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PLANNING FOR PREVENTION A WELLNESS CENTER IN THE ROCKAWAYS HUNTER COLLEGE | DEPARTMENT OF URBAN AFFAIRS AND PLANNING
ACKNOWLEDGMENTS The Hunter Team would like to thank faculty advisors, Alice Blank and William Milczarski, for their dedication and leadership throughout the year.
HUNTER COLLEGE DEPARTMENT OF URBAN AFFAIRS AND PLANNING
We are grateful to our client, J.R. Peter Nelson, Ph.D, Executive Director, Joseph P. Addabbo Family Health Center Inc., for his guidance and unwavering support of our project.
The Hunter Team Nichole Altmix Laura Azze Paul Costa Paula Di Stefano Heidi Exline Jesse Goldman Jordan Katon Paulo Lellis Terri Mills Rich Zanoni
The Hunter Team is also appreciative of the tireless efforts of Seth Bornstein, Executive Director, Queens Economic Development Corporation, who continually challenged our team to be innovative in our thinking. We would like to thank Jonathan Gaska, District Manager, Community Board 14; Patricia Simon, Executive Director, Ocean Bay Community Development Corporation; and Liz Sulik, Director of External Affairs, Peninsula Hospital, for their willingness to share their insights and perspectives about the Rockaway community. The following individuals were also invaluable in assisting the Hunter Team with our community outreach efforts: from the Joseph P. Addabbo Family Health Center, Inc., Rachel Williams, Director of Outreach; Gail Hills and Daniel Olufemi, Outreach Coordinators; and from the Ocean Bay Community Development Corporation, Bernadette Luina, Administrative Assistant.
Faculty Advisors Alice Blank William Milczarski, Ph.D
The Hunter Team would also like to thank the following faculty and staff from Hunter’s Department of Urban Affairs and Planning for sharing their time and expertise in shaping our project: Tom Angotti, Ph.D, John Chin, Ph.D, Sigmund C. Shipp, Ph.D, Lisa Schreibman and Mary Rocco. We would also like to thank our fellow graduate students for their feedback and encouragement. We wish to extend special thanks to the residents of the Rockaways, who welcomed our team into their community. Their ideas and enthusiasm were instrumental in guiding our project.
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Planning for Prevention: A Wellness Center in the Rockaways
[1] Cover Image: Ocean Bay Community Center mural, located at 57-10 Beach Channel Drive, in Arverne, Queens
[2] Signage at New York City Transit Authority’s Beach 60 Street station, approximately a quarter of a mile from the Joseph P. Addabbo Family Health Center
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TABLE OF CONTENTS 1
EXECUTIVE SUMMARY
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THE CLIENT The Joseph P. Addabbo Family Health Center Inc.
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A NATIONAL PUBLIC HEALTH CRISIS
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A COMMUNITY IN NEED: THE ROCKAWAYS Community Profile History Study Area Health Concerns Health Disparities
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COMMUNITY OUTREACH Focus Groups Surveys Interviews
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WELLNESS: A PREVENTIVE APPROACH
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THE WELLNESS CENTER: PROGRAMMING & DEVELOPMENT Site Planning Zoning Analysis Programming & Layout
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FINANCIAL FEASIBILITY Construction Costs Funding Operating Revenue & Expenses Pro Forma
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RECOMMENDATIONS
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CONCLUSION
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APPENDIX
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WORKS CITED
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EXECUTIVE SUMMARY The Joseph P. Addabbo Family Health Center Inc. (“Addabbo”), a 501(c)3 Federally Qualified Health Center, in cooperation with the Queens Economic Development Corporation, has partnered with the Hunter College Neighborhood Development Studio (the “Hunter Team”) to develop a wellness center in the Rockaway community of Queens, New York. Since 1987, Addabbo has been providing affordable health care to underserved communities throughout Queens. In 2006, Addabbo opened its third facility, a 22,200-square foot building in the Rockaway neighborhood of Arverne (the “Health Center”). This enabled Addabbo to expand its reach and increase patient visits by 40 percent (Primary Care Development Corporation [PCDC], 2010). In 2009, the Health Center had over 69,000 patient visits, helping to establish Addabbo as the largest Federally Qualified Health Center (FQHC) in Queens (PCDC, 2010; Addabbo, 2008). There continues to be a great need for Addabbo’s services in the Rockaways, as many of its residents are disproportionately affected by chronic health conditions, such as obesity (New York City Department of Health and Mental Hygiene [NYCDOHMH], 2006). In 2007, the Rockaways became one of only seven neighborhoods in New York City (NYC) with an obesity rate over 30 percent (Black & Macinko, 2010). Furthermore, in 2009, the Health Center saw 18,000 patients who received a primary diagnosis of diabetes, overweight or obese, or having hypertension (Addabbo, 2009).
These health issues are compounded by the fact that many Rockaway residents are also poor. In 2009, within the primary zip codes served by the Health Center, 11691, 11692, and 11693 (the “Study Area”), one third of all households had incomes of less than $20,000 a year; one fifth had incomes of less than $10,000 a year (SRC/Alteryx, 2009). The combination of disproportionate health problems and concentrated poverty constitutes what the U.S. Department of Health and Human Services (USHHS) calls a health disparity: “Differences in health status among distinct segments of the population including differences that occur by gender, race or ethnicity, education or income, disability, or living in various geographic localities” (as cited in Centers for Disease Control and Prevention [CDC], 2005; as cited in Healthy Carolinians, 2010). While Addabbo has a history of providing accessible health care services to the residents of the Rockaways, the organization seeks to establish a new facility that will specifically develop and deploy “interventions which are scalable and translatable” to address health disparities (Addabbo, 2008). In the United States, health care providers have traditionally utilized the medical model, which stresses clinical diagnosis and intervention to remedy disease(s) (Shi & Singh, 2004). Although there are obvious merits to the medical model, the Hunter Team opted to explore the concept of wellness, which “emphasizes efforts and programs geared towards the prevention of disease and maintenance of an optimum state of well-being” (Shi & Singh, 2004).
[3] The site of the proposed Wellness Center, adjacent to the Joseph P. Addabbo Family Health Center, at 62-00 Beach Channel Drive
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Planning for Prevention: A Wellness Center in the Rockaways
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Executive Summary
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EXECUTIVE SUMMARY (CONTINUED) After researching various wellness paradigms, the Hunter Team adapted the National Wellness Institute’s model as the foundation for its design and programming plan for the new facility (the “Wellness Center”). This six-dimensional framework focuses on physical, spiritual, intellectual, social, emotional and occupational health. The Hunter Team believes that successful mitigation of health disparities in the Rockaways necessitates a comprehensive and preventive approach; wellness aligns with this mission. The three-story, 28,926 square foot Wellness Center will include areas dedicated to chronic disease management, nutrition education, research, physical and art therapy, mental health consultation, a teaching kitchen, business incubator space, fitness areas for adults and children and the Borrow-a-Bicycle program. The Wellness Center will be located adjacent to the existing Health Center, at 6200 Beach Channel Drive, on an open lot currently owned by the New York City Economic Development Corporation. To finance the Wellness Center, Addabbo will utilize its partnerships with nonprofit organizations and local universities to expand programming and conduct medical research. Ground floor retail space and a biogenetic repository will be the primary revenue sources for the Wellness Center. The Wellness Center will also qualify for federal funding, state grants and financial support from the Queens Borough President and the New York City Council. With the recent passage of the Patient Protection and Affordable Care Act, integrating wellness into conventional health care services is gaining attention. But wellness is still not a familiar concept for many Americans. It is often discussed in the context of a luxury – an indulgence reserved only for the wealthy. However, wellness is equally critical for impoverished communities. In this respect, the Wellness Center will not only proactively address the health needs and disparities of the Rockaways, but will ultimately serve as a replicable model for lowincome communities in need.
[4] Retail strip in the project Study Area
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Planning for Prevention: A Wellness Center in the Rockaways
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THE CLIENT THE JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC. The Joseph P. Addabbo Family Health Center (the “Health Center”) provides comprehensive health services to the low-income and medically underserved residents of Queens, NY (Addabbo, 2008). In 1986, the Health Center was granted status as a Federally Qualified Health Center (FQHC), a program established under the Medicare system to “enhance the provision of primary care services in underserved urban and rural communities” (Addabbo, 2008; Centers for Medicare and Medicaid Services [CMMS], 2009). As a member of this program, Addabbo is qualified to receive payments for “covered services furnished to Medicare beneficiaries” (CMMS, 2009). Addabbo’s mission is to “be the leading preventive and comprehensive primary health care center in the Rockaways” (Addabbo, 2002). Operating three Queens’ locations, two in the Rockaways (Far Rockaway and Arverne) and one in Jamaica, Addabbo is the largest primary health care provider in Queens (Addabbo, 2002; Addabbo, 2008). The newest location was built in 2006 in Arverne and offers services in pediatrics, dental, obstetric/ gynecological, internal medicine and endocrinology. It also treats patients with HIV/AIDS and other infectious diseases. The 22,200-square foot primary care center in Arverne provides roughly 69,000 patient visits per year (PCDC, 2010). Currently, the Health Center is the largest FQHC in Queens (Addabbo, 2008). Addabbo has been working with the Queens Economic Development Corporation (QEDC) to investigate community needs and determine how to better serve the Rockaways. QEDC’s (2007) goal is to “provide Queens residents and resident businesses broader access to economic resources and intellectual capital.”
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Planning for Prevention: A Wellness Center in the Rockaways
[5] Addabbo community outreach efforts at Earth Day Rockaway on May 1, 2010 [6] and [7] The Joseph P. Addabbo Family Health Center, corner of Beach 62 Street and Beach Channel Drive
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The Client
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A NATIONAL PUBLIC HEALTH CRISIS In only 20 years, obesity in the United States has shifted from a minor health concern to a national crisis (CDC, 2007). Dr. Thomas Frieden, former New York City Health Commissioner and current Director of the Centers for Disease Control and Prevention (CDC), stated that as a country “we are 4.6 billion pounds overweight” (CDC, 2009). Presently, one out of every three American adults and over 16 percent of children are obese. Since 1980, obesity rates have doubled for adults and tripled for children (CDC, 2009a). At its most basic level, obesity is the result of a caloric imbalance: consuming more calories than are expended. Other factors, such as an individual’s genetic make-up and metabolism also influence body weight. Recent research has shown linkages between the built environment, socioecononmic conditions and obestity rates (Papas et al., 2007). Studies have demonstrated that the burden of obesity falls disproportionately on racial and ethnic minorities, and on those with low educational attainment and limited financial resources. Obesity is a public health crisis not only because it is so widespread, but also because it is linked to 53 preventable diseases; two of the more prevalent are heart disease and type 2 diabetes. While 90-95 percent of the 24 million diabetic Americans are classified as type 2, another 57 million are pre-diabetic, a condition that increases the risk of having a stroke, as well as developing type 2 diabetes and heart
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disease (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2007). In 2007, the total cost of treating diabetes in the United States was $174 billion (American Diabetes Association, 2010). While this figure is extraordinarily high, it is not even half of America’s heart disease related expenditure. Today, heart disease is the leading cause of death for both men and women in the United States (CDC, 2010). These health issues are further complicated by a variety of external variables. There is an extreme difference in price between healthy and unhealthy foods. For example, soda costs 33 percent less today than it did 30 years ago, whereas vegetables and fruits are 41 and 46 percent more expensive, respectively (Leondhardt, 2009). Moreover, high calorie, unhealthy food costs approximately $1.76 per 1,000 calories while low calorie, healthy food averages $18.16 per 1,000 calories (Parker-Pope, 2007). For an American eating 2,000 calories a day, the difference in cost over a year is significant: $1,285 versus $13,257. Consequently, advising Americans to eat healthy food may not be an economically feasible option. While some forms of exercise, such as walking, are virtually free, the fact that only 32.5 percent of Americans engage in “regular leisure-time, physical activity” demonstrates the complexities of achieving a healthy energy balance (U.S. Census, 2007).
