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Jane Rohde—an esteemed senior care, healthcare, and sustainability expert whose Ellicott City, Maryland-based firm JSR Associates has become a leader in the building of and consultation for paradigm-shifting senior living environments—has spent the better part of two decades refining the design world’s response to the very real needs of our elders. The former VP of Design for Erickson Retirement Communities, Rohde serves on the Environmental Standards Council as part of The Center for Health Design and is a former VP for the board of the American Academy of Healthcare Interior Designers (AAHID). She lectures extensively on senior issues at top design and healthcare conferences, and is the primary author of the Senior Living Sustainability Guide.
Here, Rohde talks about the forthcoming “elder boom,” how one can affect change at a management level, and the “warm fuzzy” part of her work.
Interior Design: Some of the most significant challenges and opportunities in the design world center around our aging population—something you know plenty about. What are we up against?
Jane Rohde: One out of three people over the age of 65 will have some form of dementia. If we built a new facility every day for the rest of our days, we wouldn't have enough space or younger people to care for our elders. I think about places like China, where these statistics are in the millions. That makes our situation feel tiny in comparison. Here in the U.S., it’s hard for a lot of people who thought they were going to retire and thought, I have my nest egg. After the economy’s crash, that money is not always there; coupled with the downturn in real estate values. This will all impact their ability to access affordable elder care. On the flip side, there are huge opportunities in geriatrics and in research for dementia, which provides educational opportunities for younger generations.
ID: What are some misconceptions about the concept of “senior living,” and how do the top-tier senior environments raise the bar?
JR: Despite any functional or cognitive need, we are still dealing with a whole person. One misconception I often see is that people assume someone is going into a senior living environment to die. A lot of these people will be in a care setting for ten, fifteen, twenty years and beyond. Even clinical management staff may have this misconception, if they aren't tuned into resident-centered care. I think of one woman, Miriam, a 90 years old resident, who liked it when I'd help her select her clothes and accessories—she still wanted to feel beautiful. You don’t completely change who you are as a person just because you have a stroke or Alzheimer’s.
ID: What do you suggest for meeting these swelling needs?
JR: Smaller living models are certainly preferred. And never forget the human side of this situation. I’ll sometimes hear professionals refer to the people they care for as their medical diagnoses, forgetting that these people are just like us on the inside. They’re still human; they still have unique likes and dislikes. What’s their favorite color or food? Who is their favorite caregiver? Their favorite visitors? The more engagement and choice in things we can provide, the better. Think about your favorite coffee cup… Personally, I have a favorite mug that I use. These people may, too, if they are asked or provided an option.
ID: How can one make these services the most effective?
JR: It’s crucial to talk a lot about the details. I always say, maximize your residents’ independence, and design can limit a person or support a person. I prefer to discuss from the beginning of the programming perspective, and ask the right questions to get the right feedback. Have you considered decentralizing care? Decentralizing dining? Have you though about preparing food in the same space where residents live? I am a big proponent of person-centered care. What do your residents and their families say about activities? As a designer or a consultant I can only push clients so far—they have staffing requirements and their own goals. I can, however, hold people to a consensus based framework and resulting decisions during the design process—which ultimately benefits everyone.
ID: You mentioned China, and you have some pioneering work there. What do you have in the works?
JR: In China, the reality of the “single child rule” has lead to the “four-two-one” phenomenon; meaning that one couple would potentially be responsible for two sets of parents and four sets of grandparents. With children both working, and often a child of their own, a need for care communities is emerging in China. My firm is actually working on the very first newly constructed skilled nursing home in China right now [called Cypress Garden by China Senior Care, in Hangzhou]. We’re working on ways to meet the function needs, while working with local firms to be sure the aesthetics are culturally appropriate yet functional. There’s adult day care on first floor, and household models of eight residents each on upper floors.
ID: JSR Associates is big on research, planning, focus groups, and such. Why is this particularly key when dealing with the senior population?
