FGI Bulletin #7

Errata Sheets Posted for 2018 Hospital and Outpatient Guidelines

The errata sheets prepared for all Guidelines editions are crucial to users of the documents. An errata sheet presents items that are errors in the published books, whether editorial oversights or discrepancies that were revealed after publication. The corrections shown in the errata sheets are considered part of the official documents and should be applied as part of the standards by all users, including authorities having jurisdiction.

Dated errata sheets are posted on the FGI website, and we recommend checking back periodically to make sure you have the most current version. We also will continue to let subscribers to the FGI Bulletin know when new errata sheets are posted. For the 2018 digital documents available on MADCAD, the goal is to identify corrections in the online version of the documents.

We appreciate hearing from Guidelines users who have questions about the content they use. This is often how errors are found. Write to us here.

State Adoption Focus: Colorado

The State of Colorado recently adopted Chapter 4.1, Specific Requirements for Assisted Living Facilities, in the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities. Adoption of the assisted living facility standards includes applicable cross-references found in the chapter. Exceptions to the Guidelines requirements are parking and elevator standards, which defer to local regulations.

For assisted living residences applying for a new license, application of the FGI Residential Guidelines begins June 1, 2019; application for existing facilities planning renovations begins December 1, 2019. The State of Colorado will offer programs to educate staff and the public about applying the Guidelines to this facility type to help in the transition.

For other Colorado licensure types that already reference the Guidelines (including hospitals and settings for intellectually and developmentally disabled persons), state representatives will begin amending existing regulations to transition to the 2018 edition in the second half of 2019.

FGI Position Paper Responds to CMS Rule Changes Affecting Long-Term Care Facilities

In October 2016, the Centers for Medicare & Medicaid Services (CMS) published its final rule on the “Reform of Requirements for Long-Term Care Facilities.” This updated rule revises the requirements long-term care facilities must meet to participate in the Medicare and Medicaid reimbursement programs. FGI assembled a panel of experts from the 2018 Residential Document Group to review the rule and align FGI’s fundamental requirements with the newest CMS revisions. The review resulted in important revisions in Chapter 3.1, Specific Requirements for Nursing Homes, in the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.

FGI published a position paper outlining several of the rule changes. The paper, Guidance for Providers, Designers, and Authorities Having Jurisdiction on CMS Reform of Requirements for Long-Term Care Facilities, presents corresponding information in the Residential Guidelines to help providers and designers comply with CMS reform requirements. Of particular concern was a new requirement limiting to two the maximum number of residents in a bedroom with its own bathroom containing at least a commode and a sink.

Providers and design professionals are aware that many existing room configurations today allow more than two residents to access a shared bathroom; thus, a challenge was created for maintaining annual certification or recertification after a facility renovation. The position paper offers several room layouts that may be allowed by the new CMS ruling and comply with the performance criteria in both the 2014 and 2018 editions of the FGI Residential Guidelines.

FGI engaged with CMS representatives to examine further long-term care facility design issues, some of which may have emerged as unintended consequences of rulemaking. FGI will continue to be an advocate of design to support person-centered care for residents in long-term care facilities.

Architects and Clinicians Join Forces to Improve Childbirth Outcomes

On April 30 and May 1 in Austin, Texas, architects gathered with obstetricians, gynecologists, midwives, and nurses to explore how changes in design requirements for childbirth facilities could yield better patient outcomes. This opportunity took place at Reimagining Childbirth Facilities, a workshop co-hosted by the American College of Obstetricians and Gynecologists (ACOG) and FGI.

One of the key organizers of this collaborative workshop was Neel Shah, MD, MPP, FACOG, an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and director of the Delivery Decisions Initiative at Harvard’s Ariadne Labs, who is an advocate for using design solutions to improve obstetrical outcomes. “Childbirth is the most common reason for hospitalization in the United States, but the quality of care varies tremendously from one facility to the next,” he explained. “Emerging research demonstrates that the design of these facilities can play a critical role in either helping or hindering the provision of safe care.”

