The Environments for Aging conference and expo is an annual destination for professionals in the senior living space. It’s a gathering of administrators, designers, builders, front-line workers, developers, and researchers to discuss the latest strategies and ideas for creating functional and attractive living environments that meet the needs of an aging world.

Environments for Aging

We have more people that need care than we have people that can provide that care.

-Benjie Nycum

Check out the article here.

A portion of Benjie and Nebal‘s discussion about the design aspects was published in the May 21, 2020, edition of the paper.

Links

• Chronicle Herald article
• Blog post announcing replacement of Villa Acadienne (new design is based on the household model discussed in the interview)
• Blog post discussing impact of household design on Long Term Care facilities in Nova Scotia
• Blog post announcing engagement to present Nova Scotia’s household model at healthcare architecture forum
• Blog post announcing engagement to present Nova Scotia’s household model at conference on aging
• Annapolis Royal Nursing Home (Nycum household model project)
• Northwood at the Parks (Nycum household model project)

Links

• Hadrian’s Blog Post
• Nanuk Technologies

After construction is complete, interior and exterior renovations will result in the addition of six dialysis stations to this 63-bed inpatient facility.

Links

• Cape Breton Post Article announcing construction tender issued, April 22, 2019
• Cape Breton Post article announcing funding, March 25, 2019

July 3, 2019, saw the announcement by the Provincial Government that the facility would, indeed, be replaced: a successful outcome for the hard work of Villa Acadienne, its board and our consulting team.

The new Villa Acadienne is designed based on a “household” model of care where residents live in smaller groups, or households, each with its own dining, food prep and other support areas. The new building will increase the facility’s bed count by ten to a total of 96 residents.

Links

• Digby Courier Article announcing replacement, July 3, 2019
• Blog post discussing impact of household design standard in Nova Scotia, Observations from Implementation
• Blog post announcing LEED certification of one of our long-term care projects
• Blog post announcing LEED certification of two of our household-model long-term care projects
• Blog post announcing engagement to present Nova Scotia’s household model at healthcare architecture forum
• Blog post announcing engagement to present Nova Scotia’s household model at conference on aging
• Annapolis Royal Nursing Home (Nycum household model project)
• Northwood at the Parks (Nycum household model project)

Links

• CBC Article, October 26, 2018
• Blog post announcing release of construction tender
• Blog post announcing project

The full article can be found here, beginning on pg. 26

Links

• Kings County News Article, August 24, 2018
• NovaNewsNow Article, February 24, 2018
• Blog post announcing project

It allows me to live where I want to live.

Future Patient

An important factor in the quality of life and health for all Nova Scotians.

Links

• Kings County News article, August 13, 2018
• CBC Article announcing project, January 13, 2017
• Blog post announcing project

Here is an excerpt from the abstract:

This talk explores the environments where people are most likely to die. Using visual and graphic descriptions taken primarily from architectural designs (many in Nova Scotia), concepts of home, ageing, dying, dignity, boredom, family, care, and the taboo of death are viewed through the lens of these environments to shed light on their objectives, their roles, their operations and the experience they offer.

From 2007 to 2010, Nova Scotia built 1533 new and replacement Nursing Home Beds. Currently Nova Scotia is building community based Hospice projects. Home care is also a trend that is politically and practically topical. Hospitals remain an important emphasis.

How do we as citizens and a province advocate for the appropriate environments for care and ageing? How do we avoid allowing our misconceptions about the dying process to inappropriately influence our direction and priorities? What do we want and what can we expect from environments where we are likely to die?

This presentation reveals these environments emphasizing facilities in Nova Scotia, and explores them through the context of these important questions to enable and arm the audience to become better advocates for them.

This work took advantage of underutilised space to expand and enhance the surgical case mix, throughput and efficiency to nearly double the surgical capacity of the hospital, alleviate wait times and help reduce load at nearby hospitals.

Nycum is excited to see this project open and is proud to play a part in improving healthcare services and access for Nova Scotians.

