Seward: City Council Work Session 9/28/2026

Forwards at least 5 proposals for Seward in the late summer to capture some of those RHTP funds. 2 Of those were approved, and we'll talk a little bit about some of those as we go into figuring out how to utilize those dollars to the highest capacity. We have been considering how to use the foot footprint of the hospital in the best way. So we will talk about that a little bit as well as we go through some of the specific proposals that we've got in the 2027 capital budget. Um, so I, I guess we can start there with RHTP.

The two projects that were approved— the first is bringing prenatal services to Providence Seward Medical Center that will entail hiring an advanced practice nurse and adding capabilities for virtual technologies to allow us to communicate with maternal fetal medicine physicians in Anchorage for high-risk pregnancies. That will allow our moms in Seward to have those prenatal visits here locally instead of having to drive to Soldotna or drive to Anchorage for all of those visits. Traditionally there are approximately 13 prenatal visits during the 9-month pregnancy, and having those services in town will be phenomenal.

The pitfall with that is that we need to find a place to put an advanced practice nurse and a small specialty clinic. So thinking about the best way to utilize the footprint of the hospital, um, the administration team over at the hospital has come up with a plan to vacate the admin section of the hospital and re-utilize that space as clinical patient-facing space. Um, it is much more advantageous for us to move administration outside of the footprint of the hospital because there's fewer clinical regulations around that space, of course, whereas the admin space that's inside the hospital was already built with that intent. So we do have at least one budget proposal that is going to be— I'm sorry, it's pretty small, but we've got a line there that says construction for specialty clinic in 2027. Right now our real estate team is working on an estimate for that, so that $250,000 that's on the 2027 capital budget is very much an estimate, but we anticipate, uh, little impact to the walls of the administrative space there.

We would move infusion services and then a small specialty clinic into the admin space, again to, to make sure that we are using the footprint of the hospital clinical space as best as we can.

The second RHTP project that was approved is for a social services hub that will include transitional housing— at some point transitional housing, food pantry, food kitchen, community health workers that will be able to go into the community and help coordinate care and our referral networks. That proposal, we are currently looking at space. I had a great conversation with Kat today about some opportunities at the senior center, which we're very excited about.

That proposal, I think you guys have a projected budget for the 5-year term for RHTP. It's a significant amount of money, and we're really excited that we were approved for that. That program would not impact the footprint of the hospital, and we do not have any additional budget requests from the city for that. That will be funded entirely by RHTP, and we'll be working closely with all of the stakeholders on sustainability after the 5-year program is completed.

Any questions about RHTP and how we're trying to utilize those funds?

Pretty exciting amount of money. It is. Over 5 years for both of these programs. Now, full transparency, we will have to go back in the spring to request years 2 through 5. The expectation is that the CMS will request some sort of report back on how we are succeeding exceeding in that first fiscal year of RHTP, and we'll go back in the spring to request those additional years.

So what's been approved right now is just for year 1, but we do anticipate asking for the remainder. And when is year 1? '27? Year 1 was September of '26 through July of '27, I believe. Oh, so it's a very shortened timeline.

The state is working hard to get those funds into the provider's hands so that we can start using them. But when you're thinking about infrastructure, that there's going to be a significant amount of work that needs to be done to stand these things up, just like in the hospital for the advanced nurse practitioner. We do have a very limited time frame to work with our real estate folks to make sure that we can spend those monies quickly, get folks hired quickly. We currently have a position open for another clinic nurse. I believe we're working on the position for the advanced practice nurse as well, but we absolutely have to get moving on that.

We've got notification of approval, it was probably only 2 weeks ago or so. So yeah, it's a very short timeline. Wow. Questions? Okay, go ahead.

So we can move on to the capital requests that are in the 2027 budget.

These are obviously very high level. I can talk through any of the details here. Um, but can you tell me where the—. I think I had that one, the one that I had, one right there. Yeah, right here.

Yes, yes.

All of these projects are going to facilitate, um, either expansion of the services or, uh, continuation of the operations of the hospital. Line 23 is a communications room and universal power supply or battery backup for the hospital. Uh, we have a very small technology closet right now. There is a proposal to build a larger UPS in the event that all of the additional technology that's come over the last 20 years, um, can be in one single location. That we can continue the operations of the hospital in the event of electric interruptions.

That proposal right now is for $1.1 million. We are working closely with the SEHC Community Clinic because their comm— their comms closet is situated right on the other side of ours, so we would have to make sure to integrate them in those conversations as we we, uh, revise that space.

