Long-Term Care Home Design Manual. Ministry of Health and Long-Term Care

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1 Long-Term Care Home Design Manual 2009 Ministry of Health and Long-Term Care

2 Table of Contents INTRODUCTION Background: The Evolution of Ontario s Long-Term Care Home The Resident Home Area Concept i ii iii PART 1 Using This Design Manual 1 Definitions 1 Measurement Abbreviations 3 Application and Scope Who and What the Design Manual Covers 3 PART 2 The Standards Resident Home Areas (RHAs) Resident Home Areas (RHAs) Resident Personal Space in the RHAs Resident Bedrooms Resident Washrooms Resident Bath Rooms and Shower Rooms Spaces for Staff Activities in the RHA Nursing and Program/Therapy Work Space RHA Storage Space for Resident Care Supplies and Equipment Resident Lounge and Program/Activity Space Resident Lounge and Program/Activity Space Dining Areas and Dietary Service Space Resident Dining Areas Dietary Service Space Resident Community Space Outdoor Space 22

3 6.2 Beauty Salon/Barber Shop Place of Worship Enhanced Resident Space Environmental Services Laundry Space Housekeeping Service Support Space Utility Space Maintenance Service Support Space Safety and Security Features Resident/Staff Communication and Response System Door Access Control System Water Temperature Control System Building Systems Lighting Systems Heating, Ventilation and Air-Conditioning (HVAC) System Emergency Generating System Other Features Storage Space Non-Resident Space Receiving/Service Space Reception/Entrance Space Way-Finding Elevators Public Washrooms Corridors 38 PART 3 Resources 39

4 INTRODUCTION The Long-Term Care Home Design Manual, 2009 (the Design Manual) contains the Ministry of Health and Long-Term Care s revised design standards and retrofit standards for long-term care homes in Ontario. In using this Design Manual, please keep in mind that the standards are the minimum design features that must be achieved for all applicable long-term care home projects. Introduction. It includes background information on the evolution of long-term care home design standards in Ontario. Part 1 Using this Design Manual. It has definitions of words and terms in the Design Manual and its application and scope. Part 2 The Standards. It has design objectives, design standards and retrofit standards for long-term care homes resident, staff and public spaces. There are also recommendations for design options that operators may want to consider for further improving spaces in long-term care homes and that are consistent with the mandatory standards in this Design Manual. Part 3 Other Resources for Long-Term Care Home Operators. There is a contact information list for other Ontario government and municipal resources. Ministry of Health and Long-Term Care i

5 Background: The Evolution of Ontario s Long-Term Care Home Design Standards In 1998, the Government of Ontario announced a new capital program to support the building of approximately 20,000 new long-term care beds and the redevelopment of approximately 16,000 existing D classification long-term care beds. This initiative included a new capital funding program and a new set of long-term care home design standards. The Ministry of Health and Long-Term Care (the Ministry) consulted with many stakeholders in the development of these standards. The objective of the new standards was to create less institutional, more residential long-term care homes that would provide a higher quality of life to the people who lived there. The Ministry published the new design standards in the Long-Term Care Facility Design Manual, May In January 2002, the Ministry introduced the 2002 D Bed Program, which included the Retrofit Option to provide operators with more flexibility to bring their existing long-term care homes up to current design standards. The Long-Term Care Retrofit Design Manual, January 2002 set out retrofit design standards based on the Long-Term Care Facility Design Manual, May In publishing the 2002 retrofit manual, the Ministry recognized that there may be circumstances where an operator could not fully comply with the standards within the existing structure. The Long-Term Care Home Design Manual, 2009 represents a consolidation and revision of policies contained in both The Long-Term Care Facility Design Manual, May 1999 and the Long-Term Care Retrofit Design Manual, January The Long-Term Care Home Design Manual, 2009 promotes innovative design in long-term care homes in Ontario. These new design standards give service providers greater flexibility to create environments that make it possible to respond positively and appropriately to the diverse physical, psychological, social and cultural needs of all long-term care home residents. The Design Manual s goal is to integrate design concepts that will: facilitate the provision of quality resident care in an environment that is comfortable, aesthetically pleasing and as home-like as possible. support well-coordinated, interdisciplinary care for residents who have diverse care requirements. Ministry of Health and Long-Term Care ii

