5.1 Specific Requirements for Adult Day Care and Adult Day … · 2020. 6. 29. · 5.1 Adult Day Care and Adult Day Health Care Facilities DRAFT 2022 FGI Guidelines for Design and

5.1 Adult Day Care and Adult Day Health Care Facilities

DRAFT 2022 FGI Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 1

5.1 Specific Requirements for Adult Day Care and Adult Day Health Care Facilities

Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.

5.1-1 General

5.1-1.1 Application

5.1-1.1.1 General

*5.1-1.1.1.1 This chapter applies to facilities that provide adult day care and adult day health care services.

A5.1-1.1.1.1 Adult day care and adult day health care (ADHC) facility types. Adult day care and ADHC services are group programs designed to meet the needs of functionally and/or cognitively impaired adults. The facilities that house these programs are an integral component of the continuum of care for the elderly and disabled. These facilities may be freestanding facilities or distinct parts of a general hospital, continuing care retirement community, or other health care facility.

Adult day care and ADHC facilities are designed to accomomodate a structured, comprehensive non-residential program that provides for a variety of health and wellness, social, and support services in a protective setting. Facilities may provide services for multiple care populations or one specialized care population.

a. Many facilities offer specialized services such as programs for individuals with dementia, developmental disabilities, traumatic brain injury, mental illness, HIV/AIDS, and vision and hearing impairments. Typical services offered are listed here:

—Adult day care facilities • Dementia adult day care facilities • Behavioral and mMental health and/or developmental or cognitive

disability adult day care facilities

—Adult day health care facilities • Dementia ADHC facilities • Behavioral and mMental health and/or developmental or cognitive

disability ADHC facilities • PACE (Programs for All-Inclusive Care for the Elderly) adult day health

care facilities • Adult day care hospice facilities. See information in appendix table A3.2-a

(Hospice Care Model Characteristics).

b. Adult day care and ADHC facilities provide the following:



—A caring, non-institutional setting for individuals who, for their own safety and well-being, can no longer be left at home alone

—Protected, safe, and secure settings —A mixture of health and support services

c. Each type of facility has unique needs that affect usable activity space requirements:

—Adult day care facilities include programs that are primarily activity-driven, without a clinical component.

—Adult day health care (ADHC) facilities include activities as well as a clinical component. ADHC centers typically include examination and treatment rooms, clinical staff work areas, and other diagnostic and treatment support areas.

—PACE ADHC facilities provide an integrated program of services to participants, including adult day health care, primary care, rehabilitation therapy, socialization, and home health care.

5.1-1.1.1.2 The common elements in Part 2 of the Guidelines for Residential Health, Care, and Support Facilities shall apply to adult day care and adult day health care (ADHC) facilities when they are referenced in this chapter.

5.1-1.1.2 Design Criteria

5.1-1.1.2.1 Sustainable design. See Section 2.2-2 (Sustainable Design Criteria) for requirements for adult day care and ADHC facilities.

5.1-1.1.2.2 Design criteria for accommodations for care of individuals of size. Where the care population includes individuals of size, see Section 2.2-3 (Design Criteria for Accommodations for Care of Individuals of Size) for requirements.

5.1-1.1.2.3 Dementia, behavioral and mental health, and cognitive and developmental disability design criteria. Where the care population includes participants with dementia, behavioral or mental health issues, or cognitive and developmental disabilities, see Section 2.2-4 (Design Criteria for Dementia, Behavioral and Mental Health, and Cognitive and Development Disability Facilities) for requirements.

5.1-1.2 Functional Program

5.1-1.2.1 See Section 1.2-2 (Functional Program) and Section 1.2-3 (Resident Safety Risk Assessment) for requirements.

5.1-1.2.2 Shared Services and Space

*5.1-1.2.2.1 Where an adult day care and ADHC facility is part of (or contractually linked with) another facility, sharing of services and space for home health, dietary, storage, pharmacy, linen, and other services shall be permitted insofar as practical.

A5.1-1.2.2.1 Shared services and space. In some cases, ancillary service requirements will be met by the principal facility and the only modifications necessary will be in the support facility. In other cases, programmatic concerns and requirements may dictate separate service areas.



5.1-1.2.2.2 Where a project calls for sharing or purchasing services from another entity, appropriate modifications in the requirements for space and parking shall be permitted.

5.1-1.2.2.3 An adult day care and ADHC facility located in a facility that houses other services shall have its own identifiable space.

5.1-1.2.2.4 All support spaces shall be permitted to be shared.

5.1-1.3 Reserved

*5.1-1.4 Environment of Care Requirements

See Section 1.2-1.3 (Environment of Care and Facility Function Considerations) and Section 1.2-4 (Environment of Care Requirements) for requirements.

A5.1-1.4 Environment of care. Person-centered care in the long-term continuum of care should address movement away from institutional and traditional models toward models that are more residentially scaled, facilitate wayfinding, and provide a comfortable environment for the population served through provision of appropriate lighting and acoustics.

a. Adult day care and ADHC facilities should be designed to provide flexibility to meet the changing needs of the care population(s) served and the types of care services provided.

b. The facility design should produce a supportive environment to enhance and extend quality of life for facility users and promote their privacy and dignity while they receive care and services.

c. Facility design should maximize opportunities for ambulation and minimize the negative aspects of an institutional environment.

d. The architectural environment should eliminate as many barriers to effective access to and use of space, services, equipment, and utilities as possible.

e. Facilities should provide accessibility for participants with disabilities in accordance with the state or local building code and the Americans with Disabilities Act.

