**CHAPTER 106: VETERANS HEALTH ADMINISTRATION -- COMMUNITY LIVING**

**CENTER (CLC) (formerly Nursing Home Care Unit)**

1\. Purpose and Scope 106‑2

2\. Definitions 106‑2

3\. Operating Rational and Basis of Criteria 106‑4

4\. Program Data Required (Input Data Questions) 106‑5

5\. Space Criteria 106‑6

6\. Planning and Design Considerations 106‑11

7\. Functional Relationships 106‑13

8\. Functional Diagram 1 106‑15

9\. Functional Diagram 2 106‑16

1.  **PURPOSE AND SCOPE**

## This document outlines Space Planning Criteria for Chapter 106: Nursing Home Residential Care Facilities (formerly Nursing Home Care Units) in VA healthcare facilities. These criteria apply to all renovation, modernization and new construction projects. {#this-document-outlines-space-planning-criteria-for-chapter-106-nursing-home-residential-care-facilities-formerly-nursing-home-care-units-in-va-healthcare-facilities.-these-criteria-apply-to-all-renovation-modernization-and-new-construction-projects. .Style-1}

## Nursing Home / Residential Care Facilities provide specialized preventative, therapeutic, and rehabilitative care for residents with long term illnesses in a home-like environment. Facilities can also provide care for short stay services such as skilled nursing and rehabilitation. Clinical and diagnostic services are provided at the VA Medical Center.  {#nursing-home-residential-care-facilities-provide-specialized-preventative-therapeutic-and-rehabilitative-care-for-residents-with-long-term-illnesses-in-a-home-like-environment.-facilities-can-also-provide-care-for-short-stay-services-such-as-skilled-nursing-and-rehabilitation.-clinical-and-diagnostic-services-are-provided-at-the-va-medical-center. .Style-1}

2.  **DEFINITIONS**

    A.  [Alzheimer's]{.underline}: Dementia of the Alzheimer's type is
        the most common form of dementia (accounting for at least 50
        percent of cases) and is characterized by a gradual onset of
        symptoms, with progressive intellectual deterioration and
        decline in ability for self-care over a period of several years.

    B.  [Activities of Daily Living (ADL)]{.underline}: Basic activities
        individuals nee to perform to live independently and include
        bathing, physical ambulation, grooming, dressing, feeding, and
        toileting.

## [Admissions]{.underline}: A unit of measurement of productivity; the number of new residents that enter a facility during a specific period.  {#admissions-a-unit-of-measurement-of-productivity-the-number-of-new-residents-that-enter-a-facility-during-a-specific-period. .Style-1}

## [Average Daily Census]{.underline}: A unit of measurement of productivity; the average number of residents receiving inpatient care each day during a specific period. {#average-daily-census-a-unit-of-measurement-of-productivity-the-average-number-of-residents-receiving-inpatient-care-each-day-during-a-specific-period. .Style-1}

## [Dementia]{.underline}: Dementia is a symptom complex characterized by intellectual deterioration (including disturbances in memory as well as impulse control, language, spatial abilities, judgment, etc.) severe enough to interfere with social of occupational functioning. {#dementia-dementia-is-a-symptom-complex-characterized-by-intellectual-deterioration-including-disturbances-in-memory-as-well-as-impulse-control-language-spatial-abilities-judgment-etc.-severe-enough-to-interfere-with-social-of-occupational-functioning. .Style-1}

## [Departmental Net to Gross (DNTG) Conversion Factor]{.underline}: A parameter, determined by the VA for each space planning criteria chapter, used to convert the programmed Net Square Foot (NSF) area to the Department Gross Square Foot (DGSF) area. The DNTG Departmental Conversion Factor for Nursing Home / Residential Care Facilities is 1.55. {#departmental-net-to-gross-dntg-conversion-factor-a-parameter-determined-by-the-va-for-each-space-planning-criteria-chapter-used-to-convert-the-programmed-net-square-foot-nsf-area-to-the-department-gross-square-foot-dgsf-area.-the-dntg-departmental-conversion-factor-for-nursing-home-residential-care-facilities-is-1.55. .Style-1}

## [Full-Time Equivalent (FTE)]{.underline}: A work force equivalent to one individual working full time for a specific period, which may be made up of several part-time individuals or one full-time individual. This will include everyone working in the facility; VA and contractor personnel, {#full-time-equivalent-fte-a-work-force-equivalent-to-one-individual-working-full-time-for-a-specific-period-which-may-be-made-up-of-several-part-time-individuals-or-one-full-time-individual.-this-will-include-everyone-working-in-the-facility-va-and-contractor-personnel .Style-1}

## [General Resident]{.underline}: A resident that does not have special care and/or socialization needs. {#general-resident-a-resident-that-does-not-have-special-care-andor-socialization-needs. .Style-1}

