Part 1 General

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

Part 3 Residential Health Facilities

Part 4 Residential Care and Support Facilities

Part 5 Non-Residential Support Facilities

Heads up: There are no amended sections in this chapter.
Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.
This chapter contains specific requirements for long-term residential substance abuse treatment facilities.
A4.3-1.1.1.1 Long-term residential substance abuse treatment facility typology. Long-term residential treatment facilities may be located in a wide variety of settings including, but not limited to, a large suburban house, larger freestanding residential setting, or part of a nursing home, assisted living facility, homeless shelter, or facility in a prison.
Care is provided 24 hours a day, generally in non-clinical/acute care settings. This therapeutic community (TC) is a common type of long-term residential treatment setting for substance use disorders, which typically require 18 to 24 months of treatment, although funding and insurance limitations may reduce an individual's stay to three, six, or 12 months. The focus of a TC is resocialization of an individual using the program's entire community as active components of treatment. Addiction is viewed in the context of an individual's social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is typically highly structured and can be modified for specific care populations (e.g., adolescents, homeless residents, individuals from the criminal justice system, those with mental/behavioral issues).
In addition to long-term residential treatment, a therapeutic community may offer shorter-term residential or outpatient treatment. A TC acquires a medical partner has an opportunity to become a federally qualified health center or a patient-centered medical home.
A specialized type of treatment setting called a "modified therapeutic community" incorporates features of traditional therapeutic communities with a special focus on addressing co-occurring mental health conditions.
Correctional institutions may incorporate in-prison TCs, and TCs are also available for people reentering society after being released from prison with the goal of reducing drug use and recidivism.
The requirements in Part 2 (Common Elements for Residential Health, Care, and Support Facilities) shall apply to long-term residential substance abuse treatment facilities as referenced in this chapter.
See Section 2.2-2 (Sustainable Design Criteria) for requirements for long-term residential substance abuse treatment facilities.
Where the care population includes needs for persons of size, see Section 2.2-3 (Design Criteria for Accommodations for Care of Persons of Size) for requirements.
Where the care population includes residents with dementia, mental health issues, or cognitive and developmental disabilities, see Section 2.2-4 (Design Criteria for Dementia, Mental Health, and Cognitive and Developmental Disability Facilities) for requirements.
This chapter identifies the minimum requirements for long-term residential substance abuse treatment facilities, which must also comply with applicable state and local requirements.
A4.3-1.1.3 The requirements and recommendations in this chapter are intended to represent basic standards to ensure the safety, accessibility, and residential aspects of long-term residential substance abuse treatment facilities for residents recovering from drug or alcohol addiction.
See Section 1.2-2.1 (Functional Program-General) for requirements in addition to those in this section.
The sponsor of each project shall provide a functional program that:
*(1)  Defines the scope and scale of the long-term residential substance abuse treatment facility (including the care model).
(2)  Identifies resident needs.
(3)  Facilitates the application of licensure and occupancy approvals by authorities having jurisdiction (AHJs).
(4)  Addresses applicable provisions of the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.
A4.3-1.2.1.2 (1) Therapeutic community care model
  1. Care model description. In a long-term residential substance abuse treatment facility, professional medical staff and medical services are provided on-site. Often, staff members are in recovery and have earned certification and degrees in addiction counseling. Therapeutic communities (TCs) have a recovery orientation that focuses on the whole person and overall lifestyle changes rather than only on recovery from an addiction. Recovery is seen as a gradual, ongoing process of cognitive change through clinical interventions and includes stages of treatment, with personal objectives set throughout the recovery process. There is a relationship between duration of treatment in a TC and aftercare participation and subsequent recovery: Longer duration of treatment fosters consistency and yields better outcomes for residents.
    There are three stages of treatment:
    • Stage 1: Induction and early treatment: individual assimilates into the TC with full immersion into programming and activities.
    • Stage 2: Primary treatment: evidence-based behavioral treatments with the goals of changing attitudes and behavior, instilling hope, and fostering emotional growth.
    • Stage 3: Reentry: resident prepares for separation from the TC for successful reentry into the community at-large and seeks employment or educational/training opportunities. Aftercare services are arranged.
