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New healthcare design guidelines address long-term care

February 11, 2013
by Robert N. Mayer and Jane M. Rohde
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Design professionals and long-term care providers are often confronted by codes, standards and guidelines that may be unclear, outdated or difficult to use because they have been adapted from and integrated with those written for more acute-care environments such as hospitals. These guidelines also tend to be far more clinical and institutional in nature, which conflicts with the emerging trend in long-term care toward more person-centered built environments.

So what if there was a design guideline that was specifically developed for the unique requirements and new models of long-term care and related support services? And what if it was all in one volume dedicated solely to those services, such that it could be easily adopted in whole or in part by different state agencies that license everything from nursing homes to assisted living to adult day care facilities? Services and care within residential and nonresidential built environments are usually not all licensed by the same state agency.  Therefore, if all of the code information was available in one place and then adopted by different state agencies, there would be a single comprehensive code and reference for design professionals, operators and regulators. That is definitely something to be excited about.

The good news is that since 2009, the Facility Guidelines Institute (FGI) has been working with industry experts in senior living, including gerontologists, various types of facility care providers and owners, design and consulting professionals, researchers, evidence-based design advocates and regulators to create a comprehensive new volume, entitled Guidelines for Design and Construction of Residential Health, Care, and Support Facilities. These guidelineswill provide guidance, consistency and opportunities for “authorities having jurisdiction” to not only evaluate existing and traditionally designed facilities, but to also support those working on transforming and repositioning existing elder care communities to include person-centered care models. These models integrate core person-centered values of choice, dignity, respect, self-determination and purposeful living into their culture.


The transformation of elder services, based on person-centered values and practices has significant implications for the design and construction of the residential communities where those services are delivered. Transformation to a person-centered culture requires the creation of built environments where both elders and their caregivers are able to express choice and practice self-determination in meaningful ways at every level of daily life.

One of the unintended barriers to creating positive person-centered care (PCC) models in long-term care and nonresidential care settings is the often outdated and obsolete design regulations for licensing. The existing Guidelines for Design and Construction of Health Care Facilities, currently adopted by many states, were originally written for hospitals and have not been easily adapted to the many emerging new models of elder care. Person-centered settings are designed not on the traditional hospital-based institutional model of care, but as supportive living environments that better reinforce quality of life for the residents.

In response to the field of design professionals seeking to evaluate and provide innovative new changes in eldercare community models, the Facility Guidelines Institute (FGI) has devoted substantial time and resources to the development of these new guidelines. To be published in 2014, the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities will support the national movement which is integrating person-centered practice and built environments into residential care communities.  These new guidelines, created with an interdisciplinary volunteer team, are a milestone document created to support the evolution of LTC environments, while providing consistent guidance for providers, design professionals and “authorities having jurisdiction.” The ultimate goal is to provide the framework for environments that support positive resident and staff outcomes.


The new Guidelines cover different categories and typologies for a variety of care models, providing an understanding and direction for the development of a wide range of future senior living environments. The Guidelines are divided into part sections and chapters. Part 1 is dedicated to functional programming, environment of care considerations, resident safety risk assessment and other general planning information for all types of facilities. Part 2 is dedicated to “common elements” that are referenced from all of the specific facility chapters covered within the new Guidelines. This section includes design criteria that are common to all facility types, as well as overlay sections that assist design professionals in addressing the special needs of residents with dementia, mental health diagnoses and cognitive and developmental disabilities, as well as bariatric needs.