6 The Resident Home Area Concept In 1999, the Ministry established the concept of Resident Home Areas. Resident Home Areas (RHAs) are smaller, self-contained units within the home that: give residents more intimate and familiar living spaces support long-term care home staff in providing efficient care to residents. RHAs continue to be the foundation for Ontario s long-term care home design standards. In the 1999 Design Manual, the Ministry made the following commitment: as resident care, program and service requirements change, the development of new and revised design standards will be necessary to respond to these changes in resident needs... it (the Design Manual) will be revised as necessary to incorporate new ideas that will support a facility design that best meets the care, program, and service needs of residents. The Long-Term Care Home Design Manual, 2009 continues that commitment. Ministry of Health and Long-Term Care iii

7 PART 1 Using This Design Manual Definitions The following words, terms and abbreviations used in this Design Manual have the meanings set out below except where the context indicates otherwise: Bedrooms a private bedroom is a one-bed bedroom accommodating one resident and has a separate ensuite washroom; a semi-private bedroom is a one-bed bedroom accommodating one resident, another one-bed bedroom accommodating one resident with each bedroom having direct access into a shared ensuite washroom; and, a basic (standard) bedroom is a two-bed bedroom accommodating two residents and has a separate ensuite washroom. Design Manual The Long-Term Care Home Design Manual, Design Objectives the purpose and design expectations for each area, including how the space is to be used and what the resident focus should be to achieve the optimal care outcomes. the requirements set out in this Design Manual that must be incorporated into the design of each long-term care home, not including retrofit standards. Long-Term Care Homes means nursing homes under the Nursing Homes Act, charitable homes for the aged under the Charitable Institutions Act, municipal homes for the aged under the Homes for the Aged and Rest Homes Act, and long-term care homes under the Long-Term Care Homes Act, Ministry Ontario Ministry of Health and Long-Term Care. Operator an existing operator of a long-term care home or a person with whom the Ministry contracts to develop and operate a long-term care home. Recommendations the Ministry s suggestions for optional design features that further promote quality long-term care home design and quality care outcomes and, thus, are in the spirit of this Design Manual. The Ministry has included them in this Design Manual as helpful guidance for operators and encourages operators to consider them. Ministry of Health and Long-Term Care 1

8 Resident Home Areas or RHAs smaller, self-contained units within the long-term care home that give residents more intimate and familiar living spaces and supports long-term care home staff in providing efficient care to residents. Retrofit the definition of retrofit is unique to this Design Manual. It is not the definition found in provincial legislation such as the Ontario Building Code and the Ontario Fire Code. Operators considering relying on retrofit standards should consult with their architects about the requirements under other applicable law, including the Ontario Building Code and the Ontario Fire Code. Part 3 of this Design Manual has contact information. Retrofit Standards are based on the design standards, with added design flexibility to address the constraints of the existing long-term care home. The retrofit standards apply to spaces located within the existing long-term care building or to additional floors added to an existing long-term care building. The retrofit standards may also apply to an attached retirement home that is being incorporated into the redevelopment of the long term-care home or additional floors being added to that retirement home in the course of redevelopment. All other additions to an existing long-term care building must meet the design standards. Retrofit standards are identified in this Design Manual by their placement in a shaded box and by a section reference that contains a letter of the alphabet, (e.g., (a)). The Ministry prefers that a long-term care home meet the design standards in this Design Manual. However, the Ministry recognizes that there may be possible project limitations. In these cases, the operator may propose alternatives, subject to Ministry approval, provided that: the alternatives address the design objectives to the Ministry s satisfaction, and, all relevant retrofit design standards are met. If a decision is made to seek Ministry approval of plans that rely on any of the retrofit design standards in this Design Manual, please refer to the current policy for funding construction costs of long-term care homes as a reduction in funding may apply. Useable Net Floor Space in Resident Bedrooms the area of a long-term care bedroom excluding the clothes closet, resident washroom, space that is occupied by mechanical/electrical incremental units, building structure (e g., columns) and built-in furnishings and the vestibule (see below). Vestibule in Resident Bedroom the entrance space within the bedroom that, typically, is the space inclusive of, and surrounding, the door-swing of the bedroom door and the remaining areas leading into the bedroom. Ministry of Health and Long-Term Care 2

