planning for prevention: a wellness center

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PLANNING FOR PREVENTIONA WELLNESS CENTER IN THE ROCKAWAYSHUNTER COLLEGE | DEPARTMENT OF URBAN AFFAIRS AND PLANNING

Planning for Prevention: A Wellness Center in the Rockawaysii

[1] Cover Image: Ocean Bay Community Center mural, located at 57-10 Beach Channel Drive, in Arverne, Queens

[2] Signage at New York City Transit Authority’s Beach 60 Street station, approximately a quarter of a mile from the Joseph P. Addabbo Family Health Center

The Hunter Team would like to thank faculty advisors, Alice Blank and Wil-liam Milczarski, for their dedication and leadership throughout the year.

We are grateful to our client, J.R. Peter Nelson, Ph.D, Executive Director, Jo-seph P. Addabbo Family Health Center Inc., for his guidance and unwaver-ing support of our project.

The Hunter Team is also appreciative of the tireless efforts of Seth Bornstein, Executive Director, Queens Economic Development Corporation, who con-tinually challenged our team to be innovative in our thinking.

We would like to thank Jonathan Gaska, District Manager, Community Board 14; Patricia Simon, Executive Director, Ocean Bay Community Development Corporation; and Liz Sulik, Director of External Affairs, Peninsula Hospital, for their willingness to share their insights and perspectives about the Rock-away community.

The following individuals were also invaluable in assisting the Hunter Team with our community outreach efforts: from the Joseph P. Addabbo Family Health Center, Inc., Rachel Williams, Director of Outreach; Gail Hills and Dan-iel Olufemi, Outreach Coordinators; and from the Ocean Bay Community De-velopment Corporation, Bernadette Luina, Administrative Assistant.

The Hunter Team would also like to thank the following faculty and staff from Hunter’s Department of Urban Affairs and Planning for sharing their time and expertise in shaping our project: Tom Angotti, Ph.D, John Chin, Ph.D, Sigmund C. Shipp, Ph.D, Lisa Schreibman and Mary Rocco.

We would also like to thank our fellow graduate students for their feedback and encouragement.

We wish to extend special thanks to the residents of the Rockaways, who welcomed our team into their community. Their ideas and enthusiasm were instrumental in guiding our project.

HUNTER COLLEGEDEPARTMENT OF URBAN AFFAIRS AND PLANNING

The Hunter TeamNichole AltmixLaura AzzePaul CostaPaula Di StefanoHeidi ExlineJesse GoldmanJordan KatonPaulo LellisTerri MillsRich Zanoni

Faculty AdvisorsAlice BlankWilliam Milczarski, Ph.D

ACKNOWLEDGMENTS

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EXECUTIVE SUMMARY

THE CLIENT

A NATIONAL PUBLIC HEALTH CRISIS

A COMMUNITY IN NEED: THE ROCKAWAYS

COMMUNITY OUTREACH

WELLNESS: A PREVENTIVE APPROACH

THE WELLNESS CENTER: PROGRAMMING & DEVELOPMENT

FINANCIAL FEASIBILITY

RECOMMENDATIONS

CONCLUSION

APPENDIX

WORKS CITED

Community Profile

History

Study Area

Health Concerns

Health Disparities

Focus Groups

Surveys

Interviews

Site Planning

Zoning Analysis

Programming & Layout

Construction Costs

Funding

Operating Revenue & Expenses

Pro Forma

The Joseph P. Addabbo Family Health Center Inc.

TABLE OF CONTENTS

Planning for Prevention: A Wellness Center in the Rockaways

EXECUTIVE SUMMARYThe Joseph P. Addabbo Family Health Center Inc. (“Addabbo”), a 501(c)3 Federally Qualified Health Center, in cooperation with the Queens Economic Development Corporation, has partnered with the Hunter College Neighborhood Development Studio (the “Hunter Team”) to develop a wellness center in the Rockaway community of Queens, New York.

Since 1987, Addabbo has been providing affordable health care to underserved communities throughout Queens. In 2006, Addabbo opened its third facility, a 22,200-square foot building in the Rock-away neighborhood of Arverne (the “Health Center”). This enabled Addabbo to expand its reach and increase patient visits by 40 per-cent (Primary Care Development Corporation [PCDC], 2010). In 2009, the Health Center had over 69,000 patient visits, helping to establish Addabbo as the largest Federally Qualified Health Center (FQHC) in Queens (PCDC, 2010; Addabbo, 2008).

There continues to be a great need for Addabbo’s services in the Rockaways, as many of its residents are disproportionately affected by chronic health conditions, such as obesity (New York City Depart-ment of Health and Mental Hygiene [NYCDOHMH], 2006). In 2007, the Rockaways became one of only seven neighborhoods in New York City (NYC) with an obesity rate over 30 percent (Black & Macinko, 2010). Furthermore, in 2009, the Health Center saw 18,000 patients who received a primary diagnosis of diabetes, overweight or obese, or having hypertension (Addabbo, 2009).

These health issues are compounded by the fact that many Rockaway residents are also poor. In 2009, within the primary zip codes served by the Health Center, 11691, 11692, and 11693 (the “Study Area”), one third of all households had incomes of less than $20,000 a year; one fifth had incomes of less than $10,000 a year (SRC/Alteryx, 2009). The combination of disproportionate health problems and concentrated poverty constitutes what the U.S. Department of Health and Human Services (USHHS) calls a health disparity: “Differences in health sta-tus among distinct segments of the population including differences that occur by gender, race or ethnicity, education or income, disabil-ity, or living in various geographic localities” (as cited in Centers for Disease Control and Prevention [CDC], 2005; as cited in Healthy Caro-linians, 2010).

While Addabbo has a history of providing accessible health care ser-vices to the residents of the Rockaways, the organization seeks to establish a new facility that will specifically develop and deploy “in-terventions which are scalable and translatable” to address health dis-parities (Addabbo, 2008). In the United States, health care providers have traditionally utilized the medical model, which stresses clinical diagnosis and intervention to remedy disease(s) (Shi & Singh, 2004). Although there are obvious merits to the medical model, the Hunter Team opted to explore the concept of wellness, which “emphasizes efforts and programs geared towards the prevention of disease and maintenance of an optimum state of well-being” (Shi & Singh, 2004).

[3] The site of the proposed Wellness Center, adjacent to the Joseph P. Addabbo Family Health Center, at 62-00 Beach Channel Drive

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2Executive Summary


After researching various wellness paradigms, the Hunter Team adapted the National Wellness Institute’s model as the foundation for its design and pro-gramming plan for the new facility (the “Wellness Center”). This six-dimensional framework focuses on physical, spiritual, intellectual, social, emotional and oc-cupational health. The Hunter Team believes that successful mitigation of health disparities in the Rockaways necessitates a comprehensive and preventive ap-proach; wellness aligns with this mission.

The three-story, 28,926 square foot Wellness Center will include areas dedicated to chronic disease management, nutrition education, research, physical and art therapy, mental health consultation, a teaching kitchen, business incubator space, fitness areas for adults and children and the Borrow-a-Bicycle program. The Wellness Center will be located adjacent to the existing Health Center, at 62-00 Beach Channel Drive, on an open lot currently owned by the New York City Economic Development Corporation.

To finance the Wellness Center, Addabbo will utilize its partnerships with non-profit organizations and local universities to expand programming and conduct medical research. Ground floor retail space and a biogenetic repository will be the primary revenue sources for the Wellness Center. The Wellness Center will also qualify for federal funding, state grants and financial support from the Queens Borough President and the New York City Council.

With the recent passage of the Patient Protection and Affordable Care Act, inte-grating wellness into conventional health care services is gaining attention. But wellness is still not a familiar concept for many Americans. It is often discussed in the context of a luxury – an indulgence reserved only for the wealthy. How-ever, wellness is equally critical for impoverished communities. In this respect, the Wellness Center will not only proactively address the health needs and dis-parities of the Rockaways, but will ultimately serve as a replicable model for low-income communities in need.

[4] Retail strip in the project Study Area

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EXECUTIVE SUMMARY (CONTINUED)


The Joseph P. Addabbo Family Health Center (the “Health Center”) provides comprehen-sive health services to the low-income and medically underserved residents of Queens, NY (Addabbo, 2008). In 1986, the Health Center was granted status as a Federally Qualified Health Center (FQHC), a program established under the Medicare system to “enhance the provision of primary care services in underserved urban and rural communities” (Add-abbo, 2008; Centers for Medicare and Medicaid Services [CMMS], 2009). As a member of this program, Addabbo is qualified to receive payments for “covered services furnished to Medicare beneficiaries” (CMMS, 2009).

Addabbo’s mission is to “be the leading preventive and comprehensive primary health care center in the Rockaways” (Addabbo, 2002). Operating three Queens’ locations, two in the Rockaways (Far Rockaway and Arverne) and one in Jamaica, Addabbo is the largest primary health care provider in Queens (Addabbo, 2002; Addabbo, 2008). The newest location was built in 2006 in Arverne and offers services in pediatrics, dental, obstetric/gynecological, internal medicine and endocrinology. It also treats patients with HIV/AIDS and other infectious diseases. The 22,200-square foot primary care center in Arverne pro-vides roughly 69,000 patient visits per year (PCDC, 2010). Currently, the Health Center is the largest FQHC in Queens (Addabbo, 2008).

Addabbo has been working with the Queens Economic Development Corporation (QEDC) to investigate community needs and determine how to better serve the Rock-aways. QEDC’s (2007) goal is to “provide Queens residents and resident businesses broad-er access to economic resources and intellectual capital.”

THE CLIENT

[5] Addabbo community outreach efforts at Earth Day Rockaway on May 1, 2010[6] and [7] The Joseph P. Addabbo Family Health Center, corner of Beach 62 Street and Beach Channel Drive

THE JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.

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The Client 6


A NATIONAL PUBLIC HEALTH CRISISIn only 20 years, obesity in the United States has shifted from a minor health concern to a national crisis (CDC, 2007). Dr. Thomas Frieden, former New York City Health Commissioner and current Director of the Centers for Disease Control and Prevention (CDC), stated that as a country “we are 4.6 billion pounds overweight” (CDC, 2009). Pres-ently, one out of every three American adults and over 16 percent of children are obese. Since 1980, obesity rates have doubled for adults and tripled for children (CDC, 2009a).

At its most basic level, obesity is the result of a caloric imbalance: consuming more calories than are expended. Other factors, such as an individual’s genetic make-up and metabolism also influence body weight. Recent research has shown linkages between the built en-vironment, socioecononmic conditions and obestity rates (Papas et al., 2007). Studies have demonstrated that the burden of obesity falls disproportionately on racial and ethnic minorities, and on those with low educational attainment and limited financial resources.

Obesity is a public health crisis not only because it is so widespread, but also because it is linked to 53 preventable diseases; two of the more prevalent are heart disease and type 2 diabetes. While 90-95 percent of the 24 million diabetic Americans are classified as type 2, another 57 million are pre-diabetic, a condition that increases the risk of having a stroke, as well as developing type 2 diabetes and heart

disease (National Institute of Diabetes and Digestive and Kidney Dis-eases [NIDDK], 2007). In 2007, the total cost of treating diabetes in the United States was $174 billion (American Diabetes Association, 2010). While this figure is extraordinarily high, it is not even half of America’s heart disease related expenditure. Today, heart disease is the leading cause of death for both men and women in the United States (CDC, 2010).