[8] and [9] Obesity in the United States [10] Unhealthy food in the Rockaways
Planning for Prevention: A Wellness Center in the Rockaways
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A National Public Health Crisis
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A COMMUNITY IN NEED THE ROCKAWAYS COMMUNITY PROFILE The Rockaway Peninsula sits between Jamaica Bay and the Atlantic Ocean and is bordered by Nassau County, Long Island to the east. Roughly 13 neighborhoods make up the Rockaway Peninsula. These neighborhoods, along with Broad Channel, are all part of Queens Community Board 14. [11]
[11] Aerial view of the Rockaway Peninsula, and its geographical context to New York City [12] Underutilized retail strip in the Study Area
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Planning for Prevention: A Wellness Center in the Rockaways
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A Community In Need: The Rockaways
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Planning for Prevention: A Wellness Center in the Rockaways
HISTORY
THE STUDY AREA
From the 1830s through the mid-20th century, the Rockaway Peninsula was a vibrant beach resort community characterized by traditional beach bungalows. The Rockaways, like many vacation destinations in the Northeast, saw a decline in popularity when air travel became more affordable after World War II. At the same time, the Rockaways became popular for year-round, middle-income housing developments due to the affordability of land.
While Addabbo accepts patients from all of New York City and Long Island, the majority live in zip codes 11691, 11692 and 11693 (the “Study Area”), which consists of the following neighborhoods: Bayswater, Far Rockaway, Wavecrest, Edgemere, Arverne, Rockaway Beach and Hammels. The Health Center and the adjacent project site are located in Arverne, within zip code 11692. See Figure [15].
During the 1960s, there was a surge in demand for low-income housing in New York City and the distant location and affordability of land in the Rockaways made it the least contentious site for new public housing projects. By 1975, 57 percent of the public housing in Queens was located in the Rockaways (Kaplan & Kaplan, 2003; The New York Times [NYT], 2009). Years of disinvestment and failed urban renewal policies contributed to increased poverty and crime. After decades of decline, the Rockaways are changing. According to the Wall Street Journal, new housing, such as the $800 million Arverne by the Sea development, is attracting residents to the area (as cited in Arverne by the Sea, n.d.). In 2008, New York City’s Department of City Planning approved a contextual rezoning of five neighborhoods to preserve the low-scale, beach town character of the Rockaways.
Population estimates from 2009 reveal that there were 84,752 people residing in the Study Area – 32 percent of residents were white, 47 percent were black and 22 percent were Hispanic (SRC/Alteryx, 2009). While the median household income is just over $31,000, more than 21 percent of the area’s families live below the poverty level, defined as $22,050 for a family of four and $14,570 for a family of two (USHHS, 2010). The unemployment rate in the Rockaway Peninsula is 13.2 percent compared to the 9.9 percent national rate (Bureau of Labor Statistics, 2010; SRC/Alteryx, 2009). Almost one third of households earn $15,000 or less a year. Fewer than 70 percent have high school diplomas or its equivalent (U.S. Census, 2000).
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[13] Rockaway Bungalow Colony, 1912 [14] Rockaway bungalows, present day [15] The Study Area
A Community In Need: The Rockaways
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HEALTH ISSUES
HEALTH DISPARITIES
In addition to the poverty and low educational attainment rates, the Rockaway community is experiencing the same obesity problem that is plaguing the nation. As of 2007, the Rockaways was one of only seven New York City neighborhoods with an obesity rate over 30 percent (Black & Macinko, 2010). This is significantly higher than the 19 percent obesity rate in Queens and the 20 percent obesity rate in New York City (NYCDOHMH, 2006).
It is clear from these statistics that residents of the Rockaways are suffering from above average rates of obesity, heart disease, and diabetes, exacerbated by the fact that many are also living in poverty. Because many residents cannot adequately address health concerns in the same manner as a wealthy community, this constitutes what the U.S. Department of Health and Human Services calls a health disparity: “Differences in health status among distinct segments of the population including differences that occur by gender, race or ethnicity, education or income, disability, or living in various geographic localities� (as cited in CDC, 2005; as cited in Healthy Carolinians, 2010).
The Rockaway community also suffers from high rates of diabetes and high blood pressure. According to the 2006 Community Health Profile, nine percent of Rockaway adults were diabetic. Furthermore, 33 percent of adults in the Rockaways were diagnosed with high blood pressure, compared to 26 percent in Queens and New York City (NYCDOHMH, 2006). Heart disease, also closely linked to obesity, is the primary cause of premature death in the Rockaways (NYCDOHMH, 2006). Between 2003 and 2004, the death rate due to heart disease in the Rockaways was nearly 85 percent greater than that of both Queens and New York City (NYCDOHMH, 2006). According to the New York City Department of Health and Mental Hygiene (2006), during this same time period, the overall death rate in the Rockaways was 60 percent higher than in the rest of Queens and 35 percent higher than in New York City.
Furthermore, the CDC (2009) also states that nationally, blacks have a 51 percent higher prevalence of obesity and Hispanics have a 21 percent higher prevalence of obesity. Given that blacks and Hispanics have a greater risk of becoming obese and the Study Area population is predominantly black and Hispanic, the result is a community with a greater need.
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[16] Super Food Corp., Beach Channel Drive [17] Woman and child walking in the Study Area [18] A fast food restaurant in the Study Area
Planning for Prevention: A Wellness Center in the Rockaways
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A Community In Need: The Rockaways
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COMMUNITY OUTREACH The Hunter Team held three focus groups, distributed nearly 300 surveys and conducted one-on-one interviews with stakeholders, in order to better understand the challenges and needs of Rockaway residents. Two critical themes that emerged were the need for preventive services and the desire among the community to adopt healthier lifestyles.
FOCUS GROUPS
SURVEY
Focus group participants were asked to list their health concerns and propose potential solutions. They identified asthma, diabetes, and high blood pressure as their top health concerns. As possible solutions, participants suggested yoga and dance classes, a bike and running club, and improved access to fresh foods.
The Hunter Team developed a set of twenty-five survey questions. In addition to collecting demographic information, questions focused on participants’ perspectives on exercise and food access. The following are selected results from the responses:
Several of these proposals prompted more detailed discussion. When talking about the idea of a bike and running club, one participant noted that it is equally important to include children’s activities in the Wellness Center “so adults can workout and know children are safe.” Ensuring that children’s needs are also met was a recurring theme throughout all of the focus groups. Additionally, residents emphasized the need for healthy food options. Many Rockaway residents described living in a “food desert” because of the lack of fresh produce. Community residents expressed interest in farmers’ markets, community supported agriculture, and having more places to buy fresh food with WIC vouchers (Special Supplemental Nutrition Program for Women, Infants and Children). Participants recommended the inclusion of obesity support groups, cooking classes (specifically for families with diabetic children) and guidance on understanding nutritional information. The affordability of all of these programs and services was also stressed. Overall, focus group participants were extremely receptive and enthusiastic about the Wellness Center. See Appendix A for more information.
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Planning for Prevention: A Wellness Center in the Rockaways
n Almost 50 percent of respondents reported receiving supplemental income n Almost 80 percent of respondents reported being covered by either Medicare or Medicaid n A supermarket was the top requested use of the retail space in the Wellness Center n 16.3 percent of respondents claimed to exercise one to four times per month, while 25 percent reported not exercising at all n Over 50 percent of survey respondents walk four or more blocks to buy groceries, while 25 percent of respondents walk 10 or more blocks
See Appendix B for more information.
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[19] Chalkboard listing of focus group’s top health concerns [20] The Hunter Team conducting a focus group at the Joseph P. Addabbo Family Health Center on May 4, 2010
Community Outreach
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Planning for Prevention: A Wellness Center in the Rockaways
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INTERVIEWS The Hunter Team’s interview process confirmed that wellness services were missing from the community and that there was strong interest in having a place where residents could learn preventive techniques and receive wellness services. Included among the community interviews conducted by the Hunter Team were: n J.R. Peter Nelson, Ph.D, Executive Director of the Joseph P. Addabbo Family Health Center n Seth Bornstein, Executive Director of the Queens Economic Development Corporation n Patricia Simon, Executive Director of the Ocean Bay Community Development Corporation n Liz Sulik, Director of External Affairs at Peninsula Hospital n Jonathan Gaska, District Manager of Community Board 14
See Appendix A for more information. [21] The Hunter Team conducting a focus group at Ocean Bay Community Center on May 1, 2010 [22] The Hunter Team speaking with employees of the Ocean Bay Community Development Corporation on May 1, 2010
Community Outreach
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WELLNESS
A PREVENTIVE APPROACH In the United States, health care services have traditionally been rooted in the medical model, which stresses clinical diagnosis and intervention to remedy disease(s) (Shi & Singh, 2004). Although there are obvious merits to the medical model, the Hunter Team opted to explore the concept of wellness, which “emphasizes efforts and programs geared towards the prevention of disease and maintenance of an optimum state of well-being” (Shi & Singh, 2004). In addition to improved health, studies have also shown that prevention strategies have the potential to reduce healthcare costs for insurers. For example, a 2004 study of 55,439 people with diabetes determined that the overall cost per diabetic person in a prevention program was $417 compared to $554 in the control group (Villagra & Tamim, 2004). The Hunter Team used the National Wellness Institute’s model (the “Wellness Model”) to guide the planning process of the Wellness Center. The National Wellness Institute (2010) defines wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.” This six-dimensional framework is holistic in its design and focuses on physical, spiritual, intellectual, social, emotional and occupational health. The Hunter
Team adapted the Wellness Model and incorporated the environment as a seventh dimension to address how a safe, healthy and sustainable environment positively contributes to wellness. A successful implementation of the Wellness Model creates programs or services that integrate multiple dimensions simultaneously. See Appendix C for more information. The Hunter Team’s vision is to create a safe, supportive space that engages, educates and empowers the community and provides opportunities to integrate wellness into everyday life. Critical to this vision is ensuring that each dimension of the Wellness Model is reflected in the allocation of space for programs. For instance, the spiritual aspect of wellness is represented in meditation and yoga programs, which can help participants manage stress. Activities related to the rooftop space, such as gardening, might be linked to the physical and environmental dimensions. Finally, the allocation of space for mental health services would address the emotional aspect of wellness. The Wellness Center will not only complement the services already being provided by the Health Center, but will also be at the forefront of prevention. Most importantly, the services offered by the Wellness Center will be affordable to residents living in the area.
[23] Fruit and vegetable selection at the Super Food Corp., Beach Channel Drive
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Planning for Prevention: A Wellness Center in the Rockaways
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THE WELLNESS CENTER
PROGRAMMING & DEVELOPMENT SITE
ZONING
The Wellness Center will be located at 62-00 Beach Channel Drive in Arverne, adjacent to the existing Health Center. The site, situated on Lot 1 of Block 16015, is owned by the New York City Economic Development Corporation. The lot size, orientation and zoning are consistent with a mixed-use development similar to the adjacent Health Center. The site is easily accessible by public transit and convenient for patients of the existing Health Center.
