Chapter 6
Continuing Care Facilities

Bill Diefenbach, AIA; Karen Hargarther, AIA

Hargarther

We're from Stone Marraccini Patterson architects in San Francisco. We're both leading a design studio that is part of a larger architectural firm and one of our main focuses is on life-care projects. We've been doing a number of them over the past few years. We've been asked today to discuss the continuing care community.

Continuing care has developed out of the "aging in place" concept which I'm sure all of you are familiar with. The concept is based on individuals residing in a single community over the span of years of their decline, without the need to relocate elsewhere, in the company of spouses, old friends, new friends, and with healthcare and other services at their fingertips. For us, it's an even greater question both philosophically and socially. For us, it's how to make a physical place that also represents a community.

Our goal, which was developed with a client several years ago, is to create life-care communities that are not for individuals to go just to retire but to go to live as well. I think that's a very important difference. It's something that's going to be, in my mind, a cultural shift. It's a different mindset. I heard at a conference a couple of years ago that, as we know, people are no longer retiring at age 65 and then living five years in retirement and dying like clockwork at age 70. What we have to start to think about is when all of you retire at age 65, what are you going to do for the following 20 years? It's a pretty serious question. It's a long couple of decades that we have to deal with and that's really what our thinking is based on, creating spaces that all of us are going to be living in at some point in our lives and creating the right thing now.

What Bill and I have done is try to get a little bit of everything out to you. We've divided our presentation into three sets of slides. The first thing we're going to show you is one of our continuing care retirement communities in Los Gatos which is a project by American Baptist Homes of the West. That was completed a couple of years ago and is now occupied so what we thought we would do first, is show you that facility, some of the concepts we worked with there, what is working and what isn't working. Secondly, we'll move into a series of slides that will take you on a very quick trip to Japan. Bill and I spent some time in Japan a few years ago researching a number of life-care communities and their whole life-care system. There is a lot to be learned. We want to give you some of those ideas and the kinds of concepts that we brought back from there. Finally what we'll do is give you a preview of the Three Bridges community; it's just now getting through the design development, and we're looking forward to moving into construction drawings soon. So, we'll show you the work we've done, some of the new things we've been learning from abroad, and what we're doing in our practice today.

Diefenbach

I think the first thing you should know is, as an architect whenever you start working with a client, you need to understand the client's culture. What are the goals of that client? These three clients you'll see are all very different. There are a lot of commonalties but a lot of differences as well. The first client is American Baptist Homes of the West (ABHOW). Many of you know them I'm sure; they have 17 facilities from Los Angeles to Seattle varying in occupancy from 100 to 400 people. They're a group that's very experienced; they know what they want. They know what they feel seniors need. They know what they feel is safe for seniors, and appropriate for seniors. And they bring a lot of knowledge and education to the projectto us. That makes for a bit more restricted environment within which we design. Maybe not as much innovative potential for us but yet we, of course, try to stretch them as they try to stretch us.

Let's go on to the first project, the Terraces of Los Gatos. The town of Los Gatos is as restrictive a town as you can find with regard to developing the city. It is a town of one- and two-story single-family homes. This project that you see on the left is entirely surrounded, at least to the north and south, by single-family homes. There is a large community to the left which is a shopping center and there is a school over on the right. But the scale within which we are trying to develop is the issue. The town in a very restrictive manner wanted us to bring the scale down. There are 175 independent living units on about six and a half acresthat's about 25 residential units per acrewith a skilled nursing facility right at the main entry, off the main street which is a very busy street bringing cars into the facility with a loop road at the rear. There is an assisted living facility adjacent to the skilled nursing facility. All three types of care are around the focus at the end, the terminus, which is the commons building, the location of all services whether dining, mail, auditorium, et cetera.

The planning issues on this project are probably the most significant. The planning, I think, is where we succeeded best. There's a very strong axial relationship, right up through the middle, focusing on the commons building such that all individuals may walk from their units or find their way along outdoor single-loaded corridors or exterior exit balconies as they're called in the code. They can go down a number of elevators in a number of locations and take the center landscaped alleyway down to the commons building. The units themselves range from alcoves of about 550 square feet, single-bedrooms of about 800 square feet, two-bedrooms of about 1150 square feet, and some larger two-bedroom, one den, facilities along the perimeter which face the single-family homes opposite. We tried to graduate the buildup from single-family units across the street to two stories to then three. This graduation helped shape the community from a very low scale at the edge to a high scale at the center of the project which needed to be three stories in order to accommodate enough residents to make the facility profitable.

Traffic is the last aspect of site organization. There is entry through a couple of porte cocheres. Parking is zoned in three areas. There is visitor parking right off the main drive, staff parking at the rear, and there is resident parking in two levels under the facility; this is required by the town of Los Gatos.