These health issues are further complicated by a variety of external variables. There is an extreme difference in price between healthy and unhealthy foods. For example, soda costs 33 percent less today than it did 30 years ago, whereas vegetables and fruits are 41 and 46 percent more expensive, respectively (Leondhardt, 2009). Moreover, high calorie, unhealthy food costs approximately $1.76 per 1,000 cal-ories while low calorie, healthy food averages $18.16 per 1,000 calo-ries (Parker-Pope, 2007). For an American eating 2,000 calories a day, the difference in cost over a year is significant: $1,285 versus $13,257. Consequently, advising Americans to eat healthy food may not be an economically feasible option. While some forms of exercise, such as walking, are virtually free, the fact that only 32.5 percent of Ameri-cans engage in “regular leisure-time, physical activity” demonstrates the complexities of achieving a healthy energy balance (U.S. Census, 2007).

[8] and [9] Obesity in the United States[10] Unhealthy food in the Rockaways

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A National Public Health Crisis 8


COMMUNITY PROFILEThe Rockaway Peninsula sits between Jamaica Bay and the Atlantic Ocean and is bordered by Nassau County, Long Island to the east. Roughly 13 neighborhoods make up the Rockaway Peninsula. These neighborhoods, along with Broad Channel, are all part of Queens Community Board 14.

A COMMUNITY IN NEEDTHE ROCKAWAYS

[11] Aerial view of the Rockaway Peninsula, and its geographical context to New York City

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[12] Underutilized retail strip in the Study Area

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A Community In Need: The Rockaways 10


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From the 1830s through the mid-20th century, the Rockaway Pen-insula was a vibrant beach resort community characterized by tradi-tional beach bungalows. The Rockaways, like many vacation desti-nations in the Northeast, saw a decline in popularity when air travel became more affordable after World War II. At the same time, the Rockaways became popular for year-round, middle-income housing developments due to the affordability of land.

During the 1960s, there was a surge in demand for low-income housing in New York City and the distant location and affordability of land in the Rockaways made it the least contentious site for new public housing projects. By 1975, 57 percent of the public housing in Queens was located in the Rockaways (Kaplan & Kaplan, 2003; The New York Times [NYT], 2009). Years of disinvestment and failed ur-ban renewal policies contributed to increased poverty and crime.

After decades of decline, the Rockaways are changing. According to the Wall Street Journal, new housing, such as the $800 million Arverne by the Sea development, is attracting residents to the area (as cited in Arverne by the Sea, n.d.). In 2008, New York City’s De-partment of City Planning approved a contextual rezoning of five neighborhoods to preserve the low-scale, beach town character of the Rockaways.

HISTORY

While Addabbo accepts patients from all of New York City and Long Island, the majority live in zip codes 11691, 11692 and 11693 (the “Study Area”), which consists of the following neighborhoods: Bay-swater, Far Rockaway, Wavecrest, Edgemere, Arverne, Rockaway Beach and Hammels. The Health Center and the adjacent project site are located in Arverne, within zip code 11692. See Figure [15].

Population estimates from 2009 reveal that there were 84,752 peo-ple residing in the Study Area – 32 percent of residents were white, 47 percent were black and 22 percent were Hispanic (SRC/Alteryx, 2009). While the median household income is just over $31,000, more than 21 percent of the area’s families live below the poverty level, defined as $22,050 for a family of four and $14,570 for a family of two (USHHS, 2010). The unemployment rate in the Rockaway Pen-insula is 13.2 percent compared to the 9.9 percent national rate (Bu-reau of Labor Statistics, 2010; SRC/Alteryx, 2009). Almost one third of households earn $15,000 or less a year. Fewer than 70 percent have high school diplomas or its equivalent (U.S. Census, 2000).

THE STUDY AREA

[13] Rockaway Bungalow Colony, 1912[14] Rockaway bungalows, present day[15] The Study Area

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In addition to the poverty and low educational attainment rates, the Rockaway community is experiencing the same obesity problem that is plaguing the nation. As of 2007, the Rockaways was one of only sev-en New York City neighborhoods with an obesity rate over 30 percent (Black & Macinko, 2010). This is significantly higher than the 19 percent obesity rate in Queens and the 20 percent obesity rate in New York City (NYCDOHMH, 2006).

The Rockaway community also suffers from high rates of diabetes and high blood pressure. According to the 2006 Community Health Pro-file, nine percent of Rockaway adults were diabetic. Furthermore, 33 percent of adults in the Rockaways were diagnosed with high blood pressure, compared to 26 percent in Queens and New York City (NYC-DOHMH, 2006).

Heart disease, also closely linked to obesity, is the primary cause of pre-mature death in the Rockaways (NYCDOHMH, 2006). Between 2003 and 2004, the death rate due to heart disease in the Rockaways was nearly 85 percent greater than that of both Queens and New York City (NYC-DOHMH, 2006). According to the New York City Department of Health and Mental Hygiene (2006), during this same time period, the overall death rate in the Rockaways was 60 percent higher than in the rest of Queens and 35 percent higher than in New York City.

HEALTH ISSUESIt is clear from these statistics that residents of the Rockaways are suffering from above average rates of obesity, heart disease, and di-abetes, exacerbated by the fact that many are also living in poverty. Because many residents cannot adequately address health concerns in the same manner as a wealthy community, this constitutes what the U.S. Department of Health and Human Services calls a health disparity: “Differences in health status among distinct segments of the population including differences that occur by gender, race or ethnicity, education or income, disability, or living in various geo-graphic localities” (as cited in CDC, 2005; as cited in Healthy Carolin-ians, 2010).

Furthermore, the CDC (2009) also states that nationally, blacks have a 51 percent higher prevalence of obesity and Hispanics have a 21 percent higher prevalence of obesity. Given that blacks and His-panics have a greater risk of becoming obese and the Study Area population is predominantly black and Hispanic, the result is a com-munity with a greater need.

HEALTH DISPARITIES

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[16] Super Food Corp., Beach Channel Drive[17] Woman and child walking in the Study Area[18] A fast food restaurant in the Study Area


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The Hunter Team held three focus groups, distributed nearly 300 surveys and conducted one-on-one interviews with stakeholders, in order to better understand the challenges and needs of Rockaway residents. Two critical themes that emerged were the need for preventive services and the desire among the community to adopt healthier lifestyles.

COMMUNITY OUTREACH

FOCUS GROUPS SURVEY

Focus group participants were asked to list their health concerns and propose potential solutions. They identified asthma, diabetes, and high blood pressure as their top health concerns. As possible solutions, participants suggested yoga and dance classes, a bike and running club, and improved access to fresh foods.

Several of these proposals prompted more detailed discussion. When talking about the idea of a bike and running club, one par-ticipant noted that it is equally important to include children’s activi-ties in the Wellness Center “so adults can workout and know children are safe.” Ensuring that children’s needs are also met was a recurring theme throughout all of the focus groups.

Additionally, residents emphasized the need for healthy food op-tions. Many Rockaway residents described living in a “food desert” because of the lack of fresh produce. Community residents expressed interest in farmers’ markets, community supported agriculture, and having more places to buy fresh food with WIC vouchers (Special Supplemental Nutrition Program for Women, Infants and Children). Participants recommended the inclusion of obesity support groups, cooking classes (specifically for families with diabetic children) and guidance on understanding nutritional information. The affordabil-ity of all of these programs and services was also stressed. Overall, focus group participants were extremely receptive and enthusiastic about the Wellness Center.

See Appendix A for more information.

The Hunter Team developed a set of twenty-five survey questions. In addition to collecting demographic information, questions focused on participants’ perspectives on exercise and food access. The follow-ing are selected results from the responses:

Almost 50 percent of respondents reported receiving supplemental income

Almost 80 percent of respondents reported being covered by either Medicare or Medicaid

A supermarket was the top requested use of the retail space in the Wellness Center

16.3 percent of respondents claimed to exercise one to four times per month, while 25 percent reported not exercising at all

Over 50 percent of survey respondents walk four or more blocks to buy groceries, while 25 percent of re-spondents walk 10 or more blocks

See Appendix B for more information.

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[19] Chalkboard listing of focus group’s top health concerns[20] The Hunter Team conducting a focus group at the Joseph P. Add-abbo Family Health Center on May 4, 2010

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Community Outreach 16

Planning for Prevention: A Wellness Center in the Rockaways17

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INTERVIEWS

The Hunter Team’s interview process confirmed that wellness ser-vices were missing from the community and that there was strong interest in having a place where residents could learn preventive techniques and receive wellness services.

Included among the community interviews conducted by the Hunt-er Team were:

J.R. Peter Nelson, Ph.D, Executive Director of the Joseph P. Addabbo Family Health Center

Seth Bornstein, Executive Director of the Queens Economic Development Corporation

Patricia Simon, Executive Director of the Ocean Bay Community Development Corporation

Liz Sulik, Director of External Affairs at Peninsula Hospital

Jonathan Gaska, District Manager of Community Board 14

See Appendix A for more information. [21] The Hunter Team conducting a focus group at Ocean Bay Community Center on May 1, 2010[22] The Hunter Team speaking with employees of the Ocean Bay Community Development Corporation on May 1, 2010

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Community Outreach 18


In the United States, health care services have traditionally been rooted in the medical model, which stresses clinical diagnosis and in-tervention to remedy disease(s) (Shi & Singh, 2004). Although there are obvious merits to the medical model, the Hunter Team opted to explore the concept of wellness, which “emphasizes efforts and pro-grams geared towards the prevention of disease and maintenance of an optimum state of well-being” (Shi & Singh, 2004).

In addition to improved health, studies have also shown that pre-vention strategies have the potential to reduce healthcare costs for insurers. For example, a 2004 study of 55,439 people with diabetes determined that the overall cost per diabetic person in a prevention program was $417 compared to $554 in the control group (Villagra & Tamim, 2004).

The Hunter Team used the National Wellness Institute’s model (the “Wellness Model”) to guide the planning process of the Wellness Center. The National Wellness Institute (2010) defines wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.” This six-dimensional framework is holistic in its design and focuses on physical, spiritual, intellectual, social, emotional and occupational health. The Hunter

Team adapted the Wellness Model and incorporated the environ-ment as a seventh dimension to address how a safe, healthy and sus-tainable environment positively contributes to wellness. A successful implementation of the Wellness Model creates programs or services that integrate multiple dimensions simultaneously. See Appendix C for more information.

The Hunter Team’s vision is to create a safe, supportive space that en-gages, educates and empowers the community and provides oppor-tunities to integrate wellness into everyday life. Critical to this vision is ensuring that each dimension of the Wellness Model is reflected in the allocation of space for programs. For instance, the spiritual aspect of wellness is represented in meditation and yoga programs, which can help participants manage stress. Activities related to the rooftop space, such as gardening, might be linked to the physical and environmental dimensions. Finally, the allocation of space for mental health services would address the emotional aspect of wellness.

The Wellness Center will not only complement the services already being provided by the Health Center, but will also be at the forefront of prevention. Most importantly, the services offered by the Wellness Center will be affordable to residents living in the area.