The development site falls within three zoning districts: R4-1 and R5-D with a C1-3 district overlay. According to the New York City Zoning Map, the R4-1 and the R5-D zoning district boundaries cut directly through the site. The Hunter Team adhered to the R4-1 zoning regulations in creating the building envelope. The calculations yielded a three story, 28,926 square foot building with a footprint of 67 feet wide by 156 feet deep at ground level.
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The R4-1 regulations require both the front and side yards to be 15 feet wide. The internal side yard, adjacent to the neighboring Health Center, must be at least eight feet wide. The height regulations permit a third floor with the incorporation of a setback. Under Article II of the New York City Zoning Resolution, the building would be categorized as Use Group 4, which governs community facilities in residential areas (New York City Department of City Planning [NYCDCP], 2006). The building would be designated as a community facility, allowing for a floor area ratio (FAR) of 2.0. Off-street parking requirements were determined by using a conversion factor that equates square footage of developed space into the number of parking spaces required. Using standard formulas and the requirements set forth by the New York City Department of City Planning, the Hunter Team concluded that the proposed site plan is short by approximately 32 parking spaces. Under normal conditions, an underground parking garage would be utilized to make up for this shortfall, but because of the site’s proximity to the waterfront, this is not a viable alternative.
[24] The site of the proposed Wellness Center, adjacent to the Joseph P. Addabbo Family Health Center, at 62-00 Beach Channel Drive
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Planning for Prevention: A Wellness Center in the Rockaways
See Appendix D for more information.
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[25] New York City Zoning Map of project site and surrounding area [26] Aerial map of project site and surrounding area
The Wellness Center: Programming & Development
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PROGRAMMING & LAYOUT Before beginning the design process, the Hunter Team researched existing wellness centers to serve as best practices. The purpose of this research was to better understand how wellness is currently being integrated into building design and programming. These case studies included The College of New Rochelle Wellness Center in New Rochelle, NY; the Mary and Gary West Senior Center in San Diego, CA; and the Peterson Family Wellness Center in Harlan, IA. The Hunter Team also consulted the New York City Active Design Guidelines (the “Guidelines”), which were developed to promote health through building design. These Guidelines present the most appropriate framework for the Wellness Center and stress that “active design is environmental design that encourages stair climbing, walking, bicycling, transit use, active recreation, and healthy eating”
(New York City Department of Design and Construction [NYCDDC], NYCDOHMH, & New York City Department of Transportation [NYCDOT], 2010). The Guidelines align with the physical dimension of the Wellness Model by providing design considerations that encourage physical activity in everyday living. The environmental dimension is also addressed by emphasizing the “synergies between active design and sustainable design initiatives such as LEED and PlaNYC” (NYCDCP, NYCDDC, NYCDOHMH, & NYCDOT, 2010). The results of the community outreach and field work, the Wellness Model and the specific health issues facing the Rockaway community (obesity, diabetes, heart disease and hypertension) also informed the Hunter Team’s allocation of space within the facility.
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[27] A three-dimensional model of the proposed Wellness Center
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Planning for Prevention: A Wellness Center in the Rockaways
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[28] Conceptual rendering of the proposed Wellness Center
The Wellness Center: Programming & Development
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GROUND FLOOR The entrance of the Wellness Center will feature a spacious, light-filled atrium with a prominent staircase that encourages visitors to use the stairs when participating in activities on the other floors. The Active Design Guidelines recommend designing space to “increase stair use among the able-bodied by providing a conveniently located stair for everyday use” (NYCDCP, NYCDDC, NYCDOHMH, & NYCDOT, 2010). The ground floor will include a community kitchen, which will be used for cooking classes, workshops, and serve as an incubator for local chefs and small businesses. Not only will these uses generate revenue for the Wellness Center and foster a sense of entrepreneurship, they will directly address needs voiced by focus group participants: better access to nutrition information and food preparation skills. One local organization, the Lower Eastside Girls Club in Manhattan, has a program called Sweet Things Bake Shop, which is a production and training site where members can acquire baking and business skills. The Sweet Things Bake Shop is one of three revenue generating programs that offset operating expenses for the Lower Eastside Girls Club (n.d.) (Carmody Consulting Evaluation Services, 2008). See Appendix E for more information.
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Image Source: sasaki.com/
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Rental of the ground floor retail space will serve as a source of revenue for the Wellness Center. Focus group participants expressed interest in sporting goods stores, restaurants and fresh produce stores as potential retail options. Ideally, the retail option Addabbo ultimately selects should be a healthy one. The Hunter Team researched healthy pizzerias as one possibility. See Appendix F for more information. The ground floor will also feature the Borrow-a-Bicycle Program, which presents the opportunity for Addabbo to partner with a local non-profit organization. The results of the community outreach indicated a strong demand for the Wellness Center to offer cycling as a way to encourage outdoor exercise.
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Members of the community voiced a need for event space within the neighborhood. To address this, a multi-use room for community activities will be included on the ground floor. Finally, yoga and meditation programs, which were also in high demand, will have dedicated studio space. Studies have shown that yoga participation is beneficial to obesity prevention, hypertension control, and a positive quality of life (Lippincot’s Nursing Center, 2006). Additional space on the ground floor will be reserved for administrative use and maintenance.
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Planning for Prevention: A Wellness Center in the Rockaways
Inspirational images: [29] staircase in lobby atrium, [30] Borrow-a-Bicycle Program and [31] visitors participating Image Source: rentals.astorcenternyc.com/ in a healthy cooking demonstration in the community kitchen
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GROUND FLOOR
[32] Proposed layout, ground floor (all square footage calculations are approximate)
The Wellness Center: Programming & Development
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SECOND FLOOR A substantial portion of the second floor will be devoted to fitness centers for both adults and children. The adult fitness center is adjacent to physical therapy rooms, allowing therapists to continually monitor the activity of their patients. The children’s fitness room will be supervised, giving both adults and children the chance to exercise simultaneously.
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The remainder of the second floor will house Addabbo’s chronic disease management facilities, which will focus on asthma, obesity, hypertension and diabetes treatment. This space will include nine exam rooms, three doctors’ offices and a dedicated waiting room, reception and administration area. A biogenetic repository will also be located on the second floor. Addabbo hopes that the work performed in this space will help doctors understand the link between genetics and chronic diseases. This laboratory will be a primary revenue generator for the Wellness Center. [36]
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Image Source: tampabay.com
Image Source: Addabbo Family Health Center
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Planning for Prevention: A Wellness Center in the Rockaways
Image Source: magazine.concordia.ca/
Inspirational images: [33] fitness area, [34] view of open atrium from second floor, [35] children’s fitness area and [36] child being seen by doctor in consultation room
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SECOND FLOOR
[37] Proposed layout, second floor (all square footage calculations are approximate)
The Wellness Center: Programming & Development
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THIRD FLOOR Addabbo’s Mental Health Department will be relocated from the existing Health Center to the third floor of the new Wellness Center. The department will have eight consultation rooms that will also serve as offices for mental health professionals. There will be a separate waiting room, reception, and administration area.
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The remaining space on the third floor will be designated as offices rented by academic institutions that might partner with the Wellness Center for research purposes. This floor will also feature a setback to create a sizable outdoor area, half of which will be enclosed in glass, for year-round recreational and entertainment uses. Lastly the third floor will contain a multi-use room and a kitchen, both of which can be rented by community members and organizations for events. [38]
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Image Source: landelements.com/
Inspirational images: [38] academic research area, [39] outdoor art therapy classes and [40] the outdoor terrace
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Planning for Prevention: A Wellness Center in the Rockaways
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THIRD FLOOR
[41] Proposed layout, third floor (all square footage calculations are approximate)
The Wellness Center: Programming & Development
30
ROOFTOP Participants in the focus groups cited an interest in learning how to grow their own food. Vegetable gardens offer many benefits to communities. One study found that households with at least one family member belonging to a community garden were significantly more likely to consume fruits and vegetables on a regular basis than those families without a gardening household member (Alaimo, Packnett, Miles & Kruger, 2008). Gardens have also shown to be successful in teaching children to eat more healthfully, especially when combined with nutrition education (Morris, Neustadter, & Zidenberg-Cherr, 2001; McAleese & Rankin, 2007). The Wellness Center will include a rooftop garden that not only benefits the community, but also the immediate facility and its surrounding environment. The rooftop garden has the potential to: reduce stormwater runoff, provide building insulation, reduce the heat island effect and provide habitats for many species (Berghage, Jarrett, Thuring, & Razaie, 2009; U.S. Environmental Protection Agency [EPA], 2010). [42]
[43]
Inspirational images: [42] children learning gardening techniques and [43] the rooftop garden
31
Planning for Prevention: A Wellness Center in the Rockaways
[44]
ROOFTOP
[44] Proposed layout, rooftop (all square footage calculations are approximate)
The Wellness Center: Programming & Development
32
FINANCIAL FEASIBILITY CONSTRUCTION COSTS The total cost of construction of the Wellness Center is approximately $16 million. This total represents hard costs, soft costs and land acquisition. Addabbo anticipates that it can acquire the land from the New York City Economic Development Corporation for a nominal cost. Using construction costs from the existing Health Center and three comparable New York City development projects, the Hunter Team [45] Property Information Address Lot Size Gross Building Area (Sq.Ft.)
[46] Estimated Cost of Construction Hard Costs Purchase Price 1 Construction Cost (Per Sq. Ft) 2 Contingency Fee 3 Total Hard Costs Soft Costs Soft Costs 4
62-00 Beach Channel Drive 54,000 28,926
$300,000.00 $450.00 5% $13,667,535.00
Total Soft Costs Total Hard and Soft Costs Developer's Fee (7%) 5
7% $956,727.45 $14,624,262.45 $1,023,698.37
Total Construction Costs
$15,947,960.82
estimated hard construction costs at $13.7 million, based on $450 per square foot. The remaining costs for the construction are considered soft costs, which include insurance, legal and architecture fees. Finally, a developer fee is added to determine the total construction costs. See Figures [45] and [46] for more information.
[47] Permenant Loan Information Construction Costs Total Construction Costs Equity Sponsor Foundation(s) Other Funding Total Equity Debt Service Total Debt Amortization Schedule Interest Rate (Per Annum) Monthly Payments Yearly Debt Service 6
$15,947,960.82
$2,000,000.00 $1,000,000.00 $2,000,000.00 $5,000,000.00
$10,947,960.82 30 6% -$65,638.56 -$787,662.72
Assumptions (1) The Health Center lot was acquired from the NYCEDC for $300,000. As the NYCEDC owns the lot for the Wellness Center, the Hunter Team assumed that the agreement for land transfer would be similar. (2) Approximation of the average of three comparable development projects: (a) Private new construction community center, Marion McMahon Abbe Clubhouse in Flushing, Queens ($372.00 per Sq. Ft.) (b) Private new construction mixed-use community center, Bronx ($368.00 per Sq. Ft) (c) Public new construction mixed-use building, Wave Hill Vistor Center, Bronx ($664.00 per Sq. Ft.) (3) A 5% contingency rate was utilized based on the estimated construction cost. (4) Soft Costs (architects, building permits, construction management) were estimated at 7% . This number was based on soft costs for the current Health Center. (5) Developer’s fee was estimated at 7%. As this project is a community development for a non-profit corporation, it is customary to keep the developer’s fee low. (6) Yearly Debt Service was calculated using a 30 year mortgage at a rate of 6.0% on the principal.
