The future can be uncertain when it comes to predicting the level of supportive living care your community will need. By implementing construction standards that suit the highest level of care today, you can adapt resident units to meet your needs tomorrow. This forward-thinking approach makes addressing the needed changes more financially feasible later.
In general, skilled nursing environments have the most stringent construction requirements, and these requirements can vary from state to state. Working with a design team that knows your state’s unique requirements is beneficial to avoid surprises. In Florida, for example, all skilled nursing facilities must be built at or above the designated storm surge elevation based on FEMA flood maps. If these specific standards are not discussed early in the design process and a strategy is not developed to accommodate them, the costs to transition to a skilled nursing environment after the building is complete may be insurmountable.
Building Construction & Space Planning
When comparing supportive living environments, the biggest difference is in the construction type. A multi-story, wood frame building may be acceptable for an assisted living use, but a similar skilled nursing facility will need to be a non-combustible building type. This is the one area where adapting a building to the highest level of supportive care is not an option if the building structure itself would not be code compliant.
Along with increased levels of care comes the need for more code required space. Planning corridor widths at a minimum of eight feet, additional office space for increased staffing, and larger storage areas for specialized equipment will make transitions easier in the future. Considerations also need to be given to protecting these spaces with fire protection systems and fire resistive rated assemblies. These items could potentially be able to be added later but would come at a much greater cost and disruption to occupants of the building.
In addition to the building construction and space planning, building systems are greatly influenced by the licensed levels of care. As residents age, systems that provide a higher level of safety are essential. For example, all metal ductwork with ducted returns and dedicated exhaust systems provide an increased protection against the spread of infection or airborne irritants. Also, providing separate life safety, critical branch and emergency power systems in anticipation of adding an emergency backup generator is a significant investment. Plumbing fixture design and placement can be affected as well since most states require a greater percentage of resident rooms be accessible in higher levels of care. Following accessibility guidelines in all resident rooms will offer the greatest flexibility for future transitions and avoid costly plumbing corrections.
Finishes and Materials
While the interior finishes may not be as difficult to modify later than the building structure or systems, it is worth mentioning them since their requirements too will vary with the type of care to be provided. In higher levels of care, wider doors are required at patient care areas and consideration may be needed for access controls or power door operators at entrance doors to the building or care wing. Carpeting takes a lot of abuse as well. Not only is wheel friendly and stain resistant carpeting helpful to the provider, carpeting with a Class I finish rating is required in higher levels of supportive care. Handrails in corridors, grab bars at toilets and showers, and hospital grade outlets at patient care areas all enhance safety for the resident as well.
The Bottom Line
So, when contemplating whether or not to invest in building a structure that meets the requirements of the highest level of supportive living, the provider really needs to think about how much work they want to take on later to convert the building. Any changes to building systems after the building is occupied will be costly and a significant disruption to occupants and care givers. Building preparations to consider are:
- Providing separation of electrical distribution systems for future generator and emergency power needs.
- Providing empty conduit and chases above hard lid ceilings to allow additional electrical, low voltage and nurse call needs.
- Incorporating upgraded mechanical systems to meet requirements for a higher level of care.
- Providing floor, wall and ceiling finishes that meet the finish classification required for the future expected level of care throughout the facility.
- Providing accommodations in the structural system to allow for wider door openings at patient care areas in the future; 3’-10” doors are required in skilled nursing facilities.
- Creating flexible spaces to accommodate future regulatory needs such as offices that can be converted to nurse stations and storage rooms that can be converted to med/utility rooms.
- Providing blocking within walls and showers for future grab bars and handrails.
Working Collaboratively to Facilitate Flexibility
Based on the community’s strategic plan, the architecture and engineering team can work with the provider to develop the best solution that addresses currents needs and budgets while preparing for the future. AG has worked with clients in different markets across the country to address such decisions in the concept phase. In two more recent cases with out-of-state clients, the assisted living and memory care buildings were purposefully designed with the units, public areas and corridors adaptable to any level of care. This meant the building was planned for non-combustible construction, 8’-0” wide corridors and 3’-10” entry doors as well as 50-percent of the units with fully accessible bathrooms. These clients wanted the planning stages to include this level of future adaptability so they could evaluate all costs and considerations.
In the end, the decision of how to build flexibility into supportive living structures needs to support the leadership goals and strategic plan of a community. See how a few Wisconsin clients as well as a Florida community have approached this strategic decision.
At Congregational Home in Brookfield, WI, AG worked with the provider to address the marketability of its independent living units as well as the ability to transition these units to service assisted living residents when needed. The intent of this provider was to allow residents the opportunity to age in place. By reorganizing the existing 24-unit building, the team created 32 updated independent living apartments with modern conveniences, making them a more attractive option in the marketplace. In the redesign, the units were planned with accessibility features such as roll-in-showers, accessible kitchens and greater clearances in front of appliances and plumbing fixtures that are needed if the units were to be adapted to assisted living units. This project not only made the independent living units more attractive to potential residents, it offered the comfort of knowing there was the option to age in place should a greater level of care be required.
For its assisted living property in Elm Grove, Heritage Senior Living wanted a building that allowed a portion of its supportive living units to be converted from the specific Wisconsin licensing standards for a Residential Care Apartment Complex (RCAC) to the higher care requirements of a Community Based Residential Facility (CBRF). Knowing the cost involved with the level of construction needed for the CBRF, the provider carefully considered the balance of cost and the need for flexibility later. The decision was made to proceed with a portion of the building as a non-combustible construction type. This allows some units that are currently functioning as RCACs to be converted to CBRFs later.
At its campus in Cutler Bay, Florida (East Ridge at Cutler Bay), SantaFe HealthCare wanted the option to convert memory support beds to skilled nursing beds depending on future market demands and resident needs. In Florida, memory support occupancy types fall under assisted living guidelines for construction and code compliance. In this case, AG worked with the local building authority to allow the memory support wings to be constructed as a skilled nursing occupancy. While this increased construction costs to build a non-combustible masonry building type and follow more stringent requirements for MEP systems, this strategy resulted in open corridors and a home-like environment for the residents. Furthermore, this plan means the provider has the ultimate flexibility in the type of care they can offer.
Working collaboratively with a savvy design team that understands the technical aspects of supportive living and the associated construction implications allows providers the ability to address current market needs while also preparing for the future.