7a. 578-20-002 Basis of Design -BOD Part 1.pdf

Edward Hines Jr. VA Hospital | Renovations to Building 217 CLC

VA Project No: 578-20-002

VA Contract No: 36C25223C007

Bancroft-AE Project No: 23-009

Renovations to Bldg. 217 CLC

Basis of Design | 100% Construction Documents

Hines Jr. VA Hospital

5000 South 5th Avenue Hines, IL 60141

December 09, 2024

BASIS OF DESIGN

Edward Hines Jr. VA Hospital

Renovations to Building 217 CLC

VA Contract Number: 36C25223C007

Bancroft Project Number: 23-0019

Issued For: User and VA approval

By:

Bancroft Architects + Engineers

3300 Dundee Road

Northbrook, Illinois 60062

847.952.9362 | www.bancroft-ae.com

1. Executive Summary

• Introduction

• Design Team

• Applicable Codes & Standards

• Overview

• Project Scope

• Budget

2. Basis of Design Schematic Design 30%

• Existing Plans

• Specialized Rooms

• Dining Options

• Front Playground

• Dementia Options

• Entrance, Geri Clinic & Easy Street

3. Interiors

• Program Guide for Finishes PG 18-14

• Dementia Supportive Interiors

• Next Steps

4. 90% Renderings

• Primary Entry and Clinic

• First Floor Dining

• Easy Street

• Second Floor Dining

• Outdoor Patio

• Dementia Unit

Basis of Design Table of Contents

6. 100% Renderings

• Primary Entry and Clinic

• First Floor Dining

• Easy Street

• Second Floor Dining

5. Basis of Design MEP

• Mechanical

• Electrical

• Telecommunications/Electronic Security

• Plumbing

• Fire Protection

Appendix A

Meeting Minutes

Appendix B

Interior Review 30% Selections

Appendix C

Mechanical Products

Appendix D

Architectural Products

Basis of Design Table of Contents Cont.

7 Basis of Design

Executive Summary

Introduction and overview of the project

• Introduction

• Design Team

• Applicable Codes & Standards

• Overview

• Project Scope

• Budget

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INTRODUCTION

This document is a Conceptual Design Summary which will serve as the starting point for the Basis of

Design (BOD), a living document that will evolve through the duration of this project. This document was created starting from the following key elements of developmental discovery:

• Kickoff Meeting on August 8, 2023

• Design Meeting on August 20, 2023

• Design Meeting on October 20, 2023

• Conference Call October 30, 2023

• Interiors Conference Call November 3, 2023

It is not the BOD’s function or intent to document every element of this entire process as it is developed;

rather it is to perform as an organized summary of the key developments of the project process. In addition to the BOD, total documentation of the design process consists of project minutes of meetings, numerous design studies and options presented for consideration.

This document provides a sequential concept development of Requirements discussed.

DESIGN TEAM

Name Company Role

Juan Gaytan Network Contracting Office Contracting Officer

Aaron Walsh Edward Hines Jr. VA Hospital Project Contracting Officer Representative

Mary Tucker Edward Hines Jr. VA Hospital Alt. COR/Interior Designer

Vickie Bastin Bancroft Architects + Engineers Project Manager

Dennis Mika Bancroft Architects + Engineers VP of Healthcare Design + Planning

Crotan Zakarija Bancroft Architects + Engineers Project Architect / VP of Architecture

Connor Rollins Bancroft Architects + Engineers Project Architect

John King Bancroft Architects + Engineers Fire Protection Engineer

David Greene Bancroft Architects + Engineers Mechanical Engineer / Director of Eng.

Walter Groszko Bancroft Architects + Engineers Electrical Engineer

Harold Santiago Bancroft Architects + Engineers Plumbing Engineer

Robert Bishop Bancroft Architects + Engineers Mechanical Engineer

Darlene Flook Bancroft Architects + Engineers Interior Designer

Dick Engleman Building First Nations Senior Cost Estimator

The lead firm for the project is Bancroft Architects + Engineers (BAE) and is providing architectural design, mechanical engineering, electrical engineering, plumbing and fire protection. BAE will be utilizing the following consultants listed below for this project:

1 Executive Summary

1-2

The following are Codes and Standards that will be used for this project as adopted by the VA. The most recent editions to the codes should apply unless noted otherwise:

• VA Directives, Space Planning Criteria, Design Manuals, Master Specifications, VA National CAD

Standard Application Guide, and other Guidance on the Technical Information Library (TIL). (http:// www.cfm.va.gov/til/)

• International Building Code (IBC) (Only when specifically referenced in VA Design Documents).

• NFPA 101 Life Safety Code.

• NFPA National Fire Codes, with the exception of NFPA 5000 and NFPA 900.

• VA Seismic Design Requirements, H-18-8—May 1, 2020

• National Electrical Code (NEC)

• International Energy Conservation Code (IECC).

• International Mechanical Code (IMC).

• International Plumbing Code (IPC).

• International Fire Protection Code (IFPC).

• ASME Boiler and Pressure Vessel Code.

• ASME Code for Pressure Piping.

• Occupational, Safety and Health Administration (OSHA) Standards.

