Access, community, and experience. These words encapsulate three recurring themes in designing and planning multifamily mixed-use developments. The constructs of apartment homes are merely the place to reside within a platform of services, physical and social amenities, and access to transit, lifestyle, and convenience. The most successful mixed-use projects contain the right blend of tenants and offer a sense of community and connected experience with the goal of enhancing the quality of life of those who live, work, and play there.
However, this promise to facilitate an amplified life excludes an obvious fundamental human need: access to health and wellness. Although multifamily has shifted its attitude to address the trend by incorporating health spas, expansive fitness centers, yoga nidra, urban gardens, and the like in Class A assets, it is not enough. In order to meaningfully integrate health and wellness, the industry must address both health, the healing of illness and injury, and wellness, the preventative measures taken to preserve mind, body and soul. Furthermore, the COVID-19 pandemic serves as a powerful reminder that health and wellness, within the context of access, community, and experience, needs to be at the center of human-focused real estate development and operations.
“We have known for a long time the role that housing plays in a person’s health, but as an industry we have primarily focused on eliminating ‘bad things,’ such as lead, asbestos, excessive moisture, and toxic chemicals from the construction and operation of multifamily buildings,” says Matt Hoffman, managing partner at HousingTech Ventures, an investment and advisory firm working at the intersection of housing, technology, and innovation. “COVID has accelerated the attention we are giving to actual health care at home and how to deliver that both remotely and in person, when appropriate. Although the value proposition of bringing health care into the multifamily business model has been around for a while, the current health and economic crisis has cleared away much of the fog that has made it difficult for many to realize the opportunity. Plus, residents are now likely to be much more sensitive to how health secure their housing is and landlords who want to command preferential rents will need to respond.”
At the same time that real estate has been undergoing a great technological revolution, the health and wellness industry is experiencing the same. According to a news article written by JLL, “The health care industry is an undeniable force in the U.S. economy—it is the largest U.S. employer as of 2018, employing more than 13% of the workforce. It is also one of the fastest-growing industries in the U.S. economy. Technology is pushing more health care services outside hospital walls.” Data, virtual offices, and a shift toward smaller outpatient clinics that offer personalized, local care are allowing centers to expand into new markets and provide patients with more convenient and affordable options. The article continues to report, “But even as the health care real estate has grown to more than $1.2 trillion in value and is more diversified than ever, new construction is not keeping pace. For many hospitals and health systems, reconfiguring their footprints to include more outpatient medical offices is the key to meeting new demand, delivering care to more patients safely, efficiently, and conveniently.”
MIT professor Dennis Frenchman, director of the MIT Center for Real Estate and faculty director of MIT designX, keenly observes, “Underlying the intersection of these two giant industries [real estate and health care] are fundamental demographics. Right now, we have the two largest generations in history increasingly focused on health and wellness. The 72.1 million millennials are prioritizing healthy activities and lifestyles over acquiring things like cars, they favor sharing rather than purchase, and see shopping, living, even work as social activities essential to wellness. They are rejecting commuting and want services now and here. A few years in front of them are the 71.6 million baby boomers, who are aging, but not about to be institutionalized in assisted living, nursing homes, or hospitals, and overwhelmingly prefer to stay in their homes and communities with family, social, and service networks to sustain them. The convergence of these two different types of demand from these two cohorts creates a powerful long-term trend.”
Frenchman further emphasizes the significance of this topic, “At the MIT Center for Real Estate, we try to focus our research, theses, and projects on fundamental topics that will inform and transform the real estate industry. This year we have asked the question: How will the demands for health-centered communities, workplaces, and lifestyles affect real estate and medicine?” The partnership of these two industries can play an incredibly important role in reimagining access to a more efficient and convenient health and wellness system that truly enhance the quality of lives of our constituents and neighbors. It begins with a collaboration between real estate developers and health tech companies and culminates with an extraordinary opportunity to provide safer and healthier communities.
Redefining Access to Health and Wellness
HealthQuarters is a new venture aiming to solve this diverse need by working with real estate developers to launch experiential health and wellness centers rooted in local community. They are bringing together top doctors, wellness practitioners, and consumer health brands to provide connected, seamless, and comprehensive health experiences. Their health centers are anchored in hospital system partnerships so each location has on-site doctors practicing a range of care (primary care, women’s health, ophthalmology, dermatology, etc.) and the provision of wellness services (acupuncture, massage, mental health, physical therapy, etc.) under one roof that treat the whole patient. They also carry brands such as supplements and skin care that can address their ongoing needs.
To help patients navigate and surface these offerings, they index heavily on service and thoughtful design. The digital experience brings together many of these same wellness practitioners and brands through carefully curated virtual services and written content, so guests can connect with care, information, and support right from home. They seamlessly combine digital and physical experiences to unite all aspects of modern care, so it is more accessible and intuitive than ever before. It also ensures that guests receive a predictable and consistent experience and are able to efficiently address their needs in several hours rather than days, encouraging them to be more proactive about their health and wellness.
Additionally, they are designing their centers to ensure guests can feel safe, welcome, and cared for. The physical locations lean on biophilic design principles that go well beyond natural colors and office plants. Textures and materials that are present in nature help create a sense of calm, and the rooms are organized along a central spine to give them a sense of order and make them easy to navigate.
