This past week we celebrated the groundbreaking for the RMC Heber Skilled Nursing Facility. The groundbreaking was attended by members of RMC ownership, the Heber City mayor, construction team, design team, and residents of the existing RMC Heber facility.
Located in Heber, Utah, the new facility will be nestled inside native, woodsy landscaping complete with a dry creek and tall trees. Accommodating up to 110 patients in both private and semi-private rooms, RMC Heber provides a large selection of day-to-day amenities and activities including a beauty parlor, occupational and physical therapy services, private and public dining, lush courtyards, and resident neighborhood wings.
The entrance is across a bridge and into a garden area before you reach the main lobby which is wrapped by tall curtain glass windows. From the lobby is direct access to the “main street” area where the activity and life of the facility will flow. Down main street you feel like you are walking along store fronts with hanging lanterns, planters, and a large skylight above. From here you have access to every amenity. At the far ends of the resident wings there are gathering areas around fire places which are open to the inside and outside in the courtyards for all the residents to enjoy.
Estimated completion and grand opening is fall of 2018.
Our Experts Share
Dark, cold rooms and a boring fish tank vs. bright and cheery design and fresh baked cookies? We think the winner is obvious.
My earliest experience of health care design was as a child over 25 years ago, from my memories of visiting my father’s mother in a nursing home. The home in which my grandmother was placed fit the very definition of institutional. At the entrance we were greeted with a slightly used waiting area also used for social gatherings. The main feature of the entrance was the dark blue fish tank filled with exotic marine life. Resilient, easy-to-clean floors marked the path to my Grandmother’s room down the long and narrow corridors. While going for visits the path from our car to her room seemed daunting, however it was the patient room that was the least welcoming. The patient rooms were oftentimes cold and dark with limited seating. It usually was occupied by not only my grandmother but a complete stranger beyond the dividing curtain. I won’t deny that the foreign aspect of the equipment, cold design finishes, and lack of patient privacy did not encourage me to want to visit my grandmother. How unfortunate it was that when my grandmother needed my visits the most, I was repelled by the space she was residing in. Visiting grandma in the care center was not the same as visiting her at home.
It is easy to develop perceptions and fears about health care spaces. They are traditionally known for their long and dreary corridors, impersonal waiting areas, sterile rooms, foreign equipment, unseen diseases and unfamiliar smells. Fortunately today, owners and designers are breaking past that stigma of health care design and are making great strides in understanding how the environments we design influence health and well-being- especially true in Senior Care and Assisted Living. Studies have shown that good design increases patient experience and recovery time, allows for higher quality care, and increases emotional support.
Good Design Increase Patient Experience and Recovery Time
Most Senior Living Residents receiving long-term care suffer from a chronic illness, thus the focus of care is usually on supporting and maintain rather than curing. As such, creating a safe home-like atmosphere is key to improved sleep, better orientation and wayfinding, and reduced stress and aggression. These factors play key roles in allowing better recovery time and experience for the patients.
Facilities today are offering more small private rooms than shared semi-private rooms. The benefits of the smaller rooms include more privacy, more natural light, less aggression, better sleep for the patient, and also allows for increased mobility. The layout of the private unit allows for more safety features and rails for patients to maneuver from their bed and access their private bathroom. These increased safety factors actually decrease the number of falls and allow for better recovery time. In addition, private rooms encourages the patients to get out of their confined beds and into more public spaces to mingle with others. From a guest perspective, visiting a family member in a private rooms increases quality time, and provides for a less stressful atmosphere with their loved ones.
As the patient ventures out of their private space, wide corridors with seating throughout offer opportunities for patients to sit outside their “front door” and view the happenings of the day. In addition, amenities such as activity, dining, ice-cream parlors and a salon increase the interaction between patients as well as patients and their guests. Outdoor courtyards and paths encourage more physical activity and reduce patient agitation. Higher lighting levels in the dining spaces is also imperative as it allows patients to view their food better, which increases appetites and calorie intake.
Good Design allows for higher quality of care.
A happy patient makes for a happy nurse and a happy nurse makes for better care. Nursing staff in long-term care settings work under challenging conditions and experience their own physical and emotional stress. The high stress level can directly affect the quality care they administer to their patients. In efforts of better design to increase quality care, it is important to position nurse stations within central proximity to the patient rooms they care for. A central location allows more visual contact and quicker access to their patients. A nurse station should be designed with natural elements and light to provide and encourage good morale and satisfying work environments. In addition, the staff is benefited in their work abilities by the smaller patient rooms and proximity to patient amenities.
Good Design Increases Emotional Support
Recent research shows that feeling disconnected and alone can trigger major health problems. Loneliness is not immune to those living with others in group settings. Even those who appear most social and engaging can experience loneliness. Visits from close family and friends, however, always
provide good opportunities for connection. Good Design including private dining areas and private patient rooms creates an inviting environment for family and guests to congregate. Interior finish selections also provide a strong factor to the comfortability of a guest visit. Interestingly, studies show that guests stay substantially longer during visits when resident rooms are carpeted and furnished with home-like accessories. When activities and amenities are provided for guests and patients to enjoy together, memories are created, increasing emotional support. If a guest feels at home, there is no doubt the probability of return also increases.
