Design Decisions: A household into a home

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Design Decisions: A household into a home
Design Decisions: A household into a home
When the management team at Homewood at Williamsport set out to renovate the 1950s-style skilled nursing facility at their continuing care retirement community in 2002, they had no idea they'd end up with a modified Green House. But they didn't know they'd have to take on Hurricane Katrina, either.

Richard Lenehan, Homewood's executive director, said his team had planned to maintain the building's 121 beds when it started taking bids from contractors. The leaders also had planned to build a traditional hospital-style nursing home.

Then Hurricane Katrina came along. While it didn't strike anywhere near the Williamsport, MD-based campus, it drove up the cost of materials by one-third. Lenehan said he then realized they wouldn't be able to build the three-floor building they were planning.

“We were landlocked,” he said.

After conducting more research and attending some LeadingAge seminars about the patient-centered and household models of care, Lenehan said he decided to move in that direction. However, that also meant the facility would need to shrink in capacity, down to 82 residents from 121. That meant each “household” would have about 16 residents.

Michael Allen Hall, Homewood's architect, said going to a household model made sense for many reasons, such as the campus's affiliation with the United Church of Christ. But it made logistical sense, too.

“From a design standpoint, far and away the biggest issue was existing campus with very little land. We had to shoehorn the facility into this space,” Hall explained. “But once we got the numbers down and started to go philosophically in the right direction, it was pretty straightforward.”

In addition to improving care, the household model offers unique marketing opportunities, says Hall. The design improves a nurse's access to residents and encourages relationship-building, he said.

Construction started in May 2007. Knowing that he had to winnow down his total number of residents, Lenehan worked with his facility's board of directors to make sure nobody was asked to leave. They closed the SNF to new admissions and let residents transfer to different facilities voluntarily.

Construction was completed in 2009. Half the rooms are private; half are semi-private.

Lenehan said the switch to a household model improved morale and resident satisfaction very quickly.

“We've seen fewer falls since hallways are less cluttered. And since meals are served in each household, we've seen better meal acceptance and weight gain. And turnover among staff has definitely improved,” Lenehan said.
Hall said the households were designed with flexibility in mind so that should couples be admitted to the facility, rooms could be adapted to be shared.

Lenehan says that when they first started planning, he wasn't entirely sold on the household model, but now he's all in.

“Buildings don't give care, our staff does,” he notes. “We treat residents like they are our parents. We try to instill this in everybody.”

Lessons learned

  • Buildings don't give care — staff members do — so try to make sure they're on board in a redesign.
  • State regulators are coming around on the culture change front, but still be prepared to do some educating.
  • Make sure CNAs know how different their duties are in a household model.


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