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ADAPTING TO CHANGE
A RECOMMENDATION GUIDE TO SAFE BUILDING DESIGN
The senior living industry is charting new territory, defining how the next normal will look. The pandemic has shifted operational models and torn the threads of connectivity that caregivers, residents, and families share with one another. Meeting current minimum design requirements for senior living and nursing facilities is no longer enough. Resident and caregiver health and safety are the epicenter of our considerations, with social and emotional connectors as a close second. We have examined areas where design produces immediate positive results. These include: • Evaluating points of entry and sterilization • Visitor, caregiver, and materials management • Studying infrastructure systems that deliver increased clean, sanitized, humidified, air volumes, and “touchless” systems is key
We have developed this in response to clients’ need for solutions and marketable assurances that their residents will enter and reside in good health within their communities.
Congregate Space Planning
No facility is created equal and no single solution will serve all needs.
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Market Share & Marketing
With input from major national owner operators, we attempt to provide thought-leadership providing scalable options to address concerns.
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BEST PRACTICES
HOW CAN FACILITIES EVOLVE TO PRESERVE HEALTH, MAINTAIN SAFETY AND SOCIALIZATION, AND CONTROL ACCESS WHILE REDUCING OPPORTUNITIES FOR TRANSMISSION?
RESIDENT ROOMS As sacred spaces and a respite, residence rooms should continue to foster a feeling of safety, security, and comfortability. Maintaining air quality, implementing infection control measures, and promoting a healthy individual dwelling has always been paramount in the case of senior living facilities. We must be able to adapt existing facilities to respond to the needs of everyone from the resident and their family to caregivers and staff.
BEST
BETTER
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• Incorporate smart technology to allow control of lighting, HVAC, call systems, TV, window shades, etc. • Maximize natural light • Add tunable lighting within units in care settings • Replace windows with larger and more easily operable windows • Install trench drain type shower units with flush transitions • Remodel bathrooms and kitchens to be fully accessible to allow aging in place • Design-Build Process Ideal for Design & Project Delivery • Phasing: Required • Capital Planning: Required • Professional Project Delivery
• Install flush transition strips where flooring material changes are made • Add easy functioning window shades • Design Assist with General Contractor • Phasing: Less Invasive • Capital Planning: Budget Minimal • Hybrid Project Delivery • Provide flexible light switching/dimming • Provide towel bars capable for use as grab bar • Provide accessible bathroom storage
• Facilitate an open and accessible room and bathroom layout to maintain ease of ambulating • Where kitchens are provided, adapt accessibility technics within current layout. » Access to sinks » Adapt cabinetry to be accessible » Appliance accessibility • Clean/Inspect window operation for ease of use • Owner to Contract w/ General Contractor to Perform the Work • Phasing: Minimal • Capital Planning: Minimal
SOCIALIZATION & CONNECTIVITY Until recently, many took for granted the immeasurable impact of socialization and connectivity. The pandemic world has seen those elements that bring us together, stripped away. It is here that we describe how facilities can respond to the necessary requirements of infection control and limit transmission, yet preserve the social fiber that is necessary for a healthy lifestyle in a senior setting.
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• Invest in more expansive technology for memory such as “INTL” • Invest in new fitness equipment that limits inputting settings • Remodel spaces that are designed for smaller group activity areas and larger areas that can accommodate flexible seating/table arrangements • Incorporate visitation rooms that can safely allow visitors of family/friends • Zone altered or flex areas • Building automation and improve air changes • Design-Build Process Ideal for Design & Project Delivery • Phasing: Required • Capital Planning: Early • Professional Project Delivery
• Upgrade WiFi signal strength • Update TV system to allow remote activity viewing, i.e. chapel, music, art, educational, remote learning etc. • Add door auto operators to toilet rooms, outdoor access and other key commons spaces • Add outdoor shade structures for better utilization • Incorporate dinner reservation policy to control group sizes • Design Assist with General Contractor for Code Compliance & Adherence to Regulatory Agency Requirements • Phasing: Less Invasive • Capital Planning: Early/ Budget • Hybrid Project Delivery
• Adapt existing common spaces to smaller living rooms, dining rooms and activity spaces • WiFi signal strength review • Adapt a room near the entrance to a safe visitation room. • Utilize existing TV system to incorporate daily messaging/updates • Provide sanitation stations throughout • Re-evaluate large assembly spaces to accommodate smaller groups safely • Expand/adapt outdoor areas • Facilities Director or On-site Maintenance Director with Specialized Contractor(s) • Phasing: Minimal • Capital Planning: Minimal
BEST PRACTICES
HOW WILL THEY DO THIS WHILE FACING REDUCED MARGINS WAITING FOR A VACCINE TO ALLOW FOR MORE “NORMAL” OPERATIONS?
CAREGIVER WORKFLOW Caregivers are tasked with delivering quality care in a safe environment while managing risk and preventing crises in an effective and efficient manner. Transforming workflow by remodeling shared spaces or increasing infection control measures allows caregivers to respond to critical needs safely and aids in improving staff satisfaction. Best practices serve as a guide to not only meet standards but also exceed workflow expectations.
