All too often, care
for elders occurs in buildings designed decades ago to accommodate a medical
model of nursing. Long Term Care (LTC) providers with older Skilled
Nursing Facilities (SNFs) are under increasing competitive and regulatory
pressure to replace or remodel such aging physical settings to provide a
Person-Centered Care environment. Residential design and scale,
along with resident choice and control that supports involvement in meaningful
relationships and activities, are now widely acknowledged to be essential for
high quality long term care.
Many providers that
have embarked on the "culture change" journey have recognized that
their existing facilities hamper effective implementation of true
Person-Centered Care. Thus planning for new construction or
renovation projects needs to begin by establishing consensus among stakeholders
on the desired outcomes for residents and staff, as well as the functional
parameters required to produce these outcomes. Before an architect
is engaged to design a facility that will successfully support such an
operational model, he or she must be equipped with this essential
information. Prematurely embarking on the design process often
results in a compromised product that can prove expensive and impractical to
correct later on.
A systematic new
approach known as SAGE P.L.A.C.E. is now available to help LTC providers
effectively prepare for the transformation or creation of physical settings to
accommodate their organization’s unique vision of "culture
change". It was developed by a team of SAGE-member architects,
designers, regulators, researchers, and providers, as well as the Institute on
Aging and Environment at the
The initial step of
the SAGE P.L.A.C.E. process is a full-day introductory seminar led by SAGE
members at the site of the LTC provider. Because the process may
impact every aspect of the organizational environment, participants include
members of the provider’s governing body, executive leadership, direct care and
support staff, and residents/families. Utilizing adult learning
concepts, the process promotes a team approach, which is critical to the
success of subsequent planning and implementation phases.
resource materials to guide the provider through the process. The
subsequent steps in the process will be determined by the status of the
provider on the "culture change" journey, available financial and
staff resources, and the timetable for design and construction. SAGE
members are available to assist with the analysis of the variables, the
identification of options for next steps, and ongoing support.
SAGE is especially
well positioned to help providers develop a pre-design program that takes into
account the needs and desires of residents, staff, and family members as well
as all aspects of the organization, operations, and physical
plant. Since its inception in 1994, SAGE has recognized that the Nursing Home Reform Act of 1987 (OBRA
’87) offers a philosophical foundation for the
multi-disciplinary collaboration required to create Person-Centered Care
settings. Drawing upon the wealth of experience and diverse perspectives
of its broad membership, SAGE crafted a set of values-based Principles which guide the SAGE P.L.A.C.E.
The SAGE P.L.A.C.E.
seminar begins by exploring the impetus in the LTC field for initiating the
Person-Centered Care transformation. Next, a SAGE-produced video
The Fullness of Life illustrates the quality of life
experienced by residents of one skilled nursing facility founded on this
premise. The remainder of the day is dedicated to providing an understanding
through experiential learning of the four steps for intentional creation of the
Person-Centered resident and staff experiences the provider determines to be
Develop Foundational Statements
Complete Experiential Analyses
Make Functional Assessments
Prepare Architectural Program
learn how to apply this knowledge in the selection of an architect that is
well-positioned and properly qualified to partner with them to design a
At the conclusion of
the SAGE P.L.A.C.E. process, LTC provider organizations will be able to:
Define core values and principles to guide decision-making and
ensure program integrity.
Develop a clear vision of desired resident outcomes for use in
measuring project success.
Understand the relationship of the organizational culture and the
physical environment, and how to make them mutually supportive.
Recognize that every element of the environment and every
characteristic of the culture must be evaluated and designed to support a
Describe for each category of facility user the desired user
experience in each activity and the functional requirements to yield these
Communicate effectively the desired user experiences and the
functional requirements to the architect for use in designing a Person-Centered
Select an architect and design team that will serve as a strong
Collaborate with the design team to develop the architectural
program that is the basis for the design of the desired physical setting.
Produce a physical setting that supports the provision of
The SAGE P.L.A.C.E.
introductory seminar is being piloted with several LTC organizations around the
country at a significantly discounted cost thanks to a generous grant from the
Rothschild Foundation, which also supported the development of the
process. The first pilot in
Ohio generated evaluations which
strongly supported its adoption by other organizations. Once the
refinement of SAGE P.L.A.C.E. has been completed through three pilot projects,
state SAGE chapters will begin offering the workshop to LTC providers at a
standard fee plus expenses.
If your organization
would like to consider serving as one of the pilot sites, please contact
David Green for