Parkside Lutheran Home has always been known for the high standard of care it provides residents. Located in the small, peaceful community of Lisbon, North Dakota (population 2,300), great pride is taken in the quality of life for the entire town. Although the level and quality of care in Parkside Lutheran Home is high, the physical environment of the 40-bed, not-for-profit facility did not reflect this. In 2007, Administrator Tim Kennedy, along with the board of directors, decided to change the physical environment of the facility to embody the quality of the care provided. According to Kennedy, the residents, both current and future, were entitled to a better quality of living.

At a glance…

Parkside Lutheran Home in rural Lisbon, North Dakota, offers the same quality of care that larger communities offer, in the peaceful rural setting their residents grew up in.

‘Healthcare institution’

The original building that housed Parkside Lutheran was built in 1992-just before the industry started to talk about culture change and the idea of providing a homelike environment for residents. It was designed as a healthcare institution. Prominent in the original design of the facility was a large, central nurses' station that joined two resident wings. This nurses' station was built as a large circle with ample room around it that provided one of the only spaces for the residents to sit. Because of this design, the nurses' station was the center of social activity for the residents and their caregivers, with the caregivers behind the barrier of the nurses' station. It was also a visitor's first image upon entering a resident wing. Although the building was only 15 years old, it was modeled on nursing homes built in the 1950s and 1960s that evolved out of hospital care settings. The central nursing station-the icon of the medical model-evoked an image of acute care and sickness. It was far from homelike.

In December of 2007, Kennedy and the board retained Horty Elving to develop a master plan, redesign the facility and to execute the construction. Horty Elving, a design-build firm in Minneapolis, Minnesota, has specialized in community healthcare design since 1955. The final master plan included major remodeling to the existing facility and the addition of two new resident households. The plan increased the census from 42 to 50 beds. Specifically, the project increased the number of private beds from 4 to 28 and decreased the number of double rooms from 28 to 6. Ten basic care units (similar to assisted living care) were added to the facility along with provisions for independent living units to be added in the future. This provides more lifestyle choices for the residents and allows them to continue their lives within the facility even if their level of care changes. The entire facility was to be designed so that resident-centered care could be delivered under the household concept.

At the start of the design process, the team from Horty Elving conducted an interactive brainstorming session called a design charette that included the residents, the staff, the board, and the community. In the charette, the discussion focused on delivering care to the residents with dignity and respect, providing for the residents the continuation of self and control over choices, and the importance of ensuring residents live in a homelike environment on their own individual schedule. The design of the building needed to support these ideals and be an aid to the caregivers so that they can focus on providing great care to the residents without being impeded by the physical setting of the facility.

The new floor plan divides the building into four separate households. In each household 10-14 residents live in a family-style setting. In conjunction with the new setting, the staffing concept was changed. CNAs and “homemakers” are assigned to and remain consistent with the household so relationships between the residents and the staff can be nurtured. The homemakers' duties are universal and include directing activities, serving food, and cleaning. Staff will now use pocket pagers to minimize unnecessary overhead pages that disrupt a peaceful environment. The staff and residents worked together to name each household and to decorate their households. The social life of the residents and staff is now centered on the common living areas that they helped to create instead of the institutional nursing station.

Sara Malin, AIA
Sara Malin, AIA

The design team overcame several challenges in the design of the project. The structure of an existing building often limits options for remodeling and this was no exception. The team also successfully resolved a challenging building site which was sloping and rocky to fit the four neighborhoods onto the property. Despite these challenges both the renovated and new households have private resident rooms with private bathrooms centered around a common kitchen, dining area, living room, laundry room, and patio. The private resident rooms nurture self-empowerment and independence. Residents are encouraged to keep their cherished belongings around them in their room. With the living and dining areas in close proximity to the residents' room, one can come and go on his or her own schedule without much assistance from the staff. This allows staff to spend more “face” time with the residents, rather than merely transporting them to and from a remote group dining area for rigidly scheduled meals.

Sara Malin, AIA
Sara Malin, AIA

An interesting facet of the project occurred when the facility closed the large, central nursing station as the first phase of the culture change transition. The residents still continued to socialize around the nursing station even though it was abandoned and the nurses were stationed near the residents in each wing. In the original building design there was no consideration given to creating a space in which people make informal connections with each other and the staff as part of their daily lives.

The institutional look of the old facility was dramatically changed. The Horty Elving design team brought ample daylight into the facility. The team made sure the height of the window sills allows a resident in a wheelchair to comfortably view the outdoors. Patios were designed to be easily accessible for the residents, with pergolas to provide shade from direct summer sun. The design team worked with the staff and residents to select color schemes that are warm, inviting, and reflect the culture of the community. Warm terra cotta, rich greens, blues, and gold create richness and warmth in the interior spaces and create identities for the households. These color schemes were expressed as accents in entry walls and carpet insets for each household; they provide helpful cues to residents and visitors so they can more easily find their way through the facility. The design team involved the staff in the finish selections to ensure they were not only visually pleasing but also met the needs of staff and residents for safety, comfort, and durability.

Perhaps the most dramatic change in the environment is the face it presents to the Lisbon community and visitors as they enter into the building. Because the large group dining room was no longer needed, the space was reconfigured to create an inviting town center. Upon entering the building a visitor is welcomed by a water fountain that flows peacefully over a stone wall. The sound of the water adds a calming, restful quality to the atmosphere. A large fireplace is the focus for a lounge area and café located adjacent to the entry. The administration area is discreetly tucked behind the fireplace wall and out of view, to continue the ambience of home rather than institution. The chapel was rebuilt to be larger and have the flexibility to serve as a large, multipurpose activity room. With the warm colors, inviting spaces, and pleasant sounds, the new image for the facility is one of peacefulness, dignity, and life.

As the design-builder, Horty Elving was able to use many local contractors and suppliers who worked to build the new facility with great care. The community of Lisbon, North Dakota, is proud of its new state-of-the-art facility. It is a showcase for the quality of care that this community provides for its residents. They are proud to boast that they are able to provide the same quality of care that larger communities offer, yet their residents can remain near their loved ones in the peaceful rural setting to which they are accustomed. D

Sara Malin, AIA, is an architect at Horty Elving, a full-service, multidisciplinary design and construction management firm located in Minneapolis, Minnesota that specializes in community health care and senior living projects.

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Design Environments for Aging 2010 2010 March;():20-23