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Design for adult day care.

A cult Day Care Centers have become increasingly popular components of contemporary nursing homes. For caregivers, Adult Day Care Centers provide a welcome respite for the periodic care of their loved ones. For the nursing home, they represent an additional income stream. As an "introduction" to the possibility of future long-term skilled nursing care, these facilities can serve as a very powerful marketing tool and also provide a means for the facility to reach out to the community.

The most inviting of these facilities feel, to the greatest degree possible, like a home away from home. They also provide a range of activities and services designed to enrich the guests during the time they spend there. These characteristics are both restorative for the guest and reassuring for the caregiver, who can frequently be anxious about leaving a loved-one behind. Meanwhile, nursing home management is rightfully concerned with the efficiency and functionality of the spaces, the marketability of the facility, and the durability and maintenance of materials, fixtures, and furnishings. The good news is that thoughtful planning and a little creativity can bridge all of these requirements.

Take, for example, the Adult Day Care component of the new Genesis Center for Health and Rehabilitation (GCH&R) in Windsor, Connecticut. The Center is located within a freestanding pavilion at Windsor Hall, a newly renovated, skilled nursing facility, owned by GHV Associates.

Anticipating guests who would have a range of physical and emotional states, Genesis offers three different environments, along with reception and conferencing areas. Since the ideal floor-plan for an Adult Day Care Center consolidates all activities on one level and minimizes corridors to reduce the number of staff required per guest, at GCH&R, all activities revolve around a multi-purpose room located in the center of the facility. We designed this room to be light and airy, although it is fully equipped for the safety and comfort of the elderly and the utility of the staff. Dining and activity tables are wheelchair height, and vinyl-coated fabrics are used that clean up easily, but appear to be elegant chintz. Chairs are equipped with arms and pommel grips; they are also specified with a space between back and seat for easy cleaning. A functional kitchenette, suitable for light snacks and refreshments, does double duty as a backdrop for cooking and arts and crafts I demonstrations.

Both the quiet room and the TV room connect to the multi-purpose room. In order to increase the interaction between guests and facilitate their care by staff, views are provided through clear glass for the multi-purpose room into both the quiet and TV rooms

The quiet room palette draws on traditional furniture and rich jewel tones to impart the feeling of a traditional, cozy study. The room is furnished with bookcases, lounge seating with ottomans, recliners for sleeping, and occasional tables. Cream-colored walls are bordered in a stylized floral pattern. Window treatments provide good sun control, an important design feature for quiet rooms.

The TV room presents a decidedly more casual atmosphere. We dressed up ivory colored walls with a rattan, ribbon-pattern wallcovering border. Queen Anne-style furniture in whitewashed pine is covered with a floral chintz in cooling, pale shades of soft green, blue and lavender. The room is equipped with lounge seating, ottomans, and occasional tables.

Conference and reception areas play an important role in establishing the feel of an Adult Day Care Center. Reception sets the tone for the facility and helps establish the mindset of both quest and caregiver. We prefer that reception areas feel more like a hotel lobby or conceirge desk -- an environment in which guests "check-in" for the day, rather than feel as though they are being "admitted".

Because they are frequently used for meetings with family members during periods of stress, we design conference spaces to be conversational rather than "conference-ational". At GCH&R, for instance, cream walls serve as a backdrop for comfortable chairs and Queen Anne-style coffee tables. Medium cherry wood finishes complement the floral, tapestry-like fabric of the furniture, rich in peaches and greens. A lowboy both serves refreshments and store brochures and other marketing information about the facility.

In designing Adult Day Care Centers, we fully expect guests to bring some "baggage". For some, it will be medications which need to be refrigerated or secured. Others might carry books, a favorite pastime, or a comforting afghan. Many guests will bring a change or "comfort clothes" such as slippers. For this reason, the availability of closets, and preferably lockers, is a critical consideration.

GCH&R also felt it was important to include four special amenities not always found in these facilities: a walk-in shower for therapy and training; a patio equipped with a departure alert system; a physical therapy room; and Physician's Services office.

Offering an Adult Day Care Center that is able to provide retraining in personal habits gives the facility a significant marketing advantage, presenting a welcome resource to caregivers who are unskilled or too overwhelmed to retrain loved ones. Double-sized showers greatly enhance the efficiency of these activities. The shower room is best located near a toilet. One-piece, pre-fabricated showers are available from several resources and must be of a size to accommodate two adults and a wheelchair. Floors should be of nonskid tile. and the room should be equipped with separate storage for both clean and soiled linens and guests clothes. Small-patterned vinyl wall covering and decorative shower curtains help ameliorate any institutional feeling. If budget permits, a small vanity with a lighted mirror adds a spa-like feeling. A washer and dryer for guests' accidentally soiled clothing provides an additional convenience.

At the GCH&R facility, a modest patio presents still another activity alterative. In nice weather, picnics or barbecue lunches can provide another "change of scenery". Bomonite, a stamped concrete, is an attractive and cost-effective paving material. A nice touch are wheel-chair-height planter boxes equipped with hand rails to foster "garden club" activities. Chairs should be equipped with arms, and the patio should be departure alarmed (or have an attractive fence as an alternative; it must be at least 4' high and not "climbable").

Because the skin of elderly guests is often sensitive to the sun, tables should be equipped with umbrellas. Awnings or canopies are practical and elegant, albeit more costly, alternatives.

Adding a Physicians Service office and physical therapy suite contributes to the marketability of the facility, and allow the facility, if it so chooses, to reach out into the community. It is important that the decor and "feeling" of these areas coordinate with the other spaces so that residents feel that their physical therapy and/or examination are as normal a part of their expected activities as are resting, reading, or arts and crafts.

As is often the case, one of our challenges in designing the Genesis facility was budget. To maximize budget without detracting from the coziness of the facility, we were very strategic in our selection of materials. Throughout the facility, walls are painted in neutral colors with an easily maintained satin finish. Vinyl wallcovering borders add visual interest and help reduce the scale. Matted and framed posters were selected to complement each environment, including Physicians Services and physical therapy. Throughout the facility we used vinyl composition tile in a subtle diamond and dot pattern to provide an illusion of stone. In more expansive spaces, larger-scale patterns help define different areas, add interest to the floor, and reduce the "vastness" of the space. Whenever possible we chose prefabricated, rather than custom-built, storage units. Our selections, including upholstery and accessories, were made from manufacturer's standard health care and hospital lines, and utilized standard flame-proofing and laminating; this helped reduce both cost and installation lead time. Throughout the facility we primarily relied on energy-efficient fluorescent fixtures, augmented with decorative ceiling fixtures, scones and table lamps. As America continues to age and to age more gracefully, old notions about the ways in which we will spend our remaining days are beginning to disappear. Successful health facility design in the 21th century will be grounded in this understanding, although all the while responsive to the economic priorities of the institution. In concert, they will produce health care and nursing facilities in which form and function ultimately evolve in a humanistic direction.

Annemarie Kretschmann is principal of Annemarie Kretschmann Interior Design, Westport, CT, a six-year-old firm that specializes in the interior design of health-related facilities. Ms. Kretschmann has designed medical offices, hospitals, skilled nursing facilities and long-term living centers, and has had tenures with Cesar Pelli, The Eggers Group, Train Olson & Yougren, and Jeter Cook & Jepson.
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Author:Kretschmann, Annemarie
Publication:Nursing Homes
Date:Sep 1, 1994
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