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Aggie’s Senior Outpatient Clinic An Exciting Place to Start A New Life


Aggie’s Senior Outpatient Clinic Final Study Design Master of Architecture Department of Architecture College of Architecture Texas A&M University September 2017 - May 2018 Behzad Yaghmaei


ACKNOWLEDGEMENT


I would like to express my gratitude to my Chair member, Dr. Kirk Hamilton, for his patience, motivation, and immense knowledge, and his continuous support of my final study. Besides, I would like to thank my committee members: Dr. Susan Rodiek and Dr. Eric Bardenhagen, for their encouragement and insightful comments.I would like to give a special thanks to Dr. Ray Pentecost for all his support during the last year. Last but not the least, I would like to thank my family and my wife, for supporting me spiritually throughout my life.


S C O N T E N T

Project Goal and Description

1

Inspirational Case Study

6

Site Location

10

Master Planning

12

Program and Space Requirements

14

Concepts

20

Final Design

28

Snapshots of The Project

42

References

44


Project Brief

A typical inpatient stay in a hospital is about 5 days, and that may cost you over $10,000. It found that even people with health insurance payments, on average, more than $1,000 out of their pockets for a hospital stay (Maggie, 2016). This figure does not include major procedures, ambulance fees, or other charges. It is easy to see how a short stay in the hospital may leave your family in a difficult financial situation. Due to all expenses for utilizing hospital services, this project aims to propose the new idea in future health facilities, especially for seniors. The main idea is to design an outpatient senior clinic, rather than a hospital, next to a hotel and seniors’ recreational center, which will give them an opportunity to have procedures in the clinic, use recreational facilities in the wellness center and pay less for their stay in the hotel. Moreover, there are also many hotel services that can be used by patients and their families, especially for those who have kids. In order to achieve this goal, I plan to establish a 72-hour Recovery Care Center for postprocedure recovery in the hotel. The project mission is to preserve the building design traditions in Texas, but in a modern architectural language. This modern design concept can be representative of the clinic’s modern facilities and up-to-date, sophisticated physicians.

2 | Project Goal and Description


The design mission is to promote healthy aging by keeping older adults well, active and independent for as long as possible. Patients 65 years and older have unique medical needs, and the Senior Clinic not only recognizes those needs, but also is focused on proactively protecting and preserving the quality of life for our region’s older patients. Geriatricians are physicians who specialize in the care of older adults. We can provide acute care or coordinate treatment with other primary care physicians. According to the site potential, designing an outpatient senior clinic in this area, which could provide both primary care and long-term care for patients, becomes the project goal. This new clinic can work closely with both Mature Well and the Stella hotel. Patients are able to use the therapy facilities at MatureWell and they could stay for a few days after their treatment in the hotel with their families. The clinic will also contain 24-hours emergency room for patients who need special treatment. There would be also a community in the clinic, which would provide consulting services and improve the patients’ knowledge to have a better healthy lifestyle. Interior design for senior has changed significantly in the last decades. The reality is that today’s senior clinic facilities are more like hospitality facilities design than with institutional hospital design (Santini, 2017). Thus, in designing interior spaces, the project will provide the elements that help them to experience homelike spaces. Accessibility is an issue for the seniors. They cannot walk for a long time, while they need a clear wayfinding in the clinic space. Social support is very important for the seniors, which can have positive effects on their restoration and rehabilitation. It is recommended to set up

a weekly meeting to educate senior how they can have a healthy lifestyle. Aggie’s Senior Clinic provides a variety of surgical and ambulatory services. It also works as a community in which social support, day-healthcare services, health education programs and so forth, are established to help seniors having a better lifestyle. Personal behavior has a great impact on senior health. Many people have access to the healthy food and nutrition, however many don’t have it. Most of the American people have obesity. Many diseases are related to obesity, especially in the older ages. It can be prevented by encouraging people to have more physical activities. Yoga sessions and group activities can be helpful to reduce the obesity in society. There are many facilities in MatureWell center that can be used by patients in order to reduce their weight or have physical therapy. The clinic can provide classes and group activity to improve seniors’ health. Walking, Aerobics (floor, water, or chair aerobics), Bicycling, Gardening, playing with grandchildren, Swimming, and Golfing are some example of activities that can be facilitated for the senior healthy lifestyle. Diseases that can be treated in the clinic are:

Chronic lung & heart disease

Asthma is one of the most common lung diseases among old adults. It is often diagnosed as a long-term condition in older people. For other people, it may be a continuing problem for younger years. In Texas, asthma affects nearly 12.2% of adults and an estimated 7% of residents aged 75 and older. (MI BRFS, 2007) According to The National Heart, Lung and Blood Institute, The most renowned treatment for lung diseases are:

Project Goal and Description | 3


- Elderly patients may need assistance in order to keep their asthma under control. They may have difficulty with transportation, prescription costs or emotional stress. - Because compliance with multiple therapies – for both asthma and coexisting diseases and conditions – may be difficult, elderly patients often need special education and training in using asthma medications and devices - Avoidance of environmental triggers, including tobacco smoke and other airborne irritants to which the patient is sensitive, is useful for many elderly patients with asthma - The seniors with Asthma problems have to be protected from any air pollutant and other contaminations in the enclosed spaces.

