Planning and Design of Behavioral Healthcare Facilities

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today's top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to "manage" disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society's expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to "store" not to "rehabilitate."

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: "Epidemiology of Mental Illness" also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) - defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America's population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing - and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants

Right-sizing

Today's Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for natural light, window views to nature for all patient areas, and outdoor open-air gardens "wrapped" within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

"When you look at the program mix in these buildings, there's a high demand for perimeter because there are a lot of rooms that need natural light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand natural light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint." - James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called "neighborhoods." With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called "houses", of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, "There's a move away from central dining facilities. So, while facilities will still have a central kitchen, it's a whole lot easier moving food than it is patients." However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

"Our approach to designing these facilities is to view the facility as an extension of the community where patients will end up when they're released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible." - Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one's region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to "treat" instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their "business matrixes" and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. "There are three rules I had drummed in me," says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. "First, there can't be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown." Hanchar says that the typical facility is, "a hospital with medium-security prison construction." This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, "Glass walls around nursing stations just aggravate the patients." Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, "The view is that [nursing staff] need to be out there treating their patients."

Therapeutic Design Tenants

As medicine is increasingly moving towards "evidence-based" medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 - most from top peer-reviewed journals - to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness - all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today's therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, "The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity," published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative - natural light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of natural elements on patient recovery and stress reduction. Thus, it is clear that interior designs which integrate natural elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from "the difficult" and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music - and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient's healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of "managing" patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing "quiet hours."

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled "The Contributions of Color" authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.

About the Author
Tara Hill is a full-scope, state registered interior designer, and the founder and principle of Little Fish Think Tank. Before founding Little Fish, Ms. Hill was an Associate + Senior Designer at HOK, and the Director of Interiors at Stanley, Beaman & Sears. She has implemented award-winning, innovative design solutions for commercial and institutional interiors.

Ms. Hill also has significant experience regarding the science and theory of color, both as a design tool and a promoter of healing. She has conducted extensive research in evidence-based design regarding color and its profound impact on the human spirit.

Prior to her work with Norix, Ms. Hill developed the Healing Colors Collection for Corian® solid surfaces, by Dupont®, for the healthcare environment. http://www.golittlefish.net

About Norix Group Inc.

For over 25 years, Norix has offered the most complete line of correctional furniture, for use throughout correctional facilities. With their extensive experience in providing secure furniture for prisons and jails, Norix is a trusted resource for every corrections application.

Norix also offers a vast array of furniture for several industries including behavioral healthcare, commercial, higher education, public safety, GSA and shelters. All furniture is designed for safety, security and extreme durability. Norix intensive-use furniture is extraordinary by design, surpassing industry standards for strength, safety and long-term performance.

3 Top Tips To Help You Succeed With Self Build And Design Home Projects

For most people the idea of a self build and design project would be a new kitchen, bathroom or extension but for several thousand people every year the ultimate project is a complete energy efficient home.

However, there are some hurdles that need to be overcome even if you have a plot of land that is suitable for building on, so as one of the most innovative new self build companies in the UK we thought we would cover 3 top hurdles you will face and offer 3 possible solutions to help you move forward with your self build project.

Self Build And Design Tip #1: Self Build Mortgages, Site Insurance And The CE Mark

As with all home purchases, mortgages tend to be an essential element to successfully securing the house of your dreams and until recently self build mortgages were not high on the priority list for UK banks.

The National Self Build Centre in Swindon have what is believed to be a revolutionary approach to the problem and they offer full consultancy for every aspect of your self build and design project.

The usual way in which self build mortgages are managed is for funds to be released in stages for land purchase and then build costs at various stages. Borrowing will always depend on circumstances and in some cases payments may be released in advance.

What the National Self Build Centre offers is a new concept of self build and design mortgages that allow you total freedom with your self build project by offering a complete self build mortgage insured payment upfront that would allow you to totally manage your project without the constant stopping and starting in between stage payments.

Self Build And Design Site Insurance and The CE Mark

We are used to our NHBC warranties in the UK and it has been the industry standard for decades.

