Adapted for all

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Building an on-site dialysis suite can improve the quality of life for residents.
Building an on-site dialysis suite can improve the quality of life for residents.

The 20 bump-outs dotting the second story of the Leonard Florence Center for Living are but a small clue to the innovative design at play inside the Chelsea, MA, skilled nursing facility.

Extra space in each private bedroom dedicated for amyotrophic lateral sclerosis and multiple sclerosis patients allows enough turning room for a powered wheelchair equipped with a ventilator pack. It's an integral component of the Florence Center, an urban Green House community where building design and technology combine to give residents with severe physical limitations a sense of freedom.

Many of today's senior living residents desire a home that mimics their lives before long-term care. Forward-thinking providers are adding personal space, adapting equipment and redesigning their facilities to incorporate residential style.

Hidden beneath high-end finishes and cozy touches are functional improvements for patients coping with chronic conditions. Families of today's special needs residents expect their loved ones to continue doing the things they enjoy with gentle support that intensifies over time.

“They're the ones bringing their family members in, and they want their parents to have everything in case,” says Jeanna Swiatkowski, a senior design consultant with Direct Supply Aptura. “It's creating settings …where the medical needs are hidden in the room.”

While the majority of facilities still provide care for people with mixed needs, others have launched specialized options targeting specific populations. 

The Florence Center hopes to be a model for others devoted exclusively to patients who maintain strong cognitive abilities despite physical challenges; Columbus Colony Elderly Care provides services for deaf-blind residents and cottages for deaf residents; and memory centers around the country are taking on a new feel with populations divided by stage of symptoms or even shared attitudes.

Louis Tenenbaum, a Potomac, MD-based expert in aging in place, says many components of specialized facilities carry the appeal of universal design — features that provide the best service to the most people. Bells and whistles attract residents and improve quality of care; they may also attract employees, improve retention and reduce operators' liability costs.

“You have to look at how these technologies and design elements help the patients, the administrator or the staff in ways that are unexpected,” says Tenenbaum.

For dialysis patients used to spending six to seven hours away from home on treatment days, a single design change can be life-changing. Dedicating space for on-site dialysis rooms eliminates patient travel, improves quality of life and leads to better health outcomes, says Barbara Bednar, president and CEO of Reliant Renal Care.

Reliant runs dialysis centers and provides in-home dialysis training in six states.

Last year, the company established its first on-site dialysis room at a Baton Rouge-area nursing facility.

Instead of traveling three days a week to spend four hours on dialysis, patients are treated in a designated room where they can talk with fellow patients, watch TV or take supplemental feedings. The sessions run five days a week for two hours at a time. Bednar said more routine sessions are easier on the body, and the medical staff coordinates efforts to follow patient treatment plans.

“Dialysis is a very tough life for people in their twilight years,” says Bednar. “This gives us a loop of communication that better meets their needs.”

Reliant's on-site services require a minimum of space for four patients, electrical outlets and a sink. Portable dialysis units are about the size of an end table.

Setting aside a room for medical treatment isn't enough in these times of personalization and house-holding. Furniture and durable medical equipment are also expected to reflect attention to special needs.

“An assisted living facility that provides several levels of care is supported by these critical care devices that offer treatment and mobility,” says Mike Santillo, vice president of healthcare for Flexsteel. 

Santillo says his company's products help accommodate more types of treatment, which ultimately means residents can stay in one unit longer. The treatment recliner can be used to wheel patients into dialysis or oncology treatment, recline them or move them from a seated position to a gurney. It has become the company's No. 1 acute care item in less than a year on the market, and Santillo says assisted living and skilled nursing facilities are among his best customers.

Memory care and bariatric

Todd Kaestner, executive vice president of corporate development for Brookdale Senior Living, says the company approaches redesigns based on market demand — and the market continues to demand specialized memory care options.

“We've found that it's not appropriate to take those with early stage dementia and mix them with those who have already aged in place for four or five years,” Kaestner says.

Brookdale's “Crossings” are small-scale centers that segregate early-onset dementia patients from those whose condition has worsened. Such innovations appeal to consumers, Kaestner says. Beyond that, memory units are designed to provide comfort and lessen the frustration of Alzheimer's patients. Dead-end corridors and disorienting carpet patterns that could lead to falls remain on the outs. 

Those who have dementia along with blindness or visual impairment can still respond to texture, notes Lissa Rolenc, ASID, of the Wisconsin-based firm 4 design. 

“Adding textures on walls in key areas can help the blind with way-finding when coming to a ‘T' in a corridor,” she says. “A special texture can be used on bathroom doors to make them stand out as they are approached.” 