WELLNESSA PREVENTIVE APPROACH

[23] Fruit and vegetable selection at the Super Food Corp., Beach Channel Drive

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THE WELLNESS CENTERPROGRAMMING & DEVELOPMENT

SITE

The Wellness Center will be located at 62-00 Beach Channel Drive in Arverne, adjacent to the existing Health Center. The site, situated on Lot 1 of Block 16015, is owned by the New York City Economic Devel-opment Corporation. The lot size, orientation and zoning are consis-tent with a mixed-use development similar to the adjacent Health Center. The site is easily accessible by public transit and convenient for patients of the existing Health Center.

The development site falls within three zoning districts: R4-1 and R5-D with a C1-3 district overlay. According to the New York City Zon-ing Map, the R4-1 and the R5-D zoning district boundaries cut directly through the site. The Hunter Team adhered to the R4-1 zoning regu-lations in creating the building envelope. The calculations yielded a three story, 28,926 square foot building with a footprint of 67 feet wide by 156 feet deep at ground level.

The R4-1 regulations require both the front and side yards to be 15 feet wide. The internal side yard, adjacent to the neighboring Health Center, must be at least eight feet wide. The height regulations permit a third floor with the incorporation of a setback. Under Article II of the New York City Zoning Resolution, the building would be categorized as Use Group 4, which governs community facilities in residential ar-eas (New York City Department of City Planning [NYCDCP], 2006). The building would be designated as a community facility, allowing for a floor area ratio (FAR) of 2.0.

Off-street parking requirements were determined by using a conver-sion factor that equates square footage of developed space into the number of parking spaces required. Using standard formulas and the requirements set forth by the New York City Department of City Plan-ning, the Hunter Team concluded that the proposed site plan is short by approximately 32 parking spaces. Under normal conditions, an underground parking garage would be utilized to make up for this shortfall, but because of the site’s proximity to the waterfront, this is not a viable alternative.

See Appendix D for more information.

ZONING

[24] The site of the proposed Wellness Center, adjacent to the Joseph P. Addabbo Family Health Center, at 62-00 Beach Channel Drive

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[25] New York City Zoning Map of project site and surrounding area[26] Aerial map of project site and surrounding area

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The Wellness Center: Programming & Development 22


Before beginning the design process, the Hunter Team researched existing wellness centers to serve as best practices. The purpose of this research was to better understand how wellness is currently be-ing integrated into building design and programming. These case studies included The College of New Rochelle Wellness Center in New Rochelle, NY; the Mary and Gary West Senior Center in San Diego, CA; and the Peterson Family Wellness Center in Harlan, IA.

The Hunter Team also consulted the New York City Active Design Guidelines (the “Guidelines”), which were developed to promote health through building design. These Guidelines present the most appropriate framework for the Wellness Center and stress that “ac-tive design is environmental design that encourages stair climbing, walking, bicycling, transit use, active recreation, and healthy eating”

(New York City Department of Design and Construction [NYCDDC], NYCDOHMH, & New York City Department of Transportation [NYC-DOT], 2010). The Guidelines align with the physical dimension of the Wellness Model by providing design considerations that encourage physical activity in everyday living. The environmental dimension is also addressed by emphasizing the “synergies between active design and sustainable design initiatives such as LEED and PlaNYC” (NYCDCP, NYCDDC, NYCDOHMH, & NYCDOT, 2010).

The results of the community outreach and field work, the Wellness Model and the specific health issues facing the Rockaway community (obesity, diabetes, heart disease and hypertension) also informed the Hunter Team’s allocation of space within the facility.

PROGRAMMING & LAYOUT

[27] A three-dimensional model of the proposed Wellness Center

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[28] Conceptual rendering of the proposed Wellness Center



The entrance of the Wellness Center will feature a spacious, light-filled atrium with a promi-nent staircase that encourages visitors to use the stairs when participating in activities on the other floors. The Active Design Guidelines recommend designing space to “increase stair use among the able-bodied by providing a conveniently located stair for everyday use” (NYCDCP, NYCDDC, NYCDOHMH, & NYCDOT, 2010).

The ground floor will include a community kitchen, which will be used for cooking classes, workshops, and serve as an incubator for local chefs and small businesses. Not only will these uses generate revenue for the Wellness Center and foster a sense of entrepreneurship, they will directly address needs voiced by focus group participants: better access to nutri-tion information and food preparation skills. One local organization, the Lower Eastside Girls Club in Manhattan, has a program called Sweet Things Bake Shop, which is a produc-tion and training site where members can acquire baking and business skills. The Sweet Things Bake Shop is one of three revenue generating programs that offset operating ex-penses for the Lower Eastside Girls Club (n.d.) (Carmody Consulting Evaluation Services, 2008). See Appendix E for more information.

Rental of the ground floor retail space will serve as a source of revenue for the Wellness Center. Focus group participants expressed interest in sporting goods stores, restaurants and fresh produce stores as potential retail options. Ideally, the retail option Addabbo ul-timately selects should be a healthy one. The Hunter Team researched healthy pizzerias as one possibility. See Appendix F for more information. The ground floor will also feature the Borrow-a-Bicycle Program, which presents the op-portunity for Addabbo to partner with a local non-profit organization. The results of the community outreach indicated a strong demand for the Wellness Center to offer cycling as a way to encourage outdoor exercise. Members of the community voiced a need for event space within the neighborhood. To ad-dress this, a multi-use room for community activities will be included on the ground floor. Finally, yoga and meditation programs, which were also in high demand, will have dedicat-ed studio space. Studies have shown that yoga participation is beneficial to obesity preven-tion, hypertension control, and a positive quality of life (Lippincot’s Nursing Center, 2006).

Additional space on the ground floor will be reserved for administrative use and mainte-nance.

GROUND FLOOR

Image Source: sasaki.com/

Image Source: rentals.astorcenternyc.com/Inspirational images: [29] staircase in lobby atrium, [30] Borrow-a-Bicycle Program and [31] visitors participating in a healthy cooking demonstration in the community kitchen

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[32] Proposed layout, ground floor (all square footage calculations are approximate)

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GROUND FLOOR


A substantial portion of the second floor will be devoted to fitness centers for both adults and children. The adult fitness center is adjacent to physical therapy rooms, allowing therapists to continually monitor the activity of their patients. The chil-dren’s fitness room will be supervised, giving both adults and children the chance to exercise simultaneously. The remainder of the second floor will house Addabbo’s chronic disease manage-ment facilities, which will focus on asthma, obesity, hypertension and diabetes treatment. This space will include nine exam rooms, three doctors’ offices and a dedicated waiting room, reception and administration area.

A biogenetic repository will also be located on the second floor. Addabbo hopes that the work performed in this space will help doctors understand the link be-tween genetics and chronic diseases. This laboratory will be a primary revenue generator for the Wellness Center.

SECOND FLOOR

Image Source: tampabay.com Image Source: magazine.concordia.ca/Image Source: Addabbo Family Health Center

Inspirational images: [33] fitness area, [34] view of open atrium from second floor, [35] children’s fitness area and [36] child being seen by doctor in consultation room

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[37] Proposed layout, second floor (all square footage calculations are approximate)

SECOND FLOOR


Addabbo’s Mental Health Department will be relocated from the existing Health Center to the third floor of the new Wellness Center. The department will have eight consultation rooms that will also serve as offices for mental health professionals. There will be a separate waiting room, reception, and administration area.

The remaining space on the third floor will be designated as offices rented by academic institutions that might partner with the Wellness Center for research purposes. This floor will also feature a setback to create a sizable outdoor area, half of which will be enclosed in glass, for year-round recreational and entertainment uses. Lastly the third floor will contain a multi-use room and a kitchen, both of which can be rented by community members and organizations for events.

THIRD FLOOR

Image Source: landelements.com/Inspirational images: [38] academic research area, [39] outdoor art therapy classes and [40] the outdoor terrace

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[41] Proposed layout, third floor (all square footage calculations are approximate)

THIRD FLOOR


ROOFTOPParticipants in the focus groups cited an interest in learning how to grow their own food. Vegetable gardens offer many ben-efits to communities. One study found that households with at least one family member belonging to a community garden were significantly more likely to consume fruits and vegetables on a regular basis than those families without a gardening household member (Alaimo, Packnett, Miles & Kruger, 2008). Gardens have also shown to be successful in teaching children to eat more healthfully, especially when combined with nutrition education (Morris, Neustadter, & Zidenberg-Cherr, 2001; McAleese & Rankin, 2007).

The Wellness Center will include a rooftop garden that not only benefits the community, but also the immediate facility and its surrounding environment. The rooftop garden has the potential to: reduce stormwater runoff, provide building insulation, reduce the heat island effect and provide habitats for many species (Berghage, Jarrett, Thuring, & Razaie, 2009; U.S. Environ-mental Protection Agency [EPA], 2010).

Inspirational images: [42] children learning gardening techniques and [43] the rooftop garden

[43][42]


[44]

[44] Proposed layout, rooftop (all square footage calculations are approximate)

ROOFTOP


FINANCIAL FEASIBILITY

The total cost of construction of the Wellness Center is approximately $16 million. This total represents hard costs, soft costs and land acqui-sition. Addabbo anticipates that it can acquire the land from the New York City Economic Development Corporation for a nominal cost. Using construction costs from the existing Health Center and three comparable New York City development projects, the Hunter Team

estimated hard construction costs at $13.7 million, based on $450 per square foot. The remaining costs for the construction are consid-ered soft costs, which include insurance, legal and architecture fees. Finally, a developer fee is added to determine the total construction costs. See Figures [45] and [46] for more information.

CONSTRUCTION COSTS

Assumptions(1) The Health Center lot was acquired from the NYCEDC for $300,000. As the NYCEDC owns the lot for the Wellness Center, the Hunter Team assumed that the agreement for land transfer would be similar.(2) Approximation of the average of three comparable development projects: (a) Private new construction community center, Marion McMahon Abbe Clubhouse in Flushing, Queens ($372.00 per Sq. Ft.) (b) Private new construction mixed-use community center, Bronx ($368.00 per Sq. Ft) (c) Public new construction mixed-use building, Wave Hill Vistor Center, Bronx ($664.00 per Sq. Ft.) (3) A 5% contingency rate was utilized based on the estimated construction cost. (4) Soft Costs (architects, building permits, construction management) were estimated at 7% . This number was based on soft costs for the current Health Center.(5) Developer’s fee was estimated at 7%. As this project is a community development for a non-profit corporation, it is customary to keep the developer’s fee low. (6) Yearly Debt Service was calculated using a 30 year mortgage at a rate of 6.0% on the principal.

[45] Property Information [47] Permenant Loan InformationAddress 62-00 Beach Channel Drive Construction CostsLot Size 54,000 Total Construction Costs $15,947,960.82Gross Building Area (Sq.Ft.) 28,926

EquitySponsor $2,000,000.00

[46] Estimated Cost of Construction Foundation(s) $1,000,000.00Hard Costs Other Funding $2,000,000.00Purchase Price 1 $300,000.00 Total Equity $5,000,000.00Construction Cost (Per Sq. Ft) 2 $450.00Contingency Fee 3 5% Debt Service

Total Hard Costs $13,667,535.00 Total Debt $10,947,960.82Amortization Schedule 30

Soft Costs Interest Rate (Per Annum) 6%Soft Costs 4 7% Monthly Payments -$65,638.56

Total Soft Costs $956,727.45 Yearly Debt Service 6 -$787,662.72Total Hard and Soft Costs $14,624,262.45

Developer's Fee (7%) 5 $1,023,698.37

Total Construction Costs $15,947,960.82

33

Funding will be obtained from both public and private sources in order to make the Wellness Center financially feasible. Potential funding sources are discussed below.