Line 24 is a reconfiguration of the nurse's station including, uh, badge access for security. Right now, if you've walked through the hospital, as I'm sure many of you have, um, you can walk right from the lobby into the ED space, and, uh, we have identified that as security concern, especially as we're bringing more services and a specialty clinic into the hospital. So that project is intended to add those security measures to that main hallway as you're coming out of the lobby. That project is currently estimated at $603,000.

Line 25, maybe a little bit more palatable. There's a conference room at Mountain Haven where our technology is quite old, and as we, you know, all figure out how to work virtually with folks in Anchorage and Valdez, we are asking to redo the video conferencing in that conference room.

Line 26 is a lab analyzer. Over the last 4 or 5 months, we have had significant issues with the current lab analyzer. Earlier in the year, it was down for almost a week. We had Siemens on-site at the hospital trying to fix it. We actually— that was aligned with a visit from System Faults who came down at the same time from, from Seattle, and they were pivotal in raising the alarm that this is something that we absolutely have to get fixed ASAP.

Siemens was able to patch that lab analyzer. We do have an analyzer in Anchorage that we're going to be able to inherit from Providence Anchorage Medical Center. Um, that $500,000 estimated in the 2027 budget is for, uh, construction that would allow both analyzers, the current and the new, to run in parallel. You have to run those two systems in parallel for up to 8 months to validate the results of the new analyzer, which means that you need space for another one. And we do not have that space right now.

So right now the current plan is to cannibalize the break room. Um, that is difficult. We currently share a conference room that is adjacent to the break room with SCHC. We are in discussions with them on how we can potentially reconfigure that conference room and figure out how to get this project done so that we can safely care for our patients.

The, um, $250,000 for construction of the specialty clinic, we already spoke about a little bit. That is the reconfiguration of the administrative space to accommodate a specialty clinic.

So those are the top 5 capital projects that we have slated for 2027. Um, if we want to to go on to 2028, I'm happy to do so. Those may be a little bit more speculative. You can see that we have two TBDs, but those two are, from what I've been told from our facilities team, incredibly important. One is that we currently have an underground fuel tank that requires a significant amount of maintenance.

I was told today that they have to do weekly testing, and I'm sure that there's annual regular regulatory requirements they have for that as well. The current standard is to have above-ground fuel tanks and we would like to research how to get that done. I do not have a dollar estimate on that one. The second is the retaining wall that is behind the hospital. This is, again, very much outside of my scope.

I've been told that that retaining wall is aged to the point where it needs replacement. And I expect for that project to be a significant amount of money as well.

Moving down, we do have a few more on the list. Nursing station redesign. That nursing station, in addition to security concerns, is a challenging workflow for the nurses. We have been talking about redesigning that space I've been working with Providence Seward for 2 years, and it has been on the capital list since that time. So we are still trying to figure out what the optimal design for that is.

Again, that's not slated until 2028. But when I got here in 2024, it was probably slated for 2026, right? So we just keep kind of pushing that one back a little bit. Not necessarily a patient safety critical project, but definitely something that we're looking at to optimize workflows. The two manual transfer switches, one of those is for, uh, is for Mountain Haven, one of those is for the acute hospital.

That allows the generator to seamlessly switch on in the event of lost power. Removal of solid surfaces, that $195,000 project Is that— I looked at that line right? I'm sorry, that one's the $136,000 project. That removal of solid surfaces is an antimicrobial project. If you've ever been involved in the Joint Commission or CMS coming down to the hospital to walk through and tell you all of the things that you're doing wrong, not that they tell us that we're doing much wrong.

We have great scores with CMS. But they will call out wallpaper if there's wallpaper. They don't like to see that. If there's trim on the walls, those surfaces can accumulate dust and other things. That project is to revise all of the sinks and countertops in order to be more compliant with our friends at CMS.

And then the remainder have been on the list also for many, many years. I'm sure you guys are certainly familiar with the plan to add a fifth lodge that would add 10 resident beds at Mountain Haven. We feel like that is a wonderful opportunity for us to grow Mountain Haven. We have the space, the that space has been slated for a fifth lodge for a very long time. Of course, the longer that we push back that expansion project, the more expensive that it gets.

So when I got here, we were estimating about $9 million, and at this point we're estimating about $9.7 million. And then the last one on the list is the expansion of the hospital footprint. So Kat and I talked a lot today about what opportunities we have to continue to bring new services to Providence Seward. One of those options is to expand the footprint of the hospital. I was talking to our real estate guru today.

