Adopts Without Amendments:

FGI Residential, 2018

Part 1 General

Part 2 Common Elements for Residential Health, Care, and Support Facilities

Part 3 Residential Health Facilities

Part 4 Residential Care and Support Facilities

Part 5 Non-Residential Support Facilities

Heads up: There are no amended sections in this chapter.
Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.
Table 3.1-1
Design Parameters for Ventilation of Residential Health Spaces
Function of Space Pressure Relationship to Adjacent Areas1 Minimum Outdoor ACH Minimum Total ACH All Room Air Exhausted Directly to Outdoors2 Minimum Filter Efficiencies3 Design Temperature4 °F/°C
All room5 Negative 2 12 Yes 13/NR6 70-85/21-29
All anteroom7 Negative NR6 10 Yes 13/NR6 70-85/21-29
Resident room NR6 2 2 NR6 13/NR6 70-85/21-29
Resident living/activity/dining spaces NR6 4 4 NR6 13/NR6 70-85/21-29
Resident corridor NR6 NR6 4 NR6 13/NR6 70-85/21-29
Physical therapy Negative 2 6 NR6 13/NR6 70-85/21-29
Occupational therapy NR6 2 6 NR6 13/NR6 70-85/21-29
Toilet/bathing room Negative NR6 10 Yes 13/NR6 70-85/21-29
Hair salon Negative NR6 10 Yes 7/NR6 70-85/21-29
Food preparation8 NR6 2 6 NR6 13/NR6 70-85/21-29
Warewashing Negative NR6 10 Yes 7/NR6 70-85/21-29
Dietary storage NR6 NR6 2 NR6 7/NR6 70-85/21-29
Central laundry Negative 2 10 Yes 7/NR6 70-85/21-29
Personal laundry Negative 2 10 Yes 7/NR6 70-85/21-29
Soiled utility Negative 2 10 Yes 7/NR6 70-85/21-29
Clean utility Positive 2 10 Yes 7/NR6 70-85/21-29
Environmental services room Negative NR6 10 Yes 7/NR6 70-85/21-29
Hazardous waste storage Negative 2 10 Yes 7/NR6 70-85/21-29
Linen and trash chute room Negative NR6 10 Yes 7/NR6 70-85/21-29
1If pressure-monitoring device alarms are installed, allowances shall be made to prevent nuisance alarms. Short-term excursions from required pressure relationships shall be allowed while doors are moving or temporarily open. Simple visual methods such as smoke trail, ball-in-tube, or flutterstrip shall be permitted for verification of airflow direction.
2In some areas with potential contamination and/or odor control problems, exhaust air shall be discharged directly to the outdoors and not recirculated to other areas. Individual circumstances may require special consideration for air exhausted to the outdoors. To satisfy exhaust needs, constant replacement air from the outdoors is necessary when the system is in operation.
3Table entries are the minimum filter efficiencies required for each space. The first entry in this table is the minimum filter efficiency for Filter Bank No. 1. The second table entry (after the slash) is the minimum filter efficiency for Filter Bank No. 2. The minimum efficiency reporting value (MERV) is based on the method of testing described in Informative Appendix B in ANSI/ASHRAE Standard 52.2: Method of Testing General Ventilation Air-Cleaning Devices for Removal Efficiency by Particle Size.
4Systems shall be capable of maintaining the rooms within the range identified. Operationally, 71-81/22-27 is required by CMS. Lower or higher temperature shall be permitted when residents' comfort and/or medical conditions require different conditions.
5The All room described in this standard shall be used for isolating the airborne spread of infectious diseases (e.g., measles, varicella, tuberculosis). Supplemental recirculating devices using HEPA filters shall be permitted in the All room to increase the equivalent room air exchanges; however, the minimum outdoor air changes shown in this table are still required. All rooms that are retrofitted from standard resident rooms from which it is impractical to exhaust air directly outdoors may be recirculated with air from the All room, provided that air first passes through a HEPA filter. When the All room is not used for airborne infection isolation, the pressure relationship to adjacent areas, when measured with the door closed, shall remain unchanged and the minimum total air change rate shall be 6 ACH.
6NR = no requirement.
7Where an All anteroom is provided, the pressure relationships shall be as follows: (1) the All room shall have negative pressure with respect to the anteroom and (2) the anteroom shall have negative pressure to the corridor; both shall be designed in accordance with Section 3.1-2.2.3.1 (4) (Anteroom).
8Minimum total air changes per hour (ACH) shall be required to provide makeup air to kitchen exhaust systems as specified in ANSI/ASHRAE Standard 154: Ventilation for Commercial Cooking Operations. In some cases, excess exfiltration or infiltration to or from exit corridors compromises the exit corridor restrictions of NFPA 90A: Standard for the Installation of Air-Conditioning and Ventilating Systems, the pressure requirements of NFPA 96: Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, or the maximum defined in this table. During operation, a reduction in the number of air changes to any extent required for odor control shall be permitted when the space is not in use.
This chapter contains specific requirements for nursing homes.
A3.1-1.1.1.1 Nursing home types. The nursing services and facilities provided in a nursing home are distinguished by the level of care, size of resident unit, and types of staff support areas and service areas provided. Nursing homes may be freestanding facilities or distinct parts of a hospital, continuing care retirement community, or other health care facility.
The requirements in Part 2 (Common Elements for Residential Health, Care, and Support Facilities) shall apply to nursing homes as referenced in this chapter.
See Section 2.2-2 (Sustainable Design Criteria) for requirements.
If the care population includes persons of size, see Section 2.2-3 (Design Criteria for Accommodations for Care of Persons of Size) for requirements.
If the care population includes residents with dementia, mental health issues, or cognitive or developmental disabilities, see Section 2.2-4 (Design Criteria for Dementia, Mental Health, and Cognitive and Development Disability Facilities) for requirements.
This chapter identifies the minimum requirements for a nursing home, whether it is a freestanding facility or part of another facility.
See Section 1.2-2 (Functional Program) for requirements.
A3.1-1.2 Staff distances, staff station locations, and decentralized vs. centralized functions that will directly affect facility design should be specified in the functional program. Different care models should be evaluated to provide a resident-centered solution; see appendix sections A3.1-2.2.1.3 (1) (Traditional model and staffing considerations), A3.1-2.2.1.3 (2) (Cluster and/or neighborhood model and staffing considerations), and A3.1-2.2.1.3 (3) (Connected and freestanding household model units and staffing considerations).
See Section 1.2-3 (Resident Safety Risk Assessment) for requirements.
See Section 1.2-1.3 (Environment of Care and Facility Function Considerations) and Section 1.2-4 (Environment of Care Requirements) for requirements.
Nursing homes shall be designed to provide flexibility to meet the changing physical, medical, and psychological needs of residents.
The facility design shall produce a supportive environment to enhance and extend quality of life for residents and facilitate wayfinding while promoting choice, dignity, privacy, meaningful engagement, and self-determination.
A3.1-1.4.3.1 Culture change in long-term care should address movement away from a traditional model toward one that is residential in scale, has homelike amenities, facilitates wayfinding, and allows residents and direct care workers to express choice in meaningful ways.
Design shall maximize opportunities for ambulation and self-care, socialization, and independence and minimize the negative aspects of a traditional environment.
The architectural design—through the organization of functional space, the specification of ergonomically appropriate and arranged furniture and equipment, and selection of details and finishes—shall eliminate as many barriers as possible to access and use by residents of all space, services, equipment, and utilities appropriate for daily living.
See Chapter 2.1 (Site Elements) for requirements.
In addition to the requirements in Section 2.1-3.3 (Parking), the facility shall provide a minimum of one parking space for every four beds.
Resident areas in a nursing home shall comply with the requirements in this section.
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.
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.
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.
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.
*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.
(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.
Use of the following care models shall be allowed.
*(1)  Traditional model. This model typically includes 40 or more residents in a double-loaded corridor configuration with centralized service/community areas, staff work areas, and resident support areas.
*(2)  Cluster and/or neighborhood model. This model typically includes 8 to 18 residents in a cluster with clusters grouped in neighborhoods of 21 to 40 residents. Clusters are located directly adjacent to decentralized service areas, optional satellite staff work areas, and optional decentralized resident living areas such as dining areas.
*(3)  Connected household and freestanding household models
(a)  Facilities using a household model typically include 10 to 20 residents in a group and may be freestanding or located in a larger facility and/or attached to another similar household. The household model includes a residentially scaled kitchen and living room designed in conjunction with staff areas organized to provide resident-centered care.
(b)  Households shall be permitted to share support spaces/services.
A3.1-2.2.1.3 (1) Traditional model and staffing considerations
  1. Definition. The traditional model is a medical model of care with double-loaded corridors, a central nursing station, and community spaces for resident dining and activities. Evaluation of the potential for incorporating some level of decentralization of services and other model types described in this appendix is recommended during the planning process.
  2. Functional program
    • —This type of unit includes centralized environmental services rooms, soiled and clean utility rooms, and provisions for medication storage and distribution, linens, and accommodations for other services provided by care staff for residents.
    • —Staff models are typically hierarchical in nature and direct care staff typically does not have a strong role in managing overall care.
    • —Staff often does not consistently care for the same residents; minimizing the opportunity for developing familiarity with a resident's individual needs.
    • —Travel distances for staff and residents are greater than in other types of units and schedules are dictated more by regulation than by resident/staff choice or satisfaction.
  3. Physical setting
    • —In lieu of resident rooms designed with beds side by side, alternative room layouts are recommended that provide minimally private alcove sleeping areas and access to a bathroom shared by no more than two residents. See Section 3.1-2.2 (Resident Unit) for additional information.
    • —Evaluation of some decentralized services and activity areas to reduce travel distances for staff and residents is recommended.
A3.1-2.2.1.3 (2) Cluster and/or neighborhood model and staffing considerations