QEII Redevelopment Project Reaches First Milestone
Shelburne County Coast Guard Article
Chronicle Herald Article
QEII Redevelopment

Surgical Department Redevelopment

QEII Redevelopment – Hants Hospital OR
Important Piece of the Puzzle
Press release

Surgical Department Redevelopment

See this video discussing the benefits this important project will bring:

The residential scale of the interior spaces lent itself well to traditional dimensional framing – spaces were designed to evoke feelings of home, most of which are wood framed. The wood framing was combined with plywood sheathing to provide shearwalls in an economical and easy-to-construct manner.

The potential for the building to appear as a large institutional facility was mitigated by introducing traditional peak-roofed “house” forms to dissolve the large facility into smaller units. Each “house” is home to ten residents, and all of the houses are linked together to allow support and care staff access to individuals and groups and encourage healthy socialization among the residents. Prefabricated engineered wood trusses were a natural and economic fit for this residential vocabulary in an institutional setting, and the material easily accommodated complex shapes.

The client wanted the exterior of the building to relate to the adjacent residential community, helping the project to fit in with its neighbours and reduce the stigma for people entering a “hospital” for mental health care. Prefinished wood siding is a durable and attractive cladding that relates to vernacular wood sided houses in Nova Scotia – the variety of finishes and profiles available allowed the design team to further break down the mass of the project using pattern and colour.

A wood and steel hybrid system of construction was chosen to combine the ease and economy of wood construction with the longer spans of steel frame construction. The hybrid construction mirrored the hybrid program of the building: a large institutional facility that feels smaller-scaled and residential.

Wood framing was chosen for its speed of installation, stainability benefits, familiarity with material for trades and ease of sourcing locally. Shorter spans were realized by utilizing the interior partitions as load-bearing and shearwall structures – this helped simplify structural connections by maintaining consistent structural materials in these areas and minimized the depth of the roof/ceiling.

The high-pitched roof design lent itself to prefabricated wood trusses: a local product, familiar to local trades and with benefits to the schedule with their ease of construction. Pre-finished wood cladding provided residential feel to the exterior of the building, helping to relate to the surrounding community.

Steel was used to address snow loading and the weight of vegetated roofs over areas the program required to be clear span – the use of steel was minimized by using it selectively in conjunction with economical wood construction. Steel and wood were a good combination with relatively simple and common connections between the two materials, with many pre-fabricated, simple to install, solutions.

WoodWorks! Atlantic

Healthcare challenges in the future do not have a roadmap of experiences on which to create policies and plans, but they will be real, massive and swift: Technology-driven change is coming to healthcare that will combine with real pressures to disrupt almost every current healthcare practice. We have seen this disruption happen to other industries (for example the music industry in the 00’s presently in education and the taxi business). Much of this change has been good for consumers, but for providers it has created a new landscape. Unlike for other industries and service providers, technology-driven change has been slow and incremental for healthcare because there is so much liability and risk. But once these factors are overcome, the current paradigm will be massively disrupted. Most of the change will not be predictable or created and managed by the people in the know. It will come through the backdoor in unexpected ways. The driver of this disruption will be the superconvergence of technologies combined with diminished financial and human resources. The current planning window for any healthcare facility must recognize that plans will be implemented during this disruption so it is very important to avoid applying current assumptions. Things to think about:
• What are the factors and technologies leading to this disruption?
• How will the roles of patients and healthcare providers change?
• What will be the role of facilities when technology enables healthcare to be delivered in environments created by algorithms and networks rather than bricks and mortar?
• What is the future of the hospital?
• How do we get ahead of this so we can seize it as an opportunity rather than be subordinated to it?

This project represents the second in a series of three health centres in Nunavut designed in conjunction with Stantec (formerly FSC Architects and Engineers). Nycum provided full architectural services, interior design and healthcare specialty design expertise related to the building interiors, as well as furniture and medical equipment consulting. The third project, in Arctic Bay, is presently under construction and slated to open in 2017.

Here is the CBC’s article on the opening!

Check out our Facebook page for project photo albums

Find Arctic Bay on a map (look up, look way up!)

