The Center for Health Design Blog

Political Correctness & Old People’s Homes

Every once and a while new terms come along to replace old ones, or we decide some terms are more politically correct than others.

Most of the ones I can think of refer to terms to describe types of people/professions — policemen are police officers; postman is a mail carrier; old people are seniors. But some refer to things or conditions — a man hole is a utility cover; handicapped is physically challenged. You get the picture.

So, remember the term “old people’s homes?” That’s what we used to call nursing homes. Then nursing homes became long-term care facilities and then senior living facilities — assisted living, continuing care retirement centers — came along.

Some think that long-term care and senior living are not the right terms to describe the industry. The Guidelines for the Design and Construction of Health Care Facilities now calls it “residential care” and includes adult day care in the mix.

The Veteran’s Administration used to offer our nation’s rehabbing and aging veterans care in VA Nursing Home facilities, but it’s recently changed the name of the program to “Community Living Centers.”

All of these are a lot better than old people’s homes, but I still think there needs to be some consensus on what to call what. Personally, I like the term, “residential care” to describe the industry, but I’m not sure if most nursing homes are really community living centers.

Maybe they are. At least we’re moving toward a more politically correct society when it comes to caring for our seniors and disabled — I mean physically challenged — individuals.

Systematic Approach to Lifting Solutions May Not be Best

Many believe that the jury is still out, on ceiling lifts. Limited research has shown savings in workman’s comp for staff injuries, but there needs to be more data.

As reported in Health Facilities Management, some in the industry are alarmed by a bill introduced by Senator Al Franken last October to protect staff from injuries related to manual patient lifting — not because of its intent, but because the timeline for its implementation might not allow enough time to make changes to the built environment to install the lifts.

What’s more, the Revisions Committee of the Guidelines for Design and Construction of Health Care Facilities worked with experts to develop patient handling and movement assessment standards — and published a very comprehensive white paper on the subject, with can be downloaded free from the Facility Guidelines Institute’s (FGI) website.

There is great potential for innovation in this area — especially in equipment and technology used to support patient handling and movement. Kudos to FGI and the Guidelines Committee for helping to push the industry forward at the pace it needs to go.

Evidence-based Design in New Zealand

Rob Ansell, Principal Healthcare Architect for AECOM in New Zealand, is the first person to achieve Evidence-based Design Accreditation & Certification (EDAC) in the country. Rob is leading the charge to incorporate evidence-based design in healthcare facilities down under and growing the international EDAC community.

He recently shared his perspective on the growing interest in evidence-based design (EBD) and the challenges that come with applying it in New Zealand.

There remains a great deal of interest with respect to evidence-based design in New Zealand from both from individual hospitals and the Government. The “National Infrastructure Plan” is a guidance document produced by our government to address challenges to our infrastructure including healthcare facilities and its plan to meet them.

Either way it is agreed that an evidence-based approach is the logical path.

Notes from Abroad: China

The other day, I received an email from Center for Health Design board member Craig Zimring, who is in China, learning about its healthcare system and talking about evidence-based design. Below is an excerpt of his note:

We have been having a very interesting time in China. I have met with architects and Ministry of Health officials in Beijing and Nanjing and am heading to Shanghai. The people I met have great interest in evidence-based design and evidence-based best practice examples.

We did get a few days to walk in the rice paddies in the countryside; it’s lovely and calm, with a uniquely Chinese combination of water buffalos plowing the fields and Internet access.

Training About Architecture or Training to Be Architects?

Yesterday, I spoke about evidence-based design and our EDAC program at the 3rd annual Architecture + Health Educators Summit in Chicago that was organized and moderated by David Allison, Director of the Architecture + Health Program at Clemson.

Ray Pentecost, the current president of the American Institute of Architects Academy of Architecture for Health (AIA/AAH) also gave a presentation. He spoke about a “national knowledge strategy” that the AIA is looking to adopt. Basically what this means is that the AIA is acknowledging that architecture is a knowledge-driven business and that any building type is going to be knowledge-driven.

For educators, the key question is whether they are training people about architecture or to be architects?

Pentecost explained that for the AIA/AAH, this means that architecture has to be central in the discussion about personal health and that it is looking to shift its focus from healthcare design to creating healthy buildings. Which is interesting, because that’s exactly the bigger long-term vision of The Center for Health Design.

It’s why we didn’t call ourselves The Center for HealthCARE Design. We always thought that design could improve peole’s health and well-being in any building type — we just focused on healthcare first because it was the area of expertise of our founders.

