The New Wave of Foodservice Technology in Senior Care

Obstacles and solutions in real-world design

For the fourth year participants in the DESIGN Showcase were asked to discuss the real challenges they faced in developing and executing a design. Going beyond displaying a project's highlights, many honestly laid out the difficulties they encountered in realizing this success. Here are excerpts from this year's entries:

The Cottages at Brushy Creek

Tim Buchman Photography

Design Strategies

Obstacle: This project was the first family oriented, residential, 12-bed cottage-style skilled nursing facility to be built in South Carolina. The greatest obstacle was working within institutional state regulations to implement a small, intimate residential project.

Solution: The reviewing and licensing agencies of the state of South Carolina embraced the concept of smaller (12-bed) cottages and worked with the owner/architect to implement this innovative concept, while still keeping the intent of the state nursing home regulations.

Obstacle: The open kitchen presented challenges in terms of fire code and exhaust hood restrictions for residential versus nursing home full-service kitchens.

Solution: Architects specified a commercial hood meeting the minimum size requirements. Additional “tank” fire extinguishers were installed while maintaining the aesthetic look of a home kitchen.

Obstacle: This “non-lift” facility, in which staff members are not allowed to manually lift residents, incorporated the ceiling-mounted lift track system in each private bedroom.

Solution: Swinging, residential-style 7′-0″ doors, open above to the ceiling, were installed at the private baths, which not only enhanced the residential feel but met the institutional needs of the track system.

Obstacle: Creating an intimate feel in the large gathering/living area of each home.

Solution: One very successful element was the use of authentic Williamsburg historic colors, using a darker color below the “Mission” style 7′2″ trim and a lighter shade of the same color above to break up the space. Also, Arts and Crafts style dividers were used to separate the dining area from the family/living room space.

The Watermark at 3030 Park

Rick Scanlan Photography

Esposito Design Associates, The Freshwater Group, and Construction Services of Branford

Obstacle: Working in a 40-year-old building that has fallen into disrepair offers its share of challenges. For example, upon purchasing the community, the ownership realized that a substantial portion of the budget scheduled for this project would be required to address unanticipated issues with plumbing and HVAC systems. Added to this, the original budget only included the renovation of the pool and creation of the fitness center and new café. The budget did not include the creation of the Wellness Center, SalonSpa, bank, or renovation of the auditorium.

Solution: The team worked hard to create a premium space without use of many costly materials. Specialty finishes were used only where they would have the most impact, such as Venetian plaster at the café fireplace surround. Acoustical ceiling tiles were used in place of gypsum board ceiling. Surfaces originally slated for bamboo panels were successfully substituted with paint in warm wood tones, and porcelain tile was substituted for natural stone at the entry. The use of art and accessories, specifically selected for the design of this community, helped to enhance the overall appeal of the space. All of these value engineering decisions allowed the team to retain more of the budgeted funds for lighting, which was very important to the success of this project. More than half of the space is subterranean, allowing for limited natural light and views. In the corridors, fluorescent fixtures provide bright ambient lighting, and incandescent accent lighting provides a warm sparkle. Wood and glass partitions and doors were used wherever possible so that the limited natural light could filter through to the interior spaces. These partitions also suggest the idea of exterior windows and vistas. Lighted domed ceilings highlight special areas, as well as provide the illusion of a midday sky.

Crystal Cove Care Center

www.falkephoto.com

Interior Images, Inc.

Obstacle: This facility was completely depopulated for demolition by the owner of the property, who reconsidered his decision. After realizing his mistake, the owner put the lease and facility restart operations up for bid. The state licensing board mandated that the facility had to be occupiable for at least 10% of the maximum number of licensed beds (96) within six weeks, which left no time for the usual programming, research, and specification to meet the mandatory timeline.

Solution: We chose to focus first on the West Corridor as a section that could be completely staffed and functional until the rest of the facility could be completed, with as little disruption of the new patients as possible. This included 15 patient rooms with adjoining lavatories, the front lobby, three offices, one shower room, and one guest lavatory to be completed by the deadline. All of the existing furniture, fixtures, and equipment were sorted and sent to storage for emergency use in case the new materials were unavailable in the time frame required. All vendors were requested to identify anything within their lines that met our required lead times and color palette.

Obstacle: We specified a custom-colored, solution-dyed, moisture barrier backing that the vendor guaranteed would meet our deadline, which it did. The problem was that half of the patterned carpet arrived defective, such that one roll would not pattern match with the next.

