If you pay attention to current events and news coverage, you may have noticed an atmosphere of anticipation and trepidation in the healthcare sector. The cause: the last of the Baby Boomers—one of the largest living generational groups—turns 65 over the next two decades. In his book The Next America: Boomers, Millennials and the Looming Generational Showdown, Paul Taylor highlights many of the key figures and concerns surrounding this phenomenon. In 2030, the youngest members of the Boomer generation will be 65 years old, and 80 million will be on Social Security and Medicare.1 Key findings from the Center for Disease Control and Prevention’s 2013 study The State of Aging & Health in America 2013 support the growing concern over how the healthcare industry will cope with an increasingly large number of older adults needing greater levels of care. One particular finding states that “two out of every three older Americans have multiple chronic conditions and treatment for this population accounts for 66% of the country’s healthcare budget.”2 An increase in chronic conditions is likely to cause an increase in physician visits, tests and procedures, and may affect the number of high acuity inpatient admissions, particularly as the age of the population rises.3
The healthcare industry has already begun to react accordingly: many hospitals and care facilities are gearing up for the influx by building variable acuity inpatient suites, expanding outpatient facilities and locating new outpatient facilities in neighborhood settings and non-traditional buildings. The healthcare design communities are also responding through various dialogues about the incorporation of features, and required level of flexibility, to meet the specific needs of the growing Boomer population. At the most recent Healthcare Design Conference in November 2014, more than 40 healthcare and design professionals gathered at a roundtable entitled “Are You Ready for Boomer Nation?” Potential design improvements, such as the inclusion of culturally-appropriate signage and the need for more flexible environments, were discussed and debated.4 Healthcare Design magazine has also published articles on the topic of senior care, specifically related to Boomers, which call for elderly-care design that is more integrated into the acute-care setting, allowing for greater flexibility. A 2009 report from the American Hospital Association entitled, When I’m 64: How Boomers Will Change Health Care, points out that “Boomers are more racially and ethnically diverse than previous generations,” have higher levels of education and are much more active than previous generations (particularly in their older age)—all characteristics which are impacting the way hospitals are, and will be, designed.5
Compounding these issues, a large population of roughly 80 million Millennials is set to continue many of the trends triggered by the Boomers. A Pew Research Center report, Millennials: A Portrait of Generation Next, highlights that this population group, which is only 61% white, is even more diverse than the previous Boomer generation and is “on track to becoming the most educated generation in America’s history.”6 Millennials are also described as true masters of digital technology and social media.7 This impacts their expectations of what should be provided by hospitals, as well as how that care is delivered. Unfortunately, Millennials may also be on their way to outpacing their predecessors with higher instances of chronic disease, based on the prevalence of obesity within this generation.8 Armed with a plethora of research on these two generations, as well as a desire for efficient and meaningful architecture, what are we as designers to do?
If we truly espouse a sustainable approach to healthcare design we must ask ourselves if the decisions we make today are planned to meet the current needs while permitting hospitals to fulfill their obligation to the future generations. Using the past as our reference, we can assume that not all features built (or even anticipated) in hospitals today will be relevant in the next 20, or even 10 years. If this is accurate, how do we plan for sustainable flexibility?
Using Commonalities for Sustainable Design
It is fair to accept that not every future need will be met, but there are several key shared characteristics among Boomers and Millennials that can help forecast the needs of future generations. As the population grows more diverse, it is imperative that our designs embrace the melding of cultures that are sure to walk through the corridors and sleep in the beds of our hospitals. We must consider more than one approach to community spaces and question the cultural context in which industry research is conducted. Culturally, blue does not always symbolize tranquility, nor does black always imply mourning. Not all families consist of two parents and 2.5 children, and family dynamics and values are rapidly changing. The number of Millennials that lived with only one parent is higher than any other generation, at over 30 percent.9 Unfortunately, the progressively diverse patient population does not necessarily mean an increased diversity in staff, if current trends continue.10 To support closing that gap, designers can also consider the ways in which staff lounges, offices and communal spaces can be designed to accommodate various work preferences or modes of communication. If we can positively influence the hospital work environment, we may also be able to improve retention.
