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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
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
3.2-5 Design and Construction Requirements 166

Part 5 Non-Residential Support Facilities 255
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
4.1-2 Resident Areas 185
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
4.2-1 General 203
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
4.3- 1 General 221
4.3-3 Diagnostic and Treatment Areas 226 Index 293
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 been the cornerstone of Guidelines development for more
the 100+ members of the 2018 Health Guidelines Revi than three decades.
sion Committee who served on the Hospital, Outpa There is a certain logic behind the four-year cycle
tient, and Residential document groups and associated for development of each Guidelines edition, but health
task groups. FGI also is indebted to the additional sub care changes rapidly and certainly not on a static cycle.
ject matter experts who served on the Residential Docu Beginning with the 2018 documents, FGI will be offer
ment Group and 2018 topic groups as well as individu ing a series of resources in addition to its Guidelines for
als who reviewed material in their areas of expertise (see Design and Construction documents. Termed "Beyond
the acknowledgments for lists of groups and individuals). Fundamentals," these materials are intended to support
These talented individuals volunteered their time and and expand the minimum design requirements pub
considerable expertise to develop the content of the 2018 lished in the Guidelines. Possible topics include detailed
edition of the FGI Guidelines for Design and Construction discussion of Guidelines requirements and how to apply
documents. We thank you all for your dedication and them, research supporting Guidelines requirements, draft
contributions of knowledge and experience! minimum requirements supported with research or other
The 2018 edition of the Guidelines is being pub evidence, best practices, and trends in practice that are
lished as three separate documents to clearly differentiate changing health care facility design. In the form of white
the needs of hospitals, outpatient facilities, and residen papers, articles, case studies, adVisory opinions, checklists,
tial care facilities and to support greater flexibility in the and so on, this material will to help facility managers and
design of outpatient facilities as health care expands into designers learn about advancements in health care design
a greater variety of outpatient spaces. that can make facilities safer for patients and staff and
The three documents are the Guidelines for Design improve clinical outcomes. Please follow the FGI website
and Construction of Hospitals, the Guidelines for Design (www.fgiguidelines.org) for updates on the Beyond Fun
and Construction of Outpatient Facilities, and the Guide damentals as well as future educational programs.
lines for Design and Construction of Residential Health, We encourage all users of the Guidelines to get
Care, and Support Facilities, which addresses nursing involved in the public proposal and comment process
homes and other long-term care facilities. FGI undertakes cyclically to revise the Guidelines stan
The 2018 edition is the latest in the 71-year history dards. Please keep notes as you use the documents and let
of the Guidelines document and the eighth to be revised us know what needs to be improved during the proposal
through a multidisciplinary consensus process supported period. The Guidelines must stay in step with changes in
by public input and review. It is the fifth edition devel the industry, and we count on all who use the documents
oped under the guidance of FG!. FGI remains commit to help us keep them current.
ted to updating these publications on a four-year revision
cycle using the multidisciplinary public process that has Kurt Rockstroh, FAIA, FACHA
President
Facility Guidelines Institute
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xi
Acknowledgments
A project as complex as the development of the Guide FGI appreciates the tremendous work of all who
lines for Design and Construction of Residential Health, participated during the 2018 Guidelines revision cycle.
Care, and Support Facilities, which focuses on the long Thank you for your efforts in developing a document that
term living market, would not be possible without the supports and encourages the provision of person-centered
generous contributions of many volunteers. During the care. Thanks are also extended for the continuing advo
2018 Guidelines revision cycle, the Residential Document cacy and support of the Center for Health Design's Envi
Group included Health Guidelines Revision Committee ronmental Standards Council and related task groups
(HGRC) members as well as additional non-voting long and the Hulda B. & Maurice L. Rothschild Foundation,
term care experts. The volunteers met both in person and which has long supported and been involved in numer
electronically to update existing text on nursing homes, ous initiatives with different organizations with the goal
hospice facilities, assisted living facilities, independent of creating person-centered models and regulations to
living settings, adult day care facilities, wellness centers, improve environments designed for elders.
and outpatient rehab centers and to develop and reach Note: HGRC members who served on more than
consensus on new text for facilities that serve individuals one of the groups listed have a shortened listing after their
with developmental disabilities and those in residential first appearance.
substance abuse treatment programs.
2018 Health Guidelines Revision Committee
Executive Steering Committee Linda Dickey, RN, MPH, CIC, FAPIC

University of California Irvine Medical Center
Orange, California
Chair
John P. Kouletsis, AIA, EDAC
Douglas S. Erickson, FASHE, CHFM, HFDp, CHC San Francisco, California
Facility Guidelines Institute
Sr. Louis, Missouri Jane M. Rohde, AIA, FIIDA, ASID, ACHA, CHID, LEED AP
BD+C, GGA-EB
JSR Associates, Inc.
Vice Chair Catonsville, Maryland
David B. Uhaze, RA
Health Facility Design Consulting Ellen Taylor, PhD, AIA, MBA, EDAC
Retired AHJ State of New Jersey The Center for Health Design
Trenton, New Jersey Paoli, Pennsylvania
Chair Emeritus
Steering Committee
Joseph G. Sprague, FAIA, FACHA, FHFI
HKS, Inc. Maria AlIo, MD, FACS, FCCM
Dallas, Texas Santa Clara Valley Medical Center
Los Altos, California
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 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 Michael Sheerin, PE, LEED AP BD+C
TLC Engineering for Architecture
Kathryn W. Gallagher, MS, RN, NE-BC Orlando, Florida
Universi ty of Pennsylvania Health System ASHRAE 170 Standing Standard Project Committee
Philadelphia, Pennsylvania
David M. Sine, DrBE, ARM, CSP, CPHRM
Debra Hawks, MPH Safety Logic Systems
American College of Obstetricians and Gynecologists Ann Arbor, Michigan
Washington, D.C. 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 Thomas A. Smith, CHPA, CPp, Chair
Hill-Rom
Patricia A. Lenaghan, RN, MSN, NE-BC, FAAN
Jeffrey T. O'Neill, AIA, ACHA Leo A Daly
Hospital of the University of Pennsylvania
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

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 The Revision Process
updated every four years to keep pace with evolving care
models, facility types, and requests for up-to-date guid The Guidelines and the methodology for revising its con
ance from care providers, designers, and regulators. For tent have been, and still are, evolving. When first pub
the 2018 edition, the Facility Guidelines Institute (FGI) lished, the document was a set of regulations developed
published three Guidelines for Design and Construction by a single department of the federal government as a
(Guidelines) standards, separating the requirements for condition for receiving a federal hospital construction
hospitals and outpatient facilities for the first time and grant under the Hill-Burton Act. Today, FGI develops
maintaining a separate document for residential health the Guidelines using a consensus process similar to that
facilities (nursing homes and hospice), care and support approved by the American National Standards Institute.
facilities (independent living settings and assisted living This process brings together the members of the
facilities of various types), and non-residential support Health Guidelines Revision Committee (HGRC), a bal
facilities integral to the continuum of care. anced group of stakeholders in health and residential care
For the 2014 edition, the standards for residential facility planning, design, construction, and operations
health, care, and support facilities were pulled into a sepa and clinical services who volunteer their time to the devel
rate Guidelines document to reflect changes in the long opment of the Guidelines. The committee considers pro
term care industry as person-centered care has become posals for change received from the public; achieves con
more prevalent and to emphasize the importance of pro sensus on facility issues; and develops proposed revisions
viding a residential environment in these facilities. For to the previous edition. The proposed revisions are then
2018, the goal for development of a separate Outpatient posted for public comment and revised by the HGRC, as
Guidelines document was to provide a framework for needed, in response to those comments. The product of
physical environments that support the unique needs of this revision process is compiled and published as a new
outpatients and outpatient facility staff and support flex edition of the Guidelines.
ible development as outpatient facility services change to When possible, the Guidelines standards are perfor
meet market demands. In recent years, services provided mance-oriented for desired results. Prescriptive measure
in outpatient facilities have rapidly evolved and expanded ments, when given, have been carefully considered rela
so that many procedutes and operations formerly per tive to generally recognized standards and research. For
formed only in hospitals now routinely take place in example, at the beginning of the 2018 revision cycle,
outpatient settings. In inpatient settings, changes in the members of the HGRC engaged in a workshop to deter
insurance market and the size of the aging population in mine baseline clearances needed to accommodate equip
the United States have pushed the numbers of patients ment and caregivers when caring for patients of size. This
served to all-time highs. These changes will continue to information was used to write proposals for new require
have significant implications for the design and construc ments for accommodations for care of patients of size
tion of health care facilities and the communities where in hospitals and outpatient facilities. Such revisions to
those services are delivered, and the Guidelines must the Guidelines are not made for the sake of change, but
change to support how care is provided. rather are submitted for public review and comment and
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xxi
ABOUT THE GUIDELINES
thoroughly reviewed and evaluated by the approximately • An asterisk (*) preceding a section or paragraph
100 professionals in health care delivery and design who number indicates that explanatory or educational
make up the HGRC. material can be found in an appendix item located
For the 2018 edition of the Guidelines, the HGRC at the bottom of the page.
was broken into three document groups-Hospital, • AppendiX items are identified by the letter "A" pre
Outpatient, and Residential-ro streamline develop ceding the section or paragraph number in the main
ment of the three Guidelines documents. The Hospital text to which they relate.
and Residential document groups focused on refining the
content of those documents, while the Outpatient Docu Cross-references. Cross-references are used throughout
ment Group worked to develop the inaugural edition of the Guidelines to include language from another chapter
the Guidelines for Design and Construction of Outpatient in the text where the cross-reference is located. These ref
Facilities. As well, the Hospital and Outpatient document erences include both the section number and the section
groups worked together to correlate the content of the name in parentheses. For example: See Section 2.2-3.1.4
Guidelines sections that would appear in both the hospital (Resident and Participant Kitchen).
and outpatient documents, identifying instances where
Front and back matter. Informative introductory sec
the requirements needed to be different but always striv
tions, including the table of contents, acknowledgments,
ing to support safe environments for patients and staff
an essay on major additions and revisions, and a glossary,
wherever services are provided.
precede the main body of the document. A detailed index
appears at the end of the book.
Basic Organization of the Residential The glossary generally includes only terms that require
a specific definition to clarify their use in the Guidelines.
Guidelines If a term as it is used in the Guidelines is clearly defined in
Main body. The main body of this document is com the Merriam- Webster Collegiate Dictionary, a definition is
posed of five parts: not included in the glossary.
• Part 1 contains chapters that address considerations

applicable to all residential health, care, and support Uses of this Document
facilities, except as noted or modified in specific
facility chapters in the remaining parts. The Guidelines documents are made available for a wide
• Part 2 includes common elements applicable to variety of public and private uses. These include adoption
most of the facility types in the book. This material by states for regulatory purposes and other reference in
applies when referenced from the facility chapters in laws, codes, rules, and regulations as well as use in private
Parts 3 through 5. self-regulation and standardization of space and equip
• Part 3 provides requirements for residential health ment requirements and the promotion of safe practices
facilities: nursing homes and hospice facilities. and methods in planning, design, and construction for
• Part 4 provides requirements for residential care various types of health care facilities.
and support facilities: assisted living facilities, Regulatory use. Use of the Guidelines or any portion
independent living setrings, long-term residential thereof for regulatory putposes should be accomplished
substance abuse facilities, and settings for through adoption by reference. The term "adoption by
individuals with intellectual and/or developmental reference" means citing title, edition, and publishing
disabilities. information only.
• Part 5 provides requirements for non-residential
support facilities: adult day care and adult day • Any deletions, additions, and changes desired by the
health care facilities, wellness centers, and outpa adopting authority should be noted separately in the
tient rehabilitation therapy facilities. adopting instrument.
• To help FGI follow the uses made of this document,
Appendix. An appendix is associated with the main body adopting authorities are requested to notify FGI at
of the Guidelines text. info@fgiguidelines.org when they adopt an edition
xxii Guidelines for Design and Construction of Residential Health, Care. and Support Facilities
of the Guidelines or use the documents in any other requirements be verified for compliance with all authori
regulatory fashion. ties having jurisdiction over a project. Where require
ments appear to be conflicting or contradictory, the AH]
Authorities adopting the Guidelines should encour with primary responsibility for resolution should be
age design innovation and grant exceptions where the consulted.
intent of the standards is met. These standards assume
Errata. From time to time, FGI issues errata to correct
that appropriate architectural and engineering practice
an ertor in its published Guidelines documents. This
and compliance with applicable codes will be observed as
information is posted on the FGI website and announced
part of normal professional service.
in the FGI Bulletin, a quarterly newsletter of the Facil
It is recognized that many health care services may
ity Guidelines Institute. All errata are considered to be
be provided in facilities not subject to licensure or regula
corrections to errors in the Guidelines text and should be
tion, and the Guidelines is intended to be suitable for use
applied as such.
by all care and service providers. It is further intended
that when used as regulation, some latitude be granted Formal interpretations of requirements. Users of the
in complying with the Guidelines requirements as long Guidelines can request formal interpretations of the
as the health and safety of the facility's occupants are not language in the documents. Interpretations, which are
compromised. provided by members of the Health Guidelines Revi
sion Committee, are intended to provide clarification; a
Code language in the Guidelines. For brevity and conve
summary of any background and previous discussion, if
nience, these standards are presented in "code language."
appropriate and available; and a rationale for the inter
Use of words such as "shall" indicates mandatory
pretation rendered.
language only where the text is applied by an adopting
It is understood that any such interpretation is advi
authority having jurisdiction (AHJ). However, when
sory in nature and is intended to assist the designer,
adopted by an AH], design and construction must con
care or service provider, and adopting AH] to maximize
form to the requirements of the Guidelines.
the value of the Guidelines. When an inquiry does not
The word "Reserved" is used to help standardize
require a formal interpretation, an advisory opinion may
numbering of the text and is not intended as a place
be provided.
holder for specific requirements.
Requests for interpretation should be submitted
Use with other codes. The Guidelines documents address through the FGI website; see www.fgiguidelines.org/
certain details of construction and engineering that are guidelines/interpretations-2 for information.
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. Disclaimers
• Local codes. For aspects of design and construction While FGI administers the revision process and estab
not included in the Guidelines, local governing lishes rules to promote fairness in the development of
building and licensing codes shall apply. consensus, it does not independently test, evaluate, or
• Model codes. Where there is no local governing verifY the accuracy of any information or the soundness
building code, the prevailing model code used in of any judgments or advice contained in the Guidelines.
the relevant geographic area is hereby specified FGI endeavors to develop performance-oriented and
for all requirements not otherwise specified in the evidence-based minimum requirements as guidance for
Guidelines. design of U.S. health care facilities without prescribing
design solutions. FGI disclaims liability for any per
AHJ verification. Some projects may be subject to the sonal injury or property or other damages of any nature,
regulations of several different jurisdictions, including whether special, indirect, consequential, or compensa
local, state, and federal authorities. While coordination tory, directly or indirectly resulting from the publication,
efforts have been made, the Guidelines may not always use of, or reliance on this document. FGI also makes no
be consistent with all applicable codes, rules, and regu guaranty or warranty as to the accuracy or completeness
lations. Therefore, it is essential that individual project of any information published herein.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xxiii
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 4 (residential care and support facilities), and 5
dential Health, Care, and Support Facilities is the first revi (non-residential support facilities) were removed.
sion of the inaugural edition of this document, which The content from these chapters was integrated into
was published in 2014. The 2018 Residential Docu the facility chapters, which include cross-references
ment Group responsible for revising the 2014 Guidelines to Part 2-now the only common element section
approached the revision as an opportunity to refine the referenced from facility chapters. This change
2014 text, restructure the document for clarity, and reduces the number of times a reader may need to
based on needs in the residential long-term care market reference another section of the document to find a
place-provide guidance for additional facility types. For minimum requirement or guidance.
information that was revised, added, or moved from the • Requirements for food service and kitchen facilities
appendix into the main body requirements, the docu were corrected, added to, and/or aligned across facil
ment group's approach included a concerted effort to ity types to increase clarity and consistency.
base changes on evidence-based research, information
from subject matter experts, and experience in the field Updates were made to the Residential Guidelines
across a broad spectrum of interrelated disciplines. glossary to support new material and editorial changes,
The following revisions are global to the 2018 Resi clarify intent, and remove inconsistencies for the user.
dential Guidelines document: As in past editions of the Guidelines, significant
changes have been marked throughout the print version
• A shift in terminology was made from "bariatric
of the 2018 Residential Guidelines with vertical rules
resident" to "person of size." This distinction
beside the text.
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. Part 1: General
• On the topics of acoustics and lighting, subject
In Part 1, additional guidance has been provided to clar
matter experts actively collaborated with the
ify the definition, purpose, and function of the resident
document group to refine requirements and
safety risk assessment (RSRA) in Section 1.2-3. Advi
provide additional guidance based on acoustics
sory information was revised to emphasize the impor
research conducted in a continuing care retirement
tance of balancing the need for safety and mi tigation of
community and updated Illuminating Engineering
risks with recognition of residents' rights to self-deter
Society (IES) standard requirements for aging and
mination and personal decision-making. The additional
disabled populations. For example, the notion of
information supports the execution of a RSRA that
"speech privacy" has been employed to make clear
balances opportunities for providing a person-centered
the benefit residents, staff, and participants gain
approach with maintenance of or improvements to resi
when acoustic design is considered during project
dent quality oflife.
design. Evaluation and decibel levels in various
Advisory appendix information was added to Section
community spaces have been revised based on the
1.2-3.2 (Infection Control Risk Assessment) to highlight
research completed.
some of the common risks to staff and residents based on
• Common element chapters for the facility type
the latest research.

categories in PartS 3 (residential health facilities),
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xxv
MAJOR ADDITIONS AND REVISIONS
Hallways and corridors were added as locations to be fit-outs) includes updates to related standards, includ
assessed as part of the resident mobility and transfer risk ing ANSIIASHRAE/ASHE 189.3: Design, Construction
assessment (Section 1.2-3.3) because of the impact the and Operation of Sustainable High-Performance Health
design of these areas has on independent resident mobil Care Facilities and newer life cycle assessment tools and
ity. The goal is to provide design interventions that maxi resources that have become available since publication of
mize resident freedom of movement. the 2014 Residential Guidelines.
Also as part of the resident mobility and transfer New Section 2.3-3.5 (Care Consultation Area) was
risk assessment, a new requirement and associated rec added to recognize that in the residential environment
ommendations were added for bed safety under Section care consultation often takes place outside of examina
1.2-3.3.2.10 (Coordination between mobility and trans tion or treatment rooms. Minimum requirements for this
fer equipment and other aspects of the physical environ type of space were added to support the concept that set
ment). The goal for this change was to require evaluation tings for these care consultation areas, like resident living
of bed options to reduce the risk of injury related to bed environments overall, should be homelike rather than
rails, mattresses, and bed configurations. clinical.
Recommendations were added as guidance to sup New Section 2.3-4.2.9 (Accommodations for Tele
port development of the security plan required in Section medicine Services) was added to reflect the increasing use
1.2-3.7.1.4 (Security considerations for project design). of telemedicine services in residential health, care, and
Several clarifications were made in Section 1.2-4 support facilities. The requirements are minimal with
(Environment of Care). In Section 1.2-4.5.2, views of advisory information in the appendix listing components
nature were distinguished from access to nature to clar to consider for spaces where telemedicine will occur.
ify each element. Added advisory information further Guidance was added to Section 2.4-2.2.9 (Grab Bars)
defines views of nature, which can include views of the based on the latest research on alternative configurations
sky, vegetation, natural light, precipitation, birds, and for swing-up grab bar placement at the toilet, which was
other living organisms. The goal is for the resident to published in the Health Environments Research 6' Design
be able to sense seasonal and weather changes and the Journal article "Beyond ADA Accessibility Requirements:
change of time throughout the day. In Section 1.2-4.5.5, Meeting Seniors' Needs for Toilet Transfers" in Septem
the sensory components for visual and auditory privacy ber 2017. New appendix table A2.4-a (Resources for
were separated to further define requirements for privacy Grab Bar Configurations) provides advisory information
and confidentiality in the design of the physical environ for consideration in design, including research findings
ment. This change is intended to address issues such as about preferred alternative configurations for one-person,
the use of cubicle curtains, which provide visual privacy two-person, or equipment-assisted transfers as compared
but do not support speech privacy. to ADA accessibility standards.
In Section 1.2-5.8 (Resident Quality of Life), addi Section 2.4-2.2.10 (Handrails and Lean Rails) was
tions and refinements were made to the core values of expanded to include lean rails. Residential long-term care
person-centered care and explanatory appendix mate settings often rely on lean rails or handrails or a combina
rial was added to describe each attribute to help users of tion of both, depending on the resident care population,
the Guidelines apply these important concepts to facility to support residents' mobility.
designs. 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
Part 2: Common Elements for maximize resident independence. Appendix language was
Residential Health, Care, and Support added to recommend provision of a "zero" height thresh
Facilities old or transition between the shower and adjacent floor
because the ADA guidance that allows for a difference in
The sustainable design requirements have been updated transition height can limit resident mobility and access to
to reflect current industry standards for whole building a shower, whether independently or with assistance from
life cycle and product selection criteria. Advisory infor a caregiver.
mation in appendix section A2.2-2.5 (Use of reduced The requirement in Section 2.5-3.5.2.2 (Duct
impact materials for building assemblies and interior humidifiers) in the 2014 Residential Guidelines was
xxvi Guidelines for Design and Construction of Residential Heaith, Care. and Support Facilities
MAJOR ADDITIONS AND REVISIONS
stricken to allow other standards to prevail, specifically or spa room or area remains optional, and the decision
ANSI!ASH RAE/ASHE Standard 170: Ventilation of whether to have one depends on the needs of the care
Health Care Facilities, ANSI!ASH RAE Standard 62.1: population. The options for the bathing fixture if a cen
Ventilation for Acceptable Indoor Air Quality, and ANSI! tral one is provided have been expanded to include a spa
ASHRAE Standard 62.2: Ventilation and Acceptable tub as well as a bathtub or shower.
Indoor Air Quality in Residential Buildings. New chapters on two facility types were added to
Part 4:
Part 3: Specific Requirements for • Chapter 4.3, Specific Requirements for Long-Term
Residential Substance Abuse Treatment Facilities,
Residential Health Facilities presents new requirements and guidance for
Late in the development of this edition, the Centers for facilities that provide a 24-hour-a-day therapeutic
Medicare & Medicaid Services (CMS) published a final community setting for treatment and counseling
rule on the "Reform of Requirements for Long-Term of individuals with substance use disorders. The
Care Facilities" affecting the maximum capacity of resi chapter was developed in response to requests from
dent rooms in nursing homes. A maximum of two per the industry to provide design guidance for these
sons is permitted in a resident room, and each room is community-based settings, which are becoming
required to have a bathroom with toilet and sink. This more prevalent in response to the opiate epidemic.
requirement no longer allows for a bathroom to be located • Chapter 4.4, Specific Requirements for Settings
between two double-occupancy or two single-occupancy for Individuals with Intellectual and/or
rooms that have separate resident room entry doors. Sec Developmental Disabilities, presents new design
tion 3.1-2.2.2 (Resident Room) was revised to align with requirements and guidance for intermediate
the new CMS requirement. The maximum number of care facilities such as a community residence
occupants in a resident room after a renovation changed or personal care home for individuals with
from four to two people in Section 3.1-2.2.2.1 (Capac intellectual and/or developmental disabilities.
ity) to allow facilities to remain compliant and eligible for The chapter does not address larger residential
reimbursement from CMS. health settings (nursing homes) or hospitals for
New text in Section 3.1-2.2.2.2 (Space require residents or patients who have intellectual and/
ments) requires nursing home rooms to be configured or developmental disabilities. This chapter was
so each resident can view the television from a resident added because these facilities may be regulated as
chair. Additional recommendations suggest dimensions recipients of reimbursements from CMS.
for determining space needs. Similar revisions were
made for Section 3.2-2.2.2.2 (Space requirements) for
Part 5: Specific Requirements for Non
hospice rooms.
New Section 3.1-2.2.4.2 (Post-acute care facilities), Residential Support Facilities
with accompanying advisory information in the appen
Minimal and editorial revisions were made to Part 5 to
dix, was added to respond to changing reimbursement
make the language clearer. As well, in the chapter on
rules and shorter hospital stays. Post-acute care facilities
adult day care facilities, the minimum requirement for
are intended for residents receiving rehabilitation services
location of a toilet room in Section 5.1-2.3.3.4 (Support
rather than long-term or palliative care services.
areas for dining, recreation, lounge, and activity loca
tions) was relaxed to allow location adjacent to dining,
Part 4: Specific Requirements for recreation, lounge, and activity areas rather than a specific
distance measured in linear feet. For Chapter 5.3, Out
Residential Care and Support Facilities patient Rehabilitation Therapy Facilities, the minimum
In Chapter 4.1, Specific Requirements for Assisted Living space requirements in Section 5.3-3.2.4.2 were revised to
Facilities, Section 4.1-4.2.3 (Central Bathing or Spa make them more flexible and thus more easily applied to
Room or Area) was revised to clarifY the requirements for the services an organization provides and the care popula
central bathing facilities. Provision of a central bathing tion it serves.
-------- ------------------ -------------------- -----------------------

Guidelines for Design and Construction of Residential Health. Care, and Support Facilities 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 Centralized services: As used in this document, a resi
used by residents and activity directors/coordinators to dent unit, facility, or setting that provides central services.
engage in activities such as arts and crafts, individual or
Clearance: The shortest unencumbered distance between
group games (e.g., cards, electronic games, board games),
the outermost dimensions of a specified object (e.g., a
education, watching videoltelevision. Note: This is dif
resident bed or exam table) and specified, fixed reference
ferentiated from a recreation area.
points (e.g., walls, cabinets, sinks, and doors).
Adjacent: See Location terminology.
Clear dimension: An unobstructed room dimension
Administrative areas: Designated spaces such as offices exclusive of built-in casework and equipment and avail
and meeting rooms that accommodate admission and able for functional use.
discharge processes, medical records storage, medical and
Clear floor area: The floor area of a defined space that is
nursing administration, business management and finan
available for functional use excluding toilet rooms, clos
cial services, human resources, purchasing, community
ets, lockers, wardrobes, alcoves, vestibules, anterooms,
services, education, and public relations.
and auxiliary work areas. Note: Door swings and floor
Airborne infection isolation (AIl) room: A room desig space below sinks, counters, cabinets, modular units, or
nated for persons having or suspected of having an infec other wall-hung equipment that is mounted to provide
tion that is spread through coughing or other ways of usable floor space counts toward "clear floor area." Space
suspending droplets of pathogens into the air (e.g., tuber taken up by minor fixed encroachments that do not inter
culosis, smallpox). fere with room functions can be included in calculating
clear floor area.
Ambulate: To walk or move about from place to place
with or without assistance. Clinical sink: A flushing-rim sink or "hopper" used for
disposal of blood or body fluids (e.g., bedpan washing).
Area: A particular extent of space or surface serving a
Note: This is not the same as a hand-washing sink or an
defined function.
instrument-cleaning sink (single- or double-sink type).
Authority having jurisdiction (AHJ): An individual or
Community residence (CR): A residential facility that
organization designated by a state or government agency
provides supervised and supportive living environments.
to enforce building codes and other regulations related to
Note: In a supervised CR, staff are immediately available
construction projects.
on-site 24/7 and supplies for daily living, like food and
Bariatric resident: See Person of size. toiletries, are provided. Supervised CRs are designed to
provide a home-like atmosphere where individuals with
Bed size: Minimum rectangular dimensions for planning
developmental disabilities can acquire the skills needed to
minimum clearances around beds-40 inches 001.6
live as independently as possible.
centimeters) wide by 96 inches (2.43 meters) long.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xxix
GLOSSARY
Country kitchen: An activity component usually con may be moved horizontally either manually or with the
nected to a great room or other activity room that is assistance of motorized wheels. When the term "por
intended for use by residents, participants, or outpatients table" is used in connection with ceiling lifts, it may also
as well as staff. Note: A country kitchen is used for activi refer to a lift motor and hoist that can be removed from
ties and for warming food and serving food as part of an a track system in one room and attached to the track
integrated food service program. system in another room.
Culture change: Common name given to resident-cen Examination room: A toom with a bed or examination
tered care processes for transforming health, care, and table and capability for periodic monitoring and check
supportive services based on person-directed values and ups.
practices in which the voices of residents, their fami
Facility: A discrete physical entity composed of various
lies, and those working with them are considered and
functional units as described in the Guidelines.
respected and person always comes before task.
Fixed equipment: Equipment with track systems
Curbless shower: An area of a room that serves as the
attached at some point in the toom. Note: Fixed equip
shower. Note: Other terms may include open shower,
ment includes ceiling-mounted or overhead lifts, wall
European shower, or European wet room.
mounted lifts, and other lifting devices with fixed
Differential pressure: A measurable difference In air tracking. An alternative would be a demountable track
pressure that creates a directional airRow between adja that may be fully or partially disassembled and removed
cent spaces. from the space.
Direcdyaccessible: See Location terminology. Functional program: A record of the key environment
of care considerations and facility functional and opera
Documentation area: A work area associated with or
tional parameters that drive the space program for a proj
near a resident care area where information specific to
ect. Note: The governing body or its delegate develops
residents is recorded, stored, and reviewed to facilitate
the functional program, which is intended to inform the
ready access by authorized individuals.
designers of record, authority having jurisdiction, and
Emergency call system: Devices that are activated to users of the facility. The size and compleXity of the proj
indicate the need for staff assistance. Note: Such devices ect will determine the length and complexity of the func
produce an audible or visual indication (or both) or may tional program.
be connected or transmit to an area alert monitor or per
Governing body: The person or persons who have over
sonal hand-held device.
all legal responsibility for the operation of a residential
Environment of care: Those physical environment fea health, care, or support facility. Note: Often, the "owner"
tures in a residential health, care, or support facility that or "provider" is representative of the governing body.
are created, structured, and maintained to support and
Hand sanitation dispenser: A dispenser that contains a
enhance the delivery of care and services.
liquid solution that has been approved by the FDA for
Environmental services (housekeeping): Services any hand hygiene.
where in a residential health, care, or support facility that
Hand-washing station: An area that provides a sink with
provide general cleaning and supply identified cleaning
a faucet that can be operated without using hands, cleans
materials (e.g., soaps, towels). Note: Although routine
ing agen ts, and means for drying hands.
disinfection protocols can be included in such a defini
tion, the definition is not intended to include complex, Hands-free faucets: Faucets that are controlled by knee
non-routine disinfection procedures nor the non-routine or foot-operated pedals or by motion sensors such as elec
disposition of hazardous materials such as potentially tric eye controls. Note: This term does not refer to faucets
toxic drugs or other chemicals. operated using wrist blades or single-lever faucets.
Equipment, portable or mobile: Floor-based equip Hazard: Anything that has the potential to cause harm.
ment that moves on the Roor surface, such as Roor-based
Health, care, or support facility: Any facility type listed
sling lifts and sit-to-stand lifts. Note: This equipment
in the table of contents of this book.
-----_._- -------_._._---.... _----_._- - - - ---------------_. ----- --------_. -------_.
xxx Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
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 Resident: A person living and receiving health, care, and/
therapy in an outpatient facility. or support services in a nursing home, hospice facility,
assisted living facility, independent living setting, or inpa
Patient care area: An area used primarily for the provi
tient rehabilitation facility.
sion of clinical care to patients. Note: Such care includes
outpatient rehabilitation therapy services. Resident-centered care: A philosophical approach to
residential health, care, and support environments that
Person of size: A person whose height, weight, body
honors and respects the voice of those being served and
width, weight distribution, and/or size require increased
those working most closely with them. Note: This care
space for care and expanded-capacity devices, equipment,
model process is intended to individualize care and dein
furniture, technology, and supplies. Note: This term is
stitutionalize the residential health, care, and/or support
often interchangeable with obese, morbidly obese, and
environment.
bariatric.
Residential care and support facilities: Category of
Personal care home: A residence that provides residents
facilities such as assisted living facilities and independent
with shelter, meals, supervision, and assistance with per
living settings in which services such as assistance with
sonal care tasks. Note: The services provided vary and
activities of daily living (ADL) and/or instrumental activ
are based on the individual needs of each resident. These
ities of daily living (IADL) are provided to residents.
facilities typically house older people or people with
physical, behavioral health, or cognitive disabilities who Residential health facilities: Category of facilities in
are unable to care for themselves but do not need nutsing which long-term health services are provided (e.g., nurs
home or medical care. ing homes and hospice facilities).
Places of respite: Spaces within a residential health, care, Residential support facilities: Category of facilities in
or support facility or on a campus provided to connect res which health, care, and/or support services that do not
idents, participants, outpatients, visitors, and staff to the require overnight accommodation are provided.
health benefits of the natural environment. (Green Guide
Resident-operated mobility devices: Equipment (e.g.,
for Health Care, Sustainable Site Design: Places of Respite
wheelchairs, walkers, ambulation-assistance equipment,
Technical Brief, www.gghc.org/tools.technical.php)
battery-operated mobile chairs) used by residents, partici
Post-acute care: Category of residents who are discharged pants, and outpatients in residential health, care, support,
from acute care hospitals to inpatient rehabilitation facili and related settings to enable them to mobilize.
ties, nursing homes, or home health care providers.
Resident safety risk assessment (RSRA): A multidisci
Provisions for drinking water: Availability of readily plinary organizational process that focuses on reducing
accessible potable water for resident, staff, and visitor risk from infections, mobility and transfer activities, resi
needs. Note: Water may be provided in a variety of ways, dent falls, dementia and mental health issues, medication
including fountains, pitchers, and bottled water. errors, security issues, and disasters throughout planning,
design, and construction (including renovation) for resi
Public or community areas: Designated spaces freely
dential health, care, and support facilities and settings.
accessible to the public. Note: These spaces include park
ing areas, secured entrances and areas, entrance lobbies, Risk: The likelihood that somebody or something will
reception and waiting areas, public toilets, snack bars, be harmed by a hazard, multiplied by the severity of the
cafes, vending areas, gift shops and other retail locations, potential harm.
resource libraries and meeting rooms, chapels, and gar
Room: A space enclosed by hard walls and having a door.
dens.
Note: Where the word "room" or "office" is used in the
Readily accessible: See Location terminology. Guidelines, a separate, enclosed space for the one named
function is intended. Otherwise, the described area may
Recreation area: An area in a residential care facility that
be a specific space in another room or common area.
is used by residents and recreation therapists/coaches for
physical exercise and movement. Note: This is differenti Service areas: Designated spaces that house auxiliary
ated from an activity area. functions that do not routinely involve contact with resi-
xxxii Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
GLOSSARY
dents, participants, or the public (e.g., supply, processing, Support areas (staff): Designated spaces for the personal
storage, and maintenance services such as dietary, laundry use of staff (e.g., changing areas, toilet rooms, showers,
processing and storage, environmental services (house lounges, dining areas). Note: Where the word "room"
keeping), maintenance operations, and clean and soiled or "office" is used, a separate, enclosed space for the one
utility rooms). named function is intended. Otherwise, the described
area is permitted to be a specific space in another room
Speech privacy: Techniques to render speech unin
or common area.
telligible to casual listeners. (Definition from ANSI
T1.523-2001: Glossary, a standard maintained by the Sustainability: A means of configuring human activity
U.S. Department of Commerce, National Telecommu so that society, its members, and its economies are able
nications and Information Administration, Information to meet their needs and express their greatest potential
Security Program.) Note: This definition matches ear in the present, while preserving biodiversity and natural
lier ones in ANSI S3.5 (1969) and ASTM El130 (1997 ecosystems in the long term; improving the quality of
& 2001) and is consistent with ASTM E2638 (2011). human life while living within the carrying capacity of
See ASTM El130 and ASTM E2638 for four defined, supporting ecosystems.
measurable levels of speech privacy. Speech privacy is a
Sustainable design: The art of designing physical objects,
condition required by HIPAA (the Health Insurance Por
the built environment, and services to comply with prin
tability and Accountability Act) and is the subject of the
ciples of economic, social, and ecological sustainability.
"noise-at-night question" on the HCAHPS patient satis
faction survey. Therapeutic and restorative gardens: A space, usually
outdoors but sometimes indoors, that promotes physi
Station: See Hand-washing station, Nurse station.
cal and emotional health and well-being through passive
Subacute care: Category of care requiring less intensity and/or active engagement with nature. Note: At best,
of care/resources than acute care. Note: Subacute care these spaces are designed based on research (evidence
falls within a continuum of care determined by resident based design) for a specific population, site, and intended
acuity, clinical stability, and resource needs. outcome (e.g., stress reduction, positive distraction, exer
cise, facilitating social connection, rehabilitation, play).
Support areas (resident units, diagnostic and treat
Sometimes referred to as a "healing garden."
ment areas, etc.): Designated spaces or areas in which
staff members perform auxiliary functions that support Treatment room: A room where therapy or other care
the main purpose of the unit or other location. Note: services are provided.
Where the word "room" or "office" is used, a separate,
Type III environmental product declaration (EPD):
enclosed space for the one named function is intended.
A Type III environmental product declaration provides
Otherwise, the described area is permitted to be a specific
quantified environmental data using predetermined
space in another room or common area.
parameters and, where relevant, additional environmen
Support areas (resident, family, and/or visitor): Des tal information. Note: An EPD can be either brand-spe
ignated spaces for the use of residents, participants, cific or industry-wide.
patients, or visitors (e.g., changing areas, dining rooms,
Unit: An area or space usually dedicated to a single
toilet rooms, activity rooms) or families and visitors (e.g.,
defined organizational function.
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 , Universal design: The concept of designing all products
a separate, enclosed space for the one named function is and the built environment to be usable and non-stigma
intended. Otherwise, the described area is permitted to tizing to the greatest extent possible by everyone, regard
be a specific space in another room or common area. less of age, ability, or status in life.
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities xxxiii
List of Acronyms
ADA-Americans with Disabilities Act ICC-International Code Council

ADAAG-ADA Accessibility Guidelines for Buildings ICRA-infection control risk assessment
and Facilities ICRMR-infection control risk mitigation
AHJ-authority having jurisdiction recommendation
AlA-American Institute of Architects LCA-life cycle assessment
AI-Articulation Index LRV-light reflectance value
AIl-airborne infection isolation NFPA-National Fire Protection Association
ANSI-American National Standards Institute NIC-not-in-contract
ASA-Acoustical Society of America NIOSH-National Institute for Occupational Safety
ASHE-American Society for Healthcare Engineering and Health
ASHRAE-American Society of Heating, Refrigerating NSC-National Stone Council
and Air-Conditioning Engineers NSF-NSF International
BOD-basis of design OPR-owner's project requirements
C-Celsius OSHA-U.S. Occupational Safety and Health
CDC-U.S. Centers for Disease Control and Administration
. Prevention PACE-Programs of All-Inclusive Care for the Elderly
CFC-chlorofluorocarbon PHAMA-patient handling and movement assessment
CFR-Code of Federal Regulations RSRA-resident safety risk assessment
CHD-Center for Health Design SAGE-Society for the Advancement of Gerontological
CMS-US. Centers for Medicare & Medicaid Services Environments
DHHS-US. Department of Health and Human SII-Speech Intelligibility Index
Services SPC-speech privacy class
EIS-environmental impact statement STC-sound transmission class
EPA-US. Environmental Protection Agency TAB-testing and balancing
FDA-US. Food and Drug Administration TBC-total building commissioning
F-Fahrenheit TC-therapeutic community
HAl-health care-associated infection TEC-total environment commissioning
HEPA-high efficiency particulate air TGB--telecommunications grounding bus
HFCx-health facility commissioning UFAS---Uniform Federal Accessibility Standards
HID-high-intensity discharge UL-Underwriters Laboratories, Inc.
HIPAA-Health Insurance Portability and Account USDA-U.S. Department of Agriculture
ability Act USP- NF- U S. Pharmacopeia and National Formulary
HVAC-heating, ventilation, and air conditioning VOC-volatile organic compound
IBC-International Building Code
Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 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 Projects with any of the following scopes of work shall
The provisions of rhis chapter shall apply to all new be considered new construction and shall comply
construction and renovation of residential health, care, with the requirements in the Guidelines for Design and
and support facilities. Construction ofResidential Health, Care, and Support
Facilities:
*1.1-1.2 Minimum Standards for New
Facilities and Renovations 1.1-2.1 Site preparation for and construction of
entirely new structures and systems
1.1-1.2.1 Each chapter in this document contains
information intended as minimum standards for 1.1-2.2 Structural additions ro existing facilities that
design and construction of new, and for major renova result in an increase of occupied floor area
tion of existing, residential health, care, and support
facilities. 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
1.1 INTRODUCTION
GuidelinesfOr Residential Facilities and local, state, and 1.1-3.1.2.21he following exceptions to the require
federal codes. ments in Section 1.1-3.1.1 (Compliance Require
ments) shall be permitted provided they do not reduce
1.1-3.1.1.2 Major renovation projects. Projects with the level of health and safety in an existing facility.
either of the following scopes of work shall be con (1) Routine repairs and maintenance to buildings,
sidered a major renovation and shall comply with the systems, or equipment shall not require
requirements for new construction in the Guidelines improvements to building features or systems.
fOr Residential Facilities to the extent possible as deter (2) Replacement of building furnishings and
mined by the applicable authority having jurisdiction: movable or fixed equipment shall only require
(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 provide sufficient capacity for the replacement.
an entire building or an entire area in a building to (3) Minor changes to the configuration of an existing
accommodate a new use or occupancy space shall not require upgrade of the entire space.
(4) Cosmetic changes or upgrades to an existing space
1.1-3.1.1.3 Conversion projects. When a building is shall not require upgrade of the entire space.
converted from one occupancy type to another, it shall (5) Improvements to a building system or a space
comply with the new construction requirements. that cannot reasonably meet the requirements of
this document shall be permitted provided the
1.1-3.1.1.4 Building system projects improvement does not impair other systems or
(1) Only the altered, renovated, or modernized functions of the building.
portion of an existing building system or (6) Existing systems that are not in strict compliance
individual component shall be required to meet with the provisions of this document shall be
the installation and equipment requirements in the permitted to continue in use, unless the AH] has
Guidelines. determined that such use constitutes a distinct
(2) When such construction impairs the performance hazard to life.
of the balance of an affected building system, (7) Replacement of mechanical, electrical, plumbing,
upgrades to that system shall be required beyond and fire protection equipment and infrastructure
the limits of the project to the extent required to for maintenance purposes due to the failure or
maintain existing operational performance. degraded performance of the components being
replaced shall be permitted provided the health and
*1.1-3.1.2 Exceptions safety in the facility is maintained at existing levels.
1.1-3.1.2.1 Where major structural elements make *1.1-3.1.3 Phased Projects

total compliance impractical or impossible, exceptions These standards shall not be construed as prohibiting a
shall be considered. single phase of improvement.
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
A.l.1-3.1.3 Phased projects. As an example, afacility may
so it totally conforms to requirements in the Guidelines. Therefore,
plan to replace aflammable ceiling with noncombustible material but
authorities having jUrisdiction are permitted to grant approval to
lack funds to do other corrective work. However, the Guidelines stan
renovate portions ofastructure, spiKe, or system if facility operations

dards are not intended as encouragement to ignore deficiencies when
and resident safety in renovated and existing areas are not jeopardized by
resources are available to correct life-threatening problems. See Section
existing features of areas retained without complete corrective measures.

1.1"6 (EqUivalency Concepts).
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 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 • 1.1-5 Building Codes and Standards

*1.1-4.4 National Standards for the Protection 1.1-5.1 Safe Environment
of Resident Health Information Every residential health, care, and support facility shall
provide and maintain a safe environment for residents,
1.1-4.5 Environmental Regulations participants, outpatients, personnel, and the public.
*1.1-4.5.1 Federal Environmental Regulations *1.1-5.2 Code Compliance
*1.1-4.5.2 State and Local Environmental 1.1-5.2.1 In the absence of state or local requirements,
Regulations 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.
Building Seismic Safety Council for the Federal Emergency Management A.1.1-4.S.1 Federal environmental regulations.
Agency. The following seismic standards are essentially equivalent to The principal federal environmental statutes likely to be applied to
the ASCE/SEI7 provisions: residential health, care, and support facilities include the follOWing:
a. NEHRP Recommended SeismicProvisions forNew Buildings and Other a. Clean Air Act (CAA)
Structures b. National Environmental Policy Act (NEPA)
b. International Building Code c. Occupational Safety and Health Act (OSHA)
d. Resource Conservation and Recovery Act (RCRA)
A1.1-4.3 Flood protection. When designing for flood
e. Safe Drinking Water Act (SDWA)
protection/ providers and designers should be aware of the possibil
f. Superfund Amendments and Reauthorization Act (SARA)
ity that applicable tables, charts, and standards may be outdated or
g. Toxic Substance Control Act (TSCA)
under review, due to climatic changes and other factors that affect the
potential for flooding and storm surges. They should also be familiar A.1.1-4.S.2 State and local environmental regula
with Executive Order 11988: Flood Protection, issued May 24,1977, to tions. U.S. Department of Health and Human Services and U.S. Envi
minimize financial loss from flood damage to facilities constructed with ronmental Protection Agency regional offices as well as other federal,
federal assistance. state, or local AHJs can provide information on state and local regula
tions pertaining to environmental pollution-including management
A1.1-4.4 HIPAA. The Health Insurance Portability and
of trash, noise, and traffic-that may affect the design, construction, or
Accountability Act (HIPAA) became law in 1996. HIPAA consists of
operation of residential health, care, and support facilities.
three major parts: the Privacy Rule, Transaction and Code Sets, and the
Security Rule. The U.S. Department of Health and Human Services (HHS) A1.1-5.2 References made in the Guidelines to appropriate model
issued the Privacy Rule to implement the requirement of HIPAA.ln HHS, codes and standards do not, generally, duplicate wording of the
the Office of Civil Rights has responsibility for enforcement of the HIPAA referenced codes. National Fire Protection Association (NFPA) standards
regulations. HHS may proVide direction and clarification on the Privacy are the basic standards of reference, but other codes and/or standards
Rule and Security Rule. may be included as part of the GUidelines. See Section 1.1-8 (Codes,
HIPAA does not preempt or override laws that grant individuals Standards, and Other Documents Referenced in the Guidelines).
even greater privacy protection. Additionally, covered entities are free to
A.1.1-5.2.2 The latest revision of code material is usually a
retain or adopt more protective policies or practices.
clarification of intent and/or ageneral improvement in safety concepts
Ultimately, designers and owners are responsible for developing
and may be used as an explanatory document for earlier editions ofa
policies and procedures to verify that all applicable requirements that
code.
appropriately limit access to personal health information are being met
Questions of applicability should be addressed as the need occurs.
without sacrificing the quality of care.
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 INTRODUCTION
• *1.1-6 Equivalency Concepts Later editions will normally be acceptable where

requirements for function and safety are not reduced;
1.1-6.1 Although the Guidelines is adopted as a regu however, editions of different dates may have portions
latory standard by many jurisdictions, it is the intent renumbered or retitled. Care must be taken to ensure
of the document to permit and promote equivalency that appropriate sections are used.
concepts. U.S. Access Board (www.access-board.gov)
ADA Standards for Accessible Design (www.ada.gov/reg
1.1-6.2 Nothing in this document shall be construed s20 10/20 1OADAStandards/20 1OADAstandards.
as restricting innovations that provide an equivalent htm)
level of performance with these standards provided Uniform FederalAccessibility Standards (UFAS) (www.
that no other safety element or system is compromised access-board. gov/guidel ines-and-standards/
to establish equivalency. buildings-and-sites/about-the-aba-standards/ufas)
Acoustics Research Council, Acoustics Working

• 1.1-7 English/Metric Measurements Group (www.speechprivacy.org)
"Sound & Vibration Design for Health Care Facilities"
1.1-7.1 Where measurements are given in this docu (2010) (www.fgiguidelines.org/resources)
ment, the English units shall constitute the basic
requirement. Approximately equivalent metric units Air Force Civil Engineer Center (www.wbdg.org.ffe!
are provided in parentheses after the English units. af-afcee!design-guides-standards)
''Air Force Services Facilities Design Guide,
1.1-7.2 Either method shall be consistently used Design: Fitness Centers" (2011) (www.wbdg.
throughout a given project design. org/ffe!af-afcee!design-guides-standards/
fitness-centers-design-guide/fitness_centeedg.pdf)
• 1.1-8 Codes, Standards, and

American Institute of Architects (www.aia.org)
Other Documents Referenced in the Moore, Keith Diaz. "Design Guidelines for Adult
Guidelines Day Services" in AlA Report on University Research
2005.
1.1-8.1 Listed in this section are codes and standards
that have been referenced in whole or in part in the American National Standards Institute (www.ansi.
various sections of this document and documents from org)
which Guidelines concepts have been adopted. ANSI S1.1: Acoustical Terminology (2013)
ANSIIASA S2.71: Guide to the Evaluation ofHuman
1.1-8.2 Users of the Guidelines are encouraged to con Exposure to Vibration in Buildings (2012)
sult these publications for further information as may ANSIIASA S3.5 (R2012): Methodsfor Calculation of
be necessary to achieve the final product. 1he editions the Speech Intelligibility Index (1997)
cited are those available at the time of publication.
APPENDIX
A.,.'-6Equivalency c:oncepts. When considering ties when the facility can effectively demonstrate that the intent of the
eqUivalency allowances, the AHJ may consult avariety ofexpert sources Guidelines is met and the variation does not reduce the safety, opera
and may document the reasons for approval or denial of equivalency to tional effectiveness, or resident quality of life below that reqUired by the
the requester. exact language of the Guidelines.
Extraordinary circumstances, new programs, or unusual conditions In all cases where specific limits are described, eqUivalent solutions
may lead the AHJ to approve methods, procedures, design criteria, and will be acteptable if the AHJ approves them as meeting the intent of the
functional variations other than those that appear in the Guidelines for Guidelines.
Design and[onstruction ofResidential Health, (are, andSupport Facili-
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) AWWA M14: Recommended Practicefor Backflow
Prevention and Cross-Connection Control (2015)
American Society of Mechanical Engineers (www.
asme.org) Americans with Disabilities Act (U.S. Department of
ANSIIASME A17.1: Safety Code for Elevators and Justice) (www.ada.gov)
Escalators (2016) ADA Standards for Accessible Design (www.ada.gov/reg
ANSIIASME A17.3: Safety Code for Existing Elevators s20 10120 1OADAStandards/20 1OADAstandards.
and Escalators (2015) htm)
American Society of Safety Engineers (www.asse.org) British Standards Institution (shop.bsigroup.com)

Holman, G. T., Troy Blackburn, and S. Maghsoodloo. BS EN 15804: Sustainability ofconstruction works.
"The Effects of Restricting Space: A study involv Environmental product declarations. Core rules for
ing a patient-handling task." Professional Safety the product category ofconstruction products (2013)
55(7),38-46 (2010).
Bureau of Labor Statistics (www.bls.gov)
Industries at a Glance: Healthcare and Social Assistance
(www.bls.gov/iag/tgs/iag62.htm#Workforce)
1.1 INTRODUCTION
Business + Institutional Furniture Manufacturers Centers for Medicare & Medicaid Services (www.
Association (www.bifma.org) cms.gov)
ANSIIBIFMA e3: Furniture Sustainability Standard "Medicare and Medicaid Programs; Reform of
(2014) Requirements for Long-Term Care Facilities."
Federal Register, 2016. (www.federalregister.gov/
California Department of Public Health, documents/20 161 10104/20 16-235031 medicare
Environmental Health Laboratory Branch, and-medicaid-programs-reform-of-requirements
Indoor Air Quality Section for-long-term-care-facilities)
Standard Methodfor the Testing and Evaluation ofVola
tile Organic Chemical Emissions from Indoor Sources Center for Occupational Safety and Ergonom
Using Environmental Chambers, version 1.2 (2017) ics Research, Department of Occupational &
Environmental Safety & Health, University of
Canadian Standards Association (www.csagroup.org) Wisconsin-Whitewater
CAN/CSA Z809: Sustainable Forest Management: Choi, Sang, D. and Kathryn Brings. "Work-related
Requirements and Guidance (2016) musculoskeletal risks associated with nurses and
nursing assistants handling overweight and obese
Center for Health Design (www.healthdesign.org) patients: A literature review." WOrk, 53(2),
Joseph, Anjali, et al. "Designing for Patient Safety: 439-448. doi:10.3233/WOR-152222 (2016).
Developing Methods to Integrate Patient Safety
Concerns in the Design Process." (2012) Facility Guidelines Institute (www.fgiguidelines.org)
Joseph, Anjali, and Xiaobo Quan. "Summary Behavioral Health Design Guide (2017)
of Literature Review: Resident Safety Risk "Patient Handling and Movement Assessments: A
Assessment." (2012) White Paper" (2010)
Lee, Su Jin, et al. "Beyond ADA Accessibility "Resources for Selecting Architectural Details, Surfaces,
Requirements: Meeting Seniors' Needs for Toilet and Furnishings for Health Care Facilities" (2010)
Transfers." Health Environments Research & Design
Journal (2017). Federal Emergency Management Agency (www.fema.
Malone, Eileen B., and Barbara A. Dellinger. "Furni gov)
ture Design Features and Healthcare Outcomes." FEMA P-750: NEHRP [National Earthquake Hazards
(201l) Reduction Program} Recommended Seismic Provisions
Rohde, Jane. "Issue Briefs: Residential Healthcare for New Buildings and Other Structures (2009)
Facilities" (2012).
Forest Stewardship Council (https:llic.fsc.org/index.
Centers for Disease Control and Prevention htm)
(www.cdc.gov) FSC-STD-01-001 (V5-2): FSC Principles and Criteria
"Design and Operation of Pools and Hot Tubs," a for Forest Stewardship (2015)
CDC Web page (www.cdc.gov/healthywater/
swimmingl poolsl design -0 peration-pools-hot-tubs. Georgia Institute ofTechnology (www.gatech.edu)
html#design) Sanford, Jon A., and Margaret Calkins, PhD. "Beyond
"Guidelines for Preventing the Transmission of Myco ADA Accessibility Requirements: Meeting Seniors'
bacterium tuberculosis in Health-Care Settings, Needs for Toilet Transfers" (unpublished article,
2005." Morbidity and Mortality Weekly Report 54 2016).
(RR-17), 2005. (www.cdc.gov/mmwrlpreview/
mmwrhtmllrr5417a1.htm?s_cid=rr5417aLe) Green Building Initiative™ (www.thegbi.org)
"Guidelines for Environmental Infection Control in ANSIIGBI 01: Green Building Assessment Protocolfor
Health-Care Facilities." Morbidity and Mortality Commercial Buildings (2010) (www.thegbi.
Weekly Report 52 (RR-10):1-48, 2003. (www.cdc. orglcontentlmisciANSI-GBI-O1-201O-Standard.pdf)
gov/mmwrlpreview/mmwrhtmllrr5210a1.htm) Green Globes® for New Construction
Green Globes® for Existing Buildings
Guidelines for Design and Construction of Residential Health, Care, and Support Faciiities 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)
1.1 INTRODUCTION
Bradley, ]. S. "The Acoustical Design of Conventional Programme for the Endorsement of Forest Certifica
Open Plan Offices," NRCC-46274 (2003). tion (www.pefc.org)
Veitch,]. A., et al. "Masking Speech in Open-Plan PEFC National Standards
Offices with Simulated Ventilation Noise: Noise
Level and Spectral Composition Effects on Acous South Coast Air Quality Management District
tic Satisfaction," IRC-IR-846 (April 2002). (www.aqmd.gov)
SCAQMD Rule 1168: Adhesive and Sealant Applica
National Stone Council (www.naturalstonecouncil. tions (www.aqmd.gov/rules/reg/reg11/r1168.pdf)
org)
ANSIINSC 373: Sustainable Production o/Natural Sustainable Forestry Initiative® (www.sfiprogram.org)
Dimension Stone (2013) SFI 2015-2019 Forest Management Standard
New York State Office of Mental Health Telecommunications Industry Association (www.
Patient Safety Standards, Materials and Systems Guide tiaonline.org )
lines (www.omh.ny.gov/omhweb/patiencsafety_ TIA-607-C: Generic Telecommunications Bonding and
standards/guide.pdf) Grounding (Earthing) for Customer Premises (2015)
Noise and Vibration Control Engineering Tile Council of North America (www.tcnatile.com)
Ver, Istvan L., and Leo L. Beranek. Noise and Vibration ANSI A138.1: Green Squarecf> -American National
Control Engineering: Principles and Applications, Standard Specifications for Sustainable Ceramic Tiles,
2nd ed. (Wiley, 2005). Glass Tiles, and Tile Installation Materials (2011)
North Carolina Office on Disability and Health and Toxic Substance Control Act
the Center for Universal Health Title VI-Formaldehyde Standards for Composite
Removing Barriers to Health Clubs and Fitness Facilities: Wood Products (www.epa.gov/formaldehyde/
A Guide for Accommodating All Members, Including fo rmaldehyde-emission-standards-composite
People with Disabilities and Older Adults (2008) wood-products)
(/pg. unc. edulsiteslfpg. unc. eduljilesl. ..INCODH_
RemovingBarriersToHealthClubs.pdfJ Underwriters Laboratories (www.ul.com)
UL 100: Standardfor Sustainability for Gypsum Boards
NSF International (www.nsf.org) and Panels (2012)
NSF/ANSI 140: Sustainability Assessmentfor Carpet UL 102: Standardfor Sustainability for Swinging Door
(2015) Leafs (2012)
NSF/ANSI 332: Sustainability Assessmentfor Resilient UL 1069: Standardfor Hospital Signaling and Nurse
Floor Coverings (2015) Call Equipment (2007)
NSF/ANSI 336: Sustainability Assessmentfor Commer UL 2560: Standardfor Emergency Call Systems for
cial Furnishings Fabric (2011) Assisted Living and Independent Living Facilities
NSF/ANSI 342: Sustainability Assessmentfor Wallcover (2011)
ing Products (2014) UL 2762: Adhesives (2011)
NSF/ANSI 347: Sustainability Assessmentfor Single Ply UL 2768: Standardfor Sustainability for Architectural
Roofing Membranes (2012) Surface Coatings (2011)
Occupational Safety and Health Administration, U.S. Department of Housing and Urban
U.S. Department of Labor (www.osha.org) Development
Code 0/Federal Regulations (CFR) Title 29-0SHA The Noise Guidebook (www.hudexchange.info/
Regulations, Part 1910 (29 CFR 1910), Occupa resource/313/hud-noise-guidebookJ)
tional Safety and Health Standards (www.osha.gov/
pls/oshaweb/owastand.display_standard_group?p_
toc_Ievel= 1&p_part_number= 1910)
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)
U.s. Pharmacopeia! Convention (www.usp.org)
U.s. Department ofVeterans Affairs, Veterans
u.s. Pharmacopeia-National Formulary (USP-NF)
Health Administration
<Chapter 1066>: "Physical Environments that
VHA Handbook 1330.01: Health Care Services for
Promote Safe Medication Use" (www.uspnf.com)
WDmen 1Ieterans (https://www.va.gov/vhapublica
tions/searchform.cfm?Pub=9))
University ofWisconsin-Milwaukee, School of
Architecture & Urban Planning
U.s. Food and Drug Administration (www.fda.gov) Dementia Design Info Database (in partnership with
Hospital Bed Safety Workgroup. "Clinical Guidance I.D.E.A.S., Inc. and Polisher Research Institute)
for the Assessment and Implementation of Bed (www.dementiadesigninfo. uwm.edu)
Rails In Hospitals, Long Term Care Facilities,
and Home Care Settings" (2003) (www.fda.gov/ With Seniors in Mind, Inc. (www.withseniorsinmind.
downloads/MedicalDevices/ProductsandMedical org)
Procedures/GeneralHospitalDevicesandSupplies/ Senior Living Sustainability Guide® (2011)
HospitalBeds/UCM397178.pdf)
1.2 Planni g/Predesign Process
• 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:
1.2 PlANNING/PREDESIGN PROCESS
1.2-2.1.1.1 The functional program shall be used Residential Health, Care, and Support Facilities (Guide
to develop the physical space program that serves lines for Residential Facilities). If acronyms are used,
as the basis for the project design and construction they shall be clearly defined.
documents.
1.2-2.1.3.2 The names and spaces indicated in the
1.2-2.1.1.2 The care provider shall retain the func functional program shall also be consistent with those
tional program with other design data to facilitate used on submitted floor plans.
future alterations, additions, and program changes.
1.2-2.1.4 Shared Services
1.2-2.1.2 Functional Program Requirement
1.2-2.1.4.1 Each residential health, care, or support
1.2-2.1.2.1 The care provider shall be responsible for facility shall, at minimum, contain the elements
providing a functional program for each facility project described in the applicable chapters of the Guidelines
to the project architect/engineer and the authority
for Residential Facilities. However, where a project
having jurisdiction (AHJ). calls for sharing or purchasing services, appropriate
(1) Projects that only involve activities such as modifications or deletions in space and parking
equipment replacement, fire safety upgrades, or requirements shall be permitted.
minor renovations that will not change the facility's
function or character shall not require a functional *1.2-2.1.4.2 Where a residential health, care, or
program. support facility is part of or contractually linked
(2) Findings and recommendations from the resident with another facility, sharing of services such as
safety risk assessment (see Section 1.2-3) shall be dietary, storage, pharmacy, linen, and laundry shall be
addressed in the functional program. permitted insofar as practical.
1.2-2.1.2.2 The functional program shall include an 1.2-2.2 Functional Program Content
executive summary as well as detailed information
about each operation conducted in the facility that will 1.2-2.2.1 Owner's Project Requirements
affect the physical setting design.
1.2-2.2.1.1 The functional program shall describe in
1.2-2.1.2.3 The functional program or a functional detail the care provider's expectations for the project,
program summary shall be submitted to the AHJ for including the delivery of care model.
review along with the plans and specifications.
*1.2-2.2.1.2 The functional program shall provide the
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
model and project scope:
1.2-2.1.3.1 Names for spaces and departments used in *(1) Who will be served by the project (residents, staff,
the functional program shall be consistent with those families, volunteers, etc.)
used in the Guidelines for Design and Construction of (a) If the care population includes residents who
are persons of size, see Section 2.2-3 (Design
APPENDIX
A1.2-2.1.4.2 Shared services. In some cases, all ancillary ser A1.2-2.2.1.2 (1) Evaluation of ways to incorporate intergenera
vice requirements will be met by the principal facility and modifications tionaIinteraction and integration with the community at-large into the
will be necessary only in the residential facility. In other cases, program project should be part of the functional programming process.
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.
1.2 PLANNING/PREDESIGN PROCESS
Criteria for Accommodations for Care of (b) Major points of entry

