Bringing Long-Term Care Facilities to Life for Home, Work, and Destination

The design of a skilled nursing facility requires more than just adherence to codes, as it applies art as well as in science to create a facility that suits its multiple functions—a home to its many residents, a place of work, and a place to visit. The various needs of the various groups the facility serves requires that it not only expertly meet functional requirements, but that it takes advantage of every opportunity to express the concepts of “home,” “workplace,” and “destination.” The art expressed in the design of a long-term care facility stems from an imaginative exploration of the key elements of meaning in these concepts, as well as the key design milieus familiar to those who will live and work in the facility. These elements of meaning are derived from profound personal needs for privacy, interaction, safety, and comfort. It is in understanding these needs, and applying architectural and engineering arts to meeting them, that a successful design is created. Addressing the individual needs of each facility begins during the program confirmation stage and extends through the design and construction of the facility to the completion.

It is important to make sure that the space is adequate and appropriate according to regulations, and that all required spaces and functions are provided. The architect for an Environment for Aging project needs to have extensive knowledge of the code and spatial requirements mandated by the Bureau of Long Term Care to best fulfill these requirements. It is also important to respond to the specific needs and desires of the staff and residents of the existing facility, and predict long-term needs based on observation of users and potential users of the facility, as well as the surrounding community.

During the Program Confirmation stage of these projects, a programming questionnaire distributed to key facility managers can help to uncover the key space and functional requirements, particularly when followed up by face-to-face interviews that probe for additional ideas and concerns. Since these concerns and needs are often unstated in formal documents, the observations of the facility users are vital to unlocking the design for creative improvements for future facilities. It is out of the interactive discussions between the programmers, clients, and designers that the opportunities for nurturing environments are born.

Aesthetic design for Environments for Aging begins with an understanding of the practical needs of those who occupy the facility, and incorporates responsive features into a beautiful, elegant design. Needs such as resident privacy, resident personalization, interaction, emotional outlets, physical outlets, staff needs, functional nursing needs, orientation and circulation, and control of undesirable stimuli are some of the issues that are typically considered in developing a design for a long-term care facility for the elderly.

Each long-term care facility is unique in that the residents are accustomed to visual and building cues that they have experienced commonly in their daily lives. The residents of an area that is comprised of mostly small-scale buildings and single-family homes, for example, often feel more comfortable with a design that emphasizes these traditional patterns and design motifs. Small-scale buildings, use of design patterns and materials commonly found in the homes and buildings of the surrounding area may be used as starting points for the design team in selecting an aesthetic for the new skilled nursing facility. For instance, when designing the new Oaks Congregate Care Facility for a 27-acre suburban parcel of land in Somers, NY, RBSD designed a three-story facility that resembles a large country manor, with two central courtyards, one enclosed by the building and one open. For the design for the new nursing home for The Jamaica Hospital Medical Center, which will be set in an urban neighborhood comprised of rowhomes, RBSD designed an undulating façade in a stucco-like material that evokes the design of elegant city townhouses.  

One approach to achieving a residential atmosphere within long-term care facilities is the “podular” or cluster concept, which breaks down nursing units into several clusters with varying spaces, waypoints, and views into and out of the facility, and creates possibilities for small-scale outdoor interactive space. By eliminating the institutional corridor and developing instead a cluster of mini-lounges and alcoves around which a small set of resident rooms can be developed, an institutional design can be broken into small forms more in keeping with the home experience of residents.

Another approach, the “facility” concept, combines different pod clusters into nursing unit “neighborhoods” via a “Main Street” concept, which can contain the major large group and activity spaces: shops, services, multi-purpose rooms, therapy facilities, lobby/greeting, assembly spaces, day care centers, craft rooms, etc. Decentralizing the nursing unit using a cluster concept allows for greater flexibility in scheduling the activities of daily living. Residents are able to establish a more personal relationship with each other and their caregivers, thereby enhancing the quality of care administered. This design also allows for grouping together of residents with unique needs, such as rehabilitation or Alzheimer’s.

Reducing the size of the resident area establishes an atmosphere reminiscent of home. Each room will also reflect that atmosphere through more home-like, non-institutional furnishings. Particular attention is paid to the style of the furniture and accessories selected for each room.

RBSD’s in-depth understanding of the needs and desires residents and staff of a long-term care facility allows RBSD to tailor their design and planning of facilities to best suit those who will use it long after the building’s intial design and construction has been completed.