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Theses and Dissertations 1. Thesis and Dissertation Collection, all items 


1997 


Health care facilities construction and maintenance 


Lee, Eric 


http://ndl.handle.net/10945/8459 


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Health Care Facilities 


Construction and 
Maintenance 





A Study of Construction and 

Maintenance Activities, Needs, and 
Procurement Policies of the Health 
Care Industry in the United States 


By 

Eric Lee 

University of Washington 
Seattle, Washington 98195 
(206) 543-7612 





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TABLE OF CONTENTS 


PAGE 
General Introduction .............0c cece cece eeceseccncccesceesceucceeseness l 
Regional Division of Facilities............. 0 eeeeeeeeeeee Z 


Construction and Maintenance Activities, Needs, and Procurement 
Policies of Hospitals 


Description of Hospital Respondents ............ cc ceeeeeee 3 
er eMPPMUIEPIO INA CULVILY..:..:.....00+000000snsdanssedens>araceanateosnnencees 4 
Pel MMe AACUVILY.,......020....0000800eseseseseeeeneezstdesnescteneeen 6 
Mmenmimeeumne PrOCCAUIPES......:.........--.sededsseasareosennesueeasecseess y 
Amalysis by Facility ClianactenStic :................2.:.000000.60- 8 
BZ OI Na Re MRE oo sso <'nnnda oo cece venduuaaubendbasssvue0sbededescees 8 
IMTGSHISI Wis ecm eACINMELGS 5 cteneee cose sac 0 rte cccctassteencceecnse 9 
FACT C Viernes. .ccycssacveecoueiemeemmea steven t aemmemenemnee nearer e eee 10 
OC CUNIATON MINIS ee rapes. oe: ose unette Nae) ak sa laatedeteeess-0deees 10 
Eni ay See river ACM oteee ts .c.ss,s5,00-sscnserlecseverseess’ 11 
ENG PON A OM MeO Ss -.05 losis. ssssseshes.-.-0dudsenteeeeeeeee eve ee 13 
Wonstruction Related PTODICINS ...22.......22s..cssse+.0.0002 Ie 
Future Trends Impacting Construction..............e eee 14 
» OVPC] TOSCO Sena 5 cone coy SOc aN e 15 
eS 1 = 1 eer sresade inte s ieee eae eae ets sss unnga sess t5eeUe 16 


Construction and Maintenance Activities, Needs, and Procurement 
Policies of Long Term Care Facilities 


Description of Long Term Care Facility Respondents ...32 


Mera eMNUCUIOM NOUV IVY... ..cacls-ssccsesseet-cesanaeo-+------->--cnnuseas 33 
Pee MATICE CVGEIVILY..........c2c.20c00--cidecr-+->seusegquagaiinesssees 34 
RMIT AC ENO PP POG COULES &... ...01500..... Acsdscssgeseamersnnoscoeuesoe a7 
Pandiveis by Facility CharacteriStiC......2......22050---+-cs0ee0e00s 38 
Ze. Ol eM css iaeaes eva ncncgeesPno.a-cBencec tee... -o8tecwatea. 38 
Sa Leu Nitisitnss hACTINULES 1.0. :csaicsvssseasameeeee-cos~0s-scce sere 38 
FCM ENS rtssts eects cnn -c2eaes/cccceetemee cies is ret Cosas 39 
Ge MD ACY IN ALC 03 25.3dsccevevsnesseaenas shea cess Peeneaeeesereere ee a) 
Pallolice VS: PEVatesaetles..,..:.s.0cs20rcs2. egueaeee oe 40 
Reeei@ial IiTChENCES......0-20sso eee 42 








Construction Related Problems .....................cccceeeeceeceeees 42 


Pueeresiitends Impacting Construction...........:.............. 42 
aT Nive. sda ese mean aise acedeeasaucicanen tad, ¢ 43 
eres. 11-200... %,.....:c ee... 45 
SPN LUNN ee Oe ee ii sa nsec ooecsasasessnoatscoscoste 6] 


Survey of Hospital Construction Needs 
Survey of Long Term Care Facility Construction Needs 


List of Tables 


(Table 1-10 for Hospitals) 


Table 1 General Description of Hospitals 

Table 2 Information on Hospital Construction Expenditure 

Table 3 Information on Maintenance 

Table 4 Information on Contracting 

Table 5 Variable Impacted by Size (# of Set-Up Beds) of Hospitals 
Table 6 Variable Impacted by % Intensive Care Beds of Hospitals 
Table 7 Variable Impacted by Age of Structure 

Table 8 Variable Impacted by Occupancy Rate 

Table 9 Difference between Public and Private Hospitals 


Table 10 Hospital Characteristics by Region 
(Table 11-20 for Long Term Care Facilities) 


Table 11 General Description of Facilities 

Table 12 Expenditure on Construction, Maintenance, and Repair 
Table 13 Information on Maintenance 

Table 14 Information on Contracting 


Table 15 Variable Impacted by Size (# of Set-Up Beds) of Facility 
Table 16 Variable Impacted by Percent Skilled Nursing Beds 
Table 17 Variable Impacted by Age of Structure 

Table 18 Variable Impacted by Occupancy Rate 

Table 19 Difference between Public and Private Hospitals 

Table 20 Hospital Characteristics by Region 





List of Figures 


Figure | 


Relative Construction Budget Trends by Study Regions 


(Figure 2-9 for Hospitals) 


Figure 2 
Figure 3 
Figure 4 
Figure 5 
Figure 6 
Figure 7 
Figure 8 
Figure 9 


Breakdown of Private and Publicly-Owned Hospital Facilities 
Construction Expenditures 

General Nature of Construction 

Construction Budget Trends for Next 5 Years (1997-2001) 

Relative Expenditures on Major Maintenance and Repair 

Relative Contributing Cause for Major Maintenance and Repair 
Breakdown of Contracting Methods 

Breakdown of Bidding Methods between Public and Private Facilities 


(Figure 10-17 for Long Term Care Facilities) 


Figure 10 
Figure 11 
emeure | 2 
Figure 13 
Figure 14 
Figure 1'5 
Figure 16 
Figure 17 


Breakdown of Private and Publicly-Owned Facilities 

Construction Expenditures 

General Nature of Construction 

Construction Budget Trends for Next 5 Years (1997-2001) 

Relative Expenditures on Major Maintenance and Repair 

Relative Contributing Cause for Major Maintenance and Repair 
Breakdown of Contracting Methods 

Breakdown of Bidding Methods between Public and Private Facilities 


ill 





General Introduction 


This document contains the results of two surveys aimed at studying the construction 
activities, maintenance needs, and procurement policies of the U.S. hospitals and long 
term care facilities. A similar study conducted in 1989 was used as a baseline of the trend 
analysis presented in portions of this study. This 1996 survey did not ask some of the 
questions which were posed in the 1989 survey. Likewise there were questions 
concerning the trends of spending projection, major facility maintenance problem areas, 
and the source of maintenance requirements that were added to this survey. 


The survey results show there are some marked differences between hospitals and long 
term care facilities. The average occupancy rate and number of admissions per year for 
hospitals are 66% and 8495, compared to 95% and only 199 respectively for long term 
care facilities. Hospitals also have a higher percentage of public ownership. The average 
construction budget for hospitals is three to ten times greater than that of long term care 
facilities, while the average number of set-up beds is almost the same. 


On the other hand, the order of relative expenditures broken down by the different areas 
of the facility and the order of contributing cause for major maintenance and repairs are 
consistent between hospitals and long term care facilities. 


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Regional Division of Facilities 


The United States was divided into the seven regions shown in Figure 1 for the purpose of 
this study. Tables 10 and 20 summarize the respective regional differences in the hospital 
and long term care facilities. 


Hospitals 


Region _{overall | 1 | _2 | 3 14751611 
Long Term Care Facilities 
——esion__—_.averall | | 2} 3 a | Se 





















Figure 1: Relative Construction Budget Trends by Study Regions 
2 





Construction and Maintenance Activities, Needs, and 
Procurement Policies of Hospitals 


DESCRIPTION OF HOSPITAL RESPONDENTS 


A total of 173 responses were received from hospitals throughout the United States. 
These respondents represented facilities with an average of 309 licensed beds and 244 
set-up beds. They also represented an average of 25 intensive care or critical care beds, 
93 private rooms and 110 semi-private rooms. About 22 percent of the respondents (38 
hospitals) also had wards. 


The average occupancy rate was 66.3% with an average of 8,495 admissions per year or 
an equivalency of 34.8 admissions per set-up bed. The average age of the primary 
hospital structure was 30 years. Approximately 28% of the responding hospitals were 
publicly-owned, of which 43%, 25%, 29%, and 4% were owned by federal, state, county, 
and city agencies, respectively (Figure 2). While this survey represents fewer hospitals 
and fewer number of beds per facility than the previous study, percentage breakdowns are 
quite similar. Notable exceptions are a lower occupancy rate (from 71% to 66%) and a 
higher percentage of federally owned hospitals (from 28% to 43%) among the publicly- 
owned facilities. See Table 1 for details. 


Publicly 
Owned 
28% 


Owned 
12% 


| 
Privately —~ —_ —> 


— 





Figure 2: Breakdown of Private and Publicly-Owned Hospital Facilities 


j 
| 
| 


7 





CONSTRUCTION ACTIVITY 


Table 2 contains and Figure 3 depicts construction expenditure figures for 1995, 1996, 
and 1997. The average amount spent on construction during 1995 was $5.6 million. Of 
this, 29% was allocated to new construction, 19% was spent on maintenance and repairs, 
and 51% was spent on renovation and remodeling. 


In response to the question of the general nature of construction, addition of the support 
space (laboratories, pharmacy, radiology space, etc.) accounted for 23%, followed by 
patient rooms for 11%, administrative space for 5.1%, operating rooms for 3.2%, 
psychiatric ward for 2.9%, and Alzheimer's ward for 0.4%. (Figure 4) The majority of 
respondents (53%), however, indicated that these funds were spent in "other" areas, 
which included general renovation/remodeling (27 respondents), outpatient facilities (12 
respondents), emergency room expansion (9 respondents), clinics (8 respondents), 
parking (6 respondents), ambulatory care (6 respondents), MD offices (5 respondents), 
life safety code requirements (4 respondents), utility upgrade (4 respondents), and facelift 
(3 respondents). Some funds were channeled into new service areas. Examples of new or 
expanded services include sleep lab, express care room, TB Iso room, community 
education facility, youth development facility, CRC lab, cardiovascular program space, 
and radiation therapy wards. Some other areas mentioned were infrastructure, roof 
repairs, window replacement, conversion from semi-private to private rooms, 
replacement of beds, skilled nursing facility, urgent care facility, environmental upgrade, 
and fire alarm system upgrades. 


The survey indicated only 16.4% (an average of $487,000) of the construction work (not 
including maintenance and repairs) was performed by hospital in-house personnel in 
1995. 


Hospital respondents projected that they would be spending an average of $6,017,000 in 
1996 (25% for new construction, 23% for maintenance/repairs, and 52% for renovation) 
and $5,622,000 in 1997 (31% for new construction, 21% for maintenance/repairs, and 
48% for renovation). 


In projecting construction budgets for the next five years (1997-2001), Figure 5 shows 
25%, 12%, 25%, 19%, and 19% of respondents respectively marked "Increase 
Significantly", "Increase Slightly", "Remain Roughly the Same", "Decrease Slightly", 
and "Decrease Significantly". Approximately 20% of all construction expenditures are 
received from government sources such as direct appropriations, tax supported bonds, etc. 
See Table 2 for further details. 





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$5,900 


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$5,700 





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1995 1996(projected) 1997(projected) 


Figure 3: Construction Expenditures 


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Wl Alzheimers ! | Significantly 
Ward | oe 
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au | len ee | 
Figure 4: General Nature of Figure 5: Construction Budget Trends 
Construction for Next 5 years (1997-2001) 








MAINTENANCE ACTIVITY 


A series of questions were asked about the maintenance aspects of the facility (see Table 
3). Figure 6 shows the tally of responses to the question of the source of major 
maintenance and repair costs. Mechanical (HVAC) system was ranked the highest 
(greatest expenditure), followed by roof, plumbing, electrical, "others" (not shown), 
flooring, interior walls, lighting, conveyance(elevator), handicap accessibility, windows, 
exterior walls, security, and structure. A total of seven respondents marked "others" for 
this question. The list of "others" consisted of life safety, steam plant, fire alarms, 
asbestos removal, parking, water distribution, and ground maintenance. 

















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Repair Expenditures 








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Ranking of Sources of Maintenance and 


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Figure 6: Relative Expenditures on Major Maintenance and Repair (Actual figures 
from Table 3 were adjusted by taking the inverse of a modified scale, 1-10, for a better 
visual representation of the ranking of expenditures) 


A total of 70 responded on a question of what change would be made if any particular 
system or component were to be replaced based on the past problems. The largest group 
of respondents (41 respondents) expressed their concerns over HVAC systems, wanting 
either an increase in the capacity of the system, conversion of the system to DDC (Direct 
Digital Control), or more efficient Air Conditioning and Heating. Each of these desires 
reflects dissatisfaction with earlier system specifications. The roofing system was a 
concern for many respondents, but no clear conclusion could be drawn as to which type 
of roofing system was favored by most respondents. Some other examples of the 
changes they would like to make were more efficient lighting systems, flexible facilities, 
design, and elevator upgrade. 


6 





Figure 7 shows the response to the question of the cause of major maintenance and repair 
costs. Aging of the facility was ranked the highest (most contributing cause), followed 
by normal wear and tear; technology replacement; federal, state, and local laws; poor 
design; materials (accelerated deterioration); construction (poor workmanship); and 
"others". 











| Ranking of Contributing Cause of 
Maintenance and Repair 





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Figure 7: Relative Contributing Cause for Major Maintenance and Repair (Actual 
figures from Table 3 were adjusted by taking the inverse of a modified scale, 1-10, for a 
better visual representation of the ranking of contributing cause) 


CONTRACTING PROCEDURES 


A series of questions were asked about the awarding of construction contracts (see Table 
4). An average of 9.1 construction contracts per facility was expected to be awarded in 
1997. As shown in Figure 8, the majority (77%) of respondents use a lump sum (fixed 
price) contracting method, while 16% of them use a cost plus method. Approximately 
7% responded that they used other methods. Examples of the other methods were GMP 
(guaranteed maximum price) (13 respondents), design build (4 respondents), time and 
materials (2 respondents), and a GMP with shared savings. 








Most construction contracts (82%) are competitively bid. For these competitively bid 
contracts, only 30 % of them are "open to all contractors", 58% are "restricted to selected 
firms on bidders list", 9% are based on "negotiations", and 3% are "others". Examples of 
"others" include set-aside contracts for the small business and the small business owned 
by the disadvantaged group. The total percentage of the above breakdown exceeds 100% 
because some respondents marked more than one answer. 


To the question of how the cost of construction contracts were distributed among 
different contractors in monetary terms, 59% was awarded to general contractors, 
followed by subcontractors (specialty contractors) (22%), professional construction 
management (CM) (11%), design build (9%), and "others" (0.6%). Examples of "others" 
included architect/engineering design, in-house personnel, and purchase order. 


sl a — 


Type of Contracts Invitation for Bidding 
Cost Other Others Open to all 
Plus 7% Negotiation 3% = Contractor 
16% 30% 


9% 





| Lump Selected 
| Sum Firm 
Me | 58% 


Figure 8: Breakdown of Contracting Methods 


ANALYSIS BY FACILITY CHARACTERISTIC 


The survey results were analyzed to see how the construction budgets, contracting 
procedures, facility maintenance, and other facility related matters were influenced by 
different variables such as the size of hospital (number of set-up beds), number of 
Intensive Care Facilities, age of facility, occupancy rate, public vs private facilities, and 
regional differences. 


Size of Facility 


Responding hospitals were grouped into four different size categories, consistent with the 
1989 study. Table 5 contains a tabulation of data with respect to these size categories. 
As one might expect, the total budgets of the hospitals and number of construction 


8 





contracts to be awarded increased with the size of hospital (number of set-up beds). The 
larger hospitals also had higher occupancy rates. Other variables noted to be related to 
the size of hospital was the ownership of the hospital. Larger hospitals had a higher 
percentage of government ownership compared to smaller ones, although the overall 
average percentage of government ownership regardless of the size of hospital was only 
28.3%. 


Many variables, however, did not reveal a discernible pattern in relation to the size of 
hospital. Examples of the variables that were not related to the size of hospitals were the 
allocation of the funds to new construction, renovation, and maintenance, the nature of 
expenditures in terms of adding different spaces, the percentage of construction work 
performed by in-house personnel, problem areas for major maintenance or repair. This 
was also true for the type of construction contracts awarded (lump sum or cost plus), 
percentage of competitively bid contracts, bidding process, and distribution of 
construction contracts (general, subcontract, design build, or professional construction 
management). 


Intensive Care Facilities 


Responding hospitals were grouped into five different categories on the basis of the ratio 
of intensive care/critical care beds to set-up beds. About 72% of 132 respondents 
accounted for the middle two categories of the ratio between 5% and 15% (see Table 6). 
It must be noted that intensive/critical care beds generally require a higher degree of 
focus on patient care, necessitating greater requirements for nursing care and patient 
monitoring. Hospitals with larger portions of intensive/critical care beds had higher total 
budgets for construction in 1995 through 1997. This is also true for the percentage of the 
construction work performed by in-house personnel and the occupancy rates. 


Many variables, however, did not vary in a discernible pattern in relation to the portions 
of intensive/critical care beds. Some of the variables that were not related to the portions 
of intensive care/critical beds were the allocation of the funds to new construction, 
renovation, and maintenance, the nature of expenditures in terms of adding different 
spaces, problem areas and causes that had been the source of major maintenance or repair 
costs. This was also true for the type of construction contracts awarded (lump sum or 
cost plus), percentage of competitively bid contracts, bidding process, and distribution of 
construction contracts (general, subcontract, design build, or profession construction 
management). 








There were some notable differences between the results of this survey and the one 
performed in 1989. In the 1989 survey, it was noted that the hospitals with a larger 
percentage of intensive/critical care beds occur in slightly smaller, newer, and private 
hospitals, and that no significant differences were noted between hospitals when 
compared on the basis of occupancy rates. This survey, however, showed that the 
hospitals with a larger percentage of intensive/critical care beds occur in larger hospitals, 
and did not present any discernible pattern for the age of structures and private hospitals. 
These results underscore the fact that such relationships cannot be assumed to remain the 
same from year to year. 


Facility Age 


The survey was analyzed by grouping into five different age categories (see Table 7). 

