Attachment 1 - 508-349 AE SOW.pdf

508-349 Construct TDVV CLC 20 Beds February 16, 2022

Martinson

STATEMENT OF WORK

PROJECT NO: 508-349

PROJECT NAME: Construct TDVV CLC 20 Beds

ESTIMATED GROSS SQUARE-FEET: 21,950 GSF

CONSTRUCTION COST LIMITATION (CCL): $13,273,983

I. General Description:

Provide all necessary professional services to perform planning and design of the systems for project # 508-349, Construct TDVV CLC 20 Beds. The A/E is responsible and liable for the professional design in accordance with the contract, good engineering practices, VA standards, VA project-specific requirements and applicable codes.

II Project Scope:

Design Services: Prepare construction bid documents (Plans and Specifications) to provide the following:

A. Project Overview: This project will provide for the construction of two (2) Community Living Centers (CLCs) each to be referred to as the “Small House Model" or “Small House”. Each Small House will house ten (10) patients. These homes will exceed the community standard for Nursing Home Care by providing a more personal level of care in an enhanced environment and augment the four

(4) existing CLC small homes (TDVV CLC Units A, B, C, and D). VA Small Houses are owned and operated by the Department of Veterans Affairs. These facilities provide long and short-term skilled nursing care and rehabilitation. The AE will investigate the following three proposed site and building options, see Attachment #001 Conceptual Planning Layout Options:

• Option 1: Construct 21,950 SF, 2-Level 20-Bed Small Home Model facility located at TDVV Campus 1.75-acre site located south of the existing parking lot, east of existing parking structure, and west of Martin Drive.

• Option 2: Construct two (2) 10,550 SF, 1-Level 10-Bed Small Home Model facilities located at TDVV Campus on two (2) 0.34-acre sites northeast and northwest of existing CLC building located west of Martin Drive.

• Option 3: Construct 21,350 SF, 2-Level 20-Bed Small Home Model facility located at TDVV Campus located on one (1) 0.34-acre site northeast of existing CLC building located west of Martin Drive.

Based on the A/E’s site and building evaluation, one option will be selected for design.

B. Project Concept of Operation:

I. Environment of Care - The overarching goal of the “Small House Model” is to provide a home where veterans can have the highest possible quality of life and receive the best quality care. This environment is a place that supports care-giving that is administered with integrity, commitment, and respect.

Overall, the environment provides veterans with the following:

a. Independence: the resident has choices and control over their day.

b. Dignity: The resident is honored, treated with respect, and allowed to have privacy and express their own identity.

c. Engagement: The resident has opportunities for social interaction and activities that help maintain or improve activities of daily living.

d. Family involvement: The resident’s family is part of the care and well-being of the resident and has access to dedicated family space.

II. Principles of Small House Design - The VA’s commitment to resident-centered care is exemplified in the House, the 10-bed area that is the resident house and center of daily life. The purpose of the House design is to:

a. Foster a sense of family among residents and staff.

b. Provide a variety of opportunities for engagement in social spaces, both large and small, including space for families.

c. Give the resident a sense of ownership of the House as their personal space.

d. Increase physical activity and restore function.

The House is “home-like.” It is a household that supports the basic principles of “Small House” design. These basic principles of design include:

a. The House is designed around a central gathering area, or focal point.

In some Houses this is a fireplace; for the Small Houses the hearth is the kitchen. While there may still be a fireplace in the living room, the kitchen is the focal point of the House because it is the hub of activity.

b. Common areas such as living, and dining rooms are easily accessible from resident rooms so that residents are encouraged to be out of their rooms and participate in activities.

c. There is an on-stage/off-stage approach to support space. Support space is “off-stage” and seen as little as possible. Common spaces such as living and dining rooms are the “on-stage” visible spaces to encourage resident use.

d. There is some decentralized supply such as linen and medicine cabinets so that they are close to resident rooms.

e. Resident activity and interaction is supported by locating recreation storage in common areas so that it is easily accessible.

f. Efficiencies related to the House and the Neighborhood include the use of common resources to limit duplications which may also serve to encourage social interaction with the residents.

The design of the Small House has a direct effect on the quality and efficiency of care that can be provided. The buildings must operate to support the needs of the resident. Examples include:

a. Sufficient space is allocated for staff use in spaces which do not conflict with resident circulation and living areas.

b. Open plan layouts are utilized with visibility to all areas of the Home

c. Security will be both active and passive for residents and the facility in general, including but not limited to electronic security at exterior doors and alignment with security measures, procedures and systems of the local VA facility, where applicable.

d. Universal design concepts and full accessibility must be provided by application of VA PG 18- 13 Guidelines.

e. The Kitchen serves as the central staff work space which allows staff to remain in close contact with residents.

III. Residents – Each Small House will be designed to meet the operational needs of the individual home. The demographics and acuity levels for the types of residents in both houses are defined as follows:

1. Long-Term Residents with Dementia:

a. Long term residents stay 91 days or longer at the Small House.

