Posts tagged with "Healthcare":

Healthcare Facilities Symposium & Expo

The mission of the Healthcare Facilities Symposium & Expo is to create a multi-disciplinary environment that inspires you to evoke change and the advancement of a better delivery of healthcare through the physical space. Competitors, clients, and colleagues come together as friends to collaborate, share research, hear fresh perspectives and participate in the ever changing conversation of your industry. The healthcare industry is poised for disruption.  Ground-breaking technologies, game-changing financing models, and market-shifting business deals are all converging.  Are you ready?  Join us in Austin, Texas for an unforgettable experience designed to prepare you for what’s ahead!
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Printed metal panels clad new healthcare facility in Minneapolis

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Reorganizing nearly two million square feet to offer centralized and accessible care for people who need convenient access to a doctor, same-day surgery, or cancer treatment, Hennepin County Medical Center’s latest project is a new six-story building that consolidates over 40 primary and specialty clinics currently spread across nine buildings. The healthcare project, led by local architect BWBR, has resulted in Minneapolis/Saint Paul’s largest teaching hospital. The project prominently features corrosion-resistant metal panel cladding printed with a “corten” patterning.
  • Facade Manufacturer McGrath, Pure + FreeForm (provided finished flat sheets only)
  • Architects BWBR
  • Facade Installer McGrath
  • Facade Consultants Ericksen Roed & Associates (Structural), Dunham Associates (MEP/Energy)
  • Location Minneapolis, Minnesota
  • Date of Completion 2018
  • System aluminum panels
  • Products Pure + Freeform Lumiflon (FEVE) off-set graveur direct paint system, AMA 2605 rated, Class A finish on 2mm thick Aluminum in custom finishes
BWBR’s design team said they worked closely with Pure + FreeForm from schematic design through construction administration to ensure the custom finish met aesthetic and budgetary criteria. “The early and constant collaboration was, in fact, what allowed BWBR to comfortably select and realistically defend a more radical solution to represent the character of the client and their facility.” The design team started out by creating a high-resolution mapping of rust steel and wood grains and manipulated them digitally to be suitable for an application massive in scale. The specific coloration, toning, and detailing of the imagery was finalized through an extensive process requiring several rounds of physical samples and on-site reviews. The collaborative design and manufacturing process allowed BWBR to control precisely the pattern and color that eventually was realized on the facade. Pure + FreeForm said the scale of the patterning and reflectivity of the samples played a role in final selections. “This process included examining the various conditions of natural light on the surface of the panels and how each condition would affect the perceived color, texture, or pattern. There is also a custom wood grain finish, for which we played with scale so that the pattern would be visible from the user’s point of view. By the end of our design process, we had completed five rounds of proofs and matching to arrive at the final design.”
The panels were “printed” using a Lumiflon ink, allowing for bright orange and red tones in the final finishes while offering corrosion-resistance, which would not be possible with other fluoropolymers. The refining of the panel configuration was a process of designer-contractor collaboration, which Pure + FreeForm’s custom finishes enabled: to blend patterns on a larger area in a way that was not visually repetitive. The team was able to downsize the metal panel to an economical dimension without sacrificing the perceived large pattern on the facade. This was achieved by combining three narrower panels with butt-joints and using the custom pattern to disguise the seam in between. Originally, the system was conceived as 3-millimeter plate panels, but moved to 2-millimeter flush panels, which more appropriately suited the budget. By varying the widths and locations of the panel joints, the team was able to create the appearance of larger panels. The 2-millimeter flush panels were attached to the building structure using #14 TEK 3 Long Life coated exterior fasteners. Coordination with the glazing manufacturer was required for the areas requiring flashing. There were two fabrication challenges, for which McGrath worked extensively with BWBR in the preconstruction and construction phases. First was the actual forming of the flush panels and creating the female pocket in 2-millimeter gauge. The second challenge was the panel layout and alignment with windows, in which BWBR required a layout for the panel reveals to align with the windows throughout. This meant panel sizes had to be carefully coordinated, adjusted both in fabrication design and in the field. The miscellaneous trims in the building did not use custom patterning, but rather a solid paint to match. This was achieved by working closely with McGrath and Mortenson to ensure the solid lines were not distracting from the primary jointing pattern and panel finishes.
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North America’s largest healthcare project completes phase one