Healthcare challenges in the future do not have a roadmap of experiences on which to create policies and plans, but they will be real, massive and swift: Technology-driven change is coming to healthcare that will combine with real pressures to disrupt almost every current healthcare practice. We have seen this disruption happen to other industries (for example the music industry in the 00’s presently in education and the taxi business). Much of this change has been good for consumers, but for providers it has created a new landscape. Unlike for other industries and service providers, technology-driven change has been slow and incremental for healthcare because there is so much liability and risk. But once these factors are overcome, the current paradigm will be massively disrupted. Most of the change will not be predictable or created and managed by the people in the know. It will come through the backdoor in unexpected ways. The driver of this disruption will be the superconvergence of technologies combined with diminished financial and human resources. The current planning window for any healthcare facility must recognize that plans will be implemented during this disruption so it is very important to avoid applying current assumptions. Things to think about:
• What are the factors and technologies leading to this disruption?
• How will the roles of patients and healthcare providers change?
• What will be the role of facilities when technology enables healthcare to be delivered in environments created by algorithms and networks rather than bricks and mortar?
• What is the future of the hospital?
• How do we get ahead of this so we can seize it as an opportunity rather than be subordinated to it?

April 30, 2015

In recent decades, the debate over institutionalization vs. de-institutionalization has highlighted the tensions that continue to exist between architecture and psychiatric care and treatment. This is nothing new: architecture and psychiatry have shared parallel and intertwined roles in the care and treatment of persons with mental illness for the past 200 years. For example, the influential Kirkbride asylum design formalized the theory that the built environment was a key factor in the cure of mental illness in the middle of the 19th century. Psychiatric architecture reflects moral beliefs and social systems of urbanization, community, shelter, control and our quest for utopia. It is therefore not surprising that they each address social issues with solutions that are usually prescriptive but occasionally utterly inspiring.

As the professions of psychiatry and architecture face the future, changes like virtualization, technology, convergence, integration, and availability of resources will drastically alter the social needs they serve. Present day Psychiatry will increasingly be unburdened by the need for space in which to do its work, providing an opportunity to lead all types of medical practice through the transformation of healthcare, society, and the built environment.

What happens when you design a portfolio of projects using a design standard?

We examined the designs of 44 newly constructed Nursing Home facilities in Nova Scotia in order to study how they followed a newly introduced design standard. We wanted to learn how closely the facilities resembled one another, and where they differed. The projects were designed by different teams for different builder-operators, and were designed and constructed roughly simultaneously. We found it intriguing how design standards can both restrict and encourage innovation and best practices (which are always evolving). This is a summary of our findings along with some considerations for crafting a design standard.

1. Not everyone interprets design standards in the way in which they were intended, and their meaning may not be widely and consistently understood. What is a “design standard” and what does it actually mean? (Is it official? Is it a guideline? A law?)
View the standard as driven by outcomes, rather than prescribed methods of getting to those outcomes, and include explanations of intent within the standard. Be clear about the enforceability of the standard.

2. Procurement processes in a multi-project portfolio impact the interpretation of the standard. The values against which the winning designers/constructors/operators are selected (i.e. cost, sustainability, durability, quality etc.) can impact the way the standard is interpreted and either curtail or enhance opportunities for innovation
Consider how procurement mechanisms relate to the standard that will be enforced. Are the procurement values in synch with the standard’s values? Seek alignment. If the main objective of the standard is durability, do not procure for lowest cost – the result will be challenges to the standard where durability can be interpreted in multiple ways.

3. A standard that is radically different from existing practices means that the processes of the occupants will be forced to change. Culture change must occur quickly and within the premise of “what will be.” This can be challenging at the best of times, but difficulties in adapting can be amplified when the impacts of a standard are not well understood, as is often the case.
Implement a structured culture change process as part of the design standard roll-out.

4. Designing and constructing several facilities simultaneously reduces opportunities to learn from project to project. This is not a factor of standards, but of the timing of implementation of projects that follow the standard.
Implement projects in sequence and include a mechanism for studying impacts on a project-by-project basis. Include mechanisms in the standard to allow for adaptations from lessons learned.

5. Unexpected interdepartmental conflicts may emerge within government agencies responsible for various aspects of review and approval. For example, in a healthcare project in Nova Scotia, the Department of Agriculture may have concerns with food delivery, floor finishes, and tasks of the front line workers as outlined in the standard. Work-arounds during implementation to satisfy conflicts between agencies can cause cost and timeline chain reactions.
Cast a wide stakeholder engagement net in the early stages of writing the standard.