BEST • In care settings, consider smaller households • Remodel serving/ kitchen areas to be more thoughtfully designed to promote better execution between clean and dirty areas • Consider sharing serving areas to limit risk and gain efficiency • Consider individual med passes in care settings where possible • Residentially scaled rooms that allow visual control to adjacent areas • Design-Build Process Ideal for Design & Project Delivery • Phasing: Required • Capital Planning: Early • Operational Team to work on the team to evaluate process engineering • Professional Project Delivery (Infection Control)
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• Update staff break areas to accommodate needs/ desires — consider reassigning multiple smaller rooms to allow social distancing and remove vulnerability to staff from each other • Take better advantage of outdoor spaces for staff dedicated areas • Design Assist with General Contractor for Code Compliance & Adherence to Regulatory Agency Requirements • Phasing: Less Invasive • Capital Planning: Moderate • Hybrid Project Delivery
• Provide adequate space for staff to do their job • Provide adequate handwashing and sanitation stations • Review serving area sanitation practices by defining clean and dirty areas • Reallocate storage areas to accommodate sufficient PPE • Facilities Director or On-site Maintenance Director with Specialized Contractor(s) • Phasing: Minimal (at facility discretion for speed of delivery) • Capital Planning: Minimal
SECURITY & ACCESS CONTROL When adapting to exceed safe building design standards, security and access control are at the forefront of this discussion. Safety controls include, but are not limited to, upgrading systems to allow for remote access, increasing PPE storage security, and installing fob hardware throughout the campus.
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• Secure storage area for emergency supplies: » Masks, PPE » UV lighting • Review care settings, especially memory care for elopement risks • Update facility management systems for better remote control (fire alarm, MEP, nurse call, etc.) • Update camera locations throughout your campus • Install fob enabled hardware for caregivers and family access • Owner to Contract w/ General Contractor to Perform the Work • Phasing: None • Capital Planning: Minimal
• Upgrade capability to provide remote access to facility staff • Install motion detection (hand wave) door activation in double egress corridor openings • Owner to Contract w/ General Contractor to Perform the Work • Phasing: None • Capital Planning: Minimal
GOOD • Review safety and security control in all areas of your campus • Owner to Contract w/ General Contractor to Perform the Work • Phasing: None • Capital Planning: None
BEST PRACTICES
HOW DOES THE COMPREHENSIVE CARE AND ADMINISTRATIVE TEAM ADHERE TO SAFETY REGULATIONS, ADAPT TRAVEL PATTERNS, COMPLY WITH EQUIPMENT REQUIREMENTS, AND PERFORM THEIR DUTIES TO ELIMINATE OPPORTUNITIES FOR TRANSMISSION AND INFECTION?
SAFE BUILDING DESIGN Safe building design encompasses ventilation and air control, modifying shared spaces, and implementing stricter infection control measures. Approaching building design with a 360-degree view while focusing on each detail is key to operating and maintaining a facility that provides safety reassurances for residents, families, and caregivers.
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• Increase ventilation with 100% outside air capable equipment to provide dilution and the options of negative pressure and flexibility towards the current threat level • Provide final filtration – MERV-13 is the minimum efficiency appropriate for viruses (HEPA is recommended) • Install “touchless” lighting control system and automatic doors to reduce high traffic touch areas • Sensor activated faucets and flush valves (in all public spaces) • Auto flush on tank water closets • Auto sensor hand dryer & soap dispenser at each sink • Hand sanitizer station at each sink or lavatory • Remove drinking fountains and have protocol in place on providing water on request • Remodel the production kitchen to adapt to individual meal service • Design access control to allow hands free access to building, outdoor areas, and toilet rooms • Eliminate all double occupancy rooms and all shared resident toilet rooms • Provide facility management system that would allow remote access by staff • Consider negative pressure rooms in care settings • Design better staff and volunteer break spaces (interior and exterior) • Design to universal design standards to allow for aging in place • Individual/app controlled HVAC systems in units • Tunable lighting throughout care settings • Design-Build Process Ideal for Design & Project Delivery • Phasing: Complex Multi- Phased Approach Required • Capital Planning: Intensive/Early • Operational Team to work on the team to evaluate process engineering • Professional Project Delivery (Infection Control)
• Consider active air cleaning, UV-C (recommended) and air ionization are the most common • As above, increase ventilation capability, but specific to Areas of Refuge • Provide electrical support for mechanical active air cleaning system • Consider installing “far-UVC” light fixtures in high traffic areas • Use wrist blades on all sinks • Soap dispenser at each sink • Auto sensor drinking fountains and towel dispensers • Eliminate any raised transition strips between change in flooring materials • Review staff entry areas to consolidate if possible • Remodel to allow visitors to enter the building without traveling through care areas • Provide safe visitation rooms near the entry • Design-Build or Design Assist with General Contractor for Code Compliance & Adherence to Regulatory Agency Requirements • Phasing: Moderately Invasive • Capital Planning: Moderate/Intensive • Hybrid Project Delivery
• Modify ventilation system controls to maximize outside air, without negatively affecting thermal conditions indicated below • Keep ventilation systems running longer for increased outside air flush • Maintain temperature 70oF-75oF and 40%-60% relative humidity levels • Revise lighting controls schedule, if equipped, to minimize number of touchpoints of building occupants to local control • Clean faucet and flushing device handle daily • Bar soap at each sink • Manual towel dispenser • Push bar drinking fountains • Maintain good public toilet rooms for residents, families, and caregivers • Provide hands free door access control for residents, visitors and staff • Provide ample space for staff break rooms • Facilities director, housekeeping, or on-site maintenance director with specialized contractor(s) • Phasing: Minimal (at facility discretion for speed of delivery) • Capital Planning: Minimal
CONTACT US
Hank Nirider, PE, LEED AP Smith Seckman Reid, Inc. hnirider@ssr-inc.com
Janet Lively, CPSM Schaefer Construction janet@schaefercompany.com
Larry Schneider Plunkett Raysich Architects lschneider@prarch.com