Pentecost posed the question to the educators about what that would mean for design education. A rich discussion followed, in which several professors in the room said that the approach to education has to be interdisciplinary — involving not just the schools of architecture, but also the schools of interior design, engineering, construction, landscape architecture, and public health.

Pentecost urged this group to write a white paper outlining the challenges and opportunities of such an approach. It will be interesting to see what comes of this dialog and thinking.

Healthcare Going for the Gold in Sustainability

In the past week, I’ve received emails about three healthcare facilities that have achieved a LEED rating:

Laguna Honda Hospital & Rehabilitation Center, San Francisco, designed by Anshen+Allen Architects and Stantec Architecture (LEED Silver).

Jersey Shore University Medical Center, Neptune, NJ, designed by WHR Architects (LEED Gold).

Arlington Free Clinic, VA, designed by Perkins+Will (LEED Gold)

I proud to say that two of these organizations — Laguna Honda and Jersey Shore — are members of The Center for Health Design’s Pebble Project research initiative.

It’s good to see that more healthcare organizations are realizing that health outcomes and sustainability are compatible. And that many evidence-based design strategies support designing a facility to meet LEED criteria — including reducing toxins and energy use through materials, air-handling systems, water processing systems, and lighting.

But, the LEED for Healthcare rating system hasn’t been without it’s critics. Gary Cohen, President of Health Care Without Harm(HCWH), wrote a commentary in Modern Healthcare last month criticizing the U.S. Green Buildings Council for removing all language about persistent bioaccumulative toxic (PBT) chemicals (including dioxin and halogenated materials) from LEED for Healthcare credits.

“Without these material credits, LEED for Healthcare falls short of providing guidance and credits to the healthcare sector for reducing toxic materials in healthcare buildings,” he wrote, stating that there remains “fundamental” differences between LEED for Healthcare and the Green Guide for Healthcare that was developed under HCWH’s guidance.

Whatever the shortfalls of LEED, healthcare is moving in the right direction toward a more sustainable future.

Details Do Matter

It only takes a hospital experience to remind me of the significance of the work that we do at The Center for Health Design. Last weekend, my husband went to the ER for severe back pain and was eventually admitted for an overnight stay in our local hospital in Evanston, IL.

Judging from the furnishings, finishes, and unit layouts, this hospital was renovated about 10 years ago. I was struck by two things while in the ER and later on the patient unit — noise and smell.

We were in the ER on a Sunday morning, when it wasn’t too busy. The hospital still uses overhead paging, so several times, we were subjected to the droning, “Will doctor so-and-do please call radiology? Will doctor so-and-so please call radiology?” Or something like that.

Also, the attending ER physician’s computer station was right outside the exam room where my husband and I waited for six hours. At one point, I heard him talking on the phone to another patient’s family member, explaining all the details of her illness.

When I went to get a cup of water in a small kitchenette adjacent to the nurse station, I used the ice machine. It was so loud that I cringed and wondered if any of the ER patients could hear it.

As we got my husband settled into his private room (thank goodness) on the patient unit, I checked out the bathroom and was overpowered by the smell of urine. Admittedly, I do have a more sensitive nose than most, but it was bad.

The room had a large window overlooking a courtyard with a green roof. It was small — and there wasn’t really a family zone, but it did have a flat screen television on the wall. Trouble is, whoever installed the TV, completely missed the fact that the ugly black wires were hanging down from the back. I tucked them up out of the way — something the facility department should have thought of to do.

My husband got excellent care in this hospital — although I did notice in the ER that the blood pressure monitor that he was wearing on his finger was replaced four times because they had to take it off for whatever reason and it couldn’t be reused. Talk about waste in healthcare. I’m sure we’ll pay for the cost of that little item.

In the end, it’s really the details that matter. You can use the best evidence available to design a healing environment, but if staff doesn’t take care of the details — like the smell or wires hanging down from the TV — it will fall short. Noise, which causes stress for both patients and staff, is an issue that should be addressed in the design of every unit and department in a hospital, and dealt with from a cultural perspective as well.

Most people wouldn’t have noticed the things that I did. But that does not make it okay. Because the goal is to motivate and inspire hospitals to do better. And it doesn’t stop when you open the doors to a new or renovated building.

Wellness, Anyone?

One of the current trends in healthcare is wellness programs offering complimentary and alternative therapies and preventative screenings. A recent survey by the American Hospital Association indicates that 37% percent of hospitals are offering such programs, which can be used by people in the community as well as hospital patients and staff.

Last week, I participated in a workgroup to look at the design guidelines for residential care facilities (i.e., nursing homes and assisted living). The assignment of my sub-group was to see if there was a place to insert something about wellness centers.