9 Measurement Abbreviations The following common abbreviations for measurement are used in this Design Manual: ft feet in inches lx lux, luxes or luces m metres mm millimetres. Application and Scope Who and What the Design Manual Covers Except as the Ministry may otherwise specify in writing, the Long-Term Care Home Design Manual: applies to the construction of all long-term care homes in Ontario, except for the construction of long-term care homes that the Ministry approves under development agreements entered into before March, supersedes any prior Ontario government requirements and guidelines on long-term care home design used in the past by either the Ministry of Health and Long-Term Care or the Ministry of Community and Social Services for long-term care home development. contains the minimum design features that must be achieved for all long-term care home development projects. In using this Design Manual, please keep in mind that: The retrofit standards are the only standards where there is design flexibility. In addition to complying with the design standards and the retrofit standards, all longterm care homes are required to operate under all applicable Ontario government legislation, regulation, operational and program standards. This Design Manual is subject to all applicable law of Ontario and Canada. For more information on Ontario government legislation, regulation, operational and program standards, contact ServiceOntario, see PART 3 Resources. Ministry of Health and Long-Term Care 3

10 PART 2 The Standards The standards are organized under the following 10 sections: 2. Resident Home Areas (RHAs) 3. Resident Personal Space in the RHAs 4. Spaces for Staff Activities in the RHAs 5. Resident Lounge and Program/Activity Space 6. Dining Areas and Dietary Services Space 7. Resident Community Space 8. Environmental Services 9. Safety and Security Features 10. Building Systems 11. Other Features Each of the 10 sections has the: design objective design standards. In addition, some sections have: retrofit standards recommendations. Ministry of Health and Long-Term Care 4

11 1.0 Resident Home Areas (RHAs) 1.1 Resident Home Areas (RHAs) Design Objective Each RHA must be a self-contained unit for residents of that area to use. The intent is to create smaller home-like units instead of large group/institutional living environments RHAs must be clearly defined, distinct units located on the same floor and provide accommodation for a maximum of 32 residents. Retrofit Standards 1.1.1(a) RHAs must be clearly defined distinct units that may provide accommodation for a maximum of 40 residents (b) RHAs must be clearly defined distinct units. They may be split between two adjacent floors provided that each floor of the split RHA has the following spaces: lounge space (there must be at least 1 lounge on each floor that is a minimum of 14 square m (150 square ft) housekeeping/janitor closet soiled utility space staff work space. Please Note Dining space in a split RHA can be located on each floor or only on one of the floors. Where there is dining space on only one of the floors, the project summary must include the operator s plan for transporting residents from one floor to another for meal times In each RHA, the bath and shower rooms, dining area(s), lounge area(s) and program/activity space must be located close to the resident bedrooms The RHA must be a self-contained living system. It must not allow for anyone (resident, staff member or visitor) to pass through the RHA to get from one part of the home to another. Ministry of Health and Long-Term Care 5

12 1.1.4 The Resident Home Areas as well as the other areas of a long-term care home must be completely separate and distinct from space which is used for other purposes. If the long-term care home is to be part of a larger integrated complex (e.g., a combined complex that includes a rest/retirement home and a long-term care home) the space allocated for the long-term care residents must be distinct from the rest of the complex. It is acceptable to share building service areas such as the kitchen, laundry and staff rooms. Ministry of Health and Long-Term Care 6