  1. Definition. This model includes several concepts in which the design of traditional nursing home floor plans (straight halls, double-loaded corridors) is reorganized to benefit residents and improve caregiver effectiveness.
    Clustering is a decentralization strategy used to improve aesthetics, streamline service, shorten travel distances, and simplify handling of linen. It also permits more localized social areas and optional decentralized staff work areas.
    Clusters of resident bedrooms may be grouped in a neighborhood that provides shared activity, therapeutic, and support areas.
  2. Functional program. A functioning cluster as described here is more than an architectural form where rooms are grouped around social areas without reference to caregiving. In a functioning cluster, the following will be accomplished:
    • —Unit scale and appearance reinforces the relationship between smaller groups of rooms: Clusters should offer identifiable social groups for staff and residents, thereby reducing the sense of traditional size often associated with centralized facilities.
    • —Utility placement is better distributed for morning care: Clean and soiled linen rooms are located closer to resident rooms, minimizing staff steps and improving the aesthetics and functioning of corridors (carts are not scattered through halls).
    • —Geographically effective staffing: The staffing pattern and facility design reinforce each other so that nursing assistants can offer primary nursing care to a given set of residents. Staff room assignments are grouped together and generally do not require unequal travel distances to basic utilities. Staff "buddying" is possible. Buddying involves sharing responsibilities such as lifting a non-weight-bearing resident or covering for a staff member while the buddy provides off-unit transport or is on break.
    • —Staffing that works as well at night as during the day: An effective cluster design accommodates multiple staffing ratios. With clustering, a facility or neighborhood with 42 beds could be staffed effectively in various ratios of licensed nurses to nursing assistants. For example: 1:7 for days (six clusters of seven residents); 1:14 or 1:21 nights (two or three groupings of two to three clusters, respectively).
  3. Additional benefits
    • —Cluster design can provide more efficient gross/net area where a variety of single and/or double rooms are nested.
    • —For a project with a high proportion of private occupancy rooms, cluster design can reduce walking/travel distances to staff work areas or nurse stations.
    • —Cluster units support distribution of nursing staff throughout a building, so staff are closer to resident rooms at night and can be more responsive to vocal calls for assistance and toileting. (Central placement of staff requires more understanding of how to use a traditional call system than many residents possess.)
    • —Cluster units of a given size may "stack" or be placed over each other, but can be staffed differently to serve varying care populations.
    • —Where electronic call systems are used (e.g., systems that allow reprogramming of which room reports to which zone or nursing assistant's work area), staffing for a unit might easily be changed over time, such as when resident needs justify higher ratios of nursing assistants to residents. For example, a 48-bed unit might start at 1:8 staffing but switch to 1:6 when residents require more care. In some units, staffing might also be slightly uneven, such as 60-bed units made up of clusters of 1:7 and 1:8 during the day based on care population needs.
  4. Physical setting. Clusters require an architectural form and may affect overall building shape. The goal of the physical setting is to support the care model.
    • —The longer length of stay of nursing home residents (as compared to hospital patients) makes clustering particularly appropriate for nursing homes. Architectural clustering may help staff and residents socially identify with an area or space in a larger facility.
    • —Though architectural clustering may involve grouping rooms, this should not result in windowless social areas or the incorporation of all social options in a windowless social area directly outside the resident room doorways. Access to daylight, views, and the outdoors is critical to a successful design.
    • —Decentralized spaces are sized appropriately for equipment and carts used on the unit. They are placed to avoid long staff and resident travel distances and long wait times for residents to receive services.
    • —Circulation paths that lead through one cluster to gain access to another cluster should be avoided.
A3.1-2.2.1.3 (3) Connected and freestanding household model units and staffing considerations
  1. Definition. Household units use resident-centered care models that change the philosophy of care to create a household-scale environment. The goal is to create a small community of residents in a home that is supported by staff members specially trained in this philosophy of care.
  2. Functional program
    • —Resident-centered care models include a team-based management approach to staffing roles and responsibilities.
    • —Food service is completely or partially decentralized. The household has a functional kitchen, where a wide variety of food is available around the clock. Meals may be prepared and served in the household or partially prepared and served in the household with some centralized support. Regardless of where food is prepared, meals are served from the kitchen in the household. Trays are only used for room service.
    • —Residents maintain freedom of movement and have safe access to all spaces in the household as they would in their own home.
  3. Additional benefits
    • —The small size of resident care groups in a household allows staff to better understand a resident's individual needs.
    • —Travel distances are typically reduced for residents and staff in a household, providing more opportunities for residents to ambulate rather than use a resident-operated mobility device as a time-saving mechanism to meet regulatory requirements.
    • —The smaller environment in a household is residential rather than traditional in nature.
  4. Physical setting. Household designs support an environment that allows staff to care for a consistent group of residents in a small-scale space, fully supporting the functional program and operations developed by the organization. Characteristics include:
    • —Residentially scaled spaces that include an open kitchen, living room, dining room, etc.
    • —Access to safe outdoor space from common areas
    • —Appropriate storage in community spaces and resident rooms to support a decentralized care model
    • —Minimization of double-loaded corridor lengths
    • —An open plan with a living room, dining room, and residentially scaled open kitchen
    • —Architectural features that reflect home and regional characteristics
    • —A separate and distinct entry for each household
    • Meals partially prepared and served with some centralized support, meals served in the household using all centralized support, or completely decentralized food service where all meals are prepared and served in the household
    • —Routine services often shared by connected households (e.g., food, laundry, trash collection). It is common for households to share environmental service rooms, food service pantries, central storage, trash rooms, personal laundry facilities, and other similar service rooms/spaces.
Each resident room shall meet the following requirements:
(1)  In new construction, maximum room capacity shall be two residents.
*(2)  Where renovation work is undertaken and the present capacity is more than two residents, maximum room capacity after renovation shall be no more than two residents in accordance with CMS-3260-F, "Reform of Requirements for Long-Term Care Facilities."
A3.1-2.2.2.1 Single-resident rooms with an individual toilet room are encouraged. Evidence suggests that single-resident rooms decrease risks for medication errors, health care-acquired infections, resident anxiety, and incidents of aggressive behavior while improving resident sleep patterns and staff effectiveness. In two-bed rooms, consideration should be given to creating room configurations that maximize individual resident privacy, access to windows, and room controls and provide equivalent space for each resident (e.g., alcoves for each).
A3.1-2.2.2.1 (2) On October 4, 2016, the Centers for Medicare & Medicaid Services (CMS) published a final rule on the "Reform of Requirements for Long-Term Care Facilities," CMS-3260-F, in the Federal Register. This rule revises the requirements that long-term care facilities must meet to participate in the Medicare and Medicaid reimbursement programs. Effective November 28, 2016, each resident room must have a maximum capacity of two residents and a dedicated bathroom with at least a toilet and sink. Look for guidance on room configurations to meet CMS requirements under the Resources tab on the FGI website.
  1. *(1) Area. Single- and multiple-resident rooms shall be sized to accommodate the functional placement of required furnishings and equipment essential to resident comfort and safety.
    1. (a) Where a single-resident room is provided, it shall have the following:
      1. (i) Minimum clear floor area of 120 square feet (11.15 square meters), excluding closet or wardrobe, bathroom, and vestibule entry
      2. (ii) Minimum clear dimension of 11 feet (3.35 meters)
    2. (b) Where a multiple-resident room is provided, it shall have the following:
      1. (i) Minimum clear floor area of 108 square feet (10.03 square meters) per resident bed, excluding closet or wardrobe, bathroom(s), and vestibule entry
      2. (ii) Minimum clear dimension of 9 feet 6 inches (2.90 meters)
    3. *(2) Clearances. Clearances shall accommodate resident mobility and transfer.
    4. (3) Resident room accommodations. Accommodations provided for each resident room shall be accessible from a wheelchair or other resident-operated mobility device and include the following:
      1. (a) Window
      2. (b) Bed
      3. *(c) Resident chair or recliner
        1. (i) Location of the resident chair or recliner adjacent to the head of the bed shall be permitted.
        2. (ii) Use of a recliner in lieu of a bed shall be permitted based on resident preference.
      4. (d) Wardrobe(s) or closet(s). Where a movable wardrobe(s) is provided, it shall be permitted to be located adjacent to the head of the bed.
      5. (e) Dresser. The dresser shall be permitted to be located:
        1. (i) In or as part of a wardrobe or closet.
        2. (ii) On the wall adjacent to the head of the bed.
      6. (f) Nightstand. The nightstand shall be permitted to be located adjacent to the head of the bed.
      7. *(g) Space for a side chair
      8. (h) The room shall be configured to provide each resident with a view of the television from a resident chair or recliner.
      9. (i) Direct access shall be provided from the room entry to the bed, toilet room, closet or wardrobe, and window without traveling through the living space of another resident.
A3.1-2.2.2.2 (1) Space should be provided to accommodate the care population, resident care, and maneuverability when resident-operated mobility devices are used. Functional placement is based on considerations for safe resident mobility, mobilization, weight-bearing activity, and ambulation and for minimization of risks to caregivers.