    The care model should include services that are structured for each individual. Although TCs are community-based, the treatment plan is individualized to maximize successful treatment. Over time, various combinations of treatment services may be required. Evidence-based interventions include cognitive-behavioral therapy to help residents learn positive behavioral change and motivational enhancement to increase treatment engagement and retention.
    • Residents who have been incarcerated and may have received prison-based treatment; therefore, the care model requires providers to be aware of correctional supervision requirements and treatment provided prior to release from prison, if applicable.
    • Residents may have co-occurring drug abuse and mental health issues, requiring an integrated treatment approach. High rates of mental health problems are found both in offender populations and in those with substance abuse problems.
    • Resident treatment planning may include prevention and/or treating of serious chronic medical conditions, such as HIV/AIDS, hepatitis B and C, and tuberculosis. The rate of infectious diseases is higher in drug abusers, incarcerated offenders, and community-supervised offenders than in the general population.
    • Treatment for juveniles requires a comprehensive assessment, treatment, case management, and support services appropriate for their age and developmental stage. Abuse is common among juveniles requiring treatment, along with physical health issues and family problems. The treatment approach includes multi-systemic therapy, multidimensional family therapy, and functional family therapy.
  2. Physical setting. Long-term residential treatment environments include group or community living and activities to drive individual change and attainment of therapeutic goals. TC is "community as method"-people living together free of drugs and alcohol in a residential setting in the community (or in a prison or shelter setting). A typical program in a community-based setting accommodates 40 to 80 residents. Some TCs are located on the grounds of former camps or ranches or in suburban houses, while others are in jails, prisons, and shelters. There is an average of one counselor for every 11 residents in treatment in addition to social workers, nurses, psychologists, and other clinical staff.
    The physical setting should support the following:
    • Rehabilitation by relearning or reestablishing healthy functioning skills and values and regaining physical and emotional health. Design should reflect an orderly function supportive of a structured daily regimen for residents.
    • Routine morning and evening house meetings, job assignments, group sessions, seminars, scheduled personal time, recreation, and individual counseling
    • Vocational and educational activities in group sessions
  3. Additional information about substance abuse treatment is available in the National Institute on Drug Abuse (NIDA) publication "Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide." The NIDA research report "Therapeutic Community" outlines the goals and activities of TCs.
Long-term residential substance abuse treatment facilities shall be permitted to be freestanding facilities or distinct parts of another residential health, care, or support facility.
When a project calls for sharing or purchasing services from another entity, modifications in space and parking requirements shall be permitted.
Where the long-term residential substance abuse treatment facility is part of (or contractually linked with) another facility, sharing of facilities for services such as home health, hospice, dietary, storage, pharmacy, linen, and laundry services shall be permitted.
A4.3-1.2.2.3 Shared services and facilities. Services may be contractually provided or shared with other entities. In some cases, all ancillary service requirements will be met by the principal facility and the only modifications necessary will be in the long-term residential substance abuse treatment facility. In other cases, programmatic concerns and requirements may dictate separate service areas.
See Section 1.2-3 (Resident Safety Risk Assessment) for requirements.
See sections 1.2-1.3 (Environment of Care and Facility Function Considerations) and 1.2-4 (Environment of Care Requirements) for requirements.
A4.3-1.4.3 Supportive environment. A supportive environment for long-term residential substance abuse treatment facilities should also include "protective elements" to control access to both addictive substances and individuals who traffic in those substances. This requires consideration of the immediate residential environment, site elements, and the geographic location of the facility. These considerations are critical to the environment of care and development of the functional program.
The facility design shall produce a supportive environment to:
  1. Enhance and extend quality of life for residents.
  2. Facilitate wayfinding.
  3. Promote resident privacy and dignity.
The physical environment of the long-term residential substance abuse treatment facility shall support the services and levels of care provided in the facility.
Long-term residential substance abuse treatment facilities shall be designed and constructed to provide a supportive residential environment that is conducive to day-to-day community activities and responsibilities.
The physical environment shall eliminate as many barriers as possible to effective access and use of the space, services, equipment, and utilities appropriate for daily living and treatment.
