Our Island Home – Feasibility Study

Frequently Asked Questions

As of 08/19/2020

1. Wasn’t a feasibility study already completed for OIH?

OIH commissioned an earlier architectural feasibility study in 2015 for OIH replacement /renovation on its current site, or relocation to one of several alternate sites in Town. Potential benefits of relocation included single phase construction, lower construction costs, more site area to accommodate best practice living environments, parking and future expansion, and less disruption for patients during construction. More Information

However, the study found specific issues associated with each alternate site that would potentially offset the assumed lower construction costs (existing utilities, buried historic artifacts, cost of acquiring site, potential abutter resistance). Presentation of the alternate sites to Town Meeting in October 2015 met with strong and impassioned community opposition. Ultimately, the decision was made in March 2016 to recommend a study for renovation or rebuilding of OIH on its current site, to maintain its traditional location and take advantage of its ocean view, assuming a strategy could be found to avoid disruption for patients. This is the study currently underway by LWDA.

2. Why do we need a new facility?

The existing building is approximately 39 years old. Most of the systems and infrastructure date back to the original 1980 construction. There have been system upgrades over the years to keep the facility operational; however, the building layout is outdated, inefficient and does not meet current best practices for patient care, current state Department of Public Health regulations for nursing support and mechanical systems. Some of the systems cannot be maintained without significant cost that will impact the physical space.

The care model for skilled nursing has radically changed from the institutional setting of the 1980’s and earlier, to a more home-like model where residents have more choice and control over their lives in a setting that mirrors home-like features rather than a ‘medical facility’. This new model is proven to provide a higher quality of life and better-quality outcomes to residents and their families.

3. Why can’t we leave Our Island Home where it is and just repair the building as needed?

The existing infrastructure will be very costly to repair and maintain and/or entirely replace. Systems are antiquated and require replacement. Some systems are not compliant with current energy code and do not operate in a responsibly sustainable way; other systems are not easy to replace given the facility structure (e.g., plumbing beneath the facility floor slab). Major capital expenditure on the facility’s deteriorated systems will require bringing the entire facility up to Life Safety and Building codes. It is important to note that the facility is currently occupied so any repair and expansion of this magnitude will require multiple phasing over several years and will be highly disruptive to patients and their families.

4. Is it possible to just renovate the existing building and stay on the current site? What really will be permitted or prohibited?

This question of what will be permitted or prohibited needs to be more specific, regulations that govern this are in the thousands of pages – see Determination of Need Regulations 105 CMR 100.000, Mass DPH licensing and physical plant regulations, Mass Building Code 780 CMR, Local and Federal accessibility regulations, CMS Medicare / Medicaid regulations – to name a few.

Renovation of the existing facility would cause significant disruption to the elderly population living in the building. Construction would have to be phased over many years requiring reduction in resident census to accommodate the phasing, potential reduction in staff, and increase the cost of the construction.

A feasibility study is currently underway with LWDA Design Architects (LWDA) to understand preliminary concepts on constructing a new building around the current which will involve phased-build stages and phased demolition of the current building.

In July of 2018, the Town engaged CliftonLarsonAllen (CLA) to review the current operations of Our Island Home and propose financial, operational and strategic options for a future Our Island Home. They were tasked with analyzing changes in reimbursements in the industry overall, demographics, bed capacity, types of services offered, specific model staffing structures, DPH regulations and requirements, and changes to the Massachusetts Determination of Need process into consideration.

A lot of the work done thus far with CLA has been to develop cost estimates on different scenarios of operations in keeping with similar staffing patterns that currently exist as well as bed capacity, mix of private and semi-private rooms; and, level of care. Some discussion has been held on level of care (Level II skilled nursing plus Level IV rest home). With the recent engagement of a feasibility study with LWDA, more collaboration between the two can occur and thus help determine not only cost of construction but also cost of operation and impacts of phased construction on revenue and staffing.

