HomeMy WebLinkAboutVENCOR, FORT COLLINS NURSING CARE - PDP/FDP - 23-97 - SUBMITTAL DOCUMENTS - ROUND 1 - MODIFICATION REQUESTPROJECTED 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: 8
PROJECTED 0UTPATIENT/DAYPATIENT UTILIZATION
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
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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
evening shift overlap (2:00-2:30 p.m.). At such time, 80 percent of the skilled nursing staff will be
on shift, ancillary and administrative staff will 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 FTE, 37 per day
80% are staffed during patient waking hours, day and evening shift
Total: 43 staff at day/evening shift overlap
Nursing Administration:
Director of Nursing: 1
Staff Development: 1
Unit Secretaries: 2
CQI/Infection Control: 1
Total: 5
Business Office: 5
Medical Records:
Activities: 4
Laundry/Housekeeping: 6
Maintenance/Grounds: 3
Rehab Staff: 18
Case Management: 2
Dietary: 5
Volunteers: 2
Total Staff at Peak Time 96
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developed by infusing the home with many plants, animals and children. Plants and animals (cats,
dogs and birds) 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 of life for the individuals living in this section of the
facility. There will be 90 beds dedicated to long-term residential care.
SHORT-TERM INPATIENT SUB -ACUTE REIL4BILITATIVE 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 full 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.
REHA BILITA TION SER VICES 0UTPATIENT/DAYPATIENT
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 a.m. 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.
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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 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 roof,
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-TERM RESIDENTIAL CARE
The focus of this service will be long-term (greater than 3 months) care. The population will
consist primarily of very 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
Alternative" 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 of suffering in nursing
homes. The model provides for the development of a "human habitat" that is infused with many
ZGolden West Health Care Center
A Vencor Facility
1005 - East Elizabeth Street -T
Fort Collins, Colorado 80524-3911
(970)482.2525
(970) 482 .1138 Fax
ADDENDUM
Prepared by Shelly Fischer
BACKGROUND
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 1983, 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 of patient 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 care 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 ill. 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 of the
ill will be provided by sub -acute providers in a non -hospital environment.
FORT COLLINS NURSING CARE CENTER
Calculation of Maximum Parking Allowed
pursuant to
Land Use Code Section 3.2.2(K)(1)(g)(2)(a)
Use
Maximum Parking
Medical Office
4.5/1000
or
Vencor's Outpatient/Daypatient
49.5 spaces
Rehabilitation Services will
occupy approximately 11,000
square feet of the facility
Health Facilities
a. Hospitals
1.0/bed
or
Vencor's Short-term inpatient
30 spaces
sub -acute rehabilitative and
medical care unit will
operate 30 beds
b. Long Term Care Facilities
.33/bed
or
Vencor's Long-term Residential
30 spaces
Care unit will operate 90 beds
Subtotal
109.5 spaces
20% increase of maximum parking
21.9 spaces
(109.5 x 20%)
TOTAL MAXIMUM PARKING ALLOWED
131.4 spaces
Leanne A. Harter, AICP
October 21, 1997
Page 3
Vencor does not plan to request a modification to the parking standards based upon the above stated
interpretation of the Code which would allow a sufficient number of spaces. We look forward to
discussing this issue with you on Wednesday.
Sincerely,
MARCH & 7ATT, P.C.
j,
Lucij A. Liley
LAL/jpk
Attachments
cc: Shelly Fischer (via Facsimile)
Linda Ripley (Via Facsimile)
Leanne A. Harter, AICP
October 21, 1997
Page 2
in the health care and insurance industries which have impacted the provision of health care services
and, thus, the design of facilities for such care. Ms. Fischer has also provided a summary overview
of the health care services to be provided at Vencor's new facility and an estimate of the number of
parking spaces necessary to support the facility based upon staffing needs and professional and patient
traffic. Also provided by Ms. Fischer is a sketch of the facility which illustrates the area which will
be occupied by each use and the common areas shared by all uses. This information assists us in
understanding the uniqueness of Vencor's proposed facility and how to reasonably apply the Code's
parking requirements.
As explained by Ms. Fischer, the Vencor - Fort Collins Nursing Care Center will essentially
provide three distinct types of health care services, each with its own unique patient population, in
one combined use facility. Because the current version of the Code, at Section 3.2.2(K)(1)(g)(2)(a),
calculates the allowed number of parking spaces based on "the square footage of the gross leasable
area and of the occupancy of specified uses", we interpret this standard to allow 109.5 spaces. In
addition, and pursuant to the same Code section, we have increased the maximum parking allowed
by 20%, to 131.4 spaces, because "on -street or shared parking is not available on land adjacent to
the use". Please see the attached calculations.
