This chapter contains specific requirements for freestanding hospice facilities and separately licensed hospice facilities that are part of other health, care, and support settings.

A3.2-1.1.1.1 Hospice facilities provide a medically directed, interdisciplinary care program of palliative care and services for terminally ill individuals. Palliative care is care and treatment for management of multiple chronic diseases. Care tends to be focused on resident comfort.

Hospice care is provided by a specialized team of professionals that may include nurses, social workers, certified nursing assistants, dietitians, therapists, pain management specialists, and physicians as well as trained volunteers and clergy. The focus of the hospice team is to provide end-of-life care that supports quality of life and maintains dignity for residents and their families and friends. No curative interventions are used.

Hospice services may be provided in independent and assisted living, ambulatory care, hospital, and nursing home settings. Hospice care may be provided as outpatient or inpatient services in existing, new, or renovated facilities as well as through home care.

3.2-1.1.1.2

The requirements in Part 2 (Common Elements for Residential Health, Care and Support Facilities) shall apply to hospice facilities as referenced in this chapter.

3.2-1.1.2 Design Criteria

3.2-1.1.2.1 Sustainable Design

See Section 2.2-2 (Sustainable Design Criteria) for requirements.

3.2-1.1.2.2 Design Criteria for Accommodations for Care of Persons of Size

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.

3.2-1.1.2.3 Dementia, Mental Health, and Cognitive and Developmental Disability Design Criteria

Where 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.

3.2-1.2 Functional Program

See Section 1.2-2 (Functional Program) for requirements.

3.2-1.3 Resident Safety Risk Assessment

See Section 1.2-3 (Resident Safety Risk Assessment) for requirements.

3.2-1.4 Environment of Care Requirements

3.2-1.4.1 General

See Section 1.2-1.3 (Environment of Care and Facility Function Considerations) and Section 1.2-4 (Environment of Care Requirements) for requirements.

*3.2-1.4.2 Flexibility

Hospice facilities shall be designed to provide flexibility to meet the changing needs of families and visitors attending to residents receiving hospice care.

A3.2-1.4.2 Flexibility can be accomplished through several means, such as provision of a variety of activity spaces or private counseling spaces or simply the ability to rearrange furniture to accommodate different family unit sizes and needs.

*3.2-1.4.3 Supportive Environment

The facility design shall produce a supportive environment to enhance quality of life for residents and their families and friends and promote privacy and dignity for those receiving hospice care.

A3.2-1.4.3 Person-centered care in hospice care settings should address movement away from a traditional model toward one that is residential in scale; includes homelike amenities for families, friends, and residents; and goes beyond a typical medical model to address the emotional and spiritual needs of patients and their loved ones. Hospice facilities, treatments, and services generally are not aimed at a cure but may include complementary therapies that promote safety and comfort. Many residents are in advanced stages of illness with weeks or days to live.

3.2-1.4.4 Barrier-Free Environment

The architectural design-through organization of functional space, specification of ergonomically appropriate and arranged furniture and equipment, and selection of details and finishes-shall eliminate as many barriers as possible to access by families, friends, staff, and residents to space, services, equipment, and utilities that support the resident receiving hospice services.

*3.2-1.5 Site

See Chapter 2.1 (Site Elements) for requirements.

A3.2-1.5 Parking. Provision of a minimum of one additional parking space for every four beds should be considered for a freestanding hospice facility.

3.2-2 Resident Areas

3.2-2.1 General

The requirements in this section shall apply to hospice facilities that include the space types described.

*3.2-2.2 Resident Unit

A3.2-2.2 Resident units are groups of resident rooms and support areas whose size and layout are based on the care model staffing patterns, functional operations, and communications used in the facility.

3.2-2.2.1 General

3.2-2.2.1.1 Hospice Unit Size

In the absence of local requirements, consideration shall be given to restricting the size of the care unit to a maximum of 25 beds unless just cause can be demonstrated and approval obtained from the local authority having jurisdiction (AHJ).

*3.2-2.2.1.2 Layout

(1) In new construction, hospice units shall be arranged to avoid unrelated travel through the unit.

*(2) The facility layout shall reflect the care model and related staffing.

A3.2-2.2.1.2 Overwhelming fatigue is the predominant complaint of hospice residents and staff. Arranging groups of resident rooms adjacent to decentralized service areas, optional satellite staff work areas, and optional decentralized resident support areas to reduce travel distances should be considered.

A3.2-2.2.1.2 (2) Hospice care models. See appendix table A3.2-a (Hospice Care Model Characteristics) for information in addition to the care model descriptions below.

Adult day care hospice. This model includes day services for residents receiving hospice services while living in an independent living setting (either with family or other caregivers). Adult day care hospice services are provided for residents with family caregivers who work during the day. Adult day care hospice services may be provided in private space in a standard adult day care or adult day health care center that has been set aside for residents receiving hospice services.
Home-based hospice services. This model includes services that are brought to a resident living in an assisted living facility or independent living setting. Home-based hospice services are provided for residents who live in an independent or assisted living setting. Hospice services to be provided by a care and support facility, if any, should be identified during the functional programming process.
Small ambulatory residential care hospice facilities. This model typically includes 6 to no more than 15 private beds in a small group home for ambulatory residents. These facilities are provided for residents who are still ambulatory but need hospice services.
Small non-ambulatory inpatient care hospice facilities. This model typically includes 6 to no more than 15 private beds in a small group home setting for non-ambulatory residents or a combination of ambulatory and non-ambulatory residents. These facilities are provided for residents who are predominantly non-ambulatory.
Freestanding hospice facilities. This model typically includes 16 or more beds in a large group home setting. Freestanding hospice facilities offer acute care end-of-life services, which should be provided in private rooms that include adequate family space.
Hospital-based hospice facilities. This model follows hospice regulations and includes any number of beds housed in a hospital setting. These facilities provide acute care end-of-life services and should be located in a dedicated area with private rooms that include adequate family space.
Nursing home-based hospice facilities. This model follows hospice regulations and includes any number of beds housed in a nursing home setting. Nursing home-based hospice facilities provide end-of-life services and should be provided in a private room that includes adequate family space. Nursing homes should provide hospice services and related accommodations for residents and family.

