Healthcare Design October 2021 - 32

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the detoxification of infants born to mothers who have an opioid dependency.
This functional description and the appropriate facility type to
care for such babies falls outside the typical healthcare facility " categories "
used by local and state regulatory officials for construction approvals
and permitting. This means that one of the first challenges for project
teams is working with code enforcement representatives to change their
perception of who the " patient " truly is and how that differs from what
their codes and regulations were written to accommodate.
For example, there can be challenges related to occupancy levels and
codes. The Hushabye Nursery facility has 12 patient rooms, which is
greater than the five-room limit set by the City
of Phoenix for similar care facilities where patients
are incapable of self-rescue in the event
of a fire or other emergency. To counter the
city's concerns, the designers and clinicians explained
how the staffing model at Hushabye of
one-to-one care with the parents or other assigned
care providers would provide for 24/7
coverage, so that in the event of an emergency
such providers can carry the babies out of the
building directly. After considering the unique
operational model, the city allowed the greater
occupancy level within the new facility.
The Arizona Department of Health Services (AZDHS) also presented
ity's patient rooms have minimal windows for
daylight, offering instead controllable lighting
based on tolerance needs of each individual
baby. The 12 private rooms for babies are located
along isolated corridors, segregated from
other nursery activities and the more public
functions. Each private room has furnishings,
such as an adult-sized bed, wardrobe storage,
and rocking chair, to allow primary caretakers
to room in with the babies, promoting social
bonding critical for recovery and improved
health outcomes.
THESE BABIES ARE IN A STATE
OF AGITATION FROM OPIOID
WITHDRAWAL AND NEED AN
ENVIRONMENT OF REDUCED
STIMULI AND LOW NOISE
AND LIGHTING LEVELS.
With the one-on-one care, staff and volunteers
work in shifts with the biological parents
and are present in the room 24/7 with the babies,
acting as caregivers and support. Spaces
for daily needs of the care providers such as
communal meal areas, showers, and separate
toileting facilities are present for caregiver
use in the baby zone, while remaining staff areas
are centralized outside of the patient-care
zone to further reduce unnecessary and undesired
noise.
similar code challenges to the development of the facility. By AZDHS'
definition, the nursery falls under the category of a behavioral health
facility, which has the added design and construction cost burden of installing
anti-ligature devices and fixtures to prevent patients from selfharm
or harming healthcare staff. To address this issue, the project team
described that the NAS babies acquired their dependency as fetuses and
as newborns they're not capable of harming themselves or others, making
such devices and fixtures unnecessary at this facility. After several
rounds of discussion and explanations, AZDHS agreed that the facility
would not be required to meet the ligature-resistant requirements due
to the age of the residents and granted Hushabye Nursery approval to
proceed with construction and occupancy.
While states and local municipalities have differing codes and regulations,
projects like Hushabye Nursery provide examples of how to work
closely with officials to educate them regarding the care of NAS babies
and how these facilities can be supportive to their unique needs without
disregarding the codes and regulations designed to protect the safety
and welfare of the public these agencies represent.
RIGHT " DESIGN " PRESCRIPTION
As a nonprofit organization, Hushabye Nursery had limited funds for
facility development and sought an existing commercial property that
could be economically renovated to meet the facility's unique needs. The
8,000-square-foot facility is organized into public and private zones.
Reception, family service spaces, counseling, and staff education areas
comprise the public zone in the front of the facility, while the baby and
caregiver spaces are located toward the rear of the facility in a private area.
NAS babies are in a state of agitation from the opioid withdrawal and
need an environment with reduced stimuli, low noise levels, and low
lighting levels including avoidance of daylight. To address this, the facil32
OCTOBER
2021
HCDMAGAZINE.COM
GROWING NEED
More NAS recovery centers are needed not
only in more regions of the country, but in every
state and most major population centers
that are under attack by the growing opioid
crisis. In 2017, nearly 80 newborns were diagnosed
with NAS every day in the U.S., which
equates to almost 30,000 babies per year. This
reality drives a national bed need for more facilities
to serve this specialized patient population,
as there are less than 100 beds currently in
operation through Hushabye Nursery and two
other facilities in the U.S. The right type of care
environment for NAS babies can make a big difference
by reducing drug dependency of these
babies, lengths of stay for care, medical costs,
and the impact the opioid crisis is having on the
American healthcare system. 
Matthew Kennedy, ACHA, is a senior healthcare
planner at Orcutt/Winslow (Phoenix). He can be
reached at KENNEDY.M@OWP.COM .
http://www.HCDMAGAZINE.COM
Healthcare Design October 2021

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