The highest quality log homes from Europe often carry the CE Mark which is a construction certification that guarantees the resistance and strength of the structure..

For most people the thought of a timber house creates an element of fear about fire risks. Most houses in the UK are built with a timber frame and a brick outer skin and a closed door is supposed to allow for a half an hour escape time in the event of a fire. In Europe the standards are twice as strict as in the UK and there must be a one hour escape time.

As for self build site insurance you can now get instant cover and save money with several online companies who now cover this type of construction.

Self Build And Design Tip # 2: Code 6 Houses And Planning Permission

First and foremost there are no guarantees when it comes to obtaining Planning Permission, but as it stands your best chance in an unconventional planning situation is to apply for permission to build a Code 6 Home.

The home will have to be completely zero carbon for example it must have zero net emissions of carbon dioxide (CO2) from all energy use in the home. There are many factors that combine to produce a Code 6 Home including

• Improving the thermal efficiency of the walls, windows, and roof.

• Reducing air permeability to the minimum consistent with health requirements

• Installing a high efficiency condensing boiler, or being on a district heating system

• Using low and zero carbon technologies such as solar thermal panels,

• Reducing domestic water usage, managing surface water and waste and using low energy appliances and lighting within the home and the impact on the environment.

Self Build And Design Tip # 3: Building A House In Your Garden

Planning Permission will generally be granted when it can be demonstrated that the site is capable of accommodating a suitable scheme which adheres to the Local Planning Authority's development control criteria and Local Planning Policy.

If you live in a village or town, the development boundaries are likely to be established and there will be other constraints that need to be considered such as the provision of a suitable and safe access which is a high priority.

Your local County Highways department will often give free advice on whether an access is suitable. Your site is likely to be a non-starter. The site, its constraints and local planning policies form the framework for your self build and design project and at that point design considerations should be discussed.

Pete Cossie of Contemporary Log Living is on a mission to inspire and empower people to look at unique energy efficient self-build home kits, log cabins and Contemporary Affordable Homes to make a great investments in the real estate of tomorrow today.

Protect Your Design Business

Do you know how to protect your creative ideas and the income from them? Do you know how to protect yourself and those who work with you? What about legal responsibilities? Here are some ideas: use them to kick-start the personalized advice you get and the steps you take. Ensure sources of advice and information are properly qualified.

Protect reputation, premises, equipment and people

Precisely what insurance you should get depends on regulations in your country and what type of business you run. But here are several types of insurance commonly held by businesses: professional indemnity; employer's; negligence; fire and theft; buildings; contents; and public liability.

Unbiased information and advice is provided by many organisations, including Chambers of Commerce, reputable business advice websites and professional associations* (see the end of the article for a short list of associations). It is often possible to get discounted insurance through professional associations.

Protect ideas

The most obvious example for a designer is copyright. To help prevent problems, discuss in advance what is your intellectual property (IP) and what is your client's. Organisations including Chambers of Commerce and professional associations often offer workshops or fact-sheets on understanding, and protecting your IP. Specialist IP lawyers also provide advice.

Protect time and money

Assumptions and confusion can sour a promising relationship between a designer and client, and could involve issues like number of revisions included in a job price, amount of time in discussions with the client, acceptable payment timeframe - and many more. Agreeing things in writing before any work starts, perhaps in contract form can help.

Organisations including Chambers of Commerce, professional associations and lawyers usually offer information or advice on this. There are also websites with template contracts, these vary in quality and which country they apply to, but can be a useful starting point.

Protect yourself and other people

You need to understand relevant business law in your country and ensure you comply. Typical areas include premises, equipment, noise levels, chemicals and activities. People who work solo at home, are lone workers, which has its own risks. The government departments in your country that deal with Health and Safety, business, trade or industry often produce easy-to-understand information and advice.

Protect your home and other assets

In some countries the legal type of business formed, for example working solo as opposed to creating a company, affects the level of protection individuals have should a business be sued or fail financially. Organisations including government tax departments, Chambers of Commerce and professional associations often offer information or advice on this.