Heart problems

Heart failure is one of the most serious conditions among older adults. Scientists estimate that 5 million people in the U.S. have heart failure and that number is growing. It contributes to 300,000 deaths each year. Heart failure is most common in those who are age 65 years and older and is the first cause of seniors hospitalization. Heart failure can be the result of other diseases or conditions that damage the heart muscle. It is often caused by coronary artery disease, including heart attacks. Diabetes and high blood pressure also contribute to heart failure risk. The clinic provides appropriate facilities for a series of checkups and small procedure for those patients who have hearth problems. The healing space inside of the clinic can provide a comfortable space for seniors. Having more connection with nature can reduce the stress and high blood pressure among older adults.

Impaired overall function and falls

In general, fractures are the most common serious injury resulting from falls in older persons.

4 | Project Goal and Description

Specifically, fractures of the hip, wrist, and pelvis in this age group result from the combined. Each year in the United States there are approximately 220,000 each of hip and wrist fractures in persons over the age of 65. The clinical environment, which is designed for seniors, should be covered with safe materials that reduce the possibility of falls and fractures.

Osteoporosis

Osteoporosis is a common problem among seniors that causes bones to become thin, weakened, and easily broken (fractured). Women are at a higher risk for osteoporosis after menopause due to lower levels of estrogen, a female hormone that helps to maintain bone mass (Rosen, 2017) Fortunately, preventive treatments are available that can help to maintain or increase bone density. For those already affected by osteoporosis, prompt diagnosis of bone loss and assessment of fracture risk are essential because therapies are available that can slow further loss of bone or increase bone density (Rosen, 2017).

Parkinson’s disease

Parkinson’s Disease occurs when cells that produce dopamine begin to die, thus decreasing dopamine in the body. The messages to the brain controlling movement are interrupted. This leaves a person incapable of controlling movement. (Barichella, 2009) Some surgical treatment options include deep brain stimulation (DBS). In DBS, surgeons implant a battery-operated device called a neuro-stimulator. This device delivers an electrical charge to areas of the brain that control movement. They block the abnormal nerve signals that cause tremors. Exercise is another way to address the symptoms of PD. Activities like bicycling, yoga can improve brain coordination, balance, and flexibility. (Barichella, 2009)


Stroke

A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives your brain of oxygen and nutrients, which can cause your brain cells to die. Every stroke center should have a territorial relationship with the surrounding centers. This relationship, which would be the key to transition patient care and to providing better comprehensive stroke care to all residents of a region. According to Filho 2013, it would include the following: - 24-hour availability of a superior stroke care center if a need arises. - A referral system easy and reliable enough to be completed in minutes. - Extension of air medical transport coverage for patients that might need be transferred to a higher-level stroke care center. - A close relationship with rehabilitation program(s) that specialize in stroke habilitation - Availability of a CT and/or MRI equipment for an urgent scan within 30 minutes of a patient’s arrival at the ER. - Availability of a vascular laboratory (e.g., carotid ultrasound and transcranial Doppler) and cardiac imaging facility. - Stroke data bank to collect measures applicable to quality assurance and better patient care.

consulting neurologist, or a psychiatrist refers patients to the Memory Clinic. (Walestra, 1997) In clinic design, Colors and patterns on walls should not be sharp. Transitions have to be seamless. For example, if there is suddenly a very dark color on the floor, they may think it is a hole or stair and not want to cross over it. A focal point in the waiting room could be a large aquarium, which research indicates could be soothing to dementia patients. Where the natural light possible, is recommended to use the panel to control the amount of light coming through the spaces, which would make unwanted glazing. It is also recommended to mute sound. Finally, it is necessary not only to meet privacy requirements, but also to minimize distractions (Cordel, 2013). The outdoor space should be designed with high physician observation capability. It is recommended to use a closed loop in designing sidewalks. This policy would reduce the possibility of getting lost or any confused among Alzheimer patients. The clinic also provides group meetings, volunteer activities, day-healthcare services, and a variety of other activities that help seniors to be involved in the community and enhance their social support.

