Nov 29, 1995 The Honorable Barbara Cubin U.S. House of Representatives Washington, D.C.

20515-5001 Dear Congresswoman Cubin: This is in response to your letter on behalf of your constituent, Ms. Ann Snow, regarding the application of the Americans with Disabilities Act (ADA) to an alteration of the Weston County Memorial nursing home. Please excuse our delay in responding. We assume that the Weston County Memorial nursing home is a State or local government entity. Title II of the ADA prohibits discrimination on the basis of disability by such entities. The Department of Justice's regulation implementing title II requires that when a covered entity alters a facility, the altered area must, to the maximum extent feasible, be made accessible to individuals with disabilities. 28 C.F.R. S 35.151(b). The regulation allows covered entities to apply either the ADA Standards for Accessible Design (Standards), 28 C.F.R. pt. 36, Appendix A, or the Uniform Federal Accessibility Standards (UFAS), 41 C.F.R. pt. 101-19.6, Appendix A, as the accessibility standard for the altered area. 28 C.F.R. S 35.151(c). Title II does not require that the altered facility be completely retrofitted to satisfy the applicable accessibility standard. Instead, only the altered area generally needs to be made accessible. ADA Standards S 4.1.6; UFAS S 4.1.6. The addition of eight bedrooms to the nursing home described by Ms. Snow would, therefore, require only those added bedrooms, with their associated toilet and bathing facilities, to be fully accessible. It would not require unaltered portions of the building to be made accessible. The ADA Standards differ somewhat from the UFAS regarding what portion of the altered rooms must be made accessible. Under the ADA Standards, if the altered rooms constitute an entire

01-04081 -2wing, department, or unit, only a percentage of the altered rooms must be accessible. ADA Standards S 6.1(4)(a). The percentage to be applied is the same percentage applicable to newly constructed facilities; in this case 50%. ADA Standards S 6.1(3). If the rooms are being altered individually, the ADA Standards require them all to be made accessible. ADA Standards S 6.1(4)(b). In both cases the ADA Standards would require an accessible path of travel from the entrance to the altered rooms. ADA Standards S 4.1.6(2). The UFAS requires all the altered rooms to be made accessible. UFAS S 4.1.6(1)(a). The UFAS would only require an accessible entrance and accessible route to the altered area if the alteration were "substantial" (costing over 50% of the value of the building). UFAS S 4.1.6(3). I hope this information is helpful to you in responding to your constituent. Sincerely, Deval L. Patrick Assistant Attorney General Civil Rights Division

01-04082 WESTON COUNTY MEMORIAL hospital and manor 746-2793 August 24, 1995

1124 WASHINGTON BOULEVARD NEWCASTLE, WYOMING 82701 HOSPITAL (307) 746-4491 MANOR

Elaine McCauley District Representative to Congresswoman Barbara Cubin 2015 federal Building Cheyenne, WY 82001 Dear Ms. McCauley: It was a pleasure to meet you following the Medicare meeting in Newcastle last week. At that time I briefly mentioned our concerns over compliance with the ADA and with meeting state regulations at the nursing home. I would like to provide you with more detailed information and request Mrs. Cubin's assistance in containing costs for this project. State regulations require an upgrade to the ventilation system at the nursing home. A needs assessment survey resulted in the decision to add another eight beds to the nursing home while remodeling for the ventilation upgrade. The total project cost including interest was estimated to be just under $3,000,000. In March, an election was held for a 1% capital facilities sales tax (that included several other community projects) that, with a 60% voter turnout, was defeated by 90 votes. We are working with the Wyoming Office of Health Quality on the state regulations in an effort to reduce costs where possible before bringing it before the voters again. One concern I have over the cost of this project is the ADA space requirements Which necessitate the demolition of a portion of the nursing home (22 beds) in order to achieve a net gain of eight beds. The Uniform Federal Accessibility Standards in Appendix IV, section 4.1.4 (b) state that ADA space requirements for Long Term Care Facilities apply to "At least 50% of patient toilets and bedrooms; all public use, common use of areas which may result in employment

of physically handicapped persons". The costs of demolition and reconstruction of existing rooms adds greatly to the total project cost. Weston Manor has been owned and operated by the county since 1975. For twenty years we have provided quality care for the residents. We could continue to provide the same quality care in this section of the nursing home without the expense of extensive ADA remodeling. Ten beds were added in a 1990 project and this addition met ADA requirements. If the ADA space requirements were applied only to new construction and not 50% of the entire facility, we could meet the state ventilation requirements and add eight beds at a much more reasonable cost. We currently have 51 beds with an average occupancy rate of 95-98%. The demolition and reconstruction would result in the need to relocate the twenty two residents. Since we could not accommodate the total number (in hospital swing beds) at one time, the project would need to be completed in phases which would also add to additional construction costs. Any assistance or advice you can give us in reducing construction costs in relation to ADA compliance would be appreciated. If you need additional information, please contact me. Sincerely, Ann Snow Administrator 01-04084