A $10.4 million, 130,000-sq.-ft. combination of renovations and additions is transforming the outdated assisted-living spaces into home-style environments at the Bethesda Lutheran Home in Watertown, Wis.

"The Bethesda campus is not unlike a lot of similar facilities," said Steven Raasch, architect and project manager for the Milwaukee-based Eppstein Uhen Architects. "It had grown bit by bit over the years through different projects and expansions. They ended up sprawling with less than ideal circulation patterns."

Some of the institution's facilities were outmoded and many were separated by long stretches of corridors.

"We have 11 miles of hallways," said Debbie Zubke, north-central regional administrator for Bethesda Lutheran Homes and Services Inc. "Sometimes it felt as though you moving everyone all 11 miles every day. All that moving, to programmed activities and meals, had slowed the pace of the residents' lives.

"Now staff and residents can be more casual, more conversational and less harried."

She said the process of moving residents from living spaces to program spaces, dining areas and the like used to take about 2.5 hours of each day. Administrative offices, too, were scattered among various buildings.

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A Four-Phase Project

A solution to the logistics was found in a four-phase construction program that began with five existing dormitory buildings, the Dierker complex. The connected buildings had been constructed in the mid-1970s, when a dormitory style of living - with four residents in each room - was the standard in care for the mentally disabled.

"There were very few living spaces adjacent to where the residents would sleep," Raasch said. "The facility was relatively inaccessible to people in wheelchairs, which a large number of the residents are, and it was all hard surfaces. With all the good things Bethesda has to offer its residents, the residence environment did not do much to support the staff's efforts to improve the lives of the residents."

He said the design task was to take these buildings that are an outdated model of institutional care and turn them into a current, residential, inviting, noninstitutional environment.

"We renovated the vast majority of the interior spaces, making small additions on the ends of the buildings," he added. "We created six households, incorporating a living room space, a dining room and a kitchen in each household."

The redesign created a homelike environment in which the 40 residents of the Dierker complex live, eat and sleep in a household that functions like a family. The residents leave home after breakfast in the morning to go to their daily program activities, returning in the evening for dinner and relaxation.

The facility provides care to severely and profoundly mentally disabled people of a wide age range. Each of the households will group people in similar situations, based on care needs and age.

Raasch said that the renovated spaces have a large number of windows to provide visual stimulation and natural light, and accessible outdoor patios. The interiors are done in warm, inviting finishes that reflect a home environment. Gabled roofs and pergolas - outdoor, trellis-like structures - were added to diminish the institutional appearance of the old buildings.

Addressing Staff Concerns

"One of the goals was to make Bethesda a nicer place to work," Raasch said. "This is a very dedicated staff and it is important to have good staff retention."

Architects and caregivers talked through many facets of the daily routine in Dierker to incorporate staff needs into the design.

"We ensured that supplies were available to staff where they needed them," Zubke said. "We put plenty of cupboards in the bathrooms and plenty of storage where the tubs are." This eliminates the need for staff to push institutional laundry carts and carry caddies from room to room every day.

And she added that, as much as possible, "We kept more things unlocked than were previously and used push button codes instead of keys."

Computer terminals for direct-care staff were taken out of the interior of nursing stations and placed in armoires in the central living room of each household so that caregivers are not removed from the residents as they work on charts.

Working in a Functioning Facility

Residents and staff were also a prime concern in the construction process of the Dierker living area because the facility remained occupied throughout construction.

"For us the biggest concern was working in and around the residents and staff," said Nathan Keller, project manager for The Bentley Co., the project's Milwaukee-based general contractor.

"They would move people out of one building and then we would completely gut it and remodel it and put up the addition," he added. "But the buildings all have connecting corridors that had to remain open and in use, so we had to stage access points."
Eventually those corridors were redone also.

"Working around the residents took a lot of coordination with the staff," Keller said. "We had monthly meetings with the owner and weekly meetings with our subcontractors and the owner's maintenance manager. We had those weekly meetings for about two years."

In addition to sharing corridors, the five Dierker buildings shared centralized electrical, mechanical and fire alarm systems.

"If we had to shut a system down for a tie-in, we had to have it back up again by the end of the day," Keller said. "This required a lot of coordination with the maintenance manager."

The Dierker buildings, a mix of two-story and single-story structures, presented a learning curve for Bentley's crews and an opportunity to fine tune the end product.
"The first building took eight months, but we learned a lot by the time we had completed the first building and a lot of things went more quickly on the others," Keller said. He added that the owner made a few changes after the first building was completed, having learned from the process as well, and those changes were then incorporated into the subsequent buildings.

A new 55,000-sq.-ft., three-story corporate building was constructed as phase 2a of the project at a cost of about $8.5 million.

"The biggest issue in the office building was the layout," Keller said. "There is a big radial section and a lot of step-backs." He said executing the geometry of the structure required coordination and communication between the site superintendent and the structural steel contractor's foreman.

The $3.8 million Phase 2b of the four-phase project entailed renovations in the Olsen, Pingel and Werner buildings. The cafeteria space will become a Main Street area housing offices for dentists and doctors, a cafe, barber shop and beauty parlor for the residents.

The third and fourth phases of the project are still in the planning stages.