Creating a Subacute Care Unit

What is a Subacute care unit?

The definition of Subacute Care that has been developed is as follows:

Subacute care is comprehensive inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process. It is goal oriented treatment rendered immediately after, or instead of, acute hospitalization to treat one or more specific active complex medical conditions or to administer one or more technically complex treatments, in the context of a person’s underlying long-term conditions and overall situation.

This means that the subacute care unit is usually more intensive care than traditional nursing, but less intensive than the acute care that one might require at a hospital. Subacute care is a new and rapidly growing discipline in the United States. A subacute care unit merges the technology available in a hospital with the efficient operation of a skilled nursing facility. Often nursing facilities will develop a team to work with the patient with the goal of restoring activities of daily living.

How does a Subacute care unit differ from a traditional nursing unit?

Since patients in a subacute care unit need more specialized care than traditional nursing patients, and the goal is to return them to the activities of daily living, there are additional facilities required to provide that care. While continuing to have all of the requirements of a traditional nursing wing such as residence rooms, clean and soiled utility rooms, medicine prep rooms, and nutrition stations, along with a nursing station, subacute care units also have occupational therapy and physical therapy, sometimes speech therapy, and often have an “Activities of Daily Living” suite consisting of a residential style bathroom, kitchen, and dinette.

Activities of Daily Living

Activities of Daily Living

The ADL suite is designed to help residents re-learn typical house-hold skills before the subacute care team will feel confident in their abilities to function on their own once again.

Subacute care units may also contain “isolation” rooms of varying levels depending on the requirements of the patient. Because infectious diseases are easily transmitted through contamination of the air, a minimum number of isolation rooms is required. This requirement is set by each State, and can sometimes vary.

 How can an architect help?

Subacute care units should be designed to convey a message. They should feel comfortable, and have a sense of home, but also have a strong emphasis on healing. Successful subacute care facilities do not happen by accident, but rather through the team work and careful planning by the owners, administrators, architect, and qualified team of consultants. By bringing the right team together you can construct the project on time and within the intended budget. To achieve this goal, our team is familiar with facility licensure standards and certificate of need requirements, is creative, is able to envision cost effective ways to incorporate excellence in design elements that have therapeutic benefits, works closely with local and state officials, and deals with construction contractors that have experience with health care projects. If you are thinking of converting an existing wing, or creating a new one for a subacute care unit, give us a call today to see how we can help you.

 

Foundation Repair with Helical Piles

The Issue

I bought a house. It was a GREAT deal! The reason I could afford so much property in such a great location is because the house has differential settlement. It was built in the 1950s. Mid-century ranch house on a sloping site with a walk-out basement at the rear. There was all sorts of speculation as to why the house was settling before I bought. One New Jersey Professional Engineer suggested that it was because of an addition added to the rear. Another soil engineer suggested the entire site was ‘fill’ and that was why. A third engineer attributed the problem to not enough leaders diverting rain water away from the front of the house.

The floor was noticeably out of level. Approximately four inches of settlement had occurred at the rear of the house only. I knew from previous experience that I could fix this, and about how much it was going to cost.

The Solution

I developed a plan using helical piles installed from the inside of the basement to arrest further settlement and to provide deep foundation elements on which we could lift the rear wall of the house. The plan was to restore the first floor to a level condition.

Helical Piles plan

Plan for foundation repair with helical piles

The first step was to saw-cut the existing concrete basement slab and excavate soil to expose the existing footing. Visionary Construction was the general contractor for the job. After we exposed the footing, we found that the footing at the rear wall did not have sufficient depth.  This was most likely the cause for the differential settlement. Visionary sub-contracted with Shore House Lifters, LLC. to install the helical piles and provide the lifting services. This company proved to be unreliable, and after starting the job, then delaying for over six weeks, finally admitted to not having the proper equipment to install the helical piles, and that they did not expect to lift the house.

Visionary Construction was able to find a replacement sub-contractor in Shore Earth Anchoring, (http://www.earthanchoring.com/) who not only had the equipment, but were also available to do the work quickly, and had a good price.

The helical piles were installed to the proper depth, torque, and in the correct locations. Hydraulic jacks are used to lift the wall.IMAG0486 IMAG0487 IMAG0488During the  IMAG0489lift, there were cracks in wall finishes on the first floor and some doorways did not operate as they did before. Issues like this have to be expected when you are returning a house to a level condition. Anything that had been repaired while the house was uneven would now be subject to forces when the house was returned to a level and plumb condition.

I can not say that the house was returned to a perfectly level condition. We were able to lift about three inches. What we did do was to restore the floor to a condition where there is imperceptible unevenness. I also designed the helical piles with the capacity to support a future second floor addition.

The cost of the the project is approximately $30,000. The value added is about $100,000.IMAG0490

Answering Why Some Architectural Fees Vary

Initial Email

Dear <Client>,

Please see the attached proposal for Architectural Design Services for a
Modular Trailer for Synagogue for you review.
Please contact Mr. Schreiber with any questions in this regard.

