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.