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Physical Environment - Dining & Lounge Space

 

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States

Complete Transcript of State Requirements on Physical Environment - Dining & Lounge Space (PDF)

Federal Regulations & Related F-tags Applicable Federal Regulation
(g) The facility must provide one or more rooms designated for resident dining and activities. These rooms must-
  (1) Be well lighted;
  (2) Be well ventilated, with nonsmoking areas identified;
  (3) Be adequately furnished; and
  (4) have sufficient space to accommodate all activities. | F-464
 
483.70 Physical Environment
483.15 Quality of Life
483.10 Resident Rights

Description of Federal Requirements    (TOP)    (NEXT)

The Federal regulation requires that a facility provide sufficient space and equipment in dining, health services, recreation, and program areas to en­able staff to provide residents with needed services as required by these standards and as identified in each resident’s plan of care. It also requires that the facility must provide one or more rooms designated for resident dining and activities and that the rooms be well lighted, well ventilated, with non­smoking areas identified, be adequately furnished; and have sufficient space to accommodate all activities.


Comparison of State Requirements    (TOP)    (NEXT)

Square footage for dining, lounge, and activity areas is regulated in almost every state. States differ in how they establish square footage requirements in terms of specifying a variety of areas separately or requiring combined square footage for several purposes.  Often the square footage requirements are cast as per ambulatory resident or per residents who are not bedbound. [NH Regs Plus Comment: The problems with this kind of a metric include that: the mix of ambulatory to non-ambulatory residents is changeable whereas the construction tends to be permanent; the state-of-the-art of care would suggest that residents who are not ambulatory have opportunities to leave their rooms; bedbound is a rather antiquated concept given that residents who cannot sit in a wheelchair still can be assisted to leave their rooms, and such residents tend to require more space to accommodate special bedlike chairs.]

Some states also intersperse requirements for furnishings, window views, and other attributes of the spaces.  Below are some examples of different state regulations for dining and lounge space.

Square Footage    (TOP)    (NEXT)

In Texas, “combined living and dining areas should be not less than 19 square feet per bed, but must not be less than ten square feet per bed.” Arkansas, the District of Columbia, and Georgia require minimums of 20 sq. feet per bed and state that at least half of the required area may be used for dining. Colorado requires 10 sq. feet per bed (excluding hallways) of common space.

Existing facilities in Idaho are required to have a minimum of 25 sq. feet per bed of multipurpose areas. Delaware, Iowa, New York, Rhode Island, and Oklahoma require at least 30 sq. feet per bed for the first 100 beds and 27 sq. feet per for bed in excess of 100. Florida requires at least 35 square feet per resident, with a minimum of 225 sq. feet, of which at least 20 sq. feet per resident must be used for dining. Hawaii requires 50 sq. feet per bed for seventy-five percent of total bed capacity. In Indiana space requirements for “living areas” (dining, activity and lounge) increases from square feet per bed for facility licensed prior to June 1970, at least  20 square feet per bed for facilities licensed after June 1970, and 30 square feet for new construction after 1984.  In Maine after July 1994 40 sq. feet per bed of living room and dining areas are required.

Connecticut separates requirements for lounge, recreation and dining space as follows: each wing or floor shall contain at least one lounge of 225 sq. feet or 9 sq. feet per resident, recreation and dining combined be not less than 30 sq. feet per bed and recreation if separated from dining area to include 15 sq. feet per resident.  Ten square feet per resident shall be provided for outdoor porches or paved patio areas. [NH Regs Plus Comment: This reference to a minimum allocation for outdoor porches and patio areas is of interest related to quality of life given that we find, relatively little specificity about outdoor spaces across all the state regulatory language.  We note that the regulation does not specify that the space be located where residents would have easy access.]

In North Dakota, the dining and activities areas may not be the same space. [NH Regs Plus Comment: This proviso is noteworthy for quality of life. Dining room spaces are often wasted for many periods of the day and when permitted, residents can use the space off-hours in ways that enhance resident autonomy, relationships, and enjoyment.  But if the dining room(s) are the only spaces for activity, in-progress games, puzzles, or projects need to be removed for meals, and an eating area is not conducive to many activity purposes.]