FEDERALThe majority of the Wellness Center’s proposed programming initiatives will benefit from the funding available through the Patient Protec-tion and Affordable Care Act passed in March 2010. This legislation “will promote prevention, wellness, and the public health and provides an unprecedented funding commitment to these areas. It directs the creation of a national prevention and health promotion strategy that incorporates the most effective and achievable methods to improve the health status of Americans and reduce the incidence of preventable illness and disability in the United States” (U.S. Executive Office, 2010). Specifically, the Wellness Center will be eligible for funding under Title IV of this legislation entitled Prevention of Chronic Disease and Improving Public Health. Title IV provides funding to non-profit entities that develop strategies to prevent the onset of chronic diseases including those associated with obesity (Patient Protection and Affordable Care Act [PPACA], 2010).

Also included within Title IV is the Prevention and Public Health Fund, which was established to “to provide for expanded and sustained na-tional investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs” (PPACA, 2010). This fund has appropriated seven billion dollars to be distributed to organizations dedicated to improving the quality of health care by the end of 2015 (PPACA, 2010).

STATEState funding is also available for construction of the Wellness Center. One source is the Preventive Health & Health Services Block Grant, which provides funding for programs that prevent the leading causes of death and disability. This grant has distributed $3.2 million to reduce health disparities (CDC, 2009).

LOCALThe Wellness Center is eligible for funding from New York City. The Health Center received strong support from the community and funding from Councilman Gregory Meeks, Queens Borough President Helen Marshall, the Port Authority of New York & New Jersey and other local of-ficials and agencies. FOUNDATIONSFoundations are another potential revenue source for the Wellness Center. The Kresge Foundation gives operating and construction cost grants to centers that are health-focused and impact community development. The W.K. Kellogg Foundation (n.d.) focuses on children and specifically provides funding for child obesity management and prevention. The Robert Wood Johnson Foundation (2010) strives to improve general community health, decrease obesity rates and reduce inequality. This foundation specifically aims to fund proposals that address health disparities (Robert Wood Johnson Foundation, 2010).

FUNDING

Financial Feasibility 34


The Wellness Center can leverage its space to produce reve-nue streams that will cover operating costs. Year one monthly operating expenses will be approximately $241,139, which factors in start-up costs associated with the biogenetic repos-itory. Beginning year two, monthly operating expenses will dip to $203,487 and then increase annually based on a 3 per-cent rate of inflation. The Hunter Team calculated a monthly debt service of approximately $65,639, but notes that debt service has the potential to change based on the amount of funding that is received; for every million dollars of funding, debt service would be reduced by roughly $72,000 per year. The ground floor retail space is a potential revenue stream, providing goods and services that enhance the goals of the Wellness Center. Based on comparable retail rents, the Well-ness Center can charge $24 per square foot per year, produc-ing an annual rental income of $48,000. Other rental income may come from non-profit organizations that will rent space in the Wellness Center.

The Wellness Center will also use fees from clinical services as revenue. The Chronic Disease Management Unit of the Well-ness Center will see approximately 36 patients a day; the Nu-trition and Mental Health Units will see approximately 64 pa-tients a day combined; and the Physical Therapy Unit will see approximately 10 patients a day – all at a rate of $135 per visit. Using the assumption of 300 days of operation per calendar year, the combined revenue from these services will total ap-proximately $4.46 million per year.

OPERATING REVENUE & EXPENSES

Assumptions(1) Wellness Services: 4 patients per room per day for Chronic Disease Management, 6 patients per room per day for Mental Health Counseling, 10 patients per day for Physical Therapy and 16 patients per day for Nutritional Counseling (P. Nelson, personal communication, June 18, 2010).(2) Wellness Research: Approximately 6-7 samples collected per day (P. Nelson, personal communication, June 18, 2010).(3) 300 operational days per year(4) Net Patient Revenue is based on the payout rate to Addabbo from Medicaid, Medicare or both (P. Nelson, personal communication, April 13, 2010).(5) According to research conducted by Addabbo, genetic samples can be sold for approximately $800 (P. Nelson, personal communication, June 18, 2010). (6) The yearly retail rent is based on CoStar comparables for the neighborhood.(7) Expense estimations based on Addabbo’s knowledge of running the three existing health centers.

[48] REVENUE: Wellness Retail Rental IncomeRetail Net Rental Area (Sq. Ft.) 2,000Average Rent (Sq. Ft.)6 $24

Total Year 1 Retail Rental Income $48,000.00

[49] REVENUE: Wellness Services/ Research

Wellness ServicesPatients/

Per Day 1, 2Patients / Per Year 3

Patient Reimbursement/

Per Day4

Patient Reimbursement/

Per Year4

Chronic Disease Mgmt. 36 10800 $135.00 $1,458,000.00Physical Therapy 10 3000 $135.00 $405,000.00Mental Health Counseling 48 14400 $135.00 $1,944,000.00Nutritional Counseling 16 4800 $135.00 $648,000.00

Total Wellness Services Revenue $4,455,000.00

Wellness ResearchBiogenetic Repository5 ~6.67 2000 $800.00 $1,600,000.00

Total Wellness Services/Research Revenue $6 055 000 00Total Wellness Services/Research Revenue $6,055,000.00

[50] EXPENSE: Wellness Staff 7

Building Staff Community KitchenFacilities $40,000.00 Nutritionist $50,000.00Administrator $65,000.00 Staff $40,000.00Receptionist $40,000.00

Chronic Disease Management Physical Therapy Nurses (2) $160,000.00 Physical Therapist $60,000Doctors (2) $300,000.00Unit Clerk $45,000.00

Mental Health CounselingTherapists (8) $480,000.00

Total Wellness Staff $1,280,000.00

Assumptions(1) All Revenue components will be subject to a 3% increase based on inflation (Exception: Net Patient due to unknown variability of Medicaid/Medicare).(2) All Expenses will be subject to a 3% increase based on inflation (Exceptions: Debt and Biogenetic Repository Start-up costs).(3) Utility costs are derived from Addabbo’s current health centers’ utility costs (P. Nelson, personal communication, April 13, 2010). (4) Insurance costs are derived from Addabbo’s current health centers’ insurance costs (P. Nelson, personal communication, April 13, 2010). (5) Biogenetic Repository Start-up cost is derived from research conducted by Addabbo (P. Nelson, personal communication, April 13, 2010). (6) Other Expenses are derived from Addabbo’s current health centers’ other expenses (P. Nelson, personal communication, April 13, 2010).

PRO FORMA2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Operating Revenue 1

Space Rental - Retail $48,000.00 $49,440.00 $50,923.20 $52,450.90 $54,024.42 $55,645.16 $57,314.51 $59,033.95 $60,804.96 $62,629.11Net Patient $4,455,000.00 $4,455,000.00 $4,455,000.00 $4,455,000.00 $4,455,000.00 $4,455,000.00 $4,455,000.00 $4,455,000.00 $4,455,000.00 $4,455,000.00Biogenetic Repository $1,600,000.00 $1,648,000.00 $1,697,440.00 $1,748,363.20 $1,800,814.10 $1,854,838.52 $1,910,483.67 $1,967,798.18 $2,026,832.13 $2,087,637.09

Total Revenue $6,103,000.00 $6,152,440.00 $6,203,363.20 $6,255,814.10 $6,309,838.52 $6,365,483.67 $6,422,798.18 $6,481,832.13 $6,542,637.09 $6,605,266.21

Operating Expenses 2

Debt -$787,662.72 -$787,662.72 -$787,662.72 -$787,662.72 -$787,662.72 -$787,662.72 -$787,662.72 -$787,662.72 -$787,662.72 -$787,662.72Staff Salaries -$1,280,000.00 -$1,318,400.00 -$1,357,952.00 -$1,398,690.56 -$1,440,651.28 -$1,483,870.82 -$1,528,386.94 -$1,574,238.55 -$1,621,465.70 -$1,670,109.68Utilities 3 -$42,000.00 -$43,260.00 -$44,557.80 -$45,894.53 -$47,271.37 -$48,689.51 -$50,150.20 -$51,654.70 -$53,204.34 -$54,800.47Insurance 4 -$84,000.00 -$86,520.00 -$89,115.60 -$91,789.07 -$94,542.74 -$97,379.02 -$100,300.39 -$103,309.40 -$106,408.69 -$109,600.95Biogenetic Start-up 5 -$500,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00Other Expenses 6 -$200,000.00 -$206,000.00 -$212,180.00 -$218,545.40 -$225,101.76 -$231,854.81 -$238,810.46 -$245,974.77 -$253,354.02 -$260,954.64

Total Expenses -$2,893,662.72 -$2,441,842.72 -$2,491,468.12 -$2,542,582.28 -$2,595,229.87 -$2,649,456.88 -$2,705,310.71 -$2,762,840.15 -$2,822,095.47 -$2,883,128.45

OPERATING INCOME $3,209,337.28 $3,710,597.28 $3,711,895.08 $3,713,231.81 $3,714,608.65 $3,716,026.79 $3,717,487.48 $3,718,991.98 $3,720,541.62 $3,722,137.75

[51]

Financial Feasibility 36

The Wellness Center will also operate a biogenetic repository. This re-pository will be the site of DNA collection, storage and analysis. The ge-netic information collected will be used for research in developing cures and treatments for chronic diseases and will be sold to research orga-nizations to generate revenue. It is estimated that the Wellness Center can receive $800 per sample (P. Nelson, personal communication, June

18, 2010). Assuming 300 days of operation per calendar year, and an average collection rate of 6 to 7 samples per day at $800 per sample, the Hunter Team calculated annual revenue from the biogenetic repository at $1.6 million. See Figures [48], [49], [50] and [51] for more information.

OPERATING REVENUE & EXPENSES (CONTINUED)


RECOMMENDATIONSForm a Community Task Force. The Task Force should advocate the

ideas and concerns of Rockaway residents and business owners to ensure that the Wellness Center’s programming and outreach efforts continue to be reflective of the community’s needs. The Task Force could be comprised of community members who would like to lead the charge in ensuring that the voice of the community is heard. The Hunter Team has prioritized the needs and desires of the community in its design and programming of the Wellness Center and the Task Force should continue this work. Several participants of the focus groups have already expressed an interest in joining the Task Force.

Create strategic partnerships. The Wellness Center should establish new and strengthen existing partnerships with non-profit groups, hospitals, housing developments and other community organiza-tions. One method of reaching potential clients is to invite other non-profits to operate some of the programs within the Wellness Center.

Hire a grant and funding specialist. Given the complexity of the current healthcare system, as well as the intricacies of the Patient Pro-tection and Affordable Healthcare Act, Addabbo should hire a grant specialist who will research feasibility of funding through federal, state, local and/or non-profit sources.