5.1-1.5 Site

5.1-1.5.1 General

See Chapter 1.3 (Site Selection) and Chapter 2.1 (Site Elements) for requirements in addition to those in this section.

*5.1-1.5.2 Facility/Community Access

A5.1-1.5.2 Facility/community access

a. Where possible, the facility should be located at street level or equipped with ramps or elevators to allow easy access for individuals with disabilities.



b. A covered entrance should be provided to protect participants from inclement weather.

c. A space (zone of transition) should be created as a physical buffer between entry spaces and program spaces and as an experiential buffer that signals transition from home to day care program.

d. The entry and reception area should be separate from the primary program space and not visually accessible from it.

*5.1-1.5.2.1 Emergency access. Fire department and emergency vehicle access shall be provided in accordance with local requirements.

A5.1-1.5.2.1 Emergency access. Other vehicular or pedestrian traffic should not conflict with access for emergency vehicles.

5.1-1.5.2.2 Availability of transportation. See 2.1-2.2 (Availability of Transportation) for requirements.

5.1-1.5.2.3 Security. See Section 2.1-2.3 (Security) for requirements.

5.1-1.5.2.4 Access to utilities. See Section 1.3-2.4 (Access to Utilities) and Section 2.1-2.4 (Access to Utilities) for requirements.

5.1-1.5.3 Site Features

5.1-1.5.3.1 Roads. See Section 2.1-3.1 (Roads) for requirements.

5.1-1.5.3.2 Pedestrian walkways. Accessible paved walkways shall be provided for pedestrian traffic.

5.1-1.5.3.3 Parking

(1) In the absence of local requirements, each facility shall have parking spaces to satisfy the needs of users, staff, and visitors.

(2) Reduction of parking requirements shall be permitted, as acceptable to local authorities having jurisdiction (AHJs).

5.1-1.5.3.4 Signage and wayfinding. See Section 1.2-4.5.3 (Signage and Wayfinding) and Section 2.4-2.2.12 (Signage and Wayfinding) for requirements.

5.1-1.5.3.5 Site lighting. See Section 2.1-3.5 (Site Lighting) for requirements.

5.1-1.5.3.6 Landscape features

(1) General. See Section 1.2-4.5.1 (Light) and Section 1.2-4.5.2 (Views of and Access to Nature) for requirements.

(2) Outdoor water features. See Section 2.1-3.6.3 (Outdoor Water Features) for requirements.

5.1-1.5.4 Building Orientation

See Section 1.2-2.2.2.2 (1) (Site) and Section 2.2-2.1 (Sustainable Site Design) for requirements.



5.1-2 Participant Areas

5.1-2.1 General

The facility shall have sufficient space, furnishings, gardens or other outdoor space, and equipment to accommodate the range of program activities and services for the number of participants to be served.

5.1-2.2 Reserved

5.1-2.3 Participant Community Areas

5.1-2.3.1 General

See Section 2.3-2.3.1 (Resident, Participant, and Outpatient Community Areas—General) for requirements.

*5.1-2.3.2 Lobby

Where a central lobby is provided as part of the day care center, see Section 2.3-2.3.2 (Lobby) for requirements.

A5.1-2.3.2 Vehicular drop-off and pedestrian entrance. The length of the covered/canopied entrance should be determined by the number of accessible vans to be accommodated. The number of vans should be determined by the number of participants being served.

5.1-2.3.3 Dining, Recreation, and Lounge Areas

5.1-2.3.3.1 General. See Section 2.3-2.3.3.1 (Dining, Recreation, and Lounge Areas—General) for requirements.

*5.1-2.3.3.2 Dining area. See Section 2.3-2.3.3.2 (Dining areas) for requirements.

A5.1-2.3.3.2 Dining area

a. Dining should occur in a space that is visually and spatially distinct from activity areas.

b. Depending on the care population being served, no single dining seating should serve more than 16 participants to decrease the potential for unpredictable social and sensory stimulation.

c. Refer to Keith Diaz Moore, “Design Guidelines for Adult Day Services” in AIA Report on University Research 2005 for additional information and further detail on toilets, dining, and the zone of transition.

*5.1-2.3.3.3 Recreation, lounge, and activity areas

A5.1-2.3.3.3 Recreation, lounge, and activity areas

a. Typically, inclusion of two to three dayrooms provides the opportunity to have distinct activities in each area based on the care population being served.



b. Access to outdoor activity spaces from recreation, lounge, and activity areas should be considered. See Section 5.1-2.8 (Outdoor Activity Spaces) for requirements.

c. Provision of a den or hearth room close to the lobby and reception area should be considered. Participants often use this space as a library, computer area, and living room-type setting.

(1) Spaces for different activities shall be provided based on the care population served.

(2) Space requirements

(a) Net usable space. Only spaces used by participants shall be counted as net usable activity space. Reception areas, storage areas, offices, restrooms, and service areas shall not be included.

(i) Where a warming/serving kitchen pantry or participant social activity kitchen is used for activities other than meals, 50 percent of the floor area shall be permitted to be counted as activity space.

(ii) A commercial kitchen shall not count as activity space.

(iii) Where a clearly marked corridor is treated as a wandering pathway with lean rails or handrails, 100 percent of the floor area shall be permitted to be counted as activity space.

