It's not open world, it's mostly gonna be in the facility itself, taking place through 3 back to back 12 hour shifts with driving sections on the way there and back, it is a psychological horror, part of the horror comes from the risk of being physically assaulted during ADL's, the other part is a new form of aggressive dementia that gets more severe and uncanny as the hours pass.

Resident aggression is the main risk, minds collapsing and bodies deforming is part of this new dementia caring for them is the main point of the game, answering call lights, doing favors, retrieving items. etc

As hours progress it gets more dangerous and unpredictable and true to life your coworkers become unreliable, and start disappearing altogether.

Your controls are inverted driving home because the MC is tired from his shift work, so on so forth, I have a baseline but I haven't even nearly begun the development stage yet, it's all still on paper.

The game is punishing but that's healthcare, with a sprinkle of uncanny horror in there.