33
Planning for Prevention: A Wellness Center in the Rockaways
FUNDING Funding will be obtained from both public and private sources in order to make the Wellness Center financially feasible. Potential funding sources are discussed below. FEDERAL The majority of the Wellness Center’s proposed programming initiatives will benefit from the funding available through the Patient Protection and Affordable Care Act passed in March 2010. This legislation “will promote prevention, wellness, and the public health and provides an unprecedented funding commitment to these areas. It directs the creation of a national prevention and health promotion strategy that incorporates the most effective and achievable methods to improve the health status of Americans and reduce the incidence of preventable illness and disability in the United States” (U.S. Executive Office, 2010). Specifically, the Wellness Center will be eligible for funding under Title IV of this legislation entitled Prevention of Chronic Disease and Improving Public Health. Title IV provides funding to non-profit entities that develop strategies to prevent the onset of chronic diseases including those associated with obesity (Patient Protection and Affordable Care Act [PPACA], 2010). Also included within Title IV is the Prevention and Public Health Fund, which was established to “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs” (PPACA, 2010). This fund has appropriated seven billion dollars to be distributed to organizations dedicated to improving the quality of health care by the end of 2015 (PPACA, 2010). STATE State funding is also available for construction of the Wellness Center. One source is the Preventive Health & Health Services Block Grant, which provides funding for programs that prevent the leading causes of death and disability. This grant has distributed $3.2 million to reduce health disparities (CDC, 2009). LOCAL The Wellness Center is eligible for funding from New York City. The Health Center received strong support from the community and funding from Councilman Gregory Meeks, Queens Borough President Helen Marshall, the Port Authority of New York & New Jersey and other local officials and agencies. FOUNDATIONS Foundations are another potential revenue source for the Wellness Center. The Kresge Foundation gives operating and construction cost grants to centers that are health-focused and impact community development. The W.K. Kellogg Foundation (n.d.) focuses on children and specifically provides funding for child obesity management and prevention. The Robert Wood Johnson Foundation (2010) strives to improve general community health, decrease obesity rates and reduce inequality. This foundation specifically aims to fund proposals that address health disparities (Robert Wood Johnson Foundation, 2010).
Financial Feasibility
34
OPERATING REVENUE & EXPENSES The Wellness Center can leverage its space to produce revenue streams that will cover operating costs. Year one monthly operating expenses will be approximately $241,139, which factors in start-up costs associated with the biogenetic repository. Beginning year two, monthly operating expenses will dip to $203,487 and then increase annually based on a 3 percent rate of inflation. The Hunter Team calculated a monthly debt service of approximately $65,639, but notes that debt service has the potential to change based on the amount of funding that is received; for every million dollars of funding, debt service would be reduced by roughly $72,000 per year. The ground floor retail space is a potential revenue stream, providing goods and services that enhance the goals of the Wellness Center. Based on comparable retail rents, the Wellness Center can charge $24 per square foot per year, producing an annual rental income of $48,000. Other rental income may come from non-profit organizations that will rent space in the Wellness Center.
[48] REVENUE: Wellness Retail Rental Income Retail Net Rental Area (Sq. Ft.) Average Rent (Sq. Ft.)6
2,000 $24 Total Year 1 Retail Rental Income
[49] REVENUE: Wellness Services/ Research Patients/ 1, 2 Per Day 36 10 48 16
Wellness Services Chronic Disease Mgmt. Physical Therapy Mental Health Counseling Nutritional Counseling
Patients / Per Year 3 10800 3000 14400 4800
Patient Patient Reimbursement/ Reimbursement/ Per Day4 Per Year4 $135.00 $1,458,000.00 $135.00 $405,000.00 $135.00 $1,944,000.00 $135.00 $648,000.00
Total Wellness Services Revenue Wellness Research Biogenetic Repository5
$4,455,000.00
~6.67
2000
$800.00
Total Wellness Services/Research Revenue
The Wellness Center will also use fees from clinical services as revenue. The Chronic Disease Management Unit of the Wellness Center will see approximately 36 patients a day; the Nutrition and Mental Health Units will see approximately 64 patients a day combined; and the Physical Therapy Unit will see approximately 10 patients a day – all at a rate of $135 per visit. Using the assumption of 300 days of operation per calendar year, the combined revenue from these services will total approximately $4.46 million per year.
$48,000.00
$1,600,000.00
$6 055 000 00 $6,055,000.00
7
[50] EXPENSE: Wellness Staff Building Staff Facilities $40,000.00 Administrator $65,000.00 Receptionist $40,000.00 Chronic Disease Management Nurses (2) $160,000.00 Doctors (2) $300,000.00 $45,000.00 Unit Clerk Mental Health Counseling Therapists (8)
Community Kitchen Nutritionist Staff
$50,000.00 $40,000.00
Physical Therapy Physical Therapist
$60,000
Total Wellness Staff
$1,280,000.00
$480,000.00
Assumptions (1) Wellness Services: 4 patients per room per day for Chronic Disease Management, 6 patients per room per day for Mental Health Counseling, 10 patients per day for Physical Therapy and 16 patients per day for Nutritional Counseling (P. Nelson, personal communication, June 18, 2010). (2) Wellness Research: Approximately 6-7 samples collected per day (P. Nelson, personal communication, June 18, 2010). (3) 300 operational days per year (4) Net Patient Revenue is based on the payout rate to Addabbo from Medicaid, Medicare or both (P. Nelson, personal communication, April 13, 2010). (5) According to research conducted by Addabbo, genetic samples can be sold for approximately $800 (P. Nelson, personal communication, June 18, 2010). (6) The yearly retail rent is based on CoStar comparables for the neighborhood. (7) Expense estimations based on Addabbo’s knowledge of running the three existing health centers.
35
Planning for Prevention: A Wellness Center in the Rockaways
OPERATING REVENUE & EXPENSES (CONTINUED) The Wellness Center will also operate a biogenetic repository. This repository will be the site of DNA collection, storage and analysis. The genetic information collected will be used for research in developing cures and treatments for chronic diseases and will be sold to research organizations to generate revenue. It is estimated that the Wellness Center can receive $800 per sample (P. Nelson, personal communication, June
18, 2010). Assuming 300 days of operation per calendar year, and an average collection rate of 6 to 7 samples per day at $800 per sample, the Hunter Team calculated annual revenue from the biogenetic repository at $1.6 million. See Figures [48], [49], [50] and [51] for more information.
PRO FORMA [51] 2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
$48,000.00 $4,455,000.00 $1,600,000.00
$49,440.00 $4,455,000.00 $1,648,000.00
$50,923.20 $4,455,000.00 $1,697,440.00
$52,450.90 $4,455,000.00 $1,748,363.20
$54,024.42 $4,455,000.00 $1,800,814.10
$55,645.16 $4,455,000.00 $1,854,838.52
$57,314.51 $4,455,000.00 $1,910,483.67
$59,033.95 $4,455,000.00 $1,967,798.18
$60,804.96 $4,455,000.00 $2,026,832.13
$62,629.11 $4,455,000.00 $2,087,637.09
$6,103,000.00
$6,152,440.00
$6,203,363.20
$6,255,814.10
$6,309,838.52
$6,365,483.67
$6,422,798.18
$6,481,832.13
$6,542,637.09
$6,605,266.21
-$787,662.72 -$1,280,000.00 -$42,000.00 -$84,000.00 -$500,000.00 -$200,000.00
-$787,662.72 -$1,318,400.00 -$43,260.00 -$86,520.00 $0.00 -$206,000.00
-$787,662.72 -$1,357,952.00 -$44,557.80 -$89,115.60 $0.00 -$212,180.00
-$787,662.72 -$1,398,690.56 -$45,894.53 -$91,789.07 $0.00 -$218,545.40
-$787,662.72 -$1,440,651.28 -$47,271.37 -$94,542.74 $0.00 -$225,101.76
-$787,662.72 -$1,483,870.82 -$48,689.51 -$97,379.02 $0.00 -$231,854.81
-$787,662.72 -$1,528,386.94 -$50,150.20 -$100,300.39 $0.00 -$238,810.46
-$787,662.72 -$1,574,238.55 -$51,654.70 -$103,309.40 $0.00 -$245,974.77
-$787,662.72 -$1,621,465.70 -$53,204.34 -$106,408.69 $0.00 -$253,354.02
-$787,662.72 -$1,670,109.68 -$54,800.47 -$109,600.95 $0.00 -$260,954.64
-$2,893,662.72
-$2,441,842.72
-$2,491,468.12
-$2,542,582.28
-$2,595,229.87
-$2,649,456.88
-$2,705,310.71
-$2,762,840.15
-$2,822,095.47
-$2,883,128.45
$3,209,337.28
$3,710,597.28
$3,711,895.08
$3,713,231.81
$3,714,608.65
$3,716,026.79
$3,717,487.48
$3,718,991.98
$3,720,541.62
$3,722,137.75
Operating Revenue 1 Space Rental - Retail Net Patient Biogenetic Repository Total Revenue Operating Expenses 2 Debt Staff Salaries Utilities 3 4 Insurance 5 Biogenetic Start-up 6 Other Expenses Total Expenses OPERATING INCOME
Assumptions (1) All Revenue components will be subject to a 3% increase based on inflation (Exception: Net Patient due to unknown variability of Medicaid/Medicare). (2) All Expenses will be subject to a 3% increase based on inflation (Exceptions: Debt and Biogenetic Repository Start-up costs). (3) Utility costs are derived from Addabbo’s current health centers’ utility costs (P. Nelson, personal communication, April 13, 2010). (4) Insurance costs are derived from Addabbo’s current health centers’ insurance costs (P. Nelson, personal communication, April 13, 2010). (5) Biogenetic Repository Start-up cost is derived from research conducted by Addabbo (P. Nelson, personal communication, April 13, 2010). (6) Other Expenses are derived from Addabbo’s current health centers’ other expenses (P. Nelson, personal communication, April 13, 2010).
Financial Feasibility
36
RECOMMENDATIONS n Form a Community Task Force. The Task Force should advocate the ideas and concerns of Rockaway residents and business owners to ensure that the Wellness Center’s programming and outreach efforts continue to be reflective of the community’s needs. The Task Force could be comprised of community members who would like to lead the charge in ensuring that the voice of the community is heard. The Hunter Team has prioritized the needs and desires of the community in its design and programming of the Wellness Center and the Task Force should continue this work. Several participants of the focus groups have already expressed an interest in joining the Task Force.
