Building project for PAHCS moves forward

This article submitted by Michael Jacobson on 9/8/99.

Remodeling sketch A major remodeling project to the facilities of the Paynesville Area Health Care System got preliminary approval from the Paynesville Area Hospital District Board of Directors at a special meeting on Tuesday, Aug. 31, at 700 Stearns Place.

The project would consist of additions to the Paynesville Area Hospital, Paynesville Area Medical Clinic, and to the Koronis Manor. Renovations would be done in the hospital, and extensive renovations would be done in the nursing home.

Estimated cost for the project is $4.5 million.

The board approved moving ahead with the project and having their architect prepare final construction documents. The plans must also meet Minnesota Department of Health requirements.

If the final project is approved by the board, bids could be let in February 2000, with construction beginning next May. All the new additions would be built first, and then the remodeling would be done in three stages. "Most of the work would happen in the first year," said architect Richard Engan, "but some of the remodeling work would take two years (to complete)."

At the start of the meeting, Willie LaCroix, hospital system administrator, compared the project to the major renovation at the hospital in 1983. "Had we not done that," he explained, "I don't think you'd have what you have today." PAHCS will pay off the bonds for that 1983 project in March 2000.

Long-term care is at a similar crossroads today, LaCroix explained. Facilities throughout the area have empty beds. "I believe you're going to have the amenities, the nice stuff, cause they're not just going to come there. They're going to have choices," he told the board.

The Manor was built in 1964, and LaCroix said that while some minor renovations have been done, in some ways the delivery of care really hasn't changed in 35 years. Like the hospital in 1983, the Manor currently only has one tub for baths. The staff has to start giving baths at 5 a.m. to accommodate all 64 residents. In the afternoon, LaCroix added, a line of wheelchairs usually forms at the nurse's station to wait for the bathroom. "There are some really, really glaring problems there," said LaCroix.

Hospital, clinic additions
Using diagrams, Engan proceeded to explain the various additions and renovation the project would include. (See diagram in shaded box.)

Another tier of parking would be added to the west side of the hospital and a new emergency entrance would be built that would connect to the hospital near the current nurse's station. The addition would include an ambulance garage and an emergency room suite.

A new nurse's station, which could better handle the needs of modern communication and technology, would be built in part of the current nursery.

The advantage of this addition would be for the night nurse to be closer to the emergency room. The public entrance would also be at this new addition, allowing the nurses more control of after-hours accessibility.

The current emergency room could then be used all the time as a second operating room. It is utilized now for overflow on busy surgery days.

On the north side of the hospital, a new warehouse area for purchasing and supplies will be built. It will also include room for maintenance.

This addition would allow the current maintenance and supply areas to be remodeled for use by the outpatient department. The current outpatient area can handle only two physicians comfortably. But the specialists dictate their schedules, so more than two are at the hospital at the same time. The expanded outpatient clinic would be able to handle four doctors at a time. "They control the admitting, so it's very vital to have them," Engan explained, about the need for specialists. "You don't control their schedules."

To the north side of the clinic, the equivalent of 12 exam rooms would be added. Eight would be single rooms, and two would be double rooms. The extra rooms could accommodate two more physicians.

Additionally, the psychology department would be relocated to the clinic, where their patients would join the main patient stream of the clinic. Radiology would get the vacated psychology rooms.

Koronis Manor project
"Half the project is really the nursing home," said Engan. Of the $4.5 million total cost, the hospital and clinic portion would cost $2.1 million and the Koronis Manor portion would cost $2.4 million. "We have to make it a place where people want to live," he added.

Engan explained that when the nursing home was built, less than five percent of the patients used wheelchairs. Now the majority of the residents are in wheelchairs, which requires extra space in rooms, in toilets, in tub rooms, for activities, and for eating. "Everywhere they go they need more space," he said.

More private rooms and private baths were also considered necessary, especially considering that the residents of the future will be baby boomers, who will have grown up with indoor plumbing.

Two additions to the nursing home would be done. The major one would be a new wing, extending east from the patio. The other would be another dining room added to the south side.

The Koronis Manor would still have 64 beds, but more of them would be in private rooms. Right now, it has four private rooms. The plan calls for 28 private rooms and 18 double rooms. Some present rooms would become private rooms and house only one resident.

With only four private rooms now, LaCroix said they don't come free very often. "If you have 28 privates," he explained, "you're going to have some turnover, so if someone came into a double room, they'd at least have hope of getting a private room in the near future."

Other additions to the Manor would be a new sprinkling system; a better ventilation system; two new tub rooms, which would have room for two nurses and a lift; a new handicap-accessible restroom; and more one-on-one chat rooms for patients and their visitors.

At a meeting with residents prior to the board meeting, a suggestion was made to have a television in the dining room. That's just the type of amenity that LaCroix and Engan said the public would demand in the future. After the remodeling, there would be three dining rooms, and possibly televisions in all three.

More renovation
The nursing home rooms on the north edge, closest to the hospital, would be renovated to house the physical therapy department. In addition to a treatment area, there would be an occupational therapy room, a speech therapy room, and an exercise room.

The location of the physical therapy would be better, too, as many of the Manor residents utilize some form of therapy or exercise.

The present physical therapy area, located on the east side of the facility, next to the clinic, would be turned into a education room and a pharmacy.

LaCroix said the hospital system needs to change to a unidose dispensing system, where drugs would come in an individual package and not in a large bottle. This would entail fewer errors in medication, less waste in returning prescriptions, and more efficient use of time, as nurses would no longer have to open bottles and count pills. "The advantage to our organization is that it's estimated we'd spend four hours less in nursing time per day," said LaCroix. "When you multiply that out, it's $80,000 per year."

LaCroix added that if the hospital system went to the unidose system, there'd be opportunities to subcontract to other facilities in the area.

The first option for the pharmacy would be to lease it out, according to LaCroix. If no bids were received, LaCroix told the board he was convinced the hospital system could recruit the personnel needed to staff it, despite the current shortage of pharmacists in rural Minnesota.

Construction manager
After deciding to advance the project, the board discussed the merits of hiring a construction manager versus using a general contractor for the project and voted to hire E & V Consulting as construction manager for the proposed project.

The major considerations were cost and service.

In using a general contractor, that company includes the cost for managing the project and coordinating the subcontractors. This method would require only one large bid.

If the hospital system hired a construction manager, the project would be broken into as many as 50 contracted jobs. The construction manager would be responsible for coordinating the work.

Some board members felt that more competitive bids could be obtained if the project were broken into smaller pieces. Also, more local businesses might have an opportunity to bid on smaller components of the project.

The proposed project would include substantial renovation, which often leads to changes. A construction manager, some felt, would be more motivated to find the cheapest solution.

The other worry is keeping the Manor operating, within the state code requirements, at all times during the construction. "My concern is trying to take care of 64 residents," said LaCroix.

In the hospital, moving the nursing station could be tricky, but at the nursing home the whole project could be difficult. The hospital system has interviewed E & V Consulting, and board members were impressed with reports of the person the company would assign and with the company's record on similar projects.

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