Persons of Size). (c) Landscaping and garden features (hardscape
*(b) If the care population includes residents with and softscape)
dementia, mental health issues, or cognitive (d) Pedestrian circulation
and developmental disabilities, see Section (e) Vehicular circulation (roads and parking)
2.2-4 (Design Criteria for Dementia, Mental (f) Wayfinding (landmarks and signage)
Health, and Cognitive and Developmental (g) Art
Disability Facilities). (h) Outside programming
(i) Lighting
*(2) What user activities will occur in the spaces
affected or created by the project (2) Operational circulation patterns. These shall
(3) Why each user group is engaged in each activity include interior and exterior circulation patterns
(4) When these activities will take place for:
(5) Where these activities will take place (inside and
(a) Residents, staff, and family/visitors
outside the building)
(b) Equipment for infectious waste handling
(6) What resources (i.e., people, equipment, supplies,
processes, training) will be needed to carry out
(3) Space and equipment needs. The following shall be
these activities
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
(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 A1.2-3.1.2 RSRA components
pli nary, documented assessment process used to proactively identify The resident safety risk assessment should also address how the physical
hazards and risks and mitigate underlying conditions of the built envi environment of the residential health, care, or support facility can help
ronment that may contribute to adverse safety events while balancing maintain residents'functional capabilities.
the importance of quality of life for individual residents. Hazard and risk For additional information on safety outcome categories
events include infections, falls, medication errors, immobility-related incorporated in the RSRA component descriptions, see aliterature
outcomes, security breaches, and musculoskeletal or other injuries. The review undertaken by the Center for Health Design (CHO): "Summary
RSRA process takes into account the models of care, operational plans, of Literature Review: Resident Safety Risk Assessment" (July 2012) on
sustainable design elements, and performance improvement initiatives the CHO website (www.healthdesign.org). See the Facility Guidelines
of the care prOVider organization. The process also includes evaluation of Institute website (www.fgiguidelines.org) for a RSRA matrix based
the population at risk, the nature and scope of the project, and opportu on six categories of resident safety outcomes identified in the CHO
nities to adjust the acceptable level of safety risk in accord with individ literature review.
ual personal assessments to support quality of life. The RSRA proposes
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
*1.2-3.1.4.2 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 enhance quality of life.
assessment to determine potential risks and resulting (1) The care population profile (including cognitive
impacts to residents and caregivers for each space and abilities of residents) identified during the
building component that is part of the project. functional programming process shall be used as a
basis for evaluating resident safety-related risks and
1.2-3.1.5.1 Identify risks. For each space in the quality-of-life opportunities.
building, the RSRA shall identify the following specific (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
(a) Likelihood of opportunity based on historical (b) Remain an active component of the following
data, if available project documents:
(b) Degree of potential enhancement to resident
(i) Planning, design, equipment and
quality of life
furniture specifications
(ii) Construction documentation
*1.2-3.1.5.3 Prepare RSRA reporting and comply
(iii) Commissioning records
with the recommendations provided.
(iv) Postoccupancy evaluation documents
(1) The RSRA team shall produce a written report that:
(3) Changes to the original design plans and as-built
(a) Identifies known environmental risks based on documentation, including changes in identified
RSRA components to be used in development risks and solutions, shall be recorded, updated, and
of the functional program and in the design, shared among RSRA team members throughout
construction, and commissioning of a project design, construction, and commissioning.
residential health, care, or support facility:
(i) Infection control risk *1.2-3.2 Infection Control Risk Assessment

(ii) Resident mobility and transfer risk For a facility project to support safe designs, finishes,
(iii) Resident fall risk and prevention surfaces, HVAC systems, and plumbing systems, an
(iv) Resident dementia and mental health risk infection control risk assessment (I CRA) shall be part
(v) Medication error risk of the resident safety risk assessment.
(vi) Security risk
(vii) Disaster risk and emergency preparedness 1.2-3.2.1 Elements to Be Assessed
(b) Specifies design features intended to reduce or The care provider shall provide the results of an evalua
eliminate potential risks from adverse events tion of infection control risk for the following ele
for inclusion in the project design. ments for incorporation into the functional program:
(c) Identifies opportunities to improve the quality
of life for residents for inclusion in the project *1.2-3.2.1.1 Design elements
design. (1) Heating, ventilation, and air-conditioning (HVAC)
systems
(2) The conclusions in the written report shall:
(a) Where airborne infection isolation (All) rooms
(a) Be incorporated into the functional and
are required, the number, location, and type
physical space programs.
shall be identified in the functional program.
*(b) Special HVAC needs to accommodate the
APPENDIX
A1.2-3.1.5.3 Where available, benchmarked resident and caregiv.er A1.2-1.2-3.2.1.1 Design elements. Research demonstrates
safety data and national industry resident and caregiver safety trends that single-resident rooms reduce health care-associated infections
should be used as a benchmark for developing the report. (HAls), medical errors, falls, resident stress, and staff injuries while
improving resident sleep, privacy, and social support; staff efficacy and
A1.2-3.2 leRA. The infection control. risk assessment is an

communication with care consumers and family members; as well as
interdisciplinary, documented process intended to identify and

satisfaction of both residents and staff.
mitigat~ risks from infection that could occur as a result of design and
construction activities, taking into account: A1.2-3.2.1.1 (1 Hb) Special HVAC needs. Airborne
a. The resident population at risk contamination can result where HVAC systems are improperly specified,
b. The nature and scope of the project designed, built, or maintained. In addition to providing comfort and
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 is 99.97 percent effective in removing harmful particulates). An HVAC
biological contaminants in the facility 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:
18 Guidelines for Design and Con'struction of Residential Health, Care, and Support FaCilities
1.2 PLANNING/PRE DESIGN PROCESS
services provided in or affected by the project *(1) The effects of disrupting essential services to
(e.g., HVAC needs for All rooms, pharmacies, residents and staff
local exhaust systems for areas where hazardous (2) The specific hazards and protection levels for each
agents are present, and other special areas) designated area
shall be identified in the functional program. (3) Location of residents according to their
(c) Strategies for design of HVAC systems, susceptibility to infection and the identification of
including those intended to reduce energy risks to each
costs, shall include development of designs (4) Impact of movement of debris, traffic flow, spill
that minimize the risk of airborne transmission cleanup, and testing and certification of installed
of biological agents. systems
(5) Assessment of external and internal construction
(2) Water/plumbing systems

activities
*(a) The number, location, and type of hand (6) Location of known hazards
washing stations, hand sanitation dispensers,
and emergency first-aid equipment (eyewash 1.2-3.2.2 Infection Control Risk Mitigation
stations and deluge showers) needed shall be Recommendations (ICRMRs)
identified in the functional program. The following shall be included in the RSRA report:
*(b) Strategies for design of water systems or water
conservation systems shall include develop *1.2-3.2.2.1 Specific methods for avoiding transmis
ment of designs that minimize the risk of sion of airborne and waterborne biological contami
waterborne transmission of Legionella spp. and nants during construction and commissioning, where
other opportunistic pathogens. HVAC and plumbing systems and equipment (e.g., ice
(3) General design requirements for architectural machines) are started/restarted
details, surfaces, and furnishings. See sections 2.4
2.2.8 (Hand-Washing Stations), 2.4-2.3 (Surfaces), *1.2-3.2.2.2 Provisions for monitoring infection con
and 2.4-2.4.2 (Casework, Millwork, and Built trol risk, including:
Ins). (1) Written procedures for emergency suspension of
work
1.2-3.2.1.2 Construction process elements. The fol (2) Protective measures indicating the responsibilities
lowing shall be evaluated for infection control risk: and limitations of each party (care provider,
designer, contractor, monitor)
APPENDIX (continued)
a. Characteristics of overall system design as well as design for spe A1.2-3.2.1.1 (2)(bl Water conservation sY$tems.
cific sensitive areas, including components, capacity, filtration, air Providing touch-point cleaning that uses microfiber technologies. may
changes, pressure relationships, and directional flow reduce HAls as well as chemical andwater use.
b. Ease of access. for system maintenance
A1.2-3.2.1.2(1) Hazards specific to different types ofessential
c. Ease of general maintenance activities and system cleaning
service disruptions should be proactively determine.d. AnJilnshould
d. Selection of air distribution devices that allow for minimal or easy
be developed to ensure continued provision of service in the event of
cleaning
planned and unplanned disruptions,
e. Location of air intakes and exhaust outlets to prevent cross-contami
nation A1.2-3.•2.2.1 Responsibilities for performing risk-mitigation proce
f. Redundancy in equipment and systems dures should be included in infection control risk mitigation recommen
g. Plan for system 'Outages and maintenance (planned and unplanned) dations to assure the proper actions are taken at the appropriate time.
Al.2-3.2.1.1 (2)(a) location of hand-washing sta A1.2-3.2.2.2 Monitoring efforts will be determined by the care
tions. Locating hand-washing stations and/or hand sanitation dis proVider and may be conducted by staff responsible for infection control,
pensers.in all high-volume care areas, including resident rooms, in the safety staff,or independent outside conSUltants.
sight lines of staff improves hand-sanitizing compliance, which redu,ees
HAls.
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.
1.2-3.3.1 Locations to Be Assessed 1.2-3.3.1.4 Wellness centers

Resident mobility and transfer risk evaluation shall
address the specific needs of all areas affected by the 1.2-3.3.1.5 Outdoor areas
project where resident transfers and movement occur,
including but not limited to the following: 1.2-3.3.1.6 Hallways and corridors
1.2-3.3.1.1 Resident rooms and toilet rooms *1.2-3.3.2 Mobility and Mobilization Concerns
The following shall be evaluated for all areas where
1.2-3.3.1.2 Residential living and community spaces resident mobility and transfers occur:
(e.g., dining and recreation areas), including associated
toilet and bathing areas *1.2-3.3.2.1 Specific design recommendations to
support safe mobility and transfer tasks. This shall
1.2-3.3.1.3 Examination rooms and other diagnostic include accommodations for charging batteries for
and treatment areas battery-operated equipment.
APPENDIX
Al.2-3.3.2 Mitigation for mobility and -Exiting furniture or beds (e.g., bedrails, extended chair arm
mobilization concerns. The types of equipment needed fronts)
in each residential unit and treatment area are determined by the -Supported ambulation extending beyond the resident room
characteristics of the resident population. Recommendations for (e.g., room-to-hallway ceiling track-supported walkway
mitigating mobility and transfer risks should be developed for all areas system), if indicated in the functional program
in a new construction or renovation project. These recommendations -Transfers from resident chairs or other seats (e.g., adequate
should address the locations where resident transfers and mobilization clearances)
will occur and the types of resident mobility and transfer tasks relevant To correctly identify all resident mobility and transfer tasks and
to the care population. impediments or hindrances to mobility in an area, care proViders and
The objective of preparing these recommendations is to assure other staff should be interviewed for their perceptions of which tasks
proper accommodations are proVided for resident mobility and for mobi carry ahigh risk.
lization devices based on their type, size, weight capacity, and quantity. b. Types of resident mobiUty and transfer equipment that may be used
Storage should be sized to accommodate the lift equipment, assistive to minimize risk include:
devices, and resident-operated mobility devices that will actually be -Sit-to-stand lifts. For a resident who requires partial assistance
used. and possesses some weight-bearing ability,sit-to-stand lifts
are used to assist in vertical transfers, toileting, dressing, arid
A1.2-3.3.2.1 Design recommendations for
ambulation.
safe mobility and transfer. Technology, equipment, and
-Floor-based sling lifts and ceiling-mounted lifts. Botnofthese
architectural details can be used to address evaluations of structural,
lift types are used for residents who are completely or sub
electrical, mechanical, and other design considerations.
stantially unable to assist caregivers. Residents requiring these
a. Resident mobility and transfer tasks for which risk can be minimized
levels of care are often described as "dependent" or requiring
using equipment or other measures include the follOWing:
"extensive assistance:'The utility of these lifts for this popula
-Vertical and lateral transfers (from/to abed, chair, commode,
tion includes-but is not limited to-vertical transfers, lateral
toilet, wheelchair, gurney, or trolley)
transfers, repositioning in bed and chair, lifting appendages,
-Positioning/repositioning in bed (side to side, up to the head of
and lifting residents from the floor. These lifts can also be used
the bed, raising or lowering head or feet)
for assistance with ambulation rehabilitation or mobilization of

-Repositioning in chair
residents with some weight-bearing capability.

-Showering/bathing
-Resident-operated mobility devices. These are devices residents

-lifting appendages
can use on their own and are intended to foster their indepen
-Transporting residents
dence.
-Assistance with resident ambulation
-Weighing residents on bed scales
*1.2-3.3.2.2 Types of resident mobility and sy~temsand related equipment and for resident-oper
transfer equipment ated mobility devices shall be determined by evaluating
(1) Implementation of any architectural solution that equipment use in the facility.
supports ambulation and incentivizes mobility and
ambulation using the equipment available on-site *1.2-3.3.2.7 Provision of clearances
shall be considered. (1) Space shall be provided for resident care and for
(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
furnished to maximize safe resident mobility,
*1.2-3.3.2.3 Minimization of physical environment mobilization, weight-bearing, and ambulation
impediments to resident, participant, and potential while minimizing risk to caregivers.
outpatient mobility and mobilization. Evaluation (3) Unimpeded clearances shall be provided at the
of cognitive ability of the care population shall be front and at least one side of the resident chair.
included in determining how impediments can be Clearances shall be equal to or greater than those
minimized for a particular facility. required around the sides and foot of the resident
bed.
*1.2-3.3.2.4 Quantity of each type of resident (4) Resident units shall be designed to maximize safe
mobility and transfer equipment resident ambulation opportunities from resident
rooms into and through corridors.
*1.2-3.3.2.5 Weight-carrying capacities

*1.2-3.3.2.8 Destination points for resident
*1.2-3.3.2.6 Storage for mobility devices. The need ambulation, transfers, and movement
for storage accessible by staff and residents for lift (1) Identified destination points (e.g., resident rooms,
bathrooms, community spaces) shall be evaluated
- - -~
APPENDIX
A1.2-3.3.2.2 Identifying resident mobility and A1.2-3.3.2.5 lift weight capacities range from approXimately 400
transfer equipment for a project. Resident care prOViders pounds (181.8 kg) to expanded-capacity lifts of 1,000 pounds (454.5
who are familiar with the characteristics of their unique resident kg) or more. Specification of lifts with acapacity of 500-600 pounds
populations should be included in the functional programming process (227.3~272.7 kg) will accommodate the greatest range of residents. If
to ensure appropriate equipment is identified for use in the facility. admissions of persons of size warrant, aminimum of one expanded
Equipment may include manual or power-assisted fixed ceiling or wall capacity lift (preferably fixed, ceiling-mounted) per unit should be
mounted lifts, manual or power-assisted portable/floor-mounted lifts, included,in addition tothe lower-weight-capacity lifts.
electrlc height-adjustable beds, or acombination th.ereof.
A 1.2-3.3.2.6 Space and electrical services for charging batteries
When.developing an equipment list, any existing equipment that
should be included in storage rooms for portable, floor-based lifts and

will be used in the facility should be included. Preparation of alog is
resident-operated mobility devices. Access to electrical power and

suggested to relay information on existing equipment, the percentage
control services should be provided for fixed lifts and devices. Provision
oftime it is used, and ifthis is not 100 percent, the reasons for the per
of an eyewash station in these spaces should be considered depending

centage oftime indicated.
on the types of batteries being charged; Consideration should be given

A 1.2-3.3.2.3 Minimizing impediments to resident, participant, and to providing storage space for resident-operated mobility devices in
outpatient mobility and mobilization supports an active lifestyle during resident rooms or dwelling units as space in common areas may prove
a resident's long-term stay or rehabilitation recovery process. inadequate and inconvenient for resident accessibility.
Consideration ofresident weight and sire is important to assure that
A 1.~-3.3..2.7 Maintenance of dearance zones should be included in
.equipment capacities and dimensions for other accommodations are

facilJty policy.
appropriate.
A 1.2-.3.3.2.8 Consider access routes to destination points in the
A 1.2-3.3.2.4 The community should have sufficient lifts to meet
facility that will welcome residents (e.g., community and activity
the needs of the current resident population based on the outcome of
rooms, gift shops, dining rooms, and healing gardens). Evaluate various
the resident safety risk assessment.
for ease of door operation to assure that passage in conflict with plumbing, mechanical, electrical,
either direction is not hindered due to door weight communication, and life safety system equipment
or closure pressure. installations.
(2) Door openings shall be provided in sizes and types (2) Environment of care characteristics. The effects of
that allow passage of resident mobility and transfer the installation and use of resident mobility and
equipment and accompanying staff. transfer equipment on the environment of care
characteristics listed in Section 1.2-4.5 (Physical
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
evaluated.
transitions shall be used.
(2) No items with parts that all lie below a resident's I

*(4) Bed safety. The configuration of beds being used
field of vision shall be used (e.g., built-in planters, shall be evaluated based on the care population
benches) to reduce the risk of injury related to bed rails,
(3) See Sections 2.4-2.2 (Architectural Details), mattresses, and bed configurations.
2.4-2.3 (Surfaces), and 2.4-2.4 (Furnishings) for
additional requirements. *1.2-3.4 Resident Fall Risk and Prevention
Assessment
1.2-3.3.2.10 Coordination between mobility

and transfer equipment and other aspects of the 1.2-3.4.1 Requirement
physical environment An evaluation of resident fall risk and prevention shall
(1) Building systems. Resident mobility and transfer address the following specific design elements:
equipment installations shall be evaluated for
, APPENDIX (continued) ,
destirlationsfor residents using resident mobility and transfer equip For mpre information, see "Clinical Guidance for the Assessment and
ment (Le., locations to and from which residents travel, such as between Implementatioo of Bed Rails in Hospitals, long Term:Care Fatilities,
the bed, chair, andcornlTlode inthe resident room or into an a~sociated and Home Care Settings;' published.by the Food and Drug Adminis
toilet room or bathroom). Such considerations will aid in recognizing tration.
appropriate'equipmentand designing a room and door openings to b. Other bedsafety options. The follOWing environmental adjustments
accommodate portable equipment and the residents and caregivers should be considered depending on an individual resident'S assess
using ,it. ment:
~Use'of low beds with adjacent mat on the·floor
A1.2-1.3.2.10 (3) Where fixed-lift sy~tems are installed, care
~Use of electrically adjustable low beds
should be taken to minimize the vi.sual impact of fixed tracks, slings,
~Placement of resident's nurse call device within easy reach'and
hanger bars, and motQrs on the aesthetics ofthe physical environment,
visual and verbal cues for use ofthe device
especially in nursing homes and other long-term care settings where a
~Inclusion of bed exiting alarms in the call system
home-like environment is ess.ential. Use of recessed tracks is suggested.
~Use of body pillow/cushions or raised mattress edges to define
Other suggestions include enclosing lift motors in decorative cabinets
the edges or borders of the mattress
and concealing or masking wall-mounted rails for traveling gantry lifts
~Potential use of atrapeze affixed to the'bedto increase a resi
with Hown molding or indirect ceiling light coves.
dent's bed mobility
A1.2-3.3.2.10 (4) Bed safety ~Placement of cues for interdisciplinary care team recommenda
a. Bed rail safety. Depending on the care population an!! individual tionsregarding each resident's unique needs
resident needs, the same device may act as a restraint or asupport
A1.2-3.4 Resident faU risk. Safe environments help ptevent
ive aid. For example, someone cognitively intact may use bed rails
falls and mitigate injuries associated with falls. Evaluation of fall .risks
to safely enter and exit a bed. However, ~omeone who is confused
byan interdisciplinary team shou,ld be used to create acoordinated plao
or unsteady may slide between the rails or between the mattress
that identifies physical environment fijctors thijtcontribute to resident
and bed, Heating a risk for entrapment, entanglement, or falling.
falls and associated injuries.
Guidelines for Design and Construction of ReSidential Health, Care, and Support Facilities 23
1.2-3.4.1.1 Flooring characteristics. See Sections 2.4-2.1.2 (Characteristics and Criteria for Selecting
2.4-2.1.2 (Characteristics and Criteria for Selecting Materials and Products) and 2.4-2.4 (Furnishings).
Materials and Products) and 2.4-2.3.2 (Flooring and
Wall Bases). *1.2-3.4.2 Resident Fall Risk Prevention Measures
1.2-3.4.1.2 Furniture characteristics. See Sections
APPENDIX
A1.2-3.4.2 Rt!sldent fall risk prevention measures between ahandrail and the wall allows the handrail to be found
a. Environmental design can effectively reduce re-sident fall risk easily, encouraging use and decreasing fall risk.
through these actions: Contrast in percentage should be determined by the following
-Increasing ambient lighting levels formula:
-Reducing light glare Contrast =[81- B2/Bl] x 100: where Bl =light reflectance value
-Reducing use of physical restraints,including bedrails (lRV) of the lighter area and B2 = LRV ofthe darker area
-Positioning beds to prevent residents fromfaUing out of bed b. Sleep disorders frequently lead to resident faUs, delirium, morbidity,
-Selecting low-height beds or chairs and mortality. Residents' nighttime awakenings and daytime sleep
-Selecting flooring with small motifs and low contrast can be significantly reduced by the following:
-Optimizing the configuration of grab bars near bathing, shower, -Higher lighting levels during the day
and toilet areas -Exposure to bright light (avoiding glare)
-Designing awander garden and/or indoor spaces that are -Sunlight exposure
accessible for safe walking and exploring. This can reduce the -Improved acoustics to reduce unwanted noise and sounds. See
frequency and severity of falls for residents with dementia. the white paper Sound &Vibration: Design Guidelines for Health
-Providing smaller residential carelliving areas in separate build (are Facilities, prepared by the joint Acoustics Research Council
ings or interconnected within alarger building. Smaller areas Facility Guidelines Institute Acoustics Working Group and linked
are easier to navigate for individuals with impaired mobility. from the FGI website under the Resources tab.
-Decentralizing nurse stations to satellite work stations proximal -Access to outdoor nature/wander garden during the day
to patient/resident rooms with small charting alcoves. This Co Research has established that older adults sleep best in total dark
arrangement improv.es visibility, fall prevention, transfer rates, ness, but night-lights are essential to reduce falls. To minimize resi
and medical error rates without being disruptive to persons dent sleep disruption, night-lights should:
receiving care. -Be located to minimize light scatter and reflections on room
-Positioning the bed near the bathroom, along with handrail surfaces.
support. Evidence suggests this reduces falls while residents are -Have illuminated switches or motion sensors to light the path
transitioning from the bed. way between the sleeping area and the bathroom.
-Using passive infrared nurse call technology in bedrooms -Use warm CCT sources (red or amber in color) at alow illumina
-Providing single-occupancy bedro.om-s tion level. Research shows these colors are less disruptive to
-Providing acuity-adaptable rooms that enable aging in place sleep.
-Considering furniture selectH>n and location/layout d. lighting control strategies should be considered to facilitate provi
-Providing multi-sensory environments sion of lighting levels that support resident safety.
-Selecting floor surface materials with auniform value (light -All wall switches, including dimmers in resident rooms, bed
ness/darkness). Abutting horizontal materials with highly rooms, and bathrooms, should have pilot lights (illuminated
contrasting values creates an optical illusion ofastep or change SWitch) so switches can be located with ease.
of level, which contributes to fall risks. -In community spaces, including corridors, light controls should
-Using contrasting values between horizontal and vertical accommodate daytime and nighttime illuminance levels
surfaces and objects. This helps older adults and the low-vision as referenced in Table 1(Minimum Maintained Illuminance
population comprehend the geometry of aspace and assists Recommendations) oflES/ANSI RP-28: Lighting and the Visual
with wayfinding. For example, a30-percent contrast between Environment for Seniors und the Low VisiOll PopulatiQnand
floors and walls, between walls and door frames/doors, and Appendix 50 (Dimming and Other Control Strategies) of the
between background and furniture/toilets reduces the pos National Institute of Building Sciences' Design Guidelines for the
sibility of walking or moving into objects, thereby increasing Visual Environment.
independence while redUcing fall risk. A50 percent contrast
*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.
------------ .. _.--_.-----_._ •._.
*(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 1.2-3.6.1.11he medication safery plan shall include
ment Elements for Risk Reduction) and 2.5-5 (Com the number of medication distribution locations.
munication Systems) for additional requirements.
1.2-3.6.1.2 See common element and faciliry chap
*1.2-3.6 Medication Error Risk Assessment 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 -Increased environmental lighting to support the aging eye and
exiting. Unsafe exitingisa special problem in long-term care low vision, promoting negotiationof the physical setting with
settings, especially for residents with dementia or cognitive and mental less. stress
health concerns. Residents exhibit fewer unsafe exiting behaviors in an -Heightened value contrast to support the aging eye and low
environment that prOVides the follOWing: vision, promoting negotiation ofthe physical setting with less
a. Asoothing atmosphere stress
-Wander gardens help reduce aggressive behavior among, resi b. For some individuals who suffer from sensory processing issues (e.g.,
dents with dementia and cognitive and mental health concerns, ASD, ADHD, and similar attention issues):
-Indoor spaces that are .accessible offer opportunities for safe -Av.oidance of high light levels, glare, light flicker, and environ
wandering, walking; and exploring. mental clutter
-Provision of safe exits and transitionS from residential areas to -Increased consideration of the quality and quantity of light to
wander gardens reduces eXit-seeking behavior or provides asafe help residents feel safe and comfortable
outlet for such behaVior. -Provision of asimple interior environment, including ac1utter
b. Appropriate sensory stimulation. Environmental features, decor, and free ceiling and less complex patterns on surfaces, finishes, and
objects are used to mitigate over-stimulation (e.g., excessive noise) furnishings
and ,arouse one or more ofthefive senSeS (sight, smell, hearing, c. Other design considerations that may decrease resident stress and
taste, and touch), with the goal of evoking positive feelings. agitation include:
c. Positive distractions
...-;Decreased spatial and social density (Le., fewer residents per
-Nature scenes, artwork
unit, larger space per resident)
-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.
----------------------
*1.2-3.7 Security Risk Assessment 1.2-3.7.1.4 Security considerations for project

design
*1.2-3.7.1 Security Plan *(1) Parking and exterior spaces. The design of parking
Security recommendations for a new construction and exterior spaces shall minimize the opportunity
or renovation project shall be included in the RSRA for violent and property crime, promote efficient
report. The security plan shall include the following: resource management, and provide a welcoming
environment.
1.2-3.7.1.1 A description of the effects of demolition *(2) Buildings and interior spaces
and phasing on existing site functions and protection
(a) Residential health, care, and support areas
efforts
(i) Security design considerations shall
1.2-3.7.1.2 An assessment of the need for temporary address the particular risks associated
security barriers such as fencing and security sys with the resident care population and
tems (e.g., intrusion detection and video surveillance demographics, facility needs expressed in
systems) the functional program, characteristics of
the surrounding community, and other
1.2-3.7.1.3 A schedule for installation of security sys environmental factors.
tems for completion during move-in activities to allow *(ii) The project design shall include a compre
for protection of the facility and equipment 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
zones, control points, circulation routes, located in them, are critical assets for
and required egress paths. residential care providers and should
support uninterrupted resident care,
(b) Protected health information
basic building comfort, and extraordinary
(i) The design of residential health, care, and emergency response capabilities.
support facilities shall address handling (ij) See Chapter 2.5 (Building Systems) for
of all forms of confidential resident additional information and requirements.
information commonly referred to as
(d) Biological and chemical materials
protected health information (PHI).
(ii) The design shall address ways in which (i) The design of residential health, care, and
this information could be compromised support facilities shall address the unique
and shall apply integrated physical and security risks presented by the presence of
electronic security systems (e.g., access and hazardous materials, including biological
audit featutes), as appropriate, to locations and chemical materials.
for charting, care planning and manage (ii) Facilities shall be designed and constructed
ment, record storage, and waste collection/ to provide integrated physical security,
disposal as well as in data systems (e.g., protect the internal and external environ
electronic health records). ment and the surrounding community,
and assist in the audit of materials in
(c) Utility, mechanical, and infrastructure-related
accordance with policy, regulation, best
spaces
practices, and assessed risk.
(i) The design of utility, mechanical, and
infrastructure-related spaces in residential *1.2-3.8 Disaster Risk and Emergency
health, care, and support facilities shall be Preparedness
based on the recognition that such spaces,
along with the mechanical, electrical, *1.2-3.8.1 Provisions for Disaster Preparedness
plumbing, and communication systems
APPENDIX (continued]
-Provision of emergency call boxes and sufficient illumination in required to protect systems and essential building services such as
parking areas and remote walking trails power, water, medical systems, and, in certain areas, air condition
-Provision ofacommunication system for staff and others who ing systems. In addition, special conSideration must be given to the
may work alone likelihood of temporary loss of externally supplied power, gas, water,
and communications.
A1.2-3.8 Disaster risk and emergency
b. Wind- and earthquake-resistant design for new buildings
preparedness. Residential health, care, and support facilities
~Facilities should be designed to meet the requirements of
generally are expected to be functional, safe, and secure for residents,
American Society of Civil Engineers/Structurat Engineering Insti
family members, visitors, and staff while remaining prepared for natural
tute (ASCE/SEI) 7or building codes with s~bstantially equivalent
and man-made emergencies 24 hours adayl7 days aweek.
requirements. See Section 1.1-4.2 (Regulations for Earthquake
a. An evaluation of potential risks from disasters informs the emer
Resistant Design for New Buildings) for specifics.
gency preparedness plan.
-Seismic construction inspection. During construction, the care
b. Design of the facility should consider emergency management prac
provider should complete the testing described in Section 11 A.2
tices that allow for the flexibility '1M resilience required to manage
and special inspection of the seismic systems described in Sec
emergency events.
tion llA.1J of ASCE/SEI7.
c. Apotential risks approach to the design should be applied to help
-Roofconsiderations
the care provider prepare for, respond to, and recover from man
Roof coverings and mechanical equipment should be
made events and natural disasters.
securely fastened or ballasted to the supporting roof con
A1.2-3.8.1 Provisions for disaster preparedness struction and provide weather protection for the bUilding
a. Design for continued operation. For those facilities that must remain at the roof.. If ballast is used, it should be designed so it is
operational in the <Ifterniath ofadisaster, special designs are unlikely to become aprojectile.
--------------- -------_._-----------------------------------
*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:
1.2-4.2 Users
(a) Resident placement and relocation
(b) Standards for barriers and other protective The physical environment shall support the operation
measures required to protect areas of refuge of the delivery of care model and the desired experi
from identified potential disasters ence for residents, family members, visitors, and staff.
• 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
*1.2-4.3 Systems Design *1.2-4.5.1 Light

The physical environment shall support organiza [ Use, availability, and control of natural light and illu
tional, technological, and building systems designed mination shall be addressed in the design of the physi
in response to the functional program, including the cal environment to provide the visual and non-visual
delivery of the care model and operational services. benefits of access to both natural light and darkness.
*1.2-4.4 Layout/Operational Planning 1.2-4.5.2 Views of and Access to Nature

The layout and design of the physical environment
shall enhance operational efficiencies and the satisfac 1.2-4.5.2.1 Accessible outdoor space or a suitable
tion of residents, families, and staff. alternative for residents, visitors, and staff shall be
provided. Such spaces shall allow for visual observation
1.2-4.5 Physical Environment Elements by staff.
The physical environment shall be designed in
response to the functional program, including the *1.2-4.5.2.2 Views of nature shall be provided from
intended delivery of care model, and shall address the resident living areas.
key elements listed below:
APPENDIX
A1.2-4.3 Systems design. Information technology, medical b. Direct physical access to the outdoors (e.g., agarden, local park,
technology, and/or staff use and cross training are issues that shOljld be adjacent green space) and views of nature and indoor gardens/atria
addressed in relation to the environment of (ar~ components. should be provided. Where direct access is not possible, alternatives
include indoor gardens with natural Ught (atria), roof gardens, and
A1.2-4.4 Layout/operational planoing. Criteria for
green roofs.
evaluation of the layouts should be consistent with the delivery of
c. Views of nature can include views of the sky, vegetation, natural

care model to allow each proposed layout and operational plan to be
light, precipitation, and birds and other liVing organisms.

reviewed in context
d. Outdoor respite areas should be proVided for direct care and support
A1.2-4.5.1 Light. Provision of natural light should be considered staff.
wherever possible in the design of the physical environment. Visual' e. The abilities ofthe care population served (e.g., level of acuity,
benefits refer to sufficient light for vision and safety; noncvisual benefits level of physical frailty, dementia issues) should be considered in
relate to biological factors (circadian rhythms, etc.). designing outdoor spaces or alternatives.
a. Access to natural light should be prOVided no farther than 50 feet f. Opportunities for both active and passive interactions with nature
from any resident activity area, visitor space, or staff work area. To should be proVided in outdoor space(s), including exercise and play
the extent possible, the source of such natural light should also pro or othertypes of physical activity and therapies (e.g., physical,
vide opportunities for exterior views. occupational, horticultural).
b. Window sill height should not exceed 3feet (.91 meter) above the g. Wayfinding and/or views should be prOVided to encourage residents
floor and should be above grade. to visit and return from outdoor garden(s) and/or atria.
c. Access to natural light should be available without entering private h. Access to both sun and shade, with trees and/or built shade
spaces (Le., staff should not have to enter a resident room to have structures, should be provided. Shady places are particularly
access to natural light). Examples of such access include windows at important for residents who are photosensitive.
the ends of corridors, clerestory windows in corridors, skylights into L Water features. Where provided, open water features should be
deep areas ofthe bUilding in highly traveled areas, transoms, and eqUipped to safely manage water quality to protect occupants from
door sidelights. infectious or irritating aerosols. See Section 2.1-3.6.3 (Outdoor
d. In residential health, care, and support occupancies, dining areas, Water Features) and appendiX section AlA-2.2.B (Decorative water
lounges, and activity areas should be designed to include natural features) for additional information and requirements.
light. j. For additional information on landscape and gardens, see appendiX
section A2.1-3.6.1 (Landscape features).
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.
*1.2-4.5.3 Signage and Wayfinding *1.2-4.5.4 User Control of Environment

How, by what means, and to what extent users of the
*1.2-4.5.3.1 An organized approach to wayfinding/clar finished project (residents, participants, outpatients,
iry of access for the entire campus or faciliry shall be staff, and visitors) are able to control their environ
provided. ment shall be considered in the design of the physical
environment.
*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 A1.2-4.5.3.2 Wayfinding elements. The wayfinding
a. Entry points to all residential health, care, and support faCilities approach should coordinate elements such as:
should be clearly identifiable from all major exterior circulation a. Visible and easy-to-understand signs and numbers
modes (roadways, bus stops, vehicular parking). b. Landmarks
b. Planning for wayfinding should begin with the concept that the c. Distinctive exterior views
average visitor or staff member will be able to easily find his or her d. Distinctive changes in interior decor (surface color and texture,
way throughout the facility. furnishings, and window treatments
c. Outside wayfinding should be considered for both those walking e. Provision of verbal directions
and those driving to the facility. If public transportation is available, f. Paper information
directions and signage to and from transportation sites should be g. Electronic information
provided. h. Internet access
A1.2-4.5.3.1 Organized approach to clarity of A1.2-4.5.4 User control of environment. During the
access. During the functional programming process, input from functional programming process, all opportunities to provide individual
hands-on care staff, facility managers, visitors, families, and residents control over as many elements of the environment as possible and
should be sought regarding wayfinding. This should include evaluation reasonable (including but not limited to temperature, lighting, sound,
of the most common and problematic scenarios to identify shortcomings and privacy) should be evaluated.
in the wayfinding approach and help develop design criteria to address a. lighting in resident and staff areas should prOVide variety in lighting
them. types and levels.
a. Consider use ofthe follOWing in the design ofawayfinding system -Residents should have control in their dwelling unit of all
to assist with orientation, informed decision-making, and self lighting.
managed care: -Residents should have control of varied lighting in resident
-Universal Symbols in Health Care™, where possible bathrooms.
-Unique landmarks (e.g., design elements such as color, artwork, -lighting in staff areas should allow for individual control.
texture, change in architecture, plants) -Staff should have control of varying lighting levels in corridors
-Placement of wayfinding features and signage, along with outside resident rooms, at caregiver areas, and at central
technological access to the internet, in concourses, hallways, caregiver areas to ensure that resident sleep is not disturbed by
and intersections general lighting not under control of residents/visitors.
b. Consider the need for the wayfinding approach to: b. Building systems design should incorporate individual control over
~Accommodate the needs of aparticular care population (e.g., the thermal environment, including zoning of mechanical systems
the elderly, children, cognitively impaired, visually impaired, that allow heating and cooling to achieve thermal comfort for indi
and other particularly vulnerable populations, including vidual residents.
residents with dementia and Alzheimer's). c. Noise should be minimized in the design of the physical environment
-Offer varied presentations of the same information to and the selection of op.erational systems and equipment. Residents
accommodate users with different cognitive processes. should have the ability to control their auditory environment where
-Accommodate users with limited English proficiency (LEP) and feasible and clinically safe. In community spaces that include
speakers of multiple languages. televisions, audio presentations, or other types of performances,
-Address the stress experienced by residents and families while alternative listening devices should be proVided for residents who
finding their way to unfamiliar areas in the facility. need supplemental amplification.
-Address the needs of first-time users.
c. The wayfinding plan should be integrated with relevant security
plans.
*1.2-4.5.5 Privacy and Confidentiality *1.2-4.5.7 Characteristics and Criteria for Selection
of Materials and Products for Architectural
1.2-4.5.5.1 Methods fot protecting the visual and Details, Surfaces, and Furnishings
auditory privacy and confidentiality of users shall be
included in the design of the physical environment. 1.2-4.5.7.1 The effects of materials, details, colors,
textures, and patterns on residents, staff, and visitors
1.2-4.5.5.2 In facilities with multiple-occupant shall be considered in the overall planning and design
resident rooms, a separate space shall be provided to of the facility. See Section 2.4-2 (Architectural Details,
give residents and families a place with both visual and Surfaces, and Furnishings) for specific requirements.
auditory privacy.
1.2-4.5.7.2 Maintenance and performance shall be
*1.2-4.5.6 Safety and Security considered when selecting these items.
How the safety and security of residents, staff, and
*1.2-4.5.8 Cultural Responsiveness
visitors will be addressed shall be considered in the
The culture of residents, staff, and visitors shall be
overall planning of the facility. See Section 1.2-3.7
consideted in the overall planning of the facility.
(Security Risk Assessment) for additional information
and requirements.
*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
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.
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)
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 1.2-5.3.2 The planning process for new and renovated
Lighting Systems) for additional requirements. residential health, care, and support facilities shall
include:
1.2-5.2 Acoustic Planning
1.2-5.3.2.1 Evaluation of care population in relation
1.2-5.2.1 General to thermal conditions
The planning of new and renovated residential health,
care, and support facilities shall include identification 1.2-5.3.2.2 Evaluation of building systems that affect
of acoustic needs during the programming phase to thermal conditions
determine desired outcomes based on the resident care
population. 1.2-5.3.2.3 Evaluation of building systems that affect
thermal controls in resident rooms, staff areas, and
1.2-5.2.2 The planning process for new and renovated common spaces
residential health, care, and support facilities shall
include: 1.2-5.3.3 See Section 2.5-3.1.2 (Ventilation and Space
Conditioning) for additional requirements.
1.2-5.2.2.1 Evaluation of building location related to
exterior noise 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
,--------------------------- ---------------------'--.
*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 incorporates an integrated project management approa~h and offers
knowledge is available to help design professionals and care provider third-party certification. GBl tools are available forNew(onstruc
organizations that provide residential health, care, and support services tion (NC) and for Continual Improvement lifExisting Buildings for
understand how buildings affect human health and the environment Healthcare (OEB H\l. GBI has developed ANSI/GBIOt Green BUilding
and how negative effects can be mitigated through avariety ofstrate Assessment Protocol for Commercial BUildings to irlform the develoJl~
gieS. To meet theSe objectives, care provider organizations should use ment of Green Globes rating systems.
an integrated project delivery process and develop an interdisciplinary c. tEED v4 Green BUilding Rating System. Along with thi.s rating system,
design team to gUide facility design. The intent of integrated project the US. Green Building Council (USGBC) has established athird
delivery is to improve building performance by including design and party certification framework for the design of suStaiilablebuildings.
construction considerations from project inception. d. Green Guide tor Health Care. This resour~e is avoluntary sel.f-certifica
tion metric tool that specifically addresses the health care sector.
A1.2-5.5.•2.1 Sustainability goals. Development of
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.
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.
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
1.3 Site Selection
• 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
• Design, Construction, and Commissioning
Considerations and Requirements
• 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
---------------------------------_._-_. __._._-_._-------_•. _
1.4 DESIGN, CONSTRUCTION, AND COMMISSIONING CONSIDERATIONS AND REQUIREMENTS
1.4-2.2 Sustainable Design • 1.4-3 Renovation

Sustainable site and building design, construction,
and maintenance practices to improve building *1.4-3.1 Phasing
performance shall be considered in the design and Projects involving renovation of existing buildings shall
renovation of residential health, care, and support use phasing to minimize disruption of existing resident
facilities. See Section 2.2-2 (Sustainable Design servICes.
Criteria) for specific requirements.
1.4-3.1.1 Phasing Provisions
*1.4-2.3 Design Considerations for Phasing provisions shall include:
Accommodation of Persons of Size

Where residents who are persons of size are part of 1.4-3.1.1.1 Clean-to-dirty airflow
the care population, the facility shall be designed
with support and clearances appropriate for these 1.4-3.1.1.2 Emergency procedures
individuals. Other requirements for accommodating
persons of size are contained in the facility chapters 1.4-3.1.1.3 Criteria for interruption of protection
of this document. See Section 2.2-3 (Design Criteria
for Accommodations for Care of Persons of Size) for 1.4-3.1.1.4 Construction of roof surfaces
additional information.
1.4-3.1.1.5 Written notification of interruptions
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, and outpatients who are persons of size will likely be the largest
weight, body width, weight distribution, and/or sjze requires incre.ased resident (are environment in Cl facility. If so, Clil other resident types
space for care and use of expanded-capacity devices, equipment, will become subsets of design parameters established for this envi
furniture, technology, and supplies. The term is often interchangeable ronment.
with obese, morbidly obese, and bariatric. For specific details for accommodating residents, participants,
a. The need to accommodate residentswhoare extremely obese Or tall and outpatients who are persons of size, see Section 2.2-3 (Design
is increasing in the United States. In addition to requiring facilities Criteria for Accommodation of Persons of Size).
with more space and patient handling equipmentand furnishings c. Worker's compensation costs for nurses and nursing assistants
with greater weight capacities (e.g.,grab bars, chairs, toilets), these amount to nearly $1 billion per year (Bureau of Labor Statistics).
residents have avariety of special health care needs from climate Caring for obese patients presents challenges to.patient positioning,
control requirements to specialty bathing fixtures. Visiting family mobility tasks, ana ov.erall patient and staff safety. The Bureau of
members of residents also~may be persons of size. .Labor Statistics haHeported that nursing employees suffer more
b. Creating residential health, care,Clnd support environments that than 200,000 work-related injuries and illnesses ayear, including
can accommodate persons of size requires attention to issues that sprains/strains; low back pain; and wrist, knee, and Shoulder injuries,
significantly affect design. To determine the number of beds per unit, especially when manually moVing or lifting patients who are over
dwelling units per project, or needs required in. anon-residential weight or obese (5. D.Choi and K.Briggs, "Work-related musculo
setting that should be able to Clccommodate apopulation of persons skeletal risks associated with nurses and nursing assistants handling
of size, the design tearnshould consider design issues along with an overweight and obese patients: Aliterature review,"Work vol. 53, no.
analysis of factors such as resident volume, expected length of stay, 2, pp. 439-448, 2016). Restricted space increases exposure to high
the nature of the care population, current codes, and local regulation risk events known to cause injury (GJ. Holman, T. Blackburn, and S.
requirements. Maghsoodloo, "The Effects of Restricting Space: AStudy InvolVing
Another primary space driver isthe staffing-per-resident (or a Patient-Handling Task;' Journal of the American Society of Safety
PClrticipant or outpatient) ratio and associated space needed for Engineers July 2010:38-46). Clear floor space for correct positioning
maneuverability in environments accommodating persons of size. may reduce injuries during patient handling activities.
In some instances, additional caregivers are recommended for
A1.4-3.1 Phasing is essential to maintenance of asafe environment
resident, participant, or outpatient transfers. Many users may also

in resident care areas during construction.
need enlarged facilities to accommodate resident-operated mobility
42 Guide!ines for Design and Construction of Residentia! Health. Care. and Support acl!ities
1.4-3.1.1.6 Communication authority construction projects. This shall include documenta

tion of existing mechanical, electrical, plumbing, and
1.4-3.1.2 Noise and Vibration structural capacities and quantities.
Phasing plans shall include consideration of noise and
vibration control during construction activities.
• 1.4-4 Record Drawings and Manuals
1.4-3.2 Isolation of Construction Areas
1.4-4.1 Drawings
During construction, renovation areas shall be isolated
from occupied areas based on an infection control risk 1.4-4.1.1 Record Drawings
assessment. See Section 1.2-3.2 (Infection Control

Upon occupancy of the building or a portion thereof,
Risk Assessment) for requirements.

the care provider shall receive a complete set of as-built
documents that shows construction, fixed equipment,
1.4-3.3 Maintenance of Air Quality

and mechanical, electrical, plumbing, and structural
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.
1.4-4.1 .2 Life Safety Overlay
1.4-3.4 Maintenance of Utilities

Drawings shall include a life safety plan for each floor
Existing utility requirements for occupied areas shall that reflects NFPA 101 requirements.
be maintained during any renovation or construction.

1.4-4.2 Equipment Information
1.4-3.5 Nonconforming Conditions
It is not always financially feasible to renovate an entire 1.4-4.2.1 Upon completion of the contract, the care
existing structure in accordance with the Residential provider shall be furnished with the following for each
Guidelines. Therefore, authorities having jurisdiction piece of equipment installed as part of the project:
shall be permitted to grant approval for renovation of a
portion of a building as long as preexisting features in 1.4-4.2.1.1 Operations and maintenance manual.
unrenovated areas do not jeopardize facility operations Complete set of manufacturers' operations, mainte
and resident safety in renovated areas. nance, and preventive maintenance instructions (0 &
M manual) for installed systems and equipment
*1.4-3.6 Existing Conditions
1.4-4.2.1.2 Parts list
Existing conditions and operations shall be docu
mented prior to initiation of renovation and new
1.4-4.2.1.3 Model number and description

APPENDIX
A1.4-3.6 EXisting conditions -Plumbing systems (e.g., domestic water, ueated water,
a. Documentation of existing conditions should cover the following: wastewater, pneumatic control,medical gaslvacuum)
-Subsurface conditions (e.g., soil testing reports, soil type -Existing airflow of affected areas
identification, known water table information, active/ ~Main electrical service and electrical service affected by
abandoned utility locations) construction, including rating and actual load/peak and feeder
-Foundation and superstructure information. including the sizes, as.applicable, i1nd power factor
ability of the structure and equipment (elevator) to handle the -Emergency power system, including rating and aCfualload/
movement of heavy and/or large.loads from one location to peak and feeder sites, as applicable, for life safety,.emergency
another and critical systems, and equipment branches
-=Types of fire ~uppression, detection, and alarm systems, b. The potential for reusing existing structure.sand interiors shau1dbe
including whether the building is fully sprinklered evaluated and considered when conducting arenovation.
-Communications systems (e.g., telephone, nurse call, overhead
paging)
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 according to design intent, specifications, equipment manufacturers'
alterations, additions, and changes, including energy audits and retrofits data sheets, and operational criteria. Because all building systems
for energy conservation. are integrated and validated during commissioning, the owner can
expect the commissioning process to improve occupant comfort,
A 1.4-5 Commissioning. Commissioning is aquality control
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
1.4-5.1.1 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
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.
---_._-_.--_ _.._----_._----_.
1.4-5.1.2 Preparation of the Basis of Design (BOD) 1.4-5.1.3.1 Commissioning plan. This document
In response to the OPR, the design team shall prepare shall establish the scope, structure, and schedule of the
a BOD narrative describing the design intent and commissioning activities and address how the commis
systems to be commissioned. The BOD narrative shall sioning process will verify that the OPR and BOD are
include, at minimum, the following elements: achieved.
1.4-5.1.2.1 Description of the systems, components, 1.4-5.1.3.2 Commissioning specifications. These

and methods used to meet the OPR specifications shall establish requirements for physi
cal environment elements to be included in the
1.4-5.1.2.2 Levels of redundancy planned project scope and identify responsibilities related to
commissioning.
1.4-5.1.2.3 Limitations and restrictions of systems and
assemblies assumed *1.4-5.1.3.3 Construction checklists. These docu
ments shall establish inspections and individual
1.4-5.1.2.4 Indoor and outdoor conditions assumed component tests that will be used to verify proper
(e.g., space temperature, relative humidity, lighting functioning of physical environment elements that
power density, glazing fraction, V-value and shading have been installed or modified.
coefficient, wall and ceiling R-values, ventilation and
infiltration rates, etc.). *1.4-5.1.4 Performance of Functional/Operational
Tests
1.4-5.1.2.5 Description of emergency operation Testing of the dynamic function and operation of the
intended. See Table 1.2-1 (Resident Safety Risk Assess physical environment elements under full operation
ment Components) for additional information. shall be performed. Elements shall be tested in vari
ous modes included in the OPR and run through all
1.4-5.1.3 Preparation of Commissioning Plan, sequences of operation.
Commissioning Specifications, and Construction
Checklists
APPENDIX
A1.4-5.1.3.3 Construction checklists. The commission (direct observation) or monitoring methods. (For example, the chiller
ing agent proVides subcontractors with a list of items to inspect and pump is tested interactively with the chiller functions to see if the pump
elementary component tests to conduct to verify proper installation of ramps up and down to maintain the differential pressure setpoint.)
equipment. Items on construction checklists are primarily static inspec Systems are tested in various modes, such as during low cooling or
tions and procedures to prepare the equipment or system for initial heating loads, component failures, unoccupied conditions, varying
operation (e.g., checking belt tension, oil levels, labeling, installation of outside air temperatures, fire alarm activation, and power failure. The
gauges, calibration of sensors, etc.). However, some construction check systems are run through all the control system's sequences of operation,
list items entail simple testing of the function of acomponent, piece of and the responses of components are verified to make sure they match
equipment, or system (e.g., measuring the voltage imbalance of athree what the sequences state.
phase pump motor in achiller system). Construction checklists augment Traditional air or water testing and balancing (TAB) is not functional
and are combined with the manufacturer's start-up checklist. Even with testing. The primary purpose ofTAB is to set up the system flows and
out acommissioning process, contractors typically perform some, if not pressures as specified. Functional testing, on the other hand, is used to
all, of the construction checklist items on their own. The commissioning verify the performance of that which has already been set up.
agent requires documentation of procedures in writing and does not The commissioning agent develops the functional test procedures
necessarily witness much of the construction checklist testing, except for in asequential written form, then coordinates, oversees, and docu
testing of larger or more critical pieces or where desired by the owner. ments the actual testing, which is usually performed by the installing
contractor or vendor. Functional tests are performed after items on the
A1.4-5.1.4 Functional performance tests. Functional
construction checklists and start-up procedures are complete.
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
1.4-5.1.5 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
·s Equipment
• *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
1.5 EQUIPMENT
1.5-1.3.2.1 Design development documents. Equip • *1.5-2 Equipment Classification

ment that is not included in the construction contract
but requires mechanical or electrical service connec Equipment to be used in projects shall be classified as
tions or construction modifications shall be identified building service equipment, fixed equipment, or mov
on the design development documents to facilitate able equipment.
coordination with the architectural, mechanical, and
electrical phases of construction.
• 1.5-3 Equipment Requirements
1.5-1.3.2.2 Construction documents. All equipment
shall be identified in the construction documents as *1.5-3.1 Major Technical Equipment
owner-provided or not-in-contract for purposes of Location and installation of major technical equip
coordination. ment that affects the overall operation and occupancy
of a residential health, care, or support facility shall
1.5-1.3.3 Final Equipment Selections be documented to facilitate coordination between the
care provider, building designer, installer, construction
1.5-1.3.3.1 Adjustments shall be made to the contractors, and other members of the project team.
construction documents to accommodate final
selections for NIC equipment during shop drawing 1.5-3.2 Electronic Equipment
and submittal review.
1.5-3.2.1 Protection
1.5-1.3.3.2 When final selections are made, the

Surge protection shall be provided to protect comput
construction documents shall be revised to show the

erized equipment from power surges and spikes that
equipment placed in service.

might damage the equipment or software programs.
APPENDIX
A1.5-2 Equipment classification floor space or electrical and/or mechanical connections but are
a. Building service equipment. Building service equipment includes portable, such as wheeled carts or beds, office-type furnishings,
items such as heating, ventilation, and air-conditioning equipment; and diagnostic or monitoring equipment. Movable equipment may
electrical power distribution equipment; emergency power genera require special structural design or access, mechanical and electrical
tion equipment; energy/utility management systems; conveying connections, or other considerations.
systems; security systems and devices; and other eqUipment with a -Movable medical equipment. This includes items such as por
primary function of building service (e.g., humidification equipment, table X-ray, electroencephalogram (EEG), and electrocardiogram
filtration equipment, chillers, boilers, fire pumps, etc.). (EKG) eqUipment; dialysis machines; treadmill and exercise
b. Fixed equipment. Fixed equipment includes items that are perma equipment; examination and treatment tables; dental chairs;
nently affixed to the building or permanently connected to aservice and similar equipment.
distribution system that is designed and installed for the specific use -Movable nonmedical equipment. This includes personal com
of the equipment. Fixed equipment may require special structural puter stations, printers, copiers, resident room, furnishings, food
designs, mechanical and electrical proVisions, or other consider service carts, distribution carts, and other portable equipment.
ations.
A1.5-3.1 Major technical equipment
-Fixed medical equipment. This includes items such as com
a. Major technical eqUipment includes specialized equipment (medical
munication systems, built-in casework for equipment, imaging
or nonmedical) that is customarily installed by the manufacturer
equipment, and ceiling-mounted mechanical resident lifting
or vendor. Examples of major technical equipment are food service
devices.
equipment, laundry eqUipment, servers, communication systems,
-Fixed nonmedical equipment. This includes items such as
elevators, computers, and similar items.
walk-in refrigerators, kitchen cooking equipment, serving lines,
b. Major technical equipment may require special structural designs,
conveyors, computer servers, and laundry equipment.

mechanical and electrical provisions, clearances, or other consider
c. Movable eqUipment. Movable equipment includes items that require

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

*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.
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

arrangements such as carpooling or shuttle buses
*2.1-3.1 Roads
Access roads to entrances and service areas shall be 2.1-3.4 Signage and Wayfinding
provided on the property as applicable to the care
Wayfinding shall be provided to direct people
population and facility/setting type. unfamiliar with the facility to parking areas and
entrances. See Section 1.2-4.5.3 (Signage and
2.1-3.2 Pedestrian Walkways Wayfinding) and Section 2.4-2.2.12 (Signage and
Wayfinding) for additional requirements.
*2.1-3.2.1 Accessible paved walkways shall be provided
for pedestrian traffic. *2.1-3.5 Site Lighting
Site lighting shall be provided on roads, parking lots,
2.1-3.2.2 Aligned curb cuts shall be provided for
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 to prOVide multiple lighting levels or to designate night parking
should be considered. closer to the bUilding.
c. lighting design for the site, roadway, and parking lots should control
A2.1-3.2.1 Walkways. To avoid vehicular and pedestrian
glare.
conflict, walkways should be kept separate from driveways and
pedestrian crossings should be provided at intersections rather than A2.1-3.6.1 Landscape features
mid-block. 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
2.1 SITE ElEMENTS
See Section 1.2-4.5.1 (Light) and Section 1.2-4.5.2 Gardens and outdoor activity spaces shall be located to
(Views of and Access to Nature) for additional receive direct sunlight at some time during the day.
requirements.
2.1-3.6.3 Outdoor Water Features
*2.1-3.6.2 Outdoor Activity Spaces
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.
2.1 SITE ELEMENTS
2.1-3.6.3.1 Where provided, open outdoor water 2.1-4.2 See Section 2.2-2.1 (Sustainable Site Design)
features shall be designed to support maintenance of for building orientation requirements.
safe water quality to protect the public from infectious
or irritating aerosols.
• *2.1-5 Environmental Pollution
2.1-3.6.3.2 Where provided for facilities that serve Control
special care populations, outdoor water features shall
be designed with the care population in mind to pro The design, construction, renovation, expansion,
vide safe and accessible environments. equipment, and operation of residential health, care,
and support facilities shall meet the provisions of
applicable government environmental pollution con
• 2.1-4 Building Orientation rrollaws and associated agency regulations. See Section
2.2-2.6 (Emissions, Effluents, and Pollution Control)
2.1-4.1 See Section 1.2-2.2.2.2 (l)(a) (Site-Building for additional information.
orientation) for planning requirements.
APPENDIX
A2.1-5 Environmental Pollution Control includes a meeting to which members of the interested public
a. Design, construction, renovation, expansion, equipment review, and are invited to express their concerns. The EIS and/or HRA should
operational review of residential health, care, and support facilities be prepared in accordance with afinal protocol approved by the
are all subject to provisions of several federal environmental pollu appropriate agency or agencies.
tion control laws and associated agency regulations. -Protocol document. Once the EIS and/or HRA scope has been
b. Many states have enacted statutes and regulations that are sub established, a protocol document should be prepared for agency
stantially equivalent to or more stringent than federal regulations, approval. The protocol document should describe the scope and
thereby implementing national priorities under local jurisdiction and procedures to be used to conduct the assessment(s). Approval
addressing local priorities (e.g., underground storage tanks; hazard is most likely to be obtained in atimely manner and with mini
ous materials and waste storage, handling, and disposal; storm mum revisions if standard methods are initially proposed for use
water control; medical waste storage and disposal; lead and asbestos in the EIS and/or HRA. Standard methods suitable for specific
in bUilding materials). assessment tasks are set forth in EPA documents.
c. Consult the appropriate U.S. Department of Health and Human d. Mercuryelimination. Residential health, care, and support
Services (DHHS) and U.S. Environmental Protection Agency (EPA) facilities should collect and properly store, recycle, or dispose of
regional offices and any other federal, state, or local AHJs for the mercury encountered during construction or demolition (such
latest applicable state and local regulations pertaining to envi as mercury accumulated in P-traps, air-handling units, sumps,
ronmental pollution that may affect the design, construction, or etc.).
operation of the residential health, care, or support facility, including -Residential health, care, and support facility projects should
management of industrial chemicals, pharmaceuticals, and wastes comply with local codes and standards for mercury reduction
from the facility, as well as trash, noise, and traffic (including air and elimination.
traffic). -In new construction, residential health, care, and support facili
-Permits. Residential health, care, and support facilities regu ties should not use mercury-containing equipment, including
lated under federal, state, and local environmental pollution thermostats, switching devices, and other bUilding system
laws may be required to support permit applications with sources.
appropriate documentation of proposed impacts and mitiga -For renovation, residential health, care, and support facilities
tions. should develop a plan to phase out mercury-containing sources
-Environmental impact statement/health risk assessment. and upgrade current mercury-containing lamps to low or no
Impact and mitigation documentation is typically reported in an mercury lamp technology.
environmental impact statement (EIS) with respect to potential e. Release of toxic substances from equipment. Equipment should
effects on the environment and in a health risk assessment minimize the release of chlorofluorocarbons (CFCs) and any
(HRA) with respect to potential impacts on public health. The potentially toxic substances that may be used in their place (e.g.,
HRA may constitute a part or an appendix of the EIS. The scope the design of air-conditioning systems should specify CFC alter
ofthe EIS and the HRA is typically determined in consultation natives and recovery systems).
with appropriate regulatory agency personnel and, if required,
58 Guidelines for Design and Construction of Residential Health, Care. and Support Facilities
• Design Criteria
• 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

site and building orientation shall be evaluated
*2.2-2.1.1 Environmental Impacts for potential solar and wind energy feasibility and
The site design shall be developed to minimize negative subsequent installations.
environmental impacts associated with buildings and
related site development. 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.
2.2 DESIGN CRITERIA
See appendix section A1.2-2.2.2.2 (l)(a) (Building 2.2-2.2.1.1 Energy efficiency goals shall be considered
orientation) for more information about building in all phases of facility development or renovation.
orientation and related site issues. Architectural elements that reduce energy consump
tion shall be considered as part of facility design.
2.2-2.1.3.3 The location of the building shall be evalu
ated according to the impact of site exterior noise, 2.2-2.2.1.2 The quality of the health care facility
acoustics, and the care population. See Section environment shall be supportive of the occupants
1.2-5.2 (Acoustic Planning) and Section 2.5-8 (Acous and the function served. Therefore, design for energy
tic Design Systems) for additional requirements. efficiency shall enhance, not adversely affect, resident
health, safety, and accepted personal comfort levels.
*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 2.2-2.2.2.1 Mechanical and electrical systems shall be

selected and sized to meet loads, minimize space use,
2.2-2.2.1 General and take advantage of climate characteristics, daylight
ing opportunities, and building orientation to reduce
overall energy demand and consumption.
. APPENDIX
A2.2-2.1.3.4 Irrigation of landscape areas -Design to meet International Green Construction Code (IgCC)
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 opportunities.
ing to the needs of different plant materials, such as turf grass vs. -Reduce overall energy demand. Sample strategies for this
shrubs. Landscaping sprinklers should be installed to prevent water purpose include using a high-efficiency building envelope;
spray either on or within 3feet (91.44 centimeters) of a bUilding. passive and low-energy sources of lighting (including
c. Irrigation systems serving the project site should be controlled by a daylighting); advanced lighting controls integrated with
smart controller that uses weather data to adjust irrigation schedules daylighting strategies; heat recovery and natural ventilation;
or an on-site rain or moisture sensor that automatically shuts the and high-efficiency equipment, as part of building mechanical
system off after a predetermined amount of rainfall or sensed mois and electrical systems (e.g., chillers and air handlers) and for
ture in the soil. plug loads (e.g., ENERGY STAR copiers, computers, medical
d. Atemporary irrigation system used exclusively for new landscape equipment, appliances).
establishment should be used no longer than necessary for successful -Optimize energy efficiency. Mechanical and electrical control
landscape establishment. systems should optimize consumption to the minimum actual
needs for the bUilding. Consider using multiple modular HVAC
A2.2-2.2 Energy efficiency. Health care facilities should set
equipment units or variable-speed drives for variable loads. Con

energy efficiency goals and consider energy efficiency strategies while
sider co-generation systems for converting natural gas to heat

making sure to meet the light power density and functional needs of
ing (or cooling) and electricity. Select equipment with improved

residents and staff.
energy efficiency ratings.

a. Sample energy efficiency goals -Reduce environmental impacts associated with combustion of
-Apply ASHRAE 90.1: Energy Standard for Buildings Except Low fossil fuels and refrigerant selection. Consider various renew
Rise Residential BUildings. able sources of energy generation, including purchase of green
-Apply ANSI/ASHRAE/ASHE Standard 189.3: Design, Construc power, solar and wind energy, or geothermal ground source
tion, and Operation ofSustainable High-Performance Health Care heat pumps.
Facilities.
A2.2-2.2.2 For information on lighting, lighting levels, and auto
-Design to earn ENERGY STAR rating.

mated lighting controls, see Section 2.5-7 (Daylighting and Artificial
-Design to meet LEED, Green Globes, or other green building

