According to the Centers for Disease Control and Prevention (CDC), 128 people die in the United States every day as a result of an opioid overdose. Locations like the Medically Assisted Drug Treatment (MAT) Clinic recently completed in Salem, Oregon is one location that helps to fight the opioid crisis by providing addiction counseling and services to the community.
Recently completed by Perlo and PKA Architects, the Salem MAT Clinic renovation was a 6,000 SF tenant improvement in an existing building that included the construction of a new pharmacy, as well as multiple exam rooms, counseling rooms, staff break areas, dosing rooms, a lab/nurse station and patient waiting rooms. The new space will operate as a rehabilitation clinic for patients with opioid addiction. Owned by the Confederated Tribes of Grand Ronde, this community service-based clinic included mostly standard construction elements, with many regulatory concerns to work through.
With a 3-month construction duration, the longest leg of the project was the preconstruction phase, as Perlo worked with the ownership teams for more than a year to help identify, budget for and gain approval on the build-out in this space. Rehabilitation clinics require extensive review by a variety of regulatory agencies, and this unique factor tends to make the preconstruction process much longer than the actual construction.
Today we will explore a little more about what went into the clinic, the agencies involved in review and unique construction elements of this kind of facility.
Construction Elements for Rehabilitation Clinics
Much of the construction work on this project was relatively standard, with items like casework, paint, VCT flooring and the demolition and addition of walls. Some unique items included the following for additional safety and security:
- New and existing walls had stricter sound rating requirements for privacy concerns.
- Pharmacy walls are full height and reinforced for security.
- Pharmacy security protocols included security window film and roll-down gates at window enclosures.
- An extensive security system with alarms and cameras in all possible locations.
- All building and furniture elements are secured and unable to be lifted, thrown or otherwise used as a weapon.
- Backup power beyond normal egress requirements was installed to provide at least 4 hours of power in the event of an emergency.
Additionally, our teams engaged in selective demolition and re-routed existing ductwork for the new layout. Existing roof-top units (RTU’s) were able to be used for the new layout. This particular space also included some new underground plumbing, installation of a new split system and a full refresh of all finishes.
Regulatory Agencies for Rehabilitation Clinics
Rehabilitation centers such as this one are regulated by a variety of jurisdictions in addition to the local city or county governments. Application and approval processes and/or inspections were completed by the following agencies in addition to the local building department:
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Oregon Health Authority (OHA)
- United States Drug Enforcement Administration (DEA)
Each one of these regulators govern various facets of the project. The CARF and SAMHSA approvals are applied for during the design phase and requires the floor plan, location and a rough schedule outline be completed before applying. The DEA and OHA regulators are more concerned with the actual construction work and those reviews take place during and post-construction.
While the owner was largely completing the day-to-day interactions and approval processes with each of these regulators, the construction timing had to be planned well in advance so that onsite inspections could take place. These agencies often set inspection dates months in advance of their site visits, so maintaining the construction schedule was critical for keeping the approval processes on track for each regulatory agency.
In addition to the known regulations that each of these agencies required, the site inspectors had the power to issue additional changes during their visits. Prior to the COVID-19 pandemic, it was common to have preconstruction walk-throughs with these agencies, but current operations make that option far more limited. With this in mind, it was critical for the design and construction teams to be well aware of the requirements of each agency and include those in the construction documents to minimize any re-work or schedule delays.
A Team Effort from Preconstruction to Closeout
The ownership, design and construction teams spent considerable time searching for the right space to place the Salem MAT Clinic. Regulatory agencies have strict requirements for locations of rehabilitation clinics in terms of proximity to schools and daycares, as well as requirements for access to public transportation. These guidelines reduce the quantity of real estate options available to the operator and makes finding an ideal location that isn’t cost prohibitive the first puzzle to solve.
Beyond finding and identifying the physical location, preconstruction efforts included several rounds of budgets and backchecking with the various agencies for approval of the design. With the many agencies involved, close communication between all parties during both preconstruction and construction was paramount.
The coordination with the security vendor was one of the most important pieces of the construction and closeout process. Compared to normal renovation projects, this clinic required significantly more work than normal to plan and install security systems and coordinate with the vendor for the transition to regular monitoring. With proper pre-planning, this system was installed without interruption.
