MULTILEVEL (MLC) DESIGN GUIDELINES (1994 BRITISH COLUMBIA)

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MULTILEVEL CARE

DESIGN GUIDELINES (MLC)

The MLC Guidelines were first released in 1992 by

Facilities Planning and Construction Division Care Services
Ministry of Health and
Ministry Responsible for Seniors, British Columbia

These Guidelines evolved from earlier Hospital Services Extended Care Guidelines; and were intended to encompass several levels of care, from Intermediate to Extended, with particular attention paid to Special Care Units.

Coming from the Hospital Services Division of the Ministry of Health, these guidelines were based on a medical model.  The Continuing Care Division, Residential Services Branch, wanted to move to a Social Model of care. Consequently, Andrew Butler, Regional Director of the Residential Services Branch contracted with Jensen Group Architecture Inc. to undertake a Review of the Guidelines with the assistance of Ministry of Health Senior Research Analyst Bill Benbow, who chaired the MLC Design Guidelines Review Committee.  A draft Report was produced in December 1994 which encompassed input from industry and government as well as current literature and research. It was released as two Volumes. Volume One included updated Guidelines in Three Sections: the Resident Care Unit; Direct Care Support Areas; and Resident Common Activity Areas.   Volume Two was an extensive commentary on the Guidelines. (The 1992 Guidelines remained in place for the support elements such as Administration, Food Service, Service facilities, Heating, Electrical, Plumbing, Ventilation  etc.)

This 1994 Report, titled Multilevel Care Design Guideline Review Final Report became the minimum standard for MLC facility development for many years.

In December 1998 the Ministry of Finance undertook a further review and issued the following letter.  However, no updated Guidelines were  released.  Some Health Authorities have worked on developing their own versions of Facility Design Guidelines, and some issue specific design requirements as part of an  RFP for new bed development.  The 1994 Review Report remains the only Province wide Ministry of Health Design Guidelines for care facilities.

Ministry of Finance Letter:

December 18, 1998

To: Multilevel Care Guidelines Users Re: Interim Issuance of Guidelines

The Multilevel Care Guidelines are currently being revised and as a result, no formal reprinting of the “old” guidelines will occur until revisions are complete. As an interim measure, the enclosed copy of the existing guidelines has been photocopied for you at no charge.

The key areas where changes are proposed in the new guidelines are:

  • The Pod/House concept for residential bedroom clusters (recommend 18-22 beds) in order to create a ‘home-like” environment.
  • Walking/wandering loops incorporated into the circulation of the pods/houses.
  • Additional space is required for wheelchair accessibility in resident dining areas. (increase from 2.0 m2 per resident to 3.0 m2 per resident).
  • Increase the single bedroom size from 20.0 m2 to 21.0 m2.
    • Recommend 6 foot wide corridors for single-loaded bedroom corridors, where possible.
    • Double rooms not to exceed 10% of resident population.
    • Allow flexibility to accommodate increasing numbers of Special Care residents.

Once the guidelines have been revised, you will be notified of their availability. Please contact KL (Kerry) Magnus at (250) 356-3083 or Rudi van den Broek at (250) 356-2413, if you have any questions.

Sincerely,

Rudi van den Broek

Manager, Technical and Cost Analysis Implementation Branch

Enclosure

Ministry of Finance and Corporate Relations  Capital Division

Multilevel Care Design Guidelines   Review

Executive Summary

Final Report December 1994

the Jensen Group architecture inc.

111 – 1034 Johnson Street
Victoria, B.C. WV 3N7
PH: (604) 360-9009 FAX: (604) 360-9026

CONTENTS                                                                                                                         VOLUME 1

Section/Page

EXECUTIVE SUMMARY

Forward

Preface

1.0 INTRODUCTION

1.1 DEFINITION OF MULTILEVEL CARE 1-1

1.2 PROGRAM AND OBJECTIVES 1-1

1.3 FUTURE FACILITY CARE NEEDS 1-1

1.4 THE CARE UNIT CONCEPT – 1-2

1.5 FLOOR AREA CALCULATIONS 1-3

1.6 SPACE SUMMARY                              1-3

2.0 BUILDING SITE CONSIDERATIONS 2-1

3.0 THE RESIDENT CARE UNIT

3.1 INTEGRATED CARE PROGRAM

3.2 DIVERSE CARE NEEDS OF RESIDENT

3.3 THE BASIC CARE UNIT CONCEPT 3-1

3.3.1 The Care Unit and Care Group Concept 3-1

3.3.2 Facility Size and Staffing 3-1

3.3.3 Creating a Home Environment 3-1.

3.3.4 Strategically Stimulating Care Environment 3-1

3.4 DESIGN PRINCIPLES 3-2

3.4.1 Internal Walking Loop 3-2

3.4.2 Corridor Dimensions & Details 3-2

3.4.3 Exit Control 3-3

3.4.4 Outdoor Areas 3-3

3.4.5 Resident Shared Common Areas 3-3

3.4.6 Views from Care Unit 3-4

3.4.7 Front Porch Concept 3-4

3.4.8 Transition From Public to Private 34

3.4.9 Finishes                                                          3-4

3.4.10 Engineering Considerations 3-6

3.5

RESIDENT ROOM

3.5.1 Room Occupancy

3.5.2 Interconnecting Rooms

3.5.3 Bed Location

3.5.4 Ensuite Location

3.5.5 Clearances

3.5.6 Views

3.5.7 Doors

3.5.8 Windows

3.5.9 Privacy Curtain Tracks

3.5.10 Furniture 3-9
3.5.11 Medical Gases 3-10
3.5.12 Nurse Call System 3-10
3.5.13 Personalization 3-10
3.5.14 Single Occupancy Room Area 3-10
3.5.15 Double Occupancy Room Area 3-11

3.6

ENSUITE WASHROOM

3.6.1 Washroom Layout 3-11
3.6.2 Double Occupancy Rooms 3-11
3.6.3 Securing Fixtures 3-11
3.6.4 Toilets 3-11
3.6.5 Washbasins 3-12
3.6.6 Shower 3-12
3.6.7 Bed Pan Flashing 3-12
3.6.8 Grab bars & Towel Rails 3-13
3.6.9 Medicine Storage Cabinet 3-13
3.6.10 Nurse Cali System 3-13

3.7

BATHING AREA

3.7.1 Concept 3-13
3.7.2 Residential Appearance 3-13
3.7.3 Wheelchair Accessible Showei 3-13
3.7.4 Assisted Bathing Tub 3-14
3.7.5 Personal Grooming 3-14
3.7.6 Mixing Valves 3-14
3.7.7 Toilet 3-14
3.7.8 Comfort Level 3-14
3.7.9 Space Allowance 3-14

4.0

DIRECT CARE SUPPORT AREAS

4.1 INTRODUCTION 4-1
4.2 CARE CENTRE 4-1
4.3 CARE STATION 4-2


4.4 MEDICATION ROOMS Section/Page

4-3

4.5 CLEAN UTILITY 4-4
4.6 EXAMINATION/TREATMENT ROOM 4-4
4.7 OCCUPATIONAL/PHYSIOTHERAPY 4-5
4.8 LINEN STORAGE 4-5
4.9 SOILED UTILITY ROOM 4-5
4.10 CARE EQUIPMENT STORAGE 4-6

5.0

RESIDENT COMMON ACTIVITY AREAS

5.1 INTRODUCTION 5-1
5.2 LOUNGE AREAS 5-1
5.3 ACTIVITIES AREAS 5-1
5.3.1 Size and Location 5-1
5.3.2 Care Unit Activity Space 5-2
5.3.3 Facility Multi-Purpose Room 5-2
5.4 DINING AREA 5-2
5.5 FACILITY FOOD SERVICE 5-3
5.6 RESIDENT KITCHEN. AND SERVERY 5-3
5.7 HAIRDRESSING SALON 5-4
5.8 OUTDOOR SPACE 5-5

Executive Summary

1.0  Introduction

This revision of the Multilevel Care Design Guidelines has focused on four (4) existing sections of the current guidelines, titled:

Section 1. Introduction

Section 3. Resident Unit

Section 4. Resident Group Activities

Section 6. Special Care

Revisions of the other sections (2,5,7-14) of the current guidelines will take place under a subsequent review.