13 2.0 Resident Personal Space in the RHAs 2.1 Resident Bedrooms See the definition of bedroom in Part 1. Design Objectives The resident bedroom is the centre of a resident s personal space. It is the place where the most private activities take place: e.g., sleeping, grooming and dressing. Its design must meet each resident s need for comfort and safety, promote the resident s independence and, provide for resident privacy. Each bedroom must be designed to maximize a sense of familiarity for residents and support direct care staff in the safe delivery of quality resident care. There are three types of accommodation: private bedroom, semi-private bedroom and a basic (standard) bedroom. Please Note Ontario regulations establish the proportion of beds that must be provided at the basic/standard rate Resident bedrooms must have one or two beds but not more than two beds per bedroom A one-bed bedroom must have at least square m (130 square ft) of useable net floor space. Retrofit Standard 2.1.2(a) A one-bed bedroom may have a minimum square m (120 square ft) of useable net floor space A two-bed bedroom must have at least square m (115 square ft) of useable net floor space per resident. Ministry of Health and Long-Term Care 7

14 Retrofit Standards 2.1.3(a) A two-bed bedroom may have a minimum of 9.75 square m (105 square ft) of usable net floor space per resident (b) Two-bed bedrooms may meet a minimum of 9.3 square m (100 square ft) of usable net floor space per resident provided that: the average of the retrofitted two-bed bedrooms throughout the home is at least 9.75 square m (105 square ft) of usable net floor space per resident AND no more than 10 per cent of the retrofitted two-bed bedrooms throughout the home are less than 9.75 square m (105 square ft) of usable net floor space per resident Two-bed bedrooms must provide privacy for each resident of the room Every bedroom must have an ensuite washroom The entrance to the washroom must be from within the bedroom itself (which includes the vestibule) Bedrooms must have a clothes closet for each resident. Each clothes closet must have at least 0.56 square m (6 square ft) of floor space. The clothes closet must be large enough in height and depth to store and hang clothes. If portable, the clothes closet must have a non-tipping design. Retrofit Standard 2.1.7(a) Bedrooms must have clothes closets for each resident. Each clothes closet may have a minimum of 0.46 square m (5 square ft) of floor space. The clothes closet must be large enough in height and depth to store and hang clothes. If portable, the clothes closet must have a non-tipping design Bedroom doors must be a minimum width of 1120 mm (44 in) If a lock is installed on a bedroom door, the lock must be readily releasable and easy for residents and staff to open In each bedroom, there must be sufficient space to give caregivers access to three sides of each bed that is, both sides of the bed and the foot of the bed. Ministry of Health and Long-Term Care 8

15 Bedrooms must be designed to allow specialized program equipment access around the two sides and the foot of the bed Bedrooms must be designed to allow a 180 degrees change of direction of any care equipment within the room Bedrooms must have at least one window that provides a direct view to the outdoors or to other naturally-lit space when both sitting and lying in bed. The lowest edge of window glass must be no more than 600 mm (2 ft) from the floor to ensure an unobstructed view to the outside. The size of the window must be equal to, or greater than, 10 per cent of the floor area of the bedroom to ensure that there is sufficient natural lighting for the bedroom Windows that open to the outdoors must have screens in the spring, summer and fall seasons Telephone and television service capability must be provided for each resident in each bedroom. 2.2 Resident Washrooms Design Objective Each washroom must be designed to promote resident privacy, dignity and independence. In addition, the washroom space must also allow caregivers to provide effective and safe care delivery Resident washrooms must contain a toilet and a hand washbasin Resident washrooms must have an entrance width of at least 914 mm (3 ft) When open, a washroom door must not block the bedroom entrance-way and must not swing into another door in the bedroom, such as the bedroom door or a clothes closet door A lock on a washroom door must be readily releasable and easy for residents and caregivers to open There must be no direct view of the toilet in the ensuite washrooms from the corridor when the washroom door is open Washrooms must have sufficient space to enable independent and/or assisted transfer from the front and at least one side of the toilet. Ministry of Health and Long-Term Care 9