A3.1-2.2.2.2 (2) Clearances. To facilitate planning for minimum clearances around beds, bed type and maximum bed size should be established by the residential care organizations as part of the functional program. Whenever possible, bed placement should be chosen by individual residents and their representatives or persons of significance (e.g., family, spouse/partner, residentappointed advocate) to satisfy the needs and desires of the resident.
  1. In resident rooms, the following minimum clearances should be used around the resident bed to support resident and staff safety:
    1. —48 inches (121.92 centimeters) on the transfer side
    2. —36 inches (91.44 centimeters) on the nontransfer side
    3. —36 inches (91.44 centimeters) at the foot in single-resident rooms
    4. —48 inches (121.92 centimeters) at the foot of each bed in multiple-resident rooms
  2. In resident rooms, a clear circulation pathway of 36 inches (91.44 centimeters) should be provided between fixed elements or equipment. This circulation pathway should be permitted to overlap other required clearances.
  3. Sizing of resident rooms should accommodate clearances for resident chairs, recliners, and other movable furnishings; these items and their clearances may overlap with the bed clearances. The size of each room should allow unimpeded clearance on at least one side and at the front of any resident chair, as follows:
    • —48 inches (121.92 centimeters) on the transfer side
    • —36 inches (91.44 centimeters) for the approach to the chair
  4. Arrangement of furniture that reduces these clearances should be permitted as long as access for other occupants is not reduced and there is at least one layout that meets the recommended clearances in appendix section A3.1-2.2.2.2 (2) (Clearances).


A3.1-2.2.2.2 (3)(c) Resident chair or recliner. The lounge chair or recliner provided in a resident room to give residents an alternative to bed-stay should be evaluated for provision of the following:
  1. Comfort sufficient for long-term sitting
  2. Cervical support and support for the resident's head (backrest)
  3. Opportunity to recline the backrest to enable periodic redistribution of body weight during long periods of sitting (recliner) 
  4. Ease of entry and exit
See appendix section A2.4-2.4.3.1 (Furniture selection recommendations) for additional information.


A3.1-2.2.2.2 (3)(g) Visitor seating. Provision of a side chair for a visitor means residents do not have to remain in bed when they have a visitor.
  1. See Section 2.4-2.2.6 (Windows) in addition to the requirements in this section.
  2. In renovated construction, beds shall be no more than two deep from windows.
*(1)  Visual privacy shall be provided for each resident in two-bed rooms.
(2)  Design for privacy shall not restrict resident access to the toilet, room entrance, window, or other shared common areas in the resident room.
A3.1-2.2.2.4 (1) Resident privacy. Consideration should be given to use of a wall or partition to preserve visual and acoustic privacy for each resident. Alcoves may be used for this purpose in double-occupancy resident rooms.
A hand-washing station shall be provided in each resident room.
  1. Omission of this station shall be permitted in a single-bed or two-bed room where a hand-washing station is located in an adjoining toilet room that serves that room only.
  2. Design requirements
    1. For hand-washing station design details, see Section 2.4-2.2.8 (Hand-Washing Stations).
    2. For sink design, see Section 2.5-2.3.2 (Plumbing Fixtures—Hand-Washing Sinks).
    3. For casework details, see Section 2.4-2.4.2 (Casework, Millwork, and Built-Ins).
Each resident shall have access to a toilet room without entering a general corridor.
*(1)  One toilet room shall serve no more than two residents in a bedroom.
(2)  Space requirements
(a)  Toilet rooms shall be sized and configured to accommodate:
(i)  Staff assistance, including use of lifting equipment
(ii)  Accessibility standards that support independent resident use
(b)  Clearance shall be provided on both sides of the toilet to enable physical access and maneuvering by staff members assisting the resident with wheelchair-to-toilet transfers and returns.
(3)  The toilet room shall contain the following:
(a)  Toilet
(b)  Hand-washing station
(c)  Mirror. For requirements, see Section 2.4-2.2.8.7 (Mirror).
(d)  Individual storage for the personal effects of each resident
(4)  Doors and door hardware shall be provided in accordance with Section 3.1-5.2.2.4 (Doors and door hardware).
(5)  Grab bars
(a)  Grab bars shall be provided in accordance with Section 2.4-2.2.9 (Grab Bars).
(b)  Where residents are capable of independent transfers, alternative grab bar configurations shall be permitted.
A3.1-2.2.2.6 (1) See appendix section A3.1-2.2.2.1 (2) (On October 4, 2016...) for information about compliance with CMS requirements.
Where a bathtub or shower is provided in a resident toilet room, the following requirements shall be met in addition to the requirements in Section 3.1-2.2.2.6 (Resident toilet room):
(1)  Space shall be provided for drying, dressing, and grooming.
(2)  A counter and a shelf or cabinet for personal item storage shall be provided. See Section 2.4-2.4.2 (Casework, Millwork, and Built-Ins) for details.
*(3)  See Section 2.5-2.3.3.2 (Accessible showers) for shower requirements.
A3.1-2.2.2.7 (3) Accessible showers. Provision of a curbless shower that is open to the surrounding bathroom should be considered for ease of access by resident and staff.
Each resident shall be provided with an individual wardrobe or closet.
  1. This storage shall have a minimum net depth of 24 inches (55.88 centimeters) and a minimum net width of 2 feet 6 inches (76.20 centimeters).
  2. A clothes rod shall be provided that can be adjusted to a height accessible to the resident. Accommodations shall be made for storage of full-length garments.
  3. A shelf shall be provided that can be adjusted to a height accessible to the resident. Omission of the shelf shall be permitted where the unit provides at least two accessible drawers.
Where a resident room(s) designed to accommodate persons of size is provided, it shall meet the requirements in Section 3.1-2.2.2 (Resident Room) except as amended in this section.
  1. *(1) The need for, number, and type of resident rooms accommodating persons of size shall be determined for the intended care population during the functional programming process.
  2. (2) Where the facility provides resident rooms for persons of size, see sections 1.2-5.6 (Planning Considerations for Persons of Size) and 2.2-3 (Design Criteria for Accommodations for Care of Persons of Size) for further requirements.
A3.1-2.2.3.1 (1) Considerations for persons of size. The projected need for accommodations for care of persons of size should be defined in the planning phase and include the following: 
    1. —Projected weight capacities for persons of size in the population to be served
    2. —Projected number of resident rooms required to accommodate persons of size
    3. —Projected number of expanded-capacity lifts required to accommodate persons of size
  1. (1) Area
    1. Where a single-resident room with a fixed overhead lift is provided, it shall have the following:
      1. Minimum clear floor area of 200 square feet (18.58 square meters), excluding closet or wardrobe, bathroom, and vestibule entry
      2. Minimum clear dimension of 13 feet 2 inches (4.01 meters)
    2. Where a multiple-resident room with a fixed overhead lift is provided, it shall have the following:
      1. Minimum clear floor area of 197 square feet (18.30 square meters) per resident bed, excluding closet or wardrobe, bathroom(s), and vestibule entry
      2. Minimum clear dimension of 13 feet 2 inches (4.01 meters) for the clear floor area for each resident
    3. Where a single-resident room without an overhead lift is provided but mobile lifts will be used, the room shall have the following:
      1. Minimum clear floor area of 219 square feet (20.35 square meters), excluding closet or wardrobe, bathroom, and vestibule entry
      2. Minimum clear dimension of 13 feet 2 inches (4.01 meters) for the clear floor area
    4. Where a multiple-resident room without an overhead lift is provided but mobile lifts will be used, the room shall have the following:
      1. Minimum clear floor area of 216 square feet (20.07 square meters) per resident bed, excluding closet or wardrobe, bathroom(s), and vestibule entry
      2. Minimum clear dimension of 13 feet 2 inches (4.01 meters) for the clear floor area for each resident
  2. *(2) Clearances. Clearances shall accommodate resident mobility and transfer equipment for persons of size.
A3.1-2.2.3.2 Resident lifting equipment. See Section 1.2-3.3 (Resident Mobility and Transfer Risk Assessment) for information on providing resident lifts to mitigate risks involved in resident handling and mobility tasks. Information and guidance for evaluating resident mobility and transfer risks can be found in "Patient Handling and Mobility Assessments," a white paper published by the Facility Guidelines Institute and available from www.fgiguidelines.org

