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Guidelines

FOR DESIGN AND CONSTRUCTION OF

Residential Health, Care,

and Support Facilities

The Facility Guidelines Institute

2018 edition

FGI
 © 2018 Facility Guidelines Institute

Published by

The Facility Guidelines Institute

9750 Fall Ridge Trail

St. Louis, MO 63127

info@fgiguidelines.org

www.fgiguidelines.org

ISBN: 978-0-9991355-2-5 (print version)

ISBN: 978-0-9991355-3-2 (digital version)

Inquiries or questions about the content of the Guidelines may be addressed to

the Facility Guidelines Insritute, as follows:

interpretations@fgiguidelines.org (if the text of the Guidelines is unclear)

advisoryopinions@fgiguidelines.org (when more technical information is needed)

Questions about the Guidelines revision process and use of this document may be

addressed to info@fgiguidelines.org.

For questions about purchasing the Guidelines documents, please visit www.MADCAD.com or

write to info@madcad.com. Information is also available at the Facility Guidelines Institute website

at www.fgiguidelines.org.

Cover illustrations:

Top: Edward N. and Della L. Thome Adult and Senior Care Center daytoom;

JSR Associates, Inc. (Nicole Lowder)

Middle: Edward N. and Della L. Thome Adult and Senior Care Center on the Harry and

Jeanette Weinberg Campus dining area; JSR Associates, Inc. (Nicole Lowder)

Bottom: Citizens Care & Rehabilitarion Center nurse station;

Morris & Ritchie Associates, Inc. (Nicole Lowder)

Printed in the United States of America on archival quality recycled paper

Book design by DesignForBooks.com

The 2018 edition of the Guidelines for Design and Construction ofResidential Health,
Care, and Support Facilities is dedicated to Robert Nathan Mayer, PhD. Rob was a
visionary exemplar whose passion for respecting the personhood of every individual
infused his work as president of the Hulda B. & Maurice L. Rothschild Foundation
for more than 35 years. Rob's vision and leadership were a driving force in the removal
of barriers to achieving person-centered environments and effected significant and
meaningful regulatory changes for nursing homes and other long-term care settings.
His understanding and support for the well-being of elders living in shared residential
care communities was a key contributing factor to the separation of residential
care settings from acute care and outpatient centers in the 2014 edition of the FGI
Guidelines, and the revisions for the 2018 Residential Guidelines carry forward his
desire to support resident quality of life. Rob's inspirational ideals, "everything-is­
achievable" attitude, and vision of fully embraced person-centered approaches live on
through the many organizations, agencies, and individuals he profoundly influenced
and forever inspired.
Contents

Preface xi Part 2 Common Elements for Residential

Acknowledgments xiii Health, Care, and Support Facilities 123
About the Guidelines xxi
2.1 Site Elements 55
Major Additions and Revisions xxv
2.1-1 General 55
Glossary xxix
2.1-2 Facility/Community Access 55
List of Acronyms xxxv 2.1-3 Site Features 56
2.1-4 Building Orientation 57
2.1-5 Environmental Pollution Control 58
Part 1 General
2.2 Design Criteria 59
1.1 Introduction 3 2.2-1 General 59
1.1-1 General 3
2.2-2 Sustainable Design Criteria 59
1.1-2 New Construction 3 2.2-3 Design Criteria for Accommodation of

1.1-3 Renovation 3
Persons of Size 66
1.1-4 Government Regulations 5
2.2-4 Design Criteria for Dementia, Mental

1.1-5 Building Codes and Standards 6 Health, and Cognitive and Developmental

1.1-6 Equivalency Concepts 7

Disability Facilities 67
1.1-7 English/Metric Measurements 7
2.3 Design Elements 73
1.1-8 Codes, Standards, and Other 2.3-1 General 73
Documents Referenced in the Guidelines 7 2.3-2 Resident, Participant, and Outpatient Areas 73
1.2 Planning/Predesign Process 13 2.3-3 Diagnostic and Treatment Areas 76
1.2-1 General 13
2.3-4 Facilities for Support Services 78
1.2-2 Functional Program 14
2.4 Design and Construction Requirements 87
1.2-3 Resident Safety Risk Assessment (RSRA) 16 2.4-1 General 87
1.2-4 Environment of Care Requirements 30 2.4-2 Architectural Details, Surfaces, and Furnishings 87
1.2-5 Planning Considerations and Requirements 34
2.5 Building Systems 101
1.3 Site Selection 39
2.5-1 General 101
1.3-1 General 39 2.5-2 Plumbing Systems 101
1.3-2 Location 39 2.5-3 Heating, Ventilation, and Air-Conditioning

1.3-3 Functional Site Requirements 39

(HVAC) Systems 104
1.4 Design, Construction, and Commissioning 2.5-4 Electrical Systems 107
Considerations and Requirements 41 2.5-5 Communications Systems 108
1.4-1 General 41 2.5-6 Electronic Safety and Security Systems 109
1.4-2 Design Considerations and Requirements 41 2.5-7 Daylighting and Artificial Lighting Systems 110
1.4-3 Renovation 42 2.5-8 Acoustic Design Systems 111
1.4-4 Record Drawings and Manuals 43
2.5-9 Elevator Systems 115
1.4-5 Commissioning 44

1.5 -Equipment 49 Part 3 Residential Health Facilities 123

1.5-1 General 49
1.5-2 Equipment ClaSSification 50 3.1 Specific Requirements for Nursing Homes 125
1.5-3 Equipment Requirements 50 3.1-1 General 125
1.5-4 Space Requirements for Equipment 51 3.1-2 Resident Areas 126

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
CONTENTS

3.1-3 Diagnostic and Treatment Areas 136 4.4 Specific Requirements for Settings for

3.1-4 Facilities for Support Services 139 Individuals with Intellectual and/or

3.1 -5 Design and Construction Requirements Developmental Disabilities 237

for Nursing Homes 143 4.4- 1 General 237
3.1-6 Building Systems 144 4.4-2 Resident Areas 241
3.2 Specific Requirements for Hospice Facilities 155 4.4-3 Reserved 244
3.2-1 General 4.4-4 Facilities for Support Services 244
155
3.2-2 Resident Areas 4.4-5 Design and Construction Requirements 247
156
3.2-3 Diagnostic and Treatment Areas
4.4-6 Building Systems 249
162

3.2-4 Facilities for Support Services 162

3.2-5 Design and Construction Requirements 166

Part 5 Non-Residential Support Facilities 255
3.2-6 Building Systems 167
5-1 Requirements for Adult Day Care and
Part 4 Residential Care and Support Facilities 179 Adult Day Health Care Facilities 257
5.1-1 General 257
4.1 Specific Requirements for Assisted Living
5.1-2 Participant Areas 259
Facilities 181
5.1-3 Diagnostic and Treatment Areas 261
4.1-1 5.1-4 Facilities for Support Services 262
General 181
5.1-5 Design and Construction Requirements 265
4.1-2 Resident Areas 185
5.1-6 Building Systems 266
4.1-3 Diagnostic and Treatment Areas 188
4.1-4 Facilities for Support Services 188 5.2 Specific Requirements for Well ness Centers 271
4.1-5 Design and Construction Requirements 192 5.2-1 General 271
4.1-6 BUilding Systems 194 5.2-2 Participant Areas 273
4.2 Specific Requirements for Independent Living 5.2-3 Diagnostic and Treatment Areas 275
Settings 203 5.2-4 Facilities for Support Services 276
5.2-5 Design and Construction Requirements 277
4.2-1 General 203
5.2-6 Building Systems 278
4.2-2 Resident Areas 206
4.2-3 Reserved 209 5.3 Specific Requirements for Outpatient
4.2-4 Facilities for Support Services 209 Rehabilitation Therapy Facilities 283
4.2-5 Design and Construction Requirements 211 5.3-1 General 283
4.2-6 BUilding Systems 213 5.3-2 Outpatient Areas 285
4.3 Specific Requirements for Long-Term 5.3-3 Diagnostic and Treatment Areas 286
Residential Substance Abuse 5.3-4 Facilities for Support Services 288
Treatment Facilities 221 5.3-5 Design and Construction Requirements 290
5.3-6 Building Systems 291
4.3- 1 General 221
4.3-2 Resident Areas 223
4.3-3 Diagnostic and Treatment Areas 226 Index 293
4.3-4 Facilities for Support Services 226
4.3-5 Design and Construction Requirements 230
4.3-6 BUilding Systems 231

viii Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
List of Tables

Part 1

Table 1.2-1: Resident Safety Risk Assessment Components

Part 2

Table 2.S-1 Hot Water Use-Residential Health, Care, and Support Facilities 116
Table 2.5-2 Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems 117
Table 2.5-3 Categorization of Residential Health, Care, and Support Facility Sites by Exterior Ambient Sound
with Design Criteria for Sound Isolation of Exterior Shell in New Construction 118
Table 2.5-4 Minimum Design Room Sound Absorption Coefficients 119
Table 2.5-5 Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms 120
Table 2.5-6 Design Criteria for Speech Privacy for Enclosed Rooms and Open-Plan Spaces 121
Appendix Table A2.2-a Maximum Concentration of Air Pollution Relevant to Indoor Air Quality 71
Appendix Table A2.4-a Resources for Grab Bar Configurations 99
Appendix Table A2.5-a Maximum Length of Hot Water System Pipe or Tube 116
Appendix Table A2.5-b Approximate Distance of Noise Sources for Use in Categorization of Residential Health,
Care, and Support Facility Sites by Exterior Ambient Sound 1 19

Part 3

Table 3.1-1: Design Parameters for Ventilation of Residential Health Spaces 000
Appendix Table A3.1-a Nursing Home Care Model Characteristics 150
Appendix Table A3.2-a Hospice Care Model Characteristics 172

Part 4

Appendix Table A4.1-a: Assisted Living Facility Type Characteristics 000

Appendix Table A4.4-a: Characteristics of Settings for Individuals with Intellectual and/or Developmental Disabilities 000

----------------
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities ix
Preface
The Facility Guidelines Institute (FGI) owes much to
the 100+ members of the 2018 Health Guidelines Revi­
sion Committee who served on the Hospital, Outpa­
tient, and Residential document groups and associated
task groups. FGI also is indebted to the additional sub­
ject matter experts who served on the Residential Docu­
ment Group and 2018 topic groups as well as individu­
als who reviewed material in their areas of expertise (see
the acknowledgments for lists of groups and individuals).
These talented individuals volunteered their time and
considerable expertise to develop the content of the 2018
edition of the FGI Guidelines for Design and Construction
documents. We thank you all for your dedication and
contributions of knowledge and experience!
The 2018 edition of the Guidelines is being pub­
lished as three separate documents to clearly differentiate
the needs of hospitals, outpatient facilities, and residen­
tial care facilities and to support greater flexibility in the
design of outpatient facilities as health care expands into
a greater variety of outpatient spaces.
The three documents are the Guidelines for Design
and Construction of Hospitals, the Guidelines for Design
and Construction of Outpatient Facilities, and the Guide­
lines for Design and Construction of Residential Health,
Care, and Support Facilities, which addresses nursing
homes and other long-term care facilities.
The 2018 edition is the latest in the 71-year history
of the Guidelines document and the eighth to be revised
through a multidisciplinary consensus process supported
by public input and review. It is the fifth edition devel­
oped under the guidance of FG!. FGI remains commit­
ted to updating these publications on a four-year revision
cycle using the multidisciplinary public process that has
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
been the cornerstone of Guidelines development for more
than three decades.
There is a certain logic behind the four-year cycle
for development of each Guidelines edition, but health
care changes rapidly and certainly not on a static cycle.
Beginning with the 2018 documents, FGI will be offer­
ing a series of resources in addition to its Guidelines for
Design and Construction documents. Termed "Beyond
Fundamentals," these materials are intended to support
and expand the minimum design requirements pub­
lished in the Guidelines. Possible topics include detailed
discussion of Guidelines requirements and how to apply
them, research supporting Guidelines requirements, draft
minimum requirements supported with research or other
evidence, best practices, and trends in practice that are
changing health care facility design. In the form of white
papers, articles, case studies, adVisory opinions, checklists,
and so on, this material will to help facility managers and
designers learn about advancements in health care design
that can make facilities safer for patients and staff and
improve clinical outcomes. Please follow the FGI website
(www.fgiguidelines.org) for updates on the Beyond Fun­
damentals as well as future educational programs.
We encourage all users of the Guidelines to get
involved in the public proposal and comment process
FGI undertakes cyclically to revise the Guidelines stan­
dards. Please keep notes as you use the documents and let
us know what needs to be improved during the proposal
period. The Guidelines must stay in step with changes in
the industry, and we count on all who use the documents
to help us keep them current.
Kurt Rockstroh, FAIA, FACHA
President
Facility Guidelines Institute
xi
Acknowledgments
A project as complex as the development of the Guide­
lines for Design and Construction of Residential Health,
Care, and Support Facilities, which focuses on the long­
term living market, would not be possible without the
generous contributions of many volunteers. During the
2018 Guidelines revision cycle, the Residential Document
Group included Health Guidelines Revision Committee
(HGRC) members as well as additional non-voting long­
term care experts. The volunteers met both in person and
electronically to update existing text on nursing homes,
hospice facilities, assisted living facilities, independent
living settings, adult day care facilities, wellness centers,
and outpatient rehab centers and to develop and reach
consensus on new text for facilities that serve individuals
with developmental disabilities and those in residential
substance abuse treatment programs.
2018 Health Guidelines Revision Committee
Executive Steering Committee
Chair
Douglas S. Erickson, FASHE, CHFM, HFDp, CHC
Facility Guidelines Institute
Sr. Louis, Missouri
Vice Chair
David B. Uhaze, RA
Health Facility Design Consulting
Retired AHJ State of New Jersey
Trenton, New Jersey
Chair Emeritus
Joseph G. Sprague, FAIA, FACHA, FHFI
HKS, Inc.
Dallas, Texas
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
FGI appreciates the tremendous work of all who
participated during the 2018 Guidelines revision cycle.
Thank you for your efforts in developing a document that
supports and encourages the provision of person-centered
care. Thanks are also extended for the continuing advo­
cacy and support of the Center for Health Design's Envi­
ronmental Standards Council and related task groups
and the Hulda B. & Maurice L. Rothschild Foundation,
which has long supported and been involved in numer­
ous initiatives with different organizations with the goal
of creating person-centered models and regulations to
improve environments designed for elders.
Note: HGRC members who served on more than
one of the groups listed have a shortened listing after their
first appearance.
Linda Dickey, RN, MPH, CIC, FAPIC
University of California Irvine Medical Center
Orange, California
John P. Kouletsis, AIA, EDAC
San Francisco, California
Jane M. Rohde, AIA, FIIDA, ASID, ACHA, CHID, LEED AP
BD+C, GGA-EB
JSR Associates, Inc.
Catonsville, Maryland
Ellen Taylor, PhD, AIA, MBA, EDAC
The Center for Health Design
Paoli, Pennsylvania
Steering Committee
Maria AlIo, MD, FACS, FCCM
Santa Clara Valley Medical Center
Los Altos, California
xiii
ACKNOWLEDGMENTS

Ramona Conner, MSN, RN, CNOR, FMN Residential Document Group

Association of periOperative Registered Nurses
Center for Nursing Practice
Denver, Colorado Chairs
Addie Abushousheh, PhD, EDAC, Assoc. AlA
Thomas C. Gormley, PhD, CHC Gerontological Researcher and Consultant
Middle Tennessee State University West Bend, Wisconsin
Nashville, Tennessee The Mayer-Rothschild Foundation

Richard D. Hermans, PE, HFDP Jane M. Rohde, AIA, FIIDA, ASID, ACHA, CHID, LEED AP
AECOM BD+C, GGA-EB
Lino Lakes, Minnesota
American Society ofHeating, Refrigerating and Air-Conditioning John Shoesmith, AIA, LEED AP
Engineers Shoesmith Cox Architects
Seattle, Washington
Steve Lindsey Society for the Advancement ofGerontological Environments
Garden Spot Village AIA Design for Aging Knowledge Community
New Holland, Pennsylvania
LeadingAge
HGRC Members
R. Gregg Moon, AIA, ACHA, EDAC
Lockwood, Andrews & ewnam, Inc. Ashley Blankenship
Houston, Texas Southridge Village
Conway, Arkansas
AIA Academy ofArchitecturefor Health
National Center for Assisted Living
Wade Rudolph, MBA, CHFM
Glenn S. A. Gall, AIA
Mayo Clinic Health System - Franciscan Healthcare
California Office of Statewide Health Planning and Development
Onalaska, Wisconsin
Sacramento, California
D. Paul Shackelford, Jr., MD, FACOG
Steve Lindsey
Vidant Medical Center
Greenville, North Carolina
Robert Mayer, PhD
Hulda B. & Maurice L. Rothschild Foundation
Dana E. Swenson, PE, MBA, SASHE
Chicago, Illinois
UMass Memorial Health Care System
Worcester, Massach usetts
Bart Miller, CHFM, CHC, CHSp, CHEp, SASHE
AVP Facilities Management Kennedy Health
Cherry Hill, New Jersey
Members of Multiple Document Groups
Gaius G. elson, RA
These veteran HGRC members participated in the meetings of more Nelson-Tremain Partnership - Architecture for Design and Aging
than one document group. Minneapolis, Minnesota

Linda Dickey, RN, MPH, CIC, FAPIC Eric Rosenbaum, PE

Jensen Hughes
Roger W Gehrke Baltimore, Maryland
Retired AHJ State ofIdaho American Health Care Association
Boise, Idaho
Charles Schlegel
James. R. (Skip) Gregory, NCARB Pennsylvania Department of Health, Division of Safety Inspection
Health Facility Consulting, LLC Harrisburg, Pennsylvania
Tallahassee, Florida
James D. Scott, PE
R. Gregg Moon, AIA, ACHA, EDAC Michigan Department of Licensing and Regulatory Affairs
Lansing, Michigan
David B. Uhaze, RA
Phillip A. Thomas
Walter Vernon, PE Phil Thomas + Associates
Mazzetti Fort Smith, Arkansas
San Francisco, California

---------------------_._--_._-­
xiv Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 ACKNOWLEDGMENTS

Subject Matter Experts Hospital Document Group

Larry Beresford

Hospice House Nerwork

Alameda, California
Chairs
William J. Bonn III, NCARB
Sreven Friedman, PE, HFDP, LEED AP BD+C
University of Utah
Memorial Sloan-Kettering Cancer Center Salt Lake City, Utah
New York, New York
Robert J. Heidelbaugh, AlA, NCARB
Leisa Hardage, AlA

WellSpan Health
AECOM

York, Pennsylvania
Atlanta, Georgia

Todd M. Liebert, AlA, NCARB

Debra Harris, PhD, RID, AAHID

Clark Patterson Lee

Baylor University
Rochester, New York
Waco, Texas

Wade Rudolph, MBA, CHFM

Steven Heaney

Brandywine Senior Living

• Mount Laurel, New Jersey

HGRC Members

Asha Hegde, PhD, LC

James Aberle, AlA, NCARB
Texas Srare University
Indian Health Service
San Marcos, Texas
Dallas, Texas

Mandy Kachur, PE, INCE Bd. Cett.

Maria AlIo, MD, FACS, FCCM
Soundscape Engineering

Plymouth, Michigan
Udo Ammon, AlA, RA, CEO
New York State Department of Health
Tom Mullinax, AlA
Albany, New York
Hospice Design Resource, PLLC

Bent Mountain, Virginia

Angelene Baldi, AlA, EDAC, LEED GA
Kaiser Permanente
Francis M. Pitts, FAlA, FACHA
Oakland, California
archi tecture+

Troy, New York

Roland M. Binker, AlA, LEED AP
CallisonRTKL
Chris P. Rousseau, PE Washingron, D.C.

Jerry Smith, FASLA

Christine M. Carr, MD, CPE, FACEP
SMITH I GreenHealth Consulting, LLC
Medical University of South Carolina
Columbus, Ohio
Department of Emergency Medicine and Department of Public
Health Sciences
Scott Tittle
Charleston, South Carolina
National Center for Assisted Living
American College ofEmergency Physicians
Washington, D.C.

Kenneth N. Cates, SASHE, CHC

Michael David White, EDAC
Northstar Management Company
Schuler Shook
St. Louis, Missouri
Minneapolis, Minnesota

Ramona Conner, MSN, RN, CNOR, FAAN

Adviser Steven D. Cutter, CHFM, HFDp, MBA, FASHE

Dartmouth-Hitchcock Medical Center
Margaret P. Calkins, PhD, EDAC

Lebanon, New Hampshire

The Mayer-Rothschild Foundation

Kirtland, Ohio

David Dagenais, CHSP, CHFM, FASHE

Wenrworth-Douglass Hospital
Dover, New Hampshire
American Society for Healthcare Engineering

------_._-----------------------­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xv
ACKNOWLEDGMENTS

Robert Dehler, PE Bill Rostenberg, FAIA

Minnesota Department of Health Architecture for Advanced Medicine
St. Paul, Minnesota Greenbrae, California

Patrice A. Fagen, RN D. Paul Shackelford, Jr. MD, FACOG

Iowa Department ofInspections and Appeals
Des Moines, Iowa
Kathryn W. Gallagher, MS, RN, NE-BC
Universi ty of Pennsylvania Health System
Philadelphia, Pennsylvania
Debra Hawks, MPH
American College of Obstetricians and Gynecologists
Washington, D.C.
Michael Sheerin, PE, LEED AP BD+C
TLC Engineering for Architecture
Orlando, Florida
ASHRAE 170 Standing Standard Project Committee
David M. Sine, DrBE, ARM, CSP, CPHRM
Safety Logic Systems
Ann Arbor, Michigan
National Association of Psychiatric Health Systems

Richard D. Hermans, PE, HFDP Judith Smith, MHA

Smith Hager Bajo, Inc.
Todd WHite, PE Scottsdale, Arizona
Indiana State Department of Health
Indianapolis, Indiana David R. Soens, PE, RA, ME, MA
Wisconsin Department of Health Services
Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC Madison, Wisconsin
Universi ty of North Carolina School of Medicine
Chapel Hill, North Carolina Joseph G. Sprague, FAIA, FACHA, FHFI
Centers for Medicare & Medicaid Services
Arthur St. Andre, MD, FCCM
Walter Jones, PE, LEED AP MedStar Washington Hospital Center
Lendlease Washington, D.C.
Nashville, Tennessee
Joseph J. Strauss, AIA, ACHA
Bryan Langlands, AIA, ACHA, EDAC, LEED GA Cleveland Clinic, Center for Design
NBBJ Cleveland, Ohio
New York, New York
AIA Academy of Architecture for Health Dana E. Swenson, PE, MBA, SASHE

John T. Larson, RA, NCARB Terry Thurston, RN, MBA

Oklahoma State Department of Health BSA LifeStructures
Oklahoma City, Oklahoma Indianapolis, Indiana
Nursing Institute ofHealth Design
Brenda McDermott, RN, MSN, EDAC
Defense Health Agency Kevin M. Tuohey, CHPA
Falls Church, Virginia Boston University
Boston, Massachusetts
Farhad Memarzadeh, PhD, PE International Association for Healthcare Security & Safety
National Institutes of Health
Bethesda, Maryland Enrique J. Unanue, AIA, ACHA, NCARB
Code Services, LLC
M. Terry Miller Springfield, Illinois
Retired from GBA (now Mazzetti-GBA)
Franklin, Tennessee Laurie Waggener, CHID, EDAC, NBRC, NDICQ
EYP Health
Kenneth N. Monroe, PE, MBA, CHC, PMP Houston, Texas
The Joint Commission/DSSM
Oakbrook Terrace, Illinois Scott Waltz, NCARB
Florida Agency for Health Care Administration
Margaret Montgomery, RN, MSN Tallahassee, Florida
American College of Emergency Physicians
Irving, Texas Pamela Ward, AIA, LEED AP, CHC
Cooper University Health Care
Camden, ew Jersey

xvi Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 ACKNOWLEDGMENTS

James Woodson, PE, CHFM Lynn Kenney, EDAC, SASHE

The Joint Commission The Center for Health Design
Oakbrook Terrace, Illinois Concord, California
American Society for Healthcare Engineering
Paula Wright, RN, CIC, FAPIC
Massachusetts General Hospital Tom C. Krejcie, MD
Boston, Massachusetts Northwestern University Feinberg School of Medicine
Chicago, Illinois
American Society ofAnesthesiologists

Outpatient Document Group Patrick Leahy, AlA, EDAC, LEED AP

CMBA Architects
Chairs Omaha, Nebraska
John P. Kouletsis, AlA, EDAC
Rebecca J. Lewis, FAlA, FACHA, cm
Ellen Taylor, PhD, AlA, MBA, EDAC DSGW Architects
Duluth, Minnesota
Kirsten Walr-i:, AlA, ACHA, EDAC, LEED AP AlA Academy ofArchitecturefor Health
Steflian Bradley Architects
Enfield, Connecticut Steven C. Lewis
North Carolina Department of Health Service Regulation
Raleigh, North Carolina
HGRC Members
Charles S. Maggio, AlA, NCARB
Collin Beers, AlA
CBRE I Healthcare
Stantec Architecture New York, New York
Philadelphia, Pennsylvania
Kevin A. Matuszewski, AlA, LEED AP
Robert D. Booth, MPH, CIH, LHRM Cannon Design
Oncore, Inc. Chicago, Illinois
Tampa, Florida
Richard D. Moeller, PE, FASHE, HFDP, CHC, LEED AP
Roger V. Brown, PE GnGB
Bristol Hospital Laguna Niguel, California
Bristol, Connecticut
Dylan Neu
Byron Burlingame, MS, RN, CNOR CDC/National Institute for Occupational Safety and Health
Association of periOperative Registered Nurses Cincinnati, Ohio
Denver, Colorado
Russell N. Olmsted MPH, CIC, FAPIC
Jennifer Butterfield, MBA, RN, CNOR, CASC Trinity Health
Lakes Surgery Center Livonia, Michigan
West Bloomfield, Michigan Society for Healthcare Epidemiology ofAmerica
Ambulatory Surgery Center Association
Chris P. Rousseau, PE, LEED AP
Jack Chamblee, AlA Newcomb & Boyd
Carolinas HealthCare System Atlanta, Georgia
Charlotte, North Carolina ASHRAE 170 Standing Standard Project Committee

John M. Dombrowski, PE, HFDp, CPMp, CCp' LEED AP Sheila Ruder, AlA, ACHA, EDAC, Lean Six Sigma CE, LEED AP
Mazzetti HKS, Inc.
Erie, Pennsylvania Dallas, Texas

Ella S. Franklin, MSN, RN, EDAC Alberto Salvarore, AlA, NCARB, EDAC
National Center for Human Factors in Healthcare, MedStar Health Perkins + Will
Washington, D.C. Boston, Massachusetts
Centerfor Health Design Environmental Standards Council
Tobias Gilk, MArch, MRSO, MRSE
RAD-Planning Daniel J. Scher, MBA
Kansas City, Missouri Medxcel Facilities Management
St. Louis, Missouri
Thomas C. Gormley, PhD, CHC

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xvii
ACKNOWLEDGMENTS

David Shapiro, MD, CHC, CHCQM, CHPRM, LHRM, CASC

Red Hills Surgical Center
Benefit-Cost Committee
Tallahassee, Florida Thomas C. Gormley, PhD, CHC, Chair
Ambulatory Surgery Center Association
W. Howard Allums
Deborah Smith, AIA, ACHA, LEED AP BD+C Turner Construction Company
FLAD Architects
Tampa, Florida Cheryl Crosby, CSI, CCCA
AMSURG
Thomas A. Smith, CHPA, CPP
Healthcare Security Consultants, Inc. Walter Jones, PE, LEED AP

Chapel Hill, North Carolina

International Association for Healthcare Security 6- Safety Charles S. Maggio, AIA, NCARB

George R. Tingwald, MD, AIA, ACHA M. Terry Miller

Stanford Hospital and Clinics

Stanford, California Daniel J. Scher, MBA

John Williams Clay Seckman, PE

Washington State Department of Health Smith Seckman Reid, Inc.

Olympia, Washington
Pamela Ward, AIA, LEED AI', CHC

Acoustics Proposal Review Committee

FGI Topic Groups
David M. Sykes, MA, Chair, Founder
Rensselaer Polytechnic Insti tute These groups, comprised largely of subject matter experts outside the
HGRC (With the exception of the Infection Prevention Topic Group),
William Cavanaugh, FASA, F/INCE, Co-Founder met at the beginning of the 2018 revision cycle to review the Guide­
Cavanaugh Tocci Associates lines content for several topics identified by the Steering Committee
with the goal of developing proposals to update the requirements for
Mandy Kachur, PE, MS, INCE Bd. Cert., Vice Chair/Special Projects these topics. (Individuals without full listings in the topic group lists
Soundscape Engineering are HGRC members.)

Ed Logsdon, PE, Vice Chair/Education

Logsdon Acoustical Consulting, LLC
Bariatric Accommodations Topic Group
Paul Barach, MD, MPH
Wayne State University School of Medicine Joseph J. Strauss, AIA, ACHA, Chair

Daniel Fink, MD, MBA Mary Matz, Vice Chair

American Tinnitus Association Patient Care Ergonomic Solutions, LLC
The Quiet Coalition
Eric Boss
Jean-Francois Latour SizeWise
SNC-Lavalin
Gloria A. Cascarino
Kurt Rockstroh, FAIA, FACHA Francis Cauffman
Steflian Bradley Architects
Facility Guidelines Institute Quinn de Menna, AIA
Alberto & Associates
Noral D. Stewart, PhD, FASA, FASTM
Stewart Acoustical Consultants Traci Galinsky, PhD
U.S. Public Health Service/NIOSH
Elizabeth Val mont, PhD, Assoc. AIA, LEED AP
Arup Susan Gallagher, PhD, RN, CSPHI', CBN
Celebration Institute, Inc.
Douglas S. Erickson, FASHE, CHFM, HFDP, CHC, Contributor
Leisa Hardage, AIA
Jane M. Rohde, AIA, FIIDA, ASID, ACHA, CHID, LEED AP
BD+C, GGA-EB, Contributor

xviii Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 ACKNOWLEDGMENTS

Debra Harris, PhD Paula Wright, RN, crc, FAPrC

Andrew Hepburn
ArjoHuntleigh
Security Topic Group
Scott Holmes, ACHA, LEED AP
BWBR Kevin M. Tuohey, CHPA, Chair

Dee Kumpar, MBA, RN, CSPHP
Hill-Rom
Jeffrey T. O'Neill, AIA, ACHA
Hospital of the University of Pennsylvania
Thomas A. Smith, CHPA, CPp, Chair
Patricia A. Lenaghan, RN, MSN, NE-BC, FAAN
Leo A Daly

Matt Stormont, AIA, MBA

Technology Topic Group
Oregon Health & Science University

Travis Tyson, AIA M. Terry Miller, Chair

Cleveland Clinic
Rebecca J. Lewis, FAIA, FACHA, cm, Vice Chair
Neal Wiggerman, PhD
Hill-Rom Jill Bergman AIA, ACHA, EDAC, LEED AP
HDR

David Brennan, MBE

Emergency Preparedness Topic Group MedStar Institute for Innovation

Roger V. Brown, PE, Chair Anne Carter, MBA

Healthcare Change Consulting Group
Jack Chamblee, AIA
Gloria A. Cascarino
Jeff Hammond, AIA, ALA Francis Cauffman
Fishbeck, Thompson, Carr & Huber, Inc.
Misty S. Chambers, MSN, RN, Assoc. AIA, EDAC
Patricia A. Lenaghan, RN, MSN, NE-BC, FAAN ESa
Leo A Daly
Ken Kirkpatrick, CHFM, CHEP
John D. Maurer, SASHE, CHFM, CHSP Baptist Memorial Hospital- Desoto
The Joint Commission
Donald L. Myers, AIA, NCARB
H. V. Nagendra, AIA, NCARB U.S. Department of Veterans Affairs
Roy Anderson Corp.
Jason E. Notdling, AIA
Matt Stormont, AIA, MBA BWBR
Oregon Health & Science University
Virginia R. Pankey, AIA, LEED AP
Steve Templet, AIA, ACHA, LEED AP HOK
Sizeler Thompson Brown Architects

Infection Prevention TOpic Group

Additional Acknowledgments
Dana E. Swenson, PE, MBA, SASHE, Chair
These individuals either served on small HGRC task groups or were
asked to review and comment on specific areas of text in theit area of
Linda Dickey, RN, MPH, CIC, FAPIC, Vice Chair
expertise. We appteciate their willingness to pitch into development
of the Guidelines content.
Ella S. Franklin, MSN, RN, EDAC
Brett Bernstein, MD
Karen Hoffmann, RN, MS, crc, FSHEA, FAPIC
Mount Sinai Health System and Eastside Endoscopy, LLC

Russell N. Olmsted, MPH, cre, FAPIC

H. David Chandlet, PE, LEED AP BD+C
Newcomb & Boyd Consulting Engineeting Group

Guidelines for Design and Construction of Residential Health. Care. and Support Facilities xix
ACKNOWLEDGMENTS

Cheryl Crosby, CSI, CCCA

The Facility Guidelines Institute
AMSURG
The FGI Board of Directors extends its sincere thanks to those who
Patrick Down worked diligently to update the Guidelines for Design and Construction
STERIS Corpotation I Healthcare documents.

Adam Higman
Soyring Consulting
Board
GeorgeJ. Hruza, MD, MBA
Laset & Dermatologic Surgery Center Kurt A. Rocksrroh, FAlA, FACHA, President
Kenneth N. Cates, SASHE, CHC, President-Elect
James M. Hunt, AIA, NCARB Arthur St. Andre, MD, FCCM, Treasurer
Behavioral Health Faciliry Consulting, LLC Joseph G. Sprague, FAIA, FACHA, FHFI,!mmediate Past President
Douglas S. Erickson, FASHE, CHFM, HFDp, CHC, FG! CEO
Brice R. Johnson, MSM, PMP Julie Benezet
JBVAMC Chicago Neil A. Halpern, MD, MCCM, FACP, FCCP
James T. Lussier, MBA
Mike Masker David M. Shapiro, MD, CHC, CHCQM, CHPRM, LHRM,
CHI Health, Immanuel Rehabilitation Institute CASe
Dana E. Swenson, PE, MBA, SASHE
Teri B. Spencer, RN (retired) Walter Vernon, PE
TB Spencer Consulting, LLC

Andrew J. Srreifel
Universiry of Minnesota Staff

Douglas S. Erickson, FASHE, CHFM, HFDp, CHC, FG! CEO

Pamela James Blumgart, Managing Editor
Heather B. Livingston, Associate Editor
Yvonne Chiarelli, Associate Editor
A. Christine Erickson, Administrative Manager

xx Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
About the Guidelines
The Guidelinesfor Design and Construction documents are
updated every four years to keep pace with evolving care
models, facility types, and requests for up-to-date guid­
ance from care providers, designers, and regulators. For
the 2018 edition, the Facility Guidelines Institute (FGI)
published three Guidelines for Design and Construction
(Guidelines) standards, separating the requirements for
hospitals and outpatient facilities for the first time and
maintaining a separate document for residential health
facilities (nursing homes and hospice), care and support
facilities (independent living settings and assisted living
facilities of various types), and non-residential support
facilities integral to the continuum of care.
For the 2014 edition, the standards for residential
health, care, and support facilities were pulled into a sepa­
rate Guidelines document to reflect changes in the long­
term care industry as person-centered care has become
more prevalent and to emphasize the importance of pro­
viding a residential environment in these facilities. For
2018, the goal for development of a separate Outpatient
Guidelines document was to provide a framework for
physical environments that support the unique needs of
outpatients and outpatient facility staff and support flex­
ible development as outpatient facility services change to
meet market demands. In recent years, services provided
in outpatient facilities have rapidly evolved and expanded
so that many procedutes and operations formerly per­
formed only in hospitals now routinely take place in
outpatient settings. In inpatient settings, changes in the
insurance market and the size of the aging population in
the United States have pushed the numbers of patients
served to all-time highs. These changes will continue to
have significant implications for the design and construc­
tion of health care facilities and the communities where
those services are delivered, and the Guidelines must
change to support how care is provided.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
The Revision Process
The Guidelines and the methodology for revising its con­
tent have been, and still are, evolving. When first pub­
lished, the document was a set of regulations developed
by a single department of the federal government as a
condition for receiving a federal hospital construction
grant under the Hill-Burton Act. Today, FGI develops
the Guidelines using a consensus process similar to that
approved by the American National Standards Institute.
This process brings together the members of the
Health Guidelines Revision Committee (HGRC), a bal­
anced group of stakeholders in health and residential care
facility planning, design, construction, and operations
and clinical services who volunteer their time to the devel­
opment of the Guidelines. The committee considers pro­
posals for change received from the public; achieves con­
sensus on facility issues; and develops proposed revisions
to the previous edition. The proposed revisions are then
posted for public comment and revised by the HGRC, as
needed, in response to those comments. The product of
this revision process is compiled and published as a new
edition of the Guidelines.
When possible, the Guidelines standards are perfor­
mance-oriented for desired results. Prescriptive measure­
ments, when given, have been carefully considered rela­
tive to generally recognized standards and research. For
example, at the beginning of the 2018 revision cycle,
members of the HGRC engaged in a workshop to deter­
mine baseline clearances needed to accommodate equip­
ment and caregivers when caring for patients of size. This
information was used to write proposals for new require­
ments for accommodations for care of patients of size
in hospitals and outpatient facilities. Such revisions to
the Guidelines are not made for the sake of change, but
rather are submitted for public review and comment and
xxi
ABOUT THE GUIDELINES
thoroughly reviewed and evaluated by the approximately
100 professionals in health care delivery and design who
make up the HGRC.
For the 2018 edition of the Guidelines, the HGRC
was broken into three document groups-Hospital,
Outpatient, and Residential-ro streamline develop­
ment of the three Guidelines documents. The Hospital
and Residential document groups focused on refining the
content of those documents, while the Outpatient Docu­
ment Group worked to develop the inaugural edition of
the Guidelines for Design and Construction of Outpatient
Facilities. As well, the Hospital and Outpatient document
groups worked together to correlate the content of the
Guidelines sections that would appear in both the hospital
and outpatient documents, identifying instances where
the requirements needed to be different but always striv­
ing to support safe environments for patients and staff
wherever services are provided.
Basic Organization of the Residential
Guidelines
Main body. The main body of this document is com­
posed of five parts:
• Part 1 contains chapters that address considerations
applicable to all residential health, care, and support
facilities, except as noted or modified in specific
facility chapters in the remaining parts.
• Part 2 includes common elements applicable to
most of the facility types in the book. This material
applies when referenced from the facility chapters in
Parts 3 through 5.
• Part 3 provides requirements for residential health
facilities: nursing homes and hospice facilities.
• Part 4 provides requirements for residential care
and support facilities: assisted living facilities,
independent living setrings, long-term residential
substance abuse facilities, and settings for
individuals with intellectual and/or developmental
disabilities.
• Part 5 provides requirements for non-residential
support facilities: adult day care and adult day
health care facilities, wellness centers, and outpa­
tient rehabilitation therapy facilities.
Appendix. An appendix is associated with the main body
of the Guidelines text.
xxii Guidelines for Design and Construction of Residential Health, Care. and Support Facilities
• An asterisk (*) preceding a section or paragraph
number indicates that explanatory or educational
material can be found in an appendix item located
at the bottom of the page.
• AppendiX items are identified by the letter "A" pre­
ceding the section or paragraph number in the main
text to which they relate.
Cross-references. Cross-references are used throughout
the Guidelines to include language from another chapter
in the text where the cross-reference is located. These ref­
erences include both the section number and the section
name in parentheses. For example: See Section 2.2-3.1.4
(Resident and Participant Kitchen).
Front and back matter. Informative introductory sec­
tions, including the table of contents, acknowledgments,
an essay on major additions and revisions, and a glossary,
precede the main body of the document. A detailed index
appears at the end of the book.
The glossary generally includes only terms that require
a specific definition to clarify their use in the Guidelines.
If a term as it is used in the Guidelines is clearly defined in
the Merriam- Webster Collegiate Dictionary, a definition is
not included in the glossary.
Uses of this Document
The Guidelines documents are made available for a wide
variety of public and private uses. These include adoption
by states for regulatory purposes and other reference in
laws, codes, rules, and regulations as well as use in private
self-regulation and standardization of space and equip­
ment requirements and the promotion of safe practices
and methods in planning, design, and construction for
various types of health care facilities.
Regulatory use. Use of the Guidelines or any portion
thereof for regulatory putposes should be accomplished
through adoption by reference. The term "adoption by
reference" means citing title, edition, and publishing
information only.
• Any deletions, additions, and changes desired by the
adopting authority should be noted separately in the
adopting instrument.
• To help FGI follow the uses made of this document,
adopting authorities are requested to notify FGI at
info@fgiguidelines.org when they adopt an edition

of the Guidelines or use the documents in any other
regulatory fashion.
Authorities adopting the Guidelines should encour­
age design innovation and grant exceptions where the
intent of the standards is met. These standards assume
that appropriate architectural and engineering practice
and compliance with applicable codes will be observed as
part of normal professional service.
It is recognized that many health care services may
be provided in facilities not subject to licensure or regula­
tion, and the Guidelines is intended to be suitable for use
by all care and service providers. It is further intended
that when used as regulation, some latitude be granted
in complying with the Guidelines requirements as long
as the health and safety of the facility's occupants are not
compromised.
Code language in the Guidelines. For brevity and conve­
nience, these standards are presented in "code language."
Use of words such as "shall" indicates mandatory
language only where the text is applied by an adopting
authority having jurisdiction (AHJ). However, when
adopted by an AH], design and construction must con­
form to the requirements of the Guidelines.
The word "Reserved" is used to help standardize
numbering of the text and is not intended as a place­
holder for specific requirements.
Use with other codes. The Guidelines documents address
certain details of construction and engineering that are
important for facility design and construction, but they
are not intended to be all-inclusive nor used to the exclu­
sion of other guidance or codes.
• Local codes. For aspects of design and construction
not included in the Guidelines, local governing
building and licensing codes shall apply.
• Model codes. Where there is no local governing
building code, the prevailing model code used in
the relevant geographic area is hereby specified
for all requirements not otherwise specified in the
Guidelines.
AHJ verification. Some projects may be subject to the
regulations of several different jurisdictions, including
local, state, and federal authorities. While coordination
efforts have been made, the Guidelines may not always
be consistent with all applicable codes, rules, and regu­
lations. Therefore, it is essential that individual project
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
ABOUT THE GUIDELINES
requirements be verified for compliance with all authori­
ties having jurisdiction over a project. Where require­
ments appear to be conflicting or contradictory, the AH]
with primary responsibility for resolution should be
consulted.
Errata. From time to time, FGI issues errata to correct
an ertor in its published Guidelines documents. This
information is posted on the FGI website and announced
in the FGI Bulletin, a quarterly newsletter of the Facil­
ity Guidelines Institute. All errata are considered to be
corrections to errors in the Guidelines text and should be
applied as such.
Formal interpretations of requirements. Users of the
Guidelines can request formal interpretations of the
language in the documents. Interpretations, which are
provided by members of the Health Guidelines Revi­
sion Committee, are intended to provide clarification; a
summary of any background and previous discussion, if
appropriate and available; and a rationale for the inter­
pretation rendered.
It is understood that any such interpretation is advi­
sory in nature and is intended to assist the designer,
care or service provider, and adopting AH] to maximize
the value of the Guidelines. When an inquiry does not
require a formal interpretation, an advisory opinion may
be provided.
Requests for interpretation should be submitted
through the FGI website; see www.fgiguidelines.org/
guidelines/interpretations-2 for information.
Disclaimers
While FGI administers the revision process and estab­
lishes rules to promote fairness in the development of
consensus, it does not independently test, evaluate, or
verifY the accuracy of any information or the soundness
of any judgments or advice contained in the Guidelines.
FGI endeavors to develop performance-oriented and
evidence-based minimum requirements as guidance for
design of U.S. health care facilities without prescribing
design solutions. FGI disclaims liability for any per­
sonal injury or property or other damages of any nature,
whether special, indirect, consequential, or compensa­
tory, directly or indirectly resulting from the publication,
use of, or reliance on this document. FGI also makes no
guaranty or warranty as to the accuracy or completeness
of any information published herein.
xxiii
ABOUT THE GUIDELINES

In issuing and making this document available, FGI Inc. By making this document available for use and adop­
is not undertaking to render professional or other ser­ tion by public authorities and private users, FGI does not
vices for or on behalf of any person or entiry. Nor is FGI waive any rights in copyright to this document.
undertaking to perform any dury owed by any person or
entiry to someone else.
Anyone using this document should rely on his or Publication of the 2018 Documents
her own independent judgment or, as appropriate, seek
With the release of the 2018 edition, the Guidelines for
the advice of a competent professional in determining the
Design and Construction documents are offered as a sub­
exercise of reasonable care in any given circumstance.
scription-based service in addition to the soft-cover ver­
FGI does not have any power, nor do they under­
sion of the Guidelines. FGI is pleased to provide our users
take, to police or enforce compliance with the contents
with a digital seat/site-based version of our documents
of this document. FGI does not list, certifY, test, or
that delivers enhanced functionaliry and searchabiliry
inspect designs or construction for compliance with this
and unparalleled access from the field.
document.
Note: For a history of the Guidelines documents,
Any certification or other statement of compliance
please visit the FGI website at www.fgiguidelines.org.
with the requirements of this document shall not be
attributable to FGI and is solely the responsibiliry of the
certifier or maker of the statement.

Copyright
The content of this document, in both print and digital
form, is copyrighted by the Faciliry Guidelines Institute,

xxiv Guidelines for Design and Construction of Residential Health. Care. and Support Facilities
Major Additions and Revisions
The 2018 Guidelines for Design and Construction ofResi­
dential Health, Care, and Support Facilities is the first revi­
sion of the inaugural edition of this document, which
was published in 2014. The 2018 Residential Docu­
ment Group responsible for revising the 2014 Guidelines
approached the revision as an opportunity to refine the
2014 text, restructure the document for clarity, and­
based on needs in the residential long-term care market­
place-provide guidance for additional facility types. For
information that was revised, added, or moved from the
appendix into the main body requirements, the docu­
ment group's approach included a concerted effort to
base changes on evidence-based research, information
from subject matter experts, and experience in the field
across a broad spectrum of interrelated disciplines.
The following revisions are global to the 2018 Resi­
dential Guidelines document:
• A shift in terminology was made from "bariatric
resident" to "person of size." This distinction
recognizes that persons of size include those who
are very tall as well as those who are very large in
relation to their height. Bariatric is a term used
specifically for those undergoing bariatric treatment.
• On the topics of acoustics and lighting, subject
matter experts actively collaborated with the
document group to refine requirements and
provide additional guidance based on acoustics
research conducted in a continuing care retirement
community and updated Illuminating Engineering
Society (IES) standard requirements for aging and
disabled populations. For example, the notion of
"speech privacy" has been employed to make clear
the benefit residents, staff, and participants gain
when acoustic design is considered during project
design. Evaluation and decibel levels in various
community spaces have been revised based on the
research completed.
• Common element chapters for the facility type
categories in PartS 3 (residential health facilities),
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4 (residential care and support facilities), and 5
(non-residential support facilities) were removed.
The content from these chapters was integrated into
the facility chapters, which include cross-references
to Part 2-now the only common element section
referenced from facility chapters. This change
reduces the number of times a reader may need to
reference another section of the document to find a
minimum requirement or guidance.
• Requirements for food service and kitchen facilities
were corrected, added to, and/or aligned across facil­
ity types to increase clarity and consistency.
Updates were made to the Residential Guidelines
glossary to support new material and editorial changes,
clarify intent, and remove inconsistencies for the user.
As in past editions of the Guidelines, significant
changes have been marked throughout the print version
of the 2018 Residential Guidelines with vertical rules
beside the text.
Part 1: General
In Part 1, additional guidance has been provided to clar­
ify the definition, purpose, and function of the resident
safety risk assessment (RSRA) in Section 1.2-3. Advi­
sory information was revised to emphasize the impor­
tance of balancing the need for safety and mi tigation of
risks with recognition of residents' rights to self-deter­
mination and personal decision-making. The additional
information supports the execution of a RSRA that
balances opportunities for providing a person-centered
approach with maintenance of or improvements to resi­
dent quality oflife.
Advisory appendix information was added to Section
1.2-3.2 (Infection Control Risk Assessment) to highlight
some of the common risks to staff and residents based on
the latest research.
xxv
MAJOR ADDITIONS AND REVISIONS
Hallways and corridors were added as locations to be
assessed as part of the resident mobility and transfer risk
assessment (Section 1.2-3.3) because of the impact the
design of these areas has on independent resident mobil­
ity. The goal is to provide design interventions that maxi­
mize resident freedom of movement.
Also as part of the resident mobility and transfer
risk assessment, a new requirement and associated rec­
ommendations were added for bed safety under Section
1.2-3.3.2.10 (Coordination between mobility and trans­
fer equipment and other aspects of the physical environ­
ment). The goal for this change was to require evaluation
of bed options to reduce the risk of injury related to bed
rails, mattresses, and bed configurations.
Recommendations were added as guidance to sup­
port development of the security plan required in Section
1.2-3.7.1.4 (Security considerations for project design).
Several clarifications were made in Section 1.2-4
(Environment of Care). In Section 1.2-4.5.2, views of
nature were distinguished from access to nature to clar­
ify each element. Added advisory information further
defines views of nature, which can include views of the
sky, vegetation, natural light, precipitation, birds, and
other living organisms. The goal is for the resident to
be able to sense seasonal and weather changes and the
change of time throughout the day. In Section 1.2-4.5.5,
the sensory components for visual and auditory privacy
were separated to further define requirements for privacy
and confidentiality in the design of the physical environ­
ment. This change is intended to address issues such as
the use of cubicle curtains, which provide visual privacy
but do not support speech privacy.
In Section 1.2-5.8 (Resident Quality of Life), addi­
tions and refinements were made to the core values of
person-centered care and explanatory appendix mate­
rial was added to describe each attribute to help users of
the Guidelines apply these important concepts to facility
designs.
Part 2: Common Elements for
Residential Health, Care, and Support
Facilities
The sustainable design requirements have been updated
to reflect current industry standards for whole building
life cycle and product selection criteria. Advisory infor­
mation in appendix section A2.2-2.5 (Use of reduced­
impact materials for building assemblies and interior
xxvi Guidelines for Design and Construction of Residential Heaith, Care. and Support Facilities
fit-outs) includes updates to related standards, includ­
ing ANSIIASHRAE/ASHE 189.3: Design, Construction
and Operation of Sustainable High-Performance Health
Care Facilities and newer life cycle assessment tools and
resources that have become available since publication of
the 2014 Residential Guidelines.
New Section 2.3-3.5 (Care Consultation Area) was
added to recognize that in the residential environment
care consultation often takes place outside of examina­
tion or treatment rooms. Minimum requirements for this
type of space were added to support the concept that set­
tings for these care consultation areas, like resident living
environments overall, should be homelike rather than
clinical.
New Section 2.3-4.2.9 (Accommodations for Tele­
medicine Services) was added to reflect the increasing use
of telemedicine services in residential health, care, and
support facilities. The requirements are minimal with
advisory information in the appendix listing components
to consider for spaces where telemedicine will occur.
Guidance was added to Section 2.4-2.2.9 (Grab Bars)
based on the latest research on alternative configurations
for swing-up grab bar placement at the toilet, which was
published in the Health Environments Research 6' Design
Journal article "Beyond ADA Accessibility Requirements:
Meeting Seniors' Needs for Toilet Transfers" in Septem­
ber 2017. New appendix table A2.4-a (Resources for
Grab Bar Configurations) provides advisory information
for consideration in design, including research findings
about preferred alternative configurations for one-person,
two-person, or equipment-assisted transfers as compared
to ADA accessibility standards.
Section 2.4-2.2.10 (Handrails and Lean Rails) was
expanded to include lean rails. Residential long-term care
settings often rely on lean rails or handrails or a combina­
tion of both, depending on the resident care population,
to support residents' mobility.
The title of Section 2.5-2.3.3.2 was changed from
"Showers" to "Accessible showers" to better align with
accessibility standards related to designing showers to
maximize resident independence. Appendix language was
added to recommend provision of a "zero" height thresh­
old or transition between the shower and adjacent floor
because the ADA guidance that allows for a difference in
transition height can limit resident mobility and access to
a shower, whether independently or with assistance from
a caregiver.
The requirement in Section 2.5-3.5.2.2 (Duct
humidifiers) in the 2014 Residential Guidelines was

stricken to allow other standards to prevail, specifically
ANSI!ASH RAE/ASHE Standard 170: Ventilation of
Health Care Facilities, ANSI!ASH RAE Standard 62.1:
Ventilation for Acceptable Indoor Air Quality, and ANSI!
ASHRAE Standard 62.2: Ventilation and Acceptable
Indoor Air Quality in Residential Buildings.
Part 3: Specific Requirements for
Residential Health Facilities
Late in the development of this edition, the Centers for
Medicare & Medicaid Services (CMS) published a final
rule on the "Reform of Requirements for Long-Term
Care Facilities" affecting the maximum capacity of resi­
dent rooms in nursing homes. A maximum of two per­
sons is permitted in a resident room, and each room is
required to have a bathroom with toilet and sink. This
requirement no longer allows for a bathroom to be located
between two double-occupancy or two single-occupancy
rooms that have separate resident room entry doors. Sec­
tion 3.1-2.2.2 (Resident Room) was revised to align with
the new CMS requirement. The maximum number of
occupants in a resident room after a renovation changed
from four to two people in Section 3.1-2.2.2.1 (Capac­
ity) to allow facilities to remain compliant and eligible for
reimbursement from CMS.
New text in Section 3.1-2.2.2.2 (Space require­
ments) requires nursing home rooms to be configured
so each resident can view the television from a resident
chair. Additional recommendations suggest dimensions
for determining space needs. Similar revisions were
made for Section 3.2-2.2.2.2 (Space requirements) for
hospice rooms.
New Section 3.1-2.2.4.2 (Post-acute care facilities),
with accompanying advisory information in the appen­
dix, was added to respond to changing reimbursement
rules and shorter hospital stays. Post-acute care facilities
are intended for residents receiving rehabilitation services
rather than long-term or palliative care services.
Part 4: Specific Requirements for
Residential Care and Support Facilities
In Chapter 4.1, Specific Requirements for Assisted Living
Facilities, Section 4.1-4.2.3 (Central Bathing or Spa
Room or Area) was revised to clarifY the requirements for
central bathing facilities. Provision of a central bathing
-------- ------------------ --------------------
Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
MAJOR ADDITIONS AND REVISIONS
or spa room or area remains optional, and the decision
whether to have one depends on the needs of the care
population. The options for the bathing fixture if a cen­
tral one is provided have been expanded to include a spa
tub as well as a bathtub or shower.
New chapters on two facility types were added to
Part 4:
• Chapter 4.3, Specific Requirements for Long-Term
Residential Substance Abuse Treatment Facilities,
presents new requirements and guidance for
facilities that provide a 24-hour-a-day therapeutic
community setting for treatment and counseling
of individuals with substance use disorders. The
chapter was developed in response to requests from
the industry to provide design guidance for these
community-based settings, which are becoming
more prevalent in response to the opiate epidemic.
• Chapter 4.4, Specific Requirements for Settings
for Individuals with Intellectual and/or
Developmental Disabilities, presents new design
requirements and guidance for intermediate
care facilities such as a community residence
or personal care home for individuals with
intellectual and/or developmental disabilities.
The chapter does not address larger residential
health settings (nursing homes) or hospitals for
residents or patients who have intellectual and/
or developmental disabilities. This chapter was
added because these facilities may be regulated as
recipients of reimbursements from CMS.
Part 5: Specific Requirements for Non­
Residential Support Facilities
Minimal and editorial revisions were made to Part 5 to
make the language clearer. As well, in the chapter on
adult day care facilities, the minimum requirement for
location of a toilet room in Section 5.1-2.3.3.4 (Support
areas for dining, recreation, lounge, and activity loca­
tions) was relaxed to allow location adjacent to dining,
recreation, lounge, and activity areas rather than a specific
distance measured in linear feet. For Chapter 5.3, Out­
patient Rehabilitation Therapy Facilities, the minimum
space requirements in Section 5.3-3.2.4.2 were revised to
make them more flexible and thus more easily applied to
the services an organization provides and the care popula­
tion it serves.
-----------------------
xxvii
Glossary

Specific terms and definitions are provided to facilitate consistency in the interpretation and application ofthe Guidelines.
Some ofthese terms may have a broader definition in other contexts, but the definitions provided here reflect the use ofthe terms
in the Guidelines.

Activity area: An area of a residential care facility that is
used by residents and activity directors/coordinators to
engage in activities such as arts and crafts, individual or
group games (e.g., cards, electronic games, board games),
education, watching videoltelevision. Note: This is dif­
ferentiated from a recreation area.
Adjacent: See Location terminology.
Administrative areas: Designated spaces such as offices
and meeting rooms that accommodate admission and
discharge processes, medical records storage, medical and
nursing administration, business management and finan­
cial services, human resources, purchasing, community
services, education, and public relations.
Airborne infection isolation (AIl) room: A room desig­
nated for persons having or suspected of having an infec­
tion that is spread through coughing or other ways of
suspending droplets of pathogens into the air (e.g., tuber­
culosis, smallpox).
Ambulate: To walk or move about from place to place
with or without assistance.
Area: A particular extent of space or surface serving a
defined function.
Authority having jurisdiction (AHJ): An individual or
organization designated by a state or government agency
to enforce building codes and other regulations related to
construction projects.
Bariatric resident: See Person of size.
Bed size: Minimum rectangular dimensions for planning
minimum clearances around beds-40 inches 001.6
centimeters) wide by 96 inches (2.43 meters) long.
Centralized services: As used in this document, a resi­
dent unit, facility, or setting that provides central services.
Clearance: The shortest unencumbered distance between
the outermost dimensions of a specified object (e.g., a
resident bed or exam table) and specified, fixed reference
points (e.g., walls, cabinets, sinks, and doors).
Clear dimension: An unobstructed room dimension
exclusive of built-in casework and equipment and avail­
able for functional use.
Clear floor area: The floor area of a defined space that is
available for functional use excluding toilet rooms, clos­
ets, lockers, wardrobes, alcoves, vestibules, anterooms,
and auxiliary work areas. Note: Door swings and floor
space below sinks, counters, cabinets, modular units, or
other wall-hung equipment that is mounted to provide
usable floor space counts toward "clear floor area." Space
taken up by minor fixed encroachments that do not inter­
fere with room functions can be included in calculating
clear floor area.
Clinical sink: A flushing-rim sink or "hopper" used for
disposal of blood or body fluids (e.g., bedpan washing).
Note: This is not the same as a hand-washing sink or an
instrument-cleaning sink (single- or double-sink type).
Community residence (CR): A residential facility that
provides supervised and supportive living environments.
Note: In a supervised CR, staff are immediately available
on-site 24/7 and supplies for daily living, like food and
toiletries, are provided. Supervised CRs are designed to
provide a home-like atmosphere where individuals with
developmental disabilities can acquire the skills needed to
live as independently as possible.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xxix
GLOSSARY
Country kitchen: An activity component usually con­
nected to a great room or other activity room that is
intended for use by residents, participants, or outpatients
as well as staff. Note: A country kitchen is used for activi­
ties and for warming food and serving food as part of an
integrated food service program.
Culture change: Common name given to resident-cen­
tered care processes for transforming health, care, and
supportive services based on person-directed values and
practices in which the voices of residents, their fami­
lies, and those working with them are considered and
respected and person always comes before task.
Curbless shower: An area of a room that serves as the
shower. Note: Other terms may include open shower,
European shower, or European wet room.
Differential pressure: A measurable difference In air
pressure that creates a directional airRow between adja­
cent spaces.
Direcdyaccessible: See Location terminology.
Documentation area: A work area associated with or
near a resident care area where information specific to
residents is recorded, stored, and reviewed to facilitate
ready access by authorized individuals.
Emergency call system: Devices that are activated to
indicate the need for staff assistance. Note: Such devices
produce an audible or visual indication (or both) or may
be connected or transmit to an area alert monitor or per­
sonal hand-held device.
Environment of care: Those physical environment fea­
tures in a residential health, care, or support facility that
are created, structured, and maintained to support and
enhance the delivery of care and services.
Environmental services (housekeeping): Services any­
where in a residential health, care, or support facility that
provide general cleaning and supply identified cleaning
materials (e.g., soaps, towels). Note: Although routine
disinfection protocols can be included in such a defini­
tion, the definition is not intended to include complex,
non-routine disinfection procedures nor the non-routine
disposition of hazardous materials such as potentially
toxic drugs or other chemicals.
Equipment, portable or mobile: Floor-based equip­
ment that moves on the Roor surface, such as Roor-based
sling lifts and sit-to-stand lifts. Note: This equipment
-----_._- -------_._._---.... _----_._- - - - ­
xxx Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
may be moved horizontally either manually or with the
assistance of motorized wheels. When the term "por­
table" is used in connection with ceiling lifts, it may also
refer to a lift motor and hoist that can be removed from
a track system in one room and attached to the track
system in another room.
Examination room: A toom with a bed or examination
table and capability for periodic monitoring and check­
ups.
Facility: A discrete physical entity composed of various
functional units as described in the Guidelines.
Fixed equipment: Equipment with track systems
attached at some point in the toom. Note: Fixed equip­
ment includes ceiling-mounted or overhead lifts, wall­
mounted lifts, and other lifting devices with fixed
tracking. An alternative would be a demountable track
that may be fully or partially disassembled and removed
from the space.
Functional program: A record of the key environment
of care considerations and facility functional and opera­
tional parameters that drive the space program for a proj­
ect. Note: The governing body or its delegate develops
the functional program, which is intended to inform the
designers of record, authority having jurisdiction, and
users of the facility. The size and compleXity of the proj­
ect will determine the length and complexity of the func­
tional program.
Governing body: The person or persons who have over­
all legal responsibility for the operation of a residential
health, care, or support facility. Note: Often, the "owner"
or "provider" is representative of the governing body.
Hand sanitation dispenser: A dispenser that contains a
liquid solution that has been approved by the FDA for
hand hygiene.
Hand-washing station: An area that provides a sink with
a faucet that can be operated without using hands, cleans­
ing agen ts, and means for drying hands.
Hands-free faucets: Faucets that are controlled by knee­
or foot-operated pedals or by motion sensors such as elec­
tric eye controls. Note: This term does not refer to faucets
operated using wrist blades or single-lever faucets.
Hazard: Anything that has the potential to cause harm.
Health, care, or support facility: Any facility type listed
in the table of contents of this book.
---------------_. ----- --------_. -------_.
 GLOSSARY

Immediately accessible: See Location terminology. Coordinating Council for Medication Error Reporting
and Prevention definition; see www.nccmerp.org.)
Independent living: Category of residential living that
often includes supportive services for residents. Minimum clearance: See Clearance and Clear dimen­
slon.
Intermediate care facility for individuals with intel­
lectual disabilities: A residential institution (or distinct Mobility: The functional ability of a resident, participant,
part of an institution) for individuals with intellectual or outpatient to move readily from place to place, with or
disabilities or related conditions that (1) is primarily for without the use of mobility-related assistive devices.
the diagnosis, treatment, or rehabilitation of the intel­
Mobilize or mobilization: The application of resources
lectually disabled or persons with related conditions and
necessary to cause or enable a resident, participant, or
(2) provides, in a protected residential setting, ongoing
outpatient or limb of a resident, participant, or outpa­
evaluation, planning, 24-hour supervision, coordination,
tient ,to move or continue to move to help the resident,
and integration of health or rehabilitation services to help
participant, or outpatient maintain or increase physical
each individual function to his or her greatest ability.
activity and movement.
Location terminology (terms for relationship to an
Movement: Staff-assisted transfers of a dependent resi­
area or room)
dent (e.g., from a bed to a chair or toilet or from a room
to another location). Note: "Movement" can apply to
Located within the identified area or
I repositioning a dependent resident in a bed or chair and
l'" Directly accessible
room

Connected to the identified area

can be the result of ambulation or mobilization. See also
Ambulation, Mobilization.
I or room through a doorway, pass-
I through, or other opening without Nature: An organic environment in which the major­
going through an intervening room or ity of ecosystem processes are present (e.g. birth, death,
public space reproduction, relationships between species) or any single
I··

i Adjacent
I·
I Located next to but not necessarily
......•.........
element of the natural environment (e.g., plants, ani­
mals, soil, water, air). Note: This includes the spectrum
I connected to the identified area or
of habitats from wilderness areas to farms and gardens as

~
._--------------­ ..
--------.------~-_ _._---_._.-._-_.-_._-_..­.. ­ ...• _-_•...• -._--------_._­
well as domestic and companion animals and cultivated
Immediately Available either in or adjacent to the potted plants. Nature can also refer collectively to the
accessible identified area or room
geological, evolutionary, biophysical, and biochemical
processes that have occurred throughout time to create
Readily accessible Available on the same floor as the
I
identified area or room the Earth as it is today.
~_._ _ .
Net usable program area: The sum of all interior areas in
In the same bUilding Available in the same building as
the identified area or room, but not
a project available to house the project's program. Areas
necessarily on the same floor housing building equipment, vertical circulation, and
structural systems shall be excluded.

Marine plywood: Wood construction that resists delami­ Nurse call: A hardwired or wireless system for calling care
nation and fungal attack to perform longer in humid and staff to a resident room or other location when a resident,
wet conditions. participant, or outpatient is in need of assistance.

Medication errors: Any preventable event that may Nurse station: A multipurpose staff work area used by all
cause or lead to inappropriate medication use or resident, caretakers in a resident unit in centralized care models.
participant, or outpatient harm while a medication is
Office: See Room.
in the control of a health care professional, resident, or
consumer, whether that person is prescribing; commu­ Participant: A person receiving care and services in an
nicating an order for; dispensing; distributing; admin­ adult day care, adult day health care, or PACE facility or
istering; educating about; monitoring use of; or using a wellness center that provides day services only and no
a medication. (Definition adapted from the National overnight stays.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xxxi
GLOSSARY
Patient: A person receiving medical care or rehabilitation
therapy in an outpatient facility.
Patient care area: An area used primarily for the provi­
sion of clinical care to patients. Note: Such care includes
outpatient rehabilitation therapy services.
Person of size: A person whose height, weight, body
width, weight distribution, and/or size require increased
space for care and expanded-capacity devices, equipment,
furniture, technology, and supplies. Note: This term is
often interchangeable with obese, morbidly obese, and
bariatric.
Personal care home: A residence that provides residents
with shelter, meals, supervision, and assistance with per­
sonal care tasks. Note: The services provided vary and
are based on the individual needs of each resident. These
facilities typically house older people or people with
physical, behavioral health, or cognitive disabilities who
are unable to care for themselves but do not need nutsing
home or medical care.
Places of respite: Spaces within a residential health, care,
or support facility or on a campus provided to connect res­
idents, participants, outpatients, visitors, and staff to the
health benefits of the natural environment. (Green Guide
for Health Care, Sustainable Site Design: Places of Respite
Technical Brief, www.gghc.org/tools.technical.php)
Post-acute care: Category of residents who are discharged
from acute care hospitals to inpatient rehabilitation facili­
ties, nursing homes, or home health care providers.
Provisions for drinking water: Availability of readily
accessible potable water for resident, staff, and visitor
needs. Note: Water may be provided in a variety of ways,
including fountains, pitchers, and bottled water.
Public or community areas: Designated spaces freely
accessible to the public. Note: These spaces include park­
ing areas, secured entrances and areas, entrance lobbies,
reception and waiting areas, public toilets, snack bars,
cafes, vending areas, gift shops and other retail locations,
resource libraries and meeting rooms, chapels, and gar­
dens.
Readily accessible: See Location terminology.
Recreation area: An area in a residential care facility that
is used by residents and recreation therapists/coaches for
physical exercise and movement. Note: This is differenti­
ated from an activity area.
xxxii Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
Resident: A person living and receiving health, care, and/
or support services in a nursing home, hospice facility,
assisted living facility, independent living setting, or inpa­
tient rehabilitation facility.
Resident-centered care: A philosophical approach to
residential health, care, and support environments that
honors and respects the voice of those being served and
those working most closely with them. Note: This care
model process is intended to individualize care and dein­
stitutionalize the residential health, care, and/or support
environment.
Residential care and support facilities: Category of
facilities such as assisted living facilities and independent
living settings in which services such as assistance with
activities of daily living (ADL) and/or instrumental activ­
ities of daily living (IADL) are provided to residents.
Residential health facilities: Category of facilities in
which long-term health services are provided (e.g., nurs­
ing homes and hospice facilities).
Residential support facilities: Category of facilities in
which health, care, and/or support services that do not
require overnight accommodation are provided.
Resident-operated mobility devices: Equipment (e.g.,
wheelchairs, walkers, ambulation-assistance equipment,
battery-operated mobile chairs) used by residents, partici­
pants, and outpatients in residential health, care, support,
and related settings to enable them to mobilize.
Resident safety risk assessment (RSRA): A multidisci­
plinary organizational process that focuses on reducing
risk from infections, mobility and transfer activities, resi­
dent falls, dementia and mental health issues, medication
errors, security issues, and disasters throughout planning,
design, and construction (including renovation) for resi­
dential health, care, and support facilities and settings.
Risk: The likelihood that somebody or something will
be harmed by a hazard, multiplied by the severity of the
potential harm.
Room: A space enclosed by hard walls and having a door.
Note: Where the word "room" or "office" is used in the
Guidelines, a separate, enclosed space for the one named
function is intended. Otherwise, the described area may
be a specific space in another room or common area.
Service areas: Designated spaces that house auxiliary
functions that do not routinely involve contact with resi-

dents, participants, or the public (e.g., supply, processing,
storage, and maintenance services such as dietary, laundry
processing and storage, environmental services (house­
keeping), maintenance operations, and clean and soiled
utility rooms).
Speech privacy: Techniques to render speech unin­
telligible to casual listeners. (Definition from ANSI
T1.523-2001: Glossary, a standard maintained by the
U.S. Department of Commerce, National Telecommu­
nications and Information Administration, Information
Security Program.) Note: This definition matches ear­
lier ones in ANSI S3.5 (1969) and ASTM El130 (1997
& 2001) and is consistent with ASTM E2638 (2011).
See ASTM El130 and ASTM E2638 for four defined,
measurable levels of speech privacy. Speech privacy is a
condition required by HIPAA (the Health Insurance Por­
tability and Accountability Act) and is the subject of the
"noise-at-night question" on the HCAHPS patient satis­
faction survey.
Station: See Hand-washing station, Nurse station.
Subacute care: Category of care requiring less intensity
of care/resources than acute care. Note: Subacute care
falls within a continuum of care determined by resident
acuity, clinical stability, and resource needs.
Support areas (resident units, diagnostic and treat­
ment areas, etc.): Designated spaces or areas in which
staff members perform auxiliary functions that support
the main purpose of the unit or other location. Note:
Where the word "room" or "office" is used, a separate,
enclosed space for the one named function is intended.
Otherwise, the described area is permitted to be a specific
space in another room or common area.
Support areas (resident, family, and/or visitor): Des­
ignated spaces for the use of residents, participants,
patients, or visitors (e.g., changing areas, dining rooms,
toilet rooms, activity rooms) or families and visitors (e.g.,
waiting areas and lounges, children's play areas, toilet
rooms ) . Hote:
l\T Wh ere t h e word "room"or"0 ffi ce".IS use d ,
a separate, enclosed space for the one named function is
intended. Otherwise, the described area is permitted to
be a specific space in another room or common area.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
GLOSSARY
Support areas (staff): Designated spaces for the personal
use of staff (e.g., changing areas, toilet rooms, showers,
lounges, dining areas). Note: Where the word "room"
or "office" is used, a separate, enclosed space for the one
named function is intended. Otherwise, the described
area is permitted to be a specific space in another room
or common area.
Sustainability: A means of configuring human activity
so that society, its members, and its economies are able
to meet their needs and express their greatest potential
in the present, while preserving biodiversity and natural
ecosystems in the long term; improving the quality of
human life while living within the carrying capacity of
supporting ecosystems.
Sustainable design: The art of designing physical objects,
the built environment, and services to comply with prin­
ciples of economic, social, and ecological sustainability.
Therapeutic and restorative gardens: A space, usually
outdoors but sometimes indoors, that promotes physi­
cal and emotional health and well-being through passive
and/or active engagement with nature. Note: At best,
these spaces are designed based on research (evidence­
based design) for a specific population, site, and intended
outcome (e.g., stress reduction, positive distraction, exer­
cise, facilitating social connection, rehabilitation, play).
Sometimes referred to as a "healing garden."
Treatment room: A room where therapy or other care
services are provided.
Type III environmental product declaration (EPD):
A Type III environmental product declaration provides
quantified environmental data using predetermined
parameters and, where relevant, additional environmen­
tal information. Note: An EPD can be either brand-spe­
cific or industry-wide.
Unit: An area or space usually dedicated to a single
defined organizational function.
Universal design: The concept of designing all products
and the built environment to be usable and non-stigma­
tizing to the greatest extent possible by everyone, regard­
less of age, ability, or status in life.
xxxiii
List of Acronyms
ADA-Americans with Disabilities Act
ADAAG-ADA Accessibility Guidelines for Buildings
and Facilities
AHJ-authority having jurisdiction
AlA-American Institute of Architects
AI-Articulation Index
AIl-airborne infection isolation
ANSI-American National Standards Institute
ASA-Acoustical Society of America
ASHE-American Society for Healthcare Engineering
ASHRAE-American Society of Heating, Refrigerating
and Air-Conditioning Engineers
BOD-basis of design
C-Celsius
CDC-U.S. Centers for Disease Control and
. Prevention
CFC-chlorofluorocarbon
CFR-Code of Federal Regulations
CHD-Center for Health Design
CMS-US. Centers for Medicare & Medicaid Services
DHHS-US. Department of Health and Human
Services
EIS-environmental impact statement
EPA-US. Environmental Protection Agency
FDA-US. Food and Drug Administration
F-Fahrenheit
HAl-health care-associated infection
HEPA-high efficiency particulate air
HFCx-health facility commissioning
HID-high-intensity discharge
HIPAA-Health Insurance Portability and Account­
ability Act
HVAC-heating, ventilation, and air conditioning
IBC-International Building Code
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
ICC-International Code Council
ICRA-infection control risk assessment
ICRMR-infection control risk mitigation
recommendation
LCA-life cycle assessment
LRV-light reflectance value
NFPA-National Fire Protection Association
NIC-not-in-contract
NIOSH-National Institute for Occupational Safety
and Health
NSC-National Stone Council
NSF-NSF International
OPR-owner's project requirements
OSHA-U.S. Occupational Safety and Health
Administration
PACE-Programs of All-Inclusive Care for the Elderly
PHAMA-patient handling and movement assessment
RSRA-resident safety risk assessment
SAGE-Society for the Advancement of Gerontological
Environments
SII-Speech Intelligibility Index
SPC-speech privacy class
STC-sound transmission class
TAB-testing and balancing
TBC-total building commissioning
TC-therapeutic community
TEC-total environment commissioning
TGB--telecommunications grounding bus
UFAS---Uniform Federal Accessibility Standards
UL-Underwriters Laboratories, Inc.
USDA-U.S. Department of Agriculture
USP- NF- U S. Pharmacopeia and National Formulary
VOC-volatile organic compound
xxxv
 1.1 Introduction
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 1.1-1 General • 1.1-2 New Construction

*1.1-1.1 Application
The provisions of rhis chapter shall apply to all new
construction and renovation of residential health, care,
and support facilities.
*1.1-1.2 Minimum Standards for New
Facilities and Renovations
1.1-1.2.1 Each chapter in this document contains
information intended as minimum standards for
design and construction of new, and for major renova­
tion of existing, residential health, care, and support
facilities.
Projects with any of the following scopes of work shall
be considered new construction and shall comply
with the requirements in the Guidelines for Design and
Construction ofResidential Health, Care, and Support
Facilities:
1.1-2.1 Site preparation for and construction of
entirely new structures and systems
1.1-2.2 Structural additions ro existing facilities that
result in an increase of occupied floor area
1.1-2.3 Major change in function in an existing space

*1.1-1.2.2 Standards set forth in the Guidelines for

Design and Construction ofResidential Health, Care, • 1.1-3 Renovation
and Support Facilities shall be considered minimum
and do not prohibit designing facilities and systems 1.1-3.1 General
that exceed these requirements where desired by the
governing body of the health, care, or support facility. 1.1-3.1.1 Compliance Requirements

1.1-3.1.1.1 Where renovation or replacement work is

done in an existing facility, all new work or additions
or both shall comply with applicable sections of the

APPENDIX

A1.1-1.1 Application. This document covers residential health,

outpatient; equipment; or staff activity that identifies its use avoids the
care, and support facilities common to communities in the United
need for complex descriptions of procedures for appropriate functional
States. Facilities witll unique services will require special consideration.
programming.
However, sections hNein may be applicable for parts of any facility and

A1.1-1.2.2 The Guidelines text is not intended to restrict innovation

may be used where appropriate.

and improvement in design or construction techniques. Accordingly,

A1.1-1.2 Performance vs. prescriptive standards. authorities adopting thes~ standards as code may approve plans and
The minimum standards in the Guidelines for Residential Health, Care,
specifications that contain deviations if they determine the applicable
and Support Care Facilities have been established to obtain adesired
intent or objective of the standards has been met. For more information,
performance result. Prescriptive limitations (such as exact minimum
see sections 1.1-3.1.2 (Exceptions) and 1.1-6 (Equivalency Concepts).
dimensions or quantities), when given, describe acondition that is
Final implementation of Guidelines requirements may be subject to
commonly recognized as apractical standard for normal operation. For
decisions of the authority havingjurisdiction (AHJ).
example, referencing a room or area by the resident, participant, or

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
1.1 INTRODUCTION
GuidelinesfOr Residential Facilities and local, state, and
federal codes.
1.1-3.1.1.2 Major renovation projects. Projects with
either of the following scopes of work shall be con­
sidered a major renovation and shall comply with the
requirements for new construction in the Guidelines
fOr Residential Facilities to the extent possible as deter­
mined by the applicable authority having jurisdiction:
(1) A series of planned changes and updates to the
improvements to building systems that serve that
physical plant of an existing facility
equipment and only to the extent necessary to
(2) A renovation project that includes modification of
an entire building or an entire area in a building to
accommodate a new use or occupancy
1.1-3.1.1.3 Conversion projects. When a building is
converted from one occupancy type to another, it shall
comply with the new construction requirements.
1.1-3.1.1.4 Building system projects
(1) Only the altered, renovated, or modernized
portion of an existing building system or
individual component shall be required to meet
the installation and equipment requirements in the
Guidelines.
(2) When such construction impairs the performance
of the balance of an affected building system,
upgrades to that system shall be required beyond
the limits of the project to the extent required to
maintain existing operational performance.
*1.1-3.1.2 Exceptions
1.1-3.1.2.1 Where major structural elements make
total compliance impractical or impossible, exceptions
shall be considered.
APPENDIX
A1.1-3.1.2 Nonconforming conditions. When
where total compliance would create an unreasonable hardship and
renovating or expanding existing facilities, it is not always practical or
would not substantially improve safety.
financially reasonableto renovate or upgrade an entire existing facility
so it totally conforms to requirements in the Guidelines. Therefore,
authorities having jUrisdiction are permitted to grant approval to
renovate portions ofastructure, spiKe, or system if facility operations
and resident safety in renovated and existing areas are not jeopardized by
existing features of areas retained without complete corrective measures.
This recommendation does not guarantee an AHJ will grant an
exception, but attempts to minimize restrictions on those improvements
4 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
1.1-3.1.2.21he following exceptions to the require­
ments in Section 1.1-3.1.1 (Compliance Require­
ments) shall be permitted provided they do not reduce
the level of health and safety in an existing facility.
(1) Routine repairs and maintenance to buildings,
systems, or equipment shall not require
improvements to building features or systems.
(2) Replacement of building furnishings and
movable or fixed equipment shall only require
provide sufficient capacity for the replacement.
(3) Minor changes to the configuration of an existing
space shall not require upgrade of the entire space.
(4) Cosmetic changes or upgrades to an existing space
shall not require upgrade of the entire space.
(5) Improvements to a building system or a space
that cannot reasonably meet the requirements of
this document shall be permitted provided the
improvement does not impair other systems or
functions of the building.
(6) Existing systems that are not in strict compliance
with the provisions of this document shall be
permitted to continue in use, unless the AH] has
determined that such use constitutes a distinct
hazard to life.
(7) Replacement of mechanical, electrical, plumbing,
and fire protection equipment and infrastructure
for maintenance purposes due to the failure or
degraded performance of the components being
replaced shall be permitted provided the health and
safety in the facility is maintained at existing levels.
*1.1-3.1.3 Phased Projects
These standards shall not be construed as prohibiting a
single phase of improvement.
A.l.1-3.1.3 Phased projects. As an example, afacility may
plan to replace aflammable ceiling with noncombustible material but
lack funds to do other corrective work. However, the Guidelines stan­
dards are not intended as encouragement to ignore deficiencies when
resources are available to correct life-threatening problems. See Section
1.1"6 (EqUivalency Concepts).
 1.1 INTRODUCTION

1.1-3.1.4 Temporary Waivers start of the work. However, a safety level that exceeds
When parts of an existing facility essential to con­ that required for new facilities is not required for the
tinued overall facility operation cannot comply with renovation.
particular standards during a renovation project, a
temporary waiver of those standards shall be permitted 1.1-3.4 Long-Range Improvement
as determined by the authority having jurisdiction if
resident, participant, or outpatient health and safety 1.1-3.4.1 Nothing in the Guidelines shall be construed
will not be jeopardized as a result. as placing restrictions on a facility that chooses to
do work or alterations as part of a phased long-range
1.1-3.2 Facilities Subject to Compliance with
safety improvement plan.
the Guidelines

1.1-3.4.2 All hazards to life and safety and all areas of

1.1-3.2.1 Affected Areas noncompliance with applicable codes and regulations
shall be corrected as soon as possible in accordance
In renovation projects and additions to existing facili­
with a plan of correction.
ties, only that portion of the total facility affected by
the project shall be required to comply with applicable
sections of the Residential Guidelines.
• 1.1-4 Government Regulations
*1.1-3.2.2 Unaffected Areas
*1.1-4.1 Design Standards for Accessibility
Existing portions of the facility and associated build­
ing systems that are not included in a renovation Flexibility in applying general accessibility standards
project but are essential to the functionality or code shall be permitted to address considerations for trans­
compliance of the renovated spaces shall, at minimum, fer assistance.
comply with the applicable occupancy chapter of
NFPA 101: Life Safety Code. *1.1-4.2 Regulations for Earthquake-Resistant
Design for New Buildings
1.1-3.3 Undiminished Safety
Renovations, including new additions, shall not

diminish the safety level that existed prior to the

APPENDIX

A1.1-3.2.2 When construction is complete, the facility should

rights protection to individuals with disabiliti.es. Under Titles II and
satisfy functional requirements for its classification (e.g., nursing home,
III of the APA, health care facilities are required to comply with the
hospice, assisted Ilving, independent Hving) in an environment that will
Americans with Disabilities Act Standards for Accessible Dgsign for
prOVide acceptable care, safety, and quality of Ilfe to all occupants.
alterations and new construction. The Uniform FederalAccessibility
Standards (UFAS) also provides criteria for accessible design.
A1.1-4.1 Design standar~s for accessibility
Individual federal agencies prOVide direction on applicable criteria
a. Users of residential health, care, and support facilities often have
to be used in the design offederal facilities.
very different accessibility needs than the typical adult with dis­
c. State and local accessibility standards. Many state and local jurisdic­
abilities addressed byfederal model standards and gUidelines that
tions have Cldopted ICC A117.1: Accessible and Usable Buildings
focus on design for the disabled. long-term care facility residents,
and Facilities, which may be used to provide quallty deSign for the
especially elderly residents, due to their stature, reach, and strength
disabled. However, some state and lotal standards for accessibility
characteristics, typically require the assistance of caregivers during
and usability are more stringent than ADA, UFAS, or ICC A11 Z.l.
transfer maneuvers. Many prescriptive requirements of rnodel acces­
Designers and owners, therefore, are responsible fQr adherence to all.
sibility standards place these persons and their caregivers at greater
applicable requirements.
risk of injury than would noncompliance. Thus, flexibility is needed
in applying model guidelines to support many residents' need for A1.1-4.2 Seismic standards. The seismic provisions in ASC&

transfer assistance. SEI Z: Minimum Design foads for Buildings and Other Structures are

b. Federal accessibility standards. The Americans with Disabilities Act

based on the National Earthquake Hazards Reduction Program (NEHRP)

(ADA), which became law in 1990, extends comprehensive civil

:provisions developed by the National In.stitute of Building Science's

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 5
1.1 INTRODUCTION
*1.1-4.3 Flood Protection
*1.1-4.4 National Standards for the Protection
of Resident Health Information
1.1-4.5 Environmental Regulations
*1.1-4.5.1 Federal Environmental Regulations
*1.1-4.5.2 State and Local Environmental
Regulations
Building Seismic Safety Council for the Federal Emergency Management
Agency. The following seismic standards are essentially equivalent to
the ASCE/SEI7 provisions:
a. NEHRP Recommended SeismicProvisions forNew Buildings and Other
Structures
b. International Building Code
A1.1-4.3 Flood protection. When designing for flood
protection/ providers and designers should be aware of the possibil­
ity that applicable tables, charts, and standards may be outdated or
under review, due to climatic changes and other factors that affect the
potential for flooding and storm surges. They should also be familiar
with Executive Order 11988: Flood Protection, issued May 24,1977, to
minimize financial loss from flood damage to facilities constructed with
federal assistance.
A1.1-4.4 HIPAA. The Health Insurance Portability and
Accountability Act (HIPAA) became law in 1996. HIPAA consists of
three major parts: the Privacy Rule, Transaction and Code Sets, and the
Security Rule. The U.S. Department of Health and Human Services (HHS)
issued the Privacy Rule to implement the requirement of HIPAA.ln HHS,
the Office of Civil Rights has responsibility for enforcement of the HIPAA
regulations. HHS may proVide direction and clarification on the Privacy
Rule and Security Rule.
HIPAA does not preempt or override laws that grant individuals
even greater privacy protection. Additionally, covered entities are free to
retain or adopt more protective policies or practices.
Ultimately, designers and owners are responsible for developing
policies and procedures to verify that all applicable requirements that
appropriately limit access to personal health information are being met
without sacrificing the quality of care.
6 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
• 1.1-5 Building Codes and Standards
1.1-5.1 Safe Environment
Every residential health, care, and support facility shall
provide and maintain a safe environment for residents,
participants, outpatients, personnel, and the public.
*1.1-5.2 Code Compliance
1.1-5.2.1 In the absence of state or local requirements,
the project shall comply with approved nationally rec­
ognized building codes except as modified in the latest
edition ofNFPA 101: Life Safety Code and/or herein.
*1.1-5.2.2 Code material referred to in the Guidelines is
contained in the edition of the referenced code current
when this edition of the Guidelines was published.
A.1.1-4.S.1 Federal environmental regulations.
The principal federal environmental statutes likely to be applied to
residential health, care, and support facilities include the follOWing:
a. Clean Air Act (CAA)
b. National Environmental Policy Act (NEPA)
c. Occupational Safety and Health Act (OSHA)
d. Resource Conservation and Recovery Act (RCRA)
e. Safe Drinking Water Act (SDWA)
f. Superfund Amendments and Reauthorization Act (SARA)
g. Toxic Substance Control Act (TSCA)
A.1.1-4.S.2 State and local environmental regula­
tions. U.S. Department of Health and Human Services and U.S. Envi­
ronmental Protection Agency regional offices as well as other federal,
state, or local AHJs can provide information on state and local regula­
tions pertaining to environmental pollution-including management
of trash, noise, and traffic-that may affect the design, construction, or
operation of residential health, care, and support facilities.
A1.1-5.2 References made in the Guidelines to appropriate model
codes and standards do not, generally, duplicate wording of the
referenced codes. National Fire Protection Association (NFPA) standards
are the basic standards of reference, but other codes and/or standards
may be included as part of the GUidelines. See Section 1.1-8 (Codes,
Standards, and Other Documents Referenced in the Guidelines).
A.1.1-5.2.2 The latest revision of code material is usually a
clarification of intent and/or ageneral improvement in safety concepts
and may be used as an explanatory document for earlier editions ofa
code.
Questions of applicability should be addressed as the need occurs.
The version of acode adopted by ajurisdiction may differ from the latest
version. Confirm the version adopted for use in a specific lo.cation with
the AHJ.

• *1.1-6 Equivalency Concepts
1.1-6.1 Although the Guidelines is adopted as a regu­
latory standard by many jurisdictions, it is the intent
of the document to permit and promote equivalency
concepts.
1.1-6.2 Nothing in this document shall be construed
as restricting innovations that provide an equivalent
level of performance with these standards provided
that no other safety element or system is compromised
to establish equivalency.
• 1.1-7 English/Metric Measurements
1.1-7.1 Where measurements are given in this docu­
ment, the English units shall constitute the basic
requirement. Approximately equivalent metric units
are provided in parentheses after the English units.
1.1-7.2 Either method shall be consistently used
throughout a given project design.
• 1.1-8 Codes, Standards, and
Other Documents Referenced in the
Guidelines
1.1-8.1 Listed in this section are codes and standards
that have been referenced in whole or in part in the
various sections of this document and documents from
which Guidelines concepts have been adopted.
1.1-8.2 Users of the Guidelines are encouraged to con­
sult these publications for further information as may
be necessary to achieve the final product. 1he editions
cited are those available at the time of publication.
APPENDIX
A.,.'-6Equivalency c:oncepts. When considering
eqUivalency allowances, the AHJ may consult avariety ofexpert sources
and may document the reasons for approval or denial of equivalency to
the requester.
Extraordinary circumstances, new programs, or unusual conditions
may lead the AHJ to approve methods, procedures, design criteria, and
functional variations other than those that appear in the Guidelines for
Design and[onstruction ofResidential Health, (are, andSupport Facili-
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
1.1 INTRODUCTION
Later editions will normally be acceptable where
requirements for function and safety are not reduced;
however, editions of different dates may have portions
renumbered or retitled. Care must be taken to ensure
that appropriate sections are used.
U.S. Access Board (www.access-board.gov)
ADA Standards for Accessible Design (www.ada.gov/reg
s20 10/20 1OADAStandards/20 1OADAstandards.
htm)
Uniform FederalAccessibility Standards (UFAS) (www.
access-board. gov/guidel ines-and-standards/
buildings-and-sites/about-the-aba-standards/ufas)
Acoustics Research Council, Acoustics Working
Group (www.speechprivacy.org)
"Sound & Vibration Design for Health Care Facilities"
(2010) (www.fgiguidelines.org/resources)
Air Force Civil Engineer Center (www.wbdg.org.ffe!
af-afcee!design-guides-standards)
''Air Force Services Facilities Design Guide,
Design: Fitness Centers" (2011) (www.wbdg.
org/ffe!af-afcee!design-guides-standards/
fitness-centers-design-guide/fitness_centeedg.pdf)
American Institute of Architects (www.aia.org)
Moore, Keith Diaz. "Design Guidelines for Adult
Day Services" in AlA Report on University Research
2005.
American National Standards Institute (www.ansi.
org)
ANSI S1.1: Acoustical Terminology (2013)
ANSIIASA S2.71: Guide to the Evaluation ofHuman
Exposure to Vibration in Buildings (2012)
ANSIIASA S3.5 (R2012): Methodsfor Calculation of
the Speech Intelligibility Index (1997)
ties when the facility can effectively demonstrate that the intent of the
Guidelines is met and the variation does not reduce the safety, opera­
tional effectiveness, or resident quality of life below that reqUired by the
exact language of the Guidelines.
In all cases where specific limits are described, eqUivalent solutions
will be acteptable if the AHJ approves them as meeting the intent of the
Guidelines.
7
1.1 INTRODUCTION

American Society of Civil Engineers (www.asce.org)

American Society of Sanitary Engineering
ASCE/SEI 7: Minimum Design Loadsfor Buildings and
(www.asse-plumbing.org)
Associated Criteria and Other Structures (2016)
ANSIIASSE 6000: Professional Qualifications Standard
for Medical Gas Systems Personnel (2015)
American Society of Heating, Refrigerating and
Air-Conditioning Engineers (www.ashrae.org) American Society for Testing and Materials (www.
ASHRAE Handbook-HVAC Applications (2015) astm.org)
ANSIIASHRAE Standard 55: Thermal Environmental ASTM E492: Standard Test Methodfor Laboratory
Conditions for Human Occupancy (2013)
Measurement ofImpact Sound Transmission Through
ANSIIASHRAE Standard 62.1: Ventilation and
Floor-Ceiling Assemblies Using the Tapping Machine
Acceptable Indoor Air Quality (2016)
(2016)
ANSIIASHRAE Standard 62.2: Ventilation and ASTM E 1007: Standard Test Methodfor Field
Acceptable Indoor Air Quality in Low-Rise Measurement ofTapping Machine Impact Sound
Residential Buildings (2016) Transmission Through Floor-Ceiling Assemblies and
ANSIIASHRAE/IES Standard 90.1: Energy Standard Associated Support Structures (2016)
for Buildings Except Low-Rise Residential Buildings ASTM E 1130: Standard Test Methodfor Objective
(2016) Measurement ofSpeech Privacy in Open Plan Spaces
ANSIIASHRAE Standard 90.2: Energy-Efficient Design Using Articulation Index (2016)
ofLow-Rise Residential Buildings (2007) ASTM E2638: Standard Test Methodfor Objective
ANSIIASHRAE Standard 154: Ventilation for Measurement ofthe Speech Privacy Provided by a
Commercial Cooking Operations (2016) Closed Room (2010)
ANSIIASH RAE Standard 188: Legionellosis: Risk ASTM E2921: Standard Practice for Minimum Criteria
Management for Building ~ter Systems (2015) for Comparing Whole Building Life Cycle Assessments
ANSIIASHRAElIES/USGBC 189.1: Standardfor the for Use with Building Codes and Rating Systems
Design ofHigh-Performance, Green Buildings Except (2016)
Low-Rise Residential Buildings (2014)
ANSIIASHRAE/ASHE Standard 189.3: Design,
American Tree Farm System (American Forest Foun­
Construction, and Operation ofSustainable High­
dation) (www.treefarmsystem.org)
Performance Health Care Facilities (2017)
American Tree Farm System 2015-2020 Standards of
Humidity Control Design Guide for Commercial and
Sustainability (2015)
Institutional Buildings (2014)

Thermal Guidelines for Data Processing Environments,

American Water Works Association (www.awwa.org)
4th ed. (2015)
American Society of Mechanical Engineers (www.
asme.org)
ANSIIASME A17.1: Safety Code for Elevators and
Escalators (2016)
ANSIIASME A17.3: Safety Code for Existing Elevators
and Escalators (2015)
AWWA M14: Recommended Practicefor Backflow
Prevention and Cross-Connection Control (2015)
Americans with Disabilities Act (U.S. Department of
Justice) (www.ada.gov)
ADA Standards for Accessible Design (www.ada.gov/reg
s20 10120 1OADAStandards/20 1OADAstandards.
htm)

American Society of Safety Engineers (www.asse.org) British Standards Institution (shop.bsigroup.com)

Holman, G. T., Troy Blackburn, and S. Maghsoodloo.
"The Effects of Restricting Space: A study involv­
ing a patient-handling task." Professional Safety
55(7),38-46 (2010).
BS EN 15804: Sustainability ofconstruction works.
Environmental product declarations. Core rules for
the product category ofconstruction products (2013)
Bureau of Labor Statistics (www.bls.gov)
Industries at a Glance: Healthcare and Social Assistance
(www.bls.gov/iag/tgs/iag62.htm#Workforce)

8 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

Business + Institutional Furniture Manufacturers
Association (www.bifma.org)
ANSIIBIFMA e3: Furniture Sustainability Standard
(2014)
California Department of Public Health,
Environmental Health Laboratory Branch,
Indoor Air Quality Section
Standard Methodfor the Testing and Evaluation ofVola­
tile Organic Chemical Emissions from Indoor Sources
Using Environmental Chambers, version 1.2 (2017)
Canadian Standards Association (www.csagroup.org)
CAN/CSA Z809: Sustainable Forest Management:
Requirements and Guidance (2016)
Center for Health Design (www.healthdesign.org)
Joseph, Anjali, et al. "Designing for Patient Safety:
Developing Methods to Integrate Patient Safety
Concerns in the Design Process." (2012)
Joseph, Anjali, and Xiaobo Quan. "Summary
of Literature Review: Resident Safety Risk
Assessment." (2012)
Lee, Su Jin, et al. "Beyond ADA Accessibility
Requirements: Meeting Seniors' Needs for Toilet
Transfers." Health Environments Research & Design
Journal (2017).
Malone, Eileen B., and Barbara A. Dellinger. "Furni­
ture Design Features and Healthcare Outcomes."
(201l)
Rohde, Jane. "Issue Briefs: Residential Healthcare
Facilities" (2012).
Centers for Disease Control and Prevention
(www.cdc.gov)
"Design and Operation of Pools and Hot Tubs," a
CDC Web page (www.cdc.gov/healthywater/
swimmingl poolsl design -0 peration-pools-hot-tubs.
html#design)
"Guidelines for Preventing the Transmission of Myco­
bacterium tuberculosis in Health-Care Settings,
2005." Morbidity and Mortality Weekly Report 54
(RR-17), 2005. (www.cdc.gov/mmwrlpreview/
mmwrhtmllrr5417a1.htm?s_cid=rr5417aLe)
"Guidelines for Environmental Infection Control in
Health-Care Facilities." Morbidity and Mortality
Weekly Report 52 (RR-10):1-48, 2003. (www.cdc.
gov/mmwrlpreview/mmwrhtmllrr5210a1.htm)
Guidelines for Design and Construction of Residential Health, Care, and Support Faciiities
1.1 INTRODUCTION
Centers for Medicare & Medicaid Services (www.
cms.gov)
"Medicare and Medicaid Programs; Reform of
Requirements for Long-Term Care Facilities."
Federal Register, 2016. (www.federalregister.gov/
documents/20 161 10104/20 16-235031 medicare­
and-medicaid-programs-reform-of-requirements­
for-long-term-care-facilities)
Center for Occupational Safety and Ergonom­
ics Research, Department of Occupational &
Environmental Safety & Health, University of
Wisconsin-Whitewater
Choi, Sang, D. and Kathryn Brings. "Work-related
musculoskeletal risks associated with nurses and
nursing assistants handling overweight and obese
patients: A literature review." WOrk, 53(2),
439-448. doi:10.3233/WOR-152222 (2016).
Facility Guidelines Institute (www.fgiguidelines.org)
Behavioral Health Design Guide (2017)
"Patient Handling and Movement Assessments: A
White Paper" (2010)
"Resources for Selecting Architectural Details, Surfaces,
and Furnishings for Health Care Facilities" (2010)
Federal Emergency Management Agency (www.fema.
gov)
FEMA P-750: NEHRP [National Earthquake Hazards
Reduction Program} Recommended Seismic Provisions
for New Buildings and Other Structures (2009)
Forest Stewardship Council (https:llic.fsc.org/index.
htm)
FSC-STD-01-001 (V5-2): FSC Principles and Criteria
for Forest Stewardship (2015)
Georgia Institute ofTechnology (www.gatech.edu)
Sanford, Jon A., and Margaret Calkins, PhD. "Beyond
ADA Accessibility Requirements: Meeting Seniors'
Needs for Toilet Transfers" (unpublished article,
2016).
Green Building Initiative™ (www.thegbi.org)
ANSIIGBI 01: Green Building Assessment Protocolfor
Commercial Buildings (2010) (www.thegbi.
orglcontentlmisciANSI-GBI-O1-201O-Standard.pdf)
Green Globes® for New Construction
Green Globes® for Existing Buildings
9
1.1 INTRODUCTION

Green Guide for Health Care™ (www.gghc.org) Sanford, Jon, and Margaret Calkins. "Determination
of Grab Bar Specifications for Independent and
Green Seal (www.greenseal.org)
Assisted Transfers in Residential Care Settings."
GS-ll: Paints, Coatings, Stains, and Sealers (2015)
(2014)
GS-36: Adhesives for Commercial Use (2013)

National Fire Protection Association (www.nfpa.org)

Illuminating Engineering Society (www.ies.org) NFPA 13: Standardfor the Installation ofSprinkler
ANSIIIES RP-28: Lighting and the Visual Environment Systems (2016)
for Seniors and the Low Vision Population (2016) NFPA 70: National Electrical Code® (2017)
NFPA 72: National Fire Alarm and Signaling Code
International Association for Healthcare Security
(2016)
and Safety (www.iahss.org)
NFPA 90A: Standardfor the Installation of
Security Design Guidelines for Health Care Facilities Air-Conditioning and Ventilating Systems (2018)
(2016) NFPA 96: Standardfor Ventilation Control and Fire
Protection ofCommercial Cooking Operations (2017)
International Code Council (www.iccsafe.org)
NFPA 99: Health Care Facilities Code (2015)
NFPA 101: Life Safety Code® (2015)
ICC AI17.1: Accessible and Usable Buildings and Facili­
ties (2017)
NFPA 110: Standardfor Emergency and Standby Power
International Building Code (2015)
Systems (2016)
International Energy Conservation Code (2015)
NFPA 255: Standard Method ofTest ofSurface Burning
International Green Construction Code (2015)
Characteristics ofBuilding Materials (2006)
International Plumbing Code (2015)

National Institute of Building Sciences (www.nibs.org)

International Organization for Standardization Design Guidelines for the Visual Environment (May
(www.iso.org) 2015). (www.nibs.org/resourcelresmgr/LVDC/
ISO-7731: Danger Signals for WOrk Places-Auditory LVDP_Guidelines_052815.pdf)
Danger Signals (2003)
ISO 9921: Ergonomics-Assessment ofSpeech Communi­ National Institute on Drug Abuse (www.drugabuse.
cation (2003) gOY)
ISO 14025: Environmental labels and declarations­ Principles ofDrug Abuse Treatment for CriminalJus­
TJpe III environmental declarations-Principles and tice Populations: A Research-Based Guide (www.
procedures (2006) drugabuse.gov/publications/principles-drug­
ISO 14040: Environmental management-Life cycle
abuse-treatment-criminal-justice-populations/
assessment-Principles andframework (2006)
principles)
ISO 14044: Environmental management-Life cycle
Therapeutic Community (http://archives.drugabuse.gov/
assessment-Requirements and guidelines (2006) researchreports/TherapeuticlTherapeutic3.html)
ISO 21930: Sustainability in building construction­
Environmental declaration ofbuildingproducts (2017) National Institute of Occupational Safety and
Health (www.cdc.gov/niosh)
The Joint Commission (www.jointcommission.org) DHHS (NIOSH) Publication 97-111: "Selecting,
''Advancing Effective Communication, Cultural Com­ Evaluating, and Using Sharps Disposal Containers"
petence, and Patient- and Family-Centered Care: Oanuary 1998) (www.cdc.gov/niosh/docs/97-11l)
A Roadmap for Hospitals" (www.jointcommission. DHHS (NIOSH) Publication 2004-165: NIOSH
org/assets/ 1/6/ARoadmapforHospitalsfinalver­ Alert-Preventing Occupational Exposure to Antineo­
sion727.pdf) plastic and other Hazardous Drugs in Health Care
Settings
The Mayer-Rothschild Foundation (www.themayer­
rothschildfoundation.org) National Research Council Canada, Institute for
Research in Construction (www.nrc-cnrc.gc.ca)

10 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

Bradley, ]. S. "The Acoustical Design of Conventional
Open Plan Offices," NRCC-46274 (2003).
Veitch,]. A., et al. "Masking Speech in Open-Plan
Offices with Simulated Ventilation Noise: Noise
Level and Spectral Composition Effects on Acous­
tic Satisfaction," IRC-IR-846 (April 2002).
National Stone Council (www.naturalstonecouncil.
org)
ANSIINSC 373: Sustainable Production o/Natural
Dimension Stone (2013)
New York State Office of Mental Health
Patient Safety Standards, Materials and Systems Guide­
lines (www.omh.ny.gov/omhweb/patiencsafety_
standards/guide.pdf)
Noise and Vibration Control Engineering
Ver, Istvan L., and Leo L. Beranek. Noise and Vibration
Control Engineering: Principles and Applications,
2nd ed. (Wiley, 2005).
North Carolina Office on Disability and Health and
the Center for Universal Health
Removing Barriers to Health Clubs and Fitness Facilities:
A Guide for Accommodating All Members, Including
People with Disabilities and Older Adults (2008)
(/pg. unc. edulsiteslfpg. unc. eduljilesl. ..INCODH_
RemovingBarriersToHealthClubs.pdfJ
NSF International (www.nsf.org)
NSF/ANSI 140: Sustainability Assessmentfor Carpet
(2015)
NSF/ANSI 332: Sustainability Assessmentfor Resilient
Floor Coverings (2015)
NSF/ANSI 336: Sustainability Assessmentfor Commer­
cial Furnishings Fabric (2011)
NSF/ANSI 342: Sustainability Assessmentfor Wallcover­
ing Products (2014)
NSF/ANSI 347: Sustainability Assessmentfor Single Ply
Roofing Membranes (2012)
Occupational Safety and Health Administration,
U.S. Department of Labor (www.osha.org)
Code 0/Federal Regulations (CFR) Title 29-0SHA
Regulations, Part 1910 (29 CFR 1910), Occupa­
tional Safety and Health Standards (www.osha.gov/
pls/oshaweb/owastand.display_standard_group?p_
toc_Ievel= 1&p_part_number= 1910)
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
1.1 INTRODUCTION
Programme for the Endorsement of Forest Certifica­
tion (www.pefc.org)
PEFC National Standards
South Coast Air Quality Management District
(www.aqmd.gov)
SCAQMD Rule 1168: Adhesive and Sealant Applica­
tions (www.aqmd.gov/rules/reg/reg11/r1168.pdf)
Sustainable Forestry Initiative® (www.sfiprogram.org)
SFI 2015-2019 Forest Management Standard
Telecommunications Industry Association (www.
tiaonline.org )
TIA-607-C: Generic Telecommunications Bonding and
Grounding (Earthing) for Customer Premises (2015)
Tile Council of North America (www.tcnatile.com)
ANSI A138.1: Green Squarecf> -American National
Standard Specifications for Sustainable Ceramic Tiles,
Glass Tiles, and Tile Installation Materials (2011)
Toxic Substance Control Act
Title VI-Formaldehyde Standards for Composite
Wood Products (www.epa.gov/formaldehyde/
fo rmaldehyde-emission-standards-composite­
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UL 100: Standardfor Sustainability for Gypsum Boards
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UL 102: Standardfor Sustainability for Swinging Door
Leafs (2012)
UL 1069: Standardfor Hospital Signaling and Nurse
Call Equipment (2007)
UL 2560: Standardfor Emergency Call Systems for
Assisted Living and Independent Living Facilities
(2011)
UL 2762: Adhesives (2011)
UL 2768: Standardfor Sustainability for Architectural
Surface Coatings (2011)
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The Noise Guidebook (www.hudexchange.info/
resource/313/hud-noise-guidebookJ)
11
1.1 INTRODUCTION

U.S. Department ofVeterans Affairs, Office of

U.s. Green Building Council (www.usgbc.org)
Construction & Facilities Management
LEED® vA (includes LEED for Healthcare) Green
Mental Health Facilities Design Guide (www.cfm.va.gov/ Building Rating System (2013)
tilldguide/dgMH. pdf)
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u.s. Pharmacopeia-National Formulary (USP-NF)­
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<Chapter 1066>: "Physical Environments that
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tions/searchform.cfm?Pub=9))
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org)
Senior Living Sustainability Guide® (2011)

12 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 1.2 Planni g/Predesign Process
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 1.2-1 General natural environment, residential health, care, and

support facilities shall be designed in a framework that
1.2-1.1 Application considers the following:
The provisions of this chapter shall apply to all residen­
tial health, care, and support facility projects. 1.2-1.3.2.1 Organizational philosophy

*1.2-1.2 Planning Process 1.2-1.3.2.2 Organizational structure

To meet the objectives of this chapter, residential
health, care, and support organizations shall develop 1.2-1.3.2.3 Staff roles
an interdisciplinary planning process to guide facility
design. 1.2-1.3.2.4 Staff education and training

1.2-1.3 Environment of Care and Facility

*1.2-1.3.2.5 Resident quality of life
Function Considerations

1.2-1.3.2.6 Operational processes and procedures

*1.2-1.3.1 General
Environment of care and facility function directly 1.2-1.3.2.7 Resident safety, including provisions for
affect the experience of residential health, care, and infection control. See Section 1.2-3 (Resident Safety
support facility occupants. See sections 1.2-2 (Func­ Risk Assessment) for requirements.
tional Program) and 1.2-4 (Environment of Care
Requirements) for requirements.
• 1.2-2 Functional Program
1.2-1.3.2 Framework for Res.idential Health, Care,
1.2-2.1 General
and Support Facility Design
Because the physical environment has a profound
1.2-2.1.1 Functional Program Purpose
effect on human health and productivity and on the

APPENDIX"

A1.2~ 1.2 Pla.nning process a. Resident and staff outcomes

a. Project planning, design, and implementation are three separate
b. Resident experiencE' of the core values for resident care: choice, dig­
processes. ~unctional programming occurs during the planning
nity, privacy, mea"ningful engagement, individuality, and residential
phase. The design process inCludes architectural programming,
environment
design, and construction documentation. Implementation is the
c. tevels of resident and staff stress
realization of the functional program in the built environment.
d. Overall facility operations
b. In the planning phase, input from avariety of interdisciplinary teams
A1.2-1.3.2~5 Resident quality of life. Residential health,

may be appropriate. Members of these teams should be selected

care, and support organizations should engage residents, potential

from stakeholder groups affected by the project.

residents,ana their families in project planning.

A1.2-1.3.1 How environment of care and facility function

requirements are addressed in the design of residential health, care,.and

support facilities influences the following:

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 13
1.2 PlANNING/PREDESIGN PROCESS
1.2-2.1.1.1 The functional program shall be used
to develop the physical space program that serves
as the basis for the project design and construction
documents.
1.2-2.1.1.2 The care provider shall retain the func­
tional program with other design data to facilitate
future alterations, additions, and program changes.
1.2-2.1.2 Functional Program Requirement
1.2-2.1.2.1 The care provider shall be responsible for
providing a functional program for each facility project
to the project architect/engineer and the authority
having jurisdiction (AHJ).
(1) Projects that only involve activities such as
equipment replacement, fire safety upgrades, or
minor renovations that will not change the facility's
function or character shall not require a functional
program.
(2) Findings and recommendations from the resident
safety risk assessment (see Section 1.2-3) shall be
addressed in the functional program.
1.2-2.1.2.2 The functional program shall include an
executive summary as well as detailed information
about each operation conducted in the facility that will
affect the physical setting design.
1.2-2.1.2.3 The functional program or a functional
program summary shall be submitted to the AHJ for
review along with the plans and specifications.
1.2-2.1.3 Nomenclature in the Functional
following information for the project consistent with
Program
the provider's expectations for the delivery of care
1.2-2.1.3.1 Names for spaces and departments used in
the functional program shall be consistent with those
used in the Guidelines for Design and Construction of
APPENDIX
A1.2-2.1.4.2 Shared services. In some cases, all ancillary ser­
vice requirements will be met by the principal facility and modifications
will be necessary only in the residential facility. In other cases, program­
matic concerns and requirements may dictate separate service areas.
A1.2-2.2.1.2 The information should take into account potential
future changes in the care model and the need for flexibility in the
physical setting.
14 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
Residential Health, Care, and Support Facilities (Guide­
lines for Residential Facilities). If acronyms are used,
they shall be clearly defined.
1.2-2.1.3.2 The names and spaces indicated in the
functional program shall also be consistent with those
used on submitted floor plans.
1.2-2.1.4 Shared Services
1.2-2.1.4.1 Each residential health, care, or support
facility shall, at minimum, contain the elements
described in the applicable chapters of the Guidelines
for Residential Facilities. However, where a project
calls for sharing or purchasing services, appropriate
modifications or deletions in space and parking
requirements shall be permitted.
*1.2-2.1.4.2 Where a residential health, care, or
support facility is part of or contractually linked
with another facility, sharing of services such as
dietary, storage, pharmacy, linen, and laundry shall be
permitted insofar as practical.
1.2-2.2 Functional Program Content
1.2-2.2.1 Owner's Project Requirements
1.2-2.2.1.1 The functional program shall describe in
detail the care provider's expectations for the project,
including the delivery of care model.
*1.2-2.2.1.2 The functional program shall provide the
model and project scope:
*(1) Who will be served by the project (residents, staff,
families, volunteers, etc.)
(a) If the care population includes residents who
are persons of size, see Section 2.2-3 (Design
A1.2-2.2.1.2 (1) Evaluation of ways to incorporate intergenera­
tionaIinteraction and integration with the community at-large into the
project should be part of the functional programming process.
 1.2 PLANNING/PREDESIGN PROCESS

Criteria for Accommodations for Care of (b) Major points of entry

Persons of Size).
*(b) If the care population includes residents with
dementia, mental health issues, or cognitive
and developmental disabilities, see Section
2.2-4 (Design Criteria for Dementia, Mental
Health, and Cognitive and Developmental
Disability Facilities).
*(2) What user activities will occur in the spaces
affected or created by the project
(3) Why each user group is engaged in each activity
(4) When these activities will take place
(5) Where these activities will take place (inside and
outside the building)
(6) What resources (i.e., people, equipment, supplies,
processes, training) will be needed to carry out
these activities
(c) Landscaping and garden features (hardscape
and softscape)
(d) Pedestrian circulation
(e) Vehicular circulation (roads and parking)
(f) Wayfinding (landmarks and signage)
(g) Art
(h) Outside programming
(i) Lighting
(2) Operational circulation patterns. These shall
include interior and exterior circulation patterns
for:
(a) Residents, staff, and family/visitors
(b) Equipment for infectious waste handling
(3) Space and equipment needs. The following shall be
described for each space:

1.2-2.2.2 Functional Requirements (a) Size and function

(b) Projected occupant load (staff; residents,
1.2-2.2.2.1 The project design shall accommodate the including their mobility needs; and visitors)
care provider's operational needs and objectives com­ (c) Projected numbers and types of community
mensurate with the scope and purpose of the project. spaces
(d) Required adjacencies
1.2-2.2.2.2 Explanation of the functional require­
(e) Technology requirements
ments for the project shall cover, at minimum, the
(f) Acoustic requirements
following:
(g) Lighting requirements
(1) Site (h) Electrical requirements
(i) Heating, ventilation, and air-conditioning
*(a) Building orientation requirements

APPENDIX

A 1.2-2.2.1.2 (1 Hb) Residents with dementia and

b. Items used in community spaces
<:ognitive or mental health issues
c. Staff belongings
a. When discussing residents with dementia and cognitive or mental d. Supplies required for resident and staff activities
health issues during the functional programming process, it is
A 1.2-2.2.2.2 (1 Ha) Building orientation. Building
important to emphasize the residents' capabilities and not focus on
orientation and related site issues that should be considered include the
their deficits. Individual residents should be viewed as who they are
following:
in total, not defined by abilities they have lost.
a. Solar aspect to maximize daylighting in interior spaces and northern
b. In some facilities, asignificant percentage of individuals with some

and southern exposures for glaZing

level of dementia may reside outside adesignated dementia care

b. Glare control on all exposures (includes use of light shelves, over­

unit. Specific considerations for residents with dementia, mental

hangs, window treatments, etc.)

health issues, or cognitive and developmental disabilities should be

c. Direction of prevailing winds

evaluated.

d. Topographical information
A1.2-2.2.1.2 (2) Evaluation of storage requirements related to
e. Ground water and surface water management
different user activities should be part of the functional programming
f. Sustainability issues
process. At minimum, storage should be provided for the following:
g. Views and vistas
a. Resident belongings

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 15
1.2 PlANNING/PREDESIGN PROCESS

(j) Fixed and movable equipment 1.2-3.1.1.2 To support this goal, a resident safety risk
(k) Furnishings and fixtures assessment shall be developed and completed by an
interdisciplinary team.
(4) Short- and long-term planning considerations.

These shall include the following:

*1.2-3.1.2 RSRA Components

(a) Flexibility and future growth The RSRA shall address how the physical environ­
(b) Impact on existing adjacent facilities ment of the residential health, care, or support facility
(c) Effect on existing operations may affect resident safety outcomes and shall include
(d) Integration of technology and equipment assessment of the components identified in Table 1.2-1
(e) Changes in resident population over time, (Resident Safety Risk Assessment Components).
including cognitive and physical abilities
(f) Provisions for end-of-life care for residents and 1.2-3.1.3 RSRA Timing
support of families
1.2-3.1.3.1 The resident safety risk assessment shall
be initiated by the care provider during the functional
• *1.2-3 Resident Safety Risk
programming phase of the health, care, or support
facility project (i.e., before construction begins) and
Assessment (RSRA)
continue through project construction and commis­
sioning as applicable.
1.2-3.1 General
*1.2-3.1.3.2 The RSRA shall be updated with addi­
1.2-3.1.1 RSRA Requirement
tional detail as required to support a safe environment
throughout the design, construction, and commission­
*1.2-3.1.1.1 Every new or renovated residential health,
ing phases of the project.
care, or support facility shall be designed to facilitate
safe delivery of care consistent with the level of care
1.2-3.1.4 RSRA Team
outlined in the functional program.

1.2-3.1.4.1 The care provider shall appoint an

interdisciplinary team to conduct the resident safety
risk assessment.
APPENDIX

A1.2-3 RSRA. The resident safety risk assessment is a multidisci­
pli nary, documented assessment process used to proactively identify
hazards and risks and mitigate underlying conditions of the built envi­
ronment that may contribute to adverse safety events while balancing
the importance of quality of life for individual residents. Hazard and risk
events include infections, falls, medication errors, immobility-related
outcomes, security breaches, and musculoskeletal or other injuries. The
RSRA process takes into account the models of care, operational plans,
sustainable design elements, and performance improvement initiatives
of the care prOVider organization. The process also includes evaluation of
the population at risk, the nature and scope of the project, and opportu­
nities to adjust the acceptable level of safety risk in accord with individ­
ual personal assessments to support quality of life. The RSRA proposes
A1.2-3.1.2 RSRA components
The resident safety risk assessment should also address how the physical
environment of the residential health, care, or support facility can help
maintain residents'functional capabilities.
For additional information on safety outcome categories
incorporated in the RSRA component descriptions, see aliterature
review undertaken by the Center for Health Design (CHO): "Summary
of Literature Review: Resident Safety Risk Assessment" (July 2012) on
the CHO website (www.healthdesign.org). See the Facility Guidelines
Institute website (www.fgiguidelines.org) for a RSRA matrix based
on six categories of resident safety outcomes identified in the CHO
literature review.
A1.2-3.1.3.2 Postoccupancy evaluations should be undertaken,

built environment solutions to mitigate identified risks and hazards

and information from these evaluations should be included in the RSRA

without detracting from resident qualify of life wherever possible.

updates.

A1.2-3.1.1.1 The RSRA should be evaluated in terms of the care

population, including residents' cognitive ability, to encourage fleXibility
for individual resident quality of life.