The first phase in the construction of three-million-square-foot Centre hospitalier de l’Université de Montréal (CHUM) created by CannonDesign and Montreal-based NEUF architect(e)s is now complete. Located in the heart of Montreal, the new campus is the first new hospital built in the city in 30 years and is the largest public-private healthcare partnership in Canadian history. In order to get the hospital up and running as fast as possible, phase one of the project focused on healthcare spaces. These include the 772 patient rooms, the operating theaters, and the diagnostic and therapeutic spaces. Phase two will build out the administrative offices, a conference center, more ambulatory spaces, and additional parking. “Walking through the completed spaces today, we feel a spatial quality that is in line with the ambitions of this great institution,” explained Azad Chichmanian, partner and architect with NEUF architect(e)s in a press release. “As the public finally begins to discover the architectural moments that have been created, from the inviting, light-filled public spaces to the state-of-the-art clinical facilities, we believe the building will succeed in completely redefining Montrealers’ image of what a hospital feels like.” CHUM covers two full city blocks, making it an important urban fixture in the city. Designed to be the anchor of Quartier de la Santé, Montreal’s new healthcare district, the entire complex was conceived to mend a large gap in the city’s fabric. The project’s large footprint included the historic structure of a 145-year-old abandoned church. While much of the church was demolished for the construction, its impressive steeple, along with the facade of a neighboring gray-stone mansion, were integrated into the overall design. Along with a number of indoor and outdoor public spaces, the campus will eventually include 13 large-scale public art pieces. Before the first phase was completed, the project was recognized and shortlisted for multiple awards. Some of those include awards for healthcare design, facade design and engineering.The second phase of the project is expected to be complete in 2021.
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A whole new breed of architecture can help fight drug addiction and save thousands of lives every year

On January 13, 2016, police found the body of a 31-year-old man, who had been dead for “at least” 12 hours, in a car parked on Pike Street in Capitol Hill, Seattle. He had died from a drug overdose in the shadows, which is common, as drug users often are too ashamed to seek help or use in the open. In the United States, 52,404 people died from overdoses in 2015.

In the eyes of some, this man’s death would have been preventable if he had attended a harm reduction facility—a new typology emerging in the developed world. Just over 100 miles away from Seattle, in Vancouver, one such facility oversees at least one overdose incident every day, on average. In its 14 years of operation so far, the facility has seen more than 5,000 overdoses, yet no one has died there.

The facility, called InSite, is a public place where drug users can go to consume their own substances in a safe, secure, and welcoming environment in Vancouver’s Downtown Eastside. For 13 years, the self-described “supervised injection facility” was the only one of its kind operating legally in North America. As of this May, three more facilities—all in Montreal—received approval and two are scheduled to open later this year.

There are now more than 100 legally operating supervised injection facilities across the world, the majority of which can be found in Continental Europe. The first opened in Bern, Switzerland, in 1986, and many European cities have slowly been adopting similar schemes.

None currently exist in the United States, but several models operating abroad and one prototype stateside might offer clues about how to make these places palatable for a U.S. political environment that is more centered around fighting a war on drug “crime” than on treating addiction as a public health issue.

Inside InSite

Canadian architect Sean McEwen designed InSite in 2002. With high ceilings, dark walls, and no Plexiglas inside to separate staff from visitors, the space eschews the notions of traditional medical institutions. Russell Maynard, who has been working at InSite for eight years, said that, “from a design perspective, it’s all about controlling the flow; that is more important than security.”

Three-phase-oriented circulation is a constant throughout almost all official drug-consumption spaces and can be summarized as: pre-consumption, consumption, and post-consumption.