Alzheimer’s disease and other Dementias

Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. All patients undergo standardized neurobehavioral examinations, including neuropsychological and social work evaluations, as well as appropriate laboratory and neuroimaging studies. There can be a day clinic for people with earlyonset dementia. Their primary care physician, a

Project Goal and Description | 5


ASAHICHO CLINIC Architects: HKL Studio Location: Chiba, Japan Area: 310.0 sq. m. Project Year: 2015

The Asahicho Clinic was designed by HKL architect , which is located in a site near a residential complex. The outstanding strategies for utilizing more daylights inside the space and natural material, can conduct a sense of relief to the patients and their families who are mostly in stressful

circumstance. The sloped roofing system remind us to the historical building form in that area and it represent a sense of homelike space rather than an institutional space. (Photos and drawings are credited to www.Archdaily.com)

Inspirational Case Studies | 7


SAYANAMOTO CLINIC Architects: Kentaro Yamazaki Location: Saga, Japan Area: 308.58 sq. m. Project Year: 2014

Having visual access to nature is the most noticeable idea in designing Syanamoto clinic. The project was designed for the dementia patients and the insightful use of the library in lobby space, shows the advantage of reading books for preventing the disease among elderly

8 | Inspirational Case Studies

generation. This idea can also encourage the patients and their families to spend their time on reading a variety of books while they are waiting for their beloved one. (Photos and drawings are credited to www.Archdaily. com)


METROPOL PARASOL Architects: JĂźrgen Mayer Location: Sevile Spain Area: 112,700 sq. ft. Project Year: 2011

The Metropole Parasol is a great urban space in Seville, Spain. The insightful use of the timber structure on the plaza has made a pleasant space for people to spend their time there during the day. The pattern of the structure is passed on rectangular framing particles, which are supported by x bracing cable inside it in order to provide enough strength against lateral forces. The structure supports a walking bridge on top of the frame, that provides an amazing view for the visitor toward the city. (Photos and drawings are credited to www.Archdaily. com)

Inspirational Case Studies | 9


Texas A&M

Traditional Club

Project Site

The project site is located near the Traditions Club Maintenance, having an access from HSC Pkwy. The site zone is called “ The Atlas Area”. According to the City of Bryan’s future land use plan, this zone is going to provide a variety senior’s facilities. Currently, There is a recreational facility for seniors which is called MatureWell

Watching Tower

Traditional Club

Lake Walk

Project Site

MatureWell

Coffee Shop


PROXIMITY

Assited Living Coffee Shop

Site

cultural property Educational property Hotel Lake walk Medical facility Recreational facility Residential property

Site location is at Bryan in Texas. It is almost a flat open area next to the Stella Hotel, CHI St. Joseph Health MatureWell Lifestyle Center and the Traditions Club. The site is located in a particular place. It has adjacency to the CHI St. Joseph Health MatureWell Lifestyle Center and the Stella hotel. MatureWell center is actually a senior wellness center facility, which includes

physiotherapy, seminar rooms and other similar facilities for midlife users. The hotel Stella has 176 bedrooms and includes 20,000 SF of flexible meeting and event space - Indoor and Outdoor, restaurant and bars and a Lake walk facility. The Lake Walk facility is located around the lake, which contains seating places, shaded walkways, a golf station and playground.

The project has a healing garden inside of the clinic in which caregivers can watch seniors’ outdoor activity in a safe place. The site area is almost 15000 sq. ft. and it is not on flood plan or streamlines. It is located near the Health Science Center Pkwy and traditions DR. Blvd. Vegetation in this area includes Live Oak trees and which have mostly height of 50’ to 60’.

Master Planning | 13


Prep/Recov

Education

Consulting

Laboratory

Imaging

P.R.

Day Healthcare Gerontology Customer Service

Diabetes Heart/Stroke Arthritis

SUPPORTS

Memory Care Pulmonary

SERVICES

CLINIC Project spaces are divided into three parts: Clinic, Services and Supports. In clinic zone, doctors can visit patients and offer consultant in their own offices. After a quick examination, the doctor will refer them to the service zone which includes the procedure room,

Alzheimer Parkinson

imaging facilities and laboratory. Then patients can be treated or get more information about their health status. Support zone is the part in which patients can use the consulting services about their drugs and prescription..

In addition, physicians can improve the patients’ knowledge about how they can have a healthy lifestyle. A variety of events can be established in the support zone in order to achieve this goal.

