Making life easier and more enjoyable for residents is the top priority at senior living facilities. Whether providing independent living apartments and cottages, assisted living services, or nursing care these types of communities reflect a focus on safety, comfort, and social interaction. Continuing care environments—those that allow residents to age in place—are increasing as the senior population is poised to grow significantly over the next decade or so.
In North Andover, MA, the Edgewood Retirement Community recently underwent a renovation and expansion that addressed the requests and needs of its approximately 260 residents. Completed in spring 2010, the project encompassed a 22,000 square foot renovation and 26,000 square feet of new construction. Located on 80 acres in a rural setting, the facility also benefitted from numerous improvements to its site and outdoor amenities.
A Chat With Kevin Tremblay,
Director of Facilities,
Edgewood Retirement Community
What are your title and responsibilities at Edgewood Retirement Community? As director of facilities, I am responsible for the smooth operation of all aspects of the facility.
How long have your worked at this facility? I have worked here for 11 years.
During your tenure in the facilities profession, can you name a development that’s changed how you do your job? A notable development is having to keep current with modern technology by using both computer aided facility management systems and computer maintenance management systems.
Kevin Tremblay, director of facilities at Edgewood, was part of the team that headed up the project. He worked with the architects, engineers, and other firms hired for the expansion to ensure the construction plan fit with the vision of the community, and he was involved throughout to ensure facility systems would operate as planned. Another significant role for Tremblay was to communicate to residents the status of construction, and this task included keeping them informed of changes to pedestrian flow inside the facility.Meanwhile, the project included upgrades to building systems that the facility management (FM) staff uses to maintain comfortable, healthy conditions for residents of both the independent living and nursing care areas.
“Open communication of resident concerns to staff, and the responsive follow up by the design and construction team, was the pivotal component of this logistically complex project,” says Tremblay. “With the numerous parties involved, our goal was to maximize space in the renovated areas and to create a state-of-the-art facility. I was the liaison between the design team and residents.”
At project inception, Edgewood was nearly a decade old and, while successful, there were areas that the Board of Directors there had identified as ripe for improvement. This drove an expansion and renovation plan largely focused on addressing suggestions for the existing facility. Staff input was also solicited.
The facility wide improvements included additions and upgrades to common spaces, such as dining areas, as well as new space types. An example of a common space improvement is the new “Bistro 575”, which provides casual dining and takeout options. The 4,500 square foot restaurant was a requested amenity by residents, and it features a dining room, kitchen, and a billiards room (relocated from another area of the facility). The bistro seats 80, includes a small bar, and provides space for events and performances.
Bistro 575 is an example of the importance residents’ input played in the Edgewood construction project. This input was part of the information gathering and collaboration Tremblay and the rest of the team employed to arrive at a design that would meet the needs of all who live and work at the facility. To begin planning, a design committee was formed and it was comprised of the executive director, Tremblay, project architects, and two resident members. In addition, staff members from the facility, food service, and clinical departments participated in focus groups and attending design meetings when appropriate.
Reducing Medicaid “Never Events” Underfoot
By Keith Gray
The assisted living industry is in a period of dramatic regulatory change and increasing financial pressure. In this environment, prudent facility managers (fms) of assisted living settings are leaving no stone unturned in looking for ways to drive down costs. A focus of many of these cost containment efforts is reducing the incidence of Medicaid “never events.” These are events, mistakes, and errors affecting residents’ health that should never occur in assisted living facilities.
The annual tab for never events nationwide, including litigation and fines, is estimated in the hundreds of billions of dollars. And the stakes are getting higher. Private insurance companies are moving toward non-reimbursement of never events, challenging administrators of assisted living facilities to seek ways to reduce their occurrence.
Often marginalized in efforts to reduce these events is the role of flooring. But two important concerns with senior populations—falls and medication errors—can be impacted by flooring choices.
Effectively Reducing Falls
Reducing the occurrence of falls and the severity of injuries when they occur is most effectively done using flooring that is less slippery, as measured by the static coefficient of friction. While this seems obvious, it is often overlooked by fms when they specify flooring.
The Occupational Safety and Health Administration (OSHA) recommends that walking surfaces in assisted living facilities have a static coefficient of friction of 0.5. Research involving people with disabilities has concluded that they need an even higher coefficient of friction for safety: 0.6 is recommended for accessible routes and 0.8 for ramps.
