17/09/2015Home and Community Care1 Long Term Care Administration Thursday, November 25, 2010 Week 12...

23-04-19 Home and Community Care 1

Long Term Care Administration

Thursday, November 25, 2010

Week 12 - Chapter 8

Environmental Design


Dr. Powell Lawton

Gained national attention in the early 1960's for his pioneering investigations into the psychological and social aspects of aging. During his prolific career, he was the first to recognize the importance of designing living environments for the elderly, particularly those with Alzheimer's Disease.

His groundbreaking studies of the needs of Alzheimer's patients and their caregivers, as well as his continuing interest in probing areas of health and well-being in aging, have continued to play a major role in enhancing the quality of life of the elderly.


Environmental Design

Six Phases Design Process1. Predesign programming.2. Design phase.3. Construction phase with concurrent

planning.4. Design review.5. Activation6. Post occupancy evaluation.


Cost-Effective Design

Unit configuration to efficiently assign space for job-related activities such as record keeping, staff meetings and family communication.

Distances to be travelled so that time used to transport residents, food and linen is minimized.

Processes required to maintain floor, bathrooms, furnishings and walls


Cost-Effective Design, cont…

Allocation pf time to morning care, dining, bathing and toileting.

Bathroom design and equipment.Noise associated with group meetings,

visits and documentation.Light glare.


Unit Configuration

Wages largest budget item, time = money:Functional arrangement of spaces that are

appropriate for the population served and activities is the basic cost-saving measure.

Minimize hallway lengths.Minimize distances between service

areas, storage areas and resident rooms.


Designing Space for Job-Related Activities

The presence of a large central nursing desk gives the message that staff are more important than residents.

Staff can do charting in lounges, kitchens, dining areas, while sitting with residents who require supervision and monitoring.

Space still needed for computers, meetings, medications, supplies, etc…



Integrating workspace within the resident’s environment accomplishes two goals:

1. Encouraging the resident and staff to develop a relationship.

2. Allowing staff oversight of resident activities.



Storage space is often overlooked.Unused wheelchairs, lifts, equipment.No storage in hallways.Tripping and hazard during an evacuation.Clutter is time-wasting.Obliterates an aesthetically appealing

décor.



Resident laundries, snack kitchens, extra dining room, scaled for family celebrations, adequate number of lounges.

Encourage residents to be independent and encourage families to participate in care.

Can also reduce staff workload.


Transport Time

Food and linen transport time has a direct impact on costs.

Shorter distances between resident rooms, dining and activities areas

Small kitchens on unitsCost analysis should be done to determine

whether centralized or off-site laundries or food preparation is more or less costly than unit and in-house services.


Maintenance Processes

Time taken to maintain floors, bathrooms, furnishings and walls is just as important as the initial cost.

Vinyl floor will outlast carpet 10 times over.

Carpet easier and less costly to maintain.Consider the cost of equipment, supplies

and labour costs to maintain flooring.


Time-Consuming Care

Private rooms and well-designed ensuite bathrooms with good equipment can be cost-effective, staff work more efficiently.

Cupboards in the wall between each resident’s bathroom and bedroom.

Store supplies for the resident where both staff and residents can easily obtain them.


Time-Consuming Care

Dining arrangements allowing residents to be less dependent on staff, promote self-care are cost-effective.

Short travel distances, decrease the need for staff to transport seniors.

If food service arrangements encourage seniors to serve themselves, less staff will be required.


Toileting and Bathroom Design

Big space for two staff members on either side of the resident who cannot self care.

Residents should be able to see the bathroom from their bed.

Nightlight that highlights the bathroom.Grab bars assistive devices independenceBathing area hand held showerhead,

controls on the showerhead end.Proper drain for incontinence and pericare.


Noise Control

Effective noise abatement reduces resident and staff agitation.

Auditory systems of seniors limits their ability to hear conversations with background noise.

Noise levels in the dining, nursing, foyer, and lobby areas are directly related to resident behaviours and agitation.


