Libby Laguta, CHID, EDAC

Tuesday, 08 October 2019 21:51

ED for Seniors?

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Today there are emergency departments designed especially for children. These are set up differently with specific and adjacent waiting areas. The staff are well-educated in the illnesses of children.

At the VA, there are specific mental health sectors in the ED to deal with traumatic brain injury, PTSD, and a host of illnesses that are best treated without visibility to the typical ED patients and families. Behavioral health has become synonomous with privacy and specific treatment regimes. At the very least, a standard ED department should have a mental health professional on staff at all times.

Why then, do we not provide a specialty ED for those over the age of 65? With the changing demographics of the US population and seniors predicted to out-number our children in the next 9 years, it is highly likely that senior ED's will be the norm. Seniors require medical staff with knowledge of their lifestyles and characteristic ailments. Gerontologists need to evaluate the patients and determine if they are capable of making their own medical decisions. If not, the families and caregivers need to be incorporated in treatment programs.

In her blog post, Anne-Marie Botek, listed the senior emergency room design offering:

  • Floors with more traction and less glare
  • Lighting that is gentler on elderly eyes
  • Reclining chairs and mattresses designed to lessen pressure
  • Personal rooms for patients
  • Telephones, clocks and documents with larger print
  • Blankets warmed in ovens
  • Equipment to aid in hearing/communication between patient and health professional

What if families are far away? Teleconferences with families need to be immediately available. It is possible that Dad or Grandad has chosen to hide his medical condition from his family. This is his decision, but staff are there to explain and prepare him for what lies ahead as his illness progresses. Plans need to be made for caregivers if he needs help.

The idea of self-contained "Senior Emergency Medicine Clinics" seems feasible and necessary. If this is not enacted, those 65 and over will impede the flow of the typical ED and cause the ED's to reach capacity with regularity. The solution is as simple as a re-direction of the group to a more resourceful staff at a facility built specifically for their needs.

According to the Wall Street Journal, the good news is that more than 50 geriatric emergency departments have earned the Geriatric Emergency Department Accreditation (GEDA) and 100 more ED's are in the process of accreditation.

 

So, if a senior over 65 cannot care for his or herself, the private pay community option is always available, right? Wrong.

Within the next 10 years, there is a missing source of housing for seniors who do not qualify for HUD and who do not have the income or savings for private pay communities. This generation also had less children and subsequently, there is a shortage of caregivers. On whom are they to depend then?

I listened to a webinar this week by NIC entitled, "The New Growth Opportunity: Senior Housing for the Forgotten Middle" and the facts are staggering. By 2029, the US will be 700,000 short on available housing for the middle income senior.

By 2035, the over 65 demographic will outnumber those under the age of 18. It would seem that developers would be interested in housing for the middle income senior. They, however, are fixated on the upper income senior willing to pay north of $5,000 per month to live in a CCRC community or a life care community. Meanwhile, there is a growing census of those over 65 who need alternatives to this model of housing.

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In Portland, Oregon, there are zoning allowances for "Accessory Dwelling Units" on existing properties. Families can build what equates to a tiny house in their back yard for Grandma to function independently while joining the family for meals. Grandma is sometimes within 20 feet of help if a need arises.

I love it!

Perhaps there are other options such as co-housing communities or Nana could share her house with another senior to lessen costs. I suggest that there are options and given the short time frame to bring a solution to fruition, we need to get moving.

Friday, 10 May 2019 19:14

The Influx of Boomers' Effect on HC

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There are 10,000 baby boomers turning 65 every day for the next 20 years.

What it means for healthcare is an influx of acute care needs inside the hospital and an increased demand for telehealth access, mental health treatment, and emergency room visits. Medical office visits will increase in the areas of heart health, bone health, and cancer treatment.

In addition, people are living longer and wellness is a very real trend to consider for the over 65 crowd. A hospital near me has opened up a brand new senior center within 5 minutes of my house. It offers a gym, line dancing classes, a pickle ball court, and yoga. The cost to join is very reasonable and most classes are free with membership.

The design of these facilities are influenced by the aging consumer. Hospitals need to trump up their game to address senior needs, for instance, assistance to find their way to a department deep within the system. More "front doors" are needed with direct access from parking. More locations for outpatient facilities embedded in suburban communities are being built to bring the hospital brand out further and further. We've seen the expansions of the hospital brands through remote locations and acquisitions of competitors in the last 10 years. This will mean even more prominence as the reach is mandatory to alleviate overcrowding at current facilities.

Friday, 19 April 2019 19:09

Modularity in Healthcare

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As the over 65 population ages, the demand for healthcare expands. Owners and operators of hospitals are struggling to keep up. Medical office buildings are in short supply in many areas of the US and as a result, modular buildings are becoming a quick and easy solution.

I remember when modular workstations were a new idea in office furnishings. It was a much-needed solution to the lack of space and the rising costs of leasing. I liken this to the need for affordable and fast options for medical office space. Suburban sites and convenient access to major hospital brands close to home dictate a need for modularity.

Just like the hospital staff designs protocols and standards of care, I believe standards for the physical modularity of the space are needed. By this I mean prefabricated parts and pieces assembled on site to meet a particular building size and configuration.

