Feasibility, financing, and design are keys to success of inpatient hospice
Detailed planning required before ground breaking
What am I doing? I'm a nurse. What do I know about building a hospice facility?
This question has popped into Pat Stropko-O'Leary's mind quite often in the past two years as Hospice of Medina (OH) County, has moved closer to having its own building to house a 16-bed inpatient program along with administrative offices for the home health and home hospice services offered by the agency.
As executive director of the agency, Stropko-O'Leary has overseen efforts to raise funds, purchase land, design the facility, and build it.
"In 2000, our board members developed a strategic plan to expand our services," she explains. A bereavement center was established and a home health service for patients who don't yet meet hospice eligibility requirements was developed as two ways to meet unmet needs in the community, Stropko-O'Leary says. "We also began to look at offering inpatient hospice services because there was no inpatient service in our area, and it is not easy for family members to travel great distances to see a loved one at the end of their life," she says.
Although the feasibility study for inpatient hospice initially showed enough support for a 10-bed unit, board members were not convinced that the study justified the financial commitment a building required, says Stropko-O'Leary. The logical next step was to find a way to offer the service and gain experience in managing an inpatient unit without the hospice owning its own building.
"In 2003, we leased space in an assisted living facility to set up an eight-bed hospice unit," she says. During the seven years, the inpatient unit operated at close to 100% capacity. "We gained valuable experience, solidified our ideas about what we wanted in our own building, and proved that there is a need for the service in our community."
Groundbreaking for Hospice of Medina County inpatient facility occurred 10 years after the strategic plan called for expansion of services, but this delay is not unusual, says Jim Faulkner, AIA, NCARB, LEED AP, president of Dayton, OH-based Matrix Architects, an architectural firm that specializes in hospices. "Fear of the unknown is the biggest challenge to overcome to get a hospice inpatient facility built," he says. "Board members and hospice leadership often don't have any experience with major capital fundraising campaigns, construction of a health care facility, or staffing a 24-hour inpatient program."
When consulting with a hospice that is considering an inpatient facility, Faulkner advises board members to move forward if a feasibility study indicates a need for the facility. "In most cases, construction costs never go down, so each year the project is delayed, the costs will go up," he points out.
Waiting was a smart move
For Hospice of Medina, waiting until 2010 to break ground actually helped financially, says Stropko-O'Leary. "We were estimating that our initial 12-bed design would cost $10 million to build, but when we received bids on the project, they were lower than we expected, so we are building a 16-bed project for less than we planned to pay for a 12-bed facility," she says. The lower costs for construction are attributable to the economy and the competition among builders and building supply companies, as well as the competitive bidding process the hospice used, Stropko-O'Leary says.
"We had to bid the project on an open-bid process because of the low-interest loan we are using from the U.S. Dept. of Agriculture's Rural Development Program [www.rurdev.usda.gov]," she says. The loan, along with funds raised through the hospice's capital campaign and money saved by the hospice since 2000 for this project, will pay for the building. All administrative offices, along with the bereavement center and inpatient unit, will move to the new building, Stropko-O'Leary reports. The cost of current leases for the administrative offices, inpatient unit, and bereavement center are three-fourths of the total cost of the monthly mortgage payments, so the hospice is not looking at a significant increase in monthly expenses for space, she points out.
Incorporating administrative offices and other services into the same building is a way to maximize use of your investment, but be sure the facility doesn't look like an office building, suggests Faulkner. "An inpatient hospice facility should have a homelike look both inside and outside," he says.
While a more institutional look might be less expensive to build, fewer patients and families will choose that type of environment, he says. "Our buildings look like residential homes with dormers, hipped roofs, bump-outs, brick, and stone," Faulkner says. "We also like to build on sites that are in residential neighborhoods because family members have places to walk, backyard gardens in which to relax, and a quiet place with less traffic than a commercial area."
Inside the facility, spaces should continue the homelike look, suggests Faulkner. "Space in a hospice facility is used differently than other health care facilities," he says. Rooms must be large enough to accommodate family members, space for family members to spend the night must be available, and small areas throughout the facility should be available for family members to sit when they are not in the patient's room, Faulkner says.
There will be unexpected challenges, warns Stropko-O'Leary. The hospice was able to purchase a beautiful piece of land that borders a state park, but the state Department of Transportation (DOT) would not allow the hospice to build a driveway from the highway, she says. "We are on a corner, and the DOT rules state that a corner piece of property must use the side street, not a state highway, for access," Stropko-O'Leary says.
Although the hospice appealed the decision, highway access was not allowed. "We wanted highway access because it means cutting down or damaging fewer trees," she says. Because the hospice is building their facility as an energy-efficient, environmentally friendly building, the goal has been to remove as few trees as possible. "We can make the driveway from the side street work, and we will just replant trees when we are finished construction," Stropko-O'Leary says.
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