In contrast, Ohio regulations state that, “A nursing home may use the dining room or area for recreational purposes when the room or area is not being used for dining.”

Lounge Space and Common Areas    (TOP)    (NEXT)

Connecticut stipulates that areas used for activities must be easily accessible by persons in wheelchairs. The District of Columbia requires that “each social area shall be located along walls that receive at least two (2) hours of direct sunlight a day” and that “each social area shall be attractively furnished and attractively decorated.” The D.C. regulations also require that furniture be arranged so as to facilitate small group conversation and that a refreshment station is located near each social area. Illinois requires that living room furnishings “shall be well constructed and of satisfactory design for the residents.” Oregon requires that every facility have “a solarium, living room, or sun porch for the use of residents on each floor.” South Carolina regulates that, “consideration shall be given to the preferences of the residents in determining an appropriate homelike atmosphere in resident rooms and activity and dining areas.”

Kansas requires a “quiet room” with a minimum floor area of 80 sq. feet, unless each resident room in the facility is a one-bed room. Residents shall have access to the quiet room for reading meditation, solitude, or privacy with family and other visitors. Any facility constructed before 2-15-77 shall not be required to provide a quiet room. In Kentucky, each living room or lounge area and recreation area “shall have an adequate number of reading lamps, and tables and chairs or settees of sound construction and satisfactory design.” In Minnesota, after 11-12-96 if provided a ceramic kiln must be installed in accordance with the Uniform Mechanical Code. Also in Minnesota, a display case for resident projects must be provided. Mississippi requires a “space for hobbies and activities that cannot be included in a day room, living room, or recreational room.”

Dining Spaces    (TOP)    (NEXT)

The District of Columbia regulates that, “the dining area may be used for social purposes when it can be shown that use of the room can be accommodated without interference with the facility's food services.” Hawaii requires that a “sufficient number of tables shall be of proper height to accommodate wheelchair patients.”  In Louisiana, the dining room(s) or area(s) shall seat not less than fifty percent of the licensed capacity of the nursing home at one seating where plans were initially approved by the Fire Marshall after 1-20-1998.  No smoking shall be allowed in these areas during meal time. Nebraska states that the dining area must have an outside wall with windows for natural light and ventilation.  In New Mexico and Wisconsin, dining rooms shall be of sufficient size to seat all residents at no more than two shifts. Dining tables and chairs shall be provided. TV trays or portable card tables shall not be used as dining tables.

In Indiana, room-bound residents must have suitable and sturdy tables or adjustable over-bed tables or other suitable devices and chairs of proper height to facilitate independent eating.  Deficiencies related to dining are addressed in Indiana with the requirement that facilities having continuing deficiencies in the service of resident meals directly attributable to inadequacies in the size of the dining room or dining areas shall submit a special plan of correction detailing how meal service will be changed to meet the resident’s needs.  In Maryland the dining area shall be large enough to accommodate all patients able to eat out of their rooms. There shall be an allowance of at least 12 sq. feet per ambulatory patient; this allowance shall be substantially increased proportionately to wheelchair cases

Food Preparation and Kitchen Areas    (TOP)    (NEXT)

Alabama calls for food preparation areas that will be large enough to “avoid overcrowding and congestion of operations.”  Connecticut requires a commercial dishwasher for any facility with 25 or more beds. The District of Columbia requires locker rooms for male and female food preparation staff. Missouri requires that facilities “shall provide adequate cooking and baking areas. [NH Regs Plus Comment: Much of the state specificity and variation from federal minimums concerning dining rooms, lounges, and common areas seems directed at providing better spaces for living. Presumably, expectations for all residents to be able to be seated in a single sitting or two sittings aim to make large gatherings possible and to avoid residents needing to select undesirable eating times.  The down side is that cavernous dining and lounge spaces do not offer a real residential ambiance.  However, the trend towards dining and living in smaller nursing home neighborhoods may make requirements obsolete or demand interpretation; e.g., the square footage per person may refer to the persons on the unit(s) using the particular lounges or dining rooms. In general, the state requirements on this topic offer innovative facilities considerable flexibility in designing a variety of common space areas.]