Develop marketing strategies. While the Hunter Team recognizes that the Wellness Center will rely on referrals from the Health Cen-ter, Addabbo should also be proactive in developing creative mar-keting strategies to raise awareness and increase engagement. One example is the Walking-While-Waiting program, conceptualized by the Hunter Team. Instead of passively sitting in the Health Center waiting room, patients will be given acccess to treadmills in the Well-ness Center and a wireless pager to notify them when their doctor is available. This treadmill area will be supervised by personnel, who can both monitor patients’ physical activity and answer questions about the Wellness Center.

Establish a commitment to affordability. During outreach efforts, the Hunter Team repeatedly heard that cost would be a driving factor in determining usage of the Wellness Center. While market research of the surrounding area has revealed that there are fitness centers and a planned YMCA (located on Beach 73 Street), these facilities re-main financially inaccessible to the Wellness Center’s target commu-nity. So while the Wellness Center will overlap with neighboring fa-cilities in some capacities, its affordability, supportive programs and focus on prevention should be its key differentiators.

Research alternative fee structures. Recognizing that affordability is critical to the utilization and ultimate success of the Wellness Cen-ter, Addabbo should research the feasibility of a sliding fee structure that will accommodate the financial limitations of some community members, while reinforcing the concept of personal responsibility.

Consider retail possibilities. The Hunter Team recommends a healthy pizzeria for the retail space. It will address the limited dining options in the study area. Secondly, pizza is both an affordable, popu-lar, and familiar food option. Finally, pizza can also easily be prepared in a healthy manner, creating an opportunity to introduce fresh in-gredients grown in the Wellness Center’s rooftop garden.

Investigate zoning variances. Because the zoning analysis con-ducted by the Hunter Team concluded that the new site plan, which includes both the proposed Wellness Center and the existing Health Center, came up slightly short on the parking requirement, it is rec-ommended that Addabbo consult with a zoning specialist for parking considerations and potentially apply for a variance. The Hunter Team also recommends exploring the possibility of using Rated Capacity as an alternate methodology for calculating site parking requirements. Rated Capacity takes the maximum number of persons per use, at any given time throughout the day and uses a conversion factor to determine the number of required spaces.

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Promote sustainability. As Addabbo moves into the next phases of building and site design, the Hunter Team recommends that consider-ation be given to the environmental dimension of the Wellness Model. Green building principles should be used and Addabbo should seek LEED certification for the Wellness Center.

Endorse employee wellness. Addabbo should strive to emphasize employee wellness. Not only will this enhance employee productiv-ity, but it will also strengthen relationships with patients. This is par-ticularly important given feedback from the focus groups conducted

by the Hunter Team. Participants expressed concern on the some-what transient nature of staff members; the underlying thought be-ing that if there was more consistency in staffing, patients would feel that they were being monitored more regularly and comprehensively. To accomplish this goal, Addabbo should create specific programs designed to increase employee satisfaction and retention. Poten-tial funding for this recommendation can stem from a Title IV of the Patient Protection and Affordable Care Act. This program, called the Workplace Wellness Program, has allocated $200 million in funds to small businesses and non-profits.

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[52]

[52] A Rockaway family


[53]

[53] Little boy sitting on Rockaway boardwalk, Earth Day Rockaway on May 1, 2010

CONCLUSIONAchieving wellness demands action, both literally and figuratively. As a country, a community and as individuals, we must move – and encourage the government, on all levels, to do the same. With the passage of the Patient Protection and Affordable Care Act in March 2010 – and more specifically, the National Prevention and Wellness Strategy – our Federal government has taken a step in the right di-rection. At the local level, the Hunter Team has developed a proposal that aligns with these national priorities. The Wellness Center will offer affordable programming and services that emphasize preventive strategies and respond to health disparities in lower income areas of the Rockaways. If implemented, Addabbo’s new Wellness Center can become a rep-licable model, used in poor communities across the country suffer-ing from similar health disparities. This will ultimately reveal that wellness perhaps more than any other preventive strategy, can lead Americans to live longer, healthier and more productive lives.

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APPENDIX


APPENDIX A

As part of the process of understanding the community and its needs, interviews were conducted with community advocates and representatives. The interviewees included the Executive Director of the Ocean Bay Community Development Corporation, Patricia Si-mon; the Director of External Affairs at Peninsula Hospital and former member of the Queens Chamber of Commerce, Liz Sulik; and Com-munity Board 14 District Manager, Jonathan Gaska.

The overarching theme that emerged throughout these interviews was the lack of comprehensive wellness services available in the Rockaways. Interviewees stressed that the community needs an ac-cessible place to obtain targeted, preventive care. Ocean Bay Execu-tive Director Patricia Simon noted that the Ocean Bay Houses lack a comprehensive center providing health and social services. More specifically, Ms. Simon stated that a wellness center could provide services for the seniors who reside in the developments (P. Simon, personal communication, March 9, 2010).

Similarly, Liz Sulik of Peninsula Hospital stated that there is a need for a space in the community to address concerns about diabetes, exercise and nutrition. While Peninsula Hospital would like to provide preventive care, it currently does not have adequate funding to do so. This equates to a lack of preventive care staff, such as Certified Diabetic Assistants. Additionally, Ms. Sulik emphasized the linkages between poor nutrition and high diabetes rates in the community. She suggested that a cost-effective, health food franchise could ad-dress this issue and serve as a potential retail anchor for the Wellness Center. Lastly, Ms. Sulik highlighted the disconnect between what doctors advise patients to do and the reality of the community. “If you tell people to exercise,” contended Ms. Sulik, “you have to give them a place to do it” (L. Sulik, personal communication, March 9,

2010). This statement underscores the need for Addabbo to create a comprehensive Wellness Center that provides medically supervised exercise space, along with nutritional counseling.

The interview with Community Board 14 District Manager Jonathan Gaska informed the Hunter Team that any community outreach and/or marketing must be thoughtfully positioned in order to be success-ful. Mr. Gaska mentioned the importance of appealing to seniors, and emphasized that this group may not be responsive if the services are offered in an environment that is also frequented by younger com-munity members. Additionally, Mr. Gaska emphasized the need to provide affordable services to the community, particularly in light of current unemployment rates (J. Gaska, personal communication, March 10, 2010). The unemployment rate in the Rockaway Peninsula is approximately 13.2 percent compared to the 9.9 percent national rate (Bureau of Labor Statistics [BLS], 2010; SRC/Alteryx, 2009).

INTERVIEWS WITH COMMUNITY ADVOCATES AND REPRESENTATIVES

[54]

[ 54] Youth basketball game at the Ocean Bay Community Center on May 1, 2010

41

Appendix A

In addition to interviews and surveys, the Hunter Team also con-ducted three focus groups with Rockaway residents. Questions were drafted that explored the strengths and weaknesses of existing com-munity services; exercise and lifestyle choices; and preferred services to include in the Wellness Center.

Separate adult and teen focus groups were held at the Ocean Bay Community Center on May 1, 2010. In the adult session, participants voiced a desire for more information on healthy living and exercise. Additionally, when asked about existing services in the community, one respondent questioned, “What services? There aren’t any servic-es.” Some respondents stated that they would welcome a facility that would offer yoga, dance classes and a gym. Several potential barriers to using the Wellness Center were noted by participants including cost. One participant, using the $50 membership fee from the Police Athletic League gym as a baseline, said this price is too high, but that she could afford $19.99 a month. Other participants said that aside from cost, lack of motivation was another reason for not exercising and utilizing available services. Lastly, while participants were famil-iar with Addabbo and the Health Center through friends or family, most were not patients themselves.

During the teen focus group, participants commented that they wanted more information on healthy living and exercise. Most of the teens were fairly physically active, often participating in sponsored basketball and coach-led conditioning offered through the Ocean Bay Community Development Corporation. As a result, they felt that supervised exercise is a good strategy to motivate teenagers. When the Hunter Team inquired why the teenagers were were so active, one participant commented that it is because he “does not want to be overweight” when he gets older. When asked about the needs the Wellness Center might address, another respondent said that the Wellness Center could provide a place for children to “occupy their time and get them off the street.” Participants also suggested that a sporting goods outlet could occupy the retail space.

The third focus group was held at the Joseph P. Addabbo Family Health Center on May 4, 2010 and consisted of twelve Health Center patients, who were compensated $10 for their time. The three topics that continually emerged were staffing concerns at the Health Cen-ter, access to fresh food and childhood nutrition and fitness.

Participants expressed concern about the somewhat transient na-ture of staff members at the Health Center. They thought that if there was more consistency in staffing, patients would feel that they were being monitored more regularly and comprehensively.

Participants also noted that they would like to see more mental health services, family counseling, cooking classes targeted towards families with diabetic members (specifically children) and also nutri-tion classes for children. Many participants were parents who were concerned with school lunch programs that provide unhealthy, over-processed, high calorie food. Residents voiced interest in more chil-dren’s activities in the Wellness Center so adults “can work out and know children are safe.” They also requested “treadmills, fitness class-es, exercise bikes, basketball courts and an indoor running track.” Some participants noted that they would consider doing these same activities outside if they were coordinated through organized clubs.

Lastly, many in the focus groups described the Rockaways as a “food desert” due to the lack of fresh produce. To address this, participants discussed the need for outlets to buy fresh food with WIC vouchers, farmers’ markets, and community supported agriculture, while also acknowledging that this may require improved public transportation options to reach these destinations.

FOCUS GROUPS

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APPENDIX B

The Hunter Team developed a set of 25 survey questions in order to better understand community perspectives on health, exercise and food access. The Team wanted to gauge the community’s interest in the proposed Wellness Center and how they felt it could be best programmed. Finally, demographic data was collected to gain insight into populations that might use the Wellness Center.

Once the survey was developed and approved by Seth Bornstein, Queens Economic Development Corporation and the client, Dr. J.R Peter Nelson, Executive Director of the Joseph P. Addabbo Family Health Center Inc., it was distributed to two groups:

Patients in the waiting room at the Health Center Residents attending events at the Ocean Bay Community Center

Respondents were not compensated for their answers and filling out the anonymous survey was optional at both locations. Over the course of three weeks, 293 surveys were collected.

SURVEYS

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Appendix B

SURVEY

Wellness Center SurveyHelp us determine how best to serve the Rockaway community with a center for wellness and health!

We are 10 Hunter College students working with Addabbo Family Health Center to develop a wellness center for theRockaways. Typically, a wellness center is a place for a community to address its emotional, nutritional, physical andoccupational needs. Please tell us what you would like to see in this new building that will be located next to Addabbo!