(b) Area. Minimum square footage requirements shall be based on the services offered by the adult day care or adult day health care (ADHC) facility.

(i) A minimum of 100 square feet (30.48 9.29 square meters) shall be provided for each of the first five participants and 60 square feet (18.28 5.57 square meters) of net usable program activity space for each participant thereafter.

(ii) Where the facility offers physical rehabilitation therapy, an additional 50 square feet (15.24 4.65 square meters) of space per participant using the therapy space at one time shall be provided for activity space needed for equipment and treatment.

(iii) For facilities that serve residents with dementia, an additional 40 square feet (12.19 3.72 square meters) of space shall be provided per participant to allow for at least two separate spaces for socializing in small groups. See Section 2.2-4 (Design Criteria for Dementia, Behavioral and Mental Health, and Cognitive and Developmental Disability Facilities) for additional requirements.

(iv) For facilities that serve residents with behavioral and mental health and/or developmental disabilities, an additional 70 square feet (21.33 6.5 square meters) of space shall be provided per participant to make it possible to maintain the therapeutic milieu. See Section 2.2-4 (Design Criteria for Dementia, Behavioral and Mental Health, and Cognitive and Developmental Disability Facilities) for additional requirements.

5.1-2.3.3.4 Support areas for dining, recreation, lounge, and actvity locations

(1) All communal activity areas shall have access to a hand-washing station.



(2) Toilet rooms. The adult day care facility shall have at least one toilet for every 10 participants and fraction thereof.

(a) Location. A participant toilet room shall be located adjacent to dining, recreation, lounge, and activity areas.

(b) Type

(i) Toilet rooms shall be permitted to be an individual toilet room or a toilet room with multiple stalls.

(ii) The facility shall provide a toilet room or toilet stall types to accommodate the level of care provided.

(iii) All facilities shall include at least one toilet room that can accommodate a two-person assisted transfer between participant-operated mobility device and toilet.

(c) Space requirements. Toilet rooms or stalls shall be sized and configured to accommodate staff assistance including use of lifting equipment, where applicable, and accessibility standards that support independent participant use.

(d) The toilet room shall contain the following:

(i) Toilet or stalls with toilets

(ii) Hand-washing station(s)

(iii) Mirror. For requirements, see Section 2.4-2.2.8.7 (Mirror).

*5.1-2.3.4 Participant Kitchen Reserved [relocated to Section 5.1-4.5]

Where kitchen facilities are provided for use by participants, volunteers, and family members, see Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.

A5.1-2.3.4 Participant kitchen. Examples of participant kitchen facilities include a “country kitchen,” a “great room,” or an activity room that supports continued participant involvement in activities of daily living.

*5.1-2.3.5 Personal Services (Hair Salon/Spa) Areas

A5.1-2.3.5 Hair salon ventilation. Mechanical ventilation and exhaust, including negative pressure, 10 minimum total air changes per hour, and exhaust directly to the outdoors, should be provided for hair salons.

*5.1-2.3.5.1 Where hair salon services are offered, a styling bowl and station shall be provided.

A5.1-2.3.5.1 Provision of an adjustable styling bowl should be evaluated based on the needs of the care population.

5.1-2.3.5.2 Location. These facilities shall be permitted to be located with the bathing facilities in Section 5.1-4.2.3 (Central Bathing Rooms or Areas).

*5.1-2.3.6 Family Room



A meeting room shall be provided for private meetings for a participant, staff, and family; for caregiver assessments; and for other activities that require privacy.

A5.1-2.3.6 The family meeting room should have exterior views as well as direct access to the exterior.

5.1-2.3.7 Quiet Room in a Participant Community Area

5.1-2.3.7.1 If the care population includes individuals subject to personal conflicts, agitation, episodic mental disturbances, illness, or similar conditions that require a quiet or low-stimulation, positive-distraction room, a quiet room shall be provided in accordance with Section 2.3-2.3.7 (Quiet Room in a Resident or Participant Community Area).

5.1-2.3.7.2 This room or area shall be considered part of the net usable space for participants.

*5.1-2.3.8 Outdoor Activity Spaces

A5.1-2.3.8 Outdoor activity spaces. Outdoor space(s) should be accessible via short, navigable distances.

5.1-2.3.8.1 See Section 2.1-3.6.2 (Outdoor Activity Spaces) for requirements in addition to those in this section.

5.1-2.3.8.2 Outdoor recreation and/or relaxation area(s) for participants shall be visible and accessible from the common dining, living, and activity spaces.

5.1-2.3.8.3 Outdoor spaces shall have a fence or landscaping to create a boundary that prevents participant elopement.

5.1-3 Diagnostic and Treatment Areas

5.1-3.1 General

See Section 2.3-3.1 (Diagnostic and Treatment Areas—General) for requirements in addition to those in this section.

5.1-3.2 Examination, Observation, and/or Treatment Rooms

See Section 2.3-3.2 (Examination, Observation, and/or Treatment Rooms) for requirements in addition to those in this section.

5.1-3.2.1 For an ADHC facility, a minimum of one examination or treatment room shall be required.

5.1-3.2.2 For a PACE ADHC facility, see federal Programs for All-Inclusive Care for the Elderly regulations for additional requirements.

5.1-3.3 Rehabilitation Therapy Areas

Where a space is used to provide rehabilitation therapy services, the space shall comply with applicable requirements in Chapter 5.3 (Specific Requirements for Outpatient Rehabilitation Therapy Facilities).



