the newsletter of tbd consultants - 4th qtr 2013

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In this Edition

VA Healthcare System
Nursing Homes
Battle-Weary Market

Construction Management Specialists

111 Pine Street, Suite 1315
San Francisco, CA 94111
(415) 981-9430 (San Francisco office)
9705 Cymbal Drive
Vienna, VA 22182
(703) 268-0852 (Washington, DC office)
4361 35th Street
San Diego, CA 92104
(619) 550-1187 (San Diego office)
8538 173rd Avenue NE
Redmond, WA 98052
(206) 571-0128 (Seattle office)


VA Healthcare System

The VA can trace its ancestry back to the early years of the nation. The first Federal medical facility for veterans was the Naval Home, Philadelphia, PA, built in 1812, followed in 1853 by the Soldiersí Home and then St. Elizabethís Hospital in 1855, the last two both being in Washington, DC.

World War I brought increased need for veteransí services and in 1930 the Veterans Administration (VA) was brought into being under President Hoover. World War II increased that need even more substantially and the number of VA hospitals rose accordingly.

In 1988 the VA gained cabinet status under President Ronald Reagan, and in 1989 Ed Darwinski became the first Secretary of Veteran Affairs under the George H. W. Bush administration. The largest section of the Department of Veteran Affairs (VA) is the Veteran Health Administration (VHA) which has more employees than the other two sections of the VA combined. Those other sections are the Veterans Benefits Administration (VBA) and the National Cemetery Administration (NCA).

The Department of Veterans Affairs Act, 1988, and a task force created in the early 1990s in relation to the Clinton Healthcare Reform proposal, led to an increase in primary care being made available through the VA.

The Department of Veterans Affairs Act, 1988, and a task force created in the early 1990s in relation to the Clinton Healthcare Reform proposal, led to an increase in primary care being made available through the VA.

Nowadays, based on hospital count alone, the VA Healthcare System would rank among the top ten hospital systems in the nation in size, and that is after it has actually been reducing the number of its hospitals in favor of providing more clinic facilities to better meet its needs. The VA healthcare system also scores highly in patient satisfaction ratings. Traditionally, veterans have been almost exclusively male, but with the opening up of the military to both sexes, womenís health has been an additional service provided by the VA, but it is estimated that almost 50% of eligible women do not use the service because they are currently unaware of its availability.

The VA system is involved in research in many medical fields, the development of improved prosthetic limbs and the treatment of PTSD (post-traumatic stress disorder) being obvious ones, along with such things as Parkinsonís Disease and spinal cord injuries.

The VA also provides nursing home or assisted living accommodation through Community Living Centers (CLCs). The last count of VA health care facilities that we can find lists 171 medical centers, over 350 clinics, 126 nursing home care units, and 35 domiciliaries.

Electronic medical records have proved to be extremely useful to patients and to medical practitioners, and the VA has developed its own low-cost open-source system, known as VistaA, that not only records a patientís medical history, but via the use of bar-codes on medicine containers and on patient wristbands, helps monitor the medications being given, to ensure that any errors are caught in time. Medical providers can also access the VistA system remotely with secure access.

Many of the VAís buildings are historic, and the VA Historic Preservation Office helps monitor compliance with Federal preservation requirements.

The wars in Iraq and Afghanistan, sadly, have led to another influx of veterans requiring medical attention, and the Fiscal Year 2014 Military Construction and Veterans Affairs Appropriation Bill provides $73.3 billion in discretionary funding ($1.4 billion more than for 2013). Fortunately, the VA is one area of government work that is largely immune to the automatic budget cuts resulting from sequestration.

For design professionals involved with new or renovation work to VA facilities, the VA provides Design Guides that clarify the scope requirements of the VAís various building types, and are designed to help speed the design process. The Design Guides are being constantly updated to conform to current practices and technology.

The fact that the VA is building the same kinds of structures throughout the US provides a valuable source of comparative cost data, and the VA publishes the costs for its various building types for each of its regions (for both new and renovation work), along with a comparative city cost index.


Nursing Homes

Life-span has been increasing, which is good, but that has also led to increasing numbers of elderly who require regular assistance and special housing facilities. In this article we look at some of the features of nursing homes.


Battle-Weary Market

The economy is improving, but many people still have a hard time believing the recession is over. Investors seem to view good signs as bad news, and employment isn't increasing anywhere near as fast people would like. Here our editor look as some aspects of this battle-weary market.



Design consultant: Katie Levine of Vallance, Inc.