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Facility Condition Assessments in Nursing Homes

June 1, 2007
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Managing a nursing home for the present and for the future depends on how well it is cared for

Day-to-day operations, including the staff and appearance of the building and its equipment, are the “face” of the nursing home for its residents and their families, and for those considering it as a future home. But as facilities age they become tired, which displays itself in unreliable mechanical and electrical systems and an overall deterioration in appearance. Without attention to the future, facilities can become obsolete. And unlike many businesses that can pass on renovation costs directly to the customer, nursing homes’ dependence on third-party reimbursement requires great vigilance to control costs through best-management practices.

One of the facility's best management tools for this is the Facility Condition Assessment (FCA), the methodical observation of each building and site system to develop not only a “to-do” list for improvement, but to project budget years for high-cost items and otherwise promote the necessary budgeting and engineering planning to replace or renew these systems so that they will continue to operate reliably and remain in good repair.

The world of a nursing home building is similar to that of most other buildings in that the relevant issues tend to be grouped almost entirely among architectural, mechanical, and electrical disciplines. Unless located in an urban setting, the site probably also includes such systems of value as pavement and trees. Regularly scheduled walk-around inspections to note daily operations are extremely important; this knowledge can provide valuable information to those who perform the annual, biennial, or less-frequent formal FCAs.

The assessment team should have an eye on the future as well as the present, as one of the goals of an FCA is to identify systems reaching the end of their estimated life cycles. Engineers have their own thoughts about the expected life of a system based on its use, maintenance history, and manufacturer, and some equipment is installed, maintained, or manufactured better than others. Formal life cycle estimates are available from groups such as the Building Owners and Managers Association (BOMA).

Along with identifying aging systems that should be replaced, the other primary reason for an FCA is to identify code compliance problems. As buildings age, codes get revised and municipalities selectively adopt these revisions. Nursing homes can respond passively or actively to this normal course of events. A “passive” response would be to wait until being hounded by the code enforcement official to make upgrades. On the other hand, an “active” response would be to identify the issues, estimate the cost of resolving them, and determine schedules to fund and accomplish this work.

Sometimes it is more cost-effective to group several projects together. A group of nursing homes may find economies in working with a single vendor or engineer to perform the work at the same time under favorable bidding conditions—i.e., economies of scale from grouping similar jobs together either at one location or multiple locations. Standardizing restroom renovations, for example, can result in the use of similar finishes, plumbing, and electrical fixtures.

The FCA Process

A typical methodology for performing an FCA is for the in-house facilities management staff or an outsourced architectural/engineering team to walk the building and grounds with a manager, engineer, or technician knowledgeable about the building. There should be site, floor, and roof plans showing key features, e.g., service entrances, major equipment, restroom fixtures, roof hatches, fire protection equipment, and site improvements. If these plans don't already exist, a special effort should be made to prepare them for the FCA. Typically, 11 × 17" plans work well for taking notes.

A building's age may not be known exactly, but a “best estimate” is needed to determine the date of original construction, additions, renovations, and major equipment replacement. Redevelopment may make this a challenge, but data from commissioning plaques, blueprints, and equipment nameplates usually can pinpoint a year. There will most definitely be problems with the building that are not readily seen but are either well documented in reports or past correspondence, or staff has simply noticed them in passing and did not file formal paperwork. Also, and specifically, a report from the elevator contractor on necessary upgrades and estimated cost is important information to add to the assessment report. Photos are invaluable, and the report should ideally have a photo for each recommendation.

Walking the exterior gives the assessment team a chance to see meaningful features before entering the building. Windows, doors, siding, vents, mechanical rooms or enclosures; mechanical or electrical services; exterior-accessed rooms—the condition of these often serves as an indicator of what will be found inside. Once the inspection moves inside, the reports and evidence of ceiling and window leaks and unreliable mechan-ical or electrical equipment become understandable.

Typical nursing home–specific findings might include improperly selected and installed handrails in the corridor, wall and door surfaces damaged by wheelchairs, extensive use of extension cords connected to computers and other consumer electronics because of insufficient outlets, inadequate storage areas for equipment, and noncompliant ADA restroom (resident and public), water cooler, or corridor details.