Upon entering InSite, visitors are greeted by a receptionist. After providing a name (which can be fake), they are asked if they want to inject or detox and then are placed on a waiting list. The wait time is approximately seven minutes. According to Marilou Gagnon, a nurse at InSite and an associate professor at the School of Nursing, University of Ottawa, this is the period when InSite sees some visitors leave to shoot up outside, in a nearby alleyway, often using puddles to clean their needles.

“Needing to get a hit is like having chopped your finger off—you’re not going to want to wait very long or travel very far to fix it,” Gagnon said. Vancouver is a city of alleyways, and drug users favor them because they are discreet and easy to find. As Gagnon explained, however, this is problematic for two main reasons: Shooting up in an alleyway is unhygienic, and if you overdose, it’s not a great idea to be hidden.

Designing for anonymity and privacy, unfortunately, is paradoxical to health and well-being in the context of addiction. There is no hiding at InSite, but this is a good thing. Within the injection room, there are 13 booths, which line the interior perimeter, allowing nurses a clear line of sight into each.

These booths, each with their own lights, are mirrored to provide nurses and users with better visibility; this is particularly important for users, to help them avoid being surprised by approaching staff and when injecting into their necks. (Staff are not allowed to actually inject for users but can provide advice, prepare drugs, and clean needles, among other things.) Additionally, female users, who on average constitute a quarter of the visitors, often use the mirrors to do their makeup.

As the designer, McEwen also specified comfortable and easily cleanable chairs. “This may be the best seat users sit in all week,” he said. After injecting, users exit to a “chill-out” room, where they can speak to peers (usually former users), counselors, and nurses and find out about detox programs. Maynard stressed that visitors only enroll in such programs of their own accord.

Easing the Stigma

Politically, injection facilities are toxic. InSite went through a court case when the federal government attempted (unsuccessfully) to shut it down. “A common misconception is that people are shit-faced here; that’s not the case,” explained Maynard, speaking of InSite. “There are consumption sites everywhere for alcohol—they’re called bars. When you go into a bar, not everyone is off-their-face drunk, and that’s the case here.”

To avoid public conflict, almost all facilities have anonymous facades, with little or no signage. At InSite, zoning requirements for storefront retail meant the facility had to pretend to be a coffee shop to get development approval. More recently as a trial, the Canadian government funded the Narcomane Research and Help Center in Montreal, which provided heroin to registered users—a first for North American facilities. It was shrouded in secrecy at the time, and is now closed. “Not even the neighbors knew about it,” said its architect, Ron Rayside.

Margot Young, a law professor at the University of British Columbia, is interested in this aspect of the typology. She argues that the sight of InSite fuels the “larger political goal of putting injection drug addicts ‘in the sight’ of policy makers and governments.”

The sight of InSite, though, is in need of work. According to Maynard, the facility is operating at above full capacity, sometimes seeing more than 1,300 visitors a day; Hannah Leyland, a Master’s student covering InSite in her thesis, described it as looking “low budget,” noting chipped paint. InSite has annual operating costs of $2.15 million. A 2010 study into its financial wellbeing touched upon how the facility’s hygienic provisions prevent HIV infections. The study concluded that if InSite were closed, HIV infections would increase by 46 percent, costing Canadian taxpayers $12.9 million (CDN$17.6 million).

Ad hoc America

In the U.S., however, a cheaper solution is more politically viable. Dr. Gregory Scott, a visual sociologist, who has 17 years of experience in the field of drug-use harm reduction, is pursuing this route. He is traveling the U.S. with SAFE SHAPE, a “pop-up public health exhibit” that acts as a mock safe-injection site.

Scott designed SAFE SHAPE with architect Andrew Santa Lucia, of Portland, Oregon–based firm Office Andorus. The ten-square-foot pavilion uses two-inch-thick aluminum tubes to compose a white frame over which a bright-white, translucent spandex shell is stretched. It weighs less than 100 pounds and can be broken down and packaged into four ski bags and two storage tubs, allowing it to be easily transportable by plane.

