CARE FACILITY REVIEWS USING BPDG AS MEASURE
This section reviews several recently built care facilities in Ontario and British Columbia, and analyses their designs based on the Best Practices Design Guideline developed by the author. Five basic principles are utilized to organize the analysis.
1. Privacy: All resident rooms in new Complex Care facilities should be private rooms: i.e. accommodate one resident.
2. Accessibility: Complex Care facilities must be fully wheel chair accessible.
3. Small homelike units: Complex Care facilities should be divided into small self contained house units of no more than 18 beds.
4. Bathing: All resident Rooms should have ensuite showers. An assisted bathing tub should be provided in each house unit to supplement these showers.
5. Functionality: Complex Care facilities need to function efficiently and effectively
Eight facilities reviewed
Eight recently built complex care facilities located in Ontario and British Columbia are reviewed:
St. Mary’s (Mount Hope): London, Ontario (1997)
Strathmere Lodge: Strathroy, Ontario (2006)
Dearness Home: London, Ontario(2005)
Chateau Gardens: London, Ontario (2003)
Longworth, London, Ontario (2003),
McCormick Home: London, Ontrio (2006)
Highview: London, Ontario (2003)
Ayre Manor: Sooke British Columbia (2008)
St. Mary’s, Mount Hope Centre for LTC, London, Ontario
aTRM Architects and Dunlop Farrow Inc.
MOUNT HOPE – ST. MARY’S: LONDON, ONTARIO
This 173-bed facility, operated by St.Joseph’s Health Care, was built in 1997, shortly before the Ontario Long-Term Care Facility Design Manual (LTCFDM) was issued. It is a good example of a state of the art facility built just prior to the guidelines. The facility was designed by aTRM Architects (http://www.atrm.on.ca/) in conjunction with Dunlop Farrow Inc. Located in an older part of the city, it is a six story urban building with five resident floors. Resident floors are L shaped and each is comprised on one Home of approximately 36 residents. The ground floor is a large Main Street with lobby, The Courtyard Café, The Village Shoppe, The Library, The Rec Hall/auditorium, The Chapel, The Hair Trends Beauty Shop, and Greenhouse space is available to residents. There are wellness clinics and PT/OT. A central courtyard opens off the main floor lounge. The facility has an experimental Snoezelen room for dementia residents.
St. Mary’s has a far greater proportion of private rooms than the LTCFDM standard of 60% privates. There are 8 basic beds in 4 rooms on each of the 5 residential floors: i.e. 78% of beds are private. The basic (double) room lay out has a solid wall separating the two beds, with the ensuite a separate room off to the side. The basic (double) rooms are the size of two private rooms and do not consume any greater space than if they had been designed as two privates. The facility could have achieved 100% privates with no additional area cost.
SMALL HOUSE UNITS:
Each of the approximately 36 bed floors is self-sufficient with one central dining room. This size is considerably larger than the BPDG recommendation of maximum 18. However, each 36-bed floor is grouped into smaller home units of 12 and 13. The two arms of the L shaped layout provide short corridors with distinct bedroom zones and on three of the floors wandering loops. The angle of the L forms the third wing which includes 12 bedrooms, a small lounge, and the large dining room for all 36 beds on the floor. This central wing also includes a wandering loop around the core of the elevators and stairs. Subdividing the floor into these three wings, each with its own lounge, care station and bathing, provides a small scale more homelike setting to offset the larger dining experience. There are actually four lounge/activity areas per floor. Each of the lounges averages around 28 sq.m. This works out to about 2.8 sq. m. per resident of lounge/activity space.
About 50 % of residents are wheel chair dependent so accessibility is quite important. Resident rooms are on average 13.2 square.metres excluding the ensuite and vestibule which is adequate for accessibility for residents using wheel chairs. Resident room doors are 1120mm (44 inches) which is excellent for wheelchair accessibility. The ensuites are well sized for wheel chairs and commodes. Rooms have overhead lifts, but they are not continuous into the ensuite. The ensuite toilet is located on an angled wall which may make wheel chair access difficult from the side. Resident rooms and corridors are carpeted.
Ontario Provincial policy requires 2 baths per weeks for the residents. There is at least one bathing room or shower per wing. Unlike the BPDG the ensuites have no showers. As a growing proportion of residents are not toiletted, but wear briefs (adult diapers) there may be some cleanliness and infection control concerns. Residents are cleaned up on their beds. Resident rooms are carpeted. This could pose a contamination risk.
