Henry J. Carter Specialty Hospital & Nursing Facility

Designs Delivered Henry J. Carter Specialty Hospital & Nursing Facility

Henry J. Carter| PAGE 1

Table of Contents

LTAC | Skilled Nursing Facilities

4

New Beds, Better Location

6 8

Functionality & Efficiency

10

Superstorm Sandy Equitable, Compassionate Environment

12

Culture Change Initiative

14

Schedule Acceleration

16

The Henry J. Carter Specialty Hospital & Nursing Facility features the renovation of an existing hospital to be re-purposed as a Long Term Acute Care Facility (LTAC) and a new 185,000 SF Skilled Nursing Facility. Array was engaged to design both facilities with the charge to create a seamless transition between them while simultaneously supporting the distinct requirements of two different resident populations, staff and guests. In addition to coordinating the renovation, construction and relocation of facilities, as well as creating a sense of place for residents, the team had to develop and manage a plan to accelerate the project completion 16 months ahead of schedule while maintaining the project budget.

Long-Term Acute Care | Skilled Nursing When a patient has medically complex needs that require special attention and care, a Long-Term Acute Care Hospital or Skilled Nursing Facility may be the most appropriate option.

Both are specifically designed to care for patients who have conditions that may require a prolonged recovery time, and as such, special attention must be given to design elements not found in a traditional hospital. Needs for group dining areas, kitchens, community lounges and respite areas for staff all must be considered.

A well-designed space has a profound impact on residents in long-term care situations.

LTACs focus on treating critically ill and/or high-acuity patients in an intensive way with specialized, physician-led interdisciplinary treatment programs geared to each patient’s needs.

Skilled Nursing Facilities are designed to fulfill residents’ basic healthcare needs while allowing residents to “own” their living spaces, which isn’t usually achievable in an LTAC, where patient acuity is higher and mobility is lower.

There are community living and dining rooms on all resident floors, as well as centrally-located spaces for therapeutic and recreational activities. Safe outdoor areas should always be considered. Popular are places that can be gardened or tended by residents.

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New Beds, Better Location With the closing of Harlem’s North General Hospital in July 2010, it was announced that the space would be renovated to become a specialty nursing facility to continue to house critical healthcare services for the surrounding community and city.

In the interim between closing and renovation, the New York City Health and Hospitals Corporation (NYCHHC) contracted Manhattan Maintenance to minimally maintain and operate the former hospital. Nearly a year later in April 2011, Array Architects began visioning and design meetings to relocate the Coler-Goldwater Specialty Hospital and Nursing Facility from Manhattan’s Roosevelt Island to an adjacent site of the former North General Hospital.

The $285-million-dollar project was to be divided into two standalone projects, each with unique goals. The Long Term Acute Care Hospital with 201 beds would be located in the 270,000 SF renovated space of the former North General Hospital. The Skilled Nursing Facility with 164 beds would be located in an adjacent 185,000 SF new construction, previously the hospital’s parking lot. Together the LTAC and Skilled Nursing Facility would compose an entire city block in East Harlem.

Being minimally maintained, the former North General Hospital needed major interior renovations not only to bring the space up to code and ADA compliance, but it had also fallen into some disrepair in the months before renovation. Services included new construction, replacement and upgrade of MEP/ low voltage building infrastructure systems as well as cosmetic improvements. The Skilled Nursing Facility project scope included new building construction, including a partial basement level; a twelve-story tower; an enclosed mechanical penthouse; and screened rooftop equipment at the 13th and 14th floor levels, renovation to the existing site and to the existing building at connected floors.

Additionally, all new construction and renovation had to be complete prior to moving 281 specialty hospital patients from Roosevelt Island, which was fast-tracked for demolition, to the new Henry J. Carter Specialty Hospital and Nursing Facility.

The accelerated schedule placed an emphasis on collaborative and efficient project planning, and it was vital that our project team become experts in New York Department of Health and Department of Building codes, along with other relevant agencies’ codes and regulations.

