- Residential health, care, and support facilities should incorporate architectural detail, surface, and furnishing materials and products that:
- —Optimize sensory function in accordance with the vision and lighting guidelines established by ANSI/IES RP-28: Lighting and the Visual Environment for Seniors and the Low Vision Population and provide optimum light levels and glare-free finishes for the safety and vision comfort of residents and staff.
- —Optimize acoustic comfort, speech privacy, and accurate oral communications; mitigate alarm fatigue; and consider residents' use of hearing aids.
- The additional characteristics and criteria in this section should be used for designing architectural details and selecting and specifying products and materials for all residential health, care, and support facility design and construction projects. (The characteristics included in this text are supported by quantifiable industry test methods. See the Facility Guidelines Institute website under the Resources tab.)
- —Durable. Architectural detail, surface, and furnishing materials and products should be resistant to breakage, punctures/tears, stains, and damage and wear from abrasion as appropriate to the function of the material and product type being selected. See appendix section A2.2-2. (Use of reduced-impact materials) for additional information.
- —Resilient and impact-resistant. Architectural detail, surface, and furnishing materials should remain intact, safe, and functional in heavy weight-bearing, high-traffic, and impact-susceptible areas. Materials and products selected should meet the following requirements:
- • "Pounds per square inch" (PSI) weight tolerances for loads
- • Tensile strength, flexibility, impact, and abrasion testing standards for the required use and application
- • Surface bounces back from compressions caused by repeated use and does not shatter or fragment under abrasion or impact
- —Reduces user fatigue and musculoskeletal injury. Architectural detail, surface, and furnishing materials should:
- • Meet specific safety, assembly, and construction industry criteria for flexibility to address foot compression and heel strike absorption.
- • Support foot comfort and reduce the fatigue and musculoskeletal injury effects of long-term continued use or bodily damage from impacts or falls.
- —Uses safe and compatible materials in assemblies, including substrate and surface finish materials
- • All assembled materials should meet the characteristics listed in Sections 2.4-2.2 (Architectural Details), 2.4-2.3 (Surfaces), and 2.4-2.4 (Furnishings).
- • All seams and joints in assemblies should be joined to reduce wear and degradation and should be able to remain intact during the proposed service life of the assembly.
- • Water-resistant materials, sealed-seam construction methods, and moisture-impervious surface selections should be used for assemblies where water or moisture is continuously present (e.g., clinical use work surfaces with inset or integral sinks, flooring, cove base assemblies, showers, other bathing areas) to reduce or eliminate the possibility of seepage in or under the assembly.
- —Safe and efficient for use in occupied residential settings over time. Throughout their life cycle, architectural detail, surface, and furnishing materials and products should minimize and/or prevent the incidence and effects of noise, odors, gas, particulates, dust, and debris that reduce indoor air quality during product assembly, installation, and operations as well as maintenance, repair, or demolition in occupied residential health, care, and support facilities. See appendix section A2.2-188.8.131.52 (Emissions and VOCs) for additional information.
- —Appropriate for the emotional and cultural well-being of residents, staff, and visitors. Design, layout, size, color, and pattern of architectural details, surfaces, and furnishings shall create resident environments that support the model of care and operations provided in the facility or setting. See Section 1.2-4.5.8 (Cultural Responsiveness) for additional information.
- • In any design project, the selection of a color palette should be based on many factors, including the building population, anticipated activities in the space, and lighting design strategy.
- • Finishes and color palettes should respond to the geographic location of the residential health, care, and support facility, taking into account climate and light, regional responses to color, and the cultural characteristics of the community served.
- • Because the lenses of older adults' eyes yellow, the ability to see colors at low saturation and to discern different colors (particularly short-wavelength colors such as those in the blue/violet range) is impaired. In general, low saturated colors appear gray in interior applications, which is problematic for visibility. Using colors that support the visual needs of older adults is recommended.
- —Has acoustic properties that support resident safety and well-being. Material and products selected should meet the noise reduction requirements for resident care areas in Section 2.5-8.3 (Design Criteria for Acoustic Finishes) and Section 2.5-8.6 (Design Guidelines for Speech Privacy) where applicable to the function of the specific material or product.
- —Made of non-allergenic materials. A product review of potential product-based allergens should be performed during the material selection process (conducted during functional programming) to identify products inappropriate for use with the resident care population being served.
- —Ability to control and minimize reflectivity and glare. Architectural details, surfaces and furnishing materials and light fixtures and lamps that are specified should combine to meet ANSI/IES RP-28: Lighting and the Visual Environment for Seniors and the Low Vision Population light levels. See Section 2.5-7 (Daylighting and Artificial Lighting Systems) for additional information.