• Underwriter’s Laboratories (UL).

• Ventilation for Acceptable Indoor Air Quality – ASHRAE Standard 62.1 – 2019.

• Safety Standard for Refrigeration Systems – ASHRAE Standard 15 – 2019.

• Sheet Metal and Air Conditioning Contractors Association (SMACNA).

• Architectural Barriers Act Accessibility Standards (ABAAS) including VA supplement, Barrier Free

Design Guide (PG-18-13).

• Building Code Requirements for Reinforced Concrete, American Concrete Institute and Commentary

(ACI 318).

• Manual of Steel Construction, Load and Resistance Factor Design Specifications for Structural Steel

Buildings, American Institute of Steel Construction (AISC).

• Energy Policy Act of 2005 (EPAct2005).

• Executive Order 13423: Strengthening Federal Environmental, Energy, and Transportation

Management.

• The Provisions for Construction and Safety Signs. Stated in the General Requirements Section 01010 of the VA Master Construction Specification.

APPLICABLE CODES & STANDARDS

Specific VA Manuals Guidelines and Assessments are used for this project:

• PG 18-14 Room Finishes, Door, & Hardware Schedule—December 2018

• D-7545 Cultural Resource Management

• VA Fire Protection Design Manual / 8th Edition—June 1, 2021

• Telecommunications Spaces (Clinical and Non-Clinical Environments) v3.0—August 21, 2020 http://www.cfm.va.gov/til/ http://www.cfm.va.gov/til/

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OVERVIEW

Edward Hines Jr. Veterans Affairs Hospital provides primary, extended, and specialty care services which is reliant upon supporting infrastructure, programmed spaces, and functioning environments keeping up with demand.

Building 217 is a 120,137 SF, two (2) story brick building. Constructed in 1983, the building has not been updated since it first opened. Services in the building have evolved since its construction and patients and staff have expressed a desire for an update, as the existing spaces are no longer optimized for their needs.

PROJECT SCOPE

..The scope of the design services includes, but not limited to the following design services: investigative services, schematic design, preparation of design development documents, preparation of construction documents including architectural, structural, electrical, mechanical and any others necessary for complete construction documents, with reviews, cost estimates, and reproduction of design documents.

The objectives of this project are to renovate portions of Building 217 in the below areas:

1. Easy Street 1A43 & Rehabilitation Medicine Recreation 1A108

2. Entrance lobby renovation.

3. Dining Rooms 1A118 and 2A26 renovation.

4. Library

5. Update three (3) bariatric rooms

6. Repair of 2nd floor courtyard.

7. Investigate and design a Dementia Unit.

8. Four (4) high fall risk rooms

9. Equipment Storage 2B41 and 2B78 update count

10. Playground demolition and restoration

11. Exterior Smoke Shelter demolition

12. New flooring throughout Building 217 as required.

PROJECT SUMMARY

In 2023, Bancroft Architects + Engineers was contracted to provide design/engineering services at the

Edward Hines Jr. VA Hospital in Hines, Illinois for the Conceptual Design, Schematic Design, Design

Development, and Construction Document phases for the renovation of multiple projects (Requirements) in Building 217 Community Living Center (CLC) and outlined in four Clinical Line Items (CLIN) found in the Scope of Work..

The design services includes, but not limited to the following : investigative services, schematic design, preparation of design development documents, preparation of construction documents including architectural, structural, electrical, mechanical and any others necessary for complete construction documents, with reviews, cost estimates, and reproduction of design documents.

The project consists multiple renovations in Building 217 with projects including renovation of the first floor entry/lobby, a 5 office/exam room Geri Clinic, options for updating dining rooms on both floors, renovation of the current Easy Street into a new multi-use space, a new 12 room Dementia Unit, updating several resident rooms to accommodate Bariatric and High Risk Fall residents and updating of flooring throughout the first and second floor.

BUDGET

The project has been allocated a construction budget. As part of this report, Bancroft A+E has prepared a preliminary Opinion of Probable Construction Cost (OPCC) for accomplishing the project scope described above.

1 Executive Summary

1-2

SCOPE OF WORK - REQUIREMENTS FOR CLIN 1

PHOTOS - EXISTING CONDITIONS

13 Basis of Design

Basis of Design

Schematic Design 35%

• Existing Plans

• Specialized Rooms

• Dining Options

• Front Playground

• Dementia Options

FIRST FLOOR - EXISTING CONDITIONS

15 2

SECOND FLOOR - EXISTING CONDI-

Existing Plans

REQUIREMENT 6 BARIATRIC ROOMS 2B49, 1C49, and 2C49

Space Issues: Patient rooms/toilet rooms design

• The Bariatric private room. Optimal clearances according to the Bariatric

Room Design Advisory Board are 5’-0” on both sides of the bed and front of the bed with a 6’-0” turning radius.

• Recommended wheelchair turning radius of 6’-0”

• Door widths recommended to accommodate Bariatric beds, wheelchairs and equipment is 4’-0” with a 2’-0” leaf.