The most unique aspect occurred in the first age category, less than five years of age. The 
uniqueness within this period was somewhat consistent with the 1989 survey result. For 
the hospitals less than five years of age, construction expenditures in 1995 and 1996 are 
disproportionally high compared to the older hospitals. This is also true for the ratio of 
the intensive/critical care beds to set-up beds as well as the percentage of the construction 
work performed by in-house personnel. However, if only hospitals with more than five 
years of age were considered, the construction expenditures generally increased with the 
age of structures. 


Some other variables were related to the age of hospital. For example, newer hospitals 
had more beds in private rooms, which was consistent with the trends of the health care 
industry. Although the survey results indicate a higher percentage of government 
ownership for the hospitals with less than five and more than 46 years of age, no clear 
pattern could be established over the different age categories. The newer hospitals also 
spent a higher percentage of funds in adding supporting spaces such as laboratory, 
pharmacy, radiology, etc. 


Many variables, however, did not vary in a discernible pattern in relation to the age of 
hospitals. The allocation of the funds to new construction, renovation, and maintenance, 
the type of construction contracts awarded (lump sum or cost plus), percentage of 
competitively bid contracts, bidding process, and distribution of construction contracts 
(general, subcontract, design build, or professional construction management) were not 
related to the age of hospitals. 


Occupancy Rate 


The occupancy rates are an indication of a hospital's activity. In this analysis, the 
hospitals were grouped into five different categories (see Table 8). The survey results 


10 








indicated larger hospitals had generally higher occupancy rates. This was also true for 
hospitals with more intensive/critical beds and more private beds. 


The occupancy rates were closely related to the construction expenditures in 1995 and 
1996. The numbers indicate that the higher occupancy rates necessitated more 
expenditures in construction. The trend of the construction expenditures in 1997, 
however, was not as striking without clear reasons other than the fact that the 1997 
expenditures were future estimates, not actual or reserved, for most respondents. The 
categories of higher occupancy rates represent higher proportions of government-owned 
hospitals. Lower health care cost and more widely available trauma units might have 
attracted more patients to government-owned hospitals. 


In responding to a question of construction budgets for the next five years (1997 - 2001), 
a higher percentage of hospitals in lower occupancy rate categories responded their 
budgets are likely to "Increase Significantly" or "Decrease Significantly", while a higher 
percentage of hospitals in higher occupancy rate categories responded their budgets are 
likely to "Remain Roughly the Same". Hospitals with higher occupancy rates appear to 
be more likely to maintain their current budget level, while budgets for the hospitals with 
lower occupancy rates will likely be fluctuating. 


Many variables, however, did not show a discernible pattern in relation to the occupancy 
rates. Some of the variables that were not related to the portions of occupancy rates were 
the distribution of the funds to new construction, renovation, and maintenance, the nature 
of expenditures in terms of adding different spaces, problem areas and causes that had 
been the source of major maintenance or repair costs. This was also true for the type of 
construction contracts awarded (lump sum or cost plus), percentage of competitively bid 
contracts, bidding process, and distribution of construction contracts (general, 
subcontract, design build, or professional construction management). 


Public versus Private Facilities 


Responding hospitals were grouped into two different categories, public and private (see 
Table 9). Public hospitals, which account for 28% of all respondents, tend to be slightly 
larger and older facilities when compared to private hospitals. They also tend to have 
slightly higher occupancy rates as discussed in the previous section and a much lower 
number of admissions per year. 


Construction expenditures and plans were examined for these two categories. It is 
notable that public hospitals compared to private hospitals spent more than twice as much 
in overall construction in 1995 and 1996, and were projected to spend slightly more in 
1997. When hospitals were compared in terms of the budgets for the next five years, a 


11 








greater portion of private hospitals responded that their budgets will "Increase 
Significantly", while more portions of public hospitals responded that their budget will be 
likely to "Decrease Significantly". The conclusion, thus, could be drawn from these 
trends that differences in budgets between public and private hospitals for the next five 
years or so will level out. It is of interest to note that the 1989 survey results showed the 
private hospitals spent slightly more per facility than the public hospitals. 


The allocation of funds to new construction, maintenance/repairs, and renovation was 
examined for public and private hospitals. There was a discernible pattern in allocating 
construction funds. The public hospitals allocated a higher percentage of funds in 
maintenance and repairs compared to private hospitals, while the private hospitals 
allocated a higher percentage of funds to renovation and remodeling. This may have to 
do with the average age of the public hospitals being greater than that of the private 
hospitals. Older facilities would naturally require more work in maintenance and repairs 
than newer ones. The survey results also revealed the public hospitals allocated more 
funds for the construction work performed by in-house personnel, compared to the 
private hospitals. 


As expected, some significant differences were noted in contracting practices between 
public and private hospitals. A total of 93% of all contracts awarded for the public 
hospitals was the lump sum type contract, compared to 78% for the private hospitals. 
Only a total of 6% of contracts awarded for the public hospitals was the cost plus type 
contract, compared to 20% for the private hospitals. The private hospitals also utilize 
some (10%) other types of contract such as time and materials and guaranteed maximum 
price (GMP). 


To a question of how the costs of construction contracts are distributed, the public 
hospitals awarded a majority (79%) of their contracts to general contractors and 19% to 
the specialty contractors, while the private hospitals awarded considerably less (51%) for 
general contractors and more (23%) for specialty subcontractors. Another notable fact 
was the private hospitals used design build and professional construction management 
(CM) contracts in 9.3% and 15% of overall contract awards, respectively, while the 
public hospitals utilized these types of contract for only 1.9% and 0.2%, respectively. 


Figure 9 shows clear differences between public and private facilities on how contractors 
are invited to submit bids. Most public hospitals (80%) responded "open to all public", 
while this was the case for only 13% of private hospitals respondents. Most private 
hospitals (81%), however, used a bidding process that was "restricted to selected firms on 
bidders list", while this was the case for only 14% of the public hospitals. 


I 

















Public Hospitals fos opto ||| Private Hospitals (gi 7 








) ("] Open to 
| All | | All | 
| 0 Contractors | Contractors | 
>i | 10% 1% 13% 
ca | | mi CRResstricted | By ORRestricted 
14% to Selected to Selected 
Firms on Firms on 
| bidders list bidders list 
| | 
ee a: 81% a 
Negotiation | Negotiation 
(Others | Mm (Others 








ee ND an 
Figure 9: Breakdown of Bidding Methods between Public and Private Hospitals 
(The total exceeds 100% because some respondents provided multiple marks) 


The public and private hospitals do not appear to differ appreciably when compared on 
the basis of the source and cause of major maintenance and repairs. 


Regional Differences 


Hospitals responding to this study were grouped into the same seven different geographic 
regions as for the 1989 study. (See Table 10 for details and page 2 for regional 
breakdown. Although it was generally difficult to note clear patterns on most variables, 
readers might be able to obtain information for specific variables on the interested regions 
from the table provided. 


CONSTRUCTION RELATED PROBLEMS 


One of the questions in the survey was "What is your top construction related problem?" 
A total of 68% (118 of 173) of respondents provided an answer to the question. The most 
frequently cited problem was the timely completion of the projects (17 respondents). 
Among other answers provided were: meeting state and safety code requirements (13 
respondents); interruption of the hospital operation (10 respondents); lack of competent 
contractors (10 respondents); high construction cost and cost control after the contract 
award (10 respondents); poor, inflexible, and incomplete design (15 respondents); 


13 





punchlist and contract close-out (5 respondents); impact of change orders (4 
respondents); lack of quality CM (construction manager) and PM (project manager) (3 
respondents); lack of funds (3 respondents); lack of planning including site visit (2 
respondents); material availability (2 respondents); low bid selection contracting practice 
(2 respondents); compliance with the contract documents (2 respondents); and warranty 
(2 respondents). Problems that were mentioned as inherent to the hospital facilities 
included: HVAC system (4 respondents); asbestos removal (2 respondents); roof 
replacement (2 respondents); facility modernization; replacement of aging plant; and 
exterior walls. Other problems mentioned were: lack of coordination between projects; 
relocation of existing units; and construction safety. 


Most of the items addressed above appear to be typical problems related to the 
construction of hospitals, as the similar problems had also been addressed in the previous 
survey performed in 1989. 


FUTURE TRENDS IMPACTING CONSTRUCTION 


The last question asked in the survey was "What trends relating to construction, if any, do 
you see impacting facility construction over the next 5- 10 years?" A total of 63% (109 
of 173) of respondents provided an answer to this question. The most frequently 
addressed future trend was the outpatient service emphasis (27 respondents) in the health 
care industry. This change in service philosophy also appeared to provide an influence 
on at least one major facility related area: More renovation/remodeling of the facility but 
less new construction (15 respondents) to accommodate outpatient service. Survey 
results revealed that the renovation/remodeling trend was also fueled by several other 
factors such as decreasing construction funds (9 respondents), merging of functions (1 
respondents), emphasis on managed care (3 respondents), etc. 


Changes in technology seemed to have a significant impact on the hospital construction 
industry. A total of 5 respondents said that new technology will require space 
modification to accommodate the changes. Systems for flexibility (7 respondents) and 
increasing demands for more cost effective practice (3 respondents) were also expected 
with less construction funds available in the future. A total of eight respondents said 
more stringent code requirements were anticipated for the future, of which three were 
related to the Americans with Disabilities Act (ADA). 


More attention will be given to environmental concerns such as conversion to energy 
efficient systems (3 respondents) and additional seismic requirements (4 respondents). It 
is, however, interesting to note that not a single respondent addressed hazardous waste 
concerns, which was a complete turnaround from the 1989 survey. The 1989 survey 


14 


1 Dom 





received a total of 16 responses collectively for such environmental concerns as energy 
management, asbestos, and hazardous waste. 


Several other significant changes were noted in the way construction services will be 
obtained. Seven respondents predicted more Design Build contracts will be used, while 
three mentioned CM service. Two responded that partnering between the owner and the 
contractor will be the way to manage projects. Three respondents expressed a concern 
over a shortage of qualified contractors and diminishing workmanship. Other trends 
noted were: anticipation of tighter QC practice; more hotel-like hospital settings; and 
emphasis on smaller and more custom projects. 


Most of the items addressed above appear to be the same issues that had been mentioned 
in the previous survey performed in 1989. 


CONCLUSIONS 


Construction budgets for the construction industry overall for the next five years are 
projected to remain at a steady level. Considering increasing construction costs, it 
appears considered that market opportunity for construction contractors for the hospital 
industry is not as bright as it was in the past. However, a few pointers out of these survey 
results could be utilized in seeking future business opportunities. There is a definite 
emphasis on renovation and remodeling over new construction due to several reasons 
such as change in operational philosophy, new technology accommodation, savings of 
funds, etc. This climate may represent a unique opportunity for some contractors to enter 
into long term contracts to provide construction services to hospitals that are undergoing 
rapid changes in facility needs. Such customer-supplier relationship are not unusual in 
industries where owners operate large facilities. Contractors also must be aware of the 
different methods being used to award the construction contracts. As it always has been, 
the public hospitals will more likely have a bidding process open to all interested parties, 
while private hospitals will use selected bidders lists more extensively. The public 
hospitals also will use the lump sum type of contract extensively, while the private 
hospitals are expected to mix other types such as cost plus and guaranteed maximum 
price contracts with the lump sum type of contract. 


15 





Table 1 


General Description of Hospitals* 


descriptor 


Number of Licensed Beds 
Number of Set Up Beds 
Number of {ntensive/critical Care Rooms 
Number of Private Rooms 
Number of Semi-Private Rooms 
Number of Wards 
Occupancy Rate 
Number of Admission per Year 
Age of the Primary Structure (Years) 
Government Owned 
Federal 
State 
County 
City 


Privately Owned 


mean 


309 
244 
29 

93 
110 
33 
66.3% 
8495 
30 
28.3% 
42.9% 
24.5% 
28.6% 


4.1% 


11 


median 


266 


202 


16 


54 


16 


0 


68.0% 


6400 


30 


maximum minimum 


1032 


900 


200 


739 


911 


500 


100.0% 


20000 


130 


42 


20.0% 


20 





*173 respondents 


16 





Bai sea epee s 


/ = “oF 





Table 2 


Information on Hospital Construction Expenditure* 


descriptor 


Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


General Nature of Construction 
% Add Patient Room 
% Add Administration Space 
% Add Support Space (lab, pharmacy, etc) 
% Add Operating Rooms 
% Add Alzheimer's Ward 
% Add Psychiatric Ward 
% Others 


Construction(excl. maint./repair) by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


Construction Budgets for the Next Five Years (1997-2001) 


Remain Roughly the Same 
Increase Slightly 

Increase Significantly 
Decrease Slightly 
Decrease Significantly 


Amount of Construction that is Government Funded 





*173 respondents 
**F in thousands 


17 


mean** 


$5,631 
28.9% 
18.9% 
591.1% 


10.9% 
5.1% 
23.1% 
3.2% 
0.4% 
2.9% 
53.0% 


$487 
(16.4%) 


$6,017 
25.4% 
23.4% 
51.6% 


$5,622 
30.9% 
20.8% 
48.0% 


26.0% 
11.6% 
25.4% 
18.5% 
18.5% 


20.4% 


median** 


$2,500 


$70 
(5.0%) 


$2,000 
0.0% 
13.0% 
50.0% 


$3,000 
0.0% 
10.0% 
50.0% 


0.0% 


$70,000 


$10,000 
(100%) 


$150,000 


100.0% 
100.0% 
100.0% 


$71,500 
100.0% 
100.0% 
100.0% 


100.0% 


maximum** minimum** 


$0 


$0 
(0.0%) 


$0 
0.0% 
0.0% 
0.0% 


$0 
0.0% 
0.0% 
0.0% 


0.0% 





nA & an 
at Terwmil” 


OT be 


ogni «0 





Table 3 
Information on Maintenance** 





descriptor mean median maximum minimum 


Source of Major Maintenance and/or Repair Costs, '1" being the worst problem area 


Exterior Walls 7.6 8.0 13.0 1.0 
Interior Walls 6.2 6.0 13.0 1.0 
Security 7.6 8.0 1ae8 1.0 
Flooring 5.8 5.0 14.0 1.0 
Electrical 5.1 4.5 12.0 1.0 
Roof 3.9 3.0 13.0 1.0 
Structure 9.7 11.0 14.0 1.0 
Windows 7.0 76 13.0 1.0 
Handicap Accessibility 6.9 7.0 13.0 10 
Mechanical (HVAC) 2.4 2.0 9.0 1.0 
Plumbing 4.1 4.0 13.0 1.0 
Lighting 6.5 6.0 13.0 1.0 
Conveyance (elevator) 6.7 6.0 13.0 1.0 
Others *5.4 *3:0 *14.0 m0 


Cause of Significant Maintenance and Repair Costs, "1" being the worst problem area 


Federal, State, Local Laws 3.6 3.0 11.0 1.0 
Materials (accelerated deterioration) 4.7 5.0 7.0 1:0 
Construction (poor workmanship) 5.1 6.0 9.0 1.0 
Normal Wear and Tear 3.0 3.0 7.0 1.0 
Aging of Facility le? 1.0 6.0 1.0 
Poor Design 3.8 3.0 8.0 1.0 
Technology Replacement 3.0 3.0 1.0 1.0 
Others "6:3 *8.0 76.0 *1.0 





* not an accurate representation due to either very limited number of or no respondent 
**173 respondents 


18 





Table 4 
Information on Contracting* 





descriptor 
# of Construction Contracts to be Awarded in 1997 


Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
% Cost Plus 
% Others 


Percentage of Contracts that are competitively Bid 


Invitation for Bidding 
Open to All Contractors 
Restricted to Selected Firms on Bidders List 
Negotiation 
Others 


Distribution of Contracts 
% General Contractor 
% Subcontractors (specialty contractors) 
% Design Build 
% Professional Construction Mgmnt (CM) Contract 
% Others 


*173 respondents 


19 


mean 


9.1 


17.4% 
15.8% 
6.8% 


81.9% 


30.1% 
58.4% 
8.7% 
2.7% 


99.4% 
21.8% 
1.1% 
10.9% 
0.6% 


median 


4.0 


100.0% 


0.0% 
0.0% 


95.0% 


67.5% 
10.0% 
0.0% 
0.0% 
0.0% 


maximum 


160.0 


minimum 


0.0 








Table 5 


Variable Impacted by Size (# of Setup Beds) of Hospital 


Number of set-up beds 
Number of Hospitals 


Information about Hospital 
Avg. Number of Licensed Beds 
Avg. Number of Set Up Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure (Years) 
Privately Owned 
Government Owned 

Federal 

State 

County 

City 


Construction Plans for the Hospital 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General Nature of Construction 
% Add Patient Room 
% Add Administration Space 
% Add Support Space (lab, pharmacy, etc) 
% Add Operating Rooms 
% Add Alzheimer's Ward 
% Add Psychiatric Ward 
% Others 
Construction(excl. maint./repair) by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Budgets for the Next Five Years (1997-2001) 
Remain Roughly the Same 
Increase Slightly 
Increase Significantly 
Decrease Slightly 
Decrease Significantly 
% of Construction that is Government Funded 
“Category range includes the lower-end integer. 
$ in thousands 
20 


150-** 


30 


159.9 
99.8 
58.1% 
5 los 
30.1 
80.0% 
20.0% 
30.0% 
10.0% 
50.0% 
10.0% 


$2,639 


38.9% 
18.6% 
40.1% 


12.3% 
4.1% 
17.0% 
3.2% 
0.5% 
0.2% 
62.7% 
$112 


(13.5%) 
$2,930 


21.6% 
24.9% 
47.5% 


$3,018 


32.1% 
17.6% 
49.3% 


24.0% 
8.0% 
38.0% 
8.0% 
22.0% 
14.6% 


150-250" 