Gensler, a leading global architecture, design, and planning firm, reinforces the importance of thoughtfully designed spaces in health care in its article, Social Design, Creative Spaces, and the Future of Healthcare. “Central to these ideas [creative space design] is an attempt to give people more convenient, effective access to health care. This is a unique challenge in the health care industry, where trust is essential. If it’s difficult to get to the doctor, or if the visit is dehumanizing, you’re less likely to go. That undermines preventive care, forcing people to only consider their health once they’re sick. By better understanding the patient and the provider, we can design spaces that foster the trust necessary for holistic care. This is what we call social design.”
The current environment and impact of COVID means individuals are taking a closer look at immunity and well-being with an intensified interest in strengthening health. The right design can not only help weave together diverse aspects of care in a way that feels easy and seamless, but also inspires a sense of well-being and security that will be essential to bring back to a post-COVID world. The centers, all ground-up developments, will require 10,000 to 20,000 square feet of ground floor space and consider design elements such as:
- A pre-entry vestibule for temperature checks, PPE distribution, and hand sanitization
- A lounge with flexible seating that faces away from neighboring guests
- Touchless doors, wherever possible
- Touchless faucets, bathroom fixtures, and equipment wherever possible
- HVAC virus filtration
- Bleach-cleanable surfaces throughout
- Wall-mounted hand sanitizer pumps
“The goal is to elevate the guest/patient experience by providing a convenient, curated, interactive, and beautifully designed space in which to address all of their health and wellness needs. We are collaborating with a real estate developer to open our first location in New York City in late 2020 and believe this will be the first step in starting to transform health care delivery in the U.S.,” says Bhavdeep Singh, co-founder and CEO of HealthQuarters. “We are also in the process of identifying several locations around the country with plans to ramp up to over 100 centers over the next few years. But we are looking to move the needle even further as we work collaboratively with our partners to innovate in ways that are beneficial to not only these partners, but the whole patient. Specifically, we're focused on breaking down silos and bringing different modalities of care closer together. For patients and providers, there's a real difference between knowing that certain treatments are complementary and being able to access and explore them under one roof.”
Empowering Social and Emotional Health
Health and wellness are not limited to the physical and mental, but also extend to the emotional and social. Multifamily operators and developers dedicate numerous hours and resources to program events and social activities in an effort to build community, foster relationships, and drive engagement. However, discovering new friendships in a building of 400 residents may be a daunting task for many, especially those who are not comfortable engaging with random strangers at a building gathering.
Living in an apartment building during a pandemic can become an even more isolating experience. Recent reports have shown that an increasing number of people, between 33% and 47% more, are feeling lonely and suffering emotionally. This combined with the amount of noise, judgment, and extremity in an unprecedently connected world can exasperate one’s anxiety.
Research reveals that small, selective social circles of supportive peers can help filter through the chaos and carry people through difficult times. To aid with social and emotional wellness, operators and developers can offer residents tech-enabled solutions such as Cobu, an app that makes it easy for residents to connect with each other and facilitate deep, meaningful relationships.
The Cobu app offers residents the ability to connect with their neighbors, local businesses, and their community. Residents can easily join micro-communities like pet owner groups or foodie groups, create and attend virtual and in-person social gatherings, organize volunteer efforts, buy and sell goods in a convenient marketplace, and more.
Ben Pleat, founder and CEO of Cobu, shares, “During COVID, residents have used the app to help others and spread positivity by sharing resources and doing errands for immunocompromised neighbors, hosting their own events via Zoom (like a 'BollyHop masterclass' or Virtual Networking Nights). Other examples include series of balcony concerts—one of which involved a marriage proposal from a resident to his now fiancé!” Cobu has experienced a more than 130% increase in resident activity through the pandemic, which reflects the accelerated need for human connection in today’s world.
Senior housing operators in particular should invest in these types of tech-enabled engagement tools as they house the most vulnerable of residents. “Isolation and loneliness among older adults was a serious public health problem long before the pandemic: In the U.S., a quarter of older adults living at home are considered to be socially isolated, and 43% of them report feeling lonely,” writes Rachel Harrison in her article How to Combat Loneliness in Older Adults During COVID-19. She cites the Global Health Research and Policy journal written by Bei Wu, dean's professor in global health at NYU Rory Meyers College of Nursing, where Wu says, “The outbreak of COVID-19 will have a long-term and profound impact on older adults’ health and well-being. Social isolation and loneliness are likely to become major risk factors that affect older adults’ health outcomes.”
Seniors may need to quarantine for an extended period of time as compared with other age groups thus prolonging the negative effects caused by isolation and loneliness. Harrison suggests, “A key way to maintain social connection at a safe distance is to use technology, which has transformed how we interact with one another, especially during the pandemic.” Even though technology is not a one-to-one replacement for in-person interactions, leveraging these tools can help foster essential and meaningful connections virtually.
Health and Real Estate: A Powerful Collaboration
“We now have a compelling business case to integrate health care into the multifamily business model that not only can improve the immediate bottom line, but also mitigate risk and improve resiliency. Like with the transition for green building from being viewed as another project cost to a way to save operating dollars and attract and retain residents seeking value alignment, we will see a similar shift with health security and multifamily housing,” says Hoffman.
Ultimately, if health and wellness are a part of every project’s design and operating goals, real estate developers can lead the way in providing healthier, more dynamic neighborhoods that serve the physical, mental, social, and emotional needs of the communities around them.