Program and Space Requirements | 15


Program Description: Goals Function

Facts

People

 Improving public knowledge about having a healthy lifestyle and talking about threats that have an impact on their wellness

 45% of human diseases are related to personal behavior and lifestyle, and 60% of death is related to personal lifestyle (Zhen, 2008)

Activities

 Reducing obesity by motivating seniors to use walking facilities outside of the building

 30.7% people in 65+ have obesity. Obese people are far more likely to become sick or disabled as they age (Varney, 2015).  Giving your body the right nutrients and maintaining a healthy weight can help you stay active and independent.  An accessible environment allows our seniors to maintain essential links to friends, family and the wider community. It facilitates seniors in maintaining their independence.

 Provide healthy foods for seniors which can be produced in healing garden adjacent to the clinic site  Easy accessibility inside and outside and designing visible destinations Relationship

Form Site

 Improving social interaction Between patients and visitors

 Seniors benefit physically from social interactions and confirm a reduced risk for diseases like some cancers, rheumatoid arthritis, cardiovascular disease, and osteoporosis

 Easy wayfinding is an issue for seniors

 Wayfinding problems can cause anxiety, distress, and decreased interaction in individuals with dementia (Davis, 2016)

 Connecting indoor and outdoor spaces Environment

 Expose to nature  More daylight in interior spaces

 Sunlight may reduce the risk of hip fractures, high blood pressure and stroke or heart attack for older adults (Wuest, 2016).

Quality

 Using modern form and natural materials inside and outside of the building to  Choosing appropriate healing color

 The modern form can be representative of the clinic’s modern facilities and improve reliability  A thoughtful composition can become a form of positive distraction, calming the senses by reducing anxiety (Cavin, 2013).

Initial Budget

 Cost-effective design

 Save money with the cost-effective design method

Operating Costs LCC

 Save money by sustainable design approach  Make financial resources

 Using clean energies  Using recyclable materials

Present

 This project will be a daily clinic  Follow the future land use

 Site boundary is defined by the city municipal

Future

 Possibility for future expansion

 New facilities can be added to project in future

Economy

Time

16 | Program and Space Requirements

3


Concepts  Establish group discussion  Establish a community which gives consulting services to the patients and supports them  Providing comfortable outdoor space  Establishing group activities and exercises  Producing healthy food in the healing garden  Walking connectors  Separate doctors’ offices from patients’ exam rooms  Establishing events for volunteer activity

 Define entrance as a landmark  Design straightforward corridors  Using different color in different clinic’s sections  Design transparent façade on the Lakeside  controlling sunlight reflection from Lake water by designing Kinetic façade  Slope roof shape  Using different color due to the space character. Blue, Green, Yellow, White, and Red are the most common ones. (Stevenson, 2015)

 Choosing local materials and local workers  producing healthy food  Utilizing active cooling system  Providing 24-hour consulting service  The site design should be changed in order to have better performance and accessibility  Expansibility on North-West side

Needs

Problem Statement

 There should be an organized community in the clinic, which care about all patients wellness and follow up their health status.  There should be proper space for group activities like yoga and so on, to improve social interaction and prevent adult depression after treatment.  Designing with ADA standards  Designing Healing garden  Establishing event who let other people come to the clinic and do voluntary services would help to improve social interaction.

The buildings on the site are separated and there are large parking areas between those properties and these parking zones are not covered. Since College Station has mostly hot and humid weather, they are not pleasant spaces for seniors to be encouraged to walk outside of the buildings.

 It is better to split long corridor into different parts with a different color, material, and readable signs.  It is better to control the intensity of light inside the building.  Designing semi-private courtyards, which can be used by patients with the serious condition.  Choosing appropriate materials and colors for different parts.  Designing building with slop roof shape due to the weather condition

Wayfinding is one of the significant issues that seniors usually dealing with it during their lives. The project must have elements that help seniors to find their way easily and without any disturbance.

 Using green walls and a green roof.  The consulting service has to be always available for the patients who have serious conditions.

The new building should be designed based on LEED requirements and it is recommended to work better with nature.

 The clinic required to have this potential to add future expansion due to medical advancements and subjoin research labs.

It is necessary to make an urban space in that area to connect that mixed-use facility together and be able to share their services

4

Some properties blocked the pedestrian access route between buildings on the site, which results to have longer walking distances between those facilities.

The sloped roof system can remind older adult patients to their home. It looks and feels like a home for seniors rather than an institutional space.

Program and Space Requirements | 17


Subtotal

200

Volunteer Support Space Supervisor

1

60

60

Work Room

1

100

100

Locker

10

5

50

Kitchen/Pantry

1

40

40

Toilet Room

1

55

55

Subtotal

305

Total DNSF

2,785

Dept. Net to Gross Factor

1.25

Total GDSF

3,480

Reception

1

40

40

Visitors’ Waiting Area

1

80

80

Manager Office

1

120

120

Small Conference Room

1

140

140

Medium Conference Room

1

300

300

Open Workstation

1

40

40

Quantity

NSF. Area

Total (Sq. ft.)

