Federal and Georgia law govern how the floorplan of each nursing home may be constructed, as well as how fixtures may be placed in a resident’s room. Some address resident safety, while others address quality of life. On this week’s episode, we discuss Georgia nursing home building requirements, otherwise known as “physical plant standards,” and what they mean for the residents’ well-being.
Schenk: Hey out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’m going to be your host for this week. Very sexy topic this week – we are going to be talking all about the regulations governing the building and construction and how nursing homes should be laid out in the state of Georgia.
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So on the podcast today, we are going into a rather boring topic, and that is what are the origins, where does the requirements for how a nursing home should be constructed come from, and what implications do those regulations have on the overall care that residents receive? So the quick answer to that is that if you’re a long-time listener to this show, you know that nursing homes are governed by both federal law under the OBRA regulations and each state has their own special sauce that they provide nursing homes.
In the state of Georgia, the Georgia Department of Community Health is the agency in charge of what we say promulgating or enacting regulations that function as the guidelines for what nursing homes can do. And I say that because in my opinion, there are not very many what we would call physical plant standards, meaning construction floorplan layout. There are not too many guidelines in the federal regulations. I feel like the federal regulations leave it to the state to determine how facilities should be constructed, laid out, that type of thing. So almost all of the information that we are going to be talking about today comes from the Georgia Department of Community Health’s rules and regulations as opposed to the federal regulations.
And there are plenty. Like I said, a lot of what we talk about stem from federal regulations. With regard to physical plant standards, it’s the opposite. The state has pages and pages of physical plant standards for nursing homes whereas the federal regulations are a little scant on it.
So I wanted to break the episode down into the various components of the nursing home. So we are going to start with the actual room that the resident lives in. What are the requirements for a nursing home resident’s room in Georgia?
So starting off with regard to access, a resident’s room is required to be open to a corridor leading to the exterior of the building. So a room cannot be off somewhere without access to a hallway in which that hallways actually is an exit. No room can be located as to make it necessary for a resident to pass through another room to gain entrance in that hallway. So sometimes what you’ll see is maybe a nursing home will maybe split a room in two or maybe have a room off in the corner where you’ve got to walk through one room to get to another room. You can’t do that. Every room must be open to a corridor, a hallway that goes out. So make sure that whatever room your loved one is placed in, it is for the purposes of being a livable room in that it has that type of open access to an exit.
The next thing is that each patient room shall be an outside room with window space equal to at least one-eighth of the floor area with opening in an area large enough to remove the resident by a mattress. So in other words, you cannot have a resident room on the inside of the building that does not have a window. We require windows because that increases the quality of life. It helps to be able to look outside. It helps in terms of natural light. There’s all kinds of reasons why each resident’s room should be required to have an actual window. So if your loved one is in a room that’s on the inside of the building, that’s a no-no under the Georgia physical plant standards and regulations.
Patient bedrooms shall contain not less than 100 square feet of usable floor space in private or single rooms and no less than 80 square feet per bed for usable floor space in multi-bedrooms. Usable floor space is in addition to area provided for closets, toilet rooms and entryways. So 100 square feet at least in usable floor space in single rooms, 80 square feet if it’s a double room.
This is a must because you need to have room to be able to walk around. You need to have room in order to have dignity, to have quality of life. We’re trying to prevent residents from being crammed into closets or crammed into rooms that weren’t designed to be a livable space for people.
So this next requirement is one that I think is really important, particularly if your loved one is at a fall risk because violation of this particular regulation presents a fall hazard and interrupts the ability for residents to help the – I’m sorry, the staff to help the resident out of bed, and that is that the room, that in the room, not less than three feet of space shall be provided between beds and between the foot of the bed and wall or other obstruction. There shall be sufficient space so beds may be made accessible from both sides for nursing care when needed.
So I have seen clients come in with pictures of their loved ones in these rooms in which there’s furniture and fixtures all around the bed making it impossible to transfer in that bed on both sides or even barely on one side. So that’s something that you should definitely watch out for. There should really be plenty of space to get them out of that bed without having to hit a bedside table or an air conditioning unit or a radiator or whatever the case may be. You really should have a space all around the bed.
