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Successful design in long-term care begins with a master plan

February 28, 2012
by Gary Prager, AIA, NCARB, LEED AP, CEFPI, CDT
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Successful design begins with a unified vision

Perhaps no other residence demands as much diverse design skill and thoughtful care as a senior living and healthcare facility. In the past 20 years, there has been significant change in the way senior healthcare is delivered. “Modern” seniors are becoming more demanding in the type of facility that can accommodate their needs. The challenge to house the full spectrum of seniors from fully independent to skilled nursing can be daunting because of the range of health conditions, acuity and social needs involved. The efficient use of common facilities, while maintaining the separation of programs, presents unique challenges not found in traditional buildings. Entering into this puzzle is the need to provide community and family access while maintaining adequate levels of security. Designing for senior living demands creative solutions to several conflicting sets of needs.       

The questions for operators are: “Do I build a replacement facility, add on to the current facility or simply renovate what I already have?” “How do we maintain our current income during construction?” A comprehensive master plan approach can answer these questions and more.

FACILITY MASTER PLAN

The Facility Master Plan (FMP) provides a direction from the existing physical plant to a consensus future vision of senior living that is fully aligned with the provider’s objectives and the residents’ needs. An FMP is an investment not an expense. It coordinates and aligns diverse considerations into a strategic long-term vision. It can be all-encompassing or cursory and limited to a portion of the facility, the entire property or targeted to specific levels of acuity. The greater the effort that is put into its development, the more credible the results will be.

PARTICIPANTS, STAKEHOLDERS

The most viable Master Plans reflect extensive engagement of administration, staff and affected stakeholders. To achieve this, the FMP effort is led by a committee of experienced professionals with strong leadership capabilities and facilitation skills as well as a grasp of the technical aspects of facility planning.

Typically, professional planners have a solid understanding of both senior healthcare and building design. As appropriate, specialists such as architects, engineers, industrial hygienists, realtors and a variety of specialists in communications, security, technology, landscape design, costs and more add depth to the effort. Nurses, department heads, therapists and healthcare providers are the experts in geriatrics and patient care and their involvement is essential. Jurisdictional agencies and other regulatory and advisory resources such as EPA, ADA and LEED also contribute to the successful achievement of a Master Plan.

COMMUNICATION

To be credible, the FMP reflects the extensive input from many constituencies and stakeholders. Communication enables groups to arrive at a shared understanding of the values and goals of the operator, who should be informed of all decisions.

To facilitate the candid communications objective, the FMP Committee should be knowledgeable of streamlined and efficient—yet interactive and productive—methods of collaboration.

Lengthy brainstorming sessions engage the committee and can generate valuable information and ideas. These sessions identify issues and visions.

Workshops are another alternative for data collection, communication and validation. Conduct a workshop for the stakeholders group before initiating the FMP. A separate “goals and criteria” workshop can be used to develop organized and balanced approaches to decision making.

Focus groups usually consist of all interested stakeholders to ensure that all aspects of facility planning are considered and an understanding of the delivery of healthcare, technical, financial, administrative and political dimensions of the implementation of the FMP is established.

Regardless of the communication format(s) selected, the committee’s willingness to absorb information and make timely decisions is crucial to Master Planning, scheduling and outcome budgeting.

PROCESS

The Master Plan process consists of five interrelated parts that resolve, depending upon the size of the facility, the services provided and expectations for the conclusion.

Part 1: Vision

The vision is the foundation of the Master Plan defining many variables that affect the environment and is conducive to the delivery of healthcare.

The mission statement identifies parameters and develops core values and goals, which will serve as a pragmatic and creative compass for future decisions. At this point, a schedule with realistic milestones for completion of the Master Plan should be established, allowing for adequate analysis and stakeholder involvement.

Demographics provide the statistical basis for planning. This data analyzes the age of the population, income levels and survival rates. It also identifies the gender population and familial status that will become a target market. When this data is evaluated in the context of mission and the healthcare program, a framework for capital planning begins to develop.

Defined healthcare and social programs ensure flexibility of the physical plant to accommodate the changes in medical technology and healthcare programs, regardless of acuity level. Operations establish the link between programs, building and site. They define the use, the size and configuration of spaces and utility requirements, furnishings and equipment necessary for delivery of programs to users.

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