A3.1-2.2.3.2 (2) Clearances. To facilitate planning for minimum clearances around beds, bed type and maximum bed size should be established by the residential care organization as part of the functional program. Whenever possible, bed placement should be chosen by individual residents and their representatives or persons of significance (e.g., family, spouse/partner, residentappointed advocate) to satisfy the needs and desires of the resident.
  1. In resident rooms for persons of size with an overhead lift, the following minimum clearances should be used around the bed to support resident and staff safety:
    1. —66 inches (167.64 centimeters) from the bed by 126 inches long (320 centimeters) on the transfer side
    2. —66 inches (167.64 centimeters) on the nontransfer side
    3. —60 inches (152.4 centimeters) at the foot
  2. In resident rooms for persons of size without an overhead lift where mobile lifts will be used, the following minimum clearances should be used around the bed to support resident and staff safety:
    1. —84 inches (213.36 centimeters) from the bed by 126 inches long (320 centimeters) on the transfer side
    2. —66 inches (167.64 centimeters) on the nontransfer side
    3. —60 inches (152.4 centimeters) at the foot
  3. In resident rooms for persons of size, a clear circulation pathway of 60 inches (152.4 centimeters) should be provided between fixed elements or equipment. This circulation pathway should be permitted to overlap other required clearances.
  4. Sizing of resident rooms for persons of size where a mobile lift will be used, whether or not an overhead lift is present, should accommodate clearances for resident chairs, recliners, and other movable furnishings; these items and their clearances may overlap with the bed clearances. The size of each room for a person of size should allow unimpeded clearance on at least one side and at the front of any resident chair as follows:
    1. —48 inches (121.92 centimeters) on the transfer side
    2. —66 inches (167.64 centimeters) for the approach to the chair
  5. Mobile vs. fixed lift clearance considerations
    1. —Where lifts are used, additional clearance is needed to accommodate use of the lift, an expanded-capacity wheelchair, and space for staff to help a person of size transfer from bed to wheelchair or gurney. Mobile lifts require more floor space than overhead lifts to accommodate the lift footprint. Selection of lift equipment should be completed during the functional programming process to evaluate clearances required.
    2. —Use of portable lifting equipment requires more clearance for maneuvering than fixed lifting equipment; however, the use of fixed equipment does not eliminate the need for portable equipment. Portable equipment could be needed when a resident is not in proximity to a fixed lift or requires a sit-to-stand lift.
    3. —Using a portable lift without powered wheels to move a resident laterally requires more exertion by staff than using a fixed lift, and the exertion required is increased where the floor is carpeted. See Section 2.4-2.3.2 (Flooring and Wall Bases) for additional information.
    4. —Resident rooms and associated toilets may be equipped with a ceiling-mounted track to accommodate ceiling-mounted mobility and lifting devices. The track layout should be designed to aid in maintaining or improving resident mobility and ambulation, independent function, and strength and to assist staff members with transfer of residents to or from bed/chair/toilet/bathing facilities/stretcher or repositioning residents in a bed or chair.
    5. —One objective of using ceiling lift systems is to support residents who have poor balance or are unable to bear all of their weight to stand and ambulate throughout the room. A second objective is to maximize resident choice and control of bed location and room arrangement, key factors in creating "home" for the resident. These objectives can be met by installing permanent tracks the full length of two sides of the room with a perpendicular spur that extends into the toilet room over the toilet and into a shower (i.e., an "I" or "H" layout) to achieve maximum flexibility. This approach would make all areas of the room accessible to the resident using the lifting device, thereby offering the resident a variety of room arrangements and substantially reducing the need for a portable lift.
Where a single resident room is provided to accommodate care requirements for residents experiencing issues such as personal conflicts, agitation, episodic mental disturbances, or similar conditions, the requirements in Section 2.3-2.2.3.3 (Quiet room in a resident care/living area) shall be met in addition to the requirements in Section 3.1-2.2.2 (Resident Room).
A3.1-2.2.4 Subacute care facilities. Since subacute care programs are offered in various settings, the design of such units/facilities should focus on the following major components:
  1. The unit/facility should comply with all applicable nursing home requirements in Chapter 3.1 (Specific Requirements for Nursing Homes) to the extent that these do not conflict with the functional program.
  2. The unit/facility should comply with operational requirements. The authority having jurisdiction may allow the flexibility to substitute alternative uses (e.g., occupational/physical therapy space, additional family spaces) for spaces typically used for dining.
  3. Inclusion of dining space in each resident room should be provided where community dining spaces have been replaced with spaces for alternative uses.
*(1)  Pediatric resident rooms shall be designed to accommodate the age-related characteristics of the proposed pediatric residents.
(a)  Rooms shall be permitted to accommodate more than two pediatric residents where sleeping accommodations are in cribs.
(b)  Area and dimensions. The area and dimensions of each pediatric resident space shall be based on provision of the following:
(i)   The ability to accommodate crib or bed locations, including one where staff members have access to the crib or bed on three sides
(ii)  Clear access to one side of the crib or bed along 75 percent of its length.
(iii) Overnight accommodations for family
(iv) Enhanced (additional) staffing, closer observation, and equipment as identified by the functional program
(v) Privacy accommodations for family members and each pediatric resident
(vi) Space for placement of a stretcher along one side for lateral transfer of the pediatric resident from crib or bed by at least two staff members without substantial rearrangement of furniture
(vii) In multiple-crib or -bed rooms, clearance permitting movement of cribs or beds and equipment without disturbing other crib or bed locations
(viii) Space for mechanical and fixed equipment that prevents obstructed access to any required element
(c)  Unless otherwise stated in the functional program, pediatric resident rooms shall be separated from units serving adult populations.
*(2)  Resident support
(a)  At least one hand-washing station equipped with hands-free operable controls shall be provided for each four or fewer pediatric residents accommodated in a single room.
(b)  Indoor and outdoor activity space shall be designed with consideration of pediatric resident and family culture, age cohorts, and age-appropriate activities and needs.
A3.1-2.2.4.1 The unique characteristics of long-term pediatric nursing care can have a significant impact on facility planning and design. The potential age range of pediatric residents creates different needs from those of other residents. Daily care activities are likely to be more intense, while continuing social development and maturity present privacy considerations different from those in a geriatric setting. The number of children in a room should be decided by balancing the resident's privacy needs with the need for appropriate levels of nursing care.
A3.1-2.2.4.1 (1) Pediatric long-term care stakeholders include the children, their families, and the staff. Residences (long-term care) that group children by age cohort and create an environment of care that focuses on the specific needs of children of those ages enhance the children's functionality. While there is a disease state for the child (either progressive or static), the child's development continues. Family-centered care and other person-centered approaches are often implemented in pediatric long-term care facilities.
A3.1-2.2.4.1 (2) In comparison to what is required for the typical geriatric facility, pediatric long-term care facilities often require additional equipment and more intensive staffing and observation. Parent/family involvement also tends to be more frequent in pediatric facilities, requiring rooms designed to accommodate family participation in direct care as well as privacy during visits.
Due to the potential age range and length of stay of pediatric residents, functional and space needs vary significantly from those of adult residents. Daily care activities are likely to be more complex from a functional perspective, while continuous social development and physical/mental maturity require a physical environment that is flexible to accommodate the pediatric resident's evolving needs. The number of children in a room is related to the individual residents' needs for privacy as well as efficient and appropriate staff access, monitoring, and care.
Because of the varying age and degree of socialization of pediatric residents, room capacities range from four infants/toddlers requiring heavy nursing care in a single room to more private accommodations for adolescents. All resident rooms must accommodate the direct care activities of enhanced staffing as well as the likelihood of significant family presence.
The various functional and physical abilities of this diverse population must be taken into account when designing facilities for toileting and bathing.
  1. For resident unit size and layout requirements, see Section 3.1-2.2.1.2 (Resident Unit—Layout).
  2. For additional post-acute care resident room requirements, see Section 3.1-2.2.2 (Resident Room).
  3. Where resident community areas are provided, see Section 3.1-2.3 (Resident Community Areas) for requirements.
  4. Where diagnostic and treatment areas are provided, see Section 3.1-3 (Diagnostic and Treatment Areas) for requirements.
    1. See Section 3.1-3.3.2 (Physical Therapy Area) and Section 3.1-3.3.3 (Occupational Therapy Facilities) for designated rehabilitation requirements.
    2. See Section 3.1-3.3.4 (Other Rehabilitation Therapy Facilities) for additional requirements based on the types of therapy being provided.
  5. See Section 3.1-4 (Facilities for Support Services) for requirements.
  6. See Section 3.1-5 (Design and Construction Requirements for Nursing Homes) for additional requirements.
  7. See Section 2.5-1 (Building Systems—General) for requirements.
A3.1-2.2.4.2 Post-acute care facilities. With changes in regulations that result in shorter stays in acute care settings, post-acute care facilities are being developed and built—often under nursing or skilled nursing licensing. Post-acute care facilities are intended for residents receiving rehabilitation services rather than long-term or palliative care services.
Post-acute care units often use a household care model that includes one or more "households" or units dedicated to post-acute care residents. A household may also be dedicated to a special type of rehabilitation, such as orthopedic, cardiology, stroke, or other specialty.