These revisions are intended to incorporate the recommendations of the Review Committee and the Consultant for a care facility design capable of supporting suitable care of residents with complex and comprehensive, physical and mental needs including severe cognitive impairments.

2.0     Future Care Population

The average population for care facilities in the next five to ten years is projected to be 10% IC2, 45% IC3, and 45% EC. This reflects the trend in our health care system which is resulting in long term facility care becoming increasingly limited to the highest levels of care, for residents with severe cognitive impairment and/or behaviour dysfunctions and for extremely physically frail residents assessed at the highest levels of intermediate care or extended care.

3.0    Operational and Capital Costs

This review of the Multilevel Care Guidelines assumes that current multilevel care staffing formulas will not be increased in the foreseeable future. Health care costs and the pressure to control costs is expected to increase with the aging of our overall population. Effective design can, however, enhance an efficient use of staffing.

The population of the very elderly (85+) who are the primary users of long term facility care is projected to increase by 64% between 1994 and the year 2004. The population of 75+ is expected to increase by 44% over the same period. This dramatic ten year increase in the elderly population will increase health care costs at a time when there’ are fewer working taxpayers to support increased costs.

Effective cost management for the capital cost and operating cost has been a major concern in these recommended Multilevel Care Design Guidelines. More than 80% of the operating costs of a care facility are staffing costs. The operating cost of the average care facility equals the capital cost of construction within 2 to 3 years. The useful life of a new care facility is estimated by the Ministry to be 30 to 40 years during which time the operating costs will continue to rise.

This document emphasises the need for effective use of staff time and the need to produce a residential care configuration and environment which is proven effective in reducing the care workload. Residents are encouraged to maintain as much independent functioning as possible.

4.0  The Care Unit and Care Group Concept

The recommended care unit cohsists of a number of resident rooms which have the dining area, lounge, resident kitchen and activities areas for daily living within the care unit or in close proximity to provide the environment of a large family home. For effective staffing some of these areas (e.g..dining), could be shared between two care units. A care group will be formed where two or more care units are combined for staffing efficiencies.

5.0   Facility Size and Staffing

The care unit should have the smallest number of beds that is operationally feasible with available staffing.

The revised design guidelines which follow are based on a 75 to 110 bed multilevel care facility which is stand-alone (rather then being interdependent with an adjacent health care facility). The current Guidelines are based on a prototype of 75 beds. To provide staffing and support efficiencies in the future, larger care facilities of 100-110 beds may be recommended. As an example, this would correlate approximately with three (3) care groups of thirty-six (36) beds each group composed of two care units of eighteen (18) beds.

6.0  Creating a Home Environment

The guidelines describe a flexible basic care unit concept which has a “home-liken care environment within its institutional setting. The care units have been kept as small as possible to produce the atmosphere of a large family home and to provide the opportunity to house small numbers of residents with similar impairments in one care unit where they can be provided with more appropriate care.

7.0     Resident Rooms

All resident rooms are to be wheelchair accessible with single occupancy room having their own ensuite bathroom. Up to 10% of the beds can be in double occupancy rooms sharing a bathroom.

8.0      Walking Loops

For many residents in the early to moderate stages of dementia, the need to wander and pace is very strong. These guidelines recommend that each care unit contain internal walking loop and that where adjacent care units form a care group, they be linked to provide a more extensive walking loop.

By providing a clearly defined and attractive circulation path within the residential care unit and care group, all residents can be given a chance to enjoy exercise (by walking or by wheelchair) within their own home. This is an important substitute for more active forms of exercise for the very physically frail elderly.

9.0 Outdoor Access

The guidelines also recommend that each care unit have direct access to an outdoor area with exit control capability. Systems of exit control must be considered which maximize safety while allowing individual freedom. (The ability to secure the outdoor area is required when a care unit houses cognitively impaired residents.)

The outdoor area should contain an external walking loop which connects strategic areas within a garden environment.

10.0 Direct Care Support

Where two or more adjacent care units are designated as a Care Group they can be served by one professional care team. The revised guidelines recommend that a care station be provided to serve each Care Group allowing staff to carry out administrative duties without leaving the Care Group.

The care station should be located with good views into the care units and if possible, views to the exterior walking loops. If additional control is needed, particularly at the entry of each care unit, the guidelines recommend that a simple table or care desk be located near the entry.

As an alternate to a central medication room serving the whole facility, the Guidelines propose separate medications rooms located adjacent to each Care Station, again making it unnecessary for staff to leave the care group.

Overall care planning and professional supervision during the night hours will be shared among the groups from a .care control centre. The care centre will provide central monitoring of the nurse call systems and other sensors and security systems within the care facility.

11.0 Resident Common Areas

The primary resident common areas for daily activities consisting of dining, kitchen, lounge and activity space are located within the care unit or the care group. Some additional common areas including a multi-purpose room can be provided for use by all residents of the facility.

The multi–purpose room will provide space for larger scale resident activities including choirs, sing-alongs and seasonal special events and can also be used for staff in-service training.

12.0    Wheelchair Manoeuvrability

The existing policy of designing all portions of a facility used by residents to be wheelchair manoeuvrable is to remain in these guideline revisions.

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Multilevel Care

Design Guidelines Review

Volume 1

MLC Design Guidelines Revisions

Final Report December 1994


The Jensen Group architecture inc.

111 – 1034 Johnson Street
Victoria, B.C. V8V 3N7
PH: (604) 360-9009 FAX: (604) 360-9026

1. INTRODUCTION

1.1 DEFINITIONS OF MULTILEVEL CARE

A person is eligible for multilevel care benefits when there is a demonstrated need for daily care by nursing staff but the person does not immediately need the resources of an acute, rehabilitation, or psychiatric health facility, in addition, they may require the services of a physician, pharmacist, occupational and physiotherapists, social worker, dietician, and other health care professionals as available. This need is not related to specific disease classifications, but rather to a continuing physical and/or mental disability whereby the person may be unable to function in an independent manner. Although the majority of persons may reach this degree of functional dependence as a result of diseases associated with aging, a care facility may also be concerned with the provision of multilevel care to eligible young adults.

The introduction of multilevel care facilities permits the integration of the various levels of chronic care in one setting, enabling residents with deteriorating health to remain in the facility of their choice.

1.2 PROGRAM AND OBJECTIVES IN CARE OF MULTILEVEL FACILITY RESIDENTS

Realization of resident’s individual potential for activities of daily living is a primary goal of a multilevel care facility. It has been clearly demonstrated that putting elderly or disabled persons to bed, or locating them in an institution where they are the passive recipients of complete care, will very quickly lead to further physical and mental deterioration. Conversely, a program that provides training and practice in activities of daily living and mobility, makes available a variety of social, recreational and other types of activities providing stimulation and pleasure which can arrest or reverse such deterioration.

The staff of multilevel facilities are required to assess an individual’s needs, and develop a program of activities that will assist in maintaining or improving the functional ability of each person, thereby permitting a more useful and fulfilling life.