16 Guidelines for Design and Construction of Residential Health, Care, and Support FaCilities
 1.2 PlANNING/PREDESIGN PROCESS

*1.2-3.1.4.2 The RSRA team shall include stakeholders (6) Security risk
for the identified project. (7) Disaster risk and emergency preparedness

1.2-3.1.5 RSRA Process *1.2-3.1.5.2 Evaluate risks and opportunities to

The care provider shall complete a resident safety risk
assessment to determine potential risks and resulting
impacts to residents and caregivers for each space and
building component that is part of the project.
1.2-3.1.5.1 Identify risks. For each space in the
building, the RSRA shall identify the following specific
enhance quality of life.
(1) The care population profile (including cognitive
abilities of residents) identified during the
functional programming process shall be used as a
basis for evaluating resident safety-related risks and
quality-of-life opportunities.
(2) Identified risks should also be evaluated for the

categories of risk: following:

(1) Infection control risk (a) Likelihood of occurrence based on historical

(2) Resident mobility and transfer risk data, if available
(3) Resident fall risk and prevention (b) Degree of potential harm to residents
(4) Resident dementia and mental health risk
(5) Medication error risk (3) Identified quality-of-life opportunities shall be

evaluated for the following:

APPENDIX

A 1.~-3.1.4.2 RSRA team members. Project stakeholders -Visual disorganization of spa(e, including lack of standardiza­
may include the folloWing as well as others, depending on the nature tion in layout and location of spaces and equipment
and needs of the project: -Impediments to resident movement and ambulation, including
a. Maintenance and environmental services staff environmental hazards that may cause residents to slip, trip, or
b. Safety, security, and transportation staff fall
c. Direct care staff -Impediments to staff movement and work flow, including envi­
d. Quality assurance staff ronmental hazards that may cause staff to slip, trip, or fall
e. Activity staff -Communication, including design features· that may hinder
f. Management staff communication between staff members, residents and staff,
g. Therapy staff residents and family members, and staff and family members.
h. Planning and design professionals -Space requirements that may unduly limit auditory; visual, and/
i. Residents and family members or lighting control by residents and family
b. For additional information, see the Center for Health Design report
A1.2-3.1.5.2 Evaluation of risks and opportunities
"Designing for Patient Safety: Developing Methods to Integrate
to enhance quality of life
Patient Safety Concerns in the Design Process" (2012), which identi­
a. Each space should be assessed for the presence of harmful, stress­

fies 10 environmental factors as "latent conditions that can be

inducing agents or latent conditions as well as for opportunities

designed to help eliminate harm."Such "built environment latent

to mitigate those conditions to enhance quality of life. Examples

conditions [holes and weaknesses] that adversely impact patient

include the follOWing:

safety" should be identified and eliminated during the planning,

-Noise and vibration
design, and construction of health care facilities. The report can be
-Visual distraction
found at www.healthdesign.org/sites/defaultlfiles/chd416_ahrqre- ..
-Light type, quality, and quantity, including lighting that
port_final.pdf.
addresses specific tasks and promotes ease of ambulation
An example of the importance of assessing risks during. the plan­
-Surface characteristics, including environmental sources of
ning, design, and construction phases of a project is the location
infection
of hand-washing stations. According to the CHD report, placement
-Indoor air characteristics, including environmental sources of
of these facilities in "inconvenient or inaccessible locations"could
infection
"result in poor hand-washing compliance" among physicians, nurses,
-Ergonomics, including design features that contribute to staff
and other care providers.
fatigue
-Space requirements, including space adjacencies that do not
support the care model

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 17
1.2 PLANNING/PREDESIGN PROCESS
(a) Likelihood of opportunity based on historical
data, if available
(b) Degree of potential enhancement to resident
quality of life
*1.2-3.1.5.3 Prepare RSRA reporting and comply
with the recommendations provided.
(1) The RSRA team shall produce a written report that:
(a) Identifies known environmental risks based on
RSRA components to be used in development
of the functional program and in the design,
construction, and commissioning of a
residential health, care, or support facility:
(i) Infection control risk
(ii) Resident mobility and transfer risk
(iii) Resident fall risk and prevention
(iv) Resident dementia and mental health risk
(v) Medication error risk
(vi) Security risk
(vii) Disaster risk and emergency preparedness
(b) Specifies design features intended to reduce or
eliminate potential risks from adverse events
for inclusion in the project design.
(c) Identifies opportunities to improve the quality
of life for residents for inclusion in the project
design.
(2) The conclusions in the written report shall:
(a) Be incorporated into the functional and
physical space programs.
APPENDIX
A1.2-3.1.5.3 Where available, benchmarked resident and caregiv.er
safety data and national industry resident and caregiver safety trends
should be used as a benchmark for developing the report.
A1.2-3.2 leRA. The infection control. risk assessment is an
interdisciplinary, documented process intended to identify and
mitigat~ risks from infection that could occur as a result of design and
construction activities, taking into account:
a. The resident population at risk
b. The nature and scope of the project
c. The functional program of the residential health, care, or support
minimizing exposure to chemical pollution, ventilation systems are an
facility
important means of preventing infection (e.g., HEPA filtration, which
d. The potential risk oftransmission of various airborne and waterborne
biological contaminants in the facility
18 Guidelines for Design and Con'struction of Residential Health, Care, and Support FaCilities
(b) Remain an active component of the following
project documents:
(i) Planning, design, equipment and
furniture specifications
(ii) Construction documentation
(iii) Commissioning records
(iv) Postoccupancy evaluation documents
(3) Changes to the original design plans and as-built
documentation, including changes in identified
risks and solutions, shall be recorded, updated, and
shared among RSRA team members throughout
project design, construction, and commissioning.
*1.2-3.2 Infection Control Risk Assessment
For a facility project to support safe designs, finishes,
surfaces, HVAC systems, and plumbing systems, an
infection control risk assessment (I CRA) shall be part
of the resident safety risk assessment.
1.2-3.2.1 Elements to Be Assessed
The care provider shall provide the results of an evalua­
tion of infection control risk for the following ele­
ments for incorporation into the functional program:
*1.2-3.2.1.1 Design elements
(1) Heating, ventilation, and air-conditioning (HVAC)
systems
(a) Where airborne infection isolation (All) rooms
are required, the number, location, and type
shall be identified in the functional program.
*(b) Special HVAC needs to accommodate the
A1.2-1.2-3.2.1.1 Design elements. Research demonstrates
that single-resident rooms reduce health care-associated infections
(HAls), medical errors, falls, resident stress, and staff injuries while
improving resident sleep, privacy, and social support; staff efficacy and
communication with care consumers and family members; as well as
satisfaction of both residents and staff.
A1.2-3.2.1.1 (1 Hb) Special HVAC needs. Airborne
contamination can result where HVAC systems are improperly specified,
designed, built, or maintained. In addition to providing comfort and
is 99.97 percent effective in removing harmful particulates). An HVAC
system expert, whether an independent engineer or an employee of
the care provider, should determine which of the follOWing HVAC design
considerations should be covered in the ICRA:

services provided in or affected by the project
(e.g., HVAC needs for All rooms, pharmacies,
local exhaust systems for areas where hazardous
agents are present, and other special areas)
shall be identified in the functional program.
(c) Strategies for design of HVAC systems,
including those intended to reduce energy
costs, shall include development of designs
that minimize the risk of airborne transmission
of biological agents.
(2) Water/plumbing systems
*(a) The number, location, and type of hand­
washing stations, hand sanitation dispensers,
and emergency first-aid equipment (eyewash
stations and deluge showers) needed shall be
identified in the functional program.
*(b) Strategies for design of water systems or water
conservation systems shall include develop­
ment of designs that minimize the risk of
waterborne transmission of Legionella spp. and
other opportunistic pathogens.
(3) General design requirements for architectural
details, surfaces, and furnishings. See sections 2.4­
2.2.8 (Hand-Washing Stations), 2.4-2.3 (Surfaces),
and 2.4-2.4.2 (Casework, Millwork, and Built­
Ins).
1.2-3.2.1.2 Construction process elements. The fol­
lowing shall be evaluated for infection control risk:
APPENDIX (continued)
a. Characteristics of overall system design as well as design for spe­
cific sensitive areas, including components, capacity, filtration, air
changes, pressure relationships, and directional flow
b. Ease of access. for system maintenance
c. Ease of general maintenance activities and system cleaning
d. Selection of air distribution devices that allow for minimal or easy
cleaning
e. Location of air intakes and exhaust outlets to prevent cross-contami­
nation
f. Redundancy in equipment and systems
g. Plan for system 'Outages and maintenance (planned and unplanned)
Al.2-3.2.1.1 (2)(a) location of hand-washing sta­
tions. Locating hand-washing stations and/or hand sanitation dis­
pensers.in all high-volume care areas, including resident rooms, in the
sight lines of staff improves hand-sanitizing compliance, which redu,ees
HAls.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
1.2 PLANNING/PRE DESIGN PROCESS
*(1) The effects of disrupting essential services to
residents and staff
(2) The specific hazards and protection levels for each
designated area
(3) Location of residents according to their
susceptibility to infection and the identification of
risks to each
(4) Impact of movement of debris, traffic flow, spill
cleanup, and testing and certification of installed
systems
(5) Assessment of external and internal construction
activities
(6) Location of known hazards
1.2-3.2.2 Infection Control Risk Mitigation
Recommendations (ICRMRs)
The following shall be included in the RSRA report:
*1.2-3.2.2.1 Specific methods for avoiding transmis­
sion of airborne and waterborne biological contami­
nants during construction and commissioning, where
HVAC and plumbing systems and equipment (e.g., ice
machines) are started/restarted
*1.2-3.2.2.2 Provisions for monitoring infection con­
trol risk, including:
(1) Written procedures for emergency suspension of
work
(2) Protective measures indicating the responsibilities
and limitations of each party (care provider,
designer, contractor, monitor)
A1.2-3.2.1.1 (2)(bl Water conservation sY$tems.
Providing touch-point cleaning that uses microfiber technologies. may
reduce HAls as well as chemical andwater use.
A1.2-3.2.1.2(1) Hazards specific to different types ofessential
service disruptions should be proactively determine.d. AnJilnshould
be developed to ensure continued provision of service in the event of
planned and unplanned disruptions,
A1.2-3.•2.2.1 Responsibilities for performing risk-mitigation proce­
dures should be included in infection control risk mitigation recommen­
dations to assure the proper actions are taken at the appropriate time.
A1.2-3.2.2.2 Monitoring efforts will be determined by the care
proVider and may be conducted by staff responsible for infection control,
safety staff,or independent outside conSUltants.
19
1.2 PLANNING/PRE DESIGN PROCESS

1.2-3.2.2.3 Recommendations for resident placement emergencies, including the need to protect residents
and relocation during construction and commissioning during planned and unplanned utility outages

*1.2-3.2.2.4 Standards for barriers and other protective 1.2-3.2.2.9 Impact of movement of debris, traffic Row,
measures required to protect adjacent areas and suscep­ cleanup, elevator use for construction materials and
tible residents from airborne contaminants construction workers, and construction worker routes

1.2-3.2.2.5 Temporary provisions or phasing for con­ 1.2-3.2.2.10 Provision for use of bathroom and food
struction or modification of HVAC and water supply facilities by construction workers
systems
*1.2-3.2.2.11 Installation of clean materials (particu­
1.2-3.2.2.6 Protection from demolition larly ductwork, drywall, and wood/paper/fabric mate­
rials) that have not been damaged by water
1.2-3.2.2.7 Training for facility staff, visitors, and

construction personnel
*1.2-3.3 Resident Mobility and Transfer Risk
Assessment
*1.2-3.2.2.8 Impact of potential utility outages or

APPENDIX

A1.2-3.2.2.4 Ventilation of the construction z:one c. Drywall installation should not proceed until exterior prot~ction

a. Airflow into the construction zone from occupied spaces should be

against rain damage has been installed.

maintained by means of adedicated exhaust system for th~ con­

A1.2-3.3 Resident mobility and transfer risk

stryction area.

assessment. The evaluation of resident mobility and transfer risks

b. Locations of exhaust discharge relative to existing fr~sh air intakes

is intended to proactiv~ly identify and mitigate the risk from physical

and filters, as well as the disconnection and sealing of existing air

environment features that contribute to resident immobility and to

ducts, should be reviewed as reqUired.

resident and staff injuries associated with resident mobility and transfer.
c. If the existing building system or a portion thereof is used to achieve
Information and guidance for evaluating resident mobility and transfer
this requirement, the system should be thoroughly cleaned prior to
risks can be found in "Patient Handling and Movement Assessments:
occupancy of the construction area.
AWhite Paper:' prepared by the 2010 Health Guidelines Revision
d. Construction barriers in high-risk areas (e.g., areas serving immuno­
Committee Specialty Subgroup on Patient Movement and posted at
compromised residents and All rooms) should have visual display of
www.fgiguidelines.org/resources.
airflow direction.
Caregivers repositioning and transferring resid~nts cannot manually
A1.2-3.2.2.•8 Disaster plans for water supply and
lift more than 35 pounds (15.89 kilograms) without putting themselves
ventilation emergencies
at risk for back injury. Assisting a resident out of bed and into and out
a. The care proVider should prOVide awritten plan for what will happen of achair and supporting an unsteady resident both carry additional
in the event ofawater outage~ This should include:
risks. As aconsequence, caregivers are at high risk for injury as aresult
-Where supplies are located
of resident handling and moving. If caregivers are not safely eqUipped
-Who is responsible for what
to perform these necessary physical tasks, residents may not receive
-Who is to be notified
adequate care and may spend more time sedentary in a bed or wheel­
b. The care proVider should proVide awritten plan for what will happen chair than is clinically adVisable or desirable. Increasing evidenc~ shows
in the event of an HVAC shutdown. This should include who is that early and frequent mobilization and movement is vital to the health
responsible for what and who is to be notified. of residents and integral to quality care.
c. The care prOVider should prOVide awritten plan for what will happen EqUipment is now available to facilitate necessary transfers,
in the event of awater leak. This should include who is to be notified. movement, and mobilization while significantly reducing the risk
of injury to caregivers and residents from these activities. By better
A1.2-3.2.2.11 Protection of b-..i1ding materials
supporting appropriate levels of care and redUcing the risk of injury
a. Construction materials should be kept clean and dry, as appropriate.
to caregivers, use of such equipment and related architectural
b. Ductwork should be kept capped/dean during demolition and dust­
accommodations will help maintain functional capabilities and improve
generating construction.
outcomes, thus redUcing the overall cost of care.

20 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

1.2-3.3.1 Locations to Be Assessed
Resident mobility and transfer risk evaluation shall
address the specific needs of all areas affected by the
project where resident transfers and movement occur,
including but not limited to the following:
1.2-3.3.1.1 Resident rooms and toilet rooms
1.2-3.3.1.2 Residential living and community spaces
(e.g., dining and recreation areas), including associated
toilet and bathing areas
1.2-3.3.1.3 Examination rooms and other diagnostic
and treatment areas
APPENDIX
Al.2-3.3.2 Mitigation for mobility and
mobilization concerns. The types of equipment needed
in each residential unit and treatment area are determined by the
characteristics of the resident population. Recommendations for
mitigating mobility and transfer risks should be developed for all areas
in a new construction or renovation project. These recommendations
should address the locations where resident transfers and mobilization
will occur and the types of resident mobility and transfer tasks relevant
to the care population.
The objective of preparing these recommendations is to assure
proper accommodations are proVided for resident mobility and for mobi­
lization devices based on their type, size, weight capacity, and quantity.
Storage should be sized to accommodate the lift equipment, assistive
devices, and resident-operated mobility devices that will actually be
used.
A1.2-3.3.2.1 Design recommendations for
safe mobility and transfer. Technology, equipment, and
architectural details can be used to address evaluations of structural,
electrical, mechanical, and other design considerations.
a. Resident mobility and transfer tasks for which risk can be minimized
using equipment or other measures include the follOWing:
-Vertical and lateral transfers (from/to abed, chair, commode,
toilet, wheelchair, gurney, or trolley)
-Positioning/repositioning in bed (side to side, up to the head of
the bed, raising or lowering head or feet)
-Repositioning in chair
-Showering/bathing
-lifting appendages
-Transporting residents
-Assistance with resident ambulation
-Weighing residents on bed scales
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
1.2 PLANNING/PREDESIGN PROCESS
1.2-3.3.1.4 Wellness centers
1.2-3.3.1.5 Outdoor areas
1.2-3.3.1.6 Hallways and corridors
*1.2-3.3.2 Mobility and Mobilization Concerns
The following shall be evaluated for all areas where
resident mobility and transfers occur:
*1.2-3.3.2.1 Specific design recommendations to
support safe mobility and transfer tasks. This shall
include accommodations for charging batteries for
battery-operated equipment.
-Exiting furniture or beds (e.g., bedrails, extended chair arm
fronts)
-Supported ambulation extending beyond the resident room
(e.g., room-to-hallway ceiling track-supported walkway
system), if indicated in the functional program
-Transfers from resident chairs or other seats (e.g., adequate
clearances)
To correctly identify all resident mobility and transfer tasks and
impediments or hindrances to mobility in an area, care proViders and
other staff should be interviewed for their perceptions of which tasks
carry ahigh risk.
b. Types of resident mobiUty and transfer equipment that may be used
to minimize risk include:
-Sit-to-stand lifts. For a resident who requires partial assistance
and possesses some weight-bearing ability,sit-to-stand lifts
are used to assist in vertical transfers, toileting, dressing, arid
ambulation.
-Floor-based sling lifts and ceiling-mounted lifts. Botnofthese
lift types are used for residents who are completely or sub­
stantially unable to assist caregivers. Residents requiring these
levels of care are often described as "dependent" or requiring
"extensive assistance:'The utility of these lifts for this popula­
tion includes-but is not limited to-vertical transfers, lateral
transfers, repositioning in bed and chair, lifting appendages,
and lifting residents from the floor. These lifts can also be used
for assistance with ambulation rehabilitation or mobilization of
residents with some weight-bearing capability.
-Resident-operated mobility devices. These are devices residents
can use on their own and are intended to foster their indepen­
dence.
21
1.2 PlANNING/PREDESIGN PROCESS
*1.2-3.3.2.2 Types of resident mobility and
transfer equipment
(1) Implementation of any architectural solution that
supports ambulation and incentivizes mobility and
ambulation using the equipment available on-site
shall be considered.
(2) Provision of any furnishings that offer usable
maneuvering in and around areas where staff will
alternatives to extended bed-stays shall be
use resident mobility or transfer equipment.
considered.
(2) Resident rooms shall be sized, arranged, and
*1.2-3.3.2.3 Minimization of physical environment
impediments to resident, participant, and
outpatient mobility and mobilization. Evaluation
of cognitive ability of the care population shall be
included in determining how impediments can be
minimized for a particular facility.
*1.2-3.3.2.4 Quantity of each type of resident
mobility and transfer equipment
*1.2-3.3.2.5 Weight-carrying capacities
*1.2-3.3.2.6 Storage for mobility devices. The need
for storage accessible by staff and residents for lift
- - -~
APPENDIX
A1.2-3.3.2.2 Identifying resident mobility and
transfer equipment for a project. Resident care prOViders
who are familiar with the characteristics of their unique resident
populations should be included in the functional programming process
to ensure appropriate equipment is identified for use in the facility.
Equipment may include manual or power-assisted fixed ceiling or wall­
mounted lifts, manual or power-assisted portable/floor-mounted lifts,
electrlc height-adjustable beds, or acombination th.ereof.
When.developing an equipment list, any existing equipment that
will be used in the facility should be included. Preparation of alog is
suggested to relay information on existing equipment, the percentage
oftime it is used, and ifthis is not 100 percent, the reasons for the per­
centage oftime indicated.
A 1.2-3.3.2.3 Minimizing impediments to resident, participant, and
outpatient mobility and mobilization supports an active lifestyle during
a resident's long-term stay or rehabilitation recovery process.
Consideration ofresident weight and sire is important to assure that
.equipment capacities and dimensions for other accommodations are
appropriate.
A 1.2-3.3.2.4 The community should have sufficient lifts to meet
the needs of the current resident population based on the outcome of
the resident safety risk assessment.
22 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
sy~temsand related equipment and for resident-oper­
ated mobility devices shall be determined by evaluating
equipment use in the facility.
*1.2-3.3.2.7 Provision of clearances
(1) Space shall be provided for resident care and for
furnished to maximize safe resident mobility,
mobilization, weight-bearing, and ambulation
potential while minimizing risk to caregivers.
(3) Unimpeded clearances shall be provided at the
front and at least one side of the resident chair.
Clearances shall be equal to or greater than those
required around the sides and foot of the resident
bed.
(4) Resident units shall be designed to maximize safe
resident ambulation opportunities from resident
rooms into and through corridors.
*1.2-3.3.2.8 Destination points for resident
ambulation, transfers, and movement
(1) Identified destination points (e.g., resident rooms,
bathrooms, community spaces) shall be evaluated
A1.2-3.3.2.5 lift weight capacities range from approXimately 400
pounds (181.8 kg) to expanded-capacity lifts of 1,000 pounds (454.5
kg) or more. Specification of lifts with acapacity of 500-600 pounds
(227.3~272.7 kg) will accommodate the greatest range of residents. If
admissions of persons of size warrant, aminimum of one expanded­
capacity lift (preferably fixed, ceiling-mounted) per unit should be
included,in addition tothe lower-weight-capacity lifts.
A 1.2-3.3.2.6 Space and electrical services for charging batteries
should be included in storage rooms for portable, floor-based lifts and
resident-operated mobility devices. Access to electrical power and
control services should be provided for fixed lifts and devices. Provision
of an eyewash station in these spaces should be considered depending
on the types of batteries being charged; Consideration should be given
to providing storage space for resident-operated mobility devices in
resident rooms or dwelling units as space in common areas may prove
inadequate and inconvenient for resident accessibility.
A 1.~-3.3..2.7 Maintenance of dearance zones should be included in
facilJty policy.
A 1.2-.3.3.2.8 Consider access routes to destination points in the
facility that will welcome residents (e.g., community and activity
rooms, gift shops, dining rooms, and healing gardens). Evaluate various

for ease of door operation to assure that passage in
either direction is not hindered due to door weight
or closure pressure.
(2) Door openings shall be provided in sizes and types
that allow passage of resident mobility and transfer
equipment and accompanying staff.
1.2-3.3.2.9 Floor finishes, surfaces, and
Environment Elements) shall be evaluated.
transitions to facilitate safe and effective use of
*(3) Aesthetics. The effects of the installation and use
resident mobility and transfer equipment
of resident mobility and transfer equipment on
(1) No raised thresholds or other raised flooring
the aesthetics of the resident care space shall be
transitions shall be used.
(2) No items with parts that all lie below a resident's
field of vision shall be used (e.g., built-in planters,
benches)
(3) See Sections 2.4-2.2 (Architectural Details),
2.4-2.3 (Surfaces), and 2.4-2.4 (Furnishings) for
additional requirements.
1.2-3.3.2.10 Coordination between mobility
and transfer equipment and other aspects of the
physical environment
(1) Building systems. Resident mobility and transfer
equipment installations shall be evaluated for
, APPENDIX (continued) ,
destirlationsfor residents using resident mobility and transfer equip­
ment (Le., locations to and from which residents travel, such as between
the bed, chair, andcornlTlode inthe resident room or into an a~sociated
toilet room or bathroom). Such considerations will aid in recognizing
appropriate'equipmentand designing a room and door openings to
accommodate portable equipment and the residents and caregivers
using ,it.
A1.2-1.3.2.10 (3) Where fixed-lift sy~tems are installed, care
should be taken to minimize the vi.sual impact of fixed tracks, slings,
hanger bars, and motQrs on the aesthetics ofthe physical environment,
especially in nursing homes and other long-term care settings where a
home-like environment is ess.ential. Use of recessed tracks is suggested.
Other suggestions include enclosing lift motors in decorative cabinets
and concealing or masking wall-mounted rails for traveling gantry lifts
with Hown molding or indirect ceiling light coves.
A1.2-3.3.2.10 (4) Bed safety
a. Bed rail safety. Depending on the care population an!! individual
resident needs, the same device may act as a restraint or asupport­
ive aid. For example, someone cognitively intact may use bed rails
to safely enter and exit a bed. However, ~omeone who is confused
or unsteady may slide between the rails or between the mattress
and bed, Heating a risk for entrapment, entanglement, or falling.
Guidelines for Design and Construction of ReSidential Health, Care, and Support Facilities
1.2 PlANNING/PREDESIGN PROCESS
conflict with plumbing, mechanical, electrical,
communication, and life safety system equipment
installations.
(2) Environment of care characteristics. The effects of
the installation and use of resident mobility and
transfer equipment on the environment of care
characteristics listed in Section 1.2-4.5 (Physical
evaluated.
I
*(4) Bed safety. The configuration of beds being used
shall be evaluated based on the care population
to reduce the risk of injury related to bed rails,
mattresses, and bed configurations.
*1.2-3.4 Resident Fall Risk and Prevention
Assessment
1.2-3.4.1 Requirement
An evaluation of resident fall risk and prevention shall
address the following specific design elements:
For mpre information, see "Clinical Guidance for the Assessment and
Implementatioo of Bed Rails in Hospitals, long Term:Care Fatilities,
and Home Care Settings;' published.by the Food and Drug Adminis­
tration.
b. Other bedsafety options. The follOWing environmental adjustments
should be considered depending on an individual resident'S assess­
ment:
~Use'of low beds with adjacent mat on the·floor
~Use of electrically adjustable low beds
~Placement of resident's nurse call device within easy reach'and
visual and verbal cues for use ofthe device
~Inclusion of bed exiting alarms in the call system
~Use of body pillow/cushions or raised mattress edges to define
the edges or borders of the mattress
~Potential use of atrapeze affixed to the'bedto increase a resi­
dent's bed mobility
~Placement of cues for interdisciplinary care team recommenda­
tionsregarding each resident's unique needs
A1.2-3.4 Resident faU risk. Safe environments help ptevent
falls and mitigate injuries associated with falls. Evaluation of fall .risks
byan interdisciplinary team shou,ld be used to create acoordinated plao
that identifies physical environment fijctors thijtcontribute to resident
falls and associated injuries.
23
1.2 PLANNING/PREDESIGN PROCESS
1.2-3.4.1.1 Flooring characteristics. See Sections
2.4-2.1.2 (Characteristics and Criteria for Selecting
Materials and Products) and 2.4-2.3.2 (Flooring and
Wall Bases).
1.2-3.4.1.2 Furniture characteristics. See Sections
APPENDIX
A1.2-3.4.2 Rt!sldent fall risk prevention measures
a. Environmental design can effectively reduce re-sident fall risk
through these actions:
-Increasing ambient lighting levels
-Reducing light glare
-Reducing use of physical restraints,including bedrails
-Positioning beds to prevent residents fromfaUing out of bed
-Selecting low-height beds or chairs
-Selecting flooring with small motifs and low contrast
-Optimizing the configuration of grab bars near bathing, shower,
and toilet areas
-Designing awander garden and/or indoor spaces that are
accessible for safe walking and exploring. This can reduce the
frequency and severity of falls for residents with dementia.
-Providing smaller residential carelliving areas in separate build­
ings or interconnected within alarger building. Smaller areas
are easier to navigate for individuals with impaired mobility.
-Decentralizing nurse stations to satellite work stations proximal
to patient/resident rooms with small charting alcoves. This
arrangement improv.es visibility, fall prevention, transfer rates,
and medical error rates without being disruptive to persons
receiving care.
-Positioning the bed near the bathroom, along with handrail
support. Evidence suggests this reduces falls while residents are
transitioning from the bed.
-Using passive infrared nurse call technology in bedrooms
-Providing single-occupancy bedro.om-s
-Providing acuity-adaptable rooms that enable aging in place
-Considering furniture selectH>n and location/layout
-Providing multi-sensory environments
-Selecting floor surface materials with auniform value (light­
ness/darkness). Abutting horizontal materials with highly
contrasting values creates an optical illusion ofastep or change
of level, which contributes to fall risks.
-Using contrasting values between horizontal and vertical
surfaces and objects. This helps older adults and the low-vision
population comprehend the geometry of aspace and assists
with wayfinding. For example, a30-percent contrast between
floors and walls, between walls and door frames/doors, and
between background and furniture/toilets reduces the pos­
sibility of walking or moving into objects, thereby increasing
independence while redUcing fall risk. A50 percent contrast
24 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.4-2.1.2 (Characteristics and Criteria for Selecting
Materials and Products) and 2.4-2.4 (Furnishings).
*1.2-3.4.2 Resident Fall Risk Prevention Measures
between ahandrail and the wall allows the handrail to be found
easily, encouraging use and decreasing fall risk.
Contrast in percentage should be determined by the following
formula:
Contrast =[81- B2/Bl] x 100: where Bl =light reflectance value
(lRV) of the lighter area and B2 = LRV ofthe darker area
b. Sleep disorders frequently lead to resident faUs, delirium, morbidity,
and mortality. Residents' nighttime awakenings and daytime sleep
can be significantly reduced by the following:
-Higher lighting levels during the day
-Exposure to bright light (avoiding glare)
-Sunlight exposure
-Improved acoustics to reduce unwanted noise and sounds. See
the white paper Sound &Vibration: Design Guidelines for Health
(are Facilities, prepared by the joint Acoustics Research Council­
Facility Guidelines Institute Acoustics Working Group and linked
from the FGI website under the Resources tab.
-Access to outdoor nature/wander garden during the day
Co Research has established that older adults sleep best in total dark­
ness, but night-lights are essential to reduce falls. To minimize resi­
dent sleep disruption, night-lights should:
-Be located to minimize light scatter and reflections on room
surfaces.
-Have illuminated switches or motion sensors to light the path­
way between the sleeping area and the bathroom.
-Use warm CCT sources (red or amber in color) at alow illumina­
tion level. Research shows these colors are less disruptive to
sleep.
d. lighting control strategies should be considered to facilitate provi­
sion of lighting levels that support resident safety.
-All wall switches, including dimmers in resident rooms, bed­
rooms, and bathrooms, should have pilot lights (illuminated
SWitch) so switches can be located with ease.
-In community spaces, including corridors, light controls should
accommodate daytime and nighttime illuminance levels
as referenced in Table 1(Minimum Maintained Illuminance
Recommendations) oflES/ANSI RP-28: Lighting and the Visual
Environment for Seniors und the Low VisiOll PopulatiQnand
Appendix 50 (Dimming and Other Control Strategies) of the
National Institute of Building Sciences' Design Guidelines for the
Visual Environment.
 1.2 PLANNING/PREDESIGN PROCESS

*1.2-3.5 Resident Dementia and Mental Health 1.2-3.5.3.1 The design of care settings for residents
Risks with Alzheimer's, dementia, and cognitive or mental
health diagnoses shall address the need for a safe
1.2-3.5.1 Requirement living and care environment for those who may pres­
Each program area shall be evaluated to identify the ent unique challenges and risks as a result of their
physical environment features accessible to residents condition.
to be addressed as a potential risk. The features ro be
assessed shall include the following: 1.2-3.5.3.2 The resident environment shall be
designed to protect the residents' experience of choice,
1.2-3.5.1.1 Architectural details dignity, privacy, meaningful engagement, and cour­
tesy as well as health and to address the potential risks
1.2-3.5.1.2 t1ardware, surfaces related to resident elopement and harm to self, others,
and the environment.
1.2-3.5.1.3 Furnishings
1.2-3.5.3.3 An evaluation of the means available to
1.2-3.5.1.4 Plumbing, mechanical, fire protection, reduce the possibility of residents causing unaccept­
able levels of harm to themselves or others, includ­
and electrical devices and components
ing suicide risks, shall be completed. Simultaneous
1.2-3.5.2 Resources consideration of the following elements shall be part of
the evaluation:
One of the following standards shall be used to evalu­
ate dementia and mental health risk: (1) Resident profile and acuity
(2) Staffing levels
1.2-3.5.2.1 Behavioral Health Design Guide, published (3) Space visibility and supervision
by the Facility Guidelines Institute (4) Inherent danger from any individual physical

environment feature

1.2-3.5.2.2 Patient Safety Standards, Materials and Sys­

tems Guidelines, recommended by the New York State 1.2-3.5.3.4 Evaluation of resident dementia and
mental health risk shall address the following specific
Office of Mental t1ealth
design elements:
*1.2-3.5.3 Design Considerations [ *(1) Security systems and monitoring
(2) Areas to be secured
APPENDIX

A1.2-3.5 Risks from dementia and mental

spend long periods of time out of direct supervision of the staff)
health diagnoses. In its evaluation of the care population, an
b. Medium risk level
interdisciplinary team should identify the number of residents with
-Activity spaces, living rooms, and treatment spaces (supervised
dementia, mental health diagnoses, and cognitive and developmental
with good visibility)
disabilities who will be served in each program area and develop a
-Dining rooms and recreation spaces, both indoor and outdoor
detailed assessment of the level of risk for each area. This assessment
-Corridors
should inform the development of the functional program so that
c. Lower risk level

facilities and details can be appropriately designed for the population

-Exam rooms, private offices, and conciliation rooms (always

served. See appendix section A2.2-4.1 (Facilities for residents with

supervised)

dementia, mental health diagnoses, and cognitive or developmental

-Staff and support area (not accessible to residents)

disabilities) for additional information.

A1.2-3.5.3.4 (1) Silent communication systems.

A1.2-3.5.3 Sample mental health residential risk If possible, passive monitoring should be used as well as silent
assessment and visually discrete nurse call systems to mitigate interference
a. Highest risk level with communications, distractions. negative effects on cognitive
-Seclusion rooms (where resident acuity poses an increased risk) performance and concentration, stress, and fatigue, especially for
-Resident bedrooms and toilet rooms (areaswhere residents resident populations with cognition impairments.
------------ .. _.--_.-----_._ •._.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 25
1.2 PLANNING/PREDESIGN PROCESS

*(3) Elopement and unsafe exiting 1.2-3.6.1 Medication Safety Plan

(4) Doors and windows to be secured Medication safery recommendations for a new con­
*(5) Physical environment means to address resident struction or renovation project shall be included in the
stress and agitation RSRA report.

1.2-3.5.3.5 See sections 2.2-4.2 (Physical Environ­
ment Elements for Risk Reduction) and 2.5-5 (Com­
munication Systems) for additional requirements.
*1.2-3.6 Medication Error Risk Assessment
1.2-3.6.1.11he medication safery plan shall include
the number of medication distribution locations.
1.2-3.6.1.2 See common element and faciliry chap­
ters in Parts 3 through 5 for specific requirements for
centralized and decentralized medication distribution
and storage locations.

APPENDIX

Al.2-3.5.3.4 (3) Resident elopement.and unsafe
exiting. Unsafe exitingisa special problem in long-term care
settings, especially for residents with dementia or cognitive and mental
health concerns. Residents exhibit fewer unsafe exiting behaviors in an
environment that prOVides the follOWing:
a. Asoothing atmosphere
-Wander gardens help reduce aggressive behavior among, resi­
dents with dementia and cognitive and mental health concerns,
-Indoor spaces that are .accessible offer opportunities for safe
wandering, walking; and exploring.
-Provision of safe exits and transitionS from residential areas to
wander gardens reduces eXit-seeking behavior or provides asafe
outlet for such behaVior.
b. Appropriate sensory stimulation. Environmental features, decor, and
objects are used to mitigate over-stimulation (e.g., excessive noise)
and ,arouse one or more ofthefive senSeS (sight, smell, hearing,
taste, and touch), with the goal of evoking positive feelings.
c. Positive distractions
...-;Decreased spatial and social density (Le., fewer residents per
-Nature scenes, artwork
unit, larger space per resident)
-Increased environmental lighting to support the aging eye and
low vision, promoting negotiationof the physical setting with
less. stress
-Heightened value contrast to support the aging eye and low
vision, promoting negotiation ofthe physical setting with less
stress
b. For some individuals who suffer from sensory processing issues (e.g.,
ASD, ADHD, and similar attention issues):
-Av.oidance of high light levels, glare, light flicker, and environ­
mental clutter
-Increased consideration of the quality and quantity of light to
help residents feel safe and comfortable
-Provision of asimple interior environment, including ac1utter­
free ceiling and less complex patterns on surfaces, finishes, and
furnishings
c. Other design considerations that may decrease resident stress and
agitation include:

-Plants
-Single-resident rooms

-Nature sounds
-Positive distractions, such as:

-Music
• Visual, audio, and olfactory stimuli
-Aromas
• Asmall-scal.e homelike environment with features such as a
d. No opportunities for egress through windows
residential kitchen
e.Disguised means of exit
Wander gardens and other accessible spaces for safe wan­
dering, walking, and exploring
A1.2-3.5.3.4 (5) Resident stress, agitation, and aggressive
-Improved acoustics to reduce unwanted noise and sounds
behaviors may cause a resident to harm him- or herself, other residents,
or staff members. Based on evaluation of the care population and A1.2-3.6 Medication error ris,k assessment. An
the types of mental health diagnoses, cognitive and developmental assessment of medication error risk should proactively identify and plan
disabilities, and/or identified dementia present, the following measures design elements to address medication safety. Medication distribution
have been found to reduce levels of agitation and aggression. and storage locations, scope of project, care population needs, design
a, For individuals with Alzheimer's and dementia who are typically
features, and appropriate lighting should be identified to mitigate
older adults:
risk based on the nature and scope of the planned use of medication
-Bright light exposure during the daytime and low-light expo­ systems. See common element and facility chapters in Parts 3through
sure during the evening to reset circadian rhythms, positively 5for specific requirements for centralized and decentralized medication
impact cognitive abilities, and lessen agitation distribution and storage locations.
----------------------
26 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 1.2 PLANNING/PREDESIGN PROCESS

*1.2-3.7 Security Risk Assessment 1.2-3.7.1.4 Security considerations for project

*1.2-3.7.1 Security Plan
Security recommendations for a new construction
or renovation project shall be included in the RSRA
report. The security plan shall include the following:
1.2-3.7.1.1 A description of the effects of demolition
and phasing on existing site functions and protection
efforts
1.2-3.7.1.2 An assessment of the need for temporary
security barriers such as fencing and security sys­
tems (e.g., intrusion detection and video surveillance
systems)
1.2-3.7.1.3 A schedule for installation of security sys­
tems for completion during move-in activities to allow
for protection of the facility and equipment
design
*(1) Parking and exterior spaces. The design of parking
and exterior spaces shall minimize the opportunity
for violent and property crime, promote efficient
resource management, and provide a welcoming
environment.
*(2) Buildings and interior spaces
(a) Residential health, care, and support areas
(i) Security design considerations shall
address the particular risks associated
with the resident care population and
demographics, facility needs expressed in
the functional program, characteristics of
the surrounding community, and other
environmental factors.
*(ii) The project design shall include a compre­
hensive security plan that indicates a lay­
ered approach to access control, including

APPENDIX

A1.2-3.7 Security risk assessment. An assessment of

doors to adjacent public transit stations, utility tunnels, loading
security risk should address the unique characteristics of afacility,
docks, parking garages)
including specific needs related to the protection ofvulnerable resident
-BUilding design and construction materials that might enhance
populations, security of sensitive areas, application of security and
the probability the facility would be damaged in an adverse
safety systems, and the infrastructure required to support these needs.
event
The evaluation should cover external and internal security needs and
-locations where protection of the HVAC system may be inad­
security needs related to emergency management and response. More
equate
detailed information on evaluation of security can be found in Security
-locations where protection of utility services (electricity, natural
Design Guidelines for Health Care Facilities published by the International
gas, water, communication) may be inadequate
Association for Healthcare Security & Safety (IAHSS).
-Locations where control of access to sensitive information may
be inadequate
A 1.2-3.7'.1 Security requirements for construction, commissioning,
-Room layout (e.g., whether it could cause entrapment of a
and move-in vary according to the complexity of the functional program
victim, whether furniture could be used as aweapon)
and the scope of services provided.
-Location and function of alarm systems and panic buttons
A 1.2-3.7.1.4 (1) Residential health, care, and support facility b. Security responses
surroundings may include open space, parking facilities, and private -Use of security camera systems (at entry locations, key internal
ways and may border other businesses, residential properties, or major locations, external parking areas, and points of vehicular entryl
transportation routes. egress)
-Provisions for refuge and evacuation
A1.2-3.7.1.4 (2) The physical design of bUildings and integration
-Use of personnel identification systems for access control (e.g.,
of electronic security systems in the built environment are important
fingerprints, biometrics, ID cards, etc.)
components of the facility protection plan and the resident, family,
-Protection ofthe physical infrastructure that supports informa­
visitor, and staff experience.
tion technology systems. If the computer system is electronically
A 1.2-3.7.1.4 (2)(aHii) Security plan. The following should secured but vulnerable to physical destruction, it may need
be considered in developing the security plan: more protection.
a. Areas Of potential risk -Provision of computer software and hardware devices to detect,
-:"'locations where control of access to the building by nonresi­ monitor, and prevent unauthorized access to or destruction of
dents and their vehicles may be inadequate (at exterior doors, sensitive information

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 27
1.2 PLANNING/PREDESIGN PROCESS
zones, control points, circulation routes,
and required egress paths.
(b) Protected health information
(i) The design of residential health, care, and
support facilities shall address handling
of all forms of confidential resident
information commonly referred to as
protected health information (PHI).
(ii) The design shall address ways in which
this information could be compromised
and shall apply integrated physical and
electronic security systems (e.g., access and
audit featutes), as appropriate, to locations
for charting, care planning and manage­
ment, record storage, and waste collection/
disposal as well as in data systems (e.g.,
electronic health records).
(c) Utility, mechanical, and infrastructure-related
spaces
(i) The design of utility, mechanical, and
infrastructure-related spaces in residential
health, care, and support facilities shall be
based on the recognition that such spaces,
along with the mechanical, electrical,
plumbing, and communication systems
APPENDIX (continued]
-Provision of emergency call boxes and sufficient illumination in
parking areas and remote walking trails
-Provision ofacommunication system for staff and others who
may work alone
A1.2-3.8 Disaster risk and emergency
preparedness. Residential health, care, and support facilities
generally are expected to be functional, safe, and secure for residents,
family members, visitors, and staff while remaining prepared for natural
and man-made emergencies 24 hours adayl7 days aweek.
a. An evaluation of potential risks from disasters informs the emer­
gency preparedness plan.
b. Design of the facility should consider emergency management prac­
tices that allow for the flexibility '1M resilience required to manage
emergency events.
c. Apotential risks approach to the design should be applied to help
the care provider prepare for, respond to, and recover from man­
made events and natural disasters.
A1.2-3.8.1 Provisions for disaster preparedness
a. Design for continued operation. For those facilities that must remain
operational in the <Ifterniath ofadisaster, special designs are
--------------- -------_._-----------------------------------­
28 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
located in them, are critical assets for
residential care providers and should
support uninterrupted resident care,
basic building comfort, and extraordinary
emergency response capabilities.
(ij) See Chapter 2.5 (Building Systems) for
additional information and requirements.
(d) Biological and chemical materials
(i) The design of residential health, care, and
support facilities shall address the unique
security risks presented by the presence of
hazardous materials, including biological
and chemical materials.
(ii) Facilities shall be designed and constructed
to provide integrated physical security,
protect the internal and external environ­
ment and the surrounding community,
and assist in the audit of materials in
accordance with policy, regulation, best
practices, and assessed risk.
*1.2-3.8 Disaster Risk and Emergency
Preparedness
*1.2-3.8.1 Provisions for Disaster Preparedness
required to protect systems and essential building services such as
power, water, medical systems, and, in certain areas, air condition­
ing systems. In addition, special conSideration must be given to the
likelihood of temporary loss of externally supplied power, gas, water,
and communications.
b. Wind- and earthquake-resistant design for new buildings
~Facilities should be designed to meet the requirements of
American Society of Civil Engineers/Structurat Engineering Insti­
tute (ASCE/SEI) 7or building codes with s~bstantially equivalent
requirements. See Section 1.1-4.2 (Regulations for Earthquake­
Resistant Design for New Buildings) for specifics.
-Seismic construction inspection. During construction, the care
provider should complete the testing described in Section 11 A.2
and special inspection of the seismic systems described in Sec­
tion llA.1J of ASCE/SEI7.
-Roofconsiderations
Roof coverings and mechanical equipment should be
securely fastened or ballasted to the supporting roof con­
struction and provide weather protection for the bUilding
at the roof.. If ballast is used, it should be designed so it is
unlikely to become aprojectile.
 1.2 PlANNING/PREDESIGN PROCESS

*1.2-3.8.2 Compliance Elements (c) See Section 1.2-3.2 (Infection Control Risk
Assesment) for additional information and
1.2-3.8.2.1 In locations with recognized potential requirements.
for hurricanes, tornadoes, flooding, earthquakes, or
other regional disasters, the need to protect the life
safety of all residential health, care, and support facility • 1.2-4 Environment of Care

occupants and the potential need for continuing Requirements

services following such a disaster shall be considered

during project planning and design. The functional program shall describe the functional
requirements and relationships among the follow­
1.2-3.8.2.2 Disaster preparedness plan ing components and key elements of the physical
(1) A disaster preparedness plan for the new
environment.
construction or renovation project shall be

included in the RSRA report.

*1.2-4.1 Delivery of Care Model Concepts
(2) This plan shall include disaster planning risk
The delivery of care model shall be defined in the
mitigation recommendations prepared by the
functional program.
interdisciplinary team that address the following:

(a) Resident placement and relocation
(b) Standards for barriers and other protective
measures required to protect areas of refuge
from identified potential disasters
1.2-4.2 Users
The physical environment shall support the operation
of the delivery of care model and the desired experi­
ence for residents, family members, visitors, and staff.

APPENDIX (continued)

• In addition to the wind force design and construction functional program contingency plan to obtaln food, sterile sup­
requirements specified, particular attention should be given plies, medication supplies, linen, and water forsanitati(lO.
to the design of roofing, entryways, glazing, and flashing -Storage capacity. Such storage capacity or plans should be suf·
to,minimize uplift, impact damage, and other damage that ficient for at least four continuous days of operation.
could seriously impair building function.
A1.2-3'.8.2 Disaster preparedness compliance
c. D~sign to mitigate the potential for progressive collapse. Design

a. Facility evaluation. (are prOViders of existing facilities shouldevalu­

gUidelines for the prevention of progressive collapse typically take

ate their facility's ability to withstand the effects of regional n<ltural

athreat-independent approach that, regardless.of initial cause, is

disasters. The assessment should consider performance of structural

intended to develop inherent robustness and continuity in the struc­

and critical nonstructural building systems and the likelihood of loss

tlue to resist and arrest propagation of failure.

ofexternally supplied power, gas, water, and communlcations under

d. floodptotection
such conditions.

-In accordance with Executive Order 11988: Floodplain Manage­

b. Facility planning. Facility master planning should consider miti9,a­
ment/ possible flood effects should be considered when select­
tion measures reqUired to address conditions that may be hazardous,
ing and developing the site for aresidential health, care, or
to residents and conditions that may compromise the ability of the
support facility.
facility to fulfill care needs.
-Insofar as possible, new facilities should not be located on des­
c. Seismic considerations. Particular attention should be paid to seismic
ignated floodplains.
considerations.in areas where the seismic design classification of
-Where locating afacility on afloodplain is unavoidable, consult
a bUilding would fall into Seismic Design CategoryC,D, £, or:F a.s
the U.S. Army Corps of Engineers' regional office for the latest
described in A5CE/SEll: MinimlJm Design Loads and Associated Crite­
applicable regulations pertaining to required flood insurance
ria for Buildings andOrher Structures.
and protection measures.
e. Emergency supply storage A1.2-4.1 Delivery of care model concepts. Examples

-Required supplies. Should n.ormal operations be disrupted, of delivery of care models include resident- or person-centered care,

the facility should have i1dequate storage capacity for, or a relationship-centered care, and medical model care.

Guidelines for Design and Construction of Residentiai Health, Care, and Support Facilities 29
1.2 PLANNING/PREDESIGN PROCESS
*1.2-4.3 Systems Design
The physical environment shall support organiza­
tional, technological, and building systems designed
in response to the functional program, including the
delivery of the care model and operational services.
*1.2-4.4 Layout/Operational Planning
The layout and design of the physical environment
shall enhance operational efficiencies and the satisfac­
tion of residents, families, and staff.
1.2-4.5 Physical Environment Elements
The physical environment shall be designed in
response to the functional program, including the
intended delivery of care model, and shall address the
key elements listed below:
APPENDIX
A1.2-4.3 Systems design. Information technology, medical
technology, and/or staff use and cross training are issues that shOljld be
addressed in relation to the environment of (ar~ components.
A1.2-4.4 Layout/operational planoing. Criteria for
evaluation of the layouts should be consistent with the delivery of
care model to allow each proposed layout and operational plan to be
reviewed in context
A1.2-4.5.1 Light. Provision of natural light should be considered
wherever possible in the design of the physical environment. Visual'
benefits refer to sufficient light for vision and safety; noncvisual benefits
relate to biological factors (circadian rhythms, etc.).
a. Access to natural light should be prOVided no farther than 50 feet
from any resident activity area, visitor space, or staff work area. To
the extent possible, the source of such natural light should also pro­
vide opportunities for exterior views.
b. Window sill height should not exceed 3feet (.91 meter) above the
floor and should be above grade.
c. Access to natural light should be available without entering private
spaces (Le., staff should not have to enter a resident room to have
access to natural light). Examples of such access include windows at
the ends of corridors, clerestory windows in corridors, skylights into
deep areas ofthe bUilding in highly traveled areas, transoms, and
door sidelights.
d. In residential health, care, and support occupancies, dining areas,
lounges, and activity areas should be designed to include natural
light.
A1,2-4.5.2.2 Views ·of and access to nature
a. Siting and organization of the bUilding should respond to and priori­
tize unique natural views and other natural site features.
30 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
*1.2-4.5.1 Light
[ Use, availability, and control of natural light and illu­
mination shall be addressed in the design of the physi­
cal environment to provide the visual and non-visual
benefits of access to both natural light and darkness.
1.2-4.5.2 Views of and Access to Nature
1.2-4.5.2.1 Accessible outdoor space or a suitable
alternative for residents, visitors, and staff shall be
provided. Such spaces shall allow for visual observation
by staff.
*1.2-4.5.2.2 Views of nature shall be provided from
resident living areas.
b. Direct physical access to the outdoors (e.g., agarden, local park,
adjacent green space) and views of nature and indoor gardens/atria
should be provided. Where direct access is not possible, alternatives
include indoor gardens with natural Ught (atria), roof gardens, and
green roofs.
c. Views of nature can include views of the sky, vegetation, natural
light, precipitation, and birds and other liVing organisms.
d. Outdoor respite areas should be proVided for direct care and support
staff.
e. The abilities ofthe care population served (e.g., level of acuity,
level of physical frailty, dementia issues) should be considered in
designing outdoor spaces or alternatives.
f. Opportunities for both active and passive interactions with nature
should be proVided in outdoor space(s), including exercise and play
or othertypes of physical activity and therapies (e.g., physical,
occupational, horticultural).
g. Wayfinding and/or views should be prOVided to encourage residents
to visit and return from outdoor garden(s) and/or atria.
h. Access to both sun and shade, with trees and/or built shade
structures, should be provided. Shady places are particularly
important for residents who are photosensitive.
L Water features. Where provided, open water features should be
eqUipped to safely manage water quality to protect occupants from
infectious or irritating aerosols. See Section 2.1-3.6.3 (Outdoor
Water Features) and appendiX section AlA-2.2.B (Decorative water
features) for additional information and requirements.
j. For additional information on landscape and gardens, see appendiX
section A2.1-3.6.1 (Landscape features).

*1.2-4.5.3 Signage and Wayfinding
*1.2-4.5.3.1 An organized approach to wayfinding/clar­
iry of access for the entire campus or faciliry shall be
provided.
*1.2-4.5.3.2 The wayfinding approach shall include
an integrated system with coordinated wayfinding
elements.
, APPENDIX
A1.2-4.5.3 Signage and wayfinding
a. Entry points to all residential health, care, and support faCilities
should be clearly identifiable from all major exterior circulation
modes (roadways, bus stops, vehicular parking).
b. Planning for wayfinding should begin with the concept that the
average visitor or staff member will be able to easily find his or her
way throughout the facility.
c. Outside wayfinding should be considered for both those walking
and those driving to the facility. If public transportation is available,
directions and signage to and from transportation sites should be
provided.
A1.2-4.5.3.1 Organized approach to clarity of
access. During the functional programming process, input from
hands-on care staff, facility managers, visitors, families, and residents
should be sought regarding wayfinding. This should include evaluation
of the most common and problematic scenarios to identify shortcomings
in the wayfinding approach and help develop design criteria to address
them.
a. Consider use ofthe follOWing in the design ofawayfinding system
to assist with orientation, informed decision-making, and self­
managed care:
-Universal Symbols in Health Care™, where possible
-Unique landmarks (e.g., design elements such as color, artwork,
texture, change in architecture, plants)
-Placement of wayfinding features and signage, along with
technological access to the internet, in concourses, hallways,
and intersections
b. Consider the need for the wayfinding approach to:
~Accommodate the needs of aparticular care population (e.g.,
the elderly, children, cognitively impaired, visually impaired,
and other particularly vulnerable populations, including
residents with dementia and Alzheimer's).
-Offer varied presentations of the same information to
accommodate users with different cognitive processes.
-Accommodate users with limited English proficiency (LEP) and
speakers of multiple languages.
-Address the stress experienced by residents and families while
finding their way to unfamiliar areas in the facility.
-Address the needs of first-time users.
c. The wayfinding plan should be integrated with relevant security
plans.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
1.2 PlANNING/PREDESIGN PROCESS
*1.2-4.5.4 User Control of Environment
How, by what means, and to what extent users of the
finished project (residents, participants, outpatients,
staff, and visitors) are able to control their environ­
ment shall be considered in the design of the physical
environment.
A1.2-4.5.3.2 Wayfinding elements. The wayfinding
approach should coordinate elements such as:
a. Visible and easy-to-understand signs and numbers
b. Landmarks
c. Distinctive exterior views
d. Distinctive changes in interior decor (surface color and texture,
furnishings, and window treatments
e. Provision of verbal directions
f. Paper information
g. Electronic information
h. Internet access
A1.2-4.5.4 User control of environment. During the
functional programming process, all opportunities to provide individual
control over as many elements of the environment as possible and
reasonable (including but not limited to temperature, lighting, sound,
and privacy) should be evaluated.
a. lighting in resident and staff areas should prOVide variety in lighting
types and levels.
-Residents should have control in their dwelling unit of all
lighting.
-Residents should have control of varied lighting in resident
bathrooms.
-lighting in staff areas should allow for individual control.
-Staff should have control of varying lighting levels in corridors
outside resident rooms, at caregiver areas, and at central
caregiver areas to ensure that resident sleep is not disturbed by
general lighting not under control of residents/visitors.
b. Building systems design should incorporate individual control over
the thermal environment, including zoning of mechanical systems
that allow heating and cooling to achieve thermal comfort for indi­
vidual residents.
c. Noise should be minimized in the design of the physical environment
and the selection of op.erational systems and equipment. Residents
should have the ability to control their auditory environment where
feasible and clinically safe. In community spaces that include
televisions, audio presentations, or other types of performances,
alternative listening devices should be proVided for residents who
need supplemental amplification.
31
1.2 PlANNING/PREDESIGN PROCESS

*1.2-4.5.5 Privacy and Confidentiality
1.2-4.5.5.1 Methods fot protecting the visual and
auditory privacy and confidentiality of users shall be
included in the design of the physical environment.
1.2-4.5.5.2 In facilities with multiple-occupant
resident rooms, a separate space shall be provided to
give residents and families a place with both visual and
auditory privacy.
*1.2-4.5.6 Safety and Security
How the safety and security of residents, staff, and
visitors will be addressed shall be considered in the
overall planning of the facility. See Section 1.2-3.7
(Security Risk Assessment) for additional information
and requirements.
*1.2-4.5.7 Characteristics and Criteria for Selection
of Materials and Products for Architectural
Details, Surfaces, and Furnishings
1.2-4.5.7.1 The effects of materials, details, colors,
textures, and patterns on residents, staff, and visitors
shall be considered in the overall planning and design
of the facility. See Section 2.4-2 (Architectural Details,
Surfaces, and Furnishings) for specific requirements.
1.2-4.5.7.2 Maintenance and performance shall be
considered when selecting these items.
*1.2-4.5.8 Cultural Responsiveness
The culture of residents, staff, and visitors shall be
consideted in the overall planning of the facility.
*1.2-4.5.9 Support for Person-Centered Care
The relationship between the physical environment
and the person-centered cate approach to planning,

APPENDIX

A1.2-4.5.5 Privacy and confidentiality. The Health

surfaces, and landscaping that does not proVide locations for hiding
Insurance Portability and Accountability Act tHIPAA) requires that
should be considered for exterior spaces.
residents' health care information be kept private in all residential

A1.2-4.5.7 Selecting materials and products

health,care, and support settings that include discussion of medical'

a. Testing standards can verify whether a product provides specific

conditions.

characteristics. When selecting architectural details, surfaces, and

a. In traditional settings, public circulation and staff/resident

furnishings, verification of third-party independent testing can

circulation should be separated wherever possible.

ensure that surfaces meet necessary code requirements.

b. In neighborhoods/clusters and small house/household settings,

b. In certain areas ofa residential health, care, or support facility,

public and private circulation paths should be provided and

it will not be possible to use products with all the characteristics

identified to support privacy for resident rooms.

in appendiX section A2.4-2.1.2.1 (Characteristics and criteria for

c. Private spaces should be provided for all communication concerning

selecting surface and furnishing materials and products); the goal is

personal information relative to resident illness, care plans, life

to choose products with as many of these characteristics as possible.

programming, and insurance and financial matters.

A1.2-4.5.8 Cultural responsiveness
A1.2-4.5.6 Safety and security
a. Organizational culture is defined by the history of the organization,

a. Asystem to control and secure all access points at certain times of

leadership philosophy, management style, and caregivers' back­

day and in the event of an emergency should be provided. During

grounds.

these times, electronic locks and monitoring cameras should be

b. Regional culture is defined by the physical location and demograph­

proVided to permit entry by authorized perso[ls. Exterior lighting

ics (including age, nationality, religion, and economics) of the com­

should be provided for parking lots and all entry points to the

munities served.

facility. At primary access points, provision oflocal or remote

c. Built environment design, finishes, and color palettes should respond

reception or security services may enhance security.

to the geographic location of the residential health, care, or support

b. Since strict physical control of access to a residential health, care,

facility, taking into account climate and light; regional responses to

or support facility is neither possible nor appropriate, security is

color; the cultural characteristics of the community served, including

enhanced through staff and resident training.

resident choice; and the cultural background of the staff.

c. The physical environment should be designed to support the overall

safety and security policies and protocols ofthe organization. A1.2-4.5.9 Support for person-centered care.
d. Safety and security monitoring, where provided, should respect
Person-centered care is an approach to the planning, delivery, and
resident privacy and dignity.
evaluation of residential health, care, and support services with the
e. Provision of safety features such as adequate lighting, non-tripping objective of providing apersonalized liVing environment for each

32 Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
 1.2 PLANNING/PREDESIGN PROCESS

delivering, and evaluating residential health, care, 1.2-5.1.2 lighting Planning Process

and support services shall be considered during the The process for lighting planning for new and reno­

functional programming process. See Section 1.2-5.8 vated residential health, care, and support facilities

(Resident Quality of Life) for core values information. shall include the following:

1.2-5.1.2.1 Evaluation of site conditions and building

• 1.2-5 Planning Considerations and orientation. See Section 1.2-2.2.2.2 (1) (Site) for
Requirements requirements.

1.2-5.1 Lighting Planning 1.2-5.1.2.2 Evaluation of care population and access

to daylighting
1.2-5.1.1 General *(1) Access daylighting shall be included in the
to
The planning of new and renovated residential health, project. See Sections 1.2-4.5.1 (Light) and
care, and support facilities shall include identification 1.2-4.5.2 (Views of and Access to Nature) for
of daylighting, artificial lighting, and vision and additional information.
health needs during the programming phase to (2) Daylighting goals shall be established for the

determine desired outcomes based on the resident care project.

population. (3) Fenestration, types of glazing, and window

treatments for exterior windows and doors shall be
evaluated in relation to the use of interior spaces to
assure access to daylight is provided.

APPENDIX (continued)

resident. The physical setting is designed to support the personalization -Pioneer Network (www.pioneernetwork.net). Business case
of services by staff, with an emphasis on the development and information for culture change is available at www~pioneernet­
maintenance of relationships and activities that are meaningful for each work.net/Providers/CaseStudies and www.pioneernetwork.net/
resident. Data/Documents/MedicaidCongresslong reljune12007. pdf.
a. The person-centered care movement strives to transform health, -Action Pact (www.actionpact.com)
care, and support services based on person-directed values and ~Society for the Advancement of Gerontological Environments
practices. The voices of the residents, both spoken and unspoken (SAGE) (www.sagefederation.org)
and sometimes interpreted by their families, provide the primary -"Senior living Sustainability Guide" (www.withseniorsinmind.
gUidance for the services, support, and care proVided. Staff are org)
trained to make the development ofa positive relationship with the -Institute for Patient- and Family-Centered Care (www.ipfcc.org/
resident as important as the service/care task being completed. advance/supporting.html)
b. Person-centered care may require changes in organizational values -The Joint Commission monograph "Advancing Effective
and practices, management philosophy, workplace models, and staff Communication, Cultural Competence, and Patient- and
relationships at all levels, with an emphasis on teamwork. The goal Family-Centered Care: ARoadmap for Hospitals"
is to provide better outcomes for residents, families, and care prOVid­ -IDEAS Institute (www.IDEASlnstitute.org)
ers.
A1.2-5.1.2.2 (1) Access to daylighting
c. Integral to person-centered care is the recognition that the built
a. Due to the significant health benefits of the natural environment

environment has asignificant effect on quality of life. Both lon9- and

(e.g., circadian rhythm entrainment, Vitamin Dsynthesis, reduced

short-term living environments should be designed to minimize

depression), access to exterior spaces with daylight should be pro­

institutional spaces and maximize home-like spaces. Person­

vided for all residents, participants, and outpatients.

centered outcomes are the result of the interaction between care

b. Windows, skylights, and other sources of daylighting should be

practices and the built environment.

considered to minimize the need for artificial light during the day­

d. Information on person-centered care (and the larger, more encom­

time and to aHow residents to experience the natural daylight cycle,

passing term of culture change) is available at:

which supports circadian rhythm entrainment.

-Planetree (www.planetree.org)

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 33
1.2 PLANNING/PRE DESIGN PROCESS

r*1.2-5.1.2.3 Verification that artificial lighting and day­ of the staff's and residents' desired outcomes and level
l[lighting in a project responds to the needs of the care of control of systems that contribute to thermal condi­
population described in the functional program tions and human comfort.

1.2-5.1.3 See Section 2.5-7 (Daylighting and Artificial
Lighting Systems) for additional requirements.
1.2-5.2 Acoustic Planning
1.2-5.2.1 General
The planning of new and renovated residential health,
care, and support facilities shall include identification
of acoustic needs during the programming phase to
determine desired outcomes based on the resident care
population.
1.2-5.2.2 The planning process for new and renovated
residential health, care, and support facilities shall
include:
1.2-5.2.2.1 Evaluation of building location related to
exterior noise
1.2-5.3.2 The planning process for new and renovated
residential health, care, and support facilities shall
include:
1.2-5.3.2.1 Evaluation of care population in relation
to thermal conditions
1.2-5.3.2.2 Evaluation of building systems that affect
thermal conditions
1.2-5.3.2.3 Evaluation of building systems that affect
thermal controls in resident rooms, staff areas, and
common spaces
1.2-5.3.3 See Section 2.5-3.1.2 (Ventilation and Space
Conditioning) for additional requirements.
1.2-5.4 Indoor Air Quality Planning

1.2-5.2.2.2 Evaluation of interior noise sources, 1.2-5.4.1 Planning for new and renovated residential
including the following: health, care, and support facilities shall include identi­
fication of all interior factors and building systems that
(1) Elevators and their proximity to resident rooms
affect indoor air quality (1AQ).
(2) HVAC fans and other MEP building systems
(3) Noise-generating appliances, whether for private,
1.2-5.4.2 The planning process for new and renovated
communal, or facility use
residential health, care, and support facilities shall
(4) Community and staff work spaces proximate to
include:
resident rooms

1.2-5.4.2.1 Evaluation of care population in relation

1.2-5.2.2.3 Verification of compliance with the func­
to indoor air quality
tional program needs of the care population and staff

1.2-5.4.2.2 Establishment of IAQ goals for the facility

1.2-5.2.3 See Section 2.5-8 (Acoustic Design Systems)
for additional requirements.
1.2-5.4.3 See Section 2.2-2.4 (Indoor Environmental
Quality) for additionallAQ requirements.
1.2-5.3 Thermal Conditions

1.2-5.3.1 General
1.2-5.5 Planning for Sustainability
The planning of new and renovared residential health,
care, and support facilities shall include identification

APPENDIX

A1.2-5.1.2.3 Darkness is important to human health and well­ rhythm. Therefore, achieving darkness is as important as providing
being. Aregular pattern of both light and darkness across the 24-hour access to daylight.
day is fundamental to establishing and maintaining astable circadian
,--------------------------- ---------------------'--.
34 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 1.2 PLANNING/PRE DESIGN PROCESS

*1.2-5.5.1 Requirement 1.2-5.6.1.1 Areas of the facility designated for accom­

Planning for new and renovated residential health, care, modations for care of persons of size, including those
and support facilities shall include establishment of sus­ undergoing bariatric treatment
tainability goals by an integrated stakeholder team.
1.2-5.6.1.2 Paths of egress to reach areas supporting

1.2-5.5.2 Planning for Sustainability Process the needs of persons of size

The planning process for new and renovated residential

health, care, and support facilities shall include these 1.2-5.6.2 The areas identified in Section 1.2-5.6.1

steps: shall be programmed and planned with appropriate

weight support and clearances.

*1.2-5.5.2.1 Establish sustainability goals for the facility.

1.2-5.6.3 See Section 2.2-3 (Design Criteria for
1.2-5.5.2.2 See Section 2.2-2 (Sustainable Design Accommodations for Care of Persons of Size) for other
Criteria) for additional requirements. requirements.

1.2-5.6 Planning Considerations for Persons of 1.2-5.7 Dementia, Mental Health, Cognitive,

Size and Developmental Disability Planning

1.2-5.6.1 If it has been indicated in the functional *1.2-5.7.1 See Section 1.2-2.2.1.2 (1) (Functional
program that a facility will accommodate persons of program-Who will be served...) for planning
size, the following shall be identified and evaluated: requirements.

APPENDIX

A1.2-5.5.1 S.ustainability planning. Agrowing body of
knowledge is available to help design professionals and care provider
organizations that provide residential health, care, and support services
understand how buildings affect human health and the environment
and how negative effects can be mitigated through avariety ofstrate­
gieS. To meet theSe objectives, care provider organizations should use
an integrated project delivery process and develop an interdisciplinary
design team to gUide facility design. The intent of integrated project
delivery is to improve building performance by including design and
construction considerations from project inception.
A1.2-5.5.•2.1 Sustainability goals. Development of
incorporates an integrated project management approa~h and offers
third-party certification. GBl tools are available forNew(onstruc­
tion (NC) and for Continual Improvement lifExisting Buildings for
Healthcare (OEB H\l. GBI has developed ANSI/GBIOt Green BUilding
Assessment Protocol for Commercial BUildings to irlform the develoJl~
ment of Green Globes rating systems.
c. tEED v4 Green BUilding Rating System. Along with thi.s rating system,
the US. Green Building Council (USGBC) has established athird­
party certification framework for the design of suStaiilablebuildings.
d. Green Guide tor Health Care. This resour~e is avoluntary sel.f-certifica­
tion metric tool that specifically addresses the health care sector.
These various tools establiSh "beSt practice" criteria and prOVide

sustainability goals should include evaluation and use of one or more

planning/design/development process gUidance for site design, water

green building codes or rating systems.

and energy usage, materials, and indoor environmental quality.

The International Code Council-has developed the International

Green Construction Code (IgCCl, whi~h has been adopted by an increas­

A1.2-5.7.1 Planning for facilities that serve

ing number ofstates and municipalities. The IgCC includes content from
those with dementia, mental health or cognitive

ASH RAE 189.1: Standard for the Design offligh-Performance, Green BUild­
issues, or de"elopment~1disabilities. Facilities for

ings, Except tow-Rise Residential Buildings and ASHRAE 189.3: Standard

this care population should be designed to maintain dignity, respect

for Design, Construction alld Operation ofSustainable High-Performance

for indiViduality, and privacy for residents without compromising tlTe

Health Core FacilitIes.

operational need for dose observation, safety, and security. Facility

Several green building rating systems are applicable to residelJtial

design should consider resident vulnerability fo stress from noise, lack 9f

health, care, and support Settings, including:

privacy, poor or inadequate lighting, poor ventilation, and other physical

a. Senior tivingSustainability Guide. This online resource, provided by

environmenteffects that may prove harmful to resident well-being.

With Seniors in Mind, Inc., identifies fQur dimensions in which sus­

Provision of accommodations for visits from family members.and

tainability applies in senior living communities.

overnight stays should be considered based on the cognitive concerns

b. Ereen Globes assessment and rating system. This interactive green

of acare population to support choice and options for family categivers

building design tool from the Green Building Initiative (GBI)

ana residents.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 35
1.2 PLANNING/PREDESIGN PROCESS

1.2-5.7.2 See Section 1.2-3.5 (Resident Dementia and *1.2-5.8.2 Comfort and dignity
Mental Health Risks) for resident safety risk assess­
ment (RSRA) requirements. *1.2-5.8.3 Privacy and respect

1.2-5.8 Resident Quality of Life *1.2-5.8.4 Meaningful engagement

The core values of person-centered care shall be
applied to the design of residential health, care, and *1.2-5.8.5 Courtesy and concern
support facilities. At minimum, these shall include the
following: *1.2-5.8.6 Community

[*1.2-5.8.1 Choice and control

APPENDIX

A1.2-5.8.1 Choice and control. Tne culture of the commu­ A1.2-5.8.3 Privacy and respect. Spaces are designed to pre­
nity supports a range of opportunities for all persons to make decisions serve visual and auditory privacy. Residents should be able to live in an
concerning their personal and professional lives as well as their health environment shielded from the business of everyday "institutional" life
and welfare~ Resident areas should provide for choice, flexibility, and and in aspace that respects the processes of liVing a meaningful life and
control in environmental matters, including personalization of spaces of aging, along with associated emotions and existential/spiritualissues.
and options for engaging in major activities such as meals and bath­
A1.2-5.8.4 Meaningful engagement. Awide variety
ing. Lack of choice in these matters can be astressor for residents and
of opportunities is availableto allow all persons in the community to
guests. Providing residents with options for where they spend time,
participate in programs and activities aligned with their individual
and whether they choose to be sociable or private, is essential. Giving
needs, interests, and abilities. Spaces support family interaction, con­
residents adegree of control over their immediate environment, such as
templation, community, and meaningful activities with optimal social,
temperature, ventilation, and sound, sometimes in collaboration with
emotional, pllysical, and cognitive support.
staff, is also important.
A1.2-5.8.5 Courtesy and conce.rn. Members of the tare
A1.2-5.8.2 Comfort and dignity. Dignity is the state or
community (staff and persons receiving care) show politeness and
quality of being worthy of respect, including self-respect, and the built
respect in their attitudes and behavior toward each other. There is a
environment can contribute to, or detract from, a person's sense of dig­
demonstration of mutual respect and an interest in or care for another's
nity. As they age, people strive for and are entitled to dignity, and resi­
well-being. Spaces provide for personal control of the environment and
dential health, care, and support environments should safeguard and
pleasant sensory experiences.
promote respect for individuals and their intimate and personal needs.
Building design should therefore actively seek to prevent indignities A1.2-5.8.6 Community. Asense of fellowship with others
that can arise from environments that do not support person-centered results from sharing common attitudes, interests, and goals. Spaces are
care. Staff should consider the needs and preferences of the individu· welcoming and support the cultural diversity of residents and families.
als who are receiving care assistance. Persons receiVing care are equal
partners in the planning of care and their opinions are important and to
be respected.

36 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 1.2 PlANNING/PREDESIGN PROCESS

Table 1.2-1
Resident Safety Risk Assessment Components

Risks Section Facility Type!Area Project Scope

Nursing home, hospice, assisted living, adult day care, outpatient 1. New construction
Infection control risk 1.2-3.2
diagnostic and treatment, and outpatient rehabilitation 2. All renovations

Resident mobility and 1. New construction

1.2-3.3 All
transfer risk 2. All renovations

Resident fall risk and 1. New construction

1.2-3.4 All
prevention 2. All renovations

Resident dementia and All, based on whether the care population includes residents with 1. New construction
1.2-3.5
mental health risk dementia or mental health issues 2. All renovations

All facilities where medications are prescribed, transcribed, 1. New construction

Medication error risk 1.2-3.6
prepared, administered, monitored, or documented 2. All renovations

1. New construction
Security risk 1.2-3.7 All
2. All renovations

Disaster risk and emergency 1. New construction

1.2-3.8 All
preparedness 2. All renovations

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 37
 1.3 Site Selection
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 1.3-1 General 1.3-2.4 Access to Utilities

The site shall have access to utilities (water, gas, sewer,
1.3-1.1 Application electricity) to meet requirements in the facility chap­
The provisions of this chapter shall apply to all residen­ ters in this document.
tial health, care, and support facilities.

• 1.3-3 Functional Site Requirements

• 1.3-2 Location
See Section 1.2-2.2.2.2 (1) (Site) for functional
1.3-2.1 Access requirements to consider when selecting the site for a
The site of any residential health, care, and support
residential health, care, or support facility.
facility shall be accessible to the community and to

service and emergency vehicles.

*1.3-2.2 Availability of Transportation

1.3-2.3 Security
See Section 1.2-3.7 (Security Risk Assessment) for
security considerations to review during the site selec­
tion process.

APPENDIX

A1.3-2.2 Availability of transportation. Facilities should that supports alternatives to fossil-fueled single-occupancy vehicles,
be located convenient to publictransportation where available, unless including preferred van/carpool parking, bike parking and changing
acceptable alternative methods of transportation to public facilities facilities, alternative vehicle fueling stations, and nearby transit access.
and services are provided. Atransportation plan should be developed

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 39
 • Design, Construction, and Commissioning
Considerations and Requirements
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 1.4-1 General • 1.4-2 Design Considerations and

Requirements

1.4-1.1 Application
The provisions of this chapter shall apply to all *1.4-2.1 Acoustic Design
residential health, care, and support facility projects.
*1.4-2.1.1 Application
*1.4-1.2 Design Process Design for new and renovated residential health, care,
To meet the objectives of this chapter, care provider and support facilities shall conform to the Guidelines
organizations shall develop an integrated design and all applicable codes and regulations with respect to
process to guide facility design. exterior environmental sound and interior sound in all
occupied building spaces.
*1.4-1.3 Design Team
An interdisciplinary design team shall participate
1.4-2.1.2 Design Parameters
throughout the project design process.
See Section 2.5-8 (Acoustic Design Systems) for

specific design requirements.

APPENDIX

A.1.4-1.2 The intent of an integrated design process is to improve A-weighted sound levels in dBA. Separate limits .aretypically seffor
'building performance by incorporating input from all project team day and night periOds, with the nighttime Iilhit typically 5to 10d~A
members (including constructors and installers) and consideringsus~ lower than the daytime limit Daytime limits typically vary between
tainable design principles from project inception. See appendix section 55 and 65 dBA.
A1.M.5.1 (Sustainability planning) for additional information. b. Following are acoustic design codes, regulati9ns, and g!Jidelines for
reference:
A1.4-1.3 The interdisciplinary team should include administrators,
-U.S. Department of Health and Human Services regulations
facility managers, clinicians, infection preventionists, environmental
(including Health Insurance Portability and Accountability Act)
services managers, safety officers, support staff, architecture and engi­
-Building code used by the local or statejyrisdiction
neering consultants, residents/resident advocates and family members,
-Local and state limits on environmental sound
construction specialists, and other identified stakeholders. See appendix
-Occupational Safety and. Health Administration regUlations for
section A1.2-1.2 (Planning process) for additional information.
worker noise exposure in areas where sound levels exceed 85
A1.4-2.1 ACQustic terms. The definitions of acoustic terms
dBA
used in this publication are based on American National Standards
-Professional society design guidelines for noise (e.g.! American
Institute (ANSn Sl.l: Acoustical TermiTlology.See "Sound and
Society of Heating, Refrigerating, and Air-Conditioning
Vibration Design for Health Care Facilities;' awhite paper prepared by
Engineers guidelines for mechanical system sound and vibration
the Acoustics Working Group of the Acoustics Research Council and
control)
coordinated with the current edition of the FGI Guidelines, for the
-American National Standards Institute guidelines for sound in
glossary of acoustic terminology used in this document.
building spaces and specialspaces (e.g., booths for measuring
hearing threshold)
A1.4-2.1.1 Acoustic design codes, regulations, and
-Manufacturers'gUidelines for equipment that is sensitive to
guidelines
sound and vibration Or produces sound and/or vibration
a. Noise limits set by codes often are expressed as maximum
---------------------------------_._-_. __._._-_._-------_•. _­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 41
1.4 DESIGN, CONSTRUCTION, AND COMMISSIONING CONSIDERATIONS AND REQUIREMENTS
1.4-2.2 Sustainable Design
Sustainable site and building design, construction,
and maintenance practices to improve building
performance shall be considered in the design and
renovation of residential health, care, and support
facilities. See Section 2.2-2 (Sustainable Design
Criteria) for specific requirements.
*1.4-2.3 Design Considerations for
Accommodation of Persons of Size
Where residents who are persons of size are part of
the care population, the facility shall be designed
with support and clearances appropriate for these
individuals. Other requirements for accommodating
persons of size are contained in the facility chapters
of this document. See Section 2.2-3 (Design Criteria
for Accommodations for Care of Persons of Size) for
additional information.
A 1.4-2.3 Design considerations for
devices, transfer .and toileting assistance, and bathing assistance.
accommodations for care of pe.rsonsof size
Any environment sized to accommodate reSidents, participants,
"Person ofsize"is aterm intended to describe a.person whose height,
weight, body width, weight distribution, and/or sjze requires incre.ased
space for care and use of expanded-capacity devices, equipment,
furniture, technology, and supplies. The term is often interchangeable
with obese, morbidly obese, and bariatric.
a. The need to accommodate residentswhoare extremely obese Or tall
is increasing in the United States. In addition to requiring facilities
with more space and patient handling equipmentand furnishings
with greater weight capacities (e.g.,grab bars, chairs, toilets), these
residents have avariety of special health care needs from climate
control requirements to specialty bathing fixtures. Visiting family
members of residents also~may be persons of size.
b. Creating residential health, care,Clnd support environments that
can accommodate persons of size requires attention to issues that
significantly affect design. To determine the number of beds per unit,
dwelling units per project, or needs required in. anon-residential
setting that should be able to Clccommodate apopulation of persons
of size, the design tearnshould consider design issues along with an
analysis of factors such as resident volume, expected length of stay,
the nature of the care population, current codes, and local regulation
requirements.
Another primary space driver isthe staffing-per-resident (or
PClrticipant or outpatient) ratio and associated space needed for
maneuverability in environments accommodating persons of size.
In some instances, additional caregivers are recommended for
resident, participant, or outpatient transfers. Many users may also
need enlarged facilities to accommodate resident-operated mobility
42 Guide!ines for Design and Construction of Residentia! Health. Care. and Support
• 1.4-3 Renovation
*1.4-3.1 Phasing
Projects involving renovation of existing buildings shall
use phasing to minimize disruption of existing resident
servICes.
1.4-3.1.1 Phasing Provisions
Phasing provisions shall include:
1.4-3.1.1.1 Clean-to-dirty airflow
1.4-3.1.1.2 Emergency procedures
1.4-3.1.1.3 Criteria for interruption of protection
1.4-3.1.1.4 Construction of roof surfaces
1.4-3.1.1.5 Written notification of interruptions
and outpatients who are persons of size will likely be the largest
resident (are environment in Cl facility. If so, Clil other resident types
will become subsets of design parameters established for this envi­
ronment.
For specific details for accommodating residents, participants,
and outpatients who are persons of size, see Section 2.2-3 (Design
Criteria for Accommodation of Persons of Size).
c. Worker's compensation costs for nurses and nursing assistants
amount to nearly $1 billion per year (Bureau of Labor Statistics).
Caring for obese patients presents challenges to.patient positioning,
mobility tasks, ana ov.erall patient and staff safety. The Bureau of
.Labor Statistics haHeported that nursing employees suffer more
than 200,000 work-related injuries and illnesses ayear, including
sprains/strains; low back pain; and wrist, knee, and Shoulder injuries,
especially when manually moVing or lifting patients who are over­
weight or obese (5. D.Choi and K.Briggs, "Work-related musculo­
skeletal risks associated with nurses and nursing assistants handling
overweight and obese patients: Aliterature review,"Work vol. 53, no.
2, pp. 439-448, 2016). Restricted space increases exposure to high­
risk events known to cause injury (GJ. Holman, T. Blackburn, and S.
Maghsoodloo, "The Effects of Restricting Space: AStudy InvolVing
a Patient-Handling Task;' Journal of the American Society of Safety
Engineers July 2010:38-46). Clear floor space for correct positioning
may reduce injuries during patient handling activities.
A1.4-3.1 Phasing is essential to maintenance of asafe environment
in resident care areas during construction.
acl!ities
 1.4 DESIGN, CONSTRUCTION, AND COMMISSIONING CONSIDERATIONS AND REQUIREMENTS
1.4-3.1.1.6 Communication authority
1.4-3.1.2 Noise and Vibration
Phasing plans shall include consideration of noise and
vibration control during construction activities.
1.4-3.2 Isolation of Construction Areas
During construction, renovation areas shall be isolated
from occupied areas based on an infection control risk
assessment. See Section 1.2-3.2 (Infection Control
Risk Assessment) for requirements.
1.4-3.3 Maintenance of Air Quality
Existing air quality requirements for occupied
systems that reflect known changes from the construc­
areas shall be maintained during any renovation or
tion documents.
construction.
1.4-3.4 Maintenance of Utilities
Existing utility requirements for occupied areas shall
be maintained during any renovation or construction.
1.4-3.5 Nonconforming Conditions
It is not always financially feasible to renovate an entire
existing structure in accordance with the Residential
Guidelines. Therefore, authorities having jurisdiction
shall be permitted to grant approval for renovation of a
portion of a building as long as preexisting features in
unrenovated areas do not jeopardize facility operations
and resident safety in renovated areas.
*1.4-3.6 Existing Conditions
Existing conditions and operations shall be docu­
mented prior to initiation of renovation and new
APPENDIX
A1.4-3.6 EXisting conditions
a. Documentation of existing conditions should cover the following:
-Subsurface conditions (e.g., soil testing reports, soil type
identification, known water table information, active/
abandoned utility locations)
-Foundation and superstructure information. including the
ability of the structure and equipment (elevator) to handle the
movement of heavy and/or large.loads from one location to
another
-=Types of fire ~uppression, detection, and alarm systems,
including whether the building is fully sprinklered
-Communications systems (e.g., telephone, nurse call, overhead
paging)
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
construction projects. This shall include documenta­
tion of existing mechanical, electrical, plumbing, and
structural capacities and quantities.
• 1.4-4 Record Drawings and Manuals
1.4-4.1 Drawings
1.4-4.1.1 Record Drawings
Upon occupancy of the building or a portion thereof,
the care provider shall receive a complete set of as-built
documents that shows construction, fixed equipment,
and mechanical, electrical, plumbing, and structural
1.4-4.1 .2 Life Safety Overlay
Drawings shall include a life safety plan for each floor
that reflects NFPA 101 requirements.
1.4-4.2 Equipment Information
1.4-4.2.1 Upon completion of the contract, the care
provider shall be furnished with the following for each
piece of equipment installed as part of the project:
1.4-4.2.1.1 Operations and maintenance manual.
Complete set of manufacturers' operations, mainte­
nance, and preventive maintenance instructions (0 &
M manual) for installed systems and equipment
1.4-4.2.1.2 Parts list
1.4-4.2.1.3 Model number and description
-Plumbing systems (e.g., domestic water, ueated water,
wastewater, pneumatic control,medical gaslvacuum)
-Existing airflow of affected areas
~Main electrical service and electrical service affected by
construction, including rating and actual load/peak and feeder
sizes, as.applicable, i1nd power factor
-Emergency power system, including rating and aCfualload/
peak and feeder sites, as applicable, for life safety,.emergency
and critical systems, and equipment branches
b. The potential for reusing existing structure.sand interiors shau1dbe
evaluated and considered when conducting arenovation.
43
1.4 DESIGN, CONSTRUCTION, AND COMMISSIONING CONSiDERATIONS AND REQUIREMENTS

1.4-4.2.2 Instruction Manual for Staff

1.4-4.3.3 Estimated water consumption
Operating staff shall be provided with instructions

1.4-4.3.4 Medical gas outlet list, if applicable to the

for the correct operation of installed systems and

residential health, care, and support facility

equipment.

1.4-4.3.5 List of applicable codes

*1.4-4.3 Design Data
1.4-4.3.6 Electric power requirements of installed
The provider shall receive a complete set of design data
for the facility, including the following: equipment

1.4-4.3.1 Structural design loads

• *1.4-5 Commissioning
1.4-4.3.2 Summary of heat loss assumption and

calculations
1.4-5.1 Commissioning Activities
At minimum, the following commissioning activities
shall be undertaken:
APPENDIX

A 1.4-4.3 The provided design data will be used to facilitate future
alterations, additions, and changes, including energy audits and retrofits
for energy conservation.
A 1.4-5 Commissioning. Commissioning is aquality control
according to design intent, specifications, equipment manufacturers'
data sheets, and operational criteria. Because all building systems
are integrated and validated during commissioning, the owner can
expect the commissioning process to improve occupant comfort,

energy savings, environmental conditions, system and equipment

process used to document and validate the planning, construction,

function, building operations and maintenance, and building

installation, testing, and operation offacilities and component

occupant productiVity.
infrastructure systems. The goal is to ensure that infrastructure systems

-Feedback: The TBC process should include afeedback mechanism

and equipment are capable of being operated and maintained in

that can be incorporated into the owner's postoccupancy evaluation

conformity with the care model and design intent to meet the owner's

process to enhance future facility designs.

project requirements (OPR).

-Acceptance building testing: Facility acceptance criteria should be

a. Commissioning gUidance. Many organizations, including NEBB, BCA,
based on the commissioning requirements specified in the contract
and ASHE, have published commissioning manuals, gUidelines,
documents. These criteria specify the tests, training, and reporting
standards, and handbooks. The ASHE Health Facility Commissioning
the owner must complete to validate that each bUilding system
Guidelines (HFCx GUidelines) is structured to foster asuccessful transi­
complies with the performance standards of the basis of design
tion from planning, design, and construction to high-performance
before final acceptance of the facility.
operations (Le., operations that are code-compliant, safe, and
-Systems and components included in TBC: Key systems and
energy-efficient and that support positive outcomes and high levels
components that need to be tested and validated, at minimum,
of resident, participant, or outpatient and visitor satisfaction).
during the TBC process include design and operations of HVAC,
The ASHE HFCx Guidelines includes the follOWing unique
plumbing, electrical, emergency power, fire protection/suppression,
features:
telecommunication, nurse call, intrusion and other alarm device,
-Establishment of a project energy-efficiency goal
medical gas (if applicable), daylight harvesting, and artificial
-Involvement of health care facility operations and maintenance
lighting control systems as well as any specialty eqUipment.
staff in the design review process
• Air balancing, pressure relationships, and exhaust criteria
-Development of a utility management plan during the design
for mechanical systems should be clearly described and
process instead of during the postoccupancy period
tested to create an environment of care that prOVides for
-Comprehensive training of the operations and maintenance
infection control.
staff, including pre-testing to assess training needs and post­
• Areas requiring emergency power should be specified and
testing to assure competency
tested.
-Testing of fire and smoke dampers prior to occupancy
• Special plumbing systems should be certified for support of
-Measurement and verification of actual energy performance as
the chemicals scheduled for use in them.
compared to the energy-efficiency goal or model
• Water lines, taps, showers, and ice machines to which
b. Total building commissioning (TBC)
service has been disrupted or stagnant should be flushed
-Objective: TBC is a process whereby the owner is assured all building
before use by building occupants.
systems and components (not just the HVAC system) will function
-Areas to be included in commissioning: While all areas of a
.__. _ - - - - - - - - - - - ---- -------_._---------------_._---..
44 Guidelines for Design and Construction of Residential Health, Care, i1nd Support Fac:!!ties
 1.4 DESIGN, CONSTRUCTION, AND COMMISSIONING CONSIDERATIONS AND REQUIREMENTS

1.4-5.1.1 Development of the Owner's Project 1.4-5.1.1.2 The OPR shall define the parameters
Requirements (OPR) required to meet the owner's expectations, including
The owner shall develop the OPR. the following:
(l) Performance
*1.4-5.1.1.1 The OPR shall identify the building (2) Operations
systems and elements to be commissioned as part of (3) Maintenance
the project scope. (4) Longevity
(5) Energy and water efficiency

APPENDIX (continued)

residential health, care, and support facility are included in the The next step is to determine corrective changes needed in
commissioning process, areas of particular concern are isolation operations, the care model, and the physical setting. TEC requires
rooms used for airborne infection and spaces containing hazard­ acoustical instrumentation that can determine compliance with
ous substances. sound absorption, isolation, and noise reduction requirements. A
c. Total environment commissioning (TEC). While the objective ofTB( light meter is needed to determine the adequacy of light levels for
is to assure the owner that all facility systems and components will different activities. An infiltration review of the bUilding envelope
function as designed, TEC is illtended to assure the owner-to the should be performed. The effectiveness of the wayfinding system,
fullest extent possible-that the facility meets the user needs and staff preparation and teamwork, staff and resident satisfaction, and
desires defined during the functional programming process. This all operating systems and processes should also be evaluated.
requires the owner to identify those needs and desires with the The TEC process should include afeedback mechanism thatran be
understanding that the ultimate measure of afacility's success is its incorporated into the owner's postoccupancy evaluation process to
ability to prOVide positive user experiences and outcomes. inform future facility designs and renovations.
To achieve afacility that consistently provides positive user expe­
A1.4-5.1.1.1 Systems and elements to be
riences, the owner must identify all potential users, all activities in
commissioned. At minimum, the following should be
which they may participate, and what they would consider aposh
commissioned for projects that involve installation of neW physical
tive experience in each activity. The owner must then evaluate and
environment elements critical to resident care and safety or facility
design all dimensions of the environment other than the physical
resource use or that modify such physical environment elements already
setting to prOVide such experiences. The physical setting design team
existing in the facility:
will use this information to create afacility that supports the other
a. HVAC systems
dimensions in providing the experiences users desire. This approach
b. Lighting systems and controls
is becoming known in the design/construction field as "experience­
c. Automatic temperature control systems
based design:'
d. Energy and water measurement devices
TEC is the process for evaluating whether all dimensions ofthe
e. Plumbing systems. At least the follOWing should be commissioned:
environment work together to provide the user experiences defined
-Domestic hot water systems
during the functional programming process and making adjust­
-Any specialty plumbing systems provided (e.g., medical and
ments accordingly. Just as inTaC changes can be made to align the
laboratory gas systems)
environment with expectations articulated by the owner.
-Domestic and process water pumping and mixing systems
TEC is part of afeedback loop-Plan, Do, Check, Act-intended
-Irrigation systems
to prOVide continuous learning and quality improvement for the
f. Fire alarm and fire protection systems. Integration of the fire alarm
owner and the design team. The functional and architectural pro­
and fire protection systems with other systems that affect health,
grams are the "Plan" stage; the design of operations and the physical
safety, and welfare (e.g., the nurse call system) should be evaluated.
setting are the "Do" phase; commissioning is the "Check" phase; and
g. Essential electrical power systems
corrections are the "Act" phase.
h. Renewable energy systems
Amultidisciplinary team should be used to design every aspect of
i. Building envelope systems
the operations and physical setting that support the care model. This
In addition to the systems listed above, consider commissioning
team remains in place throughout the continuous quality improve­
communication systems and acoustic systems. Reference the Senior
ment process established for afacility. TEC requires staffand end
Living Sustainability Guide from With Seniors in Mind for additional
users to evaluate the effectiveness of the interaction of operations
information.
and the physical setting in providing desired user experiences.
---_._-_.--_ _.._----_._----_.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 45
1.4 DESIGN, CONSTRUCTION, AND COMMISSIONING CONSIDERATIONS AND REQUIREMENTS
1.4-5.1.2 Preparation of the Basis of Design (BOD)
In response to the OPR, the design team shall prepare
a BOD narrative describing the design intent and
systems to be commissioned. The BOD narrative shall
include, at minimum, the following elements:
1.4-5.1.2.1 Description of the systems, components,
and methods used to meet the OPR
1.4-5.1.2.2 Levels of redundancy planned
1.4-5.1.2.3 Limitations and restrictions of systems and
assemblies assumed
1.4-5.1.2.4 Indoor and outdoor conditions assumed
(e.g., space temperature, relative humidity, lighting
power density, glazing fraction, V-value and shading
coefficient, wall and ceiling R-values, ventilation and
infiltration rates, etc.).
1.4-5.1.2.5 Description of emergency operation
intended. See Table 1.2-1 (Resident Safety Risk Assess­
ment Components) for additional information.
1.4-5.1.3 Preparation of Commissioning Plan,
Commissioning Specifications, and Construction
Checklists
APPENDIX
A1.4-5.1.3.3 Construction checklists. The commission­
ing agent proVides subcontractors with a list of items to inspect and
elementary component tests to conduct to verify proper installation of
equipment. Items on construction checklists are primarily static inspec­
tions and procedures to prepare the equipment or system for initial
operation (e.g., checking belt tension, oil levels, labeling, installation of
gauges, calibration of sensors, etc.). However, some construction check­
list items entail simple testing of the function of acomponent, piece of
equipment, or system (e.g., measuring the voltage imbalance of athree­
phase pump motor in achiller system). Construction checklists augment
and are combined with the manufacturer's start-up checklist. Even with­
out acommissioning process, contractors typically perform some, if not
all, of the construction checklist items on their own. The commissioning
agent requires documentation of procedures in writing and does not
necessarily witness much of the construction checklist testing, except for
testing of larger or more critical pieces or where desired by the owner.
A1.4-5.1.4 Functional performance tests. Functional
testing assesses the dynamic function and operation of equipment and
systems (rather than components) under full operation using manual
46 Guidelines for Design and Construction of Residentiai Heaith, Care, and Support Facilities
1.4-5.1.3.1 Commissioning plan. This document
shall establish the scope, structure, and schedule of the
commissioning activities and address how the commis­
sioning process will verify that the OPR and BOD are
achieved.
1.4-5.1.3.2 Commissioning specifications. These
specifications shall establish requirements for physi­
cal environment elements to be included in the
project scope and identify responsibilities related to
commissioning.
*1.4-5.1.3.3 Construction checklists. These docu­
ments shall establish inspections and individual
component tests that will be used to verify proper
functioning of physical environment elements that
have been installed or modified.
*1.4-5.1.4 Performance of Functional/Operational
Tests
Testing of the dynamic function and operation of the
physical environment elements under full operation
shall be performed. Elements shall be tested in vari­
ous modes included in the OPR and run through all
sequences of operation.
(direct observation) or monitoring methods. (For example, the chiller
pump is tested interactively with the chiller functions to see if the pump
ramps up and down to maintain the differential pressure setpoint.)
Systems are tested in various modes, such as during low cooling or
heating loads, component failures, unoccupied conditions, varying
outside air temperatures, fire alarm activation, and power failure. The
systems are run through all the control system's sequences of operation,
and the responses of components are verified to make sure they match
what the sequences state.
Traditional air or water testing and balancing (TAB) is not functional
testing. The primary purpose ofTAB is to set up the system flows and
pressures as specified. Functional testing, on the other hand, is used to
verify the performance of that which has already been set up.
The commissioning agent develops the functional test procedures
in asequential written form, then coordinates, oversees, and docu­
ments the actual testing, which is usually performed by the installing
contractor or vendor. Functional tests are performed after items on the
construction checklists and start-up procedures are complete.
 1.4 DESIGN, CONSTRUCTION, AND COMMISSIONING CONSIDERATIONS AND REQUIREMENTS

1.4-5.1.5 Preparation of the Commissioning 1.4-5.1.5.4 Mitigation or resolution of performance

Report Issues
A commissioning report shall be prepared and
presented to the owner to formally document the 1.4-5.1.5.5 Maintenance staff training to achieve
following: operational sustainability

1.4-5.1.5.1 Description of systems commissioned 1.4-5.1.5.6 Compliance with the OPR and BOD

1.4-5.1.5.2 Performance of the physical environment *1.4-5.2 Commissioning Agent

elements I If commissioning is completed for a project, it shall
be led by an independent commissioning agent with
1.4-5.1.5.3 Performance issues identified experience and expertise relevant to the project.

APPENDIX

A1.4-5.2 Commissioning agent. An independent process. Use of an in,dependent commissioning agent assures the
commissionirig.agent with residential health care experience commissioning agent is afocused owner advocate who can objectively
compensated directly by the owner and not affiliated or associated with complete the commissioning tasks without real or perceived conflict.
either the design team or the contractor should lead the commissioning

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 47
 ·s Equipment

Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• *1.5-1 General 1.5-1.2.3.4 Existing salvaged, reconditioned,

relocated, and owner-installed
1.5-1.1 Application
1.5-1.2.3.5 Existing salvaged, reconditioned,
The provisions of this chapter shall apply to all residen­
relocated, and contractor-installed
tial health, care, and support facility projects.

1.5-1.2.3.6 Existing salvaged, relocated, and owner­

1.5-1.2 Equipment List
installed
An equipment list shall be developed and maintained
throughour the design development process and 1.5-1.2.3.7 Existing salvaged, relocated, and
included in the contract documents to assist in overall contractor-installed
coordination of the acquisition, installation, and
relocation of equipment. 1.5-1.2.3.8 Not-in-contract

1.5-1.2.1 The equipment list shall include all 1.5-1.3 Documentation Requirements
equipment necessary to operate the facility.
*1.5-1.3.1 Provisions for Equipment
1.5-1.2.2 The equipment list shall include the clas­
sifications identified in Section 1.5-2 (Equipment 1.5-1.3.1.1 The drawings and other project documen­
Classification). tation shall indicate provisions for the installation of
fixed or movable equipment that requires dedicated
1.5-1.2.3 The equipment list shall specifY whether the building services or special structures and illustrate
items are: how the major equipment will function in the space.

1.5-1.2.3.1 New owner-furnished and owner-installed 1.5-1.3.1.2 An equipment utility location drawing
shall be produced to locate all services for equipment
1.5-1.2.3.2 New owner-furnished and contractor­ that requires floor space and mechanical connections.
installed
*1.5-1.3.2 Not-in-Contract (NIC) Equipment
1.5-1.2.3.3 New contractor-furnished and c:ontractor­
installed

APPENDIX

A1.5~1 Planningi~ required to assure the equipment chosen for a support maintenance ofcirculation paths and residE!nt, staff, and visitor

specific project is accommodated in the design. EquipmE!nt/technolo~y safety.

planning should be based on the care population and operational need

A1.5-1.3.2 Some equipment may notbeincluded in the construc­

identified during the functional programming process.

tion contract but may requirl! c{jordination during construction.

A1.5-1.3.1 Cord placement. Placement of cords from recep­

tacles to portable equipment should be considered during design to

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 49
1.5 EQUIPMENT
1.5-1.3.2.1 Design development documents. Equip­
ment that is not included in the construction contract
but requires mechanical or electrical service connec­
tions or construction modifications shall be identified
on the design development documents to facilitate
coordination with the architectural, mechanical, and
electrical phases of construction.
1.5-1.3.2.2 Construction documents. All equipment
shall be identified in the construction documents as
owner-provided or not-in-contract for purposes of
coordination.
1.5-1.3.3 Final Equipment Selections
1.5-1.3.3.1 Adjustments shall be made to the
construction documents to accommodate final
selections for NIC equipment during shop drawing
and submittal review.
1.5-1.3.3.2 When final selections are made, the
construction documents shall be revised to show the
equipment placed in service.
APPENDIX
A1.5-2 Equipment classification
a. Building service equipment. Building service equipment includes
items such as heating, ventilation, and air-conditioning equipment;
electrical power distribution equipment; emergency power genera­
tion equipment; energy/utility management systems; conveying
systems; security systems and devices; and other eqUipment with a
primary function of building service (e.g., humidification equipment,
filtration equipment, chillers, boilers, fire pumps, etc.).
b. Fixed equipment. Fixed equipment includes items that are perma­
nently affixed to the building or permanently connected to aservice
distribution system that is designed and installed for the specific use
of the equipment. Fixed equipment may require special structural
designs, mechanical and electrical proVisions, or other consider­
ations.
-Fixed medical equipment. This includes items such as com­
munication systems, built-in casework for equipment, imaging
equipment, and ceiling-mounted mechanical resident lifting
devices.
-Fixed nonmedical equipment. This includes items such as
walk-in refrigerators, kitchen cooking equipment, serving lines,
conveyors, computer servers, and laundry equipment.
c. Movable eqUipment. Movable equipment includes items that require
50 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
• *1.5-2 Equipment Classification
Equipment to be used in projects shall be classified as
building service equipment, fixed equipment, or mov­
able equipment.
• 1.5-3 Equipment Requirements
*1.5-3.1 Major Technical Equipment
Location and installation of major technical equip­
ment that affects the overall operation and occupancy
of a residential health, care, or support facility shall
be documented to facilitate coordination between the
care provider, building designer, installer, construction
contractors, and other members of the project team.
1.5-3.2 Electronic Equipment
1.5-3.2.1 Protection
Surge protection shall be provided to protect comput­
erized equipment from power surges and spikes that
might damage the equipment or software programs.
floor space or electrical and/or mechanical connections but are
portable, such as wheeled carts or beds, office-type furnishings,
and diagnostic or monitoring equipment. Movable equipment may
require special structural design or access, mechanical and electrical
connections, or other considerations.
-Movable medical equipment. This includes items such as por­
table X-ray, electroencephalogram (EEG), and electrocardiogram
(EKG) eqUipment; dialysis machines; treadmill and exercise
equipment; examination and treatment tables; dental chairs;
and similar equipment.
-Movable nonmedical equipment. This includes personal com­
puter stations, printers, copiers, resident room, furnishings, food
service carts, distribution carts, and other portable equipment.
A1.5-3.1 Major technical equipment
a. Major technical eqUipment includes specialized equipment (medical
or nonmedical) that is customarily installed by the manufacturer
or vendor. Examples of major technical equipment are food service
equipment, laundry eqUipment, servers, communication systems,
elevators, computers, and similar items.
b. Major technical equipment may require special structural designs,
mechanical and electrical provisions, clearances, or other consider­
ations.
 1.5 EQUiPMENT

1.5-3.2.2 Constant Power 1.5-4.2 Movable and Portable Equipment

Uninterruptible power supply (battery backup or
generator) shall be provided where loss of data input 1.5-4.2.1 Locations for the following shall be
may compromise resident care. considered during facility planning and design:

1.5-4.2.1.1 Placement of equipment requiring floor

• 1.5-4 Space Requirements for space and mechanical connections
Equipment
1.5-4.2.1.2 Power required for electrical connections
where portable equipment is expected to be used
1.5-4.1 Fixed and Building Service Equipment
Space for accessing and servicing fixed and building
1.5-4.2.2 See Section 1.5-1.3 (Documentation
service equipment shall be provided.
Requirements) for drawing requirements.

Guide!ines for Design and Construction of Residentia! Health, Care, and Support Facilities 51
 2. Site Elements
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 2.1 - 1 General other natural disasters. See Section 1.2-3.8 (Disaster

Risk and Emergency Preparedness) for additional
2.1-1.1 Application requitements.

2.1-1.1.1 This chapter contains elements that are
common to most types of tesidential health, care,
and support facilities. The elements are required only
where referenced in a specific facility chapter in Part 3
(Residential Health Facilities), Part 4 (Residential Care
and Support Facilities), and Part 5 (Non-Residential
Support Facilities).
2.1-1.1.2 Additional specific requirements are located
in the facility chapters in Parts 3, 4, and 5. Consult the
facility chapters to determine whether elements in this
chapter are required.
2.1-2.1.2 Fire department and emergency vehicle
access shall be provided in accordance with local
requirements.
2.1-2.2 Availability of Transportation
2.1-2.2.1 Site design shall integrate building and
parking locations, adjacencies, and access points with
on-site and off-site vehicular and pedestrian patterns
and transportation services.
2.1-2.2.2 The site design shall be developed to support

the project care model and operational requirements as

2.1-1.2 Location described in the functional program.

For requirements regarding site location and envi­

2.1-2.3 Security
ronmental pollution control, see Section 1.3-2 (Site
Selection-Location), Section 2.1-5 (Environmental 2.1-2.3.1 Residential health, care, and support

Pollution Control), and Section 2.2-2.1 (Sustainable facilities shall have security features for residents,

Site Design). families, staff, and the public that are consistent with

the conditions and risks inherent in the location of the

facility. See Section 1.2-3.7 (Security Risk Assessment)

• 2.1-2 Facility/Community Access

for additional requirements.

*2.1-2.1 Emergency Access

*2.1-2.3.2 Primary access points to the facility shall be
visible from ourside.
2.1-2.1.1 Access to emergency services shall be

located to incur minimal damage from floods and

APPENDIX

A2.1-2.1 Emergency access. Non-emergency vehicular or

A2.1-2.4 Availability of utilities in an emergency.
pedestrian traffic should not conflict with access for emergency vehicles.
The need for emergency and backup water supplies, emergency genera­
tors, and backup emergency power should be evaluated and addressed
A2.1-2.3.2 Security plan. Asecurity plan should be developed

in the functional program.

that addresses site access.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.1 SITE ELEMENTS

*2.1-2.4 Access to Utilities major addition, or major change in function and

included in the functional program.
2.1-2.4.1 General

Facilities shall be provided with access to reliable utili­

2.1-3.3.1 In the absence oflocal requirements, each
ties (water, gas, sewer, electricity) in compliance with
residential health, care, and support facility shall
local, state, and federal regulations for facility types.
provide parking to satisfy the needs of residents, staff,
and visitors.
2.1-2.4.2 Water Supply

2.1-3.3.2 Unless otherwise prohibited by facility

The water supply for each facility shall have the capac­

chapters in Parts 3, 4, and 5 of the Guidelines,

ity to provide for both normal usage and fire-fighting

reduction of parking requirements shall be permitted,

requirements.

as acceptable to local authorities having jurisdiction

(AH]s), based on whether the following characteristics
2.1-2.4.3 Electricity

apply to the facility or setting:

Electricity with stable voltage and frequency shall be

provided to serve facilities.

2.1-3.3.2.1 Located in an area convenient to pedestri­
ans, public transportation, or public parking facilities

• 2.1-3 Site Features 2.1-3.3.2.2 Accessible to alternative transportation

*2.1-3.1 Roads
Access roads to entrances and service areas shall be
provided on the property as applicable to the care
population and facility/setting type.
2.1-3.2 Pedestrian Walkways
*2.1-3.2.1 Accessible paved walkways shall be provided
for pedestrian traffic.
2.1-3.2.2 Aligned curb cuts shall be provided for
arrangements such as carpooling or shuttle buses
2.1-3.4 Signage and Wayfinding
Wayfinding shall be provided to direct people
unfamiliar with the facility to parking areas and
entrances. See Section 1.2-4.5.3 (Signage and
Wayfinding) and Section 2.4-2.2.12 (Signage and
Wayfinding) for additional requirements.
*2.1-3.5 Site Lighting
Site lighting shall be provided on roads, parking lots,

and pedestrian walkways. See Section 2.5-7 (Daylight­

continuity of access throughout the community or

ing and Artificial Lighting Systems) for additional

facility grounds.

requirements.
2.1-3.3 Parking

2.1-3.6 landscape Features

Parking needs shall be evaluated for each new facility,

*2.1-3.6.1 General

A2.1-3.1 Roads. Separation of public entry and service entry
should be considered.
A2.1-3.2.1 Walkways. To avoid vehicular and pedestrian
conflict, walkways should be kept separate from driveways and
pedestrian crossings should be provided at intersections rather than
mid-block.
to prOVide multiple lighting levels or to designate night parking
closer to the bUilding.
c. lighting design for the site, roadway, and parking lots should control
glare.
A2.1-3.6.1 Landscape features
a. Care providers should consider opportunities to promote physical

activity and/or use of the outdoors for residents, staff, family, and

A2.1-3.5 Site lighting

visitors. Subject to site constraints, landscape elements such as

a. Exterior lighting should be designed to minimize night-sky pollution.

healing gardens or natural landscapes should be integrated into

b. lighting controls should permit zoned operation, allowing facilities

56 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.1 SITE ElEMENTS

See Section 1.2-4.5.1 (Light) and Section 1.2-4.5.2
(Views of and Access to Nature) for additional
requirements.
*2.1-3.6.2 Outdoor Activity Spaces
Gardens and outdoor activity spaces shall be located to
receive direct sunlight at some time during the day.
2.1-3.6.3 Outdoor Water Features

APPENDIX (cantiquedj

residential health, care, and support facilities wherever possible. -Security enclosures at the perimeter of outdoor spaces as

C:onsider arange of locations, including roof gardens, horticultl,lre needed to support the model of care and re~pond to the

therapy gardens, walking trails, and so on to provide diverse outdoor community at large

experiences. b. Architeeturaldetait surface, and buiJdingsystem

b. Indigenous and low-maintenance landscape materials and plants recommendations

should be used to reduce the use of water for irrigation and the life -Walkways should be smooth, level, nrm, and have a non-glare
cycle costs of maintenance. See appendix section A2.2-2.1.3.4 (Irri­ surface.
gation of landscape areas) for water conservation recommendations. -Walkways should not have steps.
~Walkways should be a minimum of5feet (1 n centimeters)
A2.1-3,6.2 Outdoor activity spaces. Fa.cilities should
wideto accommodate pedestrians and resident-operated
provide outdoor spaces designed t1> promote outdoor activity on the
mobility deVices passing in two directions. ·Provision of seating
part ofresidents, participants, and ol,ltpatients. Views Qf outdoor spaces
or benches on awalkway should not encroach on th.e minimum
from common dining, liVing, and activity rooms and from therapy areas
width.
can encourage users to go outdoors. Facilitating independent access
-Walkway configuration should consider the turning radius and
to outdoor space, such as locating dbOr~ to outside space near resident
turning capability of resident-operated mobilitydevitesand
rooms and providing automatic opening doors and flush thresholds, will
assure stability on the walkway.
encourage residents to go outside without assistance.
-Walkways should be dearly visible and minimize dead ends.
Outdoor activity5paces may include gardens on grade, roofdecks,
~Smooth, solid-surface transitions should be proVided between
and outdoor seating areas such as solaria, porches, and balconies.
walkways and adjacent surfaces.
Secure, accessible outdoor space can prOVide acalming change in envi­
-Walkway lighting should be low tothe ground with a.controlled
ronment as well as aconvenient place.for residents, staff, and families to
light spread to avoid spilling light into bedroom windows at
walk and nndJespite.
night.
Consideration should be given to provision of indoor/outdoor spaces
-Doors to the outdoors should op.erate easily from both
such as solaria, three-season rooms, and greenhouse rooms, whi(h can
directions.
be used in inclement weather and will allow access.to nature for frail
-Automatic orassistive door openers and/or resident-operative
residents who are unable to go outside.
hardware should be provided on all doors.
a. Features for outdoor activity spaces include:
-Where doordosers are used, resistance should be appropriate
-A quiet location with nature sounds to mask man-made sounds
for the care population being served:
-Natural or man-rnade shade and shelter (trees and pergolas)
-Door thresholds should not impede residents using mobility
-Plantings that offer four-season. interest and attract wildlife
devices.
-Raised beds and other planting space
-Mane-finish materials with a medium value contrast should be
~Water features that prOVide positive acoustic distraction
used for walkways, seating, and tables to avoid glare.
-Areas for group activities, gathering, and social events
• Materials that are light in color value should not be used.
-Space for avariety offurniture designed for persons with
Glarewhere the sun's rays reflect from light-value surfaces
physical limitations (e.g., benches and chairs with arms, tables
can temporarily blind older adults. Reflected' glare from
on which to place items)
below or from the side of the eye is much more problematic
• Seating should be placed at regular intervals along walk­
than glare from above.
ways and paths to facilitate rest during walks.
• Anon-glare finish should be used for concrete surfaces. New
• Seating should be movable so it can be rearranged to
(oncrete surfaces have alight reflectance value (LRV) of65
accommodate those using resident-operated mobility
or higher. Sunlight reflecting off this surfac.e is experienced
devices.
as adisabling glare. To lower the LRV, aQQ:colorar'lt to the
-Electricity for special events as well as individual use

mix or apply an acid wash to the finished (oncrete to darken

-Access to nearby restrooms and drinking water

the value to below 35 LRV.

-Access to water. Hose bibs should be proVided.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 57
2.1 SITE ELEMENTS
2.1-3.6.3.1 Where provided, open outdoor water
features shall be designed to support maintenance of
safe water quality to protect the public from infectious
or irritating aerosols.
2.1-3.6.3.2 Where provided for facilities that serve
special care populations, outdoor water features shall
be designed with the care population in mind to pro­
vide safe and accessible environments.
• 2.1-4 Building Orientation
2.1-4.1 See Section 1.2-2.2.2.2 (l)(a) (Site-Building
orientation) for planning requirements.
APPENDIX
A2.1-5 Environmental Pollution Control
a. Design, construction, renovation, expansion, equipment review, and
operational review of residential health, care, and support facilities
are all subject to provisions of several federal environmental pollu­
tion control laws and associated agency regulations.
b. Many states have enacted statutes and regulations that are sub­
stantially equivalent to or more stringent than federal regulations,
thereby implementing national priorities under local jurisdiction and
addressing local priorities (e.g., underground storage tanks; hazard­
ous materials and waste storage, handling, and disposal; storm
water control; medical waste storage and disposal; lead and asbestos
in bUilding materials).
c. Consult the appropriate U.S. Department of Health and Human
Services (DHHS) and U.S. Environmental Protection Agency (EPA)
regional offices and any other federal, state, or local AHJs for the
latest applicable state and local regulations pertaining to envi­
ronmental pollution that may affect the design, construction, or
operation of the residential health, care, or support facility, including
management of industrial chemicals, pharmaceuticals, and wastes
from the facility, as well as trash, noise, and traffic (including air
traffic).
-Permits. Residential health, care, and support facilities regu­
lated under federal, state, and local environmental pollution
laws may be required to support permit applications with
appropriate documentation of proposed impacts and mitiga­
tions.
-Environmental impact statement/health risk assessment.
Impact and mitigation documentation is typically reported in an
environmental impact statement (EIS) with respect to potential
effects on the environment and in a health risk assessment
(HRA) with respect to potential impacts on public health. The
HRA may constitute a part or an appendix of the EIS. The scope
ofthe EIS and the HRA is typically determined in consultation
with appropriate regulatory agency personnel and, if required,
58 Guidelines for Design and Construction of Residential Health, Care. and Support Facilities
2.1-4.2 See Section 2.2-2.1 (Sustainable Site Design)
for building orientation requirements.
• *2.1-5 Environmental Pollution
Control
The design, construction, renovation, expansion,
equipment, and operation of residential health, care,
and support facilities shall meet the provisions of
applicable government environmental pollution con­
rrollaws and associated agency regulations. See Section
2.2-2.6 (Emissions, Effluents, and Pollution Control)
for additional information.
includes a meeting to which members of the interested public
are invited to express their concerns. The EIS and/or HRA should
be prepared in accordance with afinal protocol approved by the
appropriate agency or agencies.
-Protocol document. Once the EIS and/or HRA scope has been
established, a protocol document should be prepared for agency
approval. The protocol document should describe the scope and
procedures to be used to conduct the assessment(s). Approval
is most likely to be obtained in atimely manner and with mini­
mum revisions if standard methods are initially proposed for use
in the EIS and/or HRA. Standard methods suitable for specific
assessment tasks are set forth in EPA documents.
d. Mercuryelimination. Residential health, care, and support
facilities should collect and properly store, recycle, or dispose of
mercury encountered during construction or demolition (such
as mercury accumulated in P-traps, air-handling units, sumps,
etc.).
-Residential health, care, and support facility projects should
comply with local codes and standards for mercury reduction
and elimination.
-In new construction, residential health, care, and support facili­
ties should not use mercury-containing equipment, including
thermostats, switching devices, and other bUilding system
sources.
-For renovation, residential health, care, and support facilities
should develop a plan to phase out mercury-containing sources
and upgrade current mercury-containing lamps to low or no
mercury lamp technology.
e. Release of toxic substances from equipment. Equipment should
minimize the release of chlorofluorocarbons (CFCs) and any
potentially toxic substances that may be used in their place (e.g.,
the design of air-conditioning systems should specify CFC alter­
natives and recovery systems).
 • Design Criteria

Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 2.2-1 General 2.2-2.1.2 Development Considerations

Site development considerations shall include the
2.2-1.1 Application following:
This chapter contains elements that are common to
most types of residential health, care, and support 2.2-2.1.2.1 Land use
facilities.
2.2-2.1.2.2 Storm water management
2.2-1.1.1 The common elements in this chapter
are required only where referenced in the facility 2.2-2.1.2.3 Habitat preservation
chapters in Part 3 (Residential Health Facilities), Part
4 (Residential Care and Support Facilities), and Part 5 2.2-2.1.2.4 Landscape design and irrigation systems
(Non-Residential Support Facilities).
2.2-2.1.2.5 Shading
2.2-1.1.2 Additional specific requirements are located
in the facility chapters in Parts 3, 4, and 5. 2.2-2.1.2.6 Natural ventilation

2.2-2.1.2.7 Renewable energy use

• 2.2-2 Sustainable Design Criteria
2.2-2.1.2.8 Mitigation of effects from heat islands
See Section 1.2-5.5 (Planning for Sustainability) for
additional requirements. 2.2-2.1.3 Evaluation of Conservation Measures

2.2-2.1 Sustainable Site Design 2.2-2.1.3.1 To reduce energy consumption, the

*2.2-2.1.1 Environmental Impacts
The site design shall be developed to minimize negative
environmental impacts associated with buildings and
related site development.
site and building orientation shall be evaluated
for potential solar and wind energy feasibility and
subsequent installations.
2.2-2.1.3.2 The orientation of the buildings on the
site shall be evaluated to maximize use of daylighting.

APPENDIX

A2.2-~.1.1 Sustain.able design features. Aminimum of

b. Agreen roof with agrowing medium at least 3inches (75 mm) deep.
40 percent of the entire site should incorporate one or any combination
Co Permeable pavement, permeable pavers (open-grid pavers), or open
of the following:
graded (uniform-sized) aggregate with a minimum percolation rate
a. Bio-retention facilities, rain gardens, filter strips, grass swales, veg­ of 2gallons/minute/ft2 (100 Uminute/m2). Consideration oftheir .
etated level spreaders, constructed wetlands, planters, or open space effect on the care population (including cognitive and physical abil­
with plantings in agrowing medium at least 12 inches (300 mm) ity) and how exterior spaces will be used should be evaluated before
deep. Planted areas should be bio-diverse with at least 60 percent selecting permeable pavement, permeable pavers, or open graded
coverage in native or adapted plants. aggregate.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.2 DESIGN CRITERIA
See appendix section A1.2-2.2.2.2 (l)(a) (Building
orientation) for more information about building
orientation and related site issues.
2.2-2.1.3.3 The location of the building shall be evalu­
ated according to the impact of site exterior noise,
acoustics, and the care population. See Section
1.2-5.2 (Acoustic Planning) and Section 2.5-8 (Acous­
tic Design Systems) for additional requirements.
*2.2-2.1.3.4 Landscape areas shall be evaluated for
irrigation needs and estimated water consumption.
*2.2-2.2.2 Equipment Selection
*2.2-2.2 Energy Efficiency
2.2-2.2.1 General
. APPENDIX
A2.2-2.1.3.4 Irrigation of landscape areas
a. An irrigation system should supply no more than athird ofthe
requirements.
improved landscape area with potable water. All other irrigation
b. Sample energy efficiency strategies
should be proVided from alternative on-site sources of water or
-Use computer modeling early in schematic design of major
municipally reclaimed water.
new projects to help develop energy efficiency strategies and
b. Automatic irrigation systems should be hydro-zoned to water accord­
ing to the needs of different plant materials, such as turf grass vs.
shrubs. Landscaping sprinklers should be installed to prevent water
spray either on or within 3feet (91.44 centimeters) of a bUilding.
c. Irrigation systems serving the project site should be controlled by a
smart controller that uses weather data to adjust irrigation schedules
or an on-site rain or moisture sensor that automatically shuts the
system off after a predetermined amount of rainfall or sensed mois­
ture in the soil.
d. Atemporary irrigation system used exclusively for new landscape
establishment should be used no longer than necessary for successful
landscape establishment.
A2.2-2.2 Energy efficiency. Health care facilities should set
energy efficiency goals and consider energy efficiency strategies while
making sure to meet the light power density and functional needs of
residents and staff.
a. Sample energy efficiency goals
-Apply ASHRAE 90.1: Energy Standard for Buildings Except Low­
Rise Residential BUildings.
-Apply ANSI/ASHRAE/ASHE Standard 189.3: Design, Construc­
tion, and Operation ofSustainable High-Performance Health Care
Facilities.
-Design to earn ENERGY STAR rating.
-Design to meet LEED, Green Globes, or other green building
rating system energy criteria.
60 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.2-2.2.1.1 Energy efficiency goals shall be considered
in all phases of facility development or renovation.
Architectural elements that reduce energy consump­
tion shall be considered as part of facility design.
2.2-2.2.1.2 The quality of the health care facility
environment shall be supportive of the occupants
and the function served. Therefore, design for energy
efficiency shall enhance, not adversely affect, resident
health, safety, and accepted personal comfort levels.
2.2-2.2.2.1 Mechanical and electrical systems shall be
selected and sized to meet loads, minimize space use,
and take advantage of climate characteristics, daylight­
ing opportunities, and building orientation to reduce
overall energy demand and consumption.
-Design to meet International Green Construction Code (IgCC)
opportunities.
-Reduce overall energy demand. Sample strategies for this
purpose include using a high-efficiency building envelope;
passive and low-energy sources of lighting (including
daylighting); advanced lighting controls integrated with
daylighting strategies; heat recovery and natural ventilation;
and high-efficiency equipment, as part of building mechanical
and electrical systems (e.g., chillers and air handlers) and for
plug loads (e.g., ENERGY STAR copiers, computers, medical
equipment, appliances).
-Optimize energy efficiency. Mechanical and electrical control
systems should optimize consumption to the minimum actual
needs for the bUilding. Consider using multiple modular HVAC
equipment units or variable-speed drives for variable loads. Con­
sider co-generation systems for converting natural gas to heat­
ing (or cooling) and electricity. Select equipment with improved
energy efficiency ratings.
-Reduce environmental impacts associated with combustion of
fossil fuels and refrigerant selection. Consider various renew­
able sources of energy generation, including purchase of green
power, solar and wind energy, or geothermal ground source
heat pumps.
A2.2-2.2.2 For information on lighting, lighting levels, and auto­
mated lighting controls, see Section 2.5-7 (Daylighting and Artificial
Lighting Systems).
 2.2 DESIGN CRITERIA

2.2-2.2.2.2 Products shall comply with the minimum *2.2-2.3.2 Water Measurement Devices
efficiencies addressed in one or more of the following:
(I) National Appliance Energy Conservation Act
2.2-2.3.3 Plumbing Fixtures and Fittings

(NAECA)
Evaluate plumbing fixtures and fittings to maximize

(2) Energy Policy Act (EPAct) water conservation based on the care population.

(3) Energy Independence and Security Act (EISA)

*2.2-2.3.4 Water Recovery Options
2.2-2.3 Potable Water Quality and Where potable water is used, evaluate once-through
Conservation cooling equipment for water recovery options.

*2.2-2.3.1 General *2.2-2.4 Indoor Environmental Quality

2.2-2.3.1.1 Potable water quality and conservation *2.2-2.4.1 Indoor Air Quality
strategies shall be evaluated in all phases of facility
See Section 1.2-5.4 (Indoor Air Quality Planning) for
development or renovation.
additional requirements.
2.2-2.3.1.2 Design for water conservation shall not
adversely affect resident health, safety, or infection
control.

APPENDIX

A2.2-2.3.1 Potable water consumption can be reduced by using
low-<onsumption plumbing fixtures and controls, low-consumption
irrigation systems, and landscape design such as xeriscaping as well as
replacing items such as water-cooled pumps and <om pressors that use
.potable water sources with non,evaporative heat rejection equipment
(aiN:ooled or ground source) or equipment that uses non-potable water
sources.
A2.2-2.3.2 Water measurement devices. Measurement
devices with remote communication capability should be provided to
<olIect water consumption data for the domestic water supply to the
building. In addition, for individual leased, rented, or other tenant or
sub-tenant space in any building totaling more than 50,000 square
feet (4,645 square meters), separate sub-meters should be provided for
potable and reclaimed water used in the building project. For subsys­
tems with multiple similar units, such as multi-cell cooling towers, only
one measurement device is required for the subsystem. Utility company
service entrance/interval meters should be permitted for use in comply­
ing with this requirement.
A2.2-2.3.4 Water recovery options. Where potable water is
low- or zero-VQC (volatile organic <ompound) finishes and furnish­
ings, reduced moisture entrapment, daylighting, and acoustic design
measures. Such measures should not conflict with health care safety
and infection control codes, standards, and requirements.
b. Carpeting, uphoistery, paint, adhesives, and manufactured wO.od
products may emit volatile organic compounds, such as formalde­
hyde and benzene. Use low- or zero-VQC paints, stains, adhesives,
sealants, and other construction materials, where practical, for
building products.
c. Materials or construction systems that are permeable and can trap
moisture may promote microbial growth. All permeable building
materials shouJdbe protected from exposure to moisture priorto and
during construction. If permeable materials are exposed to moisture,
they should be dried within 72 hours or removed.
d. High-volume photocopiers and aerosolized. cleaners and medications
have'been identified as sources. of indoor airpollution. Dedicated
exhaust ventilation may be necessary for specialty areas where these
pollutants may accumulate orbe disbursed (e.g., housekeeping,
maintenance, and copy rooms and hair salons).

A2.2-2.4.1 Indoor air quality

used in an open-loop (once-through) configuration as the emergency

a. Thermal environmental conditions for human occupancy. The building

backup cooling system, it should Adt be used as the primary cooling

should be designed in compliance with Section 6.1 (Design) and

system. The primary cooling system in these critical applications should

Section 6.2 (Documentation) of ANSI/ASHRAE 55: ThermalEnviron­

be aclosed-loop system requiring no potable water use except for

mental Conditions for Human Occupancy.

system makeup.

For additional information, see appendix section A1.2-4.5.4 (User

A2.2-2.4Indoor environmental quality control of environment), Section 2.5-3.1.2 (Ventilation and Space
a. Ahealthy and productive indoor environment shouldbe accom­
Conditioning), and building system sections in the facility chapters
plished through design measures such as adequate ventilation,
in Parts 3through 5.

Guidelines for Design and Construction of Residential Health, Care. and Support Facilities 61
2.2 DESIGN CRITERIA

*2.2-2.4.1.1 Emissions and volatile organic com­ Concentration of AirPollution Relevant to Indoor Air
pounds. See appendix table A2.2-a (Maximum Quality) for recommended allowable concentrations.

APPENDIX (continued)

b. Tobacco smoke-free environment -\lOC content requirements..vOC content should comply with and
-Signageindicatingthat smoking is notallowed in bUildings be d.etermined according to the follOWing reqUirements:
should b.e posted within 10 feet (3 meters) ofeach building Architectural paints, coatin9s and primers applied to inte·
entrance. rior surfaces: Green Seal Standard GS-ll: Paints; Coatings,
-Where designated smoking aJeas are provided, they should· 'Stains, and Sealers.
be located aminimum of25 feet (7.6.meters) from building: • Clear WOod finishes, .floOr coatings, stains, seal~rs, and shel­
entrances, outdoor air intakes/and oper~ble windows. lacs: SCAQMD Rule 1113.
c. Floor (OVering materials. Floor covering materials Installed in the
A2.2":2.4.1.1 Emissions andVOCs
bUilding interior should comply with the follOWing:
a. Adhesiltes ant/sealants. Products in this categoryindude adhesives
-Limit reqUirements in California Department of Public Health 'Stan­
for the folloWing materials: carpet, resilient,.and wood floorin9; base
dard Metflod for the Testing and Evaluation.of Volatile Organic
cove; ceramic tile; drywall and other wall and ceiling panels; aerosol
(hemica/Emissions from Indow Sources Using Environmental
adhesives;andadhesiveprimers. They also include theJollowing
Chambers, version 1.2
sealants: acoustic sealants; firestop materials; HVAC air duct seal­
~M~ltlple"attribute standards withthird-party certification, inclu­
ants; and primers and caulks. All adhesives and:sealants used in the
sive of Indoor air quail",:
interior ofthe bUilding (e.g., inside the weatherproofing system and
• ANSI A138.1: Green Squared Specifications for Sustainable
applied oh-site) should comply with thefollowi.ng requirements:
Ceramic nles, Glass nles, and Tile Installation Materials
~Emissions requirements. Emissions should be determinM
• NSC 373: Sustainability Assessment for Natural Dimension
(lccordingtothe limit requirements inthe Standard Method for
Stone
the Testing and Evaluation ofVolatile Organic ChemicalEmissions
• NSF/ANSll40: SustaitlObility Assessment for Carpet
from Indoor Sources UsingEnvironmental Chambers, version 1.2,
• NSFI ANSI 332: SustainabiJity Assessment fOJ Resilient Floor
published by the California Departmentof Public Health.
{overings
-VOC content requirements. VOCcontent shOUld comply with and
d. Compositewood, wood structural panel, and agrifiberproducts, Com­
should be determined according to the following requirements:
posite wood, wood structu.ral panel, and agrifiber products used on
•.. Adhesives, sealants, and sealant primers: SCAQMD Rule 1168:
the interior of the building (defined as inside theweatherptoofing
Adhesive and Sealant Applications. HVAC ductsealants should
system) should contain no added urea-formaldehy.de resins.
be classified inthe"Other" category"in the $CAQMDRule 1168
-Laminating adhesives used tofabricateon·slte and shop­
sealants table.
applied cilmposlte wood and a9rifiberassemblies should con­
• Aerosol adhesives: Green Seal Standard GS-36: Adhesives for
tain no added'urea-formaldehyde resins,
Commercial Use.
~Composite wood and agrifiber productS are defined as particle"
Exception: The follOWing solvent welding and sealant products are
board, medium-densityfiberhoard (MDF), wheatboard; straw­
not required to meet the emissions or VOC content requirements
board, panel substrates, and door cores.
.listed above.
-Emissions for products covered by this section should be
~Cleaners, solvent cements, and primers IIsed with plastic piping and
determined according to and should comply with one oUhe
condUit in plumbing, firesuppression,and.electrical systems.
follOWing.:
-HVAC air duct sealants when the airtempl1rature ofthe space in
• Third-party certification indicating compliance with Title
which they are applied is.less than 40.° F(4.5° Cl.
Vr~Formaldehyde Standards for Composite Wood Products
b. Paints and coatings. :Products inthis cate.gory ind!:lde sealers, stains,
of the federal Toxic Substance ~ontrol Act
dear wood finishes, floor sealers and coatings, waterproofing seale
• ~imit requirements in California Department of Public
ers, primers, flat paints and coatings, non-flatpalots and coatings,
Health Standard Method fot the Testing and Evaluation of
and rust-preventative coati09s. Paints and coatings used on the
Volatile Organic Chemical Emissions from Indoor Sources
interior of the bUilding (defined as Inside the weatherproofing
Using Environmental Chambers, version 1.2
system and appJledon-site) should comply with the follOWing:
Exception:. Structural panel components such as plywood,
-Emissions requirements. Emissions should be determined
partide board, wafer board, and oriented strand boar<lidentified
according.to the limit requirements in the California Department
as EXPOSURE 1, EXTERIOR, or HI)D-APPRQVED are considered
of Public Health Standard Methodfor the Testingandbaluation
acceptable for interior use.
ofVolatile Organit(hemital Emissions from Indoor SOUfC€sUsing
e. Ceiling and wall systems. These systems indude ceiling and wall
Environmental Champers, versi0l11.2.

