ESPOIR SPECIALIZED ELDER CARE
ALYSSA ALEXANDRA SMITH
LSU INTERIOR DESIGN SENIOR CAPSTONE PROJECT
FA C E B O O K. C O M / L S U I D S E N I O R C A P S TO N E 2 0 1 3 S M I T H
ESPOIR SPECIALIZED ELDER CARE
ALYSSA ALEXANDRA SMITH ID 4720 - Seminar in Interior Design - Jun Zou Louisiana State University This document has been prepared for educational purposes only. Limited edition: 2 copies printed. No further copies shall be made.
table of contents chapter 1 - introduction - 8 INTRODUCTION TO THE STUDY PROBLEM STATEMENT USER CLIENT NEEDS RATIONALE FOR STUDY ORGANIZATION OF THE PROJECT
chapter 2 - research - 10 SENIOR LIVING FORMATS DEMENTIA WAYFINDING AND DEMENTIA LIGHTING AND OLDER EYES COLOR AND OLDER EYES
chapter 3 - building & site - 24 OVERVIEW OF LOUISIANA OVERVIEW OF BATON ROUGE OVERVIEW OF THE BUILDING
chapter 4 - precedents - 40 WARROAD SENIOR CENTER, MINNESOTA HERITAGE MANOR, BATON ROUGE COLONIAL OAKS, NEW ORLEANS MORNINGTON CENTER, AUSTRIA FIRMA DOO PROJECT, SPAIN
chapter 5 - programming -60 SPACE REQUIREMENTS BUBBLE DIAGRAMS DEMOED FLOOR PLAN BLOCKING PLAN STACKING DIAGRAM
chapter 6 - design solution - 74 INTRODUCTION TIMELINE GRAPHIC ANALYSIS DESIGN SYNTHESIS SPECIFICATIONS
chapter 7 - components -146 RESIDENT HALLWAY KITCHEN DINING BEDROOMS
references - 168 BUILDING CODES NATIONAL ORGANIZATIONS TEXTBOOKS RESEARCH WORKS CITED
acknowledgements
MY INTERIOR DESIGN STUDIO SISTERS
The past three years in this program would have been nothing without my classmates. Y’all have been my clients, critics, competition and family throughout this stressful process. I owe so many of my successes to the ten million opinions I’ve asked for. Thank you so much for being such a positive part of my life in and out of studio. I do not know how I could have completed the program without each and every one of you.
MY AMAZING FAMILY AND FRIENDS
Although it was often times extremely difficult to explain life in studio, your undying support and love has carried me through my college career and motivated me to always do my very best. I am excited to enter the real world knowing I have the best support group anyone could ask for.
PROFESSOR JUN ZOU AND MATT DUNN
I could have never completed this project without the motivation, advice, opinions and information you have each given me throughout the past year. You have taught me so much more than any textbook could about design. But even more so of how I work as a designer and how I can always improve.
POPPA EDWARD RODRIGUEZ, AIA-E
Thank you for spending countless hours with me reviewing my floor plans and giving me opinions on my project. Your enthusiasm for design and drive to do things correctly flows through me, I hope I can make you proud as a designer, myself.
COLONIAL OAKS, METAIRIE
Thank you for providing a better housing solution for my Grame. Her move to the nursing home was the strongest inspiration for this project. I have spent much time volunteering in nursing homes, but this direct connection really made me want to design the best possible space for those who need this type of home.
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i n t ro d u c t i o n
INTRODUCTION TO THE STUDY
This book is a look at the proposed design of a new housing format for people with dementia. This new format challenges the nursing homes of the past and hopes to provide a window into the future of senior living, especially for those affected by dementia. Traditional nursing homes today are too institutionalized, even more so for those who care for seniors who live with dementia. In Baton Rouge there are many traditional nursing homes with beds available, but none that centralize on design for residents with dementia. The available homes, while they may provide dementia skilled care and be recognized by the Alzheimer’s organization, are still lacking the success of creating a homelike place for these specific residents.
PROBLEM STATEMENT
In most of these said facilities, the residents with dementia are located in a separate wing of the nursing home. A place in which although they are safe and secure, they are removed from the amenities of the facility, and restricted to smaller spaces.
USER CLIENT NEEDS
People living with dementia need assistance with many daily living activities. In most cases they require 24 hour skilled nursing care. The effects of dementia and their specific needs are discussed in the dementia section of the research chapter of this book.
RATIONALE FOR STUDY
In its simplest form, this project was done to design a new nursing home housing model for the residents of Baton Rouge suffering from dementia. This comfortable, functional and welcoming center will accommodate for the effects of dementia in its residents and provide daily living activities assistance in a new form. This will be a new type of nursing home not yet implemented in Baton Rouge. Residents will feel much more at home in smaller living groups that take in account the various effects of dementia that will be discussed in chapter 2.
ORGANIZATION OF THE PROJECT
This project was completed in one school year. The first semester was dedicated to programming, research, site selection and analysis. The second semester focused on design and presentation.
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r e s e a r c h
INTRODUCTION
It can be said that interior design is the process of making choices to create spaces fitting specific client needs. What separates interior designers from decorators is the responsibility for the life, health, safety and welfare of the clients served. In designing an elder care home, especially for those of not sound mind, even more precautions need to be taken than ordinary spaces. To fully understand the users’ needs research was conducted on how to design for this specific group of people. For two focused months and throughout the process of design, research was conducted on several topics relating to dementia care. Information was found through the LSU library, online databases such as Academic Search Complete, national organizations including the Alzheimer’s Association and Parkinson’s Association, and other organizations for elder care.
WHAT WAS RESEARCHED
In order to create a home for elders with dementia, senior living facilities were studied to find the difference in formatting and the history of how and why such businesses were created. Because of the focus on dementia, it was also studied in detail to find complete understanding of the mind-state and needs of the users. While researching dementia, the importance of wayfinding was recognized and studied in further detail. Finally, because of the direct relation to interior design and the client, the effects of age on the human eye and how that relates to elder’s perception of color and light was also researched. Summaries of important information are included in this chapter for reference.
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SENIOR LIVING FORMATS
As people age and their health declines, daily living activities require assistance. When older people live alone and are unable to care for themselves it is necessary for their health and safety to move to a place where they can be cared for. In many cases, family members try to help, but are unable to successfully care for their loved one in the best possible way. In these cases the elder needs a place with experienced, knowledgeable help. This “place” has many different names, each with more specific amenities and services as the one before it.
DEFINITIONS
Senior Living Communities, also called senior independent living communities or retirement communities, create opportunities for older generations to live together in homes designed for independent individuals their age with few medical problems. Assisted Living Facilities are considered more residential housing models, where help is available as needed. Usually these facilities have many separate living spaces which can be organized like apartment and condominium complexes but are located within the same campus, ensuring that help is always available and in close proximity. This housing model reinforces independence and individuality. Residents are free to do what they want, when they want. Their living activities are not scheduled but are assisted. Assisted living facilities generally do not provide intensive health care. Skilled Nursing Facilities, however, are required to have 24-hour nurses on staff. According to federal regulations, these facilities and their residents remain under the supervision of a physician and need the skills of technical or professional personnel. These personnel include but are not limited to: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), physical therapists, occupational therapists, speech pathologists and audiologists. Alzheimer’s and Dementia Care Facilities require different assistance than generally offered by senior housing facilities. In most cases, residents with Alzheimer’s or the other forms of dementia live in special wings of the various forms of housing that are more secured, separate from the other residents and designed with their needs in mind.
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Because these facilities are living centers for the elderly, their built environment changes as the included services and amenities do. The design of their spaces becomes more regulated as the level of assistance and care increases, which can have a negative effect on the aesthetics of the space and the users comfort levels.
APPLICATION TO THE BUILT ENVIRONMENT
The design of these facilities is very much a combination of residential, commercial and health care design because the building itself serves as a home, an office and a health care institution when necessary. Historically the United States has approached the “problem” of dependent people by institutionalizing them. Today’s nursing home stems from the idea of a solution similar to mental hospitals, in its simplest form. This simple form is a place where people with special needs or health related issues are sent, a place away from home and their relatives for the problem to be fixed. The elderly and dependent have been treated as a problem that friends and relatives do not have the time, skill or funding to solve.
HISTORICAL AND ECONOMIC FACTORS
Economically, nursing homes can be a challenge or a solution. For some families, changing their home or taking time off from work can be too much of an economic burden to take care of their elder on their own. In this case, nursing homes can be a solution because most facilities are Medicare approved or payable through medical insurance. This solution should be personally researched on case by case basis because some policies do not cover as much as needed. The typical nursing home format is being challenged. Current research points to a downsizing in the number of residents per skilled nursing facility. Studies show that smaller groupings of residents result in less disruptive behaviors, greater socialization, reduced psychoactive medication use, greater resident and staff satisfaction. There is also a movement to make senior living centers more like homes and less like institutions. A common term used today is people-centered care rather than service-centered.