- —Has low or no volatile organic compounds. Only materials with low or no volatile organic compounds (VOCs) should be used. See Section 2.2-184.108.40.206 (Emissions and VOCs) for additional information.
- Flooring types (e.g., carpet; non-textile flooring such as rubber, VCT, sheet vinyl). Flooring should be specified based on function.
- Flooring pattern. Scale and type of flooring design patterns should be considered. Research suggests that flooring with a medium-sized pattern (1-6 inches wide) was associated with more falls than floors with no pattern, a small pattern (less than 1 inch wide), or a large pattern (wider than 6 inches).
- Flooring contrast. Flooring materials with high-contrast patterns can be associated with more falls.
- Flooring resilience. Use of flooring material that is flexible and "gives" should be reviewed to reduce injury to residents who fall.
- Floor reflectivity. Use of non-glare finished floors should be considered to avoid compromising vision and potentially disrupting balance of residents.
- Flooring cushioning. Floors should be firm enough so they do not disrupt gait and posture or inhibit roller traffic.
- Noise attenuation should be considered. Noise has been found to contribute to falls, especially noise generated from overhead paging and alarms.
- Door openings shall be sized based on the model of care and the needs of the care population to allow proper clearance for:
- Ambulation of residents
- Passage of the following:
- Portable/mobile mechanical lifts
- Shower gurney devices
- Shower chairs
- Resident-operated mobility devices
- Architecturally framed and trimmed openings in corridors and rooms shall be permitted, provided a minimum height of 6 feet 8 inches (2.03 meters) is maintained.
- With the exception of an approved exit door, exterior doors used for ventilation purposes shall include insect screens.
- Where regionally appropriate, this requirement shall not apply.
- Windows shall comply with applicable building codes.
- Resident rooms, suites, and dwelling units shall have exterior window(s).
- See Section 2.2-220.127.116.11 (Physical Environment Elements for Risk Reduction—Operable windows) for requirements that address safety risks for residents with dementia, mental health diagnoses, and cognitive and developmental disabilities.
- For requirements in addition to those in this section, see:
- A sill height of 32 inches (81.28 centimeters) is preferable to allow residents in wheelchairs or beds to easily see out the window.
- The depth of the sill and its relationship to a curtain or blind should be considered as residents commonly use windowsills as display space for personal items.
- Operable exterior windows that may be left open shall have insect screens.
- Where regionally appropriate, this requirement shall not apply.
- The number and placement of hand-washing stations shall be determined by the infection control risk assessment (ICRA).
- Hand sanitation dispensers shall be permitted to be used in lieu of hand-washing stations as determined by the ICRA.
- Hand-washing stations in resident care areas shall be located so they are visible and access to them is unobstructed.
- Design of hand-washing stations shall not permit storage in casework beneath the sink basin or in areas below a sink open to the floor.
- The presence of water around hand-washing sinks has consistently proven to encourage the presence of molds and bacteria in the substrate materials if the countertops are not properly sealed and maintained.
- Integral backsplashes eliminate intersections that need to be caulked.
- Use of marine-grade plywood substrate for plastic laminate countertops should be considered.
- Under-mount basins are difficult to clean, and their use is discouraged.
- Hand-washing stations shall include a hand-drying device that does not require hands to contact the dispenser.
- These provisions shall be enclosed to protect against dust or soil and to ensure single-unit dispensing.
- Hot air dryers shall be permitted unless the care population dictates otherwise. See Section 2.2-4 (Design Criteria for Dementia, Mental Health, and Cognitive and Developmental Disability Facilities) for specific care population requirements.
- Where provided, hand towels shall be directly accessible to sinks.
- Mirror placement shall allow for use by both wheelchair occupants and ambulatory persons.
- Top and bottom edges of mirrors shall be at levels usable by individuals either sitting or standing.
- A separate full-length mirror shall be permitted to serve as the required mirror.