Most categories of new and older installed flooring on dry, level surfaces meet these requirements. However, this changes under wet conditions. Laboratory and in-situ tests show static coefficients of friction of smooth surfaced floors, like vinyl and even rubber, decrease significantly when wet, often below recommended levels. In addition, polishes and finishes used on smooth, hard flooring can reduce the static coefficient of friction.
One in-situ study measured the slipperiness of wet flooring in nursing homes, comparing carpet to vinyl. The results showed conclusively that under wet conditions, falls are more likely to occur on smoother, harder surfaces. (Buntergchit Y. et al. Age Related Effects of Transitional Floor Surfaces and Obstruction of View on Gaot Characteristics Related to Slips and Falls. International Journal of Industrial Ergonomics. 25(3). (223-232)
Medication Errors Linked To Noise
Medication errors also fall under the heading of Medicaid never events. While there are many causes, among the most prominent is high noise level, which disrupt or impede communication between caregivers and patients. Increasingly, assisted living facilities are providing post-acute care such as basic medical monitoring, daily medication administration, and medical supervision.
There are many sources of noise in assisted living facilities beyond the human voice. These include telephones, pagers, paging systems, televisions, and wheeled equipment. Often overlooked as a noise source, however, are HVAC systems, which are a common source of background noise.
Numerous studies show that staff performance is enhanced in quieter environments, resulting in fewer distractions, lower mental fatigue, and less vocal strain. Researchers further report that 20% to 30% reductions in staff errors can be achieved with good acoustics management.
In one case, Methodist Hospital in Indianapolis, IN attributed its improved medication error index to noise reduction in a redesigned coronary care unit, with decentralized nursing and carpet in the hallways. (Mazer, Susan E. “Stop the Noise, Reduce Errors by Creating a Quieter Hospital Environment,” Patient Safety and Quality Healthcare, March/April 2005)
Different flooring categories provide significantly different levels of noise control. Smoother, harder flooring surfaces typically found in assisted living facilities, such as luxury vinyl tile, rubber flooring and engineered wood flooring absorb no more than 5% of the airborne noise. In sharp contrast, textile surfaces, including carpet and modular textile flooring, absorb between 15% and 35% of airborne noise. Equally important, modular textile flooring and carpet are especially effective in absorbing those frequencies common to background noise, which dramatically improves speech recognition.
The role of flooring in reducing both the frequency and severity of falls and medication errors should not be marginalized. Properly specified flooring provides high levels of slip resistance and acoustic management, which can create an environment favorable to less Medicaid never events.
Gray is director of product innovation at J&J Industries. He is recognized as a leader in evidence based flooring design, with a focus on healthcare and assisted living and holds U.S. and foreign patents for commercial floor coverings.
“Guiding Principles” from the Strategic Planning Initiative of the Board were created to support and enhance Edgewood’s philosophy of Aging in Place by maintaining and improving assets and amenities including: its natural setting and exterior landscape; its quality interior environment and facilities for residents; and its supportive and therapeutic facilities.
John Pearson, project architect for Margulies Perruzzi Architects (MPA) in Boston, MA, the prime architecture firm on the project, says, “From the beginning the design team considered the functional requirements in the context of an overall improved and revitalized community. We considered the flow of residents and staff through the new facility as part of a total experience of the retirement community redefining itself.”Implementation of the goals put forth by the Board included a strengthened connection between interior and exterior environments; improved and expanded functions (including the bistro, expanded living room, expanded Wellness Clinic and Rehabilitation services, Supportive Day Care services expanded in the new space, and improved skilled nursing and a dementia care unit.
Throughout, MPA worked with Levi+Wong Design Associates, an architecture firm in Concord, MA that provided healthcare and senior care consulting as well as landscape architecture services.
During construction the project team maintained its collaborative approach. Tremblay ensured residents’ safety was maintained and that they were informed of the progress, especially as it would impact their environments. This effort included updates using internal cable television as well as prominent displays of drawings and photos to share progress.
“During construction, the priority was to minimize impact and inconvenience for our residents,” says Tremblay. “For instance, we created a temporary entrance to the facility, along with temporary corridors for access from one area to another.”
