Lessons from two facilities.

Two projects recently completed by our firm offered several lessons of possible assistance to any nursing home administrator or owner contemplating adding to a facility or developing a new one. The St. Cabrini Nursing Home of Dobbs Ferry, NY, and the Booth Silvercrest Extended Care Facility of Jamaica, NY, provided highly satisfactory end results, but not without careful planning, negotiating and attention to detail

St. Cabrini Nursing Home

Creation of this three-story, modern addition to a nursing facility on the shores of the Hudson River started yielding insights from very early on in the planning process. For example, there was the issue of:

Dealing with Regulatory Agencies 

Our firm, Architecture for Health, Science & Commerce, has found that a cooperative approach with agency officials is the best way to obtain speedy approvals for our clients. At St. Cabrini Nursing Home, the Town of Dobbs Ferry was very concerned that the new addiction not be visible from the Hudson River. To respond to their concerns, AHSC kept the profile of the addition low. The architects even photographed the project site from a boat on the Hudson River, so that a rendering of the facility could be prepared. The picture was worth a thousand words, convincing the Town Board that the addition would not be visible. The application sailed through the approvals process.

Addressing building codes and regulations was, of course, another important stage in the process. It is tempting to speculate on the type of facility which one could design if codes and regulations did not exist or were not enforced. However, in the case of the design of St. Cabrini, codes, regulations and zoning restrictions all contributed toward ensuring the safety, comfort and privacy of the residents and staff. Although these regulations may have initially presented a design challenge, we found that the process of working toward a solution freed, rather than hampered, the creative abilities of the architectural design team.

The zoning restrictions of the Town of Dobbs Ferry stipulated that the new structure could not be visible from the public road bordering the site. This stipulation inspired the architects to consider a variety of alternatives (number of floors of the new addition, the height of the floors, the siting of the building given the topography, the interconnection of the new addition with the existing facility, the configuration of the expansion) ultimately, the design team developed the concept of a Y-shaped, 3-story structure which would jut out from the building and branch out towards the Hudson River on the sloping hillside.

This proved to offer several advantages. In addition to taking full advantage of the site's natural amenities - and thus creating an atmosphere which is almost rural, given the views of the river and the surrounding countryside - the siting of the addition also shelters the residents from the view and noise of the busy thoroughfare which runs parallel to the front of the existing facility.

A felicitious and, admittedly, unexpected result of the siting of the new addition has been that the residents have been presented with choices as to the setting and views they prefer; some choose to sit in the lobby and watch the cars and people passing by the front of the facility, others prefer to enjoy the views of the river and hillside, from the lounges at the end of each wing.

Another design element involved gaining an exception to a state regulation. The owner of the facility elected to slightly exceed the state cap in order to produce a higher quality facility. The 36,000-square foot addition was completed at a cost of $160 per square foot because it includes above-standard exterior finishes and larger than minimum windows throughout the addition.

Creating an Environment for

Caring

Good design can support an environment for caring. At St. Cabrini, a variety of socialization spaces needed to be provided to enhance resident interaction and support different types of activities. The solarium lounges that AHSC designed have proved a success for residents, their families, and staff. The lounges take advantage of the splendid view of the Hudson River, and provide a space for programmed and unprogrammed activities. The lounges are used constantly by families visiting their loved ones, by staff and residents for group therapy sessions, and by staff for meetings.

Controlling Construction Costs

With continuing reductions in Medicaid aid reimbursement, nursing homes are increasingly strapped for funds. For those facilities contemplating construction, it is now, more than ever, important to get the most for limited construction dollars.

For larger projects, one way to keep costs under control is to hire a construction manager to work with the owner and architect from the outset of the project. At St. Cabrini Nursing Home, W.J. Barney and AHSC worked as a team to bring the project in $500,000 under budget. For example, AHSC implemented an alternate mechanical system suggested by the construction manager, which resulted in a 25% savings in this trade alone.

Project Description

The new 3-story addition harmonizes well with the existing facility (built in 1974) and its surroundings. A comparison between the two structures not only serves as an example of how a new expansion may complement all older, existing structure, but also serves to bring the unique qualities of the modernization into sharp relief.

The qualitative differences between the new and old design are immediately apparent: The residents of the new wings, with 36-beds per floor (compared to the existing units which average 50 beds) enjoy an atmosphere which is airy and flooded with natural light and are provided with numerous lounges to entice them from their rooms and facilitate social interaction. Sitting areas are also located in areas opposite each nursing station, allowing the residents to participate in the typical bustle and activity of staff areas.

The compact Y-shape of the wings, each ending in floor-to-ceiling glass triangular lounges, has numerous advantages: Shorter corridors lend a non-institutional atmosphere, minimize, travel distances, and allow direct visual supervision from the nursing stations. Other benefits of the smaller unit size are increased ease in staff oversight and greater patient privacy.

The preservation of the scenic river views from the existing residential units and the provision of direct views from all rooms in the new wings presented an additional design challenge. Siting the new facility on the hillside, building the first floor below the existing one, and minimizing floor-to-floor heights were the innovative design solutions proposed.

In sum, great care was taken to create a quality environment for the staff and residents of St. Cabrini. As a result, functional relationships between all areas of the facility are improved, social interaction is maximized, patient comfort and privacy is ensured, and the natural amenities of the site are maximized by the spectacular views of the Hudson River.

Booth Silvercrest Extended

Care Facility

This project produced similar challenges to the St. Cabrini addition, but led to different solutions. Again, we started with:

Dealing with Regulatory Agencies

AHSC was well into the Design Development Phase when the State Bureau of Long Term Care requested "dispersed bathing" to enhance resident privacy and dignity. Although at the time there was no code requirement for dispersed bathing, AHSC knew that what the Bureau of Long Term Care wanted, they usually got. So AHSC revised the plans quickly, and Agency approval followed soon thereafter. To have contested the Bureau's request would have delayed the project schedule, resulting in a greater cost to the owner than the additional plumbing fixtures entailed.

Creating an Environment for

Caring

Again, a principal design challenge, as at St. Cabrini, was to provide a variety of socialization spaces to enhance resident interaction and support different types of activities. The solarium lounges provide pleasant views of the surrounding neighborhood, as well as space for programmed and unprogrammed activities. The lounges are used constantly by families visiting their loved ones, by staff and residents from small group therapy sessions, and by staff for meetings.

Controlling Construction Costs

At Booth Silvercrest, Turner Construction Company and AHSC worked as a team to create the first nursing home to be built in New York in over a decade under the State's stringent cost caps. Turner, the facility owner and AHSC established a budget for the project based upon a predetermined level of quality and building site. Also established at the outset were a contingency for scope development, as well as a "wish list" of what we called "add alternates."

Turner provided estimates throughout the design process, and AHSC revised the design documents accordingly. As the project became better defined, it was possible to transfer dollars from the contingency to the wish list. For example, the contingency included the cost of half a mile of new sewer. When the City confirmed that the sewer extension would not be required, it was possible to reduce the contingency, and add better finishes and a central T.V. system to the base project.

This careful planning, flexibility and cooperative effort led to a gratifying result: Booth Silvercrest has become the standard against which the New York State Department of Health judges new nursing home construction.