1

40

40

Record/File Storage

10

10

100

55

110

Office Equipment Space

1

80

80

Total DNSF

1,220

Staff Toilet Room

2

55

110

Dept. Net to Gross Factor

Total DNSF

1,050

Program Space Requirement:

Administration Area

Customer Service Space Description

Quantity

NSF. Area

Total (Sq. ft.)

Lobby

1

200

200

Reception

1

60

60

Registrar/Cashier Work Area

1

80

80

Discharge Lounge

1

300

300

Family Waiting Space

1

200

200

Library (book shelves)

1

140

140

Public Toilet Room

2

150

300

Wheelchair Alcove

1

20

20

Child Play Area

5

50

250

Subtotal

1,550

Space Description Kitchen/Pantry

11

200

200

Cashier

1

40

40

Dining area

1

120

120

Food preparation

1

200

200

Bulk Storage

1

60

60

Public Toilet Room

2

55

110

Register Workstation

1

Quantity

Subtotal NSF. Area

Total530 (Sq. ft.)

Office/consult room

2

200

400

Exam room General

1

100

100

Dept. Net to Gross Factor

Coffee Shop

Space Description Gift Shop

NSF. Area

Total (Sq. ft.)

1

100

100

Equipment Storage Room

Total GDSF

Dept. Net to Gross Factor

2,618

Quantity

NSF. Area

Total (Sq. ft.)

Register Workstation

1

60

60

Patient waiting area

1

100

100

Office/consult room

2

200

400

Exam Room

2

120

240

Equipment Storage Room

1

100

100

Private Patient Room

1

100

100

Patient Toilet Room

2

55

110

Staff Toilet Room

2

Space Description

60

60

1

120

120

Display

1

100

100

Equipment Storage Room

1

100

100

Storage

10 1

60

60

Patient Toilet Room

2

55

100

Subtotal

200

Phlebotomist Work Area

5

10

50

Supervisor Office/Cubicle

1

60

60

subtotal DNSF

990

Supervisor

1

60

60

Work Room

1

100

100

Arthritis/Osteoporosis

Locker

10

5

50

Register Workstation

1

Kitchen/Pantry

1

40

40

Office/consult room

2

Toilet Room

1

55

55

Subtotal

305

Total DNSF

2,785

Dept. Net to Gross Factor

1.25

Total GDSF

3,480

Exam Room Space Description Equipment Storage Room

Quantity

60 200

60 400

1

60

60

Patient waiting area

100

100

Office/consult room

2

200

400

Exam Room

2

120

240

1

Equipment Storage Room

Stroke Register Workstation

1

60

60

Office/consult room

2

200

400

Patient waiting area

1

100

100

Exam Room

2

120

240

Equipment Storage Room

1

100

100

Patient Toilet Room

2

55

110

Staff Toilet Room

2

55

110

240

1

100

100

subtotal DNSF

1,020

subtotal DNSF

880

Total DNSF

2,820

Total DNSF

1,870

12

Dept. Net to Gross Factor

Dept. Net to Gross Factor

1.4

Total GDSF

2,618

Quantity

NSF. Area

Total (Sq. ft.)

60

60

80

Space Description Register Workstation

1

140

140

Patient waiting area

1

100

100

1

300

300

Office/consult room

2

200

400

1

40

40

Exam Room

2

120

240

Equipment Storage Room

1

100

100

Private Patient Room

1

100

100

Patient Toilet Room

2

55

110

Staff Toilet Room

2

Open Workstation

11

18 | Program and Space Requirements

900

Total (Sq. ft.)

120

Medium Conference Room

100

120

80

1

100 subtotal DNSF

NSF. Area

120

Small Conference Room

Total (Sq. ft.)

2

Pulmonary Diseases

Manager Office

NSF. Area

Quantity

40

1

1,708

13 1

Register Workstation

Total GDSF

Administration Area

1

1.4

Total GDSF

Heart Disease

Diabetes

Exam Room Special

Visitors’ Waiting Area

1.4

Total GDSF

Space Description

Gerontology

40

40

1,870

Heart Disease/Stroke

40

1

880

Total DNSF

1,470

1

Reception

subtotal DNSF

1.4

Cashier

Volunteer Support Space

Quantity

Pulmonary Diseases

1

Chapel

Space Description

55

110

Total DNSF

1,220

14

1.4 3,948


Pharmacy Space Description

Quantity

NSF. Area

Total (Sq. ft.)