## [House]{.underline}: A replacement term for \"unit,\" comprised of a number of rooms and support spaces, emphasizing the residential, homelike environment required for VA long term care. See also Residential House. {#house-a-replacement-term-for-unit-comprised-of-a-number-of-rooms-and-support-spaces-emphasizing-the-residential-homelike-environment-required-for-va-long-term-care.-see-also-residential-house. .Style-1}

## [House Care / Work Station]{.underline}: An unobtrusive work area that provides staff with the ability to visually supervise all common areas of the house. {#house-care-work-station-an-unobtrusive-work-area-that-provides-staff-with-the-ability-to-visually-supervise-all-common-areas-of-the-house. .Style-1}

## [Input Data Statement]{.underline}: A set of questions designed to elicit information about the healthcare project in order to create a Program for Design (PFD) based on the criteria parameters set forth in this document. Input Data Statements could be Mission related, based in the project's Concept of Operations; and Workload or Staffing related, based on projections and data provided by the VHA or the VISN about the estimated model of operation. This information is processed through mathematical and logical operations in SEPS II. {#input-data-statement-a-set-of-questions-designed-to-elicit-information-about-the-healthcare-project-in-order-to-create-a-program-for-design-pfd-based-on-the-criteria-parameters-set-forth-in-this-document.-input-data-statements-could-be-mission-related-based-in-the-projects-concept-of-operations-and-workload-or-staffing-related-based-on-projections-and-data-provided-by-the-vha-or-the-visn-about-the-estimated-model-of-operation.-this-information-is-processed-through-mathematical-and-logical-operations-in-seps-ii. .Style-1}

## [Net-to-department gross factor (NTDG)]{.underline}: A factor that when multiplied by the programmed Net Square Foot (NSF) area, determines the Departmental Gross Square Feet (DGSF). The NTDG for Residential Care Developments is **1.55** {#net-to-department-gross-factor-ntdg-a-factor-that-when-multiplied-by-the-programmed-net-square-foot-nsf-area-determines-the-departmental-gross-square-feet-dgsf.-the-ntdg-for-residential-care-developments-is-1.55 .Style-1}

## [Residential Care Facility / Complex]{.underline}: A specialized nursing facility designed to care for residents with long term illness requiring preventive, therapeutic and rehabilitative nursing care services. Nursing, medical and related health care is provided in a homelike environment with specialized clinical and diagnostic services available at the medical center facilities. {#residential-care-facility-complex-a-specialized-nursing-facility-designed-to-care-for-residents-with-long-term-illness-requiring-preventive-therapeutic-and-rehabilitative-nursing-care-services.-nursing-medical-and-related-health-care-is-provided-in-a-homelike-environment-with-specialized-clinical-and-diagnostic-services-available-at-the-medical-center-facilities. .Style-1}

## [Patient Days]{.underline}: A unit of measurement or productivity; the total number of inpatient days of care provided to residents. {#patient-days-a-unit-of-measurement-or-productivity-the-total-number-of-inpatient-days-of-care-provided-to-residents. .Style-1}

## [Program for Design (PFD)]{.underline}: A space program generated by SEPS II based on criteria set forth in this document and specific information about Concept of Operations, Workload projections and Staffing levels authorized. {#program-for-design-pfd-a-space-program-generated-by-seps-ii-based-on-criteria-set-forth-in-this-document-and-specific-information-about-concept-of-operations-workload-projections-and-staffing-levels-authorized. .Style-1}

## [Provider]{.underline}: An individual, who examines, diagnoses, treats, prescribes medication and manages the care of the patients within his or her scope of practice as established by the governing body of a healthcare organization. {#provider-an-individual-who-examines-diagnoses-treats-prescribes-medication-and-manages-the-care-of-the-patients-within-his-or-her-scope-of-practice-as-established-by-the-governing-body-of-a-healthcare-organization. .Style-1}

## [Residential House]{.underline}: A group of maximum seventeen residents complete with living, dining (possibly kitchen) and support spaces that functions independently for smaller groups of residents. These areas replicate the atmosphere of a large family home and provide the opportunity to co-locate small numbers of residents with similar care needs together to optimize care delivery. An alternate term for "unit". Residential Houses can be suited for General or Specialty Residents. {#residential-house-a-group-of-maximum-seventeen-residents-complete-with-living-dining-possibly-kitchen-and-support-spaces-that-functions-independently-for-smaller-groups-of-residents.-these-areas-replicate-the-atmosphere-of-a-large-family-home-and-provide-the-opportunity-to-co-locate-small-numbers-of-residents-with-similar-care-needs-together-to-optimize-care-delivery.-an-alternate-term-for-unit.-residential-houses-can-be-suited-for-general-or-specialty-residents. .Style-1}

