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Obstacles and Solutions in Real-World Design

March 1, 2008
by Long-Term Living Editors
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The downs and eventual ups of several participating projects
  • Near major roadways for easy access

  • Specifically in a residential neighborhood

  • Affordable


  • Solution: Several sites were evaluated, but one on donated land nestled into an existing Scarborough, Maine, neighborhood met all the criteria. However, to build the new 15,763-sq.-ft. “house,” the owners and design team needed to seek a special exemption appeal for this hospice use. The team put much effort into producing materials and information to support this zoning exemption: traffic studies, lighting studies, elevations to show the residential scale, and a comparison with inpatient hospices of similar programs in other states. Due to numerous voices of support for the project, incorporating neighbors’ concerns into the design elements, and the agreement not to expand the facility, the zoning board approved the exemption.

    Obstacle: The owners’ intention was to be a good neighbor but the obstacle was neighbors who were concerned about a healthcare facility located there.

    Solution: The solution was to hold several neighborhood meetings to listen to concerns, help inform neighbors about hospice's services for patients in need of expert comfort care when their own home is no longer an option, and resolve misconceptions regarding loud ambulances or activity 24 hours a day. During these meetings, the owners emphasized that a neighborhood setting was critical for this inpatient facility to be a home-away-from-home. As a result, the design team created a layout making the 18-unit building look one third of its actual size. Exterior lighting was adjusted on timers so the lights would only be on at key times, such as staff changes. The “house” was set 270 feet back from the road, existing vegetation was kept, and new buffers were added, including the blue spruce selected by neighbors.

    Regents Point

    ©2006 John Bare Photography

    ©2006 John Bare Photography

    Architect: CastleRock Design Group, Inc.

    Obstacle: Having more than 50 walkers lined up in the entrance to the dining room made it appear like a giant walker parking lot—not so attractive before dinner!


    Solution: The most effective solution was to make use of a large room adjacent to the main dining room for a place to store walkers out of sight. However, the room had large dividing accordion doors that were cumbersome and didn't give the space much flexibility. By replacing the out-of-date doors with movable wall partitions with standard-size doors, the staff can take the walkers before residents dine and park them out of view. The result now leaves the approach to the dining room visually clear of these reminders of dependence.

    Renaissance Gardens at Wind Crest

    Art and Design Studios—Sergei Loseva

    Art and Design Studios—Sergei Loseva

    Architect: Wallace Roberts & Todd

    Obstacle: The state had not been introduced to the household model of care prior to this building. A meeting of the reviewers, both state and local, had to occur before the schematic design of the building even really began. Compounding the problem was that the state has no fee structure or process that allows it to review skilled nursing plans prior to construction. The reviewers were reluctant even to talk to us on the phone. Can you imagine building a new care model and having the state walk through after construction and decide that it doesn't work? It does not encourage designers and providers to push the envelope.


    Solution: Eventually, we were able to get them to agree to meet with us and review the building. We had representatives from life safety, nursing, and licensing at the table. The state is still reviewing the information for compliance, but we feel that with certain concessions, the model can be implemented. We are hoping to be able to continue the dialogue as the design progresses and are working with all parties to ensure full code compliance.

    Obstacle: One of the obstacles that we have been working to overcome is the use of a commercial-grade grease hood over the stove. We feel that this will really detract from the homelike quality of the kitchen. Plus, with the open kitchen layout, the noise from the fan will create a distraction and interfere with conversation both in the kitchen and in the dining area.

    Solution: Each household has its own kitchen to prepare and cook meals, and the kitchen is the main place of activity in most houses, so we have been working closely with the local officials on alternates to a commercial hood. Also, in an effort to make the kitchen feel as homelike as possible, we are using residential appliances. The use of the induction cooktop (no open flame), combined with a no-frying policy and additional sprinkler heads in the kitchen, are some of the extra safety measures that we have implemented.

    Obstacle: The adjacent neighbors have been very vocal about the size, placement, and aesthetic of the building.

    Solution: Through numerous meetings with the neighbors and the client, an aesthetic was established to complement the adjacent neighborhoods and allow the neighbors and the extended care center's residents to have a view of the beautiful Rocky Mountains.

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