Clients today are looking for solutions to the rapidly evolving senior housing market. Confronted with an increasingly frail resident at entry, coupled with a move toward a “household” model for both Skilled Nursing and Assisted Living, attention to design is heightened. Smallhouse and Household models dictate life-quality, choice and dignity, delivered in a “home-like” setting are becoming the norm. How do we maintain continuity with the design and the required culture change shift to a resident centered care model? Operations and design are not autonomous and design for this population is quite specialized.