Take a Peek Inside a Small House Design Project
THE NEXT GENERATION OF CARE ENVIRONMENTS
About Maine Veterans Homes
Mission: “Caring for those who served”
Vision: Provider and Employer of Choice and Veterans Advocate
Established by Maine Legislature 1977
6 Facilities (rural and urban areas)
Skilled, long-term & residential care services for Veterans and spouses
How it Got Started – THE FACTORS
The Research
★ We did the homework
★ Facility Tours
★ Attended Presentations
★ Operational Research
★ Small House Research
WHY?
Right decision to support veterans and MVH caretakers
★ Wanted to get it right
★ Key funding depended on pursuing the small house model
Guiding Principles for Design
Enhance Privacy & Independence Provide Broader Resident Experiences
Town Center
Improve ResidentDirected Care with Small House Concepts
Develop Modern, Distinct, And Separate Care Units Provide Wellness Opportunities Increase Community Outreach
Historical Landscape
★ QAPI Dashboard
★ Measurement of Culture Change
★ Use of small house and neighborhood concepts in unit renovations
★ Education of workforce on small house model philosophy
CULTURE CHANGE SCORE
Augusta Campus Planning – KEY SCHEDULE MILESTONES
Warming The Soil
Education of Key Stakeholders
Project Approvals
RFP and Contracting of Project Team
2015 2018
Certificate of Need
Secure Funding
Engage Culture
Change Consultant
Construction Start February 2019
Substantial Completion July 2021
Augusta Campus Planning
★ Key Decisions
★ Project Leadership
★ New Building Location – Site Acquisition
★ One Story Or Two
★ Food Service Program
★ Free Standing Community Center
★ Universal Worker Model
★ Staffing
★ Use Of Language
Architectural Design and How it Positively Affects Healthcare Outcomes
UNDERSTAND
CORE PRACTICE
PROGRAM VS. BUDGET
ARCHITECTURAL DESIGN
SITE
DESIGN
Design Factors
Understanding Core Practice – QUANTITATIVE GOALS
★ Turnover: 15-25%
★ DART: 5
★ Culture Change Score: 500
★ 5 Star rating: 5*
★ Hospital Readmissions: <10
★ SNF DC to community: 90%
★ Payer Mix: to be determined after we review data
★ Res/Family Recommend: top decile performance
★ Fall reduction: 6 per 1000 pt days
★ Occupancy: 95%
★ Energy Star rating for building efficiency
★ LEAN Design Considerations
Understanding Core Practice - INFORMATION GATHERING
★ Person Directed Care Assessment
★ Baseline (current day) and Goals
★ Leadership/Staff Questionnaires
★ Household size
★ Food service
★ Laundry/Housekeeping
★ Medication
★ Therapy – OT/PT/Speech/Recreational
★ Public - Community Center
Understanding Core Practice - DAY IN THE LIFE
As a recognized national leader in the continuum of care for Veterans, MVH emphasizes caring for our veterans in communities where the rhythms of the day are determined by the individual resident’s needs and desires and not by staff routine. MVH strives to create the ideal living environment that celebrates the spirit, the accomplishments, and the value of the individual person.
AN EXAMPLE OF A TYPICAL DAY AT MVH AUGUSTA SCARBOROUGH CAMPUS:
• Each household will develop its own routine based on the individual needs of the residents
• Residents will awaken and sleep at will and coffee will be available 24/7 and in room if appropriate.
• Residents will dress, groom and receive assistance with ADL’s at a time of their choosing and in accordance with their individual plan of care.
Budget vs. Program - FUNCTIONAL SPACE PROGRAM
INDUSTRY STANDARDS
INITIAL FRAMEWORK MVH FRAMEWORK
Small House (SH) Model Design Guidelines (2021, June). VA US Department of Veteran Affairs. https://www.cfm.va.gov/til/dGuide/dgSHModel.pdf
Architectural Design – HOME CONCEPT
more intimate
less institutional
contains fewer residents
home setting ★ private room/bathroom ★ wayfinding
★ connection to nature
★ natural light
Architectural Design - RESIDENT ROOM
★ Larger resident Rooms – floor area, storage, functions
★ Private toilet/shower in each room
★ Potential to add ceiling lift
★ Staff support area
Add image of resident room entry
Mock Resident Room
★ Inclusion of the community
★ Two pages of feedback were provided and used in final designs
★ The end user was a key component in all planning
Architectural Design - LEAN FLOW DIAGRAM
Architectural Design – HOUSEHOLDS
Enlarged image of household kitchen
Mock Kitchen Findings
★ Simple design changes were made when the rooms were used
★ Altering the kitchen design after a chef prepared a meal in the mock kitchen
★ The kitchen was a crucial element of the house to get right- all operationally the same, but look distinctly different
Architectural Design - EXTERIOR SURVEYS
Site Design – THE SITE
★ Topography
★ Rock and Soils
★ Vernal Pools
★ Endangered
Species
★ Wetlands
★ Secondary Access
Site Design
★ Only 11 acres buildable
★ One story approach vs. two story
★ Site footprint
★ Cost
★ Long resident avenues - the one-story approach
Capacity of the site drives design and the model
Site Design - INDIVIDUAL ENTRANCES
Site Design - AMENITIES
Interior Architecture
and How it Positively Affects Health Care Outcomes
Unique House Designs
Seaside Resort Coastal Cottage Farmhouse Lake House
Themes & Color Theory
Way-Finding
★ All twelve houses distinctly different from each other
★ Way-finding
★ Art selection
★ Furniture
Each home has a welcoming kitchen as the heart of the home where residents can see, smell, and help prepare meals.
Resident room entrances are distinctive with strong architectural elements that resemble familiar home exteriors to create a sense of ownership and help residents with memory impairment to locate their room.
Veteran Maine Patriotic Vision
Changing Operations
and How it Was Executed
Change Management
★ Reduction Of Meds
★ Paper Reduction
★ Individualized Mornings
★ Dining And Menu Planning
★ Collaborative Engagement
★ Change Management For Residents & Families
★ Hiring To New Staffing Model Prior To Move
The Outcomes – DINING
& WEIGHT GAIN
Food Intake Increase
Food & Dining
The Outcomes – FALL REDUCTION
★ Lighting Changes
★ Noise Reduction
★ Private Rooms and Spaces
★ More Navigation Space
★ Therapy Services
★ Increased Activity Levels through Life Enrichment
The Outcomes – BEHAVIORS & MEDICATIONS
Decrease Agitation & Anxiety
Reduction in Medications
The Outcomes – ENGAGEMENT
Resident Happiness
Family Visits
Community Engagement
The Outcomes – WORK FORCE
Staff Turnover Decrease
The Journey Continues
★ 8 years to get here
★ Journey is not over
★ Hardwiring the new model
★ Changes to operations plan after move in
★ Leadership commitment
★ Celebrating Successes
★ Educating others and sharing the learnings
Excellence in all that we do in “Caring for those who served” as a provider and employer of choice!