Unlikely Inspiration

Necessity and her daughter, Invention.

Don't you hate blogs that start with a tired, old cliche?  I know I do.

I am from Lancaster, Pennsylvania.  Lancaster has a lot of barns.  Barns have doors that slide along a track.  Lancaster also has a lot of retirement communities.  I think you know where I am going here....  No?  Let me back up.

One of the biggest trends in the last 20 years is trying to get some privacy into shared, or double-occupancy nursing rooms.  This makes a lot of sense.  Shared rooms are much more economical, as that means building half as many bathrooms as private rooms.  But residents, family members, health care staff and even HIPPA, want some privacy for each individual occupant.  As square footage is king, any ways to improve privacy in tight spaces are at a premium.

I know nursing homes aren't "sexy" to architects.  But consider this is what we are trying to improve:

Typical "semi-Private" Nursing Bed - Unchanged from 1900 

Ideally, we would layout a new building to provide layouts that accommodate separate quarters for each resident, along with a common foyer that allowed for entry into the bathroom as well as the corridor.  Pretty straight forward, but this was not what most nursing rooms looked like in the early 1990's.  This was a big leap.  What's more, if you've ever worked in healthcare, you know that they hate pocket doors.  You can't clean the pockets, yet stuff can get back there, so there is a fear of infection, etc.  In our original plans, we used cubical curtains.  

State of the Art Circa 1990-something.  "Shared Room" takes the place of "Semi-Private.

What can we do to improve upon this?  Doors are the obvious answer, but how?  It turns out, we were able to convince the Health Department that "barn doors" are a hygienic alternative to pockets.  With a barn door, we get all the benefits of a pocket door and eliminate all the space a typical swinging door needs.  Did I mention that all these doors needed to be 3'-8" wide to be able to move the beds through them in an emergency?  Each room not only has its own space, but each bed has a window.  Not the case in the first example:  one resident gets proximity to a window, the other gets the bathroom door!

Saving space is particularly important in projects that combine additions that have the nice layout of the Shared Room, but also renovations that try to provide the same privacy in a space that wasn't designed for it.  Below is a sample reconfigured space - the exterior walls and corridor walls did not move:

Here we had two former traditional layouts combined but maintain privacy.

In the diagram above, barn doors can literally slide behind the dressers.  Swinging doors would not have worked at all.  The bathroom also uses a barn door.  In this instance, we were completely re-configuring the space "inside the box", but were able to provide similar privacy in the renovated space as in the brand new building.

But what if you have a double occupancy room which cannot be reconfigured substantially?  The diagram below is an example of that.  The alterations only include a dividing wall to create privacy.  But the space was so tight, that the openings into the rooms were forced into a 45 degree angle.  

Revised room with added privacy wall and sliding doors.

The intervention is minimal but we are left with a problem as to how to close off the private rooms.  The client was not satisfied with cubical curtains.  The door track required to open a sliding door at a 45 degree angle is not something that's off the shelf at Home Depot.  As we are not in the business of inventing door hardware, the Contractor and a local metal fabricator designed and built something that actually worked.  But that is only the first hurdle.  We had to get the health Department to sign off on it.  Did I mention that a floor track was forbidden?  The Contractor devised a track that ran along the wall to keep the door from flopping around.

A complete mocked up room and opening was built to demonstrate its performance.

Mock up - Half Open.  Or is it Half Closed?

Mock up - Mostly Closed.

Mock up - Track from Foyer Side.

Mock up - Track from Resident Side.

The door was approved and went on to be installed.  Between the modest renovation plans, tight spaces and an Owner who was unwilling to compromise, a brand new type of door was created.  We just don't have a name for it yet.  Any inspired suggestions?

Finished project - door in closed position.  Transom lights allow borrowed light into the foyer.

Finished project from the room side.