|Georgia Tech Study*
Preferred alternative configuration for one-person, two-person, or equipment-assisted transfer
|Wall Partition Location||Behind and adjacent||Behind and adjacent, where provided|
|Grab Bar Dimensions|
|Centerline of toilet from side wall or permanent fixture||16 to 18 inches (40.64 to 45.72 centimeters)||24 inches (60.96 centimeters) for independent resident transfer|
|Side wall partition grab bar length||
42 inches (106.68 centimeters) long
12 inches (30.48 centimeters) maximum from rear wall
54 inches (137.16 centimeters) minimum from rear wall
|Rear wall partition grab bar length||
36 inches (91.44 centimeters) long minimum
12 inches (30.48 centimeters) from centerline of toilet on one side and 24 inches (60.96 centimeters) on the other side
|Eliminate in favor of installing swing-up grab bars|
|Fixed horizontal grab bar height||
33 to 36 inches (83.82 to 91.44 centimeters) above finished floor to top of gripping surface
|Swing-up grab bar height||Not applicable||
31 to 33 inches (78.74 centimeters) above finished floor to top of gripping service
|Swing-up grab bar length||Not applicable||Extend 6 to 9 inches (15.24 to 22.86 centimeters) in front of toilet|
|Swing-up grab bar from centerline of toilet||Not applicable||13 to 15 inches (33.02 to 38.1 centimeters)|
- For independent transfers. Grab bars at toilets in bathrooms and bathing cores should allow residents to be as safe and independent as possible. This includes using swing-up grab bars, where possible, with or without integral toilet paper holder. See appendix section A2.4-18.104.22.168 (1) (Alternative grab bar configurations) for additional information.
- For assisted transfers. Grab bars in bathrooms should allow staff to complete a two-person transfer for a single resident. This includes evaluation of the toilet in relation to the wall and the grab bars provided. Clearance is required on both sides of the toilet for a double transfer to occur. See appendix table A2.4-a (Resources for Grab Bar Configurations) for further information on space for transfers.
- Alternative grab bar configurations should address the following scenarios:
- —For a resident capable of independent transfer facilitated by the grab bar and side wall location required by accessibility standards, a removable/temporary wall structure and grab bar can be installed alongside the toilet.
- —For a resident who requires partial assistance to transfer, provision of swing-up grab bars on one or both sides of the toilet would facilitate such transfers.
- Installation of swing-up grab bars requires evaluation of the toilet in relation to the wall and the grab bars provided. Clearance is needed on both sides of the toilet for an assisted transfer involving two or more staff members. The location of the toilet should be reviewed with regulators.
- Spacing of grab bars and appropriate lengths and heights for grab bars should be ergonomically evaluated in conjunction with the following:
- —Toilet height
- —Sink location
- —Type of bathing fixture
- —Specific type of lifting equipment and toileting/bathing sling used by the care provider
- Grab bar configurations for older adults should be configured as referenced in appendix table A2.4-a (Resources for Grab Bar Configurations) and state and local regulations.
- Where design for persons of size is required, the length of rear wall grab bars should be 44 inches (112 centimeters) and mounted per the ADA Standards for Accessible Design.
- Creation of mock-ups should be considered when evaluating alternative grab bar configurations. In some cases, grab bar redundancy may be appropriate. See Section 1.2-3.3 (Resident Mobility and Transfer Risk Assessment) for criteria to be evaluated in a mock-up.
- Grab bars may be vertical or horizontal based on the model of care and the needs of the care population.
- Grab bars, including those that are part of fixtures such as soap dishes and toilet paper holders, shall be anchored to sustain a minimum concentrated load of 250 pounds (113.4 kilograms).
- Grab bars installed in areas intended for use by persons of size shall be anchored to sustain a minimum concentrated load of 800 pounds (362.88 kilograms).
- Handrails shall comply with local, state, and federal requirements referenced in Section 1.1-4.1 (Design Standards for Accessibility) as amended in this section.
- Use of alternative handrail cross-sections and configurations that support senior mobility shall be permitted.
- A destination hierarchy should be developed to ensure the right information is presented at the right time. The destination hierarchy should manage the number of symbols by building, zone, or floor. Users have difficulty differentiating more than 16 unique symbols in one set.
- Boundaries between public and private areas should be well-marked or implied and clearly distinguished.
- A wayfinding system should be designed for consistency in the overall wayfinding plan. This should include:
- —Directional and orientation signs (overhead, wall-mounted, maps, etc.)
- —Destination signs
- —Room identification signs
- —Regulatory signs, including provisions for residential health, care, and support facility-specific policy and information signs
- —Interior "landmarks" to aid occupants in cognitive understanding of destinations
- • To be effective, landmarks should be unique. Landmarks may include water features, major artworks, distinctive colors, or decorative treatments at major decision points in the building.
- • Design of landmarks should attempt to involve tactile, auditory, and language cues as well as visual recognition.
- • Landmarks should only be used at decision points.
- Each sign should be accurate, legible, and functional.
- —Nomenclature should be consistent and understandable to the general public. Signs should be written at a sixth grade level.
- —Letters should contrast with the background to conform to ADA requirements.
- • Signs in areas with housing and services primarily for older adult residents should have letters that contrast with the background by a minimum of 70 percent.
- • Greatest readability is usually achieved through the use of light-colored characters or symbols on a dark background.