• The optimal clearances in a Bariatric toilet room are 6’-0” turning radius,4’-0” x 5’-0” shower stall with floor mounted toilet typically mounted 21” off the side wall., clearly in conflict with ADA requirement of

18”. Toilet room door– 4’-0”.

• Toilet accessories recommended to be recessed to allow adequate clearances for staff in assisting patients.

• Use of vertical grab bars with proper support in aiding patients in getting up from the toilet.

• Use of a Bariatric shower chair is preferred.

• Patient lift system: a built-in mechanical lift system (e.g., a ceiling rail system) capable of transporting a 600-pound patient from the bed to the toilet room.

• Patient Room: Minimum patient room width: 14’-6” Minimum patient room depth 14’-4”

Requirement 6

2B49, 1C49, and 2C49

• Shares existing inboard plumbing riser location

• Easy Toilet / Shower Access

• Resident room lifts, extend into toilet room

• Viewing resident from corridor difficult

Specialized Rooms 2

Inboard Toilet Room Outboard Toilet Room Inboard Toilet Room

2 3

• Outboard toilet configuration requires additional cost

• Easy Toilet/Shower access

• Resident room lifts, extend into toilet room

• Viewing resident from corridor enhanced

• Decreased light/window visibility

• Inboard toilet located at existing plumbing risers

• Resident requires more steps to access toilet/shower

• Resident room lifts, can be extended into toilet room

• Direct line of sight of resident from corridor

REQUIREMENT 9 HIGH-RISK FALL PATIENT ROOMS 1C104, 1C178, 2C204 and 2C278

Environmental assessment high-fall risk includes:

• Environmental layout (shape of space and ease of getting around)

• Lighting and glare

• Presence of obstructions in both resident rooms and common areas

• Accessibility, visibility and safety of bathroom and dining room

• Sturdiness and visibility of handrails and furniture

• Contrast of the toilet and sink from the wall and the floor

• Safety and working condition of equipment and fixtures (e.g., bedside commodes, shower chairs, adequacy of brakes on wheel chairs)

• Appropriate use of personal safety devices, such as canes, walkers or wheelchairs

• Bathing facilities with non-slip surfaces

• Floor surfaces, textures and patterns Example: A blue-and-black border may look like a river or a hole.

• Fit and use of resident footwear Example: Examine shoes and slippers regularly for potential poor traction.

• Use of housekeeping equipment Example: Ensure that machines like floor buffers are run when residents are not likely to be moving about.

However, they should not be used at night when residents are sleeping.

Requirement 9

1C104, 1C178, 2C204 and 2C278

• Added handrails

• Cushion absorbing floor

• Inboard, outboard toilet configuration

• Toilet with shower

• Resident room lifts, extend into toilet room

Specialized Rooms 2

Inboard Toilet Room

Outboard Toilet Room Inboard Toilet Room

• Shares existing inboard plumbing riser location

• Easy Toilet / Shower Access

• Resident room lifts, extend into toilet room

• Viewing patient from corridor difficult

Inboard Toilet Room

Outboard Toilet Room

Inboard Toilet Room

• Outboard toilet configuration requires additional cost

• Easy Toilet/Shower access

• Resident room lifts, extend into toilet room

• Viewing patient from corridor enhanced

• Decreased light/window visibility

• Inboard toilet located at existing plumbing risers

• Resident requires more steps to access toilet/shower

• Resident room lifts, can be extended into toilet room

• Direct line of sight of Resident from corridor

Requirement 4 Dining Rooms

Rooms 1A118 and 2A25

• Add double door entry

• Upgrade flooring, finishes and lighting

• Design for flexibility

• Make the room a destination

Option B All moveable furniture with full height corridor resin panel. Option A Incorporates built-in seating and Resin panels with biophilic reference.

Dining 2

Requirement 11 Playground

• Add double door entry

• Upgrade flooring, finishes and lighting

Option B All moveable furniture with full height corridor resin panel. Option A Incorporates built-in seating and Resin panels with biophilic reference.

Playground 2

Requirement 13 Playground

• Add double door entry

• Upgrade flooring, finishes and lighting

Option B All moveable furniture with full height corridor resin panel. Option A Incorporates built-in seating and Resin panels with biophilic reference.

Playground 2

DEMENTIA UNIT – LOCATION OPTIONS

Option 1-Pros and Cons

• Relocates the Dementia Unit to Primary Care location.

• Allows Primary Care exam rooms to be right-sized in a new location.

• NHCU offices to remain-with possibility of moving remote.

• Potential direct access to a secured outdoor space.

• Potential for growth of the Dementia Unit into NHCU offices.

• Room for additional amenities including activity space, wandering paths.

• Nurse station located to have supervision of total unit.

• Maintains an adjacent Resident Care Unit of 15+beds

Primary Care

Dementia

Unit

NHCU

Resident Care Unit-15 Rooms

Secure Outdoor Garden

Nurse

Current Courtyard Access

Requirement for design

1. Identify most appropriate location

2. 4-6 Resident rooms with private toilet/showers

3. Nurse station with support

4. Secured unit/Wander Guard/cameras

5. Location which allows best efficiency and growth potential

6. Keeps remaining floor space program viable.

7. Appropriate amenities-ambulation path, activities, dining.

Multi-sensory room

Dementia Unit

5-7 Rooms

NHCU

Resident Care Unit-15 Rooms

Primary Care

7 Exam Rooms

Nurse

Option 1A - Pros and Cons

• Creates a separate Primary Care Unit with Toilet Rm.