3.2-2.2.2 Resident Room

Each resident room shall meet the following requirements:

*3.2-2.2.2.1 Capacity

Maximum room occupancy shall be one resident unless justified in the functional program and approved by the AHJ, in which case resident room capacity shall not exceed two resident beds.

A3.2-2.2.2.1 Consideration should be given to accommodating couples each receiving hospice care at the same time.

*3.2-2.2.2.2 Space Requirements

(1) Space shall be provided to accommodate resident care and for maneuverability when resident-operated mobility devices are used.

(2) Resident rooms shall be sized, arranged, and furnished to maximize safe resident mobility, mobilization, weight-bearing activity, and ambulation potential and to minimize risks to caregivers. This requirement shall apply to all resident rooms, regardless of resident weight or condition.

(3) Room size shall be based on the care model and in-room furniture and clothing storage requirements.

(a) Where required by the care model, accommodation for dining shall be provided in the resident room.

(b) Space to allow access to both sides and the foot of the resident bed shall be provided.

*(c) Resident and visitor seating

*(i) Space for seating for residents and visitors shall be provided.

(ii) The room shall be configured so that each resident can view the television from a resident chair.

(4) Space shall be provided for at least one sleeping accommodation for visitors in resident rooms.

(a) Allow space for circulation when the sleeping accommodation (e.g., recliner, sleep chair, sleep sofa) is fully open for use so staff can access the resident in case of an emergency.

(b) Provide storage space to accommodate and secure overnight guests' belongings.

*(5) Space to accommodate resident food storage, refrigeration, and reheating shall be located in the resident room or in an area close to resident rooms. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for additional information for resident and family kitchen areas outside the resident room.

A3.2-2.2.2.2 Space requirements. Resident rooms should be sized, arranged, and furnished to maximize safe patient mobility, mobilization, weight-bearing exercise, and ambulation potential while minimizing risk to caregivers. This should apply to all populations being cared for and served.

Clearances should be provided and maintained to accommodate safe resident mobility and mobilization of residents. Designated clearances should not be obstructed by any object that does not qualify as movable according to Section 1.5-4.2 (Movable and Portable Equipment).

To facilitate planning for minimum clearances around beds, bed type and size should be established as part of the functional program. As acceptable to AHJs, bed placement should be chosen by individual residents and their families to satisfy the needs and desires of the resident.
Provision of bed clearances to support resident safety should include the following:
- -Standard resident room:
  - 48 inches (121.92 centimeters) on the transfer side
  - 36 inches (91.44 centimeters) on the non-transfer side of the bed
  - 36 inches (91.44 centimeters) at the foot of the bed
- -Resident rooms for persons of size with a ceiling lift:
  - 72 inches (182.88 centimeters) from the bed by 120 inches long (304.8 centimeters) on the transfer side
  - 36 inches (91.44 centimeters) on the non-transfer side of the bed
  - 66 inches (167.64 centimeters) at the foot of the bed
- -Resident rooms for persons of size without a ceiling lift to accommodate use of a mobile lift:
  - 84 inches (213.36 centimeters) from the bed by 120 inches long (304.8 centimeters) on the transfer side
  - 36 inches (91.44 centimeters) on the non-transfer side of the bed
  - 66 inches (167.64 centimeters) at the foot of the bed
Sizing of resident rooms should accommodate clearances for resident chairs, recliners, wheelchairs, or other devices; these 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, etc., as follows:
- -48 inches (121.92 centimeters) on the transfer side of the chair, etc. for both standard and person of size room types
- -36 inches (91.44 centimeters) for the approach to the chair for a standard room
- -66 inches (167.64 centimeters) for the approach to the chair for a room accommodating a person of size

A3.2-2.2.2.2 (3)(c) Resident and visitor seating

All resident rooms should have space for at least one chair to provide residents with an alternative to bed-stay. Chairs should be evaluated for provision of the following:
- -Comfort sufficient for long-term sitting
- -Cervical support and support for the resident's head (backrest)
- -Opportunity to recline the backrest to enable periodic redistribution of body weight during long periods of sitting (recliner)
- -Ease of entry and exit
Resident rooms should have space for an additional chair for a visitor so residents do not have to remain in bed when they have a visitor.
See appendix section A2.4-2.4.3.1 (Furniture selection recommendations) for additional information.

A3.2-2.2.2.2 (3)(c)(i) Seating accommodations should be provided for persons of size and their families, who are typically of larger size.

A3.2-2.2.2.2 (5) Kitchenettes usually include a small refrigerator, a microwave, food storage, and a small sink.

*3.2-2.2.2.3 Window

See Section 2.4-2.2.6 (Windows) in addition to the requirements in this section.
Provision shall be made for resident and family to completely darken the resident room.

A3.2-2.2.2.3 Window. Exterior windows should provide views to the natural environment and light where possible. Residents who are confined to their beds need a venue for visual stimulation. Plantings and other attempts to provide objects of visual interest should be made where exterior views of the natural environment are not possible due to existing building adjacencies. See Section 1.2-4.5.1 (Light) and Section 1.2-4.5.2 (Views of and Access to Nature) for additional information.

3.2-2.2.2.4 Resident Privacy

*(1) Visual privacy shall be provided for each resident in multiple-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.