Lighting Systems).
rating system energy criteria.
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- or zero-VQC (volatile organic <ompound) finishes and furnish
low-<onsumption plumbing fixtures and controls, low-consumption ings, reduced moisture entrapment, daylighting, and acoustic design
irrigation systems, and landscape design such as xeriscaping as well as measures. Such measures should not conflict with health care safety
replacing items such as water-cooled pumps and <om pressors that use and infection control codes, standards, and requirements.
.potable water sources with non,evaporative heat rejection equipment b. Carpeting, uphoistery, paint, adhesives, and manufactured wO.od
(aiN:ooled or ground source) or equipment that uses non-potable water products may emit volatile organic compounds, such as formalde
sources. hyde and benzene. Use low- or zero-VQC paints, stains, adhesives,
sealants, and other construction materials, where practical, for
A2.2-2.3.2 Water measurement devices. Measurement
building products.
devices with remote communication capability should be provided to
c. Materials or construction systems that are permeable and can trap
<olIect water consumption data for the domestic water supply to the
moisture may promote microbial growth. All permeable building
building. In addition, for individual leased, rented, or other tenant or
materials shouJdbe protected from exposure to moisture priorto and
sub-tenant space in any building totaling more than 50,000 square
during construction. If permeable materials are exposed to moisture,
feet (4,645 square meters), separate sub-meters should be provided for
they should be dried within 72 hours or removed.
potable and reclaimed water used in the building project. For subsys
d. High-volume photocopiers and aerosolized. cleaners and medications
tems with multiple similar units, such as multi-cell cooling towers, only
have'been identified as sources. of indoor airpollution. Dedicated
one measurement device is required for the subsystem. Utility company
exhaust ventilation may be necessary for specialty areas where these
service entrance/interval meters should be permitted for use in comply
pollutants may accumulate orbe disbursed (e.g., housekeeping,
ing with this requirement.
maintenance, and copy rooms and hair salons).
A2.2-2.3.4 Water recovery options. Where potable water is
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.
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.
2.2 DESIGN CRITERIA
2.2-2.4.1.2 Ventilation (1) Omission of mats shall be permitted at secondary

(1) For minimum ventilation requirements, see Section entrances or entrances with minimal pedestrian
2.5-3 (Heating, Ventilation, and Air-Conditioning traffic.
Systems) and facility chapters in Parts 3 through 5. (2) No surface shall be used that impedes resident
(2) For filtration and air cleaner requirements, see ambulation or contributes to fall risks.
Section 2.5-3 (Heating, Ventilation, and Air *(3) Mat size. Each surface shall have a minimum width
Conditioning Systems) and facility chapters in equivalent to the width of the entry opening.
Parts 3 through 5.
2.2-2.4.2 Acoustic Control
2.2-2.4.1.3 Building entry mats. Building entrances, See Section 1.2-5.2 (Acoustic Planning) and Section
except entrances to individual dwelling units and service 2.5-8 (Acoustic Design Systems) for requirements.
areas, shall employ an entry mat or entry mat system to

reduce particulate in the indoor environment. *2.2-2.5 Materials and Resources
This section includes requirements for the selection
and management of materials and resources, including
insulation, acoustic ceiling panels, tackable wall panels, gypsum wall the presence ofabarrier (e.g., acounter, partition, wall) or local regula
board and panels, and wall-coverings. tions prohibiting the use ofscraper surfaces outside the entry. In this
-Emissions for these products should be determined accord ease, entry mat surfaces shall have aminimum length of3feet (l meter)
ing to limit requirements in California Department of Public of indoor surface, with aminimum combined length of6 feet (2 meters).
Health StandardMethod for the Testing and Evaluation ofVolatile
A2.2-2.S Use of reduced~impactmaterials. Described
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.

building assemblies and interior fit-outs.
-Multiple-attribute standards with third-party certification,

a. Consider the whole building life cycle. Aminimum of two different
inclusive of indoor air quality:

building designs should be evaluated using ASTM E2921: Standard
• ANSI A138.1: Green SquaredSpecifications for Sustainable

Practice for Minimum Criteria for Comparing Whole Building Life Cycle
Ceramic Tiles, Glass Tiles, and Tile Installation Materials

Assessments for Use with Building Codes and Rating Systems and the
• GS-11: Paints, Coatings, Stains, and sealers

follOWing criteria:
• GS-36: Adhesives for Commercial Use

-Global warming potential
• NSFI ANSI 342: Sustainability Assessment for Wallcoverings
-Acidification potential
• UL 100: Standard for Sustainability for Gypsum Boards and
-Eutrophication potential
Panels
-Ozone depletion potential
• UL 102: Standard for Sustalnability forDoar Leafs
-Smog potential
f. Furniture
The goal is to select a proposed final building design with lower
-Emissions for these products should be determined accord
anticipated environmental impact. Assemblies and the building
ing to limit reqUirements in California Department of Public
envelope should be part of the project design.
Health StandardMethod for the Testing and Evaluation of Volatile
Life cycle assessment tools such as the following can be used
Organic Chemical Emissions from Indoor Sources Using Environ
to evaluate comparable building designs during the conceptual
mental Chambers, version 1.2.
design phase:
-Office furniture installed prior to occupancy should be tested
-Athena Impact Estimator for Buildings (caleulatelea.com/soft
according to ANSI/BIFMA M7.1: Standard Test Method for Deter
ware/impact-estimatorI)
mining VOC Emissions from Office Furniture Systems, Components,
-GaBi Software Building LCA (www.gabi-software.com/america/
and Seating and should not exceed the limit requirements in
solutions/building-Iea/)
Section 7.6 of ANSI/BIFMA e3: Furniture SustainabiJity Standard.
-SimaPro Sustainability Life Cycle Assessment Carbon Footprint
-Resident room furniture andseating installed prior to occupancy
ing (www.simapro.co.uk)
should be tested according to ANSI/BFMA Ml.l.
-Tally (choosetally.coml)
A2.2-2.4.1.3 (3) Building entry mat length b. Reuse portions of an existing building, if possible and applicable.
a. The minimum length should be measured inthe primary direction of c. Incorporate reused, refurbished, and/or off-site salvaged materials or
travel. furnishings into a project in place of new materials.
b. Length ofentry mat surfaces should be permitted to be reduced due to
2.2 DESIGN CRITERIA
construction waste management and for storage and dedicated to the collection and storage of non-hazard
collection of recyclables. It also includes recommen ous materials for recycling, including paper, corrugated
dations for the use of reduced impact materials in cardboard, glass, plastics, and metals.
construction projects in appendix section A2.2-2.5.
See Section 2.4-2 (Architectural Details, Surfaces, and 2.2-2.5.1.2 Fluorescent and high-intensity discharge
Furnishings) for requirements in addition to those in (HID) lamps and ballasts.
this section. (1) An area shall be provided for the collection and
storage of fluorescent and HID lamps and ballasts.
*2.2-2.5.1 Storage and Collection of Recyclables (2) Accessibility of the area shall facilitate proper
and Discarded Goods disposal and recycling according to state and local
*2.2-2.5.1.1 Recydables. For new building projects, hazardous waste requirements.
there shall be areas serving the entire building that are
d. Evaluate the material content of products used in abUilding based -Select products with an environmental product declaration
on performance criteria and building service life. (EPD) or product life cycle assessment (LCA):
-Use a multiple-attribute approach by basing product selection • Third-party verified Type III Environmental Product Declara
on standards and certifications such as those listed here: tion (EPD) according to ISO 21930: Sustainability in buildings
• ANSI A138.1: Green Squared - American National Standard and civil engineering works, which includes, at minimum, a
Specifications for Sustainable Ceramic Tiles, Glass Tiles, and aadle-to-gate scope
Tile Installation Materials Third-party verified product life cycle assessment based on
• ANSI/BIFMA e3: Furniture Sustainability Standard ISO Standards 14040: Environmental management-Life
• BI FMA LEVEl, the sustainability certification program for cycle assessment-Principles and framework and 14044:
furniture Environmental management-Life cycle assessment
NSC 373: Sustainable Production ofNatural Dimension Stone Requirements and gUidelines
• NSF 140: Sustainability Assessment for Carpet
A2.2-2.S.1 Storage and collection of recyclables
NSF 332: Sustainability Assessment for Resilient Floor Cover
and discarded goods
ings
a. Building service life pIon. Abuilding service life plan should be
NSF 336: Sustainability Assessment for Commercial Furnish
created that-estimates the service life of the bUilding's structural
ings Fabric
system, building sy~ems, bUilding envelope, interior fit-out, and
• NSF 342: Sustainability Assessment for Wallcovering Products
hardscape materials. See appendix section A2.2-2.5 (Use of reduced
NSF 347: Sustainability Assessment for Single Ply Roofing
impact materials) for additional information.
Membranes
b. Construction waste management plan. During the project planning
• UL 100: Standard for Sustainability for Gypsum Boards and
phase, awaste management plan should be established before
Panels
demolition or construction begins. At completion of construction, a
UL 102: Standard for Sustainability for Swinging Door Leafs
final waste management report should be completed that identifies
-Use third-party certification such as sustainable forestry certifi
all waste and recycling/reuse materials.
cation systems:
American Tree Farm System, ATFS Standards for Sustainabil A2.2-2.S.1.1 Recyclables
ity for Forest Certification a. For renovation projects, space should be evaluated for inclusion of
• CAN/CSA- Z809: Sustainable Forest Management: Require designated recycling areas, both for the area being renovated and for
ments and Guidance overall collection points.
Forest Stewardship Council Standard FSC-STO-Ol-00l (V4 b. For both renovation and new construction projects, space should be
0): FSC Principles and Criteria for Forest Stewardship provided for recycling containers at point of use (e.g., offices, copy
• Programme for the Endorsement of Forest Certification areas, food service areas, etc.).
national standards c. The size and functionality of recycling areas should be coordinated
• Sustainable Forestry Initiative 2010-2014 Standard with anticipated collection services to maximize the effectiveness of
the dedicated areas.
2.2 DESIGN CRITERIA
(*2.2-2.6 Emissions, Effluents, and Pollution reduction of greenhouse gas emissions (primarily
Control carbon dioxide) shall be considered in building design
and selection of mechanical equipment.
This section gives requirements and recommendations
for emissions, effluents, and pollution control, includ
2.2-2.6.2 Effluents
ing refrigerants, boilers, emergency backup generators,
effluent flows, and waste streams. *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
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
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 a. These facilities are designed for the particular needs and behaviors
of size should be interspersed with more traditional furnishings of residents with dementia, mental health diagnoses, and cognitive
to avoid confining persons of size to specific areas of the waiting and developmental disabilities. They are secured where required to
environment. be so in the functional program.
-Community spaces. living rooms, dining rooms, activity rooms, b. Design recommendations for these facilities include the follOWing:
and similar interior spaces as well as exterior gardens and simi -A key architectural objective should be to minimize the institu
lar outdoor spaces should be sized to accommodate the number tional aspects of care and create aliving environment for resi
of persons ofsize-residents or participants-expected as dents with furniture, furnishings, and fixtures that are appropri
identified during the planning phase. ate from asafety standpoint and are residential in appearance.
2.2 DESIGN CRITERIA
2.2-4.1.1 The facility shall be designed to facilitate the *2.2-4.2.1 Safety and Security Systems
highest level of functioning for all residents. Resident security shall be provided through systems
that secure the resident unit and comply with life
2.2-4.1.2 The resident living environment shall be safety codes.
equipped with special features (e.g., personalized resi
dent bedrooms, features that support resident orienta 2.2-4.2.1.1 The resident care model shall be the basis
tion to the surroundings, secured storage, safe outdoor for the type of security system used, whether it is
areas, and security considerations) to support individu operationally and/or physically based.
als with varying levels of cognitive impairment.
2.2-4.2.1.2 If the functional program requires limiting
2.2-4.2 Physical Environment Elements for Risk the movements of any resident(s) for their safety, all
Reduction door locking arrangements shall be in full compliance
Consistent with an individual facility's functional with applicable requirements ofNFPA 101: Life Safety
program, the design concepts and architectural details Code.
described in this section, which are intended to address
safety risks to residents and staff in care settings for 2.2-4.2.1.3 Areas to be secured shall be based on the
residents with dementia, mental health diagnoses, and needs of the care population and shall be permitted to
cognitive and developmental disabilities, shall be inte include, bathing, soiled utility, service areas, storage
grated into the project to reduce those risks. and staff work areas.
-Proper planning and design should elevate the spirit and sensi a. The number of entrances and exits from residential areas should be
bilities of both residents and care providers. kept to a minimum.
-A sense of community with a respect for privacy should be b. Secure therapeutic outdoor areas, using security measures that are
encouraged. as non~institutional as possible, should be provided.
-Facilities should prOVide a healing environment that stimulates c. Electronic door controls, including delayed egress, should be used for
mind and body for people with dementia, mental health diag emergency egress where allowed by code.
noses, and cognitive and developmental disabilities. d. Circulation patterns should be simple and without blind spots.
-Features that are included to prOVide resident safety and e. Means of casual observation of resident liVing areas should be pro
security should be unobtrusive and integrated in a manner that vided from staff offices and work areas.
supports this concept. f. Locks on wardrobes, closets, or cupboards should be inconspicuous.

c. Resources regarding design for this population include the following: g. Asecure vestibule with a pair of locked doors should be provided at
-Dementia Design Info database (School of Architecture & the entrance as needed to minimize resident elopement.
Urban Planning, University of Wisconsin-Milwaukee in partner h. Protective film should be added to the interior face of laminated
ship with I.D.E.A.S., Inc., and Polisher Research Institute). This glaZing panels to inhibit access to glass shards if the glass is dam
resource provides information on space design, user needs, and aged.
levels of scale for site, bUilding, room/space, details, finishes, i. Entry, exit, or service doors may be disgUised, ptovided all ofthe
FF&E, and experiential ambience, decor, and aesthetics. following are met:
-Behavioral Health Design Guide (Facility Guidelines Institute) • Staff can readily unlock the door at all times.
-Mental Health Facilities Design Guide (Department of Veterans • The door-releasing hardware, where provided, is readily
Affairs, Office of Construction &Facilities Management) accessible for staff use.
-Patient Safety Standards, Materials and Systems Guidelines (New • Where door leaves, windows, and door hardware, other
York State Office of Mental Health) than door-releasing hardw;are, are covered by a mural, the
-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
training.
A2.2-4.2.1 Elopement prevention. Where elopement is a
j. Locating exit doors outside of direct resident line of sight may also
concern, the follOWing should be considered:

be effective.
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
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.
*2.2-4.4 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 Backlighting visual cues can help individuals with aging eyes and
a. Support areas for staff. Due to the level of staff stress in caring for low vision notice cues.
residents with cognitive impairment and in working with family h. Night-lights with warm correlated color temperature sources (amber
caregivers, places of respite and staff break areas that include access or red) at avery low light level should be used for the path between
to views, secured storage for personal items, and food preparation the sleeping area and the bathroom. Based on resident/s needs and
areas should be provided. preferences, controlling night-lights with motion sensors should be
b. Support areas for residents. Due to the need for private time with a considered.
spouse or other family member, resident area(s) that includes pri
A2.2-4.3.3 Family area. Aprivate room for residents and fami
vacy with aloved one should be provided.
lies should be proVided.
A2.2-4.3.2.2 Special design elements for dementia
A2.2-4.3.3.2 Dining areas
resident rooms
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.
2.3 Design Elements
• 2.3-1 General 2.3-2.2.2 Reserved
2.3-2.2.3 Special Care Resident Rooms

2.3-1.1 Application
See facility chapters in Parts 3 and 4 for requirements
for airborne infection isolation rooms and ventilator
most types of residential health, care, and support
dependent resident rooms, and other special care
facili ties.
resident room types and facility chapters in Part 5
for requirements for quiet rooms in non-residential
2.3-1 .1.1 The common elements in this chapter
support facilities.
are required only where referenced in the facility
2.3-2.2.3.1 - 2.3-2.2.3.2 Reserved
4 (Residential Care and Support Facilities), and Part 5
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
in the facility chapters in Parts 3, 4, and 5.
encing issues such as personal conflicts, agitation, epi
sodic mental disturbances, or similar conditions that
• 2.3-2 Resident, Participant, and
require a quiet or low-stimulation, positive distraction
room, the following requirements shall be met:
Outpatient Areas
(1) Capacity. Each quiet room shall contain only one

2.3-2.1 General bed.
(2) Space requirements
The requirements for resident carelliving areas
(units), community areas, and associated support (a) Based on the care population, the quiet room
areas included in this section are common to most shall be sized to accommodate the equipment,
residential health, care, and support facilities. For special furnishings, or positive distractions
requirements specific to a facility type, see the facility provided.
chapters in Parts 3 through 5. (b) The level of cognitive ability of the care
population shall be identified during the
*2.3-2.2 Resident Care/Living Area (Unit) functional programming process. See Section
2.2-4 (Design Criteria for Dementia, Mental
2.3-2.2.1 General Health, and Cognitive and Developmental
See facility chapters in Parts 3 and 4 for requirements Disability Facilities) for additional
for resident care/living areas (units). requirements.
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.
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 provided, it shall be located close to the entry for
(iii) Mirror. For requirements, see Section deliveries and centralized for resident access.
2.4-2.2.8.7 (Mirror).
2.3-2.3.2.5 Public notice area. Areas for posting
(b) The toilet room shall not be shared with required notices, documents, and other written
another resident room. materials shall be provided in public locations visible
to and accessible to residents, staff, and visitors.
(4) Acoustic requirements. See Section 2.5-8.3 (Design
Criteria for Acoustic Finishes), Section 2.5-8.4 2.3-2.3.2.6 Public toilet room. A toilet room(s) shall
(Design Criteria for Room Noise Levels), and be located close to the lobby.
Section 2.5-8.5 (Design Criteria for Performance
ofInterior Wall and Floor/Ceiling Constructions) 2.3-2.3.3 Dining, Recreation, and Lounge Areas
for requirements.
2.3-2.3.3.1 General. The space needed for dining,
recreation, and activities shall be determined by the
*2.3-2.3 Resident, Participant, and Outpatient
following considerations:
Community Areas
(1) The extent to which users need adaptive equipment
*2.3-2.3.1 General and mobility aids and assistance from support and
service staff
For new construction and renovation, community
(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
(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,
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.
2.3 DESIGN ELEMENTS
(7) Access to self-dispensing drinking water and ice Health, and Cognitive and Developmental
Disability Facilities) for additional information.
(a) Ice for resident consumption shall be provided
by ice-making equipment.
2.3-2.3.7.3 Toilet room
*(b) Ice-making equipment shall be located,
designed, and installed to minimize noise. (1) A toilet room shall be adjacent to the quiet room.
(c) Ice-making equipment shall be permitted to (2) This toilet room shall be permitted to be shared by
serve more than one food area in resident and residents using other activity spaces.
participant kitchen facilities.
(8) A hand-washing station. This shall be located
in or immediately accessible to the resident and 2.3-2.3.8.1 See the following Guidelines sections for
participant kitchen facilities. requirements:
(1) Section 1.2-4.5.1 (Light)
2.3-2.3.5 Personal Services (Hair Salon/Spa) Areas
(2) Section 1.2-4.5.2 (Views of and Access to Nature)
See the facility chapters in Parts 3 through 5 for (3) Section 2.1-3.6.2 (Outdoor Activity Spaces)
requirements.
2.3-2.3.8.2 For additional requirements for residents
2.3-2.3.6 Family Room with dementia, mental health issues, and cognitive
Where a family room is included in a project, see facil and developmental disabilities, see Section 2.2-4.3.5
ity chapters in Parts 3 through 5 for requirements. (Outdoor Activity Spaces).
*2.3-2.3.7 Quiet Room in a Resident or Participant

Community Area • 2.3-3 Diagnostic and Treatment
Areas
2.3-2.3.7.1 Where a quiet room is provided for
residents experiencing personal conflicts, agitation, 2.3-3.1 General
episodic mental disturbances, or similar conditions
that require a quiet, multi-sensory, low-stimulation, 2.3-3.1.1 Application
positive distraction room, the following requirements Where clinical and support areas described in this sec
shall be met: tion are provided, the requirements in this section shall
be met. See the facility chapters in Parts 3 through 5
2.3-2.3.7.2 Space requirements for specific requirements.
(1) Based on the care population, the quiet room shall
be sized to accommodate the equipment, special 2.3-3.1.2 Community Access
furnishings, or positive distractions provided. Where examination, observation, or treatment rooms
(2) If the care population includes residents with in a clinical services area in a residential health, care,
dementia or other cognitive issues, see Section or support facility are used by patients from the
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, distractions is aSnoezelen room, acontrolled multi-sensory
consider locating the equipment in a room with adoor or separating environment. Time in such a room is atherapy for residents with
the compressor and dispenser so the compressor is not in the corridor. dementia, autism, developmental disabilities, or other agitated
In some settings, use of residential ice makers, which are quieter than conditions. Some facilities have also found that agitated or stressed staff
commercial ice makers, could be appropriate depending on the size and have benefited from h\lving aquiet room available.
nature of the care population being served. In quiet rooms where tne risk of self-injury is evident, opportunities
for self-harm should be eliminated by concealing protruding elements,
A2.3-2.3.7 Quiet room in a community area. An
using surfaces to which It would be difficult to attach items, and haVing
example of aquiet rOOm or"time out" room that includes positive
doors swing out So they cannot be barricaded from the inside.
-------------------------------------
2.3 DESIGN ELEMENTS
community at-large, dedicated circulation shall be 2.3-3.2.2.2 Clearances. Clearances shall be deter
provided for outside patients. mined based on the type of examination table, recliner,
or chair chosen for use. For further requirements based
2.3-3.2 Examination, Observation, and/or on an evaluation of patient or resident cognitive abil
Treatment Rooms ity, see Section 2.3-3.2.1.2 (Examination, Observation,
and/or Treatment Rooms-General).
2.3-3.2.1 General (1) Room arrangement shall permit a minimum
clearance of 3 feet (91.44 centimeters) at each side
2.3-3.2.1.1 An evaluation of specific examinations,
and at the foot of the examination table, recliner,
observations, and treatments to be provided in a facil
or chair.
ity shall be completed to determine if additional space
(2) Where an examination or treatment room is used
beyond that specified in Section 2.3-3.2.2 (Examina
for a population that includes persons of size,
tion and Treatment Room Space Requirements) is
clearances shall be evaluated based on the size of
required to accommodate the following:
the equipment and furniture to be used, including
(1) Needs of the care population (but not limited to) bariatric wheelchairs,
(2) Specialty equipment used examination table or bed, and resident seating.
(3) Transfers or other resident movement required in
the room *2.3-3.2.3 Resident, Participant, and Outpatient
Privacy
2.3-3.2.1.2 The type of examination table, recliner,
Provision shall be made to preserve resident, partici
or chair to be used shall be based on an evaluation of
pant, or outpatient privacy from observation from
operational requirements and an assessment of the cog
outside an examination or treatment room when the
nitive ability of the care population being served. See
door is open.
Section 1.2-2.2.1 (Owner's Project Requirements) and
Section 2.2-4 (Design Criteria for Dementia, Mental
2.3-3.2.4 Hand-Washing Station
Health, and Cognitive and Developmental Disability
Facilities) for requirements and recommendations. A hand-washing station shall be provided in accor
dance with Section 2.4-2.2.8 (Hand-Washing
2.3-3.2.1.3 Where an examination or treatment room Stations).
is used as an observation room, a toilet room shall be
immediately accessible. 2.3-3.2.5 Toilet Room
A toilet room shall be provided adjacent to or directly
2.3-3.2.2 Examination and Treatment Room accessible from the examination or treatment room.
Space Requirements
2.3-3.2.5.1 Space requirements. Toilet rooms shall
2.3-3.2.2.1 Area be sized and configured to accommodate accessibility
(1) Each examination or treatment room shall have a standards that support independent resident, partici
minimum clear floor area of 120 square feet (11.15 pant, or outpatient use.
square meters).
(2) Where an examination or treatment room is used 2.3-3.2.5.2 The toilet room shall contain the
for a population that includes persons of size, a following:
minimum clear floor area of210 square feet (19.51 (1) Toilet
square meters) shall be provided. (2) Hand-washing station
(3) Mirror. For requirements, see Section 2.4-2.2.8.7
(Mirror).
APPENDIX
A2.3-3.2.3 Resident, participant, and outpatient privacy. Visual privacy can be achieved with cubicle curtains blinds or other types
l l
of movable screens.
--_._._.... __. _ - - - - - - - - - - - - - - - - - - - - -_ _ _ - - - - - - - - - - - - - - - - -
... ...
2.3 DESIGN ELEMENTS
2.3-3.2.6 Documentation Area • 2.3-4 Facilities for Support Services

Accommodations for written or electronic documenta
tion shall be provided. 2.3-4.1 General
2.3-3.3 Well ness Center 2.3-4.1.1 Functional Requirements

Where wellness facilities are part of a residential health,
2.3-4.1.1.1 Identifiable spaces shall be provided
care, or support facility, see requirements in facility
for each operational function, but use of a space for
chapters in Part 3 (Residential Health Facilities) and
multiple purposes shall be permitted as long as the
Part 4 (Residential Care and Support Facilities) and in
space complies with the requirements for each purpose
Chapter 5.2 (Wellness Centers).
served.
2.3-3.4 Rehabilitation Therapy Facilities
2.3-4.1.1.2 Except where the word "room" or "office"
Where rehabilitation therapy facilities are part of a
is used, accommodation of support functions in a
residential health, care, or support facility, see require multipurpose area(s) shall be permitted.
ments in facility chapters in Part 3 (Residential Health
Facilities) and Part 4 (Residential Care and Support 2.3-4.1.2 Size
Facilities) and in Chapter 5.3 (Outpatient Rehabilita
The size of each support area shall depend on the
tion Therapy Facilities).
number and types of residents served.
2.3-3.5 Care Consultation Area

2.3-4.1.3 Location
2.3-3.5.1 General
2.3-4.1.3.1 Support areas for resident care shall be
Where care consultation is provided, the requirements located in or readily accessible to each resident unit.
in this section shall be met.
2.3-4.1.3.2 Arrangement and location of support areas
2.3-3.5.2 Space Requirements to serve more than one resident unit shall be permit
ted, but at least one such support area shall be located
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). 2.3-4.2 Facilities that Support Resident,
Participant, or Outpatient Care
2.3-3.5.2.2 Space for care of persons of size

(1) Where the care population includes persons of 2.3-4.2.1 Staff Work Area(s)
size, the consultation area shall be sized based on
equipment, furnishing, and maneuvering space [ *2.3-4.2.1.1 Resident carelliving areas (units), partici
requirements. pant activity areas, and outpatient rehabilitation areas
(2) Circulation from entry to exit of the facility shall shall have staff work areas in centralized or decentral
be evaluated for use by and care of persons of size. ized direct care locations.
APPENDIX
A2.3-4.2.1.1 Staff work areas to foster dose, open relationships between residents, participants,
a. Decentralized nursing models proximal to patient/resident rooms outpatients, and staff.
may improve staff efficiency, visibility, fall prevention, transfer rates, (. Confidential or noisy staffconversations should be accommodated in
and medical errors without being disruptive to residents. an enclosed staff lounge and/or .conference area.
b. Whether centralized or decentralized, staff work areas should be d. At least part of each staff work area should be low enough and open
designed to minimize the institutional character, command-station enough to permit easy conversations between staff and residents
appearance, and noise associated with traditional nurse stations and seated utilizing resident-operated mobility devices.
2.3 DESIGN ELEMENTS
2.3-4.2.1.2 See the facility chapters in Parts 3 through (d) Double-locked storage for controlled drugs
5 for additional requirements. *(e) Sharps containers, where sharps are used.
Where provided, these shall be placed in
2.3-4.2.2 Medication Distribution and Storage accordance with the OSHA Bloodborne
Locations (Centralized and Decentralized) Pathogen standard at 29 CFR 1910.1030(d)
(4) (iii) (A) (2) (i).
*2.3-4.2.2.1 General (f) Task-specific lighting levels as recommended in
(1) Provisions shall be made to support 24-hour
USP-NF <Chapter 1066>
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 2.3-4.2.2.3 Self-contained medication distribution
50 square feet (4.65 square meters) or meet the units, automated medication-dispensing stations,
requirements in the functional program. or mobile medication-dispensing carts. Where these
*(2) Each medication room shall include the following: or other systems approved by the AH] are used, the
following shall apply:
(a) A work counter sized to accommodate
functions for the facility type and care (1) Location of such units shall be permitted at the
population staff work area, in the clean utility room, in an
(b) Hand-washing station. See Section 2.4-2.2.8 alcove, or in a resident room as approved by the
(Hand-Washing Stations) for requirements. AH].
(c) Refrigerator for storage (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
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 2.3-4.2.5.3 Where the room is used for clean linen
care and services. Storage space(s) for equipment and and laundry, see Section 2.3-4.2.7 (Personal Laundry
supplies used by staff for resident, participant, and Facilities) for additional requirements.
outpatient care and services shall be immediately acces
sible to the areas where they are used. 2.3-4.2.5.4 Where the room is also used as a medi
(1) Sufficient storage space(s) shall be provided to keep cation room, see Section 2.3-4.2.2 (Medication
required corridor width free of equipment and Distribution and Storage Locations) for additional
supplies. requirements.
(2) Cabinets, closets, rooms, and alcoves shall be
permitted to provide storage.

2.3-4.2.6 Soiled Utility Room
Where a soiled utility room is provided, it shall meet
*2.3-4.2.4.2 Storage for mobility devices and support the following requirements:
equipment. Storage shall be provided for resident
operated mobility devices and personal support equip 2.3-4.2.6.1 Combining the soiled utility room with
ment that is: the soiled linen and laundry and/or environmental
(1) Sized to meet the needs of the functional program. services room shall be permitted for areas with small
(2) Located out of the way of traffic and circulation. 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.
._---------_._------
2.3 DESIGN ELEMENTS
(2) Hand-washing station shall be permitted where the airBow is from the
(3) Space for soiled linen receptacles washing/drying area to the soiled utility/holding
(4) Space for waste receptacles area.
(2) Combination of personal laundry facilities and
2.3-4.2.6.3 Where the room is used for soiled linen clean utility and clean linen storage shall be
and laundry, see Section 2.3-4.2.7 (Personal Laundry permitted.
Facilities) for additional requirements. *(3) Provision of accessible laundry equipment in a

resident activity room and/or therapy room shall
2.3-4.2.6.4 Where the room serves as an environ be permitted.
mental services room, see facility chapters in Parts 3
through 5 for additional requirements. *2.3-4.2.8 Resident and Participant Telephone
Access
2.3-4.2.7 Personal Laundry Facilities Provisions shall be made in or near each resident unit
Where decentralized personal laundry services are to allow residents to make and receive telephone calls
provided for washing and drying personal resident or in private.
participant laundry, the following requirements shall
be met: *2.3-4.2.9 Accommodations for Telemedicine
Services
2.3-4.2.7.1 Separate laundry facilities shall be pro Where telemedicine services are provided, provisions
vided for small groups of residents or participants. shall be made to support the practice of exchang
ing medical information between sites via electronic
2.3-4.2.7.2 A work counter for sorting and folding communications.
shall be provided.
2.3-4.3 Support Areas for Staff
2.3-4.2.7.3 Hand-washing stations shall be provided
in, adjacent to, or directly accessible from the laundry 2.3-4.3.1 General
room. Areas that support staff breaks and respite for
caregivers and administrative staff shall be provided.
2.3-4.2.7.4 Shared facilities

(1) Combination of personal laundry facilities and *2.3-4.3.2 Staff Lounge Area
soiled utility and soiled linen holding facilities
APPENDIX
A2.3-4.2.7.4 (3) loading, transferring, sorting, and folding laun duration of the visit in the room or area where services are offered.
'I dry are familiar activities that may be therapeutic for many residents.
A2.3-4.2.8 Telephone access. Use of technology is becom
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
ing increasingly prevalent in residential care facilities. Cable television,

help control glare from natural or artificial light sources.
high-speed Internet, and ready access to bedside telephones are just a

e. Access to technology should be prOVided.
few examples of the expected norm in resident rooms. Many residents
will expect access to the Internet to communicate with family and A2.3-4.3.2 Staff lounge area. Provision of the follOWing
friends. Provision of telephone/data connections or wi-fi access for each should be considered:
resident room 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
A2.3-4.2.9 Accommodations for telemedicine

information.
services. The follOWing should be considered where aspace is used

b. Furniture for relaxation and respite, especially in settings where staff
for telemedicine services:
are commonly scheduled to work extended and double shifts
a. The space should be designed to accommodate the service being
c. Anotification area to facilitate communication (e.g., human
provided.
resources notices, resident passing, etc.)
b. It should be possible to maintain visual and speech privacy for the
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) Food receiving, storage, and preparation areas shall
be located to support staff oversight of operations.
*2.3-4.3.2.3 Space for vending machines shall be pro
(3) Facilities shall be furnished to support provision of
vided based on facility and staff needs.
nourishment and snacks between scheduled meals.
See Section 2.3-2.3.4 (Resident and Participant
*2.3-4.3.3 Staff Toilet Room
Kitchen) for requirements.
Toilet room(s) shall contain toilets with hand-washing
stations for staff and shall be permitted to be unisex. *2.3-4.5.1.2 Layout. The equipment and design layout
shall provide a workBow that minimizes potential for
2.3-4.3.4 Staff Storage cross-contamination of clean food and wares with
Lockable storage shall be provided for safekeeping of contaminated trays from residents, participants, outpa
staff members' personal effects. 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

2.3-4.5.3 Functional Elements
(e.g., sleeping areas, feeding areas, waste areas, storage
for food and pet care supplies) shall be designated for Where food services are provided on-site, the following
them. 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.
2.3 DESIGN ELEMENTS
2.3-4.5.3.1 Control station for managing food provided to support assembly and distribution of resi
supplies dent meals. These shall be permitted to be centralized
or decentralized.
2.3-4.5.3.2 Hand-washing station(s) in rhe food
preparation area. See Section 2.4-2.2.8 (Hand-Wash 2.3-4.5.3.6 Warewashing space. Commercial-type
ing Stations) for requirements. warewashing equipment shall be provided.
(1) Depending on the care model, warewashing space
2.3-4.5.3.3 Food preparation facilities to accommo shall be provided in a room or an alcove separate
date the method of food preparation used from the food preparation and serving area.
(1) Where conventional food preparation systems are
(a) This shall be permitted to be centralized or
used, space and equipment shall be provided for
decentralized.
food preparation, cooking, and baking.
(b) Where a cluster/neighborhood, household/
(2) Where convenience food service systems using
small house or similar model of care is used,
frozen prepared meals, bulk packaged entrees, and
commercial warewashing may be decentralized
individual packaged portions or systems using
and located in a resident or participant
contracted, outsourced services are used, space
kitchen. See Section 2.3-2.3.4 (Resident and
and equipment shall be provided for thawing,
Participant Kitchen) for requirements.
portioning, cooking, and baking.
(3) Where "cook-chill" food preparation systems are (2) Space shall be provided for receiving, scraping,
used, space and equipment shall be provided for sorting, and stacking soiled tableware and for
food preparation, cooking and baking, chilling, transferring clean tableware to point-of-use areas.
portioning, and reheating. (3) Hand-washing stations shall be provided in or
directly accessible to warewashing space(s).
2.3-4.5.3.4 Ice-making equipment and drinking (4) Warewashing facilities shall be designed to prevent
water source contamination of clean wares or food preparation
(1) Location of ice-making equipment in the food areas with soiled wares through cross-traffic.
preparation area or in a separate room shall be
permitted as long as the equipment is directly 2.3-4.5.3.7 Pot-washing facilities. Depending on the
accessible to the food preparation area. type of food service and the care model, pot-washing
(2) Ice-making equipment shall be cleanable. facilities shall be provided. This shall be permitted to
(3) Ice-making equipment shall be self-dispensing if be centralized or decentralized.
it is accessible to residents, participants, and/or
visitors. 2.3-4.5.3.8 Offices(s). Office(s) or desk spaces for
(4) Ice-making equipment under control of staff dietitian(s), a dietary service manager, head chef, or
and not for use by residents, participants, and/or other food service professional shall be provided in or
visitors shall be permitted to be bin-type or self adjacent to the kitchen.
dispensing.
(5) See Section 2.3-2.3.4.2 (7) (Access to self 2.3-4.5.3.9 Storage. The following shall be provided:
dispensing drinking water and ice) for *(1) Food storage space, including cold storage
decentralized ice-making requirements. (2) Storage areas and sanitizing facilities for cans, carts,
(6) A filtered self-dispensing drinking water source and mobile-tray conveyors (where used)
shall be provided. (3) Waste, storage, and recycling facilities (per local
requirements) located with access to the outside for
2.3-4.5.3.5 Assembly and distribution facilities. direct pickup or disposal
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.
2.3 DESIGN ELEMENTS
2.3-4.5.3.10 Environmental services room load of at least 100 lbs. per linear foot (148.80
(1) Location kgllinear meter).
(c) The interior shall be lighted.
(a) An environmental services room shall be
located in the commercial kitchen where food *2.3-4.5.3.12 Cart wash. Where cans are used, a des
service is centralized. ignated area with a sloped floor with floor drain and a
(b) An environmental services room shall be source of water and sanitizing agents shall be provided.
located in or directly accessible to a resident
unit where food service is decentralized. 2.3-4.6 Linen and Laundry Service Facilities
(2) See Section 2.3-4.9.3.2 (Environmental services See facility chapters in Parts 3 through 5 for require
room) for room requirements. 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
and waste removal may include trash chutes, individual container
air-dry.
storage, or acombination of both. The process to be used for trash and
A2.3-4.7.1 Materials management includes procurement, receipt, waste removal should be identified so that physical space square foot
storage, and distribution of services or products, including both delivery age can be determined.
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.
• Design and Construction Requirements
• 2.4-1 General 2.4-1.2.2.2 Insulation materials. Building insulation

materials, unless sealed on all sides and edges with
2.4-1.1 Application
noncombustible material, shall have a flame-spread
rating of 25 or less and a smoke-developed rating of
150 or less when tested in accordance with NFPA

most types of residential health, care, and support
255: Standard Method ofTest ofSurface Burning
facili ties.
Characteristics ofBuilding Materials.
*2.4-1.1.1 The common elements in this chapter

are required only where referenced in the facility • 2.4-2 Architectural Details,

4 (Residential Care and Support Facilities), and Part 5
Surfaces, and Furnishings

2.4-2.1 General
2.4-2.1.1 Application
in the facility chapters in Parts 3, 4, and 5.
2.4-2.1.1.1 Applicable standards

2.4-1.2 Building Codes and Standards
*(1) All materials and products selected and specified
2.4-1.2.1 Building Codes for residential health, care, and support facility
All parts of a residential health, care, and support facil design and construction projects shall meet
ity shall be designed and constructed in accordance local, state, and federal regulations and industry
with applicable building codes; engineering practices standards for infection control and assembly or
and standards; and applicable sections of NFPA 101: construction.
Life Safety Code. (2) National testing standards shall be used to verifY
whether a product or material provides specific
2.4-1.2.2 Construction Requirements characteristics.
2.4-1.2.2.1 Interior finishes. Interior finish materials *2.4-2.1.1.2 Selected materials and products shall
used for architectural details, surfaces, and furnishings comply with application and use requirements and
shall comply with the flame-spread limitations and shall support the findings of the resident safety risk
smoke-production limitations in NFPA 101. assessment and model of care, which are documented
in the functional program.
APPENDIX
A2.4-2.1.1.1 For additional information, seethe white paper A2.+Z.1.1.2 Selectjon of fini.shes ~nd materjals for furnishings
"Resources for Selecting Architectural Details, Surfaces, and Furnish'ings should include resident input based on the model ohare.
for Health (are Facilities" posted on the FGlwebsite.
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 -Reduces user fatigue and musculoskeletal injury. Architectural
of materials and products used in residential health, care, and support detail, surface, and furnishing materials should:
facilities should be considered when selecting surface and furnishing • Meet specific safety, assembly, and construction industry
materials and products for use in environments that are occupied 24 criteria for fleXibility to address foot compression and heel
hours aday, seven days aweek. strike absorption.
Support foot comfort and reduce the fatigue and musculo
A2.4-2.1.2.1 Characteristics and criteria for
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 ~
support facilities and settings shall meet performance ambulation of long-term residents, short-term reha
characteristics and criteria that address risks identified bilitation residents, and participants in non-residential
in the resident safety risk assessment results. settings.
*(1) Reduction of resident falls and associated injuries.
See Section 1.2-3.4 (Resident Fall Risk and 2.4-2.2.2 Corridors
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.
fountains, public telephones, vending machines, and
(2) Reduction of medication errors. Where medication
wall-mounted items such as organizers, retractable
areas are provided in the facility or setting,
computer workstations, etc., shall not restrict cor
medication work surfaces shall be designed to
ridor traffic or reduce the corridor width below the
reduce glare and reflectivity.
minimum stipulated in applicable building codes and
NFPA 101.
2.4-2.2 Architectural Details
2.4-2.2.2.2 Placement of fixtures. The height of
2.4-2.2.1 General
drinking fountains, public telephones, handrails, lean
Architectural details in residential health, care, and rails, and wall-mounted lighting fixtures shall comply
support facilities shall be designed to encourage with applicable accessibility standards referenced in
Section 1.1-4.1 (Design Standards for Accessibility).
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.
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.
(b) Section 1.2-4.5.1 (Light) storage in casework beneath the sink basin or in
(c) Section 2.5-7 (Daylighting and Artificial areas below a sink open to the floor.
Lighting Systems)
2.4-2.2.8.2 Sinks. For sink and fitting requirements,
( *2.4-2.2.6.2 Sill height. Windows in resident rooms, see Section 2.5-2.3.2 (Hand-Washing Sinks).
suites, and dwelling units shall have sills located no

higher than 36 inches (91.44 centimeters) above the 2.4-2.2.8.3 Anchorage. For hand-washing stations,
finished floor. allowable stresses shall not be exceeded at any point on
the hand-washing station where a vertical or horizontal
2.4-2.2.6.3 Insect screens force of250 pounds (1112N) is applied.
(1) Operable exterior windows that may be left open
shall have insect screens. 2.4-2.2.8.4 Hand-washing station countertops
(2) Where regionally appropriate, this requirement (1) Hand-washing station countertops and their
shall not apply. substrates shall be moisture-resistant.
*(2) Hand-washing sinks set into countertops shall

2.4-2.2.7 Glazing Materials include a water-tight seal.
(1) Glazing materials shall meet all local, state, and
federal requirements. 2.4-2.2.8.5 Provisions for drying hands. Provisions
(2) Glazing materials shall be readily accessed for for hand drying shall be required at all hand-washing
cleaning and maintenance. stations.
(1) Hand-washing stations shall include a hand-drying

2.4-2.2.8 Hand-Washing Stations device that does not require hands to contact the
dispenser.
2.4-2.2.8.1 General. Where hand-washing stations are (2) These provisions shall be enclosed to protect
provided in a residential health, care, or support facil against dust or soil and to ensure single-unit
ity, the requirements in this section shall be met. dispensing.
(1) The number and placement of hand-washing (3) Hot air dryers shall be permitted unless the care
stations shall be determined by the infection population dictates otherwise. See Section 2.2-4
control risk assessment (ICRA). (Design Criteria for Dementia, Mental Health, and
(2) Hand sanitation dispensers shall be permitted Cognitive and Developmental Disability Facilities)
to be used in lieu of hand-washing stations as for specific care population requirements.
determined by the ICRA. (4) Where provided, hand towels shall be directly
(3) Hand-washing stations in resident care areas shall accessible to sinks.
be located so they are visible and access to them is

unobstructed. 2.4-2.2.8.6 Cleansing agent. Hand-washing stations
(4) Design of hand-washing stations shall not permit shall include liquid or foam soap dispensers.
APPENDIX
A2.4-2.2.6.2 Windowsills proven to encourage the presence of molds and bacteria in the
a. Asill height of 32 inches (81.28 centimeters) is preferable to allow substrate materials if the countertops are not properly sealed and
residents in wheelchairs or beds to easily see out the window. maintained.
b. The depth ofthe sill and its relationship to acurtain or blind should b. Integral backsplashes eliminate intersections that need to be
be considered as residents commonly use windowsills as display caulked.
space for personal items. c. Use of marine-grade plywood substrate for plastic laminate
countertops should be considered.
A2.4-2.2.8.4 (2) Hand-washing station
d. Under-mount basins are difficult to clean, and their use is
countertops
discouraged.
a. The presence ofwater around hand-washing sinks has consistently
2.4-2.2.8.7 Mirror. A mirror shall be provided at *2.4-2.2.9.2 Grab bars shall be installed at toilets and
each resident hand-washing station. showers in addition to other locations required to meet
(1) Mirror placement shall allow for use by both accessibility requirements in resident toilet rooms,
wheelchair occupants and ambulatory persons. showers, and bathing facilities.
(2) Top and bottom edges of mirrors shall be at levels
usable by individuals either sitting or standing. 2.4-2.2.9.3 Alternative grab bar configurations
(3) A separate full-length mirror shall be permitted to *(1) Where residents can undertake independent
serve as the required mirror. transfers, alternative grab bar configurations shall
be permi tted.
2.4-2.2.9 Grab Bars *(2) Evaluation of the care population shall be
considered in determining alternative grab bar
*2.4-2.2.9.1 Grab bars shall comply with local, state, configurations that meet specific resident needs.
and federal requirements.
A.2.4-2.2.9.1 ADAAG, UFAS, and ANSI accessibility standards be installed alongside the toilet.
were all developed with the intention of providing greater access for -For aresident who requires partial assistance to transfer, provi
individuals with disabilities. However, their standards are based on sion of swing-up grab bars on one or both sides of the toilet
assumed stature and strength, and thus their dimensional and grab bar would facilitate such transfers.
requirements are intended to facilitate wheelchair-to·toilettransfers by b. Installation of swing-up grab bars requires evaluation of the toilet in
individuals with sufficient upper body strength and mobilityto accom relation to the wall and the grab bars provided. Clearance is needed
plish such atransfer. The typical residential health, care, or support on, both sides of the toilet for an assisted transfer involVing two or
facility resident is unlikely to have such capabilities and thus will require more staff members.. The location of the toilet should be reviewed
the assistance of one or more staff members. Insufficient clearance at with regulators.
the side of the toilet can restrict staff mobility and access and result in c. Spacing of grab bars and appropriate lengths and heights for grab
injury, The Mayer-Rothschild Foundation white paper "Determination bars should be ergonomically evaluatedin conjunction with the
of Grab Bar Specifications for Independent and Assisted Transfers in follOWing:
Residential Care Settings" outlines recommendations for grab bar con -Toilet height
figuration and placement to meet the needs of residents of a residential ~Sink location
health, care, or support facility. -Type of bathing fixture
-Specific typ.eof lifting eqoipment and toileting/bathing sling
A2.4-2.2.9.2 Grab bars in bathrooms
used by th.e care proVider
a. For independent transfers. Grab bars at toilets in bathrooms and
d, Grab bar configurations for older adults should be configured as
bathing cores should allow residents to be as safe and independent
referenced in appendiX tableA2A-a (Resources for Grab Bar Configu
as possible. This includes using swing-up grab bars, where possible,
rations) and state and local regulations.
with or without integral toilet paper holder.. See appendix section
e. Where design for persons of size is reqUired, the length of rear wall
A2.4-2.2.9.3 (1) (Alternative grab bar configurations) for additional

grab bars should be 44 inches (112 centimeters) and mounted per
information.
the ADA Standards for Accessible Design.
b. For assisted transfers. Grab bars in bathrooms should allow staffto

f. Creation of mock-ups should be considered when evaluating alterna
complete atwo-person transferfor·a single resident. This includes
tivegrab bar configurations. In some cases, grab bar redundancy
evaluation of the toilet in relation to the wall and the grab bars pro
may be appropriate. See Section 1.2-3.3 (Resident Mobility and
Vided. Clearance is reqUired on both sides of the toilet for adouble
Transfer Risk Assessment) for criteria to be evaluated in a mock-up.
transfer to occur. See appendiX table Al.4 ca(Resources for Grab Bar
g. Grab bars may be vertical or horizontal based on the model of care
Configurations) for further information on space for transfers.

and the needs of the care population.
A2.4-2.2.9.3 (1) Alternative grab bar

A2.4-2.2.9.3 (2) Based on the care population, temporary alterna
configurations
tive grab bar configurations may be permitted to allow for transfers
a. Alternative grab bar configurations should address the folloWing

for residents who have changing abilities, are in rehabilitation, or are
scenarios:
increasingly frail. Grab bar configurations that offer flexible solutions
-For a resident capable of independent transfer facilitated bythe

should be considered. Installation of temporary or flexible configura
grab bar and side wall location required by accessibility stan

tions should be tested for safety and security before residents use them.
dards, aremovable/temporary wall structure and grab bar can
90, Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
*2.4-2.2.9.4 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.
2.4-2.2.12.2 Signage shall be consistent with all local, *2.4-2.2.12.3 Strategically placed interior and exterior
state, and federal regulations. signage as well as visual environment and surface
applied cues shall be provided for resident and visitor
orientation.
APPENDIX
A2.4-2.2.12.3 Signage and wayfinding. Clearly visible • Where health care symbols are combined with other univer
and understandable signage, icons, universal symbols, landmarks, sal symbols used in transportation or accessibility signage,
and/or cues for orientation (including views to the outside) should be the meaning of the different sets of symbols should be
coordinated and prOVided. Use of technology as part ofa wayfinding clearly differentiated for users.
system should be evaluated. e. Signage systems should be fleXible, expandable, adaptable, and easy
a. Adestination hierarchy should be developed to ensure the right to maintain.
information is presented at the right time. The destination hierarchy -Fabrication should allow messages to be changed.
should manage the number of symbols by building, zone, or floor. -Signage should be consistent with other resident and family
Users have difficulty differentiating more than 16 unique symbols in communications, supporting printed collaterals, Web and elec
one set. tronic media, and branding of afacility or community.
b. Boundaries between public and private areas should be well.-marked f. "You Are Here" (YAH) map recommendations
or implied and clearly distinguished. -YAH maps should be oriented so that forward is up.
c. Awayfinding system should be designed for consistency in the over -It is preferable to use a perspective view. Where vertical naviga
all wayfinding plan. This should include: tion is required, consider illustrating the relationship between
-Directional and orientation signs (overhead, wall-mounted, levels and which elevator cores serve which areas, especially
maps, etc.) where floors are not contiguous.
-Destination signs -Inset maps should be used to locate details in the overall map
-Room identification signs where appropriate.
-Regulatory signs, including provisions for residential health, g. Exterior signage (general)
care, and support facility-specific policy and information signs -Directional signs should be easily visible from the street and
-lnterior"landmarksHto aid occupants in cognitive understand located and sized so that drivers can easily read them when
ing of destinations traveling at the local speed limit.
• To be effective, landmarks should be unique. landmarks -Consistency should be used in the nomenclature of bUildings.
may include water features, major artworks, distinctive -Directions should be clear to all users.
colors, or decorative treatments at major decision points in -Signage should be placed within an individual's 60-degree"cone
the building. ofvision;'whetherthe person is walking or driving.

• Design of landmarks should attempt to involve tactile, audi -Exterior directional signs should be visible at night.
tory, and language cues as well as visual recognition. -Signage should be located where it may easily be seen.
landmarks should only be used at decision points. h. Exterior signage (parking)
d. Each sign should be accurate, legible, and functional. -Directions should be prOVided to the various parking locations,
-Nomenclature should be consistent and understandable to the where applicable.
. general public. Signs should be written at asixth grade level. -Directions should be prOVided from the parking structure to the
-letters should contrast with the background to conform to ADA entrance of the facility.
requirements. -Signage should clearly indicate short-term and long-term park
• Signs in areas with housing and services primarily for older ing rates where applicable.
adult residents should have letters that contrast with the -Where valet parking is prOVided, its location should be clearly
background by a minimum of 70 percent. marked.
• Greatest readability is usually achieved through the use of -Directional signage should be provided for automobile and
light-colored characters or symbols on adark background. pedestrian traffic at an appropriate scale for each.
-Signs should have an eggshell finish (11 to 19 degree gloss on -Floor numbers or sections should be clearly marked.
60 degree glossimeter). i. Interior signage (entrance and exit)

-Where used, symbols and pictographs should be recognizable -A well-designed and located set of interior signs and clearly
to the general public and the community served. (The Universal labeled directional maps should be located near the entrance.
Symbols in Healthcare have been tested for usability and com Symbols used on directional signage should also be used in
prehension.) orientation maps for consistency and to help users find primary
• The number of symbols used on asingle sign should be destinations.
limited and should indicate primary destinations only. -Signage should clearly identify all publicly accessible functional
*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.
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:
(1) The slip resistance ratings of flooring surfaces shall 2.4-2.3.2.7 Food preparation areas
be appropriate for the area of use-for dry or wet (1) Floors in areas used for food preparation and
conditions and for use on ramps and slopes. assembly shall be water-resistant.
(2) Slip-resistant flooring products shall be used for (2) Floor surfaces, including tile joints, shall be
surfaces in bathing areas and rooms, wet areas, and resistant to food acids.
ramps and entries from exterior to interior spaces. (3) Floor construction in dietary and food preparation
(3) Carpet in resident areas shall be installed to areas shall be free of spaces that can harbor pests.
prevent trip hazards or interference with resident, All joints shall be sealed.
participant, or outpatient use of resident-operated (4) Slip-resistant flooring products shall be used
mobiliry devices and assistive ambulation devices throughout kitchens, including wet areas.
and staff use of carts and equipment.

*2.4-2.3.2.8 Highly polished flooring or flooring
*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 2.4-2.3.2.9 Floor openings for pipes, ducts, or con
workrooms, toilet rooms, and other areas subject duits as well as joints at structural elements shall be
to wet-cleaning methods shall be constructed tightly sealed.
of materials that are not physically affected by
germicidal or other rypes of cleaning solutions. *2.4-2.3.2.10 All changes oflevel (i.e., stairs, steps,
(2) Areas subject to wet cleaning shall have floors that and ramps) shall have a strong value contrast between
are homogeneous and have sealed joints. vertical and horizontal surfaces.
(3) Wall bases in areas that require wet cleaning (e.g.,
soiled and clean utiliry rooms, environmental 2.4-2.3.3 Walls and Wall Protection
services rooms with mop sinks) shall be
continuous, integral or sealed to the floor and the *2.4-2.3.3.1 Wall finishes
wall, and constructed without voids.
A2.4-2.3.2.6Flooring are important in creating a comfortable, attractive living

-a. See appendiX section A2.4-2.1.2.2 (1:) (Env.ironmental factors ahd environment for residents.
falls) for information about the relationship between flooring and
A2.4-2.3.2.8 Use of non-wax flooring eliminates finish glare. Where
falls.
afinish coat is reqUired, smooth flooring surfaces should be sealed with
b. Flooring materials should have a mediumcolorlvalue; use of flooring
a matte finish to reduce surface glare.
in dark colors/values should be aVOided.
c. Strongly patterned flooring materials should be avoided as they can A2.4-2.3.2.10 Color contrast between walls and floors and mini
be confusing to residents with impaired vision. mization of transitions between different types of f1Qoring may reduce
d. Moving an elevated resident around and through aspace using por fall risk. See Table 4D-2 (Performance Criteria for Surfaces and Materials)
table lifting equipment without powered wheels may require more in the National Institute of Buildihg Sciences'Design Guidelines for the
exertion by staff than using ceiling-mounted equipment. Visual fnvironmentfor additional information.
-The exertion required by staff may increase with the use of
A2.4-2.3.3.1 Color/value contrast of wall finishes
carpet; however, different types and brands of carpet may have
a. Wall finishes should consist of colors/values that contrast with the
significantly different levels of resistance to wheeled devices.
floor material to distinguish vertical and horizontal planes (an issue
-Installation of a mock-up is recommended to test the action of
of balance).
wheeled eqUipment and devices used in afacility over proposed
b. The color/value contrast of wall finishes should be in the range of
flooring materials.
60-80 percent light reflectance value (LRV) to provide acceptable
-Carpet should not be automatically discounted as inappropriate
contrast with the floor and maximize light distribution in the space.
due to this challenge as it has major advantages over hard
C. See Table 4D-2 (Performance Criteria for Surfaces and Materials)
surface flooring in terms of noise reduction, other acoustic

in the Design Guidelines for the Visual Environment, published by
considerations, and residential appearance, all of which

National Institute of Building Sciences for additional information.
*(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 work, millwork, and built-ins that are fixed in a space
well as joints at structural elements shall be sealed. or room as well as movable furniture and window
treatments in residential health, care, and support
2.4-2.3.3.2 Wall protection facilities.
(1) Wall, door, and corner protection shall be provided
in areas where movable equipment is present. 2.4-2.4.2 Casework, Millwork, and Built-Ins
(2) Wall protection and corner guards shall be durable
and scrubbable. 2.4-2.4.2.1 In resident use areas, corners shall be
(3) Sharp, protruding edges shall be avoided. rounded or eased.
(4) Acoustics shall be considered when selecting wall
finishes. See Section 1.2-5.2 (Acoustic Planning) 2.4-2.4.2.2 Casework, millwork, and built-ins shall be
and Section 1.4-2.1 (Acoustic Design) for in contrasting colors/values to the walls.
requirements.
2.4-2.4.2.3 Casework hardware shall have a value
2.4-2.3.4 Ceilings 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
and outpatient areas and community spaces shall be 2.4-2.4.4.1 Privacy curtains and window treatments
designed to support resident transfer and weight shall comply with NFPA 101.
bearing requirements and ambulation to enhance user
independence. 2.4-2.4.4.2 Window treatments shall be provided in
resident areas to diffuse the daylight and control glare.
2.4-2.4.3.2 Furniture selected shall have rounded and
eased edges. 2.4-2.4.4.3 Window treatments provided in resident
accommodations shall be designed for operation by
2.4-2.4.3.3 Furniture selected shall be upholstered the resident.
with impervious materials in locations where infection
control and incontinence are a concern. 2.4-2.4.4.4 Operational requirements and the type
of care provided shall dictate the need for privacy
2.4-2.4.4 Window Treatments and Privacy
curtains.
Curtains
~The car~ population should bE! evalu~tE!d to ilE!termhie appropri, d. Spacecbeoeath as~at front should allow a user to pull back hisor her
.ateseat hE!ights, whichrangE! from 16to 19 inches. (41 to lf8' heels far enough under the seat to assist with rising.
centimeters) with arm heights ].to 8inches (18to 20' centime e.Furniture shouJdhave eased "Or rounded edges and corners of nO less
tersl aQOVe(OOlpressed seat height attheelbow. than .318 inch radiUS to minimi~e ris~ of resident patient injuries.
~Arm fronts should extend all the way to Qr pa.stthefrontofthe f. Furniture usedincresident areas. should be sturdy and stable to safely
seatat a height ap1>Topriate tohelp residents safely sitdown, support residenttransfer and weight-bearing requirements.
and push offto astanding position g.Rolling furnitureQr equipment in resident areas should have lo¢king
-Seats shdyldbe firm, with seat depth and configu.rati6I'kth~t rollerslcastersfor safE!ty. However, sE!ating that has casters oMnly
allow residents, participants, and outpati.ents to exitseating two legs'to aUowfor movement on carpeted flooring, surfacesshould
comfortably and safely without assistance. not have locking cilsters.
-The aogle of the seat ~ndseat back should oot hindE!r risiog nor h. Chairs that provide opportunities to rock without compromising the
caoseshoulder-forward or hip-forward,slumplng'oTsliding out ability to exit safely (e.g., with stable arm fronts) should be consid
ofthe seat. ered for their relaxation and exercise'benefits.

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:'
2.5 Building Systems
• 2.5-1 General 2.5-2.2 Plumbing and Other Piping Systems
2.5-1.1 Application 2.5-2.2.1 General Piping and Valves

This chapter contains elements that are common to All piping, except control-line tubing, shall be
most types of residential health, care, and support identified.
facili ties.
2.5-2.2.2 Potable Water Supply Systems
2.5-1.1.1 The elements are required only when
referenced in the facility chapters in Part 3 (Residential 2.5-2.2.2.1 Capacity
Health Facilities), Part 4 (Residential Care and (1) Systems shall be designed to supply water at
Support Facilities), and Part 5 (Non-Residential pressures sufficient to operate all fixtures and
Support Facilities). equipment during maximum demand.
(2) Supply capacity for hot- and cold-water piping
2.5-1.1.2 Additional specific requirements are located shall be determined on the basis of fixture units,
in the facility chapters in Parts 3, 4, and 5. using recognized engineering standards.
2.5-1.2 Building System Design 2.5-2.2.2.2 Valves. Each water service main, branch
main, riser, and branch to a group of fixtures shall have
2.5-1.2.1 Facilities shall have building systems that valves.
are designed and installed in a manner that provides
(1) Stop valves shall be provided for each fixture.
for the safety, comfort, and well-being of residents,
(2) Access panels shall be provided at all valves where
participants, or outpatients.
required.
(3) Valves shall be tagged, and a valve schedule shall
2.5-1.2.2 The primary goal in building system design be provided to the facility owner for permanent
shall be to support resident, participant, and out
record and reference.
patient needs and/or operational functions. Energy
consumption and efficiency shall be a secondary goal.
2.5-2.2.2.3 Backflow prevention
(1) Systems shall be protected against cross-connection
• 2.5-2 Plumbing Systems in accordance with American Water Works
Association (AWWA) Recommended Practice for
2.5-2.1 General Backfiow Prevention and Cross-Connection Control.
(2) Vacuum breakers or backflow prevention devices
In the absence of local and state plumbing codes, all
shall be installed on hose bibs and supply nozzles
plumbing systems shall be designed and installed in
used to connect hoses or tubing to housekeeping
accordance with the International Plumbing Code.
sinks and, where used, to bedpan-flushing
attachments.
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,
branches with no fixture) shall not be permitted.
2.5-2.2.3.1 General. Provisions shall be included in (2) In renovation projects, dead-end piping shall be
the heated potable water distribution system to limit removed.
the amount of Legionella bacteria and other opportu (3) Installation of empty risers, mains, and branches
nistic waterborne pathogens. installed for future use shall be permitted.
2.5-2.2.3.2 Recirculation of hot water. Heated *2.5-2.2.3.4 Capacity. The water-heating system shall
potable water distribution systems serving resident have supply capacity at the temperatutes and amounts
areas shall be under constant recirculation to provide indicated in Table 2.5-1 (Hot Water Use-Residential
continuous hot water at each hot water outlet or to Health, Care, and Support Facilities). Storage of water
provide alternative means for maintaining hot water. at higher temperatures shall be permitted.
(1) Non-recirculated fixture branch piping shall not
exceed 25 feet (7.62 meters) in length. *2.5-2.2.3.5 Hand-washing sinks. For hand-washing
(2) Alternative means shall be permitted to include the sinks, water shall be permitted to be supplied at a
installation of instantaneous systems or another constant temperature between 70° F and 80° F using a
type of water heating system at point of use. single-pipe supply.
APPENDIX
A2.5-2.2.3 Heated potable water distribution volume of hot or tempered water in hot water distribution
systems piping should be calculated in accordance with the gUidance
l
a. legionella response. ASHRAf 188: Prevention ofLegionel/osis Associ in the paragraph on water volume determination below.
ated with BUilding Water Systems should be used when designing hot The maximum volume in piping to public hand-washing
water systems. sinks, metering or non-metering, should be 2ounces (0.06
b. Design for efficient heatedpotable water distribution. Hot water l). For fixtures other than those at public hand-washing
distribution systems should be designed to deliver hot or tempered sinks, the maximum volume should be 64 ounces (l.89l)
water in areasonable time. low-flow faucets, longer pipe runouts for hot or tempered water from awater heater or boiler and
between arecirculated main and the fixture, and larger diameter 24 ounces (O.7l) for hot or tempered water from a circula
pipes increase the time it takes toachieve desired temperatures. tion loop pipe or an electrically heat-traced pipe.
Given the water conservation benefits of low-flow faucets, design -Water volume determination. The volume should be the sum of
ers should consider reducing the length of uncirculated runouts, the internal volumes of pipe, fittings, valves, meters, and mani
redUcing the pipe size, providing heat tracing for the runout, or using folds between the source of the hot water and the termination
point-of-use water heaters. Following is agUide that may be used in ofthe fixture supply pipe. The volume should be determined
designing asystem based on delivery time. from the liquid ounces per foot column of appendix table A2.5
-Design method. Hot and tempered water distribution systems a. The volume contained in fixture shutoff valves, flexible water
should be designed using either the maximum pipe length or supply connectors to afixture fitting, or afixture fitting should
maximum pipe volume limits provided in this appendix section not be included in the water volume determination. Where hot
and in appendix table Al.5-a (Maximum length of Hot Water or tempered water is supplied by a circulation loop pipe or an
System Pipe or Tube). For purposes of this discussion, references electrically heat-traced pipe, the volume should include the
to pipe should also apply to tubing and the source of hot or tem portion ~f the fitting on the source pipe that supplies water to
pered water is considered to be awater heater, boiler, circulation the fixture.
loop piping, or electrically heat-traced piping. -Maximum flow rate. The maximum flow rate of fixtures should
Maximum allowable pipe length method. The maximum be limited to 0.5 gpm when connected to l/4-inch piping, 1
allowable pipe length from the source of hot or tempered gpm when connected to 5/16-inch piping, and 1.5 gpm when
water to the termination of the fixture supply pipe should connected to 3/8-inch piping.
be in accordance with the maximum pipe length columns in
A2.5-2.2.3.4 Water temperature is measured at the point of use Of
appendix table A2.5-a. Where the length contains piping of
inlet to the equipment.
more than one size, the largest pipe size should be used to
determine the maximum allowable pipe length in the table. A2.5-2.2.3.5 One way to limit the potential growth of Legionel/a in
Maximum allowable pipe volume method. The maximum a heated potable water system is to distribute water at atemperature
100 Guidelines for Design and Construction of Residential Health, Care, and Support FaCilities
2.5-2.2.4 Drainage Systems square centimeters), with a minimum centerline

dimension of 9 inches (58.06 centimeters) in
2.5-2.2.4.1 Piping width or length.
(1) Installation of exposed drainage piping or piping (3) Hand-washing sink basins shall be made of
in the ceiling shall be avoided in food preparation vitreous china, porcelain, stainless steel, or solid
centers, food service facilities, food storage areas, surface materials.
central services, electronic data processing areas,
electric closets, and other sensitive areas. 2.5-2.3.2.2 Sink basins shall be installed so they fit
(2) Where overhead drainage piping in these areas is tightly against the wall or countertop and are sealed to
unavoidable, provisions shall be made to protect prevent leaks.
the space below from leakage, condensation, and
dust particles. *2.5-2.3.2.3 Fittings
(1) The water discharge point of a hand-washing
[*2.5-2.2.4.2 Kitchen grease traps. Where grease traps sink faucet shall be at least 8.5 inches (21.59
are used, they shall be located so they are easily acces centimeters) above the bottom of the basin for
sible for cleaning. resident rooms/bathrooms and 10 inches (25.4
centimeters) above the bottom of the basin for all
2.5-2.2.4.3 Sewers. Building sewers shall discharge other locations.
into community sewerage. Where such a system is not (2) Hand-washing sinks used by care and nursing staff
available, the facility shall treat its sewage in accor and food service staff shall have fittings-including
dance with local and state regulations. single-lever or wrist blade devices-that allow for
hands-free operation.
2.5-2.3 Plumbing Fixtures
(a) Blade handles used for this purpose shall be at
least 4 inches (10.16 centimeters) in length.
2.5-2.3.1 General
(b) The location and arrangement of fittings shall
The material used for plumbing fixtures shall be non provide the clearance required for operation of
absorptive and acid-resistant. blade-type handles.
2.5-2.3.2 Hand-Washing Sinks (3) Sensor-regulated (electronic) faucets
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.
(b) Electronic faucets shall be capable of
2.5-2.3.2.1 Basin design functioning during loss of normal power.
(1) Sinks used for hand-washing shall be designed with (c) Sensor-regulated faucets with manual
basins that reduce splashing. temperature control shall be permitted.
(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
lower than 80°F (26.6°Cl for hand-washing use. Water at this tempera dementia to simplify the interface and avoid burns. This type of faucet
ture may be warm enough to encourage good hand-washing practice should be provided in hand-washing sinks in resident rooms and dwell
but cooler than the ideal growth conditions for Legionel/a. ing units occupied by residents with dementia and in public toilet rooms
accessible to these residents. Sensor-regulated faucets are not recom
A2.S-2.2.4.2 Kitchen grease traps. An exterior location

mended for those with dementia because they find them confusing.
with vehicular access is preferred for maintenance.