They may live at the Small House for many months or years.

b. Dementia is an umbrella term that describes any kind of change in the brain that results in a cognitive impairment. Typically, executive function and memory are most affected. Dementia is most commonly caused by Alzheimer’s disease, but other neurological or vascular diseases such as Parkinson’s and Huntington’s may also be causes.

c. Symptoms of dementia can include short and long-term memory loss, an increase in anxiety and confusion, obsessive behavior, challenges in spatial navigation, behavioral fluctuations, wandering, and lower thresholds for being overwhelmed by stress and or stimulation. Symptoms can vary greatly among residents.

d. For residents with dementia it is important to reinforce personal identity, enhance self- esteem, maximize independence, encourage social interaction, and create a wayfinding and orientation strategy that is easy to understand.

e. The dementia resident has special needs that have been developed in the VA Mental Health Design Guide. It is recommended that the long-term care sections of that guide be referenced when planning for the resident with dementia.

IV. Enhanced Design Concepts – Features supporting enhanced designs may include:

1. Safety features that are not imposing

2. Reduced background noise

3. Enhancements of visible access

4. Signage and wayfinding tools or cues

5. Carpets that are textural and not patterned, to avoid the appearance of objects sitting on a field.

6. Contrasting color finishes on walls to help define space

7. Exit doors disguised or camouflaged in some fashion (specifically for dementia residents).

8. Floor materials and colors with complementing and limited contrast

9. Tactile art and life skills stations.

V. Staff - Operational efficiency is important to maximize the time staff are in direct contact with residents. To achieve this, the small house uses minimal back-of-house support spaces to allow staff to spend as much time as possible in the common areas with residents. The intent is to maximize visibility from staff work areas to resident common areas and resident room entries so that staff are quickly alerted to any problems.

The small house concept assumes a “universal-type” worker. The universal worker is a caregiver who provides a wide range of services, including meal planning, cooking, activity planning, laundry, light housekeeping, and personal care.

Space for staff respite, break space, is provided in the House and staff shall be considered in the design of landscaped spaces around the facility.

VI. Food and Nutrition Services - The VA prefers that Small House do all food preparation and cooking in each House. The pantry and home kitchen are designed with the flexibility to accommodate the following:

1. Food is delivered in bulk to the House and then moved to the pantry and home kitchen. Dry goods are stored in the pantry; refrigerator and freezer storage is located in the kitchen and pantry. Food is then prepared, cooked and served in the kitchen.

Dining is one of the most important aspects of the resident’s day-to-day experience. Resident-focused dining involves offering food choices, developing appropriate menus, and planning the production and distribution of food. It may also include allowing residents to be involved in the activity of preparing the food. The Small House must respond to residents’ dietary preferences and individual dining schedules as part of resident centered care. Cooking and food preparation is a Home activity for residents that is about more than just eating, it is an essential part of their social interactions and activities of daily living.

Snacks are accommodated and available to residents at all times of the day.

Residents have access to a refrigerator and microwave for personal food items.

VII. Medication - Medications will be delivered directly to the medication room.

Some medication storage shall be provided in lockable casework at each resident room, adjacent to the resident room entry for ease of access by staff.

The use of carts will be kept to a minimum. If use of carts is required/preferred, care must be taken to reduce the impact on the home environment by utilizing non-institutional looking carts and those that create minimal noise. Cart usage will be controlled or regulated and only utilized at times of day that are least disruptive to residents, as determined by the nursing staff.

VIII. Linen and Materials Management - The management of linen and materials in the House operates in the background with minimal disruption to the residents as a result of using the “off-stage” approach.

1. Clean Linen and Supplies: Frequency of cart use is lessened by decentralizing the storage of clean linen. Main linen and supply storage will be located in the Neighborhood Center when available, or in a clean linen room in the home. Secondary supply will be in decentralized closets in the House, and in casework in each resident room.

2. Soiled Linen: Each resident room will contain a soiled linen hamper.

Soiled linen will be transported from the hamper to a cart housed in the soiled utility room in each House. Other biohazards and soiled linens such as those from the dining room will be transported in a closed hamper or cart directly to the soiled utility room. These hampers are then brought to a central soiled linen room in the Neighborhood Center.

3. Oxygen: An oxygen storage room will hold portable tanks for when residents are out of their rooms and require portable oxygen.

IX. Trash - Trash will be held in trash receptacles throughout the House and brought to the soiled utility room in the House. It will then be transferred to the Neighborhood Center soiled utility room before being moved off-site.

C. Project Basis of Design: Each project and site have their own unique characteristics. The type of setting, number of residents, expansion potential, and physical restrictions will be different for each. The site design must consider the activities of multiple types of users including residents, staff, visitors, maintenance personnel, service providers, and emergency responders.

Components of the site plan include:

I. Site Access and Parking -

1. Provide access for emergency, service and personal vehicles. Design roads, fire lanes, and turn-arounds for the weight and turning radius of fire apparatus. Consult local fire department for fire apparatus requirements. At minimum, one of the long sides of every building shall be accessible to fire department equipment.