1. Zip Code:___________

2. Are you Male or Female? (Circle one) Male Female

3. Age:

a. 18 or younger b. 19 – 25 c. 26 – 35

d. 36 – 50 e. 51 – 64 f. 65 and over

4. Do you currently have health insurance? (Circle one) Yes No

4a. If yes, what kind of health insurance do you have? (Circle one)

a. Medicare b. Medicaid c. Other_______________

4b. Do your children have health insurance? (Circle one)

Yes No I do not have children

5. Are you currently employed? (Circle one) Yes No

6. What is your yearly income? (Circle one)

a. Less than $10,000 b. $10,000 – $19,999 c. $20,000 – $29,999 d. $30,000 – $39,999

e. $40,000 – $49,999 f. $50,000 – $59,999 g. $60,000 – $70,000 h. More than $70,000

7. Do you currently receive supplemental income? (Circle one) Yes No

7a. If yes, which supplement(s) do you receive? (Circle all that apply)

a. WIC e. Foster care reimbursements

b. SNAP f. Veterans benefits

c. SSI g. Other(s)_________________

d. Rental Income

8. Where do you usually buy groceries? (Circle one)

a. Supermarket / grocery store

b. Convenience store / bodega / corner store

c. Places for eating out / take out / delivery

8a. How far is the store from your residence? _____________blocks

8b. Does this store carry fresh fruits/vegetables? (Circle one)

Yes No I am not sure

9. If a retail store were to be located near Beach Channel Drive and Beach 63rd Street (the future site of a WellnessCenter), what type of store would you like to see at the location? _______________________________________

10. How do you usually travel (to work, to school, to the doctor’s office, etc)? (Circle one)

a. Car b. Bus c. Subway d. Walking

e. Biking f. Taxi/car service g. Other_________

11. On average, how often do you exercise? (Circle one monthly or weekly choice)

a. I do not exercise b. 1 4 times/month c. 2 times/week

d. 3 5 times/week e. 6 or more times/week

12. If services at the proposed wellness center cost a small fee, what amount would be too much for youto pay? (Circle one)

a. $5 per visit b. $10 per visit c. $20 per visit

Be creative! Tell us what you’d like to see in a new wellness center.______________________________________________________________________________________________________________________________________________________________________________________

For Questions 13 25, consider how likely you are to use the following services at a community Wellness Center:

Never likely Seldom likely Sometimes likely Often likely Very likely

1 2 3 4 5

Exercise13. Fitness classes?

1 2 3 4 514. Exercise machines (i.e. Treadmills & resistance machines)?

1 2 3 4 515. Ball courts?

1 2 3 4 516. Bike lending program?

1 2 3 4 517. Fitness trainer?

1 2 3 4 5Food & Nutrition

18. Weight loss program?1 2 3 4 5

19. Nutrition counseling?1 2 3 4 5

20. Cooking classes?1 2 3 4 5

21. Fruit & vegetable garden?1 2 3 4 5

Lifestyle22. Support group?

1 2 3 4 523. Job & personal finance workshop?

1 2 3 4 524. Education workshop on preventing and treating obesity?

1 2 3 4 525. Education workshop on preventing and treating diabetes?

1 2 3 4 5

Thank you!Your answers will be kept confidential and your identity will remain anonymous.

44


APPENDIX BSUMMARY OF RESPONSES

1.) Zip Code 2.) Are you Male or Female? 4b.) If other (write-in)Zipcode Frequency Valid % Gender Frequency Valid % Type Frequency Valid %10457 1 0.3% Male 89 30.9% 1 1 2.5%10460 1 0.3% Female 198 68.8% 1199 6 15.0%11096 1 0.3% Other 1 0.3% Affantis 1 2.5%11208 3 1.0% No Response 5 Affinity 1 2.5%11218 1 0.3% Total 293 100.0% Amerigroup 1 2.5%

11233 1 0.3% Blue Cross Blue Shield 1 2.5%11377 1 0.3% 3.) Age (select) Child Health Plus 1 2.5%11414 1 0.3% Age Range Frequency Valid % Emblem 1 2.5%

11416 1 0.3% 18 or younger 14 4.9% Fidelis 1 2.5%11417 1 0.3% 19-25 52 18.2% GHI 1 2.5%11420 4 1.4% 26-35 83 29.0% Health First 6 15.0%11422 1 0.3% 36-50 86 30.1% Health Plus 3 7.5%11427 1 0.3% 51-64 35 12.2% HIP 7 17.5%11428 1 0.3% 65 and over 16 5.6% Local 1197 1 2.5%11432 1 0.3% No Response 7 Medicare/Medicaid 1 2.5%11434 1 0.3% Total 293 100.0% Metroplus 1 2.5%

11436 1 0.3% Oxford 1 2.5%11438 1 0.3% 4.) Do you currently have health insurance? Self pay 3 7.5%11481 1 0.3% Yes/No Frequency Valid % United Healthcare 2 5.0%11690 3 1.0% Yes 224 82.4% No Response 25311691 73 25.4% No 48 17.6% Total 293 100.0%11692 99 34.5% No Response 2111693 51 17.8% Total 293 100.0%11694 26 9.1%11696 1 0.3% 4a.) If yes, what kind of health insurance 4c.) Do your children have health11697 2 0.7% do you have? insurance?11698 3 1.0% Type Frequency Valid % Yes/No Frequency Valid %11699 3 1.0% Medicare 33 15.6% Yes 195 84.1%11961 2 0.7% Medicaid 135 64.0% No 37 15.9%No Response 6 Other (see below) 43 20.4% I do not have chilrden 36Total 293 100.0% No Response 82 No Response 25

Total 293 100.0% Total 293 100.0%

45

Appendix B

SUMMARY OF RESPONSES

5.) Are you currently employed? 8.) Where do you usually buy groceries? 8a.) How far (# of blocks) is the location you Yes/No Frequency Valid % Type of Store Frequency Valid % buy groceries from your residence (write-in)?Yes 122 44.0% Supermarket/ Zipcode Frequency Valid %No 153 55.2% Grocery Store 0 1 0.4%Other 2 0.7% Convenience Store/ 1 23 9.1%No Response 16 Bodega/Corner Store 2 47 18.7%Total 293 100.0% Places for Eating Out/ 3 19 7.5%

Take Out/Delivery 4 13 5.2%No Response 13 5 28 11.1%

6.) What is your yearly income Total 293 100.0% 6 13 5.2%(select range)? 7 8 3.2%Age Range Frequency Valid % 8 13 5.2%

Less than $10,000 74 29.7% 8b.) Does this store usually carry 9 1 0.4%$10,000 - $19,999 80 32.1% fresh fruits/vegetables? 10 23 9.1%$20,000 - $29,999 45 18.1% Yes/No Frequency Valid % 12 4 1.6%

$30,000 - $39,999 33 13.3% Yes 237 87.1% 13 3 1.2%$40,000 - $49,999 6 2.4% No 20 7.4% 15 17 6.7%$50,000 - $59,999 7 2.8% I am not sure 15 5.5% 16 1 0.4%$60,000 - $70,000 3 1.2% No Response 21 18 1 0.4%More than $70,000 1 0.4% Total 293 100.0% 19 1 0.4%No Response 44 20 18 7.1%Total 293 100.0% 21 1 0.4%

26 1 0.4%30 6 2.4%

7.) Do you currently receive 31 1 0.4%supplemental income? 33 1 0.4%Yes/No Frequency Valid % 48 1 0.4%

Yes 120 49.4% 49 1 0.4%No 122 50.2% 50 2 0.8%Other 1 0.4% 53 1 0.4%No Response 50 58 1 0.4%Total 293 100.0% 60 2 0.8%

No Response 41Total 293 100.0%

242

29

9

86.4%

10.4%

3.2%

46


APPENDIX BSUMMARY OF RESPONSES9.) If a retail store were to be located near Beach Channel Channel Drive and beach 63rd Street, what type of 10) How do you usually travel (to work,store would you like to see at the location (write-in)? to school, to doctor's office, etc.)?

Zipcode Frequency Valid % Type of Transport Frequency Valid %99 cent store 2 0.9% Car 64 28.3%supermarket 83 36.6% Bus 69 30.5%clothing and housing supply store 1 0.4% Subway 58 25.7%mall 20 8.8% Walking 25 11.1%beautician 1 0.4% Biking 2 0.9%BJ 4 1.8% Taxi/car service 7 3.1%movie 6 2.6% Other (See text field) 1 0.4%bowling 6 2.6% No Response 67camera shop 1 0.4% Total 293 100.0%car wash 1 0.4%clothing 5 2.2%community center 1 0.4%convenience store 1 0.4% 11.) On average, how often do you exercise?cosco 2 0.9% Range Frequency Valid %daycare 2 0.9% I do not exercise 66 25.1%gym 11 4.8% 1-4 times a month 43 16.3%discount store 2 0.9% 2 times a week 91 34.6%DK 1 0.4% 3-5 times a week 39 14.8%drug 2 0.9% 6 or more times a week 24 9.1%electronics 1 0.4% No Response 30fruit and vegetable grocery 18 7.9% Total 293 100.0%grocery store 8 3.5%foot locker 1 0.4%hardware store 1 0.4%health food store 5 2.2% 12.) If services at the proposed Wellness Center health pharamcy 2 0.9% cost a small fee, what amount would be tooice cream parlor 1 0.4% much for you to pay? Kmart 3 1.3% Amount Frequency Valid %Laundromat 1 0.4% $5 per visit 66 25.3%macy 1 0.4% $10 per visit 50 19.2%mcdonalds 1 0.4% $20 per visit 145 55.6%meat market 2 0.9% No Response 32novelt shop 2 0.9% Total 293 100.0%

target 2 0.9%repair shop 1 0.4%restaurant 2 0.9%school 1 0.4%CVS 1 0.4%Wellness center 2 0.9%variety store 1 0.4%walmart 5 2.2%walgreens 3 1.3%other 10 4.4%No Response 66Total 293 100.0%

47

APPENDIX B

Appendix B

SUMMARY OF RESPONSESOpen Question: Be creative! Tell us what you'd like to see in a new wellness center (Note: As much as possible, write-in responses were copied in theiroriginal form to preserve authenticity. Exception: Identical responses were consolidated).Response Response 99 Cent Store Indoor swimming pool, paddle ball court, BIG gymBasketball court, tennis court Information & equipment on how to stay healthyA drop-off center for children (ages 1-11 yrs) while adults are taking care of their needs or pool, yoga classes, fitness for children It would be good to have a TV in the waiting area for the patients to watch while they wait for the doctorA great wellness center to help the far Rockaway community control weight especially the diabetic ppl It would be good to have a vending machine with healthy snacks and juice for patientsA gym with a swilling pool, learning swimming as exercise Kids play houseA parking lot for consumers/visitors/patients Massage therapistA place where kids can better themselves and get off the streets Meat market, fresh vegetablesA productive environment for the youth and young mothers/More community activity within the community More activities for the community/more stores in the areaA snack bar More doctorsArts & crafts workshop More doctors so people can be seen fasterBasketball, swimming, exercise class More growth opportunities and more benefits Better Service Movie theaterBig balls to exercise buttocks. Bicycles Not sureBike shop Nutrition classesBike store Parents learning areaBJ Meat Market Pathmark/gymBurger King Pizza shopCatering/baking supplies store Play area for small children, yoga, pool, water exercisingChildcare area that is both supervised and away from adult area also directed towards children Play room for kidsClasses on cooking and how to shop for food PoolClothing Pool, pilates classes

Clothing storePrograms/classes to exercise; educating about health and nutrition foods in support of the class, healthy choices, spiritual support; jamba juice :) Trader Joe's (or organic options) career support!

