Long Term Care Administration

1. Long Term Care Administration Thursday, November 25, 2010 Week 12 - Chapter 8 Environmental Design Home and Community Care

2. 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. Home and Community Care

3. Environmental Design Six Phases Design Process • Predesign programming. • Design phase. • Construction phase with concurrent planning. • Design review. • Activation • Post occupancy evaluation. Home and Community Care

4. 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 Home and Community Care

5. 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. Home and Community Care

6. 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. Home and Community Care

7. 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… Home and Community Care

8. Designing Space for Job-Related Activities • Integrating workspace within the resident’s environment accomplishes two goals: • Encouraging the resident and staff to develop a relationship. • Allowing staff oversight of resident activities. Home and Community Care

9. Designing Space for Job-Related 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. Home and Community Care

10. Designing Space for Job-Related Activities • 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. Home and Community Care

11. 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 units • Cost 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. Home and Community Care

12. 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. Home and Community Care

13. 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. Home and Community Care

14. 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. Home and Community Care

15. 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 independence • Bathing area hand held showerhead, controls on the showerhead end. • Proper drain for incontinence and pericare. Home and Community Care

16. 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. Home and Community Care

17. 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. Home and Community Care

18. 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 Home and Community Care

19. 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. Home and Community Care

20. 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 Home and Community Care

21. 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. Home and Community Care

22. 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). Home and Community Care

23. 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. Home and Community Care

24. 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. Home and Community Care

25. 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. Home and Community Care

26. Design Issues Six Specific Issues in LTCF Design: • Accessibility and Aides. • Safety • Colour-contrast and brightness • Redundant Cuing • Lighting and Communication • Control Systems Home and Community Care

27. 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. Home and Community Care

28. 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, ok • Transparent blinds should be avoided. Home and Community Care

29. 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. Home and Community Care

30. 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. Home and Community Care

31. Lighting • Uniform, indirect, variable intensity lighting • Night lighting highlight the toilet. • Rope lighting under the handrails. • Wall scones for indirect light. Home and Community Care

32. 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. Home and Community Care

33. 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 Home and Community Care

34. Accessing the Environment • PEAP Professional Environmental Assessment Protocol • Maximizing awareness and orientation • Maximizing safety and security • Providing privacy, stimulation and coherence (regulation), and stimulation and coherence (quality) • Supporting functional abilities Home and Community Care

35. Accessing the Environment PEAP, cont… • Providing opportunities for personal control, continuity of the self. • Facilitating social contact. Home and Community Care

36. Impact of a Consumer-Oriented Model of Care on Design • Support or inhibit choice. • Individuality • Independence • Privacy • Dignity • Residential atmosphere • Feelings of security • Control over the environment Home and Community Care

37. 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. Home and Community Care

38. 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. Home and Community Care

39. Assisted Living Federation of America • COMMUNITY SYSTEMS INFRASTRUCTUREA 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. Home and Community Care

40. 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. Home and Community Care

41. 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. Home and Community Care

42. 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. Home and Community Care

43. 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. Home and Community Care

44. 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. Home and Community Care

45. 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. Home and Community Care

46. 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. Home and Community Care