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Introduction

Worksite Redesign Technical Advisory Project

Fairview Training Center, in Salem, Oregon, one of the nation's oldest and largest state-operated residential institutions, closed in February of 2000. At its peak in the 1960s, it housed more than 3000 persons with developmental disabilities. Upon the direction of the Departmet of Justice, downsizing and the eventual closure of Fairview took place, and residents were placed in community group homes. The major focus in the design and construction of residential group homes has been the safety and welfare of the resident and of achieving a "home-like" atmosphere.

The health and safety of the staff in these settings was largely unaddressed and has resulted in increased injuries, time loss from work, and a disruption in the continuity of care for the residents. As a result of this problem, the Oregon Mental Health and Developmentally Disabled Services Division (MHDDSD) applied for, and was awarded a grant through the Oregon Occupational Safety and Health Division (OR-OSHA) to investigate mitigation of injuries through architectural design, equipment research and development, and safety plans. More specifically, the task was to evaluate and develop structural design plans and specifications to provide a safe work environment, to use sound ergonomic principles, and the same time, maintaining a home-like atmosphere for the residents. The belief is that improvements in physical layout, space, light and equipment protect the safety of residents and staff.

MHDDSD assembled a multi-disciplinary Technical Advisory Group consisting of an ergonomist, a nurse safety specialist, two architects, a building contractor, a workers' compensation loss-specialist, representatives from MHDDSD, and OR-OSHA. The Group began its investigations using information gathered from focus groups made up of workers from Fairview and community group homes. This information was invaluable in giving the Redesign Group direction. As would be expected, competing interests between Group members surfaced in this collaborative process. Different backgrounds, perspectives and priorities enriched the process, and eventually produced a better quality and more balanced product.

The Group visited some 25 homes throughout western Oregon. This included new construction homes and remodeled (retrofitted) homes that present great challenges. Staff at the homes completed a safety survey and responded to questions on specific issues during the onsite investigations. Over 300 photographs were taken and the Group has selected, for this manual, those that give you a pictorial survey of: what we observed, what was changed, what appeared to be defective situations, and what we recommend. Where pictures did not serve to illuminate our point, illustrations were used. Architectural drawings were also developed for specific, high use problem areas of homes. It was difficult to separate redesign and safety because of their integrated relationship. In these instances, we included safety information for the reader's use.

This manual is the result of the Technical Advisory Group's investigative and problem solving efforts. The book is divided into sections corresponding to living areas of the home and site. Some general design considerations and suggestions introduce each of these sections. The Group has attempted to provide accurate information at a technical level, useful to anyone interested in safe and efficient group home design. The manual concludes with various appendixes that provide additional technical information related to home design and staff safety. The names, professional experience and phone numbers of the Group members are also given. All members of the Group are willing to provide further information on any of the topics discussed in this volume.

We hope the information collected here will be useful to readers interested in all issues related to design and safety, where people with developmental disabilities live, and where staff perform the important task of assisting them to realize their full potential. Recommendations in this book are not meant to supercede existing laws, rules and regulations, which take priority in all circumstances.

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General Information

The following information was discussed in our meetings and as part of our onsite evaluations. It was difficult to capture the various issues in a cogent manner since every home layout was unique to the particular home and no two were the same. There were some safety issues that transcended site and were applicable at every home. Here are a few of those identified.

Soften Edges

Soften corners and "round" the exposed edges on walls, cabinets, countertops, mantles, hearths, half-wall room dividers, posts, and handrails to prevent serious injury. This is of particular concern in bathrooms and kitchen. Note: Furniture should also be chosen using this criteria.

Floor Plans

Encourage open floor plans. Provide for maximum staff visibility of clients throughout the house. Avoid closed hallways and blind or hidden spaces. If the house is designed to prevent this, then a light source at the closed or blind area should be installed.

  • Develop a floor plan to identify safe and unobstructed evacuation points

Single Story Dwellings

Single story dwellings are always recommended over multiple storied dwellings. When a double storied dwelling is used, resident rooms and bathrooms should be on the main floor.

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Floors

Carpeting and rugs raise issues of hygiene and safety. Rugs present problems for residents and staff where resident mobility is impaired by introducing unwanted friction. Hygiene is dangerously compromised and, in some cases, replacement is the only solution. Replacement of carpets is highly undesirable since off-gas from new carpets presents serious and unnecessary lung-irritant exposure to both residents and staff. If carpets are used, choose commercial grade, vinyl-backed carpeting that is antibacterial-treated. Area rugs with beveled edges should be considered if the home environment is an issue.

