The building that currently house Riverside Rest Home is more than a half century old and is no longer serving its purpose well. By law, each county needs to provide for elderly citizens who are not able to live on their own if they do not have the resources to afford a private rest home. The demographics and needs of the elderly population have changed substantially in the last 50 years, as have federal a state laws defining standards of care. The current building is not meeting these needs well. It lacks insulation and air conditioning and the old construction has asbestos and other toxic materials that would make it impossible to renovate with the residents in place. The design of the building makes highly efficient staffing impossible, and the sanitary facilities are not sufficient to serve the residents well.
There was a proposal for a newly constructed rest home that came forward in 2022. Initially the project had broad bi-partisan support, but the Republican delegation balked at the price-tag of the proposed project. At a meeting at the end of the 21-22 term, we discussed using a bond to fund the project. Bonding for the project requires a 2/3 vote, and the Republicans blocked that bonding. In a compromise, I moved that we bond enough to get a more thorough set of designs, and the Democrats were joined by a small number of Republicans so that the design could go forward. Most of the Republicans who voted with us were not re-elected for the current term.
The details of the design considerations are too complicated to go into here, but there are certain design elements that we Democrats feel are critical.
First, the building needs to meet the current Federal and state standards for rest homes. This includes things like minimum room size, private toilet facilities for each room, outside windows, and capacity for necessary care equipment, such as lifts for residents who are too heavy for nursing staff to safely lift and turn.
Second, the building needs to be constructed so that it will remain viable for the next 50 years. This includes some capacity for expansion and certainly includes use of quality materials and construction. A building that is only good for 25 years might cost less up-front, but will cost the county a lot more in the long run.
Third, the building needs to be designed with staffing and operational efficiency in mind. Sight lines from nursing stations that maximize the number of rooms visible from the station reduces the number of staff that need to be at stations. Infrastructure designed for efficient distribution of meals and handling of laundry will reduce operating costs. Reduction of long operation costs will more than pay for a higher up-front capital expense.
Fourth, rehabilitation facilities need to be available on site. Currently, residents who are recovering from hospital operations can not stay at Riverside, but have to go to one of the private rehab facilities in the area. Riverside needs to hold those beds open for the residents return, but they get no medicaid reimbursement. Furthermore, Riverside misses out on the higher reimbursement rates that Medicaid pays for rehabs. This loss of revenue means higher county taxes, paid by our property taxes. The new building has to be designed so we don't lose this revenue.
Fifth, federal standards require that certain amenities be available to residents, like a hair salon, access to banking, and postal service. Many new rest homes, such as the one in Merrimack County, have "Main Street" areas that have these amenities, along with a cafe where residents can sit with loved ones. The services offered in these places could be provided by local businesses who rent the space, creating another revenue stream for the county.
Sixth, childcare for the staff. This is a less obvious need for a rest home, but one of the major challenges for health care facilities right now is qualified staffing. Anything that will make Strafford County's rest home more attractive for employees is an advantage. An onsite day-care would give us a significant advantage in hiring. Once again, this could be run by a qualified third party who pays rent on the space.
The refusal of Republicans to come to a reasonable compromise on this project has already cost us 15 million dollars in lost state funding. The longer the project gets put off, the more expensive it will get, and the longer our residents at Riverside have to live in substandard housing.
For more details on this issue, see this letter in Foster'swww.fosters.com/story/opinion/columns/2024/05/12/commentary-moving-forward-for-a-new-strafford-county-nursing-home/73624983007/
There was a proposal for a newly constructed rest home that came forward in 2022. Initially the project had broad bi-partisan support, but the Republican delegation balked at the price-tag of the proposed project. At a meeting at the end of the 21-22 term, we discussed using a bond to fund the project. Bonding for the project requires a 2/3 vote, and the Republicans blocked that bonding. In a compromise, I moved that we bond enough to get a more thorough set of designs, and the Democrats were joined by a small number of Republicans so that the design could go forward. Most of the Republicans who voted with us were not re-elected for the current term.
The details of the design considerations are too complicated to go into here, but there are certain design elements that we Democrats feel are critical.
First, the building needs to meet the current Federal and state standards for rest homes. This includes things like minimum room size, private toilet facilities for each room, outside windows, and capacity for necessary care equipment, such as lifts for residents who are too heavy for nursing staff to safely lift and turn.
Second, the building needs to be constructed so that it will remain viable for the next 50 years. This includes some capacity for expansion and certainly includes use of quality materials and construction. A building that is only good for 25 years might cost less up-front, but will cost the county a lot more in the long run.
Third, the building needs to be designed with staffing and operational efficiency in mind. Sight lines from nursing stations that maximize the number of rooms visible from the station reduces the number of staff that need to be at stations. Infrastructure designed for efficient distribution of meals and handling of laundry will reduce operating costs. Reduction of long operation costs will more than pay for a higher up-front capital expense.
Fourth, rehabilitation facilities need to be available on site. Currently, residents who are recovering from hospital operations can not stay at Riverside, but have to go to one of the private rehab facilities in the area. Riverside needs to hold those beds open for the residents return, but they get no medicaid reimbursement. Furthermore, Riverside misses out on the higher reimbursement rates that Medicaid pays for rehabs. This loss of revenue means higher county taxes, paid by our property taxes. The new building has to be designed so we don't lose this revenue.
Fifth, federal standards require that certain amenities be available to residents, like a hair salon, access to banking, and postal service. Many new rest homes, such as the one in Merrimack County, have "Main Street" areas that have these amenities, along with a cafe where residents can sit with loved ones. The services offered in these places could be provided by local businesses who rent the space, creating another revenue stream for the county.
Sixth, childcare for the staff. This is a less obvious need for a rest home, but one of the major challenges for health care facilities right now is qualified staffing. Anything that will make Strafford County's rest home more attractive for employees is an advantage. An onsite day-care would give us a significant advantage in hiring. Once again, this could be run by a qualified third party who pays rent on the space.
The refusal of Republicans to come to a reasonable compromise on this project has already cost us 15 million dollars in lost state funding. The longer the project gets put off, the more expensive it will get, and the longer our residents at Riverside have to live in substandard housing.
For more details on this issue, see this letter in Foster'swww.fosters.com/story/opinion/columns/2024/05/12/commentary-moving-forward-for-a-new-strafford-county-nursing-home/73624983007/