1.

Introduction

Worldwide, the total number of elderly people is growing more rapidly compared to other age
groups [1]. Consequently, the share of older persons is increasing almost everywhere. In 2015, one
out of eight people worldwide was aged 60 years or over. By 2030, one out of six people will be in
this age group globally. Furthermore, elderly people will outnumber children aged 0–9 years by 2030.
By 2050, they may outnumber adolescents and youths aged 10–24 years. The aging process is more
advanced in high-income countries. Japan has the most-aged population by far. In 2015, 33% of the
population was aged 60 years or over. Regarding elderly population, Japan is followed closely by
Germany (28%), Italy (28%), and Finland (27%). Therefore, the pace at which the world population is
aging is increasing over time. By 2030, older persons are anticipated to account for substantially
more than 25% of the populations in Europe and Northern America, 20% in Oceania, 17% in Asia,
and 6% in Africa. As shown in Figure 1, the elderly population (aged 60 years or more) will increase
faster as a percentage of the total population than the population of ages 15–59 years. If the trend
continues, there will not be enough people to take care of the elderly in the distant future. Hence,
assisted living technologies will be needed in the future to take care of elderly people and help them
to live independently.

Understanding Different Types of Senior Living Options

Understanding the diverse senior living options available is key to designing a project that meets the
unique needs of each type of senior housing facility. These options include:

 Independent Living

 Assisted Living

 Memory Care

 Skilled Nursing

 Continuing Care Retirement Communities (CCRCs)

Each option serves a distinct purpose and requires specific design construction considerations to
ensure the well-being and satisfaction of its residents.

Independent Living

Independent living communities provide a comfortable and social environment for seniors who can
live autonomously in the long term.

These facilities are dedicated to creating a pleasant atmosphere where seniors can enjoy their golden
years without the burden of daily chores or home maintenance.

Aging in place is a key consideration in independent living design, allowing seniors to remain within
their community as their needs change over time.

When designing this type of senior housing, the architect must incorporate into the design phase
such considerations as space utilization, accessibility, building materials, natural light, and other
factors that can significantly enhance residents’ emotional and mental well-being.

Furthermore, designing spaces that foster social interaction and provide opportunities for
engagement with neighbors, friends, and family can help promote a sense of community and
belonging.
Assisted Living

Assisted living facilities, providing a comfortable environment, cater to seniors who require
assistance with daily activities and personal care. These senior housing units, also known as assisted
living facilities, often feature a range of services and amenities, including:

 Housekeeping

 Dining

 Transportation

 Wellness Programs

These services ensure residents receive the support they need while maintaining a sense of
independence.

Memory Care

Memory care facilities cater to seniors with Alzheimer’s or dementia, requiring specialized design
elements to support cognitive function.

These facilities often feature secure outdoor spaces, color-coded signage, and dementia-friendly
furniture to create a safe and supportive environment that promotes a sense of familiarity and
routine for residents.

The architect of such a project must consider not only the physical needs of the residents but also
their mental and emotional needs.

Skilled Care

For seniors recovering from health events like surgery or illness, skilled care facilities, also known as
nursing homes, offer short-term care.

Nursing homes can be standalone or part of existing facilities that offer multiple levels of care.
Among the services often provided are:

 24-Hour Care

 Physical Therapy

 Occupational Therapy

 Speech-Language Pathology

 Wound Care

These senior care services ensure the residents’ quality of life.

CCRCs

Continuing Care Retirement Communities (CCRCs) offer a multi-level environment that allows seniors
to seamlessly transition between different levels of care as their needs evolve over the long term.
These facilities often provide a range of amenities, such as:

 On-Site Dining

 Fitness Centers
  Recreational Activities

 Transportation Services

These amenities ensure that residents can maintain a high quality of life and an active community
environment as their care requirements change.

Fall Prevention

Implementing fall prevention strategies in senior living facilities can significantly mitigate accident
risks. Some key measures include:

 Installing non-slip, even flooring

 Installing handrails in hallways and staircases to help prevent falls

 Ensuring adequate lighting throughout the facility

 Eliminating tripping hazards, such as loose rugs or cluttered walkways

These measures are crucial in creating a safe environment for seniors, as seniors tend to be more
susceptible to falls and their associated health complications. Keep in mind that ensuring their safety
is of utmost importance.

Mobility Enhancements

Implementing mobility enhancements like ramps, elevators, and stairlifts enhances accessibility for
seniors with mobility limitations.

Incorporating these solutions into senior housing projects allows designers and builders to create
environments that cater to the needs of all residents, regardless of their physical limitations.

Technology Integration

The integration of technology is pivotal in augmenting safety and accessibility for those living in a
senior living community. Smart home features, such as automated lighting, temperature control, and
voice-activated appliances, can improve convenience and independence for seniors.

Additionally, emergency call systems provide residents with a quick and easy way to contact staff in
case of an emergency, offering a sense of security and protection.

Energy Efficiency

Incorporating energy-efficient features into senior living projects can have several benefits, including:

 Reduced operational costs

 Positive environmental impact

 Lower energy bills

 Cost savings

 Minimized emissions of greenhouse gasses and other pollutants

Biophilic Design
The inclusion of natural elements like plants and natural light in biophilic design enhances residents’
well-being and fosters a more appealing atmosphere.

Connecting residents with nature through biophilic design can lead to reduced stress levels,
improved mental health, and a more tranquil and comforting living space.

Infection Control Measures

Implementing infection control measures like improved ventilation and easy-to-clean surfaces aids in
protecting residents from potential future outbreaks.

By enhancing air circulation and integrating materials that inhibit the growth and transmission of
germs and bacteria, designers and builders can develop secure environments for elderly individuals
who might be at a higher risk of contracting illnesses.

Between the years 2015 and 2030, the global population aged 60 years or over is predicted to grow
from 901 million to 1.4 billion [1]. By 2050, it is predicted to have more than doubled in size relative
to 2015, to nearly 2.1 billion. The number of people in the world who are aged 80 years or over is
growing even faster. Projections indicate that in 2050, the number of people who are aged 80 years
or over will be 434 million. This is more than triple the number in 2015, when there were 125 million
people aged 80 years or over. Figure 2 shows the projected world population range between 2000
and 2050 for the people aged 60 years or over. Similarly, Figure 3 shows the projected world
population range between the years 2000 and 2050 for people aged 80 years or over. A major
challenge in handling an aging population is the effective delivery of healthcare services. Also,
personal care of elderly people is a matter of great concern for their relatives, especially when they
stay alone in the home and unforeseen circumstances may occur that affect their well-being. Hence,
solutions are required to manage the complex care demands and to satisfy the necessities of elderly
people for prolonged living in their own homes. Elderly people also have great risk of falling [2]. One
of the major problems in handling this complex care is that resources are becoming scarcer day by
day [3,4]. Through recent advances in sensor and communication technologies, monitoring
technologies have become an important solution for achieving a robust healthcare system that can
help elderly people live independently for a longer time [5,6].
2. Ambient Sensors in Elderly Care

The concept of sensing arises in the smart home, in which various types of sensors/devices are
integrated into everyday objects. Infrastructure in the smart home is connected by network
technologies for gathering contextual information such as vital signs and behavioral information of
the elderly via the sensors. The most common approaches for elderly monitoring in smart homes are
based on machine vision. However, other sensors (e.g., motion, radar, object pressure, and floor
vibration sensors) are also used for elderly health and behavior monitoring. In this section, we will
summarize the works that apply these sensors to monitor elderly behavior or health status in recent
research.

2.1. Passive Infrared (PIR) Motion Sensors

Many research works have applied passive infrared (PIR) motion sensors to detect the movements of
individuals. PIR motion sensors are installed on walls or ceilings of the homes of elderly people to
continuously collect motion data that are related to predefined activities in the scope of the sensors.
PIR motion sensors are usually heat-sensitive. The sensors detect the presence of users in rooms by
utilizing the changes in temperature. PIR motion sensors are used in different places to detect
different types of events, such as stove use, room temperature, use of water, and opening of
cabinets. Motion data are collected and transmitted to the caregivers of a user through a base
station. Then, the collected data are interpreted for analysis of trends to detect changes in daily
activities. They can also be analyzed to identify potential changes in health status. Thus, PIR sensors
can be used to recognize patterns in daily activities and generate alerts if deviations occur. The
sensors can be adopted for various applications in smart homes, such as detecting the degree of
activity and detecting falls or other significant events. In most cases, monitoring technologies are
combined for more than one aim, such as detecting daily activities along with significant events.
Besides, PIR motion sensors can also be applied to analyze gait velocities, user location, time out of
the home, sleeping patterns, and activities at night. Table 2 lists research works that were conducted
based on PIR sensors [32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55].

2.2. Video Sensors

The most commonly used ambient sensors for eldercare are video sensors. Many research works
have been carried out in ambient assistive living using video cameras for various applications, such as
locating residents and recognizing their activities in their homes. Cameras are installed on the walls
or ceilings to detect activity through background subtraction, body shape extraction, feature analysis,
and machine learning. Among many applications, video monitoring technology has mostly been used
to detect activities of daily living and falls or other significant events. Table 3 lists several research
works that were conducted based on video cameras
[56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,
88,89,90,91,92,93,94,95,96,97,98].

2.3. Pressure Sensors

Pressure sensors are applied to detect the presence of residents on chairs or in bed. They can be
used to detect sit-to-stand transfers and stand-to-sit transfers. Three articles are reported in this
work that applied pressure sensors in smart homes [99,100,101]. Given that all three articles focused
on detecting transitions from sit-to-stand and from stand-to-sit, determining the transfer duration
was the main outcome. Determining the maximum force on grab bars was also discussed. Table
4 lists some works that were conducted based on pressure sensors [99,100,101].

2.4. Sound Sensors

For sound recognition, sensors such as microphones are utilized to detect different events such as
daily activities, e.g., the sound that is generated while handling dishes or during the falling of an
object or person. In the articles that are listed in Table 5, the detection of activities of daily living,
along with significant events such as falls, was the main target of the monitoring
[102,103,104,105,106,107,108,109].

2.5. Floor Sensors

Sensing of floors plays an important role in the development of sensing environments with low
invasiveness. Floor sensors can make the sensing layer invisible to the user, as the floor appears to be
a traditional floor. They can be applied in various practical areas, including private and public
environments. For instance, smart buildings can use floor sensors to detect the presence of people to
automatically control the switches of the lighting and heating systems. In smart eldercare systems,
floor sensors can be used to detect emergency situations such as falls. They can also be adopted for
counting people and monitoring crowd movements during public events. Articles that explain various
applications that use only floor sensors are listed in Table 6 [110,111,112].

2.6. Radar Sensors

Among different ambient sensors, the Doppler radar is attractive because it can detect and measure
any movement in the presence of stationary clutter in the background. It achieves better perception
of elderly people compared to vision-based sensors since it can penetrate strong obstacles such as
furniture items and walls. Furthermore, it does not raise privacy issues for in-home monitoring and
avoids the inconvenience of wearable devices [96]. In addition, Doppler radar can be used for the
detection of human cardiopulmonary motion, which could provide a promising approach to
overcoming the problems of false triggers. Articles that analyzed various applications of radar
sensors are reported in Table 7 [113,114,115,116,117].