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Functionality & Efficiency During the design and construction process, many potential delays

The project team, an environmental remediation engineer

threatened the project schedule and budget. Any one of these items

and the Mayor’s office collaborated to evaluate solutions and

could have adverse effects on the completion date and final project

recommendations. City Hall confirmed that if all of the gypsum board

cost.

and studs were removed for this remediation, the area would not be

The team discovered extensive mold when renovation began at North general, which threatened a cost-savings opportunity to re-use the patient rooms on the west side of the existing hospital. Re-use provided cost savings and allowed these rooms to be grandfathered, locating the 10% ADA rooms in the new construction on the east side of the building. Mold on the gypsum board and rusted studs behind the showers compromised the structural integrity of the wall and blocking required for grab bars.

PAGE 8 | Designs Delivered

considered as “remaining as existing” and therefore would no longer be grandfathered. If these patient rooms could not be re-used and ADA rooms needed to be included, the number of available beds would decrease. Even though reducing the number of beds would have been more cost effective and had less impact on the schedule, it would neither have met our client’s needs nor the needs of the community.

Working with the environmental remediation engineer, a program was implemented to remove a portion of the bottom of the wall so it was no longer directly on the concrete.

Rusted studs were also remediated; and air quality testing was performed to confirm

PHOTO: Elevator Machine Room in North General Hospital

mold was remediated. With all parties working together, the cost and schedule impacts were kept minimal and client expectations were maintained.

In addition to mold, the existing elevator machine room (EMR) was in need of updating to meet certain codes. Though the system complied with the New York City Building Code, it did not comply with the State Building Code. The current NYC Building Code does not permit automatic sprinklers in EMRs, while NY State Department of Health (DOH) implies that EMRs be provided with a sprinkler system.

With directly conflicting requirements, bringing the elevator safety to code required our team to submit formal waiver requests to the City and State, suggesting equivalencies to satisfy life safety intent.

Neither entity accepted the requests.

NYC Department of Buildings (DOB) stated that elevators are used during fire fighting so it would be unacceptable to shut them down due to sprinkler system discharge. NY State DOH cited CMS’ recent interpretations related to Long Term Care Facilities to reinforce their requirement to have fire suppression in the EMR. However, both agencies were interested in finding a solution to their contradictory codes.

To remedy the code discrepancies we held a meeting with representatives from both the DOH and DOB to begin to consider alternative fire suppression systems for the EMR. Both agreed that

After further review, an aerosol system was found to meet requirements outlined by both agencies. This system uses a potassium-based aerosol to extinguish the fire. The aerosol is inert, does not affect the equipment in the EMR, is non-toxic and will not harm people if they were to be caught in the discharge. Additionally, the aerosol is lighter than air so it would float within the EMR and not enter the hoistway.

However, the current version of codes does not address this system and it had never been installed in NYC before. The Fire Department of New York (FDNY) knew of the system, yet they were hesitant to approve its installation. Our team met with FDNY staff in-person and confirmed that the system is effective in extinguishing EMR fires.

Then, working with the manufacturer, we compiled a list of reference contacts at other Authorities Having Jurisdiction where this system was installed. This process addressed their issues and we received approval to proceed with the design.

Having communication and professionalism by all involved were the core skills required to work through these issues. Our team worked with state and city agencies to find the most pragmatic solution to problems that arose from renovating a dated building and the results will surely become a standard for future projects within Harlem and New York City.

alternative fire suppression systems should be considered for the EMR. With that, the engineers began to draft available options.

Dry Chemical Systems, Wet Chemical Systems, Clean Agent Systems, CO2 Systems & Aerosols were briefly considered. The first three options quickly proved to be inappropriate for use in an EMR with slab penetrations, as is normal for a traction elevator system. Furthermore, in older traction elevator EMRs (as was the case for this project), the shaft is vented through the EMR. In addition, CO2 systems created

BROWSE Our Thoughts Click here to view Array’s thought leadership regarding planning.

concerns for the life safety of occupants in the EMR or hoistway.

Henry J. Carter| PAGE 9

Superstorm Sandy On October 29, 2012, when Superstorm Sandy made landfall at

Having to evacuate 200 patients, the client’s experience through the

New York City, the Henry J. Carter Project was half way through

aftermath of Sandy posed interesting questions and solutions for the

construction with only a year to finish.