St. Mary’s is a first choice facility, given its high proportion of good-sized private rooms, overhead lifts, amenity spaces, and being part of a larger health care complex. There is a separate dementia floor, which has recently won an award for excellence. This facility is a great improvement over its more institutional neighbour, Marion Villa, which has 3 and 4 bed wards. The L layout lends itself to sub-grouping and a more homelike scale and keeps corridors short: i.e. reduces distance from resident rooms to amenities. However, the three sub groupings on each floor do not have their own exit controls, and share one large dining room per floor. This impacts management of disparate groups: i.e. it would be difficult to mix Alzheimer and frail elderly on the same floor.
STRATHMERE LODGE: STRATHROY, ONTARIO
ATRM and STANTEC ARCHITECTURE Ltd.
This 160-bed complex care facility opened February, 2006 just outside of London, in the town of Strathroy. It is owned and operated by the County of Middlesex, and was designed by Stantec Architecture Ltd. (formerly Dunlop) and a TRM.
Closely following the Ontario model, there are 100 private rooms and 30 two-bed wards (63% privates) divided into five residential homes of 32 beds each. Each of these five homes has its own dining, home kitchen, sunroom, den, bathing, and exam/treatment room. One of the homes is a designated dementia care house.
The building structure is two floors with a basement. The first floor is a variation on the traditional X form: there are three Y house units combined in the middle forming a core of amenity spaces including a great room, café, family dining, tuck shop and chapel. The basement is under the central core and includes support services such as the commercial kitchen, laundry, staff rooms, storage, maintenance, electrical, housekeeping, garbage and loading areas.
The second floor is reduced to two houses, with the core including a hairdressing room. The stem of each Y has the dining and sunrooms for each house, as well as a nurse station called a communication centre.
The top of the Y that forms a V shape houses the individual resident rooms with the intersection of the V wings providing the bathing room, storage, and a small den. Actually, the V is more of an inverted A shape with a circular wandering loop formed by the cross corridor.
At 63% privates, this facility is only slightly better than the Ontario model in terms of private accommodation. Strathmere has compensated for this lack of privacy by providing a separate palliative care suite on the second floor for residents of standard rooms. This lack of privacy for nearly 40% of the residents can be problematic for those requiring higher levels of care.
SMALL HOUSE UNITS:
At 32 beds per residential house unit, Strathmere follows the Ontario maximum size for house units. The V design of the residential area does sub-divide the house into two 16-bed wings. However, all of the amenity areas are shared, so the house really functions at the 32 residents level. This can be difficult both for residents and staff, particularly for residents at the complex care level.
Staff estimate that nearly 75% of residents use wheelchairs or walkers. With 13.8 square metres of exclusive space in the private rooms, and 14 square metres per resident in the doubles, the facility is well designed to accommodate these aids. Despite being only 12 feet wide, the private room works well because the built in wardrobes leave adequate clear manouevring space. On resident room doors there is some limitation in the short 18-inch wall adjacent to the door jam. Guidelines call for this wall to be a minimum of 24 inches (600mm) to allow for wheelchair movement with the inward door swing. The ensuite toilet is well placed to permit three-sided access from a wheelchair. The ensuite doors slide on the outside so are quite safe, and facilitate passage. Only nine of the rooms are equipped with overhead lifts. This is partly due to the high cost of maintenance. However, experience has shown that ceiling lifts are beneficial for both residents and staff, and are space savers. The dining rooms appear well-sized for residents who use mobility aids, and double as activity areas.
Each resident house unit has a bathing room with Arjo assisted bathtub, and a wheelchair shower. Unfortunately the ensuites are not equipped with showers, so all 32 residents are portered to the central bathing area for the standard two baths or showers a week.
This is a well-designed facility, within the limitations of the Ontario Model guidelines. The Y shape makes for short corridors and easily accessible amenities, including the central multi-purpose spaces. The V part of the layout provides an excellent privacy zone for the residential rooms, and the bathing area. The corridors are carpeted, while the dining uses sheet vinyl. This gives a residential feel, yet is practical.
There is a great deal of amenity area both within the house units, and centrally. The corridors do narrow to a little over 6 feet, with a wider allowance at doorways. This may be a bit tight for passing wheelchairs.
There are excellent turnaround areas at the end of the corridors, as well as wandering loops through the cross corridor of the A shape. The small dens are not well utilized, with residents preferring to be where more activities are occurring.
The nurses care unit is central in each house, adjacent to the dining and sunroom areas. It includes a large counter, small meeting room, and medication room.
The houses, being self sufficient, can be designated for specific care needs, with one set up as a dementia unit. The large population of the houses does pose a problem for special care groups, especially where behaviours can be difficult to manage.
