The following list of suggested changes was compiled from meetings with staff and residents of Montgomery Meadows:

1.Construct at least one new state-of-the-art resident wing with mostly private rooms. Private rooms are important because they improve the quality of care, and in turn, the quality of life of the resident.

• Private rooms are essential for the care of residents with behavioral problems related to dementia. These residents often disturb other residents or are themselves disturbed by other residents, which increases the behavioral problems.

• Private rooms are an important ingredient in relating to privacy issues concerning mental health needs and coping strategies.

• Private rooms are required by code for infection control, which has been an increasing problem, particularly among new admissions.

• Most people want privacy. This is directly related to their individual choice and lifestyle patterns.

• Privacy is essential for couples, so that they don’t have to share their intimacy with others who occupy the same room. The only exception is for couples who occupy a double room.

• The ideal wing configuration would contain ninety percent private rooms.

• With the increased resident acuity and the need for more equipment, it is essential to have at least five feet of space on the non-window side of the bed.

• There should be five feet of space between the bed and the window to allow for a lounge chair and turning radius for a wheelchair.

• Private rooms should have a full handicapped bathroom with a roll-in shower. Such a bathroom would save staff time and preserve resident dignity.

2. The following problems are associated with converting the existing resident wings to meet the above criteria. The original construction was in 1970 and several of the then state-of-the-art designs, while being "grandfathered" are not conducive to the needs of today’s residents. As examples:

• 713-1.2 (a) of the New York State Department of Health Code states in part that each single-bed room shall be equipped with a private bath and shower.

Only one of the four single-bed rooms has a private bath and toilet.

The other single-bed rooms are not large enough to accommodate a shower.

In the following plan of a 1-Bed Room we can observe some of the problems:

• There is insufficient space at the room entrance (vestibule) to provide for wheelchair accessibility.

• There is insufficient space in the toilet room to provide a five-foot turning radius for a wheelchair.

• The space between the bathroom door and the window wall must be a minimum of 11’-4" clear of obstructions, such as the swing of the toilet room door.

To provide full handicapped accessibility to the toilet room, add a shower, and eliminate the toilet room door obstruction in the bedroom, the inside dimension of the bathroom would have to be expanded to 7’-0" wide by 8’-6" long. The door should then open into a five-foot wide vestibule without the wardrobe unit. This would make the minimum inside width of the bedroom 12’-6", or 6" wider than the present width.

There is a similar problem with the depth of the room, which would have to be lengthened by 5’-0" to accommodate the wardrobe or closet on the bedroom side of the bathroom.

A suggested renovation solution would be to take the two adjoining 1-Bed Rooms and construct one 2-Bed Room. See the discussion on converting the 2-Bed Rooms to 1-Bed Rooms.

• In most of the 2-Bed resident rooms, the toilet room door opens adjacent to a bed. This creates a serious congestion problem, and can be disturbing to that resident, if the other resident uses the bathroom. (See plan-right)

With the bedrooms slightly less than 17 feet in length, there is only three feet of space on either side of the beds. This leaves slightly less than a five-foot turning radius to make the toilet room wheelchair accessible.

Access to the bathroom has resulted in the elimination of a wheelchair accessible area adjacent to the windows to accommodate both residents.

Additionally, only one bed has a five-foot accessible turning radius on one side of the bed, and this space is in conflict with the swing of the toilet room door. Additionally, the five-foot space is required to be between the beds, which is impossible to achieve in the present configuration and still permit access to the toilet room.

We have discussed moving the toilet room door to the vestibule side of the toilet room. But the vestibule is only 54 inches wide due to the location of the wardrobe, which does not provide full wheelchair accessibility to the bathroom, wardrobe and entry door.

• We have discussed the possibility of converting these double rooms into single rooms.

If a roll-in shower were constructed in the toilet room and the wardrobe was relocated to the bedroom side of the toilet room, or new bathroom, it would reduce the size of the bedroom to slightly less than 12 feet. This would allow five feet of space between the bed and the wardrobe and slightly less than four feet adjacent to the window.

If this were the only consideration, the bedroom would function.

However, with converting the two-bed rooms to single-bedrooms, there is insufficient space on the site to construct the additional bedrooms to maintain a forty-bed complement to the wing that would meet Code.

If a new forty-bed wing were to be constructed, there might be sufficient site space to convert the existing resident wings to three 27-bed units, but this would increase operational costs.

Additionally, this does not resolve the toilet room and vestibule width problems. (See Resident Bathroom Changes, and the discussion of the 1-Bed Room changes above.)

The following 1-bedroom plan is one of the suggested options to meet the above requirements.

The bathroom in the lower left of the plan has a linen closet built into it.  While this solves the staff problems, it also could create a turning radius problem with wheelchair access to the lavatory.

The next suggested plan eliminates the linen closet in the bathroom and utilizes a locked drawer for the storage of linen in a three foot wide, 4-drawer dresser located next to the bedroom closet.