1. Environmental Design

2.  Is there a relationship between physical environment factors and resident and staff outcomes?

3. Environmental Design  Health Promotion by Design in Long- Term Care Settings  Anjali Joseph, Ph.D. The Center for Health Design, August 2006 Prepared for the Laguna Honda Foundation with funding from the California HealthCare Foundation  www.healthdesign.org/research/reports/l ongtermcare.php

4. Environmental Design  The physical environment impacts outcomes among residents, their family, and staff in three main areas: (a) resident quality of life (b) resident safety (c) staff stress.

5. Environmental Design Different aspects of the physical environment—such as the unit layout, supportive features and finishes, reduced noise, as well as access to outdoor spaces—may be linked to better outcomes,

6. Environmental Design Better Outcomes include:  improved sleep  better orientation and wayfinding  reduced aggression and disruptive behavior  increased social interaction  increased overall satisfaction and well-being

7. Environmental Design  The Kingswood Manor Health Care Center in Kansas City, Missouri was originally designed on the philosophy of a medical model of care. The physical environment was focused more on the medical care of the residents and staff efficiency and sacrificed, for the most part, the residents' social, psychological, cultural and spiritual needs. As a result, the environment reflected many "institutional" characteristics, typical of many long-term care facilities built in the 1960's and 1970's.

8. Environmental Design  Environmental Characteristics of the Facility  Long-corridors with resident rooms on both sides  Double occupancy resident rooms  A large dining area  One large activity area  A central environmentally dominant nurses' station  Institutional finishes such as vinyl flooring and uniform fluorescent lighting.

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10. Environmental Design  The pre-renovation floor plan of the Kingswood Manor Health Care Center. Long hallways with resident rooms on both sides, a large dining room, and a centrally-located institutional nurses' station characterized the institutional nature of the health center before renovation.

11. Environmental Design

20.  The Kingswood Manor Health Care Center underwent a major renovation in 1999- 2000 to incorporate innovative design features responsive to the needs of people with dementia and elderly residents in general. The environmental changes are based on a number of therapeutic goals. The goal statements highlight the desired relationship between the environment and the residents with dementia.

21. Environmental Design  The therapeutic goals are (Cohen & Weisman, 1991):  Ensure safety and security  Support functional ability through meaningful activity  Maximize awareness and orientation  Provide opportunities for stimulation and change  Maximize autonomy and control  Adapt to changing needs  Establish links to the healthy and familiar  Provide opportunities for socialization  Provide appropriate privacy

22. Environmental Design  Based on these therapeutic goals, several design principles have evolved. These design principles provided the basis for environmental modifications at Kingswood Manor. These modifications include:  Noninstitutional character  Household cluster  Domestic kitchen  Domestic dining  Enhanced privacy in semi-private resident rooms  Dignified bathing

23. Environmental Design

25.  A new section was created based on a household model. The other two wings have their separate dining spaces and kitchens.  Above is the floor plan of the newly-constructed 10-resident household cluster.  The central activity space at the heart of the household provides easy access from resident rooms. The adjacent dining space and kitchen have domestic scale and ambiance. The household has eight single-occupancy resident rooms and two semi-private rooms. These latter two rooms have much greater privacy than simple rectangular rooms de to their L-shape and a wall to partition the spaces.

26. Environmental Design

28.  The scale of the new nurses' station has been reduced to reduce the institutional image. The nurses' station is centrally located but is in the corner contributing to more resident-oriented spaces. The central nurses' station has been replaced by an aviary. The residents enjoy sitting around the aviary and watching the birds. This area has become popular for family members to spend time with their loved ones when they are visiting.

29. Environmental Design

31.  The kitchen (adjacent to the dining space) provides potential opportunities for residents' involvement in working with the staff in baking or other cooking activities.  Dining space in the new household -- adjacent to the living/activity space. This space is homelike in scale and finishes. The windows provide natural light and views to the outside garden area.

32. Environmental Design

36. Post-renovation: bedroom  Double-occupancy resident rooms in the renovated wings have carpet that creates a homelike setting and helps improve the acoustics of the room. Homelike furniture, curtains, and wall treatment create a residential ambiance.  The double-occupancy room in the new household provides greater privacy for the residents with its L-shaped configuration and partition wall.  Bay-window seat in the resident rooms provides ample horizontal surface to put personal belongings that are meaningful to the resident and help create a sense of home.  Bathing equipment appropriate for frail elderly.

37. Environmental Design

39. Post-renovation: hallway Renovated hallways with residential finishes and ambiance. Carpeting, wall finishes, and lighting help reduce institutional aspects. Household focus -- living/activity space. The space has a homelike scale (used by 10 residents) and ambiance.

40. Environmental Design

42.  Rosa Coplon Living Center The only nursing home to be awarded the prestigious Peter F. Drucker Award for Non-Profit Innovation.  Hailed as the "nursing home of the future," Rosa Coplon Living Center has revolutionized the delivery of care to the elderly..

43. Environmental Design  Gone are long corridors lined with wheelchairs and the odors associated with nursing homes. Instead, residents live in home-like clusters where spacious private bedrooms open into sun-lit living rooms. With only 7 or 8 residents per cluster, caregivers are never more than a few steps away. Our medical director, who specializes in geriatrics, and our full-time geriatric nurse practitioner monitor patient needs on an on-going basis

44. Environmental Design  Life-enriching activities that consider individual interests and abilities are part of life on each cluster. Many residents enjoy helping to care for the plants and pets that are part of the natural habitat. We are proud to also offer music and art therapy programming which further enhances the quality of life at Rosa Coplon.

45. Environmental Design

46.  Our Passion We are passionate about creating a home-like environment that enables individuals to live according to their needs, wishes and values.  We will sensitively and empathetically listen and respond to the needs of our customers.  We expect associates at every level within our organization to demonstrate an eagerness to serve.  We will provide an environment that fosters and celebrates creativity and innovation  We will demonstrate compassion, respect and dignity for all members in our community.

47. Environmental Design  Innovations Weinberg Campus' thoughtful and innovative design has been both a national and international model. In 1993, we were one of five national recipients for outstanding architecture design for the elderly. We were also the first nursing home to receive the Peter F. Drucker award for non-profit innovation for our Cluster management Program in 1994. Opened in 1998, Garden House Apartments offer a one of a kind program and architectural design specifically for the memory impaired.

48. Environmental Design

49. Baycrest

50.  Baycrest is one of the world's premier academic health sciences centers focused on aging. Through its strengths in research and education, Baycrest is using the power of inquiry and discovery to improve the health of tomorrow's elderly while at the same time care for and enhance the quality of life of the elderly today.  Baycrest provides care and service to approximately 2,000 people a day through the Baycrest Geriatric Health Care System which includes a unique continuum of care from wellness programs residential housing and outpatient clinics, to a 472-bed nursing home, and a 300- bed complex continuing care hospital facility with an acute care unit.