There are countless skilled nursing facilities out there that have long outlived their shelf life, presenting owners with decisions on whether to renovate or build an addition, how to address deficiencies, and ways to update the built environment to respond to new trends and culture in care delivery.
"What do you do to make sure your product is marketable?" said Dan Godfrey of RLPS in the session "Renovation Realities: Creative Conversion of Medical Models" on Monday of the Environments for Aging Conference in Baltimore.
In this two-hour deep-dive session, Godfrey was joined by the team behind the renovation of the 453-bed, three-floor skilled nursing community Masonic Village at Elizabethtown in Elizabethtown, Pa., including Beth Bossert, COO of healthcare services for Masonic Villages, Derek Perini, senior interior designer for RLPS, and Michael Funk, senior vice president of Wohlsen Construction Co.
The project was a physical transformation to better support Masonic Village's culture change to provide more resident-centered care. The community had adopted the Eden Alternative as its care model 15 years ago and made strides as far as staff and resident buy-in, but Bossert said it wasn't enough. "We realized our building and infrastructure was starting to slow us down," she said.
The existing facility featured a typical nursing home floor plan with a staff station at its core and redundant circulation around it. "That's really just the way it was done in the 70s and 80s," Godfrey said. The goal for the renovation was to instead create a place that balanced a homelike atmosphere with a new operational approach.
To start, the team held a town hall meeting with stakeholders. "We told them, 'Dream. What works here and what doesn't?'" Bossert said. After hearing feedback and doing plenty of their own brainstorming and gathering of best practices, the team opted for a design that decentralizes nursing with a smaller staff room and satellite nurses' stations. The move freed up the building core to create a centralized living area and large kitchen and dining space.
Another key move in the renovation plans was taking away the redundant circulation loop in resident wings. That additional square footage allowed the team to design private resident bathrooms with showers in each room, eliminating the need for staff to transport residents to shower facilities down the corridor.
But all of this wasn't carried out without lots of careful planning and collaboration, starting early with what dictates most projects: codes and regulations. For this project, they were working with a local code that dated back to 1999, so many more modern solutions to long-term care didn't always fall within that, requiring conversations with officials to discuss possible waivers to avoid difficulty later. "If you have an argument you want to make, make it before you get started. If you wait until the end of the project, it's too late," Godfrey said.
Some of the exceptions made for the Masonic Village project included moving to wireless nurse call systems, satellite care stations, special locking arrangements for doors, and new shower controls.
As far as how the interiors answered resident needs, details like color, lighting, and contrast were heavily weighed, Perini said. Providing positive distractions was important, too, such as a piece of artwork placed nearby more institutional items like a fire extinguisher or sprinkler system, to maintain a homelike feel. Signage was also dramatically reduced, with cues provided instead to ensure residents find their way without visual interruptions that, again, remind one more of a healthcare facility than residence.
In resident rooms, large windows bring in natural light, and for the one-third of rooms that are shared, a partial wall separating individual spaces provides a residential-style window and curtain to allow more light into the interior side. Furniture was also specified to allow flexibility in layout to residents, especially for couples who want to sleep side-by-side.
Dining was another big component of the renovation, with the owner choosing to do away with the central commissary of old and eliminate its tray system, adding more choice in food and flexible hours. The kitchen offers views to staff preparing meals for residents to be more engaged in the process, with a variety of seating options offered, as well. The kitchen, although not accessible to residents, is closely tied to the dining and adjacent living area to create a "great room" feel.
As for carrying out the renovation, which has been ongoing over the past three years, Bossert said Masonic Village conducted a cost analysis to assess the the financial effect of taking rooms offline compared to the price of a longer construction schedule, identifying 12 rooms as the ideal to work on at once, with residents carefully scheduled to be moved in 30-day waves to allow the work to be phased appropriately.
Goals for construction included keeping census high, minimizing the impact to residents and staff, maintaining all of the systems necessary to keep the community operational throughout the project, and controlling costs while also keeping the schedule as short as possible. Wohlsen was brought in early as construction manager, investigating the building condition before any work was begun to help avoid surprises down the line and testing the application of finishes and materials before installation to avoid change orders. Temporary walls were constructed to separate living areas from construction zones and provide infection control.
The final phase of the project will be completed in June.