Senator Julian Cyr and Representative Dylan Fernandes sent the DPH a letter on December 26, 2017, on the Town’s behalf, requesting guidance on next steps especially surrounding renovation-in-place or closure during a rebuild period. A response was received on February 1, 2019 from Elizabeth Chen of the Executive Office of Health and Human Services with DPH. The letter indicated that while the uniqueness of our questions and concerns is understood, under state law, plan review and approval is required before construction or renovation of a nursing home can begin and any formal answers can be provided to the Town. Continuation of operations while renovating or constructing a building around the current building is possible – with a plan for minimizing impact on residents and ensuring all necessary care and services remain in operation and at acceptable care levels.

5. Can demolition/construction occur proximate to current residents?

The disruption of living in a “construction zone” to our current residents, and neighbors, is a large part of our analysis when considering options. The physical and emotional impact even minor upgrades to the facility have on residents was seen during a recent minor flooring replacement, which only lasted about one week. For example, there was sleep disturbances, odor impact, increase in agitation and confusion, relocation of activities, and even staff were challenged to concentrate on work. Impact on Residents would also be part of the approval consideration by DPH.

6. OIH is currently licensed for 45 Level II/III beds. Will there be a request for more beds?

A Memorandum was issued by DPH on December 11, 2018 regarding an update on licensure statutes and further stated that the department will review the long-standing moratorium on new long-term care facility beds. Requesting an increase in licensed beds requires approval by DPH through the Determination of Need process. These regulations can be found under 105 CMR 100.000 and 153.000.

An actual need for more beds must be documented during the application process. At this time, there is no wait list at OIH and the facility has run an average daily census of 33 residents over the last 12-month period. Simply stating that demographers note an anticipated population increase in the senior age bracket is likely not strong enough of an argument to provide for an increase in licensure if current licensed capacity of the facility is not met. Based on current census trends, there will be no request to increase our current licensed bed capacity at this time.

The design phase of the new facility will examine expansion opportunity. If there is a way to construct a new facility on the current site that also provides for area to expand if there is a demand for more beds in the future, then that should be part of the site and building plan. It should be noted that efforts, services, and reimbursement trends to support individuals staying in their own homes longer is likely to impact the demand for long-term care beds on Nantucket.

7. Is changing the level of care offered from Level II/Level III to some beds at Level IV Rest Home still part of the discussion and what do these levels mean?

OIH has a history of serving those who have no viable way of living on their own, due to disability or physical condition – rather than serving only those who need skilled nursing care. It is understood that as an island we have limited resources and options to provide multiple levels of care that accept multiple payment types. Having the option to change the licensed level of care for facility beds provides for an avenue to help address this but only if it is deemed necessary (community need) and feasible economically to do so. In the past, on average, about 25% of the OIH residents would have met eligibility and had their care needs met in a lower level of care setting than a skilled nursing home.

This concept of planning the facility layout to allow for a change in licensure has still been part of the discussion with CLA and LWDA. The focus is on keeping 45 Skilled Nursing Facility/ long-term care Level II beds as we currently have. However, if there is a way to provide for changing the licensure from Level II to Level IV (Level IV nursing home are also referred to as Rest Home or even comparable to assisted living oversight) as the community need changes, then we are encouraging that be part of the planning process for consideration. Any licensure changes require application and approval from DPH.

8. What model is being looked at for OIH?

There is no specific model focus for Our Island Home’s future currently, except to incorporate more ‘home-like’ culture-change elements in the environment and aesthetics of the building. A blending of current operational model and ‘Small House’ model concepts is being explored as the basis for preliminary schematic layouts and financial modeling.

9. Will there be special provisions for residents with dementia? Memory Unit? Will there be special provisions for residents with special needs? ALS? Parkinson’s?

No special units that segregate residents by diagnosis are planned. There will not be a memory care unit – research does not support benefit in segregating elders by diagnosis and OIH is too small to support this model of division. OIH staff training will address special needs within the overall population. There are very specific regulations that cover ‘Memory Units.’

10. Prospect of sea level rise for this site over next 50 years?

The property has been determined to be vulnerable in response to storm surge potential and Category 4 hurricanes. With climate change and sea level rise posing major concerns, the existing site location will be subject to strict FEMA Flood Mitigation requirements, given its proximity to the wetlands and shore. This will increase the cost of developing the site.

