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Bright lights, big hallways.

Good design can contribute dramatically to life safety. Although building codes are the major determinant of what goes into structural and building safety, which includes fire prevention and containment, the more safety-conscious providers view codes as just a beginning.

"Codes are a minimum standard," says Vincent Dilorio Jr., an electrical engineer. "If you know you're going to have a building full of elderly people, some with limited mobility, go the next step or two. Do everything in your power to minimize risk."

Dilorio's company, Vincent A. Diorio Inc., in Norwood, Mass., has designed electrical systems for a variety of senior living projects. "We have set our own criteria" he says. "We design the systems as though our own parents were in one of these places."

Where there's smoke...

Codes dictate nearly every aspect of building design when it comes to minimizing risk and loss of life in the event of catastrophe. This is especially true when it comes to fire safety. The National Fire Protection Association publishes no fewer than five separate codes: the National Electrical Code, the Life Safety Code, the Fire Prevention Code, the National Fuel Gas Code, and the National Fire Alarm Code. What's more, fire codes also vary by state and even by community. "If a community has [fire-fighting] equipment that reaches just 30 feet in height, it may approach codes differently and fight fires differently than a community that has different equipment," says James Warner, principal of JSA Inc., a Portsmouth, N.H.-based architectural firm that specializes in assisted living projects.

Code intricacies aside, building design can prove crucial to the integrity of a structure and the safety of its residents in the event of a fire. Sunrise Assisted Living properties typically are constructed of Type 2 concrete and steel, with maximum attention paid to its fire suppression or sprinkler system. "We have a professional obligation to provide care and a moral obligation to ensure that our residents are as safe as possible," says Joe Mikalajunas, executive director of a Sunrise facility in Oakton, Va.

As assisted living has proliferated, code officials have begun to understand that it is a hybrid encompassing residential and health care standards, says Warner. "This has resulted in codes that force design away from wood-frame construction to concrete-and-steel, non-combustible structures."

Like Sunrise, most large developers are building assisted living facilities according to institutional occupancy standards despite the added cost, Warner says. "It sounds onerous to add a $5- to $7-persquare-foot premium to construction costs," he says, "but it affords more flexibility from a program perspective by allowing you to keep space open the way you might see it in a home."

Had Oakton not been built to institutional occupancy code, local fire marshals would not have allowed partial-opening windows in the fourth-floor dementia unit, says Mikalajunas.

You must build to institutional occupancy codes whenever "you have more than six people incapable of self preservation," Warner says. Depending on building height, Type 2 construction includes enlarged stairwell landings with communication access to accommodate residents awaiting rescue. Sunrise's "areas of refuge," as it calls these stairwells, are 15-foot-wide staging areas in which the doors and sealing materials are fire-rated to 90 minutes.

For sprinklers, DiIorio says maximum coverage is set forth in National Fire Protection Association Code 13R (residential-rated). This stringent regulation requires sprinklers for areas not covered under NFPA 13, such as kitchens, closets, bathrooms, and spaces between floors. "If I were considering residency for a family member, I would always ask, 'Is this sprinklered under 13 or 13R?"' DiIorio says.

DiIorio also recommends "analog addressable" smoke detection and fire alarm systems. They incorporate microprocessors that allow smoke detectors to talk to control panels. By placing smoke detectors in all living and bedroom spaces, warnings of smoke conditions occur 7 to 10 minutes before sprinkler activation. "Not only are you saving people, you're not even harming the building," says DiIorio.

State-of-the-art smoke detectors can also help prevent a leading cause of false alarms known as "burnt toast syndrome." Should a resident burn toast and set off smoke detectors, a reset/re-test scenario repeats in 30 or 90 seconds. Re-test times can be adjusted based on individual needs and prevent an emergency dispatch triggered over burnt breakfast.

Depending on construction type, other fire-safe design factors may be warranted or required by law. Fire-rated doors can help protect residents awaiting evacuation; firewalls can help stop flamespread; and automatic fire doors can compartmentalize building zones during a fire. Everything in your facility should be evaluated for flammability and toxicity. Specify fire-retardant or fire-rated building materials, upholstery, furniture, window treatments, and foam. Even artificial plants can be treated for fire retardancy.

When the earth moves

Seismic codes (intended to help protect in case of earthquake) are continually changing as structural research and building products improve. Some recently amended seismic codes now demand structural peer review: The owner or developer must pay a nominal fee of $3,000 to $5,000 to a structural engineering firm to check the original structural calculations.

In addition to specifying brace requirements for ceiling systems, seismic codes mandate structural support for pendant lighting. Ceiling fan boxes must now be bolted to building structures. Seismic construction factors typically add $1 to $2 per square foot to project costs, depending on location and codes, Warner says.

Hurricane-related codes require tie-downs to reduce risk of uplift of roofs and building components, and enhanced materials such as reinforced windows.

