Geriatric Behavioral Health
A Focus on the Senior Needs for Arizona's White Mountain Region
The new Geriatric Behavioral Health Unit at Summit Healthcare Regional Medical Center in Show Low, Arizona provides much needed behavioral health services within the White Mountain region. The 14,000 square foot renovation project on the fifth floor of the hospital was designed, permitted, constructed and opened for business in a compressed 12-month schedule. This rural healthcare provider, in an effort to secure the lost revenue stream of transporting behavioral health patients out of the area to larger, urban providers, leveraged their recently vacated floor to create twelve private behavioral health patient rooms with future conversion possibilities to expand to sixteen total rooms.
Speed to Market
As with many service lines, the project was driven by patient reimbursement requirements. A January 1, 2020 opening posed an incentive to receive Medicare funding for that calendar year and required at least one admitted patient by 11:59 p.m. on December 31, 2019.
Interdisciplinary Design Team Perspective.
Architect: Tyler Kimball--The challenge of this project was coming up with a solution that does not have an obvious answer…Behavioral Health has a lot of those opportunities. Summit gave us the chance to design a home-focused environment that could bring nature inside and not just meet a ‘standard’.”
Interior Designer: “(Over)hearing people take ownership of the space and the pride that goes with that makes me really proud of the job we’ve done -- putting the patient first has a domino effect on a facility like this,” Jennifer Wilcynski.
Focused Demographic of Patient Care
As a geriatric unit, the retirees of the surrounding communities will provide the majority of the patient base. The facility offers a short-term inpatient mental health program for older adults, providing quality treatment by a team of healthcare providers in a caring and compassionate environment.
The services provide for an acute care stay for geriatric patients, and is designed to evaluate and treat adults who have psychiatric conditions with and without concurrent medical issues. Care is offered for acute emotional and behavioral concerns, such as depression, adjustment difficulties, and anxiety with release after 2 to 3 days, given they are stable
The nature of behavioral health care itself brings certain obvious design and operational priorities to the forefront. That being said, the design team concentrated on 5 main areas of focus:
- Safety and Risk Assessment Prioritization
- Creation of a Residential Environment within a Hospital Setting
- The Experiential Engagement of Patients, Staff and Visitors
- Consideration of Material Choice for Cleanability and Durability
- High Performance Design and Operations within Behavioral Health
Safety and Risk Assessment Prioritization
In any behavioral health facility, safety must be paramount with attention given to every detail of potential harm or risk to the patient and/or staff. As a geriatric unit, these risks must be weighed against their potential gain. In this case, strong consideration was given to design components like ceiling heights, line of sight and patient visibility, possible ligature points and furniture selections.
Ceiling Materiality & Height: One of the main design considerations was the ceiling material and heights throughout the floor. Ceilings were lower than expected due to existing mechanical above the ceiling. This prompted the design team to utilize a specialized acoustical gypsum wallboard ceiling system that provided a NRC (noise reduction coefficient) equal to that of typical acoustical ceiling tiles. In the corridor areas, the team decided to use acoustical ceiling tile grid with panel clips to secure in place. This allows Facilities to access the equipment above ceiling with special tools when needed for routine maintenance and repairs while remaining secure so that patients cannot hide contraband in the plenum space.
Patient Room Doors & Frames: With the construction budget and schedule in mind, the existing patient room door frames remained in place in the new design. However, the existing doors swung into the patient room, which is a safety concern as it can contribute to a possible barricade situation. Therefore, the new Acrovyn impact-resistant doors included a wicket door, the smaller door leaf inside the larger door that would allow it to be opened if it were ever to be barricaded from the patient room side.
Nursing Station: In an effort to deinstitutionalize the unit, offer maximum communication opportunities between staff and patients, and provide a clear line of sight to the main entrance, an open nursing station was built to be “geriatric-centered.” The open station kept staff safety in mind by incorporating a slightly higher and sloped transaction countertop surface. This impedes a geriatric patient from jumping over the countertop. Additionally, the placement of the nurse station allows for a direct line of sight to the main unit entrance for ease of monitoring.
Creation of a Residential Environment within a Hospital Setting
One of the most important design focuses was the psychological environment, how the space makes the occupants feel. Oftentimes behavioral health facilities struggle by portraying a prison rather than a place for healing. The goal of this project was to provide a more comfortable, residential-style space for both the patients and staff. From full spectrum, dimmable lighting to large scale landscape photography murals to the selection of the finishes and furniture, all attempted to be residential in nature and connect to the natural world. One of the architect’s favorite parts of the entire project was “providing the home-like atmosphere to the space,” said Kimball.
Due to the effects of the aging eye, this patient demographic views color, depth and contrast differently. The designer used a yellow lens while selecting materials to best choose flooring, accent paint, and upholstery, to truly see what these patients see. Additionally, geriatric patients perceive depth from high contrasting materials. Therefore, being mindful of the contrast between different flooring helps to prevent falls from patient disorientation, while the high contrast of the dark wood handrail and corner guards to the light paint color defines the horizontal and vertical surfaces for the visually impaired.
Biophilic design was incorporated by utilizing large murals of geographically significant landscape photography, wood-look sheet vinyl flooring, and wood wainscot panels in addition to exterior windows with views to the mountains beyond. The nature photography is what “makes the place,” said Summit’s Chief of Operations, Doug Gilcrest. As the designer, Wilcynski said one of her favorite parts of the whole project was, “giving the patients and staff views of nature and the outside environment to heal.”
The Experiential Engagement of Patients, Staff and Visitors
The entire unit is designed to engage all users in the healing powers of this short-term solution to mental health illness.
Consideration of Material Choice and Durability: Technology as problem-solving tool
Material choice, lifecycle costs and durability played a huge role in the decision-making process. Many solutions to the challenges that arose during the project were explored through technology solutions within BIM (Building Information Modeling) or actual 3D physical modeling. Given there are not many products on the market aimed for behavioral facilities, a 3D printer was used to test coverings for all existing fire alarm devices and window knobs. “We were able to make some design decisions based on breakability, structure and cost-effectiveness with our test models. In some cases, as a team, we chose to make operational changes vs. costly product choices.” In addition, technology such as acoustic devices that employ white noise were used to minimize the intelligibility and/or noise from one room to another.
High Performance Design and Operations within Behavioral Health
The intake time for patients was streamlined with the administration area connected directly to the Unit. The patient can be examined, family members consulted and insurance taken care of directly on the unit. This is done safely and effectively on one floor without transfer to other departments.
Another high performance enhancement was that the unit possesses a large equipment room that stores two additional platform beds. If a patient is suicidal, then the behavioral health specific hospital bed is stored and a platform bed is utilized. Additionally, the patient is placed in a room nearest to the Nurse Station. All of these operational changes helps to make Summit’s Behavioral Health Unit one of the safest places where patients can receive treatment.
The attention to detail and the determination of the project designers left Summit and Horizon Health pleased with the end result. The Summit Healthcare Regional Medical Center now has a functioning 12 room Geriatric Behavioral Health Unit that will serve its community for many years to come.