TODAY’S NURSING HOME AND CURRENT RESEARCH
Universal design focuses on making interior spaces accessible to everyone, no matter their physical condition. Elderly people have significantly different mobility and sense strength to the average user. ADA guidelines will be strictly adhered to in the project, more information is available in Chapter 5.
UNIVERSAL DESIGN ISSUES
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DEMENTIA
Dementia is a general term for the degenerative changes that occur to human brain functions. It affects memory, thinking, language, judgment and behavior. The most common form of dementia is Alzheimer’s Disease but dementia is also a side effect of stroke, AIDS, Parkinson’s Disease and vascular diseases.
GENERAL FEATURES OF DEMENTIA
• Memory impairment • Aphasia – inability to speak • Apraxia – disorder of motor planning • Agnosia – inability to recognize objects, shapes, persons etc. • Disturbance in executive functioning – the ability to think abstractly and to plan, initiate, sequence monitor and stop complex behavior
ALZHEIMER’S DISEASE
Today there are more than 4,000,000 Americans with Alzheimer’s. Dementia of the Alzheimer’s type is the most common dementia – accounting for 50 to 75% of the total number of cases, the percentage increasing with age. • • • • • • • • • •
Recent memory loss, including eating & drinking May lead to dehydration, dizziness and confusion Problems with language Memory loss of simple words and sentence combinations Disorientation of time & space Disrupted wake-sleep cycle Problems with orientation and wayfinding Problems with abstract thinking Resulting in bizarre behavior – iron in the fridge Changes in mood or behavior resulting in confusion, fear and overreaction to stimuli
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These Alzheimer’s symptoms can lead to other issues including: • • • • •
Difficulty with the expression of appropriate emotion Problematic social skills Impaired judgment Reduced ability to plan and anticipate Dangerous situations – particularly problematic are complicated by an inability to change behavior to override the situation
Design program must be a team effort involving staff, residents & families. The designer should have a personal experience with the disease, at least experience a day in the life of a person with dementia before beginning the design process. Residents need better quality of life, not just more therapies. The design of the building and the daily functions should focus on the residents should focus on what they support health maintenance and stabilize declining mental health not focus on improvement which is in most cases not possible. Locked nursing homes or isolation in their own home is not appropriate for people with dementia. Group home with trained staff in a residential neighborhood is often the better solution. Program repetition, familiar surroundings and set routines with the same staff contribute to memory reinforcement.
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ALZHEIMER’S SYMPTOMS
APPLICATION TO THE BUILT ENVIRONMENT
WAYFINDING & DEMENTIA
The design of the physical environment plays a major role in supporting the wayfinding abilities of people with dementia; the floor plan itself plays an important role on residents’ spatial orientation and wayfinding. Other design elements such as signage, furnishings, lighting and colors can help just as well. The process of finding ones way includes knowing where you are knowing your destination knowing and following the best route to the destination recognizing the destination upon arrival and finding the way back.
Four critical parts of wayfinding: Cognitive abilities: - Process spatial information - Process sensory information Physical abilities: - Ambulate the space - Perceive sensory information
Cognitive ability may be limited because of dementia and physical abilities may be reduced by sensory impairment, for example elderly sight issues. The lack of good wayfinding abilities may be related to other negative symptoms of dementia, such as wandering. In present nursing home designs the number of exit points within a route was correlated with the tendency of residents to get lost. Repetitive elements (large number of doors in a corridor) and numerous shifts in direction became equally as challenging. Wayfinding signage needs to be distinct from other information within the space, for example wayfinding signage should not be placed among meal plans and staff announcements. This is mainly because people with dementia become incapable of understanding the hierarchy of important information in situations such as this. The height of signage needs to be adapted to the downward gaze of elderly people. Signage on the floor is a possible solution but this idea needs to be tested for perception reasons. Signage alone is not able to provide all the necessary information a person with dementia needs to travel through a space. Solutions to these common problems with wayfinding design in dementia living centers include architectural differentiation in different areas, floor plan configuration, perceptual access to the entire space, location maps, and behavior training techniques. The spatial proximity of the kitchen, dining room and activity room is supportive for residents travel and comprehension. Spatial anchor points, reference points and places, can be spaces with distinct functions . Spaces with differentiated furniture & decorations, and also spaces with different meaning from the others in the home.
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LIGHTING & ELDER VISION
As people age, they need more light in order to see at the same level they did when they were younger. The lens of the eye becomes more opaque, thickens, hardens and becomes yellow. The eyes cannot adjust as rapidly to changes in illumination levels. When a higher degree of illumination is required, glare becomes a more acute problem. Bright, sparkling lights present special problems for seniors; they may produce so many reflections that they interfere with vision. The retina of an 80-year-old perceives 1/6th the light of a 25-year-old, but this does not signify a need for increased general light levels. A better use of the existing light source will solve the problem, including light placement, degrees of reflectance, absorption & diffusion. As we age our ability to adjust quickly from light to dark contrasts is slower. This can cause disorientation and dizziness, especially when processing a repetitive series of high and low lighting extremes in rapid succession. This requires too much visual and mental adjustment for elders.
NURSING HOME LIGHTING
Lighting can readily affect mood, tease our perceptions toward enjoyment or pleasantness in a given setting. The placement of lights can make us perceive closeness or distance and spaciousness or intimacy at a glance. Lighting also helps gain orientation to a space, avoid danger, and perceive textural richness. Light reflectance helps us perceive color, which in turn can animate or calm us. Sufficient lighting is particularly important in areas where concentration is required, decisions are made or danger is present. Decision areas (reception room/entryway) may require increased lighting. Light ceiling color increases the quantity of reflected light. Many accidents occur in bathrooms; increase lighting levels without glare to prevent accidents. Extra lighting is helpful when using a shower chair or seat . Lighting in seniors environments should be of medium brightness, except in task-specific areas. Washing walls with indirect light is an effective method of lighting the corridors without producing “hot spots�. A bare light bulb should never be exposed to view without shading. Bare windows should be covered with a window covering that diffuses the incoming light to avoid contrast and glare problems. Down lighting causes deep shadowing and is inappropriate for reading and most general tasks. Indirect troffer or valance lighting is particularly useful for offering an even illumination to wall and floor surfaces. It is not necessary to light flooring surfaces directly. Contrast between wall and floor surfaces should be considered in design decision. Cool florescent light emphasizes the blue-green tones that are most difficult for people with cataracts to perceive. A lighting spectrum as close as possible to daylight may reduce depression, fatigue, hyperactivity and some incidences
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of disease, which may also increase calcium absorption and reaction time to light and sound. Day lighting may also increase staff productivity and patient progress. Ultraviolet light in the spectrum is also helpful in sanitizing the space for people with allergies. Cool or blue light source – cool fluorescent tube lighting – can cancel out the warmth of certain colors. Warm or orange light rendered by incandescent lamps can cancel out the effect of an otherwise well-placed cool colors Especially in nursing homes, special precautions should be taken in lighting fixture selection. As lighting quantity increases, be careful to avoid excessive heat by using luminaries with low heat output. Flickering fluorescent lights have been found to trigger epileptic seizures. Studies show people with Alzheimer’s disease become agitated under fluorescent lighting. It is possible to achieve a less institution appearance when only the light is seen, not the source of the light. Exposed lighting systems are often harsh and glaring and can visually rake over a space. In concealed lighting systems, the emphasis is placed on the beauty of the room and its occupants rather than on the light fixtures. Also, concealed fixtures are less expensive than decorative fixtures. When using wall fixtures, keep controls within the reach of patients – fixtures must protrude less than 4in when placed 27-80 above finished floors. Sufficient lighting has been shown to be a central aspect of a supportive environment and to have a major influence on residents wayfinding abilities. The more light (both artificial and natural) there is in a nursing home, the more residents are able to find their way around. Several studies focused on the positive effects of artificial bright light (2,000 lux) and also of outdoor natural light on people with dementia. Both positive effects, including increased sleep duration along with less aggressive and agitated behavior. Sufficient lighting (500 lumens of ambient light, up to 2000 lumens in activity areas) is a prerequisite for good vision, it is good for being able to see and interpret the environment including the perception of the size and shape of rooms.
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COLOR & OLDER VISION
The ability to discriminate colors is affected in Alzheimer’s disease, dementia and as our eyes age. Most of these errors happen in blue and green areas, with fewer indescrepencies in yellow and red.
COLOR PERCEPTION
Colors with no yellow component (lavender, purple, blues, reds, magenta, some browns and grays) are difficult to perceive. It is much easier for older people to see yellows, oranges and reds yet these colors can become too intense. Colors partially yellow and easily perceived include primary yellow, peach, coral, clay, orange, some pinks, greens, aqua & some browns.
