Due to the coronavirus, senior care centers have closed their doors to visitors including family members of residents. Though this separation can be heartbreaking, infection control is paramount.
So, what is the role of architects amid the coronavirus pandemic? The American Institute of Architects has established a task force to address this question. The AIA task force will create a database to house a collection of their findings to be a resource for future pandemics. They will also address how to provide rapid-response for Alternative Care Sites (ACS) when healthcare facilities are overwhelmed.
Architectural senior living and healthcare design professionals are also looking for ways to expand their ability to isolate infected individuals. The CDC recommends that residents infected with COVID-19 be placed in Airborne Infection Isolation Rooms (AIIR). These isolation rooms provide special care for individuals who fall under one or more of the following categories: residents with acute illnesses, disruptive residents, and residents who are terminally ill.
In 2017, Montag Architects completed a project at Guthrie County Hospital that included a negative pressure isolation room to contain airborne contaminants. There are two types of isolation room to contain contaminants; negative pressure rooms and positive pressure rooms. Negative pressure isolation rooms isolate patients with infectious conditions. All air in negative pressure isolation rooms must be exhausted to the outside and not recirculated throughout the facility in order to protect everyone else in the facility from becoming ill. Positive pressure isolation rooms maintain a higher pressure inside and keep all contaminants away from the patient or resident. Contaminants from the surrounding environment are not allowed to enter the room. (Think “boy in the plastic bubble” with his compromised immune system.)
The state of Iowa does not currently require isolation rooms in skilled nursing facilities. However, codes are constantly changing and maybe this pandemic will change airborne isolation room codes once again.
In April, Montag Architects attended our first Environments For Aging (EFA) conference in Savannah, Georgia. As stated by Debra Levin, President and CEO of The Center for Health Design, the goal of the EFA conference is "To bring together the myriad of stakeholders involved in creating a diverse collection on environments for seniors that promote healthy aging and maintain the dignity of their residents."
Our goal in attending the conference was to discover new trends in senior living and connect with and learn from this "myriad of stakeholders". We attended educational sessions on resident-centered regulatory improvements, post-occupancy evaluation reviews, the resident-centered approach to planning, design, and construction, environments for the generations, radical transformations - turning tired old buildings into "the place to be", and the IBC 2015 international Building Code and what it means for assisted living.
I will never forget hearing my father say, "Don't you ever put me in a nursing home." When you think about that statement for a moment you begin to understand the fear and dread that many seniors feel at the prospect of having to move to such a place. You think about the long, sterile hallways very similar to a hospital, losing your independence, and the feeling of being isolated due to the lack of social interaction. The institutional approach with one large central dining room, repetition of corridors with room after room on both sides, and institutional finishes are being replaced with households which means smaller "neighborhoods" that create an atmosphere more like home. These households limit the number of residents in a group and generally accommodate between 10 – 18 people. Each has its own living room, dining room, and smaller kitchen that is accessible to residents just like at home in place of a huge commercial kitchen with no access. The household model gives residents a sense of ownership and control.
Though the household model is a more recent design development, we started implementing this model in 1997 at facilities like Heritage House in Atlantic, Iowa and Park Center in Newton, Iowa. Our goal was to give residents a better way to stretch their legs and interact with one another. Rather than taking a walk down a long corridor to stop, turn around and walk back, we created smaller neighborhoods so residents could walk in a circular pattern from one neighborhood or household to another.
The household model is not just about the physical structure of the building and creating smaller groups of people, it also includes a change in philosophy of care that empowers residents and ensures that seniors live with a sense of well-being. This means not being regimented by a strict schedule, rules, and boundaries, but giving resident more freedom to choose such things as wake up time, meal times and menus, showers, and activities.
In the household model there are also changes in how the staff interacts with residents. Certified nursing assistants are often referred to as partners who make sure the resident's needs and wishes are attended to. This facilitates the residents making choices and decisions for themselves. This shift in approach to caregiving helps to create meaningful relationships.
When I look at current trends, my guess is dad would have a different opinion of nursing homes were he alive today. Hopefully, due to this household model, feelings of dread at the prospect of having to move in are being replaced with a sense of optimism and excitement.
This takeaway hits close to home as we recently completed conversion work for administrator, Shannon Minshall at Fleur Heights Care Center in Des Moines, Iowa. We provided a code review and a plan for the conversion of a Skilled I-2 (Institutional 2) occupancy space to an assisted living, dementia specific space.