Protect your money and the tax-man's

You must keep financial records of your business that are in-line with the regulations in your country. Obviously your government's tax department can provide information & advice on this. Chambers of Commerce & professional organisations can also provide information. Don't worry about this, it's usually more simple than you might think!

The great news about keeping financial records, is that many expenses which businesses incur can be used to legally reduce tax payments. Tax departments offer information and advice on what will apply to different businesses. They often provide factsheets and sometimes workshops (which can be good places to meet other business owners and potential clients). Chambers of Commerce & professional organisations can also provide information.

Because business taxes are often paid some months after earning business income, many sources of advice recommended ensuring enough money is saved to pay business taxes, social/national insurances and any other taxes or levies that apply. Sources of advice often suggest saving 25% of your business income.

Protect yourself and the whole business

If you're working for yourself, you must comply with legal business responsibilities in your area. These vary according to your country and type of business. It wouldn't be sensible to think that ignorance of the law would protect anyone. Chambers of Commerce, local government, tax departments, government business departments, professional associations and lawyers can be good sources of information and advice.

* A small selection of professional associations for designers and other creative people

American Institute of Graphic Arts, NZ Institute of Professional Photographers, Chartered Society of Designers, Designers and Art Directors, Australian Graphic Design Association, Association of Photographers, Association of Web Design Professionals, etc.

Use a search engine to find an organisation in your area that fits your needs.

Mhairi Gordon helps design-business-owners and creative freelancers become more profitable and more fulfilled. Get her free eCourse for new design businesses "Designers StressFree StartUp", plus a gift subscription to her Design Business Success eZine at http://www.suitfreebusinesshelpfordesigncompanies.com

How to Sell Disability Insurance - Plan Design Key to Corporate Executive Market

If you're looking for a disability insurance market that is both lucrative and under-penetrated, consider the corporate executive market. Many of the nation's millions of small to mid-size businesses offer employees no disability income protection whatsoever. And, of those that do, the coverage is often inadequate, particularly for middle- and upper-management.

As a result, numerous opportunities exist in the corporate executive market - opportunities you can take advantage of through creative, expert plan design.

A good disability plan design is one that is custom-tailored to fit the unique needs of your client company. Usually, it will include a blend of group and individual features that provide the most coverage at the best price. Such "combination plans" emphasize the strengths of group long term disability and individual non-can while minimizing the drawbacks of each, and are excellent door openers in the corporate executive market.

Ask the right questions.
To begin, approach your prospective clients with questions: What are their problems? What do they want to accomplish? How much coverage would they like to provide? Do they want upper-level executives to have more favorable treatment than others? How much money are they willing to spend?

Questions help clients clarify their disability insurance needs and enable you to explain many of the options that are available. Often, you will need to take an educational role. Group insurance is the only disability product that's been introduced to many employers. The concepts of combination plans, underwriting concessions, and discounting are new to them.

Combination plans are especially attractive because of their flexibility. They can be structured to meet a variety of needs, thereby giving employers great control over their benefit programs.

Determine the right coverage mix.
Traditionally, the standard approach to combination plans has been to add a small amount of individual disability insurance to long term disability - say 20 percent individual added to 40 percent LTD. But more recently the group/individual mix has become more varied, and there is really no longer a "standard" approach. The right mix is determined by the unique make-up and goals of the client company, as well as any concessions the underwriting department is able to offer.

After you have determined the insurance goals of your clients, the next stop is to work closely with a risk manager or advanced underwriter. Always remembering that the primary strength of combination plans is flexibility - both in product blending and in underwriting - it is important to work with underwriters who are thorough professionals in plan design. The knowledgeable underwriter will look at the dynamics of each case to determine the optimum package for the client company and to establish the guidelines under which the case will be underwritten.

Consider Guaranteed Issue.
In large cases, guaranteed issue (GI) frequently replaces individual underwriting. GI means that a disability policy is issued at the standard rate with no restrictions. The size, occupations, incomes, and ages of the group are carefully evaluated in order to establish specific underwriting concessions. Guarantee to issue is a variation on the guaranteed issue offer, in that it is the standard policy but with certain rights reserved by the insurer.

