Community Rehabilitation Centres Generic Brief

Community Rehabilitation Centres

Generic Brief

Acknowledgements

Many people have contributed to the development and completion of this document. They include:

Mr Ralph HampsonBusiness and Facility Development Unit, Aged, Community and Mental Health Division, Department of Human Services

Mrs Judy Kelso Business and Facility Development Unit, Aged, Community and Mental Health Division, Department of Human Services

Ms Kirrily Young Business and Facility Development Unit, Aged, Community and Mental Health Division, Department of Human Services

Ms Lecki OrdSweetnam, Godfrey and Ord Pty Ltd, Consultant Architect to the project.

Members of the CRC generic working group (a sub-group of the CRC steering committee):

Ms Joy Arnot Dandenong Community Rehabilitation Centre

Mr John Haliczer Port Phillip Community Rehabilitation Centre

Ms Tracey Seeleither Booroondara Community Rehabilitation Centre, Camberwell Campus

Ms Janet Walsh Lyndoch Community Rehabilitation Centre, Warrnambool

Ms Jan Champlin Aged Services Redevelopment, Department of Human Services

Ms Maureen Robinson Aged Services Redevelopment, Department of Human Services

Ms Robyn Smith National Ageing Research Institute

Ms Anna Laffy National Ageing Research Institute

The CRC coordinators and staff of the centres visited who shared their opinions in regards to CRC space and design issues:

Ms Heather Ashcroft Belmont Community Rehabilitation Centre

Ms Cathy BadgerSpringvale Community Rehabilitation Centre

Ms Tracey Corsini Wangaratta Community Rehabilitation Centre

Ms Jenny Hadimioglu Werribee Community Rehabilitation Centre

Ms Kerri Halley Bundoora Extended Care Centre Community Rehabilitation Centre

Ms Paula Hillgrove East Bentleigh Community Rehabilitation Centre

Ms Linda Hirst North Geelong Community Rehabilitation Centre

Ms Barbara ManningCambridge Community Rehabilitation Centre, Collingwood

Ms Janet Oliver Rosebud Community Rehabilitation Centre

Ms Jay PetersonPeter James Centre Community Rehabilitation Centre

Published by the Aged, Community and Mental Health Division

Victorian Government Department of Human Services

Melbourne, Victoria

June 2000

Also published on the Aged, Community and Mental Health Division Websitre at

ISBN 0 7311 6078 9

(0290899)

Contents

1 Introduction1

1.1Generic Brief1

1.2Functional Brief1

1.3Policy and Service Context2

2 Functions and Operations3

2.1Philosophy 3

2.2Method of Operation4

2.3Staffing5

2.4Components7

3 Design9

3.1Implications for the People within the Facility 9

3.2General Design Criteria9

4 Functional Areas and Relationships17

4.1Introduction to Functional Zones17

4.2Functional Relationships18

4.3 Functional Zone 1: Arrival Areas23

4.4Functional Zone 2: Office Areas25

4.5Functional Zone 3: General Clinical Areas27

4.6Functional Zone 3A: Core Clinical Spaces29

4.7Functional Zone 3B: Other Specialist Spaces34

4.8Functional Zone 4: Service Areas34

4.9Functional Zone 5: Staff Amenities37

5 Other Planning Issues39

5.1Town Planning39

5.2Property Agreement39

6 Appendices41

Appendix 1: Accommodation Schedule42

Appendix 2: References and Bibliography47

Appendix 3: Glossary of Terms49

Appendix 4: Example Sizes of Typical Equipment51

1Introduction

1.1Generic Brief Purpose

A generic brief provides detailed guidelines for the planning and design of health and aged care facilities. This generic brief has been developed for a community rehabilitation centre (CRC) facility.

The aim of this generic brief is to:

•Outline the guidelines for the development of project specific briefs for individual State-funded CRCs in Victoria.

•Provide a consistent and clear framework within which regions develop and negotiate health service delivery strategies with potential service providers.