Noise Control

Noise reduction coefficient (NRC) is a scaler representation of the amount of sound energy absorbed upon striking a particular surface.

An NRC of 0 indicates perfect reflection; an NRC of 1 indicates perfect absorption.

Minimize sound control by sound-absorbent materials on flooring, window coverings and walls such as book cases.


Noise Control

Fans, heating ventilation air conditioning (HVAC) ice machines, cleaning equipment, elevators, electrical devices.

Table coverings, felt gliders reduce noise.Public address systems only used for

emergencies.Staff use hand held remote phones

including for staff to resident communication such as nurse call systems


Spaces for Natural Interaction and Noise Abatement

Good interpersonal space design for conversations and interactions.

Chairs are often lined up in a row.Smaller lounges, hallway alcoves,

residential furniture arrangements.Small clusters where 3-4-6-8 can sit

facing eachother.Quiet rooms are helpful.


Spaces for Natural Interaction and Noise Abatement

Televisions should be limited to specific areas and purposes.

Televisions, inhibit conversations.Dementia residents have difficulty

distinguishing reality from the television screen, it triggers behaviour problems.

Adequate seating is needed in hubs.Lounges, meals, movies, music, relaxation


Nurses’ Stations

Assisted living settings have reception areas rather than formal nurses stations.

Welcoming centre for information and informal conferences.

Influence interactions and encourage face-to-face communications.

Low counter tops, home design.Staff lounges or meeting areas for short

breaks or private conversations.


Light and Glare

300 lux level – minimum average illumination (50 foot candles)

Each bedroom must, in the opinion of the medical health officer, have sufficient natural or artificial illumination to provide task or reading, bathroom and general illumination sufficient to meet the needs and preferences of each person in care accommodated in the bedroom (ACR).


Light and Glare

Artificial and natural light can cause resident anxiety and irritability.

Shiny areas on floors = wet = falls.Reflection in mirrors, windows, glasslike

surfaces = ambiguous images illusions.Mate surfaces = reduce glare, distortions

and paradoxical images.


Safety and Security Systems

Prime directive = safety and security.Exit control, fire safety, falls prevention,

poison control, issues in LTCF.Perimeter security systems monitor all exit

doors – magnetic locks and wander guard.Oakfield Estates – beds, toilets, residents

are monitored by sensors providing info to central database on weight, vitals, sleeping and exact location.


Comparing Costs of Building and Renovating

Hiatt’s Analysis includes: capital, operational costs (new staff, lost days), interim costs (catering), compliance (asbestos removal), contingency funds.

Life cycle “useful life of a building in terms of materials, systems and spaces.

Non-profit 30 – 60 years.Three categories of expenditures:

capital costs, consumables, labour.


Design Issues

Six Specific Issues in LTCF Design:Accessibility and Aides.SafetyColour-contrast and brightnessRedundant CuingLighting and CommunicationControl Systems


Accessibility and Aids

Principle design feature is accessibility.LTCF should be wheelchair accessible.Sidewalks, parking areas, steps & curbs.Light switches, electrical outlets, work

surfaces and sinks may not be accessible for persons in wheelchairs.

More accessibility = more independence and more capability for self care routines.


Other Safety Considerations

Dark areas on floor are holes and shiny areas are wet or icy for dementia resident.

Contrasting colours = poor design.Bright lighting & dark patches poor design.Venetian blinds are not advisable.Translucent shades of continuous cloth,

okTransparent blinds should be avoided.


Colour Contrast and Brightness

Colours appear faded for seniors.Blue and green cannot be distinguished

as the cornea of the eye yellows with age.Signage large enough to read and text

contrasting with the background.Signs are not just labels, they are

wayfinding tools.Signs should be placed at decision points.


Redundant Cuing

Using multiple cues together that appeal to different senses.

Sensory loses of the elderly include: vision, hearing, olfaction, skin sensitivity, joints and muscle feedback.

