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Renovating an Azheimer's SCU on-site.

New challenges -- and fulfillment -- came with this nursing home's renovation project

Special Care Units may be state-of-the-art for Alzheimer's care, but developing one on-site presents many challenges. That's why the completion of the 2,650-square-foot, two-story addition to the SCU at The Hillhaven Corporation's San Luis Medical and Rehabilitation Center, a licensed nursing home in Green Bay, Wisconsin, was a dream come true for Tom Larson, Senior Administrator. Larson's goal for the project was to enlarge the existing unit and to make its environment less restrictive and more homelike for residents, resulting in better, more specialized care.

"We had been trying for about five years to secure funding for the addition," said Jim Bishop, Maintenance Supervisor. "Our old unit was an existing wing with a small dining area. Now we can provide special care for advanced cases of Alzheimer's. We're more equipped to treat special needs residents."

The addition included nurses' stations, dining and activities areas, bathing facilities, and rehabilitation kitchens for both floors at the end of the SCU unit, with a double-loaded corridor. A secured courtyard on the ground level was a special feature of the addition.

Design for people with dementia is a complex process; every detail must be seen as a therapeutic tool. As stated in Contemporary Environments for People with Dementia, by Uriel Cohen and Kristen Day, "It has been argued that many of the behaviors attributed to dementia are, in part, a consequence of counter-therapeutic settings."

"Rather than designing the space for the families, which is often a pitfall, we really wanted to stimulate the residents in every way possible," said Gene Eggert, AIA. "I truly believe architectural design can directly assist in minimizing resident disorientation and anxiety."

Design

Maintaining a home-like atmosphere was the primary goal. The project team researched the newest, most advanced design techniques available to them within their budget, and combined those techniques with a residential focus.

Prior to beginning the design of this addition, the project team from Architectural Designs toured other SCU units, such as Hillhaven's Mount Carmel facility in Burlington, Wisconsin. From the tours, problem design areas, or areas which could be improved in existing SCU facilities, were studied. Some consistent observations from the tours were that the residents enjoy and need to touch objects and materials; the nurses' stations are typically too small; chairs in the activity rooms are often too large for residents; and kitchen cabinets and resident room closets are not specified with locks.

Design Concept

The entire unit was designed to maintain full visibility of the common areas by the nursing staff at all times, with observation windows surrounding the nurses' station. All patient rooms are housed on a corridor, with the nurses' station centrally located at the end of the corridor. On either side of the nurses' station are common areas for meals and activities. Secured doors were installed to prevent patients from wandering.

There were some special considerations in designing the various areas:

1. Nurses' Stations

Caring for people with dementia is an extremely demanding and draining job, from which staff members will need an occasional break. In addition, they need a space for charting and private conversations with physicians and colleagues. Also required is a location for potentially dangerous (to the residents) equipment and supplies. The nurses' station was designed to meet these needs and to allow for comfortable seating, sufficient storage space with built-in wood cabinetry, and convenient work areas.

2. Dining and Activity Areas

These rooms were designed as "public centers" of space, but resembling living rooms or family rooms in typical modern habitats. Like many households, each activity room has an adjoining toilet room. The large, residential windows let in plenty of light. Some of the wall hangings consist of washable quilts, which encourage the residents to explore their environments both visually and tactilely.

3. Rehabilitation Kitchens

The kitchens were designed to enhance the domestic ambiance of the unit. These spaces are useful to dementia patients because they make available meaningful and therapeutic activities and experiences, including such familiar household tasks as washing dishes, simple meal preparation, setting tables and folding towels. Workspace is provided for both counter and table heights.

The fully-equipped kitchenettes are complete with refrigerators and ovens, which can be controlled by a lock box installed in the adjacent cabinet, to avoid unsafe use by certain residents.

4. Courtyard

A large, secured courtyard was also added to allow for outdoor activities for the residents in a safe environment. The courtyard area is square, with a cement wandering path. "The path has curved corners, to assist residents. Soon, plants and foliage will line the path, with grass in the middle. Two patios and a pavilion will also be available to the residents," said Stacie Herzog, the facility's Alzheimer's Program Director. "The courtyard will provide residents with even more activities."