## [Residential Neighborhood]{.underline}: A combination of maximum three Residential Houses combined for staffing and spatial efficiencies to share functions such as activity areas, personal laundry, care stations, and clean and soiled utility rooms. {#residential-neighborhood-a-combination-of-maximum-three-residential-houses-combined-for-staffing-and-spatial-efficiencies-to-share-functions-such-as-activity-areas-personal-laundry-care-stations-and-clean-and-soiled-utility-rooms. .Style-1}

## [Specialty Resident]{.underline}: A resident with care and/or socialization needs such as dementia, complex medical conditions or chronic behaviors. {#specialty-resident-a-resident-with-care-andor-socialization-needs-such-as-dementia-complex-medical-conditions-or-chronic-behaviors. .Style-1}

## [Specialty Residential House]{.underline}: A group of twelve to sixteen residents specifically dedicated to residents with care and/or socialization needs such as dementia, complex medical conditions or chronic behaviors. {#specialty-residential-house-a-group-of-twelve-to-sixteen-residents-specifically-dedicated-to-residents-with-care-andor-socialization-needs-such-as-dementia-complex-medical-conditions-or-chronic-behaviors. .Style-1}

## [Staff]{.underline}: Refers to all facility nursing, care-aids, therapy, administration or support staff. {#staff-refers-to-all-facility-nursing-care-aids-therapy-administration-or-support-staff. .Style-1}

## [VA-SEPS]{.underline}: Acronym for Space and Equipment Planning System, a digital tool developed by the Department of Defense (DoD) and the Department of Veterans Affairs to generate a Program for Design (PFD) and an Equipment List for a VA healthcare project based on specific information entered in response to Input Data Statements. SEPS II, the current version, incorporates the propositions set forth in all VA space planning criteria chapters. SEPS II has been designed to aid healthcare planners in creating a space plan based on a standardized set of criteria parameters. {#va-seps-acronym-for-space-and-equipment-planning-system-a-digital-tool-developed-by-the-department-of-defense-dod-and-the-department-of-veterans-affairs-to-generate-a-program-for-design-pfd-and-an-equipment-list-for-a-va-healthcare-project-based-on-specific-information-entered-in-response-to-input-data-statements.-seps-ii-the-current-version-incorporates-the-propositions-set-forth-in-all-va-space-planning-criteria-chapters.-seps-ii-has-been-designed-to-aid-healthcare-planners-in-creating-a-space-plan-based-on-a-standardized-set-of-criteria-parameters. .Style-1}

3.  **OPERATING RATIONALE AND BASIS OF CRITERIA**

    A.  Workload Projections or planned services / modalities for a
        specific VA medical center, hospital or satellite outpatient
        clinic project are provided by the VA Central Office (VACO) /
        VISN CARES Capacity Projection Model and VACO Nursing Home /
        Residential Care Program input. The workload projections are
        generated by methodology based upon the expected veteran
        population in the respective market / service area. Healthcare
        planners working on VA medical center, hospital or satellite
        outpatient clinic projects will utilize and apply the workload
        based criteria set forth herein for identified services and
        modalities to determine room requirements for each facility.

    B.  Space planning criteria have been developed on the basis of an
        understanding of the activities involved in the functional areas
        of Nursing Home / Residential Care Facilities and its
        relationship with other services of a medical facility. These
        criteria are predicated on established and/or anticipated best
        practice standards, as adapted to provide environments
        supporting the highest quality heath care for Veterans.

    C.  These criteria are subject to modification relative to
        development in the equipment, medical practice, vendor
        requirements, and subsequent planning and design. The selection
        of the size and type of Nursing Home / Residential Care
        equipment is determined by VACO and upon Veterans Health
        Administration (VHA) anticipated medical needs.

    D.  The number of Residents is determined by the VACO Nursing Home /
        Residential Care Program Office based on CARES modeling of
        Nursing Home / Residential Care projected needs. Following are
        general guidelines for understanding a basis for these
        projections.

    E.  General Resident Number Determination Factors. The number of
        general residents is based on the following:

        a.  Multiply projected general resident admissions by projected
            average length of stay to obtain projected Resident days.

        b.  Divide projected Resident days by 365 to obtain average
            daily census.

        c.  Divide average daily census by target utilization or
            occupancy rate of 95% to calculate total resident beds
            needed.

        d.  100% of General Resident beds shall be in single-bed rooms.

    F.  Specialty Resident Beds. The need for Specialty Resident beds is
        based upon the following:

        a.  Multiply projected Specialty Resident admissions by
            projected average length of stay to obtain projected
            Resident days.

        b.  Divide projected Specialty Resident days by 365 to obtain
            average daily census.

        c.  Divide average daily census by target utilization or
            occupancy rate of 95% to calculate Specialty Resident
            numbers needed.

        d.  100% of Specialty Residents shall be in single-bed rooms.

    G.  House / Neighborhood Size Determination

        a.  The size of each house is expressed as the number of
            resident beds and is influenced by staff to Resident ratios.

        b.  Staffing models shall be developed on an individual project
            basis with VACO Nursing Home / Residential Care Program
            Officials, and integrated with the configuration of the
            facility.

