. Regardless of the make-up (glass, ceramic, porcelain, quarry, stone, etc.) tile can control ambient temperature, be water-resistant, minimize slip resistance and reduce maintenance/upkeep. Its durability is self-evident.  

6. Tile installation can be relatively straightforward for almost everyone and any skilled contractor can do it

Well yes and no actually. Depending on the type of tile selected, shapes, patterning, and sub-straight, installation can range from simple to quite complicated.  

A kitchenette designed by Peter Wilson featuring SAVOY GLASS.

Risk Management for floor specifications relating to tile

There are numerous other features to assist when it comes to a well-thought-out tile design solution, including tile accessories. Consult your local representatives or suppliers for more information. These all have important criteria for appropriate senior living applications and managing fall risk damage and injuries. There also are the every-minute aspects of tile placement in senior living applications. 

As one ages, your skin thins, resulting in easier means of bruising and lacerations. One might think that specifying a tile with a grit texture is a good solution against slipping but think about the wear on sensitive skin if a fall does occur.

Something frequently overlooked is how a hard floor surface affects someone standing for a long time; is tile the right selection? Standing fatigue influences older adults far quicker than others and may excel premature stain and wear on older body joints.  

ATTITUDE

Physical Characteristics, Qualifications, and Fundamentals

In a world consumed with promoting personal preferences and subjectivity within the built environment regarding material-appropriate placements, there are some absolutes regarding tile selections, especially concerning senior living conditions and beyond aesthetic appeal.

1. Aging-in-Place factors

When selecting tile, ask yourself what the intended longevity of the application is. Tile is not easily swapped out for other materials and requires considerable prep and sub-surface work. One may not want to select something “too aesthetically trendy” unless the application has a good chance to have a longer life. I am not advocating or suggesting solely to design with classic styles, but rather be cognizant of changing preferences over time. Also, though many contractors do so, it is not great to overlay existing tile with another material for the risk of telegraphing through the new surface.

2. Lighting of surfaces

3. It is easy to forget that our built environment is a variety of elements that work in concert with each other: materials, colors, lighting, textures, etc. For one feature, if a tiled surface is not illuminated appropriately, both benefits of lighting and finishes are not realized, and safety risks increase. Senior's eyes and the ability to visualize and distinguish colors and associated patterns become confusing and disorientating.  

Since older eyesight can change dramatically as one ages (macular degeneration or yellowing of eyesight), we recommend acknowledging that certain colors and tones may not look the same over time. Also, where one may love energetic colors and patterns for some things, over time, those preferences may fade with passing fashion.

4. The scale of design features and individual pieces

Similarly, think about the scale of the tile color and pattern within a space. If it is complex or overwhelming, older eyes may become unsettled and disorientated. 

On the other hand, if the design is proportionally appropriate, an accent of tile can be a welcome pop of attention and be a beacon for specific attention.

Another matter to consider is the size of individual tiles. Though there is no proven thesis or generally accepted design philosophy for proper tile sizes specific to senior living installations, logical selection criteria apply. Larger tiles tend to cost more than smaller ones and are more expensive to install for a variety of reasons. They can be heavier to transport and install, causing an installation up-charge depending on the contractor. Many smaller module tiles, especially if there is a precise pattern intended come with a factory-provided backing mesh which can expedite installation. Smaller modules also increase the grout: tile ratio, which not only is a familiar tile visual application but can help with slip resistance depending on the specific tile. 

Though more grout may be considered harder to clean, the safety benefits for seniors outweigh those conveniences.

5. Contrasts intentionally considered for safety

Monochromatic or mono-tonal applications can look trendy to others and be a challenge for older eyes. Specific placement to highlight different horizontal surfaces or even clarify changing vertical to/ and horizontal surfaces can facilitate navigating spaces, especially in kitchens and bathrooms.

Logical locations for contrasting tile and/or tile accessories (nosings, reducer strips, etc) include transitions between spaces without tile, high traffic areas and zones, and at the tops/bottoms of stairs.

Visual contrast of surfaces and even textural variations help to distinguish changes in planes & surfaces. 

6. Sheen and Glare

Slip resistance and texture of tile take precedence. 

Visual aesthetics play a factor in selections, sometimes at the expense of older adult practicalities. Who doesn’t think they, themselves, may slip in a new car dealer showroom or at airports because of polished large format tiles? However, sometimes we cannot resist how cool and clean glossy finishes can look. Remember, glare is defined not by spot-lighting, but rather by overall contrast between surfaces, and reflectivity and sheen can compound those physics.

7. Accents vs general field applications

Again, it’s all about proportions, especially with the application of tile. Some tile styles and series already factor in complementing and contrasting materials to create accent features. That does not mean those specific selections are to be specified for large fields of tiled areas. Accents to create a separation or cap of tile to tile or tile to another material are a welcome and suitable application.

8. Keeping a residential appearance and not a clinical one in personal spaces

Though current (and reoccurring) aesthetic styles like seeing pure white design environments, sometimes with certain materials, these spaces can appear unintentionally austere and medical. I am not sure that is the intention of readers here.

Also, it is important to envision potential uses and conditions for prudent product placement. Consider general empty nester homes or an assisted living or independent living kitchen(ette) in a senior living community. Many times, those residents are not routinely cooking for themselves, so why would they need moisture and grease slip-resistance flooring? 