A4.3-1.4.4 Barrier-free environment
  1. "Universal design" practices that promote barrier-free environments should be encouraged. See appendix section A4.2-1.4-c (Environment of care design recommendations-Barrier-free environment) for more information.
  2. Facilities should provide accessibility for residents with disabilities in accordance with the state or local building code and the Americans with Disabilities Act.
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site Elements) for requirements.
The requirements in this section are common to most long-term residential substance abuse treatment facilities and shall apply where the areas described are included in a particular therapeutic community (TC) and based on the needs of the care population.
Areas for the care and treatment of outpatient users not residing in the facility shall not interfere with or infringe on the private living area of residents.
Facility layout shall reflect the care model and related staffing.
Bedrooms or resident rooms shall be provided that are sized to:
Allow for sleeping.
Afford privacy.
Provide access to furniture and belongings.
Accommodate the care and treatment provided to each resident.
A4.3-2.2.2 Resident room capacity. Bedrooms should be limited to single or double occupancy.
  1. Resident room size (area and dimensions) shall permit resident(s) to move about the room with the assistance of a resident-operated mobility device, allowing access to at least one side of a bed, window, closet or wardrobe, chair, dresser, and nightstand.
  2. Room size and configuration shall comply with spatial requirements of the AHJ.
  3. Bedrooms shall not be used as passageways, corridors, or access to other bedrooms.
See Section 4.3-5.2.2.6 (Windows) for requirements.
Where a hand-washing station is provided, see Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.
Each resident shall have access to a bathroom.
  1. The bathroom shall contain the following:
    1. Toilet
    2. Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.
    3. Mirror. See Section 2.4-2.2.8.7 (Mirror) for requirements.
    4. Private individual storage for the personal effects of each resident. See Section 2.4-2.4.2 (Casework, Millwork, and Built-Ins) for requirements.
    5. Shower. See Section 2.5-2.3.3.2 (Accessible showers) for requirements.
  2. Where the bathroom is shared, privacy locks shall be permitted with provisions for emergency access.
A4.3-2.2.2.7 Resident bathroom
  1. Clearances. Toilets used by residents should have sufficient clearance on both sides of the toilet to enable physical access and maneuvering by staff. See appendix section 2.4-2.2.9.2-b (Grab bars in bathroom-For assisted transfers) for additional information.
  2. Grab bars. Where mobility-challenged residents are capable of independent transfers, alternative grab bar configurations should be permitted. See Section 2.4-2.2.9.3 (Alternative grab bar configurations) for additional information.
  1. Each resident shall be provided with an individual wardrobe or closet.
  2. Separate, enclosed storage in the resident room shall be provided for each resident.
A4.3-2.2.2.8 Resident storage
  1. Resident closets or wardrobes should have an adjustable-height bar for hanging clothes.
  2. Consideration should be given for storage of resident mobility devices, depending on the needs of the care population.
Where a single resident room is provided to accommodate care requirements for residents experiencing personal conflicts, agitation, episodic mental disturbances, or similar conditions, see Section 2.3-2.2.3.3 (Quiet room in a resident care/living area) for requirements.
See Section 2.3-2.3.1 (Resident, Participant, and Outpatient Community Areas-General) for requirements.
Where a lobby is provided, see Section 2.3-2.3.2 (Lobby) for requirements.
See Section 2.3-2.3.3.1 (Dining, Recreation, and Lounge Areas-General) for requirements.
  1. Space for communal dining shall be provided.
  2. Space requirements. Clear and unobstructed circulation paths shall be provided for residents and food service staff based on the food delivery process used in the therapeutic community.
  3. Location. Provision of separate satellite dining areas in or adjacent to living areas shall be permitted if required by differing care populations being served.
  4. Natural light shall be provided in resident dining areas.
  1. Recreation, lounge, and activity areas shall accommodate both group and individual activities and recreational opportunities.
  2. Space requirements. Recreation, lounge, and activity areas shall provide the following:
    1. Space for planned resident activities
    2. Areas sufficient in number and configuration to accommodate the following:
      1. Gatherings of resident groups of various sizes
      2. Occurrence of separate and distinct activities
Toilet facilities shall be readily accessible to all dining, recreation, and lounge locations.