“For me, design and aesthetics become heavily politicized in terms of the stigma associated with drug addicts,” said Scott. He wanted something that didn’t leap out at people as a place for users, instead adopting a “high-design” look that, semiotically, didn’t reference preconceived ideas surrounding drug addiction.

“Using a taut skin, we were able to produce a bright image that stands out in almost any landscape and becomes an icon,” explained Santa Lucia.

So far, only one SAFE SHAPE has been built. Scott erected the pavilion in Chicago as an actual consumption facility for both injectable and smokable (usually crack cocaine) drugs, albeit temporarily and illegally. Despite its small size, SAFE SHAPE is able to cater to two injectors or three smoking users at a time. The latter is a rarity for the harm reduction typology, due to issues of ventilation. SAFE SHAPE’s varied-height apertures, however, allow for such use.

Additionally, its size may be an advantage in terms of providing a safe place for drug consumption that can cater to drug users quickly and efficiently, but one thing SAFE SHAPE doesn’t provide is permanence. Many visitors to drug-consumption spaces do not have registered addresses, and time spent in such facilities can provide private moments to feel at ease and escape street life.

Scandinavian Sample

Another site that caters to smoking users is H17, in Copenhagen, Denmark. Occupying a former slaughterhouse in the gentrified, artsy district of Vesterbro, H17 cost $4.4 million and opened in August. It is more than 1,000 times larger than SAFE SHAPE and was designed by Copenhagen firm PLH Arkitekter. To Scott, “H17 is a fine example of bringing design and function together for the purpose of interrupting a criminalizing, moralizing discourse that really does harm people.”

PLH used a technique the firm calls “nudging” to encourage visitors on a linear path through the building and to separate pre- and post-consumers. “There are no 90-degree or smaller corners,” explained Lars Toksvig, a partner at PLH Arkitekter, which worked on H17. The facility’s entrance is open and employs a palette of cool “calming” colors.

The injection booths at H17 are wide and mirrored, and each has a hole on its stainless-steel desk that allows easy and safe disposal of used syringes, etc. A chill-out space is also provided, where inflatable furniture and warmer colors create a calm and less-clinical environment. “When we looked at precedents, we found many were insufficient in size,” said Toksvig. “When they get too small, users can become stressed inside and outside. It is important to cater to this.”

What is Next?

In Canada, some architecture firms are becoming more familiar with designing injection sites. Rayside said his Montreal practice, Rayside Labossière, has worked on five such facilities, most recently Spectre de Rue and CACTUS, both in Montreal and on course to open this year.

Meanwhile, back in the U.S., in Seattle, King County Executive Dow Constantine and Mayor Ed Murray granted approval for two injection sites, officially known as “Community Health Engagement Locations.” The two facilities could be America’s first. Currently, officials are in the process of finding the right locations and working out funding.

However, according to Mark Townsend, former executive director of the PHS Community Services Society, NIMBYism can slow proceedings. “Ideally, you want these spaces established before there is an overdose epidemic,” he said.

In addition to saving lives, drug consumption facilities can serve as paradoxical stepping-stones toward detox. They bring the very real work of designing for harm reduction into the public eye, while also providing private, dignified spaces that benefit both users and nonusers. Though these facilities are sadly only born out of crises, the progress in their design represents a change in public and political attitudes, an area in which the U.S. still has a long way to go.