PSYCHOLOGICAL EFFECTS OF COLOR
Color can have negative and positive psychological effects. For example, because of their warm tint, yellow-related hues such as aqua are perceived as uppers or mood elevating. Also research shows that vivid color coding may enhance short-term memory and improve functional ability. Colors can also help to individualize residents rooms, giving them a sense of territory, ownership, and personalization.
As the eyes lens becomes yellowed and less transparent with age certain colors and color intensities are not as discernible – same effect as wearing yellow tinted glasses. Lavender may appear muddy, purple may seem brown, blues greens and violets may become particularly problematic.
Evidence of increased activity, alertness in the presence of warm and luminous colors, which creates environments conducive to muscular effort, action and cheerful feeling. Some excitable individuals respond more therapeutically to stimulating colors and withdrawn individuals to cool colors. Color can affect perceptions of time, size, weight and volume. In spaces where pleasant activities occur (dining/ recreation room) warm color scheme makes the activities seem to last longer. On the other hand, rooms where monotonous tasks are performed a cool color scheme can make time pass more quickly. As we age, there is a natural tendency to interpret a change in flooring color as a change in flooring height or level – same for walls. Repetitive patterns that appear to move or vibrate will often cause disorientation. However this effect can be used positively when warning users of change in height of depth such as stairs, busy intersections, key orientation points, counter-top edges or other hazards. As people age they have greater problems with contouring, or the capacity to perceive the boundary between two adjacent surfaces. This is most apparent when two intense colors such as red and green are next to each other.
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When color and light values are the same (as on stairs and floors) it becomes difficult to know where the surfaces start or end. Depth perception and peripheral vision are impaired, and accentuating contrasts on walls or doors can reduce the effects of these impairments. Darker and bolder colors need to be used if contrasts are designed for functional as well as for aesthetic purposes – but this too can be overdone. Use intense colors only for accents and for contrast to improve visual organization (grab bars, door frames, levers, & switches). Door frames, light switches, exposed pipes and other details should be visually prominent to facilitate efficiency and safety as older people move from room to room. For example, handrails tend to be more obvious if painted brightly. Doors in different colors can help residents distinguish the closet from the hall or bathroom. For those who suffer from a deficiency of perception plan variety in color, pattern and texture. Texture makes tones appear darker, absorbing important ambient light. Color values that contrast by more than two digits on the gray scale are adequate to increase the imagery of objects. Monochromatic schemes throughout the building may be perceived as institutional, monotonous and boring. This contributes to sensory deprivation which leads to disorganization of brain function, deterioration of intelligence & an inability to concentrate, all of which are the opposite of the desired effect of the interior design of a dementia care center.
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building & site study
LOUISIANA
One of the most unique states in the US, Louisiana’s culture is as elaborate as its very long history. The largest land purchase in the history of the United States is more well-known today for gator-hunting “Swamp People” and wild nights spent in New Orleans. Louisiana culture is marked by its Cajun-French influences and easygoing feel. With a population of 4.5 million, state residents vary widely in age, race, and economic standing. Where they live have marked differences as well. From bayou river homes to bustling city streets, Louisiana has much to offer in real estate. The main transportation through the state by road using the major interstates, I10 and I12. There are two international airports and multiple regional ones as well.
The Mississippi River bridge in Baton Rouge, Louisiana.
BATON ROUGE
Baton Rouge is home to more than 225,390 people, the state government capital, two state universities including the flagship LSU and many interesting places. Within the city are numerous outdoor parks, casinos, museums and amusement parks. Baton Rouge also represents Louisiana’s strong history with buildings almost as old as the state itself. In relation to the subject of Senior Living, 15% of Baton Rouge’s population is 65 or older. Looking to the future of this business, 33% of the population is over 45 years old. Although Baton Rouge is home to a number of retirement homes and nursing facilities, there is not currently a dementia living center in the city. Some of the Skilled Nursing Facilities are capable of housing people with dementia, but their living areas are quarantined from the rest of the facility, and do not have the same accessibility to facility amenities as the residents with forms of severe dementia.
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Due to its location and architectural style, the office building at 5565 Bankers Avenue was an easy choice for the location of this specialized elder care home. Because this building will serve as first and foremost a home, it is important that the building resemble a home, and also be in located in a residential area.
BUILDING
As seen on the map, this location is ideal because not only is it located near residential neighborhoods, it is also secluded yet close to many commercial businesses. Hopefully the proximity of this home to other large attractions will make visiting residents much more feasible for friends and family. This is further influenced by the buildings proximity to Interstate 10, which also caters to staff and emergency personnel.
ADDRESS:
SELECTION 5565 Bankers Ave Baton Rouge, Louisiana 70820
EXISTING BUILDING SITE Aerial view provided by Google Maps.
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LOCATION GOOGLE MAP ANALYSIS RIGHT: Location marked by the letter A, visible is Interstate 12 and its exit ramp to Bankers Avenue. BOTTOM: Map of Baton Rouge including the Mississippi River, Interstate 10 and where it splits to Interstate 12.
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The building is currently being used as office space for Providence Resource Group. All 11,000 square feet of the first floor is occupied by this company. The spaces include open and closed office spaces, a break room, lounge, wet bar, two conference rooms, a board room and large filing space. The almost 3,000 square foot second floor is available for expansion or lease but is currently being used as storage space.
EXISTING BUILDING
This building was completed in December of 2007 and designed by Chenevert Architects. As described on the architects website, “the exterior is a traditional Louisiana Acadian vernacular style utilizing brick and stucco with architectural roof shingles with slate caps.” This look provides a residential feeling to the building than can easily be implemented in the interior design.
Images from Chenevert Architecture’s website of the existing building’s front facade and interior spaces
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EXISTING FLOOR PLANS
FIRST FLOOR EXISTING PLAN
Not to scale
SECOND FLOOR EXISTING PLAN
Not to scale
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The buildings location on its site leaves room for extensions. It is classified as type C commercial zoning, which in Baton Rouge leaves no minimum side or back yard but a 10 foot minimum front yard. The large amounts of parking also create room for an addition. The surrounding buildings are also businesses, which provides a guarantee of quiet nights in the building.
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EXISTING SITE PLAN
EXISTING BUILDING
All drawings were provided by Chenevert Architects to a previous Interior Design student at Louisiana State University. The interior design department kept records of these files and shared them for the purposes of this project.
ELEVATIONS
BUILDING FRONT FACADE SOUTH ELEVATION
Not to scale
BUILDING REAR FACADE NORTH ELEVATION
Not to scale
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BUILDING SIDE FACADE EAST ELEVATION Not to scale
BUILDING SIDE FACADE WEST ELEVATION Not to scale
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PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT
EXISTING BUILDING Not to scale
PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT
PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT
PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT
PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT
PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT
PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT
SECTIONS
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MARCH 21ST 9 AM
12 PM
3 PM
JUNE 21ST 9 AM
12 PM
3 PM
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DAYLIGHT ANALYSIS SEPTEMBER 21ST 9 AM
12 PM
3 PM
DECEMBER 21ST 9 AM
12 PM
3 PM
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MAR21ST 9 AM
SEPT 21ST 9 AM
12 PM 12 PM
3 PM 3 PM
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JUNE 21ST 9 AM
DEC 21ST 9 AM
12 PM
12 PM
3 PM
3 PM
MAR 21ST 9 AM
SEPT 21ST 9 AM
12 PM
12 PM
3 PM
3 PM
JUNE 21ST 9 AM
DEC 21ST 9 AM
12 PM
12 PM
3 PM
3 PM
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MARCH 21ST 9 AM
SEPT 21ST 9 AM
12 PM
12 PM
3 PM
3 PM
JUNE 21ST 9 AM
DEC21ST 9 AM
12 PM
12 PM
3 PM
3 PM
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precedent studies
INTRODUCTION
In order to have a successful project previous examples of nursing homes were studied in great detail. The examples included in this chapter were all used to analyze square footages, space adjacencies, amenities and services. For certain projects, including many unpublished in this book, the company’s mission statements and self descriptions were also analyzed to find key words they all found important. The included precedents located in Louisiana were visited on site to gain a better understanding of typical activities and design attributes.
