The Senior Associate at Perkins Eastman and co-host of the Shaping Dementia Environments podcast talks the importance of the built environment for older adults.
Max Winters is a pioneer in the creation of built environments that make a positive impact on the lives of older adults. As Senior Associate of Perkins Eastman and co-host of the Shaping Dementia Environments podcast, he is committed to driving new models of senior living. Max recently spoke to Nancy Griffin about the company’s 40-year history, senior housing solutions for the “forgotten middle,” and the potential impact on senior living from venture capital and corporate investment.
Nancy: Tell us about your background and how you got your start in senior living.
Max: My background is in architecture. The focus of my undergraduate architecture program at the University of Maryland was how built environments enhance people’s lives. There was a lot of emphasis on “the user” which is a great place to start in architectural education, but as a college student, my ability to connect with this sort of archetypal user was limited, as was my life experience.
During that time, I was close with both sets of my grandparents, and watched their process of aging and having encounters with what we call senior living. I saw a lot of challenges and barriers for older adults, and the idea of the mythical “user” clicked. I understood the impact of the built environment, especially for older adults.
So that's how I got interested in senior living design. I focused on that topic for my Master of Architecture thesis, specifically about aging and community approaches for older adults without financial resources, especially in urban settings. My research quickly led me to Perkins Eastman because they share the same values and ethos about the importance of research and design, specifically for senior living design.
As an architect and a planner at Perkins Eastman for almost seven years, I do a lot of work “on the front end”—strategic planning, master planning, and concept design for senior living communities, both existing and new and for-profit and not-for-profit. I help them set their vision and then realize that vision through the built environment. And that's where I am today.
Nancy: Tell me about Perkins Eastman. How did the company become an authority in using the built environment to change the culture of senior living?
Max: Forty years ago, when Perkins Eastman started and when our senior living practice began, frankly, there weren't that many people in the space. Perkins Eastman pioneered watershed moments in how the built environment progressed, working on the prototype for assisted living in partnership with The American Association of Homes and Services for the Aging (AAHSA)—now LeadingAge and designing one of the very first residential dementia communities in the United States. We also did several prototypes for small house nursing environments when that was gaining traction.
Today, we're working on a couple things that are similarly watershed moments in terms of the built environment. We do a lot of repositioning in campuses and communities, and that kind of work involves getting your boots on the ground—meeting with residents and staff members to hear how they use the spaces that you have designed or are going to design. We learn about each organization’s quirks and idiosyncrasies through meaningful interactions with the communities’ residents and staff members.
It's not only about coming up with new ideas and being on the forefront as innovators, but then putting those ideas to the test when you explain it to a resident or a staff member. That's really at the core of how we've positioned ourselves and learn so much about this industry—that feedback loop of research and innovation.
Nancy: Perkins Eastman leads the conversation in middle market solutions. What are your thoughts on how to solve this growing challenge?
Max: The term “middle market” can be nebulous. Essentially, we are talking about the big 80% donut hole in the middle of the donut—those who can't afford the high-end communities but are not eligible for subsidized housing.
The challenge is when you get towards the bottom of the middle market spectrum, and you have people who are just above the threshold of subsidized housing. People who are in the mid- or upper mid-income range have options, but people who are just above that threshold for low-income housing is a hard challenge to solve.
2Life Communities recently announced the development of “Opus,” a unique middle income housing option for adults aged 62 and up. Making the lower income-subsidized housing bracket their mission, their next logical progression is one shade up where residents can't qualify for subsidized housing but still need options. Opus Newton is connected to 2Life’s Coleman House on the campus of the Greater Boston Jewish Community Center and will feature more than eight different housing options ranging from 650 to 1,350 square feet.
There are a couple of important elements that make this concept work:
The partnership with the JCC allows Opus to think differently about what amenities residents truly need. From a development standpoint, amenity space by nature adds to the expense without generating revenue. Using partnerships to think differently about how you build amenities is one important strategy.
Locating a critical mass of people together is an important financial tool. The price residents pay for services drops drastically if you have 300 people on one campus, because caregivers only have to shift over from apartment to apartment or floor to floor, versus driving to multiple addresses.
Apart from partnerships design is also a crucial component. How people use the space and relate to each other socially is going to drive how you design a space, not the other way around. You can't social engineer people as much as you think.
Figuring out the minimum “chassis” to keep entry fee as low as possible is a key ingredient. Saving money on design is simple stuff, like making crown molding optional and the selection of cabinet types. Residents can upgrade finishes based on their personal budgets and preferences.
