Girdwood Health & Childcare CARES Act Request

Girdwood Alliance is currently collaborating on a Girdwood Health & Childcare COVID-19 Impact Project.

Summary:

Girdwood’s community clinic and childcare center have been severely impacted by events related to the COVID-19 public health crisis and are at a potential breaking point.  Both facilities face capacity constraints and an uncertain future moving forward. They are jointly seeking immediate CARES Act funding for upgrades toward proper facilities that would serve the current and future needs of the local community, first responders, residents of greater Southcentral Alaska, and a rebounding visitor industry, consistent with recent U.S. Treasury guidance on use of CARES Act funds. 

Girdwood Project Consistency with Treasury Guidance on CARES Act Funds:

The proposed project meets the April 22 U.S. Treasury Guidance for using CARES Act funding, per the following:

“• Expenses of establishing temporary public medical facilities and other measures to increase COVID-19 treatment capacity, including related construction costs. Expenses of actions to facilitate compliance with COVID-19-related public health measures, such as

• Expenses to facilitate distance learning, including technological improvements, in connection with school closings to enable compliance with COVID-19 precautions.

Any other COVID-19-related expenses reasonably necessary to the function of government that satisfy the Fund’s eligibility criteria.”

Total Financial CARES Act Funds Request: $10,235,000

Includes:

Girdwood Health Clinic Project – $5,525,000

Childcare Facility Project – $4,710,000

Background:

The COVID-19 crisis has had a dramatic and devastating impact on our local community. As the public health situation evolves there is vast uncertainty about how the tourism industry and local communities will provide necessary public health support services for residents and visitors in a ‘new normal’ world.  The pandemic has accentuated Girdwood public health and childcare facility issues in a dramatic way and has emphasized the need to support Girdwood’s residents, visitors, and first responders with a more direct approach.

Girdwood’s existing health clinic and childcare center have both been dramatically impacted by the pandemic.  The health clinic’s facility operation has been turned upside down almost overnight, and the only licensed childcare center in the community closed as they felt they were unable to operate under public health guidance due to COVID-19.  These two long-time non-profits have come together in support of new improvements to address the situation, and provide improved “measures to increase COVID-19 treatment capacity” and “compliance with COVID-19-related public health measures”– per April 22nd Treasury Department guidance. 

Girdwood is in a central location and serves as a regional resource. Girdwood first responders cover as much as 50+ miles of highway and serve a much broader population than just its residents. Girdwood has traditionally been an economic engine for the municipality and the state, but has seen its tourism economy devastated by closure of the Alyeska Resort during the crisis, with associated job losses and economic impacts. At the same time, Girdwood’s unique location is essential for responding within the municipal boundary, as identified on the attached map, and investment is desperately needed to adequately serve the public in this crisis and beyond. (See Appendix 1)

Girdwood Health Clinic Background & COVID Impacts:

The Girdwood Health Clinic is a federally qualified health center (FQHC) with a defined service area of Indian to Hope. The Clinic provides both primary and acute care for the residents and visitors and as an FQHC the clinic provides care to anyone, regardless of their ability to pay – serving patients in their service area and from the Mat-Su Valley, Anchorage and all communities on the Kenai Peninsula, including Whittier.  The clinic has coordinated care for multiple COVID-19 patients. Testing and spacing requirements presented a situation where their facility has literally been turned upside-down (for more detail, see Appendix 2).

In the past 18 months the community of Girdwood has experienced two emergency situations, a significant earthquake in November 2018 and the current COVID-19 pandemic. Both scenarios have highlighted the limited ability of the clinic to function independently from Anchorage for an extended period of time. Any time access, either north or south on the Seward Highway, is restricted due to earthquake, accidents, avalanches, etc. the clinic is left to function with the supplies and equipment that is needed to treat a patient surge. These events illustrate the need for a more robust and local healthcare infrastructure to support our residents and visitors in emergency situations.

In addition to serving the local Girdwood community, ill patients arriving via cruise ship from Whittier, Seward, and visitors to Alyeska Resort and the Alaska Wildlife Conservation Center, are often transferred to Girdwood Clinic for health services. The community must plan for a return to a new normal where travel is eventually flowing at previous capacity, but with greatly expanded healthcare services. The clinic must be prepared and equipped to handle all incoming sick patients in the new normal with a greater emphasis on potential recurrence of COVID-19 or other future pandemics.

The COVID-19 experience has created a nearly impossible situation for the staff at Girdwood Clinic to operate in their current space. Presently, the current facility utilizes temporary structures and mobile units to offer care. The current facility lacks storage space for PPE, medications and supplies that are needed to meet a patient surge. The facility lacks a physical safety net structure, such as separate entrances for contagious patients, to protect well patients and staff. It lacks adequate laundry and cleaning facilities for high-level virus mitigation, and an adequate exterior structure for providing parking lot testing during a patient surge. It lacks any type of air exchange or a negative pressure room which creates a huge burden if a contagious patient has been seen in the building. The administrative space has been sacrificed as clinical space to provide adequate distancing and protection for the staff. It has not been optimal to have clinic leadership working remotely during times when their guidance and direction is needed the most.