This post is part of the ArchiTalks series where a group of us (architects who also blog) all post on the same day and promote each other’s blogs. This month’s theme is "Unlikely Inspiration" and was led by Eric Faulkner.  A lot of other talented writers who also are architects are listed below and are worth checking out:

Lee Calisti, AIA - Think Architect (@LeeCalisti)
unlikely inspiration was there all along
Eric T. Faulkner - Rock Talk (@wishingrockhome)
Inspire -- A Clover
Jeffrey Pelletier - Board & Vellum (@boardandvellum)
Unlikely Inspiration: The Strange Journeys of the Creative Process
Mark Stephens - Mark Stephens Architects (@architectmark)
Unlikely Inspiration - Herbert Simms
Lora Teagarden - L² Design, LLC (@L2DesignLLC)
Unlikely inspiration
Michele Grace Hottel - Michele Grace Hottel, Architect (@mghottel)
"unlikely inspiration"
Tim Ung - Journey of an Architect (@timothy_ung)
Inspired by Leather Working
Steve Mouzon - The Original Green Blog (@stevemouzon)
A Most Unexpected Inspiration

House or Home?

The bulk of my architectural career has and is spent designing structures that are not considered Residential per the building codes.  Some may call it Commercial.  Much of it is Institutional by Code.  But that does not mean it is not someone’s Home.  You see, I primarily design buildings in the Senior Living sector; have been my entire career.

When I began my career more than 20 years ago, there was already a movement under way to make retirement and senior living spaces much more residential.  Even in dwellings classified as Skilled Nursing Facilities, the idea that these building should feel like someone’s home had been one that many providers had embraced.  The problem was that most of the providers (at that time) had buildings that looked like hospitals instead of your home. 

A Cruciform Church.  Early hospitals took their shapes from churches.  Thus, so did the early nursing home.

Beddington Corner Hospital. (source: historic-hospitals.com )
The economy is easy to see.  The result is not necessarily a religious experience.

What can you do for an existing building?

I feel the best way to illustrate how our buildings fulfill the qualifications of "home" is by showing how we can improve existing condtions.  The difficulty lies in all of the regulations associated with a facility that provides nursing care to its residents.  The International Building Code identifies these buildings as an Institutional or I-2 building.  NFPA reviews these buildings in (almost) exactly the same way as a hospital (Health Care).  In either case, the Use Group enclosed therein is the second most hazardous category according to code.  What would be worse in terms of hazard?  Think fireworks factory.  The hazard to Skilled Nursing Facilities is exiting…someone bed or chair bound is not able to get out on their own; or not capable of self-preservation in CodeSpeak.  Also in Institutional buildings, nearly all aspects of the building have to be accessible.  So features required in these buildings are not similar to those you have in your home, nor in a building pre-1990.

So what can we do?

Sometimes an improvement to the exterior facade can make a significant impact with easier application as it is, more or less, surface applied.  However, most Institutional buildings are non-combustible construction, so there are limits.  You can’t just add anything to the exteriors.  In new construction, you can utilize scale and materials to humanize the sequential experience.  Many vintage Skilled Nursing Facilities are economic 'blocks'.  Even modest additions to the exterior may improve the approach to a building.  

Mennonite Home Exterior - Before

Mennonite Home Exterior - After (Obviously).  The addition to the right created a one-story, human scale.

But let’s face it, the folks who reside in these buildings spend nearly 100% of their time inside.

What about the interiors?

In new buildings, it is much easier to provide open, residentially scaled rooms on the interior with connections to the outside.  In the many, many renovation projects of nursing homes we have done, it is much more of a challenge.  Traditionally. resident rooms line up in a continuous 8-foot wide corridor up to 120 feet from the original nurse’s station.  One way to bring some residential life to these facilities is to blow out a couple of rooms to allow the addition of a living room with access to windows.  Many of these buildings are non-combustible, as I said earlier, so exterior and corridor walls are often concrete block and they do not have tall ceilings.  You can see the challenges.

Corridor - Before.  Hard and highly reflective surfaces are not atypical in vintage nursing homes.

Corridor Concept Sketch 

Corridor  - After.  Sometimes all you have to work with are finishes and lighting.

Another issue is that whether there are 15 or 50 residents, they all need to eat in a dining room.  No one has a dining room with seating for 50 (well, no one that invites me over for dinner anyway).  These rooms need to be broken up visually into human scaled rooms.  Some times that means providing a serving (residential looking) kitchen with several smaller rooms around it for dining.

Dining Room - Before.  No connection to the outside or the community at large.

Dining Room - After.  Here we had the opportunity to add skylights to add natural daylight.

Adding just a bit of privacy and homelike environments can also do wonders for one's main living area.  This is especially true in a double occupancy room.