Differences between a long-term care and post-acute care household or unit typically include the following:
  1. Post-acute care resident rooms are usually private and designed to accommodate family and visitors. Consideration should be given to providing wi-fi access in resident rooms.
  2. Post-acute care resident room bathrooms are usually private and include a shower.
  3. In a larger facility setting, physical, occupational, and speech therapy may be provided in the post-acute care household or unit or centrally located with other fitness or wellness areas.
  4. Food service for post-acute care is usually provided by a centralized kitchen with a room service component rather than in a communal dining setting (decentralized or centralized).
  5. In lieu of activity space, a lounge or family area is usually provided for family members visiting the resident. The lounge or family area should offer access to a wi-fi network.
  6. Staff usually is rehabilitation-focused rather than dementia-focused in a post-acute care household or unit. However, it is recommended that staff in a unit where rehabilitation services are provided also be trained in working with residents with dementia because of the care population generally being served.
Where the facility provides resident rooms for persons of size, see Section 2.2-3 (Design Criteria for Accommodations for Care of Persons of Size) for further requirements.
See Section 2.3-2.3.1 (Resident, Participant and Outpatient Community Areas—General) for requirements.
See Section 2.3-2.3.2 (Lobby) for requirements in addition to those in this section.
Where a central lobby is provided, the following requirements shall be included:
  1. A counter or desk for reception and information
  2. Public waiting area(s)
  3. Public toilet facilities
  4. Public telephone(s) or access to a courtesy phone. See Section 2.3-4.2.8 (Resident and Participant Telephone Access) for resident telephone requirements.
  5. Provisions for drinking water
See Section 2.3-2.3.3.1 (Dining, Recreation, and Lounge Areas—General) for requirements.
See Section 2.3-2.3.3.2 (Dining areas) for requirements.
Recreation, lounge, and activity areas shall provide the following:
*(1)  Space adequate for resident activities and associated equipment
(2)  Areas sufficient in number and size to:
(a)  Allow resident groups of various sizes to gather
(b)  Accommodate separate and distinct activities
A3.1-2.3.3.3 (1) Recreation and lounge space needs. Activity programs focus on the social, spiritual, intellectual, physical, and creative needs of residents and provide them with quality, meaningful experiences. These programs may be facility-wide or for smaller groups. The activities the care provider will support, based on residents' or clients' expressed and individual interests, should be identified in the functional program.
Activity programs generally include coordination and implementation of activities for large and small groups and personalized individual programs involving one resident and one activity coordinator. These activities may be conducted in other spaces in a facility (e.g., dining rooms), but dedicated spaces are preferred for efficient operation of quality programs. The need for large activity spaces (e.g., libraries; chapels; auditoriums; conference, classroom, and training spaces) depends on the programming decisions of the care provider.
Following are some optional space needs to support recreation, lounge, and activity areas:
  1. If required in the functional program, space should be included for the following:
    • —Storage for files and records
    • —Computers
    • —Administrative tasks
    • —Storage for supplies and equipment
  2. A quiet space for effective resident/staff communication. This space may be incorporated into the space for administrative tasks or located in a private room setting.
  3. Space for storage of items used for activities (e.g., recreation materials, exercise equipment, supplies for religious services) located near the point of use
Toilet facilities that accommodate resident-operated mobility devices shall be readily accessible to all dining, recreation, lounge, and activity locations.
Where kitchen facilities that permit use by residents and family members are provided, see Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.
A3.1-2.3.5 Personal services areas. Consideration should be given to providing the following in the design of these areas:
  1. General
    • —Changing areas
    • —Storage for supplies and linens
    • —Provisions for resident privacy
  2. Hair salon
    • —Adjustable sink bowls for shampooing and treatment
    • —Freestanding dryers for use by residents using resident-operated mobility devices
  3. Space for circulation and staff assistance around spa tubs
  1. Facilities and equipment for resident hair care and grooming shall be provided separate from resident rooms.
  2. Mechanical ventilation and exhaust shall be provided for hair salons. See Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces) for additional requirements.
  3. See Table 3.1-1 for minimum filter efficiencies for hair salons.
Personal services areas shall be permitted to be unisex and located next to central resident activity areas.
Resident toilets shall be located adjacent to or directly accessible from hair salon and grooming area(s).
Where a quiet room is provided, see Section 2.3-2.3.7 (Quiet Room in a Resident or Participant Community Area) for requirements.
See Section 2.1-3.6.2 (Outdoor Activity Spaces) for additional requirements and information.
Nursing homes shall provide outdoor spaces consistent with the geographic location designed to promote and encourage residents to spend time in a safe outdoor setting or to provide direct access to the outdoors.
A3.1-2.3.8.2 Outdoor activity spaces
  1. Visual access to outdoor activity spaces from indoors should be provided for staff and residents.
  2. Resident outdoor spaces should be located close to the building and allow for direct staff observation.
  3. Outdoor space(s) should be accessible to residents via short navigable distances.
  4. Outdoor spaces should be designed to accommodate the resident care population served.
See Section 2.3-3.1 (Diagnostic and Treatment Areas—General) for requirements.
Where an examination, observation, and/or treatment room(s) is provided, see Section 2.3-3.2 (Examination, Observation, and/or Treatment Rooms) for requirements.
A3.1-3.3 Rehabilitation therapy services. Rehabilitation therapy programs may include the following:
  1. Hydrotherapy
  2. Speech and hearing therapy
  3. Occupational therapy
    • —Activities of daily living therapy
    • —Recreational therapy. Recreational therapy assists residents with the development and maintenance of community living skills and socialization through the use of leisure-time activity tasks. These activities may occur in a recreational therapy department, in a specialized facility such as a fitness room or area, in resident activity areas, or outdoors.
    • —Education therapy
    • —Vocational therapy. Vocational therapy assists patients in the development and maintenance of productive work and interaction skills through the use of work tasks. These activities may occur in an industrial therapy workshop, in another department, or outdoors.
    • —Other occupational therapy activities. Occupational therapy may include such activities as woodworking, leather-tooling, art, needlework, painting, sewing, metalwork, and ceramics.
  4. Art and music therapy
  5. Horticulture therapy
  6. Prosthetics and orthotics
At minimum, the facilities included in this section shall be provided on-site and shall be easily accessible for the residents served.
  1. Space and equipment shall be provided for carrying out each type of therapy the facility offers.
  2. Where two or more rehabilitation services are provided, sharing of facilities and equipment shall be permitted.
  3. Where a nursing home is part of a general hospital or other facility, rehabilitation services shall be permitted to be shared.
  4. Where outpatient therapy services are provided on-site at a nursing home, see Chapter 5.3 (Specific Requirements for Outpatient Rehabilitation Therapy Facilities) for additional requirements.
A3.1-3.3.1.1 Where resident units are not located near a facility's central rehabilitation therapy department, provision of smaller therapy rooms or areas in a specific resident unit or in a location central to a group of units should be considered.
The requirements in this section shall be met in any location where rehabilitation therapy services are provided.
A3.1-3.3.1.2 Rehabilitation therapy services can be provided in a department or a facility that is specifically designed for these services, or they can be provided where convenient for the resident, for example, in the resident's room or in corridor space near the resident's room.
Private therapy room(s) shall be provided where private communication with a resident and/or family is required or where therapy requires privacy or seclusion to preserve resident dignity.
  1. Space requirements. Space requirements shall be based on the equipment used for therapeutic treatment(s) provided in the facility. Sufficient space shall be provided to allow access to the equipment when in use by the resident and the therapist.
    1. Area. Each individual treatment space shall have a minimum clear floor area of 60 square feet (5.57 square meters).
    2. Clearances. Room arrangement shall permit a minimum clearance of 2 feet 8 inches (711 millimeters) on at least three sides of the treatment furniture (e.g., chairs, recliners, tables, beds, mats).
  2. Resident or client privacy
    1. Exterior and interior windows in therapy areas shall have window treatments or shades to provide resident privacy during individual therapy treatments.
    2. Individual treatment areas shall have privacy screens or cubicle curtains and appropriate provisions for resident dignity or private communication.
  3. Hand-washing stations. Individual therapy area(s) shall have access to either a hand-washing station or a hand sanitation dispenser.
    1. Hand-washing stations shall be provided in each therapy room where hands-on resident care is provided.
    2. Any therapy room that does not require a hand-washing station shall have a dedicated hand sanitation dispenser.
    3. One hand-washing station shall be permitted to serve several treatment stations for both physical therapy and occupational therapy.
  1. Space requirements. Group treatment areas shall be sized to accommodate one type of therapy at a time.
  2. Hand-washing stations
    1. Group treatment area(s) shall have access to either a hand-washing station or a hand sanitation dispenser.
    2. One hand-washing station shall be permitted to serve several group treatment areas, including spaces for physical therapy and occupational therapy.
Where occupational therapy services are provided in the facility, the requirements in this section shall be met.
The following shall be provided:
(1)  Work areas, counters, and/or tables suitable for resident-operated mobility device access and standard seated access
*(2)  An area for practicing activities of daily living
(3)  Hand-washing stations. Occupational therapy area(s) shall have access to either a hand-washing station or a hand sanitation dispenser.
(a)  Hand-washing stations shall be provided in each occupational therapy room where hands-on resident or client care is provided.
