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*3.1-2.2 Resident Unit
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A3.1-2.2 Resident units are groups of resident rooms and support areas whose size and layout are based on the care model staffing patterns, functional operations, and communications used in the facility.
3.1-2.2.1 General
*3.1-2.2.1.1 Resident Unit Size
See Section 3.1-2.2.1.2 (Layout) for typical resident unit size in different types of nursing home models and appendix table A3.1-a (Nursing Home Care Model Characteristics) for additional information.
Appendix Table A3.1-a
Nursing Home Care Model Characteristics
| Care Model Type* | Typical # Residents | Food Service/Dining Type | Resident Accommodations | Bathing Facility Type | Design Drivers | Environment of Care and Relevant Descriptions |
| Traditional | 40-60 or more | Centralized | Primarily double-occupancy rooms with shared half-baths | Centralized | Perceived care delivery efficiency |
1. Light: Most traditional resident units have side-by-side bedroom layouts, making access to natural light difficult, especially for the resident on the hallway side. Alternate layouts that allow each resident to control access to a window are preferred. Community spaces with access to daylight should be provided wherever possible.
2. Views of and access to nature: Often residents in traditional settings do not have the opportunity to go outside; however, it is recommended that residents be provided with both views and outdoor spaces that are safe and within sight lines of staff.
3. Signage and wayfinding: Long corridors with closed-in spaces can be disorienting; therefore, a clear, multi-layered wayfinding system should be provided. Use landmarks and distinctive features in addition to signs that are easy to read for residents who are visually impaired.
4. User control of environment: Individual control is limited with double-occupancy rooms, long corridors, and large institutional spaces, but individual lighting controls (artificial and natural) should be provided for residents in their personal environment. Headphones can be used to reduce acoustic disturbances from TV/radio.
5. Privacy and confidentiality: This is limited with double-occupancy rooms and central bathing; therefore, private space should be provided for residents and family members to gather as well as for individualized, unstructured activity time. Use of technology (e.g., pagers, cell phones) is recommended in lieu of an overhead paging system.
6. Safety and security: With centralized nurse stations, use of technology is key to the provision of safe and secure environments for residents. Technology solutions are recommended to minimize overhead paging. Wireless systems should be considered.
7. Characteristics and criteria for selection of materials and products for architectural details, surfaces, and furnishings: Selection of finishes is usually done with little input from residents and family members. It is recommended that such input be sought and that facilities encourage personalization of individual spaces. Resident council participation in development of community space recommendations is suggested.
8. Cultural responsiveness: The cultural orientation and needs, customs, desires, etc. of the care population and staff should inform the design of the physical environment. This understanding addresses the "who" element of the functional programming process, considered critical to developing the environment of care. For example, the designer would provide a physical environment that helps a caregiver from Jamaica caring for an orthodox Jewish woman understand and support kosher customs and resident and family expectations.
9. Support for person-centered care: Management should evaluate opportunities to provide a resident-centered focus in their institutional setting. For example, every effort should be made to eliminate the use of meal trays and to use food service delivery methods that facilitate choice. Tablecloths and household place settings can be used to create a less institutional environment for dining.
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| Cluster and/or neighborhood | 8-18 in a cluster 21-40 in a neighborhood (Neighborhoods are typically made up of 7 to 10 clusters.) |
Decentralized and/or centralized | Mixture of double and private bedrooms with shared or private full baths | Decentralized and/or centralized | Multidisciplinary teams from across the facility or community Staff efficiency |
1. Light: Clustering of rooms that support community spaces with access to daylight is encouraged.
2. Views of and access to Nature: Clustering of rooms may provide opportunities for courtyards and other types of outdoor areas that can be easily accessed by residents. It is recommended that residents be provided with views as well as outdoor spaces that are safe and within sight lines of staff.
3. Signage and wayfinding: A wayfinding program should be provided that distinguishes each cluster or neighborhood from another (personalization of space).
4. User control of environment: Opportunities should be provided for residents to personally control natural and artificial light in their personal space and to arrange furniture based on preference and location of nurse call devices. Wireless systems allow for more flexibility in the resident room layout.
5. Privacy and confidentiality: Private rooms or alcove/enhanced shared rooms (where each resident has their own defined living space) should be provided for residents.