Where kitchen facilities that permit use by residents, family members, and visitors are provided, see Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.
Where a quiet room is provided, see Section 2.3-2.3.7 (Quiet Room in a Resident or Participant Community Area) for requirements.
Outdoor spaces shall be provided for residents, visitors, and staff.
A4.3-2.3.8.1 Outdoor activity spaces
  1. Visual access to outdoor activity spaces from indoors should be provided for staff and residents.
  2. Outdoor spaces should be accessible via short, navigable distances.
See Section 2.1-3.6.2 (Outdoor Activity Spaces) for additional requirements and information.
Where diagnostic and treatment areas are required for the resident care population or as part of community-based services, see Section 2.3-3 (Diagnostic and Treatment Areas) for requirements.
See Section 2.3-3.2 (Examination, Observation, and/or Treatment Rooms) for requirements.
Where outpatient rehabilitation therapy facilities are provided, see Chapter 5.3 (Specific Requirements for Outpatient Rehabilitation Therapy Facilities) for requirements.
Where wellness facilities are provided, see Chapter 5.2 (Specific Requirements for Wellness Centers) for requirements.
See Section 2.3-4.1 (Facilities for Support Services-General) for requirements.
These area(s) shall be provided where required by the care model to serve resident needs.
Lockable storage shall be provided for resident records.
See Section 2.3-4.2.1 (Staff Work Area) for additional requirements.
See Section 2.3-4.2.2 (Medication Distribution and Storage Locations) for requirements.
Security for all medications shall be provided.
Where a shower is not provided in the resident bathroom, a central bathing or spa room or area shall meet the requirements in this section.
A4.3-4.2.3.1 Resident privacy. Consideration should be given to privacy when locating entrances to bathing or spa rooms.
Based on the needs of the care population, at least one central bathtub, spa tub, or shower shall be provided for resident use, where a shower is not provided in the resident bathroom.
Bathing fixtures shall be located in individual rooms or enclosures that provide the following:
  1. Space for private use of the bathing fixture
  2. Space for drying and dressing
  3. Access to a grooming location with a sink, mirror, and counter or shelf
A toilet shall be provided in or directly accessible to each resident bathing facility without requiring entry into the general corridor.
Where a shower is included in the bathing or spa room or area, see Section 2.5-2.3.3.2 (Accessible showers) for requirements.
See Section 2.3-4.2.4 (Equipment and Supply Storage) for requirements in addition to those in this section.
  1. A separate, secured closet, or designated area shall be provided for clean linens.
  2. Where a closed-cart system is used, storage in an alcove where staff control can be exercised shall be permitted.
Storage space(s) for supplies and recreation items shall be immediately accessible and secured to support recreation and activities offered.
Storage space(s) for resident equipment and supplies shall be immediately accessible to support services offered and secured based on the care population.
Where the residential setting includes delivery of medical care, a clean utility room shall be provided for storage and holding as part of a system for distribution of clean materials. See Section 2.3-4.2.5 (Clean Utility Room) for requirements.
Where the residential setting includes delivery of medical care, a soiled utility room shall be provided for storage and holding as part of a system for collection of soiled materials. See Section 2.3-4.2.6 (Soiled Utility Room) for requirements.
Provision of personal laundry facilities for residents to complete their own laundry shall be provided. Equipment shall include:
  1. Washers and dryers based on the number of residents being served
  2. Hand-washing station. See Section 2.5-2.3.2 (Hand-Washing Sinks) for requirements.
  3. Folding area
See 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.
See Section 2.3-4.2.8 (Resident and Participant Telephone Access) for requirements.
See Section 2.3-4.3.1 (Support Areas for Staff-General) for requirements.
See Section 2.3-4.3.2 (Staff Lounge Area) for requirements.
Toilet rooms shall be designated for visitors, staff, and residents based on the size of the facility and the total number of users.
Community space for family and visitors shall be provided based on the care model.
Spaces shall be able to be supervised as required by individual treatment plans.
The type and size of the long-term residential substance abuse treatment facility shall determine the dietary environment and the food service facilities provided.
Where a centralized commercial kitchen is provided, the food service facilities shall meet the requirements in Section 2.3-4.5 (Food Service Facilities).
