The Carlington Hub in Ottawa, Ontario is a work in progress. This ambitious project is an interesting story because it highlights how the two Hub partners, Carlington Community Health Centre and Ottawa Community Housing, have worked diligently together to move the project forward, and sometimes around, challenges. The innovative Carlington Hub will include a new building that features a community health centre clinic and 42 units of affordable seniors housing as well as renovations to the existing circa 1923 CHC building. Construction on the new building has begun with an anticipated end date of 2018. Full project completion, including renovations, is slated for 2020.
The Hub Partners
The Hub Leads
- Ottawa Community Housing (OCH) is the largest affordable housing provider in Ottawa. It provides homes for 32,000 residents in 15,000 units, which represents about 70% of the City’s social housing stock. Ottawa Community Housing is a nonprofit corporation, the City of Ottawa is the sole shareholder.
Ottawa Community Housing has over 4,200 residents living in 1,927 units in the Carlington Community Health Centre catchment area. It’s estimated that almost one quarter of these residents are over the age of 65 (within this group, approximately one quarter are over 75 years of age). Altogether about 70% of these senior residents live alone, and nearly two-thirds are women.
- Carlington Community Health Centre (CCHC) has origins as a resident-driven initiative to coordinate services in the Carlington area of Ottawa. A Resource Centre, established in 1984 grew with the addition of programs and services and in 1991 received health centre funding. About two-thirds of the Health Centre’s current funding comes from the Local Health Integration Network (the LHIN); the remaining funding comes from nearly 30 other sources. The Community Health Centre serves a diverse population of about 53,000 residents in Ottawa. They provide a wide range of health, mental health and addiction services to parents and children, youth and teens. Over one third of the population is low income and one in five speaks a language other than English or French. About 23% of residents receive income from the Ontario Disability Support Program).
- The City of Ottawa has played an active role in the hub development process in several ways: through its formal planning role in the zoning, design and oversight of the proposed development; by providing capital funding via the Investment in Affordable Housing program; and by funding some of the services provided by the Community Health Centre. The City also helped resolve an issue around the relocation of a community garden.
- Local Health Integration Network (LHIN) played an important role in the early stages of the capital approval process, and in providing advice prior to referring the proposal for approval. As well they administer the contract with the Community Health Centre on behalf of the Ministry of Health and Long Term Care.
- Ministry of Health and Long Term Care (MoHLTC) provides oversight and approvals for capital investments through the Health Capital and Investment Branch. It manages a five-phase process and must approve all stages.
- Members of Provincial Parliament (MPPs) were very supportive of the vision for a hub. In particular, Ministers Chiarelli and Naqvi were influential in their roles as local MPPs.
- Carlington Community Garden has 150 garden plots cultivated over 20 years. Plans for the new hub site will result in the loss of most of these gardens (to make way for the new building, parking and other services).
- Lawyers and consultants were involved in developing formal partnership agreements, memorandums of understanding and in supporting the process related to, funding and development applications, the construction process or who can negotiate and work well with others.
The Carlington Hub vision is to develop a new building on their existing two-acre site, so as to provide the community with much-needed housing and health services:
- Health services will be provided in an accessible, modern and efficient clinic, with extra space for community meetings and activities.
- Forty-two units of seniors’ housing, including 12 barrier-free units, will be built on top of the ground floor Community Health Centre clinic. There will be 12 market units and 30 affordable housing units. Each floor will have laundry, common space and there will be a roof garden.
The Community Health Centre will also renovate the existing 1923 building where they are currently located.
The partners are enthusiastic about this vision for many reasons:
- The hub will meet an increasing need for affordable and accessible supports and services: it will provide more services to the community at large, as well as additional housing and services for seniors, thus proactively addressing the needs of an aging population.
- Collaborating on a hub is a creative way to deal with the challenge of limited resources: the partners contribute their resources to a project and achieve more together than they would have separately.
- Connecting community members to accessible services will enhance wellness, result in better health outcomes and a stronger sense of community and quality of life.
- Both partners share a commitment to serving senior members of the population.