Hargarther

When Bill was talking about the concentration of the project, that was one of the things we focused on very heavily in the beginning. The town's concern, and the design review board that we had to work with there, wanted to make sure that there was a one-story feeling at the front and sides of the community. These front units do create this one-story feeling of the neighboring houses. The board also wanted to make sure we took contextual cues from the mountains beyond using roof forms and colors that worked in with the community. It took us five years to get this through the town and design review boards in Los Gatos. They were very, very concerned about how this kind of institution would fit into their community.

Diefenbach

The entire goal is to blend with the community and achieving this comes from using certain materials, the siding, the stucco and wood shingles.

Hargarther

So we would break down the concentration even further. As we stepped back, we went from the one-story units you saw up to the two-story buildings and then on to the three-story buildings. Once we had these large blocks we had to look at both horizontal and vertical ways of breaking them down even further. Taking a banding approach, vertically, we broke it down to a stucco base and then we used the siding as a field and used a topband with shingles; all three of these materials were in the neighborhood on other houses. Then we went in the opposite direction, trying to break the scale down by putting on vertical elements and porticos to really highlight the balconies.

There is a lot of layering, a lot of patterning. We wanted to add a little bit more interest to the facades of the buildings. This was both for the outside community looking in and for the residents inside, as Gita talked about yesterday, so one wouldn't be walking up to a monolithic building.

Diefenbach

This is a view from the central axial organization down to the end. This also functions as a fire access lane through the middle, hence the proportions of this gateway. Once we get down to that end, at night the commons facility is what we call a beacon to draw people down toward the dining area and the public spaces which are within this facility. A couple of porte cocheres on either side allow a covered drop-off. There's a fully covered walkway from every resident's apartment all the way into dining.

Hargarther

So every time you went to a meal you were able to go under cover.

Diefenbach

There are no stairs, no level changes, one minor ramp. ABHOW was very concerned about safety of the environment and very concerned about ramps.

This is a major focus at the end with the fountain. Once inside the commons room we attempted to achieve many of the things we've been talking about here in the last couple of days. Very diffused light, for example. The skylights are there but they diffuse the light; they're made of a thick sandwiched material to bring down soft light. There is accent lighting down below for reading. There is light up high on the walls at night to give ambient light to the space.

In this area all the functions for the commons occur. At the lower level there is a library, there are activity rooms, there is an auditorium, there's an ice-cream shop which, by the way, has closed due to lack of interest. Upstairs there are more administrative functions and training facilities.

Hargarther

We should also point out that on the upper level, on the left slide here, if you went to the left you would go into the skilled nursing portion of the facility. If you went to the right you'd go into the assisted living portion. A number of residents have commented to me that they really like the idea that they can come out and see this atrium space from that upper level without ever having to leave their own home or their own level, and see the interaction of all the independent living people coming in for dinner or other social activities. It's kind of a passive way for them to participate in things they don't necessarily, or can't, participate in.

Diefenbach

More slides of the details. Some of the character of the inside came from the exterior; you'll see some of the details that were found on the exterior of the building brought in. Some of the functions around the auditorium which I hope is a square plan because we were told yesterday it's a little bit more rectangular. This is the ice cream parlor which closed but soon will find a new use.

We did not do the interior of the dining facilities. The basic spaces are ours, but ABHOW has an interior designer, used on many of its projects, that they are comfortable with. Those were independent living and assisted-living dining facilities.

Moving on to the skilled nursing facility which is immediately adjacent to that large space. It is a corridor which loops around. We used a plan that actually evolved from much of our medical work. Fifty percent of the work we do at SMP is hospitals. We also do residential and what we have here is somewhat of a meeting in the middle. Relative to clustered, we have four roomsall doublesaround an area. This area is quite generous. This window is looking at this window here overlooking the central court. We get light into the corridors this way. At all four major intersections, and the two interior ones, we bring light down from above with the soft filtered skylight method and also light from the central court coming through windows on either side. There is an area in front of eight residences such that they can come out and use the space and look out into the court.

Hargarther

They really do end up functioning as neighborhoods here. The residents travel through different activity zones so there is a lot of cross-interaction occurring.

Diefenbach

That interaction is also pulled right through the activity room into where the more formalized activities occur. It has views outward to the main street; it has access doors into the courtyard to get outside into a very sheltered environment. It's sheltered from light because the perimeter is screened. It has trellis areas to filter light into these areas which is why you see no direct sunlight. It is landscaped within the middle and pulls people through the activity room by use of hold-open doors, separating it from the corridor, with stairs at the end so you eliminate the dead-end corridors which one might otherwise have. This allows residents to become pulled into activities.

