August's Showcase feature, “Full-Service Lifecare” (p. 74), featuring Laguna Honda Hospital, brought back memories for me, and reiterated a paradox of healthcare design, i.e., how a niche field can lead the way to better design overall. The word “hospital” is actually a misnomer when referring to Laguna Honda, which rather is a long-term care facility par excellence. Its main mission is to provide round-the-clock care over the course of months or years for profoundly impaired elderly patients and others (although it includes important short-term care components as well). From a healthcare design standpoint, Laguna Honda is a “hospital” in name only. Its new design incorporates features that go considerably above and beyond even the most contemporary hospital design.

Long-term care is, of course, a niche field not well understood by most in healthcare design, but it has much to offer the industry. My appreciation of this comes from my previous incarnation as Editor-in-Chief of a publication called Long-Term Living, although it was known for most of my 18 years there as Nursing Homes/Long-Term Care Management. Long-term care design became a regular topic of coverage when I started in 1991, and we went on to develop the annual DESIGN series in 1997. DESIGN proved to be the progenitor of the HEALTHCARE DESIGN publication you are now reading and its associated annual conference, which this year will be held Nov. 13-16 in Las Vegas. It could be said that I came into healthcare design through the back door!

Working on the Laguna Honda Showcase this summer reminded me of contemporary concepts that, though fairly well-recognized in long-term care, are relatively new to mainstream healthcare designers. They were addressed square-on by architects Jeff Logan and Sharon Woodworth of Anshen + Allen and Larry Bongort of Stantec Architects, and included safety-oriented floorcoverings, brighter but glare-free lighting, aging-friendly color schemes, spaces for socialization (beauty parlors and barber shops, as well as cafés and libraries), and patient room layouts called “households” and “neighborhoods.” The “households” combine a grouping of patient rooms-15, in this case-with their own dining rooms and living rooms, and then incorporates them into “neighborhoods” occupying the entire floor. It's a way of breaking down the sheer mass of patient-occupied spaces into something more homelike in scale-a definite plus for patients living at Laguna Honda for long periods of time.

Clearly, households and neighborhoods are not necessarily applicable to acute care facilities. But what struck me was that the Laguna Honda architects still found much in their design that is valuable to hospital design in general. They pointed out that with today's increasingly geriatric patient population, many features used in the project would make any hospital setting more accommodating for the elderly.

With the coming tsunami of patients in their 80s, 90s, and 100s, hospitals wanting to stay ahead of the design curve will have to acknowledge this in their future planning and construction. Consider opening yourself up to colleagues who have acquired some experience in long-term care design, if you haven't already. The healthcare design mainstream is about to become broader.

Healthcare Design 2010 November;10(11):134