Ensure continuity and flexibility.
If you're looking to replace or enhance an existing disability insurance plan design, the underwriter will want to be certain that nobody loses under the new plan. This is especially important in smaller cases, where the individual portion of the plan design is individually underwritten. Your goal should be to create seamless coverage for everyone in the plan.

A good plan design should also stand the test of time. It must be flexible enough to cover promotions, salary increases, future employees and other personnel changes. In many cases, a well-designed disability plan provides the best coverage for your employer clients. Learning to develop good plan designs can also be highly rewarding for you: You will profit from multiple cases in one sale, add-on sales, and new enrollments. What's more, your client base will grow, as you are able to offer precisely what your customer wants.

To develop and offer the best paycheck protection plan designs, it's important to work with an experienced carrier or distributor. The best carriers have been developing combination plans for many years and have entire departments dedicated to helping producers devise the best plans for their clients.

Offer the best of all worlds.
By developing first-rate disability insurance plan designs, you will be able to offer your clients flexibility and quality - the best of both worlds. And you will have the necessary skills to open new doors in the corporate business market.

Daniel C. Steenerson, CLU, ChFC, RHU, is the President of Disability Insurance Services, headquartered in San Diego, Calif. For more information about disability insurance and to obtain free sales tools and articles, visit http://www.diservices.com.

Polystyrene Beehives Design Concepts for British National Hives

The most important consideration when designing a new polystyrene beehive is to ensure compatibility with existing wooden and polystyrene beehives. If every manufacturer designs their own beehives independently and without reference to the existing designs, they will probably not be compatible with each other. This would ultimately lead to a lack of consumer confidence whereby beekeepers would not know what was compatible with their existing beehives, both wooden and polystyrene. By manufacturers following a few common design principles they can ensure that all polystyrene British National beehives are compatible with each other and with existing wooden hives. These common design principles will still allow each manufacturer to have sufficient freedom of design to ensure that the designs can be differentiated from each other in both form and function, whilst allowing each manufacturer to have their own unique selling point.

The design of polystyrene beehives is not limited like wooden hives by commonly available sizes or cutting profiles, therefore the design options for a polystyrene version of an existing hive are numerous. The most important design concept is compatibility with existing beehive frames this ensures that the beekeeper can simply transfer their frames from their existing wooden hive or nucleus into the new hive. Frame size is fundamentally what differentiates beehive types from one another and therefore is what makes a particular beehive a British National or not.

An additional feature of the British National beehive design, not common in other beehives, is that it is square externally. This allows the beekeeper to align the frames with the entrance in either the warm way or cold way. Although there is little evidence to support any differences between the results obtained by aligning the frames either way, many beekeepers will not change their management practices. It is therefore important that the beehive is square and can be aligned in either orientation.

The density of the polystyrene used in the manufacture of the hives is important as this determines the balance between strength, insulation and cost. Higher density material is stronger but provides less insulation and is more expensive. Lower density polystyrene provides better insulation but is subject to damage during inspections and the bees are able to chew holes in the material. Recent attempts to produce cheap polystyrene beehives in the UK to British National designs were made using insulation grade polystyrene cut to size. These were initially popular but rarely lasted for more than one or two seasons and have now been withdrawn from sale. These low grade hives caused distrust within the beekeeping community towards polystyrene beehives and have severely damaged their reputation in Britain. It is essential that this error is not repeated. A minimum of 100 grammes per litre is recommended as giving the best balance between maintaining adequate insulation in the walls while delivering sufficient strength and damage resistance. It is the density of material used extensively in mainland Europe.

To achieve the same strength the walls of a polystyrene hive need to be thicker than a corresponding wooden hive. Also, if the walls of the hive are too thin, the bees may chew through a thinner section to create an additional entrance. This is of particular relevance in sections such handle rebates and the wall at the end of the top bar of the frames.

