Architectural Design Requirements – Affordable Supportive Living Initiative

The grant applicant must meet the following Architectural Design Requirements in relation to building and physical environment.

SECTION A RESIDENCE/FACILITY AND SUPPORT STANDARDS

The grant applicants will provide accommodations that meet or exceed legislated requirements including Alberta Building Codes, Fire Safety Codes, Land Use (zoning) Bylaws, as established by the local building authority and the Province of Alberta.

The project must also meet the design requirements for B2 building classification of the Alberta Fire Code. The Code refers to B2 buildings as those with the physical elements that support the evacuation of residents requiring assistance. This includes: masonry construction (over two stories), sprinklers, fire separation and fire rated doors.

B3 construction and the anticipated cost savings will be recognized once approved into the Alberta Building Code by 2013 dependent on legislation.

The grant applicant will also need to meet the Design Guidelines for Continuing Care Facilities in Alberta (2011). The grant applicants will demonstrate efforts to incorporate features that maximize resident privacy, accessibility, personal choice and control over their environment.

General Guidelines

As a guideline, the minimum size (area per bed) of a supportive living accommodation is 81m2, based on total square footage of the entire building divided by the total number of units built. Included in the 81m2, is the minimum average room size of 32.5m2 (approximately 350 square feet), which represents roughly 40% of all the space in the entire building.

Once the Affordable Supportive Living Initiative (ASLI) grant funding agreement has been awarded, any subsequent requests for adaptations to the original conceptual design must be submitted to the evaluation committee (which includes representation from Alberta Seniors, Alberta Health and Wellness, Alberta Infrastructure, Alberta Housing and Urban Affairs and Alberta Health Services) for review and approval. This will in turn minimize additional costs to the grant applicant.

1. General Building Requirements

In addition to meeting the above established building requirements, any project upgrading or development should be committed to the achievement of:

  1. A minimum of barrier-free design throughout resident accessible areas. Compliance with the requirements of the latest Link to External Site Barrier Free Design Guide, of the Safe Codes Council.
  2. Convenient access to outdoor space appropriate to resident needs.
  3. Well lit, unobstructed stairs, hallways, ramps and exits that are of adequate width to accommodate walkers and wheelchairs.
  4. Safe and secure handrails on all corridors.
  5. Accessible office space for visiting health professionals and community service workers.
  6. Accessible mailbox system.
  7. Adequate laundry facilities for residents, or their families, for the residents' personal laundry.
  8. Adequate linen laundry facilities. If contractual services are used, provide an area for soiled linen awaiting pickup and a separate area for storage and distribution of clean linen.
  9. Public washrooms for use by residents and public conveniently located in areas commonly used by residents and the public. Washrooms can be unisex.
  10. When required, provision for 24-hour distribution of medications including locked storage for controlled drugs.
  11. Lockable storage for resident records.

2. Site Requirements

  1. Supportive living projects shall obtain applicable land use (zoning) approval from the local jurisdiction.
  2. Roadways shall be provided within the property for convenient and direct access to the main public entrance and to service areas. Provide access for fire department and emergency vehicles in accordance with local requirements.
  3. Each supportive living project shall have parking spaces to satisfy the needs of residents, staff, and visitors.

3. Resident Rooms

Operators should be able to demonstrate their efforts to incorporate the following features that maximize resident privacy and personal choice:

  1. Resident room sizes (area and dimensions) that permit residents to move within the room with assistance of a walker or wheelchair and that allow access to at least one side of the bed for transfers.
  2. Private room accommodation with access to an en suite private bathroom. Some semi-private room accommodation for couples will be permitted. The use of bathrooms shared between resident rooms is discouraged for reasons of infection prevention and control.
  3. Make available, at no cost to the resident, a conventional bed and mattress as well as other furniture including chair(s), dresser and night stand, if the resident chooses not to provide their own.
  4. An emergency call station with 24-hour monitoring in the sleeping area.
  5. Individual connections for a telephone, cable television, and conveniently located electrical outlets in each room.
  6. Operable windows to the exterior or to naturally lit interior areas must be configured to enable unobstructed viewing from a seated position and with window curtains or blinds that fully cover the windows when closed.
  7. Lever handled resident room door locking hardware. Residents will be allowed 24-hour access to the facility and to their rooms with keys provided by the operator. Where room entrance door closers are required to meet building code, they shall be sentronic swing free type.
  8. Provision of a suitable number of portable lifting devices within the building to accommodate the transfer needs of designated supportive living (DSL) residents (the number to be based on operator experience and discussions with Alberta Health Services).
  9. Provision of a suitable number of ceiling lifts in a portion of the resident rooms (the number and location to be based on operator experience and discussions with Alberta Health Services).
  10. Storage for personal items designed to permit access by residents with reduced upper and lower reach capability.
  11. A three-piece, wheelchair accessible bathroom within each resident room. Each bathroom will be equipped with a toilet, sink and provision for bathing (either a handicapped accessible bathtub or shower with no threshold). Each resident bathroom must include the following:
    1. A wheelchair accessible turning space of 1500 mm. (5 feet) in diameter, and appropriate space for door swing.
    2. Adequate ventilation.
    3. Access door with clear width of 900 mm (36.0 inches). Privacy hardware that can be unlocked from the outside in case of an emergency.
    4. Non-skid surfaces on floors, and grab bars installed for toilet, bathtub, and shower transfers.
    5. Shower stall should not have pre-molded seating or a lip that impedes movement in and out of the shower.
    6. Adequate vanity space and shelving for storage of personal items.
    7. Lever faucets and a hand-held shower fixture on vertical rail.
    8. At a minimum, allowance for one-sided transfer onto toilet.
    9. Availability of toilets that can be adapted to address the specific needs of a resident having a minimum height of 407 to 457 mm (16 inches to 18 inches).
    10. The provision of grab bars in appropriate locations within the resident bathrooms (e.g. beside toilet, within shower stall).
    11. Emergency call station with 24-hour monitoring.