Nancy: You are big on middle market projects that mix people from different socioeconomic statuses. Why is that?
Max: The history of senior living is needs-based, and often faith-based. These institutions focused on taking care of older adults with physical or cognitive disabilities who can no longer live independently. As the industry evolved in the 20th century, senior living developed more want-based and consumer-driven choices, such as independent living, active adult communities, assisted living and CCRC/life plan communities. These communities are in peaceful suburban settings, whereas the need-based products are in more urban areas or less desirable semi-urban or suburban areas. This approach unintentionally creates a separation between people by socioeconomic status and geography.
Projects like Opus represent an important shift the senior living industry needs to make. Besides cost savings from sharing amenities between the two buildings, the residents benefit from a more diverse community.
Nancy: You took a trip to the Netherlands to study their senior living models, which led to your white paper Missing Main Street and your podcast Shaping Dementia Environments. Tell us about how your trip shaped your current views on senior living and dementia care.
Max: In the summer of 2017, I received a travel fellowship from Perkins Eastman to visit the Netherlands with some colleagues and some of our senior living leadership. The impetus for that trip was especially around the much-discussed Hogewey Dementia Village. We agreed as a practice that we needed to go see it for ourselves so we can talk to our clients and have an intelligent, informed opinion.
That was the genesis for the trip, but we saw a lot of other things while we were there, too. Speaking specifically about dementia environments, the most interesting thing about Hogewey Dementia Village is the philosophy that they espoused that, instead of starting with the regulations and the constraints from governments, health departments, etc., let’s start with what is normal and then work creatively within the constraints to achieve that.
We saw a lot of important philosophy and visioning that we felt would be helpful for our clients back in the States, so a colleague and I wrote a white paper called Missing Main Street: Reconnecting Older Adults with Dementia to the Fabric of Authentic Living, which unpacks our observations and helps people understand how to apply them in a different country, funding context, geography, and culture. The white paper features eleven patterns of innovation for dementia specific environments and is available to download at perkinseastman.com.
The conversation around Missing Main Street gave us the ability to engage with our clients in a new way. We built on the original research with our own research, interviewing not only designers, but operators and policy-shapers who focus on dementia specific environments. This goes back to my first point about the Perkins Eastman “way” — testing research and innovation against realities.
These conversations morphed into our podcast Shaping Dementia Environments. Each episode addresses a single pattern of innovation and features one operator, one policy-shaper, and one designer.
Nancy: What are some of the biggest myths that senior living professionals have about dementia environments?
Max: The biggest one is that the primary job of the physical environment of a dementia community is to protect the residents from themselves and from other people. Obviously, safety and security are extremely important for this population because there can be some real challenges. The conversation is about experience and aesthetics whenever we have conversations about independent living but turns to safety and security immediately when it comes to memory care.
We heard in all the conversations we had on the podcast from organizations that physical environment obviously plays a role in safety and security for people living with dementia, but more important are the relationships between the caregivers or the team members and the residents. The strength of those relationships is more effective than locking the door to the courtyard.
The other side of that myth is that the primary role of the physical environment is to protect other people from the dementia residents by separating them. We're locking them away when some do much better cognitively in group settings where they can socialize with people who don't have dementia.
We are working hard to dispel those myths, and more work needs to be done. We need to develop a more nuanced understanding of safety and security and how the built environment can achieve that while still connecting people together socially, regardless of cognitive ability.
Nancy: What gets you most excited these days, Max?
Max: Given the demographic shift of the aging baby boomers, new disruptors are entering the senior living space. I'm extremely excited to see how this new spotlight on senior living shakes out in the coming years and how that changes the pace and the level of innovation in the industry.
The thing that gets me the most excited is also the thing that gets me the most scared, which is that our little industry that existed in this little bubble with limited resources now has a “shot in the arm” with venture capital firms and large corporations like Amazon and Google coming in with resources because of the increased demand. On one hand, it’s been extremely exciting, but I wonder how a small, rural not-for-profit senior living community can share the table with those kinds of big players. It’s a fascinating question and certainly not one I have an answer to sitting here today.
Nancy: Can you share something personal about yourself?
Max: The thing I missed most during times of quarantine was live theater. There is something magical to me about physically gathering a crowd of humans together to share an emotional experience like that. It also turned out to be something that is impossible to truly replicate in a digital format, which I think makes it even more valuable in our lives that are flooded with the virtual. I am looking forward to having these kinds of experiences again in 2022!