An Adaptive Reuse Approach for Older Hospitals

By Plunkett Raysich Architects

In 1946, Congress passed the Hill-Burton Act to provide federal grants to states for the construction of new, non-profit community hospitals.  While this led to a boom in new hospitals in rural communities, many of these are aging and still in use, though not necessarily well-suited for today’s technology and clinical needs.  Therefore, administrators are often faced with the need to adapt these portions of their campuses for new uses, or tear down and rebuild, which can be an economically challenging proposition.

Fort HealthCare in Fort Atkinson was faced with such a dilemma.  The oldest portions of their hospital were constructed in 1949 and 1959, and were an ongoing liability in terms of current life safety code compliance.  In addition, narrow floor plates, limited floor to floor heights, and small column bays posed challenges in accommodating today’s clinical needs.  Buildings of this era were frequently constructed with little to no insulation and compromised enclosures with inefficient heating and cooling infrastructure, resulting in higher energy consumption costs.

Recognizing the expense of operating satellite clinics while hospital spaces were underutilized, the decision was made to adapt these areas of the hospital for outpatient clinic and office space.  A two-hour fire rated separation was created so that the renovated area could be changed to a business occupancy.  Additional space was captured for a new lobby and waiting space by enclosing a mechanical courtyard.  Food services were relocated from a subgrade level to space adjacent to the lobby to enhance accessibility and encourage greater use by families and the community. 

After a nearly complete demolition of the interior, the vacated areas were completely renovated for clinic and staff support functions.  In order to reduce the challenges of fitting new mechanical services within an extremely limited ceiling plenum, 3D virtual coordination was utilized extensively by the design and construction team to resolve conflicts prior to fabrication and installation.

The exterior brick was removed, and new insulation, metal panels, and windows were installed to meet current energy code requirements.  This also upgraded the dated and deteriorating exterior to complement newer areas of the hospital.  While limitations on energy modeling software could not recognize the true magnitude of air leakage or lack of insulation from the existing enclosure, calculations conservatively indicated a reduction in energy use intensity of 16% from the ASHRAE 90.1 – 1999 baseline used.

Lessons learned:

• Once a portion of the hospital is remodeled, other areas may warrant new finishes to maintain visual consistency,
• Accurate three dimensional modeling is critical to minimize costly coordination in the field during construction,
• No matter how accurate the model is, multiple renovations over the years may expose concealed conditions that were not documented. In addition, this provides an opportunity to remove obsolete systems such as telephone wiring that were abandoned but never removed.  Include sufficient allowances or cost contingencies to cover these situations,
• Beyond the cost of construction, budgets for new equipment, signage, furniture, and the like need to be considered, and
• While consistent layouts for clinical spaces such as exam rooms is the goal, expect adjustments in order to fit within the existing building constraints.

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