A3.2-2.2.2.4 (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- or multiple-occupancy resident rooms.

3.2-2.2.2.5 Hand-Washing Station

A hand-washing station shall be provided in each resident room.

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.
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).

3.2-2.2.2.6 Resident Toilet Room

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

(d) Individual storage for the personal effects of each resident

(4) Doors and door hardware shall be provided in accordance with Section 3.2-5.2.2.4 (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.

A3.2-2.2.2.6 (1) 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.

3.2-2.2.2.7 Resident Bathroom

Where a bathtub or shower is provided in the resident toilet room, the following requirements shall be met in addition to the requirements in Section 3.2-2.2.2.6 (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.

A3.2-2.2.2.7 (3) Accessible shower. Provision of a curbless shower that is open to the surrounding bathroom should be considered for ease of access by resident and staff.

3.2-2.2.2.8 Resident Storage

Each resident shall be provided with an individual wardrobe or closet.

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).
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.
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.

3.2-2.2.3 Special Care Resident Rooms

The requirements in this section shall apply to all hospice facilities that include these room types.

*3.2-2.2.3.1 Airborne Infection Isolation Room

(1) General

(a) The need for and number of AII rooms shall be determined by an infection control risk assessment.

(b) Where provided, each AII room shall comply with the requirements in Section 3.2-2.2.2 (Resident Room) as well as the following requirements:

(2) Capacity. Each resident room shall contain only one bed.

(3) The toilet room provided for each AII room shall include a shower.

(4) Anteroom. An anteroom is not required; however, where an anteroom is part of the design concept, it shall meet the following requirements:

(a) The anteroom shall provide space for persons to don personal protective equipment before entering the resident room.

(b) All doors to the anteroom shall have self-closing devices.

(5) Where no anteroom is provided, provision shall be made for storage of personal protective equipment at the entrance to the room.

(6) Special design elements

(a) Architectural details

(i) AII room perimeter walls, ceiling, and floor, including penetrations, shall be sealed tightly so that air does not infiltrate the environment from the outside or from other spaces.

(ii) AII rooms shall have self-closing devices on all room exit doors.

(b) Window treatments and privacy curtains shall be provided in accordance with Section 2.4-2.4.4 (Window Treatments and Privacy Curtains).

(i) Ventilation upon loss of electrical power. The space ventilation and pressure relationship requirements of Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces) shall be maintained for AII rooms, even in the event of loss of normal electrical power.

*(ii) Use of recirculating room units shall not be permitted in new construction.

(iii) Use of recirculating devices with HEPA filters shall be permitted in existing facilities as interim, supplemental environmental controls to meet requirements for the control of airborne infectious agents. The design of such recirculating systems shall allow for easy access for scheduled preventive maintenance and cleaning. The design of either portable or fixed recirculating systems shall prevent stagnation and short-circuiting of airflow.

(iv) Design relative humidity shall be a maximum of 60 percent.

A3.2-2.2.3.1 For additional information, refer to the Centers for Disease Control and Prevention (CDC) publications "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings" and "Guidelines for Environmental Infection Control in Health-Care Facilities."

A3.2-2.2.3.1 (6)(c)(ii) Use of recirculating room units is prohibited in new construction due to the difficulty of cleaning the units and the potential for buildup of contamination in the AII room.

*3.2-2.2.3.2 Ventilator-Dependent Resident Units

Where a unit dedicated to serving residents dependent on a ventilator is provided, resident rooms in this unit shall meet the following requirements in addition to those in Section 3.2-2.2.2 (Resident Room).

Resident rooms for ventilator-dependent residents shall have:
1. Space for the ventilator unit at the bedside
2. Space to accommodate clearances for resident-operated mobility devices that may be oversized to accommodate a ventilator
3. Provisions for oxygen and suction. See Section 3.2-6.2.4 (Medical Gas and Vacuum Systems) for requirements.
4. Backup electrical requirements. See Section 2.5-4.4 (Electrical Requirements for Ventilator-Dependent Resident Rooms and Areas) for requirements.
Resident support areas
1. Support space shall be provided in the nursing unit to accommodate staffing associated with ventilator services.
2. A dedicated space shall be provided for servicing and maintenance of ventilator equipment or storage shall be provided to accommodate ventilators for backup or exchange.
3. All resident activity and support areas shall be provided with essential power outlets to support continued ventilator support in the event of a power outage. See Section 2.5-4.4 (Electrical Requirements for Ventilator-Dependent Resident Rooms and Areas) for additional requirements.

A3.2-2.2.3.2 Where a dedicated unit is provided for ventilator-dependent residents, piped oxygen and vacuum should be provided. Refer to NFPA 99: Health Care Facilities Code and ANSI/ASSE 6000: Professional Qualifications Standard for Medical Gas Systems Personnel for essential power requirements and medical gas installation information.

3.2-2.2.3.3 Quiet Room in a Resident Unit

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 3.2-2.2.2 (Resident Room).

3.2-2.3 Resident Community Areas

3.2-2.3.1 General

See Section 2.3-2.3.1 (Resident, Participant and Outpatient Community Areas-General) for requirements.

3.2-2.3.2 Lobby

Where a central lobby is provided, see Section 2.3-2.3.2 (Lobby) for requirements.

3.2-2.3.3 Dining, Recreation and Lounge Areas

3.2-2.3.3.1 General

Space for dining and recreation shall be provided to meet the needs of the care model.
See Section 2.3-2.3.3.1 (Dining, Recreation, and Lounge Areas-General) for additional requirements.