Harlem project. Although the Harlem site is not part of the 500-year

Sandy quickly became the largest Atlantic hurricane on record.

Preliminary estimates assess damage at nearly $75 billion. New York City’s healthcare industry felt a particularly heavy impact. The

floodplain, the client asked the design team to review storm and flood elevations, as well as provide a list of current redundant power capabilities already included in the project.

total cost of repairing damaged infrastructure and replacing medical

The project team included additional equipment protection, such

equipment may exceed $1 billion. Images of critically ill patients being

as re-locating the fuel oil pumps to a higher elevation and elevating

evacuated in the darkness prompted concerns from some emergency

critical electrical equipment on higher pads. Additional redundancies

experts that hospitals in New York and elsewhere were not sufficiently

in the IT system were included by adding secondary UPS units for

prepared for such times.

each project’s main telecommunication rooms and closets on each

When Sandy arrived in Harlem, the job site was secured to handle the high winds and torrential rains. As a result, the job site fared very well,

floor. Backup air conditioning and flood mitigation were added to all elevators.

with little damage and no flooding. The existing facility on Roosevelt

By working with sub-contractors to verify available equipment and

Island, where staff and patients were moving from, was another story.

coordinate its installation, the hardening of the Harlem campus was

Extreme flooding and extended power outages forced five of the city’s major hospitals, including Coler-Goldwarter, to shut down and evacuate their waterlogged and powerless facilities. Hospital evacuations impacted the entire New York City area and hospitals remain vulnerable to future storms.

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able to occur without disruption to the schedule or budget.

Kent Doss Kent’s deep understanding of all aspects of project design and delivery, combined with a “roll-up-his-sleeves attitude,” al-

DISASTER PREPAREDNESS

lows him to excel in managing teams

The aftermath of Sandy prompted calls to update the local

and construction. From accelerated

building codes to ensure buildings can withstand similar, future

schedules to coordinating package re-

natural disasters.

views, from working closely with the con-

Post-Sandy overall building resilience objectives to consider: 1. Minimizing damage to critical infrastructure during the event 2. Maintaining operational integrity and critical services immediately following the event 3. Returning the building to normal, safe operating conditions as soon as possible

through the dynamic process of design

struction management team to monitoring a project’s schedule and budget, collaboration ensures project expectations are achieved.

Design and construction projects will always have their issues and challenges.

A cooperative team motivated by shared goals and working in true partnership can better address these challenges

NYC Building Code adopted the “ASCE 24-05 Flood

and deliver a more successful project.

Resistant Design and Construction”, which provides minimum requirements for the design and construction of buildings in flood hazard areas. Buildings designed according to ASCE 24 are better able to resist flood loads and flood damage.

Click here to visit Kent’s Thoughts Page

Preliminary conclusions of lessons learned underline the importance of the following: 1. Pre-disaster planning 2. Building to 500-year-flood elevation or ABFE - build to V-Zone regulations in Coastal A-Zone 3. Provide flood protection in three dimensions, not just two 4. Elevating of utilities or dry flood-proof mechanical and electrical service components 5. Balanced approach In general these are flood mitigation techniques: 1. Relocation / acquisition (best) 2. Elevation (passive measure) 3. Dry flood-proofing 4. Wet flood-proofing 5. Flood walls and levees

Click Here

to read our thought leadership on disaster preparedness

Click here to see the FEMA Mitigation Assessment Team’s (MAT) presentation, “Hurricane Sandy - Lessons Learned.”