- Hub plans align with Provincial Government priorities, for instance, the aging-in-place model of supporting seniors in or nearby their their current home (Ontario Senior’s Strategy).
- The hub vision is supported by the local municipality.
Barron Meyerhoffer, Director of Planning and Engineering at Ottawa Community Housing is proud of the development. The new building will be “beautiful” and will “enhance the local community.” Construction will be based on high-performance building standards and will have a very low impact on the environment. Further details are included in this 2016 overview of the project prepared by the partners.
“Not a Short or a Straight Path”
The vision for a health and housing hub was first articulated in 2002 by the Executive Director of the Community Health Centre. His successor took up the idea in 2011 with the proposed partner, Ottawa Community Housing, and a business case and preliminary plans were drawn up.
In 2011, the Community Health Centre submitted the pre-capital submission, the first phase of the approval process to the Ministry of Health and Long Term Care. They received feedback in 2012, however financial challenges and a change in leadership at the Community Health Centre stalled the hub project and little progress was made.
In 2013, the new Executive Director of the Community Health Centre met with Minister Bob Chiarelli, an MPP for Ottawa. Interest was renewed in the service hub and the two partners worked to rewrite the business case. Unfortunately, later that year, the CEO of Ottawa Community Housing resigned and there was a further gap before the position was filled.
In the meantime, the Ministry of Health and Long Term Care was reviewing the business case submission from the Community Health Centre. In 2014, an announcement was made that CCHC would receive $4.85M in funding for their portion of the health/housing hub.
A year later, both Boards of Directors formally confirmed their commitment to the project and began the process of securing additional funding. Ottawa Community Housing applied for funding from the Investment in Affordable Housing program (IAH) administered by the City of Ottawa, and was approved in September 2015, on condition that construction start within one year.
The Community Health Centre continued to work on the five-phase funding process for capital investments, administered through the Health Capital Investment Branch of the Ministry of Health and Long Term Care. The Community Health Centre submitted the Phase 1 pre-capital proposal and business plan to the Local Health Integration Network for approval before submitting it to the Ministry for review and approval. The Phase 2 functional plan was submitted in March 2017 and approval is expected in the fall of 2017.
The development path is complicated because the capital funding approval process is different for health-funded programs than it is for housing. Capital funding for housing, approved in the fall 2015, required that shovels be in the ground by September 2016 or funding could be lost.
The capital funding for the Community Health Centre hadn’t proceeded past the first phase of the investment review process. As the health centre will occupy the ground floor of the new building and set the footprint for the building, Ottawa Community Housing could not design their four stories of housing without confirming the size and shape of the space below – and they definitely couldn’t start building within the one-year timeline.
The challenge was how to manoeuver through the different processes and requirements. In the end, the Community Health Centre did a ‘best guess’ of what they hoped would be approved by the Ministry. Ottawa Community Housing has designed their housing project above the clinic and construction is proceeding. There is an obvious risk to proceeding without capital funding approval – if the Ministry doesn’t approve funding for the space which has already been built, the Community Health Centre will have a shortfall and will have the difficult task of trying to find alternate sources of capital funding. While the Community Health Centre Board of Directors is very supportive “the risk part of it makes them a bit nervous,” comments Executive Director Cameron MacLeod. If funding is approved for a smaller square footage than they have estimated (and are building), the Health Centre may be stuck with the all the costs, including construction, related to that space.
The construction project is expected to be completed in August 2018 and pressure is mounting on the Community Health Centre to plan for and design the internal space. MacLeod explains that they can’t start on this work “until they have the final funding approvals in place.”
As well, the $4.85 capital funding announced in 2014 is designated for the portion of new construction related to Ministry of Health and Long Term Care programs. Total costs (including construction) were recently estimated at $10.7 million! The Community Health Centre must contribute their own funds, or raise money, to cover the capital costs associated with programs and services that are funded from other sources. This is estimated at about $1.2 million or 28% of the total cost of the Community Health Centre renovation portion of the project, and is a significant challenge for a nonprofit organization with only minimal reserves.