3.2-2.3.3.2 Dining Areas

See Section 2.3-2.3.3.2 (Dining areas) for requirements in addition to those in this section.
See Section 3.2-2.2.2.2 (3)(a) (Resident Room-Space requirements) for requirements for dining accommodations in resident rooms.
Dining areas separate from those for residents and visitors shall be provided for staff.
1. Combination of the staff dining area and a staff break/report area shall be permitted.
2. See Section 3.2-4.3.2 (Staff Lounge) for requirements.

*3.2-2.3.3.3 Recreation, Lounge, and Activity Areas

Lounge areas shall be provided for resident and visitor use based on the number of residents being served.

A3.2-2.3.3.3 Recreation and lounge areas

A minimum of 15 square feet per resident is recommended for sizing recreation and lounge area(s) for resident and visitor use.
Provision of smaller-scaled lounge spaces close to groups of resident rooms should be considered.

3.2-2.3.3.4 Toilet Rooms

Toilet facilities that accommodate resident-operated mobility devices shall be readily accessible to all dining, recreation, lounge, and activity locations.

3.2-2.3.4 Resident Kitchen

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.

*3.2-2.3.5 Personal Services (Hair Salon/Spa) Areas

Where a hair salon is provided:

Mechanical ventilation and exhaust shall be provided. See Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces) for additional requirements.
See Table 3.1-1 for minimum filter efficiencies for hair salons.

A3.2-2.3.5 Personal services areas. Where personal services are provided, consideration should be given to providing the following in the design of these areas:

General
- -Changing areas
- -Storage for supplies and linens
- -Provisions for resident privacy
Hair salon
- -Adjustable sink bowls for shampooing and treatment
- -Freestanding dryers for use by residents using resident-operated mobility devices
- -Location of toilet room adjacent to or directly accessible from hair salon
Space for circulation and staff assistance around spa tubs

*3.2-2.3.6 Family Room

A family room(s) sized to accommodate visitors and family shall be provided.

A3.2-2.3.6 Family room. The family room should have exterior views as well as direct access to the exterior.

3.2-2.3.6.1

Each family room shall be permitted to serve a variety of functions, including those listed in this section. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for additional information.

Children's playroom
Family kitchenette
Dining area

3.2-2.3.6.2

Inclusion of a gas fireplace shall be permitted in a family room where non-operable glass doors are used.

3.2-2.3.7 Quiet Room and/or Meditation Area

3.2-2.3.7.1 Quiet Room in a Resident Area

Where a quiet room is provided, see Section 2.3-2.3.7 (Quiet Room in a Resident or Participant Community Area) for requirements.

3.2-2.3.7.2 Meditation Area

A meditation area(s) that offers a private place for individuals shall be provided and sized based on the unit size and care model.
This space shall be permitted to be shared with other health care settings and used by both residents and staff.

3.2-2.3.8 Outdoor Activity Spaces

3.2-2.3.8.1

See Section 2.1-3.6.2 (Outdoor Activity Spaces) for requirements.

*3.2-2.3.8.2

Outdoor activity spaces shall be available to residents and visitors.

A3.2-2.3.8.2 Outdoor activity spaces

Gardens symbolize the full cycle of life and death and can be a source of serenity and spiritual calm.
Visual access to outdoor activity spaces from indoors should be provided for staff and residents.
Outdoor space(s) should be accessible to residents via short navigable distances.

3.2-3 Diagnostic and Treatment Areas

3.2-3.1 General

See Section 2.3-3.1 (Diagnostic and Treatment Areas-General) for requirements.

3.2-3.2 Examination and Treatment Room

Where an examination room and/or treatment room(s) is provided, see Section 2.3-3.2 (Examination, Observation, and/or Treatment Rooms) for requirements.

3.2-4 Facilities for Support Services

3.2-4.1 General

See Section 2.3-4.1 (Facilities for Support Services-General) for requirements.

3.2-4.2 Facilities That Support Resident Care

3.2-4.2.1 Staff Work Area(s)

See Section 2.3-4.2.1 (Staff Work Area) for requirements.

3.2-4.2.2 Medication Distribution Locations (Centralized and Decentralized)

See Section 2.3-4.2.2 (Medication Distribution and Storage Locations) for requirements.

*3.2-4.2.3 Central Bathing Rooms or Areas

A3.2-4.2.3 Consideration should be given to privacy when locating entrances to bathing rooms.

3.2-4.2.3.1

See Section 2.5-2.3.3.2 (Accessible shower) for requirements.

3.2-4.2.3.2 Number

A minimum of one accessible bathtub or shower that is available to all residents shall be provided.
Additional bathtubs or showers shall be provided as required to serve the unit size and care population.

3.2-4.2.3.3 Accessibility

The bathtub or spa tub in this room shall be accessible to residents in wheelchairs.
The shower shall have fittings accessible to a resident in a recumbent position.
Adult resident shower rooms shall be designed to allow entry of portable/mobile mechanical lifts, shower gurney devices, and shower chairs.

3.2-4.2.3.4

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.

3.2-4.2.3.5

Access to a grooming location without reentry to the general corridor shall be provided. This shall contain the following:

Hand-washing station
Mirror
Counter or shelf

3.2-4.2.4 Equipment and Supply Storage

3.2-4.2.4.1 General

See Section 2.3-4.2.4 (Equipment and Supply Storage) for requirements in addition to those in this section.

3.2-4.2.4.2 Decentralized Clean Linen Storage

A separate closet or designated area shall be provided for clean linen storage.

A decentralized clean utility room shall be permitted to be used for the storage of clean linen.
Where a closed-cart system is used, storage in an alcove shall be permitted.

3.2-4.2.4.3 Storage for Mobility Devices and Support Equipment

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.

3.2-4.2.5 Clean Utility Room

See Section 2.3-4.2.5 (Clean Utility Room) for requirements.