Boomers and, subsequently, Millennials are becoming more highly educated, and are demanding increasingly greater communication with their healthcare providers and better access to their personal medical records. Designers have already been including message boards near patient beds and creating space for the provider to interact more personally with the patient. We must also consider the shifting technological landscape. As multiple media sources indicate, technology is undoubtedly changing the ways in which people of all ages interact with their healthcare. Everything from simple online health forums and diagnosis to the highest-tech wearables are becoming inescapable realities. Last year, ASHE conducted a construction survey that included a random sample of 3,714 hospitals. They found that the top two technology features currently being added to patient rooms are wireless technology for staff and barcoding for medication administration.11 While these features are very important, only half of the top ten features were specifically for patient use and engagement, and very few are cutting-edge technology. With more than eight in ten Millennials sleeping with a cell phone at their bedside, ready for interaction at any moment, designers and hospitals should consider ways to integrate technological options to better engage these patients.12 Consideration for how Boomers, and other non-digital natives, interact with new technology is also important to achieve maximum benefit from such a substantial investment.
Wellness for All
It is important that reactionary or anticipatory design features do not become the sole focus or drivers of design. In all of our buildings, but particularly healthcare, a good design is a thoughtful consideration of many elements, but a truly great design is transformative for its users. We have an obligation to better promote wellness in all of our buildings, for all generations, especially those to come. Considering the pervasiveness of obesity and chronic conditions, as well as the desire for active aging, it would be beneficial for designers to include incentives for various levels of engagement, maintaining sensitivity for the elderly, the young and all manner of people in between. Rewarding users with a glimpse of a skyline seen only from a landing, or encouraging patients to engage with an outdoor garden, can help to promote better health outcomes and increase patient activity. Understanding how to incorporate flexibility, where appropriate, while meeting the needs of the changing healthcare patient population will be a question we continue to explore in our healthcare blog series this year.
Cultural Shifts Transforming Healthcare Design: An Introduction
Does Remote Health Monitoring Mean the End of the Exam Room?
1. Taylor, Paul. The Next America: Boomers, Millennials and the Looming Generational Showdown. New York, NY: PublicAffairs; 2014. Print
2. “The State of Aging and Health in America 2013,” Centers for Disease Control and Prevention.
3. “When I’m 64: How Boomers Will Change Healthcare,” American Hospital Association, First Consulting Group. www.aha.org/content/00-10/070508-boomerreport.pdf
4. “Are you Ready for Boomer Nation?,” Mayberry, Sara.
5. “When I’m 64: How Boomers Will Change Healthcare,” American Hospital Association, First Consulting Group. www.aha.org/content/00-10/070508-boomerreport.pdf
6. “Millennials: A Portrait of Generation Next,” Keeter, Scott and Paul Taylor. http://www.pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
7. “Millennials: A Portrait of Generation Next,” Scott Keeter and Paul Taylor. http://www.pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
8. “Millennials and the World of Work: The Impact of Obesity on Health and Productivity,” Shari L. Barkin, William J. Heerman, Michael D. Warren, and Christina Rennhoff. http://link.springer.com/article/10.1007/s10869-010-9166-5/fulltext.html
9. “Millennials: A Portrait of Generation Next,” Scott Keeter and Paul Taylor. http://www.pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf
10. “When I’m 64: How Boomers Will Change Healthcare,” American Hospital Association, First Consulting Group. www.aha.org/content/00-10/070508-boomerreport.pdf
11. “2014 Health Facility Design Survey,” Health Facilities Management and American Society for Healthcare Engineering. http://www.hfmmagazine.com/display/HFM-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HFM/Magazine/2014/Oct/cover-health-facility-design-survey
12. “Millennials: A Portrait of Generation Next,” Scott Keeter and Paul Taylor. http://www.pewsocialtrends.org/files/2010/10/millennials-confident-connected-open-to-change.pdf