Strafford County nursing home project vote on hold, but optimism for passage builds

DOVER — A final vote on funding a new $170 million Strafford County nursing home on County Farm Road has been put on hold.

The county's delegation of state representatives will make the decision. The delegation met for a workshop Sept. 1 to learn more about financing and more details of the project. but delayed a final vote. The delegation had voted the previous week 21-13 in favor of the project but didn't hold a vote on a $170 million bond, which county leaders say won't be the final cost of the project with grants expected to help fund it. The 21-13 vote, mostly along party lines with all but one Democrat voting in favor, was just shy of the two-thirds majority that would have been needed to approve the bond.

Strafford County Administrator Ray Bower said there was a lot of confusion over the initial vote as a result of the directives and language given to the delegation by the bond council.

“The delegation gave a show of support, but they wanted to see what other money might be available before they made a final vote on how to raise the difference,” Bower said. “The vote signaled that the majority of the delegation supported the $170 million appropriation. We plan to fund that appropriation in the budget with a bond, but we will vote on the bond itself at a future meeting.”

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At the time of the Aug. 25 vote, the delegation had been told they needed to approve the project before a Sept. 9 deadline to qualify for roughly $20 million to $25 million in federal America Rescue Plan Act funds available through the state. Strafford County commissioners chair George Maglaras explained the supplemental budget vote was enough of a blessing to start writing the grant application to apply for the funds.

Sullivan County is the only other county in New Hampshire eligible to apply for the pot of $50 million dedicated to nursing home construction, because it is the only other county that started the approval process in time, clearing key votes with its county delegation, according to Maglaras.

Maglaras first pitched the nursing home plan to the legislative delegation in May. It received initial bipartisan support and funds were approved to hire an architect with the intention of reviewing more detailed plans on the facility and how to fund it in August. At the August meeting, the project received pushback not on the idea, but on the cost. The new facility is part of Maglaras' and the commissioners' three-pronged approach to addressing the need for modern nursing care, a shelter for the homeless population by converting the existing Riverside Rest Home on County Farm Road and addressing the lack of affordable housing in the county through the local communities. It all hinges on the building of a new nursing home.

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Nursing home cost concerns

Bower said there is no intention of spending that $170 million, calling any votes on that figure a placeholder.

“We have appropriated that money for the entire project, but it doesn’t mandate us to spend it,” Bower said. “We will bond the cost of the project after we know what grants we can subtract. The value of an affirmative vote allows us to apply for the governor's fund and seek other grants.”

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Bower said the workshop helped the county's state delegation get the detailed information on the cost.

"I feel the delegation would be more comfortable voting with that knowledge. If we knew that, we could deduct the funding and take out a smaller bond,” Bower said.

The delegation was expecting to vote on the bond Sept. 6, but that has been called off for now, while the county waits to see how much they receive in the state funds set aside for nursing home improvements. Maglaras said he’s hopeful that there will be even more federal American Rescue Plan Act money coming from the state to support behavioral health units at the nursing home. Maglaras told the delegation that it would be ideal to try to have these two funding sources lined up before voting on the bond, to relieve some of the representatives’ concerns about the price of the project.

The $170 million cost for the new nursing facility is based on $520 per square foot. Site preparations are expected to cost $3.6 million, building construction and design was quoted at $156.9 million, equipment and facilities are expected to be $9.5 million.

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The proposal estimates the project could receive $20 million in state nursing home funds and $5 million in American Rescue Plan Act funds. Additionally, there’s an estimated $5 million in offset from: $1.3 million in additional Medicaid reimbursement, $1.2 million in jail bond retirement, $1.7 million from city complex solar farm, $200,000 to additional bond retirement and $600,000 in other reimbursements.

Maglaras had suggested the delegation cancel its next meeting, as the grants get squared away.

“The delegation has worried about costs, so let us work on those costs and bring them back before you vote,” Maglaras said.

More details on the new nursing home proposal

Two representatives of Warren Street Architects were at the meeting to explain the specifics of the project in more depth beyond the conceptual drawings. The company is also working on Sullivan County’s nursing home rehab project, and has experience with projects of this nature.

The current footprint of the proposed nursing home is 326,373 square feet. This includes roughly 124,000 square feet of residential rooms, 46,000 square feet of administrative offices, 24,000 square feet of maintenance and laundry equipment , 22,000 square feet of a Main Street commons shopping and recreation area, and an 82,000-square-foot unfinished basement space. This would give residents roughly 400 square feet per room.

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The basement space and Main Street plaza were at the forefront of the discussion Thursday night. Some questioned if these amenities were needed. Bower and Maglaras said they are vital aspects to the project. They explained the basement is an investment into the nursing home’s future. Building on a slab would only save the project $2 million, which Bower said is an insignificant savings in the long run.

“We’re very pleased that the delegation seemed to see our vision for the basement,” Bower said. “Some were concerned with it being unfinished, but really it’s just space with a concrete floor that has no designation for space on the blueprint. We’ve said we want this nursing home to carry us through the next 50 years, so it makes sense to have extra space to flex for future needs, whether that is storage, an additional unit of rooms, or services like adult day care.”

At the center of the facility will be an area of amenities for residents and families he calls Main Street commons. It could house a café, restaurants, a bank, barber shop, library, health care providers, post office, retail and theater. Maglaras stated it's an area where families can spend time with their loved ones safely, and those in the nursing home can access to feel a sense of independence.

The plan also states the nursing home will expand the behavioral unit in the new building. It will provide more Medicaid reimbursement, and could open the door to funding from the state as it looks to close the Glencliff Nursing Home, which is a state run behavioral health facility. Currently Riverside has 22 behavioral health beds, this would expand the unit count to between 32 and 38.

Several representatives raised concerns over staffing, since Riverside nursing home is operating at 75% capacity due to staffing restrictions. Bower said much of that problem is due to inefficiencies in how the building is designed that stretches the available staff thin. He expects that reimagining the blueprints to curb these inefficiencies, like they did when building the county jail, will help the nursing home operate more efficiently. The county also hopes to strengthen the workforce pipeline by partnering with the Dover Regional Career Technical Center.

This article originally appeared on Fosters Daily Democrat: Vote on new Strafford County NH nursing home in Dover on hold