Insights from Roth Marz Partnership

This article was originally publised on mcall.com on March 24, 2018.

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After years of debate, discussion and delays, Lehigh County has released early design plans for potential upgrades to Cedarbrook.

But before commissioners select any plans in the next few months, they'll have to decide Cedarbrook's future.

On Wednesday, the architectural firm Roth Marz Partnership PC presented commissioners with drafts for six options that range from upgrading support systems at the South Whitehall Township facility for $8.5 million, to building a new facility on a different property for $122.8 million.

A study due next month will dive into the savings each plan presents. In the meantime, Director of General Services Rick Molchany asked commissioners to set the benchmarks Cedarbrook must serve moving forward.

How many poor seniors, primarily on Medicaid, should the home accept? Should the nursing home maintain its current size, cut beds or build with future growth in mind?

Cedarbrook
Lehigh County is examing a plan to build a new modern nursing home to replace the Cedarbrook facilities in South Whitehall Township and Fountain Hill. (ROTH MARZ PARTNERSHIP P.C. / CONTRIBUTED RENDERING)
The answers to those questions will shape the debate and influence what options the county will consider for the nursing home. For example, the county could cut 113 beds under one plan, but the number of poor, aging Lehigh County residents is expected to increase in the future.

"If you have a choice that you are preferring, then I can zero in on that much quicker and maybe cut time out of the operations plan and get you options quicker," Molchany said.

The county will have to make these decisions while the health care industry is in a state of flux. Federal lawmakers are fighting over potential changes to the Affordable Care Act, which will affect Medicaid funding. Public nursing homes such as Cedarbrook are scheduled to get a better Medicaid reimbursement rate from the state in the next two years, which could mean more money. But a new governor could set a different agenda. As a result, county officials must make major decisions on how to approach issues largely outside their control.

"We're doing a Rubik's Cube, and we're doing it blindfolded," Molchany said.

Executive Tom Muller made it clear that he would oppose any option that cut beds. The number of seniors in the Lehigh Valley is expected to shoot up in the next 40 years, and people are increasingly turning to Medicaid to pay for skilled nursing care. Private nursing homes prefer patients who can pay from their own savings, leaving public facilities to pick up more and more Medicaid patients, he said.

"The mission as defined from the administration's standpoint is to provide a safety net to those who need it, which can best be defined as those on Medicaid. We currently have 560 on Medicaid. Any option that goes below that is unacceptable," Muller told the board.

Most commissioners who spoke Wednesday seemed ready to rule out options that didn't upgrade patient bedrooms or ones that dropped the census, but the feeling was not unanimous.

DETAILS
Architects with Roth Marz Partnership P.C. presented six preliminary options for Cedarbrook.

• Upgrade infrastructure but don't change any rooms. This plan ignores the dated patient rooms, which is what sparked the debate about upgrading. Cost: $8.5 million

• Upgrade infrastructure and refurbish three wings. This plan places no more than two patients to a room and adds half bathrooms, removing 113 beds . Cost: $26.3 million

• Upgrade infrastructure, refurbish three wings and build an addition. A two-story wing is constructed to offset the loss of beds from the second plan, and a new lobby is built to connect the wing to the main building. Cost: $54 million

• Upgrade infrastructure, refurbish one wing and build a new addition. Patients are removed from the two oldest wings and placed in a new four-story wing. Wing B becomes apartments for independent seniors. Wing C becomes office space and training areas for employees. Patient room improvements are made to Wing D. Cost: $67.9 million

• Build a new facility. The county builds three-floor nursing home on a new 20-acre site and closes locations in Fountain Hill and South Whitehall Township. The project would take at least three-and-a-half years. Cost: $122.8 million

• Merge Fountain Hill and South Whitehall facilities. The county builds an eight-floor addition to the South Whitehall Township facility. The Fountain Hill location is closed. Wing B becomes apartments, Wing C becomes office space and Wing D is refurbished. Cost: $107.3 million