For facilities that have a service contract with an outside vendor for food service, the following requirements shall be met:
Where an outside vendor is used to provide meals for a setting of 16 or more beds, dedicated space and equipment shall be provided for a warming kitchen, including space for minimal equipment for preparation of breakfast, emergency, or after-hours meals.
The resident kitchen shall be permitted to serve as an alternative location to accommodate the function of a warming kitchen. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.
Where food preparation is conducted on-site 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.
Where a residential communal kitchen is provided in a residential treatment setting with four or fewer unrelated residents, the following shall be provided:
Stove/range
Refrigerator
Double-bowl sink
Dishwasher
Microwave
Additional equipment required by an AHJ
A4.3-4.6.1 Based on the care model, laundry services may be centralized in the facility, decentralized using personal laundry facilities, and/or outside contracted services. See Section 2.3-4.2.7 (Personal Laundry Facilities) for additional information. Completing laundry may be part of the residents' responsibilities, depending on the care population of the therapeutic community.
Each long-term residential substance abuse treatment facility shall have provisions for storing and processing clean and soiled linen. Centralized, decentralized, or contracted services shall be permitted
Based on the care model, personal laundry services can be combined with clean utility and/or soiled utility. See Section 2.3-4.2.5 (Clean Utility Room), Section 2.3-4.2.6 (Soiled Utility Room), and 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.
Where contracted services are used, the following shall be provided:
An area for soiled linen awaiting pickup
A separate area for storage and distribution of clean linen
A control station for pickup and receiving. This shall be permitted to be shared with other services and serve as the receiving and pickup point of service for the facility.
  1. Where on-site laundry services are provided in a substance abuse treatment facility, the requirements in this section shall apply.
  2. Facilities for processing shall be permitted to be located in the facility, in a separate building on- or off-site, or in a commercial laundry.
  3. Layout. Equipment shall be arranged to permit a workflow that minimizes cross-traffic between clean and soiled operations.
    1. Areas dedicated to laundry shall be separate from food preparation areas.
    2. Laundry rooms shall not open directly into resident rooms.
At minimum, the following elements shall be included:
  1. Rooms and spaces for sorting, processing, and storage of soiled materials
  2. Soiled holding room(s). Separate central or decentralized room(s) shall be provided for receiving and holding soiled linen for pickup or processing.
    1. Rooms shall have ventilation and exhaust.
    2. Discharge from soiled linen chutes shall be received in this room or in a separate room as required by the local AHJ.
    3. Rooms used for processing shall be provided with a laundry or deep sink.
  3. 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.
  4. Linen carts
    1. Storage. Provisions shall be made for parking clean and soiled linen carts separately and out of traffic.
    2. Cleaning. Provisions shall be made for cleaning linen carts on-premises (or exchange of carts off-premises).
  5. 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.
Where materials management facilities are provided, see Section 2.3-4.7 (Materials Management Facilities) for requirements.
See Section 2.3-4.8 (Waste Management Facilities) for waste collection, storage, and disposal requirements.
Waste management requirements shall be scaled to the size and operational need of the long-term care residential facility.
See Section 2.3-4.9 (Environmental Services Rooms) for requirements.
Where facilities for engineering and maintenance services are provided on-site, see Section 2.3-4.10 (Facilities for Engineering and Maintenance Services) for requirements.
Offices or an open office area with private conference space shall be provided for business transactions, admissions, and social services and for the use of administrative and professional staff.
Space for conferences; staff, resident, and family meetings; education classes; and group counseling shall be sized according to operational needs.
  1. Space shall include provisions for use of visual aids and technology.
  2. Sharing of space for various uses shall be permitted.
A4.3-4.11.1.1 Kitchenette for conference space. Provision of kitchenette facilities, including under-counter refrigerator, microwave, and sink should be considered for the conference and educational space.
  1. Office space shall be provided for staff and file storage.
  2. Identification of required work spaces for in-house staff and contracted visiting staff, based on professional discipline, shall be taken into consideration when planning office space and work areas.
Space for storage of files, office equipment, and supplies shall be provided.
See Section 2.4-1.2 (Building Codes and Standards) for requirements.