When designing a new polystyrene beehive the options are to keep the external dimensions the same as a wooden hive and to reduce the internal dimensions, or to keep the internal dimensions the same and increase the external dimensions. Keeping the external dimensions of the hive the same as a wooden hive imposes several significant problems. To achieve an adequate wall thickness in the side walls you need to reduce the number of frames from 11 to 10, given that many queen bees in the UK are so prolific they often need to be kept in brood and a half, double brood or 14x12 hives, reducing the number of brood frames compounds this problem. The most significant problem of keeping the external dimensions of the beehive the same, is that the walls in the area of the handle rebates and at the end of the frame top bars will remain the same thickness as those of a wooden hive. These areas are too thin and highly susceptible to damage during inspections, which may significantly reduce the overall life of the beehive.

Keeping the internal dimensions the same as a wooden hive has many important advantages. Most significantly, adequate wall thickness can be maintained in the areas of the handles and at the end of the frame top bars. Careful design should also ensure that sufficient wall thickness can be maintained if a hive is designed to take commercial frames. By removing the constraint of the external dimensions the walls can be made significantly thicker. This dramatically improves the insulation of the hive, keeping the bees cooler in summer and warmer in winter, which potentially increases honey yield and reduces the need for winter feeding. For the beekeeper they can move their colony from a wooden hive directly into the new polystyrene hive. They also do not have to alter any of their management practices or techniques. The only disadvantage of this design option is that the polystyrene supers or brood bodies may not fit under existing wooden roofs. However, the majority of beekeepers switching to polystyrene will buy complete hives including roofs and, considering the advantages that design option allows for both to beekeeping and longevity, this problem is not significant.

The exact external dimensions are not so critical but it is important that they provide a balance between wall thickness and practicality. To deliver this and to ensure compatibility with existing designs it is recommended that a standard external dimension of 500mm x 500mm be adopted while keeping the internal dimensions identical to those of a wooden British National beehive. This gives thick, highly insulating end and side walls and allows deep, easy to grip, handle recesses. It also allows adequate wall thickness to be maintained if a commercial framed hive is produced. The increase in size is not too large and is not noticeable when beekeeping or moving hives of these external dimensions.

To ensure compatibility with both wooden hives and other designs of British National polystyrene hives the top and bottom edge of each lift must be flat, although a small round on the external edge assists with separating the lifts. This means that the hives can be stacked and used in the normal way. There is a temptation to put lugs or locking sections on the edges of the lifts or the floor, such that the hives fit together and cannot be misaligned. These can cause significant problems when trying to prise the lifts apart and will also prevent compatibility with any other design of hive.

The majority of British National hives sold and used in the UK have bottom bee space. Regardless of the beekeeping justifications for either system, to ensure compatibility with the majority of the UK market, polystyrene beehives should use bottom bee space.

The design of the roof, floor and entrance block, inner cover or crown board and hive stand can all be unique to a particular manufacturer. Provided they have internal dimensions identical to the wooden British National hives and are compatible with lifts with a flat top and bottom edge in a hive with external dimensions of 500mm x 500mm. This allows each manufacturer to have a unique selling point. By ensuring that the designs of each new British National polystyrene beehive are different but remain compatible with each other, consumer confidence in polystyrene beehives in the UK should improve.

The key design standards to ensure compatibility and maintain consumer confidence are:

1. The density of the polystyrene should be a minimum of 100 grammes per litre.

2. The internal dimensions of the hive should be identical to a wooden British National hive allowing 11 standard or 12 hoffman self spacing frames.

3. The external dimensions of the hive should be 500mm x 500mm.

4. The top and bottom edge of each lift should be flat, possibly with a small round on the outside edge.

5. The hives should be bottom bee space.

Ross Dyter has been a beekeeper in Britain for a number of years. After importing polystyrene beehives from Europe for his own apiaries and finding them to be a significant improvement on his wooden hives he decided to start his business Bee Hive Supplies, http://www.beehivesupplies.co.uk/ and develop, test and manufacture high density British National polystyrene beehives. These polystyrene beehives as well as a large range of high quality beekeeping equipment can be bought online as complete or empty beehive kits http://www.beehivesupplies.co.uk/index.php?main_page=index&cPath=14