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Wonkitq fon you REPORT

Meeting Date: September 12,2013 Regional Council

For Information

DATE: August 12,201 3

REPORT TITLE: PEEL MANOR BUILDING ENVELOPE STUDY RESULTS

FROM: Janette Smith, Commissioner of Health Sem'ces

OBJECTIVE

To provide the results of a technical study into the condition of the building in which Peel Manor Long Term Care and Community Support Services operate, and propose next steps taking into consideration the discussions at the Aging Population Term of Council Priority Steering Committee.

REPORT HIGHLIGHTS Peel Manor is located in a central Brampton location and has cared for vulnerable citizens for the past 1 15 years. In 2012 capital budget staff identified that significant funds will be required to maintain the building, so a comprehensive and intensive study of the building envelope was undertaken, The study concludes that costly and disruptive capital improvements will fall short of a satisfactory long tern result: for Peel's aging population demands.

* Resident and employee health and safety are not expected to be compromised during the current review and planning period. Total estimated cost of these renovations Is in excess of 85 per cent of the estimated cost of a new build. Information gathered for, and presented to the Aging Population Term of Council Steering Committee will help paint a picture of the system of services for seniors in Peel, including the long tern care sector, and the Region's role, Regional staff will work with the Central West Local Health Integration Network to develop a strategic approach and conceptual plan, informed by the work of the Steering Committee, and bring back high level options to Council.

DISCUSSION

1. Background

The Peel Manor site has a long history of serving the Region" most vulnerable citizens. From its conception in 1896, when the Wamen's Christian Temperance Union of Brampton and Port Credit pressured Peel County Council to find better accommodation than the jail for the destitute, to the present, where Peel Manor Long Term Care Centre serves 173 long term care residents and 30 adult day program participants.

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The original House of Refuge was built in 1898 with an addition in 1926. In the late 1950's and 1960's Peel Manor primarily served as a home for the aged. The structure also changed with the addition of new nursing wings and amenities. These renovations have included:

1960: a two-storey addition to the west and construction of an auditorium and chapel at the front of the building saw the final demise of the original House of Refuge on the site. Carnegie Place Adult Day Program and Huxley Hall now occupy the site of the original building. 1977-1978: renovations were made to the oldest part of the building housing the administration office and front entrance. 1980s: A new wing was added featuring rooms with ensuite washrooms and closets. 1990-1994: A major renovation and addition of a new wing to modernize the resident accommodations throughout the building was completed.

While the original Peel Manor lands of about 100 acres were owned by the Region of Peel, much of the property was sold in the 1980s to support Brampton's growth. Development on the site include:

The City of Brampton established a large open community park; Peel Living built family townhouses and an 88-unit seniors' apartment building; Other sections of the site were developed for community health and social services, including the Salvation Army Family Life Resource Centre and Cheshire Homes; Most recently Nance Horwood Place, a 30-unit seniors building, was constructed by Peel Housing Corporation and is operated by Supportive Housing in Peel (SHIP); In recent years the site graveyard was bequeathed to the City for perpetual maintenance.

The remaining site is 11 acres, accommodating the large horizontal footprint of the current Peel Manor building and a small parcel of undeveloped land (See Appendix I).

2. Current Physical Conditions

From 2002-2013 $7.6 million has been spent on project work covering a wide range of issues including waterproofing a foundation wall; renovation of Huxley Hall; updating the building's automation system; replacement of metal frames of exterior doors etc. This represents 42 per cent of the entire capital budget ($18.3 million) for all of the five LTC Homes. Additionally an amount of $3.4 million in capital funding is earmarked but not yet spent as at March 2013, to address necessary replacements and capital improvements.

During planning for the 2012 capital budget, the Capital Asset Management staff identified increasing concerns about the overall condition of the building and the remaining useful life of its major operating systems. Peel Manor accounted for more than half of the proposed spending in the LTC Division's 10-year capital plan.

As indicated in the budget documents, this prompted the decision to commission an independent and objective study to evaluate the physical condition of the building, as well as to explore the building's ability to comply with the Ministry of Health and Long-Term Care (MOHLTC) design guidelines, both present and future, and to respond to the needs of the resident population.