6. Safety and security: Decentralized staff areas should be provided to support increased staff presence near residents and points of activity. Technology solutions are recommended to minimize overhead paging. Wireless systems should be considered.
7. Characteristics and criteria for selection of materials and products for architectural details, surfaces, and furnishings: Personalization of individual spaces should be encouraged, including finish selection and personalized furnishings. Input from resident council groups should be considered in planning and design of community spaces.
8. Cultural responsiveness: The cultural orientation and needs, customs, desires, etc. of the care population and staff should inform the design of the physical environment. This understanding addresses the "who" element of the functional programming process, considered critical to developing the environment of care. For example, the designer would provide a physical environment that helps a caregiver from Jamaica caring for an orthodox Jewish woman understand and support kosher customs and resident and family expectations.
9. Support for person-centered care: Use of clustering is a step toward adopting a person-centered approach to overall care. Evaluation of other person-centered opportunities for inclusion in the facility is recommended. For example, providing a "country kitchen" solution for frequent use by residents and families decentralizes the dining experience, allowing for more individualization and a home-type setting.
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| Connected household and freestanding house | 10-20 | Decentralized | Primarily private rooms with private full baths unless resident requests co-habitation | Decentralized | Integrated household-based team Resident-centered care Reduction of walking distances Foster relationships that are deep and meaningful Creation of intentional community Foster "at-homeness" |
1. Light: Access to daylight, pleasing views, and outdoor spaces should be priorities, both in private bedroom areas and in shared social spaces.
2. Views of and access to nature: Connected households and freestanding small houses usually provide opportunities for courtyards and other types of outdoor areas that can be shared between households and easily accessed by residents. It is recommended that residents be provided with views as well as outdoor spaces that are safe and within sight lines of staff.
3. Signage and wayfinding: The smaller layout of facilities using this care model generally makes it easier to provide direct visual access to key destinations. Individualized cues should be provided or accommodated at each resident room entrance. The household or house should have clear boundaries (i.e., a front door that remains closed).
4. User control of environment: The goal of this care model is to support more resident autonomy in decision-making about all aspects of the environment and daily routine.
5. Privacy and confidentiality: The preponderance of single-occupancy rooms used in this care model supports privacy. Technology solutions that minimize overhead paging are recommended.
6. Safety and security: The smaller scale of facilities using this care model supports ease of staff monitoring. Outside spaces should be highly visible from indoors. Wireless systems should be considered.
7. Characteristics and criteria for selection of materials and products for architectural details, surfaces, and furnishings: Finishes should include low-glare, non-slip flooring; use of low-VOC materials; indirect lighting supplemented with task lighting where needed; and appropriate use of color contrast to enhance elements that residents need to easily see (e.g., the difference between floor and wall).
8. Cultural responsiveness: The cultural orientation and needs, customs, desires, etc. of the care population and staff should inform the design of the physical environment. This understanding addresses the "who" element of the functional programming, process considered critical to developing the environment of care. For example, the designer would provide a physical environment that helps a caregiver from Jamaica caring for an orthodox Jewish woman understand and support kosher customs and resident and family expectations.
9. Support for person-centered care: This care model provides true resident-directed care that honors the rhythm of each individual's life as dictated by his or her desires. The goal of this model is to create the feeling of a home for the residents, while potentially maximizing some efficiencies of care and ease of access to larger shared social spaces outside the household. Some facilities that support this model include neighborhood/town center spaces that residents from all households can access. An example of a person-centered design is the inclusion of a functional, residentially scaled kitchen in the household to support the availability of a wide variety of food and snacks around the clock.
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*Web-based references for care model types:
Pioneer Network: www.pioneernetwork.net
Action Pact: www.actionpact.com
The Eden Alternative®: www.edenalt.org
The Green House® Project: www.thegreenhouseproject.org
Planetree: www.planetree.org
With Seniors in Mind: www.withseniorsinmind.org
Society for the Advancement of Gerontological Environments (SAGE): www.sagefederation.org
A3.1-2.2.1.1 Where a section of an acute care facility is converted for use as a nursing home, it may be necessary to reduce the number of beds to provide space for long-term care services.
3.1-2.2.1.2 Layout
(1) In new construction, resident units shall be arranged to avoid unrelated travel through the units.
*(2) The layout of the facility shall reflect the care model and related staffing.
A3.1-2.2.1.2 (2) The most effective design is determined when the care model is defined during the functional programming process.
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