Solution: We inset a “rug” effect using the brown border carpet within the patterned material at two corridor junctions (see photo). This allowed the defective carpet to be temporarily installed without revealing the mismatch, as the border separated the two different patterns. The “good” material was permanently glued down while the defective material was not, and was later replaced with the corrected goods.

Worley Terrace

©2008 Emery Photography

JMM Architects, Inc.

Obstacle: To develop a large project that would fit into and be accepted by a very old residential neighborhood experiencing serious decline.

Solution: The community that the project was developed within had not had any significant construction projects completed in many years. A six-story section 8 housing facility that was deemed unsuitable for occupancy-and a source of crime-was demolished and replaced with a three-floor seniors-only tax credit building which was designed using forms of some of the surrounding homes as building modules. The building was divided into a three-winged “U,” with the main entrance and common areas at the base of the “U” to reduce the overall mass. The length of each wing was broken down in scale with 24′-wide modules reflective of the single home elements. Alternating brick colors also helped to distinguish the individual house elements of the design. Generous common areas, as compared to most tax credit projects, were grouped near the main entrance and made available to the community at large. The neighborhood association was consulted early in the design development process to gain their insights. To improve safety and encourage long-term success, the entire 17-acre site of the previous facility was cleaned up to eliminate unobservable areas, and 12 acres was transferred to the school district for use as the site of a new replacement elementary school. A 6′ wrought iron fence with brick piers was placed around the project site for security. At the facility dedication, the neighborhood association's president spoke of her great satisfaction with the overall development.

Obstacle: Tax credit funding provides very limited funds for a project's first and operational cost, making long-term viability (an owner-stated goal) very difficult to achieve.

Solution: A design providing modules of low-cost wood frame construction was developed for overall economy. The cost and benefit of each major building system and finishes were considered as they related to long-term viability, marketability, and maintenance. To help with long-term marketability of the project, in some cases higher initial cost choices were selected, such as masonry veneer, emergency generator backup power, washer and dryer hookups in each apartment, and better than average finishes. Residential heat pumps were provided for each unit for resident familiarity and individualized controls, and to permit a relatively unsophisticated maintenance staff to service the systems. Separately metered electrical services were provided to encourage judicious use of energy by the tenants. Generous common areas were made a part of the project to encourage use and acceptance by the community at large, as well as to anticipate future tenant demands, thereby extending long-term marketability. The inside of the building “U” was developed into a courtyard with common balconies on each floor and large wraparound porches for resident access and enjoyment. The nonprofit owner chose to put development fees associated with the project into the construction budget to improve and enhance the final product.

Bentley Commons at Keene

Alain Jaramillo Photography

Merlino Design Partnership, Inc., and Stampfl Hartke Associates

Obstacle: How to mesh the interior design with the historic mill building and to the town of Keene.

Solution: The architectural conversion of the 100-year-old mill building into a community building steered the interiors into a more contemporary direction. The design team implemented a loft-like design approach. The design in the old building used the existing brick and timber, and recycling much of the wood for other uses. New elements such as lighting, furnishings, and accessories were added to enhance this design. A more subtle approach was used in the residential areas within the new building. The 10 loft-style apartments that were created within the mill building were more contemporary in design, larger in square footage, and appointed with more amenities. Overall, the design fits the building and the building fits the town.

Obstacle: During construction, there were serious concerns about the structural integrity of the 100-year-old mill building.

Solution: The overall structure of the mill building used very old-fashioned 3-wythe brick exterior walls. The exterior walls were maintained with a very complicated temporary structural system, which was then replaced by a long-term steel superstructure that saved the original/historic exterior. During construction, damage was discovered at the corner of the mill building adjacent to Water Street. This had to be repaired and supported without making the repair visible. The most obvious challenge was integrating the existing chimney/cell tower into the overall design, which required maintaining the sizable, very visually negative prefab “switch box.”

Sgt. John L. Levitow (USAF) Veterans Health Center

®2008 Gregg Shupe

Moser Pilon Nelson, Architects, LLC

Obstacle: The design needed to preserve dinosaur tracks. The construction site is located across the road from the Dinosaur State Park. During construction of the park, massive rows of dinosaur tracks were discovered, resulting in significant delay and cost increases.

Solution: The design team, owners, and agency staff met with the State of Connecticut Department of Environmental Protection and the State Archeologist to determine an acceptable procedure to be followed should similar fossils be discovered during the excavation for the Levitow Veterans Health Center. The site contractor did break into the 200-million-year-old fossil-bearing strata, but since the procedures were in place for resolution, all parties were able to reach an agreement to protect the major fossils, and construction was allowed to proceed on schedule.