Establish a commitment to affordability. During outreach efforts, the Hunter Team repeatedly heard that cost would be a driving factor in determining usage of the Wellness Center. While market research of the surrounding area has revealed that there are fitness centers and a planned YMCA (located on Beach 73 Street), these facilities remain financially inaccessible to the Wellness Center’s target community. So while the Wellness Center will overlap with neighboring facilities in some capacities, its affordability, supportive programs and focus on prevention should be its key differentiators.
n
Research alternative fee structures. Recognizing that affordability is critical to the utilization and ultimate success of the Wellness Center, Addabbo should research the feasibility of a sliding fee structure that will accommodate the financial limitations of some community members, while reinforcing the concept of personal responsibility.
n
Create strategic partnerships. The Wellness Center should establish new and strengthen existing partnerships with non-profit groups, hospitals, housing developments and other community organizations. One method of reaching potential clients is to invite other nonprofits to operate some of the programs within the Wellness Center. n
Consider retail possibilities. The Hunter Team recommends a healthy pizzeria for the retail space. It will address the limited dining options in the study area. Secondly, pizza is both an affordable, popular, and familiar food option. Finally, pizza can also easily be prepared in a healthy manner, creating an opportunity to introduce fresh ingredients grown in the Wellness Center’s rooftop garden.
n
Hire a grant and funding specialist. Given the complexity of the current healthcare system, as well as the intricacies of the Patient Protection and Affordable Healthcare Act, Addabbo should hire a grant specialist who will research feasibility of funding through federal, state, local and/or non-profit sources. n
Develop marketing strategies. While the Hunter Team recognizes that the Wellness Center will rely on referrals from the Health Center, Addabbo should also be proactive in developing creative marketing strategies to raise awareness and increase engagement. One example is the Walking-While-Waiting program, conceptualized by the Hunter Team. Instead of passively sitting in the Health Center waiting room, patients will be given acccess to treadmills in the Wellness Center and a wireless pager to notify them when their doctor is available. This treadmill area will be supervised by personnel, who can both monitor patients’ physical activity and answer questions about the Wellness Center.
n
37
Planning for Prevention: A Wellness Center in the Rockaways
Investigate zoning variances. Because the zoning analysis conducted by the Hunter Team concluded that the new site plan, which includes both the proposed Wellness Center and the existing Health Center, came up slightly short on the parking requirement, it is recommended that Addabbo consult with a zoning specialist for parking considerations and potentially apply for a variance. The Hunter Team also recommends exploring the possibility of using Rated Capacity as an alternate methodology for calculating site parking requirements. Rated Capacity takes the maximum number of persons per use, at any given time throughout the day and uses a conversion factor to determine the number of required spaces.
n
Promote sustainability. As Addabbo moves into the next phases of building and site design, the Hunter Team recommends that consideration be given to the environmental dimension of the Wellness Model. Green building principles should be used and Addabbo should seek LEED certification for the Wellness Center. n
Endorse employee wellness. Addabbo should strive to emphasize employee wellness. Not only will this enhance employee productivity, but it will also strengthen relationships with patients. This is particularly important given feedback from the focus groups conducted
n
by the Hunter Team. Participants expressed concern on the somewhat transient nature of staff members; the underlying thought being that if there was more consistency in staffing, patients would feel that they were being monitored more regularly and comprehensively. To accomplish this goal, Addabbo should create specific programs designed to increase employee satisfaction and retention. Potential funding for this recommendation can stem from a Title IV of the Patient Protection and Affordable Care Act. This program, called the Workplace Wellness Program, has allocated $200 million in funds to small businesses and non-profits.
[52]
[52] A Rockaway family
Recommendations
38
CONCLUSION Achieving wellness demands action, both literally and figuratively. As a country, a community and as individuals, we must move – and encourage the government, on all levels, to do the same. With the passage of the Patient Protection and Affordable Care Act in March 2010 – and more specifically, the National Prevention and Wellness Strategy – our Federal government has taken a step in the right direction.
[53]
At the local level, the Hunter Team has developed a proposal that aligns with these national priorities. The Wellness Center will offer affordable programming and services that emphasize preventive strategies and respond to health disparities in lower income areas of the Rockaways. If implemented, Addabbo’s new Wellness Center can become a replicable model, used in poor communities across the country suffering from similar health disparities. This will ultimately reveal that wellness perhaps more than any other preventive strategy, can lead Americans to live longer, healthier and more productive lives.
[53] Little boy sitting on Rockaway boardwalk, Earth Day Rockaway on May 1, 2010
39
Planning for Prevention: A Wellness Center in the Rockaways
APPENDIX
40
APPENDIX A INTERVIEWS WITH COMMUNITY ADVOCATES AND REPRESENTATIVES As part of the process of understanding the community and its needs, interviews were conducted with community advocates and representatives. The interviewees included the Executive Director of the Ocean Bay Community Development Corporation, Patricia Simon; the Director of External Affairs at Peninsula Hospital and former member of the Queens Chamber of Commerce, Liz Sulik; and Community Board 14 District Manager, Jonathan Gaska. The overarching theme that emerged throughout these interviews was the lack of comprehensive wellness services available in the Rockaways. Interviewees stressed that the community needs an accessible place to obtain targeted, preventive care. Ocean Bay Executive Director Patricia Simon noted that the Ocean Bay Houses lack a comprehensive center providing health and social services. More specifically, Ms. Simon stated that a wellness center could provide services for the seniors who reside in the developments (P. Simon, personal communication, March 9, 2010).
2010). This statement underscores the need for Addabbo to create a comprehensive Wellness Center that provides medically supervised exercise space, along with nutritional counseling. The interview with Community Board 14 District Manager Jonathan Gaska informed the Hunter Team that any community outreach and/ or marketing must be thoughtfully positioned in order to be successful. Mr. Gaska mentioned the importance of appealing to seniors, and emphasized that this group may not be responsive if the services are offered in an environment that is also frequented by younger community members. Additionally, Mr. Gaska emphasized the need to provide affordable services to the community, particularly in light of current unemployment rates (J. Gaska, personal communication, March 10, 2010). The unemployment rate in the Rockaway Peninsula is approximately 13.2 percent compared to the 9.9 percent national rate (Bureau of Labor Statistics [BLS], 2010; SRC/Alteryx, 2009). [54]
Similarly, Liz Sulik of Peninsula Hospital stated that there is a need for a space in the community to address concerns about diabetes, exercise and nutrition. While Peninsula Hospital would like to provide preventive care, it currently does not have adequate funding to do so. This equates to a lack of preventive care staff, such as Certified Diabetic Assistants. Additionally, Ms. Sulik emphasized the linkages between poor nutrition and high diabetes rates in the community. She suggested that a cost-effective, health food franchise could address this issue and serve as a potential retail anchor for the Wellness Center. Lastly, Ms. Sulik highlighted the disconnect between what doctors advise patients to do and the reality of the community. “If you tell people to exercise,” contended Ms. Sulik, “you have to give them a place to do it” (L. Sulik, personal communication, March 9, [ 54] Youth basketball game at the Ocean Bay Community Center on May 1, 2010
41
Planning for Prevention: A Wellness Center in the Rockaways
FOCUS GROUPS In addition to interviews and surveys, the Hunter Team also conducted three focus groups with Rockaway residents. Questions were drafted that explored the strengths and weaknesses of existing community services; exercise and lifestyle choices; and preferred services to include in the Wellness Center.
The third focus group was held at the Joseph P. Addabbo Family Health Center on May 4, 2010 and consisted of twelve Health Center patients, who were compensated $10 for their time. The three topics that continually emerged were staffing concerns at the Health Center, access to fresh food and childhood nutrition and fitness.
Separate adult and teen focus groups were held at the Ocean Bay Community Center on May 1, 2010. In the adult session, participants voiced a desire for more information on healthy living and exercise. Additionally, when asked about existing services in the community, one respondent questioned, “What services? There aren’t any services.” Some respondents stated that they would welcome a facility that would offer yoga, dance classes and a gym. Several potential barriers to using the Wellness Center were noted by participants including cost. One participant, using the $50 membership fee from the Police Athletic League gym as a baseline, said this price is too high, but that she could afford $19.99 a month. Other participants said that aside from cost, lack of motivation was another reason for not exercising and utilizing available services. Lastly, while participants were familiar with Addabbo and the Health Center through friends or family, most were not patients themselves.
Participants expressed concern about the somewhat transient nature of staff members at the Health Center. They thought that if there was more consistency in staffing, patients would feel that they were being monitored more regularly and comprehensively.
During the teen focus group, participants commented that they wanted more information on healthy living and exercise. Most of the teens were fairly physically active, often participating in sponsored basketball and coach-led conditioning offered through the Ocean Bay Community Development Corporation. As a result, they felt that supervised exercise is a good strategy to motivate teenagers. When the Hunter Team inquired why the teenagers were were so active, one participant commented that it is because he “does not want to be overweight” when he gets older. When asked about the needs the Wellness Center might address, another respondent said that the Wellness Center could provide a place for children to “occupy their time and get them off the street.” Participants also suggested that a sporting goods outlet could occupy the retail space.
Participants also noted that they would like to see more mental health services, family counseling, cooking classes targeted towards families with diabetic members (specifically children) and also nutrition classes for children. Many participants were parents who were concerned with school lunch programs that provide unhealthy, overprocessed, high calorie food. Residents voiced interest in more children’s activities in the Wellness Center so adults “can work out and know children are safe.” They also requested “treadmills, fitness classes, exercise bikes, basketball courts and an indoor running track.” Some participants noted that they would consider doing these same activities outside if they were coordinated through organized clubs. Lastly, many in the focus groups described the Rockaways as a “food desert” due to the lack of fresh produce. To address this, participants discussed the need for outlets to buy fresh food with WIC vouchers, farmers’ markets, and community supported agriculture, while also acknowledging that this may require improved public transportation options to reach these destinations.
Appendix A
42
APPENDIX B SURVEYS The Hunter Team developed a set of 25 survey questions in order to better understand community perspectives on health, exercise and food access. The Team wanted to gauge the community’s interest in the proposed Wellness Center and how they felt it could be best programmed. Finally, demographic data was collected to gain insight into populations that might use the Wellness Center. Once the survey was developed and approved by Seth Bornstein, Queens Economic Development Corporation and the client, Dr. J.R Peter Nelson, Executive Director of the Joseph P. Addabbo Family Health Center Inc., it was distributed to two groups: n n
Patients in the waiting room at the Health Center Residents attending events at the Ocean Bay Community Center
Respondents were not compensated for their answers and filling out the anonymous survey was optional at both locations. Over the course of three weeks, 293 surveys were collected.