Areas For Care
Central to the Edgewood community is offering independent living options, backed by resources to provide increasing levels of assistance and nursing care. Edgewood’s existing Meadows Health Center, a 20 bed skilled nursing facility providing short-term rehabilitation and respite care, was renovated and expanded with a wing that connects to The Garden View, a new 40 bed Cognitively Impaired Unit (CIU). In that new space, 10 beds were allocated as swing space to offer flexibility for nursing care as the resident population changes. This secure unit encompasses dining, activities, and living room functions for those residents.
In the new CIU space, 10 beds were allocated as swing space to offer flexibility for nursing care as the resident population changes. This secure unit encompasses dining, activities, and living room functions for those residents.
An important piece of the project was to increase enjoyment and access to the outdoors for all residents. The Garden View area, for instance, was designed around a central court open to the sky. Accessible from that unit is an outdoor “Memory Garden.”
Outdoor improvements also included a terrace for Bistro 575 and additional courtyards and walking paths. Says Pearson, “Opportunities for enjoying the outdoors were somewhat limited before this project, which was ironic for a community that sits on such a beautiful and well cared for natural environment.”
Spaces For Staff
Once the improvements at Edgewood were complete, Tremblay’s FM staff would be responsible for maintaining the upgraded environment. The inclusion of facilities staff members on the design committee ensured improvements made in that realm would meet their potential going forward.
To that end, various components of building systems were included in the scope of the project. Tremblay shares, “As part of this project, we were able to upgrade all of our mechanical systems, including water source heat pumps and the ventilation system. We also installed a new cooling tower for the facility.”
And to facilitate operations for Edgewood staff working in all departments, the design took into account how to improve circulation of both staff and residents. Says Pearson, “The Bistro terrace with its direct access to the kitchen and dining area makes cookouts and other events easier for staff. Meanwhile, a new staff breakroom with expansive windows and natural light provides a welcome refuge during breaks and between shifts.”
Two years after the expansion, the Edgewood facility continues to meet the varying needs of its residents. As Tremblay notes, “The primary motivation for the project was to use updated technology so that we may provide all of the modern amenities available for our residents while maintaining a homelike atmosphere.”
Name of Facility: Edgewood Retirement Community. Type of Facility: Existing. Function of Facility: Senior living/continuing care. Location: North Andover, MA. Square Footage: 48,000. Budget: $9.5 million. Construction Timetable: Fall 2008 to Spring 2010. Cost Per Square Foot: $200. Facility Owner: Edgewood Retirement Community. In-House Facility Manager: Kevin Tremblay, Director of Facilities. Architect/Interior Design: Margulies Perruzzi Architects (prime architect); Levi+Wong Design Associates (healthcare and senior care consulting). Owner’s Project Manager: Trident Project Advisors and Development Group. General Contractor/Construction Manager: Eckman Construction. Electrical/Mechanical Engineer: Zade Partners LLC. Structural Engineer: Structures North Consulting Engineers, Inc. Civil Engineer: Christiansen and Sergi, Inc. Art Consultant: Chestnut Design Art Advisors. Landscape Architect: Levi+Wong Design Associates.
Furnishings: American of Martinsville; Architex; Carolina Business Furniture; Ethan Allen; Flexsteel; National; Nevins; Patrician; St. Timothy; Westin Neilsen; Space Table; Volker. Flooring: Altro; Armstrong; Daltile; Johnsonite; Lonseal; Mats, Inc. Carpet: C&A. Ceilings: Armstrong; natural cherry wood strip ceiling (bistro area). Paint: Behr; Benjamin Moore; Sherwin-Williams. Acoustics/Sound Masking: USG (acoustic wall panels). Building Management System: Johnson Controls (Metasys). Fire System Components: SimplexGrinnell (addressable fire alarm system). Other Safety Equipment: SimplexGrinnell (nurse call and e-call system). Lighting: Forecast; Hampton Bay; Lightolier. HVAC: EVAPCO; FHP Manufacturing, part of Bosch Group. Power Supply: Caterpillar; Square D. Roofing: Firestone (metal roof panels, rubber membrane); GAF (shingles); Grace (ice and water shield). Exit Signs: Lightolier. Windows: Marvin. Doors: Ceco (an ASSA ABLOY company); Marshfield.