6. In a building’s lifecycle, operating costs are much greater than upfront capital construction costs. If operations costs are not contemplated in the standard, they will be sacrificed in order to meet the capital construction project requirements.
Consider life cycle performance of the building when developing standards, not just cost on opening day.

7. Standards are uniform, but projects are impacted by unpredictable variables. Geography, labour and materials, topography, site availability, risk management, and politics are factors that can put unexpected pressure on a standard.

8. Seeing is believing. When people can touch and feel what is in their future, they imagine fewer obstacles.
Run pilot projects within existing facilities.

For more information, visit our website’s Project Page.

LEED™ is a regular part of a large portion of the world of architectural design, with traditionally less representation in the world of healthcare architecture.

In this project, we focused on the LEED™ credits with the potential for the greatest impact on those living within. For example, including operable windows in what is traditionally a sealed environment, which means working closely with our Mechanical Engineers to ensure that appropriate humidity and temperature levels are not put at risk.

This project also included exterior rooftop gardens and decks in assorted sizes providing recreational and rehabilitation opportunities at many scales for the residents, visitors and staff, while encouraging closer connections with the natural world.

In addition to being lower maintenance and climate appropriate, landscape design for this project included native plants and other appropriate non-invasive varieties to contribute to familiar views for residents, improving health outcomes, and longer-term life-cycle cost benefits for the operator.

An Insulated Concrete Forming (ICF) system was chosen as a major structural component, allowing the building to take advantage of a high level of recycled content (fly ash) in the concrete mix and providing high thermal insulation values while acoustic comfort of residents was enhanced.

The LEED™ framework aligned with the team’s goal of choosing as many natural materials as possible in a healthcare setting to help reduce the institutional feel of the building and support biophilic design philosophies that a growing body of Evidence Based Design suggests enhance healing and well-being.

Congratulations to all involved with Ivany Place: Northwood at the Parks, in the Parks of Bedford West.

Client: Northwoodcare Inc.
Project Manager: Fairwyn Developments
LEED™ Consultant: Solterre Design

The article is a reference to the NXT Patient Room 2020 Prototype, a full scale prototype that involved 30 industry partners in its construction. Among these are Amuneal, Armstrong Commerical Ceiling Systems, Barrisol, Bendheim, Christian Rae Studio, Cleankeys, DuPont, Duravit, Evans and Paul, Evergreen Medical, Grohe, Hafele, Handicare, Holosonics, Infinity Drain, Intense Lighting, Jay R Smith MFG, Co., Linet Americas, Lutron, Medline, Milliken, Osram Sylvania, PK30, Duracel Powermat, Price, Savant, Skanska, Smith, Seckman, Reid, Inc., Standard Textile, Synapse, Traxon, Trufig, and Tyco.

The prototype is the kind of thing over which techies salivate. So it’s no surprise that Wired Magazine also chimed in with a piece about it entitled “What Would the Ideal Hospital Look Like in 2020?”. In their story, Wired called it “the nicest hospital you will never visit” with design touches that “make it feel like an iPhone” and references “the sterile palette of hospitals from the 1950s and 60s.” which “also brings gamification to the hospital.” The comments left by readers in response to these claims are well worth the read.

The NXT Prototype pushes the thinking on managing the spread of hospital acquired infections and endeavors to incorporate a wide range of emerging technology into patient care – all good things. It emphasizes overcoming challenges faced by patients and caregivers, such as “patient and staff safety, engagement and empowerment in care process, quality of care, and efficiencies in work processes.” These are all valid issues that need to be considered and improved in the patient room.

Unfortunately the prototype appears to be heavily influenced by its industry partners in what should be a more rigorous academic study. Instead of casting itself in the role of a patient-centered futurist, it could more appropriately call itself “what 30 highly interested members of the supply chain would do if they could bypass the architects (and patients) when hospitals are built.”

Another issue is not with the NXT Prototype itself, but the journalistic slant that sustains the simplistic concept that high-tech and high-sterility equate to better care. In the USA, hospitals compete with one another to attract patients. By extension, promote-ability is also an important factor in room design. If Hospital A can brag about offering something Hospital B does not, then hopefully Hospital A will have more patients clamoring to occupy their beds. The problem is that the important metrics of actual patient care and outcomes are replaced with the potency of trends in technology and futuristic aesthetics. This, of course, is nothing new. Seductive images of the future are keys to promoting consumer spending, but it comes at the cost of being patient-centered. Furthermore, this is an expensive room, so it also comes at the cost of patient access, especially in the USA.

