Archive for January, 2010

HUD and USDA Financing for Critical Access Hospitals (CAH’s)

January 31st, 2010

The intent of this blog is to help Critical Access Hospitals with an overview of the steps required to submit for federal funding for a replacement hospital.  The general steps listed below apply to practically all hospital financings, including HUD, FHA Hospital Mortgage Insurance Program and the United States Department of Agriculture’s (USDA) Guaranteed Loan program.

Both of these programs will require the hospital to select a lender, as the programs offer mortgage insurance (HUD) or a loan guarantee (USDA), not an actual loan.  The hospitals and the selected lenders or mortgage bankers will be co-applicants to the appropriate agency.

Step 1)  Planning & Preparation

Step 2)  Facility Design & Financing

Step 3)  Endorsement

Step 4)  Construction

These seem like easy steps, but in reality they are comprised of many smaller steps that are costly and time consuming, and which can vary depending on the particular program selected.  However, if the candidate hospital decides very early on in their scoping process, to apply for funding under these federal programs, then the project can align itself with the requirements of these programs during the natural evolution of the project.

It should be noted that all of the upfront development costs will be borne by the hospital, so the path forward should be planned very carefully and milestones set for both schedule and budget adherence. The HUD program (and USDA) allows for these costs to be included in the financing; thus they can be refunded to the hospital if the insurance/guarantee is eventually approved.  The USDA and HUD urge the candidate hospital to get knowledgeable and experienced project management and design teams involved to assist with achieving goals and expectations of these federal programs.

Step 1:  Planning & Preparation – duration 6 – 12 months

The action steps in this phase represent the starting points for community support, determination of the debt capacity of the hospital, financing strategies, physical plant requirements, and the selection of the project team, among others.  Some will vary depending on the requirements of your State and local jurisdictions (ie:  if your State requires a Certificate of Need “CON”, bond offerings: type of feasibility/market study, etc.).

At the end of this Step, the hospital should have achieved these goals:

  • Obtain approval from the Board to investigate replacing the hospital
  • Filed the CON application (if required) with the State
  • Obtained debt capacity analysis
  • Completed market demand analysis for a new hospital
  • Implement Financing Strategy
  • Discuss hospital relocation with CMS
  • Engage local USDA or HUD representatives
  • Interview and hire financial, project management and/or architectural professionals
  • Apply for interim funding with a lender (if applicable)
  • Complete land acquisition
  • Draft the architectural programming and space planning
  • Develop Total Project Budget (including land, professional fees, equipment and construction costs)
  • Engage community and community leaders
  • Implement community capital campaign (if necessary)

Step 2:  Facility Design & Financing – duration 3 – 12 months (with some overlap to prior step)

The financial models completed in Step 1, will be built upon and enhanced.  At the completion of Step 2, the hospital should be able to obtain financing proposals from lenders.  The federal program applications will also be submitted during this Step.

At the end of this Step, the hospital should have achieved these goals:

  • Obtain financing proposals from lenders
  • Obtain approval on the CON application (if required)
  • Submit applications to the USDA or HUD
  • Engage bond consul and issuing authority (if necessary)
  • Completed architectural construction drawings
  • Bid/Award the construction work to a general contractor

Step 3:  Endorsement – duration 1 – 2 months

The federal programs will review and either accept, ask for clarification/re-submittal or deny the applications.  If your project team has been working with the local government authorities during the previous Steps, the CAH should not be surprised by the requirements of this phase or the outcome.

At the end of this Step, the hospital should have achieved these goals:

  • Closed on the Bonds (if applicable)
  • Closed on the Loan
  • Receive initial funding and approval to begin construction
  • Begin construction
  • Continue capital campaign with the community

Step 4:  Construction – duration 12 – 26 months

Project management will be key during this phase to ensure the construction is completed within expected milestone dates and budget.  At the close of the project, the costs will be finalized and loan amortization begins.