41 


260.9 

196.6 
69.5% 
7,370 

25.6 
13.2% 
26.8% 
45.5% 
18.2% 
36.4% 
0.0% 


$5,885 


26.3% 
172% 
94.7% 


12.4% 
5.5% 

18.4% 
2.3% 
0.0% 
3.3% 

Soc 
$236 


(17.0%) 
$4,850 


29.9% 
23.2% 
50.5% 


$6,464 


40.4% 
19.9% 
39.3% 


26.8% 

1.3% 
26.8% 
19.5% 
17.1% 
18.1% 


250-350** 


28 


362.0 
299.6 
68.4% 
10,882 
28.5 
67.9% 
32.1% 
55.6% 
22.2% 
113¥e 
11.1% 


$8,435 


26.1% 
15.8% 
58.1% 


1.9% 
270 
32.9% 
1.0% 
0.0% 
6.5% 
41.6% 


$1,012 
(16.1%) 
$10,141 


30.5% 
16.2% 
93.4% 


$8,443 


42.2% 
18.5% 
39.0% 


17.9% 
14.3% 
10.7% 
32.1% 
25.0% 
19.6% 


350+** 


30 


609.1 
902.1 
13.7% 
16,196 
32.5 
63.3% 
36.7% 
45.5% 
36.4% 
18.2% 

0.0% 


$8,081 


17.8% 
18.3% 
63.9% 


11.1% 
8.0% 

29.1% 
3.17% 
0.0% 
4.6% 

44.0% 
$953 


(17.5%) 
$8,842 


20.4% 
18.6% 
64.1% 


$9,043 


23.5% 
16.8% 
59.7% 


36.7% 
13.3% 
16.7% 
33.3% 

3.3% 
19.3% 





Table 5 (Continued) 


Variable Impacted by Size (# of Setup Beds) of Hospital 


($ in thousands) 


Number of set-up beds 
Information on Maintenance 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 

Interior Walls 

Security 

Flooring 

Electrical 

Roof 

Structure 

Windows 

Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 

Lighting 

Conveyance (elevator) 
Others 


Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 


Federal, State, Local Laws 
Materials (accelerated deterioration) 
Construction (poor workmanship) 
Normal Wear and Tear 

Aging of Facility 

Poor Design 

Technology Replacement 

Others 


Information on Construction Contracts 
# of Construction Contracts to be Awarded in 1997 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
% Cost Plus 
% Others 
Percentage of Contracts that are competitively Bid 
Invitation for bidding 
Open to All Contractors 
Restricted to Selected Firms on Bidders List 
Negotiation 
Others 
Distribution of Contracts 
“% General Contractor 
% Subcontractors (specialty contractors) 
% Design Build 
% Professional Construction Management (CM) 
% Others 


*not an accurate representation due to either very limited number of or no respondent 


**Category range includes the lower-end integer. 
21 


150-** 


150-250** 


123 7.6 
6.4 6.3 
2 fies. 
Sak DI 
6.5 4./ 
4.8 4.8 
10.1 8.8 
Tal 6.9 
te 6.6 
2u2 1.8 
4.4 3.4 
no 6.6 
v3 7.4 
20 “4.5 
3.6 3.0 
4.9 4.1 
ae eo 
ag 3.0 
ES 1.6 
eS 3.8 
3.1 2.8 
*8.0 “6.3 
4.3 6.4 
74.4% 75.5% 
13.5% 19.4% 
12.472 5.0% 
85.0% 16.5% 
24.0% 29.3% 
66.0% 61.0% 
10.0% 12.2% 
2.0% 2.4% 
63.0% 99.9% 
14.5% 24.9% 
8.4% 2.1% 
12.2% 8.8% 
0.4% 1.3% 


250-350** 


3a 
4.7 
30 
3.0 
ers 
3.8 
2at 
"10 


12.8 


71.0% 
17.7% 

9.4% 
13.0% 


32.1% 
64.3% 
17.9% 

0.0% 


Diee 
21.5% 
Tor 
13.8% 
0.0% 


350+** 


a2 
eZ 
ed 
Z9 
les 
48 
3.6 
*0.0 


19.4 


16.5% 
135970 

4.0% 
82.3% 


40.0% 
56.7% 
3.3% 
6.7% 


92.9% 
21.95% 
13.7% 
5.4% 
0.5% 





Table 6 


Variable Impacted by % Intensive Care Beds of Hospital 


% Of Intensive Care Beds 
Number of Hospitals 
Information about Hospital 
Avg. Number of Licensed Beds 
Avg. Number of Set Up Beds 
Avg # of Intensive/critical Care Rooms 
Avg % of Intensive/critical Care Rooms 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure 
Privately Owned 
Government Owned 
Federal 
State 
County 
City 
Construction Plan for the Hospital 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General nature of Construction 
% Add Patient Room 
% Add Administration Space 
% Add Support Space (lab, pharmacy, etc) 
% Add Operating Rooms 
% Add Alzheimer's Ward 
% Add Psychiatric Ward 
% Others 
Construction by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


0-5** 
1, 


PATE U4 
200K6 
TA 
3.1% 
60.1% 
3249 
29.8 
52970 
42.1% 
50.0% 
29.0% 
25.0% 
0.0% 


$3,745 
40.6% 
20.8% 
38.6% 


9.4% 
3.8% 
26.8% 
6.8% 
0.0% 
7.9% 
39.7% 
$224 
(10.3%) 
$2,655 
26.9% 
23.3% 
49.8% 
$2,811 
22.0% 
26.6% 
51.5% 


Construction Budget for the Next Five Years (1997-2001) 


Remain Roughly the Same 

Increase Slightly 

Increase Significantly 

Decrease Slightly 

Decrease Significantly 
% of Construction that is Government Funded 
$ in thousands 


“Category range includes the lower-end integer. 


31.6% 

0.0% 
26.3% 
31.6% 
10.5% 
25.6% 


22 


5-70** 
66 


280.9 
223.6 
1Gre 
1.5% 
64.1% 
9295 
2956 
15.8% 
24.2% 
37.5% 
12.5% 
43.8% 
6.3% 


$4,272 
21.1% 
Toes 
95.5% 


10.6% 
2.5% 
19.0% 
1.9% 
0.3% 
0.6% 
62.8% 
$318 
(14.8%) 
$4,459 
24.5% 
20.7% 
54.8% 
$6,449 
39.1% 
16.7% 
43.4% 


28.8% 
12.1% 
28.8% 
13.6% 
19.7% 
13.9% 


10-15** 
30 


331.0 
290.7 
30.1 
12.0% 
66.2% 
10456 
2176 
10.0% 
30.0% 
66.7% 
0.0% 
22/0 
11.1% 


$6,520 
35.0% 
17.8% 
47.2% 


10.2% 
9.8% 
32.5% 
2.5% 
0.0% 
1.0% 
43.3% 
$574 
(17.7%) 
$5,367 
28.7% 
28.1% 
46.5% 
$6,928 
38.4% 
15.7% 
45.7% 


16.7% 
6.7% 
33.3% 
16.7% 
26.7% 
6.9% 


15-20** 
9 


437.9 
320.4 
99.0 
18.1% 
10.7% 
8780 
31.4 
88.9% 
11.1% 
100.0% 
0.0% 
0.0% 
0.0% 


$8,294 
15.6% 
13.3% 
11.4% 


6.1% 
3.3% 
17.8% 
3.9% 
0.0% 
5 6% 
63.9% 
$2,068 
(20.3%) 
$10,153 
37.2% 
15.0% 
47.8% 
$9,961 
26.1% 
20.6% 
53.3% 


22.2% 
33.3% 
11.1% 
11.1% 
11.1% 

0.0% 


20+** 
8 


483.9 
333.9 
100.5 
47.9% 
109% 
11948 
2000 
75.0% 
25.0% 
50.0% 
50.0% 
0.0% 
0.0% 


$7,675 
13.3% 
12.8% 
14.0% 


18.6% 
6.3% 
20.0% 
0.0% 
0.0% 
10.0% 
45.1% 
$213 
(10.3%) 
$8,349 
23.8% 
21.0% 
55.3% 
$7,290 
33.1% 
29.7% 
37.2% 


12.5% 
29.0% 

0.0% 
37.5% 
12-376 
22.5% 





Table 6 (Continued) 


Variable Impacted by % Intensive Care Beds of Hospital 


% of Intensive Care Beds 0-5** 
Information on Maintenance 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


5-170** 10-15** 


Exterior Walls 9.1 Ta 7 
Interior Walls 5.8 6.3 6.6 
Security 3.9 See 8.1 
Flooring 56 5.8 52 
Electrical 6.3 5.1 5.4 
Roof 4.1 4.1 oz 
Structure 10.6 9.9 9.6 
Windows 7.6 te 7.1 
Handicap Accessibility 6.8 6.4 6.9 
Mechanical (HVAC) Zo 2.1 20 
Plumbing 3.5 4.0 4.2 
Lighting 6.2 3 ee 6.6 
Conveyance (elevator) 7.8 6.9 6.0 
Others *1.0 *6.4 *3.0 
Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 
Federal, State, Local Laws 3.1 aoe oro 
Materials (accelerated deterioration) 4.5 aie 4.1 
Construction (poor workmanship) Jao ao 32 
Normal Wear and Tear eu 3.0 2h 
Aging of Facility 1.6 1.8 1.6 
Poor Design a3 3.9 4.0 
Technology Replacement 2.8 2.6 Co2 
Others *1.0 wO.0 *0.0 


Information on Construction Contracts 
# Construction Contracts to be awarded in 1997 6.1 6.9 16.5 
Type of Construction Contracts Awarded 


% Lump Sum (fixed price) 64.9% 71.9% 81.0% 
% Cost Plus 30.4% 16.4% 16.2% 
% Others 46% 11.7% 2.8% 
% of Contracts that are competitively Bid i230 80.4% 77.1% 
Invitation for Bidding 
Open to All Contractors 42.1% 21.30 Solo 7c 
Restricted to Selected Firms on Bidders List 47.4% 66.7% 56.7% 
Negotiation 10.5% 2.1% 10.0% 
Others 15% 0.0% 3.3% 
Distribution of Contracts 
% General Contractor 7128% 573% 61.1% 
% Subcontractors (specialty contractors) 20.4% 18.7% 25.1% 
% Design Build 5246 7.7% 2.0% 
% Professional Construction Mgmnt (CM) 1.6% 19.0% 10.1% 
% Others 2.8% 0.6% 0.0% 


* not an accurate representation due to either limited number of or no respondent 
**Category range includes the lower-end integer. 
$ in thousands 

Ze 


15-20** 


14.2 


85.0% 
1.8% 
6.3% 

65.6% 


11.1% 
88.9% 
112 
11.1% 


29.0% 
44.1% 
25.5% 
1.4% 
0.0% 


20+** 


8.3 


9173% 
8.8% 
0.0% 

93.4% 


12.5% 
62.5% 
12.5% 
12.5% 


51.4% 
21.4% 
12:9% 
14.3% 

0.0% 





Table 7 


Variable Impacted by Age of Structure 





Age of Primary Structure 
Number of Hospitals 
Information about Hospital 
Avg. Number of Licensed Beds 
Avg. Number of Set Up Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure 
Privately Owned 
Government Owned 
Federal 
State 
County 
City 
Construction Plan for the Hospital 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General nature of Construction 
“% Add Patient Room 
% Add Administration Space 
% Add Support Space (lab, pharmacy, etc) 
% Add Operating Rooms 
% Add Alzheimer's Ward 
% Add Psychiatric Ward 
“% Others 
Construction by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


0-5** 
10 


338.8 

309.8 
15.7% 
10,812 

255 
40.0% 
60.0% 
33.3% 
50.0% 
16.7% 
0.0% 


918,035 
37.0% 
31.0% 
32.0% 


12.4% 
0.9% 
40.4% 
0.0% 
0.0% 
11.9% 
34.5% 
$192 
(43.4%) 
$17,860 
14.4% 
24.4% 
61.1% 
$2,025 
16.1% 
40.0% 
43.9% 


Construction Budget for the Next Five Years (1997-2001) 


Remain Roughly the Same 

Increase Slightly 

Increase Significantly 

Decrease Slightly 

Decrease Significantly 
% of Construction that is Government Funded 
““Category range includes the lower-end integer. 
> in thousands 


30.0% 
10.0% 
20.0% 
20.0% 
20.0% 
50.0% 


24 


5-15** 


16 


271.8 

2250 
62.5% 
6,343 

10.8 
81.3% 
18.8% 
6.3% 
0.0% 
6.3% 
6.3% 


$2,462 


37.2% 
seil7o 
49.7% 


3.3% 
9.0% 
28.3% 
4.0% 
1.3% 
0.7% 
53.3% 
$219 


(17.4%) 
$2,585 


30.4% 
28.2% 
41.4% 


910,718 


43.3% 
16.4% 
37.1% 


25.0% 

6.3% 
Sf570 
12,396 
18.8% 
13.6% 


15-25** 


46 


295.6 

237.1 
63.3% 
8,943 

2183 
84.8% 
15.2% 
42.9% 
28.6% 
14.3% 
14.3% 


$3,651 


23.1% 
17.3% 
57.3% 


123% 
4.4% 
28.2% 
3.0% 
0.2% 
SHIM 
48.8% 
$204 


(14.1%) 
$4,085 


18.4% 
21.2% 
62.5% 


$3,546 


24.8% 
20.2% 
55.5% 


28.3% 
10.9% 
23.9% 
19.6% 
19.6% 
13.8% 


25-35** 


43 


305.2 

22056 
63.2% 
7,369 

30:2 
72.1% 
27.9% 
41.7% 
16.7% 
41.7% 
0.0% 


poem 2 


35.7% 
20.2% 
44.3% 


9.0% 
3.5% 
23.4% 
4.7% 
0.0% 
1.3% 
54.6% 
$434 


(10.5%) 
$3,656 


239% 
25.2% 
51.3% 


$5,220 


31.9% 
23.5% 
44.4% 


20.9% 
11.6% 
32.6% 
16.3% 
20.9% 
12.0% 


35-45** 


34 


321.6 
ota 
68.8% 
9,065 
40.9 
73.5% 
26.5% 
33.3% 
22.2% 
44.4% 
0.0% 


99, fo2 


24.4% 
Ae 70 
63.9% 


14.4% 
6.5% 
15.5% 
3.2% 
0.0% 
4.2% 
52.6% 
$812 


(17.7%) 
7,602 


33.8% 
19.0% 
47.3% 


97,957 


32.5% 
NSPS Yo 
52.0% 


26.5% 
14.7% 
20.6% 
17.6% 
17.6% 
20.0% 


45+** 
21 


3300) 

2200 
1237/0 
6,688 

61.0 
47.6% 
52.4% 
63.6% 
18.2% 
18.2% 
0.0% 


97,569 
20.0% 
32.9% 
43.1% 


12.7% 
6.3% 
14.7% 
1.7% 
1.7% 
1.7% 
61.2% 
$1,066 
(18.6%) 
$9,303 
31.9% 
30.7% 
36.7% 
~O,D7o 
38.0% 
20.5% 
40.5% 


28.6% 
14.3% 
14.3% 
28.6% 

9.5% 
40.7% 





Table 7 (Continued) 


Variable Impacted by Age of Structure 





Age of Primary Structure 
Information on Maintenance 


0O25"* 


5-15** 


15-25** 


25-35** 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 
Interior Walls 
Security 
Flooring 
Electrical 
Roof 
Structure 
Windows 
Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 
Lighting 
Conveyance (elevator) 
Others 
Cause of Significant maintenance and Repair C 
Federal, State, Local Laws 
Materials (accelerated deterioration) 
Construction (poor workmanship) 
Normal Wear and Tear 
Aging of Facility 
Poor Design 
Technology Replacement 
Others 
Information on Construction Contracts 
# Construction Contracts to be awarded, 1997 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
% Cost Plus 
% Others 
% of Contracts that are competitively Bid 
Invitation for Bidding 
Open to All Contractors 
Restricted to Selected Firms on bidders list 
Negotiation 
Others 
Distribution of Contracts 
“% Genera! Contractor 
% Subcontractors (specialty contractors) 
% Design Build 
% Professional Construction Mgmnt (CM) 
% Others 


8.5 
4.0 
Sar 
oa 
3.8 
4.2 
8.8 
lo 
12 
2 
Sas 
6.5 
11.0 
ges 


Za 
9.5 
4.2 
4.0 
1.6 
2.2 
2.8 
“OE0 


7.0 
79.0% 
13.978 

7.5% 


91.4% 


10.0% 
30.0% 
10.0% 

0.0% 


73.6% 
13.6% 
12.9% 
0.0% 
0.0% 


2./ 
7.9 
8.8 
o.7 
9.4 
3.5 
4.5 
7.4 
4.6 
2.6 
4.3 
2.0 
6.8 
*4.0 


or 
3.0 
3.1 
2.0 
2.0 
2.8 
2.9 
*0.0 


14.1 
86.1% 
10.4% 

3.6% 


80.2% 


Silese 
96.3% 
12.5% 

0.0% 


62.7% 
18.5% 
2.8% 
9.0% 
0.0% 


7.3 
9.8 
8.3 
a 
6.2 
4.4 
10.2 
7.0 
7.1 
2.6 
46 
ifs 
6.8 
“4.5 


3.4 
4/7 
9.4 
a2 
2.0 
3.8 
$2 
*3.0 


v3 
75.1% 
13.5% 
11.7% 


80.6% 


17.4% 
71.7% 
10.9% 

0.0% 


64.4% 
17.2% 
5.1% 
12.6% 
0.1% 


7.0 
6.9 
6.9 
9.5 
4.9 
oe 
we 
6.8 
6.4 
ZS 
9.0 
6.1 
6.9 
BLO 


a 
5.0 
9.2 
3.1 
ey 
4.2 
2.9 
“6.3 


8.3 
80.4% 
13.8% 

9.9% 


77.5% 


32.6% 
60.5% 
7.0% 
2.3% 


94.0% 
26.1% 
14.8% 
4.3% 
1.8% 


* not an accurate representation due to either very limited number of or no respondent 


“Category range includes the lower-end integer. 
$ in thousands 


25 


35-45** 


8.2 
9.0 
8%3 
9.6 
4.6 
3.2 
no 
7.0 
ind 
Wer 
4.0 
6.0 
6.0 
733 


3.4 
4.7 
9.6 
Zo 
1.6 
33 
3.0 
"830 


9.8 
68.9% 
23.2% 

7.6% 


83.0% 


26.5% 
70.6% 
5.9% 
5.9% 


51.6% 
24.8% 
4.2% 
21-9 /o 
0.0% 


45+** 


8.7 
8.3 
8.9 
7.9 
4.9 
4.2 
on 
7.4 
8.3 
ane 
20 
6.9 
9.6 
pane 


4.3 
46 
9.3 
3.1 
‘les 
4.5 
248 
*8.0 


11.4 
84.8% 
15.0% 

0.2% 


90.0% 


52.4% 
47.6% 
9.5% 
9.5% 


67.3% 
19.1% 
28/0 
10.2% 
0.8% 





—_ leas Ly é 
“@bteijs ove bs » @€h-ee 5 TT 


vh, = pm ee 1a ‘a 


ws 


Table & 


Variable Impacted by Occupancy Rate 


% Occupancy Rate 
Number of Hospitals 


Information about Hospital 
Avg. Number of Licensed Beds 
Avg. Number of Set Up Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure 
Privately Owned 
Government Owned 

Federal 

State 

County 

City 


Construction Plan for the Hospital 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General nature of Construction 
% Add Patient Room 
% Add Administration Space 
% Add Support Space (lab, pharmacy, etc) 
% Add Operating Rooms 
% Add Alzheimer's Ward 
% Add Psychiatric Ward 
% Others 
Construction by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


50-** 
20 


206.6 

143.7 
37.2% 
4,800 

3258 
75.0% 
25.0% 
20.0% 
0.0% 
60.0% 
20.0% 


$1,863 
22.2% 
25.0% 
48.4% 


3.6% 
0.0% 
16.8% 
1.8% 
1.4% 
1.8% 
68.6% 
$133 
(10.8%) 
$3,809 
16.4% 
35.4% 
47.3% 
S37 
25.4% 
21.2% 
Sage 


Construction Budget for the Next Five Years (1997-2001) 


Remain Roughly the Same 

Increase Slightly 

Increase Significantly 

Decrease Slightly 

Decrease Significantly 
% of Construction that is Government Funded 
$ in thousands 


“Category range includes the lower-end integer. 