62 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

2.2-2.4.1.2 Ventilation
(1) For minimum ventilation requirements, see Section
2.5-3 (Heating, Ventilation, and Air-Conditioning
Systems) and facility chapters in Parts 3 through 5.
(2) For filtration and air cleaner requirements, see
Section 2.5-3 (Heating, Ventilation, and Air­
Conditioning Systems) and facility chapters in
Parts 3 through 5.
2.2-2.4.1.3 Building entry mats. Building entrances,
except entrances to individual dwelling units and service
areas, shall employ an entry mat or entry mat system to
reduce particulate in the indoor environment.
APPENDIX (continued)
insulation, acoustic ceiling panels, tackable wall panels, gypsum wall
board and panels, and wall-coverings.
-Emissions for these products should be determined accord­
ing to limit requirements in California Department of Public
Health StandardMethod for the Testing and Evaluation ofVolatile
Organic Chemical Emissions from Indoor Sources Using Environ­
are some ways to increase the use of reduced-impact materials for
mental Chambers, version 1.2.
-Multiple-attribute standards with third-party certification,
inclusive of indoor air quality:
• ANSI A138.1: Green SquaredSpecifications for Sustainable
Ceramic Tiles, Glass Tiles, and Tile Installation Materials
• GS-11: Paints, Coatings, Stains, and sealers
• GS-36: Adhesives for Commercial Use
• NSFI ANSI 342: Sustainability Assessment for Wallcoverings
• UL 100: Standard for Sustainability for Gypsum Boards and
Panels
• UL 102: Standard for Sustalnability forDoar Leafs
f. Furniture
-Emissions for these products should be determined accord­
ing to limit reqUirements in California Department of Public
Health StandardMethod for the Testing and Evaluation of Volatile
Organic Chemical Emissions from Indoor Sources Using Environ­
mental Chambers, version 1.2.
-Office furniture installed prior to occupancy should be tested
according to ANSI/BIFMA M7.1: Standard Test Method for Deter­
mining VOC Emissions from Office Furniture Systems, Components,
and Seating and should not exceed the limit requirements in
Section 7.6 of ANSI/BIFMA e3: Furniture SustainabiJity Standard.
-Resident room furniture andseating installed prior to occupancy
should be tested according to ANSI/BFMA Ml.l.
A2.2-2.4.1.3 (3) Building entry mat length
a. The minimum length should be measured inthe primary direction of
travel.
b. Length ofentry mat surfaces should be permitted to be reduced due to
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.2 DESIGN CRITERIA
(1) Omission of mats shall be permitted at secondary
entrances or entrances with minimal pedestrian
traffic.
(2) No surface shall be used that impedes resident
ambulation or contributes to fall risks.
*(3) Mat size. Each surface shall have a minimum width
equivalent to the width of the entry opening.
2.2-2.4.2 Acoustic Control
See Section 1.2-5.2 (Acoustic Planning) and Section
2.5-8 (Acoustic Design Systems) for requirements.
*2.2-2.5 Materials and Resources
This section includes requirements for the selection
and management of materials and resources, including
the presence ofabarrier (e.g., acounter, partition, wall) or local regula­
tions prohibiting the use ofscraper surfaces outside the entry. In this
ease, entry mat surfaces shall have aminimum length of3feet (l meter)
of indoor surface, with aminimum combined length of6 feet (2 meters).
A2.2-2.S Use of reduced~impactmaterials. Described
building assemblies and interior fit-outs.
a. Consider the whole building life cycle. Aminimum of two different
building designs should be evaluated using ASTM E2921: Standard
Practice for Minimum Criteria for Comparing Whole Building Life Cycle
Assessments for Use with Building Codes and Rating Systems and the
follOWing criteria:
-Global warming potential
-Acidification potential
-Eutrophication potential
-Ozone depletion potential
-Smog potential
The goal is to select a proposed final building design with lower
anticipated environmental impact. Assemblies and the building
envelope should be part of the project design.
Life cycle assessment tools such as the following can be used
to evaluate comparable building designs during the conceptual
design phase:
-Athena Impact Estimator for Buildings (caleulatelea.com/soft­
ware/impact-estimatorI)
-GaBi Software Building LCA (www.gabi-software.com/america/
solutions/building-Iea/)
-SimaPro Sustainability Life Cycle Assessment Carbon Footprint­
ing (www.simapro.co.uk)
-Tally (choosetally.coml)
b. Reuse portions of an existing building, if possible and applicable.
c. Incorporate reused, refurbished, and/or off-site salvaged materials or
furnishings into a project in place of new materials.
63
2.2 DESIGN CRITERIA
construction waste management and for storage and
collection of recyclables. It also includes recommen­
dations for the use of reduced impact materials in
construction projects in appendix section A2.2-2.5.
See Section 2.4-2 (Architectural Details, Surfaces, and
Furnishings) for requirements in addition to those in
this section.
*2.2-2.5.1 Storage and Collection of Recyclables
and Discarded Goods
*2.2-2.5.1.1 Recydables. For new building projects,
there shall be areas serving the entire building that are
APPENDIX (continued)
d. Evaluate the material content of products used in abUilding based
on performance criteria and building service life.
-Use a multiple-attribute approach by basing product selection
on standards and certifications such as those listed here:
• ANSI A138.1: Green Squared - American National Standard
Specifications for Sustainable Ceramic Tiles, Glass Tiles, and
Tile Installation Materials
• ANSI/BIFMA e3: Furniture Sustainability Standard
• BI FMA LEVEl, the sustainability certification program for
furniture
NSC 373: Sustainable Production ofNatural Dimension Stone
• NSF 140: Sustainability Assessment for Carpet
NSF 332: Sustainability Assessment for Resilient Floor Cover­
ings
NSF 336: Sustainability Assessment for Commercial Furnish­
ings Fabric
• NSF 342: Sustainability Assessment for Wallcovering Products
NSF 347: Sustainability Assessment for Single Ply Roofing
Membranes
• UL 100: Standard for Sustainability for Gypsum Boards and
Panels
UL 102: Standard for Sustainability for Swinging Door Leafs
-Use third-party certification such as sustainable forestry certifi­
cation systems:
American Tree Farm System, ATFS Standards for Sustainabil­
ity for Forest Certification
• CAN/CSA- Z809: Sustainable Forest Management: Require­
ments and Guidance
Forest Stewardship Council Standard FSC-STO-Ol-00l (V4­
0): FSC Principles and Criteria for Forest Stewardship
• Programme for the Endorsement of Forest Certification
national standards
• Sustainable Forestry Initiative 2010-2014 Standard
64 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
dedicated to the collection and storage of non-hazard­
ous materials for recycling, including paper, corrugated
cardboard, glass, plastics, and metals.
2.2-2.5.1.2 Fluorescent and high-intensity discharge
(HID) lamps and ballasts.
(1) An area shall be provided for the collection and
storage of fluorescent and HID lamps and ballasts.
(2) Accessibility of the area shall facilitate proper
disposal and recycling according to state and local
hazardous waste requirements.
-Select products with an environmental product declaration
(EPD) or product life cycle assessment (LCA):
• Third-party verified Type III Environmental Product Declara­
tion (EPD) according to ISO 21930: Sustainability in buildings
and civil engineering works, which includes, at minimum, a
aadle-to-gate scope
Third-party verified product life cycle assessment based on
ISO Standards 14040: Environmental management-Life
cycle assessment-Principles and framework and 14044:
Environmental management-Life cycle assessment­
Requirements and gUidelines
A2.2-2.S.1 Storage and collection of recyclables
and discarded goods
a. Building service life pIon. Abuilding service life plan should be
created that-estimates the service life of the bUilding's structural
system, building sy~ems, bUilding envelope, interior fit-out, and
hardscape materials. See appendix section A2.2-2.5 (Use of reduced­
impact materials) for additional information.
b. Construction waste management plan. During the project planning
phase, awaste management plan should be established before
demolition or construction begins. At completion of construction, a
final waste management report should be completed that identifies
all waste and recycling/reuse materials.
A2.2-2.S.1.1 Recyclables
a. For renovation projects, space should be evaluated for inclusion of
designated recycling areas, both for the area being renovated and for
overall collection points.
b. For both renovation and new construction projects, space should be
provided for recycling containers at point of use (e.g., offices, copy
areas, food service areas, etc.).
c. The size and functionality of recycling areas should be coordinated
with anticipated collection services to maximize the effectiveness of
the dedicated areas.
 2.2 DESIGN CRITERIA

(*2.2-2.6 Emissions, Effluents, and Pollution
Control
This section gives requirements and recommendations
for emissions, effluents, and pollution control, includ­
ing refrigerants, boilers, emergency backup generators,
effluent flows, and waste streams.
reduction of greenhouse gas emissions (primarily
carbon dioxide) shall be considered in building design
and selection of mechanical equipment.
2.2-2.6.2 Effluents
*2.2-2.6.2.1 Hazardous materials management plan

2.2-2.6.1 Emissions
*2.2-2.6.2.2 Moisture control

2.2-2.6.1.1 Refrigerants
2.2-2.7 Construction and Plans for
(1) Use of CFC-based refrigerants shall not be Commissioning
permitted in HVAC&R systems except in small
See Chapter 1.4-5 (Commissioning) for requirements.
HVAC units (defined as containing less than 0.5 lb
[0.23 kg] of refrigerant).
(2) Uses of CFC-based refrigerants shall be permitted • *2.2-3 Design Criteria for
in equipment such as standard refrigerators, small
Accommodations for Care of Persons
water coolers, and other cooling equipment that
contains less than 0.5 lb (0.23 kg) of refrigerant. of Size

*2.2-2.6.1.2 Reduction of greenhouse gas. Strate­

Where it has been determined that a facility will need
gies to reduce the effects of climate change through
to accommodate residents who are persons of size,

APPENDIX

A2.2-2.6 See ANSI/ASHRAE/ASHE Standard 189.3: Design, Con­ requirements for identification and proper disposal of ACMs.
struction, and Operation ofSustainable High-Performance Health Care
A2.2-2.6.2.2 Moisture control. The follOWing actions should

Fadlities, Section 11, "The Building's Impact on Emissions, Effluent, and

be taken during construction to control moisture that may damage

Pollution Control;'for more information.

materials or contribute to potentially harmful biological growth:

A2.2-2.6.1.2 Reduction of greenhouse gas. New

a. Absorptive materials stored or installed on-site should be protected

.and renovated facilities should be designed to comply with the carbon

from moisture damage.

reduction goals outlined in the Architecture 2030 Challenge (www.

b. Air-handling components, including ductwork and air handlers,
architecture2030.org). Strategies that reduced energy demand also
should be protected from moisture and wiped down prior to installa­
contribute to the reduction of greenhouse gas emissions. The use of
tion.
renewable energy sources and the purchase of green energy reduce
c. Building construction materials that show visual evidence of biologi­
carbon dioxide emissions as well.
cal growth due to the presence of moisture should not be installed.
A2.2-2.6.2.1 Hazardous materials management
A2.2-3 Design considerations for accommodations

plan
for care of persons of size

a. Polychlorinated biphenyl (PCB) removal

a. Accommodations for persons of size and the equipment needed to

-In all building renovations and new construction, a plan should

care for them require more operational space and more storage than

be developed for the discovery, testing, and mitigation of PCBs

a traditional resident health, care, or support environment. There­

to assure proper removal and appropriate disposal of PCBs.

fore, additional square footage may be required to accommodate

-The plan should comply with all applicable regulatory require­

these needs.

ments for identification and proper disposal of PCBs.

Size increases will be determined by the space needs of
b. Asbestos-containing materials (ACM) management
expanded-capacity portable equipment (e.g., beds, wheelchairs,
-In all building renovations and new construction, processes
lifts) and fixed equipment (e.g., exam tables) designed for persons
should be established and followed that fulfill the facility's
of size. Equipment used for persons of size is considerably larger than 1
policy for the discovery, testing, and mitigation of ACMs to
standard equipment. For example, a bed with a1,000-poundcapac­
ensure proper removal and appropriate disposal of ACMs.
ity is 44 inches (101.6 centimeters) to 57 inches (144.78 centimeters)
-The plan should comply with all applicable regulatory

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 65
2.2 DESIGN CRITERIA

Iareas of the facility designated to accommodate these

residents and the associated path of egress to arrive at
these areas shall be designed to address weight support
and clearances identified during the planning phase.
• *2.2-4 Design Criteria for

Dementia, Mental Health, and

Cognitive and Developmental

Disability Facilities

*2.2-4.1 General
APPENDIX (continued)

wide by 96 inches (243.84 centimeters) to 102 inches (259.08 centi­ -Additional staff/resident or participant interaction areas. These
meters) long. areas include resident assessment spaces, food service, physical
Resident rooms and exam rooms for persons of size should have rehabilitation areas, and family interaction areas.
a minimum clear floor area of 200 square feet (18.58 square meters);
A2.2-4 Re5idential mental health facilities.
a minimum clear dimension of 17 feet (5.18 meters); and a mini­
Residential mental health fa,cilities exist in anumber of manifestations
mum clearance of7feet (2.13 meters) on one side and 5feet (1.52
under avariety of names. All offer care to residents who do not require
meters) on the other side and at the foot ofthe treatment table or
the level of care of apsychiatric hospital. Generally, these facilities are
bed. Where a portable lift is used, a minimum of 35 square feet (3.25
more residential in character and have programs for aspecified period
square meters) of storage space should be prOVided.
of time and diagnosis, such as for alcohol and drug abuse treatment.
Toilet fixtures should be floor-mounted and designed to sustain
Residents can enter such afacility either voluntarily or involuntarily.
a minimum concentrated load of 800 pounds (362.88 kilograms)­
Accreditation programs include the Joint Commission and the
or as indicated for the care population being served-and mounted
Commission on Accreditation of Rehabilitation Facilities. This appendix
a minimum of 24 inches (60.96 centimeters) on center from the
section prOVides general information and guidance for this type of
finished wall. Aclear floor space of 5feet (1.52 meters) should be
facility. State and local licensing authorities should be contacted for
prOVided on one side of the toilet for access and assistance. Sinks
more specific requirements.
also need to be floor-mounted, as people may lean on asink and
a. Residential mental health facilities may include specific site features,
its surrounds while using the bathroom. Aclear floor area of 5feet
clinical supports, and residential, common, and administrative areas
(1.52 meters) should be prOVided on either side ofthe sink and toilet
that are similar to those prOVided at psychiatric hospitals. These ser­
to accommodate acaregiver who is assisting the resident It is also
vices may be shared or prOVided by contract, depending on program
good practice to prOVide a handrail designed to sustain a minimum
reqUirements.
concentrated load of 800 pounds (362.88 kilograms), or as indicated
b. Where afacility serves any combination of pediatric, adolescent, or
for the care population being served, adjacent to the sink to give the
adult care populations, there should be aseparation between the
resident a means of support other than the sink and its surrounds.
areas that serve them.
If a resident is able to walk, he or she will likely need to use a
e. An indoor activity area should be prOVided, and provision ofan out­
handrail for support or balance. Such handrails should be designed
door activity and exercise area is highly recommended.
to support and sustain a minimum concentrated load of 800 pounds
d. Spaces to accommodate educational therapy/services are recom­
(362.88 kilograms).
mended for all residents and typically reqUired by individual states.
b. Other design issues to consider for accommodating persons of size
e. All bUilding systems accessible to residents should meet the require­
include ingress/egress to primary treatment and service areas. The
ments of the resident safety risk assessment; see Section 1.2-3
rooms and/or destinations at the ends of these traverses also need
(Resident Safety Risk Assessment).
special consideration to accommodate persons of size, whether resi­
dent, participant, or outpatient: A2.2-4.1 Facilities for residents with dementia,

-Exam rooms. Exam rooms should be programmed and sized to mental health diagnoses, and cognitive or

accommodate the user and the associated care team. developmental disabilities

-Waiting rooms. Furnishings with capacity adequate for persons
of size should be interspersed with more traditional furnishings
to avoid confining persons of size to specific areas of the waiting
environment.
-Community spaces. living rooms, dining rooms, activity rooms,
and similar interior spaces as well as exterior gardens and simi­
lar outdoor spaces should be sized to accommodate the number
of persons ofsize-residents or participants-expected as
identified during the planning phase.
a. These facilities are designed for the particular needs and behaviors
of residents with dementia, mental health diagnoses, and cognitive
and developmental disabilities. They are secured where required to
be so in the functional program.
b. Design recommendations for these facilities include the follOWing:
-A key architectural objective should be to minimize the institu­
tional aspects of care and create aliving environment for resi­
dents with furniture, furnishings, and fixtures that are appropri­
ate from asafety standpoint and are residential in appearance.

66 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

2.2-4.1.1 The facility shall be designed to facilitate the
highest level of functioning for all residents.
2.2-4.1.2 The resident living environment shall be
equipped with special features (e.g., personalized resi­
dent bedrooms, features that support resident orienta­
tion to the surroundings, secured storage, safe outdoor
areas, and security considerations) to support individu­
als with varying levels of cognitive impairment.
2.2-4.2 Physical Environment Elements for Risk
Reduction
Consistent with an individual facility's functional
program, the design concepts and architectural details
described in this section, which are intended to address
safety risks to residents and staff in care settings for
residents with dementia, mental health diagnoses, and
cognitive and developmental disabilities, shall be inte­
grated into the project to reduce those risks.
APPENDIX (continued)
-Proper planning and design should elevate the spirit and sensi­
bilities of both residents and care providers.
-A sense of community with a respect for privacy should be
encouraged.
-Facilities should prOVide a healing environment that stimulates
mind and body for people with dementia, mental health diag­
noses, and cognitive and developmental disabilities.
-Features that are included to prOVide resident safety and
security should be unobtrusive and integrated in a manner that
supports this concept.
c. Resources regarding design for this population include the following:
-Dementia Design Info database (School of Architecture &
Urban Planning, University of Wisconsin-Milwaukee in partner­
ship with I.D.E.A.S., Inc., and Polisher Research Institute). This
resource provides information on space design, user needs, and
levels of scale for site, bUilding, room/space, details, finishes,
FF&E, and experiential ambience, decor, and aesthetics.
-Behavioral Health Design Guide (Facility Guidelines Institute)
-Mental Health Facilities Design Guide (Department of Veterans
Affairs, Office of Construction &Facilities Management)
-Patient Safety Standards, Materials and Systems Guidelines (New
York State Office of Mental Health)
-VHA Handbook 1330.01: Health (are Services for Women
tnural does not impair the operation of the door.
Veterans (Department of Veterans Affairs, Veterans Health
The location and operation of adoor disguised with a mural
Administration)
is identified in the fire safety plan and included in staff
A2.2-4.2.1 Elopement prevention. Where elopement is a
concern, the follOWing should be considered:
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.2 DESIGN CRITERIA
*2.2-4.2.1 Safety and Security Systems
Resident security shall be provided through systems
that secure the resident unit and comply with life
safety codes.
2.2-4.2.1.1 The resident care model shall be the basis
for the type of security system used, whether it is
operationally and/or physically based.
2.2-4.2.1.2 If the functional program requires limiting
the movements of any resident(s) for their safety, all
door locking arrangements shall be in full compliance
with applicable requirements ofNFPA 101: Life Safety
Code.
2.2-4.2.1.3 Areas to be secured shall be based on the
needs of the care population and shall be permitted to
include, bathing, soiled utility, service areas, storage
and staff work areas.
a. The number of entrances and exits from residential areas should be
kept to a minimum.
b. Secure therapeutic outdoor areas, using security measures that are
as non~institutional as possible, should be provided.
c. Electronic door controls, including delayed egress, should be used for
emergency egress where allowed by code.
d. Circulation patterns should be simple and without blind spots.
e. Means of casual observation of resident liVing areas should be pro­
vided from staff offices and work areas.
f. Locks on wardrobes, closets, or cupboards should be inconspicuous.
g. Asecure vestibule with a pair of locked doors should be provided at
the entrance as needed to minimize resident elopement.
h. Protective film should be added to the interior face of laminated
glaZing panels to inhibit access to glass shards if the glass is dam­
aged.
i. Entry, exit, or service doors may be disgUised, ptovided all ofthe
following are met:
• Staff can readily unlock the door at all times.
• The door-releasing hardware, where provided, is readily
accessible for staff use.
• Where door leaves, windows, and door hardware, other
than door-releasing hardw;are, are covered by a mural, the
training.
j. Locating exit doors outside of direct resident line of sight may also
be effective.
67
2.2 DESIGN CRITERIA

2.2-4.2.1.4 In facilities serving residents with various *2.2-4.2.2 Physical Environment Features and
care needs (e.g., dementia, mental health diagnoses, Harm Reduction
cognitive and developmental disabilities, and other Physical environment features shall be considered to
care populations), common areas shall be permitted to reduce harm and addtess potential risks to the care
be shared provided the needs of all residents sharing population.
the areas are met.
*2.2-4.2.3 Resident Stress
2.2-4.2.1.5 For units housing residents with a primary
Provision of relaxation spaces for agitated residents
psychiatric diagnosis, fail-secure locking shall be pro­
shall be considered to reduce stress for residents.
vided in compliance with NFPA 101 and the Interna­
tional Building Code as indicated in the resident safety
2.2-4.3 Resident Areas
risk assessment.
2.2-4.3.1 General
2.2-4.2.1.6 Operable windows. Provision of operable
For further requirements, see the resident safety risk
windows shall be permitted.
assessment component described in Section 1.2-3.5
(1) Operable windows shall be designed to address
(Resident Dementia and Mental Health Risks) and the
elopement and accidental falls.
facility chapters in PartS 3 through 5.
(2) Operable windows shall comply with the

requirements in Section 2.4-2.2.6 (Windows).

*2.2-4.3.2 Resident Unit
(3) Where indicated by the resident safety risk

assessment, security glazing shall be used for

2.2-4.3.2.1 Reserved
mental health units.

APPENDIX

A2.2-4.2.2 Physical environment features and

for, manage potentially aggressive behavior of, and reduce social
harm reduction
stigma for individuals with serious mental illness. Resident stressors
a. Provision of the following physical environment features can reduce can be reduced by providing single-occupancy bedrooms, appropriate
opportunities for residents to harm themselves, other residents, and levels of daylight, and reduction of noise. Resident areas that allow for
staff: relaxation and control ofthe social environment, such as quiet rooms
-An open layout that gives staff the ability to observe resident and secure outdoor space, should be provided to reduce stress. Positive
living areas distraction(s) for residents are often supplied by creating designated
-Architectural elements that cannot be used as weapons for self­ spaces for residents who are agitated, irritated, or need time to regroup.
harm or to harm others Sensory-stimulating and sensory-calming environmental design, used
-Abuse-resistant architectural details and materials in areas to create what are referred to as multi-sensory environments, rely on a
where residents are sometimes left alone variety of features and equipment to stimulate the senses supporting
-Technology to allow observation of areas not readily visible to activity-based interventions that meet functional performance and
staff therapeutic needs.
-Sufficient locked storage for equipment, carts, and supplies. One example is aSnoezelen room, which provides different types
Corridor alcoves should not be used for storing or parking equip­ of calming and relaxing features such as artwork (fixed and moving),
ment, carts, and assistive devices. lighting, sound, and comfortable seating for an individual in a hyper­
b. Elevated platforms, balconies, or low openings or sills, from which
agitated state for short periods of time. Another example is acomfort
residents could jump, should be avoided.
room, which is typically used as a low-stimulus environment for stress
c. The use of lifts, whether ceiling-mounted or portable, is aspecial
reduction in the care of residents.
issue for which potentially conflicting safety considerations should
Resident stress is identified as aconcern in the follOWing appendix
be evaluated.
sections in Chapter 1.2 (Planning/Predesign Process): A1.2-1.3.1 (How
environment of care ... ), A1.2-3.1.5.2 (Evaluation of risks), A1.2-4.5.3.1
A2.2-4.2.3 Relaxation spaces for agitated

(Organized approach to clarity of access), and A1.2-4.5.4 (User control of

residents. Care settings and information systems should be

environment).
designed to optimize the functioning of, prevent secondary disabilities

68 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.2 DESIGN CRITERIA

*2.2-4.3.2.2 Resident room. Special design elements [*2.2-4.3.5.1 Secure outdoor gardens and lounge areas
for dementia residents shall be considered in addition shall be available for residents living in an Alzheimer'sl
to those in Section 2.2-4.2 (Physical Environment Ele­ dementia and/or mental or cognitive health facility or
ments for Risk Reduction). setting.

*2.2-4.3.3 Resident Living Areas 2.2-4.3.5.2 Plant materials used in outdoor activity
spaces shall be nontoxic and not poisonous to humans.
2.2-4.3.3.1 Reserved
*2.2-4.4 Special Design Elements
*2.2-4.3.3.2 Dining areas
2.2-4.4.1 Signage and Wayfinding
2.2-4.3.4 Reserved
See appendix section A2.4-2.2.12.3-l (Wayfinding to
2.2-4.3.5 Outdoor Activity Spaces
serve residents with dementia) for recommendations.

See Section 2.1-3.6.2 (Outdoor Activity Spaces) for

additional requirements and information.

APPENDIX

A2.2-4.3.2 Support areas for the resident unit
a. Support areas for staff. Due to the level of staff stress in caring for
residents with cognitive impairment and in working with family
caregivers, places of respite and staff break areas that include access
to views, secured storage for personal items, and food preparation
areas should be provided.
b. Support areas for residents. Due to the need for private time with a
spouse or other family member, resident area(s) that includes pri­
vacy with aloved one should be provided.
A2.2-4.3.2.2 Special design elements for dementia
resident rooms
Backlighting visual cues can help individuals with aging eyes and
low vision notice cues.
h. Night-lights with warm correlated color temperature sources (amber
or red) at avery low light level should be used for the path between
the sleeping area and the bathroom. Based on resident/s needs and
preferences, controlling night-lights with motion sensors should be
considered.
A2.2-4.3.3 Family area. Aprivate room for residents and fami­
lies should be proVided.
A2.2-4.3.3.2 Dining areas
a. For those residents requiring extra assistance or time for eating

a. Private rooms are recommended. Research indicates psychosocial

meals, space shall be proVided to allow staff and/or residents to

and physical/clinical benefits from single-resident rooms, such as

complete their meals with dignity.

improved sleep patterns, reduced irritability, and reduced conflict

b. Smaller-scale dining areas are recommended for those with demen­

between residents.

tia and mental illness to simplify relationships and avoid overstimu­

b. The toilet should be placed in direct line of sight from the resident
lation and distraction.
toilet room doorway and should be directly visible from the sleeping
c. Use of square tables is encouraged for residents with dementia

area.
because seating spaces are defined and recognizable.

c. Closets should be designed to proVide the resident with limited daily

clothing choices. A2.2-4.3.S.1 Access to nature. Easy, unrestricted, and
d. Simple, single-mixer control devices should be provided on faucets. frequent access to awalking garden designed for barrier-free recreation
e. Designs that could promote unintended behavior (e.g., location of
with destinations offers residents these benefits:
trash can by toilet, high-contrast grilles on packaged terminal air
a. Reduction in cortisol levels
conditioner (PTAC) units, etc.) should be avoided.
b. Improved physical activity levels
f. To increase usability of architectural features (e.g., toilets, handrails, c. Reduced stress and agitation
doors, manual light controls), avalue contrast should be provided d. Improved cognition and sleep
between the features and adjacent surfaces (e.g., walls, door e. Reduced use of antipsychotics
frames). See Table 40-2 (Performance Criteria for Surfaces and Mate­ f. Reduced falls and reduction in fall-related morbidity for individuals
rials) in the National Institute of Building Sciences' Design Guidelines with impaired cognition such as dementia
for the Visual Environment.
A2.2-4.4 Blind corners should be avoided.
g. Use visual cueing elements to assist resident's wayfinding~

GUideli~es for Design and Construction of Residential Health, Care, and Support Facilities 69
2.2 DESIGN CRITERIA

Appendix Table A2.2-a

Maximum Concentration of Air Pollution Relevant to Indoor Air Quality

Contaminant Maximum Concentration (1l9/m3 unless otherwise noted)

NON-VOLATILE ORGANIC COMPOUNDS

Carbon monoxide (CO) 9 above outdoor levels
Ozone
...•.....•.•... _ . . .....................•..•......••..•••.•.•.••••. _ .•.. - _--_ __ _..•.•.__.•.•...•_-_._.__._
........•••..•.. ,..•...... (8-hour
-_. _. to 24-hour)
.- ..•....•.......
~

Particulates (PM2.5l
------- --' .. _-------~-~. ,_._-_.•_.._._....'--.'...-- .._--_._---,,-.--_._-------- _.~._----_ ..._.. -_.__ .._._._-_.._---_._._. __._._,. ------.-.__ _._--­ 35 (24-hour)
~----_._. ...

Particulates (PM lO) 1501/q-IlI11HI

VOLATI~E ORGANIC COMPOUNDS

140
5
Benzene 60
-------
1,3·Butadiene
- - -20_.. _-_.._-----_..•. __._._-- ...__ .
___..t-Butyl ..methyl
_.', ._, ."._ '." ,.. ether (Methyl-t-butyl
. __., _ __ ether)
,_.,.._ _._._._._._..__.. .~_ _._~ ·_.'V_". ,_.. __u····,_··_.·. ,,_•.__. ._ ."_" .., _
8,000
Carbon disulfide 800
Caprolactam' 100
Carbon tetrachloride 40
--------_._-----­
Chlorobenzene 1,000
Chloroform 300
1A-Dichlorobenzene 800
- - - - _ . _ - - - - - -•.. - - - - _ . - - - _.. _ - - - - - - - - - - - - - _ . _ - - _ . - - - _.. _ - - - - ­
_.-.!D~i~c.h~l~o~ro~m~e~.~th~~a~n~e~~~I~~~~~~.:c~hll~o~rid~e~).
__. _... __.__.• ._. _ .---_._.. ... ... _.
400 ._-_._---_. _.. _- ._--._-­ __ _ __
_____
lA-Dioxane
__v··•• _' .•.._."_.._··_. __. .·...· .·" ._ ...•....•.• _ •.....• _.. _-_...__._._...._.._--_._ •.•... __•._._._..._-.__..... -.-._-_._---~-_._._
3,000.. - ..• _.. _ -
.•... ...•..
·
~
Ethylbenzene ._._-._... _. ._.._._ .._...
2,000
400
33
acid' 25
n-Hexane 7,000
160
9
Nonanal' 13
Octanal' 7.2
­
........ _.•.. _ _ _.•.... _. _.­ - .. __ - _ _.. _.. _. - - .__ .__ _. ._. __.__ _.. _ _­ - _.
Phenol 200
- - - - - - - - - - - - - - - - - _..._._.. - - - - - - - - _ _- ._ .. _._--_. -----_._._------- .... ._-_._--_._-_ __ ... .

4-Phenylcyclohexene (4-PCH) , 2.5

---_._-------_.
2-Propanol (Isopropanol) 7,000
900
Tetrachloroethene (Tetrachloroethylene, Perchloroethylene) 35
---- ---_._---­
Toluene 300
~~-~~----------------~.-~.----.--------" .. ~-----------

..
1,1,l-Trichloroethane
.', "_ •.." .
(Methyl chloroform)
._.._, _.. __ _. . . .. __._ __•. _ •__ __.._.__
_.,~ ••.. ·__._.·__· ·_H"~_··_· __•__· ~. __ .···_·__·_"_""_,... ._.. ._ .__..
1,000
.__ ._.__ ._.._. .. __ ._. __ ._._..__..

Trichloroethene
._ _ _. _._-_
(Trichloroethylene)
_...... . _ _.. _ _ _.. __ .. _ _...... •.. _ _-_ _ _. _.. _.. _. __._.. _ _ _ _ , _.. - -.. __ - -- ..
600
Xylene isomers
..._---­ _._ - - -_._-_ _- .'. . .. . __ .._-_.__ _ _._
__ _._-_._--_._._---_. __ .-_ __ ._~ _-_._._ __ _ _. __ .-_ _ __ ._._.._-_._.._.._.._ - _._-"' ~." .. __ _ __ __ -
700
Total volatile organic compounds (TVOC)

'This test is required only if carpets and fabrics with styrene butadiene rubber (SBR) latex backing material are installed as part of the base bUilding
systems.
2TVOC reporting should be in accordance with the California Department of Public Health Standard Method for the Testing and Evaluation of Volatile
Organic Chemical Emissions from Indoor Sources Using Environmental Chambers as well as the individual VOC levels listed in this table.

70 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.3 Design Elements
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.
• 2.3-1 General
2.3-1.1 Application
This chapter contains elements that are common to
most types of residential health, care, and support
facili ties.
2.3-1 .1.1 The common elements in this chapter
are required only where referenced in the facility
chapters in Part 3 (Residential Health Facilities), Part
4 (Residential Care and Support Facilities), and Part 5
(Non-Residential Support Facilities).
2.3-1.1.2 Additional specific requirements are located
in the facility chapters in Parts 3, 4, and 5.
• 2.3-2 Resident, Participant, and
require a quiet or low-stimulation, positive distraction
Outpatient Areas
2.3-2.1 General
The requirements for resident carelliving areas
(units), community areas, and associated support
areas included in this section are common to most
residential health, care, and support facilities. For
requirements specific to a facility type, see the facility
chapters in Parts 3 through 5.
*2.3-2.2 Resident Care/Living Area (Unit)
2.3-2.2.1 General
See facility chapters in Parts 3 and 4 for requirements
for resident care/living areas (units).
APPENDIX
A2.3-2.2 Resident carelliving area (unit) definition. Aresident care/living area (unit) is agroup of resident rooms or dwelling quarters
in a residential living facility.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.3-2.2.2 Reserved
2.3-2.2.3 Special Care Resident Rooms
See facility chapters in Parts 3 and 4 for requirements
for airborne infection isolation rooms and ventilator­
dependent resident rooms, and other special care
resident room types and facility chapters in Part 5
for requirements for quiet rooms in non-residential
support facilities.
2.3-2.2.3.1 - 2.3-2.2.3.2 Reserved
2.3-2.2.3.3 Quiet room in a resident care/living area
(unit). Where a single resident room is provided to
a.ccommodate care requirements for residents experi­
encing issues such as personal conflicts, agitation, epi­
sodic mental disturbances, or similar conditions that
room, the following requirements shall be met:
(1) Capacity. Each quiet room shall contain only one
bed.
(2) Space requirements
(a) Based on the care population, the quiet room
shall be sized to accommodate the equipment,
special furnishings, or positive distractions
provided.
(b) The level of cognitive ability of the care
population shall be identified during the
functional programming process. See Section
2.2-4 (Design Criteria for Dementia, Mental
Health, and Cognitive and Developmental
Disability Facilities) for additional
requirements.
71
2.3 DESIGN ELEMENTS

(3) Toilet room. A toilet room shall be provided for

2.3-2.3.2.3 Storage for mobility devices. Where a
each quiet room.
central lobby is provided, storage for resident-operated
mobility devices shall be provided close to the entry.
(a) The toilet room shall contain the following:

(i) Toilet 2.3-2.3.2.4 Mailboxes. Where a mailbox area is

(ii) Hand-washing station
(iii) Mirror. For requirements, see Section
2.4-2.2.8.7 (Mirror).
(b) The toilet room shall not be shared with
another resident room.
(4) Acoustic requirements. See Section 2.5-8.3 (Design
Criteria for Acoustic Finishes), Section 2.5-8.4
(Design Criteria for Room Noise Levels), and
Section 2.5-8.5 (Design Criteria for Performance
ofInterior Wall and Floor/Ceiling Constructions)
for requirements.
*2.3-2.3 Resident, Participant, and Outpatient
Community Areas
*2.3-2.3.1 General
For new construction and renovation, community
provided, it shall be located close to the entry for
deliveries and centralized for resident access.
2.3-2.3.2.5 Public notice area. Areas for posting
required notices, documents, and other written
materials shall be provided in public locations visible
to and accessible to residents, staff, and visitors.
2.3-2.3.2.6 Public toilet room. A toilet room(s) shall
be located close to the lobby.
2.3-2.3.3 Dining, Recreation, and Lounge Areas
2.3-2.3.3.1 General. The space needed for dining,
recreation, and activities shall be determined by the
following considerations:
(1) The extent to which users need adaptive equipment
and mobility aids and assistance from support and
service staff

(2) The extent to which support programs will be

areas shall be designed and furnished to encourage

centralized or decentralized
resident, participant, and outpatient use.

(3) The number of residents or participants to be

2.3-2.3.2 Lobby seated for dining at one time

2.3-2.3.2.1 General 2.3-2.3.3.2 Dining areas

(1) See the facility chapters in Parts 3 through 5 for
(1) General
additional requirements.

(2) Shared lobbies shall be permitted in multi­

(a) The design and location of dining facilities
occupancy buildings.
shall encourage resident, participant, and
visitor use.
*2.3-2.3.2.2 Vehicular drop-off and pedestrian (b) Planned use of dining areas for other activities
entrance. A minimum of one marked, illuminated shall be permitted.
drop-off or entrance shall be reachable from grade
level.

APPENDIX

.A2.3-2.3 Daylighting in ~ommunityareas. See Section participant, or outpatient beyond what is reqUired herein for dining
1.2-4.5.1 (light) and Section 2.5-7.2 (Daylighting Systems in Resident rooms, activity areas, and other spaces included in this section.
living, Participant, and Outpatient Areas) for requirements and informa­
A2.3-2.3.2.2 Vehicular drop-off and pedestrian
tion.
entrance. Covered/canopied entrances s"ould be prOVided as
A2.3-2.3.1 Nothing in the Guidelines for Design and (onstruc­ requiredto accommodate the care population and respond to the local
tion ofResidential Health, (are, and Support Facilities is intended to
climate and community requirements.
restrict afacility from prOViding additional square footage per resident,

72 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.3 DESIGN ELEMENTS

*(2) Central dining facility. Where a central participants using resident-operated mobility
dining facility is provided, it shall be sized to devices shall be readily accessible to all dining,
accommodate the following: recreation, lounge, and activity locations.

(a) Space for dining in accordance with the needs

2.3-2.3.4 Resident and Participant Kitchen
of the care population, including residents
and participants who use resident-operated 2.3-2.3.4.1 General
mobility devices
(1) A "country kitchen," a "great room," or other
(b) Space for residents and participants, including
activity room that supports continued resident and
those using wheelchairs and resident-operated
participant involvement in activities of daily living
mobility devices, to access and leave their
shall be permitted to serve as the required resident
tables without disturbing other residents and
and participant kitchen facilities.
participants
(2) Purpose. Resident and participant kitchen facilities
(c) Clear and unobstructed circulation paths for
shall be designed to support any combination of
servers and food carts
the following functions:
(d) Space for caregivers to assist residents and
participants who require assistance with eating (a) Provision of nourishment berween meals
(b) Cooking activities for residents and
(3) Decentralized dining areas. Location of separate or
participants
satellite dining areas for small groups of residents
(c) Food preparation by family members
or participants shall be permitted:
(d) Preparation of meals by staff with or without
(a) In or adjacent to resident units assistance from residents or completion of
(b) As part of dayrooms for different adult day meal preparation begun in a central kitchen
care populations and serving/distribution of meals
(c) Near a wellness center activity (e.g., a juice bar
near a fitness center) *2.3-2.3.4.2 Facility requirements. Where these
(d) In outdoor activity spaces. See Section kitchen facilities are provided, the following require­
2.1-3.6.2 (Outdoor Activity Spaces). ments shall apply:
(1) Work countertop
2.3-2.3.3.3 Recreation, lounge, and activity (2) Refrigerator
areas. See facility chapters in Parts 3 through 5 for (3) Storage cabinets
requirements. (4) Sink with faucet with anti-scalding mixing valve
(5) Range, cooktop, oven, and/or any other cooking
2.3-2.3.3.4 Support areas for dining, recreation,
or heating device where required in the functional
lounge, and activity locations
program. These appliances shall be equipped with
(1) Hand-washing stations shall be provided in, next
secured shutoffs where residents have access to the
to, or directly accessible to dining areas.
kitchen.
(2) Toilet facilities that accommodate residents or *(6) Food-warming and dishwashing equipment where
required in the functional program
APPENDIX

A2.3-2.3.3.2 (2) The dining room should be sized at aminimum c. Resident and participant countertop. This should allow access for

of 28 square feet (2.60 square meters) for each resident or participant at residents and participants using resident-operated mobility devices

one seating. Adult day care programs may require additional participant and facilitate staff and resident interaction.

space based on the care population being served. d. Secure locked storage for sharp knives
e. Microwave
A2.3-2.3.4.2 Resident and participant kitchen. Also
f. Coffee-maker
consider provision ofthese items:
a. Double-bowl sink with faucet and sprayer A2.3-2.3.4.2 (6) Where dishwashing equipment is not included,

b. Food storage consider providing acart alcove to support carts for transferring dish­

ware to the dishwashing equipment in the central kitchen.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 73
 2.3 DESIGN ELEMENTS
(7) Access to self-dispensing drinking water and ice
(a) Ice for resident consumption shall be provided
by ice-making equipment.
*(b) Ice-making equipment shall be located,
designed, and installed to minimize noise.
(c) Ice-making equipment shall be permitted to
serve more than one food area in resident and
participant kitchen facilities.
(8) A hand-washing station. This shall be located
in or immediately accessible to the resident and
participant kitchen facilities.
2.3-2.3.5 Personal Services (Hair Salon/Spa) Areas
See the facility chapters in Parts 3 through 5 for
requirements.
2.3-2.3.6 Family Room
Where a family room is included in a project, see facil­
ity chapters in Parts 3 through 5 for requirements.
*2.3-2.3.7 Quiet Room in a Resident or Participant
Community Area
2.3-2.3.7.1 Where a quiet room is provided for
residents experiencing personal conflicts, agitation,
episodic mental disturbances, or similar conditions
that require a quiet, multi-sensory, low-stimulation,
positive distraction room, the following requirements
shall be met:
2.3-2.3.7.2 Space requirements
(1) Based on the care population, the quiet room shall
be sized to accommodate the equipment, special
furnishings, or positive distractions provided.
(2) If the care population includes residents with
dementia or other cognitive issues, see Section
2.2-4 (Design Criteria for Dementia, Mental
, APPENDtX.£C~
A2.3-2.3.4.2 (7){b) To reduce_ noise from ice-making equipment,
consider locating the equipment in a room with adoor or separating
the compressor and dispenser so the compressor is not in the corridor.
In some settings, use of residential ice makers, which are quieter than
commercial ice makers, could be appropriate depending on the size and
nature of the care population being served.
A2.3-2.3.7 Quiet room in a community area. An
example of aquiet rOOm or"time out" room that includes positive
-------------------------------------
74 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
Health, and Cognitive and Developmental
Disability Facilities) for additional information.
2.3-2.3.7.3 Toilet room
(1) A toilet room shall be adjacent to the quiet room.
(2) This toilet room shall be permitted to be shared by
residents using other activity spaces.
2.3-2.3.8 Outdoor Activity Spaces
2.3-2.3.8.1 See the following Guidelines sections for
requirements:
(1) Section 1.2-4.5.1 (Light)
(2) Section 1.2-4.5.2 (Views of and Access to Nature)
(3) Section 2.1-3.6.2 (Outdoor Activity Spaces)
2.3-2.3.8.2 For additional requirements for residents
with dementia, mental health issues, and cognitive
and developmental disabilities, see Section 2.2-4.3.5
(Outdoor Activity Spaces).
• 2.3-3 Diagnostic and Treatment
Areas
2.3-3.1 General
2.3-3.1.1 Application
Where clinical and support areas described in this sec­
tion are provided, the requirements in this section shall
be met. See the facility chapters in Parts 3 through 5
for specific requirements.
2.3-3.1.2 Community Access
Where examination, observation, or treatment rooms
in a clinical services area in a residential health, care,
or support facility are used by patients from the
distractions is aSnoezelen room, acontrolled multi-sensory
environment. Time in such a room is atherapy for residents with
dementia, autism, developmental disabilities, or other agitated
conditions. Some facilities have also found that agitated or stressed staff
have benefited from h\lving aquiet room available.
In quiet rooms where tne risk of self-injury is evident, opportunities
for self-harm should be eliminated by concealing protruding elements,
using surfaces to which It would be difficult to attach items, and haVing
doors swing out So they cannot be barricaded from the inside.

community at-large, dedicated circulation shall be
provided for outside patients.
2.3-3.2 Examination, Observation, and/or
Treatment Rooms
2.3-3.2.1 General
2.3-3.2.1.1 An evaluation of specific examinations,
observations, and treatments to be provided in a facil­
ity shall be completed to determine if additional space
beyond that specified in Section 2.3-3.2.2 (Examina­
tion and Treatment Room Space Requirements) is
required to accommodate the following:
(1) Needs of the care population
(2) Specialty equipment used
(3) Transfers or other resident movement required in
the room
2.3-3.2.1.2 The type of examination table, recliner,
or chair to be used shall be based on an evaluation of
operational requirements and an assessment of the cog­
nitive ability of the care population being served. See
Section 1.2-2.2.1 (Owner's Project Requirements) and
Section 2.2-4 (Design Criteria for Dementia, Mental
Health, and Cognitive and Developmental Disability
Facilities) for requirements and recommendations.
2.3-3.2.1.3 Where an examination or treatment room
is used as an observation room, a toilet room shall be
immediately accessible.
2.3-3.2.2 Examination and Treatment Room
Space Requirements
2.3-3.2.2.1 Area
(1) Each examination or treatment room shall have a
minimum clear floor area of 120 square feet (11.15
square meters).
(2) Where an examination or treatment room is used
for a population that includes persons of size, a
minimum clear floor area of210 square feet (19.51
square meters) shall be provided.
APPENDIX
A2.3-3.2.3 Resident, participant, and outpatient privacy. Visual privacy can be achieved with cubicle curtains blinds or other types
of movable screens.
--_._._.... __. _ - - - - - - - - - - - - - - - - - - - - -_ _ _ - - - - - - - - - - - - - - - - - ­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.3 DESIGN ELEMENTS
2.3-3.2.2.2 Clearances. Clearances shall be deter­
mined based on the type of examination table, recliner,
or chair chosen for use. For further requirements based
on an evaluation of patient or resident cognitive abil­
ity, see Section 2.3-3.2.1.2 (Examination, Observation,
and/or Treatment Rooms-General).
(1) Room arrangement shall permit a minimum
clearance of 3 feet (91.44 centimeters) at each side
and at the foot of the examination table, recliner,
or chair.
(2) Where an examination or treatment room is used
for a population that includes persons of size,
clearances shall be evaluated based on the size of
the equipment and furniture to be used, including
(but not limited to) bariatric wheelchairs,
examination table or bed, and resident seating.
*2.3-3.2.3 Resident, Participant, and Outpatient
Privacy
Provision shall be made to preserve resident, partici­
pant, or outpatient privacy from observation from
outside an examination or treatment room when the
door is open.
2.3-3.2.4 Hand-Washing Station
A hand-washing station shall be provided in accor­
dance with Section 2.4-2.2.8 (Hand-Washing
Stations).
2.3-3.2.5 Toilet Room
A toilet room shall be provided adjacent to or directly
accessible from the examination or treatment room.
2.3-3.2.5.1 Space requirements. Toilet rooms shall
be sized and configured to accommodate accessibility
standards that support independent resident, partici­
pant, or outpatient use.
2.3-3.2.5.2 The toilet room shall contain the
following:
(1) Toilet
(2) Hand-washing station
(3) Mirror. For requirements, see Section 2.4-2.2.8.7
(Mirror).
l l
... ...
75
2.3 DESIGN ELEMENTS
2.3-3.2.6 Documentation Area
Accommodations for written or electronic documenta­
tion shall be provided.
2.3-3.3 Well ness Center
Where wellness facilities are part of a residential health,
care, or support facility, see requirements in facility
chapters in Part 3 (Residential Health Facilities) and
Part 4 (Residential Care and Support Facilities) and in
Chapter 5.2 (Wellness Centers).
2.3-3.4 Rehabilitation Therapy Facilities
Where rehabilitation therapy facilities are part of a
residential health, care, or support facility, see require­
ments in facility chapters in Part 3 (Residential Health
Facilities) and Part 4 (Residential Care and Support
Facilities) and in Chapter 5.3 (Outpatient Rehabilita­
tion Therapy Facilities).
2.3-3.5 Care Consultation Area
2.3-3.5.1 General
Where care consultation is provided, the requirements
in this section shall be met.
2.3-3.5.2 Space Requirements
2.3-3.5.2.1 Area. Each care consultation area shall
on each resident floor.
have a minimum clear floor area of 100 square feet
(9.29 square meters).
2.3-3.5.2.2 Space for care of persons of size
(1) Where the care population includes persons of
size, the consultation area shall be sized based on
equipment, furnishing, and maneuvering space
requirements.
(2) Circulation from entry to exit of the facility shall
be evaluated for use by and care of persons of size.
APPENDIX
A2.3-4.2.1.1 Staff work areas
a. Decentralized nursing models proximal to patient/resident rooms
may improve staff efficiency, visibility, fall prevention, transfer rates,
and medical errors without being disruptive to residents.
b. Whether centralized or decentralized, staff work areas should be
designed to minimize the institutional character, command-station
appearance, and noise associated with traditional nurse stations and
76 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
• 2.3-4 Facilities for Support Services
2.3-4.1 General
2.3-4.1.1 Functional Requirements
2.3-4.1.1.1 Identifiable spaces shall be provided
for each operational function, but use of a space for
multiple purposes shall be permitted as long as the
space complies with the requirements for each purpose
served.
2.3-4.1.1.2 Except where the word "room" or "office"
is used, accommodation of support functions in a
multipurpose area(s) shall be permitted.
2.3-4.1.2 Size
The size of each support area shall depend on the
number and types of residents served.
2.3-4.1.3 Location
2.3-4.1.3.1 Support areas for resident care shall be
located in or readily accessible to each resident unit.
2.3-4.1.3.2 Arrangement and location of support areas
to serve more than one resident unit shall be permit­
ted, but at least one such support area shall be located
2.3-4.2 Facilities that Support Resident,
Participant, or Outpatient Care
2.3-4.2.1 Staff Work Area(s)
[ *2.3-4.2.1.1 Resident carelliving areas (units), partici­
pant activity areas, and outpatient rehabilitation areas
shall have staff work areas in centralized or decentral­
ized direct care locations.
to foster dose, open relationships between residents, participants,
outpatients, and staff.
(. Confidential or noisy staffconversations should be accommodated in
an enclosed staff lounge and/or .conference area.
d. At least part of each staff work area should be low enough and open
enough to permit easy conversations between staff and residents
seated utilizing resident-operated mobility devices.
 2.3 DESIGN ELEMENTS

2.3-4.2.1.2 See the facility chapters in Parts 3 through
5 for additional requirements.
2.3-4.2.2 Medication Distribution and Storage
Locations (Centralized and Decentralized)
*2.3-4.2.2.1 General
(1) Provisions shall be made to support 24-hour
USP-NF <Chapter 1066>
(d) Double-locked storage for controlled drugs
*(e) Sharps containers, where sharps are used.
Where provided, these shall be placed in
accordance with the OSHA Bloodborne
Pathogen standard at 29 CFR 1910.1030(d)
(4) (iii) (A) (2) (i).
(f) Task-specific lighting levels as recommended in

distribution of medications.
*(g) Medication room sound levels

(2) A medication room, a self-contained medication (i) See Table 2.5-4 (Minimum Design Room
distribution unit, medication storage in resident Sound Absorption Coefficients), Table
rooms, or other approaches acceptable to the 2.5-2 (Maximum Design Criteria for
authority having jurisdiction (AHJ) shall be Noise in Interior Spaces Caused by Build­
permitted to be used for preparing, dispensing, and ing Systems), and Table 2.5-5 (Design
administering medications. Criteria for Minimum Sound Isolation
Performance Between Enclosed Rooms)
2.3-4.2.2.2 Medication room. Where provided, a
for acoustic requirements.
medication room shall be located on each resident
(ii) See Section 2.5-5 (Communication Sys­
care/living area (unit) for srorage of emergency and
tems) for additional requirements on nurse
contingency medications and supplies or as part of a
call and paging.
medication distribution system.

(1) A medication room shall have a minimum area of
50 square feet (4.65 square meters) or meet the
requirements in the functional program.
*(2) Each medication room shall include the following:
(a) A work counter sized to accommodate
functions for the facility type and care
population
(b) Hand-washing station. See Section 2.4-2.2.8
(Hand-Washing Stations) for requirements.
(c) Refrigerator for storage
2.3-4.2.2.3 Self-contained medication distribution
units, automated medication-dispensing stations,
or mobile medication-dispensing carts. Where these
or other systems approved by the AH] are used, the
following shall apply:
(1) Location of such units shall be permitted at the
staff work area, in the clean utility room, in an
alcove, or in a resident room as approved by the
AH].
(2) Medication units located in resident rooms shall be
secured.

APPENDIX

A2.3-4.2.2.1 <Chapter 1066>,"Physical Environments that Pro­

height of sharps containers by establishing,the eYe-level height and
mote Safe Medication Use;' of the U.s. Pharmacopeia-National Formulary
maximum thumb tip reach of the staff population and then including
(USP-NF) may be used as a resource in developing the medication distri­
adrop angle of 15 degrees. For astanding work station, the sharps
bution and storage system.
container height should be 52 to 56 inches above the standing surface of
the user. For aseated work station, the sharps container height should
A2.3-4.2.2.2 (2) Medication room organization.

be 38 to 42 inches above the floor on which the chair rests. These height
Work space organization elements should be described in the functional

installation recommendations will accommodate 95 percent of all adult

program. These include:

female staff. This information can be found in found in DHHS (NIOSH)

a. Number of staff working in the medication room
Publication No. 97-111,"Selecting, Evaluating, and Using Sharps
b. Key tasks to be performed in the medication room
Disposal Containers:' NIOSH recommends locating the sharps container
c. Amount of space needed to support these tasks
as close as feasible to the immediate area where sharps are used.
d. Space for medication-associated equipment
e. Space for safety technology to be used A2.3-4.2.2.2 (2)(g) Distractions and interruptions interfere with
staff concentration and attentiveness to medication use system activi­
A2.3-4.2.2.2 (2)(e) Placement of sharps containers.

ties.
NIOSH provides an ergonomically ideal formula for determining the

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 77
2.3 DESIGN ELEMENTS

(3) Areas used for medication preparation and

2.3-4.2.4.4 See the facility chapters in Parts 3 through
distribution by mobile cart shall include task­
5 for additional requirements.
specific lighting.

2.3-4.2.5 Clean Utility Room

*2.3-4.2.2.4 Decentralized medication cabinets.
Where a clean utility room is provided, it shall meet
Where medication storage is located in the resident
the following requirements:
room, the following shall apply:

(1) Medication storage located in resident rooms shall 2.3-4.2.5.1 Where the clean utility room is used for
be secured. preparing resident care items, it shall contain:
(2) Decentralized medication cabinets in resident
(1) Work counter
rooms shall include task-specific lighting.
(2) Hand-washing station
(3) Storage facilities for clean supplies
2.3-4.2.3 Central Bathing Rooms or Areas
See the facility chapters in Parts 3 through 5 for 2.3-4.2.5.2 Where the room is used only for stor­
requirements. age and holding as part of a system for distribution
of clean materials, omission of the work counter and
2.3-4.2.4 Equipment and Supply Storage hand-washing station shall be permitted.

*2.3-4.2.4.1 Storage for equipment and supplies for
care and services. Storage space(s) for equipment and
supplies used by staff for resident, participant, and
outpatient care and services shall be immediately acces­
sible to the areas where they are used.
(1) Sufficient storage space(s) shall be provided to keep
required corridor width free of equipment and
supplies.
(2) Cabinets, closets, rooms, and alcoves shall be
2.3-4.2.5.3 Where the room is used for clean linen
and laundry, see Section 2.3-4.2.7 (Personal Laundry
Facilities) for additional requirements.
2.3-4.2.5.4 Where the room is also used as a medi­
cation room, see Section 2.3-4.2.2 (Medication
Distribution and Storage Locations) for additional
requirements.

permitted to provide storage.

2.3-4.2.6 Soiled Utility Room
*2.3-4.2.4.2 Storage for mobility devices and support
equipment. Storage shall be provided for resident­
operated mobility devices and personal support equip­
ment that is:
(1) Sized to meet the needs of the functional program.
(2) Located out of the way of traffic and circulation.
Where a soiled utility room is provided, it shall meet
the following requirements:
2.3-4.2.6.1 Combining the soiled utility room with
the soiled linen and laundry and/or environmental
services room shall be permitted for areas with small
groups of residents.

*2.3-4.2.4.3 General storage. General storage space(s) 2.3-4.2.6.2 The soiled utility room shall contain the

I
shall be provided in the same building for furniture following:
and equipment such as air mattresses, medical sup­ (1) Clinical sink or equivalent flushing-rim fixture
plies, and housekeeping supplies and equipment. with a rinsing hose or bedpan washer

A2.3-4.2.2.4 Decentralized medication 5torage areas should also b. Supplies may include linens, disposable products, slings, accessories
include awriting surface or area for electronic device (laptop, tablet, for lifts such as battery chargers, dressings, office supplies, etc.
etc.) for staff recording of resident data.
A2.3-4.2.4.3 General storage. More storage space is always
A2.3-4.2.4.1 Equipment and supply storage needed, whether for seasonal storage of lawn furniture or for holiday
a. Equipment may include portable lifts, movable commodes, shower decorations. Tall broom c1osetsshouJd also be considered in residential
chairs, and carts. spaces such as individual units and ~itchenettes.
._---------_._------­
78 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

(2) Hand-washing station
(3) Space for soiled linen receptacles
(4) Space for waste receptacles
2.3-4.2.6.3 Where the room is used for soiled linen
and laundry, see Section 2.3-4.2.7 (Personal Laundry
Facilities) for additional requirements.
2.3-4.2.6.4 Where the room serves as an environ­
mental services room, see facility chapters in Parts 3
through 5 for additional requirements.
2.3-4.2.7 Personal Laundry Facilities
Where decentralized personal laundry services are
provided for washing and drying personal resident or
participant laundry, the following requirements shall
be met:
2.3-4.2.7.1 Separate laundry facilities shall be pro­
vided for small groups of residents or participants.
2.3-4.2.7.2 A work counter for sorting and folding
shall be provided.
2.3-4.2.7.3 Hand-washing stations shall be provided
in, adjacent to, or directly accessible from the laundry
room.
2.3-4.2.7.4 Shared facilities
(1) Combination of personal laundry facilities and
soiled utility and soiled linen holding facilities
APPENDIX
A2.3-4.2.7.4 (3) loading, transferring, sorting, and folding laun­
'I dry are familiar activities that may be therapeutic for many residents.
A2.3-4.2.8 Telephone access. Use of technology is becom­
ing increasingly prevalent in residential care facilities. Cable television,
high-speed Internet, and ready access to bedside telephones are just a
few examples of the expected norm in resident rooms. Many residents
will expect access to the Internet to communicate with family and
friends. Provision of telephone/data connections or wi-fi access for each
resident room should be considered.
A2.3-4.2.9 Accommodations for telemedicine
services. The follOWing should be considered where aspace is used
for telemedicine services:
a. The space should be designed to accommodate the service being
provided.
b. It should be possible to maintain visual and speech privacy for the
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.3 DESIGN ELEMENTS
shall be permitted where the airBow is from the
washing/drying area to the soiled utility/holding
area.
(2) Combination of personal laundry facilities and
clean utility and clean linen storage shall be
permitted.
*(3) Provision of accessible laundry equipment in a
resident activity room and/or therapy room shall
be permitted.
*2.3-4.2.8 Resident and Participant Telephone
Access
Provisions shall be made in or near each resident unit
to allow residents to make and receive telephone calls
in private.
*2.3-4.2.9 Accommodations for Telemedicine
Services
Where telemedicine services are provided, provisions
shall be made to support the practice of exchang­
ing medical information between sites via electronic
communications.
2.3-4.3 Support Areas for Staff
2.3-4.3.1 General
Areas that support staff breaks and respite for
caregivers and administrative staff shall be provided.
*2.3-4.3.2 Staff Lounge Area
duration of the visit in the room or area where services are offered.
c. The acoustic environment should facilitate communications within
the room and through the telecommunication system.
d. lighting levels should be designed to allow for video capture and
help control glare from natural or artificial light sources.
e. Access to technology should be prOVided.
A2.3-4.3.2 Staff lounge area. Provision of the follOWing
should be considered:
a. Access to views and outdoor space from the staff lounge area.
See Section 1.2-4.5.2 (Views of and Access to Nature) for more
information.
b. Furniture for relaxation and respite, especially in settings where staff
are commonly scheduled to work extended and double shifts
c. Anotification area to facilitate communication (e.g., human
resources notices, resident passing, etc.)
79
2.3 DESIGN ELEMENTS

2.3-4.3.2.1 Staff lounge area(s) shall be petmitted to 2.3-4.5 Food Service Facilities
be shared by more than one service.
2.3-4.5.1 General
2.3-4.3.2.2 Staff lounge area(s) shall provide the fol­
2.3-4.5.1.1 Application
lowing based on the facility needs:
(1) Facilities and equipment shall be provided to

(1) Refrigerator
support the food services the facility offers staff,

(2) Sink
visitors, residents, and/or participants.

(3) Space for microwave and other appliances

*2.3-4.3.2.3 Space for vending machines shall be pro­
vided based on facility and staff needs.
*2.3-4.3.3 Staff Toilet Room
Toilet room(s) shall contain toilets with hand-washing
stations for staff and shall be permitted to be unisex.
2.3-4.3.4 Staff Storage
Lockable storage shall be provided for safekeeping of
staff members' personal effects.
(2) Food receiving, storage, and preparation areas shall
be located to support staff oversight of operations.
(3) Facilities shall be furnished to support provision of
nourishment and snacks between scheduled meals.
See Section 2.3-2.3.4 (Resident and Participant
Kitchen) for requirements.
*2.3-4.5.1.2 Layout. The equipment and design layout
shall provide a workBow that minimizes potential for
cross-contamination of clean food and wares with
contaminated trays from residents, participants, outpa­
tients, staff, or visitors.

2.3-4.4 Support Facilities for Family and

2.3-4.5.2 Regulations
Visitors
Food service facilities and equipment shall comply

with the requirements of:

2.3-4.4.1 General
See facility chapters in Parts 3 and 4 for requirements 2.3-4.5.2.1 U.S. Food and Drug Administration

in addition to those in this section. (FDA)

2.3-4.4.2 Overnight Guest Accommodations 2.3-4.5.2.2 U.S. Department of Agriculture (USDA)

See the facility chapters in PartS 3 and 4 for

requiremen ts.
2.3-4.5.2.3 Underwriters Laboratories, Inc. (UL)

2.3-4.4.3 Pet Accommodations 2.3-4.5.2.4 NSF International (NSF)

If pets are permitted in a facility, accommodations

(e.g., sleeping areas, feeding areas, waste areas, storage
for food and pet care supplies) shall be designated for
them.
2.3-4.5.3 Functional Elements
Where food services are provided on-site, the following
facilities, in the size and number appropriate for the
type of food service selected, shall be provided:

APPENDIX

A~.3-4.3.2.3Vending machine area. Placement of

A2.3-4.3.3 Provision of shower facilities for staff should be consid­

vending equipment near or in staff lounge area(s) and public waiting

ered.

area(s) used for outpatient therapy services should be considered.

A2.3-4.S.1.2 Layout
a. Vending equipment should be coordinated with interior finish design
a. Small retail options, cafes, or minimal amounts of storage may be

concepts through the use of custom or false fronts or enclosures.

remote from the main food service area.

b. Trash collection devices should be integrated as part of any vending

b. Where food service facilities are split into multiple vertical levels, a

equipment area.
dedicated elevator and an internal service stair should connect the

c. Environmental services facilities should be located near vending

multi-level food service operations.

areas as they are high-use areas.

80 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

2.3-4.5.3.1 Control station for managing food
supplies
2.3-4.5.3.2 Hand-washing station(s) in rhe food
preparation area. See Section 2.4-2.2.8 (Hand-Wash­
ing Stations) for requirements.
2.3-4.5.3.3 Food preparation facilities to accommo­
date the method of food preparation used
(1) Where conventional food preparation systems are
used, space and equipment shall be provided for
food preparation, cooking, and baking.
(2) Where convenience food service systems using
frozen prepared meals, bulk packaged entrees, and
individual packaged portions or systems using
contracted, outsourced services are used, space
and equipment shall be provided for thawing,
portioning, cooking, and baking.
(3) Where "cook-chill" food preparation systems are
used, space and equipment shall be provided for
food preparation, cooking and baking, chilling,
portioning, and reheating.
2.3-4.5.3.4 Ice-making equipment and drinking
water source
(1) Location of ice-making equipment in the food
preparation area or in a separate room shall be
permitted as long as the equipment is directly
accessible to the food preparation area.
(2) Ice-making equipment shall be cleanable.
(3) Ice-making equipment shall be self-dispensing if
it is accessible to residents, participants, and/or
visitors.
(4) Ice-making equipment under control of staff
and not for use by residents, participants, and/or
visitors shall be permitted to be bin-type or self­
dispensing.
(5) See Section 2.3-2.3.4.2 (7) (Access to self­
dispensing drinking water and ice) for
decentralized ice-making requirements.
(6) A filtered self-dispensing drinking water source
shall be provided.
2.3-4.5.3.5 Assembly and distribution facilities.
Depending on the care model, facilities shall be
APPENDIX
A2.3-4.5.3.9 (1) Facilities in remote geographic areas may require proportionally more food storage facilities.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.3 DESIGN ELEMENTS
provided to support assembly and distribution of resi­
dent meals. These shall be permitted to be centralized
or decentralized.
2.3-4.5.3.6 Warewashing space. Commercial-type
warewashing equipment shall be provided.
(1) Depending on the care model, warewashing space
shall be provided in a room or an alcove separate
from the food preparation and serving area.
(a) This shall be permitted to be centralized or
decentralized.
(b) Where a cluster/neighborhood, household/
small house or similar model of care is used,
commercial warewashing may be decentralized
and located in a resident or participant
kitchen. See Section 2.3-2.3.4 (Resident and
Participant Kitchen) for requirements.
(2) Space shall be provided for receiving, scraping,
sorting, and stacking soiled tableware and for
transferring clean tableware to point-of-use areas.
(3) Hand-washing stations shall be provided in or
directly accessible to warewashing space(s).
(4) Warewashing facilities shall be designed to prevent
contamination of clean wares or food preparation
areas with soiled wares through cross-traffic.
2.3-4.5.3.7 Pot-washing facilities. Depending on the
type of food service and the care model, pot-washing
facilities shall be provided. This shall be permitted to
be centralized or decentralized.
2.3-4.5.3.8 Offices(s). Office(s) or desk spaces for
dietitian(s), a dietary service manager, head chef, or
other food service professional shall be provided in or
adjacent to the kitchen.
2.3-4.5.3.9 Storage. The following shall be provided:
*(1) Food storage space, including cold storage
(2) Storage areas and sanitizing facilities for cans, carts,
and mobile-tray conveyors (where used)
(3) Waste, storage, and recycling facilities (per local
requirements) located with access to the outside for
direct pickup or disposal
81
2.3 DESIGN ELEMENTS

2.3-4.5.3.10 Environmental services room
(1) Location
(a) An environmental services room shall be
located in the commercial kitchen where food
service is centralized.
(b) An environmental services room shall be
located in or directly accessible to a resident
unit where food service is decentralized.
(2) See Section 2.3-4.9.3.2 (Environmental services
room) for room requirements.
load of at least 100 lbs. per linear foot (148.80
kgllinear meter).
(c) The interior shall be lighted.
*2.3-4.5.3.12 Cart wash. Where cans are used, a des­
ignated area with a sloped floor with floor drain and a
source of water and sanitizing agents shall be provided.
2.3-4.6 Linen and Laundry Service Facilities
See facility chapters in Parts 3 through 5 for require­
ments.

2.3-4.5.3.11 Cold storage equipment 2.3-4.7 Materials Management Facilities

(1) Walk-in coolers, refrigerators, and freezers, where
used, shall be insulated at the floor as well as at *2.3-4.7.1 General
walls and top.
(2) Coolers, refrigerators, and freezers 2.3-4.7.2 Receiving Areas
Where provided, a loading dock and receiving and
(a) Coolers, refrigerators, and freezers shall be
breakout area(s) shall be permitted to be shared with
thermostatically controlled to maintain desired
other services.
temperature settings in increments of 2 degrees
or less.
2.3-4.8 Waste Management Facilities
(b) Coolers and refrigerators shall be capable of
maintaining a temperature down to freezing.
2.3-4.8.1 Waste Collection and Storage Facilities
(c) Freezers shall be capable of maintaining
a temperature of 20 degrees below OaF Facilities shall be provided for sanitary storage of waste
(-17.78°C). and recyclables per local requirements that are separate
(d) Interior temperatures shall be indicated on the from food preparation, personal hygiene, and other
exterior of the equipment. clean functions. See Section 2.2-2.5.1 (Storage and
Collection of Recyclables and Discarded Goods) for
(3) Walk-in units, where used additional requirements.
(a) All walk-in refrigerator and low-temperature
units shall have a view panel in the door and *2.3-4.8.2 Waste Disposal Facilities
safety release mechanism for exit from the Facilities for removal of waste (e.g., trash, medical
inside. waste, etc.) and recyclables shall be provided.
(b) Shelving shall be corrosion-resistant, cleanable,
and constructed and anchored to support a

APPENDIX

A2.3-4.S.3.12 Cart wash of goods and pickup of materials for which handling is outsourced (e.g.,
a. Ahigh-pressure water and chemical hose/spray system should be
soiled linen).
provided to facilitate cleaning.

A2.3-4.8.2 Waste disposal facilities. ~acilities for trash

b. Acart drying area with floor drain should be provided where carts can
air-dry.
A2.3-4.7.1 Materials management includes procurement, receipt,
storage, and distribution of services or products, including both delivery
and waste removal may include trash chutes, individual container
storage, or acombination of both. The process to be used for trash and
waste removal should be identified so that physical space square foot­
age can be determined.

82 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.3 DESIGN ELEMENTS

2.3-4.9 Environmental Services Rooms 2.3-4.10.1 General

The facilities included in this section shall be provided
2.3-4.9.1 Location
to support operations and maintenance functions.
Environmental services rooms shall be located
throughout the facility as required to maintain a clean 2.3-4.10.2 General Maintenance Area
and sanitary environment.
A general maintenance area shall be provided.

2.3-4.9.2 Number
2.3-4.10.3 Equipment Locations
At least one environmental services room shall be

Room(s) or separate building(s) shall be provided

provided for each floor and specific departments or

for boilers, mechanical equipment, and electrical

areas (e.g., rehabilitation therapy departments/areas,

equipment.
food service areas, loading dock receiving, pick-up

areas, etc.).

2.3-4.10.4 Operations and Maintenance Records

Storage
2.3-4.9.3 Facility Requirements
Provisions shall be made for storage of facility draw­
2.3-4.9.3.1 The amount of space provided in environ­ ings, maintenance records, manuals, and similar
mental services rooms shall be based on the size and records.
number of housekeeping cart(s) used by the facility.
2.3-4.10.5 Maintenance Equipment and Supply
*2.3-4.9.3.2 Each environmental services room shall Storage
contain the following:
(l) Service sink or floor-mounted mop sink 2.3-4.10.5.1 A storage room shall be provided for
(2) An area for handling chemicals building maintenance supplies.
(3) Storage space for housekeeping equipment,

supplies, and chemicals

2.3-4.10.5.2 Storage for solvents and flammable
liquids shall comply with local, state, and federal code
2.3-4.9.3.3 A means for securing environmental ser­ requirements.
vices rooms shall be provided.
2.3-4.10.5.3 Where grounds are maintained by in­
2.3-4.10 Facilities for Engineering and house staff, yard equipment and supply storage areas
Maintenance Services shall be readily accessible to the areas to be maintained.

APPENDIX

A2.3-4.9.3.2 Ahand-washing station, hand sanitation station, or other means for hand-washing should be provided in the environmental services room.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 83
 • Design and Construction Requirements
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.
• 2.4-1 General
2.4-1.1 Application
noncombustible material, shall have a flame-spread
This chapter contains elements that are common to
most types of residential health, care, and support
facili ties.
*2.4-1.1.1 The common elements in this chapter
are required only where referenced in the facility
chapters in Part 3 (Residential Health Facilities), Part
4 (Residential Care and Support Facilities), and Part 5
(Non-Residential Support Facilities).
2.4-1.1.2 Additional specific requirements are located
in the facility chapters in Parts 3, 4, and 5.
2.4-1.2 Building Codes and Standards
2.4-1.2.1 Building Codes
All parts of a residential health, care, and support facil­
ity shall be designed and constructed in accordance
with applicable building codes; engineering practices
and standards; and applicable sections of NFPA 101:
Life Safety Code.
2.4-1.2.2 Construction Requirements
2.4-1.2.2.1 Interior finishes. Interior finish materials
used for architectural details, surfaces, and furnishings
shall comply with the flame-spread limitations and
smoke-production limitations in NFPA 101.
APPENDIX
A2.4-2.1.1.1 For additional information, seethe white paper
"Resources for Selecting Architectural Details, Surfaces, and Furnish'ings
for Health (are Facilities" posted on the FGlwebsite.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.4-1.2.2.2 Insulation materials. Building insulation
materials, unless sealed on all sides and edges with
rating of 25 or less and a smoke-developed rating of
150 or less when tested in accordance with NFPA
255: Standard Method ofTest ofSurface Burning
Characteristics ofBuilding Materials.
• 2.4-2 Architectural Details,
Surfaces, and Furnishings
2.4-2.1 General
2.4-2.1.1 Application
2.4-2.1.1.1 Applicable standards
*(1) All materials and products selected and specified
for residential health, care, and support facility
design and construction projects shall meet
local, state, and federal regulations and industry
standards for infection control and assembly or
construction.
(2) National testing standards shall be used to verifY
whether a product or material provides specific
characteristics.
*2.4-2.1.1.2 Selected materials and products shall
comply with application and use requirements and
shall support the findings of the resident safety risk
assessment and model of care, which are documented
in the functional program.
A2.+Z.1.1.2 Selectjon of fini.shes ~nd materjals for furnishings
should include resident input based on the model ohare.
85
2.4 DESIGN AND CONSTRUCTION REQUIREMENTS

*2.4-2.1.2 Characteristics and Criteria for Selecting performance shall be considered in the overall plan­
Materials and Products ning and design of the facility.

*2.4-2.1.2.1 General. The effect of surface materi­

2.4-2.1.2.2 Resident safety risk assessment issues.
als, colors, textures, and patterns on resident, staff,
Architectural detail, surface, and furnishing materials
and visitor safety and on maintenance and life cycle
and products selected for residential health, care, and

_ APPENDIX­

A2.4-2.1.2 The effects of demolition and replacement and repair
of materials and products used in residential health, care, and support
facilities should be considered when selecting surface and furnishing
materials and products for use in environments that are occupied 24
hours aday, seven days aweek.
A2.4-2.1.2.1 Characteristics and criteria for
-Reduces user fatigue and musculoskeletal injury. Architectural
detail, surface, and furnishing materials should:
• Meet specific safety, assembly, and construction industry
criteria for fleXibility to address foot compression and heel
strike absorption.
Support foot comfort and reduce the fatigue and musculo­

skeletal injury effects of long-term continued use or bodily

selecting surface and furnishing materials and

damage from impacts or falls.

products

-Uses safe and compatible materials in assemblies, including

a. Residential health, care, and support facilities should incorporate
substrate and surface finish materials
architectural detail, surface, and furnishing materials and products
All assembled materials should meet the characteristics
th.at:
listed in Sections 2.4-2.2 (Architectural Details), 2.4-2.3
-Optimize sensory function in accordance with the vision and
(Surfaces), and 2.4-2.4 (Furnishings).
lighting gUidelines established by ANSI/IES RP-28: Lighting and
• All seams and joints in assemblies should be joined to
the Visual Environment for Seniors and the Low Vision Population
reduce wear and degradation and should be able to remain
and provide optimum light levels and glare-free finishes for the
intact during the proposed service life of the assembly.
safety and vision comfort of residents and staff.
Water-resistant materials, sealed-seam construction meth­
-Optimize acoustic comfort, speech privacy, and accurate oral
ods, and moisture-impervious surface selections should be
communications; mitigate alarm fatigue; and consider residents'
used for assemblies where water or moisture is continuously
use of hearing aids.
present (e.g., clinical use work surfaces with inset or inte­
b. The additional characteristics and criteria in this section should be
gral sinks, flooring, cove base assemblies, showers, other
used for designing architectural details and selecting and specifying
bathing areas) to reduce or eliminate the possibility of seep­
products and materials for all residential health, care, and sup­
age in or under the assembly.
port facility design and construction projects. (The characteristics
-Safe<1nd efficient for use in occupied residential settings over
included in this text are supported by quantifiable industry test
time. Throughout their life cycle, architectural detail, surface,
methods. See the Facility Guidelines Institute website under the
and furnishing materials and products should minimize and/
Resources tab.)
or prevent the incidence and effects of noise, odors, gas, par­
-Durable. Architectural detail, surface, and furnishing materials
ticulates, dust, and debris that reduce indoor air quality during
and products should be resistant to breakage, punctures/tears,
product assembly, installation, and operations as well as main­
stains, and damage and wear from abrasion as appro.priate to
tenance, repair, or demolition in occupied residential health,
the function of the material and product type being selected.
care, and support facilities. See appendix section A2.2-2.4.1.1
See appendix section A2.2-2. (Use of reduced-impact materials)
(Emissions and VOCs) for additional information.
for additional information.
-Appropriate for the emotional and cultural well-being of resi­
-Resilient and impact-resistant. Architectural detail, surface, and
dents, staff, and visitors. Design, layout, size, color, and pattern
furnishing materials should remain intact, safe, and functional
of architectural details, surfaces, and furnishings shall create
in heavy weight-bearing, high-traffic, and impact-susc~ptible
resident environments that support the model of care and oper­
areas. Materials and products selected should meet the follow­
ations provided in the facility or setting. See Section 1.2-4.5.8
ing requirements:
(Cultural Responsiveness) for additional information.
• "Pounds per square inch" (PSI) weight tolerances for loads
In any design project, the selection ofacolor palette should

Tensile strength, flexibility, impact, and abrasion testing

be based on many factors, including the building popula­

standards for the reqUired use and application

tion, anticipated activities in the space, and lighting design

• Surface bounces back from compressions caused by

strategy.

repeated use and does not shatter or fragment under abra­

Finishes and color palettes should respond to the geo­

sion or impact
graphic location ofthe residential health, care, and support

86 Guidelines for Design and Construct ion of Residential Health, Care, and Support FaCilities ~
 2.4 DESIGN AND CONSTRUCTION REQUIREMENTS

support facilities and settings shall meet performance
characteristics and criteria that address risks identified
in the resident safety risk assessment results.
*(1) Reduction of resident falls and associated injuries.
See Section 1.2-3.4 (Resident Fall Risk and
Prevention Assessment) and Section 2.4-2.3.2
*2.4-2.2.2.1 Width. The placement of drinking
(Flooring and Wall Bases) for requirements.
(2) Reduction of medication errors. Where medication
areas are provided in the facility or setting,
medication work surfaces shall be designed to
reduce glare and reflectivity.
2.4-2.2 Architectural Details
2.4-2.2.1 General
Architectural details in residential health, care, and
support facilities shall be designed to encourage
ambulation of long-term residents, short-term reha­
bilitation residents, and participants in non-residential
settings.
2.4-2.2.2 Corridors
fountains, public telephones, vending machines, and
wall-mounted items such as organizers, retractable
computer workstations, etc., shall not restrict cor­
ridor traffic or reduce the corridor width below the
minimum stipulated in applicable building codes and
NFPA 101.
2.4-2.2.2.2 Placement of fixtures. The height of
drinking fountains, public telephones, handrails, lean
rails, and wall-mounted lighting fixtures shall comply
with applicable accessibility standards referenced in
Section 1.1-4.1 (Design Standards for Accessibility).

APPENDIX (continued)

facility, taking into account climate and light, regional See Section 2.2-2.4.1.1 (Emissions and VOCs) for additional
responses to color, and the cultural characteristics of the information.
community served.
A2.4-2.1.2.2 (1) Environmental factors and falls.

Because the lenses of older adults' eyes yellow, the ability

Anumber of studies in which multiple variables were studied have

to see colors at low saturation and to discern different colors

suggested an association between falls and the following material

(particularly short-wavelength colors such as those in the

characteristics:

blue/violet range) is impaired. In general, low saturated

a. Flooring types (e.g., carpet; non-textile flooring such as rubber, VeT,
colors appear gray in interior applications, which is prob­
sheet Vinyl). Flooring should be specified based on function.
lematic for visibility. Using colors that support the visual
b. Flooring pattern. Scale and type of flooring design patterns should
needs of older adults is recommended.
be considered. Research suggests that flooring with a medium-sized
-Has acoustic properties that support resident safety and well­
pattern (1-6 inches wide) was associatedwith more fa.lls than floors
being. Material and products selected should meet the noise
with no pattern, asmall pattern (less than 1inch wide), or a large
reduction requirements for resident care areas in Section 2.5­
pattern (wider than 6inches).
8.3 (Design Criteria for Acoustic Finishes) and Section 2.$-8.6
c. Flooring contrast. Flooring materials with high-contrast patterns can
(Design Guidelines for Speech Privacy) where applicable til the
be associated with more falls.
function of the specific material or product.
d. Flooring reSilience. Use offlooring material that is flexible and "gives"
-Made of non-allergenic materials. Aproduct review of poten­
should be reviewed to reduce injury to residents who fall.
tial product-based allergens should be performed during the
e. Floor reflectivity. Use of non-glare finished floors should be consid­

material selection process (conducted during functional pro­

ered to avoid compromising vision and potentially disrupting bal­

gramming) to identify products inappropriate for use with the

ance of residents.

resident care population being served.

f. Flooring cushioning. Roors should be firm enllugh so they do not

-Ability to control and minimize reflectivity and glare. Architec­

disrupt gait and posture or inhibit roller traffic.

tura
details, surfaces and furnishing materials and light fixtures

g. Noise attenuation should be considered. Noise has been found to

and lamps that are specified should combine to meet ANSI/IES

contribute to falls, especially noise generated ffom overhead paging

RP-28: lighting and the Visual Environment for Seniors and the
and alarms.

Low Vision Population light levels. See Section 2.5-7 (Daylight­

ing and Artificial lighting Systems) for additional information. A2.4-2.2.2.1 Furniture placement in the corridor should be

-Has low or no volatile organic compounds. Only materials with permitted in accordance with applicable building codes and NFPA 101:

low or no volatile organic compounds (VOCs) should be used. Ufe Safety Code.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 87
2.4 DESIGN AND CONSTRUCTION REQUIREMENTS

2.4-2.2.3 Ceiling Height (iv) Equipment

(v) Beds
*2.4-2.2.3.1 The minimum ceiling height shall be 8 (vi) Resident-operated mobility devices
feet (2.44 meters), with the following exceptions: (vii) Carts
*(1) The minimum ceiling height in corridors and
(2) Architecturally framed and trimmed openings in
normally unoccupied spaces shall be 7 feet 6 inches
corridors and rooms shall be permitted, provided a
(2.29 meters).
minimum height of 6 feet 8 inches (2.03 meters) is
(2) In rooms containing ceiling-mounted equipment
maintained.
or fixtures in the stowed position, the minimum
height from the floor to the lowest protruding
2.4-2.2.4.3 Insect screens
element of the equipment or fixture when it is in
the stowed position shall be 7 feet (2.14 meters). (1) With the exception of an approved exit door,
(3) The minimum height above the floor of suspended exterior doors used for ventilation purposes shall
tracks, rails, and pipes located in normal traffic include insect screens.
paths shall be 7 feet 6 inches (2.29 meters) above (2) Where regionally appropriate, this requirement
the floor. shall not apply.

2.4-2.2.3.2 Renovation. In renovation projects, all 2.4-2.2.5 Thresholds and Expansion Joint Covers
new work shall comply with the requirements in
2.4-2.2.5.1 Thresholds shall be designed to facilitate
Section 2.4-2.2.3 (Ceiling Height). Where existing
use by rolling traffic.
conditions make compliance impossible, the authority
having jurisdiction (AHJ) shall be permitted to grant 2.4-2.2.5.2 Thresholds, expansion/seismic joints, and
approval to deviate from these requirements. covers shall meet all local, state, and federal require­
ments.
*2.4-2.2.4 Doors and Door Hardware
See the facility chapters in Parts 3 through 5 for 2.4-2.2.6 Windows
requirements in addition to those in this section.
2.4-2.2.6.1 General

2.4-2.2.4.1 Reserved (1) Windows shall comply with applicable building

codes.
2.4-2.2.4.2 Door openings (2) Resident rooms, suites, and dwelling units shall
have exterior window(s).
(1) Door openings shall be sized based on the model of
(3) See Section 2.2-4.2.1.6 (Physical Environment
care and the needs of the care population to allow
Elements for Risk Reduction-Operable windows)
proper clearance for:
for requirements that address safety risks for
(a) Ambulation of residents residents with dementia, mental health diagnoses,
(b) Passage of the following: and cognitive and developmental disabilities.
(4) For requirements in addition to those in this
(i) Portable/mobile mechanical lifts
(ij) Shower gurney devices section, see:
(iii) Shower chairs (a) Facility chapters in Parts 3 through 5

APPENDIX

A2.4-2.2.3.1Because indirect lighting solutions should be consid~ A2.4-2.2.4 Door protection. Door protection (e.g., kick
ered for residential health, care, and support facilities, higher ceiling plates, edge stripping, etc.) should be considered to accommodate the
heights may be needed to accommodate the indireetlighting detailing. model of care andthe needs of the care population.
A2.4-2.2.3.1 (1) Examples of normally unoccupied rooms/spaces
include toilet, storage, dressing, soiled utility, clean utility, environmen­
tal service, electrical, and information technology rooms and alcoves.

88 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

(b) Section 1.2-4.5.1 (Light)
(c) Section 2.5-7 (Daylighting and Artificial
Lighting Systems)
( *2.4-2.2.6.2 Sill height. Windows in resident rooms,
suites, and dwelling units shall have sills located no
higher than 36 inches (91.44 centimeters) above the
finished floor.
2.4-2.2.6.3 Insect screens
(1) Operable exterior windows that may be left open
shall have insect screens.
(2) Where regionally appropriate, this requirement
shall not apply.
2.4-2.2.7 Glazing Materials
(1) Glazing materials shall meet all local, state, and
federal requirements.
(2) Glazing materials shall be readily accessed for
cleaning and maintenance.
2.4-2.2.8 Hand-Washing Stations
2.4-2.2.8.1 General. Where hand-washing stations are
provided in a residential health, care, or support facil­
ity, the requirements in this section shall be met.
(1) The number and placement of hand-washing
stations shall be determined by the infection
control risk assessment (ICRA).
(2) Hand sanitation dispensers shall be permitted
to be used in lieu of hand-washing stations as
determined by the ICRA.
(3) Hand-washing stations in resident care areas shall
be located so they are visible and access to them is
unobstructed.
(4) Design of hand-washing stations shall not permit
APPENDIX
A2.4-2.2.6.2 Windowsills
a. Asill height of 32 inches (81.28 centimeters) is preferable to allow
residents in wheelchairs or beds to easily see out the window.
b. The depth ofthe sill and its relationship to acurtain or blind should
be considered as residents commonly use windowsills as display
space for personal items.
A2.4-2.2.8.4 (2) Hand-washing station
countertops
a. The presence ofwater around hand-washing sinks has consistently
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.4 DESIGN AND CONSTRUCTION REQUIREMENTS
storage in casework beneath the sink basin or in
areas below a sink open to the floor.
2.4-2.2.8.2 Sinks. For sink and fitting requirements,
see Section 2.5-2.3.2 (Hand-Washing Sinks).
2.4-2.2.8.3 Anchorage. For hand-washing stations,
allowable stresses shall not be exceeded at any point on
the hand-washing station where a vertical or horizontal
force of250 pounds (1112N) is applied.
2.4-2.2.8.4 Hand-washing station countertops
(1) Hand-washing station countertops and their
substrates shall be moisture-resistant.
*(2) Hand-washing sinks set into countertops shall
include a water-tight seal.
2.4-2.2.8.5 Provisions for drying hands. Provisions
for hand drying shall be required at all hand-washing
stations.
(1) Hand-washing stations shall include a hand-drying
device that does not require hands to contact the
dispenser.
(2) These provisions shall be enclosed to protect
against dust or soil and to ensure single-unit
dispensing.
(3) Hot air dryers shall be permitted unless the care
population dictates otherwise. See Section 2.2-4
(Design Criteria for Dementia, Mental Health, and
Cognitive and Developmental Disability Facilities)
for specific care population requirements.
(4) Where provided, hand towels shall be directly
accessible to sinks.
2.4-2.2.8.6 Cleansing agent. Hand-washing stations
shall include liquid or foam soap dispensers.
proven to encourage the presence of molds and bacteria in the
substrate materials if the countertops are not properly sealed and
maintained.
b. Integral backsplashes eliminate intersections that need to be
caulked.
c. Use of marine-grade plywood substrate for plastic laminate
countertops should be considered.
d. Under-mount basins are difficult to clean, and their use is
discouraged.
89
2.4 DESIGN AND CONSTRUCTION REQUIREMENTS
2.4-2.2.8.7 Mirror. A mirror shall be provided at
each resident hand-washing station.
(1) Mirror placement shall allow for use by both
wheelchair occupants and ambulatory persons.
(2) Top and bottom edges of mirrors shall be at levels
usable by individuals either sitting or standing.
(3) A separate full-length mirror shall be permitted to
serve as the required mirror.
2.4-2.2.9 Grab Bars
*2.4-2.2.9.1 Grab bars shall comply with local, state,
and federal requirements.
A.2.4-2.2.9.1 ADAAG, UFAS, and ANSI accessibility standards
were all developed with the intention of providing greater access for
individuals with disabilities. However, their standards are based on
assumed stature and strength, and thus their dimensional and grab bar
requirements are intended to facilitate wheelchair-to·toilettransfers by
individuals with sufficient upper body strength and mobilityto accom­
plish such atransfer. The typical residential health, care, or support
facility resident is unlikely to have such capabilities and thus will require
the assistance of one or more staff members. Insufficient clearance at
the side of the toilet can restrict staff mobility and access and result in
injury, The Mayer-Rothschild Foundation white paper "Determination
of Grab Bar Specifications for Independent and Assisted Transfers in
Residential Care Settings" outlines recommendations for grab bar con­
figuration and placement to meet the needs of residents of a residential
health, care, or support facility.
A2.4-2.2.9.2 Grab bars in bathrooms
a. For independent transfers. Grab bars at toilets in bathrooms and
bathing cores should allow residents to be as safe and independent
as possible. This includes using swing-up grab bars, where possible,
with or without integral toilet paper holder.. See appendix section
A2.4-2.2.9.3 (1) (Alternative grab bar configurations) for additional
information.
b. For assisted transfers. Grab bars in bathrooms should allow staffto
complete atwo-person transferfor·a single resident. This includes
evaluation of the toilet in relation to the wall and the grab bars pro­
Vided. Clearance is reqUired on both sides of the toilet for adouble
transfer to occur. See appendiX table Al.4 ca(Resources for Grab Bar
Configurations) for further information on space for transfers.
A2.4-2.2.9.3 (1) Alternative grab bar
configurations
a. Alternative grab bar configurations should address the folloWing
scenarios:
-For a resident capable of independent transfer facilitated bythe
grab bar and side wall location required by accessibility stan­
dards, aremovable/temporary wall structure and grab bar can
90, Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
*2.4-2.2.9.2 Grab bars shall be installed at toilets and
showers in addition to other locations required to meet
accessibility requirements in resident toilet rooms,
showers, and bathing facilities.
2.4-2.2.9.3 Alternative grab bar configurations
*(1) Where residents can undertake independent
transfers, alternative grab bar configurations shall
be permi tted.
*(2) Evaluation of the care population shall be
considered in determining alternative grab bar
configurations that meet specific resident needs.
be installed alongside the toilet.
-For aresident who requires partial assistance to transfer, provi­
sion of swing-up grab bars on one or both sides of the toilet
would facilitate such transfers.
b. Installation of swing-up grab bars requires evaluation of the toilet in
relation to the wall and the grab bars provided. Clearance is needed
on, both sides of the toilet for an assisted transfer involVing two or
more staff members.. The location of the toilet should be reviewed
with regulators.
c. Spacing of grab bars and appropriate lengths and heights for grab
bars should be ergonomically evaluatedin conjunction with the
follOWing:
-Toilet height
~Sink location
-Type of bathing fixture
-Specific typ.eof lifting eqoipment and toileting/bathing sling
used by th.e care proVider
d, Grab bar configurations for older adults should be configured as
referenced in appendiX tableA2A-a (Resources for Grab Bar Configu­
rations) and state and local regulations.
e. Where design for persons of size is reqUired, the length of rear wall
grab bars should be 44 inches (112 centimeters) and mounted per
the ADA Standards for Accessible Design.
f. Creation of mock-ups should be considered when evaluating alterna­
tivegrab bar configurations. In some cases, grab bar redundancy
may be appropriate. See Section 1.2-3.3 (Resident Mobility and
Transfer Risk Assessment) for criteria to be evaluated in a mock-up.
g. Grab bars may be vertical or horizontal based on the model of care
and the needs of the care population.
A2.4-2.2.9.3 (2) Based on the care population, temporary alterna­
tive grab bar configurations may be permitted to allow for transfers
for residents who have changing abilities, are in rehabilitation, or are
increasingly frail. Grab bar configurations that offer flexible solutions
should be considered. Installation of temporary or flexible configura­
tions should be tested for safety and security before residents use them.
 2.4 DESIGN AND CONSTRUCTION REQUIREMENTS

*2.4-2.2.9.4 For wall-mounted grab bars, a minimum 2.4-2.2.10.4 A handrail shall be provided for each
clearance of 1.5 inches (3.81 centimeters) from walls clear corridor wall length exceeding 12 inches (30.48
shall be provided. centimeters) .

2.4-2.2.9.5 Concentrated load requirements 2.4-2.2.10.5 A minimum clearance of 1.5 inches

(1) Grab bars, including those that are part of fixtures (3.81 centimeters) shall be provided between the hand­
such as soap dishes and toilet paper holders, shall rail and the wall.
be anchored to sustain a minimum concentrated
load of250 pounds (113.4 kilograms). 2.4-2.2.10.6 Where a corridor is not required to
(2) Grab bars installed in areas intended for use
comply with life safety egress requirements, use of
by persons of size shall be anchored to sustain
alternative handrail cross-sections and configurations
a minimum concentrated load of 800 pounds
that support senior mobility shall be permitted.
(362.88 kilograms).
2.4-2.2.10.7 Handrails or lean rails shall return to the
2.4-2.2.9.6 Grab bars shall have a finish value that wall or floor.
contrasts with the adjacent wall surface.
2.4-2.2.10.8 Handrails, lean rails, and fasteners shall
2.4-2.2.9.7 Grab bars shall be returned to the wall or have a smooth surface that is free of rough edges.
floor with eased corners where a mitered corner condi­
tion exists. 2.4-2.2.10.9 Handrails or lean rails shall have eased
edges or corners.
2.4-2.2.10 Handrails and Lean Rails
2.4-2.2.10.10 The top of the surface of handrails or
2.4-2.2.10.1 Application lean rails shall be no higher than 32 inches (865 milli­
meters) minimum and 38 inches (965 mm) maximum
(1) Handrails shall comply with local, state, and
above the floor surface.
federal requirements referenced in Section 1.1-4.1
(Design Standards for Accessibility) as amended in
*2.4-2.2.11 Protection from Heated Surfaces
this section.
(2) Use of alternative handrail cross-sections and
2.4-2.2.11.1 Emergency shutoffs shall be provided in
configurations that support senior mobility shall be
resident areas where heated surfaces are used.
permitted.

2.4-2.2.11.2 These locations shall be identified on

2.4-2.2.10.2 All stairways and ramps shall have
construction documents.
handrails.

2.4-2.2.12 Signage and Wayfinding

*2.4-2.2.10.3 Where corridors are defined by walls,
Ihandrails (or lean rails where permitted) shall be
2.4-2.2.12.1 See Section 1.2-4.5.3 (Signage and Way­
provided on both sides of all corridors used by
finding) for functional programming requirements.
residents, participants, and outpatients.

APPEN DIX

A2.4-2.2.9.•4 Consideration should be given to increa~ing clearances A2.4-2.2.11 Heated surfaces. Heated ~uffaces referenced

for residents with arthritis and similar physical conditions. in this section are intended to incluoe those surfaces to which residents

have normal access that exceed 1lOaF (43"Cl.ln household caremodels,

A2.4-2.2.10.3 Handrails are required only where a handrail can be

stoves or other cooking elements are often'used as part of a'''horne­

affixed to awall or some supporting element; areas open to acorridor,

style" country kitchen or an activity area. This requirement does not

such as a room or an alcove, do notrequire a handrail across the open

extend to medical ortherap'eutic equipment.

space.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 91
2.4 DESIGN AND CONSTRUCTION REQUIREMENTS
2.4-2.2.12.2 Signage shall be consistent with all local,
state, and federal regulations.
APPENDIX
A2.4-2.2.12.3 Signage and wayfinding. Clearly visible
and understandable signage, icons, universal symbols, landmarks,
and/or cues for orientation (including views to the outside) should be
coordinated and prOVided. Use of technology as part ofa wayfinding
system should be evaluated.
a. Adestination hierarchy should be developed to ensure the right
information is presented at the right time. The destination hierarchy
should manage the number of symbols by building, zone, or floor.
Users have difficulty differentiating more than 16 unique symbols in
one set.
b. Boundaries between public and private areas should be well.-marked
or implied and clearly distinguished.
c. Awayfinding system should be designed for consistency in the over­
all wayfinding plan. This should include:
-Directional and orientation signs (overhead, wall-mounted,
maps, etc.)
-Destination signs
-Room identification signs
-Regulatory signs, including provisions for residential health,
care, and support facility-specific policy and information signs
-lnterior"landmarksHto aid occupants in cognitive understand­
ing of destinations
• To be effective, landmarks should be unique. landmarks
may include water features, major artworks, distinctive
colors, or decorative treatments at major decision points in
the building.
• Design of landmarks should attempt to involve tactile, audi­
tory, and language cues as well as visual recognition.
landmarks should only be used at decision points.
d. Each sign should be accurate, legible, and functional.
-Nomenclature should be consistent and understandable to the
. general public. Signs should be written at asixth grade level.
-letters should contrast with the background to conform to ADA
requirements.
• Signs in areas with housing and services primarily for older
adult residents should have letters that contrast with the
background by a minimum of 70 percent.
• Greatest readability is usually achieved through the use of
light-colored characters or symbols on adark background.
-Signs should have an eggshell finish (11 to 19 degree gloss on
60 degree glossimeter).
-Where used, symbols and pictographs should be recognizable
to the general public and the community served. (The Universal
Symbols in Healthcare have been tested for usability and com­
prehension.)
• The number of symbols used on asingle sign should be
limited and should indicate primary destinations only.
92 Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
*2.4-2.2.12.3 Strategically placed interior and exterior
signage as well as visual environment and surface­
applied cues shall be provided for resident and visitor
orientation.
• Where health care symbols are combined with other univer­
sal symbols used in transportation or accessibility signage,
the meaning of the different sets of symbols should be
clearly differentiated for users.
e. Signage systems should be fleXible, expandable, adaptable, and easy
to maintain.
-Fabrication should allow messages to be changed.
-Signage should be consistent with other resident and family
communications, supporting printed collaterals, Web and elec­
tronic media, and branding of afacility or community.
f. "You Are Here" (YAH) map recommendations
-YAH maps should be oriented so that forward is up.
-It is preferable to use a perspective view. Where vertical naviga­
tion is required, consider illustrating the relationship between
levels and which elevator cores serve which areas, especially
where floors are not contiguous.
-Inset maps should be used to locate details in the overall map
where appropriate.
g. Exterior signage (general)
-Directional signs should be easily visible from the street and
located and sized so that drivers can easily read them when
traveling at the local speed limit.
-Consistency should be used in the nomenclature of bUildings.
-Directions should be clear to all users.
-Signage should be placed within an individual's 60-degree"cone
ofvision;'whetherthe person is walking or driving.
-Exterior directional signs should be visible at night.
-Signage should be located where it may easily be seen.
h. Exterior signage (parking)
-Directions should be prOVided to the various parking locations,
where applicable.
-Directions should be prOVided from the parking structure to the
entrance of the facility.
-Signage should clearly indicate short-term and long-term park­
ing rates where applicable.
-Where valet parking is prOVided, its location should be clearly
marked.
-Directional signage should be provided for automobile and
pedestrian traffic at an appropriate scale for each.
-Floor numbers or sections should be clearly marked.
i. Interior signage (entrance and exit)
-A well-designed and located set of interior signs and clearly
labeled directional maps should be located near the entrance.
Symbols used on directional signage should also be used in
orientation maps for consistency and to help users find primary
destinations.
-Signage should clearly identify all publicly accessible functional
 2.4 DESIGN AND CONSTRUCTION REQUIREMENTS

*2.4-2.2.13 Decorative Water Features *2.4-2.3.2.1 Flooring surfaces shall meet the needs of
Provision of decorative water features shall be permit­ residents, participants, or outpatients and be cleanable
ted in residential health, care, and support facilities. and wear-resistant for the location.

2.4-2.3 Surfaces 2.4-2.3.2.2 Flooring surfaces shall provide smooth

transitions between different flooring materials.

2.4-2.3.1 General
2.4-2.3.2.3 Flooring surfaces shall allow for ease of

Light reflectance values (LRY) of all surfaces shall

ambulation and self-propulsion.

comply with ANSI/IES RP-28: Lighting and the Visual

Environmentfor Seniors and the Low Vision Population.
2.4-2.3.2.4 Flooring surfaces shall allow easy move­

ment of all wheeled equipment used in the facility.

*2.4-2.3.2 Flooring and Wall Bases

2.4-2.3.2.5 Flooring surfaces, including those on stair­

ways, shall be stable, firm, and slip-resistant.
APPENDIX (continued)

and community spaces in the facility (cafeteria/dining, gift shop, • landmarks: Design elements can provide clear reference
restrooms, etc.). points in the environment (e.g., alarge three-dimensional
-Where symbols are used, asingle symbol should be used to object, outdoor view, large picture, or other wall-mounted
represent asingle primary destination. artifact).
-Adequate signage should be prOVided to direct people out ofthe • Signs: Where appropriate, large characters and redundant
facility and back to parking and public transportation. word/picture combinations should be used on signs.
j. Interior wayfinding (room numbering) -Residents with dementia require color to be associat~d with a
-Room numbering should be of aconsistent nature from floor to symbol to be recognizable. Theywill not automatically associate
floor and area to area. color alone with aspecific meaning.
-The numbering system should be simple and continuous. -Color may be used to distract attention from spaces. For exam­
-Design of the numbering system should be flexible to allow for ple, mechanical doors and door frames that match the finish of
future expansion and renovation. the surrounding walls are less likely to draw a resident's atten­
-Room numbering should take into account the need for sequen­ tion to the mechanical room.
tial strategies for public wayfinding that may be different from
A2.4-2.2.13 Decorative water features
operational and maintenance numbering.
a. The d~sign of indoor water features should meet the following
-Signs should differentiate between those spaces used by resi­
criteria:
dents/visitors and those used by staff.
-Human contact with the water should be limited and/or water
k. Interior wayfinding (sign placement)
disinfection systems should be applied.
-Signs providing directions should be placed at major decision
-Materials used to fabricate the water feature should be resistant
points, including major intersections, major destinations, and
to chemical corrosion.
changes in bUildings and/or specific care areas.
-Water features should be designed and constructed to minimize
-In areas without major decision points, reassurance signs should
water droplet production.
be placed approximately every 250 feet (76 meters).
-Exhaust ventilation should be provided directly above the water
I. Wayfinding to serve residents with dementia
feature.
-Major characteristics of persons with Alzheimer's and other
-Surfaces that mitigate the risk of slipping should be used and
dementia are lack of attention span and an inability to orient
maintained around awater feature.
themselves in the physical environment. To address this, the
b. Aquariums should be enclosed to prevent resident or visitor contact

physical environment should prOVide discernible landmarks and

with the water. Aquariums are not subject to exhaust ventilation

wayfinding cues and information to aid in navigation from point

recommendations.

to point. Sensory cuing used in other healtb, care, and support

resident areas should also be used in areas for persons with A2.4-2.3.2 Wall bases. Wall bases in resident areas (resident

dementia. rooms, corridors, dinIng and activity rooms) and public bathrooms

-Consideration should be given to provision of the following should match the colorlvalue ofthe walls and proVide astrong contrast

wayfinding elements in dementia and mental and cognitive to the floor to distinguish the vertical and horizontal planes.

health units:

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 93
2.4 DESIGN AND CONSTRUCTION REQUIREMENTS
(1) The slip resistance ratings of flooring surfaces shall
be appropriate for the area of use-for dry or wet
conditions and for use on ramps and slopes.
(2) Slip-resistant flooring products shall be used for
surfaces in bathing areas and rooms, wet areas, and
ramps and entries from exterior to interior spaces.
(3) Carpet in resident areas shall be installed to
prevent trip hazards or interference with resident,
participant, or outpatient use of resident-operated
mobiliry devices and assistive ambulation devices
and staff use of carts and equipment.
*2.4-2.3.2.6 Areas subject to frequent wet-cleaning
finishes that create glare shall be avoided.
methods
(1) The floors and wall bases of kitchens, soiled
workrooms, toilet rooms, and other areas subject
to wet-cleaning methods shall be constructed
of materials that are not physically affected by
germicidal or other rypes of cleaning solutions.
(2) Areas subject to wet cleaning shall have floors that
are homogeneous and have sealed joints.
(3) Wall bases in areas that require wet cleaning (e.g.,
soiled and clean utiliry rooms, environmental
services rooms with mop sinks) shall be
continuous, integral or sealed to the floor and the
wall, and constructed without voids.
A2.4-2.3.2.6Flooring
-a. See appendiX section A2.4-2.1.2.2 (1:) (Env.ironmental factors ahd
falls) for information about the relationship between flooring and
falls.
b. Flooring materials should have a mediumcolorlvalue; use of flooring
in dark colors/values should be aVOided.
c. Strongly patterned flooring materials should be avoided as they can
be confusing to residents with impaired vision.
d. Moving an elevated resident around and through aspace using por­
table lifting equipment without powered wheels may require more
exertion by staff than using ceiling-mounted equipment.
-The exertion required by staff may increase with the use of
carpet; however, different types and brands of carpet may have
significantly different levels of resistance to wheeled devices.
-Installation of a mock-up is recommended to test the action of
wheeled eqUipment and devices used in afacility over proposed
flooring materials.
-Carpet should not be automatically discounted as inappropriate
due to this challenge as it has major advantages over hard­
surface flooring in terms of noise reduction, other acoustic
considerations, and residential appearance, all of which
94 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.4-2.3.2.7 Food preparation areas
(1) Floors in areas used for food preparation and
assembly shall be water-resistant.
(2) Floor surfaces, including tile joints, shall be
resistant to food acids.
(3) Floor construction in dietary and food preparation
areas shall be free of spaces that can harbor pests.
All joints shall be sealed.
(4) Slip-resistant flooring products shall be used
throughout kitchens, including wet areas.
*2.4-2.3.2.8 Highly polished flooring or flooring
2.4-2.3.2.9 Floor openings for pipes, ducts, or con­
duits as well as joints at structural elements shall be
tightly sealed.
*2.4-2.3.2.10 All changes oflevel (i.e., stairs, steps,
and ramps) shall have a strong value contrast between
vertical and horizontal surfaces.
2.4-2.3.3 Walls and Wall Protection
*2.4-2.3.3.1 Wall finishes
are important in creating a comfortable, attractive living
environment for residents.
A2.4-2.3.2.8 Use of non-wax flooring eliminates finish glare. Where
afinish coat is reqUired, smooth flooring surfaces should be sealed with
a matte finish to reduce surface glare.
A2.4-2.3.2.10 Color contrast between walls and floors and mini­
mization of transitions between different types of f1Qoring may reduce
fall risk. See Table 4D-2 (Performance Criteria for Surfaces and Materials)
in the National Institute of Buildihg Sciences'Design Guidelines for the
Visual fnvironmentfor additional information.
A2.4-2.3.3.1 Color/value contrast of wall finishes
a. Wall finishes should consist of colors/values that contrast with the
floor material to distinguish vertical and horizontal planes (an issue
of balance).
b. The color/value contrast of wall finishes should be in the range of
60-80 percent light reflectance value (LRV) to provide acceptable
contrast with the floor and maximize light distribution in the space.
C. See Table 4D-2 (Performance Criteria for Surfaces and Materials)
in the Design Guidelines for the Visual Environment, published by
National Institute of Building Sciences for additional information.
 2.4 DESIGN AND CONSTRUCTION REQUIREMENTS

*(1) Wall finishes shall be washable. areas, bathrooms, central bathing rooms or areas
(2) Wall finishes near plumbing fixtures shall be
with showers, soiled utility rooms (where applicable),
smooth, scrubbable, and moisture-resistant.
and housekeeping closets shall be impervious and
(3) Wall surfaces in areas routinely subjected to wet
moisture-resistant.
spray or splatter (e.g., kitchens, housekeeping

closets) shall be water-resistant.

2.4-2.3.4.3 The color/value of ceiling surfaces shall
(4) Wall surfaces shall have a matte finish. Use of have a light reflectance value in the range of75-90
highly polished, glossy, or shiny wall finishes that percent to maximize distribution of light in a space.
create glare shall not be permitted.
(5) In dietary and food storage areas, wall
2.4-2.4 Furnishings
construction, finish, and trim, including joints

between walls and floors, shall be free of insect­

2.4-2.4.1 General
and rodent-harboring spaces.
The requirements in this section shall apply to case­
(6) Wall openings for pipes, ducts, and conduits as
well as joints at structural elements shall be sealed.
2.4-2.3.3.2 Wall protection
(1) Wall, door, and corner protection shall be provided
in areas where movable equipment is present.
(2) Wall protection and corner guards shall be durable
and scrubbable.
(3) Sharp, protruding edges shall be avoided.
(4) Acoustics shall be considered when selecting wall
finishes. See Section 1.2-5.2 (Acoustic Planning)
and Section 1.4-2.1 (Acoustic Design) for
requirements.
2.4-2.3.4 Ceilings
work, millwork, and built-ins that are fixed in a space
or room as well as movable furniture and window
treatments in residential health, care, and support
facilities.
2.4-2.4.2 Casework, Millwork, and Built-Ins
2.4-2.4.2.1 In resident use areas, corners shall be
rounded or eased.
2.4-2.4.2.2 Casework, millwork, and built-ins shall be
in contrasting colors/values to the walls.
2.4-2.4.2.3 Casework hardware shall have a value
contrast to the casework.

2.4-2.3.4.1 Ceiling surfaces shall have a matte or satin 2.4-2.4.3 Furniture

finish to diffuse light and prevent reflected glare.
*2.4-2.4.3.1 Furniture provided in residential health,
*2.4-2.3.4.2 Ceiling surfaces in dietary and laundry care and support facilities in resident, participant,

APPENDIX

A2.4-2.3.~.1 (1) Selection of wall finishes should take into consid­

Furniture seleCted for use in residential health, care, and support
eration adjacent uses, such,as cooking, dishwashing, food preparation,
facilities should have non-abrasive surfaces to minimize risk of resident
and toileting.
injuries, such as abrasions and skin shear.
Anumber of studies have suggested an association between falls
A2.4-2.3.4.2 The face of ceiling tile, drywall, or other substrate, as

and the design of chairs, whether built-in or freestanding.

well as the suspension system and/or exposed support system in these

a. Seating for residents should.be available that supports a variety of

areas, should be moisture-re.sistant.

postures, from upright to reclined.

A2.4-2.4.3.1Furniture $eleetion recommenda­

b. BottomsQfresidents'feet, whether elevated or down, should always
tidn$. Furniture should be selected in accordance with the needs of
be fully supported (by afootrest orthe floor) so as not to~ncourage
the care program and the findings of the resident safety risk assessment
toe drop or compromise blood flow to the legs.
(see Section 1.B). See the most current edition of the ANSI/BIFMA
c. Residents shoyld be able to choose from avariety of chairs of

standards that apply to a health care setting and the Center for Health
different seat heights, depths, and widths according to their own

Design publication Furniture Design Feoturesand Healthcare Outcames.

height, weight, leg length, a,nd physical limitations so they can

execute successful sit-to-stand movements.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 9S
2.4 DESIGN AND CONSTRUCTION REQUIREMENTS
and outpatient areas and community spaces shall be
designed to support resident transfer and weight­
bearing requirements and ambulation to enhance user
independence.
2.4-2.4.3.2 Furniture selected shall have rounded and
eased edges.
2.4-2.4.3.3 Furniture selected shall be upholstered
with impervious materials in locations where infection
control and incontinence are a concern.
2.4-2.4.4 Window Treatments and Privacy
curtains.
Curtains
APPENDIX (continued)
~The car~ population should bE! evalu~tE!d to ilE!termhie appropri,­
.ateseat hE!ights, whichrangE! from 16to 19 inches. (41 to lf8'
centimeters) with arm heights ].to 8inches (18to 20' centime­
tersl aQOVe(OOlpressed seat height attheelbow.
~Arm fronts should extend all the way to Qr pa.stthefrontofthe
seatat a height ap1>Topriate tohelp residents safely sitdown,
and push offto astanding position
-Seats shdyldbe firm, with seat depth and configu.rati6I'kth~t
allow residents, participants, and outpati.ents to exitseating
comfortably and safely without assistance.
-The aogle of the seat ~ndseat back should oot hindE!r risiog nor
caoseshoulder-forward or hip-forward,slumplng'oTsliding out
ofthe seat.
96 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.4-2.4.4.1 Privacy curtains and window treatments
shall comply with NFPA 101.
2.4-2.4.4.2 Window treatments shall be provided in
resident areas to diffuse the daylight and control glare.
2.4-2.4.4.3 Window treatments provided in resident
accommodations shall be designed for operation by
the resident.
2.4-2.4.4.4 Operational requirements and the type
of care provided shall dictate the need for privacy
d. Spacecbeoeath as~at front should allow a user to pull back hisor her
heels far enough under the seat to assist with rising.
e.Furniture shouJdhave eased "Or rounded edges and corners of nO less
than .318 inch radiUS to minimi~e ris~ of resident patient injuries.
f. Furniture usedincresident areas. should be sturdy and stable to safely
support residenttransfer and weight-bearing requirements.
g.Rolling furnitureQr equipment in resident areas should have lo¢king
rollerslcastersfor safE!ty. However, sE!ating that has casters oMnly
two legs'to aUowfor movement on carpeted flooring, surfacesshould
not have locking cilsters.
h. Chairs that provide opportunities to rock without compromising the
ability to exit safely (e.g., with stable arm fronts) should be consid­
ered for their relaxation and exercise'benefits.
 2.4 DESIGN AND CONSTRUCTION REQUIREMENTS

Appendix Table A2.4-a

Resources for Grab Bar Configurations

Accessibility Standards Georgia Tech Study*

(ANSI/ADAAG) Preferred alternative configuration
for one-person, two-person, or
equipment-assisted transfer

Wall Partition Location Behind and adjacent Behind and adjacent, where provided

Grab Bar Dimensions

Centerline of toilet from side wall or 16 to 18 inches (40.64 to 45.72 centimeters) 24 inches (60.96 centimeters) for
permanent fixture independent resident transfer

Side wall partition grab bar length
42 inches (106.68 centimeters) long Not addressed
12 inches (30.48 centimeters) maximum
from rear wall
54 inches (137.16 centimeters) minimum
from rear wall

Rear wall partition grab bar length
36 inches (91.44 centimeters) long Eliminate in favor of installing swing-up
minimum grab bars
12 inches (30.48 centimeters) from
centerline of toilet on one side and 24
inches (60.96 centimeters) on the other
side

Fixed horizontal grab bar height 33 to 36 inches (83.82 to 91.44 centimeters) Not addressed
above finished floor to top of gripping
surface

SWing-up grab bar height Not applicable 31 to 33 inches (78.74 centimeters) above
finished floor to top of gripping service

SWing-up grab bar length Not applicable Extend 6 to 9 inches (15.24 to 22.86
centimeters) in front of toilet

Swing-up grab bar from centerline of toilet Not applicable 13 to 15 inches (33.02 to 38.1 centimeters)

*This data is based on the Mayer-Rothschild Foundation report"Determination of Grab Bar Specifications for Independent and Assisted Transfers
in Residential Care Settings:' A related article on the research was published in the September 2017 issue of the HERD Journal under the title
"Beyond ADA Accessibility Requirements: Meeting Seniors' Needs for Toilet Transfers:'

Guidelines for Design and Construction of Residential Health, Care. and Support Facilities 97
 2.5 Building Systems
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.
• 2.5-1 General
2.5-1.1 Application
This chapter contains elements that are common to
most types of residential health, care, and support
facili ties.
2.5-1.1.1 The elements are required only when
referenced in the facility chapters in Part 3 (Residential
Health Facilities), Part 4 (Residential Care and
Support Facilities), and Part 5 (Non-Residential
Support Facilities).
2.5-1.1.2 Additional specific requirements are located
in the facility chapters in Parts 3, 4, and 5.
2.5-1.2 Building System Design
2.5-1.2.1 Facilities shall have building systems that
are designed and installed in a manner that provides
for the safety, comfort, and well-being of residents,
participants, or outpatients.
2.5-1.2.2 The primary goal in building system design
shall be to support resident, participant, and out­
patient needs and/or operational functions. Energy
consumption and efficiency shall be a secondary goal.
• 2.5-2 Plumbing Systems
2.5-2.1 General
In the absence of local and state plumbing codes, all
plumbing systems shall be designed and installed in
accordance with the International Plumbing Code.
Guidelines for Design and Construction of Residential Health, Care. and Support Facilities
2.5-2.2 Plumbing and Other Piping Systems
2.5-2.2.1 General Piping and Valves
All piping, except control-line tubing, shall be
identified.
2.5-2.2.2 Potable Water Supply Systems
2.5-2.2.2.1 Capacity
(1) Systems shall be designed to supply water at
pressures sufficient to operate all fixtures and
equipment during maximum demand.
(2) Supply capacity for hot- and cold-water piping
shall be determined on the basis of fixture units,
using recognized engineering standards.
2.5-2.2.2.2 Valves. Each water service main, branch
main, riser, and branch to a group of fixtures shall have
valves.
(1) Stop valves shall be provided for each fixture.
(2) Access panels shall be provided at all valves where
required.
(3) Valves shall be tagged, and a valve schedule shall
be provided to the facility owner for permanent
record and reference.
2.5-2.2.2.3 Backflow prevention
(1) Systems shall be protected against cross-connection
in accordance with American Water Works
Association (AWWA) Recommended Practice for
Backfiow Prevention and Cross-Connection Control.
(2) Vacuum breakers or backflow prevention devices
shall be installed on hose bibs and supply nozzles
used to connect hoses or tubing to housekeeping
sinks and, where used, to bedpan-flushing
attachments.
99
2.5 BUILDING SYSTEMS
*2.5-2.2.3 Heated Potable Water Distribution
2.5-2.2.3.3 Elimination of dead-end piping
Systems
(1) Installation of dead-end piping (risers with no flow,
2.5-2.2.3.1 General. Provisions shall be included in
the heated potable water distribution system to limit
the amount of Legionella bacteria and other opportu­
nistic waterborne pathogens.
2.5-2.2.3.2 Recirculation of hot water. Heated
potable water distribution systems serving resident
areas shall be under constant recirculation to provide
continuous hot water at each hot water outlet or to
provide alternative means for maintaining hot water.
(1) Non-recirculated fixture branch piping shall not
exceed 25 feet (7.62 meters) in length.
(2) Alternative means shall be permitted to include the
installation of instantaneous systems or another
type of water heating system at point of use.
APPENDIX
A2.5-2.2.3 Heated potable water distribution
systems
l
a. legionella response. ASHRAf 188: Prevention ofLegionel/osis Associ­
ated with BUilding Water Systems should be used when designing hot
water systems.
b. Design for efficient heatedpotable water distribution. Hot water
distribution systems should be designed to deliver hot or tempered
water in areasonable time. low-flow faucets, longer pipe runouts
between arecirculated main and the fixture, and larger diameter
pipes increase the time it takes toachieve desired temperatures.
Given the water conservation benefits of low-flow faucets, design­
ers should consider reducing the length of uncirculated runouts,
redUcing the pipe size, providing heat tracing for the runout, or using
point-of-use water heaters. Following is agUide that may be used in
designing asystem based on delivery time.
-Design method. Hot and tempered water distribution systems
should be designed using either the maximum pipe length or
maximum pipe volume limits provided in this appendix section
and in appendix table Al.5-a (Maximum length of Hot Water
System Pipe or Tube). For purposes of this discussion, references
to pipe should also apply to tubing and the source of hot or tem­
pered water is considered to be awater heater, boiler, circulation
loop piping, or electrically heat-traced piping.
Maximum allowable pipe length method. The maximum
allowable pipe length from the source of hot or tempered
water to the termination of the fixture supply pipe should
be in accordance with the maximum pipe length columns in
appendix table A2.5-a. Where the length contains piping of
more than one size, the largest pipe size should be used to
determine the maximum allowable pipe length in the table.
Maximum allowable pipe volume method. The maximum
100 Guidelines for Design and Construction of Residential Health, Care, and Support FaCilities
branches with no fixture) shall not be permitted.
(2) In renovation projects, dead-end piping shall be
removed.
(3) Installation of empty risers, mains, and branches
installed for future use shall be permitted.
*2.5-2.2.3.4 Capacity. The water-heating system shall
have supply capacity at the temperatutes and amounts
indicated in Table 2.5-1 (Hot Water Use-Residential
Health, Care, and Support Facilities). Storage of water
at higher temperatures shall be permitted.
*2.5-2.2.3.5 Hand-washing sinks. For hand-washing
sinks, water shall be permitted to be supplied at a
constant temperature between 70° F and 80° F using a
single-pipe supply.
volume of hot or tempered water in hot water distribution
piping should be calculated in accordance with the gUidance
in the paragraph on water volume determination below.
The maximum volume in piping to public hand-washing
sinks, metering or non-metering, should be 2ounces (0.06
l). For fixtures other than those at public hand-washing
sinks, the maximum volume should be 64 ounces (l.89l)
for hot or tempered water from awater heater or boiler and
24 ounces (O.7l) for hot or tempered water from a circula­
tion loop pipe or an electrically heat-traced pipe.
-Water volume determination. The volume should be the sum of
the internal volumes of pipe, fittings, valves, meters, and mani­
folds between the source of the hot water and the termination
ofthe fixture supply pipe. The volume should be determined
from the liquid ounces per foot column of appendix table A2.5­
a. The volume contained in fixture shutoff valves, flexible water
supply connectors to afixture fitting, or afixture fitting should
not be included in the water volume determination. Where hot
or tempered water is supplied by a circulation loop pipe or an
electrically heat-traced pipe, the volume should include the
portion ~f the fitting on the source pipe that supplies water to
the fixture.
-Maximum flow rate. The maximum flow rate of fixtures should
be limited to 0.5 gpm when connected to l/4-inch piping, 1
gpm when connected to 5/16-inch piping, and 1.5 gpm when
connected to 3/8-inch piping.
A2.5-2.2.3.4 Water temperature is measured at the point of use Of
inlet to the equipment.
A2.5-2.2.3.5 One way to limit the potential growth of Legionel/a in
a heated potable water system is to distribute water at atemperature

2.5-2.2.4 Drainage Systems
2.5-2.2.4.1 Piping
(1) Installation of exposed drainage piping or piping
in the ceiling shall be avoided in food preparation
centers, food service facilities, food storage areas,
central services, electronic data processing areas,
electric closets, and other sensitive areas.
(2) Where overhead drainage piping in these areas is
unavoidable, provisions shall be made to protect
the space below from leakage, condensation, and
dust particles.
[*2.5-2.2.4.2 Kitchen grease traps. Where grease traps
are used, they shall be located so they are easily acces­
sible for cleaning.
2.5-2.2.4.3 Sewers. Building sewers shall discharge
into community sewerage. Where such a system is not
available, the facility shall treat its sewage in accor­
dance with local and state regulations.
2.5-2.3 Plumbing Fixtures
2.5-2.3.1 General
The material used for plumbing fixtures shall be non­
absorptive and acid-resistant.
2.5-2.3.2 Hand-Washing Sinks
See Section 2.4-2.2.8 (Hand-Washing Stations) for
(a) Sensor-regulated faucets shall meet user need
requirements for incorporating a sink into a hand­
for temperature and for length of time water
washing station.
flows.
2.5-2.3.2.1 Basin design
(1) Sinks used for hand-washing shall be designed with
basins that reduce splashing.
(2) The nominal open area of the basin shall not
*(4) Anchorage. For hand-washing sinks, allowable
be smaller than 144 square inches (929.03
stresses shall not be exceeded at any point on the
APPENDIX (continued)
lower than 80°F (26.6°Cl for hand-washing use. Water at this tempera­
ture may be warm enough to encourage good hand-washing practice
but cooler than the ideal growth conditions for Legionel/a.
A2.S-2.2.4.2 Kitchen grease traps. An exterior location
with vehicular access is preferred for maintenance.
A2.S-2.3.2.3 Faucets for residents with dementia.
Asingle-lever faucet with mixer is recommended for residents with
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.5 BUILDING SYSTEMS
square centimeters), with a minimum centerline
dimension of 9 inches (58.06 centimeters) in
width or length.
(3) Hand-washing sink basins shall be made of
vitreous china, porcelain, stainless steel, or solid­
surface materials.
2.5-2.3.2.2 Sink basins shall be installed so they fit
tightly against the wall or countertop and are sealed to
prevent leaks.
*2.5-2.3.2.3 Fittings
(1) The water discharge point of a hand-washing
sink faucet shall be at least 8.5 inches (21.59
centimeters) above the bottom of the basin for
resident rooms/bathrooms and 10 inches (25.4
centimeters) above the bottom of the basin for all
other locations.
(2) Hand-washing sinks used by care and nursing staff
and food service staff shall have fittings-including
single-lever or wrist blade devices-that allow for
hands-free operation.
(a) Blade handles used for this purpose shall be at
least 4 inches (10.16 centimeters) in length.
(b) The location and arrangement of fittings shall
provide the clearance required for operation of
blade-type handles.
(3) Sensor-regulated (electronic) faucets
(b) Electronic faucets shall be capable of
functioning during loss of normal power.
(c) Sensor-regulated faucets with manual
temperature control shall be permitted.
dementia to simplify the interface and avoid burns. This type of faucet
should be provided in hand-washing sinks in resident rooms and dwell­
ing units occupied by residents with dementia and in public toilet rooms
accessible to these residents. Sensor-regulated faucets are not recom­
mended for those with dementia because they find them confusing.
A2.S-2.3.2.3(4) Anchorage. See ICC A117.1: Accessible and
Usable Buildings and Facilities for more information.
101
2.5 BUILDING SYSTEMS

sink where a vertical or horizontal force of 250 2.5-2.4 Medical Gas and Vacuum Systems
pounds (1112N) is applied. See Section See the facility chapters in Pans 3 through 5 for
2.4-2.2.8.3 (Anchorage) for hand-washing station requirements.
requirements.