Girdwood Childcare COVID Impacts & Background:

A lack of adequate childcare has emerged across the country as a key challenge for community first responders, and that situation has been exacerbated in Girdwood by the public health mandates forcing a temporary closure of Little Bears Playhouse, a Girdwood non-profit adjacent to the Fire Station. Little Bears has provided quality, licensed childcare services in the valley for nearly 40 years. Little Bears staff did not believe they had the capacity to operate under the public health suggested guidelines and closed from mid-March to June 1. Already constrained in a tight space with a wait list for services, new physical distancing requirements will further reduce capacity, making operation financially unsustainable.

As the only full-time licensed childcare operation in Girdwood, the facility is essential, especially to support parents who are healthcare providers and first responders. Little Bears Playhouse, Inc. Board of Directors is supportive of this CARES Act request and the demand for childcare in our community. The organization has committed to creating a “Healthcare Parent Priority Policy” should the non-profit utilize a new proposed building, whereby children of healthcare workers would have preference for services rendered at the facility. The proposed facility would also include a designated space for those opting to participate in distance learning programs, consistent with US Treasury Guidelines.

Little Bears currently operates in an extremely dated building with many defects. Roof leaks are not uncommon. Roof snow over 3” must be removed immediately to avoid a possible collapse, per requirement from the Municipality of Anchorage. Currently, Little Bears Playhouse, Inc. is the only non-profit utilizing the deteriorating public building.  No other existing Girdwood building has been identified as a suitable replacement for childcare.

During the daycare closure, the COVID crisis provided examples of Girdwood Health Clinic employees taking their children into Anchorage for childcare, returning to Girdwood for work, driving back to Anchorage to pick up children and finally returning home to Girdwood. This is an unrealistic and nearly impossible expectation of most Girdwood working parents. It specifically emphasized the unquestionable need for first-responder childcare being locally available in a safe environment.

Conclusion and Request:

As the COVID-19 crisis evolves, it has become painfully obvious that the Girdwood Clinic and the existing child care center’s current infrastructure is not designed for a current or future pandemic. Creating a safe space for youth and access to childcare services, with emphasis on healthcare professional priority, as well as an expanded clinic, has been identified as a possible solution for our public health and community resiliency.

Girdwood Alliance leadership is in strong support of securing financial means to help our community bounce back from the COVID-19 crisis. Upgrading our health and childcare facilities would expedite our economic recovery process, create new jobs, provide critical public health and childcare capacity for community health in a changed world with greater pandemic risk, consistent with U.S. Treasury guidance on use of CARES Act funds. (See Appendix 3).

Purpose of funds:

To acquire land, or site control satisfactory to the participating non-profits, for the purpose of constructing adequate health, first responder and associated childcare facilities to serve Girdwood and adjacent municipal public areas. The non-profits shall be responsible for the care, upkeep and maintenance of the building(s), in addition to operating expenses and utilities.

Financial breakdown for COVID compliant construction, interior and equipment:

Total Financial CARES Act Funds Request: $10,235,000

Includes:

Girdwood Health Clinic Project – $5,525,000

Childcare Facility Project – $4,710,000

The above number is consistent with other recent development projects in the Girdwood Valley. It considers: Girdwood School Project (2013), prior and current cost projections from Anchorage-based architects, as well as a 2020 municipal estimate for development costs in Girdwood. The 2020 recent cost projection was municipally reviewed by Heritage Land Bank management and municipal legal department.

Appendix 1 – Girdwood First Responders cover a large amount of Municipal land area.

Appendix 2: Additional Details on Girdwood Clinic challenges during the COVID pandemic