There is ample out-door access with three gardens on the ground floor including one secure garden, and a large deck off the second floor. Architecturally, the corridors are nicely broken up with varied ceiling heights and lighting. The overall floor layout with back-to-back-dining areas enables the sharing of a servery between two of the houses on each floor.
The dining area is divided into a larger and smaller space so that residents who benefit from smaller groupings can be accommodated. The design incorporates service corridors to eliminate congestion between residents and supplies.
Accessibility is good, with some limitation in the resident room entrance area and in the width of the corridors. More ceiling lifts would also enable caring for more residents with complex care needs. Ideally all rooms should have ceiling tracks, so that lift motors can be added as needed. Retrofitting for this later can be quite expensive and difficult.
DEARNESS HOME: LONDON, ONTARIO
This replacement facility, owned by the London municipality, was completed in the summer of 2005. The architect was MMMC Inc. of Brantford and Kitchener. This firm has been involved in designing approximately 2000 new Long Term Care beds in Ontario in recent years, so has a vast amount of experience in this field.
The Dearness Home is a five story urban building based on the traditional X floor plan. The main floor has a lobby, reception, courtyard cafe, tuck shop, worship centre, volunteer centre, commercial kitchen, laundry, storage and staff spaces. There is also an Adult Day Care. Administration and the hair salon are on the second floor. This facility’s 243 beds are divided into nine homes of 27 beds each, slightly less than the Ontario maximum of 32. The main floor has one residential house at ground level, while the four higher floors have two houses each. These homes are basically the V parts of the X shape. The two Vs are elongated into a Y shape which are back-to-back to form a central amenity core for each house. The actual resident rooms are thus in a V configuration with utility, exam, storage and bathing rooms in the centre of the V. The stem of the Y has a large activity room, dining, and a small den, as well as a communication centre for the care staff. The dining rooms are back-to-back and share a servery. Each Home on the upper levels has a secured balcony off of the dining room.
The Dearness Home approximately follows the Ontario funding model and has 56% privates and 44% of residents in shared accommodation (doubles). Shared ensuites are problematic for seniors who have problems with continence. Neither of the two models utilized in this facility works well; and neither really saves much space or capital cost.
Small house units:
Though still large by the BPDG, the Homes at 27 beds are actually smaller than the maximum Ontario guideline of 32. Some sub-grouping can occur in the three amenity areas in the core: the dining, den, and activity spaces. And there is a very small sitting area at the end of each residential wing (each of the V arms). To some degree, the two wings of the V divide the home into sub-groups of 10 and 17. Still, 27 is a large group for staff to manage, especially for dementia residents or those with difficult behaviours.
Staff estimates that about 60% of residents are currently using wheelchairs. Doors to resident rooms are extra wide, 1120mm (44 inches), for good wheelchair accessibility. There may be a short-fall in the 600mm requirement adjacent to the latch door jam. Resident rooms have ceiling-mounted lifts that extend from the bed right into the ensuite. A nicely designed split door accommodates the ceiling track. The resident rooms are good-sized, at around 12.7 square metres of exclusive space. This exceeds the LTCFDM minimum of 12.1 sq. m and is adequate for wheelchair manoeuvring. Resident rooms have vinyl flooring, while the corridors are carpeted. With six square metres of amenity space per resident, the Dearness Home is close to the recommended 7 of the BPDG. The amenity areas include the dining room averaging 4 sq. metres per resident, and the activity area providing 1.9 sq. metres per resident. In addition there is a small den/lounge in each house.
Each 27-bed home has an assisted bathing tub room and a wheelchair accessible shower room, each with their own washroom. Again, Ontario does not support showers in the ensuites; thus, clean-up of diapered residents is difficult in these resident rooms.
The Y layout is quite good, with resident rooms grouped in a V of two wings that includes the bathing areas, and the stem of the Y that contains the daytime amenities. This location of the bathing rooms in the core of the resident rooms area provides short distances and supports residents’ privacy. The V is really an inverted A, with the cross corridor forming a good walking loop – which works well for dementia residents.
Nursing work areas are close to the core. The servery is well laid out to serve both dining areas of the two homes on the residential floors. Each home has a small kitchen as part of the servery area. A separate service corridor provides dedicated access to the servery and housekeeping.
There is some duplication of areas such as the exam rooms, meds and charting areas which could be shared on each floor. The homes are self-sufficient with exit controls. This allows four of them to be currently used for dedicated dementia units. There is a sizeable outdoor courtyard for all of the residents on grade, and a secure garden area for the dementia residents. There is a small balcony off the dining area on the upper floors.