Hargarther

ABHOW did ask us to provide some single rooms so there are a number of single rooms around the central corridor and all of those are occupied at this time so there's definitely interest in those.

Diefenbach

It's a 59-bed unit; it has two nursing stations one of which is occupied at night, not just from the 1 to 59 ratio, naturally, but from the 90-foot rule too.

These are typical rooms. Double rooms where the beds are not side-by-side or toe-to-toe; they are somewhat at an angle to each other. The rooms are interestingly shaped. Every bed gets its own window. Every bed can be separated by a curtain from the other.

Hargarther

There were 175 residents and over 70% of them completed the survey; we had a pretty good rating from them. Their top five positive reactions were: 1.) they said the floor plans were very good, that everybody liked their units and liked the ability to move in the units and the allocation of space in each of the rooms; 2.) they liked the use of color and interior design in the common areas and appreciated the architects taking that extra step; 3.) they appreciated compact arrangements of cabinets, sinks, counters, and refrigerators in the kitchen; 4.) they appreciated the convenience and number of electrical outlets and fixtures; and 5.) they thought there was good soundproofing of walls, doors and windows and that it was, overall, a very quiet place.

There are a couple of criticisms that I think are important to take into account as well. The first one was that even though they said it was a quiet place they also said that sound insulation was less adequate between the upper and lower units. All of us who live in rental apartments can relate to that; it is very disturbing to hear people moving around above you.

Diefenbach

It is code-compliant; it's an inch and a half of gypboard and sound insulation in the floor, but it still wasn't quite enough for them.

Hargarther

Furnace and air conditioning units were too noisy. We have gone back and modified these to keep the noise level down. Upper kitchen cabinets are still considered too high, a complaint we found interesting because we had already gone back and lowered them in the design. At this point the upper cabinet is only 15" above the lower counter which is fairly low but there's still that perception of their being too high. The residents also felt they needed more built-in storage in the bathrooms and more drawers. They felt they could use common activity spaces in the independent living buildings as well. We had focused all the activity areas up in assisted living and in the skilled nursing facility, and the independent people thought it might be nice to have additional card rooms or other activity rooms for them to use down in their own neighborhood. Windows that were too hard to open were changed during our value engineering process. That goes back to the question of whose values are addressed. Finally, there was a perceived lack of security. This was a decision made by us and the client early on; everyone wanted the building to be open to the community, to make it feel like an integrated residential site and not to have a walled or fortress-like community. Now, on the other hand, the residents are saying it might be nice to have gates, or it might be nice to have walls, so they would have that sense of security.

I think we're going to leave ABHOW at this point because we have two more groups of slides we want to show you. Our next set of slides are the ones we took while visiting Japan. As I said earlier, there are a number of cultural differences between here and there and especially in the importance of family. Nonetheless, they are now moving into a pretty drastic change in their care for the elderly. We found we could bring back many positive ideas to the United States. Right now we have a client, our Three Bridges client, who's very interested in using both Swedish and Japanese concepts in the life-care project that we're developing for them.

Diefenbach

These are some of their [Japan's] best retirement communities. As I say, you have to know their culture. This client came from a background of architecture and public health. Two individuals who joined together about 25 years ago and decided there was a need for more care facilities in Japan because family life was not exactly disintegrating, but there was a change of family life in some areas. Prior to this, children always took care of their parents without question; this started to change about 20 years ago.

Hargarther

This change occurred as the young population was moving into the urban centers and leaving mom, dad and grandparents behind in outlying communities.

Diefenbach

In Japan, we found a great sense of concern by individual caregivers; this concern results in quality care. These are some slides to get you into the feeling of the culture of Japan. Quality landscaping, natural and otherwise, and some very strange forms of landscaping. A lot of time spent waiting for taxis, a lot of time spent waiting for trains. We were in some rural areas and some urban areas. We went to a lot of different communities. There were about eight of us who went.

These are some of their life-care facilities. They're very different from ours. I can't be very positive about some of them; they're massive buildings, very monolithic and very disturbing to me.

Hargarther

They said it's the modern, brutal architecture.

Diefenbach

Some others are very interesting projects architecturally. As mentioned, the Japanese are very traditional. For example, in the heart of some of their facilities they would have a teahouse and a natural outdoor hot bath with changing facilities adjacent.

Hargarther

Something I took back from these communities was the concept of making your everyday rituals very important. The rituals of bathing and of community eating, for example; everything was done in a very sacred kind of way and this was a very important part of their lives.