This report presents the results of the building study and proposed next steps.

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3. Results of the Building Envelope Study

a) Technical Findings

MMMC Architects and Pinchin Environmental Ltd. were retained by the Region to evaluate the current state of the building. The study, performed in 2012, had two primary objectives:

To provide a thorough and intrusive Building Condition Audit and forecast a corresponding Capital Expenditure Study to address issues cited with the physical condition of the centre. To access compliance with the current MOHLTC Home Design Manual 2009.

The study concluded that much of the building's physical plant, exterior envelope and operating systemslcomponents will need major capital improvements to maintain an overall state of good repair. Several building elements, such as building heating, ventilation, and air conditioning are now approaching the end of useful life and replacing them with a "like for like" operating system is not feasible or viable in many cases.

As the building has evolved and grown, major operating systems have been extended and have reached the limits of their capacity to meet the demands placed upon them. As these systems approach end of useful life, it is expected they will struggle further with demand load. The report cautions that upgrade retrofit andlor replacement work to remedy existing conditions will be very complex and expensive to perform.

The most problematic building elements associated with the most significant repair costs are:

Heating, Ventilation and Air Conditioning (HVAC); Plumbing; Mechanical systems; Power distribution; Fire alarm system; Nurse call system; Electrical interface; A large portion of the interior finishes.

The report states that the building envelope is of paramount concern, particularly the exterior wall assembly of the 1960 construction and portions of the 1984 building construction. The complete re-construction of these portions of the exterior wall assembly is recommended to remediate the lack of airlvapour barrier and the absence of thermal insulation and to address multiple deteriorating masonry conditions.

The report also notes that Designated Substance Surveys confirm some areas of the building still contain encapsulated asbestos that must be removed before several areas of concern described in this report can be addressed.

The value of the recommended work, over a 15-year period, is expected to approach $22.0 million in 2012 dollars. The realistic costs associated with providing infection control protocols and performing work within the constraints of an occupied long term care centre environment increases that cost to $34.0 million. In all planning scenarios particular care was taken to ensure that there would be no significant compromise to building safety. All steps in any remedial work accounted for the vulnerable clients and employees health and safety.

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The report also anticipates an additional 33 per cent in associated "soft costs" which includes professional consulting fees, permits, inspections, and contingencies. The addition of these costs brings the total net present value of the recommended capital improvement costs over the next 15 years to $46.0 million.

b) Other Significant Considerations

To be diligent, a decision to address the capital improvements recommended by the report would also need to consider a range of non-technical and non-fiscal concerns.

The report confirms that, despite the best planning efforts to mitigate disruption of essential services, the nature and extent of the recommended capital improvements would require sequential construction activities to be performed on an essentially continuous basis over 15 years. The centre's ability to absorb the impact of this disruptive activity on both its operational and service delivery models would need to be considered.

The complexity and magnitude of work required, combined with responses to unforeseeable conditions and work-around scenarios, will undoubtedly result in ongoing displacement of residents and programs to a potentially questionable level of acceptance. For significant renovations, it may also be difficult to develop work plans while the centre is occupied that would be approved by the Fire Marshall, building officials, and Ministry of Health and Long-Term Care.

c) Meeting the LTC Design and Operational Needs

If the recommended work could be completed in some manner that addresses the aforementioned concerns, it is important to note there will still be several major compliance shortcomings with the Ministry of Health Long-Term Care Home Design Manual, 2009 that will remain unresolved.

While achievement of full compliance with the MOHLTC standards for existing buildings and design is not mandatory, addressing the centre's compliance shortcomings would require an entirely separate scope of renovations, with associated costs, in addition to those recommended by the study. The report notes that if such renovations were undertaken it would also result in a reduction of beds, since the design standards require more space per-bed, on average, than is achievable within the existing building foot print.

A paramount concern noted by the study was that many of the current building design elements pre-date the accommodation of resident clients with elevated acuity levels and bariatric conditions. To better respond to the needs of such clients through current design standards, the building would be subjected to complex and intrusive construction to address resident rooms, resident washrooms, and showerltub rooms size, layouts and door-width clearances, as well as size and locations of dining rooms.