A2.S-2.3.2.3(4) Anchorage. See ICC A117.1: Accessible and
A2.S-2.3.2.3 Faucets for residents with dementia.
Usable Buildings and Facilities for more information.
Asingle-lever faucet with mixer is recommended for residents with
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.
2.5-2.3.3.2 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
*(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
--------------------
*2.5-3.2.1.1 Recognized engineering procedures shall 2.5-3.2.4.1 For requirements for outdoor mechani
be followed for the most economical and effective cal equipment and noise and vibration mitigation, see
results. Section 2.5-8.2 (Site Exterior Noise) and Section
2.5-8.7 (Design Criteria for Building Vibration).
*2.5-3.2.1.2 In no case shall resident comfort or safety
be sacrificed for energy conservation. 2.5-3.2.4.2 Outdoor mechanical equipment shall not
produce sound that exceeds daytime and nighttime
*2.5-3.2.1.3 Facility design consideration shall include noise limits at neighboring properties as required by
site, building mass, orientation, fenestration, and other local ordinance.
features relative to passive and active energy systems.
See the following sections for additional information: 2.5-3.3 HVAC Requirements for Specific
(1) Section 1.2-5.5 (Planning for Sustainability) Locations
(2) Section 1.4-2.2 (Sustainable Design)
(3) Section 2.2-2 (Sustainable Design Criteria) 2.5-3.3.1 Resident, Participant, Outpatient, and
Related Support Areas
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 resident, participant, and outpatient areas and their
in Interior Spaces Caused by Building Systems) for support areas.
noise considerations.
2.5-3.3.2 Fuel-Fired Equipment Rooms
2.5-3.2.3 System Valves Rooms with fuel-fired equipment shall be provided
Supply and return mains and risers for cooling, with outdoor air to maintain equipment combustion
heating, and steam systems shall be equipped with rates and limit space temperatures.
valves to isolate the various sections of each system.
Each piece of equipment shall have valves at the supply 2.5-3.3.3 Areas of Refuge
and return ends. Areas of refuge shall be heated or cooled as determined
by the geographic location of the facility or setting.
*2.5-3.2.4 Acoustic Considerations for Outdoor
Mechanical Equipment 2.5-3.3.4 Commercial Food Preparation Areas
If a facility requires a food preparation area, the
following requirements shall apply:
A2.5-3.2.1.1 Awell-designed system can generally achieve energy It may be practical in some areas that include operable windows
efficiency with minimal additional cost and simultaneously provide to reduce mechanical ventilation and use open windows for ventilation
resident comfort. during appropriate climatic conditions as long as resident comfort needs
can be met.
A2.5-3.2.1.2 See ANSrlASHRAE Standard 55-2010: Thermal Envi
Jonmental Conditions for Human Occupancy for thermal c(lmfort informa A2.5-3.2.4 Acoustic considerations for outdoor
tion. mechanical equipment. Outdoor mechanical equipment
includes cooling towers, rooftop air handlers, exhaust fans, fans located
A2.5-3.2.1.3 Centralized air-handling systems should be designed
inside buildings with openings on the outside of the building, and other
with an economizer cycle in areas where it is appropriate to use outside
equipment. Special acoustic considerations for the building envelope in
air. See ANSI/ASHRAE/IES Standard 90.1: Energy Standard for Buildings
residential health, care, or support facility areas near such equipment
Except Low·Rise Residential Buildings or ANSI/ASHRAE Standard 90.2:
may be required to mitigate noise. The effects of mechanical equipment
Energy-Efficient Design ofLow-Rise Residential Buildings for additional
noise on adjacent properties should also be considered, with attention
information. Resident needs and/or operational function should be
to adjacent land uses and jurisdictional noise limits.
evaluated as primary concerns and energy consumption and efficiency
as secondary concerns.
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 (2) Existing accessible insulation in identified areas of
does not compromise the following: work shall be inspected, repaired, and/or replaced
(1) Exit corridot restrictions ofNFPA 90A: Standard in compliance with current code requirements.
for the Installation ofAir-Conditioning and
Ventilating Systems 2.5-3.4.2.2 Vapor barrier
(2) Pressure tequirements ofNFPA 96: Standard (1) Insulation on cold surfaces (e.g., equipment, pipes,
for Ventilation Control and Fire Protection of ductwork) shall include an exterior vapor barrier.
Commercial Cooking Operations (2) A separate vapor barrier shall not be required for
(3) Requirements for food preparation areas open to material that will not absorb or transmit moisture.
corridors in NFPA 101
(4) Ventilation requirements, including total air 2.5-3.4.3 Acoustic Insulation
changes per hour to provide makeup air to kitchen
exhaust systems, as specified in ANSI!ASH RAE
requirements.
Standard 154: Ventilation for Commercial Cooking
Operations
2.5-3.5 HVAC Air Distribution
2.5-3.3.4.3 Exhaust hoods handling grease-laden
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
(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.
required volume of airflow is present or high-limit 2.5-4.1.1 Applicable Standards

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

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
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
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.
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.
(1) The technology equipment room shall house the 2.5-5.3.3.3 The technology equipment room shall
main networking equipment, servers, and data be located a minimum of 12 feet (3.66 meters) from
storage devices that serve the building. any transformer, motors, induction heaters, radio and
(2) Telephone equipment shall be permitted to be radar systems, and other sources of electromagnetic
included in the main technology equipment room. interference.
2.5-5.3.1.2 Number. Each residential health, care, or 2.5-5.3.4 Technology Equipment Room Facilities
support facility shall have at least one main technol
ogy equipment room and additional teledata rooms or 2.5-5.3.4.1 Mechanical and electrical equipment or
closets as necessary to accommodate the systems used fixtures that are not directly related to the support of
in the facility or setting. the technology equipment room shall not be installed
in, pass through, or enter the room.
*2.5-5.3.2 Size
2.5-5.3.4.2 All computer and networking equipment
2.5-5.3.2.1 The technology equipment room shall be shall be served by uninterruptible power supply.
sized to accommodate the number of racks needed for
anticipated servers, networking, and storage. 2.5-5.3.4.3 All circuits serving the equipment in the
technology equipment room shall be dedicated to serv
2.5-5.3.2.2 The technology equipment room shall ing the technology equipment room only.
be sized to provide clearances to meet service require
ments for the equipment that will be housed there. 2.5-5.3.4.4 Cooling and heating shall be provided for
technology equipment and data room(s).
*2.5-5.3.3 Location and Access (1) Cooling systems serving the technology equipment
room shall be supplied by the essential electrical
2.5-5.3.3.1 The technology equipment room shall
system.
be located above any floodplains and, in multi-story
(2) Temperature control systems in technology
buildings, below the top level of the facility to deter
equipment room(s) shall be designed to maintain
water damage to the equipment from outside sources
environmental conditions recommended in
(e.g., leaks from the roof or flood damage).
ASHRAE's Thermal Guidelines for Data Processing
Environments or the requirements for the specific
2.5-5.3.3.2 In areas prone to hurricanes or tornados,
equipment installed.
the technology equipment room shall be located away
from exterior curtain walls to prevent wind and water
2.5-5.4 Grounding for Telecommunication
damage.
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.
- - - - - - - - - - - - - ---_._-----_._-------
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.
2.5-7.1.2.1 Lighting shall be designed to meet the *2.5-7.2 Daylighting Systems in Resident Living,
needs of occupants in specific spaces. See Section 1.2 Participant, and Outpatient Areas
5.1 (Lighting Planning) for requirements.
*2.5-7.2.1 Dining, recreation/lounge, and activity areas
2.5-7.1.2.2 Unless alternative lighting levels are justi !for daytime use shall have glazing for daylight and
fied by the functional program, minimum maintained views to the outdoors.
illuminance recommendations in ANSIIIES RP-28:
Lighting and the Visual EnvironmentfOr Seniors and the *2.5-7.2.2 Translucent shades, sheers, blinds, or
Low Vision Population shall be used as the minimum other window treatments shall be provided to control
required ambient and task lighting levels in all rooms, brightness and reduce glare.
spaces, and exterior walkways.
2.5-7.3 Artificial Lighting Systems
2.5-7.1.2.3 Means shall be provided for controlling
light levels to suit space use and availability of daylight. *2.5-7.3.1 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.
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
2.5-8.1 General *2.5-8.2.2 Facility Noise Source Emissions

See Section 1.2-5.2 (Acoustic Planning) for planning Planning and design shall include consideration of
requirements. sound emissions from facility noise sources that reach
nearby residences and other sensitive receptors.
*2.5-8.2 Site Exterior Noise
*2.5-8.2.3 Exterior Noise Classifications
*2.5-8.2.1 Existing Exterior Noise Sources
Planning and design of new facilities and retrofitting 2.5-8.2.3.1 Exterior noise classifications shall be used
of existing facilities shall include due consideration of to identifY the degree of sound attenuation required in
all existing exterior noise sources that may be transmit the building facade due to the sources of exterior noise,
ted from outside a building to its interior through the including sources being added by the facility. Exterior
exterior shell (exterior walls, windows, doors, roofs, site noise exposure categories shall be as identified in
ventilation openings, other shell penetrations). 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).
ages,slowing visual adaptation from brighter to darker spaces. In A2.5-8.2.3 Exterior noise classifications. The facility
daytime, indoor light levels at entry points need to be high, while at site should be classified into one of the noise exposure categories in
night higher exterior light levels are needed to minimize differences Table 2.5-3 (Categorization of Residential Health, Care, and Support
between indoor and outdoor light levels. Facility Site by Exterior Ambient Sound with Design Criteria for Sound
c. Upon entering aspace with aconsiderllbly lower light level, older Isolation of Exterior Shell in New Construction) by means of exterior
adults may need to stop or move to oile side of the walkway until site observations OJ asound-level monitoring survey and knowledge
their eyes adapt to the change in light level. therefore, seating area~ of confirmed new noise sources to be included in the design of th.e
should be placed in lobbies or conidors where residents may Wllit for facility. Further information for classifying sites according to exterior
their eYes to adjust. noise can be found in appendix table A2.5-b (Approximate Distance of
-Noise Sources for Use in Categorization of Residential Health, Care, and

A2.5-8.2 Site exterior noise. The requirements in this section
Support Facility Sites by Exterior Ambient Sound).
provide a means for screening sites to determine which exterior walll
a. The sound levels for noise exposure categories Athrough Dprovided
window assemblies are suitable to address site noise. They are not
in Table 2.5-3 and appendix table A2.5-b should be used to evalu
intended to be used as a means to qualify the suitability of asite with
ate required building envelope sound isolation and may differ from
respect to environmental noise exposure.
other such categorizations of community noise made elsewhere in
Examples of noise sources that should be controlled include the
this document.
facility's power plant, HVAC equipment, and emergency generators.
Category A---'Minimal environmental sound. As typified by a rural
Examples of noise sources afacility cannot control include highways, rail
or quiet suburban neighborhood with ambient sound suitable
lines, airports, and general urban, industrial, and public service equip
for single-family residences, sound produced by transportation
ment and activities.
(e.g., highways, aircraft, trains) or industrial activity may occa
A2.5-8.2.1 Future exterior noise sources. Residential sionally be audible but is only a minor feature of the acoustic
health, care, and support facility design should consider potential future environment.
noise·source development in the vicinity of the project, such as the COil Category B-Moderate environmental sound. As typified by a busy
struction of highways, airports, or rail lines. suburban 'heighborhood with ambient sound suitable for mul
tifamily residences, sound. produced by transportation or indus
A2.5-8.2.2 Facility noise source emissions. Sound
trial activity is clearly audible and may at times dominate the
from exterior facility equipment can be controlled to achieve acceptable
environment but is not loud enough to interfere with normal
sound levels inside facility spaces and at neighboring receptors by siting
conversation outdoors.
noise sources and receptors to take advantage of distance, orientation,
Clltegory C-Significant environmentlll sound. As typified by a
and shielding. Sound from exterior facility equipment can also be c'On
commercial urban location, pt;lssibly with some large apartment
trolled qy selecting quiet equipment aild making use of noise control
bUildings, sound produced by transportation or industrial activ
equipment such as silencers and barriers.
ity dominates the environment and often interferes with normal
conversation outdoors.
2.5-8.2.3.2 The building fayade's sound isolation { *2.5-8.3 Design Criteria for Acoustic Finishes
performance shall depend on the site classification and Facility spaces identified in Table 2.5-4 (Minimum
shall comply with minimum exterior shell composite Design Room Sound Absorption Coefficients) shall
sound transmission ratings, either OITCc or STCc, as incorporate permanent acoustic finishes that achieve
shown in Table 2.5-3 (Categorization of Residential design room-average sound absorption coefficients.
Health, Care, and Support Facility Sites by Exterior
Ambient Sound with Design Criteria for Exterior Shell *2.5-8.4 Design Criteria for Room Noise Levels
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 d. The requirements in Table 2.5-3 will result, in most (ases, in interior
mercial urban location immediately adjacent to transportation sound levels due to exterior sound of day-night average sound level
or industrial activities, sound nearly always interferes with (I.dn) 45 dBA. Actual results will vary depending on how well the
normal conversation outdoors. sound-blocking ability of the shell at various frequencies matches
b. Environmental noise on Category B, C, and Dsites generally may be the sound spectrum ofthe outdoor sound and other factors. such as
evaluated using the methods given for documenting site ambient area of the exposed fa~ade and absorption in the room.
sound levels using continuous sound monitoring over a minimum Some rooms require lower sound levels, such as assembly
one-week period in ANSI/ASA 512.9: Quantities and Procedures for spaces, resident bedrooms, clinical spaces, quiet rooms, and similar
Description andMeasurement ofEnvironmentalSound, Part 2: "Mea noise-sensitive rooms. These room types should be evaluated care
surement of Long-Term, Wide-Area Sound:'This information should fully to reduce the contribution of outdoor noises transmitted inside
be used to determine detailed environmental noise control require while also considering the noise levels from the bUilding systems
ments for building design. Sites where ambient sound is influenced (see Table 2.5-2: Maximum Design Criteria for Noise in Interior
by airport operations may require additional monitoring as sug Spaces Caused by Building Systems). Assemblies meeting the mini
gested in the ANSI standard to account for weather-related varia mum OITCc requirement typically will provide lower interior noise
tions in aircraft sound exposure on site. In lieu of performing such levels when the outdoor sound is dominated by sources with strong
additional monitoring, aircraft sound level contours available from low-frequency sound (e.g., locomotives or slow-moving heavy
the airport, if available, should be used to determine the day-night trucks). Assemblies meeting the minimum STCc requirement typi
average sound level on site produced by nearby aircraft operations. cally provide lower interior noise levels when strong low-frequency
Sound-level monitoring on-site still will be needed to determine sound is not present.
sound levels produced by other sources. More detailed evaluation should be considered to identify which
c. Table 2.5-3 (Categorization of Residential Health, Care, and Sup sound isolation rating (OITCe or STCc) is preferred to meet the exterior
port Facility Site by Exterior Ambient Sound with Design Criteria for shell acoustic requirements and potentially provide a more cost
Sound Isolation of Exterior Shell in New Construction) and appendix effective design.
table A2.5-b (Approximate Distance of Noise Sources for Use in
A2.S-8.3 Design criteria for acoustic finishes
Categorization of Residential Health, Care, and Support Facility Sites
a. Reduction of commercial kitchen noise propagation into dining
by Exterior Ambient Sound) present general descriptions for exterior
rooms is important for improved occupant speech communication
sound exposure categories Athrough D, including distance from
and resident comfort in the dining area. If the local code allow~,
major transportation noise sources, ambient sound levels produced
consider installing sound-absorbing ceilings made for food service
by other sound sources, and corresponding design goals for the
areas in the kitchen to reduce some of the noise.
sound isolation performance of the exterior building shell.
b. For large resident dining rooms (occupancy greater than 501,
The outdoor sound levels, expressed as A-weighted day-night
research and experience has shown that use of carpeting, table sizes
average sound levels, are proVided in the context of exterior build
of six or smaller, and provision ofat least 20 square feet of NRC 0.80
ing shell design. Outdoor resident areas may require lower sound
or equivalent acoustic absorption per person at full occupancy yield
levels, typically not exceeding aday-night average level of 50 dB.
a preferred environment for resident comfort and ease of speech
To achieve this may require accommodations such as exterior noise
communication. For rooms with high ceilings, the walls above 9feet
barriers or location of outdoor areas where the building structures
should receive acoustic finishes.
prOVide shielding from noise sources.
[ *2.5-8.4.1 Room noise levels caused by HVAC and 2.5-8.5.1 Sound isolation shall be considered for all
other building systems shall not exceed the maximum occupied spaces adjacent to construction activities.
values shown in Table 2.5-2 (Maximum Design
Criteria for Noise in Interior Spaces Caused by *2.5-8.5.2 The composite sound transmission class
Building Systems). (STC) rating of demising wall assemblies shall not be
less than the ratings indicated in Table 2.5-5 (Design
2.5-8.4.2 Room noise levels shall be determined for Criteria for Minimum Sound Isolation Performance
unoccupied rooms (e.g., without operating medical Between Enclosed Rooms).
equipment).
*2.5-8.6 Design Guidelines for Speech Privacy
2.5-8.5 Design Criteria for Performance of Inte Designated spaces in which protected health informa
rior Wall and Floor/Ceiling Constructions tion is conveyed shall be designed to meet speech pri
vacy goals using one of the four speech privacy rating
APPENDIX
A2.S-8.4.1 Design criteria for room noise levels should be given to intersection and sealing details of demising wall
a.For circumstances in which hearin~-impaired populations may
have difficulty hearing or communicating, consider designing the
t assemblies.
A2.S-S.6 Speech privacy. Federal legislation requires that
maximum background sound level at least 5points/dBA lower than
facilities protect resident, participant, and patient information privacy.
values shown in Table 2.5-2 (Maximum Design Criteria for Noise in
This includes speech privacy in all residential health, care, or support
Interior Spaces Caused by Building Systems). Historically, background
facilities wherever resident, participant, or patient heillthinformation is
sound level recommendations have been formulated for populations
distussed, whether between staff, on the telephone, or during dictatio(l.
with normal hearing. Research indicates that hearing-impaired
a. Methods for determining speech privacy. Selett only one ofthe met
populations have trouble hearing and understanding in noisy envi
rics in Table 2.% (Design Criteria for Speech. Privacy for Enclosed
ronments, which can lead to decreased socialization and increased
Rooms and Open-Plan Spaces) for determining speech privacy in
isolation ofthe resident.
c1osed- and open-plan settings. Examples of closed-plan settings
b. Kitchen eqUipment can add tothe background sound level in the
are staff private offices, conference rooms, examination rooms, and
dining space for open kitchen designs, cafeteria-style designs, drink
single-resident rooms. Examples of open-plan settings are waiting
stations, and serving areas in the dining space. Use quiet kitchen
are,as, reception areas, and staff open (not fully enclosed) offices.
equipment and/or sound-isolat~the kitchen from the dining loom.
All four metrics in Table 2.5-6 define speech privacy in terms of
For example, serving equipment such as buffet and salad bars may
the intelligibility of speech from the transmitted speech signal com
be purchased as quiet equipment or have sound-blocking enclosures
pared to the continuous background sound at a receptor position.
compatible with equipment operation and warranties; drink sta
The chQice and use ofthe selected metric should be made by quali
tions used by staff may be located behind full-height partitions; and
fied, eXPerienced professionals.
resident-accessible drink stations may use partial sound enclosures
-Criteria for the AI (Articulation Index) metric are defined in
designed for noise reduction.
ASTM El130: Standard Test Method for ObjediveMeasurement of
A2.S..S.S.2 Demising Wall ~ssemblies Speech Privacy in Open Plan Spaces Using Articulation Index.
a. A"demising wall assembly" is awall assembly that separates one -Criteriil for the SII (Speech Intelligibility Index·) metric are
occupied space from another occupied space or from acorridor. defined in ANSI/ASA S3.5: MethodS for Calcufatiqn qrthe Speech
Partitions in an occupied space are non-demising partitions. For Intelligibility Index.
example, the wall between two resident rooms is demising, but -Criteria for the SPC (Speech Privacy Class) metric are defined in
the partition in a resident room that encloses the bathroom for that ASTM E2638: Standard Test Method for Objedive Measurement
room is non-demising. ofthe Speech Privacy Provided by aClosed Room and "ASTM Met
b. Appropriate steps should be taken to ass!Jre the composite STC rics for Rating Speech Privacy of Closed Rooms and Open Plan
performance of d'emisingwall assemblies as stated In.Table 2.5-5 Spaces;' an atticle from the September 2011 edition of Canadian
(Design Criteria for Minimum Sound Isolation Performance Between Acoustics, the journal of the Canadian Atoustical Association.
Enclosed Rooms) is achieved after consideration of perimeter leaks ~(riteria for the· PI (Privacy Index) metric for converting AI values
due to lack of sealing, flanking due to continuous surfaces extending into percentages are defined in ASTM El130: Standard Test
from one room to the other, sound passing through a plenum above Method for Objective Measurement ofSpeech Privacy if! Open Plan
awall, or penetrations in the wall or ceiling. Particular attention Spaces Using Articulation Index.
methods as shown in Table 2.5-6 (Design Criteria for dwelling unit and a public or service area above it
Speech Privacy for Enclosed Rooms and Open-Plan shall be considered in the design.
Spaces). (2) Where medical or laboratory instrumentation
is used in a residential health, care, or support
*2.5-8.7 Design Criteria for Building Vibration setting, more stringent vibration criteria shall be
considered.
2.5-8.7.1 General
Seismic restraint covered elsewhere in the Guidelines 2.5-8.7.2.3 Structure-borne sound
shall be compatible with vibration isolation methods (1) Structure-borne transmitted sound shall not exceed
covered in this section. the limits for airborne sound presented in Section
2.5-8.4 (Design Criteria for Room Noise Levels).
2.5-8.7.2 Vibration Control and Isolation (2) Where necessary, vibration isolators shall be used
Vibration levels in the building shall not exceed appli to control potential sources of structure-borne
cable guidelines and limits outlined in this section. 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.
(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
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.
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
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
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.

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.
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.
*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.
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.
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.
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.
·1 Specific Requirements for Nursing Homes
• 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 3.1-2.1 General
ive environment to enhance and extend quality oflife
Resident areas in a nursing home shall comply with
for residents and facilitate wayfinding while promoting
the requirements in this section.
choice, dignity, privacy, meaningful engagement, and
self-determination.
*3.1-2.2 Resident Unit
3.1-1.4.3.2 Design shall maximize opportunities for
3.1-2.2.1 General
ambulation and self-care, socialization, and indepen
dence and minimize the negative aspects of a tradi
*3.1-2.2.1.1 Resident unit size. See Section 3.1
tional environment.
2.2.1.2 (Layout) for typical resident unit size in differ
ent types of nursing home models and appendix table
3.1-1.4.4 Barrier-Free Environment
A3.1-a (Nursing Home Care Model Characteristics)
The architectural design-through the organization for additional information.
of functional space, the specification of ergonomically
appropriate and arranged furniture and equipment, 3.1-2.2.1.2 Layout
and selection of details and finishes-shall eliminate as (l) In new construction, resident units shall be
many barriers as possible to access and use by residents arranged to avoid unrelated travel through the
of all space, services, equipment, and utilities appropri units.
ate for daily living. *(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.
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
-Staff often does not,consistently care for the same residents; -Staffing thatworks as well at night as during the day: An
minimizing the opportunity for developing familiarity with a effective cluster design accommodates multiple staffing·ratios.
resident's individual needs. With clustering, afacility or neighborhood with 42.beds could'be
-Travel distances fOfstaff and residents are greater than in other staffed effectively in variousratios of licensed nurses to nursing
'types of units and schedules are dictated more by regulation assistants. For example: 1:7 for days (sixcllfsters of seven
than by resident/staffrhoice or satisfaction. residents); 1:14 or 1:21 nights (two or three groupings of two to
(. Physical setting three clusters, respectively).
-In lieu of residentro.oms designed with beds side by side, alter (. Additionalbenefits
native room layouts are recommended that provide minimally -Cluster design can provide more efficient gross/net area where jI
private alcove sleeping areas and access to abathroom shared by variety of single and/or double rooms are nested.
no more than two residents. See Section 3.1-2.2 (Resident Unit) -For a project with a high proportion of private occupancy rooms,
for additional information. cluster design can reduce walking/travel distances to staff work
-Evaluation of some decentralized services and activity areas to areas or nurse stations.
reduce travel distances for staff and residents is recommended. -Cluster units support distribution of nursing staff throughout a
building, so staff are closer to resident rooms aloight and can
A3.1 ~2.2.1.3 (2) Cluster and/or neighborhood
be more responsive to vocal calls for assistance andtoileting.
model and staffing consid,erations
(Central placement of staff requires more understanding of how
a. Definition. This model includes several concepts in which the design
to use atraditional call system than many residents possess.)
of traditional nursing home floor plans (straight halls, double-loaded
-(luster units ofagiven size may "stack"or be placed over
corridors) is reorganized to benefit residents and improve caregiver
each other, but can be staffed differently to serve varying care
effectiveness.
populations. .
Clustering is adecentralization strategy used to improve aes
-Where electronic call systems are ljsed (e.g., systems that allow
thetics, streamline service, shorten travel distances, and simplify
reprogramming of which roOm reports to which zone or nurs
handling of linen. It also permits more localized social areas and
ing assistant's work area), staffing for a unitmight easily be
optional decentralized staff work areas.
changed over time, such as when resident needs justify higher
Clusters of resid~nt bedrooms may be grouped ina neighbor
ratios ofnursing assistants to residents. For example, a48-bed
hood that provides shared activity, therapeutic, and support areas.
unit might start at 1:8 staffing but switch to 1:6 when residents
b. Functional program. Afunctioning cluster as described here is more
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.
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 provided for each resident space shall be based on
CMS-3260-F, "Reform of Requirements for Long inclusion of the following:
Term Care Facilities."
(a) Space to accommodate a maximum of two
beds that allows staff members access to both
*3.1-2.2.2.2 Space requirements
sides and the foot of each bed
(1) Space shall be provided to accommodate resident (b) A window accessible from a wheelchair or
care and for maneuverability when resident other resident-operated mobility device
operated mobility devices are used. (c) A wardrobe or closet accessible from a
(2) Resident rooms shall be sized, arranged, and
wheelchair or other resident-operated 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 *(ii) Lounge chair
(iii) Dresser
A3.1-2.2.2.2 Determining space needs. Resident rooms • 36 inches (91.44 centimeters) on the non-transfer side of
should be sized; arranged, and furnished to maximize safe patient the bed
mobility, mobilization, weight-bearing exercise, and ambulation • 66 inches (167.64 centimeters) at the foot ofthe bed
potential while minimizing risk to caregivers. This should apply to all Where lifts are used, additional clearance is needed to accom
populations being cared for and served. modate use of the lift and an expanded-capacity wheelchair as well.
Clearances should be provided and maintained to accommodate as space for staff to help a' person of size transfer from bed to wheel
safe resident mobility and mobilization of residents. Designated clear chair or gurney. Mobile lifts require more floor space than overhead
ances should not be obstructed by any object that does not qualify as lifts to accommodate the lift footprint.
movable according to Section 1.5-4.2 (Movable and Portable Equip c. Sizing of resident rooms should accommodate clearances for resident
ment). chairs, recliners, wheelchairs, or other devices; these clearances may
a. To facilitate planning for minimum clearances around beds, bed type overlap with the bed clearances. The size of each room should allow
and size should be established as part of the functional program. As unimpeded clearance on at least one side and at the front of any
acceptable to AHJs, bed placement should be chosen by individual resident chair, etc., as follows:
residents and their families to satisfy the needs and desires of the -48 inches (121.92 centimeters) on the transfer side of the chair,
resident. etc. for both standard and person of size room types
b. Provision of bed clearances to support resident safety should include -36 inches (91.44 centimeters) for the approach to the chair for a
the following: standard room
-Standard resident room: -66 inches (167.64 centimeters) for the approach to the chair for
48 inches (121.92 centimeters) on the transfer side a room accommodating a person of size
36 inches (91.44 centimeters) on the non-transfer side of
A3.1-2.2.2.2 (3)(d)(ii) Resident seating. The lounge chair
the bed
proVided in aresident room to give residents an alternative to bed-stay
• 36 inches (91.44 centimeters) at the foot of the bed
should be evaluated for provision of the follOWing:
-Resident rooms for persons of size with an overhead lift:
-Comfort sufficient for long-term sitting
• 72 inches (182.88 centimeters) from the bed by 120 inches
-Cervical support and support for the resident's head (backrest)
long (304.8 centimeters) on the transfer side
-Opportunity to recline the backrest to enable periodic redistri
• 36 inches (91.44 centimeters) on the non-transfer side of
bution of body weight during long periods of sitting (recliner)
the bed
-Ease of entry and exit. See appendix section A2.4-2.43.1 (Furni
• 66 inches (167.64 centimeters) at the foot of the bed
ture selection recommendations) for additional information.
-Resident rooms for persons of size without anoverhead lift to
See appendix section A2.4-2.43.1 (Furniture selection recommen
accommodate use of a mobile lift:
dations) for additional information.
84 inches (21336 centimeters) from the bed by 120 inches
(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. 3.1-2.2.2.4 Resident privacy
*(1) Visual privacy shall be provided for each resident in
(4) Every bed location shall have sufficient space to
two-bed rooms.
permit placement of a stretcher along one side for
(2) Design for privacy shall not restrict resident access
lateral transfer of the resident from the bed to the
to the toilet, room entrance, window, or other
stretcher by at least two staff members without
shared common areas in the resident room.
substantial rearrangement of furniture.
(5) Clearances
3.1-2.2.2.5 Hand-washing station. A hand-washing
(a) In multiple-bed rooms, clearance shall allow station shall be provided in each resident room.
for the movement of beds and equipment (1) Omission of this station shall be permitted in a
without disturbing residents. single-bed or two-bed room where a hand-washing
(b) Clear access to one side of the bed shall be station is located in an adjoining toilet room that
provided along 75 percent of its length. serves that room only.
(c) Mechanical and fixed equipment shall not (2) Design requirements
APPENDIX~'
A3.1-2.2.2.2 (3){e) Visitor seating. Provision of aside chair bed/chair/toilet/bathing .facilities/stretcher or reposition them in a bed
for avisitor means residents do nbt have to remain in bed when they or achair.
have avisitor. 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
A3.1-2.2.2.2 (3){h) Although use of portable lifting equipment
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 A3.1-2.2.2.4 (1) Resident privacy. Consideration should be
ceiling-mounted track to accommodate ceiling-mounted mobility and given to use of awall or partition to preserve visual and acoustic privacy
lifting devices. The track layout should be designed to aid in maintaining for each resident. Alcoves may be used for this purpose in double
or improving resident mobility and ambulation, independent function, occupancy resident rooms.
and strength and to help staff members transfer residents to or from
128 Gu.delines for Desi n and Construction of Residential Hea!th, Car, an Support Facilities
(a) For hand-washing station design details, see transfers, alternative grab bar configurations
Section 2.4-2.2.8 (Hand-Washing Stations). shall be permitted.
(b) For sink design, see Section 2.5-2.3.2
(Plumbing Fixtures-Hand-Washing Sinks). 3.1-2.2.2.7 Resident bathroom. Where a bathtub
(c) For casework details, see Section 2.4-2.4.2 or shower is provided in a resident toilet room, the
(Casework, Millwork, and Built-Ins). following requirements shall be met in addition to the
requirements in Section 3.1-2.2.2.6 (Resident toilet
3.1-2.2.2.6 Resident toilet room. Each resident shall room):
have access to a toilet room without entering a general (1) Space shall be provided for drying, dressing, and
corridor. grooming.
*(1) One toilet room shall serve no more than two (2) A counter and a shelf or cabinet for personal item
residents in a bedroom. storage shall be provided. See Section 2.4-2.4.2
(2) Space requirements (Casework, Millwork, and Built-Ins) for details.
*(3) See Section 2.5-2.3.3.2 (Accessible showers) for
(a) Toilet rooms shall be sized and configured to

shower requirements.
accommodate:
(i) Staff assistance, including use of lifting 3.1-2.2.2.8 Resident storage. Each resident shall be
equipment provided with an individual wardrobe or closet.
(ii) Accessibility standards that support inde (1) This storage shall have a minimum net depth of
pendent resident use 24 inches (55.88 centimeters) and a minimum net
(b) Clearance shall be provided on both sides width of 2 feet 6 inches (76.20 centimeters).
of the toilet to enable physical access and (2) A clothes rod shall be provided that can be
maneuvering by staff members assisting the adjusted to a height accessible to the resident.
resident with wheelchair-to-toilet transfers and Accommodations shall be made for storage of full
returns. length garments.
(3) A shelf shall be provided that can be adjusted to a
(3) The toilet room shall contain the following: height accessible to the resident. Omission of the
(a) Toilet shelf shall be permitted where the unit provides at
(b) Hand-washing station least two accessible drawers.
(c) Mirror. For requirements, see Section 2.4
2.2.8.7 (Mirror). 3.1-2.2.3 Special Care Resident Rooms
(d) Individual storage for the personal effects of The requirements in this section shall apply to all nurs
each resident ing homes that include these room types.
(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
room
door hardware).
(5) Grab bars (1) General
(a) Grab bars shall be provided in accordance with (a) The need for and number of Ail rooms shall
Section 2.4-2.2.9 (Grab Bars). be determined by an infection control risk
(b) Where residents are capable of independent assessment.
(b) Where provided, each All room shall comply
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
venting the Tran~mission of Mycobacterium tuberculosis in Health-Care
A3.1-2.2.2.7 (3) Accessible showers. Provision of acurb

Settings" and "Guidelines for Environmental Infection Control in Health
less shower that is open to the surrounding bathroom should be consid

Care Facilities."
ered for ease ofaccess by resident and staff.
with the requirements in Section 3.1-2.2.2 normal electrical power.

(Resident Room) as well as the following *(ii) Use of recirculating room units shall not
requirements: be permitted in new construction.
*(iii) Use of recirculating devices with HEPA fil
(2) Capacity. Each resident room shall contain only
ters shall be permitted in existing facilities
one bed.
as interim, supplemental environmental
(3) The toilet room provided for each AIl room shall
controls to meet requirements for the
include a shower.
control of airborne infectious agents. The
(4) Anteroom. An anteroom is not required; however,
design of such recirculating systems shall
where an anteroom is part of the design concept, it
allow for easy access for scheduled preven
shall meet the following requirements:
tive maintenance and cleaning.
(a) The anteroom shall provide space for persons (iv) Design relative humidity shall be a maxi
to don personal protective equipment before mum of 60 percent.
entering the resident room.
(b) All doors to the anteroom shall have self *3.1-2.2.3.2 Ventilator-dependent resident units.
closing devices. Where a unit dedicated to serving residents dependent
(5) Where no anteroom is provided, provision shall be on a ventilator is provided, resident rooms in this unit
made for storage of personal protective equipment shall meet the following requirements in addition to
at the entrance to the room. those in Section 3.1-2.2.2 (Resident Room).
(6) Special design elements (1) Resident rooms for ventilator-dependent residents
shall have:
(a) Architectural details
(a) Space for the ventilator unit at the bedside
(i) All room perimeter walls, ceiling, and
(b) Space to accommodate clearances for resident
floor, including penetrations, shall be con
operated mobility devices that may be
structed to prevent air exfiltration.
oversized to accommodate a ventilator
(ii) AIl rooms shall have self-closing devices
(c) Provisions for oxygen and suction. Any
on all room exit doors.
installation of nonflammable medical gas, air,
(b) Window treatments and privacy curtains or clinical vacuum systems shall comply with
shall be provided in accordance with Section the requirements ofNFPA 99: Health Care
2.4-2.4.4 (Window Treatments and Privacy Facilities Code.
Curtains). (d) Backup electrical requirements. See Section
(c) Ventilation 2.5-4.4 (Electrical Requirements for
Ventilator-Dependent Resident Rooms and
(i) Ventilation upon loss of electrical power.
Areas) for requirements.
The space ventilation and pressure re
lationship requirements of Table 3.1-1 (2) Resident support areas
(Design Parameters for Ventilation of Resi
(a) Support space shall be provided in the nursing
dential Health Spaces) shall be maintained
unit to accommodate staffing associated with
for All rooms, even in the event of loss of
ventilator services.
(b) A dedicated space shall be provided for
APPENDIX
A3.1-2.2.3.1 (6)(c)(ii) Use of recirculating room units in new A3.1-2.2.3.2 Where adedicated unit is provided for ventilator
construction is prohibited due to the difficulty of cleaning the units and dependent residents, piped oxygen and vacuum should be prOVided.
the potential for buildup of contamination in the All room. Refer to NFPA 99: Health [are Facilities Code and ANSI/ASSE 6000:
Professional Qualifications Standardfor Medical Gas Systems Personnel for
A3.1-2.2.3.1 (6)(c)(iij) The design of either portable or fixed

essential power requirements and medical gas installation informatio.n.
retirculating systems should prevent stagnation and short-circuiting Of

airflow.
servicing and maintenance of ventilator (b) Area and dimensions. The area and
equipment or storage shall be provided to dimensions of each pediatric resident space
accommodate ventilators for backup or shall be based on provision of the following:
exchange.
(i) The ability to accommodate crib or bed
(c) All resident activity and support areas shall
locations, including one where staff mem
be provided with essential power outlets to
bers have access to the crib or bed on three
support continued ventilator support in the
sides
event of a power outage. See Section 2.5-4.4
(ij) Clear access to one side of the crib or bed
(Electrical Requirements for Ventilator
along 75 percent of its length.
Dependent Resident Rooms and Areas) for
(iii) Overnight accommodations for family
(iv) Enhanced (additional) staffing, closer
observation, and equipment as identified
3.1-2.2.3.3 Quiet room in a resident unit. Where
by the functional program
a single resident room is provided to accommodate
(v) Privacy accommodations for family mem
care requirements for residents experiencing issues
bers and each pediatric resident
such as personal conflicts, agitation, episodic mental
(vi) Space for placement of a stretcher along
disturbances, or similar conditions, the requirements
one side for lateral transfer of the pediatric
in Section 2.3-2.2.3.3 (Quiet room in a resident
resident from crib or bed by at least two
carelliving area) shall be met in addition to the
staff members without substantial rear
requirements in Section 3.1-2.2.2 (Resident Room).
rangement of furniture
(vii) In multiple-crib or -bed rooms, clearance
*3.1-2.2.4 Other Special Care Facilities
permitting movement of cribs or beds and
equipment without disturbing other crib
*3.1-2.2.4.1 Pediatric facilities
or bed locations
*(1) Pediatric resident rooms shall be designed to (viii) Space for mechanical and fixed equipment
accommodate the age-related characteristics of the that prevents obstructed access to any
proposed pediatric residents. required element
(a) Rooms shall be permitted to accommodate (c) Unless otherwise stated in the functional
more than two pediatric residents where program, pediatric resident rooms shall be
sleeping accommodations are in cribs. 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.
*(2) Resident support (4) Where diagnostic and treatment areas are provided,
see Section 3.1-3 (Diagnostic and Treatment Areas)
(a) At least one hand-washing station equipped
for requirements.
with hands-free operable controls shall be
provided for each four or fewer pediatric (a) See Section 3.1-3.3.2 (Physical Therapy
residents accommodated in a single room. Area) and Section 3.1-3.3.3 (Occupational
(b) Indoor and outdoor activity space shall be Therapy Facilities) for designated rehabilitation
designed with consideration of pediatric requi rements.
resident and family culture, age cohorts, and (b) See Section 3.1-3.3.4 (Other Rehabilitation
age-appropriate activities and needs. Therapy Facilities) for additional requirements
based on the types of therapy being provided.
*3.1-2.2.4.2 Post-acute care facilities
(5) See Section 3.1-4 (Facilities for Support Services)
(1) For resident unit size and layout requirements, see for requirements.
Section 3.1-2.2.1.2 (Resident Unit-Layout). (6) See Section 3.1-5 (Design and Construction
(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 requirements.
Section 3.1-2.3 (Resident Community Areas) for
requirements. 3.1-2.2.4.3 Accommodations for care of persons
of size. Where the facility provides resident rooms
A3.1-2.2.4.1 (2) In comparison to what is reqUired for the typical residents receiving rehabilitation services rather than long-term or
geriatric facility, pediatric long-term care facilitie~ often require palliative care services.
additional equipment and more intensive staffing and observation. Post-acute care units often use ahousehold care model that
Parent/family involvement also tends to be more frequent in includes one or more "households" or units dedicated to post-acute care
pediatric facilities, requiring rooms designed to accommodate family :residents. Ahousehold'may also be dedicated to aspecial type of reha
participation in direct care as well as privacy during visits. bilitation, such as orthopedic, cardiology, stroke, or other specialty.
Due to the potential age range and length ofstay of pediatric Differences between along-term care and post-acute care house
residents, functional and space needs vary significantly from thos!'! of hold or unit typically include the following:
adult residents. Dailycare activities are likely to be more complex from a. Post-acute care resident rooms are usually private and designed to
afunctional perspective, while continuous social development and accommodate family and visitors. Consideration should be given to
physical/mental maturity reqUire a physical environment that is flexible providingwi-fj access in resident rooms.
to accommodate the pediatric resident's evolving needs. The number of b. Post-acute care resident room bathrooms are usually private and
children in a room is related to the individual residents' needs for privacy include ashower.
as well as efficient and appropriate staff access, monitoring, and care. eln alarger facility setting, physical, occupational, and speech therapy
Because of the varying age and degree of socialization of pediatric may be provided in the post-acute care household or unit or centrally
residents, room capacities range from four infants/togdlersrequiring located with other fitness or wellness areas.
heavy nursing care in asingle room to more private accommodations d. Food service for post-acute care is usually provided by acentralized
for adolescents. All resident rooms must accommodate the direct care kitchen with a room service component rather than in acommunal
activities of enhanced staffing aswell as the likelihood of significant dining setting (decentralized or centralized).
family presence. e. In lieu of activity space, alounge or family area is usually proVided
The various functional and physical abilities ofthis diverse popula for family TMmbers visiting the resident. The lounge or family area
tion must be taken into account when designing facilities for toileting should offer access to awi-fi network.
and bathing. f. Staff usually is rehabilitation-focused rather than dementia-focused
in apost-acute care household or unit. However, it is recommended
A3.1-2.2.4.2 Post-acute care facilities. With change~ in
that staff in aunit where rehabilitation services are provided also be

regulations that result in shorter stays in acute care settings, post-acute
trained in working with residents with dementia because of the care

care facilities are being developed and built~often.under nursing
population. generally being served.

or skilled nursing licensing. Post-acute care facilities are intendedfor
for persons of size, see Section 2.2-3 (Design Criteria 3.1-2.3.3.1 General. See Section 2.3-2.3.3.1
for Accommodations for Care of Persons of Size) for (Dining, Recreation, and Lounge Areas-General) for
further requirements. requirements.
3.1-2.3 Resident Community Areas 3.1-2.3.3.2 Dining areas. See Section 2.3-2.3.3.2
(Dining areas) for requirements.
3.1-2.3.1 General
See Section 2.3-2.3.1 (Resident, Participant and 3.1-2.3.3.3 Recreation, lounge, and activity areas.
Outpatient Community Areas-General) for Recreation, lounge, and activity areas shall provide the
requirements. following:
*(1) Space adequate for resident activities and associated
3.1-2.3.2 Lobby equipment
(2) Areas sufficient in number and size to:
3.1-2.3.2.1 See Section 2.3-2.3.2 (Lobby) for
(a) Allow resident groups of various sizes to gather
(b) Accommodate separate and distinct activities
3.1-2.3.2.2 Where a central lobby is provided, the

3.1-2.3.3.4 Toilet rooms. Toilet facilities that
following requirements shall be included:
accommodate resident-operated mobility devices shall
(1) A counter or desk for reception and information be readily accessible to all dining, recreation, lounge,
(2) Public waiting area(s) and activity locations.
(3) Public toilet facilities
(4) Public telephone(s) or access to a courtesy phone. 3.1-2.3.4 Resident Kitchen
Where kitchen facilities that permit use by resi
Telephone Access) for resident telephone
dents and family members are provided, see Section
requirements.
2.3-2.3.4 (Resident and Participant Kitchen) for
(5) Provisions for drinking water
requirements.
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 a. If reqUired in the functional program, space should be included for
needs. Activity programs focus on the social, spiritual, intellectual, the following:
physical, and creative needs of residents and provide them with quality, -Storage for files and records
meaningful experiences. These programs may be facilitY-Wide or for -Computers
smaller groups. The activities the care provider will support, based -Administrative tasks
on residents' or clients' expressed and individual interests, should be -Storage for supplies and equipment
identified in the functional program. b. Aquiet space for effective resident/staff communication. This space
Activity programs generally include coordination and implementa may be incorporated into the space for administrative tasks or
tion of activities for large and small groups and personalized individual locat~d in a private room setting.
programs involVing one resident and one activity coordinator. These c. Space for storage of items used for activities {e.g" recreationmateri
activities may be conducted in other spaces in afacility (e.g., dining als, exercise equipment, supplies for religious services) located near
rooms), but dedicated spaces are preferred for efficient operation of the point of use
quality programs. The need for large activity spaces (e.g., libraries; cha
A3.1-2.3.S Personal services areas. Consideration should
pels; auditoriums; conference, classroom, and training spaces) depends
be given to prOViding the following in the design of these areas:
on the programming decisions of the care provider.
a. General
Following are some optional space needs to support recreation,

-Changing areas
lounge, and activity areas:

-Storage for supplies and linens
-----------------------
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
-Provisions for resident privacy c. Occupational therapy

b. Hair salon -Activities of daily living therapy
-Adjustable sink bowls for shampooing and tre~tment -Recreational therapy. Recreational therapy assists residents with
-Freestanding dryers for use by residents using resident-operated the development and maintenance of community living skills
mobility devices and socialization through the use ofleisure-time activity tasks.
c. Space for circulation and staff assistance around spa tubs These activities may occur in arecreati_onal therapy department,
in aspecialized facility such as afitness room or area, in resident
A3.1-2.3.8.2 Outdoor activity spaces
activity areas, or outdoors.
a. Visual access to outdoor activity spaces from indoors should be pro
-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
------- _._._._... _--_..-_.__.--.._-_.. _._... _.
3.1-3.3.1 General a minimum clearance of2 feet 8 inches (711

millimeters) on at least three sides of the
*3.1-3.3.1.1 Application. At minimum, the facilities treatment furniture (e.g., chairs, recliners,
included in this section shall be provided on-site and tables, beds, mats).
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. (a) Exterior and interior windows in therapy
(2) Where two or more rehabilitation services are areas shall have window treatments or shades
provided, sharing of facilities and equipment shall to provide resident privacy during individual
be permitted. therapy treatments.
(3) Where a nursing home is part of a general hospital (b) Individual treatment areas shall have privacy
or other facility, rehabilitation services shall be screens or cubicle curtains and appropriate
permitted to be shared. provisions for resident dignity or private
(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 shall have access to either a hand-washing station
Rehabilitation Therapy Facilities) for additional or a hand sanitation dispenser.
requirements.
(a) Hand-washing stations shall be provided in
*3.1-3.3.1.2 Location. The requirements in this section each therapy room where hands-on resident
shall be met in any location where rehabilitation care is provided.
therapy services are provided. (b) Any therapy room that does not require a
hand-washing station shall have a dedicated
3.1-3.3.2 Physical Therapy Area hand sanitation dispenser.
(c) One hand-washing station shall be permitted
3.1-3.3.2.1 General. Private therapy room(s) shall be 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.
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 privacy. The design shall minimize external sound
in each occupational therapy room where from high-traffic, public, and similar noisy areas.
hands-on resident or client care is provided. See Section 2.5-8 (Acoustic Design Systems) for
(b) Any occupational therapy room that does not information.
require a hand-washing station shall have a
dedicated hand sanitation dispenser. 3.1-3.3.4.31herapeutic pool and hydrotherapy
(c) One hand-washing station shall be permitted whirlpool
to serve several occupational and/or physical (1) Where a therapeutic pool(s) is provided, see
therapy treatment stations. appendix section A5.2-2.3.3.3 (3) (Aquatic center)
for information.
3.1-3.3.4 Other Rehabilitation Therapy Facilities (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.
----------------------~._._---------------_._._ ..._ - - - - - . - - - - - -
(2) Combination of the reception area with the 3.1-3.3.7.2 Toilet room(s)
documentation or charting area shall be permitted. (1) Toilet room(s) shall be usable by residents using
resident-operated mobility devices.
3.1-3.3.5.2 Documentation area. Provisions shall (2) Toilet rooms shall be provided next to or directly
be made for documentation, filing, and retrieval of accessible from changing areas.
resident records. (3) If therapy treatments include toileting, toilet rooms
shall include hand-washing stations. See 2.4-2.2.8
3.1-3.3.5.3 Clean utility room. A clean utility room (Hand-Washing Stations) for requirements.
that meets the requirements in 2.3-4.2.5 (Clean Utility (4) See Section 3.1-2.2.2.6 (Resident toilet room) for
Room) shall be provided in each resident unit. additional requirements.
3.1-3.3.5.4 Soiled utility room. A soiled utility room 3.1-3.4 Wellness Centers
that meets the requirements in 2.3-4.2.6 (Soiled Util

Where wellness facilities are provided, see Chapter
ity Room) shall be provided in each resident unit.

5.2 (Specific Requirements for Wellness Centers) for
requirements.
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 • 3.1-4 Facilities for Support Services
residents are using therapy services. These spaces
shall be located in, next to, or directly accessible 3.1-4.1 General
from the treatment area(s). See Section 2.3-4.1 (Facilities for Support Services
(2) See Section 2.3-4.2.4 (Equipment and Supply General) for requirements.
Storage) for additional requirements.

3.1-4.2 Facilities that Support Resident,
3.1-3.3.5.6 Environmental services rooms. See Participant, or Outpatient Care
Section 2.3-4.9 (Environmental Services Rooms) for

requirements. 3.1-4.2.1 Staff Work Area(s)
See Section 2.3-4.2.1 (Staff Work Area) for
3.1-3.3.6 Support Areas for Staff

requirements.
Support areas for staff shall be provided and may be

shared. See Section 2.3-4.3 (Support Areas for Staff) 3.1-4.2.1.1 Nurse station for centralized staffing.
for requirements. Where caregiving is organized on a centralized staffing
model, staff work areas shall provide for charting or
3.1-3.3.7 Resident Support Areas for transmitting charted data and any storage for adminis
Rehabilitation Therapy trative activities.
3.1-3.3.7.1 Changing areas. Where required by *3.1-4.2.1.2 Nurse station for decentralized staffing.
the therapy program, changing areas, showers,andl Where caregiving is decentralized, supervisory work
or lockers shall be provided. See Section 2.5-2.3.3.2 areas need not accommodate charting activities
(Accessible showers) for shower requirements. 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.
APPENDIX
AJ.1' -4.2.1.2 Depending on the type ofservice to be provided and accommodated with apiece of residential furniture (e.g., atable or
the care plan, direct care staff work areas need not be encumbered desk) or awork cO\lnter recessed into an alcove off acorridor or activity
with all the provisions for asupervisory administrative staff work area. space, with or without computer and communications equipment, stor
In some decentra.lized arrangements, caregiving functions maybe age facilities, and so on.
- - - - - - - - - - - - - - - - - - _.._------_._--
Guidelines for Design and Construction of Residential Health. Care, and Support Facilities 137
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

separate closet or designated area shall be provided for
(1) Where a shower is not provided in the resident
clean linen storage.
bathroom, residents shall have access to at least
one central bathing room or area per floor or unit (1) A decentralized clean utility room shall be
that is sized to permit assisted bathing in a tub or permitted to be used for the storage of clean linen.
shower. (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 3.1-4.2.4.3 Storage for mobility devices and sup
in resident bathrooms. port equipment. Storage for resident-operated mobil
ity devices and personal support equipment shall allow
3.1-4.2.3.3 Accessibility this equipment to be accessible to residents at all times
without entering another resident's living space.
(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.
3.1-4.2.5.1 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.
(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. The type and size of the nursing home facility shall
determine the dietary environment and the food
3.1-4.2.7 Personal Laundry Facilities service facilities provided.
See Section 2.3-4.2.7 (Personal Laundry Facilities) for
requirements. 3.1-4.5.2 Central Commercial Kitchen
Where a central commercial kitchen is provided, food
3.1-4.2.8 Resident Telephone Access service facilities shall be provided in accordance with
See Section 2.3-4.2.8 (Resident and Participant Section 2.3-4.5 (Food Service Facilities).
Telephone Access) for requirements.
3.1-4.5.3 Warming Kitchen
3.1-4.3 Support Areas for Staff If the facility has a service contract with an ourside
See Section 2.3-4.3 (Support Areas for Staff) for vendor for food service, a warming kitchen designed to
requirements. meet the following requirements shall be provided.