Diefenbach

More exteriors. Single-story, more remote. Three-story, more urban applications. Interiors are where buildings really change. For starters, there is the proportion of public space to private space. The Japanese are naturally used to living in very tight, confined spaces. Their private rooms, private apartments, tend to be very, very small. The public spaces are outrageously large by our standards and they are everywhere. They are interspersed throughout buildings; they're not just lobbies. They are very warm and bring in a lot of daylight. The Japanese have very little concern for glare. This facility is about 20 years old. They use these spaces in a multitude of ways, bringing in people for social interaction both organized and unorganized. I think light can be controlled a lot better than they controlled it but still the activities are terrific.

Hargarther

They didn't think twice, either, about setting up rooms differently very quickly. We happened to be there on a national holiday for girls' day so they had individuals coming in to perform all day long. They would have a performance and ten minutes later have the room set back up with lunch tables. There were a lot of big, empty, flexible spaces in which they would move both objects and people. They were very used to moving people around the facility.

Diefenbach

A lot of use of wood, a lot of use of detail.

Hargarther

Wood on floors, wood on walls, wood trim everywhere. It's something that here in California we can't do, with OSHPD, but it has definitely made a difference in a lot of their facilities as far as the warmth and quality of spaces.

Diefenbach

These are typical dining spaces with floor-to-ceiling glass, unprotected. Shown here are other entry spaces; there was direct orientation to nature wherever possible; indeed there was a very strong orientation to nature everywhere.

Hargarther

I would say that every activity space, every corridor, every bedroom, had some type of orientation to the exterior. If you couldn't get a view then a special garden was built in whatever space was available just outside that window.

Diefenbach

Again, detail on the stairs to emphasize the use of stairs. Stairs are not behind fire-rated enclosures; they're out and exposed.

Hargarther

In every facility we saw, at whatever level, always there were stairways in very obvious places, and staff encouraged the residents to move slowly and to climb stairs as often as possible.

Diefenbach

A typical corridor, very sunlit, floor-to-ceiling glass, beautiful wood floors, terrific attention to detail just on bumper guards to the perimeter. Typical corridors are enclosed; it's a much colder climate than ABHOW, but they are reaching for light. Recessed areas into residents' rooms, there are two rooms here, two there. Here's an example of the entry doors.

Hargarther

This is actually an interesting story regarding large spaces. These are living rooms in assisted care. These are probably ten-foot-wide corridors, but in addition to that large width they've carved out a space in front of every door just for wheelchair storage. The whole idea was that they wanted individuals to be able to leave behind any of the equipment when they went into their own personal home so they left enough space, more than our 18 inches, on either side of the door to actually roll up a wheelchair or a walker and have it out of the corridor in a place to stay. Then when you were in your own unit you didn't have things around reminding you that you had a wheelchair or a walker. So as you went down these corridors you would always see these things in the niches outside the doorways, not in the corridors or rooms.

Diefenbach

Here is light through the transoms and down through the side lights into the rooms. Every kind of circulation is celebratedbridge, fanciful shapes of the bridge, vertical circulation stairs for exampleand all always are oriented outdoors toward nature.

Hargarther

Again, here we have stairways. This is an activity area that was a weight room and they had a stairway right in the activity area to get people to go up and down and use as part of their therapy.

This is in that same area where the assisted living rooms and some skilled nursing rooms were flanked by corridors on either side. It's actually a concept that we use a lot in lab planning. It's the idea of having the service corridor, or the staff corridor, on one side and then a very personal or more passive corridor on the other side. Along the back here there were doors. You'll also notice that every door slides. The grey-blue doors slide open; they have keyed locks. Every resident has her/his own key and wears them on little wrist bands. Again, it's that feeling of owning one's own place. They unlock their doors and let themselves in. Staff comes in and out and services them from this side. On the other side they have the double sliding doors which literally open up their whole room and then this corridor becomes a front porch for them. It's a place that's very quiet and they have the borrowed light from the outdoors. It's kind of like opening the back porch door and sitting out in the evening.

Diefenbach

Very different environments on both sides.

Hargarther

These are some of the older models, Jasco's properties. These were assisted living units and had the bed in the back and then in front here was a very compact kitchen. These also were arranged with a service corridor out front so that attendants could come in and help bring food in or help prepare something if necessary. In a little bit later version on the right, they added some walls to divide the space a little bit more and then added some other electrical gadgets on the other side to update the rooms.

Diefenbach

This gives a little sense of privacy here when the corridor door is open.

Hargarther

These were some of their earlier skilled nursing units, at least 25 years ago. They've updated them, but skilled nursing in Japan has stayed with what we would probably call a ward. The residents all are in one room. It's probably a room the size of this one we're in here. The beds are arrayed around the edge and then utilities, such as sinks, are at individual beds. They did most of their activities during the day in that room.

