D2 Architecture, in partnership with HKS, 12 Oaks Senior Living, Heritage Oaks Management, Brasfield & Gorrie, and Bridge Construction Group, has formed a Task Force to gather information from Senior Living Communities about their pressing building needs during this pandemic. To respond, the Task Force has prototyped a variety of solutions to resource in case the need to implement any of them arises at a specific community or area of the country.
SL building needs identified so far include:
1. SECURITY CHALLENGES – Communities are facing challenges in securing porous site perimeters and building perimeters. They are looking for ways to consolidate entry points to screen staff and visitors (like healthcare professionals, local and state inspectors and others still visiting in a limited capacity.) As well as ways to consolidate exit points – to screen staff and visitors again, to control PPE disposal and to control biohazard waste.
SECURITY SOLUTIONS include temporary construction, premanufactured homes, modified shipping containers, rapidly deployable wi-fi based security systems, temporary barriers, temporary locks and more.
2. BED CAPACITY CHALLENGES – Communities are facing challenges in accommodating an influx of elders, either seeking care, seeking protection or facing transfers from other entities. This influx has exacerbated existing capacity constraints. Communities are facing the further challenge of implementing social distancing within limited space and in providing isolation suites when needed. Existing residents may not have the freedom to leave to shelter with family. They may be in need of more acute care, such as in Memory Support settings. They may be bed-ridden or otherwise have nowhere else to go. Some communities may have two residents housed in semi-private units that are virtually impossible to sequester.
BED CAPACITY SOLUTIONS include partnering with local Limited Service Hotels to try and disperse able-bodied and non-Covid positive residents off site to a second location. This approach would free up precious space and reduce density in the existing SL building. For more in-depth analysis of this option, please click here. Other solutions for temporary bed capacity increases included prototyping existing stocks of office partitions, industrial partitions, shipping container housing and premanufactured housing. Some of which could be installed in existing salon/spas and office areas that are more easily controlled, often with their own HVAC systems and exhaust to reduce cross-contamination risks. And for more serious bed expansion demands, installation in existing multi-purpose rooms so that these areas can at least be controlled more easily then open dining areas, despite their lack of use in this crisis.
C. INFECTION CONTROL CHALLENGES – Communities are facing challenges in controlling air and water cross contamination in buildings that, in many cases, have been built using multiple types of systems over many decades. These challenges may be exacerbated in communities with limited medical experience such as stand-alone rental Active Adult and Independent Living.
INFECTION CONTROL SOLUTIONS include the availability of an HKS Advisory Committee. HKS is the nation’s leading healthcare design firm and has resources and expertise that can be provided to Senior Living communities with limited healthcare experience. In addition, Brasfield & Gorrie, the nation’s leading healthcare general contractor, can also not only advise but deploy design-build staff with experience working in medical environments to adapt a senior living buildings systems. Adaptations will depend on the assessment of a building’s existing system or systems to identify which are capable of implementing new accessories, filtration systems, UV components, rebalancing, BMS settings, exhaust/air change capacities, etc. Other solutions included prototype premanufactured housing and modified shipping containers for temporary isolation room use.
4. FOOD SERVICES CHALLENGES – Communities are facing challenges in maintaining meal service, which many seniors living in a wide variety of care types, may be dependent on. Dining rooms have been reduced in use, if not abandoned altogether to facilitate social distancing and in some cases isolation areas. This has sometimes strained existing community systems and processes to provide more room service.
FOOD SERVICES SOLUTIONS include augmenting bulk food storage temporarily, the installation of readily available non-utilities intensive equipment. Such as convection ovens (MerryChef, TurboChef) that generally do not require grease exhaust hoods or dedicated fire suppression systems. Such as blast chillers that can rapidly freeze entrees, sauces and soups at the central kitchen for higher quality distribution to remote warming kitchens. Such as combi-ovens that can perform multiple types of tasks in one consolidated piece of equipment to increase production volume. Other solutions include site accommodations to improve access for more frequent grocery deliveries, UberEats type deliveries, local restaurant deliveries and even Food Trucks to augment capacity, resident choice and distribution.
5. REGULATION REFORM – Communities are facing challenges, especially in licensed care, with existing regulations still enforced in many states. The Task Force has been communicating indirectly with State of Texas officials to try and determine what kinds of changes and/or waivers may be in the works to facilitate emergency planning. UNOFFICIAL RECOMMENDATIONS include:
a. A Community should use the interim time, while officials weigh their options, to proactively amend their Emergency Preparedness Plans to include pandemics and possibly include partial evacuation to places like Hotels mentioned above. This would only be one of many contingencies included in the plan to get it ready if it becomes needed.
b. A Community representative should reach out to their Regional Director prior to calling the State Agency in Austin.
c. Assisted Living regulations, which have not been officially revised in Texas to align with the recent SNF revisions, can defer to SNF revisions if the Governor approves a waiver.
d. We also hope for a temporary waiver regarding Emergency Preparedness Plan ‘Destination Facility’ requirements. Currently, these requirements state that the facility a community evacuates to must be of equal or more stringent license type. Some Limited Services hotels could be good candidates, with full sprinkler protection, modern egress components and non-combustible construction. But these will have to be assessed first, and very quickly, since not all are built this way.
IN ADDITION, prototype designs are also underway for other uses including Telehealth Suites, Staff Training and Respite Facilities, on-campus temporary Staff Housing, detached Examination Facilities, Bio Waste processing and handling Facilities and even Sequestered Family Visitation Suites.