43
Planning for Prevention: A Wellness Center in the Rockaways
SURVEY Wellness Center Survey Help us determine how best to serve the Rockaway community with a center for wellness and health! ͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲͲ We are 10 Hunter College students working with Addabbo Family Health Center to develop a wellness center for the Rockaways. Typically, a wellness center is a place for a community to address its emotional, nutritional, physical and occupational needs. Please tell us what you would like to see in this new building that will be located next to Addabbo! 1. Zip Code:___________ 2. Are you Male or Female? (Circle one) Male Female 3. Age: a. 18 or younger
b. 19 – 25
d. 36 – 50
e. 51 – 64 f. 65 and over
11. On average, how often do you exercise? (Circle one monthly or weekly choice) a. I do not exercise
a. $5 per visit
c. 26 – 35
4. Do you currently have health insurance? (Circle one)
Yes
a. Medicare
b. Medicaid
a. Less than $10,000
b. $10,000 – $19,999
e. $40,000 – $49,999 f. $50,000 – $59,999
c. $20,000 – $29,999 d. $30,000 – $39,999
g. $60,000 – $70,000 h. More than $70,000 Yes
a. WIC
e. Foster care reimbursements
b. SNAP
f. Veterans benefits
c. SSI
g. Other(s)_________________
18. Weight loss program? 1 19. Nutrition counseling? 1 20. Cooking classes? 1 21. Fruit & vegetable garden? 1
b. Convenience store / bodega / corner store c. Places for eating out / take out / delivery 8a. How far is the store from your residence? _____________blocks 8b. Does this store carry fresh fruits/vegetables? (Circle one) Yes No I am not sure 9. If a retail store were to be located near Beach Channel Drive and Beach 63rd Street (the future site of a Wellness Center), what type of store would you like to see at the location? _______________________________________ 10. How do you usually travel (to work, to school, to the doctor’s office, etc)? (Circle one)
e. Biking
f. Taxi/car service
Very likely 5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
2
Lifestyle
a. Supermarket / grocery store
b. Bus
Often likely 4
Food & Nutrition
d. Rental Income 8. Where do you usually buy groceries? (Circle one)
c. $20 per visit
Sometimes likely 3
13. Fitness classes? 1 2 14. Exercise machines (i.e. Treadmills & resistance machines)? 1 2 15. Ball courts? 1 2 16. Bike lending program? 1 2 17. Fitness trainer? 1 2
No
7a. If yes, which supplement(s) do you receive? (Circle all that apply)
a. Car
b. $10 per visit
Exercise
No
7. Do you currently receive supplemental income? (Circle one)
c. 2 times/week
I do not have children Yes
Seldom likely 2
c. Other_______________
4b. Do your children have health insurance? (Circle one)
Yes No 5. Are you currently employed? (Circle one) 6. What is your yearly income? (Circle one)
Be creative! Tell us what you’d like to see in a new wellness center. ___________________________________________________________________________________________ ___________________________________________________________________________________________ For Questions 13Ͳ25, consider how likely you are to use the following services at a community Wellness Center: Never likely 1
No
4a. If yes, what kind of health insurance do you have? (Circle one)
b. 1Ͳ4 times/month
d. 3Ͳ5 times/week e. 6 or more times/week 12. If services at the proposed wellness center cost a small fee, what amount would be too much for you to pay? (Circle one)
c. Subway
g. Other_________
d. Walking
22. Support group? 1 2 23. Job & personal finance workshop? 1 2 24. Education workshop on preventing and treating obesity? 1 2 25. Education workshop on preventing and treating diabetes? 1 2
Thank you! Your answers will be kept confidential and your identity will remain anonymous.
Appendix B
44
APPENDIX B SUMMARY OF RESPONSES 1.) Zip Code Zipcode
2.) Are you Male or Female? Valid %
Gender
Frequency
Valid %
10457 10460 11096 11208 11218
1 1 1 3 1
0.3% 0.3% 0.3% 1.0% 0.3%
Male Female Other
89 198 1 5 293
30.9% 68.8% 0.3%
11233 11377 11414
1 1 1
0.3% 0.3% 0.3%
11416 11417 11420 11422 11427 11428 11432 11434
1 1 4 1 1 1 1 1
0.3% 0.3% 1.4% 0.3% 0.3% 0.3% 0.3% 0.3%
11436 11438 11481 11690 11691 11692 11693
1 1 1 3 73 99 51
0.3% 0.3% 0.3% 1.0% 25.4% 34.5% 17.8%
11694 11696 11697 11698
26 1 2 3
9.1% 0.3% 0.7% 1.0%
11699 11961
3 2 6 293
1.0% 0.7%
No Response
Total
100.0%
No Response
Total
Frequency
Valid %
100.0%
1 1199 Affantis Affinity Amerigroup
1 6 1 1 1
2.5% 15.0% 2.5% 2.5% 2.5%
Frequency
Valid %
Blue Cross Blue Shield Child Health Plus Emblem
1 1 1
2.5% 2.5% 2.5%
14 52 83 86 35 16 7 293
4.9% 18.2% 29.0% 30.1% 12.2% 5.6%
Fidelis GHI Health First Health Plus HIP Local 1197 Medicare/Medicaid Metroplus
1 1 6 3 7 1 1 1
2.5% 2.5% 15.0% 7.5% 17.5% 2.5% 2.5% 2.5%
1 3 2 253 293
2.5% 7.5% 5.0%
3.) Age (select) Age Range 18 or younger 19-25 26-35 36-50 51-64 65 and over No Response
Total
100.0%
4.) Do you currently have health insurance? Yes/No Yes No No Response
Total
Frequency 224 48 21 293
Valid % 82.4% 17.6%
Type Medicare Medicaid Other (see below) No Response
Planning for Prevention: A Wellness Center in the Rockaways
Type
Oxford Self pay United Healthcare No Response
Total
100.0%
100.0%
4a.) If yes, what kind of health insurance do you have?
Total
45
4b.) If other (write-in)
Frequency
4c.) Do your children have health insurance?
Frequency
Valid %
33 135 43 82 293
15.6% 64.0% 20.4%
Yes/No Yes No I do not have chilrden No Response
100.0%
Total
Frequency
Valid %
195 37 36 25 293
84.1% 15.9%
100.0%
SUMMARY OF RESPONSES 5.) Are you currently employed? Yes/No Yes No Other No Response
Total
8.) Where do you usually buy groceries?
Frequency 122
Valid % 44.0%
153 2 16 293
55.2% 0.7%
Type of Store Supermarket/
No Response
Total
Yes/No
No Response
Total
29
10.4%
9
3.2%
13 293
100.0%
Valid % 0.4% 9.1% 18.7% 7.5%
4 5 6 7 8
13 28 13 8 13
5.2% 11.1% 5.2% 3.2% 5.2%
9 10 12
1 23 4
0.4% 9.1% 1.6%
100.0%
13 15 16 18 19 20 21
3 17 1 1 1 18 1
1.2% 6.7% 0.4% 0.4% 0.4% 7.1% 0.4%
Frequency
Valid %
26 30 31 33 48
1 6 1 1 1
0.4% 2.4% 0.4% 0.4% 0.4%
120 122 1 50 293
49.4% 50.2% 0.4%
49 50 53 58 60
1 2 1 1 2 41 293
0.4% 0.8% 0.4% 0.4% 0.8%
100.0%
Total
Frequency
Valid %
74 80 45
29.7% 32.1% 18.1%
33 6 7 3 1 44 293
13.3% 2.4% 2.8% 1.2% 0.4%
7.) Do you currently receive supplemental income? Yes No Other
86.4%
1 23 47 19
6.) What is your yearly income (select range)?
$30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $70,000 More than $70,000
242
8a.) How far (# of blocks) is the location you buy groceries from your residence (write-in)? Frequency
No Response
Age Range
Valid %
0 1 2 3
Grocery Store Convenience Store/ Bodega/Corner Store Places for Eating Out/ Take Out/Delivery
Less than $10,000 $10,000 - $19,999 $20,000 - $29,999
Frequency
100.0%
8b.) Does this store usually carry fresh fruits/vegetables? Yes/No Yes No I am not sure No Response
Total
Frequency
Valid %
237 20 15 21 293
87.1% 7.4% 5.5% 100.0%
Zipcode
No Response
Total
100.0%
Appendix B
46
APPENDIX B SUMMARY OF RESPONSES 9.) If a retail store were to be located near Beach Channel Channel Drive and beach 63rd Street, what type of store would you like to see at the location (write-in)? Zipcode
Frequency
Valid %
2 83 1 20 1 4 6 6 1
0.9% 36.6% 0.4% 8.8% 0.4% 1.8% 2.6% 2.6% 0.4%
1 5 1 1 2
0.4% 2.2% 0.4% 0.4% 0.9%
2 11 2 1 2 1 18
0.9% 4.8% 0.9% 0.4% 0.9% 0.4% 7.9%
grocery store foot locker hardware store health food store health pharamcy ice cream parlor Kmart
8 1 1 5 2 1 3
3.5% 0.4% 0.4% 2.2% 0.9% 0.4% 1.3%
Laundromat macy mcdonalds meat market novelt shop
1 1 1 2 2
0.4% 0.4% 0.4% 0.9% 0.9%
2 1 2 1 1 2 1 5 3 10 66 293
0.9% 0.4% 0.9% 0.4% 0.4% 0.9% 0.4% 2.2% 1.3% 4.4%
99 cent store supermarket clothing and housing supply store mall beautician BJ movie bowling camera shop car wash clothing community center convenience store cosco daycare gym discount store DK drug electronics fruit and vegetable grocery
target repair shop restaurant school CVS Wellness center variety store walmart walgreens other No Response
Total
47
10) How do you usually travel (to work, to school, to doctor's office, etc.)? Type of Transport Car Bus Subway Walking Biking Taxi/car service Other (See text field) No Response
Total
Frequency
Valid %
64 69 58 25 2 7 1 67 293
28.3% 30.5% 25.7% 11.1% 0.9% 3.1% 0.4% 100.0%
11.) On average, how often do you exercise? Range I do not exercise 1-4 times a month 2 times a week 3-5 times a week 6 or more times a week No Response
Total
Frequency
Valid %
66 43 91 39 24 30 293
25.1% 16.3% 34.6% 14.8% 9.1% 100.0%
12.) If services at the proposed Wellness Center cost a small fee, what amount would be too much for you to pay? Amount $5 per visit $10 per visit $20 per visit No Response
Total
100.0%
Planning for Prevention: A Wellness Center in the Rockaways
Frequency
Valid %
66 50 145 32 293
25.3% 19.2% 55.6% 100.0%
SUMMARY OF RESPONSES Open Question: Be creative! Tell us what you'd like to see in a new wellness center (Note: As much as possible, write-in responses were copied in their original form to preserve authenticity. Exception: Identical responses were consolidated). Response 99 Cent Store Basketball court, tennis court A drop-off center for children (ages 1-11 yrs) while adults are taking care of their needs or pool, yoga classes, fitness for children A great wellness center to help the far Rockaway community control weight especially the diabetic ppl A gym with a swilling pool, learning swimming as exercise A parking lot for consumers/visitors/patients A place where kids can better themselves and get off the streets A productive environment for the youth and young mothers/More community activity within the community A snack bar Arts & crafts workshop Basketball, swimming, exercise class Better Service Big balls to exercise buttocks. Bicycles Bike shop Bike store BJ Meat Market Burger King Catering/baking supplies store Childcare area that is both supervised and away from adult area also directed towards children Classes on cooking and how to shop for food Clothing Clothing store Convenient store Counseling services (esp. for couples/young families), exercise classes, parenting classes Daycare Daycare center Daycare, gym Dentist, play area, counselors for teens, medical doctor, GYN, pharmacy, exercise/gym, pool Everything Everything is up to par, everyone is professional Everything we need to maintain a healthy lifestyle Exercise equipment Exercise for seniors, self-defense classes, nutrition Exercise gym, swimming, track, weights, rooms for palates and yoga Exercise room Fitness equipment, ob/gyn screening, dietician, mental health counseling, fitness trainers Fitness gym Food, bikes Free exercise machines Good equipment Good exercise equipment Good service Gym Gym center for kids while waiting to be called and more for both kids while waiting long hours to be called and a cool place please Gym, arts & crafts Gym, fitness center Gym, laundromat Gym, mental health clinic, tutoring, supermarket, parenting classes, childcare Gym, movie theater, supermarket Gym, nutritionist Health care for all residents ever without medical coverage Health food/bar I would like to see fitness classes as well as a health food shop I'm not sure, daycare
Response Indoor swimming pool, paddle ball court, BIG gym Information & equipment on how to stay healthy It would be good to have a TV in the waiting area for the patients to watch while they wait for the doctor It would be good to have a vending machine with healthy snacks and juice for patients Kids play house Massage therapist Meat market, fresh vegetables More activities for the community/more stores in the area More doctors More doctors so people can be seen faster More growth opportunities and more benefits Movie theater Not sure Nutrition classes Parents learning area Pathmark/gym Pizza shop Play area for small children, yoga, pool, water exercising Play room for kids Pool Pool, pilates classes Programs/classes to exercise; educating about health and nutrition foods in support of the class, healthy choices, spiritual support; jamba juice :) Trader Joe's (or organic options) career support! Restaurant Shopping store, Khol's, Wal-Mart Something creative for children/something not available to them Spa total fitness center Stop & Shop Stop & Shop, movie theater, gym Stop & Shop, Macy's Stop & Shop, supermarket, movie theater Stop & Shop, supermarket, vegetable stand Supermarket Supermarket, cleaner Supermarket, department store Supermarket, fish market, exercise/fitness center Supermarket, gym Supermarket, movie theater, school Supermarket, movie, bowling Supermarket, Wal-Mart Swimming pool, dance classes, gym, pleasant and friendly staff who have been where we are and know what we are going through, not read it in books Swimming pool, tennis facility, racquetball, indoor basketball courts, sauna To better the community for kids Treadmill, bikes, pool Treadmill, exercising bike, weights Treadmill, weights, exercising machine Vegetable, fruit stand Video store Volleyball, swimming, basketball Wal-Mart Wal-Mart, Home Depot, gym Wal-Mart, Sears What's a wellness center? Workout gym and a mental health center Yoga classes, pilates classes
Appendix B
48
APPENDIX B
49
al To t
In va lid
Ve ry
n Of te
So m et im
m Se ld o
Likelihood -->
Ne ve r
es
SUMMARY OF RESPONSES
13.) How likely are you to use fitness classes?
