Academy of Architecture for Health

Healthcare and Accessibility have been at cross purposses since the 60s when the access regulations were first adopted.

The heart of the issue is that Acesssibility is about independence for persons with disabitlies and Healthcare is about nurturing and interdependence.  That doesn't mean the accessibility rules are wrong.

Nothing in the ADA says that bariatric patient rooms need to be the accessible units.  If fact, as you point out, when you try make the accessible rooms do double duty as accessible AND bariatric, or accessible AND negative pressure isolation rooms, whatever  - - -  you will run into this wall.

The recent pressure in healthcare to make universal rooms - becomes untenable when you realize you shouldn't try to make bariatric rooms meet ADA standards, or that people who have had strokes become hemi-pledgic with a pronounced handedness that requires mirror image rooms for proper care.

WE  are the designers, we can integrate these disparate requirements into our projects.  Let the diversity of needs become a challenge.  This will challenge the Healthcare industry to grapple with administrative issues of patient / room-assignment  pairing - how get the person with a disability in an accessible room and the bariatric patient in bariatric room.  That's what the ADA is all about.

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Harold Kiewel AIA
Associate / Sr Specifications Writer
HMC Architects
San Diego CA
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Alas, New York City's revised constructin code now requires 100% of Acute care rooms and patient bathrooms to be handicapped accessible.  This really ties the hands of designers, no matter how creative we are, especially when the cost of construction in Manhattan requires every SF to justify its cost.
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Catherine Alberte AIA
Sr. Associate/sr. Medical Planner
NBBJ
New York NY
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Understand, I am not necessarily a proponent of every acute care patient room being accessible as Catherine mentions New York City now requires, but accommodating the code is what we must do.
 
That being said, it is a bit ironic when designing a facility that the design professional and a facility owner express concern over the square footage needed to accommodate the ADA; only to discover minimum required dimensions may be inadequate for caregivers and patient mobility. The ADA, though having health care requirements, was not specifically written for health care and each patient condition.

Health care architecture is unique. The design professional must understand the health care environment, caregiver requirements and patient specific needs; and then extrapolate from the minimum code and regulatory requirements established. 

It must be recognized that whether complying with the ADA, IBC, NFPA (life safety) or FGI Guidelines, these codes and guidelines establish minimum building requirements. Though easy to say we design "to the code",  we must also design for the need.

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Richard M. Horeis, AIA
Director, Technical Review Services
Codes and Regulations
HDR Architecture, Inc
Omaha, NE
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Original Message:
Sent: 09-27-2011 18:27
From: Catherine Alberte
Subject: Patient Toilets, Accessibility v. Care-Giving


Alas, New York City's revised constructin code now requires 100% of Acute care rooms and patient bathrooms to be handicapped accessible.  This really ties the hands of designers, no matter how creative we are, especially when the cost of construction in Manhattan requires every SF to justify its cost.
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Catherine Alberte AIA
Sr. Associate/sr. Medical Planner
NBBJ
New York NY
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