Based on the evidence gathered through this comprehensive study, staff do not recommend that we continue to invest substantial capital dollars into a building that has no capacity to adapt to the changing needs of the clients it is intended to serve.

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d) Impact on Long Term Care Capital Plan

The 2013 budget contains a 10 year capital plan for long term care equipment and facility maintenance valued at $29.0 million, with about $9.6 million belonging to Peel Manor. Coupled with the $3.4M unspent from 2012, this total represents a significant per cent of the LTC Division's capital budget that will be required to be spent on Peel Manor over the next 10 years. The consultants report has shown that this budget is not adequate to continue providing a safe and stable environment for our residents. As stated earlier, the consultant indicated that an investment of $46.0 million will be required to maintain, retrofit and update to current LTC standards.

4. Planning for the Aging Population

Through the strategic planning process, Regional Council identified the need to plan for the aging population. The purpose of Term of Council Priority (ToCP) # I 1 is to: "assess the impacts of the aging population on health and human services delivered." The vision is for Peel to be an age-friendly community where seniors have access to supports that enable them to age safely and with dignity, and to maximize their quality of life.

Council's desired outcome for this work is to determine the appropriate roles and service levels for Regional services that will respond to community need, within the context of the broader vision for Peel, the Region's long-term financial plan, and the roles and responsibilities of our sector partners.

The Provincial Government has also identified planning for the aging population as a priority for Ontario. As described in the April 11, 2013 report to Regional Council titled "Provincial Action Plan for Seniors," the Government of Ontario has moved forward with its commitment to develop a Seniors' Strategy and has identified Dr. Samir Sinha as an advisor to the strategy's development and implementation. Dr. Sinha recently authored a report, "Living Longer, Living Well," containing 166 recommendations for provincial consideration.

The Region has identified a number of promising recommendations to inform policy or advocacy from a municipal perspective. Relevant recommendations by Dr. Sinha related to the Long Term Care sector include:

Flexibility to provide greater access to convalescent or respite care to support caregivers; Increasing their capacity to serve residents with complex care needs and to identify and manage health issues that could otherwise result in an unplanned hospitalization; Enhancing services, safety and the quality of life available to residents of long term care centres; Delivery of more home-based services that enable seniors to live in the community longer; Serving as community-care hubs, providing community-oriented services that support "aging in placen; A high value placed on support services such as Adult Day Programs to extend frail seniors independence and support of their caregivers.

a) Aging Population Term of Council Priority Steering Committee

To further guide the work under ToCP # I 1 and future decision-making related to planning for the aging population, Council approved the creation of an Aging Population Term of Council Priority Steering Committee on May 23, 2013. The purpose of the

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Steering Committee is to assess and make recommendations to Regional Council on the appropriate role(s) for the Region of Peel to support the aging population in Peel.

Information gathered for and presented to the Steering Committee will help paint a picture of the system of services for seniors in Peel, including the long term care sector, and explore research and best practices to support seniors in the community and potential plans for the future. The discussions of the Steering Committee and previous work conducted as part of ToCP #I 1 will help inform a high level conceptual plan and future decisions about Peel Manor's physical environment. Peel's proposed plans for the Peel Manor site will also require close collaboration with the Central West Local Health lntegration Network (LHIN).

b) Role of the Local Health lntegration Networks

The Local Health System lntegration Act, 2006 outlined the responsibility for the LHlNs in Ontario to plan, integrate, coordinate and fund health services (including Long Term Care Homes) in their regions. The Region of Peel, as an operator of Long Term Care Homes, has comprehensive, Long-Term Care Home Service Accountability Agreements with the two LHlNs in Peel, Mississauga Halton LHIN and Central West LHIN. The Region is also accountable to the LHlNs through Multi-Sector Service Accountability Agreements for the Community Support Services operated at our Long Term Care Centres.

Since Peel Manor is accountable to the Central West LHIN and because the LHlNs play an important role in planning and funding local health services, including Long Term Care and Community Support Services, it will be important to work collaboratively with the Central West LHIN to develop a vision for the Peel Manor site that will best respond to the needs of seniors in Peel.