Convenient store Restaurant Counseling services (esp. for couples/young families), exercise classes, parenting classes Shopping store, Khol's, Wal-MartDaycare Something creative for children/something not available to themDaycare center Spa total fitness centerDaycare, gym Stop & ShopDentist, play area, counselors for teens, medical doctor, GYN, pharmacy, exercise/gym, pool Stop & Shop, movie theater, gymEverything Stop & Shop, Macy'sEverything is up to par, everyone is professional Stop & Shop, supermarket, movie theaterEverything we need to maintain a healthy lifestyle Stop & Shop, supermarket, vegetable standExercise equipment SupermarketExercise for seniors, self-defense classes, nutrition Supermarket, cleanerExercise gym, swimming, track, weights, rooms for palates and yoga Supermarket, department storeExercise room Supermarket, fish market, exercise/fitness centerFitness equipment, ob/gyn screening, dietician, mental health counseling, fitness trainers Supermarket, gymFitness gym Supermarket, movie theater, schoolFood, bikes Supermarket, movie, bowlingFree exercise machines Supermarket, Wal-MartGood equipment Swimming pool, dance classes, gym, pleasant and friendly staff who have been where we are and know what we are

going through, not read it in booksGood exercise equipment Swimming pool, tennis facility, racquetball, indoor basketball courts, saunaGood service To better the community for kidsGym Treadmill, bikes, poolGym center for kids while waiting to be called and more for both kids while waiting long hours to be called and a cool place please

Treadmill, exercising bike, weights

Gym, arts & crafts Treadmill, weights, exercising machineGym, fitness center Vegetable, fruit standGym, laundromat Video storeGym, mental health clinic, tutoring, supermarket, parenting classes, childcare Volleyball, swimming, basketballGym, movie theater, supermarket Wal-MartGym, nutritionist Wal-Mart, Home Depot, gymHealth care for all residents ever without medical coverage Wal-Mart, SearsHealth food/bar What's a wellness center? I would like to see fitness classes as well as a health food shop Workout gym and a mental health centerI'm not sure, daycare Yoga classes, pilates classes

48


APPENDIX BSUMMARY OF RESPONSES

Likelihood --> Never

Seldom

Sometim

es

Ofte

n

Very

Invalid

Total

Frequency 2 15 45 46 55 130 293Valid Percent 1.2% 9.2% 27.6% 28.2% 33.7%













13.) How likely are you to use fitness classes?

14.) How likely are you to use exercise machines (i.e. Treadmills & resistance machines)?

15.) How likely are you to use ball courts?

16.) How likely are you to use a bike lending program?

17.) How likely are you to use a fitness trainer?

18.) How likely are you to use a weight loss program?

25.) How likely are you to use an education workshop on preventing and treating diabetes?

19.) How likely are you to use nutrition counseling?

20.) How likely are you to use cooking classes?

21.) How likely are you to use a fruit and vegetable garden?

22.) How likely are you to use a support group?

23.) How likely are you to use job and personal finance workshops?

24.) How likely are you to use an education workshop on preventing and treating obesity?

49

APPENDIX B

Appendix C

Wellness can be understood as a movement along a continuum from treating disease in the traditional (reactive) medical model, to preventive (proactive) care that focuses on education, growth, and self-actualization (Ardell, 1977; Miller, 2005). The concept of wellness used in this docu-ment and for the planning of the Wellness Center stems from the work of Dr. Bill Hettler, co-founder of the National Wellness Institute (NWI) (Miller, 2005). The NWI (2010) defines wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.”

Dr. Hettler developed an interdependent wellness model with six dimensions that help individuals achieve balanced and healthy living through adherence to each dimension. The dimensions include physical, spiritual, intellectual, social, emotional and occupational health. The Hunter Team adapted the Wellness Model and incorporated the environment as a seventh dimension to address how a safe, healthy and sustainable environment positively contributes to wellness. The Hunter Team incorporated these seven dimensions into the planning, programming and design of the Wellness Center.

APPENDIX CWELLNESS MODEL

When considering the programming and design of the Wellness Center, the Hunter Team investigated other centers to serve as case studies and inform the planning process. Three types of wellness centers were studied: medical, higher education and those that targeted specific segments of the population. Medical wellness centers are often affiliated with an existing health facility, while higher education wellness centers are part of college and university campuses.

Medical Wellness CentersGenerally, the purpose of medical wellness centers is to expand services offered by an affiliated medical facility. One example is the Peterson Family Wellness Center (affiliated with Myrtue Medical Center) currently under construction in Harlan, Iowa. When com-plete, the 44,329 square foot Peterson Family Wellness Center will “promote a collaborative approach to personal and community health” (Myrtue, 2010). Although the emphasis will be on wellness, as evident by the inclusion of a 3,331 square foot fitness area, the Peterson Family Wellness Center will also include conventional medical services (Myrtue, 2010).

University/College-Based Wellness CentersThe College of New Rochelle Wellness Center is on a suburban col-lege campus 16 miles north of Manhattan (CNR, 2010). The center is

a 55,000 square foot structure that incorporates holistic elements of wellness such as a six lane swimming pool, space for meditation and a rooftop garden (CNR, 2010a; Brenner, 2007).

Age-Specific Wellness CentersThe Mary and Gary West Senior Center in San Diego, CA is an example of a center that tailors its services to a specific population. The mission of the center is to provide health services for seniors liv-ing in poverty (Senior Community Centers, 2010). Wellness services provided include mental health assessments along with nursing and social service case management (Senior Community Centers, 2010a).

Other types of Wellness Services & CentersThe concept of a wellness center may also be used as tool for eco-nomic development. Plans for the Health + Wellness Center project in Rifle, Colorado describe the creation of a community and rec-reation center that would be a centerpiece of the area’s economic development strategy (Vandewalle & Associates, 2006). The center will house a mix of enterprises including innovative ventures such as a community kitchen (Vandewalle & Associates, 2006).

WELLNESS CENTER CASE STUDIES

50


APPENDIX CWELLNESS IN DESIGN

DIMENSIONS of WELLNESS

ATTRIBUTES PROGRAM DESIGN BENEFITS

EMOTIONAL Awareness and acceptance of feelings

Mental health consultationYoga instruction

Increases level of balance and mental capacity

ENVIRONMENTAL Awareness and interaction with the environment

Borrow-a-Bicycle programRooftop garden Sustainable design practices

Increases environmental awareness

INTELLECTUAL Mental stimulationCognitive abilities

Nutrition educationDiabetes managementBiogenetic Repository

Increases knowledge of healthy practices

OCCUPATIONAL Satisfaction and enrichment through work

Workforce development services through community kitchenRetail component

Increases productivity and career development potential

SOCIAL Engagement and connectedness with other individuals

Wellness classes/workshops Increases relationship skills and healthy communication

SPIRITUAL Self-fulfillment and meaning Meditation space Increases confidence and feelings of achievement

PHYSICAL Active movementsMedical self-care

Adult and kid fitnessPhysical Therapy

Increases energy expenditure

[55] Incorporating seven dimensions of wellness into program design, adapted from the National Wellness Institute (NWI, 2004)

[55]

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

n

51

Appendix D

APPENDIX DZONING ANALYSIS

Lot Coverage MaximumBUILDING FOOTPRINT Total Square Footage of the entire lot (180w X 300d)………………………54,000 square feet

Property Setback Requirement Notes 60% of Full Lot Sq Footage (Lot Covg Req, R4 1)………………………………32,400 square feetDepth (180ft) 1 front yard 15 ft Existing Building Footprint (from above)………………………………………… 9,465 square feet

Width (90ft) 2 side yrds 15 ft, 8 ft (90 23=67) Lot Coverage Max (32,400) minus Existing Footprint (9,465) 22,935 square feet

BUILDING FOOTPRINT PROPOSAL Floor Area Ratio CalculationsDepth 156 FT Community Facility FAR for R4 1 Zoning……………………………………………2.0 FAR

Width 67 FT Total Square Footage of the entire lot………………………………………………54,000 square feet

FOOTPRINT 10452 SQ FT Total Building Square Footage Potential (FAR X Full Lot Size)……………108,000 square feetTotal Sq Footage Used for Current Building………………………………………22,200 square feet

Available Sq Footage for Proposed Building………………………………………85,800 square feet

Proposed Building Square Footage……………………………………………… 28,926 square feet

GROUND FLOOR (three sections) Potential # of Floors of Proposed Building…………………………………………2.97 floors

retail depth 50 ft Max Allowed Building Height for R4 1 Zoning……………………………………35 feetretail width 40 ft

RETAIL SQ FT 2000 sq ft

entry depth 50 ft parking requirements (based on full lot/site)entry width 27 ft retail (proposed) 2,000 1 per 300 sq feet 6.67 spacesENTRY SQ FT 1350 sq ft wellness (proposed) 26,926 1 per 500 sq feet 53.85 spaces

health ctr (existing) 22,200 1 per 500 sq feet 44.4 spaceswelln depth 106 ft retail + wellness (sq ft) 28,926 104.92 spaces*welln width 67 ftWELLNESS SQ FT 7102 sq ft

parking capacity of site (based on current build out scenario)site 1 (original) 64x121 7,744 sq ft

SECOND FLOOR (same as footprint) site 2 (proposed) 116x121 +14,036 sq ftdepth 156 ft =21,780 sq ftwidth 67 ft2ND FLOOR SQ FT 10452 sq ft Method 1 : standard conversion is 300 sq ft per spot > 21,780/300= 72.6 spaces*

orMethod 2 : existing site plans shows room for 80 spaces across

THIRD FLOOR (set back) interior of lot, w/ 6 removed for pass through= 74 spacesdepth 146 ftwidth 57 ftless: rear balcony (12x25) 300 ft Method 1: 105 (req) 73 (avail) = 32 spaces short

3RD FLOOR SQ FT 8022 sq ft Method 2: 105 (req) 74 (avail) = 31 spaces short

* all parking space allocations with fractions rounded up

52


APPENDIX DPARKING REQUIREMENTS

Off-street parking requirements were determined by using a conversion factor that equates square footage of developed space into the num-ber of parking spaces required. In order to calculate these requirements, the Hunter Team determined that the Wellness Center will be com-prised of 26,926 square feet of community use and 2,000 square feet of retail use (for a gross building area of 28,926 square feet). Because the proposed Wellness Center and the existing Health Center will be adjacent to each other, it was decided that a joint parking lot for both facilities would yield the most efficient use of space. Based on Article II (Chapter 5) and Article III (Chapter 6) of the New York City Zoning Text, the fol-lowing conversions were used to determine the amount of required parking spaces for the entire site (NYCDCP, 2006).

[56] Parking Requirement CalculationsZoning Use Parking Conversion SpacesResidential (R4) Community Use (Health Center) 1 space for every 500 square feet 44.4 spacesResidential (R4) Community Use (Wellness Center) 1 space for every 500 square feet 53.85 spacesCommercial (C1-3) Retail (Food: 2000 square feet or greater) 1 space for every 300 square feet 6.67 spaces

Total number of spaces required 104.92 spaces

Based on the current build-out proposal for the new facility, there is approximately 21,780 square feet remaining on the property that can be devoted to parking. Using a standard conversion factor of 300 square feet per parking space, this would yield the equivalent of 72.6 parking spaces (University of Colorado, 2002). To confirm this, the Hunter Team conducted a visual survey of the current site plan and its existing park-ing configuration. This generated an estimate of 74 parking spaces.