When a patient room design is authentically focused on the patient experience it is known as patient-centered design. The NXT prototype promotes things that may end up contributing to an improved patient care outcome, but in themselves have failed to put the experience of a truly ill or dying patient at the center.

There has been a lot of progress in the design of the patient-centered room of the future [1, 2, 3, 4, 5, 6] and it is often reflected in both the popular media and in media created and consumed by the relatively small international circuit of Healthcare architects.

Getting the design “right” on a patient room is important because it is a room typology that is repeated many times in a single hospital project. We admit that in our patient room designs, we don’t achieve all of our objectives. Many factors – including cost, constructability, consensus building, conflicts between staff and patient ideals and others – often conspire to water down an “ideal” patient room design. It should be noted we work primarily in Canada where we are blessed to not be burdened by the corporate objectives of hospital competition. The NXT prototype will be enjoyed here as a frame of reference, but it will be understood as a fantasy. Only the aspects that offer true value will be cautiously embraced. The staff control centre and the accessible bathroom are two examples that would be of value. The size at 400 sq ft and the halo are probably no-gos.

A compounding factor in any healthcare visioning exercise is the lag between the design of the room and actual occupancy (often 3 to 5 years). To design a patient room is, by rights, to design obsolescence. In other words we can dream of integrating all kinds of technology today but in 2020, technology and medicine will be very different. In his book “The Creative Destruction of Medicine” Dr. Eric Topol demonstrates how this will be a monumental issue in the not-so-distant future because we are upon a super-convergence where today’s practice of medicine will soon be dramatically transformed to “new, individualized medicine that is enabled by digitizing humans.” The patient room has as much chance of being eliminated altogether as having a likeness to the NXT prototype.

The NXT Patient Room 2020 Prototype’s aesthetic suggests (and the Wired article infers) that healing is best done in an environment akin to being trapped inside an iPhone. But human comfort comes from what we know: the familiar. The sterile look of the 50’s hospital fused with the latest spoon feeding from Apple is probably a pretty exciting experience better suited to a futuristic theme park ride or possibly the cabin of the latest long-haul commercial airliner (sidenote: A recent project by priestmangoode offers up some exciting potential by fusing aircraft cabin design with hospital recovery spaces). The NXT room is an environment alien to anything a patient would experience in their day-to-day life. Thus, not only is the patient forced to confront the complicated and deeply unsettling realities of their own illness or procedure, they must also overcome the overwhelming sensation that nothing around them is normal. It is hard to imagine a less healing environment.

The aesthetic of the NXT Patient Room 2020 Prototype is not just designed to be futuristic, but like hospitals of the 50’s, it is inspired by sterility itself. Designing healthcare environments to minimize or prevent the spread of infection is a given and a reflection of the function of the facility. In and of itself, however, this is not patient-centered design. What a sterility aesthetic really suggests is that the patient is an infection waiting to happen. Designing a sterile environment is not difficult. Designing a patient environment that supports and promotes the individual’s physical, emotional and psychological healing, while being efficient, cost-effective and minimizing the incidence of hospital-acquired infections should be the framework for patient-centered design.

The presence of family is another sadly lacking contributor to patient comfort, care and recovery, and safety. A patient-centered room makes family welcome and comfortable. Designers must work hard to provide this in spite of the limited square footage available. The NXT Patient Room 2020 prototype, the WSJ and Wired have missed this important feature.

Being patient-centered also means enabling the efficiency of the front-line staff that care for patients. Hiding “medical” services behind indistinguishable/blank/sound & light reflective solid-surface panels means extra steps for staff who would rather be providing care than converting a room. If we are to dream – after all that’s what prototypes are about – then we need to embrace a holistic approach that conceals the intimidating gear while also improving efficiency and productivity,

With the increasing body of evidence [1, 2] pointing to the health benefits of biophilic design, the absence of natural products, daylight, views, nature, or any kind of softness in this prototype seems like a huge oversight. The only thing missing from the NXT room is an automatically triggered laser beam to kill fresh flowers brought by unwelcome visitors.