She— they drove down earlier. No, today's Monday. That would have been last week and had a site visit And one of her bosses, Sarah Kennedy, came down today and they expect right now about $1,500 per square foot to expand the hospital footprint.

While we don't know exactly how much physical space we need, when we were discussing earlier today and last week week. It sounds like probably about 2,000 square foot is what we're looking at, um, just for the shell and utilities. So, um, the, the estimate right now is somewhere between $4 and $6 million to add to the footprint of the hospital to be able to build a more robust specialty clinic, to bring more rotating providers through, to bring orthopedics to bring ENT, to continue to support the prenatal program that was funded through RHTP. We have to have this space to be able to do procedures for OB and for moms who are living in Seward. It would be fantastic for us to, to find an additional 2,000 square foot and that physical expansion construction would be one way to accomplish that.

As I said, we're doing the best that we can with the space that we have right now by, by looking at options with the admin suite, by looking at options with medical record storage and the break room and the conference room. But at some point, you've run out of those opportunities.

And one thing I'd like to add, just as a reminder for the makeup of our hospital hospital building, the city-owned building and hospital up at the base of Mount Marathon, a portion of that is currently leased by the Seward Community Health Center. So all of that space is not utilized by the hospital in Providence, Seward Medical Center. I think we— did we get the breakdown of those numbers? And it immediately left my head. But the, the community health center takes up a chunk of that location.

That space is approximately 2,000 square feet. So 2,000 square feet of that space is utilized by the health center.

Okay. Questions right now? Yes. Just obviously that brings a question, at least it's obvious to me. What if— because I like Seward Community Health Center, I don't want anybody to take this as a negative there at all, because it's not.

What if we help them have a new home and all of that space went to Providence? That would— would that lessen the cost for you? I mean, obviously if we don't have to build 2,000 square feet more, that helps. There would be cost to reconfigure and do that, I get that, but would that be a possibility that would meet what you guys are looking for if that whole facility was yours? That, that space is built as a clinic, which is exactly what Providence needs right now to accommodate the prenatal program, to accommodate the procedural space.

You can do that in a space designed for clinic. Um, it would also change the workflow for registration. They have a large registration area we currently kind of have around the right where you register for imaging and lab. We could take that space back and do something with therapies back there. If we could work with the clinic to find new space for them, I think that that would be incre— excuse me— incredibly advantageous.

One of the other things that we were discussing today is that that clinic space has likely less regulatory restrictions around it. To expand a hospital, you probably have to go through the CON process, and it would be, would be a significant undertaking. To build a clinic is less onerous. We think that that would be a fantastic opportunity, but logistically how to do that is still something that we're exploring.

What's stopping us from doing a new fifth lodge now?

What's the impediments just going ahead with that? Just having the approval from this body, I think. Um, I believe that the Mountain Haven, uh, campus was bond funded. Um, we worked with the city and the city council to do that, and I think that it was paid back very quickly, uh, ahead of schedule. Um, for Providence Seward, that, that long-term care helps fund the operations at the hospital that likely don't have a profit side.

So it would be fantastic for the community, and it would be great for our revenue streams to be able to do that. Yes, and there's a footprint for it there already, and it's a— it sounds like a win-win situation because it's not getting cheaper to hold off and brings in revenue if we go forward. Absolutely. And you're saying obviously there's enough patients to— or residents to fill the extra 10 beds? I cannot speak directly to that, but from my understanding, yes.

We currently have an average census of between 39 and 39.5 when you look at it for 40 beds. There is always going to be a little bit of, right, uh, transition, but we have all 40 of those beds essentially filled. And from what I hear across Alaska, there's a significant need for this, and people want to be in Seward. It's a beautiful place up there. It's a nice facility.

Oh yeah, Council Member Warner. Thank you, Madam Mayor McClure. Um, Providence up in Anchorage does oversee a child care center that is near the hospital. As we talk about expansion in hospital programming, I would assume that will expand also the workforce need and being able to support our working age demographic. Has there been any conversations about potentially expanding Providence's childcare program into the Seward area?

I think it comes up often, and it came up pretty acutely during the RHTP conversations. My understanding is that there was an RHTP proposal, not by Providence and not by the city, to expand Head Start to toddler age.

I know that Providence Sewer Administration would be— would advocate strongly for that. I think it would be a great thing for us to explore. Thank you. Goes back to the— question of space as well. Again, you know, especially when we're navigating, looking for it, that's an additional space.