PROJECTS STUDIED
WARROAD SENIOR LIVING CENTER, MINNESOTA HERITAGE MANOR, BATON ROUGE COLONIAL OAKS, NEW ORLEANS MORNINGTON CENTER, AUSTRIA FIRMA DOO PROJECT, SPAIN
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SITE MAP
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WARROAD SENIOR LIVING CENTER
LOCATION:
1401 Lake Street NW Warroad, MN 56763
MISSION
CARE SERVICES
Our Mission is to provide an i ntegrated campus which includes Independent Living, Assisted Living, Memory Care and Nursing Care facilities to support the elderly. The Warroad Senior Living Center and professional care givers will provide compassionate, physical, social, emotional, rehabilitation and spiritual support for the residents thereby allowing them to age in place and live their lives to the fullest. -Professional nursing staff on-site 24 hours a day for emergencies -RN staff on-call 24 hours a day -Monthly on-site physician monitoring -Direct resident care -Licensed social worker consultant -Medication management and pharmacy consultant -IV therapy -Nutritional management and dietary consultant -Physical, occupational and speech therapy -Restorative nursing program -Hospice services
-RSVP, adult and junior volunteer program -Barber and beautician services -Scheduled transportation -Spiritual care coordinator and programs -Resident security systems -On-site services manager with 24-hour maintenance service -Specialized training in memory and Alzheimer’s care -Alzheimer’s support
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For the purposes of this project, the skilled care wings were studied in greater detail. The amenities and their related floor plans were also studied for design purposes in this new living center format.
Floor plan of one of the Skilled Care wings at Warroad Senior Living Center. (Not to scale)
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FLOOR PLAN
SKILLED CARE
“The 49 Skilled Care rooms average 400 square feet each, significantly larger than most other facilities. A group of twelve skilled care rooms comprise a single household. One ‘household’ is devoted exclusively to Alzheimer’s patients. A household includes a community living room, dining room, and kitchen.
SKILLED CARE ALZHEIMER’S CARE UNIT AS DESCRIBED BY WARROAD CENTER
We are proud to be the first in the area to offer Universal Care in our four Skilled Care wings. Universal Care offers a home-like environment that is directed by the residents. Our care-givers nurture the same residents each day, addressing not only their medical needs, but their personal and social needs as well. The households have separate dining rooms seating 12 residents, which makes their dining experience more enjoyable. The households also have a residential kitchen where residents and/or family can prepare snacks or help themselves to a stocked refrigerator, coffee or juices. If a resident wants to sleep in and misses breakfast, a continental breakfast is available. Each household features a private dining room that families can use for family functions such as birthday parties or any special occasion. This room can also be used for patient/family care conferences. Two households form a ‘neighborhood’. Each neighborhood contains staff work areas, nurses station, pantry serving area and a bathing suite. The neighborhoods feature a beautiful screened-in, three season porch that opens to the fenced courtyard.“
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SQUARE FOOT ANALYSIS
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HERITAGE MANOR SELF DESCRIPTION:
Heritage Manor of Baton Rouge is a health care and rehabilitation center “specializing in providing skilled nursing, long-term care, and short-term rehabilitation such as physical, speech, occupational, and restorative therapies. This facility works closely with other regional medical facilities, including Our Lady of the Lake, Baton Rouge General Mid City, Baton Rouge General Blue Bonnet and Ochsner Hospital, on transitions and nursing home arrangements. It is Medicare/Medicaid certified and accept private pay as well as most insurance.�
LOCATION
9301 Oxford Place Drive Baton Rouge, LA 70809
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HERITAGE MANOR SQUARE FOOT ANALYSIS
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HERITAGE MANOR CARE SERVICES SKILLED NURSING SERVICES
Supervisory nursing care inclusive of an around the clock presence. Includes wound care, pain management, tube feeding, and care after surgery.
LONG TERM CARE
Continuous nursing care for the management of chronic health conditions such as Parkinson’s, diabetes, COPD, and chronic heart conditions.
NUTRITIONAL SERVICES:
Registered dieticians design a full meal plan to cater to each resident’s individual needs.
HOSPICE CARE:
On-site compassionate care for pain management and comfort care near the end of life. The emphasis is on caring, not curing It involves symptom management coupled with emotional and spiritual support. Care is tailored to each individual resident’s needs and wishes, while support is provided to family members and loved ones in the process.
SECURED CARE UNIT FOR ALZHEIMER’S/DEMENTIA RESIDENTS
This unit provides a secure and peaceful environment while maintaining each resident’s dignity and respect.
RECREATIONAL AND THERAPEUTIC ACTIVITIES: RELIGIOUS SERVICES CARE PLAN CONFERENCES: PHYSICIAN/DENTAL/ VISION/PODIATRY SERVICES
A wide array of activities geared towards all areas of interest and functional levels. Trips out of the facility to restaurants, shopping and other area sites. On-site church services for residents and their families. Our staff works with the resident and family to develop a plan of care that meets their specific needs and goals. We will arrange for trips to a doctor or specialist or help with on-site visits so that each resident’s care is managed according to his or her needs and preferences.
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HERITAGE MANOR THERAPY SERVICES THERAPY SERVICES “Our therapists are aware of the challenges residents face when they begin a course of therapy to regain skills and abilities after orthopedic replacement surgery. The days can be tiring and discouraging at times. That’s why our therapists take a kind and steady approach to motivate each resident to progress and recover as fully as possible after an injury, medical event or surgery. PHYSICAL THERAPY Our physical therapists treat residents with both firmness and encouragement as they progress with the hard work needed to regain strength and mobility after an illness or surgery. We develop an individualized therapy plan for each rehab patient that respects the individual challenges facing each patient, with a goal of ensuring a smooth transition home. OCCUPATIONAL THERAPY Our occupational therapists focus on helping our residents eventually manage as independently as they can the activities of daily living. We work with our patients on the skills necessary for walking, bathing, dressing, eating and other common household activities, again with a goal of making the return home safe and comfortable. TRANSITIONING HOME Going home without a plan is like leaving town without a map! Prior to discharge from rehabilitation, we conduct a home evaluation and assess what needs to be done to help ensure that going home will include the modifications and assistance necessary for a safe return”
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COLONIAL OAKS METAIRIE, LOUISIANA
SELF DESCRIPTION
“At Colonial Oaks, we are dedicated to providing quality, compassionate nursing care to meet the changing needs of our residents. Our professional staff of nearly 80 health care professionals strives on a daily basis to provide the highest service levels possible, treating our residents with dignity and respect. Our team of physicians, dietary staff, rehabilitation staff, combined with the work of Colonial Oaks’ nursing team, admissions, and activities departments, are committed to providing quality services through caring and dedication. Colonial Oaks’ design creates an environment where residents can feel at home. Our 110- bed facility features comfortable semi-private rooms, all with a 24- hour call light system. We provide in-house laundry and house keeping services, a fully-staffed maintenance department and social services department.”
AMENITIES 24-hour comprehensive General Nursing & Restorative Care On-call physician coverage Semi-private rooms Medication administration Social services
Dietary Services Home-style Meals Physical Therapy Occupational Therapy Speech Pathology Oxygen for Respiratory Needs Portable Diagnostics: Laboratory
X-ray EKG Physician Services: Podiatrist Dentist Psychiatrist Optometrist Hospice Care
Volunteer organizing a game of bingo at Colonial Oaks Center in Metaire. Winners of bingo receive a quarter a turn, which they can use at the facility’s vending machines.
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COLONIAL OAKS FLOOR PLAN & SQUARE FOOT ANALYSIS
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MORNINGTON CENTER, AUSTRIA
This state of the art facility was designed to “contests the conventional paradigm of a nursing home.”
LOCATION: Mornington, Vicotria, Austria
The aesthetic and space planning was designed like a big house or coastal hotel, but it also focused on the importance of resident individuality, allowing bedrooms to have operable bay windows with accessible views from wheelchair and bed-ridden residents’ eye level. The design was also conscious in providing significant daylight and fresh air.
DESIGNED BY: Lyons Architects SQUARE FOOTAGE ea: 484,375.97 sq. ft.
As explained in research, most newly built nursing homes are designed to be more people centric. The designers of the Mornignton Center aimed towards a shift from a medico-centric care model to one where family and careers work with staff to deliver care to residents.
To reinforce the residential or hotel-like feel the clinical and medical support spaces were hidden to highlight the spaces for clients and their families. A more people-centered design enables more people-centered care .The dining room is the social heart and family focus for the building. Here family members, guests and staff come together to eat, chat and have a cup of tea. Material selection also aimed to help deliver a more homelike, residential feeling and less of an institutional heath-care facility. Timber linings, directional timber vinyl flooring, warm colours and domestic lighting were chosen to create this effect.
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FLOOR PLAN
SQUARE FOOT ANALYSIS
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FIRMA DOO PROJECT PROJECT: Nursing and Retiree Home ARCHITECTS: Firma DOO LOCATION: Alava, Spain PROJECT AREA: 7534.74 sq. ft.
When designing this project the first steps in Firma d.o.o’s design process were guided by such parameters as maximum site occupancy, maximum height and the minimum distance between buildings. The design resulted in four pavilions, planned. This created a successful neighborhood atmosphere. The architects pride themselves on creating a balance between a “community” life. They were hoping to stimulate the exchange and the relationship, but at the same time preserving the necessary privacy of each inhabitant. The first volume, located right between the “urban plot” and garden area contains public and common spaces, and is the only volume developed in two floors. The other three volumes keep one floor height containing single and double rooms for 25 users. Each room has personal bathroom designed without architectural barriers adapted to the needs of elderly people.
