Overview

Discussion of several options for PCMNHp Nelson Architects and MKK Engineers site visit –

December 6th and 7th

Existing facility – well maintained but near end of life cycle

Code and design issues – modifications will require compliance with new codes

Existing Nursing Home

12,442 sq. ft. 43 bed capacity,44 q 43 p y Original building built in 1964 –

7,560 sq. ft.12 double occupancy rooms; two rooms share toilet room 12 double occupancy rooms; two rooms share toilet room

1978 – addition added to east 4,882 sq. ft. 9 more double rooms

No central kitchen or laundry facilities

Site Configuration

Site is a square city blockq y Hospital and nursing home in center Expansion potential to south and southwestp p

Architectural Evaluation

Roof System

Windows

Other structural issues

Asbestos ADA Shower rooms Corridor used as receiving area Nurse’s station needs remodelingg Lack of office space

Mechanical System Evaluation

Resident Unit HVAC – cannot be used to provide pventilation air for resident units Need new unit

Resident unit exhaust fans Indoor environmental quality for ancillary spaces Air handling equipment in offices, common space Crawlspace ventilation Etc.

Electrical System Evaluation

PCMH provides entire electrical infrastructure to pserve nursing home including fire alarm phone and emergency power

All of electrical equipment nearing end of expected useful life

Preliminary Space Program

Allocation of types of areas and square footage yp q gneeded for project

Developed from input from Administration , staff and results of Long Term Care Market Analysis completed by CBI

Preliminary Space Allocation – Nursing Home Only

30 single occupancy rooms3 g p y 10 double occupancy rooms Public areas – 874 sq. ft. 74 q Nursing Home - 13,191 sq. ft. Building Support Space (offices, kitchen, laundry, g pp p ( , , y,

conference room, storage, etc.) – 9930 sq. ft. Building circulation – 2399 sq. ft. Total – 26,394 S.F. 68.2% common area; 11.8% net rentable area

Preliminary Space Allocation – Nursing Home and Assisted Livingand Assisted Living

Nursing Home – 50 bed 30 single occupancy rooms 10 double occupancy rooms

Assisted Living 22 unit Assisted Living – 22 unit 7 one bedroom, single occupancy (416 sq. ft.) 15 studio, single occupancy (320 sq. ft.) Public area - 748 sq. ft. Nursing Home – 11,470 sq. ft. Assisted Living – 10,996 sq. ft. Assisted Living 10,996 sq. ft. Building Support Space – 11,506 sq. ft. Building circulation – 3744 sq. ft. T t l q f t 41 185 Total square foot – 41,185

Option 1

Expansion and renovation of existing NH to bring it p g ginto compliance and to give staff needed space to operate efficiently

Does not include kitchen or laundry facilities Does not address additional nursing home beds,

i t d li i it assisted living units, or memory care No room to relocate residents while renovation takes

placeplace Total probable costs - $2,496,512 ($160/s.f.)

Option 2 – Phased Expansion

Phase I- new 50 bed nursing home to south of 5 gexisting facility

Phase II - remodeling and addition of existing nursing home facility into assisted living facility

Would include laundry and kitchen Stand-alone from hospital yet maintain campus

conceptO l h ll f b ildi b d Only shell of building can be reused

$7,132,027 ($165/s.f.)

Option 3 – Phased Approach

Phase I – new 50 bed nursing home to south of 5 gexisting facility

Phase II – demolition of existing facility Phase III - construction of new ALF in its place $7,460,870 ($181/s.f.)

Option 4

New 50 bed nursing home and 22 unit ALF in a new 5 gfacility on a new site

$7,946,166 ($193/s.f.) not including land acquisition

Option 5

50 bed nursing home in a new facility on a new site 5 g y(no ALF)

$5,235,163 ($198/sf)

Summary Options

Option1 Option 2 Option 3 Option 4 Option 5

Expand/ New 50 bed New 50 bed New 50 bed New 50 bed Expand/Renovate existing NH

New 50 bed NH

New 50 bed NH

New 50 bed NH and 22 unit ALF –new site

New 50 bed NH on new site

No kitchen, laundry or added

it

Remodel existing NH to ALF

Demolish and rebuild existing as ALF

Does not include land acquisition

capacity ALF

No relocation plan

$ illi $ illi $ illi $ illi $ illi$2.5 million($160/sf)

$7.1 million($165/sf)

$7.5 million(181/sf)

$7.9 million($193/sf)

$5.2 million($198/sf)

Eden Alternative or

The Green House Model

“Elders exist because they show us how to make a community. As we give to them, they give us their wisdom, their experience, their affection They instruct us in the art ofaffection. They instruct us in the art of caring. There is no more precious gift than that.”

-From “In the Arms of Elders” by William H. Thomas, M.D.

Residential long-term care that involves a total rethinking of the philosophy of care, architecture and organizational structure normally associated with long term carenormally associated with long-term care.

Vision of Dr. William Thomas, a Harvard-educatedVision of Dr. William Thomas, a Harvard educated geriatrician. Author of “What are Old People For?

Loneliness vs. companionship Helplessness vs. opportunities to give care Boredom vs. variety and spontaneity

◦ Living together intentionallyW◦ Warm◦ Small◦ FlatFlat◦ Rooted beliefs vs. rules◦ Smart technology

G◦ Green

Independent, self-contained home for six to twelve people

Designed to look like (and BE) a private home or apartment in the surrounding communityor apartment in the surrounding community

Licensed as skilled nursing facilities or ALF Each person has a private bedroom and full Each person has a private bedroom and full

bathroom, opening to a central hearth/living area and open kitchen and dining areap g

Elders share meals at a common table

“Shahbazim” Core training as CNAs Provide personal care, meal preparation, and

li h h k i d l dlight housekeeping and laundry Clinical support team includes nurses, social

workers therapists physicians activities andworkers, therapists, physicians, activities and dietary professionals and pharmacists

Nurses serve each Green House on a 24-hour Nurses serve each Green House on a 24 hour basis – one nurse covers two homes during the day and evening and up to three at night.

Built on equality, empowerment, and mutual respect

Elders can help cook, assist with light housekeeping and laundryhousekeeping and laundry.

No predetermined routine

Intentional communities Recognizing and valuing individuality of

elders and staffH i d h i Honoring autonomy and choice

Providing privacy Offering meaningful activity and Offering meaningful activity and

engagements Offering comprehensive care Offering comprehensive care Creating an atmosphere of security

Quality of life and social participation for elders will be better

Improved health outcomesM i i f i l i b f Maximize functional capacity because of small-scale environment and freedom from institutional routinesinstitutional routines