Taking this into consideration, LWDA is looking at elevating the 1st floor of the new facility as high as possible on site to account for resiliency and longevity, with an added benefit of better views. This is also another reason why demolition of the current structure would be favored, as any combination of old and new would want to be on the same level for accessibility.

Currently, the projection year used by NOAA is 2100, at which time it is estimated that sea level will rise between 19” to 47.” The existing structure is at elevation 13.5’ and it is being recommended to raise this to elevation 19 or 20’.

11. Is there an impact on Landmark House or a strategy to build in place that would require moving Landmark forward or to another location?

The Landmark House building is owned and operated by two private non-profit entities with one 75-year land lease with the Town which was entered June 1985 as per Article 60 ATM vote at April 1983 Town Meeting. This parcel of land also has special zoning (see other attachment on the OIH zoning). Any adjustment or moving of this building will have impact on those who live there and will require new zoning.

It has been the directive of the Select Board during the current feasibility study to examine the option to build a facility on the current site only and not require moving or impact on Landmark. Moving or impacting Landmark would require significant upgrade to that building and a plan to house those currently living at Landmark during such move and upgrades.

OIH has asked LWDA to explore the feasibility of a combined parking lot to serve both Landmark House and OIH, as that is effectively how the site functions today.

12. Modular construction alternative?

Modular, at this phase in the project, has not been fully explored. However, LWDA has expressed interest in reviewing requirements to see if there are parts that could be prefabricated (such as bathrooms) to help with the phased construction accelerated time line. While nursing home construction regulations do not tend to allow for modular options due to our unique circumstances, it will be explored.

Current MA Building Code for nursing homes requires construction to be at least Type 1B fireproof construction, per Mass MGL 111 Section 71 and 105 CMR 151.110. Type 1B is the most restrictive classification of fireproof construction, requiring non-combustible building materials and structure to confine a fire (walls, floors, structural frame work).

13. What Percent of the lot is buildable?

Approximately 77% of the site is buildable, based on what we have learned to date. There is a 50’ setback requirement from the Coastal Bank that runs more or less along the northeast line of the property (closest to Nantucket Harbor). There is another small low-lying portion of the site along the southeast property line that is also not buildable because of a similar Coastal Bank setback. This requirement is part of Wetland Protection Regulations enforced by the Nantucket Conservation Commission.

14. Population Growth, Specific to Nantucket

According to projections generated by the Donahue Institute, University of Massachusetts both population and elderly percentage will increase on Nantucket. Current projections for 2035 show a 34% increase in the population of those above the age of 65.

Among the population aged 65+, 69% will develop disabilities, and 35% will eventually enter a nursing home.

15. Connection to Bike and Walking Paths

During the 5/6/19 OIH Charrette it was suggested that the Project include connections to the growing network of bike paths and walking trails enjoyed by the community; a bike path is planned to pass close to OIH. The Nantucket Wheelers program offers bike rides to OIH residents by certified volunteers on specially outfitted bikes that need to be stored and charged. Currently, the rides are arranged in advance to schedule a van to bring residents to bike locations, but if there was a storage/ charging area on site under cover, it would be much more convenient for residents and providers, eliminating the need for the van and advance coordination.

16. Hays Property no longer considered for OIH relocation

The Hays Property at 174 Orange Street has been suggested as a possible alternate location for OIH to rebuild, but that option has now been removed from consideration, at the property owner’s request. The Nantucket Land Bank reviewed the proposal May 9 and rejected the idea, stating, “The Commission is unanimous and steadfast in their position that this is not an available option for the construction of Our Island Home.” See attached 5/15/19 letter from Nantucket Land Bank to Nantucket Select Board. The issue was reviewed and closed at the 5/22/19 Town Select Board meeting.

17. Will there be an accessible greenhouse? (and other specific spaces)

Discussions continue as to what a new or future Our Island Home may be. At this time, program specifics above and beyond what currently exist have not been determined. This is not to say that a greenhouse may not be part of the finished product but only that we are too early in the process to have a definitive answer to this. If a greenhouse will be incorporated on the grounds, it will be (as with the entire project) fully accessible and meet all ADA requirements.