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VA MEDICAL CENTER - NEW RRTP BUILDING Design by Tran Associates, Inc.

ARCH 441 Fall 2015

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CONTENTS

VISION

Background / Information…………………………………………………………………...4-5

Create a home-like and patient centered environment, which enables a spirit of community, as well as provide patients with an access to nature; Furthering the road to recovery

Precedents / Concepts / Inspirations……………………………………………………...7-8 Building Evolution…………………………………………………………………………...9 Site Information……………………………………………………………………………..11 Floor Plans………………………………………………………………………………….12-13 Elevations…………………………………………………………………………………...14 Sections……………………………………………………………………………………..15-17

DESIGN TEAM

Interior / Exterior Renderings……………………………………………………………..18-23 Structural…………………………………………………………………………………….24-25 Mechanical…………………………………………………………………………………..27 Lighting……………………………………………………………………………………....28-37 Code / Life Safety…………………………………………………………………………..38-39

Zhriong Lin (L/E)

Billy Sanders (Structural)

Fire Lane / Site Dewatering……………………………………………………………….40-42 Tunnel Considerations……………………………………………………………………..43 Site Logistics………………………………………………………………………………..44-45 Construction Schedule…………………………………………………………………….46-48 Detailed Cost Estimate…………………………………………………………………….49

Instructor: Nat Q. Belcher

Matt Torello (Mech.)

Grant Wilcox (CM)

Neil Wysocki (CM)

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BACKGROUND The United States has the most comprehensive system of assistance for Veterans of any nation in the world, with roots that can be traced back to 1636.”1 The U.S. Department of Veteran’s Affairs (VA) has essentially been around since the Civil War, but was firmly established after World War II when “there was a vast increase in the Veteran population, and congress enacted large numbers of new benefits for war Veterans.” There are currently three administrations within the VA: the National Cemetery Administration, the Veterans Benefits Administration, and the Veterans Health Administration (VHA).

Today’s VHA--the largest of the three administrations that comprise VA--continues to meet Veterans’ changing medical, surgical and quality-of-life needs. New programs provide treatment for traumatic brain injuries, posttraumatic stress, suicide prevention, women Veterans and more. VA has opened outpatient clinics, and established telemedicine and other services to accommodate a diverse Veteran population, and continues to cultivate ongoing medical research and innovation to improve the lives of America’s patriots. VHA operates one of the largest health care systems in the world and provides training for a majority of America’s medical, nursing and allied health professionals. Roughly 60 percent of all medical residents obtain a portion of their training at VA hospitals; and VA medical research programs benefit society at-large. The VA health care system has grown from 54 hospitals in 1930, to include 152 hospitals, 800 community-based outpatient clinics, 126 nursing home care units and 35 domiciliaries

The Perry Point Veterans Affairs Medical Center provides a broad range of inpatient, outpatient and primary care services. As the largest inpatient facility in the VA Maryland Health Care System, the medical center provides inpatient medical, intermediate and long-term care programs, including nursing home care, rehabilitation services, geriatric evaluation and management, respite care, chronic ventilator care and hospice care. The Medical Center is located on a beautiful campus of approximately 400 acres on the banks of the Susquehanna River and the Chesapeake Bay where patients can enjoy a variety of recreational activities, including fishing, swimming, bicycling and jogging.” 3 The Perry Point VAMC would like a new 35-bed 24/7 residential rehabilitation treatment program (RRTP) building.

The RRTP building will provide inpatient, mental (and physical) health treatment and support space for the patients at the medical center. It will include a community space, medical spaces, outpatient rooms, as well as office and administrative spaces.

The building will also include an aquatic pavilion with two swimming pools for aquatic therapy and exercise purposes. Outdoor patios and indoor spaces such as computer and group rooms and multi-purpose rooms will help to provide constructive use of unscheduled time. An outpatient clinic component will also be incorporated into the design. Inside, two patient bedrooms will share a bathroom. Each bathroom must be ADA accessible with a roll-in shower stall. The design must be developed to provide maximum views of the outdoors, courtyards, and bay. Interior concepts should include: ● ● ● ● ● ● ● ● ● ●

Homelike environment Provide for all activities of daily living Provide privacy and dignity - Access to nature Family accommodations Individual temperature and light control in bedrooms Noise control Safe and secure Materials and finishes for ease of cleaning and maintenance Appropriate light levels with no shadows Clear visibility of patients by staff

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MISSION

FLEXIBILITY OF DESIGN

The RRTP mission is to provide state-of-the-art, high-quality residential rehabilitation and treatment services for Veterans with multiple and severe medical conditions, mental illness, addiction, or psychosocial deficits. The RRTP identifies and addresses goals of rehabilitation, recovery, health maintenance, improved quality of life, and community integration in addition to specific treatment of medical conditions, mental illnesses, addictive disorders, and homelessness.