16 2.2.7 In order to allow for sufficient space for a wheelchair or a walker, and for staff to assist a resident, there must be a m (5 ft) turning circle in each resident washroom. Please Note the turning circle is measured from the edge of the toilet seat and to the edge of the countertop/sink. Retrofit Standard 2.2.6(a) The m (5 ft) foot turning circle may go underneath the toilet and the sink however the amount of space that can be measured underneath the toilet and sink will be limited to the depth of the wheelchair pedals / foot rests. The m (5 ft) turning circle does not include the space all the way to the walls where the toilet and sink hang There must be a securely fastened grab bar beside the toilet within the resident s easy reach. Each grab bar must be of sufficient size and design to support the full weight of a resident and must be placed on a reinforced wall capable of sustaining the weight load Washrooms must have counter space to allow for easy placement of personal grooming items and be equipped with a mirror There must be accessible space in each washroom for individual storage of each resident s personal items. When two residents share a washroom, there must be separate storage space available for each resident Lever-handled taps that clearly distinguish between hot and cold water must be provided in all resident washrooms. This type of fixture is the preferred model for residents with visual impairments and for residents with physical disabilities that affect hand movement If a sliding door is installed in the washroom: Door handles must be easy to grip ( C or D type handles) and located on the door so that hands and knuckles will not be hit when opening and shutting the door. The door must shut completely to ensure resident privacy. The door must slide easily to make it easy for a resident to use. Ministry of Health and Long-Term Care 10

17 Recommendation Consider providing: 1. a night-light in the bedroom near the doorway to the washroom. 2.3 Resident Bath Rooms and Shower Rooms Design Objective Resident bath rooms and shower rooms must be safe, private and comfortable for residents. They must also be designed so that caregivers can easily and safely assist residents to bath or shower in a manner that protects resident dignity and promotes independence as much as possible RHAs must have a minimum of: one separate room with a raised bathtub equipped with a hydraulic, electric or mechanical lift one separate room with a shower (the showering area must have sufficient space to accommodate a shower chair so that a resident can receive help in showering in a sitting position) a washroom (toilet and a sink) located in each bath room and shower room OR a shared washroom, (toilet and sink) with direct access from both rooms There must be no direct view of the bathtub, the shower or the toilet from the corridor outside of each resident bath room and shower room The toilet in the resident bath room and shower room must be positioned so that independent and/or assisted transfer from at least the front and one side of the toilet can occur There must be a securely fastened grab bar for resident s use at each toilet, and on the faucet wall and on the adjacent wall of each shower All resident bath rooms and shower rooms must be equipped with an independently controlled thermostat to allow the room temperature to be set at the resident s preference while bathing or showering. Ministry of Health and Long-Term Care 11

18 Retrofit Standard 2.3.5(a) All resident bath and shower rooms must be equipped with an independently controlled thermostat or heat lamp to allow for resident comfort Space must be provided in each bath and shower room to accommodate resident towels, personal clothing and toiletries Resident bath rooms and shower rooms must have secure areas to store cleaning supplies. Recommendations Consider providing: 1. separate areas in the resident bath rooms and shower rooms where residents can receive help with dressing and grooming after their bath or shower, to support resident comfort, privacy and dignity. 2. a hair washing sink in at least one resident bath room or shower room in each RHA. Ministry of Health and Long-Term Care 12

19 3.0 Spaces for Staff Activities in the RHA 3.1 Nursing and Program/Therapy Work Space Design Objectives The provision of resident care involves the assessment, planning, implementation, communication and evaluation of care. The work space for staff in each RHA must be designed to support a well-coordinated, multi-disciplinary care system that will allow staff to meet residents care and treatment needs in an efficient and effective manner. The work space for staff must also be designed so that it can readily be identified by residents, staff, visitors and others as an information centre or an area for contacting staff. See also, Way- Finding (10.5) RHAs must have work space for nursing and program/therapy staff so they can carry out their administrative duties. The space must accommodate: a work area to complete documentation multi-disciplinary team activities secure storage of resident care records On every floor where RHAs are located, there must be one space to support the delivery of therapeutic programs that the home provides such as podiatry, dental, ophthalmology, social and psychiatric services. There must be a minimum of one therapy room for every three RHAs. This space or spaces must be in a centrally accessible area In areas where therapeutic programs are delivered, there must be convenient access for residents to a washroom that is separate from resident bedroom washrooms. Ministry of Health and Long-Term Care 13