Private bedrooms (unless residents fare better with a roommate) and bathrooms have become the standard even in late-stage memory facilities. In some cases, density has been decreased for the sake of environment.

“A 200-square-foot room where you can possibly reach out from your bed and hold your roommate's hand is not dignified,” Kaestner says.

Gregg Weinschreider, owner of SleepSafe Beds, is working to get his product into more assisted living communities, noting many customers want safety products that deliver a homey feel. Customized products have never been more marketable, he says.

SleepSafe is also developing bed rails that better accommodate residents at risk for entrapment. A rail can be critical for keeping Alzheimer's patients from wandering, but an arm, leg or worse stuck in the rail can be confusing and potentially very dangerous.

Kwalu is working with its clients to deliver multi-tasking furniture that fits into memory care environments with safe but nurturing spaces.

“The idea is to deliver affordable organization including wardrobes built into an existing closet, or corner units, customized to suit the style and space of even the smallest of rooms,” says CEO Michael Zusman. “Minimal clutter can be more soothing to the resident who may have poor eyesight or dementia.”

Special needs consideration extends to common areas and activities, as well.

Accessible System's Adjust-a-Sink allows many residents to remain in their wheelchairs at the salon, reducing transfers. It has been installed in more than 2,700 facilities.

“The product is especially helpful with dementia patients as it reduces the disruption [transfers, wet clothing, excessive physical handling] normally associated with a shampoo, and thus, reduces the opportunity for agitation,” says President Dave Shusterich.

Faced with declining reimbursement and strained budgets, many facilities are focusing on cost reduction even as they seek new solutions.

“How can we make what's working, work better, safer and at a lower cost? That's what we're being asked,” says Joe Oberle, senior director of Product Marketing for Drive Medical.

Eight percent of Drive's sales are now bariatric products, which go beyond beds to walking aids, bath safety equipment and commodes. Wheelchairs with 30-inch width and 700-pound capacity can combine with specialized canes, rollators and power chairs to promote independence and mobility.

“Most end-users and some providers think that once you pass the 300-pound weight capacity that there is very limited variety,” Oberle says.

But newer products help address co-morbidities, with lower beds, higher weight tolerances and pressure management components.

Technology trends

After years of recommending technological innovations, Swiatkowski is seeing more acceptance industry-wide. Direct Supply, for example, has a showroom devoted to app-enabled equipment.

Technology can be life-altering for those suffering from hearing loss. Information about a ringing phone can be projected onto a TV or tablet, and automated lighting cues like dimming can be used to announce meal times or other daily activities. 

Hearing loops are in use at several Brookdale communities. A system looped around a communal space can transmit sound magnetically to telecoil hearing aids, keeping residents connected through programming and announcements. It can counter the loss of stereophonic hearing, which exacerbates dementia.

Kaestner credits music with keeping residents engaged and happy, adding that it can create a strong dopamine response in the human brain. But he notes that the technology won't work without attentive staff. Changing the batteries in patient devices can't be overlooked.

At the Florence Center, technology literally speaks for patients who can't. Equipped with power chairs and computers that hover over their laps, residents use eye-gaze technology to control lighting, heat, doors, even elevator keys. Each patient also can choose a computer voice to communicate with others.  

“A person's computer becomes their command center,” says Betsy Mullen, RN, chief clinical officer for the center's operator, Chelsea Jewish Foundation. “Anything you can run from an electrical outlet, they can control.”

For early-onset patients who previously lived in typical long-term care, the restored independence is akin to treatment. Mullen says her residents depend on the computer as they would an arm or leg.

One of just a handful of care facilities employing such large-scale technology, the Florence Center attracts many residents online. But design experts believe more local facilities will implement high-tech tools that promote independence as more baby boomers age and move in.

“It's going to be almost an expectation as our generation ages,” Mullen says.

Many Florence Center residents opt to use a ventilator in their final weeks or months, and the rooms were built with that space need in mind. It's part of an overall approach that keeps residents in their homes for as long as they'd like.

Swiatkowski says “convertible” spaces with wide doorways, high voltage outlets and a bigger footprint are more in demand than ever. Tenenbaum agrees, noting that families hate to see their loved ones move from one building or wing to another.

For Brookdale's Kaestner, including non-institutional details is also critical. The window-to-wall ratio, heating systems and bath fixtures might not be noticeable on their own, but they create a whole greater than its parts.

“You have to look beyond the four walls and the dimensions … to think about what really makes the room,” he says. 

Finally, administrators should not forget about lighting issues and access to outside views, Rolenc says.

“Natural lighting is important to all humankind, but specifically it has been proven to improve the mood and health of those with mobility issues,” she says. n 


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