• Right sizes exam rooms to meet VA standards

• Shifts entry corridor to the east

• Creates new toilet room at entry

Secure Outdoor Garden

DEMENTIA UNIT – LOCATION OPTIONS

Waiting

Break Out

Support

Reception

WC

Dementia Unit 2

Dementia Unit 5 Rooms

NHCU

Resident Care Unit-15 Rooms

Primary Care

Nurse

Option 2 - Pros and Cons

• Relocates the Dementia Unit adjacent to the Primary Care location.

• NHCU offices relocated with possibility of moving remote.

• Potential access to a secured outdoor space through occupied spaces.

• Potential for growth of the Dementia Unit into Primary Care.

• Room for additional amenities including activity space, wandering paths.

• Nurse station located to have supervision of total unit.

• Maintains an adjacent Resident Care Unit of 15+beds

DEMENTIA UNIT - LOCATION OPTIONS

DEMENTIA UNIT - LOCATION OPTIONS

Primary Care

Dementia Unit 6 Rooms

NHCU

Resident Care Unit-10 Rooms

Nurse

Option 3-Pros and Cons

• Relocates the Dementia Unit south of Primary Care location.

• Allows Primary Care and NHCU offices to remain

• Potential direct access to a secured outdoor space through

• adjacent RCU

• Potential for growth of the Dementia Unit into adjacent RCU

• Room for additional amenities including activity space, wandering paths.

• Nurse station located to have supervision of total unit.

• Maintains an adjacent Resident Care Unit of 10 beds

Current Courtyard Access

Dementia Unit 6 Rooms

Resident Care Unit-

Interior

Secured

Garden

Resident Care Unit-

Nurse

DEMENTIA UNIT-LOCATION OPTIONS

Secure Outdoor Garden

Option 4 - Pros and Cons

• Relocates the Dementia Unit of 5-6 Beds in the east wing of Building 217

• Allows Primary Care and NHHC offices to remain

• Potential direct access to a secure outdoor courtyard

• Potential for future growth

• Little room for added amenities without using adjacent spaces

• Nurse added in unit for supervision

N

DEMENTIA—SUPPORTIVE ENVIRONMENTS

33 Dementia Unit 2

35 Dementia Unit 2

REQUIREMENT 8

12 Bed Dementia Resident Unit

Option 5 (Preferred Option)

• Relocates the Dementia Unit to Primary Care location.

• Allows Primary Care exam rooms to be right-sized in a new location.

• NHCU offices to relocate.

• Potential direct access to a secured outdoor space.

• Possible additional amenities including activity space, wandering paths.

• Staff station located to have supervision of total unit.

Requirement for design

1. Identified as the most appropriate location

2. 12 Resident rooms with private toilet/showers including bariatric rm.

3. Staff station with support, space for interdisciplinary team

4. Secured unit/Wander Guard/cameras

5. Location which allows best efficiency and growth potential

6. Keeps remaining floor space program viable.

7. Appropriate add on amenities include -ambulation path, activities, dining multi-sensory room

Small Homes Model of Care Approach/Central Living and Dining?

TYPICAL RESIDENT ROOM

Typical resident room with new toilet/shower room and option with recessed entry. Resident room entry-opportunity for personalizing on open shelving or in memory box

REQUIREMENT 8– 12 BED RESIDENT UNIT

Entrance Vew

TYPICAL RESIDENT ROOM ENTRY

Typical Resident Room Entrance

2-Story Activity Space

View From Staff Station

Staff Station and Prep Area

Staff Station

Views of Activity Space and Dining

DEMENTIA UNIT– ENLARGED PLAN Option 2

Living

Room/

Dining

Staff

Station

Activity

Staff Station and Dining Bar

DEMENTIA UNIT– Option 2 with Modifications (Selected Option)

Option 2

The users preference was Option 2 with subtle refinements.

The dining bar counter lowered to a sit down counter height of 30”.

BAE will investigate the west wall directly behind the staff station for access to adjacent space, creating a staff toilet or conference room and possibly direct access to a shared medication room.

To minimize a “fish bowl” effect a film with a biophilic pattern will be applied to the second floor windows overlooking the 2 story space, obscuring the views into the lower level but allowing light from the atrium skylights.

Views of Activity Staff Station

DEMENTIA UNIT– ENLARGED PLAN Option 3– Planetree

Small Homes Model/ Central Kitchenette-Lounge

Living

Room/

Dining

Staff

Station

Activity

Open Staff Station and Counter Support

Views of Lounge/Fireplace

DEMENTIA UNIT– ENLARGED PLAN Option 3– Planetree

Small Homes Model/ Central Kitchenette-Lounge

51 Dementia Unit 2

Views From Staff Station

REQUIREMENT 1, 3 AND 4

Option 1A

• Primary Care moved to front door with six exam rooms and support

• Access to Primary Care is along new east west corridor adjacent to the new multi-purpose room (formerly Easy Street)

• Opportunity for Primary Care to have a separate waiting and reception.

