From: Frank L. Hoffman

To: Patricia Outhouse – 518-843-3503 – FAX 843-3537

Date: 22 May 2002 – Updated 4 June 2002

Meeting Attendance:

This meeting report is intended to be a "living document" that will be updated each week to incorporate the various suggestions, desires, and wish-lists that are intended to improve the operations, programs, and physical plant of Montgomery Meadows for the next 18-20 years (The 2020 Vision).

Initially, we will be looking at five major categories: operations, programs, physical plant, financial analysis, and market analysis, each of which is more fully described below.

(A review of the procedures that are effective and don’t need changing, and the things that can be improved or added.)

• 30 stations required
• Include laundry tracking and labeling system for residents’ clothing
• Include station(s) for resident use

• Relocate to the main floor
• Eliminate linen carts passing lobby

• Locate with administration
• Locate off employee entrance corridor

• Maintain safe environment for residents, family and staff
• At main entrance
• Part of reception
• Increase site lighting in parking area.
• Have high intensity lighting come on if exit alarms go off at night

• Privacy in times of personal loss
• Maintain privacy of other residents.
• Prevent possible stress to other residents

• Find ways to minimize need to work in them
• Increase the height and establish an exterior entrance

• Entry and lobby – covered entry
• Dining room – restaurant like

(A review of the existing services that are effective, those that need to be enhanced, and those that could be added.)

• Offer alternative level of care to foster independence and help residents plan and meet rehabilitation goals

• Offer enhanced environment to meet specific needs of dementia residents
• Provide for safe wandering activity (interior and exterior)

• Enclosed courtyard for dementia residents

• Gardening areas

• Dining

• Offer coordinated services to elderly of county
• Easy access to additional services
• Enhance communication between providers

(A review of the existing physical plant and the repairs, improvements, renovations, additions, and/or replacements that may be required.)

1. Maintenance and/or replacements necessary to maintain the status quo, including associated costs:

• Lyle received an estimate of $250,000 for the main section of the building (does not include the wings)
• Tremco’s 5 May 1998 estimate for entire building was $400,000.00
• Roof replacement should incorporate renovation changes

• Use pagers instead of speaker system so as not to disturb residents and prevent possible privacy issues (quality of life issue)
• Have classical music on speaker system
• Have voice mail
• Have combination of phone pagers to allow voice communication

• Some critical parts are no longer available from manufacturer (Dukane)
• Lyle is trying to obtain used parts as a stop-gap measure
• Replacement cost utilizing existing wiring is approximately $100,000.00
• Should be done as part of renovation, which would most likely involve new wiring

1. Additions and renovations required for operations and programs, including associated costs:

• In association with others
• Independent firm operated on site – Preferred
• With connecting corridor

• Opportunities for inter-generational programming

• Safe environment.
• Resident population formerly spent more time outdoors (more alert)
• Enclosed courtyard for dementia residents
• Gardening areas
• Raised planters for resident access
• Dining and picnics with covered area
• Outdoor activities (school concerts, etc.)
• Areas conducive to rehabilitation sessions
• Family visiting
• Change lighting so that it does not shine in bedrooms

• A facility must take care of its staff, to take care of the residents. Staff satisfaction – key to quality of care
• Smoke from smoking lounge could be smelled in non-smoking areas
• Renovations to laundry area may supply sufficient air and air conditioning to other areas of the lower level
• Relocate both laundry and staff lounges to main floor

• Create a welcoming environment for residents and family
• Have a welcome sign and flower garden at the entrance road
• Have canopy extend half way into driveway to create a covered area for drop-off and pick-up, and a by-pass lane beyond the canopy
• Expand the park and garden setting on both sides of the main entrance and include the center of the circle
• The existing lounge is very nice but should be extended through the adjacent office and men’s locker room
• The wall between the lounge and the lobby entrance should be removed
• Vault the ceiling in the lobby
• Move the vestibule closer to the driveway to enlarge lobby
• Create an atmosphere of "Light and Life" with indoor planter with skylights beside the new vestibule that is open to the lobby
• New reception desk that is open to the lobby
• Find a way to hide the view of the dish room from the lobby and entrance
• Suggested revision plan was reviewed at the meeting

• Gathering place for residents and family

• Create a solarium on the exterior side of the dining room
• Install new folding partition where old partition was installed
• Build in versatility into room scheme (alcoves, smaller areas) to allow multiple uses for space to meet individual programming needs of population
• Allow for multiple small group activities to enhance individual choice of programs
• Vault ceiling to incorporate skylights
• Install mood-lighting (chandeliers and sconces)
• Suggested revision plan was reviewed at the meeting