2.7. Combined Ambient Sensors

Some works combined more than one monitoring technology, such as accelerometers combined
with video cameras and PIR sensors. Combinations of the multiple types of sensor technologies were
very frequent and diverse in nature. The most popular combination was PIR motion sensors and
video cameras. The next most frequent was a combination of pressure and PIR sensors. Using
different types of ambient sensors together, improvements in quality of life were achieved within
different target groups, such as residents and caregivers. The use of multicomponent ambient sensor
technologies increased the sense of safety, which helped to postpone the institutionalization.
Although an increase in quality of life was observed for the residents and caregivers, the growth was
not substantial. However, a significant growth was noticed in the hours of informal care. Table 8 lists
research works that were conducted by combining different ambient sensors
[118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133].

2.8. Combined Ambient and Wearable Sensors

There have been many research works on elderly healthcare that are based on wearable sensors, as
wearable sensors can provide more accurate information on elderly health status (e.g., heartbeat,
respiration, muscle movements, and blood flow). For prolonged independent living, elderly people
may not be inclined to use body-worn sensors. Hence, we focus on mostly ambient-sensor-based
works in this survey. However, some research works that utilized both wearable and ambient sensors
have been reported here, as shown in Table 9 [134,135,136,137,138,139,140,141,142,143,144].

2.9. Ambient Sensors in Mobile Robotic Systems

Ever since the first robot was created, researchers have been trying to integrate robots into our daily
lives. Domestic assistance has been a driving goal in the mobile robotics area, where robots are
expected to assist in daily environments. Mobile robots can be very useful for helping elderly people
live independent lives. For instance, Figure 6 shows a sample schematic setup of a smart room for
behavior monitoring of an elderly person based on different ambient sensors and a mobile robot.
Many mobile robots have been developed over decades by academics and research groups. The
results and insights that are obtained through the conducted experiments will undoubtedly shape
the care robots of tomorrow. Among all the mobile robots for elder care, several notable robots are
briefly described in Table 10 [145,146,147,148,149,150,151,152,153,154,155].
While recently visiting with an older couple I know, I was surprised when the husband, not a day
younger than 75, pulled out a smartphone and asked Siri to look something up for him. After Siri
answered in her soothing tones and he pocketed his phone, I asked him how long he’d had it.

“Oh, a few years now. I use it mostly for Facebook to see how my grandkids are doing.”

“I like the word puzzle apps,” said his wife, holding up her own shiny black iPhone X. “And that bird
game.”

They are not the only older couple to catch on to modern technology. In fact, an article by Pew
Research Center shows that 67% of adults over 65 have internet in their homes, and four in ten own
smartphones. And as these tech-savvy seniors age and begin to move into assisted living homes,
technology will be an increasingly important aspect of assisted living. This article covers ten
technologies that are likely to be a big part of assisted living in the coming years, as well as a few that
can be used right now.

Internet Access
As more and more seniors are tech savvy and accustomed to accessing the internet, building-wide
wifi is essential for a senior living home. More importantly, available internet access opens up the
possibilities of many other technologies, such as resident health monitoring, entertainment, or video
chats.

Video Chats (Free with Skype and internet access).

There are so many possibilities that video chats open up for senior living. First, Skype enables
residents to remain involved in the lives of their children and grandchildren. Even though my
Grandmother lives in an assisted living home in another state, she was able to virtually attend our
Christmas party this year via Skype (with the help of a nurse who made the call and helped my not-
so-techy Grandmother use it). Skype can also be used by doctors to remotely assist patients without
the need for as many visits.

Physical Rehabilitation and Fitness

Technology offers a plethora of tools for senior fitness. For example, YouTube channel ElderGym
Senior Fitness provides workouts that can be used for group workout sessions. You can also use
Wearables, mentioned below, to track a resident’s activity and physical health.

Motion Sensors

Motion sensors are increasingly used in senior living homes for a reason. These nonintrusive systems
can be used to monitor a resident’s physical activity and improve safety. For instance, a motion
sensor on a bed can alert assisted living staff if a resident falls out of bed in the middle of the night.
Or if a sensor shows that a resident has been stationary for a long time, a nurse might be alerted to
check in.

Digital Medication Dispensers

For residents who are on medication, digital dispensers can release the correct amount at the right
time to prevent overdosing or under-dosing. They can also produce voice alerts after dispensing
medication to remind residents to take it.

Digital Content Designed for Seniors

There are lots of great digital tools available to keep residents engaged and entertained. For example,
podcasts can provide entertainment for those with fading vision. Netflix offers a wide selection of
movies and TV. For the less techy senior who still wants to be connected with family, Tapestry is a
free, more user-friendly version of Facebook and Instagram that is specifically designed for seniors.
Puzzle apps such as Wordbrain (free) can keep residents’ brains active and engaged. And for the
resident who just likes to read, EyeReader by NetSoft is an app that uses a phone’s camera to turn
your phone into a magnifying glass.

Wearables

These are bracelets with radio-frequency chips installed that track a resident’s health, heart rate,
sleep patterns, and physical activity. Wearables can also sync with staff devices so that a staff-person
can evaluate a patient’s activity and health at a glance or receive alerts if there is a problem.

Applications for Staff & Volunteers

Additionally, technology can help make life easier for staff and volunteers in assisted living homes.
There are lots of helpful mobile apps available for caregivers to use. Here’s a list of the 12 best
ones that help monitor resident health or answer questions about senior care.

https://mashable.com/article/apps-for-caregiving-caregivers#tic1dYwlMsqr

Information Security Technology

With the introduction of technology into the senior living environment comes concerns about
information privacy. Increased data protection technology can be used to combat this. Security
systems like data firewalls, endpoint solution systems, and email spam filters can help protect
residents safety.

Smart Home Technology

Though smart home technology is still a relatively new thing even for millennials and young baby
boomers, trends show that it is an up-and-coming tool in senior living. Voice-activated smart
technology like Amazon’s “Hey Alexa” can give senior residents a much-needed sense of control.
From switching the lights off with just a few words or being able to change the television volume or
channel just by speaking, a resident can maintain independence just by using his or her voice.

Activity sensors

Strategically placed motion sensors are a simple yet effective way to monitor a resident’s
daily movements without infringing on privacy. Motion sensors by the bed, in the hallway, by
the refrigerator and at the bathroom door can send alerts to a central monitoring hub
whenever they are tripped. With the right software, operators can receive notifications when
a certain sensor hasn’t been tripped by a certain time. For example, if the motion sensor by
the bed hasn’t activated by 7 a.m. or the door to the bathroom hasn’t opened for three
hours, it can send an alert that the resident has not gotten out of bed yet and that someone
should check in.

Sensors also can track whether a refrigerator has been opened and whether a medicine
cabinet has been accessed, allowing remote monitoring of a resident’s food, water and
medication intake. All these data from a dwelling can be aggregated and fed through
algorithms to help predict and, ultimately, prevent potential threats to health and safety.

Health sensors

Sensors placed in a bed can track respirations, heart rate and the number of times someone
gets out of bed during the night. These efforts can help detect health issues prior to their
becoming problems — for example, potentially identifying a urinary tract infection from an
increase in the number of trips to the bathroom before the resident experiences pain and
discomfort. One facility in Missouri found that sensor-enabled monitoring nearly doubled its
residents’ length of stay in independent living.

Digital medication dispensers

Confusion and concern about taking medication at the right time is a key reason some older
adults need constant assistance. Operators of independent and assisted living communities
can help residents deal with this tricky activity of daily living by using digital medication
 dispensers that lock compartments until the correct time, speak alerts to remind the user to
take the medication and can be monitored, controlled and programmed remotely.

Motion-activated lights

Installing lighting triggered by motion increases the safety and comfort of a resident, who no
longer needs to fiddle with small lamp switches or walk into a darkened room. This lowers
the risk for potential falls as well.

Smart door locks

Smart door locks that open automatically when an authorized user approaches carrying a
smartphone or key fob allow residents to retain independence without worrying about using
small metal keys. They also help operators retain and control access to units more easily.
There’s no need to switch out locks. New “e-keys” can be easily programmed and old keys
revoked, enhancing the security of the building.

Voice activated speakers

One of the challenges of some of these more interactive smart home devices is that an app
on a computer or tablet or smartphone was required to control many of them. With the
advent of voice-activated speakers, however, residents now easily can speak commands to
one of these devices and ask to “turn on the lights,” “raise the temperature” or “turn off the
television.”

Additionally, a voice-activated speaker such as the Amazon Echo or Google Assistant can be
used as a communication tool so residents can speak with loved ones and facility managers
more easily. The inclusion of a separate screen even can enable video calling. Voice assistants
offer all the convenience of a smartphone without the complications of typing on a small
screen or confusion of downloading apps. Everything is controlled simply via voice.

Voice-activated video calling also is an important tool for medical consultations and
emergency situations. The speakers have powerful range and can hear a wake word from a
distance, so if a person has fallen or is unwell but still can speak, he or she can use the smart
speaker to call for help.

Smart technologies are changing the way we live our lives. Data collected from
connected devices are providing new insights into our needs, health and habits and
ultimately are showing us better ways to live. Independent living and assisted living
communities can benefit greatly from these advancements and ultimately use
technology to offer a better way of life to its residents.

Combination of Different Sensor Data is Necessary to Acquire Clinically Useful Information for ADL
Profiles

Sensor data are best collected combining data from fixed installed ambient motion sensors with
wearable devices. The wearable device collects motion/activity data from 3D accelerometers and
physiological data. Examples of such devices are the Biovotion monitor (http://www.biovotion.com),
the HealthPatch MD, the Preventice BodyGuardian, the Jamar Plus+ dynamometer, the Apple watch
or the Fitbit Charge HR or Fitbit-Flex. The sensor data consist of the following variables:

• Actimetry (acceleration of the participant wrist);

• Temperature;
• Light intensity (no visual information);

• Near-field indoor location (only near/far inference possible);

• GPS location when outdoor;

• Physiological measures based on wrist-worn optical and wearable patchsensors, as well as muscle
force based on a digital dynamometer; and

• Skin conductivity (also wrist-worn).

Selection of Sensors have to be Adapted to Specific Needs of Elderly People

Procedures to combine a monitoring system using wearable sensors with an existing ambient sensor
system include the selection of sensors and platforms, the preparation of informatics/big data
analysis, the selection of study subjects according to specific inclusion and exclusion criteria, the
predefinition of vital signs interpretation and alerts, and the preparation of the evaluation process
including measurements and questionnaires.

Specific requirements for practical use of wearable sensors are the following:

• Different adhesives to ascertain adhesion without skin irritation (sensitive, normal, and strong) if
close contact to the body surface is necessary;

• Easy to apply and to change;

• Good battery capacity to avoid frequent battery change/charging on site;

• Good data quality (signal to noise ratio);

• Reliable data; and

• Adequate platform for data collection.

Potential extensions of a wearable sensor system include data accessibility from the web (tablet and
smartphone), web-based communication, e-learning/training, text messaging, artificial intelligence,
and additional opportunities for interventions (physical or psychological) (Bhavnani et al.,
2016; Rumsfeld et al., 2016).
The selection of the sensor parameters depends on their utility to provide either preventive or
emergency information. The most important parameters for monitoring elderly people long term are
summarized in Table 1.

The growth of the market is possible thanks to the development of software products in tandem with
advanced devices, including wearables, aimed at solving many tasks. Here are some of the most
widely applied devices for IoT elder care:

 Smart home devices (smart blinds, fridges, lighting, thermostats, etc.)

 Medical connected devices (glucose meters, blood pressure monitors, pill dispensers,
oximeters)

 Wearables (smartwatch or bracelets)

 Smart speakers

 Cameras (with microphones and without)

 Sensors (motion sensors, biometric sensors, etc.)