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All volumes are facing south, which means that users can take advantage of better insulation in the rooms and in common areas. Each “pavilion” is perpendicular to the street in the east of the site. The main entrance is located in the first pavilion (connecting directly to the common areas) and a glass corridor acts as the spiine of entire project. The glass corridor both ”connects and supports the elements of the building.” In the words of the designers “one can enjoy a rhythmic alternation of small gardens with views on both sides (east-west), and sequences of the interior spaces.” The only volume that stands out from the composition is the first volume with its greatest height, thus representing the public spaces and emphasizing the main entrance. The design of this home is more form concentrated than full function. It is not a good example for the home of residents with dementia, it does not have any security precautions, and the glass spine would be very psychologically challenging on the residents.
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FIRMA DOO FLOOR PLAN
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FIRMA DOO SQUARE FOOT ANALYSIS
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p ro g r a m m i n g
FIRST FLOOR PROGRAMMING
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SECOND FLOOR PROGRAMMING
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BUBBLE DIAGRAMS FIRST FLOOR
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SECOND FLOOR
RESIDENT LIVING SPACES ANALYSIS
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DEMOED FLOOR PLANS After programming, reprogramming, bubbling and attempting to block it was concluded that the buildings plan needed to change so that each bedroom could have a window. This addition was completed in order to save the number of residents proposed for the building. This addition was reviewed and reluctantly passed by an architect’s review. The demo plan to the right was created after hours of discussion, teamwork and compromise.
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UP
FIRST FLOOR
DN
SECOND FLOOR
12
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BLOCKING DIAGRAMS
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BEDROOMS
BEDROOMS
PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT EMPEROR LIVING AREA
EMPEROR DINING
BATHROOMS KITCHEN MONARCH LIVING AREA
KITCHEN
BARBER & BEAUTY SHOP
ELEV.
FAMILY ROOM
WC & STOR FAMILY ROOM
LAUNDRY
OFFICE
BEDROOMS
STAIRS
BEDROOMS
UP
FIRST FLOOR
2 4 6 8 10
ELEV
STR
LOUNGE
MEDICAL EXAM ROOM
OFFICE
WC
PHYSICAL THERAPY
DN
STR
STAIRS 12
SECOND FLOOR
WC
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RESIDENT BEDROOMS
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FAMILY ROOM
LIVING
SPACES
KITCHEN
LOUNGE
STORAGE & WC
VERTICAL CIRCULATION
STACKING DIAGRAM
FRONT OFFICE
MEDICAL EXAM ROOM
BARBER & BEAUTY SHOP
OFFICE
LAUNDRY
PHYSICAL THERAPY
STORAGE & WC
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design solution
INTRODUCTION
Named after the french word for hope, Espoir feeds on the possibility of tomorrow and the joy of today. With a focus on dementia and elderly care, the facility is a much better solution for those with memory impairment than living alone. Not only are residents monitored and aided in every possible way, they are also encouraged to preserve their memory and skills that they still have while becoming part of a new living dynamic. Living in smaller groups has been a proven positive change in senior living design. Espoir incorporates this idea by splitting the building ironically into two separate “wings” that share the same roof and several amenities. Each resident has their own bedroom and bathroom, providing a stronger sense of security, ownership and homeliness. Residents share a large open living space with ten of their house-mates that includes an entertainment living area, activity space, dining table, open kitchen and family room. Separate from each living group are the facility’s more commercial amenities including the shop (barber or beauty depending on the resident), a medical examination room and physical therapy space. Also, the building has office space on its second floor for the people behind the scenes who take care of the residents’ and facility’s care and expenses.
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PROJECT TIME LINE
At the beginning of the second semester this Gantt Project Time line file was created for personal reference.
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DESIGN CONCEPT
The main driving forces in the functional design of Espoir Specialized Care focus on the experiences and needs of the residents. The facility is designed for the safety, privacy, individuality and comfort of each resident through the space planning, furniture and finish selection. Special choices were made to help with the memory loss and confusion associated with dementia. The design aesthetic reflects various symbols of typical homes, focusing on the transition of design styles of not only today’s residents but those of the future as well. Transition is the basic idea behind Espoir’s design. Transitional design style incorporates both modern and traditional design aesthetics in a clean and pleasing way. This is ideal when designing a common space for every resident, family member and staff member of Espoir. The butterfly’s symbolism for hope and transition from a caterpillar led to its selection as the company logo. When deciding on a butterfly for the logo the image to the left was discovered online. Having mostly natural, neutral colors with accents of bright warm colors made it an easy choice for material inspiration. This palette is both easily changed and pleasing to older eyes. A focus on the contrast between main surfaces is also seen in the design, an idea that is meant to help residents perceptions of space.
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FLOOR PLANS
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KITCHEN
MONARCH LIVING KITCHEN
BARBER / BEAUTY SHOP
ELEV
FAMILY ROOM
MS. TIEK
WC
FRONT OFFICE
FAMILY ROOM
MONARCH GARDEN
LAUNDRY
STO
EMPEROR GARDEN
UP
UP
FRONT DOOR
MS. EASLEY
MR. SAL E. WALSH
SERVICE ENTRANCE
STORAGE
2 4 6 8 10
MR. SAL E. WALSH
EMPEROR LIVING
STORAGE
STO WC
WC KITCHEN
MONARCH LIVING KITCHEN
EMPEROR LIVING
BARBER / BEAUTY SHOP
ELEV
FAMILY ROOM
MS. TIEK
WC KITCHEN
LAUNDRY
STO
FRONT OFFICE
FAMILY ROOM
UP
UP
UP
ELEV
FRONT DOOR
MS. EASLEY SERVICE ENTRANCE
FAMILY ROOM
FIRST FLOOR PLAN LAUNDRY 2 4 6 8 10
UP
2 4 6 8 10 ELEV
EXAM ROOM
STO
WAITING LOUNGE
UP
OFFICE
MS. EASLEY
ICE ENTRANCE
WC
SECOND FLOOR PLAN
PHYSICAL THERAPY
DN
STO
DOWN
2 4 6 8 10 WC
79 2 4 6 8 10
REFLECTED CEILING PLANS
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UP
2 4 6 8 10
MR. SAL E. WALSH
STORAGE
EMPEROR LIVING
KITCHEN UP
UP
ELEV
FAMILY ROOM
FIRST FLOOR PLAN
2 4 6 8 10 LAUNDRY
UP
2 4 6 8 10
UP
MS. EASLEY
ICE ENTRANCE
SECOND FLOOR PLAN 2 4 6 8 10
DN
12
81 2 4 6 8 10
CIRCULATION DIAGRAMS
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MR. SAL E. WALSH
STORAGE
EMPEROR LIVING
KITCHEN UP
UP
ELEV
FAMILY ROOM
FIRST FLOOREMERGENCY PLAN CIRCULATION LAUNDRY
STO
UP
MAIN CIRCULATION
MINOR CIRCULATION
2 4 6 8 10
UP
MS. EASLEY SERVICE ENTRANCE
UP
SECOND FLOOR PLAN
DN
2 4 6 8 10
EMERGENCY CIRCULATION EMERGENCY CIRCULATION
MAIN CIRCULATION MAIN CIRCULATION
MINOR CIRCULATION MINOR CIRCULATION
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CODE COMPLIANCE DIAGRAMS
MEANS OF EGRESS - FIRST FLOOR Occupancy: 272 Minimum Number of Exits: 2 Exit Width 3’ -0“
ARRANGEMENT OF EXITS Minimum Remote Distance Diagonal Distance ½ Diagonal Distance Dead End Limit Common Path Limit Travel Distance Limit
200’ – 0” 168’ – 3” 84’ – 1 ½” 20’-0” 75’ - 0 “ 100’ - 0”
MEANS OF EGRESS - SECOND FLOOR Occupancy: 19 Number of Exits 1 Exit Width 3’ – 0” Stair Width 3’ – 8”
ARRANGEMENT OF EXITS Minimum Remote Distance Dead End Limit Travel Distance Limit
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75’ – 0” 20’ -0” 75’ - 0”
20’ DEAD END
NFPA CODE 407.4.3.5.3 MAX. DISTANCE 100 FT TRAVEL DISTANCE = 85’
MR. SAL E. WALSH
STORAGE NFPA CODE 407.4.3.5.3 MAX. DISTANCE 100 FT TRAVEL DISTANCE = 85’
EMPEROR LIVING
FIRE EXIT CORRIDOR
20’ DEAD END
KITCHEN
FIRE STAIR UP
UP
ELEV
FAMILY ROOM
FIRST FLOOR PLAN LAUNDRY
UP
2 4 6 8 10
UP
MAXIMUM TRAVEL DISTANCE = 70’ MS. EASLEY
ICE ENTRANCE
SECOND FLOOR PLAN
DN
FIRE STAIR
2 4 6 8 10 WC
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UPDATED EXTERIOR
G o dr n u 0 ' - "0
FRONT FACADE ELEVATION
BACK FACADE ELEVATION
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EMPEROR SIDE FACADE ELEVATION
MONARCH SIDE FACADE ELEVATION
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SECTION DRAWINGS
OFFICE
MEDICAL EXAM
GARDEN
BEDROOM
WC
EMPEROR LIVING
PHYSICAL THERAPY
MS EASLEY
KITCHEN
EMPEROR FAMILY ROOM
STAIRS
LAUNDRY
STAIRS
OFFICE
TO EMPEROR FAMILY ROOM
TO KITCHEN
EMPEROR LIVING
MR. SAL E. WALSH
GARDEN
2 4 6 8 10
ELEV
MS. TIEK
STOR.
