Farrow Partnership Architects Inc.

The process of planning a new or renovated facility can be a rewarding experience that results in a supportive physical environment and a valued community asset. Or the process can be an arduous exercise that misses golden opportunities along the way. While there is no shortage of advice available for anyone seeking to purchase the right washing machine or new car, when it comes to investing in the redevelopment of long term care facilities, guidance on “tips and traps” is scarce. And yet diverse teams must work together to “get it right the first time” because afterthoughts are not an option.

 

One way to begin thinking about building better long term care facilities is to make a list of fundamental questions:

On the surface, our options may seem limited and uninspiring. Design standards appear to be pre-determined, while tight budgets leave little room for innovation. Traditional project planning and delivery approaches can fail to meet expectations. When it comes time for construction, there is often animosity toward a contractor who plays “Gotcha!” with lists of extra charges for changes to the original budget. This is hardly a recipe for creating a caring environment.

 

What is the best way to address all of these concerns? First, we should recognize that great upheavals—known as disruptive or discontinuous change—often stimulate a demand for improvements that may have been ignored for years. For example, a generation ago, advocates for conserving natural resources were routinely dismissed as “tree huggers;” today these folks are more likely to be recognized as outstanding corporate citizens. In a similar vein, planning approaches for long-term care facilities that were previously labeled a tough sell may now be embraced as sensible in a world of changing priorities.  

 

We can take advantage of disruptive change in our facilities by recognizing the difference between negative and positive cost cutting. Negative cost cuts—such as staff layoffs—tend to diminish morale and quality of life. By contrast, positive cost reductions minimize wasteful or unhealthy practices. Examples of positive cost cutting include reducing energy and construction costs. The new role of planning teams, therefore, is to identify opportunities for positive cost cutting so that these funds can be redirected toward enhancing the facility.  

 

When administrators ask, “how much more will it cost for us to go green?” they miss the point that reducing toxins, minimizing waste and building a community asset is not a simple matter of incurring extra costs. Instead, there are substantial savings to be realized through water conservation, fewer sick days and other advantages. To achieve a more balanced picture of cost gains and losses, the planning team needs to assist decision makers in connecting the dots between creating a healthier environment and, for example, staff attraction and retention.

 

One of the “greenest” choices anyone can make is to avoid constructing facilities that are likely to become future landfill. In other words, we must expect more from our buildings today, and be less tolerant of poor planning decisions.

 

Globally, there is a growing demand for accountability regarding the total impact of facilities on staff, residents, visitors and the community. This trend includes paying more attention to quality of life design standards. Will the facility disappear into a bland landscape or will it be an attractive asset? Will the environment convey a life-affirming message? Does the plan support a range of safe, enriching activities for staff and residents—from social interaction to private retreat space? How can we offer more opportunities for choice in safer settings? Moreover, are we making any false assumptions about what “they” (the residents) want, without considering what it might be like to trade places with “them”? 

 

The following four steps can engage all participants in developing a personal stake in the project. Through this collaborative process, finding new ways to realize value for money becomes a positive quest rather than an onerous requirement.

 

Rather than accept the way things have always been done, there is no substitute for open dialogue that uncovers true needs, preferences, efficiencies and deficiencies. This is no time to skip over the tough questions in a race to arrive at solutions. Jumping to answers will result in little more than a new version of yesterday’s facility. Instead, there should be fresh spirit of inquiry that establishes specific goals and aspirations, regardless of how many other long term care facilities the design team has completed.

 

The dialogue process should address questions such as:

The key to success at this stage is for participants to challenge one another to think beyond standard responses. For example, merely writing the word “dignity” on a flip chart is unlikely to result in a progressive facility. More specifically, how can we demonstrate our true concern for dignity? What are the practices that inhibit dignity? How might these sensitivities translate into physical space?

 

Instead of focusing narrowly on input from the architect, the dialogue approach draws on expertise from everyone at the planning table. By engaging many voices in thinking through the issues together, there are more opportunities to uncover practical, better ideas.

 

Also at this stage, design quality standards can be articulated that go beyond absolute technical requirements. After all, how many of us would be content to live in space that is defined solely by minimum standards for fire safety hardware and number of square feet? Are some intangible qualities missing, such as warmth, serenity and optimism?  

 

The designer’s job is to connect physical environments with basic human needs and aspirations, rather than to execute any particular style. Research by Harvard biologist E.O. Wilson indicates that humans have an innate desire for close contact with the natural world. Dr. Wilson describes this affinity with nature as “the connections that human beings sub-consciously seek with the rest of life.” 

 

So rather than aim to create a “homelike” atmosphere (which could mean anything from highly patterned chintz fabrics to Scandinavian modern) nature can provide more reliable design standards criteria. A useful “test” for setting such standards is the question: are we working with or against nature? Access to natural daylight, connections with the outdoors and natural materials are universal elements that speak to us on a basic human level.  

 

Traditional approaches to facility planning put too much faith in a best-case scenario. However, moving a project forward with “fingers crossed” rarely leads to a happy ending. Instead, a realistic look at significant risks to budget, scope, schedule and protecting design standards is effort well spent. The project team can benefit from facilitated dialogue aimed at frankly identifying threats to project success. Once the potential rocks in the road are officially recognized, strategies can be collaboratively developed to prevent setbacks. This proactive approach to addressing shared concerns—such as communication protocols, municipal approvals and construction phasing—saves time, money and disappointment.

 

Rather than attempt to predict the future, the risk assessment step looks at a range of possible scenarios. The team can then determine if they are prepared to handle these scenarios, or if they will consciously choose to avoid them.

 

To take advantage of cost savings and environmentally responsible opportunities, all participants are called upon to take a more active role than in traditional redevelopment projects. The Integrated Design Process (IDP) brings everyone together from the outset—including engineers, cost consultants, facility administrators and architects—to determine priorities and how efficiencies will be achieved. 

 

Cost updates need to occur near the beginning, middle and end of the project to avoid the risk of having to strip the character from a facility in order to bring costs in line with the budget.

 

The contractor should also become involved at in the IDP in order to advise on better ways of achieving project goals. A successful construction project can be seen as the result of countless sound decisions. These decisions range from handling obstacles on the site, to recommending money-saving construction details. Bringing the contractor together with the design team and facility administrators instills a shared sense of ownership for these decisions. This IDP approach tends to result in greater value for money that the traditional contractor’s model of profiting from extras to the budget in an adversarial relationship.

It is essential to periodically monitor progress toward the goals and aspirations that were established at the outset of the project. A report card format that contains qualitative statements can be used to grade plans and design schemes as they move forward. For example, the statements below were used to assess a specific long term care redevelopment project from early conceptual design through to construction:

Healthy, attractive and life-enhancing long term care facilities can be achieved in a frugal economy. However, since new approaches to cost reduction and resource conservation are being discovered on an ongoing basis, there is no place for rigid, adversarial meetings. Putting our heads together is the best way to create a nurturing yet practical place for residents, staff and visitors.