4.  **PROGRAM DATA REQUIRED (Input Data Statements):**

    A.  [Mission:]{.underline}

        1.  Is the Kitchen / Servery in the General Residential House
            authorized to serve the Residential Neighborhood (three
            houses maximum)? (M)

        2.  Is the Kitchen / Servery in the Specialty Residential House
            authorized to serve the Residential Neighborhood (three
            houses maximum)? (M)

        3.  Is the Kitchen / Servery in the Combined Residential House
            authorized to serve the Residential Neighborhood (three
            houses maximum)? (M)

        4.  Is a Combined Residential House authorized? (M)

        5.  Is a Medication Room for each Residential Neighborhood
            authorized? (M)

        6.  Is a Pharmacy for the Therapeutic Areas authorized? (M)

        7.  Is a Chapel / Meditation Room for the Resident Support Area
            authorized? (M)

        8.  Is a Barber / Beauty Salon for the Resident Support Area
            authorized? (M)

        9.  Is a Laundry service for the Resident Support Area
            authorized? (M)

        10. Is a Maintenance / Engineering Shop for the Resident Support
            Area authorized? (M)

        11. Is a Security Office for the Resident Support Area
            authorized? (M)

    B.  [Workload:]{.underline}

        1.  How many general beds are projected? (W)

        2.  How many specialty beds are projected? (W)

    C.  [Staffing:]{.underline}

        1.  How many Activities Coordinator FTE positions are
            authorized? (S)

        2.  How many Nurse Supervisor FTE positions are authorized? (S)

        3.  How many Therapist FTE positions are authorized? (S)

        4.  How many Administrative FTE positions are authorized? (S)

        5.  How many Physician FTE positions are authorized? (S)

        6.  How many Clerical FTE positions are authorized? (S)

    D.  [Miscellaneous:]{.underline}

        1.  How many FTEs will work on peak shift? (Misc)

        2.  How many FTE positions are not authorized to have office or
            cubicle space? (Misc)

5.  **SPACE CRITERIA**

    A.  [Residential House and Neighborhood]{.underline}

        1.  **Residential House, General**

> *Provide one for a minimum of nine and a maximum of seventeen
> projected General Residents.*

2.  **Residential House, Specialty**

> *Provide one for a minimum of seven and a maximum of thirteen
> projected Specialty Residents.*

3.  **Residential House, Combined**

> *Provide one for a minimum of nine and a maximum of seventeen
> projected General and Specialty Residents.*

4.  **Residential Neighborhood**

> *Provide one for a maximum of three General, Specialty or Combined
> Houses.*

B.  [General Residential House: Resident Areas]{.underline}

    1.  **Bedroom, Resident (BRNP1) 175 NSF (16.3 NSM)**

> *Provide one for each General Resident.*

2.  **Bedroom, Bariatric (BRNP2) 320 NSF (29.7 NSM)**

> *Provide one per General Residential House.*
>
> This room is for residents with bariatric care needs, and other
> conditions which require additional space for mobility and equipment
> clearances.

3.  **Bathroom, Resident (TLTS2) 55 NSF (5.2 NSM)**

> *Provide one per General Resident Bedroom.*

4.  **Bathroom, Bariatric (TLTS2) 100 NSF (9.3 NSM)**

> *Provide one per General Bariatric Bedroom*

5.  **Vestibule (LOB02) 50 NSF (4.7 NSM)**

> *Provide one per General Residential House.*

6.  **Living Room (DAYR1) 360 NSF (33.4 NSM)**

> *Minimum NSF; provide an additional 20 NSF per general resident
> greater than twelve; provide one per General Residential House.*

7.  **Quiet Room (RAMR1) 120 NSF (11.1 NSM)**

> *Provide one per General Residential House.*

8.  **Dining Room (FSCD1) 360 NSF (33.4 NSM)**

> *Minimum NSF; provide an additional 30 NSF per general resident
> greater than twelve; provide one per Residential House.*
>
> Dining Room areas for two or more Houses should be combined into a
> centralized Neighborhood Dining Room when consistent with program of
> Operations.

9.  **Kitchen and Servery (IPK01) 150 NSF (14.0 NSM)**

> *Minimum NSF; provide an additional 25 NSF per General Residential
> House greater than one if serving a Residential Neighborhood.*
>
> Minimum space required for staging and serving food. Coordinate the
> provision, size and configuration of this space with food preparation
> and delivery system determined in collaboration with Nutrition and
> Food Service for each facility.

10. **Pantry (SRS01) 80 NSF (7.4 NSM)**

> *Minimum NSF; provide an additional 10 NSF per General Residential
> House greater than one if serving a Residential Neighborhood.*
>
> Pantries can be combined and shared by two or three houses.

