Central Living Spaces

The success of the Green House mode demonstrates the value of a central, shared, domestic-scale communal area composed of living area, an open kitchen and dining area, collectively called a ‘hearth’. Meals are prepared in the open kitchen by caregivers and shared at the common kitchen table. This shared area is typically connected to a protected outdoor space, where in the more successful settings the doors are left unlocked, and the outdoor space is used for activities and socialising (Cohen et al., 2016).  

Restricted access to common areas or shared living areas can be isolating for residents and a balance must be struck between social engagement, communal activities, and infection control. This issue pre-dates COVID-19 with Stone arguing that “Maximising quality of life for the resident while minimising transmission of infections is a known challenge facing NH staff” (Stone et al., 2015). While more research is required in this area, it is useful to consider the advice set out by the AIA (2020) to change layouts in shared spaces to facilitate social distancing or provide outdoor seating and exterior social areas for occupants and visitors. 

While some settings may need to zone or group patients, it is still important to ensure there is safe walking space, especially for residents with a cognitive impairment who may ‘walk with purpose.’

(BGS, 2020)

In line with recent WHO guidelines, good ventilation is critical to reducing the transmission of COVID-19 in indoor spaces and therefore all living, kitchen, and dining areas should be well ventilated (WHO, 2021). 

Residents being able to move freely around the floor and the back garden with fresh air and sunlight, another aspect is the residents being able to see their family members in house rather than through the pods and being able to attend activities, especially outings.

- Staff

The main day room is well ventilated, bright, as there are windows and doors that open to the outside on both sides.

- Family Member

Long corridors far away from facilities and nurses’ desk/supervision. If the floor space is too big and too far away from areas such as dining rooms, drug dispending areas, sluice rooms – it means residents have to wait for staff to retrieve items.

- Staff

I think the dayroom can be very full at times, leaving a clear, free passageway should be an option.

- Family Member

Key Findings

for social distancing

Lack of space was found to be a consistent issue, creating difficulties in the implementation of effective COVID-19 infection control measures in select case study sites. 

of life

Due to lack of space, some residents had to stay in their rooms, and this negatively impacted their quality of life. 


Lack of space required staff to adapt the delivery of certain activities, including using corridors when lounges were too small to accommodate.