A Double Room - Before.  Only the thin curtain between you and a neighbor.

A Double Room - After.  There is still a curtain, but the interior window provides a more substantial barrier.
FYI: the window wall is not a full height wall so as to not trigger sprinkler revisions.

There has been a more recent movement for skilled nursing called the Green House Project © about 10 years ago.  And while the word “house” is in the name, the feeling of “home” is what is intended.  This method limits the occupant count to 10, favors a universal worker for more homelike care, and has strict spatial rules.  This project is an actual Brand-name developed by a doctor and requires a lot of staff training.  The concept has a lot of merit and you can learn a lot more about it on their website here:   The Green House Project

It turns out that concepts we (not just my firm but others, too) had in the 1990’s have only just made it to the Code books.  In 2012, the NFPA 101 Life Safety Code addressed the ability to allow a kitchen to be open to the corridor (with a whole lot of provisions).  Nearly the same provisions made it to the 2015 IBC.  In fact, the Commentary shows a floor plan illustrating the open kitchen concept with a plan by our office in 1995.  For twenty years, we had to convince State and Local jurisdictions that it should be allowed, so that is a little sweet reward to be the example in the Code Book!

ICC used this 20 year old project of RLPS' to illustrate a brand new concept in the 2015 IBC.

While many may not consider what our office does as "residential", I would argue that it is extremely important to our end users in the buildings we design that the spaces, "Look like, act like, feel like home."  This quote is attributed to one of our clients, who had the vision to create the first freestanding Hospice facility in Pennsylvania.  That's another topic in itself.

This post is part of the ArchiTalks series (led by Bob Borson of Life of an Architect ) where a group of us (architects who also blog) all post on the same day and promote each other’s blogs. This month’s theme is led by Keith Palma and is "House or Home".  A lot of other talented writers who also are architects are listed below and are worth checking out:

Bob Borson - Life of An Architect (@bobborson)
The Designation between House and Home

-->Lora Teagarden - L² Design, LLC (@L2DesignLLC)
House or Home? It's in the story.
-->Collier Ward - One More Story (@BuildingContent)
House or Home? A Choice of Terms
-->Jeremiah Russell, AIA - ROGUE Architecture (@rogue_architect)
house or home: #architalks
-->Eric T. Faulkner - Rock Talk (@wishingrockhome)
House or Home -- Discover the Difference
-->Michele Grace Hottel - Michele Grace Hottel, Architect (@mghottel)
"house" or "home"?
-->Meghana Joshi - IRA Consultants, LLC (@MeghanaIRA)
Architalks #24 : House or Home
-->Brian Paletz - The Emerging Architect (@bpaletz)
House or Home? - Depends
-->Michael LaValley - Evolving Architect (@archivalley)
House or Home? Train for One, Design for Another
-->Greg Croft - Sage Leaf Group (@croft_gregory)
House or Home
-->Jeffrey Pelletier - Board & Vellum (@boardandvellum)
Designing a House into a Home
-->Kyu Young Kim - J&K Atelier (@sokokyu)
Making a House a Home
-->Keith Palma - Architect's Trace (@cogitatedesign)
I don't design homes
-->Mark Stephens - Mark Stephens Architects (@architectmark)
#ArchiTalks #24 House or Home? #RefugeeCrisis @GrainneHassett mentioned
-->Jarod Hall - di'velept (@divelept)
A Rose by Any Other Name...
-->Mark R. LePage - EntreArchitect (@EntreArchitect)
Emotional Marketing for Architects: House or Home?
-->Marica McKeel - Studio MM (@ArchitectMM)
ArchiTalks: House or Home?
-->Jeff Echols - Architect Of The Internet (@Jeff_Echols)
House or Home? The Answer to Everything
-->Jarod Hall - di'velept (@divelept)
A Rose by Any Other Name...
-->Samantha R. Markham - The Aspiring Architect (@TheAspiringArch)
6 Ways to Make your Architecture Studio feel like Home
-->Nisha Kandiah - ArchiDragon (@ArchiDragon)
Dwelling on a Macro scale
-->Tim Ung - Journey of an Architect (@timothy_ung)
Architalks - A House is not a home
-->Rusty Long - Rusty Long, Architect (@rustylong)
House or Home