Preserving the old while building the new.

Respect for elderly residents and for an historic old nursing home were evidenced in the planning of this new facility

Good problem recognition is the beginning of good common sense design solutions. We employed this approach in our design of Steere House, a new 120-bed skilled nursing facility on the Rhode Island Hospital Campus. Our challenge was to develop a state-of-the-art facility having a homelike charm within typical cost restraints.

Site Selection and Building Orientation

A number of practical considerations went into selecting the site.

For example, we wanted to separate the heavy support spaces, like the laundry room, from the patient areas. So, in choosing the site we chose one that had a significant change of grade. This allowed us to have a walk-out basement for access to the heavy support services, as well as grade access on the first floor for patient and visitor access.

It was a design objective to orient the building in such a fashion so that no patient room windows faced north. Placing the building on a 45 [degrees] axis from true north allowed all patient rooms to receive some direct sunlight during the course of the year. A secondary benefit of turning the building on this particular building site was that our alignment was contrary to the north/south axis of the buildings around us. We were thereby looking at adjacent buildings at an angle, as opposed to directly facing their facades. Building occupants could therefore view past other buildings, rather than having to look direct at them. This also gave our nursing home a distinct identity in the neighborhood.

Unlocking the Chains of Upstairs

Confinement 

Being in an urban setting, our building site was limited to less than two acres, which was to include all parking. Consequently, a multi-story nursing home was an absolute requirement. However, a sense of confinement can result for patients that spend day after day on upper level floors with little opportunity of ever viewing the main lobby or having contact with the ground or the outdoors. To solve these problems we created a three story atrium at the lobby, and the atrium connects to all three nursing levels. Further, the atrium serves not only as a connection to the ground floor, but also as a very open, bright, sunlit space that "imitates" the outdoors. This "indoor-outdoor" space is appreciated by people who want to get outdoors but are restricted from doing so. In addition, like the former Steere House, we built upper level porches so that patients on the second floor could easily get outdoors on their floor.

Wayfinding by Landmarks and

Openness

Landmarks are very important in any large building to help people orient themselves. They are especially important for patients with reduced cognitive abilities and their visitors. The atrium we created, being adjacent to the elevator lobby on each floor, immediately serves as a very pronounced landmark.

Other landmarks were created at corridor intersections by varying the building architecture. Here, octagonally shaped ceiling coffers were created to frame a distinctive light fixture. The walls in this area picked up on this octagonal orientation, while the carpeting directly below the coffer also followed the outline of the octagon.

These distinct architectural features, along with changes in finish material, announce that this is a destination, and therefore a landmark. These types of spaces make traveling through the building eventful. Corridor alcoves adjacent to these landmark areas further extend the prominence of the space. These alcoves allow placement of furniture adjacent to the circulation space, thus enhancing the residential character of the facility.

Interior Windows

Another technique in assisting wayfinding in the building was a utilization of windows between the corridors and common rooms. This feature helped to increase the sense of space and reduce the sense of confinement that normally exists within interior common spaces. These windows or "vision panels" allowed the transfer of natural light from the rooms adjoining the corridors, thus extending light into the interior corridor spaces. They also help to orient people walking through, since glimpses of exterior light and views are now visible from the corridor. The common rooms themselves also become visible from the corridor and serve as landmarks as one travels through the nursing home.

Clustering For Efficiency and Privacy

Reducing the corridor area was a win/win situation in this design. We won two-fold because significant building cost savings resulted, and patient and staff travel distances were cut drastically. The reduced corridors resulted from creating short dead-end corridors, with patient rooms clustered at the ends. These small corridor segments create a cozy neighborhood feeling for the small group of rooms that they serve.

The building was also able to afford a greater sense of privacy in the patient rooms as a result of the corridor arrangement. The arrangement allowed an L-shaped room design. This semi-private room had two separate 100-square foot patient bed areas which could not view each other. This was achieved because the cost savings that resulted in the corridor area reduction allowed the, patient rooms to be wider, thus providing an opportunity for patient beds to be located on opposite walls. Not only did this afford a greater degree of privacy for each patientbut gave each patient his or her own window.

To further enhance patient privacy as well as personal identity, patient room doorways were set back from the primary plane of the corridor wall. These entry alcoves serve as mini-front porches for each patient room.

Old Charm In A New Building

From the very first design program meetings at the old Steere House, it was determined that bringing the best of the old building to the new would be desirable. We felt that the utilization of traditional materials, like those found on the older building, plus the employment of traditional architectural elements, would help us achieve this goal.

On the interior of the building, it was determined that bringing a beautiful old fireplace from the existing structure to the new building would be most worthwhile. We felt that patients and staff would appreciate having a prominent feature of the old building moving with them and thus, hopefully, easing their transition, as well as maintaining the history of the home. The general contractor, O. Ahlborg & Sons, did the very meticulous job of dismantling the ceramic tile-faced fireplace from the old library. The disassembling and reassembling of this fireplace required careful planning and execution. Pieces of the fireplace were numbered during dismantling and recorded to enable its exact reconstruction at the new building site. This work was left to the late stages of construction to minimize possible damage to the fireplace.

The interior design firm, Adner/Woodman Design Inc., utilized great care in selecting a few of the best antique furnishings from the old Steere House and having them refurbished and refinished, as necessary. In most cases these older furnishings were repositioned in the new structure in comparable positions.

As an example, some of the fixtures in the old library were placed in the new library in order to maintain a sense of continuity. The new furniture chosen complemented these preserved pieces. The selection of interior finishes also helped to tie in the old with the new. Beautiful artwork from the old structure was integrated with new comparable artwork throughout.

The nursing home administrator, Steven Farrow, was very aware of concerns that many of the patients had expressed about the move to the new building. To ease the transition, therefore, he scheduled patient tours of the construction site at various stages. Other outings included involvement by patients at such times as the topping-off party on the construction site and at the ribbon cutting ceremonies.

The resurrecting of Steere House into a new building was done with care and common sense. The most important criteria was the understanding that the facility is there to serve the patients. Thus, most design decisions were made emphasizing that the patient is the true client. Keeping this in mind was the prominent guiding light to creating a quality facility.