• Does not need windows
• Offers privacy to residents and family
• Meeting place for individual counselors and pastoral care personnel

• Staff
• Community – open facility doors to community to maintain resident ties with areas of interests
• Could be in clinic/day care addition
• If laundry and break rooms are relocated to main floor, convert area to air-conditioned meeting rooms

• There does not appear to be any need for independent doctors’ offices
• Check with local providers to see if they are interested in locating a clinic on site

• An exercise room should be included for both residents and staff.
• Travel distance could be a problem – we may require a secondary area for some resident programs

• Was closed before – staff must support it, if it is reopened
• Have a "good" coffee machine for break times
• Should be adjacent to kitchen
• Should be adjacent to break room
• Problem with existing vending machines (run-out, touchy)
• Increase number of vending machines

• Should be located near lobby
• Should be located near cafeteria
• Resident access for individual purchase choices and for family use.
• Create "Community Square" atmosphere, which recognizes residents as consumers

• Offer individual resident access and services where supplies are readily available to staff in service area – resulting in more individual attention to resident needs
• Increase privacy and efficiency of care
• Find way of storing bedpans in resident bathrooms
• New medicine cabinets that residents can reach
• Have roll-in showers in each room
• Have lockable cabinet for linen storage

• Will facilitate renovating of other wings
• Design all rooms large enough to accommodate sub-acute care – medical gasses could be installed at a later date.
• Increase size of bedrooms to accommodate higher acuity resident need and equipment
• Opposite head walls with separate windows for each resident
• More private rooms
• Behavior related to dementia
• Infection control
• Privacy issues related to mental health needs and coping strategies
• Individual choice related to lifestyle patterns
• Privacy for couples
• Private rooms should have roll-in showers
• All resident rooms with roll-in showers
• Some residents may not want a private room
• All private rooms, with a few double rooms
• At resident council meeting all residents who responded preferred private rooms.
• Private rooms with roll-in showers would save staff time and preserve resident dignity
• Central nurses station and services (like Green Manor)
• If market study supports 80 adult home beds, build two new SNF wings and convert existing wings to adult home

• Enable supervision while maintaining privacy
• Have visibility to every resident door
• Have a break and charting room
• Have head nurse office adjacent to nurses station
• Ideal layout cannot be achieved with present wing configuration
• Have larger medication rooms to allow for cart storage
• Locate solarium adjacent to nurses station
• Have large storage area for wheelchairs, stretchers, and other equipment
• Clear nurses station area of staff who can perform job duties in separate but accessible areas
• Offer supervision without infringing on resident privacy or creating "institutional environment"

• Enlarge offices by constructing an addition
• A new Administrator’s Office with meeting area
• Toilet Room
• Personnel Office

• Separate Personnel Office required

• Locate with business offices
• Locate at new employee entrance
  • Separate from main entrance which should be reserved for residents, families and visitors
• Have interconnecting door with Administrator’s Office
• Offer private area for staff to address personnel issues.
• Locate at a distance from resident care environment.
• Business Office
• Relocate to this office
• Increase privacy for financial discussions
• Reception
• Create a new reception desk in present alcove
  • Greet families and visitors
  • Information center
  • Direct visitors
  • Security purposes
• Include a way to close up at night
• Close up both reception windows
• Mail/copy/storage room
• Have adjacent to reception room with one-way decorative mirror
• Maintain secure area for confidentially of resident information.
• Eliminate staff congestion in front office area

• Locate at end of corridor near A-wing
• Relocate locker rooms to this location
• Locate as an addition near service entrance (preferred)

• Have offices adjacent to resident area, but separate from resident living area
• Offices to include:
  • Medical Director and Physician’s Assistant
  • Director of Nurses
  • Assistant Director of Nurses
  • Medical Records
  • Have adjacent to Medical Director
  • Need approximately 400 Sq. Ft. for record storage and clerk’s desk
  • Conference Room
  • Space for clerk-typist, copy and fax machines
• Enables clustering of central medical service functions
• Enhances communication
• Offers central "spot" for residents
• A more home-like environment

• Residents need more direct access to these services
• Should be separate from Medical Service Offices
• Should be located adjacent or in resident area, but separate from living area.
• The following offices are independent, but may be located near each other.
• Social Service – two offices, or three, if Adult home is included in renovation.
• Patient Agent – relocate from front of building to be closer to residents
• In-service/restorative nursing
• Nursing Supervisor
• Create "home-like" atmosphere