•Provide general principles for quality design outcomes for CRCs in Victoria.

•Provide an overview of the services and activities that a CRC will commonly provide.

•Describe in generic terms the spaces required to conduct those services and activities.

Each design should be refined to suit the service needs and community circumstances as identified in the agency’s service plan, which must be approved by the Department of Human Services.

Prior to considering the requirements for service delivery it is important that each service provider develops a comprehensive knowledge and understanding of local community rehabilitation needs.

The selected design influences many elements of the economic viability of the facility. These include:

•Work practices

•Management

•Flexibility

•Maintenance

•Energy efficiency

•Operating costs.

This generic brief has been developed through literature review and an intensive consultation process. The processes used to develop the generic brief entailed:

•Consultation and meetings with the Department of Human Services Victoria, CRC service providers, policy advisers, service users, and project design and development advisers.

•A guidelines workshop with an expert group comprising key service providers and policy advisers.

•Site visits to existing facilities in Victoria.

Variations in developing each CRC may be necessary in order to adjust the design to proposed sites, including consideration of refurbishment. Whilst individual projects are subject to detailed negotiation and are dependent on the availability of capital and recurrent funds, the scale of the proposed developments highlights the need for a generic design brief to ensure consistency of approach and efficient, appropriate planning.

Some sections of this document relate to specific legislative requirements such as building codes and safety specifications, however, many aspects are indicative or conceptual in nature, providing a framework which can be adapted to meet local needs. References are provided in this document on literature, Web sites and other useful information.

The development of CRCs in Victoria will be guided by this generic brief.

1.2Functional Brief

The information in this generic brief can be taken and adapted by an agency, in conjunction with an architect, to develop a project-specific functional brief from which a building can be constructed or redeveloped. Development of a project-specific functional brief that will deliver well-planned community rehabilitation involves extensive consultation, investigation and coordination. In the planning stage, consultation for individual facilities will involve the Department of Human Services, service providers, consumers and carers in the community. Information on the development of a functional brief should be obtained from the Department of Human Services Capital Development Guidelines.

Particular note of the guidelines needs to be taken for:

•Policies and procedures for undertaking capital developments.

•The planning and evaluation phase.

•Fire risk management.

Proposed capital redevelopment projects should be supported by a current needs analysis and service plan which has been approved by the Department of Human Services.

A project control group is formed to manage and ensure a capital project is delivered in a manner that complies with functional requirements and is within the scope, budget and time constraints of an individual project. The project control group gives final endorsement for the project. Final written approval for each phase of a project must be obtained from the Department of Human Services.

Representatives from the Department of Human Services at a regional, branch and program level, together with representatives of the agency, will participate in individual project control groups to contribute constructively to the planning, design, development and implementation of the service and to facilitate the approval processes.

1.3Policy and Service Context

The Framework for Service Provision

Rehabilitation is an essential component of the health care system for people with disabilities. The World Health Organisation (1981), suggests that: ‘Rehabilitation includes all measures aimed at reducing the impact of disabling and handicapping conditions and at enabling disabled or handicapped persons to achieve social integration’.

Rehabilitation in Victoria is available to inpatients of public and private hospitals and to people living in the community through a variety of public and private non-inpatient services.

Non-inpatient services include State-funded CRCs, Commonwealth-funded day therapy centres, home-based rehabilitation services, Home and Community Care (HACC) services, community health centres, hospital outpatient services, specialist non-inpatient rehabilitation services and private practitioner services.

The focus of this document is on State-funded CRCs in Victoria.

By 2020, an estimated 16 per cent of the Australian population will be over the age of 65 (Department of Human Services—Victoria’s Health to 2050). Consequently, the number of age-related illnesses, diseases and disabilities, for example, stroke, fractured neck of femur, arthritis and diabetes, is projected to increase.

