Long-Term Care

Tip of the week: Top 10 ways to make your facility a homier dwelling

Contemporary Long-Term Care Weekly, January 8, 2009

Buy versus build: Those aren't your only options to bring your skilled nursing facility (SNF) into the era of resident-centered care. Nursing homes can make their buildings feel more like home and less like a healthcare facility-and still not spend a ton of money.

The first step is to perform a facility assessment, says Daniel Cinelli, managing principal architect in the Chicago offices of Perkins Eastman. Start by determining the time period in which the facility was designed.

In the 1960s, the nurses' stations were centrally located with dining rooms at the ends of the halls. This style came from the Civil War era when nurses needed a central set-up to see when soldiers threw their boots in the hallway, alerting staff that they were needed, Cinelli says.

A decade later, nursing home design took on more of a neighborhood feel with roughly 60 beds and one dining room per floor. More recently, the style has become a double-loaded corridor of resident rooms and a central common space.

Creativity must come into play to help these types of facilities evolve into homier environments without tearing down walls. SNFs that want to stay at the forefront of national trends should take the necessary steps to be homier because of the increased attraction that it gives to potential clientele and the improved quality of life that it offers to current residents, says Cinelli.

A good number of SNFs make upgrades every few years, but they only take it to a certain level, says Michael Allen-Hall, principal architect at Noekler & Hull in Chambersburg, PA. "We all talk about making homelike changes, but in the end, the remodeling doesn't look like your home," he says.

Build structured chaos

Break up the rhythm in your SNF, says Allen-Hall, even though it may be a difficult concept for both architects and nursing home managers to grasp. For example, a lot of principles of design say that if you have a long hallway you should put a lamp on a table every 30 ft. However, that's not a natural flow. It's not how people's homes are organized.

Instead, create interest zones in resident corridors and common areas. There's no mathematical equation to this method. Just ask yourself, "If this were my house, what would I do with it?" For example, clustering furniture to create seating areas near windows might constitute one interest zone, Allen-Hall says.

Allen-Hall and Cinelli highlight the following 10 areas in which SNFs can make small investments that put the home in nursing home:

1. Lighting. Cut down on the glare from your fluorescent lights. In this harsh lighting, even the healthiest people can look ill. Often, people think that if a room looks dark, it needs brighter lights. That's not necessarily true, because what typically happens is that the brighter the light, the more glare is added. "Glare disrupts the eyes," Allen-Hall says. If you have to use fluorescents, shine them down on the floor or lower-third of the wall.

Another way to cut down on glare, Allen-Hall says, is to not have an even distribution of light down the halls or in the rooms. He says he receives push-back from this idea, because some people equate uneven light with increasing fall risk.

"Don't create dark areas, just add variations of light to what you have," he says. For example, not all your light has to be in the ceiling. Try lamps and wall sconces too.

2. Floors. Linoleum flooring is another dated trend that is on its way out with fluorescent lighting. Advancements in rubber-backed carpeting allow for comfort as well as easy maintenance, Cinelli says. "Pick a carpet with some color, but not too much color," he says. "A carpet with a black and red block pattern wouldn't be good for SNF residents because it would look like steps to aging eyes."

3. Wall coverings. Sure, anything is better than a sterile white wall in a nursing home, but that doesn't mean that blue wallpaper with pink and white flowers should be plastered down every corridor. Remember, that's not how we would decorate our homes, Allen-Hall says. Put the wallpaper on a portion of the wall and leave another part bare. Add a soft paint color to another section.

Be cautious of which colors you use in which rooms, Cinelli adds. A mint green dining room doesn't make food appear appetizing. Instead of cool colors in your dining area, use warm ones (e.g., reddish browns or deep forest greens). Wall coverings can do more than please the eye. An acoustic wall covering in the dining room will block out any unnecessary noise from the kitchen and allow natural resident conversation during meal time, Cinelli says.

4. Ceilings. There's not a whole lot you can do with ceilings; most of them in older buildings reach no taller than 8 ft. and remain at one level throughout the facility. All design possibility is not lost, however. Consider adding a skylight, but use caution in placing it. Put it where the room can receive optimal daylight, not necessarily the most sunlight, which can make the room too warm and uncomfortable, Allen-Hall says.

5. Hallway clutter. Reduce the amount of "institutional stuff" in the hallways, Cinelli advises. Rather than using portable medication carts, install lockable medicine cabinets in each resident's room and refill them at night before the resident goes to sleep. Also, put aromatherapy-type refuse containers in each resident's bathroom to dispose of daily waste. Staff can clean them out at the end of the day.

6. Resident rooms. "Most facilities already do a pretty good job of making residents' rooms residential-looking," Allen-Hall says. "We are seeing facilities putting carpeting in the rooms and more furniture, such as armoires, rather than closets."

Also, consider room layout. If you have two people sharing a room and one's sleeping quarters are by a window and the other's are near the toilet, that's not entirely appealing. Try to rearrange the room to put both beds in desirable spots, Cinelli adds.

7. Dining rooms. In addition to choosing paint colors and wall coverings carefully, consider reorganizing the room to add a seating area behind a divider. A faux fireplace would also add warmth to the space. As is common in homes today, SNFs should try to create open areas and less compartmental spaces, Allen-Hall says.

"When you have boxed-off rooms, you tend to get a herd mentality," he says. "Opening up the space allows for the freedom of movement."

8. Common areas. Apply the same open layout concept to common areas. Create an activities section in one area of the room and a reading nook with lamps and desks in another area.

Also, look at the chairs that your SNF uses, Cinelli says. Are they easy to get in and out of? Do residents mostly stay in their wheelchairs rather than sit in the chairs? If so, it may be time to change them.

9. Nurses' stations. State mandates make hiding nurses' stations a bit challenging, so check local rules regarding these units. Some of Cinelli's clients have successfully masked nurses' stations by placing them in offices and using television cameras to monitor residents.

10. Outdoors. Don't forget your SNF's exterior. If the facility has a garden, make sure that residents and their caretakers can easily access it, Allen-Hall says. Add shaded and sunny seating areas with tables, chairs, and benches.

Also, try to build a walking path for residents to enjoy. The path should be flat and wide enough to accommodate wheelchairs.

What's it going to cost me?

Carpeting, buying new furniture and accent lighting, and building skylights into your SNF might sound great in theory. But even though they are relatively less expensive than buying or building a new facility, these upgrades will take some investment money.

How much? It depends on a variety of factors, including your facility's geographical location; how large the facility is; the types of upgrades; and use of architect, interior designer, or other consultant.

Generally speaking, however, Allen-Hall says a typical SNF might expect to pay

  • $40-$50 per sq. ft. for cosmetic finishes
  • $70 per sq. ft. for lighting
  • $90-$100 per sq. ft. for moving walls or making plumbing alterations
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