There used to be three main options for aging Americans: move in with family (and lose independence), enter a nursing home when family could no longer provide care, or stay in your own home with all its risks and inconveniences, for the sake of remaining independent.
Those choices have broadened. Whether it's assisted living, independent living, continuing care retirement facilities, or nursing homes, the growing gray market is driving a new segment of housing, kind of a cross between health care and hospitality. "Choice without worry" could be its motto. Comfort, efficiency, and good IAQ are its parameters.
GROWING, GRAYING NEEDSRichard Grimes, president and CEO of the Assisted Living Federation of America (ALFA), said, "We can thank advances in health care in America for our increased longevity. But with this longevity came increased disability and the resulting need for assistance with activities of daily living."
According to the U.S. Department of Health and Human Services Administration on Aging, in 2002 there were 35.6 million American adults aged 65 and older. By 2030, the administration expects that number to reach approximately 71.5 million.
"Americans age 65 and older have more than a 75 percent chance of needing some help with daily activities," pointed out Almost Home, a report televised on Public Broadcasting.
Half of all nursing home residents have Alzheimer's disease or a similar type of dementia, according to the National Nursing Home Survey from the National Center for Health Statistics. These people require increased care and supervision that is often beyond the ability of their family.
Assisted living facilities can provide help with daily activities such as meals, bathing, dressing, and going shopping and getting to appointments. Residents often live in their own room or apartment within a building or group of buildings, and have some or all of their meals together. Residents with Alzheimer's/dementia may live in an area that restricts their ability to wander away or cook, but they can still live with a spouse.
Other accommodations include special rooms to help residents calm down using warmth, colored lights, and other sensory methods.
Scald prevention equipment is a standard feature for residents' rooms. Thermostat controls also are provided in each room, though units may not be connected in areas that house dementia residents.
MARKET OPPORTUNITIESAccording to ALFA, "The assisted living business has great opportunities to grow and thrive over the years to come."
Finding solutions to reduce and manage energy and utility expenses is a more immediate concern. ALFA has teamed up with Affiliated Power Providers International (APPI) on a Savings Solutions Program for ALFA members.
"With energy costs on the rise and new information being released daily," said Grimes, "it is critical for ALFA member companies to understand their options. APPI has the expertise and information that our members need to reduce operating costs."
As an independent utility consulting firm, APPI provides businesses information about electricity, natural gas, water, telecommunications, and waste removal services. It could translate into HVAC options such as dual-fuel systems, thermal storage, and more sophisticated environmental controls. It could also create mechanical system renovation opportunities.
Because of their high internal moisture load, some facilities have had to address IAQ and moisture-related problems as well as energy costs. Residences in areas of high outdoor moisture in particular have had to deal with this.
THE CASE OF BARCLAYBarclay Friends Senior Living Community, West Chester, Pa., is a 150-bed facility whose mission statement is based upon the philosophy of 17th century Quaker settlers. "We operate Barclay under the principles and traditions of the Religious Society of Friends, or Quakers, so that our actions contribute to a welcoming, family-like community," said executive director Carol Hanson.
Built in 1997, the 100,000-square-foot facility replaced two old private residence houses built in the 1800s. The new living center solved multiple challenges ranging from shared bathrooms to several mechanical and structural issues common to old buildings.
"Our facility's warm, home-like feeling - very Quaker in design and layout - is based on a residence model rather than a medical model," Hanson explained. (Many assisted-living facilities apply a residence model.) However, the moisture load in such a facility is not the same as a typical home of the same square footage. The total bathing, cooking, and laundry moisture loads for the residents is considerably higher. When high external humidity loads at low external temperatures are added, it only gets worse.
"When the facility was built, there were some value engineering demands made to keep costs under control," said Bob Sickler, director of maintenance for the Barclay Friends complex.
MOISTURE PROBLEMSEight energy recovery units provided code-mandated outdoor air to the Barclay Friends complex. Six units delivered 1,600 cfm of supply air and 1,200 cfm of return air each. One unit delivered 3,000 cfm of supply air and 2,600 cfm of return air. The eighth and largest unit delivered 4,200 cfm of supply air and 3,000 cfm of return air.