15.0% 
10.0% 
30.0% 
15.0% 
251055 

5.8% 


26 


50-65** 


46 


256.0 
201.5 
5515% 


8,842 


25.4 
76.1% 
23.Gn0 
36.4% 

9.1% 
45.5% 

9.1% 


$4,939 
37.0% 
16.1% 
44.8% 


15.4% 
2.9% 
32.6% 
2.8% 
0.0% 
0.4% 
44.0% 
$226 
(17.4%) 
$3,937 
29.4% 
20.8% 
51.8% 
$6,329 
42.7% 
16.8% 
40.2% 


23.9% 
13.0% 
28.3% 
13.0% 
Zier 76 
19.4% 


65-80** 
0 


343.4 
285.6 
70.8% 
10,823 
31.3 
72.5% 
218% 
64.3% 
21.4% 
14.3% 
0.0% 


$5,276 
27.1% 
14.6% 
5/ 18H 


10.7% 
7.6% 
20.3% 
5.1% 
0.2% 
1.9% 
5350 
$709 
(16.1%) 
$4,568 
27.0% 
20.1% 
52.9% 
$5,649 
30.3% 
18.9% 
50.7% 


255% 

9.8% 
21.6% 
21.6% 
19.6% 
17.4% 


80-95** 
31 


348.4 

277.4 
84.8% 
6,032 

29.4 
64.5% 
35.5% 
45.5% 
45.5% 
Gali 
0.0% 


7,420 
21.6% 
25.2% 
93.0% 


13.7% 
6.7% 
19.4% 
1.7% 
0.0% 
6.3% 
52.3% 
$604 
(22.2%) 
$10,583 
23.7% 
27.5% 
48.8% 
$5,922 
24.4% 
27.8% 
47.7% 


38.7% 

3.2% 
19.4% 
29.0% 
16.1% 
2/.6% 


95+** 
9 


285.4 

223.8 
97.2% 
5,670 

48.4 
95.6% 
44.4% 
0.0% 
75.0% 
25.0% 
0.0% 


$8,758 
24.5% 
25070 
51.6% 


5.7% 
2.9% 
15.7% 
0.0% 
4.3% 
13.6% 
57.9% 
$481 
(15.9%) 
$5,678 
17.8% 
23.7% 
58.6% 
$3,914 
12.5% 
27.5% 
60.0% 


44.4% 
44.4% 
0.0% 
11.1% 
0.0% 
45.6% 





Table 8 (Continued) 


Variable Impacted by Occupancy Rate 





% Occupancy Rate 


50- kk 


50-65** 


65-80** 


80-95** 


g5+** 


Information on Maintenance 
Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 
Interior Walls 
Security 
Flooring 
Electrical 
Roof 
Structure 
Windows 
Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 
Lighting 
Conveyance (elevator) 
Others 
Cause of Significant maintenance and Repair Costs, 
Federal, State, Local Laws 
Materials (accelerated deterioration) 
Construction (poor workmanship) 
Normal Wear and Tear 
Aging of Facility 
Poor Design 
Technology Replacement 
Others 


Information on Construction Contracts 
# Construction Contracts to be awarded, 1997 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
% Cost Plus 
% Others 
% of Contracts that are competitively Bid 
Invitation for Bidding 
Open to All Contractors 
Restricted to Selected Firms on bidders list 
Negotiation 
Others 
Distribution of Contracts 
% General Contractor 
% Subcontractors (specialty contractors) 
% Design Build 
% Professional Construction Mgmnt (CM) 
“ Others 


8.2 
9.0 
7.4 
9.4 
6.2 
Sic 
10.5 
6.6 
a 
1.6 
4.6 
6.8 
6.3 
eG 


3.3 
4.4 
9.9 
2.4 
1.9 
oof 
2.6 
*0.0 


9.9 


80.7% 
1ors76 

5.9% 
94.8% 


35.0% 
65.0% 
5.0% 
5.0% 


95.6% 
15.5% 
11.4% 
16.9% 

1.9% 


8./ 
9.6 
Te 
4.6 
9.2 
308 
9.4 
8.3 
"0 
2.6 
3.9 
63 
8.0 
73,3 


29 
9.0 
on 
Zo 
ES 
4.0 
orl 
*8.0 


9.0 


74.9% 
16.0% 

9.1% 
83.6% 


30.4% 
56.5% 
8.7% 
0.0% 


61.0% 
22.2% 
5.7% 
11.4% 
0.9% 


7.3 
6.6 
8.4 
6.8 
9.2 
35 
a 
6.8 
6.8 
2.4 
4.1 
Ow 
9.4 
*4.0 


4.1 
4.7 
9.0 
2./ 
13 
3.5 
a 
*8.0 


10.8 


76.8% 
16.7% 

6.4% 
77.7% 


29.4% 
66.7% 
1336 

3.9% 


61.5% 
23:37 
6.2% 
9.6% 
0.5% 


“not an accurate representation due to either very limited number of no respondent 


“Category range includes the lower-end integer. 


2/ 


9.9 
6.8 
6.9 
6.8 
4.5 
4.1 
10.7 
oo 
7-0 
2.8 
4.8 
6.5 
6.6 
*4.0 


uy 
4/ 
4.5 
os 
1.6 
3.9 
3.3 
*4.9 


18.8% 
16.2% 

5.0% 
83.6% 


35.5% 
64.5% 
6.5% 
0.0% 


54.8% 
Zo 76 
4.3% 
12.2% 
0.0% 


Siz 
8.9 
6.3 
9.6 
9.0 
6.8 
To 
9.0 
9.2 
1.9 
ond 
6.7 
1.8 
*2.0 


2.6 
4.0 
9.0 
Zo 
ee 
4.0 
3.0 
*8.0 


9.4 


76.7% 
11.7% 
VIE 76 
81.7% 


33.37% 
44.4% 
11.1% 
Wisi 


65.0% 
18.8% 
8.8% 
7.5% 
0.0% 


seh tt 





Table 9 


Difference between Public and Private Hospitals 


descriptor 
Number of Hospitals 


Information about Hospital 
Avg. Number of Licensed Beds 
Avg. Number of Set Up Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure 
Privately Owned 
Government Owned 

Federal 

State 

County 

City 


Construction Plan for the Hospital 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General nature of Construction 
% Add Patient Room 
% Add Administration Space 
% Add Support Space (lab, pharmacy, etc) 
% Add Operating Rooms 
% Add Alzheimer's Ward 
% Add Psychiatric Ward 
% Others 
Construction by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Budget for the Next Five Years (1997-2001) 
Remain Roughly the Same 
Increase Slightly 
Increase Significantly 
Decrease Slightly 
Decrease Significantly 
% of Construction that is Government Funded 
> in thousands 
28 


Public 
49 


339.9 
268.8 
10.2% 
6,791 
34.2 
0.0% 
100.0% 
42.9% 
24.5% 
28.6% 
4.1% 


$8,755 
35.9% 
28.1% 
36.0% 


4.3% 
6.9% 
20.1% 
1.9% 
0.5% 
7.6% 
58.7% 
$713 
(19.1%) 
$10,729 
24.9% 
30.0% 
45.1% 
$6, 736 
26.0% 
32.8% 
40.5% 


267500 
10.2% 
18.4% 
18.4% 
28.6% 
48.7% 


Private 
124 


298.2 
234.9 
64.8% 
9,084 
Z26ur 
100.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 


$4,392 
26.1% 
15.2% 
97.0% 


13.4% 
4.4% 
24.2% 
3.6% 
0.4% 
1.2% 
50.8% 
$400 
(15.4%) 
$4,077 
25.6% 
20.7% 
54.3% 
$5,195 
32.8% 
16.1% 
50.9% 


25.62 
12.1% 
28.2% 
18.5% 
14.5% 

8.9% 





'e) tt Beal . 


iberre OPP ihr, 





Table 9 (Continued) 
Difference between Public and Private Hospitals 


descriptor Public Private 


Number of Hospitals 49 124 
Information on Maintenance 
Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 8.8 Ee 
Interior Walls 6.8 6.0 
Security A 7.9 
Flooring G2 5.6 
Electrical 3.9 5.8 
Roof 4.2 oa 
Structure 8.5 10.2 
Windows 13 6.9 
Handicap Accessibility 7.4 6.7 
Mechanical (HVAC) 2.4 2.4 
Plumbing oo 4.4 
Lighting 6.1 6.6 
Conveyance (elevator) 6.4 6.8 
Others 1.0 4.5 
Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 
Federal, State, Local Laws 3.9 34 
Materials (accelerated deterioration) 4.8 46 
Construction (poor workmanship) 5.0 on 
Normal Wear and Tear 3.0 2.9 
Aging of Facility 1.4 1.9 
Poor Design 3.9 or 
Technology Replacement oun 3.0 
Others 5 6.8 
Information on Construction Contracts 
# Construction Contracts to be awarded, 1997 10.6 8.5 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 93.5% 70.8% 
% Cost Plus 5.6% 19.9% 
% Others 0.8% 9.3% 
% of Contracts that are competitively Bid 92.7% 17.9% 
Invitation for Bidding 
Open to All Contractors 79.6% 12.9% 
Restricted to Selected Firms on bidders list 14.3% 80.6% 
Negotiation 8.2% 9.7% 
Others 8.2% 0.8% 
Distribution of Contracts 
% General Contractor 79.3% 50.9% 
% Subcontractors (specialty contractors) 18.5% 23.1% 
% Design Build 1.9% 9.3% 
“% Professional Construction Mgmnt (CM) 0.2% 15,3976 
% Others 0.6% 0.6% 





$ in thousands 
29 





Table 10 


Hospital Characteristics by Region 





Region Number 
Number of Hospitals 


Information about Hospital 
Avg. Number of Licensed Beds 
Avg. Number of Set Up Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure 
Privately Owned 
Government Owned 

Federal 

State 

County 

City 


Construction Plan for the Hospital 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General nature of Construction 
% Add Patient Room 
% Add Administration Space 
% Add Supprt Space(lab, pharmacy,etc) 
% Add Operating Rooms 
% Add Alzheimer's Ward 
% Add Psychiatric Ward 
% Others 
Construction by In-House Personnel 


Construction Expenditure projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

Construction Expenditure projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


Construction Budget for the Next Five Years (1997-2001) 


Remain Roughly the Same 

Increase Slightly 

Increase Significantly 

Decrease Slightly 

Decrease Significantly 
% of Construction that is Govmnt Funded 
> in thousands 


30 


1 2 3 

oT, 21 1 
298.4 2891 340.2 
gea3 2188 33093 
062 0.70 0.659 
6,825 8,582 11,413 
266 389 367 
74.1% 61.9% 63.6% 
25.9% 38.1% 36.4% 
42.9% 50.0% 50.0% 
0.0% 37.5% 50.0% 
57.1% 12.5% 0.0% 
0.0% 0.0% 0.0% 
$4,971 $4,437 $4,352 
24.0% 30.3% 26.2% 
18.0% 15.1% 34.0% 
57.7% 54.7% 30.7% 
10.0% 5.5% 19.9% 
55% 66% 7.8% 
32.0% 15.3% 27.3% 
3.2% 16% 3.0% 
0.9% 0.0% 0.0% 
25% 47% 4.0% 
42.3% 66.3% 38.0% 
$376 $228 $755 
(10.4%) (7.4%) (26.1%) 
$6,384 $3,914 $4,023 
20.4% 11.6% 29.7% 
24.0% 30.4% 30.4% 
55.6% 58.0% 39.9% 
$5,292 $2,958 $11,443 
28.9% 16.3% 30.0% 
17.0% 32.8% 23.9% 
52.7% 51.0% 46.0% 
26.9% 38.1% 27.3% 
7.7% 143% 9.1% 
26.9% 14.3% 63.6% 
19.2% 19.0% 0.0% 
19.2% 143% 0.0% 
17.1% 295% 47.5% 


304.7 
259.3 


0.54833 


4,367 
24.1 
42.9% 
57.1% 
50.0% 
0.0% 
50.0% 
0.0% 


$3,593 


39.3% 
24.3% 
36.4% 


0.0% 
5.0% 
25.0% 
10.0% 
0.0% 
5.0% 
95.0% 
$332 


3d sve 
32.9% 
27.9% 


$15,043 


62.1% 
14.3% 
23.6% 


0.0% 
14.3% 
42.9% 

0.0% 
42.9% 
28.6% 


15 


326.7 
281.5 
0.7038 
8,911 
20.6 
13370 
26.7% 
25.0% 
25.0% 
50.0% 
0.0% 


20.1% 
31.6% 
48.2% 


0.7% 
4.1% 
43.1% 
4.6% 
0.0% 
1.1% 
46.4% 
$518 


(18.7%) (24.7%) 
$3,150 $4,056 


8.8% 
35.0% 
63.8% 


$6,518 


32.7% 
22.3% 
44.3% 


13.3% 
13.3% 
40.0% 
26.7% 

6.776 
12.9% 


23 


384.5 
293.1 


0.68978 


10,402 
33.7 
69.6% 
30.4% 
07.1% 
14.3% 
28.6% 
0.0% 


$3,609 $11,609 


40.4% 
18.1% 
41.5% 


10.4% 
6.8% 
16.8% 
3.6% 
0.0% 
2.5% 
95.6% 


$1,167 
(22.7%) 
$9,707 


38.5% 
16.9% 
44.6% 


$7,009 


40.8% 
15.4% 
43.8% 


21.7% 
13.0% 
21.7% 
26.1% 
17.4% 
Z20ig7c 


322.5 
244.4 


0.77176 


9,773 
33.9 
89.5% 
10.5% 
90.0% 
90.0% 
0.0% 
0.0% 


$6,003 


14.8% 
15.8% 
69.4% 


6.2% 
2.4% 
23.8% 
3.8% 
2.4% 
4.7% 
96.8% 
$495 


(15.4%) 
$4,918 


23.6% 
24.1% 
92.3% 


$4,714 


24.3% 
18.1% 
08.5% 


31.6% 
10.5% 
26.3% 

9.3% 
26.3% 
31.8% 





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Table 10 (Continued) 


Hospital Characteristics by Region 





Region Number 
Information on Maintenance 


1 


2 


3 


& 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 

Interior Walls 

security 

Flooring 

Electrical 

Roof 

Structure 

Windows 

Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 

Lighting 

Conveyance (elevator) 
Others 


Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 


Federal, State, Local Laws 
Materials (accelerated deterioration) 
Construction (poor workmanship) 
Normal Wear and Tear 

Aging of Facility 

Poor Design 

Technology Replacement 

Others 


Information on Construction Contracts 
# of Constr. Contracts to be awarded, 1997 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
“% Cost Plus 
% Others 
% of Contracts that are competitively bid 
Invitation for Bidding 
Open to All Contractors 
Restricted to Select.Firms on bidders list 
Negotiation 
Others 
Distribution of Contracts 
% General Contractor 
% Subcontractors (specialty contractors) 
“% Design Build 
% Professional Construction Mgmnt (CM) 
“% Others 


“not an accurate representation due to either very limited number of or no respondent 


$ in thousands 


8.8 8.8 10.5 8.2 
6.2 oa 8.4 4.5 
os, 9.6 9.8 10.8 
Sats 9.8 5.4 9.0 
9.8 oo 2.8 5.3 
25 ao 4.6 4.9 
9.3 12.1 g2 al, 
9.1 1.1 tei, 8.8 
6.7 rz 8.9 0 
2.8 Wes: 1.6 2.1 
4.5 4.9 2.8 3.8 
ao 5.1 6.8 oa 
6.9 6.2 6.4 7.3 
*14.0 33 *9.0 *0.0 
Za 3.4 4.2 of 
4.4 4.6 5.0 Sie: 
9.3 9.5 9.0 3.8 
2.9 20 3.0 3.0 
1.9 2.1 1S ie 
46 3.2 4.3 3.3 
3.3 229 3.2 3.0 
*8.0 *0.0 *8.0 *0.0 
13.0 9.6 1072 12.3 
77.9% 179.3% 70.5% 84.3% 
15.5% 160%  12.773uo 
6.1%  S0% 16.G78 0.0% 
76.7% 86.5% 87.7% 90.0% 
33.3% 23.8% 36.4% 28.6% 
63.0% 76.2% 545% 42.9% 
7.4% 9.5% 9.1% 28.6% 
0.0% 0.0% 0.0% 28.6% 
0.0% 0.0% 0.0% 0.0% 
97.5% 61.5% 340% 76.7% 
27.396 “2G% SEM Tor NOE 
1.3% 9.6% Oto “Palz3 7o 
6.8% 10.3% 24.9% 0.0% 
1.4% 0.0% 0.4% 0.0% 


31 


4.2 
9.4 
1.4 
Gz 
9.6 
3.2 
10.0 
6.0 
i 
2.5 
4.8 
8.0 
9.8 
*2.0 


vee 
5.1 
9.0 
3.2 
1.8 
3.8 
2.8 
*0.0 


ono 


79.3% 
13.7% 

1.0% 
89.3% 


40.0% 
60.0% 
0.0% 
0.0% 
0.0% 
53.8% 
18.3% 
21.3% 
6.7% 
0.0% 


6.3 
6.0 
7.4 
9.9 
9.0 
4.6 
10.5 
7.3 
6.6 
2.9 
4.1 
9.6 
tied 
“115 


3.5 
4.9 
9.4 
3.2 
1s 
4.2 
2.6 
*3.0 


15.0 


64.8% 
19.8% 
15.4% 
Toe 


39.1% 
52.2% 
8.7% 
4.3% 
0.0% 
45.7% 
31.1% 
6.6% 
14.6% 
2.0% 


ial 
1.4 
eo 
fo 
4.9 
4.4 
10.3 
61 
ee 
2.8 
9.2 
ae 
6.8 
mies 


48 
4.6 
9.0 
2.8 
24 
er 
3.4 
*8.0 


6.1 


83.2% 
8.4% 
8.4% 

SPS 


21.1% 
13.7% 
5.3% 
10.5% 
0.0% 
5257 6 
12.4% 
4.7% 
30.2% 
0.0% 





i ~~ 2 ea) eet peut 
} ' 





Construction and Maintenance Activities, Needs, and 
Procurement Policies of Long Term Care Facilities 


DESCRIPTION OF RESPONDENTS 


A total of 110 responses were received from long-term health care facilities throughout 
the United States. These respondents represented facilities with an average of 195 skilled 
nursing beds, 69 intermediate care beds, 55 boarding house (assisted living) beds, 121 
independent living unit beds, and 21 "other beds". Some examples of "other beds" are 
developmental disability home/apartment, acute care, adult day care, short term 
rehabilitation care, cottage, intensive care unit, etc. The average occupancy rate was 
94.8% with an average of 199 admissions per year. The average age of the primary 
health care facilities was 26 years. Approximately 19% of the responding long-term care 
facilities were publicly-owned, of which 5%, 14%, 57%, 14%, and 10% are owned by 
federal, state, county, city, and hospital district agencies, respectively (Figure 10). See 
Table 11 for further details. 


