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Sustaining lifelong connections

September 1, 2010
by Bob Siebenaller, AIA, NCARB, LEED AP BD+C, ACHE
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A broad vision of sustainability seeks to nurture seniors' connections with their environment, community, humanity

Humans are relational beings. We have connections with one another and the natural environment. When we think about how we can nurture and sustain these connections, we can improve our built environments and the quality of our lives, including those of seniors.

Thus, a broad vision for a sustainable long-term care facility goes beyond environmental design and LEED® certification-it seeks to nurture seniors' connections with their environment, community, and humanity. This vision can be realized through a variety of means: design, construction, operations, and maintenance of a facility that:

  • helps sustain the environment;

  • fosters seniors' engagement in the social, cultural, and economic life of the larger community; and

  • provides seniors with opportunities for continuing education and intergenerational learning.

Through creative space planning and design strategies, designers can create a built environment that enables these connections to be made. And, through development of partnerships with the larger community, long-term care leaders can identify mutual needs that help them overcome financial challenges to realizing this vision.

Beyond environmental sustainability

Much has been written over the last several years about ways to design and construct an environmentally sustainable healthcare facility. The U.S. Green Building Council (USGBC) (, in developing the LEED Rating Systems, has made a great contribution to the transformation of the design and construction industry. The USGBC Website states: “The LEED for Existing Buildings Rating System helps building owners and operators measure operations, improvements, and maintenance on a consistent scale, with the goal of maximizing operational efficiency while minimizing environmental impacts. LEED for Existing Buildings addresses whole-building cleaning and maintenance issues (including chemical use), recycling programs, exterior maintenance programs, and systems upgrades. It can be applied both to existing buildings seeking LEED certification for the first time and to projects previously certified under LEED for New Construction, Schools, or Core & Shell.” Designing and building a LEED-certified facility that integrates high-efficiency mechanical/electrical/plumbing systems, renewable, low-VOC building materials and finishes, and other components is a worthwhile environmental goal. It also offers a return on investment in the form of a high-performance building that lowers operating costs over its own life cycle, and contributes to its users' quality of life. It is a healthier building to live and work in.

Completing checklist

Many people-including designers, builders, and owners-equate sustainability with completing a rating checklist and cutting the ribbon on a certified “green” facility.

Achieving certification under any rating system becomes a “snapshot” in time. The challenge to any facility owner is to maintain a sustainable facility. After the ribbon-cutting comes the ongoing process of operations and maintenance-activities in themselves that must be sustainable.

However worthwhile these goals and practices are, LEED certification is intended only as a starting point. To achieve true long-term sustainability, owners must periodically reassess their Operations & Maintenance (O&M) standards and practices in light of sustainability goals. They must ensure they are optimizing the productivity and efficiency of their facilities and personnel.

The challenge, whether certifying your facility or using environmental rating systems as a guide, is to broaden an understanding of sustainability beyond the checklist. Special considerations are required for specific healthcare needs, integration with the community, and developing a view of how to restore, or enhance, the quality of the natural environment around your facility.

The Green Guide for Health Care (GGHC) ( has developed a “tool kit” that broadens the definition of sustainability for healthcare facilities. For example, it recommends establishing connections with the natural environment for patients, residents, visitors, and staff through creation of landscaped outdoor spaces and gardens. To develop a relationship between food service and sustainability, the GGHC suggests offering space on the grounds to host a local farmer's market-establishing an important connection with the larger community, and other alternatives that focus on food production. The USGBC is in the processs of developing LEED for Healthcare, another companion tool that can address specific healthcare issues. While both are rooted in acute care settings, there can be beneficial elements that can be applied to any healthcare setting.