Atria Guilderland

Dean Leavanson

Angerame Architects, PC

Obstacle: Renovation of a facility while it was occupied and operational. It was a major challenge to construct the renovation, as the residence was about 80% occupied during the work.

Solution: The project was broken down into 12 smaller phases with the goal of minimally disrupting the residents' lives. Work was completed during the night hours if it was “quiet construction” and, when demolition took place, residents were taken on field trips for the day or relocated to another area having peace and quiet. Residents were thrilled to see the workers at work and became “sidewalk superintendents.”Obstacle: The existing layout provided large, cold spaces for lounge relaxation/dining. Also, corridors were long and monotonous.

Solution: The spaces were divided into smaller and more intimate surroundings, with lower ceilings and large fireplaces added to act as dividers. Ceilings were lowered in some cases and trim work and lights were added to give the space a residential feel. Ceilings were raised in the corridors and at resident entrances to create a sense of entry to the living unit. New lighting, trimwork, and handrails were added to create a more residential setting.

Cedar Crest

Angus-Young Associates, Inc.

Obstacle: Upgrading the heating, ventilating, and air conditioning (HVAC) in existing units and assessing fire protection throughout the building presented design challenges to the team. Prior to the renovation, air conditioning in the existing independent living buildings consisted of window units, which are energy inefficient and lack aesthetic appeal.

Solution: The HVAC system was upgraded to a central chiller/ice system. However, while the energy-efficiency issues were solved, the new HVAC system had to adapt to existing structural conditions-most importantly, fitting within the existing ceiling while keeping a compliant floor-to-ceiling height. To solve this issue, a high level of coordination between structural, electrical, mechanical, and plumbing engineers was implemented. Ductwork and plumbing was fit between structural members above the corridor ceilings while still maintaining a required floor-to-ceiling height. To relieve the feeling of low ceilings in the corridors, ceiling soffits were constructed that housed the necessary light fixtures to provide ample lighting. In effect, not only did the design successfully employ the required building systems for energy efficiency, the ceiling soffits and placement of fixtures within the soffits created architectural design features within the corridors.

Obstacle: Renovating with residents present.

Solution: Dust control barriers were installed to reduce the amount of negative air effects from the construction, and negative pressure machines controlled the dust in work areas. Not only a requirement but a matter of functionality, resident access to all emergency exits was maintained throughout construction to ease residents' minds in case an evacuation from the premises became necessary. On a smaller scale, construction became less an obstacle and more an opportunity through the input of the residents on the spaces that were being created. The addition and renovation became more of a “community effort” than a nuisance or marketing nightmare.

Sitter & Barfoot Veterans Care Center

John Wadsworth

Clark Nexsen

Obstacle: Although the goals of everyone involved-state and federal veterans agencies, administration, and the design team-took into account evidence-based-design criteria, program needs, and funding availability, they were not always in concert with each other.

Solution: Patients were to be provided private rooms with bathrooms. This decision was probably the most important goal to the design team. Also it was decided that because there was a desire for flexibility to accommodate varied patient types, every room would be fully handicap-accessible. This required larger areas than originally programmed for patient rooms and associated toilets. The design team worked hard early in the charrette process (one night working past midnight without dinner) to figure out ways to obtain better utilization, more efficient layouts, and organizational plans that effectively reduced the other program areas so that we could achieve the goal of private rooms and bathrooms.

Obstacle: While evidence research indicated that a decentralized model of nurse stations and dining facilities produces positive patient outcomes, it was clear early on that the care model and staffing model would not work properly with this type of facility design for the nursing department.

Solution: After reviewing multiple alternatives it was decided that the nursing stations would consist of a single main station in each unit, with multiple fully wired work alcoves with storage capability distributed throughout the patient wings. This allowed for nursing staff to work with patients while giving the staff access to technology and patient supplies close to the rooms. Also it was decided that there would be a main dining room adjacent to a central kitchen where all meals would be served. This allowed for doubling of a needed assembly space with the dining space and provided patients with a connection with the main landscaped courtyard.

Guardian Angels of Elk River

Jerry Swanson Photography

Pope Associates Inc., and Encompass Interiors

Obstacle: Typical for the 1960s, the existing care center was a traditional, flat-roofed structure appearing institutional in character. The obstacle presented to the design team was to blend the new addition seamlessly into the existing interior space, as well as visually connect the exterior façade.

