Found space: how to make your existing building work harder.

"Foundspace" hasn't really been lost; it's just space that is not being used as efficiently as possible. By finding no-cost or low-cost ways to increase efficiency, you can make your building work harder.

There are a number of reasons why space may be used inefficiently:

* Most of the nursing homes and related facilities in this country were built before 1970; because the evolving profile of the populations served, the concept of services to be provided and equipment required has changed, and existing facilities may no longer meet current needs.

* Residents of nursing homes are living longer and are more frail than they used to be; more of them are in wheelchairs, and the extra room they take up and increased nursing efforts required put pressures on space.

* Many of the detailed regulations with which nursing homes must comply address the needs of 1960's populations, not the needs of those today; regulations may therefore actually work against efficient use of space. For example, space guidelines issued when fewer residents were in wheelchairs are too low for optimal operations today.

* Increasingly complex requirements for tracking costs and reimbursements mean additional administrative personnel and equipment are necessary, and they need space.

* As facilities expand over time, inefficiencies may be introduced by new construction. In one home, the laundry was originally at the back of the main building, out of the way. When a wing was added, the main corridor now went right by the laundry room, and was frequently congested with laundry carts and subjected to blasts of steam.

* Preserving customary ways of doing things may also create inefficiencies. In a large senior care center, staff originally checked in at the administration office near the front door. When the office was moved to a more remote location, the sign-in book went with it; a better solution would have been to leave it with the security guard at the entrance.

In the past, these pressures were met by funding for new construction, but that option is less available today. Even so, it makes sense to operate any facility as efficiently as possible; whether it means refurbishing rooms, rearranging furniture, altering organizational structure or making modest physical changes, nursing homes can take advantage of some practical suggestions.

Identifying Options

The first step in improving space utilization is to bring in an outside professional who can look at your situation objectively. You should look for a trained architect, who can think in three dimensions and understands the technical aspects of construction. You should also select someone who is conversant with guidelines for running nursing homes and senior care centers. And most important, look for someone who thinks first about how design affects the users, and designs outward from there.

When you have selected a consultant, you should prepare an accurate, up-to-date floorplan indicating who occupies each space and what happens in it. You should tour the building with the consultant to see the condition of the building and give him a feel for how it works.

After the consultant becomes familiar with your operation, you will sit down together, develop space standards and review space allocations indicated on the floor plan; one helpful trick is to turn the plan upside down, so that you look at space use with fresh eyes. This is also the time to bring in key staff members to discuss their needs, ideas they have and changes they would like to make, such as adding an office assistant, or creating a separate lounge for sicker residents, or introducing part-time day-care for mothers who come to visit elderly relatives.

The next step is preparation of a space audit that identifies:

* Cramped spaces; * Underutilized space; * Critical adjacencies that may expand

the function of a space; and * Traffic paths and crossovers to work

around or reorient.

The audit will then identify no-cost or low-cost options to help you meet objectives, as well as some options involving capital costs that would bring a positive return. When you have decided which options to pursue, the consultant will prepare a detailed phasing plan showing what sequential steps are necessary to accomplish your objectives with minimal disruption to ongoing operations.

How Facilities Can Be Made To

Work Harder

Because facilities differ widely in size, age, original design, current configuration, population profile and customary ways of operation, there is no single list of potential solutions to space problems. Instead, to illustrate the possibilities, here are some actual solutions that were applied to individual situations.

* Downsizing the dining room - In one institution, the population was older than when the building was designed; fewer residents now ate in the dining room, and this allowed the nursing home to reduce total area allocated to dining while still complying with regulations. The extra space was redesigned for a personnel office.

* Reorganizing supply distribution - Instead of keeping supplies in a central supply room before distributing them to supply rooms on each floor, they were sent directly to local supply rooms in which extra shelving had been installed. This freed up enough space to install a development office on the ground floor.

* Reducing storage areas - In another institution, it proved more efficient to abolish supply rooms on each floor, gaining 100 sq. ft. per floor for nursing records, and keep general supplies with medical supplies in cabinets near the nursing station.

* Turning shaft space into vertical transportation - An older nursing home had severe problems with traffic: residents, visitors, nursing and staff shared the corridors with food and supply carts, laundry, garbage and medical wastes. The solution was to install a dumb-waiter in an unused shaft space. This reduced both traffic flow and elevator congestion, and improved the ambience, as well.

* Refurnishing for wheelchair access - For one home, it was a tight squeeze getting wheelchair around furniture in the bedrooms. They invested in new bureaus and nightstands, with different dimensions and configurations, to increase clearance without sacrificing total storage space. The improved mobility for residents meant reduced need for staff assistance.

* Reassigning offices - First, the consultant suggested moving the head of security to a newly installed desk in the lobby. Then the director of housekeeping moved into his vacated office, and her former office was turned over to supplies.

* Using the lobby for lounge space for residents - One nursing home upgraded lighting in the lobby and added comfortable seating to encourage healthy residents to use it for social interaction. This helped reduce pressure on lounge areas used by the sicker residents.

* Using the lobby for administrative tasks - By designing a handsome counter that concealed two work stations in the extra-large lobby, this senior care center was able to move the telephone operator and a bookkeeper out of cramped basement quarters without changing the appearance of the entrance.

* Adding an exterior elevator - In some cases, finding space involves capital expenditure. An institution that had built several additions over the years badly needed more elevators; the decision was made to add an elevator on the exterior of the building, which was less expensive than building it in the interior and avoided disrupting operations.

* Upgrading residential areas - Sometimes finding the most efficient way to use space means investing in an upgrade. In one private pay adult residence, rooms along a doubleloaded corridor had no private bathrooms.

The home found it increasingly difficult to attract well-to-do residents, and decided that an upgrade to improve the patient mix was mandatory. For every three rooms in that wing, the middle room was converted into two private bathrooms serving the rooms on each side. This increased the quality of the residence, not just by adding private bathrooms, but also by reducing traffic in the corridor. The reduction in room number was more than made up for by the increased income from the newly upgraded rooms.

Finding no-cost and low-cost ways to use your space more efficiently is not difficult. But it requires a clear definition of goals; an objective look at the facility and how it operates; a close working relationship with the staff to develop changes and create a phasing plan; and the commitment to follow through on changes.

Kenneth Ricci, AIA, is President of Ricci Associates Architects & Planners, based in New York City. The firm specializes in the design of institutional, educational and public facilities, including nursing homes, retirement communities, treatment centers and child and adult day care centers.