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Architect: HKW Architects General Contractor: Paric Corporation Completed: August 2012 Right: Exterior Courtyards at Dusk

Architecture that supports a cultural shift in Short-Term Rehabilitative Care by Brian Feld, AIA LEED BD+C, HKW Architects

In August 2012, The Lodge at Sherbrooke Village opened in Saint Louis, Missouri, marking a new path for the Alexian Brothers Health System and their Senior Ministries. Four major program components are housed: A Wellness Center, ShortTerm Skilled Nursing, Assisted Living and Hospice. The 60,000 square foot, 64 Bed Lodge, designed by HKW Architects, draws from the “Household” model of residential care, which has been implemented by a growing number of providers over the past 3-4 years. The model seeks to provide a more home-like setting by balancing the medical components of Skilled Nursing and Assisted Living facilities with greater freedom and amenities for its residents. What sets the Lodge apart from other attempts is how the facility creates this type of balance. Balancing these competing forces allows the facility to positively support a cultural shift in care and therefore positively support the Mission of the Alexian Brothers. 1

The Alexian Brothers Mission

The Alexian Brothers are a Catholic Order of lay members who dedicate themselves to living in the community and participating in the ministry of healing according to Roman Catholic tradition. For nearly 800 years, the Brothers’ Mission has aimed to “bring healing to a broken world through collaboration with others.” Their emphasis in Senior Ministries is centered on: • Person-centered, quality healthcare that addresses the physical, mental, spiritual and social needs of the people we serve; • Caring for those at the margins, especially the poor, the dying and those who are overlooked by society; • A prophetic approach that is daring in addressing the true healing needs of our society; • Local engagement that addresses the needs of the diverse communities we serve by meeting people where they are;


THE LODGE AT SHERBROOKE VILLAGE The smaller neighborhoods allow Alexian Brothers the flexibility to determine how best to distribute the type of care in the facility.

Left: Neighborhood Living Area with Kitchen and Dining beyond Below: Covered Porch at Front Entrance

• Formation of those who work and minister in our healthcare system to ensure that all have a deep commitment to our mission and values; • Wise stewardship of resources that achieves both fulfillment of the vision and fiscal responsibility. In 2008, a process was begun within the leadership of the organization to provide a setting that would better support the mission. The resultant Lodge design embodies this


organizational directive through the implementation and further definition of household model concepts. The Challenges

The traditional model of residential care facilities is based almost entirely on efficiency of processes and seeks to centralize functions as a means to achieve this end. Residents are grouped into sections of up to 60 beds, often combined into shared rooms. The section is controlled by a single administrative area, with all care functions radiating out from this central point. All operations involving patient care, food and medicine originates from a central point. Most of the current State and Federal regulations, up until recently, have driven predictable, yet efficient, layouts. It is therefore easy to understand how operational efficiencies and mandated standardization has led to sterile and uninspired environments. The individual resident loses priority to the larger machine of process and efficiency. Consequently, the traditional model is often at odds with the missions of many non-profit providers. The recent trend toward the “household” model in residential care facilities has increased awareness of the need to consider the rights and dignity

of the resident. At the same time, however, the processes required for the staff to operate a residential care facility have not gone away. How can a facility support a positive environment for its staff and create a more comfortable and home-like environment for its residents? Smaller Neighborhoods

First, the Lodge answers this question by creating “neighborhoods” smaller clusters of resident units that are managed by their own nurses’ areas. There are four neighborhoods in the Lodge, each being L-Shaped plans that wrap around exterior courtyards. The neighborhood nurses’ area serves a maximum of 16 residents, simplifying the programmatic requirements of the nurses’ area by reducing the patient load. Linen, bathing and laundry areas are also included in each neighborhood to maintain the traditional operational procedures and comply with current regulations. Residents are able to do their own laundry if they wish. In addition, each neighborhood has its own living, dining and kitchen areas, accessible to residents at all times of the day. The smaller neighborhood supports all the operational functions the traditional medical setting yet does so within a smaller footprint while


THE LODGE AT SHERBROOKE VILLAGE actually increasing the proportional areas dedicated for living and dining. Corridor lengths are greatly reduced and even eliminated where units are located across from living areas. The smaller neighborhoods allow Alexian Brothers the flexibility to determine how best to distribute the type of care within the facility. Currently, two of the neighborhoods are licensed as Skilled Nursing for the short-term rehabilitation in the Wellness Center, one neighborhood for Assisted Living and the other for Hospice. However, should additional skilled nursing beds need to be added, a portion or all of another neighborhood can easily be reassigned without any physical modification.

creates more opportunity for the residents to entertain family and friends and maintain a quality of life consistent with that of their homes. Units were also designed with future flexibility in mind. Shared units can easily be converted into one-bedroom private units with minor reconfiguration to the layout of the plumbing systems.