Solution: The design approach complements the existing building by using similar colors and materials while maintaining the scale of the existing one-story building. Architecturally, the new addition was designed to exude residential elements, accomplished by introducing cultured stone, hipped roofs, detailed woodwork, and residential-style windows consistent with the character of the surrounding neighborhood. The interiors made use of a soothing color scheme, inviting artwork, comfortable furniture, and homelike décor to enhance the residential character of the space and bridge the existing to the new.

Obstacle: The existing care center had been built over the past 50 years in three stages: the 100 wing, the 200 wing, and the 300 wing. The 200 wing was in the worst condition. It consisted of double bedrooms, shared bathrooms with no showers, and a traditional crowded nurse station. In order to circulate the building-whether it was to dining, administration, rehabilitation, or the beauty shop-all traffic was funneled through existing resident wings.

Solution: The new design resolved the disjointed facility by removing all semiprivate resident rooms in the 200 wing and building a new addition with licensed private beds. The vacated 200 wing was then remodeled into a Town Center and transformed into a community-oriented series of public spaces connecting the new addition, existing entry, and the existing resident wings. The well-lit and redesigned community space includes lounges, café, beauty shop, gift shop, resident computer area, guest suite, and therapy spaces. Scattered administrative offices were relocated to one central area, allowing the exiting space to be dedicated to a variety of new services. All of the construction was done while keeping the facility in safe operation.

Saint Andrews Estates South

Al Ricketts Photo

THW Design

Obstacle: The ACTS Retirement-Life Community, St. Andrews Estates South, is part of a planned unit development with conditional zoning. A significant challenge was that any modifications or expansions to the existing facility would require zoning review and approval.

Solution: To initiate a proactive approach, the owner and the architect consulted with the city's zoning board officials and planning staff during the project's preliminary stages. Their comments and concerns were solicited with the design team's assurance that each would be addressed. A local landscape architecture firm and civil engineering firm were enlisted, as both were familiar with local conditions. This resulted in a virtually seamless planning review process, warranting high praise from the zoning review board.

Obstacle: Achieving a speedy building permit process proved challenging. Due to several hurricanes hitting the area in previous years, the work efforts regarding permit reviews were extraordinarily intense.

Solution: After making several Building Department visits, the owner and architect subsequently chose to hire a consultant who tracked and managed the submittal processes.

Obstacle: The initial project concepts were developed before two consecutive, destructive hurricanes hit central Florida. The original project scope forecast a construction budget of $3 million, but this soon escalated to $4 million after the hurricanes. ACTS was in a substantial bind. Even with the budget hike, they felt strongly that the project scale could not be reduced, as the project needed to accommodate all of the residents who needed protection from such storms. Not only that, but time was of the essence and construction needed to get underway.

Solution: Extensive value engineering and cost-reduction strategies were devised involving ACTS, the architect, and the general contractor, such as using alternative roof tile products that were manufactured locally and outsourcing labor due to sparse availability of workers. Thus, they were able to significantly reduce the cost of construction without compromising the quality or integrity of the project. Additionally, a successful resident fundraising effort contributed significantly to help ensure the much-needed funding for this endeavor.

Heritage Manor

William Webb, Infinity Studio

Herman Gibans Fodor, Inc. – Architects

Obstacle: Although a major design objective was to enhance the amount and quality of natural light in the resident common areas, the existing resident lounge areas had no access to exterior walls.

Solution: By eliminating one of the resident rooms adjacent to the lounge, the lounge space was extended to include an exterior wall. A new glass window and door system was installed that provides abundant natural light and affords direct access to an adjacent resident courtyard.

Obstacle: The design team wanted to employ indirect lighting wherever possible to reduce glare and create resident-friendly lighting. Throughout the building, however, most of the existing ceilings were designed at eight feet above the finished floor. In most cases, existing structure, ductwork, and sprinkler lines made it impossible to raise the ceilings.

Solution: Ductwork and other building systems were reworked where possible to raise ceilings. In other areas, soffits were dropped and new wood-trimmed cove lights were installed. In addition, recessed down-lights with suspended acrylic bowls were installed to enhance the ceiling plane while at the same time reducing glare. In corridors and other common areas, fluorescent direct/indirect fixtures were installed to increase brightness levels and reduce objectionable glare.

Design Environments for Aging 2009 2009 March;():21-27

Topics: Articles , Design