It is crucial that research continues to push current thinking about what it means for spaces to be truly patient-centered. There is plenty to learn from the NXT prototype and much of it is very good. Hopefully the next NXT prototype room (for 2030) will incorporate a human side and not just let the industrialists and techies be the ones to imagine the future. Maybe they will let patients participate, as in the example of the Saskatoon Regional Health Board in this video, where an authentic community engagement was undertaken in the design of a pediatrics hospital. Perhaps it will embrace all the good things technology has to offer while also embracing the human stuff like interaction, our place in the natural world and more elements of psychological comfort.

As it stands right now, we might choose the hospital of future 1950 over the Hospital of the Future 2020 – at least it had a pool!

We were happy to have strong partners in our consultant team, client and project manager — all of whom put in the effort to ensure that points were counted and accounted for and followed through from concept to design to construction and after.

Congratulations to all involved with Ivey’s Terrace Nursing Home, in Trenton, and Shiretown Nursing Home, in Pictou.

Client: MacLeod Group Health Services Ltd.
Project Manager: Lampier & Associates Health Facilities Consultants Ltd.
Sustainability Consultant: Solterre Design

This is really profound and important work.

The dialysis component complements our significant portfolio of dialysis work. This is another special environment where so much can be done in the design of the spaces to impact the experience of those people who sit in dialysis chairs for hours on end, sometimes every day, in a positive way, making their experiences as comfortable and un-hospital like as possible.

Annapolis Valley Health is one of nine health districts in Nova Scotia providing programs and services to nearly 82,000 Nova Scotians in Annapolis and Kings Counties.

Planning Solutions by Design: Reuniting Healthcare Programming and Design

Hospital planning and programming can take years, often involving a number of incremental and much politicized steps. Common pitfalls may include an underestimation of the architectural impacts the programming and planning have on the project. This often includes the building site and without architectural visualization of concepts, awareness of the inputs users are making to the program may occur too late causing delays and inappropriate compromise. For a new 200 bed expansion, Capital Health (Halifax) and the Nova Scotia department of Health and Wellness recognized the pitfalls of this traditional “program first, then plan, then design” sequence and decided to combine them into a single 7 month fast-tracked, combined and simultaneous Programming/Planning/Schematic Design process. The result was a highly iterative and interactive approach that forced to the front of the room all major internal and external conflicts that the project needed to address.

For information on the International Union of Architects’ Public Health Group (UIA/PHG), click here.

For complete UIA/PHG Forum information, click here.

For more about the series of awards established by Nova Scotia’s Lieutenant Governors to recognize outstanding achievements of Nova Scotians, click here.

For more about the awards, as administered by the Provincial Association, click here.

For more about Brigadoon:
Brigadoon Website
Brigadoon on Facebook
Brigadoon on Twitter

Pilot projects are a great way to invite experimental change without having to commit entirely to the change until it has been properly evaluated. Change is happening at a staggering rate in Mental Health. Changing the way teams work together to adapt to these changes and improve patient centred care is the main goal of these experimental projects.

For more about the Quality Summit and the other award-winning projects, click here.

On June 24, 2013, all breast imaging moved to a new location at the IWK Health Centre in renovated space designed by Nycum.

We are delighted to be a part of the shared vision, giving patients the best care in one place – ensuring timely, integrated and coordinated breast health services and providing a patient-centered approach to care

See more information at:
The QEII Foundation
The IWK Foundation
Bust A Move Fundraiser

• Camp for children and youth who are blind or visually impaired
• Camp for children and youth receiving Atlantic Provinces Special Education Authority services
• BraveHeart Camp (Cardiology)
• Celiac Camp (A Canadian first!)
• Camp Treasure Chest (Asthma)
• Open Family Camp: for families with a child with a chronic illness, condition or special need.
• Camp Natawe’ige (Learning Disabilities)
• Kidney Camp
• Arthritis Camp
• Camp Goodtime (Cancer)
• Camp Guts and Glory (Crohn’s and Ulcerative Colitis)
• Down Syndrome Family Camp
• Brainchild Family Camp (Brain Tumours)
• Heart Talk (Cardiology)
• About Face (Teens with facial differences)
• Autism Family Camp

Brigadoon open for business
Brigadoon Website
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