Respectfully,
Threcia Robinson

Client Response

Thank you for getting back to me. The fellows on pine and mlk said your fee is 1500 – 2000. The fees quoted to us seem quite higher. Why?

<Client>

My Response

Hi <Client>,
My name is Brian W. Penschow and I work in the office here for Mr. Schreiber. I wrote the proposal, so I want to answer your question.
The simple answer is because it is a different project. The architectural fees are carefully considered based on the size, complexity, and several other factors of the project. I wrote a page on our website here: http://schreiber-architect.com/?page_id=1304 that REALLY explains the nitty gritty of how we figure the total fee. We consider how much time we need to put into the drawings, but also how much liability the project carries (residential, change of use, or addition, etc.). The concept though is that we want to bring value to your project. The purpose of our involvement in every project is to bring value and save money by using our expertise and talents to prevent problems, solve problems, and get your what you need, and want. We strongly believe that our fees are justified and that we are providing you the best value possible for THIS particular project.
Thank you so much for the opportunity to provide you with the best possible service. We look forward to working with you!
-Brian W. Penschow, Assoc. AIA

The Result

After a phone conversation, the client agreed to the higher fee. The point is that you need to educate your client unless you want to give your work away.

-Brian W. Penschow, Assoc. AIA

It gets worse…

Helical Pile Installation

Helical Pile Installation – Observations

129 Island View Dr., Lavallette, New Jersey
House raised to the new elevation.

House raised to the new elevation.

It is October 11th, 2013 and we are almost a year away from when Hurricane Sandy struck the east coast of the United States. We have accomplished many sets of plans for clients in different towns since the storm, but today it was finally time to install some helical piles on one of our damaged shore homes that is in the process of being elevated for flood hazard mitigation. What are helical piles, you ask? They look a little like an opener for the largest bottle of wine you would ever see. If you have absolutely no idea what they are check out this page, then come back here to read more.

Wolfe house lifters, lifted the house into the higher position and provided temporary cribbing (the wide, built up, wooden piers) to support the house while the new foundation is being installed.

Cribbing

Cribbing

The helical piles were provided by Magnum Piering, and being installed by Renova Structural Systems, as part of a ‘V-zone’ compliant foundation consisting of helical piles, a concrete grade beam (supported by the piles, and tying the piles together for lateral support), and masonry piers that support new engineered beams. This type of foundation is required in a high velocity flood zone, but is also recommended for coastal ‘A-zones’ as well.

The rain was intermittent in the middle of a slow moving Nor’easter that was buffeting us with 35 mph winds. I showed up at 9:30 a.m. ready to observe some installations, and although everything was laid out (leads, shaft extensions, and a drive head on the machine) there was nothing going on at the site. I donned my rain-suit, stowed my glassed and headed over to talk with the lead contractor on the job. The height clearance was so tight that the drive-head mounted on the machine didn’t fit under the sill plate to drive the pile, so the installer went to retrieve a smaller drive head that would get the job done.

After a two-hour delay, I was about about give up and head back to the office. I said my ‘goodbyes’ to everyone on site and headed to my car when the installers pulled up to the site with the new drive head. I thought to myself, “I should’ve just threatened to leave earlier and they would’ve shown up then!” So back to the job-site I went. After a few minutes of installing the new drive head they were ready to install the first pile.

Our design had the corner piles installed at a forty-five degree angle to the house, and a twenty degree batter angle into the soil. The reasons for the angles has to do with resisting lateral forces in different directions, but it is essential. Deep foundation elements are designed with a factor of safety ranging from two to three, but they should be installed as close to the plans as possible. The installers lined up the lead shaft in the corner, installed the drive head and pin, checked the angles, and started screwing the pile into the soil.

Installation of the lead shaft

Installation of the lead shaft

As they installed the pile, they were careful to check the angles as the pile inserted itself into the soft beach sand soil. When the first segment of pile was nearly fully inserted, they stopped the machine, bolted a new section onto the pile, and continued the installation. Our plans called for each pile to be installed to a minimum depth of sixteen feet, and a torque of 5kip-ft, and a bearing capacity of 20kips. The lead section is six feet long, and each extension is five feet long, allowing the minimum depth to be achieved with only three sections. As the last shaft was wound down into place the torque reading showed that the bearing capacity had reached a whopping 37 kips! That is nearly double the design capacity required.

Helical Pile installer checks the angle prior to installation

Helical Pile installer checks the angle prior to installation

Drive Head completes the helical pile installation

Drive Head completes the helical pile installation

Each pile installed is logged on a sheet showing the depth, pile series and number of helices, the torque rating, and bearing capacity. The piles receive a metal cap designed for a proper connection between the concrete grade-beam and the pile.  Then it is time for the contractor to form out where the concrete beam is to be placed.

Yes, it is expensive. No, you don’t get to see this money after it is spent. It isn’t like granite counter tops. It does solve the problem of installing deep foundations where they are required, and it is impossible to move the house out of the way. If you think you need this kind of foundation, or you are just interested in getting more information about the process, call our office today at (732) 886-5290, or fill out a request for information form on our website, and I would be happy to share any information I have to help.

-Brian W. Penschow, Assoc. AIA

 

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