The basic criterion used in determining the needs for all health care facilities is the ratio of beds to the population served. Generally, we find that there are approximately 1 3.2 beds
Ho&pilal statistics from Health and Hospital Planning Council of Southern New York, 1970 and Long-Term Can? (LTC) Projection, 1973 11 lustrations from Michael B Miller and William N B reger, "How to Plan for Extended Caro Service " Modern Hospital, October 1966
per thousand population. A characteristic distribution of these beds is shown in Fig. 1.
Thus, the characteristic distribution of LTC in all categories is 4.8 beds per thousand, and. equally important, is the understanding that the most significant single characteristic of this patient population is that they are elderly. Their age characteristics are indicated in Fig, 2.
^06 ltc in genertM tjfrt ond
^06 ltc in genertM tjfrt ond
Fig, 2 Age characterises of patient population.
As Or. Michael Miller says, studies of this aging population in terms of their characteristics from a medical viewpoint have indicated that terminal cancer is seen in only 3 to 5 percent of the patient population. Varying degrees of organic brain syndrome, as manifested by memory, intellectual, and judgmental deficits associated with confusion and disorientation, with or without locomotion disability, constitute at least 70 to 75 percent of the patient population. Recent studies indicate that 20 to 30 percent of a nursing home population may be expected to have experienced a significant psychiatric decompensation in the pre-aged period. Of the whole, 40 to 50 percent will demonstrate significant cardio-renal-vascular disease in varying degrees of decompensation. Arthropathies are virtuolly a universal occurrence, although only 20 to 30 percent may
' Synthesis of a Therapeutic Community for Ihe Aged III," published m Geriatrics, vol 21 pp 151-163 August 1966
require specific management techniques. Fifteen to twenty percent of the patient population will present significant visual deficits, and there will be approximately the same number with auditory deficits. Other organ system involvement in the same patient is the rule rather than exception, such as gastrointestinal, pulmonary, neurological, and metabolic disorders. Multiorgan pathology in the chronically aged is a distinguishing characteristic of disability in contrast to other age groups.
The utilization rate differs as well. Extended care facilities, both independent and attached to general hospitals, have an average turnover of 7 to 8 patients per year per bed. ur approximately 40 to 50 day stays, and there are less rapid turnovers for other LTC facilities (proprietary nursing homes, 1.17; voluntary nursing homes, 1,69; voluntary chronic hospitals, 1.30; public home infirmaries, 0.91; average of all LTC facilities, 1,43 per year).
One can conclude as well both from the demographic changes in a society that is proportionately growing elderly and Ihe societal changes of placing the elderly members of society in medically oriented facilities that the LTC facility would have a greater percentage of beds allotted to it proportionately in the future and that this area of health concern would experience real as well as proportional growth.
Another aspect of social planning is the translation of social data into the architectural program. We have found that the ideal method of determining the physical facilities of the building is in terms of the proposed patient population rated by their capacities to perform activities, including daily living, both in terms of their physical capabilities and their behavioral capacities. Tables t to 4 describe the clinical nalure of the patient population under study and give some index of the percentage of patient population in each group. At the conclusion, we will indicate the physical configuration of the nursing units that each group generates,
Group J-Physically Disabled (15-25 percent}?
Patients having significant physical disabilities but with emotional and intellectual intact-ness and the ability to socialize in an open, unsupervised environment, (See Fig. 3-)
Group M- Menially and Physically Disabled (25-30 percent)
Patients with severe physical disabilities with superimposed substantial handicaps of organic brain disease, thus requiring total nursing care for physical disabilities and major supervision for social activities. (See Fig. 4.)
Group III-Custodial (15-25 percent)
Patients presenting moderate or no physical handicaps with either no or minimal emotional or social disabilities, thus able to function in an uncontrolled social milieu. However they
' Based on I .050 patient survey by W Breger at Columbia School of Public Health and Hospital Administration, 1970
function best in o professionally supervised environment. (See Fig. 5.)
Group IV-Mentally Disabled (30-50 percent!
Patients having minimal to mild physical disabilities with major emotional and social disabilities, who therefore require minimal nursing care on n purely physical level but because of the advanced degree of organic brain die-
ease (senility) these patients are essentially totally and permanently disabled. (See Fig 6.)
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