Frequency Valid Percent
2 1.2%
15 9.2%
45 27.6%
46 28.2%
55 33.7%
130
293
14.) How likely are you to use exercise machines (i.e. Treadmills & resistance machines)?
Frequency Valid Percent
2 1.4%
11 7.9%
45 32.1%
39 27.9%
43 30.7%
153
293
15.) How likely are you to use ball courts?
Frequency Valid Percent
9 6.6%
20 14.6%
39 28.5%
40 29.2%
29 21.2%
156
293
16.) How likely are you to use a bike lending program?
Frequency Valid Percent
10 7.5%
13 9.7%
42 31.3%
39 29.1%
30 22.4%
159
293
17.) How likely are you to use a fitness trainer?
Frequency Valid Percent
2 1.5%
13 9.6%
43 31.6%
42 30.9%
36 26.5%
157
293
18.) How likely are you to use a weight loss program?
Frequency Valid Percent
7 4.5%
9 5.8%
49 31.4%
50 32.1%
41 26.3%
137
293
19.) How likely are you to use nutrition counseling?
Frequency Valid Percent
5 3.5%
14 9.7%
38 26.4%
44 30.6%
43 29.9%
149
293
20.) How likely are you to use cooking classes?
Frequency Valid Percent
5 3.6%
9 6.6%
40 29.2%
37 27.0%
46 33.6%
156
293
21.) How likely are you to use a fruit and vegetable garden?
Frequency Valid Percent
3 2.1%
10 7.1%
38 27.1%
41 29.3%
48 34.3%
153
293
22.) How likely are you to use a support group?
Frequency Valid Percent
10 6.5%
9 5.8%
41 26.6%
48 31.2%
46 29.9%
139
293
23.) How likely are you to use job and personal finance workshops?
Frequency Valid Percent
7 5.0%
15 10.6%
33 23.4%
45 31.9%
41 29.1%
152
293
24.) How likely are you to use an education workshop on preventing and treating obesity?
Frequency Valid Percent
4 2.9%
14 10.1%
34 24.6%
45 32.6%
41 29.7%
155
293
25.) How likely are you to use an education workshop on preventing and treating diabetes?
Frequency Valid Percent
4 2.9%
14 10.0%
38 27.1%
44 31.4%
40 28.6%
153
293
Planning for Prevention: A Wellness Center in the Rockaways
APPENDIX C WELLNESS MODEL Wellness can be understood as a movement along a continuum from treating disease in the traditional (reactive) medical model, to preventive (proactive) care that focuses on education, growth, and self-actualization (Ardell, 1977; Miller, 2005). The concept of wellness used in this document and for the planning of the Wellness Center stems from the work of Dr. Bill Hettler, co-founder of the National Wellness Institute (NWI) (Miller, 2005). The NWI (2010) defines wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.” Dr. Hettler developed an interdependent wellness model with six dimensions that help individuals achieve balanced and healthy living through adherence to each dimension. The dimensions include physical, spiritual, intellectual, social, emotional and occupational health. The Hunter Team adapted the Wellness Model and incorporated the environment as a seventh dimension to address how a safe, healthy and sustainable environment positively contributes to wellness. The Hunter Team incorporated these seven dimensions into the planning, programming and design of the Wellness Center. WELLNESS CENTER CASE STUDIES When considering the programming and design of the Wellness Center, the Hunter Team investigated other centers to serve as case studies and inform the planning process. Three types of wellness centers were studied: medical, higher education and those that targeted specific segments of the population. Medical wellness centers are often affiliated with an existing health facility, while higher education wellness centers are part of college and university campuses. Medical Wellness Centers Generally, the purpose of medical wellness centers is to expand services offered by an affiliated medical facility. One example is the Peterson Family Wellness Center (affiliated with Myrtue Medical Center) currently under construction in Harlan, Iowa. When complete, the 44,329 square foot Peterson Family Wellness Center will “promote a collaborative approach to personal and community health” (Myrtue, 2010). Although the emphasis will be on wellness, as evident by the inclusion of a 3,331 square foot fitness area, the Peterson Family Wellness Center will also include conventional medical services (Myrtue, 2010). University/College-Based Wellness Centers The College of New Rochelle Wellness Center is on a suburban college campus 16 miles north of Manhattan (CNR, 2010). The center is
a 55,000 square foot structure that incorporates holistic elements of wellness such as a six lane swimming pool, space for meditation and a rooftop garden (CNR, 2010a; Brenner, 2007). Age-Specific Wellness Centers The Mary and Gary West Senior Center in San Diego, CA is an example of a center that tailors its services to a specific population. The mission of the center is to provide health services for seniors living in poverty (Senior Community Centers, 2010). Wellness services provided include mental health assessments along with nursing and social service case management (Senior Community Centers, 2010a). Other types of Wellness Services & Centers The concept of a wellness center may also be used as tool for economic development. Plans for the Health + Wellness Center project in Rifle, Colorado describe the creation of a community and recreation center that would be a centerpiece of the area’s economic development strategy (Vandewalle & Associates, 2006). The center will house a mix of enterprises including innovative ventures such as a community kitchen (Vandewalle & Associates, 2006).
Appendix C
50
APPENDIX C WELLNESS IN DESIGN DIMENSIONS of WELLNESS EMOTIONAL
ENVIRONMENTAL
[55]
ATTRIBUTES n
n
PROGRAM DESIGN
Awareness and acceptance of feelings
n
Awareness and interaction with the environment
n
Mental health consultation Yoga instruction
n
Increases level of balance and mental capacity
Borrow-a-Bicycle program Rooftop garden Sustainable design practices
n
Increases environmental awareness
Nutrition education Diabetes management Biogenetic Repository
n
Increases knowledge of healthy practices
n
Increases productivity and career development potential
n
Workforce development services through community kitchen Retail component
n
n n
INTELLECTUAL
n n
Mental stimulation Cognitive abilities
n n n
OCCUPATIONAL
n
Satisfaction and enrichment through work
BENEFITS
n
SOCIAL
n
Engagement and connectedness with other individuals
n
Wellness classes/workshops
n
Increases relationship skills and healthy communication
SPIRITUAL
n
Self-fulfillment and meaning
n
Meditation space
n
Increases confidence and feelings of achievement
PHYSICAL
n
Active movements Medical self-care
n
Adult and kid fitness Physical Therapy
n
Increases energy expenditure
n
n
[55] Incorporating seven dimensions of wellness into program design, adapted from the National Wellness Institute (NWI, 2004)
51
Planning for Prevention: A Wellness Center in the Rockaways
APPENDIX D ZONING ANALYSIS Lot Coverage Maximum BUILDING FOOTPRINT Property
Setback
Depth (180ft)
1 front yard
Width (90ft)
2 side yrds
Requirement Notes 15 ft 15 ft, 8 ft (90Ͳ23=67)
square feet square feet square feet
Lot Coverage Max (32,400) minus Existing Footprint (9,465)
square feet
22,935
Floor Area Ratio Calculations
BUILDING FOOTPRINT PROPOSAL
Depth Width FOOTPRINT
Total Square Footage of the entire lot (180w X 300d)………………………54,000 60% of Full Lot Sq Footage (Lot Covg Req, R4Ͳ1)………………………………32,400 Existing Building Footprint (from above)………………………………………… 9,465
156 FT 67 FT 10452 SQ FT
GROUND FLOOR (three sections) retail depth 50 ft retail width 40 ft RETAIL SQ FT 2000 sq ft entry depth entry width ENTRY SQ FT
50 ft 27 ft 1350 sq ft
welln depth welln width WELLNESS SQ FT
106 ft 67 ft 7102 sq ft
SECOND FLOOR (same as footprint) depth 156 ft width 67 ft 10452 sq ft 2ND FLOOR SQ FT
Community Facility FAR for R4Ͳ1 Zoning……………………………………………2.0 Total Square Footage of the entire lot………………………………………………54,000 Total Building Square Footage Potential (FAR X Full Lot Size)……………108,000 Total Sq Footage Used for Current Building………………………………………22,200
FAR square feet square feet square feet
Available Sq Footage for Proposed Building………………………………………85,800 Proposed Building Square Footage……………………………………………… 28,926 Potential # of Floors of Proposed Building…………………………………………2.97 Max Allowed Building Height for R4Ͳ1 Zoning……………………………………35
square feet square feet floors feet
parking requirements (based on full lot/site) retail (proposed) 2,000 1 per 300 sq feet wellness (proposed) 26,926 1 per 500 sq feet health ctr (existing) 22,200 1 per 500 sq feet retail + wellness (sq ft) 28,926
spaces spaces spaces spaces*
6.67 53.85 44.4 104.92
parking capacity of site (based on current buildͲout scenario) site 1 (original) 64x121 7,744 sq ft site 2 (proposed) 116x121 +14,036 sq ft =21,780 sq ft Method 1 : standard conversion is 300 sq ft per spot ͲͲͲ> 21,780/300=
72.6 spaces*
or Method 2 : existing site plans shows room for 80 spaces across
THIRD FLOOR (set back) depth width less: rear balcony (12x25)
3RD FLOOR SQ FT
interior of lot, w/ 6 removed for pass through=
146 57 300 8022
ft ft ft sq ft
Method 1: 105 (req) Ͳ 73 (avail) = Method 2: 105 (req) Ͳ 74 (avail) =
74 spaces
32 spaces short 31 spaces short
* Ͳ all parking space allocations with fractions rounded up
Appendix D
52
APPENDIX D PARKING REQUIREMENTS Off-street parking requirements were determined by using a conversion factor that equates square footage of developed space into the number of parking spaces required. In order to calculate these requirements, the Hunter Team determined that the Wellness Center will be comprised of 26,926 square feet of community use and 2,000 square feet of retail use (for a gross building area of 28,926 square feet). Because the proposed Wellness Center and the existing Health Center will be adjacent to each other, it was decided that a joint parking lot for both facilities would yield the most efficient use of space. Based on Article II (Chapter 5) and Article III (Chapter 6) of the New York City Zoning Text, the following conversions were used to determine the amount of required parking spaces for the entire site (NYCDCP, 2006). [56] Parking Requirement Calculations Zoning Use Residential (R4) Community Use (Health Center) Residential (R4) Community Use (Wellness Center) Commercial (C1-3) Retail (Food: 2000 square feet or greater)
Parking Conversion 1 space for every 500 square feet 1 space for every 500 square feet 1 space for every 300 square feet Total number of spaces required
Spaces 44.4 spaces 53.85 spaces 6.67 spaces 104.92 spaces
Based on the current build-out proposal for the new facility, there is approximately 21,780 square feet remaining on the property that can be devoted to parking. Using a standard conversion factor of 300 square feet per parking space, this would yield the equivalent of 72.6 parking spaces (University of Colorado, 2002). To confirm this, the Hunter Team conducted a visual survey of the current site plan and its existing parking configuration. This generated an estimate of 74 parking spaces. Using these calculations, the Hunter Team concluded that the proposed site plan would require 105 parking spaces, approximately 32 parking spaces more than what the site physically allows. Under normal conditions, an underground parking garage would be included to make up for this shortfall, but because of the site’s proximity to the waterfront, this is not a viable alternative. As a result, the Hunter Team recommends that Addabbo apply for a variance.