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 function of a warming kitchen. See Section 2.3-2.3.4
resident room, space shall be provided for circulation (Resident and Participant Kitchen) for requirements.
when the furnishing is fully open for use so staff can
access the resident in case of an emergency. 3.1-4.5.4 Decentralized Kitchen
Where food preparation is conducted on-site, the facil
3.1-4.4.1.2 Storage space shall be provided to accom ity shall have dedicated non-public space and equip
modate and secure overnight guests' belongings. ment for preparation of meals. See Section 2.3-2.3.4
(Resident and Participant Kitchen) for requirements.
3.1-4.4.2 Pet Accommodations
See Section 2.3-4.4.3 (Pet Accommodations) for 3.1-4.6 Linen and Laundry Service Facilities
requirements.
3.1-4.6.1 General
3.1-4.4.3 Kitchen Facilities
3.1-4.6.1.1 Each facility shall have provisions for
Where kitchen facilities that permit use by family
storing and processing clean and soiled/contaminated
members and visitors are provided, see Section 3.1
linen.
2.3.4 (Resident Kitchen) for requirements.
*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
- - _.._ - - _ . _ - - - - - - - - _ .._... __.._----_._---_._--_. __._----_ __ .._ .. .. .. _----_._---
(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 3.1-4.6.4 Support Areas for Facilities Using Off
control and collection of soiled linen. Site Linen Processing
(b) Soiled linen chutes shall be permitted to Where linen is processed off-site or in a separate
discharge in this room or in an adjacent building on-site, the following shall be provided:
separate room.
3.1-4.6.4.1 A service entrance, protected from
(2) Washers/extractors. Washers/extractors shall be
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 3.1-4.8 Waste Management Facilities
tral clean linen storage and issuing room(s) shall be See Section 2.3-4.8 (Waste Management Facilities) for
provided in addition to the linen storage required at waste collection, storage, and disposal requirements.
individual resident units. See Section 2.3-4.2.5 (Clean
Utility Room) for additional information. 3.1-4.9 Environmental Services Rooms
See Section 2.3-4.9 (Environmental Services Rooms)
3.1-4.6.3.2 Soiled holding room(s). Separate central for requirements.
or decentralized room(s) shall be provided for receiving
and holding soiled linen for pickup or processing. See 3.1-4.10 Facilities for Engineering and
Section 2.3-4.2.6 (Soiled Utility Room) for require Maintenance Services
ments in addition to those in this section.
See Section 2.3-4.10 (Facilities for Engineering and
(1) Room(s) shall have ventilation and exhaust. Maintenance Services) for requirements.
(2) Discharge from soiled linen chutes shall be received
in this room or in a separate room, as required by 3.1-4.11 Administrative Areas
the local authority having jurisdiction.
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 3.1-5.2.2.4 Doors and door hardware. See Section
interviews; staff, resident, and family meetings; confer 2.4-2.2.4 (Doors and Door Hardware) for require
ences; and health education shall be sized to accom ments in addition to those in this section.
modate operational and activity needs. (1) Door type
(1) Space shall include provisions for use of visual aids (a) Doors to all rooms containing bathtubs,
and technology. showers, and toilets for resident use shall be
(2) Sharing of space by several services shall be
hinged, sliding, or folding.
permitted.
(b) All doors between corridors, rooms, or spaces
subject to occupancy shall be of the swing type
3.1-4.11.1.2 General office space. Office space shall or shall be sliding doors.
be provided for staff and file storage. (c) Manual or automatic sliding doors shall
be permitted where their use does not
3.1-4.11.1.3 Supply and copy room. Space for stor compromise fire and other emergency exiting
age of files, office equipment, and supplies shall be requirements.
provided.
(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.
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 • 3.1-6 Building Systems

2.4-2.2.8 (Hand-Washing Stations) for requirements.
3.1-6.1 General
3.1-5.2.2.9 Grab bars. See Section 2.4-2.2.9 (Grab
See Section 2.5-1 (Building Systems for Residential
Bars) for requirements.
Health, Care, and Support Facilities-General).
3.1-5.2.2.10 Handrails. See Section 2.4-2.2.10

3.1-6.2 Plumbing Systems
(Handrails and Lean Rails) for requirements.
3.1-6.2.1 General
3.1-5.2.2.11 Protection from heated surfaces. See
Section 2.4-2.2.11 (Protection from Heated Surfaces) See Section 2.5-2.1 (Plumbing Systems-General) for
for requirements. additional requirements.
3.1-5.2.2.12 Signage and wayfinding. See Section 3.1-6.2.2 Plumbing and Other Piping Systems
2.4-2.2.12 (Signage and Wayfinding) for requirements. See Section 2.5-2.2 (Plumbing and Other Piping
Systems) for requirements.
3.1-5.2.2.13 Decorative water features. Where
decorative water features are used in the facility design, 3.1-6.2.3 Plumbing Fixtures
see appendix section A2.4-2.2.13 (Decorative water
features) for recommendations. 3.1-6.2.3.1 Reserved
3.1-5.2.3 Surfaces 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
3.1-5.2.3.1 See Section 2.4-2.3 (Surfaces) for require (Hand-Washing Stations) for requirements.
3.1-6.2.3.3 Showers. See Section 2.5-2.3.3.2
*3.1-5.2.3.2 To reduce surface contamination linked (Accessible showers) for requirements and appen
to health care-associated infections, surface materials dix section A3.1-2.2.2.7 (3) (Accessible shower) for
selected for use in nursing homes shall possess the fol recommendations.
lowing performance characteristics:
(1) Surfaces shall be cleanable and have no surface
crevices or rough textures, joints, or seams.
(2) Surfaces shall be non-absorptive, nonporous, and 3.1-6.2.3.5 Clinical sinks. See Section 2.5-2.3.5
smooth. (Clinical Sinks) for requirements.
3.1-5.2.4 Furnishings 3.1-6.2.3.6 Portable hydrotherapy whirlpools. See

Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools)
See Section 2.4-2.4 (Furnishings) for requirements.
for requirements.
• APPENDIX,
A~.1-5.2.3.2S.urfaces and materials sel~cted shouldb~easy to can be _d~signed tohelp~liminate harm." Such "built environment
use and have clear, written, manufactureHecommended cleaning latent conditions [holes and weaknesses] that adversely impact patient
and disinfection protocols to assure the product willr~tnaih dUrable safety" should be identified and eliminated during the planning,
and eff~ctiv,e at meeting'COC andoth~r c1ini(al bact~rial-~Iimination design, and construction of health care facilities. Redunion of surface
requirements. contamination linked to health care-associated infections is one of
The Centerfor Health D~sign report "Designing for Patient Saf~tY: these factors. See Section 1.2-3 (Resident Safety RiSk i\ssessment) for
nev~loping Methods to Il1tegrat~ Pati~nt Safety Conc~rns in the O~sign additional information.
Process" identified environmental factors as"latent conditions that
--------------------------------------------------- ------
142 Guide ines for Design and Construction of Residential Health, Care, and Support Facilities
3.1-6.2.4 Medical Gas and Vacuum Systems be obtained from Informative Appendix B
Any installation of nonflammable medical gas, air, or in ANSI!ASHRAE 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 ANSI!
ASHRAE Standard 62.2: Ventilation and
3.1-6.3 Heating, Ventilation, and
Acceptable Indoor Air Quality in Low-Rise
Residential Buildings.
(iii) Where spaces with prescribed rates are in
3.1-6.3.1 General cluded in both ANSI!ASHRAE Standard
62.1 or 62.2 and Table 3.1-1, the higher
3.1-6.3.1.1 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
nursing homes. total air changes per hour indicated in Table
3.1-1 shall be either supplied for positive
3.1-6.3.1.2 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 those
(i) For spaces that required by Table 3.1-1 to
in this section.
have a negative pressure relationship but
*(2) Ventilation systems shall be designed to provide
are not required to be exhausted, the sup
control of environmental comfort, asepsis, and
ply airflow rate shall be used to compute
odor control in resident spaces.
the minimum total air changes per hour
(a) Design of the ventilation system shall provide required.
air movement that is generally from clean to *(ii) For spaces that require a positive or nega
less clean areas. If any form of variable-air tive pressure relationship, the number of
volume or load-shedding system is used for air changes per hour can be reduced when
energy conservation, it shall not compromise the space is unoccupied as long as the
the pressure-balancing relationships or the required pressure relationship to adjoin
minimum air changes required in Table ing spaces is maintained while the space
3.1-1 (Design Parameters for Ventilation of is unoccupied and the minimum number
Residential Health Spaces). of air changes indicated is reestablished
(b) See Table 3.1-1 for ventilation requirements whenever the space is occupied.
intended to provide for comfort and asepsis
(e) Use of controls intended to switch the required
and odor control in nursing home spaces that
pressure relationships between spaces from
directly affect resident care.
positive to negative, and vice versa, shall not be
(c) For spaces not specifically listed in Table 3.1.1:
permitted.
(i) Ventilation requirements shall be those (f) For air-handling systems serving multiple
for functionally equivalent spaces in Table spaces, system minimum outdoor air quantity
3.1-1. shall be calculated using one of the following
(ii) If no functionally equivalent spaces exist in methods:
Table 3.1-1, ventilation requirements shall
(i) As the sum of the individual space require
ments
APPENDIX
A3.1-6.3.1.2 (2) Ventilation system design. Because A3.1-6..3.1.2 (2)(d)(ii) Air exchang,es. Air change rates in
of the diversity of the population and variations in susceptibility and excess of the minimum values are expected in some cases to maintain
sensitivity, the specific care population's needs should be taken into room temperature and humidity conditions based on the cooling or
consideration when prOViding ventilation for comfort, infection control, heating load of the space.
and odor control.
----_.'._- - - - - - - - - - - - - - - - - -
(ii) By the "ventilation rate procedure" (mul (1) For centralized recirculated systems, see Table 3.1-1
tiple zone formula) of ASH RAE Standard (Design Parameters for Ventilation of Residential
62.1. The minimum outdoor air change Health Spaces) for required filter efficiencies.
rate listed in this standard shall be inter
(a) Each filter bank with an efficiency greater than
preted as the V oz (zone outdoor airflow)
MERV 12 shall be provided with an installed,
for purposes of this calculation.
readily accessible manometer or differential
(3) Outdoor air intakes and exhaust discharges. pressure-measuring device that provides a
Equipment shall comply with Table 5.5.1 (Air reading of differential static pressure across the
Intake Minimum Separation Distance) in ANSI! filter to indicate when the filter needs to be
ASHRAE Standard 62.1. replaced.
(b) All air provided to a space by centralized
3.1-6.3.2 Mechanical System Design recirculated systems shall be filtered.
See Section 2.5-3.2 (Mechanical System Design) for (2) For non-central recirculating room systems, HVAC
requirements. units shall:
3.1-6.3.3 HVAC Requirements for Specific (a) Not receive nonfiltered, nonconditioned
Locations outdoor air.
(b) Serve only a single space.
3.1-6.3.3.1 Reserved *(c) Include the manufacturer's recommended filter
for airflow passing over any surface that is
3.1-6.3.3.2 Fuel-fired equipment rooms. See designed to condense water. This filter shall be
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for located upstream of any such cold surface so
requirements. that all of the air passing over the cold surface
is filtered.
3.1-6.3.3.3 Areas of refuge. See Section 2.5-3.3.3
(Areas of Refuge) for requirements. 3.1-6.3.6.2 Filter frames for centralized systems
(1) Filter frames shall be durable and proportioned to
3.1-6.3.3.4 Commercial food preparation areas. provide an airtight fit with the enclosing ductwork.
See Section 2.5-3.3.4 (Commercial Food Preparation (2) All joints between filter segments and the enclosing
Areas) for requirements. ductwork shall have gaskets or seals to provide a
positive seal against air leakage.
3.1-6.3.4 Thermal and Acoustic Insulation
See Section 2.5-3.4 (Thermal and Acoustic Insulation) 3.1-6.3.7 Heating Systems, Cooling Systems, and
for requirements. Equipment
3.1-6.3.5 HVAC Air Distribution 3.1-6.3.7.1 Reserved
See Section 2.5-3.5 (HVAC Air Distribution) for

*3.1-6.3.7.2 Heating systems
requirements.
(1) Heating sources and essential accessories shall be
3.1-6.3.6 HVAC Filters provided in number and arrangement sufficient
to accommodate the facility needs (reserve
3.1-6.3.6.1 Filter efficiencies capacity) even when anyone of the heat sources
or essential accessories is not operational due to a
APPENDIX
A3.1-6.3.6.1 (2)(c) Filters for recirculating room A3.1-6.3.7.2 Heating systems. Storage on-site of fuel suf
systems. Filters should be replaced and/or cleaned per the manufac ficient to support the owner's facility operation plan upon loss of fuel
turer's recommendations to maintain indoor air quality. service should be considered as part of the disaster and emergency
preparedness plan.
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 nursing Standby Power Systems, requirements that
home is greater than or equal to 25° F (-40 C). address nursing homes
(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 nursing homes
for domestic hot water and dietary purposes and to
(b) Requirements for emergency lighting in
provide heating for resident care areas and resident
nursing homes shall be dictated by local codes
rooms.
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 nursing home is a
requirements. distinct part of or served by an acute care hospital
on the same campus, required emergency lighting
3.1-6.3.7.3 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
nursing home operation plan upon a breakdown continuous operation in accordance with state
or during routine maintenance of anyone of the requirements.
cooling sources. (b) Fuel storage for electricity generation shall be
(2) See Table 3.1-1 (Design Parameters for Ventilation separate from heating fuel storage.
of Residential Health Spaces) for additional
requirements. 3.1-6.4.2.2 Generators. Exhaust systems (including
locations, mufflers, and vibration isolators) for internal
3.1-6.3.7.4 Temperature control. See Section 2.5 combustion engines shall be designed and installed to
3.7.4 (Temperature Control) for requirements. minimize noise.
3.1-6.4 Electrical Systems 3.1-6.4.3 Electrical Receptacles
3.1-6.4.1 General 3.1-6.4.3.1 General. Omission of receptacles from

See Section 2.5-4.1 (Electrical Systems-General) for exterior walls where consttuction makes installation
requirements. impractical shall be permitted. See Section 2.5-4.3.1
(Electrical Receptacles-General) for additional
3.1-6.4.2 Power-Generating and Power-Storing information.
Equipment
3.1-6.4.3.2 Receptacles in corridors. See Section
3.1-6.4.2.1 Essential electrical service 2.5-4.3.2 (Receptacles in Corridors) for requirements.
(1) Applicable standards
*3.1-6.4.3.3 Receptacles in resident rooms
(a) At minimum, nursing homes or sections
(1) Each resident room shall have duplex-grounded
thereof shall have essential electrical systems as

receptacles, including at least one on each wall.
required in:
APPENDIX
A3.1-6.4.3.3 Resident room receptacles. During the resident and care uses in resident rooms that will require electrical
functional programming process, all equipment, electric beds, task receptacles should be identified during the functional programming
lamps, televisions, data equipment, telephones, electronics, and other process. Providing enough outlets to avoid the need for extension cords
(2) At least two duplex outlets shall be provided for 3.1-6.5.2.2 Resident room call stations
each bed location, with one at each side of the (1) Where a hardwired system is used, each bed
head of each bed location. Where electric-powered location shall be provided with a call device that is
beds are used, an additional outlet shall be accessible to the resident.
provided at the head of the bed.
(a) One call station shall be permitted to serve two
3.1-6.4.3.4 Essential electrical system receptacles. call devices.
See Section 2.5-4.3.4 (Essential Electrical System (b) Wireless call stations are permitted.
Receptacles) for requirements. (2) A call initiated by a resident activating either a
call device attached to a resident's call station or a
3.1-6.4.3.5 Ground fault interrupter receptacles. See portable device that sends a call signal shall register
Section 2.5-4.3.5 (Ground Fault Interrupter Recep at the staff call station or device and shall either:
tacles) for requirements.
(a) Activate a visual signal in the corridor at the
3.1-6.4.4 Electrical Requirements for Ventilator resident's door. In multi-corridor or cluster
Dependent Resident Rooms and Areas resident units, additional visual signals shall be
installed at corridor intersections; or
See Section 2.5-4.4 (Electrical Requirements for
(b) Activate a handheld mobile device carried by a
Ventilator-Dependent Resident Rooms and Areas) for
staff member, identifYing the specific resident
requirements.
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
call device shall be accessible from each toilet, bathtub,
3.1-6.5.1 General
and shower used by residents.
See Section 2.5-5.1 (Communication Systems
(1) The device shall be accessible to a resident in any
General) for requirements.
position in the room, including lying on the floor.
Inclusion of a pull cord or portable wireless device
3.1-6.5.2 Call System
shall satisfY this requirement.
A nurse/staff call system shall be provided. (2) The emergency call system shall be designed so
that a call activated will initiate a signal that is
3.1-6.5.2.1 General distinct from the resident room call device and can
(1) Use of alternative technologies, including wireless be turned off only at the activated emergency call
systems, shall be permitted for emergency or nurse device.
call systems. (3) The signal shall activate at the staff work area and/
or signal a handheld mobile device carried by staff.
(a) Where wireless systems are used, consideration
shall be given to electromagnetic compatibility
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.
-----------"-_._-------"---------
3.1-6.5.4 Grounding for Telecommunication illumination with provisions for reducing light
Spaces levels at night.
See Section 2.5-5.4 (Grounding for Telecommunica (b) Corridors and common areas used by residents
tion Spaces) for requirements. shall have even light distribution to avoid
glare, shadows, and scalloped lighting effects.
3.1-6.5.5 Cabling Pathways and Raceway (2) Resident rooms and toilet rooms. These rooms
Requirements shall have general lighting, task lighting, and night
See Section 2.5-5.5 (Cabling Pathways and Raceway lighting.
(a) Task lighting
3.1-6.6 Electronic Safety and Security Systems *(i) At least one task light shall be provided for
See Section 2.5-6 (Electronic Safety and Security each resident.
Systems) for requirements. (ii) Task light controls shall be readily accessi
ble to residents and staff at the head of the
3.1-6.7 Daylighting and Artificial Lighting bed (including multiple-bed locations).
Systems *(b) Night-lighting. Night-lighting shall be pro
vided in the pathway to and from the bedside
3.1-6.7.1 General and the bathroom.
See Section 2.5-7.1 (Daylighting and Artificial Light
(i) Night-lighting shall be mounted no higher
ing Systems-General) for requirements.
than 2 feet (61 centimeters) above the
floor.
3.1-6.7.2 Daylighting Systems in Resident Living
(ii) Night-lighting shall be controlled sepa
Areas
rately from ambient lighting.
See Section 2.5-7.2 (Daylighting Systems in Resident, *(iii) Night-lighting shall have a low light level.
Participant, and Outpatient Areas) for requirements. (iv) Because night-lights may disturb resi
dent sleep even when properly specified,
3.1-6.7.3 Artificial Lighting Systems located, and operated, care providers shall
be permitted to use portable light sources
3.1-6.7.3.1 Light fixtures. See Section 2.5-7.3.1 or switched night lights for added control
(Light Fixtures) for requirements. of this light source.
3.1-6.7.3.2 Lighting requirements for specific loca (c) Resident unit toilet rooms shall have general
tions. See appendix section A2.5-7.3.2 (Lighting in illumination with provision for reducing light
transition spaces) for recommendations. levels at night.
(1) Resident unit corridors

3.1-6.8 Acoustic Design Systems
(a) Resident unit corridors shall have general See Section 2.5-8 (Acoustic Design Systems) for
requirements.
call system stations. This evaluation should consider the care model, darkness. Therefore, to minimize residentsleep disruption, night-lights
care population, scale of the facility, and staff sight lines for observing should provide very low levels of illumination and be located to mini
residents. mize light scatter and reflections on room surfaces. Switches for night
lights are recommended for some care populations.
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 )(iii) Night-lighting should include amber or
red lamping. White, blue, or green lamping should not be used.
A3.2-6.7.3.2 (2)(b) Night-lighting in resident
rooms. Research has established that older adults sleep best in total
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 Elevator car doors shall have a clear opening of not less
gurney, and/or medical carts and resident-operated than 3 feet 8 inches (1.12 meters).
mobility device users shall be installed where
residents are living or receiving health, care, or 3.1-6.9.3 Leveling Device
support services on any floor other than the main See Section 2.5-9.3 (Leveling Device) for
entrance floor. requirements.
(2) At least two elevators shall be installed where 60 to
200 residents are living or receiving health, care, 3.1-6.9.4 Installation and Testing
or support services on floors other than the main
See Section 2.5-9.4 (Installation and Testing) for
entrance floor.
requirements.
(3) At least three elevators shall be installed where
201 to 350 residents are living or receiving health,
3.1-6.9.5 Handrails
care or support services on floors other than main
entrance floor. Elevator cars shall have handrails on all sides without
(4) For facilities with more than 350 residents living entrance door(s). See Section 2.4-2.2.10 (Handrails
and Lean Rails) for additional requirements.
or receiving health, care, or support services above
---_._------------.--_._----_._--_._----------_.__._.----_._.. __ _
..... ..
148 Guidelines for Design and Construction of Residential Health, Care, and Support Fac!lities
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 - - - -
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.
----_._-----_._-------------------.- -- -_. __ .... _-_ .. _._. __.

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
:J
0.
I:>
Vl
Technology solutions are recommended to minimize overhead paging. c
C Wireless systems should be considered. ::0
m
'0
'0
0
7. Characteristics and criteria for selection of materials and products for s:m
~
~
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
() recommended that such input be sought and that facilities encourage "l"I
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
::J:
...
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
f'l
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
I:)
0.
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
-i
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
\0
:::J
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
:::J
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
:::J
.... 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
-
OJ
....
::r
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.
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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

and developmental disability design criteria. Where
3.2-1.1 Application the care population includes residents with dementia,
mental health issues, or cognitive or developmental
3.2-1.1.1 General disabilities, see Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive and Devel
*3.2-1.1.1.1 This chapter contains specific require
opment Disabiliry Facilities) for requirements.
ments for freestanding hospice facilities and separately
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

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.
3.2 SPECIFIC REQUIREMENTS FOR HOSPICE FACILITIES
*3.2-1.4.3 Supportive Environment 3.2-2.1 General

The facility design shall produce a supportive environ The requirements in this section shall apply to hospice
ment to enhance quality of life for residents and their facilities that include the space types described.
families and friends and promote privacy and dignity
for those receiving hospice care. *3.2-2.2 Resident Unit
3.2-1.4.4 Barrier-Free Environment 3.2-2.2.1 General

The architectural design-through organization
of functional space, specification of ergonomically 3.2-2.2.1.1 Hospice unit size. In the absence of
appropriate and arranged furniture and equipment, local requirements, consideration shall be given to
and selection of details and finishes-shall eliminate as restricting the size of the care unit to a maximum of
many barriers as possible to access by families, friends, 25 beds unless just cause can be demonstrated and
staff, and residents to space, services, equipment, and approval obtained from the local authority having
utilities that support the resident receiving hospice jurisdiction (AHJ).
services.
*3.2-2.2.1.2 Layout
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
unit.
*(2) The facility layout shall reflect the care model and
• 3.2-2 Resident Areas related staffing.
, • APPENDIX.
A3.~-1.4.3 Person-centered care in hospice care settings should setting (either with family or other caregivers). Adult day care
address movement away from atraditional model toward one that is hospice services are provided for residents with family caregivers
residential in scale; includes homelike amenities for families, friends, who work during the day. Adult day care hospice services may be
and residents; and goes beyond atypical medical model to address tile provided in private space in astandard adult day care or adult day
emotional and spiritual needs of patients and their loved ones. Hospice health care center that has been set aside for residents receiving
facilities, treatments, and services generally are not aimed at acure but hospice services.
may include complementary therapies that promote safety and comfort. b. Home-based hospice services. This model includes services that are
Many residents are in advanced stage's of illness with weeks or days to brought to a resident living in an assisted living facility or inde
live. pendent liVing setting. Home-based hospice services are provided
for residents who live in an independent or assisted living. setting.
A3.2-1.5 Parking. Provision of a minimum of one additional
Hospice services to be proVided hy acare and support facility, if any,
parkingspace for every four beds should be considered for afreestand
should be identified during the functional programming process.
ing hospice facility.
c. Small ambulatory residential care hospice facilities. This model
A3.2-2.2 Resident units are groups of resident rooms and support typically includes 6to no more than lS private beds in asmall group
areas whose size and layout are based on the care model staffing pat home for ambulatory residents. These facilities are provided for
terns, functional operations, and communications used in the facility. residents who are still ambulatory but need hospicll services.
d. Small non-ambulatory inpatient care'hospice facilities. This model
A3.2-2.2.1.2 Overwhelming fatigue is the predominant complaint
typically includes 6to no more than 15 private beds in asmall
of hospice residents and staff. Arranging groups of resident rooms
group home setting for non-ambulatory residents or acombination
adjacent to decentralized service areas, optional satellite staff work
of ambulatory .and non-ambulatory residents. These facilities are
areas, .and optional decentralized resident support areas to reduce travel
proVided for reSidents who are predominantly non-ambulatory.
distances should be considered.
e. Freestanding hospice facilities. This model typically includes 16 or
A3.2-2.2.1.2 (2) Hospice care models. See appendix more beds in a large group home setting. Freestanding hospice
table A3.2-a (Hospice Care Model Characteristics) for information in facilities offer acute care end-of-life services, which should be
addition to the care model descriptions below. prOVided in private rooms that includeadequate'family space.
a. Adult day care hospice. This madel includes day services for residents f. Hospital-based hospice facilities. This model follows hospice regula
receiving hospice services while living in an independent liVing 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

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.
These facilities prov,ide acute care end-of-lifeservices and should be -Standard resident room:
,lOCated in adedicated area with private rooms that include adequate • 48 inches (121.92centimeters) on the transfer side
family space. • 36 inches (91.44 centimeters) on the non-transfer side of
g. Nursing home-basedhospice facilities. This model follows hospice the bed
regul,ations and includes anynumber of beds housed in a nursing • 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 .. 72 inches (182.88 centimeters) from the bed by 120 inches
adequate family space. Nursing homes should proVide hospice ser long (304.Scentimeters) on the transferside
vices and related accommodations for residents. and family: • 36 inches (91.44 centimeters) on the non-transfer side of
the bed
A3.2-2.2.2.1 Consideration should be given toaEEOmmodating
• 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
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
*(c) Resident and visitor seating (2) Ptovision shall be made for resident and family to
completely darken the resident room.
*(i) Space for seating for residents and visitors
shall be provided.
3.2-2.2.2.4 Resident privacy
(ii) The room shall be configured so that each
resident can view the television from a *(1) Visual privacy shall be provided for each resident in
resident chair. multiple-bed rooms.
(4) Space shall be provided for at least one sleeping
to the toilet, room entrance, window, or other
accommodation for visitors in resident rooms.
(a) Allow space for circulation when the sleeping
accommodation (e.g., recliner, sleep chair, 3.2-2.2.2.5 Hand-washing station. A hand-washing
sleep sofa) is fully open for use so staff can station shall be provided in each resident room.
access the resident in case of an emergency. (1) Omission of this station shall be permitted in a
(b) Provide storage space to accommodate and single-bed or two-bed room where a hand-washing
secure overnight guests' belongings. station is located in an adjoining toilet room that
serves that room only.
*(5) Space to accommodate resident food storage,
(2) Design requirements
refrigeration, and reheating shall be located in the
resident room or in an area close to resident rooms. (a) For hand-washing station design details, see
See Section 2.3-2.3.4 (Resident and Participant Section 2.4-2.2.8 (Hand-Washing Stations).
Kitchen) for additional information for resident (b) For sink design, see Section 2.5-2.3.2
and family kitchen areas outside the resident room. (Plumbing Fixtures-Hand-Washing Sinks).
(c) For casework details, see Section 2.4-2.4.2
*3.2-2.2.2.3 Window (Casework, Millwork, and Built-Ins).
(1) See Section 2.4-2.2.6 (Windows) in addition to the
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.
*(1) One toilet room shall serve no more than two requirements in Section 3.2-2.2.2.6 (Resident toilet
residents in a bedroom. room):
(2) Space requirements (1) Space shall be provided for drying, dressing, and
(a) Toilet rooms shall be sized and configured to grooming.
accommodate: (2) A counter and a shelf or cabinet for personal item
storage shall be provided. See Section 2.4-2.4.2
(i) Staff assistance, including use of lifting (Casework, Millwork, and Built-Ins) for details.
equipment
(ii) Accessibility standards that support inde
pendent resident use
I*(3) See Section 2.5-2.3.3.2 (Accessible showers) for
shower requirements.
(b) Clearance shall be provided on both sides 3.2-2.2.2.8 Resident storage. Each resident shall be
of the toilet to enable physical access and provided with an individual wardrobe or closet.
maneuvering by staff members assisting the (1) This storage shall have a minimum net depth of
resident with wheelchair-to-toilet transfers and 24 inches (55.88 centimeters) and a minimum net
returns. width of2 feet 6 inches (76.20 centimeters).
(2) A clothes rod shall be provided that can be
(3) The toilet room shall contain the following:
adjusted to a height accessible to the resident.
(a) Toilet Accommodations shall be made for storage of full
(b) Hand-washing station length garments.
(c) Mirror. For requirements, see Section 2.4 (3) A shelf shall be provided that can be adjusted to a
2.2.8.7 (Mirror). height accessible to the resident. Omission of the
(d) Individual storage for the personal effects of shelf shall be permitted where the unit provides at
each resident least two accessible drawers.
(4) Doors and door hardware shall be provided in
3.2-2.2.3 Special Care Resident Rooms

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 pice facilities that include these room types.
(a) Grab bars shall be provided in accordance with
Section 2.4-2.2.9 (Grab Bars). *3.2-2.2.3.1 Airborne infection isolation room
(b) Where residents are capable of independent (1) General
transfers, alternative grab bar configurations
(a) The need for and number of All rooms shall
shall be permitted.
be determined by an infection control risk
assessment.
3.2-2.2.2.7 Resident bathroom. Where a bathtub
(b) Where provided, each Ail room shall comply
or shower is provided in the resident toilet room, the
with the requirements in Section 3.2-2.2.2
following requirements shall be met in addition to the
(Resident Room) as well as the following
requirements:
APPENDIX
A3.2-2.2.2.6 (1) On October 4/2016/ the Centers for Medicare A3.2-2.2.2.7 (3) Accessible shower. Provision of acurbless
& Medicaid Services (CMS) published afinal rule on the "Reform of shower that is open to the surrounding bathroom should be considered
Requirements for Long-Term Care Facilities;' CMS-3260-F, in the Federal for ease of access by resident and staff.
Register. This rule revises the requirements that long-term care facilities
A3.2-2.2.3.1 For additional information, refer to the Centers for
must meet to participate in the Medicare and Medicaid reimbursement
Disease Control and Prevention (CDC) publications "Guidelines for Pre
programs. Effective November 28,2016/ each resident room must have
venting the Transmission of Mycobacterium tuberculosis in Health-Care
a maximum capacity oftwo residents and adedicated bathroom with at
Settings"and "Guidelines for Envirorimentallnfection Control in Health
least atoilet and sink. Look for gUidance on room configurations to meet
Care Facilities."
CMS requirements under the Resources tab on the FGI website.
3.2 SPECIFIC REQUIREMENTS fOR HOSPICE FACILITIES
(2) Capacity. Each resident room shall contain only (iii) Use of recirculating devices with HEPA fil
one bed. ters shall be permitted in existing facilities
(3) The roiler room provided for each All room shall as interim, supplemental environmental
include a shower. controls to meet requirements for the
(4) Anteroom. An anteroom is not required; however, control of airborne infectious agents. The
where an anteroom is part of the design concept, it design of such recirculating systems shall
shall meet the following requirements: allow for easy access for scheduled preven
tive maintenance and cleaning. The design
(a) The anteroom shall provide space for persons
of either portable or fixed recirculating
to don personal protective equipment before
systems shall prevent stagnation and short
entering the resident room.
circuiting of airflow.
(b) All doors to the anteroom shall have self
(iv) Design relative humidity shall be a maxi
closing devices.
mum of 60 percent.
(5) Where no anteroom is provided, provision shall be
made for srorage of personal protective equipment *3.2-2.2.3.2 Ventilator-dependent resident units.
at the entrance to the room. Where a unit dedicated to serving residents dependent
(6) Special design elements on a ventilator is provided, resident rooms in this unit
shall meet the following requirements in addition to
(a) Architectural details
those in Section 3.2-2.2.2 (Resident Room).
(i) All room perimeter walls, ceiling, and (1) Resident rooms for ventilaror-dependent residents
floor, including penetrations, shall be shall have:
sealed tightly so that air does not infiltrate
the environment from the outside or from (a) Space for the ventilator unit at the bedside
other spaces. (b) Space to accommodate clearances for resident
(ii) All rooms shall have self-closing devices operated mobility devices that may be
on all room exit doors. oversized to accommodate a ventilator
(c) Provisions for oxygen and suction. See Section
(b) Window treatments and privacy curtains 3.2-6.2.4 (Medical Gas and Vacuum Systems)
shall be provided in accordance with Section for requirements.
2.4-2.4.4 (Window Treatments and Privacy (d) Backup electrical requirements. See Section
Curtains). 2.5-4.4 (Electrical Requirements for
(c) Ventilation Ventilator-Dependent Resident Rooms and
(i) Ventilation upon loss of electrical power. Areas) for requirements.
The space ventilation and pressure re (2) Resident support areas
lationship requirements ofTable 3.1-1
(Design Parameters for Ventilation of Resi (a) Support space shall be provided in the nursing
dential Health Spaces) shall be maintained unit to accommodate staffing associated with
for All rooms, even in the event of loss of ventilator services.
normal electrical power. (b) A dedicated space shall be provided for
*(ii) Use of recirculating room units shall not servicing and maintenance of ventilator
be permitted in new construction. equipment or storage shall be provided to
APPENDIX ~
A3.2-2.2.3.1 (6)(c)(ii) Use of recirculating,room units is prohib" A3.2-2•.2.3.2 Where adedicated unit is provided for ventilator
itedin new construction due tothedifficulty of deaning the units and dependent residents, piped oxygen and vacuum should be provided.
the potential forbuildup of contamination in theA" room. 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.
accommodate ventilators for backup or and Lounge Areas-General) for additional

exchange. requirements.
(c) All resident activity and support areas shall
be provided with essential power outlets to 3.2-2.3.3.2 Dining areas
support continued ventilator support in the (1) See Section 2.3-2.3.3.2 (Dining areas) for
event of a power outage. See Section 2.5-4.4 requirements in addition to those in this section.
(Electrical Requirements for Ventilator (2) See Section 3.2-2.2.2.2 (3)(a) (Resident Room
Dependent Resident Rooms and Areas) for Space requirements) for requirements for dining
additional requirements. accommodations in resident rooms.
(3) Dining areas separate from those for residents and
3.2-2.2.3.3 Quiet room in a resident unit. Where visitors shall be provided for staff.
a single resident room is provided to accommodate
care requirements for residents experiencing issues (a) Combination of the staff dining area and a
such as personal conflicts, agitation, episodic mental staff break!report area shall be permitted.
disturbances, or similar conditions, the requirements (b) See Section 3.2-4.3.2 (Staff Lounge) for
in Section 2.3-2.2.3.3 (Quiet room in a resident requirements.
carelliving area) shall be met in addition to the
requirements in Section 3.2-2.2.2 (Resident Room). *3.2-2.3.3.3 Recreation, lounge, and activity areas.
Lounge areas shall be provided for resident and visitor
3.2-2.3 Resident Community Areas use based on the number of residents being served.
3.2-2.3.1 General 3.2-2.3.3.4 Toilet rooms. Toilet facilities that accom

modate resident-operated mobility devices shall be
See Section 2.3-2.3.1 (Resident, Participant and
readily accessible to all dining, recreation, lounge, and
Outpatient Community Areas-General) for
activity locations.
requirements.
3.2-2.3.4 Resident Kitchen

3.2-2.3.2 Lobby
Where kitchen facilities that permit use by resi
Where a central lobby is provided, see Section 2.3

dents and family members are provided, see Section
2.3.2 (Lobby) for requirements.

2.3-2.3.4 (Resident and Participant Kitchen) for
requirements.
3.2-2.3.3 Dining, Recreation and Lounge Areas
*3.2-2.3.5 Personal Services (Hair Salon/Spa) Areas

3.2-2.3.3.1 General
Where a hair salon is provided:
(1) Space for dining and recreation shall be provided
to meet the needs of the care model. (1) Mechanical ventilation and exhaust shall be
(2) See Section 2.3-2.3.3.1 (Dining, Recreation, provided. See Table 3.1-1 (Design Parameters
APPENDIX
A3.2-2.3.3.3 Recreation and lounge areas -Storage for supplies and linens
a. Aminimum of 15 square feet per resident is recommended for sizing -Provisions for resident privacy·
recreation and lounge area(s) for resident and visitor use. b. Hair salon
b. Provision of smaller-scaled lounge spaces close to groups of resident -Adjustable sink bowls for shampooing and treatment
rooms should be considered. -Freestanding dryers for use by resid~nts using resident-operated
mobility devices
A3.2-2.3.S Personal services areas. Where personal
-Location oftoilet room adjacent to or directly accessible from
services are proVided, consideration should be given to providing the
hair salon
following in the design ofthese areas:
c. Space for circulation and staff assistance around spa tubs
a. General
-Changing areas
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
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 3.2-3.1 General
in this section. See Section 2.3-2.3.4 (Resident and See Section 2.3-3.1 (Diagnostic and Treatment
Participant Kitchen) for additional information. Areas-General) for requirements.
(1) Children's playroom
(2) Family kitchenette 3.2-3.2 Examination and Treatment Room
(3) Dining area Where an examination room and/or treatment room(s)
is provided, see Section 2.3-3.2 (Examination, Obser
3.2-2.3.6.2 Inclusion of a gas fireplace shall be permit vation, and/or Treatment Rooms) for requirements.
ted in a family room where non-operable glass doors
are used.
• 3.2-4 Facilities for Support Services
3.2-2.3.7 Quiet Room and/or Meditation Area
3.2-4.1 General
3.2-2.3.7.1 Quiet room in a resident area. Where a See Section 2.3-4.1 (Facilities for Support Services
quiet room is provided, see Section 2.3-2.3.7 (Quiet General) for requirements.
Room in a Resident or Participant Community Area)
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.
Storage Locations) for requirements.
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
3.2-4.2.3.1 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 See Section 2.3-4.2.5 (Clean Utility Room) for
that is available to all residents shall be provided. requirements.
(2) Additional bathtubs or showers shall be provided as
required to serve the unit size and care population. 3.2-4.2.6 Soiled Utility Room
See Section 2.3-4.2.6 (Soiled Utility Room) for
3.2-4.2.3.3 Accessibility requirements.
(1) The bathtub or spa tub in this room shall be
accessible to residents in wheelchairs. 3.2-4.2.7 Personal Laundry Facilities
(2) The shower shall have fittings accessible to a See Section 2.3-4.2.7 (Personal Laundry Facilities) for
resident in a recumbent position. requirements.
(3) Adult resident shower rooms shall be designed to
allow entry of portable/mobile mechanical lifts, 3.2-4.2.8 Resident Telephone Access
shower gurney devices, and shower chairs.
3.2-4.2.3.4 A separate toilet and hand-washing sta

tion shall be provided in or directly accessible to each
bathing area without requiring entry into the general
corridor.
3.2-4.3.1 General

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.

(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.
3.2-4.3.2 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
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.
3.2-4.4.1.1 Where a sleeping accommodation (e.g.,

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
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.
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.
(2) Washers/extractors. Washers/extractors shall be 3.2-4.6.4 Support Areas for Facilities Using
located between the soiled linen receiving and Off-Site linen Processing
clean processing areas. Where linen is processed off-site or in a separate
(3) Dryers building on-site, the following shall be provided:
(4) Supply storage. Storage shall be provided for
laundry supplies. 3.2-4.6.4.1 A service entrance, protected from
(5) Inspection and mending area. An area shall be inclement weather. This shall be permitted to be shared
provided for linen inspection and mending. with other services.
3.2-4.6.3 Support Areas for linen Services 3.2-4.6.4.2 A control station, which can be shared
with other services
3.2-4.6.3.1 Central clean linen storage. A cen
tral clean linen storage and issuing room(s) shall be 3.2-4.7 Materials Management Facilities
provided in addition to the linen storage required at
individual resident units. See Section 2.3-4.2.5 (Clean
for requirements. However, materials management
Utility Room) for additional information.
services do not require duplication where those services
are available as part of an adjacent health care facility.
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 See Section 2.3-4.8 (Waste Management Facilities) for
ments in addition to those in this section. waste collection, storage, and disposal requirements.
(1) Room(s) shall have ventilation and exhaust.

3.2-4.9 Environmental Services Rooms
(2) Discharge from soiled linen chutes shall be received
in this room or in a separate room, as required by See Section 2.3-4.9 (Environmental Services Rooms)
the local authority having jurisdiction. for requirements.
(3) Room(s) used for processing shall have a deep sink
for soaking and/or a flushing-rim sink. 3.2-4.10 Facilities for Engineering and
Maintenance Services
3.2-4.6.3.3 Linen carts See Section 2.3-4.10 (Facilities for Engineering and
(1) Provisions shall be made for parking clean and Maintenance Services) for requirements.
soiled linen carts separately and out of traffic.
(2) Provisions shall be made for cleaning linen carts on 3.2-4.11 Administrative Areas
premises (or for exchange of carts off premises).
3.2-4.11.1 Office and Conference Space
3.2-4.6.3.4 Hand-washing stations
Offices or an open office area with private confer
(1) Hand-washing stations shall be provided in each ence space shall be provided for business transactions,
area where unbagged soiled linen is handled. admissions, and social services and for the use of
(2) See Section 2.4-2.2.8 (Hand-Washing Stations) for administrative and professional staff.
additional requirements, except for Section
2.4-2.2.8.7 (Hand-Washing Stations-Mirror). *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.
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.
(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

ence spaces required in Section 3.2-4.11.1 (Office and
Conference Space) shall be permitted to be included
in or shared with other office suites where the hospice

services are provided in another health care setting.
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.
(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.

(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

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.


Requirements

3.2-5.2.2.6 Windows. See Section 2.4-2.2.6
(Windows) for requirements.
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
3.2-5.2.2.9 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

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
3.2-5.2.3.1 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

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
requirements.
The Center for Health Design report "Designing for Patient Safety:
Developing Methods to Integrate Patient Safety Concerns in the Design
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
Acceptable Indoor Air Quality in Low-Rise
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
but are not required to be exhausted shall
environmental comfort, asepsis, and odor control
utilize the supply airflow rate to compute
in resident spaces.
the minimum total air changes per hour
(a) Design of the ventilation system shall provide required.
air movement that is generally from clean to *(ii) For spaces that require a positive or nega
less clean areas. If any form of variable-air tive pressure relationship, the number of
volume or load-shedding system is used for air changes per hour can be reduced when
energy conservation, it shall not compromise the space is unoccupied as long as the
the pressure-balancing relationships or the required pressure relationship to adjoin
minimum air changes required in Table ing spaces is maintained while the space
3.1-1 (Design Parameters for Ventilation of is unoccupied and the minimum number
Residential Health Spaces). of air changes indicated is reestablished
(b) See Table 3.1-1 for ventilation requirements whenever the space is occupied.
intended to provide for comfort and asepsis
(e) Use of controls intended to switch the required
and odor control in hospice spaces that
pressure relationships between spaces from
directly affect resident care.
positive to negative, and vice versa, shall not be
(c) For spaces not specifically listed in Table 3.1-1:
permitted.
(i) Ventilation requirements shall be those (f) For air-handling systems serving multiple
spaces, system minimum outdoor air quantity
APPENDIX
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.
shall be calculated using one of the following 3.2-6.3.6 HVAC Filters

methods:
3.2-6.3.6.1 Filter efficiencies
(i) As the sum of the individual space require
ments (1) For centralized recirculated systems, see Table 3.1-1
(ii) By the "ventilation rate procedure" (multiple (Design Parameters for Ventilation of Residential
zone formula) of AS H RAE Standard 62.1. Health Spaces) for required filter efficiencies.
The minimum outdoor air change rate (a) Each filter bank with an efficiency greater than
listed in this standard shall be interpreted MERV 12 shall be provided with an installed,
as the V oz (zone outdoor airflow) for pur readily accessible manometer or differential
poses of this calculation. pressure-measuring device that provides a
(3) Outdoor air intakes and exhaust discharges. reading of differential static pressure across the
Equipment shall comply with Table 5.5.1 (Air filter to indicate when the filter needs to be
Intake Minimum Separation Distance) in ANSI/ replaced.
ASHRAE Standard 62.1. (b) All air provided to a space by centralized
recirculated systems shall be filtered.
3.2-6.3.2 Mechanical System Design (2) For non-central, recirculating room systems,
See Section 2.5-3.2 (Mechanical System Design) for HVAC units shall:
requirements.
(a) Not receive nonfiltered, nonconditioned
outdoor air.
3.2-6.3.3 HVAC Requirements for Specific
Locations
*(c) Include the manufacturer's recommended filter
designed to condense water. This filter shall be
located upstream of any such cold surface, so
3.2-6.3.3.2 Fuel-fired equipment rooms. See Sec
that all of the air passing over the cold surface
tion 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
is filtered.
requirements.
3.2-6.3.6.2 Filter frames for centralized systems

(Areas of Refuge) for requirements. (1) Filter frames shall be durable and proportioned to
provide an airtight fit with the enclosing ductwork.
3.2-6.3.3.4 Commercial food preparation areas. (2) All joints between filter segments and the enclosing
See Section 2.5-3.3.4 (Commercial Food Preparation ductwork shall have gaskets or seals ro provide a
Areas) for requirements. positive seal against air leakage.
3.2-6.3.4 Thermal and Acoustic Insulation 3.2-6.3.7 Heating Systems, Cooling Systems, and
Equipment
See Section 2.5-3.4 (Thermal and Acoustic Insulation)
for requirements.
3.2-6.3.5 HVAC Air Distribution

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.
*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

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.
*3.2-6.4.3.3 Receptacles in resident rooms (b) Wireless systems shall comply with UL
Standard 1069: Hospital Signaling and Nurse
Call Equipment.
(2) At least two duplex outlets shall be provided for (2) Nurse and emergency call systems shall be listed by
each bed location, with one at each side of the a nationally recognized testing laboratory (NRTL).
head of each bed location. Where electric-powered
beds are used, an additional outlet shall be 3.2-6.5.2.2 Resident room call stations
provided at the head of the bed.
(1) Where a hardwired system is used, each bed
location shall be provided with a call device that is
3.2-6.4.3.4 Essential electrical system receptacles.
accessible to the resident.
See Section 2.5-4.3.4 (Essential Electrical System
Receptacles) for requirements. (a) One call station shall be permitted to serve two
call devices.
3.2-6.4.3.5 Ground fault interrupter receptacles. (b) Wireless call stations are permitted.
See Section 2.5-4.3.5 (Ground Fault Interrupter
Receptacles) for requirements. (2) A call initiated by a resident activating either a
call device attached to a resident's call station or a
3.2-6.4.4 Electrical Requirements for Ventilator portable device that sends a call signal shall register
Dependent Resident Rooms and Areas at the staff call station or device and shall either:
See Section 2.5-4.4 (Electrical Requirements for (a) Activate a visual signal in the corridor at the
Ventilator-Dependent Resident Rooms and Areas) for resident's door. In multi-corridor or cluster
requirements. resident units, additional visual signals shall be
installed at corridor intersections; or
3.2-6.5 Communication Systems (b) Activate a handheld mobile device carried by a
staff member, identifYing the specific resident
3.2-6.5.1 General
and location from which the call was placed.
See Section 2.5-5.1 (Communication Systems
General) for requirements. *3.2-6.5.2.3 Emergency call system. An emergency
call device shall be accessible from each toilet, bathtub,
3.2-6.5.2 Call System and shower used by residents.
A nurse/staff call system shall be provided. (1) The device shall be accessible to a resident in any
3.2-6.5.2.1 General Inclusion of a pull cord or portable wireless device
(1) Use of alternative technologies, including wireless shall satisfY this requirement.
systems, shall be permitted for emergency or nurse (2) The emergency call system shall be designed so
call systems. 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.
APPENDIX
A3.2-6.4.3.3 Resident room receptacles. During the regulatory citations. As well, the outlet heightthat will promote ease of
functional programming process, all equipment, electric beds, task use by residents, staff, and family members should be determined.
lamps, televisions, data equipment, telephones, electronics, and other

A3.2-6.5.2.3 Hair salons, resident lounges, and all common
resident and care uses in resident rooms that will reqUire electrical
resident areas should be evaluated for incorporation of emergency
receptacles should be identified during the functional programming

call system stations. This evaluation shuuld consider the care model,
process. Providing enough outlets to avoid the need for extension cords
care population, scale of the facility, and staff sight lines for obserVing
is recommended as use of extension cords can be a hazard and lead to

residents.
(3) The signal shall activate at the staff work area and/
3.2-6.7.3.2 Lighting requirements for specific loca
tions. See appendix section A2.5-7.3.2 (Lighting in
transition spaces) for recommendations.
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

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

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.

3.2-6.7.1 General 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.
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
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.
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.

3.2-6.9.2 Dimensions
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.
entrance floor. 3.2-6.9.5 Handrails
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
entrance floor.
- - - - - _ .. _ __
.. ._----~--~--
...
""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'>
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
!P
V> resident room, o
\Q
private home or dwelling unit
::x:l
care mentioned ::t:
'"
OJ
in appendix
in a residential o
Vl
independent living
'"
0 .. section A3.2-1) -0
n or assisted living f"'I
o unit m
'Tl
...'"
V> :l>
f"'I
,..,c r
rl ..;
o m
o'"
Vl
..."
:>J
!P
V>
Q.
ro
'"
OJ
I
!P
OJ
::7
n
OJ
~
ro
OJ
:J
0..
V1
c
<J
v
o
...
~
",..,
OJ
_.
rl
ro
V>
• Specific Requirements for
Assisted Living Facilities
• 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 the care population includes residents with dementia,
for assisted living facilities. mental health issues, or cognitive and developmental
disabilities, see Section 2.2-4 (Design Criteria for
4.1-1.1.1.2 The requirements in Part 2 (Common Dementia, Mental Health, and Cognitive and
Elements for Residential Health, Care, and Support Developmental Disability Facilities) for requirements.
Facilities) shall apply to assisted living facilities as
referenced in this chapter. *4.1-1.1.3 Minimum Standards for New Assisted
Living Facilities
4.1-1.1.2 Design Criteria This chapter identifies the minimum requirements
for assisted living facilities of various configurations,
which must also comply with applicable state and local
(Sustainable Design Criteria) for requirements for
requirements.
assisted living facilities.

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.
4.1 SPECIFIC REQUIREMENTS FOR ASSISTED LIVING FACILITIES
4.1-1.2.1.1 See Section 1.2-2.1 (Functional Pro (4) Addresses applicable provisions of the Guidelines
gram-General) for requirements in addition to those for Design and Construction ofResidential Health,
in this section. Care, and Support Facilities.
4.1-1.2.1.21he sponsor of each project shall provide a 4.1-1.2.2 Shared Services and Space
functional program that:
*(1) Defines the scope and scale of the project 4.1-1.2.2.1 Each assisted living faciliry shall, at mini
(including the care model). mum, contain the elements described in the applicable
(2) Identifies resident needs. paragraphs of this chapter. However, when a project
(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
rooms. are arranged in a residentially scaled home or household
a. (are model types. The care model will vary depending on whether that can be located in alarger community or in afreestanding
provision of services is centralized or decentralized and on the size of building. Services can be.centralized or decentralized or a
afacility. Below are general descriptions of the different size models combination of the two depending on other care services being
commonly used for assisted living facilities. offered and the type of community setting le.g., acontinuing care
SmallModel retirement community).
In 'Ismail assisted living facility, five or fewer residential rooms ~With centralized services:
generally are arranged in a residentially scaled home with • This type of community jncludes centralized dining,
centralized services, bathing facilities, and resident and staff housekeeping, laundry, medication storage and delivery,
support areas. linen storage, and other services prOVided by care staff for
-With centralized services: residents in 16 or fewer resident rooms. Where a household
• This type of community includes centralized dining, house is connected to. alarger community, dining would be cen
keeping, soiled and dean utility, medication storage and tralized in the household, but food might be supplied from
delivery, linen, and other services provided by care staff for acentral kitchen.
residents. • The staff model usually is an integrated household-based
• The staff models are hierarchical in nature, with direct care team of direct care staff who manage overall care in accor
staff managing overall care in accordance with individual dance with individualized service and care plans.
ized service plans. • Staff members proVide care for the same residents, maxi
• Staff members provide care for the same residents, maxi mizing the opportunity to develop familiarity with a resi
mizing the opportunity to develop familiarity with aresi dent's individual needs.
dent's individual needs. The travel distances for staff and residents are very short
• The travel distances for both staff and residents are very due to the household nature ofthe community.
short due to the household nature of the community. • This type of community offers an emergency response
-With decentralized services, including additional services system for the residents.
brought to the resident from outside providers!contractors: -With decentralized services:
• This type of community focuses on the holistic care of each • This type of community focuses on the holistic care of eC!ch
resident. resident.
• Specialized social, recreational, educational, and spiritual Specialized social, recreational, educational, and spiritual
programs are offered based on individual resident needs. programs are offered based on individual resident needs.
• Residents receive individualized personal care and health • Residents receive individualized personal care and health
related services as needed, induding care management related services as needed, induding care management by
from a nurse and therapy services from therapists certified a nurse and therapy services by therapists certified in physi
in physical, occupational, and speech therapy. cal, occupational, and speech therapy.
*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.
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.
4.1-1.4.1 General services, equipment, and utilities appropriate for daily

living.
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. (2) The total number of parking spaces to be provided
shall be based on local requirements as well as
4.1-1.4.3.3 Assisted living facilities shall be designed functional need of the population to be served.
and constructed to provide a supportive residential (3) When a project includes sharing or purchasing
environment that is conducive to day-to-day services, appropriate modifications in parking
activities consistent with the cultural, emotional, requirements shall be permitted. See Section 4.1
and spiritual needs of residents. This supportive 1.2.2 (Shared Services and Space) for requirements.
environment shall:
(1) Promote independence, privacy, and dignity for
• 4.1-2 Resident Areas
residents.
(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.

The requirements in this section are common to most
*4.1-1.4.4 Barrier-Free Environment
assisted living facilities and shall apply where the areas
The physical environment shall eliminate as many bar described are included in a particular assisted living
riers as possible to effective access and use of the space, 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
4.1 SPECIFIC REQUIREMENTS fOR ASSISTED LIVING FACILITIES
4.1-2.1.2 Layout 4.1-2.2.1.3 Provide access ro furniture and belongings.
4.1-2.1.2.1 Areas for the care and treatment of users 4.1-2.2.1.4 Accommodate the care and treatment
not residing in the facility shall not interfere with or provided to the resident.
infringe on the living space of residents.

4.1-2.2.2 Resident Room or Apartment
4.1-2.1.2.2 Facility layout shall reflect the care
model and related staffing. 4.1-2.2.2.1 Capacity. Bedrooms shall be limited to
(1) Small model. Arrange five or fewer residential single or double occupancy.
rooms in a residentially scaled home with

centralized services, bathing, resident, and staff 4.1-2.2.2.2 Space requirements
support areas. (1) Resident room size (area and dimensions) shall
(2) Medium model. Arrange 16 or fewer residential permit resident(s) to move about the room with
rooms in a residentially scaled home or household the assistance of a resident-operated mobility
that could be located in a larger community or device, allowing access to at least one side of a bed,
is freestanding with centralized or decentralized window, closet or wardrobe, chair, dresser, and
services, bathing, resident, and staff support areas. nightstand.
(3) Large model. Arrange 17 or more residential-style (2) Room size and configuration shall permit
apartments in a larger community or freestanding resident(s) options for bed location(s) and shall
unit with centralized or decentralized services, comply with spatial requirements of the AHJ.
bathing, resident, and staff support areas. (3) Bedrooms shall not be used as passageways,
corridors, or access to other bedrooms.
4.1-2.2 Resident Unit or Private Living Area *(4) Where cooking is permitted in resident rooms or
apartments, the cooking area shall be equipped
4.1-2.2.1 General with a dedicated sink and cooking and refrigeration
The facility shall provide bedrooms or apartments appliances.
(resident units) that:
4.1-2.2.2.3 Windows. See Section 4.1-5.2.2.6 (Win
4.1-2.2.1.1 Allow for sleeping. dows) for requirements.
4.1-2.2.1.2 Afford privacy.
considerations. Assisted living facilities may.be categorized into the ity spaces that are residential'-5caled and organized similar to atypical
following groups, although some facilities may combine elements of house. These smaller-scale homes or households maybe freestanding
multiple approaches. or grouped together in .attached or detached configurations. Commons
a. Apartmentmodel. Apartment model facilities provide private or community facilities are sometimes proVided to allow residents to
resiaent units ranging in size from efficiency to two- or three-bedroom participate in activities outside of their home or household.
apartments. These apartments typically have cooking facilities (some c. Alternative models. Many alternative facility configurations have
times limited to a microwave) and are often indistinguishable from been created that incorporate aspects of each of these approaches.
apartment units available to the general population. Common group These guidelines are intended to allow and encourage the continued
activity areas that residents may use in addition to their private apart evolution and flexibility of this facility type without locking into a par
ments are provided to promote the social and programmatic aspects of ticular program or model.
the facility.
A4.1-2.2.2.2 (4) Where cooking eqUipment is present in resident
b. Group living model. Facilities with agroup living model provide
rooms or apartments, the community must have adefinitive way of
smaller private spaces that are sometimes limited to a private or shared
disabling such devices, should they be unsafe for residents to use.
resident bedroom area. The focus of daily life is provided in shared activ
*4.1-2.3.8.1 Outdoor spaces shall be provided for 4.1-4.2.1 Staff Work Areas
residents, visitors, and staff.
4.1-4.2.1.1 These area(s) shall be provided when
4.1-2.3.8.2 See Section 2.1-3.6.2 (Outdoor Activity required by the care model to serve resident needs.
Spaces) for additional requirements and information.
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)
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.

4.1-4.2.3 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
(2) Space for drying and dressing
(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
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,
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
4.1-4.2.4 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.
(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.
4.1-4.2.4.3 Supply storage. Storage space(s) for sup
plies and recreation items shall be immediately acces
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.
4.1-4.4.1 General
4.1-4.2.7 Personal Laundry Facilities Community space for family and visitors shall be
provided based on the care model.
4.1-4.2.7.1 Provision of decentralized facilities for
washing and drying personal laundry shall be permit *4.1-4.4.2 Overnight Guest Accommodations
ted when the care model supports this approach for 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 allow staff to reach the resident in case of an emergency
a. Where visitor sleeping accommodations are prOVided in resident -Storage space to accommodate and secure overnight guests'
rooms or apartments, prOVision of the following should be con belongings
sidered: b. Provision of separate guest suites or apartments is recommended as
-Sufficient circulation around the sleeping accommodation (e.g., ameans for accommodating overnight visitors.
recliner, sleep chair, sleep sofa) when it is fully open for use to
4.1-4.4.3 Pet Accommodations 4.1-4.6.1.1 Each assisted living facility shall have
See Section 2.3-4.4.3 (Pet Accommodations) for provisions for storing and processing clean and soiled/
requirements. contaminated linen for resident care.
4.1-4.5 Food Service Facilities *4.1-4.6.1.2 Based on the care model, combination
of personal laundry facilities with clean utility and/
4.1-4.5.1 General or soiled utility rooms shall be permitted. See sections
2.3-4.2.5 (Clean Utility Room), 2.3-4.2.6 (Soiled
The type and size of the assisted living facility shall
Utility Room), and 2.3-4.2.7 (Personal Laundry
determine the dietary environment and the food ser
Facilities) for additional requirements.
vice facilities provided.
4.1-4.6.2 Facilities for Contracted Linen Services

4.1-4.5.2 Centralized Commercial Kitchen
Where contracted services are used, the following shall
Where a centralized commercial kitchen is provided,
be provided:
the food service facilities shall meet the requirements
in Section 2.3-4.5 (Food Service Facilities).
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
For facilities that have a service contract with an of clean linen
outside vendor for food service, the following require
ments shall be met: 4.1-4.6.2.3 A control station for pickup and receiving.
This shall be permitted to be shared with other services
4.1-4.5.3.1 Where an outside vendor is used to pro and serve as the receiving and pickup point of service
vide meals for a facility of 16 or more beds, dedicated for the facility.
space and equipment shall be provided for a warming
kitchen, including space for minimal equipment for 4.1-4.6.3 On-Site Laundry Service Facilities
preparation of breakfast, emergency, or after-hours
meals. 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.
Where food preparation is conducted on-site for 16 or (a) Areas dedicated to laundry shall be separate
more beds, the facility shall have dedicated non-public from food preparation areas.
staff space and equipment for preparation of meals. See (b) Laundry rooms shall not open directly into
section 2.3-2.3.4 (Resident and Participant Kitchen) resident rooms.
for requirements.
4.1-4.6.3.2 At minimum, the following elements shall
4.1-4.6 Linen and Laundry Service Facilities be included:
(1) Rooms and spaces for sorting, processing, and
4.1-4.6.1 General
storage of soiled materials
A4.1-4.6.1.2 Based on the care model, laundry services may be personal laundry facilities and contracted linen services. See 2.3-4.2.7
decentralized using personal laundry facilities and/or acombination of (Personal Laundry Facilities) for additional information.
190 Guidelines for Design and Con truction of Residential Health. Care, and Support 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 4.1-4.11 Administrative Areas
received in this room or in a separate room as
required by the local AH]. 4.1-4.11.1 Office and Conference Space
(c) Room(s) used for processing shall be provided Offices or an open office area with private confer
with a laundry or deep sink. ence space shall be provided for business transactions,
admissions, and social services and for the use of
(3) Central clean linen storage. A central clean linen
administrative and professional staff
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.
Space for private interviews; staff, resident, and family
(4) Linen carts
meetings; conferences; and health education shall be
(a) Storage. Provisions shall be made for parking sized according to operational needs.
clean and soiled linen carts separately and out (1) Space shall include provisions for use of visual aids
of traffic. and technology.
(b) Cleaning. Provisions shall be made for (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 4.1-4.11.1.2 General office space. Office space shall
shall be provided in each area where unbagged be provided for staff and file storage.
soiled linen is handled. See Section 2.4-2.2.8
(Hand-Washing Stations) for additional 4.1-4.11.1.3 Supply and copy room. Space for
requirements. storage of files, office equipment, and supplies shall be
provided.
See Section 2.3-4.7 (Materials Management Facilities) • 4.1-5 Design and Construction
for requirements.
Requirements

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.
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
4.1-5.1.1 General
(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
means of a simple operation.

(ii) All residential units shall be accessible by

staff or safety personnel.
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.
use of residential occupancy and construction types should be per released locking device must automatically open when the fire
mitted for assisted living facilities with more than 16 units: alarm system is activated or power is lost.
-Protection ofthe facilities throughout with asupervised auto -No device operation sign should be posted where 24-hour
matic fire suppression system with quick-response sprinklers in awake and trained staff supervise the locking device.
smoke compartments containing sleeping rooms. Automatic fire e. Accessibility. Assisted living facilities should consider residents with
suppression systems in facilities with more than 16 units should varying and possibly increasing levels of acuity. To maximize the
be installed in accordance with NFPA 13: Standard for the Instal potential for aging in place, attention should be paid to overall
lation ofSprinkler Systems. accessibility. locations where individuals may not require physical
-Smoke barriers subdividing every story into at least two smoke assistance from others in emergency situations typically require
compartments. Such smoke compartments should be not more compliance with standards for multifamily housing (a specific subset
than 22,500 square feet (2.09 square meters), and the travel is now used as "safe harbor" for Fair Housing architectural reqUire
distance from any point in each smoke compartment to asmoke ments). In addition, the Uniform Federal Accessibility Standards shall
barrier door should not exceed 200 feet (61 meters). apply for structures built with federal assistance. locations where
c. Resident waiting areas. The therapeutic and programmatic benefits individuals require physical assistance from others in emergency
of prOViding waiting areas and similar spaces open to the corridor in situations may require compliance with the 2010 Americans with
long-term care facilities should be considered. Spaces open to the Disabilities ActStandards for Accessible Design.
corridor significantly enhance resident mobility and accessibility to f. Barrier-free design. Universal design practices that promote barrier
programs, encouraging resident participation. free environments (see appendiX section M.1-1.4.4-Barrier-free
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
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.
----------
(3) Insect screens. See Section 2.4-2.2.4.3 (Insect

4.1-5.2.3 Surfaces
screens) for requirements.
4.1-5.2.3.1 General
4.1-5.2.2.5 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
4.1-5.2.2.6 Windows selected for use in assisted living facilities 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.
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

tion 2.4-2.3.3 (Walls and Wall Protection) for
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.
APPENDIX
A4.1-S.2.2.6 (1) Windows. Each room in a resident apartment Developing Methods to Integrate Patient Safety Concerns in the Design
should have awindow(s) that meets the requirements of Section 2.4 Process" identified environmental factors as "latent conditions that
2.2.6 (Windows). can be designed to help eliminate harm:' Such "built environment
latent conditions [holes and weaknessesl that adversely impact patient
A4.1-S.2.3.1 (2) Surfaces and materials selected should be easy
safety"should be identified and eliminated during the planning,
to use and have clear, written, manufacturer-recommended cleaning
design, and construction of health care facilities. Reduction of surface
contamination linked to health care-associated infections is one of
and effective at meeting Centers for Disease Control and Prevention and
these factors. See Section 1.2-3 (Resident Safety Risk Assessment) for
other clinical bacterial-elimination requirements.
4.1-6.2 Plumbing Systems (2) For large assisted living facilities, see ANSI!
ASHRAE Standard 62.1: Ventilation for Acceptable
4.1-6.2.1 General Indoor Air Quality for basic HVAC system
requiremen ts.
See Section 2.5-2.1 (Plumbing Systems-General) for
requirements.
4.1-6.3.1.2 Ventilation and space conditioning. See
Section 2.5-3.1.2 (Ventilation and Space Condition
4.1-6.2.2 Plumbing and Other Piping Systems
ing) for requirements.
See Section 2.5-2.2 (Plumbing and Other Piping Sys
4.1-6.3.2 Mechanical System Design
See Section 2.5-3.2 (Mechanical System Design) for
requirements.
4.1-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
Fixtures-General) for requirements.
Locations
4.1-6.2.3.2 Hand-washing sinks. See Section 2.4

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.
(Areas of Refuge) for requirements.
4.1-6.2.3.5 Clinical sinks. See Section 2.5-2.3.5
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
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,
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

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
(a) Not receive nonfiltered, nonconditioned 4.1-6.4.2.1 Essential electrical system

outdoor air. *(1) Applicable standards for care models
*(c) Include the manufacturer's recommended filter (a) Large model assisted living facilities or sections
for airflow passing over any surface that is thereof shall have essential electrical systems as
designed to condense water. This filter shall be required in:
located upstream of any such cold surface so (i) NFPA 101: Life Safety Code
that all of the air passing over the cold surface (ii) NFPA 99: Health Care Facilities Code
is filtered.
(b) For small and medium-sized models, local
4.1-6.3.6.2 Filter frames for centralized systems 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
(2) All joints between filter segments and the enclosing
lighting requirements.
ductwork shall have gaskets or seals to provide a
positive seal against air leakage. (2) Where residents on life support equipment are
served in the assisted living facility, essential
4.1-6.3.7 Heating Systems, Cooling Systems, and electrical power shall be provided to the life
Equipment support equipment.
See Section 2.5-3.7 (Heating Systems, Cooling (3) Where fuel for electricity generation is stored
Systems, and Equipment) for requirements in addition on-site, the following requirements shall be met:
to those in this section. (a) Storage capacity shall permit continuous

operation for at least 24 hours.
4.1-6.3.7.1 Heating systems. Substance abuse treat (b) Fuel storage for electricity generation shall be
ment facilities shall have a permanently installed separate from heating fuel storage.
heating system capable of maintaining an interior (c) Where heating fuel is used for diesel generators
minimum temperature of 72 0 F (22 0 C) under heating after the required 24-hour supply of diesel
design temperatures. fuel has been exhausted, positive valving and
filtration shall be provided to avoid entry of
4.1-6.3.7.2 Cooling systems. Substance abuse treat water and/or contaminants into the storage
ment facilities shall be configured and equipped with tank.
a cooling system capable of maintaining an interior
maximum temperature of75° F (24 0 C) under cooling 4.1-6.4.2.2 Generators. Where generators are
design temperatures. used for an assisted living facility, exhaust systems
(including mufflers and vibration isolators) for internal
4.1-6.4 Electrical Systems combustion engines shall be located, designed, and
installed to minimize objectionable noise.
4.1-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for 4.1-6.4.3 Electrical Receptacles
requirements.
4.1-6.4.3.1 General. See Section 2.5-4.3.1 (Electrical
4.1-6.4.2 Power-Generating and Power-Storing Receptacles-General) for requirements.
Equipment
APPENDIX
A4.1-6.3.6.1 (2)(c) Filters for recirculating room A4.1-6.4.2.1 (1) Care models are defined in appendix section
systems. Filters should be replaced and/or cleaned per the manufac M.l-l.2.1.2 (1) (Care model characteristics).
turer's recommendations to maintain indoor air quality.
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) The system shall be capable of activation/operation
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.
Receptacles) for requirements.
4.1-6.4.3.5 Ground fault interrupter receptacles. See
Section 2.5-4.3.5 (Ground Fault Interrupter Recep
Standard 2560: Emergency Call Systems
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
4.1-6.5.1.2 Communication systems equipment
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
requirements.
device.
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) Emergency call systems shall comply with UL 4.1-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
2560: Emergency Call Systems for Assisted Living and (Light Fixtures) for requirements.
Independent Living Facilities.
4.1-6.7.3.2 Lighting requirements for specific
4.1-6.5.3 Technology Equipment and Teledata locations. See appendix section A2.5-7.3.2 (Lighting
Room(s) in transition spaces) for recommendations.
See Section 2.5-5.3 (Technology Equipment and (1) Resident unit corridors
Teledata Room) for requirements.
(a) Resident unit corridors shall have general
illumination with provisions for redUcing light
4.1-6.5.4 Grounding for Telecommunication
levels at night.
Spaces
See Section 2.5-5.4 (Grounding for Telecommunica shall have even light distribution to avoid
tion Spaces) for requirements. glare, shadows, and scalloped lighting effects.
4.1-6.5.5 Cabling Pathways and Raceway *(2) Resident rooms, bedrooms, and bathrooms
Requirements (a) Task light controls shall be readily accessible to
See Section 2.5-5.5 (Cabling Pathways and Raceway residents.
Requirements) for requirements. (b) Where night-lighting is provided, it shall
be located in the pathway to and from the
4.1-6.6 Electronic Safety and Security Systems bedside and the bathroom.
See Section 2.5-6 (Electronic Safety and Security (i) Night-lighting shall be mounted no higher
Systems) for requirements. than 2 feet (61 centimeters) above the
floor.
4.1-6.7 Daylighting and Artificial Lighting (ii) Night-lighting shall be controlled sepa
Systems rately from ambient lighting.
*(iii) Night-lighting shall have a low light level.
4.1-6.7.1 General (iv) Because night-lights may disturb resi
See Section 2.5-7.1 (Daylighting and Artificial Light dent sleep even when properly specified,
ing Systems-General) for requirements. located, and operated, care providers shall
4.1-6.7.2 Daylighting Systems in Resident Living or switched night-lights for added control
Areas of this light source.
See Section 2.5-7.2 (Daylighting Systems in Resident
Living, Participant, and Outpatient Areas) for 4.1-6.8 Acoustic Design Systems
requirements. See Section 2.5-8 (Acoustic Design Systems) for
requirements.
4.1-6.7.3 Artificial Lighting Systems
APPENDIX
A4.1-6.1.3.2 (2) Lighting in resident rooms, A4.1-6.7.3.2 (2Hb)(iii) Night-lighting in resident

bedrooms, and bathrooms. Resident rooms, bedrooms, and rooms. Research has established that older adults sleep best in total
bathrooms should have general lighting and task lighting. darkness. Therefore, to minimize resident sleep disruption, night-lights
a. Provision of movable task lighting should be considered. should provide very low levels of illumination and be located,to mini
b. Resident bathrooms should provide general illumination with provi mize light scatter and reflections on room surfaces. To achieve a low
sion for redUcing light levels at night. 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.
------_._---_._-------------------
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

*4.1-6.9.2 Dimensions and Clearances
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.

