Photo By Denmarsh Photography

Veterans often face a host of unique and deeply complex issues-from chemical dependence to homelessness-that linger as a result of post-traumatic stress disorder, lack of family/community support, and other situational factors. According to the National Coalition for Homeless Veterans, approximately 200,000 veterans across the nation are homeless on any given night; of this number, 45% suffer from mental illness and 50% battle substance abuse problems.

Veterans Affairs (VA) Pittsburgh Healthcare System is committed to helping solve this grave national problem at the local level. The VA's Veterans Recovery Center, located on Pittsburgh's H. John Heinz III Progressive Care Center, provides advanced care and resources from comfortable dwellings to vocational rehabilitation. These important services enable homeless veterans to return to the community as productive individuals.

A safe haven for our nation's heroes, the center combines the supervision and support of the institution with the autonomy of residential living. The center's recovery program lasts approximately four months and empowers veterans to break the cycle of chronic hopelessness, to boost their morale, and to restore self-worth. The Veterans Recovery Center, which re-opened October 2008, is designed to serve over 1,000 veterans each year.

Finding deep insights bridging concept and design

The United States Department of Veterans Affairs recently initiated a comprehensive nationwide program, CARES (Capital Asset Realignment for Enhanced Services), to improve facility efficiency, consolidate resources, reduce costs and, most importantly, better serve the needs of its users. A component of the Pittsburgh CARES project includes $17 million to create The Veterans Recovery Center.

The VA enlisted Astorino, a Pittsburgh-based architecture, engineering, interior design, and construction services firm, to create a comfortable homelike environment that would enhance the veterans' ability to successfully transition from a recovery program to achieving individual recovery goals.

To better understand the specific needs of all generations of veterans, Astorino leveraged research from Fathom, the design research arm of the company, which translates and prioritizes subconscious thoughts and feelings into meaningful designs. Fathom uses a blend of research techniques rooted in psychology, neuroscience, anthropology, and architecture to truly understand the needs of users. These important insights are translated into specific design guidelines allowing Astorino to create environments that connect users on a more emotional, intellectual, and experiential level.

As a starting point on the Veterans Recovery Center project, Fathom gathered insight directly from veterans, family members, and staff. The Fathom team immersed themselves in the veterans' culture, spending both days and nights observing the behavioral patterns of patients and staff in various environments-what they do, how they live, how they work, their likes, dislikes, hopes, fears, and dreams. They also engaged them in one-on-one interviews, informal conversations, and interactive discovery sessions that allowed the team to dig deep into their minds (figure 1). In doing so, they got to know veterans like Chris*

Chris, Dora, and Dr. Jones are fictional characters created by Fathom to communicate the thoughts and feelings of all those interviewed.

(
figure 2), who had experienced the symptoms of schizophrenia ever since he returned home from Iraq, where he saw his closest friends die in a bombing attack. They witnessed a “day in the life” of nurses like Dora, an RN with the VA for 19 years, who described her routine as physically and mentally taxing, but also highly rewarding because she helped make a difference in veterans' lives. And they heard from doctors, such as Dr. Jones, a psychiatrist with the VA for 10 years, whose one wish was for the veterans to realize their worth.

According to Christine Astorino, CEO of Fathom, “We got to know and understand the patients and staff on a very deep and personal level. This is a group of people with great expectations and terrific optimism. They are looking for a better facility not only functionally, but one that can provide a better quality of life. They each had a voice which needed to be heard.”

Through its unique process and comprehensive research, Fathom uncovered key metaphors for the veterans' ideal recovery experience: balance, resource, and control. By focusing on balance, resource, and control, Astorino created the new Veterans Recovery Center, which includes the residential living villas and central building. This recovery center is a self-contained example of the continuum of care providing a range of services, from inpatient beds in the central building for the most critically ill veterans through independent living units in the residential living villas. The residences in the residential living villas were designed to welcome veterans with “open arms”-a stark contrast to traditional recovery institutions, which tend to be cold, bleak, and uninviting. This model allows the veterans to graduate to increasing levels of independence and social participation as they progress through their treatment.

Fostering balance

Recognizing the crucial role that physical and emotional balance play in homeless and vocational rehabilitation, Astorino created a neighborhood of residential living villas with individual balconies and front porches, varying rooflines, and multiple colors and materials (figure 3); the buildings relate to each other but still remain unique and individual. Seven separate residential villas offer a mix of private and semiprivate spaces so that privacy and community are balanced.

The villa arrangement allows veterans to reside in patio-style homes, apartments, or townhouses. The varying style of homes provides real-life living conditions that create a neighborhood feel to this community.

Inside the residences, warm wood floors, carpeted stairs, and varying color schemes provide a stark contrast to the institutional facility of the past (figures 4, 5). The interiors have been carefully designed to bridge community living with independent recovery. For example, even though veterans share their living quarters and facilities, the residential units have been designed to promote privacy through well-planned techniques (figure 6). Tall storage units or chests of drawers are carefully placed to section off certain rooms, thus fostering independence within a community environment.

Guidance, care, and support of staff and patients are all rich resources that help veterans on their path to recovery and independence. On a large scale, the Central Building offers veterans resources and support, such as group dining, job training, and development (figure 7), a game room (including ping pong and pool tables; figure 8), an exercise room, and educational facilities. On a more personal scale, families and staff can connect and interact socially through a cookout in picnic areas or a basketball game with patients in outdoor recreational areas.

Astorino's design empowers patients to have greater control not only over their environment, but also over their treatment. With flexible design features such as moveable furniture, ample areas for storage of personal items, and individual lighting and heating controls, veterans are given choices on how to live and interact with their space. Through the unique architecture and design of the facility, veterans are also able to practice the skills they will need to re-enter society. With shared kitchen and living facilities, as well as washers and dryers, the veterans (with staff supervision as needed) are able to take responsibility for their own care-cooking, cleaning, and doing their own laundry-while engaging and interacting with others.

Setting a new standard

Astorino and the VA have worked to set a new standard for the architectural design and clinical operation of a traditional domiciliary. A bold departure from traditional institution-type living, the Veterans Recovery Center and its thoughtful design meets the needs of its users and underscores the VA's commitment to veteran recovery. What's more, it empowers the veterans to take responsibility for their individual goals and creates a safe springboard into society. Of the new residential villas, Terry, a once-homeless Gulf War veteran said, “They really did this right. It makes you feel part of something that you're getting back into real life again.” HD

Tim Powers is the Senior Vice-President responsible for overseeing Astorino's largest studio: healthcare and research, with $1 billion in completed projects.

For more information, visit http://www.astorino.com.

Healthcare Design 2009 July;9(7):36-44