Office/consult Room

2

200

400

Laboratory

1

100

100

Equipment Storage Room

1

100

100

Patient waiting Area

1

100

100

Patient Toilet Room

2

55

110

Total DNSF

810

Dept. Net to Gross Factor Total GDSF

Memory Care Space Description

Service Quantity

NSF. Area

Total (Sq. ft.)

Alzheimer

Space Description

Space Description Quantity

NSF. Area

Total (Sq. ft.)

Laboratory

Register Workstation

1

40

40

Patient waiting Area

1

60

60

General Exam Room

1

90

90

Equipment Storage Room

1

100

100

Office/consult Room

1

200

200

subtotal DNSF

490

Parkinson Disease Register Workstation

1

40

40

Patient waiting Area

1

100

100

General Exam Room

1

90

90

Equipment Storage Room

1

100

100

Office/consult Room

1

200

200

Patient Toilet Room

2

55

110

Documentation Area

1

60

60

Staff Toilet Room

2

55

110

subtotal DNSF

810

Total DNSF

1,300

Dept. Net to Gross Factor Total GDSF

1.4 1,820

Pharmacy

15

Space Description

Quantity

NSF. Area

Total (Sq. ft.)

Office/consult Room

2

200

400

Laboratory

1

100

100

Equipment Storage Room

1

100

100

Patient waiting Area

1

100

100

Patient Toilet Room

2

55

110

Total DNSF

810

Dept. Net to Gross Factor

1.6

Total GDSF

1,296

Service Space Description

1.6 1,296

Quantity

NSF. Area

Total (Sq. ft.)

Registration Workstation

1

40

40

Equipment and supply storage

1

40

40

Visitor waiting area

1

50

50

Blood drawing cubicle(chair)

1

60

60

Blood Drawing Cubicle (cot)

1

80

80

Blood Drawing Exam Room

1

100

100

Specimen Collection Toilet Room

2

55

110

subtotal DNSF

480

NSF. Area

Total (Sq. ft.)

Clean Core

2

100

200

Gas storage Room

2

20

40

120

120

Registration Workstation

1

40

40

Clean Work Room

1

Equipment and supply storage

1

40

40

Soiled Work Room

1

100

100

Visitor waiting area

1

50

50

Blood Bank Refrigerator Alcove

2

30

60

30

60

Blood drawing cubicle(chair)

1

60

60

Clean Case cart holding

2

Blood Drawing Cubicle (cot)

1

80

80

Sterile Processing Room

2

Blood Drawing Exam Room

1

100

100

Specimen Collection Toilet Room

2

55

110

subtotal DNSF

480

NSF. Area

Total (Sq. ft.)

Space Description

Quantity

Imaging X-Ray Room

16

2 1

MRI Equipment

1

CT Scan Equipment

200 500 400 subtotal DNSF

400 500 400 1,300

Preparation/Recovery Room

240

480

subtotal DNSF

1,060

Other Services

Environmental Service Room

1

80

80

Laundry Room

1

100

100

Trash Holding Area

2

30

60

Ice-Making Equipment

1

20

20

Washer/sterilizer

1

100

100

Steam Sterilizer

2

80

160

Sonic Washer

1

20

20

Sterile Holding Area

1

60

60

300

300

Changing Boots

1

75

75

Kitchen/Food Preparation Area

1

Patient Locker Alcove

1

40

40

Packaging Area

1

100

100

25

25

Injection Room/Block Room

1

120

120

Dry Storage Area

1

Injection Room/Block Room

1

120

120

Refrigerated Storage Area

1

50

50

55

110

Handwashing Station

1

10

10

Staff Toilet Room

2

Medication Preparation Room

1

80

80

Conference Room

2

300

600

Mechanical

4

215

860

subtotal DNSF

2,645

Total DNSF

7,930

Clean workroom

1

100

100

Soiled Work Room

1

60

60

subtotal DNSF

605

18

Dept. Net to Gross Factor

Procedure Room General operating Room

2

600

1200

Control Room

2

120

240

Equipment component Room

1

100

100

Perfusion/Pomp Room

2

100

200

Scrub Station

2

50

100

subtotal DNSF

1,840

Total GDSF

1.3 10,309

Total DGSF TOTAL NET SF. (GDSF) BUILDING GROSS RATIO

26,649 1.3

34,643

TOTAL BGSF

Procedure Room Support

17

Laboratory

Quantity

Personal Design Philosophy and Methods: My design approach is to building comfortable space for people who are going to use it. When I start designing, the first important issue for me is finding answers for questions like: what kind of project I am going to design? How many people will use it? What is the users’ diversity? What is the users’ dominant range of age? Do they have any special ability or disability? What is the user’s cultural background? What are their behaviors? And so forth. I will try to collect more information about the users’ personality; the more I know about them, the better I can design for them. Of course, client’s requirements and initial budget is another issue that can alter the design concepts. When I define the scale of the project and the users’ needs, the next step for me is to find the site characteristics and its potential or limitation of the environment. To me, doing the site analysis is the most important part in this step. The site location, proximity, slope, access, soil stability, dominant wind direction, sound pollution, sun direction, site drainage, and other parameters that related to the site. A good analysis will always give me direction in designing different projects. Evidence Based Design is important as one of initial steps of designing project. It is better to look at the similar project that had done before and making a SWOT table for each project. Finding