IoT as an Advanced Emergency Call System

Implementing personalized IoT-enabled devices that are integrated with a real-time location system
allows senior living communities to benefit from the offerings of these smart technologies fully. RTLS
provides an effective method for automating the collection of location-based data. Automated data
collection reduces human error and frees up staff to spend time on more valuable and complex tasks,
such as patient care. Analytics related to resident trends and routines also enable communities to
improve care and outcomes.

The lightweight, waterproof IoT wearables pair to the community’s RTLS, making resident monitoring
convenient and efficient for caregivers. These devices are commonly worn as pendants, belt clips, or
watches. They are digitally assigned to residents and staff to provide definitive location information –
both indoors and outdoors – creating an advanced emergency call system. RTLS sensors and beacons,
leveraging a unique combination of technologies such as Second Generation Infrared (Gen2IR), Wi-Fi,
Low-Frequency RF, UHF Active RFID, and Bluetooth Low Energy (BLE), can be placed in strategic
locations throughout the community, including buildings, floors, common areas, rooms, and even
outdoor campus grounds. Facilities can also use geofencing capabilities to create outdoor or
additional indoor safe zones. Through sensors, beacons, cables, and IoT-enabled wearables, staff
members can quickly and accurately locate residents.

The system allows for customizable alerts, including resident- or staff-initiated alerts from IoT-
enabled pendants and pulls cords, while also offering automated location alerts that indicate
roaming, wandering, loitering, or lack of activity. To decrease response time during an emergency,
the system displays and records the current locations of residents and staff in real-time. Staff receives
immediate notifications through connected mobile apps, SMS messaging, and e-mail.

A fully connected community is possible with IoT because the devices and sensors integrate to
monitor doors, windows, elevator controllers, and building systems such as smoke detectors. System
data can also be used to automate electronic medical record solutions. The various RTLS beacons and
sensors enable senior living communities to create total wireless coverage. The closed network
system grants users visibility and control over who accesses records, minimizing the opportunity for
data breaches.

Everyday Use Cases in Senior Living

Wander management remains a significant concern in senior care communities, especially those
focusing on mild to moderate cognitive impairment and memory loss. At times, residents can
become forgetful and wander into off-limit areas or exit the building, leading to dangerous situations.

Utilizing an RTLS with other IoT-enabled devices allows staff to quickly and easily locate residents in
real-time and respectfully redirect wandering residents before they travel too far from the security of
their residence. RTLS can integrate with security and access controls to actively restrict zones within
a community. Sensors create indoor geofencing and set entrances to lock in unsanctioned areas
when certain at-risk residents approach monitored doors, elevators, or other egress points.
Previously unattainable, some systems even offer outdoor geofencing as a standard capability,
alerting staff when residents begin to wander near ponds or beyond safe community boundaries.

While real-time location insights can help redirect wander risks, the knowledge can also be crucial
information for residents under duress. The IoT-enabled wearables can come equipped with
emergency buttons that, when pushed, immediately notify nearby staff that a resident needs help or
is in a dangerous situation. Staff wearables can also act as emergency buttons to notify additional
staff or security when backup is required.

Benefits of IoT for Elderly Care

The integration of IoT for Elderly Care has revolutionized how elderly care services are provided,
enhancing the quality of life for seniors:
Continuous Health Monitoring

IoT devices track vital signs and send real-time data to caregivers, ensuring prompt medical
intervention.

Automated Daily Tasks

Smart elderly care solutions automate medication reminders and home automation, promoting
independence.

Cost Reduction

Efficient management of chronic diseases through IoT reduces healthcare costs.

Enhanced Safety

Real-time alerts from IoT devices improve elderly safety by quickly notifying caregivers of any issues.

Improved Quality of Care

Personalized care plans based on data from IoT devices ensure that seniors receive tailored
treatments.

Social Connectivity

IoT devices can help seniors stay connected with family and friends through easy-to-use
communication tools.

Facilitate independent living with IoT devices

With the help of smart home care solutions, seniors can continue living at home independently as
IoT devices give them the security of being monitored and enable them to quickly call for help in
cases of emergencies.

For instance, the wireless Motion Sensor, allows relatives or caregivers to track the status and exact
whereabouts of the senior. Moreover, a smart home care solution including the sensor is able to
immediately notify relatives or personnel via Zigbee communication, if the sensor finds something to
be out of the ordinary. Thanks to this monitoring, the senior can feel safe in their home, knowing
that they will get help in emergencies.

A wireless call button provides an easy way to independently call for help in case of emergencies.
Worn around the wrist or as a necklace, the Panic Button is always in reach when needed. Depending
on your solution, a call from the Panic Button can alert friends, family, or healthcare professionals.

You can also give a voice to your solution using the Smart Siren. With the siren’s voice prompt
function, you can record up to 50 voice messages to remind seniors of certain actions. For instance, it
can remind them to take medication at a given time.
https://www.knxtoday.com/2024/03/50247/assisted-living-knx-is-the-ideal-technology.html
Technical and performance Guidelines:

Smart home / assistive technology

Smart home technology is defined as:-

“A dwelling incorporating a communications network that connects the key electrical appliances and
services, and allows them to be remotely controlled, monitored or accessed.”
Department of Trade and Industry (DTI) : UK

Devices may be controlled automatically including door and window openers, HVAC and
environmental controls. Smart homes include the use of assistive technology.

Assistive technology is defined as:-

“Any product or service that maintains or improves the ability of individuals with disabilities or
impairments to communicate, learn and live independent, fulfilling and productive lives.”

British Assistive Technology Association (BATA)

Assistive technology is particularly useful to older people and ranges from the very simple (calendar
clocks or touch lamps) to high-tech solutions such as GPS safety-tracking to help find someone who
has gone missing.

Assistive technology sensors/devices can be described as active or passive. An active device requires
the direct action of the user to make it work, for example screen readers.

A passive device is one that operates without an action by the user for example a fall detector. The
majority of assistive technologies are passive.

Assistive technology can be further subdivided into memory devices (clocks, calendars, medication
aids etc.), telecare with safety devices (environmental, motion and tracking sensors) or telehealth
with health monitoring devices.

Telecare provides safety devices within the home environment. Telecare safety sensors continuously,
automatically and remotely monitor residents over time to manage the risks associated with living
alone. Sensors around the home are connected to the dwelling’s telecare hub. In general needs and
retirement housing the dwelling’s telecare hub is linked via a telephone line to a nominated person
or call centre. In extra care housing the telecare hub is connected to the onsite care staff.

Telecare, safety devices include the following:-

• Environmental sensors can detect flooding/gas; the system will then shut off the water/gas and
raise an alarm. Sensors can also detect if temperatures are too hot or too cold or rise very quickly;
the system will then send a warning signal.

• Motion sensors can monitor the lifestyle pattern of an occupant, such as bed occupancy detectors,
fall detectors, door detectors and movement detectors. If the sensors detect something out of the
ordinary the information is relayed to a carer or call centre.

• Tracking sensors are often used by people who have dementia. Tracking devices use satellite
technology to help trace someone who has gone missing.
59In addition to telecare, the introduction of telehealth may be considered suitable for some
residents. Telehealth can assist in the management of long-term health conditions, including chronic
obstructive pulmonary disease, chronic heart failure, diabetes and epilepsy. Telehealth can measure
blood pressure, blood glucose levels or weight. Patients undertake the tests themselves in the home
environment with the results automatically transmitted to a health professional for evaluation and
appropriate action.

Telecare and telehealth have obvious benefits for older people’s housing providing reassurance and
peace of mind to the residents and their relatives. They promote independent living and allow
people to remain living in their own homes for longer.

Security

The design and management of older people’s housing and its relationship with the public realm
contributes significantly to the safety and security of a development and can assist crime prevention
and minimise the fear of crime.

The security principles for older people’s housing incorporate the following:

• Main entrance to be clearly visible from the public realm.

• Access control, visual and audio, to all entrances linked to staff and residents’ dwellings.

• Location of the reception/manager’s office adjacent to main entrance to enable passive

surveillance of arrivals and departures.

• Clear definition of public, semi-private

and private space for dwellings.

• Progressive privacy allowing public entry to communal areas with secure ‘fob’ access to the
residential accommodation beyond. (See Section 7. General design principles.)

• Secure landscaped garden areas and courtyards which cannot be accessed from the public realm.

• Where buildings are set back from the

site boundary, the area is defined as private and enclosed by a wall, railings, fencing or planting.

• External lighting, providing a well-lit safe environment at night, to all communal spaces (including
car parking areas and main entrance).

• The main refuse store accessed directly from the public road.

Sustainable design

The Royal Borough of Kensington and Chelsea has established a Strategic Objective for respecting
environmental limits, with the aim to: “contribute to the mitigation of, and adaptation to, climate
change; significantly reduce carbon dioxide emissions; maintain low and further reduce car use;
carefully manage flood risk and waste; protect and attract biodiversity; improve air quality; and
reduce and control noise within the borough.”

Whilst housing in general is at risk from a series of environmental factors as highlighted by the Royal
Borough of Kensington and Chelsea’s Core Strategy policies, research and work elsewhere highlights
that older people are particularly vulnerable to negative health effects. Older people living in cold,
damp, poorly designed homes with low air quality are more at risk from arthritis and rheumatism
60The Royal Borough of Kensington and Chelsea Older People’s Housing Design Guidance – Nov
2015To avoid overheating, buildings should be tested by an appropriate consultant at design stage,
to ensure the thermal performance is acceptable. The consultant should use dynamic thermal 3D
modelling to determine suitable design approaches in order to effectively reduce the risks of
overheating, energy consumption and carbon dioxide emissions whilst continuing to ensure
adequate levels of day lighting and ventilation. Alterations to the model such as introducing more
thermal mass, dual aspect dwellings, a natural ventilation system, shading, night time cooling,
efficient light fittings /equipment, amending window sizes, glazing specification and orientation can
be assessed and the design modified if appropriate.

The London Housing Design Guide section on overheating notes that “development proposals should
demonstrate how the design of dwellings will avoid overheating during summer months without
reliance on energy intensive mechanical cooling systems.”

The Royal Borough of Kensington and Chelsea encourages a fabric first approach to overheating.
However, it should be noted that if the outside air temperature remains high at night, in a prolonged
heat wave, a natural ventilation system may be insufficient to reduce temperatures to an acceptable
level for older people. Providing air conditioning to at least one of the communal areas should be
implemented to provide a respite area for frail older people during a heat wave.

Correct use of the building by the residents is also important:-

“Opening windows when it is hotter outside than inside can result in making the overheating
problem worse. The advice is to keep windows in direct sunlight shut during the day if temperatures
are high, but open them at night if safe to do so.” Public Health England 2014

If mechanical heat recovery units are specified for dwellings’ correct use of the summer bypass mode
is essential along with guidance on how to operate these systems. In addition, if air conditioning is
provided, the system can be programmed to automatically shut down when windows are opened.

Overheating, in older people’s housing needs to be assessed and addressed correctly to ensure
Kensington and Chelsea residents are protected from extreme heat in the summertime both today
and well into the future as the climate is expected to change.

Air quality

Older people tend to spend long periods of time at home, which when combined with frail health
may lead to higher risks from poor air quality.

Air quality should be a major consideration when selecting a location and designing a building for
older people. Kensington and Chelsea falls within an Air Quality Management Area, therefore careful
consideration should be given to the external sources of air pollutants and how these are likely to
affect indoor air quality.