• A new reception desk extends the width of entry lobby.

Primary

Care

Entry

Lobby

Reception

Option 1B

• Primary Care moved to front door with six exam rooms and support

• Access to Primary Care is from the entry lobby. Reception for CLC and Primary Care at same location in Entry Lobby.

• Waiting for Primary Care located in Entry Lobby.

• A new reception desk architecturally projects into Entry Lobby.

Primary

Care

Primary

Care Wait

Entry

Lobby

Reception

Entrance, Geri Clinic, Easy Street 2

REQUIREMENT 1,and 3 Easy Street and Entrance Lobby & Vestibule

Seating waiting

Exam

Primary

Care

Reception

Entry

Exam

Exam

Exam

Exam

Exam

Toilet

Support

Toitet

Existing

Laundry

REQUIREMENT 1,and 3

Easy Street and Entrance Lobby & Vestibule

New Multi-Use Space

New Multi-Use Space With Upgraded Dining

View From Dining

New Dining Room With Operable Glass Doors

REQUIREMENT 1,and 3 Easy Street and Entrance Lobby & Vestibule

Waiting

Exam

Primary

Care

Reception

Entry

Exam

Exam

Exam

Exam

Exam

Toilet

Support

Existing

Laundry

Multi-

Purpose

Dining

Toilet

Vestibule

Option 1B

Option 1B Waiting and Reception

Opportunity For Library Accessed From New East-West Corridor

View From Library into Multi-Use Room

Geri Clinic Options

During the 10-20-23 User meeting onsite it was requested by the VA to look at two options for the Geri Clinic exam rooms.

Option 1 developed office/exam rooms based on what has been described as a Euro model of care, It provides 5 larger office/exam rooms with clinic support, including a patient toilet, clean room, vitals and small office. The 12’ x 12’ office/exam allow for equipment alcoves at entries.

Options 2 an 3 provide 6 exam rooms right-sized based on the VA,s

PACT model. Option 3 provides direct access into the clinic from the reception desk.

In all three options an area for wheelchair storage is provided in the lobby separated by a low partition. Additional wheelchair storage and bench seating are shown in vestibule.

Geri

Care

Entry

Lobby

Reception

Vitals

Office/

Exam

Linens

Clean

Waiting

WC

Corral

Storage

Library

Dining

Multi-Purpose

Existing

Laundry

TLT

TLT

TR

Geri

Care

Entry

Lobby

Reception

Vitals

Exam

Linens

Clean

Waiting

WC

Corral

Storage

Library

Dining

Multi-Purpose

Existing

Laundry

TLT

TLT

Existing

Laundry

TLT

TLT

Multi-Purpose

Storage

Library

Geri Clinic Options 2

REQUIREMENT 1, 3 AND 4 REFINEMENTS

Dementia Unit

• Option 5 to include 12 resident rooms and still to be determined support spaces. BAE to review existing spaces behind staff station as possible Dementia Unit support. Potential support to include a staff toilet, storage, meds/nourishment. The former social work office to be an alternate activity space for residents.

Dining

• VA preferred all moveable seating in the dining rooms.

Geri Clinic

• VA prefers 5 larger office/exam rooms

• Provide a separate toilet room

• Add space for social worker, possibly use an office/exam room.

• Preferred access/waiting to the clinic from the new corridor to eliminate possible congestion at the front door. Look at combining waiting with library.

• Use adjacent rooms as smaller consultation/sitting rooms for families and residents.

Per phone conference call with VA on 10-30-23 the following plan changes were made.

Care

Social

Work

Vitals

Reception

REQUIREMENT 1, 3 AND 4

Option 1A

• Primary Care moved to front door with six exam rooms and support

• Access to Primary Care is along new east west corridor adjacent to the new multi-purpose room (formerly Easy Street)

• Opportunity for Primary Care to have a separate waiting and reception.

• A new reception desk extends the width of entry lobby.

Linens

Office/

Exam

Existing

Laundry

Toilet

Waiting/

Library

Storage

Family

Family

Dining

Prep

Tlt

GERI CLINIC WAITING OPTION

Care

Care Wait

Entry

Lobby

Reception

Geri Clinic

• A resin panel similar to 3Form or Lumicor is used to move clinic waiting to entry lobby and maintain the

Library as a separate programmed space.

REQUIREMENT 1, 3 AND 4

Privacy Screening for Clinic Waiting Allows Front Entry with

Option for 10 Wheelchairs with Partial Walls for Screening

Care

Reception

Clinic Entry

Library

Clinic Waiting

Wheelchair

Corral for 10

Office/

Exam

Top: Waiting with Screening and Bottom: Without Screening

Geri Clinic Interior Space

Interaction Between Architecture and Human Experience

• Geri Clinic access flexibility

• Curvilinear as a wayfinding experience– inside/out

• Noninstitutional design approach

• Biophilic imagery from entry lobby continues to interior spaces.