As we got to some of the more modern facilities, which you can see on the left, you'll see that they're still wards. There are individuals spaced around the room. They now have the divider walls behind which are some of the medical gases and storage. Out in the center, these tables are used very much like the Swedish use them in terms of nursing and meeting with patients. They don't have nursing cubicles like we do; they will sit with a patient at a table and work one-on-one with them. They'll do charting there; they'll have a cup of tea with them. It's a very interactive caretaking type of situation. Any of the long-term paperwork or other kinds of things for nursing tasks are done in these other rooms that are behind the scenes and not part of the actual ward.

The other thing is that the beds unhook out of these portable walls. They call them "day beds," and they take them out in today rooms. These are some of those big flexible spaces I was talking about; you see them all the time. Individuals are wheeled out with their entire bed and brought several hundred yards down a corridor to another space to participate in things. They also are brought outside in their beds. This is just something one does. It is how you get out of your room.

I want to point out another thing about the sinks. What they've done in the newer facilities is place sinks right in the ward so they're now clustered together at the center. Everyone is groomed and sponge bathed in the same room. You're brought over in the morning; your hair is brushed and you're able to brush your teeth and get washed up. You do much less frequent full bathing which is done in a bathing facility outside of the ward. For everyday cleaning and grooming it happens right there in that tight space.

Some other interesting concepts. In an Alzheimer's unit individuals were allowed to come outside, and they did something here that I found very interesting. They didn't have walls or gates up to keep these people in. They had a small stream that was only about five inches deep and some rocks on the other side of it. For these individuals that was a barrier. They said in the ten years they've been in this facility they never once had someone try to pass it. To residents it was a natural barrier; they didn't know it was only five inches deep; they just stayed on this side of it.

Diefenbach

Some of the other public spaces, the exercise facilities. We never saw people using them. They're all oriented with a lot of daylight. People come down from upstairs, see the spaces and get involved in the spaces.

Pools are at every facility, usually interior pools with the kind of ramps that were discussed yesterday. We didn't see any trenches around the perimeter but wheelchairs go right down in them. They have communal bathing facilities segregated by gender.

Another communal facility was a library space in the middle of the corridor. They are unconcerned with our kinds of codes; for example, these were flammable materials in the corridor. Another space was a guest room. This is a living space for a guest; it's immediately adjacent to the exercise room.

Hargarther

Guest rooms were very common in the assisted living and skilled nursing facilities we toured. The guest rooms were designed to accommodate families, parents, children, relatives and other visitors. They were decorated like a traditional Japanese home so guests felt very much at home. They could stay for a day or two or a week or whatever was necessary if someone was very ill. Families stayed here for a very nominal charge; I think they paid for a portion of their meals. I spent several nights in an Alzheimer's ward in their guest room. They took a lot of pride in their guest rooms to make sure they accommodated their guests.

Diefenbach

Interestingly enough, they use a lot of materials on ceilings that we wouldn't consider. Skilled nursing patients are quite often lying in bed and are looking up so they shape the ceilings and/or construct them out of quality materialse.g., a tinted ceiling, or a curved ceiling, or a wood material ceiling.

Hargarther

We saw very simple rooms with covered ceilings and high lighting. That made a complete difference in the perception of space.

Diefenbach

This is a full continuing care facility, including independent living, assisted living, skilled nursing facility and even a mausoleum and crematorium.

Hargarther

And this was, again, common to every community we saw. You did spend the rest of your life as part of this community.

Now we're back in California with another twenty minutes to go. Coming back from Japan and having had the experience with ABHOW and other projects, we wanted to look at some other American models. We traveled in the United States with our client, John Scully from Pacific Life-care, to see what was happening in the United States. He was convinced that good facilities haven't been created here yet and that the Swedes and the Japanese were probably somewhat ahead of us. He came back having done a lot of research as we did. He had spent several years looking for the right piece of property to develop his project. He traveled all around the United States trying to find the right place where his project could be accommodated and brought into the community successfully. He landed in Santa Rosa right at the edge of the Valley of the Moon as it comes up out of Sonoma. It feels like a very, very special place. It sits right at the edge of Annadale State Park so it has a permanent natural backdrop.

He very quickly, in about two years, was able to put together 18 parcels of land to get the site he needed to begin this project. As you can see, it's got an exquisite rural beauty to it. It has hills; it has creeks; it has a lot of naturalness to it now. There are still a couple of houses and some horse farms. It's a very big challenge for us as designers to fit a new community into this place without losing the real essence of the land itself.

