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Ontario Long-Term Care Capital Projects: Taking the First Steps

by Andrew Rodrigues | Oct 30, 2020

For many existing Long-Term Care (LTC) operators, it may seem like a daunting task to navigate the development or redevelopment process beyond the daily duties of providing resident care. During the past several years, the Government of Ontario has committed to adding 15,000 new LTC beds and upgrading 15,000 existing beds to meet current design standards. In July 2020, the government announced an improved funding model to further accelerate the development of LTC homes.

LTC homes with well-defined projects that respond to future care and service needs, and are supported by robust business cases, are poised to take advantage of the current environment and receive the necessary approvals. To help you get started and stay on track, here are three areas you’ll want to consider.

Define and Align Your Vision

Successful project delivery enables organizations to achieve their business goals and objectives. It is essential to take the time upfront to clearly define the project by articulating what the organization is trying to achieve, and what is needed to meet these goals. An organization that envisions creating a campus of care with various housing options, for example, would likely have different objectives and implementation strategies than an organization looking to redevelop its home to comply with current design standards. In both cases, conducting an in-depth assessment of local needs and market capacity is a good idea to identify gaps and inform proposed care programs, services, staffing levels and physical space requirements. Consider bringing in an external facilitator at this stage to help your organization with this type of visioning and strategic planning.

It’s also valuable to connect with peers and other organizations to arrange for tours (in person or virtually) to assess different operational approaches and care models. This helps further validate your key assumptions on space requirements, as well as the benefits that can be delivered to residents and staff. For example, operators may be interested in learning more about smaller Resident Home Areas (RHAs) that accommodate fewer residents than the Ministry’s current standard of 32 residents. Evidence has shown that smaller groupings can help improve quality of life, especially for residents with the most complex care needs. Establishing these connections enables you to gain valuable knowledge that can reduce overall risk when delivering your project.

Finally, it’s important to recognize that organizations are competing on a provincial scale for capital funding. To make an impact, you need to clearly demonstrate how your project will help address future community needs, while also aligning with provincial priorities, such as helping to end ‘hallway healthcare’. Organizations with a compelling vision for how their capital project will make a difference will be best positioned to succeed.

Establish Realistic Baselines

Starting off on the right foot involves developing a strong business case and setting up realistic baselines for project costs, time and scope. As you make project decisions and new information becomes available, you should continually update, refine and validate your assumptions to develop more accurate forecasts. In the early project stages, a thorough assessment of physical space requirements (scope) and how the space will be used to deliver your intended programs and services, will lead to a higher degree of accuracy when forecasting building gross area and, in turn, construction cost. A functional program is a powerful tool that can be used at this stage to help avoid underestimating the space requirements associated with the envisioned care programs and services.

Your cost baseline should be reflective of local market conditions and include sufficient allowances for escalation based on the anticipated tender and construction period for the project. Escalation impacts alone can be significant – at times upward of 5% per year – highlighting how critical it is to factor this into your construction and overall project budget from the onset, and to calibrate it based on your master project schedule and anticipated construction timelines.

In addition, a strong business case detailing planned funding sources and uses over the construction and operating periods is one of the most valuable tools available in determining the overall financial feasibility of your project. A solid business case equips your organization’s management team, and board of directors or council with the necessary financial information to make informed decisions about the project. It will also help you to obtain the necessary lender support to accompany any Ministry application.

Manage Risk

From project initiation through to the grand opening of a new or redeveloped LTC home, managing risk is one of the most important activities to ensure the success of your project. This process involves risk identification, qualitative and quantitative analysis, response planning, monitoring and controlling, and reporting on a periodic basis.

As an effective starting point, consider using a risk checklist based on risks that have occurred during previous LTC projects of similar size and complexity. You can obtain this information from your own experiences with past capital projects or from your project manager. Consider contacting organizations with current or recently completed projects to incorporate relevant lessons learned. A risk identification workshop is also a good practice, enabling you to draw upon the collective wisdom and foresight of your consulting team and senior managers.

In addition to managing the technical aspects and associated risks of a new project, considering the operational readiness of your new LTC home is equally important in ensuring overall project success. A new home represents a significant change for the staff, families, residents, volunteers and community members who have created meaningful memories over the years. It is important to acknowledge this, and to put in place appropriate strategies to ensure that your team will be ready to perform on the day the doors open in the new space.

The successful delivery of LTC capital projects improves the quality of life for residents and provides important benefits to staff. It also plays a vital role in strengthening our communities and health care system. A focus on these three areas will help you to confidently take the first steps in getting your project started and keeping it on track throughout this very exciting journey.

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