BEDROOM
MONARCH LIVING
KITCHEN
THE SHOP
ELEVATOR
STOR
EXAM ROOM
EMPEROR FAMILY ROOM
OFFICE
BATHROOM BATHROOM
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FRONT OFFICE Upon entering Espoir through the front door, visitors will pass by the front office. This space was designed to be warm and welcoming to visitors and potential residents. Residential but interesting furniture with open shelving is meant to give the feeling of entering someone’s home who is organized, clean and cheerful, which the staff should directly reflect in the care of residents.
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FRONT OFFICE Barn doors create a way to keep this main office open to the hallway but also provide privacy when necessary. For example when interviewing a potential resident and family or discussing confidential information the doors easily slide shut and the windows keep others from interrupting. The lounge furniture provides relaxed seating for meetings, reinforcing the importance of comfort for users - including staff. Nursing homes tend to give anxiety to outsiders and this first room sets the stage for a new impression. Looking into the future of medical care and nursing home practices, Espoir has a high reliance on technology for resident files and medical information. Instead of typical filing rooms and nursing stations this room also serves as an information hub. Instead of flyers and signage throughout the halls, the surface mounted television screen serves as an electronic bulletin board. It provides information and personalization in a sleek way.
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MONARCH LIVING This is the first view of the Monarch wing of Espoir upon opening the door from the main hallway. The living spaces of Espoir are one large room with four separate types of activity spaces, all of which are easily recognized as separate by residents. These spaces fulfill more than their apparent needs while keeping the room and the residents unified. In this view, the activity table is being used for a game of cards. The coffering of the ceiling and location of the furniture separates this activity space from the entertainment space behind it. Fireplaces are one of the widest and oldest recognized symbols of residential life. The ones in this project are gas, switch controlled and, for safety precautions, inaccessible to residents. The shelving and storage provides a controlled way for residents to rummage through things and express curiosity without disturbing their peers. 95
MONARCH FAMILY ROOM Each wing of Espoir has its own family room separated from the main living space. These rooms provide the perfect amount of privacy from the other residents and staff for residents to enjoy visits with their loved ones in a place they can call their own. These rooms also provide quiet spaces for residents who may be agitated or upset that is not their bedroom. It is important for residents to be able to change location, and make the choice for themselves where they would like to spend their time. The furniture in this view shows the combination of sleek modern lines with traditional shapes and symbols, like the ones reflected in the rug selected. The white walls and large windows help to keep the space bright and airy.
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MONARCH KITCHEN In traditional nursing homes, the meals provided to residents are prepared in a commercial kitchen tucked away from their view. In Louisiana especially, the kitchen is an important part of “home�. The main idea behind Espoir is to strengthen the idea of home in a nursing home, so residents are not completely removed from such an important symbol. They are, however, removed from the kitchen’s potential danger. This view shows a look at the lowered bar, where residents are able to sit and help prepare meals, or watch from a safe distance as they are prepared no matter if they are wheelchair bound or independently mobile. Because most of the shock of moving into a care facility is the change in routine, opening the kitchen to residents provides a simple way to ease the transition from home to housing.
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MONARCH DINING This perspective shows a perfect example of a resident helping to prepare a meal. As seen in the previous picture, the center bar includes two sinks so that residents are able to help wash vegetables or clean themselves up before meals. It has been studied that practicing habits such as these help people with dementia keep their independence longer. One large dining table helps to create a sense of family among the residents and staff. Designed to seat at least twelve, there are enough seats for every resident in the Monarch Wing and two volunteers or staff to share meals. The dining space is located near the windows to help set or reset residents’ biological clocks. Having breakfast at sunrise, lunch at noon and dinner at sunset gives residents an idea of time without using clocks. Although changing your personal routine is uncomfortable, people with dementia tend to have unhealthy eating habits and this provides a way to correct and regulate eating patterns.
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MONARCH LIVING Looking at the living room from another angle, the adjacencies of each space can be greater understood. In this view, the white door on the left leads back out into the main hallway. It is white so to “disguise� it from residents because it leads outside and most residents should not leave without supervision. The french doors, finished with the dark trim, lead to the family room. French doors were selected to keep privacy and security at the same time. The solid dark stained door leads to a resident bedroom. The shelving unit inside the wall by the door along with the handrails seen in this view are components designed specifically for this project. A full description and detailed drawings of both designs are included in the focus chapter of this book.
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MONARCH GARDEN Each wing of Espoir has full access to more than 3,000 square feet of garden space outside of their living rooms. Both gardens have covered patios that include an outdoor table and raised bed gardens as seen in the perspective to the left. The raised beds provide access to the older residents, and those who require a wheelchair. Stained, plank-pressed concrete provides smooth travel paths for those in wheelchairs. The gardens are fully landscaped, but residents are motivated to be a part of the gardening. This is just another way that Espoir perpetuates resident skills. It is important to focus on what the residents can do and what they enjoy doing. Rather than focus on what they have become incapable of, Espoir keeps hope alive in its residents by more than just its name.
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EMPEROR LIVING In the Emperor Wing of Espoir, the same design ideas were applied and adapted from the Monarch living room. The Emperor Wing more strongly reflects modern furniture, but the same design concepts can be seen. Coffering the ceiling grids out and subconsciously divides this large space into its four separate spaces: entertaining, activity, dining and cooking. Leaning towards eclectic, Espoir fills its shelves with books and items that will entertain and intrigue the residents. These items give the space a more home-like feel and allowing residents full access to the shelving and storage creates a new and familiar activity to engage in.
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EMPEROR KITCHEN Identical to the Monarch kitchen, the Emperor kitchen is open to the main living space. Another positive effect of the kitchen being open to residents is that the smell of dinner permeates the entire wing. One very negative effect of dementia is the loss of appetite. Products have been designed to simulate cooking smells to entice hunger in dementia patients, but the real thing is much more effective. While designing the kitchen to be open, a challenge was presented at the thought of not having access to the refrigerator or cabinets, so a component was designed that would incorporate both. Full construction drawings for the shelving unit with minifridge are included in the focus chapter.
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EMPEROR DINING The dining table from the Monarch Wing is seen in greater detail in this perspective of the Emperor Wing having breakfast. This table was another component of Espoir’s design, the height and length designed specifically for Espoir residents. The table is even more interesting because the settings at the four corners have raising mechanisms that bring the table upwards and closer to residents who need assistance eating, as seen in the image to the right. Full construction documents are included in the focus chapter of this book.
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EMPEROR FAMILY ROOM Research has seen that nostalgic rooms designed for certain eras have a calming effect on residents of nursing homes. This view of the Emperor family room shows part of this idea in the selection of the artwork. The camera, typewriter and camcorder paintings not only complement the room, but they act as inspiration to reminisce for residents with memory loss. The Eames chair has a similar effect, it was selected because of its symbolism, hoping to bring back positive memories in residents. The Emperor family room is separate from the main living space but not as acoustically. The main, open entrance is to the left of the viewer of this perspective. The white door in this view leads directly to the fire corridor, but is not meant for unchaperoned use by residents. Doors available to the residents dramatically contrast the walls with their dark stain.
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EMPEROR GARDEN In the perspective of someone leaving the Emperor living room to go outside, this perspective view shows this wing’s first view of their garden. Not only do the gardens create a wonderful outdoor space for residents, it provides more positive activity and visiting space.
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BARBER + BEAUTY SHOP Every precedent studied included a barber shop and beauty parlor combination. It is important to have such amenities for the hygiene and self-esteem of the residents. As seen in the view to the left, Espoir’s shop provides space for two people to have their hair cut or styled. One permanent salon chair and space for a wheelchair both meet ADA code and reserve space for all residents. The table and chair on the edge of this perspective serve as a place for resident to get manicures. Especially with old age, it is important that residents hands and nails are taken care of by someone else. The artwork in the salon are all nostalgic prints of salons or barber shops chosen to reiterate to the residents what the space is, without designing a space too commercial and cold.
