Tribe to expand health facilities

BY HOLLY KAYS STAFF WRITER

The 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, completing pre-construction work following the hospital governing board’s March approval of up to $125,000 for those efforts. There may still be slight changes to the design as final planning wraps up — geotechnical borings must still be completed, for instance — but major changes are not expected.

Right now, the plan is to execute contracts in November and to complete construction between March 2022 and December 2024, with the facilities opening in early 2025. However, Lambert 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 month is a new $5.4 million facility for the Cherokee County Clinic. Lambert said he’s “pretty confident” about the accuracy of the $5.4 million figure, 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 facility is too constrained to accommodate a new, larger building as well, said Lambert at the July meeting, so the plan is to build the facility on tribally owned property along Tomotla Road. It’s located about 3 miles northeast from the Valley River Casino. The tribe owns four parcels at the proposed location totaling 329 acres.

“If all the regulatory requirements can be met, this would be a really ideal location,” Cooper said.

The new facility would include two exam rooms, three dental exam rooms, a telehealth room, an exam/procedure room and a triage room. Design would occur from October through December, with construction planned for January 2022 through January 2023, and the facility opening in mid-2023.

The resolutions for both projects state that funding would come from “available sources and debt financing.” And while the tribe would certainly be responsible for

coming up with the money for construction costs, Cooper said he’s optimistic that the hospital could pay those costs back extremely quickly through leases with the federal government.

Section 105-L of the Indian SelfDetermination and Education Assistance Act allows tribes and tribal organizations to lease their facilities to the federal government to carry out government functions. The 105-L leasing program has allowed the hospital to reimburse the tribe completely for the cost of its $80 million hospital, completed in 2015. The 105-L leasing program is currently included in both the U.S. House 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.

The planned long-term care campus would feature stunning views and allow residents easy access to the hospital next door.

EBCI rendering

A proposed replacement building for the current Cherokee County Clinic would feature upgraded and modernized facilities.

EBCI rendering

BY HANNAH MCLEOD STFF WRITER

Maggie Valley Board of Aldermen voted Aug. 17 to allow class A, B and C recreational vehicles in RV Planned Unit Developments. Previously, the board had discussed allowing PUD status for RV parks, only if vehicles were restricted to class A.

The town has received interest from developers who want to be able to subdivide their proposed RV parks, but the current approved density yield is cost prohibitive. According to town ordinance, the purpose of the PUD status is to afford substantial advantages for greater flexibility and improved marketability through permit flexibility in building sites, mixtures of housing types and land use. Residential densities are calculated on a project basis, thus allowing the clustering of buildings to create useful open spaces and preserve natural site features.

When the board discussed allowing PUD status for RV parks in July, Mayor Mike Eveland asked for caution in making a change that would have implications for all of Maggie Valley.

“Keep in mind, if this was just for one individual property, that would be great. But that’s not the case, we’re changing the actual rules and the ordinance. And I don’t believe that we want to open up the door for campgrounds throughout the valley,” he said.

Following the July meeting, the board was prepared to allow PUD status for RV parks that only allowed class A vehicles. Class A Recreational Vehicles are defined as self-contained RVs constructed on either a truck chassis or commercial bus chassis that typically has a flat or vertical front end with large side windows. These types of RVs may also feature “slide outs” which when parked allow larger internal living areas.

However, at the Aug. 17 meeting Alderwoman Twinkle Patel presented a packet of information to the board regarding other classes of RVs. Eveland chafed at the idea of presenting new information to the board at a regular board meeting saying that it would be more appropriate to discuss new information at the agenda setting meetings.

“We should have had time to look at this, we’re having to vote on this tonight and all this comes to me now. I don’t know about the rest of y’all, but this is just not the way we do things,” said Eveland. “If you want campgrounds, you can vote for that, just make sure everybody in the valley knows you voted for campgrounds. This should have been in the [agenda setting] meeting. There’s no way I should be sitting here looking at this now, having to make a decision on this.”

“Are we not supposed to do our homework?” asked Alderwoman Tammy Wight.

Patel noted that some of the RVs she presented in classes B and C cost over $100,000.

“Who are we discriminating against?” Patel asked.

Planning Board Chairman Jeff Lee spoke from the floor, stating that there was some confusion about the differences between Class A, B, and C. The intent was to have high-end, nicer motorhomes.

Eveland said that some motorhomes in class B look like vans.

Frankie Wood, the Ghost Town In The Sky developer responsible for bringing the RV/ PUD issue to the board, spoke from the audience at the board meeting, stating that everything the board was discussing would be restricted by the Homeowners Association he would create for the development. The town attorney told the board that if they were going to accept comments from the public, they would need to reopen a public hearing on the issue. The board did not.

Alderwoman Patel made the motion to revise a section of the text amendment allowing PUD status for RV parks, allowing class A, B and C recreational vehicles. Mayor Eveland opposed the motion, which passed 4 to 1.

“Developments deemed RV/PUD shall be limited to Class A, B, and C Recreational Vehicles. Recreational Vehicles are defined as a self-contained RV constructed on either a truck chassis or commercial bus chassis that typically has a flat or vertical front end with large side windows,” reads the text.

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