Traveling from BWI to LAX on United…
A delightful flight attendant was concerned because he had “stashed” extra water and blankets on the plane for back-up, and another team had used “his” plane and the extra stores were gone! He said that he is always concerned that he doesn’t have everything or enough supplies that he needs to make his guests comfortable.
This sounded like outcomes from recent focus groups that I’ve completed with hands-on care givers in long term care settings. Their comments included, “We have to ‘stash’ extra supplies in resident rooms to make sure that we have what we need to make residents and patients more comfortable.” On the surface these may appear to be operational issues, but in many ways, these are also environmental design issues. Storage spaces are rarely considered during the programming and design phase, yet contribute substantially to the quality of life and potential independence of a resident. For example, if storage was located at point of service and supplied according to operational needs, supplies, materials, snacks, and more could all be located and accessible for staff, family, residents and patients when needed.
A few years ago, I was walking through a nursing home of a prospective client that had recently renovated his existing community – it took staff 25 minutes to change a catheter. How could this be possible? The discomfort and potential pain that a resident may endure while waiting to have this minor procedure completed seemed so unnecessary. In speaking with the front line staff, the core of the issues was that the storage of supplies versus nursing areas and the location of the residents were completely disconnected. One storage space next to an elevator opened up inside a dining room, making it inaccessible when the room was in-use for a meal or activity. After further review, all of the storage spaces throughout the building were located in all the wrong places. In this case, it was the gathering of supplies that took too long—partially because of the environmental layout and partially because of reimbursement—leading to potential (and needless) suffering.
The programming process clearly did not include the operational overlay and circulation patterns that are part of operating a nursing home. This can impact types and locations of spaces, as well as the materials that are specified for areas. I’ve seen this not only in long term care, but also in hospital settings. After presenting at the AHE (Association for the Healthcare Environment), I heard a half dozen stories just during the lunch hour on how facility design was not reflective of operational needs. For example, a hospital design included lack of storage and separation between clean materials management and existing trash from the building – circulation required for the trash to be driven straight through clean materials management area. A materials example included within a Labor Delivery Room, vinyl plank was used as the flooring. At first I thought that was the right solution, however the designer selected a ‘V’ groove detail between the planks instead of a flush detail. A flush vinyl plank or continuous sheet vinyl would have been the correct flooring choice, but because of the groove, the terminal cleaning required housekeepers to get down on their hands and knees to verify all bodily fluids were cleaned to prevent the spread of infection. Typically, a set number of minutes are allowed for a terminal cleaning so that another patient can be admitted into a room. If this process takes longer, it not only impacts how much harder it is on the environmental services worker to clean the floor, but also the revenue impact of being able to turn a room for the next patient.
As a designer working in long term care, it is a cliché, but true that we spend most of our time designing bathrooms. This is because we are always looking for a better, more compact solution that meets not only ADA requirements, but also the actual circulation needed within a resident room for care givers and mobility devices. The other item almost always missing in bathroom designs in healthcare is storage. If a caregiver has to leave a resident in a precarious position to get extra towels, Depends, or any other supply, fall risk increases. With appropriate storage spaces, these types of situations could be avoided.
I think we can take some lessons from the airlines play book of designs that include compact bathrooms that are well designed with full amenities. Per the Jennifer Aniston commercials for Emirates Airlines, full showers and a designed “spa” experience awaits travelers. This approach to the design of bathrooms in healthcare could actually reduce square footages to please developers and financial folks, but more importantly establish a positive, safe outcome for residents, patients, family members, and staff.
In looking at the full bathrooms from Emirates, there are grab bars in several locations, assistive mirrors that are well lit, full length mirror for dressing, and well-marked storage compartments that contain supplies. Most notable is the access to countertop space that provides a place for bathing and other personal products and towels. Often in shower configurations in healthcare settings, there will be unattractive grab bars and tiled or fiberglass walls, but no place for personal products to be stored during the bathing process.
An opportunity to have a seating area to support dressing is another plus in the well-designed bathrooms. In healthcare settings, this would support independence and those with mobility difficulties. It may be that the TV wouldn’t be needed, but in more and more hospitality settings, flat screens within the bathroom are becoming common place. There was a time when I was told that “flat screens will never become common in long term care, because of cost.” That thinking went by the wayside along with the person who thought that the personal computer would never happen.
Because of the nature of the design, all of the surfaces are curved or rounded. Appropriate edge details are often overlooked within the design of bathrooms for healthcare – eased edges provide easier movement within a space and reduce the opportunities for bruising or being hurt from falling on to a sharp corner or edge.
The vanity area with excellent indirect edge lighting on the mirror is a detail that could be beneficial for patients and residents in healthcare and long term care design. For anyone who wears glasses, has difficulty seeing, or needs more magnification, lighting is key to making this successful. The two level mirror also provides another option for those who need further magnification to see. The soft indirect light that washes the “view” provides additional ambient lighting in a critical task area.
In conclusion, designing healthcare and long-term care settings, competition is becoming more aggressive. Looking for opportunities to be set apart from other provider’s settings has grown in importance. The users of healthcare are better informed consumers – seeking the best available healthcare solution, no matter what the setting – acute care, outpatient care or long term care. Evaluation of other industries like air travel seeking improvements (from Southwest and their “transfarency” to the higher end Emirates with a flying ‘spa’ experience) could positively impact the design of healthcare settings. Next time you are traveling, be keen to the “transformation of time zones” with the use of LED lighting and smart detailing, instead of focusing only on the leg room (or lack thereof). Bon Voyage!
Jane Rohde is the founding Principal of JSR Associates, Inc. located in Ellicott City, Maryland. She champions a global cultural shift toward de-institutionalizing senior living and healthcare facilities through person-centered principles, research and advocacy, and design of the built environment. Clientele includes non-profit and for-profit developers, government agencies, senior living and health care providers, and design firms. Jane speaks internationally on senior living, aging, healthcare, evidence based design and sustainability. She is the first recipient of the Environments for Aging Changemaker Award presented by The Center for Health Design. For more information or comments, please contact Jane Rohde at email@example.com.