A new ADA-compliant design to save revenue.

Creating handicap-access bathrooms was reducing revenue-generating space -- until a designer had a better idea

In the late 1980's, the Robert F. Kennedy Medical Center -- one of the west coast's most progressive acute care hospitals -- undertook a capital improvement project on their third-floor skilled nursing facility. As part of that, the medical center was required to set aside 10% -- total 3 -- of the unit's patient beds for handicap access, in compliance with the Americans with Disabilities Act. A 4-patient bedroom unit was chosen to be the handicap accessible room, but one of the beds would have to be eliminated due to extra space taken up by the handicap-accessible toilet room. The loss of the bed meant an estimated loss of revenue of over a quarter-million dollars a year.

As it happened, my firm was retained as Executive Architect and commissioned to remodel a minor element on the floor. When the issue of accessibility came up, we reviewed the hospital's previous construction and proposed to remodel again to retrieve the lost bed. Administration was delighted to find that, due to an innovative bathroom layout that we had designed, they could restore the bed and the revenue it generated. They immediately authorized us to proceed, our handicap toilet unit was installed, and the bed retrieved and re-licensed.

This is only one example of how innovative design thinking can pay for itself many times over.

The New Design

Our copyrighted toilet room design (patent pending) solves the problems of space limitation and wheelchair maneuverability by reducing the width of the rear plumbing wall by 2 feet. By pulling the water closet forward and providing a counter with a sink behind the water closet, the design not only meets all federal, state and local codes, it also eliminates expansion into the patient bed area. The result: a highly functional and space-efficient design enabling nursing homes and hospitals to maintain high quality health care services profitably.

In addition, by eliminating corners, grout joints, and by placing the water faucet and control levers on the back splash -- removing everything off the counter deck for easy cleaning and maintenance -- the design promotes increased infection control and reduced housekeeping costs over the long term.

An Acid Test

The new toilet room layout was tested recently by Terre Wayne, Senior Cost Estimator at Stillion Construction, a Torrance-based Healthcare and Commercial construction establishment; he has over 22 years of experience in construction. Mr. Wayne has used a wheelchair for the past seven years, after a Colorado River water skiing accident left him paralyzed. His 6-foot, 3-inch tall frame requires one of the largest custom-made wheelchairs available. As a member of the American Paralysis Association (APA) of Orange County, he demonstrated our design to Los Angeles County Supervisor of the Second District Yvonne Brathwaite Burke, and commented:

"As senior cost estimator, I have reviewed over 14,000 construction projects to date, with a special interest in barrier-free design. Siller's design is quite unique and effective, and I can maneuver within the toilet room without any obstruction or problem whatsoever -- and I have one of the largest chairs around. I can see how valuable a contribution to healthcare and other industries Siller's design can be, Compliance with ADA with Siller's design not only enhances the facilities' profitability, but is another long-awaited step to creating a barrier-free America."

Supervisor Burke commented:

"Healthcare facilities are finding survival through this recession a tremendous challenge. It is creative efforts of individuals like Architect Omar Siller that will assist facilities to maintain their patient bed counts intact while still complying with ADA...Siller's work is national in scope and is timely, with the United State's present focus on national healthcare reform and the additional financial impact caused by the loss of revenue due to the elimination of patient beds within this industry."

Another Case in Point

The Skilled Nursing Facility Remodeling Project at Queen of the Valley Medical Center in West Covina, CA was faced with an ADA compliance requirement of a 50% increase in handicap-accessible beds. The resulting design modifications would have meant a potential loss of 6 non-handicap patient beds. Our design enabled the facility to remodel the floor and be in compliance with ADA, without the loss of any revenue-generating patient beds.

Savings That Almost Happened

Los Angeles County is in the process of constructing a new $1 billion, 946-bed facility. Recently I met with Larry Colvin, Project Director of the Facilities Implementation Team for the County Department of Health Services, to see what effect our bathroom design would have had if implemented. We calculated it would have saved an area of about 40 x 40 feet, which could have been put to a variety of uses, including new patient bedrooms, with a savings of up to $500,000. Nothing transpired, however, since by this point the facility was far enough along that the change order would have cost more than the immediate savings.

Conclusion

Every dollar saved is another step towards success, and success is measured by providing quality health care profitability. Our design has proven to be a step in that direction. It also demonstrates that design, in general, is more than a matter of beautifying the surroundings. Used appropriately, it is an intrinsic part of doing business in a very challenging environment.

How We Got the Idea

When converting a medical clinic into a women's medical center, we designed a pair of men's and women's handicap-accessible toilet rooms to serve both the medical center and a conference room off the lobby. The bathrooms ended up encroaching on one of the two windows in the conference room by one foot. Rather than limit the conference room to one window, which was unacceptable, I decided to reduce the rear plumbing wall of the bathrooms by pulling the lavatories away from the wall and installing the sink fixtures in between. This saved the window and satisfied the code authorities. Soon thereafter we tried the design again in a rehabilitation center and ended up saving more than a design feature -- they placed income-producing physical therapy equipment in a 4 x 8-foot area the design opened up. That is when the financial relevance of the design to health care facilities faced with ADA compliance became apparent.

Omar G. Siller, AIA, is a Los Angeles-based architect with over 10 years experience in health care architecture. His firm, Omar G. Siller & Associates (310-645-4323), is recognized as a leading authority on innovative designs to meet handicap access and other space-saving requirements.