2. Parking for staff and visitors directly adjacent to each Home.

II. Entries -

1. Covered entry at each House.

III. Landscape Features – Gardens for residents, staff and visitors:

1. Healing or Therapy Gardens.

2. Respite Gardens.

3. Accessible Trails and Walkways.

4. Setbacks and Landscape Buffers.

5. Utility Access (Underground Services).

IV. Components of Site Plan – Refer to Attachment #001, Conceptual Site Layout Plan Options indicating approximate location relative to existing Small House (CLC) buildings, circulation, roadways, parking and various site features.

V. Site Circulation and Access - Site access may be from public roadways or access roads extended from existing roadway in accordance with Attachment #001 Conceptual Site Layout Plan Options. The location of curb cuts and aprons must be planned in accordance with the Authorities Having Jurisdiction (AHJs). On-site roadways should be planned with two-way and one-way traffic to provide safe and efficient circulation. Service access is best served by a separate service road that has different access points than public vehicular traffic.

Pedestrian and vehicular circulation on the site must put the residents’ needs first. Pedestrian and vehicular circulation shall be kept separate with distinct buffers between the two; pedestrian circulation may be integrated into the landscape to provide that separation. Connecting walkways will provide direct access between the Houses.

All walkways must be accessible and constructed of concrete or other materials appropriate for people with physical impairments using canes, walkers, and wheelchairs. Adequate resting places, including interesting landscape features, will be provided along all pedestrian paths. Special consideration should be given to the walkway that leads to the front door of each House, making each of those entries distinct in the landscape.

Service circulation shall be separate from resident, family, and visitor circulation. Receiving and refuse areas shall be designed to receive trucks in a non-obtrusive way and be screened from residents’ and visitors’ view as much as possible. Also screen ground-based HVAC and electrical equipment.

VI. Parking - The VA Parking and Design Manual and Calculation Spreadsheet on the TIL shall be referenced to determine the parking model and number of parking spaces required. Parking considerations should include peak demand based on each community’s demand load. Parking must address the following needs:

1. Staff parking

2. Visitor parking

3. Delivery parking

4. Maintenance vehicle parking

5. Small House Vans or Shuttles

Parking areas are to be located at each House. They should be in small groupings rather than large lots. Some parking should be at each House so that visitors can have direct access to each House. Orient parking in such a way to avoid headlights of cars directly facing into resident rooms. Parking for any of the community’s vans or other passenger vehicles used to transport residents will be provided in a driveway or garage, away from the main entry of the Houses.

VII. Emergency Access - Access to every part of the site for emergency vehicles shall be provided for ambulance, fire and rescue, law enforcement, and other emergency related vehicles. The widths of the roadways for emergency purposes needs to be maintained and unobstructed at all times. Consideration should be given to the House’s garage to support emergency vehicles using it for access.

A loop road, or some means of complete site access, is a desirable feature (See Proposed Site Plan) and is required. If possible, loop road design allows access for fire trucks and other emergency vehicles to complete a revolution around the facility.

IIX. Main Entry - Covered entrances at the Homes are desired if possible. The covered entrance can be a place for residents and visitors to congregate and watch the community’s activity. Ample space for seating and circulation near the main entrance will be provided and separate from vehicular traffic to ensure resident and visitor safety.

VIII. Site Wayfinding and Signage - Signage will be located on site to assist visitors, staff, and service vehicular and pedestrian circulation. Circulation paths for vehicles and pedestrians must be logical and easily identifiable with proper signage and directional arrows. Refer to VA Signage Design Guide on the TIL. It is recommended that signage is provided to identify the following:

1. Location of buildings on site.

2. Directional traffic.

3. Restrictions.

4. Parking.

5. Deliveries.

6. Passenger Pick-up.

7. Entrance to facility.

Orientation to any facility requires wayfinding. Resident disorientation can be traumatic. Some suggestions for site wayfinding include:

1. Signage with large, contrasting notations.

2. Color, patterns, or themes to assist with finding one’s way to a specific home.

3. Lighting, both for signage and along pedestrian and vehicular pathways.

4. Signage where walkways cross or meet.

IX. Gardens and Landscaping - Access to outdoor spaces and the quality of the outdoor environment has a direct effect on the quality of life for residents. It is important to provide many different types and scales of gardens for Small House residents, staff, and visitors to encourage activity, passive engagement, and tranquility. Careful consideration must be given to the location of gardens.

Visual access to them from common spaces such as living and dining rooms in the House.

Gardens need a combination of activity spaces such as raised planters for gardening activities, seating for relaxation, paths for walking, and sensory elements such as an olfactory garden. Shade and protection from the wind at seating areas will be provided to prevent exposure to the elements.

The Home garden is a protected environment (from wandering off) that residents have free access to without staff supervision. Staff shall be able to observe the residents in the garden from the House’s common spaces, and residents should be able to use the garden when they desire to. The following features should be considered:

1. Covered and un-covered seating areas for the number of residents in a Home.

2. Connection to a walking loop, turf areas, and raised planting beds.

3. Level walking surface materials on the primary routes with texture for traction.

4. Access to water source and outdoor power outlets.

Special design and security considerations must be given to any garden space designed specifically for residents with dementia. Destination areas and focal points around the garden can help with navigation. The type of fence design around the garden can assist in preventing climbing and elopement.