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BARBER + BEAUTY SHOP In this second view of the shop, the hair washing and drying stations can be seen. The specified sink is called an Adjustasink. It is specially designed to raise and lower, fitting the needs of wheelchair users at any height. The seating under the hair dryer can be used at the sink, as well. It is easily moved so that residents in wheelchairs can still use the dryer. A lounge style chair was chosen to make this commercial space more residential and comfortable. The other lounge chair in this room provides seating for residents who previously enjoyed spending time at the beauty parlor or barber shop. It also serves as a seat that staff can sit in front of, and take care of resident pedicures.
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SECOND FLOOR OFFICE Because Espoir is also a business, adequate office space is required to provide smooth operation. The 700 square foot office provides workspace for five permanent employees and hotelling for two nomadic doctors, specialists or operational staff. As previously stated, Espoir is designed with the future in mind and today’s technology incorporated. This render shows the specification of a Steelcase Mediascape table, that provides a direct connection between portable electronics such as a laptop or smart phone to the television screen mounted on the opposite wall. This screen, like the one in the hallway by the main entry, can be used as a digital bulletin board but also as a major connection to other facilities and organizations through video conferencing.
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MEDICAL EXAMINATION ROOM Along with a physical therapy room, the second floor amenities include this medical examination room. These amenities’ location on the second floor provides strong separation of business and home. The medical exam room is a place for residents to receive checkups from their physician or psychiatrist away from their bedroom. The upholstered niche shown in this view is meant to create a more comfortable and relaxing space for a doctor’s visit than a cold exam table in a bare room. For functional purposes, part of the niche can be moved away from the wall if the doctor and nurse need to be on other side of the patient. The stairs with matching finish are easily hidden underneath the component, and provide a safe and simple way to assist residents onto the exam table.
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s p e c i f i c at i o n s
STANDARD MATERIALS
WHITE PAINT
TAUPE PAINT
Benjamin Moore Color Preview Swiss Coffee OC-45
Benjamin Moore Color Preview Falcon Brown 1238
FURNITURE FINISH
DARK TRIM STAIN
LAMINATE FLOORING
Laminart Bronzed Pearwood
Minwax Water Based Wood Stain Onyx
Armstrong Natural Creations ArborArt TP052 American Walnut Sienna
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FRONT OFFICE
DESK & SHELVING LAMINATE
SHELVES LAMINATE
Wilsonart Contract Cafelle 7933
Lamin-Art 3020 Golden Satinwood
SETTEE BENCH
DESK & GUEST CHAIR
GUEST CHAIR
Ballard Designs Blair Bench Item: UB055
Ballard Designs Gramercy Upholstered Chair Item UD015
Knoll Saarinen Executive Conference Chair with Arms
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LAMP
DESK LAMP
ART LIGHT
Currey & Co Felix Floor Lamp
Circa Lighting Pimlico Boom Arm Pharmacy Desk Lamp
Circa Lighting Dean 12 Picture Light
RUG
FABRIC
ARTWORK
Decorative Carpets Inc Saffron
Pollack Circumstance 2312/01 Souffle
“Incredibly Red” Jan Groenhart
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LIVING ROOMS
ARMCHAIR
FLOOR LAMP
Cabot Wrenn Luxe Recliner 1049
Circa Lighting Hammond Column Lamp
RUG
MONARCH COUCH
Massland Elenore Area Rug
Arhaus Dante Sofa SKU: 11170SABDO
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PENDANT LIGHT
CARD TABLE
CARD TABLE CHAIRS
Restoration Hardware Weston Round Pendant 27” Diameter
Century Furniture Urn Base Table
Century Furniture Tribeca Upholstered Dining Chair
ARTWORK
ARTWORK
FABRIC
Sidonie Caron “Mellow Yellow”
Sidonie Caron “Spring, At Last”
Maharam Article Henna Anti-microbial
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RUG
TABLE LAMP
SIDE CHAIR
The Rug Company Flying Skies Area Rug
Circa Lighting Anita Table Lamp
David Edward Lolita Armchair
SOFA Steelcase Coalesse Astor Three Seat Sofa
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DINING
DINING CHAIR
DINING END CHAIR
Century Furniture Marbella Nevara Side Chair
Carolina Seek Lounge Chair
DINING CHANDELIER
DINING CHAIR FABRIC
END CHAIR FABRIC
Minka Kinston 5-Light Chandelier
Maharam Fluent Crypton 004 Rum
Maharam Fluent Crypton 004 Rum
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DINING ARTWORK
EMPEROR ARTWORK
EMPEROR ARTWORK
Janett Marie Little Paintings
Janett Marie Little Paintings
MONARCH ARTWORK
MONARCH ARTWORK
MONARCH ARTWORK
Janett Marie Little Paintings
Janett Marie Little Paintings
Janett Marie Little Paintings
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KITCHENS
BACKSPLASH
CABINETS
Daltile Serenade Mosaic Tile Indie F186
Armstrong Caruth Cabinets Vanilla Cream Finish
RANGE HOOD COPPER
BAR PENDENT LIGHTS
BAR SEATS
Chemetal Weathered Steel - 380
Trans-Luxe Bomba Pendants
Century Furniture Tribeca Dining Side Chair
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MONARCH FAMILY ROOM
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FLOOR LAMP
COFFEE TABLE
Circa Lighting Adjustable Old Pharmacy Lamp Brass
Tucker Robbins Waterfall Coffee Table
ARTWORK
COUCH
Kiele Gregoire “Strawberry Tide” Original Watercolor
Lee Jofa Sofa 3423-03
ARMCHAIR
ARMCHAIR FABRIC
RUG
David Edward Tulip Lounge Chair 21223
Maharam Aria 459950 018 Verve
Massland Morocco I Area Rug 8’x 11’
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EMPEROR FAMILY ROOM COUCH Arhaus Dante Sofa SKU: 11170SABDO
RUG Massland Flare Area Rug
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ARTWORK
ARTWORK
ARTWORK
Jessica Brilli
Jessica Brilli
Jessica Brilli
EAMES LOUNGE CHAIR
TABLE LAMP
Herman Miller Eames Lounge and Ottoman Black Leather & Plywood
Mitchell Gold + Bob Williams Deano Table Lamp Amber
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BARBER + BEAUTY SHOP SIDE TABLE
ARTWORK
Herman Miller Nelson Basic Cabinet
Kurt Ard - “Cowboy Asleep In Beauty Salon” Saturday Evening Post Cover, May 6, 1961 - Giclee Print
WALL SCONCES
FLOOR LAMP
ADJUSTASINK
Visa Lighting Avatar-Metro CV2012
Room and Board Tri-plex Floor Lamp
Adjustable height shampoo bowl
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ARTWORK
ARTWORK
ARTWORK
George Hughes Haircut And Manicure,” Saturday Evening Post Cover, December 11, 1948 - Giclee Print
Womens Hair Salon Premium Poster
Norman Rockwell “Full Treatment”, May 18,1940 Giclee Print
FLOOR TILE
WALL TILE
CABINETWORK LAMINATE
Daltile Alessi Noce
Daltile Alessi Crema
Kurt Ard - “Cowboy Asleep In Beauty Salon” Saturday Evening Post Cover, May 6, 1961 - Giclee Print
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FABRIC
SIDE CHAIR
SIDE CHAIR
DesignTex Cinnamon
David Edward Aspen Armchair
Steelcase Coalesse Bindu Side Chair
SALON CHAIR FABRIC
ARMCHAIR & SALON FABRIC
BINDU CHAIR FABRIC
DesignTex US Negril White Pearl
Richloom Contract Old Skool Stone
DesignTex Whip Caraway
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UPSTAIRS OFFICE
SYSTEMS FURNITURE FINISH
SYSTEMS FURNITURE
LaminArt Bronze Ribbon Mahogany
Steelcase Currency
CEILING PENDANT
WALLCOVERING
OFFICE CHAIR FABRIC
Circa Lighting Bryant Hanging Light
DesignTex Preclipse Sand
Richloom Contract Quicksilver Goldenrod
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GUEST CHAIRS
FREESTANDING TABLE
Herman Miller Eames Molded Plastic Chair Light Blue Plastic - WiMetal Base
Steelcase Mediascape Round Table
ARTWORK
ARTWORK
ARTWORK
Jan Groenhart “Abstracte Polder”
Jan Groenhart “Zomer”
Jan Groenhart “Bloeiend Land”
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component design
FOCUS STUDY
The design of Espoir was meant to create a new format of nursing home that would seem much less institutional than the typical formats of today. A focus was put on making all parts of the design as residential as possible, hoping to make the transition from home much smoother. To design furniture and products that aid residents’ independence, accessibility and improve daily living activities while disguising these components’ industrial purpose with a residential aesthetic.