3.2-4.2.6 Soiled Utility Room

See Section 2.3-4.2.6 (Soiled Utility Room) for requirements.

3.2-4.2.7 Personal Laundry Facilities

See Section 2.3-4.2.7 (Personal Laundry Facilities) for requirements.

3.2-4.2.8 Resident Telephone Access

See Section 2.3-4.2.8 (Resident and Participant Telephone Access) for requirements.

3.2-4.3 Support Areas for Staff

3.2-4.3.1 General

3.2-4.3.1.1

See Section 2.3-4.3 (Support Areas for Staff) for requirements in addition to those in this section.

3.2-4.3.1.2

Space for staff breaks and staff reporting areas shall be permitted to be provided as two separate rooms or combined into one room.

3.2-4.3.2 Staff Lounge

Staff lounge(s) shall be adjacent to the staff work area and staff toilet room. See sections 3.2-4.2.1 (Staff Work Area) and 2.3-4.3.3 (Staff Toilet Room).

3.2-4.3.3 Shower Room

Showering capabilities shall be provided for staff either in a central shower room or in a dedicated staff toilet/shower room.

3.2-4.4 Support Facilities for Family and Visitors

3.2-4.4.1 Overnight Guest Accommodations

Overnight accommodations shall be provided for visitors and family.

3.2-4.4.1.1

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.

3.2-4.4.1.2

Storage space shall be provided to accommodate and secure overnight guests' belongings.

3.2-4.4.2 Pet Accommodations

See Section 2.3-4.4.3 (Pet Accommodations) for requirements.

3.2-4.4.3 Shower and Toilet Facilities

Shower and toilet facilities for family and visitors shall be provided.

3.2-4.4.4 Volunteer and Clergy Accommodations

Secured storage for the belongings of volunteers and clergy shall be provided.

3.2-4.5 Food Service Facilities

3.2-4.5.1 General

The type and size of the hospice facility shall determine the dietary environment and the food service facilities provided.

3.2-4.5.2 Central Commercial Kitchen

Where a central commercial kitchen is provided, the food services facilities shall be provided in accordance with Section 2.3-4.5 (Food Service Facilities).

3.2-4.5.3 Warming Kitchen

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.

3.2-4.5.3.1

Where an outside vendor is used to provide meals for a facility of 16 or more beds, 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.

3.2-4.5.3.2

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.

3.2-4.5.4 Decentralized Kitchen

Where food preparation is conducted on-site for 16 or more beds, the facility shall have dedicated non-public staff space and equipment for preparation of meals. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.

3.2-4.6 Linen and Laundry Service Facilities

3.2-4.6.1 General

3.2-4.6.1.1

Each facility shall have provisions for storing and processing clean and soiled/contaminated linen.

*3.2-4.6.1.2

Where a facility includes a commercial laundry, the following requirements shall apply:

Processing shall be permitted to take place in the facility, in a separate building on- or off-site, or in a shared laundry.
At minimum, the elements in Section 3.2-4.6.2 (Laundry Facility) shall be provided.

A3.2-4.6.1.2 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.

3.2-4.6.2 Laundry Facility

3.2-4.6.2.1 Layout

Equipment shall be arranged to permit an orderly workflow and minimize cross-traffic that might mix clean and soiled operations.

3.2-4.6.2.2

Where linen is processed in a laundry facility in the hospice facility, the following shall be provided:

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.
Washers/extractors. Washers/extractors shall be located between the soiled linen receiving and clean processing areas.
Dryers
Supply storage. Storage shall be provided for laundry supplies.
Inspection and mending area. An area shall be provided for linen inspection and mending.

3.2-4.6.3 Support Areas for Linen Services

3.2-4.6.3.1 Central Clean Linen Storage

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.

3.2-4.6.3.2 Soiled Holding Room(s)

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.

Room(s) shall have ventilation and exhaust.
Discharge from soiled linen chutes shall be received in this room or in a separate room, as required by the local authority having jurisdiction.
Room(s) used for processing shall have a deep sink for soaking and/or a flushing-rim sink.

3.2-4.6.3.3 Linen Carts

Provisions shall be made for parking clean and soiled linen carts separately and out of traffic.
Provisions shall be made for cleaning linen carts on premises (or for exchange of carts off premises).

3.2-4.6.3.4 Hand-Washing Stations

Hand-washing stations shall be provided in each area where unbagged soiled linen is handled.
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).

3.2-4.6.4 Support Areas for Facilities Using Off-Site Linen Processing

Where linen is processed off-site or in a separate building on-site, the following shall be provided:

3.2-4.6.4.1

A service entrance, protected from inclement weather. This shall be permitted to be shared with other services.

3.2-4.6.4.2

A control station, which can be shared with other services

3.2-4.7 Materials Management Facilities

See Section 2.3-4.7 (Materials Management Facilities) for requirements. However, materials management services do not require duplication where those services are available as part of an adjacent health care facility.

3.2-4.8 Waste Management Facilities

See Section 2.3-4.8 (Waste Management Facilities) for waste collection, storage, and disposal requirements.

3.2-4.9 Environmental Services Rooms

See Section 2.3-4.9 (Environmental Services Rooms) for requirements.

3.2-4.10 Facilities for Engineering and Maintenance Services

See Section 2.3-4.10 (Facilities for Engineering and Maintenance Services) for requirements.

3.2-4.11 Administrative Areas

3.2-4.11.1 Office and Conference Space

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.

*3.2-4.11.1.1 Conference Space

Space for private interviews; staff, resident, and family meetings; conferences; and health education shall be sized to accommodate operational and activity needs.

Space shall include provisions for use of visual aids and technology.
Sharing of space by several services shall be permitted.

