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Cherokee to expand health facilities BY HOLLY KAYS STAFF WRITER he Cherokee Tribal Council approved more than $110 million for new health facilities on the Qualla Boundary and in Cherokee County, giving unanimous endorsement to two separate projects during its Aug. 5 meeting. The largest project, the first phase of a long-term care facility to be constructed on land adjacent to the Cherokee Indian Hospital, is expected to start construction in March with an opening date planned for early 2025. Of the estimated $105 million cost, site work covering other phases of the project in addition to the first phase — including utilities and earthwork — is expected to cost $28 million. Permitting, planning and design will also require a significant up-front outlay — actual construction will account for only about $60 million of the $105 million total cost, Cherokee Indian Hospital Authority Director of Engineering Damon Lambert told the Health Board during a July 21 meeting. “It’s going to be better if we do all the permitting for all of the project now, and the federal agency has made that very clear,” said Lambert. The estimate also includes $5 million in potential cost escalation. That figure comes from the construction managers, said CIHA CEO Casey Cooper, and they are at risk for that estimate. The $105 million figure also includes expenses such as furniture, medical and kitchen equipment, landscaping and artwork. Once complete, the first phase of construction will add a 100-bed skilled nursing facility, a 24-bed memory care center and a dialysis facility to tribal healthcare facilities, a total of 154,000 square feet. The final project will total 300,000 square feet and also include an adult day care, 24 assisted living apartments, 18 independent living cottages and 42 independent living apartments. It’s a plan that’s been under discussion since 2019, when Tribal Council passed a resolution directing the hospital to form a longterm plan for a new senior living campus. In that same year, the hospital hired an architecture and engineering firm and conducted community and Tsali Care input sessions to gather ideas. “We got great information,” said Lambert. “We got a lot of good ideas from the community and the residents that are at Tsali about what they want to see in the project.” The master plan was finalized in February 2020 and presented to the hospital’s governing board in March. After a lengthy discussion, the board selected an option from the menu presented, and Tribal Council endorsed that same option during a July 2020 work session. Since that time, hospital leaders have refined the plan and broken the project down into phases, complet20 ing pre-construction work following the hos-
Smoky Mountain News
September 1-7, 2021
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October through December, with construcpital governing board’s March approval of tion planned for January 2022 through up to $125,000 for those efforts. There may January 2023, and the facility opening in still be slight changes to the design as final mid-2023. planning wraps up — geotechnical borings The resolutions for both projects state must still be completed, for instance — but that funding would come from “available major changes are not expected. sources and debt financing.” And while the Right now, the plan is to execute contribe would certainly be responsible for tracts in November and to complete construction between March 2022 and The planned long-term care December 2024, with campus would feature stunning the facilities opening views and allow residents easy in early 2025. access to the hospital next door. However, Lambert EBCI rendering said, that schedule is a “bit conservative,” and it’s possible the project could finish faster. “Our goal would be to do an early release package for site work,” he said. “Site work is the biggest part of the project. It will take the longest to complete. The sooner we can get that going, the quicker the project can get done, and it will actually save us money the faster we can do it.” The second, smaller health project Council approved last A proposed replacement month is a new $5.4 building for the current million facility for the Cherokee County Clinic Cherokee County would feature Clinic. Lambert said upgraded and he’s “pretty confident” modernized about the accuracy of facilities. the $5.4 million figure, EBCI rendering as the hospital reached out to multiple vendors for pricing and received “almost identical” responses. “I think anyone who’s been to the Cherokee County clinic would agree it’s in desperate need of a new facility,” Cooper told Council in August. The property that holds the existing coming up with the money for construction facility is too constrained to accommodate a costs, Cooper said he’s optimistic that the new, larger building as well, said Lambert at hospital could pay those costs back extremethe July meeting, so the plan is to build the ly quickly through leases with the federal facility on tribally owned property along government. Tomotla Road. It’s located about 3 miles Section 105-L of the Indian Selfnortheast from the Valley River Casino. The tribe owns four parcels at the proposed loca- Determination and Education Assistance Act allows tribes and tribal organizations to tion totaling 329 acres. “If all the regulatory requirements can be lease their facilities to the federal government to carry out government functions. met, this would be a really ideal location,” The 105-L leasing program has allowed the Cooper said. The new facility would include two exam hospital to reimburse the tribe completely for the cost of its $80 million hospital, comrooms, three dental exam rooms, a telepleted in 2015. The 105-L leasing program is health room, an exam/procedure room and currently included in both the U.S. House a triage room. Design would occur from
and White House versions of the federal budget. “We think the chances of qualifying for a 105-L lease for this project are very, very high,” Cooper said. The hospital has not yet conducted an operational pro forma for the Cherokee County site to see how the operations side
might pan out financially — it is being considered as a replacement facility. However, much analysis has been conducted on the long-term care project, with a detailed pro forma concluding that “most likely scenario” would take the tribe’ annual loss on longterm care operations down to $1-1.5 million from this year’s $2.5 million. The loss could total as little as $800,000 if the proportion of Medicaid patients reaches 75% of the total beds, Cooper said. “We think we can have a world-class facility and have an annual burden on the tribe that’s much less than what it is now,” said Cooper.