2.5-2.3.3 Showers and Tubs • 2.5-3 Heating, Ventilation, and

Air-Conditioning (HVAC) Systems

2.5-2.3.3.1 General. See the facility chapters in Parts

3 through 5 for requirements in addition to those in
2.5-3.1 General
this section.

2.5-3.1.1 Application
2.5-2.3.3.2 Accessible showers. In resident
bathrooms, bathrooms in dwelling units, and central Basic HVAC system requirements for residential
bathing rooms or areas with accessible showers, the health, care, and support facilities are defined in this
following requirements shall be met: section. See the facility chapters in Parts 3 through 5
for additional requirements.
*(1) A transition between flooring and the shower floor
shall meet accessibility standards.
*2.5-3.1.2 Ventilation and Space Conditioning
*(2) The floor shall slope to the drain.
(3) Fittings and faucets for showers shall be located
2.5-3.1.2.1 All occupied rooms and areas in the facil­
within user reach to allow independent bathing as
ity shall be designed to provide continuous ventilation.
applicable to the level of assistance required by the
resident, participant, or outpatient population.
2.5-3.1.2.2 Although natural ventilation (via operable
windows) shall be permitted, mechanical ventilation
2.5-2.3.4 Reserved
shall be provided for all occupiable rooms and areas in
the facility.
2.5-2.3.5 Clinical Sinks
Clinical sinks shall have an integral trap wherein the 2.5-3.2 Mechanical System Design
upper portion of the water trap provides a visible seal.
2.5-3.2.1 Efficiency
2.5-2.3.6 Portable Hydrotherapy Whirlpools
The mechanical system shall be subject to general
A dedicated sink or drain shall be provided for review for operational efficiency and life cycle cost.
draining portable hydrotherapy whirlpools, or the
hydrotherapy fixture shall be drained into a soiled
utility fixture (e.g., a hopper or flushing-rim sink).

APPENDIX

A2.5-2.3.3.2 (1) Althoughattessibilitystandards allow varying 30~60 percent relative humidity for comfort. In cold or arid climates,
floor heights, this has been fo.und to be potentially detrimentalto inde­ achieving a relative humidity as high as 30 percent may not be practical.
pendent and safe use. Adjacent materials should be evaluated so that The relationships between humidity and resident tomfort and
transitions are level and even. between humidity and resident outcomes (e.g., the influence of h,umid­
ity on resident dehydration, dry skin, skin tears, skin breakdown, respi­
A2.5-2.3.3.2 (2) Different types of drains have been found effec­
ratory conditions) should be evaluated during the mechanical system
tive for this purpose, including trough drains. In addition, provision of
design process.
rubber gaskets at the edge of prefabricated shower units have been
~or more information about humidification in elder care facilities,
found to successfully create a"dam" between the shower and the sur­
see Chapter 25, "Eldercare,"by Lew Harriman, Geoff Brundrett, and Rein­
rounding floor area.
hold Kittler, in tne ASH RAE Humidity Control Design Guide for Commerciat
A2.5-3.1.2 Humidity control.• ANSI/ASHRAE Standard 55: and Institutional Buildings.
Thermal Epvironmental Conditions for Human Occupancy recommends
--------------------
102 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

*2.5-3.2.1.1 Recognized engineering procedures shall
be followed for the most economical and effective
results.
*2.5-3.2.1.2 In no case shall resident comfort or safety
be sacrificed for energy conservation.
*2.5-3.2.1.3 Facility design consideration shall include
site, building mass, orientation, fenestration, and other
features relative to passive and active energy systems.
See the following sections for additional information:
(1) Section 1.2-5.5 (Planning for Sustainability)
(2) Section 1.4-2.2 (Sustainable Design)
(3) Section 2.2-2 (Sustainable Design Criteria)
2.5-3.2.2 Air-Handling Systems with Unitary
See the facility chapters in Parts 3 through 5 for any
Equipment That Serve Only One Room
requirements in addition to those in this section for
See Table 2.5-2 (Maximum Design Criteria for Noise
in Interior Spaces Caused by Building Systems) for
noise considerations.
2.5-3.2.3 System Valves
Supply and return mains and risers for cooling,
heating, and steam systems shall be equipped with
valves to isolate the various sections of each system.
Each piece of equipment shall have valves at the supply
and return ends.
*2.5-3.2.4 Acoustic Considerations for Outdoor
Mechanical Equipment
A2.5-3.2.1.1 Awell-designed system can generally achieve energy
efficiency with minimal additional cost and simultaneously provide
resident comfort.
A2.5-3.2.1.2 See ANSrlASHRAE Standard 55-2010: Thermal Envi­
Jonmental Conditions for Human Occupancy for thermal c(lmfort informa­
tion.
A2.5-3.2.1.3 Centralized air-handling systems should be designed
with an economizer cycle in areas where it is appropriate to use outside
air. See ANSI/ASHRAE/IES Standard 90.1: Energy Standard for Buildings
Except Low·Rise Residential Buildings or ANSI/ASHRAE Standard 90.2:
Energy-Efficient Design ofLow-Rise Residential Buildings for additional
information. Resident needs and/or operational function should be
evaluated as primary concerns and energy consumption and efficiency
as secondary concerns.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.5 BUILDING SYSTEMS
2.5-3.2.4.1 For requirements for outdoor mechani­
cal equipment and noise and vibration mitigation, see
Section 2.5-8.2 (Site Exterior Noise) and Section
2.5-8.7 (Design Criteria for Building Vibration).
2.5-3.2.4.2 Outdoor mechanical equipment shall not
produce sound that exceeds daytime and nighttime
noise limits at neighboring properties as required by
local ordinance.
2.5-3.3 HVAC Requirements for Specific
Locations
2.5-3.3.1 Resident, Participant, Outpatient, and
Related Support Areas
resident, participant, and outpatient areas and their
support areas.
2.5-3.3.2 Fuel-Fired Equipment Rooms
Rooms with fuel-fired equipment shall be provided
with outdoor air to maintain equipment combustion
rates and limit space temperatures.
2.5-3.3.3 Areas of Refuge
Areas of refuge shall be heated or cooled as determined
by the geographic location of the facility or setting.
2.5-3.3.4 Commercial Food Preparation Areas
If a facility requires a food preparation area, the
following requirements shall apply:
It may be practical in some areas that include operable windows
to reduce mechanical ventilation and use open windows for ventilation
during appropriate climatic conditions as long as resident comfort needs
can be met.
A2.5-3.2.4 Acoustic considerations for outdoor
mechanical equipment. Outdoor mechanical equipment
includes cooling towers, rooftop air handlers, exhaust fans, fans located
inside buildings with openings on the outside of the building, and other
equipment. Special acoustic considerations for the building envelope in
residential health, care, or support facility areas near such equipment
may be required to mitigate noise. The effects of mechanical equipment
noise on adjacent properties should also be considered, with attention
to adjacent land uses and jurisdictional noise limits.
103
2.5 BUILDING SYSTEMS

2.5-3.3.4.1 Food preparation areas serving 30 or fewer 2.5-3.4.1.3 NFPA 101: Life Safety Code
residents shall be permitted to comply with require­
ments for kitchens adjacent to open corridors in NFPA 2.5-3.4.2 Thermal Insulation
101: Life Safety Code.
2.5-3.4.2.1 General
2.5-3.3.4.2 Commercial food service kitchens shall (1) Insulation shall be provided in the building to

have ventilation systems with air supply mechanisms conserve energy, protect personnel, and prevent

interfaced with exhaust hood controls or relief vents so vapor condensation.

that exfiltration or infiltration to or from exit corridors
does not compromise the following:
(1) Exit corridot restrictions ofNFPA 90A: Standard
for the Installation ofAir-Conditioning and
Ventilating Systems
(2) Pressure tequirements ofNFPA 96: Standard
for Ventilation Control and Fire Protection of
Commercial Cooking Operations
(3) Requirements for food preparation areas open to
corridors in NFPA 101
(4) Ventilation requirements, including total air
changes per hour to provide makeup air to kitchen
exhaust systems, as specified in ANSI!ASH RAE
Standard 154: Ventilation for Commercial Cooking
Operations
2.5-3.3.4.3 Exhaust hoods handling grease-laden
(2) Existing accessible insulation in identified areas of
work shall be inspected, repaired, and/or replaced
in compliance with current code requirements.
2.5-3.4.2.2 Vapor barrier
(1) Insulation on cold surfaces (e.g., equipment, pipes,
ductwork) shall include an exterior vapor barrier.
(2) A separate vapor barrier shall not be required for
material that will not absorb or transmit moisture.
2.5-3.4.3 Acoustic Insulation
See Section 2.5-8 (Acoustic Design Systems) for
requirements.
2.5-3.5 HVAC Air Distribution

2.5-3.5.1 General
vapors in commercial food service kitchens shall

comply with the following:

See the facility chapters in Parts 3 through 5 for
requirements in addition to those in this section.
(1) NFPA 96
(2) NFPA 101
*2.5-3.5.2 HVAC Ductwork

2.5-3.4 Thermal and Acoustic Insulation

*2.5-3.5.2.1 Duct humidifiers. If humidification is
provided, the following requirements shall be met:
2.5-3.4.1 General

(1) Where duct humidifiers are located upstream of

See the following documents for requirements in

the final filters, the humidifiers shall be placed

addition to the requirements in this section.

at least twice the rated distance for full moisture

absorption upstream of the final filters.

2.5-3.4.1.1 International Energy Conservation Code

(2) Ductwork with duct-mounted humidifiers shall

have a means of water removal.

2.5-3.4.1.2 NFPA 255: Standard Method ofTest of

(3) Humidifiers shall be connected to airflow proving

Surface Burning Characteristics ofBuilding Materials

switches that prevent humidification unless the

APPEND-!X_

A2.S-3.S.2 HVAC ductwork. HVAC zones should be coordi­

Additional booster humidification (if required) should be prOVided by

nated with smoke compartments insofar as practical to minimize the

steam-jacketed humidifiers for each indiVidually controlled area. Steam

need to penetrate fire and smoke barriers.

to be used for humidification may b~ generated in aseparate steam

generator. The steam generator feedwatermay be supplied either from

A2.S-3.S.2.1 Duct humidifiers. One way to achieve basic

soft or reverse osmosis water. Provisions should be made for periodic

humidification may be by asteam-jacketed manifold-type humidi­

cleaning.

fier with acondensate separator that delivers high-quality steam.

104 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.5 BUILDING SYSTEMS

required volume of airflow is present or high-limit 2.5-4.1.1 Applicable Standards

humidistats are provided.
(4) All duct takeoffs shall be sufficiently downstream
of the humidifier to ensure complete moisture
absorption.
(5) Steam humidifiers shall be used. Use of reservoir­
type water spray or evaporative pan humidifiers
shall not be permitted.
2.5-3.5.3 Exhaust Systems
All electrical material and equipment, including
conductors, controls, and signaling devices, shall
be installed in accordance with NFPA 70: National
Electrical Code.
2.5-4.1.2 Testing and Documentation
All electrical installations and systems shall be tested to
verifY that equipment has been installed and operates
as designed.

2.5-3.5.3.1 To enhance the efficiency of recovery

2.5-4.2 Power-Generating and Power-Storing
devices required for energy conservation, combined
Equipment
exhaust systems shall be permitted.
See the facility chapters in Parts 3 through 5 for
2.5-3.5.3.2 Fans serving exhaust systems shall be requirements.
located at the discharge end and shall be readily
serviceable. 2.5-4.3 Electrical Receptacles

*2.5-4.3.1 General
2.5-3.6 HVAC Filters
Convenience duplex outlets shall be provided as
See the facility chapters in Parts 3 through 5 for
follows:
requirements.

2.5-4.3.2 Receptacles in Corridors

2.5-3.7 Heating Systems, Cooling Systems, and
Equipment Duplex-grounded receptacles for general use shall be

installed a maximum of 50 feet (15.24 meters) apart

2.5-3.7.1 General in all corridors and within 25 feet (7.62 meters) of

corridor ends.

See the facility chapters in Parts 3 through 5 for

requirements in addition to those in this section.
2.5-4.3.3 Receptacles in Resident Rooms and
Dwelling Units
*2.5-3.7.2 Temperature Control
See the facility chapters in Parts 3 and 4 for
2.5-3.7.2.1 Rooms containing heat-producing
requirements.
equipment. These rooms, such as laundries or

computer rooms, shall be mechanically or naturally

2.5-4.3.4 Essential Electrical System Receptacles
ventilated.

2.5-4.3.4.1 Where an essential electrical system is

provided, electrical receptacle cover plates or electri­

• 2.5-4 Electrical Systems cal receptacles supplied from the essential electrical

system shall be distinctively colored or marked for

2.5-4.1 General identification.

APPENDIX

A2.5-3.7.2Individual temperature controls should be prOVided for

residents to charge resident-operated mobility devices should be placed

resident sleeping rooms.

at aheight above the finished floor easy for residents to access.

A2.5-4.3.1 Height and location for receptacles should be evalu­

ated based on the population being served. Receptacles available for

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 105
2.5 BUILDING SYSTEMS

2.5-4.3.4.2 If color is used for identification purposes, system shall be provided for each ventilator­
the same color shall be used throughout the facility. dependent resident room.

2.5-4.3.5 Ground-Fault Interrupter Receptacles

Ground-fault interrupters shall comply with NFPA 70:
• 2.5-5 Communications Systems
National Electrical Code.
*2.5-5.1 General
2.5-4.4 Electrical Requirements for Ventilator­
2.5-5.1.1 Application
Dependent Resident Rooms and Areas
Requirements for call systems, information systems,
2.5-4.4.1 Where ventilators are used in a residential and telecommunication systems shall be based on
health, care, or support facility or setting, battery the care population and provided in accordance
backup and/or other essential electrical system backup with requirements in the facility chapters in Parts 3
shall be provided. through 5.

2.5-4.4.2 Where ventilators are used in a facility or 2.5-5.1.2 Communications System Equipment
setting that has essential electrical power, the following Requirements
requirements shall be met:
2.5-5.1.2.1 A central location and/or decentralized
2.5-4.4.2.1 Dedicated circuit(s). This paragraph location(s) for communications systems equipment
shall apply to both new and existing facilities serving shall be provided based on the care model.
ventilator-dependent residents.
2.5-5.1.2.2 Communications system equipment
(1) A minimum of one dedicated essential electrical
locations shall be permitted ro house both commu­
system circuit per bed for ventilator-dependent
nications system equipment and electronic safety and
residents shall be provided in addition to the
security equipment. See Section 2.5-6.2.2 (Locations
normal system receptacles at each bed location
for Safety and Security Equipment).
required by NFPA 70. This circuit shall be
provided with a minimum of two duplex
2.5-5.1.2.3 Locations for terminating telecommunica­
receptacles identified for emergency use.
tion and information system devices shall be provided
(2) Additional essential electrical system circuits and
unless wireless systems are used.
receptacles shall be provided where the electrical
life support needs of the resident exceed the
2.5-5.2 Call System
minimum requirements stated in this paragraph.
See the facility chapters in Parts 3 through 5 for
2.5-4.4.2.2 Essential electrical system connections requirements.

(1) Heating equipment provided for ventilator­

2.5-5.3 Technology Equipment and Teledata
dependent resident rooms shall be connected to
Room(s)
the essential electrical system.
(2) Task lighting connected to the essential electrical
2.5-5.3.1 General

*2.5-5.3.1.1 Purpose
APPENDIX

A2.S-S.1 Audiovisual technology A2.S-S.3.1.1 Technology equipment room. This room

a. Where resident monitoring via camera is provided, family members is the core ofthe information anatechnology system and ofthe com­

should be able to tum off power for.personal privacy. munications system for aresidential health, care, or support facility. The

b. Provision of an in-room computer or integration of the audiovisual room should be environmentatly cMtrolled, have a power-conditioned

system with a television screen should be considered to ,illow electricaL supply, and be fire-protected. It must be alocked space with

remote resident/family interaction. limitedaccess.

106 Guidelines for Design and Construction of Residential Health, Care. and Support Facilities
 2.5 BUILDING SYSTEMS

(1) The technology equipment room shall house the
main networking equipment, servers, and data
storage devices that serve the building.
(2) Telephone equipment shall be permitted to be
included in the main technology equipment room.
2.5-5.3.3.3 The technology equipment room shall
be located a minimum of 12 feet (3.66 meters) from
any transformer, motors, induction heaters, radio and
radar systems, and other sources of electromagnetic
interference.

2.5-5.3.1.2 Number. Each residential health, care, or
support facility shall have at least one main technol­
ogy equipment room and additional teledata rooms or
closets as necessary to accommodate the systems used
in the facility or setting.
*2.5-5.3.2 Size
2.5-5.3.2.1 The technology equipment room shall be
sized to accommodate the number of racks needed for
anticipated servers, networking, and storage.
2.5-5.3.2.2 The technology equipment room shall
be sized to provide clearances to meet service require­
ments for the equipment that will be housed there.
*2.5-5.3.3 Location and Access
2.5-5.3.3.1 The technology equipment room shall
be located above any floodplains and, in multi-story
buildings, below the top level of the facility to deter
water damage to the equipment from outside sources
(e.g., leaks from the roof or flood damage).
2.5-5.3.3.2 In areas prone to hurricanes or tornados,
the technology equipment room shall be located away
from exterior curtain walls to prevent wind and water
damage.
2.5-5.3.4 Technology Equipment Room Facilities
2.5-5.3.4.1 Mechanical and electrical equipment or
fixtures that are not directly related to the support of
the technology equipment room shall not be installed
in, pass through, or enter the room.
2.5-5.3.4.2 All computer and networking equipment
shall be served by uninterruptible power supply.
2.5-5.3.4.3 All circuits serving the equipment in the
technology equipment room shall be dedicated to serv­
ing the technology equipment room only.
2.5-5.3.4.4 Cooling and heating shall be provided for
technology equipment and data room(s).
(1) Cooling systems serving the technology equipment
room shall be supplied by the essential electrical
system.
(2) Temperature control systems in technology
equipment room(s) shall be designed to maintain
environmental conditions recommended in
ASHRAE's Thermal Guidelines for Data Processing
Environments or the requirements for the specific
equipment installed.
2.5-5.4 Grounding for Telecommunication
Spaces

APPENDIX

A2.S-S.3.2 Technology equipment room size. The

A2.S-S.3.3 Technology equipment room lo<:ation
actual size requirements for atechnology equipment and teledata ropm
and access
should be clearly defined. Agrowth factor appropriate to the needs of
a. The technology equipment room should be located or designed to
the facility as recommended by industry organizations such as Building
avoid vibration from mechanical equipment or other sources.
Industry Consulting Services International or the Telecommunications
b. Technology equipment room location and access should allow for
Industry Association should be factored into the size of the room.
expansion in at least one direction. locations that are re>tricted by
building components that limit future expansion (e.g., elevators,
bUilding structural elements, kitchens, central energy plants, outside
walls, other fixed building walls) should be avoided.
c. Accessibility should be provided for the delivery of supplies and
equipment to the space.
- - - - - - - - - - - - - ---_._-----_._-------­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 107
2.5 BUILDING SYSTEMS

2.5-5.4.1 General
*2.5-6.2.1 General
Access control technology shall be used to help provide
Grounding, bonding, and electrical protection shall

meet the requirements ofNFPA 70 and TIA 607:

a safe environment for residents, visitors, and staff See
Commercial Building Grounding (Earthing) and Bond­
Section 1.2-3.7 (Security Risk Assessment) for infor­
ing Requirements for Telecommunications. mation on using the safety risk assessment to identifY
locations where access control is needed.
2.5-5.4.2 Telecommunications Grounding Bus Bar
2.5-6.2.2 Locations for Safety and Security

2.5-5.4.2.1 The telecommunications grounding bus Equipment

(TGB) bar shall be drilled with holes according to

National Electrical Manufacturing Association stan­ 2.5-6.2.2.1 Central location
dards to accommodate bolted compression fittings. (1) A central location for safety and security

equipment shall be provided.

2.5-5.4.2.2 All racks, cabinets, sections of cable tray, (2) Safety and security equipment shall be

and metal components of the technology system that permitted to be located with teledata

do not carry electrical current shall be grounded to this communications equipment. See Section 2.5­

bus bar. 5.1.2 (Communications System Equipment

Requirements) for additional requirements.
2.5-5.4.2.3 TGB bars shall be connected by a back­
bone of insulated, #6 (minimum) to 3/0 AWG 2.5-6.2.2.2 Locations for terminating safety and secu­
stranded copper cable between all technology rooms. rity system devices shall be provided.

2.5-5.5 Cabling Pathways and Raceway 2.5-6.3 Fire Alarm System

Requirements

Fire alarm and detection systems shall be provided

Pathways and raceways distributing cabling between

in compliance with NFPA 101: Life Safety Code and

teledata rooms shall be enclosed in conduit for protec­

NFPA 72: National Fire Alarm and Signaling Code.

tion from damage.

• 2.5-7 Daylighting and Artificial

• 2.5-6 Electronic Safety and Security Lighting Systems

Systems
2.5-7.1 General
2.5-6.1 General
Evaluation of the type of safety and security systems 2.5-7.1.1 Application
shall be completed and implemented based on the care Parking lots, approaches to buildings, and all occupied
population being served and the demographics of the spaces in buildings shall be wired and provided with
project location. lighting equipment.

2.5-6.2 Safety and Security System Equipment *2.5-7.1.2 Lighting Design

APPENDIX

A2.S-6.2.1 Safety' and security system equipment. A2.S-7.1.2 Lighting design

Consider use of security cameras, remote lock access, intercoms, ade e a. Additional lighting quality issues to consider include the following:

quate lighting, security alarms, and other types ofsecurity equipment -Color rendering properties should be addressed in lamp selec­

to provide asafe environment. In particular, use of camera monitoring tion.

equipment in centralized medication preparation areas and in corridors -Finish selection should address light reflectance values in con­
to/from the outside should be considered based on the care population. junction with lamp selection.

108 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.5 BUILDING SYSTEMS

2.5-7.1.2.1 Lighting shall be designed to meet the
needs of occupants in specific spaces. See Section 1.2­
5.1 (Lighting Planning) for requirements.
2.5-7.1.2.2 Unless alternative lighting levels are justi­
fied by the functional program, minimum maintained
illuminance recommendations in ANSIIIES RP-28:
Lighting and the Visual EnvironmentfOr Seniors and the
Low Vision Population shall be used as the minimum
required ambient and task lighting levels in all rooms,
spaces, and exterior walkways.
2.5-7.1.2.3 Means shall be provided for controlling
light levels to suit space use and availability of daylight.
*2.5-7.2 Daylighting Systems in Resident Living,
Participant, and Outpatient Areas
*2.5-7.2.1 Dining, recreation/lounge, and activity areas
!for daytime use shall have glazing for daylight and
views to the outdoors.
*2.5-7.2.2 Translucent shades, sheers, blinds, or
other window treatments shall be provided to control
brightness and reduce glare.
2.5-7.3 Artificial Lighting Systems
*2.5-7.3.1 Light Fixtures

Light fixtures in wet areas (e.g., kitchens, showers)

2.5-7.1.2.4 Glare from all light sources shall be shall be vapor resistant and have cleanable, shatter­

minimized. resistant lenses and no exposed lamps.

(1) Daylight shall be controlled and diffused to

minimize glare.
*2.5-7.3.2 Lighting Requirements for Specific

*(2) Artificial lighting sources shall be indirect, Locations

concealed, or diffused to minimize glare. See chapters in Parts 3 through 5 for requirements.

2.5-7.1.2.51he combination of connected lighting

equipment shall not produce flickering from ballast/ • 2.5-8 Acoustic Design Systems
drivers/dimmers and light sources.

APPENDIX (continued)

b. Other lighting design practices developed bythe Illuminating

b. In spaces where windows cannot proVide higher light levels and/or
Engineering Society (IES) and described in ANSI/IES RP-28: Lighting
where skylights are not practical, consider providing faux skylights
and the Visual Environment for Seniors and the Low Vision Population
with artificial light sources.
should be considered.
A2.5-7.2.1 Light shelves, diffused skylights, and other daylighting
A2.5-7.1.2.4 (2) Avoiding glare from artificial techniques may be used to balance the daylight inil space.
lighting. Lighting that creates glare because the bright light source
A2.5-7.2.2 Glare or brightness from windows can reduce visual
is visible should be avoided since glare is detrimental to visual acuity.
acuity or even disorient elders. Where windows are placed at the ends
Indirect lighting is most effective in residential care and support facili­
of corridors, the brightness of daylight and glare should be mitigated
ties since the light source is entirely hidden from view. See appendix
through bUilding orientation or adjustable window coverings. Windows
section A2.5-7.3.2 (Lighting in transition spaces) for additional infor­
and shades that can be controlled by occupants and daylight-enhancing
mation.
features such as atriums improve satisfaction, mood, and task perfor­
A2.5-7.2 Daylig hting. Because residents benefit from the mance.
higher light levels and color associated with daylight, daylighting should
A2.5-7.3.1 Light fixtures. Care should be taken to avoid injury
be provided in resident living areas. The follOWing are recommended:
from light fixtures. Light sources that may burn residents, participants,
a. Windows and skylights should be used to minimize the need for

or outpatients or ignite window coverings, clothing, orother flammable

artificial light and to allow residents, participants, and outpatients

items by direct contact s.hould be covered or protected.

to experience the natural daylight cycle. High levels of light are

required to entrain circadian rhythms and boost serotonin levels,

A2.S-7.3.2 Lighting in transition spaces
redUcing depression, the need for pain medication, and morbid­ a. Substantial differences in lighting levels between exterior and inte­
ity. While natural light is the best source for balancing circadian
rior spaces at transition points (e.g., from exterior parking lots and
rhythms, artificial light can be used to stimulate the circadian system
bUilding entrances to lobbies and corridors) should be aVOided.
when natural light cannot be provided.
b. The pupil ofthe eye becomes smaller and less elastic as the eye

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 109
2.5 BUILDING SYSTEMS
2.5-8.1 General
See Section 1.2-5.2 (Acoustic Planning) for planning
requirements.
*2.5-8.2 Site Exterior Noise
*2.5-8.2.1 Existing Exterior Noise Sources
Planning and design of new facilities and retrofitting
of existing facilities shall include due consideration of
all existing exterior noise sources that may be transmit­
ted from outside a building to its interior through the
exterior shell (exterior walls, windows, doors, roofs,
ventilation openings, other shell penetrations).
APPENDIX (continued)
ages,slowing visual adaptation from brighter to darker spaces. In
daytime, indoor light levels at entry points need to be high, while at
night higher exterior light levels are needed to minimize differences
between indoor and outdoor light levels.
c. Upon entering aspace with aconsiderllbly lower light level, older
adults may need to stop or move to oile side of the walkway until
their eyes adapt to the change in light level. therefore, seating area~
should be placed in lobbies or conidors where residents may Wllit for
their eYes to adjust.
A2.5-8.2 Site exterior noise. The requirements in this section
provide a means for screening sites to determine which exterior walll
window assemblies are suitable to address site noise. They are not
intended to be used as a means to qualify the suitability of asite with
respect to environmental noise exposure.
Examples of noise sources that should be controlled include the
facility's power plant, HVAC equipment, and emergency generators.
Examples of noise sources afacility cannot control include highways, rail
lines, airports, and general urban, industrial, and public service equip­
ment and activities.
A2.5-8.2.1 Future exterior noise sources. Residential
health, care, and support facility design should consider potential future
noise·source development in the vicinity of the project, such as the COil­
struction of highways, airports, or rail lines.
A2.5-8.2.2 Facility noise source emissions. Sound
from exterior facility equipment can be controlled to achieve acceptable
sound levels inside facility spaces and at neighboring receptors by siting
noise sources and receptors to take advantage of distance, orientation,
and shielding. Sound from exterior facility equipment can also be c'On­
trolled qy selecting quiet equipment aild making use of noise control
equipment such as silencers and barriers.
110 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
*2.5-8.2.2 Facility Noise Source Emissions
Planning and design shall include consideration of
sound emissions from facility noise sources that reach
nearby residences and other sensitive receptors.
*2.5-8.2.3 Exterior Noise Classifications
2.5-8.2.3.1 Exterior noise classifications shall be used
to identifY the degree of sound attenuation required in
the building facade due to the sources of exterior noise,
including sources being added by the facility. Exterior
site noise exposure categories shall be as identified in
Table 2.5-3 (Categorization of Residential Health,
Care, and Support Facility Sites by Exterior Ambient
Sound with Design Criteria for Sound Isolation of
Exterior Shell in New Construction).
A2.5-8.2.3 Exterior noise classifications. The facility
site should be classified into one of the noise exposure categories in
Table 2.5-3 (Categorization of Residential Health, Care, and Support
Facility Site by Exterior Ambient Sound with Design Criteria for Sound
Isolation of Exterior Shell in New Construction) by means of exterior
site observations OJ asound-level monitoring survey and knowledge
of confirmed new noise sources to be included in the design of th.e
facility. Further information for classifying sites according to exterior
noise can be found in appendix table A2.5-b (Approximate Distance of
-Noise Sources for Use in Categorization of Residential Health, Care, and
Support Facility Sites by Exterior Ambient Sound).
a. The sound levels for noise exposure categories Athrough Dprovided
in Table 2.5-3 and appendix table A2.5-b should be used to evalu­
ate required building envelope sound isolation and may differ from
other such categorizations of community noise made elsewhere in
this document.
Category A---'Minimal environmental sound. As typified by a rural
or quiet suburban neighborhood with ambient sound suitable
for single-family residences, sound produced by transportation
(e.g., highways, aircraft, trains) or industrial activity may occa­
sionally be audible but is only a minor feature of the acoustic
environment.
Category B-Moderate environmental sound. As typified by a busy
suburban 'heighborhood with ambient sound suitable for mul­
tifamily residences, sound. produced by transportation or indus­
trial activity is clearly audible and may at times dominate the
environment but is not loud enough to interfere with normal
conversation outdoors.
Clltegory C-Significant environmentlll sound. As typified by a
commercial urban location, pt;lssibly with some large apartment
bUildings, sound produced by transportation or industrial activ­
ity dominates the environment and often interferes with normal
conversation outdoors.

2.5-8.2.3.2 The building fayade's sound isolation
performance shall depend on the site classification and
shall comply with minimum exterior shell composite
sound transmission ratings, either OITCc or STCc, as
shown in Table 2.5-3 (Categorization of Residential
Health, Care, and Support Facility Sites by Exterior
Ambient Sound with Design Criteria for Exterior Shell
in New Construction).
A P PEN 0 J X (c 0 n ti lUI e d)
Category D-Extreme environmental sound. As typified by acom­
mercial urban location immediately adjacent to transportation
or industrial activities, sound nearly always interferes with
normal conversation outdoors.
b. Environmental noise on Category B, C, and Dsites generally may be
evaluated using the methods given for documenting site ambient
sound levels using continuous sound monitoring over a minimum
one-week period in ANSI/ASA 512.9: Quantities and Procedures for
Description andMeasurement ofEnvironmentalSound, Part 2: "Mea­
surement of Long-Term, Wide-Area Sound:'This information should
be used to determine detailed environmental noise control require­
ments for building design. Sites where ambient sound is influenced
by airport operations may require additional monitoring as sug­
gested in the ANSI standard to account for weather-related varia­
tions in aircraft sound exposure on site. In lieu of performing such
additional monitoring, aircraft sound level contours available from
the airport, if available, should be used to determine the day-night
average sound level on site produced by nearby aircraft operations.
Sound-level monitoring on-site still will be needed to determine
sound levels produced by other sources.
c. Table 2.5-3 (Categorization of Residential Health, Care, and Sup­
port Facility Site by Exterior Ambient Sound with Design Criteria for
Sound Isolation of Exterior Shell in New Construction) and appendix
table A2.5-b (Approximate Distance of Noise Sources for Use in
Categorization of Residential Health, Care, and Support Facility Sites
by Exterior Ambient Sound) present general descriptions for exterior
sound exposure categories Athrough D, including distance from
major transportation noise sources, ambient sound levels produced
by other sound sources, and corresponding design goals for the
sound isolation performance of the exterior building shell.
The outdoor sound levels, expressed as A-weighted day-night
average sound levels, are proVided in the context of exterior build­
ing shell design. Outdoor resident areas may require lower sound
levels, typically not exceeding aday-night average level of 50 dB.
To achieve this may require accommodations such as exterior noise
barriers or location of outdoor areas where the building structures
prOVide shielding from noise sources.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.5 BUILDING SYSTEMS
{ *2.5-8.3 Design Criteria for Acoustic Finishes
Facility spaces identified in Table 2.5-4 (Minimum
Design Room Sound Absorption Coefficients) shall
incorporate permanent acoustic finishes that achieve
design room-average sound absorption coefficients.
*2.5-8.4 Design Criteria for Room Noise Levels
d. The requirements in Table 2.5-3 will result, in most (ases, in interior
sound levels due to exterior sound of day-night average sound level
(I.dn) 45 dBA. Actual results will vary depending on how well the
sound-blocking ability of the shell at various frequencies matches
the sound spectrum ofthe outdoor sound and other factors. such as
area of the exposed fa~ade and absorption in the room.
Some rooms require lower sound levels, such as assembly
spaces, resident bedrooms, clinical spaces, quiet rooms, and similar
noise-sensitive rooms. These room types should be evaluated care­
fully to reduce the contribution of outdoor noises transmitted inside
while also considering the noise levels from the bUilding systems
(see Table 2.5-2: Maximum Design Criteria for Noise in Interior
Spaces Caused by Building Systems). Assemblies meeting the mini­
mum OITCc requirement typically will provide lower interior noise
levels when the outdoor sound is dominated by sources with strong
low-frequency sound (e.g., locomotives or slow-moving heavy
trucks). Assemblies meeting the minimum STCc requirement typi­
cally provide lower interior noise levels when strong low-frequency
sound is not present.
More detailed evaluation should be considered to identify which
sound isolation rating (OITCe or STCc) is preferred to meet the exterior
shell acoustic requirements and potentially provide a more cost­
effective design.
A2.S-8.3 Design criteria for acoustic finishes
a. Reduction of commercial kitchen noise propagation into dining
rooms is important for improved occupant speech communication
and resident comfort in the dining area. If the local code allow~,
consider installing sound-absorbing ceilings made for food service
areas in the kitchen to reduce some of the noise.
b. For large resident dining rooms (occupancy greater than 501,
research and experience has shown that use of carpeting, table sizes
of six or smaller, and provision ofat least 20 square feet of NRC 0.80
or equivalent acoustic absorption per person at full occupancy yield
a preferred environment for resident comfort and ease of speech
communication. For rooms with high ceilings, the walls above 9feet
should receive acoustic finishes.
111
2.5 BUILDING SYSTEMS
[ *2.5-8.4.1 Room noise levels caused by HVAC and
other building systems shall not exceed the maximum
values shown in Table 2.5-2 (Maximum Design
Criteria for Noise in Interior Spaces Caused by
Building Systems).
2.5-8.4.2 Room noise levels shall be determined for
unoccupied rooms (e.g., without operating medical
equipment).
2.5-8.5 Design Criteria for Performance of Inte­
rior Wall and Floor/Ceiling Constructions
APPENDIX
A2.S-8.4.1 Design criteria for room noise levels
a.For circumstances in which hearin~-impaired populations may
have difficulty hearing or communicating, consider designing the
maximum background sound level at least 5points/dBA lower than
values shown in Table 2.5-2 (Maximum Design Criteria for Noise in
Interior Spaces Caused by Building Systems). Historically, background
sound level recommendations have been formulated for populations
with normal hearing. Research indicates that hearing-impaired
populations have trouble hearing and understanding in noisy envi­
ronments, which can lead to decreased socialization and increased
isolation ofthe resident.
b. Kitchen eqUipment can add tothe background sound level in the
dining space for open kitchen designs, cafeteria-style designs, drink
stations, and serving areas in the dining space. Use quiet kitchen
equipment and/or sound-isolat~the kitchen from the dining loom.
For example, serving equipment such as buffet and salad bars may
be purchased as quiet equipment or have sound-blocking enclosures
compatible with equipment operation and warranties; drink sta­
tions used by staff may be located behind full-height partitions; and
resident-accessible drink stations may use partial sound enclosures
designed for noise reduction.
A2.S..S.S.2 Demising Wall ~ssemblies
a. A"demising wall assembly" is awall assembly that separates one
occupied space from another occupied space or from acorridor.
Partitions in an occupied space are non-demising partitions. For
example, the wall between two resident rooms is demising, but
the partition in a resident room that encloses the bathroom for that
room is non-demising.
b. Appropriate steps should be taken to ass!Jre the composite STC
performance of d'emisingwall assemblies as stated In.Table 2.5-5
(Design Criteria for Minimum Sound Isolation Performance Between
Enclosed Rooms) is achieved after consideration of perimeter leaks
due to lack of sealing, flanking due to continuous surfaces extending
from one room to the other, sound passing through a plenum above
awall, or penetrations in the wall or ceiling. Particular attention
112 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
2.5-8.5.1 Sound isolation shall be considered for all
occupied spaces adjacent to construction activities.
*2.5-8.5.2 The composite sound transmission class
(STC) rating of demising wall assemblies shall not be
less than the ratings indicated in Table 2.5-5 (Design
Criteria for Minimum Sound Isolation Performance
Between Enclosed Rooms).
*2.5-8.6 Design Guidelines for Speech Privacy
Designated spaces in which protected health informa­
tion is conveyed shall be designed to meet speech pri­
vacy goals using one of the four speech privacy rating
should be given to intersection and sealing details of demising wall
t assemblies.
A2.S-S.6 Speech privacy. Federal legislation requires that
facilities protect resident, participant, and patient information privacy.
This includes speech privacy in all residential health, care, or support
facilities wherever resident, participant, or patient heillthinformation is
distussed, whether between staff, on the telephone, or during dictatio(l.
a. Methods for determining speech privacy. Selett only one ofthe met­
rics in Table 2.% (Design Criteria for Speech. Privacy for Enclosed
Rooms and Open-Plan Spaces) for determining speech privacy in
c1osed- and open-plan settings. Examples of closed-plan settings
are staff private offices, conference rooms, examination rooms, and
single-resident rooms. Examples of open-plan settings are waiting
are,as, reception areas, and staff open (not fully enclosed) offices.
All four metrics in Table 2.5-6 define speech privacy in terms of
the intelligibility of speech from the transmitted speech signal com­
pared to the continuous background sound at a receptor position.
The chQice and use ofthe selected metric should be made by quali­
fied, eXPerienced professionals.
-Criteria for the AI (Articulation Index) metric are defined in
ASTM El130: Standard Test Method for ObjediveMeasurement of
Speech Privacy in Open Plan Spaces Using Articulation Index.
-Criteriil for the SII (Speech Intelligibility Index·) metric are
defined in ANSI/ASA S3.5: MethodS for Calcufatiqn qrthe Speech
Intelligibility Index.
-Criteria for the SPC (Speech Privacy Class) metric are defined in
ASTM E2638: Standard Test Method for Objedive Measurement
ofthe Speech Privacy Provided by aClosed Room and "ASTM Met­
rics for Rating Speech Privacy of Closed Rooms and Open Plan
Spaces;' an atticle from the September 2011 edition of Canadian
Acoustics, the journal of the Canadian Atoustical Association.
~(riteria for the· PI (Privacy Index) metric for converting AI values
into percentages are defined in ASTM El130: Standard Test
Method for Objective Measurement ofSpeech Privacy if! Open Plan
Spaces Using Articulation Index.
 2.5 BUILDING SYSTEMS

methods as shown in Table 2.5-6 (Design Criteria for
Speech Privacy for Enclosed Rooms and Open-Plan
Spaces).
*2.5-8.7 Design Criteria for Building Vibration
2.5-8.7.1 General
Seismic restraint covered elsewhere in the Guidelines
shall be compatible with vibration isolation methods
covered in this section.
2.5-8.7.2 Vibration Control and Isolation
Vibration levels in the building shall not exceed appli­
cable guidelines and limits outlined in this section.
dwelling unit and a public or service area above it
shall be considered in the design.
(2) Where medical or laboratory instrumentation
is used in a residential health, care, or support
setting, more stringent vibration criteria shall be
considered.
2.5-8.7.2.3 Structure-borne sound
(1) Structure-borne transmitted sound shall not exceed
the limits for airborne sound presented in Section
2.5-8.4 (Design Criteria for Room Noise Levels).
(2) Where necessary, vibration isolators shall be used
to control potential sources of structure-borne
sound.

2.5-8.7.2.1 Mechanical, electrical, and plumbing 2.5-8.7.2.4 Ground-borne vibration. Exterior

equipment vibration sources of ground vibration, such as road and rail
traffic, shall be considered in the site selection and
(1) All fixed building equipment that rotates or
design of a facility. See Chapter 1.3 (Site Selection) for
vibrates shall be considered for vibration isolation.
additional requirements.
(2) Equipment bases, isolators, and isolator static
deflections shall be selected based on the proximity
of the supported equipment to vibration and noise • 2.5-9 Elevator Systems
sensitive areas, structural design of the facility,
and type and operating point. The types of bases, 2.5-9.1 General
isolators and isolator static deflections chosen shall
See the facility chapters in Parts 3 through 5 for
consider the recommendations in the ASHRAE
requirements.
Handbook-HVAC Applications. More stringent
requirements shall be considered for equipment
2.5-9.2 Dimensions and Clearances
impacting sensitive areas.
See the facility chapters in Parts 3 through 5 for
2.5-8.7.2.2 Structural vibration requirements.
*(1) Impact insulation class ratings of floor-ceiling
2.5-9.3 Leveling Device
assemblies between dwelling units or between a
Elevators shall be equipped with an automatic two-way
APPENDIX (continued)

b. Speech privacy in open-plan spaces. People working in open-plan equipment; footfalls, and medical equipmenf should be considered
spaces are most productive when distraction from voices, equip­ in facility design.
ment, etc. is minimal. Therefore, the acoustic environment should
A2.S-8.7.2.2 (1) Floor-ceiling assemblies between dwelling units
be designed to minimize such distractions. One option for achieving
or between adwelling unit and apublic or service area above it should
speech privacy in open-plan spaces is prOVision ofa private room
meet one of the follOWing impact insulation class ratings:
where confidential conversations may take place.
a. Not less than 50 when using assemblies tested in accordance with
A2.S-8.7 Building vibration ASTM E49l: Standard Test Method for Laboratory Measurement of
a. Building vibration refers to vibration produced by building equip­
Impact Sound Transmission Through Floor-Ceiling Assemblies Using the
ment and activities, not vibration produced by earthquakes.
Tapping Machine
b. Vibration levels to which occupants are exposed should not exceed
b. Not less than 45 when tested after construction in accordance with
those in ANSIIASA S2.71: Guide to the Evaluation ofHuman Exposure
ASTM E1 007: Standard Test Method for Field Measurement of Tapping
to Vibration in Buildings.
Machine Impact Sound Transmission Through Floor-Ceiling Assemblies
c. Vibration produced by building mechanical, plumbing, and electrical and Associated SupportStructures

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 113
2.5 BUILDING SYSTEMS

leveling device with an accuracy of ±J.A inch (± 6.35

existing buildings. (See ASCE/SEI 7: Minimum Design
millimeters) .
Loads for Buildings and Other Structures for seismic
design and control system requirements for elevators.)
2.5-9.4 Installation and Testing
Installation and testing of elevators shall comply with 2.5-9.5 Handrails
ANSIIASME A17.l: Safety Code for Elevators and Esca­ See the facility chapters in Parts 3 through 5 for
lators for new construction and ANSIIASME 17.3 for requirements.

Appendix Table A2.5-a

Maximum Length of Hot Water System Pipe or Tube

Maximum Pipe or Tube Length (ft.)

Nominal Pipe Size Liquid Ounces per Public Hand-Washing

System without System with Circulation
(in.) Foot of Length Station Faucets
Circulation Loop or Loop or Heat Traced
(metering and non-
Heat Traced Line Line
metering)

l/.I 0.33 25 16 6

Sli6 0.5 25 16 4

% 0.75 25 16 3

V2 1.5 25 16 2

% 2 25 12

% 3 21 8 0.5

1'8 4 16 6 0.5

5 13 5 0.5
1v.. 8 8 3 0.5

Table 2.5-1
Hot Water Use-Residential Health, Care, and Support Facilities

Resident Care Areas Food Service Facilities Laundry Facilities

Liters per hour per bed1 11.9 7.2 7.6

Gallons per hour per bed1 3 2 2
Temperature (0 C) 21 - <43 2
60 3 60'
Temperature (0 F) 70 ­ <120 2 140 (min,J3 140 (min.)'

'Quantities indicated for design demand of hot water are for general reference minimums and shall not substitute for accepted engineering design
procedures using actual number and types of fixtures to be installed. Design will also be affected by temperatures of cold water used for mixing,
length of run and insulation relative to heat loss, etc. As an example, total quantity of hot water needed will be less when temperature available
at the outlet is very nearly that of the source tank and the cold water used for tempering is relatively warm.
2The range represents the minimum and maximum allowable temperatures. Where sinks are used primarily for hand-washing and are served by a
single pipe supplying tempered water, the tempered water shall not exceed 80° F (21° C).
3provisions shall be made to provide 180° F (82° C) rinse water at warewasher (may be by separate booster) unless a chemical rinse is provided.
'Provisions shall be made to provide 160° F (71 ° C) hot water at the laundry equipment when needed. (This may be by steam jet or separate
booster heater.) However, it is emphasized that this does not imply that all water used would be at this temperature. Water temperatures required
for acceptable laundry results will vary according to type of cycle, time of operation, and formula of soap and bleach as well as type and degree of
soil. Lower temperatures may be adequate for most procedures in many facilities but higher temperatures should be available when needed for
special conditions. Minimum laundry temperatures are for central laundries only.

114 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.5 BUILDING SYSTEMS

Table 2.5-2
Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems l

Room Type NC / RClN) / RNC2.3.4 dBA

Resident room/dwelling unit 40 45

Medication room 35 40

Multiple occupant resident care area 45 50

Corridor, community space 45 50

Office, examination room 40 45

Conference room 35 40

Quiet rooms 30 35

Community meeting room, auditorium 30 35

Communal dining room 6 35 40

Natatorium 45 50

Medical or pharmacy waiting area 7 40 45

1 Additional spaces shall be added based on the building program.

[ 2se~ the white ~ap~r"Sound & Vibration Design Guidelines for Health Care Facilities" at www.fgiguidelines.org/resources for a discussion of room

nOise rating criteria.

30 ne rating system shall be chosen to evaluate room noise levels, and noise from building mechanical systems shall be evaluated using that single
rating system.

4Spaces shall be designed to fall below the maximum values shown in this table with no rattles or tonal characteristics.

S Also applies to private speech and hearing services rooms and private music therapy rooms.

6Kitchen ventilation noise shall be included in the overall sound level where the kitchen is open to the dining room.

[
7 Refer to Section 1.2-4.5.5 (Privacy and Confidentiality) for HIPAA speech privacy information.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 115
 2.5 BUILDING SYSTEMS

*Table 2.5-3
Categorization of Residential Health, Care, and Support Facility Sites by Exterior Ambient Sound
Iwith Design Criteria for Sound Isolation of Exterior Shell in New Construction
Exterior Site Noise Exposure Category

A B C D

General description Minimal Moderate Significant Extreme

For residential health and care facilities:

< 65 65-69 70-74 ? 75
Outdoor day-night average sound level during (Ldn) (dBA)'

For residential support facilities:

< 65 65-69 70-74 ? 75
Outdoor average sound level during occupancy hours (Leq ) (dBA)

Outdoor average hourly nominal maximum sound level (LO,)2 (dBA) < 75 75-79 80-84 ? 85

Design Criteria for Sound Isolation of Exterior Shell in New Construction'

OITCe: 25 OITCe: 30 OITCe: 35 01TCe:40

Minimum exterior shell composite sound transmission rating 4, 5, 6 or or or or
STCe: 35 STCe: 40 STCe: 45 STCe: 50

*Also see appendix table A2.5-b (Approximate Distance of Noise Sources for Use in Categorization of Health Care Facility Sites by Exterior Ambient
Sound).
1 By definition, the day-night average sound level (Ldn) includes the A-weighting and nighttime penalty.

2Lol is the sound level exceeded' percent ofthe time.

31n the absence of a local code, emission of equipment sound to adjacent residential properties shall be considered. Exterior resident or patient
seating areas are generally acceptable for Category A sites, marginally acceptable for Category Bsites, generally not acceptable without special
acoustic consideration for Category C sites, and generally not acceptable at all for Category D sites.
4The exterior shell composite ratings are for closed windows. Opening windows effectively reduces shell composite OITC or STC ratings to '0 to' 5,
depending on the amount windows are opened. Consideration shall be given to whether windows would be opened and for how long and under
what circumstances, and the potential impact of open windows shall be identified in the design documentation.
sThe exterior shell composite sound transmission ratings for interior spaces that are not acoustically sensitive (e,g., corridors, atriums, stairways)
can be reduced by as much as '0 dB, but should be no less than OITCc 25 or STCc 35. Special consideration shall be given to interior spaces that
are more sensitive to noise than a typical resident room (e.g., a teleconferencing space or an auditorium) that may require special consideration
to determine an appropriate OITC e or STCc rating of the exterior facade.
6For rooms with a roof-ceiling assembly as part of the composite shell, the complete shell (including the roof) shall at least meet the requirements
of the table in all cases. If there are significant sound sources above the roof level (such as aircraft or mechanical equipment on roofs) or if the
roof is not flat so it is exposed to sounds from below, either the minimum composite OITC or STC of the complete shell (including the roof) shall
be 5 points greater than shown in the table or the minimum composite OITC or STC of the roof-ceiling assembly itself shall be at least' 0 points
greater than shown in the table with the fac;:ade composite rating (walls and windows) meeting the minimum requirements in the table.

116 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.5 BUILDING SYSTEMS

Appendix Table A2.5-b

Approximate Distance of Noise Sources for Use in Categorization of Residential
Health, Care, and Support Facility Sites by Exterior Ambient Sound

Exterior Site Noise Exposure Category A B C D

General description Minimal Moderate Significant Extreme

Distance from nearest highway (ft.) > 1000 250-1000 60-249 < 60

Slant distance from nearest aircraft flight track (ft.) > 7000 3500-7000 1800-3499 < 1800

Distance from nearest rail line (ft.) > 1500 500-1500 100-499 < 100

Note: This table can be used to approximate noise impact on a residential health, care, or support facility based on very conceptual conditions.
Actual sound levels at a site can vary dramatically based on traffic volume and frequency of use of the transportation system as well as
topological conditions and other features out of the control of the design team or the facility. A more accurate assessment of a site's exterior
noise exposure should be made either by performing a sound level survey for a period sufficient to properly characterize noise impacts or
by using any number of transportation noise estimation tools, such as software models recognized by the federal government or the noise
assessment guidelines in The Noise Guidebook published by the u.s. Department of Housing and Urban Development.

*Table 2.5-4
Minimum Design Room Sound Absorption Coefficients (a)

Space!,2 Design Coefficient3

Corridor (public corridor in resident care areas) 0.20

Medication rooms 0.20

Multiple occupant resident care and activity areas 0.20

Quiet room 4 0.20

Office 0.15

Examination room 0.15

Natatorium 0.10

Dining room with more than 50 occupants

'Additional spaces shall be added based on requirements in the functional program.

(llf an acoustic finish is attached using mechanical means, that surface is considered permanent.
3 Use the noise reduction coefficient (NRC) rating for estimating the design room-average sound absorption coefficient when using this table.

4Also applies to private speech and hearing services rooms and private music therapy rooms.
5Design for a minimum of 17 square feet (1.58 square meters) of floor area per person at full occupancy and an equivalent 17 square feet of (1 .58
square meters) acoustic finishes with an NRC of 0.80 or higher per person at full occupancy.

Appendix to Table 2.5-4

Minimum design room sound absorption coefficients for a single or multi-bed/multi-occupancy resident room should be 0.20 for a room when
furnished and 0.10 for a room when not furnished.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 117
2.5 BUILDING SYSTEMS

Table 2.5-5
Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms'

Adjacency Combination

Resident room/dwelling unit Resident room/dwelling unit

Resident room/dwelling unit Corridor (with entrance)

Resident room/dwelling unit Community space 50

Resident room/dwelling unit Service area

Examination room Corridor (with entrance)

Examination room Multiple-occupant resident care and activity areas or public corridor

Toilet room Multiple-occupant resident care and activity areas or public corridor 45

Care consultation room Multiple-occupant resident care and activity areas or public corridor

Care consultation room Resident room/dwelling unit 50

Care consultation room Corridor (with entrance)

'Additional spaces shall be added based on the building program.

2The STC values stated assume the need for normal speech privacy (except at corridor walls with door:;), assuming a background sound level of at
least 30 dBA. When selecting assemblies based on their tested or published STC ratings, it should be noted that STC test reports can, in general,
be considered accurate to +/- 2 STC points. Consequently, an assembly with a tested or published STC rating as low as 2 points below the stated
minimum may be considered acceptable.
3 A test of the in-situ construction for the building at hand to determine the apparent sound transmission class (ASTC) or field sound transmission

class (FSTC) can be up to 5 points lower than the STC rating. ASTC and FSTC ratings shall not be substituted for STC ratings during the design
1 stage.
41n cases where greater speech privacy is required between resident rooms when both resident room doors to the connecting corridor are closed,
the wall performance requirement shall be STC 50.
sThis is the performance required for the partition excluding the door. Note that sound isolation in these instances will be limited by the door's
performance (e.g., STC 20 for a close-fitted 5 psf door). Doors are not required to be sound sealed to maintain the STC rating, although a facility
may choose to do so for specialty resident environments such as bereavement rooms, consultation rooms, etc.
6Relaxation of STC 60 ratings shall be permitted if compliance with room noise requirements is achieved with lower performance constructions.
See Table 2.5-5 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems).
7Also applies to private speech and hearing services rooms and private music therapy rooms.

118 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 2.5 BUILDING SYSTEMS

Table 2.5-6
Design Criteria for Speech Privacy for Enclosed Rooms and Open-Plan Spaces1,2

Level Metrics

Speech Privacy-Closed Plan PI AI SII SPC

Secure N/A N/A N/A ~70

Confidential ~9S% $0.05 $0.10 60-69

Normal 80-94% 0.06-0.20 0.11-0.25 52-59

Defining Standard ASTM E1BO ASTM E1BO ANSI S3.5 ASTM E2638
--=-'''"'~''''''-

Speech Privacy-Open Plan PI AI SII SPC

ConfidentiaF Special consideration required. 3

Normal 80-94% 0.06-0.20 0.11-0.25 52-59

Marginal 60-79% 0.21-0.40 0.26-0.45 45-51

Defining Standard: ASTM E1BO ASTM E1BO ANSI S3.5 ASTM E2638

( Note: See appendix section A2.5-8.6 (Speech privacy) for explanation of AI, SII, SPC, and PI.
lThe indicated AI and SII values shall be considered the maximum accepted values. The indicated PI and SPC values shall be considered the

minimum accepted values.

2Equivalence among these metrics, as indicated, has been demonstrated. However, some of these metrics may not be suitable for a particular
space. The referenced standards indicate that PI and AI are appropriate for use in open plan spaces, and that SPC is appropriate for closed plan
spaces. The referenced standard for SII indicates that SII may be used for either type.
3Confidential speech privacy is not readily achievable in open-plan spaces due to the lack of barriers, low ambient sound levels, and typical voice
effort.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 119
 ·1 Specific Requirements for Nursing Homes
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 3.1-1 General disabilities, see Section 2.2-4 (Design Criteria for

Dementia, Mental Health, and Cognitive and
3.1-1.1 Application Development Disability Facilities) for requirements.

3.1-1.1.1 General 3.1-1.1.3 Minimum Standards for New Nursing

Homes
*3.1-1.1.1.1 This chapter contains specific requirements This chapter identifies the minimum requirements for
for nursing homes. a nursing home, whether it is a freestanding facility or
part of another facility.
3.1-1.1.1.2 The requirements in Part 2 (Common
Elements for Residential Health, Care, and Support *3.1-1.2 Functional Program
Facilities) shall apply to nursing homes as referenced in See Section 1.2-2 (Functional Program) for
this chapter. requirements.

3.1-1.1.2 Design Criteria 3.1-1.3 Resident Safety Risk Assessment

See Section 1.2-3 (Resident Safety Risk Assessment)
3.1-1.1.2.1 Sustainable design. See Section 2.2-2
for requirements.
(Sustainable Design Criteria) for requirements.

3.1-1.4 Environment of Care Requirements

3.1-1.1.2.2 Design criteria for accommodations for
care of persons of size. If the care population includes
3.1-1.4.1 General
persons of size, see Section 2.2-3 (Design Criteria
See Section 1.2-1.3 (Environment of Care and Facility
for Accommodations for Care of Persons of Size) for
Function Considerations) and Section 1.2-4 (Environ­
requirements.
ment of Care Requirements) for requirements.

3.1-1.1.2.3 Dementia, mental health, and cognitive

3.1-1.4.2 Flexibility
and developmental disability design criteria. If the
care population includes residents with dementia, Nursing homes shall be designed to provide flexibility
mental health issues, or cognitive or developmental to meet the changing physical, medical, and psycho­
logical needs of residents.

~ - APPENDIX
-~ - -

A3.1-1.1.1.1 Nursing home types. The nursing services A3.1-1.2 Staff distances, staff station locations, and decentralized

and facilities provided in a nursing home are distinguished by the level vs. centralized functions that will directly affect facility design should

of care, size of resident unit, and types of staff support areas and service be specified in the functional program. Different care models should be

areas provided. Nursing homes may be freestanding facilities or distinct evaluated to provide aresident-centered solution; see appendix sections

parts of a hospital, continuing care retirement community, or other A3.1-2.2.1.3 (1) (Traditional model and staffing considerations), A3.1­

health care facility. 2.2.1.3 (2) (Cluster and/or neighborhood model and staffing consider­

ations), and A3.1-2.2.1.3 (3) (Connected and freestanding household

model units and staffing considerations).

G u ide lin e s for De s i 9 nan d Co n s t rue t ion of Res i de n t i a I H e a It h, Car e, and 5 u P po rt Fa c iI it i e s

3,1 SPECIFiC REQUIREMENTS FOR NURSING HOMES

3.1-1.4.3 Supportive Environment • 3.1-2 Resident Areas

*3.1-1.4.3.1 The facility design shall produce a support­
ive environment to enhance and extend quality oflife
for residents and facilitate wayfinding while promoting
choice, dignity, privacy, meaningful engagement, and
self-determination.
3.1-1.4.3.2 Design shall maximize opportunities for
ambulation and self-care, socialization, and indepen­
dence and minimize the negative aspects of a tradi­
tional environment.
3.1-1.4.4 Barrier-Free Environment
The architectural design-through the organization
of functional space, the specification of ergonomically
appropriate and arranged furniture and equipment,
and selection of details and finishes-shall eliminate as
many barriers as possible to access and use by residents
of all space, services, equipment, and utilities appropri­
ate for daily living.
3.1-2.1 General
Resident areas in a nursing home shall comply with
the requirements in this section.
*3.1-2.2 Resident Unit
3.1-2.2.1 General
*3.1-2.2.1.1 Resident unit size. See Section 3.1­
2.2.1.2 (Layout) for typical resident unit size in differ­
ent types of nursing home models and appendix table
A3.1-a (Nursing Home Care Model Characteristics)
for additional information.
3.1-2.2.1.2 Layout
(l) In new construction, resident units shall be
arranged to avoid unrelated travel through the
units.
*(2) The layout of the facility shall reflect the care

model and related staffing.

3.1-1.5 Site
3.1-2.2.1.3 Use of the following care models shall be
3.1-1.5.1 General
allowed.
See Chapter 2.1 (Site Elements) for requirements.
( *(1) Traditional model. This model typically includes
40 or more residents in a double-loaded corridor
3.1-1.5.2 Parking
configuration with centralized service/community
In addition to the requirements in Section 2.1-3.3
areas, staff work areas, and resident support areas.
(Parking), the facility shall provide a minimum of one
parking space for every four beds.

APPENDIX

A3.1-1,,4.3.1 Cu.lture change inlollg..term care should address

A3.1~2 ..2. t,3 (111'radiUonal model and staffing
movement away from atraditional mOdel toward one that is residential
considetat!ol1$
in scale, has homelike amenities, facilitates wayfinding} and allows
3. Definition. The traditional model isa medical model (}f care with
residents and direct care w.orkers to express choice. in meaningful ways.
double-loaded corridors, Hentral nursing station, and community
spaces for resident dining and activities. [valygtion ofthe .potential
A~.•1-2.1 Resident unitS3re groups ofresident rooms and support

fw incorporating some level ofdecentralization of services and other

areas. whose size and layout are based on the care mO,del staffing pat­

model types described in this appendix is recommended during the

terns, functional operations, and communications usediMhe facility;

plaoning process.
A3.1~2.2.1.1 Where asection of an acute care facility is converted
b. Fu.nctionQI program
for·use as a nursing home, it may be necessary to reduce the number of
~ThiS type of unitindudes centralized environmental services
bedstoprovide space for long-term :(:aIe servi:(:es.
fOoms, soiled and dean' utility rooms, and provisions for medica­
tion storilge and djstribution, linens, and accommodations for
A3.1-2.2.1.2 (2) The most ,effecti'le design,is determined when
other services.providedby care staff for residents.
the care model is defined during the functional programming process.
-Staff models are typically hierarchical in nature and direct care
sta.ff typically does not have astrong role in managing overall
care.

124 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

*(2) Cluster and/or neighborhood model. lhis model clusters grouped in neighborhoods of 21 to 40
typically includes 8 to 18 residents in a cluster with residents. Clusters are located directly adjacent to

APPENDIX (continued)

-Staff often does not,consistently care for the same residents;
minimizing the opportunity for developing familiarity with a
resident's individual needs.
-Travel distances fOfstaff and residents are greater than in other
'types of units and schedules are dictated more by regulation
than by resident/staffrhoice or satisfaction.
(. Physical setting
-In lieu of residentro.oms designed with beds side by side, alter­
native room layouts are recommended that provide minimally
private alcove sleeping areas and access to abathroom shared by
no more than two residents. See Section 3.1-2.2 (Resident Unit)
for additional information.
-Evaluation of some decentralized services and activity areas to
reduce travel distances for staff and residents is recommended.
A3.1 ~2.2.1.3 (2) Cluster and/or neighborhood
model and staffing consid,erations
a. Definition. This model includes several concepts in which the design
of traditional nursing home floor plans (straight halls, double-loaded
corridors) is reorganized to benefit residents and improve caregiver
effectiveness.
Clustering is adecentralization strategy used to improve aes­
thetics, streamline service, shorten travel distances, and simplify
handling of linen. It also permits more localized social areas and
optional decentralized staff work areas.
Clusters of resid~nt bedrooms may be grouped ina neighbor­
hood that provides shared activity, therapeutic, and support areas.
b. Functional program. Afunctioning cluster as described here is more
-Staffing thatworks as well at night as during the day: An
effective cluster design accommodates multiple staffing·ratios.
With clustering, afacility or neighborhood with 42.beds could'be
staffed effectively in variousratios of licensed nurses to nursing
assistants. For example: 1:7 for days (sixcllfsters of seven
residents); 1:14 or 1:21 nights (two or three groupings of two to
three clusters, respectively).
(. Additionalbenefits
-Cluster design can provide more efficient gross/net area where jI
variety of single and/or double rooms are nested.
-For a project with a high proportion of private occupancy rooms,
cluster design can reduce walking/travel distances to staff work
areas or nurse stations.
-Cluster units support distribution of nursing staff throughout a
building, so staff are closer to resident rooms aloight and can
be more responsive to vocal calls for assistance andtoileting.
(Central placement of staff requires more understanding of how
to use atraditional call system than many residents possess.)
-(luster units ofagiven size may "stack"or be placed over
each other, but can be staffed differently to serve varying care
populations. .
-Where electronic call systems are ljsed (e.g., systems that allow
reprogramming of which roOm reports to which zone or nurs­
ing assistant's work area), staffing for a unitmight easily be
changed over time, such as when resident needs justify higher
ratios ofnursing assistants to residents. For example, a48-bed
unit might start at 1:8 staffing but switch to 1:6 when residents

require more care. In some units, staffing might also be slightly

than an architectural form where rooms are grouped around social

uneven, such as 60-bed units made up of clusters of 1:7 and 1:8

areas without reference to caregiving.ln afunctioning cluster, the

during the day based on care population needs.

following will be accomplished:

d. Physical setting. Clusters require an architectural form and may affect

-Unit scale and .appearance reinforces the relationship between
overall building shape. The goal ofthe.physicalsetting./s to support
smaller groups of rooms: Clusters should offer identifiable social
the care model.
groups for staff and residents, thereby reducing the sense of
-The longer length of stay of nursing horne residents (as compared
traditional size often associated with centralized facilities.
to hospital patients) makes clustering particularly appropriate for
-Utility placement is better distributed for morning care: Clean
nursing homes. Architectural clustering may help staff and resi·
and soiled linen rooms are located closer to resident rooms,
dents socially identify with an area or space ina larger facility.
minimizing staff steps and improving the aesthetics and func­
-Though architectural clustering may.involve grouping rooms,
tioningof corridors (carts are not scattered through halls).
this should not result in windowless social qreas or the
----'Geographically effective staffing: The staffing pattern and
incorporation of all social options in awindowless social area
facility design reinforceeqch other so that nursing assistants
directly outside the resident room doorways. Access to daylight,
can offer primary nursing care to agiven set of residents. Staff
views, and the outdoors is critical to asuccessful design.
room assignments are grouped together and generally do not
-Decentralized spaces are sized appropriately for equipment and
reqljire unequal travel distances to basic utilities. Staff"buddy­
carts used on the unit. They are placed to avoid long staff and
ing" is possible. Buddying involves sharing responsibilities such
resident travel distances and long wait times for residents to
as lifting a nOh-weight-bearing resident orcovering for astaff
receive services.
member while the buddy prOVides off-unit transport oris on
-Circulation paths that lead through one c1usterto gain access to
break.
another cluster should be avoided.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 125
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

decentralized service areas, optional satellite staff (b) Households shall be permitted to share
work areas, and optional decentralized resident support spaces/services.
living areas such as dining areas.
3.1-2.2.2 Resident Room
*(3) Connected household and freestanding household
models Each resident room shall meet the following
requirements:
(a) Facilities using a household model typically
include 10 to 20 residents in a group and may *3.1-2.2.2.1 Capacity
be freestanding or located in a larger facility
[ (1) In new construction, maximum room capacity
and/or attached to another similar household.
shall be two residents.
The household model includes a residentially
[ *(2) Where renovation work is undertaken and the
scaled kitchen and living room designed in
present capacity is more than two residents,
conjunction with staff areas organized to
maximum room capacity after renovation shall be
provide resident-centered care.

APPENDIX

A3.1-2.2.1.3 (3) Connected and freestanding

-Access to safe outdoor space from common areas
household model units and staffing
-Appropriate storage in community spaces and resident rooms to
considerations
support adecentralized care model
a. Definition. Household units use resident-centered care models that -Minimization of double-loaded corridor lengths
change the philosophy of care to create a household-scale environ­ -An open plan with a living room, dining room, and residentially
ment. The goal is to create asmall community of residents in a home scaled open kitchen
that is supported by staff members specially trained in this philoso­ -Architectural features that reflect home and regional
phy of care. characteristics
b. Functional program
-A separate and distinct entry for each household
-Resident-centered care models include ateam-based manage­
-Meals partially prepared and served with some centralized
ment approach to staffing roles and responsibilities.
support, meals served in the household using all centralized
-Food service is completely or partially decentralized. The house­ support, or completely decentralized food service where all
hold has afunctional kitchen, where awide variety of food is meals are prepared and served in the household
available around the clock. Meals may be prepared and served in -Routine services often shared by connected households (e.g.,
the household or partially prepared and served in the household food, laundry, trash collection). It is common for households
with some centralized support. Regardless of where food is to share environmental service rooms, food service pantries,
prepared, meals are served from the kitchen in the household. central storage, trash rooms, personal laundry facilities, and
Trays are only used for room service. other similar service rooms/spaces.
-Residents maintain freedom of movement and have safe access
A3.1-2.2.2.1 Single-resident rooms with an individual toilet room
to all spaces in the household as they would in their own home.
are encouraged. Evidence suggests that single-resident rooms decrease
c. Additional benefits
risks for medication errors, health care-acqUired infections, resident
-The small size of resident care groups in a household allows staff
anxiety, and incidents of aggressive behavior while improving resident
to better understand a resident's individual needs.
sleep patterns and staff effectiveness. In two-bed rooms, consideration
-Travel distances are typically reduced for residents and staff
should be given to creating room configurations that maximize individ­
in a household, providing more opportunities for residents to
ual resident privacy, access to windows, and room controls and provide
ambulate rather than use a resident-operated mobility device as
equivalent space for each resident (e.g., alcoves for each).
atime-saving mechanism to meet regulatory requirements.
-The smaller environment in ahousehold is residential rather A3.1-2.2.2.1 (2) On October 4,2016, the Centers for Medicare
than traditional in nature. & Medicaid Services (CMS) published afinal rule on the "Reform of
d. Physical setting. Household designs support an environment that
Requirements for long-Term Care Facilities,' CMS-326o-F, in the Federal
allows staff to care for aconsistent group of residents in asmall­
Register. This rule revises the requirements that long-term care facilities
scale space, fully supporting the functional program and operations
must meet to participate in the Medicare and Medicaid reimbursement
developed by the organization. Characteristics include:
programs. Effective November 28, 2016, each resident room must have
-Residentially scaled spaces that include an open kitchen, living a maximum capacity of two residents and adedicated bathroom with at
room, dining room, etc. least atoilet and sink. look for guidance on room configurations to meet
CMS requirements under the Resources tab on the FGI website.

126 Guidelines for Design and Construction of Residential Health, C<lre, and Support Facilities

no more than two residents in accordance with
CMS-3260-F, "Reform of Requirements for Long­
Term Care Facilities."
*3.1-2.2.2.2 Space requirements
(1) Space shall be provided to accommodate resident
care and for maneuverability when resident­
operated mobility devices are used.
(2) Resident rooms shall be sized, arranged, and
wheelchair or other resident-operated mobility
furnished to maximize safe resident mobility,
device
mobilization, weight-bearing activity, and
(d) The following furniture accessible from a
ambulation potential and to minimize risks to
wheelchair or other resident-operated mobility
caregivers. This requirement shall apply to all
device:
resident rooms, regardless of resident weight or
condition.
(i) Bed
(3) Area and dimensions. The area and dimensions
A3.1-2.2.2.2 Determining space needs. Resident rooms
should be sized; arranged, and furnished to maximize safe patient
mobility, mobilization, weight-bearing exercise, and ambulation
potential while minimizing risk to caregivers. This should apply to all
populations being cared for and served.
Clearances should be provided and maintained to accommodate
safe resident mobility and mobilization of residents. Designated clear­
ances should not be obstructed by any object that does not qualify as
movable according to Section 1.5-4.2 (Movable and Portable Equip­
ment).
a. To facilitate planning for minimum clearances around beds, bed type
and size should be established as part of the functional program. As
acceptable to AHJs, bed placement should be chosen by individual
residents and their families to satisfy the needs and desires of the
resident.
b. Provision of bed clearances to support resident safety should include
the following:
-Standard resident room:
48 inches (121.92 centimeters) on the transfer side
36 inches (91.44 centimeters) on the non-transfer side of
the bed
• 36 inches (91.44 centimeters) at the foot of the bed
-Resident rooms for persons of size with an overhead lift:
• 72 inches (182.88 centimeters) from the bed by 120 inches
long (304.8 centimeters) on the transfer side
• 36 inches (91.44 centimeters) on the non-transfer side of
the bed
• 66 inches (167.64 centimeters) at the foot of the bed
-Resident rooms for persons of size without anoverhead lift to
accommodate use of a mobile lift:
84 inches (21336 centimeters) from the bed by 120 inches
long (304.8 centimeters) on the transfer side
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
provided for each resident space shall be based on
inclusion of the following:
(a) Space to accommodate a maximum of two
beds that allows staff members access to both
sides and the foot of each bed
(b) A window accessible from a wheelchair or
other resident-operated mobility device
(c) A wardrobe or closet accessible from a
*(ii) Lounge chair
(iii) Dresser
• 36 inches (91.44 centimeters) on the non-transfer side of
the bed
• 66 inches (167.64 centimeters) at the foot ofthe bed
Where lifts are used, additional clearance is needed to accom­
modate use of the lift and an expanded-capacity wheelchair as well.
as space for staff to help a' person of size transfer from bed to wheel­
chair or gurney. Mobile lifts require more floor space than overhead
lifts to accommodate the lift footprint.
c. Sizing of resident rooms should accommodate clearances for resident
chairs, recliners, wheelchairs, or other devices; these clearances may
overlap with the bed clearances. The size of each room should allow
unimpeded clearance on at least one side and at the front of any
resident chair, etc., as follows:
-48 inches (121.92 centimeters) on the transfer side of the chair,
etc. for both standard and person of size room types
-36 inches (91.44 centimeters) for the approach to the chair for a
standard room
-66 inches (167.64 centimeters) for the approach to the chair for
a room accommodating a person of size
A3.1-2.2.2.2 (3)(d)(ii) Resident seating. The lounge chair
proVided in aresident room to give residents an alternative to bed-stay
should be evaluated for provision of the follOWing:
-Comfort sufficient for long-term sitting
-Cervical support and support for the resident's head (backrest)
-Opportunity to recline the backrest to enable periodic redistri­
bution of body weight during long periods of sitting (recliner)
-Ease of entry and exit. See appendix section A2.4-2.43.1 (Furni­
ture selection recommendations) for additional information.
See appendix section A2.4-2.43.1 (Furniture selection recommen­
dations) for additional information.
127
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

(iv) Nightstand obstruct access to any required element.

(d) These guidelines shall allow arrangement
*(e) Space for a side chair
of furniture that may reduce these access
(f) The room shall be configured so that each
provisions, without impairing access provisions
resident can view the television from a resident
for other occupants.
chair.
(g) Direct access from the room entry to the
3.1-2.2.2.3 Window
toilet room, closet or wardrobe, and window,
without traveling through the living space of (1) See Section 2.4-2.2.6 (Windows) in addition to the
another resident requirements in this section.
*(h) Clearance for staff members to use lifting (2) In renovated construction, beds shall be no more

equipment to access the bed, chairs, and toilet. than two deep from windows.

See appendix section A3.1-2.2.2.2-b (Deter­

mining space needs) for recommendations.
*(1) Visual privacy shall be provided for each resident in
(4) Every bed location shall have sufficient space to
permit placement of a stretcher along one side for
lateral transfer of the resident from the bed to the
stretcher by at least two staff members without
substantial rearrangement of furniture.
(5) Clearances
(a) In multiple-bed rooms, clearance shall allow
for the movement of beds and equipment
without disturbing residents.
(b) Clear access to one side of the bed shall be
provided along 75 percent of its length.
(c) Mechanical and fixed equipment shall not
3.1-2.2.2.4 Resident privacy
two-bed rooms.
(2) Design for privacy shall not restrict resident access
to the toilet, room entrance, window, or other
shared common areas in the resident room.
3.1-2.2.2.5 Hand-washing station. A hand-washing
station shall be provided in each resident room.
(1) Omission of this station shall be permitted in a
single-bed or two-bed room where a hand-washing
station is located in an adjoining toilet room that
serves that room only.
(2) Design requirements

APPENDIX~'

A3.1-2.2.2.2 (3){e) Visitor seating. Provision of aside chair
for avisitor means residents do nbt have to remain in bed when they
have avisitor.
A3.1-2.2.2.2 (3){h) Although use of portable lifting equipment
bed/chair/toilet/bathing .facilities/stretcher or reposition them in a bed
or achair.
One objective in using ceiling systems would be to assist residents
who have poor balance or are unable to bear all of their weight to stand

and ambulate throughout theroom. Asecond objective would be to

requires more clearance for maneuvering than fixed lifting equipment,

maximize resident choice and control of bed location and room arrange­
use of fixed equipment does not eliminate the need for portable

ment,key factors.in creating "home" for the resident.

equipment. Portable equipment will be required when a resident falls

One way to meet these objectives is to install perma nent tracks

out of range of afixed lift or requires asit-to-stand lift.

the full length oftwo sides of the room with a perpendicular spur that
Using a portable lift without powered wheels to move aresident

extends 'into the toilet room over the toilet and into ashower, where
laterally requires more exertion by staff than using afixed lift; in .addi­

proVided. With this basic layout, when residents who require mobility
tion, the exertion required is increased where the floor is carpeted.

or transfer assistance move into aroom, across track and lift devicecan
However, carpet types differ in their resistance to wheeled devices, and

be installed for the duration of their stay. This approach would make
carpet has significant advantages over hard-surface flooring in noise

all areas of the room accessible to the resident using the lifting device,
reduction and residential appearance, both of which are important in

thereby offering the resident a variety of room arrangements and sub­

creating acomfortable, attractive liVing environment. See Section 2.4­

stantially reducing the need for aportable lift.

2.3.2 (Flooring and Wall Bases) for requirements.
Resident rooms and associated toilets may be equipped with a
ceiling-mounted track to accommodate ceiling-mounted mobility and
lifting devices. The track layout should be designed to aid in maintaining
or improving resident mobility and ambulation, independent function,
and strength and to help staff members transfer residents to or from
A3.1-2.2.2.4 (1) Resident privacy. Consideration should be
given to use of awall or partition to preserve visual and acoustic privacy
for each resident. Alcoves may be used for this purpose in double­
occupancy resident rooms.

128 Gu.delines for Desi n and Construction of Residential Hea!th, Car, an Support Facilities

(a) For hand-washing station design details, see
Section 2.4-2.2.8 (Hand-Washing Stations).
(b) For sink design, see Section 2.5-2.3.2
(Plumbing Fixtures-Hand-Washing Sinks).
(c) For casework details, see Section 2.4-2.4.2
(Casework, Millwork, and Built-Ins).
3.1-2.2.2.6 Resident toilet room. Each resident shall
have access to a toilet room without entering a general
corridor.
*(1) One toilet room shall serve no more than two
residents in a bedroom.
(2) Space requirements
(a) Toilet rooms shall be sized and configured to
accommodate:
(i) Staff assistance, including use of lifting
equipment
(ii) Accessibility standards that support inde­
pendent resident use
(b) Clearance shall be provided on both sides
of the toilet to enable physical access and
maneuvering by staff members assisting the
resident with wheelchair-to-toilet transfers and
returns.
(3) The toilet room shall contain the following:
(a) Toilet
(b) Hand-washing station
(c) Mirror. For requirements, see Section 2.4­
2.2.8.7 (Mirror).
(d) Individual storage for the personal effects of
each resident
(4) Doors and door hardware shall be provided in
*3.1-2.2.3.1 Airborne infection isolation (AIl)
accordance with Section 3.1-5.2.2.4 (Doors and
door hardware).
(5) Grab bars
(a) Grab bars shall be provided in accordance with
Section 2.4-2.2.9 (Grab Bars).
(b) Where residents are capable of independent
APPENDIX
A3.1-2.2.2.6 (1) See appendiX section A3.1-2.2.2.1 (2)(On October
A3.1-2.2.3.1 For additional information, refer to the Centers for
4,2016...) for information about compliance with CMS requirements.
Disease Control and Prevention (CDC) publications "Guidelines for Pre­
A3.1-2.2.2.7 (3) Accessible showers. Provision of acurb­
less shower that is open to the surrounding bathroom should be consid­
ered for ease ofaccess by resident and staff.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
transfers, alternative grab bar configurations
shall be permitted.
3.1-2.2.2.7 Resident bathroom. Where a bathtub
or shower is provided in a resident toilet room, the
following requirements shall be met in addition to the
requirements in Section 3.1-2.2.2.6 (Resident toilet
room):
(1) Space shall be provided for drying, dressing, and
grooming.
(2) A counter and a shelf or cabinet for personal item
storage shall be provided. See Section 2.4-2.4.2
(Casework, Millwork, and Built-Ins) for details.
*(3) See Section 2.5-2.3.3.2 (Accessible showers) for
shower requirements.
3.1-2.2.2.8 Resident storage. Each resident shall be
provided with an individual wardrobe or closet.
(1) This storage shall have a minimum net depth of
24 inches (55.88 centimeters) and a minimum net
width of 2 feet 6 inches (76.20 centimeters).
(2) A clothes rod shall be provided that can be
adjusted to a height accessible to the resident.
Accommodations shall be made for storage of full­
length garments.
(3) A shelf shall be provided that can be adjusted to a
height accessible to the resident. Omission of the
shelf shall be permitted where the unit provides at
least two accessible drawers.
3.1-2.2.3 Special Care Resident Rooms
The requirements in this section shall apply to all nurs­
ing homes that include these room types.
room
(1) General
(a) The need for and number of Ail rooms shall
be determined by an infection control risk
assessment.
(b) Where provided, each All room shall comply
venting the Tran~mission of Mycobacterium tuberculosis in Health-Care
Settings" and "Guidelines for Environmental Infection Control in Health­
Care Facilities."
129
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
with the requirements in Section 3.1-2.2.2
(Resident Room) as well as the following
requirements:
(2) Capacity. Each resident room shall contain only
one bed.
(3) The toilet room provided for each AIl room shall
include a shower.
(4) Anteroom. An anteroom is not required; however,
where an anteroom is part of the design concept, it
shall meet the following requirements:
(a) The anteroom shall provide space for persons
to don personal protective equipment before
entering the resident room.
(b) All doors to the anteroom shall have self­
closing devices.
(5) Where no anteroom is provided, provision shall be
made for storage of personal protective equipment
at the entrance to the room.
(6) Special design elements
(a) Architectural details
(i) All room perimeter walls, ceiling, and
floor, including penetrations, shall be con­
structed to prevent air exfiltration.
(ii) AIl rooms shall have self-closing devices
on all room exit doors.
(b) Window treatments and privacy curtains
shall be provided in accordance with Section
2.4-2.4.4 (Window Treatments and Privacy
Curtains).
(c) Ventilation
(i) Ventilation upon loss of electrical power.
The space ventilation and pressure re­
lationship requirements of Table 3.1-1
(Design Parameters for Ventilation of Resi­
dential Health Spaces) shall be maintained
for All rooms, even in the event of loss of
APPENDIX
A3.1-2.2.3.1 (6)(c)(ii) Use of recirculating room units in new
construction is prohibited due to the difficulty of cleaning the units and
the potential for buildup of contamination in the All room.
A3.1-2.2.3.1 (6)(c)(iij) The design of either portable or fixed
retirculating systems should prevent stagnation and short-circuiting Of
airflow.
130 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
normal electrical power.
*(ii) Use of recirculating room units shall not
be permitted in new construction.
*(iii) Use of recirculating devices with HEPA fil­
ters shall be permitted in existing facilities
as interim, supplemental environmental
controls to meet requirements for the
control of airborne infectious agents. The
design of such recirculating systems shall
allow for easy access for scheduled preven­
tive maintenance and cleaning.
(iv) Design relative humidity shall be a maxi­
mum of 60 percent.
*3.1-2.2.3.2 Ventilator-dependent resident units.
Where a unit dedicated to serving residents dependent
on a ventilator is provided, resident rooms in this unit
shall meet the following requirements in addition to
those in Section 3.1-2.2.2 (Resident Room).
(1) Resident rooms for ventilator-dependent residents
shall have:
(a) Space for the ventilator unit at the bedside
(b) Space to accommodate clearances for resident­
operated mobility devices that may be
oversized to accommodate a ventilator
(c) Provisions for oxygen and suction. Any
installation of nonflammable medical gas, air,
or clinical vacuum systems shall comply with
the requirements ofNFPA 99: Health Care
Facilities Code.
(d) Backup electrical requirements. See Section
2.5-4.4 (Electrical Requirements for
Ventilator-Dependent Resident Rooms and
Areas) for requirements.
(2) Resident support areas
(a) Support space shall be provided in the nursing
unit to accommodate staffing associated with
ventilator services.
(b) A dedicated space shall be provided for
A3.1-2.2.3.2 Where adedicated unit is provided for ventilator­
dependent residents, piped oxygen and vacuum should be prOVided.
Refer to NFPA 99: Health [are Facilities Code and ANSI/ASSE 6000:
Professional Qualifications Standardfor Medical Gas Systems Personnel for
essential power requirements and medical gas installation informatio.n.
 3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

servicing and maintenance of ventilator
equipment or storage shall be provided to
accommodate ventilators for backup or
exchange.
(c) All resident activity and support areas shall
be provided with essential power outlets to
support continued ventilator support in the
event of a power outage. See Section 2.5-4.4
(Electrical Requirements for Ventilator­
Dependent Resident Rooms and Areas) for
additional requirements.
3.1-2.2.3.3 Quiet room in a resident unit. Where
a single resident room is provided to accommodate
care requirements for residents experiencing issues
such as personal conflicts, agitation, episodic mental
disturbances, or similar conditions, the requirements
in Section 2.3-2.2.3.3 (Quiet room in a resident
carelliving area) shall be met in addition to the
requirements in Section 3.1-2.2.2 (Resident Room).
*3.1-2.2.4 Other Special Care Facilities
*3.1-2.2.4.1 Pediatric facilities
*(1) Pediatric resident rooms shall be designed to
accommodate the age-related characteristics of the
proposed pediatric residents.
(a) Rooms shall be permitted to accommodate
more than two pediatric residents where
sleeping accommodations are in cribs.
(b) Area and dimensions. The area and
dimensions of each pediatric resident space
shall be based on provision of the following:
(i) The ability to accommodate crib or bed
locations, including one where staff mem­
bers have access to the crib or bed on three
sides
(ij) Clear access to one side of the crib or bed
along 75 percent of its length.
(iii) Overnight accommodations for family
(iv) Enhanced (additional) staffing, closer
observation, and equipment as identified
by the functional program
(v) Privacy accommodations for family mem­
bers and each pediatric resident
(vi) Space for placement of a stretcher along
one side for lateral transfer of the pediatric
resident from crib or bed by at least two
staff members without substantial rear­
rangement of furniture
(vii) In multiple-crib or -bed rooms, clearance
permitting movement of cribs or beds and
equipment without disturbing other crib
or bed locations
(viii) Space for mechanical and fixed equipment
that prevents obstructed access to any
required element
(c) Unless otherwise stated in the functional
program, pediatric resident rooms shall be
separated from units serving adult populations.

APP~NDIX

A3.1-2.2.4 Subacute care facilities. Since subacute care

The potential age range of pediatric residents creates different needs
programs are offered in various settings, the design of such units/
from those of other residents. Daily care activities are likely to be more
facilities should focus on the follOWing major components:
intense, while continuing social development and maturity present
a. The unit/facility should comply with all applicable nursing home privacy considerations different from those in ageriatric setting. The
requirements in Chapter 11 (Specific Requirements for Nursing number of children in aroom should be decided by balancing the resi­
Homes)to the extent that these do not conflict with the functional dent's privacy needs with the need far appropriate levels of nursing care.
program.
A3.1-2.2.4.1 (1) Pediatric long-term care stakeholders include
b. The unit/facility should comply with operational reqUirements. The
the children, their families, and the staff. Residences (long-term care)
authority haVing jurisdiction may allow the flexibility to substitute
that group children by age cohort and create an environment of care
alternative uses (e.g., occupational/physical therapy space, addi­
that focuses on the specific needs of children of those ages enhance
tional family spaces) for spaces typically used for dining.
the children's functionality. While there is adisease state for the child
c. Inclusion of dining space in each resident room should be proVided
(either progressive or static). the child's development continues.
where community dining spaces have been replaced with spaces for
Family-centered care and other person-centered approaches are often
alternative uses.
implemented in pediatric long-term care facilities.
A3.1-2.2.4.1 The unique characteristics of long-term pediatric nurs­
ing care can have asignificant impact on facility planning and design.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 131
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
*(2) Resident support
(a) At least one hand-washing station equipped
with hands-free operable controls shall be
provided for each four or fewer pediatric
residents accommodated in a single room.
(b) Indoor and outdoor activity space shall be
designed with consideration of pediatric
resident and family culture, age cohorts, and
age-appropriate activities and needs.
*3.1-2.2.4.2 Post-acute care facilities
(1) For resident unit size and layout requirements, see
Section 3.1-2.2.1.2 (Resident Unit-Layout).
(2) For additional post-acute care resident room
Requirements for Nursing Homes) for additional
requirements, see Section 3.1-2.2.2 (Resident
requirements.
Room).
(7) See Section 2.5-1 (Building Systems-General) for
(3) Where resident community areas are provided, see
Section 3.1-2.3 (Resident Community Areas) for
requirements.
A3.1-2.2.4.1 (2) In comparison to what is reqUired for the typical
geriatric facility, pediatric long-term care facilitie~ often require
additional equipment and more intensive staffing and observation.
Parent/family involvement also tends to be more frequent in
pediatric facilities, requiring rooms designed to accommodate family
participation in direct care as well as privacy during visits.
Due to the potential age range and length ofstay of pediatric
residents, functional and space needs vary significantly from thos!'! of
adult residents. Dailycare activities are likely to be more complex from
afunctional perspective, while continuous social development and
physical/mental maturity reqUire a physical environment that is flexible
to accommodate the pediatric resident's evolving needs. The number of
children in a room is related to the individual residents' needs for privacy
as well as efficient and appropriate staff access, monitoring, and care.
Because of the varying age and degree of socialization of pediatric
residents, room capacities range from four infants/togdlersrequiring
heavy nursing care in asingle room to more private accommodations
for adolescents. All resident rooms must accommodate the direct care
activities of enhanced staffing aswell as the likelihood of significant
family presence.
The various functional and physical abilities ofthis diverse popula­
tion must be taken into account when designing facilities for toileting
and bathing.
A3.1-2.2.4.2 Post-acute care facilities. With change~ in
regulations that result in shorter stays in acute care settings, post-acute
care facilities are being developed and built~often.under nursing
or skilled nursing licensing. Post-acute care facilities are intendedfor
132 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
(4) Where diagnostic and treatment areas are provided,
see Section 3.1-3 (Diagnostic and Treatment Areas)
for requirements.
(a) See Section 3.1-3.3.2 (Physical Therapy
Area) and Section 3.1-3.3.3 (Occupational
Therapy Facilities) for designated rehabilitation
requi rements.
(b) See Section 3.1-3.3.4 (Other Rehabilitation
Therapy Facilities) for additional requirements
based on the types of therapy being provided.
(5) See Section 3.1-4 (Facilities for Support Services)
for requirements.
(6) See Section 3.1-5 (Design and Construction
requirements.
3.1-2.2.4.3 Accommodations for care of persons
of size. Where the facility provides resident rooms
residents receiving rehabilitation services rather than long-term or
palliative care services.
Post-acute care units often use ahousehold care model that
includes one or more "households" or units dedicated to post-acute care
:residents. Ahousehold'may also be dedicated to aspecial type of reha­
bilitation, such as orthopedic, cardiology, stroke, or other specialty.
Differences between along-term care and post-acute care house­
hold or unit typically include the following:
a. Post-acute care resident rooms are usually private and designed to
accommodate family and visitors. Consideration should be given to
providingwi-fj access in resident rooms.
b. Post-acute care resident room bathrooms are usually private and
include ashower.
eln alarger facility setting, physical, occupational, and speech therapy
may be provided in the post-acute care household or unit or centrally
located with other fitness or wellness areas.
d. Food service for post-acute care is usually provided by acentralized
kitchen with a room service component rather than in acommunal
dining setting (decentralized or centralized).
e. In lieu of activity space, alounge or family area is usually proVided
for family TMmbers visiting the resident. The lounge or family area
should offer access to awi-fi network.
f. Staff usually is rehabilitation-focused rather than dementia-focused
in apost-acute care household or unit. However, it is recommended
that staff in aunit where rehabilitation services are provided also be
trained in working with residents with dementia because of the care
population. generally being served.

for persons of size, see Section 2.2-3 (Design Criteria
for Accommodations for Care of Persons of Size) for
further requirements.
3.1-2.3 Resident Community Areas
3.1-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant and
Outpatient Community Areas-General) for
requirements.
3.1-2.3.2 Lobby
3.1-2.3.2.1 See Section 2.3-2.3.2 (Lobby) for
requirements in addition to those in this section.
3.1-2.3.2.2 Where a central lobby is provided, the
following requirements shall be included:
(1) A counter or desk for reception and information
(2) Public waiting area(s)
(3) Public toilet facilities
(4) Public telephone(s) or access to a courtesy phone.
See Section 2.3-4.2.8 (Resident and Participant
Telephone Access) for resident telephone
requirements.
(5) Provisions for drinking water
3.1-2.3.3 Dining, Recreation, and Lounge Areas
*3.1-2.3.5 Personal Services (Hair Salon/Spa) Areas
A3.1-2.3.3.3 (1) Recreation and lounge sp~ce
needs. Activity programs focus on the social, spiritual, intellectual,
physical, and creative needs of residents and provide them with quality,
meaningful experiences. These programs may be facilitY-Wide or for
smaller groups. The activities the care provider will support, based
on residents' or clients' expressed and individual interests, should be
identified in the functional program.
Activity programs generally include coordination and implementa­
tion of activities for large and small groups and personalized individual
programs involVing one resident and one activity coordinator. These
activities may be conducted in other spaces in afacility (e.g., dining
rooms), but dedicated spaces are preferred for efficient operation of
quality programs. The need for large activity spaces (e.g., libraries; cha­
pels; auditoriums; conference, classroom, and training spaces) depends
on the programming decisions of the care provider.
Following are some optional space needs to support recreation,
lounge, and activity areas:
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
3.1-2.3.3.1 General. See Section 2.3-2.3.3.1
(Dining, Recreation, and Lounge Areas-General) for
requirements.
3.1-2.3.3.2 Dining areas. See Section 2.3-2.3.3.2
(Dining areas) for requirements.
3.1-2.3.3.3 Recreation, lounge, and activity areas.
Recreation, lounge, and activity areas shall provide the
following:
*(1) Space adequate for resident activities and associated
equipment
(2) Areas sufficient in number and size to:
(a) Allow resident groups of various sizes to gather
(b) Accommodate separate and distinct activities
3.1-2.3.3.4 Toilet rooms. Toilet facilities that
accommodate resident-operated mobility devices shall
be readily accessible to all dining, recreation, lounge,
and activity locations.
3.1-2.3.4 Resident Kitchen
Where kitchen facilities that permit use by resi­
dents and family members are provided, see Section
2.3-2.3.4 (Resident and Participant Kitchen) for
requirements.
a. If reqUired in the functional program, space should be included for
the following:
-Storage for files and records
-Computers
-Administrative tasks
-Storage for supplies and equipment
b. Aquiet space for effective resident/staff communication. This space
may be incorporated into the space for administrative tasks or
locat~d in a private room setting.
c. Space for storage of items used for activities {e.g" recreationmateri­
als, exercise equipment, supplies for religious services) located near
the point of use
A3.1-2.3.S Personal services areas. Consideration should
be given to prOViding the following in the design of these areas:
a. General
-Changing areas
-Storage for supplies and linens
-----------------------
133
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

3.1-2.3.5.1 Hair salon/spa 3.1-2.3.8 Outdoor Activity Spaces

(1) Facilities and equipment for resident hair care and
grooming sh,all be provided separate from resident 3.1-2.3.8.1 See Section 2.1-3.6.2 (Outdoor Activity
rooms. Spaces) for additional requirements and information.
(2) Mechanical ventilation and exhaust shall be

provided for hair salons. See Table 3.1-1 (Design

*3.1-2.3.8.2 Nursing homes shall provide outdoor
Parameters for Ventilation of Residential Health
spaces consistent with the geographic location
Spaces) for additional requirements.
designed to promote and encourage residents to spend
(3) See Table 3.1-1 for minimum filter efficiencies for time in a safe outdoor setting or to provide direct
hair salons. access to the outdoors.

3.1-2.3.5.2 Other personal services areas. Personal

• 3.1-3 Diagnostic and Treatment

services areas shall be permitted to be unisex and

located next to central resident activity areas.

Areas

3.1-2.3.5.3 Toilet room. Resident toilets shall be

3.1-3.1 General
located adjacent to or directly accessible from hair
See Section 2.3-3.1 (Diagnostic and Treatment

salon and grooming area(s).

Areas-General) for requirements.

3.1-2.3.6 Reserved
3.1-3.2 Examination, Observation, and/or

Treatment Room

3.1-2.3.7 Quiet Room in a Resident Community

Where an examination, observation, and/or treatment

Area

room(s) is provided, see Section 2.3-3.2 (Examina­

Where a quiet room is provided, see Section 2.3-2.3.7
tion, Observation, and/or Treatment Rooms) for
(Quiet Room in a Resident or Participant Community
requirements.
Area) for requirements.
*3.1-3.3 Rehabilitation Therapy Facilities

APPENDIX (continued)

-Provisions for resident privacy c. Occupational therapy

b. Hair salon
-Adjustable sink bowls for shampooing and tre~tment
-Freestanding dryers for use by residents using resident-operated
mobility devices
c. Space for circulation and staff assistance around spa tubs
A3.1-2.3.8.2 Outdoor activity spaces
a. Visual access to outdoor activity spaces from indoors should be pro­
-Activities of daily living therapy
-Recreational therapy. Recreational therapy assists residents with
the development and maintenance of community living skills
and socialization through the use ofleisure-time activity tasks.
These activities may occur in arecreati_onal therapy department,
in aspecialized facility such as afitness room or area, in resident
activity areas, or outdoors.

-Education therapy
vided for staff and residents.

-Vocational therapy. Vocational therapy assists patients in the

b. Resident outdoor spaces should be located close to the bUilding and
development and maintenance of productive work and interac­
allow for direct staff observation.
tion skills through the use of work tasks. These activities may
c. Outdoor space(s) should be accessible to residents via short navi­

occur in an industrial therapy workshop, in another department,

gable distances.

or outdoors.
d. Outdoor spaces should be designed to'accommodate the resident

-Other occupational therapy activities. Occupational therapy may

care population served.

include such activities as woodworking, leather-tooling, art,

A3.1-3.3 Rehabilitation therapy services. needlework, painting, sewing, metalwork, and ceramics.
Rehabilitation therapy programs may include the following: d. Art and music therapy
a. Hydrotherapy e. Horticulture therapy
b. Speech and hearing therapy f. Prosthetics and orthotics
------- _._._._... _--_..-_.__.--.._-_.. _._... _.
134 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

3.1-3.3.1 General a minimum clearance of2 feet 8 inches (711

*3.1-3.3.1.1 Application. At minimum, the facilities
included in this section shall be provided on-site and
shall be easily accessible for the residents served.
(2) Resident or client privacy
(1) Space and equipment shall be provided for carrying
out each type of therapy the facility offers.
(2) Where two or more rehabilitation services are
provided, sharing of facilities and equipment shall
be permitted.
(3) Where a nursing home is part of a general hospital
or other facility, rehabilitation services shall be
permitted to be shared.
(4) Where outpatient therapy services are provided
communication.
on-site at a nursing home, see Chapter
(3) Hand-washing stations. Individual therapy area(s)
5.3 (Specific Requirements for Outpatient
Rehabilitation Therapy Facilities) for additional
requirements.
*3.1-3.3.1.2 Location. The requirements in this section
shall be met in any location where rehabilitation
therapy services are provided.
3.1-3.3.2 Physical Therapy Area
3.1-3.3.2.1 General. Private therapy room(s) shall be
millimeters) on at least three sides of the
treatment furniture (e.g., chairs, recliners,
tables, beds, mats).
(a) Exterior and interior windows in therapy
areas shall have window treatments or shades
to provide resident privacy during individual
therapy treatments.
(b) Individual treatment areas shall have privacy
screens or cubicle curtains and appropriate
provisions for resident dignity or private
shall have access to either a hand-washing station
or a hand sanitation dispenser.
(a) Hand-washing stations shall be provided in
each therapy room where hands-on resident
care is provided.
(b) Any therapy room that does not require a
hand-washing station shall have a dedicated
hand sanitation dispenser.
(c) One hand-washing station shall be permitted
to serve several treatment stations for both

provided where private communication with a resident physical therapy and occupational therapy.
and/or family is required or where therapy requires
privacy or seclusion to preserve resident dignity. 3.1-3.3.2.3 Group treatment areas
(1) Space requirements. Group treatment areas shall
3.1-3.3.2.2 Individual treatment areas be sized to accommodate one type of therapy at a
(1) Space requirements. Space requirements shall
time.
be based on the equipment used for therapeutic
(2) Hand-washing stations
treatment(s) provided in the facility. Sufficient
(a) Group treatment area(s) shall have access
space shall be provided to allow access to the
to either a hand-washing station or a hand
equipment when in use by the resident and the
sanitation dispenser.
therapist.
(b) One hand-washing station shall be permitted
(a) Area. Each individual treatment space shall to serve several group treatment areas,
have a minimum clear Boor area of 60 square including spaces for physical therapy and
feet (5.57 square meters). occupational therapy.
(b) Clearances. Room arrangement shall permit

APPENDIX

A3.1-3.3.1.1 Where resident units are not located near afacility's

A3.1-3.3.1.2 Rehabilitation therapy services can be prOVided in a
central rehabilitation therapy department, provision of smaller therapy
department ora facility that is specifically designed for these services,
rooms or areas in aspecific resident unit or in alocation central to a
or they can be provided where convenient for the resident, for example,
group of units should be considered.
in the resident's room or in corridor space near the resident's room.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 135
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

3.1-3.3.3 Occupational Therapy Facilities (b) Where staff is not required to work with
or mix wet material or handle material or
3.1-3.3.3.1 General. Where occupational therapy chemicals chat are caustic to the skin, provision
services are provided in the facility, the requirements in of a hand sanitation dispenser or a hand­
this section shall be met. washing station shall be permitted.

(2) Clinical sink. Where running water is required for

3.1-3.3.3.2 Physical requirements. The following

materials preparation, a clinical sink(s) or flushing­

shall be provided:

rim sink shall be provided. See Section 2.5-2.3.5

(1) Work areas, counters, and/or tables suitable for
(Clinical Sinks) for requirements.
resident-operated mobility device access and

standard seated access

3.1-3.3.4.2 Speech and hearing services
*(2) An area for practicing activities of daily living
(1) Where speech and hearing services are provided in
(3) Hand-washing stations. Occupational therapy

the facility, space for evaluation and treatment shall

area(s) shall have access to either a hand-washing

be provided.
station or a hand sanitation dispenser.

(2) The therapy area(s) shall be provided with speech

(a) Hand-washing stations shall be provided
in each occupational therapy room where
hands-on resident or client care is provided.
(b) Any occupational therapy room that does not
require a hand-washing station shall have a
dedicated hand sanitation dispenser.
(c) One hand-washing station shall be permitted
to serve several occupational and/or physical
therapy treatment stations.
3.1-3.3.4 Other Rehabilitation Therapy Facilities
privacy. The design shall minimize external sound
from high-traffic, public, and similar noisy areas.
See Section 2.5-8 (Acoustic Design Systems) for
information.
3.1-3.3.4.31herapeutic pool and hydrotherapy
whirlpool
(1) Where a therapeutic pool(s) is provided, see
appendix section A5.2-2.3.3.3 (3) (Aquatic center)
for information.
(2) Where portable hydrotherapy whirlpools

are provided, see Section 2.5-2.3.6 (Portable'

3.1-3.3.4.1 Prosthetic and orthotic work areas. Hydrotherapy Whirlpools) for requirements.

Where prosthetics and orthotics services are provided

in the facility, the following shall be provided: *3.1-3.3.4.4 Provisions for additional therapies.
(1) Space for evaluation and fitting. This space shall
Where additional therapies are offered in the facility,
have provisions for privacy for the fitting and
space for them shall be provided.
adjustment of prosthetics.

(2) Hand-washing station 3.1-3.3.5 Support Areas for Rehabilitation

Therapy
(a) Where staff is required to work with or mix
wet material, or handle material or chemicals
3.1-3.3.5.1 Reception area
that are caustic to the skin, a hand-washing
station shall be provided. (1) Where a reception area is provided, provisions
shall be made for visual observation of the waiting
areas(s).

APPENOIX

A3.1-3.3.3.2 {2} Areas for practicing activities of daily living could

A3.1-3.3.4.4 Additional therapies could include thermotherapy,

include a residential kitchen, bathroom, or other area that supports

diathermy, and ultrasonics. Art and music theraflY and recreational

daily function for aresident or client. Residents liVing in afacility could

therapy are usually tied to activities of daily living and activity program­

also practice activities. of daily living in their resident rooms or in acom­

ming and require storage, an activity room, and atoil.et room sized and

munityspace used for activities and as support space for occupational

configured to accommodate accessipility st~ndards that support inde­

therapy.
pendent resident use.

----------------------~._._---------------_._._ ..._ - - - - - . - - - - - - ­

136 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

(2) Combination of the reception area with the
documentation or charting area shall be permitted.
3.1-3.3.5.2 Documentation area. Provisions shall
be made for documentation, filing, and retrieval of
resident records.
3.1-3.3.5.3 Clean utility room. A clean utility room
that meets the requirements in 2.3-4.2.5 (Clean Utility
Room) shall be provided in each resident unit.
3.1-3.3.5.4 Soiled utility room. A soiled utility room
that meets the requirements in 2.3-4.2.6 (Soiled Util­
ity Room) shall be provided in each resident unit.
3.1-3.3.5.5 Equipment and supply storage
(1) Space(s) shall be provided to store resident­
operated mobility devices out of traffic while
residents are using therapy services. These spaces
shall be located in, next to, or directly accessible
from the treatment area(s).
(2) See Section 2.3-4.2.4 (Equipment and Supply
Storage) for additional requirements.
3.1-3.3.5.6 Environmental services rooms. See
Section 2.3-4.9 (Environmental Services Rooms) for
requirements.
3.1-3.3.6 Support Areas for Staff
Support areas for staff shall be provided and may be
shared. See Section 2.3-4.3 (Support Areas for Staff)
for requirements.
3.1-3.3.7 Resident Support Areas for
Rehabilitation Therapy
3.1-3.3.7.1 Changing areas. Where required by
the therapy program, changing areas, showers,andl
or lockers shall be provided. See Section 2.5-2.3.3.2
(Accessible showers) for shower requirements.
APPENDIX
AJ.1' -4.2.1.2 Depending on the type ofservice to be provided and
the care plan, direct care staff work areas need not be encumbered
with all the provisions for asupervisory administrative staff work area.
In some decentra.lized arrangements, caregiving functions maybe
- - - - - - - - - - - - - - - - - - _.._------_._--­
Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
3.1-3.3.7.2 Toilet room(s)
(1) Toilet room(s) shall be usable by residents using
resident-operated mobility devices.
(2) Toilet rooms shall be provided next to or directly
accessible from changing areas.
(3) If therapy treatments include toileting, toilet rooms
shall include hand-washing stations. See 2.4-2.2.8
(Hand-Washing Stations) for requirements.
(4) See Section 3.1-2.2.2.6 (Resident toilet room) for
additional requirements.
3.1-3.4 Wellness Centers
Where wellness facilities are provided, see Chapter
5.2 (Specific Requirements for Wellness Centers) for
requirements.
• 3.1-4 Facilities for Support Services
3.1-4.1 General
See Section 2.3-4.1 (Facilities for Support Services­
General) for requirements.
3.1-4.2 Facilities that Support Resident,
Participant, or Outpatient Care
3.1-4.2.1 Staff Work Area(s)
See Section 2.3-4.2.1 (Staff Work Area) for
requirements.
3.1-4.2.1.1 Nurse station for centralized staffing.
Where caregiving is organized on a centralized staffing
model, staff work areas shall provide for charting or
transmitting charted data and any storage for adminis­
trative activities.
*3.1-4.2.1.2 Nurse station for decentralized staffing.
Where caregiving is decentralized, supervisory work
areas need not accommodate charting activities
or allow a direct view of resident rooms. Rather,
decentralized direct care staff work areas shall be used
for charting or transmitting charted data and any
storage for administrative activities.
accommodated with apiece of residential furniture (e.g., atable or
desk) or awork cO\lnter recessed into an alcove off acorridor or activity
space, with or without computer and communications equipment, stor­
age facilities, and so on.
137
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

3.1-4.2.2 Medication Distribution and Storage 3.2-4.2.3.6 The design details of all bathing facilities
Locations (Centralized and Decentralized) provided shall be in accordance with Section 3.1­
See Section 2.3-4.2.2 (Medication Distribution and
2.2.2.7 (Resident bathroom).
Storage Locations) for requirements.

3.1-4.2.4 Equipment and Supply Storage

*3.1-4.2.3 Central Bathing Rooms or Areas
3.1-4.2.4.1 General. See Section 2.3-4.2.4 (Equip­
3.1-4.2.3.1 See Section 2.5-2.3.3.2 (Accessible ment and Supply Storage) for requirements in addition
showers) for requirements. to those in this section.

3.1-4.2.3.2 Number 3.1-4.2.4.2 Decentralized clean linen storage. A

(1) Where a shower is not provided in the resident
bathroom, residents shall have access to at least
one central bathing room or area per floor or unit
that is sized to permit assisted bathing in a tub or
shower.
separate closet or designated area shall be provided for
clean linen storage.
(1) A decentralized clean utility room shall be
permitted to be used for the storage of clean linen.
(2) Where a closed-cart system is used, storage in an

[ *(2) A minimum of one bathtub or shower shall be alcove shall be permitted.

provided for every 20 residents (or major fraction

thereof) not otherwise served by bathing facilities
in resident bathrooms.
3.1-4.2.3.3 Accessibility
(1) The bathtub or spa tub in this room shall be
3.1-4.2.4.3 Storage for mobility devices and sup­
port equipment. Storage for resident-operated mobil­
ity devices and personal support equipment shall allow
this equipment to be accessible to residents at all times
without entering another resident's living space.

accessible to residents in wheelchairs.

3.1-4.2.5 Clean Utility Room

(2) The shower shall have fittings accessible to a

resident in a recumbent position.

3.1-4.2.5.1 See Section 2.3-4.2.5 (Clean Utility

(3) Adult resident shower rooms shall be designed to
Room) for requirements in addition to those in this
allow entry of portable/mobile mechanical lifts,
section.
shower gurney devices, and shower chairs.

*3.1-4.2.5.2 Storage for clean linen, towels, equipment,

*3.1-4.2.3.4 A separate toilet and hand-washing sta­
safety devices, and supplies shall be provided in cabi­
tion shall be provided in or directly accessible to each
nets, closets, or a separate storeroom.
bathing area without requiring entry into the general
corridor.
3.1-4.2.6 Soiled Utility Room

3.1-4.2.3.5 Access to a grooming location without

3.1-4.2.6.1 See Section 2.3-4.2.6 (Soiled Utility
reentry to the general corridor shall be provided. This
Room) for requirements in addition to those in this
shall contain the following:
section.
(1) Hand-washing station
(2) Mirror
(3) Counter or shelf

A3.1-4.2.3 Consideration should be givento privacy wh~n locating A3.1-4.2.3 •.4 This toilet may also serve as the toilet-training facility
entrances to bathing rooms. for rehabilitation.
A3.1-4.2.3.2 (2) Number. Theminimum bathtub or shower A3.1-4.2.5.2 Provision of a dryer and folding area. should be consid­
unit requirements should be verified with the local plumbing code. ered when linens and towels are to be laundered on-site.

138 Guidelines for Design and Construction of Residential Health. Care. and Support Facilities
 3.1 SPECIFIC REQUIREMENTS fOR NURSING HOMES

*3.1-4.2.6.2 An area for temporary holding of soiled 3.1-4.5.1 General

material shall be provided.
3.1-4.2.7 Personal Laundry Facilities
See Section 2.3-4.2.7 (Personal Laundry Facilities) for
requirements.
3.1-4.2.8 Resident Telephone Access
See Section 2.3-4.2.8 (Resident and Participant
Telephone Access) for requirements.
3.1-4.3 Support Areas for Staff
See Section 2.3-4.3 (Support Areas for Staff) for
requirements.
The type and size of the nursing home facility shall
determine the dietary environment and the food
service facilities provided.
3.1-4.5.2 Central Commercial Kitchen
Where a central commercial kitchen is provided, food
service facilities shall be provided in accordance with
Section 2.3-4.5 (Food Service Facilities).
3.1-4.5.3 Warming Kitchen
If the facility has a service contract with an ourside
vendor for food service, a warming kitchen designed to
meet the following requirements shall be provided.

3.1-4.4 Support Facilities for Family and

3.1-4.5.3.1 Where an outside vendor is used to
Visitors
provide meals, the facility shall include dedicated space
and equipment for a warming kitchen, including space
3.1-4.4.1 Overnight Guest Accommodations for minimal equipment for preparation of breakfast,
Where sleeping accommodations for visitors are pro­ emergency, or after-hours meals.
vided, the following requirements shall apply:
3.1-4.5.3.2 The resident kitchen shall be permitted
3.1-4.4.1.1 Where a sleeping accommodation (e.g., to serve as an alternative location to accommodate the

recliner, sleep chair, sleep sofa) is located in the
resident room, space shall be provided for circulation
when the furnishing is fully open for use so staff can
access the resident in case of an emergency.
3.1-4.4.1.2 Storage space shall be provided to accom­
modate and secure overnight guests' belongings.
3.1-4.4.2 Pet Accommodations
See Section 2.3-4.4.3 (Pet Accommodations) for
requirements.
3.1-4.4.3 Kitchen Facilities
Where kitchen facilities that permit use by family
members and visitors are provided, see Section 3.1­
2.3.4 (Resident Kitchen) for requirements.
function of a warming kitchen. See Section 2.3-2.3.4
(Resident and Participant Kitchen) for requirements.
3.1-4.5.4 Decentralized Kitchen
Where food preparation is conducted on-site, the facil­
ity shall have dedicated non-public space and equip­
ment for preparation of meals. See Section 2.3-2.3.4
(Resident and Participant Kitchen) for requirements.
3.1-4.6 Linen and Laundry Service Facilities
3.1-4.6.1 General
3.1-4.6.1.1 Each facility shall have provisions for
storing and processing clean and soiled/contaminated
linen.

*3.1-4.6.1.2 Where a facility includes a commercial

3.1-4.5 Food Service Facilities
laundry, the following requirements shall apply:

A3.1-4.2.6.2 Provision of awasher and sorting area should be con­

of personal laundry facilities and contracted services to provide linen

sidered when linens and towels are to be laundered on-site.

service. See Section 2.3-4.2.7 (Personal Laundry Facilities) for reqUire­

ments.

A3.1-4.6.1.2 For certain care models, laundry services may be

decentralized using personal laundry facilities and/or acombination
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Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 139
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

(1) Processing shall be permitted to take place in the (3) Room(s) used for processing shall have a deep sink
facility, in a separate building on- or off-site, or in for soaking and/or a flushing-rim sink.
a shared laundry.
(2) At minimum, the elements in Section 3.1-4.6.2
3.1-4.6.3.3 Linen carts
(Laundry Facility) shall be provided.
(1) Provisions shall be made for parking clean and
soiled linen carts separately and out of traffic.
3.1-4.6.2 Laundry Facility (2) Provisions shall be made for cleaning linen cans on
premises (or for exchange of carts off premises).
3.1-4.6.2.1 Layout. Equipment shall be arranged to
permit an orderly workflow and minimize cross-traffic 3.1-4.6.3.4 Hand-washing stations
that might mix clean and soiled operations.
(l) Hand-washing stations shall be provided in each
area where unbagged soiled linen is handled.
3.1-4.6.2.2 Where linen is processed in a laundry

(2) See Section 2.4-2.2.8 (Hand-Washing Stations) for

facility in the nursing home, the following shall be

additional requirements, except for Section

provided:

2.4-2.2.8.7 (Hand-Washing Stations-Mirror).

(1) Receiving, holding, and sorting room

(a) This room shall be provided to accommodate
control and collection of soiled linen.
(b) Soiled linen chutes shall be permitted to
discharge in this room or in an adjacent
separate room.
(2) Washers/extractors. Washers/extractors shall be
3.1-4.6.4 Support Areas for Facilities Using Off­
Site Linen Processing
Where linen is processed off-site or in a separate
building on-site, the following shall be provided:
3.1-4.6.4.1 A service entrance, protected from

inclement weather. This shall be permitted to be shared

located between the soiled linen receiving and

with other services.

clean processing areas.

(3) Dryers
3.1-4.6.4.2 A control station, which can be shared
(4) Supply storage. Storage shall be provided for

with other services

laundry supplies.

(5) Inspection and mending area. An area shall be

3.1-4.7 Materials Management Facilities

provided for linen inspection and mending.

See Section 2.3-4.7 (Materials Management Facilities)

3.1-4.6.3 Support Areas for Linen Services for requirements.

3.1-4.6.3.1 Central dean linen storage. A cen­
tral clean linen storage and issuing room(s) shall be
provided in addition to the linen storage required at
individual resident units. See Section 2.3-4.2.5 (Clean
Utility Room) for additional information.
3.1-4.6.3.2 Soiled holding room(s). Separate central
or decentralized room(s) shall be provided for receiving
and holding soiled linen for pickup or processing. See
Section 2.3-4.2.6 (Soiled Utility Room) for require­
ments in addition to those in this section.
(1) Room(s) shall have ventilation and exhaust.
(2) Discharge from soiled linen chutes shall be received
in this room or in a separate room, as required by
the local authority having jurisdiction.
3.1-4.8 Waste Management Facilities
See Section 2.3-4.8 (Waste Management Facilities) for
waste collection, storage, and disposal requirements.
3.1-4.9 Environmental Services Rooms
See Section 2.3-4.9 (Environmental Services Rooms)
for requirements.
3.1-4.10 Facilities for Engineering and
Maintenance Services
See Section 2.3-4.10 (Facilities for Engineering and
Maintenance Services) for requirements.
3.1-4.11 Administrative Areas

140 Guidelines for Design and Construction of Residential Health, Care. and Support Facilities
 3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

3.1-4.11.1 Office and Conference Space

3.1-5.2.2.2 Corridors. See Section 2.4-2.2.2
Offices or an open office area with private confer­
(Corridors) for requirements.
ence space shall be provided for business transacrions,

admissions, and social services and for the use of

3.1-5.2.2.3 Ceiling height. See Section 2.4-2.2.3
administrative and professional staff.
(Ceiling Height) for requirements.

*3.1-4.11.1.1 Conference space. Space for private
interviews; staff, resident, and family meetings; confer­
ences; and health education shall be sized to accom­
modate operational and activity needs.
(1) Space shall include provisions for use of visual aids
and technology.
(2) Sharing of space by several services shall be
hinged, sliding, or folding.
permitted.
(b) All doors between corridors, rooms, or spaces
3.1-4.11.1.2 General office space. Office space shall
be provided for staff and file storage.
3.1-4.11.1.3 Supply and copy room. Space for stor­
age of files, office equipment, and supplies shall be
provided.
3.1-5.2.2.4 Doors and door hardware. See Section
2.4-2.2.4 (Doors and Door Hardware) for require­
ments in addition to those in this section.
(1) Door type
(a) Doors to all rooms containing bathtubs,
showers, and toilets for resident use shall be
subject to occupancy shall be of the swing type
or shall be sliding doors.
(c) Manual or automatic sliding doors shall
be permitted where their use does not
compromise fire and other emergency exiting
requirements.
(2) Door hardware

*(a) Sliding doors shall not have floor tracks.

• 3.1-5 Design and Construction
(b) In shared resident bathrooms, use of privacy
Requirements for Nursing Homes
locks with emergency access release shall be
permitted.
3.1-5.1 Building Codes and Standards

See Section 2.4-1.2 (Building Codes and Standards)

3.1-5.2.2.5 Thresholds and expansion joint covers.
for requirements.
See Section 2.4-2.2.5 (Thresholds and Expansion Joint
Covers) for requirements.
3.1-5.2 Architectural Details, Surfaces, and

Furnishings
3.1-5.2.2.6 Windows
(1) See Section 2.4-2.2.6 (Windows) for requirements.
3.1-5.2.1 General
(2) For facilities where resident elopement or falls
See Section 2.4-2.1 (Architectural Details, Surfaces,
from windows may be a risk to resident safety,
and Furnishings-General) for requirements.
see Section 2.2-4.2.1.6 (Physical Environment
Elements for Risk Reduction-Operable windows)
3.1-5.2.2 Architectural Details for additional requirements.

3.1-5.2.2.7 Glazing materials. See Section 2.4-2.2.7

3.1-5.2.2.1 General. See Section 2.4-2.2.1 (Architec­
(Glazing Materials) for requirements.
tural Details-General) for requirements.

APPENDIX

A3.1-4.11.1.1 Kitchenette for conference space.

A3.1-S.2.2.4 (2)(a) Eliminating the floor tracks and using break­
Provision of kitchenette facilities, including under-eounter refrigerator,
away door hardware minimizes the possibility of jamming.
microwave, and sink, should be considered for the conference space.