A3.2-4.11.1.1 Kitchenette for conference space. Provision of kitchenette facilities, including under-counter refrigerator, microwave, and sink, should be considered for the conference space.

3.2-4.11.1.2

Individual offices/spaces and conference spaces required in Section 3.2-4.11.1 (Office and Conference Space) shall be permitted to be included in or shared with other office suites where the hospice services are provided in another health care setting.

3.2-4.11.1.3 Supply and Copy Room

Space for storage of files, office equipment, and supplies shall be provided.

3.2-4.11.2 Counseling Room

A small sitting area(s) shall be provided to allow for private conversations.

3.2-4.11.2.1

The private conference room space described in Section 3.2-4.11.1.1 (Private conference space) shall be permitted to serve this function.

3.2-4.11.2.2

This space shall be permitted to serve as an alternative bereavement room.

3.2-4.11.2.3 Private Phone Area

Accommodations shall be made to allow private conversations.
Counseling room(s) shall be permitted to serve this purpose.

3.2-5 Design and Construction Requirements

3.2-5.1 Building Codes and Standards

See Section 2.4-1.2 (Building Codes and Standards) for requirements.

3.2-5.2 Architectural Details, Surfaces, and Furnishings

3.2-5.2.1 Reserved

3.2-5.2.2 Architectural Details

3.2-5.2.2.1 General

See Section 2.4-2.2.1 (Architectural Details-General) for requirements.

3.2-5.2.2.2 Corridors

See Section 2.4-2.2.2 (Corridors) for requirements.

3.2-5.2.2.3 Ceiling Height

See Section 2.4-2.2.3 (Ceiling Height) for requirements.

3.2-5.2.2.4 Doors and Door Hardware

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.

A3.2-5.2.2.4 (2)(a) Eliminating the floor tracks and using breakaway door hardware minimizes the possibility of jamming.

3.2-5.2.2.5 Thresholds and Expansion Joint Covers

See Section 2.4-2.2.5 (Thresholds and Expansion Joint Covers) for requirements.

3.2-5.2.2.6 Windows

See Section 2.4-2.2.6 (Windows) for requirements.

3.2-5.2.2.7 Glazing Materials

See Section 2.4-2.2.7 (Glazing Materials) for requirements.

3.2-5.2.2.8 Hand-Washing Stations

See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

3.2-5.2.2.9 Grab Bars

See Section 2.4-2.2.9 (Grab Bars) for requirements.

3.2-5.2.2.10 Handrails

(1) See Section 2.4-2.2.10 (Handrails and Lean Rails) for requirements in addition to that in this section.

*(2) Handrails capable of supporting 250 pounds (113.50 kilograms) shall be provided in all corridors.

A3.2-5.2.2.10 (2) Where persons of size are accommodated, supporting weight should be evaluated based on the needs of the care population.

3.2-5.2.2.11 Protection From Heated Surfaces

See Section 2.4-2.2.11 (Protection from Heated Surfaces) for requirements.

3.2-5.2.2.12 Signage and Wayfinding

See Section 2.4-2.2.12 (Signage and Wayfinding) for requirements.

3.2-5.2.2.13 Decorative Water Features

Where decorative water features are used in the facility design, see appendix section A2.4-2.2.13 (Decorative water features) for recommendations.

3.2-5.2.3 Surfaces

3.2-5.2.3.1

See Section 2.4-2.3 (Surfaces) for requirements in addition to those in this section.

*3.2-5.2.3.2

To reduce surface contamination linked to health care-associated infections, surface materials selected for use in hospice facilities shall possess the following performance characteristics:

Surfaces shall be cleanable and have no surface crevices or rough textures, joints, or seams.
Surfaces shall be non-absorptive, nonporous, and smooth.

A3.2-5.2.3.2 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.

3.2-5.2.4 Furnishings

See Section 2.4-2.4 (Furnishings) for requirements.

3.2-6 Building Systems

3.2-6.1 General

See Section 2.5-1 (Building Systems for Residential Health, Care, and Support Facilities-General).

3.2-6.2 Plumbing Systems

3.2-6.2.1 General

See Section 2.5-2.1 (Plumbing Systems-General) for additional requirements.

3.2-6.2.2 Plumbing and Other Piping Systems

See Section 2.5-2.2 (Plumbing and Other Piping Systems) for requirements.

3.2-6.2.3 Plumbing Fixtures

3.2-6.2.3.1 Reserved

3.2-6.2.3.2 Hand-Washing Sinks

See Section 2.5-2.3.2 (Hand-Washing Sinks) and Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

3.2-6.2.3.3 Showers

See Section 2.5-2.3.3.2 (Accessible showers) for requirements and appendix section A3.2-2.2.2.7 (3) (Accessible shower) for recommendations.

3.2-6.2.3.4 Reserved

3.2-6.2.3.5 Clinical Sinks

See Section 2.5-2.3.5 (Clinical Sinks) for requirements.

3.2-6.2.3.6 Portable Hydrotherapy Whirlpools

See Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for requirements.

3.2-6.2.4 Medical Gas and Vacuum Systems

Any installation of nonflammable medical gas, air, or clinical vacuum systems shall comply with the requirements of NFPA 99: Health Care Facilities Code.

3.2-6.3 Heating, Ventilation, and Air-Conditioning (HVAC) Systems

3.2-6.3.1 General

3.2-6.3.1.1 Application

HVAC systems that meet the requirements in this section shall be provided for hospice facilities.

3.2-6.3.1.2 Ventilation and Space Conditioning

(1) See Section 2.5-3.1.2 (Ventilation and Space Conditioning) for requirements in addition to those in this section.

*(2) Ventilation 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 hospice spaces that directly affect resident care.

(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) Spaces that are required by Table 3.1-1 to have a negative pressure relationship but are not required to be exhausted shall utilize the supply airflow rate 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 V_oz (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.