4. Common Bathing Areas

A common bathing room will include the following features:

  1. Therapeutic tub with automated temperature control and appropriate lifting device.
  2. Hand-sink and handicapped toilet (designed for privacy).
  3. Storage for towels.

5. Common Amenity Areas

The facility will include common amenity spaces of sufficient size and accessible to all residents to accommodate life enrichment activities and group activities including the following:

  1. Dining, social gathering and multi-purpose activity areas (e.g., exercise area, space for worship, areas and facilities to undertake crafts) with furniture layout and space to accommodate people with mobility aids.
  2. An area for personal care needs such as a beauty parlor.
  3. Entrance and reception area with sufficient seating to accommodate waiting.

6. Environmental Requirements

  1. Supportive living facilities shall incorporate features and finishes that optimize sensory functions and facilitate mobility, including ambulation and self-propulsion. Provide features that help residents find their way in the building. Potential hazards to residents, including sharp corners, slippery floors, loose carpets, and exposed hot surfaces shall be avoided.
  2. Hallways, stairways, exits and ramps must be well lit and kept clear of objects that could cause falls or obstruct passage. Color contrasting may be necessary.
  3. Lighting levels throughout residential areas of the facility should be at a minimum 210 lumens and avoid uneven lighting levels in residential areas.
  4. Public elevators must be provided for multi-storey living facilities. Elevator car/cab size must accommodate stretcher or gurney. In multi-storey settings consideration of two elevator cabs is strongly recommended.
  5. Sidewalks, exterior stairs and ramps must have adequate drainage.
  6. Outdoor areas shall be provided for residents, visitors, and staff. Outdoors spaces may include gardens on grade or on roof decks or solaria, and balconies.

SECTION B RESIDENTS WITH DEMENTIA AND RELATED NEEDS

For those spaces that will be designed for residents with dementia, the grant applicant may contact Alberta Health Services for specific details relating to the design of such a facility with regard to:

  1. Maintaining a safe and secure environment;
  2. Appropriate sensory and social stimulation of the environment;
  3. Normalization and control over the environment.

Alberta Health Services Contact
Mr. Steve Fowler
Director, Government Integration
Alberta Health Services
Phone: 780-735-0088
E-mail: Steve.Fowler@albertahealthservices.ca

Philosophy/Definition

Designing buildings that support people with cognitive impairment empowers them to live through the progression of the stages of dementia with an enhanced level of comfort and dignity. Comfortable, unobtrusive, client-centered and home-like design have all been shown to contribute improved quality of life for persons with dementia and other forms of cognitive impairment.

While the design objective and the design guidelines outlined below may be beneficial for all residents within a seniors care facility, they have particular importance for residents with dementia and other forms of cognitive impairment.

Design Objective

The environment facilitates resident independence, autonomy, choice, orientation, socialization and participation in familiar and enjoyable everyday activities. It also supports staff to interact with residents in a natural, home-like, calming environment.

The more residential the character of the building, the more control residents experience over their environment. The more control the resident feels they have, the higher the likelihood that they will assert their fullest range of function and ability.

The overall character of the space is as residential and home-like as possible. Living in a home-like environment increases the probability that the resident will become familiar with their surroundings and interact with others in a meaningful way to maintain their independence and abilities.

The overall scale of the space should not be overwhelming; rather, functional and flexible in its use and in scale and proportion to rooms found in a large family home. A mixture of a larger, congregate activity space and smaller, type spaces accommodate small group interactions and sensory reduction. Emphasis is placed on creating a ‘family-like’ environment typically including small group interactions.

The design also reduces resident confusion and orients them to the time of day through optimal natural light and to their surroundings through a simple and understandable design and the presence of familiar rooms/activities.

