Choosing an architect for quality design: for the special needs of nursing home design, the quality of the results depends on the questions you ask.

For the special needs of nursing home design, the quality of the results depends on the questions you ask

Sensible architect selection centers on knowing and matching the characteristics of your proposed facility with the experience and philosophy of the architect.

First establish the primary goals that you intend to achieve with the completion of your building project. These goals would include the scope or size of the facility, the extent of services to be provided within the facility, and an approximate budget either total budget or cost per bed. It is even more important for you to identify the features within health care facilities that you view as most desirable. For example, if homelike setting, operational efficiency, or quality appointments have a high priority, list these and other essential building characteristics that you value, in order of importance.

Once you have established the ideal of the health care facility you plan to construct or renovate, try to find examples of comparable buildings. You could start with reviewing buildings in your immediate area and follow through with other buildings you may have heard about outside your immediate area. Finally, refer to buildings you have seen in various publications. The better you are able to visualize the attributes of what you consider a model facility, the better you are able to establish a comparison with the quality of work that you would expect from potential architectural firms.

Performance Evaluation 

Because of the complexity of quality health care facilities, locating firms having a health care design background is essential. This background may not necessarily characterize the entire firm, as long as appropriate architects within the firm have experience in nursing home architecture. Because of the high degree of regulatory control in long-term care facilities, successful development absolutely requires a good working knowledge of nursing home design considerations.

Any building is a three-dimensional walk through representation of an architect's achievement - or lack thereof. As Frank Lloyd Wright once said, "The physician can bury his mistakes, but the architect can only advise his clients to plant vines." Evaluating an architect's design performance in creating quality health care facilities is best accomplished, therefore, by viewing their facilities. Doing your own post-occupancy evaluation of a building months or years after it has been in operation gives you a great advantage in being able to see how well an architect's work has served another client.

Finding a Firm

Start out by learning who designed the nursing homes you most admire. If possible, find out if the people who manage and use the facility share your admiration. With this approach, you should be able to begin a preliminary list of two or three firms that should have the experience for which you are looking.

Other sources of appropriate health care facility designers include firms listed on Health Department Certificate of Need applications. This information should be available to the public at the local health department library. You may find that health department officials are willing to provide you with a list of firms that have nursing home design experience. Another place to contact would be the state office of the American Institute of Architects (AIA). These offices maintain a listing of member architects that have experience in particular building types.

After obtaining the names of four or five firms that have suitable experience for the project that you are contemplating, request detailed qualifications from each. It would be best to send a letter to each firm, briefly noting the basic scope and characteristics of your proposed building project. Indicate that you are requesting letters of interest from qualified architects. Request a brochure which highlights the extent of their nursing home or health care experience. Specify the date you wish to receive the responses and note the number of copies that each architect should submit.

Architect Interview

Once you have received responses from appropriate firms, review the brochures in order to establish an interview list. Select three or four firms that you feel are most suitable and schedule appointments accordingly.

In order to allocate sufficient time for the presentation of the firm's work, allow at least 45 minutes (preferably 1 hour) for each interview. If possible, have your key staff present during the interview and allow yourself enough time afterwards to review with staff. I believe it may be prudent to arrange the interviews, if possible, in the order of the least likely candidate first, to the most likely candidate last. That will allow you the opportunity to acquire experience in interviewing firms before conducting your most important interview.

Key Questions to Ask

1. What is the history of the firm, and

what percent of the firm's work is in

health care design? 2. What projects have you done that best

represent your suitably for this

project? 3. What percent of the firm's work is in

design of facilities for the elderly? 4. What features in a nursing home do

you consider most important, and

how have you been successful in

incorporating these features in your

work? 5. How have you endeavored to create a

residential setting within the nursing

homes that you have designed, and

what techniques have you employed

in your design to reduce long institutional

corridors? 6. What facilities have you designed that

incorporate special design considerations

for Alzheimer's patients? 7. How do you feel about working with

environmental gerontologists or

similar consultants through the design

process, and do you have

experience working with these

consultants? 8. How have you assisted clients in developing

design programs for their

facilities? 9. How have you responded to the issues

of privacy within the patient's

room? Have any designs yielded a

high degree of patient privacy in a

semi-private room and, if so, how did

you achieve this? 10. What special features have you incorporated

in the patient room layout? 11. How have you dealt with the issues of

orientation and wayfinding within the

health care facilities you have designed?

Do you provide interior windows

or landmarks to help people

orient themselves? 12. Would you provide us with a list of

nursing home references? 13. Would it be possible for you to show

us one of the nursing homes that you

have designed that best represents

how you would design our project? 14. What are the reasons that you believe

your firm would be the most appropriate

for this project?

Final Selection

Once the interview is completed, identify one or two firms that have the most suitable experience and arrange to see at least one building from each of these firms. Now contact at least two nursing home industry references for each architect.

At this point you will be ready to make an intelligent choice of which architectural firm should design your facility. Indicate to the successful firm that you now seek a fee proposal. Tell them that you want to review the proposal and negotiate a contract for architectural services. After reviewing the proposal, should you find the fee and other specifics, including a schedule acceptable to your needs, request the architect to prepare an Owner/Architect Agreement for architectural services. Should the proposal for services not be acceptable, and you find that it is not possible to negotiate a satisfactory resolution with this firm, then indicate this in writing and proceed to negotiate with your second choice of firms.

In summation, your best insurance in making a good selection is to verify the firm's competence with as many industry sources as possible. Remember, as it says in Proverbs, "Where no council is, the people fall: but in the multitude of councillors, there is safety."

How NOT to Select an Architect

Inappropriate Selection Method

1. Letting your builder choose or greatly

influence the selection process

2. Random selection - The theory that any

architect will do - (they're all registered

architects aren't they?)

3. Design-Build Selection - Where an

architect and a builder team up and the

team is responsible for the total construction

package

4. Design Competition - Having a contest in

which the architect with the best looking

conceptual design is selected

5. Design/Build Design Competition - Having

three to four design/build team

compete

6. Competitive Bid Process - Architect

choice based on the lowest fee proposed

Why It is A Mistake

1. The builder's values and agenda are serve

but not necessarily yours

2. The medical analogy of this philosophy

would also pick a radiologist to perform

plastic surgery. They're both physicians and

it is not an impossibility to accomplish the

task, but the results may not be as pleasing

to the eye.

3. With this method there is a great likelihood

for a bare basics or mediocre building.

There is also a significant amount of design

decision control that the owner yields to the

team. In essence the builder is in the driver's

seat.

4. The owner is likely to be the loser in this

contest. The end product might look pretty

but it probably won't be buildable.

5. See any combination of reasons #3 and #4

above.

6. The low bidders are usually so low that they

are on the bottom of the barrel.

John M. Robinson, PE, AIA, is an architect and engineer. He is Vice-President of Robinson, Myrick & Associates, Inc., a Smithfield, RI, firm that specializes in the design of facilities for the elderly.