Activity spaces such as a barbecue area that can accommodate those residents will be provided. Seating arrangements should be varied in scale and type, from benches (to allow for passive observation), to tables where residents and visitors can share a meal or other activities.

Planting should be indigenous to the geographic area in which the Small House is located and include many varieties of plants to create visual interest year-round through color, shade, and texture. All plant material used should not be poisonous if ingested.

X. House - The House is the basic building block of the community; grouped together with other houses, it forms the neighborhoods and the Small House as a whole. The House’s layout in relation to other homes will have the greatest effect on the overall design of the community, see Attachment #1 Proposed Site Layout Plan. The House is where residents will spend most of their time and have the most amount of interaction with the physical environment. The planning of the House takes into account the daily lives of the residents, staff flow and processes, the movement of materials, and connection to other Houses and the Neighborhood Center. The House will be for a specific group of with dementia.

The basic components of the House are resident areas, support, areas, and staff and administrative areas.

1. Guidelines for Resident Areas Layout and Character:

a. Kitchen: The Kitchen is located at the center of the House. The Kitchen will function as the “hearth” of the House.

b. Residential Character: The House must be residential in character and scale. Use a design philosophy based on minimizing institutional aspects, for example avoid use of medical carts and pre-fabricated medical headwall units for oxygen supply.

c. Corridor Length: Corridor length has been minimized to support a more residential environment. Double loaded corridors only occur in “off-stage” staff areas.

d. Dead-End Corridors: Avoid dead ends at corridors, especially in Memory Care environments. Dead ends have been shown to frustrate or confuse those with dementia, which can lead to agitation among those who are wandering. If possible, avoid dead ends by connecting paths. End points of corridors should be a destination, such as the living room or another common area.

e. Views to the Outside: Views to the outside are to be used to help facilitate wayfinding, provide natural light, and Regulate sleep/wake patterns for residents.

f. Families and Visitors: Families and visitors are likely to come into the home often. The den, the family visiting space, is placed in a semi-public area of the House.

g. Main Entry: Each House has a weather-protected entry directly from the exterior that is the House’s “front door.”

h. Back Entry: Each House will have its own entry from the rear of the building. This entry should clearly delineate that a visitor is now entering into the residents’ private home by way of a vestibule.

i. Resident Rooms: Resident bedrooms are grouped into arrangements of rooms with access through a seating alcove.

j. Resident Room Adjacency: Consider grouping resident rooms together in a private zone of the House while still retaining staff visibility from public spaces.

k. Resident Common Areas: Resident common areas are to be open and easily accessible spaces with direct access from the resident bedrooms. Common areas should have natural light and views from at least two sides.

l. Common Areas: Common areas include both highly active and less active social areas for spontaneous interactions. Active social areas include the den, living room, and dining room. Spontaneous social interaction areas include resident room seating alcoves and circulation zones.

m. Medical Waste: Medical waste is generated in medical exam rooms or in resident bedrooms where it is bagged, collected, and transported using specially designated, closed containers, to the Soiled Utility rooms. The waste is held there until it is transported to the medical waste handling facility.

n. General Waste: General waste is generated in all spaces and is held in waste containers for collection. It is then collected by environmental services staff and transported to soiled utility rooms located in service areas or at outdoor trash collection areas.

o. Recycling: Means of sorting, collecting, transporting, and disposing of recyclable materials should be analyzed by locality, and modified to suit local conditions and practices.

p. Reusable Medical Equipment (RME): Any washable items incorporated into the plan of care are transported to and held in the soiled utility awaiting pickup for transport to Sterile Processing Service for cleaning and reprocessing.

q. Records: Resident medical and financial records are maintained and accessed electronically.

r. Specimens: Specimens are collected at the home and are transported to the parent facility laboratory or to an off- site reference laboratory for processing and reporting. Effective means are necessary for maintaining and transporting specimens to ensure integrity.

s. Pharmaceuticals: Pharmaceuticals, including narcotics, are transported in locked transport containers by pharmacy staff to the homes. Narcotics are delivered to a locked medication cabinet or Pyxis MedStation in the medication room. Medication carts are used in the Home to bring medications to residents when necessary. Some medications can be stored in Resident Bedrooms to reduce the frequency of cart traffic.

t. Supplies: Supply traffic (material) is separated from resident and visitor traffic. Clean supplies are transported via supply carts to the clean utility rooms in the home where supplies are accessed by staff.

u. Linen: Supply traffic (linen) is separated from resident and visitor traffic. Clean and soiled linens are transported in linen carts.

v. Sterile Supplies: Sterile items used are transported via dedicated closed carts. Sterile items also may be stored in the clean utility rooms.

w. Energy Conservation: Energy conservation is emphasized in all aspects of the building design. Refer to the most recent version of

ASHRAE Standard 90.1, as well as DOE Regulations, Codes, Standards & Executive Orders.

x. Disaster Planning: Situations can arise when it may not be feasible to evacuate residents for extended periods of time. In those cases, emergency power is required to maintain food service, heating, ventilating, and life safety systems.