Because life safety codes for senior housing typically require that facilities keep emergency food and water on hand, design sufficient storage space. Keep your emergency stores in several locations just in case one area is compromised by disaster.

Safe passage

Building codes, both local and federal (Americans with Disabilities Act, Fair Housing Act), have accessibility requirements for senior living environments. Areas covered by these codes include exits (width, height, number, and location), corridors (width), handrails and grab bars (location, height), equal access for handicapped, floor level changes, protruding design elements, ramp rises and landings, and space allotments per capita.

Beyond building to code, keeping natural adjacencies in mind can lessen disorientation among residents, suggests Warner. "One of the most disorienting factors in a senior care environment is design that is not home-like. The better you are at taking a 50,000-square-foot facility and making it feel like a 2,500-square-foot home, the more you decrease general disorientation. So clustering living spaces with bedrooms would be more consistent with a home."

Sunrise's Mikalajunas emphasizes the importance of designing to reduce everyday falls or mishaps. "We do our best to educate families about furniture placement." Among his tips for a wheelchair-use resident's personal quarters: avoid furniture near the bed, go for an uncluttered bathroom, and eliminate area rugs.

A. bright idea

Appropriate lighting and way-finding systems reduce risk of day-to-day injury as well as aid in situations requiring emergency egress. In Design Details for Health. Making the Most of Interior Design's Healing Potential (John Wiley & Sons), Cynthia Leibrock suggests increasing light levels in areas where "concentration is required, decisions are made, or danger is present." Particularly hazardous, she says, are bathrooms and stairwells. Whenever possible, avoid fluorescent light, which can trigger seizures and agitation, especially among dementia residents.

For power outages and emergency evacuations, codes require minimal light levels. DiIorio, however, believes owners should invest in more wattage. "If emergency lighting according to code costs $45,000 in a $4 million to $5 million building, additional auxiliary lighting would cost only about $10,000 more," he says. To maintain your facility's home-like appeal, integrate the emergency lighting into standard fixtures, all of which should tie into an emergency generator that is natural gas- or diesel-powered and offers about 24 hours of power. If your utility company profile indicates significant or frequent power failures, DiIorio recommends adding a 90-minute battery back-up system.

Photoluminescent technology allows light energy from incandescent, fluorescent, and daylight sources to be absorbed and stored for later use in darkness. Used in signs and indicators, it can provide 7 to 10 hours of glow-in-the-dark directions during the presence of smoke or in case of a blackout. Photoluminescence can be used to highlight doorways, hallways, exits, and stairwells, not only when used in signs, but in feature strips for defining a doorway, handrail, or exit route. For the blind or partially sighted, tactile warning strips, treads, and tile can help in wayfinding.

In designing your signs, aim for contrast--the ADA requires a 30/70 contrast for signage to be seen clearly, the equivalent of black on white--and simplicity of message. Also critical to wayfinding is repeated cueing. Emergency warning systems should include both very loud alarms and strobe lights to signal the hearing impaired. Tactile signals such as a vibrating alarm system might be warranted in certain situations.

Don't be skiddish

An executive for another provider says that, even after investing millions of dollars in fire and hurricane safety features, the biggest safety risk in his facility is that of independent living residents falling over coffee tables in their units.

Low-cost blocking built into the walls of bathrooms, corridors, hallways, and other areas at a standard 32 inches above the floor allows for simple installation of grab bars and handrails. Designing in extra space to accommodate the use of wheelchairs and walking aids gives residents greater freedom of movement and reduces the risk of damage to interior finishes.

In bathrooms, replace standard curb-walled showers with gently sloping floors. Make shower chairs standard. Consider replacing standard tubs with ones that have entry doors, or ledge sears that enable residents to exit with ease. In new construction, place tub faucets at the side rather than at the end of tubs to minimize the reaching that often leads to slips and falls.

Check the slip-resistance rating for all flooring products, particularly if the flooring is going in bathroom areas, in the kitchen, or around swimming pools. Pool points of entry should, of course, include support rails, non-slip steps, ramps, and even lifts.

Elevators should be large enough to accommodate both wheelchair-bound and standing occupants. The doors should be wide enough for gurney entry, and should close more slowly than usual, with a momentary pause before completely closing. Threshold entry should not exceed a half-inch rise, push-button controls should be oversized, and both a visual signal and an audible tone should accompany each stop on the elevator.

Kitchen appliances should have large, easy-to-read dials, buttons, and switches, and automatic shut-offs. Stoves and range tops should have control knobs in front so residents don't have to reach over hot pans or burners.

Rachel Long, a freelance writer from Tampa, Fla., covers hospitality, health care, and senior living design.
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Author:Long, Rachel
Publication:Contemporary Long Term Care
Date:Mar 1, 2000
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