Finishes

Shades of blue and mauve were utilized throughout the main corridors. Textured wall covering and handrails were used to provide sensory stimulation. Also, it is easier for the residents to walk the corridor if they can see and feel the wood handrails, which serve as boundaries for them.

Traditional oak furniture with floral patterned fabric projects a home-like atmosphere, while the fabrics allow for low maintenance and easy cleaning. Because of the traffic generated by staff members and residents throughout the corridors, some compromise had to be made regarding the institutionally finished flooring; it was decided that vinyl tile flooring would be easier and less expensive to maintain than carpeting.

"Everything from paint colors, lighting and hardware to fireproofing and exit stairways was carefully deliberated over," said Eggert.

Construction

This project was the first commercial job for general contractor Jim Davis. Because of our priority on a homelike environment, the firm utilized a residential contractor to ensure the high quality standards of the residential end of the construction industry.

The work was especially challenging because the residents were living in the adjacent wings during construction. At one pre-construction meeting, a list of special guidelines was given to the contractor to assist him with resident contact (see "Construction Guidelines," p. 16). The guidelines briefed the contractor on the special needs of the residents on the wing, and emphasized that they must be treated respectfully and with extra care. Throughout the construction, it was stressed that the space under construction was the residents' home. While the business of construction occurred without delay, the contractors were truly doing a residential-type renovation, and the residents were treated as honorary homeowners.

"The information provided was helpful," said Davis. "It gave my employees insight into the project before it started. And we were prepared for patient contact."

Some unavoidable challenges did arise. When a plywood wall was erected so the renovation work could continue without being disruptive, the curious residents could no longer clearly view the construction process. Some of them reacted by pushing or kicking the wall. Said Program Director Herzog, "I think the construction noise aggravated some of the residents. To deal with this, one of the dietitians had the idea to provide special viewing holes to enable them to observe the construction without being in danger. The contractor actually cut a hole in the wall and put Plexiglass in it so residents could see the progress."

Nevertheless, said Herzog, "the construction process was fairly distressing to residents. They seemed to be more agitated, and the ratio of falls went up during that time period."

Results

As was hoped, however, the benefits made up for the difficulties. "The addition has made a major difference in the behavioral patterns of residents," said Herzog. "They now have an activity room where they can relax, and they love looking out the windows."

According to administrator Larson, "The addition has very much enhanced the special care unit. It resulted in renewed interest in the community. Our waiting list had dwindled prior to construction. After the groundbreaking ceremony, the list began to grow again, and with the unit now complete, we have in excess of 20 individuals waiting to be admitted."

In short, a conscientious effort to design a resident-oriented facility paid off: It indeed made a dream come true.

Construction Guidelines

The addition being built is going to accommodate our facility's most confused residents. Obviously, the construction crew will interact from time to time with these residents throughout the construction project. The following work rules may seem like a common sense issue to the average person, and indeed they are. However, it is imperative that they be followed without exception, as the potential for accidents is much greater with these confused people.

1. Tools, equipment and supplies of any kind are not to be left unattended where residents have any possibility of access to them. It would not be uncommon to have a confused resident drink a toxic cleaning chemical or put a sharp object into his or her mouth.

2. Staff must be informed prior to disconnecting any door alarms.

3. If a resident inadvertently wanders onto the work sight, inform the staff immediately.

4. Inform the Unit Coordinator, Stacie Herzog, in advance, of any interruption in electric or water service. Twenty-four hour notice is asked for any interruption in water service, as this may affect the bathing schedules.

5. Foul language will not be tolerated.

Robin Eggert is a Principal at Architectural Designs, 1219 North Cass Street, Milwaukee, Wisconsin 53202 (414/276-7255; Fax: 414/276-7258). Founded in 1986, the firm specializes in design and construction management for senior centers, as well as commercial and residential projects.
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Title Annotation:Alzheimer's disease; special care units
Author:Eggert, Robin
Publication:Nursing Homes
Date:Oct 1, 1993
Words:1585
Previous Article:Avoiding change orders (and other renovation headaches).
Next Article:Looking good: what designs work best for residents.
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