The Dearness Home is an attractive facility with ample support and amenity areas. The resident rooms and ensuites are good sized. The overhead lifts are very prudent, as is the vinyl floor in resident rooms. The Dearness Home is commendable in breaking the 32-bed mold for the size of resident homes and for a design that facilitates sub-grouping within the house.
CHATEAU GARDENS: LONDON, ONTARIO
This 95-bed facility was opened in 2003. It was designed by Cornerstone Architecture, a firm that is quite active and innovative in the long-term care field. Chateau Gardens is an attractive two story building on the outskirts of London.
On the main floor are the support services: kitchen, laundry, administration, auditorium, staff areas, physiotherapy, family dining, beauty/barber shop and library.
This facility follows the maximum size allowed for resident home areas by the LTCFDM. On the ground floor there is a rectangular shaped dementia home (Magnolia) of 31 residents with a courtyard, and an L-shaped home (Aspen) of 32 residents for complex care. Pinebrook, also L-shaped, is on the second floor and is for more traditional care.
The L-shaped house units have 24 privates and only eight beds in basic rooms out of 32 beds, or 75% private accommodation. However, the courtyard dementia unit has 20 beds in basic double rooms and only 11 privates (35% privates). The total facility has a ratio of 62% privates to 38% doubles, or basics, which closely follows the Ontario Manual funding template. The high proportion of two bedrooms in the dementia home could be problematic. Dementia residents do not typically share accommodation well, but rather are disruptive and overly stimulating to one another.
Small house units:
Chateau Garden’s three resident home areas are all self-contained. Magnolia Home was designed specifically as a dementia unit and utilizes the courtyard design to provide a wandering loop. One side of the rectangle is composed of the core areas: dining, servery, and lounge. A small activity room is located on the far side of the rectangle.
A shower room, assisted bathing tub room, and exam room are interspersed along the three sides of the rectangle with the resident bedrooms.
Each of the two L-shaped units of 32 residents has a short wing of nine residents, a longer wing of 23 residents, and a core of services that includes dining, servery, lounge and activity.
Back-to-back communication centres for staff service the two ground floor homes. The second floor home has its own. Both layouts allow for some smaller sub-grouping of residents in the lounge and activity areas; but all three homes basically function as rather large populations relative to the BPDG recommended maximum of 18.
The resident room size is quite generous, and exceeds the Ontario design guideline of 12.1 sq. m, with 14.86 sq. m (160 sq. feet) of space exclusive of ensuite, vestibule and built-in closet for the privates.
The basic rooms (doubles) have 290 sq. ft. of usable space, again considerably exceeding the Ontario guideline of 230 sq. ft. The ensuites sized at 5.3 sq. metres are ample for wheel chairs. They are designed to accommodate a 5-foot turning circle. Wheelchair access is possible from three sides of the toilet.
The ensuite door is a barn-door style which slides on the inside of the ensuite wall. This works well and avoids the awkwardness of a swing door. The down side is that there can be a problem extricating a resident who falls on the inside of the ensuite against the sliding door. It would be preferable to have the sliding door on the outside of the ensuite. This allows for removal of the door from its track if necessary to access a fallen resident.
Although there are no overhead lifts, the room sizes are ample to accommodate floor lifts.
The Magnolia dementia unit has a wheelchair accessible shower room and an assisted bathing tub room. These are located in the bedroom zone at the two corners distant from the core. The resident room ensuites do not have showers.
The L- shaped complex care and traditional homes at Chateau Gardens each have two spas, one with an assisted bathing tub and a wheelchair shower, and the other with an assisted bathing tub.
Each of the three homes at Chateau Gardens is self-sufficient as recommended by the BPDG. The layout of the dementia home around a rectangular courtyard provides a good wandering loop. The courtyard is an attractive secure outdoor area with lots of natural light. However, our experience with homes of this size is that the courtyard design entails considerable corridor distance to navigate both for residents and staff. The multipurpose treatment room, activity room and spas would be better located closer to the core. The tub room in the dementia unit is at the opposite corner of the rectangle from the care centre. This appears cumbersome for staff and may result in a lot of staff travel.
On the ground floor, the back-to-back communication centres for staff have a duplication of meds rooms and conference rooms, which could have been reduced and shared, between homes. The two homes based on the L-shape have a better layout than the rectangular dementia unit.
The amenity spaces form a core at the right angle and include dining, lounge, activity, nurse station and a treatment room. The L-shape provides shorter corridors for both residents and staff to travel.
