Healthcare Design - June/July 2019 - 55

The

Center

HEADING FOR HOME
Our industry can contribute design strategies
to help move residential healthcare forward
By Melissa Piatkowski and Debra Levin

ADICAL SHIFTS in where care is delivered are taking

place. More chronic conditions can now be treated
in the home due to significant advances in medical
technology, changes in reimbursement structure,
and the desires and complex needs of an aging population. These factors are opening up new opportunities for people to thrive at home in a convenient,
cost-efficient way, reducing unnecessary hospital
admissions and giving patients the opportunity to receive the care they
need where they are most comfortable.
The Center for Health Design's latest online resource-an issue brief
titled "Healthcare at Home"-looks at both the research literature and
expert knowledge to present design strategies that specifically facilitate
healthcare in the home setting. The findings, which include considerations for a variety of topics from room layout and furniture selection
to technology (software and devices) and accessible equipment storage,
were completed this spring and are as relevant to designers and owners
as healthcare institutions and families.
Healthcare-at-home services range from complex dialysis and chemotherapy treatments to diabetes management and rehabilitation
from acute conditions. This rapidly growing
segment of the healthcare industry serves
ACCESSIBILITY AND
mainly older adults with acute and chronic
conditions who are stable enough to be treatPHYSICAL SAFETY ARE
ed at home but can extend to include those in
IMPORTANT AREAS TO
rehab and patients who reside in rural areas
CONSIDER.
and lack access to services. Though various
forms of home-based services, such as visiting nurses and physical rehabilitation services, have existed for years,
the trend toward more hospital-level acute and subacute care being delivered at home is relatively new and brings numerous advantages. For
many patients, the home is more comfortable and convenient and has the
advantage of family and friends being nearby. It can also reduce the risk
of complications like healthcare-associated infections.
For the provider, some studies suggest that delivering certain care services at home may be more cost-effective than providing them in a traditional setting. A paper published in Health Affairs in 2012 by Lesley
Cryer, Scott B. Shannon, Melanie Van Amsterdam, and Bruce Leff found

that healthcare at home costs were 19 percent
lower as compared to similar inpatient care.
A report, "Hospital-Level Care at Home for
Acutely Ill Adults: A Pilot Randomized Controlled Trial," published in 2018 in the Journal
of General Internal Medicine, puts the cost savings at closer to 52 percent. In addition, home
care may decrease some of the burden on an
oversaturated healthcare system, especially as
our population ages.
However, delivering home-based care is
not without its challenges. Today, very few
healthcare organizations offer formal homecare models. There are also significant challenges related to technology capabilities in
the home environment. For example, homebased internet may not support easy access to
electronic medical records, and Medicare reimbursements for telehealth are currently limited
to specific circumstances. Additionally, current
residential designs tend to be oriented toward
the young, healthy, and able-bodied, making it
difficult to support accessibility needs. Home
modifications, such as installing grab bars,
railings, and ramps, are needed to support safe
accessibility. And while initially these modifications can seem costly, they're still far less expensive than a trip to the emergency room or a
hospital stay.
The Center's research revealed that two important areas to consider are accessibility and
physical safety for activities of daily living. The
issue brief explores how to design for both safety and accessibility in building and room layout,
patient-handling equipment, furniture, accessibility fixtures, storage, waste disposal, flooring, lighting, technology, and home aesthetics.
Providing more healthcare at home offers
advantages over traditional healthcare options
but not if the home environment isn't properly
equipped. There's a great opportunity for the
design, healthcare, and manufacturing communities to better understand the value and
needs of this growing sector and help move the
residential healthcare industry forward. 
Debra Levin is president and CEO of The Center for
Health Design. She can be reached at D L E V I N @
H E A L T H D E S I G N . O R G . Melissa Piatkowski, MS,
EDAC, is research associate at The Center for Health
Design. She can be reached at M P I A T K O W S K I @
H E A LT H D E S I G N . O R G .

J U N E /J U LY 2 01 9

Healthcare Design - June/July 2019

Table of Contents for the Digital Edition of Healthcare Design - June/July 2019