So the next thing about residents’ rooms is that each room having more than one bed shall have a permanently installed curtain track to permit closing each bed with curtains to allow for the privacy of each resident without obstructing the passage of other residents either to the corridor or to the toilet. Curtains used for closing resident beds shall be rendered and maintained flame-resistant. So in other words, there needs to be a privacy curtain that goes around the bed if there are two beds in that room and they should be fire retardant. So residents’ rooms have a lot of regulations, so those are just some of the ones that jump out to me in reviewing the regulations.
I want to move onto the requirements for the restrooms, for the “water closets” as it’s referred to in the regulations. I don’t know, growing up, we never used the term “water closet.” I don’t know if that’s just a me thing in my upbringing, we didn’t use that word or maybe it’s an English word. I just know when I moved to Atlanta, in some of the old buildings, there would be a sign that said “WC” with an arrow, like bathroom this way, and I was like, “What the heck is a WC?” and of course it was water closet.
Anyway, just as there are requirements for layout design and space in a room, there are some regulations with regard to water closets or bathrooms as I call them. And that is to say that each room is not necessarily required to have a bathroom, a water closet. Really a water closet or bathroom is only required in two rooms per 50 need to have a bathroom. In general, a bathroom, an enclosed water closet and one lavatory shall be provided for each eight beds on the unit, so there needs to be at least one restroom per eight beds.
And with regard to bathrooms, there is specifically a regulation that says employees, staff and visitors shall not use water closets provided for patients. Toilets, including water closet, lavatory, soap, paper towels and dispensers shall be provided near or adjacent to the nurses’ station, kitchen, lobby area and patient bathing and toileting facilities, so it’s not like the staff should not be able to go into the restroom of your loved one and use it. They should have their own facilities for that purpose.
With regard to – one more thing about restrooms and bathing areas really, the regulations require that unless bathtubs and bathrooms adjoining patient rooms are located so as to be accessible from three sides, handrails or grab bars in the tub or on the wall of the tub shall be provided. All shower stalls shall be at least four-feet by four-feet square and must have handrails on three sides, be equipped with curtains and be designed for wheelchair use. Threshold for showers must be flush with the floor. The floor of the shower should be designed to drain properly. Grab bars securely attached to walls and conveniently located adjacent to all bathtubs, showers and water closets intended by patient use should be provided. So in other words, the flooring area of the bathroom should be flat. It should be slip-resistant. There should be grab bars and guide rails around the bathtub. There should be access to the shower, should be flush, so there shouldn’t be a step over, and it needs to be wheelchair accessible. So the regulations are pretty specific with regard to that.
With regard to the floor plan, what are the requirements for the floor plan? There are several. So one of the things that I wanted to point out because I wanted to only point out the things you have the capability of observing and maybe doing something about, so for example, you’re not going to have access to the laundry room and whether or not there’s an air vent in the laundry room – you can’t go snooping around like Scooby-Doo. So these are some things that I’m pointing out that are just some things to show you that you might be able to observe and point out to the administrator that they can change.
But the main thing about the floor plan that you can observe and take a look at is about nursing stations. The nurses’ station shall be provided in each nursing unit. It shall contain a nurses’ call system, charting desk and supplies, medicine storage, lavatory with soap, towels and towel dispenser, preparation area and refrigerator. The nurses’ station shall not be more than 120 feet from the entrance of the most remote room served. Again, the nurses’ station cannot be more than 120 feet from the entrance of the last room served. So you can eyeball that. You can actually do the foot over foot and measure that out. But if your loved one, particularly if your loved one is not getting the help they need and people aren’t responding to the call light, check and see how far that room is. That might be an issue. They might not be wanting to walk all the way down the hallway to help your loved one, so you might be able to request getting them closer to that nurses’ station. But 120 feet is only as far as they’re allowed to push that nursing station away from the furthest room.