Building design, including the location of windows, ventilation intakes and exhausts in relation to
external sources of air pollution should be carefully planned and closely aligned with the ventilation,
lighting and overheating strategies proposed for the building.

62The Royal Borough of Kensington and Chelsea Older People’s Housing Design Guidance – Nov
2015Climate change resilience (both in terms of environmental and social resilience)
Climate change poses one of the greatest risks facing society today; there is a compelling need to
adapt both new and existing buildings to enable them to respond to global changes in temperature
and extreme weather events.

Climate change will have profound social and health implications for the vulnerable in society. There
will be implications on the way buildings are designed as the complexities of balancing a reduction in
energy consumption, with the provision of natural daylight, optimisation of ventilation and
mitigation of overheating becomes increasingly difficult to deliver.

Energy performance

The energy strategy for both new build and major refurbishment residential projects should follow
the targets and guidance set out in Building Regulations (AD Part L) and the London Plan (Sustainable
Design and Construction, Supplementary Planning Guidance). When selecting an energy strategy and
suitable low or zero carbon technologies, careful consideration should be given to the end user of
the building(s). This is particularly relevant for older people as ease of use, accessibility of controls,
simplicity and indoor air quality should be key considerations in the decision making process.

Local climate

Buildings and external areas are to be designed to adapt to change (i.e. enable resilience). The design
process should be informed with thermal model information, micro-climate information and design
advice on climate change. Consideration should be given to the building form, proposed green and
blue local infrastructure, existing and subsequent micro-climate, the albedo effect and the heat
island effect to limit the risks to overheating. The London Plan provides detailed guidance on how to
adapt to climate change, tackle increased temperatures and drought. Additional guidance on
overheating, carbon abatement and climate change can be found, and should be considered, at the
Zero Carbon Hub, the Joseph Rowntree Foundation and the Innovate UK websites.

Social resilience

Environmental stressors such as extreme weather can irritate, annoy, and be a general source of
discomfort for older people. Vulnerable elderly residents will be affected by the impacts of climate
change. This includes increased fuel poverty, health problems, social isolation and reduced access to
external spaces.

A neighbourhood that is supportive is required; this means that careful consideration should be
given to how the development sits and connects to the existing social fabric and local community.
Measures that should be considered when designing and planning extra care and retirement housing
developments are:

• Creation of agreeable indoor communal spaces (adequately warmed and cooled), which could be
open to the wider community strengthening connections

• Creation of sheltered external communal spaces, with consideration to the creation of micro-
climates using adequate vegetation for enhanced health benefits

• Engaging residents, where possible, in the design of communal indoor and outdoor spaces through
research and resident engagement initiatives.

The Royal Borough of Kensington and Chelsea Older People’s Housing Design Guidance – Nov 2015A
light reflectance value contrast of at least 30 points is required between furniture/fixtures and their
surroundings. Contrast chairs and sofas to their environment possibly by colour outlining; for
example colour contrast the piping on an arm chair. Contrast curtains to their background perhaps by
introducing a colour strip to their leading edge.

Sharp shadows created by Venetian blinds sometimes cause confusion in people with dementia. Soft
sheer blinds are more appropriate in older people’s housing.

Appropriate fabrics that are impervious, antibacterial and flame-retardant should be specified. Vinyl,
faux leather, is often used in older people’s housing.

Hot water/heating

Injury from hot water or heating systems Vulnerable older people with limited mobility, reduced heat
sensitivity or dementia are particularly at risk of injury from hot water or heating systems. Controls
must be provided to ensure that hot water is less than 44°C at outlets in accommodation accessed by
older people. If radiators and towel rails are required they should be specified with a low surface
temperature so that the maximum accessible surface temperature does not exceed 43°C.

Underfloor heating

Underfloor heating is often specified for older people’s housing to avoid dangers from hot surfaces
and provide unrestricted wall space. If underfloor heating is specified, adequate space must be
provided within the dwelling for heating manifolds and controls.

Minimum temperature thresholds

During the winter months, heating controls can be set to provide a minimum temperature within
dwellings. This protects older people form cold weather. Cold weather is associated with an increase
in deaths and in addition has significant impact on morbidity.

Minimum Home Temperature Thresholds for Health in Winter, published October 2014, by Public
Health England recommends minimum temperature thresholds.

“Daytime - 18°C (65F) threshold is particularly important for people over 65yrs or with

pre-existing medical conditions. Having temperatures slightly above this threshold may be beneficial
for health.

Overnight - 18°C (65F) threshold may be

beneficial to protect the health of those over 65 or with pre-existing medical conditions. They should
continue to use sufficient bedding, clothing and thermal blankets or heating aids as appropriate.”

Interior design

Effective interiors can dramatically influence the success of a development. Depending on the size of
the housing scheme, it is often advantageous to appoint an experienced interior design consultant. A
considered scheme will improve the development’s market appeal critical in both the public and
private sectors. It is essential that sufficient budget is allowed to provide an attractive, non-
institutional, interior design.

Furniture, fixtures and equipment (FF&E)

It is important that all furniture, fixtures and equipment have a domestic, non-institutional
appearance.
Furniture should have rounded edges and comply with Fire Safety Regulations.

Within communal areas different seating options are required to give residents a choice of seat
suitable to their mobility needs. For older people seat heights must be a minimum of 450mm above
the finish floor level. Chairs should be fitted with arm rests. Sofas must have legs (rather than solid
construction below seat height) to allow a seated occupant to position their feet slightly back before
standing. Consider providing some chairs to suit bariatric residents.

65A light reflectance value contrast of at least 30 points is required between furniture/fixtures and
their surroundings. Contrast chairs and sofas to their environment possibly by colour outlining; for
example colour contrast the piping on an arm chair. Contrast curtains to their background perhaps by
introducing a colour strip to their leading edge.

Sharp shadows created by Venetian blinds sometimes cause confusion in people with dementia. Soft
sheer blinds are more appropriate in older people’s housing.

Appropriate fabrics that are impervious, antibacterial and flame-retardant should be specified. Vinyl,
faux leather, is often used in older people’s housing

Lighting design

Communal areas must be well lit and automated to standby when not needed. High levels of light,
appropriate fittings and good control of light are key factors to consider when designing the lighting
within an environment where older people will be residing.

Lighting design and choice of luminaires is a key element of the interior design and should be carried
out in consultation with the architect, interior designer and client. Lighting design should be
domestic and offer alternative settings for mood lighting.

Specify domestic style light fittings that will reduce glare and which generate a diffused and even
light within a space.

Provide directional or task lighting in areas such as offices and activity rooms. Kitchens should all
have pelmet lighting above the worktops.

Locate plug sockets where extra directional light sources are required; this is to avoid unnecessary
flexes, which are a safety hazard.

Avoid repetitive ceiling mounted fittings in the corridors and communal lounges as these can cause
glare and look institutional (especially oversized bulkhead saucer shaped fittings which are to be
avoided). Balance ceiling mounted fittings with wall mounted fittings, to give a more dispersed
source of light and provide switching which can provide different lighting moods.

External lighting proposals should consider enhancing the external space during the hours of
darkness particularly when viewed from flats and communal spaces.

Fire protection and means of escape

Consultation with a building control officer/ approved inspector is essential in the early design
stages.

Extra care housing is, typically, classified as ‘group 1 residential’. On the basis that the building
contains apartments for individual occupation where the residents have tenancy agreements or are
leaseholders (including care provision). The use of the term ‘extra care housing’ can sometimes
cause confusion so it needs to be stressed that this building is not an institution in terms of
classification i.e. not ‘group 2 residential (institutional)’.

Retirement housing (sheltered housing) is classified as ‘group 1 residential’. The Royal Borough of
Kensington and Chelsea Older People’s Housing Design Guidance – Nov 2015door closers is
acceptable. Both door leaves should be fitted with devices in order to maximise the clear opening.

• Smoke and heat detectors are required in specified locations. Fit heat detectors in kitchens as burnt
toast might trigger smoke detectors when there is no danger of a fire. (Within extra care housing
kitchen heat detectors should be linked with the telecare system, in addition to the fire alarm,
allowing staff to investigate and easily reset if appropriate.)

• Mobility scooters/buggies must not be parked or charged in communal corridors. It is essential that
mobility scooters are parked in designated stores with a fire resisting enclosure.

• Stairs and corridors to provide refuge areas if required. (A ‘stay put’ fire strategy is often adopted in
older people’s housing negating the need for refuges.)

• Furnished corridor seating areas should provide a minimum fire load and must be agreed by a fire
engineer and the London Fire Brigade.

• Extra care housing typically operates

a stay put fire strategy for older people. Where older people are potentially incapable of
independent evacuation, a fire protected area (e.g. cross corridor doors) should be accessible within
7.5m
RIBA

Anthropometric Data Introduction

The average person does not exist; when you take the average of all body dimensions of a certain
group you will end up with a description of a person that does not exist. It is very rare that an
individual person has multiple body dimensions that are average for a population. However, the
average value of one dimension, like stature, does exist and makes sense. Anthropometry is the
scientific study of measurements of the human body. Anthropometric data can be a valuable source
of information when designing products, buildings and spaces. Not only when spatial dimensions
have to be determined, but also in the early stages for the development of ideas. This shows that
although anthropometry can provide designers with statistical information about the dimensions of
the human body, this available information can never be directly translated to product dimensions.
How anthropometric information can be used depends on the specific situation, the nature and
complexity of the design problem. The decision on what techniques to use in a design process can
depend on even more factors like available data, time and money. A designer should use the
appropriate techniques to make sure that design decisions based on anthropometric data are valid.
The results that are presented are categorized according to the amount of dimensions that have
been taken into account, allowing for the basic development areas and environments. Less
dimensions can mean easier interpretation of data, but also more abstraction in comparison to the
real situation. Ergonomic development The anthropometric data diagrams are derived from two
sources. One is Henry Dreyfuss Associates’ The Measure of Man and Woman - Human Factors in
Design, published in 1993. The other is the second edition of Stephen Pheasant’s ‘Bodyspace’, sub-
titled Anthropometry, Ergonomics and the Design of Work, published in 1998. Henry Dreyfuss’s 1993
book is the updated sequel to his 1960 landmark book, The Measure of Man. During World War II he
was commissioned by the US Department of Defence to develop human engineering standards for
the design of military equipment. He undertook a survey of a large sample of adult males in military
service or suited for it. The findings informed the anthropometric diagrams in the 1960 book. In the
1976 edition of Designing for the Disabled, the anthropometric diagrams, derived from Dreyfuss’s
1960 book, the height of building fixtures that were being drafted was that the 5th percentile did not
sensibly represent short people, and nor did the 95th represent tall people. That might have been
predicted, owing to short and tall men having been disregarded for the purpose of Dreyfuss’s 1940s
project on specific equipment for military personnel. One of the concerns was that in the 1993 book
the 50th percentile for the stature of adult men continued to be shown at 1755mm as it had been in
the 1960 book, this being a measure that had come from a survey made in the 1940s. Stephen
Pheasant’s Data Adult men in Britain in the twenty-first century, an average height of 1755mm (5ft 9
in) could be an underestimate. For British adults ages 19 to 65 the Pheasant estimate for the 50th
percentile measure of the stature of men is 1740mm. This is with unshod feet; with 25mm added for
the kind of everyday shoes that men wear, this becomes 1765mm (5ft 9 ½ in) in place of Dreyfuss’s
1755mm. For the stature of the women corresponding 50th percentile Pheasant measure is
1610mm; with 10mm flat shoes the average height of women becomes 1620mm and with 100mm
high-heel shoes 1710mm. Average heel height is assumed to be 40mm, giving an average height of
1650mm (5ft 5in) in place of Dreyfuss’s 1625mm (5ft 4in). In recording anthropometric data, head
height is the key item, and average measures of other bodily characteristics may not have equally
neat statistical correspondences. Diversity is the rule. As people become older they diminish in size
and during adult life bodily changes occur within any individual and among groups of comparable
individuals. People in different geographical areas, types of employment or social groups develop in
different ways, and among people in different ethnic groups there are distinctively different bodily
characteristics. Ergonomic Information People tend to shrink slightly with age. (On average a change
of 10 cm – see table below.) More significantly, the body tends to be less flexible in regard to
adapting to dimensionally unfavourable situations. It is therefore important that design allows for
the safe and comfortable access, movement and activity of elderly people within the limits of their
height, movement & reach constraints. Statures (mm) for Britons in various age groups: The
Universal Design Pyramid In Row 1 at the foot of the eight-level pyramid are fit agile people. In Row 2
are the generality of normal adult able-bodied people, while not being athletic. Scoring as at Pointer
A, no small children in Rows 1 and 2. The people in Row 3 are in the main also normal able-bodied
people. When Row 3 attempt to use public toilets they are regularly subjected to architectural
discrimination because the number of wcs provided for them is typically less than half the number of
urinals and wcs that men are given. In row 4 are elderly people, perhaps going around with a walking
stick, people with infants in pushchairs. In row 5 are ambulant people who have disabilities.
Digital Connectivity & remote control:
Building systems There are many different types of building system that may be integrated to
produce an intelligent building. Precisely what mix of systems is included will be determined by the
intended use of the building. The focus of this document is on systems that support people to live
independently in their homes. This includes those providing care and health support. BRE IP13/08
Part 1 also provides a number of other categories these include: Energy use (monitoring and
management). Environmental control (e.g. temperature, humidity, lighting). Communications.
Security and access control. Life-safety systems. Systems monitoring and maintenance. Lifts and
escalators. Entertainment, Public services, and education services also need to be covered.
Connectivity to the home Data services are currently delivered in a variety of ways including:

Cable television networks. Dedicated broadband network. Mobile telephones, wireless and satellite
(especially in areas that cannot access other services). Powerline communications technology. This is
being considered for the provision of assisted living technologies to locations that may not be
economic using other approaches. This technology will take advantage of existing electrical wiring to
provide a range of telecommunications services to homes and communities without relying on the
availability of specialised cabling. At present it is common for digital services to be accessed within a
dwelling from a single point of entry, usually an ADSL connection using copper wires (other delivery
media can be used (e.g. cable, satellite etc.) The digital signal is received by an ADSL modem.
Following this is a ‘home hub’ – i.e. a residential gateway combining the functions of a router, switch,
wireless access point and firewall. The home hub distributes the digital signal throughout the home.
Broadband Availability At present access to broadband connectivity in the UK is about 68% although
the UK government has an objective to provide universal access across the UK. Access is most limited
in rural areas. External Connection Point For existing homes the entry point for the external cable will
be fixed. However, for new build there may be a choice of entry points. CLG guidance 3333
recommends that a secure external terminal box (also serving cabling for other services) should be
fitted at the cable entry point. The internal entry point should be an equipment cabinet which acts as
a distribution point for digital services as well as telephony, satellite and cable TV etc. Connectivity
Within the Home Equipment within the home may employ a wide range of cabling of both a
standard and proprietary type. Some may also connect using a wireless and / or powerline
technologies. Both cabling and wireless solutions are evolving and any internal infrastructure will
need to offer sufficient capacity and flexibility to meet future requirements. There are currently four
options for the distribution of digital services within the home. Irrespective of the system used each
network device will need to have a network adapter, allowing it to communicate through the
network. Ethernet The most commonly used cable network, using twisted pair copper cable.
Ethernet currently provides the fastest and most reliable transmission medium. It can be provided at
modest cost (especially when fitted as part of a new build or major refurbishment programme).
However, retrofitting into existing homes can be awkward. Signals are delivered to a standard
network access (i.e. RJ45) socket, normally mounted on a faceplate. Types of cable and fibre
commonly used in communication networks were summarised in Table 7.1. Currently the optimum
solution is likely to use Cat 5e or Cat 6 cable. However, equipment within the dwelling may employ a
wide range of cabling of both a standard and proprietary type. Some may also connect using a
wireless technology. Both cabling and wireless solutions are evolving and any internal infrastructure
will need to offer sufficient capacity and flexibility to meet future requirements. For digital-capable
cabling, current practice is Category 5e (ANSI/TIA/EIA-568-A), or Category 6/6a (ANSI/TIA-568-B.2-1)
cable, solid core for up to 100m of installed runs. The configuration of the cabling installation will
depend on the size and nature of the building. Future-proofing New cabling standards are likely to be
introduced as technology progresses and depending on the intended duration of use of the buildings
lifetime before subsequent refurbishment refitting or replacement, some future-proofing may be
appropriate. In this case, it would be prudent to lay cabling in an accessible manner, such as in
ducting, so that future upgrades may be at minimal cost and disruption. It is clearly wise to consider
the current and foreseeable range of equipment to be installed before deciding which of the
currently-available cabling standards to install. There is generally backwards-compatibility built-in to
these standards so that fitting a higher grade does not prevent the use of less-demanding
equipment. Ducting Guidance on ducting infrastructure for new homes is available from the CLG.
This guidance does not cover specific cabling requirements. Occupants of dwellings are likely to
require: Data sockets at ‘useful locations’ throughout the dwelling. A ‘readily accessible’ location
where network equipment can be installed with a simple ‘user-friendly’ method of connecting the
network equipment to ‘live’ data sockets. Mains electricity sockets that are located near the data
sockets. The possibility of installing data sockets at ‘useful locations’ will depend on the nature of the
dwellings and the type of occupancy.
However, diverse user needs can only be met by a flexible infrastructure that will allow sockets to be
readily installed as and where required. Such a flexible infrastructure would also offer the potential
for supporting other cabling distribution requirements. Main and subsidiary ducts should have
minimum dimensions to allow for the future expansion of the network. Ducting should be provided
to support the vertical and horizontal distribution of cabling and sockets. The CLG document does
not provide guidance on specific types of ducts. Options that maybe considered include: Vertical duct
concealed with other services in riser. Ducts in-wall with possibly predefined access and socket
positions. Dado ducting. Skirting ducting (if not intended for sockets). Simple surface mounted
ducting. The ducts should be installed such that later cabling, and associated faceplates and sockets,
can be installed with minimal disturbance to either previously installed cables or the fabric of the
building. The aim should be to facilitate cable installation by an electrician or a qualified competent
person. The CLG document does not specify duct sizes but provides the following as guidance (larger
ducts should be used where space permits): Main ducts (that run from the equipment cabinet both
vertically and horizontally) should have a minimum cross sectional area of 800mm2, with the
smallest dimension being 20mm (i.e. a 20mm x 40mm duct). Other ducts that spur from main ducts
to each room should have a minimum cross sectional area of 400mm2, with the smallest dimension
being 20mm (i.e. a 20mm x 20mm duct). Other recommendations in reference 3 include: The ducts
should enable cables to be installed with a minimum (long term) bending radius of 60mm. Bends in
the ducts should be kept to a minimum. Access points should be provided where there are multiple
bends or bends greater than 45 degrees. Access points to under floor horizontal ducting should
remain available through floorboards or other floor components. The ducts for data services should
be separate from main electricity cables and comply with cable separation and routing standards.
Where a vertical duct runs between floors the relevant provisions of the Building Regulations /
Standards should be followed, notably with respect to fire safety, resistance to moisture and
resistance to sound. Ducts should be positioned in such a way that damage from ‘DIY’ is minimised. A
similar approach to the best practice installation of electrical cables and sockets should be
considered. The ducts should enable ‘standard size’ face plates and data sockets to be readily
installed. By removing / cutting a section of ducting to directly insert a faceplate – using ducting that
has ideally been designed for the purpose. Locating faceplates (with appropriate back boxes)
adjacent to accessible ducting. Data sockets (and other sockets supported by the internal
infrastructure) must be located at a height above finished level floor that is in accordance with
Building Regulations/Standards. Any data sockets located in the loft area should be located in such a
position as not to put the resident at risk from trailing cables etc. Wireless This has a number of
advantages, especially in existing homes where retrofitting cables may be difficult and expensive. It is
easier to install than other current solutions; no additional wiring is required to reach equipment in
other parts of the home, and therefore new equipment maybe installed at minimal additional cost.
Wireless access points simply need access to power and data (wired or wireless). Devices connected
to a wireless network can be located anywhere within the home provided there is sufficient signal
reception. New devices can readily be added without having to install new cabling. The most
common wireless networks currently in use are Wireless B and Wireless G. However, these are being
superseded by Wireless N. Whilst wireless connectivity has many advantages there are
disadvantages. Connectivity is affected by location, and obstacles such as the building structure (e.g.
conducting metals) and water. They may be susceptible to interference from other devices including
portable/mobile telephones and microwave ovens. As the signals may be accessed outside the
boundary of the home they may be susceptible to unauthorised access. They should therefore be
suitably encrypted to ensure security. Example standards for wireless data include: Wireless Lan
(“wifi”, IEEE 802.11), Bluetooth, zigbee. Others may be introduced in the future. Wireless LAN (“wifi”)
standard is typically IEEE 802.11g or 802.11n at present. Earlier standards 802.11b and 802.11a are
slower and offer no significant cost benefits. In general the network is established by a master hub
and devices communicate through the hub. The hub will typically be connected via Ethernet on cat 5
or cat 6 cable to a wider network externally, or via ADSL on the home’s broadband telephone service.
Figure 7.2 Duct distribution in a house - CLG Guidance note 80 Bluetooth is an alternative and
commonly-used standard. Devices communicate with each other by pairing and no hub is required
(therefore no wiring is required). Bandwidth and range are more limited than for wifi, but are
typically suitable for many assisted living devices within a room or small flat. DECT is an established
wireless telephone handset standard that is only commonly used for telephone voice services. A
DECT basestation is connected like a traditional phone to the external telephone line, and a power
socket is required. This standard extends the reach of a telephone to anywhere in a standard
dwelling. Zigbee is a wireless technology standard for low data rate networks based on IEEE
802.15.4-2003. The technology defined by the ZigBee specification is intended to be simpler and less
expensive than other WPANs, such as Bluetooth. ZigBee is targeted at radio-frequency (RF)
applications that require a low data rate, long battery life, and secure networking. It is suitable for
sensors and control devices of building automation systems where small amounts of data are
transmitted. All wireless standards can be susceptible to signal limitations in buildings with thick or
metallic walls, or in larger buildings such as residential blocks. Therefore signal-repeaters may be
needed to extend the signal into all parts of the building. Wifi performs better than the other
standards in this respect. Phone network Existing home phone networks can be used as data
channels where phone sockets are suitably distributed. As the voice and data signals are transmitted
at different frequencies there is not likely to be any interference provided appropriate filters are
used. Powerline technologies use mains electricity wiring within the home for the distribution of
data. Mains plug adapters link the network devices to the mains electricity cabling. Suitably equipped
devices modulate their external data signals onto this network and other suitably-equipped devices
receive this data anywhere within the same power distribution. As most existing houses have
extensive electric cabling, with power outlets in most rooms, this approach can be widely used. It
requires no additional wiring around the home, so new equipment may be installed at minimal
additional cost. It is therefore particularly suitable for low-cost and low-disruption refurbishments.
However, there are drawbacks in that they may be susceptible to unauthorised access and may be
affected by earthing faults. In retrofit cases, there may be performance limitations depending on the
age and quality of the power cabling and installation. In new buildings, such performance limitations
should be avoidable by adhering to current standards. There may be considerations of resident
alterations to power points that may reduce the performance. Systems such as HomePlug, Universal
Powerline Association, HD-PLC are available which carry data communications over the building’s
power wiring. IEEE 1901 is a draft standard. The continued existence of non-interoperable standards
presents a risk that equipment may not be supported in the future if standards become obsolete
through competition, but equipment installed to an existing standard should remain fully functional
within an installation once installed, as long as there is no interference with power point. Installation
costs for cabling will be higher because of both labour and materials, but the benefits may be that
more functionality may be obtained at higher reliability than for wireless methods. Powerline
methods may offer the best of both worlds, but the technology is less mature and reliability is
reputedly lacking. Once installed, most data networks require little maintenance unless new
equipment is introduced, in which case access may be needed to add more capacity or replace
lower-capacity equipment. In general maintenance costs could be minimised by ensuring easy access
to cabling ducts and equipment housing. Repairs to installations should be considered in the same
light. Training of installation engineers will be higher for cabling methods, especially in
refurbishments, since it will involve making expert judgements about the best typology in each
situation, and require additional building skills. For new buildings this may be less severe. Wireless
and powerline installations require less training for the building work itself. Commissioning of
equipment may require skills such as setting up protocols and network communications; however
much equipment available today aims to minimise this work at installation through the use of
automated set-up. Wifi is particularly troublesome to introduce new equipment particularly when
security is enabled; some degree of training is probably needed for this.
 Advantages and disadvantages of the four types of data transmission media - BRE