Publicly 


ee Hospital 
5 District Federal 
10% 5% State 
City — 14% 
14% 


\ 


Privately N 
Owned 
81% 





Figure 10: Breakdown of Private and Publicly-Owned Facilities 


a2 


a? 
SteSr ay 

(ee 
VU ’ 





CONSTRUCTION ACTIVITIES 


Table 12 contains and Figure 11 depicts construction expenditure figures for 1995, 1996, 
and 1997. The average expenditure on construction during 1995 was $1.6 million. Of 
this amount, 20% was allocated to new construction, 38% was spent on maintenance and 
repairs, and 43% was spent on renovation. 


In response to the question of general nature of construction, the support space (dining 
facility, lounge, activities room, etc.) accounted for 19%, followed by the addition of 
rooms for residents at 13%, updating to meet building (fire) codes at 12%, and 
administrative space at 6.2% (Figure 12). The majority of the respondents (46%), 
however, indicated that these funds were spent in "other" areas, which included 
renovation/remodeling (20 respondents), followed by facelift (4 respondents), new 
buildings (4 respondents), general upkeep (3 respondents), HVAC system upgrade (2 
respondents), and facility modernization (2 respondents). Some other examples of 
"other" areas mentioned were parking, sidewalk, utility, interior finish, new court yard, 
housing, and common area improvement. 


The survey indicated only 18.4% (an average of $96,000) of the construction work (not 
including maintenance and repairs) was performed by in-house personnel in 1995. 


Respondents projected they will spend an average of $657,000 in 1996 (22% for new 
construction, 43% for maintenance/repairs, and 35% for renovation) and $1,931,000 in 
1997 (29% for new construction, 31% for maintenance/repairs, and 40% for renovation). 
In projecting construction budgets for the next five years (1997-2001), Figure 13 shows 
24%, 14%, 28%, 27%, and 8% of respondents respectively marked "Increase 
Significantly", "Increase Slightly", "Remain Roughly the Same", "Decrease Slightly", 
and "Decrease Significantly". Approximately 26% of all construction funds are received 
from government sources such as direct appropriations, tax supported bonds, etc. See 


Table 12 for further details. 


There is a notable drop in expenditures for 1996 ($657,000) compared to 1995 
($1,601,000) and 1997 ($1,931,000). According to the 1989 survey, long term care 
facilities spent an average of $265,000 per year for the periods of 1984 through 1988, 
$442,000 for the year 1989, and $360,000 per year for the periods of 1990 - 1994. In 
conclusion, construction expenditures for long term care facilities appears to be 
fluctuating year to year without a clear pattern. 


33 


& 
= == 
ee 
_ 
+S 
> 
- <= 
c __ 








| $2,000 _ | siti GMOS deca 


$1,800 | | 

$1,601 : 

$1,600 | 
| 








$1,400 
$1,200 
$1,000 


| 
—— $657 : 
: 


$600 [= a) 


$400 | 
i 
| 


($ in thousand) 


$200 


i | 


——————— Je 
1995 1996(projected) 1997 (projected) 








Figure 11: Construction Expenditures from 1995-1997 


i 


BB Rooms for 











| BB Remain Roughly 

















13% Residents | 14% oa 
7Yp ij Admin Space 3% A Mf Increase Slightly © 
| 9B Increase | 
48% | ® Bee | Significantly | 
20% ene | 
' | | | | Decrease 
Crem i 26% Slightly 
12% Codes 
| | | Decrease 
i Others | Significantly 
Figure 12: General Nature of Figure 13: Construction Budget Trends 
Construction for Next 5 years (1997-2001) 


MAINTENANCE ACTIVITIES 


A series of questions were asked about the maintenance aspects of the facility (see Table 
13). In response to the question of what the sources of major maintenance and repair costs 
were, mechanical (HVAC) system was ranked the highest (greatest expenditure), 
followed by roof, plumbing, flooring, electrical, "others", lighting, windows, interior 


34 





walls, conveyance (elevator), exterior walls, handicap accessibility, security, and 
Structure. 


Figure 14 shows the ranking by expenditures among different areas of the facility. A 
total of nine respondents marked "others" (not shown) for this question. Examples of 
"others" were general maintenance, parking, landscaping, boiler replacement, retaining 
walls, etc. It is notable that the order of the worst problem areas as the source of major 
maintenance and repair costs was almost the same as it was for the hospital facilities. 











Repair Expenditures 





Ranking of Sources of Maintenance and 


l 1 { 


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a 








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Se - = = 83 = 8 “4 
Pt COTS < 
= 
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Figure 14: Relative Expenditures on Major Maintenance and Repair (Actual 
figures from Table 13 were adjusted by taking the inverse of a modified scale, 1-10, for a 
better visual representation of the ranking of expenditures) 


A total of 50 participants responded to a question of what change would be made if any 
particular system or component were to be replaced based on the past problems. 
Concerns over HVAC system were expressed by 22 respondents. Desires were for larger 
capacity of the system, conversion to more sophisticated controls such as DDC (Direct 
Digital Control) system, more efficient system, and natural gas run air conditioning and 
heating systems. Roofing systems were a concern for eight respondents. However, no 


ch 





clear conclusion could be drawn on which roof system was preferred by the respondents. 
Four respondents wanted to replace their windows with more energy efficient ones. Four 
respondents also stated that they would want to change their lighting system and 
kitchen/laundry equipment with more energy efficient ones. Some other examples of the 
changes they would like to make were better security (key) systems, modernized 
elevators, and better layout of nursing stations. 


To the question of what the cause of significant maintenance and repair costs were, as 
shown in Figure 15, aging of facility was ranked the highest (most contributing cause), 
followed by normal wear and tear, poor design, technology replacement, materials 
(accelerated deterioration), construction (poor workmanship), federal, state, and local 
laws, and "others". A total of three respondents marked "others" as a part of major 
maintenance and repair costs. Examples of the "others" were poor mechanical design, 
change in usage, and water treatment. Again, it is notable that the order of the worst 
problem areas as the cause of the maintenance and repair costs was almost the same as it 
was for the hospital facilities. 

















Ranking of Contributing Cause of 


Maintenance and Repair 
| 
| 


Ce ~~ n 
a c Ei ee “a DE Ee @ 2 

ZA ° a 2S S fs g 

2 Sy $ 3&5 fas 8 As 

on O —_— UY Q = Oo 2 v & BOs — — 

<8 Se ta Ss So .< na 2 ge 

Ex 9 38 = 385 ones Sis 

58 £ Ee 9 & Oo 8 cae 

iz ~ = tE 








Figure 15: Relative Contributing Cause for Major Maintenance and Repair (Actual 
figures from Table 13 were adjusted by taking the inverse of a modified scale, 1-10, for a 
better visual representation of the ranking of contributing cause) 


36 





CONTRACTING PROCEDURES 


A series of questions were asked about the awarding of construction contracts (see Table 
14). An average of 3.5 construction contracts were expected to be awarded in 1997. 
Figure 16 shows that a majority (84%) of respondents use a lump sum (fixed price) 
contracting method, while 13% of them use a cost plus method. Approximately 3.5% 
responded that they used other methods. Examples of the other methods were GMP 
(guaranteed maximum price) (4 respondents) and time and materials (1 respondent). 
Most construction contracts (86%) are competitively bid. For these competitively bid 
contracts, only 42 % of them are "open to all contractors", 44% are "restricted to selected 
firms on bidders list", 10% are based on "negotiations", and 4% are "others". Examples 
of "others" include bids from three contractors, and open based on competitive market 
conditions. 


To the question of how the cost of construction contracts were distributed among 
different contractors in monetary terms, 63% was awarded to general contractors, 
followed by subcontractors (specialty contractors) (21%), professional construction 
management (CM) (8%), design build (9%), and "others" (0.1%). Examples of "others" 
included architect/engineering design and furniture and equipment purchasing. 


Type of Contracts | Invitation for Bidding 





Other 
Cost ¢ _..__ Others 
Plus yy Negotiation A%, 
13% 10% 
Open to All 
Contractors 
42% 
Firmson ~~ 
Lump Bidders List 
sum 44% 
83% 


J ee 


Figure 16: Breakdown of Contracting Methods 


a7 


ANALYSIS BY FACILITY CHARACTERISTIC 


The survey results were analyzed to see how the construction budgets, contracting 
procedures, facility maintenance, and other facility related matters were influenced by 
different variables such as the size of facility, percentage of skilled nursing beds, age of 
facility, occupancy rate, public vs private facilities, and regional differences. 


Size of Facility 


Responding hospitals were grouped into four different size categories (see Table 15). As 
one might expect, the total budgets of the facilities and number of construction contracts 
to be awarded generally increased with the size of the long term care facility (total 
number of set-up beds). The larger long term care facilities also had generally slightly 
higher occupancy rates. Another variable noted to be related to the size of facilities was 
the ownership of long term care facilities. Larger facilities generally had a higher 
percentage of government ownership compared to smaller ones, although the overall 
average percentage of government ownership regardless of the size of facility was only 
19.4%, which was considerably lower than that of hospitals (28.3%). 


Many variables, however, did not reveal a discernible pattern in relation to the size of the 
long term care facility. Some of the examples of the variables that were not related to the 
size of long term care facilities were the allocation of the funds to new construction, 
renovation, and maintenance, the nature of expenditures in terms of adding different 
spaces, the percentage of construction work performed by in-house personnel, and 
problem areas for major maintenance or repair. This was also true for the type of 
construction contracts awarded (lump sum or cost plus), percentage of competitively bid 
contracts, bidding process, and distribution of construction contracts (general, 
subcontract, design build, or professional CM). 


Skilled Nursing Facilities 


Responding long term care facilities were grouped into five different categories on the 
basis of the percentage of skilled nursing beds to overall set-up beds. About 40% of (42 
of 105) respondents accounted for the percentage skilled nursing beds of 100% (see Table 
16). It must be noted that a higher percentage of skilled nursing beds implies that more 
residents at the facilities have access to greater individualized health care services and 
that those facilities with skilled nursing beds have in-house capabilities to care for 
residents who might otherwise be hospitalized. Although the percentage of skilled 


38 


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nursing beds was considered as a parameter that might influence the amount of 
expenditures, no clear patterns were observed from the survey results. 


Facility Age 


The results were analyzed by grouping facilities into five different age categories and the 
tabulated results are shown in Table 17. The older facilities generally tend to be larger 
(more set-up beds and skilled nursing beds) according to the survey results. An 
interesting result occurred for the first age category, less than five years of age, in terms 
of government versus private ownership. All eight facilities in the less than five years old 
category were privately owned. While this number is too small to make solid 
conclusions, it may be indicative of a trend away from public ownership of such facilities. 
Such a trend, if real, would have definite implications on the construction contracting 
practices. 


Unlike the 1989 survey results, wherein the different age group of facility structures 
showed a few distinctive trends in budgets, areas of funds expended, occupancy rates, 
etc., these survey results did not reveal much in the way of conclusive trends for the age 
of facilities in most of the variables examined. 


Occupancy Rate 


The occupancy rates provide an indication of a facility's activity. In this analysis, the 
occupancy rates of long term care facilities were grouped into five different categories 
(see Table 18). The most dramatic change from 1989 survey in terms of occupancy rates 
is an increase (33%) in the average occupancy rate, from 71.3% to 94.8%. From this 
change, in can be concluded that more people are treated or serviced by long term care 
facilities today, compared to six to seven years ago. Another interesting trend was 
observed in the average number of admission per year. Facilities with the higher 
occupancy rates tend to have fewer admissions per year. Longer staying period per 
admission in the long term care facility naturally drives the occupancy rate up, but 
reduces number of admission due to lower turn-over rates. While it is not otherwise 
indicated by the respondents, this trend may result in more new construction down the 
road when existing capacities are exceeded by demand. 


As it was for the hospitals, the occupancy rates were closely related to the construction 
expenditures in 1995. The construction expenditures increased as the occupancy rates 
increased. It was readily apparent that the higher occupancy rates necessitated more 
expenditures in construction. The construction expenditures in 1996 and 1997, however, 
show somewhat increasing trends although the patterns are not as distinctive as 1995. 


eo 





A clear pattern was developed in the construction work performed by in-house personnel. 
Facilities with the higher occupancy rates spent more utilizing their in-house personnel. 


However, the proportion of in-house work compared to overall expenditures did not yield 
a certain pattern. In other words, in-house construction work efforts increased with the 
construction expenditures as well as with the occupancy rates. This trend also points to a 
potential opportunity for contractors to enter into long term construction service 
contracts. 


Public versus Private Facilities 


Responding long term care facilities were grouped into two different categories, public 
and private. (see Table 19) Public facilities, which account for only 19% of all 
respondents, tend to be slightly larger and older facilities when compared to private 
facilities. It is also observed that the private long term care facilities offer more variety of 
services. For example, private facilities included boarding (assisted living) beds, 
independent living unit beds, and other types of beds, while public facilities had almost 
none of these types. 


Construction expenditures and plans were examined for these two categories. No clear 
pattern was evident in construction expenditures. The private facilities compared to the 
public facilities spent almost four times and twice as much in overall construction in 1995 
and expected to do so again in 1997. However, the private facilities expected to spend 
only half of what public facilities spent in 1996. When the facilities were compared in 
terms of the budgets for the next five years, a greater portion of private facilities 
responded that their budgets would be "Increase Significantly", while more of the public 
facilities responded that their budget would be likely to "Decrease Significantly”. 


The allocation of funds to new construction, maintenance/repairs, and renovation was 
examined for public and private hospitals. There was a discernible pattern in allocating 
construction funds. The public facilities allocated a higher percentage of funds in 
renovation and remodeling, while the private facilities allocated a higher percentage of 
funds in new construction. The survey results also revealed that there were no clear 
differences in the amount of construction work performed by in-house personnel. 


Contracting practices were examined. For the type of contracts awarded, significant 


differences were noted between public and private facilities. A total of 97% of all 
contracts awarded for the public facilities was the lump sum type contract, compared to 


40 





80% for the private facilities. Only 3% of contracts awarded for the public facilities was 
the cost plus type contract, compared to 16% for the private facilities. Both private and 
public facilities utilize some other types of contract such as time and materials and 
guaranteed maximum price (GMP). As for the competition aspect of the contract bidding 
process, the public facilities, as would be expected, used competitively bid contracts for 
almost all (95%) of their construction contracts. The competitively bid contracts were 
also the dominant (84%) procedure for private facilities. 


Figure 17 shows clear differences between public and private facilities on how 
contractors are invited to submit bids. Most public facilities (91%) responded "open to 
all public", while this was the case for only 28% of private facilities respondents. The 
majority of private facilities (52%) used a bidding process that was "restricted to selected 
firms on bidders list", while this was the case for only 10% of the public facilities. 








we 


@ Open to All 


——— —— =. 











BE Opento All | Contractors 
9% Contractors | 11% ; | mw Restricted 
5% , 25% | 
! | fi] Restricted | ig Selected 
| irms on 
ai | 12% Bidders List 
Bidders List | | as 
| | [Negotiation 
49 Mi Es NNegotiation | 
Bil. | 47% | [4 Others 
"| Others 5 No 
} Response 


Figure 17: Breakdown of Bidding Methods between Public and Private Facilities 





To a question of how the cost of construction contracts are distributed, the public 
facilities awarded majority (76%) of their contracts to general contractors and 7% to the 
specialty contractors, while the private facilities awarded considerably less (58%) for 
general contractors and more (25%) for specialty subcontractors. Also notable facts were 
the public and the private facilities both used design build contracts as much as 15% and 
8% of overall contract awards, respectively. The private facilities also used 10% of their 
overall contract awards for the professional construction management (CM) contracts, 
compared to 1.5% for the public facilities. 


4] 





However, public and private facilities do not appear to differ appreciably when compared 
on the basis of the source and required areas of major maintenance and repairs. 


Regional Differences 


Long term care facilities responding to this study were grouped into the same seven 
different regions as for the hospital study (see Table 20 for details). The regional data of 
only 63 of 110 facilities was available to examine this category. Regions three, four, and 
five only had two, four, and one respondents, respectively. Although it was generally 
difficult to note clear and accurate patterns on most variables, readers might be able to 
obtain information for specific variables on the interested regions from the table 
provided. 


CONSTRUCTION RELATED PROBLEMS 


One of the questions in the survey was "What is your top construction related problem?" 
A total of 53% (58 of 110) of respondents provided an answer to the question. The most 
frequently addressed problem was obtaining qualified contractors (7 respondents). . 
Among other answers provided were: the timely completion of the projects (6 
respondents); meeting state, safety code, and ADA (Americans with Disabilities Act) 
requirements (3 respondents); aging of facilities (S respondents); interruption of the 
health care operation (4 respondents); high construction cost (2 respondents); poor, 
outdated, and incomplete design (5 respondents); and lack of funds (3 respondents). 


Problems that were inherent to the long term care facilities included: HVAC system (7 
respondents); roof replacement (3 respondents); asbestos removal; window replacement; 
electrical system; and lighting. Other problem mentioned were: lack of coordination 
between contractors; warranty and contract close-out; lack of quality CM (construction 
manager); material availability (2 respondents); and compliance with the contract 
documents. 


