Motivated by global experiences with the COVID-19 pandemic, designers have begun to generate guidelines to steer the development of future environments. While some argue that we will eventually return to a world comparable to what we previously experienced, most believe our physical spaces should be transformed in anticipation of similar future crises (Honey-Rosés et al., 2020).

While these changes impact all building typologies, some, such as education, work, and commercial transitioned quickly to online formats. Others, such as healthcare and hospitality, were at the core maelstrom of the crisis. These two building types are particularly susceptible to major crises in health and wellness as they represent the locations for treatment (hospitals, mental health facilities, skilled, assisted and independent senior living) and restoration (hotels, gyms, food service and resorts).

This paper was initiated January 2021, as COVID-19 vaccines began to become available. Without knowing how the pandemic would play out, we began to collate the research and evidence-based predictions of industry and academic experts. The paper was not intended to be a typical systematic review as the timeframe for garnering publications was from January 2020 to June 2021 and the opportunity for researchers to analyze data and publish the results was limited. As these were not traditional times, we took a non-traditional approach. The need for information regarding both research and best practice pushed us to cast the net beyond peer-reviewed journals.

The following paper summarizes our findings.

An extensive literature review was conducted that resulted in approximately 200 citations derived from university and online search platforms of which 41, which specifically address design, are discussed in this paper. An additional four papers were added during the review process for a total of 45. Databases that were accessed included Science Direct, JSTOR, Google Scholar, Sage Premier, American Medical Association, PubMed, Healthcare Administration, American Society for Microbiology, Academic Search Premier, Springer, and DOAJ (The search term strategy is demonstrated in Figure 1). Inclusion criteria included peer reviewed journals (n = 27) as well as recommendations from agencies such as the National Collaborating Center for Health, the National Investment Center, and the Substance Abuse and Mental Health Services Administration (n = 4). Also sought were best practice recommendations published by design and health practitioners (n = 10). (See Figure 2).

All references addressed the impact of COVID-19 on design as well as changes in policy that would result in physical environmental modifications. Due to delays in publishing and the need to bring data to the table quickly, some of the papers were in pre-release status. Publications in the lay press (e.g., The New York Times, The Wall Street Journal and the Washington Post), while insightful, were excluded.

The results were summarized in a draft document which was then distributed to a group of experts (N = 12) specializing in health, hospitality and design, recruited through a university industry advisory board. The organizations represented by these individuals included senior living, healthcare, hospitals, wellness providers, hospitality, architecture, mental health, and health-related finance. Each participant had more than 20 years of experience in their field and their titles included: Board of Trustees (1), CEO/President (4); Chairman (1), Partner/Principal (3), Professor of Practice (1); Executive Director (1), and COO (1).

The contribution on the part of the experts was to review the preliminary literature summary and to identify areas that were inappropriately emphasized or were missing. For example, we originally stressed the significance of technology in senior facilities without reinforcing the notion that human interaction is also critical to a good experience. As a result of this senior living expert’s recommendation, we re-reviewed the content of the cited papers and uncovered statements that also supported this observation. In another case, the hospitality design expert reaffirmed our findings regarding hospitality environments, but organized it in such in a way as to emphasize the importance of essential topics. We used the tiered structure that recommended to provide an introduction to that section of the paper. In a third case, a healthcare advocate reminded us of the importance of addressing cultural differences which had been mentioned briefly, but required more emphasis.

Input was provided via written commentary and/or 30-min interviews. The revised version was then orally presented via video conference to the collective group of experts followed by discussions in two focus groups. The document was revised again based on these subsequent contributions, resubmitted for additional input, and ultimately summarized in this paper. The process is summarized in Figure 3.

Based on the literature review and expert input, dozens of recommendations were made regarding post-COVID health, hospitality and seniors environments. Table 1 provides highlights of design strategies provided by various designers and researchers.