Program and Space Requirements | 19


The initial concept was to positioning the healing garden space between the building mass and the lake walk facility. The connection of the healing garden space and the lake walk facility provide the opportunity for the seniors to have more outdoor activity in a secure and comfortable space. However, this module blocks the air ventilation and the building spaces are more exposed to the West sunlight which is not pleasant.

The second concept is work specifically for Alzheimer patient. In this case the healing garden was located on the second floor and the patients are able to participate in outdoor activities in a safe and secure place. Meanwhile, the physicians can observe their activities and give them the services. The other advantage of this module is the amount of shade that is provided by the cantilever and trass garden on the second floor. Furthermore, the ventilation is not interrupted this time and the lake walk facility is now connected to the MatureWell center.

In this concept, we have the procedure and treatment area, administrative area, and logistics zones on the first floor and the physician’s offices are oriented to various direction on the upper levels. The orientation of offices is based on visual access to nature. In this scenario, we can see private terraces on each floor for the physician’s office. Also the air movement does not interrupt by a solid blocks. However, in this concept the wayfinding can be a big issue

In this concept the procedure & treatment area and logistics are separated form physicians offices and administrative area. The healing garden is located between these two blocks and can play a role as a waiting area for the patient’s family while they are waiting for their beloved one. In this model, it is possible to have natural ventilation and it is possible to have a better control on the clean zones and the unhygienic zones for the building spaces.

Concepts | 21


- Two buildings blocked the direct access route between the Hotel and the site - The roads and parking areas between buildings are unpleasant for seniors

Before the Site Development The main idea in this project was to connect the clinic to the hotel Stella and the MatureWell center. Thus, seniors would have an easy accessibility to the facilities and can use their services. They have access to the MatureWell center, which provides the recreational facilities and physiotherapy services for the seniors. Therefore, the clinic has to be adjacent to both of those facilities. If people want to walk to the MatureWell center for example, they can either passing the healing garden inside the clinic or walking through the outdoor pedestrian routes, which have adequate shades. There are indoor and outdoor facilities near those walking routes and there is a number of stopping spaces for them to get rest for a while. The idea of this pattern of people movement near those facilities was driven by the act of water flow between the rocks in a lake. In that case, stones represent the activities and the flow of water represents people movement on the site.

22 | Concepts

After the Site Development

Total Area: 45,000 sq. ft.

Central healing garden can provide comfortable space for families and patients.

The inside open space should be connected to outside open space.

Wayfinding would be easier for seniors by using central open space.

The space which connects indoor healing garden to the outdoor environment can be used for seniors’ indoor activities.

Physicians can have better observation on seniors’ activities while they are experiencing being in the nature.


MatureWell Center

The Hotel Stella

Concepts | 23


Wood Frame Structure

On the first floor, we can see the procedure and treatment area, administrative, and logistics. There are other public facilities like children play area, a waiting room for families, day health care, library space and reading area. The prep/recovery room is located on the south side of the building, which means the patients are close to the Hotel Stella entrance after they are being discharged. The building has four entrance.

The main entrance is on the west side of the building and is the main drop-off area. The east entrance connects the building to the adjacent coffee shop space and the entrance on the north side connect the building to the MatureWell center. Finally, the entrance on the side provides a easy access from the lake walk facility and yoga space for the patients and their families.

Sloped Roof

Level 2: •

Gerontology

Diabetes Arthritis Osteoporosis

Memory Care

Alzheimer Parkinson Dementia

Heart Disease / Stroke

Registration Patient Waiting Area Office Exam Room Equipment Storage

Pulmonary Disease

Registration Patient Waiting Area Office Exam Room Private Patient Room

Second Floor

Level 1: •

Customer Service

Reception Family Area Discharge Lounge Chapel Coffee Shop Gift shop Child play area

Support

Pharmacy Education

Administration

Service

24 | Concepts

Laboratory Imaging Preparation/Recovery Procedure Room Other Services

First Floor


Level 1: Main Stair Elevator Fire Stair

Concepts | 25


MatureWell Center

26 | Concepts


The Hotel Stella

Coffee Shop

There is a healing garden inside of the clinic, which provides the opportunity for the seniors to be more in touch with nature. The interior space has to be covered with wood frame structure elements in order to provide shade for the open space. The colorful rings which are suspended from the wood frame structure, play an important role in wayfinding for the seniors as well as they provide joyful space for the patients’ families who are mostly in stressful circumstances. There is even a playground for the children and a reading area for the seniors, in order to have positive distractions for the patients.

