Falls can have devastating effects on people’s lives and are a major health concern overall, especially for seniors or those recovering from surgery or who have mobility or sight impairments. Direct costs for falls in Canada are estimated to be as high as $2 billion per year and could have an economic impact of up to $6 billion a year. Healthcare and rehabilitation facilities recognize that addressing the concern is important from health and safety and cost perspectives. Parkin’s architects and designers are uniquely qualified to help healthcare facilities identify risk areas and provide solutions to navigate potential hazards in the built environment.
Assessing risk
Designing to reduce fall risks is a multi-modal function since a complex set of issues come into play when designers approach fall prevention in a healthcare facility. Reasons for falling can vary greatly, so it’s difficult to apply a single set of measures universally. Fall incidents typically involve both physiological and environmental factors. Healthcare design needs to take into account the various patients and others who will use the space along with the specific impairments that may affect risk for falls, like medications, dementia or those in rehabilitation.
Parkin designers review applicable building codes and assess statistics in consultation with clients and healthcare staff to identify if there are particular areas of a facility or patient populations with increased rates of falls. In addition, the age of a facility may affect what level of accessibility has been previously incorporated, since many facilities have wings of various vintages that will differ in accessibility depending on the codes that were in effect at that time. Grab bars may need to be integrated into existing spaces, or doorways may need to be expanded and inappropriate door hardware may need to be replaced.
Designing for specific populations
Both operational and functional elements need to be taken into consideration when designing for fall mitigation. For instance, elderly patients may suffer from both dementia and limited mobility, so they may misinterpret colour transitions in floors as stairs, causing them to trip. They may also have issues with glare from daylight off high-gloss flooring surfaces. On the other hand, highly slip-resistant flooring such as carpet or resilient safety flooring may cause tripping for rehabilitation patients who drag their feet. In the latter case, flooring with a lower coefficient of friction would be preferred such as rubber or linoleum flooring.
Appropriate heights for furniture and grab rails have been identified as potential problems if specific users aren’t taken into consideration. For instance, bariatric patients need particular attention in terms of providing additional reinforcing for grab bars, larger door openings and higher weight capacity in toilets and sinks. At the same time, pediatric facilities and departments should have secondary, lower-level, grab bars and handrails at stairs to accommodate the lower reach of young children.
On the operational front, areas around handwash sinks may have standing water and represent slip hazards for both staff and patients. Wet areas―such as utility rooms, shower rooms and food preparation areas―need slip-resistant flooring and appropriate drainage. Some other solutions include incorporating appropriately sized sinks to ensure that splashing water is minimized. Even the location of paper towel dispensers can reduce the extent of a drip zone thus reducing slip and fall hazards.
Spatial layout
Toilet access is a major contributor to falls for hospitals in-patients. Bathroom visibility, lighting at night, grab handles, door swing orientation, along with processes like timed toileting, can work together to reduce stress and fall risks for patients. Healthcare facility designers should consider how to provide clear paths from patient beds to washrooms and how to prevent tripping hazards. That may include specifying built-in cabinets and appropriate spaces for seating to prevent clutter and other hazards from loose equipment like IV poles. Rooms can be designed with clearances and space for parking mobility aids close to patient beds. The placement of privacy curtains needs to be carefully thought out to reduce the incidence of walking into door edges or equipment on the other side.
A holistic approach
A slip and fall prevention design strategy for a healthcare facility needs to take into consideration every interaction that patients, visitors and staff might have with the facility, from the parking lot to entrances to wayfinding. Exterior surfaces leading from parking areas can be a major source of falls if there is ice build-up along walkways and curb drops, while entrance foot griles can become slipping hazards if not draining properly. A fall prevention design might provide features like sheltered drop-off areas and heated walkways to reduce ice build-up. Entrance vestibule design should take into account environmental factors, such as prevailing winds and snow accumulation.