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HomeMy WebLinkAboutVENCOR, FORT COLLINS NURSING CARE - PDP/FDP - 23-97 - CORRESPONDENCE - PARKING STUDY`CT-31-97 FRI 05:37 PM P. l0/10 PROJECTED PHYSICIAN VISITS Our goal will be to increase medical staff involvement to the degree that very ill patients are seen daily by their primary physician and that consultants will come to the facility to see patients. Assuming that 10 of the 30 patients on the sub -acute unit are considered to be -very ill" and that there is some overlap of patients with the same physician, we would expect to see approximately 5 physician visits to that unit alone per day. Specialists, or consulting physicians, would be less frequent, perhaps one per day. The long-term care residents are seen by their physician at least every 60 days. There is no way to accurately project the scheduling of these visits; in theory there would be 1-2 physicians visiting long- term care residents per day. Total physician visits per day: PROJECTED 0 UTPA TIENTMA YPA TIENT U7ILIZ4TION We estimate that the facility will provide outpatient and rehabilitation services to an average of 20 patients per day on a regular basis. In addition, therapy and/or rehabilitative services will be available on a Contract basis to residents of assisted living centers; we estimate approximately 5 patients per day in this category. Total outpatients per day: 25 MWPCUallve ftCMUddmdum OCT-31-97 FRI 05:36 PM P. 09/10 PARKING NEEDS To establish parking needs for the facility, it is important to anticipate the maximum number of spaces needed. The peak demand for parking will occur at mid -afternoon during the day to the evg enin shift overiap (2:00-2:30 p.m.). At such timenursing staff will be on shin, , 80 percent of the skilled ancillary and administrative support staffwill be present and visitation time for family and physicians will be at its peak. The following is a breakdown of anticipated staffing and projected physician and outpatient/daypatient visits per day. Nursing: 30 patients @ 4.5 HPPD =135 hours or 24 FTE, 17 per day 90 patients @ 3.3 HPPD = 297 hours or 52 FIE, 37 per day 80% are staffed during patient waking hours, day and evening shift Ala Nursing Administration: Director of Nursing: Staff Development: Unit Secretaries: CQI/Wection Control: Total: Business Office: Medical Records: Activities- Laundry/Housekeeping: Maintenance/Grounds: Rehab Staff. Case Management: Dietary: Volunteers: Total Staff at Peak Time 43 staff at day/evening shift overlap 1 1 2 1 5 5 1 4 6 3 18 2 5 2 96 4 OCT-31-97 FRI 05:36 PM P. 08/10 SHORT-TERM INPATIENT SUBACUTE REHABUJTAT" AND MEDICAL CARE Thirty beds will be designed to provide step-down medical and rehabilitative care. The environment will be hospital -like, with a more sterile setting and clinical/medical focus. The patients admitted to this unit will have an average length of stay of 2 days to 3 months. Many will be funded by Medicare (based on medical need, not financial), but as managed care becomes more influential in Fort Collins, many will be funded by commercial insurance. The purpose of this segment of the facility is to provide a medical unit for patients who do not require the intensity of the hospital services to receive high quality rehabilitative and medical care. Health care has changed such that hospitals are only able to keep the very ill and medically unstable Patients; all others must move to alternative settings. Typical diagnoses for this unit include new strokes, hip fractures, surgical patients who need more than a week or so to regain independence, respiratory complications such as emphysema, cardiac patients who need physical support and rehabilitation, brain and spinal cord injuries that do not meet criteria for acute rehabilitation and so forth. This unit will be equipped to manage ventilator -dependent patients. Vencor will provide a fitll continuum of rehabilitative services to this patient population, with Physical, Occupational, Speech and Language and Respiratory Therapists on staff. A large portion of the building will be rehabilitation space, including a large gym equipped with state-of--the-art rehabilitation equipment and a transitional living space with a kitchen to teach independent living skills. OUTPATIENTIDAYPATIENT REHABILITATION AND ADMINISTRATIVE SUPPORT SERVICES Patients who have regained enough independence and have adequate support systems to return home oftentimes need continued rehabilitation services. Outpatient services are provided to people who are able to come to the facility for their therapy needs