• "Light and Life" theme

• A happy staff is a large part of "quality of life" for residents
• Part of cafeteria
• Should be in an area separate from residents.
• Should not be in the basement

• Retains residents in their "homes"
• Replace old roof top units with gas fired self-contained HVAC units
• New or renovated boilers to be dual fuel (oil and gas)

• Have air system temperatures at lower end of resident comfort range
• Use perimeter heating as re-heat to increase room temperatures to individual requirements
• Importance of individual choice
• Link to private rooms and lifestyle patterns

• Enclose dryers and have separate unconditioned make up air supply
• Rearrange laundry to have a separate soiled room, and wash room, with each having 10 air changes of exhaust
• Supply 10 air changes of air-conditioned air to the clean area, which should balance with the exhaust air
• Enables better facility control to ensure resident linen needs is met efficiently and in a timely manner

• Maintaining quality education and training needs of staff better insures quality of care for residents
• Size should be approximately the size of the existing conference room
• Should have bed set-up
• Should have space for CPR training
• Should have classroom space
• Have folding or stacking chairs
• Size should be approximately 400-500 sq. ft.
• If in-service training room is located in the lower level, then a main floor office will also be required in the resident area of the facility

• Have enough room for 3 carts and work and storage space
• De-clutter facility environment
• De-institutionalize atmosphere

• Electrical and plumbing
• Storage for supplies
• Storage for equipment and machines
• Locate on main floor
• Housekeeping Office should be adjacent
• Enhance communication to insure efficiency of service to residents

• Ensure more efficient transport of materials to decrease amount of time and foster a "home-like" atmosphere
• Increase size of loading dock
• Increase width of doors at end of service corridor
• Increase the width of elevator doors so that elevators can handle a pallet

1. The costs associated with replacing the entire facility:

   Based on preliminary studies, it does not appear that replacing the entire facility would be cost effective.

2. A comparison and evaluation of the merits of proceeding with A and B (above), or with C (above).

(A comparison of cost trends over the years, with an effort toward finding ways to lower costs and improve income to overcome the loss of funding, and maintain a "profitable" status.)

• Mary Ann Leone provided a preliminary break-even cost analysis of operating a cafeteria.
• Break-even cost $54,750 per year
• Minimum 60 staff per day spending an average of $2.50 each
• Costs do not include capital component
• What is the cost of present coffee vs. having improved vending operation and break area

(A review of existing and potential residents who could help improve the Case Mix Index, and the feasibility of adding other levels of care.)

• Offer alternative levels of care which maintain resident relationships with other residents and with staff and eases transition to an extended environment operating in collaboration with SNF

• On 22 March 2002 there were 10 empty SNF beds with 17 that could be relocated to an adult home, which would require 28 new residents to fill the SNF.

• On 3 April 2002 there were 12 empty beds with 17 that could be relocated to assisted living.

• On 10 April 2002 there were 11 empty beds with 17 that could be relocated to assisted living.

• Other facilities have vacant SNF beds, too.

• On 24 April 2002 there were 5 empty beds with 17 that could be relocated to assisted living.

• 4 of the 5 beds could have been filled if there were more private rooms available.

• On 1 May 2002 the bed situation was the same as on 24 April 2002.

• On 15 May 2002 there were 4 empty beds that could have been filled if there were more private rooms. The same 17 beds could be relocated to assisted living.

• On 22 May 2002 there were 2 empty beds that could have been filled if there were more private rooms. The same 17 beds could be relocated to assisted living.

• On 29 May 2002 the conditions were the same as on 22 May 2002

• Lack of private room availability has consistently been a problem with proper placement.

• The ideal nursing unit size is 40 beds.
• Efficiency of care fosters good quality of care of residents.
• "Quality of life" enhancement

• Preliminary indications are that Montgomery Meadows could fill considerably more than 80 beds.

• Lack of private rooms seems to be the most important factor in keeping the facility from being filled.

• Preliminary analysis of hospital discharges indicates that there are enough PA’s to fill at least a 40-bed adult home with an assisted living component.

• If we can justify 80 adult home beds, preliminary studies indicate that it would be cost effective to convert the existing three nursing wings into 80 adult home beds.

• Past trial runs of special $2.00 meals only attracted about 20 staff members
• Better vending machines may be the answer
• A staff survey will be conducted

• Eliminate Montgomery Infirmary perception of Montgomery Meadows.
• "You not only get a nursing home, you get a family!"
• "Caring is what we do!"
• "A community of caring!"
• "Quality of Life is the most important service we render!"