“Behavioral Health Is Part of Overall Health”

“Behavioral Health is part of overall Health,” said Debra Osteen, NAPHS board chair and president of behavioral health, Universal Health Services, Inc. at the start of the recent NAPHS Annual Meeting in Washington, DC. This statement came as no surprise to the many Mental Health professionals attending this yearly conference.

Speaker after speaker talked about the state of mental health care today and the need to seamlessly integrate Mental Health services into the overall medical care provided by family practice physicians and patient care facilities of all types. Because of “parity” legislation passed in congress in 2008 and the passage just last year of legislation for $1B funding  for mental health care for 2017 and 2018, one would have thought a mood of jubilation or at least a sense of well-being would have been present in the conference hall of the Mandarin Oriental Hotel Conference Center.  Instead, the general mood was one of despondence.

The increasing effects of the opioid pandemic are on the minds of all health care professionals. The number of baby boomers who are aging and will need increasing medical services is clear to everyone. Yet, no one knows or can accurately predict how the repeal of the ACA and the proposals for new Republican health care legislation currently being debated in the House of Representatives will affect the future delivery of health care services in America. Various presenters spoke about how funding for Medicaid will be decimated, how future Medicare changes might likely come about, how billions of dollars will be removed from the budget for health care and how millions of Americans will lose access to services. One questioner, at a lunch session presentation by Hemi Tewarson, acting director for National Governors Association Center for Best Practices, Health Division stated, “No matter how you slice and dice it, Congress is proposing to remove $800 B from the budget for healthcare services and nothing is being proposed to replace it.  How then are we, the health care professionals, going to deliver services to the most needy or to anyone, for that matter? ” General applause greeted this question. And no real answer was forthcoming.

Changing Perceptions: Contemporary Artworks in a Healthcare Environment

“Patients First” has always been Cleveland Clinic‘s guiding principle. A place for experimentation and innovation, the leading medical institution constantly seeks to improve patient outcomes. Their Art Program does just that.

Established in 2006 “to enrich, inspire and enliven patients, visitors, employees and the community,” the Program added 3,000 artworks to the Clinic’s existing eclectic collection. Today, over 5,000 artworks in all media: prints, works on paper, photography, sculpture, and video fill in the Clinic’s 23.5 million square feet of real estate.

“Art provides color and warmth, distraction from personal anxiety, Joanne Cohen, Executive Director and Curator of the Cleveland Clinic Art Program told E4H. “It provides moments of levity, lightheartedness and beauty. It alleviates stress and ameliorates patients’ experience.”

Wayfinding is another consideration. The clinic often uses art as a navigational tool. People come in. They are stressed. They can’t remember how to find the doctor, where the emergency room is or where they are parked. Art can help them find their way.

In addition, all studies performed at Cleveland Clinic related to the therapeutic benefits of art revealed its positive impact on patients’ stress, their comfort levels and overall satisfaction.

“Most people said their mood had been somewhat, if not significantly, improved by interacting with the artwork,” she added. “Hopefully this mood improvement will lead to shorter hospital stays and less need for paid medication. In any case, anything we can do to give patients something else to look at or to think about, distract them and take them out of that difficult moment is a win-win situation.”

The Future of the Medical Office?

Located in downtown San Francisco, Forward is an interesting new model for healthcare delivery. It is a meld between an Apple store, a high-end medical office, and a chic members-only health club.We learned about Forward, and its cutting edge delivery model by way of TechCrunch.

The idea of incorporating technology to make healthcare more accessible to the masses has been a growing trend. Health-insurer and insurance-technology startups raised more than $1.2 billion in venture funding in 2015. For perspective, that’s more than double the $570 million raised in 2014, and 10 times the $123 million raised in 2013, according to CB Insights, a data company that tracks private startups and venture capital. With venture capital dollars pouring into the healthcare industry, many predict tech-heavy healthcare delivery models will gain more traction (and market share) in upcoming years.

Is this the future of healthcare? We are excited to see where it goes…

Breakthrough in Autism Research

An exciting breakthrough in autism research was recently published in the highly reputable academic journal, Nature. Scientists have observed brain enlargement in children with autism spectrum disorder (ASD). A retrospective analysis of head circumference and longitudinal brain volume studies in two to four-year-olds indicate increased brain volume may be an early indicator of ASD. These findings suggest an earlier diagnosis may be possible, helping those with ASD and their caregivers better respond to challenges associated with the disorder.

In any given year, 1 in 68 Americans is diagnosed as having autism spectrum disorder, according to the Centers for Disease Control and Prevention.

Jacques Black, AIA, a partner in our New York City office, has completed several projects for the Center for Autism and the Developing Brain in White Plains, NY. Together with Cathy Lord, a clinical psychologist and director of the Center for Autism and the Developing Brain, he has published and presented on the unique dynamics of the built environment and individuals with ASD.  For example, when designing for autistic patients it is important to acknowledge and address their sensitivities to noise, color, and texture.

We are excited about the potential this research has for young families across the world and will continue to seek to better understand how to design spaces which address the unique needs of patients with ASD.

Go Red for Women

Happy Go Red for Women day! Today we show our support for women struggling with and affected by heart disease and stroke.

Did you know heart disease is the No. 1 killer of women, causing 1 in 3 deaths each year? That’s approximately one woman every minute.