Henry J. Carter| PAGE 11

Equitable, Compassionate Environment

A thoughtful and studied approach to comfort, safety, durability,

The building design had to integrate patient needs with the

flexibility and context ensure that caregivers, patients and residents

neighborhood, while creating a healing, pleasant environment that

have a beautiful and equitable environment that delights the senses

promotes a sense of community for LTAC/Skilled Nursing Facilities

every day.

patients and staff. Furthermore, renovations had to create parity

When Array sat down with the user groups of the Henry J. Carter Specialty Hospital and Nursing Facility to determine the furnishings

between the existing and new building, which utilized nature-infused, urban-inspired, sustainable materials.

of each space at the new 302-bed long-term care and skilled nursing

NYCHHC noted that a Culture Change Initiative was to accompany the

facility, there were many features to consider. Varied patient acuity

move to a new facility. Serving a unique demographic in NYC, unlike

and mobility levels needed to be taken into account. Public spaces

other Skilled Nursing Facilities throughout the country, this facility

with many a variety of potential uses had to accommodate community

is a permanent home for many residents. The building design had to

members, patients, visitors and staff. Budget and durability for this

create a sense of place for residents not only in their individual room,

public hospital were also key factors.

but within the entire facility and the neighborhood at large. To this end, it was essential that the furnishings not feel institutional.

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FURNITURE & FINISHES: A MODERN AND URBAN AESTHETIC Array selected furniture and finishes that are of a residential scale.

Furniture features include warm woods and textiles with vibrant colors and patterns, which balances the desire for beautiful furniture and the ability to withstand heavy daily use for years to come.

Inspiration came from the surrounding sight and sounds of the East Harlem neighborhood.

EMPOWERED TO ENGAGE Game tables able to accommodate wheelchairs comfortably, with chairs light enough for the residents to move independently, were included alongside space for an electric hearth, and sofas gathered around for reading and socializing. Computer stations are included in each Living Room for resident use. Large windows invite natural light and sight and sounds from the adjacent train line, which serves as an animated distraction.

SAFETY Mobility limitations were accommodated and ergonomic features ensure comfort and reduce fall risk. For those patients and residents ambulatory enough to take advantage of the communal living and dining spaces, their comfort must be maintained as they enter and leave their bedrooms. A safe route to the common areas must also be maintained. Array’s designers chose slip-resistant flooring in a low-contrast pattern to prevent patient falls as well as to prevent their “eyes playing tricks on them” with a busy floor pattern that those with impaired vision could perceive as uneven.

PUBLIC SPACES To achieve consensus, weekly committee meetings were held with facility leaders with regular input from the focus groups that included a cross section of residents. The Array team conducted detailed reviews, selecting and approving furniture for all facility areas including lounges, dining rooms, long-term care patient units, skilled nursing resident units, clinical areas and offices. Unique program elements included worship spaces, a teaching kitchen, rich library and art rooms and finally a performance space used by patients, residents and the East Harlem community at large. These meetings allowed the clinicians who work in the spaces each day to express their wishes, concerns and experience with furniture, finishes and their impressions of what does and doesn’t work for the patient population in a long term health care environment.

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The Culture Change Initiative Making a Hospital Feel Like a Home RELAXING, SOOTHING, WELCOMING Approaching a design that meets the needs of two facilities under one roof and one brand poses unique challenges. There is an inherent desire to create a seamless transition from one facility to the next, but also a necessity to acknowledge the distinct requirements of two distinctly different patient populations, staff and guests. There is a need to unify the brand, the culture and the buildings while simultaneously highlighting the purpose and requirements of each facility.

With stays of up to 10 years, incorporating elements of the home, the existing community and neighborhood is essential to make residents more comfortable. When designing the facilities at Henry J. Carter, Array spent significant time on the interior details. The overarching theme, urban park, is highly site-specific, meant to remind residents that though they are residents in a hospital, they are still residents of New York City.

Click here to read Lauren DeMattia’s thought leadership piece, “Home is Where the Art Is.”

UNITY AND DICHOTOMY Having on main entrance creates a sense of a unified facility. From this entrance, a community concourse runs to the other end of the existing building, where the LTAC is located. This concourse, or streetscape, has mutual activities available to patients and visitors of both the Skilled Nursing Facility and LTAC. Array selected materials and colors as one palette but that gradate through the space, beginning the subtle separation that is necessary for way-finding and sense of purpose.

