Designing for Safe Connection During COVID-19 - Senior Housing and Beyond with Patricia Gruits.
How can we be socially connected and still be safe during this pandemic? What is the role of the design of the physical spaces around us? What strategies could work for both you, and perhaps your loved ones living in senior housing?
In Episode 9 of the Shared Space podcast, I sit down with Patricia Gruits of MASS Design Group to explore synergies between designing for COVID-19 and designing for social connection with a special focus on senior living. Patricia shares findings from her recent report “Designing Senior Housing for Safe Interaction The Role of Architecture in Fighting COVID-19”. Understanding the toxic health effects of loneliness, her team identified ways to help people safety connect. We explore how to design for joy, hope, and connection rather than fear. Not ignoring the dangers, but rather finding the synergies in these.
Patricia is a Senior Principal & Managing Director with MASS Design Group, a leading not-for-profit design firm, where she leads both design and research projects in health, education, and equity. Her work has been featured in journals of architecture and design as well as on the BBC World News and the Discovery Channel. She has lectured and taught design across the nation. Patricia has a Bachelor of Science and Master’s in Architecture from the University of Michigan, a program that is well known for their integration of purpose driven design and research that continues to inform her approach today.
Transcript from our interview has been edited for clarity and brevity.
Erin: Patricia, can you share a few words about your background, how it informed who you are, and the work you do at MASS design?
Patricia: I was born and raised outside of Detroit. I was always interested in social justice issues. Actually, my grandparents started a non-profit medical center in Haiti back in the 60s and 70s. I always had that as my north star as I thought about my career. I was not originally sure that architecture was what I wanted to do, but I was fortunate at the University of Michigan to find this intersection of architecture and social justice. I was in school in the early 2000s when social impact design was not really a term yet. This was something that was nurtured at Michigan. I was introduced to the work and studio of Sheila Kennedy, who had a firm out in Boston called Kennedy & Violich Architecture. Together we created this project called Portable Light Project. It was a sustainable source of power and light that was embedded into the fabric. And we went to work in Mexico and Brazil to work with Indigenous Communities. This gave me a great experience of how design can be applied to the real world.
I came to MASS Design in 2013 looking for ways to learn from others. MASS was looking at co-creation and changing the way we build. I worked on many different projects from the design of the Maternity Waiting Village in Malawi, to design for affordable housing and leading the development of tools to measure the impact of design and infrastructure investments. MASS was founded in Rwanda in response to an epidemic disease. Health and infection control has always been relevant in our work but is especially relevant now as we look to help apply these lessons across countries and space types in response to COVID-19.
“I was always interested in social justice issues. Actually, my grandparents started a non-profit medical center in Haiti back in the 60s and 70s. I always had that as my north star as I thought about my career.”
Erin: What made you all decided to take on senior housing during this pandemic?
Patricia: We have focused for the last few years here in Boston on affordable senior housing. Which is a really difficult typology, balancing the needs for autonomy, control, and flexibility while creating specialized spaces for seniors needs. When COVID hit, we were already working with some great partners in this space. We just started to bring people together – developers, housing operators, funders, architects all at the same table to inform design decisions and create the principles and strategies you see in the report. This is one of my favorite things about working at MASS, we are able to bring experts across disciplines together to create consensus around ideas.
The unique issue about seniors, not only is that they are at higher risk than others, but that the “solution” was to just isolate – which is toxic for seniors. There is a way to design like this, to design for fear. But we felt like we needed to be designing for joy, and for hope, and designing for community and interaction. These conversations were full of what ifs of danger but also the question of how to bring life back into these spaces.
“MASS was founded in Rwanda in response to an epidemic disease, which has always felt very relevant but is especially relevant now as we look to help apply these lessons across countries and space types.”
Erin: Can you walk us through the principles for creating safe space for interaction, and how you all came up with these specific principles?
Patricia: We felt strongly that there are no one-size fits all for housing types or for residents. So, as we created these guidelines, we tried to define generically, the public space, which is the highest risk, then semi-public including shared spaces that are within the ownership of the residents, and the semi-private like a corridor or porch shared with neighbors, and then private where typically your risk is lowest and you have the most control. But for each individual and living situation, there is a slider bar of what is considered public and private. For instance, for a grandmother living with her daughter and granddaughter, even the door to their home would not be considered a private zone. Whereas someone else may have a good connection with neighbors that are a part of their pod, and their connection may extend into their lawn. This means that for each person and living situation, there are different thresholds for what, in healthcare we consider ‘dirty’ or potentially contaminated vs. ‘clean’.
We tried to apply this same thinking to the affordable housing space to help people understand best practices overall – including helping spaces breathe better. We are all beginning to recognize that COVID-19 can be transmitted through the air, and it is important to make sure that there are appropriate and proper quantities of fresh air delivered to residents. We should be evaluating our HVAC and creating well ventilated spaces throughout the building.
“There is a way to design like this, to design for fear. But we felt like we needed to be designing for joy, and for hope, and designing for community and interaction.”
Erin: As we think about synergies between COVID-19 prevention and the need for more sustainable design for climate change, what are your thoughts on how we may need to address not only how we design but also how we behave, dress, and expect comfort in our buildings?
Patricia: At MASS, in March, in our office in Boston we had building issues, and our solution was to open the windows and work in the cold fresh air wearing sweaters. And it is funny, because we were getting great airflow and that could have helped us throughout the whole spring. I hope this is what we see in the future. This is especially important in things like schools and hospitals where we seal them off and rely almost entirely on our HVAC systems. I hope that there will be more operability or more opportunities to bring in fresh air.
