It is always fun—and about as real as it gets—to ask designers about the problems they encountered in getting their projects together and completed. And for the third year in a row the publishers of DESIGN have asked participants just that—and we get some outstanding answers. Few stories can be as engrossing and as richly educational as stories of obstacles overcome. What follows is a selection of responses that throw a whole new light on some of the attractive, intriguing projects appearing in this issue.

Childers Place

Architect: Perkins Eastman

Obstacle: Working with regulatory authorities to evaluate design solutions by the intent of the codes rather than the verbatim “letter of the law.”

Solution: We connected with officials from the Texas Department of Aging and Disability Services (TDADS) early on to review program and concepts, ensuring that they felt like team members rather than regulators. The architectural team gained their confidence by leading them through reviews of past installations, interviews with facility directors at other installations, detailed plan and section diagrams, full-scale mock-ups, and written verifications from other states’ reviewing authorities. Earning their trust enabled us to work collaboratively to find creative solutions for egress control and security, as well as obtain variances related to resident bathroom doors and nursing stations.

Eastcastle Place

Architect: AG Architecture, Inc.

Obstacle: As the existing five-acre campus was a collection of historic and nondescript structures constructed from 1880 to the late 1990s, the primary challenge was overcoming these inherent site restrictions and establishing a clear point of entry for the senior living community.

Solution: The primary objective was to devise a strategy that would facilitate the development of a CCRC through a thoughtful weaving of selective demolition, new construction, and adaptive reuse. Demolition of a 1950s-era structure in the center of the site was the key to creating the location for a new centralized structure that housed new independent living apartments, centralized commons, a main entry, and enclosed parking.

Since earlier construction on the campus had been completed in a fashion that lacked a focal point and clear primary entry, the strategy allowed the team to develop a strong front door. This new featured entry point helped establish the quality of the project, simplify wayfinding, and enhance security while blending with the surrounding urban grid. Located on West Bradford Avenue on an axis which is, in effect, an extension of North Stowell, it creates a central point of entry to provide focus for the entire campus while seamlessly fitting into the surrounding neighborhood.

Forest Manor Rehabilitation Pavilion

Architect: New South Architects, Inc.

Obstacle: A profitable rehabilitation care facility must maintain effective operational efficiency—in this case, air temperature control.

Solution: The design team employed technical engineering advantages to enhance operational efficiency. The roof structure was designed using pre-engineered metal roof trusses to provide a noncombustible attic area. The use of a high-efficiency rigid insulation beneath a nailable roof deck keeps the main solar protection as far away from the conditioned environment as possible. A partially conditioned attic space is created by placing a layer of fire-resistant drywall against the bottom chord of the truss and dumping 5% of the HVAC capacity into this interstitial space, creating a thermal buffer area. This furnishes a better thermal resistance against the harsh solar heat gain properties common to southern states. All wiring and ductwork is placed beneath this thermally protected area to help minimize heat loss and heat gain that would otherwise occur in the ductwork itself.

Gosnell Memorial Hospice House

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Architect: Gawron Turgeon Architects

Obstacle: Finding a location that met the hospice’s criteria and obtaining appropriate approvals. The criteria to consider for site selection included being:

• Close to the patients and families
• Near major roadways for easy access
• Specifically in a residential neighborhood
• Affordable

Solution: Several sites were evaluated, but one on donated land nestled into an existing Scarborough, Maine, neighborhood met all the criteria. However, to build the new 15,763-sq.-ft. “house,” the owners and design team needed to seek a special exemption appeal for this hospice use. The team put much effort into producing materials and information to support this zoning exemption: traffic studies, lighting studies, elevations to show the residential scale, and a comparison with inpatient hospices of similar programs in other states. Due to numerous voices of support for the project, incorporating neighbors’ concerns into the design elements, and the agreement not to expand the facility, the zoning board approved the exemption.

Obstacle: The owners’ intention was to be a good neighbor but the obstacle was neighbors who were concerned about a healthcare facility located there.

Solution: The solution was to hold several neighborhood meetings to listen to concerns, help inform neighbors about hospice’s services for patients in need of expert comfort care when their own home is no longer an option, and resolve misconceptions regarding loud ambulances or activity 24 hours a day. During these meetings, the owners emphasized that a neighborhood setting was critical for this inpatient facility to be a home-away-from-home. As a result, the design team created a layout making the 18-unit building look one third of its actual size. Exterior lighting was adjusted on timers so the lights would only be on at key times, such as staff changes. The “house” was set 270 feet back from the road, existing vegetation was kept, and new buffers were added, including the blue spruce selected by neighbors.

Regents Point

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Architect: CastleRock Design Group, Inc.

Obstacle: Having more than 50 walkers lined up in the entrance to the dining room made it appear like a giant walker parking lot—not so attractive before dinner!

Solution: The most effective solution was to make use of a large room adjacent to the main dining room for a place to store walkers out of sight. However, the room had large dividing accordion doors that were cumbersome and didn’t give the space much flexibility. By replacing the out-of-date doors with movable wall partitions with standard-size doors, the staff can take the walkers before residents dine and park them out of view. The result now leaves the approach to the dining room visually clear of these reminders of dependence.