Inpatient stays in acute hospitals continue to be shorter due to advances in medical treatment and changes in funding arrangements. Subsequently, community services will increase in prominence as future health services demand more emphasis on community treatment and care for people with chronic, but generally manageable, diseases and disabilities.

It is also apparent that the role for non-inpatient rehabilitation is increasing and that there are many potential benefits from developing effective non-inpatient rehabilitation services. These include reducing demand for hospital inpatient services and maximising the opportunity for people with disabilities to return to and remain in the community.

Identifying population trends and developing services on a population-wide and system-wide basis is of growing importance in health care planning. This approach to service planning corresponds with local and regional information, and provides a basis for equity and access decisions. It also enables effective program development to meet the specific rehabilitation needs of a particular community.

Background

CRCs were auspiced by different sections of the Victorian Health Department until June 1995. From July 1995, all of these services were moved under the auspice of the Aged Care Branch, Department of Human Services. Since this time a significant amount of work has been carried out to redevelop CRCs.

The introduction of a service definition, explanation of the role of CRCs, development of both a minimum data set and clinical indicators, as well as the introduction of a formal process of designation have all contributed to the reshaping of CRCs.

Resource guidelines are being established to identify the level of CRC services required across Victoria to provide appropriately for the total population. These resource guidelines are to be used as a tool to assist in planning for future need.

2Functions and Operations

2.1Philosophy

CRCs provide a service that has an interdisciplinary focus and promotes time-limited, targeted rehabilitation. The formal definition states that: Community Rehabilitation Centres provide an interdisciplinary rehabilitation service to enable clients who are disabled, frail, chronically ill or recovering from traumatic injury to achieve and retain optimal functional independence.

The majority of clients are adults living in the community for whom there are clearly identifiable rehabilitation goals. Although not exclusively for older people, it is this group which currently form the majority of the caseload for most CRCs.

CRCs can meet a broad range of rehabilitation needs for people living in their own community, however, the needs of some client groups are best met by other specialist services. For this reason, it is recommended that clients with the following principal diagnoses are not appropriately served by CRCs.

•Principal diagnosis related to sensory impairment.

•Principal diagnosis related to psychiatric impairment.

•Principal diagnosis related to intellectual impairment.

•Principal diagnosis related to vocational impairment.

Principal diagnosis is defined as the diagnosis established after study to be chiefly responsible for occasioning the patient’s episode of care.

Services

CRCs offer a range of services provided by health professionals. The targeted rehabilitation focus of CRCs is aimed at optimising each client’s functional ability and independence.

Formal designation is required in order to receive CRC funding from the Department of Human Services, Victoria. Application to become a designated CRC must be made to the Department of Human Services.

To be designated, a CRC must provide the following core services:

•Rehabilitation medicine and/or geriatric medicine

•Nursing

•Occupational therapy

•Physiotherapy

•Social work

•Speech pathology.

Core services can be provided either by staff directly employed by the CRC or through the centre accessing those services for their clients when required. CRCs should provide access to other specialist services such as podiatry, dietetics, psychology, neuropsychology and prosthetics as needed by individual clients. Specialist services are not deemed to be essential for the purposes of achieving designation as a CRC.

Service Models

There are a number of different models for the integration of CRCs with other services. No one model is favoured or preferred over another and all exist in the current CRC system in Victoria. In terms of facility location and development, these service provider inter-relationships and the needs of the community to be served should be considered. For example, when facilities are situated together, distinctions need to be made about whether services are:

•Fully integrated (sharing staff, facilities and infrastructure support).

•Partially integrated (sharing only some aspects of service provision).

•Collocated (located together, but functioning independently of each other).

CRC Sited with an Inpatient Facility

CRCs were historically collocated or partially integrated with inpatient facilities and this remains the most common model in Victoria. Most CRCs are sited with an extended care centre or acute public hospital. There are many advantages to this model including:

•Staff support.

•Access to specialist staff and services.