Using these calculations, the Hunter Team concluded that the proposed site plan would require 105 parking spaces, approximately 32 parking spaces more than what the site physically allows. Under normal conditions, an underground parking garage would be included to make up for this shortfall, but because of the site’s proximity to the waterfront, this is not a viable alternative. As a result, the Hunter Team recommends that Addabbo apply for a variance.

53

Appendix E

APPENDIX ECOMMUNITY KITCHEN: LOWER EASTSIDE GIRLS CLUB

The Community Kitchen within the Wellness Center will be a hands-on teaching and demonstration area for instruction on healthy meal prepa-ration. When the kitchen is not being used as a classroom, it will also serve as an incubator for local chefs and small businesses. Not only will this foster a sense of entrepreneurship, but it will also provide career development opportunities within the community.

The Lower Eastside Girls Club (n.d.), “founded in 1996 to address the historic lack of services available to girls and young women on the Lower East Side,” operates a successful commercial kitchen, Sweet Things Bake Shop, which also functions as a classroom for its members. Located at 136 Avenue C between 8th and 9th Streets in New York, NY, Sweet Things Bake Shop serves as both a fully functioning bakery and a job train-ing facility (Lower Eastside Girls Club, n.d.). In addition to learning baking skills, the girls learn about “all aspects of small business, including advertising, management and entrepreneurial skills, [and] financial literacy” (Carmody Consulting Evaluation Services, 2008).

The Sweet Things Bake Shop is one of several entrepreneurial programs operated by the Lower Eastside Girls Club. These programs serve as a mechanism to teach valuable skills to community members and also generate revenue for the organization. In 2007, the combined revenue represented 8-10% of the organization’s operating budget, demonstrating the financial viability of the community kitchen model (Carmody Consulting Evaluation Services, 2008).

54


APPENDIX FHEALTHY PIZZERIA

One potential use for the Wellness Center retail space is a healthy pizzeria. Not only is there a lack of dining options within the immediate area surrounding the Health Center, but several survey respondents and focus group participants cited the need for better access to healthy food. Pizza is a food that both children and adults enjoy, and it can easily be prepared in a healthy manner. A healthy pizzeria would also create an opportunity to utilize fresh ingredients grown in the Wellness Center’s rooftop garden. Moreover, because pizza is a relatively simple food to make, a healthy pizzeria could reinforce the idea that healthy food can also be prepared at home. Using the retail space as a restaurant would also create jobs in the community.

In recent years, the concept of healthy pizzerias has grown. Pizza Fusion and Slice are presented here as case studies because of their empha-sis on healthy eating and their concern for the environment. Both companies have undergone rapid expansion, demonstrating the financial feasibility and profitability of their business models. Pizza Fusion’s first store was launched in 2006 in Florida, and since then has grown to 17 locations across seven states.

Pizza Fusion offers a menu of organic pizzas, salads, beer and wine and also uses hybrid cars for delivery service (Pizza Fusion, 2007). The company continually strives to offset 100% of their energy consumption through renewable wind energy certificates and LEED-certified build-ings.

Slice is a healthy pizza restaurant based in New York City. Since its opening in 2005, it has branched out into two locations (Slice, The Perfect Food, 2008). Slice uses fresh, all-natural and organic ingredients and has a special “Pay it forward with a slice” program that addresses the grow-ing problem of childhood obesity within New York City, where over a quarter of children are either overweight or obese. Slice allows New York City organizations and schools, who are frequent customers, to designate a less-fortunate school to receive a complimentary pizza party. Slice will also provide a free health and wellness seminar to the school (Slice, The Perfect Food, 2008).

55

Works Cited

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Miller, W. J. (2005). Wellness: The history and development of a concept. Spektrum Freizeit, 1, 84-102. Morland, K., Wing, S., Diez Roux, A., & Poole, C. (2002). Neighborhood characteristics associated with the location of food stores and food service places. American Journal of Preventive Medicine, 22(1), 23-29.

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New York City Department of Health and Mental Hygiene. (2006). Community health profiles: Take care Rockaways, Queens. Retrieved from http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-410.pdf Papas, M., Alberg, A., Ewing, R., Helzlsouer, K., Gary, T., & Klassen, A. (2007). The built environment and obesity. Epidemiology Review, 29, 129-143. Parker-Pope, T. (2007, December 5). A high price for healthy food. The New York Times. Retrieved from http://well.blogs.nytimes.com/2007/12/05/a-high-price-for-healthy-food/ Patient Protection and Affordable Care Act, Pub. L. 111-148, § 4002, 423 (2010).

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Queens Economic Development Corporation. (2007). Mission. Retrieved from http://www.queensny.org/index.php?menuoption=mission

Robert Wood Johnson Foundation. (2010). Disparities. Retrieved from http://www.rwjf.org/pr/topic.jsp?topicid=1180&p=os

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Senior Community Centers. (2010). Senior community centers transforming the aging experience. Retrieved from http://www.servingseniors.org/Default.aspx

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Slice, The Perfect Food. (2008). Yes. Slice, the perfect food. A magical world where pizza is good for you. Retrieved from: http://www.sliceper-fect.com Shi, L., & Singh, D. A. (2004). Delivering health care in America: A systems approach (5th ed.). Sudbury, MA: Jones and Bartlett.

SRC/Alteryx. (2009). Demographic detail summary report.

The New York Times. (2009, May 20). Answers about Rockaway, Queens. The New York Times. Retrieved from http://cityroom.blogs.nytimes.com/2009/05/20/answers-about-rockaway-queens/?scp=5-b&sq=Far+Rockaway&st=nyt

University of Colorado. (2002). University of Colorado environmental center blueprint for a green campus. Retrieved from http://ecenter.colorado.edu/greening_cu/2002/page3.html U.S. Census. (2000). SF-3. Profile of population and housing data: 2000 [Data File]. Retrieved from http://factfinder.census.gov

U.S. Census. (2007, June 13). Most of us still drive to work – Alone public transportation commuters concentrated in a handful of large cities. Retrieved from http://www.census.gov/Press-Release/www/releases/archives/american_community_survey_acs/010230.html

U.S. Department of Health & Human Services. (2010). The U.S. 2009 hhs poverty guidelines: One versions of the [U.S.] Federal poverty mea-sure. Retrieved from http://aspe.hhs.gov/poverty/09poverty.shtml

U.S. Environmental Protection Agency. (2010). Heat island effect; Green roofs. Retrieved from http://www.epa.gov/heatisld/mitigation/green-roofs.htm

U.S. Executive Office. (2010). Title IV: Prevention of chronic disease and improving public health. Retrieved from http://www.whitehouse.gov/health-care-meeting/proposal/titleiv Vandewalle & Associates. (2006). Rifle health + wellness: A new recreational center and icon of wellness and energy. Retrieved from http://www.rifleco.org/documents/Planning/Long%20Range/Rifle%20Rec%20Center1.pdf

Villagra,V., & Tamim, A. (2004). Effectiveness of a disease management program for patients with diabetes. Health Affairs, 23(4), 255-266.

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WORKS CITED

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Image Citations 60

Art Therapy Blog. (2007). [Inspirational Image for Third Floor, child and instructor working on art project]. Retrieved from arttherapy.files.wordpress.com/2007/09/092007-0253-1.jpg. [39].

Astor Center. (n.d.). [Inspirational Image for Ground Floor, community kitchen]. Retrieved from rentals.astorcenternyc.com/kitchen.ac?ref=navBar. [31].

Concordia University. (n.d.). [Inspirational Image for Second Floor, view of atrium from above]. Retrieved from magazine.concordia.ca/2009/fall/features/JM_lobby.jpg. [34].

Downhill Bikes. (n.d.). [Inspirational Image for Ground Floor, Bike borrowing]. Retrieved from http://www.downhillbikes.biz/resize/bikes3.jpg. [30].

Gertler Wente Architects LLP. (n.d.). [Image of the Joseph P. Addabbo Family Health Center in Arverne]. Retrieved from http://www.gwkarch.com/GWK_Flash_Launch.html. [7].

Gertler Wente Architects LLP. (2004). [Site plan of the Joseph P. Addabbo Family Health Center in Arverne, 3.22.04, used as base plan for layout of each floor]. [32], [37], [41] and [44].

Getty Images. (2010). [Image of obese woman, torso]. Retrieved from gettyimages.com. [9].

Google Maps. (2010). [Color satellite base map of Rockaway Peninusla]. Retrieved from maps.google.com. [11].

Joseph P. Addabbo Health Center. (2010). [Inspirational Image for Second Floor, child in consultation room]. Retrieved from www.addabbo.org. [36].

Open Accessible Space Information System (OASIS). (2010). [Color base map used to illustrate study area, and color satellite image of site]. Retrieved from http://oasisnyc.net. [15] and [26]

Land Elements. (n.d.). [Inspirational Image for Third Floor, outdoor area on rooftop with lounge chairs]. Retrieved from landelements.com/wp-content/uploads/Sky-Prairie-1.jpg. [40]

Los Angeles Times. (2010). [Image of obese man and boy]. Retrieved from http://latimesblogs.latimes.com/photos/uncatego-rized/2008/05/20/j09gcznc_obese.jpg. [8].

Nathan Kesinger Photography. (2009). [Salvadoran squatter’s home and garden, Rockaway bungalow]. Retrieved from http://2.bp.blogspot.com/_CQxI0Yhn97w/Sjh1jIGLP6I/AAAAAAAABbA/_vt4xoLjLLM/s1600-h/bungalow+pano.jpg. [14].

New York City Department of City Planning. (2010). [Zoning Map 30 used as a base map for illustrating zoning districts near project site]. Retrieved from http://www.nyc.gov/html/dcp/pdf/zone/map30c.pdf. [25].

IMAGE CITATIONS


My Brooklyn Year Blog. (n.d.). Inspirational Image for Rooftop, rooftop garden]. Retrieved from http://mybrooklynyear.files.wordpress.com/2009/08/annie.jpg. [43].

Sasaki. (2010). [Inspirational Image for First Floor, atrium and stairwell]. Retrieved from www.sasaki.com/what/portfolio.cgi?fid=455&region=4&page=2. [29].

Tampabay.com. (2010). [Inspirational Image for Second Floor, children’s fitness area]. Retrieved from http://www.tampabay.com/multimedia/archive/00107/passunray021310a_107599c.jpg. [35].

University of California Riverside. (n.d.) [Inspirational Image for Third Floor, student in academic research area]. Retrieved from arthscience.ucr.edu/images/Prism%201.jpg. [38].

University of Connecticut. (n.d.). [Inspirational Image for Second Floor, Fitness Area]. Retrieved from http://www.recreation.uconn.edu/im-ages/vtour/fitnesswest.jpg. [33].

Shorpy. (1910). [Bungalow Colony, Rockaway 417-12]. Retrieved from http://www.shorpy.com/node/1176?size=_original. [13].

All other images photographed by the Hunter Team. [1], [2], [3], [4], [5], [6], [10], [12], [16], [17], [18], [19], [20], [21], [22], [23], [24], [27], [28], [42], [52], [52], [54] and [56].

IMAGE CITATIONS

61

[56] Back Cover Image: A shaded street in the Study Area

planning for prevention: a wellness center

Documents

addabbo family health

qualified health center

preventiona wellness

executive director

community board

community outreach efforts

director of external

rockaway community