The standards outlined hereinafter are intended to provide appropriate space to ensure the program will fulfil the stated objectives.

1.3   FUTURE FACILITY CARE NEEDS

1.3.1 Multi-level care facilities must be prepared, and able to provide care for any chronic care need, although there may be more specialized facilities in some centres.

1.3.2 Providing that the Provincial policies of the last five years for home care continue, facility care will become increasingly limited to the highest levels of care for cognitively-impaired and/or extremely physically frail residents.

1.3.3 The average resident population in facility care in the next five to ten years is estimated as 10% Intermediate Care 2 (IC2), 45% Intermediate Care 3 (IC3) and 45% Extended Care (EC) although each facility will need to develop a “residents needs assessment” in order to determine the proportion of 1C2, 1C3 and EC residents. A great variety of resident needs exists within those broad intermediate care and extended care assessment levels. However summary descriptions can be provided to assist in planning and design of care facilities.

Most 1C2 residents in facility care will be in very frail physical condition. Many !C2 residents will also be in the early stages of dementia while others will be cognitively alert. The majority of IC3 residents will be moderately to severely cognitively impaired with severe behaviour dysfunctions requiring high levels of care. A minority of the IC3 residents will still be cognitively alert but will be in very frail physical condition requiring very high levels of care.

Residents assessed at Extended Care are no longer independently ambulant. Extended care residents need assistance to walk a few steps (if they can still walk) and/or they need assistance to transfer between their beds and their wheelchairs, crutches or other devices for mobility. A number of residents may be admitted in the last stages of illness and thereby require palliative care.

At least half of these extended care frail residents will be in some stale of mild to severe dementia. An increasing proportion will be moderately to severely cognitively impaired with behaviour dysfunctions.

Resident needs within these broad categories are diverse. The census of residents within particular functional groups shifts unpredictably.

1.3,4 To respond to future care needs, a residential care unit designed today for long-term care will need to have the flexibility in the future to support the basic requirements of care for very cognitively impaired residents with behaviour dysfunctions and for extended care residents. All portions of a facility to be used by residents are to be designed for wheelchair manoeuvrability.

1.3.5 To respond to diverse care needs, a facility will need to be composed of smaller residential units that allow the grouping of residents by functional category as necessary for more appropriate care.

1.4   THE CARE UNIT CONCEPT – SUPPORTIVE CARE ENVIRONMENT

1.4.1 A familiar and home-like care environment encourages long-term care residents to maintain as much independence as possible and avoid excess disability. A supportive care environment is essential to keep the care workload manageable as care levels increase.

1.4.2 To provide a familiar home-like setting, resident rooms should be clustered in care units which have the dining, bathing, activity and lounge areas needed for daily living. The care unit should have the smallest number of beds that is feasible with available staffing.

1.4.3 Small residential care units can provide supportive care environments for the many types of residents in facility care.

1.5    FLOOR AREA CALCULATIONS

Net space requirements are listed in each section of the guidelines.

  • Apply a factor of 1.6 to obtain building gross areas from the total net areas of the following:

Section 3.0: Resident Unit

Section 4.0: Direct Care Support Areas Section 5.0: Resident Activity Areas.

  • Multiply by a factor of 1.4 to obtain building gross areas from the total net areas in the remaining sections.

1.6   SPACE SUMMARY

As a total building area guide, new facilities will not exceed the following allowances:

m2 building gross per bed when the facility is freestanding and self—sufficient.

m2 building gross per bed when the facility is serviced by a parent health facility.

Note: These allowances do not include mechanical penthouse space. Recommendation:

The gross square metre allowances per bed need to be increased from current levels to reflect the concept of all care beds in a facility being in flexible residential care units rather than some beds being standard Multilevel Care and some being in a special care unit.

Establishing the actual total gross area allowances per bed is premature at this stage, given that the Ministry may also be revising the guidelines for the common support areas of the care facility in a subsequent review project. (Office allowances, kitchen space and other issues have been identified for future review.)

2.0 BUILDING SITE CONSIDERATIONS (to be future review project)

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3.0    THE RESIDENT CARE UNIT

3.1     INTEGRATED CARE PROGRAM See Commentary

3.2    DIVERSE CARE NEEDS OF RESIDENT See Commentary

3.3    THE BASIC CARE UNIT CONCEPT

3.3.1  The Care Unit and Care Group Concept

The recommended care unit consists of a number of residential rooms which have their dining area, lounge, resident kitchen, bathing area and activities areas for daily living within the care unit or in Close proximity to provide the environment of a family home. For effective staffing some of these areas (e.g. dining and bathing), could be shared between two care units. A care group will be formed where two or more care units are combined for staffing efficiencies.

3.3.2  Facility Size and Staffing

The care unit should have the smallest number of beds that is operationally feasible with available staffing.

The space standards of this guideline are based on a 75 to 110 bed multilevel care facility which is stand-alone (rather then being interdependent with an adjacent health care facility). Design team planning stand-alone facilities of lesser or greater number of beds will be reduced or increased as required. Design teams planning MLC facilities as additions or adjacent facilities to existing buildings will need to adapt these concepts appropriately.

3.3.3  Creating a Home Environment

The guidelines describe a flexible basic care unit concept which has a “home-like” care environment within its institutional setting. The care units have been kept as small as possible to produce the atmosphere of a large family home to provide the opportunity to house small numbers of residents with similar impairments in one care unit where they can be provided with more appropriate care.

3.3.4 Strategically Stimulating Care Environment

The care unit should provide positive meaningful stimuli to residents. Examples of positive stimuli are outdoor views, views of active functions, food aromas that whet appetite, birdsong that signals morning and hushed sound that signals the end of day.

Negative stimuli includes particularly distracting noises, glare and too many unfamiliar faces. Staff and service delivery personnel and material movement should not create through traffic in a care unit.

3.4    DESIGN PRINCIPLES FOR CARE UNIT

3.4.1    Internal Walking Loop

3.4.1.1       Each care unit should have an interior walking loop.

3.4.1.2        Consider linking the internal walking loops in adjacent care units that form a care group.

3.4.1.3 It is effective therapeutically to create this internal walking loop from “normal” circulation that links strategic areas of the care unit (dining, activities, lounge, etc.). This gives points of interest along the route that can give the resident the sense of meaningful journey and arrival that can encourage stops for rest rather than the purposeless endless walking (with the corresponding dangers of continuing weight loss). Because the internal walking loop is created from “normal circulation°, the circulation space is increased only as needed to create a continuous loop and avoid dead ends.

3.4.1.4 The walking loop needs to be independent and internal to the care unit to maintain the unit’s security. The capability for exit control is needed if every care unit is to have the flexibility to care for residents with “severe behaviour dysfunctions°.

3.4.2       Corridor Dimensions and Details

3.4.2.1    Corridor Widths

Single-loaded corridors in the care units of 1830 mm minimum width will be considered for approval by the Ministry if an equivalency has been obtained from the local authorities having jurisdiction. Double-loaded corridors in the care units and all corridors in the main facility will have a minimum of 2400 mm corridor width.

3.4.2.2    Corridor Lengths

Corridor lengths should be minimized in consideration of the need for home-like environment and efficient staff circulation. At the same time the corridors in the care unit need to form continuous walking loops for residents.

3.4.2.3    Open Central Areas Inside Corridor Loop

Care unit schemes which contain occupancies adjacent but not separated from the egress corridor require an equivalency under the B.C. Building Code.

3.4.2.4    Handrails

Handrails must be provided on both sides of the care unit corridors mounted at a recommended height of 840 mm.

3.4.2.5   Finishes

Corridor detailing should be developed to protect the walls from wheelchair damage.