Options for data infrastructure provision in new buildings – BRE

Wiring guidance and examples

There are several internal infrastructures to provide internet (broadband in most cases) connection and control for devices in a building and house. The type
of infrastructure that is required is dependent on the reliability, volume of information and security of data for the required assisted living solution. The
following examples show how smart home functionality can be implemented in practice. The cables of each system are routed back to the electronic consumer
unit.

Cable Routes and Handling

It is important that cables are handled and fixed to meet a number of requirements including: Minimum bending requirements (for Cat 5e and Cat 6). Cables
must not be kinked. Cables must be at least a minimum 300mm away from power cables, and must avoid fluorescent lighting control gear and electric motors.
Data cables and powerlines should cross at right angles where crossing is necessary. Minimum hole diameter for a single Cat 5e or Cat 6 cable is 6mm (or
18mm if terminated with an RJ45 connector). Data cables should be run through ducting of suitable dimensions. Ducting should be installed with draw strings
to facilitate pulling through cables. The pulling force should not exceed 85N to avoid damaging the cables. Where cables converge they should be labelled.
Holes in walls and floors should be of adequate size for the cable; grommets may be needed to prevent chaffing. Cable hole diameters will need to be
increased where cables converge to allow space for cable harnesses. Notched stapling guns will enable cable fixing without damaging the cable. Professional
quality crimping tools should be used where cables are to be terminated on site. Stranded patch cables should not exceed 6m in length. Ethernet installations
should be star wired. The maximum cable run length for ethernet installations is about 90m. Single-core cable should be used for network cabling. Multistrand
cables should be used for patch cables. See Chapter 8 for Sample Guidance.
PLUMBING
First: The Facility

When designing for a senior living community, we first must determine the facility type. Will it be an active-adult or independent-living community, a
continuing care facility or assisted living/skilled nursing home? Each type comes with their own specific design needs. For example, independent living
communities contain a normal residential water heater inside each unit, allowing residents to operate as they would if they lived entirely on their own.
Whereas a memory care unit typically possesses a single bathroom served by a shared water heater located in a different part of the building; this ensures the
safety of the residents, whose health issues place them at a greater risk for fall or accident.

Second: Temperature Needs

Once we’ve determined the facility type, we then establish the different temperatures the facility requires and how they will be handled. For instance, a
commercial kitchen requires 140ºF water to sanitize used pots and pans, a temperature far too high for a residential unit or common area bathroom. In fact,
on average, it only takes 5 seconds of exposure to 140ºF water for an adult to receive a 3rd degree burn. Therefore, the plumbing design must address several
questions to ensure the correct temperature is delivered to the appropriate areas:

1. Should there be two separate hot water loops (one at 140ºF and another at 120ºF) run to the respective areas?

2. Should the commercial kitchen be served by a separate water heater located in the kitchen?

3. Depending on the space available, is there room in the kitchen for another water heater?

4. Where will the central water heaters be located?

5. Are there multiple wings that will be served by their own hot water system?

Third: Water Heater Type

Once the temperature needs are determined, we then consider the water heater type that will best serve the central hot water system. Will the design consist
of multiple tank type water heaters ganged together or will it contain a boiler system with external storage? Each has their own advantages and disadvantages
depending on a number of variables: the layout of the building, how many wings there are of the building, and how each wing is being served. In general, once
the building reaches a certain square footage, a boiler with external storage tank option is selected for the central hot water system.

Fourth: Recirculation Line

During the design phase, we also establish how the recirculation line will be run for the central hot water system. Most facilities (like restaurants) use a
standard loop that returns the hot water from the furthest fixture back to the water heater. This ensures that the water in the hot water piping remains hot
(i.e. eliminating the need to “warm-up” the water if you’re a significant distance from the heater). The concept of a recirculation line is the same for senior
living facilities. That said, given the general size of a senior facility, the “loop” can take several forms to accommodate the footprint and number of floors.

Fifth: Disease Spread

In today’s pandemic-driven world, we take disease spread even more into consideration. For senior living facilities, one of the hardest hit during COVID-19,
installing touchless fixtures such as sensor lavatory faucets and toilet flushes valves is paramount, especially in public bathrooms. The use of these help reduce
the number of surfaces people must touch, thereby reducing the risk of infection.

Sixth: Environmental Considerations

While not specific to senior living facilities, we do take water conservation into consideration in every design. Nearly all plumbing fixtures produced today
reduce the amount of water utilized for their normal operation. In fact, the amount of water needed to flush a toilet has greatly reduced since the early 1990s
from an average of 3.5 gallons per flush (GPF) to the current federally mandated flow of 1.6 GPF. A WaterSense toilet does even better at 1.28 GPF. Using these
low flow fixtures in the residential units (toilets/showers) and public bathrooms can help reduce the amount of water used by the building, thereby
contributing to conservation efforts.

Whether its mechanical, electrical or plumbing design, having an expert guide you through the process is key to optimizing your project goals. Their
understanding of the intricacies, special considerations and complex code, especially those involved in senior living facilities, can mean the difference between
a project delivered on-time and on-budget and one that is not. Contact us today to see how our team of experts can make your project a success too!

What does aged care mean to you?

Traditionally it will depend on where you are from:

1. Asia – at home with family members taking care. Minimal preparation or saving for one’s Ageing because family members will take care. Minimal
support from the government.

2. Western – aged care facility or nursing home. Often individuals or their family members will plan for the transition from the family home to aged
care. Savings or the sale of the family home fund the transition, along with pensions or allowances from the government for those in need.

However, the distinction between these 2 traditions is becoming blurred as more and more people in Asia move from family farms to cities for work. The cities
are often far away from the family home and as people establish their lives in cities it becomes difficult both practically and financially to move back home
when their parents need care.

On the positive side, the ageing population can be a valuable resource to society: older people who are still able to work part-time, who raise grandchildren,
who volunteer their time in the community, and who are able to meaningfully share their culture and values with younger generations. Working out how to
make better use of this growing resource will be a key issue for society in the coming decades.

Understanding the Issue

 Longer life expectancies, ageing populations throughout most of the world and fewer workers to pay taxes to support government funded services
and facilities. Retirement ages are rising as a result. Unless people can self-fund their retirement, they will need to work longer.

 Full-time care in a dedicated nursing home facility is very expensive and places are limited. Difficult / unpleasant working conditions for staff leads
to high turn-over rates. Quality of care can vary significantly.

 Assisting people to stay in the family home as long as possible is cheaper for governments and better for people. Governments and private
enterprise can provide support services such as:

o Mobile support facilities for nursing & pathology

o Assistance with house cleaning and shopping

o Personal contact

 Population of Thailand is currently 69 Million http://www.worldometers.info/world-population/thailand-population/ The fertility rate has been
below 2.0 (replenishment rate) since 1995. The population has still been growing since 1995 because people are living longer; the death rate is
still lower than the birth rate. In 2018 the population growth rate is 0.21% and is predicted to fall below 0 by 2030.

What Happens When We Age?

a. Often a person’s ageing will be marked by either:

1. Deterioration of the mind, or

2. Deterioration of the body

b. Aged care facilities have to cater for both, but the care requirements are very different so having some separation of the facilities needs to be considered for
the welfare of the residents and the different staffing requirements

What do People Want in a Senior Living and Aged Care Facility?

 Small scale semi-detached private residential facilities (home-like Villas) with on-site medical/nursing services

 Lush landscaping with walking paths and activity stations

 Pre-fabricated, modular and adaptable housing (eg inter-connected rooms that could be 2 singles or 1 double).

 Opportunities for interaction with other residents

 Developments with staged amenities from low care through to higher levels of care

 Rooms for couples as well as singles

 Onsite kitchen that can prepare fresh meals and accommodate special requests or dietary requirements (not offsite pre-prepared meals,
microwaved onsite)

 Security and access control system

 Access to public transport for visitors and for residents

 Affordable facilities. Funding / payment models need to be explored.

 One potential option is: developers ‘building to rent’, rather than ‘building to sell’ which places more emphasis on long-term sustainability issues
and spending more initially toreduce the operating costs and lifecycle costs. This will require developers to become vertically integrated and
possibly merge with Aged Care Facility Operators to become Aged Care Providers.
Specific Design Considerations – some are MEP related, some are architectural

 Accessibility: avoid stairs and changes in floor levels

 Showers large enough to accommodate a shower chair. Walk in bathtub

 Grab bars in bathrooms

 Bed motion sensor to raise an alarm if no movement is detected within a certain time period – this will signal staff to assist the person to turn-
over to prevent pressure sores

 Medical Alert System with wearable sensors including activity monitoring, location, fall alert, call for assistance push-button

 Pull-cord alarms in bathrooms

 Thermostatic mixing valves that blend cold water with hot at the point of use to limit hot water temperature

 Higher lighting levels

 Night lighting for bathrooms

 Less tolerance of temperature extremes leads to greater reliance on air conditioning for comfort control

 Controls: large and simple; sanitary fixtures requiring minimal strength or dexterity to operate

 Provision for easy communications with remote family and friends; TV with webcam and internet access for video calls

 Connectivity with other people is key to avoiding social isolation which can lead to depression

 Visual alerts for doorbells and telephone calls

General and Specialized Electrical Load

General electrical requirements are just that. They are the items most buildings require such as the 120-volt general purpose receptacle
outlets located throughout a building. These receptacles are usually not specified to serve a particular load, but rather are for general purpose use such as
standard wall receptacles, desktop devices, etc.

Certain projects may include specialized electrical equipment that requires dedicated or separate electrical circuitry.