• Minimum of support includes equipment alcoves, social worker office and vitals room

Entrance Views into Geri Clinic (Alcoves Provide Equipment/Linen Storage)

Interior Views of Geri Clinic (Resin Biophilic Themed Panels Expand Interior Space and Provide Connection to Nature)

Geri Clinic 2

Interiors

• Program Guide for Finishes PG 18-14

• Dementia Supportive Interiors

• Next Steps

3 Interiors

The following pages include recommendations for room finishes found in the VA TIL PG 18-14.

and initial selections related to the Dementia Unit. They are shown primarily for start up conversation with the station and will be finalized in collaboration with the specific requirements of the users.

VA RECOMMENDED ROOM FINISHES PG 18-14

75 3 Interiors

VA RECOMMENDED ROOM FINISHES

77 3 Interiors

VA RECOMMENDED ROOM FINISHES

79 3 Interiors

Much has been written about designing environments for patients with Dementia and there is solid evidence that the built environment impacts the psycho-social-emotional well-being and probably physical health of individuals with dementia.

A white paper published by the Alzheimer’s Foundation of America in 2014 really set the initial foundation for interior designers in creating environments specifically for patients with this neurological disorder and are highlighted below.

Minimize over stimulation- Many patients with dementia are overwhelmed by large groups and large spaces and susceptible to confusion and distraction. Our design approach is to create smaller, more intimate group settings which minimize noise and visual stimulation.

Introduce familiar settings. We discuss many times about creating more home-like settings. More comfortable and relaxed settings are preferred. Those which are non-institutional and void of medical looking equipment. Creating residential rooms is a key while giving patients a greater control over their personal space by allowing them personalized details family photos, a place to display their handiwork, a memory wall for instance.

Introduce wayfinding as part of design, which can mitigate unnecessary stress, minimize the need for additional staffing to direct people and create a positive experience for patients. An intuitive floor parti with visual cues and landmarks help in wayfinding and help to reduce stress and anxiety while enabling patients to orient themselves in a safe environment. Distinctive cues, such as recognizable objects and artwork or a view to a specific outdoor feature, have been shown to be more effective than subtle changes, like an understated change in flooring color that could be overlooked.

Research has shown family plays an important role in the heal process in all clinical settings and similarly for a patient with Dementia families can play an important supportive role. Patient rooms and public areas should be designed for both patients and their families, providing extra seating or destinations for a quiet walk. The kitchen the heart of a residential unit becomes an important hub for both patients and their families to prepare a meal or have a snack or just to enjoy one’s company.

BAE has been involved in the design of MSE starting in 2020 when we partnered with Heroplex to collaborate with and design rooms that were flexible enough to be therapeutic, but flexible to accommodate a variety of alternate uses. Working through the Heroplex Foundation BAE designed rooms to accommodate diversionary therapies for both the VA in-patient and outpatient population.

Multi-sensory environments (MSE), also known as Snoezelen® environments, are defined as behavioral environmental intervention to help people with cognitive and physical impairments reach sensory equilibrium.

Typical elements within MSE include visual, auditory, tactile and olfactory stimuli, ergonomic vibro-acoustic furniture, bubble tubes, color-changing LED lighting solutions, music, fiber optics and aromatherapy.

The VA has implemented Multi-Sensory Environments (MSE) therapy for veterans with dementia since 2010 and the impact of MSE on aggression remains to be evaluated. In 2013, due to favorable initial results, the VA installed both fixed-room and mobile cart MSE applications in 53 VA community living centers (CLCs) across the

US, including one in Lake City, Florida which received mobile MSE carts and waterproof MSE equipment for use during assisted bathing, showering, and/or tub bathing. Most acts of aggression/agitation for people with dementia occur during assisted bathing and there is a strong need for evidence-based research of non-pharmacological interventions to reduce problem behaviors, decrease healthcare provider burden and improve quality of life (QoL) for people with dementia. The overall goal of this study is to investigate the effectiveness of

MSE in the reduction of agitation/aggression during assisted bathing, showering, and/or tub bathing for veterans with dementia.

Supportive Environments for Dementia Residents

81 3 Interiors

Colors and Dement ia : Yes, They

Can Have an Impact !

Why do colors sometimes seem to make us feel happier or more depressed? Are colors really that powerful in their ability to alter our moods? In many ways, the answer is “yes”, in that different colors and hues are interpreted differently in our brains, some having a profound, yet subliminal impact in how we feel at any different moment.

For years researchers have been studying the effect of different colors on the brain and human behavior. A study by Margaret Calkins, published in the Journal of Dementia Care, takes a look at the impact of colors on individuals living with dementia. While Calkins acknowledges that there may be certain personal and cultural variances between color interpretation, here are some of her observations:

Blue:

Has a restful, calming effect.

Often used in rooms where quiet is encouraged, such as bedrooms.

Blues of a cooler hue can make a room appear larger.

Green:

Evokes a sense of life and growth.

Has the ability to lower activity of the central nervous system, creating a sense of calmness.

As with blue, cooler greens can make a room appear larger.

Red:

Stimulates brain activity and, in some cases, can release an increased amount of adrenalin into the bloodstream.