Here are a few more facts to keep you in the know: 

  • An estimated 44 million women in the U.S. are affected by cardiovascular diseases.
  • 90% of women have one or more risk factors for heart disease or stroke.
  • Women have a higher lifetime risk of stroke than men.
  • 80% of heart disease and stroke events may be prevented by lifestyle changes and education
  • Fewer women than men survive their first heart attack.
  • The symptoms of heart attack can be different in women vs. men and are often misunderstood – even by some professionals.

Learn more about the warning signs of heart disease and stroke here.

Thoughtful Bariatric Design

Bariatric Design SummaryAs the obese population rises, so does the demand for thoughtfully designed spaces to accommodate obese patients. Bariatric design requires a fundamental shift in how designers approach healthcare environments for bariatric patients. The scale of bariatric furniture and equipment, clearances, and ratings must be carefully considered early on in the design process to meet the unique requirements of these spaces.

The FGI guidelines provide critical clearances and ratings to consider when designing a bariatric patient room. The bariatric patient room requires a larger door, larger clearances around the patient bed and a larger turning radius within the room. The hand washing sink is required to support the weight of a bariatric patient. The toilet room requires a larger shower, more clear space for the toilet, and for fixtures and grab bars that support a bariatric patient.

While it is important to include the above information into designing a bariatric patient room, designing to accommodate a bariatric patient shouldn’t stop there. Will the layout of the headwall work with a wider bariatric patient bed? Is the toilet room sink accessible for a bariatric wheelchair?  Are the counters and cabinets suitable for a bariatric patient? A bariatric patient is more likely to have obese family members. Do the public and family areas accommodate obese family members? Are the bariatric design elements incorporated into the overall design of the building? These are all questions that should be considered when designing a unit serving bariatric patients.

The goal of bariatric design is to provide a comfortable, dignified, and safe environment for bariatric patients, their family, and their healthcare providers. To achieve this goal, it is critical to consider the larger scale and capacity needed in all elements of the healthcare environment and the impact this will have on the design.

Cancer Death Rates Fall


E4H was elated to read the number of deaths from cancer in the United States have dropped 25 percent since hitting a peak in 1991. The report, issued by the American Cancer Society, hit home for a lot of us.

This drop means that 2.1 million fewer people died from cancer between 1991 and 2014 than would have died if cancer death rates had remained at their 1991 level, the researchers said. As mothers, fathers, sisters, brothers and children, we appreciate what a big deal this is for families across the world.

The continuing drops in the cancer death rate are a powerful sign of the potential we have to reduce cancer’s deadly toll,” Dr. Otis Brawley, the chief medical officer of the American Cancer Society, said in a statement. “Continuing that success will require more clinical and basic research to improve early detection and treatment, as well as strategies to increase healthy behaviors nationwide.”

We are proud of our work with both healthcare providers and researchers who work to fight the many forms of this disease.

This story was originally reported in LiveScience


Tracking Cancer


New research out in American Chemical Society (ACS) Nano suggests the approach to tracking cancers may be on the verge of revolution. Liposomes, tiny fatty envelopes, are often used to package anti-cancer drugs as they tend to congregate around loosely bound tumor cells as a matter of biophysics.

Rafael de Rosales of King’s College, London, and Alberto Gabizon of the Shaare Zedek Medical Centre in Jerusalem have treated mice with liposomes doped with radioactive metal ions and shown the special liposomes congregate around an animals’ tumor. What is special about this finding is that these supped up liposomes are visible by positron-emission tomogoraphy (PET) scanning and therefore assist physicians in following the course of drugs.

This new discovery has the potential to assist physicians in better understanding how to target cancers with missile like efficiency. The Economist published an article on this research originally published by ACS Nano.

We are excited by the progress being made in laboratories around the world to fight cancer. We feel privileged to be able to support institutions in making such remarkable strides in life sciences.

Policies on Aging

Gables at East Mountain
Gables at East Mountain

An interesting article on Elder Rights in China was published in this month’s issue of The Journal of The American Medical Association (JAMA) Internal Medicine. Author XinQi Dong, MD, MPH outlined the policies being enacted by the Chinese government to combat changing demographics and cultural expectations for filial duty.

Historically, Chinese families have seen filial piety as the highest of virtues in accordance with the treatise Classic of Filial Piety outlined by Confucius in the 4th century BC. However, these beliefs are being challenged by the Chinese people. In a recent survey by the Center for Strategic and International Studies on East Asian retirement practices only 4% of Chinese respondents believed children or family members should be responsible for proving support to older adults – the lowest percentage of all six Asian countries surveyed.

Although the One Child Policy restricting family size from 1980 to 2015 was repealed, the unintended consequence to demographics is palpable for many young workers. The realities of one working adult expected to support four grandparents and two parents are often overwhelming. Additionally, with the increase of industry around the country, many younger people are moving away from their homesteads in search of economic opportunity.

The disconnection between historical familial expectations and existing practices has forced the Chinese government to look for policy solutions to protect and support its 123 million residents (9% of the population) over 65.  In May of 2016 the Shanghai Ministry of Civil Affairs Bureau, a governmental agency ruling the largest city in China, implemented a new policy to protect older adults and shame children into supporting their families. Children found to lack devotion to their parents are placed on a ‘credit blacklist’, a tool used by the government to prevent individuals from activities such as opening a bank account, purchasing a home, or starting a business.

Dr. Dong, a professor at The Rush University Medical Center Institute for Healthy Aging, brings up an interesting and sensitive topic for many people across the globe – how do we care for our aging family members?

It is an honor to be a part of these discussions within our communities as we design senior living facilities that address the holistic needs of residents, their families and the community. Although we are far from any universal solution, it is encouraging to participate in the ongoing dialogue regarding aging with dignity and care.