53
Planning for Prevention: A Wellness Center in the Rockaways
APPENDIX E COMMUNITY KITCHEN: LOWER EASTSIDE GIRLS CLUB The Community Kitchen within the Wellness Center will be a hands-on teaching and demonstration area for instruction on healthy meal preparation. When the kitchen is not being used as a classroom, it will also serve as an incubator for local chefs and small businesses. Not only will this foster a sense of entrepreneurship, but it will also provide career development opportunities within the community. The Lower Eastside Girls Club (n.d.), “founded in 1996 to address the historic lack of services available to girls and young women on the Lower East Side,” operates a successful commercial kitchen, Sweet Things Bake Shop, which also functions as a classroom for its members. Located at 136 Avenue C between 8th and 9th Streets in New York, NY, Sweet Things Bake Shop serves as both a fully functioning bakery and a job training facility (Lower Eastside Girls Club, n.d.). In addition to learning baking skills, the girls learn about “all aspects of small business, including advertising, management and entrepreneurial skills, [and] financial literacy” (Carmody Consulting Evaluation Services, 2008). The Sweet Things Bake Shop is one of several entrepreneurial programs operated by the Lower Eastside Girls Club. These programs serve as a mechanism to teach valuable skills to community members and also generate revenue for the organization. In 2007, the combined revenue represented 8-10% of the organization’s operating budget, demonstrating the financial viability of the community kitchen model (Carmody Consulting Evaluation Services, 2008).
Appendix E
54
APPENDIX F HEALTHY PIZZERIA One potential use for the Wellness Center retail space is a healthy pizzeria. Not only is there a lack of dining options within the immediate area surrounding the Health Center, but several survey respondents and focus group participants cited the need for better access to healthy food. Pizza is a food that both children and adults enjoy, and it can easily be prepared in a healthy manner. A healthy pizzeria would also create an opportunity to utilize fresh ingredients grown in the Wellness Center’s rooftop garden. Moreover, because pizza is a relatively simple food to make, a healthy pizzeria could reinforce the idea that healthy food can also be prepared at home. Using the retail space as a restaurant would also create jobs in the community. In recent years, the concept of healthy pizzerias has grown. Pizza Fusion and Slice are presented here as case studies because of their emphasis on healthy eating and their concern for the environment. Both companies have undergone rapid expansion, demonstrating the financial feasibility and profitability of their business models. Pizza Fusion’s first store was launched in 2006 in Florida, and since then has grown to 17 locations across seven states. Pizza Fusion offers a menu of organic pizzas, salads, beer and wine and also uses hybrid cars for delivery service (Pizza Fusion, 2007). The company continually strives to offset 100% of their energy consumption through renewable wind energy certificates and LEED-certified buildings. Slice is a healthy pizza restaurant based in New York City. Since its opening in 2005, it has branched out into two locations (Slice, The Perfect Food, 2008). Slice uses fresh, all-natural and organic ingredients and has a special “Pay it forward with a slice” program that addresses the growing problem of childhood obesity within New York City, where over a quarter of children are either overweight or obese. Slice allows New York City organizations and schools, who are frequent customers, to designate a less-fortunate school to receive a complimentary pizza party. Slice will also provide a free health and wellness seminar to the school (Slice, The Perfect Food, 2008).
55
Planning for Prevention: A Wellness Center in the Rockaways
WORKS CITED Alaimo, K., Packnett, E., Miles, R., & Kruger, D. (2008). Fruit and vegetable intake among urban community gardeners. Journal of Nutrition Education and Behavior, 40(2), 94-101. American Diabetes Association. (2010). Diabetes basics. Retrieved from http://www.diabetes.org/diabetes-basics/ Ardell, D. (1977). High level wellness: An alternative to doctors, drugs, and disease. Emmaus, PA: Rodale Press. Arverne by the Sea. (n.d.). Welcome to Arverne by the sea. Retrieved from http://www.arvernebythesea.com/community/pdf/6-22-05 Berghage, D., Jarrett, A., Thuring, C., & Razaie, F. (2009). Green roofs for stormwater runoff control. (U.S. Environmental Protection Agency Publication No. 600/R-09/026). Retrieved from http://www.epa.gov/nrmrl/pubs/600r09026/600r09026.pdf Black, J., & Macinko J. (2010). The changing distribution and determinants of obesity in the neighborhoods of New York City, 2003–2007. American Journal of Epidemiology, 171(7), 765-775. Brenner, E. (2007, March 25). Fitting in on campus. The New York Times. Retrieved from http://www.nytimes.com/2007/03/25/ realestate/25WCZO.html?_r=1&scp=1&sq=College%20of%20New%20rochelle%20Wellness%20Center&st=cse Bureau of Labor Statistics. (2010). Employment situation summary. Retrieved from http://www.bls.gov/news.release/empsit.nr0.htm Carmody Consulting Evaluation Services. (2008). The Lower East Side girls club: A case study (June 2008 findings). Retrieved from http://www. girlsclub.org/files/LESGCevaluation.pdf Centers for Disease Control and Prevention. (2005). Methodological issues in measuring health disparities. Retrieved from http://www.cdc. gov/nchs/data/series/sr_02/sr02_141.pdf Centers for Disease Control and Prevention. (2007). U.S obesity trends. Retrieved from http://www.cdc.gov/obesity/data/trends.html Centers for Disease Control and Prevention. (2009, July 27). CDC weight of the nation press briefing. Retrieved from http://www.cdc.gov/media/transcripts/2009/t090727.htm Centers for Disease Control and Prevention. (2009a). Halting the epidemic by making health easier: At a glance 2009. Retrieved from http:// www.cdc.gov/chronicdisease/resources/publications/aag/obesity.htm
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Planning for Prevention: A Wellness Center in the Rockaways
IMAGE CITATIONS Art Therapy Blog. (2007). [Inspirational Image for Third Floor, child and instructor working on art project]. Retrieved from arttherapy.files. wordpress.com/2007/09/092007-0253-1.jpg. [39]. Astor Center. (n.d.). [Inspirational Image for Ground Floor, community kitchen]. Retrieved from rentals.astorcenternyc.com/kitchen. ac?ref=navBar. [31]. Concordia University. (n.d.). [Inspirational Image for Second Floor, view of atrium from above]. Retrieved from magazine.concordia.ca/2009/fall/features/JM_lobby.jpg. [34]. Downhill Bikes. (n.d.). [Inspirational Image for Ground Floor, Bike borrowing]. Retrieved from http://www.downhillbikes.biz/resize/bikes3. jpg. [30]. Gertler Wente Architects LLP. (n.d.). [Image of the Joseph P. Addabbo Family Health Center in Arverne]. Retrieved from http://www.gwkarch. com/GWK_Flash_Launch.html. [7]. Gertler Wente Architects LLP. (2004). [Site plan of the Joseph P. Addabbo Family Health Center in Arverne, 3.22.04, used as base plan for layout of each floor]. [32], [37], [41] and [44]. Getty Images. (2010). [Image of obese woman, torso]. Retrieved from gettyimages.com. [9]. Google Maps. (2010). [Color satellite base map of Rockaway Peninusla]. Retrieved from maps.google.com. [11]. Joseph P. Addabbo Health Center. (2010). [Inspirational Image for Second Floor, child in consultation room]. Retrieved from www.addabbo. org. [36]. Open Accessible Space Information System (OASIS). (2010). [Color base map used to illustrate study area, and color satellite image of site]. Retrieved from http://oasisnyc.net. [15] and [26] Land Elements. (n.d.). [Inspirational Image for Third Floor, outdoor area on rooftop with lounge chairs]. Retrieved from landelements.com/ wp-content/uploads/Sky-Prairie-1.jpg. [40] Los Angeles Times. (2010). [Image of obese man and boy]. Retrieved from http://latimesblogs.latimes.com/photos/uncategorized/2008/05/20/j09gcznc_obese.jpg. [8]. Nathan Kesinger Photography. (2009). [Salvadoran squatter’s home and garden, Rockaway bungalow]. Retrieved from http://2.bp.blogspot. com/_CQxI0Yhn97w/Sjh1jIGLP6I/AAAAAAAABbA/_vt4xoLjLLM/s1600-h/bungalow+pano.jpg. [14]. New York City Department of City Planning. (2010). [Zoning Map 30 used as a base map for illustrating zoning districts near project site]. Retrieved from http://www.nyc.gov/html/dcp/pdf/zone/map30c.pdf. [25]. Image Citations
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IMAGE CITATIONS My Brooklyn Year Blog. (n.d.). Inspirational Image for Rooftop, rooftop garden]. Retrieved from http://mybrooklynyear.files.wordpress. com/2009/08/annie.jpg. [43]. Sasaki. (2010). [Inspirational Image for First Floor, atrium and stairwell]. Retrieved from www.sasaki.com/what/portfolio. cgi?fid=455&region=4&page=2. [29]. Tampabay.com. (2010). [Inspirational Image for Second Floor, children’s fitness area]. Retrieved from http://www.tampabay.com/multimedia/archive/00107/passunray021310a_107599c.jpg. [35]. University of California Riverside. (n.d.) [Inspirational Image for Third Floor, student in academic research area]. Retrieved from arthscience. ucr.edu/images/Prism%201.jpg. [38]. University of Connecticut. (n.d.). [Inspirational Image for Second Floor, Fitness Area]. Retrieved from http://www.recreation.uconn.edu/images/vtour/fitnesswest.jpg. [33]. Shorpy. (1910). [Bungalow Colony, Rockaway 417-12]. Retrieved from http://www.shorpy.com/node/1176?size=_original. [13]. All other images photographed by the Hunter Team. [1], [2], [3], [4], [5], [6], [10], [12], [16], [17], [18], [19], [20], [21], [22], [23], [24], [27], [28], [42], [52], [52], [54] and [56].
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[56] Back Cover Image: A shaded street in the Study Area
Planning for Prevention: A Wellness Center in the Rockaways
[56]