This specialized equipment may include the following:

 Plotter / Printer

 Vending machines

 IT racks

 Microwave ovens, refrigerators and other breakroom appliances

 Overhead doors

 Electric vehicle (EV) chargers

 Lighting Systems

Designing Lighting Systems

Based on their complexity and variety of selections, lighting systems are part of the design process that generally requires the greatest amount of time to
develop.

The electrical system designs are based on an objective understanding of the project goals and budget. These systems include all the lighting fixtures with their
specifications and their controls, per NEC and energy code requirements.
The Owner/Architect will first select the fixtures they want to use based on their requirements. For complex or larger projects, owners often involve an interior
designer to help develop the lighting aesthetic while remaining within the budgeting requirements.

That said, electrical designers are equally capable of designing a lighting system, but it may lean more toward meeting electrical requirements and code
standards rather than fulfilling the aesthetic preferences of the architectural design.

Aesthetics aside, lighting is not an area for cutting corners, as poor lighting can lead to potentially costly accidents. Beyond this, a dimly lit commercial
property may not be inviting or accessible to customers, which can result in a loss of revenue.

Incorrectly installed fixtures or those that are less expensive may need frequent repairs or at worst, replacement, ultimately costing more money in the long
run. Installing high-quality / modern lights and fixtures may increase the budget somewhat initially, but in the end, will provide safety for staff and guests as
well as a more attractive ambience to new prospects.

Electrical Distribution System

A distribution system is responsible for dispensing electric power for homes, multi-family buildings, commercial businesses, industrial facilities and more.
Generally, it consists of the infrastructure responsible for delivering electrical power from the source (such as the utility transformer and/or generator) to
various electrical loads within a building or facility.

Examples include:

 the main switchboard,

 main distribution panel,

 meter centers,

 and more.

These systems receive their power source from the serving utility, and then distribute power to all the required branch circuits throughout the facility via the
associated sub panels.

Electrical engineers like ours at VP Engineering may provide various electrical distribution options, including their pros and cons. The owner, then armed with
the necessary information, will decide which one to select based on their project and budgetary requirements.

A properly designed electrical distribution system will help in the long run to not only avoid maintenance and staff safety issues, but also positively impact
your bottom line.

As an example, a poorly designed electrical distribution system may cause the breaker(s) in the electrical panel to trip, possibly resulting in an increase of
maintenance calls and ultimately, a drain on your budget.

Low-voltage systems like fire alarms and emergency call buttons are vital to these buildings, requiring specialized planning and installation that
Low-Voltage
cater to the unique needs of a senior living facility. Many of the communication and safety technology needed in nursing home facilities can be
Power
wired using a low-voltage system. GCs will need to work with experts who know how to properly wire and fit the facility for this specific type of
Systems
system. Call buttons in patient rooms and bathrooms, nursing station phones, alarms and door locks all work on low-voltage systems.

Along with wiring a substantial portion of the building using low-voltage power, GCs need to ensure there’s a powerful generator on site to keep
Power life-sustaining equipment online. In skilled nursing facilities, people may be on ventilators and getting power back could mean the difference
Backups between living and dying. In memory facilities, security doors are typically run electrically, meaning a power outage could either lock everyone in, or
let everyone out. On top of the generator, nursing facilities need battery packs as well as switchgear capabilities.

What do we know about the relationship between COVID-19 and HVAC

systems?
JB: Well, right now I think the only known is that there are so many unknowns! As far as how it relates to the transmission of infectious disease, both direct and
indirect contact transmission by droplets, and inhalation of airborne particles containing infectious microorganisms.

GR: The situation changes daily. But we’re keeping up with new products and research, working with customers and reacting accordingly.

What information have you seen come out from ASHRAE?

GR: Much of the ASHRAE research is more hospital and larger commercial-facility based, so their conclusions and methodologies meet those ventilation needs.
I’d point folks to their COVID-19 (Coronavirus) Preparedness Resources and Guidance for Building Operations During the COVID-19 Pandemic for more
information.

JB: Generally, ASHRAE’s position is that facilities of all types should follow, as a minimum, the latest practice standards and guidelines. ASHRAE 62 Standards
cover ventilation in many facility types, and Standard 170 covers ventilation in healthcare facilities. New and existing healthcare intake and waiting areas,
crowded shelters, and similar facilities should go beyond the minimum requirements of these documents, using techniques covered in ASHRAE’s Indoor Air
Quality Guide (2009) to be even better prepared to control airborne infectious disease (including a future pandemic caused by a new infectious agent). But to
Greg’s point, comparing these to Senior Living isn’t apples to apples.

Are these ASHRAE standards relevant to Senior Living equipment?

JB: Yes and no. Many of the methodologies contained within the standard may be applicable in some way to Senior Living environments. Unfortunately, most
of the systems within Senior Living do not have the capabilities to meet the recommendations as fully as ASHRAE defined above.

GR: Right, many Senior Living buildings were not designed with full building make-up air capabilities to deliver fresh outside air, which is the crux of the matter.
In fact, many buildings’ resident rooms were designed with unitary (local) HVAC equipment that recirculates and treats the air solely in that resident room.

Can you expand on that? What types of equipment don’t necessarily apply?

GR: These can be in the form of PTACs, water-source heat pumps, split-system air handlers, rooftop units, fan coils, etc. So while PTACs and rooftop units may
provide some fresh air, the typical installation of these other systems make it difficult to increase the fresh-air displacement within a specific area.

JB: Going a step further, in some cases these systems may be designed to condition up to four or more resident rooms, which leads to additional air cross-
connection or cross-contamination. While these HVAC systems control the temperature in the space, there is rarely any capability to control the relative
humidity within Senior Living facilities.

You mention humidity control as well as temperature. Why the distinction?

JB: We’ve seen various studies show that temperature and humidity may impact the spread of airborne viruses, so being able to control both is ideal. It’s
recommended that the relative humidity in buildings be maintained between 40% and 60%.

OK, so given the recommendations provided by ASHRAE and the limitations of typically installed systems in Senior Living, are there steps facilities should
consider?

JB: Yes, as they relate to system operation, maintenance and ventilation.

GR: There are practical limits to what HVAC systems can accomplish in preventing transmission of infections. HVAC systems in and of themselves may not
directly impact the transmission of infectious disease. What we’re talking about here are systems that directly impact fresh-air intake and circulation, such as
make-up air units, which should be maintained at higher levels and be operating at peak efficiency.

JB: Maybe it goes without saying, but I’ll say it anyway: any failed make-up air ventilation systems should be replaced. And any overlooked ventilation systems
should have repairs made in a timely manner. I would also recommend to test and balance as necessary to gain optimum airflows.

What is the importance of air sources, and what can be done about them?

JB: Facilities might consider increasing make-up air ventilation sources to the maximum available and close off return air to help limit the spread of any
airborne pathogens. You might also increase exhaust air to help with the draw of fresh air into the community, if these capabilities exist. I would just point out
that in any high-pollutant outdoor areas, this may impact the quality of fresh air being drawn into the community and cause other indoor air quality issues.

GR: Pertaining to cleaning, system duct work and units should be given special attention, namely those systems subject to return air which could then be
delivered back into the space. Longer term, facilities should consider instituting higher standard maintenance practices across all HVAC systems.

What are options around filtration?

JB: Increasing filtration capabilities to the maximum available is an option, with the awareness that this may impact the life expectancy of installed equipment.

GR: To add to that, give focus to those systems with return or recirculated air, and determine loss of airflow due to increased filtration. Or, put another way, at
what point is this a diminishing return?

JB: Additionally, you could provide portable air filtration with HEPA filtration and UV capabilities in rooms with potentially infected residents. While not fully
proven effective against COVID-19, UV/UVGI and Needle Point Bi-Polar Ionization has been proven against other airborne pathogens.

How else might facilities increase fresh-air intake?

JB: You can use operable windows as a means to increase fresh-air intake, obviously keeping the needs of the resident population in mind.

Are there any effects of these recommendations that facilities should be aware of?

GR: Certainly, and facilities should be aware of these before making any of these changes. They could affect system operation, including heat and cool times,
airflow if sufficient testing and balancing doesn’t occur, and impacts to seasonal humidity levels. Increased maintenance levels may be needed, including
increased filter changes.

What new technologies have you seen emerge to mitigate transmission of airborne pathogens?

JB: Evaluation, testing and effectiveness of these new technologies are ongoing, but a couple I’ve seen are GPS Air® technology and UV technology applicable
to individual resident rooms. Greg, anything to add?

GR: I would add some air purification systems, including Reme Halo and the Oransi – Erik 650A MERV 18, EJ 120 MERV 17 portable room purification solution.

How are you and TELS helping Senior Living operators and providers solve for this challenge?

GR: I think TELS is set up well to help us virtually work with customers and determine how we can find solutions for specific building types/classes.
JB: Definitely. The TELS Site Visit tool is one example. Maintenance directors are able to perform building walks to obtain information to help us solve
problems. Sending us drawings (preferably as builts), equipment schedules and emergency routing floorplans is critical. And we can evaluate so much of the
customer’s data in TELS Platform.

GR: Yeah, TELS Platform lets us include all necessary stakeholders for visibility, and our customers on this solution are finding It easy to adapt to this new
normal of virtual work and problem-solving.

JB: We’ve always been available for remote consultations, but we’re obviously seeing a spike during COVID-19 and we’ve been able to adapt and help
customers a ton.

After we emerge from COVID-19, what long-term planning should facilities consider in the event of another airborne pathogen outbreak?

JB: To quickly speak to a high level, much of Senior Living has operated under a “run to fail” mindset as it relates to equipment maintenance and replacement. I
think operators and owners need to take a closer look at this philosophy in the face of COVID-19.

GR: Agreed. To start with the long-term design aspect of HVAC systems, I would encourage facilities to keep these in mind as they work with their design
engineers.

 Meet a higher standard of outdoor air intake

 Less cross-connection of HVAC systems

 One-to-one resident room HVAC systems

 Institute fresh-air intake requirements for resident rooms

 Determine the applicability of displacement ventilation strategies

 Determine the impact of these changes on long-term energy efficiency

JB: I would add that facilities should consider isolation room build-outs based on their particular situations, as well as pathogen-killing technologies in
ventilation systems and the need for humidification systems in Long Term Care. Even the installation of pathogen-killing technologies not related to HVAC
systems.

IBC

Category :
310.6 Residential Group R-4. This occupancy shall include buildings, structures or portions thereof for more than five but not more than 16 persons,
excluding staff, who reside on a 24-hour basis in a supervised residential environment and receive custodial care. The persons receiving care are capable of
self-preservation. This group shall include, but not be limited to, the following:

Alcohol and drug centers

Assisted living facilities Congregate care facilities

Convalescent facilities

Group homes

Halfway houses

Residential board and custodial care facilities

Social rehabilitation facilities

Fire Sprinklers:

AUTOMATIC SPRINKLER SYSTEMS

[F] 903.2.8.1 Group R-3 or R-4 congregate residences. An automatic sprinkler system installed in accordance with Section 903.3.1.3 shall be permitted in
Group R-3 or R-4 congregate residences with 16 or fewer residents. [F] 903.2.8.2 Care facilities. An automatic sprinkler system installed in accordance with
Section 903.3.1.3 shall be permitted in care facilities with 5 or fewer individuals in a single-family dwelling.

[F] 903.3.1.2 NFPA 13R sprinkler systems. Automatic sprinkler systems in Groupo R occupancies up to and including four stories in height shall be permitted
to be installed throughout in accordance with NFPA 13R.

