Turner Construction – Laguna Honda Hospital

The Laguna Honda Hospital Replacement project in San Francisco will give residents and staff an updated facility with state-of-the-art design and a substantially better quality of life. “We are glad to be a part of this remarkable project,” says Ron Wilcox, project manager for Turner Construction. “It will be the most advanced residential care facility in the United States, and the first LEED-certified hospital in the state of California, earning Silver status.”

The new facility is a three-building skilled nursing facility totaling more than 500,000 square feet. An additional 150,000 square feet of the existing facility will also be remodeled. The hospital is situated on a hilly 62-acre site on Twin Peaks, adjacent to the landmark Sutro Tower. The seven-story north residence building and six-story south residence building are built with a steel frame, with a stucco exterior. The pavilion building includes four stories with a steel frame, curtain wall exterior, and houses food service, rehabilitation, and support services, Wilcox says. The project volume is in excess of $300 million and the grand opening is scheduled for June 24. 

A better quality of life is the primary benefit the 780 residents – primarily seniors and adults with disabilities – will receive. Laguna Honda opened in 1866. The current facility was built in the 1920s, providing ward-type housing with little privacy. The suites in the new facility will have one to three private bedrooms with a shared bathroom, he says. The residential buildings will be organized into households of 15 rooms each. Four households on each floor make a neighborhood that is organized around a central great room for meals and socialization, Wilcox explains. Primary design elements include a focus on wayfinding, location identity, sensory stimulation, encouragement of activity, as well as stimulation of memory and exposure to nature.

The entire campus and parkland is intended to provide a small-town feel and sense of community to the residents and staff. Incorp­oration of artwork, coordinated by the San Francisco Arts Commission, is a key, highly visible feature of the new facility.

The average stay for residents who are aiming for independent living is four-and-a-half months; for permanent residents, it is five years. 

The campus will have a petting zoo, an orchard, a greenhouse, walking paths, a meadow and a secure therapeutic garden, he adds. The pavilion building will have a café, art studio, multimedia library, barber and beauty shops, tropical bird aviary, bamboo garden, cafeteria with indoor and outdoor seating, as well as isolation rooms, radiology, audiology and rehabilitation areas. Exercise/rehabilitation facilities include a basketball court and two indoor therapy pools.

Healthcare Requirements

Turner is serving as the construction manager at-risk for the project. The project broke ground in July 2005 and has faced numerous challenges. For example, “to provide bid coverage, and to open bidding to more local and disadvantaged subcontractors, each building, the site work, and the remodel have been permitted and bid separately,” Wilcox says. “Although major subcontractors were successful in securing all three buildings, Turner manages separate contracts for each building, the site and the remodel, so some subs have up to five separate contracts.”

The space constraints also presented challenges, especially when installing mechanical, electrical and plumbing systems as overhead space was limited. “Although the new buildings were specifically designed at a scale that did not represent high-rise construction, it is a healthcare facility, so there are space demands related to HVAC, technology systems and additional utilities such as medical gas, fire protection, nurse call, patient wander, security and integrated facility management systems,” he says. 

The facility also includes emergency backup power systems, dual fuel heating and kitchen boilers, radiology equipment and dedicated electrical systems. This project was overseen by California’s Office of Statewide Health Planning and Development (OSHPD). 

“To date, the project team has facilitated the incorporation of over 9,300 requests for information and 1,000 OSHPD change orders,” Wilcox adds. Selection of certain aspects of the design were implemented late in the process in order to utilize the latest technology. “To keep pace, the architect, Anshen & Allen Architects, had an on-site construction administration staff of up to 10 full-time employees. The owner has provided on-site management and inspection support staff, which peaked at 10. At the peak of construction, we averaged over 120 inspection requests per day.”

Utilizing Best Practices

The replacement hospital is a Pebble Project, an initiative started in 2000 by the Center for Health Design. The program is a partnership between 20 healthcare providers nationwide, which allows them to collaborate to implement and analyze the benefits of incorporating best practices in design and procedures to support their clinical needs. 

“As a Pebble Project, Anshen & Allen Architects utilized evidence-based design principles in developing the new facility, which will provide increased sense of wellness for the residents and improved working conditions for the staff,” Wilcox says. “Pebble program participants share research and data regarding the more efficient and healthy ways to design and operate healthcare facilities nationwide.”

More daylighting, allocation of space and artwork were incorporated into the facility based on that data, he says. “There is a very diverse collection of artwork,” Wilcox stresses, which provides residents with cognitive challenges landmarks to assist in finding their way to their household or room using the color and art as a guide. The artwork also provides sensory stimulation, as well as establishing an identity for specific areas, and enhancing the mood and alleviating stress in the residents, which can result in lower medication rates and increased rehabilitation progress.

“Being a Pebble Project sets us apart,” he adds. “The design is based on improving quality of life along with efficient medical practices. The facility and finishes are more upscale and much nicer than a typical hospital.”

The project is on track to be the first LEED Silver-certified hospital in California, he adds. The facility will implement recycling and public outreach programs. It has a high level of energy efficiency, generous use of recovered open space and is supported by nearby public transportation.

Meeting New Standards

San Francisco’s commitment to long term care for seniors and adults, the age of the existing facility as well as the new seismic standards set by OSHPD were the main reasons why the San Francisco Department of Public Health decided to go forward with the project. “It is often more cost effective to build a new facility in California than to seismically upgrade the old one,” Wilcox explains.

The new facility shares the same site as the existing hospital, he adds. After the residents move in late this summer, portions of the old facility will be demolished and others will be used for administrative support. 

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