- —Signs should have an eggshell finish (11 to 19 degree gloss on 60 degree glossimeter).
- —Where used, symbols and pictographs should be recognizable to the general public and the community served. (The Universal Symbols in Healthcare have been tested for usability and comprehension.)
- • The number of symbols used on a single sign should be limited and should indicate primary destinations only.
- • Where health care symbols are combined with other universal symbols used in transportation or accessibility signage, the meaning of the different sets of symbols should be clearly differentiated for users.
- Signage systems should be flexible, expandable, adaptable, and easy to maintain.
- —Fabrication should allow messages to be changed.
- —Signage should be consistent with other resident and family communications, supporting printed collaterals, Web and electronic media, and branding of a facility or community.
- "You Are Here" (YAH) map recommendations
- —YAH maps should be oriented so that forward is up.
- —It is preferable to use a perspective view. Where vertical navigation is required, consider illustrating the relationship between levels and which elevator cores serve which areas, especially where floors are not contiguous.
- —Inset maps should be used to locate details in the overall map where appropriate.
- Exterior signage (general)
- —Directional signs should be easily visible from the street and located and sized so that drivers can easily read them when traveling at the local speed limit.
- —Consistency should be used in the nomenclature of buildings.
- —Directions should be clear to all users.
- —Signage should be placed within an individual's 60-degree "cone of vision," whether the person is walking or driving.
- —Exterior directional signs should be visible at night.
- —Signage should be located where it may easily be seen.
- Exterior signage (parking)
- —Directions should be provided to the various parking locations, where applicable.
- —Directions should be provided from the parking structure to the entrance of the facility.
- —Signage should clearly indicate short-term and long-term parking rates where applicable.
- —Where valet parking is provided, its location should be clearly marked.
- —Directional signage should be provided for automobile and pedestrian traffic at an appropriate scale for each.
- —Floor numbers or sections should be clearly marked.
- Interior signage (entrance and exit)
- —A well-designed and located set of interior signs and clearly labeled directional maps should be located near the entrance. Symbols used on directional signage should also be used in orientation maps for consistency and to help users find primary destinations.
- —Signage should clearly identify all publicly accessible functional and community spaces in the facility (cafeteria/dining, gift shop, restrooms, etc.).
- —Where symbols are used, a single symbol should be used to represent a single primary destination.
- —Adequate signage should be provided to direct people out of the facility and back to parking and public transportation.
- Interior wayfinding (room numbering)
- —Room numbering should be of a consistent nature from floor to floor and area to area.
- —The numbering system should be simple and continuous.
- —Design of the numbering system should be flexible to allow for future expansion and renovation.
- —Room numbering should take into account the need for sequential strategies for public wayfinding that may be different from operational and maintenance numbering.
- —Signs should differentiate between those spaces used by residents/visitors and those used by staff.
- Interior wayfinding (sign placement)
- —Signs providing directions should be placed at major decision points, including major intersections, major destinations, and changes in buildings and/or specific care areas.
- —In areas without major decision points, reassurance signs should be placed approximately every 250 feet (76 meters).
- Wayfinding to serve residents with dementia
- —Major characteristics of persons with Alzheimer's and other dementia are lack of attention span and an inability to orient themselves in the physical environment. To address this, the physical environment should provide discernible landmarks and wayfinding cues and information to aid in navigation from point to point. Sensory cuing used in other health, care, and support resident areas should also be used in areas for persons with dementia.
- —Consideration should be given to provision of the following wayfinding elements in dementia and mental and cognitive health units:
- • Landmarks: Design elements can provide clear reference points in the environment (e.g., a large three-dimensional object, outdoor view, large picture, or other wall-mounted artifact).
- • Signs: Where appropriate, large characters and redundant word/picture combinations should be used on signs.
- —Residents with dementia require color to be associated with a symbol to be recognizable. They will not automatically associate color alone with a specific meaning.
- —Color may be used to distract attention from spaces. For example, mechanical doors and door frames that match the finish of the surrounding walls are less likely to draw a resident's attention to the mechanical room.
- The design of indoor water features should meet the following criteria:
- —Human contact with the water should be limited and/or water disinfection systems should be applied.
- —Materials used to fabricate the water feature should be resistant to chemical corrosion.
- —Water features should be designed and constructed to minimize water droplet production.
- —Exhaust ventilation should be provided directly above the water feature.
- —Surfaces that mitigate the risk of slipping should be used and maintained around a water feature.
- Aquariums should be enclosed to prevent resident or visitor contact with the water. Aquariums are not subject to exhaust ventilation recommendations.