It only takes the off-routine and one-time clumsy occasion to realize a catastrophic outcome. This is where we see that the increasing à la carte baby-boomer generation takes center stage. 

They want to be independent and do what they want, which can include prepping certain foods. But can they control themselves and their potential cleanliness? 

Innocent slips left without clean-up turn into dangerous potential accidents. We must anticipate the sometimes unexpected.

OVERLOOK

Some lingering questions

Name a time when you had to break the rules of your considerations.

Around the millennium change, the conventional trends were to evoke traditional residential settings and palettes, moving beyond the pristine sterile medical presumptions and embracing common designs seen in everyday America. Hospitality design redefined itself at this time while responding to growing market expectations for conspicuous luxury for all. The various decision-makers/ leaders in Senior Living pushed away from that idea since it was thought “we don’t live in a hotel”, “we cannot afford to provide…” and “it will be too hard to maintain …”.  Thus, a lot of design responses rested on the traditional aesthetic range to suit the general tastes. When developers, designers, and providers realized that the younger adult decision-maker resisted those old-school assumptions, the alternatives opened up and were embraced. Especially these days, what was desired even 10 years ago is unacceptable today. The challenge for successful design solutions is to acknowledge current preferences while simultaneously hinting at future trends. Also, a critical consideration is to accept that finishes do not need to last for eternity and to be open to ever-changing market demands – be flexible and stay current, to avoid looking “dated”.

Could you tell me about your favorite senior living project that you've done?

They are all our babies, aren’t they? It’s hard to cite specifics. I want to acknowledge (2) however: 

1. An international project that I contributed to, where our expert SL design opinions were truly honored and not dismissed by various other entities who defensively put the almighty dollar above all else. That blindly doesn’t fly as much these days in many arenas.

2. A Senior Living community that acknowledges the need to routinely refresh their interior palettes to stay competitive in the regional marketplace. It is not because materials were inappropriately selected, nor that the aesthetic was wrong. On the contrary, it is a result of the typical natural aging of preferences and materials. This community has stayed at the forefront because they appear “fresh” to both the intended resident and the younger family members who visit.

I have been honored to affect change for this Client and its residents several times, being repeatedly asked how one can “refresh” as opposed to “completely redo”.

As a specifier, how often do you rely on your reps for info vs seeking your own? Where do you go for that info when you do seek your own?

A fluid rapport between architects/ designers and reps of all dynamics is critical to ensure updated product information and offerings. They indeed give a perspective from both a local and national level, especially regarding trends, cost, and availabilities for a client-driven world demanding the utmost immediately and at a value-focused price. We rely on that sage philosophy affecting optimal design decisions: aesthetics, availability, and cost – frequently you can get two, rarely all three.

ENIGMA LEGNO

Where is tile typically used in a senior living facility?

A variety of locations and applications, including but not exclusively (for both individual residents and general/public spaces): bathrooms, kitchens, around fireplaces/mantels, dining venues, as well as BOH applications as needed.

How has tile usage changed over time? Is there more now vs before because of better tile with slip resistance? How has tile usage in the facilities changed over time?

That depends. Yes, the offerings decades ago were somewhat limited. The world has become smaller and there are more options out there. International manufacturers are more accessible and viable for project placement, offering a wider range of styles. Also, the local mid-Atlantic user is more open to non-traditional lines and styles, including material, color, and module sizes. Tile can be visualized for more than what has been seen even just a few decades ago. Juggling the ratio of surface to grout helps too. The current trends of large slab stone or synthetic solid surface surrounds are limited and will ebb and flow with trends, while tile overall is more universal and dynamic, responding to market demands. Ultimately, it is in our current human nature to covet what others have, especially the bling of luxury proponents. Tile can be an easy avenue to achieving that.  

There are other go-to flooring selections. Not limited to Senior Living design, one sees a plethora of slip-resistance flooring options available. Whereas not long ago quarry tile was an industry standard material seen in commercial kitchens, now there are alternatives.

Are there psychological reasons for certain design elements in senior living?

Certainly. The mind is a critical component of design success. Just consider the dimensions of wellness and meaning cited earlier. Balancing mind and body is a daily dance. Visual decline due to health and aging (macular deterioration) leads to feelings of disorientation and confusion, which in turn leads to feelings of anxiety and aggravation, which then manifests itself in everyday activities, and so on. Having the built environment soothe these steps helps temper accelerated personal challenges.

What do you think the future of flooring in senior living is?

To stay current, relevant, and flexible. No industry will survive in the near future by sitting back and relying on what has worked in the past. In today’s world, change and innovation are key.

Overall, there are multiple ways to achieve a successful tile design and application for older adults. I think back to that formative scene in the 1990 movie Awakenings with Robin Williams and Robert De Niro. My point and references are basic: if we put our mind’s eye in the perspective of the user or inhabitant in a senior living environment and consider how they see, touch, interact, and thrive within a space, a successful and appropriate selection of interior finishes can be transformative.

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Peter A.R. Wilson, AIA, Leed AP®

Principal
the ateri group LLC

6247 Falls Road, Building H
Baltimore, MD 21209

410.908.5996