5 Steps to Balance Care and Operations in Remote Skilled Nursing Design

By Erin Anderson, Senior Principal, Director of Interior Design, and Mark Rogers, Associate Principal, Architectural Discipline Leader 

Designing a skilled nursing facility (SNF) in a remote or island setting, like those we’ve tackled in Northern Maine and Nantucket, is a unique opportunity. The challenges of isolation, labor shortages, and logistics serve as powerful catalysts, forcing design teams to rethink the standard model and to focus on operational efficiency and human well-being. 

At SMRT, we approach each project with a structured, integrated mindset, transforming constraints into opportunities. We design with empathy, recognizing that every space we create impacts the daily lives of its users. Our goal is to deliver financially resilient facilities that also serve as supportive human-centered homes and workplaces. 

Here is a 5-step roadmap to achieve this critical balance: 

1. Optimize Operations by Prioritizing Local Serviceability 

In remote locations, every system failure carries a high risk of critical downtime, as specialized parts and technicians are often far away. 

The solution is to redefine high-performance around simplicity and resilience. Consider moving away from specifying overly complex, specialized equipment and instead prioritizing passive design strategies and durable, energy-efficient systems for HVAC, plumbing, and laundry. Systems that are easily maintained by local tradespeople with responsive suppliers and readily available parts. This requires scrutiny and early engagement with equipment manufacturers and the facility’s operations staff to ensure the design aligns with on-the-ground maintenance realities, resulting in lower long-term operating costs and higher reliability. 

2. Elevate the Staff Experience to Power Recruitment and Retention 

The national labor shortage is magnified in remote areas, making SNF’s ability to attract and retain staff its most critical operational challenge. Thoughtful design is an effective recruitment tool. 

Consider designing for maximum efficiency and restoration. Efficiency means optimizing the layout to reduce staff travel distances and minimize wasted steps, allowing fewer staff members to provide excellent care. Restoration means providing bright, beautiful workspaces with ample natural daylight and exterior views (often aligned with the WELL Building Standard). Dedicated break areas, wellness rooms, and exploring holistic solutions like on-site modular staff housing (to mitigate local housing crises) show staff they are valued, creating a positive, sustainable work environment. 

3. Design for Dignity: Empowering Residents with Choice and Connection 

The core mission of care should be supported by a design that elevates resident autonomy. We can achieve this balance by focusing on the soft drivers of well-being: Choice and Connection. 

• Choice is empowered by moving away from institutional models toward a residential feel. This means offering private, single-occupancy rooms and integrating technology that supports independence. 
• Connection is created through small, intimate neighborhoods and varied common spaces that encourage social interaction. By maximizing access to outdoor views, therapeutic gardens, and natural light, the building acts as a partner in maintaining the residents’ dignity and quality of life. 

4. Leverage Prefabrication to Conquer Logistical and Labor Constraints 

Construction in remote locations is often hampered by high material transport costs and limited access to specialized labor. These challenges can be strategically overcome by embracing modular and prefabricated elements. 

By using components such as prefabricated bathroom pods or panelized building assemblies, we shift complex construction tasks into a controlled, high-quality setting. This process drastically shortens the on-site construction schedule, guarantees consistent quality, and reduces reliance on limited local trades, providing a smooth, predictable delivery that benefits both the project budget and the operations team. 

5. Build Local Resiliency: The Ultimate Form of Sustainability 

In a remote setting, sustainability is a prerequisite for operational strength. A self-sufficient building ensures that care will continue even when the power goes out, or supply lines are interrupted. 

We design facilities to be resilient anchors for their communities. This means integrating robust energy-efficiency, on-site backup power, and water-management systems. By reducing reliance on the external grid and ensuring operational continuity, the SNF becomes a dependable safe harbor. This commitment to local, enduring resilience is the highest standard of sustainable design for mission-critical facilities.