2. Guidelines for Support and Staff Area Layout: Support spaces are treated as back-of-house space. Minimize views from common areas to support doors and into staff and support spaces. Supply is decentralized in closets to minimize the usage of large carts. Good visibility is provided from the kitchen work area and home office to the living room and dining room. Also consider visibility to resident room doors from the kitchen, where possible.

XI. Flexibility and Inclusiveness of Houses - The House may serve residents of all types and acuities. Residents with dementia require special considerations in the design of the environment. Such environments must help residents to cope with the effects of dementia and help reinforce the functions that the residents are still capable of performing. The following guidelines are beneficial to all:

1. Elimination of environmental stresses by not having an environment that is overly cluttered but still has focal points to retain interest, views to the outside, and artwork.

2. Inclusion of elements and activities that are familiar to the residents, such as:

a. Food Preparation/Eating

b. Bathing/Dressing

c. Board Games

d. Puzzles

e. Reading

f. Stretching

g. Piano/Music

h. Dancing

i. Housekeeping and Laundry

j. Vacuuming

Consider the effects of sensory over-stimulation for dementia, both auditory and visual. The acoustics of a space shall be designed so that background noise that is distracting is minimized. Reduce visual stimulation from such things as loud patterns and glare.

Provide signage and wayfinding tools or cues that are redundant in that they use graphics, words, elements and views to assist dementia residents in navigating the environment. The houses will include Sensory Therapy Room.

The Sensory Therapy Room may take the form of one of several types:

1. A Snoezelen Room is a therapeutic environment created for the express purpose of delivering high levels of stimuli to residents with dementia. A private room displays optical illusions with combined lighting effects, aromas, colors, textures and sounds to stimulate a person’s sensory systems.

2. A Namaste Room is designed to surround residents with soothing sounds of nature, music and calming aromas similar to a spa.

Residents who can no longer participate in traditional activities or tolerate too much stimulation can receive individualized care in a quiet, welcoming space.

Consider creating life enrichment stations throughout the House. These themed stations within the programmed common areas, corridors, or seating alcoves provide other opportunities for activities. The themes may include an office, a computer station, library, or other themes.

XII. Designing for Social Engagement - Social engagement of residents with one another and with their families is of fundamental importance to the residents’ quality of life. The environment can help facilitate that social engagement by offering a variety of social spaces in order for residents to participate at any level and degree.

There is a variety of spaces for both structured and un-structured, or casual interaction. These spaces should have abundant natural light and views to the outdoors, and are able to facilitate reading, conversations, media usage, family socializing, and spontaneous interactions.

While interaction and socializing with others is encouraged, choice for the resident of where and when to interact and/or participate is key. To aid in the resident’s empowerment, places like seating alcoves and niches are provided in the design. These alcoves are configured to allow residents to preview the larger activity that is going on as passive observers or have quieter more intimate conversations with another resident or staff member. Previewed spaces from the alcove may include the living room, dining room, or den.

XIII. Room by Room Descriptions: All resident areas must be free of impediments including mechanical and structural elements, controls, hardware, and other built-in items. All areas must comply with ABA/ADA Standards for Accessible Design (See VA Small House Model Design Guide, January 2017):

1. The A/E shall incorporate a bariatric accommodation into each Home.

2. Each home shall have a tornado safe room.

D. Project Specific Design Criteria:

I. Architectural Design-

1. Life Safety Plan –

a. Project Location: Carrollton, Georgia

b. Occupancy Classification: New Health Care (Nursing Home)

c. Interior Finishes:

i. Wall and Ceiling Finishes - Class B for fully sprinkled buildings, except Class C is permitted for individual rooms having capacity not exceeding 4 persons and the lower portion of the corridor wall.

ii. Interior Floor Finishes – Floor coverings (other than carpet), shall have a minimum critical radiant flux of 0.1 W/cm2 for fully sprinklered buildings.

d. Any area with a hazard of contents classification higher than that of the health care occupancy and located in the same building shall be protected. Hazardous area Protections includes:

i. Central/Bulk Laundry Area > 100 SF (1 Hour)

ii. Rooms with Soiled Linen >64 Gal (1 Hour)

iii. Combustible Storage Rooms > 50 SF and ≤ 100 SF (Smoke partition).

iv. Combustible Storage Rooms > 100 SF (1 Hour)

v. Rooms with Trash > 64 Gal (1 Hour)

vi. Residential Cooking – Residential cooking equipment is used to prepare meals (NOT for “warming or limited cooking”) for 30 or fewer persons.

1. Residential cooking equipment is not exempt from protection and requires specialized extinguishing equipment requirements defined under NFPA 96, constituting a hazardous area.

2. Residential or commercial cooking equipment to prepare meals for 30 or fewer persons can be open to the corridor provided they meet the requirements of NFPA 101.