Assisted living I-1 occupancy defined:
Condition 1: This occupancy condition shall include buildings in which all persons receiving custodial care who, without any assistance, are capable of responding to an emergency situation to complete building evacuation.
Condition 2: This occupancy condition shall include buildings housing any persons receiving custodial care who require limited verbal or physical assistance while responding to an emergency situation to complete building evacuation.
Assistance with evacuation can occur because of care recipient's physical or mental limitations or both. Assistance with evacuation would include assisting persons who may have resistance or confusion in response to an alarm.
Assisted living I-2 occupancy defined:
Institutional Group I-2 occupancy shall include buildings and structures used for medical care on a 24 hour basis for more than five persons who are incapable of self-preservation.
Advantages for classifying assisted living as I-2 include:
The bottom line - housing options for the aged are the best they have ever been! Thankfully, that's true! There have never been more options available for seniors. From aging in place, to housing cooperatives, to the village concept, to independent living, continuing care retirement communities, to assisted living, to skilled nursing, the options are out there. The task then is look at your needs and budget to help narrow the housing option down to what works best for your situation.
If you've been to your doctor's office, hospital, or medical clinic lately, you may have noticed a few new things in the waiting room; namely, large, oversized chairs that look like they might be love seats. These are bariatric chairs designed to support more than 300 pounds of evenly distributed weight. Good healthcare and skilled nursing design includes making sure that obese patients will maintain a sense of dignity during their visit. This means not having to struggle to get in and out of chairs and that bariatric seating blends in with the other furnishings in the room. This ensures bariatric individuals will feel comfortable physically and emotionally.
Our nation's obesity epidemic is at an all-time high. The Centers for Disease Control and Prevention states that almost 40 percent of American adults and nearly 20 percent of adolescents are obese. This is the highest obesity rate ever recorded for the United States.
The most commonly accepted method of identifying bariatric patients is the body mass index (BMI), a formula currently accepted by the U.S. Department of Health and Human Services (DHHS). According to the BMI, being overweight is defined as having a BMI of 25.0 to 29.9. Obesity is defined as having a BMI of 30 or higher. Morbid obesity is typically defined as being 100 pounds or more over the ideal body weight or having a BMI of 40 or higher. The BMI is a simple calculation of the height of an individual divided by his or her weight.
With the increased rate of obesity, architects must incorporate design solutions that not only accommodate obese individuals, but also minimize the risk of workplace injury to those caring for these patients. These accommodations include such things as wider doorways, additional space for larger, heavy-duty beds (the maximum weight a standard hospital bed can handle is 350 pounds), heavy-duty toilets, bariatric chairs, and the addition of lifts, which may be freestanding or mounted on the ceiling. Many obese patients have limited mobility, and may be unable to leave their bed without the help of a mechanical device. In new construction, architects must design the structural support with this lift equipment in mind.
Hospitals routinely discharge patients to skilled nursing centers for the final stages of their healing. For obese patients, finding a facility that will take them is extremely difficult. Many times, they are left stranded at the hospital.
We recently visited a senior living center that was built in the late 1960s. The administrator said that she gets at least 2 or 3 calls a day asking if they admit obese patients. She said she has to turn them away because they are unable to accommodate them. Many obese seniors find themselves turned away from nearby senior living facilities simply because that facility does not have the necessary equipment and staff to care for them.
Most skilled nursing and rehab centers are simply unprepared to care for the increasing number of morbidly heavy patients. They are lacking in adequate staff, equipment, and knowledge. They also lack the funds to provide care as accommodations for obesity are very costly. Many care facilities cannot afford to care for them as a mechanical lift (those with lift tracks on the ceiling) can cost up to $10,000 and extra-wide beds $5,000. Architects must design specially outfitted wings for these patients/residents.
Even though obesity rates in the United States are at an all-time high, there is good news. Based on an article by Scott Kahan, MD, MPH:
Read the entire article by Scott Kahan: http://scottkahan.com/is-obesity-a-public-health-achievement/
The spectrum of care available to seniors can sometimes be confusing, leaving a person not knowing where to start. The outline below breaks down and defines the available options and ranges from adult day care to hospice. Understanding the terminology used for various types of care will help you make an informed decision.
Nursing facilities and assisted living facilities are considered "I" Occupancy (Insititutional Occupancy) buildings and are required, by the state of Iowa, to have architectural design drawings signed and sealed by a licensed Iowa architect.
Average costs listed below are for the state of Iowa and can be influenced by a number of variables. There are multiple resources available to assist you in finding the appropriate level of care. Sources for additional information are listed below the outline.