This will give you a quick overview of the site. The property itself is about 70 acres. Right along here is Highway 12; down to the left is Santa Rosa, and then Highway 12 wraps around and goes down here to Sonoma. Up along the back here is Annadale State Park which includes a significant hillside. When you come on to the property from one of the main entries up here, it's a fairly level site. This is where one of the first neighborhoods will exist; we're calling it El Noca. Then as you come up the piece of property to a loop road that runs around here, this is the top of the hill so you have a hill all down on this side. It's fairly gradual, and then a much steeper hill is along the backside. Santa Rosa Creek runs through here and then in the back there is another meadow area that we're using for a guest area.

In our planning, which took a year working with John and his staff to develop the idea he was after, we finally came up with a Main Street concept. We've all used that term a lot but it really is based on Main Street. This time it's a pedestrian way; we are not allowing vehicles or any kind of services to come up there. The other unique thing is that we have located the skilled nursing facility, which we are calling the care center, along with the assisted living lodges all right here at the heart of Main Street. In addition there are several three- and four-star restaurants like I Fratelli and Il Fornaio. There is a leisure center; there is a health and fitness center; there is an auditorium; there is a learning institute. And then at the other end there is what we're calling 'Intown Highland Housing' which are townhouses.

So this whole Main Street is where the life of the community and all the activity and action exist. And skilled nursing is placed right in with it allowing the skilled nursing residents to participate. I should also note that there is a childcare center located at one of the town plazas. It's a lively, more active center and if the residents want to participate they can. Residents can walk through the town center and watch the children or for individuals who do want to get involved they can go in and be part of the "read a book" program or whatever is going on.

So, you have independent living down in El Noca, independent living in Highlands, and independent condominium and townhouse units along the back hillside. Out in the meadow areas we have now created a guest area very similar to what the Japanese were doing. The guest area will house visitors to individuals in the community as well as Japanese guests from sister life-care communities in Japan. They're hoping to do some exchange programs for their independent living groups.

Diefenbach

One of the biggest challenges here is pedestrian and vehicular circulation. This is a site, I think, no other client would ever choose. I'd say the hill in the middle is 120 feet high running east-west. Vehicles can drive around this hill, but not on the Main Street which (with the exception of fire and ambulance vehicles) is reserved for pedestrians. If people do not want to or cannot walk, there will be a jitney service that will bring people from El Noca down through the middle of Hillside/Creekside and loop around through the Main Street. It will drop people off at any of the restaurants or the care center.

Hargarther

So the jitney service will continue throughout the day. This is a very steep hike to come up and over to Main Street. They're finding in some of their pre-sales right now that there are a lot of individuals who want to be away from the skilled nursing area and that's why they like this backside of the hill; they feel like they're not ready for skilled nursing care.

Diefenbach

It's a very, very quiet, beautiful side of the hill overlooking Annadale State Park.

Hargarther

The guest areas are actually being designed by a Japanese architect. Our client invited a Japanese architect, who we had met while we were in Japan, to be part of our team here. He's collaborating with us on the guest area. I should also mention that we're working with another architect, Backen Arrigoni & Ross, in San Francisco, who's also participating in the master planning of the project with us and designing the majority of the houses. SMP is working on some parts of the town center, on the assisted living lodges and on the skilled nursing facility.

Diefenbach

The question of style came up yesterday. How does one develop it and is it appropriate for a retirement community? We wanted to find something that fit into the context here, appropriate to the region. We believe in regional and contextual design. We drove for days through every backroad and every main road, downtown and rural areas, to find what kind of style had developed there over the years. We did find something. There are a number of wineries such as the one on the left, Buena Vista Winery, and a number of what are called hop kilns. I didn't know what one was until we went up there to research. Hop kilns are built in threes or twos; they're used to dry the hops for beer-making in the city. They're in stone-enclosed areas or are wood-sided. They have metal roofs and cedar shake roofs. They have boilers at the lower level which dry the material. The material expands upward through the ventilated cupolas at the top which opens and spills out billowing clouds of steam.

Hargarther

So our attitude isn't really that the style question is a matter of do you want to go traditional architecture or do you want to go modern architecture? It's really a matter of deciding where your facility will be, what the nature of the land is there, what the nature of the local people is, what kinds of things are happening there currently, and then responding to all these.

Diefenbach

We looked for materials, materials we thought the residents, who are very traditional, could relate to and decided on the stone and wood because of their warmth. Corrugated sheet metal roofing is not as warm but we can stretch the perception of their warmth on occasion. The stone ma terials go right out into the landscape. Clearing the fields and building stone walls were integrated into the project. These became abstract in some cases. For example, here's the main entry to the care center. It's at the lower level, due to the hillside, and visually brings people in from the outside. At the upper level, around the main circle, vision is focused inward. The lower level is focused outward; the client has a very strong vision. He's a very vision-oriented individual who wants to reach out into the community of Santa Rosa and bring those people into his community as well as give the people within the community a feeling of going out.