We concluded that residents in long-term care and assisted living facilities also have access to wellness programs, but that it is not something unique to residential care.

After doing a quick search on the Internet, we also came up with this definition of a wellness center: A place where there is access to programs that support the integration of the physical, psychological, social and spiritual components of wellness to help people of all ages and fitness levels live healthy lifestyles.

These programs may be offered in freestanding wellness center facilities that are adjacent to or affiliated with a private company, community hospital, or long-term care/assisted living facility. They may also be offered in spaces that are within the companies, hospitals, or residential care facilities themselves.

Some, like outgoing Center for Health Design board member Leonard Berry, think that employers are going to lead the way in reinventing healthcare in the U.S. Besides complimentary and alternative therapies, companies are also providing onsite primary care, which Berry claims is a very fast moving trend in this country.

I think he’s right…and it won’t end when people retire from working. They will continue to embrace the concept of wellness and want access to those services in their communities. So, it makes sense to at least acknowledge in the design guidelines that this is a trend and begin to think about what types of facilities are being designed to support wellness programs.

The Best HC Products at NeoCon

NeoCon — the annual commercial furnishings exhibition at The Merchandise Mart in Chicago that is attended by 30,000-40,000 design professionals, facility managers, product manufacturers, students, and others related to the design industry , concludes today.

Healthcare products definitely grabbed more of the spotlight this year at NeoCon. In the Best of NeoCon product design competition sponsored by Contract magazine, Merchandise Mart Properties, Inc., McMorrowReport.com, the International Interior Design Association (IIDA), and the International Facility Management Association (IFMA), 36 products were entered in the four healthcare categories.

Eight of those products won awards — including gold awards for Herman Miller’s Compass modular system, Wieland’s Allay Sleep Sofa, Pallas Textiles’ Entwined Collection, and Momentum Textiles’ Silica. Compass is clean and uncluttered — and offers many configuration options. Allay has a nice look to it and a fold down back that becomes the bed.

Contract has uploaded a nifty slide show on its website where you can view all the healthcare winners.

I saw a lot of other interesting healthcare products while walking the halls of The Mart with Rosalyn Cama, The Center for Health Design’s board chair and head of her own healthcare design firm, Cama, Inc., in CT. We liked the smaller scale and clean lines of the Gatesby Lounger from IoA (part of a collection that won a Best of NeoCon silver award).

Nurture’s new Tava seating collection and the complimentary concept casegoods they were featuring made of Corian with wood legs also looked fresh — and yet a little retro. And while we’d like to get away from computers on wheels, Nurture’s Pocket cart shows how good design can really improve a standard product.

Carolina was also showing a modular headwall system with very clean lines and Roz and I really liked the contemporary design aesthetic of its showroom and other healthcare seating collections.

So, the healthcare furniture industry is maturing. NeoCon used to be a handful of specialty manufacturers who had pretty standard healthcare products and a bunch of office furniture manufacturers who were trying to adapt their products to healthcare. But the bar has been raised, and the success of conferences such as HEALTHCARE DESIGN has helped bring this market segment to the forefront at trade shows like NeoCon.

Healthcare Grabs the Spotlight at NeoCon

The focus of NeoCon, the annual contract furniture exhibition happening this week at The Merchandise Mart in Chicago has always been office furniture and furnishings, but in recent years healthcare has grabbed some of the spotlight.

Steelcase raised the bar a few years ago when it launched Nurture and opened a dedicated showroom in The Mart to display its new line of healthcare products. This year Herman Miller finally took healthcare out of the corner of its expansive third floor showroom and showcased its Brandrud, Nemschoff, and Herman Miller lines in a separate showroom on the same floor.

KI has substantial space in its 11th floor showroom for its healthcare products and Carolina was front and center in OFS Brands redesigned showroom on the same floor. Spec opened its first Mart showroom this year — also on the 11th floor.

Flooring companies such as The Mohawk Group, Tandus, Interface/Flor, and Mannington have always had showrooms in The Mart, and for NeoCon, they don’t necessarily separate out their healthcare product lines. But if you walk in the showroom and ask about healthcare, you can be sure there is someone there to talk about it and show you the goods.

Finally, The Mart management made a smart decision this year by putting all the temporary healthcare product exhibitors into one “Healthcare Pavilion” on the 8th floor. Before, you’d have to make your way through the endless corridors of the 7th and 8th floor to find them. It makes a lot of sense for them to be all together.

More to come on notable products seen at NeoCon.