In the L-shaped Homes, the location of the spa in the short nine-bed wing is at the beginning of the bedroom zone, adjacent to the core, so is quite handy to the core area for staff. However, the spa for the 23-bed wing is at the far end of the corridor, making it inconvenient for staff.
The facility reports that the division of staff into two wings often results in a shortage of staff where two staff are required for care and transfers.
Chateau Gardens is quite an attractive facility, both externally and in terms of interior design. The L-shaped home layout works quite well, although the rectangular layout is a bit awkward with the extensive corridor distance to cover.
The large resident rooms and ample amenity space is a plus. Unfortunately, the ensuites lack a shower so the location of the bathing areas is critical. Their location in the private bedroom zone is good, but the spas at the end of corridors and at the far corners of the rectangle are distant for both staff and residents. Also, the doors sliding on the inside of the ensuites can be a safety hazard.
LONGWORTH (WESTMOUNT): LONDON, ONTARIO
This privately-owned 161-bed facility, built in 2003, is an attractive, two story building in a new subdivision of London. It is part of a campus of care that includes a seniors retirement home. The architectural firm of Sedun & Kanerva of Toronto designed the complex and closely followed the LTCFDM.
The building is built around two courtyards. Ample support areas surround the smaller courtyard on the main floor. The entrance is quite large, with a water feature in the middle. As well as reception, barber/beauty salon and tuck shop, there is a café/family dining area, and a 101 sq. metre auditorium along the side of the courtyard. A distinctive chapel is featured near the main entrance. This floor also houses the administration area, facility kitchen, laundry, staff areas, mechanical, electrical, storage, volunteer office, family stay-over suite, and a 36 sq. metre therapy room. There are five residential homes of 32 beds each.
On each floor, two of these homes are U shaped around a large courtyard: i.e. 64 beds and amenity areas spread along an extensive rectangle shaped corridor. The second floor also has a home that is U shaped around the second courtyard, over the support areas of the main floor. There are no specialized care homes.
Longworth follows the LTCFDM 60/40 funding template, with 96 singles and 64 residents in basic (double) accommodation, i.e. only 60% privates.
Small house units:
Again, Longworth follows the LTCFDM maximum of 32 beds per Home. Each of the five homes is self sufficient in dining, lounge, activity, and bathing. In addition they each have a multi-program space. With four distinct daytime amenity areas, there is a good variety of areas for sub-grouping of residents. Nevertheless, the size of the homes is considerably greater than the BPDG recommended maximum of 18 persons per Home.
Individual private rooms are slightly larger than the minimum set by the LTCFDM of 12.1 sq. metres (130 sq. ft.), and have 12.73 sq. metres (137.5 sq. ft.) of useable space, exclusive of ensuite, vestibule and built-in closet.
Each room is designed for wheelchair manoeuvrability, with a five-foot diameter turning circle beside the bed. However, only 335mm is provided to the side of the entrance door for persons in wheelchairs to swing the door inwards.
The layout of the basic (double) rooms is long and narrow with a limited view of outdoors for the resident furthest from the window. However, there is 22.07 sq. metres (237.5 sq. ft.) of usable space, which exceeds the LTCFDM requirement of 230 sq. ft. The ensuites are also designed for wheelchair accessibility with a five-foot turning circle. The toilet location allows wheelchair access from the front and one side which is standard in Ontario long-term care washroom design. The BPDG recommends access from the front and two sides.
Ensuite doorways are angled which increases the entrance area; however, swing-type doors can be awkward for residents in wheelchairs.
Space allowance for amenity areas is generous. The dining works out to 2.8 sq. metres per resident, which is what the LTCFDM requires, and just a shade under the 3 sq. metres recommended by the BPDG. The lounge/activity/multi-program areas are 3.5 sq. metres per resident, which is considerably higher than the LTCFDM of 2.5 sq. metres.
Each 32-bed home has a bathing area located in the heart of the bedroom zone, composed of an assisted bathing room, a wheelchair shower room and a wash room/grooming room. As with most Ontario facilities, there are no showers in the ensuites.
With two homes sharing a courtyard, the homes are each basically U shaped, with core amenities on one arm of the U. The resident bedrooms form an L-shaped privacy zone that includes the bathing area in one corner. Also on the corner is the nurse’s alcove with meds prep room and meeting room for staff. The multipurpose space is also in this corner, except for the home around the smaller courtyard.
There are turnarounds designed where one home’s corridor abuts the others’ so the homes can be distinct. The upper homes each have an outdoor balcony overlooking a courtyard. This layout results in two major centres of activity: the bathing/care centre corner, and the daytime amenity area.
