Making it new: the Metropolitan story.

An old facility's demise opened the way for new design ideas

Metropolitan Jewish Geriatric Center, one of the largest health care providers in the City of New York, operates two skilled nursing facilities - a 529-bed nursing home in Boro Park, and the 360-bed Shorefront Jewish Geriatric Center in Coney Island. The latter facility was formerly located in a building that was constructed in the 1920s as the Half Moon Hotel on the boardwalk. Because this building was not originally built as a nursing home and because of its age, there were numerous structural and functional problems which mandated replacement. In short, an opportunity had presented itself to create a new facility in tune with today's needs, and adaptable to tomorrow's.

Under the leadership of Eli Feldman, Executive Vice President and Chief Executive Officer, Metropolitan set about to acquire an entire city block bounded on the south by the boardwalk and Atlantic Ocean, on the north by Surf Avenue and on the east and west by West 28th and West 29th Streets. The master plan for the new site was developed by Landow and Landow Architects, a firm specializing in health care projects, which had previously been associated with Metropolitan on another project. The planning process started with a comprehensive analysis of the way Metropolitan wanted the building to function, the nature of the site, and the needs of the current residents, as well as projections about the direction of gerontological care in the decades to come.

Eli Feldman wanted to provide a state-of-the-art facility that would offer the highest level of care available in a non-institutional setting and maximize the use of his staff. His concept for accomplishing this? He requested that the architects design the building with at least two nursing units on a floor, so that social workers and physicians who covered two units would not have to divide their attention between two floors. From this developed a neighborhood concept, a further step toward making the nursing home a true home for its residents.

Based on a suggestion made by environmental psychologist and consultant Lorraine Hiatt, I designed the building based upon biaxial, or toe-to-toe, resident rooms. Most nursing home rooms have been constructed to imitate hospital rooms, with one patient closest to the window and the other patient closest to the corridor, and with both beds on the same wall. If the patient near the window has the cubicle curtains closed, the patient near the corridor is deprived of light from the window and, in most instances, of the comfort conditions created by the heating and air conditioning unit that is located below the window. In the biaxial room, each resident has his or her own private area, with separate windows and heating, ventilating and air conditioning units - approximating, in essence, two private rooms sharing a lavatory.

Most rooms that have been constructed this way were either larger than the typical hospital room and, therefore, economically unfeasible, or else they violated the privacy of one of the residents. I designed a biaxial room that was no larger than the traditional hospital room and allowed each resident to maintain privacy and dignity.

Because the neighborhood concept calls for close integration of services, the dining rooms for each unit were located adjacent to one another, thus providing a large space on each floor where important programs and activities could take place. This is very much in line with today's needs - the typical nursing home resident has become older and more frail in recent years, and the necessity of bringing programs and services to the residents rather than vice versa has become a prerequisite. By providing this large community space on each floor, programming can be readily accomplished with minimum staff and maximum control, while keeping the residents in the environment with which they are familiar.

The nursing stations have been designed in close proximity to one another and to the dining and recreation facility to allow for redundancy in supervision. The "X" shaped plan also allows each nursing station complete observation of the resident corridors, while the central core of the plan allows residents to wander under the watchful but unobtrusive eye of the staff.

In order to create a more intimate and homelike setting, the nursing units have been broken up into neighborhoods of 18 residents, each with it's own lounge, bathing room and workroom. The corridor is designed, in effect, as a pedestrian "street," with the entrance to each resident room recessed and angled to provide a "front porch." The lounge in each neighborhood has been positioned to take advantage of the facility's spectacular views of the ocean.

Construction of the $48 million project was completed on time and under budget by the cooperative efforts of Metropolitan, Landow and Landow Architects, and the construction manager, Gotham Construction Corp. Importantly, the architects had recommended to Metropolitan that the construction manager be brought on board during the design development phase. They could thus provide sufficient input on costs and the availability of materials to be certain that the design objectives were being met within budget. The cooperative relationship that developed between the three team members allowed the work to go on without the usual adversarial relationship that permeates so many construction projects.

Landow and Landow designed all of the interiors for the project to match the neighborhood design of the building. Color schemes for the building included teal and purple with many modifications in tone and texture. Two basic color schemes were utilized for the five resident floors, with five different resident room color choices that fit within both schemes.

A major innovation was the use of carpeting throughout all of the residential areas, including the residents' rooms, dining rooms and corridors. The architects spent a considerable amount of time designing the carpeting, writing the specifications and selecting a manufacturer. They were successful in negotiating a guarantee with one of the major carpet mills to assure Metropolitan that the carpet would be replaced without charge for 10 years if any stain or odor could not be removed by the cleaning process recommended by the manufacturer. The owner's life cycle cost analysis, based upon the purchase price negotiated by the architects, showed that carpet would be less expensive than the vinyl composition tile originally contemplated for the project. The carpet adds to the residential feeling and greatly reduces noise. It is also beneficial in reducing injury from falls.

Landow and Landow designed custom woodwork and furniture for the project, and all the dedication sculptures were designed by Marc Landow. An art program was established by Robin Landow, who selected a collection for the project that includes photographs of early New York from the New York Historical Society, original seragraphs by artist Mordachi Rosenstein, and posters and contemporary photographs by Victor Gagliardi. Landow and Landow also designed all of the graphics for the building, integrating the signage for resident rooms with photographs to be selected by the residents or their families to cue them to the location of their room.

Because the waterfront site is in a coastal flood zone, Landow and Landow elevated the buildings above the level projected for a 500-year flood. The resultant space below the buildings has been used for parking for staff and visitors. The entire block is designed as a gated campus with its own internal security system to assure the residents' safety.

The second phase of the master plan is currently underway with the demolition of the 14-story Half Moon Hotel building formerly occupied by the nursing home, and its replacement by a 13-story housing for the elderly project, being built under the HUD 202 program. Although this is a program for low-cost housing, Metropolitan has insisted on numerous amenities to facilitate a comfortable environment for the residents. The building includes community spaces, a warming kitchen to serve food which will be prepared in the kitchens of the nursing home, and recreational areas at the ground level connecting the nursing home to apartments. It is anticipated that there will be many residents of the apartment house who will have a spouse in the nursing home, and the proximity and campus-like setting will allow for easy visitation. Residents of the housing project will also be able to obtain medical and social services through Metropolitan's facilities. Other amenities include a roof terrace where residents will be able to have recreational activities overlooking the Atlantic Ocean. The $12 million project, constructed completely of pre-stressed and pre-case concrete, will be completed in approximately 12 months.

A multi-level campus, and a "home" at every level - these are today's concepts of long-term care, and they're exemplified by the new Metropolitan Jewish Geriatric Center.

Lloyd J. Landow is President of Landow and Landow Architects, New York.