(b)  Any occupational therapy room that does not require a hand-washing station shall have a dedicated hand sanitation dispenser.
(c)  One hand-washing station shall be permitted to serve several occupational and/or physical therapy treatment stations.
A3.1-3.3.3.2 (2) Areas for practicing activities of daily living could include a residential kitchen, bathroom, or other area that supports daily function for a resident or client. Residents living in a facility could also practice activities of daily living in their resident rooms or in a community space used for activities and as support space for occupational therapy.
Where prosthetics and orthotics services are provided in the facility, the following shall be provided:
  1. Space for evaluation and fitting. This space shall have provisions for privacy for the fitting and adjustment of prosthetics.
  2. Hand-washing station
    1. Where staff is required to work with or mix wet material, or handle material or chemicals that are caustic to the skin, a hand-washing station shall be provided.
    2. Where staff is not required to work with or mix wet material or handle material or chemicals that are caustic to the skin, provision of a hand sanitation dispenser or a hand-washing station shall be permitted.
  3. Clinical sink. Where running water is required for materials preparation, a clinical sink(s) or flushing-rim sink shall be provided. See Section 2.5-2.3.5 (Clinical Sinks) for requirements.
  1. Where speech and hearing services are provided in the facility, space for evaluation and treatment shall be provided.
  2. The therapy area(s) shall be provided with speech privacy. The design shall minimize external sound from high-traffic, public, and similar noisy areas. See Section 2.5-8 (Acoustic Design Systems) for information.
  1. Where a therapeutic pool(s) is provided, see appendix section A5.2-2.3.3.3 (3) (Aquatic center) for information.
  2. Where portable hydrotherapy whirlpools are provided, see Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for requirements.
Where additional therapies are offered in the facility, space for them shall be provided.
A3.1-3.3.4.4 Additional therapies could include thermotherapy, diathermy, and ultrasonics. Art and music therapy and recreational therapy are usually tied to activities of daily living and activity programming and require storage, an activity room, and a toilet room sized and configured to accommodate accessibility standards that support independent resident use.
  1. Where a reception area is provided, provisions shall be made for visual observation of the waiting areas (s).
  2. Combination of the reception area with the documentation or charting area shall be permitted.
Provisions shall be made for documentation, filing, and retrieval of resident records.
A clean utility room that meets the requirements in 2.3-4.2.5 (Clean Utility Room) shall be provided in each resident unit.
A soiled utility room that meets the requirements in 2.3-4.2.6 (Soiled Utility Room) shall be provided in each resident unit.
  1. Space(s) shall be provided to store resident-operated mobility devices out of traffic while residents are using therapy services. These spaces shall be located in, next to, or directly accessible from the treatment area(s).
  2. See Section 2.3-4.2.4 (Equipment and Supply Storage) for additional requirements.
See Section 2.3-4.9 (Environmental Services Rooms) for requirements.
Support areas for staff shall be provided and may be shared. See Section 2.3-4.3 (Support Areas for Staff) for requirements.
Where required by the therapy program, changing areas, showers, and/or lockers shall be provided. See Section 2.5-2.3.3.2 (Accessible showers) for shower requirements.
  1. Toilet room(s) shall be usable by residents using resident-operated mobility devices.
  2. Toilet rooms shall be provided next to or directly accessible from changing areas.
  3. If therapy treatments include toileting, toilet rooms shall include hand-washing stations. See 2.4-2.2.8 (Hand-Washing Stations) for requirements.
  4. See Section 3.1-2.2.2.6 (Resident toilet room) for additional requirements.
Where wellness facilities are provided, see Chapter 5.2 (Specific Requirements for Wellness Centers) for requirements.
See Section 2.3-4.1 (Facilities for Support Services—General) for requirements.
See Section 2.3-4.2.1 (Staff Work Area) for requirements.
Where caregiving is organized on a centralized staffing model, staff work areas shall provide for charting or transmitting charted data and any storage for administrative activities.
Where caregiving is decentralized, supervisory work areas need not accommodate charting activities or allow a direct view of resident rooms. Rather, decentralized direct care staff work areas shall be used for charting or transmitting charted data and any storage for administrative activities.
A3.1-4.2.1.2 Depending on the type of service to be provided and the care plan, direct care staff work areas need not be encumbered with all the provisions for a supervisory administrative staff work area. In some decentralized arrangements, caregiving functions may be accommodated with a piece of residential furniture (e.g., a table or desk) or a work counter recessed into an alcove off a corridor or activity space, with or without computer and communications equipment, storage facilities, and so on.
See Section 2.3-4.2.2 (Medication Distribution and Storage Locations) for requirements.
A3.1-4.2.3 Consideration should be given to privacy when locating entrances to bathing rooms.
See Section 2.5-2.3.3.2 (Accessible showers) for requirements.
(1)  Where a shower is not provided in the resident bathroom, residents shall have access to at least one central bathing room or area per floor or unit that is sized to permit assisted bathing in a tub or shower.
*(2)  A minimum of one bathtub or shower shall be provided for every 20 residents (or major fraction thereof) not otherwise served by bathing facilities in resident bathrooms.
A3.1-4.2.3.2 (2) Number. The minimum bathtub or shower unit requirements should be verified with the local plumbing code.
  1. The bathtub or spa tub in this room shall be accessible to residents in wheelchairs.
  2. The shower shall have fittings accessible to a resident in a recumbent position.
  3. Adult resident shower rooms shall be designed to allow entry of portable/mobile mechanical lifts, shower gurney devices, and shower chairs.
A separate toilet and hand-washing station shall be provided in or directly accessible to each bathing area without requiring entry into the general corridor.
A3.1-4.2.3.4 This toilet may also serve as the toilet-training facility for rehabilitation.
Access to a grooming location without reentry to the general corridor shall be provided. This shall contain the following:
  1. Hand-washing station
  2. Mirror
  3. Counter or shelf
The design details of all bathing facilities provided shall be in accordance with Section 3.1-2.2.2.7 (Resident bathroom).
See Section 2.3-4.2.4 (Equipment and Supply Storage) for requirements in addition to those in this section.
A separate closet or designated area shall be provided for clean linen storage.
  1. A decentralized clean utility room shall be permitted to be used for the storage of clean linen.
  2. Where a closed-cart system is used, storage in an alcove shall be permitted.
Storage for resident-operated mobility devices and personal support equipment shall allow this equipment to be accessible to residents at all times without entering another resident's living space.
See Section 2.3-4.2.5 (Clean Utility Room) for requirements in addition to those in this section.
Storage for clean linen, towels, equipment, safety devices, and supplies shall be provided in cabinets, closets, or a separate storeroom.
A3.1-4.2.5.2 Provision of a dryer and folding area should be considered when linens and towels are to be laundered on-site.
See Section 2.3-4.2.6 (Soiled Utility Room) for requirements in addition to those in this section.
An area for temporary holding of soiled material shall be provided.
A3.1-4.2.6.2 Provision of a washer and sorting area should be considered when linens and towels are to be laundered on-site.
See Section 2.3-4.2.7 (Personal Laundry Facilities) for requirements.
See Section 2.3-4.2.8 (Resident and Participant Telephone Access) for requirements.
See Section 2.3-4.3 (Support Areas for Staff) for requirements.
Where sleeping accommodations for visitors are provided, the following requirements shall apply:
Where a sleeping accommodation (e.g., recliner, sleep chair, sleep sofa) is located in the resident room, space shall be provided for circulation when the furnishing is fully open for use so staff can access the resident in case of an emergency.
Storage space shall be provided to accommodate and secure overnight guests' belongings.
See Section 2.3-4.4.3 (Pet Accommodations) for requirements.
Where kitchen facilities that permit use by family members and visitors are provided, see Section 3.1-2.3.4 (Resident Kitchen) for requirements.
The type and size of the nursing home facility shall determine the dietary environment and the food service facilities provided.
Where a central commercial kitchen is provided, food service facilities shall be provided in accordance with Section 2.3-4.5 (Food Service Facilities).
If the facility has a service contract with an outside vendor for food service, a warming kitchen designed to meet the following requirements shall be provided.
Where an outside vendor is used to provide meals, the facility shall include dedicated space and equipment for a warming kitchen, including space for minimal equipment for preparation of breakfast, emergency, or after-hours meals.
The resident kitchen shall be permitted to serve as an alternative location to accommodate the function of a warming kitchen. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.
Where food preparation is conducted on-site, the facility shall have dedicated non-public space and equipment for preparation of meals. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.
Each facility shall have provisions for storing and processing clean and soiled/contaminated linen.
Where a facility includes a commercial laundry, the following requirements shall apply:
  1. Processing shall be permitted to take place in the facility, in a separate building on- or off-site, or in a shared laundry.
  2. At minimum, the elements in Section 3.1-4.6.2 (Laundry Facility) shall be provided.
A3.1-4.6.1.2 For certain care models, laundry services may be decentralized using personal laundry facilities and/or a combination of personal laundry facilities and contracted services to provide linen service. See Section 2.3-4.2.7 (Personal Laundry Facilities) for requirements.
Equipment shall be arranged to permit an orderly workflow and minimize cross-traffic that might mix clean and soiled operations.
Where linen is processed in a laundry facility in the nursing home, the following shall be provided:
  1. Receiving, holding, and sorting room
    1. This room shall be provided to accommodate control and collection of soiled linen.
    2. Soiled linen chutes shall be permitted to discharge in this room or in an adjacent separate room.
  2. Washers/extractors. Washers/extractors shall be located between the soiled linen receiving and clean processing areas.
  3. Dryers
  4. Supply storage. Storage shall be provided for laundry supplies.