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Staten Island’s historic Seaview Hospital to become city’s first integrated health campus

A proposed development in the middle of Staten Island could put the borough at the forefront of healthcare design. Borough President James Oddo, NYC Health + Hospitals President and CEO Dr. Ram Raju, and NYCEDC President Maria Torres-Springer were at the Old Sea View Hospital campus to reveal plans for Sea View Healthy Community, a mixed-use development that focuses on chronic disease treatment and prevention. The first of its kind in New York City, and the first publicly funded mixed-use health development in the country, Sea View Healthy Community will be constructed on the grounds of largely abandoned Old Sea View Hospital. The development will feature housing for seniors and people with disabilities, and existing medical tenants will enjoy upgraded facilities, plus a new "wellness center" designed for physical and occupational therapy. Patients, residents, and visitors will be able to dine at farm-to-table restaurants or purchase groceries from on-site stores that specialize in healthful and local food. Bike paths and hiking trails will link up with the adjacent Staten Island Greenbelt. “Sea View Healthy Community is not just the first health-focused, mixed-use campus in the city, it will be the first publicly planned and supported healthy community in the country,” said Torres-Springer. “And what better place to build it than the Sea View campus, which pioneered a holistic approach to healthcare for previous generations of New Yorkers. This extraordinary project will improve the quality of life for thousands of Staten Islanders, and keep New York City as a national leader in pioneering approaches to public health." The hospital, which opened in 1913 to help tuberculosis patients heal in a bucolic setting, sits across the street from the Landmark Colony, a former city-run poor farm that is being converted into senior living complex by Staten Island–based vengoechea + boyland architects. Today, both sites are part of the New York City Farm Colony-Seaview Hospital Historic District. The city will make capital funds available for infrastructure improvements on the 90-acre campus. Any development at the hospital must first garner Landmarks Preservation Commission (LPC) approval, but the commission is not opposed to new construction: In March of this year, the LPC okayed plans for a two-story building for the nonprofit Meals on Wheels on-site. Later this year, NYCEDC is set to release a formal Request for Expressions of Interest (RFEI) to solicit development proposals that align with the master plan.
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Indiana University Health hires HOK to masterplan medical campus in downtown Indianapolis

Healthcare in the Indianapolis area is getting a check-up, as a new masterplan seeks to streamline operations at one of South Central Indiana's biggest medical institutions. St. Louis–based HOK is leading the design team, which will take on three big jobs: merging Indiana University Health Methodist and IU Health University hospitals’ adult services into one academic medical campus in downtown Indianapolis; building a new regional academic health campus in Bloomington, Ind.; and bringing women’s services near Riley Hospital for Children closer to IU Health in Indianapolis. The project includes an expansion of IU Health's campus north of Indianapolis' central business district, and improving its connections to Riley Hospital for Children about 1.5 miles to the southwest. Several urban planning overhauls are underway in Indianapolis, including a contentious expansion of public transit.
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Can the Martin Luther King Jr. Community Hospital help heal South Los Angeles?

In 2007, Martin Luther King Jr.–Harbor Hospital in South Los Angeles was shut down after failing a federal inspection. The facility opened to the public in 1972 and served Watts and Willowbrook in the wake of Watts Riots. The groundbreaking was in 1968, the year of the assassination of Dr. King, the hospital's namesake. But instead of fostering healing by bringing good medical care to the community, the hospital was plagued by a series of allegations of poor care and patient deaths. The closing, however, left residents without a full-service medical center. At the time the New York Times reported the tangle of racial politics that led to the demise—a kind of political neglect that still is all too familiar today. “It suffered what has often been called the soft bigotry of low expectations, because the Board of Supervisors were aware that the hospital was being nicknamed killer king by people who lived in the neighborhood and they continued to hide the ball,” Joe R. Hicks, vice president of Community Advocates, Inc., a Los Angeles research group, told the Times in 2007. Eight years later, healthcare has returned to the neighborhood. The Martin Luther King Jr. Community Hospital was officially dedicated in a ceremony led by County Supervisor Mark Ridley-Thomas on August 7, just days before the fiftieth anniversary of the Watts Riots. Designed by HMC Architects, the 280,000 square foot, 120-bed facility began operation on July 14. The $210 million community hospital is adjacent to a multi-clinic outpatient center completed in June 2014 and part of a $650 million medical campus. A metal and blue-green glass entrance welcomes patients and visitors. In keeping with studies that show correlations between nature, health, and recovery, the new campus integrates landscape and accesses to natural environments with delighting and a warm color palette. Additionally, over one million dollars in public art projects, funded by the county, are installed throughout the hospital. “We wanted to create a beautiful, efficient hospital that would be as at home in Beverly Hills as in South Los Angeles,” said HMC Architects’ Kirk Rose “Too often economically challenged communities receive poor design, and we wanted to prove with this hospital that aesthetically pleasing, effective design doesn’t have to cost a fortune.”
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Unveiled> Egypt’s National Cancer Institute hires SOM for 9 million square foot campus