5.1-4 Facilities for Support Services

5.1-4.1 General

See Section 2.3-4.1 (Facilities for Support Services—General) for requirements.

5.1-4.2 Facilities that Support Participant Care

5.1-4.2.1 Nursing Office

Adult day health care (ADHC) facilities shall have a nursing office.

5.1-4.2.1.1 Treatment rooms provided for adult day health care (including PACE) centers shall be permitted to fulfill this requirement. See Section 5.1-3.2.2 (ADHC Treatment Room) for information on ADHC treatment room requirements for PACE centers.

5.1-4.2.1.2 Work surface shall be provided in the nursing office.

5.1-4.2.2 Medication Distribution and Storage Locations (Centralized and Decentralized)

See Section 2.3-4.2.2 (Medication Distribution and Storage Locations) for requirements.

*5.1-4.2.3 Central Bathing Rooms or Areas

A5.1-4.2.3 Central bathing rooms or areas. Consideration should be given to privacy when locating entrances to bathing and personal care rooms. Where personal laundry facilities are provided, these may be included with central bathing facilities. Access to a washer and dryer is preferable where participants have incontinence or physical limitations that predispose them to soiling clothing with blood, body fluids, or food spills (e.g., swallowing or chewing problems, shakes or tremors).

5.1-4.2.3.1 Participants shall have access to at least one central bathing/personal care room sized to permit assisted bathing in a tub or shower.

(1) Where a bath or spa tub is provided in this room, it shall be accessible to participants in wheelchairs and other participant-operated mobility devices.

(2) Where a participant shower is provided, see Section 2.5-2.3.3.2 (Accessible showers) for requirements.

5.1-4.2.3.2 A separate toilet and hand-washing station shall be provided in or directly accessible to each bathing area without requiring entry into the general corridor. This toilet can be counted to comply with the requirement for one toilet to 10 participants served.

5.1-4.2.3.3 Access to a grooming location without reentry to the general corridor shall be provided.

(1) This space shall contain the following:

(a) Hand-washing station



(b) Counter or shelf

(c) Mirror

(2) See Section 2.3-4.2.7.3 (Personal Laundry Facilities¾Storage…) for requirements for storage of one change of clothing for each participant.

5.1-4.2.3.4 Special design elements

(1) Door openings. See Section 2.4-2.2.4.2 (Door openings) for requirements.

(2) Thresholds and expansion joint covers. See Section 2.4-2.2.5 (Thresholds and Expansion Joint Covers) for requirements.

5.1-4.2.4 Equipment and Supply Storage

See Section 2.3-4.2.4 (Equipment and Supply Storage) for requirements.

*5.1-4.2.5 Clean Utility Room

A5.1-4.2.5 Clean utility room. The clean utility room may be combined with clean linen storage and/or personal laundry facilities.

5.1-4.2.5.1 A clean utility room shall be provided in each adult day health care facility.

5.1-4.2.5.2 Where the clean utility room is used for preparing participant care items, including assembling supplies or items for home distribution, it shall contain:

(1) Work counter

(2) Hand-washing station

(3) Storage facilities for clean supplies

*5.1-4.2.6 Soiled Utility Room

A5.1-4.2.6 Soiled utility room. The soiled utility room may be combined with the personal laundry facilities and/or the environmental services room.

5.1-4.2.6.1 A soiled utility room shall be provided in each adult day care facility.

5.1-4.2.6.2 The soiled utility room shall contain the following:

(1) Hand-washing station

(2) Clinical sink or equivalent flushing-rim fixture with a rinsing hose

(3) Space for soiled linen receptacles

(4) Space for waste receptacles

5.1-4.2.7 Personal Laundry Facilities



5.1-4.2.7.1 Where personal laundry facilities are provided, see Section 2.3-4.2.7 (Personal Laundry Facilities), except for Section 2.3-4.2.7.4 (Shared facilities), for requirements in addition to those in this section.

5.1-4.2.7.2 Inclusion of personal laundry facilities with central bathing rooms or areas or in conjunction with soiled and clean utility rooms shall be permitted.

5.1-4.2.7.3 Storage of a minimum of one change of clothing shall be provided for each participant in the personal laundry area or near bathing facilities.

5.1-4.2.8 Participant Telephone Access

An area where participants can make and receive telephone calls in private shall be provided.

*5.1-4.2.9 Quiet Room or Observation Area

A5.1-4.2.9 Acoustic recommendations for quiet room or observation area. See Section 2.5-8.3 (Design Criteria for Acoustic Finishes), Section 2.5-8.4 (Design Criteria for Room Noise Levels), and Section 2.5-8.5 (Design Criteria for Performance of Interior Wall and Floor/Ceiling Constructions) for recommendations.

Where a quiet space to lie down is provided to accommodate participant observation by staff, the following requirements shall be met:

5.1-4.2.9.1 Capacity. Each room or area shall be provided with a single bed.

5.1-4.2.9.2 Location

(1) A quiet room or area shall be located where it can be clearly monitored.

(2) A quiet room or area shall be permitted to be part of the treatment room (for ADHC) or part of the nursing office.

5.1-4.2.9.3 Space requirements. Circulation space shall be provided to allow transfer from a mobility device to a nursing bed.

