What long-term health care facilities are like is something many of us care about. After all, our parents – or we ourselves – could wind up in one of them at some point. Plus, we all pay for them through our health insurance and taxes; we’d like to know we’re getting the best bang for our bucks.
That’s why I was intrigued by a recent New York Times article by Allison Arieff about the newly renovated Laguna Honda, a city-run health care facility in San Francisco. Laguna Honda is intended for those needing long-term rehabilitation or nursing home care who are unable to afford other alternatives. According to Arieff,
…the new Laguna Honda suggests an inspired way of thinking about not only institutionalized care but of what a truly effective health care facility might look, feel and act like.
Arieff focuses on a key architectural feature of the renovated facility: abundant natural light. That figures, as she generally writes about design and architecture. Besides, I’d certainly go along with the view that natural light enhances our sense of well-being.
But I was also intrigued by what a senior architect on the project had to say about the ultimate goal of the renovation:
“From day one, we did not want Laguna Honda to be about 1,200 beds but about 1,200 places,” says Sharon Woodworth, senior architect with Anshen/Stantec, who helped lead the charge to scale the number back to a more humane 780. “The intent was always to create a ‘home,’ not an institution. Even if the project had been 120 or just 60 beds we still would have sought to create a sense of place beyond the bed the individual slept in — a place that felt like home — in a community setting. The community setting is a key difference.”
The facility is designed to create those communities, in which residents are brought together:
Laguna Honda’s bedrooms, for example, are organized into “households” for 15 residents who all have their own room, and each of these households has its own dining and living room with residential-style bathrooms shared by one, two or three residents in private bedroom suites or semi-private, dorm-style bedrooms. Four households on each floor create a neighborhood of 60 residents. In the end, it’s less institution, and more of a mixed-use, walkable community within a building.
One of the things I find interesting here is that this new approach echoes that of another innovative project that was introduced 20 years ago on the other side of the country.
Back in 1990 New York City’s Times Square was faced with the intractable problem of homelessness: many people either couldn’t afford to find living space, or they had other problems (mental illness, AIDS or other diseases, or drug addiction) that prevented them from living in normal housing. At the same time, Times Square was plagued by the blight of decaying buildings.
At the time most people had no good solutions to these problems. But a visionary named Rosanne Haggerty saw an opportunity and created Common Ground, an organization that would take an holistic approach to the problem of homelessness by integrating individuals into community settings.
The group’s first effort was to rehabilitate the rundown Times Square – a former grand hotel that had become a decrepit rooming house – and turn it into decent housing for the homeless. But the Times Square wasn’t just a restoration of an historic building. It was designed to create a workable and supportive community for its residents as well. As Common Ground notes:
Individualized support services are designed to help tenants maintain their housing, address health issues, and pursue education and employment. On-site assistance with physical and mental health issues and substance abuse is available to all tenants, six days a week.
Like all of the organization’s projects that followed it, the Times Square embodied three components described on Common Ground’s website:
- Affordable Housing. We build and operate a range of housing options for homeless and low-income individuals – housing that is attractive, affordable, well managed, and linked to the services and support people need to rebuild their lives.
- Outreach. We identify and house the most vulnerable: those who have been homeless the longest, have the most disabling conditions, and are least likely to access housing resources. These individuals typically spend years cycling between emergency shelters, hospitals, and jails.
- Prevention. We strengthen communities and prevent homelessness by addressing the multiple factors that cause individuals and families to become homeless.
This innovative approach of combining building restorations with the creation of supportive communities for those in need has been very successful. As Common Ground notes:
Our ground-breaking Street to Home program reduced street homelessness by 87% in the 20-block Times Square neighborhood, and by 43% in the surrounding 230 blocks of West Midtown. Spearheading a citywide strategy, Common Ground is now responsible for securing homes for people living on the streets in all of Brooklyn, Queens, and midtown Manhattan.
But beyond successfully helping the homeless, Common Ground’s approach offers major savings in tax dollars:
Our housing costs approximately $36 per night to operate – significantly less than public expenditures: $54 for a city shelter bed, $74 for a state prison cell, $164 for a city jail cell, $467 for a psychiatric bed, $1,185 for a hospital bed.
Laguna Honda has just opened and patients and staff are in the process of moving in, so it’s too soon to say what its long-term effectiveness will be. But maybe, as Common Ground’s experience has shown, this new approach will demonstrate how we can provide both positive experiences for those in need as well as a savings in health care dollars.
As Arieff suggested – based on her own recent experience with a less than satisfactory health care facility:
For those who must either spend an extended period of time recovering from truly serious injury or set up permanent residence in a place like Laguna Honda, Anshen/Stantec’s new way of thinking about a hospital’s staff and its patients and their families is a shining example not only of what is possible but what should be required.