11. **Toilet, Resident / Visitor (TLTU1) 50 NSF (4.7 NSM)**

> *Provide one per General Residential House.*

12. **Laundry (NURL1) 100 NSF (9.3 NSM)**

> *Provide one per General Residential House.*

Laundries can be combined and shared by two or three houses.

C.  [Specialty Residential House: Resident Areas]{.underline}

    1.  **Bedroom, Resident (BRNP1) 175 NSF (16.3 NSM)**

> *Provide one for each Specialty Resident.*

2.  **Bedroom, Bariatric (BRNP2) 320 NSF (29.7 NSM)**

> *Provide one per Specialty Residential House.*
>
> This room is for residents with bariatric care needs, and other
> conditions which require additional space for mobility and equipment
> clearances.

3.  **Bathroom, Resident (TLTS2) 55 NSF (5.2 NSM)**

> *Provide one per Specialty Resident Bedroom.*

4.  **Bathroom, Bariatric (TLTS2) 100 NSF (9.3 NSM)**

> *Provide one per Specialty Bariatric Bedroom*

5.  **Vestibule (LOB02) 50 NSF (4.7 NSM)**

> *Provide one per Specialty Residential House.*

6.  **Living Room (DAYR1) 360 NSF (33.4 NSM)**

> *Minimum NSF; provide an additional 20 NSF per specialty resident
> greater than ten; provide one per Residential House.*

7.  **Quiet Room (RAMR1) 120 NSF (11.1 NSM)**

> *Provide one per Specialty Residential House.*

8.  **Dining Room (FSCD1) 360 NSF (33.4 NSM)**

> *Minimum NSF; provide an additional 30 NSF per specialty resident
> greater than ten; provide one per Residential House.*
>
> Dining Room areas for two or more Houses should be combined into a
> centralized Neighborhood Dining Room when consistent with program of
> Operations.

9.  **Kitchen and Servery (IPK01) 150 NSF (14.0 NSM)**

> *Minimum NSF; provide an additional 25 NSF per Specialty Residential
> House greater than one if serving a Residential Neighborhood.*
>
> Minimum space required for staging and serving food. Coordinate the
> provision, size and configuration of this space with food preparation
> and delivery system determined in collaboration with Nutrition and
> Food Service for each facility.

10. **Pantry (SRS01) 80 NSF (7.4 NSM)**

> *Minimum NSF; provide an additional 10 NSF per Specialty Residential
> House greater than one if serving a Residential Neighborhood.*
>
> Pantries can be combined and shared by two or three houses.

11. **Toilet, Resident / Visitor (TLTU1) 50 NSF (4.7 NSM)**

> *Provide one per Specialty Residential House.*

12. **Laundry (NURL1) 100 NSF (9.3 NSM)**

> *Provide one per Specialty Residential House.*

Laundries can be combined and shared by two or three houses.

D.  [Combined Residential House: Resident Areas]{.underline}

    1.  **Bedroom, Resident (BRNP1) 175 NSF (16.3 NSM)**

> *Provide one for each General and Specialty Resident if combined
> residential house is authorized.*

2.  **Bedroom, Bariatric (BRNP2) 320 NSF (29.7 NSM)**

> *Provide one per Combined Residential House.*
>
> This room is for residents with bariatric care needs, and other
> conditions which require additional space for mobility and equipment
> clearances.

3.  **Bathroom, Resident (TLTS2) 55 NSF (5.2 NSM)**

> *Provide one per Combined Resident Bedroom.*

4.  **Bathroom, Bariatric (TLTS2) 100 NSF (9.3 NSM)**

> *Provide one per Bariatric Bedroom*

5.  **Vestibule (LOB02) 50 NSF (4.7 NSM)**

> *Provide one per Combined Residential House.*

6.  **Living Room (DAYR1) 360 NSF (33.4 NSM)**

> *Minimum NSF; provide an additional 20 NSF per resident greater than
> twelve; provide one per Combined Residential House.*

7.  **Quiet Room (RAMR1) 120 NSF (11.1 NSM)**

> *Provide one per Combined Residential House.*

8.  **Dining Room (FSCD1) 360 NSF (33.4 NSM)**

> *Minimum NSF; provide an additional 30 NSF per resident greater than
> twelve; provide one per Residential House.*
>
> Dining Room areas for two or more Houses should be combined into a
> centralized Neighborhood Dining Room when consistent with program of
> Operations.

9.  **Kitchen and Servery (IPK01) 150 NSF (14.0 NSM)**

> *Minimum NSF; provide an additional 25 NSF per Combined Residential
> House greater than one if serving a Residential Neighborhood.*
>
> Minimum space required for staging and serving food. Coordinate the
> provision, size and configuration of this space with food preparation
> and delivery system determined in collaboration with Nutrition and
> Food Service for each facility.

10. **Pantry (SRS01) 80 NSF (7.4 NSM)**

> *Minimum NSF; provide an additional 10 NSF per Combined Residential
> House greater than one if serving a Residential Neighborhood.*
>
> Pantries can be combined and shared by two or three houses.