8 year ago, I once again found myself making the trek from my car to my Grandmother’s bed in a nursing home. My mother’s mom was aging and in need of more care and assistance. My family chose to have her reside in a new facility mixed with assisted living, rehabilitation care, and skilled nursing. The facility was large with many amenities including private dining, salon, an ice-cream shop, activities room, etc. The finishes were elegant and cozy. My memories and experience with this facility were much more favorable than my experience with the facility my father’s mother stayed in years before. The newer facility was bright and cheery, and inviting for patients to venture out of their room. Overall the feel was much more inviting in provided many more lasting and uplifting memories of my grandmother that complimented the memories I had of her in her own home as I grew up. Visiting my grandmother in a more home-like setting with the smell of freshly baked cookies is how I will always remember her, and that makes me happy. Good design increases the quality of good memories.
— Written by Rachel Makenzie
Anjali, Joseph (2006). Health Promotion by Design in Long-Term Care Settings Center for Health Design, Concord, CA.
Hunteman, Greg (2017) Evidence-based design in long-term care https:/www.iadvanceseniorcare.com/article/evidence-based-design-long-term-care
Scott, Paula Spencer (2017) Visiting the Elderly https://www.caring.com/articles/visiting-elderly
In an increasingly digital world, computer aided design – or CAD – is quickly becoming the most widely utilized tool for communicating architectural and design concepts to clients. While it is certainly powerful and precise in communicating developed design, CAD lacks a few key benefits that preserve hand-rendering’s place as a necessary skill in today’s world.
Unfortunately, with the ubiquity of CAD hand-rendering is becoming less prevalent and receives less emphasis throughout an architect’s education despite its usefulness. In an effort to combat this and preserve the art of putting pen and pencil to paper in the up-and-coming generation of architects, our design principal Nathan hosts a monthly class (affectionately referred to as “sketchaholics anonymous” among our team), focusing on different techniques and applications and with a variety of subjects.
Why is hand-rendering a critical skill?
At the core of our mission is jointly creating architecture that facilitates meaningful experiences, inspiring the human spirit to flourish and thrive. To do so, we delve deep into our client’s vision – drawing out not only the necessary functions of the space but also aspirational goals – the “if it were possibles” and the “it would be really cool ifs” – from each stakeholder.
As we do so, we sketch on the table right there with the client, a concept materializing for everyone to see, understand, provide feedback. It creates a truly iterative process and open dialogue. There is no lag time, no coming back in a few weeks with a digital rendering of what we hoped was communicated previously. This creates a true partnership with each client and stakeholder, giving them a front-row seat to the creative process from inception to completion.
We are pleased to announce the addition of Rebecca Weidler to our team as our new Healthcare Planner. Rebecca is a recent transplant from Philadelphia with a decade of experience in architecture for health, and has been involved in projects of all sizes and scope. Originally from Long Island, New York, she obtained her Master of Architecture from the Pratt Institute and her Bachelor of Arts from Southern Virginia University. She will be overseeing planning for the new Brigham City Hospital OR Expansion, and joining the University Hospital Infill Project team. Outside of work, she enjoys all kinds of creative pursuits including fashion design, drawing, sewing, and experimenting in the kitchen.
Project Update: University Healthcare – Center of Excellence for Orthopaedic Rehabilitation
Completed Project: Prime Insurance Company Addition + Remodel
When asked her thoughts on how the new space reflected their brand, Director and Senior Vice President Barbara Malkowski had this to say: “We’re the masters of unique risk, we’re the contrarians.. we’re not your father’s insurance company, I hate to be so trite but we’re not. Our new approach, our fresh approach, our sleek approach, I would say it definitely plays to that.”
This past January marks Nathan’s 5th anniversary of joining TSA Architects as partner and design principal. Nathan is respected for his passionate dedication and architecture, specializing in design for healthcare, senior care, and other mission-driven work. His passion for healthcare design was sparked as a patient in an operating room 20 years ago, and since that time he continually strives to create beautiful architecture and spaces that inspire not only health and healing but better the built environment we live in.
OUR EXPERTS SHARE:
How significant of a role does lighting play in the patient experience?
Answer: Very. John Meredith shares how lighting can make or break recovery.