---------------_._-------------------------------­
Guidelines for Design and Construction of Residential Health, Care, and Support Faciiities 141
3.1 SPECIFIC REQUIREMENTS fOR NURSING HOMES
3.1-5.2.2.8 Hand-washing stations. See Section
2.4-2.2.8 (Hand-Washing Stations) for requirements.
3.1-5.2.2.9 Grab bars. See Section 2.4-2.2.9 (Grab
Bars) for requirements.
3.1-5.2.2.10 Handrails. See Section 2.4-2.2.10
(Handrails and Lean Rails) for requirements.
3.1-5.2.2.11 Protection from heated surfaces. See
Section 2.4-2.2.11 (Protection from Heated Surfaces)
for requirements.
3.1-5.2.2.12 Signage and wayfinding. See Section
2.4-2.2.12 (Signage and Wayfinding) for requirements.
3.1-5.2.2.13 Decorative water features. Where
decorative water features are used in the facility design,
see appendix section A2.4-2.2.13 (Decorative water
features) for recommendations.
3.1-5.2.3 Surfaces
3.1-5.2.3.1 See Section 2.4-2.3 (Surfaces) for require­
ments in addition to those in this section.
*3.1-5.2.3.2 To reduce surface contamination linked
to health care-associated infections, surface materials
selected for use in nursing homes shall possess the fol­
lowing performance characteristics:
(1) Surfaces shall be cleanable and have no surface
3.1-6.2.3.4 Reserved
crevices or rough textures, joints, or seams.
(2) Surfaces shall be non-absorptive, nonporous, and
smooth.
3.1-5.2.4 Furnishings
See Section 2.4-2.4 (Furnishings) for requirements.
• APPENDIX,
A~.1-5.2.3.2S.urfaces and materials sel~cted shouldb~easy to
use and have clear, written, manufactureHecommended cleaning
and disinfection protocols to assure the product willr~tnaih dUrable
and eff~ctiv,e at meeting'COC andoth~r c1ini(al bact~rial-~Iimination
requirements.
The Centerfor Health D~sign report "Designing for Patient Saf~tY:
nev~loping Methods to Il1tegrat~ Pati~nt Safety Conc~rns in the O~sign
Process" identified environmental factors as"latent conditions that
---------------------------------------------------
142 Guide ines for Design and Construction of Residential Health, Care, and Support Facilities
• 3.1-6 Building Systems
3.1-6.1 General
See Section 2.5-1 (Building Systems for Residential
Health, Care, and Support Facilities-General).
3.1-6.2 Plumbing Systems
3.1-6.2.1 General
See Section 2.5-2.1 (Plumbing Systems-General) for
additional requirements.
3.1-6.2.2 Plumbing and Other Piping Systems
See Section 2.5-2.2 (Plumbing and Other Piping
Systems) for requirements.
3.1-6.2.3 Plumbing Fixtures
3.1-6.2.3.1 Reserved
3.1-6.2.3.2 Hand-washing sinks. See Section 2.5­
2.3.2 (Hand-Washing Sinks) and Section 2.4-2.2.8
(Hand-Washing Stations) for requirements.
3.1-6.2.3.3 Showers. See Section 2.5-2.3.3.2
(Accessible showers) for requirements and appen­
dix section A3.1-2.2.2.7 (3) (Accessible shower) for
recommendations.
3.1-6.2.3.5 Clinical sinks. See Section 2.5-2.3.5
(Clinical Sinks) for requirements.
3.1-6.2.3.6 Portable hydrotherapy whirlpools. See
Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools)
for requirements.
can be _d~signed tohelp~liminate harm." Such "built environment
latent conditions [holes and weaknesses] that adversely impact patient
safety" should be identified and eliminated during the planning,
design, and construction of health care facilities. Redunion of surface
contamination linked to health care-associated infections is one of
these factors. See Section 1.2-3 (Resident Safety RiSk i\ssessment) for
additional information.
------

3.1-6.2.4 Medical Gas and Vacuum Systems
Any installation of nonflammable medical gas, air, or
clinical vacuum systems shall comply with the require­
ments ofNFPA 99: Health Care Facilities Code.
3.1-6.3 Heating, Ventilation, and
Acceptable Indoor Air Quality in Low-Rise
Air-Conditioning (HVAC) Systems
Residential Buildings.
3.1-6.3.1 General
3.1-6.3.1.1 Application. HVAC systems that meet
the requirements in this section shall be provided for
nursing homes.
3.1-6.3.1.2 Ventilation and space conditioning
(1) See Section 2.5-3.1.2 (Ventilation and Space
Conditioning for requirements in addition to those
in this section.
*(2) Ventilation systems shall be designed to provide
control of environmental comfort, asepsis, and
odor control in resident spaces.
(a) Design of the ventilation system shall provide
air movement that is generally from clean to
less clean areas. If any form of variable-air­
volume or load-shedding system is used for
energy conservation, it shall not compromise
the pressure-balancing relationships or the
minimum air changes required in Table
3.1-1 (Design Parameters for Ventilation of
Residential Health Spaces).
(b) See Table 3.1-1 for ventilation requirements
intended to provide for comfort and asepsis
and odor control in nursing home spaces that
directly affect resident care.
(c) For spaces not specifically listed in Table 3.1.1:
(i) Ventilation requirements shall be those
for functionally equivalent spaces in Table
3.1-1.
(ii) If no functionally equivalent spaces exist in
Table 3.1-1, ventilation requirements shall
APPENDIX
A3.1-6.3.1.2 (2) Ventilation system design. Because
of the diversity of the population and variations in susceptibility and
sensitivity, the specific care population's needs should be taken into
consideration when prOViding ventilation for comfort, infection control,
and odor control.
----_.'._- - - - - - - - - - - - - - - - - - ­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
be obtained from Informative Appendix B
in ANSI!ASHRAE Standard 62.1: Ventila­
tion and Acceptable Indoor Air Quality or
from Informative Appendix B in ANSI!
ASHRAE Standard 62.2: Ventilation and
(iii) Where spaces with prescribed rates are in­
cluded in both ANSI!ASHRAE Standard
62.1 or 62.2 and Table 3.1-1, the higher
of the air change rates shall be used.
(d) Air change rates. The minimum number of
total air changes per hour indicated in Table
3.1-1 shall be either supplied for positive
pressure rooms or exhausted for negative
pressure rooms.
(i) For spaces that required by Table 3.1-1 to
have a negative pressure relationship but
are not required to be exhausted, the sup­
ply airflow rate shall be used to compute
the minimum total air changes per hour
required.
*(ii) For spaces that require a positive or nega­
tive pressure relationship, the number of
air changes per hour can be reduced when
the space is unoccupied as long as the
required pressure relationship to adjoin­
ing spaces is maintained while the space
is unoccupied and the minimum number
of air changes indicated is reestablished
whenever the space is occupied.
(e) Use of controls intended to switch the required
pressure relationships between spaces from
positive to negative, and vice versa, shall not be
permitted.
(f) For air-handling systems serving multiple
spaces, system minimum outdoor air quantity
shall be calculated using one of the following
methods:
(i) As the sum of the individual space require­
ments
A3.1-6..3.1.2 (2)(d)(ii) Air exchang,es. Air change rates in
excess of the minimum values are expected in some cases to maintain
room temperature and humidity conditions based on the cooling or
heating load of the space.
143
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
(ii) By the "ventilation rate procedure" (mul­
tiple zone formula) of ASH RAE Standard
62.1. The minimum outdoor air change
rate listed in this standard shall be inter­
preted as the V oz (zone outdoor airflow)
for purposes of this calculation.
(3) Outdoor air intakes and exhaust discharges.
Equipment shall comply with Table 5.5.1 (Air
Intake Minimum Separation Distance) in ANSI!
ASHRAE Standard 62.1.
3.1-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
3.1-6.3.3 HVAC Requirements for Specific
Locations
3.1-6.3.3.1 Reserved
3.1-6.3.3.2 Fuel-fired equipment rooms. See
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
requirements.
3.1-6.3.3.3 Areas of refuge. See Section 2.5-3.3.3
(Areas of Refuge) for requirements.
3.1-6.3.3.4 Commercial food preparation areas.
See Section 2.5-3.3.4 (Commercial Food Preparation
Areas) for requirements.
3.1-6.3.4 Thermal and Acoustic Insulation
See Section 2.5-3.4 (Thermal and Acoustic Insulation)
for requirements.
3.1-6.3.5 HVAC Air Distribution
See Section 2.5-3.5 (HVAC Air Distribution) for
*3.1-6.3.7.2 Heating systems
requirements.
3.1-6.3.6 HVAC Filters
3.1-6.3.6.1 Filter efficiencies
APPENDIX
A3.1-6.3.6.1 (2)(c) Filters for recirculating room
systems. Filters should be replaced and/or cleaned per the manufac­
turer's recommendations to maintain indoor air quality.
144 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
(1) For centralized recirculated systems, see Table 3.1-1
(Design Parameters for Ventilation of Residential
Health Spaces) for required filter efficiencies.
(a) Each filter bank with an efficiency greater than
MERV 12 shall be provided with an installed,
readily accessible manometer or differential
pressure-measuring device that provides a
reading of differential static pressure across the
filter to indicate when the filter needs to be
replaced.
(b) All air provided to a space by centralized
recirculated systems shall be filtered.
(2) For non-central recirculating room systems, HVAC
units shall:
(a) Not receive nonfiltered, nonconditioned
outdoor air.
(b) Serve only a single space.
*(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
designed to condense water. This filter shall be
located upstream of any such cold surface so
that all of the air passing over the cold surface
is filtered.
3.1-6.3.6.2 Filter frames for centralized systems
(1) Filter frames shall be durable and proportioned to
provide an airtight fit with the enclosing ductwork.
(2) All joints between filter segments and the enclosing
ductwork shall have gaskets or seals to provide a
positive seal against air leakage.
3.1-6.3.7 Heating Systems, Cooling Systems, and
Equipment
3.1-6.3.7.1 Reserved
(1) Heating sources and essential accessories shall be
provided in number and arrangement sufficient
to accommodate the facility needs (reserve
capacity) even when anyone of the heat sources
or essential accessories is not operational due to a
A3.1-6.3.7.2 Heating systems. Storage on-site of fuel suf­
ficient to support the owner's facility operation plan upon loss of fuel
service should be considered as part of the disaster and emergency
preparedness plan.

breakdown or routine maintenance. Exception:
Reserve capacity is not required if the ASHRAE
99% heating dry-bulb temperature for the nursing
home is greater than or equal to 25° F (-40 C).
(2) When a heat source is off-line, the capacity of the
remaining source(s) shall be sufficient to provide
for domestic hot water and dietary purposes and to
provide heating for resident care areas and resident
rooms.
(3) See Table 3.1-1 (Design Parameters for Ventilation
of Residential Health Spaces) for additional
requirements.
3.1-6.3.7.3 Cooling systems
(1) For central cooling systems greater than a 400­
ton (1407 kW) peak cooling load, the number
and arrangement of cooling sources and essential
accessories shall be sufficient to support the
nursing home operation plan upon a breakdown
or during routine maintenance of anyone of the
cooling sources.
(2) See Table 3.1-1 (Design Parameters for Ventilation
of Residential Health Spaces) for additional
requirements.
3.1-6.3.7.4 Temperature control. See Section 2.5­
3.7.4 (Temperature Control) for requirements.
3.1-6.4 Electrical Systems
3.1-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
3.1-6.4.2 Power-Generating and Power-Storing
Equipment
3.1-6.4.2.1 Essential electrical service
(1) Applicable standards
*3.1-6.4.3.3 Receptacles in resident rooms
(a) At minimum, nursing homes or sections
thereof shall have essential electrical systems as
required in:
APPENDIX
A3.1-6.4.3.3 Resident room receptacles. During the
functional programming process, all equipment, electric beds, task
lamps, televisions, data equipment, telephones, electronics, and other
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
(i) NFPA 99: Health Care Facilities Code
(ii) NFPA 110: Standardfor Emergency and
Standby Power Systems, requirements that
address nursing homes
(iii) NFPA 70: National Electrical Code,
requirements that address nursing homes
(b) Requirements for emergency lighting in
nursing homes shall be dictated by local codes
according to the care model.
(2) Shared service. Where the nursing home is a
distinct part of or served by an acute care hospital
on the same campus, required emergency lighting
and power shall be permitted to be provided by the
hospital essential electrical system.
(3) Where fuel for electricity generation is stored
on-site, the following shall be required:
(a) Storage capacity shall be sufficient to provide
continuous operation in accordance with state
requirements.
(b) Fuel storage for electricity generation shall be
separate from heating fuel storage.
3.1-6.4.2.2 Generators. Exhaust systems (including
locations, mufflers, and vibration isolators) for internal
combustion engines shall be designed and installed to
minimize noise.
3.1-6.4.3 Electrical Receptacles
3.1-6.4.3.1 General. Omission of receptacles from
exterior walls where consttuction makes installation
impractical shall be permitted. See Section 2.5-4.3.1
(Electrical Receptacles-General) for additional
information.
3.1-6.4.3.2 Receptacles in corridors. See Section
2.5-4.3.2 (Receptacles in Corridors) for requirements.
(1) Each resident room shall have duplex-grounded
receptacles, including at least one on each wall.
resident and care uses in resident rooms that will require electrical
receptacles should be identified during the functional programming
process. Providing enough outlets to avoid the need for extension cords
145
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

(2) At least two duplex outlets shall be provided for
each bed location, with one at each side of the
head of each bed location. Where electric-powered
beds are used, an additional outlet shall be
provided at the head of the bed.
3.1-6.4.3.4 Essential electrical system receptacles.
See Section 2.5-4.3.4 (Essential Electrical System
Receptacles) for requirements.
3.1-6.4.3.5 Ground fault interrupter receptacles. See
Section 2.5-4.3.5 (Ground Fault Interrupter Recep­
tacles) for requirements.
3.1-6.4.4 Electrical Requirements for Ventilator­
Dependent Resident Rooms and Areas
See Section 2.5-4.4 (Electrical Requirements for
Ventilator-Dependent Resident Rooms and Areas) for
requirements.
3.1-6.5.2.2 Resident room call stations
(1) Where a hardwired system is used, each bed
location shall be provided with a call device that is
accessible to the resident.
(a) One call station shall be permitted to serve two
call devices.
(b) Wireless call stations are permitted.
(2) A call initiated by a resident activating either a
call device attached to a resident's call station or a
portable device that sends a call signal shall register
at the staff call station or device and shall either:
(a) Activate a visual signal in the corridor at the
resident's door. In multi-corridor or cluster
resident units, additional visual signals shall be
installed at corridor intersections; or
(b) Activate a handheld mobile device carried by a
staff member, identifYing the specific resident
and location from which the call was placed.

3.1-6.5 Communication Systems

*3.1-6.5.2.3 Emergency call system. An emergency
3.1-6.5.1 General
See Section 2.5-5.1 (Communication Systems­
General) for requirements.
3.1-6.5.2 Call System
A nurse/staff call system shall be provided.
3.1-6.5.2.1 General
(1) Use of alternative technologies, including wireless
systems, shall be permitted for emergency or nurse
call systems.
(a) Where wireless systems are used, consideration
shall be given to electromagnetic compatibility
call device shall be accessible from each toilet, bathtub,
and shower used by residents.
(1) The device shall be accessible to a resident in any
position in the room, including lying on the floor.
Inclusion of a pull cord or portable wireless device
shall satisfY this requirement.
(2) The emergency call system shall be designed so
that a call activated will initiate a signal that is
distinct from the resident room call device and can
be turned off only at the activated emergency call
device.
(3) The signal shall activate at the staff work area and/
or signal a handheld mobile device carried by staff.
3.1-6.5.3 Technology Equipment and Teledata

between internal and external sources.

Room(s)

(b) Wireless systems shall comply with UL

Standard 1069: Hospital Signaling and Nurse See Section 2.5-5.3 (Technology Equipment and

Call Equipment. Teledata Room) for requirements.

(2) Nurse and emergency call systems shall be listed by

a nationally recognized testing laboratory (NRTL).

is recommended as use of extension cords can be a hazard and lead to

A3.1-6.5.2.3 Hair salons, resident lounges, and all common

regulatory citations. As well, the outlet height that willpromote ease of

resident areas should be evaluateMor incorporation of emergency

use by residents, staff, and family members should be determined.

-----------"-_._-------"---------­
146 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities

3.1-6.5.4 Grounding for Telecommunication
Spaces
See Section 2.5-5.4 (Grounding for Telecommunica­
tion Spaces) for requirements.
3.1-6.5.5 Cabling Pathways and Raceway
Requirements
See Section 2.5-5.5 (Cabling Pathways and Raceway
Requirements) for requirements.
3.1-6.6 Electronic Safety and Security Systems
See Section 2.5-6 (Electronic Safety and Security
Systems) for requirements.
3.1-6.7 Daylighting and Artificial Lighting
Systems
3.1-6.7.1 General
See Section 2.5-7.1 (Daylighting and Artificial Light­
ing Systems-General) for requirements.
3.1-6.7.2 Daylighting Systems in Resident Living
Areas
See Section 2.5-7.2 (Daylighting Systems in Resident,
Participant, and Outpatient Areas) for requirements.
3.1-6.7.3 Artificial Lighting Systems
3.1-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
(Light Fixtures) for requirements.
3.1-6.7.3.2 Lighting requirements for specific loca­
tions. See appendix section A2.5-7.3.2 (Lighting in
transition spaces) for recommendations.
(1) Resident unit corridors
(a) Resident unit corridors shall have general
APPENDIX (continued)
call system stations. This evaluation should consider the care model,
care population, scale of the facility, and staff sight lines for observing
residents.
A3.1-6.7.3.2 (2)(a)(i) Provision of movable task lighting should
be considered.
A3.2-6.7.3.2 (2)(b) Night-lighting in resident
rooms. Research has established that older adults sleep best in total
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES
illumination with provisions for reducing light
levels at night.
(b) Corridors and common areas used by residents
shall have even light distribution to avoid
glare, shadows, and scalloped lighting effects.
(2) Resident rooms and toilet rooms. These rooms
shall have general lighting, task lighting, and night­
lighting.
(a) Task lighting
*(i) At least one task light shall be provided for
each resident.
(ii) Task light controls shall be readily accessi­
ble to residents and staff at the head of the
bed (including multiple-bed locations).
*(b) Night-lighting. Night-lighting shall be pro­
vided in the pathway to and from the bedside
and the bathroom.
(i) Night-lighting shall be mounted no higher
than 2 feet (61 centimeters) above the
floor.
(ii) Night-lighting shall be controlled sepa­
rately from ambient lighting.
*(iii) Night-lighting shall have a low light level.
(iv) Because night-lights may disturb resi­
dent sleep even when properly specified,
located, and operated, care providers shall
be permitted to use portable light sources
or switched night lights for added control
of this light source.
(c) Resident unit toilet rooms shall have general
illumination with provision for reducing light
levels at night.
3.1-6.8 Acoustic Design Systems
See Section 2.5-8 (Acoustic Design Systems) for
requirements.
darkness. Therefore, to minimize residentsleep disruption, night-lights
should provide very low levels of illumination and be located to mini­
mize light scatter and reflections on room surfaces. Switches for night­
lights are recommended for some care populations.
A3.2-6.7.3.2 (2)(b )(iii) Night-lighting should include amber or
red lamping. White, blue, or green lamping should not be used.
147
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

3.1-6.9 Elevator Systems the main entrance floor, the number of elevators
shall be determined from a study of the facility
3.1-6.9.1 General plan and from the estimated vertical transportation
requirements.
3.1-6.9.1.1 Requirement. All buildings having
(5) Where the facility is part of a general hospital,
resident use areas on more than one floor shall have
elevators may be shared and the standards in
electric or hydraulic elevator(s).
Section 2.5-9 (Elevator Systems) shall apply.

3.1-6.9.1.2 Number 3.1-6.9.2 Dimensions

(1) At least one elevator sized to accommodate a bed, a
gurney, and/or medical carts and resident-operated
mobility device users shall be installed where
residents are living or receiving health, care, or
support services on any floor other than the main
entrance floor.
(2) At least two elevators shall be installed where 60 to
200 residents are living or receiving health, care,
or support services on floors other than the main
entrance floor.
(3) At least three elevators shall be installed where
201 to 350 residents are living or receiving health,
care or support services on floors other than main
entrance floor.
(4) For facilities with more than 350 residents living
or receiving health, care, or support services above
Elevator car doors shall have a clear opening of not less
than 3 feet 8 inches (1.12 meters).
3.1-6.9.3 Leveling Device
See Section 2.5-9.3 (Leveling Device) for
requirements.
3.1-6.9.4 Installation and Testing
See Section 2.5-9.4 (Installation and Testing) for
requirements.
3.1-6.9.5 Handrails
Elevator cars shall have handrails on all sides without
entrance door(s). See Section 2.4-2.2.10 (Handrails
and Lean Rails) for additional requirements.

---_._------------.--_._----_._--_._----------_.__._.----_._.. __ _
..... ..

148 Guidelines for Design and Construction of Residential Health, Care, and Support Fac!lities
 3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

Table 3.1-1
Design Parameters for Ventilation of Residential Health Spaces

Function of Space Pressure Minimum Minimum All Room Air Minimum Design
Relationship Outdoor Total ACH Exhausted Filter Temperature'
to Adjacent ACH Directly to Efficiencies 3 o F/"C

Areas' Outdoors 2

All rooms Negative 2 12 Yes 13/NR6 70-85/21-29

All anteroom 7 Negative NR6 10 Yes 13/NR6 70-85/21-29

--------,_._-~"'---,~, .... ,_._.•.. _-" ... .. _-_._, .. '-..-'--_...
,.', -.'--'.~'--_._-.-.--._-----.~-~~-~~'-'~---._----~,-,-,_ .. _._----"._--~ .. _----._-------_._._._---------------------­
Resident room NR6 2 2 NR6 13/NR6 70-85/21-29

Resident living/activity/dining spaces NR6 4 4 NR6 13/NR6 70-85 /21-29

Resident corridor 4 NR6 13/NR6 70-85/21-29

Physical therapy Negative 2 6 NR6 13/NR6 70-85/21-29

_
...... ......_-_ .. _-_......... ...................­ ................

Occupational therapy 2 6 NR6 13/NR6 70-85/21-29

Toilet/bathing room Negative 10 Yes 13/NR6 70-85/21-29

Hair salon Negative 10 Yes 7/NR6 70-85/21-29

Food preparation 8 2 6 NR6 13/NR6 70-85/21-29

Warewashing Negative NR6 10 Yes 7/NR6 70-85/21-29

Dietary storage NR6 NR6 2 NR6 7/NR6 70-85/21-29

Central laundry Negative 2 10 Yes 7/NR6 70-85/21-29

-----­
Personal laundry Negative 2 10 Yes 7/NR6 70-85/21-29

50iled utility Negative 2 10 Yes 7/NR6 70-85/21-29

----------­
Clean utility Positive 2 10 Yes 7/NR6 70-85/21-29
_ . _ - _ . _ . - . . . . _ . _ •• _ . ~ . _ . - ___ v
---_._----------------_._-".. _."."--"."-,-"----_.... _.--_._--_.,-"---_....... _..__.
Environmental services room Negative NR6 10 Yes 7/NR6 70-85/21-29

Hazardous waste storage Negative 2 10 Yes 7/NR6 70-85/21-29

Linen and trash chute room Negative NR6 10 Yes 7/NR6 70-85/21-29

'lf pressure-monitoring device alarms are installed, allowances shall be made to prevent nuisance alarms. Short-term excursions from required
pressure relationships shall be allowed while doors are moving or temporarily open. Simple visual methods such as smoke trail, ball-in-tube, or
flutterstrip shall be permitted for verification of airflow direction.
21n some areas with potential contamination and/or odor control problems, exhaust air shall be discharged directly to the outdoors and not
recirculated to other areas. Individual circumstances may require special consideration for air exhausted to the outdoors. To satisfy exhaust needs,
constant replacement air from the outdoors is necessary when the system is in operation.
3Table entries are the minimum filter efficiencies required for each space. The first entry in this table is the minimum filter efficiency for Filter
Bank No.1. The second table entry (after the slash) is the minimum filter efficiency for Filter Bank NO.2. The minimum efficiency reporting
value (MERV) is based on the method oftesting described in Informative Appendix Bin ANSI/ASH RAE Standard 52_2: Method of Testing General
Ventilation Air-Cleaning Devices for Removal Efficiency by Particle Size.
'Systems shall be capable of maintaining the rooms within the range identified. Operationally, 71-81/22-27 is reqUired by CMS. Lower or higher
temperature shall be permitted when residents' comfort and/or medical conditions require different conditions.
sThe All room described in this standard shall be used for isolating the airborne spread of infectious diseases (e.g., measles, varicella, tuberculosis).
Supplemental recirculating devices using HEPA filters shall be permitted in the All room to increase the equivalent room air exchanges; however,
the minimum outdoor air changes shown in this table are still required. All rooms that are retrofitted from standard resident rooms from which it
is impractical to exhaust air directly outdoors may be recirculated with air from the All room, provided that air first passes through a HEPA filter.
• • 00 - - - - ­

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 149
3.1 SPECIFIC REQUIREMENTS FOR NURSING HOMES

When the All room is not used for airborne infection isolation, the pressure relationship to adjacent areas, when measured with the door closed,
shall remain unchanged and the minimum total air change rate shall be 6 ACH.
6NR = no requirement.
'Where an All anteroom is provided, the pressure relationships shall be as follows: (1) the All room shall have negative pressure with respect to the
anteroom and (2) the anteroom shall have negative pressure to the corridor; both shall be designed in accordance with Section 3.1-2.2.3.1 (4)
(Anteroom).
8Minimum total air changes per hour (ACH) shall be required to provide makeup air to kitchen exhaust systems as specified in ANSI/ASH RAE
Standard 154: Ventilation for Commercial Cooking Operations. In some cases, excess exfiltration or infiltration to or from exit corridors compromises
the exit corridor restrictions of NFPA 90A: Standard for the Installation of Air-Conditioning and Ventilating Systems, the pressure requirements of
NFPA 96: Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, or the maximum defined in this table. During
operation, a reduction in the number of air changes to any extent required for odor control shall be permitted when the space is not in use.

----_._-----_._-------------------.- -- -_. __ .... _-_ .. _._. __.

150 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 Appendix Table A3.1-a
G1 Nursing Home Care Model Characteristics
_.
c
a..
III Care Model Typical # Food Resident Bathing Design Drivers Environment of Care and Relevant Descriptions
-. Type* Residents Service! Accommodations Facility Type
:;)
III Dining Type
'"
...,
0
~

0
CD
I Traditional 40-60 or more Centralized Primarily double­
occupancy rooms
Centra Iized Perceived care
delivery efficiency
[ 1. Light: Most traditional resident units have side-by-side bedroom layouts,
making access to natural light difficult, especially for the resident on the
with shared half­ hallway side. Alternate layouts that allow each resident to control access to
-
'"
\0
:J
baths a window are preferred. Community spaces with access to daylight should
OJ be provided wherever possible.
:;)
0.. 2. Views of and access to nature: Often residents in traditional settings do

(") not have the opportunity to go outside; however, it is recommended that

0
:J residents be provided with both views and outdoor spaces that are safe

'"
~
and within sight lines of staff.

c
n 3. Signage and wayfinding: Long corridors with closed-in spaces can be

_.
~

disorienting; therefore, a clear, multi-layered wayfinding system should be

0
:J provided. Use landmarks and distinctive features in addition to signs that

I
0
..., are easy to read for residents who are visually impaired.

:xl
ro 4. User control of environment: Individual control is limited with double­
'"_. occupancy rooms, long corridors, and large institutional spaces, but
0..
!ll individual lighting controls (artificial and natural) should be provided
,..._.
:J
for residents in their personal environment. Headphones can be used to
OJ
- reduce acoustic disturbances from TV!radio.
I 5. Privacy and confidentiality: This is limited with double-occupancy rooms !'"
ro
OJ and central bathing; therefore, private space should be provided for VI
,... "'CI
::r residents and family members to gather as well as for individualized, m
(") unstructured activity time. Use of technology (e.g., pagers, cell phones) is n
OJ "l"I
recommended in lieu of an overhead paging system.
;;; n
6. Safety and security: With centralized nurse stations, use of technology ::0
OJ
is key to the provision of safe and secure environments for residents. m
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7. Characteristics and criteria for selection of materials and products for s:m
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architectural details, surfaces, and furnishings: Selection of finishes is Z
-i
"Tl usually done with little input from residents and family members. It is VI
OJ
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personalization of individual spaces. Resident council participation in o

::0
!ll development of community space recommendations is suggested. Z
C
::0
*Web-based references for care model types: Planetree: www.planetree.org VI
Pioneer Network: www.pioneernetwork.net With Seniors in Mind: www.withseniorsinmind.org Z
Action Pact: www.actionpact.com
The Eden Alternative@: www.edenalt.org
Society for the Advancement of Gerontological Environments
(SAGE): www.sagefederation.org
"o
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...
The Green House@ Project: www.thegreenhouseproject.org s:
...

VI m
VI
...
VI Appendix Table A3.1-a (continued) l'"
IV
VI
Nursing Home Care Model Characteristics "'0
m
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Care Model Typical # Food Resident Bathing Design Drivers Environment of Care and Relevant Descriptions ."
Type* Residents Service! Accommodations Facility Type f'l
G1 Dining Type :xl
c: m
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III
Traditional 8. Cultural responsiveness: The cultural orientation and needs, customs, c:
(continued) desires, etc. of the care population and staff should inform the design :xl
:::J m
III ofthe physical environment. This understanding addresses the "who" ~
to
...,
element of the functional programming process, considered critical to m
Z
o
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developing the environment of care. For example, the designer would
Vl
o provide a physical environment that helps a caregiver from Jamaica caring ."
III
to for an orthodox Jewish woman understand and support kosher customs o
:xl
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and resident and family expectations. Z
9. Support for person-centered care: Management should evaluate c:
'":::J :xl
0. opportunities to provide a resident-centered focus in their institutional VI
() setting. For example, every effort should be made to eliminate the use of
Z
o
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to

~
meal trays and to use food service delivery methods that facilitate choice.

Tablecloths and household place settings can be used to create a less

":xo
c: institutional environment for dining. ~
n __ ...•-.... _-_ .. _..... m
.... -- - --._--------- ------_..----_._.._--..... _--,~_.

VI
o
:::J Cluster and/or 8-18 in a cluster Decentralized Mixture of double Decentralized Multidisciplinary 1. Light: Clustering of rooms that support community spaces with access to

o..., neighborhood and/or and private and/or teams from across daylight is encouraged.

centralized bedrooms with centralized the facility or 2. Views of and access to Nature: Clustering of rooms may provide

:JJ
III
21-40ina
to shared or private community opportunities for courtyards and other types of outdoor areas that can be

neighborhood
0. full baths Staff efficiency easily accessed by residents. It is recommended that residents be provided

III
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.... with views as well as outdoor spaces that are safe and within sight lines of

(Neighborhoods
OJ staff.

are typically made

::I: 3. Signage and wayfinding: A wayfinding program should be provided that

ro up of? to 10
distinguishes each cluster or neighborhood from another (personalization

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clusters.)
of space).

()
[ 4. User control of environment: Opportunities should be provided for
OJ residents to personally control natural and artificial light in their personal
ro space and to arrange furniture based on preference and location of nurse
'":::J call devices. Wireless systems allow for more flexibility in the resident
0. room layout.
en
c: 5. Privacy and confidentiality: Private rooms or alcove/enhanced shared
"0
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o provided for residents.
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c Appendix Table A3.1-a (continued)
Q.
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Nursing Home Care Model Characteristics
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ro
'" Care Model Typical # Food Resident Bathing Design Drivers Environment of Care and Relevant Descriptions
->,
o Type* Residents Service/ Accommodations Facility Type
Dining Type
o
ro
'" 6. Safety and security: Decentralized staff areas should be provided to
<0
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Cluster and/or support increased staff presence near residents and points of activity.
OJ neighborhood Technology solutions are recommended to minimize overhead paging.
::>
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(continued) Wireless systems should be considered.
(J
o 7. Characteristics and criteria for selection of materials and products
::> for architectural. details, surfaces, and furnishings: Personalization of
V>
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individual spaces should be encouraged, including finish selection and
C
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rt

o considered in planning and design of community spaces.

::>
8. Cultural responsiveness: The cultural orientation and needs, customs,
o->,
desires, etc. of the care population and staff should inform the design
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'" element ofthe functional programming process, considered critical to
Q.
ro developing the environment of care. For example, the designer would
::>
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OJ
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w
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ro
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rt
."
:r adopting a person-centered approach to overall care. Evaluation of m
(J other person-centered opportunities for inclusion in the facility is n
OJ 'TI
recommended. For example, providing a "country kitchen" solution for
ro n
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allowing for more individualization and a home-type setting. m
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V'I Appendix Table A3.1-a (continued)
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Nursing Home Care Model Characteristics "0
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Care Model Typical # Food Resident Bathing Design Drivers Environment of Care and Relevant Descriptions 'TI
Type* Residents Service/ Accommodations Facility Type n
CI Dining Type ::J:l
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Connected 10-20 Decentra Iized Primarily private Decentralized Integrated 1. Light: Access to daylight, pleasing views, and outdoor spaces should be C
household and rooms with private household-based priorities, both in private bedroom areas and in shared social spaces. ::J:l
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rD freestanding full baths unless team 2. Views of and access to nature: Connected households and freestanding s:m
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house resident requests Resident-centered small houses usually proVide opportunities for courtyards and other Z
o co-habitation -l
care types of outdoor areas that can be shared between households and easily VI
o Reduction of accessed by residents. It is recommended that residents be provided with 'TI
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walking distances ::J:l
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are deep and destinations. Individualized cues should be provided or accommodated at
f1 Z
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4. User control of environment: The goal of this care model is to support
c intentional
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s:
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o Foster "at­ environment and daily routine.
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o-., homeness" 5. Privacy and confidentiality: The preponderance of single-occupancy

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'" 6. Safety and security: The smaller scale of facilities using this care model
Q.
III
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I

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architectural details, surfaces, and furnishings: Finishes should include
'" low-glare, non-slip flooring; use of low-VOC materials; indirect lighting
:;,­
supplemented with task lighting where needed; and appropriate use of
f1 color contrast to enhance elements that residents need to easily see (e.g.,
'"m the difference between floor and wall).
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'"::J desires, etc. of the care population and staff should inform the design
Q.
v; ofthe physical environment. This understanding addresses the "who"
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c: Appendix Table A3.1-a (continued)
Q.
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V> Care Model Typical # ResidentsFood Service! Resident Bathing Facility Design Drivers Environment of Care and Relevant Descriptions
..., Type* Dining Type Accommodations Type
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to household and directed care that honors the rhythm of each individual's life as dictated by
::l
freestanding his or her desires. The goal of this model is to create the feeling of a home
'"
:J house for the residents, while potentially maximizing some efficiencies of care
Cl..
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(continued) and ease of access to larger shared social spaces outside the household.
o Some facilities that support this model include neighborhood/town center
:J
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V> spaces that residents from all households can access. An example of a
c: person-centered design is the inclusion of a functional, residentially scaled
...
n
kitchen in the household to support the availability of a wide variety of
o food and snacks around the clock.
:J
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..... *Web-based references for care model types:
:'J
11) Pioneer Network: www.pioneernetwork.net
_.
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Action Pact: www.actionpact.com
Cl..
11)
The Eden Alternative"': www.edenalt.org
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'" Planetree: www.planetree.org
I With Seniors in Mind: www.withseniorsinmind.org !'"
11)

Society for the Advancement of Gerontological Environments (SAGE): www.sagefederation.org

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 3.2 Specific Requirements for Hospice Facilities
Appendix material shown in shaded boxes at the bottom ofthe page, is advisory only.

• 3.2-1 General 3.2-1.1.2.3 Dementia, mental health, and cognitive

3.2-1.1 Application
3.2-1.1.1 General
*3.2-1.1.1.1 This chapter contains specific require­
opment Disabiliry Facilities) for requirements.
ments for freestanding hospice facilities and separately
and developmental disability design criteria. Where
the care population includes residents with dementia,
mental health issues, or cognitive or developmental
disabilities, see Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive and Devel­

licensed hospice facilities that are part of other health,

3.2-1.2 Functional Program
care, and support settings.
See Section 1.2-2 (Functional Program) for
requirements.
3.2-1.1.1.2 The requirements in Part 2 (Common

Elements for Residential Health, Care and Support

3.2-1.3 Resident Safety Risk Assessment
Facilities) shall apply to hospice facilities as referenced
See Section 1.2-3 (Resident Safery Risk Assessment)
in this chapter.
for requirements.

3.2-1.1.2 Design Criteria 3.2-1.4 Environment of Care Requirements

3.2-1.1.2.1 Sustainable design. See Section 2.2-2 3.2-1.4.1 General

(Sustainable Design Criteria) for requirements.
See Section 1.2-1.3 (Environment of Care and Faciliry
Function Considerations) and Section 1.2-4 (Environ­
3.2-1.1.2.2 Design criteria for accommodations for

ment of Care Requirements) for requirements.

care of persons of size. If the care population includes

persons of size, see Section 2.2-3 (Design Criteria

[ *3.2-1.4.2 Flexibility
for Accommodations for Care of Persons of Size) for

requirements.
Hospice facilities shall be designed to provide Bexibil­
iry to meet the changing needs of families and visitors
attending to residents receiving hospice care.

APPENDIX

A3.2-1.1.1.1 Hospice facilities provide a medically directed,

dignity for residents and their families and friends. No curative inter­
interdisciplinary care program of palliative care and services for
ventions are used.
terminally ill individual.s. Palliative care is care and treatment for
Hospice services may be prOVided in independent and assisted

management of multiple chronic diseases. Care tends to be focused on

living, ambulatory care, hospital, and nursing home settings. Hospice

resident comfort.
care may be provided as outpatient or inpatient services in existing,

Hospice care is provided by aspecialized team of professionals

new, or renovated facilities as well as through home care.

that may include nurses, social workers, certified nursing assistants,

A3.2-1.4.2 Flexibility can be accomplished through several means,

dietitians, therapists, pain management specialists, and physicians as

such as prOVision ofavariety of activity spaces or private counseling

well as trained volunteers and clergy. The focus of the hospice team is

spaces or simply the ability to rearrange furniture to accommodate !Iif­

to provide end-of-life care that supports quality of life and maintains

ferent family unit sizes and needs.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES
*3.2-1.4.3 Supportive Environment
The facility design shall produce a supportive environ­
ment to enhance quality of life for residents and their
families and friends and promote privacy and dignity
for those receiving hospice care.
3.2-1.4.4 Barrier-Free Environment
The architectural design-through organization
of functional space, specification of ergonomically
appropriate and arranged furniture and equipment,
and selection of details and finishes-shall eliminate as
many barriers as possible to access by families, friends,
staff, and residents to space, services, equipment, and
utilities that support the resident receiving hospice
services.
I*3.2-1.5 Site
(1) In new construction, hospice units shall be
See Chapter 2.1 (Site Elements) for requirements.
arranged to avoid unrelated travel through the
• 3.2-2 Resident Areas
, • APPENDIX.
A3.~-1.4.3 Person-centered care in hospice care settings should
address movement away from atraditional model toward one that is
residential in scale; includes homelike amenities for families, friends,
and residents; and goes beyond atypical medical model to address tile
emotional and spiritual needs of patients and their loved ones. Hospice
facilities, treatments, and services generally are not aimed at acure but
may include complementary therapies that promote safety and comfort.
Many residents are in advanced stage's of illness with weeks or days to
live.
A3.2-1.5 Parking. Provision of a minimum of one additional
parkingspace for every four beds should be considered for afreestand­
ing hospice facility.
A3.2-2.2 Resident units are groups of resident rooms and support
areas whose size and layout are based on the care model staffing pat­
terns, functional operations, and communications used in the facility.
A3.2-2.2.1.2 Overwhelming fatigue is the predominant complaint
of hospice residents and staff. Arranging groups of resident rooms
adjacent to decentralized service areas, optional satellite staff work
areas, .and optional decentralized resident support areas to reduce travel
distances should be considered.
A3.2-2.2.1.2 (2) Hospice care models. See appendix
table A3.2-a (Hospice Care Model Characteristics) for information in
addition to the care model descriptions below.
a. Adult day care hospice. This madel includes day services for residents
receiving hospice services while living in an independent liVing
158 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.2-2.1 General
The requirements in this section shall apply to hospice
facilities that include the space types described.
*3.2-2.2 Resident Unit
3.2-2.2.1 General
3.2-2.2.1.1 Hospice unit size. In the absence of
local requirements, consideration shall be given to
restricting the size of the care unit to a maximum of
25 beds unless just cause can be demonstrated and
approval obtained from the local authority having
jurisdiction (AHJ).
*3.2-2.2.1.2 Layout
unit.
*(2) The facility layout shall reflect the care model and
related staffing.
setting (either with family or other caregivers). Adult day care
hospice services are provided for residents with family caregivers
who work during the day. Adult day care hospice services may be
provided in private space in astandard adult day care or adult day
health care center that has been set aside for residents receiving
hospice services.
b. Home-based hospice services. This model includes services that are
brought to a resident living in an assisted living facility or inde­
pendent liVing setting. Home-based hospice services are provided
for residents who live in an independent or assisted living. setting.
Hospice services to be proVided hy acare and support facility, if any,
should be identified during the functional programming process.
c. Small ambulatory residential care hospice facilities. This model
typically includes 6to no more than lS private beds in asmall group
home for ambulatory residents. These facilities are provided for
residents who are still ambulatory but need hospicll services.
d. Small non-ambulatory inpatient care'hospice facilities. This model
typically includes 6to no more than 15 private beds in asmall
group home setting for non-ambulatory residents or acombination
of ambulatory .and non-ambulatory residents. These facilities are
proVided for reSidents who are predominantly non-ambulatory.
e. Freestanding hospice facilities. This model typically includes 16 or
more beds in a large group home setting. Freestanding hospice
facilities offer acute care end-of-life services, which should be
prOVided in private rooms that includeadequate'family space.
f. Hospital-based hospice facilities. This model follows hospice regula­
tions and includes any number of beds housed in a hospital setting.
 3.2 SPECIFIC REQUIREMENTS fOR HOSPICE FACILITIES

3.2-2.2.2 Resident Room

furnished to maximize safe resident mobility,
Each resident room shall meet the following require­
mobilization, weight-bearing activity, and
ments:
ambulation potential and to minimize risks to
caregivers. This requirement shall apply to all
*3.2-2.2.2.1 Capacity. Maximum room occupancy resident rooms, regardless of resident weight or
shall be one resident unless justified in the functional condition.
program and approved by the AH], in which case resi­ (3) Room size shall be based on the care model
dent room capacity shall not exceed two resident beds. and in-room furniture and clothing storage
requi rements.
*3.2-2.2.2.2 Space requirements (a) Where required by the care model,
(1) Space shall be provided to accommodate resident accommodation for dining shall be provided
care and for maneuverability when resident­ in the resident room.
operated mobility devices are used. (b) Space to allow access to both sides and the
(2) Resident rooms shall be sized, arranged, and foot of the resident bed shall be provided.

APPENDIX (continued)

These facilities prov,ide acute care end-of-lifeservices and should be
,lOCated in adedicated area with private rooms that include adequate
family space.
g. Nursing home-basedhospice facilities. This model follows hospice
regul,ations and includes anynumber of beds housed in a nursing
-Standard resident room:
• 48 inches (121.92centimeters) on the transfer side
• 36 inches (91.44 centimeters) on the non-transfer side of
the bed
• 36 inches (91.44centimeters) at the foot ofthe bed

home setting. Nursing home-based hospice facilities provide end-of­ -Residentrooms for persons ofsize with aceiling lift:

lifeserv1ces and should be provided in a private room that includes
adequate family space. Nursing homes should proVide hospice ser­
vices and related accommodations for residents. and family:
A3.2-2.2.2.1 Consideration should be given toaEEOmmodating
.. 72 inches (182.88 centimeters) from the bed by 120 inches
long (304.Scentimeters) on the transferside
• 36 inches (91.44 centimeters) on the non-transfer side of
the bed

• 66 inches (167;64 centimeters) at the foot of the bed

couples each receiving hospice we at the same time.

-Resident rooms for persons ofsize without aceiling litUo

A3.2-2.. 2.2~2 Space requirements. Resident rooms should
accommodate use of a mobile lift:
be sized, arranged, and furnished to maximize safe patient mobility,
• 84 inches (213.36 centimeters) from the.bedby 120 inches
mobilization, weight-bearing exercise,and ambulation potentialwhile
long (304.8 centimeters) on the transfer side
minimizing risk to caregivers. This should apply to all populations being
• 36 inches (91.44 centimeters) on the non-transfer side of
cared for and served.
the bed
Clearances should be provided and maintained to accommodate
• 66 inches (167.64 centimete.rs) at the foot ofthebed
safe resident mobility and mobilization of residents. Designated clear­
c Sizing of resident rooms should accommodate clearances for resident
ances. should .not be obstructed. by any object that does not qualify as
chairs,Jecliners, wheelchairs, or other devices; these c1earances'maY
mQvable accQrding to Section 1,,5-4.2 (Movable and Portable Equip­
overlap with the bed clearances. The size of each room should allow
ment).
unimpeded clearance on at least one side andatthe front of any
a. To facilitate planning for minimum clearances around beds, ,bed type resident chair, etc, as follows:
and size should be establis.hed as part of the functional program. As =48 inches (121.92 centimeters) on the transfer side ofthe chair,
acceptable to AHJs, bed placement should be chosen by individual etc for both standard and person of size ro6mtypes
residents and their families to satisfy the needs and desires of the -36 inches (91.44 centimeters) for the approach to the chairfor a
resident. standard room
b. Provision of bed clearances to support resident safety should include -66 inches (167.64 centimeters) for the approach to the chair for
the following: a room accommodating a person of size

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 159
3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

*(c) Resident and visitor seating
*(i) Space for seating for residents and visitors
shall be provided.
(ii) The room shall be configured so that each
resident can view the television from a
resident chair.
(4) Space shall be provided for at least one sleeping
to the toilet, room entrance, window, or other
accommodation for visitors in resident rooms.
shared common areas in the resident room.
(a) Allow space for circulation when the sleeping
accommodation (e.g., recliner, sleep chair,
sleep sofa) is fully open for use so staff can
access the resident in case of an emergency.
(b) Provide storage space to accommodate and
secure overnight guests' belongings.
*(5) Space to accommodate resident food storage,
refrigeration, and reheating shall be located in the
resident room or in an area close to resident rooms.
See Section 2.3-2.3.4 (Resident and Participant
Kitchen) for additional information for resident
and family kitchen areas outside the resident room.
*3.2-2.2.2.3 Window
(1) See Section 2.4-2.2.6 (Windows) in addition to the
(2) Ptovision shall be made for resident and family to
completely darken the resident room.
3.2-2.2.2.4 Resident privacy
*(1) Visual privacy shall be provided for each resident in
multiple-bed rooms.
(2) Design for privacy shall not restrict resident access
3.2-2.2.2.5 Hand-washing station. A hand-washing
station shall be provided in each resident room.
(1) Omission of this station shall be permitted in a
single-bed or two-bed room where a hand-washing
station is located in an adjoining toilet room that
serves that room only.
(2) Design requirements
(a) For hand-washing station design details, see
Section 2.4-2.2.8 (Hand-Washing Stations).
(b) For sink design, see Section 2.5-2.3.2
(Plumbing Fixtures-Hand-Washing Sinks).
(c) For casework details, see Section 2.4-2.4.2
(Casework, Millwork, and Built-Ins).

requirements in this section.

3.2-2.2.2.6 Resident toilet room. Each resident shall
have access to a toilet room without entering a general
corridor.

APPENDIX

A3.2-2.2.2.2 (3)(c:) Resident and visitor seating A3.2-2.2.2.2 (5) Kitchenettes usually include asmall refrigerator, a
a. All resident rooms should have space for at least one chair to provide microwave, food storage, and asmall sink.
residents with an alternative to bed-stay. Chairs should be evaluated
A3.2-2.2.2.3 Window. Exterior windows should provide views
for provision of the following:
to the natural-environment and light where possible. Residents who are
-Comfort sufficient for long-term sitting
confined to their beds need avenue for visual stimulation. Plantings
-Cervical support and support for the resident's nead (backrest)
and other attempts to proVide objects of visual interest should be made
-Opportunity to recline the backrestto enable periodic redistri­
where exterior views ofthe natural environment are not possible due to
bution of body weight during long periods of sitting (recliner)
existing building adjacencies. See Section 1.2-4.5.1 (Light) and Section
-Ease of entry and exit
1.2-4.5.2 (Views of and Access to Nature) for additional information.
b. Resident rooms should have space\for an additional chair for avisitor
so residents do not have to remain in bed when they have avisitor. A3.2-2.2.2.4 (1) Resident privacy. Consideration should be
c. See appendix section A2.4-2.4.3.1 (Furniture selection recommenda­ given to use of awall or partition to preserve visual and acoustic privacy
tions) for additional information. for each resident. Alcoves may be used for this purpose in double- or
multiple-occupancy resident rooms.
A3.2-2.2.2.2 (3)(c)(i) Seating accommodations should be pro­
vided for persons of size and their families, who are typically of larger
size.

160 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES
*(1) One toilet room shall serve no more than two
residents in a bedroom.
(2) Space requirements
(a) Toilet rooms shall be sized and configured to
accommodate:
(i) Staff assistance, including use of lifting
equipment
(ii) Accessibility standards that support inde­
pendent resident use
I*(3) See Section 2.5-2.3.3.2 (Accessible showers) for
(b) Clearance shall be provided on both sides
of the toilet to enable physical access and
maneuvering by staff members assisting the
resident with wheelchair-to-toilet transfers and
returns.
(3) The toilet room shall contain the following:
(a) Toilet
(b) Hand-washing station
(c) Mirror. For requirements, see Section 2.4­
2.2.8.7 (Mirror).
(d) Individual storage for the personal effects of
each resident
(4) Doors and door hardware shall be provided in
accordance with Section 3.2-5.2.2.4 (Doors and
door hardware).
The requirements in this section shall apply to all hos­
(5) Grab bars
(a) Grab bars shall be provided in accordance with
Section 2.4-2.2.9 (Grab Bars).
(b) Where residents are capable of independent
transfers, alternative grab bar configurations
shall be permitted.
3.2-2.2.2.7 Resident bathroom. Where a bathtub
or shower is provided in the resident toilet room, the
following requirements shall be met in addition to the
APPENDIX
A3.2-2.2.2.6 (1) On October 4/2016/ the Centers for Medicare
& Medicaid Services (CMS) published afinal rule on the "Reform of
Requirements for Long-Term Care Facilities;' CMS-3260-F, in the Federal
Register. This rule revises the requirements that long-term care facilities
must meet to participate in the Medicare and Medicaid reimbursement
programs. Effective November 28,2016/ each resident room must have
a maximum capacity oftwo residents and adedicated bathroom with at
least atoilet and sink. Look for gUidance on room configurations to meet
CMS requirements under the Resources tab on the FGI website.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
requirements in Section 3.2-2.2.2.6 (Resident toilet
room):
(1) Space shall be provided for drying, dressing, and
grooming.
(2) A counter and a shelf or cabinet for personal item
storage shall be provided. See Section 2.4-2.4.2
(Casework, Millwork, and Built-Ins) for details.
shower requirements.
3.2-2.2.2.8 Resident storage. Each resident shall be
provided with an individual wardrobe or closet.
(1) This storage shall have a minimum net depth of
24 inches (55.88 centimeters) and a minimum net
width of2 feet 6 inches (76.20 centimeters).
(2) A clothes rod shall be provided that can be
adjusted to a height accessible to the resident.
Accommodations shall be made for storage of full­
length garments.
(3) A shelf shall be provided that can be adjusted to a
height accessible to the resident. Omission of the
shelf shall be permitted where the unit provides at
least two accessible drawers.
3.2-2.2.3 Special Care Resident Rooms
pice facilities that include these room types.
*3.2-2.2.3.1 Airborne infection isolation room
(1) General
(a) The need for and number of All rooms shall
be determined by an infection control risk
assessment.
(b) Where provided, each Ail room shall comply
with the requirements in Section 3.2-2.2.2
(Resident Room) as well as the following
requirements:
A3.2-2.2.2.7 (3) Accessible shower. Provision of acurbless
shower that is open to the surrounding bathroom should be considered
for ease of access by resident and staff.
A3.2-2.2.3.1 For additional information, refer to the Centers for
Disease Control and Prevention (CDC) publications "Guidelines for Pre­
venting the Transmission of Mycobacterium tuberculosis in Health-Care
Settings"and "Guidelines for Envirorimentallnfection Control in Health­
Care Facilities."
161
3.2 SPECIFIC REQUIREMENTS fOR HOSPICE FACILITIES
(2) Capacity. Each resident room shall contain only
one bed.
(3) The roiler room provided for each All room shall
include a shower.
(4) Anteroom. An anteroom is not required; however,
where an anteroom is part of the design concept, it
shall meet the following requirements:
(a) The anteroom shall provide space for persons
to don personal protective equipment before
entering the resident room.
(b) All doors to the anteroom shall have self­
closing devices.
(5) Where no anteroom is provided, provision shall be
made for srorage of personal protective equipment
at the entrance to the room.
(6) Special design elements
(a) Architectural details
(i) All room perimeter walls, ceiling, and
floor, including penetrations, shall be
sealed tightly so that air does not infiltrate
the environment from the outside or from
other spaces.
(ii) All rooms shall have self-closing devices
on all room exit doors.
(b) Window treatments and privacy curtains
shall be provided in accordance with Section
2.4-2.4.4 (Window Treatments and Privacy
Curtains).
(c) Ventilation
(i) Ventilation upon loss of electrical power.
The space ventilation and pressure re­
lationship requirements ofTable 3.1-1
(Design Parameters for Ventilation of Resi­
dential Health Spaces) shall be maintained
for All rooms, even in the event of loss of
normal electrical power.
*(ii) Use of recirculating room units shall not
be permitted in new construction.
APPENDIX ~
A3.2-2.2.3.1 (6)(c)(ii) Use of recirculating,room units is prohib"
itedin new construction due tothedifficulty of deaning the units and
the potential forbuildup of contamination in theA" room.
162 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
(iii) Use of recirculating devices with HEPA fil­
ters shall be permitted in existing facilities
as interim, supplemental environmental
controls to meet requirements for the
control of airborne infectious agents. The
design of such recirculating systems shall
allow for easy access for scheduled preven­
tive maintenance and cleaning. The design
of either portable or fixed recirculating
systems shall prevent stagnation and short­
circuiting of airflow.
(iv) Design relative humidity shall be a maxi­
mum of 60 percent.
*3.2-2.2.3.2 Ventilator-dependent resident units.
Where a unit dedicated to serving residents dependent
on a ventilator is provided, resident rooms in this unit
shall meet the following requirements in addition to
those in Section 3.2-2.2.2 (Resident Room).
(1) Resident rooms for ventilaror-dependent residents
shall have:
(a) Space for the ventilator unit at the bedside
(b) Space to accommodate clearances for resident­
operated mobility devices that may be
oversized to accommodate a ventilator
(c) Provisions for oxygen and suction. See Section
3.2-6.2.4 (Medical Gas and Vacuum Systems)
for requirements.
(d) Backup electrical requirements. See Section
2.5-4.4 (Electrical Requirements for
Ventilator-Dependent Resident Rooms and
Areas) for requirements.
(2) Resident support areas
(a) Support space shall be provided in the nursing
unit to accommodate staffing associated with
ventilator services.
(b) A dedicated space shall be provided for
servicing and maintenance of ventilator
equipment or storage shall be provided to
A3.2-2•.2.3.2 Where adedicated unit is provided for ventilator­
dependent residents, piped oxygen and vacuum should be provided.
Refer to NFPA 99: Health Care Facilities Code and ANSI/ASSE 6000: Pro­
fessiona/ Qualifications Standard for Medical Gas Systems Personnelfor
essential p.ower requirements and medical gas installation information.
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES
accommodate ventilators for backup or
exchange.
(c) All resident activity and support areas shall
be provided with essential power outlets to
support continued ventilator support in the
event of a power outage. See Section 2.5-4.4
(Electrical Requirements for Ventilator­
Dependent Resident Rooms and Areas) for
additional requirements.
3.2-2.2.3.3 Quiet room in a resident unit. Where
a single resident room is provided to accommodate
care requirements for residents experiencing issues
such as personal conflicts, agitation, episodic mental
disturbances, or similar conditions, the requirements
in Section 2.3-2.2.3.3 (Quiet room in a resident
carelliving area) shall be met in addition to the
requirements in Section 3.2-2.2.2 (Resident Room).
3.2-2.3 Resident Community Areas
3.2-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant and
Outpatient Community Areas-General) for
requirements.
3.2-2.3.2 Lobby
Where a central lobby is provided, see Section 2.3­
2.3.2 (Lobby) for requirements.
3.2-2.3.3 Dining, Recreation and Lounge Areas
3.2-2.3.3.1 General
(1) Space for dining and recreation shall be provided
to meet the needs of the care model.
(2) See Section 2.3-2.3.3.1 (Dining, Recreation,
APPENDIX
A3.2-2.3.3.3 Recreation and lounge areas
a. Aminimum of 15 square feet per resident is recommended for sizing
recreation and lounge area(s) for resident and visitor use.
b. Provision of smaller-scaled lounge spaces close to groups of resident
rooms should be considered.
A3.2-2.3.S Personal services areas. Where personal
services are proVided, consideration should be given to providing the
following in the design ofthese areas:
a. General
-Changing areas
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
and Lounge Areas-General) for additional
requirements.
3.2-2.3.3.2 Dining areas
(1) See Section 2.3-2.3.3.2 (Dining areas) for
requirements in addition to those in this section.
(2) See Section 3.2-2.2.2.2 (3)(a) (Resident Room­
Space requirements) for requirements for dining
accommodations in resident rooms.
(3) Dining areas separate from those for residents and
visitors shall be provided for staff.
(a) Combination of the staff dining area and a
staff break!report area shall be permitted.
(b) See Section 3.2-4.3.2 (Staff Lounge) for
requirements.
*3.2-2.3.3.3 Recreation, lounge, and activity areas.
Lounge areas shall be provided for resident and visitor
use based on the number of residents being served.
3.2-2.3.3.4 Toilet rooms. Toilet facilities that accom­
modate resident-operated mobility devices shall be
readily accessible to all dining, recreation, lounge, and
activity locations.
3.2-2.3.4 Resident Kitchen
Where kitchen facilities that permit use by resi­
dents and family members are provided, see Section
2.3-2.3.4 (Resident and Participant Kitchen) for
requirements.
*3.2-2.3.5 Personal Services (Hair Salon/Spa) Areas
Where a hair salon is provided:
(1) Mechanical ventilation and exhaust shall be
provided. See Table 3.1-1 (Design Parameters
-Storage for supplies and linens
-Provisions for resident privacy·
b. Hair salon
-Adjustable sink bowls for shampooing and treatment
-Freestanding dryers for use by resid~nts using resident-operated
mobility devices
-Location oftoilet room adjacent to or directly accessible from
hair salon
c. Space for circulation and staff assistance around spa tubs
163
3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

for Ventilation of Residential Health Spaces) for 3.2-2.3.8.1 See Section 2.1-3.6.2 (Outdoor Activity
additional requirements. Spaces) for requirements.
(2) See Table 3.1-1 for minimum filter efficiencies for
hair salons. *3.2-2.3.8.2 Outdoor activity spaces shall be available
to residents and visitors.
*3.2-2.3.6 Family Room
A family room(s) sized to accommodate visitors and

• 3.2-3 Diagnostic and Treatment

family shall be provided.

Areas

3.2-2.3.6.1 Each family room shall be permitted to

serve a variety of functions, including those listed
in this section. See Section 2.3-2.3.4 (Resident and
Participant Kitchen) for additional information.
(1) Children's playroom
(2) Family kitchenette
(3) Dining area
3.2-2.3.6.2 Inclusion of a gas fireplace shall be permit­
ted in a family room where non-operable glass doors
are used.
3.2-2.3.7 Quiet Room and/or Meditation Area
3.2-2.3.7.1 Quiet room in a resident area. Where a
quiet room is provided, see Section 2.3-2.3.7 (Quiet
Room in a Resident or Participant Community Area)
for requirements.
3.2-3.1 General
See Section 2.3-3.1 (Diagnostic and Treatment
Areas-General) for requirements.
3.2-3.2 Examination and Treatment Room
Where an examination room and/or treatment room(s)
is provided, see Section 2.3-3.2 (Examination, Obser­
vation, and/or Treatment Rooms) for requirements.
• 3.2-4 Facilities for Support Services
3.2-4.1 General
See Section 2.3-4.1 (Facilities for Support Services­
General) for requirements.
3.2-4.2 Facilities that Support Resident Care

3.2-2.3.7.2 Meditation area 3.2-4.2.1 Staff Work Area(s)

(1) A meditation area(s) that offers a private place for See Section 2.3-4.2.1 (Staff Work Area) for
individuals shall be provided and sized based on requirements.
the unit size and care model.
(2) This space shall be permitted to be shared with
3.2-4.2.2 Medication Distribution Locations
other health care settings and used by both
(Centralized and Decentralized)
residents and staff.
See Section 2.3-4.2.2 (Medication Distribution and
Storage Locations) for requirements.
3.2-2.3.8 Outdoor Activity Spaces
*3.2-4.2.3 Central Bathing Rooms or Areas

A3.2-2.3.6 Family room. The family room should have exterior b. Visual access to outdoor activity spaces from indoors should be pro­

views as well as direct acceSs to the exterior. vided for staff and residents.

c. Outdoor space(s) should be accessible to reSidents via short navi­

A3.2-2.3.8.2 Outdoor activity spaces

g.a.ble distances.

a. Gardens symbolize the full cycle of life and death and can hea source
of serenity and spiritual calm. A3.2-4.2.3 Consideration should be given to.privacy when locating
entrances to bathing rooms.

164 Guidelines for De ign and Construction of ReSidential Health, Care, and Support Facilities
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

3.2-4.2.3.1 See Section 2.5-2.3.3.2 (Accessible this equipment to be accessible to residents at all times
shower) for requirements. without entering another resident's living space.

3.2-4.2.3.2 Number 3.2-4.2.5 Clean Utility Room

(1) A minimum of one accessible bathtub or shower
that is available to all residents shall be provided.
(2) Additional bathtubs or showers shall be provided as
required to serve the unit size and care population.
3.2-4.2.3.3 Accessibility
(1) The bathtub or spa tub in this room shall be
accessible to residents in wheelchairs.
(2) The shower shall have fittings accessible to a
resident in a recumbent position.
(3) Adult resident shower rooms shall be designed to
allow entry of portable/mobile mechanical lifts,
shower gurney devices, and shower chairs.
See Section 2.3-4.2.5 (Clean Utility Room) for
requirements.
3.2-4.2.6 Soiled Utility Room
See Section 2.3-4.2.6 (Soiled Utility Room) for
requirements.
3.2-4.2.7 Personal Laundry Facilities
See Section 2.3-4.2.7 (Personal Laundry Facilities) for
requirements.
3.2-4.2.8 Resident Telephone Access
See Section 2.3-4.2.8 (Resident and Participant

Telephone Access) for requirements.

3.2-4.2.3.4 A separate toilet and hand-washing sta­

tion shall be provided in or directly accessible to each
3.2-4.3 Support Areas for Staff
bathing area without requiring entry into the general
corridor.
3.2-4.3.1 General

3.2-4.2.3.5 Access to a grooming location without

3.2-4.3.1.1 See Section 2.3-4.3 (Support Areas for

reentry to the general corridor shall be provided. This

Staff) for requirements in addition to those in this

shall contain the following:

section.

(1) Hand-washing station

(2) Mirror 3.2-4.3.1.2 Space for staff breaks and staff reporting
(3) Counter or shelf areas shall be permitted to be provided as two separate
rooms or combined into one room.
3.2-4.2.4 Equipment and Supply Storage
3.2-4.3.2 Staff Lounge
3.2-4.2.4.1 General. See Section 2.3-4.2.4 (Equip­
Staff lounge(s) shall be adjacent to the staff work area

ment and Supply Storage) for requirements in addition

and staff toilet room. See sections 3.2-4.2.1 (Staff

to those in this section.

Work Area) and 2.3-4.3.3 (Staff Toilet Room).

3.2-4.2.4.2 Decentralized dean linen storage. A

3.2-4.3.3 Shower Room
separate closet or designated area shall be provided for
clean linen storage. Showering capabilities shall be provided for staff either
in a central shower room or in a dedicated staff toilet/
(1) A decentralized clean utility room shall be
shower room.
permitted to be used for the storage of clean linen.
(2) Where a closed-cart system is used, storage in an
3.2-4.4 Support Facilities for Family and

alcove shall be permitted.

Visitors

3.2-4.2.4.3 Storage for mobility devices and sup­

3.2-4.4.1 Overnight Guest Accommodations
port equipment. Storage for resident-operated mobil­
ity devices and personal support equipment shall allow Overnight accommodations shall be provided for

visitors and family.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 165
3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

3.2-4.4.1.1 Where a sleeping accommodation (e.g.,

3.2-4.5.3.2 The resident kitchen shall be permitted
recliner, sleep chair, sleep sofa) is located in the
to serve as an alternative location to accommodate the
resident room, space shall be provided for circulation
function of a warming kitchen. See Section 2.3-2.3.4
when the furnishing is fully open for use so staff can
(Resident and Participant Kitchen) for requirements.
access the resident in case of an emergency.

3.2-4.5.4 Decentralized Kitchen

3.2-4.4.1.2 Storage space shall be provided to accom­
Where food preparation is conducted on-site for 16 or
modate and secure overnight guests' belongings.
more beds, the facility shall have dedicated non-public
staff space and equipment for preparation of meals. See
3.2-4.4.2 Pet Accommodations Section 2.3-2.3.4 (Resident and Participant Kitchen)
See Section 2.3-4.4.3 (Pet Accommodations) for
for requirements.
requirements.

3.2-4.6 Linen and Laundry Service Facilities

3.2-4.4.3 Shower and Toilet Facilities
3.2-4.6.1 General
Shower and toilet facilities for family and visitors shall

be provided.

3.2-4.6.1.1 Each facility shall have provisions for

3.2-4.4.4 Volunteer and Clergy Accommodations storing and processing clean and soiled/contaminated
linen.
Secured storage for the belongings of volunteers and

clergy shall be provided.

*3.2-4.6.1.2 Where a facility includes a commercial

3.2-4.5 Food Service Facilities laundry, the following requirements shall apply:
(1) Processing shall be permitted to take place in the
3.2-4.5.1 General facility, in a separate building on- or off-site, or in
The type and size of the hospice facility shall determine
a shared laundry.
the dietary environment and the food service facilities
(2) At minimum, the elements in Section 3.2-4.6.2

provided.
(Laundry Facility) shall be provided.

3.2-4.5.2 Central Commercial Kitchen

3.2-4.6.2 Laundry Facility
Where a central commercial kitchen is provided, the

food services facilities shall be provided in accordance

3.2-4.6.2.1 Layout. Equipment shall be arranged to
with Section 2.3-4.5 (Food Service Facilities).
permit an orderly workflow and minimize cross-traffic
that might mix clean and soiled operations.
3.2-4.5.3 Warming Kitchen
If the facility has a service contract with an outside
3.2-4.6.2.2 Where linen is processed in a laundry

vendor for food service, a warming kitchen designed to

facility in the hospice facility, the following shall be

meet the following requirements shall be provided.

provided:

(1) Receiving, holding, and sorting room

3.2-4.5.3.1 Where an outside vendor is used to

provide meals for a facility of 16 or more beds, the

(a) This room shall be provided to accommodate
facility shall include dedicated space and equipment
control and collection of soiled linen.
for a warming kitchen, including space for minimal
(b) Soiled linen chutes shall be permitted to
equipment for preparation of breakfast, emergency, or
discharge in this room or in an adjacent
after-hours meals.
separate room.

APPENDIX

A3.2-4.6.1.2 For certain care models, laundry services may be decentralized using personal laundry facilities and/or acombination of personal laundry
facilities and contracted services to proVide linen service. See Section 2.3-4.2.7 (personill Laundry Facilities) for requirements.

166 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES
(2) Washers/extractors. Washers/extractors shall be
located between the soiled linen receiving and
clean processing areas.
(3) Dryers
(4) Supply storage. Storage shall be provided for
laundry supplies.
(5) Inspection and mending area. An area shall be
provided for linen inspection and mending.
3.2-4.6.3 Support Areas for linen Services
3.2-4.6.3.1 Central clean linen storage. A cen­
tral clean linen storage and issuing room(s) shall be
provided in addition to the linen storage required at
individual resident units. See Section 2.3-4.2.5 (Clean
Utility Room) for additional information.
3.2-4.6.3.2 Soiled holding room(s). Separate central
or decentralized room(s) shall be provided for receiving·
and holding soiled linen for pickup or processing. See
Section 2.3-4.2.6 (Soiled Utility Room) for require­
ments in addition to those in this section.
(1) Room(s) shall have ventilation and exhaust.
(2) Discharge from soiled linen chutes shall be received
in this room or in a separate room, as required by
the local authority having jurisdiction.
(3) Room(s) used for processing shall have a deep sink
for soaking and/or a flushing-rim sink.
3.2-4.6.3.3 Linen carts
(1) Provisions shall be made for parking clean and
soiled linen carts separately and out of traffic.
(2) Provisions shall be made for cleaning linen carts on
premises (or for exchange of carts off premises).
3.2-4.6.3.4 Hand-washing stations
(1) Hand-washing stations shall be provided in each
area where unbagged soiled linen is handled.
(2) See Section 2.4-2.2.8 (Hand-Washing Stations) for
additional requirements, except for Section
2.4-2.2.8.7 (Hand-Washing Stations-Mirror).
APPENDIX
A3.2-4.11.1.1 Kitchenette for conference space. Provision of kitchenette facilities, including under-counter refrigerator, microwave, and
c
sink, should be considered for the conference space.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.2-4.6.4 Support Areas for Facilities Using
Off-Site linen Processing
Where linen is processed off-site or in a separate
building on-site, the following shall be provided:
3.2-4.6.4.1 A service entrance, protected from
inclement weather. This shall be permitted to be shared
with other services.
3.2-4.6.4.2 A control station, which can be shared
with other services
3.2-4.7 Materials Management Facilities
See Section 2.3-4.7 (Materials Management Facilities)
for requirements. However, materials management
services do not require duplication where those services
are available as part of an adjacent health care facility.
3.2-4.8 Waste Management Facilities
See Section 2.3-4.8 (Waste Management Facilities) for
waste collection, storage, and disposal requirements.
3.2-4.9 Environmental Services Rooms
See Section 2.3-4.9 (Environmental Services Rooms)
for requirements.
3.2-4.10 Facilities for Engineering and
Maintenance Services
See Section 2.3-4.10 (Facilities for Engineering and
Maintenance Services) for requirements.
3.2-4.11 Administrative Areas
3.2-4.11.1 Office and Conference Space
Offices or an open office area with private confer­
ence space shall be provided for business transactions,
admissions, and social services and for the use of
administrative and professional staff.
*3.2-4.11.1.1 Conference space. Space for private
interviews; staff, resident, and family meetings;
conferences; and health education shall be sized to
accommodate operational and activity needs.
167
3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

(1) Space shall include provisions for use of visual aids

3.2-5.2.2 Architectural Details
and technology.

(2) Sharing of space by several services shall be

3.2-5.2.2.1 General. See Section 2.4-2.2.1
permitted.
(Architectural Details-General) for requirements.

3.2-4.11.1.2 Individual offices/spaces and confer­

3.2-5.2.2.2 Corridors. See Section 2.4-2.2.2
ence spaces required in Section 3.2-4.11.1 (Office and
(Corridors) for requirements.
Conference Space) shall be permitted to be included

in or shared with other office suites where the hospice

3.2-5.2.2.3 Ceiling height. See Section 2.4-2.2.3
services are provided in another health care setting.
(Ceiling Height) for requirements.

3.2-4.11.1.3 Supply and copy room. Space for

3.2-5.2.2.4 Doors and door hardware. See Section
storage of files, office equipment, and supplies shall be
2.4-2.2.4 (Doors and Door Hardware) for require­
provided.
ments in addition to those in this section.
(1) Door type
3.2-4.11.2 Counseling Room
(a) Doors to all rooms containing bathtubs,
A small sitting area(s) shall be provided to allow for

showers, and toilets for resident use shall be

private conversations.

hinged, sliding, or folding.

(b) All doors between corridors, rooms, or spaces
3.2-4.11.2.1 The private conference room space

subject to occupancy shall be of the swing type

described in Section 3.2-4.11.1.1 (Private conference

or shall be sliding doors.

space) shall be permitted ro serve this function.

(c) Manual or automatic sliding doors shall

be permitted where their use does not
3.2-4.11.2.2 This space shall be permitted to serve as

compromise fire and other emergency exiting

an alternative bereavement room.

requirements.

3.2-4.11.2.3 Private phone area (2) Door hardware

(1) Accommodations shall be made to allow private
*(a) Sliding doors shall not have floor tracks.
conversations.
(b) In shared resident bathrooms, use of privacy
(2) Counseling room(s) shall be permitted to serve this
locks with emergency access release shall be
purpose.
permitted.

3.2-5.2.2.5 Thresholds and expansion joint covers.

• 3.2-5 Design and Construction

See Section 2.4-2.2.5 (Thresholds and Expansion Joint

Requirements
Covers) for requirements.

3.2-5.1 Building Codes and Standards

3.2-5.2.2.6 Windows. See Section 2.4-2.2.6
See Section 2.4-1.2 (Building Codes and Standards)
(Windows) for requirements.
for requirements.

3.2-5.2.2.7 Glazing materials. See Section 2.4-2.2.7

3.2-5.2 Architectural Details, Surfaces, and
(Glazing Materials) for requirements.
Furnishings

3.2-5.2.2.8 Hand-washing stations. See Section

3.2-5.2.1 Reserved 2.4-2.2.8 (Hand-Washing Stations) for requirements.

A3.2-S.2.2.4 (2)(a) Eliminating the floor tracks and using breakaway door·hardware minimizes the possibility ofJamming.

168 Guidelines for Design and Construction of Residential Health, Care, nd Support Facilities
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

3.2-5.2.2.9 Grab bars. See Section 2.4-2.2.9 (Grab 3.2-5.2.4 Furnishings

Bars) for requirements. See Section 2.4-2.4 (Furnishings) for requirements.

3.2-5.2.2.10 Handrails
(1) See Section 2.4-2.2.10 (Handrails and Lean Rails) • 3.2-6 Building Systems
for requirements in addition to that in this section.
*(2) Handrails capable of supporting 250 pounds 3.2-6.1 General
(113.50 kilograms) shall be provided in all See Section 2.5-1 (Building Systems for Residential
corridors. Health, Care, and Support Facilities-General).

3.2-5.2.2.11 Protection &om heated surfaces. See

3.2-6.2 Plumbing Systems
Section 2.4-2.2.11 (Protection from Heated Surfaces)
for requirements.
3.2-6.2.1 General
3.2-5.2.2.12 Signage and wayfinding. See Section See Section 2.5-2.1 (Plumbing Systems-General) for
2.4-2.2.12 (Signage and Wayfinding) for requirements. additional requirements.

3.2-5.2.2.13 Decorative water features. Where 3.2-6.2.2 Plumbing and Other Piping Systems
decorative water features are used in the facility design, See Section 2.5-2.2 (Plumbing and Other Piping
see appendix section A2.4-2.2.13 (Decorative water Systems) for requirements.
features) for recommendations.
3.2-6.2.3 Plumbing Fixtures
3.2-5.2.3 Surfaces
3.2-6.2.3.1 Reserved
3.2-5.2.3.1 See Section 2.4-2.3 (Surfaces) for require­
ments in addition to those in this section. 3.2-6.2.3.2 Hand-washing sinks. See Section
2.5-2.3.2 (Hand-Washing Sinks) and Section 2.4-2.2.8
*3.2-5.2.3.2 To reduce surface contamination linked (Hand-Washing Stations) for requirements.
to health care-associated infections, surface materials
selected for use in hospice facilities shall possess the 3.2-6.2.3.3 Showers. See Section 2.5-2.3.3.2
following performance characteristics: (Accessible showers) for requirements and appendix
(1) Surfaces shall be cleanable and have no surface
section A3.2-2.2.2.7 (3) (Accessible shower) for
crevices or rough textures, joints, or seams.
recommendations.
(2) Surfaces shall be non-absorptive, nonporous, and
smooth. 3.2-6.2.3.4 Reserved

3.2-6.2.35 Clinical sinks. See Section 2.5-2.3.5

(Clinical Sinks) for requirements.
A~PENDIX

A3.2-S.2.2.10 (2) Where persons of size are accommodated, Process" identified environmental factors as "Iatent conditions that
supporting weight should be evaluated based on the needs of the care can be designed to help eliminate harm:'Such "built environment
population. latent conditions [holes and weaknesses] that adversely impact patient
safety" should be identified and eliminated during the planning,
A3.2-S.2.3.2 Surfaces and materials selected should be easy to
design, and construction of health care facilities. Reduction of surface
use and have clear, written, manufacturer-recommended cleaning
contamination linked to health care-associated infections is one of
and disinfection protocols to assure the product will remain durable
these factors. See Section 1.2-3 (Resident Safety Risk Assessment) for
and effective at meeting CDC and other clinical bacterial-elimination
additional information.
requirements.
The Center for Health Design report "Designing for Patient Safety:
Developing Methods to Integrate Patient Safety Concerns in the Design

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 169
3.2 SPECifiC REQUIREMENTS FOR HOSPICE FACiliTIES

3.2-6.2.3.6 Portable hydrotherapy whirlpools. See

for functionally equivalent spaces in Table
Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools)
3.1-1.
for requirements.
(ii) If no functionally equivalent spaces exist in
Table 3.1-1, ventilation requirements shall
3.2-6.2.4 Medical Gas and Vacuum Systems be obtained from Informative Appendix B
Any installation of nonflammable medical gas, air, or
in ANSIIASHRAE Standard 62.1: Ventila­
clinical vacuum systems shall comply with the require­
tion and Acceptable Indoor Air Quality or
ments ofNFPA 99: Health Care Facilities Code.
from Informative Appendix B in ANSII
ASHRAE Standard 62.2: Ventilation and
3.2-6.3 Heating, Ventilation, and
Acceptable Indoor Air Quality in Low-Rise
Air-Conditioning (HVAC) Systems
Residential Buildings.
(iii) Where spaces with prescribed rates are in­
3.2-6.3.1 General cluded in both ANSIIASHRAE Standard
62.1 or 62.2 and Table 3.1-1, the higher
3.2-6.3.1.1 Application. HVAC systems that meet
of the air change rates shall be used.
the requirements in this section shall be provided for
(d) Air change rates. The minimum number of
hospice facilities.
total air changes per hour indicated in Table
3.1-1 shall be either supplied for positive
3.2-6.3.1.2 Ventilation and space conditioning pressure rooms or exhausted for negative
(1) See Section 2.5-3.1.2 (Ventilation and Space
pressure rooms.
Conditioning) for requirements in addition to

(i) Spaces that are required by Table 3.1-1

those in this section.

to have a negative pressure relationship

*(2) Ventilation shall be designed to provide control of
environmental comfort, asepsis, and odor control
in resident spaces.
(a) Design of the ventilation system shall provide
air movement that is generally from clean to
less clean areas. If any form of variable-air­
volume or load-shedding system is used for
energy conservation, it shall not compromise
the pressure-balancing relationships or the
minimum air changes required in Table
3.1-1 (Design Parameters for Ventilation of
Residential Health Spaces).
(b) See Table 3.1-1 for ventilation requirements
intended to provide for comfort and asepsis
and odor control in hospice spaces that
directly affect resident care.
(c) For spaces not specifically listed in Table 3.1-1:
(i) Ventilation requirements shall be those
APPENDIX
but are not required to be exhausted shall
utilize the supply airflow rate to compute
the minimum total air changes per hour
required.
*(ii) For spaces that require a positive or nega­
tive pressure relationship, the number of
air changes per hour can be reduced when
the space is unoccupied as long as the
required pressure relationship to adjoin­
ing spaces is maintained while the space
is unoccupied and the minimum number
of air changes indicated is reestablished
whenever the space is occupied.
(e) Use of controls intended to switch the required
pressure relationships between spaces from
positive to negative, and vice versa, shall not be
permitted.
(f) For air-handling systems serving multiple
spaces, system minimum outdoor air quantity

A.~.l-6.3.1.l(,~) Ventilation $)'stem design. Because

A3.l-6.3.1.lll)(dHji) Air exchanges. Air(hange rates ill
ofthe div~rsity of the population ahd variations in susceptibility. and
excess of the minimum values a(~ expected in some cases to maintain
sensitivity; the spedficcare population's needs should..b~ taken into
room temperature and humidity ci>nditio.ns based on·the cooling or:
consideration when providing ventilation for cQmfort, .infection control,
heating load of the space.
and odoJ(ontrol.

170 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES
shall be calculated using one of the following
methods:
(i) As the sum of the individual space require­
ments
(ii) By the "ventilation rate procedure" (multiple
zone formula) of AS H RAE Standard 62.1.
The minimum outdoor air change rate
listed in this standard shall be interpreted
as the V oz (zone outdoor airflow) for pur­
poses of this calculation.
(3) Outdoor air intakes and exhaust discharges.
Equipment shall comply with Table 5.5.1 (Air
Intake Minimum Separation Distance) in ANSI/
ASHRAE Standard 62.1.
3.2-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
3.2-6.3.3 HVAC Requirements for Specific
Locations
3.2-6.3.3.1 Reserved
3.2-6.3.3.2 Fuel-fired equipment rooms. See Sec­
tion 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
requirements.
3.2-6.3.3.3 Areas of refuge. See Section 2.5-3.3.3
(Areas of Refuge) for requirements.
3.2-6.3.3.4 Commercial food preparation areas.
See Section 2.5-3.3.4 (Commercial Food Preparation
Areas) for requirements.
3.2-6.3.4 Thermal and Acoustic Insulation
See Section 2.5-3.4 (Thermal and Acoustic Insulation)
for requirements.
3.2-6.3.5 HVAC Air Distribution
See Section 2.5-3.5 (HVAC Air Distribution) for
requirements.
APPEN DIX
A3.2~6.3.6.1 (2)(c) Filters for recirculating room systems. Filters should be replaced and/or cleaned per the manufacturer's recom­
mendations to maintain indoor air quality.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
3.2-6.3.6 HVAC Filters
3.2-6.3.6.1 Filter efficiencies
(1) For centralized recirculated systems, see Table 3.1-1
(Design Parameters for Ventilation of Residential
Health Spaces) for required filter efficiencies.
(a) Each filter bank with an efficiency greater than
MERV 12 shall be provided with an installed,
readily accessible manometer or differential
pressure-measuring device that provides a
reading of differential static pressure across the
filter to indicate when the filter needs to be
replaced.
(b) All air provided to a space by centralized
recirculated systems shall be filtered.
(2) For non-central, recirculating room systems,
HVAC units shall:
(a) Not receive nonfiltered, nonconditioned
outdoor air.
(b) Serve only a single space.
*(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
designed to condense water. This filter shall be
located upstream of any such cold surface, so
that all of the air passing over the cold surface
is filtered.
3.2-6.3.6.2 Filter frames for centralized systems
(1) Filter frames shall be durable and proportioned to
provide an airtight fit with the enclosing ductwork.
(2) All joints between filter segments and the enclosing
ductwork shall have gaskets or seals ro provide a
positive seal against air leakage.
3.2-6.3.7 Heating Systems, Cooling Systems, and
Equipment
3.2-6.3.7.1 Reserved
171
3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

*3.2-6.3.7.2 Heating systems 3.2-6.4.2.1 Essential electrical service

(1) Heating sources and essential accessories shall be
(1) Applicable standards
provided in number and arrangement sufficient

(a) At minimum, hospice facilities or sections

ro accommodate the facility needs (reserve

thereof shall have essential electrical systems as

capacity), even when anyone of the heat sources

required in:
or essential accessories is not operational due to a

breakdown or routine maintenance. Exception:

(i) NFPA 99: Health Care Facilities Code
Reserve capacity is not required if the ASHRAE
(ii) NFPA 110: Standardfor Emergency and
99% heating dry-bulb temperature for the hospice
Standby Power Systems, requirements that
0 0
facility is greater than or equal to 25 F (_4 C).
address hospice facilities
(2) When a heat source is off-line, the capacity of the
(iii) NFPA 70: National Electrical Code,
remaining source(s) shall be sufficient to provide
requirements that address hospice facilities
for domestic hot water and dietary purposes and to

(b) Requirements for emergency lighting in

provide heating for resident care areas and resident

hospice facilities shall be dictated by local

rooms.

codes according to the care model.

(3) See Table 3.1-1 (Design Parameters for Ventilation

of Residential Health Spaces) for additional

(2) Shared service. Where the hospice facility is a
requirements.
distinct part of or served by an acute care hospital
on the same campus, required emergency lighting
3.2-6.3.7.3 Cooling systems and power shall be permitted to be provided by the
(1) For central cooling systems greater than a 400­
hospital essential electrical system.
ton (1407 kW) peak cooling load, the number
(3) Where fuel for electricity generation is stored
and arrangement of cooling sources and essential
on-site, the following shall be required:
accessories shall be sufficient to support the
(a) Storage capacity shall be sufficient to provide
hospice facility operation plan upon a breakdown
continuous operation in accordance with state
or during routine maintenance of anyone of the
requiremen ts.
cooling sources.
(b) Fuel storage for electricity generation shall be
(2) See Table 3.1-1 for additional requirements.
separate from heating fuel storage.
3.2-6.3.7.4 Temperature control. See Section

2.5-3.7.4 (Temperature Control) for requirements.

3.2-6.4.2.2 Generators. Exhaust systems (including
locations, mufflers, and vibration isolators) for internal
3.2-6.3.7.4 Temperature controL See Section
combustion engines shall be designed and installed to
2.5-3.7.4 (Temperature Control) for requirements.
. .. .
mInlmlZe nOlse.

3.2-6.4 Electrical Systems 3.2-6.4.3 Electrical Receptacles

3.2-6.4.1 General 3.2-6.4.3.1 General. Omission of receptacles from

See Section 2.5-4.1 (Electrical Systems-General) for
exterior walls where construction makes installation
requirements.
impractical shall be permitted. See Section 2.5-4.3.1
(Electrical Receptacles-General) for additional
3.2-6.4.2 Power-Generating and Power-Storing
information.
Equipment

3.2-6.4.3.2 Receptacles in corridors. See Section

2.5-4.3.2 (Receptacles in Corridors) for requirements.

APPENDIX_

A3.2-6.3.7.2 Heating systems. Storage on-site of fuel suf­

service should be considered as part ofthe disaster and emergency
ficient to support the owner's facility operation plan upon loss of fuel
preparedness plan.

172 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES
*3.2-6.4.3.3 Receptacles in resident rooms
(1) Each resident room shall have duplex-grounded
Standard 1069: Hospital Signaling and Nurse
receptacles, including at least one on each wall.
Call Equipment.
(2) At least two duplex outlets shall be provided for
each bed location, with one at each side of the
head of each bed location. Where electric-powered
beds are used, an additional outlet shall be
provided at the head of the bed.
3.2-6.4.3.4 Essential electrical system receptacles.
See Section 2.5-4.3.4 (Essential Electrical System
Receptacles) for requirements.
3.2-6.4.3.5 Ground fault interrupter receptacles.
See Section 2.5-4.3.5 (Ground Fault Interrupter
Receptacles) for requirements.
3.2-6.4.4 Electrical Requirements for Ventilator­
Dependent Resident Rooms and Areas
See Section 2.5-4.4 (Electrical Requirements for
Ventilator-Dependent Resident Rooms and Areas) for
requirements.
3.2-6.5 Communication Systems
3.2-6.5.1 General
See Section 2.5-5.1 (Communication Systems­
General) for requirements.
3.2-6.5.2 Call System
A nurse/staff call system shall be provided.
3.2-6.5.2.1 General
(1) Use of alternative technologies, including wireless
systems, shall be permitted for emergency or nurse
call systems.
(a) Where wireless systems are used, consideration
shall be given to electromagnetic compatibility
between internal and external sources.
APPENDIX
A3.2-6.4.3.3 Resident room receptacles. During the
functional programming process, all equipment, electric beds, task
lamps, televisions, data equipment, telephones, electronics, and other
resident and care uses in resident rooms that will reqUire electrical
receptacles should be identified during the functional programming
process. Providing enough outlets to avoid the need for extension cords
is recommended as use of extension cords can be a hazard and lead to
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
(b) Wireless systems shall comply with UL
(2) Nurse and emergency call systems shall be listed by
a nationally recognized testing laboratory (NRTL).
3.2-6.5.2.2 Resident room call stations
(1) Where a hardwired system is used, each bed
location shall be provided with a call device that is
accessible to the resident.
(a) One call station shall be permitted to serve two
call devices.
(b) Wireless call stations are permitted.
(2) A call initiated by a resident activating either a
call device attached to a resident's call station or a
portable device that sends a call signal shall register
at the staff call station or device and shall either:
(a) Activate a visual signal in the corridor at the
resident's door. In multi-corridor or cluster
resident units, additional visual signals shall be
installed at corridor intersections; or
(b) Activate a handheld mobile device carried by a
staff member, identifYing the specific resident
and location from which the call was placed.
*3.2-6.5.2.3 Emergency call system. An emergency
call device shall be accessible from each toilet, bathtub,
and shower used by residents.
(1) The device shall be accessible to a resident in any
position in the room, including lying on the floor.
Inclusion of a pull cord or portable wireless device
shall satisfY this requirement.
(2) The emergency call system shall be designed so
that a call activated will initiate a signal that is
distinct from the resident room call device and can
be turned off only at the activated emergency call
device.
regulatory citations. As well, the outlet heightthat will promote ease of
use by residents, staff, and family members should be determined.
A3.2-6.5.2.3 Hair salons, resident lounges, and all common
resident areas should be evaluated for incorporation of emergency
call system stations. This evaluation shuuld consider the care model,
care population, scale of the facility, and staff sight lines for obserVing
residents.
173
3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES

(3) The signal shall activate at the staff work area and/
3.2-6.7.3.2 Lighting requirements for specific loca­
or signal a handheld mobile device carried by staff.
tions. See appendix section A2.5-7.3.2 (Lighting in
transition spaces) for recommendations.
3.2-6.5.3 Technology Equipment and Teledata
(1) Resident unit corridors
Room(s)

(a) Resident unit corridors shall have general

See Section 2.5-5.3 (Technology Equipment and Tele­

illumination with provisions for reducing light

data Room) for requirements.

levels at night.
(b) Corridors and common areas used by residents
3.2-6.5.4 Grounding for Telecommunication

shall have even light distribution to avoid

Spaces

glare, shadows, and scalloped lighting effects.

See Section 2.5-5 .4 (Grounding for Telecommunica­

tion Spaces) for requirements.

(2) Resident rooms and toilet rooms. These rooms
shall have general lighting, task lighting, and night­
3.2-6.5.5 Cabling Pathways and Raceway
lighting.
Requirements
(a) Task lighting
See Section 2.5-5.5 (Cabling Pathways and Raceway

*(i) At least one task light shall be provided for

Requirements) for requirements.

each resident.
(ii) Task light controls shall be readily accessi­
3.2-6.6 Electronic Safety and Security Systems

ble to residents and staff at the head of the

See Section 2.5-6 (Electronic Safety and Security Sys­
bed (including multiple-bed locations).
tems) for requirements.

*(b) Night-lighting. Night-lighting shall be pro­

3.2-6.7 Daylighting and Artificial Lighting
vided in the pathway to and from the bedside
Systems
and the bathroom.

(i) Night-lighting shall be mounted no higher

3.2-6.7.1 General than 2 feet (61 centimeters) above the
See Section 2.5-7.1 (Daylighting and Artificial Light­
floor.
ing Systems-General) for requirements.
(ii) Night-lighting shall be controlled sepa­
rately from ambient lighting.
3.2-6.7.2 Daylighting Systems in Resident Living
*(iii) Night-lighting shall have a low light level.
Areas
(iv) Because night-lights may disturb resi­
See Section 2.5-7.2 (Daylighting Systems in Resident,
dent sleep even when properly specified,
Participant, and Outpatient Areas) for requirements.
located, and operated, care providers shall
be permitted to use portable light sources
3.2-6.7.3 Artificial Lighting Systems or switched night lights for added control
of this light source.
3.2-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
(c) Resident unit toilet rooms shall have general
(Light Fixtures) for requirements.

illumination with provision for reducing light

levels at night.

APPENDIX

A3.2-6.7.3.2 (2)(a)(i) Provision of movable task lighting should

should proVide very low levels of illumination and be located to mini­
be considered.
mize light scatter and reflections on room surfaces. Switches for night­
lights are recomml!nded for some care populations.
A3.2-6.7.3.2 (2)(b) Night-lighting in resident

rooms. Research has established that older adults sleep best in total
A3.2-6.7.3.2 (2)(b)(iii) Nightclighting should include amber or
darkness. Therefore, to minimize resident sleep disruption, night-lights
red lamping. White, blue, or green lamping should not be used.

174 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 3.2 SPECIFIC REQUIREMENTS fOR HOSPICE fACILITIES

3.2-6.8 Acoustic Design Systems (4) For facilities with more than 350 residents living
See Section 2.5-8 (Acoustic Design Systems) for or receiving health, care, or support services above
requirements. the main entrance floor, the number of elevators
shall be determined from a study of the facility
3.2-6.9 Elevator Systems plan and from the estimated vertical transportation
requiremen ts.
3.2-6.9.1 General (5) Where the facility is part of a general hospital,

elevators may be shared and the standards in

3.2-6.9.1.1 Requirement. All buildings having Section 2.5-9 (Elevator Systems) shall apply.

resident use areas on more than one floor shall have

3.2-6.9.2 Dimensions
electric or hydraulic elevator(s).
Elevator car doors shall have a clear opening of not less
3.2-6.9.1.2 Number than 3 feet 8 inches (1.12 meters).
(1) At least one elevator sized to accommodate a bed, a
3.2-6.9.3 Leveling Device
gurney, and/or medical carts and resident-operated
mobility device users shall be installed where See Section 2.5-9.3 (Leveling Device) for
residents are living or receiving health, care, or requirements.
support services on any floor other than the main
entrance floor. 3.2-6.9.4 Installation and Testing
(2) At least two elevators shall be installed where 60 to See Section 2.5-9.4 (Installation and Testing) for
200 residents are living or receiving health, care, requirements.
or support services on floors other than the main
entrance floor. 3.2-6.9.5 Handrails
(3) At least three elevators shall be installed where
Elevator cars shall have handrails on all sides without
201 to 350 residents are living or receiving health,
entrance door(s). See Section 2.4-2.2.10 (Handrails
care or support services on floors other than main
and Lean Rails) for additional requirements.
entrance floor.

- - - - - _ .. _ __
.. ._----~--~--

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 175
...

""i Appendix Table A3.2-a

\AI

0\ IV

VI
Hospice Care Model Characteristics "'l:I
m
n
Unit Type Typical # of Units Food Service/Dining Resident Room Bathing Facilities Design Drivers .."
n
C\ 1. Participation of integrated medical-based team ::l:l
c m
2. Palliative care focus o
0­
It>
c:
All unit types 3. Provision of end-of-life support ::l:l
:> m
It> 4. Support for quality of life s:m
'"
...., 5. Maintenance of personal dignity
o
Adult day care Day services with Decentralized Primarily private spaces Central bathing facility 1. Facility design should encourage mobility of participants.
...
Z
VI
o .."
hospice private spaces for located within sight lines 2. Access to outdoor space should be provided.
1tl
'"
o
co ambulatory hospice of staff ::l.1
3. Resident-operated mobility device access should be
:> participants in adult ::t:
provided at the entrance. oVI
'"0.:> day care settings
Access to toilet room from 4. A security system and/or operational process for safety "'Cl
n space, without entering should be provided for participants with dementia. n
o adult day care facility activity m
:> 5. A covered drop-off and pickup area for participants .."
'" or dining areas should be provided.
::l>
~
~ n
,..,c r­
....
o
[Does not include sleeping
6. See Chapter 5.2 (Specific Requirements for Adult Day
Care and Adult Day Health Care Facilities) for additional ...m
:> accommodations for visitors information and requirements. VI
o...., in Section 3.3-2.2.2.2 (4)]
:xJ
ro Small 6- 15 private Centralized with warming Private rooms with private Central or decentralized 1. Facility design should encourage mobility of participants.
'" ambulatory rooms in a small kitchen bath and toilet unless bathing facilities for 2. Access to outdoor space should be provided.
0­
ro residential group home justified by the functional residents
::> 3. Hallways/corridors should be sized to accommodate
-.
~ hospice for ambulatory Dining may be centralized program and approved by
gurneys.
'" facilities residents
and/or in room the AHJ [in accordance with Shower provided for staff
:r:
4. A nurse call system is required.
Section 3.3-2.2.1 (Resident
ro
Unit-General)] 5. Parking should be provided for ambulatory residents.
'"-
~ Shower provided for family
:::r
(if showers not provided in
n resident rooms)
OJ

1tl
Small non­ 6- 15 private Decentralized with public Private rooms with private Central or decentralized 1. Hallways/corridors should be sized to accommodate the
0;
:> 0 ~mb~latory rooms in a small (familylvisitor) ice dispenser toilet room bathing facilities for bed-turning radius of resident beds.
0. inpatient group home with
[
access residents 2. A nurse call system is required.
'-" residential
C
a combination of
U

3. A private staff reporting area should be provided.

care hospice non-ambulatory
U
Shower provided for staff 4. Access to oxygen should be provided.
o facilities and ambulatory
.... residents
,..,0;"
Shower provided for family
(if showers not provided in
_.
~ resident rooms)
ro
'"
 - -

G'>
c Appendix Table A3.2-a (continued)
Q.
Hospice Care Model Characteristics
'"
:J
Unit Type Typical # of Units Food Service/Dining Resident Room Bathing Facilities Design Drivers
''""
o"""
Freestanding 16 or more beds in Nourishment kitchen Private rooms with private Decentralized 1. Corridors should have a minimum width of 8'-0" (2.44
o hospice a large group home with family access that bath and toilet unless meters). Handrails should be installed in corridors.
''"" facilities setting includes coffee-maker or justified by the functional
Shower provided for staff 2. Access to oxygen should be provided.
to
automatic coffee dispenser, program and approved by
:J 3. A nurse call system is required.
tu
refrigerator, microwave, and the AHJ in accordance with
:J

Shower provided for family 4. Separate family support areas should be provided.
Q. dispensing ice machine Section 3.3-2.2.1 (Resident
n
Unit-General) (if showers not provided in S. An area for staff overnight stay should be provided for
o
resident rooms) emergency use.
:J
Decentralized facilities or
'"
r+ 6. At least one private dining room should be provided for
~
centralized facilities with Includes multiple-occupancy
C family members who need respite. (Typically, staff eats in
n
.... warming kitchen with rooms under special
a break area, family members eat in resident rooms, and
o catering contract circumstances for indigent
::J residents eat in bed.)
care with approval of local
o

"""
authorities
Dining may be centralized
::xJ
and/or in room
''""
Q..
._­
Hospital- Any number of beds Nourishment kitchen Primarily private or semi­ Central or decentralized 1. Corridors should have a minimum width of 8'-0" (2.44
....'"
::J based hospice housed in a hospital with family access that private rooms with private bathing facilities for meters). Handrails should be installed in corridors.
w
tu facilities setting, usually in a includes coffee-maker or toilet room residents 2. Access to oxygen should be provided. ....,
I dedicated nursing automatic coffee dispenser, III
3. A nurse call system is required.
ro unit, wing, or other refrigerator, microwave, "'0
tu Private rooms are Shower provided for staff 4. A hospice nurse station should be prOVided separate m
r+
::r

section of the and dispensing ice machine

recommended to allow for from any hospital nurse stations. -
f'I

hospital
(may be shared with family
family members and visitors,
Shower prOVided for family S. Separate family support areas should be provided.
""
f'I
room)
'"
overnight stays, and privacy. ::I:l
~

(l)
(if showers not provided in m
resident rooms) I:)

'" Decentralized facilities or c

::J
Q.
centralized facilities with ::I:l
m
~
VI
c warming kitchen with
"0
m
catering contract 2:
"0
o ....
III
.... Assisted liVing Any number of beds Nourishment kitchen, which Primarily private or semi­ Central or decentralized 1. Hallwayslcorridors should be sized to accommodate the

'""
facility- or housed in a nursing may be shared with family private rooms with private bathing facilities for bed-turning radius of resident beds. ""0
::I:l
n nursing home- home setting, may room toilet room residents 2. A nurse call system is required.
::I:
....
-' based hospice be in a dedicated 0
3. A private staff reporting area should be provided.
facilities wing or section of III
ro Decentralized or centralized Private rooms are Shower prOVided for family "'0
'" 4. Access to oxygen should be provided.
the nursing home
with a warming kitchen recommended to allow for (if showers are not provided f'I
or assisted living S. A hospice nurse station/staff area should be provided m
family members and visitors, in resident rooms)
facility
overnight stays, and privacy.
separate from nursing home or assisted living nurse
»""
stations/staff areas. f'I
r­
6. Separate family support areas should be provided.
.... ....
""l
m
""l
III
...

""'l Appendix Table A3.2-a (continued) W

IV
co
Vl
Hospice Care Model Characteristics -0
m
f"'I
Unit Type Typical # of Units Food Service/Dining Resident Room Bathing Facilities Design Drivers 'Tl
f"'I
C\ Home-based Services provided Decentralized Resident rooms or dwelling Decentralized bathing ::x:l
c m
Q.
hospice to residents living units in existing assisted facilities for residents I:)
C
ro services in in independent living or independent liVing
::x:l
a care and or assisted living settings m
'"ro support facility setting 3:
m
..."
o (distinguished z
..;
from home­ Vl
CJ Resident unit, 'Tl
based and
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\Q
private home or dwelling unit
::x:l
care mentioned ::t:
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in appendix
in a residential o
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independent living
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n or assisted living f"'I
o unit m
'Tl
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 • Specific Requirements for
Assisted Living Facilities
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 4.1-1 General includes needs for persons of size, see Section 2.2-3
(Design Criteria for Accommodations for Care of
4.1-1.1 Application Persons of Size) for requirements.

4.1-1.1.1 General 4.1-1.1.2.3 Dementia, mental health, and cognitive

*4.1-1.1.1.1 This chapter contains specific requirements
for assisted living facilities.
4.1-1.1.1.2 The requirements in Part 2 (Common
Elements for Residential Health, Care, and Support
Facilities) shall apply to assisted living facilities as
referenced in this chapter.
4.1-1.1.2 Design Criteria
4.1-1.1.2.1 Sustainable design. See Section 2.2-2
which must also comply with applicable state and local
(Sustainable Design Criteria) for requirements for
requirements.
assisted living facilities.
and developmental disability design criteria. Where
the care population includes residents with dementia,
mental health issues, or cognitive and developmental
disabilities, see Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive and
Developmental Disability Facilities) for requirements.
*4.1-1.1.3 Minimum Standards for New Assisted
Living Facilities
This chapter identifies the minimum requirements
for assisted living facilities of various configurations,

4.1-1.2 Functional Program

4.1-1.1.2.2 Design criteria for accommodations for
care of persons of size. Where the care population 4.1-1.2.1 General

. APPENDIX

A4.1-1.1.1.1 Assisted living facility types. ASSisted

only for people requiring minimal assistance, while otbers may offer

liVing facilities are avital and growing component ofthe continuum

more intensive services, including dementia-specific care. The design

ofcare, providing asupportive residential environment for consumer­

and construction of assisted living facilities, as much as possible, should

directed services. They may be freestanding facilities, facilities

reflect the needs and preferences of the individuals who reside in the

embedded in the community at-large, or distinct parts of acontinuing

facility.

care retirement community.

A4.1-1.1.1 This chapter acknowledges that many resident-driven

In practice, assisted living facilities can vary substantially from

variations appear in assisted living facilities, representing the program­

olie state to the liext and even in the same state. In some states, the
matic needs and preferences of the individuals who choose to live in

entity that provides services is licensed rather than the bUilding itself.
them, and that occupancy and bUilding construction requirements vary

In aQdition, assisted living facility design varies by location, taking into

among jurisdictions. Therefore, the requirements and recommenda­

consideration the cultural, geographic, socioeconomic, and ethnic char­

tions in this chapter are intended to establish basic standards to ensure

acteristics of the area.

the safety, accessibility, and residential aspects of all assisted living

Assisted living facilities provide care for individuals who need or

facilities, regardless of facility scope and scale. The common goal of this

desire assistance with medications and activities of daily living (e.g.,

chapter and local and staterequirements is to facilitate accountability

eating, bathing, dr.essing, toileting, ambulating). Some facilities care

and protection of the resident.

Guidelines for Design and Construction of Residential Health, Care. and Support Facilities 181
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES
4.1-1.2.1.1 See Section 1.2-2.1 (Functional Pro­
gram-General) for requirements in addition to those
in this section.
4.1-1.2.1.21he sponsor of each project shall provide a
functional program that:
*(1) Defines the scope and scale of the project
(including the care model).
(2) Identifies resident needs.
(3) Facilitates the application of licensure and
calls for sharing or purchasing services from another
occupancy approvals by authorities having
entiry, appropriate modifications in space and parking
jurisdiction (AH]s).
requirements shall be permitted.
APPENDIX
A4.1-1.2.1.2 (1) Care model characteristics. See
Medium-Sized Model
appendix table M.l-a (Assisted Living Facility Type Characteristics) for
In a medium-sized assisted living facility, 16 or fewer residential
additional information.
rooms. are arranged in a residentially scaled home or household
a. (are model types. The care model will vary depending on whether
provision of services is centralized or decentralized and on the size of
afacility. Below are general descriptions of the different size models
commonly used for assisted living facilities.
SmallModel
In 'Ismail assisted living facility, five or fewer residential rooms
generally are arranged in a residentially scaled home with
centralized services, bathing facilities, and resident and staff
support areas.
-With centralized services:
• This type of community includes centralized dining, house­
keeping, soiled and dean utility, medication storage and
delivery, linen, and other services provided by care staff for
residents.
• The staff models are hierarchical in nature, with direct care
staff managing overall care in accordance with individual­
ized service plans.
• Staff members provide care for the same residents, maxi­
mizing the opportunity to develop familiarity with aresi­
dent's individual needs.
• The travel distances for both staff and residents are very
short due to the household nature of the community.
-With decentralized services, including additional services
brought to the resident from outside providers!contractors:
• This type of community focuses on the holistic care of each
resident.
• Specialized social, recreational, educational, and spiritual
programs are offered based on individual resident needs.
• Residents receive individualized personal care and health­
related services as needed, induding care management
from a nurse and therapy services from therapists certified
in physical, occupational, and speech therapy.
182 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
(4) Addresses applicable provisions of the Guidelines
for Design and Construction ofResidential Health,
Care, and Support Facilities.
4.1-1.2.2 Shared Services and Space
4.1-1.2.2.1 Each assisted living faciliry shall, at mini­
mum, contain the elements described in the applicable
paragraphs of this chapter. However, when a project
that can be located in alarger community or in afreestanding
building. Services can be.centralized or decentralized or a
combination of the two depending on other care services being
offered and the type of community setting le.g., acontinuing care
retirement community).
~With centralized services:
• This type of community jncludes centralized dining,
housekeeping, laundry, medication storage and delivery,
linen storage, and other services prOVided by care staff for
residents in 16 or fewer resident rooms. Where a household
is connected to. alarger community, dining would be cen­
tralized in the household, but food might be supplied from
acentral kitchen.
• The staff model usually is an integrated household-based
team of direct care staff who manage overall care in accor­
dance with individualized service and care plans.
• Staff members proVide care for the same residents, maxi­
mizing the opportunity to develop familiarity with a resi­
dent's individual needs.
The travel distances for staff and residents are very short
due to the household nature ofthe community.
• This type of community offers an emergency response
system for the residents.
-With decentralized services:
• This type of community focuses on the holistic care of eC!ch
resident.
Specialized social, recreational, educational, and spiritual
programs are offered based on individual resident needs.
• Residents receive individualized personal care and health­
related services as needed, induding care management by
a nurse and therapy services by therapists certified in physi­
cal, occupational, and speech therapy.
 4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

*4.1-1.2.2.2 Where the assisted living facility or setting 4.1-1.3 Resident Safety Risk Assessment
is part of (or contractually linked with) another facility,
See Section 1.2-3 (Resident Safety Risk Assessment)
sharing of facilities for services such as home health,
for requirements.
hospice, dietary, storage, pharmacy, linen, and laundry
services shall be permitted.
4.1-1.4 Environment of Care Requirements

APPENDIX (continued)

Large Model Medium-Sized Model

Alarge assisted living facility may include 17 or more residential­ -Resident units should be designed to provide minimally private
style apartments arranged in alarger community or in a or semi-private sleeping and liVing areas and access to a bath­
freestanding structure, with centralized or decentralized services, room shared by no more than two residents.
bathing facilities, and resident and staff support areas. -Evaluation of the need for some decentralized services and
-With centralized services: activity areas to reduce travel distances for staff and residents is
This type of community includes centralized dining,
recommended.
housekeeping, laundry, medication storage and delivery,
-Common areas include dining, activity, and living/gathering
linen storage, and other services provided by care staff for
spaces.
residents.
Large Model
Staff models are hierarchical in nature, with direct care staff
-Private liVing quarters are provided, including sleeping areas, a
managing overall care in accordance with individualized
bathroom, and dining and living rooms.
service plans.
-Unit designs include studio and one- and two-bedroom apart­
• Travel distances for staff are usually shorter and travel dis­ ment styles.
tances for residents are usually longer in centralized models. -Evaluation ofthe need for some decentralized services and
• This type of community offers an emergency response activity areas to reduce travel distances for staff and residents is
system for the residents.
recommended.
-With decentralized services:
c. Additional benefits. Some additional benefits of the smal" medium­
• This type of community focuses on the holistic care of each sized, and large models of assisted living include the following:
resident. Smal/Model
• Specialized social, recreational, educational, and spiritual -The small nature of this setting prOVides for strong personal
programs are offered based on individual resident needs. relationships between residents and staff.
• Residents receive individualized personal care and health­ -This setting is typically provided by an owner-operator who is
related services as needed, including care management by both the owner and provider of care.
a registered nurse, therapy services by therapists certified in
Medium-Sized Model
physical, occupational, and speech therapy; and hair salon
-This setting typically allows for semi-private occupancy of the
services.
dwelling units.
Travel distances for staff and residents are usually very short
-This model can often be provided at alower cost than small or
due to the household nature of adecentralized community,
large models.
except for food service staff when food is prepared in a
central kitchen. Large Model
• This type of community offers an emergency response The size of this community allows creation of multiple households
system for residents. or neighborhoods to serve populations with specialized care needs.
b. Physical setting. Assisted living facilities are further differentiated
Examples are residents who suffer from memory or dementia
according to their physical settings.
disorders or Parkinson's disease or who need significant assistance
with activities of daily living.
Smal/Model
-Resident bedrooms are designed to provide private sleeping A4.1-1.2.2.2 Shared services and facilities. Services
areas and access to a bathroom shared by no more than two may be contractually provided or shared with other entities. In some
residents. cases, all ancillary service requirements will be met by the principal
-Evaluation of the need to prOVide a meeting area for families facility and the only modifications necessary will be in the assisted living
due to the home-style design of the community is recom­ facility. In other cases, programmatic concerns and reqUirements may
mended. dictate separate service areas.
-Common areas include dining and living spaces.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 183
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

4.1-1.4.1 General services, equipment, and utilities appropriate for daily

living.
See Section 1.2-1.3 (Environment of Care and Facility
Function Considerations) and Section 1.2-4 (Environ­
ment of Care Requirements) for requirements.
4.1-1.5 Site

4.1-1.5.1 General
4.1-1.4.2 Flexibility
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site
Residential care and support facilities shall be designed
Elements) for requirements in addition to those in this
to provide flexibility to meet the changing physical,
section.
medical, and psychological needs of residents.

4.1-1.4.3 Supportive Environment 4.1-1.5.2 Reserved

4.1-1.4.3.1 The facility design shall produce a sup­ 4.1-1.5.3 Site Features
portive environment to:
4.1-1.5.3.1-4.1-1.5.3.2 Reserved
(1) Enhance and extend quality oflife for residents.
(2) Facilitate wayfinding.
4.1-1.5.3.3 Parking. In addition the requirements
to
(3) Promote resident privacy and dignity.
in Section 2.1-3.3 (Parking), the number of parking
spaces for an assisted living facility shall be calculated
4.1-1.4.3.2 The physical environment of the assisted
using the following parameters:
living facility shall support the services and levels of
care provided in the facility, which are in large part (1) At least one parking space shall be provided for

driven by the service needs and lifestyle preferences of every residential living unit.

the residents being served.
4.1-1.4.3.3 Assisted living facilities shall be designed
and constructed to provide a supportive residential
environment that is conducive to day-to-day
activities consistent with the cultural, emotional,
and spiritual needs of residents. This supportive
environment shall:
(1) Promote independence, privacy, and dignity for
• 4.1-2 Resident Areas
residents.
(2) The total number of parking spaces to be provided
shall be based on local requirements as well as
functional need of the population to be served.
(3) When a project includes sharing or purchasing
services, appropriate modifications in parking
requirements shall be permitted. See Section 4.1­
1.2.2 (Shared Services and Space) for requirements.

(2) Balance resident autonomy with resident safety. *4.1-2.1 General

(3) Provide choice for all residents in a manner that

encourages family and community involvement.

4.1-2.1.1 Application
*4.1-1.4.4 Barrier-Free Environment
The physical environment shall eliminate as many bar­
riers as possible to effective access and use of the space,
The requirements in this section are common to most
assisted living facilities and shall apply where the areas
described are included in a particular assisted living
facility.

APPENDIX

A4.1-1.4.4 Barrier-free environment b. Facilities should provide accessibility for residents with disabilities in
a. "Universal design"practices that promote barrier-free environments accordance with the state or local bUilding code and the Americans
should be encouraged. See appendiX section A1.2-1.4-c with Disabilities Act.
(Environmento{ care recommendations-Barrier-free environment)
A4.1-2.1 Assisted living has developed into avariety of models

for more information.

that are designed to meet differing social, economic, and therapeutic

184 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.1 SPECIFIC REQUIREMENTS fOR ASSISTED LIVING FACILITIES
4.1-2.1.2 Layout
4.1-2.1.2.1 Areas for the care and treatment of users
not residing in the facility shall not interfere with or
infringe on the living space of residents.
4.1-2.1.2.2 Facility layout shall reflect the care
model and related staffing.
(1) Small model. Arrange five or fewer residential
rooms in a residentially scaled home with
centralized services, bathing, resident, and staff
support areas.
(2) Medium model. Arrange 16 or fewer residential
rooms in a residentially scaled home or household
that could be located in a larger community or
is freestanding with centralized or decentralized
services, bathing, resident, and staff support areas.
(3) Large model. Arrange 17 or more residential-style
apartments in a larger community or freestanding
unit with centralized or decentralized services,
bathing, resident, and staff support areas.
4.1-2.2 Resident Unit or Private Living Area
4.1-2.2.1 General
The facility shall provide bedrooms or apartments
(resident units) that:
4.1-2.2.1.1 Allow for sleeping.
4.1-2.2.1.2 Afford privacy.
considerations. Assisted living facilities may.be categorized into the
following groups, although some facilities may combine elements of
multiple approaches.
a. Apartmentmodel. Apartment model facilities provide private
resiaent units ranging in size from efficiency to two- or three-bedroom
apartments. These apartments typically have cooking facilities (some­
times limited to a microwave) and are often indistinguishable from
apartment units available to the general population. Common group
activity areas that residents may use in addition to their private apart­
ments are provided to promote the social and programmatic aspects of
the facility.
b. Group living model. Facilities with agroup living model provide
smaller private spaces that are sometimes limited to a private or shared
resident bedroom area. The focus of daily life is provided in shared activ­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.1-2.2.1.3 Provide access ro furniture and belongings.
4.1-2.2.1.4 Accommodate the care and treatment
provided to the resident.
4.1-2.2.2 Resident Room or Apartment
4.1-2.2.2.1 Capacity. Bedrooms shall be limited to
single or double occupancy.
4.1-2.2.2.2 Space requirements
(1) Resident room size (area and dimensions) shall
permit resident(s) to move about the room with
the assistance of a resident-operated mobility
device, allowing access to at least one side of a bed,
window, closet or wardrobe, chair, dresser, and
nightstand.
(2) Room size and configuration shall permit
resident(s) options for bed location(s) and shall
comply with spatial requirements of the AHJ.
(3) Bedrooms shall not be used as passageways,
corridors, or access to other bedrooms.
*(4) Where cooking is permitted in resident rooms or
apartments, the cooking area shall be equipped
with a dedicated sink and cooking and refrigeration
appliances.
4.1-2.2.2.3 Windows. See Section 4.1-5.2.2.6 (Win­
dows) for requirements.
ity spaces that are residential'-5caled and organized similar to atypical
house. These smaller-scale homes or households maybe freestanding
or grouped together in .attached or detached configurations. Commons
or community facilities are sometimes proVided to allow residents to
participate in activities outside of their home or household.
c. Alternative models. Many alternative facility configurations have
been created that incorporate aspects of each of these approaches.
These guidelines are intended to allow and encourage the continued
evolution and flexibility of this facility type without locking into a par­
ticular program or model.
A4.1-2.2.2.2 (4) Where cooking eqUipment is present in resident
rooms or apartments, the community must have adefinitive way of
disabling such devices, should they be unsafe for residents to use.
185
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

*4.1-2.3.8.1 Outdoor spaces shall be provided for
residents, visitors, and staff.
4.1-2.3.8.2 See Section 2.1-3.6.2 (Outdoor Activity
Spaces) for additional requirements and information.
• 4.1-3 Diagnostic and Treatment
4.1-4.2.1 Staff Work Areas
4.1-4.2.1.1 These area(s) shall be provided when
required by the care model to serve resident needs.
4.1-4.2.1.2 Lockable storage shall be provided for
resident records.

Areas
4.1-4.2.1.3 See Section 2.3-4.2.1 (Staff Work Area)
for additional requirements.
4.1-3.1 General
Where diagnostic and treatment areas are required for 4.1-4.2.2 Medication Distribution and Storage
the resident care population or as part of community­ Locations (Centralized and Decentralized)
based services, see Section 2.3-3 (Diagnostic and Treat­ See Section 2.3-4.2.2 (Medication Distribution and
ment Areas) for requirements. Storage Locations) for requirements.

4.1-3.2 Examination, Observation, and/or

4.1-4.2.3 Central Bathing or Spa Room or Area
Treatment Rooms

Where examination, observation, or treatment rooms !*4.1-4.2.3.1 General. Where a central bathing or spa
are provided, see Section 2.3-3.2 (Examination, Obser­ room or area is provided, the requirements in this
vation, and/orTreatment Rooms) for requirements. section shall be met.

4.1-3.3 Rehabilitation Therapy Facilities 4.1-4.2.3.2 Number. At least one central bathtub, spa
tub, or shower shall be provided for resident use based
Where outpatient rehabilitation therapy facilities are
on the needs of the care population.
provided, see Chapter 5.3 (Specific Requirements
for Outpatient Rehabilitation Therapy Facilities) for
4.1-4.2.3.3 Space requirements. Bathing fixtures
requirements.
shall be located in individual rooms or enclosures that
provide the following:
4.1-3.4 Wellness Centers
(1) Space for private use of the bathing fixture
Where wellness facilities are provided, see Chapter
(2) Space for drying and dressing
5.2 (Specific Requirements for Wellness Centers) for

(3) Access to a grooming location with a hand-washing

requirements.

station, mirror, and counter or shelf

• 4.1-4 Facilities for Support Services 4.1-4.2.3.4 Toilet. A toilet shall be provided in or

directly accessible to each resident bathing facility

4.1-4.1 General without requiring entry into the general corridor.

See Section 2.3-4.1 (Facilities for Support Services­

4.1-4.2.3.5 Shower. Where a shower is included in
General) for requirements.
the bathing or spa room or area, see Section
2.5-2.3.3.2 (Accessible showers) for reqUirements.
4.1-4.2 Facilities that Support Resident,

Participant, or Outpatient Care

APPENDIX

A4.1-2.3.8.1 Outdoor activity spaces A4.1-4.2.3.1 ,Resident privacy. Consideration should be

a. Visual access to outdoor activity spaces from·indoors should be pro­
given to privacy when locating entrances to bathing or spa rooms.
vided for staffand residents.

b. Outdoor spate(s),shouldbe ac(essible via'short, naVigable distances.

,------, , - - - - - ,----------,-,-,---,,--,--­

188 Guidelines for Design and Construction of Residential Heaith, Care, and Support Facilities
 4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

4.1-4.2.4 Equipment and Supply Storage 4.1-4.2.7.2 Where shared personal laundry areas are
provided, these shall be equipped with the following
4.1-4.2.4.1 See Section 2.3-4.2.4 (Equipment and for use by residents/families:
Supply Storage) for requirements in addition to those
(1) Washer and dryer
in this section.
(2) Hand-washing station
(3) Folding area
4.1-4.2.4.2 Clean linen storage
(1) A separate closet or designated area shall be 4.1-4.2.7.3 See 2.3-4.2.7 (Personal Laundry Facilities)
provided if required for the linen services offered for additional requirements.
by the facili ty.
(2) Where a closed-cart system is used, storage in an 4.1-4.2.8 Resident Telephone Access
alcove shall be permitted.
See Section 2.3-4.2.8 (Resident and Participant
Telephone Access) for requirements.
4.1-4.2.4.3 Supply storage. Storage space(s) for sup­
plies and recreation items shall be immediately acces­
4.1-4.3 Support Areas for Staff
sible to support activities and recreation offered.

4.1-4.3.1 General
4.1-4.2.4.4 Storage for resident needs. Storage
space(s) for resident equipment and supplies shall be See Section 2.3-4.3.1 (Support Areas for Staff­
immediately accessible to support services offered. General) for requirements.

4.1-4.2.5 Clean Utility Room 4.1-4.3.2 Staff Lounge Area

A clean utility room shall be provided for storage and See Section 2.3-4.3.2 (Staff Lounge Area) for
holding as part of a system for distribution of clean requirements.
materials. See Section 2.3-4.2.5 (Clean Utility Room)
for requirements. 4.1-4.3.3 Toilet Rooms
Toilet rooms shall be permitted to be shared by the

4.1-4.2.6 Soiled Utility Room public, staff, and residents.

A soiled utility room shall be provided for storage and

holding as part of a system for collection of soiled 4.1-4.4 Support Facilities for Family and

materials. See Section 2.3-4.2.6 (Soiled Utility Room) Visitors

for requirements.
4.1-4.2.7 Personal Laundry Facilities
4.1-4.2.7.1 Provision of decentralized facilities for
washing and drying personal laundry shall be permit­
ted when the care model supports this approach for
4.1-4.4.1 General
Community space for family and visitors shall be
provided based on the care model.
*4.1-4.4.2 Overnight Guest Accommodations
Space for sleeping accommodations for overnight

small groups of residents. guests shall be provided based on the care model.

APPENDIX

A4.1-4.4.2 Overnight guest accommodations
a. Where visitor sleeping accommodations are prOVided in resident
rooms or apartments, prOVision of the following should be con­
sidered:
-Sufficient circulation around the sleeping accommodation (e.g.,
recliner, sleep chair, sleep sofa) when it is fully open for use to
allow staff to reach the resident in case of an emergency
-Storage space to accommodate and secure overnight guests'
belongings
b. Provision of separate guest suites or apartments is recommended as
ameans for accommodating overnight visitors.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 189
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES
4.1-4.4.3 Pet Accommodations
See Section 2.3-4.4.3 (Pet Accommodations) for
requirements.
4.1-4.5 Food Service Facilities
4.1-4.5.1 General
The type and size of the assisted living facility shall
determine the dietary environment and the food ser­
vice facilities provided.
4.1-4.5.2 Centralized Commercial Kitchen
Where a centralized commercial kitchen is provided,
the food service facilities shall meet the requirements
in Section 2.3-4.5 (Food Service Facilities).
4.1-4.5.3 Warming Kitchen
For facilities that have a service contract with an
outside vendor for food service, the following require­
ments shall be met:
4.1-4.5.3.1 Where an outside vendor is used to pro­
vide meals for a facility of 16 or more beds, dedicated
space and equipment shall be provided for a warming
kitchen, including space for minimal equipment for
preparation of breakfast, emergency, or after-hours
meals.
4.1-4.5.3.2 The resident kitchen shall be permitted
to serve as an alternative location to accommodate the
function of a warming kitchen. See Section 2.3-2.3.4
(Resident and Participant Kitchen) for requirements.
4.1-4.5.4 Decentralized Kitchen
Where food preparation is conducted on-site for 16 or
more beds, the facility shall have dedicated non-public
staff space and equipment for preparation of meals. See
section 2.3-2.3.4 (Resident and Participant Kitchen)
for requirements.
4.1-4.6 Linen and Laundry Service Facilities
4.1-4.6.1 General
A4.1-4.6.1.2 Based on the care model, laundry services may be
decentralized using personal laundry facilities and/or acombination of
190 Guidelines for Design and Con truction of Residential Health. Care, and Support Facilities
4.1-4.6.1.1 Each assisted living facility shall have
provisions for storing and processing clean and soiled/
contaminated linen for resident care.
*4.1-4.6.1.2 Based on the care model, combination
of personal laundry facilities with clean utility and/
or soiled utility rooms shall be permitted. See sections
2.3-4.2.5 (Clean Utility Room), 2.3-4.2.6 (Soiled
Utility Room), and 2.3-4.2.7 (Personal Laundry
Facilities) for additional requirements.
4.1-4.6.2 Facilities for Contracted Linen Services
Where contracted services are used, the following shall
be provided:
4.1-4.6.2.1 An area for soiled linen awaiting pickup
4.1-4.6.2.2 A separate area for storage and distribution
of clean linen
4.1-4.6.2.3 A control station for pickup and receiving.
This shall be permitted to be shared with other services
and serve as the receiving and pickup point of service
for the facility.
4.1-4.6.3 On-Site Laundry Service Facilities
4.1-4.6.3.1 General
(1) Where on-site laundry services are provided, the
requirements in this section shall apply.
(2) Facilities for processing shall be permitted to be
located in the facility or in a separate building.
(3) Layout. Equipment shall be arranged to permit
a workflow that minimizes cross-traffic between
clean and soiled operations.
(a) Areas dedicated to laundry shall be separate
from food preparation areas.
(b) Laundry rooms shall not open directly into
resident rooms.
4.1-4.6.3.2 At minimum, the following elements shall
be included:
(1) Rooms and spaces for sorting, processing, and
storage of soiled materials
personal laundry facilities and contracted linen services. See 2.3-4.2.7
(Personal Laundry Facilities) for additional information.
 4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

(2) Soiled holding room(s). Separate central or

4.1-4.10 Facilities for Engineering and

decentralized room(s) shall be provided for

Maintenance Services

receiving and holding soiled linen for pickup or

See Section 2.3-4.10 (Facilities for Engineering and

processing.