Example, dining room signs, words, symbols, special lighting, smell of fresh bread wafted outward by fans.


Lighting

Uniform, indirect, variable intensity lightingNight lighting highlight the toilet.Rope lighting under the handrails.Wall scones for indirect light.


Communication Systems

Phones in resident rooms.Computers and internet access.Call systems link staff with residents.Staff can use pull cords to get assistance.Flashing strobe lights for emergency

system for the hard of hearing.


Air Quality Control Systems

Circulate and change air regularly.Eliminate noxious odors.Continence products, deodorizers,

eliminate any odors caused by bodily wastes.

Adjust air pressure, positive and negative, can improve air quality.

HVAC system


Accessing the Environment

PEAP Professional Environmental Assessment Protocol

Maximizing awareness and orientationMaximizing safety and securityProviding privacy, stimulation and

coherence (regulation), and stimulation and coherence (quality)

Supporting functional abilities


Accessing the Environment

PEAP, cont…Providing opportunities for personal

control, continuity of the self.Facilitating social contact.


Impact of a Consumer-Oriented Model of Care on Design

Support or inhibit choice.IndividualityIndependencePrivacyDignityResidential atmosphereFeelings of securityControl over the environment


Assisted Living Settings

Regnier definition – “a long term care alternative that involves the delivery of professionally managed personal and health care services in a group setting that is residential in character and appearance, it has the capacity to meet unscheduled needs for assistance, while optimizing residents’ physical and psychological independence.


Assisted Living Federation of America

Largest national association exclusively dedicated to professionally-operated assisted living communities for seniors. ALFA's member-driven programs promote business and operational excellence through national conferences, research, publications and executive networks. ALFA works to influence public policy by advocating for informed choice, quality care and accessibility for all Americans seeking assistance with long-term care.


Assisted Living Federation of America

COMMUNITY SYSTEMSINFRASTRUCTUREA Place in the Action BY ANYA MARTIN Placing common areas off the main circulation route is just one example of how architects are looking at how today's seniors use common spaces. Spaces and flow planning are based on the behavioral needs and desires of residents.


Homelike Settings

If the photos of a long term care facility can be mistaken for a family home, then the setting has achieved a homelike environment.

Begins with the exterior façade, residential scaled porches, window details.

Look more like family residences than hospitals.


Dignity

Design provides for private ensuite bathrooms which are safe and accessible.

Staff respond with respect and courtesy.Care plans and activities acknowledge

uniqueness.Residents are addressed by their proper

names at all times.ADLs assistance promotes independence

and choice.


Privacy

Central social need, more important when people live in a congregate setting.

Individual space, permit emotional adjustment when confronting a barrage of personal and social stimuli.

Private rooms a must.Decorated to one’s own taste with familiar

furnishings, personal taste and style.


Individuality

Heterogeneous in care and therapy needs.Resident focused care models with

individualized assessments.Rooms should be large enough to permit

more than one furniture arrangement.Space should allow for their own photos,

treasures, and clothing.Locked area for seasonal storage.


Choice

Better well being, less use of daily assistance, social and recreational activities, integration within the community.

Environment – controls for heating, lighting, fresh air in resident’s rooms.

Choice in whom they associate.Dining room table mates.


Independence

Reduced travel distance enhances independence.

Bathing spaces in ensuite bathrooms.Wheel-in showers, hi-low bathtubs.Care of animals & plants Eden Alternative,

self maintenance, helping eachother, taking responsibility, resident independence is fostered = Quality of Life.


Investigating Consumer and Staff Views into the Design Process

Design objectives and reduction of users’ anxieties regarding change.

Reduction in errors that would lead to increased construction costs.

Encouragement of positive attitudes.Creation of a sense of community.Opportunity to reassess organizational dynamics

and policies.Identification of design features important to

residents and visitors.

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17/09/2015Home and Community Care1 Long Term Care Administration Thursday, November 25, 2010 Week 12...

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