PRODUCTS DESIGNED
Hand railing Wall Panel Format Identity Shelves Kitchen Divider Dining Table Place Settings Utensils Plate Cups Resident Bed Encasement Rising Side Table Full descriptions, computer renderings and construction drawings are included in this chapter.
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RESIDENT HALLWAYS HANDRAIL WALL PANELING IDENTITY SHELVES This perspective shows the entrance to a typical bedroom at Espoir. In addition to the typical wall paneling and residentially inspired handrail, this is also a clear example of how the identity shelving units work. The shelving unit to the left is used as a way to help residents find their bedrooms. Studies show that pictures of the residents and personal belongings are one of the simplest ways to help residents recognize their room. This is also a positive way to “uninstitutionalize� the building. Instead of room numbers on typical signage, this shelving unit provides more personalized wayfinding that residents, staff and visiting family members can easily understand.
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TWO 2x4 STUDS SPACED 16” ON CENTER
IDENTITY SHELVING RESIDENT PANELED DOOR 44” WIDE
HORIZONTAL SECTION
4”
4’-0”
8x10 PORTRAIT OF RESIDENT SELECTED BY FAMILY MOUNTED 5’-4” AFF
The identity shelving unit is always located on the handle side of the door.
4”
1’-4”
4”
1’-4”
IDENITY SHELVING
HANDRAIL COMPONENT
FRONT ELEVATION
The orange dimension string denotes the typical proportions of the building’s wall paneling. The identity shelving and handrail components are referenced on the next pages. 147
HANDRAIL 1 1/2”
1 1/2”
VERTICAL SECTION
WOOD 1 1/2” x 2 1/2” x 3” MOUNTING BLOCK
2 1/2” TRIMHEAD FINISH SCREW
1/4” - 20 x 5” HEX HEAD SCREW
3 1/2” TRIMHEAD FINISH SCREW
TOGGLE BOLT
3” MEETS ADA CODE 4.26 FOR HANDRAILS
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IDENTITY SHELVING VERTICAL SECTION
1/4” SLIDING SPACE FOR ACRYLIC
HOLES FOR PEG MOUNTING 3” SPACING ADJUSTABLE 1/2” PLYWOOD SHELVES 1/4” ACRYLIC
PAINTED GYPSUM BOARD
FRAME
SEE DETAIL ON OPPOSITE PAGE
BLOCKING
2x4 STUDS GYPSUM BOARD
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KITCHEN DIVIDER This two-way shelving unit was developed so that residents are able to be more active and keep basic skills, hobbies and daily life activities such as setting the table. The perspective view to the left shows the divider with the optional mini-fridge. At home, everyone has the freedom to browse their fridge and choose their own snacks whenever they please. Providing this minifridge helps residents keep this ability and freedom. Snacks and beverages stored in the mini-fridge will be selected by the nutritionist so that every choice is healthy and safe for the residents. This component was designed to be as ADA friendly as possible. Special attention was paid to the minimum and maximum reaches for residents in wheelchairs.
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FACADE ELEVATION
(IDENTICAL ON BOTH SIDES)
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LONGITUDINAL SECTION CUT
MAXIMUM HEIGHT THE AVERAGE PERSON CAN REACH MAXIMUM HEIGHT A WHEELCHAIR USER CAN REACH
1'-3"
2'-3"
0'-9"
4'-0"
2'-7"
5'-6"
(IDENTICAL ON BOTH SIDES)
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MINIMUM HEIGHT A WHEELCHAIR USER CAN REACH
TRANSVERSE SECTION CUT
(IDENTICAL ON BOTH SIDES)
OPEN DISPLAY SHELF
ADJUSTABLE SHELVING 1/4 " PEG HOLES SPACED 3" APART VERTICALLY
HANDLES PLACED FOR WHEELCHAIR USERS WITHIN MAXIMUM REACH
OPTIONAL FRIDGE LOCATION
OPENING FOR POWER STRIP
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RESIDENT DINING One of the main daily living activities that people with dementia struggle with is feeding themselves. In order to fight this problem, two major components were developed. The first, a dining table that has designated spaces with the ability to bring the place settings closer to the user. And then the place settings themselves became a component as well.
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2'-6"
2'-6"
5'-0"5'-0"
SIDE ELEVATION
16" 16"
2"
2"
1 1 2' -12' 2" -12"
TRANSVERSE SECTION
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20'-0"
TOP VIEW
8'-3"
8'-3"
BOTTOM VIEW
ELEVATION 2'-6 1/8"
11' - 3"
2'-6 1/8"
HORIZONTAL SECTION 2' -1
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PLACE SETTINGS Products to help residents independence were an important facet of the project, products to aid dining were researched with even greater detail. The illustration to the left shows how the various utensils fit inside a rubber grip that is weighted to add stability to shaky hands. The other utensil options are seen on the opposing page. The bent silverware helps residents with difficulty gripping or moving their hands in the “normal� way of eating. The full place setting drawings include a section (top) and plan view (bottom). The section shows the plates main feature, the added lip. This small lip was designed to help residents scoop their food without creating place settings that appear to be designed for toddlers. The same can be said for the design of the cup. It shape not only helps residents with arthritis grip the cup, it also leads to fewer spills because of its bottom-heavy nature.
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RESIDENT BEDS Because most people with dementia suffer from other illnesses as well, and the mobility of people with dementia, medical beds are needed in the bedrooms. There is no need, however, for them to be an eyesore. This component was developed as a way to hide the technical and less aesthetically pleasing medical bed and also provide the residents with a means of personalization in their bedrooms. To provide residents with personalization, the main frame of the component includes the footboard, side boards and a sleek rectangular headboard. The option to add on a more traditional top is easy to change and store. The additional facade is attached like a puzzle piece and held in place by three screw and wingnut connections. The technical properties of the medical bed are not compromised by this component and one sideboard can be easily detached for medical bed removal.
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MODERN HEADBOARD
TRADITIONAL HEADBOARD
ENTIRE BED IN PLAN VIEW 161
MODERN ELEVATION
MODERN SECTION
162
TRADITIONAL ELEVATION
TRADITIONAL SECTION
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LIFTING SIDE TABLE The last component designed in detail provides multifunctional use in resident bedrooms. When not extended, this side table provides storage and counter space at resident’s bedside. The main feature of this component is its ability to raise and lock into place and serve as a bed tray. This is a much more aesthetically pleasing design than the standard designs used today. The design effectively makes this symbol of health care design an interesting piece of residential furniture.
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2'-4"
6"
2' - 6"
1' - 512"
412"
0'-2"
RISING HINGE
1'-0"
2'-2 1/4"
ADJUSTABLE SHELVING PEGS SPACED 3" APART
COUNTER WEIGHT
OPEN FOR ACCESS TO LOCKING MECHANISM
EXTENDED FINISH HIDES WHEEL FROM VIEW
1 4"
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r e f e r e n c e s
COMMITTEE MEMBERS
Jun Zou - Seminar and Studio Professor Matthew Dunn - Focus Professor Edward L. Rodriguez, AIA-E - Architect - Mentor Dr. Sidney Smith III. - Geriatric Psychologist - Mentor
BUILDING CODES
Interrnational Building Code NFPA Fire Code ADA Guidelines 2012
NATIONAL ORGANIZATIONS
Alzheimer’s Association National Parkinson Foundation The Green House Project
TEXTBOOKS
RESEARCH WORKS CITED
Aspelund, Karl. The Design Process. Binggeli, Corky. Interior Graphic Standards: Student Edition. Botti-Salitsky, Rose Mary. Programming & Research: Skills and Techniques for Interior Designers Ching, Francis D. K. Interior Design Illustrated Rengel, Roberto J. The Interior Plan. ; Concepts and Exercises. Rengel, Roberto. Shaping Interior Space. Leibrock, Cynthia. Design Details for Health: Making the Most of Interior Design’s Healing Potential. New York: Wiley, 2000. Print. Baucom, Alfred H, and Robert J. Grosch. Hospitality Design for the Graying Generation: Meeting the Needs of a Growing Market. Goodman, Raymond J., and Douglas G. Smith. Retirement Facilities: Planning, Design, and Marketing. New York: Whitney Library of Design, 1992. Print Johnson, Colleen Leahy, and Leslie A. Grant. The Nursing Home in American Society. Baltimore: Johns Hopkins UP, 1985. Print. Koncelik, Joseph A. Designing the Open Nursing Home. Stroudsburg, Pa: Dowden, Hutchinson & Ross, 1976. Print. Janice B. Schwartz, et al. “Age And Sex Variation In Prevalence Of Chronic Medical Conditions In Older Residents Of U.S. Nursing Homes.” Marquardt, Gesine. “Wayfinding For People With Dementia: A Review Of The Role Of Architectural Design.” Health Environments Research & Design Journal (HERD) 4.2 (2011): 75-90. Academic Search Complete. Web. 7 Oct. 2012. 167