At the workshop, clinicians representing various regions and facility types focused on identifying key design issues that may impede delivery of care in obstetric settings. In small groups, the attendees discussed desired birthing process outcomes, considered clinician challenges, and evaluated improvements to both design and process that have the potential to reduce negative patient outcomes and points of pain for staff. Each table prototyped solutions and presented their ideas to the full workshop. Each small group then reviewed the hospital and outpatient Guidelines for Design and Construction documents for opportunities to improve, clarify, and elaborate on design guidance for childbirth facilities. FGI will publish follow-up materials that build on the efforts of the workshop attendees.

Reimagining Childbirth Facilities was held in conjunction with the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. The workshop was organized by Mazzetti+GBA and facilitated by Catalysis.

New Resources on the FGI Website

Although FGI is developing materials for the Beyond Fundamentals library, we will continue posting new resources on the FGI website as well. In the last six months, the following have been added, along with the position paper on the new CMS rule on resident room layouts discussed in this issue of the FGI Bulletin:

Designing End-of-Life Care Settings to Enhance Quality of Life. This Cornell University research report provides design guidance for settings in which end-of-life care is delivered. The researchers examined four primary elements that profoundly influence how individuals experience these settings: the ambient environment, sources of external stimulation, furnishings, and space and layout design.

Design Guide for Long Term Care Homes. In this guide, Robert Wrublowsky offers guidance for creating personal care homes for elders, particularly those with cognitive challenges. His goal is to help designers provide spaces that encourage socialization, offer easier navigation, support better cognitive function, and set the stage for predictable care outcomes.

Video series on residential care facilities. This series of 24 short videos, developed by Mannington Commercial and the Facility Guidelines Institute, showcases the experiences and perspectives of individuals working and living in person-centered residential care settings.

Emerging Topics Affecting Health Care Facilities

During each revision cycle, the Steering Committee of the Health Guidelines Revision Committee (HGRC) identifies timely topics to consider for revision or inclusion in the Guidelines documents. Each topic group is chaired by a committee member and comprised of both HGRC members and outside subject matter experts. The group assesses how the topic is addressed in the current edition and determines what proposals need to be created to improve the forthcoming edition of the Guidelines.

The 2022 Steering Committee has assembled a preliminary list of topic groups that will convene during the next revision cycle based on feedback, inquiries, and industry trends:

• Acoustics
• Behavioral health (emergency, non-emergency, partial hospitalization program)
• Facility management (security/resiliency/emergency preparedness/business continuity)
• Geriatrics
• Infection prevention
• Lighting
• Palliative care
• Pediatrics
• Rural health
• Medical and information technology

FGI is interested in learning what topics are a priority for Guidelines users. If you have a recommendation for a topic group, or if you are interested in being a subject matter expert for one of the topic groups listed above, please write to us here.

A Guidelines Webinar for Young Professionals

AIA/AAH and FGI Present: How to Use the Guidelines

When: July 10, 2018, 2:00–3:00 p.m. (ET)
Where to register: GoToWebinar

The AIA Academy of Architecture for Health will host a 60-minute webinar for emerging professionals on how to use the Guidelines for Design and Construction documents. The webinar will be presented by Douglas S. Erickson, FASHE, CHFM, HFDP, CHC, CEO of the Facility Guidelines Institute, and consist of two sections: a primer on how to use the Guidelines and an overview of major changes in the 2018 edition.

This session is part of the Academy’s HC 101 Series of web-based seminars, which are tailored to provide budding health care design professionals with conceptual and practical primer-level knowledge. For more information, please visit AIA Knowledge Net.

FGI and CHD: The Knowledge Repository is Your EBD Go-To

Did you know that the Facility Guidelines Institute, along with several other organizations, partners with the Center for Health Design to bring you the Knowledge Repository? The Knowledge Repository is an outstanding resource for accessing thousands of research citations and hundreds of article summaries about a wide variety of health care design topics. This library is continually growing and provides a one-stop source for evidenced-based research to inform your work. Once you have identified your information of choice, embedded links direct you to the source. Visit the Knowledge Repository to learn more.

Have any questions or suggestions about the content of this newsletter? Please write to us here.