So incorporating that into the thought process as we're thinking about maybe potentially supporting a fifth lodge, I just wonder if that would be somehow built in.

Go ahead. Um, a while ago I had heard that Providence had shut down most of their long-term care facilities like Mountain Haven. And so my, my question is, if that's in fact true, kind of why they did that and why wouldn't that happen here at some point, or could it happen here at some point? Because I know there's— it's a complicated thing that's tied into Medicaid and Medicare payments and how many people are there. And so I just— my biggest concern with building a fifth house is that that happens and then all of a sudden Providence says, you know, this is not profitable anymore, we're all done.

I just don't know your thoughts on that. Yeah, I'm gonna try to react transparently to that. They— Providence Alaska had a service line called Home and Community Care that did include some long-term care facilities in Anchorage. Those were not closed, they were sold to another firm called Compassus that still operates those. Providence Seward, because it is owned by the City of Seward, has some different responsibilities and there's a different decision-making process.

I think that because this is a city-owned hospital, we have more leverage in those decision— in those decisions. The long-term care facilities in Seward and in Valdez and in Kodiak were never on the table for closure or for sale. Those 3 critical access long-term care facilities were left as is. Part of the reason for that is that critical access has— sorry, probably all 3 of those hospitals are critical access hospitals, and that means that we have a slightly different reimbursement scheme. All 3 of those long-term cares primarily accept Medicaid, so our residents are elderly and qualify for Medicare almost all of the time, but they have also exhausted all of their assets, so they also qualify for Medicaid.

So because we're critical access and because those residents almost always qualify for either Medicaid or VA benefits, we have a pretty strong revenue stream for all three of those. So that's why they're a little bit different, partially because Seward and Valdez are both owned by the, the city or the municipality, but also because we have a little bit of a different reimbursement scheme.

Okay. Further questions?

No? What else you got?

I think that that's the meat of what we wanted to talk about today. I'm going to look at Suli for, you know, some discussion. Discussion on the, on the 2027 capital budget over the next few days, and, and, um, and we'll go from there. Yeah. Did you want to speak to that?

Well, we, we are in the transition of working with numbers, especially for Enterprise Fund. We haven't gone yet to the hospital. However, um, we will discuss with Providence about numbers and the contribution. But I think one of the things to kind of be mindful of as we do move into this is our hospital enterprise fund accounts do have balances within them that are of a good size where we can accomplish some of these things as we look towards the future of our community, what we want to see in our community, and how we want to see it done. So when you look at these big numbers, it's like, ah, but the reality of it is With Ben at the helm too, the hospital has been very productive over the past few years, and we're, we're looking towards these next few years of what we can do to prepare ourselves for a stronger and more robust future for hospital services.

We have the— we had this budget survey that we did in the summertime, and I was really, really blown away by the response of our community for how strongly they supported our locally owned hospital. And so that's something we're kind of bringing forward and making sure that that conversation is at the forefront in a way that it might not have necessarily been in the past, with the underlying reminder that over the course of the next 10, 15 years, we might see a strong growth in our community through the icebreaker and the Coast Guard engagement as well. So kind of just bringing it all together and reminding you why we're here talking with Ben today to think through what we want to see in the Seward Medical Center Hospital, because it's run by Providence, but it's owned by all of us as City of Seward residents. Yes, I think that's part of the value of seeing all of these big numbers, right, is how can we protect that sales tax revenue that is helping to ensure that we have a sustainable healthcare infrastructure in Seward. It takes all of this to maintain that, and a lot of times that kind of stays behind behind the scenes.

And, you know, people see Mountain Haven built, you know, what's there 20 years, and now it's there and it's this beautiful facility. Um, it takes bringing these big numbers to groups like you so that we can maintain that.

Anything else from council? One, one tiny thing on the spreadsheet. Chris sent us your spreadsheet. And the amount for the $33.9 million for the expand hospital footprint is over there in 2030, but it's not in the requested amount thing like all the other items. So I don't know if that's an error or intentional.

That is because that is a very high-level estimate, so those numbers just won't sum in Excel. Oh. Yeah, I don't know who has control of that. Control, but you can scroll over a little bit to the right. Again, that is—.

It's a very high-level estimate right now. Um, 9.7 went over, but the 3.9—. You're right, I apologize. I was making some changes to this worksheet today. Uh, I just need to add the formula in there that captures it.

