Skilled nursing facilities: advice from the experts.

The panel offered insights on various aspects of designing skilled nursing facilities (SNFs). On programming and planning, George Pressler, president of Planning Decision Resources in Topanga, Calif., said, "Skilled Nursing Facilities (SNF) or Skilled Nursing Units (SNU) serve the living and healthcare needs of the tender, frail resident--requiring utmost respect and dignity"

He added, "Keep these things in mind when considering the design of a SNF:"

* Residents may be short-term or very longterm;

* Design space for family or visitors;

* Understand the levels of care to be provided within the SNF/SNU as the definition is quite broad and may encompass a variety of patient types with differing clinical and social needs;

* Recognize that the "world" you are designing for the resident may be as limited as a five-foot distance from the bed ... within one room;

* Resident sensitivities to light, temperature, and sound may be extreme. Consider the ability to adjust each environment to accommodate the particular needs;

* Provide for sufficient staff and clinical support spaces;

* Plan the circulation with minimal turns and circuitous routes;

* Consider emergent or urgent clinical access needs for both bringing essential services to the resident or movement of the resident to these services;

* Make certain elevators are sized to accommodate a stretcher and two to three attending staff.

* Recognize the dignity of the resident, the patient ... the person ... at all cost.

On architectural design, Armando Gonzalez, principal of Gonzalez Goodale Architects in Pasadena, Calif., said, "Challenge existing codes and statutes that limit design and human environments"

He added, "Avoid formula solutions, limited institutional attitudes, and strive for creative environments that nourish the human spirit, enhance patient care attitudes and welcome family and guest visitors;"

* Vigorously tackle regulatory requirements that limit new, creative solutions to caring environments;

* Promote the use of maximum day lighting throughout the facility;

* Integrate exterior and interior design elements that encourage effective way finding and design special visual features that assist all with orientation.

* Explore/promote decentralized nurses' stations, social spaces that are close to clustered units / beds, residential scale dining rooms and smaller work stations.

Kay Trimmer, president of Kay Trimmer Interior Design in St. Petersburg, Fla., discussed interior design.

"Skilled Nursing Facilities are built to maintain a quality healthcare style within a setting of commonly shared services such as bathing, dining, social, etc.," she said. She added:

* SNFs are, many times, located within a campus-style setting that accommodates congregate care and facilities for step-down care;

* A SNF is often referred to as a "nursing home," thus color, pattern, texture and moisture barriers must be given attention;

* SNFs are highly regulated in each state--all fire codes must be adhered to;

* Staffing of SNFs usually consists of registered nurses, nursing assistants, licensed vocational nurses and licensed practical nurses;

* SNF provides care 24 hours a day--seven days a week;

* SNFs usually signal the final stage of life, so all furniture, fixtures, and equipment are provided--hospice may be provided;

* The goal in design is to offer dignity in an institutional setting with appropriate seating--with moisture barriers with appropriate heights and widths for furniture. Slip and fall accidents occur often. With this in mind, correct flooring is crucial throughout the facility;

* Since space is only about 150 square feet per person, furnishes and finishes should be refreshed about every five years--so families of loved ones are in clean comfortable setting within their rooms;

* At times residents can bring a favorite dresser, cabinet, artwork or lamp. All seating, however, should be provided by the facility and to meet state fire codes.