Strategically planned bed growth in rehabilitation care is primarily being inspired by meeting the needs of baby boomers and beyond. On the inpatient side, emphasis on single-occupancy post-acute rooms is expected to continue, says Brenna Costello, principal and medical planner with SmithGroupJJR. However, it’s not just the size of that patient population and age-related ailments that are pushing growth.

At rehab centers, like Craig Hospital in Englewood, Colo., active patients in their 60s and 70s are being treated for injuries sustained while mountain climbing, biking, and skiing, says Diane Reinhard, vice president of patient care and chief nursing officer with Craig Hospital.

“In the last five to 10 years, we’ve seen more of a rehabilitation focus on ‘quality-of-life’ skills,” says Paul Widlarz, associate vice president, principal, and medical planner with HGA Architects and Engineers. “This is, in large part, due to the fact that the baby boomers have tended to be more actively involved in sports and fitness throughout their lives. We are seeing significant orthopedic surgeries at younger and younger ages due to degenerated joints.”

Meanwhile, outpatient spaces are being designed with an “infrastructure to ebb and flow as the inpatient world changes,” Costello says. A trend toward outpatient rehabilitation space at primary and ambulatory centers started about six years ago, Widlarz adds. These outpatient rehabilitation sites proactively emphasize fitness, not just reacting to an adverse event, with workout spaces—fitness centers and walking and jogging paths—part of a total healthcare management approach.

Primary care centers averaging 15,000 to 25,000 square feet are starting to include rehabilitation space sized at about 2,000 to 2,500 square feet. Likewise, ambulatory centers, connected to specialist practices, might include 5,000 to 7,500 square feet of rehabilitation space within a 100,000- to 200,000-square-foot building, Widlarz says, adding that HGA is currently designing two primary care centers with integrated outpatient rehabilitation centers for a large Midwestern hospital system.

The Affordable Care Act, through the hospital readmissions reduction program, is also affecting post-acute rehabilitation design and location considerations. The act outlines, for selected diagnoses (for example, hip and knee replacement) that if readmission occurs within a 30-day post-discharge period, hospitals may be assigned a retroactive penalty for not originally providing adequate care that would have prevented the readmission.

Hospitals “are incented to cover as many bases as possible,” demonstrating that they did all that was possible to prevent a readmission, says Sam Burnette, senior designer and principal with Earl Swensson Associates (ESa).

“Hospitals are being much more strategic in how they deal with a discharge patient who needs transitional care,” Widlarz says. “Now with the penalty of readmission, there is more involvement in post-acute care.” As a result, hospitals may partner with independent providers of off-site rehabilitation care but “retain oversight of the post-discharge care and ensure the right quality of care at the right level.” Or, Widlarz says, the hospitals may bring the post-acute rehabilitation programs in house.

However, keeping growth in check while considering the rehab needs associated with future age cohorts is critical. “There is a question in my mind: When the baby boomer population is no longer there, what can rehab hospitals be used for—specialty beds, skilled nursing, memory units? The reuse strategy is a tough proposition,” says Matt Manning, senior project designer and manager with ESa. “On the other side of the population, will inpatient rehabilitation use change? Flexibility of these spaces is key.”

Sharon Schnall is a writer based in Northeast Ohio. She can be reached at

For more on major trends and best practices in rehab center design, see “The Home Stretch: Designing Rehab Centers.”