Maintenance Services) for requirements.

(a) Room(s) shall have ventilation and exhaust.
(b) Discharge from soiled linen chutes shall be
received in this room or in a separate room as
required by the local AH].
(c) Room(s) used for processing shall be provided
with a laundry or deep sink.
(3) Central clean linen storage. A central clean linen
storage and issuing room(s) shall be provided in
addition to the linen storage required at individual
*4.1-4.11.1.1 Conference and educational space.
resident units.
(4) Linen carts
(a) Storage. Provisions shall be made for parking
clean and soiled linen carts separately and out
of traffic.
(b) Cleaning. Provisions shall be made for
4.1-4.11 Administrative Areas
4.1-4.11.1 Office and Conference Space
Offices or an open office area with private confer­
ence space shall be provided for business transactions,
admissions, and social services and for the use of
administrative and professional staff
Space for private interviews; staff, resident, and family
meetings; conferences; and health education shall be
sized according to operational needs.
(1) Space shall include provisions for use of visual aids
and technology.
(2) Sharing of space by several services shall be

cleaning linen cans on-premises (or exchange permitted.

of carts off-premises).

(5) Hand-washing stations. Hand-washing stations
shall be provided in each area where unbagged
soiled linen is handled. See Section 2.4-2.2.8
(Hand-Washing Stations) for additional
requirements.
4.1-4.7 Materials Management Facilities
See Section 2.3-4.7 (Materials Management Facilities)
4.1-4.11.1.2 General office space. Office space shall
be provided for staff and file storage.
4.1-4.11.1.3 Supply and copy room. Space for
storage of files, office equipment, and supplies shall be
provided.
• 4.1-5 Design and Construction

for requirements.
Requirements

4.1-4.8 Waste Management Facilities

See Section 2.3-4.8 (Waste Management Facilities) for *4.1-5.1 Building Codes and Standards
waste collection, storage, and disposal requirements. See Section 2.4-1.2 (Building Codes and Standards)
for requirements.
4.1-4.9 Environmental Services Rooms
See Section 2.3-4.9 (Environmental Services Rooms)
for requirements.

APPENDIX

A4.1-4.11.1.1 Kitchenette for conference space. some jurisdictions and institutional occupancies in others. To date,
Provision of kitchenette facilities, including under-counter refrigerator, the model codes do not adequately recognize assisted living as a
microwave, and sink, should be considered for the conference space. distinct occupancy classification. Institutional codes place overly
restrictive and costly requirements on facility construction. Residen­
A4.1-5.1 Building codes and standards
tial codes, however, may not require adequate protection.
a. Appropriate code. Facilities serving similar resident groups and
b. Safety features. With the addition of the safety features listed below,
proViding similar services are considered residential occupancies in

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 191
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

4.1-5.1.1 General
4.1-5.2.2.3 Ceiling height. See Section 2.4-2.2.3

(Ceiling height) for requirements.

A code-compliant, safe, and accessible environment

shall be provided.

*4.1-5.2.2.4 Doors and door hardware

4.1-5.1.2 Accessibility Codes
(l) Door type
The facility shall comply with applicable fedetal, state,
*(a) Doors to all rooms containing bathtubs, show­
and local tequitements; see Section 1.1-4.1 (Design
ers, and toilets for resident use shall be hinged,
Standards for Accessibility).
sliding, or folding.
(b) Resident unit doors. Resident units shall be
4.1-5.2 Architectural Details, Surfaces, and lockable by occupant(s).
Furnishings
(i) Egress from the unit shall be possible at all
4.1-5.2.1 General
times and locking hardware shall enable
occupant(s) to gain egress from within by
See Section 2.4-2.1 (Architectural Details, Surfaces,

means of a simple operation.

and Furnishings-General) for requirements.

(ii) All residential units shall be accessible by

staff or safety personnel.
4.1-5.2.2 Architectural Details
(c) Manual or automatic sliding doors shall
4.1-5.2.2.1 General. See Section 2.4-2.2.1 (Architec­ be permitted where their use does not
tural Details-General) for requirements. compromise fire and other emergency exiting
requirements.
4.1-5.2.2.2 Corridors. See Section 2.4-2.2.2 (Corri­
(2) Door openings. See Section 2.4-2.2.4.2 (Door

dors) for requirements.

openings) for requirements.

APPENDIX (continued)

use of residential occupancy and construction types should be per­
mitted for assisted living facilities with more than 16 units:
-Protection ofthe facilities throughout with asupervised auto­
matic fire suppression system with quick-response sprinklers in
smoke compartments containing sleeping rooms. Automatic fire
suppression systems in facilities with more than 16 units should
be installed in accordance with NFPA 13: Standard for the Instal­
lation ofSprinkler Systems.
-Smoke barriers subdividing every story into at least two smoke
compartments. Such smoke compartments should be not more
than 22,500 square feet (2.09 square meters), and the travel
distance from any point in each smoke compartment to asmoke
barrier door should not exceed 200 feet (61 meters).
c. Resident waiting areas. The therapeutic and programmatic benefits
of prOViding waiting areas and similar spaces open to the corridor in
long-term care facilities should be considered. Spaces open to the
corridor significantly enhance resident mobility and accessibility to
programs, encouraging resident participation.
d. Egress control Programmatic considerations may call for the control
environment) should be encouraged.
of egress from some facilities or portions of facilities. Where such
released locking device must automatically open when the fire
alarm system is activated or power is lost.
-No device operation sign should be posted where 24-hour
awake and trained staff supervise the locking device.
e. Accessibility. Assisted living facilities should consider residents with
varying and possibly increasing levels of acuity. To maximize the
potential for aging in place, attention should be paid to overall
accessibility. locations where individuals may not require physical
assistance from others in emergency situations typically require
compliance with standards for multifamily housing (a specific subset
is now used as "safe harbor" for Fair Housing architectural reqUire­
ments). In addition, the Uniform Federal Accessibility Standards shall
apply for structures built with federal assistance. locations where
individuals require physical assistance from others in emergency
situations may require compliance with the 2010 Americans with
Disabilities ActStandards for Accessible Design.
f. Barrier-free design. Universal design practices that promote barrier­
free environments (see appendiX section M.1-1.4.4-Barrier-free

A4.1-S.2.2.4 Door protection. See appendiX section

egress control is <lesired, the folloWing should be followed:

A2.4-2.2.4 (Door protection) for recommendations.

-The means of e.gress should not be locked except for well­

documented clinical reasons and where such egress control is A4.1-S.2.2.4 (1 )(a) Provisions should be made for auditory and

not asubstitutefor appropriate staffing. visual privacy and usability for doors to rooms containing bathtubs,

-Where the means of egress is locked, a keyed or electronically showers, and toilets for resident use.

----------
192 Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
 4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

(3) Insect screens. See Section 2.4-2.2.4.3 (Insect

4.1-5.2.3 Surfaces
screens) for requirements.

4.1-5.2.2.5 Thresholds and expansion joint covers.
See Section 2.4-2.2.5 (Thresholds and Expansion Joint
Covers) for requirements.
4.1-5.2.2.6 Windows
*(1) See Section 2.4-2.2.6 (Windows) for requirements
in addition to those in this section.
(2) Windows shall be provided in all sleeping areas.
4.1-5.2.2.7 Glazing materials. See Section 2.4-2.2.7
(Glazing Materials) for requirements.
4.1-5.2.3.1 General
(1) See Section 2.4-2.3.1 (Surfaces-General) for
requirements in addition to those in this section.
*(2) To reduce surface contamination linked to health
care-associated infections (HAIs), surface materials
selected for use in assisted living facilities shall
possess the following performance characteristics:
(a) Surfaces shall be cleanable.
(b) Surfaces shall have no surface crevices, rough
textures, joints, or seams.
(c) Surfaces shall be non-absorptive, nonporous,
and smooth.

4.1-5.2.2.8 Hand-washing stations. Where hand­

4.1-5.2.3.2 Flooring and wall bases. See Section 2.4­
washing stations are provided, they shall comply with
2.3.2 (Flooring and Wall Bases) for requirements.
Section 2.4-2.2.8 (Hand-Washing Stations).

4.1-5.2.3.3 Walls and wall protection. See Sec­

4.1-5.2.2.9 Grab bars. See Section 2.4-2.2.9 (Grab
tion 2.4-2.3.3 (Walls and Wall Protection) for
Bars) for requirements.
requirements.

4.1-5.2.2.10 Handrails and lean rails. See Sec­

4.1-5.2.3.4 Ceilings. See Section 2.4-2.3.4 (Ceilings)
tion 2.4-2.2.10 (Handrails and Lean Rails) for
for requirements.
requiremen ts.

4.1-5.2.4 Furnishings
4.1-5.2.2.11 Protection from heated surfaces. See
Section 2.4-2.2.11 (Protection from Heated Surfaces) See Section 2.4-2.4 (Furnishings) for requirements.
for requirements.

4.1-5.2.2.12 Signage and wayfinding. See Section

• 4.1-6 Building Systems
2.4-2.2.12 (Signage and Wayfinding) for requirements.
4.1-6.1 General
4.1-5.2.2.13 Decorative water features. Where See Section 2.5-1 (Building Systems-General) for
decorative water features are used in the facility design, requirements.
see appendix section A2.4-2.2.13 (Decorative water
features) for recommendations.

APPENDIX

A4.1-S.2.2.6 (1) Windows. Each room in a resident apartment
should have awindow(s) that meets the requirements of Section 2.4­
2.2.6 (Windows).
A4.1-S.2.3.1 (2) Surfaces and materials selected should be easy
to use and have clear, written, manufacturer-recommended cleaning
and disinfection protocols to assure the product will remain durable
and effective at meeting Centers for Disease Control and Prevention and
other clinical bacterial-elimination requirements.
The Center for Health Design report "Designing for Patient Safety:
Developing Methods to Integrate Patient Safety Concerns in the Design
Process" identified environmental factors as "latent conditions that
can be designed to help eliminate harm:' Such "built environment
latent conditions [holes and weaknessesl that adversely impact patient
safety"should be identified and eliminated during the planning,
design, and construction of health care facilities. Reduction of surface
contamination linked to health care-associated infections is one of
these factors. See Section 1.2-3 (Resident Safety Risk Assessment) for
additional information.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 193
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

4.1-6.2 Plumbing Systems
4.1-6.2.1 General
See Section 2.5-2.1 (Plumbing Systems-General) for
requirements.
4.1-6.2.2 Plumbing and Other Piping Systems
See Section 2.5-2.2 (Plumbing and Other Piping Sys­
tems) for requirements.
4.1-6.2.3 Plumbing Fixtures
4.1-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
Fixtures-General) for requirements.
(2) For large assisted living facilities, see ANSI!
ASHRAE Standard 62.1: Ventilation for Acceptable
Indoor Air Quality for basic HVAC system
requiremen ts.
4.1-6.3.1.2 Ventilation and space conditioning. See
Section 2.5-3.1.2 (Ventilation and Space Condition­
ing) for requirements.
4.1-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
4.1-6.3.3 HVAC Requirements for Specific
Locations

4.1-6.2.3.2 Hand-washing sinks. See Section 2.4­

4.1-6.3.3.1 Reserved
2.2.8 (Hand-Washing Stations) for requirements.

4.1-6.3.3.2 Fuel-fired equipment rooms. See Sec­

4.1-6.2.3.3 Showers and tubs. See Section 2.5-2.3.3
tion 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
(Showers and Tubs) for requirements.
requirements.
4.1-6.2.3.4 Reserved
4.1-6.3.3.3 Areas of refuge. See Section 2.5-3.3.3
(Areas of Refuge) for requirements.
4.1-6.2.3.5 Clinical sinks. See Section 2.5-2.3.5
(Clinical Sinks) for requirements.
4.1-6.3.3.4 Commercial food preparation areas.
See Section 2.5-3.3.4 (Commercial Food Preparation
4.1-6.2.3.6 Portable hydrotherapy whirlpools.
Areas) for requirements.
Where portable hydrotherapy whirlpools are used in
an assisted living facility, see Section 2.5-2.3.6 (Por­
4.1-6.3.4 Thermal and Acoustic Insulation
table Hydrotherapy Whirlpools) for requirements.
See Section 2.5-3.4 (Thermal and Acoustic Insulation)
4.1-6.2.4 Medical Gas and Vacuum Systems for requirements.
Where medical gas and/or vacuum systems are used,
4.1-6.3.5 HVAC Air Distribution
the installation of nonflammable medical gas, air, or
clinical vacuum systems shall comply with the require­ See Section 2.5-3.5 (HVAC Air Distribution) for
ments ofNFPA 99: Health Care Facilities Code. requirements.

4.1-6.3 Heating, Ventilation, and 4.1-6.3.6 HVAC Filters

Air-Conditioning (HVAC) Systems
4.1-6.3.6.1 Filter efficiencies
4.1-6.3.1 General (1) For centralized recirculated systems, MERV 7
shall be the minimum filter efficiency for the first
4.1-6.3.1.1 Application filter bank. There is no minimum filter efficiency
(1) For small and medium-sized assisted living requirement for the second filter bank.
facilities, see ANSIIASHRAE Standard 62.2: (2) For non-central recirculating room systems, HVAC
Ventilation and Acceptable Indoor Air Quality in units shall:
Low-Rise Residential Buildings for basic HVAC
system requirements.
._ - - - - - - - - - - - - - - - - - - - - - - - - - _ . _.. _.. -_.__._----------_..------_.---.-.
194 Guidelines for Design and Construction of Residential Health, Care, and Support Facil:t;es
 4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES
(a) Not receive nonfiltered, nonconditioned
outdoor air.
(b) Serve only a single space.
*(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
designed to condense water. This filter shall be
located upstream of any such cold surface so
that all of the air passing over the cold surface
is filtered.
4.1-6.3.6.2 Filter frames for centralized systems
(1) Filter frames shall be durable and proportioned to
provide an airtight fit with the enclosing ductwork.
(2) All joints between filter segments and the enclosing
ductwork shall have gaskets or seals to provide a
positive seal against air leakage.
4.1-6.3.7 Heating Systems, Cooling Systems, and
Equipment
See Section 2.5-3.7 (Heating Systems, Cooling
Systems, and Equipment) for requirements in addition
to those in this section.
4.1-6.3.7.1 Heating systems. Substance abuse treat­
ment facilities shall have a permanently installed
heating system capable of maintaining an interior
minimum temperature of 72 0 F (22 0 C) under heating
design temperatures.
4.1-6.3.7.2 Cooling systems. Substance abuse treat­
ment facilities shall be configured and equipped with
a cooling system capable of maintaining an interior
maximum temperature of75° F (24 0 C) under cooling
design temperatures.
4.1-6.4 Electrical Systems
4.1-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
4.1-6.4.2 Power-Generating and Power-Storing
Equipment
APPENDIX
A4.1-6.3.6.1 (2)(c) Filters for recirculating room
systems. Filters should be replaced and/or cleaned per the manufac­
turer's recommendations to maintain indoor air quality.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.1-6.4.2.1 Essential electrical system
*(1) Applicable standards for care models
(a) Large model assisted living facilities or sections
thereof shall have essential electrical systems as
required in:
(i) NFPA 101: Life Safety Code
(ii) NFPA 99: Health Care Facilities Code
(b) For small and medium-sized models, local
codes shall dictate minimum requirements for
the essential electrical system.
(c) For all assisted living facilities, local codes
and care model needs shall dictate emergency
lighting requirements.
(2) Where residents on life support equipment are
served in the assisted living facility, essential
electrical power shall be provided to the life
support equipment.
(3) Where fuel for electricity generation is stored
on-site, the following requirements shall be met:
(a) Storage capacity shall permit continuous
operation for at least 24 hours.
(b) Fuel storage for electricity generation shall be
separate from heating fuel storage.
(c) Where heating fuel is used for diesel generators
after the required 24-hour supply of diesel
fuel has been exhausted, positive valving and
filtration shall be provided to avoid entry of
water and/or contaminants into the storage
tank.
4.1-6.4.2.2 Generators. Where generators are
used for an assisted living facility, exhaust systems
(including mufflers and vibration isolators) for internal
combustion engines shall be located, designed, and
installed to minimize objectionable noise.
4.1-6.4.3 Electrical Receptacles
4.1-6.4.3.1 General. See Section 2.5-4.3.1 (Electrical
Receptacles-General) for requirements.
A4.1-6.4.2.1 (1) Care models are defined in appendix section
M.l-l.2.1.2 (1) (Care model characteristics).
195
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

4.1-6.4.3.2 Receptacles in corridors. See Section 2.5­ 4.1-6.5.2 Call System

4.3.2 (Receptacles in Corridors) for requirements.
4.1-6.5.2.1 General. Where call systems are provided,
*4.1-6.4.3.3 Receptacles in resident rooms the following requirements shall be met:
(1) Each resident room shall have duplex-grounded
(1) The system shall be capable of activation/operation
receptacles, including at least one on each wall.
from resident toilets, bedrooms, and bathing areas.
(2) There shall be at least two duplex outlets provided (2) The signal shall be transmitted to on-duty staff
for at least one bed location, with one at each side through fixed locations and/or resident wearable
of the head of each bed. devices.
(3) Use of alternative technologies, including wireless
4.1-6.4.3.4 Essential electrical system receptacles. systems, shall be permitted.
See Section 2.5-4.3.4 (Essential Electrical System
(a) Where wireless systems are used, consideration
Receptacles) for requirements.
shall be given to electromagnetic compatibility
between internal and external sources.
4.1-6.4.3.5 Ground fault interrupter receptacles. See
(b) Wireless systems shall comply with UL
Section 2.5-4.3.5 (Ground Fault Interrupter Recep­
Standard 2560: Emergency Call Systems
tacles) for requirements.
for Assisted Living and Independent Living
Facilities.
4.1-6.4.4 Electrical Requirements for Ventilator­
Dependent Resident Rooms and Areas
4.1-6.5.2.2 Resident apartment or dwelling unit
Where ventilators are used in the facility, see Section call stations
2.5-4.4 (Electrical Requirements for Ventilator-Depen­
(1) Where a hardwired system is used:
dent Resident Rooms and Areas) for requirements.
(a) Each bed location shall be provided with a call
4.1-6.5 Communication Systems device accessible to the resident.
(b) One call station shall be permitted to serve
4.1-6.5.1 General two call devices.

(2) Use of wireless call stations shall be permitted.

4.1-6.5.1.1 Application. The requirements in this
section shall apply to the following systems based on
4.1-6.5.2.3 Emergency call system. Where an emer­
the care model and the needs of residents:
gency call system is provided, an emergency call device
(1) Call system shall be located at each toilet, bath, and shower used
(2) Information system by residents.
(3) Telecommunications system
(1) The device shall be accessible to a resident in any
position in the room, including lying on the floor.
4.1-6.5.1.2 Communication systems equipment
Inclusion of a pull cord or portable wireless device
requirements
shall satisfy this requirement.
(1) Each resident unit or apartment shall be equipped (2) The emergency call system shall be designed so that
for a television and telephone. when a call is activated a signal is initiated that is
(2) See Section 2.5-5.1.2 (Communication System
distincr from the resident room call device and can
Equipment Requirements) fot additional
be turned off only at the activated emergency call
requirements.
device.
(3) The signal shall activate at the staff work area and/
or signal a handheld mobile device carried by staff.
APPENDIX

A4.1-6.4.3.3 Because assisted living facilities often include one or more bedrooms, living spaces, and private bathrooms, furniture layouts should be
used to establish receptacle locations.

196 Guidelines for Design and Construction of Residential Health, Care; and Support Facilities
 4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES
(4) Emergency call systems shall comply with UL
2560: Emergency Call Systems for Assisted Living and
Independent Living Facilities.
4.1-6.5.3 Technology Equipment and Teledata
Room(s)
See Section 2.5-5.3 (Technology Equipment and
Teledata Room) for requirements.
4.1-6.5.4 Grounding for Telecommunication
Spaces
See Section 2.5-5.4 (Grounding for Telecommunica­
tion Spaces) for requirements.
4.1-6.5.5 Cabling Pathways and Raceway
Requirements
See Section 2.5-5.5 (Cabling Pathways and Raceway
Requirements) for requirements.
4.1-6.6 Electronic Safety and Security Systems
See Section 2.5-6 (Electronic Safety and Security
Systems) for requirements.
4.1-6.7 Daylighting and Artificial Lighting
Systems
4.1-6.7.1 General
See Section 2.5-7.1 (Daylighting and Artificial Light­
ing Systems-General) for requirements.
4.1-6.7.2 Daylighting Systems in Resident Living
Areas
See Section 2.5-7.2 (Daylighting Systems in Resident
Living, Participant, and Outpatient Areas) for
requirements.
4.1-6.7.3 Artificial Lighting Systems
APPENDIX
A4.1-6.1.3.2 (2) Lighting in resident rooms,
bedrooms, and bathrooms. Resident rooms, bedrooms, and
bathrooms should have general lighting and task lighting.
a. Provision of movable task lighting should be considered.
b. Resident bathrooms should provide general illumination with provi­
sion for redUcing light levels at night.
------_._---_._-------------------­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.1-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
(Light Fixtures) for requirements.
4.1-6.7.3.2 Lighting requirements for specific
locations. See appendix section A2.5-7.3.2 (Lighting
in transition spaces) for recommendations.
(1) Resident unit corridors
(a) Resident unit corridors shall have general
illumination with provisions for redUcing light
levels at night.
(b) Corridors and common areas used by residents
shall have even light distribution to avoid
glare, shadows, and scalloped lighting effects.
*(2) Resident rooms, bedrooms, and bathrooms
(a) Task light controls shall be readily accessible to
residents.
(b) Where night-lighting is provided, it shall
be located in the pathway to and from the
bedside and the bathroom.
(i) Night-lighting shall be mounted no higher
than 2 feet (61 centimeters) above the
floor.
(ii) Night-lighting shall be controlled sepa­
rately from ambient lighting.
*(iii) Night-lighting shall have a low light level.
(iv) Because night-lights may disturb resi­
dent sleep even when properly specified,
located, and operated, care providers shall
be permitted to use portable light sources
or switched night-lights for added control
of this light source.
4.1-6.8 Acoustic Design Systems
See Section 2.5-8 (Acoustic Design Systems) for
requirements.
A4.1-6.7.3.2 (2Hb)(iii) Night-lighting in resident
rooms. Research has established that older adults sleep best in total
darkness. Therefore, to minimize resident sleep disruption, night-lights
should provide very low levels of illumination and be located,to mini­
mize light scatter and reflections on room surfaces. To achieve a low
light level, nighHighting should include amber or red lamping. White,
blue, or green lamping should not be used. Switches for night-lights are
recommended for some care populations.
197
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES

main entrance floor, the number of elevators shall

4.1-6.9 Elevator Systems
be determined from a study of the facility plan
4.1-6.9.1 General and from the estimated vertical transportation
requirements.
4.1-6.9.1.1 Requirement. All buildings having

resident use areas on more than one floor shall have

*4.1-6.9.2 Dimensions and Clearances
electric or hydraulic elevator(s).

4.1-6.9.2.1 Elevator car doors shall have a clear open­

*4.1-6.9.1.2 Number. Engineered traffic studies are rec­ ing of no less than 3 feet 8 inches (1.12 meters).
ommended, but in their absence the following guide­
lines for minimum number of elevators shall apply: 4.1-6.9.2.2 Other elevators required for passenger

(1) At least one elevator sized to accommodate a service shall be sized to accommodate resident­

gurney and/or medical carts and resident-operated operated mobility devices.

mobility device users shall be installed where

residents are living or receiving care or support 4.1-6.9.3 Leveling Device
services on any floor other than the main entrance
See Section 2.5-9.3 (Leveling Device) for

floor.
requirements.

(2) At least twO elevators shall be installed where 60 to

200 residents are living or receiving care or support
4.1-6.9.4 Installation and Testing
services on floors other than the main entrance
See Section 2.5-9.4 (Installation and Testing) for

floor.
requiremen ts.

(3) At least three elevators shall be installed where

201 to 350 residents are living or receiving care
or support services on floors other than the main
en trance floor.
(4) For facilities with more than 350 residents living
or receiving care or support services above the
4.1-6.9.5 Handrails
Elevator cars shall have handrails on all sides without
entrance door(s). See Section 2.4-2.2.10 (Handrails
and Lean Rails) for additional requirements.

APPENDIX

A4.1-6.9.1.2 Number of elevators. These standards may

b. If required to serve the care population and indicated by a mobility
be inadequate for moving large numbers of people in ashort time;
transfer assessment, at least one facility elevator should accommo­
adjustments should be made as appropriate to the care model and
date attending staff and an ambulance gurney 7feet 6inches (2.29
population served.
meters) in length and/or an expanded capacity width of 4feet (1.22
meters) for persons of size.
A4.1-6.9.2 Elevator dimensions and clearances
a. Handrail projections of up to 3.5 inches (8.89 centimeters) should

not be construed as diminishing the clear inside dimensions.

198 Guidelines for Design and Construction of Residential Health. Care. and Support Facilities
G1
c: Appendix Table A4.1-a
~ I Assisted Living Facility Type Characteristics*
:J
ro
'" Unit Type Typical Food Resident Bathing Design Drivers Environment of Care and Relevant Descriptions
....,
o #of Service! Accommodations Facility Type
Units Dining Type
CJ
ro
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lQ
Small 5 or
-
Centralized Primarily private Centralized Integrated household­ 1. Light: Maximal access to daylight should be a priority in private bedroom spaces,

:J fewer rooms with a based team work areas, and shared social spaces. The care population's low vision issues should

W bathroom shared Resident-directed care be addressed in the design, including avoidance of glare.

:J
0­ by no more than Reduced travel 2. Views of and access to nature: Maximal access to views of nature and outdoor

n two-residents spaces should be a priority. Where direct access is not possible, alternative access

o distances
:J
may include indoor gardens with natural light (sky lights). roof gardens, and green

'"
~
Support for deep
and meaningful roofs.

c:
r"I
~ relationships 3. Signage and wayfinding: The smaller size of this facility type generally makes it

easier to prOVide a layout with direct visual access to key destinations.

o
:J

o...,
Family meeting areas
recommended I 4. User control of environment: The goal is to support greater resident autonomy in all
aspects ofthe environment.
~
N
:JJ VI
ro 5. Privacy and confidentiality: Provision of all single-occupancy rooms enhances "'0
'" m
privacy, although availability of another space outside the bedroom for visiting is
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ro
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-.
w 6. Safety and security: The smaller scale makes staff monitoring easier. Outside
spaces should be visible from indoors. Multi-story residences need to conform to
"m
: xl

I I:)
ro
w
accessibility standards. All residences should conform to local and state fire and life c:
safety standards. :xl
::r m
( 7. Characteristics and criteria for selection of materials and products for architectural ~
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supported. -I
ro VI
w 8. Cultural responsiveness: The cultural orientation and needs, customs, desires, "
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etc. of the care population and staff should inform the design of the physical
o
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environment. This understanding addresses the "who" element of the functional Z
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caregiver from Jamaica caring for an orthodox Jewish woman understand and Z
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G'\
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may influence design characteristics. m
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Appendix Table A4.1-a (continued) N

III
Assisted Living Facility Type Characteristics '"0
m
Unit Type Typical Food Resident Bathing Design Drivers Environment ot Care and Relevant Descriptions "
."

CI
c:
#ot
Units
Servicel
Dining Type
Accommodations Facility Type
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:l m
fewer shared and private and/or based team
'"
V>
(Note: if more
rooms with private centralized
work areas, and shared social spaces. The care population's low vision issues should
s:m
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o Z
medium-size or shared full 2. Views of and access to nature: Maximal access to views of nature and outdoor -l
Reduced travel III
o household is bathrooms (shared
distances spaces should be a priority. Where direct access is not possible, alternative access ."

'"'" connected, by no more than

Support for deep
may include indoor gardens with natural light (sky lights), roof gardens, and green o
~
<D
each two residents) roofs.
:> and meaningful
household
z
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has its own m
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Evaluation of need for m
n dining area, should be able to be easily read by residents who are visually impaired.
o some decentralized Z
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but food may
services and activity 4. User control of environment: The goal is to support resident autonomy in all aspects o
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~ be supplied Z
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5. Privacy and confidentiality: Provision of all single-occupancy rooms enhances r-
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kitchen.)
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6. Safety and security: The smaller scale makes staff monitoring easier. Outside III
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Z
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-. 7. Characteristics and criteria for selection of materials and products for architectural
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n environment. This understanding addresses the "who" element of the functional
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CD programming process, considered critical to developing the environment of care.

OJ For example, the designer would provide a physical environment that helps a
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caregiver from Jamaica caring for an orthodox Jewish woman understand and
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 Appendix Table A4.1-a (continued)
~ I Assisted Living Facility Type Characteristics
0..
III
Unit Type Typical Food Resident Bathing Design Drivers Environment of Care and Relevant Descriptions
:::J
III #of Service! Accommodations Facility Type
'"
...., Units Dining Type
o
Large 170r Decentralized Primarily private Decentralized Multidisciplinary 1. Light: Maximal access to daylight should be a priority in private bedroom spaces,
o
III more and!or apartments with
and!or team from across the work areas, and shared social spaces. The care population's low vision issues should
'"
centralized private full baths centralized community (including be addressed in the design, including avoidance of glare.
(Q
:::J
(includes studio for therapy universal workers), 2. Views of and access to nature: Maximal access to views of nature and outdoor
OJ
:::J and one- and two­ reasons often hierarchal in spaces should be a priority. Where direct access is not possible, alternative access
0..
bedroom units) (e.g., spas centralized model may include indoor gardens with natural light (sky lights), roof gardens, and green
(}
o to enhance Staff efficiency for roofs. Provision of outdoor dedicated staff space and staff break areas with views
:l
V> lifestyle both centralized and should be considered.
....
choices) decentralized models 3. Signage and wayfinding: A wayfinding program should be provided to help
c
'...."' Staff travel distances residents, staff, and visitors distinguish one apartment from another. In a larger
o usually shorter, travel building, this can include landmarks to assist with orientation. Signage should be
:::J

o-., distances for residents able to be easily read by residents who are Visually impaired.
usually longer in 4. User control of environment: The goal is to support resident autonomy in all aspects
:xl f"
III centralized models of the environment, providing resident choice wherever possible.
VI
0­ Both staff and resident 5. Privacy and confidentiality: Provision of all single-occupancy apartments enhances "tl
III

:l
travel distances privacy. In one-bedroom ortwo-bedroom shared apartments (e.g., an apartment
m
.... f'I
OJ
usually shorter in shared by a couple), provision of separate seating areas allows for private .,.,
decentralized models, discussions. f'I
I

III
except for food ::0
OJ 6. Safety and security: Because decentralized staffing is recommended, staff presence m
.... service staff where
near residents and points of activity is greater. Outside spaces should be visible o
:r food is prepared in a c:
. from indoors. Multi-story residences need to conform to accessibility standards. All ::0
(} centralized kitchen m
OJ residences conform to local and state fire and life safety standards.
~
Evaluation of the need 3::
m
"' for some decentralized
7. Characteristics and criteria for selection of materials and products for architectural
Z
OJ details, surfaces, and furnishings: Personalization of individual spaces should be -t
:l
services and activity VI
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supported. Resident input on community spaces should periodically be reviewed .,.,
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to verify compliance with needs expressed in the functional program. o
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<:J 8. Cultural responsiveness: The cultural orientation and needs, customs, desires, >
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VI
....
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that foster deep

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environment. This understanding addresses the "who" element of the functional VI

and meaningful -t
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n
programming process, considered critical to developing the environment of care. m
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.... caregiver from Jamaica caring for an orthodox Jewish woman understand and
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<
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9. Support for person-centered care: The goal of this model is to offer residents a full
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VI
 • Specific Requirements for
Independent Living Settings
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.
• 4.2-1 General
4.2-1.1 Application
*4.2-1.1.1 General
*4.2-1.1.1.1 This chapter contains specific requirements
for independent living settings that provide resident
support services, including retirement communities.
4.2-1.1.1.2 The requirements in Part 2 (Common
Elements for Residential Health, Care, and Support
Facilities) shall apply to independent living settings as
referenced in this chapter.
4.2-1.1.2 Design Criteria
APPENDIX :,
A4.2-1.1.1 When creating environments that adapttothe changing
physical challenges of the aging or of other special need populations,
the principles of universal design should be employed to support maxi­
mum functional competente ofthe residents.
A4.2-1.1.1.1 Independent living setting types. An
independent living setting can be afreestanding house or cottage, an
attached house, or an apartment (including condominiums, co-ops,
and low-rise and high-rise buildings). The design of independent liVing
settings varies according to social and economic factors and the model
of care. Such afacility can be single- or multi-story, stand-alone or
linked with other apartments or cottages, or part of the campus of a
continuing care retirement community (CCRC). "Independent" refers to
the level of services provided.
Independent living settings may be categorized into the follOWing
broad types:
a. Freestanding house or cottage or attached house. These s.et­
tings typically include a minimllm of two bedrOoms and have
kitchen, dining, and living' areas.
b. Apartment (including condominiums andco-ops). Model senior
liVing apartment and condominium settings prOVide private
Guidelines for Design and Construction of Residential Health. Care. and Support Faci!ities
4.2-1.1.2.1 Sustainable design. See Section 2.2-2
(Sustainable Design Criteria) for requirements for
independent living settings.
4.2-1.1.2.2 Design criteria for accommodations for
care of persons of size. Where the care population
includes needs for persons of size, see Section 2.2-3
(Design Criteria for Accommodations for Care of
Persons of Size) for requirements.
4.2-1.1.2.3 Dementia, mental health, and cognitive
and developmental disability design criteria. Where
the care population includes residents with dementia,
mental health issues, or cognitive and developmen­
tal disabilities, see Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive and Devel­
opmental Disability Facilities) for requirements.
resident units ranging in size from efficiency to two- or three­
bedroom apartments. Atypical unit includes kitehe'1,dining,
and living areas and is indistinguishable from apartment units
available to the general population. Extra blocking in walls,
wider dOQr and corridor widths, and ()ther elements required
for adaptable use of the residence are recommended. In addi­
tion to their private apartments, residents may have acces.s to
common spaces (e.g., dining, lounge, activityareasHnat sup­
port the social and programmatic aspects ofthe independent
living setting.
Acondominium differs from a rental apartment or an apartment
in aCCRC in that the resident owns the unit and typically is itssessed
a homeowner's association fee for general maintenance and common
amenities.
Where an apartment is partofaCCRC, the model usually includes
an initial deposit for use of the building and thereafter it monthly fee
for services, which may be either alife care plan or an ala carte fee-for­
service plan.
Direct access to outdoor spaces from common areas and individual
residential units should be provided.
203
4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS

4.2-1.1.3 Minimum Standards for New
Independent Living Settings
4.2-1.1.3.1 This chapter identifies minimum require­
ments for new construction and shall not be applied
to existing facilities unless major renovations are
undertaken. See Section 1.4-3 (Renovation) for more
information.
*4.2-1.1.3.2 This chapter identifies the minimum
requirements for independent living settings of various
configurations, which must also comply with appli­
cable state and local requirements.
4.2-1.2 Functional Program
4.2-1.2.1 General
(4) Addresses applicable provisions of this chapter.
4.2-1.2.1.2 See Section 1.2-2 (Functional Program)
for additional requirements.
4.2-1.2.2 Shared Services and Space
4.2-1.2.2.1 Where a project calls for sharing or
purchasing services from another entity, appropriate
modifications in space and parking requirements shall
be permitted.
*4.2-1.2.2.2 Where the independent living setting is
part of (or contractually linked with) another facility,
sharing of facilities for services such as home health,
hospice, dietary, storage, pharmacy, linen, and laundry
services shall be permitted.

4.2-1.2.1.1 The sponsor of each project shall provide a 4.2-1.3 Reserved

functional program that:
(I) Defines the scope and scale of the independent
*4.2-1.4 Environment of Care Requirements
living setting.
See Section 1.2-1.3 (Environment of Care and Facility
(2) Identifies resident needs. Function Considerations) and Section 1.2-4 (Environ­
(3) Facilitates occupancy approvals by authorities
ment of Care Requirements) for requirements.
having jurisdiction.

APPENDIX

A4.2-1.1.3.2 Acknowledging that occupancy and building construc­
tion requirements vary among jurisdictions, theintertt of this. chaptet is
to establish basic gUidance for safety and accessibility for an indepen­
d~nt living setting in which we services are proVided, regardless of the
scope and scale of the physical environmenfeQr the services offer~d.
A4.2-1.2.2.2 Shared services and facilities. Services
may be contractually provided or shared with'other entities. In some
cases, all ancillary service requirements will be met by the principal
facility.and the only modifications necessary will be inthe independent
Iivingsetting.lnothercases, programmatic concerns and requirements
may dictate-separate service "reas.
A4.2-1.4I;nvir()nment of cC!re recommendatio.ns
a. Flexibility. Independent liVing facilities should be de$igned to adapt
to the changing physical needs of reSidents.
b. Supportive environmenf. The facility design should proVide a..sup­
ages family and community involvement
portive environment that facilitates the provision of services to
~The environment should support ilging in place and
enhance quality of life for residents liVing indep'endently.
acknowledge reSidents' socialization needs.
~Independentliving settings "nd associated support spaces
should be designedto meet the needs of differently abled
populations who choose to live and/or me for others in an inde­
pendent living,setting.
-Somesuppmt services are provided in most independent liVing
settirtgs; these may include transportation, social activities,
dining/food service, and housekeeping and maintenance ser­
vices. Some independent liVing settings may also include access
to a higher level of care services such as home health care, in­
ffome hospice, portable dialysis treatment, care management,
and other in-home community-based services.
~Independent liVing settings should be designed and constructed
to prOVide asupportive residentfal environment thilt is
conducive to day-to-day activities and consistent with the
cultural, emotional,spiritual,and me needs ofthe residents.
This supportive environment should:
• promote independence, privacy, and dignity
• B.alance autonomywith safety
• PrOVide choices for all residents in amanner that encour­
-The functional program for an independent livingsetting should
in~lude an evaluation of the use of resident-operated mobil ity'
devices and reasonable walking distances for individuals using
these devices.

204 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS

4.2-1.5 Site 4.2-1.5.2.3 Security. See Section 2.1-2.3 (Security)

for requirements.
4.2-1.5.1 General
See Section Chapter 1.3 (Site Selection) and Section
4.2-1.5.2.4 Access to utilities. See Section 1.3-2.4
2.1-1 (Site Elements-General) for requirements in
(Access to Utilities) and Section 2.1-2.4 (Access to
addition to those in this section.
Utilities) for requirements.

*4.2-1.5.2 Independent Living Setting/Community *4.2-1.5.3 Site Features

Access
4.2-1.5.3.1 - 4.2-1.5.3.3 Reserved
4.2-1.5.2.1 Reserved
4.2-1.5.3.4 Signage and wayfinding. See Section
4.2-1.5.2.2 Availability of transportation. See
2.1-3.4 (Signage and Wayfinding) for requirements.
Section 2.1-2.2 (Availability of Transportation) for

requirements.

APPENDIX (continued)

c. Barrier-free environment. The architectural environment should associated injuries) for information on flooring types and transi­
be barrier-free to provide for effective access to and use of tions.
space, services, equipment, and utilities appropriate for daily -Single-lever water controls (mixers) should be prOVided at all
living. plumbing fixtures. See appendix section A4.2-6.2 (Plumbing
fixtures) for additional information.
- "Universal design" practices should be encouraged to promote
barrier-free environments for residents with varying abilities, A4.2-1.5.2 Emergency access
including (but not limited to) the following; a. Fire department and emergency vehicle access should be provided in
• Adjustable height counters accordance with local requirements.
• Drawers or roll-outs in cabinetry b. Where an independent living setting is part of acontinuing care
• Raised-height dishwasher retirement community (CCR(), emergency access should be defined
• Side-by-side refrigerator by the highest level of care proVided on-site (e.g., assisted living,
• Contrasting colorIborder treatment on countertops nursing home).
• Contrasting color/edge detail between floor and wall sur­
A4.2-1.5.3 Site features
faces
a. Roads. Roads for access to the main entrance and service areas
Hand-held shower head with faucet controls accessible to
should be provided on the property where the independent living
resident and caregiver
setting is located.
Front-loading washer and dryer on raised platform
b. Pedestrian walkways
Provision of 5feet by 5feet of clear, level space both inside
-Minimum sidewalk width should be 48 inches (122 em).
and outside the entry door to allow for maneuvering
-Sidewalks and curb cuts should align to provide clear pathways
resident-operated mobility devices
to destinations.
• General illumination at doorways
c. Parking
• Accessible showers
-Each independent living setting should have parking spaces
• Adaptable-height sinks
sufficient to meet local zoning and operational needs.
Adjustable shelves for cabinetry and storage
-Where an attached or separate garage unit is included in
Raised-height electrical outlets
conjunction with an independent living dwelling unit, universal
-Adjustable rods and shelves should be provided in resident
design standards should be followed to support access to the
closets.
dwelling unit.
-A peep hole should be provided at the entry door to resident
-Where an independent living setting is part ofacontinuing care
living spaces. Consideration should be given to prOViding peep
retirement community (CCRC), parking requirements should
holes at alternative heights to accommodate residents of differ­
be applied to each level of care prOVided (e.g., assisted living,
ent heights and those using resident-operated mobility devices.
nursing home).
-See Section 2.4-2.1.2.2 (1) (Reduction of resident falls and
----- - - - - - - - - - - - - - - - - - - - -
Guid"elines for Design and Construction of Residential Health, Care, and Support Facilities 205
4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS
4.2-1.5.3.5 Site lighting. See Section 2.1-3.5 (Site
Lighting) and Section 2.5-7 (Daylighting and Artificial
Lighting Systems) for requirements.
4.2-1.5.3.6 Landscape features
(1) General. See Section 1.2-4.5.1 (Light) and Section
1.2-4.5.2 (Views of and Access to Nature) for
requirements and appendix section A2.1-3.6.1
(Landscape features) for additional information.
(2) Outdoor activity spaces. See Section 2.1-3.6.2
(Outdoor Activity Spaces) for requirements and
information.
(3) Outdoor water features. Where provided, open
outdoor water features shall be designed to support
maintenance of safe water quality to protect the
public from infectious or irritating aerosols.
4.2-1.5.4 Building Orientation
See Section 1.2-2.2.2.2 (1)(a) (Building orientation)
for planning requirements and Section 2.2-2.1
(Sustainable Site Design) for design requirements.
APPENDIX
A4.2-2.1 Space requirements for the resident dwelling units and
common areas of a particular independent living setting should be iden­
tified in the functional program.
A4.2-2.2 Resident units. The resident unit is agroup of dwell­
ing units included in an independent living setting. The types of dwell­
ing units (e.g., apartments, freestanding houses), community areas,
and support areas that make up a particular independent living setting
should be identified in the functional program.
A4.2-2.2.2 Dwelling unit. Design recommendations for
resident bathrooms, reSident storage, and resident kitchens include:
a. Resident bathroom
-Bathrooms should be designed to meet universal design stan­
dards. See appendiX section A4.2-1.4 (Barrier-free environment)
for universal design recommendations.
- The number of bathrooms to be provided in each resident unit
should be based on the population served.
-At least one bedroom in an independent dwelling unit should
have direct access to an adaptable bathroom that includes the
following:
Toilet with height appropriate to the population being
served
- The toilet should be installed 30 inches (76.2 centime­
ters) from the centerline to the adjacent wall to allow
for alternative grab bar configurations and transfers.
- Toilets used by residents should allow sufficient
206 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.2-1.5.5 Environmental Pollution Control
See Section 2.1-5 (Environmental Pollution Control)
for requirements.
• 4.2-2 Resident Areas
*4.2-2.1 General
The requirements in this section are typical of many
independent living settings and shall apply where the
areas described are included in a particular indepen­
dent living setting.
*4.2-2.2 Resident Unit
4.2-2.2.1 Reserved
*4.2-2.2.2 Dwelling Unit
clearance on both sides to enable physical access and
maneuvering by caregivers who may have to assist
residents in wheelchair-to-toilet transfers and returns.
- To provide fleXibility and adaptability, blocking should
be provided to support grab bars, whether added
during construction or in the future.
- Where grab bars are installed, their configuration
should allow for both independent and assisted
transfers.
- Towel bars should be of grab bar strength.
• An adjustable-height sink and countertop. Provision of this
feature should be considered depending on the resident
population(s).
• Sink with accessible controls. Asingle-miXing valve should
be proVided to avoid scalding.
Horizontal surface and/or countertop adjacent to the sink
• Mirror. Placement of the mirror should be evaluated to
accommodate adaptable heights based on the resident
population.
• Accessible bathing fixture
- Aheight-adjustable, detachable showerhead or hand­
held shower should be installed for fleXibility of use.
- The bathtub/shower faucet should be located so it is
easy for the resident and/or caregiver to use.
- The shower and/or bathtub provided should include
an integral or movable/adjustable seat.
 4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS

*4.2-2.2.2.1 Size and capacity. The physical size and *4.2-2.3 Resident Community Areas
layout of an independent living setting shall reflect the
care model and related services offered. 4.2-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant, and
4.2-2.2.2.2 Reserved Outpatient Community Areas-General) for
requirements.
4.2-2.2.2.3 Windows. See Section 4.2-5.2.2.6 (Win­
dows) for requirements.

APPENDIX (continued)

- Where the shower includes athreshold, a rubber
gasket or removable threshold should be proVided for
wheelchair accessibility.
- Where the shower is curbless (open to the room),
asealed waterproof floor with afloor drain should
be provided. Provision of ageneral floor drain in the
bathroom, in addition to the floor drain in the shower,
is recommended unless atrough drain is used for the
shower.
- Personal storage accessible to the resident should be provided
in the resident bathroom. This includes storage in the shower/
bathing area and general storage in the resident bathroom.
-Space for awasher and dryer near or in the bathroom should be
considered. Where the washer and dryer are stacked units, the
appliance controls should be located where residents can reach
them for optimal use.
-During the resident safety risk assessment (resident mobility
A4.2-2.3 Resident community areas
and transfer risk component) conducted during the functional
a. Personal services areas
programming process, an evaluation should identify needed
physical accommodations for lifting equipment in the resident
bathroom. See Section 1.2-3.3 (Resident Mobility and Transfer
Risk) for additional information.
b. Residentstorage. Storage should be prOVided for resident belongings,
including resident-operated mobility devices. At minimum, storage
space in the resident unit should equal 10 percent of the square foot­
age of the unit.
c. Kitchen. Where a kitchen is prOVided, it should be eqUipped with a
a. The number of residents an independent living dwelling unit should
accommodate and the number of bedrooms/bathrooms to be pro­
vided in each unit should be identified in the functional program.
b. Space planning for living areas should be designed for furniture of
proper scale for the rooms and should be sufficient to avoid obstruc­
tion of walkways.
c. Independent living dwelling units should be compact and easy to
navigate. They should also be designed to permit resident(s) to move
about with the assistance of aresident-operated mobility device and
to proVide easy access to windows, closets and storage spaces, and
furnishings.
d. living units should be accessible to community areas as a way to
facilitate socialization and reduce potential resident isolation.
e. Universal design practices that promote barrier-free environments
(see appendix section M.2-1.4-Barrier-free environment) should
be considered.
-Where personal services are provided for independent living
residents, the follOWing should be included:
• Accessible bathroom for resident use in hair saloh/spa space
Washing and styling stations
• Sinks should tilt and/or adjust to accommodate residents in
wheelchairs
• Display area for retail products
• Washer/dryerfor towels

• Manicure station, either portable or fixed

dedicated sink and cooking, dishwashing, and refrigeration appli­

• Accessible pedicure station, either portable or fixed

ances.

Waiting area furniture, including chairs with arms

-All appliance controls should be located so residents can easily
-Where a reception area is prOVided, use ofalow transaction
access them.
counter for access by residents using resident-operated mobility
-Wall cabinets should be designed to accommodate avariety
devices should be considered.
of heights for residents of different sizes to optimize usability,
-Mechanical ventilation, including negative pressure, 10 mini­
flexibility, and adaptability.
mum total air changes per hour, and exhaust directly to the
A4.2-2.2.2.1 Dwelling unit size and capacity. outdoors, should be prOVided for hair salons,
Each independent liVing dwelling unit or private living area in an
b. Outdoor activity spaces. Accessible outdoor spaces should be pro­
independent living setting should provide living, dining, and sleeping
vided for use by reSidents, visitors, and staff. See Section 2.1-3.6.2
areas and a kitchen. They should be flexible and sized to allow for
(Outdoor Activity Spaces) for information.
transitions to models of care that may reqUire more space.

Guidelines for De~ign and Construction of Residential Health, Care, and Support Facilities 207
4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS

*4.2-2.3.2 Lobby • 4.2-3 Reserved

Accessible mailboxes, either individual or centralized,

shall be provided for an independent living setting.

• *4.2-4 Facilities for Support
Services
*4.2-2.3.3 Dining, Recreation, and Lounge Areas
Where communal resident dining, recreation, and 4.2-4.1 General

lounge areas are provided in an independent living

See Section 2.3-4.1 (Facilities for Support Services­

setting, the space needed for these areas shall be deter­

General) for requirements.

mined in accordance with Section 2.3-2.3.3.1 (Dining,

Recreation, and Lounge Areas-General).
4.2-4.2 Facilities that Support Resident Care

4.2-4.2.1 Staff Work Areas

A4.2-2.3.2 Lobby -Private consultation and visits with family and/or staff and
a. Vehicular drop-offand pedestrian entrance. Where included for an caregivers
independent living setting, see Section 2.3-2.3.2.2 (Vehicular drop­ -Occurrence of more than one distinct, separate activity at the
off and pedestrian entrance) for information. same time
b. Lobby. Where a lobby area(s) and community space(s) are provided,
A4.2-4 Facilities for support services. The follOWing
these may include the follOWing:
facilities are commonly included in independent living settings.
-':""An accessible reception desk
a. Food service facilities. Where food service facilities are included
-Public waiting area
in the independent living setting, they should conform to the
-Public toilets
standards in this section and other applicable food and sanitation
-Other amenity space(s) where residents can gather and partici­
codes and standards.
pate in activities
-Food service facilities should be easy to clean and maintain in
-An area suitable for posting public notices that is visible and
asanitary condition.
accessible to residents, staff, and visitors.
-On-site facilities. Where food service facilities are proVided
c. Wayfinding. Depending on the population.being served, the inde­

on-site, the functional elements in this section should be

pendent living residents' cultural background and languages used

included:
should be considered in developing posted signage, information,

• Control point. Acontrol point for receiving and control­

and wayfinding.

ling food supplies should be designated. This is typically

A4.2-2.3.3 Dining, recreation, and lounge areas
a. Dining areas. Where dining services are offered in the community
responsible for ordering and receiving food service items.
areas of an independent living setting, the provisions in Section
Therefore, the control point should have direct sight lines
2.3-2.3.3.2 (Dining areas) should be considered along with the fol­
to the receiving area.
lowing:
Food preparation area. Facilities should be provided for
-location of community dining areas in or adjacent to commu­
nity liVing areas to support optimal accessibility
-Provision ofscalable spaces for various size dining groups
-Use of natural light sources
-Provision of a minimum of 25 square feet (2.32 square meters)
per resident in determining the size of dining areas if the resi­
dent population includes many individuals who use resident­
operated mobility devices
-Storage for resident-operated mobility devices during dining
b. Recreation, lounge, and activity areas. Where these areas are proVided
for independent living residents, they should be sufficient in number,
size, and configuration to accommodate the follOWing:
-Gatherings of reSidents, visitors, and staff, including caregivers,
for identified resident activities
monitored by apurchasing or procurement agent who is
food preparation based on the types offood service pro­
vided for the independent living setting. Hand-washing
station(s) should be located in food preparation areas.
Warewashing facilities. Facilities for dishwashing and for
washing pots should be provided based on the types of
food service provided for the independent liVing setting
and applicable local code requirements.
-Support areas for food service facilities
• Offices(s). Dietary staff office(s) should be provided as
needed.
• Storage. At minimum, refrigerated, frozen, and dry stor­
age should be provided based on the type of food service
provided.
• Environmental services room.lffood service is provided,

208 Guid,; ines for Design and Construction of Residential Health, Carc, and Support Facilities
 4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS
4.2-4.2.1.1 These area(s) shall be provided where
required to serve resident activities and needs in
independent living settings.
4.2-4.2.1.2 Secured storage shall be provided for
resident personal information.
APPENDIX (continued)
an environmental services room should be provided in
accordance with appendix section M.2-4-c (Facilities for
support services-Environmental services rooms).
-Waste management. Based on the type of food service provided,
waste sorting and storage space should be provided as well as
designated waste and recycling pickup areas (accessible to the
outside).
If composting is conducted on the independent living site,
ing clean laundry
the facility should provide appropriate sorting, storage,
• Laundry room access
and/or pickup locations for compost materials.
- Aservice entrance, protected from inclement weather,
To prevent issues with rodents or bugs, the facility should
for loading and unloading laundry should be pro­
provide an integrated pest management program.
Vided. This could be shared by other services requiring
~See Section 2.3-4.5 (Food Service Facilities) for additional infor­
mation.
b. Linen and laundry service facilities. Space should be provided for the
laundry services offered in the independent living setting.
~See appendix section M.2-2.2.2 (Dwelling unit--Resident bath­
room) and appendix section M.2-1.4 (Barrier-free environment)
for recommendations on laundry facilities in the dwelling unit.
-Central laundry areas. Central laundry areas provide a place for
independent living residents, families, housekeepers, and/or
personal caregivers to do aresident's personal laundry. Where
provided, these areas should include the following:
• Washer(s)
• Dryer(s)
• Laundry tub(s)
• Hand-washing station
Folding area
Seating area sized to accommodate the number of individu­
als estimated to use the laundry at one time
- Commercial central laundry. Where acommercial centrallaun­
dry is located in an independent living setting, the following
requirements should be met:
• Layout. Equipment should be arranged to permit aworkflow
that minimizes cross-traffic of dean and soiled operations.
Laundry equipment
- Washers/extractors should be located between the
soiled laundry receiving and clean processing areas.
- Dryers should be provided in the clean processing
area.
- Provision of laundry tubs should be considered based
on the types of laundry being serviced.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.2-4.2.2 - 4.2-4.2.3 Reserved
4.2-4.2.4 Equipment and Supply Storage
4.2-4.2.4.1 See Section 2.3-4.2.4 (Equipment and
Supply Storage) for requirements in addition to those
in this section.
Hand-washing stations. These should be provided in all
areas where untagged soiled laundry is handled.
• Equipment and supply storage. The following should be
provided:
- Storage for laundry supplies
- Carts or hampers for soiled laundry storage
- Carts, baskets, hanging space, or other means of stor­
service entry access.
- Acontrol point for pickup and receiving should be
provided. This could be shared by other services that
have pickups and deliveries.
c. Environmental services rooms. Accommodations for environmental
services should be included in all independent living settings.
Environmental services rooms provided should meet the following
requirements:
-Location. Environmental services rooms should be provided
throughout the independent living setting as needed to main­
tain aclean and sanitary environment. However, stand-alone
independent living houses, cottages, townhouses, or similar
settings without common corridors or community spaces do not
require adedicated environmental services room.
-Number. The number of environmental services rooms provided
should be based on the configuration ofthe independent living
setting. Where afacility has multiple floors and commoltcor­
ridors, provision of one environmental services room per floor
should be considered.
-Facilities. Each environmental services room should include the
following:
• Floor receptor/mop sink
• Blocking for mop hangers
• Floor space for housekeeping equipment and cart(s)
Storage space for cleaning supplies, including storage for
pre-measured chemicals for housekeeping tasks, if used
d. Facilities for engineering and maintenance services. Independent
living settings should provide the space necessary to effectively
accommodate bUilding systems and maintenance functions.
209
4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS
4.2-4.2.4.2 Supply storage. Storage space(s) for
supplies and for activity and recreation items shall be
immediately accessible to support activities and recre­
ation offered.
4.2-4.2.4.3 Storage for resident needs. Storage
space(s) for resident equipment and supplies shall be
immediately accessible to support services offered.
*4.2-4.11.1.1 Conference space. Space for conferences
4.2-4.3 Support Areas for Staff
See Section 2.3-4.3.1 (Support Areas for Staff­
General) for requirements.
*4.2-4.4 Support Facilities for Family and
Visitors
4.2-4.4.1 General
Community space for family and visitors shall be
provided if required in the functional program.
*4.2-4.4.2 Overnight Guest Accommodations
Space for sleeping accommodations for visitors shall
be provided if overnight guest stays are part of the
independent living setting requirements.
4.2-4.5 - 4.2-4.6 Reserved
4.2-4.7 Materials Management Facilities
See Section 2.3-4.7 (Materials Management Facilities)
for requirements.
4.2-4.8 Waste Management Facilities
See Section 2.3-4.8 (Waste Management Facilities) for
waste collection, storage, and disposal requirements.
4.2-4.9 - 4.2-4.10 Reserved
APPEN DIX
A4.2-4.4 Pet accommodations. If pets are permitted in the
independent living setting, waste areas for pets and other accommoda­
tions should be considered in the facility and site design.
A4.2-4.4.2 Overnight guest accommodations. Provi­
sion of separate guest suites or apartments is recommended as a means
for accommodating overnight visitors.
210 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.2-4.11 Administrative Areas
4.2-4.11.1 Office and Conference Space
Offices or an open office area with private confer­
ence space shall be provided for business transactions,
admissions, and social services and for the use of
administrative and professional staff.
and meetings shall be sized according to operational
needs and shall be permitted to be shared by several
services.
4.2-4.11.1.2 General office space. Staff office space
and file storage shall be provided based on operational
requirements.
4.2-4.11.1.3 Supply and copy room. Space for
storage of office equipment and supplies shall be
provided based on operational requirements.
• 4.2-5 Design and Construction
Requirements
4.2-5.1 Building Codes and Standards
See Section 2.4-1.2 (Building Codes and Standards)
for requirements.
4.2-5.2 Architectural Details, Surfaces, and
Furnishings
4.2-5.2.1 General
See Section 2.4-2.1 (Architectural Details, Surfaces,
and Furnishings-General) for requirements.
A4.2-4.11.1.1 Conferenc.e space. Conference space with
provisions for the use of visual aids and technology should be avail­
able for residents to meet with staff, visitors, family, or other residents.
Provision of kitchenette facilities, including under-counter refrigerator,
microwave, and sink, s~ould be considered for the conference space.
 4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS

*4.2-5.2.2 Architectural Details *4.2-5.2.2.6 Windows. See Section 2.4-2.2.6.1

(Windows-General) for requirements.
4.2-5.2.2.1 General. See Section 2.4-2.2.1
(Architectural Details-General) for requirements and 4.2-5.2.2.7 Glazing materials. See Section 2.4-2.2.7
other information. (Glazing Materials) for requirements.

*4.2-5.2.2.2 Corridors. See Section 2.4-2.2.2 (Corri­ 4.2-5.2.2.8-4.2-5.2.2.9 Reserved

dors) for requirements.
4.2-5.2.2.10 Handrails
4.2-5.2.2.3 Ceiling height. See Section 2.4-2.2.3
*(1) For handrail requirements for community space
(Ceiling Height) for requirements.
and public corridors, see Section 2.4-2.2.10
(Handrails and Lean Rails).
4.2-5.2.2.4 Reserved (2) Handrails shall not be required in independent

living dwelling units.

4.2-5.2.2.5 Thresholds and expansion joint covers.

See Section 2.4-2.2.5 (Thresholds and Expansion Joint
Covers) for requirements.
APPENDIX

A4.2-S.2.2 Architectural detail recommendations -Based on the resident population being served, alternative grab
a. Doors and door hardware
bar configurations are acceptable. See Section 2.4-2.2'.9.3 (Alter­
-Door openings
native grab bar configurations) for additional information.
• All doorways should have a minimum clearance of 3feet -Where atoilet is placed with 30 inches (76.2 centimeters) from
(91.44 centimeters). Wider doors should be used where nec­ the centerline of the toilet to the adjacent wall, swing-up grab
essary to meet the needs of the population being served. bars are recommended. This configuration allows space for both
Doorway widths should be evaluated and, if necessary, independent and assisted transfer. Note that avariance from
increased to accommodate turning radii of resident-oper­ local bUilding official(s) may be reqUired.
ated mobility devices.
A4.2-S.2.2.2 Corridors
-Door hardware
a. All corridors should have a minimum clearance of 3feet (91.44 centi­
• lever door hardware should be used.
meters).
• Where door closers are used, they should be ADA-approved.
b. Corridor widths and turning radii should be evaluated and, if neces­
or an equivalent to allow for ease of use and minimal resis­
sary, increased to accommodate resident-operated mobility devices.
tance.
-Insect screens. Adoor to the exterior that is opened for ventila­ A4.2-S.2.2.6 Windows in independent living

tion purposes, with the exception of an approved exit door, dwelling units

should be effectively covered with screening. Where regionally
appropriate, this recommendation should not apply.
-Door protection. See appendix section A2.4-2.2.4 (Door protec­
tion) for recommendations.
b. Hand-washing stations. Where hand-washing stations are proVided,
they should follow the requirements in Section 2.4-2.2.8 (Hand­
Washing Stations).
c. Grab bars
-To provide fleXibility and adaptability, blocking should be pro­
a. Dwelling units should have windows that maximize provision of
natural light with amaximum sill height of 32 inches (81.28 centi­
meters) above the finished floor.
b. Each room or group of rooms open to one another (e.g., acombined
kitchen and dining room) should have an exterior window(s) in
accordance with Section 2.4-2.2.6 (Windows).
c. Window hardware for operable windows should be easy for residents
to operate.
d. Exterior windows in independent living dwelling units should

vided to support grab bars, whether added during construction include insect screens.

or in the future.
A4.2-S.2.2.10 (l) Blocking in corridor walls/partitions in indepen­
-Grab bar configurations (e.g., agrab bar as part of acountertop)
dent living dwelling units should be proVided to allow for the addition
and aesthetics (e.g., matching towel bars) should be evaluated
of handrails as reqUired to support aging in place.
to maintain a residential environment.
-Provision of value contrast between grab bars and adjacent
surfaces should be considered.

Guideiines for Design and Construction of Residential Health, Care, and Support Facilities 211
4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS

4.2-5.2.2.11 Protection from heated surfaces. See See Section 2.4-2.3.3.2 (Wall protection) for wall
Section 2.4-2.2.11 (Protection from Heated Surfaces) protection requirements.
for requirements.
*4.2-5.2.4 Furnishings
4.2-5.2.2.12 Signage and wayfinding. See Section
2.4-2.2.12 (Signage and Wayfinding) for requirements. 4.2-5.2.4.1 General. See Section 2.4-2.4.1
(Furnishings-General) for requirements.
4.2-5.2.2.13 Decorative water features. Where
decorative water features are used in the facility design, 4.2-5.2.4.2 Reserved
see appendix section A2.4-2.2.13 (Decorative water
features) for recommendations. 4.2-5.2.4.3 Furniture. See Section 2.4-2.4.3
(Furniture) for requirements.
*4.2-5.2.3 Surfaces
*4.2-5.2.4.4 Window treatments. Window treatments
4.2-5.2.3.1 General in community areas shall comply with NFPA 101: Life
See Section 2.4-2.3.1 (Surfaces-General) for Safety Code.
requirements.

• *4.2-6 Building Systems

*4.2-5.2.3.2 Flooring and wall bases
See Section 2.4-2.3.2 (Flooring and Wall Bases) for 4.2-6.1 General
requirements.
See Section 2.5-1 (Building Systems-General) for
requirements.
*4.2-5.2.3.3 Walls and wall protection

"'A PPEN DIX

A4.2-S.2.3 Ceiling finishes A4.2-S.2.3.3 Wall finishes

a. Ceiling surfaces should have a matte or satin finish to diffuse light
a. Wall finishes should be washable, and where located near plumbing
and prevent reflected glare.
fixtures, should also be smooth, clubbable, and moisture-resistant.
b. Ceiling surfaces in dietary and laundry areas, bathrooms, bathing/ b. Wall surfaces should have amatte finish rather than ashiny or glossy
shower rooms, soiled utility rooms (where applicable), and envi­ surface.
ronmental services rooms should be non-pervious and moisture­ c. The colorlvalue of wall finishes should be evaluated to ensure a clear
resistant. The face of ceiling tile, drywall, or other substrate as well delineation between vertical and horizontal planes.
as the susp~nsion system and/or exposed support system in these d. Alight reflectance value of 60 to 80 percent should be evaluated to

areas should be moisture-resistant. maximize li~ht distribution in the space.

c. The color/value of ceiling surfaces should have a light reflectance

A4.2-S.2.4 Casework, millwork, and built-ins

value in the range of 75 to 90 percent for maximum distribution of

a. In resident use areas, corners should be rounded or eased.

Iight in aspace.

b. Provision of value contrast between casework, millwork, and built­

A4.2-S.2.3.2 Wall bases ins and adjacent walls, and between casework hardware and adja­

a. Wall bases in areas that require frequent wet cleaning (e.g., kitchens, cent casework, should be considered.

soiled and clean utility rooms, environmental services rooms' with

A4.2-S.2.4.4 Window treatments
mop sinks) should be continuous and coved with the floor, tightly
a. Window treatments used in resident dwelling units and in commu­

sealed to the wall, and constructed without voids that can harbor
nity areas should be easy for residents to operate safely.

insects or moisture.
b. Blinds, sheers, or other resident-controlled window treatments

b. Wall bases in resident community areas (resident rooms, corridors,

should be provided in resident dwelling units to allow residents to

dining and activity rooms) and public bathrooms should match the
control light levels and glare.

colorlvalue of the walls and provide astrong contrast to the floor to

distinguish the vertical and horizontal planes. A4.2-6 Acoustic design systems. Provision of acoustic
c. Use of alternative materials such as melamine board should be con­ systems should be considered for independent living settings. See Sec­
sidered when specifying wall bases. tion2.5-8 (Acoustic Design Systems) for details.

212 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS

*4.2-6.2 Plumbing Systems 4.2-6.3.1.2 Where independent living dwelling units

are housed in high-rise buildings and/or in buildings
4.2-6.2.1 General that include community space, see ANSIIASHRAE
See Section 2.5-2.1 (Plumbing Systems-General) for Standard 62.1: Ventilation for Acceptable Indoor Air
requirements. Quality for basic HVAC system requirements.

4.2-6.2.2 Plumbing and Other Piping Systems *4.2-6.3.2 Mechanical System Design

See Section 2.5-2.2 (Plumbing and Other Piping

See Section 2.5-3.2 (Mechanical System Design) for
Systems) for requirements.
requirements.

4.2-6.3 Heating, Ventilation, and

4.2-6.3.3 HVAC Requirements for Specific

Air-Conditioning (HVAC) Systems

Locations

*4.2-6.3.1 General 4.2-6.3.3.1 Reserved

4.2-6.3.1.1 For independent living dwelling units,

4.2-6.3.3.2 Fuel-fired equipment rooms. Where
see ANSIIASHRAE Standard 62.2: Ventilation and
rooms with fuel-fired equipment are provided, see
Acceptable Indoor Air Quality in Low-Rise Residential
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
Buildings for basic HVAC system requirements.
requirements.

APPENDIX

A4.2-6.2 Plumbing fixtures
a. General. Plumbing fixtures should be evaluated based on
the risk of accidental falls. See Section 2.2-4.2.1.6 (Operable win­
the population being served. Accessible solutions that allow
dows) for additional provisions based on the resident population.
independent living residents to age in place should be considered.
-All resident bedrooms should include operable windows.
Provisions for adapting the height of toilets, sinks, appliances, and
-Living rooms, dining rooms, and kitchens in resident dwelling
other plumbing-related equipment should be considered.
units should be evaluated for inclusion of operable windows
b. Hand-washing sinks. Where hand-washing sinks are provided, they
should meet the requirements in Section 2.5-2.3.2 (Hand-Washing
Sinks).
c. Showers. Where showers are included in independent liVing dwelling
units, the requirements in Section 2.5-2.3.3.2 (Accessible showers)
should be considered as amended here:
-If grab bars are not installed during construction, blocking
for vertical and horizontal grab bars should be installed in the
shower area to accommodate future installation of grab bars.
See appendix section A4.2-5.2.2 (Architectural detail recom­
mendations-Grab bars) for additional information.
-An adjustable-height shower head should be used.
d. Toilet placement. Depending on the level of aging in place incorpo­
rated in the independent living setting, toilet locations that allow
two people to assist in residenttransfer (dual or double) should be
considered. See appendix section A4.2-2.2.2 (Dwelling unit-Resi­
dent bathroom) for additional toilet placement recommendations.
e. Clinical sinks. Where clinical sinks are provided, see Section 2.5-2.3.5
(Clinical Sinks) for information.
A4.2-6.3.1 Ventilation and space conditioning. All
opening width of operable windows should be evaluated to reduce
based on the unit floor plan and location in the building.
-All community spaces should be evaluated to determine where
operable windows can be located on an exterior wall.
b. Humidity control. The relationship between humidity and resident
comfort and between humidity and resident outcomes (e.g., the
influence of humidity on resident dehydration, dry skin, skin tears,
skin breakdown, and respiratory conditions) should be evaluated
during the mechanical system design process. ANSI/ASHRAE Stan­
dard 55: Thermal Environmental Condition5 for Human Occupancy
recommends 30 to 60 percent relative humidity for comfort. In cold
or arid climates, achieving a relative humidity as high as 30 percent
may not be practical. For facilities without central ventilation sys­
tems, these humidity requirements may not be achievable. For more
information about humidity control, see Chapter 25, "Eldercare:'
by lew Harriman, Geoff Brundrett, and Reinhold Kittler, in Humid­
ity Control Design Guide for Commercial and Institutional Buildings
(ASH RAE 200n.
c. Higher levels ofcare. If a higher level of care is planned for an inde­
pendent living setting, provision of ventilation and space-condition­
ing requirements for the higher level of care should be considered.

rooms and areas in the facility should have provision for continuous
A4.2-6.3.2 For independent liVing settings, use of alternatives to

ventilation.
through-wall units that allow for better thermal comfort control should

a. Operable windows. Based on the independent living population, the be considered.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 213
4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS
4.2-6.3.3.3 Areas of refuge. Where areas of refuge are
provided, see Section 2.5-3.3.3 (Areas of Refuge) for
requirements.
4.2-6.3.3.4 Commercial food preparation areas.
Where commercial food preparation areas are
provided, see section 2.5-3.3.4 (Commercial Food
Preparation Areas) for requirements.
*4.2-6.3.4 Thermal and Acoustic Insulation
4.2-6.3.4.1 General. See Section 2.5-3.4.1 (Thermal
and Acoustic Insulation-General) for requirements.
[ *4.2-6.3.4.2 Acoustic insulation
4.2-6.3.5 HVAC Air Distribution
4.2-6.3.5.1 General
(1) For individual cottages, duplexes, townhouses,
and similar individual dwelling unit settings, see
ASHRAE 90.2: Energy Efficient Design ofLow-Rise
Residential Buildings and local building codes for
requirements.
(2) For multiple-unit dwellings, such as apartments,
condominiums, and similar types of settings that
mayor may not include community space, see
Section 2.5-3.5 (HVAC Air Distribution) for
requirements.
APPENDIX
A4.2~6.3.4Thermal insulation. For individual cottages,
duplexes, townhouses, and similar individual dwelling units, consider
the requirements in ASHRAE 90.2: (nergy-Efficient Design ofLow~Rise
Residential Buildings. and local bUilding coMs. For multiple-unit dwell­
ings,such as apartments, condominiums, andsimilarsettings that may
or may not include community space, consider the requirements in
ASH RAE 90.1: Energy Standard for Buildings Except Low-Rise Residential
Buildings.
A4.~~6.3.4.~AcQu~tic insulat,ion
a.Provisions for ac()ustit insulation should meet or exceed local
bUilding code requirements.
b. Consideration should be given to construction of demising walls and
floors in a manner that 'prOVides for speech privacy between units
andbetweenfloofs.
A4.2·6.3.6 Filter efficiencies
a. For non-central recirculating room systems, HVAC units should:
-Not receive nonfiltered, nonconditiOned outdoor air.
-Serve only asingle space.
214 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.2-6.3.5.2 HVAC ductwork. See Section 2.5-3.5.2
(HVAC Ductwork) for requirements.
*4.2-6.3.6 HVAC Filters
4.2-6.3.6.1 For individual dwelling units, see ANSI!
ASHRAE Standard 62.2: Ventilation and Acceptable
Indoor Air Quality in Low-Rise Residential Buildings for
requirements.
4.2-6.3.6.2 Where independent living dwelling units
are housed in high-rise buildings and/or in buildings
that include community space, see ANSI!AS H RAE
Standard 62.1: Ventilation fOr Acceptable Indoor Air
Quality for requirements.
*4.2-6.3.7 Heating Systems, Cooling Systems, and
Equipment
4.2-6.3.7.1 - 4.2-6.3.7.3 Reserved
4.2-6.3.7.4 Temperature control. See Section
2.5-3.7.4 (Temperature Control) for requirements.
4.2-6.4 Electrical Systems
4.2-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
~Includethe manufacturer!s recommended filter for airflow
passing Over any surface that IS designed to condense wateL This
'filter sha'lI be located upstream of any such cold surface so that
all of the air passing over the cold surface is filtered.
b. Filters sholildbe replaced and/or deanedper the manufacturer's
recommendations to maintain indoor air quality.
A4.2-6.3.7Heating systems, (oolingsystems, and
equipment
a. Heatingsystems.Requirements for heating systems .in independent
liVing settings sbould be based on the geographic location and the
need.sof reSidents. However, provision of a permanently installed
neating system capable of rnaintaining an interior minimum
temperature of 72 F(22 under heating design temperatures is
0 0
()
recomrnended.
~lf acornrnunity includes acentral heating plant, the needior
capacity redundancy should be evaluated based on the resident
popUlation, geographic region, and' other operational needs.
Completion ofan emergency preparedness plan thatindudes
 4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS
*4.2-6.4.2 Power-Generating and Power-Storing
Equipment
Where independent living settings include essential
electrical systems, these systems shall comply with
NFPA 101: Life Safety Code.
*4.2-6.4.3 Electrical Receptacles
4.2-6.4.3.1 Reserved
*4.2-6.4.3.2 Receptacles in corridors
(1) See NFPA 70: National Electrical Code for
requirements.
If ventilator-dependent residents are part of the
(2) For cottages, duplexes, town homes, and other
care population, see Section 2.5-4.4 (Electrical
similar settings, see local building codes for
Requirements for Ventilator-Dependent Resident
corridor requirements.
Rooms and Areas) for requirements.
APPENDIX (continued)
an evaluation tlf the geographic region and neecHor extended
operations during emergency outa.ges (e.g., those caused by
hurricanes, tornadoes, earthquakes) should be completed before
.building occupancy. Information on completing such assess­
mentsis avaIlable in NFPA 99: HealthCare facilities Code.
-Boiler plant accessories. If acommunity includes acentral plant,
rllajQr supportIng'components ofthe heatin9 plant (including
feed:waterpumps, fuel pumps, and condensate transfer pumps)
should be provided with redundancy that makes it possible to
meet the required heating capacity of the plantwhen anyone
of these components is out of service due to failure or routine
maintenance.
b. .Cooling systems. Capacity requirements for cooling systemsinll'lde­
pendent living settings should be based on the geographic location
and the needs ofthe residents. However, provision ofacooling
sYstem capable of maintaining an interior maximum temperature of
]SO F(24· C) under cooling design temperatures is recommended.
-Ifacommunity includes acentral cooling plant capacity
,redundancy should be evaluated based on the resident care
population, geographic region, and other operational needs.
An:emergency preparedness plan should be completed prior
to building occupancy and should include an evaluation ofthe
geographic region and need for extended operations during
emergency outages such as those caused by hurricanes, torna­
does, or earthquakes.
-Chiller plant accessories. If acommunity includes acentral
chiller plant, major supporting components of the cooling plant
(including pumps and heat rejection e.quipment) should be
prOVided with redundancy that makes it possible to meet the
reqUired cooling capacity of the plant when anyone of these
components is out of service due to failure or routine mainte­
nance.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.2-6.4.3.3 Receptacles in resident dwelling units.
For apartments, condos, and similar dwelling units, see
local building code requirements.
4.2-6.4.3.4 Reserved
4.2-6.4.3.5 Ground fault interrupters. Ground fault
interrupters shall comply with NFPA 70: National
Electrical Code.
4.2-6.4.4 Electrical Requirements for Ventilator­
Dependent Resident Room and Areas
A4.2-6.4.2 Power-genetating andpowet-storing
.equipment
a. Emergenry lighting. Where independentliving settings indude emer­
gency lighting, an essentjal electrIcal source sho.oldprovide lighting
and/or power during an interruption ofthe normal electrical su,pply.
Emergency lighting for safe egress and access shoul(tbe evaluated
for all independent liVing settings, including differenttypes of dwell­
ing units. For more information on lighting, see secti()Os 4.2-6.7.3
(Artificial lighting Systemsland 2.5-73 (Arfifidallighting Systems).
b. Generators. Wher~ generators are provided for an independenlJiving
setting, exhaust systems (including mufflers and Vibration isolators)
for internal combustion engines should be·locat~d, designed, and
installed to minimize objectionubl.e noise.
A4.2-6.4.3 Receptacles
a. Placement ofreceptacles. Heightand]ocation for receptac1esshoold
beevaluatedbasedon the population being serNed. Recepf~des
available for residents to charge resident~{)perated mobility devices
should be placed at aheight above the finishedtloor easy for resi­
denMo access.
b. Essential electrical system receptacles. For corridors, community
spaces, and dwelling units that include an essential electrical
system, electrical receptacle cover plates or electrical receptacles
supplied from the essential electrical system should be distinctivel~
colored or marked for identification. If color is used for identification
purposes, fhe same color should be used throughout the facility.
A4.2-6.4.3.2 Receptacle$ in cottidors. For corridors in
public spaces, duplex-grounded receptacles for general use should be
installed approximately 50 feet (15.24 meters) apart in all corridors and
within 25 feet (7.62 meters) of corridor ends. The need for add.itional,
outlets should be indicated in the furniture and equipment layout.
215
 4.3 Specific Requirements for Long-Term
Residential Substance Abuse Treatment Facilities
Appendix material shown in shaded boxes at the bottom ofthe page, is advisory only.
• 4.3-1 General
4.3-1.1 Appl ication
4.3-1.1.1 General
*4.3-1.1.1.1 This chapter contains specific requirements
for long-term residential substance abuse treatment
facilities.
4.3-1.1.1.2 The requirements in Part 2 (Common
Elements for Residential Health, Care, and Support
Facilities) shall apply to long-term residential substance
abuse treatment facilities as referenced in this chapter.
4.3-1.1.2 Design Criteria
4.3-1.1.2.1 Sustainable design. See Section 2.2-2
(Sustainable Design Criteria) for requirements for
A4.3-1.1.1.1 Long-term residential substance
abuse treatment facility typology. long-term
residential treatment facilities may be located in awide variety of
settings including, but not limited to, a large suburban house, larger
freestanding residential setting, or part of a nursing home, assisted
liVing facility, homeless shelter, or facility in a prison.
Care is provided 24 hours a day, generally in non-clinical/acute care
settings. This therapeutic community (TC) is acommon type of long­
term residential treatment setting for substance use disorders, which
typically require 18 to 24 months oftreatment, although funding and
insurance limitations may reduce an individual's stay to three, six, or
12 months. The focus of aTC is resocialization of an individual using the
program's entire community as active components of treatment. Addic­
tion is viewed in the context of an individual's social and psychological
deficits, and treatment focuses on developing personal accountability
and responsibility as well as ~ocially productive lives. Treatment is typi­
cally highly structured and can be modified for specific care populations
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
long-term residential substance abuse treatment
facilities.
4.3-1.1.2.2 Design criteria for accommodations for
care of persons of size. Where the care population
includes needs for persons of size, see Section 2.2-3
(Design Criteria for Accommodations for Care of
Persons of Size) for requirements.
4.3-1.1.2.3 Dementia, mental health, and cognitive
and developmental disability design criteria. Where
the care population includes residents with dementia,
mental health issues, or cognitive and developmen­
tal disabilities, see Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive and Devel­
opmental Disability Facilities) for requirements.
*4.3-1.1.3 Minimum Standards for New Long-Term
Residential Substance Abuse Treatment Facilities
This chapter identifies the minimum requirements
for long-term residential substance abuse treatment
(e.g" adolescents, homeless residents, individuals from the criminal
justice system, those with mental/behaVioral issues).
In addition to long-term residential treatment, atherapeuticcom­
munity may offer shorter-term residential or outpatient treatment. A
TC acquires a medical partner has an opportunity to become afederally
qualified health center or a patient-centered medical home.
Aspecialized type of treatment setting called a"modified therapeu­
tic community" incorporates features of traditional therapeutic com­
munities with aspecial focus on addressing co-occurring mental health
conditions.
Correctional institutions may incorporate in-prison TCs, and TCs are
also available for people reentering society after being released from
prison with the goal of reducing drug use and recidivism.
A4.3-1.1.3 The requirements and recommendations in this
chapter are intended to represent basic standards to ensure the safety,
accessibility, and residential aspects of long-term residential substance
abuse treatment facilities for residents recovering from drug or alcohol
addiction.
219
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT fACILITIES
facilities, which must also comply with applicable state
and local requirements.
4.3-1.2 Functional Program
4.3-1.2.1 General
4.3-1.2.1.1 See Section 1.2-2.1 (Functional
Program-General) for requirements in addition to
those in this section.
APPENDIX
A4.3-1.2.1.2 (1) Therapeutic community care
model
a. (are model description. In along-term residential substance abuse
treatment facility, professional medical staff and medical services
are proVided on-site. Often, staff members are in recovery and have
earned certification and degrees in addiction counseling. Therapeutic
communities (TCs) have a recovery orientation that focuses on the
whole person and overall lifestyle changes rather than only on recov­
ery from an addiction. Recovery is seen as agradual, ongoing pro­
cess of cognitive change through clinical interventions and includes
stages of treatment, with personal objectives s.et throughout the
recovery process. There is a relationship between duration of treat­
ment in aTC and aftercare participation and subsequent recovery:
longer duration oftreatment fosters consistency and yields better
outcomes for residents.
There are three stages of treatment
• Stage 1: Induction and early treatment: individual assimi­
lates into the TC with full immersion into programming and
activities.
• Stage 2: Primary treatment: eVidence-based behavioral
treatments with the goals of changing attitudes and behav­
ior, instilling hope, and fostering emotional growth.
• Stage 3: Reentry: resident prepares for separation from the
TC for successful reentry into the community at-large and
seeks employment or educational/training opportunities.
Aftercare services are arranged.
The care model should include services that are structured for
each individual. Although TCs are community-based, the treat­
ment plan is individualized to maximize successful treatment. Over
time, various combinations of treatment services may be required.
EVidence-based interventions include cognitive-behavioral therapy
to help residents learn positive behavioral change and motivational
enhancement to increase treatment engagement and retention.
Residents who have been incaJcerated and may have
received prison-based treatment; therefore, the care model
requires providers to be aware of correctional supervision
requirements and treatment provided prior to release from
prison,if applicable.
Residents may have co-occurring drug abuse and mental
health issues, requiring an integrated treatment approach.
High rates of mental health problems are found both in
220 Guidelines for Design and Construction of Residential Health. Care. and Support Facilities
4.3-1.2.1.2 The sponsor of each project shall provide a
functional program that:
*(1) Defines the scope and scale of the long-term
residential substance abuse treatment facility
(including the care model).
(2) Identifies resident needs.
(3) Facilitates the application of licensure and
occupancy approvals by authorities having
jurisdiction (AH]s).
offender populations. and in those with substance abuse
problems.
• Resident treatment planning may include prevention andl
or treating of serious chronic medical conditions, such as
HIV/AIDS, hepatitis Band C, and tuberculosis. The rate of
infectious diseases is higher in drug abusers, incarcerated
offenders, and community-supervised offenders than in the
general population.
Treatment for juveniles requires acomprehensive assess­
ment, treatment, case management, and support services
appropriate for their age and developmental stage. Abuse is
common among juveniles requiring tre.atment, along, with
physical health issues and family problems. The treatment
approach includes multi-systemic therapy, multidimen­
sional family therapy, and functional family therapy.
b. Physical setting. long-term residential treatment environments
include group or community living and activities to drive individual
change and attainment of therapeutic goals. TC is "community as
method" -people living together free of drugs and alcohol in
a residential setting in the community (or in a prison or shelter
setting). Atypical program in acommunity-based setting accom­
modates 40 to 80 residents. Some TCs are located onthe grounds of
former camps or ranches or in suburban houses, while others are in
jails, prisons, and shelters. There is an average of one counselor for
every 11 residents in treatment in addition to social workers, nurses,
psychologists, and other clinical staff.
The physical setting should support the follOWing:
• Rehabilitation by relearning or reestablishing healthy
functioning skills and values and regaining physical and
emotional health. Design should reflect an orderly function
supportive of astructured daily regimen for residents.
Routine morning and evening house meetings, job assign­
ments, group sessions, seminars, scheduled personaltime,
recreation, and individual counseling
• Vocational and educational activities in group sessions
c Additional information about substance abuse treatment is available
in the National Institute on Drug Abuse (NIDA) publication "Prin­
ciples ofDrug Abuse Treatment for Criminal Justice Populations: A
Research-Based Guide:'The NIDA'research report "Therapeutic Com­
munity" outlines the goals and activitiesofTCs.
 4.3 SPECIFIC REQUIREMENTS fOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT fACILITIES
(4) Addresses applicable provisions of the Guidelines
fOr Design and Construction ofResidential Health,
Care, and Support Facilities.
4.3-1.2.2 Shared Services and Space
4.3-1.2.2.1 Long-term residential substance
abuse treatment facilities shall be permitted to be
freestanding facilities or distinct parts of another
residential health, care, or support facility.
4.3-1.2.2.2 When a project calls for sharing or pur­
chasing services from another entity, modifications in
space and parking requirements shall be permitted.
*4.3-1.2.2.3 Where the long-term residential substance
abuse treatment facility is part of (or contractually
linked with) another facility, sharing of facilities
for services such as home health, hospice, dietary,
storage, pharmacy, linen, and laundry services shall be
permitted.
4.3-1.3 Resident Safety Risk Assessment
See Section 1.2-3 (Resident Safety Risk Assessment)
for requirements.
4.3-1.4 Environment of Care Requirements
4.3-1.4.1 General
See sections 1.2-1.3 (Environment of Care and Facility
Function Considerations) and 1.2-4 (Environment of
Care Requirements) for requirements.
4.3-1.4.2 Reserved
APPENDIX
A4.3-1.2.2.3 Shared services and facilities. Services
may be contractually proVided or shared with other entities. In some
cases, all ancillary service requirements will be met by the principal
facility and the only modifications necessary will be in the long-term
residential substance abuse treatment facility. In other cases, program­
maticconcerns and requirements may dictate separate service areas.
A4.3-1,4.3 Supportive environment. Asupportive
environment for long-term residential substance abuse treatment facili­
ties should also indl)de"protective elements"to control access to both
addictive substances and individuals who traffic in those substances.
This reqUires consideration ofthe immediate residential environment,
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
*4.3-1.4.3 Supportive Environment
4.3-1.4.3.1 The facility design shall produce a
supportive environment to:
(l) Enhance and extend quality of life for residents.
(2) Facilitate wayfinding.
(3) Promote resident privacy and dignity.
4.3-1.4.3.2 The physical environment of the long­
term residential substance abuse treatment facility shall
support the services and levels of care provided in the
facility.
4.3-1.4.3.3 Long-term residential substance abuse
treatment facilities shall be designed and constructed
to provide a supportive residential environment that
is conducive to day-to-day community activities and
responsibilities.
*4.3-1.4.4 Barrier-Free Environment
The physical environment shall eliminate as many
barriers as possible to effective access and use of the
space, services, equipment, and utilities appropriate for
daily living and treatment.
4.3-1.5 Site
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site
Elements) for requirements.
• 4.3-2 Resident Areas
4.3-2.1 General
site elements, and the geographic location of thefacility. These consid­
erations are critical to the environment of care and development ofthe
functional program.
A4.3-1.4.4 Barrier-free environment
a. "Universal design" practices that promote barrier-free environments
should be encouraged. See appendix section A4.2-1.4-c(Environ­
ment of care design recommendations~Barrier-free environment)
for more information.
b. Facilities should provide accessibility for residents with disabilities in
accordance with the state or local buildingocode and the Americans
with Disabilities Act.
221
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES

4.3-2.1.1 Application the assistance of a resident-operated mobility

The requirements in this section are common to device, allowing access to at least one side of a bed,
most long-term residential substance abuse treatment window, closet or wardrobe, chair, dresser, and
facilities and shall apply where the areas described are nightstand.
included in a particular therapeutic community (TC) (2) Room size and configuration shall comply with

and based on the needs of the care population. spatial requirements of the AH].

(3) Bedrooms shall not be used as passageways,

4.3-2.1.2 Layout corridors, or access to other bedrooms.

4.3-2.1.2.1 Areas for the care and treatment of outpa­ 4.3-2.2.2.3 Windows. See Section 4.3-5.2.2.6 (Win­
tient users not residing in the facility shall not interfere dows) for requirements.
with or infringe on the private living area of residents.
4.3-2.2.2.4 Reserved
4.3-2.1.2.2 Facility layout shall reflect the care model
and related staffing. 4.3-2.2.2.5 Hand-washing station. Where a hand­

washing station is provided, see Section 2.4-2.2.8

4.3-2.2 Resident Unit or Private Living Area (Hand-Washing Stations) for requirements.

4.3-2.2.1 General 4.3-2.2.2.6 Reserved

Bedrooms or resident rooms shall be provided that are

*4.3-2.2.2.7 Resident bathroom. Each resident shall
sized to:
have access to a bathroom.

4.3-2.2.1.1 Allow for sleeping. (1) The bathroom shall contain the following:

(a) Toilet
4.3-2.2.1.2 Afford privacy. (b) Hand-washing station. See Section 2.4-2.2.8
(Hand-Washing Stations) for requirements.
4.3-2.2.1.3 Provide access to furniture and belongings. (c) Mirror. See Section 2.4-2.2.8.7 (Mirror) for
requirements.
4.3-2.2.1.4 Accommodate the care and treatment (d) Private individual storage for the personal
provided to each resident. effects of each resident. See Section 2.4-2.4.2
(Casework, Millwork, and Built-Ins) for
*4.3-2.2.2 Resident Room requirements.
(e) Shower. See Section 2.5-2.3.3.2 (Accessible
4.3-2.2.2.1 Reserved showers) for requirements.

4.3-2.2.2.2 Space requirements (2) Where the bathroom is shared, privacy locks shall
be permitted with provisions for emergency access.
(1) Resident room size (area and dimensions) shall
permit resident(s) to move about the room with

APPENDIX

A4.3-2.2.2 Resident room capacity. Bedrooms Should be maneuvering by staff. See appendix section 2.4-2.2.9.2-b(Grab bars
limited to single or double occupancy. in bathroom-For assisted transfers) for additional information.
b. Grab bars. Where mobility-challenged residents are capable of
A4.3-2.2.2.7 Resident bathroom
independent transfers, alternative grab bar configurations should be
a. Clearances. Toilets used by residents should have sufficient clear­
permitted. See Section 2.4-2.2.9.3 (Alternative grab bar configura­
ance on both sides of the toilet to enable physical access and
tions) for additional information.

222 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES

*4.3-2.2.2.8 Resident storage (3) Location. Provision of separate satellite dining areas
(1) Each resident shall be provided with an individual in or adjacent to living areas shall be permitted if
wardrobe or closet. required by differing care populations being served.
(2) Separate, enclosed storage in the resident room
(4) Natural light shall be provided in resident dining
shall be provided for each resident.
areas.

4.3-2.2.3 Special Care Resident Rooms
4.3-2.2.3.1- 4.3-2.2.3.2 Reserved
4.3-2.2.3.3 Quiet room in a resident unit. Where
a single resident room is provided to accommodate
care requirements for residents experiencing personal
conflicts, agitation, episodic mental disturbances, or
similar conditions, see Section 2.3-2.2.3.3 (Quiet
room in a resident carelliving area) for requirements.
4.3-2.3 Resident Community Areas
4.3-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant, and
4.3-2.3.3.3 Recreation, lounge, and activity areas
(1) Recreation, lounge, and activity areas shall
accommodate both group and individual activities
and recreational opportunities.
(2) Space requirements. Recreation, lounge, and
activity areas shall provide the following:
(a) Space for planned resident activities
(b) Areas sufficient in number and configuration
to accommodate the following:
(i) Gatherings of resident groups of various
sizes
(ii) Occurrence of separate and distinct activi­
ties

Outpatient Community Areas-General) for

4.3-2.3.3.4 Toilet rooms. Toilet facilities shall be
requirements.
readily accessible to all dining, recreation, and lounge
locations.
4.3-2.3.2 Lobby
4.3-2.3.4 Resident Kitchen
Where a lobby is provided, see Section 2.3-2.3.2

(Lobby) for requirements.

Where kitchen facilities that permit use by residents,
family members, and visitors are provided, see Sec­
4.3-2.3.3 Dining, Recreation, and Lounge Areas tion 2.3-2.3.4 (Resident and Participant Kitchen) for
requirements.
4.3-2.3.3.1 General. See Section 2.3-2.3.3.1
(Dining, Recreation, and Lounge Areas-General) for 4.3-2.3.5 - 4.3-2.3.6 Reserved
requirements.
4.3-2.3.7 Quiet Room in a Resident Community
4.3-2.3.3.2 Dining areas Area

(1) Space for communal dining shall be provided. Where a quiet room is provided, see Section 2.3-2.3.7
(2) Space requirements. Clear and unobstructed
(Quiet Room in a Resident or Participant Community
circulation paths shall be provided for residents
Area) for requirements.
and food service staff based on the food delivery

process used in the therapeutic community.

4.3-2.3.8 Outdoor Activity Spaces

APPENDIX

A4.3-1.1.2.8 Resident storage

a. Resi~ent c1o~ets or wardrobes Should have an adjustable-height bar for hanging clothes.
b. Consideration should be given for storage of resident mobility deVices, depending on the needs of the care population.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 223
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES

*4.3-2.3.8.1 Outdoor spaces shall be provided for 4.3-4.2 Facilities that Support Resident, Partici­
residents, visitors, and staff. pant, or Outpatient Care

4.3-2.3.8.2 See Section 2.1-3.6.2 (Outdoor Activity
Spaces) for additional requirements and information.
• 4.3-3 Diagnostic and Treatment
4.3-4.2.1 Staff Work Areas
4.3-4.2.1.1 These area(s) shall be provided where
required by the care model to serve resident needs.

Areas
4.3-4.2.1.2 Lockable storage shall be provided for
resident records.
4.3-3.1 General

Where diagnostic and treatment areas are required for

4.3-4.2.1.3 See Section 2.3-4.2.1 (Staff Work Area)

the resident care population or as part of community­

for additional requirements.

based services, see Section 2.3-3 (Diagnostic and Treat­

ment Areas) for requirements.

4.3-4.2.2 Medication Distribution and Storage
Locations (Centralized and Decentralized)
4.3-3.2 Examination, Observation, and/or
Treatment Rooms
4.3-4.2.2.1 See Section 2.3-4.2.2 (Medication Distri­
bution and Storage Locations) for requirements.
See Section 2.3-3.2 (Examination, Observation, and/

or Treatment Rooms) for requirements.

4.3-4.2.2.2 Security for all medications shall be

provided.
4.3-3.3 Rehabilitation Therapy Facilities

Where outpatient rehabilitation therapy facilities are

4.3-4.2.3 Central Bathing or Spa Room or Area
provided, see Chapter 5.3 (Specific Requirements

for Outpatient Rehabilitation Therapy Facilities) for

*4.3-4.2.3.1 General. Where a shower is not pro­
requiremen ts.
vided in the resident bathroom, a central bathing or
spa room or area shall meet the requirements in this
4.3-3.4 Wellness Centers
section.
Where wellness facilities are provided, see Chapter

5.2 (Specific Requirements for Wellness Centers) for

4.3-4.2.3.2 Number. Based on the needs of the care

requiremen ts.
population, at least one central bathtub, spa tub, or

shower shall be provided for resident use, where a

shower is not provided in the resident bathroom.

• 4.3-4 Facilities for Support

Services
4.3-4.2.3.3 Space requirements. Bathing fixtures
shall be located in individual rooms or enclosures that
4.3-4.1 General
provide the following:
See Section 2.3-4.1 (Facilities for Support Services­
(1) Space for private use of the bathing fixture
General) for requirements.
(2) Space for drying and dressing
(3) Access to a grooming location with a sink, mirror,
and counter or shelf

APPENDIX

A4.3-2.3.8.1 Outdoor activity spaces A4.3-4.2.3.1 Resident privacy. Consideration should be

a. Visual access to outdoor activity spaces from indoors should be pro­
given to privacy when locating entrances to bathing or spa rooms.
vided for staff and residents.

b. Outdoor spaces should be accessible via short, navigable distances.

224 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
4.3-4.2.3.4 Toilet. A toilet shall be provided in or
directly accessible to each resident bathing facility
without requiring entry into the general corridor.
4.3-4.2.3.5 Shower. Where a shower is included in
the bathing or spa room or area, see Section
2.5-2.3.3.2 (Accessible showers) for requirements.
4.3-4.2.4 Equipment and Supply Storage
4.3-4.2.4.1 See Section 2.3-4.2.4 (Equipment and
Supply Storage) for requirements in addition to those
in this section.
4.3-4.2.4.2 Clean linen storage
(1) A separate, secured closet, or designated area shall
be provided for clean linens.
(2) Where a closed-cart system is used, storage in an
alcove where staff control can be exercised shall be
permitted.
4.3-4.2.4.3 Supply storage. Storage space(s) for sup­
plies and recreation items shall be immediately acces­
sible and secured to support recreation and activities
offered.
4.3-4.2.4.4 Storage for resident needs. Storage
space(s) for resident equipment and supplies shall be
immediately accessible to support services offered and
secured based on the care population.
4.3-4.2.5 Clean Utility Room
Where the residential setting includes delivery of
medical care, a clean utility room shall be provided for
storage and holding as part of a system for distribution
of clean materials. See Section 2.3-4.2.5 (Clean Utility
Room) for requirements.
4.3-4.2.6 Soiled Utility Room
Where the residential setting includes delivery of
medical care, a soiled utility room shall be provided for
storage and holding as part of a system for collection
of soiled materials. See Section 2.3-4.2.6 (Soiled Util­
ity Room) for requirements.
4.3-4.2.7 Personal Laundry Facilities
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.3-4.2.7.1 Provision of personal laundry facilities
for residents to complete their own laundry shall be
provided. Equipment shall include:
(1) Washers and dryers based on the number of
residents being served
(2) Hand-washing station. See Section 2.5-2.3.2
(Hand-Washing Sinks) for requirements.
(3) Folding area
4.3-4.2.7.2 See 2.3-4.2.7 (Personal Laundry Facilities)
for additional requirements.
4.3-4.2.8 Resident Telephone Access
See Section 2.3-4.2.8 (Resident and Participant
Telephone Access) for requirements.
4.3-4.3 Support Areas for Staff
4.3-4.3.1 General
See Section 2.3-4.3.1 (Support Areas for Staff­
General) for requirements.
4.3-4.3.2 Staff Lounge Area
See Section 2.3-4.3.2 (Staff Lounge Area) for
requirements.
4.3-4.3.3 Toilet Rooms
Toilet rooms shall be designated for visitors, staff, and
residents based on the size of the facility and the total
number of users.
4.3-4.4 Support Facilities for Family and
Visitors
4.3-4.4.1 General
4.3-4.4.1.1 Community space for family and visitors
shall be provided based on the care model.
4.3-4.4.1.2 Spaces shall be able to be supervised as
required by individual treatment plans.
4.3-4.5 Food Service Facilities
4.3-4.5.1 General
The type and size of the long-term residential sub­
stance abuse treatment facility shall determine the
225
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES

dietary environment and the food service facilities 4.3-4.5.5.4 Dishwasher

provided.
4.3-4.5.5.5 ~icrowave
4.3-4.5.2 Centralized Commercial Kitchen
Where a centralized commercial kitchen is provided, 4.3-4.5.5.6 Additional equipment required by an AH]
the food service facilities shall meet the requirements
in Section 2.3-4.5 (Food Service Facilities). 4.3-4.6 Linen and Laundry Service Facilities

4.3-4.5.3 Warming Kitchen *4.3-4.6.1 General

For facilities that have a service contract with an

4.3-4.6.1.1 Each long-term residential substance abuse
outside vendor for food service, the following require­
treatment facility shall have provisions for storing and
ments shall be met:
processing clean and soiled linen. Centralized, decen­
tralized, or contracted services shall be permitted
4.3-4.5.3.1 Where an outside vendor is used to pro­
vide meals for a setting of 16 or more beds, dedicated
4.3-4.6.1.2 Based on the care model, personallaun­
space and equipment shall be provided for a warming
dry services can be combined with clean utility and/
kitchen, including space for minimal equipment for
or soiled utility. See Section 2.3-4.2.5 (Clean Utility
preparation of breakfast, emergency, or after-hours
Room), Section 2.3-4.2.6 (Soiled Utility Room), and
meals.
2.3-4.2.7 (Personal Laundry Facilities) for additional
requirements.
4.3-4.5.3.2 The resident kitchen shall be permitted
to serve as an alternative location to accommodate the
4.3-4.6.2 Facilities for Contracted Linen Services
function of a warming kitchen. See Section 2.3-2.3.4
(Resident and Participant Kitchen) for requirements. Where contracted services are used, the following shall
be provided:
4.3-4.5.4 Decentralized Kitchen
4.3-4.6.2.1 An area for soiled linen awaiting pickup
Where food preparation is conducted on-site for 16 or
more beds, the facility shall have dedicated non-public
4.3-4.6.2.2 A separate area for storage and distribution
staff space and equipment for preparation of meals. See
of clean linen
section 2.3-2.3.4 (Resident and Participant Kitchen)
for requirements.
4.3-4.6.2.3 A control station for pickup and receiving.
This shall be permitted to be shared with other services
4.3-4.5.5 Residential Communal Kitchen
and serve as the receiving and pickup point of service
Where a residential communal kitchen is provided in for the facility.
a residential treatment setting with four or fewer unre­
lated residents, the following shall be provided: 4.3-4.6.3 On-Site Laundry Service Facilities

4.3-4.5.5.1 Stove/range 4.3-4.6.3.1 General

(1) Where on-site laundry services are provided

4.3-4.5.5.2 Refrigerator
in a substance abuse treatment facility, the

requirements in this section shall apply.

4.3-4.5.5.3 Double-bowl sink

(2) Facilities for processing shall be permitted to be

APPENDIX

A4.3-4.6.1 Based on the care model, laundry services may be cen­ Laundry Facilities) for additional information. Completing laundry may
tralized in the facility, decentralized using personal laundry facilities, be part of the residents' responsibilities, depending on the care popula­
and/or outside contracted services. See Section 2.3-4.2.7 (Personal tion of the therapeutic community.

226 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.3 SPECIFIC REQUIREMENTS FOR lONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
located in the facility, in a separate building on- or
off-site, or in a commercial laundry.
(3) Layout. Equipment shall be arranged to permit
a workflow that minimizes cross-traffic between
clean and soiled operations.
(a) Areas dedicated to laundry shall be separate
from food preparation areas.
(b) Laundry rooms shall not open directly into
resident rooms.
4.3-4.6.3.2 At minimum, the following elements shall
be included:
(1) Rooms and spaces for sorting, processing, and
storage of soiled materials
(2) Soiled holding room(s). Separate central or
decentralized room(s) shall be provided for
receiving and holding soiled linen for pickup or
processing.
(a) Rooms shall have ventilation and exhaust.
(b) Discharge from soiled linen chutes shall be
received in this room or in a separate room as
required by the local AH].
(c) Rooms used for processing shall be provided
with a laundry or deep sink.
(3) Central clean linen storage. A central clean linen
storage and issuing room(s) shall be provided in
addition to the linen storage required at individual
resident units.
(4) Linen carts
(a) Storage. Provisions shall be made for parking
clean and soiled linen carts separately and out
of traffic.
(b) Cleaning. Provisions shall be made for
cleaning linen carts on-premises (or exchange
of carts off-premises).
(5) Hand-washing stations. Hand-washing stations
shall be provided in each area where unbagged
soiled linen is handled. See Section 2.4-2.2.8
(Hand-Washing Stations) for additional
requirements.
APPENDIX
A4.3-4.11.1.1 Kitchenette for conference space. Provision of kitchenette facilities, including under-counter refri~erator,mi(r<iWave, and
sink should be considered for the conference and educational space.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.3-4.7 Materials Management Facilities
Where materials management facilities are provided,
see Section 2.3-4.7 (Materials Management Facilities)
for requirements.
4.3-4.8 Waste Management Facilities
4.3-4.8.1 See Section 2.3-4.8 (Waste Management
Facilities) for waste collection, storage, and disposal
requirements.
4.3-4.8.2 Waste management requirements shall be
scaled to the size and operational need of the long­
term care residential facility.
4.3-4.9 Environmental Services Rooms
See Section 2.3-4.9 (Environmental Services Rooms)
for requirements.
4.3-4.10 Facilities for Engineering and
Maintenance Services
Where facilities for engineering and maintenance
services are provided on-site, see Section 2.3-4.10
(Facilities for Engineering and Maintenance Services)
for requirements.
4.3-4.11 Administrative Areas
4.3-4.11.1 Office, Conference, and Educational
Space
Offices or an open office area with private confer­
ence space shall be provided for business transactions,
admissions, and social services and for the use of
administrative and professional staff.
*4.3-4.11.1.1 Conference and educational space.
Space for conferences; staff, resident, and family meet­
ings; education classes; and group counseling shall be
sized according to operational needs.
(1) Space shall include provisions for use of visual aids
and technology.
(2) Sharing of space for various uses shall be permitted.
227
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES

4.3-4.11.1.2 General office space 4.3-5.2.1 General

(1) Office space shall be provided for staff and file
See Section 2.4-2.1 (Architectural Details, Surfaces,
storage.
and Furnishings-General) for requirements.
(2) Identification of required work spaces for
in-house staff and contracted visiting staff, based 4.3-5.2.2 Architectural Details
on professional discipline, shall be taken into
consideration when planning office space and work 4.3-5.2.2.1 General. See Section 2.4-2.2.1
areas. (Architectural Details-General) for requirements.

4.3-4.11.1.3 Supply and copy room. Space for stor­ 4.3-5.2.2.2 Corridors. See Section 2.4-2.2.2
age of files, office equipment, and supplies shall be (Corridors) for requirements.
provided.
4.3-5.2.2.3 Ceiling height. See Section 2.4-2.2.3
(Ceiling Height) for requirements.
• 4.3-5 Design and Construction
Requirements *4.3-5.2.2.4 Doors and door hardware
(1) Door type
4.3-5.1 Building Codes and Standards
*(a) Doors to all rooms containing bathtubs, show­
See Section 2.4-1.2 (Building Codes and Standards)
ers, and toilets for resident use shall be hinged,
for requirements.

sliding, or folding.
*(b) Resident unit doors
4.3-5.1.1 General

A code-compliant, safe, and accessible environment

(i) Egress from the unit shall be possible at all
shall be provided.
times and locking hardware shall enable
occupant(s) to gain egress from within by
4.3-5.1.1.1 A facility that seeks accreditation, certifica­
means of a simple operation.
tion, licensure, or other credentials shall comply with
(ii) All resident units shall be accessible by
applicable design and construction standards.
staff or safety personnel in case of emer­
gency.
4.3-5.1.1.2 Where institutional codes are required,
(c) Manual or automatic sliding doors shall
the facility shall maintain the residential environment
be permitted where their use does not
desired by residents.
compromise fire and other emergency exiting
requirements.
4.3-5.1.2 Accessibility Codes

(2) Door openings. See Section 2.4-2.2.4.2 (Door

The facility shall comply with applicable federal, state,

openings) for requirements.

and local requirements; see Section 1.1-4.1 (Design

(3) Insect screens. See Section 2.4-2.2.4.3 (Insect

Standards for Accessibility).

screens) for requirements.

4.3-5.2 Architectural Details, Surfaces, and

4.3-5.2.2.5 Thresholds and expansion joint covers.
Furnishings
See Section 2.4-2.2.5 (Thresholds and Expansion Joint
Covers) for requirements.
APPENDIX

A4.3-S.2.2.4 Door protection. See appendix section A2.4­ A4.3-S.2.2.4 (1 )(b) Resident unit doors. Based on the

2.2.4 (Door protection) for recommendations. care population, use of doors that can be locked by occupant(s) should

be evaluated.

A4.3-S.2.2.4 (1 )(a) Provisions should be made for auditory and

visual privacy and usability for doors to rooms containing bathtubs,
showers, and toilets for resident use.

228 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES

4.3-5.2.2.6 Windows 4.3-5.2.3.1 General

*(1) See Section 2.4-2.2.6 (Windows) for requirements (1) See Section 2.4-2.3.1 (Surfaces-General) for

in addition to those in this section. requirements in addition to those in this section.

(2) Windows shall be provided in all sleeping areas. *(2) To reduce surface contamination linked to health
care-associated infections, surface materials selected
4.3-5.2.2.7 Glazing materials. See Section 2.4-2.2.7 for use in substance abuse treatment facilities shall
(Glazing Materials) for requirements. possess the following performance characteristics:

(a) Surfaces shall be cleanable.

4.3-5.2.2.8 Hand-washing stations. Where hand­
(b) Surfaces shall have no surface crevices, rough
washing stations are provided, they shall comply with
textures, joints, or seams.
Section 2.4-2.2.8 (Hand-Washing Stations).
(c) Surfaces shall be non-absorptive, nonporous,
and smooth.
4.3-5.2.2.9 Grab bars. See Section 2.4-2.2.9 (Grab
Bars) for requirements.
4.3-5.2.3.2 Flooring and wall bases. See Section
2.4-2.3.2 (Flooring and Wall Bases) for requirements.
4.3-5.2.2.10 Handrails and lean rails. Where hand­
rails or lean rails are provided, see Section 2.4-2.2.10
4.3-5.2.3.3 Walls and wall protection. See Sec­
(Handrails and Lean Rails) for requirements.
tion 2.4-2.3.3 (Walls and Wall Protection) for
requirements.
4.3-5.2.2.11 Protection from heated surfaces. Where
it is necessary to protect the care population from
4.3-5.2.3.4 Ceilings. See Section 2.4-2.3.4 (Ceilings)
heated surfaces, see Section 2.4-2.2.11 (Protection
for requirements.
from Heated Surfaces) for requirements.

4.3-5.2.4 Furnishings
4.3-5.2.2.12 Signage and wayfinding. See Section
2.4-2.2.12 (Signage and Wayfinding) for requirements. See Section 2.4-2.4 (Furnishings) for requirements.

4.3-5.2.2.13 Decorative water features. Where deco­

• 4.3-6 Building Systems
rative water features are included in the facility design,
see appendix section A2.4-2.2.13 (Decorative water
4.3-6.1 General
features) for recommendations.
See Section 2.5-1 (Building Systems-General) for
4.3-5.2.3 Surfaces requirements.

4.3-6.2 Plumbing Systems

APPENDIX

A4.3-S.2.2.6 (1) Windows. Each room in aresident setting Process" identified environmental factors as "latent conditions that
should have awindow(s) that meets the requirements of Section 2.4­ can be designed to help eliminate harm:' Such "built environment
2.2.6 (Windows). latent conditions [holes and weaknesses] that adversely impact patient
safety" should be identified and eliminated during planning, d~sign,
A4.3-S.2.3.1 (2) Surfaces and materials selected should be easy
and construction of health care facilities. Reduction of surface contami­
to use and have clear, written, manufacturer-recommended cleaning
nation linked to health care-associated infections· is one of,these fac­
and disinfection protocols to assure the product will remain durable
tors. See Section 1.2-3 (Resident Safety Risk Assessment)Jor additional
and effective at meeting Centers for Disease Control and Prevention and
information.
other clinical bacterial-elimination requirements.
The Center for Health Design report "Designing for Patient Safety:
Developing Methods to Integrate Patient Safety Concerns in the Design

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 229
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
4.3-6.2.1 General
See Section 2.5-2.1 (Plumbing Systems-Genetal) for
requirements.
4.3-6.2.2 Plumbing and Other Piping Systems
See Section 2.5-2.2 (Plumbing and Other Piping
Systems) for requirements.
4.3-6.2.3 Plumbing Fixtures
4.3-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
Fixtures-General) for requirements.
4.3-6.2.3.2 Hand-washing sinks. See Section
2.5-2.3.2 (Hand-Washing Sinks) for requirements.
4.3-6.2.3.3 Showers and tubs. See Section 2.5-2.3.3
(Showers and Tubs) for requirements.
4.3-6.2.3.4 Reserved
4.3-6.2.3.5 Clinical sinks. See Section 2.5-2.3.5
(Clinical Sinks) for requirements.
4.3-6.2.3.6 Portable hydrotherapy whirlpools.
Where portable hydrotherapy whirlpools are used
in a substance abuse treatment facility, see Section
2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for
requirements.
4.3-6.2.4 Medical Gas and Vacuum Systems
Where medical gas and/or vacuum systems are used,
the installation of nonflammable medical gas, air, or
clinical vacuum systems shall comply with the require­
ments ofNFPA 99: Health Care Facilities Code.
4.3-6.3 Heating, Ventilation, and
Air-Conditioning (HVAC) Systems
4.3-6.3.1 General
4.3-6.3.1.1 Application
(1) For subsrance abuse treatment facilities with 16
or fewer residents, see ANSIIASHRAE Standard
62.2: Ventilation and Acceptable Indoor Air Quality
in Low-Rise Residential Buildings for basic HVAC
system requirements.
230 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
(2) For substance abuse treatment facilities with more
than 16 residents, see ANSIIASHRAE Standard
62.1: Ventilation for Acceptable Indoor Air Quality
for basic HVAC system requirements.
4.3-6.3.1.2 Ventilation and space conditioning. See
Section 2.5-3.1.2 (Ventilation and Space Condition­
ing) for requirements.
4.3-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
4.3-6.3.3 HVAC Requirements for Specific
Locations
4.3-6.3.3.1 Reserved
4.3-6.3.3.2 Fuel-fired equipment rooms. See
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
requirements.
4.3-6.3.3.3 Areas of refuge. See Section 2.5-3.3.3
(Areas of Refuge) for requirements.
4.3-6.3.3.4 Commercial food preparation areas.
Where these areas are provided, see Section
2.5-3.3.4 (Commercial Food Preparation Areas) for
requirements.
4.3-6.3.4 Thermal and Acoustic Insulation
See Section 2.5-3.4 (Thermal and Acoustic Insulation)
for requirements.
4.3-6.3.5 HVAC Air Distribution
See Section 2.5-3.5 (HVAC Air Distribution) for
requirements.
4.3-6.3.6 HVAC Filters
4.3-6.3.6.1 Filter efficiencies
(1) For centralized recirculated systems, MERV 7
shall be the minimum filter efficiency for the first
filter bank. There is no minimum filter efficiency
requirement for the second filter bank.
(2) For non-central recirculating room systems, HVAC
units shall:
 4.3 SPECiFIC REQUIREMENTS FOR lONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
(a) Not receive nonfiltered, nonconditioned
outdoor air.
(b) Serve only a single space.
*(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
designed to condense water. This filter shall be
located upstream of any such cold surface so
that all of the air passing over the cold surface
is filtered.
4.3-6.3.6.2 Filter frames for centralized systems
(1) Filter frames shall be durable and proportioned to
provide an airtight fit with the enclosing ductwork.
(2) All joints between filter segments and the enclosing
ductwork shall have gaskets or seals to provide a
positive seal against air leakage.
4.3-6.3.7 Heating Systems, Cooling Systems, and
Equipment
See Section 2.5-3.7 (Heating Systems, Cooling
Systems, and Equipment) for requirements in addition
to those in this section.
4.3-6.3.7.1 Heating systems. Substance abuse
treatment facilities shall have a permanently installed
heating system capable of maintaining an interior
minimum temperature of 72° F (22° C) under heating
design temperatures.
4.3-6.3.7.2 Cooling systems. Substance abuse
treatment facilities shall be configured and equipped
with a cooling system capable of maintaining an
interior maximum temperature of 75° F (24° C) under
cooling design temperatures.
4.3-6.4 Electrical Systems
4.3-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
4.3-6.4.2 Power-Generating and Power-Storing
Equipment
APPENDIX
A4.3-6.3.6.1(2J(c) Filters for recirculating room systems. Filters SllOUld be replaced and/or cleaned per the manufacturers recom­
mendations to maintain indoQr air quality.
------------------------- - - - - - -
Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
4.3-6.4.2.1 Reserved
4.3-6.4.2.2 Generators. Where generators are used for
a substance abuse treatment facility, exhaust systems
(including muffiers and vibration isolators) for internal
combustion engines shall be located, designed, and
installed to minimize objectionable noise.
4.3-6.4.3 Electrical Receptacles
4.3-6.4.3.1 General. See Section 2.5-4.3.1 (Electrical
Receptacles-General) for requirements.
4.3-6.4.3.2 Receptacles in corridors. See Section
2.5-4.3.2 (Receptacles in Corridors) for requirements.
4.3-6.4.3.3 Receptacles in resident rooms. Each
resident room shall have duplex-grounded receptacles,
including at least one on each wall.
4.3-6.4.3.4 Essential electrical system receptacles.
See Section 2.5-4.3.4 (Essential Electrical System
Receptacles) for requirements.
4.3-6.4.3.5 Ground fault interrupter receptacles. See
Section 2.5-4.3.5 (Ground Fault Interrupter Recep­
tacles) for requirements.
4.3-6.5 Communication Systems
4.3-6.5.1 Application
The requirements in this section shall apply to the
following systems based on the care model and the
needs of residents:
4.3-6.5.1.1 Call system
4.3-6.5.1.2 Information system
4.3-6.5.1.3 Telecommunication system
4.3-6.5.2 Call System
4.3-6.5.2.1 General. Where call systems are provided,
the following requirements shall be met:
---------------------
231
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
(1) The system shall be capable of activation/operation
from resident toilets, bedrooms, and bathing areas.
(2) The signal shall be transmitted to on-duty staff
through fixed locations and/or resident wearable
devices.
(3) Use of alternative technologies, including wireless
systems, shall be permitted.
(a) Where wireless systems are used, consideration
shall be given to electromagnetic compatibility
between internal and external sources.
(b) Wireless systems shall comply with UL
Standard 2560: Emergency Call Systems
for Assisted Living and Independent Living
Facilities.
4.3-6.5.2.2 Resident room call stations
(1) Where a hardwired system is used:
(a) Each bed location shall be provided with a call
device accessible to the resident.
(b) One call station shall be permitted to serve
two call devices.
(2) Use of wireless call stations shall be permitted.
4.3-6.5.2.3 Emergency call system. Where an emer­
gency call system is provided, an emergency call device
shall be located at each toilet, bath, and shower used
by residents.
(1) The device shall be accessible to a resident in any
position in the room, including lying on the floor.
Inclusion of a pull cord or portable wireless device
shall satisfY this requirement.
(2) The emergency call system shall be designed so that
when a call is activated a signal is initiated that is
distinct from the resident room call device and can
be turned off only at the activated emergency call
device.
(3) The signal shall activate at the staff work area and/
or signal a handheld mobile device carried by staff.
(4) Emergency call systems shall comply with UL
2560: Emergency Call Systems for Assisted Living and
Independent Living Facilities.
4.3-6.5.3 Technology Equipment and Teledata
Room(s)
232 Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
See Section 2.5-5.3 (Technology Equipment and
Teledata Room) for requirements.
4.3-6.5.4 Grounding for Telecommunication
Spaces
See Section 2.5-5.4 (Grounding for Telecommunica­
tion Spaces) for requirements.
4.3-6.5.5 Cabling Pathways and Raceway
Requirements
See Section 2.5-5.5 (Cabling Pathways and Raceway
Requirements) for requirements.
4.3-6.6 Electronic Safety and Security Systems
See Section 2.5-6 (Electronic Safety and Security
Systems) for requirements.
4.3-6.7 Daylighting and Artificial Lighting
Systems
4.3-6.7.1 General
See Section 2.5-7.1 (Daylighting and Artificial light­
ing Systems-General) for requirements.
4.3-6.7.2 Daylighting Systems in Resident living
Areas
See Section 2.5-7.2 (Daylighting Systems in Resident
Living, Participant, and Outpatient Areas) for
requirements.
4.3-6.7.3 Artificial lighting Systems
4.3-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
(Light Fixtures) for requirements.
4.3-6.7.3.2 Lighting requirements for specific loca­
tions. See appendix section A2.5-7.3.2 (Lighting in
transition spaces) for recommendations.
(1) Resident unit corridors
(a) Resident unit corridors shall have general
J
illumination with provisions for reducing light
levels at night.
(b) Corridors and common areas used by residents
shall have even light distribution to avoid
glare, shadows, and scalloped lighting effects.
*(2) Resident rooms, bedrooms, and bathrooms
 4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
(a) Task light controls shall be readily accessible to
residents.
(b) Where night-lighting is provided, it shall
be located in the pathway to and from the
bedside and the bathroom.
(i) Night-lighting shall be mounted no higher
than 2 feet (61 centimeters) above the
floor.
(ii) Night-lighting shall be controlled sepa­
rately from ambient lighting.
*(iii) Night-lighting shall have a low light level.
(iv) Because night-lights may disturb resi­
dent sleep even when properly specified,
located, and operated, care providers shall
be permitted to use portable light sources
or switched night-lights for added control
of this light source.
4.3-6.8 Acoustic Design Systems
See Section 2.5-8 (Acoustic Design Systems) for
requirements.
4.3-6.9 Elevator Systems
4.3-6.9.1 General
4.3-6.9.1.1 Requirement. Where elevators are
provided in large settings for residents with intellectual
and/or developmental disabilities, the requirements in
this section shall be met:
A4.3-6.7.3.2 (2) Lighting in resident. rooms,
bedrooms, and bathrooms
a. Resident rooms, bedrooms, and bathrooms should have general
lighting and task lighting.
b. Resident bathrooms should proVide general illumination with
provision for redu<ing light levels at night.
A4,3-6.7.3.2 (2)(bHiii) Night-lighting in resident
rooms. Research has established that older adults sleep best in total
darkness. Therefore, to minimize resident sleep disruption, night-lights
should provide very low levels of illumination and be located to mini­
mize light scatter and reflections on room surfaces. To achieve alow
light level, nighHighting should include amber or red lamping; white,
blue, or green lamping should not be used. Switches for night-lights are
recommended for some care populations.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
*4.3-6.9.1.2 Number. Engineered traffic studies are
recommended, but in their absence the following
guidelines for the minimum number of elevators
shall apply:
(1) At least one elevator sized to accommodate a
gurney and/or medical carts and resident-operated
mobility device users shall be installed where
residents are living or receiving care or support
services on any floor other than the main entrance
floor.
(2) At least two elevators shall be installed where 60 to
200 residents are living or receiving care or support
services on floors other than the main entrance
floor.
(3) At least three elevators shall be installed where
201 to 350 residents are living or receiving care
or support services on floors other than the main
entrance floor.
(4) For facilities with more than 350 residents living
or receiving care or support services above the
main entrance floor, the number of elevators shall
be determined from a study of the facility plan
and from the estimated vertical transportation
requirements.
*4.3-6.9.2 Dimensions and Clearances
Elevator car doors shall have a clear opening of no less
than 3 feet 8 inches (1.12 meters).
4.3-6.9.3 Leveling Device
See Section 2.5-9.3 (Leveling Device) for
requirements.
A4.3-6.9.1.2 Number of elevators. These standards may
be inadequate for moving large numbers ofpeople in ashorttime;
adjustments should be made as appropriate to the care model and
population served.
A4.3-6.9.2 Elevator dimensions and clearances
a. Handrail projections of up to 3.5 inches t8;89 centimeters) should
not be construed as diminishing the clear inside dimensions.
b. If required to Serve the care population and indicated by a
mobility transfer assessment, at least one facility elevator should
accommodate attending staff and an ambulance gurney 7feet6
inches (2.29 meters) in length and/or an expanded capacity widrhof
4feet (1.22 meters) for persons of size.
c. Additional elevators required for passenger service shalf be sized to
accommodate resident-operated mobility devices, if needed by the
care population.
233
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES

4.3-6.9.4 Installation and Testing 4.3-6.9.5 Handrails

See Section 2.5-9.4 (Installation and Testing) for Elevator cars shall have handrails on all sides without
requirements. entrance door(s). See Section 2.4-2.2.10 (Handrails
and Lean Rails) for additional requiremenrs.