As communities grow, constituents demand access to care within the limits of their geographical area. The scale of the facility is based on how many patients are seen and processed. It may sounds like a factory, but truthfully, it is reality to think in terms of numbers and shear accessibility. Deficiencies in service areas can be addressed by telehealth. If a modular building location begins to see the need for a service such as orthopedics or rheumatology that is not currently offered, then a remote team is utilized by a telehealth platform.

Just as modular workstations provide more efficient square footage for planning people in a work space, prefabricated buildings afford more people access to healthcare within their day to day domains. This is quicker for the patient and by spending less than the cost of brick and mortar, hospitals and owners save on the physical building cost.

Wednesday, 03 April 2019 19:02

Giving Back

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Recently, I attended an ACHE event to mingle with the healthcare community in the low country of Charleston. I met wonderful people doing great things to better healthcare experiences for patients. There was one conversation that was a particularly clarifying moment for me.

I met an administrator at the VA Medical Center. We talked about what Veterans need. I mentioned that in my observation, their wait times are tremendous and they can be at a facility all day. She stopped me in my tracks. She told me that they are not necessarily there all day because of their appointment; they are there because they want to be there! Veterans feel a sisterhood and brotherhood with those that served in the crucible of combat. It is like going home to family. If you listen in on discussions within the waiting areas, you will hear comparisons of experiences and war stories. Where else are these individuals able to connect so well to such a captivating audience? Now this is a "healing environment" if I ever heard of one!

She went on to explain that the coffee shop was once in the middle of the hospital with little visibility. It was moved to the front lobby in response to the need for a place to accommodate the comaraderie between their patients. The shop gives a spot for a "sit down" and a sharing platform over a cup of joe.

I have a renewed respect for our VA Hospitals. They know what their patients need and they are providing it. I sincerely appreciate the "aha moment" and the sharing of information. I strongly suspect that this clarifying instance will transfer into other areas for me as I design. Thank you for this realization.

At a recent conference we talked extensively about mentoring young professionals to bring them up through the ranks. Since then, I've had conversations with other senior professionals about snagging even earlier "groupies". I am interested in giving back and shamelessly soliciting to college students to choose a path as a healthcare interior designer.

So I went to Auburn University and gave a class on "Patient Room Design" to interior architectural undergrad students. It was the Monday morning after Spring Break week at 8 am. They were awake and attentive and asked many questions. Their next project would be the design of a head wall in a patient room - a life-size mock-up! I wish I could have seen the results of that exercise. I believe that minus the distractions of years of being told, "not you can't do that", the designs were probably fresh, creative, and exciting.

Once we have been designing for so many years or decades, our box sometimes gets quite small. It takes a new viewpoint from a fresh perspective to throw away the box and look at the solution in a whole new slant. I can get behind that idea. It has proven it's worth many times in my career.

According to CIDA, the course requirements for a degree in interior design do not allow for a specialty focus until the graduate program. At that level, I would like to see the focus on healthcare be more widespread. I am willing to help. It started at Auburn to plant a seed with undergrads and I'm hoping it could lead to genuine interest for a few brave souls. . . . . AND . . . . I would be remiss if I didn't wish Auburn good luck on their FINAL FOUR play-offs!

Friday, 01 March 2019 18:32

An Aha Moment in Design

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Recently, I attended an ACHE event to mingle with the healthcare community in the low country of Charleston. I met wonderful people doing great things to better healthcare experiences for patients. There was one conversation that was a particularly clarifying moment for me.

I met an administrator at the VA Medical Center. We talked about what Veterans need. I mentioned that in my observation, their wait times are tremendous and they can be at a facility all day. She stopped me in my tracks. She told me that they are not necessarily there all day because of their appointment; they are there because they want to be there! Veterans feel a sisterhood and brotherhood with those that served in the crucible of combat. It is like going home to family. If you listen in on discussions within the waiting areas, you will hear comparisons of experiences and war stories. Where else are these individuals able to connect so well to such a captivating audience? Now this is a "healing environment" if I ever heard of one!

She went on to explain that the coffee shop was once in the middle of the hospital with little visibility. It was moved to the front lobby in response to the need for a place to accommodate the comaraderie between their patients. The shop gives a spot for a "sit down" and a sharing platform over a cup of joe.

I have a renewed respect for our VA Hospitals. They know what their patients need and they are providing it. I sincerely appreciate the "aha moment" and the sharing of information. I strongly suspect that this clarifying instance will transfer into other areas for me as I design. Thank you for this realization.

Thursday, 21 February 2019 18:21

Early Feedback Brings Project Success

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The effective design process includes visioning sessions, focus groups, and mock-ups. All is relevant to providing the most patient-focused design solutions. However, some interior architectural design firms simply blow through the design process utilizing the typical FGI Guidelines and seemingly provide a decent result. Or do they?

The proof is in the post-occupancy evaluation. Did the patients' path of travel intersect with the staff at key steps in the process or were there shortcuts in the cycle of care? The staff needs to understand the patient's path and buy into it. Otherwise, they ignore the space design and adjust the signage to meet their needs thereby changing the patient's course of travel. I know this from experience.