Most of the items addressed above appear to be typical problems related to the 
construction of long term care facilities, as the similar problems had been addressed in 
the previous survey performed in 1989. 


FUTURE TRENDS IMPACTING CONSTRUCTION 


The last question asked in the survey was "What trends relating to construction, if any, do 
you see impacting facility construction over the next 5- 10 years?" A total of 43% (47 of 


42 


> 
a=» 222 ——_——_-  —- 
Gap 
@& > ee 
= oad 
Es a 
[SESE - 
a 
= —> 
ae 
——> > - — 





110) of respondents provided an answer to this question. The most frequently addressed 
future trend was the construction cost escalation (11 respondents) due to overly restrictive 
code requirements, ADA, increasing materials costs, etc. They predicted there will be 
more stringent new code requirements especially due to the ADA. Five respondents 
expected less funds available for the future. The government cutback in spending was 
one of the reasons provided. The formation of capital (2 respondents) was mentioned to 
cope with the funding shortage. 


The change in service philosophy appeared to be evident. More emphasis is expected to 
be placed upon offering a more comfortable environment for the patient such as a private 
room setting, more common space in the facility, etc. Three respondents predicted more 
managed care and more government involvement 1n the future due to federal and state 
regulations. Changes in technology seemed to have some impact on construction. A 
total of four respondents said that new technology and materials will have a great impact 
on future facility design. Changes in contracting were also mentioned. Some examples 
of those mentioned are more design build contracts (2 respondents), emphasis on value 
engineering, and more partnering between the owner and contractor. 


CONCLUSIONS 


Construction budgets for the long term care facility construction industry overall for the 
next five years 1s expected to remain at a steady level. When increasing construction 
costs are considered, it appears market opportunity for construction contractors for the 
long term health care industry is not as bright as it was in the past. However, a few 
pointers out of these survey results could be utilized in seeking future business 
opportunities. 


There is a greater emphasis on maintenance and repairs; and renovation and remodeling 
over new construction due to several reasons such as change in operational philosophy, 
new technology accommodation, savings of funds, etc. Increased need for in-house 
construction capability could signal an opportunity for long term construction service 
contracts to be established. 


High occupancy rate (average of 95%), although not explicitly addressed by the 
respondents, can be viewed as a potential new construction opportunity down the road 
when existing capacities are exceeded by demand and funds become available. 


Contractors also must be aware of the different methods currently being used to award the 
construction contracts. As it always has been, the public hospitals will more likely have 


43 


eee 





bidding open to all interested parties, while private hospitals will use selected bidder's list 
more extensively. The public hospitals also will use the lump sum type contract 
extensively, while the private hospitals are expected to mix other types such as cost plus 
and guaranteed maximum price contracts with the lump sum type of contract. The survey 
results also suggest that more design build for fast tracking projects will be utilized in the 
future. 


44 





Table 11 
General Description of Facilities* 





descriptor mean 
Number of Skilled Nursing Beds 195 
Number of Intermediate Care Beds 69 
Number of Boarding House(assisted living) Beds 55 
Number of Independent Living Unit Beds 121 
Number of Other Beds 21 
Occupancy Rate 94.8% 
Number of Admission per Year 199 
Age of the Primary Structure (Years) 26 
Government Owned 19.4% 
Federal 4.8% 
State 14.3% 
County 57.1% 
City 14.3% 
Hospital District 9.5% 
Privately Owned 80.6% 


median 


178 


60 


46 


84 


3 


97.0% 


igs 


25 


Zo 


Zo2 


248 


482 


169 


100.0% 


1600 


92 


maximum minimum 





*110 respondents 


45 





t. 


se ee i 


niet 





Table 12 


Expenditure on Construction, Maintenance and Repair* 





descriptor 


Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


General Nature of Construction 
% Add Rooms for Residents 
% Add Administration Space 
% Add Support Space(dining, lounge, activities r 
% Updating to meet Building(fire) Code 
% Other 


Construction(excl. maint./repair) by In-House Person 
Construction(excl. maint./repair) by In-House Person 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


Construction Budgets for the Next Five Years (1997-2001) 


Remain Roughly the Same 
Increase Slightly 

Increase Significantly 
Decrease Slightly 
Decrease Significantly 


% of Construction that is Government Funded 


*110 respondents 
**$ in thousands 


46 


mean*™ 


$1,601 


19.7% 
3/:5% 
42.9% 


12.7% 

6.2% 
18.9% 
115% 
45.6% 


$96 
18.4% 


$657 
21.3% 
42.6% 
34.8% 


$1,931 


28.6% 
31.0% 
40.1% 


28.4% 
23.5% 
26.5% 

1.8% 
13.7% 


25.8% 


median** 


$200 


$11 
5.0% 


$150 

0.0% 
30.0% 
25.0% 


$300 

0.0% 
20.0% 
31.7% 


0.0% 


maximum** 


$25,000 


$1,280 
100.0% 


$14,500 
100.0% 
100.0% 
100.0% 


$21,000 
100.0% 
100.0% 
100.0% 


100.0% 


minimum 


50 


$0 
0.0% 


$0 
0.0% 
0.0% 
0.0% 


$0 
0.0% 
0.0% 
0.0% 


0.0% 








Table 13 
Information on Maintenance** 





descriptor 


Source of Major Maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 

Interior Walls 

Security 

Flooring 

Electrical 

Roof 

Structure 

Windows 

Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 

Lighting 

Conveyance (elevator) 
Others 


mean 


median 


10.0 
220) 
8.0 
2.0 
3.0 
5.0 
6.0 

ale0 


maximum 


13.0 
38 
15.0 


11.0 
eee 
13.0 
13.0 
14.0 

a0 

8.0 
8 
13.0 
“320 


Cause of Significant Maintenance and Repair Costs, "1" being the worst problem area 


Federal, State, Local Laws 
Materials (accelerated deterioration) 
Construction (poor workmanship) 
Normal Wear and Tear 

Aging of Facility 

Poor Design 

Technology Replacement 

Others 





4.0 
39 
3.9 
2.9 
2.0 
3.6 
3.8 


“4.6 


4.0 
4.0 
4.0 


“not an accurate representation due to either very limited number of or no respondent 


**110 respondents 


47 


minimum 





Table 14 
Information on Contracting* 





descriptor 
# of Construction Contracts to be Awarded in 1997 


Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
% Cost Plus 
% Others 


Percentage of Contracts that are competitively Bid 


Invitation for Bidding 
Open to All Contractors 
Restricted to Selected Firms on Bidders List 
Negotiation 
Others 


Distribution of Contracts 
% General Contractor 
% Subcontractors (specialty contractors) 
% Design Build 
% Professional Construction Mgmnt (CM) Contract 
% Others 


*110 respondents 


48 


mean 


3.5 


83.6% 
12.9% 
3.5% 


86.2% 


41.5% 
44.3% 
10.4% 

3.8% 


62.5% 
20.8% 
9.0% 
8.4% 
0.1% 


median 


2.9 


maximum 


20.0 


minimum 


0.0 





SS Sw = 


1 
7e) 





-—-— os © ee eee ——— 





Table 15 


Variable Impacted by Size (# of Set-Up Beds) of Facility 


Number of Set-Up Beds 
Number of Hospitals 


Information about Facility 
Avg. Number of Set-up Beds 
Avg. Percent of Skilled Nursing Beds 
Avg. Number of Skilled Nursing Beds 
Avg. Number of Intermediate Care Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure (Years) 
Privately Owned 
Government Owned 
Federal 
state 
County 
City 
Hospital District 
Construction Plans for Long Term Care Facility 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General Nature of Construction 
% Add Rooms for Residents 
% Add Administration Space 
% Add Supprt Space(dining, lounge, activities room) 
% Updating to meet Building(fire) Code 
% Others 
Construction(excl. maint./repair) by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Budgets for the Next Five Years (1997-2001) 
Remain Roughly the Same 
Increase Slightly 
Increase Significantly 
Decrease Slightly 
Decrease Significantly 
Percentage of Construction that is Government Funded 
$ in thousands 
*“Category range includes the lower-end integer. 
49 


200-** 


26 


140.9 
81.7% 
Vez 

24.7 
94.0% 
17 fa 

21.3 
76.9% 
23.1% 

0.0% 

0.0% 
33.3% 
16.7% 
33.3% 


$520 
10.6% 
50.6% 
38.8% 


8.2% 
1.1% 
14.9% 
8.1% 
S fede 
$35 


(16.3%) 


$167 
24.4% 
46.7% 
27.3% 


$1,269 


16.9% 
28.9% 
94.2% 


34.6% 
19.2% 
19.2% 
15.4% 

116 
1oavie 


200-300** 


29 


248.0 
10.7% 
17220 
118.9 
93.9% 
226.4 
26.8 
82.8% 
1?:2% 
0.0% 
40.0% 
20.0% 
40.0% 
0.0% 


$2,128 


10.5% 
42.8% 
46.7% 


8.5% 
6.5% 
10.9% 
11.2% 
92.6% 
$56 


(28.5%) 


$190 
11.5% 
47.6% 
40.6% 

$321 
18.8% 
37.3% 
43.4% 


37.9% 
24.1% 
20.7% 
3.4% 
3.4% 
38.0% 


300-400** 


23 


346.7 
62.8% 
218.9 
29 
94.4% 
205.9 
24.5 
78.3% 
21.7% 
20.0% 
20.0% 
80.0% 
0.0% 
0.0% 


$1 fa2 


26.0% 
31.3% 
42.7% 


18.1% 
8.5% 
19.6% 
12.78% 
41.9% 
$203 


(21.2%) 


$854 
22.13% 
45.0% 
28.5% 


$2,635 


33.4% 
36.9% 
28.6% 


17.4% 
17.4% 
39.1% 

4.3% 
13.0% 
18.9% 


400+** 


30 


547.5 
48.0% 
261.9 
Mie2 
96.6% 
19126 
30.4 
83.3% 
16.7% 
0.0% 
0.0% 


100.0% 


0.0% 
0.0% 


$1,869 


29.9% 
29.3% 
41.1% 


15.2% 
1.6% 
29.9% 
Ze 76 
36.6% 
$109 


(10.4%) 
$1,330 


2tnt% 
35.4% 
36.9% 


$3,254 


41.6% 
23.6% 
34.8% 


16.7% 
2000 
20.0% 

6.7% 
26.7% 
ot /0 





PoP Gas? FIT 
DAPI TS OO Der tbrie' 


Toyah eT) Vib Vault Uh: 





Table 15 (Continued) 
Variable Impacted by Size (# of Set-Up Beds) of Facility 


Number of Set-Up Beds 200-** 200-300** 300-400** 
Information on Maintenance 
Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 8.4 Oro 5.9 
Interior Walls 6.3 4.5 51 
Security 8.4 oor lo 
Flooring Ger 3.8 4.2 
Electrical oor 4.8 4.9 
Roof 3.9 293 S22 
Structure 8.8 8.0 6.7 
Windows 5.6 5.8 4.9 
Handicap Accessibility 6.6 9.2 8.3 
Mechanical (HVAC) 2.8 2:6 3.0 
Plumbing 3% 3.5 Sf 
Lighting 4.4 Ori 4.9 
Conveyance (elevator) ov 5 5.4 
Others *1.0 *4.0 “250 
Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 
Federal, State, Local Laws 3:5 4.1 4.7 
Materials (accelerated deterioration) 3:9 3.8 4.2 
Construction (poor workmanship) 4.1 6 3.6 
Normal Wear and Tear 2.0 26 Zt 
Aging of Facility 225 2.1 Thai, 
Poor Design San 2.9 3.1 
Technology Replacement oo 4.2 3.4 
Others *0:G *4.7 “10 
information on Construction Contracts 
# of Construction Contracts to be awarded in 1997 320 2.4 3:5 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 82.4% 92.6% 85.8% 
% Cost Plus 12.9% 7.4% 4.7% 
% Others 57 5% 52.6% 41.9% 
% of Contracts that are competitively bid 96.4% 88.5% 10.9% 
Invitation for Bidding 
Open to All Contractors 46.2% 44.8% 39.1% 
Restricted to Selected Firms on Bidders List 38.5% 41.4% 39.1% 
Negotiation 7.7% 3.4% 21.7% 
Others 3.8% 3.4% 0.0% 
Distribution of Contracts 
% General Contractor 64.4% 64.3% Ti2o70 
% Subcontractors (specialty contractors) 26.0% 16.4% 13.8% 
% Design Build 0.2% 17.5% 1.7% 
% Professional Construction Mgmnt (CM) 11.9% 1.4% feo 70 
% Others 0.0% 0.3% 0.0% 


“not an accurate representation due to either very limited number of or no respondent 
“*Category range includes the lower-end integer. 
50 


400+** 


*8.0 


4.6 


14.2% 
24.4% 
36.6% 
88.0% 


30.0% 
53.3% 
10.0% 

6.7% 


48.2% 
25.3% 
14.1% 
12.8% 

0.1% 





! 
‘ \! ‘ ‘ s% 
f 
. 
= tt = : .. - 
v ‘ senpeees =~ «@ 


Table 16 


Variable Impacted by Percent Skilled Nursing Beds 





% Skilled Nursing Beds 
Number of Hospitals 


Information about Facility 
Avg. Number of Set-up Beds 
Avg. Percent of Skilled Nursing Beds 
Avg. Number of Skilled Nursing Beds 
Avg. Number of Intermediate Care Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure (Years) 
Privately Owned 
Government Owned 
Federal 
state 
County 
City 
Hospital District 
Construction Plans for Long Term Care Facility 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General Nature of Construction 
Add Rooms for Residents 
Add Administration Space 
Add Suprt Space(dining, lounge, activity rm) 
Updating to meet Building(fire) Code 
Others 
Construction by In-House Personnel ($) 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


25-** 


23 


391.4 
16.8% 
67.3 
Sor 
94.5% 
15746 
21.8 
91.3% 
8.7% 
50.0% 
50.0% 
0.0% 
0.0% 
50.0% 


$3,676 
33.2% 
25.0016 
41.7% 


18.4% 
6.9% 
11.7% 
15.8% 
42.7% 
$155 
(15.0%) 
$423 
14.7% 
41.0% 
44.3% 
$1,412 
43.0% 
25.3% 
31.1% 


Construction Budgets for the Next Five Years (1997-2001) 


Remain Roughly the Same 
Increase Slightly 
Increase Significantly 
Decrease Slightly 
Decrease Significantly 
% of Construction that is Government Funded 
$ in thousands 
*“Category range includes the lower-end integer. 


30.4% 
17.4% 
26.1% 
4.3% 
8.7% 
9.8% 


51 


25-50** 


17 


405.4 
38.9% 
1221 
90.5 
94.9% 
193.6 
27.4 
100.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 


$1,877 
21.9% 
34.1% 
38.0% 


20.5% 
9.5% 
22.3% 
16.9% 
30.8% 
$149 
(19.1%) 
$712 
30.6% 
40.5% 
22.8% 
$2,477 
42.0% 
17.1% 
39.5% 


11.8% 
29.4% 
29.4% 

5.9% 
24.570 
22.9% 


50-75** 


14 


364.8 
58.4% 
214.7 
95.0 
95.9% 
198 
28.6 
92.9% 
Tale 
0.0% 
0.0% 
100.0% 
0.0% 
0.0% 


$833 
26.3% 
32.8% 
40.9% 


12.3% 
2.5% 
46.2% 
12.7% 
26.4% 
$32 
(13.9%) 
$608 
35.3% 
46.5% 
18.3% 
$3,260 
49.4% 
31.2% 
19.4% 


14.3% 
14.3% 
50.0% 

0.0% 
14.3% 
29.8% 


/5-100** 


9 


2245 
86.4% 
192.1 
20.3 
89.3% 
260.6 
30.4 
77.8% 
22.2% 
0.0% 
50.0% 
0.0% 
0.0% 
50.0% 


$553 

0.0% 
43.3% 
56.7% 


0.0% 
16.7% 
5.0% 
0.0% 
65.8% 
$19 
(16.7%) 
$180 
28.6% 
42.1% 
29.3% 
$493 
6.3% 
42.5% 
51.3% 


44.4% 
22.2% 

0.0% 
22.2790 
ideo 
21.9% 


100** 


42 


Zion 
100.0% 
21383 
0.0 
95.8% 
219.8 
26.4 
64.3% 
35.7% 
0.0% 
0.0% 
73.3% 
20.0% 
0.0% 


$1,042 
13.0% 
43.2% 
43.8% 


8.3% 
3.3% 
12.6% 
6.9% 
62.6% 
$90 
(22.4%) 
$904 
14.3% 
42.1% 
43.0% 
$1,934 
13.1% 
37.1% 
49.8% 


31.0% 
21.4% 
19.0% 

99970 
11.9% 
32.8% 








; ,% ry ‘ li 

‘2 | . i ie | 

' | . | 

] | 

; 4 sees ; | 
whe ryeuirs at ai 4 


ytd bevetes nil wis i; 
"ivi Put? 5 See veri i) | 


Lomi halt Oi) ei: 
a EE feriiinn 





ad 





Table 16 (Continued) 
Variable Impacted by Percent Skilled Nursing Beds 
% Skilled Nursing Beds 25-** 25-50** 





50-75** 


75-100** 


100** 


Information on Maintenance 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 7.0 5.7 9.3 
Interior Walls 5.2 2.3 7.2 
Security ot Of 5.6 
Flooring 4.4 3.5 6.4 
Electrical 5.4 5.3 5.0 
Roof 2.4 3.4 3.1 
Structure 10.9 3.8 8.8 
Windows 6.9 10.0 3.8 
Handicap Accessibility 8.5 79 10.3 
Mechanical (HVAC) 2.0 2.4 2.3 
Plumbing 3.1 3.6 3.9 
Lighting 6.5 5.3 S33 
Conveyance (elevator) 6.5 6.2 6.3 
Others "0 e253 518 
Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 
Federal, State, Local Laws 4.0 39 4.8 
Materials (accelerated deterioration) 8.5 4.9 33 
Construction (poor workmanship) 3.2 4.7 3.7 
Normal Wear and Tear PS 2.1 1.8 
Aging of Facility 1.9 1.6 1.9 
Poor Design 3.6 3 3.8 
Technology Replacement 4.4 4.2 oar 
Others *0.0 eO.7 *0.0 
Information on Construction Contracts 
# Construction Contracts to be awarded in 1997 3.9 3.1 4.9 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 16.9% 91.8% 16.7% 
% Cost Plus 21.9% 3.2% 21.3% 
% Others 42.7% 30.8% 26.4% 
% of Contracts that are competitively bid 81.6% 69.0% 18.3% 
Invitation for Bidding 
Open to All Contractors 21.7% 17.6% 35.7% 
Restricted to Selected Firms on Bidders List 56.5% 58.8% 50.0% 
Negotiation 4.3% 17.6% 14.3% 
Others 0.0% 0.0% 14.3% 
Distribution of Contracts 
% General Contractor 62.3% 47.2% 43.6% 
% Subcontractors (specialty contractors) 23.1% 16.1% 31.0% 
% Design Build 14.0% 3.3% 21.8% 
% Professional Construction Mgmnt (CM) 0.8% 30.3% 3.290 
% Others 0.0% 0.0% 0.2% 