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
floor.
requiremen ts.

201 to 350 residents are living or receiving care
4.1-6.9.5 Handrails
en trance floor. Elevator cars shall have handrails on all sides without
(4) For facilities with more than 350 residents living entrance door(s). See Section 2.4-2.2.10 (Handrails
or receiving care or support services above the 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.
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
'"
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
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Family meeting areas
recommended I 4. User control of environment: The goal is to support greater resident autonomy in all
aspects ofthe environment.
~
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ro 5. Privacy and confidentiality: Provision of all single-occupancy rooms enhances "'0
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privacy, although availability of another space outside the bedroom for visiting is
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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
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w
accessibility standards. All residences should conform to local and state fire and life c:
safety standards. :xl
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( 7. Characteristics and criteria for selection of materials and products for architectural ~
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supported. -I
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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
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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'\
Criteria for Dementia, Mental Health, and Cognitive and Development Disability Facilities) for additional information. Payment source and inclusion of the assisted living facility as part of a campus VI
may influence design characteristics. m
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Appendix Table A4.1-a (continued) N
III
Assisted Living Facility Type Characteristics '"0
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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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fewer shared and private and/or based team
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(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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5. Privacy and confidentiality: Provision of all single-occupancy rooms enhances r-
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kitchen.)
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privacy, although availability of another space outside the bedroom to allow for <
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6. Safety and security: The smaller scale makes staff monitoring easier. Outside III
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spaces should be visible from indoors. Multi-story residences need to conform to -l
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Z
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standards. CI
-. 7. Characteristics and criteria for selection of materials and products for architectural
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'" details, surfaces, and furnishings: Personalization of individual spaces should be
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caregiver from Jamaica caring for an orthodox Jewish woman understand and
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._.'•. _---~-_.- -
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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
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:l
services and activity VI
0..
areas recommended
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 Resident-directed care
<:J 8. Cultural responsiveness: The cultural orientation and needs, customs, desires, >
o Multiple spaces etc. of the care population and staff should inform the design of the physical VI
VI
....
~
that foster deep

.."
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
_. relationships For example, the designer would proVide a physical environment that helps a o
.... caregiver from Jamaica caring for an orthodox Jewish woman understand and
r-
"'
V> support kosher customs and resident and family expectations.
<
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9. Support for person-centered care: The goal of this model is to offer residents a full
experience of home as well as larger social interaction opportunities. ".,.,
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IV
o...
m
VI
• Specific Requirements for
Independent Living Settings
• 4.2-1 General 4.2-1.1.2.1 Sustainable design. See Section 2.2-2

4.2-1.1 Application independent living settings.
*4.2-1.1.1 General 4.2-1.1.2.2 Design criteria for accommodations for

care of persons of size. Where the care population
*4.2-1.1.1.1 This chapter contains specific requirements includes needs for persons of size, see Section 2.2-3
for independent living settings that provide resident (Design Criteria for Accommodations for Care of
support services, including retirement communities. Persons of Size) for requirements.
4.2-1.1.1.2 The requirements in Part 2 (Common 4.2-1.1.2.3 Dementia, mental health, and cognitive
Elements for Residential Health, Care, and Support and developmental disability design criteria. Where
Facilities) shall apply to independent living settings as the care population includes residents with dementia,
referenced in this chapter. mental health issues, or cognitive and developmen
tal disabilities, see Section 2.2-4 (Design Criteria for
4.2-1.1.2 Design Criteria Dementia, Mental Health, and Cognitive and Devel
opmental Disability Facilities) for requirements.
APPENDIX :,
A4.2-1.1.1 When creating environments that adapttothe changing resident units ranging in size from efficiency to two- or three
physical challenges of the aging or of other special need populations, bedroom apartments. Atypical unit includes kitehe'1,dining,
the principles of universal design should be employed to support maxi and living areas and is indistinguishable from apartment units
mum functional competente ofthe residents. available to the general population. Extra blocking in walls,
wider dOQr and corridor widths, and ()ther elements required
A4.2-1.1.1.1 Independent living setting types. An
for adaptable use of the residence are recommended. In addi
independent living setting can be afreestanding house or cottage, an
tion to their private apartments, residents may have acces.s to
attached house, or an apartment (including condominiums, co-ops,
common spaces (e.g., dining, lounge, activityareasHnat sup
and low-rise and high-rise buildings). The design of independent liVing
port the social and programmatic aspects ofthe independent
settings varies according to social and economic factors and the model
living setting.
of care. Such afacility can be single- or multi-story, stand-alone or
Acondominium differs from a rental apartment or an apartment
linked with other apartments or cottages, or part of the campus of a
in aCCRC in that the resident owns the unit and typically is itssessed
continuing care retirement community (CCRC). "Independent" refers to
a homeowner's association fee for general maintenance and common
the level of services provided.
amenities.
Independent living settings may be categorized into the follOWing
Where an apartment is partofaCCRC, the model usually includes
broad types:
an initial deposit for use of the building and thereafter it monthly fee
a. Freestanding house or cottage or attached house. These s.et
for services, which may be either alife care plan or an ala carte fee-for
tings typically include a minimllm of two bedrOoms and have
service plan.
kitchen, dining, and living' areas.
Direct access to outdoor spaces from common areas and individual
b. Apartment (including condominiums andco-ops). Model senior
residential units should be provided.
liVing apartment and condominium settings prOVide private
Guidelines for Design and Construction of Residential Health. Care. and Support Faci!ities 203
4.2 SPECIFIC REQUIREMENTS FOR INDEPENDENT LIVING SETTINGS
4.2-1.1.3 Minimum Standards for New (4) Addresses applicable provisions of this chapter.
Independent Living Settings
4.2-1.2.1.2 See Section 1.2-2 (Functional Program)
4.2-1.1.3.1 This chapter identifies minimum require for additional requirements.
ments for new construction and shall not be applied
to existing facilities unless major renovations are 4.2-1.2.2 Shared Services and Space
undertaken. See Section 1.4-3 (Renovation) for more
information. 4.2-1.2.2.1 Where a project calls for sharing or
purchasing services from another entity, appropriate
*4.2-1.1.3.2 This chapter identifies the minimum modifications in space and parking requirements shall
requirements for independent living settings of various be permitted.
configurations, which must also comply with appli
cable state and local requirements. *4.2-1.2.2.2 Where the independent living setting is
part of (or contractually linked with) another facility,
4.2-1.2 Functional Program sharing of facilities for services such as home health,
hospice, dietary, storage, pharmacy, linen, and laundry
4.2-1.2.1 General 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.
(2) Identifies resident needs. Function Considerations) and Section 1.2-4 (Environ
(3) Facilitates occupancy approvals by authorities
having jurisdiction.
APPENDIX
A4.2-1.1.3.2 Acknowledging that occupancy and building construc -Somesuppmt services are provided in most independent liVing
tion requirements vary among jurisdictions, theintertt of this. chaptet is settirtgs; these may include transportation, social activities,
to establish basic gUidance for safety and accessibility for an indepen dining/food service, and housekeeping and maintenance ser
d~nt living setting in which we services are proVided, regardless of the vices. Some independent liVing settings may also include access
scope and scale of the physical environmenfeQr the services offer~d. to a higher level of care services such as home health care, in
ffome hospice, portable dialysis treatment, care management,
A4.2-1.2.2.2 Shared services and facilities. Services
and other in-home community-based services.
may be contractually provided or shared with'other entities. In some
~Independent liVing settings should be designed and constructed
cases, all ancillary service requirements will be met by the principal
to prOVide asupportive residentfal environment thilt is
facility.and the only modifications necessary will be inthe independent
conducive to day-to-day activities and consistent with the
Iivingsetting.lnothercases, programmatic concerns and requirements
cultural, emotional,spiritual,and me needs ofthe residents.
may dictate-separate service "reas.
This supportive environment should:
A4.2-1.4I;nvir()nment of cC!re recommendatio.ns • promote independence, privacy, and dignity
a. Flexibility. Independent liVing facilities should be de$igned to adapt • B.alance autonomywith safety
to the changing physical needs of reSidents. • PrOVide choices for all residents in amanner that encour
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 -The functional program for an independent livingsetting should
should be designedto meet the needs of differently abled in~lude an evaluation of the use of resident-operated mobil ity'
populations who choose to live and/or me for others in an inde devices and reasonable walking distances for individuals using
pendent living,setting. these devices.
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
4.2-1.5.2.2 Availability of transportation. See
2.1-3.4 (Signage and Wayfinding) for requirements.
Section 2.1-2.2 (Availability of Transportation) for
requirements.
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
4.2-1.5.3.5 Site lighting. See Section 2.1-3.5 (Site 4.2-1.5.5 Environmental Pollution Control
Lighting) and Section 2.5-7 (Daylighting and Artificial See Section 2.1-5 (Environmental Pollution Control)
Lighting Systems) for requirements. for requirements.
4.2-1.5.3.6 Landscape features

(1) General. See Section 1.2-4.5.1 (Light) and Section • 4.2-2 Resident Areas
1.2-4.5.2 (Views of and Access to Nature) for
requirements and appendix section A2.1-3.6.1 *4.2-2.1 General
(Landscape features) for additional information. The requirements in this section are typical of many
(2) Outdoor activity spaces. See Section 2.1-3.6.2 independent living settings and shall apply where the
(Outdoor Activity Spaces) for requirements and areas described are included in a particular indepen
information. dent living setting.
(3) Outdoor water features. Where provided, open
outdoor water features shall be designed to support *4.2-2.2 Resident Unit
maintenance of safe water quality to protect the
public from infectious or irritating aerosols. 4.2-2.2.1 Reserved
4.2-1.5.4 Building Orientation *4.2-2.2.2 Dwelling Unit

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 clearance on both sides to enable physical access and
common areas of a particular independent living setting should be iden maneuvering by caregivers who may have to assist
tified in the functional program. residents in wheelchair-to-toilet transfers and returns.
- To provide fleXibility and adaptability, blocking should
A4.2-2.2 Resident units. The resident unit is agroup of dwell
be provided to support grab bars, whether added
ing units included in an independent living setting. The types of dwell
during construction or in the future.
ing units (e.g., apartments, freestanding houses), community areas,
- Where grab bars are installed, their configuration
and support areas that make up a particular independent living setting
should allow for both independent and assisted
should be identified in the functional program.
transfers.
A4.2-2.2.2 Dwelling unit. Design recommendations for - Towel bars should be of grab bar strength.
resident bathrooms, reSident storage, and resident kitchens include: • An adjustable-height sink and countertop. Provision of this
a. Resident bathroom feature should be considered depending on the resident
-Bathrooms should be designed to meet universal design stan population(s).
dards. See appendiX section A4.2-1.4 (Barrier-free environment) • Sink with accessible controls. Asingle-miXing valve should
for universal design recommendations. be proVided to avoid scalding.
- The number of bathrooms to be provided in each resident unit Horizontal surface and/or countertop adjacent to the sink
should be based on the population served. • Mirror. Placement of the mirror should be evaluated to
-At least one bedroom in an independent dwelling unit should accommodate adaptable heights based on the resident
have direct access to an adaptable bathroom that includes the population.
following: • Accessible bathing fixture
Toilet with height appropriate to the population being - Aheight-adjustable, detachable showerhead or hand
served held shower should be installed for fleXibility of use.
- The toilet should be installed 30 inches (76.2 centime - The bathtub/shower faucet should be located so it is
ters) from the centerline to the adjacent wall to allow easy for the resident and/or caregiver to use.
for alternative grab bar configurations and transfers. - The shower and/or bathtub provided should include
- Toilets used by residents should allow sufficient an integral or movable/adjustable seat.
*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.
- Where the shower includes athreshold, a rubber a. The number of residents an independent living dwelling unit should
gasket or removable threshold should be proVided for accommodate and the number of bedrooms/bathrooms to be pro
wheelchair accessibility. vided in each unit should be identified in the functional program.
- Where the shower is curbless (open to the room), b. Space planning for living areas should be designed for furniture of
asealed waterproof floor with afloor drain should proper scale for the rooms and should be sufficient to avoid obstruc
be provided. Provision of ageneral floor drain in the tion of walkways.
bathroom, in addition to the floor drain in the shower, c. Independent living dwelling units should be compact and easy to
is recommended unless atrough drain is used for the navigate. They should also be designed to permit resident(s) to move
shower. about with the assistance of aresident-operated mobility device and
- Personal storage accessible to the resident should be provided to proVide easy access to windows, closets and storage spaces, and
in the resident bathroom. This includes storage in the shower/ furnishings.
bathing area and general storage in the resident bathroom. d. living units should be accessible to community areas as a way to
-Space for awasher and dryer near or in the bathroom should be facilitate socialization and reduce potential resident isolation.
considered. Where the washer and dryer are stacked units, the e. Universal design practices that promote barrier-free environments
appliance controls should be located where residents can reach (see appendix section M.2-1.4-Barrier-free environment) should
them for optimal use. be considered.
-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
-Where personal services are provided for independent living
physical accommodations for lifting equipment in the resident
residents, the follOWing should be included:
bathroom. See Section 1.2-3.3 (Resident Mobility and Transfer
• Accessible bathroom for resident use in hair saloh/spa space
Risk) for additional information.
Washing and styling stations
b. Residentstorage. Storage should be prOVided for resident belongings,
• Sinks should tilt and/or adjust to accommodate residents in
including resident-operated mobility devices. At minimum, storage
wheelchairs
space in the resident unit should equal 10 percent of the square foot
• Display area for retail products
age of the unit.
• Washer/dryerfor towels
c. Kitchen. Where a kitchen is prOVided, it should be eqUipped with a
• 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
*4.2-2.3.2 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

setting, the space needed for these areas shall be deter

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 monitored by apurchasing or procurement agent who is
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 food preparation based on the types offood service pro
nity liVing areas to support optimal accessibility vided for the independent living setting. Hand-washing
-Provision ofscalable spaces for various size dining groups station(s) should be located in food preparation areas.
-Use of natural light sources Warewashing facilities. Facilities for dishwashing and for
-Provision of a minimum of 25 square feet (2.32 square meters) washing pots should be provided based on the types of
per resident in determining the size of dining areas if the resi food service provided for the independent liVing setting
dent population includes many individuals who use resident and applicable local code requirements.
operated mobility devices -Support areas for food service facilities
-Storage for resident-operated mobility devices during dining • Offices(s). Dietary staff office(s) should be provided as
b. Recreation, lounge, and activity areas. Where these areas are proVided needed.
for independent living residents, they should be sufficient in number, • Storage. At minimum, refrigerated, frozen, and dry stor
size, and configuration to accommodate the follOWing: age should be provided based on the type of food service
-Gatherings of reSidents, visitors, and staff, including caregivers, provided.
for identified resident activities • Environmental services room.lffood service is provided,
208 Guid,; ines for Design and Construction of Residential Health, Carc, and Support Facilities
4.2-4.2.1.1 These area(s) shall be provided where 4.2-4.2.2 - 4.2-4.2.3 Reserved

required to serve resident activities and needs in
independent living settings. 4.2-4.2.4 Equipment and Supply Storage
4.2-4.2.1.2 Secured storage shall be provided for 4.2-4.2.4.1 See Section 2.3-4.2.4 (Equipment and
resident personal information. Supply Storage) for requirements in addition to those
in this section.
an environmental services room should be provided in Hand-washing stations. These should be provided in all
accordance with appendix section M.2-4-c (Facilities for areas where untagged soiled laundry is handled.
support services-Environmental services rooms). • Equipment and supply storage. The following should be
-Waste management. Based on the type of food service provided, provided:
waste sorting and storage space should be provided as well as - Storage for laundry supplies
designated waste and recycling pickup areas (accessible to the - Carts or hampers for soiled laundry storage
outside). - Carts, baskets, hanging space, or other means of stor
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 service entry access.
mation. - Acontrol point for pickup and receiving should be
b. Linen and laundry service facilities. Space should be provided for the provided. This could be shared by other services that
laundry services offered in the independent living setting. have pickups and deliveries.
~See appendix section M.2-2.2.2 (Dwelling unit--Resident bath c. Environmental services rooms. Accommodations for environmental
room) and appendix section M.2-1.4 (Barrier-free environment) services should be included in all independent living settings.
for recommendations on laundry facilities in the dwelling unit. Environmental services rooms provided should meet the following
-Central laundry areas. Central laundry areas provide a place for requirements:
independent living residents, families, housekeepers, and/or -Location. Environmental services rooms should be provided
personal caregivers to do aresident's personal laundry. Where throughout the independent living setting as needed to main
provided, these areas should include the following: tain aclean and sanitary environment. However, stand-alone
• Washer(s) independent living houses, cottages, townhouses, or similar
• Dryer(s) settings without common corridors or community spaces do not
• Laundry tub(s) require adedicated environmental services room.
• Hand-washing station -Number. The number of environmental services rooms provided
Folding area should be based on the configuration ofthe independent living
Seating area sized to accommodate the number of individu setting. Where afacility has multiple floors and commoltcor
als estimated to use the laundry at one time ridors, provision of one environmental services room per floor
- Commercial central laundry. Where acommercial centrallaun should be considered.
dry is located in an independent living setting, the following -Facilities. Each environmental services room should include the
requirements should be met: following:
• Layout. Equipment should be arranged to permit aworkflow • Floor receptor/mop sink
that minimizes cross-traffic of dean and soiled operations. • Blocking for mop hangers
Laundry equipment • Floor space for housekeeping equipment and cart(s)
- Washers/extractors should be located between the Storage space for cleaning supplies, including storage for
soiled laundry receiving and clean processing areas. pre-measured chemicals for housekeeping tasks, if used
- Dryers should be provided in the clean processing d. Facilities for engineering and maintenance services. Independent
area. living settings should provide the space necessary to effectively
- Provision of laundry tubs should be considered based accommodate bUilding systems and maintenance functions.
on the types of laundry being serviced.
4.2-4.2.4.2 Supply storage. Storage space(s) for 4.2-4.11 Administrative Areas

supplies and for activity and recreation items shall be
immediately accessible to support activities and recre 4.2-4.11.1 Office and Conference Space
ation offered. Offices or an open office area with private confer
ence space shall be provided for business transactions,
4.2-4.2.4.3 Storage for resident needs. Storage admissions, and social services and for the use of
space(s) for resident equipment and supplies shall be administrative and professional staff.
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 and meetings shall be sized according to operational
See Section 2.3-4.3.1 (Support Areas for Staff needs and shall be permitted to be shared by several
General) for requirements. services.
*4.2-4.4 Support Facilities for Family and 4.2-4.11.1.2 General office space. Staff office space
Visitors and file storage shall be provided based on operational
requirements.
4.2-4.4.1 General
Community space for family and visitors shall be 4.2-4.11.1.3 Supply and copy room. Space for
provided if required in the functional program. storage of office equipment and supplies shall be
provided based on operational requirements.
*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. Requirements
4.2-4.5 - 4.2-4.6 Reserved 4.2-5.1 Building Codes and Standards

4.2-4.7 Materials Management Facilities for requirements.
for requirements. 4.2-5.2 Architectural Details, Surfaces, and
Furnishings

4.2-5.2.1 General
See Section 2.3-4.8 (Waste Management Facilities) for
waste collection, storage, and disposal requirements. See Section 2.4-2.1 (Architectural Details, Surfaces,
4.2-4.9 - 4.2-4.10 Reserved
APPEN DIX
A4.2-4.4 Pet accommodations. If pets are permitted in the A4.2-4.11.1.1 Conferenc.e space. Conference space with
independent living setting, waste areas for pets and other accommoda provisions for the use of visual aids and technology should be avail
tions should be considered in the facility and site design. able for residents to meet with staff, visitors, family, or other residents.
Provision of kitchenette facilities, including under-counter refrigerator,
A4.2-4.4.2 Overnight guest accommodations. Provi
microwave, and sink, s~ould be considered for the conference space.
sion of separate guest suites or apartments is recommended as a means
for accommodating overnight visitors.
*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.
(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
*(1) For handrail requirements for community space
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.

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 a. Dwelling units should have windows that maximize provision of
appropriate, this recommendation should not apply. natural light with amaximum sill height of 32 inches (81.28 centi
-Door protection. See appendix section A2.4-2.2.4 (Door protec meters) above the finished floor.
tion) for recommendations. b. Each room or group of rooms open to one another (e.g., acombined
b. Hand-washing stations. Where hand-washing stations are proVided, kitchen and dining room) should have an exterior window(s) in
they should follow the requirements in Section 2.4-2.2.8 (Hand accordance with Section 2.4-2.2.6 (Windows).
Washing Stations). c. Window hardware for operable windows should be easy for residents
c. Grab bars to operate.
-To provide fleXibility and adaptability, blocking should be pro 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
4.2-5.2.2.11 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
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.
decorative water features are used in the facility design, 4.2-5.2.4.2 Reserved
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.
*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

requirements.


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 opening width of operable windows should be evaluated to reduce
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 based on the unit floor plan and location in the building.
should meet the requirements in Section 2.5-2.3.2 (Hand-Washing -All community spaces should be evaluated to determine where
Sinks). operable windows can be located on an exterior wall.
c. Showers. Where showers are included in independent liVing dwelling b. Humidity control. The relationship between humidity and resident
units, the requirements in Section 2.5-2.3.3.2 (Accessible showers) comfort and between humidity and resident outcomes (e.g., the
should be considered as amended here: influence of humidity on resident dehydration, dry skin, skin tears,
-If grab bars are not installed during construction, blocking skin breakdown, and respiratory conditions) should be evaluated
for vertical and horizontal grab bars should be installed in the during the mechanical system design process. ANSI/ASHRAE Stan
shower area to accommodate future installation of grab bars. dard 55: Thermal Environmental Condition5 for Human Occupancy
See appendix section A4.2-5.2.2 (Architectural detail recom recommends 30 to 60 percent relative humidity for comfort. In cold
mendations-Grab bars) for additional information. or arid climates, achieving a relative humidity as high as 30 percent
-An adjustable-height shower head should be used. may not be practical. For facilities without central ventilation sys
d. Toilet placement. Depending on the level of aging in place incorpo tems, these humidity requirements may not be achievable. For more
rated in the independent living setting, toilet locations that allow information about humidity control, see Chapter 25, "Eldercare:'
two people to assist in residenttransfer (dual or double) should be by lew Harriman, Geoff Brundrett, and Reinhold Kittler, in Humid
considered. See appendix section A4.2-2.2.2 (Dwelling unit-Resi ity Control Design Guide for Commercial and Institutional Buildings
dent bathroom) for additional toilet placement recommendations. (ASH RAE 200n.
e. Clinical sinks. Where clinical sinks are provided, see Section 2.5-2.3.5 c. Higher levels ofcare. If a higher level of care is planned for an inde
(Clinical Sinks) for information. pendent living setting, provision of ventilation and space-condition
ing requirements for the higher level of care should be considered.
A4.2-6.3.1 Ventilation and space conditioning. All
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.
4.2-6.3.3.3 Areas of refuge. Where areas of refuge are 4.2-6.3.5.2 HVAC ductwork. See Section 2.5-3.5.2
provided, see Section 2.5-3.3.3 (Areas of Refuge) for (HVAC Ductwork) for requirements.
requirements.
*4.2-6.3.6 HVAC Filters
Where commercial food preparation areas are 4.2-6.3.6.1 For individual dwelling units, see ANSI!
provided, see section 2.5-3.3.4 (Commercial Food ASHRAE Standard 62.2: Ventilation and Acceptable
Preparation Areas) for requirements. Indoor Air Quality in Low-Rise Residential Buildings for
requirements.
*4.2-6.3.4 Thermal and Acoustic Insulation
4.2-6.3.6.2 Where independent living dwelling units
4.2-6.3.4.1 General. See Section 2.5-3.4.1 (Thermal are housed in high-rise buildings and/or in buildings
and Acoustic Insulation-General) for requirements. that include community space, see ANSI!AS H RAE
Standard 62.1: Ventilation fOr Acceptable Indoor Air
[ *4.2-6.3.4.2 Acoustic insulation Quality for requirements.
4.2-6.3.5 HVAC Air Distribution *4.2-6.3.7 Heating Systems, Cooling Systems, and
Equipment
4.2-6.3.5.1 General
(1) For individual cottages, duplexes, townhouses, 4.2-6.3.7.1 - 4.2-6.3.7.3 Reserved
and similar individual dwelling unit settings, see
ASHRAE 90.2: Energy Efficient Design ofLow-Rise 4.2-6.3.7.4 Temperature control. See Section
Residential Buildings and local building codes for 2.5-3.7.4 (Temperature Control) for requirements.
requirements.
(2) For multiple-unit dwellings, such as apartments, 4.2-6.4 Electrical Systems
condominiums, and similar types of settings that
mayor may not include community space, see 4.2-6.4.1 General
Section 2.5-3.5 (HVAC Air Distribution) for See Section 2.5-4.1 (Electrical Systems-General) for
requirements. requirements.
APPENDIX
A4.2~6.3.4Thermal insulation. For individual cottages, ~Includethe manufacturer!s recommended filter for airflow
duplexes, townhouses, and similar individual dwelling units, consider passing Over any surface that IS designed to condense wateL This
the requirements in ASHRAE 90.2: (nergy-Efficient Design ofLow~Rise 'filter sha'lI be located upstream of any such cold surface so that
Residential Buildings. and local bUilding coMs. For multiple-unit dwell all of the air passing over the cold surface is filtered.
ings,such as apartments, condominiums, andsimilarsettings that may b. Filters sholildbe replaced and/or deanedper the manufacturer's
or may not include community space, consider the requirements in recommendations to maintain indoor air quality.
ASH RAE 90.1: Energy Standard for Buildings Except Low-Rise Residential
A4.2-6.3.7Heating systems, (oolingsystems, and
Buildings.
equipment
A4.~~6.3.4.~AcQu~tic insulat,ion a. Heatingsystems.Requirements for heating systems .in independent
a.Provisions for ac()ustit insulation should meet or exceed local liVing settings sbould be based on the geographic location and the
bUilding code requirements. need.sof reSidents. However, provision of a permanently installed
b. Consideration should be given to construction of demising walls and neating system capable of rnaintaining an interior minimum
floors in a manner that 'prOVides for speech privacy between units temperature of 72 F(22 under heating design temperatures is
0 0
()
andbetweenfloofs. recomrnended.
~lf acornrnunity includes acentral heating plant, the needior

A4.2·6.3.6 Filter efficiencies
capacity redundancy should be evaluated based on the resident
a. For non-central recirculating room systems, HVAC units should:
popUlation, geographic region, and' other operational needs.
-Not receive nonfiltered, nonconditiOned outdoor air.
Completion ofan emergency preparedness plan thatindudes
-Serve only asingle space.
*4.2-6.4.2 Power-Generating and Power-Storing 4.2-6.4.3.3 Receptacles in resident dwelling units.

Equipment For apartments, condos, and similar dwelling units, see
Where independent living settings include essential local building code requirements.
electrical systems, these systems shall comply with
NFPA 101: Life Safety Code. 4.2-6.4.3.4 Reserved
*4.2-6.4.3 Electrical Receptacles 4.2-6.4.3.5 Ground fault interrupters. Ground fault

interrupters shall comply with NFPA 70: National
4.2-6.4.3.1 Reserved Electrical Code.
*4.2-6.4.3.2 Receptacles in corridors 4.2-6.4.4 Electrical Requirements for Ventilator

Dependent Resident Room and Areas
(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.
an evaluation tlf the geographic region and neecHor extended A4.2-6.4.2 Power-genetating andpowet-storing
operations during emergency outa.ges (e.g., those caused by .equipment
hurricanes, tornadoes, earthquakes) should be completed before a. Emergenry lighting. Where independentliving settings indude emer
.building occupancy. Information on completing such assess gency lighting, an essentjal electrIcal source sho.oldprovide lighting
mentsis avaIlable in NFPA 99: HealthCare facilities Code. and/or power during an interruption ofthe normal electrical su,pply.
-Boiler plant accessories. If acommunity includes acentral plant, Emergency lighting for safe egress and access shoul(tbe evaluated
rllajQr supportIng'components ofthe heatin9 plant (including for all independent liVing settings, including differenttypes of dwell
feed:waterpumps, fuel pumps, and condensate transfer pumps) ing units. For more information on lighting, see secti()Os 4.2-6.7.3
should be provided with redundancy that makes it possible to (Artificial lighting Systemsland 2.5-73 (Arfifidallighting Systems).
meet the required heating capacity of the plantwhen anyone b. Generators. Wher~ generators are provided for an independenlJiving
of these components is out of service due to failure or routine setting, exhaust systems (including mufflers and Vibration isolators)
maintenance. for internal combustion engines should be·locat~d, designed, and
b. .Cooling systems. Capacity requirements for cooling systemsinll'lde installed to minimize objectionubl.e noise.
pendent living settings should be based on the geographic location
A4.2-6.4.3 Receptacles
and the needs ofthe residents. However, provision ofacooling
a. Placement ofreceptacles. Heightand]ocation for receptac1esshoold
sYstem capable of maintaining an interior maximum temperature of
beevaluatedbasedon the population being serNed. Recepf~des
]SO F(24· C) under cooling design temperatures is recommended.
available for residents to charge resident~{)perated mobility devices
-Ifacommunity includes acentral cooling plant capacity
should be placed at aheight above the finishedtloor easy for resi
,redundancy should be evaluated based on the resident care
denMo access.
population, geographic region, and other operational needs.
b. Essential electrical system receptacles. For corridors, community
An:emergency preparedness plan should be completed prior
spaces, and dwelling units that include an essential electrical
to building occupancy and should include an evaluation ofthe
system, electrical receptacle cover plates or electrical receptacles
geographic region and need for extended operations during
supplied from the essential electrical system should be distinctivel~
emergency outages such as those caused by hurricanes, torna
colored or marked for identification. If color is used for identification
does, or earthquakes.
purposes, fhe same color should be used throughout the facility.
-Chiller plant accessories. If acommunity includes acentral
chiller plant, major supporting components of the cooling plant A4.2-6.4.3.2 Receptacle$ in cottidors. For corridors in
(including pumps and heat rejection e.quipment) should be public spaces, duplex-grounded receptacles for general use should be
prOVided with redundancy that makes it possible to meet the installed approximately 50 feet (15.24 meters) apart in all corridors and
reqUired cooling capacity of the plant when anyone of these within 25 feet (7.62 meters) of corridor ends. The need for add.itional,
components is out of service due to failure or routine mainte outlets should be indicated in the furniture and equipment layout.
nance.
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 long-term residential substance abuse treatment

facilities.
4.3-1.1 Appl ication
4.3-1.1.1 General care of persons of size. Where the care population
includes needs for persons of size, see Section 2.2-3
*4.3-1.1.1.1 This chapter contains specific requirements (Design Criteria for Accommodations for Care of
for long-term residential substance abuse treatment Persons of Size) for requirements.
facilities.
4.3-1.1.1.2 The requirements in Part 2 (Common and developmental disability design criteria. Where
Elements for Residential Health, Care, and Support the care population includes residents with dementia,
Facilities) shall apply to long-term residential substance mental health issues, or cognitive and developmen
abuse treatment facilities as referenced in this chapter. tal disabilities, see Section 2.2-4 (Design Criteria for
Dementia, Mental Health, and Cognitive and Devel
4.3-1.1.2 Design Criteria opmental Disability Facilities) for requirements.
4.3-1.1.2.1 Sustainable design. See Section 2.2-2 *4.3-1.1.3 Minimum Standards for New Long-Term
(Sustainable Design Criteria) for requirements for Residential Substance Abuse Treatment Facilities
This chapter identifies the minimum requirements
for long-term residential substance abuse treatment
A4.3-1.1.1.1 Long-term residential substance (e.g" adolescents, homeless residents, individuals from the criminal
abuse treatment facility typology. long-term justice system, those with mental/behaVioral issues).
residential treatment facilities may be located in awide variety of In addition to long-term residential treatment, atherapeuticcom
settings including, but not limited to, a large suburban house, larger munity may offer shorter-term residential or outpatient treatment. A
freestanding residential setting, or part of a nursing home, assisted TC acquires a medical partner has an opportunity to become afederally
liVing facility, homeless shelter, or facility in a prison. qualified health center or a patient-centered medical home.
Care is provided 24 hours a day, generally in non-clinical/acute care Aspecialized type of treatment setting called a"modified therapeu
settings. This therapeutic community (TC) is acommon type of long tic community" incorporates features of traditional therapeutic com
term residential treatment setting for substance use disorders, which munities with aspecial focus on addressing co-occurring mental health
typically require 18 to 24 months oftreatment, although funding and conditions.
insurance limitations may reduce an individual's stay to three, six, or Correctional institutions may incorporate in-prison TCs, and TCs are
12 months. The focus of aTC is resocialization of an individual using the also available for people reentering society after being released from
program's entire community as active components of treatment. Addic prison with the goal of reducing drug use and recidivism.
tion is viewed in the context of an individual's social and psychological
A4.3-1.1.3 The requirements and recommendations in this
deficits, and treatment focuses on developing personal accountability
chapter are intended to represent basic standards to ensure the safety,
and responsibility as well as ~ocially productive lives. Treatment is typi
accessibility, and residential aspects of long-term residential substance
cally highly structured and can be modified for specific care populations
abuse treatment facilities for residents recovering from drug or alcohol
addiction.
4.3 SPECIFIC REQUIREMENTS FOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT fACILITIES
facilities, which must also comply with applicable state 4.3-1.2.1.2 The sponsor of each project shall provide a
and local requirements. functional program that:
*(1) Defines the scope and scale of the long-term
4.3-1.2 Functional Program residential substance abuse treatment facility
(including the care model).
4.3-1.2.1 General
(2) Identifies resident needs.
4.3-1.2.1.1 See Section 1.2-2.1 (Functional (3) Facilitates the application of licensure and
Program-General) for requirements in addition to occupancy approvals by authorities having
those in this section. jurisdiction (AH]s).
APPENDIX
A4.3-1.2.1.2 (1) Therapeutic community care offender populations. and in those with substance abuse
model problems.
a. (are model description. In along-term residential substance abuse • Resident treatment planning may include prevention andl
treatment facility, professional medical staff and medical services or treating of serious chronic medical conditions, such as
are proVided on-site. Often, staff members are in recovery and have HIV/AIDS, hepatitis Band C, and tuberculosis. The rate of
earned certification and degrees in addiction counseling. Therapeutic infectious diseases is higher in drug abusers, incarcerated
communities (TCs) have a recovery orientation that focuses on the offenders, and community-supervised offenders than in the
whole person and overall lifestyle changes rather than only on recov general population.
ery from an addiction. Recovery is seen as agradual, ongoing pro Treatment for juveniles requires acomprehensive assess
cess of cognitive change through clinical interventions and includes ment, treatment, case management, and support services
stages of treatment, with personal objectives s.et throughout the appropriate for their age and developmental stage. Abuse is
recovery process. There is a relationship between duration of treat common among juveniles requiring tre.atment, along, with
ment in aTC and aftercare participation and subsequent recovery: physical health issues and family problems. The treatment
longer duration oftreatment fosters consistency and yields better approach includes multi-systemic therapy, multidimen
outcomes for residents. sional family therapy, and functional family therapy.
There are three stages of treatment b. Physical setting. long-term residential treatment environments
• Stage 1: Induction and early treatment: individual assimi include group or community living and activities to drive individual
lates into the TC with full immersion into programming and change and attainment of therapeutic goals. TC is "community as
activities. method" -people living together free of drugs and alcohol in
• Stage 2: Primary treatment: eVidence-based behavioral a residential setting in the community (or in a prison or shelter
treatments with the goals of changing attitudes and behav setting). Atypical program in acommunity-based setting accom
ior, instilling hope, and fostering emotional growth. modates 40 to 80 residents. Some TCs are located onthe grounds of
• Stage 3: Reentry: resident prepares for separation from the former camps or ranches or in suburban houses, while others are in
TC for successful reentry into the community at-large and jails, prisons, and shelters. There is an average of one counselor for
seeks employment or educational/training opportunities. every 11 residents in treatment in addition to social workers, nurses,
Aftercare services are arranged. psychologists, and other clinical staff.
The care model should include services that are structured for The physical setting should support the follOWing:
each individual. Although TCs are community-based, the treat • Rehabilitation by relearning or reestablishing healthy
ment plan is individualized to maximize successful treatment. Over functioning skills and values and regaining physical and
time, various combinations of treatment services may be required. emotional health. Design should reflect an orderly function
EVidence-based interventions include cognitive-behavioral therapy supportive of astructured daily regimen for residents.
to help residents learn positive behavioral change and motivational Routine morning and evening house meetings, job assign
enhancement to increase treatment engagement and retention. ments, group sessions, seminars, scheduled personaltime,
Residents who have been incaJcerated and may have recreation, and individual counseling
received prison-based treatment; therefore, the care model • Vocational and educational activities in group sessions
requires providers to be aware of correctional supervision c Additional information about substance abuse treatment is available
requirements and treatment provided prior to release from in the National Institute on Drug Abuse (NIDA) publication "Prin
prison,if applicable. ciples ofDrug Abuse Treatment for Criminal Justice Populations: A
Residents may have co-occurring drug abuse and mental Research-Based Guide:'The NIDA'research report "Therapeutic Com
health issues, requiring an integrated treatment approach. munity" outlines the goals and activitiesofTCs.
High rates of mental health problems are found both in
4.3 SPECIFIC REQUIREMENTS fOR LONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT fACILITIES
(4) Addresses applicable provisions of the Guidelines *4.3-1.4.3 Supportive Environment

fOr Design and Construction ofResidential Health,
Care, and Support Facilities. 4.3-1.4.3.1 The facility design shall produce a
supportive environment to:
4.3-1.2.2 Shared Services and Space (l) Enhance and extend quality of life for residents.
4.3-1.2.2.1 Long-term residential substance (3) Promote resident privacy and dignity.
abuse treatment facilities shall be permitted to be
freestanding facilities or distinct parts of another 4.3-1.4.3.2 The physical environment of the long
residential health, care, or support facility. term residential substance abuse treatment facility shall
support the services and levels of care provided in the
4.3-1.2.2.2 When a project calls for sharing or pur facility.
chasing services from another entity, modifications in
space and parking requirements shall be permitted. 4.3-1.4.3.3 Long-term residential substance abuse
treatment facilities shall be designed and constructed
*4.3-1.2.2.3 Where the long-term residential substance to provide a supportive residential environment that
abuse treatment facility is part of (or contractually is conducive to day-to-day community activities and
linked with) another facility, sharing of facilities responsibilities.
for services such as home health, hospice, dietary,
storage, pharmacy, linen, and laundry services shall be *4.3-1.4.4 Barrier-Free Environment
permitted.
The physical environment shall eliminate as many
barriers as possible to effective access and use of the
4.3-1.3 Resident Safety Risk Assessment
space, services, equipment, and utilities appropriate for
See Section 1.2-3 (Resident Safety Risk Assessment) daily living and treatment.
for requirements.
4.3-1.5 Site
Elements) for 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 • 4.3-2 Resident Areas
Care Requirements) for requirements.
4.3-2.1 General
4.3-1.4.2 Reserved
APPENDIX
A4.3-1.2.2.3 Shared services and facilities. Services site elements, and the geographic location of thefacility. These consid
may be contractually proVided or shared with other entities. In some erations are critical to the environment of care and development ofthe
cases, all ancillary service requirements will be met by the principal functional program.
facility and the only modifications necessary will be in the long-term

A4.3-1.4.4 Barrier-free environment
residential substance abuse treatment facility. In other cases, program
a. "Universal design" practices that promote barrier-free environments
maticconcerns and requirements may dictate separate service areas.

should be encouraged. See appendix section A4.2-1.4-c(Environ
A4.3-1,4.3 Supportive environment. Asupportive ment of care design recommendations~Barrier-free environment)
environment for long-term residential substance abuse treatment facili for more information.
ties should also indl)de"protective elements"to control access to both b. Facilities should provide accessibility for residents with disabilities in
addictive substances and individuals who traffic in those substances. accordance with the state or local buildingocode and the Americans
This reqUires consideration ofthe immediate residential environment, with Disabilities Act.
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.
4.3-2.1.2.2 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.
*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 4.3-2.3.3.3 Recreation, lounge, and activity areas
(1) Recreation, lounge, and activity areas shall
4.3-2.2.3.1- 4.3-2.2.3.2 Reserved accommodate both group and individual activities
and recreational opportunities.
4.3-2.2.3.3 Quiet room in a resident unit. Where (2) Space requirements. Recreation, lounge, and
a single resident room is provided to accommodate activity areas shall provide the following:
care requirements for residents experiencing personal
(a) Space for planned resident activities
conflicts, agitation, episodic mental disturbances, or
(b) Areas sufficient in number and configuration
similar conditions, see Section 2.3-2.2.3.3 (Quiet
to accommodate the following:
room in a resident carelliving area) for requirements.
(i) Gatherings of resident groups of various
4.3-2.3 Resident Community Areas sizes
(ii) Occurrence of separate and distinct activi
4.3-2.3.1 General ties

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.

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.
*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 4.3-4.2.1 Staff Work Areas
Spaces) for additional requirements and information.
4.3-4.2.1.1 These area(s) shall be provided where
required by the care model to serve resident needs.
Areas
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

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)
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.

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
4.3-4.1 General
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
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.
4.3-4.2.3.4 Toilet. A toilet shall be provided in or 4.3-4.2.7.1 Provision of personal laundry facilities
directly accessible to each resident bathing facility for residents to complete their own laundry shall be
without requiring entry into the general corridor. provided. Equipment shall include:
(1) Washers and dryers based on the number of
4.3-4.2.3.5 Shower. Where a shower is included in residents being served
the bathing or spa room or area, see Section (2) Hand-washing station. See Section 2.5-2.3.2
2.5-2.3.3.2 (Accessible showers) for requirements. (Hand-Washing Sinks) for requirements.
(3) Folding area
4.3-4.2.7.2 See 2.3-4.2.7 (Personal Laundry Facilities)
4.3-4.2.4.1 See Section 2.3-4.2.4 (Equipment and for additional requirements.
Supply Storage) for requirements in addition to those
in this section. 4.3-4.2.8 Resident Telephone Access
4.3-4.2.4.2 Clean linen storage
(1) A separate, secured closet, or designated area shall
be provided for clean linens. 4.3-4.3 Support Areas for Staff
(2) Where a closed-cart system is used, storage in an
alcove where staff control can be exercised shall be 4.3-4.3.1 General
permitted.
See Section 2.3-4.3.1 (Support Areas for Staff
4.3-4.2.4.3 Supply storage. Storage space(s) for sup
plies and recreation items shall be immediately acces
4.3-4.3.2 Staff Lounge Area
sible and secured to support recreation and activities
offered. See Section 2.3-4.3.2 (Staff Lounge Area) for
requirements.
4.3-4.2.4.4 Storage for resident needs. Storage
space(s) for resident equipment and supplies shall be 4.3-4.3.3 Toilet Rooms
immediately accessible to support services offered and Toilet rooms shall be designated for visitors, staff, and
secured based on the care population. residents based on the size of the facility and the total
number of users.
Where the residential setting includes delivery of 4.3-4.4 Support Facilities for Family and
medical care, a clean utility room shall be provided for Visitors
storage and holding as part of a system for distribution
of clean materials. See Section 2.3-4.2.5 (Clean Utility 4.3-4.4.1 General
Room) for requirements.
4.3-4.4.1.1 Community space for family and visitors
4.3-4.2.6 Soiled Utility Room shall be provided based on the care model.
Where the residential setting includes delivery of

4.3-4.4.1.2 Spaces shall be able to be supervised as
medical care, a soiled utility room shall be provided for
required by individual treatment plans.
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.
4.3-4.5.1 General
4.3-4.2.7 Personal Laundry Facilities
The type and size of the long-term residential sub
stance abuse treatment facility shall determine the
dietary environment and the food service facilities 4.3-4.5.5.4 Dishwasher

provided.
4.3-4.5.5.5 ~icrowave
Where a centralized commercial kitchen is provided, 4.3-4.5.5.6 Additional equipment required by an AH]
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
Room), Section 2.3-4.2.6 (Soiled Utility Room), and
meals.
2.3-4.2.7 (Personal Laundry Facilities) for additional
requirements.
4.3-4.6.2 Facilities for Contracted Linen Services
(Resident and Participant Kitchen) for requirements. Where contracted services are used, the following shall
be provided:
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
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

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.
4.3 SPECIFIC REQUIREMENTS FOR lONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
located in the facility, in a separate building on- or 4.3-4.7 Materials Management Facilities
off-site, or in a commercial laundry. Where materials management facilities are provided,
(3) Layout. Equipment shall be arranged to permit see Section 2.3-4.7 (Materials Management Facilities)
a workflow that minimizes cross-traffic between for requirements.
(a) Areas dedicated to laundry shall be separate 4.3-4.8 Waste Management Facilities
from food preparation areas.
(b) Laundry rooms shall not open directly into 4.3-4.8.1 See Section 2.3-4.8 (Waste Management
resident rooms. Facilities) for waste collection, storage, and disposal
requirements.
4.3-4.6.3.2 At minimum, the following elements shall

be included: 4.3-4.8.2 Waste management requirements shall be
scaled to the size and operational need of the long
(1) Rooms and spaces for sorting, processing, and

term care residential facility.
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 See Section 2.3-4.9 (Environmental Services Rooms)
processing. for requirements.
(a) Rooms shall have ventilation and exhaust. 4.3-4.10 Facilities for Engineering and
(b) Discharge from soiled linen chutes shall be Maintenance Services
received in this room or in a separate room as

Where facilities for engineering and maintenance
required by the local AH].
services are provided on-site, see Section 2.3-4.10
(c) Rooms used for processing shall be provided
(Facilities for Engineering and Maintenance Services)
with a laundry or deep sink.
for requirements.
(3) Central clean linen storage. A central clean linen
storage and issuing room(s) shall be provided in 4.3-4.11 Administrative Areas
addition to the linen storage required at individual
resident units. 4.3-4.11.1 Office, Conference, and Educational
(4) Linen carts Space
(a) Storage. Provisions shall be made for parking Offices or an open office area with private confer
clean and soiled linen carts separately and out ence space shall be provided for business transactions,
of traffic. admissions, and social services and for the use of
(b) Cleaning. Provisions shall be made for administrative and professional staff.
cleaning linen carts on-premises (or exchange

of carts off-premises). *4.3-4.11.1.1 Conference and educational space.
Space for conferences; staff, resident, and family meet
(5) Hand-washing stations. Hand-washing stations ings; education classes; and group counseling shall be
shall be provided in each area where unbagged sized according to operational needs.
soiled linen is handled. See Section 2.4-2.2.8
(1) Space shall include provisions for use of visual aids
(Hand-Washing Stations) for additional
and technology.
requirements.
(2) Sharing of space for various uses shall be permitted.
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.
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
storage.
(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.
Requirements *4.3-5.2.2.4 Doors and door hardware
(1) Door type
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

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,
the facility shall maintain the residential environment
desired by residents.
compromise fire and other emergency exiting
requirements.
The facility shall comply with applicable federal, state,
and local requirements; see Section 1.1-4.1 (Design
Standards for Accessibility).

Furnishings
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.
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.

(b) Surfaces shall have no surface crevices, rough
and smooth.
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
(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
heated surfaces, see Section 2.4-2.2.11 (Protection
for requirements.
from Heated Surfaces) for requirements.
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,
4.3-6.1 General
4.3-5.2.3 Surfaces requirements.
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
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.
Developing Methods to Integrate Patient Safety Concerns in the Design
4.3-6.2.1 General (2) For substance abuse treatment facilities with more
See Section 2.5-2.1 (Plumbing Systems-Genetal) for than 16 residents, see ANSIIASHRAE Standard
requirements. 62.1: Ventilation for Acceptable Indoor Air Quality
for basic HVAC system requirements.

4.3-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing See Section 2.5-3.2 (Mechanical System Design) for
Fixtures-General) for requirements. requirements.
4.3-6.2.3.2 Hand-washing sinks. See Section 4.3-6.3.3 HVAC Requirements for Specific
2.5-2.3.2 (Hand-Washing Sinks) for requirements. Locations
4.3-6.2.3.3 Showers and tubs. See Section 2.5-2.3.3 4.3-6.3.3.1 Reserved

(Showers and Tubs) for requirements.
4.3-6.3.3.2 Fuel-fired equipment rooms. See
4.3-6.2.3.4 Reserved Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for
requirements.
4.3-6.2.3.5 Clinical sinks. See Section 2.5-2.3.5
(Clinical Sinks) for requirements. 4.3-6.3.3.3 Areas of refuge. See Section 2.5-3.3.3
(Areas of Refuge) for requirements.
Where portable hydrotherapy whirlpools are used 4.3-6.3.3.4 Commercial food preparation areas.
in a substance abuse treatment facility, see Section Where these areas are provided, see Section
2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for 2.5-3.3.4 (Commercial Food Preparation Areas) for
4.3-6.2.4 Medical Gas and Vacuum Systems 4.3-6.3.4 Thermal and Acoustic Insulation
Where medical gas and/or vacuum systems are used, See Section 2.5-3.4 (Thermal and Acoustic Insulation)
the installation of nonflammable medical gas, air, or for requirements.
clinical vacuum systems shall comply with the require
ments ofNFPA 99: Health Care Facilities Code. 4.3-6.3.5 HVAC Air Distribution
4.3-6.3 Heating, Ventilation, and requirements.
4.3-6.3.6 HVAC Filters
4.3-6.3.1 General
(1) For centralized recirculated systems, MERV 7
(1) For subsrance abuse treatment facilities with 16 shall be the minimum filter efficiency for the first
or fewer residents, see ANSIIASHRAE Standard filter bank. There is no minimum filter efficiency
62.2: Ventilation and Acceptable Indoor Air Quality requirement for the second filter bank.
in Low-Rise Residential Buildings for basic HVAC (2) For non-central recirculating room systems, HVAC
system requirements. units shall:
4.3 SPECiFIC REQUIREMENTS FOR lONG-TERM RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITIES
(a) Not receive nonfiltered, nonconditioned 4.3-6.4.2.1 Reserved

outdoor air.
(b) Serve only a single space. 4.3-6.4.2.2 Generators. Where generators are used for
*(c) Include the manufacturer's recommended filter a substance abuse treatment facility, exhaust systems
for airflow passing over any surface that is (including muffiers and vibration isolators) for internal
designed to condense water. This filter shall be combustion engines shall be located, designed, and
located upstream of any such cold surface so installed to minimize objectionable noise.
is filtered. 4.3-6.4.3 Electrical Receptacles
4.3-6.3.6.2 Filter frames for centralized systems 4.3-6.4.3.1 General. See Section 2.5-4.3.1 (Electrical
(1) Filter frames shall be durable and proportioned to Receptacles-General) for requirements.
(2) All joints between filter segments and the enclosing 4.3-6.4.3.2 Receptacles in corridors. See Section
ductwork shall have gaskets or seals to provide a 2.5-4.3.2 (Receptacles in Corridors) for requirements.
4.3-6.4.3.3 Receptacles in resident rooms. Each
4.3-6.3.7 Heating Systems, Cooling Systems, and resident room shall have duplex-grounded receptacles,
Equipment including at least one on each wall.
See Section 2.5-3.7 (Heating Systems, Cooling

Systems, and Equipment) for requirements in addition
4.3-6.3.7.1 Heating systems. Substance abuse

4.3-6.4.3.5 Ground fault interrupter receptacles. See
treatment facilities shall have a permanently installed
Section 2.5-4.3.5 (Ground Fault Interrupter Recep
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 The requirements in this section shall apply to the
interior maximum temperature of 75° F (24° C) under following systems based on the care model and the
cooling design temperatures. needs of residents:
4.3-6.4 Electrical Systems 4.3-6.5.1.1 Call system
4.3-6.4.1 General 4.3-6.5.1.2 Information system

4.3-6.5.1.3 Telecommunication system
requirements.

Equipment
the following requirements shall be met:
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.
------------------------- - - - - - - ---------------------
(1) The system shall be capable of activation/operation See Section 2.5-5.3 (Technology Equipment and
from resident toilets, bedrooms, and bathing areas. Teledata Room) for requirements.
(2) The signal shall be transmitted to on-duty staff
through fixed locations and/or resident wearable 4.3-6.5.4 Grounding for Telecommunication
devices. Spaces
(3) Use of alternative technologies, including wireless See Section 2.5-5.4 (Grounding for Telecommunica
systems, shall be permitted. tion Spaces) for requirements.
shall be given to electromagnetic compatibility 4.3-6.5.5 Cabling Pathways and Raceway
between internal and external sources. Requirements
(b) Wireless systems shall comply with UL See Section 2.5-5.5 (Cabling Pathways and Raceway
Standard 2560: Emergency Call Systems Requirements) for requirements.
Facilities. 4.3-6.6 Electronic Safety and Security Systems
See Section 2.5-6 (Electronic Safety and Security
4.3-6.5.2.2 Resident room call stations Systems) for requirements.
(1) Where a hardwired system is used:
(a) Each bed location shall be provided with a call

Systems
device accessible to the resident.

4.3-6.7.1 General
two call devices.
See Section 2.5-7.1 (Daylighting and Artificial light
(2) Use of wireless call stations shall be permitted. ing Systems-General) for requirements.
4.3-6.5.2.3 Emergency call system. Where an emer 4.3-6.7.2 Daylighting Systems in Resident living
gency call system is provided, an emergency call device Areas
shall be located at each toilet, bath, and shower used
by residents.
Living, Participant, and Outpatient Areas) for
(1) The device shall be accessible to a resident in any requirements.
Inclusion of a pull cord or portable wireless device 4.3-6.7.3 Artificial lighting Systems
(2) The emergency call system shall be designed so that 4.3-6.7.3.1 Light fixtures. See Section 2.5-7.3.1
when a call is activated a signal is initiated that is (Light Fixtures) for requirements.
be turned off only at the activated emergency call 4.3-6.7.3.2 Lighting requirements for specific loca
device. tions. See appendix section A2.5-7.3.2 (Lighting in
(3) The signal shall activate at the staff work area and/ transition spaces) for recommendations.
(4) Emergency call systems shall comply with UL
2560: Emergency Call Systems for Assisted Living and (a) Resident unit corridors shall have general
J
Independent Living Facilities. illumination with provisions for reducing light
levels at night.
4.3-6.5.3 Technology Equipment and Teledata (b) Corridors and common areas used by residents
Room(s) shall have even light distribution to avoid
*(2) Resident rooms, bedrooms, and bathrooms
(a) Task light controls shall be readily accessible to *4.3-6.9.1.2 Number. Engineered traffic studies are
residents. recommended, but in their absence the following
(b) Where night-lighting is provided, it shall guidelines for the minimum number of elevators
be located in the pathway to and from the shall apply:
bedside and the bathroom. (1) At least one elevator sized to accommodate a
(i) Night-lighting shall be mounted no higher gurney and/or medical carts and resident-operated
than 2 feet (61 centimeters) above the mobility device users shall be installed where
floor. residents are living or receiving care or support
(ii) Night-lighting shall be controlled sepa services on any floor other than the main entrance
rately from ambient lighting. floor.
*(iii) Night-lighting shall have a low light level. (2) At least two elevators shall be installed where 60 to
(iv) Because night-lights may disturb resi 200 residents are living or receiving care or support
dent sleep even when properly specified, services on floors other than the main entrance
located, and operated, care providers shall floor.
be permitted to use portable light sources (3) At least three elevators shall be installed where
or switched night-lights for added control 201 to 350 residents are living or receiving care
of this light source. or support services on floors other than the main
entrance floor.
4.3-6.8 Acoustic Design Systems (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
requirements.
be determined from a study of the facility plan
and from the estimated vertical transportation
requirements.
4.3-6.9.1 General
*4.3-6.9.2 Dimensions and Clearances
4.3-6.9.1.1 Requirement. Where elevators are Elevator car doors shall have a clear opening of no less
provided in large settings for residents with intellectual than 3 feet 8 inches (1.12 meters).
and/or developmental disabilities, the requirements in
this section shall be met: 4.3-6.9.3 Leveling Device
requirements.
A4.3-6.7.3.2 (2) Lighting in resident. rooms, A4.3-6.9.1.2 Number of elevators. These standards may
bedrooms, and bathrooms be inadequate for moving large numbers ofpeople in ashorttime;
a. Resident rooms, bedrooms, and bathrooms should have general adjustments should be made as appropriate to the care model and
lighting and task lighting. population served.
b. Resident bathrooms should proVide general illumination with
A4.3-6.9.2 Elevator dimensions and clearances

provision for redu<ing light levels at night.
a. Handrail projections of up to 3.5 inches t8;89 centimeters) should
A4,3-6.7.3.2 (2)(bHiii) Night-lighting in resident not be construed as diminishing the clear inside dimensions.
rooms. Research has established that older adults sleep best in total b. If required to Serve the care population and indicated by a
darkness. Therefore, to minimize resident sleep disruption, night-lights mobility transfer assessment, at least one facility elevator should
should provide very low levels of illumination and be located to mini accommodate attending staff and an ambulance gurney 7feet6
mize light scatter and reflections on room surfaces. To achieve alow inches (2.29 meters) in length and/or an expanded capacity widrhof
light level, nighHighting should include amber or red lamping; white, 4feet (1.22 meters) for persons of size.
blue, or green lamping should not be used. Switches for night-lights are c. Additional elevators required for passenger service shalf be sized to
recommended for some care populations. accommodate resident-operated mobility devices, if needed by the
care population.
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.
.4
Specific Requirements for
Settings for Individuals with Intellectual
and/or Developmental Disabilities
• 4.4-1 General 4.4-1.1.2.2 Design criteria for accommodations for

care of persons of size. Where the care population
4.4-1.1 Application includes needs for persons of size, see Section 2.2-3
(Design Criteria for Accommodations for Care of
4.4-1.1.1 General Persons of Size) for requirements.
*4.4-1.1.1.1 This chapter contains specific requirements 4.4-1.1.2.3 Dementia, mental health, and cognitive
for residential settings for individuals with intellectual and developmental disability design criteria. Where
and/or developmental disabilities. the care population includes residents with dementia,
mental health issues, or cognitive and developmen
4.4-1.1.1.2 The requirements in Part 2 (Common tal disabilities, see Section 2.2-4 (Design Criteria for
Elements for Residential Health, Care, and Support Dementia, Mental Health, and Cognitive and Devel
Facilities) shall apply to settings for persons with opmental Disability Facilities) for requirements.
intellectual and/or developmental disabilities as
referenced in this chapter. *4.4-1.1.3 Minimum Standards for Settings for
Individuals with Intellectual and/or Developmen
4.4-1.1.2 Desig n Criteria tal Disabilities
This chapter identifies the minimum requirements
4.4-1.1.2.1 Sustainable design. See Section 2.2-2 for residential settings for persons with intellectual
(Sustainable Design Criteria) for requirements for and/or developmental disabilities, recognizing various
residential settings for individuals with intellectual configurations for small, medium, and large residential
and/or developmental disabilities. settings, which must comply with applicable state and
local requirements.
APPENDIX
A4.4-1.1.1.1 Setting types for individuals with A4.4-1.1.3 This chapter acknowledges that both residential and day
intellectual and/or developmental disabilities. care programs are available to serve residents and participants who have
Settings for persons with intellectual and/or developmental disabilities intellectual and/or developmental disabilities. The chapter does not
are acomponent ofthe continuum of care for those being served and include larger residential health settings (nursing homes) or hospitals
provide a supportive residential environment for services. They can for residents or patients who have intellectual and/or developmental
be freestanding facilities, part of a residential health, care, or support disabilities, but is intended to cover intermediate care facilities for
facility, or asetting embedded in the community at-large. individuals with intellectual disabilities (ICF1ID), community residences,
These settings can vary substantially from one state to the next and and personal care homes. For information on day care settings for these
even in the same state. In some states, the entity that provides services individuals, see Chapter 5.1, Specific Requirements for Adult Day Care
is licensed rather than the building itself. and Adult Day Health Care Facilities.
For the purposes of this chapter, the term "resident" is intended to The common goal of this chapter and local and state requirements
be interchangeable with the term "client;' as both are used by different is to facilitate accountability and protection for individuals with intel
jurisdictions. 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 occupancy approvals by authorities having

4.4-1.2.1 General (4) Addresses applicable provisions of the Guidelines
for Design and Construction ofResidential Health,
4.4-1.2.1.1 See Section 1.2-2.1 (Functional Pro Care, and Support Facilities.
gram-General) for requirements in addition to those
in this section. 4.4-1.2.2 Shared Services and Space
4.4-1.2.1.21he sponsor of each project shall provide a 4.4-1.2.2.1 Settings for residen ts with intellectual
functional program that: and/or developmental disabilities shall· be permitted
*(1) Defines the scope and scale of the setting for to be freestanding facilities or distinct parts of another
individuals with intellectual and/or developmental residential health, care, Ot support facility.
disabilities (including the care model).
(2) Identifies resident needs. 4.4-1.2.2.2 Each setting for residents with intellectual
(3) Facilitates the application of licensure and and/or developmental disabilities shall, at minimum,
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 space could be included in the community area. Because staff
provision of services is centralized or decentralized and on the size of space is usually located in a residential setting in the small set
a residential setting. Following are general descriptions ofthe differ ting model, it would include residential equipment and furnish
ent size models commonly used for individuals with intellectual and/ ings.
or developmental disabilities. Medium Setting (are Model
Small Setting (are Model The medium setting model includes community residences
The small setting care model includes personal care homes, which and intermediate care facilities for individuals with intellectual
are single-family-style homes that typically have the following disabilities (ICF/ID), which typically have the following
characteristics: characteristics:
-Integration into communities to create residential settings that -Integration into the community to create residential settings
are part of the community at-large (e.g., use of residential roof that are part ofthe community at-large
lines, heights, etc. to avoid institutional appearance and stigma) -Resident rooms for up to 16 residents and shared common
-Four or fewer residents liVing in ashared house setting, such as space. Smaller groups of resident rooms (e.g., two settings of
an apartment/home/triplex with private or shared rooms based eight resident rooms each) attached to shared commonspace
on resident choice would be considered a"small house" setting. These smaller
-Bedrooms directly accessible to common living areas such as a scaled homes may be freestanding or grouped together in
kitchen, living room, dining room, and other shared community attached or detached configurations.
spaces -A combination of private and shared resident rooms based on
-Shared or private bathrooms based on individual resident needs, resident choice and the care population being served
with shower or tub prOVided in the resident bathroom -Shared or private bathing area(s) based on individual resident
-Shared kitchen based on individual resident needs and capabili needs, with ashower provided in resident room bathrooms
ties. For example, based on the care population, it may be nec -Shared common areas for every eight resident beds
essary to support staff supervision of resident use ofthe kitchen -Separate facilities for food service and food-handling activities
or to provide a key-operated switch on an electric range or oven -Views of and access to nature
to prevent unsafe use ofacooking appliance, but the goal is to -Support for decentralized and self-administered medications
allow residents to be as independent as possible. -Dedicated staff space, which is often located in the "garage" area
-Shared living/dining room based on needs of the care popula of aresidential home that includes resident rooms and common
tion for circulation and access spaces. Alternatively, staff space could be included in the com
-Views of and access to nature munityarea.
Large Setting Care Model Residential kitchen

Alarge setting model typically includes the following: • Dining room
-Seventeen or more residents using a"household" model of care • living room
-Resident rooms assembled in smaller groups with shared • Optional den and additional activity space for family and
common space to create a household concept similar to that care provider visits
used in nursing homes or assisted living facilities -Dedicated staff space
-Neighborhood(s) of two or more households that mayor may -Views of and access to nature, and areas for outdoor activities
not be integrated into the community at-large. An overall com Large Setting Care Model
munity is composed of one or more neighborhoods. -Single- or double-occupancy resident bedrooms with direct
-Shared or private bathing areas based on individual resident access into a"household"that includes aresidentially scaled
needs, with ashower in the resident room bathroom(s) kitchen, living room, and dining room
- Shared common spaces that serve 12 to 16 resident rooms per -Space to accommodate decentralized, semi-decentralized, or
household centralized services based on the care model
-An optional larger event space. This may be included in the -Common areas that include:
overall community for larger activities or gatherings for all resi • Residentially scaled kitchen
dents, family, and the community at-large. • Dining room
-Separate facilities for food service and food-handling, including living room
acommercial kitchen or satellite kitchens that serve the house Den
holds and/or neighborhoods • Optional additional activity spaces

-Facilities for decentralized or centralized support services, -Centralized or satellite commercial kitchens based on the care
depending on the care model and services proVided. For exam model
ple, laundry services for linens may be centralized or outsourced, -Dedicated staff space
but personal laundry is completed in the household. -':"Views of and access to nature, and areas for outdoor activities
-Views of and access to nature, and areas for outdoor activities -Travel distances for staff and residents based on household and
-Support for decentralized or centralized medications. Medica neighborhood layout to maximize residents' independence and
tion distribution and storage locations may be located in a mobility
household, semi-decentralized in a neighborhood, or centrally c. Additional benefits. Some additional benefits of the small, medium,
located in acommunity. Decentralized or semi-decentralized and large setting models for residents with intellectual and/or devel
medication delivery typically reduces staff travel distances. opmental disabilities include the following:
-Dedicated staff space Small Setting Care Model
b. Physical setting. Settings for individuals with intellectual and/or -The small nature of this residential setting promotes strong
developmental disabilities are further differentiated according to personal relationships between residents and staff.
their functional and programmatic characteristics. -This setting is typically provided by an owner-operator who is
Small Setting Care Model both the owner and provider of care.
-Single- or double-occupancy resident bedrooms based on avail Medium Setting Care Model
ability and choice -This residential setting typically allows for strong personal rela
-Common areas that include: tionships between residents and staff.
• Shared kitchen -This setting prOVides a non-institutional setting for residents
• Dining room with intellectual and/or development disabilities.
• living room
Large Setting Care Model
• Optional additional space for den or family room to accom
-The size of this community allows creation of multiple house
modate activities and family visits
holds or neighborhoods to serve populations with specialized

-Accommodation of staff space
care needs.
-Access to the outdoors
-This setting allows for smaller-scaled residential-type spaces

Medium Setting Care Model Characteristics in alarger community context supporting a larger number of
-Single- or double-occupancy resident bedrooms as determined residents for-economies of scale.
to meet care population needs -Reduction in the number of corridors as a result of using a
-Space to accommodate decentralized services based on evalua household model reduces travel distances for staff.
tion of need
-Common areas that include:
contain the elements described in the applicable para (3) Promote resident privacy and dignity.
graphs of this chapter. However, when a project calls
for sharing or purchasing services from another entity, 4.4-1.4.3.2 The physical environment of a setting
modifications in space and parking requirements shall for residents with intellectual and/or developmental
be permitted. disabilities shall support the services and levels of care
provided in the residential setting, which are in larger
*4.4-1.2.2.3 Where the setting for residents with part driven by the service needs and lifestyle prefer
intellectual and/or developmental disabilities is part of ences of the residents being served.
(or contractually linked with) another facility, sharing
of facilities for services such as home health, dietary, 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 (3) Provide choice for all residents in a manner that
See Section 1.2-1.3 (Environment of Care and Facility encourages family and community involvement.
ment of Care Requirements) for requirements. *4.4-1.4.4 Barrier-Free Environment
The physical environment shall eliminate as many bar
4.4-1.4.2 Flexibility riers as possible to effective access and use of the space,
Settings for residents with intellectual and/or devel services, equipment, and utilities appropriate for daily
opmental disabilities shall be designed to provide living.
flexibility to meet the changing physical, medical, and
psychological needs of residents. 4.4-1.5 Site
4.4-1.4.3 Supportive Environment 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
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).
4.4-2.1.1 Application 4.4-2.2.1.3 Provide access to furniture and belongings.