3.4.3      Exit Control from Care Unit

3.4.3.1 Each care unit should have the capability for exit control (when needed) from the care unit to the rest of the facility, and from the care unit to outdoor areas.

3.4.3.2 Exit control, when needed, should be unobtrusive and immediate.

3.4.3.3 For the safety of residents a flexible exit control is needed to provide control particularly from’the care unit to the secure outdoor area.

3.4.3.4 Overall security and separation of the unit is an important factor in creating peace of mind in resident, staff and family members. Technology should be used to control exits and to ensure residents do not access service areas.

3.4.4 Outdoor Areas

3.4.4.1   Access and Security

Each care unit should have direct access to its own independent outdoor area where site conditions allow. This outdoor access should have the capacity for exit control when conditions are unsuitable (bad weather, cold nights). The outdoor area which serves a care unit should have the capability for exit control when needed to control access into other outdoor areas.

3.4.4.2  External Walking Loop

The outdoor area should have a clear continuous walking loop located so as to allow observation by staff from inside the unit. When staff are able to check easily for resident safety on the outdoor walking loop, staff feel more secure about allowing residents to use the outdoor areas unaccompanied. Free open access to a secure outdoor area is preferred for dementia care. See Section 5.8 for detail.

3.4.5   Resident Shared Common Areas

3.4.5.1 Provide separate dedicated space for dining, lounge and a space for activities.

Common areas used by residents of the care units, care group and the facility common areas used by all residents are detailed in Section 5.

3.4.5.2 The dining areas for two adjacent care units can be located together, as long as

there are flexible ways of dividing the space into smaller areas.

3.4.5.3 Activity areas from two adjacent units could also be co-located to provide flexibility

for larger special activities. However for normal use, the activity space would be divided by movable walls into an activity area for each care unit. Sound control will need to be considered (see Section 5).

3.4.6   Views from Care Unit

3.4.6.1 Views to the outside should be available from common areas and resident rooms

in a care unit.

3.4.6.2 Active views (traffic moving, children playing, etc.) are more desirable than passive

views from the common areas.

3.4.6.3 Views from the care unit common areas in a courtyard scheme should be a mix

of views out to the care facility grounds and views into the courtyard.

3.4.7   Front Porch Concept

Consider using some of the common areas of the care unit to create a “front porch” or entry for the care unit. Residents in the “front porch” area would have views of higher activity spaces of the overall care facility. This area can help to satisfy the residents’ urge to gather where they can watch people coming and going.

3.4.8  Transition from Public to Private Areas

Functions in the care unit should be located to provide a transition from the common spaces such as the lounge, dining and activity areas to the most private spaces like the resident bedrooms. Traffic through the private spaces should be minimized consistent with a home-like setting.

3.4.9  Finishes

3.4.9.1 All finishes and colours in a care facility should be selected to give meaning to the

care environment emphasizing landmarks and other features which make it easier for residents and visitors to find their way.

3.4.9.2 Consider using finishes and colours in the care unit to emphasize the room

clusters that form smaller social groups. This can also aid with wayfinding.

3.4.9.3 Selection of colours and finishes should pay careful attention to the visual

impairment which is characteristic of increasing age. It is essential that there be sufficient contrast between a door frame and a door, for example, to help the resident see the door. The same applies to door handles, cabinet pulls, etc.

In the inverse, when a doorway is intended for use only by staff by having the door and frame in the same finish and colour as the wall and having the locking or handle mechanism unobtrusive will make it relatively likely that the cognitively impaired resident will not be as aware of its existence.

3.4.9.4 Residents with visual impairment will have perceptual difficulty with a reflective

finish. Flooring materials should be low glare easily maintainable surfaces which also cushion falls and absorb sound. It is also helpful to avoid bright white walls for the same reasons.

3.4.9.5 Adequate contrast of finishes and colours is particularly important in the bathing area of the care facility.

3.4.9.6      Flooring

Avoid use of materials that will increase the walking difficulty of residents with gait disturbance or impede easy movement of residents in wheelchairs.

3.4.9.7       Carpeting

Carpet absorbs sound, avoids glare, cushions falls and contributes to a residential character. Carpets are now available which meet the concerns for stain control and movement of wheelchairs. Only direct glue-down carpet installations are recommended (no carpet under layment).

Consider carpeting as .a floor material for the corridor and other common areas of the care facility, with the exception of those areas where the need for a particularly cleanable surface or water resistance is an issue. For example, carpet should not be used in the dining area, resident kitchen or bathing area.

Carpeting should not be used as a standard floor material for resident rooms, however it can be considered for particular resident rooms with justification made for its use.

3.4.9.8       Ceramic Tile

Consider ceramic tile in those areas subject to high humidity and moisture. Use a non-slip tile finish in the bathing rooms and resident washrooms that are used as showers.

3.4.9.9       Heat Welded Seamed Flooring with a Low-Glare/No Wax Finish

Heat Welded Seamed flooring with a no wax non-glare finish provides a warm floor finish and is an appropriate flooring for areas where cleanability and water resistance is an issue. Examples include the dining area and resident kitchen areas.

It is important to minimize changes in floor finishes. Junctions between floor finishes changes in colour and strong pattern can be difficult for residents due to gait disturbances and perceptual problems.

3.4.10  Engineering Considerations

Most engineering systems and equipment should meet the guidelines established by existing Multilevel Care Design Guidelines Section 11 with further considerations as listed below:

3.4.10.1 Electrical Design

  1. All receptacles in resident care areas should be tamper-proof type.
  2. Fire alarm pull stations should be of the guarded type.
  3. Security systems can be utilized but should have the emphasis placed on exit door locking in conjunction with alarms rather than monitoring.There are several types of wandering resident alarm systems available but the total function and reliability of these systems need to be carefully examined. The design of the physical space should try to maximize control and supervision of residents and discourage any walking away from the facility, thereby reducing the requirement for electric type controls. Code regulations must be complied with. Motion sensors in residents rooms connected to nurse call alarm system may be appropriate during the time when residents are sleeping.
  4. Nurse call system resident bedside stations should have geriatric cord sets.
  5. Soothing background music systems can have a calming influence on residents. Intercom and paging systems are not recommended.
  6. Lighting systems should be capable of offering a range of different lighting levels to make use of available daylight and also take into consideration the different activities of the residents. Supplemental incandescent lighting could be provided in order to make use of any dimming requirements and halogen lighting can help achieve a homelike appearance.
  7. Generally illumination le’vets should be higher than recommended minimums prescribed in Section 11. Lighting levels should provide an even distribution throughout different areas to help reduce shadows and glare. The use of indirect and/or louvred fluorescent fixtures installed out of the normal field of view is also recommended for overall illumination. Supplementary lighting in the form of table or stand lamps may be utilized for task (reading) lighting. Fluorescent lamps should be warm white or daylight type.

  8. Light switches for corridor lighting should be located at the care centre;
    night light switches in resident rooms may be of the illuminated type and should be located at the bed head and the entrance door.
  9. Radiant heating panels (ceiling mounted) should be used in lieu of
    baseboard heaters.

3.4.10.2  Mechanical Design

  1. Sprinkler heads should be the concealed or recessed type.
  2. Thermostats and/or temperature sensor controls in resident areas should
    be tamper proof.

3.5  RESIDENT ROOM


3.5.1  Room Occupancy

Nearly all beds in a care ‘facility should be single-occupancy rooms with the percentage of total beds allowable in double-occupancy rooms to be determined by the Ministry of Health (currently 10% see Volume 2).