and return home for on -going care. Daypatient services are provided for those patients who need relatively intensive therapy (three or more services) but have a solid support system to provide for residential care in the home. Daypatients generally arrive at the facility around 9:00 am. and leave around 3:00 p.m. Their days are spent with therapists, nurses and educators with scheduled rest periods. Vencor will also provide therapy services for other facilities (such as assisted living facilities) so that patients who graduate to assisted living will be able to be treated by the same therapist they had in the step-down unit. Ancillary services that are necessary to support the operation of the outpatient and daypatient components of the facility include the Business Office, Medical Record Department, Social Services, Admissions, and Administration Offices. These areas are critical to providing high quality service to patients, and as such, are typically found in any facility that treats any volume of patients. 3 OCT-31-97 FRI 05:35 PM P. 07/10 in Fort Collins within the next two years, creating an even greater need for sub -acute care facilities_ It is critical that this community have a facility designed and built to manage a population that even five years ago was a considered a "hospital" population. OPERATIONAL SUMMARY The Vencor-Fort Collins Nursing Care Center facility will provide three types of care: (i) Long-term residential care; (ii) Short-term inpatient sub -acute rehabilitative and medical care; and (iii) Outpatient/daypatient rehabilitation services. The three distinct types of service will be integrated into one operation under one root, providing a continuum of care that is further extended into assisted living and home health care through collaborative efforts with other agencies. This arrangement will better meet the actual needs of patients and provide comprehensive and holistic care for all residents/patients who choose Vencor for health care services. All 120 inpatient beds will be licensed as "skilled nursing facility" beds with the State of Colorado Department of Health. LONG-TERMRESIDENTL4L CARE The focus of this service will be long-term (greater than 3 months) care. The population will consist primarily ofvery disabled people who are unable to be cared for in a less intensive setting (i, e. home or assisted living). Generally, this population requires nearly total care for all aspects of daily living, such as grooming, hygiene, nutrition, toileting and mobility, either as a result of grave physical or cognitive disability. Typical diagnoses include multiple stroke, chronic degenerative disease such as Parkinson's or Multiple Sclerosis, or dementia -related diagnoses such as Alzheimer's Disease. The average age of the residents will be mid -seventies, though actual ages may range from teenage to greater than 100 years. Most residents admitted to this program will stay until they die. The facility truly becomes their permanent place of residence_ Programmatically, the long-term residential portion of this facility will adopt the "Eden A ternative" model of care. This new model is socially based versus medically based, founded on the Premise that boredom, helplessness and hopelessness account for the bulk ofsuffering in nursing homes. The model provides for the development of a "human habitat" that is infused with many species at varying stages of growth to create a very biodiverse environment. The human habitat is developed by infusing the home with many plants, animals and children. Plants and animals (cats, dogs and buds) take up residence; children are integrated through school and preschool programs. A "home", rather than an institution, is created that individualizes care and thrives on spontaneity rather than routine. The emphasis is on quality oflife for the individuals living in this section of the facility. There will be 90 beds dedicated to long-term residential care- 2 OCT-31-97 FRI 05:35 PM P. 06/10 ADDENDUM Prepared by Shelly Fischer B,�KGROUND It is important to understand some recent changes in the health care industry in order to understand the nature of health care today and the subsequent impact on facilities offering health care services. Prior to 1993, Medicare reimbursed health care facilities on a percentage of charges basis. There were no controls in place that limited hospital admissions, treatment or charges. It became clear that the Medicare system would quickly be bankrupt at the rate it was being drained financially. In 1983, the Health Care Financing Administration imposed the