Looking to expand its footprint across 35 acres outside Cairo, Egypt's National Cancer Institute has hired Skidmore Owings & Merrill to design and plan nine million square feet of healthcare space for an “international nexus of cancer research, education, and discourse” that is targeting LEED Gold. Situated in Giza's Sheikh Zayed City, approximately 17 miles west of central Cairo, the sprawling new cancer center is organized around modules and separate circulation spines for staff and patients. The whole facility is undergirded by a massive support plinth sitting atop six levels below grade. Above that subterranean campus, six towers for inpatients shade outdoor courtyards, while four more comprise the outpatient facility. Both complexes connect to a “multilevel diagnostic and treatment platform” with imaging equipment, surgery centers and all kinds of treatment. The center includes ample space for training new medical professionals, including a 1,000-bed teaching hospital and research center, nursing and technician training institutes and a scientific center. Despite its mammoth size, the 200-acre campus is intended to feel cohesive, according to SOM's project description, because of its highly organized layout.
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Unveiled> Foster + Partners’ Health Education Campus in Cleveland

Cleveland's ongoing efforts to solidify its place among the nation's top cities for medical education got a new face last week when Foster + Partners unveiled new designs for a joint "Health Education Campus" run by the Cleveland Clinic and Case Western Reserve University. The 485,000-square-foot building, sited for the intersection of East 93rd Street and Euclid Avenue, conceals millions of dollars of medical equipment beneath a broad, overhanging plane meant to recall the midwestern horizon. The designers are targeting a Spring groundbreaking date, assuming they get approval from the city's Planning Commission on meetings scheduled December 4 and 5. As the Cleveland Plain Dealer's Steven Litt observes, the building—which could cost anywhere from $197 million to $388 million—is part of a larger trend:
The Cleveland Health Education Campus is part of a national construction boom in medical education. The medical college association's website lists 145 current projects at colleges and universities that total $30.4 billion.
In an accompanying commentary piece, Litt lauds the project as "a fresh sign of Cleveland's evolution as a postindustrial city" but raises questions about Cleveland's reliance on outside architects. Cleveland Clinic has been rolling out its expansion for years, a process which is helping remake the University Circle area of the city.
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Winning Moved to Care Design Brings Mobile Healthcare to Southeast Asia

A team of American architects and public health professionals has won an international competition to design a mobile health center for impoverished communities in Southeast Asia. The Moved to Care Design Competition, which received more than 200 entries from around the world, called on designers  “to create an innovative design solution for a relocatable healthcare facility.” The winning team of Patrick Morgan, Jhanea Williams, and Simon Morgan designed a colorful, compact, and secure healthcare structure that can be easily transported. The multi-purpose space can also serve as an educational hub for the surrounding community. “Working through design challenges we focused on how architecture and public health were consistently always beneficial to each other, focusing on not only the clinical aspect, but also the community that will be affected by the facility,” said Patrick Morgan in a statement. The jury also announced Christopher Knitt from the University of Wisconsin–Milwaukee won their student competition. The competition was organized by Building Trust International, a non-profit that helps bring design projects to impoverished parts of the globe. David Cole, the organization's founding partner, said in a statement, “we look forward helping realize the project over the coming months.”
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Michael Graves’ paralysis informs design for Omaha Rehabilitation Hospital

