§ 17.222 - General design guidelines and standards.

(a) General. Nursing homes and domiciliaries should be planned to approximate the home atmosphere as closely as possible. These guidelines and standards include minimum requirements for site selection and development; architectural design including handicapped accessibility and allowable space criteria; structural, mechanical, and electrical design; plumbing systems and elevator requirements; fire safety criteria; and asbestos abatement rules. State homes to be constructed or acquired with Federal financial assistance shall comply with applicable National, State, and local codes. Such codes include building codes, electrical codes, seismic codes, fire and life safety codes, plumbing codes, and others. Both nursing homes and domiciliaries are health care occupancies, and all space shall be protected with a sprinkler system as well as quick response sprinklers for all smoke compartments containing patient sleeping rooms.

(1) Except as provided in paragraphs (a)(1)(i) and (a)(1)(ii) of this section, in no case shall the total cost of remodeling exceed the cost of constructing a comparable new building or facility.

(i) If a building or facility is on or eligible for the National Register of Historic Places, the total cost of remodeling, renovating, or adapting it may exceed the cost of comparable new construction by five percent.

(ii) If the demolition of a building on or eligible for the National Register of Historic Places is necessary, the cost to professionally record the building for the Historic American Buildings Survey (HABS) plus the total cost for demolition and site restoration shall be included by the State in calculating the total cost of new construction.

(2) The cost of routine maintenance and replacement of mechanical, electrical, structural and architectural work, or maintenance and repair of any building system or equipment will not be considered as a cost for construction or acquisition for a State home grant application. The Department of Veterans Affairs may waive this requirement if it is determined that the work is necessary to comply with standards of life safety or quality patient care or is involved inextricably with the construction or acquisition project.

(b) Site selection and development.—(1) Site accessibility. The site should be located in a safe, secure, residential-type area which is accessible to acute medical care facilities, community activities and amenities, and transportation facilities typical of the area.

(2) Mineral rights. The State shall establish whether the site is subject to mineral rights which have not been developed and include a report on the mineral rights as part of the formal application.

(3) Limitations. The State should avoid sites that are near insect-breeding areas, noise or other industrial developments: airports, railways or highways producing noise or air pollution; or potential flood hazards. In the event that these site related disadvantages cannot be avoided, adequate provision will be made to eliminate or minimize the condition.

(4) Alternatives. The State shall look at alternative sites for the State home unit and submit a report on these sites to the Department of Veterans Affairs for review early in the application phase.

(5) Demolition plan. The cost of demolition of a building cannot be included in the cost of construction unless the proposed construction is in the same location as the building to be demolished or unless the demolition is inextricably linked to the design of the construction project. If the State believes that this cost may be included in the cost of the construction project, a demolition plan should be submitted which includes the extent and cost of existing site features to be removed, stored, or relocated.

(6) Asbestos abatement. For existing buildings, a certified industrial hygienist shall be hired for assessment, design, cost estimate, and construction monitoring for asbestos abatement. The abatement process shall follow EPA, OSHA, State, and local regulations and guidelines.

(c) Architectural requirements. (1) Finishes. Walls shall be washable or easily cleaned and smooth. Walls in kitchens and related spaces shall have glazed materials or similar finish and bases shall be waterproof and free from voids. Walls subjected to wetting should also be glazed to a point above the splash or spray line. Wainscots of durable material should be used in patient corridors and other corridors where there is considerable wheeled traffic. Emphasis should be placed on the use of materials for walls and floors that are safe, sanitary, and noise-reducing. The color scheme should provide an attractive and therapeutic environment for elderly patients.

(2) Handicapped accessibility. All State home facilities shall provide necessary ingress, egress, and movement throughout the facility for the physically handicapped and elderly in compliance with the Uniform Federal Accessibility Standards (UFAS). Disabled persons shall be provided with access and use that is independent, convenient, and substantially equivalent to that provided other persons.

(3) Doors. All doors should be easy to open and in accordance with UFAS requirements.