A nice feature of the layout is that the dining rooms are back-to-back and can utilize one servery accessed by a service corridor. However, for the frail elderly, the extensive corridor length may be a tiresome undertaking; staff may find the layout inefficient as well.
Residents on the opposite side of the rectangle are distant from the main amenity spaces; i.e. dining may be a major outing from the far end of the unit for residents with mobility problems.
The location of the care centre may also pose problems being distant from the core areas of dining, lounge, and activity. The location of the bathing close to the care centre is handy. However, both would be better located closer to the daytime amenities.
One positive to this design would be the option to close off the daytime amenity area at night; in this case the care centre is ideally located for night-time supervision.
The layout of the ensuites is particularly useful for dementia residents and those with incontinence. The bed placement is such that it affords an immediate view through the doorway of the washroom to the toilet, which cues residents upon awakening. A night light illuminates the toilet at night. The angled doorway facilitates visibility into the ensuite. The double rooms can incorporate this layout for the bed closest to the ensuite. These design features have dramatically reduced the use of diapers relative to other facilities, a design feature that nicely demonstrates the positive effect that design can have upon residents’ wellbeing.
McCORMICK HOME: LONDON, ONTARIO
This 160-bed facility opened in February, 2006. Cornerstone is the architectural firm responsible for the design. It is a replacement facility and is operated by the Women’s Christian Association (Wisdom, Compassion, Achievement).
It is a three-story urban building on the outskirts of London. Each of the five homes has 32 beds. The ground floor has the major support services of a commercial kitchen, administration, hair salon, chapel, staff areas, an adult day care for 60, and one of the residential homes. This ground floor home, called Memory Lane, is dedicated for dementia residents, and has a secure outdoor garden space. The entrance is very welcoming with a great room adjacent to the reception area. This includes a café/tuck shop which is ideal for meeting visitors.
The second and third floors each have two residential homes. The Homes are L-shaped with amenities grouped at the right angle, including dining, activity, den, bathing, and care centre. On the second and third floors, the two homes are connected by a corridor that includes the elevator lobby, stairs, an exam room, meeting room, offices and space for volunteers. This corridor also accesses the servery that provides for the two dining rooms.
McCormick Home has 66% private accommodation, exceeding the LTCFDM funding template. Only 60% are assessed the preferred rate.
Small house units:
McCormick Home follows the LTCFDM maximum of 32 beds. The Lshape does divide the unit into two wings of 14 and 18; and there is some ability to sub-divide the population into smaller groups in the activity and den areas. Still, this is a large group to manage, especially the residents with dementia. The BPDG recommends homes of a maximum 18 residents.
The resident rooms are an excellent design, with the ensuites between each pair of rooms, rather than forming a panhandle/vestibule which wastes space. The usable space in each resident room is approximately 14 sq. metres (150 sq. ft.). This exceeds the LTCFDM minimum of 12.1 sq. metres (130 sq. ft.) and, with the built in wardrobe, provides good access to the bed from both sides.
The BPDG recommends 16.3 sq. metres (175 sq. ft.) to ensure wheelchair manoeuvrability). The width of the resident rooms at 3.135 metres (10.3 ft.) is narrow for wheelchairs. The BPDG recommends 4 metres (13.1 ft.). Generous room width is required for wheelchair and walker clearance past the end of the bed. This is affected by the furniture layout, so that the location of the built-in wardrobe and the raised TV shelf mitigates this somewhat. However, room narrowness will adversely affect wheelchair manoeuvrability at the entrance to the ensuite which is close to the end of the bed. However, The sliding “barn door” to the ensuites is much easier for wheelchair use than a swing door, particularly in tight quarters.
The resident room entrance doors have the required 600 mm on the side for inward swing by a person in a wheelchair. The ensuite is 4.6 sq. metres which is tight for a 1500mm (five foot) turning circle. A bit more width would have been ideal. The toilet is well situated for access from three sides. There are overhead lifts in some of the resident rooms which will mitigate the limited area for manoeuvring floor lifts past the ends of beds.
The dining room area is good sized; however, the activity/den space allocation may be tight for wheelchairs, walkers, and geri-chairs.
The assisted bathing tub room and wheelchair shower are nicely located at the entrance to the bedroom zone, yet close to the core for staff access. As with most Ontario facilities, the ensuites lack showers so all 32 residents are bathed in the one bathing area, other than from bedbaths.