At the end of this Step, the hospital should have achieved these goals:

  • Substantial Completion of the facility
  • Occupation of the Hospital
  • Cost certification
  • Final Closing of Loan

My deepest gratitude to Mr. Calvin Green, former CEO of Franklin Foundation Hospital.  Without Mr. Green’s support and leadership, Franklin’s replacement hospital would not have been such an enjoyable, successful and delightful project.  The City of Franklin truly has a hospital reflective of the magnificent people and history of their community.

For more on the HUD and USDA programs visit these websites below:

HUD

http://portal.hud.gov/portal/page/portal/HUD/federal_housing_administration/healthcare_facilities

USDA

www.ruralhealth.hrsa.gov

What’s Cooking – Week 3

January 29th, 2010

Last week’s menu plan yielded some great results. The dishes were easy to make and generally well received by my husband and son. The Chicken Piccata and Quinoa with Kale made for several tasty leftover lunches, as did the Chicken and Beef Stir-fry. We even experimented a little with the pizza, using some pesto and goat cheese on one half with pepperoni on the other. Yum!
This week I am planning on serving an old favorite (Meatloaf) and trying something completely new (Egg Fried Rice)! Quinoa makes another appearance, but in a different recipe. FYI, quinoa is a major source of protein containing all of the essential amino acids, including a hefty amount of lysine. Quinoa is commonly referred to as a grain, but it is actually the seed of a leafy green vegetable (similar to spinach and Swiss Chard). Use this nugget of trivia to impress someone at your next office happy hour or dinner party!
Over the weekend I picked up a copy of Martha Stewart’s Dinner at Home: 52 Quick Meals to Cook for Family and Friends. I’ve been pouring over the pictures and recipes and can’t wait to try some. I even have a quick dessert picked out for Valentine’s Day! In case last week’s post left you wondering which cookbooks I was using, I’ve included some references for this week’s meals.
Sunday – Meatloaf (The All New Joy of Cooking), Dirty Broccoli (Quick & Fresh with Ellie Krieger) and Herbed Quinoa (Giada DiLaurentis)
Monday – Maple Mustard Salmon with Gingered Snap Peas (Peace Meals)
Tuesday – YOYO
Wednesday – Jungle Curry (this is another short cut meal)
Thursday – Egg Fried Rice with Edamame and Tofu (Quick & Fresh with Ellie Krieger)
Friday – Homemade Pizza with Spinach, Arugula and Herb Salad
By the way, I finished watching all of the Chef Academy episodes that aired on Bravo recently. I’m not a big fan of reality television but the whole family found it addicting. It was inspirational as well as instructional – I am ready to try making the risotto that we watched the students prepare. Perhaps this dish will make an appearance in a future meal plan!
Until next week, bon appétit!

What’s Cooking this Week – Chez Mims!

January 20th, 2010

As a working mother whose husband’s culinary skills are limited to boiling water, I am faced with the challenge of providing nutritious meals for my family without adding stress to our already busy lives. What is the secret to providing healthy, tasty food each night when we don’t even get home until 6pm? You guessed it – planning!!!

One of my New Year’s resolutions is to provide better food for my family. For us, this means cutting back on meals at restaurants, using fresher ingredients, and serving meals that include most of the four food groups. At least I think there are four, and I am pretty sure that one of them is not pizza. My seven-year old is not convinced.

So, here I am at week two of my resolution (the first week we were out of the country and didn’t go to the grocery store for a while – so it didn’t count) and I am going to share with you what I am doing to achieve my New Year’s goal.

On Saturday morning, I wake up and start perusing my cookbook collection. As an aside, I LOVE cookbooks – reading them, looking at them, collecting them. Until very recently, however, I rarely used them for the express purpose of cooking. In any case, I keep them in the kitchen so they are within arm’s reach should I feel inspired…

Using my cookbooks as a starting point, I start to build a menu of dishes that are easy to assemble and won’t take too long. For the dishes that take the longest to prepare, I schedule these for Sunday, when I have a few extra hours to spend in the kitchen. I also keep a calendar of our family’s activities in the kitchen, so it is easy to see when we have plans or commitments and won’t be cooking, in which case I tell everyone YOYO (you’re on your own). Usually there are some leftovers in the fridge.