Prior to the Planning and Zoning Board (the "Board") hearing on the Vencor - Fort Collins
Nursing Care Center PDP, the Board and the City Council will consider amendments to the Code
pertaining to "long-term care facilities" on November 6 and November 18, 1997, respectively. The
draft of the proposed amendments, a copy of which was provided by Tom Vosburg, City Policy
Analyst, indicates that the changes are two -fold. First, "long-term care facilities" will be moved to
the list of non-residential uses in the L-M-N Zoning District (Code Division 4.4) and the title of
Section 3.5.3 will be changed to include this type of use. The purpose of these changes is to make
it clear that design and building standards for non-residential, commercial and mixed -use buildings
apply to a long-term care facility. Despite the conflicting provisions in the Code as of the date of
Vencor's PDP submittal, which this amendment remedies, Vencor will seek to comply with the non-
residential, commercial and mixed -use standards.
The second proposed Code amendment would change the parking table at Section
3.2.2(K)(1)(g)(2)(a) to "more appropriately address the number of maximum parking spaces that
should be allowed for long-term care facilities". According to the draft we were provided, the
number of parking spaces for this facility, which will have up to 96 employees on shift at one time,
would be increased by 48 spaces (1 space per 2 employees) to 157.5 spaces. The 20% contingency
would then add an additional 31.5 spaces, for a total maximum of 189 allowed spaces. Although this
Code amendment may not technically be applicable to the Vencor - Fort Collins Nursing Care Center
PDP, we believe that the intent and purpose of the amendment should be considered when applying
the parking standards to this project.
In conclusion, we request that you consider this interpretation of the parking requirements
and respond to us as soon as possible. Vencor intends to submit its PDP revisions by November 4,
1997 in order to secure a January 15, 1998 Planning and Zoning Board hearing date. At this time,
ARTHUR E. MARCH, JR.
RAMSEY D. MYATT
ROBERT W. BRANDIES, JR,
RICHARD S. OAST
LUCIA A. ULEY
J. BRADFORD MARCH
LINDA S. MILLER
JEFFREY J. JOHNS
MATTHEW J. DOUGLAS
Leanne A. Harter, AICP
Current Planning Department
City of Fort Collins
281 North College Ave.
Fort Collins, Colorado
MARCH & MYATT, P.C.
ATTORNEYS AND COUNSELORS AT LAW
110 E. OAK STREET
FORT COLLINS, COLORADO 80524.28W
(970) 482.4322
Fax (WO) 4823038
October 21, 1997
ARTHUR E. MARCH
19WI981
MAILING ADDRESS:
P.O. BOX 409
FORT COLLINS. CO 80522-0489
VIA HAND DELIVERY
Re: Fort Collins Health Care and Rehabilitation Center,
now known as Vencor - Fort Collins Nursing Care Center
Project #23-97
Dear Leanne:
This firm represents META Associates, Inc. and First Healthcare Corporation ("Vencor"),
the applicants for approval of a health care and rehabilitation center at the southwest corner of South
Lemay Avenue and Southridge Greens Boulevard. We understand that, following a review by the
Conceptual Review Team on June 2, 1997 and a neighborhood meeting on June 24, 1997, Vencor
formally submitted its preliminary Project Development Plan (the "PDP") to the Current Planning
Department on August 19, 1997. City Staff has conducted its initial review and comments were
provided to Vencor by letters dated September 19, 1997 and October 2, 1997.
Vencor's PDP submittal was accompanied by a request for a modification to the City's parking
requirements to permit a total of 82 parking spaces. Staffs only comment relative to the number of
parking spaces was a request for additional information in support of the modification request (See
September 19, 1997 Comment Letter, page 6). Having thoroughly reviewed the applicable provisions
of the Land Use Code (the "Code") on behalf of Vencor, particularly Sections 3.2.2(G) and
3.2.2(K)(1)(g)(2)(a), we believe that the Code can reasonably be interpreted to allow Vencor a
sufficient number of parking spaces and thus a modification of the requirements may not be necessary.
The purpose of this letter is to outline what we believe to be a reasonable interpretation of the
Code's non-residential parking requirements as it applies to the specific uses proposed by Vencor.
Shelly Fischer, an employee of Vencor, registered nurse and the current Administrator of the Golden
West Health Care facility, has prepared an addendum to this letter which describes in detail changes