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HomeMy WebLinkAbout1970 09-22 PCP CITY OF D-ROOKLYT4 CEN7'Ep pLAIINING COMMISSION AGENDA Study Meeting December 22, 1.970 Call to Order 29 Izoll call of Iqinutes� November 12, 1970 November 24, 1970 December 3, 10,70 4. Chairinaft' s Explanation: The Planning Cori'mission is an advisory body. one of the COVOissiOW8 functions is to hold public Fearings. in the matters concerned in these hearings, the Columission makes recovaendations to the city council. The CitV- COUncil makes all final decisions on these matters. 5� old Businesst a, Midwest. Planning Report jjc-.,w Dosiness: Brooklyn Park Con►prehe)rtsive Plall 7 . Dj-scvtssit*,)n Items, a. priorltv Schedu1c:L for futul7e Planning Comr, IsSi011 act ion. b. r. ield. TK-y p �,o 50-".,h and Fr�.,,n.ce Industrial D:Lstrict. c, pie fen, of Brooklyn Center Comprehensive Plan, d; Other TWORIKATION SHEET 1. 141MIEST PLAWK1NG REPORT It is anticipated that the Comntission will continue its review of this study. Additional BacKqro4nd_- Mr. Ernst, at the City Council meeting of December 7, 1970, requested the Council t.o take a,-,%-.ion on Application No. 69005 which is related to this study. Refer to page 4 of the loccember 7, 1970, City Council minutes for furt.ber information in regard to Council action. 2, BROO.KLYS PARK COMPREHENSIVE PLAN The C-Lty of Brooklyn Park has requested that Brooklyn Center review their Comprehensive Plan and make comment or those areas that directly affect our City. BrooR.!yn. Park anticipates that they will have a formal hearing on the Plan in early February, therefore it is recommended that the ConLmission forward its comments to the E4.rooklyn Center City Counci';'_ as soon as possible. The eaclosed copies of the Comprehensive Plan are on loan from the Brooklyn Park Planning Department and it would be appreciated if they are not marked or. altered., 3v PRIOR17Y SCIETMOULE The priority sched,ule submitted to the Planning Commission in November is re-submitted for your, review requesting that sequential priorities be plaCed upon the various items. (Note Appendix 1) 4r FIELD TRTP It is req�xested that the Comwissio?n set a date for a field trip to the 50tb and France Tndustrial area. 5„ REVIF.;' OP BROOKLYN CENTER C014PREHEN PLAN It is s,,aggested that review of the Brooklyn Center Compre- hersive Plan should be taken up as soon as possible, even if the Southwest Neighborhood question is not resolved. To date, four of the six Neighborhood comi-Littees have submitted recommendeO changes for review by the Commission. (See .Appendix 11) APPQ\U11-W I it Ls anticipated that the Planning Coranission would u,ant. to g1ve its attention to the following after the 1st of the year. a) Complete the updating of the Comprehensive Plan. b) Review of Pv-3 disitricts as directed by the City lounc-1 in its' minutes of May 254 1970 (Page 3) . c) Review the ramifications of a "0" side yard set baclk as djreCtL,ed by the (.-,.I- ty Council in its minutes of September 14, 1970„ d) Initiate a study regarding transportation facilities within the City. e) Initiate a stuOy in regard to lcyw income housing for -the elderly. Q Review the - Sign Ordinance and specificailly detemaine any need for modifications relative to t3he .freeway development zone. a-) tbe concept, of the Planning Ccmri.-tission detenil.ining final. action in vari.ances and related matters with the City 0ouncil acttitng as the Board of Appeals on related matters,, tStudy suggested by Councilman A,.isell) h) Stud-v (if Soutboast T.--,,'eiq'hborbood. i) joint meeting with. the City Council in regard to corwaterc la). uses within multiple developments. It appears that the aforementioned items are the most. pressing Insofar as future Planning Commission action is coi- cerned and it is submitted to you for your review. MEMO TO-. Planning Commission FROM: Administrative Staff DATE: september 21, 1970 SUBJECT-. I-qursinq Home Report #1 The responsibility for the care of an increasing number of our senior citizens has shifted from the individual and the family, to the community and to society in general. This shift has been brought about by many factors, among which are small homes, change in living palCterns from the rural to the urban mode, and the migration of young people away from their family homes to other areas in pursuit of education and employment,, The basic elements that have com]-Aned to create the need for nursing homes are social and biological factors, While other important elements have contrib-ated to the dictating of this need. our way of life has been transformed by six factors. 1) The change and place of work from home to factory; • 2) The change and locale of residents from farm to city; 3) The change from the multi-generation to the two generation family! 