Oh, okay. Yeah, the $3.9 million was a— came out of the conversations that we've just been having today with the expectation of about $1,500 per square foot, 2,000 square foot plus an additional 30% for interior outfit. So that's where that number comes from. I apologize, the formula does not capture that. So it should be adding to the 9.7?

No, it's a—. It's not addition, it's a cross. Okay. It's just not in cell 36 either. Okay.

Yep, it just—. I understand. Okay. We have—. Oh, I was just— um, thank you, Madam Mayor.

I was just going to add some sort of next steps from our standpoint and conversations. Just, there's no direction that can be given at a work session, but based off of this conversation and as we move through the budget cycle, we'll incorporate these requests into that upcoming FY 27-28. And I believe we'll start working or continue working on some of the expansion conversations and looking towards opportunities. I also think it'll be prudent to, to check in with the community health center and see what their long-term vision is. I know they're looking to leave that building and build their own space and how we can accommodate or support that in any way.

So just kind of wrapping together of what, from an administrative standpoint, our next steps will be as we continue talking through this. We do have a couple members of the public here, and it is a work session. If there were questions—. Well, I had a couple questions about the proposed budget and how much of it do you plan on writing for and submitting for the RHTP, because that's another 5 years of rolling funds, and there's quite a bit on that list that could be submitted and would qualify. I mean, not the capital project and the projects, but I mean, the, like, you know, remodeling of spaces and things like that.

And so, um, I'm just curious what that looks like. Um, I mean, I know you guys were awarded locally for a couple RHT projects, but now looking at this, I'm kind of like, why didn't we write for those things if those feel like a high need versus, say, the social service hub? Um, and so I guess that was my—. Yeah, part of it is resources. The time frame that we had to come up with plans and to put those submittals forward was pretty small.

We did have some other proposals that did not make it on that to the second phase.

I don't I don't think that any of those were included though.

CMS and the Alaska Department of Health has come out with proposals for the next round that are significantly more limited than the first round. So we're still trying to navigate with that with DOH and understand what we can submit for starting in a couple of days here. I think it's October 1st is when the new submittal round starts. It runs through the end of October. But based on conversations with DOH, we still won't have guidance on really their fleshing out of the focus areas until October 15th.

So we'll really only have 2 weeks to submit, which is going to be very difficult. The dollar amount of the awards does not change. It will stay at $270 million, but there will also be a spring submill that will include— that will include years 2 through 5 of all the proposals that have multiple years. So, for example, the social safety hub that we talked about, we will be submitting for years 2 through 5 in the spring. So, the DOH is going to have a limited amount of funds for new proposals New proposals are going to be limited to 5 per provider organization.

So for the entire state of Alaska, Providence will only be able to submit 5. We have worked closely with the city to submit proposals as the city, which would potentially navigate that restriction, but we are definitely looking at how we can do as much as we can within this framework. And to add to that, as Ben said, we as a city organization applied for 5 additional capital improvements through the RHDP, and we were not awarded any of them. And so a lot of these would fall under our submissions because it's capital into the city-owned medical hospital. So one of the things we're going to do is follow up and see why we didn't get any and other people did.

So that's part of navigating and seeing like, yes, it's all in the city of Seward area. Was there a, say, administrative thing that may have flagged it because of the ownership clause thing? So.

Any other questions? Yeah, go ahead, Rhonda. I'm just curious on your long-term facility expansion. You're going to have to speak a little louder so that—. The long-term facility expansion.

And then, uh, what were the types of facilities that you sold? Were they more residential type, and did they have their own units? Is it—. Was it a different model than what we have here at Mountain Haven? Frankly, I don't know a whole lot about what, what there was in Anchorage in that home and community care bucket, unfortunately.

Um, I, I mean, I believe that if you generalize, they were long-term care assisted living facilities. I believe that most of the Anchorage facilities were assisted living, which is a higher acuity of care. I'm sorry, skilled nursing, which is a higher level of care than what we offer at the 3 critical access hospitals where it is more of a long-term care program. Because we were— I was wondering Would it ever be possible to have rates lowered to where people that didn't have to give up everything, they could afford— if we had at least one unit for that type of modeling, other than just— I don't know what you call it— just Medicare and Medicaid patients? Yeah, I mean, and again, I think it's that stratification of the acuity of the needs for the patients who are there, right?

You start with like an assisted living, which is very little acute intervention, and you move up to long-term care, which is what Project Steward is, where you do have a significant amount of.