The impact of the aging population on acute care facilities

The need for elder-friendly, geriatric-focused environments is growing—along with a variety of questions and concerns about these healthcare facilities and how they can address the specific physical, emotional, and social needs of this demographic. During the Environments for Aging Conference, April 6–9, 2013, in New Orleans, Progressive AE’s Laurie Placinski and Lon Morrisson will present a session that’s designed to facilitate a better understanding of how the aging population, along with changes from the Affordable Care Act, are impacting how acute care facilities operate and how design can influence a successful transformation.

Laurie Placinski is an interior project designer and client leader at Progressive AE (Grand Rapids, Mich.). Lon Morrisson is a healthcare practice leader with the firm.

If there’s one thing you want people to take away from your session, “Elder-friendly Design—The Impact on the Evolution of Acute Care,” what would that be?

Laurie Placinski: Designing for geriatric spaces is a priority. From an aging perspective, people have viewed this type of care as long-term care, skilled or assisted living facilities; they didn’t look at it as having a true, dedicated large specialty within an acute care setting. The reason now that it’s a priority is because of the health system, the direction it’s going and the impact the Affordable Care Act is going to have. So essentially those that weren’t ready to jump on the wagon now have no other choice.

How is the Affordable Care Act impacting the design of acute care facilities for the elderly?

Lon Morrisson: No one 100 percent understands what the Affordable Care Act is going to do but there are some themes that are starting to emerge. One is moving people from the acute-care environment to the long-term care environment or the ambulatory environment for care. It’s about providing the right care, at the right place, at the right time. Part of this will be potentially bundled payments and how all of that is distributed. One of the other things that you’ll see this year is the partnering of different types of facilities that you haven’t seen in the past. So acute-care hospitals will start partnering with long-term care facilities to help with this continuum of care that’s going to be needed.

What are some of the areas of concern that need to be addressed when creating environments that meet the complex needs of these older patients?

Laurie Placinski: The first is the space itself, the construction, and everything inside, from the levels and color of the lighting, the type of flooring, and the transitions to the construction of the furniture, and the accessibility of amenities.  It’s also about creating services. For example, during our session we’re going to present examples from the Senior Adult Unit at Saint Mary’s Health Care in Grand Rapids, Mich. They have their staff go through specific training to understand this population. And then beyond that, it’s looking at the demographic shift and their families. A lot of older patients tend to have an older spouse who may visit longer than younger guests. They may also have family visit, so it’s looking at the amenities not only for the patient but also for the family members. The other layer is that many of these patients may not return home, so there has to be a transitional space that allows for patients and their families to make that shift.

Lon Morrisson: Just the convenience to move from one level of care to another is going to be important.

Does that ability exist in most acute care facilities right now?

Laurie Placinski: There are pockets of it out there but it’s not seamless yet. At Saint Mary’s, they reached out to several local long-term care facilities to do a brainstorming session and talk about improving that process. They felt there are areas to improve not only when the patient gets admitted to the hospital from a long-term care facility and that reporting structure, but also when they’re discharged from the hospital and admitted to a new facility. A lot of these places are looking at better continuums of care to provide a more holistic approach.

Lon Morrisson: From the Affordable Care Act perspective, the focus is around the patient, getting the right care, and the ease of that care going from place to place. Electronic medical records that can travel with patients and be shipped to their next appointment are going to be an important piece of this.

Name three design elements that you think should be part of any environment serving this demographic.

Laurie Placinski: Safety is the biggest thing, from a flooring and finish perspective. It’s looking at the type of material and understanding the demographic and what to put in that environment. Another element is proximity to amenities. For example, if a patient can see the bathroom, they’re more likely to get up on their own and go there verses when they can’t see it and then feel like they can’t get up, so then they lose that empowerment factor. The third feature is the function of the unit and the staff. This can be an emotional unit to work on, so giving staff a space where they can not only form relationships with patients but also have an off-space to relax and find respite is important. At Saint Mary’s Senior Adult Unit, the staff has a beautiful break room with massage recliners to help them feel appreciated.

Lon Morrisson: There are also trip hazards and infection control issues that you want to make sure you have covered. Simple things like color palettes that can appear as holes in the floor to the elderly are also a concern, so it’s looking at all the safety features together. I’d also underscore what Laurie said about efficiency and layout. With the decline in how many caregivers we’re going to have coming up in the future, it’s important that we don’t burn them out. We need to make life as easy as we can for them to give good care because if we’re not taking care of them then they can’t provide good care to the patients.

It’s important for designers and owners to have a full understanding of this demographic and their needs. What stands out to you about this population?

Lon Morrisson: Boomers are highly educated, they know where to get information, and they’re highly independent. So they’re going to fight tooth and nail to give up that independence. Understanding how they want to function and how they want to age and go gracefully into the future is really important.

Laurie Placinski: In the acute care system, when you’re discharging patients, sometimes you’re discharging them home or to a rehab facility. With most of these [geriatric] patients, they’re not all discharging home. They may be going back to the facility they came from or another for the first time. So it’s a completely different path.

Lon Morrisson: It all ties back to the convenience of care—as the elderly slowly give up their independence that care needs to be more convenient for them to get. I think you’ll see a lot more of these services coordinated together and closer together.

Learn more about this session and the Environments for Aging Conference 2013, April 6–9, 2013, in New Orleans.

Anne DiNardo is senior editor of Healthcare Design magazine.