A code-compliant, safe, and accessible environment shall be provided.
A facility that seeks accreditation, certification, licensure, or other credentials shall comply with applicable design and construction standards.
Where institutional codes are required, the facility shall maintain the residential environment desired by residents.
The facility shall comply with applicable federal, state, and local requirements; see Section 1.1-4.1 (Design Standards for Accessibility).
See Section 2.4-2.1 (Architectural Details, Surfaces, and Furnishings-General) for requirements.
See Section 2.4-2.2.1 (Architectural Details-General) for requirements.
See Section 2.4-2.2.2 (Corridors) for requirements.
See Section 2.4-2.2.3 (Ceiling Height) for requirements.
(1)  Door type
*(a)  Doors to all rooms containing bathtubs, showers, and toilets for resident use shall be hinged, sliding, or folding.
*(b)  Resident unit doors
(i)  Egress from the unit shall be possible at all times and locking hardware shall enable occupant(s) to gain egress from within by means of a simple operation.
(ii)  All resident units shall be accessible by staff or safety personnel in case of emergency.
(c)  Manual or automatic sliding doors shall be permitted where their use does not compromise fire and other emergency exiting requirements.
(2)  Door openings. See Section 2.4-2.2.4.2 (Door openings) for requirements.
(3)  Insect screens. See Section 2.4-2.2.4.3 (Insect screens) for requirements.
A4.3-5.2.2.4 Door protection. See appendix section A2.4-2.2.4 (Door protection) for recommendations.
A4.3-5.2.2.4 (1)(a) Provisions should be made for auditory and visual privacy and usability for doors to rooms containing bathtubs, showers, and toilets for resident use.
A4.3-5.2.2.4 (1)(b) Resident unit doors. Based on the care population, use of doors that can be locked by occupant(s) should be evaluated.
See Section 2.4-2.2.5 (Thresholds and Expansion Joint Covers) for requirements.
*(1)  See Section 2.4-2.2.6 (Windows) for requirements in addition to those in this section.
(2)  Windows shall be provided in all sleeping areas.
A4.3-5.2.2.6 (1) Windows. Each room in a resident setting should have a window(s) that meets the requirements of Section 2.4-2.2.6 (Windows).
See Section 2.4-2.2.7 (Glazing Materials) for requirements.
Where hand-washing stations are provided, they shall comply with Section 2.4-2.2.8 (Hand-Washing Stations).
See Section 2.4-2.2.9 (Grab Bars) for requirements.
Where handrails or lean rails are provided, see Section 2.4-2.2.10 (Handrails and Lean Rails) for requirements.
Where it is necessary to protect the care population from heated surfaces, see Section 2.4-2.2.11 (Protection from Heated Surfaces) for requirements.
See Section 2.4-2.2.12 (Signage and Wayfinding) for requirements.
Where decorative water features are included in the facility design, see appendix section A2.4-2.2.13 (Decorative water features) for recommendations.
(1)  See Section 2.4-2.3.1 (Surfaces-General) for requirements in addition to those in this section.
*(2)  To reduce surface contamination linked to health care-associated infections, surface materials selected for use in substance abuse treatment facilities shall possess the following performance characteristics:
(a)  Surfaces shall be cleanable.
(b)  Surfaces shall have no surface crevices, rough textures, joints, or seams.
(c)  Surfaces shall be non-absorptive, nonporous, and smooth.
A4.3-5.2.3.1 (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 Centers for Disease Control and Prevention 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 planning, design, and construction of health care facilities. Reduction of surface contamination linked to health care-associated infections is one of these factors. See Section 1.2-3 (Resident Safety Risk Assessment) for additional information.
See Section 2.4-2.3.2 (Flooring and Wall Bases) for requirements.
See Section 2.4-2.3.3 (Walls and Wall Protection) for requirements.
See Section 2.4-2.3.4 (Ceilings) for requirements.
See Section 2.4-2.4 (Furnishings) for requirements.
See Section 2.5-1 (Building Systems-General) for requirements.
See Section 2.5-2.1 (Plumbing Systems-General) for requirements.
See Section 2.5-2.2 (Plumbing and Other Piping Systems) for requirements.