234 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 .4
Specific Requirements for
Settings for Individuals with Intellectual
and/or Developmental Disabilities
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.
• 4.4-1 General
4.4-1.1 Application
4.4-1.1.1 General
*4.4-1.1.1.1 This chapter contains specific requirements
for residential settings for individuals with intellectual
and/or developmental disabilities.
4.4-1.1.1.2 The requirements in Part 2 (Common
Elements for Residential Health, Care, and Support
Facilities) shall apply to settings for persons with
intellectual and/or developmental disabilities as
referenced in this chapter.
4.4-1.1.2 Desig n Criteria
4.4-1.1.2.1 Sustainable design. See Section 2.2-2
(Sustainable Design Criteria) for requirements for
residential settings for individuals with intellectual
and/or developmental disabilities.
APPENDIX
A4.4-1.1.1.1 Setting types for individuals with
intellectual and/or developmental disabilities.
Settings for persons with intellectual and/or developmental disabilities
are acomponent ofthe continuum of care for those being served and
provide a supportive residential environment for services. They can
be freestanding facilities, part of a residential health, care, or support
facility, or asetting embedded in the community at-large.
These settings can vary substantially from one state to the next and
even in the same state. In some states, the entity that provides services
is licensed rather than the building itself.
For the purposes of this chapter, the term "resident" is intended to
be interchangeable with the term "client;' as both are used by different
jurisdictions.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.4-1.1.2.2 Design criteria for accommodations for
care of persons of size. Where the care population
includes needs for persons of size, see Section 2.2-3
(Design Criteria for Accommodations for Care of
Persons of Size) for requirements.
4.4-1.1.2.3 Dementia, mental health, and cognitive
and developmental disability design criteria. Where
the care population includes residents with dementia,
mental health issues, or cognitive and developmen­
tal disabilities, see Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive and Devel­
opmental Disability Facilities) for requirements.
*4.4-1.1.3 Minimum Standards for Settings for
Individuals with Intellectual and/or Developmen­
tal Disabilities
This chapter identifies the minimum requirements
for residential settings for persons with intellectual
and/or developmental disabilities, recognizing various
configurations for small, medium, and large residential
settings, which must comply with applicable state and
local requirements.
A4.4-1.1.3 This chapter acknowledges that both residential and day
care programs are available to serve residents and participants who have
intellectual and/or developmental disabilities. The chapter does not
include larger residential health settings (nursing homes) or hospitals
for residents or patients who have intellectual and/or developmental
disabilities, but is intended to cover intermediate care facilities for
individuals with intellectual disabilities (ICF1ID), community residences,
and personal care homes. For information on day care settings for these
individuals, see Chapter 5.1, Specific Requirements for Adult Day Care
and Adult Day Health Care Facilities.
The common goal of this chapter and local and state requirements
is to facilitate accountability and protection for individuals with intel­
lectual and/or developmental disabilities by providing baSic standards
for supportive environments for these individuals.
4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES
4.4-1.2 Functional Program
4.4-1.2.1 General
4.4-1.2.1.1 See Section 1.2-2.1 (Functional Pro­
gram-General) for requirements in addition to those
in this section.
4.4-1.2.1.21he sponsor of each project shall provide a
functional program that:
*(1) Defines the scope and scale of the setting for
individuals with intellectual and/or developmental
disabilities (including the care model).
(2) Identifies resident needs.
(3) Facilitates the application of licensure and
APPENDIX
A4.4-1.2.1.2 (1) Care model characteristics. See
-Support for decentralized and self-administered medications
appendiX table A4.4-a (Characteristics of Settings for Individuals
-Dedicated staff space usually located in aresidential unit (e.g.,
with Intellectual and/or Developmental Disabilities) for additional
atwo-bedroom apartment could include athird bedroom for
information.
staff). Alternatively, if residents share community space, staff
a. (are model types. The care model will vary depending on whether
provision of services is centralized or decentralized and on the size of
a residential setting. Following are general descriptions ofthe differ­
ent size models commonly used for individuals with intellectual and/
or developmental disabilities.
Small Setting (are Model
The small setting care model includes personal care homes, which
are single-family-style homes that typically have the following
characteristics:
-Integration into communities to create residential settings that
are part of the community at-large (e.g., use of residential roof
lines, heights, etc. to avoid institutional appearance and stigma)
-Four or fewer residents liVing in ashared house setting, such as
an apartment/home/triplex with private or shared rooms based
on resident choice
-Bedrooms directly accessible to common living areas such as a
kitchen, living room, dining room, and other shared community
spaces
-Shared or private bathrooms based on individual resident needs,
with shower or tub prOVided in the resident bathroom
-Shared kitchen based on individual resident needs and capabili­
ties. For example, based on the care population, it may be nec­
essary to support staff supervision of resident use ofthe kitchen
or to provide a key-operated switch on an electric range or oven
to prevent unsafe use ofacooking appliance, but the goal is to
allow residents to be as independent as possible.
-Shared living/dining room based on needs of the care popula­
tion for circulation and access
-Views of and access to nature
236 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
occupancy approvals by authorities having
jurisdiction (AH]s).
(4) Addresses applicable provisions of the Guidelines
for Design and Construction ofResidential Health,
Care, and Support Facilities.
4.4-1.2.2 Shared Services and Space
4.4-1.2.2.1 Settings for residen ts with intellectual
and/or developmental disabilities shall· be permitted
to be freestanding facilities or distinct parts of another
residential health, care, Ot support facility.
4.4-1.2.2.2 Each setting for residents with intellectual
and/or developmental disabilities shall, at minimum,
space could be included in the community area. Because staff
space is usually located in a residential setting in the small set­
ting model, it would include residential equipment and furnish­
ings.
Medium Setting (are Model
The medium setting model includes community residences
and intermediate care facilities for individuals with intellectual
disabilities (ICF/ID), which typically have the following
characteristics:
-Integration into the community to create residential settings
that are part ofthe community at-large
-Resident rooms for up to 16 residents and shared common
space. Smaller groups of resident rooms (e.g., two settings of
eight resident rooms each) attached to shared commonspace
would be considered a"small house" setting. These smaller­
scaled homes may be freestanding or grouped together in
attached or detached configurations.
-A combination of private and shared resident rooms based on
resident choice and the care population being served
-Shared or private bathing area(s) based on individual resident
needs, with ashower provided in resident room bathrooms
-Shared common areas for every eight resident beds
-Separate facilities for food service and food-handling activities
-Views of and access to nature
-Support for decentralized and self-administered medications
-Dedicated staff space, which is often located in the "garage" area
of aresidential home that includes resident rooms and common
spaces. Alternatively, staff space could be included in the com­
munityarea.
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES
APPENDIX (continued)
Large Setting Care Model
Alarge setting model typically includes the following:
-Seventeen or more residents using a"household" model of care
-Resident rooms assembled in smaller groups with shared
common space to create a household concept similar to that
used in nursing homes or assisted living facilities
-Neighborhood(s) of two or more households that mayor may
not be integrated into the community at-large. An overall com­
munity is composed of one or more neighborhoods.
-Shared or private bathing areas based on individual resident
needs, with ashower in the resident room bathroom(s)
- Shared common spaces that serve 12 to 16 resident rooms per
household
-An optional larger event space. This may be included in the
overall community for larger activities or gatherings for all resi­
dents, family, and the community at-large.
-Separate facilities for food service and food-handling, including
acommercial kitchen or satellite kitchens that serve the house­
holds and/or neighborhoods
-Facilities for decentralized or centralized support services,
depending on the care model and services proVided. For exam­
ple, laundry services for linens may be centralized or outsourced,
but personal laundry is completed in the household.
-Views of and access to nature, and areas for outdoor activities
-Support for decentralized or centralized medications. Medica­
tion distribution and storage locations may be located in a
household, semi-decentralized in a neighborhood, or centrally
located in acommunity. Decentralized or semi-decentralized
medication delivery typically reduces staff travel distances.
-Dedicated staff space
b. Physical setting. Settings for individuals with intellectual and/or
developmental disabilities are further differentiated according to
their functional and programmatic characteristics.
Small Setting Care Model
-Single- or double-occupancy resident bedrooms based on avail­
ability and choice
-Common areas that include:
• Shared kitchen
• Dining room
• living room
• Optional additional space for den or family room to accom­
modate activities and family visits
-Accommodation of staff space
-Access to the outdoors
Medium Setting Care Model Characteristics
-Single- or double-occupancy resident bedrooms as determined
to meet care population needs
-Space to accommodate decentralized services based on evalua­
tion of need
-Common areas that include:
Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
Residential kitchen
• Dining room
• living room
• Optional den and additional activity space for family and
care provider visits
-Dedicated staff space
-Views of and access to nature, and areas for outdoor activities
Large Setting Care Model
-Single- or double-occupancy resident bedrooms with direct
access into a"household"that includes aresidentially scaled
kitchen, living room, and dining room
-Space to accommodate decentralized, semi-decentralized, or
centralized services based on the care model
-Common areas that include:
• Residentially scaled kitchen
• Dining room
living room
Den
• Optional additional activity spaces
-Centralized or satellite commercial kitchens based on the care
model
-Dedicated staff space
-':"Views of and access to nature, and areas for outdoor activities
-Travel distances for staff and residents based on household and
neighborhood layout to maximize residents' independence and
mobility
c. Additional benefits. Some additional benefits of the small, medium,
and large setting models for residents with intellectual and/or devel­
opmental disabilities include the following:
Small Setting Care Model
-The small nature of this residential setting promotes strong
personal relationships between residents and staff.
-This setting is typically provided by an owner-operator who is
both the owner and provider of care.
Medium Setting Care Model
-This residential setting typically allows for strong personal rela­
tionships between residents and staff.
-This setting prOVides a non-institutional setting for residents
with intellectual and/or development disabilities.
Large Setting Care Model
-The size of this community allows creation of multiple house­
holds or neighborhoods to serve populations with specialized
care needs.
-This setting allows for smaller-scaled residential-type spaces
in alarger community context supporting a larger number of
residents for-economies of scale.
-Reduction in the number of corridors as a result of using a
household model reduces travel distances for staff.
237
4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES

contain the elements described in the applicable para­
graphs of this chapter. However, when a project calls
for sharing or purchasing services from another entity,
modifications in space and parking requirements shall
be permitted.
*4.4-1.2.2.3 Where the setting for residents with
intellectual and/or developmental disabilities is part of
(or contractually linked with) another facility, sharing
of facilities for services such as home health, dietary,
(3) Promote resident privacy and dignity.
4.4-1.4.3.2 The physical environment of a setting
for residents with intellectual and/or developmental
disabilities shall support the services and levels of care
provided in the residential setting, which are in larger
part driven by the service needs and lifestyle prefer­
ences of the residents being served.
4.4-1.4.3.3 Settings for residents with intellectual

storage, pharmacy, linen, and laundry services shall be and/or developmental disabilities shall be designed

permitted. and constructed to provide a supportive residential

environment that is conducive to day-to-day

4.4-1.3 Resident Safety Risk Assessment activities consistent with the cultural, emotional,

See Section 1.2-3 (Resident Safety Risk Assessment) and spiritual needs of residents. This supportive

for requirements. environment shall:

(1) Promote independence, privacy, and dignity for

4.4-1.4 Environment of Care Requirements residents.

(2) Balance resident autonomy with resident safety.

4.4-1.4.1 General
See Section 1.2-1.3 (Environment of Care and Facility
Function Considerations) and Section 1.2-4 (Environ­
ment of Care Requirements) for requirements.
4.4-1.4.2 Flexibility
Settings for residents with intellectual and/or devel­
opmental disabilities shall be designed to provide
flexibility to meet the changing physical, medical, and
psychological needs of residents.
4.4-1.4.3 Supportive Environment
(3) Provide choice for all residents in a manner that
encourages family and community involvement.
*4.4-1.4.4 Barrier-Free Environment
The physical environment shall eliminate as many bar­
riers as possible to effective access and use of the space,
services, equipment, and utilities appropriate for daily
living.
4.4-1.5 Site
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site
Elements) for requirements.

4.4-1.4.3.1 The facility design shall produce a sup­

portive environment to:

• 4.4-2 Resident Areas
(1) Enhance and extend quality of life for residents.
*4.4-2.1 General
(2) Facilitate wayfinding.

APPEN DJX

A4.4-1.2.2.3 Shared services and facilities. Services

(Environment of care design recommendations-Barrier-free envi­
may be contractually provided or shared with other entities. In some
ronment) for more information.
cases, all ancillary servicerequirell1ents will be met by the principal
b. Facilities should provide accessibility for residents with disabilities in
facility and the only modifications necessary will be in the setting for
accordance with the state or local building code and the Americans
residents with intellectual and/or developmental disabilities. In other
with Disabilities Act.
cases, programmatic toncerns and requirements may dictate separate

A4.2-2.1 Settings for residents with intellectual and/or develop­

service areas.

mental disabilities include avariety of care models that are designed to

A4.4-1.4.4 Barrier-free environment meet differing social, economic, and care considerations. Descriptions of
a. "Universal design" practices that promote barrier-free environ­
small, medium, and large care model settings are included in appendix
ments should be encouraged. See appendiX section M.2-1.4-c
section M.4-1.2.1.2 (1) (Care model characteristics).

238 Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES
4.4-2.1.1 Application
The requirements in this section are common to most
settings for residents with intellectual and/or develop­
mental disabilities and shall apply as indicated for each
setting type.
4.4-2.1.2 Layout
4.4-2.1.2.1 Areas for the care and treatment of users
not residing in the facility shall not interfere with
or infringe on the space of residents who live in the
facility.
4.4-2.1.2.2 Facility layout shall reflect the care model
and related staffing.
(1) Small model. Four or fewer resident rooms shall
be arranged in a residentially scaled home with
centralized services and bathing, resident, and staff
support areas.
(2) Medium model. Five to16 resident rooms shall
be arranged in a residentially scaled home that is
freestanding or located in a larger community with
centralized or decentralized services and bathing,
resident, and staff support areas.
(3) Large model. Seventeen or more resident rooms
shall be arranged using a household model with
centralized or decentralized services and bathing,
resident, and staff support areas.
4.4-2.2 Resident Unit or Private Living Area
4.4-2.2.1 General
Bedrooms or resident rooms shall be provided and
sized to:
4.4-2.2.1.1 Allow for sleeping.
4.4-2.2.1.2 Afford privacy.
APPENDIX
A4.4-2.2.2 Resident room capacity. Bedrooms should be
limited to single or double occupancy.
A.4.4-2.2.2.2 Space requirements. It should be considered
for each resident to have the option of bringing his or her own furniture
to their resident room depending on specific resident and safety needs
in the setting.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.4-2.2.1.3 Provide access to furniture and belongings.
4.4-2.2.1.4 Accommodate the care and treatment
provided to each resident.
*4.4-2.2.2 Resident Room
4.4-2.2.2.1 Reserved
*4.4-2.2.2.2 Space requirements
(1) Resident room size (area and dimensions) shall
permit resident(s) to move about the room with
the assistance of a resident-operated mobility
device, allowing access to at least one side of a bed,
window, closet or wardrobe, chair, dresser, and
nightstand.
(2) Room size and configuration shall permit resident
options for bed location(s) and shall comply with
spatial requirements of the AH].
(3) Bedrooms shall not be used as passageways,
corridors, or access to other bedrooms.
4.4-2.2.2.3 Windows. See Section 4.4-5.2.2.6
(Windows) for requirements.
4.4-2.2.2.4 Resident privacy
*(1) Visual privacy shall be provided for each resident in
double-occupancy rooms.
(2) Design for privacy shall not restrict resident access
to the toilet, room entrance, window, or other
shared common areas in the resident room.
4.4-2.2.2.5 Hand-washing station. Where a hand­
washing station is provided, see Section 2.4-2.2.8
(Hand-Washing Stations) for requirements.
4.4-2.2.2.6 Reserved
*4.4-2.2.2.7 Resident bathroom. Each resident shall
have access to a bathroom.
A4.4-2.2.2.4 (1) Consideration should be given to using awall or
partition as adivider to preserve visual and auditory privacy for each
resident. Alcoves may be used in double-occupancy resident rooms.
A4.4-2.2.2.7.Resident bathrooms in small setting
models. Because small setting models are located in aresidential
home setting, clearances and grab bars should·beconsideredbased
239
4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTelLECTUAL AND/OR DEVelOPMENTAL DISABILITIES
(1) The bathroom shall contain the following:
(a) Toilet
(b) Hand-washing station. See Section 2.4-2.2.8
(Hand-Washing Stations) for requirements.
(c) Mirror. See Section 2.4-2.2.8.7 (Mirror) for
requirements.
(d) Private individual storage for the personal
effects of each resident. See Section 2.4-2.4.2
(Casework, Millwork, and Built-Ins) for
requirements.
*(e) Tub or shower. See Section 2.5-2.3.3.2
(Accessible showers) for requirements.
(2) Where the bathroom is shared, privacy locks shall
be permitted with provisions for emergency access.
*4.4-2.2.2.8 Resident storage
(1) Each resident shall be provided with an individual
wardrobe or closer.
*(2) Separate, enclosed storage in the resident room
shall be provided for each resident.
4.4-2.3 Resident Community Areas
4.4-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant, and
Outpatient Community Areas-General) for
requirements.
APPENDIX (continued)
on the needs of the care population. Since these settings are often in
be considered for ease of access by resident and staff.
an existing house with standard residential bedrooms and bathrooms,
b. For resident bathrooms that include atub and/or shower, the need
meeting the requirements in Section 2.4-2.2.9 (Grab Bars), especially
for lift(s), shower chair(s) and other equipment should be evaluated
appendix section 2.4-2.2.9.2-b (For assisted transfers), may not be
based on the care population.
achievable.
a. Clearances. Toilets used by residents should have sufficient clearance
on both sides of the toilet to enable physical access and maneu­
vering by staff based on the care population and physical need
requirements. appendix section A2.4-2.2.9.2-b (Grab bars in bath­
rooms-For assisted transfers) for additional information.
b. Grab bars. Where independent transfers are feasible, alternative grab
bar configurations should be permitted. See Section 2.4-2.2.9.3 (1)
(Alternative grab bar configurations) for additional information.
A4.4-2.2.2.7 (1 He) Tub or shower
a. Acurbless shower that is open to the surrounding bathroom should
240 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.4-2.3.2 Lobby
Where a lobby is provided, see Section 2.3-2.3.2
(Lobby) for requirements.
4.4-2.3.3 Dining, Recreation, and Lounge Areas
4.4-2.3.3.1 General
(1) See Section 2.3-2.3.3.1 (Dining, Recreation, and
Lounge Areas-General) for requirements.
(2) Space for circulation of resident-operated mobility
devices shall be provided in activity areas.
4.4-2.3.3.2 Dining areas
(1) Space for dining shall be provided.
*(2) Space requirements
(a) Space provided for resident dining shall allow
residents, including those using wheelchairs
and resident-operated mobility devices, to
access and leave their tables without disturbing
other residents.
(b) Where servers and food carts are utilized, clear
and unobstructed circulation paths shall be
provided.
(c) Space shall be provided for staff to help
residents who require assistance with eating
based on the care population.
(3) Location. For "small house" and "household"
models, it is anticipated that dining areas will
be adjacent to living areas to accommodate less
A4.4-2.2.2.8 Resident storage
a. Resident closets or wardrobes should have an adjustable-height bar
for hanging clothes.
b. Providing storage for resident mobility devices as required by the
care population should be considered.
A4.4-2.2.2.8 (2) Lockable storage. Lockable drawers or
cabinets should be provided to allow residents to secure some personal
belongings.
A4.4-2.3.3.2 (2) Dining area size. Provision of a dining
area(s) with aminimum floor area of 25 square feet per resident should
be considered for new construction.
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES

densely populated groups of residents and to make 4.4-2.3.8.2 See Section 2.1-3.6.2 (Outdoor Activity
dining areas easily accessible to residents. Spaces) for additional requirements and information.
(4) Natural light shall be provided in resident dining
areas.
• 4.4-3 Reserved
4.4-2.3.3.3 Recreation, lounge, and activity areas
for medium and large setting models • 4.4-4 Facilities for Support
(1) Recreation areas shall accommodate both group Services
and individual activities.
(2) Space requirements. Recreation, lounge, and
4.4-4.1 General

activity areas shall provide the following:

See Section 2.3-4.1 (Facilities for Support Services­

(a) Space for planned resident activities General) for requirements.

(b) Areas sufficient in number and configuration
to accommodate the following:
(i) Gatherings of resident groups of various
sizes
(ii) Occurrence of separate and distinct activi­
ties
(iii) Simultaneous dining and recreational
activities
4.4-2.3.3.4 Toilet rooms. Toilet facilities that accom­
modate resident-operated mobility devices shall be
readily accessible to all dining, recreation, activity, and
lounge locations for medium and large setting models.
4.4-4.2 Facilities that Support Resident,
Participant, or Outpatient Care
4.4-4.2.1 Staff Work Areas
4.4-4.2.1.1 These area(s) shall be provided where
required by the care model to serve resident needs.
4.4-4.2.1.2 Lockable storage shall be provided for
resident records.
4.4-4.2.1.3 Direct visualization of resident rooms or
corridors from staff work areas shall not be required.

4.4-2.3.4 Resident Kitchen 4.4-4.2.1.4 See Section 2.3-4.2.1 (Staff Work Area)
Where kitchen facilities that permit use by residents, for additional requirements.
family members, and visitors are provided, see Sec­
tion 2.3-2.3.4 (Resident and Participant Kitchen) for 4.4-4.2.2 Medication Distribution and Storage
requirements. Locations (Centralized and Decentralized)
See Section 2.3-4.2.2 (Medication Distribution and
4.4-2.3.5 - 4.4-2.3.7 Reserved
Storage Locations) for information as applicable to the
4.4-2.3.8 Outdoor Activity Spaces care model-small, medium, or large.

*4.4-2.3.8.1 Outdoor spaces shall be provided for resi­ 4.4-4.2.3 Central Bathing or Spa Room or Area
dents, visitors, and staff.

APPENDIX

A4.4-2.3.8.1 Outdoor activity spaces c. Location ofoutdoor spaces adjacent to community spaces as well as
a. Visual access to outdoor activity spaces from indoors should be pro­ individual resident rooms or bedrooms should be considered based on
vided for staffand residents. the care population.
b. Outdoor spaces should be accessible via short, navigable distances.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 241
4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTEllECTUAL AND/OR DEVElOPMENTAL DISABILITIES
4.4-4.2.3.1 General
*(1) Where a shower is not provided in the resident
bathroom, a central bathing or spa room or area
shall meet the req uirements in this section.
(2) Where a central bathing or spa room or area is
provided or required by the AH], see Section
2.5-2.3.3 (Showers and Tubs) for requirements in
addition to those in this section.
4.4-4.2.3.2 Number. Based on the needs of the care
population, at least one central bathtub, spa tub, or
shower shall be provided for resident use, where a
shower is not provided in the resident bathroom.
4.4-4.2.3.3 Space requirements. Bathing fixtures
shall be located in individual rooms or enclosures that
provide the following:
(1) Space for private use of the bathing fixture
(2) Space for drying and dressing
(3) Access to a grooming location with a sink, mirror,
and counter or shelf
4.4-4.2.3.4 Toilet. A toilet shall be provided in or
directly accessible to each resident bathing or spa
room or area without requiring entry into the general
corridor.
4.4-4.2.3.5 Shower. Where a shower is included in
the bathing room or area, see Section 2.5-2.3.3.2
(Accessible showers) for requirements.
4.4-4.2.4 Equipment and Supply Storage for
Medium and Large Settings
4.4-4.2.4.1 See Section 2.3-4.2.4 (Equipment and
Supply Storage) for requirements in addition to those
in this section.
4.4-4.2.4.2 Clean linen storage
(1) A separate closet or designated area shall be
APPENDIX
A4.4-4.2.3.1 (1) Central bathing in medium and
c. Shower rooms that allow for entry and maneuvering of portable/
large settings. Central bathing or spa rooms or areas in medium
mobile mechanical lifts and shower chairs
and large settings should include the following:
d. Separate toilet and hand-washing station in OJ directly accessible to
a. Entrances located with consideration for privacy
b. Accessibility for residents in wheelchairs
242 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
provided if required for the linen services offered
by the facility.
(2) Where a closed-cart system is used, storage in an
alcove where staff control can be exercised shall be
permitted.
4.4-4.2.4.3 Supply storage. Storage space(s) for
supplies and recreation items shall be immediately
accessible and secured to support recreation and
activities offered.
4.4-4.2.4.4 Storage for resident needs. Storage
space(s) for resident equipment and supplies shall be
immediately accessible to support services offered and
secured based on the care population.
4.4-4.2.5 Clean Utility Room
Where a clean utility room is provided for storage and
holding as part of a system for distribution of clean
materials, see Section 2.3-4.2.5 (Clean Utility Room)
for requirements.
4.4-4.2.6 Soiled Utility Room
Where a soiled utility room is provided for storage
and holding as part of a system for collection of soiled
materials, see Section 2.3-4.2.6 (Soiled Utility Room)
for requirements.
4.4-4.2.7 Personal Laundry Facilities
4.4-4.2.7.1 Provision of decentralized facilities for
washing and drying personal laundry shall be permit­
ted where the care model supports this approach for
small groups of residents.
4.4-4.2.7.2 Where shared personal laundry areas are
provided, these shall be equipped with the following
for use by residents/families:
(1) Washer and dryer
(2) Hand-washing station
(3) Folding area
the bathing area without requiring entry into a general corridor
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTEllECTUAL AND/OR DEVelOPMENTAL DISABILITIES
4.4-4.2.7.3 Where personal laundry facilities are pro­
vided, see 2.3-4.2.7 (Personal Laundry Facilities) for
additional requirements.
4.4-4.2.8 Resident Telephone Access
See Section 2.3-4.2.8 (Resident and Participant
Telephone Access) for requirements.
4.4-4.3 Support Areas for Staff in Medium and
Large Settings
4.4-4.3.1 General
See Section 2.3-4.3.1 (Support Areas for Staff­
General) for requirements.
4.4-4.3.2 Staff Lounge Area in Large Settings
See Section 2.3-4.3.2 (Staff Lounge Area) for
requirements.
4.4-4.3.3 Toilet Rooms
Toilet rooms shall be permitted to be shared by the
public, staff, and residents.
4.4-4.4 Support Facilities for Family and
Visitors
4.4-4.4.1 General
Community space for family and visitors shall be
provided based on the care model and setting type.
*4.4-4.4.2 Overnight Guest Accommodations
Space for sleeping accommodations for overnight
guests shall be provided based on the care model and
setting type.
4.4-4.4.3 Pet Accommodations
If pets are accommodated in the setting type,
see Section 2.3-4.4.3 (Pet Accommodations) for
requirements.
A4.4:-4.4.2 Overnight guest accommodations.
Where visitor sleeping accommodations are provided in resident rooms,
provision of the folloWing should be considered:
a. Sufficient circulation around the sleeping accommodation (e.g.,
._ _ _ - - - - _.•. __._ _ _.._--_._--------._-------_•.•. _----_._.•__
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.4-4.5 Food Service Facilities
4.4-4.5.1 General
The type and size of the setting for residents with
intellectual and/or developmental disabilities shall
determine the dietary environment and the food
service facilities provided.
4.4-4.5.2 Centralized Commercial Kitchen
Where a centralized commercial kitchen is provided,
the food service facilities shall meet the requirements
in Section 2.3-4.5 (Food Service Facilities).
4.4-4.5.3 Warming Kitchen
For facilities that have a service contract with an
outside vendor for food service, the following
requirements shall be met:
4.4-4.5.3.1 Where an outside vendor is used to pro­
vide meals for a setting of 16 or more beds, dedicated
space and equipment shall be provided for a warming
kitchen, including space for minimal equipment for
preparation of breakfast, emergency, or after-hours
meals.
4.4-4.5.3.2 The resident kitchen shall be permitted
to serve as an alternative location to accommodate the
function of a warming kitchen. See Section 2.3-2.3.4
(Resident and Participant Kitchen) for requirements.
4.4.-4.5.4 Decentralized Kitchen
Where food preparation is conducted on-site for 16 or
more beds, the facility shall have dedicated non-public
staff space and equipment for preparation of meals. See
section 2.3-2.3.4 (Resident and Participant Kitchen)
for requirements.
4.4-4.6 Linen and Laundry Service Facilities
recliner, sleep thair, sleep sofa) when it is fully open for use to allow
staffto reach the resident in case ofan emergency
b. Storage space to accommodate and secure overnight guests'
belongings
_._---_.. _-_.._ - - ­
243
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVElOPMENTAL DISABILITIES
*4.4-4.6.1 General
4.4-4.6.1.1 Each setting for residents with intellectual
and/or developmental disabilities shall have provisions
for storing and processing clean and soiled/contami­
nated linen for resident care based on the requirements
of the care model and the setting type.
4.4-4.6.1.2 Based on the care model, personal laundry
services can be combined with clean utility and/or
soiled utility. See Section 2.3-4.2.5 (Clean Utility
Room), Section 2.3-4.2.6 (Soiled Utility Room), and
2.3-4.2.7 (Personal Laundry Facilities) for additional
requirements.
4.4-4.6.2 Facilities for Contracted Linen Services
Where contracted services are used, the following shall
be provided:
4.4-4.6.2.1 An area for soiled linen awaiting pickup
4.4-4.6.2.2 A separate area for storage and distribution
of clean linen
4.4-4.6.3 On-Site Laundry Service Facilities for
Large Settings
4.4-4.6.3.1 General
(1) Where on-site laundry services are provided in a
large setting for residents with intellectual and/or
developmental disabilities, the requirements in this
section shall apply.
(2) Facilities for processing shall be permitted to be
located in the facility, in a separate building on- Ot
off-site, or in a commercial or shared laundry.
(3) Layout. Equipment shall be arranged to permit
4.4-4.7.1 All settings shall provide for the delivery,
a workRow that minimizes cross-traffic between
breakdown, and storage of materials and supplies in
clean and soiled operations.
a manner that does not conflict with resident living
(a) Areas dedicated to laundry shall be separate
from food preparation areas.
(b) Laundry rooms shall not open directly into
resident rooms.
APPENDIX
A4.4-4.6.1 Based on the care model, laundry services may be decentralized using personal laundry facilities and/or acombination of personal laundry
[ facilities and contracted services to prOVide linen service. See Section 2.3-4.2.7 (Persona/laundry Facilities) for additional information.
244 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
4.4-4.6.3.2 At minimum, the following elements
shall be included:
(1) Rooms and spaces for sorting, processing, and.
storage of soiled materials
(2) Soiled holding room(s). Separate central or
decentralized room(s) shall be provided for
receiving and holding soiled linen for pickup or
processing.
(a) Room(s) shall have ventilation and exhaust.
(b) Discharge from soiled linen chutes shall be
received in this room or in a separate room as
required by the local AH].
(c) Room(s) used for processing shall be provided
with a laundry or deep sink.
(3) Central clean linen storage. A central clean linen
storage and issuing room(s) shall be provided in
addition to the linen storage required at individual
resident units.
(4) Linen carts
(a) Storage. Provisions shall be made for parking
clean and soiled linen carts separately and out
of traffic.
(b) Cleaning. Provisions shall be made for
cleaning linen carts on-premises (or exchange
of carts off-premises).
(5) Hand-washing stations. Hand-washing stations
shall be provided in each area where unbagged
soiled linen is handled. See Section 2.4-2.2.8
(Hand-Washing Stations) for additional
requirements.
4.4-4.7 Materials Management Facilities
areas.
4.4-4.7.2 Materials management facilities provided in
large settings shall meet the requirements in Section
2.3-4.7 (Materials Management Facilities).
 4.4 SPECIFI'C REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES

4.4-4.8 Waste Management Facilities 4.4-4.11.1.2 General office space. Office space shall
be provided for staff and file storage.
4.4-4.8.1 All settings shall provide for the collection
4.4-4.11.1.3 Supply and copy room. Space for
and storage of waste materials in a manner that does
storage of files, office equipment, and supplies shall be
not have a negative impact on resident living areas.
provided.
4.4-4.8.2 Waste management facilities provided in
large settings shall meet the waste collection, storage,
• 4.4-5 Design and Construction
and disposal requirements in Section 2.3-4.8 (Waste
Management Facilities). Requirements

4.4-4.9 Environmental Services Rooms 4.4-5.1 Building Codes and Standards

See Section 2.4-1.2 (Building Codes and Standards)
4.4-4.9.1 All settings shall provide for safe storage of, for requirements.
and safe access to, cleaning materials and equipment.
4.4-5.1.1 General
4.4-4.9.2 In medium and large settings, see Section A code-compliant, safe, and accessible environment
2.3-4.9 (Environmental Services Rooms) for shall be provided.
requirements.
4.4-5.1.1.1 A facility that seeks accreditation, certifica­

4.4-4.10 Facilities for Engineering and tion, licensure, or other credentials shall comply with

Maintenance Services in Medium and Large applicable design and construction standards.

Settings
See Section 2.3-4.10 (Facilities for Engineering and 4.4-5.1.1.2 Where institutional codes are required,

Maintenance Services) for requirements. the facility shall maintain the residential environment

desired by residents.

4.4-4.11 Administrative Areas

4.4-5.1.2 Accessibility Codes

4.4-4.11.1 Office and Conference Space The facility shall comply with applicable federal, state,

Where an office(s) or an open office area with private and local requirements; see Section 1.1-4.1 (Design

conference space is provided for business transactions, Standards for Accessibility).

admissions, and social services and for use by admin­

istrative and professional staff, the following shall be 4.4-5.2 Architectural Details, Surfaces, and
required: Furnishings

*4.4-4.11.1.1 Conference space. Space for private 4.4-5.2.1 General

interviews; staff, resident, and family meetings; confer­ See Section 2.4-2.1 (Architectural Details, Surfaces,

ences; and health education shall be sized according to and Furnishings-General) for requirements.

operational needs.
(1) Space shall include provisions for use of visual aids 4.4-5.2.2 Architectural Details
and technology.
(2) Sharing of space for various uses shall be permitted. 4.4-5.2.2.1 General. See Section 2.4-2.2.1
(Architectural Details-General) for requirements.

APPENDIX

A4.4-4.11.1.1 Kitchenette for conference space. Provision of kitchenette facilities, including under-counter refrigerator, microwave, and
[ sink should be considered for the private conference space.
----------- -. __..... _.•_---_.----_.__ ... _.--._..._­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 245
4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVElOPMENTAL DISABILITIES

4.4-5.2.2.2 Corridors. See Section 2.4-2.2.2 4.4-5.2.2.7 Glazing materials. See Section 2.4-2.2.7
(Corridors) for requirements. (Glazing Materials) for requirements.

4.4-5.2.2.3 Ceiling height. See Section 2.4-2.2.3

4.4-5.2.2.8 Hand-washing stations. Where hand­
(Ceiling Height) for requirements.
washing stations are provided, they shall comply with
Section 2.4-2.2.8 (Hand-Washing Stations).
*4.4-5.2.2.4 Doors and door hardware
(1) Door type 4.4-5.2.2.9 Grab bars. See Section 2.4-2.2.9 (Grab
Bars) for requirements.
*(a) Doors to all rooms containing bathtubs, show­
ers, and toilets for resident use shall be hinged, 4.4-5.2.2.10 Handrails and lean rails. See Section
sliding, or folding. 2.4-2.2.10 (Handrails and Lean Rails) for require­
*(b) Resident unit doors ments for medium and large settings.
(i) Egress from the unit shall be possible at all
times and locking hardware shall enable 4.4-5.2.2.11 Protection from heated surfaces. See
occupant(s) to gain egress from within by Section 2.4-2.2.11 (Protection from Heated Surfaces)
means of a simple operation. for requirements.
(ii) All resident units shall be accessible by
staff or safety personnel. 4.4-5.2.2.12 Signage and wayfinding. See Section
2.4-2.2.12 (Signage and Wayfinding) for requirements.
(c) Manual or automatic sliding doors shall
be permitted where their use does not 4.4-5.2.2.13 Decorative water features. Where
compromise fire and other emergency exiting decorative water features are used in the facility design,
requirements. see appendix section A2.4-2.2.13 (Decorative water
(2) Door openings. See Section 2.4-2.2.4.2 (Door
features) for recommendations.
openings) for requirements.

(3) Insect screens. See Section 2.4-2.2.4.3 (Insect

4.4-5.2.3 Surfaces
screens) for requirements.

4.4-5.2.3.1 General
4.4-5.2.2.5 Thresholds and expansion joint covers. (1) See Section 2.4-2.3.1 (Surfaces-General) for

See Section 2.4-2.2.5 (Thresholds and Expansion Joint requirements in addition to those in this section.

Covers) for requirements. *(2) To reduce surface contamination linked to health

care-associated infections (HAIs), surface materials
4.4-5.2.2.6 Windows selected for use in medium and large settings shall
*(1) See Section 2.4-2.2.6 (Windows) for requirements possess the following performance characteristics:
in addition to those in this section. (a) Surfaces shall be cleanable.
(2) Windows shall be provided in all sleeping areas. (b) Surfaces shall have no surface crevices, rough
textures, joints, or seams.
(c) Surfaces shall be non-absorptive, nonporous,
and smooth.
APPENDIX

A4.4-S.2.2.4 Door protection. See appendix section A2,4­

care population, use of doors that occupants can locksho:uld be

2.2,4 ([)Qor proteetion) for recommen4ations.

evaluat"fd.

A4.4~S.2.2.4 {1 Hal ProvisiQns should be made for au4itory and

A4.4-S.2.2.6 (1) Windows. fach room in aresident setting

visual privacy and usability for dborsto rooms.containing bathtubs,

should have awindow(s) that meets the requirements ofSection 2,4­

showers, and toilets for resident use.

2.2.6 (Windows).

A4.4-S.2.2.4 (1 Hbl Resident unit doors. Based on the A4.4-S.2.).' (2) Surfaces and materials selected should be easy

to use and have dear, written, manufacturer-recommended-deaning

----_._._. __ . _ - _ . _ - - - - - - ­
246 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES
4.4-5.2.3.2 Flooring and wall bases. See Section
2.4-2.3.2 (Flooring and Wall Bases) for requirements.
4.4-5.2.3.3 Walls and wall protection. See Sec­
tion 2.4-2.3.3 (Walls and Wall Protection) for
requirements.
4.4-5.2.3.4 Ceilings. See Section 2.4-2.3.4 (Ceilings)
for requirements.
4.4-5.2.4 Furnishings
See Section 2.4-2.4 (Furnishings) for requirements.
• 4.4-6 Building Systems
4.4-6.1 General
See Section 2.5-1 (Building Systems-General) for
requirements.
4.4-6.2 Plumbing Systems
4.4-6.2.1 General
See Section 2.5-2.1 (Plumbing Systems-General) for
requirements.
4.4-6.2.2 Plumbing and Other Piping Systems
See Section 2.5-2.2 (Plumbing and Other Piping
Systems) for requirements.
4.4-6.2.3 Plumbing Fixtures
4.4-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
. Fixtures-General) for requirements.
4.4-6.2.3.2 Hand-washing sinks
(1) See Section 2.5-2.3.2 (Hand-Washing Sinks) for
requirements.
APPENDIX (continued)
and disinfection protocols to assure the product will remain durable
and effective at meeting Centers for Disease Control and Prevention and
other clinical bacterial-elimination requirements.
The Center for Health Design report "Designing for Patient Safety:
Developing Methods to Integrate Patient Safety Concerns in the Design
Process" identified environmental factors as "latent conditions that
can be designed to help eliminate harm:' Such "built environment
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
(2) Design of sinks shall not permit storage beneath
the sink basin in casework or in areas below a sink
open to the floor for accessible units.
4.4-6.2.3.3 Showers and tubs. See Section 2.5-2.3.3
(Showers and Tubs) for requirements.
4.4-6.2.3.4-4.4-6.2.3.5 Fteserved
4.4-6.2.3.6 Portable hydrotherapy whirlpools.
Where portable hydrotherapy whirlpools are used in
a setting for residents with intellectual and/or devel­
opmental disabilities, see Section 2.5-2.3.6 (Portable
Hydrotherapy Whirlpools) for requirements.
4.4-6.3 Heating, Ventilation, and
Air-Conditioning (HVAC) Systems
4.4-6.3.1 General
4.4-6.3.1.1 Application
(1) For small and medium-sized settings for residents
with intellectual and/or developmental disabilities,
see ANSIIASHRAE Standard 62.2: Ventilation
and Acceptable Indoor Air Quality in Low-Rise
Residential Buildings for basic HVAC system
requirements.
(2) For large settings for residents with intellectual
and/or developmental disabilities, see ANSI/
ASHRAE Standard 62.1: Ventilation for Acceptable
Indoor Air Quality for basic HVAC system
requirements.
4.4-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
4.4-6.3.3 HVAC Requirements for Specific
Locations
latent conditions [holes and weaknesses] that adversely impact patient
safety" should be identified and eliminated during planning, design,
and construction of health care facilities. Reduction of surface contami­
nation linked to health care-associated infections is one of these fac­
tors. See Section 1.2-3 (Resident Safety Risk Assessment) for additional
information.
247
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES

4.4-6.3.3.1 Reserved 4.4-6.3.6.2 Filter frames for centralized systems

4.4-6.3.3.2 Fuel-fired equipment rooms. Where
these are provided, see Section 2.5-3.3.2 (Fuel-Fired
Equipment Rooms) for requirements.
4.4-6.3.3.3 Areas of refuge. See Section 2.5-3.3.3
(Areas of Refuge) for requirements.
4.4-6.3.3.4 Commercial food preparation areas.
Where these are provided, see Section 2.5-3.3.4 (Com­
mercial Food Preparation Areas) for requirements.
(1) Filter frames shall be durable and proportioned to
provide an airtight fit with the enclosing ductwork.
(2) All joints between filter segments and the enclosing
ductwork shall have gaskets or seals to provide a
positive seal against air leakage.
4.4-6.3.7 Heating Systems, Cooling Systems, and
Equipment
See Section 2.5-3.7 (Heating Systems, Cooling
Systems, and Equipment) for requirements in addition
to those in this section.

4.4-6.3.4 Thermal and Acoustic Insulation

See Section 2.5-3.4 (Thermal and Acoustic Insulation)
for requirements.
4.4-6.3.5 HVAC Air Distribution
See Section 2.5-3.5 (HVAC Air Distribution) for
4.4-6.3.7.1 Heating systems. Settings for residents
with intellectual and/or developmental disabilities shall
have a permanently installed heating system capable of
maintaining an interior minimum temperature of72°
0
F (22 C) under heating design temperatures.

requirements.
4.4-6.3.7.2 Cooling systems. Settings for residents

with intellectual and/or developmental disabilities

4.4-6.3.6 HVAC Filters shall be configured and equipped with a cooling

system capable of maintaining an interior maximum

0
4.4-6.3.6.1 Filter efficiencies temperature of75" F (24 C) under cooling design

(1) For centralized recirculated systems, MERV 7 temperatures..

shall be the minimum filter efficiency for the first

filter bank. There is no minimum filter efficiency
requirement for the second filter bank.
(2) For non-central recirculating room systems, HVAC
units shall:
(a) Not receive nonfiltered, nonconditioned
outdoor air.
(b) Serve only a single space.
*(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
designed to condense water. This filter shall be
located upstream of any such cold surface so
that all of the air passing over the cold surface
is filtered.
. APPENDIX
4.4-6.4 Electrical Systems
4.4-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
4.4-6.4.2 Power-Generating and Power-Storing
Equipment
4.4-6.4.2.1 Essential electrical service
*(1) Applicable standards for care models
(a) Facilities with a large setting care model shall
have essential electrical systems as required in
NFPA 101: Life Safety Code.
(b) For facilities with small and medium setting
care models, local codes shall dictate minimum
requirements for the essential electrical service.

A4.4-6.3.6.1 (2)(c) Filters for recirculating room

A4.4-6.4.2.1 (1) Care models are defined in appendix section

systems. Filters should be replaced and/or cleaned per the

M.4-1.2.1.2 (1) (Care model characteristics).

manufacturer's recommendations to mainta.in indoor air qua.lity.

248 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVelOPMENTAL DISABILITIES

(c) For all settings for residents with intellectual 4.4-6.4.3.5 Ground fault interrupter receptacles. See
and/or developmental disabilities, local codes Section 2.5-4.3.5 (Ground Fault Interrupter Recep­
and care model needs shall dictate emergency tacles) for requirements.
lighting requirements.
4.4-6.5 Communication Systems
(2) Where residents on life support equipment are
served in a setting for residents with intellectual
4.4-6.5.1 General
and/or developmental disabilities, essential
electrical power shall be provided to the life
4.4-6.5.1.1 Application. The requirements in this
support equipment.
section shall apply to the following systems based on
(3) Where fuel for electricity generation is stored
the care model and the needs of residents:
on-site, the following requirements shall be met:
(1) Call systems
(a) Storage capacity shall permit continuous (2) Information systems
operation for at least 24 hours. (3) Telecommunication systems
(b) Fuel storage for electricity generation shall be
separate from heating fuel storage. 4.4-6.5.1.2 Communication system equipment
(c) Where heating fuel is used for diesel generators requirements
after the required 24-hour supply of diesel
(1) Each resident room shall be equipped for a
fuel has been exhausted, positive valving and
television and telephone.
filtration shall be provided to avoid entry of
(2) See Section 2.5-5.1.2 (Communication System
water and/or contaminants into the storage
Equipment Requirements) for additional
tank.
requirements.

4.4-6.4.2.2 Generators. Where generators are used

for a setting for residents with intellectual and/or
developmental disabilities, exhaust systems (including
mufflers and vibration isolators) for internal combus­
tion engines shall be located, designed, and installed to
minimize objectionable noise.
4.4-6.4.3 Electrical Receptacles
4.4-6.4.3.1 General. See Section 2.5-4.3.1 (Electrical
Receptacles-General) for requirements.
4.4-6.4.3.2 Receptacles in corridors. See Section
2.5-4.3.2 (Receptacles in Corridors) for requirements.
*4.4-6.4.3.3 Receptacles in resident rooms. Each
resident room shall have duplex-grounded receptacles,
including at least one on each wall.
4.4-6.4.3.4 Essential electrical system receptacles.
See Section 2.5-4.3.4 (Essential Electrical System
Receptacles) for requirements.
APPENDIX
4.4-6.5.2 Call System
4.4-6.5.2.1 General. Where call systems are provided,
the following requirements shall be met:
(1) The system shall be capable of activation/operation
from resident toilets, bedrooms, and bathing areas.
(2) The signal shall be transmitted to on-duty staff
through fixed locations and/or resident wearable
devices.
(3) Use of alternative technologies, including wireless
systems, shall be permitted.
(a) Where wireless systems are used, consideration
shall be given to electromagnetic compatibility
between internal and external sources.
(b) Wireless systems shall comply with UL
Standard 2560: Emergency Call Systems
for Assisted Living and Independent Living
Facilities.
4.4-6.5.2.2 Resident apartment or dwelling unit
call stations

A4.4-6.4.3.3 Because settings for residents with intellectual and/ living spaces, and private'bathrooms, furniture layouts should be used to
[ or developmental disabilities often include one or more bedrooms, establish receptacle locations.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 249
4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES

(1) Where a hardwired system is used:
(a) Each bed location shall be provided with a call
device accessible to the resident.
(b) One call station shall be permitted to serve
two call devices.
4.4-6.6 Electronic Safety and Security Systems
See Section 2.5-6 (Electronic Safety and Security
Systems) for requirements.
4.4-6.7 Daylighting and Artificial Lighting

Systems

(2) Use of wireless call stations shall be permitted.

4.4-6.7.1 General
4.4-6.5.2.3 Emergency call system. Where an emer­
See Section 2.5-7.1 (Daylighting and Artificial Light­
gency call system is provided, an emergency call device
ing Systems-General) for requirements.
shall be located at each toilet, bath, and shower used
by residents.
4.4-6.7.2 Daylighting Systems in Resident Living
(1) The device shall be accessible to a resident in any Areas
position in the room, including lying on the floor.
See Section 2.5-7.2 (Daylighting Systems in Resident
Inclusion of a pull cord or portable wireless device
Living, Participant, and Outpatient Areas) for
shall satisfY this requirement.
requirements.
(2) The emergency call system shall be designed so that
when a call is activated a signal is initiated that is
4.4-6.7.3 Artificial Lighting Systems
distinct from the resident room call device and can
be turned off only at the activated emergency call
4.4-6.7.3.1 Light fixtures. See Section 2.5-7.3.1

device.
(Light Fixtures) for requirements.

(3) The signal shall activate at the staff work area and/
or signal a handheld mobile device carried by staff.
4.4-6.7.3.2 Lighting requirements for specific
(4) Emergency call systems shall comply with UL
locations. See appendix section A2.5-7.3.2 (Lighting
2560: Emergency Call Systems for Assisted Living and
in transition spaces) for recommendations.
Independent Living Facilities.
(1) Resident unit corridors in large and medium

4.4-6.5.3 Technology Equipment and Teledata settings

Room(s) (a) Resident unit corridors shall have general

See Section 2.5-5.3 (Technology Equipment and Tele­
data Room) for requirements.
4.4-6.5.4 Grounding for Telecommunication
Spaces
See Section 2.5-5.4 (Grounding for Telecommunica­
tion Spaces) for requirements.
4.4-6.5.5 Cabling Pathways and Raceway
Requirements
See Section 2.5-5.5 (Cabling Pathways and Raceway
Requirements) for requirements.
illumination with provisions for reducing light
levels at night.
(b) Corridors and common areas used by residents
shall have even light distribution to avoid
glare, shadows, and scalloped lighting effects.
*(2) Resident rooms, bedrooms, and bathrooms
(a) Task light controls shall be readily accessible to
residents.
(b) Where night-lighting is provided, it shall
be located in the pathway to and from the
bedside and the bathroom.
(i) Night-lighting shall be mounted no higher

A4.4-6.7.3.2 (2) Lighting in resident rooms, b. Resident bathrooms should proVide general illumination with provi­
bedrooms, and bathrooms. Resident rooms, bedrooms, and sion for reducing light levels at night.
bathrooms should have general lighting and task lighting.
a. Provision of movable task lighting should be considered.

250 Guideline.s for Design and Construction of Residential Health, Care, and Support Facilities
 4.4 SPECIFIC REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES
than 2 feet (61 centimeters) above the
floor.
(ii) Night-lighting shall be controlled sepa­
rately from ambient lighting.
*(iii) Night-lighting shall have a low light level.
(iv) Because night-lights may disturb resi­
dent sleep even when properly specified,
located, and operated, care providers shall
be permitted to use portable light sources
or switched night-lights for added control
of this light source.
4.4-6.8 Acoustic Design Systems for Large and
Medium Settings
See Section 2.5-8 (Acoustic Design Systems) for
requirements.
4.4-6.9 Elevator Systems
4.4-6.9.1 General
4.4-6.9.1.1 Requirement. Where elevators are
provided in large settings for residents with intellec­
tual and/or developmental disabilities the following
requirements shall be met:
*4.4-6.9.1.2 Number. Engineered traffic studies are
recommended, but in their absence the following
guidelines for the minimum number of elevators shall
apply:
(1) At least one elevator sized to accommodate a
gurney and/or medical carts and resident-operated
mobility device users shall be installed where
residents are living or receiving care or support
APPENOIX __
A4.1-6.7.3.2 (2)(b)(iii) Night-lighting in resident
rooms. Research has established that older adults sleep best in total
darkness. Therefore, to minimize resident sleep disruption, night-lights
should provide very low levels of illumination and be located to mini­
mize light scatter and reflections on room surfaces. To achieve alow
light level, night-lighting should include amber or red lamping. White,
blue, or green lamping should not be used. Switches for night-lights are
recommended for some care populations.
A4.4-6.9.1.2 Number of elevators. These standards may
be inadequate for moving large numbers of people in ashort time;
adjustments should be rnade as appropriate to the care model and
population served.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
services on any floor other than the main entrance
floor.
(2) At least two elevators shall be installed where 60 to
200 residents are living or receiving care or support
services on floors other than the main entrance
floor.
(3) At least three elevators shall be installed where
201 to 350 residents are living or receiving care
or support services on floors other than the main
entrance floor.
(4) For facilities with more than 350 residents living
or receiving care or support services above the
main entrance floor, the number of elevators shall
be determined from a study of the facility plan
and from the estimated vertical transportation
requirements.
*4.4-6.9.2 Dimensions and Clearances
Elevator car doors shall have a clear opening of no less
than 3 feet 8 inches (1.12 meters).
4.4-6.9.3 Leveling Device
See Section 2.5-9.3 (Leveling Device) for
requirements.
4.4-6.9.4 Installation and Testing
See Section 2.5-9.4 (Installation and Testing) for
requirements.
4.4-6.9.5 Handrails
Elevator cars shall have handrails on all sides without
entrance door(s). See Section 2.4-2.2.10 (Handrails
and Lean Rails) for additional requirements.
A4.4-6.9.2 Elevator dimensions and clearances
a. Handrail projections of up to 3.5 inches (8.89 centimeters) should
not be construed as diminishing the clear inside dimensions.
b. If reqUired to serve the care population and indicated by a mobility
transfer assessment, at least one facility elevator should accommo­
date attending staff and an ambulance gurney 7feet 6inches (2.29
meters) in length and/or an expanded capacity widfh of 4feet (1.22
meters) for persons of size.
e. Additional elevators reqUired for passenger service should be sized to
accommodate resident-operated mobility devices.
251
IV .;.
U'I Appendix Table A4.4-a ~
IV
- VI
Characteristics of Settings for Individuals with Intellectual and/or Developmental Disabilities* Z"tl
-1m
Typical Food mn
r- _
Setting # of Service! Resident Bathing r- .."
Environment of Care and Relevant Descriptions m
n
----:-:=~--------
Type Units Dining Type Accommodations Facility Type Design Drivers
n
C\ -I""
c em
Small 5 or . Centralized: Single- or double­ Centralized: Resident-centered ,. Light: Maximal access to daylight should be a priority in private bedroom spaces, ;r;.o
a. r-e
ro fewer residential occupancy residential care supportive of work areas, and shared social spaces. Where the care population has low vision ;r;.;;
::l kitchen bedrooms with a accessible residential versus issues, the design should avoid glare. Zm
ro
bathroom shared bathroom institutional living OS:
U>
2. Views of and access to nature: Maximal access to views of nature and outdoor -m
..... by no more than Oz
o Strong personal spaces should be a priority. Where direct access is not possible, alternative access ""-I
two residents relationship may include indoor gardens with natural light (sky lights), roof gardens, and green OVI
o m.."
ro opportunities roofs. <0
'"
<.0 between staff and 3. Signage and wayfinding: The smaller size of this facility type generally makes it m""
r-
::l OVI
residents supported easier to provide a layout with direct visual access to key destinations. "tim
'"
::l by the smaller scale 4. User control of environment: The goal is to support greater resident autonomy in s:~
a. m­
n Embedded within the all aspects of the environment. zZ
o -11:\
:::l
community at-large 5. Privacy and confidentiality: Provision of all single-occupancy rooms enhances ;r;.VI
r-.."
...
U>
privacy, although availability of another space outside the bedroom for visiting is 00
C
important. Vi""
...
n
6. Safety and security: The smaller scale of this facility type makes staff monitoring
;r;.­
lXl Z
o -0
::l easier. Outside spaces should be visible from indoors. Multi-story residences need to r- ­
-<
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o conform to accessibility standards. All residences conform to local and state fire and
..... -0
::0 life safety standards. me
ro VI;r;.
U>
7. Characteristics and criteria for selection of materials and products for r­
a. VI
ro
::l
architectural details, surfaces, and furnishings: Personalization of individual :e
spaces should be supported. -I
::J:
'" 8. Cultural responsiveness: The cultural orientation and needs, customs, desires,
I
ro
etc. of the care population and staff should inform the design of the physical
'" environment. This understanding addresses the "who" element of the functional
::r programming process, considered critical to developing the environment of care. For
n example, the designer would provide a physical environment that helps a caregiver
'"
~
from Jamaica caring for an orthodox Jewish woman understand and support kosher
ro
customs and resident and family expectations.
'"
::l 9. Support for person-centered care: The goal of this model is to offer residents a
a.
full experience of home.
V'
c
"0
"0
o
...
~

*Payment source requirements may influence design characteristics.

."

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ro
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C\
c Appendix Table A4.4-a (continued)
a.
!tl

::l
(J)
--------......;;,."".,----------------......;;......-----------------------­
Characteristics of Settings for Individuals with Intellectual and/or Developmental Disabilities*
Setting Typical
# of
Food
S · I
R ·d t B thO
AeSI en d f Fa TtmgT D·
eSlgn D·
V>
..., Type ervlce rivers Environment of Care and Relevant Descriptions
o Units Dining Type ccommo a Ions aCI I y ype
CJ
!tl
V>
Medium 160r Centralized: Single- or double­ Decentralized • Resident-centered 1. Light: Maximal access to daylight should be a priority in private bedroom spaces,
-,
\Q fewer residentially occupancy resident in resident care supportive of work areas, and shared social spaces. The care population's low vision issues should
::l
scaled rooms with private room residential versus be addressed in the design, including avoidance of glare.
'"
:;; kitchen with or shared full bathrooms institutional living 2. Views of and access to nature: Maximal access to views of nature and outdoor
0­
dedicated bathrooms (shared but may also Strong personal spaces should be a priority. Where direct access is not possible, alternative access
il
o food service by no more than include a relationship may include indoor gardens with natural light (sky lights), roof gardens, and green
::l
V>
~
staff two residents) centralized opportunities roofs.
~

c bathing core between staff and 3. Signage and wayfinding: The smaller size of this facility type generally makes
r;
-,
M residents supported it easier to prOVide a layout with direct visual access to key destinations. Signage
o by the smaller scale ~
::l should be able to be easily read by residents who are visually impaired.
~
o..., • Most services are 4. User control of environment: The goal is to support resident autonomy in all II'!
;J:J
decentralized in aspects of the environment, prOViding resident choice wherever possible. "l:I
rt> m
V>
smaller residential S. Privacy and confidentiality: Provision of all single-occupancy rooms enhances n
Q. environments of eight "'1'1
privacy, although availability of another space outside the bedroom for visiting is
(I)
::l residents each n
important.
z:lO
OJ Total of two eight­
6. Safety and security: The smaller scale makes staff monitoring easier. Outside -1
m
person homes mO
I spaces should be visible from indoors. Multi-story residences need to conform to r-C
!tl r-­
accessibility standards. All residences conform to local and state fire and life safety m:lO
OJ
- nm
~

::r standards. -I;:

cm
il 7. Characteristics and criteria for selection of materials and products for )::02
,...-1
'" architectural details, surfaces, and furnishings: Personalization of individual )::oil'!
!tl
spaces should be supported. 2'""
OJ
:;;
a.
8. Cultural responsiveness: The cultural orientation and needs, customs, desires, 0°
-.:10
Oil'!
etc. of the care population and staff should inform the design of the physical :10m
V'
C environment. This understanding addresses the "who" element of the functional 0""
'D m-l
'D
o
programming process, considered critical to developing the environment of care. For
example, the designer would provide a physical environment that helps a caregiver
<z
mC'l
~

from Jamaica caring for an orthodox Jewish woman understand and support kosher bll'!
"'CI"'I'I
"
OJ
r; customs and resident and family expectations. ;:0
m:lO
-,
,.. 9. Support for person-centered care: The goal of this model is to offer residents a 2 2­
full experience of home. -1
(I) )::00
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;:::\1\
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Appendix Table A4.4-a (continued) ~
-VI
Characteristics of Settings for Individuals with Intellectual and/or Developmental Disabilities* Z"'O
-1m
Typical Food mn
r- ­
Setting # o~ Service! Resident. Bathing .. Environment of Care and Relevant Descriptions r--n
Type Units Dining Type Accommodations Facility Type Design Drivers m;::;
n
C\ -I:xI
c_. em
I Large 170r Decentralized Single- or double­ Decentralized Resident-centered 1. Light: Maximal access to daylight should be a priority in private bedroom spaces, ~o
0. I r-e
ID
- more and/or occupancy resident in resident care supportive of work areas, and shared social spaces. The care population's low vision issues should ~;;
-
:l centralized: rooms with private room residential versus be addressed in the design, including avoidance of glare. Zm
ID O~
'"-.. residentially or shared full bathrooms institutional living 2. Views of and access to nature: Maximal access to views of nature and outdoor ...... m
bathrooms (shared but may also Oz
0
~
scaled Often a spaces should be a priority. Where direct access is not possible, alternative access :xI-I
kitchen, by no more than include a multidisciplinary may include indoor gardens with natural light (sky lights), roof gardens, and green OVI
0 m-n
ID
co commercial two residents) centralized team approach in a roofs. Provision of outdoor dedicated staff space and staff break areas with views <0
- bathing core m:xl
to kitchen as household setting should be considered. r­
:l OVI
required Cross-training 3. Signage and wayfinding: A wayfinding program should be provided to help "'Om
'"
:l based on care a consideration residents, staff, and visitors distinguish one apartment from another. In a larger ~~
m-
Q..

n model, and for care staff and building, this can include landmarks to assist with orientation. Signage should be zz
-ICI
0 dedicated housekeeping staff able to be easily read by residents who are visually impaired. ~VI
:l
food service r--n
'"
~ Staff travel distances 4. User control of environment: The goal is to support resident autonomy in all 00
~

c staff shorter due to use of aspects of the environment, providing resident choice wherever possible. Vi:xl
"_.
~
a household model 5. Privacy and confidentiality: Provision of all single-occupancy apartments
~­
Cll Z
0
except for food -0
:l enhances privacy. Two-bedroom or shared one-bedroom apartments (e.g., shared by r- ­
-<
service staff where -1_
0
-.. a couple) provide separate seating areas for private discussions. -0
food is prepared in a 6. Safety and security: Because decentralized staffing is recommended, staff
me
VI~
;;0
ID
co
_. centralized kitchen presence near residents and points of activity is greater. Outside spaces should r­
VI
Q..
Household model be visible from indoors. Multi-story residences need to conform to accessibility
ro
::J is operationally
=t
~ standards. All residences conform to local and state fire and life safety standards. -I
conducive to ::I:
'"
- 7. Characteristics and criteria for selection of materials and products
J:
providing some/all for architectural details, surfaces, and furnishings: Personalization of

ro decentralized services

'"- individual spaces should be supported. Resident input on community spaces should
~ and activity areas periodically be reviewed to verify compliance with needs expressed in the functional
::T
Consideration for program.
n
'" larger event space 8. Cultural responsiveness: The cultural orientation and needs, customs, desires,
~

ro to gather various etc. of the care population and staff should inform the design of the physical
'"::J household residents environment. This understanding addresses the "who" element of the functional
0.. into a larger group for programming process, considered critical to developing the environment of care. For
VI activities and events example, the designer would provide a physical environment that helps a caregiver
c
'0
'0 from Jamaica caring for an orthodox Jewish woman understand and support kosher
0 customs and resident and family expectations.
~

.,., 9. Support for person-centered care: The goal of this model is to offer residents a
'" full experience of home and more opportunities for social interaction.
"
--
-
M
-
ro
'"
 5.1 Specific Requirements for Adult Day
Care and Adult Day Health Care Facilities
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 5.1-1 General 5.1-1.1.2 Design Criteria

5.1-1.1 Application 5.1-1.1.2.1 Sustainable design. See Section 2.2-2

(Sustainable Design Criteria) for requirements for
5.1-1.1.1 General adult day care and ADHC facilities.

*5.1-1.1.1.1 This chapter applies facilities that pro­

to
vide adult day care and adult day health care services.
5.1-1.1.1.2 The common elements in Part 2 of the
Guidelines for Residential Health, Care, and Support
Facilities shall apply to adult day care and adult day
health care (ADHC) facilities when they are referenced
in this chapter.
5.1-1.1.2.2 Design criteria for accommodations for
care of persons of size. Where the care population
includes persons of size, see Section 2.2-3 (Design
Criteria for Accommodations for Care of Persons of
Size) for requirements.
5.1-1.1.2.3 Dementia, mental health, and cogni­
tive and developmental disability design criteria.
Where the care population includes participants with

APPENDIX

A5.1-1.1.1.1 Adult day care and adult day health • Mental health and/or developmental or cognitive disability
care (ADHC) facility types. Adult day care and ADHC services ADHC facilities
are group programs designed to meet the needs of functionally and/ • PACE (Programs for All-Inclusive Care for the Elderly) adult
or cognitively impaired adults. The facilities that house these programs day health care facilities
are an integral component of the continuum of care for the elderly and • Adult day care hospice facilities. See information in appen­
disabled. These facilities may be freestanding facilities or distinct parts dix table Al2-a (Hospice Care Model Cltaracteristics).
of ageneral hospital, continuing care retirement community, or other b. Adult day care and ADHC facilities provide the follOWing:
health care facility. -A caring, non-institutional setting for individuals who, for their
Adult day care and ADHC facilities are designed to accomomodate a own safety and well-being, can no longer be left at home alone
structured, comprehensive non-residential program that prOVides for a -Protected,. safe, and secure settings
variety of health and well ness, social, and support services in a protec­ -A mixture of health and support services
tivesetting. Facilities may provide services for multiple care populations c. Each type of facility has unique needs that affect usable activity
or one specialized care population. space requirements:
a. Many facilities offer specialized services such as programs for indi­
-Adult day care facilities include programs that are primarily
viduals with dementia, developmental disabilities, traumatic brain
actiVity-driven, without aclinical component.
injury, mental illness, HIV/AIDS, and vision and hearing impair­
-Adult day health care (ADHC) facilities include activities as well
ments. Typical services offered are listed here:
as aclinical component. ADHC centers typically include exami­
-Adult day care facilities nation and treatment rooms, clinical staff work areas, and other
• Dementia adult day care facilities diagnostic and treatment support areas.
• Mental health and/or developmental or cognitive disability -PACE ADHC facilities prOVide an integrated program of services
adult day care facilities
to participants, including adult day health care, primary care,
-Adult day health care facilities
rehabilitation therapy, socialization, and home health care.
• Dementia ADHC facilities
-------------------------------
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 257
5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES

dementia, mental health issues, or cognitive and devel­ 5.1-1.2.2.4 All support spaces shall be permitted to be
opmental disabilities, see Section 2.2-4 (Design Crite­ shared.
ria for Dementia, Mental Health, and Cognitive and
Development Disability Facilities) for requirements. 5.1-1.3 Reserved

5.1-1.2 Functional Program *5.1-1.4 Environment of (are Requirements

See Section 1.2-1.3 (Environment of Care and Facility
5.1-1.2.1 See Section 1.2-2 (Functional Program) and Function Considerations) and Section 1.2-4 (Environ­
Section 1.2-3 (Resident Safety Risk Assessment) for ment of Care Requirements) for requirements.
requirements.
5.1-1.5 Site
5.1-1.2.2 Sha red Services and Space
5.1-1.5.1 General
*5.1-1.2.2.1 Where an adult day care and ADHC
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site
facility is part of (or contractually linked with) another
Elements) for requirements in addition to those in this
facility, sharing of services and space for home health,
section.
dietary, storage, pharmacy, linen, and other services
shall be permitted insofar as practical.
*5.1-1.5.2 Facility/Community Access

5.1-1.2.2.2 Where a project calls for sharing or

*5.1-1.5.2.1 Emergency access. Fire department and
purchasing services from another entity, appropriate
emergency vehicle access shall be provided in accor­
modifications in the requirements for space and park­
dance with local requirements.
ing shall be permitted.

5.1-1.5.2.2 Availability of transportation. See 2.1­

5.1-1.2.2.3 An adult day care and ADHC facility
2.2 (Availability ofTransportation) for requirements.
located in a facility that houses other services shall have
its own identifiable space.
5.1-1.5.2.3 Security. See Section 2.1-2.3 (Security)

for requirements.

APPENDIX

AS.l-l.2.2.1 Shared services and space. In some cases,

d. The architectural environment should eliminate as many barriers to
ancillary service requirements will be met by the principal facility and
effective access to and use of space, services, eqUipment, and utili­
the only modifications necessary will be in the support facility. In other
ties as possible.
cases,·programmatic concerns and requirements may dictate separate
e. Facilities should prOVide accessibility for participants with disabilities
service areas.
in accordance with the state or local bUilding code and the Ameri­
cans with Disabilities Act.
AS.l-l.4 Environment of care, Person-centered care in

the long-term continuum of care should address movement away

AS.l-l.S.2 Facility/community access
from institutional and traditional models toward models that are more·
a. Where possible, the facility should be located at street level or

residentially scaled, facilitate wayfinding, and prOVide acomfortable

eqUipped with ramps or elevators to allow easy access for persons

environment for the population served through provision of appropriate

with disabilities.

lighting and acoustics.

b. Acovered entrance should be proVided to protect participants from

a. Adult day care and ADHC facilities should be designed to prOVide

inclement weather.

fleXibility to meetthe changing needs of the care population(s)

c. Aspace (zone of transition) should be created as aphysical buffer

served and the types of care services prOVided.

between entry spaces and program spaces and as an experiential

b. The facility design should produce asupportive environment to

buffer that signals transition from home to day care program.

enhance and extend quality of life for facility users and promote
d. The entry and reception area should be separate from the primary

their privacy and dignity while they receive care and services.
program space and not Visually accessible from it.

c. Facility design should maximize opportunities for ambulation and

AS.l-l.S.2.1 Emergency access. Other vehicular or pedes­

minimize the negative aspects of an institutional e.nvironment..

trian traffic should not conflict with access for emergency vehicles.

258 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES
5.1-1.5.2.4 Access to utilities. See Section 1.3-2.4
(Access to Utilities) and Section 2.1-2.4 (Access to
Utilities) for requirements.
5.1-1.5.3 Site Features
5.1-1.5.3.1 Roads. See Section 2.1-3.1 (Roads) for
requirements.
5.1-1.5.3.2 Pedestrian walkways. Accessible paved
walkways shall be provided for pedestrian traffic.
5.1-1.5.3.3 Parking
(1) In the absence oflocal requirements, each faciliry
shall have parking spaces to satisfY the needs of
users, staff, and visitors.
(2) Reduction of parking requirements shall be
permitted, as acceptable to local authorities having
jurisdiction (AH]s).
5.1-1.5.3.4 Signage and wayfinding. See Section
1.2-4.5.3 (Signage and Wayfinding) and Section 2.4­
2.2.12 (Signage and Wayfinding) for requirements.
5.1-1.5.3.5 Site lighting. See Section 2.1-3.5 (Site
Lighting) for requirements.
5.1-1.5.3.6 Landscape features
(1) General. See Section 1.2-4.5.1 (Light) and Section
1.2-4.5.2 (Views of and Access to Nature) for
requirements.
(2) Outdoor water features. See Section 2.1-3.6.3
(Outdoor Water Features) for requirements.
5.1-1.5.4 Building Orientation
See Section 1.2-2.2.2.2 (1) (Site) and Section 2.2-2.1
(Sustainable Site Design) for requirements.
APPENDIX
A5.1-2.3.2 Vehicular drop-off and pedestrian
entrance. The length of the covered/canopied entrance should be
determined by the number of accessible vans to be accommodated. The
number of vans should be determined by the number of participants
being served.
A5.1-2.3.3.2 Dining area
a. Bining should occur in aspace that is Visually and spatially distinct
from activity areas.
b. Bepending on the care population being served, no single dining
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
• 5.1-2 Participant Areas
5.1-2.1 General
The faciliry shall have sufficient space, furnishings, gar­
dens or other outdoor space, and equipment to accom­
modate the range of program activities and services for
the number of participants to be served.
5.1-2.2 Reserved
5.1-2.3 Participant Community Areas
5.1-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant, and
Outpatient Communiry Areas-General) for
requirements.
*5.1-2.3.2 Lobby
Where a central lobby is provided as part of the
day care center, see Section 2.3-2.3.2 (Lobby) for
requirements.
5.1-2.3.3 Dining, Recreation, and Lounge Areas
5.1-2.3.3.1 General. See Section 2.3-2.3.3.1 (Dining,
Recreation, and Lounge Areas-General) for require­
ments.
*5.1-2.3.3.2 Dining area. See Section 2.3-2.3.3.2
(Dining areas) for requirements.
*5.1-2.3.3.3 Recreation, lounge, and activity areas
(1) Spaces for different activities shall be provided
based on the care population served.
(2) Space requirements
(a) Net usable space. Only spaces used by
participants shall be counted as net usable
seating should serve more than 16 participants to decrease the
potential for unpredictable sodal and sensory stimulation.
c. Refer to Keith Biaz Moore, "Besign Guidelines for Adult Bay Services"
in AlA Report on University Research 2005 for additional information
and further detail on toilets, dining, and the zone of transition.
A5.1-2.3.3.3Recreation, lounge, and activity areas
a. Typically, inclusion of two to three dayrooms provides the opportu­
nity to have distinct activities in each area based on the care popula­
tion being served.
259
5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES
activity space. Reception areas, storage areas,
offices, restrooms, and service areas shall not
be included.
(i) Where a warming pantry or participant
kitchen is used for activities other than
meals, 50 percent of the Boor area shall be
permitted to be counted as activity space.
(ii) A commercial kitchen shall not count as
activity space.
(iii) Where a clearly marked corridor is treated
as a wandering pathway with lean rails or
handrails, 100 percent of the Boor area
shall be permitted to be counted as activity
space.
(b) Area. Minimum square footage requirements
shall be based on the services offered by
the adult day care or adult day health care
(ADHC) facility.
(i) A minimum of 100 square feet (30.48
square meters) shall be provided for each
of the first five participants and 60 square
feet (18.28 square meters) of net usable
program activity space for each participant
thereafter.
(ii) Where the facility offers physical rehabili­
tation therapy, an additional 50 square feet
(15.24 square meters) of space per partici­
pant using the thetapy space at one time
shall be provided for activity space needed
for equipment and treatment.
(iii) For facilities that serve residents with
dementia, an additional 40 square feet
(12.19 square meters) of space shall be
provided per participant to allow for at
least two separate spaces for socializing in
small groups. See Section 2.2-4 (Design
Criteria for Dementia, Mental Health, and
Cognitive and Developmental Disability
Facilities) for additional requirements.
(iv) For facilities that serve residents with
mental health and/or developmental
"~;:APPENDIX (continued)
b. Access to outdoor activity spaces from recreation, lounge, and activ­
ity areas should be considered. See Section 5.1-2.8 (Outdoor Activity
Spaces) for requirements.
260 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
disabilities, an additional 70 square feet
(21.33 square meters) of space shall be
provided per participant to make it pos­
sible to maintain the therapeutic milieu.
See Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive
and Developmental Disability Facilities)
for additional requirements.
5.1-2.3.3.4 Support areas for dining, recreation,
lounge, and actvity locations
(1) All communal activity areas shall have access to a
hand-washing station.
(2) Toilet rooms. The adult day care facility shall have
at least one toilet for every 10 participants and
fraction thereof
(a) Location. A participant toilet room shall be
located adjacent to dining, recreation, lounge,
and activity areas.
(b) Type
(i) Toilet rooms shall be permitted to be an
individual toilet room or a toilet room
with multiple stalls.
(ii) The facility shall provide a toilet room or
toilet stall types to accommodate the level
of care provided.
(iii) All facilities shall include at least one toilet
room that can accommodate a two-person
assisted transfer between participant-oper­ ,
ated mobility device and toilet.
(c) Space requirements. Toilet rooms or stalls shall
I
be sized and configured to accommodate staff
assistance including use of lifting equipment, I
;
where applicable, and accessibility standards
that support independent participant use.
(d) The toilet room shall contain the following:
(i) Toilet or stalls with toilets
(ii) Hand-washing station(s)
(iii) Mirror. For requirements, see Section
2.4-2.2.8.7 (Mirror).
c. Provision ofaden or hearth room dose to-the lobby and reception
area should be considered. Participants often use this space as a
library, computer area, and living room-type setting.
 5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES

*5.1--2.3.4 Participant Kitchen 5.1-2.3.8.2 Outdoor recreation and/or relaxation

Where kitchen facilities are provided for use by
participants, volunteers, and family members, see
Section 2.3-2.3.4 (Resident and Participanr Kitchen)
for requirements.
*5.1-2.3.5 Personal Services (Hair Salon/Spa) Areas
area(s) for participants shall be visible and accessible
from the common dining, living, and activity spaces.
5.1-2.3.8.3 Outdoor spaces shall have a fence or land­
scaping to create a boundary that prevents participant
elopement.

I*5.1-2.3.5.1 Where hair salon services are offered, a • 5.1-3 Diagnostic and Treatment
styling bowl and starion shall be provided.
Areas
5.1-2.3.5.2 Location. These facilities shall be permit­
ted to be located with the bathing facilities in Section 5.1-3.1 General
5.1-4.2.3 (Central Bathing Rooms or Areas). See Section 2.3-3.1 (Diagnostic and Treatment
Areas-General) for requirements in addition to those
*5.1-2.3.6 Family Room in this section.
A meeting room shall be provided for private meetings
for a participant, staff, and family; for caregiver assess­ 5.1-3.2 Examination, Observation, and/or
ments; and for other activities that require privacy. Treatment Rooms
See Section 2.3-3.2 (Examination, Observation, and/
5.1-2.3.7 Quiet Room in a Participant Community or Treatment Rooms) for requirements in addition to
Area those in this section.

5.1-2.3.7.1 If the care population includes persons

5.1-3.2.1 For an ADHC facility, a minimum of one
subject to personal conflicts, agitation, episodic
examination or treatment room shall be required.
mental disturbances, illness, or similar conditions that
require a quiet or low-stimulation, positive-distraction
5.1-3.2.2 For a PACEADHC facility, see federal
room, a quiet room shall be provided in accordance
Programs for All-Inclusive Care for the Elderly
with Section 2.3-2.3.7 (Quiet Room in a Resident or
regulations for additional requirements.
Participant Community Area).
5.1-3.3 Rehabilitation Therapy Areas
5.1-2.3.7.2 This room or area shall be considered part
of the net usable space for participants. Where a space is used to provide rehabilitation ther­
apy services, the space shall comply with applicable
*5.1-2.3.8 Outdoor Activity Spaces requirements in Chapter 5.3 (Specific Requirements
for Outpatient Rehabilitation Therapy Facilities).
5.1-2.3.8.1 See Section 2.1-3.6.2 (Outdoor Activity
Spaces) for requirements in addition to those in this
section.
, APPENDIX ,

A5.1-2.3.4 Participant kitchen. Examples of participant AS.1-2.3.S.1 Provision of an adjustable styling bowl should be
kitchen facilities include a"country kitchen;' a"great room;' or an activity evaluated based on the needs ofthe care population.
room that supports continued participant involvement in activities of
AS~ 1-2.3.6 The family meeting room should have exterior views as
daily living.
well as direct access to the exterior.
AS.1-2.3.S Hair salon ventilation. Mechanical ventilation
AS.1-2.3.8 Outdoor activity spaces. Outdoor space(s)
and exhaust, including negative pressure, 10 minimum total air changes
should be accessible via short, navigable distances.
per hour, and exhaust directly to the outdoors, should be provided for
hair salons.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 261
5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES

• 5.1-4 Facilities for Support Services bathing area without requiring entry into the general
corridor. This toilet can be counted to comply with the
5.1-4.1 General
requirement for one toilet to 10 participants served.

See Section 2.3-4.1 (Facilities for Support Services­

5.1-4.2.3.3 Access to a grooming location without

General) for requirements.

reentry to the general corridor shall be provided.

5.1-4.2 Facilities that Support Participant Care (1) This space shall contain the following:

(a) Hand-washing station

5.1-4.2.1 Nursing Office (b) Counter or shelf
Adult day health care (ADHC) facilities shall have a (c) Mirror
nursing office.
(2) See Section 5.1-4.2.7.3 (Personal Laundry

Facilities-Storage ...) for requirements for

5.1-4.2.1.1 Treatment rooms provided for adult day

storage of one change of clothing for each

health care (including PACE) centers shall be permit­

participant.

ted to fulfill this requirement. See Section 5.1-3.2.2

(ADHC Treatment Room) for information on ADHC
5.1-4.2.3.4 Special design elements
treatment room requirements for PACE centers.
(1) Door openings. See Section 2.4-2.2.4.2 (Door

5.1-4.2.1.2 Work surface shall be provided in the openings) for requirements.

nursing office. (2) Thresholds and expansion joint covers. See Section
2.4-2.2.5 (Thresholds and Expansion Joint Covers)
5.1-4.2.2 Medication Distribution and Storage for requirements.
Locations (Centralized and Decentralized)
5.1-4.2.4 Equipment and Supply Storage
See Section 2.3-4.2.2 (Medication Distribution and
Storage Locations) for requirements. See Section 2.3-4.2.4 (Equipment and Supply Storage)
for requirements.
*5.1-4.2.3 Central Bathing Rooms or Areas
*5.1-4.2.5 Clean Utility Room
5.1-4.2.3.1 Participants shall have access to at least
one central bathing/personal care room sized to permit 5.1-4.2.5.1 A clean utility room shall be provided in

assisted bathing in a tub or shower. each adult day health care facility.

(1) Where a bath or spa tub is provided in this room,

it shall be accessible ro participants in wheelchairs
5.1-4.2.5.2 Where the clean utility room is used for

preparing participant care items, including assem­

and other participant-operated mobility devices.

(2) Where a participant shower is provided, see Section bling supplies or items for home distribution, it shall

contain:

2.5-2.3.3.2 (Accessible showers) for requirements.

(1) Work counter
5.1-4.2.3.2 A separate toilet and hand-washing sta­ (2) Hand-washing station
tion shall be provided in or directly accessible to each (3) Storage facilities for clean supplies

APPENDIX

AS.1-4.2.3 Central bathing rooms or areas. Consid~

limitations that predispose them to soiling clothing with blood, body

eration should be given to privacy when locating entrances to bathing

fluids, or food spills (e.g., swallowing or chewing problems, shakes or

anp personal care rooms. Where personal laundry facilities are provided,
tremors).

these may be included with central bathing facilities. Access to awa$her

AS.1-4.2.S Clean utility room. The clean utility room may

and dryer is preferable where partitipants have incontinence or physical

be COmbined with clean linen storage and/or personal laundry facilities.

262 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES
*5.1-4.2.6 Soiled Utility Room
5.1-4.2.6.1 A soiled utility room shall be provided in
each adult day care facility.
5.1-4.2.6.2 The soiled utility room shall contain the
following:
(1) Hand-washing station
(2) Clinical sink or equivalent flushing-rim fixture
shall be provided to allow transfer from a mobility
with a rinsing hose
device to a nursing bed.
(3) Space for soiled linen receptacles
(4) Space for waste receptacles
5.1-4.2.7 Personal Laundry Facilities
5.1-4.2.7.1 Where personal laundry facilities are pro­
vided, see Section 2.3-4.2.7 (Personal Laundry Facili­
ties), except for Section 2.3-4.2.7.4 (Shared facilities),
for requirements in addition to those in this section.
5.1-4.2.7.2 Inclusion of personal laundry facilities
with central bathing rooms or areas or in conjunction
with soiled and clean utility rooms shall be permitted.
5.1-4.2.7.3 Storage of a minimum of one change of
clothing shall be provided for each participant in the
personal laundry area or near bathing facilities.
5.1-4.2.8 Participant Telephone Access
An area where participants can make and receive tele­
phone calls in private shall be provided.
*5.1-4.2.9 Quiet Room or Observation Area
Where a quiet space to lie down is provided to accom­
modate participant observation by staff, the following
requirements shall be met:
5.1-4.2.9.1 Capacity. Each room or area shall be pro­
vided with a single bed.
APPENDIX
AS.1-4.2.6 Soiled utility room. The soiled utility room may
be combined with the personal laundry facilities and/or the environ­
mental ser.vices room.
AS. t -4.2.9 Acoustic recommendations for quiet
room or observation area. See Section 2.5-8.3 (Design Crite­
ria for Acoustic Finishes), Section 2.5-8.4 (Design Criteria for Room Noise
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
5.1-4.2.9.2 Location
(1) A quiet room or area shall be located where it can
be clearly monitored.
(2) A quiet room or area shall be permitted to be part
of the treatment room (for ADHC) or part of the
nursing office.
5.1-4.2.9.3 Space requirements. Circulation space
5.1-4.2.9.4 Participant toilet room. A toilet room
that meets the requirements in Section 5.1-2.3.3.4 (2)
(Toilet rooms) shall be located adjacent to the quiet
room.
(1) This shall be an individual toilet room or a toilet
room with multiple stalls.
(2) This toilet room shall be permitted to be shared by
participants using other activity spaces.
5.1-4.3 Support Areas for Staff
5.1-4.3.1 General
See Section 2.3-4.3.1 (Support Areas for Staff-Gen­
eral) for requirements.
*5.1-4.3.2 Staff Lounge Area
5.1-4.3.2.1 The staff lounge area shall meet the
requirements of Section 2.3-4.3.2 (Staff Lounge Area)
as amended in this section.
5.1-4.3.2.2 The staff lounge area shall be permitted to
also serve as a private conference area.
5.1-4.3.3 Staff Toilet Room
See Section 2.3-4.3.3 (StaffToilet Room) for require­
ments.
levels), and Section 2.5-8.5 (Design Criteria for Performance of Interior
Wall and Floor/Ceiling Constructions) for recommendations.
AS.1-4.3•.2 Staff lounge area. Where the facility capacity is
40 participants or greater, aseparate staff lounge should be prOVided.
263
5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES
5.1-4.3.4 Staff Storage
See Section 2.3-4.3.4 (Staff Storage) for requirements.
5.1-4.4 Support Areas for Family and Visitors
5.1-4.4.1 General
For shared private meeting areas, see Section 5.1­
4.11.1.1 (Private conference space) for requirements.
5.1-4.4.2 Reserved
5.1-4.4.3 Pet Accommodations
Where pets are permitted, see Section 2.3-4.4.3 (Pet
Accommodations) for requirements.
5.1-4.5 Food Service Facilities
5.1-4.5.1 Centralized Commercial Kitchen
Where a centralized commercial kitchen is provided,
it shall comply with Section 2.3-4.5 (Food Service
Facili ties).
5.1-4.5.2 Warming/Catering Kitchen
For facilities that have a service contract with an
outside vendor for food service, provision of a warm­
ing/catering kitchen designed in accordance with the
following requirements shall be permitted.
5.1-4.5.2.1 Where an outside vendor is used to pro­
vide meals, the facility shall include dedicated space
and equipment for a warming kitchen, including space
for minimal equipment for preparation of breakfast,
lunch, or emergency meals.
5.1-4.5.2.2 Use of the participant kitchen in Section
5.1-2.3.4 (Participant Kitchen) shall be permitted as
an alternative location to accommodate the function of
a warming kitchen.
5.1-4.5.3 Decentralized Kitchen
Where food preparation is conducted on-site, the
A5.1-4.11.1 Office and conference space. Provision of
the following office space should be considered:
a. One director's office at 140 square feet (13 square meters)
264 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
facility shall have dedicated non-public staff space and
equipment for preparation of meals. See 2.3-2.3.4
(Resident and Participant Kitchen) for requirements.
5.1-4.6 Reserved
5.1-4.7 Materials Management Facilities
See Section 2.3-4.7 (Materials Management Facilities)
for requirements.
5.1-4.8 Waste Management Facilities
See Section 2.3-4.8 (Waste Management Facilities) for
waste collection, storage, and disposal requirements.
5.1-4.9 Environmental Services Rooms
See Section 2.3-4.9 (Environmental Services Rooms)
for requirements.
5.1-4.10 Facilities for Engineering and
Maintenance Services
See Section 2.3-4.10 (Facilities for Engineering and
Maintenance Services) for requirements.
5.1-4.11 Administrative Areas
*5.1-4.11.1 Office and Conference Space
Offices or an open office area with private conference
space shall be provided for business transactions and
participant assessments and for the use of administra­
tive and professional staff.
*5.1-4.11.1.1 Conference space. Space for private con­
ferences and meetings, including participants meeting
with staff, visitors, and family, shall be sized to accom­
modate operational needs.
(1) Sharing of space by several services shall be
permitted.
(2) For PACE ADHC facilities, medical professional
offices shall be provided in accordance with PACE
regulations.
5.1-4.11.1.2 General office space. Staff office space
and file storage shall be provided based on the staff
b. One activity professional's office at 140 square feet (13 square
meters)
 5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES

required to operate the adult day care center and the

(a) Doors to all rooms containing bathtubs,
services being provided.
showers, and toilets for participant use shall be
hinged, sliding, or folding.
5.1-4.11.2 Equipment and Supply Storage (b) Manual or automatic sliding doors shall
Space for storage of office equipment and supplies shall be permitted where their use does not
be provided based on staff requirements and partici­ compromise fire and other emergency exiting
pant needs. requirements.

(2) Door openings. See Section 2.4-2.2.4.2 (Door

openings) for requirements.

• 5.1-5 Design and Construction

(3) Insect screens. See Section 2.4-2.2.4.3 (Insect

Requirements
screens) for requirements.

5.1-5.1 Building Codes

5.1-5.2.2.5 Thresholds and expansion joint covers.
See Section 2.4-1.2 (Building Codes and Standards)
See Section 2.4-2.2.5 (Thresholds and Expansion Joint
for requirements.
Covers) for requirements.

5.1-5.2 Architectural Details, Surfaces, and 5.1-5.2.2.6 Windows. See Section 2.4-2.2.6

Furnishings (Windows) for requirements.

5.1-5.2.1 General
5.1-5.2.2.7 Glazing materials. See Section 2.4-2.2.7
See Section 2.4-2.1 (Architectural Details, Surfaces,
(Glazing Materials) for requirements.
and Furnishings-General) for requirements.

5.1-5.2.2.8 Hand-washing stations

5.1-5.2.2 Architectural Details
5.1-5.2.2.1 General. See Section 2.4-2.2.1
(Architectural Details-General) for requirements.
5.1-5.2.2.2 Corridors. See Section 2.4-2.2.2
(Corridors) for requirements.
(1) See Section 2.4-2.2.8 (Hand-Washing Stations) for
requirements.
(2) Omission of the mirror shall be permitted.
5.1-5.2.2.9 Grab bars
*(1) Grab bars shall be installed at all participant toilets,
showers, and tubs.
(2) Alternative grab bar configurations. See Section

5.1-5.2.2.3 Ceiling height. See Section 2.4-2.2.3 2.4-2.2.9.3 (Alternative grab bar configurations)

(Ceiling Height) for requirements. for additional information.

*5.1-5.2.2.4 Doors and door hardware (a) Where independent transfers are feasible,
alternative grab bar configurations shall be
(1) Door type
permitted.
APPENDIX

A5.1-4.11.1.1 Kitchenette for conference space.

b. Where participants who require a physicallitt bytwostC\ff members

Provision of kitchenette facilities, including under-counter refrigerator,

are served at the facility, toilets used by participants should have

microwave, and sink, for this space should be considered.

aminimum clearance of 24 inches (60.96 centimeters) from the

centerline ofthe toilet bowl to the wall to enable physical access

A5.1-5.2.2.4 Door protection. See appendix section A2.4­

and maneuvering by staff, who may have to assist the participant in

2.2.4 (Door protection) for recommendations.

wheelchair-to-toilet transfers and return.

A5.1-5.2.2.9 (1) Grab bars in toilet rooms c. Grab bars in toilet rooms should allow staff to complete atwo-per­

a. Grab bars in toilet rooms should allow participants to be as safe and

son transfer for asingle participant. This includes evaluation of the

independent as possible. This includes using SWing-up grab bars,

toilet in relation to the wall and the grab bars proVided, Clearance is

where needed, with or without integral toilet paper holder.

required on both sides of the toilet for adouble transfer to Occur.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 265
5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES

(b) The care population shall be evaluated to 5.1-5.2.3 Surfaces

determine alternative grab bar configurations See Section 2.4-2.3 (Surfaces) for requirements.

that meet specific participant needs.

(3) For wall-mounted grab bars, a minimum clearance 5.1-5.2.4 Furnishings

of 1.5 inches (3.81 centimeters) from walls shall be See Section 2.4-2.4 (Furnishings) for requirements.

provided.
(4) Grab bar load requirements shall be evaluated for
alignment with the needs of the care population. • 5.1-6 Building Systems
(a) Grab bars, including those that are part of 5.1-6.1 General
fixtures such as soap dishes and toilet paper
See Section 2.5-1 (Building Systems-General) for
holders, shall have the strength to sustain
requirements.
a concentrated load of250 pounds (113.4
kilograms).
5.1-6.2 Plumbing Systems
(b) Where a population includes persons of size,
grab bars installed in areas intended for use by
5.1-6.2.1 General
persons of size shall be anchored to sustain a
minimum concentrated load of 800 pounds See Section 2.5-2.1 (Plumbing Systems-General) for
(362.88 kilograms). requirements.

(5) Grab bars shall have a finish color with a value that 5.1-6.2.2 Plumbing and Other Piping Systems
contrasts with the adjacent wall surface.
See Section 2.5-2.2 (Plumbing and Other Piping Sys­
(6) Grab bars shall be returned to the wall or floor

tems) for requirements.

with eased corners where a mitered corner

condition exists.

5.1-6.2.3 Plumbing Fixtures

5.1-5.2.2.10 Handrails. See sections 2.4-2.2.10.1,
5.1-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
2.4-2.2.10.2, and 2.4-2.2.10.5 through 2.4-2.2.10.10
Fixtures-General) for requirements.
in Section 2.4-2.2.10 (Handrails and Lean Rails) for
requirements.
5.1-6.2.3.2 Hand-washing sinks. See Section
*5.1-5.2.2.11 Protection from heated surfaces. Where 2.5-2.3.2 (Hand-Washing Sinks) for requirements.
cooking accommodations are provided for participants
for activities for adult day care, emergency shutoffs 5.1-6.2.3.3 Showers. See Section 2.5-2.3.3.2 (Acces­
shall be provided. sible showers) for requirements.

5.1-5.2.2.12 Signage and wayfinding. See Section 5.1-6.2.3.4 Reserved

2.4-2.2.12 (Signage and Wayfinding) for requirements.
5.1-5.2.2.13 Decorative water features. Where
decorative water features are used in the facility design,
see appendix section A2.4-2.2.13 (Decorative water
features).
APPENDIX
5.1-6.2.3.5 Clinical sinks. Where clinical sinks are
provided in an adult day care or adult day health care
(ADHC) facility, see Section 2.5-2.3.5 (Clinical Sinks)
for requirements.
5.1-6.2.3.6 Portable hydrotherapy whirlpools.
Where portable hydrotherapy whirlpools are used

AS.l-S.2.2.11 Protection from heated surfaces. surfaces referenced in this section are intended to include th()se surfaces
Many adult day care facilities include activity and/or rehabilitation to which participants have normal access that exceed 110°F (43°(). This
kitchens that may be used in asupport hub or country kitchen. Heated requirement does not extend to medical or therapeutic equipment.

266 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES
in an adult day care or ADHC facility, see Section
2.5-2.3.6 (Portable Hydrotherapy Whirlpools) fot
requirements.
5.1-6.3 Heating, Ventilation, and
Air-Conditioning (HVAC) Systems
5.1-6.3.1 General
5.1-6.3.1.1 Application. For basic HVAC system
requirements for adult day care and ADHC facilities,
see ANSIIASHRAE Standard 62.1: Ventilation for
Acceptable Indoor Air Quality.
5.1-6.3.1.2 Ventilation and space conditioning. See
Section 2.5-3.1.2 (Ventilation and Space Condition­
ing) fot tequitements.
5.1-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
5.1-6.3.3 HVAC Requirements for Specific
Locations
5.1-6.3.3.1 Participant and related support areas.
See ANSIIASH RAE Standard 62.1: Ventilation for
Acceptable Indoor Air Quality for basic HVAC system
requirements.
5.1-6.3.3.2 Fuel-fired equipment rooms. Where
rooms with fuel-fired equipment are provided, see
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
requirements.
5.1-6.3.3.3 Areas of refuge. Where areas of refuge are
provided, see Section 2.5-3.3.3 (Areas of Refuge) for
requirements.
5.1-6.3.3.4 Commercial food preparation areas.
Where commercial food preparation areas are
APPENDIX
AS.1-6.3.4 Thermal and acoustic insulation
a. See ASHRAE 90.1: Energy Standard for Buildings Except Low-Rise Resi­
dential BUildings for more information.
b. Provisions for acoustic insulation should meet or exceed local build­
ing code requirements.
c. Consideration should be given to construction of demising walls and
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
provided, see Section 2.5-3.3.4 (Commercial Food
Preparation Areas) for requirements.
*5.1-6.3.4 Thermal and Acoustic Insulation
See Section 2.5-3.4.1 (Thermal and Acoustic Insula­
tion-General) for requirements.
5.1-6.3.5 HVAC Air Distribution
See Section 2.5-3.5 (HVAC Air Distribution) for
requirements.
5.1-6.3.6 HVAC Filters
5.1-6.3.6.1 General. See ANSIIASHRAE Standard
62.1: Ventilation for Acceptable Indoor Air Quality for
requirements.
5.1-6.3.6.2 Filter efficiencies.
(1) For centralized recirculated systems, MERV 7
shall be the minimum filter efficiency for the first
filter bank. There is no minimum filter efficiency
requirement for the second filter bank.
(2) For non-central recirculating room systems, HVAC
units shall:
(a) Not receive nonfiltered, nonconditioned
outdoor air.
(b) Serve only a single space.
*(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
designed to condense water. This filter shall be
located upstream of any such cold surface so
that all of the air passing over the cold surface
is filtered.
5.1-6.3.7 Heating Systems, Cooling Systems, and
Equipment
See Section 2.5-3.7 (Heating Systems, Cooling
Systems, and Equipment) for requirements in addition
to those in this section.
floors in a manner that provides for speech privacy between occu­
pied spaces and between floors.
AS.1-6.3.6.2 (2)(c) Filters for recirculating room
systems. Filters should be replaced and/or cleaned per the manufac­
turer's recommendations to maintain indoor air quality.
267
5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES
5.1-6.3.7.1 Heating systems. Adult day care and
ADHC facilities shall have a permanently installed
heating system capable of maintaining an interior
minimum temperature of 72° F (22° C) under heating
design temperatures.
5.1-6.3.7.2 Cooling systems. Adult day care and
ADAHC facilities shall be configured and equipped
with a cooling system capable of maintaining an
interior maximum temperature of 75° F (24° C) under
cooling design temperatures.
5.1-6.4 Electrical Systems
5.1-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
5.1-6.4.2 Power-Generating and Storing
Equipment
5.1-6.4.2.1 Essential electrical service
(1) Adult day care and ADHC facilities that require
essential electrical systems shall comply with the
appropriate occupancy requirements ofNFPA 101:
Life Safety Code
(2) As required by local codes and the care types, an
essential electrical source shall provide emergency
lighting and/or power during an interruption of
the normal electrical supply.
5.1-6.4.2.2 Generators. Where generators are used in
adult day care and ADHC facilities, exhaust systems
(including locations, mufflers, and vibration isolators)
for internal combustion engines shall be designed and
installed to minimize objectionable noise.
5.1-6.4.3 Electrical Receptacles
See sections 2.5-4.3.1, 2.5-4.3.2, 2.5-4.3.4, and 2.5­
4.3.5 in Section 2.5-4.3 (Electrical Receptacles) for
requirements.
APPENDIX
AS.1-6.S.2.3 (1) Emergency call devices. Based on the
care population served, physical therapy, quiet rooms, fitness and exer­
cise areas, pool areas and other therapy areas, and other common areas
268 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
5.1-6.4.4 Electrical Requirements for Areas
Serving Ventilator-Dependent Participants
Where ventilators are used in an adult day health care
center, see Section 2.5-4.4 (Electrical Requirements for
Ventilator-Dependent Resident Rooms and Areas) for
requirements.
5.1-6.5 Communication Systems
5.1-6.5.1 General
See Section 2.5-5.1 (Communication Systems-Gen­
eral) for requirements.
5.1-6.5.2 Call System
5.1-6.5.2.1 General. Where call systems are provided,
the use of alternative technologies, including wireless
systems, shall be permitted.
(1) Where wireless systems are used, consideration
shall be given to electromagnetic compatibility
between internal and external sources.
(2) Wireless systems shall comply with UL Standard
2560: Standardfor Emergency Call Systems for
Assisted Living and Independent Living Facilities.
5.1-6.5.2.2 Reserved
5.1-6.5.2.3 Emergency call system. An emergency
call system shall be provided in adult day care facilities.
*(1) An emergency call device shall be provided at
each toilet, bath, shower room, and examination,
observation, or treatment room.
(2) The device shall be accessible to a person lying
on the floor. Inclusion of a pull cord or portable
wireless device shall satisfY this requirement.
(3) The signal shall activate a visual and/or audio
signal located at an appropriate location and/or a
handheld mobile device carried by staff.
(4) Emergency call systems shall be listed by a
nationally recognized testing laboratory.
5.1-6.5.3 Technology Equipment and Teledata
Room(s)
should be evaluated for incorporation of emergency call system stations.
This evaluation should consider the care model, care population, scale of
the facility, and staffsight lines for observation.
 5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES

5.1-6.5.3.1 General *5.1-6.7.3.2 Lighting requirements for specific loca­

(1) See Section 2.5-5.3.1.1 (Technology Equipment tions. See appendix section A2.5-7.3.2 (Lighting in
and Teledata Room-Purpose) for requirements. transition spaces) for recommendations.
(2) Number. Each adult day care and ADHC shall (1) Reserved
have a room or closet to accommodate technology (2) Participant toilet rooms
systems used in the facility.
(a) Toilet rooms shall have general lighting and
task lighting.
5.1-6.5.3.2 Size. SSection 2.5-5.3.2 (Size) for require­
(b) Task light controls shall be readily accessible to
ments.
participants.

5.1-6.5.3.3 Location and access. See Section 2.5­

5.1-6.8 Acoustic Design Systems

5.3.3 (Location and Access) for requirements.

See Section 2.5-8 (Acoustic Design Systems) for

5.1-6.5.3.4 Technology equipment room facilities. requirements.

See Section 2.5-5.3.4 (Technology Equipment Room

Facilities) for requirements. 5.1-6.9 Elevator Systems

5.1-6.6 Electronic Safety and Security Systems 5.1-6.9.1 General

See Section 2.5-6 (Electronic Safety and Security Sys­

5.1-6.9.1.1 Application. All buildings having partici­
tems) for requirements.
pant and/or staff use areas on more than one floor shall
have an electric or hydraulic elevator(s).
5.1-6.7 Daylighting and Artificial Lighting
Systems
*5.1-6.9.1.2 Number. Engineered traffic studies are rec­
ommended, bur in their absence the following guide­
5.1-6.7.1 General
lines for minimum number of elevators shall apply:
See Section 2.5-7.1 (Daylighting and Artificial Light­
(1) At least one elevator sized to accommodate
ing Systems-General) for requirements.
participant-operated mobility device users shall be
required where spaces used by participants are on
5.1-6.7.2 Daylighting Systems in Participant
any floor other than the main entrance floor.
Areas
(2) Where adult day or ADHC facilities are part of a
See Section 2.5-7.2 (Daylighting Systems in Resi­ general hospital, the hospital's elevators shall be
dent Living, Participant, and Outpatient Areas) for permitted to meet the requirement in Section
requirements. 5.1-6.9.1.1 (Application).

5.1-6.7.3 Artificial Lighting Systems 5.1-6.9.2 Dimensions and Clearances

Elevator car doors shall have a clear opening of not less
5.1-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
than 3 feet 8 inches (1.12 meters).
(Light Fixtures) for requirements.

5.1-6.9.3 Leveling Device

See Section 2.5-9.3 (Leveling Device) for

requirements.

APPENDIX

A5.1-6.7.3.2 Lighting for corridors and common A5.1-6.9.1.2 These standards may be inadequate for moving large

areas used by participants. Corridors and common areas numbers of people in ashort time; adjustments should be made as

used by participants should have even light distribution to avoid glare, appropriate.

shadows, and scalloped lighting effects. See appendiX section A2.4­

2.1.2.2 (1) (Environmental factors and falls) for additional information.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 269
5.1 SPECIFIC REQUIREMENTS FOR ADULT DAY CARE AND ADULT DAY HEALTH CARE FACILITIES

5.1-6.9.4 Installation and Testing 5.1-6.9.5.1 Elevator cars shall have handrails on all
See Section 2.5-9.4 (Installation and Testing) for
sides without entrance door(s).
requiremen ts.

5.1-6.9.5.2 See Section 2.4-2.2.10 (Handrails and

5.1-6.9.5 Handrails
Lean Rails) for additional requirements.

270 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.2 Specific Requirements for Well ness Centers
AppendiX material, shown in shaded boxes at the bottom ofthe page, is advisory only.
• 5.2-' General
5.2-1.1 Application
5.2-1.1.1 General
*5.2-1.1.1.1 This chapter applies to facilities that offer
wellness services.
5.2-1.1.1.2 The common elements in Part 2 of the
Guidelines for Residential Care Facilities shall apply
to wellness centers where they are referenced in this
chapter.
5.2-1.1.2 Design Criteria
5.2-1.1.2.1 Sustainable design. See Section 2.2-2
(Sustainable Design Criteria) for requirements for
adult day care and ADHC facilities.
5.2-1.1.2.2 Design criteria for accommodations for
care of persons of size. Where the care population
includes persons of size, see Section 2.2-3 (Design
Criteria for Accommodations for Care of Persons of
Size) for requirements.
5.2-1.1.2.3 Dementia, mental health, and cognitive
and developmental disability design criteria. Where
the care population includes participants with demen­
tia, mental health issues, or cognitive and developmen­
tal disabilities, see Section 2.2-4 (Design Criteria for
APPENDIX
AS.2-1.1.1.1 Well ness centers may be freestanding or attached to
a residential health, care, or support facility. Services provided include
primary care, physical fitness, socialization, education, and therapies
focused on wellness and creating apositive lifestyle and sense of well­
being. Wellness centers can be integrated into continuing care retire­
ment communities orthe community at-large, or they can be part of an
acute care campus.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
Dementia, Mental Health, and Cognitive and Devel­
opment Disability Facilities) for requirements.
5.2-1.2 Functional Program
5.2-1.2.1 See Section 1.2-2 (Functional Program) for
requirements.
5.2-1.2.2 Shared Services and Space
*5.2-1.2.2.1 Where a wellness center is part of (or
contractually linked with) another facility, sharing of
services and space for home health, dietary, storage,
pharmacy, linen, and other services shall be permitted
insofar as practical.
5.2-1.2.2.2 Where a project calls for sharing or
purchasing services from another entity, appropriate
modifications in the requirements for space and park­
ing shall be permitted.
5.2-1.2.2.3 Each wellness center located in a facility
housing other services shall have its own identifiable
space.
5.2-1.2.2.4 All support spaces shall be permitted to be
shared.
5.2-1.3 Resident Safety Risk Assessment
See Section 1.2-3 (Resident Safety Risk Assessment)
for requirements.
AS.2-1.2.2.1 Shared services and space. In some cases,
ancillary service requirements will be met by the principal facility and
the only modifications necessary will be in the support facility. In other
cases, programmatic concerns and reqUirements may dictate separate
service areas.
271
5.2 SPECIFIC REQUIREMENTS FOR WELLNESS CENTERS

*5.2-1.4 Environment of Care Requirements 5.2-1.5.3.2 Pedestrian walkways. Accessible paved

See Section 1.2-1.3 (Environment of Care and Facility
walkways shall be provided for pedestrian traffic.
Function Considerations) and Section 1.2-4 (Environ­

ment of Care Requirements) for requirements.

5.2-1.5.3.3 Parking
(1) In the absence oflocal requirements, each facility
5.2-1.5 Site shall have parking spaces to satisfY the needs of
users, staff, and visitors.
5.2-1.5.1 General (2) Reduction of parking requirements shall be
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site
permitted, as acceptable to local authorities having
Elements) for requirements in addition to those in this
jurisdiction (AH]s).
section.

5.2-1.5.3.4 Signage and wayfinding. See Section

5.2-1.5.2 Facility/Community Access
*5.2-1.5.2.1 Emergency access. Fire department and
emergency vehicle access shall be provided in accor­
dance with local requirements.
1.2-4.5.3 (Signage and Wayfinding) and Section 2.4­
2.2.12 (Signage and Wayfinding) for requirements.
5.2-1.5.3.5 Site lighting. See Secrion 2.1-3.5 (Site
Lighting) for requirements.

5.2-1.5.2.2 Availability of transportation. See 2.1­ 5.2-1.5.3.6 Landscape features

2.2 (Availability ofTransportation) for requirements. (1) General. See Section 1.2-4.5.1 (Light) and Section
1.2-4.5.2 (Views of and Access to Nature) for
5.2-1.5.2.3 Security. See Section 2.1-2.3 (Security)
requirements.
for requirements.
(2) Outdoor water features. See Section 2.1-3.6.3
(Outdoor Water Features) for requirements.
5.2-1.5.2.4 Access to utilities. See Section 1.3-2.4

(Access to Utilities) and Section 2.1-2.4 (Access to

5.2-1.5.4 Building Orientation
Utilities) for requirements.
See Section 1.2-2.2.2.2 (1) (Site) and Section 2.2-2.1
(Sustainable Site Design) for requirements.
5.2-1.5.3 Site Features

5.2-1.5.3.1 Roads. See Section 2.1-3.1 (Roads) for

requirements.

APPENDIX

A5.2-1.4 Environment of care. Person-centered care in

minimize the negative aspectS of an institutional environment.
the long-term continuum of care should address movement away
d. The architectural environment should eliminate as many barriers to
from institutional and traditional models toward models that are more
effective access to and use ofspace, services, equipment, and utili­
residentially scaled, facilitate wayfinding, and provide acomfortable
ties as possible.
environment for the population served through provision of appropriate
e. Facilities should provide accessibility for participants with disabilities
lighting and acoustics.
in accordance with the state ot local building code and the Ameri­
a. Wellness centers should be designed to provide flexibility to meet
cans with Disabilities Act.
the changing needs ofthe care population(s) served and the types of

A5.2-1.5.2.1 Emergency access

care services provided.

a. Ambulance access for the wellness center site should be conSidered.

b. The facility design should produce asupportive environment to

If ambulance use is applicable, canopy and COvered entrance heights

enhance and extend quality of life for facility users and promote

should be designed to accommodate ambulance arrival.

their privacy and dignity while they receive care and services.

b. Other vehicular or pedestrian traffic should not conflict with access

c. F'lcility design should maximize opportunities for ambulation and
for emergency vehicles.

272 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.2 SPECIFIC REQUIREMENTS FOR WElLNESS CENTERS

• 5.2-2 Participant Areas 5.2-2.3.3.2 Dining area

(1) Where a cafe, bistro setting, or central dining

5.2-2.1 General facility is provided, following requirements shall

See Section 2.3-2.1 (Resident, Participant, and

apply:

Outpatient Areas-General) for requirements.

(a) Design and location shall encourage
participant and visitor use.
5.2-2.2 Reserved (b) Space shall be provided for dining in
accordance with the needs of the care
5.2-2.3 Participant Community Areas population, including participants who use
participant-operated mobility devices.
5.2-2.3.1 General
(c) Space shall allow participants to access and
See Section 2.3-2.3.1 (Resident, Participant, and
leave their tables without disturbing other
Outpatient Community Areas-General) for
participants.
requirements.

(2) For central dining facilities, clear and unobstructed

circulation paths for servers and food cans shall be
5.2-2.3.2 Lobby

provided.
Where a central lobby is provided as part of the
(3) Planned use of dining areas for other activities shall
wellness center, see Section 2.3-2.3.2 (Lobby) for
be permitted.
requirements.

5.2-2.3.3.3 Recreation, lounge, and activity areas

*5.2-2.3.3 Participant Health and Wellness Areas
(1) General. See Section 2.3-2.3.3.1 (Dining,

Recreation, and Lounge Areas-General) for

5.2-2.3.3.1 General. See Section 2.3-2.3.1 (Resident,

requirements in addition to those in this section.

Participant, and Outpatient Community Areas­

*(2) Recreation, exercise, and fitness training space.
General) for requirements.
Spaces shall be provided to accommodate the

APPENDIX

AS.2-2.3.3 Health and wellness services -Waiting areas should be provided based on the services being
a. Wellness center services. The services to be provided at awellness delivered and participant waiting time required for specific
center should be identified in the functional program. The range of services or treatments.
services provided by this type of facility may include: c. Quiet room in participant community area. Where aquiet room

-Therapies, such as acupuncture, aromatherapy, chiropractic or meditation room is provided, it should be located adjacent to

services, homeopathy, and light, horticulture, animal, art, and outdoor activity space.

music therapy d. Sources for design information relevant to wellness centers:

-Primary care clinical health services

-Access Board, ADA Standards for Accessible Design

-Spa services (e.g., hair salon services, manicures, pedicures,

-Air Force Civil Engineer Center, Air Force Services Facilities Design

massage therapy) Guide, "Design: Fitness Centers"

~Exercise and fitness training (e.g., yoga, pilates, tai chi, aerobics) -North Carolina Office on Disability and Health and the Center for
-Aquatics Universal Health, Removing Barriers to Health Clubs and Fitness
-Physical health and wellness screenings Facilities: AGuide for Accommodating All Members, Including
-Disease management programs People with Disabilities and Older Adults
-Nutritional counseling
AS.2-2.3.3.3 (2) Sizing recreation, exercise, and

-Individual and small group consultations

fitness training spaces

-Education classes, including lectures, field trips, activities

a. Typical sizing for standing or seated exercise classes is 15 square feet

~Retailservices (e.g., food service/juice bar, gift shop)

per person.

b. Personal services (hair salon/spa) areas

b. When sizing space where fitness equipment is used, allowances

-See the International Spa Association website

for circulation for participants using mobility devices should be

(www.experienceispa.com) for information.

considered.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 273
5.2 SPECIFIC REQUIREMENTS FOR WELLNESS CENTERS

recreational activities, exercise classes, and fitness
training programs offered to participants in the
wellness center.
*(3) Aquatic center. Where aquatic facilities are
provided, see appendix section A5.2-2.3.3.3 (3)
(Aquatic center) for additional information.
(3) Locker rooms
*(4) Education and consultation facilities. Where
education and consultation facilities are provided,
see appendix section A5.2-2.3.3.3 (4) (Education
and consultation facilities) for additional
information.
5.2-2.3.3.4 Support areas for dining, recreation,
lounge, and activity locations
(l) Reserved
*(2) Public toilet rooms. Public toilet rooms shall be
provided adjacent to or directly accessible from
exercise and fitness training spaces.
(a) Toilets for the recreation, exercise, and fitness
training space shall be permitted to be shared
with other activities.
(b) Location of toilets in a locker room shall be
permitted.
*(a) Changing areas and storage lockers shall be
provided where required to support the ser­
vices provided.
(b) Toilet room(s). See Section 5.2-2.3.3.4 (2)
(Public toilet rooms) for requirements.
(c) Showers shall be provided as required for the
wellness/fitness program offered in the wellness
center.
(I) See Section 2.5-2.3.3.2 (Accessible show­
ers) for requirements.
(Ii) Location of the showers in a locker room
shall be permitted.

APPENDIX

AS.2-2.3.3.3 (3) Aquatic center. According to the Arthritis

~Handicapped parking spaces or other designated parking close
Foundation Aq/Jatics facility GUidelines, host sites (well ness centers)
to an accessible building entrance
in which Arthritis Foundation Aquatics Program classes are conducted
~Accessible locker room facilities with adequate provisions for
should have the following minimum facilities and characteristics to
seating located near the pool
assure their accessibility; safety, and overall sUitability:
~Restrooms accessible to people with disabilities
a. An indoor heated pool with locker room and deck area ~Entrance doors to the locker room, locker, and restroom that
b. Pool water heated to a minimum temperature of 83°F and a
people with upperextremity limitations can easily operate
maximum temperature of 88°F
See the CDC Web page "Design and Operation of Pools and Hot Tubs"
c. Air temperature in the deck area within 5degrees of water
for additional information.
temperature

AS.2-2.3.3.3 (4) Education and consultation

d. For basic and advanced classes, pool depth sufficient for class
facilities
participants to sit or stand comfortably with shoulders submerged
a. Provision of c1assroQms and other training space should be consid­
during upper extremity exercises
ered based on the education provided in the well ness center.
e. For the deep-water class, pool depth sufficient for class participants
b. Typical classroom size for lecture-style teaching is 700 square feet
wearing aflotation device to float upright, without touching the
(65.10 square meters).
pool bottom
f. Apool with accessible entry into and exit from the water, including AS.2-2.3.3.4 (2) Public toilet rooms
handrails, ramps, and lifts a. Accessible public toilet rooms should be located near activity spaces.
g. Aclean and uncluttered deck area with aslip-resistant finish. The b. Provision for accommodating participant-operated mobility devices

area should be large enough to provide space for participant­ should be considered.

operated mobility devices and slower ambulation.lt also should be

AS.2-2.3.3.4 (3)(a) Changing are.as and storage
large enough to accommodate the activities offered, including space
lockers
for instructors and/or lifeguards and transition space for students
a. Private areaswith benches or other seating shQuld be provided for
attending classes.
dressing.
h. Readily accessible safety and water rescue equipment

b. The types of locks used should be chosen based on the population

i.. Speakers for music and other programming, where needed

served.

j. An (\ccessible Site, including:

~At least one building entrance accessible to people with dis­
abilities

274 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.2 SPECIFIC REQUIREMENTS FOR WELLNESS CENTERS

5.2-2.3.4 Participant Kitchen and Treatment Areas) for requirements in addition to

5.2-2.3.4.1 Where a participant kitchen is provided
to support nutrition planning, education, and
demonstrations, see Section 2.3-2.3.4 (Resident and
Participant Kitchen) for requirements.
5.2-2.3.4.2 Incorporation of a cafe, juice bar, or
facility for other for-sale items shall be permitted. See
Section 5.2-2.3.3.2 (Dining area) for requirements.
5.2-2.3.5 - 5.2-2.3.7 Reserved
5.2-2.3.8 Outdoor Activity Space
Where an outdoor activity space(s) is provided, see
Section 2.1-3.6.2 (Outdoor Activity Spaces) for
requirements.
those in this section.
5.2-3.2 Examination, Observation and/or
Treatment Rooms
Where examination, observation, and/or treatment
rooms are provided, see Section 2.3-3.2 (Examina­
tion, Observation and/or Treatment Rooms) for
requirements.
5.2-3.3 Reserved
5.2-3.4 Rehabilitation Therapy Areas
Where rehabilitation therapy services are provided,
the space shall comply with applicable requirements
in Chapter 5.3 (Specific Requirements for Outpatient
Rehabilitation Therapy Facilities).

*5.2-2.3.9 Retail Space 5.2-3.5 Waiting Areas

Where retail space is provided, layout shall allow for Waiting areas shall be provided based on the services
circulation of participants using participant-operated being delivered and participant waiting times required
mobility devices. See Section 5.2-2.3.3.2 (Dining for specific services or treatments.
Area) for food service venue requirements.

• *5.2-4 Facilities for Support

• 5.2-3 Diagnostic and Treatment

Services

Areas

5.2-4.1 General
5.2-3.1 General
See Section 2.3-4.1 (Facilities for Support Services­
Where diagnostic and treatment services are provided General) for requirements.
in the wellness center, see Section 2.3-3 (Diagnostic

APPENDIX

AS.2-2.3.9 Retail space. Location of retail spaces, including

-Where laundry is done on-site, washer(s) and dryer(s), folding
agift or sundries shop, should be considered in conjunction with the
areas, and storage should be provided, including exhaust for the
lobby and other recreation and activity areas.
dryer.
-Where acontract service is used and laundry is processed off­
AS.2-4 Additional facilities for support services
site, the following should be provided:
a. Support areas for staff

• Service entrance. This can be shared with other services

-Secured storage for personal belongings ofstaff members

and serve as the loading/maintenance area for the wellness

should be provided.

center.
-Showers and toilet rooms for staff should be provided and may
• Control station. Acontrol station for pickup and receiving
be shared with participant facilities.
can be shared with other services and serve as the service
b. Facilities for laundry or towel service. Provision of laundry accom­
receiving and pickup point for the wellness center.
modations should be considered unless the facility plans to use an
outside towel service for towels and linens.

Guidelines for Design and Construction of Residential Health. Care, and Support Facilities 275
5.2 SPECIFIC REQUIREMENTS FOR WElLNESS CENTERS

*5.2-4.2 Facilities that Support Participant Care 5.2-4.7 Materials Management Facilities

5.2-4.2.1 Staff Work Area(s)

5.2-4.7.1 See Section 2.3-4.7 (Materials Management
Staff work areas shall be provided to support the
Facilities) for requirements in addition to that in this
specinc services provided in the wellness center.
section.
Evaluation of staffing space needs shall be completed

as part of the functional programming process.

5.2-4.7.2 Sharing of materials management areas
with other health, care, and support facilities shall be
5.2-4.2.2 - 5.2-4.2.3 Reserved permitted.

5.2-4.2.4 Equipment and Supply Storage

5.2-4.8 Waste Management Facilities
See Section 2.3-4.2.4 (Equipment and Supply Storage)

5.2-4.8.1 See Section 2.3-4.8 (Waste Management

for requirements.

Facilities) for requirements for waste collection, stor­

age, and disposal.
5.2-4.3 - 5.2-4.4 Reserved
5.2-4.8.2 Sharing of waste collection, storage, and
5.2-4.5 Food Service Facilities
disposal facilities with other health, care, and support
facilities shall be permitted.
5.2-4.5.1 Commercial Kitchen

Where a commercial kitchen is provided, see Section

5.2-4.9 Environmental Services Rooms
2.3-4.5 (Food Service Facilities) for requirements.

5.2-4.9.1 See Section 2.3-4.9 (Environmental Services

5.2-4.5.2 Warming/Catering Kitchen Rooms) for requirements.

5.2-45.2.1 For wellness centers that have a service

5.2-4.9.2 Sharing of environmental services rooms
contract with an outside vendor for food service,
with other health, care, and support facilities shall be
provision of a warming/catering kitchen designed in
permitted.
accordance with the following requirements shall be

permitted.
5.2-4.10 Facilities for Engineering and Mainte­
nance Services
5.2-45.2.2 Where an outside vendor is used to

provide meals, the facility shall include dedicated space

5.2-4.10.1 See Section 2.3-4.10 (Facilities for Engi­
and equipment for a warming kitchen.
neering and Maintenance Services) for requirements.

5.2-45.2.3 Where food is prepared on-site, the facility

5.2-4.10.2 Sharing of facilities for engineering and
shall have dedicated non-public staff space and equip­
maintenance services with other health, care, and
ment for preparation of meals. See Section 2.3-4.5
support facilities shall be permitted.
(Food Service Facilities) for requirements.

*5.2-4.11 Administrative Areas

5.2-4.6 Reserved
Administrative areas shall be provided to support
the administrative services performed in the wellness
center as indicated by an evaluation of staffing needs.

AS.2-4.2 Equipment cleaning area. Provision ofaclean­ AS.2-4.11 Staff office. Provision ofastaff office adjacent to the

ing area for physical fitness and exercise room equipment should be reception area and copy/supply storage should be considered. See Sec­

conSidered; this would include asink or tub, ahand-washing station, and a tion 2.3-2.3.2 (Lobby) for additional recommendations.

drying area. Where il cart wash is provided in another part ofthe wellness
center, this space could also be used as an equipment cleaning area.
. _----_ _. __.._ _._--_. _-_ _--- _.._ - - ­
276 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.2 SPECIFIC REQUIREMENTS FOR WELLNESS CENTERS

• 5.2-5 Design and Construction

(3) Insect screens. See Section 2.4-2.2.4.3 (Insect

screens) for requirements.

Requirements

5.2-5.2.2.5 Thresholds and expansion joint covers.

5.2-5.1 Building Codes and Standards

See Section 2.4-2.2.5 (Thresholds and Expansion Joint

See Section 2.4-1.2 (Building Codes and Standards)
Covers) for requirements.
for requirements.

5.2-5.2.2.6 Windows. See Section 2.4-2.2.6

5.2-5.2 Architectural Details, Surfaces, and

(Windows) for requirements.

Furnishings

5.2-5.2.2.7 Glazing materials. See Section 2.4-2.2.7

5.2-5.2.1 General
(Glazing Materials) for requirements.
See Section 2.4-2.1 (Architectural Details, Surfaces,

and Furnishings-General) for requirements.

5.2-5.2.2.8 Hand-washing stations
(1) See Section 2.4-2.2.8 (Hand-Washing Stations) for
5.2-5.2.2 Architectural Details requirements.
(2) Omission of rhe mirror shall be permitted.
5.2-5.2.2.1 General. See Section 2.4-2.2.1
(Architectural Details-General) for requirements.
5.2-5.2.2.9 Grab bars
*(1) Grab bars shall be installed at all participant toilets,
5.2-5.2.2.2 Corridors. See Section 2.4-2.2.2
showers, and tubs.
(Corridors) for requirements.
(2) Alternative grab bar configurations. See Section

2.4-2.2.9.3 (Alternative grab bar configurations)

5.2-5.2.2.3 Ceiling height. See Section 2.4-5.2.2.3

for additional information.