Hargarther

This is the care center down here and it's divided into five, what we're calling, cottages. They're very big. There are four long-term cottages and one short-term rehabilitation cottage. All are connected by an enclosed street or by activity spaces. We're really looking at that as an outdoor street. We're introducing a lot of stone and slate and outdoor materials so that these really do function as their own independent houses. The main bridge space, as we're calling it, has more formal activities. There's a cafe there; there's a seating area; and there is a place where performances can be held. The curve here is an all glass curve which expands out in this direction to a great view out to the end of the Valley of the Moon.

Diefenbach

There's also an exterior, unenclosed canopy area that will be covered in grape ivy. It focuses on the chapel, at the end of the canopy, which is at the heart of the care center. Exterior elevation, views of the full height looking out over the hills of Sonoma valley.

Hargarther

You've never seen so many models in your life. We had models all over our office because, obviously, it was a very big challenge in terms of topography and really trying to get all the different components onto the site.

Diefenbach

This bridge will be a multi-use space, much like the ones you saw in the Japanese slides, where activities of any type can occur. There's a small cafe at the lower end of it. The chapel is on the right at the end of the trellis area. Using materials, again, the stone and battered forms here, inverting the battering to go out to the top. The metal roofing we saw out in the farm areas.

Hargarther

We really tried to set all of the different kinds of buildings from the outer community right into the landscape so that we didn't have a whole new development perched on top of this piece of property.

Diefenbach

The ivy-covered trellis area, in the right-hand slide, reflects the current use of the vineyards adjacent.

Hargarther

Looking through a section of the bridge space here, you can see where some of the activities will be. Ceiling patterns are created here from different colored lights that will be suspended to get the feeling of a very active zone. It's a place that not only the care center residents will be part of but will encourage everyone in the community on Main Street to come down and use the cafe and the activity room.

Diefenbach

The natural landscape flows in underneath it; it truly is a bridge bringing the natural landscape up and underneath and inside. Here are views both to the north and the south, sheltered by a long overhang on the south. You can see the floor patterns within; we're in the formative stage right now trying to define seating areas. We have concerns about the patterns and textures, and we're going to work more on that.

The chapel itself is a pair of praying hands practically, outdoor-indoor related. There's an outdoor vestibule to the right entering into the chapel itself which brings water in from the outside through a lower level of clear glass. There's translucent glass above it in the elevation and clear glass above to look out and through to the sky beyond.

Hargarther

I have to say this was strongly influenced by our trip to Japan. We brought back a lot of symbols, tree of life, natural materials, creating spaces that are very serene, very meditative and at the same time secular. We also located it in a place, as Bill said, right at the end of that walkway from the care center so that people who are mourning or needed to grieve could instantly have access to a place like this. You can see this as you come down Main Street here. Again, the care center court and then that chapel is located right at the end here.

Why don't I talk very quickly about the long-term care houses? These are arranged on an upstairs-downstairs concept, the way they are set into the landscape. What you're looking at here are two different houses, this one being a typical floor plan of the upstairs and this one being a typical floor plan of the lower level. The idea here was to create a home-like setting having bedroom spaces located around the perimeter and having an entrance sequence where you come into a foyer space and don't have direct view into any of the bedroom spaces. Then as you come in, there is a community space or living room. Each living room has a fireplace. And the nursing station is much like we saw in Japan and Sweden where there was an open table, a very interactive space with a lot of other functions besides nursing. There are steps up and down in the back. We've got more firestairs over here and there is an elevator. There are seven individual residents on this floor and seven residents on the upper floor. Right now we've got 14 residents in each cottage. All of the rooms are single-resident rooms. That's something John really wanted to try to start with. They could in the future, accommodate two beds, but he wanted to begin with one.

This is a typical skilled nursing room in the cottage. As you come in there will be the bed in this area. We've created the extra area over here designed to have a loveseat and a little desk area, with the loveseat having a fold-up bed for another sleeping space. This was important to all of us, that visitors could spend the night with a resident.

Every room has its own patio. In our recent design these patios are connected so there are two rooms adjoining a single patio. You'll see here the residential character of every cottage taking on a feeling of home with the balconies, and architecturally achieving a feeling of abundant space where the living room is down on the lower level. On the upper level there is a small library area which has an overlook to the living room below.

