Building committee vital for nursing home pathway to move forward

Due to what we consider a myopic focus by the commissioners on a single desired solution, just short of 2 million dollars of our county's funds have been wasted. (Courtesy image)

To Strafford County Commissioners, Administrator and other Stakeholders:

As previously promised in our memo of January 9, 2024, the Republican Caucus members of the Strafford County Delegation have compiled a list of our concerns and ideas that are essential for a pathway forward. Regarding a potential solution to the current nursing facility issue, what follows is our vision and requirements to move forward on that pathway.

Due to what we consider a myopic focus by the commissioners on a single desired solution, just short of 2 million dollars of our county's funds have been wasted. The Past While we won't rehash every one of our complaints with the previous attempt at a grand-plan facility, reviewing a few is essential to ensure no misunderstandings as we proceed anew. Most of the caucus is not against a new nursing home; most have expressed willingness to travel that road.

Still, several other options have never been explored or at least had their potential deficiencies explained to the delegation. Those alternatives now need to be reviewed; a few are noted below. Due diligence by the commissioners and the administrator has been insufficient in the past. Due diligence by all involved parties will be essential to move forward. Above all, the focus needs to be on sufficient care for our county's indigent population; that is what is required of the county, nothing more.

The county should provide a service for this segment of the population, not an extravagant top-of-the-line facility. A bureaucratic entity should never be in the business of competing with high-end private nursing facilities. We believe any public messaging targeting high-pay patients as a goal for this project isn't helpful and should cease. Waterfalls, mini-golf, boutique fashion storefronts, and on-site childcare facilities go above and beyond the sufficient care required to be delivered efficiently to our target population.

Artificial timelines will not be tolerated, especially those based on the lure of "free" funding from any source. As noted above, due diligence is required, and such diligence is time-consuming; it's the nature of the beast. Lastly, transparency and trust have been severely lacking. In the future, we believe these issues must change, and as part of that change, we will insist on a "Building Committee," as described in detail later in this memo. Options Going Forward The Republican Caucus of the Strafford County Delegation believes there has not been sufficient time and effort spent exploring nursing home options other than the elaborate new facility we were pressed on.

To date, it is our opinion that there has been little to no consideration given to other possible options, including but not limited to:

 A new facility that meets all the requirements Strafford County may desire, but at a much more reasonable and affordable cost to taxpayers that aligns with industry standards. For example, many members of our delegation (along with one commissioner and the administrator) visited the Carrol County Nursing Facility. It was found to be aesthetically appealing, well laid out for its purpose, and built at a substantially lower cost than our county's recent proposal. In fact, we have been in contact with the architects who planned Carroll County and they have provided preliminary numbers and additional information. Knowing that there could be variables, the firm has stated that a replica of the Carroll County facility could be built presently at a cost of approximately $32 million. If doubled to approximate our county's current size, the cost would be about $64 million. This would represent savings of nearly $200 per square foot over what was previously proposed. While Carroll County might not possess the perfect floor plan for 100% employee efficiency, we believe the over 100 million dollars in construction cost savings and the associated extra interest on bonding savings can counteract the costs of those inefficiencies for decades.

 A new, smaller facility that fits on the current county-owned land will be followed by renovation of the existing nursing facility. While renovations to the current home alone may be complex, combining the two could be a definite possibility.

 Separate facilities that are not co-located. With a price over 100 million dollars lower than the previous proposals, purchasing land to accommodate a new facility would not disqualify the project.

 Consider renovating the current nursing home in stages or a new addition to the existing facility that would ease the renovation process. With a long waiting list and high approval marks from our current community, a modified current facility may be sufficient.

 Current construction costs are at an all-time high due to multiple factors, many of which are unique. As the labor shortage returns to normal levels and prices level or even retreat during recessionary periods in our economy, it may be beneficial for our taxpayers to postpone construction of any new facility(s) until more economically advantageous times.

 Perform a serious and complete investigation into whether it would be more efficient and less expensive, in both the short and long term, for our county's taxpayers to pursue paying for the indigent to receive care within the private sector. The logistics of how this would work would also need research. Since there is no mandate for a county to have a nursing facility with any required number of beds, this option is a distinct possibility. Clarity & Transparency of Any Project To gain the affirmative votes from our caucus for any future nursing home bonding, we will require nothing less than a complete and comprehensive advanced "plan" of the construction project. Additionally, to avoid unnecessary future costs to our county's taxpayers, accurate and conservative revenue and cost projection analysis for the facility's operation will be necessary. As to the construction project itself, completed contracts and plans would require a building design along with all the particulars such as, but not limited to, the following:

 Interviewing and open communication with chosen architectural firm, engineering firms, and general contractor with the Building Committee.

 Construction schedules (phases if necessary.)

 Start and finish dates and penalties for exceeding the contract completion date.

 Building contents other than those that comprise the structure and mechanical systems, as well as estimated workforce requirements to provide the level of service we are promoting.

 Finalized blueprints with all required pages signed by the appropriate architects, engineers, soil scientists, etc.

 The breakdown of all associated costs of this project in an acceptable format to the Building Committee and delegation. Along with the construction plans, if a new nursing home is the chosen direction, we will require an accurate plan of action to transition current nursing home residents from the old building to potential new facility(s). We anticipate and expect that during the construction phase, changes will inevitably impact timing, costs, or both. No significant changes, as determined by the Building Committee, shall occur without the review and approval of the delegation. Operating Revenue and expense projections must be realistic and conservative in their estimations. Previous estimates contained significant contributions to the revenue side of the ledger by including a high percentage of private-payer populations. Since the county's obligation is to the indigent, revenue estimates should consist of no more than a 10% private-payer population. Estimated occupancy rates must be realistic and based on historical norms and trends.

Building Committee

If it is determined that a new nursing facility is the best option forward, we believe the delegation's involvement in the entirety of the process would be required. Since it is the position of the Republican Caucus members of the delegation that we are now beginning at "square one," and should a new RFP be required, a building subcommittee of the delegation is essential. It will ultimately be the Republican members who determine the outcome of any bonding vote(s). Therefore, we believe a "Building Committee" is mandatory. The Committee shall, therefore, be chaired by a member of the Republican Caucus and be elected by the Republican Caucus members. Once chosen, the chair will then select two additional Republicans and three Democrats they best believe to be an asset to serve on the Building Committee for a total of six members. The chair of the Building Committee will be able to call subcommittee meetings at their discretion and without obstruction. Additionally, the Building Committee chair shall have the authority to call a county delegation meeting whenever they believe a vote on any aspect of the construction project is required.

Some individuals from the public body have produced relevant and helpful testimony based on their professional experience. The chair of the Building Committee will have the option of utilizing their voluntary input.

In Closing The members of the Republican Caucus hope we have clearly stated our united concerns and expressed our vision for the future. We see a potential solution to the current nursing facility as a pedestal seat at the counter of an old-fashioned diner, not one piece of a three-legged stool grand plan. Everything promoted and discussed prior that is not related to a nursing facility is off the table: no expensive solar farms, geothermal projects, transitional housing, or homeless shelters.

We are undoubtedly available to explain anything in this memo in greater detail, address items we may have overlooked, and explore areas of concern you may have.

- Sincerely, and on behalf of the entirety of the Republican Caucus members,

Representative Claudine Burnham

Representative Cliff Newton

Representative Kelley Potenza

Representative Len Turcotte