Built to weather the storm

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Built to weather the storm
Built to weather the storm
When a skilled nursing facility more than doubles in size — but adds only 20 beds — and switches to a brand new model of care, one could reasonably expect some growing pains. But officials at WillowBrooke Court, the skilled nursing community at the continuing care retirement center Indian River Estates, are genuinely pain-free with their new replacement center.

Located in what used to be a relatively rural area in Vero Beach, FL, the 120-bed community ballooned from its original 40,000-square-feet footprint to 100,000 square feet. The ACTS Retirement Life community, which added only 20 new residents as part of the upgrade, transitioned from a traditional hospital-like nursing home to a household-style home. It debuted its new look in April.

The harmonious transition was due to more than a year's worth of monthly staff meetings to discuss components of the transition — be they culinary or clinical in nature. Staff members also wrote regular letters to residents' families to keep them apprised of the move.

“We transported 100 people over the course of a week, or one household [20 people] per day. It worked very well,” Dianne O'Rourke, RN, the community's director of nursing, said. “By the time they got to the new building, their households were intact. We were very tired by the end of that week!”

O'Rourke said one of the biggest changes for the nursing staff was the transition away from any kind of official uniform. Under the household model, nurses and aides are required to wear street clothes. They may not wear scrubs or all white.

The community's administrator, Erin Montegut, said this change was hardest for “younger nurses who worked hard to wear white.”

On the construction side, convincing the state of Florida that a household-style SNF could meet state regulations was by far the most difficult part of the project, according to Sean Fletcher, director of construction services for ACTS. The operator had decided 10 years prior to the completion of WillowBrooke to build the community in the household model. When ACTS finally started construction in 2009, state regulators had no experience working with their type of design, in part because of a state moratorium on new skilled nursing beds.

The combination of the regulatory environment and original design elements “was really challenging,” Fletcher explained.

A top priority for ACTS was ensuring the building could withstand a Category 4 hurricane.

“This building is basically a bomb shelter,” Fletcher said. “We shelter in place, which means that if a storm is coming, we keep our residents and staff in the building.”

Fletcher's design team made the decision to build the structure in compliance with Miami-Dade County building codes, the most stringent in the state, even though local codes didn't require it.

“We could literally ride out any type of storm,” he said. “We have a 1,500-kilowatt generator that could power the building for seven days if we lost power.”