The requirements in this section are common to most
settings for residents with intellectual and/or develop 4.4-2.2.1.4 Accommodate the care and treatment
mental disabilities and shall apply as indicated for each provided to each resident.
setting type.
*4.4-2.2.2 Resident Room
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 *4.4-2.2.2.2 Space requirements
or infringe on the space of residents who live in the (1) Resident room size (area and dimensions) shall
facility. permit resident(s) to move about the room with
the assistance of a resident-operated mobility
4.4-2.1.2.2 Facility layout shall reflect the care model device, allowing access to at least one side of a bed,
and related staffing. window, closet or wardrobe, chair, dresser, and
(1) Small model. Four or fewer resident rooms shall nightstand.
be arranged in a residentially scaled home with (2) Room size and configuration shall permit resident
centralized services and bathing, resident, and staff options for bed location(s) and shall comply with
support areas. spatial requirements of the AH].
(2) Medium model. Five to16 resident rooms shall (3) Bedrooms shall not be used as passageways,
be arranged in a residentially scaled home that is corridors, or access to other bedrooms.
freestanding or located in a larger community with

centralized or decentralized services and bathing, 4.4-2.2.2.3 Windows. See Section 4.4-5.2.2.6
resident, and staff support areas. (Windows) for requirements.
(3) Large model. Seventeen or more resident rooms

shall be arranged using a household model with 4.4-2.2.2.4 Resident privacy
centralized or decentralized services and bathing, *(1) Visual privacy shall be provided for each resident in
resident, and staff support areas. double-occupancy rooms.
4.4-2.2 Resident Unit or Private Living Area to the toilet, room entrance, window, or other
4.4-2.2.1 General
Bedrooms or resident rooms shall be provided and 4.4-2.2.2.5 Hand-washing station. Where a hand
sized to: washing station is provided, see Section 2.4-2.2.8
4.4-2.2.1.1 Allow for sleeping.

4.4-2.2.1.2 Afford privacy.
*4.4-2.2.2.7 Resident bathroom. Each resident shall
have access to a bathroom.
APPENDIX
A4.4-2.2.2 Resident room capacity. Bedrooms should be A4.4-2.2.2.4 (1) Consideration should be given to using awall or
limited to single or double occupancy. partition as adivider to preserve visual and auditory privacy for each
resident. Alcoves may be used in double-occupancy resident rooms.
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 A4.4-2.2.2.7.Resident bathrooms in small setting
to their resident room depending on specific resident and safety needs models. Because small setting models are located in aresidential
in the setting. home setting, clearances and grab bars should·beconsideredbased
INTelLECTUAL AND/OR DEVelOPMENTAL DISABILITIES
(1) The bathroom shall contain the following: 4.4-2.3.2 Lobby
(a) Toilet Where a lobby is provided, see Section 2.3-2.3.2
(b) Hand-washing station. See Section 2.4-2.2.8 (Lobby) for requirements.

(c) Mirror. See Section 2.4-2.2.8.7 (Mirror) for 4.4-2.3.3 Dining, Recreation, and Lounge Areas
requirements.
(d) Private individual storage for the personal 4.4-2.3.3.1 General
effects of each resident. See Section 2.4-2.4.2 (1) See Section 2.3-2.3.3.1 (Dining, Recreation, and
(Casework, Millwork, and Built-Ins) for Lounge Areas-General) for requirements.
requirements. (2) Space for circulation of resident-operated mobility
*(e) Tub or shower. See Section 2.5-2.3.3.2 devices shall be provided in activity areas.
(Accessible showers) for requirements.
4.4-2.3.3.2 Dining areas
(2) Where the bathroom is shared, privacy locks shall
be permitted with provisions for emergency access. (1) Space for dining shall be provided.
*(2) Space requirements
*4.4-2.2.2.8 Resident storage (a) Space provided for resident dining shall allow
(1) Each resident shall be provided with an individual residents, including those using wheelchairs
wardrobe or closer. and resident-operated mobility devices, to
*(2) Separate, enclosed storage in the resident room access and leave their tables without disturbing
shall be provided for each resident. other residents.
(b) Where servers and food carts are utilized, clear
4.4-2.3 Resident Community Areas and unobstructed circulation paths shall be
provided.
4.4-2.3.1 General (c) Space shall be provided for staff to help
See Section 2.3-2.3.1 (Resident, Participant, and residents who require assistance with eating
Outpatient Community Areas-General) for based on the care population.
requirements. (3) Location. For "small house" and "household"
models, it is anticipated that dining areas will
be adjacent to living areas to accommodate less
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.
A4.4-2.2.2.8 Resident storage

a. Clearances. Toilets used by residents should have sufficient clearance
a. Resident closets or wardrobes should have an adjustable-height bar
on both sides of the toilet to enable physical access and maneu

for hanging clothes.
vering by staff based on the care population and physical need

b. Providing storage for resident mobility devices as required by the
requirements. appendix section A2.4-2.2.9.2-b (Grab bars in bath

care population should be considered.
rooms-For assisted transfers) for additional information.

b. Grab bars. Where independent transfers are feasible, alternative grab A4.4-2.2.2.8 (2) Lockable storage. Lockable drawers or
bar configurations should be permitted. See Section 2.4-2.2.9.3 (1) cabinets should be provided to allow residents to secure some personal
(Alternative grab bar configurations) for additional information. belongings.
A4.4-2.2.2.7 (1 He) Tub or shower A4.4-2.3.3.2 (2) Dining area size. Provision of a dining
a. Acurbless shower that is open to the surrounding bathroom should area(s) with aminimum floor area of 25 square feet per resident should
be considered for new construction.
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:
(a) Space for planned resident activities General) for requirements.

(b) Areas sufficient in number and configuration
to accommodate the following: 4.4-4.2 Facilities that Support Resident,
(i) Gatherings of resident groups of various
sizes 4.4-4.2.1 Staff Work Areas
(ii) Occurrence of separate and distinct activi
ties 4.4-4.2.1.1 These area(s) shall be provided where
(iii) Simultaneous dining and recreational required by the care model to serve resident needs.
activities
4.4-2.3.3.4 Toilet rooms. Toilet facilities that accom resident records.
modate resident-operated mobility devices shall be
readily accessible to all dining, recreation, activity, and 4.4-4.2.1.3 Direct visualization of resident rooms or
lounge locations for medium and large setting models. 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)
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.
INTEllECTUAL AND/OR DEVElOPMENTAL DISABILITIES
4.4-4.2.3.1 General provided if required for the linen services offered

*(1) Where a shower is not provided in the resident by the facility.
bathroom, a central bathing or spa room or area (2) Where a closed-cart system is used, storage in an
shall meet the req uirements in this section. alcove where staff control can be exercised shall be
(2) Where a central bathing or spa room or area is permitted.
provided or required by the AH], see Section
2.5-2.3.3 (Showers and Tubs) for requirements in 4.4-4.2.4.3 Supply storage. Storage space(s) for
addition to those in this section. supplies and recreation items shall be immediately
accessible and secured to support recreation and
4.4-4.2.3.2 Number. Based on the needs of the care activities offered.
population, at least one central bathtub, spa tub, or
shower shall be provided for resident use, where a 4.4-4.2.4.4 Storage for resident needs. Storage
shower is not provided in the resident bathroom. space(s) for resident equipment and supplies shall be
immediately accessible to support services offered and
4.4-4.2.3.3 Space requirements. Bathing fixtures secured based on the care population.
provide the following: 4.4-4.2.5 Clean Utility Room
(1) Space for private use of the bathing fixture Where a clean utility room is provided for storage and
(2) Space for drying and dressing holding as part of a system for distribution of clean
(3) Access to a grooming location with a sink, mirror, materials, see Section 2.3-4.2.5 (Clean Utility Room)
and counter or shelf for requirements.
4.4-4.2.3.4 Toilet. A toilet shall be provided in or 4.4-4.2.6 Soiled Utility Room

directly accessible to each resident bathing or spa Where a soiled utility room is provided for storage
room or area without requiring entry into the general and holding as part of a system for collection of soiled
corridor. materials, see Section 2.3-4.2.6 (Soiled Utility Room)
for requirements.
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 4.4-4.2.7 Personal Laundry Facilities
4.4-4.2.7.1 Provision of decentralized facilities for
4.4-4.2.4 Equipment and Supply Storage for washing and drying personal laundry shall be permit
Medium and Large Settings ted where the care model supports this approach for
small groups of residents.
4.4-4.2.4.1 See Section 2.3-4.2.4 (Equipment and
Supply Storage) for requirements in addition to those 4.4-4.2.7.2 Where shared personal laundry areas are
in this section. provided, these shall be equipped with the following
for use by residents/families:
4.4-4.2.4.2 Clean linen storage (1) Washer and dryer
(1) A separate closet or designated area shall be (2) Hand-washing station
(3) Folding area
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 the bathing area without requiring entry into a general corridor
b. Accessibility for residents in wheelchairs
INTEllECTUAL AND/OR DEVelOPMENTAL DISABILITIES
4.4-4.2.7.3 Where personal laundry facilities are pro 4.4-4.5 Food Service Facilities
vided, see 2.3-4.2.7 (Personal Laundry Facilities) for
additional requirements. 4.4-4.5.1 General
The type and size of the setting for residents with
4.4-4.2.8 Resident Telephone Access intellectual and/or developmental disabilities shall
See Section 2.3-4.2.8 (Resident and Participant determine the dietary environment and the food
Telephone Access) for requirements. service facilities provided.
4.4-4.3 Support Areas for Staff in Medium and 4.4-4.5.2 Centralized Commercial Kitchen
Large Settings Where a centralized commercial kitchen is provided,
4.4-4.3.1 General
in Section 2.3-4.5 (Food Service Facilities).
See Section 2.3-4.3.1 (Support Areas for Staff
General) for requirements. 4.4-4.5.3 Warming Kitchen
For facilities that have a service contract with an
4.4-4.3.2 Staff Lounge Area in Large Settings
outside vendor for food service, the following
See Section 2.3-4.3.2 (Staff Lounge Area) for requirements shall be met:
requirements.
4.4-4.5.3.1 Where an outside vendor is used to pro
4.4-4.3.3 Toilet Rooms vide meals for a setting of 16 or more beds, dedicated
Toilet rooms shall be permitted to be shared by the space and equipment shall be provided for a warming
public, staff, and residents. kitchen, including space for minimal equipment for
4.4-4.4 Support Facilities for Family and meals.
Visitors
4.4-4.4.1 General to serve as an alternative location to accommodate the
Community space for family and visitors shall be function of a warming kitchen. See Section 2.3-2.3.4
provided based on the care model and setting type. (Resident and Participant Kitchen) for requirements.
*4.4-4.4.2 Overnight Guest Accommodations 4.4.-4.5.4 Decentralized Kitchen
Space for sleeping accommodations for overnight Where food preparation is conducted on-site for 16 or
guests shall be provided based on the care model and more beds, the facility shall have dedicated non-public
setting type. staff space and equipment for preparation of meals. See
section 2.3-2.3.4 (Resident and Participant Kitchen)
4.4-4.4.3 Pet Accommodations for requirements.
If pets are accommodated in the setting type,

4.4-4.6 Linen and Laundry Service Facilities
see Section 2.3-4.4.3 (Pet Accommodations) for
requirements.
A4.4:-4.4.2 Overnight guest accommodations. recliner, sleep thair, sleep sofa) when it is fully open for use to allow
Where visitor sleeping accommodations are provided in resident rooms, staffto reach the resident in case ofan emergency
provision of the folloWing should be considered: b. Storage space to accommodate and secure overnight guests'
a. Sufficient circulation around the sleeping accommodation (e.g., belongings
._ _ _ - - - - _.•. __._ _ _.._--_._--------._-------_•.•. _----_._.•__ _._---_.. _-_.._ - -
INTELLECTUAL AND/OR DEVElOPMENTAL DISABILITIES
*4.4-4.6.1 General 4.4-4.6.3.2 At minimum, the following elements

shall be included:
4.4-4.6.1.1 Each setting for residents with intellectual (1) Rooms and spaces for sorting, processing, and.
and/or developmental disabilities shall have provisions storage of soiled materials
for storing and processing clean and soiled/contami (2) Soiled holding room(s). Separate central or
nated linen for resident care based on the requirements decentralized room(s) shall be provided for
of the care model and the setting type. receiving and holding soiled linen for pickup or
processing.
4.4-4.6.1.2 Based on the care model, personal laundry
services can be combined with clean utility and/or (a) Room(s) shall have ventilation and exhaust.
soiled utility. See Section 2.3-4.2.5 (Clean Utility (b) Discharge from soiled linen chutes shall be
Room), Section 2.3-4.2.6 (Soiled Utility Room), and received in this room or in a separate room as
2.3-4.2.7 (Personal Laundry Facilities) for additional required by the local AH].
requirements. (c) Room(s) used for processing shall be provided
with a laundry or deep sink.
4.4-4.6.2 Facilities for Contracted Linen Services (3) Central clean linen storage. A central clean linen
Where contracted services are used, the following shall storage and issuing room(s) shall be provided in
be provided: addition to the linen storage required at individual
resident units.
4.4-4.6.2.1 An area for soiled linen awaiting pickup (4) Linen carts
(a) Storage. Provisions shall be made for parking

clean and soiled linen carts separately and out
of clean linen
of traffic.
(b) Cleaning. Provisions shall be made for
4.4-4.6.3 On-Site Laundry Service Facilities for
cleaning linen carts on-premises (or exchange
Large Settings
of carts off-premises).
4.4-4.6.3.1 General (5) Hand-washing stations. Hand-washing stations

(1) Where on-site laundry services are provided in a shall be provided in each area where unbagged
large setting for residents with intellectual and/or soiled linen is handled. See Section 2.4-2.2.8
developmental disabilities, the requirements in this (Hand-Washing Stations) for additional
section shall apply. requirements.
located in the facility, in a separate building on- Ot 4.4-4.7 Materials Management Facilities
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
a manner that does not conflict with resident living
areas.
(a) Areas dedicated to laundry shall be separate
from food preparation areas. 4.4-4.7.2 Materials management facilities provided in
(b) Laundry rooms shall not open directly into large settings shall meet the requirements in Section
resident rooms. 2.3-4.7 (Materials Management Facilities).
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.
4.4 SPECIFI'C REQUIREMENTS FOR SETTINGS FOR INDIVIDUALS WITH
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,
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

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

4.4-4.11.1 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
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.
----------- -. __..... _.•_---_.----_.__ ... _.--._..._
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.

*4.4-5.2.2.4 Doors and door hardware
(1) Door type 4.4-5.2.2.9 Grab bars. See Section 2.4-2.2.9 (Grab
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.
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
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

4.4-5.2.3 Surfaces
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
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
----_._._. __ . _ - _ . _ - - - - - -
4.4-5.2.3.2 Flooring and wall bases. See Section (2) Design of sinks shall not permit storage beneath
2.4-2.3.2 (Flooring and Wall Bases) for requirements. the sink basin in casework or in areas below a sink
open to the floor for accessible units.
tion 2.4-2.3.3 (Walls and Wall Protection) for 4.4-6.2.3.3 Showers and tubs. See Section 2.5-2.3.3
requirements. (Showers and Tubs) for requirements.

4.4-6.2.3.4-4.4-6.2.3.5 Fteserved
for requirements.
4.4-5.2.4 Furnishings 4.4-6.2.3.6 Portable hydrotherapy whirlpools.

Where portable hydrotherapy whirlpools are used in
See Section 2.4-2.4 (Furnishings) for requirements.
a setting for residents with intellectual and/or devel
opmental disabilities, see Section 2.5-2.3.6 (Portable
• 4.4-6 Building Systems Hydrotherapy Whirlpools) for requirements.
4.4-6.1 General 4.4-6.3 Heating, Ventilation, and

requirements.
4.4-6.3.1 General

4.4-6.2.1 General (1) For small and medium-sized settings for residents
with intellectual and/or developmental disabilities,
see ANSIIASHRAE Standard 62.2: Ventilation
requirements.
and Acceptable Indoor Air Quality in Low-Rise
Residential Buildings for basic HVAC system
requirements.
See Section 2.5-2.2 (Plumbing and Other Piping (2) For large settings for residents with intellectual
Systems) for requirements. and/or developmental disabilities, see ANSI/
ASHRAE Standard 62.1: Ventilation for Acceptable
4.4-6.2.3 Plumbing Fixtures Indoor Air Quality for basic HVAC system
requirements.
. Fixtures-General) for requirements. 4.4-6.3.2 Mechanical System Design
4.4-6.2.3.2 Hand-washing sinks
requirements.
(1) See Section 2.5-2.3.2 (Hand-Washing Sinks) for
requirements. 4.4-6.3.3 HVAC Requirements for Specific
Locations
and disinfection protocols to assure the product will remain durable latent conditions [holes and weaknesses] that adversely impact patient
and effective at meeting Centers for Disease Control and Prevention and safety" should be identified and eliminated during planning, design,
other clinical bacterial-elimination requirements. and construction of health care facilities. Reduction of surface contami
The Center for Health Design report "Designing for Patient Safety: nation linked to health care-associated infections is one of these fac
Developing Methods to Integrate Patient Safety Concerns in the Design tors. See Section 1.2-3 (Resident Safety Risk Assessment) for additional
Process" identified environmental factors as "latent conditions that information.
can be designed to help eliminate harm:' Such "built environment
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 provide an airtight fit with the enclosing ductwork.
these are provided, see Section 2.5-3.3.2 (Fuel-Fired (2) All joints between filter segments and the enclosing
Equipment Rooms) for requirements. ductwork shall have gaskets or seals to provide a
(Areas of Refuge) for requirements. 4.4-6.3.7 Heating Systems, Cooling Systems, and
Equipment
Where these are provided, see Section 2.5-3.3.4 (Com
mercial Food Preparation Areas) for requirements.

4.4-6.3.7.1 Heating systems. Settings for residents
See Section 2.5-3.4 (Thermal and Acoustic Insulation) with intellectual and/or developmental disabilities shall
for requirements. have a permanently installed heating system capable of
maintaining an interior minimum temperature of72°
4.4-6.3.5 HVAC Air Distribution 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..

filter bank. There is no minimum filter efficiency 4.4-6.4 Electrical Systems
requirement for the second filter bank.
(2) For non-central recirculating room systems, HVAC 4.4-6.4.1 General
units shall: See Section 2.5-4.1 (Electrical Systems-General) for
requirements.
outdoor air.
Equipment
4.4-6.4.2.1 Essential electrical service
located upstream of any such cold surface so *(1) Applicable standards for care models
that all of the air passing over the cold surface (a) Facilities with a large setting care model shall
is filtered. 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.
. APPENDIX
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.
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.
(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
the following requirements shall be met:
tion engines shall be located, designed, and installed to
minimize objectionable noise. (1) The system shall be capable of activation/operation
from resident toilets, bedrooms, and bathing areas.
4.4-6.4.3 Electrical Receptacles (2) The signal shall be transmitted to on-duty staff
through fixed locations and/or resident wearable
4.4-6.4.3.1 General. See Section 2.5-4.3.1 (Electrical devices.
Receptacles-General) for requirements. (3) Use of alternative technologies, including wireless
systems, shall be permitted.
2.5-4.3.2 (Receptacles in Corridors) for requirements. (a) Where wireless systems are used, consideration
*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.
Standard 2560: Emergency Call Systems
Facilities.
4.4-6.5.2.2 Resident apartment or dwelling unit
call stations
APPENDIX
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.
(1) Where a hardwired system is used: 4.4-6.6 Electronic Safety and Security Systems
(a) Each bed location shall be provided with a call See Section 2.5-6 (Electronic Safety and Security
device accessible to the resident. Systems) for requirements.
two call devices. 4.4-6.7 Daylighting and Artificial Lighting
Systems
(2) Use of wireless call stations shall be permitted.

4.4-6.7.1 General
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 Areas
requirements.
(2) The emergency call system shall be designed so that
when a call is activated a signal is initiated that is
device.
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 illumination with provisions for reducing light
data Room) for requirements. levels at night.
4.4-6.5.4 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 *(2) Resident rooms, bedrooms, and bathrooms
tion Spaces) for requirements.
(a) Task light controls shall be readily accessible to
4.4-6.5.5 Cabling Pathways and Raceway residents.
Requirements (b) Where night-lighting is provided, it shall
be located in the pathway to and from the
See Section 2.5-5.5 (Cabling Pathways and Raceway
bedside and the bathroom.
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
than 2 feet (61 centimeters) above the services on any floor other than the main entrance
floor. floor.
(ii) Night-lighting shall be controlled sepa (2) At least two elevators shall be installed where 60 to
rately from ambient lighting. 200 residents are living or receiving care or support
*(iii) Night-lighting shall have a low light level. services on floors other than the main entrance
(iv) Because night-lights may disturb resi floor.
dent sleep even when properly specified, (3) At least three elevators shall be installed where
located, and operated, care providers shall 201 to 350 residents are living or receiving care
be permitted to use portable light sources or support services on floors other than the main
or switched night-lights for added control entrance floor.
of this light source. (4) For facilities with more than 350 residents living
or receiving care or support services above the
4.4-6.8 Acoustic Design Systems for Large and main entrance floor, the number of elevators shall
Medium Settings be determined from a study of the facility plan
See Section 2.5-8 (Acoustic Design Systems) for and from the estimated vertical transportation
4.4-6.9 Elevator Systems *4.4-6.9.2 Dimensions and Clearances

Elevator car doors shall have a clear opening of no less
4.4-6.9.1 General than 3 feet 8 inches (1.12 meters).
4.4-6.9.1.1 Requirement. Where elevators are 4.4-6.9.3 Leveling Device

provided in large settings for residents with intellec See Section 2.5-9.3 (Leveling Device) for
tual and/or developmental disabilities the following requirements.
requirements shall be met:
*4.4-6.9.1.2 Number. Engineered traffic studies are
recommended, but in their absence the following

requirements.
guidelines for the minimum number of elevators shall

apply:
4.4-6.9.5 Handrails
(1) At least one elevator sized to accommodate a
Elevator cars shall have handrails on all sides without
gurney and/or medical carts and resident-operated

entrance door(s). See Section 2.4-2.2.10 (Handrails

residents are living or receiving care or support
APPENOIX __
A4.1-6.7.3.2 (2)(b)(iii) Night-lighting in resident A4.4-6.9.2 Elevator dimensions and clearances

rooms. Research has established that older adults sleep best in total a. Handrail projections of up to 3.5 inches (8.89 centimeters) should
darkness. Therefore, to minimize resident sleep disruption, night-lights not be construed as diminishing the clear inside dimensions.
should provide very low levels of illumination and be located to mini b. If reqUired to serve the care population and indicated by a mobility
mize light scatter and reflections on room surfaces. To achieve alow transfer assessment, at least one facility elevator should accommo
light level, night-lighting should include amber or red lamping. White, date attending staff and an ambulance gurney 7feet 6inches (2.29
blue, or green lamping should not be used. Switches for night-lights are meters) in length and/or an expanded capacity widfh of 4feet (1.22
recommended for some care populations. meters) for persons of size.
e. Additional elevators reqUired for passenger service should be sized to
A4.4-6.9.1.2 Number of elevators. These standards may
accommodate resident-operated mobility devices.

be inadequate for moving large numbers of people in ashort time;
adjustments should be rnade as appropriate to the care model and
population served.
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-
-<
-1
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
'" 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.

."
'"n
ro
U>
C\
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'!
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spaces should be supported. 2'""
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:;;
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
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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
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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
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,.. 9. Support for person-centered care: The goal of this model is to offer residents a 2 2
full experience of home. -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
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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
• 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

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 5.1-1.1.2.2 Design criteria for accommodations for
vide adult day care and adult day health care services. care of persons of size. Where the care population
includes persons of size, see Section 2.2-3 (Design
5.1-1.1.1.2 The common elements in Part 2 of the Criteria for Accommodations for Care of Persons of
Guidelines for Residential Health, Care, and Support Size) for requirements.
Facilities shall apply to adult day care and adult day
health care (ADHC) facilities when they are referenced 5.1-1.1.2.3 Dementia, mental health, and cogni
in this chapter. 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
-------------------------------
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

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
facility is part of (or contractually linked with) another
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.
5.1-1.5.2.4 Access to utilities. See Section 1.3-2.4 • 5.1-2 Participant Areas

Utilities) for requirements. 5.1-2.1 General
The faciliry shall have sufficient space, furnishings, gar
5.1-1.5.3 Site Features
dens or other outdoor space, and equipment to accom
modate the range of program activities and services for
5.1-1.5.3.1 Roads. See Section 2.1-3.1 (Roads) for
the number of participants to be served.
requirements.
5.1-2.2 Reserved
5.1-1.5.3.2 Pedestrian walkways. Accessible paved
walkways shall be provided for pedestrian traffic.
5.1-2.3 Participant Community Areas
5.1-1.5.3.3 Parking
5.1-2.3.1 General
(1) In the absence oflocal requirements, each faciliry
shall have parking spaces to satisfY the needs of
Outpatient Communiry Areas-General) for
users, staff, and visitors.
requirements.
(2) Reduction of parking requirements shall be
permitted, as acceptable to local authorities having
*5.1-2.3.2 Lobby
Where a central lobby is provided as part of the
5.1-1.5.3.4 Signage and wayfinding. See Section day care center, see Section 2.3-2.3.2 (Lobby) for
1.2-4.5.3 (Signage and Wayfinding) and Section 2.4 requirements.
2.2.12 (Signage and Wayfinding) for requirements.
5.1-2.3.3 Dining, Recreation, and Lounge Areas
5.1-1.5.3.5 Site lighting. See Section 2.1-3.5 (Site
Lighting) for requirements. 5.1-2.3.3.1 General. See Section 2.3-2.3.3.1 (Dining,
Recreation, and Lounge Areas-General) for require
5.1-1.5.3.6 Landscape features ments.
(1) General. See Section 1.2-4.5.1 (Light) and Section

*5.1-2.3.3.2 Dining area. See Section 2.3-2.3.3.2
(Dining areas) for requirements.
requirements.
(2) Outdoor water features. See Section 2.1-3.6.3
*5.1-2.3.3.3 Recreation, lounge, and activity areas
(Outdoor Water Features) for requirements.
(1) Spaces for different activities shall be provided
5.1-1.5.4 Building Orientation based on the care population served.
(2) Space requirements

See Section 1.2-2.2.2.2 (1) (Site) and Section 2.2-2.1
(Sustainable Site Design) for requirements. (a) Net usable space. Only spaces used by
participants shall be counted as net usable
APPENDIX
A5.1-2.3.2 Vehicular drop-off and pedestrian seating should serve more than 16 participants to decrease the
entrance. The length of the covered/canopied entrance should be potential for unpredictable sodal and sensory stimulation.
determined by the number of accessible vans to be accommodated. The c. Refer to Keith Biaz Moore, "Besign Guidelines for Adult Bay Services"
number of vans should be determined by the number of participants in AlA Report on University Research 2005 for additional information
being served. and further detail on toilets, dining, and the zone of transition.
A5.1-2.3.3.2 Dining area A5.1-2.3.3.3Recreation, lounge, and activity areas
a. Bining should occur in aspace that is Visually and spatially distinct a. Typically, inclusion of two to three dayrooms provides the opportu
from activity areas. nity to have distinct activities in each area based on the care popula
b. Bepending on the care population being served, no single dining tion being served.
activity space. Reception areas, storage areas, disabilities, an additional 70 square feet
offices, restrooms, and service areas shall not (21.33 square meters) of space shall be
be included. provided per participant to make it pos
sible to maintain the therapeutic milieu.
(i) Where a warming pantry or participant
See Section 2.2-4 (Design Criteria for
kitchen is used for activities other than
Dementia, Mental Health, and Cognitive
meals, 50 percent of the Boor area shall be
and Developmental Disability Facilities)
permitted to be counted as activity space.
(ii) A commercial kitchen shall not count as
activity space.
5.1-2.3.3.4 Support areas for dining, recreation,
(iii) Where a clearly marked corridor is treated
lounge, and actvity locations
as a wandering pathway with lean rails or
handrails, 100 percent of the Boor area (1) All communal activity areas shall have access to a
shall be permitted to be counted as activity hand-washing station.
space. (2) Toilet rooms. The adult day care facility shall have
at least one toilet for every 10 participants and
(b) Area. Minimum square footage requirements fraction thereof
shall be based on the services offered by
the adult day care or adult day health care (a) Location. A participant toilet room shall be
(ADHC) facility. located adjacent to dining, recreation, lounge,
and activity areas.
(i) A minimum of 100 square feet (30.48 (b) Type
square meters) shall be provided for each
of the first five participants and 60 square (i) Toilet rooms shall be permitted to be an
feet (18.28 square meters) of net usable individual toilet room or a toilet room
program activity space for each participant with multiple stalls.
thereafter. (ii) The facility shall provide a toilet room or
(ii) Where the facility offers physical rehabili toilet stall types to accommodate the level
tation therapy, an additional 50 square feet of care provided.
(15.24 square meters) of space per partici (iii) All facilities shall include at least one toilet
pant using the thetapy space at one time room that can accommodate a two-person
shall be provided for activity space needed assisted transfer between participant-oper ,
for equipment and treatment. ated mobility device and toilet.

(iii) For facilities that serve residents with (c) Space requirements. Toilet rooms or stalls shall
I
dementia, an additional 40 square feet be sized and configured to accommodate staff
(12.19 square meters) of space shall be assistance including use of lifting equipment, I
;
provided per participant to allow for at where applicable, and accessibility standards
least two separate spaces for socializing in that support independent participant use.
small groups. See Section 2.2-4 (Design (d) The toilet room shall contain the following:
Criteria for Dementia, Mental Health, and
Cognitive and Developmental Disability (i) Toilet or stalls with toilets
Facilities) for additional requirements. (ii) Hand-washing station(s)
(iv) For facilities that serve residents with (iii) Mirror. For requirements, see Section
mental health and/or developmental 2.4-2.2.8.7 (Mirror).
"~;:APPENDIX (continued)
b. Access to outdoor activity spaces from recreation, lounge, and activ c. Provision ofaden or hearth room dose to-the lobby and reception
ity areas should be considered. See Section 5.1-2.8 (Outdoor Activity area should be considered. Participants often use this space as a
Spaces) for requirements. library, computer area, and living room-type setting.
*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 area(s) for participants shall be visible and accessible
participants, volunteers, and family members, see from the common dining, living, and activity spaces.
Section 2.3-2.3.4 (Resident and Participanr Kitchen)
for requirements. 5.1-2.3.8.3 Outdoor spaces shall have a fence or land
scaping to create a boundary that prevents participant
*5.1-2.3.5 Personal Services (Hair Salon/Spa) Areas 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.
• 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.

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.
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)
Storage Locations) for requirements. See Section 2.3-4.2.4 (Equipment and Supply Storage)
for requirements.
*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.
*5.1-4.2.6 Soiled Utility Room 5.1-4.2.9.2 Location

(1) A quiet room or area shall be located where it can
5.1-4.2.6.1 A soiled utility room shall be provided in be clearly monitored.
each adult day care facility. (2) A quiet room or area shall be permitted to be part
of the treatment room (for ADHC) or part of the
5.1-4.2.6.2 The soiled utility room shall contain the
nursing office.
following:
(1) Hand-washing station 5.1-4.2.9.3 Space requirements. Circulation space
(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 5.1-4.2.9.4 Participant toilet room. A toilet room
that meets the requirements in Section 5.1-2.3.3.4 (2)
5.1-4.2.7 Personal Laundry Facilities (Toilet rooms) shall be located adjacent to the quiet
room.
5.1-4.2.7.1 Where personal laundry facilities are pro
vided, see Section 2.3-4.2.7 (Personal Laundry Facili (1) This shall be an individual toilet room or a toilet
ties), except for Section 2.3-4.2.7.4 (Shared facilities), room with multiple stalls.
for requirements in addition to those in this section. (2) This toilet room shall be permitted to be shared by
participants using other activity spaces.
5.1-4.2.7.2 Inclusion of personal laundry facilities
with central bathing rooms or areas or in conjunction 5.1-4.3 Support Areas for Staff
with soiled and clean utility rooms shall be permitted.
5.1-4.3.1 General
5.1-4.2.7.3 Storage of a minimum of one change of See Section 2.3-4.3.1 (Support Areas for Staff-Gen
clothing shall be provided for each participant in the eral) for requirements.
personal laundry area or near bathing facilities.
*5.1-4.3.2 Staff Lounge Area
5.1-4.2.8 Participant Telephone Access
An area where participants can make and receive tele 5.1-4.3.2.1 The staff lounge area shall meet the
phone calls in private shall be provided. requirements of Section 2.3-4.3.2 (Staff Lounge Area)
as amended in this section.
*5.1-4.2.9 Quiet Room or Observation Area
5.1-4.3.2.2 The staff lounge area shall be permitted to
Where a quiet space to lie down is provided to accom also serve as a private conference area.
modate participant observation by staff, the following
requirements shall be met: 5.1-4.3.3 Staff Toilet Room
5.1-4.2.9.1 Capacity. Each room or area shall be pro See Section 2.3-4.3.3 (StaffToilet Room) for require
vided with a single bed. ments.
APPENDIX
AS.1-4.2.6 Soiled utility room. The soiled utility room may levels), and Section 2.5-8.5 (Design Criteria for Performance of Interior
be combined with the personal laundry facilities and/or the environ Wall and Floor/Ceiling Constructions) for recommendations.
mental ser.vices room.

AS.1-4.3•.2 Staff lounge area. Where the facility capacity is
AS. t -4.2.9 Acoustic recommendations for quiet 40 participants or greater, aseparate staff lounge should be prOVided.
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
5.1-4.3.4 Staff Storage facility shall have dedicated non-public staff space and
See Section 2.3-4.3.4 (Staff Storage) for requirements. equipment for preparation of meals. See 2.3-2.3.4
5.1-4.4 Support Areas for Family and Visitors
5.1-4.6 Reserved
5.1-4.4.1 General
For shared private meeting areas, see Section 5.1
4.11.1.1 (Private conference space) for requirements. See Section 2.3-4.7 (Materials Management Facilities)
for requirements.
5.1-4.4.2 Reserved
5.1-4.4.3 Pet Accommodations See Section 2.3-4.8 (Waste Management Facilities) for
Where pets are permitted, see Section 2.3-4.4.3 (Pet waste collection, storage, and disposal requirements.
Accommodations) for requirements.
5.1-4.5 Food Service Facilities See Section 2.3-4.9 (Environmental Services Rooms)
for requirements.
Where a centralized commercial kitchen is provided, 5.1-4.10 Facilities for Engineering and
it shall comply with Section 2.3-4.5 (Food Service Maintenance Services
Facili ties). See Section 2.3-4.10 (Facilities for Engineering and
Maintenance Services) for requirements.
5.1-4.5.2 Warming/Catering Kitchen
For facilities that have a service contract with an 5.1-4.11 Administrative Areas
outside vendor for food service, provision of a warm
ing/catering kitchen designed in accordance with the *5.1-4.11.1 Office and Conference Space
following requirements shall be permitted. Offices or an open office area with private conference
space shall be provided for business transactions and
5.1-4.5.2.1 Where an outside vendor is used to pro participant assessments and for the use of administra
vide meals, the facility shall include dedicated space tive and professional staff.
and equipment for a warming kitchen, including space
for minimal equipment for preparation of breakfast, *5.1-4.11.1.1 Conference space. Space for private con
lunch, or emergency meals. ferences and meetings, including participants meeting
with staff, visitors, and family, shall be sized to accom
5.1-4.5.2.2 Use of the participant kitchen in Section modate operational needs.
5.1-2.3.4 (Participant Kitchen) shall be permitted as (1) Sharing of space by several services shall be
an alternative location to accommodate the function of permitted.
a warming kitchen. (2) For PACE ADHC facilities, medical professional

offices shall be provided in accordance with PACE
5.1-4.5.3 Decentralized Kitchen regulations.
Where food preparation is conducted on-site, the
5.1-4.11.1.2 General office space. Staff office space
and file storage shall be provided based on the staff
A5.1-4.11.1 Office and conference space. Provision of b. One activity professional's office at 140 square feet (13 square
the following office space should be considered: meters)
a. One director's office at 140 square feet (13 square meters)
required to operate the adult day care center and the

services being provided.
showers, and toilets for participant use shall be
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.
Requirements
5.1-5.1 Building Codes

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 Architectural Details (1) See Section 2.4-2.2.8 (Hand-Washing Stations) for
requirements.
5.1-5.2.2.1 General. See Section 2.4-2.2.1 (2) Omission of the mirror shall be permitted.
5.1-5.2.2.9 Grab bars
5.1-5.2.2.2 Corridors. See Section 2.4-2.2.2 *(1) Grab bars shall be installed at all participant toilets,
(Corridors) for requirements. 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.
(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
holders, shall have the strength to sustain
requirements.
a concentrated load of250 pounds (113.4
kilograms).
(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

with eased corners where a mitered corner
condition exists.

5.1-5.2.2.10 Handrails. See sections 2.4-2.2.10.1,
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

5.1-6.2.3.5 Clinical sinks. Where clinical sinks are
5.1-5.2.2.13 Decorative water features. Where provided in an adult day care or adult day health care
decorative water features are used in the facility design, (ADHC) facility, see Section 2.5-2.3.5 (Clinical Sinks)
see appendix section A2.4-2.2.13 (Decorative water for requirements.
features).
Where portable hydrotherapy whirlpools are used
APPENDIX
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.
in an adult day care or ADHC facility, see Section provided, see Section 2.5-3.3.4 (Commercial Food
2.5-2.3.6 (Portable Hydrotherapy Whirlpools) fot Preparation Areas) for requirements.
requirements.
*5.1-6.3.4 Thermal and Acoustic Insulation
5.1-6.3 Heating, Ventilation, and See Section 2.5-3.4.1 (Thermal and Acoustic Insula
Air-Conditioning (HVAC) Systems tion-General) for requirements.
5.1-6.3.1 General 5.1-6.3.5 HVAC Air Distribution

5.1-6.3.1.1 Application. For basic HVAC system
requirements.
requirements for adult day care and ADHC facilities,
see ANSIIASHRAE Standard 62.1: Ventilation for
Acceptable Indoor Air Quality.
5.1-6.3.6.1 General. See ANSIIASHRAE Standard

62.1: Ventilation for Acceptable Indoor Air Quality for

requirements.
ing) fot tequitements.
5.1-6.3.6.2 Filter efficiencies.

requirements.
filter bank. There is no minimum filter efficiency
(2) For non-central recirculating room systems, HVAC
Locations
units shall:
5.1-6.3.3.1 Participant and related support areas. (a) Not receive nonfiltered, nonconditioned
See ANSIIASH RAE Standard 62.1: Ventilation for outdoor air.
Acceptable Indoor Air Quality for basic HVAC system (b) Serve only a single space.
requirements. *(c) Include the manufacturer's recommended filter
5.1-6.3.3.2 Fuel-fired equipment rooms. Where designed to condense water. This filter shall be
rooms with fuel-fired equipment are provided, see located upstream of any such cold surface so
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for that all of the air passing over the cold surface
requirements. is filtered.
5.1-6.3.3.3 Areas of refuge. Where areas of refuge are 5.1-6.3.7 Heating Systems, Cooling Systems, and
provided, see Section 2.5-3.3.3 (Areas of Refuge) for Equipment
requirements.
5.1-6.3.3.4 Commercial food preparation areas. to those in this section.
Where commercial food preparation areas are
APPENDIX
AS.1-6.3.4 Thermal and acoustic insulation floors in a manner that provides for speech privacy between occu
a. See ASHRAE 90.1: Energy Standard for Buildings Except Low-Rise Resi pied spaces and between floors.
dential BUildings for more information.
AS.1-6.3.6.2 (2)(c) Filters for recirculating room
b. Provisions for acoustic insulation should meet or exceed local build
systems. Filters should be replaced and/or cleaned per the manufac

ing code requirements.
turer's recommendations to maintain indoor air quality.

c. Consideration should be given to construction of demising walls and
5.1-6.3.7.1 Heating systems. Adult day care and 5.1-6.4.4 Electrical Requirements for Areas
ADHC facilities shall have a permanently installed Serving Ventilator-Dependent Participants
heating system capable of maintaining an interior Where ventilators are used in an adult day health care
minimum temperature of 72° F (22° C) under heating center, see Section 2.5-4.4 (Electrical Requirements for
design temperatures. Ventilator-Dependent Resident Rooms and Areas) for
requirements.
5.1-6.3.7.2 Cooling systems. Adult day care and
ADAHC facilities shall be configured and equipped 5.1-6.5 Communication Systems
with a cooling system capable of maintaining an
interior maximum temperature of 75° F (24° C) under 5.1-6.5.1 General
cooling design temperatures.
See Section 2.5-5.1 (Communication Systems-Gen
eral) for requirements.
5.1-6.4 Electrical Systems

5.1-6.4.1 General
See Section 2.5-4.1 (Electrical Systems-General) for 5.1-6.5.2.1 General. Where call systems are provided,
requirements. the use of alternative technologies, including wireless
systems, shall be permitted.
5.1-6.4.2 Power-Generating and Storing
(1) Where wireless systems are used, consideration
Equipment
5.1-6.4.2.1 Essential electrical service

(2) Wireless systems shall comply with UL Standard
(1) Adult day care and ADHC facilities that require
2560: Standardfor Emergency Call Systems for
essential electrical systems shall comply with the Assisted Living and Independent Living Facilities.
appropriate occupancy requirements ofNFPA 101:
Life Safety Code 5.1-6.5.2.2 Reserved
(2) As required by local codes and the care types, an
essential electrical source shall provide emergency 5.1-6.5.2.3 Emergency call system. An emergency
lighting and/or power during an interruption of call system shall be provided in adult day care facilities.
the normal electrical supply.
*(1) An emergency call device shall be provided at
each toilet, bath, shower room, and examination,
5.1-6.4.2.2 Generators. Where generators are used in
observation, or treatment room.
adult day care and ADHC facilities, exhaust systems
(2) The device shall be accessible to a person lying
(including locations, mufflers, and vibration isolators)

on the floor. Inclusion of a pull cord or portable
for internal combustion engines shall be designed and

wireless device shall satisfY this requirement.
installed to minimize objectionable noise.

(3) The signal shall activate a visual and/or audio
signal located at an appropriate location and/or a
5.1-6.4.3 Electrical Receptacles

handheld mobile device carried by staff.
See sections 2.5-4.3.1, 2.5-4.3.2, 2.5-4.3.4, and 2.5

(4) Emergency call systems shall be listed by a
4.3.5 in Section 2.5-4.3 (Electrical Receptacles) for

nationally recognized testing laboratory.
requirements.
Room(s)
APPENDIX
AS.1-6.S.2.3 (1) Emergency call devices. Based on the should be evaluated for incorporation of emergency call system stations.
care population served, physical therapy, quiet rooms, fitness and exer This evaluation should consider the care model, care population, scale of
cise areas, pool areas and other therapy areas, and other common areas the facility, and staffsight lines for observation.
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

5.3.3 (Location and Access) for requirements.

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
pant and/or staff use areas on more than one floor shall
have an electric or hydraulic elevator(s).
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:
(1) At least one elevator sized to accommodate
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

than 3 feet 8 inches (1.12 meters).

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.
5.1-6.9.4 Installation and Testing 5.1-6.9.5.1 Elevator cars shall have handrails on all
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.
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 Dementia, Mental Health, and Cognitive and Devel

opment Disability Facilities) for requirements.
5.2-1.1 Application
5.2-1.1.1 General
5.2-1.2.1 See Section 1.2-2 (Functional Program) for
*5.2-1.1.1.1 This chapter applies to facilities that offer requirements.
wellness services.
5.2-1.2.2 Shared Services and Space
5.2-1.1.1.2 The common elements in Part 2 of the
Guidelines for Residential Care Facilities shall apply *5.2-1.2.2.1 Where a wellness center is part of (or
to wellness centers where they are referenced in this contractually linked with) another facility, sharing of
chapter. services and space for home health, dietary, storage,
pharmacy, linen, and other services shall be permitted
5.2-1.1.2 Design Criteria insofar as practical.
5.2-1.1.2.1 Sustainable design. See Section 2.2-2 5.2-1.2.2.2 Where a project calls for sharing or
(Sustainable Design Criteria) for requirements for purchasing services from another entity, appropriate
adult day care and ADHC facilities. modifications in the requirements for space and park
care of persons of size. Where the care population 5.2-1.2.2.3 Each wellness center located in a facility
includes persons of size, see Section 2.2-3 (Design housing other services shall have its own identifiable
Criteria for Accommodations for Care of Persons of space.
Size) for requirements.

5.2-1.2.2.4 All support spaces shall be permitted to be
5.2-1.1.2.3 Dementia, mental health, and cognitive shared.
the care population includes participants with demen 5.2-1.3 Resident Safety Risk Assessment
tia, mental health issues, or cognitive and developmen See Section 1.2-3 (Resident Safety Risk Assessment)
tal disabilities, see Section 2.2-4 (Design Criteria for for requirements.
APPENDIX
AS.2-1.1.1.1 Well ness centers may be freestanding or attached to AS.2-1.2.2.1 Shared services and space. In some cases,
a residential health, care, or support facility. Services provided include ancillary service requirements will be met by the principal facility and
primary care, physical fitness, socialization, education, and therapies the only modifications necessary will be in the support facility. In other
focused on wellness and creating apositive lifestyle and sense of well cases, programmatic concerns and reqUirements may dictate separate
being. Wellness centers can be integrated into continuing care retire service areas.
ment communities orthe community at-large, or they can be part of an

acute care campus.
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

walkways shall be provided for pedestrian traffic.

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
permitted, as acceptable to local authorities having
section.

5.2-1.5.2 Facility/Community Access 1.2-4.5.3 (Signage and Wayfinding) and Section 2.4
*5.2-1.5.2.1 Emergency access. Fire department and
emergency vehicle access shall be provided in accor 5.2-1.5.3.5 Site lighting. See Secrion 2.1-3.5 (Site
dance with local requirements. 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
5.2-1.5.2.3 Security. See Section 2.1-2.3 (Security)
requirements.
for requirements.
(Outdoor Water Features) for requirements.

5.2-1.5.4 Building Orientation
Utilities) for requirements.
(Sustainable Site Design) for requirements.
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.
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
leave their tables without disturbing other
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,

Participant, and Outpatient Community Areas

*(2) Recreation, exercise, and fitness training space.
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.
recreational activities, exercise classes, and fitness (a) Toilets for the recreation, exercise, and fitness
training programs offered to participants in the training space shall be permitted to be shared
wellness center. with other activities.
*(3) Aquatic center. Where aquatic facilities are (b) Location of toilets in a locker room shall be
provided, see appendix section A5.2-2.3.3.3 (3) permitted.
(Aquatic center) for additional information.
(3) Locker rooms
*(4) Education and consultation facilities. Where
education and consultation facilities are provided, *(a) Changing areas and storage lockers shall be
see appendix section A5.2-2.3.3.3 (4) (Education provided where required to support the ser
and consultation facilities) for additional vices provided.
information. (b) Toilet room(s). See Section 5.2-2.3.3.4 (2)
(Public toilet rooms) for requirements.
5.2-2.3.3.4 Support areas for dining, recreation, (c) Showers shall be provided as required for the
lounge, and activity locations wellness/fitness program offered in the wellness
(l) Reserved center.
*(2) Public toilet rooms. Public toilet rooms shall be (I) See Section 2.5-2.3.3.2 (Accessible show
provided adjacent to or directly accessible from ers) for requirements.
exercise and fitness training spaces. (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
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
5.2-2.3.4 Participant Kitchen and Treatment Areas) for requirements in addition to

those in this section.
5.2-2.3.4.1 Where a participant kitchen is provided
to support nutrition planning, education, and 5.2-3.2 Examination, Observation and/or
demonstrations, see Section 2.3-2.3.4 (Resident and Treatment Rooms
Participant Kitchen) for requirements. Where examination, observation, and/or treatment
rooms are provided, see Section 2.3-3.2 (Examina
5.2-2.3.4.2 Incorporation of a cafe, juice bar, or tion, Observation and/or Treatment Rooms) for
facility for other for-sale items shall be permitted. See requirements.
Section 5.2-2.3.3.2 (Dining area) for requirements.
5.2-3.3 Reserved
5.2-2.3.5 - 5.2-2.3.7 Reserved
5.2-3.4 Rehabilitation Therapy Areas
5.2-2.3.8 Outdoor Activity Space
Where rehabilitation therapy services are provided,
Where an outdoor activity space(s) is provided, see the space shall comply with applicable requirements
Section 2.1-3.6.2 (Outdoor Activity Spaces) for in Chapter 5.3 (Specific Requirements for Outpatient
requirements. 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
Services
Areas
5.2-4.1 General
5.2-3.1 General
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.
*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.

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
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

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,
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.
. _----_ _. __.._ _._--_. _-_ _--- _.._ - -

Requirements


for requirements.
5.2-5.2.2.6 Windows. See Section 2.4-2.2.6

(Windows) for requirements.
Furnishings

5.2-5.2.1 General

5.2-5.2.2 Architectural Details requirements.
(2) Omission of rhe mirror shall be permitted.
5.2-5.2.2.9 Grab bars
*(1) Grab bars shall be installed at all participant toilets,
showers, and tubs.
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
(a) Where independent transfers are feasible,

*5.2-5.2.2.4 Doors and door hardware alternative grab bar configurations shall be
(1) Door type permitted.
(b) The care population shall be evaluated to
determine alternative grab bar configurations
showers, and toilets for participant use shall be that meet specific participant needs.
(b) Manual or automatic sliding doors shall (3) For wall-mounted grab bars, a minimum clearance
be permitted where their use does not of 1.5 inches (3.81 centimeters) from walls shall be
compromise fire and other emergency exiting provided.
requirements. (4) Grab bar load requirements shall be evaluated for
alignment with the needs of the care population.

(a) Grab bars, including those that are part of
APPENDIX
AS.2-S.2.2.4 Door protection. See appendix section A2.4 a minimum clearance of 24 inches (60.96 centimeters) fr()m the
2.2.4 (Door protection) for recommendations. centerline of the toilet bowl to the wall to enable physical access
and maneuvering by staff, who may have to assist the partidpant in
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
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
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
holders, shall have the strength to sustain 5.2-6.2.2 Plumbing and Other Piping Systems
a concentrated load of 250 pounds (113.4 See Section 2.5-2.2 (Plumbing and Other Piping
kilograms). Systems) for requirements.
(b) If a population includes persons of size, grab
bars installed in areas intended for use by 5.2-6.2.3 Plumbing Fixtures
minimum concentrated load of 800 pounds 5.2-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing
(362.88 kilograms). Fixtures-General) for requirements.
(5) Grab bars shall have a finish color with a value that
contrasts with the adjacent wall surface. 5.2-6.2.3.2 Hand-washing sinks. See Section
(6) Grab bars shall be returned to the wall or floor 2.5-2.3.2 (Hand-Washing Sinks) for requirements.
condition exists. 5.2-6.2.3.3 Showers. See Section 2.5-2.3.3.2
5.2-5.2.2.10 Handrails. See Section 2.4-2.2.10
(Handrails and Lean Rails) for requirements. 5.2-6.2.3.4 Reserved
5.2-5.2.2.11 Protection from heat-producing 5.2-6.2.3.5 Clinical sinks. Where clinical sinks are
equipment. See Section 2.4-2.2.11 (Protection from provided in a wellness center, see Section 2.5-2.3.5
Heated Surfaces) for requirements. (Clinical Sinks) for requirements.
5.2-5.2.2.12 Signage and wayfinding. See Section 5.2-6.2.3.6 Portable hydrotherapy whirlpools.
2.4-2.2.12 (Signage and Wayfinding) for requirements. Where portable hydrotherapy whirlpools are used in a
wellness center, see Section 2.5-2.3.6 (Portable Hydro
5.2-5.2.2.13 Decorative water features. Where therapy Whirlpools) for requirements.
decorative water features are used in the facility design,
see appendix section A2.4-2.2.13 (Decorative water 5.2-6.3 Heating, Ventilation, and
features) for recommendations. Air-Conditioning (HVAC) Systems
5.2-5.2.3 Surfaces 5.2-6.3.1 General
See Section 2.4-2.3 (Surfaces) for requirements.

requirements for wellness centers, see ANSIIASHRAE
Standard 62.1: Ventilation for Acceptable Indoor Air
See Section 2.4-2.4 (Furnishings) for requirements. Quality.

• 5.2-6 Building Systems Section 2.5-3.1.2 (Ventilation and Space Condition
5.2-6.1 General
See Section 2.5-1 (Building Systems-General) for 5.2-6.3.2 Mechanical System Design
requirements.
requirements.

5.2-6.2.1 General
Locations
requirements.
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
requirements.
outdoor air.
5.2-6.3.3.2 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.
located upstream of any such cold surface so
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
Where commercial food preparation areas are

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 5.2-6.3.7.1 Heating systems. Wellness centers shall
have a permanently installed heating system capable of
See Section 2.5-3.4.1 (Thermal and Acoustic Insula
maintaining an interior minimum temperature of 72°
tion-General) for requirements.
F (22° C) under heating design temperatures.

5.2-6.3.7.2 Cooling systems. Wellness centers shall be
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.
5.2-6.4 Electrical Systems
5.2-6.4.1 General
requirements.

requirements.
(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
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.
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
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
Where call systems are provided, use of alternative
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

requirements.
5.2-6.5.2.2 Wireless systems shall comply with UL
Standard 2560: Emergency Call Systems for Assisted

Living and Independent Living Facilities.

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.
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) .
task lighting. 5.2-6.9.2 Dimensions and Clearances
(b) Task light controls shall be readily accessible to
participants.

requirements.
requirements.

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).
lines for minimum number of elevators shall apply: 5.2-6.9.5.2 See Section 2.4-2.2.10 (Handrails and
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.
5.3 Specific Requirements for Outpatient
Rehabilitation Therapy Facilities
• 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 and developmental disability design criteria.
Where the care population includes outpatients
*5.3-1.1.1.1 This chapter applies to facilities where with dementia, mental health issues, or cognitive
outpatient rehabilitation services and therapies are and developmental disabilities, see Section 2.2-4
provided. (Design Criteria for Dementia, Mental Health, and
Cognitive and Development Disability Facilities) for
5.3-1.1.1.2 The common elements in Part 2 of the requirements.
Guidelines for Residential Care Facilities shall apply to
outpatient rehabilitation therapy facilities where they 5.3-1.2 Functional Program
are referenced in this chapter.
5.3-1.2.1 See Section 1.2-2 (Functional Program) and
5.3-1.1.2 Design Criteria Section 1.2-3 (Resident Safety Risk Assessment) for
requirements.
(Sustainable Design Criteria) for requirements for 5.3-1.2.2 Shared Services and Space
outpatient rehabilitation therapy facilities.
APPENDIX
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 *5.3-1.4.2.1 Emergency access. Fire department and
therapy faciliry is part of (or contractually linked with) emergency vehicle access shall be provided in accor
another faciliry, sharing of services and space for home dance with local requirements.
health, dietary, storage, pharmacy, linen, and other
services shall be permitted insofar as practical. 5.3-1.4.2.2 Availability of transportation. See 2.1
2.2 (Availabiliry ofTransportation) for requirements.
5.3-1.2.2.2 Where a project calls for sharing or
purchasing services from another entiry, appropriate 5.3-1.4.2.3 Security. See Section 2.1-2.3 (Securiry)
modifications in the requirements for space and park for requirements.
5.3-1.2.2.3 An outpatient rehabilitation faciliry (Access to Utilities) and Section 2.1-2.4 (Access to
located in a faciliry housing other services shall have its Utilities) for requirements.
own identifiable space.
5.3-1.2.2.4 All support spaces shall be permitted to be
shared. 5.3-1.4.3.1 Roads. See Section 2.1-3.1 (Roads) for
requirements.
*5.3-1.3 Environment of Care Requirements
See Section 1.2-1.3 (Environment of Care and Faciliry 5.3-1.4.3.2 Pedestrian walkways. Accessible paved
Function Considerations) and Section 1.2-4 (Environ walkways shall be provided for pedestrian traffic.
5.3-1.4.3.3 Par10Utg
5.3-1.4 Site (1) In the absence of local requirements, each faciliry
shall have parking spaces to satisfy the needs of
5.3-1.4.1 General users, staff, and visitors.
See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site (2) Reduction of parking requirements shall be
Elements) for requirements. permitted, as acceptable to local authorities having
5.3-1.4.2 Facility/Community Access
1.2-4.5.3 (Signage and Wayfinding) and Section 2.4
APPENDIX
A5.3-1.2.2.1 Shared services and space. In some cases, b. The facility design should produce asupportive environment to
ancillary service requirements will be met by the principal facility and enhance and extend quality of life for facility users and promote
the only modifications necessary will be in the support facility. In other their privacy and dignity while they receive care and services.
cases, programmatic concerns and requirements may dictate separate c. Facility design should maximize opportunities for ambulation and
service areas. minimize the negative aspects of an institutional environment.
A5.3-1.3 Environment of care. Person-centered care in

d. The architectural environment should eliminate as many barriers
the long-term continuum of care should address movement away to effective access to and use of space, services, equipment, and
from institutional models toward models that are more residentially utilities as possible.
scaled, facilitate wayfinding, and provide acomfortable environment e. Facilities should provide accessibility for outpatients with disabilities
for the population served through provision of appropriate lighting and in accordance with the state or local bUilding code and the
acoustics. Americans with Disabilities Act.
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.
-----------
5.3-1.4.3.5 Site lighting. See Section 2.1-3.5 (Site 5.3-2.3.3.3 Provisions for drinking water. A drink
Lighting) for requirements. ing water source shall be provided for outpatient use.
5.3-1.4.3.6 Landscape features *5.3-2.3.4 Outpatient Therapy Kitchen

(1) General. See Section 1.2-4.5.1 (Light) and Section Where kitchen facilities with an operating kitchen
1.2-4.5.2 (Views of and Access to Nature) for (rather than a mock-up for therapy only) are provided,
requirements. the following requirements shall apply:
(Outdoor Water Features) for requirements. 5.3-2.3.4.1 Purpose. Design of the outpatient therapy
kitchen to support cooking activities used for occupa
5.3-1.4.4 Building Orientation tional and physical therapy shall be permitted:
(Sustainable Site Design) for requirements. 5.3-2.3.4.2 Where provided, outpatient therapy
kitchen facilities shall include the following:
(1) Work counter
• 5.3-2 Outpatient Areas (2) Refrigerator
(3) Storage cabinets
5.3-2.1 General (4) Sink
See Section 2.3-2.3.1 (Resident, Participant, and (5) Range, cooktop, and/or oven wirh emergency
Outpatient Areas-General) for requirements. shutoffs. Provision of a functional cooking
appliance shall be permitted.
5.3-2.2 Reserved (6) Dishwasher

(7) Hand-washing station. This shall be located in or
5.3-2.3 Outpatient Community Areas immediately accessible from the therapy kitchen
facilities. See Section 2.4-2.2.8 (Hand-Washing
5.3-2.3.1 General Stations) for requirements.