See Section 2.5-2.3.1 (Plumbing Fixtures-General) for requirements.
See Section 2.5-2.3.2 (Hand-Washing Sinks) for requirements.
See Section 2.5-2.3.3 (Showers and Tubs) for requirements.
See Section 2.5-2.3.5 (Clinical Sinks) for requirements.
Where portable hydrotherapy whirlpools are used in a substance abuse treatment facility, see Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for requirements.
Where medical gas and/or vacuum systems are used, the installation of nonflammable medical gas, air, or clinical vacuum systems shall comply with the requirements of NFPA 99: Health Care Facilities Code.
  1. For substance abuse treatment facilities with 16 or fewer residents, see ANSI/ASHRAE Standard 62.2: Ventilation and Acceptable Indoor Air Quality in Low-Rise Residential Buildings for basic HVAC system requirements.
  2. For substance abuse treatment facilities with more than 16 residents, see ANSI/ASHRAE Standard 62.1: Ventilation for Acceptable Indoor Air Quality for basic HVAC system requirements.
See Section 2.5-3.1.2 (Ventilation and Space Conditioning) for requirements.
See Section 2.5-3.2 (Mechanical System Design) for requirements.
See Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for requirements.
See Section 2.5-3.3.3 (Areas of Refuge) for requirements.
Where these areas are provided, see Section 2.5-3.3.4 (Commercial Food Preparation Areas) for requirements.
See Section 2.5-3.4 (Thermal and Acoustic Insulation) for requirements.
See Section 2.5-3.5 (HVAC Air Distribution) for requirements.
(1)  For centralized recirculated systems, MERV 7 shall be the minimum filter efficiency for the first filter bank. There is no minimum filter efficiency requirement for the second filter bank.
(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.
A4.3-6.3.6.1 (2)(c) Filters for recirculating room systems. Filters should be replaced and/or cleaned per the manufacturer's recommendations to maintain indoor air quality.
  1. Filter frames shall be durable and proportioned to provide an airtight fit with the enclosing ductwork.
  2. All joints between filter segments and the enclosing ductwork shall have gaskets or seals to provide a positive seal against air leakage.
See Section 2.5-3.7 (Heating Systems, Cooling Systems, and Equipment) for requirements in addition to those in this section.
Substance abuse treatment facilities shall have a permanently installed heating system capable of maintaining an interior minimum temperature of 72° F (22° C) under heating design temperatures.
Substance abuse treatment facilities shall be configured and equipped with a cooling system capable of maintaining an interior maximum temperature of 75° F (24° C) under cooling design temperatures.
See Section 2.5-4.1 (Electrical Systems-General) for requirements.
Where generators are used for a substance abuse treatment facility, exhaust systems (including mufflers and vibration isolators) for internal combustion engines shall be located, designed, and installed to minimize objectionable noise.
See Section 2.5-4.3.1 (Electrical Receptacles-General) for requirements.
See Section 2.5-4.3.2 (Receptacles in Corridors) for requirements.
Each resident room shall have duplex-grounded receptacles, including at least one on each wall.
See Section 2.5-4.3.4 (Essential Electrical System Receptacles) for requirements.
See Section 2.5-4.3.5 (Ground Fault Interrupter Receptacles) for requirements.
The requirements in this section shall apply to the following systems based on the care model and the needs of residents:
Call system
Information system
Telecommunication system
Where call systems are provided, the following requirements shall be met:
  1. The system shall be capable of activation/operation from resident toilets, bedrooms, and bathing areas.
  2. The signal shall be transmitted to on-duty staff through fixed locations and/or resident wearable devices.
  3. Use of alternative technologies, including wireless systems, shall be permitted.
    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 2560: Emergency Call Systems for Assisted Living and Independent Living Facilities.
  1. Where a hardwired system is used:
    1. Each bed location shall be provided with a call device accessible to the resident.
    2. One call station shall be permitted to serve two call devices.
  2. Use of wireless call stations shall be permitted.
Where an emergency call system is provided, an emergency call device shall be located at each toilet, bath, and shower used by residents.
  1. The device shall be accessible to a resident in any position in the room, including lying on the floor. Inclusion of a pull cord or portable wireless device shall satisfy this requirement.