The Perry Point RRTP building should be designed for maximum flexibility. This is necessary “in order to most efficiently meet the rehabilitative needs of a diverse Veteran population.”6 In RRTPs, treatment, rehabilitation, and psychosocial programming may range from relatively short-term care of limited focus, (less than 30 days) to long-term, comprehensive rehabilitation (exceeding 1 year). This project presents an opportunity to create architecture and spaces that help the healing process and wellbeing of the residents. “Some residents will have jobs outside the facility and may be coming and going at different hours. Residents will be working at full-time or part time jobs while living here or undergoing intensive therapy or educational programs.

GOAL RRTP’s goal is to provide opportunities for Veterans to achieve and maintain their highest level of independent community integration through the provision of residential services designed for improved functional status, sustaining rehabilitation gains, disability management, recovery, and breaking the cycle of recidivism.

OBJECTIVES ● ●

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Provide residential rehabilitation and treatment services that focus on the Veteran’ s strengths, abilities, needs, and preferences rather than on illness and symptoms.

Provide residential rehabilitation and treatment services utilizing a therapeutic community based on peer and professional supports in a structured and supervised setting.

Provide rehabilitation and treatment services that address medical conditions, mental illness, addiction, and psychosocial deficits.

Facilitate the transition to safe, affordable, and appropriate community housing.

Assist Veterans in choosing, accessing, and utilizing the community and natural supports needed to be independent, self-supporting, and successful in their individual recovery

AQUATIC THERAPY AND EXERCISE PAVILION In addition to the Mental Health programmatic requirements of the new RRTP building, the Perry Point VA has requested an aquatic therapy and exercise pavilion to help supplement their physical therapy building (23H) and patient needs. Some of the physical therapy patients may be living in the new RRTP building, but most will be brought from other buildings on the Perry Point campus. Unisex assisted care-giver dressing rooms and showers, examining and treatment rooms for the therapist(s) to evaluate patient's, land-based exercise equipment for cross training and evaluation purposes are required.

Site The Perry Point VA Medical Center is located in Perry Point, Maryland, roughly one hour north of Baltimore and one and a half hours south of Philadelphia. The medical center sits adjacent to the Susquehanna River and Chesapeake Bay. The site is presently an open meadow with groupings of evergreens to the west and existing vegetation at the shoreline. There are excellent views to the water, meadow and passing wildlife. Visitors and residents arriving at the new building by car or transport will enter the site off of Avenue D where a new protected pedestrian drop off area shall be designed at the building entrance. A fire lane should also be designed to encircle the perimeter of the building connecting to the entry and a service drive. New sidewalks shall be designed to connect the existing sidewalk along Avenue D to the entrance of the proposed building.

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PRECEDENTS

St. Elizabeth's East Gateway Pavilion Design Influences: ●

Morangis Retirement Home ● ●

Design Influences: ● ● ●

Therapeutic Environment Access to nature Affordability

El Carmen Hospital Maipu Design Influences: ● ● ● ●

Offset of floors Courtyard Glass Facade Open landscape

Woy Woy Rehab Center Design Influences: ● ● ●

Separation between Public/Private Courtyards gave us our garden idea Exterior views to nature will be a big focus

Visible and Welcoming View for People from Different Areas Roof Activities Outside gathering space with roof

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CONCEPTS / INSPIRATIONS

PATIENT CARE & SAFETY ●

Physical and visual access to nature to promote healing ○ Implement courtyards instead of fenced in areas

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Patient autonomy, respect, and privacy ○ Minimize stress from noise

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Appropriate accommodations for disabled and bariatric patients

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Eliminate balconies, openings that would allow a patient to jump from an elevated platform

KEY CONCEPTS ●

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Create strong home-like and patient centered environments ○ Warm and welcoming colors and finishes ○ Create a spirit of community ○ Open and bright design Surround patients with furniture, furnishings, and fixtures

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BUILDING EVOLUTION 1.