New Construction    (TOP)    (NEXT)

New Construction - Square Footage Requirements    (TOP)    (NEXT)

One-third of states explicitly address new construction of dining and lounge space in their requirements, with varying level of detail. For those states that do include these regulations, common topics include square footage, separate recreational and day room space, compliance with standards, and kitchen equipment.

New Construction - Lounge Space and Common Area    (TOP)    (NEXT)

Many of the regulations for new construction of communal areas and day rooms simply stipulate that such spaces must exist. Newly constructed facilities in Oklahoma are not permitted to locate recreational or exercise rooms "directly over resident bed areas unless special provisions are made to minimize such noise."

New Construction - Dining Space    (TOP)    (NEXT)

Again, with dining space, most states who address this simply require that such space exist and meet certain size requirements. Washington goes further, though, requiring that newly constructed communal and dining space be designed "for resident convenience and comfort and to provide a homelike environment. These areas must be located on the same floor as the residents who will use the areas."

New Construction - Food Preparation and Kitchen Areas    (TOP)    (NEXT)

When kitchen equipment is mentioned, as it is by Iowa, Minnesota, South Dakota, and Texas, it is usually to require that it is constructed and installed in compliance with the state's food safety standards. Oregon simply states that all construction, equipment, and installation of food service areas must comply with the state's "food sanitation rules."

Table Comparing States  (TOP)

Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Physical Environment - Dining & Lounge Space by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Physical Environment - Dining & Lounge Space.