The Relationship Between the Partners
The formal relationship between the OCH and CCHC is set out in various partnership agreements including:
- The Memorandum of Agreement defining the relationship during the early stages of hub development.
- The Ground Lease Agreement stipulating that the Community Health Centre has leased the land to Ottawa Community Housing for the period of construction.
- The Project Agreement defining the roles and responsibilities of both parties during construction, including how costs will be shared.
- The Ownership and Operating Agreement stipulating that the two partners have agreed to create a two-unit condominium, with each partner owning one unit. (The Community Health Centre continues to own the land on which the new building is located and the ground floor clinic. Ottawa Community Housing will own everything above the ground floor.)
The partners faced challenges about how to define their relationship and the shared ownership of the new building which led to the proposed condominium agreement, a solution that Ottawa Community Housing had used successfully in joint ownership situations with other partners. The Ministry of Health and Long Term Care expressed significant concerns about the proposed condominium agreement and joint ownership arrangement but delegated the decision to the LHIN, which approved the arrangement.
“A lot of time [and money] was spent on lawyers to develop the agreements,” acknowledges Cameron MacLeod. Although Ottawa Community Housing had similar agreements for other developments, they needed a lot of amendment to accommodate the unique situation between the partners and the requirements from the Ministry of Health and Long Term Care.
As well there were issues around construction. Ottawa Community Housing acts as their own General Contractor, hires subcontractors and manages and directs all aspects of their housing developments. They have a budget for a project but there is not a guaranteed fixed price. The Ministry of Health and Long Term Care however, demands fixed-price bids for work, including costs associated with subcontractors. While there is an advantage in that the price is firm, contractors generally mark-up the sub-contracts by 15 – 20%, and the costs incurred can be higher than the Ottawa Community Housing approach.
Ottawa Community Housing and the Community Health Centre both felt that the general contractor approach would bring cost and other benefits – it would avoid the mark-up fees paid to general contractors for managing the work of the sub-contractors and would give both parties greater control over the work.
The partners negotiated a creative solution whereby the Community Health Centre severed the land and leased the development parcel to Ottawa Community Housing for the period of construction. That allows Ottawa Community Housing to do the development work on their land (leased from the Community Health Centre) using the general contracting approach. The Community Health Centre has signed an agreement with Ottawa Community Housing that sets out the cost of the Health Centre part of the building. Upon completion, the lease will be terminated, and the condominium agreement will come into effect. The Community Health Centre will be responsible for the internal clinic space – and will complete the design and fittings, and Ottawa Community Housing will be responsible for their space.
As mentioned, the Carlington CHC site contained 150 community garden plots. When they informed the community of the plans for the expansion and advised the gardeners that they should not plan on having the space in the future, the Health Centre was surprised at the intensity of the reaction to the anticipated loss of the gardens.
At times it seemed that the issue surrounding the loss of the community garden overshadowed the positive story about the additional services and housing that would benefit the community. Two community meetings were arranged to share information, in which the community and gardeners voiced their opposition to the loss of the beloved 20 year-old community asset.
Resolution of the situation occurred over a difficult and stressful two years. The Community Health Centre, the gardeners, Just Food (a local nonprofit), a City Councillor and the City of Ottawa have worked together to find an alternate space for the gardens. So far, about 20 of the plots have been relocated to a new site with accessible walkways, a shed, and water access. The plan is to increase the number of plots annually over the next few years to a maximum of 104.
In addition to the work on the garden, efforts are underway to establish a Community Advisory Committee to provide input into the design and plans for the new Community Health Centre space.
While there has been limited opportunity for staff input in the early stages of the development, the space design and renovation of the existing building will provide more opportunity for staff input in the future. MacLeod advised, at a March 2017 staff meeting, that “opportunities for staff input are being scoped out” to identify the best ways of engaging staff and receiving input.
Benefits and Value Added
In addition to benefitting existing clients and the local community with enhanced services, the hub will demonstrate value in several other ways.