  • We lack a negative pressure room, so if we have a suspected COVID patient in any exam room, we are then unable to use that room for at least 2 hours as we allow for it to ventilate naturally.  With only three exam rooms, this is a significant impact.
  • During COVID we are requiring staff to change into scrubs when they get to work and leave them at the clinic after their shift.  Our laundry facility is inadequate to keep up with the cleaning needs.  Also, we should upgrade to a washing machine that can kill virus and we do not currently have that. And we do not have the space for a commercial washer and dryer.  Right now we have a very small, apartment-style stacked unit.
  • We lack a shower facility that staff should have access to if they have exposure concern.
  • We are trying to keep COVID patients in the parking lot for testing, but we lack a dedicated entrance for clinical staff to bring in swabs into the lab.  Our options are to 1) go through the lobby which risks patient safety,  2) go through the staff lunch room which risks staff safety or 3) to use the emergency exit out of the x-ray room which potentially contaminates the x-ray room and ties up that space if we have a trauma patient.  We are currently using the x-ray room option.  This is a very serious concern for us.
  • We lack any outdoor covering to keep patients and staff out of the elements during parking lot services.  We have had to utilize a pop-up tent which can be ineffective given our heavy amount of rain and snowfall in Girdwood.
  • We are unable to use our cleaning service company during the pandemic. We lack storage space for adequate cleaning supplies.  We are storing our cleaning materials in the staff bathroom.
  • We lack storage space to have a stockpile of PPE, hand sanitizer, testing supplies and mailing materials, test kits and medical supplies.  When we do get an order, items are stored in the staff lunch room, administrative offices, in the hallways, etc.
  • In order to reduce staff exposure we have physically separated provider teams during clinic hours.  In order to do this, the Executive Director, the Director of Operations and the Director of Finance have all had to give up their work space/offices in order to accommodate clinical staff.  It is challenging, at best, to have the leadership working off-site during a time when so many decisions related to work flow, staff/ patient safety and constantly changing  testing and treatment guidelines.
  • We lack a space for staff audioconference meetings and have had to utilize the staff lunchroom to accommodate these meetings.  The lunch room is very small (seats about 5 at a time) so it’s difficult to even maintain any adequate social distancing during meetings.
  • To eliminate patient exposure we have used telemedicine heavily, but again lack any private space for providers to conduct these appointments unless they are constantly moving from space to space.  There are also connectivity issues within the old building that make this challenging.
  • We do not have a private or secure lab space.  This makes it challenging to process labs under HIPAA guidelines if, and when, we have a patient in the clinic.  The lab also lacks a sink.  Patient samples are processed on a counter in a hallway that patients pass through when going to an exam room.
  • One of our exam rooms is not plumbed and lacks a sink.  We have been unable to secure hand sanitizer so it makes this room virtually unusable for anything other than telehealth appointments.  At this time we have two exam rooms and a trauma/x-ray room.  We do not have any additional space to handle any significant patient surge.
  • We lack space to provide therapy services needed to meet the behavioral health demand that we have seen during the pandemic.   Currently our behavioral health is through telemedicine only, but we would like to plan to move back to face-to-face services as we head into summer but we do not have a physical space to do this in.
  • Our nurse case manager is extremely busy working with patients during this time and she does not have a dedicated desk to work from.  She floats around to whatever is available.
  • The clinic lacks any meeting space whatsoever.  If the integrative clinical team or the administrative team needs to meet they have to use the staff lunchroom.  There is no privacy in this space so sensitive, confidential information, such as PHI or clinic financial information, is difficult to discuss.
  • Finally, the clinic lacks space for any longer patient support services, such as breathing treatments and/or IV hydration.  If/when we do provide these services it ties up a normal exam room that should be utilized for other patients.

Appendix 3 – Treasury Guidelines

Appendix 4 – Letters of Support

Jerry Fox – (Girdwood Board of Supervisors) & Carol Fox

Eryn Boone – Girdwood Board of Supervisors

James Glover – Girdwood Board of Supervisors

Briana Sullivan – Girdwood Board of Supervisors

Di Whitney, Chair – Girdwood Alliance

Dale Goodwin, Vice Chair – Girdwood Alliance

Henry Munter, Treasurer – Girdwood Alliance

Ethan Tyler, Past Chair – Girdwood Alliance

John Rense – Girdwood Alliance

Diana Livingston – Past Chair, Girdwood Alliance

Larry Daniels – Girdwood Alliance & Turnagain Arm Health Care

Joe Bell – Girdwood Alliance

Hank Hosford – Girdwood Alliance

David McVeigh – Girdwood Alliance

Bob Gross – Girdwood Alliance

Blake Phillips – Girdwood Alliance

Lynn Johnson – Girdwood Alliance

Carol Makar – Girdwood Alliance

Erin Eker – Girdwood Alliance

Sarah Mattingly-Faulkner – Girdwood Alliance

Marco Zaccaro – Girdwood Alliance

Kathy Trautner – President, Girdwood Health Clinic

Lou Theiss – Girdwood Health Clinic

Camilla Seifert – Girdwood Health Clinic

Jennifer McCombs – Girdwood Health Clinic

Kalie Harrison – Girdwood Health Clinic

Joan Lower – President, Little Bears Playhouse, Inc.

Phillip Peterson – Vice President, Little Bears Playhouse, Inc.

Mandy Hawes – Alyeska Resort General Manager

“I’ve seen the proposal from the Girdwood community and I think it’s a great proposal … I am 100% supportive of the improved public health infrastructure, Girdwood Clinic, any of those things, so I am happy to support the work that you guys are trying to do and I am looking forward to it. I can totally empathize and it looks like a great project.”

Natasha Pineda – Municipality of Anchorage – Director of Director of Health & Human Services – June 22, 2020 GBOS Special Meeting Re: COVID-19

If you are interested in providing a letter of support for this project, please email executivedirector@girdwoodalliance.org

This proposal is currently under review with Municipality of Anchorage for CARES Act Funding.

Project PowerPoint Presentation