3. Residential or commercial cooking equipment to prepare meals for 30 or fewer persons are also allowed provided they are separated from the corridor and meet the less stringent requirements of NFPA 101.

e. Evacuation Standards: A percentage of residents may suffer from some degree of cognitive impairment. Those afflicted can become frightened by an evacuation alarm. It is therefore suggested that fire alarm systems use private operating mode. Horizontal evacuation plans, (also known as “defend-in-place” strategy) is a requirement for all healthcare and ambulatory healthcare occupancies. All facilities must plan for horizontal evacuation through smoke barriers to a safe area. Designers should refer to NFPA 101 for guidelines including but not limited to the following:

i. Designing the facility so that each floor is divided into at least two smoke compartments, not more than 22,500 sq ft. separated by 1-hour fire rated smoke barriers.

ii. All penetrations in smoke barriers are to be protected using UL-listed firestop systems.

iii. Cross-corridor doors in smoke barriers are required to be a pair of opposite swing double egress doors, equipped with fire-rated vision panels and astragals. This will allow occupants in either smoke compartment to safely egress to an adjacent smoke compartment on the other side of the barrier.

iv. Travel distance from any point in a smoke compartment to a smoke barrier door should not exceed 200 feet.

v. Ducts are permitted to penetrate smoke barriers without the use of smoke dampers in fully ducted HVAC systems (due to complete sprinkler protection requirements).

2. Accessibility: Current profiles of the VA residents indicate that a high percentage require assistance in activities of daily living such as toileting and showering. It is required that the Small House facilities adhere to the requirements of PG-18-13 and provide accessibility in 100% of bedrooms and resident toilets designed to accommodate both male and female Veterans.

a. Assisted Transfers: Small House’s empower staff and promote the use of overhead lifts to help in toileting and bathing. The A/E shall incorporate overhead ceiling-mounted lifts in all patient bedrooms and toilet rooms.

b. Bariatric Lifts: At least one room in each Home shall be provided with a built-in mechanical lift system (e.g., a ceiling rail system) capable of transporting a 600-pound (272.16-kilogram) patient from the bed to the toilet.

3. Exterior Enclosure: The exterior closure of a building, the "thermal envelope", plays a major role in a structure’s energy performance. It must be designed to minimize heat gain and loss from conduction, solar radiation, and air leakage. Refer to ASHRAE 90.1, 2007, for recommended "U" values for walls, glazing, roofs, and floors.

II. Interior Design -

1. Interior Room Finish/Plans/Schedules: The interior of the Small House must be welcoming and reflect the comforts of home. The geographic identity of each Small House can be reflected by a diversity of design and a variety of finish selections, as appropriate to the location of each facility across the United States.

The creative use of finishes, architectural detailing, lighting, furniture, wayfinding and artwork will ensure a quality experience for residents, staff and visitors. Each Small House will be designed and detailed to express a residential theme and provide a concept of Home to its residents. For typical interior finishes refer to VA PG 18-14 for additional information regarding Small House finishes.

a. Overall Selection Criteria: Individual perceptions differ according to diverse social norms and situations. The creation of a home and healing environment can greatly affect the resident’s perception of overall well-being and sense of control.

b. Perception is not based upon isolated responses to a particular stimulus, but rather as a reaction to the total stimulus field. Therefore, a variety of factors must be considered when planning the interior of the Small House.

c. The interior architecture, finishes and furnishings of the Small House should be designed and selected with the following goals in mind:

i. Achieve an environment that is comfortable, familiar and residential in aesthetic.

ii. Recognize and reflect the geographical region of the Small House.

iii. Ensure an ease of maintenance and durability for daily use.

iv. Appropriate for both safety and ergonomics.

v. Environmentally responsible, toward the interior environment of the Small House as well as the global environment.

2. A Familiar, Comfortable Environment: Interior architectural elements and finishes should reflect those typically found in a residential house.

Architectural elements such as chair rails, crown molding, door casings, and baseboards whenever possible shall be designed/detailed in a manner and scale similar to a private residence. Choose Finishes and Furniture that will enhance the residential aesthetic in all Resident areas while also maintaining commercial/healthcare grade levels for durability and maintenance.

3. Reflect the Geographical Area: Interior design and architecture for each House shall reflect and be appropriate to the geographical region in which it is sited, and sensitive to the local climate, quality of light, and regional materials.

4. Ensure Ease of Maintenance: Finishes should be selected with consideration to durability and maintenance practices of the VA Small House. Flooring tends to be the most time-consuming finish to maintain. The number of cleaning supplies and time spent to maintain these finishes can be reduced by selecting a family of floor finishes that have similar maintenance requirements. Designs that utilize a conservative number of paint colors throughout the community will likewise contribute to an ease of maintenance and reduced attic stock. These benefits can also be seen by specifying lighting fixtures with the same lamp types.

Wall protection can minimize damage done to walls due to everyday use and, used prudently, can avoid an institutional appearance. In determining the amount and type of wall protection to be used, consider the following:

a. Carefully consider the color, pattern and texture of wall protection. It should be selected to be integral with the overall design concept. Use full height corner guards.

b. Avoid the use of stainless steel except in service areas

c. Handrails should be designed as an integral part of the wall protection package.