Construction of the new building will be based on ‘passive house standards’ and WELL Building Standards. Passive standards are high-performance building standards which use up to 90% less heating and cooling than conventional buildings. Meyerhoffer, from Ottawa Community Housing describes the approach as “styrofoam blocks, with rebar in the middle, filled with concrete.” The result is a significantly reduced carbon footprint. Certification standards require that the building have an energy cost of 15% or lower than a similar building – this will result in an estimated savings of $30,000 to $40,000 per year for the housing portion of the building. The Community Health Centre will also benefit from similarly low operating costs.
The general contractor approach to managing the construction and shared site is expected to be more cost-effective than other alternatives, benefitting both partners.
After accommodating some Community Health Centre programs relocated from a portable on the site, there will be about 400 sq. ft. of space left for use by other service partners. MacLeod acknowledges that “more thinking needs to be done on how this space can be used to benefit the residents and the community”.
And finally, the hub development results in better and more effective use of public space. Meyerhoffer comments that partnering in a development like this “is the right thing to do”, Ottawa Community Housing was not required to pay for the land, which was made available at no cost by the Community Health Centre. The community at large also benefits from the addition of 42 affordable housing units for seniors. Cameron MacLeod, the Community Health Centre Executive Director notes that he has had to manage expectations, but that there will be an “awesome community kitchen!”
Lessons Learned And Advice
The partners’ shared vision has helped them to make decisions involving tradeoffs and compromises. For example, they recently deferred a planned expenditure on final-stage landscaping to re-direct the money in favour of another shared priority requiring additional resources. They hope to find alternative funding and/or efficiencies to complete landscaping at a later date.
The Community Health Centre and Ottawa Community Housing approached their relationship from a foundation of openness and transparency, which has led to a strong relationship built on trust. They do not always agree on matters and they experienced struggles at various points in the process (especially around funding and timing of approvals), but their commitment to mutual trust and honesty has meant that they’ve been able to fairly resolve challenges as they arise.
The process of bringing the vision for the Carlington Hub to reality has extended over a number of years. Finance and funding issues at the CHC caused delays and, as well, staff turnover at the CEO level in both organizations resulted in further delays.
Continuous, strong relationships are very important to the development of hubs and the trust and shared vision that they are based on. The development process is multi-year and needs consistent and stable leadership at the CEO and Board levels as well as from staff who support the process on a day-to-day basis.
The hub planning process requires much additional time and effort alongside regular responsibilities. The Executive Director of the Community Health Centre estimates he has so far spent 15 – 20% of his time on hub development (and noted that some periods demand more time and attention than others). Health Centre staff are also involved in the process and have been carrying out work “off the side of their desks”. Board members have also contributed throughout the process. While the CCHC secured funding for the ‘planning’ part of the process, these funds are now depleted, and the planning stage has not yet ended, leading to concern about work implications for the Community Health Centre.
In addition, MacLeod cautions that “primary health care and construction are two very different skill sets.” The Community Health Centre is skilled at the former but has needed to access support from experts, consultants, project managers and lawyers who know the construction and development business.
Like any ambitious project, the Carlington Hub has encountered some ‘bumps’ along the way, yet the partners have ably proven they can problem-solve and be creative in addressing challenges as they arise. Their response to the dilemma of the housing construction deadline and the lack of approval for Phase 1 is a good example of risk-taking. In this situation, the Community Health Centre undertook to provide an informed estimate of the space and related funding needed and that was likely to be approved, and the development proceeded. The partners agree that both organizations were willing to take a risk, based on good will and the desire to do something innovative to fill a pressing need.
The Hub partners had an approach of starting from a “yes” perspective. This positive approach informed the many creative solutions to major hurdles, including the successful handling of complex funding processes and guidelines, and issues pertaining to building ownership and construction. Such “out of the box” solutions weren’t always initially supported by key stakeholders, yet the partners persevered to keep things moving forward.
Because political support has been important to the success of the Carlington Hub, both partners make regular efforts to communicate with provincial and municipal representatives; they provide updates, share challenges and make sure to stay on the “radar”.
The controversy surrounding the relocation of the community garden highlighted the very important need to proactively consult with and listen to community members when proposing a major change. Hubs need support of the local community and early in the process should share information, engage community members, and solicit input and ideas.