In addition to the work related to the tenant improvement space, the building itself had a second-floor tenant that remained operational during construction. There are future plans for that tenant to vacate the building, and an expansion of the Salem MAT clinic will take place at that time. With future planning in mind, the current space was designed to easily expand into the other areas of the building while still allowing for secure separation between spaces during construction and for future uses.
The Perlo team was grateful to have the opportunity to complete the Salem MAT Clinic with the Grand Ronde tribe and PKA Architects. From start to finish, the group was collaborative, thoughtful in their planning and above all, great to work with. We support their mission and service to the Salem community in supporting those recovering from opioid addiction.
Perlo engages in a wide variety of healthcare projects and is happy to help with clinics such as this one. If you have an upcoming project, please don’t hesitate to reach out to our teams here.
If you or someone you know is struggling with addiction, there is help available.
Please visit https://findtreatment.gov/ or call 1-800-662-HELP (4357).
Week three’s Year in Review brings us to several very unique projects that we completed in 2020. Each included tight working spaces or odd sites, and significant coordination to complete. Take a look at these shining examples of excellent construction:
Pharmacy Renovations Shriners’ Portland Hospital | Portland, OR
This 643 SF remodel of a fully occupied pharmacy for Shriners Hospitals for Children was completed ahead of schedule in 3 months and over multiple phases. The work included remodeling an existing space and installing new exhaust fans and mechanical systems, as well as a hazardous drug room, ante room, non-hazardous negative pressure and positive pressure rooms and two separate compounding hoods for mixing and compounding drugs onsite.
In addition to coordinating multiple trades and phases in a very small location, one of the largest challenges the project faced was coordinating the installation of the new chiller on the roof. A crane was required to lift the chiller into place, the coordination of which involved Shriners, OHSU and careful attention to placement of the crane to avoid pedestrian traffic and underground tunnels.
Additionally, there was no existing shaft to run the new ductwork and chiller lines directly into the pharmacy. The team had to investigate each floor to find the best path to the roof, spending significant time on the design and installation. These challenges were all overcome with pre-planning and diligence, and a great installation team.
Shriners Hospitals for Children
CBRE / SLAM
Catena Consulting Engineering
Mechanical and Electrical Engineer
LG Columbia Self-Storage | Portland, OR
The LG Columbia Self-Storage project was made up of two separate 4-story buildings separated only by a 2” seismic gap, totaling 195,000 SF. The basement of one building started at level 3 of the second building. Construction began almost simultaneously with the emergence of the COVID-19 pandemic in the united states, challenging the project teams to work together to stay safe and still get the work done. In fact, the project finished 3 weeks ahead of schedule.
The nature of the building site and design meant plenty of challenges for the project team. Significant time was spent planning the work sequencing, taking into account the fall hazards due to the elevation changes between buildings, completing deep excavations and doing it all on an extremely tight site.
The project makes up one of the largest self-storage facilities in the Pacific Northwest. Please enjoy the time-lapse to see more of the complexities and work flow that brought this project to completion:
Touchmark in the West Hills Vineyard Homes | Portland, OR
This 15,000 SF senior living apartment complex included two high-end, three-story buildings with garages, mechanical rooms and storage areas, luxury kitchens, custom tile and casework, modern furnishings and full-sized laundry rooms. The building structure includes structural steel and concrete with wood framing on all three levels. Each garage includes electric car chargers, and the homes have western facing views from the front and winery views in the back. Appliances included subzero refrigerators and Wolf ranges, among others. Heated tile floors, heated towel racks, heated toilets and bidets are just some of the high-end features.
One site challenge included re-building the hillside behind the development. The work occurred over the winter and included re-sloping the hillside, building rock walls, placing decorative boulders and maintaining the road to the neighboring vineyard.
The initial designs were followed by input from individual unit tenants. These tours led to a high number of changes after construction began, mostly to finishes such as custom tile work, customized doors, intercom systems, custom lighting and plumbing fixtures. The project team fielded questions from the individual tenants on a daily basis, in addition to the residents that lived within the existing complex. Our teams enjoyed the high level of interaction throughout.