5.1-4.2.9.4 Participant toilet room. A toilet room that meets the requirements in Section 5.1-2.3.3.4 (2) (Toilet rooms) shall be located adjacent to the quiet room.

(1) This shall be an individual toilet room or a toilet room with multiple stalls.

(2) This toilet room shall be permitted to be shared by participants using other activity spaces.

5.1-4.3 Support Areas for Staff

5.1-4.3.1 General

Support areas for staff shall be provided that meet the requirements in See Section 2.3-4.3.1 (Support Areas for Staff—General) for requirements except as amended in this section.

*5.1-4.3.2 Staff Lounge Area



A5.1-4.3.2 Staff lounge area. Where the facility capacity is 40 participants or greater, a separate staff lounge should be provided.

5.1-4.3.2.1 The staff lounge area shall meet the requirements of Section 2.3-4.3.2 (Staff Lounge Area) as amended in this section.

5.1-4.3.2.2 The staff lounge area shall be permitted to also serve as a private conference area.

5.1-4.3.3 – 5.1-4.3.4 Reserved

5.1-4.3.3 Staff Toilet Room

See Section 2.3-4.3.3 (Staff Toilet Room) for requirements.

5.1-4.3.4 Staff Storage

See Section 2.3-4.3.4 (Staff Storage) for requirements.

5.1-4.4 Support Areas for Family and Visitors

5.1-4.4.1 General

For shared private meeting areas, see Section 5.1-4.11.1.1 (Conference space) for requirements.

5.1-4.4.2 Reserved

5.1-4.4.3 Pet Accommodations

Where pets are permitted, see Section 2.3-4.4.3 (Pet Accommodations) for requirements.

5.1-4.5 Food Service Facilities

5.1-4.5.1 General

5.1-4.5.1.1 The type and size of the adult day care or adult day health care facility shall determine the dietary environment and the food service facilities provided.

5.1-4.5.1.2 Where the following food service facility types are provided, they shall meet the requirements in Section 2.3-4.5 (Food Service Facilities):

5.1-4.5.2 Commercial Kitchen

5.1-4.5.3 Retail Kitchen

5.1-4.5.4 Household Kitchen

5.1-4.5.5 Social Activity Kitchen

5.1-4.5.6 Outpatient Therapy Kitchen

5.1-4.5.7 Warming/Serving Kitchen

5.1-4.5.1 Centralized Commercial Kitchen



Where a centralized commercial kitchen is provided, it shall comply with Section 2.3-4.5 (Food Service Facilities).

5.1-4.5.2 Warming/Catering Kitchen

For facilities that have a service contract with an outside vendor for food service, provision of a warming/catering kitchen designed in accordance with the following requirements shall be permitted.

5.1-4.5.2.1 Where an outside vendor is used to provide meals, the facility shall include dedicated space and equipment for a warming kitchen, including space for minimal equipment for preparation of breakfast, lunch, or emergency meals.

5.1-4.5.2.2 Use of the participant kitchen in Section 5.1-2.3.4 (Participant Kitchen) shall be permitted as an alternative location to accommodate the function of a warming kitchen.

5.1-4.5.3 Decentralized Kitchen

Where food preparation is conducted on-site, the facility shall have dedicated non-public staff space and equipment for preparation of meals. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.

5.1-4.6 Reserved

5.1-4.7 Materials Management Facilities

See Section 2.3-4.7 (Materials Management Facilities) for requirements.

5.1-4.8 Waste Management Facilities

See Section 2.3-4.8 (Waste Management Facilities) for waste collection, storage, and disposal requirements.

5.1-4.9 Environmental Services Rooms

See Section 2.3-4.9 (Environmental Services Rooms) for requirements.

5.1-4.10 Facilities for Engineering and Maintenance Services

See Section 2.3-4.10 (Facilities for Engineering and Maintenance Services) for requirements.

5.1-4.11 Administrative Areas

*5.1-4.11.1 Office and Conference Space

Offices or an open office area with private conference space shall be provided for business transactions and participant assessments and for the use of administrative and professional staff.

A5.1-4.11.1 Office and conference space. Provision of the following office space should be considered:

a. One director’s office at 140 square feet (13 square meters)

b. One activity professional’s office at 140 square feet (13 square meters)



*5.1-4.11.1.1 Conference space. Space for private conferences and meetings, including participants meeting with staff, visitors, and family, shall be sized to accommodate operational needs.

A5.1-4.11.1.1 Kitchenette for conference space. Provision of kitchenette facilities, including under-counter refrigerator, microwave, and sink, for this space should be considered.

(1) Sharing of space by several services shall be permitted.

(2) For PACE ADHC facilities, medical professional offices shall be provided in accordance with PACE regulations.

5.1-4.11.1.2 General office space. Staff office space and file storage shall be provided based on the staff required to operate the adult day care center and the services being provided.

5.1-4.11.2 Equipment and Supply Storage

Space for storage of office equipment and supplies shall be provided based on staff requirements and participant needs.

5.1-5 Design and Construction Requirements

5.1-5.1 Building Codes

See Section 2.4-1.2 (Building Codes and Standards) for requirements.

5.1-5.2 Architectural Details, Surfaces, and Furnishings

5.1-5.2.1 General

See Section 2.4-2.1 (Architectural Details, Surfaces, and Furnishings—General) for requirements.

5.1-5.2.2 Architectural Details

5.1-5.2.2.1 General. See Section 2.4-2.2.1 (Architectural Details—General) for requirements.

