Pandemic-proof Design in Health & Social Care Spaces: Alessandro Caruso Architects

ACA’s Response to COVIC-19 – Pandemic-proof Design in Health & Social Care Spaces

The COVID-19 pandemic raises challenges for us all, in particular for care home residents, their families and staff.  Indeed, the majority of people living in care homes are over the age of 80.  Most of them are affected by physical disability and cognitive impairment as well as long-term health conditions.  So, these factors partly explain the vulnerability to COVID-19 of older people living in care homes.

Certainly, this is not the world’s first pandemic, but it is in OUR lifetime.  And there is plenty that we can do in care homes to improve outcomes for residents during these challenging times.


A New Design For a New Age

So, it would help to understand lessons learnt from the previous pandemic, the Spanish Flu in 1918, in response to today’s pandemic.  For instance, the effects it had on people’s behaviour and the consequences on physical and mental health. Regrettably, there isn’t a lot of data on the long-term impacts of the Spanish Flu on the survivors’ and front-line workers’ mental health.

However, since 1918, many things have evolved and we are also witnessing a change in the way healthcare services are provided: from one focusing on physical health, mental health and specific care needs to one focusing on relationships, wellbeing and thriving communities.

Indeed, we have long promoted the idea that good design can support such models of care and in some cases, prevent or delay the use of medicine.

What follows is an investigative journey of some of our recent projects affected by COVID-19, to understand how to improve design in the future.

Pandemic-proof Design in Care Homes and Independent Living Facilities

Abbeyfield, Fern House Extra Care, Bingley

In 2017, ACA co-ordinated the interior design strategy for a six-storey development in Bingley, comprising extra-care apartments, dementia bedrooms and a day centre with communal facilities.

During the pandemic, both residents and staff have been affected by COVID-19, so it was important to understand what works and required future improvements.

What Works:

  • Firstly, the dementia bedroom wing designed over three floors to accommodate for progressive care needs proved useful to group residents with COVID together and temporarily isolate them.
  • Secondly, the intermediate doors along the corridors, designed to create “group households”, proved useful to control access to hot and cold areas.
  • Thirdly, the variety and large amount of space available made it possible for residents to sit and observe social distancing, whilst having much needed contact.

Lessons Learnt:

  • As a result of the virus, the development had to change seating arrangements in dining rooms and communal areas and set different timetables for activities.
  • We had to reconsider the number of two and three seater sofas.  It was difficult to get residents to observe social distancing as this disrupted their routine of usually sitting next to their friend(s) on the same sofa.
  • Regrettably, the community hub, designed as a space for people from the neighbourhood to find peer support, became redundant

How We Responded:

  • The independent access to the community hub became a barrier nursing system.  Thus separating staff accessing the building and changing in uniform, from those using the dedicated entrance to the kitchen. This guaranteed safe transportation of food deliveries and minimisation of contact.

Pandemic-proof Design in Assisted-Living Communities

Choice Care Group, Complex Care Development, Fishbourne

The case of the Choice Care Development is particularly interesting. We had only just completed the foundations when the first lockdown forced us to stop work on site. As a result, we had to take stock of the developing situation and use that time to review the original design.

ACA’s Teams designed the development for a small group of ten people with complex and different needs. In this “village setting”, the residents can be actively involved in the community as much or as little as they wish, retaining independence, dignity and an active lifestyle.

How We Responded:

  • We concluded that the home design for a small group of residents, whilst ideal to create a homely atmosphere, presents its challenges for social-distancing. Personal Protective Equipment (PPE) and enhanced cleaning regimes are in place, requiring more storage capacity in future buildings.
  • The provision of self-contained apartments is critical to support isolation requirements when needed. Our review has also exposed the need to create a proportion of larger bed-sits, with sofas to support self-isolation, within the comfort of the service users’ environment. The larger bedrooms would also future-proof the environment to accommodate hospital size beds if required.

Pandemic-proof Design for Mental Health and Learning Disabilities Developments

Humber Teaching NHS FT, Townend Court, Hull

Over the years we have completed a number of developments for Humber Teaching NHS FT including: medium secure and psychiatric intensive care units; dementia care centres and learning disabilities developments.   Recently, there have been COVID-19 cases within the Trust’s facilities which are located in a variety of urban and acute hospital settings.  So, this has facilitated a more strategic approach for the location of cohort wards, particularly associating mental health service users affected by the virus within an acute hospital setting.

For the future…

In the case of the Learning Disabilities Developments in Hull:

  • Developments will require PPE for the foreseeable future, so we will need to review the temporary changing facilities created in proximity of entrances. For this reason, we will allow for more storage capacity in future buildings.
  • The front of house will be a big area of focus for the future of these facilities. For example, introducing non-touch door access controls, to stop the spreading of this and other viruses.

Pandemic- proof Design in Dementia Care

Humber Teaching NHS FT, Maister Lodge, Hull

Last year ACA completed the refurbishment of Maister Lodge. In fact, we created a more dementia-friendly environment to care for the complex needs associated to dementia.

What the Pandemic Changed

  • We had to make bespoke adaptations such as the requirement for sanitisers at ward entry points.  As a result, we had to review the ligature risk associated to these dispensers.
  • A telephone and video conference-based service replaced the community services associated to specific users’ needs. Obviously, this was to maintain staff and service user’s safety. Yet, whilst many activities currently take place remotely, we can foresee the important role of the environment again in the future.

The Environmental Response to Mental Health in COVID Times

  • The environment will play an even more important role to complete the design of mental health facilities in future. This is because there are increased levels of both patient and staff anxiety.   Particularly, staff need somewhere other than the ward for a break and to wind down. This means a re-design of the staff room, to focus on both well-being and social-distancing measures.
  • It will be critical to understand how isolation areas can be introduced, to support patients in self- isolation.
  • We will need to consider the shared use of space into the design of facilities, considering social-distance and interaction.

Asking The Right Questions

All of the above spaces are different, due to difference in the specific needs of patients and residents.  However, they all have ONE thing in common….we didn’t design them with the pandemic in mind! Nobody could have predicted it, so we have responded by adjusting the design. We did so with a solution-focused and collaborative approach involving all stakeholders. We asked ourselves and others critical questions in order to:

  • understand the needs of the patient groups and the service requirements.
  • understand how the service works in the community, to achieve a successful outcome.
  • identify the design challenges linked to the complexity of emotional experiences.
  • assess the risks associated to the microbe’s ecosystem.
  • prevent COVID-19 from spreading, through: social-distancing measures, creating hot and cold areas with independent accesses; limiting surface contact; adopting access control technology and controlling aerosol via maximising natural ventilation.

We recognize the impact of the virus on the adaptability of existing facilities and the design of future facilities. Furthermore, we know we need to improve the resilience of our healthcare facilities. To do so, we need a new and deeper understanding of the ergonomics of space to support social-distancing.

To sum up, pandemic-proof design is a “new” concept that is here to stay. This is why we need an attentive design to support a culture of health and wellbeing for the community.

If you need help with a consultation to assess your environment with recommendations, please get in touch for a free consultation. 

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