(4) Fire Protection. Facilities shall meet the applicable provisions of the 1988 edition of the National Fire Protection Association's Life Safety Code, NFPA 101, dated February 2, 1988, including NFPA 101M, Alternative Approaches to Life Safety, dated December 2, 1987, (which are incorporated by reference). Incorporation by reference of the 1988 edition of the Life Safety Code including NFPA 101M was approved by the Director of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. The Code is available for inspection at the Office of the Federal Register, room 8301, 800 North Capitol Street, NW., suite 700, Washington, DC. Copies may be obtained from the National Fire Protection Association, Battery March Park, Quincy, MA 02269. If any changes in this Code are also to be incorporated by reference, a document to that effect will be published in the Federal Register.

(5) Space program criteria. (i) General. The chart at paragraph (c)(5)(iii) of this section shows the net square footage allowed for Department of Veterans Affairs participation in the cost of the State nursing homes and domiciliaries.

(ii) Deviations. Any deviation from these space criteria of more or less than 10 percent, except to meet a more stringent State or local requirement, must be justified by the State and approved by the Department of Veterans Affairs if the space is to be included in the cost of construction. The Assistant Chief Medical Director for the Office of Geriatrics and Extended Care may approve a deviation if it will improve the safety, quality of care, or quality of life provided to veterans in a State home. If a deviation is not approved by the Department of Veterans Affairs, the cost of questionable space will not be included and the percentage of Federal participation may be reduced.

(iii) Chart of net square feet (NSF) allowed.

Non-Convertible Domiciliary (DOM)Convertible DOM/Nursing HomeI. Support facilities (maximum allowable square feet per facility for VA participation):Administrator's office 200200.Assistant administrator150150.Medical officer, director of nursing or equivalent150150.Nurse's office and dictation area120120.General administration (each office/person)120120.Clerical staff (each)8080.Computer area4040.Conference room (consultation area, in-service training)300 (each)500 (each).Lobby/waiting area3 (per bed) (150 min./600 max. per facility)3 (per bed).Public/patient toilets (male/female)25 (per fixture)25 (per fixture).Pharmacy0(As required).Dietetic service(As required)(As required).Dining area20 (per bed)20 (per bed).Canteen/retail sales2 (per bed)2 (per bed).Vending machines1 (per bed) (450 maximum per facility)1 (per bed).Resident toilets (male/female)25 (per fixture)25 (per fixture).Child daycare(As required)(As required).Medical support (staff offices/exam/treatment room/family counseling, etc.)140 (each)140 (each).Barber and/or beauty shops140140.Mail room120120.Janitor's closet4040.Multipurpose room15 (per bed)15 (per bed).Employee lockers6 (per employee)6 (per employee).Employee lounge120 (maximum 500 per facility)120.Employee toilets25 (per fixture)25 (per fixture).Chapel450450.Physical therapy2.5 (per bed)5 (per bed).Office if required 120 120.Occupational therapy5 (per bed)5 (per bed).Office if required120120.Library1.5 (per bed)1.5 (per bed).Building maintenance storage2.5 (per bed)2.5 (per bed).Resident storage6 (per bed)6 (per bed).General warehouse storage6 (per bed)6 (per bed).Medical/dietary7 (per bed)7 (per bed).General laundry(As required)(As required).II. Bed units (50 Beds):One150150.Two230245.Large two-bed (2 per unit)0305.Three340370Four450460Lounge areas (resident lounge with storage)8 (per bed)8 (per bed).Resident quiet room3 (per bed)3 (per bed).Clean utility120120.Soiled utility105105.Linen storage90150.General storage100100.Nurses station, ward secretary0260.Medication room075.Waiting area5050.Unit supply and equipment5050.Staff toilet25 (per fixture)25 (per fixture).Stretcher/wheelchair storage75100.Kitchenette150120.Janitor's closet4040.Resident laundry125125.Trash collection6060.III. Bathing and Toilet Facilities:1(A) Private or shared facilities:Wheelchair facilities25 (per fixture)25 (per fixture).Standard facilities15 (per fixture)15 (per fixture).(B) Full bathroom7575.(C) Congregate bathing facilities:First tub/shower 8080.Each additional fixture2525.1 Bathing and toilet facilities must comply with the Uniform Federal Accessibility Standards.