A drinking fountain, which shall not impair any passageway, shall be provided in each nursing unit, so you need to see whether or not there is a water fountain. Hydration, as you know, is extremely important for residents. We’ve talked about that in other episodes, particularly with regard to healing and pressure ulcers. You need to stay hydrated, so to stay hydrated, it’s easier to stay hydrated when you’ve got a fountain nearby.
There shall be a treatment room convenient to resident rooms containing a treatment table, lavatory equipped with soap, paper towels and dispenser, instrument table and storage cabinet and providing adequate room for transfer of patient.
There should be a patient dining and recreation area provided in each home. The minimum total area shall be 20 feet of floor space per bed. So there should be a substantial dining and recreational area in nursing homes. If you don’t see those, that’s a major problem because theoretically these are people’s homes and they should have a place where they can spread out and eat or do activities.
There shall be at least one building exit at ground level and at least one building exit shall be provided with a suitable ramp designed for a stretcher and a wheelchair. There shall be one such exit leading to the outdoor recreation area. So that’s critical that the building exit needs to be at ground level, obviously, and it must be able to be accessed by a stretcher and a wheelchair, so there needs to be a lot of space and it needs to be flat.
Floor, wall and ceiling finishes should be smooth, easily cleaned and be wear-resistant, appropriate to location. In addition, the floors of the following spaces shall be waterproof: toilets, baths, bedpan rooms, floors of pantries, kitchens, utility rooms, janitor’s closets and treatment rooms. Areas subject to wetting shall have non-slip flooring. Carpeting, wall and ceiling finishes shall be approved by the state fire marshal. So what to look out for is to makes sure the floors are actually water resistant where they need to be.
And finally, the patient’s room corridor entrances, meaning the doorway from the room to the outside corridor, to the hallway, and all required exits shall be not less than 44 inches in width. So again, it’s important to be able to get a stretcher, get a gurney and get a wheelchair through the corridors without there being a problem.
So these are many of the design elements required under the federal regulations – sorry, under the state regulations – for nursing homes here in Georgia. So can a nursing home be liable for failure to follow building requirements? You bet you. Typically what happens is if a resident is injured and that resident is injured at least in part because of a failure to adhere to the building code, then the nursing home can be liable, and in many states, not necessarily Georgia but in many states, we call that negligence per se. The regulation was designed to prevent this type of injury and failure to meet the regulation is negligence per se, meaning that’s it. So yes.
But can you sue the nursing home if there’s no injury at all and they’ve violated the regulation? Maybe not. Typically in order to sue for nursing home abuse or neglect, there needs to be some type of an injury, although in some instances maybe not necessarily. So if you walk in and go, “Ah-ha! I got you! The nurses’ station is more than 120 feet from this farthest room. I’m going to sue you,” unless that had something to do with your loved one being injured, then typically that’s not going to be an avenue for you to pursue.
So can you sue? Can a nursing home be liable? Yes, but not in every single instance. You still will typically need to meet the standards of a negligence claim or if the violation of that regulation coincides with some other right that the resident has. So we’ve had other episodes dealing with residents’ rights. It’s possible that a building code violation will be an infringement of a resident’s rights, and that’s something else altogether I made before in another episode.
But again, these are just some of the building requirements, for rooms, for floorplans, for bathrooms, the whole gambit. There are plenty of other ones. Now I’m not saying that you have to become a building inspector for your loved one, but some of these you want to keep in mind that if you go in and you see that there’s clutter around the bed or fixtures around the bed or if the lighting is not right or if doorways are too slim for your loved one to get in and out easily, then that could potentially be a dangerous problem and you want to have them, the nursing home, address those issues. That’s kind of the point of the episode I wanted to have. And I think that’s going to conclude this episode.
Really quick episode about nursing home building requirements. If you’re enjoying the content of the Nursing Home Abuse Podcast, be sure to like and subscribe wherever you get your podcasts from. Check out our YouTube channel. New episodes every other week on Mondays. And with that, we’ll see you next time.