5. Ergonomically Appropriate: The specification of ergonomically appropriate furniture, details and finishes should eliminate as many barriers as possible for daily living of residents. Standards shall be per VA Accessibility (Barrier Free Design Guide) at a minimum.

a. Visual Considerations:

i. Provide a color/value contrast between floor and wall planes and between hand-rails and walls

ii. Maintain a similarity of color value between different floorings

iii. Provide low glare surfaces, particularly on floors

iv. Provide wayfinding cues in the interior architecture

v. Ambient lighting should be augmented with focused task lighting

vi. Provide access to daylight and control glare

b. Physical Considerations:

i. Provide lean rails or hand-rails in resident hallways and other pathways to aid residents walking independently

ii. Provide slip resistant floors

iii. Provide minimal thresholds between changes of floor finishes

6. Environmentally Responsible: Provide a level of design that, at a minimum, is in compliance with the current standards and tenets set forth in the VA Sustainable Design Manual. This will ensure that the VA Small House support the VA mission in a manner that is socially, economically, and environmentally sustainable. The specification and implementation of sustainable finishes and materials supports the health of residents, visitors, staff and the larger community. When specifying finishes and materials give consideration to the following:

a. Low VOCs: Low pollutant-emitting materials and the protection of indoor air quality with regard to:

i. Materials and adhesives

ii. Installation of all materials

iii. Maintenance procedures and products

b. Recycled Content

c. Biobased Content

d. Life-cycle Costing

e. Ground-Source Heat Pumps. The TDVV Campus currently utilizes a ground-source heat pump system sized to heat and cool the existing buildings. If possible, the ground-source heat pump system may be expanded to accommodate the new CLC building(s).

7. Design Language: The overarching scheme and style of the Small House is that of “home.” The residential design vocabulary for the Small House uses is to be taken into consideration when selecting the complement of products and architectural details. The theme and vocabulary shall be evident in the choices of materials, color, shapes, patterns, textures and layouts.

a. Color: Color can have a dramatic effect on the aesthetic appeal of an interior design. It can transform a plain space into an uplifting environment. As people age, cells in the retina that are responsible for normal color vision decline in sensitivity causing colors to become less bright and the contrast between different colors to be less noticeable.

This is also described as a yellowing of the lens. This change in vision results in an intensifying of yellow hues and tones. People with a yellowing of the lens tend to confuse pale colors in the blue-green region of the spectrum with other pale colors. Blue and green become more difficult to tell apart than red, yellow and orange. In consideration of this effect, select a multitude of colors, not just blue and green.

b. Color Pallets: Color palettes shall be developed for both homes together as a whole. The palettes developed for Small House shall have an overriding theme while also providing variation to allow spaces within the community to be emphasize with different colors. Select neutral tones for some of the most permanent finishes such as flooring, doors, and casework. Accent colors can be implemented on walls, furniture, and in art, and elements that can more easily be changed. Color palettes and their implementation are to reflect the following color concepts:

i. Full spectrum of color – encompassing both warm and cool tones.

ii. Contrast - Contrast between floor and wall planes, between furniture seats and the floor to differentiate the planes from each other and assist with depth perception.

iii. Minimize value (light to dark) contrasts between adjacent flooring, as the elderly eye may perceive this as a step or a hole.

c. Textures and Patterns: Use pattern and texture to bring another level of depth, variety and visual interest to the Home design scheme. These aspects should reinforce the residential theme. Patterns and textures can also be used functionally to help to hide soil and conceal wear. Select Patterns and Textures with consideration of the following principles:

i. Use both large and small-scale patterns to reinforce residential design themes.

ii. Limit large patterns to one surface or furniture item.

iii. Sample large patterns in large-size samples to ensure that the pattern does not produce an optic effect.

iv. Review smaller patterns in large-size samples as they may not be visible by an aging adult eye.

8. Design Elements: Design elements include the surfaces, materials, furnishings, acoustical properties, lighting and positive visual distractions that will be selected to execute the interior design of the Small House. The principal finish surfaces are floors, walls, and ceilings. Refer to the VA PG-18- 14 and the Room Templates for further direction on interior finishes. These elements should be selected in accordance with confirmed project standards and reinforce the residential theme present as described for all VA Small House projects.

a. Floor Finishes: Flooring finishes are extremely varied in pricing, installation methods, and durability. Select a flooring appropriate to the space function and geographic location. Selection criteria include initial cost, life- cycle cost, sound absorption, slip resistance, and ease of maintenance. The levelness, texture and moisture content of the subfloor are also important considerations. The Design team should be aware of any special or recommended installation practices for a specified flooring material; including recommended backing materials or moisture barriers.

Flooring transitions and transition materials will be detailed and selected to achieve as smooth a transition between flooring materials as possible.

