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 February 2016

This month's issue focuses on getting your LTC Building and its infrastructure ready to care for heavier case mix, post-acute residents. Let us know what you think, we welcome your input.

Making Your Building More Subacute

Driving Forces
As a Senior Care Professional, you have probably been spending a good part of your time in recent years dealing with wave after wave of changes in the Managed Long Term Care Environment. (MLTC). You have no doubt become expert in negotiating contracts with ACOs and in fighting the "Battle of the Bundle". Your focus has been on getting your organization motivated and trained to handle heavier care, subacute residents. So you and your organization are ready.... Is your Building Ready?
Yes Your Building! A heavier case mix requires more "Care Area", (more square footage per resident) than a baseline geriatric census. Depending on your ACO contracts and/or care plans, your building's infrastructure and systems may also need to be modified to support subacute care.
Regulatory changes and market forces which parallel MLTC are also impacting your building and its bones. I will discuss these impacts across the full breadth of a typical Long Term Care Center Building (LTC) starting where the first impression of your organization is formed... at the curb.
At the Curb
Upgrading your building's curb appeal is not mandatory and your ACOs in most cases could care less what your building looks like. You most likely are not going to get "better rates" if you dress up your building's fa├žade. So why do it? My clients who upgrade their facades and public spaces do it essentially for one reason: Branding. Although the MLTCs/ACOs are dictating when a resident with a "hip" or "knee" is eligible for a subacute stay, your residents and their families still have a choice, and you want them to choose your organization. One of our more typical "curb appeal" upgrades is a lobby renovation which also includes a nicely appointed family room as an extension of the admissions suite. Fireplaces, wet-bars, flat screens and comfort seating are typical amenities in this family lounge.
A facade upgrade is a big commitment, but can go a long way in improving your customer's perception of your organization and its brand. The most common approach to spruce up your building's exterior is to "re-skin" it by applying an Exterior Insulation and Finish System (EIFS). EIFS is essentially synthetic stucco applied over a rigid foam insulation board and a plastic mesh. EIFS comes in an almost infinite number of colors and can be sculpted into many forms and shapes, giving your architect the design flexibility to preset any number of motifs for you to consider.
A good balance of budget and aesthetics is to upgrade just the main entrance facade of your building. This gives you curb appeal where it counts the most. We strongly recommend that our clients replace their windows in conjunction with an EIFS upgrade as this allows for water proofing materials to be wrapped behind the window for a better installation.

We hope you enjoy this month's issue. Do you have questions or feedback about the information provided or regarding your facility that we can answer?  Contact us at and we will be happy to provide you with any additional information you may need.  We want to continue to offer content that interests you, our readers. Please drop us a line and let us know what topics you might want to learn more about. As always, we love hearing from you.


John W. Baumgarten, RA, AIA, NCARB, LEED AP
Principal & President

Michael A. Sciara, RA, AIA, NCARB, LEED AP
Principal & Vice President


John W. Baumgarten Architect, P.C., headquartered in New York, is a full-service, regional architectural firm serving proprietary and not-for-profit organizations in the healthcare, education, commercial, corporate and public arenas.  The firm has been recognized for its work with senior housing, urgent care centers, skilled nursing, dialysis, community centers and more.  This award winning firm provides architectural design services to clients in New York, New Jersey, Pennsylvania, Connecticut, Massachusetts, Delaware and Florida.
Call us for a Complimentary Consultation at
(516) 939-2333 or email us at