Renaissance Gardens at Wind Crest

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Architect: Wallace Roberts & Todd

Obstacle: The state had not been introduced to the household model of care prior to this building. A meeting of the reviewers, both state and local, had to occur before the schematic design of the building even really began. Compounding the problem was that the state has no fee structure or process that allows it to review skilled nursing plans prior to construction. The reviewers were reluctant even to talk to us on the phone. Can you imagine building a new care model and having the state walk through after construction and decide that it doesn’t work? It does not encourage designers and providers to push the envelope.

Solution: Eventually, we were able to get them to agree to meet with us and review the building. We had representatives from life safety, nursing, and licensing at the table. The state is still reviewing the information for compliance, but we feel that with certain concessions, the model can be implemented. We are hoping to be able to continue the dialogue as the design progresses and are working with all parties to ensure full code compliance.

Obstacle: One of the obstacles that we have been working to overcome is the use of a commercial-grade grease hood over the stove. We feel that this will really detract from the homelike quality of the kitchen. Plus, with the open kitchen layout, the noise from the fan will create a distraction and interfere with conversation both in the kitchen and in the dining area.

Solution: Each household has its own kitchen to prepare and cook meals, and the kitchen is the main place of activity in most houses, so we have been working closely with the local officials on alternates to a commercial hood. Also, in an effort to make the kitchen feel as homelike as possible, we are using residential appliances. The use of the induction cooktop (no open flame), combined with a no-frying policy and additional sprinkler heads in the kitchen, are some of the extra safety measures that we have implemented.

Obstacle: The adjacent neighbors have been very vocal about the size, placement, and aesthetic of the building.

Solution: Through numerous meetings with the neighbors and the client, an aesthetic was established to complement the adjacent neighborhoods and allow the neighbors and the extended care center’s residents to have a view of the beautiful Rocky Mountains.

Rainbow Hospice Ark

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Architect: Hanna Z. Interiors, Ltd.

Obstacle: Long-term care (LTC) space needs are different from hospice space needs. LTC spaces are not designed with the mandated common elements required for hospice spaces. We inherited LTC patient room spaces that took up a substantial amount of the total square footage of the total project, with resident rooms averaging more that 320 sq. ft. This unbalanced ratio of common versus resident room space created a challenge of limited common space design. However, major renovation and reconfiguration of the existing space could not be designed because of limited funds.

Solution: Without taking down full-height walls or reconfiguring the space, we created individual zones of concierge desk/nurses station, living room, lounge, music area, children’s room, and coffee bar/worktable area. These zones were defined through a creative lighting plan; changes in carpet color, pattern, and texture; a warm wood bookcase; coffee bar divider; and the use of artwork and soft draperies. This was cost-effective, functionally effective, and aesthetically effective. Taking advantage of the larger than usual hospice resident room sizes, we created gracious, expansive patient suites, each with a sofa, recliner, desk, dressers, a closet and in-room sinks. The size of these patient care suites provides ample space for multiple family members to stay overnight and for residents to receive massage and music therapy within the privacy of their own rooms. Money was conserved to overcome the limited budget constraints by designing around existing built-in closets, drawers, and writing/work areas, and reusing existing handrails and toilet fixtures. All materials were carefully selected to hold up for the limited life of the rental lease so as not to “overdesign” and waste money from the limited budget.

Obstacle: The challenge of coordinating donor items and their final selection and timely installation to meet the Grand Opening deadline was often daunting.

Solution: To help offset costs, Rainbow Hospice Ark conducted a capital campaign inviting donors to make cash gifts, as well as gifts of goods and services, in order to carry out the approved design concept.

Shenandoah Valley Westminster-Canterbury

Architect: THW Design

Obstacle: The client at Shenandoah Valley required an accelerated master planning process and product delivery, calling for the ability to plan and execute measures quickly.

Solution: The designers facilitated an interactive planning process specifically developed to accelerate decision making. Interactive Project Planning, or “iPP,” is a process that has helped many of the design team’s clients through the complexities of project planning in a fraction of the time needed for a traditional linear process. Additionally, iPP provides all team members and stakeholders an opportunity to objectively evaluate various options in a transparent and open format. Proprietary software tools allow the design choices to be visible instantly, along with the associated costs. This unique process provides for a more comprehensive and timely evaluation of a project’s program and budget development.

Obstacle: Constantly increasing project costs.

Solution: In an effort to better manage these cost escalations, Shenandoah Valley made a decision to include three general contractors (GCs) throughout the preconstruction and pricing phases of the project. During this time, each GC was given the opportunity to competitively price the documents at each stage of completion. This process provided maximum competitive pricing as well as increased cost-saving opportunities. The process provided the owner with enough confidence to accept an early guaranteed maximum price, thus reducing time to develop project financing and with that, the potential escalation risk.

I Advance Senior Care

I Advance Senior Care is the industry-leading source for practical, in-depth, business-building, and resident care information for owners, executives, administrators, and directors of nursing at assisted living communities, skilled nursing facilities, post-acute facilities, and continuing care retirement communities. The I Advance Senior Care editorial team and industry experts provide market analysis, strategic direction, policy commentary, clinical best-practices, business management, and technology breakthroughs.

I Advance Senior Care is part of the Institute for the Advancement of Senior Care and published by Plain-English Health Care.