11. **Toilet, Resident / Visitor (TLTU1) 50 NSF (4.7 NSM)**

> *Provide one per Combined Residential House.*

12. **Laundry (NURL1) 100 NSF (9.3 NSM)**

> *Provide one per Combined Residential House.*

Laundries can be combined and shared by two or three houses.

E.  [Residential House (General, Specialty or Combined): Support
    Areas]{.underline}

    1.  **House Care / Workstation (NSTA3) 50 NSF ( 4.6 NSM)**

> *Provide one per Residential House.*
>
> This space functions as a nursing sub-station.

2.  **Storage, Clean Linen (LCCL1) 20 NSF (1.9 NSM)**

> *Provide one per Residential House.*

3.  **Storage, Soiled Carts (LCSL1) 20 NSF (1.9 NSM)**

> *Provide one per Residential House.*

4.  **Storage, Equipment (SRE01) 100 NSF (9.3 NSM)**

> *Provide one per Residential House.*

5.  **Storage, Medical Supplies (SRSE1) 100 NSF (9.3 NSM)**

> *Provide one per Residential House.*

6.  **Housekeeping Aides Closet - HAC (JANC1) 50 NSF (4.7 NSM)**

> *Provide one per Residential House.*

F.  [Residential Neighborhood: Patient Areas]{.underline}

    1.  **Activity / Multipurpose (DAYR1) 400 NSF (37.2 NSM)**

> *Minimum NSF; provide an additional 15 NSF per neighborhood resident
> greater than twenty. Provide one per Residential Neighborhood.*

2.  **Bathing Suite (TLTS2) 360 NSF (33.5 NSM)**

> *Provide one per Residential Neighborhood.*

G.  [Residential Neighborhood: Support Areas]{.underline}

    1.  **Neighborhood Care (Nursing) Station (NSTA1) 250 NSF (23.2
        NSM)**

> *Provide one per Residential Neighborhood.*

2.  **Exam Room (EXRG3) 120 NSF (11.2 NSM)**

> *Provide one per Residential Neighborhood.*

3.  **Medication Room (MEDP1) 100 NSF (9.3 NSM)**

> *Provide one per Residential Neighborhood if Medication Room is
> authorized in Concept of Operations.*

1.  **Utility Room, Clean (UCCL1) 120 NSF (11.2 NSM)**

> *Provide one per Residential Neighborhood.*

2.  **Utility Room, Soiled (USCL1) 100 NSF (9.3 NSM)**

> *Provide one per Residential Neighborhood.*

3.  **Housekeeping Aides Closet - HAC (JANC1) 50 NSF (4.7 NSM)**

> *Provide one per Residential Neighborhood.*

4.  **Storage, Stretcher / Wheelchair (SRLW1) 60 NSF (5.6 NSM)**

> *Provide one per Residential Neighborhood.*

H.  [Residential Neighborhood: Staff and Administrative
    Areas]{.underline}

    1.  **Office, Activities Coordinator (OFDC1) 120 NSF (11.2 NSM)**

> *Provide one per Activities Coordinator FTE position authorized.*

2.  **Office, Nurse Supervisor (OFD03) 120 NSF (11.2 NSM)**

> *Provide one per Nurse Supervisor FTE position authorized.*

3.  **Conference / Classroom (CRA01) 240 NSF (22.3 NSM)**

> *Provide one per Residential Neighborhood.*
>
> Could be combined and shared by two neighborhoods.

4.  **Toilet, Staff (TLTU1) 50 NSF (4.7 NSM)**

> *Provide one if total number of Residential Neighborhood FTE positions
> authorized is between three and fifteen. Provide an additional one if
> total number of Residential Neighborhood FTE positions authorized if
> greater than fifteen.*

I.  [Therapeutic Areas]{.underline}*.*

    1.  **Physical Therapy (PTEA1) 400 NSF (37.2 NSM)**

> *Provide one for Nursing Home / Residential Care.*

2.  **Occupational Therapy (OTDL1) 300 SF (27.9 NSM)**

> *Provide one for Nursing Home / Residential Care.*

3.  **Office, Therapist (OFD03) 120 NSF (11.2 NSM)**

> *Minimum NSF; provide an additional 50 NSF per each increment of four
> Therapist FTE positions authorized greater than two.*

4.  **Pharmacy (MEDP1) 160 NSF (14.9 NSM)**

> *Provide one if Pharmacy is authorized in Concept of Operations.*

5.  **Toilet, Resident (TLTU1) 50 NSF (4.7 NSM)**

> *Provide one for Nursing Home / Residential Care.*

J.  [Resident Support Areas]{.underline}*.*

    1.  **Chapel / Meditation (RAMR1) 300 NSF (27.9 NSM)**

> *Provide one if Chapel / Meditation is authorized in Concept of
> Operations.*

2.  **Barber / Beauty Salon (XXYYC) 240 NSF (22.3 NSM)**

> *Provide one if Barber / Beauty Shop is authorized in Concept of
> Operations.*

3.  **Laundry (LCCL1) 600 NSF (55.8 NSM)**

> *Provide one if Laundry is authorized in Concept of Operations.*
>
> Laundry service is usually provided by commercial service or VAMC EMS
> Laundry and Linen Operation. Space indicated is for nominal
> stand-alone Residential Care Facility based operation to be provided
> only when authorized by VACO.