A3.2-6.3.1.2 (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.

A3.2-6.3.1.2 (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.

3.2-6.3.2 Mechanical System Design

See Section 2.5-3.2 (Mechanical System Design) for requirements.

3.2-6.3.3 HVAC Requirements for Specific Locations

3.2-6.3.3.1 Reserved

3.2-6.3.3.2 Fuel-Fired Equipment Rooms

See Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for requirements.

3.2-6.3.3.3 Areas of Refuge

See Section 2.5-3.3.3 (Areas of Refuge) for requirements.

3.2-6.3.3.4 Commercial Food Preparation Areas

See Section 2.5-3.3.4 (Commercial Food Preparation Areas) for requirements.

3.2-6.3.4 Thermal and Acoustic Insulation

See Section 2.5-3.4 (Thermal and Acoustic Insulation) for requirements.

3.2-6.3.5 HVAC Air Distribution

See Section 2.5-3.5 (HVAC Air Distribution) for requirements.

3.2-6.3.6 HVAC Filters

3.2-6.3.6.1 Filter Efficiencies

(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.

A3.2-6.3.6.1 (2)(c) Filters for recirculating room systems. Filters should be replaced and/or cleaned per the manufacturer's recommendations to maintain indoor air quality.

3.2-6.3.6.2 Filter Frames for Centralized Systems

Filter frames shall be durable and proportioned to provide an airtight fit with the enclosing ductwork.
All joints between filter segments and the enclosing ductwork shall have gaskets or seals to provide a positive seal against air leakage.

3.2-6.3.7 Heating Systems, Cooling Systems, and Equipment

3.2-6.3.7.1 Reserved

*3.2-6.3.7.2 Heating Systems

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 hospice facility is greater than or equal to 25° F (—4° C).
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.
See Table 3.1-1 (Design Parameters for Ventilation of Residential Health Spaces) for additional requirements.

A3.2-6.3.7.2 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.

3.2-6.3.7.3 Cooling Systems

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 hospice facility operation plan upon a breakdown or during routine maintenance of any one of the cooling sources.
See Table 3.1-1 for additional requirements. 3.2-6.3.7.4 Temperature control. See Section 2.5-3.7.4 (Temperature Control) for requirements.

3.2-6.3.7.4 Temperature Control

See Section 2.5-3.7.4 (Temperature Control) for requirements.

3.2-6.4 Electrical Systems

3.2-6.4.1 General

See Section 2.5-4.1 (Electrical Systems-General) for requirements.

3.2-6.4.2 Power-Generating and Power-Storing Equipment

3.2-6.4.2.1 Essential Electrical Service

Applicable standards
1. At minimum, hospice facilities 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 hospice facilities
  3. NFPA 70: National Electrical Code, requirements that address hospice facilities
2. Requirements for emergency lighting in hospice facilities shall be dictated by local codes according to the care model.
Shared service. Where the hospice facility 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.
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.

3.2-6.4.2.2 Generators

Exhaust systems (including locations, mufflers, and vibration isolators) for internal combustion engines shall be designed and installed to minimize noise.

3.2-6.4.3 Electrical Receptacles

3.2-6.4.3.1 General

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.

3.2-6.4.3.2 Receptacles in Corridors

See Section 2.5-4.3.2 (Receptacles in Corridors) for requirements.

*3.2-6.4.3.3 Receptacles in Resident Rooms

Each resident room shall have duplex-grounded receptacles, including at least one on each wall.
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.

A3.2-6.4.3.3 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.

3.2-6.4.3.4 Essential Electrical System Receptacles

See Section 2.5-4.3.4 (Essential Electrical System Receptacles) for requirements.

3.2-6.4.3.5 Ground Fault Interrupter Receptacles

See Section 2.5-4.3.5 (Ground Fault Interrupter Receptacles) for requirements.

3.2-6.4.4 Electrical Requirements for Ventilator-Dependent Resident Rooms and Areas

See Section 2.5-4.4 (Electrical Requirements for Ventilator-Dependent Resident Rooms and Areas) for requirements.

3.2-6.5 Communication Systems

3.2-6.5.1 General

See Section 2.5-5.1 (Communication Systems-General) for requirements.

3.2-6.5.2 Call System

A nurse/staff call system shall be provided.

3.2-6.5.2.1 General

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.
Nurse and emergency call systems shall be listed by a nationally recognized testing laboratory (NRTL).

3.2-6.5.2.2 Resident Room Call Stations

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.
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.

*3.2-6.5.2.3 Emergency Call System

An emergency call device shall be accessible from each toilet, bathtub, and shower used by residents.

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.
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.
The signal shall activate at the staff work area and/or signal a handheld mobile device carried by staff.

A3.2-6.5.2.3 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.

3.2-6.5.3 Technology Equipment and Teledata Room(s)

See Section 2.5-5.3 (Technology Equipment and Teledata Room) for requirements.

3.2-6.5.4 Grounding for Telecommunication Spaces

See Section 2.5-5.4 (Grounding for Telecommunication Spaces) for requirements.

3.2-6.5.5 Cabling Pathways and Raceway Requirements

See Section 2.5-5.5 (Cabling Pathways and Raceway Requirements) for requirements.

3.2-6.6 Electronic Safety and Security Systems

See Section 2.5-6 (Electronic Safety and Security Systems) for requirements.

3.2-6.7 Daylighting and Artificial Lighting Systems

3.2-6.7.1 General

See Section 2.5-7.1 (Daylighting and Artificial Lighting Systems-General) for requirements.

3.2-6.7.2 Daylighting Systems in Resident Living Areas

See Section 2.5-7.2 (Daylighting Systems in Resident, Participant, and Outpatient Areas) for requirements.