This is the Alzheimer's group home. This is an attempt where Charles Silverman's ideas are taken maybe a little bit further. We're only one step closer in that it's now designed. We have taken a lot of his principles to try and see if it is possible to create a family-type group home for people who are afflicted with Alzheimer's disease. We've designed one home that will house 16 residents, eight residents in each pod. Residents could work in the bedrooms and have their own family room, dining room, and some activity spaces, and not have the disturbance of the other eight residents. Once you're over 10 to 12 residents, there's too much activity, too much confusion, and staff find it much harder to work. We're trying this pod concept to keep the number of residents who are together small, yet at the same time we have designed this walking path, where residents can wander through living spaces and come back, or go outdoors and come through an outdoor space and back in, or go outdoors and use the central courtyard.

Another thing we're doing is, rather than creating fences and walls back here, for protection and security, we're using the topography of the land here. It's going into a very steep berm; up along the top here we have rock gardens and a very nicely landscaped area that then has a wall or fence behind it. So when you're standing down in this area you have a perception of a landscaped garden with the sky beyond.

This is a typical bedroom in the Alzheimer's group home. The wardrobe dressing area is right at the front of the room. We learned this from Nancy Mays. I don't know if any of you have worked with her; she's a very wonderful person, and I highly recommend using her to help develop programming for Alzheimer's group homes. She's the author of The 36 Hour Day, a book about caring for people with Alzheimer's disease. She worked with us extensively during programming to come up with many of the innovative notions and principles for planning for Alzheimer's patients.

Diefenbach

Again, we have a client here who is very, very interested in innovation. He wanted us to use the Swedish concepts and to use the expertise of Nancy and others; to bring in the best minds we could find. Here you see another bit of created character; we searched for spaces in some of the assisted living areas, to bring in the enclosed family spaces within the community. There are three different kinds of assisted living areas. One has assisted living personnel within it. Another one, across the street, has a dining area, and the other one does not. In either of these last two, assistants come in to help rather than stay all the time. This is similar to the service concept that Victor was talking about yesterday.

Hargarther

This is a good slide to show the three lodges of assisted living. There's one here, there's another one here, and then the one Bill was talking about is across the street. All of them have central family rooms. They're activity rooms with fireplaces, with the laundry room, going back to the idea mentioned yesterday that one can do his/her own laundry and have an attendant right in this family space as well. That assistant could go under covered walkways and help anyone during the day. Right now the assisted living units are designed to use a dining room that is right here. The dining room is attached to one of the assisted living lodges but not to these two. Pacific Life-care feels they want to try this model of having the dining outside of the assisted living areas for those individuals who are not quite at a complete assisted need level, those who are able to function on their own. So these assisted living units really are much more similar to a small apartment. Eventually, if they find that need for assistance is great, they can convert these units so that dining spaces will be enclosed within the lodge itself.

Diefenbach

This is very much in character with the rest, bringing nature down into the facility here.

Here you can sit in your living-dining area or out on the patio and overlook all of the activity on Main Street. There are commercial spaces below, a bistro and a general store and a pottery area. Everything on the Main Street level supports activity with housing located above, much like it was in small towns years ago.

Hargarther

Here's the dining room we were talking about. Here's the short-term rehabilitation cottage, and over here is the other assisted living lodge with a large room attached to it. This is the short-term rehabilitation center which has, I believe, 24 beds. There are 12 on each floor for individuals in the community, independent living people, who perhaps have broken a hip. They've gone into the hospital in Santa Rosa and now are returning to the community. They can come in for short-term rehabilitation, I think up to 60 days, spending time in the skilled nursing facility and then returning back to their independent living units or back to assisted living.

Diefenbach

The great room and dining room are immediately adjacent to Main Street and are off this court in the middle for a multitude of activities. There is a two-century-old oak tree preserved in the middle.

Hargarther

They're hoping to have tea parties and activities out here to encourage all the assisted living people to get out and enjoy the site as much as possible.

Diefenbach

The dining room itself is broken down into three areas, much like the hop kilns, to create smaller dining areas. It's a little bit different from the Japanese who all dine in the large area. The great room is very similar to some of the wineries that we saw, large scale rooms for multi-use. Here we change floor materials to define different zones yet allow the entire space to be opened up. We bring the exterior materials inside on the piers, for example, of the great roomstone materials, wood materials, expressing chimneys inside and outside. Again, we bring in the hop kiln forms and materials, the winery forms and materials, to express the character of the region in the architecture of this facility.

On the left is the dining facility with a little fun at the topinstead of ventilated areas which allow steam out of the hop kilns here we have some free-flowing forms which are uplit at night and provide a beacon to draw people in. On the right is the great room, sheltered all the way around from the sunlight.

Hargarther

As I said earlier, we have just finished the design phase of this project. We have received notice from the Department of Social Services that we have the go-ahead to begin taking deposits. When enough funding is received from deposits, we can then begin the construction drawings. We hope that next time we'll be able to come with photographs of the actual project.