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The expression, "long term care" rarely invokes
thoughts of a non-institutional healthcare facility, such as
one's own home, but toss in phrases such as, "Aging in Place" or
"Universal Design" and most people in the world of building and
health science know what you are referring to. I have always
seen these descriptors as lacking in substance because the
implied ergonomics of such spaces is predominately product- or
geometrically-based (i.e., devices or aids for daily living and
accessibility). They virtually ignore the
indoor environmental ergonomics of light, sound, thermal
comfort and indoor air quality (IAQ).
I am not aware, for
example, of any single or multi-family residential builder along with their HVAC
contractor who designs homes to accommodate the scope of
CSA
Z317.2 Special Requirements for Heating, Ventilation, and Air
Conditioning (HVAC) Systems in Health Care Facilities or
ANSI/ASHRAE Standard 170 Ventilation of Health Care Facilities.
Yet some elements from these institutional standards, and all of
the elements of
ANSI/ASHRAE Standard 55 Thermal Environmental Conditions for
Human Occupancy, have a place in homes that for some, will
become non-institutional, end of life satellite facilities to
the institutional healthcare system. For this reason I am more
supportive of the terms "inclusive housing" or "lifetime
housing." These terms recognize that
indoor environmental systems are in fact on an evolving
continuum serving the physiological needs of the young and
elderly in the same way ergonomics addresses
products and space geometries to accommodate changes in physical
abilities.
Consider the physical and physiological changes
due to aging on: mobility, agility and personal and
environmental hygiene. Consider that respiration, thermal, sound
and lighting discomfort drive autonomic responses and human
adaptive behaviour. For the able bodied,
the active and adaptive strategies pushed by engineering and
architectural associations for energy conservation; such as of opening a window, putting
on a sweater,
adjusting a thermostat or closing the blinds is easily
accomplished. However, in the case of seniors or those with disabilities,
these seemingly simple tasks can be hampered by reduced agility
and mobility, reduced visual acuity, loss of manual dexterity
and impaired cognitive abilities.
Compensating for general and local discomforts
such as drafts,
cold floors, excessive temperature stratifications and
radiant asymmetry can become very difficult for the elderly. This is compounded
for those with circulatory ailments or diseases affecting
thermal regulation. Also, consider the effects to the
respiratory and olfactory systems from the use and inadequate
disposal of incontinence products, or failures to respond to
building-related moisture problems resulting in environments
supportive of
mould, bacteria and other microbes.
Those seniors who live indoors with pets and/or smokers,
and subsequently become “immune” or desensitized” to the odours,
illustrate an unfortunate aspect of the olfactory system and
hygiene. They are not immune to the physiological effects of
microbial associated with animal urine and feces, or toxins from
tobacco products. Add in the fact that air-based heating and
cooling systems require recirculation of contaminated air,
regardless of the means of ventilation.
What develops is a complex combination of indoor
environmental quality aspects that are very difficult for
live-in or visiting caregivers and can create both physiological
and psychological stress for all involved. This is particularly
true in the presence of better living options, such as modern
institutional healthcare facilities.
The worse case scenario is the senior with
physical and mental disabilities and impaired hygiene who
refuses to leave his/her dilapidated home regardless of the
conditions. At the other end are the able bodied, active seniors
who have no problem taking care of themselves and their property
and are quite satisfied with their indoor environments.
To give some perspective around the demographics,
this quote relating to the Alberta population states: "Most
seniors live in private housing. In 2006, approximately 71 per
cent of the seniors' population lived in homes that they owned.
An estimated 19 per cent resided in rental accommodation and
about seven per cent lived in provincial housing settings,
including seniors' lodges. Approximately three per cent of
seniors lived in long-term care facilities.i
Regardless of the quantitative distribution of
quality of living standards, the message is that most seniors
avoid the institutional offering but the need for the
environmental offering of the modern institution is present
regardless.