4) . The rise of the great industrial organization; 5) The grovftih of'. autoutation and of leisure time,- 631 The conse.rvation of human life. All of these factors have been more or less unkind to the aged, whose Toles, functions, and status in the society at large have declined at the same time that their numbers have been increasing. People's usefulness. their places in society, and the work that they do now all disappear more or less abruptly as they pass an arbitrary time barrier into the world of the aged. Conservat-ion j.v1plies a deliberate effort to preserve the full usefulness of these people. it does not signify merely an effort to keep them alive. Conservation should be the concern of those who are -responsible for nursing home programs. An older person who enters a nursing home seeks comfort, convenience and • companionship and security. Amenitlies oo longer can maintain for himself in his own home. in addition, as time passes, he finds himself in progressively greater need of specialized nursing care for functions that he is unable to perforra for himself. ideally, the more home life atmosphere then can be found in hospitals should prevail in the nursing home that provides professional nursing service for ill and convalescent elderly patients. As you are aware, the adminAstrative staff has been con- ducting a comprehensive study in regard to nursing home care and regulations, To date the staff has visited a variety of homes providing in most instances the three levels of Patit%Nnt care (board and care, interraittant care, and skilled care) . However, it is apparent to the staff that although- levels of care are similar, there is a distinct difference in patient service, administrative philosophy and individual patient dignity. Although philosophy at a point in time may appear to be rather nebulous, we think it is important to look at it in • depth when comparing the operations of proprietary and non- proprietary nursing facilities. This staff member was particularly struck with the attitude of the proprietary facility. it app,.-eared that once a foxtialitY of discussing the basic types of pativnt care have gone bY the boards, the parartiount, question appeared to be, "Can We Makt:, Money?" . 'rhis was usually brought about by our questions in regard to two, three,. and four beds per unit. -in all instances, proprietary nursing homes, with the exception being tk.-.ie New Hope Nursing Ha-pe, a price was being placed upon a bed and conscq.aerxtl�,-, patien-;s. This is significant in the opinica of the staff because there are other factors beyond monetary to be considered suc.4 as patient dignity, privacy, and a heAlthful social environment. Obstensively, it appears that maximizing income May, in some instances, minimize a patient dignity and social envinoment. C., P. Thompson of the New Hope Mursinc,' Rome pointed oat the crux of the issue when he stated 'Co us that "if he were looXing at his financial stat"'.evient only, then his facility would contain only three and four bed units. ". 'He tarther stated. that the administrator must determine "if he coL,Id conscientiously place • his own mother or father in his facility. " -3- At this point it becomes clear that the attitude of the administrator and his staff becomes a tangible entity, and that those individuals must be much more humanitarian then entrepreneur. It is appropriate at this point to examine the depreciable differences that are recognizable at the non-proprietary facility when compared to the proprietary home. It appeared on the surface that the non-proprietary home, because of the very nature,, were more concerned with the social and religious environment as well as the physical care of the patient. A case in point would be the St. Joseph Nursing 13ome operated by the Little Sister's of the Poor in Northeast Minne- apolis. This facility is rather old and by normal criteria rather densely populated because some wards have up to eight beds per unit. However, it is particularly interesting to note, even -with these handicaps, the facility was excellently maintained and above and beyond that, both patient and staff attitudes • were excellent. There was a rapport among patients and staff not commonly detectable in various other facilities visited. It is the opinion of the staff that perhaps this unusual circumstance is a result of a religious order (Little Sister's of the Poor) that have a 100 year tradition that dedicates them to the care of the poor and elderly. Consequently, it appears that the attitudes of the administrator transcends to the staff and ultimately to the patient. It is the opinion of the staff, that we, as a municipality, can regulate nursing homes effectively in regard to health standards and so forth, however, it goes without saying that it is a very difficult task indeed to regulate attitudes and social environment within nursing facilities. Consequently, it is the opinion of the staff that any nursing home regulations above and beyond those already promul- gated by the minnesota State Board of Ilealth should be, on the face of things, at least a subtle attempt to enhance the social environment of the patient. The following are recommendations of guidelines that the • staff feels should be an integral part of a nursing home ordinance for the City of Brooklyn Center. -4- A. IVTRODU2T_�Off Realistic standards for an effective nursing home should include full time professional nursing care; pil.y . .. si1cal therapy; case work service,- physiciatr-ic attention; consultation by physicians; recreational tberapy; and a dynatuic uncorapromising drive to restore the aged to the s4aue of jp4hysical aad mental well being. This approach calls for a network of services; and it must be complete and systematic and not piece meal and 'haphazard. In recent years the architecture and designs of buildinum intended fax the care of