According to Wessling, the subdivision of these little communities drives the need for “swing rooms” that can be used for different levels of care depending on current demand. As patients progress through their treatment, they transition from primary care to extended care and are introduced to a new peer group. Swing rooms intersect the different care units and can be used for either level. “The room itself might not differ. It’s about understanding community. A primary patient is part of the primary community—it’s where the fellowship happens. If someone [a patient] moves to extended, fellowship will happen there,” Wessling says.
At the outset of Project Legacy, a new replacement medical center for the Department of Veterans Affairs now under way in New Orleans, the design team of Studio Nova—a joint venture between NBBJ and local partners Eskew+Dumez+Ripple and Rozas Ward Architects—sought feedback from veterans and their families. Some 630 hours of conversation led to a whole host of insights and design priorities for the comprehensive healthcare facility that includes substance-abuse services, NBBJ principal Susan Bower says.
Some of those priorities, such as designing wide, open stairwells, directly relate to co-occurring disorders, such as post-traumatic stress disorder. “We focused on reducing anxiety and putting patients at ease with simple navigation choices and easy wayfinding,” Bower says.
Patients also played a key role in color selection. Bower explains that the original palette, composed of bright, cheerful colors, was nixed once it was discovered that veterans preferred muted tones. Even that seemingly simple change led to new concerns: Because many veterans have vision problems, designers are looking at ways to improve contrast on reception graphics, she says.
The industry is moving toward evidence-based design, Vickery says. HGA “always does a pre-occupancy study to ask people where they are now, what are their issues and what we can improve upon,” she says.
A 2009 study from the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that 22.5 million Americans, or 8.9 percent of the population, were classified with substance dependence or abuse in the past year. Not everyone seeks treatment, however. The National Survey of Substance Abuse Treatment Services (N-SSATS), conducted in 2008 by SAMHSA, concluded that financial burden, including lack of health insurance, was a barrier to individuals with substance-abuse problems that did not seek treatment.
The fee varies based on the provider and level of treatment, but Hazelden estimates that inpatient alcohol and drug treatment costs about $28,300 at one of its facilities. New legislation, such as the Mental Health Parity and Addiction Equity Act of 2008, aims to reduce restrictions and limitations placed on mental-health or substance-use disorder benefits. And the Patient Protection and Affordable Care Act (ACA), signed into law March of last year, will fundamentally change what services will be available to individuals with mental health and addiction disorders. But Bray says that the implications of these new laws have yet to be fully felt, and Bray and Vickery agree that it’s too soon to plan new facilities based on these impending changes.
The future of facilities may also be shaped by “retail” healthcare services. Vickery speculates that this could mean more outpatient clinics, perhaps set up in retail environments. For Hazelden’s part, Bray says that the organization is especially sensitive to changes in healthcare and is purposefully planning facilities to serve different needs depending on what the future holds.
“Our design philosophy is staying flexible, [to] grow outpatient care if that’s where there’s future demand. We need to be able to reconfigure readily,” she says.