3.5.2  Interconnecting Rooms

Consider providing interconnecting doors between two single rooms to allow the flexibility for a married couple or two roommates to share those rooms as a suite. Using the concept of connecting two single rooms as a suite does not preclude providing double-occupancy rooms, if the care provider so desires.

3.5.3  Bed Location

The desired bed location should be determined early in design. Consider the proposed bed location in the placement of the nurse call system, reading lights, switches, other room controls and bed-head bumper rails to protect wall against damage from bed movement. To reduce incontinency in some residents it is useful to have views from the bed location to the toilet.

3.5.4 Ensuite Locations

The ensuite washroom location which is preferred is one that provides privacy for the resident when the door to the resident room is opened and is visible from the bed location.

3.5.5  Clearances

All equipment, ergonomics and furniture in the residents room is to be laid out in accordance with currently accepted ergonomic guidelines and the recommendations of the WCB.

Without moving adjacent beds or furniture, except chairs, it should be possible to move any bed into or out of the room. A minimum 1200 mm wide passage for such movement shall be provided within all bedrooms.

At least 1200 mm clear space between beds is required for nursing care, to assist people into wheelchairs, and for operating person lifting devices and stretchers. This space shall be unobstructed by tables, etc. Wall-mounted cupboards between the beds cannot be accepted as they interfere both with management of the person and the person’s freedom to manoeuvre into and from a wheelchair. The other side of the beds shall have a minimum of 900 mm clearance for manoeuvring room.

3.5.6  Views

It is desirable that every resident in a multiple bed room have a direct view out of an adjacent window from their bed position.

Certain architectural features can unnecessarily restrict the views of those confined to bed. Consideration of resident views must take priority over architectural aesthetics.

3.5.7  Doors

Door openings into bedrooms from corridors shall have a clear minimum width of 1150 mm to allow for the movement of beds and, if designed with two opening leaves, should have a minimum opening width of 900 mm for normal usage. Locking hardware on resident bedrooms will generally not be allowed but, depending on the level of care and acuity of the resident, the flexibility should be available to install locks if required.

Door openings from resident bedrooms to the resident en suites shall be no less than 900 mm wide.

Sliding or folding doors are not generally considered suitable for use by residents.

3.5.8  Windows

An openable window is desirable (and required if mechanical ventilation is not provided). The opening location and size of opening needs to be safe for the cognitively-impaired. The window needs to be operable by the physically-frail. Window sills should be low enough to permit a view out and down from a low bed or wheelchair position.

Window openings must be strong enough to withstand abuse by residents and restricted to prevent egress. Window drapes need to be installed with quick-release fastenings so that they cannot be ripped. Use of draw cords must be avoided.

3.5.9  Privacy Curtain Tracks

In multiple bed rooms mounted curtain tracks shall be provided for privacy screening’ of beds. The curtains, if full height, shall be fitted with mesh at the top for air circulation. A clear space of at least 300 mm should be provided between the foot of the bed and the privacy curtain, and the track must provide for the resident nearest the door to be screened from view from the corridor.

3.5.10  Furniture

3.5.10.1    Beds

The space allowance for residents beds shall be 2200 x 1000 mm. Bed heads should be constructed to allow for clamping on self-help devices such as a trapeze. Safety aides should be the sliding type, with clamp fasteners fastened to the bed frame, but some beds may be fitted . with half sides for assisted  transfers. All beds in a facility should be of the high-low type.

3.5.10.2  Resident Wardrobe

In each ‘bedroom ‘provide individual resident wardrobe. Provide a minimum space of 0.5 m2. Consider designing the wardrobe with two sections, a small unlocked section for one day use clothes and a larger locked section for general clothing storage.

3.5.10.3  Bedside Bureau

Provide a free-standing bedside bureau for each resident’s personal belongings. May also be designed to contain a’ washbasin and bedpan. Alternative arrangements may be made for storage of the washbasin and bedpan in the bedroom or bathroom areas. Provide space 600 x 600 mm.

3.5.10.4  Other Furnishings

Refer to Figs. 3-16 to 3-18. Area to be provided for armchair and space for a personal item of the resident’s own furniture.

3.5.11    Medical Gases

Piped gas is not necessary but may be permitted in some multilevel care facilities. Oxygen which may be required can be satisfactorily administered from portable equipment including concentrators. When not in use by residents the equipment must be stored in rooms approved for the purpose.

Suction equipment of the portable electrically operated type is considered to be satisfactory.

3.5.12   Nurse Call System

Provide a nurse call system in the resident room.

3.5.13   Personalization

Design features that provide the opportunity for residents to personalize the room are highly desirable.

3.5.14   Single Occupancy Room Area

See Figs. 3-16 and 3-17 which show the recommended bed location for privacy and two alternate bed locations.

Space allowance 21.0 sq.m.

For two inteconnecting: space allowance 42.0 sq.m.

3.5.15   Double Occupancy Room Area

See Fig. 3-18 for suggested layout of double occupancy room. Space allowance 33.0 sq.m.

3.6      ENSUITE WASHROOM

3.6.1   Washroom Layout

Fig. 3-19 illustrates an ensuite washroom arrangement. Note wheelchair turning radius requirement. An ensulte*washroom containing a toilet and vanity with washbasin is required in every resident room.

All ensuite washrooms should be wheelchair-accessible and be provided with swing-up grab bars beside the toilet.

Consider removing the ensuite washroom door in certain circumstances to ensure the resident has a clear view of the toilet from the bed location. See 3.5.3.

Space allowance included in resident room allowance.

3.6.2   Double Occupancy Rooms

The ensuite washroom for a double-occupancy room will have one toilet and one vanity with washbasin plus a lockable storage unit for each resident. A second washbasin in the resident room is not required.

3.6.3   Securing of Fixtures

Provide suitable anchorage for all wall mounted fixtures.

3.6.4   Toilets

3.6.4.1 The following toilets will be acceptable in the ensuite washrooms:

1. Floor-mounted tank toilet.

2. Wall-mounted tank toilet.

3. Wall-mounted flush valve toilet:

Flush valve fixture shall have a backrest mounted in front of the flush valve to support the resident. This should not interfere with the proper functioning of the hinged toilet seat.

A simple and domestic environment is the objective and for this reason the familiar tank-back toilet is recommended instead of the flush-valve alternative. Where tank-back toilets are used, the tank lid must be tightly secured to prevent violent residents causing damage and injury. The floor-mounted toilet is preferred over the wall-mounted toilet because of the advantages of cost and familiarity. The wall-mounted toilet has the advantage of making the floor easier to clean (see Volume 2 for Commentary).

3.6.4.2 Toilets for resident use require a floor-to-rim height of 460 mm. The alternatiVe

of using a special toilet seat to raise the height of the toilet to wheelchair height can be discussed with Continuing Care, Any seat used to adjust toilet height must be fixed tightly enough to ensure safety and be easy to clean.

3.6.4.3 The toilet flush handle shall, if possible, be close enough to be reached by a

person in a wheelchair (approximately 600 mm reach).

3.6.4.4 Provision of toilet seat restraint belts will be approved.

3.6.5   Washbasins

Washbasins shall be provided for the occupants use and for the control procedures required of the health facility personnel. Each basin should be equipped with a gooseneck faucet with aerator head, 100 mm blade handles and pop-up waste.

Adjacent to each basin, for staff use provide space for a paper towel, soap and protective glove dispenser and waste container. Confirm extent of this requirement with each facility.

The washbasin shall be installed in a vanity (avoid sharp corners); otherwise, a shelf shall be provided adjacent to the basin. Behind each washbasin there shall be an adjustable tilt mirror mounted for use by both wheelchair and standing users.