4.  **Housekeeping (XXYYC) 200 NSF (18.6 NSM)***.*

> *Provide one for Nursing Home / Residential Care.*
>
> Provides nominal staging and storage area for housekeeping supplies
> and personnel.

5.  **Maintenance / Engineering Shop (PMCC1) 800 NSF (74.3 NSM)**

> *Provide one if Maintenance and Engineering Shop is authorized in
> Concept of Operations.*
>
> Maintenance and Engineering Shops usually provided by adjacent VAMC
> Engineering Service. Space indicated is for nominal shop facilities to
> be provided only for stand alone facility not located on a VAMC
> campus. Space to be subdivided into receiving, shops, storage,
> staging, and shop areas

6.  **Office, Security (COM03) 200 NSF (18.6 NSM)**

> *Provide one if Security service is authorized in Concept of
> Operations.*
>
> Security facilities are usually provided by adjacent VAMC Police
> Service. Space indicated is for nominal control/office/staging
> facilities to be provided only for stand alone facility not located on
> a VAMC campus.

7.  **Receiving / Loading (MMRP1) 150 NSF (13.9 NSM)**

> *Provide one for Nursing Home / Residential Care*
>
> Space provided for receipt and staging of materiel from either VAMC
> delivery system or stand-alone facility loading dock. For additional
> Receiving/Loading areas required for food service refer to Nutrition
> and Food Service -- Chapter 224.

8.  **Storage, Bulk (SRE01) 100 NSF (9.4 NSM)**

> *Provide one for Nursing Home / Residential Care.*
>
> Space provided for storage of bulk materiel. For additional Bulk
> Storage areas as may be required for food service refer to Nutrition
> and Food Service -- Chapter 224.

9.  **Food Preparation (FSNP1) 0 NSF (0 NSM)**

> *Refer to Nutrition and Food Service Chapter 224*

10. **Storage, Resident (SRPB1) 150 NSF (13.9 NSM)**

> *Minimum NSF; provide an additional 2 NSF per projected General and
> Specialty Resident greater than forty-eight.*
>
> Storage for resident clothing, luggage and other personal items.

K.  [Staff and Administrative Areas]{.underline}*.*

    1.  **Lobby (LOB01) 200 NSF (18.6 NSM)**

> *Provide one for Nursing Home / Residential Care.*

2.  **Toilet, Visitor / Resident (TLTU1) 50 NSF (4.7 NSM)**

> *Provide two for Nursing Home / Residential Care.*

3.  **Office, Service Chief (OFC01) 150 NSF (14.0 NSM)**

> *Provide one for Nursing Home / Residential Care.*

4.  **Office, Nursing Administration (OFA01 / OFA02) 120 NSF (11.2
    NSM)**

> *Provide one per Administrative FTE position authorized; provide OFA01
> if standard furniture is authorized or OFA02 if systems furniture is
> authorized.*

5.  **Office, Physician (OFD03) 120 NSF (11.2 NSM)**

> *Provide one per Physician FTE position authorized.*

6.  **Conference Room (CRA01) 300 NSF (27.9 NSM)**

> *Provide one for Nursing Home / Residential Care.*

7.  **Medical Records / QA (MRS01) 150 NSF (14.0 NSM)**

> *Provide one for Nursing Home / Residential Care.*

8.  **Copy Room (RPR01) 100 NSF (9.4 NSM)**

> *Provide one for Nursing Home / Residential Care.*

9.  **Cubicle, Clerical (OFA03) 64 NSF (5.9 NSM)**

> *Provide one per clerical FTE position authorized.*

10. **Toilet, Staff (TLTU1) 50 NSF (4.7 NSM)**

> *Provide one for Nursing Home / Residential Care.*

L.  [Staff Lockers, Lounge, and Toilets]{.underline}

> The spaces below provide programming of Lounge, Lockers, and Toilets
> at department / service / chapter level. Alternatively, sum all
> departments/services data for Lockers, Lounges and Toilets, and
> program space in Chapter 410-EMS Lockers, Lounges, Toilets and
> Showers. Either/or -- do not duplicate space. Provide locker space
> only for those FTEs without office or cubicle space.

1.  **Lounge, Staff (SL001) 80 NSF (7.5 NSM)**

> *Minimum NSF; provide an additional 15 NSF per each projected FTE on
> peak shift greater than five; maximum 210 NSF*
>
> For less than five FTE combine Lounge facilities with adjacent
> department or sum in chapter 410.