5.1-5.2.2.2 Corridors. See Section 2.4-2.2.2 (Corridors) for requirements.

5.1-5.2.2.3 Ceiling height. See Section 2.4-2.2.3 (Ceiling Height) for requirements.

*5.1-5.2.2.4 Doors and door hardware

(1) Doors and door hardware shall meet the requirements in this section and in Section 2.4-2.2.4 (Doors and Door Hardware).

A5.1-5.2.2.4 Door protection. See appendix section A2.4-2.2.4 (Door protection) for recommendations.

(2) (1) Door type

(a) Doors to all rooms containing bathtubs, showers, and toilets for participant use shall be hinged, sliding, or folding.



(b) Manual or automatic sliding doors shall be permitted where their use does not compromise fire and other emergency exiting requirements.

(2) Door openings. See Section 2.4-2.2.4.2 (Door openings) for requirements.

(3) Insect screens. See Section 2.4-2.2.4.3 (Insect screens) for requirements.

5.1-5.2.2.5 Thresholds and expansion joint covers. See Section 2.4-2.2.5 (Thresholds and Expansion Joint Covers) for requirements.

5.1-5.2.2.6 Windows. See Section 2.4-2.2.6 (Windows) for requirements.

5.1-5.2.2.7 Glazing materials. See Section 2.4-2.2.7 (Glazing Materials) for requirements.

5.1-5.2.2.8 Hand-washing stations

(1) See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

(2) Omission of the mirror shall be permitted.

5.1-5.2.2.9 Grab bars

*(1) Grab bars shall be installed at all participant toilets, showers, and tubs.

A5.1-5.2.2.9 (1) Grab bars in toilet rooms

a. Grab bars in toilet rooms should allow participants to be as safe and independent as possible. This includes using swing-up grab bars, where needed, with or without integral toilet paper holder.

b. Where participants who require a physical lift by two staff members are served at the facility, toilets used by participants should have a minimum clearance of 24 inches (60.96 centimeters) from the centerline of the toilet bowl to the wall to enable physical access and maneuvering by staff, who may have to assist the participant in wheelchair-to-toilet transfers and return.

c. Grab bars in toilet rooms should allow staff to complete a two-person transfer for a single participant. This includes evaluation of the toilet in relation to the wall and the grab bars provided. Clearance is required on both sides of the toilet for a double transfer to occur.

(2) Alternative grab bar configurations. See Section 2.4-2.2.9.3 (Alternative grab bar configurations) for additional information.

(a) Where independent transfers are feasible, alternative grab bar configurations shall be permitted.

(b) The care population shall be evaluated to determine alternative grab bar configurations that meet specific participant needs.

(3) For wall-mounted grab bars, a minimum clearance of 1.5 inches (3.81 centimeters) from walls shall be provided.

(4) Grab bar load requirements shall be evaluated for alignment with the needs of the care population.



(a) Grab bars, including those that are part of fixtures such as soap dishes and toilet paper holders, shall have the strength to sustain a concentrated load of 250 pounds (113.4 kilograms).

(b) Where a population includes individuals of size, grab bars installed in areas intended for use by individuals of size shall be anchored to sustain a minimum concentrated load of 800 pounds (362.87 kilograms).

(5) Grab bars shall have a finish color with a value that contrasts with the adjacent wall surface.

(6) Grab bars shall be returned to the wall or floor with eased corners where a mitered corner condition exists.

5.1-5.2.2.10 Handrails and lean rails. Where handrails or lean rails are provided, see See sections 2.4-2.2.10.1, 2.4-2.2.10.2, and 2.4-2.2.10.5 through 2.4-2.2.10.10 in Section 2.4-2.2.10 (Handrails and Lean Rails) for requirements.

*5.1-5.2.2.11 Protection from heated surfaces. Where cooking accommodations are provided for participants for activities for adult day care, emergency shutoffs shall be provided.

A5.1-5.2.2.11 Protection from heated surfaces. Many adult day care facilities include activity and/or rehabilitation kitchens that may be used in a support hub or country kitchen. Heated surfaces referenced in this section are intended to include those surfaces to which participants have normal access that exceed 110ºF (43ºC). This requirement does not extend to medical or therapeutic equipment.

5.1-5.2.2.12 Signage and wayfinding. See Section 2.4-2.2.12 (Signage and Wayfinding) for requirements.

5.1-5.2.2.13 Decorative water features. Where decorative water features are used in the facility design, see appendix section A2.4-2.2.13 (Decorative water features).

5.1-5.2.3 Surfaces

See Section 2.4-2.3 (Surfaces) for requirements.

5.1-5.2.4 Furnishings

See Section 2.4-2.4 (Furnishings) for requirements.

5.1-6 Building Systems

5.1-6.1 General

See Section 2.5-1 (Building Systems—General) for requirements.

5.1-6.2 Plumbing Systems

5.1-6.2.1 General

See Section 2.5-2.1 (Plumbing Systems—General) for requirements.



5.1-6.2.2 Plumbing and Other Piping Systems

See Section 2.5-2.2 (Plumbing and Other Piping Systems) for requirements.

5.1-6.2.3 Plumbing Fixtures

5.1-6.2.3.1 General. See Section 2.5-2.3.1 (Plumbing Fixtures—General) for requirements.