20 3.2 RHA Storage Space for Resident Care Supplies and Equipment Design Objective There must be space for storing required medications, supplies and equipment for the care and treatment for residents in each RHA. Medications and nursing care supplies and equipment must be stored in a place where they are readily accessible to caregivers but do not intrude on the residents personal space The storage space for resident care supplies and equipment must be convenient and accessible to the staff working in each RHA Secured space must be provided either within every RHA or shared between RHAs on the same floor, for the storage of resident medications, stock medications and medication carts There must be secure space with lockable cupboards for the storage of all supplies and equipment related to care delivery Areas used for charging of batteries (e.g., wheelchair batteries) must have adequate and continuous mechanical ventilation. Ministry of Health and Long-Term Care 14

21 4.0 Resident Lounge and Program/Activity Space 4.1 Resident Lounge and Program/Activity Space Design Objectives Residents lounges must be comfortable and designed so that residents can interact in a relaxed atmosphere with other residents, family members and visitors. The lounges must be designed for conversation, reading, and other social activities. Program and activity areas must be able to accommodate a variety of resident-focused activities and support social functions which promote resident quality of life The minimum total required space for resident lounge and program/activity space is 2.5 square m (27 square ft) per resident. Retrofit Standard 4.1.1(a) The minimum total required space for resident lounge and program/activity space is 1.95 square m (21 square ft) per resident At least 70 per cent of the required resident lounge and program/activity space for each RHA must be located in the RHA. The remaining required space for the resident lounge and program/activity space may be located outside the RHA(s) for access by all residents of the long-term care home. Retrofit Standard 4.1.2(a) At least 50 per cent of the required resident lounge, program/activity space for each RHA must be located in the RHA. The remaining required space for lounge, program/activity space may be located outside the RHA for all residents of the longterm care home Each RHA must have at least one resident lounge with a minimum of 14 square m (150 square ft) of total floor area. Ministry of Health and Long-Term Care 15

22 4.1.4 Each RHA must have at least one resident program/activity space with a minimum of 14 square m (150 square ft) of total floor area At least one resident lounge in each RHA must have a window with a direct view to the outside or to a naturally-lit area Resident program/activity areas must have convenient access to a washroom that is separate from and not located in resident bedrooms or tub and shower rooms Where resident-accessible electrical appliances are provided, there must be deactivation ( kill ) switches. Ministry of Health and Long-Term Care 16

23 5.0 Dining Areas and Dietary Service Space 5.1 Resident Dining Areas Design Objectives All resident dining areas must include design features that promote a home-like feel and that reinforce familiar eating patterns associated with smaller social gatherings. Efforts must be made to keep noise to a minimum in dining area(s) by providing finishes that reduce reflected noise and increase sound absorption RHAs must have dedicated space for dining that is separate from any other type of space The minimum, total required space for dining area(s) is 2.8 square m (30 square ft) of floor area per resident, excluding servery space. Retrofit Standard 5.1.2(a) The minimum required space for dining area(s) is 2.32 square m (25 square ft) of floor area per resident, excluding the servery space per cent of the required space for dining area(s) must be located within the RHA. Retrofit Standard 5.1.3(a) At least 70 per cent of the total required space for dining must be located within the RHAs and allocated based on the numbers of residents in each RHA. Up to 30 per cent of the total required space for dining may be located outside the RHA(s) to support alternative dining programs. However, the Ministry requirements for meal service (e.g., the provision of three meals per day, which includes alternates /choices, diet types, etc.) must be provided in these areas Dining areas must have convenient access to a washroom that is separate from and not located in resident bedrooms and tub and shower rooms and does not open directly into food preparation or dining areas. Ministry of Health and Long-Term Care 17

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