  2. The emergency call system shall be designed so that when a call is activated a signal is initiated that is distinct from the resident room call device and can be turned off only at the activated emergency call device.
  3. The signal shall activate at the staff work area and/or signal a handheld mobile device carried by staff.
  4. Emergency call systems shall comply with UL 2560: Emergency Call Systems for Assisted Living and Independent Living Facilities.
See Section 2.5-5.3 (Technology Equipment and Teledata Room) for requirements.
See Section 2.5-5.4 (Grounding for Telecommunication Spaces) for requirements.
See Section 2.5-5.5 (Cabling Pathways and Raceway Requirements) for requirements.
See Section 2.5-6 (Electronic Safety and Security Systems) for requirements.
See Section 2.5-7.1 (Daylighting and Artificial Lighting Systems-General) for requirements.
See Section 2.5-7.2 (Daylighting Systems in Resident Living, Participant, and Outpatient Areas) for requirements.
See Section 2.5-7.3.1 (Light Fixtures) for requirements.
See appendix section A2.5-7.3.2 (Lighting in transition spaces) for recommendations.
(1)  Resident unit corridors
(a)  Resident unit corridors shall have general illumination with provisions for reducing light levels at night.
(b)  Corridors and common areas used by residents shall have even light distribution to avoid glare, shadows, and scalloped lighting effects.
*(2)  Resident rooms, bedrooms, and bathrooms
(a)  Task light controls shall be readily accessible to residents.
(b)  Where night-lighting is provided, it shall be located 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.
A4.3-6.7.3.2 (2) Lighting in resident rooms, bedrooms, and bathrooms
  1. Resident rooms, bedrooms, and bathrooms should have general lighting and task lighting.
  2. Resident bathrooms should provide general illumination with provision for reducing light levels at night.
A4.3-6.7.3.2 (2)(b)(iii) 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. To achieve a low light level, night-lighting should include amber or red lamping; white, blue, or green lamping should not be used. Switches for night-lights are recommended for some care populations.
See Section 2.5-8 (Acoustic Design Systems) for requirements.
Where elevators are provided in large settings for residents with intellectual and/or developmental disabilities, the requirements in this section shall be met:
Engineered traffic studies are recommended, but in their absence the following guidelines for the minimum number of elevators shall apply:
  1. At least one elevator sized to accommodate a gurney and/or medical carts and resident-operated mobility device users shall be installed where residents are living or receiving care or support services on any floor other than the main entrance floor.
  2. At least two elevators shall be installed where 60 to 200 residents are living or receiving care or support services on floors other than the main entrance floor.
  3. At least three elevators shall be installed where 201 to 350 residents are living or receiving care or support services on floors other than the main entrance floor.
  4. For facilities with more than 350 residents living or receiving 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.
A4.3-6.9.1.2 Number of elevators. These standards may be inadequate for moving large numbers of people in a short time; adjustments should be made as appropriate to the care model and population served.
Elevator car doors shall have a clear opening of no less than 3 feet 8 inches (1.12 meters).
A4.3-6.9.2 Elevator dimensions and clearances
  1. Handrail projections of up to 3.5 inches (8.89 centimeters) should not be construed as diminishing the clear inside dimensions.
  2. If required to serve the care population and indicated by a mobility transfer assessment, at least one facility elevator should accommodate attending staff and an ambulance gurney 7 feet 6 inches (2.29 meters) in length and/or an expanded capacity width of 4 feet (1.22 meters) for persons of size.
  3. Additional elevators required for passenger service shall be sized to accommodate resident-operated mobility devices, if needed by the care population.
See Section 2.5-9.3 (Leveling Device) for requirements.
See Section 2.5-9.4 (Installation and Testing) for requirements.
Elevator cars shall have handrails on all sides without entrance door(s). See Section 2.4-2.2.10 (Handrails and Lean Rails) for additional requirements.
Linked Resources
P
P Premium Feature

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

Learn More
Code Compare
P
Code compare is not available for this code.
Bookmarks
P
P Premium Feature

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

Learn More
Amendment Styling
P
P Premium Feature

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

Learn More