patients has been undergoing a revolution especially in the psychiatric field. There is a _qS2wing recognition that the environment dented by the institutional. setting has a definite effect on the emotional state of the residents livin2i therein and that it is no long--er. sufficient to desicn buildings with the rime focus beincr the convenience of the staff and the institttion. Such factors as the location of the institution, size and s2 ace Rrinci les, harmmon material,, s and .gplorj sam, licity of coLiplexity of arrasnt all .,..121ay an is ortant t. since familiarity of surroundings is extremely iraportan in meeting the emotional needs of residents in nursing homese the architecture of the facility must be one that is familiLar and appropriate to the culture and geograp;hical area from which the patient comes.. B. GENERAL PILANNING 1) Site Although it may seeat that the location of a nursing horiee in the country a-via,,, from the hustle and 'bustle of the city, with beautiful Vista of the countryside may be most appro- priate,, there are many factors to be considered here. Such a site lends itself admirably to the individual seeking ten- porary retreat or assylum from the pressures of life. - owever most persons entering a nursing home vvill probably spend rather long periods in the horae and the experience is not one of temporary retreat. in addition, many of the aged already feel that they have been or are being excluded from the ivain stream of life around thea). and are in need of 'ways to maintain contact with 1--he rnain stream rather then being provided with the means -For a further retreat. The aged, in addition, are often in need of many Odistractions and outside stimuli in order to maintain their interest in life and to prevent further deterioration. Being situated in a pleasant location which is still adjacent to much activity that lends itself to interested passive observers will provide much needed stimulation from the environment. Often the nursing home resident is extremely apprehensive concerning his physical condition and needs the reassurance of knowing that medical facilities that may be needed in emergencies, are nearby and within reach. Location of nursing homes distant from such facilities may do much to enhance the anxiety. Visiting by relatives and friends place an extremely important part in sustaining interezt on the part of the nursing home resident through maintaining contact with the world outside of the home. 2) Color Much information is accumulating in literature as to the effects WE color on the emotional states of residents. Just as with other external stimuli, color may be experienced • physicaily and mentally. Color may be stimulating, exhilarating,: uplifting, or depressing. Color imparts feelings of warmth, sterility, distance and coolness. Through proper harmony, color may induce feelings of relaxation, and tranquility, or by its use in a discordant manner may induce feelings of tension and uneasiness. monotony in the use of color TrIcay Oro ve to be =.-t-rcalcly de . ki:aSsIve. Different parts of the nursing home maybe treated with different color in order to achieve certain desired effects. Studies indicate that older people avoid reds and tend to prefer various soft colors snc],- as cj The use of warm and cheerful colors in entrances and wards and sittincr rooms can provide an atmosphere of stimulation and interest. 3) RLghtiaa The use of lighting can contribute 'fauch to the emotional state of residents, especially the aged. Good lighting will help facilitate an atmosphere of ease and relaxation. Proper lighting can do much to overcome fear, anxiety, and the restlessness growing out of the failure of adequate • lighting to find ones way easily or the type of lighting that cast bazarre shadows. • 4) Ventilation and §SA2,e In years past, in institutional settings there was great concern for providing so many cubic feet of- space per patient resident in a room. 01'Zten Vais leads to extremely high ceilings, resu).ting in rooms of imposing dimensions and overwhelming impact on the individual. Such rooras are far removed from the nonvol living experiences of most and contribute to feelings of uneasiness, anxiety, and some fe;elinga of depersonalization. Focussing rather on the adequate exca7iange of air enables rooms to be designed for the provisions of the care to MaIrly, residents within space lifaitations that are familiar to vtost individuals and are not oveivhelming. 5) Living .2ua ers Per Residents •- Need for Feel of Securitv Any _qood treat),nent is a basic need. to es-'�-_ablish .2rogran a fet1jaZ of security in the residents. Feelings of insecurity engender anxiety, wehicb may in turn lead to • confusion, restlessness, insomnia and an inability to benefit from the treatment program. Such anxiety can be kept to a minimu-m for the patients physical and social, environment and are comprised only of factors to which the patient is able to adapt. Privacyg Although the resident is living in an institutional setting, it is important that he he provided with as many elements of privacy as possible to establish. Caution must be used, however, that the privacy does not lead to isolation, for the feeling of isolation is one of the most serious emotional problems in the aged. Facilities should be so planned as to provide the residents ulitb z socially accept-able degree of privacy in meeting his private needs. Especially -ijaportant is the provision of faciiitie-, for visiting with some degree of pri,,Yacy. The inability to visit with ones friends or relaitives with any degree of privacy over, a prolonged period of time is a highly frustrat-ina, depriving, and embittering experlence, enhancing the f-Eeeling of isolation and separation f%o m the outer wor-ld. Lack. of privacy is also embarrassing to visitors and it • c an Influence i 1h em em to curtail their visii-s. Basic to sound programw-Lng to 1-neet the mental health needs of the aged in institutions and nursing homes is a recognitior that the cause ol* much of the bel,,avior s4:�er L -e is due to -7- • the reaction of the environment. 