Developing a strong over-arcing master palette for both facilities allowed for bolder, stronger colors and patterns in the light-filled spaces of the Skilled Nursing Facility, balanced out by the brighter, softer colors and more subtle patterns that help to uplift the lower ceilings and smaller windows of the LTAC. Additionally, the colors in each way finding graphic or image work with and speak to the colors on each floor of both the LTAC and Skilled Nursing Facility.

Incorporating large-scale graphics, imagery from East Harlem into the way finding on each floor solidifies the patient or resident’s sense of place within their new community.

to bright and softer colors and hues in the LTAC. Each activity space, which is full of light and color, is visible from the concourse to create a

The flooring material and pattern remain constant as the color palette

sense of hustle and bustle that a long-term resident can appreciate as a

gently shifts from bold and saturated, in the Skilled Nursing Facility,

community or larger neighborhood.

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ACTIVITIES AND PATIENT ENGAGEMENT The activities housed in each facility along the concourse also speak to the individual facility while still guiding one through the space with a sense of community and unity, from the center of town to a quieter neighborhood street.

The Skilled Nursing Facility with long-term, loweracuity patients houses higher-level activities like arts and culinary, music and movement. Directly off the main entrance and visible from the vestibule is the Community Meeting Hall. Bold colors and playful, large-scale pendants fill the sun-lit gathering space outside this room, where activities like food from arts and culinary and socialization occur. Inside is nothing short of a theater with sound-absorbing wall panels and a fully-functioning performance stage. Here the facility can draw in the community at large, offering events ranging from concerts to craft sales and movies. This provides residents a much-needed connection with their surrounding community.

As we move through the streetscape, we transition into the LTAC, which houses areas of worship and respite. As LTAC patients have higher acuity and more complicated needs, the activities shift and the colors soften. At the end of the concourse in the LTAC, there is a resident’s lounge with a café and outdoor seating, walking and dining. Here is the more intimate side street of our neighborhood. Soft, bright colors and lounge seating invite groups and patients to connect and relax, drawing people through the entire facility and balancing the use of both spaces.

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Schedule Acceleration

In December 2011, Cornell University and its partner, the TechnionIsrael Institute of Technology, announced its new applied sciences and technology campus was to be built on the south end of Roosevelt Island, the location of Coler-Goldwater Specialty Hospital. Construction of the Cornell NYC Tech campus, announced to begin in 2014, required the demolition of the Specialty Hospital.

To meet the accelerated schedule of 28 months from start of design to resident move-in, the team implemented integrated project delivery (IPD) strategies and a collocation system. The collocated design and construction management (CM) team, comprised of eight full-time and six part-time designers, and 16 full-time CM staff, occupied offices within the existing hospital.

The collaborative set up enabled impromptu and scheduled meetings, which reduced the back-and-forth of the traditional RFI process. Since details could be worked out in the field, the on-site team resolved issues before submitting formal follow-up sketches or RFI responses to the off-site teams.

Instant responses and validation of issues aided in accelerated decision-making, planning and documentation throughout the project.

To save time by eliminating the design development phase, the client became instrumental in keeping to the schedule and making quick decisions related to operational issues and building functionality.

To help enhance the team effort, performance incentives that included shared cost and schedule metrics for both the contractor and design team were implemented. The incentives tied to schedule conformance not only enhanced team effort, but also helped maintain collaboration during critical points in the project.

You’re joined at the hip by money, but since we were collocated, we put that piece aside and started to work as a cohesive team; We were all working toward the same goal.

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Click Here to read the Schedule Acceleration case study

Full-team strategy meetings, including page-turn reviews of contract documents —to evaluate design, details material availability and possible value management—and bid packages.

The 13 early-release packages included demolition, early MEP, structural, elevator, long lead MEP equipment, major medical equipment, exterior & core and shell, lower and upper floors of the LTAC, architectural finishes and furniture packages. Dividing the two projects into multiple bid packages facilitated the quick release of information, award of contract and start of construction.

The client, contractor and design team spent a full day working side-by-side to review and approve packages, incorporating any revisions prior to final submission. When bids were returned, the design team and consultants reviewed to confirm that scope was correctly included, as well as evaluate any additional value information.

Even with all of the construction challenges resulting from unforeseen issues, the move-in schedule never changed.

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