Table 1.

Proposed Design Solutions for Nursing Home Design at Various Spatial Scales

Spatial Scale	Design-Related Problems	Potential Design Solutions
MACRO (overall urban setting)
Proximity to home community	Isolation and undermining sense of self, connectedness, and resilience.	Strategic location and integration of nursing homes within existing communities.
Integration with health or social care	Disconnection from community health organizations and emergency services.	Strategic planning to integrate nursing homes with existing community services.
MESO (neighborhoods and districts)
Overall neighborhood factors, public realm	Disconnection from, or location within poor-quality neighborhood or public realm.	Age-attuned urbanism that creates walkable, safe, accessible, and attractive neighbors as the nursing home context.
Air quality	Poor community or neighborhood air quality.	Local policies to reduced traffic emissions, or improve air quality, the presence/planting of urban trees.
MICRO (site/building design)
Care model and overall building configuration	Large institutional settings that undermine quality of life and increase potential ingress of virus.	Small-scale homelike models that enhance well-being and reduce potential ingress of virus.
Access and internal circulation	Large settings with high-traffic levels, singular entrances/exits with high usage and contamination risk, lack of signage or information, lack of social distancing space in corridors.	Smaller settings with dedicated resident/visitor and staff access, contact free doors, generous circulation space and controlled traffic flow.
Key resident spaces	Shared rooms and bathrooms, poor-quality rooms, and lack of direct access to outside, infection-related restricted access to shared spaces and isolation.	High-quality single rooms with outdoor spaces, carefully managed shared spaces, provision for transitional spaces, safe walking areas, and access and views to outside.
Staff space	Consolidated spaces currently provided (ie, central locker room, centralized care stations).	Decentralized care stations, ability to subdivide staff spaces and provision for respite areas to support mental health.
Outdoor areas and spaces to exercise	Lack of access to outdoors and nature, and lack of outdoor exercise areas.	Provision of safe, secure, and easily observed/monitored outdoor space within easy access for all residents.
Air quality/ventilation	Poor ventilation and air quality.	Provision of high-quality natural and mechanical ventilation as required, carefully designed/maintained HVAC.