Humidity issues first showed up in the typical problem areas: the commercial kitchen, hair salon and, a couple of the heavily used community rooms. This raised concerns that the humidity could contribute to mold growth.
Barclay Friends found an HVAC contractor who could address the entire HVAC system: Total Services Inc., Lansdale, Pa., which worked with the Desert Aire rep firm Air Tectonics, Fairless Hills, Pa.
Gradually, it became clear that the original system was being called upon to perform in a way that it was not designed to do. "Outside air was being pulled in raw and it was being run through an energy recovery wheel, which would transfer energy from the outside air to the exhaust air, thus reducing the cooling equipment's load," said Jim McCoy, owner of Air Tectonics.
The building's valence cooling system consists of a cold pipe that runs around the perimeter of the room and is protected by a trough to collect condensation. Len Wood, president of Total Services, observed that the pipe was condensing frequently; the supply air was not below the pipe's dew point.
"Air was being introduced at a higher dew point than the valence cooling system, so it not only was condensing on the pipes, but on the walls as well," Wood said.
DEHUMIDIFICATION PAIRED UP"There was temperature control but not humidity control," McCoy said. "The system wasn't designed to do that. It could be 75°F outside and pouring rain, and the air being brought in was very humid but at the desired temperature." In short, the system successfully met the target temperature, but did not address the humidity.
To address the problem, eight Desert Aire VerticalAireâ„¢ makeup air units were paired up with the existing energy recovery units. McCoy said the ductwork was properly sized to bring in the amount of outdoor air mandated by the American Society of Heating, Refrigerating, Air-Conditioning Engineers (ASHRAE). "We wanted to match the original HVAC design of what the air quantities were expected to be," he said.
Six 8-ton makeup air units now deliver the 1,600-cfm supply air from the six energy recovery units, and provide a leaving-air dew point of 50.2°. The 3,000-cfm energy recovery unit was matched to a 15-ton makeup unit to deliver 3,000 cfm of fresh supply air at a leaving-air dew point of 48.9°. The largest energy recovery unit was paired up with a 20-ton makeup air unit to deliver 4,200 cfm of fresh supply air at a leaving-air dew point of 49°.
TIGHT INSTALLATIONSpace was a major consideration. According to Desert Aire, it took four and a half months to squeeze the units into close proximity with the existing energy recovery equipment.
James Wright, vice president of Total Services, coordinated much of the retrofit work. To avoid interfering with residents' lives, he and his crew worked around their normal daily schedules. "When the residents were in the dining room, we knew we had about an hour and 15 minutes to get an activity completed that could be disruptive to their daily living," said Wright.
Hanson said she was pleased with the installation process. "Everyone from Total Services and Air Tectonics was very considerate of the residents and our staff, which is a very high compliment considering the challenging care and needs of many of our residents."
"We'd have briefing meetings in the morning to let the staff know what would be taking place that day and what had been accomplished the previous day," Sickler said.
Shortly after the dehumidification units were up and running, staff and residents commented on how much more comfortable the building felt, according to Desert-Aire.
"Our Barclay Friends community now has a comfortable temperature and humidity system to match our warm, home-like feeling," said Hanson.
Sidebar: Market SnapshotNIC (National Investment Center) MAPâ„¢ is a quarterly data and analysis service that tracks revenue, occupancy, property, and demographic information on over 7,400 senior housing properties, representing over 1 million units/beds located within America's 30 largest metro areas. The subscription-based service covers market rate (25-plus units/beds), independent living, assisted living, continuing care retirement communities (CCRCs), dementia care, and nursing care properties.
As of 1999-2000, the NIC National Supply Estimate of Seniors Housing & Care Properties counted 46,131 senior housing properties with supportive services in the United States with a capacity to hold more than 3.4 million seniors. Of these 46,131 properties:
NIC's 2004 update estimated 33,000 professionally managed properties (independent living, assisted living, nursing homes, and CCRCs), with a capacity to hold 3,675,000 seniors.
For information on managers, operators, providers, or lenders involved with the seniors housing and care, check out:
For more information, visit www.NICMAP.org.
Publication date: 11/06/2006