5.1-6.2.3.2 Hand-washing sinks. See Section 2.5-2.3.2 (Hand-Washing Sinks) for requirements.

5.1-6.2.3.3 Showers. See Section 2.5-2.3.3.2 (Accessible showers) for requirements.

5.1-6.2.3.4 Reserved

5.1-6.2.3.5 Clinical sinks. Where clinical sinks are provided in an adult day care or adult day health care (ADHC) facility, see Section 2.5-2.3.5 (Clinical Sinks) for requirements.

5.1-6.2.3.6 Portable hydrotherapy whirlpools. Where portable hydrotherapy whirlpools are used in an adult day care or ADHC facility, see Section 2.5-2.3.6 (Portable Hydrotherapy Whirlpools) for requirements.

5.1-6.3 Heating, Ventilation, and Air-Conditioning (HVAC) Systems

5.1-6.3.1 General

5.1-6.3.1.1 Application. For basic HVAC system requirements for adult day care and ADHC facilities, see ANSI/ASHRAE Standard 62.1: Ventilation for Acceptable Indoor Air Quality.

5.1-6.3.1.2 Ventilation and space conditioning. See Section 2.5-3.1.2 (Ventilation and Space Conditioning) for requirements.

5.1-6.3.2 Mechanical System Design

See Section 2.5-3.2 (Mechanical System Design) for requirements.

5.1-6.3.3 HVAC Requirements for Specific Locations

5.1-6.3.3.1 Participant and related support areas. See ANSI/ASHRAE Standard 62.1: Ventilation for Acceptable Indoor Air Quality for basic HVAC system requirements.

5.1-6.3.3.2 Fuel-fired equipment rooms. Where rooms with fuel-fired equipment are provided, see Section 2.5-3.3.2 (Fuel-Fired Equipment Rooms) for requirements.

5.1-6.3.3.3 Areas of refuge. Where areas of refuge are provided, see Section 2.5-3.3.3 (Areas of Refuge) for requirements.

5.1-6.3.3.4 Commercial food preparation areas. Where commercial food preparation areas are provided, see Section 2.5-3.3.4 (Commercial Food Preparation Areas) for requirements.

*5.1-6.3.4 Thermal and Acoustic Insulation

See Section 2.5-3.4.1 (Thermal and Acoustic Insulation—General) for requirements.

A5.1-6.3.4 Thermal and acoustic insulation



a. See ASHRAE 90.1: Energy Standard for Buildings Except Low-Rise Residential Buildings for more information.

b. Provisions for acoustic insulation should meet or exceed local building code requirements.

c. Consideration should be given to construction of demising walls and floors in a manner that provides for speech privacy between occupied spaces and between floors.

5.1-6.3.5 HVAC Air Distribution

See Section 2.5-3.5 (HVAC Air Distribution) for requirements.

5.1-6.3.6 HVAC Filters

5.1-6.3.6.1 General. See ANSI/ASHRAE Standard 62.1: Ventilation for Acceptable Indoor Air Quality for requirements.

5.1-6.3.6.2 Filter efficiencies. See Section 4.1-6.3.6.1 (Filter efficiencies) for requirements.

(1) For centralized recirculated systems, MERV 7 shall be the minimum filter efficiency for the first filter bank. There is no minimum filter efficiency requirement for the second filter bank.

(2) For non-central recirculating room systems, HVAC units shall:

(a) Not receive nonfiltered, nonconditioned outdoor air.

(b) Serve only a single space.

*(c) Include the manufacturer’s recommended filter for airflow passing over any surface that is designed to condense water. This filter shall be located upstream of any such cold surface so that all of the air passing over the cold surface is filtered.

A5.1-6.3.6.2 (2)(c) Filters for recirculating room systems. Filters should be replaced and/or cleaned per the manufacturer’s recommendations to maintain indoor air quality.

5.1-6.3.7 Heating Systems, Cooling Systems, and Equipment

See Section 2.5-3.7 4.1-6.3.7 (Heating Systems, Cooling Systems, and Equipment) for requirements in addition to those in this section.

5.1-6.3.7.1 Heating systems. Adult day care and ADHC facilities shall have a permanently installed heating system capable of maintaining an interior minimum temperature of 72° F (22° C) under heating design temperatures.

5.1-6.3.7.2 Cooling systems. Adult day care and ADHC facilities shall be configured and equipped with a cooling system capable of maintaining an interior maximum temperature of 75°F (24°C) under cooling design temperatures.

5.1-6.4 Electrical Systems



5.1-6.4.1 General

See Section 2.5-4.1 (Electrical Systems—General) for requirements.

5.1-6.4.2 Power-Generating and Storing Equipment

5.1-6.4.2.1 Essential electrical service

(1) Adult day care and ADHC facilities that require essential electrical systems shall comply with the appropriate occupancy requirements of NFPA 101: Life Safety Code.

(2) As required by local codes and the care types, an essential electrical source shall provide emergency lighting and/or power during an interruption of the normal electrical supply.

5.1-6.4.2.2 Generators. Where generators are used in adult day care and ADHC facilities, exhaust systems (including locations, mufflers, and vibration isolators) for internal combustion engines shall be designed and installed to minimize objectionable noise.

5.1-6.4.3 Electrical Receptacles

See sections 2.5-4.3.1, 2.5-4.3.2, 2.5-4.3.4, and Electrical receptacles shall meet the requirements in Section 2.5-4.3 (Electrical Receptacles), except the requirements at Section 2.4-4.3.3 (Receptacles in Resident Rooms and Dwelling Units) for requirements.

