Engineered for Seniors

A visit to a senior-living facility today presents a much different picture from the traditional retirement home of a decade or two ago. Particularly with the development of more continuing-care retirement communities (CCRCs), the trend has been for designers to extend the "residential nature" of each phase of the community for as long as possible—allowing residents to feel as if they are living in their own homes.

Resident comfort plays a critical role, and sometimes something as simple as the ability to regulate one's room temperature or apartment can affect a facility's success. However, while comfort is the most important consideration from a design standpoint, other factors such as budget, population size and project goals make system selection much more difficult.

"You really need to understand the concerns of the client," says David Murray, president of the San Antonio engineering firm Murray & Associates Inc.

"Do they maintain a skilled maintenance staff, or are they unskilled? Can you justify added costs for M/E systems, or is the money better spent on resident programs? It's a tough decision."

While the battle between first cost and life-cycle cost did not originate with the development of senior-living facilities, it certainly plays a significant role in terms of how the projects are designed.

"The elder-care community is still largely developer-based, and developers look for returns of three to five years," says David McMullin, P.E., a principal with Gresham, Smith and Partners in Nashville. "It won't be until we move away from the developer mentality that we'll see a change in the way mechanical systems are designed."

Due to budget constraints, the most commonly used HVAC systems in senior facilities are direct-expansion split or through-wall systems. To their advantage, these systems have been developed for residential applications, and provide a sense of familiarity to residents. However, despite the first-cost savings, the systems are expensive to operate and maintain in the long run. They are also noisy—one reason Murray will not use packaged units in Alzheimer care facilities. "Male dementia patients become particularly agitated by the units and at some point start viewing them as urinals," notes Murray.

Another system is the behind-the-wall, ducted system—often tied to an air- or water-source heat pump. A ducted system is beneficial in that it delivers air more quietly and with a more gentle air-distribution pattern, as opposed to the direct blowing experienced with through-wall systems. Energy efficiency is also greater with a heat-pump system than with the through-wall option.

On the downside, however, space limitations in existing facilities can restrict the use of ducted systems, as can the added cost involved in increased ceiling heights in new facilities. In addition, the initial cost—particularly for installing ground-source systems—remains higher.

"A lot of providers can't get over the first cost," says Gary Hartfield, AIA, a project manager for RTKL's Dallas office. "But with the help of utility incentives, the payback is enough to offset debt coverage, and they'll do it."

Given the choice, most engineers would install a remotely piped chilled-water system. Not only does this system provide the most comfort for residents, but it is also the most energy-efficient of all the options. In addition, having a remote mechanical room means that all maintenance and operation is performed away from the residents, reducing disturbances.

Unfortunately, other factors limit use of this system type. While economical over the life of the system, a central chilled-water plant has the highest first cost of the options discussed—at times accounting for as much as 25 percent of a project's cost. The system is also better suited for campus-style developments like CCRCs—with multiple resident apartments along with a large number of assisted-living facilities and long-term, critical-care patients—rather than smaller-scale projects. But one of the biggest disqualifying factors for this type of system is the sophisticated maintenance it requires.

"A central plant with a water tower on the roof may be the most economical choice from an efficiency standpoint, but if you don't have the people to maintain it properly, the efficiency decreases tremendously," says Steven Ruiz, AIA, Beery, Rio & Associates, Springfield, Va.

"In some cases, it's simply easier to have four or five extra packaged units stored on site," Murray adds. "When one goes out, you take it out for repair and put another one in. In the end, our 'bag of tricks' is pretty limited."

What, then, can engineers do to improve system design? At present, select the highest-efficiency and easy-to-maintain systems within the classes of equipment being used.

"We really need things to settle down on the health-care side of the issue," says McMullin of Gresham, Smith and Partners. "If institutions can't predict what they're going to be paid [for medical costs], then they're less likely to commit money to long-term solutions. Yes, they want to minimize the cost of utility consumption, but it's more likely they'll want to minimize the length of time their capital is exposed."

Bigger changes in system design are on the horizon, however, as a result of changes in the resident population, according to RTKL's Hartfield. "The average age of people living in senior facilities is dropping," Hartfield says. "People are moving in at 65, when they're mobile and can play golf. As a result, they're going to be paying living expenses for a longer time, and they're going to have to manage their money. Residents will become more demanding, and systems will have to become more flexible and more efficient."