6) To o c r22hy The site should be located above flood levels and be level or have only a slight slope to aid in drainage. The type of soil at the site should be given serious consideration, particularly if a private sewage disposal system must be constructed. The subterrainean characteristics of the soil must, be considered if private sewage disposal and/or water supply systems are to be used to provide safe and satisfactory operation. The general topography should be considered since very level areas must be provided for aging residents who would walk around the grounds. Grass, trees, and flowers are an asset to the site. Any trees on the site should be protected during construction. 7) Trans 2or ation Public transportation close to the site is an important consideration particularly in cities and urban areas • where the population depends on such means of -L-ran sportatIon. This is not only for the convenience of the visitors who would visit the Datients or residents at the home but also for the residents who are able to leave the home and visit churches, shopping centers and friends. in urban areas, employees may also depend upon public transportation. improved roads' and streets from the caimunity center to the location are almost mandatory. They provide easy access for the doctors* nurses, clergy, staff members, and visitors to the home. They are also needed for dependable delivery of the basic necessities such as food, laundry an6 similar materials. The close proximity to churches, stores and theaters is a valuable asset to those patients or residents xAfho can leave the facility. Such location also promotes visiting of the patients and residents by families, friends and auxilliary groups which provide entertainment and personal services -F-Or the patients. 8) Nuisances and Anao aces The home should not be located near sources of noxio-as • wgr • and/or hazardous fumes or smoke. Locations to avoid are industries creating fumes or smoke, incinerators, dumping grounds and similar business enterprises. The location should be such so as to avoid continuous loud and impact noises such as railroads, airports, and heavy industries. The adjusted m4x::.,°r�urm noise levels is 50 decibels. Consideration should be given to the location of the home away from tl±ose things in tho co. aunitY way have an effect on the mental well. being of the patient or resident. Locations adjacent to cemeteries and :;Funeral, parlors are certainly not condusive to the mental well being to the persons Living in a nursing home or home for the aged. The nearness of hospitals may be desirable from the vimi-- poi t of medical, and nursing profession, but may be, in turn, affect the men}t::al outlook of some patients. C. PATIENT USE AREAS These areas are considered to be those portions of the home • which are primarily used by the patient and are provided for their comfort and general day to day living activities. 1. Patient Rooms The room should be large enough for the patient bed, bedside table, and straight. chair. There should also be space for a comfortable chair. in the rood for the use of the patient or visitors. The roam should be :urge enough for one or two visitors to visit each patient at one times There needs to be ample space to manuver wheel chairs and other self -help apparatus throughout the room. Space consideration also needs to be made for the staff of the nursing home to wort. in the patients room. There must be room fo;r the nursing and house-- keeping personnel to work in the room without disturbing the patient. Beds should not be more then two deep from the outside wall and so placed that all bedridden patients 4n the room can see outside through the windows. i • -9- Present code requirements throughbot the United States vary from 50 square feet per bed to 80 square feet per bed in multiple bedrooms and from 80 square feet to 120 square feet per bed in single rooms. It can be seen that the lower area per bed is difficult or almost impossible to provide necessary space for patients and staff of the nursing home] therefore, generally accepted essential sizes are from 80 to 100 square feet in multiple zooms and from 100 to 125 square feet~ per bed in single rooms Hill.