- The slip resistance ratings of flooring surfaces shall be appropriate for the area of use—for dry or wet conditions and for use on ramps and slopes.
- Slip-resistant flooring products shall be used for surfaces in bathing areas and rooms, wet areas, and ramps and entries from exterior to interior spaces.
- Carpet in resident areas shall be installed to prevent trip hazards or interference with resident, participant, or outpatient use of resident-operated mobility devices and assistive ambulation devices and staff use of carts and equipment.
- The floors and wall bases of kitchens, soiled workrooms, toilet rooms, and other areas subject to wet-cleaning methods shall be constructed of materials that are not physically affected by germicidal or other types of cleaning solutions.
- Areas subject to wet cleaning shall have floors that are homogeneous and have sealed joints.
- Wall bases in areas that require wet cleaning (e.g., soiled and clean utility rooms, environmental services rooms with mop sinks) shall be continuous, integral or sealed to the floor and the wall, and constructed without voids.
- See appendix section A2.4-22.214.171.124 (1) (Environmental factors and falls) for information about the relationship between flooring and falls.
- Flooring materials should have a medium color/value; use of flooring in dark colors/values should be avoided.
- Strongly patterned flooring materials should be avoided as they can be confusing to residents with impaired vision.
- Moving an elevated resident around and through a space using portable lifting equipment without powered wheels may require more exertion by staff than using ceiling-mounted equipment.
- — The exertion required by staff may increase with the use of carpet; however, different types and brands of carpet may have significantly different levels of resistance to wheeled devices.
- — Installation of a mock-up is recommended to test the action of wheeled equipment and devices used in a facility over proposed flooring materials.
- — Carpet should not be automatically discounted as inappropriate due to this challenge as it has major advantages over hard-surface flooring in terms of noise reduction, other acoustic considerations, and residential appearance, all of which are important in creating a comfortable, attractive living environment for residents.
- Floors in areas used for food preparation and assembly shall be water-resistant.
- Floor surfaces, including tile joints, shall be resistant to food acids.
- Floor construction in dietary and food preparation areas shall be free of spaces that can harbor pests. All joints shall be sealed.
- Slip-resistant flooring products shall be used throughout kitchens, including wet areas.
- Wall finishes should consist of colors/values that contrast with the floor material to distinguish vertical and horizontal planes (an issue of balance).
- The color/value contrast of wall finishes should be in the range of 60-80 percent light reflectance value (LRV) to provide acceptable contrast with the floor and maximize light distribution in the space.
- See Table 4D-2 (Performance Criteria for Surfaces and Materials) in the Design Guidelines for the Visual Environment, published by National Institute of Building Sciences for additional information.
- Wall, door, and corner protection shall be provided in areas where movable equipment is present.
- Wall protection and corner guards shall be durable and scrubbable.
- Sharp, protruding edges shall be avoided.
- Acoustics shall be considered when selecting wall finishes. See Section 1.2-5.2 (Acoustic Planning) and Section 1.4-2.1 (Acoustic Design) for requirements.
- Seating for residents should be available that supports a variety of postures, from upright to reclined.
- Bottoms of residents' feet, whether elevated or down, should always be fully supported (by a footrest or the floor) so as not to encourage toe drop or compromise blood flow to the legs.
- Residents should be able to choose from a variety of chairs of different seat heights, depths, and widths according to their own height, weight, leg length, and physical limitations so they can execute successful sit-to-stand movements.
- —The care population should be evaluated to determine appropriate seat heights, which range from 16 to 19 inches (41 to 48 centimeters) with arm heights 7 to 8 inches (18 to 20 centimeters) above compressed seat height at the elbow.
- —Arm fronts should extend all the way to or past the front of the seat at a height appropriate to help residents safely sit down and push off to a standing position
- —Seats should be firm, with seat depth and configuration that allow residents, participants, and outpatients to exit seating comfortably and safely without assistance.
- —The angle of the seat and seat back should not hinder rising nor cause shoulder-forward or hip-forward slumping or sliding out of the seat.
- Space beneath a seat front should allow a user to pull back his or her heels far enough under the seat to assist with rising.
- Furniture should have eased or rounded edges and corners of no less than 3/8 inch radius to minimize risk of resident patient injuries.
- Furniture used in resident areas should be sturdy and stable to safely support resident transfer and weight-bearing requirements.
- Rolling furniture or equipment in resident areas should have locking rollers/casters for safety. However, seating that has casters on only two legs to allow for movement on carpeted flooring surfaces should not have locking casters.
- Chairs that provide opportunities to rock without compromising the ability to exit safely (e.g., with stable arm fronts) should be considered for their relaxation and exercise benefits.