FGI Residential Document Responds to Culture Change in Residential Care

The new FGI document Guidelines for Design and Construction of Residential Health, Care, and Support Facilities provides minimum recommendations for new construction and renovation of nursing homes, hospice facilities, assisted living facilities, independent living settings, adult day care facilities, wellness centers, and outpatient rehabilitation centers.

The new standard was developed in response to the widespread adoption of person-centered care and deinstitutionalization in the residential care industry. Based on Part 4 (Residential Care Facilities) of the 2010 edition of the FGI Guidelines for Design and Construction of Health Care Facilities and public proposals submitted on that text in fall 2011, the book is divided into a section on planning and predesign, a section on design and construction elements common to all facility types in the book, and three sections grouped by facility type. ANSI/ASHRAE/ASHE Standard 170-2013: Ventilation of Health Care Facilities has been included as Part 6.

“The new FGI Guidelines, created with an interdisciplinary volunteer team, is a milestone document created to support the evolution of long-term care environments, while providing consistent guidance for providers, design professionals, and authorities have jurisdiction. The ultimate goal is to provide the framework for environments that support positive resident outcomes,” said Jane Rohde, chair of the FGI Specialty Subgroup on Residential Care Facilities, the committee that developed the new document.

Rise of Person-Centered Care Drove Decision for Separate Publication

Publication of the FGI Guidelines for residential care in a separate book was a logical step for FGI for two reasons: (1) the philosophical approach to residential care is fundamentally different than that for hospitals and outpatient facilities and (2) the state regulators who oversee residential care facilities are often based in a different part of state government—and have a different mandate—than regulators who oversee hospital and outpatient facility design and construction.

Person-centered care began to take hold in some nursing homes in the 1990s, and in the last decade has spread to other residential care environments as well. This philosophical approach requires a reevaluation of the roles of all staff and operational functions with the goal of achieving a care model—and the buildings that support it—oriented toward the needs of residents.

The intent is to get away from the institutional environment of traditional nursing homes and to offer seniors and others who require significant assistance with activities of daily living a home-like environment in which they receive the care they need.

The recommendations in the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities are less prescriptive than those in its retitled sister document, the Guidelines for Design and Construction of Hospitals and Outpatient Facilities. This difference is intended to facilitate provision of a homelike environment suited to the particular residents and locale of each facility.

The programming process is covered in detail as the basis for well-designed and well-constructed long-term care environments. Added are specific overlay information to help designers address the needs of residents with dementia, mental health diagnoses, and cognitive and developmental disabilities; information on how facilities support bariatric needs; and sustainable design criteria for residential care facilities.

The new book generally follows the format of the original, with text written as code language so it can easily be adopted by states to regulate design and construction of included facility types.

Acknowledgments

The text of the new FGI Guidelines book was prepared under the direction of Jane Rohde, AIA, FIIDA, ACHA, AAHID, LEED AP, by the Specialty Subgroup (SSG) on Residential Care Facilities, a multidisciplinary subcommittee of the 2014 Health Guidelines Revision Committee (HGRC). The HGRC is the body responsible for updating the Guidelines for Design and Construction of Health Care Facilities.

The SSG had participation from other industry groups as well, including the Rothschild Foundation, the Environmental Standards Council of The Center for Health Design, the American Institute of Architects Academy of Architecture for Health, the University of Minnesota, the ASHRAE 170 and 189.2 development committees, the National Center for Assisted Living, and the Vancouver Coastal Health Authority.