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Full-service lifecare

November 12, 2010
by Richard L. Peck, Contributing Editor
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Laguna Honda Hospital San Francisco, California

Project Summary

Client: Laguna Honda Hospital

Architects: Anshen + Allen; Stantec Architecture

Associate Architect, Interior Design: Fougeron Architecture

Interior Design: Kai-Yee Woo and Associates

Associate Architects: Powell & Partners Architects; Tsang Architecture

MEP Engineer: Arup & Partners California

Construction Manager At-Risk: Turner Construction

Photography: ©2010 David Wakely

Construction Square Footage: 156,993 (south residence); 208,377 (east residence); 143,044 (link building); 150,000 (renovation)

Total Project Cost: $584,946,602

Construction Cost (new): $363,000,000

Cost/Sq. Ft. (new): $726

Construction Cost (remodel): $32,000,000

Cost/Sq. Ft. (remodel): $213

To call the 150-year-old Laguna Honda Hospital a “hospital” is most definitely a misnomer. Emerging from a 10-year design, new construction, and renovation process, the 150-year-old facility now offers a complete range of services: long-term care, rehabilitation, special care for Alzheimer's disease and HIV/AIDs populations, and hospice. It uses the latest concepts in long-term care, offering a personalized environment extending well beyond the usual acute care hospital design. Along the way the project achieved the first LEED Silver registration of any healthcare facility in California. Perhaps the signature achievement of the new design is to translate large-sized 780 mostly skilled nursing beds into homelike accommodation suitable for an average 17 month length of stay. Discussing how this was done, and such unusual features as fully operable windows, are Laguna Honda Associate Administrator Larry Funk; architects Jeff Logan and Sharon Woodworth, Director of Design and Senior Architect, respectively, for Anshen + Allen; and Larry Bongort, Senior Health Architect, Stantec Architects, interviewed by Contributing Editor Richard L. Peck.

Larry Funk: We wanted to transform Laguna Honda from our former self, with large, four-patient rooms, to a modern, polished, state-of-the-art facility providing high-quality, culturally competent rehabilitation and skilled nursing services for the San Francisco community. We wanted to set the standard for enhanced quality of life for our residents and patients-and I believe that we have succeeded in raising the bar for “best in class” services in the United States and, possibly, the world.

The initial planning for this was a wonderful educational experience, thanks largely to Derek Parker, Director Emeritus at Anshen + Allen, who insisted that we do our homework, including national benchmarking. After a two-day visioning conference involving some 60 local leaders and international experts, we toured facilities in New York City and State, Chicago and Wisconsin, taking copious notes on the best design practices of a variety of facilities. We synthesized these into best practices for our own facility, and started programming with a direction and a compass. Leaders from The Center for Health Design provided us with great assistance, including Roger Ulrich, Craig Zimring, Kirk Hamilton, and Blair Sadler. We never could have achieved this project without this background effort.

Sharon Woodworth: Probably the biggest change in the program was moving from the four-patient room with shared bathroom to a design encompassing seven different room types, including singles, single isolation, doubles in toe-to-toe arrangement, and closed and open triples, the latter for residents in need of total assist. The basic idea behind this was to offer residents choice, one of the main concepts of today's long-term care. Even in a facility as large as 1,200 beds, which eventually evolved to 780 beds, we weren't out to create beds per se, but places. This approach to patient rooms contrasts with acute care hospital design, in which the bulk of patient rooms are for general acute care, with about 20% for critical care, 5% for labor and delivery, and units set aside for pediatric care. In long-term care the patient isn't just aging in place, but changing in place, and should have available to them the choice of environments encouraging maximum level of function at all stages.

Jeff Logan: Another difference is that, in hospital design, the patient towers tend toward the monolithic. Here we had a level of crenellation along the edges of the residence buildings that allowed us to create nooks and crannies and a sense of privacy within. Each of the residence buildings-a seven-story tower on the north hill and a six-story tower on the south hill-offers a sense of layering of space inside. It ranges from the private, to the household, to the neighborhood, to the social gathering places in the horizontal component connecting them called the Pavilion, the “link building,” as we called it during design development.

Funk: Each resident has an operable window by the bed, so each has a view and can open the sash and control the blinds. This adds to the resident's sense of autonomy and independence.