5. Proposed Direction

Regional staff will work with the staff of the Central West LHIN and their counterparts in the Ministry of Health and Long-Term Care in respect of their service and system planning role to develop a strategic approach and conceptual plan in relation to the long term care and community services that are provided through the programs operated at Peel Manor. A study will be undertaken to consider high level options while integrating the deliberations of the Aging Population Term of Council Priority Steering Committee in respect of Peel's role in the delivery of services to the senior population. The outcome of this work will be important for both the Committee and Regional Council before making decisions related to Peel Manor. In 2014 we intend to provide Council with a conceptual framework for approval. This framework would recommend a role for the site that is consistent with the Aging Term of Council Priority Steering Committee's deliberations for meeting the needs of seniors in Peel Region. Typically, the planning and implementation of a change of significant magnitude is five years, considering prior work completed.

a) Communication with Stakeholders

Ultimately, it is the people who call Peel Manor "home", and those who provide care at Peel Manor who are most immediately and persistently affected by the current state of the building. They will continue to experience, to a greater or lesser degree, inconvenience and disruption resulting from any option chosen to address the building's condition, including status-quo.

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Council will recall that during the 2012 budget deliberations, communication with residents, families and employees about the intention to undertake a building envelope study of Peel Manor created significant concerns among these stakeholders. This experience underscores the need for these and other stakeholders in Peel Long Term Care to be aware of and engaged in the process or processes that will unfold as this topic is further explored.

The recent creation of the Aging Population Term of Council Priority Steering Committee with its broad mandate to "assess and determine the appropriate role(s) for the Region of Peel to support the growing aging population in Peel" has the potential to confuse stakeholders who are primarily interested in the Peel Manor discussions. As a result, staff will ensure Peel Manor stakeholders have access to information about the Steering Committee's work and progress.

A detailed communication strategy will be developed for Peel Manor's stakeholders to include:

Providing regular information about the work being undertaken by the Aging Population Term of Council Steering Committee; Regular information bulletins related to work undertaken at Peel Manor to address current infrastructure issues.

FINANCIAL IMPLICATIONS

Peel Manor will require significant capital funding to maintain the current building. Estimates from the consultant put the investment required at $46.0 million. The consultant's report notes this total anticipated cost is in excess of 85 per cent of the estimated cost of a new build long term care centre with the same resident-bed-capacity in a land neutral scenario.

An investment at any level for the maintenance of Peel Manor would still result in an inefficient building that will always be faced with compliance challenges due to the present design. However, having a plan in place can minimize the capital outlay for the short term future.

In order to investigate and report back to Council on an appropriate conceptual plan for future services, staff will propose funding as part of the 2014 Budget. This will also include consideration of management of the current physical structure, and essential state of good repair for the immediate future.

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CONCLUSION

The results of % review into the conditEon of the building in which Peel Manor LTC and Community Support Services operate, support the need tta undertake a high level conceptual plan for the future services on the Peal Manor site. Funds will be induded in the 2014 budget for e planning study and propasal development that is informed by the work of the Aging Pwpulation Term rrf Council Prfority Steering Committee.

Janette Smith Cornmissionat of Health Services

Approved for Submission:

For futher inhrmatian mg~dSng this repoft, please contact Cmlym C1ubin.e at extension 2647 or vlEa emM at e:walyn. cIubia7e@pe-elre~ion. ca

e. Legislative Sewices Manager, Financial Support Unit (FSU)

August 12, 2013PEEL MANOR BUILDING ENVELOPE STUDY RESULTS

APPENDIX I

MUNICIPAL PARK \

HISTORIC CEMETERY

PEEL MANOR EMERGENCYGENERATOR

APPROXIMATE LOCATION OFPROPERTYBOUNDA~ES

PEEL MANOR PHYSICAL PLANT

PEEL MANOR EMERGENCY---- ACCESS RIGHT-OF-WAY

---- SALVATION ARMY BUILDING

NANCE HORWOOD PLACE -AFFORDABLE HOUSING FORSENIORS WITH SPECIAL NEEDS(NIC)

_- PEEL MANOR GARDEN:I:t-o:::oZt-WW0:::t-t/)

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PEEL LIVING APARTMENTBUILDING

10.30PEEL MANOR: PART B - FUTURE STATEBRAMPTON, ONTARIO

PLAN

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