Often recommended for use in areas where there is more activity, along with common areas.

Red can increase the perception of higher temperature in the room.

Orange:

Shares many of the same properties of red.

As an earth-based color, however, it can produce an increased association with nature.

Taking into consideration the special needs of dementia (memory care) facilities. The attached color palette is designed tohelp aging eyes “see” better. With a balance of wsrm and cool tones, these saturated colors can highlight the location as destinations or lead one along a “wander path”

Colors often look muted as the eyes ages. Using more varied, brighter colors help residents to distinguish between spaces allowing them to better navigate their environment.

https://pdfs.semanticscholar.org/9d22/975f4fe1fc17a3c2c6957f6716ec2d5b90ad.pdf

ENVIRONMENTAL SPACE LESSONS LEARNED for DEMENTIA RESIDENT

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ENVIRONMENTAL SPACE LESSONS LEARNED for DEMENTIA RESIDENT

Based on BAE’s research we have compiled two options with examples of color palettes flooring and objects that bring comfort and relief to those with Dementia. The color palettes and flooring types are based off the Light Reflectance Value (LRV) which is the measure of light reflected from a surface illuminated by a light source. Each finish is in a similar LRV value and allows for contrast to be created between the finishes selected. As we age our eyes cannot see contrast and light the same way young eyes can, along with reduced peripheral vision, and loss of sensitivity to color. In addition, those with dementia in particular have difficulties seeing in 3D, perceiving dimension in single colored object and have a hard time recognizing patterns and gloss surfaces. Therefore, it is key that we focus on creating depth and using high and low contrast items to our advantage. With BAE’s approach to color, we want to bring in nature and biophilic items to make residents feel safe and comfortable.

Option one is based off warmer tones, like being in the woods or on a hike, option two is a cooler approach like sitting on the beach. Option one possesses greens, creams and blue tones allowing for more natural items to come into play. Adding Lumicore panels like grass or cat tails further gives the sensation of being in nature. We take a similar approach with option two but instead thinking about sandy beaches and blue water. Lumicore panels of sea grass and fossil appearing leaves can give the impression of your toes in the sand. Both options have corresponding solid surface options that take our selection a step further. With both options the wood LVT would go through patient rooms and corridors. The accent flooring would be in the center gathering space, and the middle option is in patient bathrooms and wet rooms. Wall colors are interchangeable and can be used anywhere, as well as the solid surface options being interchangeable throughout the space.

Our findings brought on a variety of options to make patients feel as comfortable and welcomed as possible. Some of the options include important wayfinding options, the use of adjustable lighting options and dimming capabilities and certain furniture options. Wayfinding objects such as pictures, statues or even something hanging from the ceiling is imperative in decision making areas, whether it be at a turn or to enter a room. This can help them remember and make connections on what to do in these spaces

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Option 1 Option 2

ENVIRONMENTAL COLOR PALETTES for DEMENTIA RESIDENT

FLOORING FINISHES

WALL FINISHES

SOLID SURFACE

LUMICORE PANELS

FLOOR FINISHES

LUMICORE PANELS

SOLID SURFACE

WALL FINISHES

COMMON SPACE

GATHERING SPACE

RR

COMMON SPACE

GATHERING SPACE

RR

NEXT STEPS

The Schematic Design 30% package includes both Basis Of Design (BOD) and Drawing set containing options for Hines Renovation of Building 217 CLC scope Requirements. The majority of options have been reviewed with the station, primarily those found within the BOD. The drawing set provides clarity to those options and together provide the basis for the Opinion of Probable

Construction Cost (OPCC).

Many of the Requirements such as the Front Entry and Dementia Unit have several architectural options or variations to be reviewed and finalized, while several such as Dining, Easy Street and

Specialized Resident Rooms (Bariatric and High-Risk Falls) are more limited to options in the selections of furniture, lighting, materials and finishes. These will be explored in more detail with the users moving beyond Schematic Design and finalized for the Design Documents 60% deliverable package..

Referential Images

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COMPLIANT FLOORING FOR HIGH-RISK FALL RESIDENTS

Falls are the leading cause of injury-related hospitalization among seniors and are responsible for annual direct costs of $34 billion in the USA. Hip fracture and traumatic brain injury (TBI) are the most serious fall-related injuries and are associated with lasting and devastating consequences, including loss of independence, reduced quality of life and premature mortality

Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, is a passive intervention approach designed to reduce the stiffness of the ground in order to attenuate the impact forces applied to the body in the event of a fall. It has the potential to reduce the incidence and severity of all fall-related injuries. If effective, compliant flooring should be most beneficial in high-risk environments such as long-term care

(LTC), where fall and injury rates are up to three times higher than in older adults living in the community.

A significant number of previous studies indicate that compliant flooring systems, broadly known as shock-absorbent flooring, might be a cost-effective strategy for reducing injuries caused by patient falls. These flooring systems include shock-absorbing flooring, safety flooring, dual stiffness flooring, acoustic flooring, carpet, and rubber flooring. Before installing a compliant flooring system, the potential physical demands placed on healthcare workers should be carefully considered.