483.70 Physical Environment

Dining & Lounge Space
(Note: Certain sections of 483.15, Quality of Life and 483.10 Resident Rights may also apply.)
State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
Alabama Yes Food Preparation Space; Hand-washing; Dish and Utensil Storage
Alaska No No state-specific environmental regulations.
Arizona No Nothing Beyond Federal Minimums
Arkansas Yes Square Feet per Bed (Existing and New Construction); Wallpaper; Kitchen Surfaces; Location of Kitchen (New Construction); Kitchen Work Area; Hand-washing; Kitchen Location, Space, Work Area; Handwashing; Dining Room Square Footage
California No No state-specific environmental regulations.
Colorado Yes Square Feet per Bed
Connecticut Yes Size/Ratio per Resident; Space per Non-Resident (Adult Day Care); Accessible, Storage Space; Square Feet per Resident for Outdoor Porches/Paved Patios; Recreation; Dietary Facilities; Kitchen Location
Delaware Yes Square Feet per Bed; Seating Capacity
District of Columbia Yes Resident Recreation; Furnishings and Decoration; Accessibility; Visiting Space; Square Feet per Resident; Partitions; Special Event Space; Food Service Employee Locker Rooms; Hand-Washing
Florida Yes Square Feet per Resident; Institutional vs. Household Design Models; Food Storage; Hand-washing; Staff Lockers
Georgia Yes Square Feet per Bed; Kitchen Location; Food Storage
Hawaii Yes Square Feet per Bed; Dayroom and Dining Equipment; Accessibility; Multi-Purpose Room
Idaho Yes Square Feet per Bed (Existing vs. New Construction); Recreational Equipment Storage; Square Feet per Bed; Storage
Illinois Yes Living Room and Dining Room Design and Furnishings
Indiana Yes Date Specifics; Square Feet per Bed; Dining Room Size; Deficiencies; Equipment and Supplies; Accessibility; Lighting; Structurally Sound Furniture; Square Feet per Bed; Accessible Restroom
Iowa Yes Square Feet per Bed; Open Area; Accessibility; Storage; Dietetic and Sanitation Equipment; Equipment Installation and Plans
Kansas Yes Square Feet per Resident; Date Specifics; Facility-Size Specifics; Nourishment Area;  Quiet Room; Activities Room; Storage; Food Preparation Equipment and Supplies
Kentucky Yes Equipment; Square Feet per Resident; Storage; Day Care Space; Furnishings
Louisiana Yes Seating Capacity (Date-Specific); Corridors; Furniture
Maine Yes Square Feet per Bed; Furniture; Square Feet per Bed; Window Area
Maryland Yes Furnishings, Size; Square Feet per Patient; Accommodation; Day Room; Kitchen Location; Food Preparation Equipment; Storage; Minimum Space Requirements
Massachusetts No No state-specific environmental regulations.
Michigan No No state-specific environmental regulations.
Minnesota Yes Square Feet per Bed; Dayroom Space; Lighting; Display Space for Resident Projects; Ceramic Kiln; Square Feet per Bed; Day Room Space; Display Space for Resident Projects; Ceramic Kiln; Kitchen Supplies and Equipment
Mississippi Yes Areas; Square Feet per Bed; Special Activities Area; Equipment; Refrigeration Facilities; Food Storage; Day Room; Dining Room Capacity; Storage; Day Room
Missouri Yes Square Feet per Resident; Kitchen Equipment; Hand-washing; Storage; Range Hood; Community Room
Montana Yes Food Preparation Equipment; Hand-washing
Nebraska Yes Outside Wall in Dining and Activities Areas; Square Feet per Resident; Group Dining; No Other Uses; Dining Room Square Feet per Resident
Nevada No No state-specific environmental regulations.
New Hampshire Yes Equipment; Seating Capacity
New Jersey Yes Equipment
New Mexico Yes Seating Capacity; Furnishings; Equipment; Storage; Square Feet per Resident; Multi-Purpose Space
New York Yes Furnishings; Square Feet per Resident; Storage; Equipment; Hand-washing; Communal Areas; Food Service Facility Standards; Communal Area
North Carolina Yes Square Feet per Bed; Adult Care Home Bed; Accessibility; Storage
North Dakota Yes No Combined Space; Square Feet per Bed; Day Room; Toilet Room; Dietary Services
Ohio Yes Date Specifics; Square Feet per Resident; Adult Day Care Program; Separate Dining and Recreational Rooms; Square Feet per Resident; Adult Day Care Program
Oklahoma Yes Square Feet per Bed; Day Care Program; Storage Space; Location of New Construction; Hand-washing; Location of New Construction
Oregon Yes Square Feet per Bed; Storage; Solarium/Living Room/Sum Porch; Food Preparation Areas; Hand-washing; Exceptions; Compliance with Food Sanitation Rules
Pennsylvania Yes Square Feet per Bed; Equipment; Accessibility; Ice Containers
Rhode Island Yes Clean & Orderly; Square Feet per Bed; Storage; Multi-purpose Room
South Carolina Yes Home-like Environment; Square Feet per Resident; Meal Service
South Dakota Yes Equipment; Hand-washing; Storage; Food Service Ventilation; Dietary Department Construction, Equipment, and Installation
Tennessee No No state-specific environmental regulations.
Texas Yes Square Feet per Bed; Outside Window; Nonsmoking Area; Storage; Exits; New Construction; Food Preparation Areas; Hand-washing; Living Room; Windows; Kitchen Facilities, Temperature, and Equipment; Food Storage; Auxiliary Kitchens
Utah Yes Furnishings; General Purpose Room; Square Feet
Vermont Yes Lighting; Ventilation; Sufficient Space; Adequate Furnishings
Virginia Yes Nothing Beyond Federal Minimums
Washington Yes New Construction; Windows; Square Feet per Bed; Storage Space; Toilet Facility; Hand-washing; Equipment; Homelike Environment; Windows; Square Feet per Bed; Day Room; Storage
West Virginia No  No state-specific environmental regulations.
Wisconsin Yes Seating Capacity; Furnishings; Space; Square Feet per Bed; Equipment; Hand-washing
Wyoming Yes Dietary Equipment and Facilities; Clean and Orderly

Complete Transcript of State Requirements on Physical Environment - Dining & Lounge Space    (TOP)