Neilson Place: small facility, big changes; A rural organization has created a contemporary social model of long-term care.

The specialty of long-term care design is experiencing significant evolution. Creative sponsors of long-term care projects are reaching out for unique methods to better support the desires of elders, their families, and staff. Today's long-term care programs are departing from "institutional" designs and developing "social" models. Many designs are derived from architectural styles once only found in hotels, restaurants, resorts, or other segments of the hospitality industry. The social model supports resident independence, dignity, and privacy while emphasizing a home environment conducive to wellness.

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A current expression of these trends can be found in a 78-bed skilled nursing facility serving the community of Bemidji, Minnesota, and its 50-mile-radius service area. Dedicated in late 2004, the facility, called Neilson Place, is a part of North Country Health Services, a nonprofit corporation. As such, it shares a campus with North Country Regional Hospital, a synergy allowing for efficient management of human resources, enhanced materials management, and financial support for an array of quality programs and services.

The vision of Neilson Place is to be the destination uniting all ages; innovatively partnering to nourish and invigorate the mind, body, and spirit. The facility's long-range mission is to provide a home where elders are allowed to age in place instead of moving from place to place as physical needs dictate. The goal is to create a place where elders, their families, and facility staff work as a team to ensure that the facility is caring for the human spirit and creating opportunities for growth and learning, while providing excellence in physical rehabilitative and medical care.

The primary design objective was to "bring the services to the elder" instead of the elder moving, or being moved, toward care and services. The design "backbone" consists of L-shaped residential neighborhoods organized along a rectangular "Town Center." The 16-bed short-term stay unit (see figure 1 on page 48) is located near the rehabilitation department. At the end of the building are two hospice rooms, which are located next to an overnight visitors' room. This allows for out-of-town loved ones to remain close to their family member. French doors allow direct private access to the outdoor patio area.

Two L-shaped neighborhoods are connected by "knuckles" and stacked as a two-story structure adjacent to the one-story Town Center. The "public" Entry/Lobby/Business Office/Common Area/Rehabilitation specialties (figure 1) are located in the Town Center side, with a truck service/employee entrance located on the "service" side of the Town Center. The households look into outdoor, landscaped courtyards.

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Upon entering the main lobby, one can sense a homelike feel in the texture of the slate/wood combination used at the fireplace (figure 2) and reception desk (figure 3). The two-story entry atrium (figure 3) is flooded with natural daylight, and rich colors used on the floors and walls support the concept of bringing the outdoors inside. Durable vinyl wallcoverings, simulating the soft textural look of linens, silks, and grasses, are used throughout the public spaces and as accents in the residents' rooms. Drinking fountains and public restrooms, which are handicapped accessible, are located throughout the facility for the ease of visitor and family use.

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Each neighborhood consists of either 18 or 20 resident rooms occupying two households, with a separate dining and living room for each. Catering to the social model, each living room was designed with a theme unique to northern Minnesota. For example, with logging a predominant trade in the area for many years, it was only appropriate that one of the living rooms be dedicated to the history of logging and involvement of the local railway (figure 4). The local history center was able to provide copies of historical photos that are now on display for families and residents, and books on the history of logging and the railway help to reinforce the unique background of families from the area. With Bemidji located just miles from the source of the Mississippi River, it was appropriate to include the history of the Mighty Mississippi as the "feature wall" in another living room.

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The eight small dining rooms (figure 5) were designed with durable wood-look flooring and comfortable wooden armchairs to create an intimate dining experience. Each dining room is supported by a country kitchen (figure 6), which provides a customized breakfast at staggered times based on the desires of each resident. Along with the small dining rooms in each neighborhood, a large private dining room was designed to provide residents and families a space to privately celebrate birthdays and special events.

The private resident rooms (figure 7) each contain a small refrigerator, microwave, sink, and cupboard. All resident rooms have handicap-accessible bathrooms, consisting of a hotel-style counter with sink, toilet, and shower (figure 8). It is important to make sure that shower floors slope properly to an adequately sized floor drain to prevent water from backing up into the room. A ceiling-mounted patient lift system was installed over the bed and in the bathrooms to better assist staff in moving residents during the activities of daily living. The windows are oversized, energy-efficient, triple-glazed units designed to allow maximum viewing for each resident. Resident rooms were designed with a "welcome light" at each entry and a memory box (figure 9). Soft-textured resilient flooring was used in the resident rooms for durability, and a central medical gas system provides suction and oxygen piped into each room.

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A spa area is centrally located between the two neighborhoods on each floor of the facility and features special lighting, warm-colored/textured tile surfaces, and a solid-surface countertop with integral sink. This activity becomes a pleasant event for resident and staff alike.

Staff work areas (figure 10) were designed to be noninstitutional appearing. Through the use of natural wood and slate, the staff work areas were designed to look and function more like a hotel concierge desk than a traditional nurses' station. The desk heights are meant to be welcoming and support maximum efficiency while protecting the confidentiality of resident information.

Neilson Place also hosts a unique Health Professional Program, which is used by local colleges to recruit, educate, and train nursing students for multiple levels of service. Besides a nursing laboratory with audiovisual equipment and computer hookups for conferences and long distance learning opportunities, the area includes a replica of a resident room, complete with bed, cubicle curtains, overhead lift, linen storage areas, piped in oxygen and suction, and weighing scale (figure 11). When the room is in use, the bed is occupied by a manikin for students to deliver hands-on care (bathing, positioning, etc.). Students are also able to work directly with staff and residents in the nursing home to further their education. According to administrator Sandy Benson, the space has been invaluable in certifying Neilson Place's entire nursing assistant staff and opening up training to community residents interested in nursing careers.

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In short, Neilson Place is a little place that has thought big about long-term care design. It proves that you don't need to be a big-city palace to keep in step with today's long-term care design trends.

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Peter Rauma, AIA, NCARB, and Christine G. Vickery, CID, are an architect and interior designer, respectively, with Hammel, Green and Abrahamson, Inc. (HGA), of Minneapolis. For further information, phone [phone] or visit www.hga.com. To send your comments to the authors and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].

BY PETER RAUMA, AIA, NCARB, AND CHRISTINE G. VICKERY, CID