These buildings demonstrate the high level of sophistication and finish level that Perlo can deliver. The team worked closely with the design team and ownership teams to deliver the project. These buildings ranked highly with the owner, touted as one of the best finished products they have seen.
This concludes Week 3 in our Year in Review series. Next week brings us to our final look back at 2020’s completed projects. Tune in again for more!
The healthcare construction market has been in a growth pattern for some time due to pressures from an aging population and as a result of shifting demands for how medical services are delivered. Traditionally, the healthcare industry has been more recession-proof than other industry sectors.
Over the past decade, however, political turmoil related to the Affordable Care Act have created uncertainties. Given this uncertainty, some healthcare organizations have been more hesitant to invest in capital-intensive construction projects. With the onset of the pandemic, change has accelerated.
Changes in the Healthcare Industry
Even before COVID-19, healthcare delivery was in a state of transition. Thomas Quesenberry, Senior Project Manager at Perlo, shares his observations. “Over the past several years, we’ve seen a shift towards smaller clinics and medical office buildings, known as ‘MOBs.’ Even larger entities like Legacy Health and Providence Health have pushed for more neighborhood clinics.”
According to Todd Duwe, Director of Business Development at Perlo, “Our healthcare clients are under pressure to create more flexible medical spaces that can be easily adapted and modified for different medical services. All healthcare facilities are under pressure to make sure space is devoted to its highest and best use.” As a result, some clinics and hospitals are moving administrative offices from patient care buildings which are higher cost per square foot into less expensive office buildings that are off campus.
The Impact of COVID-19 on the Healthcare Industry
COVID-19 has, of course, had a massive impact on healthcare providers. Many clinics and hospitals have had to severely restrict elective services and surgeries to conserve PPE and bed space for COVID patients.
As a result of COVID-19, many clinics and hospitals have taken a real hit as elective services often account for a substantial percentage of their revenue. This shortfall has led to the deferment of many healthcare construction projects. Some of those projects may come back online this fall, but recent projections indicate it could take a year or more for a somewhat normal project schedule to resume.
Another impact has been the rise of telehealth services. Although these services were starting to gain traction before the pandemic, they’re now fully embraced by many healthcare providers. “Online health services were the way of the future. Because of COVID-19, they’re happening today,” adds Quesenberry. “Given this new model of healthcare delivery, most likely we’ll see changes in how clinics and hospitals are designed.”
Construction Companies Must Have the Right Skills for Healthcare
For healthcare organizations considering a construction project, it’s important to find a general contractor that’s the right fit. “When looking for a healthcare construction partner, it’s important to find a company that has experience in the industry and knows how to make informed recommendations,” says Duwe. “For example, clinics must be built to control and contain infections, particularly in the COVID environment.”
In fact, healthcare providers’ insurance reimbursements are calculated based in part on the clinic’s ability to control rates of infection as well as patient satisfaction. Successful construction projects hinge on minimizing contaminants and disruption to the patient experience.
Often healthcare projects require an “invisible contractor,” which means construction activities must restrict noise, vibration, and dust. To minimize impact to the patient experience, construction companies must stagger the shifts of their employees and sub-contractors for both regular and off-work hours.
A “New Normal” for Healthcare Construction?
In the long term, perhaps we will see a “new normal” as a result of COVID-19. The pandemic has highlighted some shortcomings in our healthcare system in Oregon, such as a low bed count in most hospitals around the state.
There is also likely to be a long-term impact on how healthcare facilities are designed given the heightened standards for cleanliness and perhaps the long-term need for social distancing. “Even waiting rooms may have a completely different design as a way to control potential infections, whether from a coronavirus or other potential viruses,” says Quesenberry. We expect that some focus will be dedicated to isolation rooms and/or floors that include reconfigured mechanical systems, ante rooms, and changes to central sterile rooms and corridors to improve virus containment. “Given these inevitable changes, it’s important to work with a construction company that can provide out-of-the-box ideas and innovative solutions.”
Most likely, the effects of COVID-19 will have long-lasting effects, both in the healthcare industry and in every other sector of our economy.