Where design, staff and budget meet, great communities are found
By Chad Ulman and Amy Ruedinger
One of the greatest struggles that we see senior care providers experience during the planning and design of a new or renovated facility is finding the appropriate balance between offering a home-like environment (warm with more intimate spaces and smaller groups of residents), addressing operational/staffing efficiencies, and meeting budgetary restrictions.
While it’s wonderful to have a newly designed facility, if you neglect to consider the operational and staffing impact early during programming and design, you’ll likely end up with significant budget challenges when trying to staff your new facility.
When considering the household concept for your next facility, changing the physical environment is not sufficient. Culture change needs to be embraced by all within the organization. Bringing together the facility’s administration/staff, an external operations expert and a senior living design expert as a team in the early planning is integral to successfully avoiding an institutional feel.
Combining design expertise with operational insight sets the stage for great success.
Consider key components
There are many items that impact operations:
• Nurses’ stations are increasingly decentralized in household concepts that are designed to create a more home-like feel. This allows the nurses and other staff to be out in the neighborhoods, allowing for more natural interaction with residents. Office supplies and paperwork can be secured in armoires or in built-in casework to maintain confidentiality yet keep a more home-like appearance and environment.
• Decentralizing the nurses’ station in each household reduces how often employees must leave their area to go to a central supply closet.
• Enclosed conference rooms or private offices should still be provided to allow for private conversations or personal time.
• Communal space to interact with other staff members is key to a positive culture and improved employee engagement.
• Consider creating dining spaces that allow the staff to join the residents for meals — increasing the feeling of home while enabling staff to assist residents as needed.
• Many facilities now securely store and administer medications in resident rooms. Some even utilize pass-through cupboards in residents’ rooms (accessed from both the hallway and their rooms). This allows staff to restock without disrupting the resident.
•Utilizing technology so staff can be mobile is a great idea for increasing efficiency, but be sure to create an appropriate space for charting. Providers can address potential infection control concerns by not taking computers from one resident room to another.
• Personal care provided in the resident’s own room should be the goal. From a design perspective, ensure sufficient space (beyond code minimums) for two staff members to maneuver equipment and provide care safely and comfortably in both the living area and bathroom.
• Ceiling lifts within resident rooms are increasing in popularity. They can be expensive, but are extremely useful, especially with bariatric patients. They are a valuable tool for staff and can reduce workers’ compensation situations and minimize staffing inefficiencies.
• Residents enjoy the sights, sounds and smells of food preparation in the household. These sensory experiences can help improve nutritional intake, which is a significant concern for residents.
Know your numbers
As you move through the planning and design stages, be aware of census and budgetary projections. It is vital that you understand your census goals during design, how and why census may change, and how this will align with staffing.
If your facility is being renovated (versus new construction), there may be times when census will need to be adjusted as certain rooms and areas may be unavailable. In these situations, you may decide to delay new admissions or allow for attrition.
Actively manage payer mix during these times, so that you maximize the reimbursement for the available beds. You may also need to adjust staffing to accommodate for the temporary change in census and any temporary movement of residents.
Planning ahead for what the census and payer mix will need to be during each phase of the project will allow the team to have an accurate picture of how the project will impact finances.
Achieve optimal operations
Typically, caregivers and certified nursing assistants (CNAs) are paid at a higher rate than dietary aides and housekeeping and laundry staff. If you select a universal worker model (with employees responsible for a variety of areas), understand that you most likely will be paying more than is needed for certain tasks. This model may be ideal for promoting a homelike environment, but it will require significant financial consideration.
In addition, it is important to consider your facility’s “fixed costs,” meaning the number and type of staff that are necessary regardless of census. Contemplate how increasing or decreasing the unit size will potentially impact staffing ratios and the budget.
From an operational perspective, the team will need to plan for the ratio and type of staff needed for each shift and at each level of occupancy, census, and acuity. Regulations allow for various levels of acuity in assisted living settings.
Operators should acknowledge that staffing decisions affect the types of residents they can care for. If the intent is to retain residents with higher care needs, consider the HR and payroll ramifications of professionals to safely provide this level of care.
Maintain eyes and ears
With the household model, be careful not to disperse staff too much. If staff can’t easily see or hear residents, that’s a problem.
Work with your designer to explore options for keeping your residents protected regardless of their individual care needs.
Issues such as resident falls can be minimized when the staff can hear residents getting restless or see them venturing out of their room or apartment. It is easier to anticipate and meet needs when you can see and hear what residents are doing and see when call lights are activated.
To this end, consider a design that has resident rooms open into a central common space that is used for dining, activities, gathering, and more by locating rooms in a circle around the outside of the common space.
As well, be vigilant to eliminate “hidden areas” where residents can’t be seen or heard.
Find your formula
How you design the household concept and staff it efficiently without exceeding your budget can be a challenge. However, combining the diverse insight and knowledge from a design expert and staffing professional, along with prudent planning, can help you find the right formula for your organization.