2.

Initial design thought with multiple levels and lower level residential

3.

Examining peak sun times on initial design

Additional sun room connecting residential area with admin space

5.

4.

Extension of residential wing to allow all patient rooms to have few of the bay

Current and final design

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SITE INFORMATION KEY SITE ASPECTS ● Site slopes Southwest & South, away from Avenue D ● ● ●

Elevations: Range from high EL 35 to low EL 15 Site previously used as a golf course Soil consists of mostly silts and clays with traces of sand & gravel

Solar Path

Typical SE Wind Direction

CHESAPEAKE BAY

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FLOOR PLAN

Fall 2015 ● ● ● ●

VA Medical Center - New RRTP Building 12 Private patient rooms separate from public space Small Lounges strategically placed throughout building to help break up long hallways and create unique spaces Centralized dining area Wider than average corridors and abundant natural light

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AXONOMETRIC FLOOR PLAN Patient/ Private Patient/ Public Administrative Mechanical Aquatic Therapy

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1

ELEVATIONS

4 2

2

3

3

4

4

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SECTIONS ●

1. Top building section cut through North Office - Admin portion of building

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2. Bottom section shows Residential area with bedroom and shared bathrooms

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Axonometric sections shows ceiling heights and building systems throughout

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Highlights pool area and entrance lobby

2 1 2 2

1

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WALL SECTIONS Administrative

Top Connection

Base Connection

Drainage System

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Typical Office Wall Section

WALL SECTIONS

1 2

3

2. Curtainwall Section

3. Residential Lobby Wall Section

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INTERIOR RENDERINGS

Gathering Space

Interior Hallway with a View of the Courtyard

Interior Hallway in the Admin. Area

Main Entrance and Lobby

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TYPICAL BEDROOM/BATHROOM LAYOUT

Bathroom view from doorway

Patient Room

Bathroom view from shower

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EXTERIOR RENDERINGS

2. Main Entrance 2

1. North view 4

4. West Aerial View

3. South View Corner Lounge

3

1

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5. Front View

7. Rear Canopy

EXTERIOR RENDERINGS 6. Private Courtyard 5

6 7

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8. Aerial Front

5. Front View 10. Retention Pond

EXTERIOR RENDERINGS 9. Aerial Back

8

10 9

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Foundation Materials

STRUCTURAL CONSIDERATIONS Moment Connection ● ● ● ●

Structural steel 20 x 20 grid Topography raised to level, slab on grade Pool area has truss spanning length Moment frames for lateral bracing

FOUNDATION CONSIDERATIONS ● Column spread footings for column bases ○ 2 feet min wall foundations ○ 3.5 feet min isolated columns ○ Net allowable soil bearing pressure is 2500 psf ○ 32 inch min foundation depth (nonheated) ● ● ● ●

Extreme emphasis on waterproofing foundations Using of mats and drains to maintain integrity of the structural foundations Soil bearing capacity is increased with the new soil brought in Footings will be relatively shallow because of the high water table

3D Rendering of Structure

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STRUCTURAL SEQUENCE

1.

Only columns are erected when building pad constructed. Aquatherapy pools installed

3.

Clerestory roofs are installed.

All beams and columns are completed besides aquatherapy pool.

2.

Aquatherapy supports and trusses are placed completing the structure.

Beams only over main area supporting lower roofs are installed

4.

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POOL SYSTEM: ● Ideal Conditions for pool: ○ 82 F water temp ○ 84 F air temp ○ 50-60% RH ● DECTRON (Dehumidification, EA, Cooling & Heating, Total Supply Air, Required access space, OA, No condensation allowed) ○ Linear Diffusers lined along curtain to prevent condensation

MECHANICAL CONSIDERATIONS STAFF/ADMIN. SYSTEM: ● VAV system ○ Allows for individual office control ○ One VAV per office

Admin. System Layout

Pool System Layout

Residential System Layout

RESIDENTIAl SYSTEM: ● VAV system ○ Allows for individual room control ○ One VAV per room ○ Exhaust Air for all storage and bathrooms Clearstory

DECTRON System

Sample of VAV System

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DAYLIGHTING CONSIDERATIONS Shadow Analysis:

Summer Solstice:

The goal of daylighting design is taking the advantage of daylight instead of artificial light during the daytime in order to reduce the energy and cost.