*not an accurate representation due to either very limited number of or no respondent 
**Category range includes the lower-end integer. 
$ in thousands 

52 


"0:0 


1.4 


97.1% 

2.9% 
65.8% 
98.9% 


22.2% 
44.4% 
22.2% 
11.1% 


86.4% 
12.1% 
1.4% 
0.0% 
0.0% 


3.2 


84.3% 
12.9% 
62.6% 
93.3% 


61.9% 
31.0% 
4.8% 
0.0% 


69.1% 
17.7% 
6.2% 
8.7% 
0.0% 


— ee be 


—————— 


& 
ty 


— 





Table 17 
Variable Impacted by Age of Structure 





Age of Primary Structure 0-5** 

Number of Hospitals 8 
Information about Facility 

Avg. Number of Set-up Beds 163.7 
Avg. Number of Skilled Nursing Beds 103.1 
Avg. Number of Intermediate Care Beds 60.6 
Avg. Occupancy Rate 95.0% 
Avg. Number of Admission per Year 227.0 


Avg. Age of the Primary Structure (Years) 3.3 


Privately Owned 100.0% 
Government Owned 0.0% 
Federal 0.0% 
State 0.0% 
County 0.0% 
City 0.0% 
Hospital District 0.0% 
Construction Plans for Long Term Care Facility 
Construction Expenditures in 1995 $2,679 
New Construction 28.6% 
Maintenance & Repair 28.6% 
Renovation/Remodeling 42.9% 
General Nature of Construction 
Add Rooms for Residents 0.0% 
Add Administration Space 0.0% 
Add Suprt Space(dining, lounge, activity rm) 0.0% 
Updating to meet Building(fire) Code 25.0% 
Others 75.0% 
Construction by In-House Personnel ($) $81 
(1.0%) 
Construction Expenditures projected for 1996 $233 
New Construction 20.0% 
Maintenance & Repair 25.0% 
Renovation/Remodeling 41.7% 
Construction Expenditures projected for 1997 $212 
New Construction 34.0% 
Maintenance & Repair 35.0% 
Renovation/Remodeling 27.0% 


Construction Budgets for the Next Five Years (1997-2001) 


Remain Roughly the Same 37.5% 
Increase Slightly 0.0% 
Increase Significantly 25.0% 
Decrease Slightly 25.0% 
Decrease Significantly 0.0% 
% of Construction that is Government Funded 2.9% 


> in thousands 
Category range includes the lower-end integer. 
53 


5-15** 


18 


176.9 
144.4 
32.5 
93.0% 
210.5 
2 
77.8% 
22.2% 
0.0% 
0.0% 
50.0% 
50.0% 
0.0% 


$2,951 


20,080 
25.9% 
48.6% 


24.8% 
11.5% 
26.2% 
3.0% 
21a 
$42 


(24.0%) 


$436 
40.4% 
30.8% 
25.5% 


2,368 


42.9% 
20.2% 
36.2% 


16.7% 
22.2% 
3o.oue 

5.6% 
11.1% 
19.3% 


15-25** 


34 


292.0 
1896 
92.4 
95.4% 
172.4 
22.0 
79.4% 
20.6% 
0.0% 
14.3% 
71.4% 
0.0% 
0.0% 


$1,940 


25.3% 
39.8% 
34.9% 


Noe 6 

2.2% 
17.7% 
15.0% 
42.8% 
$146 


(26.6%) 


$589 
15.3% 
54.9% 
29,9 


93,054 


36.4% 
34.7% 
28.9% 


23.5% 
20.6% 
32.4% 

2.9% 
14.7% 
38.2% 


25-35** 


28 


Zo0 3 
201.1 
92.2 
94.6% 
247.0 
30.1 
85.7% 
14.3% 
25.0% 
25.0% 
25.0% 
25.0% 
0.0% 


$556 
12.7% 
90.2% 
37.1% 


3.5% 
12.9% 
20.6% 

4.1% 
94.4% 

$115 


(16.9%) 
$1,082 


23.8% 
41.8% 
34.1% 


$1,476 


18.0% 
34.3% 
47.8% 


42.9% 
14.3% 
10.7% 

7.1% 
21.4% 
17.0% 


35-45** 


8 


390.5 
286.5 
104.0 
95.3% 
164.2 
38.6 
62.5% 
37.5% 
0.0% 
0.0% 


100.0% 


0.0% 
0.0% 


$891 
11.8% 
18.9% 
70.6% 


1.7% 
0.0% 
11.7% 
25.0% 
61.7% 
$18 
(6.0%) 
$666 
5.0% 
38.8% 
56.3% 
$825 
14.3% 
23.6% 
62.1% 


25.0% 
Sine 
12.5% 
12.5% 
12.5% 
34.4% 


45+** 


2 


334.4 
268.9 
635.9 
94.9% 
179.8 
Of 
77.8% 
22.2% 
0.0% 
50.0% 
50.0% 
0.0% 
0.0% 


$2,283 


21.0% 
31.0% 
48.0% 


25.0% 
0.9% 
26.2% 
12.1% 
28.7% 
$81 


(11.5%) 


$504 
11.3% 
47.7% 
41.1% 


$1,540 


19.1% 
34.0% 
46.9% 


11.1% 
44.4% 
22.2% 
11.1% 

0.0% 
41.4% 





é itce 6S ‘4 pea i‘ ' 
igy mihi: sia Gouda: | 
ib Via be Neoeery: | 
oe ee vi? heriedr, rn 


| et 7 





Table 17 (Continued) 


Variable Impacted by Age of Structure 





Age of Primary Structure 
Information on Maintenance 


0-5** 


5-15** 


15-25** 


25-35** 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 

Interior Walls 

Security 

Flooring 

Electrical 

Roof 

Structure 

Windows 

Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 

Lighting 

Conveyance (elevator) 
Others 


Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 


Federal, State, Local Laws 
Materials (accelerated deterioration) 
Construction (poor workmanship) 
Normal Wear and Tear 
Aging of Facility 
Poor Design 
Technology Replacement 
Others 
Information on Construction Contracts 
# Construction Contract to be awarded in 1997 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
% Cost Plus 
% Others 
“ of Contracts that are competitively bid 
Invitation for Bidding 
Open to All Contractors 
Restricted to selected firms on Bidders List 
Negotiation 
Others 
Distribution of Contracts 
% General Contractor 
% Subcontractors (specialty contractors) 
% Design Build 
% Professional Construction Mgmnt (CM) 
% Others 


*0.0 3.6 8.4 9.0 
220 3.4 {22 6.8 
4.0 4.3 8.4 10.4 
2m 3.4 4.0 4.3 
3.0 4.3 47 4.5 
1.7 2.1 4.1 2.9 
*0.0 6.5 og 8.9 
*0.0 4.0 48 4.3 
*0.0 to 7.0 72 
a3 Zo 2.4 2.6 
3.0 2.6 3.0 3.3 
3.0 3,0 6.3 4.1 
2.0 403 6.4 6.3 
73.0 *2.0 lee EZ. 
4.0 4.0 4.0 3.5 
ee. Shit 3.9 4.1 
13 2.0 4.8 ao 
2.6 die 2.4 2.6 
6.5 2s 1.9 1.8 
25 63 4.1 3.1 
4.3 3.3 4.1 3.8 
"4.5 “0.0 3.0 “0.0 
13 3.8 4.0 Z.6 
83.3% 86.8% 85.2% 79.8% 
16.7% 13.2% 7.00% 15.8% 
15.0% 27.7% 42.8% 54.4% 
82.5 7omeee’7.1% geo8% 86i0% 
12.5% 38.9% 50:0% 355% 
62.5% 33.38% 441% 42.9% 
0.0% 22.2% 5.9% 14.3% 
0.0% 0.0% 5:9% 3.6% 
0.0% 0.0% 0.0% 0.0% 
83.3% 72.5% Sm05% ‘280% 
8.3% 14.5% 249% 23.2% 
0.0% 12.5% 12.3% D0 
8.3% 0.5% 13.7% 8.4% 
0.0% 0.0% 0.3% 0.0% 


“not an accurate representation due to either very limited number of or no respondent 


““Category range includes the lower-end integer. 
> in thousands 


54 


35-45** 


10.0 
6.0 
10.0 
4.6 
4.0 
4.4 
7.8 
1.5 
9.4 
4.0 
4.6 
9.8 
8.0 
"ZO 


4.2 
4.0 
9.9 
2.8 
107 
3.8 
aan 
“0.0 


ae 


85.7% 
14.3% 
61.7% 
17:9% 


50.0% 
25.0% 
12.5% 
0.0% 
0.0% 
TAS 
13.0% 
8.3% 
1.3°% 
0.0% 


45+** 


8.4 
ez 
7.0 
4.3 
6.1 
3.4 
ti 
6.2 
9.2 
37 
5.3 
ee 
6.8 
*0.0 


4.9 
48 
3.8 
2.0 
eo 
46 
3.7 
“O20 


1.1 
75.0% 


25.0% 
28.7% 


100.0% 


338% 
55.6% 
0.0% 
1194 
0.0% 
59.9% 
28.6% 
11.2% 
0.1% 
0.3% 








Table 18 


Variable Impacted by Occupancy Rate 





% Occupancy Rate 
Number of Hospitals 


Information about Facility 
Avg. Number of Skilled Nursing Beds 
Avg. Number of Intermediate Care Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure (Years) 
Privately Owned 
Government Owned 

Federal 

State 

County 

City 

Hospital District 


Construction Plans for Long Term Care Facility 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General Nature of Construction 
Add Rooms for Residents 
Add Administration Space 
Add Suprt Space(dining, lounge, activity room) 
Updating to meet Building(fire) Code 
Others 
Construction by In-House Personnel ($) 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


93-** 


26 


1675 

37.3 
86.8% 
2713 
26.9 
84.6% 
15.4% 
0.0% 
25.0% 
50.0% 
25.0% 
0.0% 


$755 

7.8% 
44.3% 
47.9% 


6.9% 
2.7% 
8.2% 
1527 70 
61.7% 
$67 


(20.3%) 


$509 
11.6% 
51.9% 
36.0% 

$659 
20.0% 
39.1% 
40.9% 


Construction Budgets for the Next Five Years (1997-2001) 


Remain Roughly the Same 
Increase Slightly 
Increase Significantly 
Decrease Slightly 
Decrease Significantly 
% of Construction that is Government Funded 
$ in thousands 
**Category range includes the lower-end integer. 


42.3% 
26.9% 
T.T% 
11.5% 
1.1% 
15.7% 


95 


93-95** 


7 


219.3 
2229 
93.5% 

226 
24.4 
85.7% 
14.3% 

0.0% 
0.0% 


100.0% 


0.0% 
0.0% 


$834 
24.2% 
35707 
40.0% 


6.0% 
4.0% 
14.0% 
24.0% 
52.0% 
$34 
(5.6%) 
$639 
31.1% 
23.1% 
45.7% 


$1,600 


27.8% 
40.2% 
32.0% 


28.6% 
14.3% 
28.6% 

0.0% 
28.6% 
33.0% 


95-97** 


a 


180.1 
80.0 
95.6% 

2S 
ote 
82.4% 
17.6% 
0.0% 
0.0% 


100.0% 


0.0% 
0.0% 


$1,358 


SOPryc 
23.5% 
38.1% 


21.1% 
10.0% 
5.8% 
7.7% 
48.9% 
$72 


(26.8%) 


$490 
40.4% 
30.5% 
29.1% 


$1,534 


48.2% 
34.7% 
16.3% 


17.6% 
23.5% 
41.2% 

5.9% 
11.8% 
13.3% 


97-99** 


31 


222.0 
64.8 
97.8% 

181 
28.0 
14.2% 
25.8% 

0.0% 
12.5% 
37.5% 
25.0% 
0.0% 


$1,805 


20.4% 
36.4% 
43.2% 


1.8% 

4.8% 
30.6% 
10.2% 
41.4% 

$115 


(13.6%) 


$533 
15.8% 
47.7% 
33.5% 


$1,280 


23.6% 
28.7% 
46.9% 


22.6% 
25.8% 
16.1% 

9.7% 
16.1% 
26.4% 


99+** 


23 


194.4 

109.7 
99.5% 
Ts 

22.0 
82.6% 
17.4% 
25.0% 
25.0% 
75.0% 
0.0% 
0.0% 


$2,963 


15.3% 
41.1% 
43.7% 


18.8% 
10.0% 
23.8% 
11.5% 
28.8% 
$174 


(22.9%) 
$1,166 


21.7% 
43.5% 
34.2% 


$5,040 


35.3% 
19.9% 
44.7% 


17.4% 
17.4% 
34.8% 

4.3% 
13.0% 
47.5% 





Table 18 (Continued) 
Variable Impacted by Occupancy Rate 





% Occupancy Rate 93-** 93-95** 95-97** 
Information on Maintenance 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 6.2 8.3 7.6 
Interior Walls 360 7.0 i3 
Security ona 10.0 10.7 
Flooring oat 6.0 4.2 
Electrical 4.8 aee 4.7 
Roof 3.4 3.3 3:5 
Structure 6.3 9.3 8.4 
Windows eZ i3 6.4 
Handicap Accessibility 7.0 6.3 8.8 
Mechanical (HVAC) oa 3.4 2.3 
Plumbing 3:5 4.2 325 
Lighting 4.8 7.0 5.4 
Conveyance (elevator) 6.3 73 D2 
Others Poo EO Te 
Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 
Federal, State, Local Laws 4.4 3.8 4.8 
Materials (accelerated deterioration) 4.0 4.2 4.1 
Construction (poor workmanship) 3.5 5:3 St6 
Normal Wear and Tear 2:5 ZnS 25 
Aging of Facility 1.3 2.1 2.4 
Poor Design 2.6 4.8 or 
Technology Replacement 3.0 3.8 4.6 
Others *2.0 *0.0 *Sad 
information on Construction Contracts 
# Construction Contracts to be awarded in 1997 S.3 4.3 373 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 79.0% 65.8% 89.6% 
% Cost Plus 16.0% 26.7% 10.4% 
% Others 61.7% 52.0% 48.9% 
% of Contracts that are competitively bid 96.2% 82.9% 84.4% 
Invitation for Bidding 
Open to All Contractors 34.6% 28.6% 41.2% 
Restricted to Selected Firms on Bidders List 50.0% 42.9% 35.3% 
Negotiation 11.5% 14.3% 11.8% 
Others 3.8% 14.3% 5.9% 
Distribution of Contracts 
% General Contractor 67.8% 73.0% 65.2% 
% Subcontractors (specialty contractors) S224 17.0% 135fo6 
% Design Build 0.0% 12.0% 2.8% 
% Professional Construction Mgmnt (CM) 0.0% 0.0% 18.3% 
% Others 0.0% 0.0% 0.0% 


*not an accurate representation due to either very limited number of or no respondent 
“Category range includes the lower-end integer. 
56 


97-39* 


8.9 
6.5 
7.5 
4.1 
4.3 
3.4 
73 
4.1 
a0 
Zee. 
3.0 
4.8 
6.0 
ee 


3.9 
Zag 
4.1 
eee 
2.4 
4.1 
3.6 
"470 


Zao 


83.8% 
12.2% 
41.4% 
92.8% 


41.9% 
41.9% 
6.5% 
3.2% 


59.8% 
28.4% 
10.8% 
2.8% 
0.4% 


99+** 


1.3 
1.6 
oe 
4.4 
5.4 
Zao 
10.2 
4./ 
6.0 
Zal 
3.1 
ono 
7.6 
*0.0 


2.4 


85.7% 
11.0% 
28.8% 
75.0% 


47.8% 
43.5% 
8.7% 
0.0% 


58.8% 
8.3% 
16.1% 
16.8% 
0.0% 


a 6 0 


ve” «4 








7 eae 7) (fC 





ai Satis tat 


Table 19 


Difference between Public and Private Facilities 





descriptor 
Number of Hospitals 


Information about Facility 
Avg. Number of Skilled Nursing Beds 
Avg. Number of Intermediate Care Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure (Years) 
Privately Owned 
Government Owned 

Federal 

State 

County 

City 

Hospital District 


Construction Plans for Long Term Care Facility 
Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
General Nature of Construction 
Add Rooms for Residents 
Add Administration Space 
Add Suprt Space(dining, lounge, activity rm) 
Updating to meet Building(fire) Code 
Others 
Construction(excl. maint./repair) by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 
Construction Budgets for the Next Five Years (1997-2001) 
Remain Roughly the Same 
Increase Slightly 
Increase Significantly 
Decrease Slightly 
Decrease Significantly 
% of Construction that is Government Funded 
$ in thousands 


o/ 


Public 


21 


285.1 

131.2 
95.1% 
149 

252 
0.0% 
100.0% 
4.8% 
14.3% 
57.1% 
14.3% 
9952% 


$512 
13.1% 
26.9% 
60.1% 


7.3% 
1.5% 
14.3% 
6.9% 
64.2% 
$88 
(18.4%) 
$1,076 
19.7% 
37.5% 
42.9% 
$1,328 
13.1% 
41.8% 
45.1% 


28.6% 
14.3% 
19.0% 

9.5% 
19.0% 
68.9% 


Private 


87 


173.3 
61.4 
94.7% 

213 
25-0 
100.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 


$1,910 
21.4% 
39.9% 
38.9% 


13.9% 
7.3% 
19.9% 
12.5% 
41.4% 
$98 
(18.4%) 
$556 
22.0% 
44.1% 
32.3% 
$2,091 
32.5% 
28.7% 
38.4% 


26.4% 
24.1% 
25.3%6 

6.9% 
11.5% 
14.2% 


— or | a 


= 
-_ 
| ’ 
~ é 





Table 19 (Continued) 


Difference between Public and Private Facilities 





descriptor 
information on Maintenance 


Public 


Private 


Source of Major maintenance and/or Repair Costs, "1” being the worst problem area 


Exterior Walls 

Interior Walls 

Security 

Flooring 

Electrical 

Roof 

Structure 

Windows 

Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 

Lighting 

Conveyance (elevator) 
Others 


Cause of Significant maintenance and Repair Costs, "1" being the worst problem area 