2.  **Locker Room, Staff (LR001) 80 NSF (7.5 NSM)**

> *Minimum NSF if total number of FTEs for whom office or cubicle space
> is not authorized is between five and thirteen; provide an additional
> 6 NSF per FTE for whom office or cubicle space is not authorized
> greater than thirteen.*
>
> Provide locker space only for those FTEs without assigned office or
> cubicle space. For less than five FTE combine Locker Room facilities
> with adjacent department or sum in chapter 410.

3.  **Toilet, Staff (TLTU1) 50 NSF (4.7 NSM)**

> *Minimum one; provide an additional staff toilet for each increment of
> five projected FTEs on peak shift greater than thirteen.*

6.  **PLANNING AND DESIGN CONSIDERATIONS**

    A.  A residential care environment provides living, treatment and
        support space in a residential, home-like setting for qualified
        veterans.

    B.  Employ a resident "house" concept consisting of smaller
        groupings of resident rooms co-located with living, dining, and
        kitchen areas.

    C.  Employ a "Residential Neighborhood" concept, which involves
        co-location of support services between or amongst houses.

    D.  Encourage resident interaction and privacy by providing space
        for larger social activities and private spaces.

    E.  Incorporate design features that facilitate activities of daily
        living.

    F.  Provide clear spatial organization and "way-finding" cues.

    G.  Encourage resident access to the outdoors for active and passive
        therapeutic activities.

    H.  The use of single (private) resident bed rooms is encouraged.

    I.  Provide 100 percent accessibility in all resident areas both
        indoors and out.

    J.  The net-to-gross conversions factor for estimating department
        gross square feet (DGSF) is 1.55. This number, when multiplied
        by the programmed net square foot area, gives an estimate of the
        DGSF.

    K.  Plan to maximize, to the degree possible, staff efficiencies by
        arranging resident units consistent with staffing patterns.

    L.  Provide adequate space for supplies and equipment to promote
        worker safety and care delivery (e.g., ceiling lifts).

7.  **FUNCTIONAL RELATIONSHIPS (MATRIX)**

    **TABLE 1: FUNCTIONAL RELATIONSHIP MATRIX: SAME BUILDING**

  --------------------------------------- ------------------ -------------
  **SERVICES**                            **RELATIONSHIP**   **REASON**

  Audio and Speech Pathology Program      3                  G,H

  Canteen Service                         3                  G,H

  Chaplain Service                        3                  G,H

  Dental Service                          3                  G,H

  Dietetic Service                        3                  G,H

  Eye Clinic                              3                  G,H

  ENT Clinic                              3                  G,H

  Laboratory Service                      3                  G,H

  Voluntary Service                       3                  G,H

  Med. Res. And Dev. -- Animal Res.       X                  G,H

  Warehouse and Maintenance Shops         X                  G,H
  --------------------------------------- ------------------ -------------

**TABLE 2: FUNCTIONAL RELATIONSHIP MATRIX: SEPARATE BUILDING**

  --------------------------------------- ------------------ -------------
  **SERVICES**                            **RELATIONSHIP**   **REASON**

  Parking Facilities                      3                  G,H

  Ambulatory Care                         3                  G,H

  Audio and Speech Pathology Program      3                  G,H

  Dental Service                          3                  G,H

  Dietetic Service-Food Proc.             3                  A, B,H

  ENT Clinic                              3                  G

  Eye Clinic                              3                  G

  Laboratory Service                      3                  C,H

  Pharmacy Service                        3                  B

  Voluntary Service                       3                  G,H

  Med. Res. And Dev. -- Animal Res.       X                  K, E, F

  Warehouse and Maintenance Shops         X                  D, E, F

                                                             
  --------------------------------------- ------------------ -------------

> Relationship

1.  Adjacent

2.  Close/Same Floor

3.  Close/Different Floor Acceptable

4.  Limited Traffic

> X. Separation Desirable
>
> Reasons:
>
> A. Common use of resources
>
> B. Accessibility of supplies
>
> C. Urgency of contact
>
> D. Noise or vibration
>
> E. Presence of odors or fumes
>
> F. Contamination hazard
>
> G. Sequence of work
>
> H. Resident's convenience
>
> I. Frequent contact
>
> J. Need for security
>
> K. Others (specify)
>
> L. Closeness inappropriate

8.  **FUNCTIONAL DIAGRAM 1 - Concept Diagram - Nursing Home /
    Residential Care Facility**

![](media/image1.jpeg){width="6.297916666666667in"
height="3.7069444444444444in"}

9.  **FUNCTIONAL DIAGRAM 2 - Concept Diagram -- Nursing Home /
    Residential Care Facility -- Typical House**

![](media/image2.jpeg){width="6.297916666666667in"
height="7.402777777777778in"}