Vinyl composition tile, composition wood, tile, and even cork should be considered as better flooring choices. These materials reduce the amount of force required to move equipment.

  • Non-skid waxes should always be used on vinyl surfaces
  • All floors should be maintained per the manufacturers' specifications

Lighting

Natural and abundant light and ventilation should be an integral part of the remodel/retrofit plan (except where light is medically precluded).

Purchases and Maintenance

Equipment:: Properly maintained equipment is critical and this element must be integral to purchasing decisions. A system to identify, prioritize, and communicate the need for repairs and maintenance of equipment is essential. A regular preventative maintenance program must be in place.

Equipment Specifications and Reliability: Equipment specifications should be assigned only after the staff who will be responsible for the use of such equipment has been consulted. The specifications must be considered and included in the care plan and therefore followed by the staff. Equipment function may mean little to an offsite purchaser but will be extremely significant to an end user. For example, a bath water fixture that is not adjustable and is outside the reach of the caregiver, presents an imminent danger to the resident and staff member. The fixture represents a purchase order on paper but a critical care item for resident and staff. It is critical to communicate with the end user when considering equipment specifications to allow for the most effective (cost, both financial and in human terms) application possible.

Equipment reliability is critical. If equipment is broken and unusable, a system for immediate repair, replacement or loan/rental process is highly recommended. It is not a reasonable or safe alternative to expect staff to work without designated equipment, which would represent a hazard to the resident and staff member. We can avoid such accident scenarios by taking the time and thought to include maintenance and replacement specifications in purchase contracts.

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Equipment Purchase Contracts: Contracts should be negotiated to include an evaluation window in order to determine the equipment's efficacy in the specific application and establish vendor responsiveness to maintenance and delivery of loaner equipment.

Furniture: During onsite investigations, staff related the importance of furniture and recommended various factors for consideration when purchases are made.

  • Size-in relation to the room where furniture will be placed. Furniture that is too large for the room impedes traffic and care to residents
  • Durability-well constructed furniture that will clean easily for low maintenance
  • Height-furniture that is too low, or where cushioning makes assistance or care to residents difficult creates unsafe lifting situations
  • Dangerous construction-rounded and soft edges provide safety to residents and staff
    Lighting
The Illuminating Engineering Society nursing home standard document (see page 125) is used to determine maximum light in all areas. Dimmers may be helpful in living areas to manipulate lighting in group living situations. Task lighting as described in the IES document should be considered as the recommended illuminance.

Provide for:

  • Maximum lighting at all ramps, porches, walkways and parking areas. Exterior light fixtures should be kept low to ground to minimize glare, prevent shadows and protect neighbors
  • Provide battery back-up lighting for emergency egress. Lights should be guarded to prevent breakage
  • Exposed light bulbs must have covers, cages, or other guarding devices
  • Light suppression-use of dimmers as options in lighting
  • Fluorescent lighting can be too harsh in some settings
  • Be aware of low-hanging fixtures which present danger
  • Entryways must be illuminated on inside and outside
  • Parking areas and walkways should provide adequate lighting for safety. Low profile lights can identify pathways without causing shadows or disturbing neighbors

Acoustics

SOUND DAMPENING: Overall noise can be a stressor to employees and clients. Employees must be able to hear clients within the house and be able to easily use phones and direct staff's behavior. Clients may be bothered by noise, so an acoustically-sheltered system can be beneficial for clients. Sound dampening between employee rooms, offices, utility rooms and bathrooms is recommended. Pay attention to the range of the client's needs prior to accepting them into the home. The resident care plan should identify if the client is sensitive to noise and respond to this need prior to placement.

Space Needs

Specialized equipment is often necessary to support residents with their activities of daily living. Although the home is designated residential, the specialized equipment necessary to support the resident may require setting design adjustment to accommodate movement safely. Storage of the equipment must be available near the areas in which is will be used. If the equipment is not readily available to the staff in a timely manner when needed, it will create movement difficulties, wasted time, and injuries can easily result. Wheelchairs, Gurney, shower chairs, transfer equipment, and lifts are but a short list of specialized equipment that may be required for the special needs of residents. The home environment must accommodate the equipment including hallway widths, doorway widths, flooring material, and storage areas. In addition to convenient storage, space requirements for the turning radius of such equipment also requires special consideration.

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