This past Saturday I decided on the following meal plan:
Sunday: Chicken Piccata with Quinoa & Kale
Monday: Chicken and Beef Stir-fry (a meal in itself)
Tuesday: YOYO (I have a meeting from 6-8pm)
Wednesday: Gnocchi w/ Italian Sausage and Spinach Pesto Salad
Thursday: Take-out Sushi
Friday: Homemade Pepperoni Pizza and Salad
Saturday: Dine out!

The next thing I do is use one of my favorite iPhone apps, Grocery IQ, to put together a grocery list. I add all of the items that I will need for the dinners I am going to make, and also the staples that we usually consume over the course of a week (apples, bananas, yogurt, milk, etc.). For me, it is critical to make sure that all of the ingredients for the recipes are on hand; if I forget one and someone has to run to the store, dinner is quickly derailed and I end up abandoning the project.

Sunday morning is our shopping day – we head out early before the grocery store gets too crowded and make our way through the aisles, list in hand. Now, part of what allows us to have dinner on the table in NO LONGER than ½ an hour are what I call “shortcuts.” You might pay a premium for shortcuts, but in our case it is important that we also be able to eat dinner before 7pm (we need the rest of the evening for homework, showers, and getting ready for the next day). For example, the shortcuts for Monday’s dinner (Chicken and Beef Stir-fry) include ready-made rice (already cooked and pre-portioned), marinated chicken and beef, pre-cut vegetables, and freshly made stir-fry sauce. When we are ready to cook, we heat up the wok, add the meats, add the vegetables, and add the sauce. This takes about 10-12 minutes total. While all of the activity is happening in the wok, the rice goes in the microwave to reheat. Dinner is served in 15 minutes!

The other weekday meals use the same strategy – for the Gnocchi w/ Italian Sausage I’ve found a wonderful fresh tomato sauce. For the Spinach Pesto Salad, I use prepared pesto. For the Pepperoni Pizza, we find that Pillsbury Pizza Dough (in a tube) works great. Admittedly the dough is not fresh, but I’ve heard that some restaurants will sell you their pizza dough to use at home.

The day we spend the most time in the kitchen is Sunday; it’s good to use those extra hours to prepare something that takes a little longer to make, or to make something where you know you’ll have lots of leftovers. Most of our dinners provide us with leftovers that we can take for lunches during the week, so we are outing even less at lunchtime.

Thankfully, my resolution has not been met with resistance at home. Everyone is willing to pitch in and help cook and clean up, and though there is less delivery pizza on the menu, we are on our way to a healthy New Year!

Working w/ Remember the Milk

January 11th, 2010

Here at Milestone, we have been working with one of our clients to provide real time up to date access to project information. Check out the site here.  By using this third party application, anyone with privilages can log into the project and view action items and tasks on either their computer, laptop, iphone or blackberry.

Everyone associated with this in-house project is very excited to have our communication available for our clients staff, architects, contractors, and other consultants.  We are developing timelines and protocols over the next few weeks that should have all involved in a project contributing to this central database.

We have found that in order to use this application, there are some groundrules that should be consistantly applied on each task and project tab.  Here is what we have developed this far:

1)  All tasks will be actions ie:  ”Sign Contract for GC”, not “Contract” or such.
2)  All tasks will be in their Project Folders
3)  All tasks will be taged with a person responsible for the task in this format ie:  -cmims, slatulipe, etc
4)  Notes can be written in a task, but must have the initals of the author, ie:  -eserna, cmims, etc
5)  Project Tabs will be named their Project Numbers.

We would like your feedback on how you are working with RTM, please let us know your success stories and what just simply does not work.

Thanks, Eric