If the patient intuitively understands where to go and what to do, they do not need a staff member to assist them. Nurses and physicians must be on board in the planning process to show the patient how to maneuver the space. I find that as a designer, my biggest ally, source of information, and advocate is the people who work in the space. A relaxed and happy staff provides a relaxed and happy patient.

During the focus groups, the community voices "wants and needs" based on the culture of the neighborhood and geographical area. Unique idiosyncrasies surface at these sessions and the designer begins to understand and "feel" the group's needs and aspirations. This provides the background and foundation to build the design. In short, get to know what is fun and interesting to the people who will occupy the space. They will appreciate your attention to detail.

Show photos in the visioning session to get feedback. I have found that what I picture in my mind can often be totally different than what a nurse or focus group participant was conveying to me. Interpretation of thought is important and continual feedback along the design process eliminates surprises in the end result.

Finally, mock-ups of strategic areas uncover a wealth of information to discuss. Physical placement of tools and design of spacial proximity provide the 3D representation that many cannot grasp until the they see and touch the environment. Once constructed in the field, it is too late to make costly changes and concessions are made. This leads to disappointing compromises to the flow of their space and no client wants to end with less than they bargained for after waiting years for a new and technologically advanced space.

So we're aware of the prediction that self-driving cars will change the delivery industry, from delivery of mundane packages, to groceries, to delivery of pharmacy prescriptions. How does this affect seniors? In retirement, there will be less and less reason to leave their homes. Virtually everything can and will be dropped at their door; except for family and friends.

With the downturn in occupancy of retirement communities, we can see that if all supplies and staples needed for existence can be delivered, then why would a grandfather of 80 years want to move into a facility? The answer falls into the category of socialization and the need for interaction with people.
 
That is why grandpa feels good about a move into a community of individuals with similar needs. He wants to entertain his friends and family. He still helps his grandchildren with their homework some afternoons, but he is not lonely.

Loneliness and isolation is a very prominant and real precipice for poor mental health. By joining a group of people who live and dine together, our elders have interactions and stimulating conversations that are healthy and worthwhile.

This is why these communities exist.

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Friday, 10 January 2020 20:32

What is Your Life Plan When You Turn 75?

Do you plan to change how you live and what you enjoy when you turn "senior"? Will you give up being a foodie and your love of wine? Of course not. You will be the same person you are today with multiple interests and enjoyments with more time to focus on your bucket list! Keep that in mind when designing for senior living environments. The correct term for these facilities is now "Life Plan Communities". I like it. It no longer labels the population as senior, therefore, aged and done. It means that the PLAN is to keep on living your best life.

The residents' best life might be different than you assume. As designers, we need to ask the right questions and get to know the community. By that, I mean the physical location of the community as well as the minds of residents within the community. Get to know everyone. Programming is not about asking the director and designated project team for information, it's going directly to the source. Ask Mrs. Johnson what her expectations are for amenities for herself and her extended family. Her children and grandchildren visit often and she would like to have quiet and active time with all of them. After all, she is the star of the visit. The designer and architectural group needs to support her needs to satisfy her and her family.

Mrs. Johnson wants to push her grandaughter on a swing and play a board game with her grandson. We owe it to her to provide a place to do that. She wants choices in the food venue and take her family to lunch, so we need to know that as well. Let's make sure we listen and accommodate all her needs.

When I walk into a facility and all is quiet, I am concerned. On the other hand, when I enter and hear laughter and chatter, I know I am in a good place. I am certain that the design team listened to the number one user group, the resident, and provided what they asked. You can FEEL the joy and celebrate living life with Mrs. Johnson and all her friends.

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Monday, 17 December 2018 20:20

Defensive Medicine

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Back in 2015, the New York Times published an article which summarized that the physicians' best defense against litigation was to communication better with patients and families. This is still a true statement today.

Many times, I feel rushed through my appointment and rarely does a physician sit down to discuss my visit with me. The few times that I felt synergy with my caretaker included eye contact, a friendly banter, then pointed questions followed by a dialogue which ended with me having a new understanding of my medication or illness. That would be deemed a successful visit. While I was in dialogue with my physician, the assistant was busy inputting the information into the computer. All was recorded.

The days of a standard exam room equipped with an exam table, casework for storage, a computer station, a side chair, and a physician stool are passe. The educated consumer/patient now expects interaction and friendly exchanges of personal chatter followed by more serious exchanges of health status and symptom checks. A physician who gets to know his or her patients is more effective at spotting differences in health changes.

The designer can support the process of dialogue and discussion by the room design. The basics of furnishings and equipment are now supplemented by the addition of a place to sit side-by-side and review charts and visuals on a screen. In some cases, videos are available for patients to watch in the exam room to delve deeper into understanding their steps and process in care. The provision of warm wood finishes are not the only means to ease the stress of a doctor visit. The layout of the space plays an important role as well. When the entire room becomes usable and there is no separation between the physician area and the patient area, there is a sense of equality established. Adding upholstery and more comfortable seating also creates a space that speaks to a caring and interactionary environment. The patient feels empowered and welcomed. This is the future of healthcare.

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