Outpatient Community Areas-General) for 5.3-2.3.5 - 5.3-2.3.7 Reserved
requirements.
5.3-2.3.2 Lobby See Section 2.1-3.6.2 (Outdoor Activity Spaces) for
Where an outpatient rehabilitation facility has a sepa requirements.
rate entrance and lobby, see Section 2.3-2.3.2 (Lobby)
for requirements.
5.3-2.3.3 Outpatient Waiting Areas Areas
5.3-2.3.3.1 Size. The waiting room capacity needed 5.3-3.1 General

for each therapy provided shall be based on the care
population being served. 5.3-3.1.1 See Section 2.3-3.1 (Diagnostic and
Treatment Areas-General) for requirements in
5.3-2.3.3.2 Location. Outpatient waiting area(s) shall addition to those in this section.
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 or residential kitchen for continued or improved involvement in
of outpatient therapy kitchen facilities include acountry kitchen instrumental activities of daily living.
5.3-3.1.2 Where two or more rehabilitation therapies 5.3-3.2.2.2 Individual therapy area. Where indi
and services are provided, sharing of facilities and vidual therapy areas are provided in a larger therapy or
equipment between the therapies and services shall be exercise area, each therapy space shall have a minimum
permitted. clear floor area of 80 square feet (7.43 square meters).
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
several therapy spaces.
5.3-3.2.1 General (2) See Section 2.4-2.2.8 (Hand-Washing Stations) for
requirements.
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 5.3-3.2.3.1 Where retraining, educational, or small
each type of therapy and service provided. Space shall group therapies are provided for outpatients, at least
be permitted to be shared with another function. one classroom shall be provided.
5.3-3.2.2 Therapy Areas 5.3-3.2.3.2 Space requirements

(1) Each classroom shall provide 30 square feet (2.79
5.3-3.2.2.1 Individual therapy room
square meters) per outpatient in addition to space
(1) Where an individual therapy room(s) is provided, for the instructor and instructional resources.
it shall meet the requirements in this section. (2) At minimum, each classroom shall have an area of
*(2) Space requirements shall be based on the 150 square feet (13.94 square meters).
equipment used for therapy. Space provided shall
allow access to the equipment when in use by the 5.3-3.2.4 Physical Therapy Exercise Area
outpatient and the therapist.
(a) Area 5.3-3.2.4.1 General. A physical therapy exercise area

shall be permitted to be shared with other fitness train
(i) An individual therapy room shall have a ing spaces, based on the services being provided and
minimum clear floor area of 80 square feet the setting (e.g., a stand-alone facility versus one that is
(7.43 square meters). part of a continuing care retirement community).
(ii) For design criteria for accommodations for
care of persons of size, see Section 2.3 5.3-3.2.4.2 Space requirements
3.2.2.1 (2) (Examination and Treatment
(1) The layout of the exercise area shall include a staff
Room Space Requirements-Area) for
work area arranged so that staff can view activi ties
requirements.
taking place in the exercise area.
(b) Clearances. Room arrangement shall permit a (2) An open, barrier-free space for rehab therapy shall
minimum clearance of 2 feet 8 inches (81.28 be provided based on the following:
centimeters) on at least three sides of the
(a) Number of patients treated at the same time
therapy furniture and equipment.
(b) Number of staff members present at the same
time
(c) Clearance requirements for equipment used
APPENDIX
AS•.3-3.2.2.1 (2) Therapy room space to accommodate outpatients using mobility devices. For additional
requirements. Depending on the care population, most therapy information, see Section 2.3-3.2.2.2 (Examination and Treatment Room
spaces may need to be larger than 80 square feet (7.43 square meters) Space Requirements-Clearances).
._ - - - - - - - - - _ . _ - - - - - - - - - - - - - - - - - - - - - - - - - - -
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.
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIEN-T REHABILITATION THERAPY FACILITIES
5.3-3.3.2.3 Speech privacy 5.3-4.2.2 Reserved

(1) A gasketed door with a sweep shall be provided in
5.3-4.2.3 Central Bathing Rooms or Areas
speech and hearing room(s)
(2) The room design shall minimize external sound
from high-traffic, public, and similarly noisy areas. 5.3-4.2.3.1 General. Where therapy services provided
include a focus on residential activities of daily living,
5.3-3.3.2.4 Hand-washing station or hand including bathing, a mock-up or real residential-style
sanitation dispenser. A hand-washing station shall be bathroom shall be provided for therapy activities.
provided in speech and hearing room(s).
5.3-4.2.3.2 Outpatient changing areas. Where
[ *5.3-3.3.3 Facilities for Other Therapy Services required by the therapy program, the following shall
be provided:
5.3-3.3.3.1 Where other services are provided, dedi (1) Changing areas
cated diagnostic and treatment area(s) to accommodate (2) Toilets
those services shall be provided, including work space (3) Showers
for therapists. (4) Securable lockers
5.3-3.3.3.2 Hand-washing station 5.3-4.2.3.3 Toilet room. A toilet room with space for
(1) A hand-washing station shall be provided for any toilet training for outpatients shall be provided.
additional therapy rooms provided.
(2) Where additional areas are shared with other
therapy areas, a hand-washing station shall also be
5.3-4.2.4.1 Clean and soiled linen storage
permitted to be shared with those areas.
(1) Storage for clean linen and towels shall be provided
in cabinets, closets, or separate storeroom(s) .
• 5.3-4 Facilities for Support Services (2) Separate storage for soiled linen, towels, and
supplies shall be provided.
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
shall be provided for the following areas when they are
5.3-4.2 Facilities that Support Outpatient Care part of the clinical services offered by the facility:
(1) Exercise area(s)
5.3-4.2.1 Staff Work Area(s) (2) Therapy room(s) and therapy area(s)
(3) Pool area(s)
5.3-4.2.1.1 See Section 2.3-4.2.1 (Staff Work Area) (4) Prosthetic, orthotic, speech, hearing, or other
for requirements in addition to those in this section. clinical services
*5.3-4.2.1.2 Documentation area. Accommodations 5.3-4.2.5 - 5.3-4.2.6 Reserved

for written and/or electronic documentation shall be
provided in all therapy service areas. 5.3-4.2.7 Personal Laundry Facilities
Where the therapy services provided include washing
laundry, folding clothing, and other laundry-related
APPENDIX
AS.3-3.3.3 Additional therapy services. These services AS.3-4.2.1.2 Documentation area. Accommodations
may include social services, psychological services, and vocational should include awriting surface and/or area with storage for an
services. electronic device.
activities of daily living, the outpatient setting shall 5.3-4.8.1 See Section 2.3-4.8 (Waste Management
include a washer and a dryer. Facilities) for waste collection, storage, and disposal
requirements.
See Section 2.3-4.3.1 (Support Areas for Staff 5.3-4.8.2 Sharing of waste collection, storage, and
General) for requirements. disposal facilities with other health, care, and support
facilities shall be permitted.
5.3-4.4 Support Areas for Family and Visitors
5.3-4.4.1 - 5.3-4.4.2 Reserved
5.3-4.9.1 See Section 2.3-4.9 (Environmental Services
5.3-4.4.3 Pet Accommodations Rooms) for requirements.
Where pet therapy is offered in the outpatient
rehabilitation facility, see Section 2.3-4.4.3 (Pet 5.3-4.9.2 Sharing of environmental services rooms
Accommodations) for requirements. with other health, care, and support facilities shall be
permitted.
5.3-4.5 Reserved
5.3-4.10 Facilities for Engineering and
5.3-4.6 Linen and Laundry Service Facilities Maintenance Services
Where a contract service is used in lieu of the facili
ties in Section 5.3-4.2.7 (Personal Laundry Facilities) 5.3-4.10.1 See Section 2.3-4.10 (Facilities for Engi
and linen is processed off-site, the following shall be neering and Maintenance Services) for requirements.
provided:
5.3-4.10.2 Sharing of facilities for engineering and
5.3-4.6.1 Service Entrance maintenance services with other health, care, and
support facilities shall be permitted.
A service entrance, protected from inclement weather,
shall be provided for loading and unloading of linen.
5.3-4.11 Administrative Areas
This can be shared with other services and serve as the
loading dock for the facility. Administrative areas shall be provided to support the
administrative services performed in the outpatient
5.3-4.6.2 Control Station rehabilitation center as indicated by an evaluation of
staffing needs.
A control station for pickup and receiving shall be
provided. This can be shared with other services and
5.3-4.11.1 Office Space
serve as the service receiving and pickup point for the
facility.
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.
5.3-4.7.1 See Section 2.3-4.7 (Materials Management

5.3-4.11.1.2 Reception shall be permitted to be com
Facilities) for requirements.
bined with office and clerical space.
5.3-4.7.2 Sharing of materials management areas

permitted. Space for storage of office equipment and supplies shall
be provided based on staff requirements and outpa
5.3-4.8 Waste Management Facilities tient needs.
-----------------------------------------------_.

Requirements

5.3-5.1 Building Codes
for requirements.
5.3-5.2.2.6 Windows. See Section 2.4-2.2.6 (Win

dows) for requirements.
Furnishings

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
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.

2.4-2.2.9.3 (Alternative grab bar configurations)

(a) Where independent transfers are feasible,

*5.3-5.2.2.4 Doors and door hardware alternative grab bar configurations shall be
(1) Door type permitted.
(b) The care population shall be evaluated to
determine alternative grab bar configurations
showers, and toilets for outpatient use shall be
that meet specific outpatient needs.
(b) Manual or automatic sliding doors shall (3) For wall-mounted grab bars, a minimum clearance
be permitted where their use does not of 1.5 inches (3.81 centimeters) from walls shall be
compromise fire and other emergency exiting provided.
requi rements. (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 (Doot

(a) Grab bars, including those that are part of
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
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

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
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
bars installed in areas intended for use by
requirements.
minimum concentrated load of 800 pounds
(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.
condition exists.
5.3-5.2.2.10 Handrails. See sections 2.4-2.2.10.1,
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
requirements.
*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.
5.3-6.2.3.3 Showers. See Section 2.5-2.3.3.2
decorative water features are used in the facility design,
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.
5.3-6.3 Heating, Ventilation, and *5.3-6.3.4 Thermal and Acoustic Insulation

Air-Conditioning (HVAC) Systems See Section 2.5-3.4.1 (Thermal and Acoustic
Insulation-General) for requirements.
5.3-6.3.1 General
requirements for outpatient rehabilitation therapy

requirements.
facilities, see ANSIIASHRAE Standard 62.1:

Ventilation for Acceptable Indoor Air Quality.


requirements.

requirements.
Locations
(2) For non-central recirculating room systems, HVAC
units shall:
5.3-6.3.3.1 Outpatient and related support areas.
See ANSIIASHRAE Standard 62.1: Ventilation for (a) Not receive nonfiltered, nonconditioned
Acceptable Indoor Air Quality for basic HVAC system outdoor air.
requirements. (b) Serve only a single space.
5.3-6.3.3.2 Fuel-fired equipment rooms. Where for airflow passing over any surface that is
rooms with fuel-fired equipment are provided, see designed to condense water. This filter shall be
Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for located upstream of any such cold surface so
requirements. that all of the air passing over the cold surface
is filtered.
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 5.3-6.3.7 Heating Systems, Cooling Systems, and
requirements. Equipment
5.3-6.3.3.4 Commercial food preparation areas. Systems, and Equipment) for requirements in addition
Where commercial food preparation areas are to those in this section.
provided, see Section 2.5-3.3.4 (Commercial Food
Preparation Areas) for requirements.
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
A5.3-6.3.4 The.rmal and acoustic ins.ulation and floors in a manner that provides for speech privacy between
a. See ASH RAE 90J:lnergy Standard for BUildings Except Low-Rise occupied spaces and between floors.
Residential BUildings for more information.
A5.3..;6.3.6.2 (2)(c) Filters for recirculating room
b. Provisions fOJ acoustic insulation should meet or exceed local

systems. Filters should be replaced and/or cleaned per the
building code requirements.

manufacturer~s recommendations to maintain indoor air quality.
c. Consideration should be given to construction of demising walls
5.3 SPECIFIC REQUIREMENTS FOR OUTPATIENT REHABILITATION THERAPY FACiliTIES
0 0
temperature of 72 F (22 C) under heating design See Section 2.5-5.1 (Communication Systems
temperatures. General) for requirements.
5.3-6.3.7.2 Cooling systems. Outpatient rehabilita 5.3-6.5.2 Call System

tion facilities shall be configured and equipped with
a cooling system capable of maintaining an interior 5.3-6.5.2.1 General. Where call systems are provided,
0
maximum temperature of75° F (24 C) under cooling the use of alternative technologies, including wireless
design temperatures. systems, shall be permitted.
(1) Where wireless systems are used, consideration
5.3-6.4 Electrical Systems shall be given to electromagnetic compatibility
5.3-6.4.1 General (2) Wireless systems shall comply with UL Standard

See Section 2.5-4.1 (Electrical Systems-General) for 2560: Emergency Call Systems for Assisted Living and
requirements. Independent Living Facilities.
5.3-6.4.2 Power-Generating and Power-Storing 5.3-6.5.2.2 Reserved

Equipment
5.3-6.4.2.1 Essential electrical service gency call system is provided in an outpatient rehabili
(1) At minimum, outpatient rehabilitation therapy tation facility, the requirements in this section shall be
settings that require essential electrical systems met.
shall comply with the appropriate occupancy *(1) An emergency call device shall be provided at
requirements ofNFPA 101: Life Safety Code each toilet, bath, shower room, and examination,
(2) As required by local codes and the care types, an observation, or treatment room.
essential electrical source shall provide emergency (2) The device shall be accessible to a person lying
lighting and/or power during an interruption of on the floor. Inclusion of a pull cord or portable
the normal electrical supply. wireless device shall satisfy this requirement.
(3) The signal shall activate a visual and/or audio
5.3-6.4.2.2 Generators. Where generators are used signal located at an appropriate location and/or a
in outpatient rehabilitation therapy settings, exhaust handheld mobile device carried by staff.
systems (including locations, muffiers, and vibra (4) Emergency call systems shall be listed by a
tion isolators) for internal combustion engines shall nationally recognized testing laboratory.
be designed and installed to minimize objectionable

noise. 5.3-6.5.3 Technology Equipment and Teledata
Room(s)
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 5.3-6.5.3.1 General
2.5-4.3.5 in Section 2.5-4.3 (Electrical Receptacles) for (1) See Section 2.5-5.3.1.1 (Technology Equipment
requirements. and Teledata Room-Purpose) for requirements.
(2) Number. Each outpatient rehabilitation therapy

5.3-6.5 Communication Systems setting shall have a room or closet to accommodate
technology systems used in the facility.
5.3-6.5.1 General
APPENDIX
AS.3-6.S.2.3 (1) Emergency call devices. Based on the should beevaluated for incorporation of emergency call system stations.
care population served, physical therapy, quiet rooms, fitness and exer This evaluation should consider the care model, care population, scale of
cise areas, pool areas and other therapy areas, and other common areas the facility, and staffsight lines for observation.
---------_._._•...•... _..... ------------------ _
.. .._._._._-----_.
5.3-6.5.3.2 Size. See Section 2.5-5.3.2 (Size) for 5.3-6.8 Acoustic Design Systems
requirements. See Section 2.5-8 (Acoustic Design Systems) for
requirements.
5.3-6.5.3.3 Location and access. See Section 2.5
5.3.3 (Location and Access) for requirements. 5.3-6.9 Elevator Systems
5.3-6.5.3.4 Technology equipment room facilities. 5.3-6.9.1 General

See Section 2.5-5.3.4 (Technology Equipment Room
Facilities) for requirements. 5.3-6.9.1.1 Application. All buildings having out
patient or staff use areas on more than one floor shall
5.3-6.6 Electronic Safety and Security Systems have an electric or hydraulic elevator(s).
See Section 2.5-6 (Electronic Safery and Securiry
Systems) for requirements. *5.3-6.9.1.2 Number. Engineered traffic studies are rec
lines for minimum number of elevators shall apply:
Systems
outpatient-operated mobiliry device users shall be
5.3-6.7.1 General
required where spaces used by outpatients are on
See Section 2.5-7.1 (Daylighting and Artificial Lighr any floor other than the main entrance floor.
ing Systems-General) for requirements. (2) Where outpatient rehabilitation therapy facilities
are part of a general hospital, the hospital's
5.3-6.7.2 Daylighting Systems in Outpatient elevators shall be permitted to meet the
Areas requirement in Section 5.1-6.9.1.1 (Application).
See Section 2.5-7.2 (Daylighting Systems in Resi
dent Living, Participant, and Outpatient Areas) for 5.3-6.9.2 Dimensions and Clearances
requirements. Elevator car doors shall have a clear opening of not less
5.3-6.7.3.1 Light fixtures. See Section 2.5-7.3.1 See Section 2.5-9.3 (Leveling Device) 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. See Section 2.5-9.4 (Installation and Testing) for
requirements.
(1) Reserved
(2) Outpatient toilet rooms
5.3-6.9.5 Handrails
task lighting. 5.3-6.9.5.1 Elevator cars shall have handrails on all
(b) Task light controls shall be readily accessible ro sides without entrance door(s).
outparients.
5.3-6.9.5.2 See Section 2.4-2.2.10 (Handrails and
AS.3-6.7.3.2 Lighting for corridors. Corridors used by AS.3-6.9.1.2 These standards may be inadequate for moving large
outpatients 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.
------_._----------------------
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),

need for assisrance in assisred living, A1.1-4.1.1
Access A4.1-1.1.1.1, A4.1-1.2.1.2 (l)-b Accessibiliry Guidelines (ADAAG),
to adulr day (healrh) care faciliries, practice area, 3.1-3.3.3.2 (2), A2.4-2.2.9.1
5.1-1.5.2 5.3-4.2.3.1, 5.3-4.2.3.7 approved door closers, A4.2-5.2.2-a
to clinic services, 2.3-3.1.2 in resident and parricipant kirchen, 2.3 guidance for signage,
communiry, 2.1-2.2, 2.3-3.1.2, 2.3.4.1 (1), A5.1-2.3.4, A5.3-2.3.4 A2.4-2.2.12.3-d
5.1-1.5.2,5.2-1.5.2,5.3-1.4.2 rherapy for, A3.1-3.3-c, A5.3-1.1. 1.1-c Standards for Accessible Design,
to daylighring, A1.2-5.1.2.2 (1) Acriviry areas A2.4-2.2.9.3 (1)-e, A5.2-2.3.3-e
emergency, A2.1-2.1, A4.2-1.5.2, 5.1 for adult day (health) care facilities, 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 for hospice facilities, 3.2-2.3.3.3 rooms, 3.1-2.2.3.1 (4)
to narure, 1.2-4.5.2, A2.2-4.3.5.1 for independent living SWings, Aparrment model, A4.1-2.1, A4.2-1.1. 1.1-b,
site, 1.3-2.1 A4.2-2.3.3-b A4.4-2.1
to technology equipment room, 2.5-5.3.3 for nursing homes, 3.1-3.3.3.2 Aquaric cenrer, 5.2-2.3.3.3 (3)
relephone, 2.3-4.2.8, 5.1-4.2.8 for subsrance abuse treatmenr facilities, Archirecrural derails, 2.4-2.2
to uriliries, 1.3-2.4,2.1-2.4 4.3-2.3.3.3 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)
- - - _•..•.•_ - - - _ . _ . _ -
ASHRAE (continued) for nursing homes, 3.1-2.2.2.7 and environment of care requirements,
ANSIIASHRAE 90.1, A2.2-2.2-a, for substance abuse treatment facili ties, 1.2-4
A2.5-3.2.1.3, A4.2-6.3.4, A5.1-6.3.4, 4.3-2.2.2.7, A4.3-2.2.2.7 for hospice facilities, A3.2-2.2.1.2 (2),
A5.2-6.3.4, A5.3-6.3.4 Behavioral health. See Mental health AT3.2-a
ANSIIASHRAE 90.2, A2.5-3.2.1.3, Behavioral Health Design Guide, 1.2-3.5.2.1 household
A4.2-6.3.4, 4.2-6.3.5.1 (1) Building service life plan, A2.2-2.5.1 dining areas in intellectual/devel
ANSIIASHRAE 154,2.5-3.3.4.2 (4) Building systems, 1.1-3.1.1.4,2.5 opmental disability settings,
ANSIIASHRAE 188, A2.5-2.2.3-a for adult day (health) care facilities, 5.1-6 4.4-2.3.3.2 (3)
ANSI/ASHRAE 189.1, A1.2-5.5.2.1 for assisted living facilities, 4.1-6 for nursing homes, 3.1-2.2.1.3 (3),
ANSIIASHRAE 189.3, A1.2-5.5.2.1, for hospice facilities, 3.2-6 AT3.1-a
A2.2-2.2-a, A2.2-2.6
for independent living settings, 4.2-6 for post-acute care, A3.1-2.2.4.2
Guideline 12,
for intellectual/developmental disability for independent living settings,
Handbook-HVAC Applications, settings, 4.4-6 4.2-2.2.2.1
2.5-8.7.2.1 (2) for nursing homes, 3.1-6 for nursing homes, A3.1-1.2,
Humidity Control Design Guide, for wellness centers, 5.2-6 3.1-2.2.1.3, AT3.1-a
A2.5-3.1.2, A4.2-6.3.1-b for substance abuse treatment facilities, in owner's project requirements, 1.2-2.2.1
Thermal Guidelines, 2.5-5.3.4.4 (2) 4.3-6 for settings for intellectuallyl
Assisted living facilities, 4.1 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
--------------_._-------_.._-_... _ - - - - - - - - - - - - - - - - _ .._----...------------_._------ ... _,,-_.._- ._.. _-_.. __ ....
Clergy, storage for, 3.2-4.4.4 Consultation areas/rooms, 2.3-3.5, T2.5-5 planning considerations, 1.2-5.7
Clienr. See under Residenr for wellness cenrers, A5.2-2.3.3.3 (4) resident rooms, design criteria,
Cluster care model. See Care models Conrrol, person-cenrered care and, 1.2-5.8.1 A2.2-4.3.2.2
Codes, 1.1-5,2.4-1.2 Conrrol areas/rooms/stations risk management, design for, 1.2-3.5
for acoustic design, 1.4-2.1.1
for independenr living settings, A4.2-4-a wayfinding for, A2.4-2.2.12.3 (I)
for assisred living facilities, 4.1-5.1
for outpatienr rehab facilities, 5.3-4.6.2 Demising wall assembly, 2.5-8.5.2,
Cognitive disabilities. See Demenria, design for substance abuse treatmenr facilities, A4.2-6.3.4.2, A5.1-6.3.4, A5.2-6.3.4,
for residenrs with; Residenrial care A4.3-4-a A5.3-6.3.4
and support facilities for wellness cenrers, A5.2-4-b Department of Health and Human Services,
Cold storage equipment, for dietary facili Conrrol of environmenr, user, 1.2-4.5.4, 1.1-4.4, AI.1-4.5.2, A2.1-5
ties, 2.3-4.5.3.11 AT3.1-a, AT4.1-a, AT4.4-a Design, 1.4
Comfort, person-cenrered care and, 1.2-5.8.2 Conversion projects, 1.1-3.1.1.3 of adult day (health) care facilities, 5.1-5
Commissioning, 1.4-5 Corridors, 2.4-2.2.2 of assisted living facilities, 4.1-1.1.2, 4.1-5
Communication systems, 2.5-5 acoustics criteria for criteria, 2.2
for adult day (health) care facilities, 5.1-6.5 noise in, T2.5-2 elemenrs, 2.3
for assisted living facilities, 4.1-6.5 sound absorption coefficients for, framework for, 1.2-1.3.2
equipmenr requiremenrs, 2.5-5.1.2 T2.5-4 of independent living settings, 4.2-5
for independent living settings, 4.2-6.5 sound isolation performance, T2.5-5 of nursing homes, 3.1-5
for inrellectual/developmenral disabiliry handrails in, 2.4-2.2.10.3 of outpatienr rehab facilities, 5.3-5
settings, 4.4-6.5 for hospice facilities, AT3.2-a requiremenrs, 2.4
for nursing homes, 3.1-6.5 for independent living settings, Developmental disabilities. See Dementia
silenr, A1.2-3.5.3.4 (1) A4.2-5.2.2.2 units; Residential care and support
for substance abuse treatmenr facilities, lighting for, A1.2-4.5.4-a, 3.1-6.7.3.2 facilities
4.3-6.5 (1),3.2-6.7.3.2 (1), 4.1-6.7.3.2 (1), Diagnostic facilities/services, 2.3-3
for well ness cenrers, 5.2-6.5 A4.2-6.7.3.2-a, 4.3-6.7.3.2 (1), for nursing homes, 3.1-3
Community, person-cenrered care and, 4.4-6.7.3.2 (1), A5.1-6.7.3.2, Dietary facilities. See Food service facilities
1.2-5.8.6 A5.2-6.7.3.2, A5.3-6.7.3.2 Dignity
Community areas, 2.3-2.3 receptacles in, 2.5-4.3.2, 4.2-6.4.3.2, definition of, Al.2-5.8.2
for adult day (health) care facilities, A4.2-6.4.3.2 person-cenrered care and, 1.2-5.8.2
5.1-2.3 Counseling room, 3.2-4.11.2 Dining areas
for assisted living facilities, 4.1-2.3 Courtesy, person-centered care and, for adult day (health) care facilities,
for hospice facilities, 3.2-2.3 1.2-5.8.5 5.1-2.3.3.2, A5.1-2.3.3.2
for independenr living settings, 4.2-2.3 Cultural responsiveness for assisted living facilities, 4.1-2.3.3.2
for nursing homes, 3.1-2.3 for assisted living facilities, AT4.1-a for dementia units, 2.2-4.3.2
for outpatient rehab facilities, 5.3-2.3 for inrellectual/developmenral disability design elements, 2.3-2.3.3.2
for substance abuse treatmenr facilities, settings, AT4.4-a for hospice facilities, 3.2-2.3.3.2
4.3-2.3 planning considerations, 1.2-4.5.8 for independenr living settings, 4.2-2.3.3
for well ness centers, 5.2-2.3 Culture change, in long-term care, for nursing homes, 3.1-2.3.3.2
Concern, person-cenrered care and, Al.2-4.5.9-d, A3.1-1.4.3.1 for intellectual!developmenral disability
1.2-5.8.5 Curtains, privacy, 2.4-2.4.4 settings, 4.4-2.3.3.2
Conference rooms for substance abuse treatmenr facilities,
for adult day (health) care facilities, D 4.3-2.3.3.2
5.1-4.11.1 for wellness cenrers, 5.2-2.3.3.2
for assisted living facilities, 4.1-4.11.1 Daylighting, 1.2-4.5.1, 1.2-5.1.2.2,2.5-7 Disaster planning, 1.2-3.8
for hospice facilities, 3.2-4.11.1 for adult day (health) care facilities, for water supply and venrilation
for independenr living settings, 5.1-6.7 emergencies, Al.2-3.2.2.8
4.2-4.11.1 for assisted living facilities, 4.1-6.7 Documentation area, 2.3-3.2.6
for inrellectual/developmenral disability for hospice facilities, 3.2-6.7 for outpatient rehab facilities, 5.3-4.2.1.2
settings, 4.4-4.11.1 in community areas, A2.3-2.3 for rehabilitation therapy in nursing
for nursing homes, 3.1-4.11.1 for independent living settings, 4.2-6.7 home, 3.1-3.3.5.2
for substance abuse treatmenr facilities, for intellectual!developmenral disability Doors
4.3-4.11.1 settings, 4.4-6.7 for adult day (health) care facilities,
Confidenriality, planning considerations for, for nursing homes, 3.1-6.7 5.1-5.2.2.4
1.2-4.5.5 for substance abuse treatmenr facilities, and door hardware, 2.4-2.2.4
Conservation, design criteria and, 2.2-2.1.3 4.3-6.7 for assisted living facilities, 4.1-5.2.2.4
Construction, 1.4 Delivery of care model. See Care models for hospice facilities, 3.2-5.2.2.4
of adult day (health) care facilities, 5.1-5 Dementia, design for residents with, for independent living settings,
of assisted living facilities, 4.1-5 A1.2-2.2.1.2 (1)(b) A4.2-5.2.2.4
of independenr living settings, 4.2-5 design criteria, 2.2-4 for intellectual!developmental disability
of nursing homes, 3.1-5 outdoor activity spaces for, 2,2-4.3.5 settings, 4.4-5.2.2.4
of outpatienr rehab facilities, 5.3-5 physical environment elements for risk for nursing homes, 3.1-5.2.2.4
requiremenrs, 2.4 reduction, 2.2-4.2 openings, 2.4-2.2.4.2
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

design elements, 2.3-4.10 design elements, 2.3-4.2.4
Earthquake-resistant design, 1.1-4.2, for independent living settings, A4.2-4-d for independent living settings,
AI.2-3.8.I-b for substance abuse treatment facilities, 4.2-4.2.4
Education facilities A4.3-4-d for maintenance supplies, 2.3-4.10.5
for assisted living facilities, 4.1-4.11.1.1 Entrances for outpatient rehab facilities,
for outpatient rehab facilities, 5.3-3.2.3 for adult day (health) care facilities, 5.3-4.2.4, 5.3-4.11.2
for substance abuse facilities, 4.3-4.11.1 A5.1-2.3.2 for rehabilitation therapy, 3.1-3.3.5.5
for wellness centers, A5.2-2.3.3.3 (4) for persons of size, A2.2-3-d for nursing homes, 3.1-4.2.4
Effluents, 2.2-2.6.2 for community areas, 2.3-2.3.2.2 for substance abuse treatment facili
Electrical receptacles, 2.5-4.3 mat system for, 2.2-2.4.1.3 ties, 4.3-4.2.4
for assisted living facilities, 4.1-6.4.3 for outpatient rehab facilities, 5.3-4.6.1 Examination areas/rooms, space require
for independent living settings, 4.2-6.4.3 vehicular drop-off and pedestrian ments, 2.3-3.2.2
for nursing homes, 3.1-6.4.3 entrance, 2.3-2.3.2.2, A5.1-2.3.2 Exercise areas/rooms, for outpatient rehab
for resident rooms, 3.1-6.4.3.3, 3.2 Environmental impact statement (£IS), facilities, 5.3-3.2.4
6.4.3.3 A2.1-5-c Exits
Electrical systems, 2.5-4 Environmental pollution control, 2.1-5 for assisted living facilities, A4.1-5.I-d
for adult day (health) care facilities, Environmental Protection Agency, See also Doors and door hardware
5.1-6.4
AI.I-4.5.2, A2.1-5 Expansion joint covers, 2.4-2.2.5
for assisted living facilities, 4.1-6.4
Environmental regulations, 1.1-4.5
essential, 3.1-6.4.2.1
Environmental services room F
for assisted living facilities, 4.1-6.4.2.1 design elements, 2.3-4.9
connections, 2.5-4.4.2.2 for dietary facilities, 2.3-4.5.3.10 Fall risk and prevention
for hospice facilities, 3.2-6.4.2.1 for independent living settings, A4.2-4-c resident safety risk assessment, 1.2-3.4
for intellectual/developmental dis for outpatient rehab facilities, 5.3-4.9 and building entry mats, 2.2-2.4.1.3 (2)
ability settings, 4.4-6.4.2.1 for substance abuse treatment facilities, selection of materials and products,
receptacles for, 2.5-4.3.4, A4.2 A4.3-4-c performance characteristics to address
6.4.3-b for wellness centers, 5.2-4.9 risks, 2.4-2.1.2.2 (I)
for hospice facilities, 3.2-6.4 Environment of care Family, support facilities for, AI.2-5.7.1
for independent living settings, 4.2-6.4 for adult day (health) care facilities, for adult day (health) care facili ties,
for intellectual/developmental disability 5.1-1.4
5.1-2.3.6, 5.1-4.4
settings, 4.4-6.4 for assisted living facilities, 4.1-1.4
for nursing homes, 3.1-6.4 care models and
for hospice facilities, 3.2-4.4
for substance abuse treatment facilities, for assisted living facilities, AT4.I-a for independent living settings, 4.2-4.4
4.3-6.4 for nursing homes, AT3.I-a for intellectual/developmental disability
Elevators, 2.5-9 codes and standards, 1.1-5 settings, 4.4-4.4
for adult day (health) care facilities, 5.1-6.9 and functional program, 1.2-4 for nursing homes, 3.1-4.4
for assisted living facilities, 4.1-6.9 for hospice facilities, 3.2-1.4 for substance abuse treatment facilities,
for independent living settings, 4.2-6.9 for independent living settings, 4.2-1.4 4.3-4.4
See also Guest accommodations and criteria for selecting, 1.2-4.5.7 for nursing homes, 3.1-4.4.1
Family room or area, A2.2-4.3.3, 2.3-2.3.6 See also Built-in furnishings for persons of size, A3.2-2.2.2.2 (3)
for adult day (health) care facilities, Furniture, 2.4-2.4.3 showers, 3.2-4.4.3
5.1-2.3.6 resident seating, A3.1-2.2.2.2 (3)(d) (ii) for substance abuse treatment facilities,
for hospice facilities, 3.2-2.3.6 selection recommendations, A2.4-2.4.3.1 4.3-4.4

Finishes for waiting area, A4.2-2.3-a
acoustic, A2.5-8.3 H
for independent living settings, G
M.2-5.2.3, A4.2-5.2.3.3 Hand drying, provisions for, 2.4-2.2.8.5
requirements for, 2.4-1.2.2.1 Gardens. See Outdoor areas/spaces Handrails
See also Surfaces Generators, 1.5-3.2, A2.1-2.4 design requirements, 2.4-2.2.10
Fire alarms, 2.5-6.3
for adult day (health) care facilities, for elevators, 3.1-6.9.5, 3.2-6.9.5,
Fitness training spaces, for well ness centers,
5.1-6.4.2.2 A4.1-6.9.2, 4.1-6.9.5, A4.2-6.9-b,
5.2-2.3.3.3 (2) for assisted living facilities, 4.1-6.4.2.2 A4.3-6.9.2-b,4.3-6.9.5,
Flood protection, 1.1-4.3, AI.2-3.8.I-d fuel storage for, 3.1-6.4.2.1 (3),4.1 A4.4-6.9.2-a, 4.4-6.9.5, 5.1-6.9.5,
Flooring 6.4.2.1 (3),4.4-6.4.2.1 (3)
5.2-6.9.5,5.3-6.9.5
design requirements, 2.4-2.3.2 for hospice facilities, 3.2-6.4.2.2
for hospice facilities, 3.2-5.2.2.10
and falls, association with, for independent living settings,
A2.4-2.1.2.2 (I) M.2-6.4.2-b 4.2-5.2.2.10, A4.2-6.9-b
for residen t mobility and transfer, for intellectual/developmental disability for persons of size, A2.2-3-d
1.2-3.3.2.9 settings, 4.4-6.4.2.2 Hand sanitation dispensers,
slip-resistant, 2.4-2.3.2.5 for nursing homes, 3.1-6.4.2.2 1.2-3.2.1.1 (2)(a), 2.4-2.2.8.1 (2)
Fluorescent lamps, collection area for, for outpatient rehab facilities, 5.3-6.4.2.2 Hand-washing stations, 1.2-3.2.1.1 (2)(a),
2.2-2.5.1.2 for substance abuse treatment facilities, 2.5-2.3.2
Food preparation areas 4.3-6.4.2.2 countertops for, 2.4-2.2.8.4
acoustic finishes for, A2.5-8.3 for wellness centers, 5.2-6.4.2.2 design requirements, 2.4-2.2.8
commercial, HVAC requirements for, Glazing materials, 2.4-2.2.7 heated water for, 2.5-2.2.3.5
2.5-3.3.4 Grab bars, 2.4-2.2.9 for hospice facilities, 3.2-2.2.2.5
Food service facilities, 2.3-4.5 for adult day (health) care facilities, for laundty facilities, 3.1-4.6.3.4,
for adult day (health) care facilities, 5.1-4.5 5.1-5.2.2.9 4.1-4.6.3.2 (5)
for assisted living facilities, alternative configurations, 2.4-2.2.9.3 location of, AI.2-3.2.1.1 (2)(a)
4.1-2.2.2.2 (4),4.1-4.5 resources for, AT2.4-a for nursing homes, 3.1-2.2.2.5
flooring for, 2.4-2.3.2.7 in bathrooms, A2.4-2.2.9.2 for outpatient rehab facilities, 5.3-3.2.2.3,
for'hospice facilities, 3.2-4.5, AT3.2-a adult day (health) care, 5.3-3.2.4.3, 5.3-3.3.1.2, 5.3-3.3.2.4,
HVAC requirements, 2.5-3.3.4 A5.1-5.2.2.9 (I) 5.3-3.3.3.2
for independent living settings, A4.2-4-a, assisted living, A4.1-2.2.2. 7-b for therapy areas, 3.1-3.3.2.2 (3),
4.2-4.5 nursing homes, 3.1-2.2.2.6 (5) 3.1-3.3.3.2 (3), 3.1-3.3.4.1 (2)
for intellectual/developmental disability hospice facilities, 3.2-2.2.2.6 (5) sinks for, 2.5-2.3.2
settings, 4.4-4.5 independent living, A4.2-6.2-c Harm reduction, design criteria and,
for nursing homes, 3.1-4.5 intellectual/developmental disability 2.2-4.2.2
care models and, AT3.I-a settings, A4.4-2.2.2.7 Hazardous materials management plan,
for post-acute care facilities, outpatient rehab, A5.3-5.2.2.9 (I) 2.2-2.6.2.1
A3.1-2.2.4.2-d substance abuse treatment, A4.3 Health and well ness services, A5.2-2.3.3
for substance abuse treatment facilities, 2.2.2.7-b Health Insurance Portability and
4.3-4.5, M.3-4-a
wellness centers, A5.2-5.2.2.9 (I) Accountability Act, AI.I-4.4,
for wellness centers, 5.2-4.5
design requirements, 2.4-2.2.7 A1.2-4.5.5
See also Ki tchen
for independent living settings, Health risk assessmen t, A2.I-5-c
Functional performance test, 1.4-5.1.4 M.2-5.2.2-c Heated potable water systems, 2.5-2.2.3
Functional program, 1.2-2 for ourpatient rehab facilities, 5.3-5.2.2.9 maximum pipe/tube length, AT2.5-a
for adult day (health) care facilities, 5.1-1.2 in toilet rooms, A5.1-5.2.2.9 (I), water use, T2.5-1
for assisted living facilities, 4.1-1.2 A5.2-5.2.2.9 (I), A5.3-5.2.2.9 (I) Heated surfaces, protection from,
and environment of care elements, 1.2-4 for wellness centers, 5.2-5.2.2.9 2.4-2.2.11,5.1-5.2.2.11,5.3-5.2.2.11
for independent living settings, 4.2-1.2 Green Globes, AI.2-5.5.2.I-b, A2.2-2.2-a Heating, ventilation, and air-conditioning
for intellectual/developmental disability Greenhouse gas reduction, 2.2-2.6.1.2 systems. See HVAC systems
settings, 4.4-1.2 Group living model, A4.1-2.1, A4.4-2.1 High-intensity discharge lamps, collection
for nursing homes, 3.1-1.2 Guest accommodations area for, 2.2-2.5.1.2
for outpatient rehab facilities, 5.3-1.2 for assisted living facilities, 4.1-4.4.2 Home-based hospice services, A3.2-2.2.1.2
for substance abuse treatment facilities, for hospice facilities, 3.2-2.2.2.2 (4), (2)(b), AT3.2-a
4.3-1.2 3.2-4.4.1 Hospice facilities, 3.2
Furnishings, 2.4-2.4 for independent living settings, 4.2-4.4.2 freestanding, A3.2-2.2.1.2 (2)(e), AT3.2-a
for independent living settings, 4.2-5.2.4 for intellectual/developmental disability in hospitals, A3.2-2.2.1.2 (2)(f), AT3.2-a
materials and products for, characteristics settings, 4.4-4.4 Household models. See Care models
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 assisted living facilities, 4.1-4.2.7, Living area, 2.3-2.2
for adult day (health) care faciliries, 4.1-4.6
A5.1-6.3.4 for hospice faciliries, 3.2-4.6
daylighting in, A2.5-7.2
for independent living settings, for independent living settings,
for dementia units, 2.2-4.3.3
A4.2-6.3.4 A4.2-2.2.2-a, A4.2-4-b for intellectual/developmental disability
for outpatient rehab faciliries, A5.3-6.3.4 for intellectual/developmental disability settings, 4.4-2.2
characterisrics of, AT4.4-a settings, 4.4-4.6 for substance abuse treatment facilities,
materials, 2.4-1.2.2.2 for nursing homes, 3.1-4.6 4.3-2.2
minimum srandards for, 4.4-1.1.3 for outpatient rehab facilities, 5.3-4.2.7 Lobby, 2.3-2.3.2
types of, A4.4-1.1.1.1 for substance abuse treatment facilities, for adult day (health) care faciliries,
for wellness centers, A5.2-6.3.4 4.3-4.6, A4.3-2.2.2-a, A4.3-4-b 5.1-2.3.2
International Code Council for well ness centers, A5.2-4-b for nursing homes, 3.1-2.3.2
ICC Al17.1, A1.1-4.1-c Leadership in Energy & Environmental for independent living setrings, 4.2-2.3.2
International Building Code, A1.1-4.2, Design (LEED), A1.2-5.5.2.1-c Locker rooms, for wellness centers,
2.2-4.2.1.5 Lean rails, 2.4-2.2.10 5.2-2.3.3.4 (3)
International Energy Conservation Code, Legionella bacreria, 1.2-3.2.1.1 (2)(b), Lounge areas
2.5-3.4.1.1 A2.5-2.2.3-a for adult day (health) care facilities,
Internarional Green Construction Code, Life Safety Code 5.1-2.3.3.3
A1.2-5.5.2.1, A2.2-2.2 Life safety overlay, 1.4-4.1.2 for assisted living facilities, 4.1-2.3.3.3
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
Outdoot ateas/spaces (continued) guest accommodations for, for outpatienr rehab facilities, 5.3-3.2.5,
fat hospice facilities, 3.2-2.3.8 A3.2-2.2.2.2 (3) 5.3-3.3.2.3
for independenr living serrings, handrails for, A3.2-5.2.2.1 0 (2) person-cenrered care and, 1.2-5.8.3
4.2-1.5.3.6 (3) Pet accommodations, 2.3-4.4.3 for residenr rooms, 3.1-2.2.2.4,
for inrellectual/developmenral disabiliry for independenr living serrings, A4.2-4.4 4.4-2.2.2.4
serrings, AT4.4-a Phased projects, 1.1-3.1.3 speech
for nursing homes, 3.1-2.3.8 Physical therapy facilities, 5.3-3.2, A5.3-1-a design guidelines for, 2.5-8.6,
and srress reduction, A2.2-4.2.3.2 exercise area, 5.3-3.2.4 T2.5-6
for substance abuse treatment facilities, for nursing homes, 3.1-3.3.2 for outpatienr rehab facilities,
4.3-2.3.8 Planning, 1.2-5 5.3-3.3.2.3
water fearures, 2.1-3.6.3 Plumbing fixrures, 2.5-2.3 for telephone area, 3.2-4.11.2.3
Overnight guest accommodations. See Guest Plumbing systems, 2.5-2 for therapy areas, 3.1-3.3.2.2 (2)
accommodations for independenr living serrings, 4.2-6.2 Program for All-Inclusive Care for the
Owner's project requiremenrs (OPR), and infection conrrol, 1.2-3.2.1.1 (2) Elderly, A5. 1-1. 1. 1.1
1.4-5.1.1 Pollution conrrol, 2.1-5 Prosthetics facili ry
Polychlorinated biphenyl (PCB) removal, for nursing home, 3.1-3.3.4.1
p A2.2-2.6.2.1-a for outpatienr rehab facilities, 5.3-3.3.1
Pools Public rransporration, and site selection,
Palliative care, definition of, A3.2-1. 1. 1.1 for outpatienr rehab facilities, 5.3-3.2.6 1.3-2.2
Parking therapeutic, for rehabilitation facilities,
for adulr day (health) care facilities, 3.1-3.3.4.3
Q
5.1-1.5.3.3 for well ness cenrers, 5.2-2.3.3.3 (3)
for assisred living facilities, 4.1-1.5.3.3 See also Whirlpools

Qualiry of life
for hospice facilities, A3.2-1.5 Post-acure care facilities, 3.1-2.2.4.2 planning considerations for, 1.2-5.8,
for independenr living serrings, Potable water supply systems, 2.5-2.2.2 A1.2-1.3.2.5
A4.2-1.5.3.1-c conservation and, 2.2-2.3 residenr safery risk assessmenr and,
for nursing homes, 3.1-1.5.2 heated, 2.5-2.2.3 1.2-3.1.5.2, A1.2-3
securiry considerations for, 1.2-3.7.1.4 Pot-washing facilities, design elemenrs, Quiet room/space
site selection and, 2.1-3.3 2.3-4.5.3.7 for adulr day (healrh) care facilities,
Parricipanr areas, for wellness cenrers, 5.2-2 Power equipmenr 5.1-2.3.7, 5.1-4.2.9
Patienr-cenrered care. See Person-centered for adult day (health) care facilities, for communiry area, 2.3-2.3.7
care 5.1-6.4.2 for residenr care/living areas (units),
Pediatric facilities, A2.2-4-b, 3.1-2.2.4.1 for assisted living facilities, 4.1-6.4.2 2.3-2.2.3.3, 3.1-2.2.3.3
Peep holes, A4.2-1.4-c for independenr living serrings, 4.2-6.4.2 and srress reduction, A2.2-4.2.3.2
Personal services areas Power supply

for adult day (health) care facilities, for electronic equipmenr, 1.5-3.2.2 R
5.1-2.3.5 essenrial systems, 3.1-6.4.2.1
for assisted living facilities, 4.1-2.3.5 Privacy Receiving areas, 2.3-4.7.2
for hospice facilities, 3.2-2.3.5 for adult day (health) care facilities, Receptacles. See Electrical receptacles
for independenr living serrings, 4.2-2.3 A5.1-6.3.4 Reception areas, for rehabilitation therapy,
for nursing homes, 3.1-2.3.5 for assisted living facilities, 4.1-2.2.2.4, 3.1-3.3.5.1
for well ness cenrers, 5.2-2.3.5, A4.1-4.2.3 (1) Record drawings, 1.4-4
A5.2-2.3.3.5 for bathrooms, for substance abuse Recreation areaslrooms
Person-cenrered care treatmenr facilities, A4.3-4.2.3.1 for adult day (health) care facilities,
assisted living facilities and, AT4.1-a care models and 5.1-2.3.3.3
core values of, A1.2-1.3.1 for assisted living facilities, AT4.1-a for assisted living facilities, 4.1-2.3.3.3
definition of, A1.2-4.5.9 for nursing homes, AT3.1-a for hospice facilities, 3.2-2.3.3.3
design and, 1.2-5.8 for conference rooms, 3.1-4.11.1.1, for independenr living serrings,
hospice serrings and, A3.2-1.3.3, 4.1-4.11.1.1 A4.2-2.3.3-b
A3.2-1.4.3 for adult day (health) care facilities, for nursing homes, 3.1-2.3.3.3
inrellecrual/developmenral disabiliry 5.1-4.11.1.1 for substance abuse rreatmenr facilities,
serrings and, AT4.4-a
for independenr living serrings, 4.3-2.3.3.3
nursing homes and, AT3.1-a
A4.2-4.11.1 for wellness centers, 5.2-2.3.3.3
planning considerations, 1.2-4.5.9
for substance abuse rreatmenr facili Recreation therapy, A5.3-1-c
well ness cenrers and, A5.2-1.4
ties, A4.3-4.11.1 Recyclables, design cri teria for storage and
Persons of size curtains, 2.4-2.4.4 collection, 2.2-2.5.1.1
care unit for design guidelines for, 1.2-4.5.5 Refrigerants, 2.2-2.6.1.1
design considerations, 1.4-2.3 for examination rooms, 2.3-3.2.3 Regulations
design criteria, 2.2-3 for hospice facilities, 3.2-2.2.2.4 for acoustic design, 1.4-2.1.1
planning considerations, 1.2-5.6 for inrellectual/developmenral disabiliry government, 1.1-4
consultation areas/rooms for, 2.3-3.5.2.2 serrings, AT4.4-a
Rehabilitation facilities
definition of, A2.2-3 for nursing homes, 3.1-2.2.2.4
for nursing hom~s, 3.1-3.3
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 architectural detail, surface, and clinical,3.1-6.2.3.5
Resident fall risk and prevention, 1.2-3.4 furnishing materials and, 2.4-2.1.2.2 See also Hand-washing stations
Residential care and support facilities for assisted living facilities, A4.1-5.1-b Site elements, 2.1
assisted living, 4.1 bed, 1.2-3.3.2.10 (4) for adult day (health) care facilities,
independent living, 4.2 care models and, for assisted living 5.1-1.5
settings for individuals with intellectual/ facilities, AT4.1-a for assisted living facilities, 4.1-1.5
developmental disabilities, 4.4 codes and standards, 1.1-5 for hospice facilities, 3.2-1.5
substance abuse treatment facilities, 4.3 design criteria, 2.2-4.2 for independent living settings, 4.2-1.5
Residential health facilities electronic systems, 2.5-6 for nursing homes, 3.1-1.5
nursing homes, 3.1 for intellectual/developmental disability for wellness centers, 5.2-1.5
hospice facilities, 3.2 settings, AT4.4-a Site exterior noise, 2.5-8.2, T2.5-3,
Resident mobility and transfer planning considerations, 1.2-4.5.6 AT2.5-b
destination points and, 1.2-3.3.2.8 Safety devices, srorage for, 5.3-4.2.4.2 classifications, Al.5-8.2.3
equipment, 1.2-3.3.2.2 Safety risk assessment. See Resident safety Site selection, 1.3
quantity of, 1.2-3.3.2.4 risk assessment building orientation and,
storage for, 1.2-3.3.2.6 Seating, Al.4-2.4.3.1 1.2-2.2.2.2 (1)(a), 2.1-4
types of, 1.2-3.3.2.2 for resident rooms, A3.1-2.2.2.2 (3) Smoke-free environment, Al.2-2.4.l
grab bars for, 2.4-2.2.9.2 (d)(ii), A3.2-2.2.2.2 (3)(c) Snoezelen room, Al.2-4.2.3, Al.3-2.3.7
risk See also Furnishings, Furniture Soiled holding room
assessment of, 1.2-3.3 Security for assisted living facilities, 4.1-4.6.3.2 (2)
design recommendations for reduc design criteria, 2.2-4.2.1 for hospice facilities, 3.2-4.6.3.2
ing, 1.2-3.3.2.1 for dementia units, 1.2-3.5.3.4 (1) for nursing homes, 3.1-4.6.3.2
Resident quality of life electronic systems, 2.5-6 Soiled utility room, 2.3-4.2.6
planning considerations for, 1.2-5.8, for intellectual/developmental disability for adult day (health) care facilities,
A1.2-1.3.2.5 settings, AT4.4-a
5.1-4.2.6
resident safety risk assessment and, planning considerations, 1.2-3.7.1,
for assisted living facilities, 4.1-4.2.6
1.2-3.1.5.2, A1.2-3 1.2-4.5.6
for intellectual/developmental disability
Resident rooms, 3.1-2.2.2 site selection and, 2.1-2.3 settings, 4.4-4.2.6
for assisted living facilities, 4.1-2.2.2 Security risk assessment, 1.2-3.7 for nursing homes, 3.1-4.2.6
call stations for, 3.1-6.5.2.2, 4.1-6.5.2.2 Seismic design. See Earthquake-resistant for substance abuse facilities, 4.3-4.2.6
for hospice facilities, 3.2-2.2.2 design Speech and hearing therapy facility, 5.3-3.3.2
for intellectual!developmental disability Sewers, 2.5-2.2.4.3 for nursing home, 3.1-3.3.4.2
settings, 4.4-2.2.2
Shared services Speech privacy
lighting for, 4.1-6.7.3.2 (2),
adult day (health) care facilities and, design guidelines for, 2.5-8.6, T2.5-6
A4.2-6.7.3.2 (2)
5.1-1.2.2 for speech and hearing therapy area,
for nursing homes, 3.1-2.2.2
outpatient rehab facilities and, 5.3-1.2.2, 3.1-3.3.4.2 (2), 5.3-3.3.2.3
Staff facilities for hospice facilities, 3.2-4 for hospice facilities, 3.2-4.11.2.3
for adult day (health) care facilities, for independent living settings, 4.2-4 TGB bar, 2.5-5.4.2
5.1-4.3.2 for laundry facilities, 3.1-4.6.3, 3.1-4.6.4 Therapeutic community, A4.3-1.1.1.1
for assisted living facilities, 4.1-4.2.1, for nursing homes, 3.1-4 care model, A4.3-4.2.4.2 (1)
4.1-4.3 for outpatient rehab facilities, 5.3-4 Therapeutic equipment, storage for,
design elements, 2.3-4.2.1, 2.3-4.2.8 for rehabilitation therapy, 3.1-3.3.7 5.3-4.2.4.2
for hospice facUities, 3.2-4.3, 3.2-4.3.2 staff Thermal conditions
for independent living settings, 4.2-4.2.1 design elements, 2.3-4.2.8 design considerations, A2.2-2.4.1
lounges, 2.3-4.3.2 for hospice facilities, 3.2-4.3 planning considerations, 1.2-5.3
for rehabilitation therapy, 3.3-4.2.1 for independent living settings, Thresholds, 2.4-2.2.5
for substance abuse treatment facilities, 4.2-4.2.1 Toiletsltoilet rooms
4.3-4.2.1 for substance abuse treatment for adult day (health) care facilities,
toilet rooms, 2.3-4.3.3 facilities, 4.3-4.2.1 5.1-2.3.3.4 (2)
for well ness centers, 5.2-4.2.1, A5.2-4.11, for well ness centers, A5.2-4-a for assisted living facilities, 4.1-2.3.3.4,
A5.2-4-a for substance abuse treatment facilities, 4.1-4.3.3
Storage 4.3-4 for hospice facilities, 3.2-2.2.2.6
for assisted living facilities, 4.1-2.2.2.8 for ventilator-dependent resident units, for independent living settings,
for dietary facilities, 2.3-4.5.3.9 3.1-2.2.3.2 (2) A4.2-2.2.2-a, A4.2-6.2-d

for hospice facilities, 3.2-2.2.2.8 for well ness centers, 5.2-2.3.3.4, 5.2-4 lighting for, 3.1-6.7.3.2 (2), 5.1-6.7.3.2 (2)
for independent living settings, Supportive environment for nursing homes, 3.1-2.2.2.6
A4.2-2.2.2-b for assisted living facilities, 4.1-1.4.3 for outpatient rehab facilities, 5.3-4.2.3.3
for intellectual/developmental disability for independent living settings, A4.2-1.4-b public, 2.3-2.3.2.6
settings, 4.4-2.2.2.8 for intellectual/developmental disability for quiet rooms, 2.3-2.2.3.3 (3)
for laundry facilities, 4.1-4.6.3.2 (4)(a) settings, 4.4-1.4.3 for rehabilitation therapy in nursing
for maintenance services, 2.3-4.10.5 for nursing homes, 3.1-1.4.3 homes, 3.1-3.3.7.2
for mobility devices, 1.2-3.3.2.6, 2.3 for substance abuse treatment facilities, staff, 2.3-4.3.3
2.3.2.3,2.3-4.2.4.2,3.1-4.2.4.3 A4.3-1.4.3 for substance abuse treatment facilities,
for outpatient rehab facilities, 5.3-3.2.6.3 Surfaces A4.3-2.2.2-a
for resident rooms, 3.1-2.2.2.8 for assisted living facilities, 4.1-5.2.3 for visitors, 3.2-4.4.3
for substance abuse treatment facilities, design requirements, 2.4-2.3 for well ness centers, 5.2-2.3.3.4 (2)
4.3-2.2.2.8, A4.3-2.2.2-b
for hospice facilities, 3.2-5.2.4 Total building commissioning (TBC),
for well ness centers, 5.2-2.3.3.4 (3)
for independent living settings, 4.2-5.2.3 Al.4-5-b
See also Supply storage
for intellectual/developmental disability activities, 1.4-5.1
Stress reduction, design criteria and, 2.2-4.2.3 settings, 4.4-5.2.3 Total environment commissioning (TEC),
Subacute care facilities, A3.1-2.2.4 materials and products for, characteristics A1.4-5-c
Substance abuse treatment, stages of, and criteria for selecting, 1.2-4.5.7 Towel service. See Linen services
A4.3-4.2.4.2 (1) for nursing homes, 3.1-5.2.3 Traditional model. See Care models
Substance abuse treatment facili ties, long for outdoor activity spaces, Transfer. See under Resident mobility and
term residential, 4.3
A2.1-3.6.2-b transfer
minimum standards for, 4.3-1.1.3
selection of materials and products for, Transition spaces, lighting for, A2.5-7.3.2
types of, 4.3-1.1.1.1
2.4-2.1 Transportation, site selection and, 2.1-2.2
Supplies, office, storage of, 3.1-4.11.1.3, for substance abuse treatment facilities, Treatment areas/rooms, 2.3-3
4.1-4.11.1.3,4.2-4.11.1.3,4.3 4.3-5.2.3 for nursing homes, 3.1-3
4.11.1.3,4.4-4.11.1.3 Also see Finishes space requirements, 2.3-3.2.2
Supply storage Sustainable design, 1.4-2.2 Tubs, 2.5-2.3.3
for assisted living facilities, 4.1-4.2.4 design criteria, 2.2-2
design elements, 2.3-4.2.4 planning considerations, 1.2-5.5 u
for emergency supplies, Al.2-3.8.I-e
for independent living settings, 4.2-4.2.4 T Uniform Federal Accessibility Standards,
for outpatient rehab facilities, 5.3-4.2.4, 1.1-4.1.1
5.3-4.11.2 Technology equipment room, 2.5-5.3 U.S. Green Building Council,
for rehabilitation therapy, 3.1-3.3.5.5 facility requirements, 2.5-5.3.4 A1.2-5.5.2.1-c
for nursing homes, 3.1-4.2.4 location and access requirements, 2.5-5.3.3 Utilities, access to, site selection and, 2.1-2.4
for substance abuse treatment facilities, Telecommunication spaces, grounding for,
4.3-4.2.4 2.5-5.4 v
Support areas Teledata rooms, 2.5-5.3, A4.2-6.5-c
for adult day (health) care facilities, Telemedicine services, accommodations for, Vacuum systems, for nursing homes,
5.1-2.3.3.4,5.1-4 2.3-4.2.9 3.1-6.2.4
for assisted living facilities, 4.1-4 Telephones Valves, 2.5-2.2.2.2
for dementia units, 2.2-4.3.2 access to, 2.3-4.2.8 Vapor barrier, 2.5-3.4.2.2
design elements, 2.3-4 for adult day (health) care facilities, Vehicular drop-off and pedestrian entrance.
for dining and activity areas, 2.3-2.3.3.4 5.1-4.2.8 See En trances
Vending machines/services, 2.3-4.3.2.3 exterior, lighting for, 2.5-7.1.2.2
recovery options, 2.2-2.3.4
Ventilation, 2.2-2.4.1.2 for independent living settings,
Wayfinding
of construction zone, A1.2-3.2.2.4 A4.2-1.5.3.1-b for assisted living facilities, AT4.1-a
disaster planning and, A1.2-3.2.2.8 in outdoor activity spaces, A2.1-3.6.2-b design requirements, 2.4-2.2.12
and space conditioning, 2.5-3.1.2 for outpatient rehab facilities, 5.3-1.5.3.2 for intellectual!developmental disability
for independent living settings, for wellness centers, 5.2-1.5.3.2 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
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

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FOR DESIGN AND CONSTRUCTION OF

Residential Health, Care,

The Facility Guidelines Institute

The Facility Guidelines Institute

9750 Fall Ridge Trail

St. Louis, MO 63127

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)

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

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Preface xi Part 2 Common Elements for Residential

1.1-6 Equivalency Concepts 7

1.3-3 Functional Site Requirements 39

1.5 -Equipment 49 Part 3 Residential Health Facilities 123

3.1 -5 Design and Construction Requirements Developmental Disabilities 237

3.2-4 Facilities for Support Services 162

3.2-5 Design and Construction Requirements 166

Table 1.2-1: Resident Safety Risk Assessment Components

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

2018 Health Guidelines Revision Committee

Executive Steering Committee Linda Dickey, RN, MPH, CIC, FAPIC

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

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

Subject Matter Experts Hospital Document Group

Hospice House Nerwork

Todd M. Liebert, AlA, NCARB

Clark Patterson Lee

Wade Rudolph, MBA, CHFM

Brandywine Senior Living

• Mount Laurel, New Jersey

Asha Hegde, PhD, LC

Mandy Kachur, PE, INCE Bd. Cett.

Bent Mountain, Virginia

Troy, New York

Jerry Smith, FASLA

Kenneth N. Cates, SASHE, CHC

Ramona Conner, MSN, RN, CNOR, FAAN

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

Lebanon, New Hampshire

David Dagenais, CHSP, CHFM, FASHE

Robert Dehler, PE Bill Rostenberg, FAIA

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

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

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

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

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

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

Chapel Hill, North Carolina

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

Stanford Hospital and Clinics

lack funds to do other corrective work. However, the Guidelines stan

1.1-4.5.1 Federal Environmental Regulations 1.1-5.2 Code Compliance