  5. Inspection and mending area. An area shall be provided for linen inspection and mending.
A central clean linen storage and issuing room(s) shall be provided in addition to the linen storage required at individual resident units. See Section 2.3-4.2.5 (Clean Utility Room) for additional information.
Separate central or decentralized room(s) shall be provided for receiving and holding soiled linen for pickup or processing. See Section 2.3-4.2.6 (Soiled Utility Room) for requirements in addition to those in this section.
  1. Room(s) shall have ventilation and exhaust.
  2. Discharge from soiled linen chutes shall be received in this room or in a separate room, as required by the local authority having jurisdiction.
  3. Room(s) used for processing shall have a deep sink for soaking and/or a flushing-rim sink.
  1. Provisions shall be made for parking clean and soiled linen carts separately and out of traffic.
  2. Provisions shall be made for cleaning linen carts on premises (or for exchange of carts off premises).
  1. Hand-washing stations shall be provided in each area where unbagged soiled linen is handled.
  2. See Section 2.4-2.2.8 (Hand-Washing Stations) for additional requirements, except for Section 2.4-2.2.8.7 (Hand-Washing Stations—Mirror).
Where linen is processed off-site or in a separate building on-site, the following shall be provided:
A service entrance, protected from inclement weather. This shall be permitted to be shared with other services.
A control station, which can be shared with other services
See Section 2.3-4.7 (Materials Management Facilities) for requirements.
See Section 2.3-4.8 (Waste Management Facilities) for waste collection, storage, and disposal requirements.
See Section 2.3-4.9 (Environmental Services Rooms) for requirements.
See Section 2.3-4.10 (Facilities for Engineering and Maintenance Services) for requirements.
Offices or an open office area with private conference space shall be provided for business transactions, admissions, and social services and for the use of administrative and professional staff.
Space for private interviews; staff, resident, and family meetings; conferences; and health education shall be sized to accommodate operational and activity needs.
  1. Space shall include provisions for use of visual aids and technology.
  2. Sharing of space by several services shall be permitted.
A3.1-4.11.1.1 Kitchenette for conference space. Provision of kitchenette facilities, including under-counter refrigerator, microwave, and sink, should be considered for the conference space.
Office space shall be provided for staff and file storage.
Space for storage of files, office equipment, and supplies shall be provided.
See Section 2.4-1.2 (Building Codes and Standards) for requirements.
See Section 2.4-2.1 (Architectural Details, Surfaces, and Furnishings—General) for requirements.
See Section 2.4-2.2.1 (Architectural Details—General) for requirements.
See Section 2.4-2.2.2 (Corridors) for requirements.
See Section 2.4-2.2.3 (Ceiling Height) for requirements.
See Section 2.4-2.2.4 (Doors and Door Hardware) for requirements in addition to those in this section.
(1)  Door type
(a)  Doors to all rooms containing bathtubs, showers, and toilets for resident use shall be hinged, sliding, or folding.
(b)  All doors between corridors, rooms, or spaces subject to occupancy shall be of the swing type or shall be sliding doors.
(c)  Manual or automatic sliding doors shall be permitted where their use does not compromise fire and other emergency exiting requirements.
(2)  Door hardware
*(a)  Sliding doors shall not have floor tracks.
(b)  In shared resident bathrooms, use of privacy locks with emergency access release shall be permitted.
A3.1-5.2.2.4 (2)(a) Eliminating the floor tracks and using breakaway door hardware minimizes the possibility of jamming.
See Section 2.4-2.2.5 (Thresholds and Expansion Joint Covers) for requirements.
  1. See Section 2.4-2.2.6 (Windows) for requirements.
  2. For facilities where resident elopement or falls from windows may be a risk to resident safety, see Section 2.2-4.2.1.6 (Physical Environment Elements for Risk Reduction—Operable windows) for additional requirements.
See Section 2.4-2.2.7 (Glazing Materials) for requirements.
See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.
See Section 2.4-2.2.9 (Grab Bars) for requirements.
See Section 2.4-2.2.10 (Handrails and Lean Rails) for requirements.
See Section 2.4-2.2.11 (Protection from Heated Surfaces) for requirements.
See Section 2.4-2.2.12 (Signage and Wayfinding) for requirements.
Where decorative water features are used in the facility design, see appendix section A2.4-2.2.13 (Decorative water features) for recommendations.
See Section 2.4-2.3 (Surfaces) for requirements in addition to those in this section.
To reduce surface contamination linked to health care-associated infections, surface materials selected for use in nursing homes shall possess the following performance characteristics:
  1. Surfaces shall be cleanable and have no surface crevices or rough textures, joints, or seams.
  2. Surfaces shall be non-absorptive, nonporous, and smooth.
A3.1-5.2.3.2 Surfaces and materials selected should be easy to use and have clear, written, manufacturer-recommended cleaning and disinfection protocols to assure the product will remain durable and effective at meeting CDC and other clinical bacterial-elimination requirements.
The Center for Health Design report "Designing for Patient Safety: Developing Methods to Integrate Patient Safety Concerns in the Design Process" identified environmental factors as "latent conditions that can be designed to help eliminate harm." Such "built environment latent conditions [holes and weaknesses] that adversely impact patient safety" should be identified and eliminated during the planning, design, and construction of health care facilities. Reduction of surface contamination linked to health care-associated infections is one of these factors. See Section 1.2-3 (Resident Safety Risk Assessment) for additional information.
See Section 2.4-2.4 (Furnishings) for requirements.
See Section 2.5-1 (Building Systems for Residential Health, Care, and Support Facilities—General).
See Section 2.5-2.1 (Plumbing Systems—General) for additional requirements.
See Section 2.5-2.2 (Plumbing and Other Piping Systems) for requirements.
See Section 2.5-2.3.2 (Hand-Washing Sinks) and Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.
See Section 2.5-2.3.3.2 (Accessible showers) for requirements and appendix section A3.1-2.2.2.7 (3) (Accessible shower) for recommendations.
See Section 2.5-2.3.5 (Clinical Sinks) for requirements.
See Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for requirements.
Any installation of nonflammable medical gas, air, or clinical vacuum systems shall comply with the requirements of NFPA 99: Health Care Facilities Code.
HVAC systems that meet the requirements in this section shall be provided for nursing homes.
(1)  See Section 2.5-3.1.2 (Ventilation and Space Conditioning for requirements in addition to those in this section.
*(2)  Ventilation systems shall be designed to provide control of environmental comfort, asepsis, and odor control in resident spaces.
(a)  Design of the ventilation system shall provide air movement that is generally from clean to less clean areas. If any form of variable-air-volume or load-shedding system is used for energy conservation, it shall not compromise the pressure-balancing relationships or the minimum air changes required in Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces).
(b)  See Table 3.1-1 for ventilation requirements intended to provide for comfort and asepsis and odor control in nursing home spaces that directly affect resident care.
(c)  For spaces not specifically listed in Table 3.1.1:
(i)  Ventilation requirements shall be those for functionally equivalent spaces in Table 3.1-1.
(ii)  If no functionally equivalent spaces exist in Table 3.1-1, ventilation requirements shall be obtained from Informative Appendix B in ANSI/ASHRAE Standard 62.1: Ventilation and Acceptable Indoor Air Quality or from Informative Appendix B in ANSI/ASHRAE Standard 62.2: Ventilation and Acceptable Indoor Air Quality in Low-Rise Residential Buildings.
(iii)  Where spaces with prescribed rates are included in both ANSI/ASHRAE Standard 62.1 or 62.2 and Table 3.1-1, the higher of the air change rates shall be used.
(d)  Air change rates. The minimum number of total air changes per hour indicated in Table 3.1-1 shall be either supplied for positive pressure rooms or exhausted for negative pressure rooms.
(i)  For spaces that required by Table 3.1-1 to have a negative pressure relationship but are not required to be exhausted, the supply airflow rate shall be used to compute the minimum total air changes per hour required.
*(ii) For spaces that require a positive or negative pressure relationship, the number of air changes per hour can be reduced when the space is unoccupied as long as the required pressure relationship to adjoining spaces is maintained while the space is unoccupied and the minimum number of air changes indicated is reestablished whenever the space is occupied.
(e)  Use of controls intended to switch the required pressure relationships between spaces from positive to negative, and vice versa, shall not be permitted.
(f)  For air-handling systems serving multiple spaces, system minimum outdoor air quantity shall be calculated using one of the following methods:
(i)  As the sum of the individual space requirements
(ii)  By the "ventilation rate procedure" (multiple zone formula) of ASHRAE Standard 62.1. The minimum outdoor air change rate listed in this standard shall be interpreted as the Voz (zone outdoor airflow) for purposes of this calculation.
(3)  Outdoor air intakes and exhaust discharges. Equipment shall comply with Table 5.5.1 (Air Intake Minimum Separation Distance) in ANSI/ASHRAE Standard 62.1.
A3.1-6.3.1.2 (2) Ventilation system design. Because of the diversity of the population and variations in susceptibility and sensitivity, the specific care population's needs should be taken into consideration when providing ventilation for comfort, infection control, and odor control.
A3.1-6.3.1.2 (2)(d)(ii) Air exchanges. Air change rates in excess of the minimum values are expected in some cases to maintain room temperature and humidity conditions based on the cooling or heating load of the space.
See Section 2.5-3.2 (Mechanical System Design) for requirements.
See Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for requirements.
See Section 2.5-3.3.3 (Areas of Refuge) for requirements.
See Section 2.5-3.3.4 (Commercial Food Preparation Areas) for requirements.
See Section 2.5-3.4 (Thermal and Acoustic Insulation) for requirements.
See Section 2.5-3.5 (HVAC Air Distribution) for requirements.
(1)  For centralized recirculated systems, see Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces) for required filter efficiencies.
(a)  Each filter bank with an efficiency greater than MERV 12 shall be provided with an installed, readily accessible manometer or differential pressure-measuring device that provides a reading of differential static pressure across the filter to indicate when the filter needs to be replaced.
(b)  All air provided to a space by centralized recirculated systems shall be filtered.
(2)  For non-central recirculating room systems, HVAC units shall:
(a)  Not receive nonfiltered, nonconditioned outdoor air.