Creating healthy spaces involves a vast array of criteria and considerations, and crafting energy efficient and sustainable design also encompasses a large swath of factors. Finding the overlap between healthy spaces and sustainable design can achieve the best possible outcomes for both the people who occupy the spaces, as well as benefiting the environment and planet. One of the many factors in both is proper lighting design, which ideally incorporates daylighting and energy efficient systems for a cohesive outcome. Just as there are many things to consider in sustainable and healthy design, lighting design is more complex than might first be imagined. It is not merely about illumination levels, or the foot-candles needed to perform certain functions safely and effectively, though that is primarily what the building codes focus on. Nor is it simply about energy used, as the new energy codes focus on. Lighting has a profound effect on human behavior and physiology, in ways we are only beginning to understand and address. Here we’ll discuss a few of the major factors, and what the targets should be, as well as the potential outcomes.
As humans, we have evolved to respond to the daily, or diurnal cycle. Our bodies establish a circadian rhythm, and depend on cues from the sun to tell us when to awake, eat, and sleep. Research is showing this is dependent not only on the presence of light, but also upon its specific properties. Many people are familiar with color temperature, or the apparent color of light relative to known natural sources, such as the sun (blue light) and firelight (orange or yellow light).
However, the property that helps us comprehend the appearance of the light is CRI, or Color Rendition Index. This is a measurement of the ‘trueness’ of colors reflected off of objects, corrected for certain color temperatures. One of the most dramatic examples of this seen daily is the very warm (low Kelvin temperature) light of most highway and parking lot lights. While rather energy efficient from a perspective of watts used to lumens produced, they are very low CRI, and therefore colors appear dull and distorted. Contrast these to halogen incandescent bulbs in retail display environments, which use a relatively high amount of energy and produce very true to life color rendition, ideal for selling products.
In designing spaces that humans will occupy for several hours, such as hospitals and other healthcare settings, careful application of CRI must be applied. Light that is too warm, while soothing, may not be sufficient for fine work, such as surgery and other invasive procedures. Light that is too cool can increase stress levels of both staff and patients, increasing errors and hampering recovery. New research is showing this is especially important at night, when our bodies, in the absence of daylight, can miss the cue to produce melatonin, the chemical that induces sleep. Sleep deprivation is know known to delay recovery, and increase hospital stay durations, which in turn increases the chance of hospital-acquired infection. Hospital staff, however, may benefit from light that assists in aiding alertness, and blue light may be effective in work areas used around the clock. It is therefore necessary to tune the color of the light for the function of the space. Further developments in technology and software are even enabling us to program a simulated diurnal cycle, with blue light during the day, and warm light at night, particularly in patient areas.
This new level of adjustability is in addition to dimming, or tuneing of levels of light output, a long available, but often overlooked option in lighting design. Finite and intelligent control of light levels can have a positive impact on the usability of the space, as well as provide dramatic energy savings. Sensors and other equipment can even allow the complete turning off of lights in high use environments, and still be code compliant. LED lamps and fixtures are nearing full maturity, and are changing the game in terms of efficiency and tunability. Glare-avoidance can now be achieved through both careful architectural detailing, as well as within the fixtures themselves, through careful lens design. The best light quality will be achieved through indirect lighting of surfaces, and therefore the lighting must be designed and selected in a holistic effort with the architects, interior designers, and electrical and lighting engineers. Since CRI is the driving factor of the appearance of the light in a space, and it is measured as the colors reflected off of surfaces, the surface applications (wall coverings, flooring, ceilings and furniture) must all be considered in conjunction with the lighting specifications, and in some cases mock-ups may be useful or necessary to confirm performance expectations.
While not always available, whenever possible artificial lighting should be provided as a complement to day lighting. As much as technology has advanced, it is still no substitute for the sun, in performance, quality, or energy efficiency. Daylighting is not as simple as having a window though. Care must be taken to avoid unnecessary glare, heat gain, and to provide adequate privacy, particularly in patient areas. When possible, as with artificial lighting, daylight should seek to always be indirect, and potentially diffused as well. Mitigating daylight, and balancing contrast by avoiding harsh shadows is critical to an efficient and pleasing work environment. Lighting control systems can now be integrated with other ‘smart’ building systems, such as window shades, to vary and control levels of combined lighting, rather than simply levels of daylight or artificial light independently. Having daylight available provides an additional connection to nature, which has long been shown to reduce stress and increase positive mental health. While the cost of such systems includes additional sensors and backbone infrastructure, as these systems are becoming more popular, price is falling, and effectiveness and adaptability is rising. While many building owners do not have a means of calculating the return on investment of such systems, many healthcare providers already collect detailed and quantifiable user and patient surveys, and quality of the environment is high on the priorities for patient satisfaction. And as previously mentioned, many studies now point to reduced hospital stays, and more positive recovery rates, when the physical environment is improved. While there are many factors at play, the quality of lighting cannot be underestimated, and should be carefully considered from the outset of any project, whether it be new construction, or renovation/modernization. Big data is providing increasingly useful, but also potentially confusing information. Frequently the better solution is the simplest one, but more often, the best solution is the one that appears simple, while taking advantage of the depth of research, data, and systems available to us. Architects and designers need to work collaboratively with each other, and end users to better understand issues, and to enable optimized solutions.
Article contributed by John Meredith