Five years ago, Howard County General Hospital leadership decided it was time to enlarge the 225-bed comprehensive acute-care medical center that had opened in Columbia in 1973.
After three years of construction, a $48 million, two-story addition was unveiled to the public at the end of January.
“This project has gotten us to where we need to be,” said hospital President Steven Snelgrove, who left a 25-year career as an administrator at Wake Forest Baptist Health in North Carolina to take charge at Howard County General Hospital in 2014.
“The new addition provides comfort and convenience for visitors and patients while increasing efficiency for care providers and supporting high-quality health care,” said Snelgrove, 62, of the project, which adds 50,000 square feet of space but not beds.
Two of the projects main goals were enlarging the amount of space previously occupied by the hospital’s inpatient psychiatric unit and patient observation unit to meet current standards and improving efficiency and patient flow, he said.
The addition, which faces Little Patuxent Parkway instead of Cedar Lane, also serves as the new emergency room entrance for adult and pediatric patients and houses an enlarged emergency department waiting room with updated features.
The construction was funded by private and public sources, including a $5 million pledge by the county in the fiscal 2019 budget under then-County Executive Allan Kittleman to be paid out over five years to the hospital’s capital campaign, according to county spokesman Scott Peterson.
“Howard County is an amazing community and because of that it has been growing and aging disproportionate to other counties in the state,” said Snelgrove, who lives in Clarksville.
When the addition was conceived, demand for emergency room services “was growing dramatically at that time but has leveled off,” he said.
Contributing to that leveling off are the actions undertaken by primary care physicians to increasingly encourage patients to come to their offices when possible instead of to the hospital’s emergency room, he said.
Also relieving some of the burden on the only emergency room in the county are the 22 urgent care facilities in the area, he added.
The hospital relies on population figures and projections when determining facility utilization, Snelgrove said.
When the decision to construct the addition was made in 2015, Howard County’s total population had climbed from 287,085 in 2010 to 313,364, an increase of more than 26,000 residents, according to figures from the U.S. Census Bureau.
Previous population increases of 20,000 each were logged between 2000 and 2005 and 2005 and 2010.
The county has supplemented the Census Bureau figures with its own population projections in five-year increments for 2000 to 2040 in a chart titled, “Howard County Population by Age,” explained Jeff Bronow, chief of the research division of the county Department of Planning and Zoning.
The county had projected population will grow by about 15,000 — from 313,364 to 329,986 — between 2015 and 2020, Bronow said.
With the decennial census about to start April 1, “We’ll get the actual data for 2020 soon and see how close our projections are,” he said.
The population of those older than 65 in the county grew from 29,045 to 39,435 from 2010 to 2015, coinciding with a national trend of older members of the baby boom generation — which refers to citizens born between 1946 and 1964 — beginning to retire in 2010, Bronow noted.
“Howard County is experiencing the same thing,” Bronow said. “We’re halfway through the big surge [of baby boomer retirements] and will continue to experience that for another decade.”
The county projects the 65-plus population will grow from 18,468 in 2000 to 81,657 in 2040, a 342% increase, according to the chart.
That increase is more than six times the second-highest projection of 55% growth for the 45 to 64 age group over the same 40-year period.
The chart projects that total county population will climb from 247,842 in 2000 to 370,823 in 2040, a 50% increase.
Demand for care
Population changes, both real and projected, are an integral part of planning for hospital services.
“There’s a higher demand nationally for psychiatric and adult behavioral health care,” Snelgrove said, and that trend is reflected in Howard County.
There’s a 50% chance of someone age 75 or older being diagnosed with dementia and that’s relevant to the county due to its increasingly aging population, he noted.
The county’s growing population helps drive demand for expanded adult behavioral health services in the psychiatric unit, which includes care for patients with mental health issues and substance abuse disorders, among other services, Snelgrove explained.
“The opioid crisis is beginning to flatten out, but there’s a need for that safety net,” he said.
The psychiatric unit has the capacity to treat 20 patients and is designed to create an improved healing environment, in part by more than doubling its space from 7,000 square feet to 15,000 square feet.
New dedicated spaces within the unit include a conference room for family and legal hearings, spaces for activities and group gatherings, a dining room and a quiet room for patients.
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Snelgrove said, “There’s also been a shift in demand [in the industry] for observation beds” — which allow for patients to remain in the hospital for treatment and monitoring without being fully admitted — “with insurers moving the needle on that.”
He noted that psychiatric standards have changed dramatically in the past 20 years, when there were no observation units.
The 23-bed observation unit in the new addition was expanded to 11,000 square feet from 7,000 square feet, he said.
Most of the observation rooms are private and all have their own bathrooms, unlike the previous observation unit, which had semi-private rooms and shared bathrooms, he said.
What will be done with the hospital’s vacant space has yet to be decided.
“The hospital is just beginning to think about how to use that vacated space,” Snelgrove said. “There’s no specific need to grow into the older space, which is too outdated for our purposes.
“But we’re constantly looking toward the horizon for how [standards of] care will develop in the future and we’re monitoring the volume of patients and demand for services.”