•Potential to reduce infrastructure costs and achieve economy of scale with support services.

•Referral networks.

•Continuity of care between inpatient and

community services.

Some of the issues which arise with this model include:

•The reinforcement of the ‘sick role’.

•Difficulty of access by the community as the service is seen as a hospital/medical service rather than a community one.

•Large, often more cumbersome systems for staff and clients to negotiate.

There is a trend for CRCs to be fully integrated with inpatient rehabilitation services, with therapy areas and therapy staff accessed by both inpatient and CRC clients. This has been taken into account throughout this document. The descriptions of functional areas and relationships indicate areas which may be shared within the CRC, by different components of the CRC and external to the CRC, with complementary type services.

Where the functions of the CRC are fully integrated with those of inpatient services, the most significant differences will be the size of the spaces and the number of spaces required (number of interdisciplinary treatment rooms). Careful consideration will also need to be given to the opportunities for mixing clients from the inpatient and CRC components of the facility.

CRC Sited with Another Community or

Non-Inpatient Facility

This is not a common model, however, it is gaining popularity with a number of CRCs now collocated or partially integrated with community health centres or day centres. Some of the advantages of this model include:

•A community focus.

•Emphasis on community integration.

•Health promotion and ‘wellness’ approach.

•Potential for improved staff support.

•Economies of scale in support services and

infrastructure.

Some of the issues which arise with this model include:

•A mismatch of clients attending CRCs and

community health centres.

•A confusion about service roles.

•Isolation from specialist medical and rehabilitation services.

•The need to develop complete infrastructure

systems (including medical records).

For example, older people attending the CRC for stroke rehabilitation and younger people attending the community health centre for a needle exchange program may not feel comfortable with each other or be clear about the services available to meet their needs.

The issues related to fully integrating inpatient rehabilitation CRC services also apply with the integration of CRCs and non-inpatient facilities.

One of the key differences is the focus of the services to be integrated. It is important to the effective and efficient function of a CRC that the environment in which the services operate is designed to facilitate rehabilitation activities. This will require close consultation with staff of the facility and careful planning in order to ensure that the essential elements of the CRC are preserved in the design and operation of an integrated facility.

CRC Sited Independently, Off-Campus from Auspicing Facility

This model has existed for some time and is commonly a CRC operating as a satellite of an extended care centre or hospital. Some of the advantages of this model are that:

•The centre is perceived as a community facility.

•Clients can see they have progressed from the

hospital to the community.

•A smaller facility and site provides ease of

negotiation for clients.

Many of the issues which arise with this model relate to:

•Isolation from the infrastructure supports and clinical support services, such as medical records or information technology, and the need to provide these at a remote site.

•Decreased opportunities for staff support and specialist involvement.

CRC Linked with Other Ambulatory Care or Day Surgery Services

This is an emerging model for locating community rehabilitation services. The issues are similar to those encountered when siting with other non-inpatient facilities.

2.2Method of Operation

Community Rehabilitation Centres

Rehabilitation is a continuous process which ideally starts from the onset of recovery from sickness or injury.

CRCs are a vital link in the rehabilitation chain and their functions include:

•Preventing undue loss of mental and physical function during illness.

•Assisting clients to recover optimal function and resume their normal way of life without undue delay.

•Helping those for whom permanent disability is unavoidable to regain the maximum possible level of function and to adapt to their residual disability.

Team roles include:

•Rehabilitation

•Community liaison

•Networking

•Community development

•Evaluation and quality improvement

•Education and consultation.

Rehabilitation Role

In order to achieve the overall objectives of rehabilitation, the CRC team should have responsibility for a number of basic client-related functions that may be defined as follows:

•Receive referrals of people in need of community rehabilitation services.

•Conduct assessments which balance the person’s physical and mental health with their social, environmental and economic condition.

•Devise a rehabilitation plan that consists of an individualised package of services consistent with the goals to be achieved and takes into account the personal preferences of the person and carer.