[F] 903.3.1.3 NFPA 13D sprinkler systems. Automatic sprinkler systems installed in one- and two-family dwellings, Group R-3 and R-4 congregate residences
and townhouses shall be permitted to be installed throughout in accordance with NFPA 13D. [F] 903.3.2 Quick-response and residential sprinklers. Where
automatic sprinkler systems are required by this code, quick-response or residential automatic sprinklers shall be installed in the following areas in
accordance with Section 903.3.1 and their listings: 1. Throughout all spaces within a smoke compartment containing care recipient sleeping units in Group
I-2 in accordance with this code. 2. Throughout all spaces within a smoke compartment containing treatment rooms in ambulatory care facilities. 3.
Dwelling units and sleeping units in Group I-1 and R occupancies. 4. Light-hazard occupancies as defined in NFPA 13.

[F] 903.3.3 Obstructed locations. Automatic sprinklers shall be installed with due regard to obstructions that will delay activation or obstruct the water
distribution pattern. Automatic sprinklers shall be installed in or under covered kiosks, displays, booths, concession stands, or equipment that exceeds 4
feet (1219 mm) in width. Not less than a 3- foot (914 mm) clearance shall be maintained between automatic sprinklers and the top of piles of combustible
fibers. Exception: Kitchen equipment under exhaust hoods protected with a fire-extinguishing system in accordance with Section 904. [F] 903.3.4 Actuation.
Automatic sprinkler systems shall be automatically actuated unless specifically provided for in this code. [F] 903.3.5 Water supplies. Water supplies for
automatic sprinkler systems shall comply with this section and the standards referenced in Section 903.3.1. The potable water supply shall be protected
against backflow in accordance with the requirements of this section and the International Plumbing Code.

[F] 903.4.2 Alarms. An approved audible device, located on the exterior of the building in an approved location, shall be connected to each automatic
sprinkler system. Such sprinkler water-flow alarm devices shall be activated by water flow equivalent to the flow of a single sprinkler of the smallest orifice
size installed in the system. Where a fire alarm system is installed, actuation of the automatic sprinkler system shall actuate the building fire alarm system.
[F] 903.4.3 Floor control valves. Approved supervised indicating control valves shall be provided at the point of connection to the riser on each floor in high-
rise buildings.

SECTION 906 PORTABLE FIRE EXTINGUISHERS

On each floor of structures under construction, except Group R-3 occupancies, in accordance with Section 3315.1 of the International Fire Code

SECTION 907 FIRE ALARM AND DETECTION SYSTEMS

[F] 907.2.11.2 Groups R-2, R-3, R-4 and I-1. Single or multiple-station smoke alarms shall be installed and
maintained in Groups R-2, R-3, R-4 and I-1 regardless of occupant load at all of the following locations: 1. On
the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. 2. In each
room used for sleeping purposes. Exception: Single- or multiple-station smoke alarms in Group I-1 shall not be
required where smoke detectors are provided in the sleeping rooms as part of an automatic smoke detection
system. 3. In each story within a dwelling unit, including basements but not including crawl spaces and
uninhabitable attics. In dwellings or dwelling units with split levels and without an intervening door between
the adjacent levels, a smoke alarm installed on the upper level shall suffice for the adjacent lower level
provided that the lower level is less than one full story below the upper level. [F] 907.2.11.3 Interconnection.
Where more than one smoke alarm is required to be installed within an individual dwelling unit or sleeping
unit in Group R or I-1 occupancies, the smoke alarms shall be interconnected in such a manner that the
activation of one alarm will activate all of the alarms in the individual unit. Physical interconnection of smoke
alarms shall not be required where listed wireless alarms are installed and all alarms sound upon activation of
one alarm. The alarm shall be clearly audible in all bedrooms over background noise levels with all intervening
doors closed. [F] 907.2.11.4 Power source. In new construction, required smoke alarms shall receive their
primary power from the building wiring where such wiring is served from a commercial source and shall be
equipped with a battery backup. Smoke alarms with integral strobes that are not equipped with battery backup
shall be connected to an emergency electrical system. Smoke alarms shall emit a signal when the batteries are
low. Wiring shall be permanent and without a disconnecting switch other than as required for overcurrent
protection. Exception: Smoke alarms are not required to be equipped with battery backup where they are
connected to an emergency electrical system

[F] 907.2.12.1 Alarm. Activation of any single smoke detector, the automatic sprinkler system or any other
automatic fire detection device shall immediately activate an audible and visible alarm at the building at a
constantly attended location from which emergency action can be initiated, including the capability of manual
initiation of requirements in Section 907.2.12.2. [F] 907.2.12.2 System response. The activation of two or more
smoke detectors, a single smoke detector equipped with an alarm verification feature, the automatic sprinkler
system or other approved fire detection device shall automatically: 1. Cause illumination of the means of
egress with light of not less than 1 footcandle (11 lux) at the walking surface level; 2. Stop any conflicting or
confusing sounds and visual distractions; 3. Activate an approved directional exit marking that will become
apparent in an emergency; and 4. Activate a prerecorded message, audible throughout the special amusement
building, instructing patrons to proceed to the nearest exit. Alarm signals used in conjunction with the
prerecorded message shall produce a sound which is distinctive from other sounds used during normal
operation. [F] 907.2.12.3 Emergency voice/alarm communication system. An emergency voice/alarm
communication system, which is also allowed to serve as a public address system, shall be installed in
accordance with Section 907.5.2.2 and be audible throughout the entire special amusement building. [F]
907.2.13 High-rise buildings. High-rise buildings shall be provided with an automatic smoke detection system in
accordance with Section 907.2.13.1, a fire department communication system in accordance with Section
907.2.13.2 and an emergency voice/alarm communication system in accordance with Section 907.5.2.2.

Exceptions:

1. Airport traffic control towers in accordance with Sections 907.2.22 and 412.

2. Open parking garages in accordance with Section 406.5.

3. Buildings with an occupancy in Group A-5 in accordance with Section 303.1.

4. Low-hazard special occupancies in accordance with Section 503.1.1.

5. Buildings with an occupancy in Group H-1, H-2 or H-3 in accordance with Section 415.

6. In Group I-1 and I-2 occupancies, the alarm shall sound at a constantly attended location and occupant
notification shall be broadcast by the emergency voice/alarm communication system.

SECTION 909 SMOKE CONTROL SYSTEMS

[F] 909.1 Scope and purpose. This section applies to mechanical or passive smoke control systems when they
are required by other provisions of this code. The purpose of this section is to establish minimum requirements
for the design, installation and acceptance testing of smoke control systems that are intended to provide a
tenable environment for the evacuation or relocation of occupants. These provisions are not intended for the
preservation of contents, the timely restoration of operations or for assistance in fire suppression or overhaul
activities. Smoke control systems regulated by this section serve a different purpose than the smoke- and heat
venting provisions found in Section 910. Mechanical smoke control systems shall not be considered exhaust
systems under Chapter 5 of the International Mechanical Code.

[F] 909.16.1 Smoke control systems. Fans within the building shall be shown on the fire-fighter’s control panel.
A clear indication of the direction of airflow and the relationship of components shall be displayed. Status
indicators shall be provided for all smoke control equipment, annunciated by fan and zone, and by pilot-lamp-
type indicators as follows: 1. Fans, dampers and other operating equipment in their normal status—WHITE. 2.
Fans, dampers and other operating equipment in their off or closed status—RED. 3. Fans, dampers and other
operating equipment in their on or open status—GREEN. 4. Fans, dampers and other operating equipment in a
fault status—YELLOW/AMBER. [F] 909.16.2 Smoke control panel. The fire-fighter’s control panel shall provide
control capability over the complete smoke-control system equipment within the building as follows: 1. ON-
AUTO-OFF control over each individual piece of operating smoke control equipment that can also be controlled
from other sources within the building. This includes stairway pressurization fans; smoke exhaust fans; supply,
return and exhaust fans; elevator shaft fans and other operating equipment used or intended for smoke control
purposes. 2. OPEN-AUTO-CLOSE control over individual dampers relating to smoke control and that are also
controlled from other sources within the building. 3. ON-OFF or OPEN-CLOSE control over smoke control and
other critical equipment associated with a fire or smoke emergency and that can only be controlled from the
fire-fighter’s control panel.

909.20.5 Stair pressurization alternative. Where the building is equipped throughout with an automatic
sprinkler system in accordance with Section 903.3.1.1, the vestibule is not required, provided that interior exit
stairways are pressurized to a minimum of 0.10 inches of water (25 Pa) and a maximum of 0.35 inches of water
(87 Pa) in the shaft relative to the building measured with all stairway doors closed under maximum
anticipated conditions of stack effect and wind effect.

909.21 Elevator hoistway pressurization alternative. Where elevator hoistway pressurization is provided in lieu
of required enclosed elevator lobbies, the pressurization system shall comply with Sections 909.21.1 through
909.21.11. 909.21.1 Pressurization requirements. Elevator hoistways shall be pressurized to maintain a
minimum positive pressure of 0.10 inches of water (25 Pa) and a maximum positive pressure of 0.25 inches of
water (67 Pa) with respect to adjacent occupied space on all floors. This pressure shall be measured at the
midpoint of each hoistway door, with all elevator cars at the floor of recall and all hoistway doors on the floor
of recall open and all other hoistway doors closed. The opening and closing of hoistway doors at each level
must be demonstrated during this test. The supply air intake shall be from an outside, uncontaminated source
located a minimum distance of 20 feet (6096 mm) from any air exhaust system or outlet.

FIRE COMMAND CENTER [F] 911.1 General. Where required by other sections of this code and in all buildings
classified as high-rise buildings by this code, a fire command center for fire department operations shall be
provided and shall comply with Sections 911.1.1 through 911.1.5. [F] 911.1.1 Location and access. The location
and accessibility of the fire command center shall be approved by the fire chief. [F] 911.1.2 Separation. The fire
command center shall be separated from the remainder of the building by not less than a 1-hour fire barrier
constructed in accordance with Section 707 or horizontal assembly constructed in accordance with Section
711, or both. [F] 911.1.3 Size. The room shall be a minimum of 200 square feet (19 m2 ) with a minimum
dimension of 10 feet (3048 mm).

SECTION 913 FIRE PUMPS [F] 913.1 General. Where provided, fire pumps shall be installed in accordance with
this section and NFPA 20. [F] 913.2 Protection against interruption of service. The fire pump, driver and
controller shall be protected in accordance with NFPA 20 against possible interruption of service through
damage caused by explosion, fire, flood, earthquake, rodents, insects, windstorm, freezing, vandalism and
other adverse conditions. 913.2.1 Protection of fire pump rooms. Fire pumps shall be located in rooms that are
separated from all other areas of the building by 2-hour fire barriers constructed in accordance with Section
707 or 2-hour horizontal assemblies constructed in accordance with Section 711, or both.

PLUMBING
[P] 2902.2.1 Family or assisted-use toilet facilities serving as separate facilities. Where a building or tenant
space requires a separate toilet facility for each sex and each toilet facility is required to have only one water
closet, two family/assisted-use toilet facilities shall be permitted to serve as the required separate facilities.
Family or assisted-use toilet facilities shall not be required to be identified for exclusive use by either sex as
required by Section 2902.4. [P] 2902.3 Employee and public toilet facilities. Customers, patrons and visitors
shall be provided with public toilet facilities in structures and tenant spaces intended for public utilization. The
number of plumbing fixtures located within the required toilet facilities shall be provided in accordance with
Section 2902.1 for all users. Employees shall be provided with toilet facilities in all occupancies. Employee toilet
facilities shall either be separate or combined employee and public toilet facilities.