(b)  Serve only a single space.
*(c)  Include the manufacturer's recommended filter for airflow passing over any surface that is designed to condense water. This filter shall be located upstream of any such cold surface so that all of the air passing over the cold surface is filtered.
A3.1-6.3.6.1 (2)(c) Filters for recirculating room systems. Filters should be replaced and/or cleaned per the manufacturer's recommendations to maintain indoor air quality.
  1. Filter frames shall be durable and proportioned to provide an airtight fit with the enclosing ductwork.
  2. All joints between filter segments and the enclosing ductwork shall have gaskets or seals to provide a positive seal against air leakage.
  1. Heating sources and essential accessories shall be provided in number and arrangement sufficient to accommodate the facility needs (reserve capacity) even when any one of the heat sources or essential accessories is not operational due to a breakdown or routine maintenance. Exception: Reserve capacity is not required if the ASHRAE 99% heating dry-bulb temperature for the nursing home is greater than or equal to 25° F (—4° C).
  2. When a heat source is off-line, the capacity of the remaining source(s) shall be sufficient to provide for domestic hot water and dietary purposes and to provide heating for resident care areas and resident rooms.
  3. See Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces) for additional requirements.
A3.1-6.3.7.2 Heating systems. Storage on-site of fuel sufficient to support the owner's facility operation plan upon loss of fuel service should be considered as part of the disaster and emergency preparedness plan.
  1. For central cooling systems greater than a 400-ton (1407 kW) peak cooling load, the number and arrangement of cooling sources and essential accessories shall be sufficient to support the nursing home operation plan upon a breakdown or during routine maintenance of any one of the cooling sources.
  2. See Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces) for additional requirements.
See Section 2.5.3.7.4 (Temperature Control) for requirements.
See Section 2.5-4.1 (Electrical Systems—General) for requirements.
  1. Applicable standards
    1. At minimum, nursing homes or sections thereof shall have essential electrical systems as required in:
      1. NFPA 99: Health Care Facilities Code
      2. NFPA 110: Standard for Emergency and Standby Power Systems, requirements that address nursing homes
      3. NFPA 70: National Electrical Code, requirements that address nursing homes
    2. Requirements for emergency lighting in nursing homes shall be dictated by local codes according to the care model.
  2. Shared service. Where the nursing home is a distinct part of or served by an acute care hospital on the same campus, required emergency lighting and power shall be permitted to be provided by the hospital essential electrical system.
  3. Where fuel for electricity generation is stored on-site, the following shall be required:
    1. Storage capacity shall be sufficient to provide continuous operation in accordance with state requirements.
    2. Fuel storage for electricity generation shall be separate from heating fuel storage.
Exhaust systems (including locations, mufflers, and vibration isolators) for internal combustion engines shall be designed and installed to minimize noise.
Omission of receptacles from exterior walls where construction makes installation impractical shall be permitted. See Section 2.5-4.3.1 (Electrical Receptacles—General) for additional information.
See Section 2.5-4.3.2 (Receptacles in Corridors) for requirements.
  1. Each resident room shall have duplex-grounded receptacles, including at least one on each wall.
  2. At least two duplex outlets shall be provided for each bed location, with one at each side of the head of each bed location. Where electric-powered beds are used, an additional outlet shall be provided at the head of the bed.
A3.1-6.4.3.3 Resident room receptacles. During the functional programming process, all equipment, electric beds, task lamps, televisions, data equipment, telephones, electronics, and other resident and care uses in resident rooms that will require electrical receptacles should be identified during the functional programming process. Providing enough outlets to avoid the need for extension cords is recommended as use of extension cords can be a hazard and lead to regulatory citations. As well, the outlet height that will promote ease of use by residents, staff, and family members should be determined.
See Section 2.5-4.3.4 (Essential Electrical System Receptacles) for requirements.
See Section 2.5-4.3.5 (Ground Fault Interrupter Receptacles) for requirements.
See Section 2.5-4.4 (Electrical Requirements for Ventilator-Dependent Resident Rooms and Areas) for requirements.
See Section 2.5-5.1 (Communication Systems— General) for requirements.
A nurse/staff call system shall be provided.
  1. Use of alternative technologies, including wireless systems, shall be permitted for emergency or nurse call systems.
    1. Where wireless systems are used, consideration shall be given to electromagnetic compatibility between internal and external sources.
    2. Wireless systems shall comply with UL Standard 1069: Hospital Signaling and Nurse Call Equipment.
  2. Nurse and emergency call systems shall be listed by a nationally recognized testing laboratory (NRTL).
  1. Where a hardwired system is used, each bed location shall be provided with a call device that is accessible to the resident.
    1. One call station shall be permitted to serve two call devices.
    2. Wireless call stations are permitted.
  2. A call initiated by a resident activating either a call device attached to a resident's call station or a portable device that sends a call signal shall register at the staff call station or device and shall either:
    1. Activate a visual signal in the corridor at the resident's door. In multi-corridor or cluster resident units, additional visual signals shall be installed at corridor intersections; or
    2. Activate a handheld mobile device carried by a staff member, identifying the specific resident and location from which the call was placed.
An emergency call device shall be accessible from each toilet, bathtub, and shower used by residents.
  1. The device shall be accessible to a resident in any position in the room, including lying on the floor. Inclusion of a pull cord or portable wireless device shall satisfy this requirement.
  2. The emergency call system shall be designed so that a call activated will initiate a signal that is distinct from the resident room call device and can be turned off only at the activated emergency call device.
  3. The signal shall activate at the staff work area and/or signal a handheld mobile device carried by staff.
A3.1-6.5.2.3 Hair salons, resident lounges, and all common resident areas should be evaluated for incorporation of emergency call system stations. This evaluation should consider the care model, care population, scale of the facility, and staff sight lines for observing residents.
See Section 2.5-5.3 (Technology Equipment and Teledata Room) for requirements.
See Section 2.5-5.4 (Grounding for Telecommunication Spaces) for requirements.
See Section 2.5-5.5 (Cabling Pathways and Raceway Requirements) for requirements.
See Section 2.5-6 (Electronic Safety and Security Systems) for requirements.
See Section 2.5-7.1 (Daylighting and Artificial Lighting Systems—General) for requirements.
See Section 2.5-7.2 (Daylighting Systems in Resident, Participant, and Outpatient Areas) for requirements.
See Section 2.5-7.3.1 (Light Fixtures) for requirements.
See appendix section A2.5-7.3.2 (Lighting in transition spaces) for recommendations.
(1)  Resident unit corridors
(a)  Resident unit corridors shall have general illumination with provisions for reducing light levels at night.
(b)  Corridors and common areas used by residents shall have even light distribution to avoid glare, shadows, and scalloped lighting effects.
(2)  Resident rooms and toilet rooms. These rooms shall have general lighting, task lighting, and night-lighting.
(a)  Task lighting
*(i)  At least one task light shall be provided for each resident.
(ii) Task light controls shall be readily accessible to residents and staff at the head of the bed (including multiple-bed locations).
*(b)  Night-lighting. Night-lighting shall be provided in the pathway to and from the bedside and the bathroom.
(i)   Night-lighting shall be mounted no higher than 2 feet (61 centimeters) above the floor.
(ii)  Night-lighting shall be controlled separately from ambient lighting.
*(iii)  Night-lighting shall have a low light level.
(iv)  Because night-lights may disturb resident sleep even when properly specified, located, and operated, care providers shall be permitted to use portable light sources or switched night lights for added control of this light source.
(c)  Resident unit toilet rooms shall have general illumination with provision for reducing light levels at night.
A3.1-6.7.3.2 (2)(a)(i) Provision of movable task lighting should be considered.
A3.2-6.7.3.2 (2)(b) Night-lighting in resident rooms. Research has established that older adults sleep best in total darkness. Therefore, to minimize resident sleep disruption, night-lights should provide very low levels of illumination and be located to minimize light scatter and reflections on room surfaces. Switches for night-lights are recommended for some care populations.
A3.2-6.7.3.2 (2)(b)(iii) Night-lighting should include amber or red lamping. White, blue, or green lamping should not be used.
See Section 2.5-8 (Acoustic Design Systems) for requirements.
All buildings having resident use areas on more than one floor shall have electric or hydraulic elevator(s).
  1. At least one elevator sized to accommodate a bed, a gurney, and/or medical carts and resident-operated mobility device users shall be installed where residents are living or receiving health, care, or support services on any floor other than the main entrance floor.
  2. At least two elevators shall be installed where 60 to 200 residents are living or receiving health, care, or support services on floors other than the main entrance floor.
  3. At least three elevators shall be installed where 201 to 350 residents are living or receiving health, care or support services on floors other than main entrance floor.
  4. For facilities with more than 350 residents living or receiving health, care, or support services above the main entrance floor, the number of elevators shall be determined from a study of the facility plan and from the estimated vertical transportation requirements.
  5. Where the facility is part of a general hospital, elevators may be shared and the standards in Section 2.5-9 (Elevator Systems) shall apply.
Elevator car doors shall have a clear opening of not less than 3 feet 8 inches (1.12 meters).
See Section 2.5-9.3 (Leveling Device) for requirements.
See Section 2.5-9.4 (Installation and Testing) for requirements.
Elevator cars shall have handrails on all sides without entrance door(s). See Section 2.4-2.2.10 (Handrails and Lean Rails) for additional requirements.
Linked Resources
P
P Premium Feature

This feature is included in the premium subscription. Visit the feature page to learn more.

Learn More
Bookmarks
P
P Premium Feature

This feature is included in the premium subscription. Visit the feature page to learn more.

Learn More