Mark Huxta headshot
Mark Huxta
Mark Huxta
Mark Huxta

While the COVID-19 pandemic challenged the world with two of the most difficult years in recent history, long-term care and other healthcare workers were on the front line of the pandemic and experienced a completely new level of strain and demand in the workplace. In light of these challenges, senior living and care communities are expected to provide a safe and healthy environment for residents and a positive working experience for nursing and other staff members. Be it an independent living community, an assisted living community or a nursing home, the physical and emotional health of the nurse caregiver and other workers has a direct effect on the quality of care and services delivered.

The average age of today’s nurse is 52 years. Nurses work 10 to 12 hour shifts, walk numerous miles in one day and experience other physically demanding aspects of the job. Those can lead to a variety of injuries, including back and knee pain, bone spurs and plantar fasciitis.

It’s critical, therefore, for long-term care providers to focus on and enhance the ergonomic conditions of the staff’s environment, to improve productivity and retention. Improved seating, better work tools and new technology all contribute to a more ergonomically friendly healthcare space. The not so obvious contributor to employee comfort and health? The floor.

The topic of ergonomics as related to flooring should be comprehensively defined to include comfort, fatigue, musculoskeletal strain and injury and emotional stress created by noise in the interior environment. Each factor contributes to or detracts from the general well-being of the resident or staff member.

Injuries among healthcare workers rank among the highest by industry, according to the Bureau of Labor Statistics. Musculoskeletal disorders account for one-third of all occupational injuries reported to employers, whereas back, leg and foot fatigue follow closely behind. It’s a main reason that designers, facility managers and administrators are paying more attention to create environments that support the workforce, starting with the floor.

Flooring design and specification

Most traditional flooring products provide little, if any, ergonomic relief and consequently can contribute to pain, discomfort and fatigue among staff. Flooring performance once solely was measured by durability, maintainability, resident mobility and affordability. Although those characteristics still are important, today we are entering a new age where expectations for a floor are changing, and we are asking it to do more.

When building and designing a space, the focus of the work environment must be on people and not just about product. It should be about how flooring and other materials can enhance the lives of residents and staff members. This focus is achieved by specifying a flooring product that is more appropriately designed and engineered for long-term care applications.

Tie between built environment, wellness

A clear relationship between the built environment and the effect of flooring on nurse wellness was indicated in evidence-based design studies for healthcare facilities conducted by The Center for Health Design. Those studies also reveal the effect on the resident experience and satisfaction. A nurse who is not fatigued, stressed or in pain due to enhanced ergonomics provides better quality of care. It follows that similar benefits are seen related to other staff members.

Nursing staff who have experienced ergonomic flooring report better underfoot comfort and relief and also often mention the reduced noise and acoustic properties of the product. Nurses even have told us that they requested reassignment to other departments because of the better flooring areas. Those examples reveal how ergonomics is playing a much larger role in product specification.

Further, flooring products that reduce noise and provide superior acoustic properties also lead to better resident satisfaction. Noise is a major issue in senior living and care communities. Caregivers roll mobile medical carts, linen carts, food carts and waste barrels up and down hallways continuously throughout a day, all of which can create much noise. Adding sound-absorbing materials can greatly improve the environment for a peaceful, more home-like setting for residents and a calmer care environment for staff members.

Residents and caregivers also want to feel at home in a senior living community. Drawing from lessons learned through evidence-based design research, the direction of designers and architects today is away from the sterile, institutional environment to flooring looks that are more natural, warmer and homeopathic in design. This influence comes from the hospitality industry with the focus on providing a soothing, pleasurable environment for residents, visitors and staff members.

Optimal flooring technology

One must factor force reduction and energy restitution, or the storing and returning of energy, to understand the science behind a truly ergonomic flooring. Force reduction measures the amount of energy the floor will absorb when stepped on. Energy restitution measures the amount of energy that is returned from the flooring to the body when a step is made. Those are the key components to consider when selecting the right flooring for a healthcare setting.

With a softer floor, more energy will be absorbed by the floor and less energy will return to the foot. The result is that more force will be required to take each step. Alternatively, the harder the floor, the greater the return of energy to the foot, resulting in more discomfort to the body. Finding the optimal balance between the energy the floor should absorb and the amount that should comfortably be returned to the body is essential.

One also must consider slips and falls, which can have life-threatening consequences for older adults. Installing a thicker surface — specifically an engineered one featuring a heterogenous sheet vinyl or homogeneous sheet rubber fusion bonded to vulcanized composition rubber backing — can reduce force impact up to 35.5% compared with thinner surfaces.

Ecore’s senior living flooring products, for example, use a patented, tested technology called itsTRU to fuse a performance wear layer to a 5 mm Ecore recycled rubber backing. It is designed to significantly reduce fall impact as well as provide better foot-fall reduction and energy return compared with other traditional resilient floor coverings, to make life more comfortable for residents and staff members. Additionally, Ecore’s line of itsTRU products also are able to reduce structure-borne sound, providing a quieter space.


Ergonomic materials in the healthcare setting including how a floor — the foundation of the healthcare environment design — can contribute to nurse comfort, and health is officially getting the attention it deserves from designers, architects and specifiers. When long-term care caregivers and other staff members have a better quality of life, it affects the quality of care and services they provide, which in turn can contribute meaningful improvements for the older adults under their care, and overall satisfaction rates.

Specifying a more comfortable, ergonomic flooring material can contribute to reduced chronic pain to improve productivity and resident quality of care, reduce staff absenteeism and workers’ compensation claims, and lead to an overall improvement in quality of life for dedicated senior living and care providers.

Mark Huxta is healthcare director of sales for Ecore, a company that transforms reclaimed wasted into performance flooring surfaces, aligning substantial force reduction with a balanced amount of energy return. More information is available at

The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.

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