Nursing Homes and Assisted Living Centers Renovate to Improve Patient Care for Seniors
So, what does current long term care management have to review about their physical set-up and service delivery? In preparation for interviewing three administrators whose facilities have recently gone through or are in the midst of renovations, I told a random group of ten individuals, aged mid-thirties to mid-fifties and located all over the United States, that I was writing an article (without divulging its topic, targeted readership, or slant), and asked them these questions: 1) When I say, “nursing home,” what’s the first thing you think of?; and 2) When I say “assisted living,” what’s the first thing you think of?
The answers I got are revealing about the stereotypes that long term care still has in our society. The first things the people thought of for nursing home were old people and urine smell, “old folks home,” and prison. The first things they thought about for assisted living were retirement community, independence, access to nurses on demand, light and airy. My deductions are these: nursing facilities are still seen as places of the last resort, where incontinent people who have no choice must go and surrender their control; whereas, assisted living is considered congregate living for the older, healthy, involved and savvy consumer.
Armed with my results and research, I determined that the main considerations administrators must have for expansion and/or renovation were: market, money, physical plant expertise, and regulation:
� What was the greatest demand for the combination of elderly housing and health care services in a particular location, and what did the potential and current resident want in that living environment?
� Where would they get the funding for the project and would their building plans be advantageous to their profits in the future?
� Whom could they learn from who had experience in expansions/renovations similar in scope?
� What regulatory landmines did they need to avoid?
Three facilities that cited recent renovations were chosen at random from those found on the Internet. They are: Tower One, located in downtown New Haven Connecticut; Washburne Court, located in Paynesville, Minnesota; and Maryfield Nursing Home and Pennybyrn at Maryfield, located in High Point, North Carolina.
Dorothy Giannini-Myers, President for Tower One, which contains 205 high-rise units, said the 2004 renovations at the facility were designed to for residents needing more assistance, making the units fully handicapped-accessible. That included lowering cabinets, installing no-slip floors, wider halls, and adding a common room with a kitchen to each floor.
The renovation process took from August 2003 to December 2004. One of management’s challenges was to move the residents of six floors containing 60 apartments to other apartments in the building, because they were very eager to return to their former living quarters. Richard L. Horowitz, COO, also mentioned that, since the renovations were extensive, it was quite a challenge working in an occupied building.
Regarding the funding for the project, Tower One was fortunate to receive $12 million in Department of Housing and Urban Development (HUD) monies. Eligible Tower One residents are also able to receive subsidies from HUD, which makes the tower highly affordable and desirable. New Haven has limited affordable assisted living for those on low fixed incomes.
Formerly known as Good Samaritan Care Center, Washburne Court is a much smaller facility than Tower One. It underwent renovations in 2003 to change 46 skilled nursing beds into 24 assisted living units. According to Tom Kooiman, Chief Operating Officer for Paynesville Area Health Care System, of which Washburne Court is a part, a market study conducted by the hospital district indicated a need for affordable assisted living in the community and a decreasing need for skilled nursing home beds. Since the home had been operating with empty beds and with red ink on its balance sheet, switching to assisted living appeared to be the best option.
Additions to the rooms included a kitchenette, individual air-conditioning and mailboxes, locking doors and sprinkler systems. As was true at Tower One, the renovations required moving residents during construction. Close to two dozen employees also took early retirement or severance packages, and another ten or so were laid off due to the change-over. However, another skilled nursing facility in the system benefited, increasing to ninety-nine percent occupancy.
Another huge snag in the renovations came when construction delays were encountered, due to both bidding and permitting. The first round of bidding only produced one bid, so the process had to be repeated and the health care system scaled-back the project. Thankfully, the half-million dollar project received half its monies from a state grant and lower income residents in the new units are eligible for financial assistance through the county’s health and human services department. Also, due to a statewide initiative, Minnesota will reimburse the health care system $2,080 each year for each skilled nursing bed decertified. Mari Louis, Director of Housing Services, says Washburne Court continues to maintain a 100% occupancy.
The final project reviewed was an expansion of a retirement community at Pennybyrn at Maryfield, and renovation of the Maryfield Nursing Home. Richard Newman, President and Administrator, told me that the facility was begun in 1947 by a group of Irish sisters named Poor Servants of Mother of God. Maryfield is the only holding they have in the United States, and it is operated almost solely by its local board. The project, which is currently underway started in the conceptual phase in 2000 and all expected construction should be completed by mid-2006. The retirement community expansion will include the addition of 131 apartments, 10 cottages, a 24-unit memory support center, and 24 assisted living units.
For purposes of this article, I will focus on the renovations of the nursing home. Built in the late 60s-early 70s, Maryfield had an institutional structure of long hallways with nurse stations and one central area, which was an asset, in that it had a huge ceiling solarium and a large living and dining room. The renovations will completely revamp the appearance, with six households constructed around the central core. Each household will hold 20-22 residents and will have the feel of home, complete with front doors, some with porches, doorbells, their own kitchens and central shared space. The central core of the building will be constructed as an enclosed town square with community space, including beauty shop, therapy center, and a caf�©. The staff also worked with the residents on changing from a medical-driven to patient-centered model, a model that requires a change in attitudes and approach and results in a cultural transformation.
Mr. Newman said the keys to their success were raising money in the community, more than $4 million, as well as a bond issue, and the planning efforts have included community buy-in, and a dedicated board, consisting of community and business leaders with corporate business experience. They were significantly involved in the strategy development and commitment to the vision of the new patient-driven environment. Staff and board spent a great amount of time with LaVrene Norton, Action Pact, Minnesota, and Steve Shields, Meadowlark Hills, in Manhattan, Kansas, who are experts in the new long term care cultural change movement.
These administrators have pointed out valuable lessons for those facilities considering renovations, including: 1) know your market; 2) plan carefully and with community buy-in; 3) design a time-frame that allows for unexpected delays, and 4) learn from those who have succeeded, just like these three facilities.