3.6.6   Shower

Consider utilizing the ensuite washroom as a shower room particularly useful for severely incontinent residents. The room finishes would need to be impervious to water and easily cleanable. The floor of the ensuite would slope to a faecal drain and be of non-slip impervious material. Controls for the shower should automatically maintain water temperature. A low pressure telephone type hand shower spray should be provided.

3.6.7   Bed Pan Flushing

The ensuite washrooms may have, if required, approved bedpan flushing facilities comprised of a flexible hose connected to the adjacent washbasin via a diverter valve.

Bedpan lugs may be provided on toilets where applicable.

3.6.8   Grab Bars and Towel Rails

Unless swing-away or drop grab bars are provided, there shall be at least one grab rail, wall mounted, adjacent to the toilet, installed in accordance with B.C.Building Code requirements. See Fig.3.19. Grab Bars must have a minimum of 30 mm diameter with a non-slip textured finish for use by residents who have arthritic hands. Towel rails are also to be designed to be used as grab bars.

3.6.9    Medicine Storage Cabinet

Provide a medicine storage cabinet for each resident adjacent to the wash hand basin.

3.6.10   Nurse Call System

An emergency pull cord connected to the nurse call system must be accessible from the toilet to enable a resident to summon help.

3.7      BATHING AREA

3.7.1   Basic Concept

Provide one bathing area for each care unit or shared within a care group. This bathing area will contain one assisted bathing tub or a wheelchair accessible shower and a wheelchair accessible basin and toilet adjacent. Each assisted bathing tub will serve a minimum of 24 beds and a maximum of 36 beds. These ratios can be adjusted where justified through application to the Ministry. In a multi-storey facility there will be at least one bathing area for each care floor.

3.7.2   Residential Appearance

The bathing area should be designed to have an appearance that is as small and residential as possible, yet provide room for staff to assist the bather. The use of familiar “home bathroom” details can help the cognitively-impaired resident recognize the purpose of the bathing room and help overcome the discomfort and fear produced by the unfamiliar appearance of an assisted-bathing tub. To maintain privacy the bathing area is intended to accommodate only one bather and necessary staff at a time.

3.7.3   Wheelchair Accessible Shower

A wheelchair accessible shower should be included to assist in cleaning incontinent residents. A shower is also the preferred bathing mode for some residents.

The showers should be designed to facilitate bathing residents in “shower chairs” as well as being provided with a hinged seat. The cubicle should be approximately 1200 mm square, without a curb at the entrance, and with a 800 mm grab bar both sides.

Controls should be placed outside of the shower area and should automatically maintain water temperature. A low pressure telephone type hand shower spray should be provided. There shall be working space on one side of the shower stall, which shall be separated from the shower by a half wall.

3.7.4   Assisted-Bathing Tub

Consider providing more than one type of tub in the fixtures that serve the facility overall.

3.7.5   Personal Grooming

Provide space for residents to dry and comb their hair. Consider the provision of a vanity, washbasin, and mirror.

3.7.6   Mixing Valves

A non-scald mixing valve of the pressure-activated type shall be incorporated in both shower and bath facilities.

3.7.7   Toilet

Consider providing a wheelchair accessible toilet complete with grab bars screened from bathing area or in a separate adjacent room for wheelchair accessible shower or assisted bathing tub plus washbasin and toilet.

3.7.8    Comfort Level

Provide a ceiling heat radiation device over the resident drying space and consider additional ways of helping a resident to feel warm in the bathing area. Curtains that pull around the tub can be used to control drafts and increase the feeling of privacy appropriate to this intimate activity. Towel warming cabinets can be used to warm towels for the end of the bath. Curtain materials and towel cabinets should be selected to give a home-like rather than an institutional appearance.

3.7.9 Space allowance for wheelchair shower or assisted tub and toilet plus wash, hand, basin 10 sq.m.

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4.0   DIRECT CARE SUPPORT AREAS

4.1    INTRODUCTION

4.1.1 The Care Centre will be the main location within the facility for staff to carry out residents health care planning and monitor building security and nurse call systems.

4.1.2 A Care Station will occupy a central location within a care unit or care group which will provide space for staff to carry out administrative duties in private yet still remain in close observational contact with residents.

4.1.3 Figure 4-1 shows potential relationships between a care station and care centre. The facility layouts which incorporate these relationships will vary depending on the particular care providers, resident groups and site conditions involved.

4.1.4 The functions assigned to care stations, medications rooms and other care support areas serving the care unit(s) must be coordinated with the functions assigned to the care centre and other central support areas serving the entire facility. The determination of the need for central support and/or satellite areas for particular functions and whether the care station serves one or more care units should be based on the number of beds in the unit, the types of residents and the levels of care required. Supply and distribution systems also need to be considered.

4.1.5 The key concern for care providers, consultants and Ministry representatives alike should be to define the functions of each support area carefully. This makes it possible for all parties to ensure that each needed function is covered and that duplicated functions are avoided except where justified.

4.2   CARE CENTRE

4.2.1 The Care Centre should be located as centrally as possible in the facility. It is desirable that the care centre command the best view possible of the facility corridor(s) and the entrance(s) to the facility. (Direct views can be supplemented where necessary by remote cameras or sensors that monitor activity in the. corridors of the care units and in the main corridors of the care facility.) Close proximity of the care centre to the entrance(s) is an advantage as it facilitates observation and direction of persons entering or leaving the facility by the staff. The Care Centre may also be used for night reception and security control.

4.2.2 The Care Centre serving the entire facility will contain a main work area with file storage. Observation and control, nurse call system and telephone, and main work area should be concentrated so that all functions can be carried out when necessary by one person. Some method (door or gate) is necessary to prevent non-staff from walking into the area. The care centre will include one room to serve as the office for the Director of Care or head nurse for the facility. Proximity to the Administration/Reception suite is useful since the Care Director normally has frequent interaction with the Administrator.

4.2.3 Considerable variation in the arrangement of spaces and the nature of the main work area is possible.

4.2.4 Space allowance 20.0 sq.m.

4.3    CARE STATION

4.3.1 A Care Station space may be defined as an enclosed office, “reception” type counter facing the residents or simply a desk located in a quiet space away from resident activity.

4.3.2 The Care Station if proVided in the form of an office will be an enclosed workroom containing two work areas: a desk for the supervising nurse and a staff desk (with computer) for charting and care planning along with the necessary file storage and bookcase for references. Two to three people will also meet here to discuss a resident’s care plan. A window(s) looking into the common area of the care unit(s) and exterior walking areas is desirable to maintain visual contact with residents.

4.3.3 This Care Office could also provide secure storage for one medications cart if required (see Medications Alternative 2 below).

4.3.4 If an additional control point for each care unit is needed, a simple desk or table for staff can be integrated into a common area. The care desk should be located to supplement the coverage provided by the Care Office particularly if serving two or more care units. For example, a care desk could be located to control the entry to each care unit if the Care Office were located elsewhere. The care desk should be visible (directly or by camera) from the Care Office. The desk height should allow for level eye contact with a resident in a wheelchair.

4.3.5 The location for the Care Station should be carefully selected for the best views of the resident common areas indoors and out. Cameras can be used to monitor activity in hidden parts of the corridors. For night use motion or other sensors can be used in the resident rooms in addition to the nurse call system. These types of remote systems (which can be monitored at night from the Care Centre as well) are one of the ways of assisting a few staff to cover a large facility.

4.3.6 In a multi-floor facility, control of access to each floor needs to be considered either through the Care Centre, Care Office or Care Desk.

4.3.7  Space allowance: Care Office 17.5 sq.m.

4.4    MEDICATIONS ROOMS

4.4.1   Requirements for Medications Rooms

Adjacent to, and easily accessible from the Care Station (Alternate 1) or the Care Centre for the entire facility (Alternate 2), provide a medications room fitted with counter space that includes a sink with a gooseneck faucet and storage cupboards.

