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November 16, 2006

Boomers shaping future of health care design

  • Coming construction boom will bring improvements for older patients and staff
  • By BARBARA BRECKENFELD
    Blue Horse Marketing

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    Breckenfeld

    Our health care system is grappling with the shape of hospitals and health care in the 21st century. One of the biggest questions is how to prepare for the baby boomers reaching 65.

    The future appears to hold a delicate balance between contrasting influences:

    • Medicare reimbursements decline as revenues from out-of-pocket services grow.

    • Facilities expand and upgrade to attract aging baby boomers while health insurers and retirement communities help people stay healthy.

    • Nursing stations and patient lifts gain ergonomic features to retain an aging workforce while telemedicine and robotic technology help compensate for physician shortages.

    Through numbers and attitude, the baby boom generation has already reshaped what it means to grow older. Boomers are investing in sports medicine and joint replacements to support continued activity, opting for plastic surgery so they can look good, and seeking to not just survive cancer and chronic diseases, but to cure them.

    Image courtesy of Clark/Kjos Architects
    A 92,000-square-foot retail box in Woodburn, Ore., underwent a $9 million renovation to become a health and wellness center. The center combines spa and fitness uses with rehabilitation, urgent care and complementary medicine.

    Determined to live longer, healthier and more active lives, this group expects to live into their 80s and beyond.

    Seeking disposable income

    The health care industry is justifiably concerned about the coming surge of Medicare users while reimbursements continue to drop.

    David Olson, vice president of business development at Harrison Medical Center in Bremerton notes, “In the state as a whole, Medicare payments are not a great source of profit for health care providers. They tend to lose money on patients treated under the Medicare system.”

    Health care is banking on those with disposable income to continue purchasing the health services they desire with specialized facilities and services paid out of pocket to improve profitability. At many facilities, patients can now pay to see a movie or select their meals.

    Designing for the future

    According to the Center for Health Design in Concord, Calif., the U.S. health care system is expecting a hospital construction boom worth $200 billion over the next 10 years. Most hospitals in the Northwest were built in the 1940s and 1950s, and like their human contemporaries, the facilities are showing their age.

    With the existing gap between the need and the supply of doctors and nurses, an aging work force promises growing shortages from retirement and attention to issues of older staff.

    A nurse’s average age is 47. With shorter hospitalization, only the sickest patients are hospitalized, and more of these patients are obese. Moving and helping patients to the bathroom is beyond many nurses’ ability. It is becoming common for rooms to be outfitted with patient lifts.

    The rigors of working in a hospital discourage many people from staying.

    Adam Kerner of Anshen+Allen observes that a typical nurse spends 80 percent of her workday gathering supplies, walking 12-16 miles per day looking for things that could be provided at the bedside: medical charts, supplies and medications. Replacing centralized nursing stations with bedside stations and other ergonomic improvements helps retain staff.

    Medical students today tend toward specialties such as plastic surgery, orthopedics and cardiology because they are in great demand, rather than areas of greatest need such as general surgery, primary care and gerontology.

    Richard Dallam of NBBJ sees collaborative team medicine as one way health care will cope with shortages. Physician-led teams will include multiple disciplines to solve problems — integrating behavioral health and pharmacology, for example.

    Healing and health care rely upon the human touch, human contact and caring. Yet, some facilities are planning for telemedicine and communications technology to compensate for a lack of doctors.

    With patients and doctors in different locations, exams may be conducted with robotics, though space needs of the equipment will impact facilities.

    Customer-oriented care

    With increased competition for patients, the health care industry has become more customer oriented.

    Health care delivered with a hospitality-style environment and services can attract patients and boost revenues. Research conducted by the Center for Health Design has demonstrated that the quality of environment makes a difference to healing outcomes.

    Daylight, views of nature, artwork and splashing water add pleasant ambience while also lowering stress. Reduced stress enhances the body’s healing mechanisms and potentially shortens time in the hospital.

    The boom generation tends to focus on experience over outcome. Many medical facilities are moving towards spa environments that cater to patient needs and desires with elegant finishes and services to enhance comfort. Examples include concierge services, Internet access in hospital rooms, meals on demand and pay movies.

    With Internet resources, consumers are now empowered to make informed decisions about their health care. When selecting health care providers, people looking for clues about the quality of care often find it through the built environment. Demonstrated concern for detail in the physical facility helps health care providers attract patients.

    Staying healthy

    As David Frum of Clark/Kjos points out, “Baby boomers believe that if we eat better and exercise better, we will live longer and have better quality of life.”

    Baby boomers’ interest in exercise and fitness fueled demand for sports medicine. Now integrated care centers bring together related services under one roof. Wellness centers such as WellSpring in Woodburn, Ore., combine fitness, spas, rehab, urgent care, nutrition counseling and complementary medicine.

    Lois Jean Broadway of Taylor Gregory Butterfield Architects reports that some health insurers are taking a lesson from auto insurance by offering lower premiums for staying healthy. Using pedometers and exercise logs, they make the consumer responsible for demonstrating healthy habits.

    The oldest baby boomers have just turned 60. Will they flock to retirement communities as their parents did?

    Mike Miller of Rice Fergus Miller Architects expects that as boomers become elderly, senior housing will look better and better. Remaining active as long as possible, they’ll move to senior housing for the services, whether health care or housekeeping.

    Helping people stay healthy is smart business.

    Miller adds, “There is a good body of research showing that for those over 80, even frail, a structured exercise program has a very positive effect on health and well being. Brain activity increases, food intake improves, muscle mass grows — muscle creates a cushion, makes it possible not to fall, increases blood flow which reduces dizziness — and the overall quality of life goes up. Retirement communities who provide health care for their residents see a bottom-line benefit to keeping their elderly healthy.”

    Many continuing-care retirement communities include prominent wellness centers. Some include exercise therapy pools, hot tubs, rooms for cardio machines, weight rooms, treatment rooms for massage, acupuncture and touch therapies, and a small health clinic.

    When residents see a friend exercise, they figure, “If he can, I can too,” and it becomes a social gathering place in support of health.


    Barbara Breckenfeld, of Blue Horse Marketing, writes regularly about health care and sustainable design — one way she helps businesses tell their stories.



     


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