3.2-6.7.3 Artificial Lighting Systems

3.2-6.7.3.1 Light Fixtures

See Section 2.5-7.3.1 (Light Fixtures) for requirements.

3.2-6.7.3.2 Lighting Requirements for Specific Locations

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.

A3.2-6.7.3.2 (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.

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.
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.
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.
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.
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.

Hospice Care Model Characteristics

Unit Type	Typical # of Units	Food Service/Dining	Resident Room	Bathing Facilities	Design Drivers
All unit types					1. Participation of integrated medical-based team 2. Palliative care focus 3. Provision of end-of-life support 4. Support for quality of life 5. Maintenance of personal dignity
Adult day care hospice	Day services with private spaces for ambulatory hospice participants in adult day care settings	Decentralized	Primarily private spaces located within sight lines of staff Access to toilet room from space, without entering adult day care facility activity or dining areas [Does not include sleeping accommodations for visitors in Section 3.3-2.2.2.2 (4)]	Central bathing facility	1. Facility design should encourage mobility of participants. 2. Access to outdoor space should be provided. 3. Resident-operated mobility device access should be provided at the entrance. 4. A security system and/or operational process for safety should be provided for participants with dementia. 5. A covered drop-off and pickup area for participants should be provided. 6. See Chapter 5.2 (Specific Requirements for Adult Day Care and Adult Day Health Care Facilities) for additional information and requirements.
Small ambulatory residential hospice facilities	6—15 private rooms in a small group home for ambulatory residents	Centralized with warming kitchen Dining may be centralized and/or in room	Private rooms with private bath and toilet unless justified by the functional program and approved by the AHJ [in accordance with Section 3.3-2.2.1 (Resident Unit-General)]	Central or decentralized bathing facilities for residents Shower provided for staff Shower provided for family (if showers not provided in resident rooms)	1. Facility design should encourage mobility of participants. 2. Access to outdoor space should be provided. 3. Hallways/corridors should be sized to accommodate gurneys. 4. A nurse call system is required. 5. Parking should be provided for ambulatory residents.
Small non-ambulatory inpatient residential care hospice facilities	6—15 private rooms in a small group home with a combination of non-ambulatory and ambulatory residents	Decentralized with public (family/visitor) ice dispenser access	Private rooms with private toilet room	Central or decentralized bathing facilities for residents Shower provided for staff Shower provided for family (if showers not provided in resident rooms)	1. Hallways/corridors should be sized to accommodate the bed-turning radius of resident beds. 2. A nurse call system is required. 3. A private staff reporting area should be provided. 4. Access to oxygen should be provided.
Freestanding hospice facilities	16 or more beds in a large group home setting	Nourishment kitchen with family access that includes coffee-maker or automatic coffee dispenser, refrigerator, microwave, and dispensing ice machine Decentralized facilities or centralized facilities with warming kitchen with catering contract Dining may be centralized and/or in room	Private rooms with private bath and toilet unless justified by the functional program and approved by the AHJ in accordance with Section 3.3-2.2.1 (Resident Unit-General) Includes multiple-occupancy rooms under special circumstances for indigent care with approval of local authorities	Decentralized Shower provided for staff Shower provided for family (if showers not provided in resident rooms)	1. Corridors should have a minimum width of 8'-0" (2.44 meters). Handrails should be installed in corridors. 2. Access to oxygen should be provided. 3. A nurse call system is required. 4. Separate family support areas should be provided. 5. An area for staff overnight stay should be provided for emergency use. 6. At least one private dining room should be provided for family members who need respite. (Typically, staff eats in a break area, family members eat in resident rooms, and residents eat in bed.)
Hospital-based hospice facilities	Any number of beds housed in a hospital setting, usually in a dedicated nursing unit, wing, or other section of the hospital	Nourishment kitchen with family access that includes coffee-maker or automatic coffee dispenser, refrigerator, microwave, and dispensing ice machine (may be shared with family room) Decentralized facilities or centralized facilities with warming kitchen with catering contract	Primarily private or semi-private rooms with private toilet room Private rooms are recommended to allow for family members and visitors, overnight stays, and privacy.	Central or decentralized bathing facilities for residents Shower provided for staff Shower provided for family (if showers not provided in resident rooms)	1. Corridors should have a minimum width of 8'-0" (2.44 meters). Handrails should be installed in corridors. 2. Access to oxygen should be provided. 3. A nurse call system is required. 4. A hospice nurse station should be provided separate from any hospital nurse stations. 5. Separate family support areas should be provided.
Assisted living facility-or nursing home-based hospice facilities	Any number of beds housed in a nursing home setting, may be in a dedicated wing or section of the nursing home or assisted living facility	Nourishment kitchen, which may be shared with family room Decentralized or centralized with a warming kitchen	Primarily private or semi-private rooms with private toilet room Private rooms are recommended to allow for family members and visitors, overnight stays, and privacy.	Central or decentralized bathing facilities for residents Shower provided for family (if showers are not provided in resident rooms)	1. Hallways/corridors should be sized to accommodate the bed-turning radius of resident beds. 2. A nurse call system is required. 3. A private staff reporting area should be provided. 4. Access to oxygen should be provided. 5. A hospice nurse station/staff area should be provided separate from nursing home or assisted living nurse stations/staff areas. 6. Separate family support areas should be provided.
Home-based hospice services in a care and support facility (distinguished from home-based and private home care mentioned in appendix section A3.2-1)	Services provided to residents living in independent or assisted living setting Resident unit, resident room, or dwelling unit in a residential independent living or assisted living unit	Decentralized	Resident rooms or dwelling units in existing assisted living or independent living settings	Decentralized bathing facilities for residents