(Ceiling Height) for requirements.

(a) Where independent transfers are feasible,

*5.2-5.2.2.4 Doors and door hardware
(1) Door type
(a) Doors to all rooms containing bathtubs,
showers, and toilets for participant use shall be
hinged, sliding, or folding.
(b) Manual or automatic sliding doors shall
be permitted where their use does not
compromise fire and other emergency exiting
requirements.
alternative grab bar configurations shall be
permitted.
(b) The care population shall be evaluated to
determine alternative grab bar configurations
that meet specific participant needs.
(3) For wall-mounted grab bars, a minimum clearance
of 1.5 inches (3.81 centimeters) from walls shall be
provided.
(4) Grab bar load requirements shall be evaluated for

alignment with the needs of the care population.

(2) Door openings. See Section 2.4-2.2.4.2 (Door

openings) for requirements.

(a) Grab bars, including those that are part of
fixtures such as soap dishes and toilet paper
APPENDIX

AS.2-S.2.2.4 Door protection. See appendix section A2.4­
2.2.4 (Door protection) for recommendations.
AS.2-S.2.2.9 (1 J Grab bars in toilet rooms
a. Grab bars rn toilet rooms should allow partidpants to be as safe and
a minimum clearance of 24 inches (60.96 centimeters) fr()m the
centerline of the toilet bowl to the wall to enable physical access
and maneuvering by staff, who may have to assist the partidpant in
wheelchair-to-toilet transfers and return.

c. Grab bars in toilet rooms should allow staff to complete atwo-per­

rndependent as possible. This includes using SWing-up grab bars,

son transfer for asingle partidpant. This includes evaluation ofthe

where needed, with or without integral toilet paper holder.

toilet in relation to the wall and the grab bars proVided. Clearance is

b. If partidpants who require a physical lift by two staff members

required on both sides of the toilet for adouble transfer to occur.

are served at the fadlity, toilets used by partidpants should have

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 277
5.2 SPECIFIC REQUIREMENTS FOR WElLNESS CENTERS
holders, shall have the strength to sustain
a concentrated load of 250 pounds (113.4
kilograms).
(b) If a population includes persons of size, grab
bars installed in areas intended for use by
persons of size shall be anchored to sustain a
minimum concentrated load of 800 pounds
(362.88 kilograms).
(5) Grab bars shall have a finish color with a value that
contrasts with the adjacent wall surface.
(6) Grab bars shall be returned to the wall or floor
with eased corners where a mitered corner
condition exists.
5.2-5.2.2.10 Handrails. See Section 2.4-2.2.10
(Handrails and Lean Rails) for requirements.
5.2-5.2.2.11 Protection from heat-producing
equipment. See Section 2.4-2.2.11 (Protection from
Heated Surfaces) for requirements.
5.2-5.2.2.12 Signage and wayfinding. See Section
2.4-2.2.12 (Signage and Wayfinding) for requirements.
5.2-5.2.2.13 Decorative water features. Where
decorative water features are used in the facility design,
see appendix section A2.4-2.2.13 (Decorative water
features) for recommendations.
5.2-5.2.3 Surfaces
See Section 2.4-2.3 (Surfaces) for requirements.
5.2-5.2.4 Furnishings
See Section 2.4-2.4 (Furnishings) for requirements.
• 5.2-6 Building Systems
5.2-6.1 General
See Section 2.5-1 (Building Systems-General) for
requirements.
5.2-6.2 Plumbing Systems
5.2-6.2.1 General
See Section 2.5-2.1 (Plumbing Systems-General) for
requirements.
278 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
5.2-6.2.2 Plumbing and Other Piping Systems
See Section 2.5-2.2 (Plumbing and Other Piping
Systems) for requirements.
5.2-6.2.3 Plumbing Fixtures
5.2-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
Fixtures-General) for requirements.
5.2-6.2.3.2 Hand-washing sinks. See Section
2.5-2.3.2 (Hand-Washing Sinks) for requirements.
5.2-6.2.3.3 Showers. See Section 2.5-2.3.3.2
(Accessible showers) for requirements.
5.2-6.2.3.4 Reserved
5.2-6.2.3.5 Clinical sinks. Where clinical sinks are
provided in a wellness center, see Section 2.5-2.3.5
(Clinical Sinks) for requirements.
5.2-6.2.3.6 Portable hydrotherapy whirlpools.
Where portable hydrotherapy whirlpools are used in a
wellness center, see Section 2.5-2.3.6 (Portable Hydro­
therapy Whirlpools) for requirements.
5.2-6.3 Heating, Ventilation, and
Air-Conditioning (HVAC) Systems
5.2-6.3.1 General
5.2-6.3.1.1 Application. For basic HVAC system
requirements for wellness centers, see ANSIIASHRAE
Standard 62.1: Ventilation for Acceptable Indoor Air
Quality.
5.2-6.3.1.2 Ventilation and space conditioning. See
Section 2.5-3.1.2 (Ventilation and Space Condition­
ing) for requirements.
5.2-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
5.2-6.3.3 HVAC Requirements for Specific
Locations
 5.2 SPECIFIC REQUIREMENTS FOR WELLNESS CENTERS

5.2-6.3.3.1 Participant and related support areas. (2) For non-central recirculating room systems, HVAC
See ANSIIASHRAE Standard 62.1: Ventilation for units shall:
Acceptable Indoor Air Quality for basic HVAC system
(a) Not receive nonfiltered, nonconditioned
requirements.
outdoor air.
(b) Serve only a single space.
5.2-6.3.3.2 Fuel-fired equipment rooms. Where
*(c) Include the manufacturer's recommended filter
rooms with fuel-fired equipment are provided, see
for airflow passing over any surface that is
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
designed to condense water. This filter shall be
requirements.
located upstream of any such cold surface so
that all of the air passing over the cold surface
5.2-6.3.3.3 Areas of refuge. Where areas of refuge are
is filtered.
provided, see Section 2.5-3.3.3 (Areas of Refuge) for
requirements.
5.2-6.3.7 Heating Systems, Cooling Systems, and
Equipment
5.2-6.3.3.4 Commercial food preparation areas.

Where commercial food preparation areas are

See Section 2.5-3.7 (Heating Systems, Cooling
provided, see Section 2.5-3.3.4 (Commercial Food
Systems, and Equipment) for in addition to those in
Preparation Areas) for requirements.
this section.

*5.2-6.3.4 Thermal and Acoustic Insulation
See Section 2.5-3.4.1 (Thermal and Acoustic Insula­
tion-General) for requirements.
5.2-6.3.7.1 Heating systems. Wellness centers shall
have a permanently installed heating system capable of
maintaining an interior minimum temperature of 72°
F (22° C) under heating design temperatures.

5.2-6.3.5 HVAC Air Distribution

5.2-6.3.7.2 Cooling systems. Wellness centers shall be
See Section 2.5-3.5 (HVAC Air Distribution) for
configured and equipped with a cooling system capa­
requirements.
ble of maintaining an interior maximum temperature
of 75° F (24° C) under cooling design temperatures.
5.2-6.3.6 HVAC Filters
5.2-6.4 Electrical Systems
5.2-6.3.6.1 General. See ANSIIASHRAE Standard
62.1: Ventilation for Acceptable Indoor Air Quality for
5.2-6.4.1 General
requirements.

See Section 2.5-4.1 (Electrical Systems-General) for

requirements.
5.2-6.3.6.2 Filter efficiencies
(1) For centralized recirculated systems, MERV 7 5.2-6.4.2 Power-Generating and Storing
shall be the minimum filter efficiency for the first Equipment
filter bank. There is no minimum filter efficiency
requirement for the second filter bank.

APPENDIX

AS.2-6.3.4 Thermal and acoustic insulation AS.2-6.3.6.2 (2)(c) Filters for recirculating room
a. See ASH RAE 90.1: Energy Standard for Buildings Except Low-Rise
systems. Fi.!ters should be replaced and/or cleaned per the
Residential Buildings for more information.
manufacturer's recommendations to maintain indoor air quality.
b. Provisions for ~coustic insulation should meet or exceed local

building code requirements.

c. Consideration should be given to construction of demising walls

and floors in a manner that provides for speech privacy between

occupied spaces and between floors.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 279
5.2 SPECIFIC REQUIREMENTS FOR WEllNESS CENTERS

5.2-6.4.2.1 Essential electrical service 5.2-6.5.3 Technology Equipment and Teledata

(1) Well ness centers rhat require essential electrical
Rooms(s)
systems shall comply with the appropriate

occupancy requirements ofNFPA 101: Life Safety

5.2-6.5.3.1 General
Code
(1) See Section 2.5-5.3.1.1 (Technology Equipment
(2) As required by local codes and the care types, an
and Teledata Room-Purpose) for requirements.
essential electrical source shall provide emergency
(2) Number. Each wellness center shall have a room or
lighting and/or power during an interruption of
closet to accommodate technology systems used in
the normal electrical supply.
the facility.

5.2-6.4.2.2 Generators. Where generators are used in

5.2-6.5.3.2 Size. See Section 2.5-5.3.2 (Size) for
a wellness center, exhaust systems (including locations,
requirements.
mufflers, and vibration isolators) for internal combus­

tion engines shall be designed and installed to mini­

5.2-6.5.3.3 Location and access. See Section
mize objectionable noise.
2.5-5.3.3 (Location and Access) for requirements.

5.2-6.4.3 Electrical Receptacles 5.2-6.5.3.4 Technology equipment room facilities.

See sections 2.5-4.3.1,2.5-4.3.2,2.5-4.3.4, and 2.5­ See Section 2.5-5.3.4 (Technology Equipment Room
4.3.5 in Section 2.5-4.3 (Electrical Receptacles) for
Facilities) for requirements.
requirements.

5.2-6.6 Electronic Safety and Security Systems

5.2-6.5 Communication Systems See Section 2.5-6 (Electronic Safety and Security
Systems) for requirements.
5.2-6.5.1 General
See Section 2.5-5.1 (Communication Systems­ 5.2-6.7 Daylighting and Artificial Lighting
General) for requirements. Systems

5.2-6.7.1 General
*5.2-6.5.2 Call System
See Section 2.5-7.1 (Daylighting and Artificial Light­
Where call systems are provided, use of alternative
ing Systems-General) for requirements.
technologies, including wireless systems, shall be
permitted.
5.2-6.7.2 Daylighting Systems in Participant
Areas
5.2-6.5.2.1 Where wireless systems are used, consid­

eration shall be given to electromagnetic compatibility

See Section 2.5-7.2 (Daylighting Systems in Resident
between internal and external sources.
Living, Participant, and Outpatient Areas) for
requirements.
5.2-6.5.2.2 Wireless systems shall comply with UL

Standard 2560: Emergency Call Systems for Assisted

5.2-6.7.3 Artificial Lighting Systems
Living and Independent Living Facilities.

5.2-6.7.3.1 Light fixtures. See Section 2.5-7.3.1

(Light Fixtures) for requirements.

APPENDIX

AS.2-«).S.2Em~rgell<;Ycelli $ys,tem rooms or pool areas, and any other space with ahigh risk of partici­
a. (orilmunityspaces should be evaluated for provision ofan emer­
pant falls.
gency call system at each public toilet room, shower room in locker
b. Emergency call systems should comp.ly with Ul2560: Emergency Call
Systems for Assisted Livin9 and Independent LivingJacilities.

280 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.2 SPECIFIC REQUIREMENTS FOR WELlNESS CENTERS

*5.2-6.7.3.2 Lighting requirements for specific loca­ required where spaces used by participants are on
tions. See appendix section A2.5-7.3.2 (Lighting in any floor other than the main entrance floor.
transition spaces) for recommendations. (2) Where a wellness center is part of a general
(1) Reserved hospital, the hospital's elevators shall be permitted
(2) Participant toilet rooms to meet the requirement in Section 5.2-6.9.1.1
(Application) .
(a) Toilet rooms shall have general lighting and
task lighting. 5.2-6.9.2 Dimensions and Clearances
(b) Task light controls shall be readily accessible to
Elevator car doors shall have a clear opening of not less
participants.
than 3 feet 8 inches (1.12 meters).

5.2-6.8 Acoustic Design Systems

5.2-6.9.3 Leveling Device
See Section 2.5-8 (Acoustic Design Systems) for

See Section 2.5-9.3 (Leveling Device) for

requirements.

requirements.

5.2-6.9 Elevator Systems

5.2-6.9.4 Installation and Testing

5.2-6.9.1 General See Section 2.5-9.4 (Installation and Testing) for

requirements.
5.2-6.9.1.1 Application. All buildings having

participant or staff use areas on more than one floor

5.2-6.9.5 Handrails
shall have an electric or hydraulic elevator(s).

5.2-6.9.5.1 Elevator cars shall have handrails on all

*5.2-6.9.1.2 Number. Engineered traffic studies are rec­ sides without entrance door(s).
ommended, but in their absence the following guide­
lines for minimum number of elevators shall apply: 5.2-6.9.5.2 See Section 2.4-2.2.10 (Handrails and
Lean Rails) for additional requirements.
(1) At least one elevator sized to accommodate
participant-operated mobility device users shall be

APPENDIX

AS.2-6.7.3.2 Lighting for corridors. Corridors used by AS.2-6.9.1.2 These standards may be inadequate for moving large
participants should have even light distribution to avoid glare, shadows, numbers of people in ashort time; adjustments should be made as
and scalloped lighting effects. See appendix section A2.4-2.1.2.2 (1) appropriate.
(Environmental factors and falls) for additional information.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 281
 5.3 Specific Requirements for Outpatient
Rehabilitation Therapy Facilities
Appendix material, shown in shaded boxes at the bottom ofthe page, is advisory only.

• 5.3-' General 5.3-1.1.2.2 Design criteria for accommodations for

Care of persons of size. Where the care population
The requirements in this chapter shall be met in any
includes persons of size, see Section 2.2-3 (Design
location where rehabilitation therapy services are
Criteria for Accommodations for Care of Persons of
provided.
Size) for requirements.

5.3-1.1 Application
5.3-1.1.1 General
*5.3-1.1.1.1 This chapter applies to facilities where
outpatient rehabilitation services and therapies are
provided.
5.3-1.1.1.2 The common elements in Part 2 of the
Guidelines for Residential Care Facilities shall apply to
outpatient rehabilitation therapy facilities where they
are referenced in this chapter.
5.3-1.1.2 Design Criteria
5.3-1.1.2.1 Sustainable design. See Section 2.2-2
(Sustainable Design Criteria) for requirements for
outpatient rehabilitation therapy facilities.
APPENDIX
5.3-1.1.2.3 Dementia, mental health, and cognitive
and developmental disability design criteria.
Where the care population includes outpatients
with dementia, mental health issues, or cognitive
and developmental disabilities, see Section 2.2-4
(Design Criteria for Dementia, Mental Health, and
Cognitive and Development Disability Facilities) for
requirements.
5.3-1.2 Functional Program
5.3-1.2.1 See Section 1.2-2 (Functional Program) and
Section 1.2-3 (Resident Safety Risk Assessment) for
requirements.
5.3-1.2.2 Shared Services and Space

AS.3-1.1.1.1 Outpatient rehabilitation facilities may be -Recreation therapy. Recreation therapy assists outpatients in
freestanding or attached to a residential health, care, or support facility. the development and maintenance of community living skills
Rehabilitation therapy is primarily intended to restore body functions. through the use of leisure-time activity tasks. These activities
In mental health facilities, it may be used to diagnose and treat mental may occur in arecreation therapy area, specialized facilities
functions and to address physical functions to varying degrees. In both (e.g., a gymnasium), a multipurpose space in another area, or
cases, one or several categories of services may be offered. outdoors.
The therapies and services offered in an outpatient rehabilitation -Education therapy
therapy program may include the following: -Vocational therapy. Vocational therapy assists outpatients in the
a. Physical therapy
development and maintenance of productive work and interac­
-Ultrasonics
tion skills through the use of work tasks. These activities may
-Hydrotherapy
occur in an industrial therapy workshop, in another department,
-Thermotherapy
or outdoors.
-Diathermy
-Other occupational therapy activities. Occupational therapy may
b. Speech and hearing therapy include such activities as woodworking, leather-tooling, art,
c. Occupational therapy
needlework, painting, sewing, metalwork, and ceramics.
-Activities of daily living therapy
d. Prosthetics and orthotics

Guidelines for Design and Construction of Residential Health. Care. and Support Facilities
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES
*5.3-1.2.2.1 Where an outpatient rehabilitation
therapy faciliry is part of (or contractually linked with)
another faciliry, sharing of services and space for home
health, dietary, storage, pharmacy, linen, and other
services shall be permitted insofar as practical.
5.3-1.2.2.2 Where a project calls for sharing or
purchasing services from another entiry, appropriate
modifications in the requirements for space and park­
ing shall be permitted.
5.3-1.2.2.3 An outpatient rehabilitation faciliry
located in a faciliry housing other services shall have its
own identifiable space.
5.3-1.2.2.4 All support spaces shall be permitted to be
shared.
*5.3-1.3 Environment of Care Requirements
See Section 1.2-1.3 (Environment of Care and Faciliry
Function Considerations) and Section 1.2-4 (Environ­
ment of Care Requirements) for requirements.
5.3-1.4 Site
5.3-1.4.1 General
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site
Elements) for requirements.
5.3-1.4.2 Facility/Community Access
APPENDIX
A5.3-1.2.2.1 Shared services and space. In some cases,
ancillary service requirements will be met by the principal facility and
the only modifications necessary will be in the support facility. In other
cases, programmatic concerns and requirements may dictate separate
service areas.
A5.3-1.3 Environment of care. Person-centered care in
the long-term continuum of care should address movement away
from institutional models toward models that are more residentially
scaled, facilitate wayfinding, and provide acomfortable environment
for the population served through provision of appropriate lighting and
acoustics.
a. Outpatient rehabilitation therapy facilities should be designed
A5.3-1.4.2.1 Emergency access. Other vehicular or
to provide flexibility to meet the changing needs of the care
pedestrian traffic should not conflict with access for emergency vehicles.
population(s) served and the types of care services provided.
-----------
284 Guidelines for Design and Construction of Residential Health. Care. and Support Facilities
*5.3-1.4.2.1 Emergency access. Fire department and
emergency vehicle access shall be provided in accor­
dance with local requirements.
5.3-1.4.2.2 Availability of transportation. See 2.1­
2.2 (Availabiliry ofTransportation) for requirements.
5.3-1.4.2.3 Security. See Section 2.1-2.3 (Securiry)
for requirements.
5.3-1.4.2.4 Access to utilities. See Section 1.3-2.4
(Access to Utilities) and Section 2.1-2.4 (Access to
Utilities) for requirements.
5.3-1.4.3 Site Features
5.3-1.4.3.1 Roads. See Section 2.1-3.1 (Roads) for
requirements.
5.3-1.4.3.2 Pedestrian walkways. Accessible paved
walkways shall be provided for pedestrian traffic.
5.3-1.4.3.3 Par10Utg
(1) In the absence of local requirements, each faciliry
shall have parking spaces to satisfy the needs of
users, staff, and visitors.
(2) Reduction of parking requirements shall be
permitted, as acceptable to local authorities having
jurisdiction (AH]s).
5.3-1.4.3.4 Signage and wayfinding. See Section
1.2-4.5.3 (Signage and Wayfinding) and Section 2.4­
2.2.12 (Signage and Wayfinding) for requirements.
b. The facility design should produce asupportive environment to
enhance and extend quality of life for facility users and promote
their privacy and dignity while they receive care and services.
c. Facility design should maximize opportunities for ambulation and
minimize the negative aspects of an institutional environment.
d. The architectural environment should eliminate as many barriers
to effective access to and use of space, services, equipment, and
utilities as possible.
e. Facilities should provide accessibility for outpatients with disabilities
in accordance with the state or local bUilding code and the
Americans with Disabilities Act.
 5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES
5.3-1.4.3.5 Site lighting. See Section 2.1-3.5 (Site
Lighting) for requirements.
5.3-1.4.3.6 Landscape features
(1) General. See Section 1.2-4.5.1 (Light) and Section
1.2-4.5.2 (Views of and Access to Nature) for
requirements.
(2) Outdoor water features. See Section 2.1-3.6.3
(Outdoor Water Features) for requirements.
5.3-1.4.4 Building Orientation
See Section 1.2-2.2.2.2 (1) (Site) and Section 2.2-2.1
(Sustainable Site Design) for requirements.
• 5.3-2 Outpatient Areas
5.3-2.1 General
See Section 2.3-2.3.1 (Resident, Participant, and
Outpatient Areas-General) for requirements.
5.3-2.2 Reserved
5.3-2.3 Outpatient Community Areas
5.3-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant, and
Outpatient Community Areas-General) for
requirements.
5.3-2.3.2 Lobby
Where an outpatient rehabilitation facility has a sepa­
rate entrance and lobby, see Section 2.3-2.3.2 (Lobby)
for requirements.
5.3-2.3.3 Outpatient Waiting Areas
5.3-2.3.3.1 Size. The waiting room capacity needed
for each therapy provided shall be based on the care
population being served.
5.3-2.3.3.2 Location. Outpatient waiting area(s) shall
be located out of traffic with provisions for wheelchairs
and other outpatient-operated mobility devices.
APPENDIX
AS.3-2.3.4 Outpatient therapy kitchen. Examples
of outpatient therapy kitchen facilities include acountry kitchen
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
5.3-2.3.3.3 Provisions for drinking water. A drink­
ing water source shall be provided for outpatient use.
*5.3-2.3.4 Outpatient Therapy Kitchen
Where kitchen facilities with an operating kitchen
(rather than a mock-up for therapy only) are provided,
the following requirements shall apply:
5.3-2.3.4.1 Purpose. Design of the outpatient therapy
kitchen to support cooking activities used for occupa­
tional and physical therapy shall be permitted:
5.3-2.3.4.2 Where provided, outpatient therapy
kitchen facilities shall include the following:
(1) Work counter
(2) Refrigerator
(3) Storage cabinets
(4) Sink
(5) Range, cooktop, and/or oven wirh emergency
shutoffs. Provision of a functional cooking
appliance shall be permitted.
(6) Dishwasher
(7) Hand-washing station. This shall be located in or
immediately accessible from the therapy kitchen
facilities. See Section 2.4-2.2.8 (Hand-Washing
Stations) for requirements.
5.3-2.3.5 - 5.3-2.3.7 Reserved
5.3-2.3.8 Outdoor Activity Spaces
See Section 2.1-3.6.2 (Outdoor Activity Spaces) for
requirements.
• 5.3-3 Diagnostic and Treatment
Areas
5.3-3.1 General
5.3-3.1.1 See Section 2.3-3.1 (Diagnostic and
Treatment Areas-General) for requirements in
addition to those in this section.
or residential kitchen for continued or improved involvement in
instrumental activities of daily living.
285
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES
5.3-3.1.2 Where two or more rehabilitation therapies
and services are provided, sharing of facilities and
equipment between the therapies and services shall be
permitted.
5.3-3.2 Physical/Occupational Therapy Rooms
5.3-3.2.2.3 Hand-washing station(s) shall be provided.
and Areas
(1) Hand-washing stations shall be permitted to serve
5.3-3.2.1 General
5.3-3.2.1.1 Where physical and/or occupational
therapy is offered, the requirements in this section
5.3-3.2.3 Education and Vocational Therapy
shall be met.
Classroom
5.3-3.2.1.2 Space shall be provided for carrying out
each type of therapy and service provided. Space shall
be permitted to be shared with another function.
5.3-3.2.2 Therapy Areas
5.3-3.2.2.1 Individual therapy room
(1) Where an individual therapy room(s) is provided,
it shall meet the requirements in this section.
*(2) Space requirements shall be based on the
equipment used for therapy. Space provided shall
allow access to the equipment when in use by the
outpatient and the therapist.
(a) Area
(i) An individual therapy room shall have a
minimum clear floor area of 80 square feet
(7.43 square meters).
(ii) For design criteria for accommodations for
care of persons of size, see Section 2.3­
3.2.2.1 (2) (Examination and Treatment
Room Space Requirements-Area) for
requirements.
(b) Clearances. Room arrangement shall permit a
minimum clearance of 2 feet 8 inches (81.28
centimeters) on at least three sides of the
therapy furniture and equipment.
APPENDIX
AS•.3-3.2.2.1 (2) Therapy room space
requirements. Depending on the care population, most therapy
spaces may need to be larger than 80 square feet (7.43 square meters)
._ - - - - - - - - - _ . _ - - - - - - - - - - - - - - - - - - - - - - - - - - - ­
286 Guidelines for Design and Construction of Residential Health. Care. and Support Facilities
5.3-3.2.2.2 Individual therapy area. Where indi­
vidual therapy areas are provided in a larger therapy or
exercise area, each therapy space shall have a minimum
clear floor area of 80 square feet (7.43 square meters).
several therapy spaces.
(2) See Section 2.4-2.2.8 (Hand-Washing Stations) for
requirements.
5.3-3.2.3.1 Where retraining, educational, or small
group therapies are provided for outpatients, at least
one classroom shall be provided.
5.3-3.2.3.2 Space requirements
(1) Each classroom shall provide 30 square feet (2.79
square meters) per outpatient in addition to space
for the instructor and instructional resources.
(2) At minimum, each classroom shall have an area of
150 square feet (13.94 square meters).
5.3-3.2.4 Physical Therapy Exercise Area
5.3-3.2.4.1 General. A physical therapy exercise area
shall be permitted to be shared with other fitness train­
ing spaces, based on the services being provided and
the setting (e.g., a stand-alone facility versus one that is
part of a continuing care retirement community).
5.3-3.2.4.2 Space requirements
(1) The layout of the exercise area shall include a staff
work area arranged so that staff can view activi ties
taking place in the exercise area.
(2) An open, barrier-free space for rehab therapy shall
be provided based on the following:
(a) Number of patients treated at the same time
(b) Number of staff members present at the same
time
(c) Clearance requirements for equipment used
to accommodate outpatients using mobility devices. For additional
information, see Section 2.3-3.2.2.2 (Examination and Treatment Room
Space Requirements-Clearances).
 5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES

5.3-3.2.4.3 Hand-washing station. At least one [ *5.3-3.2.6.3 Pool storage. Separate storage for pool
hand-washing station shall be provided in the exercise chemicals and testing equipment shall be provided.
area. See Section 2.4-2.2.8 (Hand-Washing Stations) Pool chemicals and supplies shall not be stored in an
for requirements. environmental services room.

5.3-3.2.5 Outpatient Privacy 5.3-3.3 Outpatient Care Areas

5.3-3.2.5.1 See Section 2.3-3.2.3 (Resident, Partici­ 5.3-3.3.1 Prosthetics and Orthotics Area
pant, and Outpatient Privacy) for requirements in Where space for evaluation and fitting of prosthetics
addition to those in this section. and orthotics is provided, it shall meet the require­
ments in this section.
5.3-3.2.5.2 Windows in therapy rooms or areas shall
have window treatments to provide outpatient privacy. 5.3-3.3.1.1 Privacy. Space for evaluation and fitting
of prosthetics and orthotics shall have provision for
5.3-3.2.5.3 Where multiple therapies occur in an privacy.
exercise or therapy area, individual therapy spaces shall
have provisions for privacy. 5.3-3.3.1.2 Hand-washing station
(1) If staff is required to work with or mix wet material
[ *5.3-3.2.6 Therapeutic Pool
or handle material or chemicals that are caustic to
the skin, a hand-washing station and an eyewash
5.3-3.2.6.1 Space requirements. Where therapy
station shall be provided.
services include use of a pool, the pool shall be large
(2) If staff is not required to work with or mix wet
enough to accommodate the number of patients to be
material or handle material or chemicals that are
served at one time.
caustic to the skin, provision of a hand sanitation
dispenser or a hand-washing station shall be
5.3-3.2.6.2 Outpatient changing area. An outpatient
permitted.
changing area shall be provided where therapy services
include use of a pool.
5.3-3.3.1.3 Clinical sink. Where running water is
needed for materials preparation in the prosthetic and
(1) The outpatient changing area shall consist of single
orthotic areas, a clinical sink(s) shall be provided in
unisex rooms or a locker room to service multiple
accordance with Section 2.5-2.3.5 (Clinical Sinks).
people of the same sex.
(2) The outpatient changing area shall be directly
5.3-3.3.2 Speech and Hearing Area
accessible to the pool without entering public or
exercise areas.
5.3-3.3.2.1 Application. Where speech and hearing
(3) A toilet room shall be provided that is directly

therapies are offered, room(s) that meet the require­

accessible to the changing area.

ments in this section shall be provided.

(4) At least one shower shall be provided separate from
the toilet room.
5.3-3.3.2.2 Space requirements. Speech and hearing
(5) Securable lockers shall be provided.
therapy rooms shall have a clear floor area of 80 square
feet (7.43 square meters).
APPENDIX

AS.3-3.2.6 Therapeutic pool. Where atherapeuticpoo] is AS.3-3.2.6.3 Pool chemical storage. See the

provided, consider complying with the Arthritis Foundation Aquatics Environmental Protection Agency publication "Safe Storage and

Facility GUidelines. Also refer to the CDC Web page "Design and Operation Handling of Swimming Pool Chemicals"for more information.

of Pools and HotTubs"for additional information. Also see appendix

section A5.2-2333 (3) (Aquatic center) for information on aquatic
facilities.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 287
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIEN-T REHABILITATION THERAPY FACILITIES
5.3-3.3.2.3 Speech privacy
(1) A gasketed door with a sweep shall be provided in
speech and hearing room(s)
(2) The room design shall minimize external sound
from high-traffic, public, and similarly noisy areas.
5.3-3.3.2.4 Hand-washing station or hand
sanitation dispenser. A hand-washing station shall be
provided in speech and hearing room(s).
[ *5.3-3.3.3 Facilities for Other Therapy Services
5.3-3.3.3.1 Where other services are provided, dedi­
cated diagnostic and treatment area(s) to accommodate
those services shall be provided, including work space
for therapists.
5.3-3.3.3.2 Hand-washing station
(1) A hand-washing station shall be provided for any
additional therapy rooms provided.
(2) Where additional areas are shared with other
therapy areas, a hand-washing station shall also be
permitted to be shared with those areas.
• 5.3-4 Facilities for Support Services
5.3-4.1 General
See Section 2.3-4.1 (Facilities for Support Ser­
5.3-4.2.4.2 Storage for therapeutic equipment and
vices-General) for functional, size, and location
safety devices. Designated storage for therapeutic
requirements.
equipment, safety devices, and other clinical supplies
5.3-4.2 Facilities that Support Outpatient Care
5.3-4.2.1 Staff Work Area(s)
5.3-4.2.1.1 See Section 2.3-4.2.1 (Staff Work Area)
for requirements in addition to those in this section.
*5.3-4.2.1.2 Documentation area. Accommodations
for written and/or electronic documentation shall be
provided in all therapy service areas.
APPENDIX
AS.3-3.3.3 Additional therapy services. These services
may include social services, psychological services, and vocational
services.
288 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
5.3-4.2.2 Reserved
5.3-4.2.3 Central Bathing Rooms or Areas
5.3-4.2.3.1 General. Where therapy services provided
include a focus on residential activities of daily living,
including bathing, a mock-up or real residential-style
bathroom shall be provided for therapy activities.
5.3-4.2.3.2 Outpatient changing areas. Where
required by the therapy program, the following shall
be provided:
(1) Changing areas
(2) Toilets
(3) Showers
(4) Securable lockers
5.3-4.2.3.3 Toilet room. A toilet room with space for
toilet training for outpatients shall be provided.
5.3-4.2.4 Equipment and Supply Storage
5.3-4.2.4.1 Clean and soiled linen storage
(1) Storage for clean linen and towels shall be provided
in cabinets, closets, or separate storeroom(s) .
(2) Separate storage for soiled linen, towels, and
supplies shall be provided.
shall be provided for the following areas when they are
part of the clinical services offered by the facility:
(1) Exercise area(s)
(2) Therapy room(s) and therapy area(s)
(3) Pool area(s)
(4) Prosthetic, orthotic, speech, hearing, or other
clinical services
5.3-4.2.5 - 5.3-4.2.6 Reserved
5.3-4.2.7 Personal Laundry Facilities
Where the therapy services provided include washing
laundry, folding clothing, and other laundry-related
AS.3-4.2.1.2 Documentation area. Accommodations
should include awriting surface and/or area with storage for an
electronic device.
 5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES
activities of daily living, the outpatient setting shall
include a washer and a dryer.
5.3-4.3 Support Areas for Staff
See Section 2.3-4.3.1 (Support Areas for Staff­
General) for requirements.
5.3-4.4 Support Areas for Family and Visitors
5.3-4.4.1 - 5.3-4.4.2 Reserved
5.3-4.4.3 Pet Accommodations
Where pet therapy is offered in the outpatient
rehabilitation facility, see Section 2.3-4.4.3 (Pet
Accommodations) for requirements.
5.3-4.5 Reserved
5.3-4.6 Linen and Laundry Service Facilities
Where a contract service is used in lieu of the facili­
ties in Section 5.3-4.2.7 (Personal Laundry Facilities)
and linen is processed off-site, the following shall be
provided:
5.3-4.6.1 Service Entrance
A service entrance, protected from inclement weather,
shall be provided for loading and unloading of linen.
This can be shared with other services and serve as the
loading dock for the facility.
5.3-4.6.2 Control Station
A control station for pickup and receiving shall be
provided. This can be shared with other services and
serve as the service receiving and pickup point for the
facility.
5.3-4.7 Materials Management Facilities
5.3-4.7.1 See Section 2.3-4.7 (Materials Management
Facilities) for requirements.
5.3-4.7.2 Sharing of materials management areas
with other health, care, and support facilities shall be
permitted.
5.3-4.8 Waste Management Facilities
-----------------------------------------------_.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
5.3-4.8.1 See Section 2.3-4.8 (Waste Management
Facilities) for waste collection, storage, and disposal
requirements.
5.3-4.8.2 Sharing of waste collection, storage, and
disposal facilities with other health, care, and support
facilities shall be permitted.
5.3-4.9 Environmental Services Rooms
5.3-4.9.1 See Section 2.3-4.9 (Environmental Services
Rooms) for requirements.
5.3-4.9.2 Sharing of environmental services rooms
with other health, care, and support facilities shall be
permitted.
5.3-4.10 Facilities for Engineering and
Maintenance Services
5.3-4.10.1 See Section 2.3-4.10 (Facilities for Engi­
neering and Maintenance Services) for requirements.
5.3-4.10.2 Sharing of facilities for engineering and
maintenance services with other health, care, and
support facilities shall be permitted.
5.3-4.11 Administrative Areas
Administrative areas shall be provided to support the
administrative services performed in the outpatient
rehabilitation center as indicated by an evaluation of
staffing needs.
5.3-4.11.1 Office Space
5.3-4.11.1.1 Staff office space and file storage shall be
provided based on the staff required to operate and
provide therapy services.
5.3-4.11.1.2 Reception shall be permitted to be com­
bined with office and clerical space.
5.3-4.11.2 Equipment and Supply Storage
Space for storage of office equipment and supplies shall
be provided based on staff requirements and outpa­
tient needs.
289
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES

• 5.3-5 Design and Construction

(3) Insect screens. See Section 2.4-2.2.4.3 (Insect

screens) for requirements.

Requirements

5.3-5.2.2.5 Thresholds and expansion joint covers.

5.3-5.1 Building Codes
See Section 2.4-2.2.5 (Thresholds and Expansion Joint
See Section 2.4-1.2 (Building Codes and Standards)
Covers) for requirements.
for requirements.

5.3-5.2.2.6 Windows. See Section 2.4-2.2.6 (Win­

5.3-5.2 Architectural Details, Surfaces, and

dows) for requirements.

Furnishings

5.3-5.2.2.7 Glazing materials. See Section 2.4-2.2.7

5.3-5.2.1 General See Section 2.4-2.1 (Architectural (Glazing Materials) for requirements.
Details, Surfaces, and Furnishings-General) for
requirements. 5.3-5.2.2.8 Hand-washing stations
(1) See Section 2.4-2.2.8 (Hand-Washing Stations) for
5.3-5.2.2 Architectural Details
requirements.
(2) Omission of the mirror shall be permitted.
5.3-5.2.2.1 General. See Section 2.4-2.2.1 (Architec­
tural Details-General) for requirements.
5.3-5.2.2.9 Grab bars
5.3-5.2.2.2 Corridors. See Section 2.4-2.2.2 (Corri­ *(1) Grab bars shall be installed at all outpatient toilets,
dors) for requirements. showers, and tubs.
(2) Alternative grab bar configurations. See Section

5.3-5.2.2.3 Ceiling height. See Section 2.4-2.2.3

2.4-2.2.9.3 (Alternative grab bar configurations)

(Ceiling Height) for requirements.

for additional information.

(a) Where independent transfers are feasible,

*5.3-5.2.2.4 Doors and door hardware
(1) Door type
(a) Doors to all rooms containing bathtubs,
showers, and toilets for outpatient use shall be
hinged, sliding, or folding.
(b) Manual or automatic sliding doors shall
be permitted where their use does not
compromise fire and other emergency exiting
requi rements.
(2) Door openings. See Section 2.4-2.2.4.2 (Doot
alternative grab bar configurations shall be
permitted.
(b) The care population shall be evaluated to
determine alternative grab bar configurations
that meet specific outpatient needs.
(3) For wall-mounted grab bars, a minimum clearance
of 1.5 inches (3.81 centimeters) from walls shall be
provided.
(4) Grab bar load requirements shall be evaluated for
alignment with the needs of the care population.

openings) for requirements.

(a) Grab bars, including those that are part of
fixtures such as soap dishes and toilet paper

APPENDIX

AS.3-S.2.2.4 Door protection. See appendix section a minimum clearance of24 inches .(60.% centimeters) from the
A2.4-2.2.4 (Door protection) for recommendations. centerline of the toilet bowl to the wa.1I to enable physical access
and maneuvering by staff, who may have to assist the outpatient in
AS.3-S.2.2.9 (1) Grab bars in toilet rooms
wheelchair-to-toilet transfers and return.
a. Grab bars in toilet rooms should allow outpatients to be as safe and
c. Grab bars in toilet rooms should allow staff to complete a two-per­

independent as possible. This includes using swing-up grab bars,

son transfer for asingle outpatient. This includes evaluationofthe

where needed, with or without integral toilet paper holder.

toilet in relation to the wall and the grab bars provided. Clearance is

b. If outpatients who require a physical lift by two staff members

required on both sides of the toilet for adouble transfer to occur.

are served at the facility, toilets used by outpatients should have

290 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES

holders, shall have the strength to sustain • 5.3-6 Building Systems

a concentrated load of250 pounds (113.4
kilograms). 5.3-6.1 General
(b) If a population includes persons of size, grab
See Section 2.5-1 (Building Systems-General) for
bars installed in areas intended for use by
requirements.
persons of size shall be anchored to sustain a
minimum concentrated load of 800 pounds
5.3-6.2 Plumbing Systems
(362.88 kilograms).

(5) Grab bars shall have a finish color with a value that 5.3-6.2.1 General
contrasts with the adjacent wall surface. See Section 2.5-2.1 (Plumbing Systems-General) for
(6) Grab bars shall be returned to the wall or floor
requirements.
with eased corners where a mitered corner

condition exists.
5.3-6.2.2 Plumbing and Other Piping Systems
See Section 2.5-2.2 (Plumbing and Other Piping
5.3-5.2.2.10 Handrails. See sections 2.4-2.2.10.1,
Systems) for requirements.
2.4-2.2.10.2, and 2.4-2.2.10.5 through 2.4-2.2.10.10
in Section 2.4-2.2.10 (Handrails and Lean Rails) for
5.3-6.2.3 Plumbing Fixtures
requirements.
5.3-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
*5.3-5.2.2.11 Protection from heated surfaces. See Fixtures-General) for requirements.
appendix section A5.3-5.2.2.11 (Protection from
heated surfaces) for recommendations.
5.3-6.2.3.2 Hand-washing sinks. See Section 2.5­
2.3.2 (Hand-Washing Sinks) for requirements.
5.3-5.2.2.12 Signage and wayfinding. See Section
2.4-2.2.12 (Signage and Wayfinding) for requirements.
5.3-6.2.3.3 Showers. See Section 2.5-2.3.3.2
(Accessible showers) for requirements.
5.3-5.2.2.13 Decorative water features. Where
decorative water features are used in the facility design,
5.3-6.2.3.4 Reserved
see appendix section A2.4-2.2.13 (Decorative water
features) for recommendations. 5.3-6.2.35 Clinical sinks. Where clinical sinks
are provided in an outpatient rehabilitation therapy
5.3-5.2.3 Surfaces facility, see Section 2.5-2.3.5 (Clinical Sinks) for
See Section 2.4-2.3 (Surfaces) for requirements. requirements.

5.3-5.2.4 Furnishings 5.3-6.2.3.6 Portable hydrotherapy whirlpools.

See Section 2.4-2.4 (Furnishings) for requirements. Where portable hydrotherapy whirlpools are used in
an outpatient rehabilitation therapy facility, see Section
2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for
requirements.

APPENDIX

AS.3-S.2.2.11 Protection from heated surfaces Heated surfaces referenced in this section are intended to include
a. Where cooking accommodations are prOVided for rehabilitation
those surfaces to which outpatients have normal access that exceed
services, inclusion of emergency shutoffs should be considered
110°F (43° C). This requirement does not extend to medical or
where cooking appliances are fully installed.
therapeutic equipment.
b. Many rehabilitation facilities include activity and/or rehabilitation

kitchens that may be used in asupport hub or country kitchen.

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 291
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES
5.3-6.3 Heating, Ventilation, and
Air-Conditioning (HVAC) Systems
5.3-6.3.1 General
5.3-6.3.1.1 Application. For basic HVAC system
requirements for outpatient rehabilitation therapy
facilities, see ANSIIASHRAE Standard 62.1:
Ventilation for Acceptable Indoor Air Quality.
5.3-6.3.1.2 Ventilation and space conditioning. See
Section 2.5-3.1.2 (Ventilation and Space Condition­
ing) for requirements.
5.3-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
5.3-6.3.3 HVAC Requirements for Specific
Locations
5.3-6.3.3.1 Outpatient and related support areas.
See ANSIIASHRAE Standard 62.1: Ventilation for
Acceptable Indoor Air Quality for basic HVAC system
requirements.
5.3-6.3.3.2 Fuel-fired equipment rooms. Where
rooms with fuel-fired equipment are provided, see
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
requirements.
5.3-6.3.3.3 Areas of refuge. Where areas of refuge are
provided, see Section 2.5-3.3.3 (Areas of Refuge) for
requirements.
5.3-6.3.3.4 Commercial food preparation areas.
Where commercial food preparation areas are
provided, see Section 2.5-3.3.4 (Commercial Food
Preparation Areas) for requirements.
A5.3-6.3.4 The.rmal and acoustic ins.ulation
a. See ASH RAE 90J:lnergy Standard for BUildings Except Low-Rise
Residential BUildings for more information.
b. Provisions fOJ acoustic insulation should meet or exceed local
building code requirements.
c. Consideration should be given to construction of demising walls
292 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
*5.3-6.3.4 Thermal and Acoustic Insulation
See Section 2.5-3.4.1 (Thermal and Acoustic
Insulation-General) for requirements.
5.3-6.3.5 HVAC Air Distribution
See Section 2.5-3.5 (HVAC Air Distribution) for
requirements.
5.3-6.3.6 HVAC Filters
5.3-6.3.6.1 General. See ANSIIASHRAE Standard
62.1: Ventilation for Acceptable Indoor Air Quality for
requirements.
5.3-6.3.6.2 Filter efficiencies
(1) For centralized recirculated systems, MERV 7
shall be the minimum filter efficiency for the first
filter bank. There is no minimum filter efficiency
requirement for the second filter bank.
(2) For non-central recirculating room systems, HVAC
units shall:
(a) Not receive nonfiltered, nonconditioned
outdoor air.
(b) Serve only a single space.
*(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
designed to condense water. This filter shall be
located upstream of any such cold surface so
that all of the air passing over the cold surface
is filtered.
5.3-6.3.7 Heating Systems, Cooling Systems, and
Equipment
See Section 2.5-3.7 (Heating Systems, Cooling
Systems, and Equipment) for requirements in addition
to those in this section.
5.3-6.3.7.1 Heating systems. Outpatient rehabilita­
tion facilities shall have a permanently installed heating
system capable of maintaining an interior minimum
and floors in a manner that provides for speech privacy between
occupied spaces and between floors.
A5.3..;6.3.6.2 (2)(c) Filters for recirculating room
systems. Filters should be replaced and/or cleaned per the
manufacturer~s recommendations to maintain indoor air quality.
 5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACiliTIES
0 0
temperature of 72 F (22 C) under heating design
temperatures.
5.3-6.3.7.2 Cooling systems. Outpatient rehabilita­
tion facilities shall be configured and equipped with
a cooling system capable of maintaining an interior
0
maximum temperature of75° F (24 C) under cooling
design temperatures.
5.3-6.4 Electrical Systems
5.3-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
5.3-6.4.2 Power-Generating and Power-Storing
Equipment
5.3-6.4.2.1 Essential electrical service
(1) At minimum, outpatient rehabilitation therapy
settings that require essential electrical systems
shall comply with the appropriate occupancy
requirements ofNFPA 101: Life Safety Code
(2) As required by local codes and the care types, an
essential electrical source shall provide emergency
lighting and/or power during an interruption of
the normal electrical supply.
5.3-6.4.2.2 Generators. Where generators are used
in outpatient rehabilitation therapy settings, exhaust
systems (including locations, muffiers, and vibra­
tion isolators) for internal combustion engines shall
be designed and installed to minimize objectionable
noise.
5.3-6.4.3 Electrical Receptacles
See sections 2.5-4.3.1, 2.5-4.3.2, 2.5-4.3.4, and
2.5-4.3.5 in Section 2.5-4.3 (Electrical Receptacles) for
requirements.
5.3-6.5 Communication Systems
5.3-6.5.1 General
APPENDIX
AS.3-6.S.2.3 (1) Emergency call devices. Based on the
care population served, physical therapy, quiet rooms, fitness and exer­
cise areas, pool areas and other therapy areas, and other common areas
---------_._._•...•... _.....
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
See Section 2.5-5.1 (Communication Systems­
General) for requirements.
5.3-6.5.2 Call System
5.3-6.5.2.1 General. Where call systems are provided,
the use of alternative technologies, including wireless
systems, shall be permitted.
(1) Where wireless systems are used, consideration
shall be given to electromagnetic compatibility
between internal and external sources.
(2) Wireless systems shall comply with UL Standard
2560: Emergency Call Systems for Assisted Living and
Independent Living Facilities.
5.3-6.5.2.2 Reserved
5.3-6.5.2.3 Emergency call system. Where an emer­
gency call system is provided in an outpatient rehabili­
tation facility, the requirements in this section shall be
met.
*(1) An emergency call device shall be provided at
each toilet, bath, shower room, and examination,
observation, or treatment room.
(2) The device shall be accessible to a person lying
on the floor. Inclusion of a pull cord or portable
wireless device shall satisfy this requirement.
(3) The signal shall activate a visual and/or audio
signal located at an appropriate location and/or a
handheld mobile device carried by staff.
(4) Emergency call systems shall be listed by a
nationally recognized testing laboratory.
5.3-6.5.3 Technology Equipment and Teledata
Room(s)
5.3-6.5.3.1 General
(1) See Section 2.5-5.3.1.1 (Technology Equipment
and Teledata Room-Purpose) for requirements.
(2) Number. Each outpatient rehabilitation therapy
setting shall have a room or closet to accommodate
technology systems used in the facility.
should beevaluated for incorporation of emergency call system stations.
This evaluation should consider the care model, care population, scale of
the facility, and staffsight lines for observation.
------------------ _
.. .._._._._-----_.­
293
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACILITIES
5.3-6.5.3.2 Size. See Section 2.5-5.3.2 (Size) for
requirements.
5.3-6.5.3.3 Location and access. See Section 2.5­
5.3.3 (Location and Access) for requirements.
5.3-6.5.3.4 Technology equipment room facilities.
See Section 2.5-5.3.4 (Technology Equipment Room
Facilities) for requirements.
5.3-6.6 Electronic Safety and Security Systems
See Section 2.5-6 (Electronic Safery and Securiry
Systems) for requirements.
5.3-6.7 Daylighting and Artificial Lighting
lines for minimum number of elevators shall apply:
Systems
(1) At least one elevator sized to accommodate
5.3-6.7.1 General
See Section 2.5-7.1 (Daylighting and Artificial Lighr­
ing Systems-General) for requirements.
5.3-6.7.2 Daylighting Systems in Outpatient
Areas
See Section 2.5-7.2 (Daylighting Systems in Resi­
dent Living, Participant, and Outpatient Areas) for
requirements.
5.3-6.7.3 Artificial Lighting Systems
5.3-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
(Light Fixtures) for requirements.
*5.3-6.7.3.2 Lighting requirements for specific loca­
tions. See appendix section A2.5-7.3.2 (Lighting in
transition spaces) for recommendations.
(1) Reserved
(2) Outpatient toilet rooms
(a) Toilet rooms shall have general lighting and
task lighting.
(b) Task light controls shall be readily accessible ro
outparients.
AS.3-6.7.3.2 Lighting for corridors. Corridors used by
outpatients should have even light distribution to avoid glare, shadows,
and scalloped lighting effects. See appendix section A2.4-2.1.2.2 (1)
(Environmental factors and falls) for additional information.
------_._----------------------­
294 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
5.3-6.8 Acoustic Design Systems
See Section 2.5-8 (Acoustic Design Systems) for
requirements.
5.3-6.9 Elevator Systems
5.3-6.9.1 General
5.3-6.9.1.1 Application. All buildings having out­
patient or staff use areas on more than one floor shall
have an electric or hydraulic elevator(s).
*5.3-6.9.1.2 Number. Engineered traffic studies are rec­
ommended, but in their absence the following guide­
outpatient-operated mobiliry device users shall be
required where spaces used by outpatients are on
any floor other than the main entrance floor.
(2) Where outpatient rehabilitation therapy facilities
are part of a general hospital, the hospital's
elevators shall be permitted to meet the
requirement in Section 5.1-6.9.1.1 (Application).
5.3-6.9.2 Dimensions and Clearances
Elevator car doors shall have a clear opening of not less
than 3 feet 8 inches (1.12 meters).
5.3-6.9.3 Leveling Device
See Section 2.5-9.3 (Leveling Device) for
requirements.
5.3-6.9.4 Installation and Testing
See Section 2.5-9.4 (Installation and Testing) for
requirements.
5.3-6.9.5 Handrails
5.3-6.9.5.1 Elevator cars shall have handrails on all
sides without entrance door(s).
5.3-6.9.5.2 See Section 2.4-2.2.10 (Handrails and
Lean Rails) for additional requirements.
AS.3-6.9.1.2 These standards may be inadequate for moving large
numbers of people in ashort time; adjustments should be made as
appropriate.
Index

Note: Numbers preceded by ''A'' indicate information presented in the appendix. Information presented in tables is
preceded by "T" or ''AT'' for appendix tables.

A Acriviries of daily living Americans wirh Disabiliries Acr (ADA),

Access
to adulr day (healrh) care faciliries,
5.1-1.5.2
to clinic services, 2.3-3.1.2
communiry, 2.1-2.2, 2.3-3.1.2,
5.1-1.5.2,5.2-1.5.2,5.3-1.4.2
to daylighring, A1.2-5.1.2.2 (1)
emergency, A2.1-2.1, A4.2-1.5.2, 5.1­
need for assisrance in assisred living,
A4.1-1.1.1.1, A4.1-1.2.1.2 (l)-b
practice area, 3.1-3.3.3.2 (2),
5.3-4.2.3.1, 5.3-4.2.3.7
in resident and parricipant kirchen, 2.3­
2.3.4.1 (1), A5.1-2.3.4, A5.3-2.3.4
rherapy for, A3.1-3.3-c, A5.3-1.1. 1.1-c
Acriviry areas
for adult day (health) care facilities,
A1.1-4.1.1
Accessibiliry Guidelines (ADAAG),
A2.4-2.2.9.1
approved door closers, A4.2-5.2.2-a
guidance for signage,
A2.4-2.2.12.3-d
Standards for Accessible Design,
A2.4-2.2.9.3 (1)-e, A5.2-2.3.3-e
See also Uniform Federal Accessibiliry

1.5.2.1, A5.2-1.5.2.1 5.1-2.3.3.3 Srandards, U.S. Access Board

communiry, 2.1-2, 2.3-3.1.2 for assisted living facilities, 4.1-2.3.3.3 Anrerooms, for airborne infecrion isolarion

to independenr living serrings, 4.2-1.5.2
to narure, 1.2-4.5.2, A2.2-4.3.5.1
site, 1.3-2.1
to technology equipment room, 2.5-5.3.3
relephone, 2.3-4.2.8, 5.1-4.2.8
to uriliries, 1.3-2.4,2.1-2.4
for hospice facilities, 3.2-2.3.3.3
for independent living SWings,
A4.2-2.3.3-b
for nursing homes, 3.1-3.3.3.2
for subsrance abuse treatmenr facilities,
4.3-2.3.3.3
rooms, 3.1-2.2.3.1 (4)
Aparrment model, A4.1-2.1, A4.2-1.1. 1.1-b,
A4.4-2.1
Aquaric cenrer, 5.2-2.3.3.3 (3)
Archirecrural derails, 2.4-2.2
abuse-resisrant, A2.2-4.2.2

to wellness centers, 5.2-1.5.2, for wellness cenrers, 5.2-2.3.3.3 for adult day (health) care faciliries,

5.2-2.3.3.3 (3) Administrarive areas/offices 5.1-5.2.2

Accessibiliry for adult day (health) care facilities, for AIl room, 3.1-2.2.3.1 (6)(a)
for assisred living facilities, 4.1-5.1.2, 5.1-4.11 for assisred living faciliries, 4.1-5.2.2
A4.1-5.1-e, AT4.1-a for assisted living facilities, 4.1-4.11 mare rials and producrs for, characrerisrics
for central barhing areas, 3.1-4.2.3.3, for hospice facilities, 3.2-4.11 and crireria for selecring, 1.2-4.5.7
3.2-4.2.3.3 for independent living serrings, 4.2-4.11 for inrellectual/developmental disabiliry
design srandards for, 1.1-4.1, for inrellectual/developmental disabiliry swings, 4.4-5.2.2
A5.2-2.3.3-d serrings, 4.4-4.11 for hospice faciliries, 3.2-5.2.2
for inrellecrual/developmental disabiliry for outpatienr rehab facilities, 5.3-4.11 for independenr living serrings, 4.2-5.2.2
sWings, 4.4-5.1.2 for nursing homes, 3.1-4.11 producrs for, 1.2-4.5.7,2.4-2.1.2,
standards for grab bars, A2.4-2.2.9.1, for subsrance abuse treatment facilities, AT3.1-a
AT2.4-a 4.3-4.11 for nursing homes, 3.1-5.2.2
for subsrance abuse rrearmenr faciliries, for wellness centers, 5.2-4.11 for ourdoor acriviry spaces, A2.1-3.6.2-b
4.3-5.1.2 Adult day (health) care facilities, 5.1 for ourparient rehab faciliries, A5.3-5.2.2
Accessible showers, 2.5-2.3.3.2, hospice faciliries in, A3.2-2.2.1.2 (2)(a), for subsrance abuse rrearmenr faciliries,
A3.1-2.2.2.7 (3), A3.2-2.2.2.7 (3) AT3.3-a 4.3-5.2.2
Acousric design, 1.4-2.1, 2.5-8 rypes of, A5.1-1.1.1.1 for wellness cenrers, 5.2-5.2.2
design codes, regularions, guidelines, Airborne infecrion isolarion (AIl), resident Arrhriris Foundarion Aquarics Program,
A1.4-2.1.1 rooms, 3.1-2.2.3.1, 3.2-2.2.3.1 A5.2-2.3.3.3 (3)
crireria for finishes, 2.5-8.3 Air-condirioning sysrems. See HVAC Asbesros-containing mare rials, management
for independent living serrings, A4.2-6 systems of, A2.2-2.6.2.1-b
insulation, 2.5-3.4 American Narional Srandards Insrirure ASHRAE
minimum design room sound absorprion accessibiliry srandards, A2.4-2.2.9.1 ANSIIASHRAE 55, A2.2-2.4.1, A2.5­
coefficients, T2.5-4
ANSI S1.1, A1.4-2.1 3.1.2, A2.5-3.2.1.2, A4.2-6.3.1-b
for ourdoor mechanical equipmenr,
American Sociery for Healthcare ANSIIASHRAE 62.1, 4.1-6.3.1.1 (2),
2.5-3.2.4
Engineering 4.2-6.3.1.2, 4.2-6.3.6.2, 4.3-6.3.1.1
planning considerations, 1.2-5.2
Health Facility Commissioning Guidelines, (2),4.4-6.3.1.1 (2),5.1-6.3.1.1,
for quier room or observarion area,
Al.4-1 5.1-6.3.3.1,5.1-6.3.6.1,5.2-6.3.1.1,
A5.1-4.2.9
American Sociery of Civil Engineers 5.2-6.3.3.1, 5.2-6.3.6.1, 5.3-6.3.1.1,
and selecrion of wall finishes,
ASCE/SEI 7, A1.1-4.2 5.3-6.3.3.1, 5.3-6.3.6.1
2.4-2.3.3.2 (4)
American Sociery of Hearing, Refrigeraring ANSIIASHRAE 62.2, 4.1-6.3.1.1 (1),
rerminology, A1.4-2.1
and Air-Condirioning Engineers. See 4.2-6.3.1.1, 4.2-6.3.6.1, 4.3-6.3.1.1
Also see Noise conrrol
ASHRAE (1),4.4-6.3.1.1 (1)
- - - _•..•.•_ - - - _ . _ . _ - ­
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 295
ASHRAE (continued)
ANSIIASHRAE 90.1, A2.2-2.2-a,
A2.5-3.2.1.3, A4.2-6.3.4, A5.1-6.3.4,
A5.2-6.3.4, A5.3-6.3.4
ANSIIASHRAE 90.2, A2.5-3.2.1.3,
A4.2-6.3.4, 4.2-6.3.5.1 (1)
ANSIIASHRAE 154,2.5-3.3.4.2 (4)
ANSIIASHRAE 188, A2.5-2.2.3-a
ANSI/ASHRAE 189.1, A1.2-5.5.2.1
ANSIIASHRAE 189.3, A1.2-5.5.2.1,
A2.2-2.2-a, A2.2-2.6
for independent living settings, 4.2-6
Guideline 12,
for intellectual/developmental disability
Handbook-HVAC Applications,
2.5-8.7.2.1 (2)
Humidity Control Design Guide,
A2.5-3.1.2, A4.2-6.3.1-b
Thermal Guidelines, 2.5-5.3.4.4 (2)
Assisted living facilities, 4.1
for nursing homes, 3.1-2.2.2.7 and environment of care requirements,
for substance abuse treatment facili ties, 1.2-4
4.3-2.2.2.7, A4.3-2.2.2.7 for hospice facilities, A3.2-2.2.1.2 (2),
Behavioral health. See Mental health AT3.2-a
Behavioral Health Design Guide, 1.2-3.5.2.1 household
Building service life plan, A2.2-2.5.1 dining areas in intellectual/devel­
Building systems, 1.1-3.1.1.4,2.5 opmental disability settings,
for adult day (health) care facilities, 5.1-6 4.4-2.3.3.2 (3)
for assisted living facilities, 4.1-6 for nursing homes, 3.1-2.2.1.3 (3),
for hospice facilities, 3.2-6 AT3.1-a
for post-acute care, A3.1-2.2.4.2
for independent living settings,
settings, 4.4-6 4.2-2.2.2.1
for nursing homes, 3.1-6 for nursing homes, A3.1-1.2,
for wellness centers, 5.2-6 3.1-2.2.1.3, AT3.1-a
for substance abuse treatment facilities, in owner's project requirements, 1.2-2.2.1
4.3-6 for settings for intellectuallyl
Built-in furnishings, 2.4-2.4.2, A4.2-5.2.4 developmentally disabled,

characteristics of, A4.1-1.2.1.2, AT4.1-a A4.4-1.2.1.2 (1), AT4.4-a

design criteria, 4.1-1.1.2 c electrical system standards for,

hospice facilities in, AT3.2-a 4.4-6.4.2.1 (I)

types of, A4. 1-1. 1.1.1 Cabling, pathways and raceways, 2.5-5.5 facility layout for, 4.4-2.1.2.2
Audiovisual technology, A2.5-5.1 Call systems therapeutic community, A4.3-] .2.].2 (1)
for adult day (health) care facilities, traditional, for nursing homes,
B 5.1-6.5.2 3.1-2.2.1.3 (I), AT3.1-a
for assisted living facilities, 4.1-6.5.2 Carts
BackRow prevention, 2.5-2.2.2.3 emergency, 5.1-6.5.2.3 linen, 3.1-4.6.3.3, 4.1-4.6.3.2 (4)
Bariatric needs, residents with. See Persons for adult day (health) care facilities, washing area for, 2.3-4.5.3.12
of size 5.1-6.5.2.3 Casework, 2.4-2.4.2, A4.2-5.2.4
Barrier-free environment for assisted living facilities, Ceilings
access to nature and, A2.2-4.3.5.1 4.1-6.5.2.3 design requirements, 2.4-2.3.4
for assisted living facilities, 4.1-1.4.4, for hospice facilities, 3.1-6.5.2.3 emissions standards for, A2.2-2.4.].]-e
M.I-5.1-f for in tellectualldevelopmental dis­ height of, 2.4-2.2.3
for hospice facilities, 3.2-1.4.4 ability settings, 4.4-6.5.2.3 Changing rooms, for outpatient rehab
for independent living settings, A4.2-1.4-c for nursing homes, 3.1-6.5.2.3 facilities, 5.3-3.2.6.2, 5.3-4.2.3.2
for intellectual/developmental disability for substance abuse treatment facili­ ChloroAuorocarbons (CFCs), 2.2-2.6.1.1,
settings, 4.4-1.4.4
ties, 4.3-6.5.2.3 A2.] -5-e
for nursing homes, 3.1-1.4.4
for well ness centers, A5.2-6.5.2 Choice, person-centered care and, 1.2-5.8.1
for outpatient rehab facilities,
for hospice facilities, 3.2-6.5.2 Classrooms
5.3-3.2.4.2 (2) for intellectualldevelopmental disability for outpatient rehab facilities, 5.3-3.2.3
for substance abuse treatment facili ties, settings, 4.4-6.5.2
for well ness centers, A5.2-2.3.3.3 (4)
4.3-1.4.4 for nursing homes, 3.1-6.5.2
Clean linen storage
Basis of design (BOD), 1.4-5.1.2 for resident rooms, 3.1-6.5.2.2,
for assisted living facilities, 4.1-4.2.4.2,
Bathing facilities, central 3.2-6.5.2.2 4.1-4.6.3.2 (3)
for adult day (health) care facilities, for substance abuse treatment facilities, for hospice facilities, 3.2-4.6.3.]
5.1-4.2.3, A5.1-4.2.3 4.3-6.5 decentralized, 3.2-4.2.4.2
for assisted living facilities, 4.1-4.2.3 for well ness centers, 5.2-6.5.2 for intellectualldevelopmental disability
for hospice facilities, 3.2-4.2.3 Care consultation area. See Consultation settings, 4.4-4.2.4.2, 4.4-4.6.3.2 (3)
for intellectual/developmental disability areaslrooms for nursing homes, 3.1-4.6.3.1
settings, 4.4-2.2.3.1 Care, environment of. See Environment of decentralized, 3.1-4.2.4.2
for outpatient rehab facilities, 5.3-4.2.3 care for outpatient rehab facilities, 5.3-4.2.4.1
for rehabilitation therapy, 3.1-4.2.3 Care models for substance abuse treatment facilities,
Bathrooms for assisted living facilities, A4.1-1.2.1.2 4.3-4.2.4.2,4.3-4.6.3.2 (3)
for assisted living facilities, 4.1-2.2.2.7, (I), M.I-2.1, AT4.1-a Clean utility room, 2.3-4.2.5
4.1-6.7.3.2 (2)
electrical system standards for, for adult day (health) care facilities,
for hospice facilities, 3.2-2.2.2.7
4.1-6.4.2.1 (I) 5.] -4.2.5
for independent living settings,
facility layout for, 4.1-2.1.2.2 for assisted living facilities, 4.1-4.2.5
A4.2-2.2.2-a as basis for security system, for intellectual/developmental disability
for intellectual/developmental disability 2.2-4.2.1.1 settings, 4.4-4.2.5
settings, 4.4-2.2.2.7 cluster/neighborhood, for nursing homes, for nursing homes, 3.1-3.3.5.3, 3.1-4.2.5
lighting for, 4.1-6.7.3.2 (2), 3.1-2.2.1.3 (2), AT3.1-a for substance abuse treatment facilities,
A4.2-6.7.3.2-b and commissioning, A1.4-5 4.3-4.2.5
--------------_._-------_.._-_... _ - - - - - - - - - - - - - - - - _ .._----...------------_._------ ... _,,-_.._- ._.. _-_.. __ .... ­

296 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
Clergy, storage for, 3.2-4.4.4
Clienr. See under Residenr
Cluster care model. See Care models
Codes, 1.1-5,2.4-1.2
for acoustic design, 1.4-2.1.1
for independenr living settings, A4.2-4-a
for assisred living facilities, 4.1-5.1
for outpatienr rehab facilities, 5.3-4.6.2
Cognitive disabilities. See Demenria, design
for residenrs with; Residenrial care
and support facilities
Cold storage equipment, for dietary facili­
ties, 2.3-4.5.3.11
Comfort, person-cenrered care and, 1.2-5.8.2
Commissioning, 1.4-5
Communication systems, 2.5-5
for adult day (health) care facilities, 5.1-6.5
for assisted living facilities, 4.1-6.5
equipmenr requiremenrs, 2.5-5.1.2
for independent living settings, 4.2-6.5
for inrellectual/developmenral disabiliry
settings, 4.4-6.5
for nursing homes, 3.1-6.5
silenr, A1.2-3.5.3.4 (1)
for substance abuse treatmenr facilities,
4.3-6.5
for well ness cenrers, 5.2-6.5
Community, person-cenrered care and,
1.2-5.8.6
Community areas, 2.3-2.3
for adult day (health) care facilities,
5.1-2.3
for assisted living facilities, 4.1-2.3
for hospice facilities, 3.2-2.3
for independenr living settings, 4.2-2.3
for nursing homes, 3.1-2.3
for outpatient rehab facilities, 5.3-2.3
for substance abuse treatmenr facilities,
4.3-2.3
for well ness centers, 5.2-2.3
Concern, person-cenrered care and,
1.2-5.8.5
Conference rooms
for adult day (health) care facilities,
5.1-4.11.1
for assisted living facilities, 4.1-4.11.1
for hospice facilities, 3.2-4.11.1
for independenr living settings,
4.2-4.11.1
for inrellectual/developmenral disability
settings, 4.4-4.11.1
for nursing homes, 3.1-4.11.1
for substance abuse treatmenr facilities,
4.3-4.11.1
Confidenriality, planning considerations for,
1.2-4.5.5
Conservation, design criteria and, 2.2-2.1.3
Construction, 1.4
of adult day (health) care facilities, 5.1-5
of assisted living facilities, 4.1-5
of independenr living settings, 4.2-5
of nursing homes, 3.1-5
of outpatienr rehab facilities, 5.3-5
requiremenrs, 2.4
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
Consultation areas/rooms, 2.3-3.5, T2.5-5
for wellness cenrers, A5.2-2.3.3.3 (4)
Conrrol, person-cenrered care and, 1.2-5.8.1
Conrrol areas/rooms/stations
wayfinding for, A2.4-2.2.12.3 (I)
Demising wall assembly, 2.5-8.5.2,
for substance abuse treatmenr facilities,
A4.3-4-a
for wellness cenrers, A5.2-4-b
Conrrol of environmenr, user, 1.2-4.5.4,
AT3.1-a, AT4.1-a, AT4.4-a
Conversion projects, 1.1-3.1.1.3
Corridors, 2.4-2.2.2
acoustics criteria for
noise in, T2.5-2
sound absorption coefficients for,
T2.5-4
sound isolation performance, T2.5-5
handrails in, 2.4-2.2.10.3
for hospice facilities, AT3.2-a
for independent living settings,
A4.2-5.2.2.2
lighting for, A1.2-4.5.4-a, 3.1-6.7.3.2
(1),3.2-6.7.3.2 (1), 4.1-6.7.3.2 (1),
A4.2-6.7.3.2-a, 4.3-6.7.3.2 (1),
4.4-6.7.3.2 (1), A5.1-6.7.3.2,
A5.2-6.7.3.2, A5.3-6.7.3.2
receptacles in, 2.5-4.3.2, 4.2-6.4.3.2,
A4.2-6.4.3.2
Counseling room, 3.2-4.11.2
Courtesy, person-centered care and,
1.2-5.8.5
Cultural responsiveness
for assisted living facilities, AT4.1-a
for inrellectual/developmenral disability
settings, AT4.4-a
planning considerations, 1.2-4.5.8
Culture change, in long-term care,
Al.2-4.5.9-d, A3.1-1.4.3.1
Curtains, privacy, 2.4-2.4.4
D 4.3-2.3.3.2
Daylighting, 1.2-4.5.1, 1.2-5.1.2.2,2.5-7
for adult day (health) care facilities,
5.1-6.7
for assisted living facilities, 4.1-6.7
for hospice facilities, 3.2-6.7
in community areas, A2.3-2.3
for independent living settings, 4.2-6.7
for intellectual!developmenral disability
settings, 4.4-6.7
for nursing homes, 3.1-6.7
for substance abuse treatmenr facilities,
4.3-6.7
Delivery of care model. See Care models
Dementia, design for residents with,
A1.2-2.2.1.2 (1)(b)
design criteria, 2.2-4
outdoor activity spaces for, 2,2-4.3.5
physical environment elements for risk
reduction, 2.2-4.2
planning considerations, 1.2-5.7
resident rooms, design criteria,
A2.2-4.3.2.2
risk management, design for, 1.2-3.5
A4.2-6.3.4.2, A5.1-6.3.4, A5.2-6.3.4,
A5.3-6.3.4
Department of Health and Human Services,
1.1-4.4, AI.1-4.5.2, A2.1-5
Design, 1.4
of adult day (health) care facilities, 5.1-5
of assisted living facilities, 4.1-1.1.2, 4.1-5
criteria, 2.2
elemenrs, 2.3
framework for, 1.2-1.3.2
of independent living settings, 4.2-5
of nursing homes, 3.1-5
of outpatienr rehab facilities, 5.3-5
requiremenrs, 2.4
Developmental disabilities. See Dementia
units; Residential care and support
facilities
Diagnostic facilities/services, 2.3-3
for nursing homes, 3.1-3
Dietary facilities. See Food service facilities
Dignity
definition of, Al.2-5.8.2
person-cenrered care and, 1.2-5.8.2
Dining areas
for adult day (health) care facilities,
5.1-2.3.3.2, A5.1-2.3.3.2
for assisted living facilities, 4.1-2.3.3.2
for dementia units, 2.2-4.3.2
design elements, 2.3-2.3.3.2
for hospice facilities, 3.2-2.3.3.2
for independenr living settings, 4.2-2.3.3
for nursing homes, 3.1-2.3.3.2
for intellectual!developmenral disability
settings, 4.4-2.3.3.2
for substance abuse treatmenr facilities,
for wellness cenrers, 5.2-2.3.3.2
Disaster planning, 1.2-3.8
for water supply and venrilation
emergencies, Al.2-3.2.2.8
Documentation area, 2.3-3.2.6
for outpatient rehab facilities, 5.3-4.2.1.2
for rehabilitation therapy in nursing
home, 3.1-3.3.5.2
Doors
for adult day (health) care facilities,
5.1-5.2.2.4
and door hardware, 2.4-2.2.4
for assisted living facilities, 4.1-5.2.2.4
for hospice facilities, 3.2-5.2.2.4
for independent living settings,
A4.2-5.2.2.4
for intellectual!developmental disability
settings, 4.4-5.2.2.4
for nursing homes, 3.1-5.2.2.4
openings, 2.4-2.2.4.2
297
Doors (continued) for intellectual/developmental disability for intellectual/developmental disability
protection, A2.4-2.2.4 settings, 4.4-6.9 settings, 4.4-1.4

for substance abuse treatment facilities, number of, 3.1-6.9.1.2, 3.2-6.9.1.2 for nursing homes, 3.1-1.3

4.3-5.2.2.4 for nursing homes, 3.1-6.9 for outpatient rehab facilities and,

Drainage systems, 2.5-2.2.4 for substance abuse treatment facilities, 5.3-1.3

for portable hydrotherapy whirlpools, 4.3-6.9 for substance abuse treatment facilities,
3.1-6.2.3.6 Elopement, AI.2-3.5.3.4 (3) 4.3-1.4
Drawings, project, 1.4-4 prevention, A2.2-4.2.1 for well ness centers, 5.2-1.4
Drinking water Emergency access Equipment, 1.5
provisions for for adult day (health) care facilities, acoustic design for, 2.5-3.2.4
nursing home lobby, 3.1-2.3.2.2 (5) 5.1-1.5.2.1 classification of, 1.5-2
outpatient rehab facilities, 5.3-2.3.3.3 hardware for in resident bathroom, cleaning area, for well ness centers,
Safe Drinking Water Act, AI.I-4.5.1 3.1-5.2.2.4 (2)(b), 4.1-2.2.2.7 (2), A5.2-4.2

source, 2.3-4.5.3.4 (6) 4.3-2.2.2.7 (2),4.4-2.2.2.7 (2) electronic, 1.5-3.2

Dwelling units for independent living settings, 4.2-1.5.2 information on, 1.4-4.2

for independent living settings, 4.2-2.2.2 for outpatient rehab facilities, 5.3-1.4.2.1 lifting, space requirements for,

for intellectual/developmental disability site selection and, 2.1-2.1 A3.2-2.2.2.2 (I )(f)

settings, 4.4-2.2.2 for wellness centers, A5.2-1.5.2.1 manuals, 1.4-4

number for persons of size, AI.4-2.3-b Emergency call system. See Call systems, not-in-contract (NIC), 1.5-1.3.2
for substance abuse treatment facilities, emergency residen t mobility and transfer, quanti ty
4.3-2.2.2
Emergency preparedness, 1.2-3.8 of, 1.2-3.3.2.4

See also Resident rooms

Emissions, 2.2-2.4.1.1,2.2-2.6.1 space requirement for, 1.5-4

Energy efficiency, 2.2-2.2 storage

E Engineering service areas for assisted living facilities, 4.1-4.2.4

Earthquake-resistant design, 1.1-4.2,
AI.2-3.8.I-b
Education facilities
for assisted living facilities, 4.1-4.11.1.1
for outpatient rehab facilities, 5.3-3.2.3
for substance abuse facilities, 4.3-4.11.1
for wellness centers, A5.2-2.3.3.3 (4)
Effluents, 2.2-2.6.2
Electrical receptacles, 2.5-4.3
for assisted living facilities, 4.1-6.4.3
for independent living settings, 4.2-6.4.3
for nursing homes, 3.1-6.4.3
for resident rooms, 3.1-6.4.3.3, 3.2­
6.4.3.3
Electrical systems, 2.5-4
for adult day (health) care facilities,
5.1-6.4
AI.I-4.5.2, A2.1-5
for assisted living facilities, 4.1-6.4
Environmental regulations, 1.1-4.5
essential, 3.1-6.4.2.1
Environmental services room
for assisted living facilities, 4.1-6.4.2.1
connections, 2.5-4.4.2.2
for hospice facilities, 3.2-6.4.2.1
for intellectual/developmental dis­
ability settings, 4.4-6.4.2.1
receptacles for, 2.5-4.3.4, A4.2­
6.4.3-b
for hospice facilities, 3.2-6.4
for independent living settings, 4.2-6.4
for intellectual/developmental disability
5.1-2.3.6, 5.1-4.4
settings, 4.4-6.4
for assisted living facilities, 4.1-4.4
for nursing homes, 3.1-6.4
for hospice facilities, 3.2-4.4
for substance abuse treatment facilities,
4.3-6.4
Elevators, 2.5-9
for adult day (health) care facilities, 5.1-6.9
for assisted living facilities, 4.1-6.9
for independent living settings, 4.2-6.9
design elements, 2.3-4.10
for independent living settings, A4.2-4-d
for substance abuse treatment facilities,
A4.3-4-d
Entrances
for adult day (health) care facilities,
A5.1-2.3.2
for persons of size, A2.2-3-d
for community areas, 2.3-2.3.2.2
mat system for, 2.2-2.4.1.3
for outpatient rehab facilities, 5.3-4.6.1
vehicular drop-off and pedestrian
entrance, 2.3-2.3.2.2, A5.1-2.3.2
Environmental impact statement (£IS),
A2.1-5-c
Environmental pollution control, 2.1-5
Environmental Protection Agency,
Expansion joint covers, 2.4-2.2.5
F
design elements, 2.3-4.9
for dietary facilities, 2.3-4.5.3.10
for independent living settings, A4.2-4-c
for outpatient rehab facilities, 5.3-4.9
for substance abuse treatment facilities,
A4.3-4-c
for wellness centers, 5.2-4.9
Environment of care
for adult day (health) care facilities,
5.1-1.4
for assisted living facilities, 4.1-1.4
care models and
for assisted living facilities, AT4.I-a
for nursing homes, AT3.I-a
codes and standards, 1.1-5
and functional program, 1.2-4
for hospice facilities, 3.2-1.4
for independent living settings, 4.2-1.4
design elements, 2.3-4.2.4
for independent living settings,
4.2-4.2.4
for maintenance supplies, 2.3-4.10.5
for outpatient rehab facilities,
5.3-4.2.4, 5.3-4.11.2
for rehabilitation therapy, 3.1-3.3.5.5
for nursing homes, 3.1-4.2.4
for substance abuse treatment facili­
ties, 4.3-4.2.4
Examination areas/rooms, space require­
ments, 2.3-3.2.2
Exercise areas/rooms, for outpatient rehab
facilities, 5.3-3.2.4
Exits
for assisted living facilities, A4.1-5.I-d
See also Doors and door hardware
Fall risk and prevention
resident safety risk assessment, 1.2-3.4
and building entry mats, 2.2-2.4.1.3 (2)
selection of materials and products,
performance characteristics to address
risks, 2.4-2.1.2.2 (I)
Family, support facilities for, AI.2-5.7.1
for adult day (health) care facili ties,
for independent living settings, 4.2-4.4
for intellectual/developmental disability
settings, 4.4-4.4
for nursing homes, 3.1-4.4
for substance abuse treatment facilities,
4.3-4.4

298 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 See also Guest accommodations
Family room or area, A2.2-4.3.3, 2.3-2.3.6
for adult day (health) care facilities,
5.1-2.3.6
for hospice facilities, 3.2-2.3.6
Finishes
acoustic, A2.5-8.3
for independent living settings,
M.2-5.2.3, A4.2-5.2.3.3
requirements for, 2.4-1.2.2.1
See also Surfaces
Fire alarms, 2.5-6.3
for adult day (health) care facilities,
Fitness training spaces, for well ness centers,
5.1-6.4.2.2
5.2-2.3.3.3 (2)
Flood protection, 1.1-4.3, AI.2-3.8.I-d
Flooring
5.2-6.9.5,5.3-6.9.5
design requirements, 2.4-2.3.2
for hospice facilities, 3.2-5.2.2.10
and falls, association with,
for independent living settings,
A2.4-2.1.2.2 (I)
for residen t mobility and transfer,
1.2-3.3.2.9
slip-resistant, 2.4-2.3.2.5
Fluorescent lamps, collection area for,
2.2-2.5.1.2
Food preparation areas
acoustic finishes for, A2.5-8.3
commercial, HVAC requirements for,
2.5-3.3.4
Food service facilities, 2.3-4.5
for adult day (health) care facilities, 5.1-4.5
for assisted living facilities,
4.1-2.2.2.2 (4),4.1-4.5
flooring for, 2.4-2.3.2.7
for'hospice facilities, 3.2-4.5, AT3.2-a
HVAC requirements, 2.5-3.3.4
for independent living settings, A4.2-4-a,
4.2-4.5
for intellectual/developmental disability
settings, 4.4-4.5
for nursing homes, 3.1-4.5
care models and, AT3.I-a
for post-acute care facilities,
A3.1-2.2.4.2-d
for substance abuse treatment facilities,
4.3-4.5, M.3-4-a
wellness centers, A5.2-5.2.2.9 (I)
for wellness centers, 5.2-4.5
design requirements, 2.4-2.2.7
See also Ki tchen
for independent living settings,
Functional performance test, 1.4-5.1.4
Functional program, 1.2-2
for adult day (health) care facilities, 5.1-1.2
for assisted living facilities, 4.1-1.2
and environment of care elements, 1.2-4
for independent living settings, 4.2-1.2
for intellectual/developmental disability
settings, 4.4-1.2
for nursing homes, 3.1-1.2
for outpatient rehab facilities, 5.3-1.2
for substance abuse treatment facilities,
4.3-1.2
Furnishings, 2.4-2.4
for independent living settings, 4.2-5.2.4
materials and products for, characteristics
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
and criteria for selecting, 1.2-4.5.7
See also Built-in furnishings
Furniture, 2.4-2.4.3
resident seating, A3.1-2.2.2.2 (3)(d) (ii)
selection recommendations, A2.4-2.4.3.1
for waiting area, A4.2-2.3-a
G
Gardens. See Outdoor areas/spaces
Generators, 1.5-3.2, A2.1-2.4
for elevators, 3.1-6.9.5, 3.2-6.9.5,
A4.1-6.9.2, 4.1-6.9.5, A4.2-6.9-b,
for assisted living facilities, 4.1-6.4.2.2
fuel storage for, 3.1-6.4.2.1 (3),4.1­
6.4.2.1 (3),4.4-6.4.2.1 (3)
for hospice facilities, 3.2-6.4.2.2
for independent living settings,
M.2-6.4.2-b
for intellectual/developmental disability
settings, 4.4-6.4.2.2
for nursing homes, 3.1-6.4.2.2
for outpatient rehab facilities, 5.3-6.4.2.2
for substance abuse treatment facilities,
4.3-6.4.2.2
for wellness centers, 5.2-6.4.2.2
Glazing materials, 2.4-2.2.7
Grab bars, 2.4-2.2.9
for adult day (health) care facilities,
5.1-5.2.2.9
alternative configurations, 2.4-2.2.9.3
resources for, AT2.4-a
in bathrooms, A2.4-2.2.9.2
adult day (health) care,
A5.1-5.2.2.9 (I)
assisted living, A4.1-2.2.2. 7-b
nursing homes, 3.1-2.2.2.6 (5)
hospice facilities, 3.2-2.2.2.6 (5)
independent living, A4.2-6.2-c
intellectual/developmental disability
settings, A4.4-2.2.2.7
outpatient rehab, A5.3-5.2.2.9 (I)
substance abuse treatment, A4.3­
2.2.2.7-b
Accountability Act, AI.I-4.4,
A1.2-4.5.5
Health risk assessmen t, A2.I-5-c
M.2-5.2.2-c
for ourpatient rehab facilities, 5.3-5.2.2.9
in toilet rooms, A5.1-5.2.2.9 (I),
A5.2-5.2.2.9 (I), A5.3-5.2.2.9 (I)
for wellness centers, 5.2-5.2.2.9
Green Globes, AI.2-5.5.2.I-b, A2.2-2.2-a
Greenhouse gas reduction, 2.2-2.6.1.2
Group living model, A4.1-2.1, A4.4-2.1
Guest accommodations
for assisted living facilities, 4.1-4.4.2
for hospice facilities, 3.2-2.2.2.2 (4),
3.2-4.4.1
for independent living settings, 4.2-4.4.2
for intellectual/developmental disability
settings, 4.4-4.4
for nursing homes, 3.1-4.4.1
for persons of size, A3.2-2.2.2.2 (3)
showers, 3.2-4.4.3
for substance abuse treatment facilities,
4.3-4.4
H
Hand drying, provisions for, 2.4-2.2.8.5
Handrails
design requirements, 2.4-2.2.10
A4.3-6.9.2-b,4.3-6.9.5,
A4.4-6.9.2-a, 4.4-6.9.5, 5.1-6.9.5,
4.2-5.2.2.10, A4.2-6.9-b
for persons of size, A2.2-3-d
Hand sanitation dispensers,
1.2-3.2.1.1 (2)(a), 2.4-2.2.8.1 (2)
Hand-washing stations, 1.2-3.2.1.1 (2)(a),
2.5-2.3.2
countertops for, 2.4-2.2.8.4
design requirements, 2.4-2.2.8
heated water for, 2.5-2.2.3.5
for hospice facilities, 3.2-2.2.2.5
for laundty facilities, 3.1-4.6.3.4,
4.1-4.6.3.2 (5)
location of, AI.2-3.2.1.1 (2)(a)
for nursing homes, 3.1-2.2.2.5
for outpatient rehab facilities, 5.3-3.2.2.3,
5.3-3.2.4.3, 5.3-3.3.1.2, 5.3-3.3.2.4,
5.3-3.3.3.2
for therapy areas, 3.1-3.3.2.2 (3),
3.1-3.3.3.2 (3), 3.1-3.3.4.1 (2)
sinks for, 2.5-2.3.2
Harm reduction, design criteria and,
2.2-4.2.2
Hazardous materials management plan,
2.2-2.6.2.1
Health and well ness services, A5.2-2.3.3
Health Insurance Portability and
Heated potable water systems, 2.5-2.2.3
maximum pipe/tube length, AT2.5-a
water use, T2.5-1
Heated surfaces, protection from,
2.4-2.2.11,5.1-5.2.2.11,5.3-5.2.2.11
Heating, ventilation, and air-conditioning
systems. See HVAC systems
High-intensity discharge lamps, collection
area for, 2.2-2.5.1.2
Home-based hospice services, A3.2-2.2.1.2
(2)(b), AT3.2-a
Hospice facilities, 3.2
freestanding, A3.2-2.2.1.2 (2)(e), AT3.2-a
in hospitals, A3.2-2.2.1.2 (2)(f), AT3.2-a
Household models. See Care models
299
Humidity control, A2.5-3.1.2 International Plumbing Code, 2.5-2.1 Liftsllift equipment, space requirements for,
fat independent living settings, A3.1-2.2.2.2-b, 3.1-2.2.2.2 (3)(b),
A4.2-6.3.1-b K A3.2-2.2.2.2-b
HVAC systems, 2.5-3 Lighting, 2.5-7
for adult day (health) care facilities, Kitchen for adult day (health) care facilities,
5.1-6.3 grease traps, 2.5-2.2.4.2 5.1-6.7

for assisted living facilities, 4.1-6.3 central commercial, 2.3-4.5 for assisted living facilities, 4.1-6.7

for hospice facilities, 3.2-6.3 decentralized, 3.1-4.5.4, 3.2-4.5.4, care models and, for assisted living

for independent living settings, 4.2-6.3 4.1-4.5.4,4.3-4.5.4,4.4-4.5.4, facilities, AT4.1-a

and infection control, 1.2-3.2.1.1 (1) 5.1-4.5.3 emergency
for intellectual/developmental disability equipment, and room noise levels, for independent living settings,
settings, 4.4-6.3 A2.5-8.4.1-b, T2.5-2 A4.2-6.4.2-a
for nursing homes, 3.1-6.3 warming, 3.1-4.5.3, 3.2-4.5.3, 4.1-4.5.3, for nursing homes, 3.1-6.4.2.1 (l)(b)
for outpatient rehab facilities, 5.3-6.3 4.3-4.5.3, 4.4-4.5.3, 5.1-4.5.2 exterior, AI.2-4.5.6-a
for substance abuse treatment facilities, for outparient rherapy, 5.3-2.3.4 for hospice facilities, 3.2-6.7
4.3-6.3
warming/catering, 5.1-4.5.2, 5.2-4.5.2 for independent living settings, 4.2-6.7
for well ness centers, 5.2-6.3
See also Food service facili ties for intellectual/developmental disability
See also Mechanical system design
Kirchen, resident and participant, 2.3-2.3.4 settings, 4.4-6.7, AT4.4-a
Hydrotherapy whirlpools, portable, for adult day (health) care facilities, for medication locations (task-specific),
3.1-3.3.4.3 A5.1-2.3.4 2.3-4.2.2.2 (2)(0, 2.3-4.2.2.3 (3),
for assisted living facilities, 4.1-2.2.2.2 2.3-4.2.2.4
I (4),4.1-4.5.2,4.1-4.5.3 for nursing homes, 3.1-6.7
for hospice facilities, 3.2-2.2.2.2 (5) planning considerations, 1.2-5.1
Ice-making facilities/machines for independent living settings, A4.2­ site, 2.1-3.5
design elements, 2.3-4.5.3.4 2.2.2-c for substance abuse treatment facilities,
for resident and participant kitchens, for nursing homes, 3.1-2.3.4, 3.1-4.4.3 4.3-6.7
2.3-2.3.4.2 (7) for well ness centers, 5.2-2.3.4 for telemedicine services, A2.3-4.2.9-d
Independent living settings, 4.2 Kitchenette, A3.2-2.2.2. (5) and user control of environment,
minimum standards fat, 4.2-1.1.3 for conference space, A3.1-4.11.1.1, A1.2-4.5.4-a
types of, 4.2-1.1.1.1 A3.2-4.11.1.1, A4.1-4.11.1.1, Linen carts, 3.1-4.6.3.3, 4.1-4.6.3.2 (4)
Indoor air quality, 2.2-2.4.1 A4.2-4.11.1.1, A4.3-4.11.1.1, Linen services
maximum concentration levels and, A4.4-4.11.1.1, A5.1-4.11.1.1 for adult day (health) care facilities,
AT2.2-1
5.1-1.2.2.1
planning considerations, 1.2-5.4
L for assisted living facilities, 4.1-4.6
and renovarion, 1.4-3.3
for hospice facilities, 3.2-4.6
Indoor environmental quality, 2.2-2.4 Landscape for independent living settings, A4.2-4-b
Infection control risk assessment (ICRA), design features, 2.1-3.6 for intellectual/developmental disability
1.2-3.2 for independent living settings, settings, 4.4-1.2.2.3
and renovation, 1.4-3.2 4.2-1.5.3.6 for nursing homes, 3.1-4.6
Infection control risk mitigarion recommen­ irrigation of, 2.2-2.1.3.4 for outpatient rehab facilities, 5.3-4.6
dations (ICRMRs), 1.2-3.2.2 Laundry facilities, 2.3-4.2.7 for substance abuse treatment facilities,
Insect screens, 2.4-2.2.4.3, 2.4-2.2.6.3 for adult day (health) care facilities, A4.3-4-b

for assisted living facilities, A4.2-5.2.2-a 5.1-4.2.7, A5.1-4.2.3 for wellness centers, A5.2-4-b

Insulation, 2.5-3.4
for adult day (health) care faciliries,
for assisted living facilities, 4.1-2.2
A5.1-6.3.4
daylighting in, A2.5-7.2
for independent living settings,
for dementia units, 2.2-4.3.3
A4.2-6.3.4
for outpatient rehab faciliries, A5.3-6.3.4
characterisrics of, AT4.4-a
materials, 2.4-1.2.2.2
minimum srandards for, 4.4-1.1.3
types of, A4.4-1.1.1.1
for wellness centers, A5.2-6.3.4
International Code Council
ICC Al17.1, A1.1-4.1-c
International Building Code, A1.1-4.2,
2.2-4.2.1.5
International Energy Conservation Code,
2.5-3.4.1.1
Internarional Green Construction Code,
A1.2-5.5.2.1, A2.2-2.2
for assisted living facilities, 4.1-4.2.7,
4.1-4.6
for hospice faciliries, 3.2-4.6
for independent living settings,
A4.2-2.2.2-a, A4.2-4-b
for intellectual/developmental disability
settings, 4.4-4.6
for nursing homes, 3.1-4.6
for outpatient rehab facilities, 5.3-4.2.7
for substance abuse treatment facilities,
4.3-4.6, A4.3-2.2.2-a, A4.3-4-b
for well ness centers, A5.2-4-b
Leadership in Energy & Environmental
Design (LEED), A1.2-5.5.2.1-c
Lean rails, 2.4-2.2.10
Legionella bacreria, 1.2-3.2.1.1 (2)(b),
A2.5-2.2.3-a
Life Safety Code
Life safety overlay, 1.4-4.1.2
Living area, 2.3-2.2
for intellectual/developmental disability
settings, 4.4-2.2
for substance abuse treatment facilities,
4.3-2.2
Lobby, 2.3-2.3.2
for adult day (health) care faciliries,
5.1-2.3.2
for nursing homes, 3.1-2.3.2
for independent living setrings, 4.2-2.3.2
Locker rooms, for wellness centers,
5.2-2.3.3.4 (3)
Lounge areas
for adult day (health) care facilities,
5.1-2.3.3.3
for assisted living facilities, 4.1-2.3.3.3

300 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
 for hospice facilities, 3.2-2.3.3.3 Mobiliry. See under Residenr mobiliry and for independenr living serrings,
for independenr living serrings, 4.2-2.3.3 rransfer A4.2-6.7.3.2-b
for inrellecrual/developmenral disabiliry Mobiliry devices, srorage of, 1.2-3.3.2.6, for inrellecrual/developmenral disabiliry
serrings, 4.4-2.3.3.3
2.3-2.3.2.3,2.3-4.2.4.2,3.1-4.2.4.3 serrings, A4.4-6.7.3.2 (2)(b)
for nursing homes, 3.1-2.3.3.3
Moisrure conrrol, 2.2-2.6.2.2 for nursing homes,
sraff, 2.3-4.3.2
Mulri-sensory environmenr, A2.3-2.3.7 3.1-6.7.3.2 (2)(b)
for adulr day (healrh) care faciliries, for subsrance abuse facilities,
5.1-4.3.2 N A4.3-6.7.3.2 (2)(b)
for hospice faciliries, 3.2-4.3.2 Noise conrrol
for subsrance abuse rrearmenr facilities, Narional Earrhquake Hazards Reducrion exrerior noise, 2.5-8.2, T2.5-3
4.3-2.3.3.3 Program provisions, A1.1-4.2 inrerior noise, T2.5-2
for wellness cenrers, 5.2-2.3.3.3 Narional Fire Prorecrion Associarion See also Acousric design
srandards, A1.1-5.2 Non-residenrial supporr faciliries
M NFPA 13: Standardfor the Installation of adulr day (healrh) care faciliries, 5.1
Sprinkler Systems, A4.1-5.1-b ourparienr rehab faciliries, 5.3
Mailboxes, 2.3-2.3.2.4 NFPA 70: National Electrical Code, wellness cenrers, 5.2
for independenr living serrings, 2.5-4.1.1, 2.5-4.3.5, 2.5-4.4.2.1 (1), Norice area, 2.3-2.3.2.5
4.2-2.3.2 2.5-5.4.1, 3.1-6.4.2.1 (1)(a), Nurse srarions
Mainrenance services, faciliries for, 2.3-4.10 3.2-6.4.2.1 (1)(a), 4.2-6.4.3 for hospice faciliries, AT3.2-a
for independenr living serrings, A4.2-4-d NFPA 72: National Fire Alarm and
for nursing homes, 3.1-4.2.1, AT3.1-a
for ourparienr rehab facilities, 5.3-4.10 Signaling Code, 2.5-6.3
Nursing homes, 3.1
for subsrance abuse rrearmenr faciliries, NFPA 90A: Standardfor the Installation hospice faciliries in, A3.2-2.2.1.2 (2)(f),
A4.3-4-d ofAir-Conditioning and Ventilating AT3.2-a
Marerials managemenr faciliries, 2.3-4.7 Systems, 2.5-3.3.4.2 (1) rypes of, A3.1-1.1.1.1
for hospice faciliries, 3.2-4.7 NFPA 96: Standardfor Ventilation Control Nursing office, for adulr day (healrh) care
for ourparienr rehab faciliries, 5.3-4.7 and Fire Protection ofCommercial faciliries, 5.1-4.2.1
for wellness cenrers, 5.2-4.7 Cooking Operations, 2.5-3.3.4
Meaningful engagemenr, person-cenrered NFPA 99: Health Care Facilities Code, o
care and, 1.2-5.8.4 3.1-2.2.3.2,3.1-6.2.4,3.1-6.4.2.1
Mechanical sysrem design, 2.5-3.2 (1)(a), A3.2-2.2.3.2, 3.2-6.2.4, Obesiry. See Persons of size
for independenr living serrings, A4.2-6.3.2 3.2-6.4.2.1 (1)(a), 4.1-6.2.4, 4.1­ Observarion faciliries, for adulr day (healrh)
Medical gas sysrem 6.4.2.1 (1)(a), A4.2-6.3.7, 4.3-6.2.4 care faciliries, 5.1-4.2.9
for assisred living faciliries, 4.1-6.2.4 NFPA 101: Life Safety Code, 1.1-3.2.2, Occuparional rherapy faciliries, 5.3-3.2,
for hospice faciliries, 3.2-6.2.4 1.1-5.2.1, 2.2-4.2.1.2, 2.2-4.2.1.5, A5.3-1-c
for nursing homes, 3.1-6.2.4 2.4-1.2.1,2.4-2.2.2.1,2.4-2.4.4.1, in nursing homes, A3.1-3.3-c, 3.1-3.3.3
for subsrance abuse faciliries, 4.3-6.2.4 2.5-3.3.4, 2.5-3.4.1.3, 2.5-6.3, Offices/office space
for venrilaror-dependenr residenr unir, 4.1-6.4.2.1 (l)(a), 4.2-6.4.2, for adulr day (healrh) care faciliries,
A3.1-2.2.3.2, A3.2-2.2.3.2 4.4-6.4.2.1 (1),4.5-5.2.4.4, 5.1-4.2.1,5.1-4.11.1
Medicarion disrriburion and srorage 5.1-6.4.2.1 (1),5.2-6.4.2.1 (1), for assisred living facilities, 4.1-4.11.1
locarions, 2.3-4.2.2
5.3-6.4.2.1 (1) for dierary faciliries, 2.3-4.5.3.8
cabiners, 2.3-4.2.2.4
NFPA 110: Standardfor Emergency and for hospice facilities, 3.2-4.11.1
moniroring, A2.5-6.2.1
Standby Power Systems, 3.1-6.4.2.1 for independenr living serrings,
rooms, 2.3-4.2.2.2
(1)(a), 3.2-6.4.2.1 (1)(a) 4.2-4.11.1, A4.2-4-a
self-conrained, 2.3-4.2.2.3
NFPA 255: Standard Method ofTest of for inrellecrual/developmenral disabiliry
Medicarion error risk assessmenr, 1.2-3.6 Suiface Burning Characteristics of serrings, 4.4-4.11.1
Medirarion area, for hospice faciliries, Building Materials, 2.4-1.2.2.2, for ourparienr rehab facilities,
3.2-2.3.7.2 2.5-3.4.1.2 5.3-4.11.1
Menral healrh Narure, views of and access ro, 1.2-4.5.2 for nursing homes, 3.1-4.11.1
design considerarions, 1.2-3.5.3 for assisred living faciliries, AT4.1-a for subsrance abuse rrearmenr faciliries,
Patient Safety Standards, Materials and for demenria faciliries, A2.2-4.3.5.1 4.3-4.11.1, A4.3-4-a

Systems Guidelines (New York Srare for inrellecrual/developmenral disabiliry for wellness cenrers, A5.2-4.11

Deparrmenr of Menral Healrh), serrings, AT4.4-a Orrhorics work area

1.2-3.5.2.2 for nursing homes, AT3.1-a for nursing home, 3.1-3.3.4.1
risk assessmenr sample, Al.2-3.5.3
Neighborhood model. See Care models for ourparienr rehab faciliries, 5.3-3.3.1
risks, 1.2-3.5
Ner usable space, for adulr day (healrh) care Ourdoor areas/spaces, 2.1-3.6.2
See also Demenria
faciliries, 5.1-2.3.3.3 (2)(a) for adulr day (healrh) care faciliries,
Mercury eliminarion, A2.1-5-d Nighr-lighrs, for residenr rooms, 5.1-2.8
Millwork, 2.4-2.4.2 A2.5-7.3.2.2 for assisred living faciliries, 4.1-2.3.8,
for independenr living serrings, for assisred living faciliries, AT4.1-a
A4.2-5.2.4 A4.1-6.7.3.2 (2)(b) for demenria unirs, 2.2-4.3.5,

Mirrors, for hand-washing srarions, for demenria faciliries, A2.2-4.3.2.2-h A1.2-3.5.3.4 (3) (a)

2.4-2.2.8.7 for hospice faciliries, 3.2-6.7.3.2 (2)(b) benefirs of, A2.2-4.3.5.1

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 301
Outdoot ateas/spaces (continued)
fat hospice facilities, 3.2-2.3.8
for independenr living serrings,
4.2-1.5.3.6 (3)
for inrellectual/developmenral disabiliry
serrings, AT4.4-a
for nursing homes, 3.1-2.3.8
and srress reduction, A2.2-4.2.3.2
for substance abuse treatment facilities,
4.3-2.3.8
water fearures, 2.1-3.6.3
Overnight guest accommodations. See Guest
accommodations
Owner's project requiremenrs (OPR),
1.4-5.1.1
p A2.2-2.6.2.1-a
Palliative care, definition of, A3.2-1. 1. 1.1
Parking
for adulr day (health) care facilities,
5.1-1.5.3.3
for assisred living facilities, 4.1-1.5.3.3
Qualiry of life
for hospice facilities, A3.2-1.5
for independenr living serrings,
A4.2-1.5.3.1-c
for nursing homes, 3.1-1.5.2
securiry considerations for, 1.2-3.7.1.4
site selection and, 2.1-3.3
Parricipanr areas, for wellness cenrers, 5.2-2
Patienr-cenrered care. See Person-centered
care
Pediatric facilities, A2.2-4-b, 3.1-2.2.4.1
Peep holes, A4.2-1.4-c
Personal services areas
for adult day (health) care facilities,
5.1-2.3.5
for assisted living facilities, 4.1-2.3.5
for hospice facilities, 3.2-2.3.5
for independenr living serrings, 4.2-2.3
for nursing homes, 3.1-2.3.5
for well ness cenrers, 5.2-2.3.5,
A5.2-2.3.3.5
Person-cenrered care
assisted living facilities and, AT4.1-a
core values of, A1.2-1.3.1
definition of, A1.2-4.5.9
design and, 1.2-5.8
hospice serrings and, A3.2-1.3.3,
A3.2-1.4.3
inrellecrual/developmenral disabiliry
serrings and, AT4.4-a
for independenr living serrings,
nursing homes and, AT3.1-a
A4.2-4.11.1
planning considerations, 1.2-4.5.9
for substance abuse rreatmenr facili­
well ness cenrers and, A5.2-1.4
ties, A4.3-4.11.1
Persons of size
care unit for
design considerations, 1.4-2.3
design criteria, 2.2-3
planning considerations, 1.2-5.6
consultation areas/rooms for, 2.3-3.5.2.2
Rehabilitation facilities
definition of, A2.2-3
for nursing hom~s, 3.1-3.3
302 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
guest accommodations for,
A3.2-2.2.2.2 (3)
handrails for, A3.2-5.2.2.1 0 (2)
Pet accommodations, 2.3-4.4.3
for independenr living serrings, A4.2-4.4
Phased projects, 1.1-3.1.3
Physical therapy facilities, 5.3-3.2, A5.3-1-a
exercise area, 5.3-3.2.4
for nursing homes, 3.1-3.3.2
Planning, 1.2-5
Plumbing fixrures, 2.5-2.3
Plumbing systems, 2.5-2
for independenr living serrings, 4.2-6.2
and infection conrrol, 1.2-3.2.1.1 (2)
Pollution conrrol, 2.1-5
Polychlorinated biphenyl (PCB) removal,
Pools
for outpatienr rehab facilities, 5.3-3.2.6
therapeutic, for rehabilitation facilities,
3.1-3.3.4.3
Q
for well ness cenrers, 5.2-2.3.3.3 (3)
See also Whirlpools
Post-acure care facilities, 3.1-2.2.4.2
Potable water supply systems, 2.5-2.2.2
conservation and, 2.2-2.3
heated, 2.5-2.2.3
Pot-washing facilities, design elemenrs,
2.3-4.5.3.7
Power equipmenr
for adult day (health) care facilities,
5.1-6.4.2
for assisted living facilities, 4.1-6.4.2
for independenr living serrings, 4.2-6.4.2
Power supply
for electronic equipmenr, 1.5-3.2.2
essenrial systems, 3.1-6.4.2.1
Privacy
for adult day (health) care facilities,
A5.1-6.3.4
for assisted living facilities, 4.1-2.2.2.4,
A4.1-4.2.3 (1)
for bathrooms, for substance abuse
treatmenr facilities, A4.3-4.2.3.1
care models and
for assisted living facilities, AT4.1-a
for nursing homes, AT3.1-a
for conference rooms, 3.1-4.11.1.1,
4.1-4.11.1.1
for adult day (health) care facilities,
5.1-4.11.1.1
4.3-2.3.3.3
for wellness centers, 5.2-2.3.3.3
Recreation therapy, A5.3-1-c
Recyclables, design cri teria for storage and
curtains, 2.4-2.4.4
design guidelines for, 1.2-4.5.5
for examination rooms, 2.3-3.2.3
for hospice facilities, 3.2-2.2.2.4
for inrellectual/developmenral disabiliry
serrings, AT4.4-a
for nursing homes, 3.1-2.2.2.4
for outpatienr rehab facilities, 5.3-3.2.5,
5.3-3.3.2.3
person-cenrered care and, 1.2-5.8.3
for residenr rooms, 3.1-2.2.2.4,
4.4-2.2.2.4
speech
design guidelines for, 2.5-8.6,
T2.5-6
for outpatienr rehab facilities,
5.3-3.3.2.3
for telephone area, 3.2-4.11.2.3
for therapy areas, 3.1-3.3.2.2 (2)
Program for All-Inclusive Care for the
Elderly, A5. 1-1. 1. 1.1
Prosthetics facili ry
for nursing home, 3.1-3.3.4.1
for outpatienr rehab facilities, 5.3-3.3.1
Public rransporration, and site selection,
1.3-2.2
planning considerations for, 1.2-5.8,
A1.2-1.3.2.5
residenr safery risk assessmenr and,
1.2-3.1.5.2, A1.2-3
Quiet room/space
for adulr day (healrh) care facilities,
5.1-2.3.7, 5.1-4.2.9
for communiry area, 2.3-2.3.7
for residenr care/living areas (units),
2.3-2.2.3.3, 3.1-2.2.3.3
and srress reduction, A2.2-4.2.3.2
R
Receiving areas, 2.3-4.7.2
Receptacles. See Electrical receptacles
Reception areas, for rehabilitation therapy,
3.1-3.3.5.1
Record drawings, 1.4-4
Recreation areaslrooms
for adult day (health) care facilities,
5.1-2.3.3.3
for assisted living facilities, 4.1-2.3.3.3
for hospice facilities, 3.2-2.3.3.3
for independenr living serrings,
A4.2-2.3.3-b
for nursing homes, 3.1-2.3.3.3
for substance abuse rreatmenr facilities,
collection, 2.2-2.5.1.1
Refrigerants, 2.2-2.6.1.1
Regulations
for acoustic design, 1.4-2.1.1
government, 1.1-4
 outpatient, 5.3 pediatric, 3.1-2.2.4.1 (1)
5.3-4.7.2, 5.3-4.8.2, 5.3-4.9.2,
Renovation, 1.4-3 receptacles in, 3.1-6.4.3.3, 4.1-6.4.3.3
5.3-4.10.2
use of Guidelines for, 1.1-3 space requirements, 3.1-2.2.2.2
residential care and support facilities
Resident areas, 2.3-2 for substance abuse treatment facilities,
and, 4.1-1.2.2, 4.2-1.2.2, 4.3-1.2.2,
for assisted living facilities, 4.1-2 4.3-2.2.2 4.4-1.2.2
for dementia units, 2.2-4.3 Resident safety risk assessment, 1.2-3 wellness centers and, 5.2-1.2.2, 5.2-4.7.2,
for hospice facilities, 3.2-2 architectural detail, surface, and 5.2-4.8.2, 5.2-4.9.2
for independent living settings, 4.2-2 furnishing materials and, 2.4-2.1.2.2 Sharps containers, 2.3-4.2.2.2 (2)(e)
for inrellectual/developmental disability components of, 1.2-3.1.2, T1.2-1 Showers, 2.5-2.3.3
settings, 4.4-2 evaluation in, 1.2-3.1.5.2 accessible, 2.5-2.3.3.2
lighting for, 2.5-7.2 process for, 1.2-3.1.5 for assisted living facilities, A4.1-2.2.2.7
for nursing homes, 3.1-2 report on, 1.2-3.1.5.3 (1)(e)
for substance abuse treatment facilities, team for, 1.2-3.1.4 for independent living settings,
4.3-2 timing of, 1.2-3.1.3 A4.2-6.2-c
Resident care/liVing area (unit) Retail space, for wellness centers, 5.2-2.3.9, for resident rooms, A3.1-2.2.2.7
for assisted living facilities, 4.1-2.2 A5.2-2.3.3-d staff, for hospice facilities, 3.2-4.3.3
definition of, Al.3-2.2, A3.1-2.2 Roads for visitors, 3.2-4.4.3
design elements, 2.3-2.2 for independent living settings, See also Bathing facilities
for hospice facilities, 3.2-2.2 A4.2-1.5.3.1-a Signs
for independent living settings, 4.2-2.2 site selection and, 2.1-3 for assisted living facilities, AT4.1-a
for intellectual/developmental disability Room noise levels, design criteria for, design requirements, 2.4-2.2.12
settings, 4.4-2.2 2.5-8.4, T2.5-5 for intellectual/developmental disability
for nursing homes, 3.1-2.2 settings, AT4.4-a

for substance abuse treatment facilities, s for parking, 2.1-3.4

4.3-2.2 planning for, 1.2-4.5.3

Resident-centered care. See Person-centered Safety Sinks

care
Resident fall risk and prevention, 1.2-3.4
Residential care and support facilities
assisted living, 4.1
independent living, 4.2
settings for individuals with intellectual/
developmental disabilities, 4.4
substance abuse treatment facilities, 4.3
Residential health facilities
nursing homes, 3.1
hospice facilities, 3.2
Resident mobility and transfer
destination points and, 1.2-3.3.2.8
equipment, 1.2-3.3.2.2
quantity of, 1.2-3.3.2.4
storage for, 1.2-3.3.2.6
types of, 1.2-3.3.2.2
grab bars for, 2.4-2.2.9.2
risk
assessment of, 1.2-3.3
design recommendations for reduc­
ing, 1.2-3.3.2.1
Resident quality of life
planning considerations for, 1.2-5.8,
A1.2-1.3.2.5
5.1-4.2.6
resident safety risk assessment and,
for assisted living facilities, 4.1-4.2.6
1.2-3.1.5.2, A1.2-3
for intellectual/developmental disability
Resident rooms, 3.1-2.2.2
for assisted living facilities, 4.1-2.2.2
call stations for, 3.1-6.5.2.2, 4.1-6.5.2.2
for hospice facilities, 3.2-2.2.2
for intellectual!developmental disability
settings, 4.4-2.2.2
Shared services
lighting for, 4.1-6.7.3.2 (2),
adult day (health) care facilities and,
A4.2-6.7.3.2 (2)
5.1-1.2.2
for nursing homes, 3.1-2.2.2
outpatient rehab facilities and, 5.3-1.2.2,
architectural detail, surface, and
furnishing materials and, 2.4-2.1.2.2
for assisted living facilities, A4.1-5.1-b
bed, 1.2-3.3.2.10 (4)
care models and, for assisted living
facilities, AT4.1-a
codes and standards, 1.1-5
design criteria, 2.2-4.2
electronic systems, 2.5-6
for intellectual/developmental disability
settings, AT4.4-a
planning considerations, 1.2-4.5.6
Safety devices, srorage for, 5.3-4.2.4.2
Safety risk assessment. See Resident safety
risk assessment
Seating, Al.4-2.4.3.1
for resident rooms, A3.1-2.2.2.2 (3)
(d)(ii), A3.2-2.2.2.2 (3)(c)
See also Furnishings, Furniture
Security
design criteria, 2.2-4.2.1
for dementia units, 1.2-3.5.3.4 (1)
electronic systems, 2.5-6
for intellectual/developmental disability
settings, AT4.4-a
planning considerations, 1.2-3.7.1,
1.2-4.5.6
site selection and, 2.1-2.3
Security risk assessment, 1.2-3.7
Seismic design. See Earthquake-resistant
design
Sewers, 2.5-2.2.4.3
Speech privacy
design guidelines for, 2.5-8.6, T2.5-6
for speech and hearing therapy area,
3.1-3.3.4.2 (2), 5.3-3.3.2.3
clinical,3.1-6.2.3.5
See also Hand-washing stations
Site elements, 2.1
for adult day (health) care facilities,
5.1-1.5
for assisted living facilities, 4.1-1.5
for hospice facilities, 3.2-1.5
for independent living settings, 4.2-1.5
for nursing homes, 3.1-1.5
for wellness centers, 5.2-1.5
Site exterior noise, 2.5-8.2, T2.5-3,
AT2.5-b
classifications, Al.5-8.2.3
Site selection, 1.3
building orientation and,
1.2-2.2.2.2 (1)(a), 2.1-4
Smoke-free environment, Al.2-2.4.l
Snoezelen room, Al.2-4.2.3, Al.3-2.3.7
Soiled holding room
for assisted living facilities, 4.1-4.6.3.2 (2)
for hospice facilities, 3.2-4.6.3.2
for nursing homes, 3.1-4.6.3.2
Soiled utility room, 2.3-4.2.6
for adult day (health) care facilities,
settings, 4.4-4.2.6
for nursing homes, 3.1-4.2.6
for substance abuse facilities, 4.3-4.2.6
Speech and hearing therapy facility, 5.3-3.3.2
for nursing home, 3.1-3.3.4.2

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 303
Staff facilities
for adult day (health) care facilities,
5.1-4.3.2
for assisted living facilities, 4.1-4.2.1,
4.1-4.3
design elements, 2.3-4.2.1, 2.3-4.2.8
for hospice facUities, 3.2-4.3, 3.2-4.3.2
for independent living settings, 4.2-4.2.1
lounges, 2.3-4.3.2
for rehabilitation therapy, 3.3-4.2.1
for substance abuse treatment facilities,
4.3-4.2.1
toilet rooms, 2.3-4.3.3
for well ness centers, 5.2-4.2.1, A5.2-4.11,
A5.2-4-a
Storage
for assisted living facilities, 4.1-2.2.2.8
for dietary facilities, 2.3-4.5.3.9
for hospice facilities, 3.2-2.2.2.8
for independent living settings,
A4.2-2.2.2-b
for intellectual/developmental disability
settings, 4.4-2.2.2.8
for laundry facilities, 4.1-4.6.3.2 (4)(a)
for maintenance services, 2.3-4.10.5
for mobility devices, 1.2-3.3.2.6, 2.3­
2.3.2.3,2.3-4.2.4.2,3.1-4.2.4.3
for outpatient rehab facilities, 5.3-3.2.6.3
for resident rooms, 3.1-2.2.2.8
for substance abuse treatment facilities,
4.3-2.2.2.8, A4.3-2.2.2-b
for hospice facilities, 3.2-5.2.4
for well ness centers, 5.2-2.3.3.4 (3)
for independent living settings, 4.2-5.2.3
See also Supply storage
for intellectual/developmental disability
Stress reduction, design criteria and, 2.2-4.2.3
Subacute care facilities, A3.1-2.2.4
Substance abuse treatment, stages of,
A4.3-4.2.4.2 (1)
Substance abuse treatment facili ties, long­
term residential, 4.3
A2.1-3.6.2-b
minimum standards for, 4.3-1.1.3
selection of materials and products for,
types of, 4.3-1.1.1.1
2.4-2.1
Supplies, office, storage of, 3.1-4.11.1.3,
4.1-4.11.1.3,4.2-4.11.1.3,4.3­
4.11.1.3,4.4-4.11.1.3
Supply storage
for assisted living facilities, 4.1-4.2.4
design elements, 2.3-4.2.4
for emergency supplies, Al.2-3.8.I-e
for independent living settings, 4.2-4.2.4
for outpatient rehab facilities, 5.3-4.2.4,
5.3-4.11.2
for rehabilitation therapy, 3.1-3.3.5.5
for nursing homes, 3.1-4.2.4
for substance abuse treatment facilities,
4.3-4.2.4
Support areas
for adult day (health) care facilities,
5.1-2.3.3.4,5.1-4
for assisted living facilities, 4.1-4
for dementia units, 2.2-4.3.2
design elements, 2.3-4
for dining and activity areas, 2.3-2.3.3.4
304 Guidelines for Design and Construction of Residential Health. Care, and Support Facilities
for hospice facilities, 3.2-4
for independent living settings, 4.2-4
for laundry facilities, 3.1-4.6.3, 3.1-4.6.4
for nursing homes, 3.1-4
for outpatient rehab facilities, 5.3-4
for rehabilitation therapy, 3.1-3.3.7
staff
design elements, 2.3-4.2.8
for hospice facilities, 3.2-4.3
for independent living settings,
4.2-4.2.1
for substance abuse treatment
facilities, 4.3-4.2.1
for well ness centers, A5.2-4-a
for substance abuse treatment facilities,
4.3-4
for ventilator-dependent resident units,
3.1-2.2.3.2 (2)
for well ness centers, 5.2-2.3.3.4, 5.2-4
Supportive environment
for assisted living facilities, 4.1-1.4.3
for independent living settings, A4.2-1.4-b
for intellectual/developmental disability
settings, 4.4-1.4.3
for nursing homes, 3.1-1.4.3
for substance abuse treatment facilities,
A4.3-1.4.3
Surfaces
for assisted living facilities, 4.1-5.2.3
design requirements, 2.4-2.3
Total building commissioning (TBC),
Al.4-5-b
activities, 1.4-5.1
settings, 4.4-5.2.3
materials and products for, characteristics
and criteria for selecting, 1.2-4.5.7
for nursing homes, 3.1-5.2.3
for outdoor activity spaces,
transfer
Transition spaces, lighting for, A2.5-7.3.2
Transportation, site selection and, 2.1-2.2
for substance abuse treatment facilities,
4.3-5.2.3
Also see Finishes
Sustainable design, 1.4-2.2
design criteria, 2.2-2
planning considerations, 1.2-5.5
T Uniform Federal Accessibility Standards,
Technology equipment room, 2.5-5.3
facility requirements, 2.5-5.3.4
location and access requirements, 2.5-5.3.3
Telecommunication spaces, grounding for,
2.5-5.4
Teledata rooms, 2.5-5.3, A4.2-6.5-c
Telemedicine services, accommodations for,
2.3-4.2.9
Telephones
access to, 2.3-4.2.8
for adult day (health) care facilities,
5.1-4.2.8
for hospice facilities, 3.2-4.11.2.3
TGB bar, 2.5-5.4.2
Therapeutic community, A4.3-1.1.1.1
care model, A4.3-4.2.4.2 (1)
Therapeutic equipment, storage for,
5.3-4.2.4.2
Thermal conditions
design considerations, A2.2-2.4.1
planning considerations, 1.2-5.3
Thresholds, 2.4-2.2.5
Toiletsltoilet rooms
for adult day (health) care facilities,
5.1-2.3.3.4 (2)
for assisted living facilities, 4.1-2.3.3.4,
4.1-4.3.3
for hospice facilities, 3.2-2.2.2.6
for independent living settings,
A4.2-2.2.2-a, A4.2-6.2-d
lighting for, 3.1-6.7.3.2 (2), 5.1-6.7.3.2 (2)
for nursing homes, 3.1-2.2.2.6
for outpatient rehab facilities, 5.3-4.2.3.3
public, 2.3-2.3.2.6
for quiet rooms, 2.3-2.2.3.3 (3)
for rehabilitation therapy in nursing
homes, 3.1-3.3.7.2
staff, 2.3-4.3.3
for substance abuse treatment facilities,
A4.3-2.2.2-a
for visitors, 3.2-4.4.3
for well ness centers, 5.2-2.3.3.4 (2)
Total environment commissioning (TEC),
A1.4-5-c
Towel service. See Linen services
Traditional model. See Care models
Transfer. See under Resident mobility and
Treatment areas/rooms, 2.3-3
for nursing homes, 3.1-3
space requirements, 2.3-3.2.2
Tubs, 2.5-2.3.3
u
1.1-4.1.1
U.S. Green Building Council,
A1.2-5.5.2.1-c
Utilities, access to, site selection and, 2.1-2.4
v
Vacuum systems, for nursing homes,
3.1-6.2.4
Valves, 2.5-2.2.2.2
Vapor barrier, 2.5-3.4.2.2
Vehicular drop-off and pedestrian entrance.
See En trances
Vending machines/services, 2.3-4.3.2.3
recovery options, 2.2-2.3.4
Ventilation, 2.2-2.4.1.2
Wayfinding
of construction zone, A1.2-3.2.2.4
disaster planning and, A1.2-3.2.2.8
and space conditioning, 2.5-3.1.2
for independent living settings,
exterior, lighting for, 2.5-7.1.2.2
for independent living settings,
A4.2-1.5.3.1-b
in outdoor activity spaces, A2.1-3.6.2-b
for outpatient rehab facilities, 5.3-1.5.3.2
for wellness centers, 5.2-1.5.3.2
for assisted living facilities, AT4.1-a
design requirements, 2.4-2.2.12
for intellectual!developmental disability
settings, AT4.4-a

A4.2-6.3.1 Wall bases for parking, 2.1-3.4

See also HVAC systems design requirements, 2.4-2.3.2 planning for, 1.2-4.5.3

Ventilator-dependent resident bedrooms, for independent living settings, Wellness centers, 2.3-3.3, 5.2
3.1-2.2.3.2, 3.2-2.2.3.2 A4.2-5.2.3.2 Whirlpools, portable hydrotherapy,
electrical systems for, 2.5-4.4 Walls 2.5-2.3.6
Vibration control, 2.5-8.7 demising wall assembly, A2.5-8.5.2, Windows
Visitors, support facilities for, 3.1-4.4.1 A5.1-6.3.4 for assisted living facilities, 4.1-5.2.2.6
for assisted living facilities, 4.1-4.4 design requirements, 2.4-2.3.3 for daylighting, A2.5-7.2-a
for hospice facilities, 3.2-4.4.1 emissions standards for, A2.2-2.4.1. 1-e glare from, A2.5-7.2.2
for independent living settings, 4.2-4.4 finishes, 2.4-2.3.3.1 for hospice facilities, 3.2-2.2.2.3
for intellectual/developmental disability for independent living settings, for independent living settings,
settings, 4.4-4.4 4.2-5.2.3.3
A4.2-5.2.2.6, A4.2-6.3.1-a
for persons of size, A3.2-2.2.2.2 (3) protection for, 2.4-2.3.3.2
for intellectual/developmental disability
showers, 3.2-4.4.3 Warewashing facilities settings, A4.4-5.2.2.6
for substance abuse treatment facilities, design elements, 2.3-4.5.3.6 for nursing homes, 3.1-2.2.2.3,
4.3-4.4 for independent living settings, A4.2-4-a 3.1-5.2.2.6
Vocational therapy, A5.3-1-c Waste management facilities operable, 2.2-4.2.1.6, A2.5-3.2.1.3,
classrooms for, 5.3-3.2.3 design elements, 2.3-4.8 A4.2-6.3.1-a
Volatile organic compounds (VOCs), for independent living settings, requirements for, 2.4-2.2.6
2.2-2.4.1.1 A4.2-4-a for substance abuse facilities, 4.3-5.2.2.6
maximum concentration levels, AT2.2-1 for outpatient rehab facilities, 5.3-4.8 Window treatments, 2.4-2.4.4
Volunteer facilities, storage for, 3.2-4.4.4 for substance abuse treatment facilities, for daylighting control, 2.5-7.2.2
A4.3-4-a
for independent living settings,
w for wellness centers, 5.2-4.8
A4.2-5.2.4.4
Water features for physical therapy spaces, 3.1-3.3.2.2
Waiting areas/rooms design requirements, 2.4-2.2.13 (2)(a), 5.3-3.2.5.2
for assisted living facilities, A4.1-5.1-c outdoor, 2.1-3.6.3 Wind-resistant design, A1.2-3.8.1-b
for outpatient rehab facilities, 5.3-2.3.3 Water supply systems Wireless systems, for call systems,
seating for persons of size, A2.2-3-e access to, site selection and, 2.1-2.4.2 3.1-6.5.2.4 (1),4.1-6.5.2.1 (3),
for wellness centers, A5.2-2.3.5-b, 5.2-2.3 conservation and, 2.2-2.3 5.1-6.5.2.1, A4.2-6.5-a
Walkways, 2.1-3.2, A4.2-1.5.3.1-b disaster planning and, A1.2-3.2.2.8 Workers' compensation costs, caring for
for adult day (health) care facilities, and infection control, 1.2-3.2.1.1 (2) persons of size and, A2.2-3-c
5.1-1.5.3.2 measurement devices for, 2.2-2.3.2

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 305