-Burton Standards allows 6 beds, not more than 3 deep front the outside wall in homes over 100 beds however . not more than two beds per patient room is a desirable situation. Floor, wall and ceiling finished materials should be selected for cteanability and fire safety. if a home- like atmosphere is to be provided, plaster and wood fini6hes are indicated„ The flame spreading rate of • any wall or ceiling finish material should be invest .gated or approved by the fire authority prior to its instal.l.ationu Floors must, be smooth and cleanable. Patient rooms should be decorated to avoid the institutional. look. Pastel colors in flat or semigloss paint is recommended, while wrall paper may be used in some instances. Rocris should appear to be airy and bright. Adequate artificial and natural illumination and ventilation must be considered. Artificial illumina'ri.on should be provided in the amount or 30 foot candies. Windows are to be provided not only for light and ventilation bu.t also for vision to 'Cae Qi tz.—Lde; therefore, the window sill should not be more than 2 .feet 6 inches above the floor to enable the bed and chaos-bound patients to see out. - A signal.. system should be provided at each patient's bed so that the patient may contact the nursing service for aid. -10- 2:- Toilet and bathrooms The toilet rooms should be located adjacent to the patient room for convenience and privacy. The location adjacent to the patient's room furthers the bomeli.ke atmosphere. it is necessary only to furnish the toilet and lavatory in this locations the bathing facility is beat located in the central bathroom. Central locations for toilet rooms offer little privacy. Code requirements for the number of toilets and lavatory fixtures vary. F.H.A. minimum standards require one toilet and lavatory facility for every four beds.. The Public Health Service "Nursing Home Standard Guide" and the Burton-Bill Standards recomtends such faci?ities on the basis of one for every S beds for each sex. Toiler rooms reed to be large enough to accommodate wheel chairs. Bathing facilities a :-e best -located in the central areas since the attendants are normally present to aid in bathing. it is recommended that freestanding tubs be provided for ease in assisting patients. Special showers with low walls and no curving should be provided to facilitate handling of patients in wheel chairs. Crab bars should be furnished for all bathing facilities. Emergency call systems should be located in bath, and toilet rooms so that patients or attendants may obtain help when needed. The floors, walls, and ceiling finishes in bath and toilet rooms must be smooth and waterproof. Non-skid floor surfaces are recommended. Mechanical exhaust ventilation is recommended for all bath and toilet rooms even though the room may have a window on the outside wall. 3. Sitti rater' rooms and day rooms. Location of rooms within a facility is a very important consideration. The large central clay room near the front entrance is not ideal., although one large room is usually necessary for entertainment of patients, church services, and similar functions. Many patients will not use such rooms for day to day living purposes Ssince they feet, they are put "on display" to visitors and the general. public. Smaller day roams scattered 1 • throughout the building provide more privacy and promote visiting patients throughout the facility. An ideal means of furnishing living space is to combine small living areas with the patient rooms. Living rooms should be furnished in a n:ome like atmosphere with attractive, serviceable and comfortable furniture provided for ,patients and their visitors. °dotal space recommended for recreational areas, occupational. activities, and patient dining varies with particular crAes. The Public Health. Service "Nursing 14-ome Standard ,aide" recommends 25 square feet of day room space for 75% of the beds in the home. Some state codes recommend 15 square feet of floor space for each bed in the home. Hill-Burton Standards require at least 50 square feet per bed for 759 of the beds. P.R.A. mini-mum property standards for nursing homes recommends a minimum total area of 20 square feet per bed, for dining and recreation. 4. Din inRooms • ideally, dining rooms are reserved for eating purposes, however, they are more often combined with day rooms. They should be furnished and decorated in a tasteful and home like manner. Location of the dining room, and table arrangernent should be such that privacy is afforded patients :from the general public and visitors to the home. Small tables present the best arrangement, persons can then be group::dly physical abilities at meal. time. Outdoor living areas it is essential to afford the patiento of nursing homes an opportunity to enjoy the outdoors in good weather. Therefore, it is necessary for such areas to open at floor level and be provided with ramps so that wheel- chair pattents and those having difficulty in walking will be able to use this convenience. Care should be taken in planning the outdoor living areas since all patients do not lake to be exposed to the public. Certain amounts of privacy are indicated. • 17ursing bm. es with interior courts have ideal outside living areas; ,patients have privacy and there is • little or no possibility of the confused patient wandering from the premises. b w NLWING AND MEDICAL USE AWE 1. Nursing Stations An adequate nursing station is necessary in all nursing homes. These areas are the base of operation For the nursing personnel. in this area are usually located the patient charts, medicine preparation and the counsel of the patient signal system. An area with locked cabinets with the