Hospitality settings come with their own unique challenges. McCarthy (T. McCarthy, personal communication, March 31, 2021) notes that there are three “tiers” of responsible action:

1. Precautionary operating protocols within existing, established hospitality environments.

In a study by Bonfanti et al. (2021) involving interviews with hotel managers seven safety measures were identified including hygiene, work reorganization, service reorganization, technology innovations, modifications to customer wait time, staff training and improved communication. The intended outcome is improved customer safety experience. According to the recent Gensler Hospitality Pulse Survey (Hoskins and Cohen, 2021), hotel guests are more comfortable staying in hotels than using adjacent amenities such as outdoor bars and restaurants and 88% are wanting hotels to modify their services post-pandemic. Hoskins and Cohen (2021) suggest that hotels of the future will address guest needs for supporting work in multiple settings; the “blurring” of work boundaries will necessitate the development of adjacent spaces such as short-term rentals and “work from hotel” options (Hoskins and Cohen, 2021). Based on the use of hotels as healthcare delivery spaces during the COVID-19 pandemic, this repurposing certainly has precedent when considering future needs. The possibility that guestrooms can be converted to gyms, small dining areas or small meeting areas will meet social needs and enhance revenues (Hoskins and Cohen 2021).

Several protocols will enhance the role of hotels in the future: room service transitioning to support healthier food options, enhanced cleanliness protocols and touch free interfaces (such as registration desks), and more thorough digital services (such as preset lighting and entertainment, and climate control) (Hoskins and Cohen 2021, Glu).

Keeping in mind the need to provide “soft-touch” in hospitality environments, the increased use of robots is a likely strategy for infection control in hotels in the future. Zhong and Verma (2019) found that guests generally rated robot-assisted services highly in a study of 88 hotels in China. Two-thirds thought of robots as a good value and would return to a hotel that employed this technology. The technology was perceived as supportive of food and other deliveries as well as check-in and check-out functions.

With indoor dining capacity cut during the pandemic, restaurant operators creatively expanded their outdoor dining venues to accommodate social distancing requirements. Close collaboration within municipalities to adjust the zoning requirements to use sidewalks, closed off sections of streets, or even adjacent parking lots to add tables for guests was needed. Building restaurant pods or tents to completely enclose the tables was a method some restaurants utilized but the safety of such structures is still debated.

Dining completely in the open air already has its challenges, with guest preferences regarding noise, wind, bugs, light, scents and temperature impacting their desire to remain in doors. In addition, al fresco dining creates difficulty regarding the logistics of service delivery with longer distances from kitchens, service bars and point of sale machines as well as creative adaptations for service ware and tabletop décor. Outdoor dining has severe limitations, especially in cool weather climates and seasons. “On average, 60.5 [Fahrenheit] is the lowest temperature diners say they’ll tolerate to eat outside,” according to the National Restaurant Association Household survey. Building an enclosed and temperature controlled ventilated tent can be expensive, but many guests are willing to go out to eat if social distancing measures are maintained through such a space. Will this trend continue once the pandemic fully subsides? While the zoning requirements might return to pre-pandemic status limiting the use of space outside the restaurant, the concept of al fresco dining will remain popular in moderate climates.

Reconfiguring restaurant dining spaces to be more flexible for guests is also a lasting impact from the pandemic. Having more flexible and moveable seating to create clusters of tables or separated sections to increase space between guests will offer more options for hotel dining. During the pandemic, some hotels converted unused guest rooms into private dining areas, as the space was available due to lower occupancy levels. While perhaps not cost effective in the long run, creative applications of unused space can allow for more flexibility in accommodating guests who are dining in the hotel.

Resourceful uses of outdoor spaces abounded throughout the pandemic, from turning balconies and courtyards into dining areas or parking lots into dining rooms, and in moderate temperature climates this approach will continue to be popular. Repurposing outdoor spaces to create al fresco kitchens can also create the enhanced perception of dining in the middle of the action and being part of the “show,” while allowing for increased air flow and social distancing. Further, the popularity of the open kitchen model in many restaurants can be recreated in outdoor spaces.