The design of the individual resident rooms is particularly noteworthy. The ensuites located between each pair of private rooms eliminates the panhandle vestibule which is a waste of space. In addition it simplifies the creation of semi-private rooms and allows the flexibility of later modifying semi-privates into privates.
A note of caution: the ensuite doors follow the Chateau Gardens pattern and slide on the inside of the ensuite, thus posing a safety hazard.
There is good separation between the private bedroom zones and the core services. The amenities are all nicely grouped in the core, including the dining, activity, and den. The open design, with pony walls marking the dining area, is quite attractive, and flexible with sliding glass doors to form a sub-group for the activity room. This can be used for family dining as well.
The bathing area is located adjacent to the core, yet in the private zone. The care centre is well located in the core.
The home is divided into two wings to divide the population into smaller subgroups. This creates shorter corridors for both residents and staff to access the amenity area.
Soiled and clean utilities are well located at the beginning of one of the bedroom wings. The corridor adjoining the two homes is a good location for shared services such as the exam room, extra meeting room, volunteer space. The servery is well located between the two dining areas and has dishwashing equipment to eliminate transport of dirty dishes.
Despite the resident rooms and ensuites being a bit tight in terms of width for wheelchairs, and the ensuite doors a possible safety concern, McCormick Home is still an excellent design.
HIGHVIEW RESIDENCES: LONDON, ONTARIO
Highview Residences, London, is the most remarkable facility I have visited in Ontario, and one of the most excellent designs I have come across. Again the architect is CORNERSTONE ARCHITECTURE INC. of London, Ontario. Highview is a one storey home built in 2003 comprised of two twelve resident cottages within one building which provides secure residential care for individuals with early to mid stage Alzheimer Disease with a focus on providing a home-like environment. Residents are required to be mobile. The facility meets all the criteria for an excellent dementia residence, but was not designed for the higher levels of medically frail and immobile complex care residents. Because it operates without government operating dollars, it was able to build without reference to the Ontario Design Manual. Much of the functional program and design is based on Dr. Uriel Cohen’s concepts. Each cottage is T shaped and when linked form an H shaped building. Each cottage is self-contained in dining, lounge, activity, bathing, laundry and kitchen. Each functions as a distinct home.
All of the resident rooms are private. This is most suitable for dementia residents.
SMALL HOUSE UNITS:
Each cottage has 12 residents, is very home like, and self-contained. This is an ideal size for caring for dementia residents.
This is where there is some limitation to the design. Because it was not intended for floor lifts, geri-chairs and wheelchairs, the rooms are slightly undersized for full complex care. The width at 3276 mm (10’ 9”) could be problematic for wheelchairs. The resident rooms at 13.75 sq.m (148 sq.f.) exceed the Ontario Design Manual, but may be tight for wheelchair manoeuvrability. Likewise, the ensuites at 4.55 sq.m (49 sq.f) may be difficult for wheelchairs. The attractive glass block wall between the toilet and shower prevent wheelchair access from the side and impedes rotation. However, the design works excellently for the mobile residents that it was designed for.
There are plenty of amenity areas, including the dining, family room, lounge, and sunrooms. The dining room is 42 sq.m which is 3.5 sq.m per resident, excellent for wheelchair accessibility. The combined Family Room, Lounge, Sitting Room and Porch areas is 121 sq.m or 10 sq.m. per resident. This far exceeds the Ontario Long Term Care Design Manual minimum of 2.5 sq.m. per resident. And, again, this is excellent for wheelchair accessibility and great for providing a variety of locations and sizes of sitting area.
Like the Australian, European, British Columbian and the BPDG, the ensuites all have European style showers. This is excellent for dementia residents. In addition there is a beautiful spa for those residents who do want a tub bath. Bright windows look out upon the garden from the spa which includes a grooming/hair salon. This is well located within the bedroom zone.
The small scale of the cottages, 12 residents, and the private rooms all make for a very functional Home. The core amenities further divide each Home into two wings of 6 resident rooms. The corridors are thus quite short for both staff and residents. At the end of each wing is a screened sun room/porch as a destination and turn around area which affords lovely outdoor views. The heart of each house is the fully functional kitchen where all meals are actually prepared. The two kitchens are joined through the pantry so that one chef can service both. Each home also has a laundry/utility room. The link between the cottages includes offices and a staff area. The overall effect is very homelike. This design could be easily modified to better accommodate wheelchairs by modestly increasing the room areas and widths, providing 44 inch doors, and modifying the ensuites for better toilet access. This would allow residents to more easily age in place as they lose mobility. Highview meets all of the BPDG criteria, with the exception of some limits to resident room and ensuite accessibility. The generous amenity areas offset this shortfall and provide a very spacious, light, and homelike living space. Highview demonstrates that best practice design is economically feasible in Ontario.