Passive House is a great example of this. It prioritizes insulating the building, but also brings in large amounts of fresh air. It is something we are looking at for a number of our projects. It is not a passive ventilation system, it is actually the opposite, but it does require a large amount of fresh air and could be a model to look at as we think about how to build for the future.
“This means that for each person and living situation, there are different thresholds for what, in healthcare we consider ‘dirty’ or potentially contaminated vs. ‘clean’.”
Erin: Your team’s report on housing design for safe interaction talks a lot about thresholds, can you say more about what they are and why they are important?
Patricia: Thresholds are moments where the environment shifts. It can be a door, an entry, a portico, but oftentimes with infection control, the thresholds between what is dirty and what is clear are not always clear. One of the things we point to in the guide is the idea of spatial literacy, keying people in through wayfinding, design and visual cues that their space and potential risk is somehow changing and to change behavior. Some of this can be the sequencing of behavior and the rhythm of our days. A lot of the fundamentals of infection control do actually align when you start to create meaningful community spaces. They are not necessarily at odds as you’d expect them to be.
Some of this learning comes from our work at the Maternity Waiting Village in Malawi, which is essentially a dormitory for expectant mothers near the hospital. Originally, the program was for one large open room, which in a lot of ways didn’t make sense for social dynamics. We did social network studies and decided to create smaller clusters or pods of 4 rooms each to allow enough people so that you could always have support and also some options in social dynamics.
When we think about designing for senior housing, it is about designing for community, and when you look at a lot of senior housing you see upwards of 150-200 people in one location, and that does not fit the scale in which we connect. If you look at Dunbar’s Number, it shows that 150 is the most people you can meaningfully have a relationship with, so we look at ways to break down the scale. That is one of the things that we wanted to emphasize in the guide, is the concept of villages. This is the happy medium between complete exposure and complete isolation. I think a lot of people are now calling these pods. This is allowing people to come together but also stay safe – there are synergies between comfortable group sizes and infection control principles.
“A lot of the fundamentals of infection control do actually align with when you start to create meaningful community spaces. They are not necessarily at odds as you’d expect them to be.”
Erin: Can you talk a bit more about The Green House Project model that you mention in your report?
Patricia: Green House is an assisted living model, which is not what our report is about, but there are some lessons there that can be applied more widely. For years, advocates have been saying ‘how can we design assisted living not to be so institutional’. This model is where each resident has their own bedroom and bathroom but access to a shared kitchen and communal space, usually around 8-10 residents. Also, as it relates to COVID, the model of staffing has some lessons for how we think about housing. If you’ve heard of the co-housing trend, that is big in San Francisco and other areas. They have common shared programs, like a shared kitchen and communal space, and you really only have ownership over your bedroom and a smaller space. There are a lot of interesting precedents out there. The ability to innovate or modify is really challenged by our funding. I hope that part of what this guide is advocating for is a re-examination of what is considered adequate and what is considered luxury.
“The ability to innovate or modify is really challenged by our funding. I hope that part of what this guide is advocating for is a re-examination of what is considered adequate and what is considered luxury.”
Erin: Is there anything that you wish more people would consider about design?
Patricia: That would probably be the consideration around trauma informed design. A lot of people misunderstand when we use this term, but essentially something like 61% of us have experienced some type of trauma from more adverse like abuse and neglect to things like divorce or economic hardship. When you think of the collective experience right now, where people are going through undue hardship, job loss, shifts in schooling. This is going to become this universal experience and I think then the design needs to shift and acknowledge not just our physical health but our mental health.
You and I fundamentally agree that space shapes behavior. Space can shape how you feel. It can do so in a positive way or it can do so in a negative way. At MASS we talk about spaces that hurt and spaces that heal. As we go forward, I hope more of these lessons around evidence-based design and design for health will continue. I hope we will not just stop at infectious disease but looking more broadly around design for health to create more beautiful and dignified spaces.
“I hope we will not just stop at infectious disease but looking more broadly around design for health to create more beautiful, dignified spaces and more healthy spaces.”
To learn more about Patricia & The work at MASS Design:
Portable Light Project: The Portable Light Project enables people in the developing world to create and own energy harvesting textiles, providing the benefits of renewable power as an integral part of everyday life.
Link to Full Report on MASS Design.
Credits for the Team that worked on the Designing Senior Housing for Safe Interaction Guide: MASS Design team members, Patricia Gruits, Katie Swenson, Annie Wang, and Regina Yang -- who led the development of the senior living COVID-19 guide. This guide and its design principles were developed through research and focused conversations with leaders in affordable housing development, operation, and design. We are grateful to Jennifer Molinsky of the Joint Center for Housing Studies; Emi Kiyota, founder of IBASHO, for their partnership and to Alma Balonon-Rosen, Massachusetts Housing Partnership; Susan Gittelman, B’nai B’rith; Carrie Niemy, Enterprise Community Partners; Jane Rohde, JSR Associates; and Enterprise Rose Fellows Peter Aeschbacher, Sam Beall, Nick Guertin, Yuko Okabe, Kelsey Oesmann, and Jason Wheeler for their experience, consultation and review.
Designing Senior Housing for Safe Interaction: Links from topics and projects mentioned during our interview:
Green House Project: A different way to design for aging at scale
Research on how Green House project homes have fared through COVID-19. Spoiler alert - Green House Project residents have fared much better than other types of skilled nursing.