It’s easy to forget that there was a time when standard practice was to build a hospital with double-occupancy patient rooms. But you likely won’t see a project break ground anytime soon that uses that model, and for good reason. Private rooms decrease the incidence of healthcare-associated infections, reduce length of stay, and improve patient satisfaction, for starters.
On the senior living side of the coin, though, we’re not quite there yet. Sure, there are plenty of supporters of the single resident room model, with SAGE at the head of that charge, not to mention it’s just good practice for person-centered design. But in terms of code minimum requiring the move—as it does for acute care—well, it doesn’t.
The issue was raised recently when a jury of industry professionals gathered for our Environments for Aging Design Showcase judging. Within the dozens of projects submitted to the program, there were those prickly shared rooms, which rightly sparked lots of discussion. Some felt the projects should be instantly disqualified, while others were simply disappointed that the design teams hadn’t found a better solution for their clients. Others let it go since, again, if code allows it and a client demands it, it sort of is what it is.
I think all were in agreement that a side-by-side bed arrangement segmented by a privacy curtain was unacceptable. However, while some jurors stuck to their guns that a shared room with a partial wall separating living spaces and a shared bathroom, for example, was objectionable, others saw it as a decent solution to maintain a required census and budget as well as achieve a reasonable amount of patient privacy.
I walked away from the judging wondering where exactly we’re at as an industry on the topic. Are we on the brink of a culture change, transitioning to an all-private model like acute care has done?
I decided to reach out to Jane Rohde at JSR Associates Inc., who has worked with the Facility Guidelines Institute (FGI) on its 2014 debut of Guidelines for Design and Construction of Residential Health, Care, and Support Facilities. It’s the first time a separate set of guidelines was issued by FGI for long-term care spaces.
Rohde confirmed that there’s been a great deal of discussion related to the topic of private rooms, but discussion is about all that’s going to happen.
“Some care models and care populations may benefit from a shared room; therefore, the single room mandate will not be coming out like it did for acute care,” she told me via email. Examples of resident populations that have demonstrated improved outcomes by sharing a room include adolescents in long-term care, adults with dementia, and couples who don't want to be split up.
Beyond the benefits seen in some cases, Rohde added that so often design projects in residential care are renovations rather than new builds, making it extremely difficult for providers to transition from double to single occupancy and maintain the census they require to stay afloat.
However, that doesn’t mean a privacy curtain is the answer. In fact, FGI set out to limit it altogether.
Rohde said the guidelines were updated in 2010 and improved upon in 2014 to provide performance criteria for clearances in new construction. For example, a resident has to have access to a bathroom and to a window without going through another resident’s personal space. That’s pretty tough to accomplish in a side-by-side scenario.
It may not be the kind of progress that some are seeking, but it’s a start. There’s always room for designers to present new ideas and solutions to providers, ways to scale back other parts of the program to make private rooms more financially feasible. Code minimum, after all, is just the minimum.
