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Design for Better Infection Control

Published on May 30th, 2020

The coronavirus has shown that nursing homes were not prepared either with proper training and supplies or sufficient numbers of qualified and competent staff.  Shortages of safety gear and staff. Workers who may inadvertently be carriers.  These are some of the reasons the coronavirus has hit nursing homes hard. But some experts and advocates claim the design of the buildings should be included.

Many of the nursing homes across the country are laid out like hospitals, and some house hundreds of residents. Most rooms are double occupancy, but some have three or even four residents. With shared resident rooms off long narrow corridors and large cavernous dining rooms where everyone interacts, nursing homes have been designed to be cost effective not safe.

Before the pandemic, a movement under the banner of “culture change” was challenging this institutional model, calling for dividing up large nursing home populations into small, self-sufficient units with kitchens, private rooms and a dedicated staff.  This type has been set up in multistory buildings with a couple of households per floor and in single-story purpose-built structures with homelike interiors. This smaller-is-better approach arose out of a concern for residents’ privacy and dignity, but evidence is emerging that it may also be helping with infection control.

A private room or even an entire household can be closed off more easily, keeping out or confining viruses. Staff members who are focused on a small number of residents may be more likely to pick up on warning signs, such as a lack of appetite, that someone is sick. The preparation of food and laundry in a household — rather than in central facilities and then distributed — also eliminates a few of the ways diseases can infiltrate.
Administrators of nursing homes large and small, as well as the architects who renovate and design their facilities, expect to zero in on disease control in the future as a result of the pandemic. Air circulation and filtration will be scrutinized when heating, ventilation and air conditioning systems are planned, they said.  Nursing home providers and their architects are also talking about easy-to-clean, nonporous surfaces; antimicrobial materials, like copper, for “high touch” features such as hand railings; and voice- or sensor-activated controls for doors, lighting, curtains, faucets and toilets.
The Department of Veterans Affairs began embracing a small-house model in 2011; now, 13 of its 134 nursing homes are organized around communities of 10 to 14 residents. In these settings, only a single veteran has tested positive for Covid-19.
“If we don’t see change in the nursing home market now,” said Jane Rohde, principal at JSR Associates, a design and health care consultancy in Catonsville, Md., “I don’t know when we will.”

 

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