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Showcase for care

April 1, 2010
by Sara Malin, AIA
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Parkside Lutheran Home has always been known for the high standard of care it provides residents. Located in the small, peaceful community of Lisbon, North Dakota (population 2,300), great pride is taken in the quality of life for the entire town. Although the level and quality of care in Parkside Lutheran Home is high, the physical environment of the 40-bed, not-for-profit facility did not reflect this. In 2007, Administrator Tim Kennedy, along with the board of directors, decided to change the physical environment of the facility to embody the quality of the care provided. According to Kennedy, the residents, both current and future, were entitled to a better quality of living.

At a glance…

Parkside Lutheran Home in rural Lisbon, North Dakota, offers the same quality of care that larger communities offer, in the peaceful rural setting their residents grew up in.

‘Healthcare institution’

The original building that housed Parkside Lutheran was built in 1992-just before the industry started to talk about culture change and the idea of providing a homelike environment for residents. It was designed as a healthcare institution. Prominent in the original design of the facility was a large, central nurses' station that joined two resident wings. This nurses' station was built as a large circle with ample room around it that provided one of the only spaces for the residents to sit. Because of this design, the nurses' station was the center of social activity for the residents and their caregivers, with the caregivers behind the barrier of the nurses' station. It was also a visitor's first image upon entering a resident wing. Although the building was only 15 years old, it was modeled on nursing homes built in the 1950s and 1960s that evolved out of hospital care settings. The central nursing station-the icon of the medical model-evoked an image of acute care and sickness. It was far from homelike.

In December of 2007, Kennedy and the board retained Horty Elving to develop a master plan, redesign the facility and to execute the construction. Horty Elving, a design-build firm in Minneapolis, Minnesota, has specialized in community healthcare design since 1955. The final master plan included major remodeling to the existing facility and the addition of two new resident households. The plan increased the census from 42 to 50 beds. Specifically, the project increased the number of private beds from 4 to 28 and decreased the number of double rooms from 28 to 6. Ten basic care units (similar to assisted living care) were added to the facility along with provisions for independent living units to be added in the future. This provides more lifestyle choices for the residents and allows them to continue their lives within the facility even if their level of care changes. The entire facility was to be designed so that resident-centered care could be delivered under the household concept.

At the start of the design process, the team from Horty Elving conducted an interactive brainstorming session called a design charette that included the residents, the staff, the board, and the community. In the charette, the discussion focused on delivering care to the residents with dignity and respect, providing for the residents the continuation of self and control over choices, and the importance of ensuring residents live in a homelike environment on their own individual schedule. The design of the building needed to support these ideals and be an aid to the caregivers so that they can focus on providing great care to the residents without being impeded by the physical setting of the facility.

The new floor plan divides the building into four separate households. In each household 10-14 residents live in a family-style setting. In conjunction with the new setting, the staffing concept was changed. CNAs and “homemakers” are assigned to and remain consistent with the household so relationships between the residents and the staff can be nurtured. The homemakers' duties are universal and include directing activities, serving food, and cleaning. Staff will now use pocket pagers to minimize unnecessary overhead pages that disrupt a peaceful environment. The staff and residents worked together to name each household and to decorate their households. The social life of the residents and staff is now centered on the common living areas that they helped to create instead of the institutional nursing station.

Sara malin, aia
Sara Malin, AIA