The shadow analysis provided in the right portray the hours through 8 am to 4 pm of entire building in summer solstice, spring equinox and winter solstice. The critical time is winter solstice which has lower projection and get more daylight penetrate to the space. North faรงade does not have direct light to the space which has static performance under different condition. Solar control is needed for the south faรงade which get more daylight into space.

After analyzing the solar effect of our building, which helps to determine the critical space and get the solution.

8 am

12 pm

4 pm

8 am

12 pm

4 pm

8 am

12 pm

4 pm

Spring Equinox:

Winter Solstice:

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DAYLIGHTING CONSIDERATIONS

Corridor Clerestory System

Retractable Horizontal Louver Shade

Blind Exterior Horizontal Aluminum Louver Shade

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DAYLIGHTING CONSIDERATIONS Patient Room:

After Blind Applied Before Blind Applied @Winter Solstices

After Blind Applied

Corridor with Clerestory System:

Summer Solstices

Summer Solstices 77.4째

Spring Equinox 51.3째

Winter Solstices 27.6째

Equinox Spring

Winter Solstices

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DAYLIGHTING CONSIDERATIONS

Curtain Wall System Analysis Space

Pool:

Summer Solstice

Winter Solstice Before Shading

Spring Equinox

Winter Solstice After Shading

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DAYLIGHTING CONSIDERATIONS

Curtain Wall System Analysis Space

South West Rest Area:

Summer Solstice

Winter Solstice Before Shading

Spring Equinox

Winter Solstice After Shading

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DAYLIGHTING CONSIDERATIONS

Curtain Wall System Analysis Space

Entrance:

Summer Solstice

Winter Solstice Before Shading

Spring Equinox

Winter Solstice After Shading

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ARTIFICIAL LIGHTING CONSIDERATIONS

Corridor:

Patient Room: • Ceiling Pendant Application • Frosted Glass Diffuser • 70 W 2C T6 2700K Fluorescent Lamp • Standard with electronic ballast (120V, 60Hz) • Manual Control

21-1/2” 24”

66-5/8”

Bathroom: • • • •

8" Incandescent Can Recessed Ceiling Application 802A Clear Diffuse Open Manual Control

▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪

2x4 Troffer Light Recessed Ceiling Application 2'x4' GTL LED replaces 2-lamp T8 LED technology with MVOLT (120277V) driver 0-10V Dimming on the GTL LED Troffer 4000 lumens CCT 4000K 39w Occupant Sensor/ Automatic Time Switch Control Device

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ARTIFICIAL LIGHTING CONSIDERATIONS Facade:

• WST LED • Architectural Wall Sconce •

4000 K

• 8’ Mounting

7-1/4” 16-1/4”

9-1/8”

• ARM-Mounted Rectilinear Cutoff Light • Low Pressure Sodium • 90 W, 20’- 30’ Mounting • UL Listed for Wet Location

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ARTIFICIAL LIGHTING CONSIDERATIONS Entrance:

Private Courtyard:

Public Courtyard:

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Lighting Rendering Entrance:

North West Rest Area

Public Courtyard

Corridor (Curtain Wall + Clerestory)

Entrance

North West Exterior View

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CODE ANALYSIS

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MEANS OF EGRESS ●

6 total exits at different locations around the building

OCCUPANCY CLASSIFICATION ● ●

Assembly A-3, Business Group B, Institutional Group I-2, Assembly Group A Max Building Height 65 feet

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BUILDING PROGRAM ● Proposed building program and room square footages compared to the actual, designed program and square footages is illustrated in the following diagram

● Original SF: 21,020 SF ● GSF: 33,632 SF

● Designed SF: 22,752 SF ● GSF: 36,403 SF

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FIRE LANE ● ● ●

Fire Lane Signs will accompany the exit/entrance to the fire lane at 100’ intervals 20’ width <5% grade, unpaved gravel road

AIRPAVE SYSTEM BY AIRFIELD SYSTEMS ●

Flexible porous paving and drainage for grass fire lane ○ 233 psi unfilled ○ 6747 psi sand filled

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91,000 sq. ft per truck load

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Made of 100% recycled materials which can contribute to LEED points

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SOIL AND WATER MANAGEMENT POOR SOIL CONDITIONS ●

Due to fine-grained on-site soils, construction activities will degrade soil conditions