Depending upon the nursing procedure for medication administration the room will be
required to accommodate one to three medication carts approximately 700 mm x 500 mm
x 1000 mm high. The medications carts are not to obstruct the work areas in the room.

As the monitored dosage system requires storage for residents medication cards, storage cupboards or wall racks must be provided.

A lockable and alarmed medicine storage cabinet shall include a separate locked compartment for narcotics, controlled drugs and liquor designed to meet the requirements of the College of Pharmacists of B.C. “Recommendations for Drug Storage cabinets”.

Space shall be provided for a small refrigerator for biologicals. The door to the medications room should be lockable.

4.4.2    Alternative 1: Satellite Medication Rooms

Provide a satellite medication room adjacent to the Care Stations. The satellite medication room would include space for storage of a medications cart and the full required medications support for the care unit or group.

The space allowance is 7.5 sq.m.

No central medication room would be required next to the Care Centre.

4.4.3   Alternative 2: Central Medications Room

Provide a central medication room serving the entire facility adjacent to the Care Centre. The space allowance is 11.0 sq.m.

The Care Station serving each care unit or group would include secure storage for the medications cart.

4.5      CLEAN UTILITY

4.5.1   Clean Supply Cupboard or Cart Storage (Care Units)

Provide a cupboard or cart storage space for medical and surgical supplies, dressings, sterile trays, incontinency supplies, etc. on every care unit at a central location easily accessible from the resident rooms and the Care Station.

Space allowance 1.5 sq.m.

4.5.2  Central Clean Utility Room (Facility)

Provide one central clean utility room to stock medical and surgical supplies, dressings, sterile trays, incontinency supplies, etc. for the entire care facility. This room should be centrally located and adjacent to the Care Centre for the overall facility.

Space allowance is 11.0 m2.

4.6   EXAMINATION/TREATMENT ROOM

4.6.1 Provide a room for medical examinations, minor surgical and dental procedures provided with the following fixtures:

Work counter approximately 600 mm x 1500 mm long, with storage cupboards over, and space under for mobile cart, trash container, etc.

Counter sink with elbow operated controls, gooseneck faucet, soap or detergent dispenser, paper towel dispenser, and waste container.

4.6.2 Provide space for the following equipment:

Examination table.

Small surgical lamp which may be pedestal type.

Mobile utility table.

Wall mounted clock with second hand.

For dental services provide spade for:

Movable non-hydraulic dental chair.

Dental examination light.

Generator for portable suction equipment and a pressure operated hand drill.

4.6.3 Consideration should be given to identifying space for specific portable testing services where changing technology makes it more effective to bring the service to the residents rather than the resident to the service. These types of portable testing services could be accommodated temporarily in the examination/treatment room.

4.6.4 Space allowance 18.0 sq.m.

4.7     OCCUPATIONAL/PHYSIOTHERAPY AREA

4.7.1 Provide an occupational/physiotherapy area located adjacent to the Resident Activity Area in each Care Group.

4.7.2 Provide with the following fixtures:

Counter sink, gooseneck faucet, soap or detergent dispenser, paper towel dispenser and waste container.

Work counter approximately 600 x 1500 mm long with storage cupboards under and shelves over.

4.7.3 Provide space for the following equipment:

Table and chairs.

Physiotherapy equipment.

Parallel bars.

4.7.4  The space allowance is 15.0 sq.m

4.8   LINEN STORAGE

4.8.1 Each Care Unit will be served by a linen alcove or cupboard where a linen cart or carts can be stored with shelf space for extra pillows and blankets over.

4.8.2  The space allowance is 2.5 sq.m per cart.

4.9   SOILED UTILITY ROOM

4.9.1 Provide a soiled utility room for each Care Unit or Group which functions as a holding area for soiled linen, used equipment, trash and waste. The soiled utility room will include an area to wash off soiled sheets and storage for soiled linens.

4.9.2 Provide the following fixtures:

–      Counter top with counter sink (single compartment), elbow controlled mixing faucet, paper towel cabinet and soap dispenser.

–      Shelves under and over counter.

–      Flushing rim sink.

–      Wall hung bedpan flusher-sanitizer.

–      Janitors’ curb sink.

4.9.3 Provide space for the following equipment:

– Soiled linen hampers.

– Utility cart.

– Garbage container (or cart).

– In addition to the above, one room shall contain a utensil washer-sanitizer.

4.9.4 Space allowance 11.0 sq.m.

4.10   CARE EQUIPMENT STORAGE

4.10.1 Provide one Care Equipment Storage Room for each Care Group. This room is intended for ready storage of care equipment which is needed for daily use in the care units as opposed to the longer-term bulk storage room provided for the entire care facility.

4.10.2 Space allowance 20 sq.m. For details of equipment storage and other associated storage see Commentary.

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5.0   RESIDENT COMMON ACTIVITY AREAS

5.1 INTRODUCTION

The care unit will contain the primary resident activities areas (lounges, activities, dining and resident kitchen areas) and will provide direct access to suitable outdoor areas. To provide effective staffing and/or more flexibility, these areas can be located adjacent to or combined with the same areas in the adjoining care unit.

Some residents will require assistance and/or mechanical aids to reach activities and the areas must therefore be located so that they are easily accessible.

Consider locating a washroom close to the dining area if the dining area is distant from resident rooms.

Some resident common areas will serve the entire care facility (examples: multipurpose activity, hairdressing salon, etc.). Consider locating these particular common areas in conjunction with physiotherapy and examination rooms on a ‘main street” giving residents somewhere to go for an outing outside their care unit but still inside the care facility. Other “main street” features may include a banking counter, tuck shop, and retail crafts displays. Fig. 5-1 shows the potential relationships between the resident common areas in the care units and those in the overall facility.

5.2      LOUNGE AREA

5.2.1 The resident lounges are intended to be small spaces within the care unit. Consider dividing this space into one quiet sitting area (for visiting with family, reading, sitting) and a separate space for louder uses like television-watching. Area should be located to provide views of both inside and outside activities.

5.2.2 Encourage the formation of smaller social groups within the care unit by associating each small lounge with a cluster of resident rooms.

5.2.3 Space allowance 1.4 sq.m per resident.

5.3    ACTIVITIES AREAS

5.3.  Size & Location

There is a need for both small and large activities areas in a care facility. The small activities area in or adjacent to the care unit is the primary space for daily use. To supplement the care unit areas, some facility common areas can also be provided for residents.

5.3.2    Care Unit Activity Space

5.3.2.1 Some flexibility is needed to allow the area to serve both sedentary activities like crafts and puzzles (generally long term) and physical activities (generally short term) which take more space. Consider locating the activities areas for two adjacent care units next to each other and providing a movable wall between the two rooms. The rooms would normally be used separately by small groups but could be combined for larger activities when needed. Sound control between the two rooms must be considered.

5.3.2.2 Space allowance 1.4 sq.m per resident.

5.3.3 Facility Multi-Purpose Room

5.3.3.1 It is desirable, budget and space permitting, to provide a large activity and training room to serve the entire care facility. The space could be used for larger-scale resident activities that cannot be accommodated within the care unit, staff in-service training and team conferences, religious events, and family and community education meetings. The multi-purpose room should have a central location with easy access from the main building. Where appropriate this multi-purpose activity room could also be offered or rented out for community events.

5.3.3.2 Space requirements for this multi-purpose room will vary depending on the projected number of residents in the particular care population able to use the room. To check adequacy of the proposed space when used for staff training, divide the proposed net area by 1.0 sq.m to determine the number of staff who could be accommodated.