Concepts | 27


The floating wood frame structure above the healing garden space, has upstream and downstream, and it is covered with titanium dioxide coating glass. The titanium dioxide is a sensitive material to the water and by chemical activity that occurred after rainwater touch the surface, it can clean itself automatically. In addition, the lower part of the wood frame structure is connected to the supportive cone-shaped structural column and can

30 | Final Design

rainwater into the rainwater storage tank, which is underneath the healing garden, to be circling back into the system as a grey water. On the first floor, all the walls are designed as partitions, which are consist of 8’ wall partitions and 4’ window frame above it. The window frame fills the gap between the top level of those partitions and the suspended ceiling underneath the second floor. This idea would let the light coming

into spaces and provide natural lighting for inboard areas of clinical spaces. In addition, since the users are able to recognize the distinction between colors of each department by the visual access that they have from the void space in the second floor, using different colors in each department can be a key component to enhance their wayfinding ability.


The colorful glass rings have been continuously placed on both the interior and the exterior part of the wood frame structure. they communicate the sense of place to the patients and their families and represent something more than an institutional clinic. It gives them an idea of what joyful and energetic space they may experience if they come to this clinical and public space. Designing a public space inside of a senior clinical facility, improves

the social relation and provide more possibilities to connect older generation to the young generation, which will give them more hope and support. Research shows that seniors who have social support live longer after they lived clinical facilities rather than those do not have it (Lunstad, 2010). The facilities which are provided for seniors and their families between the clinic and the Hotel Stella or between the clinic and the MatureWell center

includes: outdoor fitness equipment, outdoor coffee shop, garden space, yoga space and so forth. Most of these areas are covered by the wood structure frame. It is possible to use vine to cover the supportive cone-shape structural column and make a pleasant area for those who seats outside of the clinic.

Final Design | 31


Diagnostic and Treatment Public and Administrative

First Floor Plan

Logistics

Mechanical


Diagnostic and Treatment Public and Administrative

Second Floor Plan

Logistics

Mechanical Final Design | 33


Main Entrance and Drop off area

34 | Final Design


Final Design | 35


The wood frame structure entirely covers the interior healing garden space and it provides an enclosed space in which the quality of air can be controlled by the mechanical ventilation system. The air pollutant can be eliminated by using appropriate filters in the ventilation system and it can really help the asthma patients who are very sensitive to the contaminations. So we can expect a comfortable space inside of the building, in which seniors and their families are feasible to spend time together inside the healing garden space. The window partitions fill the gap between the floating wood structure frame and the top level of wall partitions inside of the building. In order to make an enclosed space, that parts of the wood frame structure that should be connected to the window partition, have the double glazed glasses on the top and bottom side of each triangular pieces. The top frame of the window partition would follow the curvilinear shape of the wood frame structure and all gapes will be filled by appropriate sealant material.

36 | Final Design

There is an open space on the second floor for the Alzheimer patients. Because of their mental problem, caregivers have to watch them simultaneously while they are using the outdoor spaces. The wood frame structure provides shade for the terrace garden space of the second floor, which let the patient spend their time in a comfortable space. The terrace garden has also a good visual access to the lake and surrounding landscape features. There is also a day health care service for seniors in the clinic. There are two spaces that are dedicated to this service, which are connected to both levels by a separate elevator. The day health care area on the second level is opened to the terrace garden space. It can be a pleasant place for physicians and caregivers to observe senior’s behavior. The terrace garden has a loop pathway beside the landscape features in order to prevent any confusion for the Alzheimer patients.

Terrace garden space on the second floor


Wood frame structure’s detail

Cone-shape Structural Column

Final Design | 37


Sloped Roof

Metal Cladding Mechanical Installation Glass Window Exterior/Interior Partition 8’ Height

Source: PWP Landscape Architects

The open space between partition walls’ top level and the suspended ceiling’s level, will let the light come through the spaces inside of the building.

38 | Final Design


Concrete Slab

Foundation Beam

Compacted Soil

Final Design | 39


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Scan the QR code to experience being in the project. VR mode is availible

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42 | Snapshots of The Project

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Behzad Yaghmaei ‘18

Aggies senior outpatient clinic  
Aggies senior outpatient clinic  
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