44 Facilities, 1553 Beds, 3 Years: A Case Study From Nova Scotia Thursday , September 26, 2013

1. 44 Facilities, 1553 Beds, 3 Years: A Case Study From Nova Scotia Thursday, September 26, 2013 Benjie Nycum, NSAA, PMP, CEO, William Nycum & Associates Limited Stephen Terauds, M.Arch, Manager Innovation & Development, William Nycum & Associates Limited William Nycum & Associates Limited

3. Introduction: Nursing Homes in Nova Scotia Single entry system Operated by private organizations Province regulates operations Province funds construction & operations Province sets design standards Province determines locations

4. Nursing Home Design Standards New standards – Well researched and written • Household groups of residents • Minimum of 12 residents per household • Maximum building gross : 940 s.f. / resident • Private rooms = 190 s.f. + 50 s.f. WC • Maximum travel distances for residents • Easy outdoor access

5. Nursing Home Design Standards

6. Standards: Significant Increase in Room Size Typical former situation New Standard W/C 34 NSF W/C 50 NSF

7. Standards: Significant Increase in Room Size Typical former situation New Standard

8. Standards: Significant Increases in Elders’ Living Spaces Typical former situation New Standard NSF/Res.: Liv: 36sf Kit: 17sf Din: 36sf NSF/Res.: Liv: 0sf Kit: 4sf Din: 0sf Kit Liv Din

9. Standards: Significant Decreases in Travel Distances to Dining and Living Areas Dining 50’ max. to Dining from elders bedrooms (75’ max. for half of residents)

10. Projects Built under new Long Term Care Strategy Illustrated in this Presentation William Nycum & Associates Limited Northwood at the Parks Shiretown Ivey’s Terrace Windsor Elms Village Annapolis Royal Nursing Home Port Hawkesbury Nursing Home WHW Architects with Montgomery Sisam Architect Tideview Terrace The Meadows Alderwood SP Dumeresq Architect Limited The Admiral The Heart of the Valley

11. Example Plans: 12-Bed Households

12. Example Plans: 9-14-Bed Households

13. Example Plans: 9-Bed Households

14. Building Massing: Impact of Household Size

15. Household Exteriors Varied approaches to requirement for “residential” scale…

16. Household Interiors

17. Household Plan: 12 Beds Balance between household perimeter and common space & access to views and natural light Kitchen/dining/living room not central – impacts staffing and resident travel distances. Visitors to household pass staff control station prior to entering the more private realms of the elders living here Elders’ toilet rooms are on exterior walls, providing clear view to resident bed for staff – entry to toilet angled for privacy

18. Household Plan: 12 Beds Balance between household perimeter and common space & access to views and natural light Kitchen/dining/living room central to household Staff work areas central to household – visitors to household may encounter resident room prior to meeting staff Elders’ toilet rooms are on interior walls, provide transition from semi-private corridor to private bedroom, but obstructing staff view of residents in bed

19. 12-Bed Addition to Existing: Plan This is an addition to an existing home – less restrictions with respect to ability to access the household without passing through other households Staff workspaces are incorporated within the central kitchen/dining/living space Resident dining/living area and activity space are minimally enclosed with few full-height partition walls leading to excellent supervisory capabilities for staff

20. 12-Bed Addition to Existing: Photo

21. Household Plan: 9 Beds Easier to balance household perimeter & access to views and natural light Staff work areas central to household – designed as “home office,” part of dining/living/kitchen Households linked with shared spa area (assisted bathing), lowering capital costs and providing flexibility for staffing. Resident washrooms on exterior walls increase building perimeter, but help provide more efficient building gross by not requiring room widths to accommodate an accessible door and toilet room side-by-side.

22. Household Plan: 9 Beds Similar to other 9-bed plan – centralized elders’ common space and staff work spaces. Resident washrooms are on interior walls, providing a flattened and more cost effective exterior, but driving up building gross. Each household has its own assisted bathing suite – increasing the overall size of the individual households & pushing first and last bedrooms further away from the central area,

23. Direct Access to Exterior Space

24. Direct Access to Exterior Space

25. Reasons for Deviation from Standards Site & local climate Local politics Client organization • Culture • Willingness to innovate • Champions for change

26. Replacements New Replacements New Replacements New Care Providers Architects Maximize profit margin between implementation costs of standards and 25 year pay back Maximize allocation of space and amenities in spite of standards and 25 year pay back Replacements New

27. Unexpected Factors Not everyone interprets the same • Difficulty understanding what a standard meant Procurement set-up had impact on innovation Fast culture change Designing/building all at once gave no opportunity to tweak and improve Interdepartmental conflicts in government • Department of Agriculture • Food delivery • Floor finishes • Tasks of front line workers • Office of the Fire Marshal • Open plan concept

28. Unexpected Factors Design • How to measure floor area • Could not average out floor areas to suit construction cost efficiencies, for example resident washrooms • Bathing room heat up times • Cost per square foot comparisons • Operating costs not thoroughly evaluated in replacements • Number of beds per household • Floor finishes • Administrative spaces • Accessibility • Systems • Lighting • Anything outside of strict interpretation

29. Include Innovation in the Process A model that gives innovation a chance before the standard is finalized: Study Draft Seek Input Pilot Innovate Revise Implement A model that anticipates innovation is going to happen after the standard is finalized: Revise Implement Innovate Study Draft Seek Input Pilot Revise A model that realizes innovation occurs always, and incorporates it into the standard: Study Draft Seek Input Pilot Implement Implement

30. Benjie Nycum bnycum@nycum.com Stephen Terauds sterauds@nycum.com