Space Allowance 1.4 sq.m x 25% of total residents in a care faculty.

5.4 DINING AREA

5.4.1 Provide dining areas for each Care Unit or Group. Provide flexible ways of creating smaller dining groups that is feasible with available staffing and by screening the eating assistance areas from other diners. The provision of permanent walls is preferred over the use of free standing dividers for stability, although this may limit necessary flexibility. See commentary.

5.4.2 The dining area needs to have sufficient room for residents, their walkers, wheelchairs, portable oxygen carts and staff providing assistance with eating. The proposed space allowance below is for dining only. Provide a separate space for a servery and resident kitchen.

5.4.3 Control of noise is essential so that elderly residents with some hearing loss. are not hampered by room noise from socializing with others at their table.

5.4.4 Consider providing a washroom adjacent to the dining area.

5.4.5   Space allowance 3.0 sq.m. per resident.

5.5     FACILITY FOOD SERVICE

See Commentary

5.6     RESIDENT KITCHEN AND SERVERY

5.6.1 Provide a resident kitchen ,adjacent to the dining area. The space allowance is intended to provide a large family kitchen that would be used by residents between meals and at meal times, would act as a servery and be used to accommodate the portable bulk food cart and other servery equipment needed for service of food prepared in the central kitchen. The food cart and other equipment would normally occupy the space only during food service.

5.6.2 The basic function of this space is as a resident kitchen that can be used by residents, who are not cognitively impaired, to cook, bake, make coffee and snacks for themselves. Cognitively impaired residentS may also use this space for some kitchen activities with supervision from care staff. The kitchen will also function as an emergency night nourishment centre for the residents. All counters and appliances (ie. sink, oven, range top, etc.) must be accessible to residents in wheelchairs.

5.6.3 Safety is of paramount importance. A lock-out switch to control the on/off operation of the rangetop and oven should be provided in a location accessible to staff only. A lock may also be required on the refrigerator to control access for residents with eating disorders.

5.6.4 Between meals the room should have the familiar appearance of a large family kitchen. If a portable cart for cups and saucers is used between meals to dispense and collect cups for cleaning, consider ways of locating the cart (alcove etc.) to retain a residential appearance. When the servery equipment is in place for meal service the space must function to institutional standards and resident access controlled.

5.6.5 The kitchen layout should be as familiar as possible, consistent with its functions. Galley L-shaped and U-shaped layouts (with a stove-sink-refrigerator triangle) are more familiar kitchen layouts than extremely angular layouts.

5.6.6 Consider the resident kitchen/servery as a separate room. Walls and a door (with access control) are an effective way to keep cognitively-impaired residents out of the resident kitchen. A separate room would also control servery noise during meals although sound-absorbing materials inside the resident kitchen should also be considered.

5.6.7 Consider providing a large pass-through window which can be opened to give views of the resident kitchen when appropriate and hand out dishes or drinks. Provide a roll-down screen or other methods to control noise and/or close off views when needed.

5.6.8 Counter cabinets and equipment should be designed and located for ease of use by residents as well as staff. Finishes should be easy to clean.

5.6.9 Provide the following fixtures:

– Work counters at heights suitable for resident and staff use. Provide open areas under sink, rangetop and work areas for wheelchair users.

–      A two compartment Sink 150 mm deep with a minimum of 650 mm clearance under, and 100 mm lever handle faucets. Insulate bowl and pipes to protect residents’ legs.

–      Storage cabinets: Below counter storage or separate wall-hung storage is preferred to above counter storage for ease and safety of use. Consider providing lazy-susan units to improve accessibility to any corner cabinets.

Provide space for the following suggested equipment:

–      Rangetop, electric. Large front mounted controls with raised markings to aid residents

with diminished vision. Range hood with domestic type exhaust fan connected to duct work required. Safety switch (staff operated) required.

–   Conventional Oven; self cleaning, electric. A side-hung oven door with glass panel with accessible controls. Safety switch (staff operated) required.

–      Microwave Oven, may be provided for resident snacks. The microwave could also be used for reheating food from the central kitchen, depending on the food delivery method used. The microwave is sometimes used in place of the conventional oven, although it does not provide the same capability for baking. Safety switch (staff operated) required. – Fridge, self-defrosting domestic type with separate opening compartments for fridge and freezer.

–      Dishwasher: if required to be under counter institutional type to comply with local health requirements for water temperature.

5.6.11 Space allowance 12.0 sq.m.

5.7     HAIRDRESSING SALON (Care Facility)

5.7.1 Provide sufficient space inside the room for three or four residents to congregate while awaiting their appointments. A pleasant atmosphere should be created that encourages residents to take pride in their personal appearance. Suitable ventilation must be provided.

5.7.2 Provide space for a waiting area outside the room possibly in conjunction with the physiotherapy room.

5.7.3 Provide the following fixtures:

–      Vanity unit with storage cupboards under.

–      Shampoo basin at height suitable for wheelchair access.

–      Wall mirrors.

5.7.4 Provide space for the following furniture.

–      2 hairdressing chairs

5.7.5 Space allowance: 10.0 sq.m.

5.8      OUTDOOR AREA (Care Unit)

5.8.1 An outdoor area should be directly accessible from each care unit. Two or more care units can share an outdoor area when necessary due to site restrictions.

5.8.2 The outdoor area should include a clear continuous walking loop designed to connect strategic areas of the garden so that residents have the sense of a meaningful journey and arrival at destinations, Landmarks should be. developed to mark the different areas of the garden and help residents with wayfinding.

The walking loop should have a hard surface that is suitable for use by residents with gait impairments and residents using walkers and canes, wheelchairs and scooters. The finish material should be low-glare, non-slip and avoid defects detrimental to movement of residents.

5.8.3 Locate the outdoor walking loop to provide reasonable observation from the common areas. The location of the outdoor area should not obstruct interesting views from the interior of the care unit and still maintain residents room privacy.

5.8.4 The outdoor area should have the capability for exit control which is immediate and unobtrusive. To secure the area, suitable barriers which do not accommodate climbing to a height of at least 1800 mm are required to deter the more active residents. Consider 2400 mm barrier with back sloped top for outdoor areas above ground level.

5.8.5 Outdoor areas at ground level are most desirable. While the Ministry has a preference for care facilities on one floor, most urban sites require multi-story solutions. Where possible on sloping sites, grade access should be provided to more than one care floor.

5.8.6 Care units on floors without immediate grade access should provide access to an large outdoor balcony or deck with barriers that provide safety and wind protection without restricting views.

5.8.7 The outdoor area should be designed to be usable for the maximum amount of the year. Shelter from rain prevailing, wind and sun must be provided in at least part of the outdoor area. In most parts of B.C. the effects of blowing snow will also have to be considered in the design of the outdoor area.

5.8.8 Paving and wall materials selected for outdoor areas should avoid glare.

5.8.9 Residents should have the opportunity to exercise, relax, practice gardening and interact with other residents, staff, family members or visitors in the outside activity area. Sheltered seating is needed to make this possible.

5.8.10 A wide mix of garden stimuli should be provided. Plant material should be selected to provide colour and fragrance for most of the year. Plants selected should be non-toxic because of the risk that some residents may unknowingly poison themselves. Raised planters or other methods of bringing the planting close to people in wheelchairs and allowing them to participate in gardening should be considered.

5.8.11 Space requirements for controlled garden environments will differ widely dependent on building configuration, site restrictions, and activity of residents. A minimum of 1.4 m2/resident of hard surfaced patio area is to be provided with seating for 25% of the residents it serves.

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