AYRE MANOR: SOOKE, BC
Built in 2008, Ayre Manor is a 57 unit facility comprised of 25 Assisted Living apartments and 32 Complex Care suites forming a community of care with 18 existing independent living cottages. It has been developed by the Sooke Elderly Citizens’ Housing Society with financing arranged through the assistance of BC Housing. The new facility is designed by Jensen Group Architects, one of BC’s most experienced architectural firms in the Long Term Care field. The design follows the British Columbia Multilevel Care Design Guidelines of 1992 and 1994, with enhancements suggested by the author, Bill Benbow, based on the BPDG, who developed the Functional Program for the facility. The single story Complex Care building is divided into two Homes of 15 private resident rooms, each with their own ensuite. The two Homes are laid out around a courtyard. In addition there are 2 respite/hospice beds adjacent to one of the Homes. The Homes are U shaped with amenity areas grouped near the entrance to each Home, and the resident bedrooms forming an L shape privacy zone. The courtyard is divided so that residents can loop through their own portion of the courtyard. The Support Wing includes Offices, Hair Salon, Exam/Treatment room, Central Storage, Soiled Utility, Housekeeping, Commercial Laundry, commercial Kitchen, storage and Staff Room.
All private rooms with own ensuite as per BPDG.
SMALL HOUSE UNITS:
Two Homes of 15 beds each, and one adjacent area of two respite rooms. Each home is fully self contained with good sized dining, lounge/activity, and assisted bathing rooms. In addition each Home has janitorial, storage and clean utility areas. Exit controls facilitate special grouping such as one home dedicated to dementia and one to frail elderly.
Each resident room is fully wheelchair accessible with 18.3 square metres of exclusive space. This is achieved by pairing or stacking the ensuites between rooms so that there is no wasted panhandle space. Ceiling lift tracks continue from over the bed right into the ensuite. The ensuite doorway has a privacy curtain rather than a door, since ensuite doors are cumbersome for wheelchair users and often left open. The amenity areas are right-sized for wheelchair and walker use: there is no sense of crowding, with 3 square metres per resident for dining and 4 for lounge/activity. The corridors are quite accessible at 2438 mm (8 feet) with a special feature: acrovyn wall protection. Handrails have been omitted based on the experience that they are poorly utilized: with handrails folks in wheelchairs end up pulling themselves into the walls and those with difficulty walking are better off with walkers.
The bathing room in each Home is located at the beginning of the resident room area so that privacy is preserved. One Home has an Arjo Century Hydromassage tub, and the other has an Arjo Rhapsody System Hydrosound tub. Each bathing room has an ceiling lift system; and in addition there is a Miranti Lift bath Trolley with scale and an Alenti Lift Hygiene Chair with scale.
Besides these two Assisted Bathing tubs, each ensuite is equipped as a European style shower which is particularly useful for infection control and incontinence.
With only 15 rooms per Home the corridor lengths are quite manageable in this semi-courtyard layout. Amenity areas are co-located at the entrance end of each Home. The two dining rooms share a servery which is accessed from a service corridor. The dining rooms look out upon the Courtyard, while the Lounge/activity areas have views of the surroundings. The Assisted Bathing area is at the beginning of the Privacy zone of resident rooms, yet close to the core. Major staff support areas such as the Care Station are outside of the Homes so that paper work and confidential phone calls can be undertaken privately. One concern is that at the far end of each Home, two suites are around a corner of the U shaped layout, and out of the predominant line of sight, so may pose a problem for staff. CCTV cameras are installed at this corridor angle in each Home and can be monitored at the Central Care Station. The corridor dead ends unless the door is open for courtyard access, so again this could pose a problem for some, particularly those who perseverate when they wander. However, the Homes are small enough, with just 15 residents each, so that staff coverage should not be a problem. The two respite/hospice rooms are adjacent to the North Home and close to the Central Care Station to facilitate monitoring. These two rooms are larger in order to accommodate a sleeper-chair for family. In addition there is an adjacent meeting room for family use. Overall, this facility is an excellent model of the BPDG.
Several facilities have been reviewed in this chapter to demonstrate the importance of the design and layout of care facilities, with a view to Privacy, Accessibility, Home size, Bathing facilities, and Functionality, particularly in terms of the relationship between amenities, bathing rooms, and resident suites. This methodology is offered as a framework for analyzing and evaluating design layouts for facilities across the country.
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