5.1-6.4.4 Electrical Requirements for Areas Serving Ventilator-Dependent Participants

Where ventilators are used in an adult day health care center, see Section 2.5-4.4 (Electrical Requirements for Ventilator-Dependent Resident Rooms and Areas) for requirements.

5.1-6.5 Communication Systems

Communication systems shall meet the requirements in Section 4.2-6.5 (Communication Systems).

5.1-6.5.1 General

See Section 2.5-5.1 (Communication Systems—General) for requirements.

5.1-6.5.2 Call System

5.1-6.5.2.1 General. Where call systems are provided, the use of alternative technologies, including wireless systems, shall be permitted.

(1) Where wireless systems are used, consideration shall be given to electromagnetic compatibility between internal and external sources.

(2) Wireless systems shall comply with UL Standard 2560: Standard for Emergency Call Systems for Assisted Living and Independent Living Facilities.

5.1-6.5.2.2 Reserved

5.1-6.5.2.3 Emergency call system. An emergency call system shall be provided in adult day care facilities.



*(1) An emergency call device shall be provided at each toilet, bath, shower room, and examination, observation, or treatment room.

A5.1-6.5.2.3 (1) Emergency call devices. Based on the care population served, physical therapy, quiet rooms, fitness and exercise areas, pool areas and other therapy areas, and other common areas should be evaluated for incorporation of emergency call system stations. This evaluation should consider the care model, care population, scale of the facility, and staff sight lines for observation.

(2) The device shall be accessible to a person lying on the floor. Inclusion of a pull cord or portable wireless device shall satisfy this requirement.

(3) The signal shall activate a visual and/or audio signal located at an appropriate location and/or a handheld mobile device carried by staff.

(4) Emergency call systems shall be listed by a nationally recognized testing laboratory.

5.1-6.5.3 Technology Equipment and Teledata Room(s)

5.1-6.5.3.1 General

(1) See Section 2.5-5.3.1.1 (Technology Equipment and Teledata Room—Purpose) for requirements.

(2) Number. Each adult day care and ADHC shall have a room or closet to accommodate technology systems used in the facility.

5.1-6.5.3.2 Size. See Section 2.5-5.3.2 (Size) for requirements.

5.1-6.5.3.3 Location and access. See Section 2.5-5.3.3 (Location and Access) for requirements.

5.1-6.5.3.4 Technology equipment room facilities. See Section 2.5-5.3.4 (Technology Equipment Room Facilities) for requirements.

5.1-6.6 Electronic Safety and Security Systems

See Section 2.5-6 (Electronic Safety and Security Systems) for requirements.

5.1-6.7 Daylighting and Artificial Lighting Systems

5.1-6.7.1 General

See Section 2.5-7.1 (Daylighting and Artificial Lighting Systems—General) for requirements.

5.1-6.7.2 Daylighting Systems in Participant Areas

See Section 2.5-7.2 (Daylighting Systems in Resident Living, Participant, and Outpatient Areas) for requirements.

5.1-6.7.3 Artificial Lighting Systems

5.1-6.7.3.1 Light fixtures. See Section 2.5-7.3.1 (Light Fixtures) for requirements.

*5.1-6.7.3.2 Lighting requirements for specific locations. See appendix section A2.5-7.3.2 (Lighting in transition spaces) for recommendations.



A5.1-6.7.3.2 Lighting for corridors and common areas used by participants. Corridors and common areas used by participants should have even light distribution to avoid glare, shadows, and scalloped lighting effects. See appendix section A2.4-2.1.2.2 (1) (Environmental factors and falls) for additional information.

(1) Reserved

(2) Participant toilet rooms

(a) Toilet rooms shall have general lighting and task lighting.

(b) Task light controls shall be readily accessible to participants.

5.1-6.8 Acoustic Design Systems

See Section 2.5-8 (Acoustic Design Systems) for requirements.

5.1-6.9 Elevator Systems

5.1-6.9.1 General

5.1-6.9.1.1 Application. All buildings having participant and/or staff use areas on more than one floor shall have an electric or hydraulic elevator(s).

*5.1-6.9.1.2 Number. Engineered traffic studies are recommended, but in their absence the following guidelines for minimum number of elevators shall apply:

A5.1-6.9.1.2 These standards may be inadequate for moving large numbers of people in a short time; adjustments should be made as appropriate.

(1) At least one elevator sized to accommodate participant-operated mobility device users shall be required where spaces used by participants are on any floor other than the main entrance floor.

(2) Where adult day or ADHC facilities are part of a general hospital, the hospital’s elevators shall be permitted to meet the requirement in Section 5.1-6.9.1.1 (Application).

5.1-6.9.2 Dimensions and Clearances

Elevator car doors shall have a clear opening of not less than 3 feet 8 inches (1.12 meters).

5.1-6.9.3 Leveling Device

See Section 2.5-9.3 (Leveling Device) for requirements.

5.1-6.9.4 Installation and Testing

See Section 2.5-9.4 (Installation and Testing) for requirements.

5.1-6.9.5 Handrails

5.1-6.9.5.1 Elevator cars shall have handrails on all sides without entrance door(s).

5.1-6.9.5.2 See Section 2.4-2.2.10 (Handrails and Lean Rails) for additional requirements.

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