JR: I am a big believer in a workshop type of format, and engaging a client from the start. It’s our job to listen. Oftentimes, no one has actually talked to the staff or existing residents within a senior living environment—and yet the goal is to engage people. With our research groups, we focus on people who use the services to determine what a community needs, and include post-occupancy evaluations wherever possible.
I think of Bastion in New Orleans, for example, which is an intergenerational community for wounded warriors. There are a huge amount of soldiers coming home with traumatic brain injuries (TBI), and it’s uniquely being programmed to address these issues. Within that project, which is potentially replicable, we’ve conducted charrette focus groups on sustainability and vocational re-entry for soldiers, health and rehabilitation, community at-large, and local design and construction input. There’s a senior component to Bastion, as well, serving as part of an intentional, supportive community. People will move to Bastion because they want to help and support a wounded warrior family. We’ve found that people want a purpose in retirement.
ID: What else do you have on your plate?
JR: Among our other projects is an adult day care center for Easter Seals, which will have some really amazing outdoor garden spaces designed by Smith\GreenHealth Consulting. This is rare for adult day care centers in our area. There’s great potential for a potential community garden that will allow people to share the space and integrate with the community at-large. We do a good bit of work in healthcare, primarily on the ambulatory care side of things, and we’ve found that clients want privacy and openness. It’s about looking less like a doctor’s office than a cafe or a retail space. Meanwhile, I’m also part of the Health Guidelines Revision Committee and the main editor of The Guidelines for Design and Construction of Residential Health, Care, and Support Facilities—which is coming out in early 2014.
ID: What kind of a dynamic do you like to cultivate with clients?
JR: We track hours for billing, but honestly it is not about billable hours. Most of our work is by referral, and we put a high premium on collaboration. I think it’s key to build an ongoing relationship with clients, so they know they are part of the team. We try to bring on the right team for the right project, and tend to be very selective. When someone needs something in senior living, if I can't help them, I usually will know someone who can, and if there is someone else who can do something better—if what we can give you isn’t necessarily the best value for your needs—I say that.
People tend to respond well to that way of conducting business. Our consulting practice makes far more money than the design practice, and that’s just the way our group works. Since I used to work with owners at Erickson Retirement Communities I understand things from that perspective, which is seen as very valuable. When an owner needs their design team to get out of the weeds, they bring me in. I ask, “Is this design for design’s sake or is it need?” I am function-need-function. I’ve found that if you build your reputation well, know what you’re doing, and become an expert, people will know they can use and trust you.
ID: How have you steered the creative team dynamics at JSR Associates?
JR: I’ve always had a small company, and I like to recognize that if the staff is happy—or not happy—it comes through in the workplace. I have a really solid staff; one guy, Roy, has worked with me for 20 years and has been in the senior living sector since he was a college student. Another gal, Lauren, who has an art background, manages our business, and provides art consulting, way finding expertise, and interior design direction. It’s all about building a synergistic team of interiors and design and graphics people—and calling on outside people and consultants, too. We do a lot of partnering.
If all that weren’t enough, we run a little social cause gallery (Perspectives), which we started as a reaction to the recession to better utilize our storefront building, as a way to help the local children’s home art program. We’ve actually managed to grow a little business. Who knew?
ID: What serves as inspiration to you, and keeps your engaged in the industry?
JR: My dad was always a huge inspiration, in terms of being my support. As far as the “warm fuzzy” part, I think of meeting Jane Heald, age 76 (now 82), who came with her friend, Shirley, to a focus group we were doing with Interface. We had done a project in which she represented the residents on sustainability issues. For the focus group, she told a story about how, at 75, she was asked what her life would be like at 85. The takeaway was this: aging is natural, but it’s scary. It touched me. When you can change how people behave and act, a place like a nursing home can become a community center. That is significant change. What can I say? My husband makes fun of me. I love old people.