first prospective payment system on hospitals, which placed significant control on the type ofpatient admitted as well as the amount of reimbursement offered, via Diagnosis Related Groups (or "DRGs"). Hospitals were paid a flat fee based on the diagnosis of the patient, and all charges had to come out of that fee. One way for hospitals to decrease the charges per patient was to decrease the length of the hospital stay. As a result, patients began to be treated more frequently as outpatients, and hospital stays were decreased, from an average length of stay of 10-14 days to an average length of stay of 4-5 days. The impact ofthis legislation on nursing homes was dramatic. Prior to the mid-1980s, nursing homes were "rest homes" or "poor folks' homes". The typical patient was elderly, needing assistance with the activities of daily living, and was a permanent resident. When hospitals began to discharge people earlier, the nursing home was called upon to admit people until they were independent enough to go home. All of a sudden, the type of patient admitted to the nursing home was very different. The care needed was step-down hospital care, not long term "rest home" type care. Step-down or sub -acute we of the `90s looks nothing like nursing home care of the `80s. Other factors which have impacted health care and health care facilities are changes in the insurance industry. As commercial insurance becomes more heavily "managed", hospital stays become shorter and shorter currently approximately 2-3 days in length on the average. The longer and more expensive hospital stay is reserved for those patients who are seriously M. Patients who have moved beyond the acute crisis phase are expected to move to an alternative setting_ Though this is perceived by many as cold and heartless, it is motivated by a demand from society for less expensive health care. The average hospital days costs approximately $1.800.00. The average sub -acute unit day costs approximately $450.00. It is for these reasons that more and more care ofthe ill will be provided by sub- acute providers in a non -hospital environment. Currently, Medicare requires a 3-day hospital stay in order to access Medicare payment for subsequent nursing home days. It is predicted that managed care will eliminate this requirement, thereby encouraging physicians to admit patients directly into nursing homes for their care. This change will be seen OCT-31-97 FRI 05:35 PM P. 05/10 CALCULATION OF MAXIMUM PARKING ALLOWED PURSUANT TO LAND USE CODE SECTION 3.2.2 (K) (1) (g) (2) (a) SAL OFFICE BIUTATION 3729 S.F. COMMON SPACE 4,158 S.F LESS: N.KITCHEN, DINING, LAUNDRY, �( 0('• HOUSEKEEPING, MAINTENANCE L.9 AND GROUNDS 8932 S.F. 15,226 S.F. O JL At TOTAL 1819SS S.F. MAXIMUM PARKING 4.5/1000 HEALTH FACUTY LONG TERM CARE 90 BEDS MAXIMUM PARKING 33/BED SUB -ACUTE CARE 29 BEDS MAXIMUM PARKING 1/BED TOTAL _ 20%ALLOABLE INCREASE TOTAL PARKING ALLOWED 30 143 SEMIS 301331IN3tlV VMT '83d4NS I L66i 26 :LO :2[ Be 130 PaN MOIVAtlVd\OSi00V3105t[6j :I 0004D '39I 'SIDALIN"V vmr .... I., OCT-31-97 FRI 05:34 PM P. 04/10 FORT COLLINS NURSING CARE CENTER Calculation of Ma)dmum Parking Allowed pursuant to Land Use Code Section 3.2.2(K)(I)(gx2xa) Use Maximum Parldng Medical Office 4.5/1000 Outpatient/DayZment.Rehabilitation or and Administraport Services 125.6 spacesWill occupy 24are feet of the facility Health Facilities b. Long Term Care Facilities .33/bed or Long-term Residential Care unit 39.3 spaces and Short-term inpatient sub- acute rehabilitative and medical care. Will o &rate 119 beds. Subtotal 164.9 s ace 20% increase of maximum parking 33 spaces 164.9 x 20% TOTAL KAXIMUH PARKING ALLOWED 197.9 spaces m .0s •,6 . ;P�.(D3 OCT-31-97 FRI 05:34 PM P. 03/10 FORT COLLINS NURSING CARE CENTER Calculation of Maximum Pariong Allowed pursuant to Land Use Code Section 3.2.2(KXl)(gx2)(a) use Maximum AarkiAg Medical Office 4.5/1000 outpatient/Daypatient Rehabilitation or and Admi.niatrative support Services 85.29 spaces will OCCUPY 18,955 square feet of the facility Health Facilities b- Long Term care Facilities .33/bed or Long-term Residential Care Unit 39.3 spaces and short-term inpatient sub- acute rehabilitative and medical care. Vill operate 119 beds. Subtotal 124.s9 spaces 20% increase of maximum parking 24.91 spaces I24.59 x 208 TOTAL MAXIMUM PARKING ALLOWED 149.5 spaces OCT-31-97 FRI 05:34 PM P.02/10 OCT-31-97 FRI 05:33 PM P. 01/10 oFFort FAX NO: 416-2020 DATE: October 31. 1997 AL NUMBER OF PAGES MESSAGE: MARCH & MYATT, P.C. 110 EAST OAK STREET, SUITE 200 P. 0. 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