The architect of Omaha’s new rehabilitation hospital says his own paralysis has given him “greater empathy,” which has informed his designs for the healthcare industry. Local firm DLR Group and Texas-based engineering firm Page are working with Michael Graves, who lost the use of his legs in 2003 as the result of an infection, on the $93 million Madonna Rehabilitation Hospital in west Omaha. Expected to be complete in 2016, the facility will use technology to afford sedentary patients greater control over the TV, thermostat, nurse call system, and other things in their room. Omaha’s World-Herald describes how Graves, 79, drew from personal experience while designing the 250,000-square-foot hospital:
Giving patients some control over their environment is important, said Graves and Patrick Burke, a principal in Graves' firm. Graves recalled one instance early in his rehab when he was being transferred from his bed to a chair using a motorized sling. “I was getting into the chair that day and I was up in the air, in a sitting position over my chair but not in it yet. The nurse's aide's friend came in and said, 'It's time for our break.' So they left me there dangling in the air and they went on a break. That's as low as it gets.”
The average stay at Madonna is more than 30 days, but residents tend to be more mobile than many hospital patients. That creates a need for active social spaces, Graves said, but also a pitfall: many architects want hospitals to resemble hotels. “Well, I don’t,” he told the Omaha World-Herald's Bob Glissmann. “I don't think it needs a big atrium and I don't think the rooms have to look like a hotel room. These are hospital rooms, and you want to have good care. What makes the difference is the empathy.”
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Report: Hundreds of Historic Properties at Risk Due to VA Negligence

Hundreds of historic buildings and landscapes under the administration of the US Department of Veterans Affairs (VA) are at risk of being abandoned or demolished, claims a study from the National Trust for Historic Preservation released earlier this month. According to the report, entitled "Honoring Our Veterans: Saving Their Places of Health Care and Healing," the VA has failed to comply with federal preservation requirements and maintain their historic properties, some dating back to the Civil War. The agency has instead favored the expensive construction of new facilities. Owners of over 2,000 historic buildings and landscapes across the country, including hospitals, cemeteries, farm houses, and residences—nearly half of which are unoccupied and at risk of deterioration—claim the VA is currently constructing $10 billion worth of new medical centers despite analysis revealing that it may be more cost effective to renovate existing properties. Texas attorney and preservation expert, Leslie Barras, argues in the report that the VA’s poor management has lead to “wasted taxpayer dollars and the irreversible loss of our nation’s cultural legacy.”  The National Trust particularly highlights two projects, the Battle Mountain Sanitarium in Hot Springs, South Dakota, and the Milwaukee National Soldiers Home in Wisconsin, both of which have been designated “National Treasures” by the organization. Battle Mountain Sanitarium was built in 1907 using local sandstone in the Spanish Colonial/Romanesque Revival style. Architect Thomas Rogers Kimball designed the building to provide short-term respiratory treatment for veterans of the Civil War. Instead of restoring the historic building, the VA is proposing to close down the facility and relocate its medical services 60 miles away, citing the claim–identified by the report as false–that patients and staff would prefer a new facility. Another Civil War–era property, the Milwaukee National Soldiers Home and its campus, represents one of the first buildings of its kind in the country as well as some of the oldest in the VA’s holdings. Designed in a Gothic Revival style by Milwaukee architect Edward Townsend Mix in the 1860s, the campus’ stunning "Old Main" stands unoccupied, unmaintained, and in danger of collapse. While the VA’s stock of buildings crumbles, the number of veterans turning to the department for healthcare in the has dramatically risen in the past decade, climbing from 3.4 million in 2000 to 6 million today. But according to the report, the VA has repeatedly elected to construct new facilities instead of putting in the effort to restore and maintain their amazing wealth of historic properties. As Barras told the LA Times, “there’s a perspective that we can’t adapt old buildings, especially for medical facilities.” (Prentice Women's Hospital, anyone?) But preservationists are trying to change that notion.