In addition to the need for healthcare standards
in conditioning of air, lighting, sound and thermal comfort
systems, there may be need for specialized healthcare devices
and instruments for those who stay home right to the end. Many
of these aids, such as dialysis and oxygen machines, lifts and
elevators, need an uninterrupted power supply of sufficient load
capacity. Some equipment is sensitive to electromagnetic
interference or to indoor environmental conditions such as
temperature and
humidity and other devices are sensitive to light.ii
Devices needing air filtration are sensitive to particles, such
as pet hair, lint and dust.iii Many of these devices
are wheel mounted, as such the choice in floor coverings is also
an important consideration. Lifetime housing requires the
original designers to think about future power needs, HVAC
systems,
interior design, as well as the more traditional "Aging in
Place" or "Universal Design" principles.
As noted by specialists in the field, "The goals
of human factors are to optimize human and system efficiency and
effectiveness, safety, health, comfort, and quality of life.iii
In consideration of these factors and the home as
an "end of life satellite facility" to the institutional
healthcare system, I default to the virtually invisible and
integrated HVAC strategies of;
1.
Radiant cooled and
heated
slab on grade floors for safety, hygiene,
comfort and efficiency.
2.
Dedicated outdoor air systems with high performance air
filtration on the intake for indoor air quality, efficiency and
effectiveness.
3. Heat recovery on the exhaust for efficiency.
4. Dedicated dehumidification and
steam humidification for indoor air quality and comfort.
5. Backup power supply of sufficient capacity for
life safety and HVAC systems,
6. Extra circuit outlets in one or more "care"
rooms to accommodate future equipment.
For many it will be difficult if not impossible
to predict end of life states of physical, physiological and
psychological heath. Likewise, it will be difficult, if not
impossible, to predict the required and necessary state of the
power systems, interior design and indoor environmental systems
necessary to serve the occupants in an end of life
non-institutional facility. However, with certainty one can
observe, follow or lead the changes necessary to integrate
"lifetime housing" principles today to serve one or more
generations over the evolving continuum of indoor environmental
quality.
REFERENCES
i) Seniors' Programs ENetwork, (Alberta), No. 84,
September 2, 2011
ii) The Role of Human Factors in Home Health
Care: Workshop Summary, National Research Council, National
Academy of Sciences, 2010
iii) Health Care Comes Home: The Human Factors,
Committee on the Role of Human Factors in Home Health Care,
Board on Human- Systems Integration, Division of Behavioral and
Social Sciences and Education, National Academy of Sciences,
2011
Bibliography:
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The Center for Inclusive Design and
Environmental Access. http://www.ap.buffalo.edu/idea/
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Accreditation Standards, Infection Prevention
& Control, Heating, Ventilation and Air-Conditioning System
(HVAC), College of Physicians and Surgeons of British
Columbia, March 2013,
https://www.cpsbc.ca/files/u6/NHMSFP-AS-HVAC-Class-2.pdf
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Contractors HVAC (Mechanical) Permit Plans &
Documents Requirements Checklist, City of Calgary,
Development and Building Approvals,
https://www.calgary.ca/PDA/DBA/Documents/building/contractors-hvac-mechanical-permit-checklist-PL1224.pdf?noredirect=1
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Ventilation Systems and Prevention of
Respiratory Illness: Requirements for Heating, Ventilation
and Air Conditioning in Health Care Facilities, Dr. Leon
Genesove, Provincial Physician, Ontario Ministry of Labour,
November 9, 2005
www.osach.ca/products/teleconf/legionnaires.ppt
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National Academy of Sciences - Health Care
Comes Home: The Human Factors.
http://www.nap.edu/catalog.php?record_id=13149
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The Canadian Building and Health Sciences
Network (CBHSN)
http://cbhsn-rcesbs.proteus.cisti.nrc.ca/eng/relevant.html.
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Chan, S.L., Wei, Z., Chigurupathi, S., Tu, W.,
Compromised respiratory adaptation and thermoregulation in aging
and age-related disease, Ageing research reviews, 2009.
http://www.ncbi.nlm.nih.gov/pubmed/19800420
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Taylor, N. A.S.., Machado-Moreira, C., van den
Heuvel, A., Caldwell, J., Taylor, E. A.. & Tipton, M. J. The
roles of hands and feet in temperature regulation in hot and
cold environments. Thirteenth International Conference on
Environmental Ergonomics; Boston, USA: University of Wollongong;
2009. 405-409. http://ro.uow.edu.au/hbspapers/190
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