storage and preparation of medicines must; be provided. In many hranies, toilet and hand washing facilities are also provided at the nursing station for nurses and staff use. 2. UtilitX Rooms Utility rooms should be planned in conjunction with • the nursing station. The room should be separate from the station but inclose proximity. ideally, two utility rooms should be provi.dedi one soiled room and one clean room. The soiled utility room is used for disposal of .liquid waste from the bedpans, utensils, collection of solid waste, collection of soiled linens (prior to the transporation to the laundry) and collection of gather soiled materials which may originate in the nursing unit. plumbing facilities should be available to the room for receiving of Liquid haste and the clean. up and sani.t-.ati.on of utensils used in the nursing unit. Clean utility rooms are used for the storage of materials after they have been cleaned and sanitized In the soiled utility room and for storage of other cleaned nursing and medical supplied. 3. Examining or Treatment Room An e::cami.ni.ng or treatment rove is des1rab:f e. The room • is used for examination and treatment of patients b�� the medical. staffs Such treatment nay be given in this room or the patient's room. Hill-Burton Standards, provide for 'the provision of a treatment room., -13- • ri'he room needs to be equipped with a small desk, storage cabinets, examining table and high intensity examining light. 4. Isolation or Special Care Rooms These rooms are essentially single patient bedrooms set aside and specifically equipped for the segregation of patients in need of isolation., The Public }health Service "Nursing Home Standards wide" recommends that there should be at least one such room for every 25 patient beds. Dill-Burton Standards require a minimum of two isolation rooms per nursing home. They should meet the standards for patient rooms in every respect. The following are specific staff recommendations of standards, in addition to the proposed aforementioned guidelines as ,§et forth in this document. 1. Beds Per Unit • Limiting the nun ber to a maxjx um of tv.,7o per unit with a minimum of 200 square feet per unit, would, in the opinion of the staff, provide adequate living facilities for the elderly while at the same time provide for privacy of patients who for the most part are thrust from a home environment to a communual living situation. 2. Internal Open Space Requiring 10% of the gross floor area of the dwelling units of a floor to be devoted to sitting rooms, recreation rooms, party rooms or related activities, not including dining areas. The State Statutes do provide for such facilities but i.t is worded in such a manner to leave the size of such facilities to the descreti.on of the owner. It is the opinion of the staff that the City regulation, should guarantee a minimum area to be devoted for this pu:rpose.n 3. External 0 en Space An area or areas determined by the City Council. exclusive • of parking and driveway areas should be provided for or o en space that would be accessabl.e to the patients,, 0 -1.4.- • 4< Location Nursing homes should be located on collector or arterial type thoroughfare facilities due to the fact that it has been indicated that nursing home patients find it particularly appropriate to be located in high activity areas., 5. ln�.sRecttion It is recommended that the ordinance authorize the City Manager or his representative to make periodic, unannounced inspections of the nursing home facilities to insure that normal health and sanitation practices are being adhered too The State does provide for inspection, houlever, it has been related to us that theyi 1) have been unable in some instances to cover all facilities; and 2) have consistenttily given warnings to violators rather then taking severe remedial. action. 6. personnel Character Chwk it is recommended that all staff personnel of nursing • hoarse facilities be required to .:fear a character check upon application for employment at a nursing :home in the City of Brooklyn Center., it has been indicated to the staff try an expert in the field that some of the greatest instances of drug abuse and related physical and social problems have taken place in facilities such as hospitals and nursing homes where such elicit drug ite,-ns are readily available. 7. Ventilation Nursing 'homes should be well ventilated through the use of windows, forced air, or combination of both. Ventilation is to remove dust, offensive Odors, and excessive heat and moisture. The ventilating space for natural ventilation should not be less than four per cent of the floor area„ when forced air ventilation is used„ the system should change air at least once every aix minutes • A In conclusion, it should be pointed out that this memorandum in no way is attempting to degrade or insinuate the particular facilities visited have abused or mistreated patients in any way, but our staff observations indicate that there are conditions above and beyond routine care that should be recognized. It is important to note that the application of the aforementioned guidelines and standards, in the opinion of the staff, are an important basis for maintAining health and welfare of the patient while at the same time recognizing the social and environmental needs of the nursing home patients