RFP-Attch G-Small House Model Design Guide.pdf

Small House (SH) Model Design Guide March 2019

1.0 GENERAL

1.3. Introduction

We are pleased to present this edition of the VHA Small House (SH) Model Design Guide, formerly known as the Community Living Centers Design Guide. This design guide provides enhanced, expanded guidance for creating an environment in which residents that require extended care services are at the literal and figurative center of the household. The model of care is resident-centered, where care is driven by the resident and involves the resident and family, when available, in decisions regarding care. This commitment to cultural transformation was made by VHA in 2005, in keeping with shifting standards in the nursing home industry.

The transformation away from the medical / institutional model of care that serves the needs of the institution and changes the focus to the needs and preferences of the resident is at the heart of the HATCh (Holistic Approach to Transformational Change) Model, and our nation’s Veterans deserve no less. The HATCh Model, designed by the Centers for Medicare and Medicaid Services, places the resident at the center of Work Practices, Care Practices and the Environment of Care. Care practices such as individualized meals, snacks and daily activity planning are central to the model. Work practices including consistent staffing, horizontal leadership and professional staff development give staff autonomy and responsibility to manage care delivery according to the preferences of the Veterans they serve. This guide addresses the environment of care with facility design, decor and elements in the home that support the transformed care and work practices. Private bedrooms with full baths allow each Veteran/resident a place of their own in addition to large communal spaces that encourage socialization and interaction. Smaller conversational spaces facilitate visits with family and friends.

A small house is an intentional community of 10, 12 or 14 residents and a staff of highly trained workers who live and work in a well-designed environment organized and operated around the guiding principles of autonomy and dignity. When successfully implemented, the Small House (SH) Model provides exceptional rehabilitative and hospice care and chronic disease management, with sufficient staff and equipment to support all personal care and assistance needs. While comprehensive data on outcomes is limited, the currently available evidence suggests that implementation of the Small House (SH) Model leads to better resident outcomes and higher resident satisfaction at comparable or lower overall cost. VHA is committed to use of the Small House (SH) Model of care in all of its facility-based settings, including Community Living Centers and State Veterans Homes.

We are proud to share this new version of the VHA Small House (SH) Model Design Guide that now includes designs for building vertical households for spaces where land for individual homes is not available, and specific suggestions for renovations within existing footprints and space.

Delivering high-quality, high-value care to our nation’s Veterans in a resident-centered environment is our shared mission. This guide for the development of therapeutic environments of care is a critical step in the cultural transformation journey.

Marianne Shaughnessy, PhD, AGPCNP-BC Lisa Minor, RN, MSSL

Director, Facility-Based Program Policy Director, Facility-Based Program Operations

Department of Veterans Affairs Office of Construction & Facilities Management 1-9