Few conversions of independent living or assisted living rooms to
Alzheimer’s care rooms start with ideal circumstances. “We say it’s
like a can of worms. You get into it and are not sure what you’re
getting into,” says Greg Irwin of Irwin Partners Architects. “You
have to find enough space… How do you set up that activities
base? And how do you handle wandering?”
All but one of Silverado’s communities was the result of a
conversion from another type of use, from psychiatric hospitals
to general assisted living. Some of the lessons Silverado has
learned from converting buildings from other uses are relevant
to smaller-scale repurposing of existing space by assisted living
communities. “The big thing I look for before the details is the
location—the structure of the building and the layout relative to
the program I want to implement,” says Shook.
In older or acquired properties, Shook advises being prepared
for costly surprises. “You have to have a great team, a cohesive
DRaftING the maSteR PlaN
team of the architect, the contractor, and yourself. Every time you
open that wall number three, it’s a surprise and the team has to be
able to respond to that. Change orders are a given. They’re going to
happen,” he says. Shook prefers having a long-term contractor and
architect work on more of a cost-plus basis to avoid haggling and
delays over every unexpected revelation. “Whatever they think the
budget should be, add 25 to 50 percent more on top of it for what
they don’t know is coming, and have a good team,” says Shook.
In cases where changes are required to bring a building up to
code, Silverado does not compromise on the life safety systems it
considers most important. If a building is “grandfathered” out of
sprinkling system requirements, Silverado will install one, anyway.
Lighting is another area where Silverado routinely surpasses code
requirements. On the other hand, not every bathroom will need to
be ADA-accessible in a community where staff is available to assist
with toileting.
version; one community in particular was “landlocked,” as Bacon
puts it. “It came down to what area or hallway would it be worth
converting, and would it make sense,” adds Nadelstumph.
When embarking on conversions, Brandywine identified
those residents who would most benefit from Reflections and
started communicating with the families through a combination
of informal conversations and formal presentations. “Commu-
nication is one of the key pieces,” says Nadelstumph. “Families
must be updated from start to finish.”
Brandywine worked out a transition plan that would ease the
transition for all parties, moving residents into new apartments
as necessary but giving the residents the controls as much as
possible. “They select the date and find the next apartment,” says
Nadelstumph.
Adding to an Alzheimer’s program is not the same as adding
general assisted living apartments. Brandywine hired a Reflec-
tions coordinator for each expansion to initiate programming
right away, even when they had only one or two residents in the
program so far. “An 11-unit program has a very different dynamic
from a 25-unit program,” says Bacon. “The whole program has
to be reviewed.”
Converting apartments can be inconvenient and expensive, at
least at first. “You can usually assume it’s going to be a revenue
negative in the beginning,” says Grape. But it does not require
strategic repositioning in quite the same way as, say, introducing
assisted living to an independent living residence. Over the long
term, an Alzheimer’s conversion should generate more revenue,
albeit at a lower margin, with a higher return on investment per
apartment.
Grape’s rule of thumb is to do at least 15 units at a time, or not
at all, and to truly tailor the space to the residents it will serve.
“Don’t keep the kitchenette because it’s cheaper than converting
it,” he advises. “The theme I’m saying is: You can’t do it halfway.
You have to be in it, or not.” ❏
Whitney Redding is a contributing writer to Assisted Living Executive.
Reach her at wredding@alfa.org.
who’s who
Contact information for members in this article.
› Brenda Bacon, baconb@brandycare.com
› Beverly donaldson, bev@innsmanagement.com
› tom grape, tgrape@benchmarkquality.com
› michael hargrave, mhargrave@nic.org
› greg irwin, girwin@ipaoc.com
› maria nadelstumph, nadelstumphm@brandycare.com
› Loren shook, lbshook@silveradosenior.com
› holly tenner, htenner@constantcare.com
