PROJECT SUMMARY
Eastern State Hospital (ESH) was originally opened in 1773 and was the first state hospital in the country dedicated to treating the mentally ill. Located in Williamsburg, VA, ESH is one of seven state-run psychiatric hospitals operated by the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS). ESH moved to a 500-acre campus in the 1930s to accommodate an increase in patients and by the late 1990s, ESH was comprised of 26 buildings spread over half the campus. Although ESH always served patients of all ages, in the 1960s and 1970s, the care of geriatric patients (age 65 and older) was moved to separate, free-standing facilities and the buildings were designated the Hancock Geriatric Treatment Center (Hancock) to be run as a separate center within ESH.

By the beginning of the twenty-first century, five buildings comprised Hancock and all were over forty years old. With patients spread over four buildings and administrative services housed in the fifth building, because of this, as well as high staff attrition, affective treatment programs became difficult to administer. Hancock was not compliant with HIPPA, JCAHP (Joint Commission on the Accreditation of Healthcare Organizations) and was possibly going to lose its Medicare/Medicaid status because the number of patients per room and the use of pony walls (walls about three feet tall) in rooms did not meet regulations. Upgrades to the facilities were also necessary to ensure ADA compliance, HVAC compliance and life-safety-issues.

A feasibility study was conducted to decide if upgrades to the existing facilities or a new consolidated facility would best meet Hancock’s needs in the most efficient manner. The study showed that a new facility would represent the more expedient and less costly approach. Gilbane approached DMHMRSAS in an unsolicited bid to apply a turnkey approach to providing a state-of-the-art facility that would meet patients’ needs and provide for more effective care.

Gilbane delivered Hancock on time and the new 150-bed, 116,000 square-foot facility opened its doors in April 2008. By utilizing a PPP, DMHMRSAS received the facility in one-third of the time it would have been under traditional procurement and will realize operational cost savings through increased efficiency.

PROJECT OBJECTIVES
The objective of the project for DMHMRSAS was to improve patient care; to accomplish this, the facilities needed to be replaced with a facility that was compliant with Medicare and Medicaid, HIPPA, JCAHP, ADA and HVAC. DMHMRSAS wanted to continue the special center for geriatric patients because their needs are different than younger psychiatric patients; without the new facility the best patient care would not be possible.

A second objective of the project was to get the best value out of the campus. With limited capital funding, DMHMRSAS needed a solution that would minimize costs while simultaneously providing a facility that would meet the needs of the patients and staff. The department also wanted to optimize the value of surplus land.

PROJECT DESCRIPTION
Partners
The public sector partner for this project was the Virginia Department of Mental Health, Mental Retardation & Substance Abuse Services (DMHMRSAS). The department provides treatment, habilitation and prevention services for individuals and their families whose lives are affected by mental illness, mental retardation or substance use disorders. The system is compromised of forty locally-run community service boards (providing pre-admission screening services) and sixteen state-operated facilities, which include seven mental health facilities, five mental retardation training centers, a psychiatric facility for children and adolescents, a medical center, a psychiatric geriatric hospital and a center for behavioral rehabilitation.

The private sector partner was Gilbane Development Company, which has a Public-Private Development Group that specializes in implementing innovative real estate solutions for public entities and institutions.

Implementation Environment—Legislative and Administrative
Virginia State Legislature passed the Public-Private Education Facilities and Infrastructure Act (PPEA) in 2002. The law authorizes private entities to “acquire, design, construct, improve, renovate, expand, equip, maintain or operate qualifying projects” and seeks to facilitate the use of innovative financing approaches. The PPEA has been applied to numerous public facilities including schools, courthouses, utility and telecommunications infrastructure, recreational facilities and any other public building. Private sector partners must prove there is a public need for the project, the estimated cost is reasonable when compared to similar projects and the project can be executed in a timely manner.

Financial Agreement
The total cost of the new, state-of-the-art Hancock was $28 million. The total includes the cost of planning, design, construction, furniture, fixtures and equipment. The new facility improves staffing and operational efficiencies which are anticipated to generate cost savings that will pay for the new facility within 15 years.

Gilbane was responsible for all predevelopment expenses, as well as selected development expenses. The company received monthly payments from DMHMRSAS from the schematic design onward. Under this financing plan, several financing constraints were removed from the project and helped lead to an expedited delivery

Implementation Metrics
Eastern State Hospital’s staff helped during the design phase of the project to ensure patients’ needs would be met. By combining best practices in the industry for geriatric and psychiatric care with knowledge provided by staff, patients’ needs were met more effectively and efficiently. Designers also consulted behavioral health and geriatric design experts to better meet patients’ needs.

The layout of Hancock is essential to the increased efficiencies at the center. There is a central core area, “Main Street,” that houses both patient activities and administrative functions. Large, brightly colored signs guide patients to different areas of the center to ease patient mobility. Patients’ rooms are found in four wings, which are connected to the central core. Each resident wing has a wander garden feature and also has closed-loop arrangements to keep patients, especially those with dementia, from getting lost. The wider doorframes help to better accommodate wheelchairs and hospital beds and handrails are found throughout the hallways.

Commentary
By utilizing a turnkey delivery model, DMHMRSAS received the completed facility in 26 months, which covered the time between the first partnering session and the final patient move. The facility was completed in the required 24 months and an additional two months were used to relocate the patients. Gilbane delivered the facility in approximately one-third the time the project would have taken under traditional procurement and the final cost of the project was less than it would have been under traditional procurement because future construction escalation costs did not play a role (as they typically can under traditional procurement). The payback from savings due to improved efficiencies is estimated to take less than 15 years.

Through the use of a PPP, DMHMRSAS was able to retain Hancock’s Medicare and Medicaid compliant status, improve patient care and make serving patients’ more efficient.