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Building new therapy centers and avoiding the pitfalls.

An architect and some administrators offer advice for subacute care construction

Enhancing nursing home therapy in the '90s is no longer confined to converting a patient room. New facilities, often additions to current buildings, offer better servicing of residents, as well as attracting additional revenue from servicing outpatients. As administrators encounter problems along the way, they can benefit from solutions others have found. On the following pages are suggestions ranging from pre-construction, personnel and code compliance to budget and reimbursement issues.

1. PROBLEM: A patient room, beauty shop or lounge was long ago converted to a therapy room. Now that space is no longer adequate for the types and levels of services demanded.

SOLUTION: It's time for a therapy addition. The influx of fees generated by outpatients, as well as expanded services offered to existing residents, will soon justify the cost. It is important to accept the need for change: "Years ago, when many nursing homes were built, there was no consideration given to therapy. Now therapy is a big deal," says Ken Barton, Director of Environmental Services, Unicare Health Facilities.

2. PROBLEM: I've received the go-ahead to build an addition. Where do I go from here?

SOLUTION: The key to designing and building a rehabilitation center is establishing a strong project team from the beginning, and then relying on that team to ensure the project stays within budget, on time, and under control. Allow the experienced professionals to guide your project and ensure that your finished center is functional, profitable, and beneficial to your residents. Michael Hults, Regional Maintenance Engineer at The Hillhaven Corporation says, "Workability of plans and familiarization with the architect are very important. <An architect> previously experienced with long-term care can be extremely beneficial."

3. PROBLEM: What about the space I converted to a therapy room before building the addition?

SOLUTION: If the room is no longer used for therapy purposes, its square footage is not reimbursable. It is imperative to plan for this when calculating the therapy addition's return on investment for your center. If a patient room was being used for therapy before its conversion, licensure can be returned to the beds. An alternative is for a portion of therapy to remain in the existing space to retain the reimbursable square footage. Either way, the effect will seem minimal compared to the profit generated by the construction of your new therapy addition.

4. PROBLEM: The addition demands storage area, but closet space is non-reimbursable square footage. How can I store my equipment without reducing the return on investment?

SOLUTION: Designing cabinetry as part of the space, rather than incorporating bulky closets can drastically increase usable square footage. Deep, pantry cabinets give a residential feel to the rooms, as well as functionality, and since they can be moved, the space they occupy will remain reimbursable.

5. PROBLEM: I don't have time to supervise the construction of an addition, nor do I have any construction experience. I want resulting profits for the center, but not the headaches of construction.

SOLUTION: Having one point of contact on the project can save you, and others involved, countless hours of frustration. Many architectural firms offer construction management services. Having a competent project manager is the key to headache-free construction.

6. PROBLEM: To receive the maximum return on investment possible with my therapy addition, I have to complete the project on time. How can I exercise an upper hand over the contractors?

SOLUTION: The threat of liquidated damages in the contractor's contract is an excellent motivational tool. "Maintaining a detailed project schedule, having weekly construction meetings, and keeping in close contact with your project manager are crucial to timeline management," says Tom Henschel, Administrator at Colony Oaks CareCenter in Appleton, Wisconsin. "Having a design/build contract with an architect is the only way to go. It saved me hours of work and worry."

7. PROBLEM: The staff therapy professionals' input regarding the design of the addition, resulting in more square footage than the budget allows.

SOLUTION: To justify the cost of an addition, the square footage allotted must be reimbursable. If the center as planned meets profit goals, another addition can always be built at a later date. An experienced architect can plan for future expansion when designing your rehabilitation center. No matter what, though, therapists must be involved in the design process, at least in the earliest stages. "They're the ones who work in the space every day and know what they require to be effective," says Mary Ellen Drager, Eastview Manor Medical and Rehabilitation Center Administrator, Antigo, Wisconsin.

8. PROBLEM: My therapy staff wants private offices, but the square footage for designated office space is non-reimbursable. How can I satisfy everyone?

SOLUTION: A workstation in a therapy addition is considered reimbursable square footage, as long as there are no doors on the space to label it as an office. One effective option is library-style cubicles. This solution offers privacy and adequate work space but with the added advantage of viewing access to the therapy room and patients.

9. PROBLEM: My maintenance crew might be tempted to use the contractors to do other work at the facility, such as a little extra touching up of a resident's room during down time. Or they may volunteer to do some of the construction work themselves. How can I keep them from distracting the contractors in this way?

SOLUTION: Hold an up-front meeting before the start of construction with you, your architect, maintenance crew, and the contractors. Make it perfectly clear that the contractor is totally responsible for all the work done. If the maintenance crew or therapy staff asks the contractor for assistance on non-contractual related tasks, the contractor must absorb the cost.

10. PROBLEM: Building codes for health care facilities change as often as the weather. The location for this addition might not allow true compliance with all current building codes.

SOLUTION: An experienced architect will make sure that regulatory officials, including the building inspector, are an informed and integrated part of the project team. "It is important to have the architect stay in touch with the code official constantly," says Jim Haefner of the Bureau of Quality Compliance of Wisconsin's Department of Health and Social Services.

11. PROBLEM: The relationship of my facility with the state and local building inspectors has been less than perfect in the past. How can I avoid problems in this area?

SOLUTION: Make sure your architect meets with the appropriate building inspectors before any design work takes place. This will insure that inspectors' special concerns are addressed and met at the earliest stages of the project, saving plan revision fees at a later date. "We have wanted to work very closely with architects and administrators when the design process starts for a long time," says Haefner.

12. PROBLEM: How will I be able to keep this project within the budget parameters assigned to it? Every day it seems we have more expenses and surprises to contend with.

SOLUTION: When addressing budget parameters, be sure to identify the existing pieces of furniture and equipment that can be utilized in the new addition, and what must specifically be purchased beyond that. Also, by adding a contingency to the project budget, you will more likely have finances available to cover unexpected changes in the work. Detailed cost estimates provided regularly by your architect will keep you abreast of the total project costs. Administrator Henschel says, "My advice to other administrators is to insist on written change orders, approved by all before the additional work begins."

13. PROBLEM: How can I minimize changes to the drawings? Each time I alter them, the cost is substantial.

SOLUTION: Substantial time spent in the pre-design phase of the project will undoubtedly pay off. Once the drawings are finalized, everyone involved with the project should sign off on them, giving their consent. This includes therapists and administrators (building inspectors sign off during plan approval).

14. PROBLEM: I am dreading move-in coordination. What steps can I take to alleviate the deadline crunch?

SOLUTION: When setting the timeline for your project, leave enough time between the end of construction and move-in for events such as final clean-up, installing artwork and window treatments, landscaping, final inspections, and the open house.

15. PROBLEM: How should I market the rehabilitation addition to the community to attract outpatients?

SOLUTION: Administrator Drager says the best thing she did was to plan a groundbreaking ceremony to christen the start of construction, "I invited the newspaper, contractor, and advisory committee." Press releases upon completion signal a photo opportunity for local media. Also, having a staff member videotape or photograph the construction as it progresses spawns a great "Before & After Addition" marketing piece.

Designing and constructing a therapy addition for your facility can be a challenging experience, and when approached properly, a rewarding one for you, your residents, and your workplace.

Cori Eggert is a project manager at Architectural Designs in Milwaukee, Wisconsin, an architectural firm experienced in serving the design and construction management needs of several national health care organizations.
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Article Details
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Author:Eggert, Cori
Publication:Nursing Homes
Date:Jul 1, 1993
Previous Article:Getting started with subacute.
Next Article:Increasing Medicare revenues: the EverCare approach.

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