Many manufactures in the market place including Forbo and Tarkett have developed flooring product designed specifically in creating safe, comfortable environments for residents and staff in long term care settings. These will be explored in greater detail with staff and end users as the design is refined.

On a recently completed Community Living Center project with similar requirements for high-risk fall patients the staff selected an ECO Surface product, a sheet good with a wood look appearance having a vinyl surface layer and a composition rubber base layer. A Post

Occupancy Evaluation of the product is still pending.

Referential Product Images

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DEMENTIA UNIT

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DEMENTIA UNIT

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RESIDENT ROOM

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EASY STREET

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DINING

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CLINIC

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LUXURY VINYL TILE (LVT-2)

INTERFACE / CRITERION CLASSIC

WOODGRAINS

CE-

LUXURY VINYL TILE (LVT-3)

INTERFACE / BRUSHED LINES

SANDALWOOD - A01608

ENTRANCE

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LUXURY VINYL TILE

INTERFACE / CRITERION CLASSIC

WOODGRAINS

WASHED MAPLE - C00104

ENTRANCE CARPET

TARKETT / TERRA TURF

BLACK/BROWN

90% Renderings

• First Floor Dining

• Easy Street

• Second Floor Dining

4 90% Renderings

We begin in the Primary Care Entry entering through the front entrance. The patient is greeted by a comforting seating area and a reception desk.

107 4 Primary Care Entry

The patient can proceed down the corridor to enter into the waiting room. This view is facing down the corridor between Easy Street.

This view is from behind the reception desk facing the central seating area.

109 4 Primary Care Entry

A centralized view of the seating area.

From the corridor, the patient enters the waiting room where they can sign in and wait to be taken back to the clinic. This view is facing the reception desk from the corner of the room.

111 4 Primary Care Waiting

This view is of the opposite side of the room showing additional seating and a set of bookshelves.

From the waiting room the patient will enter the Primary Care Corridor. This view is looking down the corridor from the entry from reception.

113 4 Primary Care Clinic

This view is looking down the corridor towards the entrance from the end of the corridor.

The patient enters the exam room where the patient and Doctor will have an intimate and personal interaction.

115 4 Primary Care Clinic: Typical Exam Room

This view is looking towards the entry from the corner of the room.

The patient will continue down the main corridor where they can enter into easy street or the dining room. This view is facing the opposite end of the corridor towards easy street.

117 4 Primary Care Clinic: Typical Exam Room

This view is entering into the dining room from the corridor. The patient is greeted with a bustling, enjoyable environment with an adjustable view into Easy Street.

This view is from the corner of the Dining Room looking towards Easy Street. In this view, the adjustable walls to Easy Street are shown open.

119 4 First Floor Dining

This view is the same, but showing the adjustable walls to Easy Street shut.

From the dining room, the patient enters into Easy Street where they are having an afternoon of watching shows and enjoying family.

121 4 First Floor Dining Entering Easy Street

This view is looking from the corner of Easy Street looking towards the dining room. Both of the adjustable walls are shown as open.

This view is similar to the last but shows the adjustable walls closed.

123 4 Easy Street

This view is from one of the tables facing the projection screen where an episode of MASH is playing.

The patient can also enjoy the second floor dining room which has a similar arrangement to the first floor. This view is from the entrance looking towards the back.

125 4 Second Floor Dining

This view is looking from the corner of the room out towards the center.

The patient may also enjoy the inviting patio area next to the second floor dining area. This view is facing the entrance from the corner of the patio where residents and their families can enjoy each others company

127 4 Second Floor Patio

This view is looking from the opposite corner looking towards the second floor dining room and Easy Street.

The patient is entering one of the Dementia Unit entries. We are looking at the edge of the nurse station to the center gathering area. Here, people are enjoying snacks and good conversation.

129 4 Dementia Unit

This view is looking from behind the nurse station where a nurse and Doctor are catching up on paperwork. This view also shows the nutrition area where residents have access to drinks and a microwave.

From behind the nurse station we are looking directly out to the center of the room.

131 4 Dementia Unit

This is the opposite corridor. Memory boxes line the walls giving resident a reminder to which room is theres. Accent strips line the corridors assisting with wayfinding throughout the facility.

Entering the Resident room, the resident is greeted with a personalized shelf, cabinet and a soothing fractal design wall. Each resident room has its own private restroom and shower.

133 4 Dementia Unit: Resident Room

Looking from the opposite side of the room, the resident has an attractive wardrobe, along with a matching sink and bedside table.

100% Renderings

• First Floor Dining

• Easy Street

• Second Floor Dining

• Outdoor Patio

• Dementia Unit

• High-Fall Risk Patient Rooms

• Bariatric Patient Rooms

• Conference Rooms

• Family Room

5 100% Renderings

View of the wheelchair alcove area when first entering Building 217 amurray Snapshot amurray Rectangle

We begin in the Primary Care Entry entering through the front entrance. The patient is greeted by a comforting seating area and a reception desk.

137 5 Primary Care Entry

The patient can proceed down the corridor to enter into the waiting room. This view is facing down the corridor between Easy Street.