Unit Sizes, Privacy and Flexibility

Within these neighborhoods, attention was also given within the units themselves to support the balance of function and comfort. Over two-thirds of the units within the facility are private rooms, and all units are at least 30% larger than the units offered in Sherbrooke Village’s other adjacent facility. All private units have kitchenettes, dining tables and living room furnishings that enable residents much greater freedom of choice in how they spend their time. The increased unit size

Wellness Center and Community Space

The inclusion of a Wellness Center, which serves both inpatient and outpatient rehabilitation, is a critical component in balancing function and comfort. The Lodge

Wellness Center not only includes a state-of-the-art rehabilitation center, but also a large multi-purpose living and activity space, which serves as meeting space for the Lodge and the larger community. The Wellness Center provides space to serve Club Alexian, Alexian Brothers’ community-based health and social lifestyle program. All of the spaces are located near the main entrance of the facility. The Center anchors the facility to the local community by providing a place of holistic healing for a transitional population not necessarily ready for long-term residential care. This directly

The Lodge Program • 60,000 GSF • 1 Story • 4 Neighborhoods + Wellness Center • 64 Beds • SNF, ALF & Hospice Units

Wellness Center

SNF Neighborhood 1

Left: Floor Plan showing four neighborhoods and Wellness Center

ALF Neighborhood

SNF Neighborhood 2

Hospice Neighborhood

Above: Typical Studio Unit



THE LODGE AT SHERBROOKE VILLAGE The Wellness Center anchors the facility to the local community by providing a place of holistic healing for a transitional population not necessarily ready for long-term residential care.

Left and below: Wellness Center Rehabilitation Area

supports the Brothers’ vision of local engagement and serving diverse communities. The Wellness Center also offers greater opportunities for residents to stay connected with their family, friends and community with the steady stream of outpatient traffic. Daylighting and Volume

There is a noticeable difference in the amount and quality of the daylight in this facility compared to other similar facilities. Daylighting was carefully considered throughout the design process; one example of its thoughtful use in is the design of the exterior porches. All common living areas are connected to exterior porches, which

allow soft daylight to enter the spaces at nearly all times of the year without any direct rays from the sun. It allows large storefront openings in the common spaces to be used, completely opening up the entire wall surface between the living areas and the courtyards. The common areas of the facility also use the additional volume from large dormers to bring soft, controlled daylight in from clerestory windows. The Rehabilitation Area in the Wellness Center uses the same approach as the neighborhood living areas, with a Northern orientation in lieu of a porch to benefit from favorable indirect daylight. Resident units also have large

window openings, with 54 square feet of windows in the unit living rooms and 32 square feet of windows in the unit bedrooms. Increased daylighting that is carefully designed is a tremendous benefit to the well-being of both residents and staff. Connecting to the Outdoors

Throughout the facility, views extend into exterior courtyards and outward into the surrounding landscape. The smaller neighborhood footprint allows residents to more easily connect with the outdoors by always being very close to exterior views. In addition, the enclosed exterior courtyards enable residents to freely move outdoors while safely remaining inside the facility footprint. The facility encourages the mobility and freedom of the resident through these connections. Rethinking Functional Areas to be More Welcoming and Approachable

One of the most important ways the Lodge balances resident comfort and the medical function is in transforming elements that are typically inaccessible and unfriendly, making them approachable and welcoming places. Nurses’ areas are no longer fortresses with sprawling transaction height counters to hide all the administrative functions needed to serve a high quantity of beds; instead, simple low, desk height work areas are located 4


THE LODGE AT SHERBROOKE VILLAGE within the volume of the dining area. The friendly, approachable design of the desk coupled with its placement within the dining room space removes the institutional nature of this element while maintaining the function required for the staff to serve residents and manage the neighborhood. Directly behind the desk is a small office space with filing and additional desk space for the staff, obscured by frosted glass behind the nurses’ area. The concept of approachability can be seen throughout the entire facility. Neighborhood kitchens are open, residential-type spaces placed between the dining and living areas to let residents freely use them as they wish. The Concierge desk at the main facility entrance and the reception desk at the Wellness Center are both kept purposely low and simple in their expression to promote a more personal interaction between staff and either a resident or a visitor.

The concept of approachability can be seen throughout the entire facility. Elements are both kept purposely low and simple in their expression to promote a more personal interaction between staff and either a resident or a visitor. Above: Concierge Desk at the main entrance Below: Activity Space within the Wellness Center



THE LODGE AT SHERBROOKE VILLAGE around internal courtyards and placing common areas close to the inside corners of the courtyard. All of the reasons given for how the facility balances function and comfort are interrelated and interdependent; the result is a place that positively supports the Mission of the Brothers.

Supporting Mission with Architecture

Alexian Brothers understood that there was a need in the community for a different type of patient care experience, one that was more directly in tune with their vision to provide more holistic, person-centered care and healing, as well as provide a place that furthered connected the Brothers to the larger community. In order to support this change in culture, the facility needed to respond accordingly to enable the staff to effectively implement the mission. For example, the only way the nurses’ areas could be redefined into a more welcoming and approachable place was to organize the facility into smaller neighborhoods, thereby reducing workspace, patient filing and medication needs that overwhelm traditional nurses areas. The same could be said with the relationship between smaller neighborhoods and the connection to the outdoors. Longer corridors serving more units with centralized functions offer fewer opportunities for residents to have spaces that connect directly with the outdoors. The Lodge offers residents and staff visual access to the outdoors from nearly every point in the facility by simply wrapping the neighborhoods


the Alexian Brothers to carry out their mission. © 2012 by HKW Architects. All images and descriptions contained herein are property of HKW Architects and shall not be used without permission.


The Lodge at Sherbrooke Village is designed to support a positive environment for its staff and create a more comfortable and home-like environment for its residents through the following methods: • Smaller Neighborhoods; • Larger Unit sizes with more private rooms and flexibility to modify room types; • Inclusion of a Wellness Center; • Careful and effective use of Daylighting and Volume; • Connection to the Outdoors • Rethinking functional areas to be more welcoming and approachable. Through these methods, the Lodge design defines how a facility can support the concepts of the household model and provide a beautiful place for


Architecture That Supports a Cultural Shift in Short-Term Rehabilitative Care  

Full article explaining how an organization's mission is supported by architecture.