General Design Guidelines

1. Sensory Changes

Sensory changes are common in the elderly and in particular, persons with dementia. The senses help to interpret one’s environment and as such must give clear messages. The following summarizes some common sensory changes in the elderly and implications for facilities.

a. Vision

  • Steps should be taken to ensure that lighting is not overly bright (creating glare) or overly dim (creating shadows). Aging eyes need more light and have a reduced capacity to discern between varying levels of light intensity. Natural or incandescent light should be utilized wherever possible. Sconces which produce various lighting patterns are not desirable in areas used by residents with dementia.
  • Changes in flooring elevation, or perceived changes in flooring elevation caused by color extremes or patterns can result in falls. Boldly patterned flooring or bright/shiny flooring should be avoided. Residents with dementia will often avoid walking in rooms with visually confusing flooring quickly leading to a reduction in mobility.
  • The reduced ability to perceive slight differences in lighting, shade, and hue experienced by residents with dementia require an increased emphasis on contrasting colors to assist residents in discerning walls from floors, door handles from doors, toilets from bathroom walls and floors, etc. Contrasting colors utilized in toilet seats, door handles, handrails, and other architectural features often assist residents to accurately identify those elements.
  • In buildings where resident elopement is problematic, non-contrasting architectural elements assist in reducing the likelihood of elopement. Exits can be disguised with design features that make the fixture/exit invisible to the resident.
  • All furnishings, wall colors, flooring, and window coverings should be chosen from colors in warm, mid-range colors. Beiges, peaches, and pale pinks and blues are perceived as white and indistinguishable, while harsher dark colors such as chocolate browns, navies, and blacks are all seen as black. Warm mid- range colors are comforting and discernible; some report red and yellow as “best perceived” colours.
  • Mirrors, shiny appliances, and excessive use of glass should be avoided. Shimmery surfaces produce glare which impedes visibility. For some with dementia, mirrors may cause confusion. Accordingly, they should have the capacity to be covered or removed.

b. Auditory

  • Furnishings should be chosen to assist in the reduction of excessive noise – fabrics, window coverings, and floor finishes should be selected from those that absorb noise rather than amplify it. Hearing in the elderly tends to diminish and ordinary sounds may cause confusion when too many sounds are presented together. Efforts should be made to dampen extraneous noise to assist residents in processing auditory information.
  • The use of overhead paging systems should be avoided.
  • Music and television should be used selectively in common areas.
  • Equipment and carts should utilize rubber tires.

c. Tactile

  • The sense of touch also diminishes with age. This requires more contrast in textures that are meant to orient the resident to their surroundings.

2. Orientation and Familiarity

Resident bedroom design should respect the individuality of each resident. Residents and families should be encouraged to personalize the resident’s room, as much as possible. Familiar surroundings assist in orientating residents to their living environment. For example, personal items such as a favourite ornament or personal photos may be displayed in a small curio window outside each resident’s bedroom to assist in orienting the resident to their own space.

Enlarged photos of residents at meaningful times in their lives (weddings, graduations, births, working) may also be a source of personal comfort to the residents.

Built-in shelving units, hutches, or desks should be considered for displaying interesting collections of objects within residents’ reach. Rummaging through collections of fragrant, textured, or visually attractive objects provides opportunity for reminiscence and meaningful conversation.

3. Staffing

The design should balance needs for smaller grouping of residents with staff needs to provide overview of resident activities, all within an efficient staffing model.

4. Safety

The design should create support spaces that are invisible to residents to ensure residents do not access them and put themselves at risk. For example, doors into support rooms should have the same colour as the surrounding walls. The design should also allow for optimal visibility by staff into several congregate resident spaces, to ensure optimal safety, yet without compromising privacy.

5. Outdoor Spaces

Residents should be allowed unrestricted access to the outdoors independently, and in most seasons/weather types. There should be shaded areas protected from the elements and open, yet secured areas. Enclosed gardens can provide stimulation as well as an additional distraction when behaviours escalate. The space should be inviting and representative of a residential garden, but not overly large like a public park.

A variety of flower beds and gardens, both ground level and elevated should be considered. Natural plants allow both sensory stimulation as well as endless opportunity for meaningful engagement in activities previously enjoyed by most residents. Lists of toxic and non-toxic plants should be consulted when designing an outdoor space.

Outdoor spaces should provide opportunities for residents to engage in/observe familiar everyday activities. For example, the area may include:

  • a clothesline to hang laundry;
  • comfortable seating (i.e., does not absorb heat);
  • a bird bath to observe birds;
  • an area to pile firewood/logs, etc.;
  • shaded area; or
  • circuitous pathways.

Fences should be attractive and natural. Trees, shrubs, and climbing or flowering vines will disguise fences reducing the enticement to explore elsewhere. Chain-link or plexi- glass fences are an invitation for elopement as occurrences in the distance can attract the resident’s attention.

Several seating options should be available, scattered along a continuous walking path, to encourage purposeful wandering. Walking surface should be smooth to avoid tripping or stumbling hazards.

Areas of indirect sunlight should be readily available. The use of gazebos, trellises, canopies, or umbrellas will allow residents to enjoy the outdoors without the glare of direct sunlight. A “back porch” environment is the goal.

Gates should be avoided and if required they should blend into the overall fence to be invisible to residents.

Interesting objects/features should be created within the centre of the space to draw attention away from the periphery.

6. Signage

Meaningful methods of way finding (rather than the written word) through illustrations or objects should be considered. For example, large comfy quilts on sofas to encourage gathering in a congregate activity area, a photo of a toilet on a shared bathroom, or large plants near the doors to the garden may be more helpful in orientating the residents.

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