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Retaining the bearing qualities of the soil will be a goal throughout the duration of construction ○ Proper site drainage prior to construction activities will be required ○ Excavations and Foundations must be done in phases, in the same day, to retain bearing quality of the soil Boring Info: ● Dense soils encountered B-6, SWM-2

STORMWATER MANAGEMENT / SWALE ● ●

Implemented to manage water run-off Retention pond to filter water

●

Groundwater encountered at all locations except P-3

WATER LEVEL OBSERVATIONS ● ●

Swale adjacent to site

Obtained from Geotechnical Report Groundwater encountered at depth of 5-13 feet ○ Groundwater should not pose any major problems for proposed building construction, but will impact tunnel and SWM construction

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SITE DE-WATERING STRATEGY ● ● ●

Excavate building pad Place permanent sump-pumps Backfill with drainable materials ○ mixture of coarse and fine-grained materials

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Extreme emphasis on waterproofing foundations

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Use of mats and drains to maintain integrity of the structural foundations

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Soil bearing capacity is increased with the new soil brought in

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Footings will be relatively shallow because of the high water table

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TUNNEL CONSIDERATIONS

BACKFILLING Slope of 56.3 degrees from foundation wall base upwards

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Connection to the northwestern portion of the existing Acute Psychiatric Care Building ● “Cut and Cover” structure ● Bottom Elevation - 19’ 8” ● Precast structure ○ Height - 8’ ○ 11-12’ excavations

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Where the subgrade soils are soft, loose, or saturated, flowable fill, lean-mix concrete, or compacted fill materials must be used Tunnel may be designed for a net allowable soil bearing pressure of 2,500 psf Based on the soil bearing pressure; 1 inch max settlements will occur and differential settlements shouldn’t be over .5” per 30’

A dewatering system for groundwater control is needed to provided a dry and stable subgrade so subgrade soil bear strengths are maintained Pre-drainage: well points, sump pumps, and impermeable barriers to cut off groundwater (sandbag diversions and cofferdams).

UPLIFT RESISTANCE ● ● ●

Utilize the weight of the tunnel with a min safety factor of 1.2 Hydrostatic pressure has been approximated to be 250 psf exposed subgrade soils need to be protected to maintain bearing capacities. Use a mud mat comprised of 2-3” of lean concrete or over excavate 12” and fill with 57 stone and approved filter fabric

fill consists of granular fill or suitable on-site soils without organics or roots

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SITE LOGISTICS EXISTING UTILITIES

RELOCATED EXISTING UTILITIES

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Existing Sanitary Sewer (#1, 2, 3) & Water (#4) lines to be relocated

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Most economical to relocate existing utilities that interfere with building footprint

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Roadway will have to be closed for short period of time for utility trenching and replacement

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SITE LOGISTICS FOUNDATIONS

STRUCTURE

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Any free water encountered shall be dealt with by mechanical means such as a sump pump

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Due to moisture content, fine-grained soils degrade easily. Suggested to perform earthwork during warmer, dryer weather ○ Wet weather delaying schedule should be anticipated

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Mobile cranes will be utilized due to building design

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CONSTRUCTION SCHEDULE

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CONSTRUCTION SCHEDULE

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CONSTRUCTION SCHEDULE

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SF & DETAIL ESTIMATES CALCULATIONS: APARTMENT (1-3 STORIES) ● ● ●

Perimeter: 902 LF Area: 14,610 SF Face brick w/concrete block backup + steel joists (assumed) ● @ 15,000 SF - $178.50/SF ● Adjusted cost: $268.45/SF ● Total Cost = $3,922,000

CALCULATIONS: MEDICAL OFFICE (1-3 STORIES) ● ● ●

Perimeter: 758 LF Area: 14,380 SF Face brick w/concrete block backup + steel joists (assumed) ● @ 14,500 SF - $205.15/SF ● Adjusted cost: $221.30/SF ● Total Cost = $3,182,000 Combined Total Cost (+/-15%) $3,922,000 + $3,182,000 =

$7,104,000 (+/-15%)

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Broken into Apartment 1-3 stories and Medical Office 1 story

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SUMMARY / CONCLUSION After putting much time and thought into creating our design, Tran Associates, Inc. hopes that we have given the Department of Veterans Affairs everything they need to further the recovery of our veterans.