Subfloors should be sealed wherever there is a probability of incontinent residents. Balance the need for highly cleanable flooring against the goal of achieving a residential environment.

b. Wall Finishes: Interior walls comprise the single largest area of finish in a project and serve as the backdrop to a room. The finishes, colors and textures applied to them help to define the aesthetic of a space.

Selection criteria should include initial cost, maintenance cost, contributions to light levels and sound absorption. Select a wall finish that is appropriate to the space function. Balance the need for cleanable, durable wall finishes against the goal of achieving a residential environment.

c. Acoustics and Sound Control: Acoustics are important to the quality of life of the residents. Analyze sound quality and transmission both in a single room and between two spaces. Careful consideration must be given to the following aspects:

i. Design partitions between rooms to have an STC (Sound Transmission Class) rating that complies with VA PG-18-14 Room Template data sheets.

ii. Consider using acoustically absorbent ceilings, walls, floors, and furniture in all public spaces and where sounds privacy is desired.

iii. Acoustical finishes should support the residential theme.

d. Wall Protection and Accessories: The amount and type of wall protection should be an integral part of the project design. The extent must be balanced with the use and associated maintenance requirements. Care should be taken regarding the following:

i. Hand Rails: All resident and public corridors should receive hand-rails or lean rails. Color should contrast with wall color.

ii. Wall Protection: Consider sheet wall protection, especially on lower half of wall, in corridors with a frequent wheelchair traffic.

iii. Corner Guards: Corner guards, in a tone to match the wall color or be of a profile to suggest a residential aesthetic, at outside corners.

iv. Stainless Steel Wall Protection: Stainless steel wall protection is used only in back-of house support spaces, such as garage and gas storage areas.

v. Wall Base: Wall base in resident areas should be of a resilient type for durability but of a profile that will match the residential aesthetic.

e. Ceilings: In addition to the typical gypsum board and acoustical tiles, ceiling material options include wood, fabric and metal. Ceiling modules can be used in either panels or planks. Ceiling systems designs can include integrated lighting fixtures and air handling grills. Ceilings can have a major design impact on a space, a variety of ceiling types in a Small House community can help differentiate spaces and reinforce a residential aesthetic. Refer to VA PG-18-14 Room Templates for preferred ceiling heights. Consider the following when designing and specifying ceilings:

i. Use monolithic ceiling material, gypsum wall board, in resident rooms and other resident areas.

ii. Consider the acoustical requirements of the space.

iii. Review ceiling access requirements of the space for utility maintenance, the ease of access of ceiling system options, and the appearance of access panels.

f. Lighting: As people age, their eyes undergo changes. These changes of vision typically cause less light to reach the eye and a sensitivity to glare.

Providing higher levels of lighting from multiple sources will allow aging individuals to see detail and reduce glare. Innovative lighting designs and advanced technologies, including LEDs, photo sensors and occupancy sensors, can help residents both to maintain independence and create a more comfortable environment. An appropriate lighting design will contribute to safer rooms by reducing risks and minimizing falls. Lighting designs shall include the following aspects:

i. Locate lighting controls for ease of access.

ii. Limit glare from light fixtures through fixture lens position.

iii. Provide both ambient and task lighting.

iv. Provide higher illumination levels, per VA standards, particularly in bathrooms, for safety.

v. Provide low level motion activated light adjacent to each resident bed and in each resident bathroom.

g. Window Coverings: A wide range of window coverings are available:

drapery, shutters, mini blinds, vertical blinds, cellular shades, and solar shades. Each provides a distinct set of benefits and downsides, including cost and appearance. There can be substantial cost differences between the styles. Care should be taken in the following respects:

i. Determine the degree of sun control required on each exposure of the building.

ii. Determine the degree of visual privacy required in resident spaces both from the inside out and the outside in. Consider both daytime and nighttime conditions.

iii. Review the ease of operation for residents for each product.

iv. Verify that the window covering selected is compatible with the way the window opens and the associated window hardware.

v. Provide window coverings in resident rooms with room darkening capabilities.

h. Interior Furnishings: Comfortable, safe furniture is critical in order to encourage residents to leave their rooms and socialize. Provide a variety of seating types, configurations, and furniture styles. Many residents will lean on furniture for extra support when walking through a space, so chairs and tables must remain stable when used for support. In general, outside corners of furniture should be rounded to prevent injury from sharp edges. Care should be taken in the following respects:

i. Specify seating with higher and shallower than normal seats (recommended dimensions are: Seat Height: 18” - 20”, seat depth: 20” - 24”) arms that extend to the front of the seat (to aid in sitting and standing), wood or plastic arm caps, and an open space between the seat and back (crumb space) to make cleaning easier.

ii. Specify upholstered furnishings with firm foam, and seat cushions with moisture barrier inner wraps.

iii. Extra-large glides on dining chairs can make it easier to move chairs in and out from the table.

iv. Use only commercial grade fabrics with a high double-rub rating, and solution dyed or bleach resistant fibers.

v. Provide bariatric-quality seating (appropriate size and weight capacity) as required for the bariatric population of the Home.

9. Artwork: Art work adds interest and a residential…