One drastic change that occurred during the pandemic was the cessation of self-service buffets across all industry segments, including: retail prepared foods in grocery stores, restaurants, banquet events and gatherings to on site commercial foodservice such as hospitals and campus dining. Concerns regarding food safety and airborne pathogens made the process of self-service buffets too dangerous, and most buffets were shut down due to local food health department regulations. Often the spaces used to hold large portions of food were turned into compartments for grab-and-go meals or left bare. Modified stations where personnel would portion and package meals from a buffet, or select items for a guest behind the protection of a Plexiglas shield were utilized during the pandemic. This method of buffet service, having an employee portion and serve guests, has increased labor costs and may be unappealing to guests who are used to selecting their own food. Nonetheless, this method is a safer alternative to open-style buffets. Finally, the space dedicated to buffet style service can still be modified in multiple ways to create an attractive yet functional area for guests.

Managers of senior facilities persevered to protect their residents, while at the same time maintaining critical social links. Supporting safer environments meant a reduction in residents. The National Investment Center found that senior housing occupancy in the United States decreased 1.3% in the fourth quarter of 2020 (National Investment Center, 2021a) and 1.8% below that (National Investment Center, 2021b) in the first quarter of 2021. The NIC suggests that move-ins were reduced as the result of moratoriums to enhance patient safety, and move-outs were the result of transitioning to higher levels of care. Nevertheless, it is likely that the number of residents will increase post-pandemic.

The physical environments of nursing homes are generally very different than that of the preponderance of private pay senior housing (independent living, assisted living, memory care, continuing care, retirement communities) settings which are appreciably newer and feature much larger living space (Argentum, 2016). Fulmer et al. (2020) suggest that future nursing home populations might be more effectively cared for in dedicated sites such as hospice or memory programs. Longer stay patients may be better located in small facilities such as Green Houses and similar residential settings. Fulmer et al. (2020) also suggest improvements to adult day health centers which would potentially deflect residents from nursing homes. For short-stay rehabilitation, Fulmer and colleagues propose reconsideration of extended care wings in hospitals that might swing between functions but regulatory environment and payment models must change to facilitate this transition. Vipperman et al., 2021 note that recommendations for assisted living facilities and skilled nursing homes are similar, but the demands for visitation during COVID are higher and required better integration of psychosocial and medical services than has been previously offered.

At the neighborhood level, access to public transportation, amenities, and green spaces support quality of life and resilience (Sharifi and Yamagata 2018). These “will also benefit the residents and staff of nursing homes, and family members. For older people in particular, a well-designed public realm with safe, accessible, and attractive pedestrian space is linked to walkability and improved social outcomes for older adults” (Anderson et al., 2020).

The pandemic has created an opportunity to investigate physical plant innovations and flexibility in congregate living health facilities. Several recommendations have been suggested by experts as summarized in Table 2.

The authors of this paper include specialists in design, policy analysis, and hospitality. This combination of skills helped us to examine the issues from multiple perspectives. Per Capolongo and colleagues (2020a), “Even more than in the past, a multidisciplinary approach is essential, to develop systemic operational skills, capable of dealing with complexity and therefore, as a paradigm, also with the effects of the current pandemic.” Through this shared lens, we have summarized the current common knowledge regarding the design of health and hospitality environments. The range of building typologies addressed were purposely selected. By sharing the tools of diverse design genres, we are able to problem-solve more creatively. When considering health and hospitality specifically, we come to understand the symbiotic benefits of applying design goals from one sector to the other. Prior to developing a response to the physical environmental demands of the pandemic, researchers had found that patients prefer healthcare facilities that embrace concepts from hospitality and guests in hospitality settings often seek wellness amenities. During the pandemic and now, as we transition to a post-pandemic world, these contributions and overlaps are even more clear.