Federal, State, Local Laws 

Materials (accelerated deterioration) 

Construction (poor workmanship) 

Normal Wear and Tear 

Aging of Facility 

Poor Design 

Technology Replacement 

Others 
Information on Construction Contracts 
Number of Construction Contracts to be awarded in 1997 
Type of Construction Contracts Awarded 

% Lump Sum (fixed price) 

% Cost Plus 

% Others 
% of Contracts that are competitively bid 
Invitation for Bidding 


Open to All Contractors 
Restricted to Selected Firms on Bidders List 
Negotiation 
Others 
Distribution of Contracts 
% General Contractor 
% Subcontractors (specialty contractors) 
% Design Build 
% Professional Construction Mgmnt (CM) 
% Others 


10.6 hack 
6.1 6.1 
TAS 7.4 
4.8 og 
9.6 4.4 
2.9 3.9 
8.7 8:3 
2.9 6.5 
6.1 8.2 
2.8 2.6 
3.8 3.3 
4.1 9.9 
7.4 6.1 
*0.0 [eo 
46 3.9 
3.8 one 
4.1 3.9 
ZS Ze 
1.9 ZU 
3.0 3.7 
3.4 4.0 
*0.0 "4.6 
3.6 3.3 
97.2% 79.9% 
2.8% 15.7% 
64.2% 41.4% 
95.0% 83.7% 
90.5% 27.6% 
9.5% 91.7% 
0.0% 12.6% 
0.0% 4.6% 
76.3% 98.2% 
7.1% 24.7% 
14.6% 1.0% 
1.5% 10.4% 
0.4% 0.0% 


“not an accurate representation due to either very limited number of or no respondent 


$ in thousands 
58 









i 
1. | i} 
| | 
" i : t | piel 
1 11a | imei eit 


Table 20 


Facility Characteristics by Region 





Region Number 
Number of Hospitals 


Information about Facility 
Avg. Number of Skilled Nursing Beds 
Avg. Number of Intermediate Care Beds 
Avg. Occupancy Rate 
Avg. Number of Admission per Year 
Avg. Age of the Primary Structure (Years) 
Privately Owned 
Government Owned 

Federal 

State 

County 

City 

Hospital District 


1 
10 


150.9 
14.3 
89.9% 

262 
30.1 
90.0% 
10.0% 
0.0% 
100.0% 
0.0% 
0.0% 
0.0% 


Construction Plans for Long Term Care Facility 


Construction Expenditures in 1995 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

General Nature of Construction 
Add Rooms for Residents 
Add Administration Space 
Add Support Space 
Updating to meet Building(fire) Code 
Others 

Construction by In-House Personnel 


Construction Expenditures projected for 1996 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 

Construction Expenditures projected for 1997 
New Construction 
Maintenance & Repair 
Renovation/Remodeling 


Construction Budgets for the Next Five Years (1997-2001) 


Remain Roughly the Same 
Increase Slightly 
Increase Significantly 
Decrease Slightly 
Decrease Significantly 
% of Construction that is Government Funded 


$1,449 
24.4% 
30.0% 
45.6% 


9.3% 
11.4% 
14.3% 
23.6% 
41.4% 

$91 

(15.8%) 

$358 
18.9% 
47.8% 
33.3% 

$320 
36.3% 
39.4% 
24.4% 


40.0% 
10.0% 
10.0% 
20.0% 
20.0% 
21500 


10 


205:3 
73.0 
94.4% 

176 
Jono 
40.0% 
60.0% 
0.0% 
0.0% 
50.0% 
0.0% 
0.0% 


$627 

0.0% 
23.9% 
76.1% 


0.6% 
0.3% 
29.1% 
5.0% 
55.6% 
$11 
(4.6%) 
$582 
28.3% 
10.3% 
61.4% 
$954 
18.8% 
32.8% 
48.5% 


30.0% 
10.0% 
40.0% 

0.0% 
20.0% 
35.0% 


115.0 
0.0 
80.0% 


n/a 


12.0 
100.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 


$2,400 
95.0% 
5.0% 
0.0% 


49.2% 
5.0% 
3 ivero 
16.7% 
0.0% 
$0 


(35.0%) 


$3,000 
95.0% 
5.0% 
0.0% 

$2,500 
95.0% 
5.0% 
0.0% 


0.0% 
0.0% 
100.0% 
0.0% 
0.0% 
0.0% 


102.7 

123% 
95.6% 
208 

19.9 
15.0% 
25.0% 
0.0% 
100.0% 
0.0% 
0.0% 
0.0% 


$1,136 


42.8% 
18.8% 
38.5% 


27.5% 
0.0% 
20.3% 
25.0% 
27.3% 
$35 
(4.7%) 
$1,262 
46.3% 
19.3% 
34.5% 
$1,067 
58.3% 
23.3% 
18.3% 


0.0% 
50.0% 
25.0% 

0.0% 
25.0% 
25.0% 


14.0 
144.0 
97.0% 

48 

200 

100.0% 

0.0% 

0.0% 

0.0% 

0.0% 

0.0% 

0.0% 


$8,800 
85.0% 
5.0% 
10.0% 


40.0% 
0.0% 
0.0% 

60.0% 
0.0% 

$0 

(0.0%) 

$1,300 
0.0% 

33.0% 

67.0% 

$2,500 

40.0% 

20.0% 

40.0% 


100.0% 
0.0% 
0.0% 
0.0% 
0.0% 
0.0% 


176.7 
68.2 
95:5% 

Wea? 
39.5 
17.8% 
22.2% 
0.0% 
0.0% 
100.0% 
0.0% 
0.0% 


$266 
12.3% 
57.8% 
315% 


1932770 
4.8% 
8.0% 

10.0% 

58.0% 

$16 


(18.7%) 


$481 
34.0% 
3m 7/0 
30.7% 

$1,394 
21.7% 
24.7% 
53.6% 


22.2% 
22.2% 
55.6% 
0.0% 
0.0% 
36.0% 


2/ 


240.1 
Vane 
97.4% 

163 
27.0 
81.5% 
11.1% 

0.0% 
0.0% 
66.7% 
33.3% 
0.0% 


$1,389 


18.7% 
44.1% 
37.2% 


5.8% 
2.4% 
22.1% 
10.6% 
50.4% 
$87 


(26.3%) 


$347 
16.5% 
47.0% 
32.6% 


$4,285 


40.9% 
22.0% 
36.2% 


16.8% 
33.3% 
3370 
8.3% 
8.3% 
32.1% 





$ in thousands 


99 





Table 20 (Continued) 


Facility Characteristics by Region 





Region Number 
Information on Maintenance 


1 


Source of Major maintenance and/or Repair Costs, "1" being the worst problem area 


Exterior Walls 

Interior Walls 

Security 

Flooring 

Electrical 

Roof 

Structure 

Windows 

Handicap Accessibility 
Mechanical (HVAC) 
Plumbing 

Lighting 

Conveyance (elevator) 
Others 


10.3 
10.0 
7.3 
3.4 
4.2 
3.0 
ao 
6.0 
4.0 
3.3 
on 
4.5 
6.3 
1.0 


Cause of Significant maintenance and Repair Costs, "1" 


Federal, State, Local Laws 
Materials (accelerated deterioration) 
Construction (poor workmanship) 
Normal Wear and Tear 
Aging of Facility 
Poor Design 
Technology Replacement 
Others 
Information on Construction Contracts 
# Construc. Contracts to be awarded in 1997 
Type of Construction Contracts Awarded 
% Lump Sum (fixed price) 
% Cost Plus 
% Others 
% of Contracts that are competitively bid 
Invitation for Bidding 
Open to All Contractors 
Restricted to Selec. Firms on Bidders List 
Negotiation 
Others 
Distribution of Contracts 
% General Contractor 
% Subcontractors (specialty contractors) 
“% Design Build 
% Professional Construction Mgmnt (CM) 
% Others 


n/a: data not available 
$ in thousands 


3.4 
4.3 
4.4 
Za 
2.3 
3.0 
3.8 
n/a 


1.0 


68.8% 
Siro 7e 
41.4% 
93.3% 


30.0% 
50.0% 
10.0% 

0.0% 


98.3% 
5.0% 
20.0% 
16.7% 
0.0% 


60 


2 3 4 5 
11.0 4.0 a3 n/a 
5.3 3.0 6.0 n/a 
5.0 n/a n/a n/a 
4.6 210 4.8 3.0 
3:6 n/a 35 4.0 
516 1.0 4.7 5.0 
6.3 n/a LS n/a 
3:0 7.0 8.0 n/a 
8.7 n/a 6.3 n/a 
2.7 6.0 4.8 2.0 
4.0 n/a 5:3 1.0 
5.6 5.0 8.0 n/a 
6.0 8.0 9.0 6.0 
n/a 1.0 1.0 n/a 

being the worst problem area 

3.8 Deo 3.3 n/a 
2.8 3.0 3.0 n/a 
5.8 n/a 4.3 n/a 
2 1.5 oo 1.0 
2.9 n/a 2.0 2.0 
3.3 n/a 57 n/a 
31 2.0 ore 3.0 
n/a n/a n/a n/a 
5.4 10.5 6.3 1.0 
81.3% 72.5% 82.5% 100.0% 
18.8% 27.5% 150% 0.0% 
55.6% 0.0% 27.3% 0.0% 
86.1% 55.0% 62.5% 100.0% 
50.0% 500% 250% 0.0% 
40.0% 50.0% 25.0% 100.0% 
0.0% 50.0% 50.0% 0.0% 
10.0% 0.0% 00% 0.0% 
67.3% 0.0% 78.3% 100.0% 
14.2% 100.0% 11.3% 0.0% 
17.9% 0.0% 11.3% 0.0% 
0.2% 0.0% 03% 0.0% 
0.4% 0.0% 15% 0.0% 


10.0 
Gan 
10.6 
9.9 
6.2 
2.6 
9.5 
7.0 
10.3 
ZA 
4.3 
ies 
7 
4.0 


5.0 
4.8 
5.0 
2.1 
1.3 
3.9 
Av 
n/a 


oF 


96.7% 

0.6% 
58.0% 
92.2% 


44.4% 
44.4% 

0.0% 
11.1% 


94.4% 
33.4% 
5.4% 
6.9% 
0.0% 


7.0 
8.0 
an 
4.3 
4.5 
3.9 
ohde 
6.0 
9.1 
ans 
2.8 
9.8 
6.3 
3.0 


44 
4.2 
4.2 
2.0 
1.6 
4.4 
SAT) 
3.8 


4.2 


88.5% 

7.2% 
90.4% 
84.8% 


33.3% 
59.3% 
7.4% 
0.0% 


62.9% 
21.6% 
6.5% 
11.4% 
0.0% 


=> 





Appendix 


e Survey of Hospital Construction Needs 


e Survey of Long Term Care Facility Construction Needs 


61 





CONSTRUCTION NEEDS OF HOSPITAL FACILITIES 


I. INFORMATION ABOUT THE HOSPITAL 


II. 


= 


moan 





How many beds are in the hospital? Licensed beds: Set up beds: 
b. How many beds are in each of the following?: 
Intensive/critical care rooms: Private rooms: 
Semi-private rooms: Wards: 
What is the average occupancy rate? % of set up beds 
What is average number of admissions per year? 
What is the age of the primary hospital structure? years 
Is the hospital owned or operated wholly or in part by a government agency? 
yes no 
If yes, please specify: federal: % state: % 
county: % city: % 


CONSTRUCTION PLANS FOR THE HOSPITAL 


How much money was spent on construction at the hospital in 1995?$ 
Approximately how were those expenditures distributed? 
New construction: % Maintenance and repair: % 
Renovation/remodeling: % 
What is the general nature of the new construction or the renovation/remodeling? 
% add patient rooms 
% add administrative space 
% add support space (laboratory, pharmacy, radiology space, etc.) 
“% add operating rooms 


% add Alzheimer's ward 

“% add psychiatric ward 

% other (specify): 
How much of this work (excluding maintenance/repair) will be done by hospital 
employees? 
$ Or % 


How much is anticipated to be spent on construction in this year(1996)? $ 
How much will probably be spent next year (1997) ? $ 
Approximately how will these expenditures be distributed? 


1996 1997 
New construction: % % 
Maintenance & repair: % % 
Renovation/remodeling: % % 


62 


aio = = = 
Fz. 
—_———-> 
—— 
ia 
oo = ————» - = - 
aio a... 
a a 
> 
Se 
o 7 
ee aa a Qa 2a» 
———. 
—- 
oe 
> 
= => 
= eS 





g. Which of the following is most descriptive of your expected facilities construction 
budget for the next five years? (1997-2001) (check one) 
Remain roughly the same Decrease slightly 
Increase slightly Decrease significantly 
Increase significantly (major addition anticipated) 
h. What % of the construction funds are obtained from a state or local government 
agency (e.g., direct appropriations, tax supported bonds)? % 


Il. INFORMATION ON MAINTENANCE 
a. Of the following, please rank those which have been the source of major 


maintenance and/or repair costs to your hospital beginning with "1" as the worst 
problem area. 


external walls windows 

internal walls handicap accessibility 
security mechanical (HVAC) 
flooring plumbing 

electrical lighting 

roof conveyance 

structure other (specify) 


b. Based on the past problems, describe any changes that would be made if any 
particular system or component were to be replaced. 


c. Which of the following have been the cause of significant maintenance and repair 
costs to your hospital? Please, rank the following beginning with "1" as the worst 
problem area: 





federal, state, or local laws aging of facility 
material (accelerated deterioration) poor design 
construction (poor workmanship) technology replacement 
normal wear and tear other (specify) 


IV. INFORMATION ON CONSTRUCTION CONTRACTS 


a. Approximately how many separate construction contracts will be awarded next 
year (1997)? 
b. What type of construction contracts are generally awarded? 
% lump sum (fixed price) 
% cost plus 
% other (specify): 


63 





c. What percent of the construction contracts are competitively bid? % 
d. How are contractors invited to submit bids? (check one) 
bidding is open to all contractors 
bidding is restricted to selected firms on bidders list 
contract awards are made on the basis of negotiation 
other (specify): 
e. How are the costs of construction contracts distributed (in monetary terms)? 
% general contractor 
% subcontractors (specialty contractors) 
% design build 
% professional construction management (CM) contract 


% other (specify): 
V. OPTIONAL 


What is your top construction-related problem? 


What trends relating to construction, if any, do you see impacting hospital construction 
over the next 5-10 years’? 


VI. REQUEST FOR SUMMARY REPORT 
If you would like a copy of the summary report please provide the following 
information. Please note that your comments and survey responses will be treated as 
strictly confidential. 

Name: ‘Titles 

Institution: 


Street Address: 


City: State: Zip: 


64 


SURVEY OF LONG-TERM CARE FACILITY CONSTRUCTION NEEDS 


I. INFORMATION ABOUT THE LONG-TERM CARE FACILITY 


a. Please describe your facility: 
Number of skilled nursing beds: licensed: set up beds: 


Number of intermediate care beds: licensed: set up beds: 
Number of boarding house (assisted living) beds: licensed: set up beds: 


Number of independent living unit beds: licensed: set up beds: 
Number of other beds: (please specify: ) 

What is the average occupancy rate? % of set up beds 

What is average number of admissions per year? 

What is the age of the facility's primary structure? years 

Is the facility owned or operated wholly or in part by a government agency? 
yes no 
If yes, please specify: federal: % state: % 

county: You “Citye % hospital district: = % 


SS) Sa 





Il. CONSTRUCTION PLANS FOR THE LONG-TERM CARE FACILITY 


a. How much money was spent on construction at the facility in 1995?$ 
b. Approximately how were those expenditures distributed? 
New construction: % Maintenance and repair: % 
Renovation/remodeling: % 
c. What is the general nature of the new construction or the renovation/remodeling? 
% add rooms for residents 
% add administrative space 
% add support space (dining, lounge area, activity room, etc.) 
% updating to meet building (fire) codes 


% other (specify): 
d. How much of this work (excluding maintenance/repair) will be done by facility 
employees? 
$ or % 


e. How much is anticipated to be spent on construction in this year(1996)? $ 
How much will probably be spent next year (1997) ? $ 
f. Approximately how will these expenditures be distributed? 


1996 1998 
New construction: % % 
Maintenance and repair: % % 
Renovation/remodeling: % % 


65 


oO 





g. Which of the following is most descriptive of your expected facilities construction 
budget for the next five years? (1997-2001) (check one) 
Remain roughly the same Decrease slightly 
Increase slightly Decrease significantly 
Increase significantly (major addition anticipated) 
h. What % of the construction funds are obtained from a state or local government 
agency (e.g., direct appropriations, tax supported bonds)? % 


Ill. INFORMATION ON MAINTENANCE 


a. Of the following, please rank those which have been the source of major 
maintenance and/or repair costs to your hospital beginning with "1" as the worst 
problem area. 


external walls windows 

internal walls handicap accessibility 
security mechanical (HVAC) 
flooring plumbing 

electrical lighting 

roof conveyance 

structure other (specify) 


b. Based on the past problems, describe any changes that would be made if any 
particular system or component were to be replaced. 


c. Which of the following have been the cause of significant maintenance and repair 
costs to your hospital? Please, rank the following beginning with "1" as the worst 
problem area: 





federal, state, or local laws aging of facility 
material (accelerated deterioration) poor design 
construction (poor workmanship) technology replacement 
normal wear and tear other (specify) 


IV. INFORMATION ON CONSTRUCTION CONTRACTS 


a. Approximately how many separate construction contracts will be awarded next 
year (1997)? 
b. What type of construction contracts are generally awarded? 
% lump sum (fixed price) 
% cost plus 
% other (specify): 


66 


| 
| 





c. What percent of the construction contracts are competitively bid? % 
d. How are contractors invited to submit bids? (check one) 
bidding is open to all contractors 
bidding is restricted to selected firms on bidders list 
contract awards are made on the basis of negotiation 
other (specify): 
e. Howare the costs of construction contracts distributed (in monetary terms)? 
% general contractor 
% subcontractors (specialty contractors) 
% design build 
% professional construction management (CM) contract 
% other (specify): 


V. OPTIONAL 


What is your top construction-related problem? 


What trends relating to construction, if any, do you see impacting facility construction 
over the next 5-10 years? 


VI. REQUEST FOR SUMMARY REPORT 


If you would like a copy of the summary report please provide the following 
information. Please note that your comments and survey responses will be treated as 
strictly confidential. 


Name: aitle: 

Institution: 

Street Address: 

City: State: Zip: 


67 


on SINPS 1 
a in zu 
1 /9Q 99097-1657 ;. 


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