From the Hill-Burton Era to the 21st Century
Developing a Vision for 2024
By Barbara Carey and Mike McCall
In the mid - 20th Century, the Federal Government through Hill-Burton Grants funded many hospitals in rural areas. These grants stopped in 1997. These hospitals were very much needed. There was little hospital construction during the depression and after World War II there was still limited access to healthcare, especially in rural areas.
Today, these hospitals are 40-50 years old. Many hospital boards and communities are faced with a question: Should we continue to remodel our hospital or replace it? TCI has worked with many hospitals who needed to answer that question.
After many studies and discussions, the answer is nearly always to replace the hospital with a modern facility that meets the community's needs in the 21st Century. This holds true of large systems that are managing these rural hospitals or deciding on what to do with their older medical office buildings, imaging centers or women's centers.
Facilities that were built for the delivery of care when inpatient services were highly utilized and when technology was less sophisticated cannot be remodeled cost effectively. Financial studies of many clients and areas always suggest that it is more cost effective to replace these facilities.
Here are some of the issues that are considered:
Asbestos - Many older hospitals have asbestos in their walls, and this is extremely expensive to remediate.
ER services - This department needs private rooms with the latest technology as well as diagnostic services in proximity to the ER. The private room requirement increases the space the ER needs. The nurses’ station also needs to be larger to accommodate the technology monitoring patients who are enroute and the technology in patient rooms.
Private Rooms - These are the standards of care that consumers demand. Remodeled rooms in older facilities have difficulty meeting ADA requirements.
Technology infrastructure and electrical grid - Putting technology in patient rooms, ERs and diagnostic areas using an aging electrical grid is a recipe for disaster. Maintenance directors know that one can only patch the electrical system so many times before it is literally overpowered.
Optics - Even though some older hospitals have redesigned and upgraded their lobby and waiting areas, the older parts of the hospital still look outdated. Consumers are extremely critical of the “way things look.” An outdated ER, patient room or lab builds an image of “outdated” care. In this competitive healthcare environment, the hospital then functions at a disadvantage.
Can Replacement Hospitals and Facilities be Funded and Built?
Absolutely and many have been constructed in the last 15 years. The process takes 2-3 years, but it is worth the effort.
This is the team that a hospital needs, and TCI has provided to build a replacement facility:
Funding Experts - Need people who can navigate the USDA process and gain New Market Tax Credits.
Community Investment - The USDA wants the community to have “skin in the game” to get their low cost loans. If the community doesn’t currently have a dedicated property or sales tax, they need to initiate one.
Architects specializing in Hospital Design - These firms save time and money because they understand the design, technology and compliance issues needed in new construction.
Specialized Legal Services - Regulatory and financial compliance is important and needs to be considered during the process.
Community Outreach and Communication Consultants - No hospital achieves success without the support of the community, and they must be involved during the planning and building process. Their opinions of what services they want and are willing to use are an integral part of this process.
This is the team that TCI uses to assist hospitals in their quest for a 21st Century hospital for their community. The same team can provide an easy path to replacing ancillary facilities. It’s doable with expertise and persistence.
Consider your future plans and talk about your facility and it's future at your next board retreat and call us to answer questions on how you can bring healthcare for your community into the next Century!
We Help Our Clients Understand Their Environment and to Find Solutions.
Call Us 1-888-922-2824 or Email barbara@tciconsults.com
