The Family Health Center Inc. (FHC) is a non-profit healthcare provider that was established in 1976 with seven locations throughout the Louisville, Ky., metro area. It now serves more than 37,000 patients annually, without regard to the ability to pay.

In 2012, FHC’s East Broadway Center location had outgrown its existing facility, and with the impending patient increase anticipated from Kentucky Gov. Steve Beshear’s decision to expand Medicaid, FHC leadership determined it was time to improve and expand services. Successful in obtaining a $5 million Affordable Care Act grant through the U.S. Health Services and Resource Administration, FHC entered into a long-term agreement to relocate to the nearby Standard Sanitary Building.

Built in 1925, the Standard Sanitary Building is a historic five-story masonry structure that was located just one block west of the existing FHC. The building originally housed the offices and showroom for Standard Sanitary Co., which was founded in Louisville in the late 1890s and became American Standard in 1929. It also had more than four times the square footage of the FHC, allowing for both the proposed expansion and future growth, as well.   

Following a design team selection process, FHC chose JRA Architects and CMTA Engineers (both of Louisville) to implement the renovation of the landmark building. Soon after, the design team began programming the functional requirements as well as assessing the infrastructure needs of the old building, with ground breaking in December 2013.

Getting started
One positive aspect of the Standard Sanitary Building’s existing conditions was that the previous tenant had used it as a warehouse: There were few walls and no ceilings to obstruct visual reconnaissance and no occupants to protect during construction. However, there were plenty of challenges to come.

While an iconic structure, the building wasn’t on the National Register of Historic Places or within a historic district, so there were no restrictions as to maintaining the original exterior appearance or other preservation guidelines. The design team was sensitive to the aesthetic nature of the building, though, and sought to retain the character as much as possible.

An initial observation of the building also revealed some initial concerns, including two different levels on the first floor. The front section was about 5 feet lower than the rear section in answer to the threat of flooding during heavy rains due to a nearby creek. Although flooding was a rare occurrence, the risk of potentially several feet of floodwaters had to be addressed properly in order to obtain a building permit.

Following code review with FEMA and the local regulatory agency, it was required that the entire first floor elevation be raised by 12 inches—or 6 feet above the front section. Existing perimeter vestibules therefore needed small interior ramps to negotiate the offset, so they were enlarged to accommodate 12-foot-long ADA ramps. And, instead of 12 inches of solid concrete being poured, polystyrene foam was used and then concrete topping was placed over it. This composition provided for a lightweight surface that wouldn’t add more loads on the existing structural slab below.

Vertical circulation also needed significant improvement. There were two existing elevators: one passenger and one freight. Another passenger elevator was needed, but the location was undecided, influencing the process of determining a main entry to the facility. Initially, the plan was to have the primary access at the rear, where a surface parking lot was located. However, there was a vacant tract of land just to the west that could serve as ADA parking for patients and a drop-off zone.

With a bus stop also out front, where many patients will arrive for care, the decision was made to position the main entry at the northwest building corner, with a new passenger elevator strategically located there to facilitate the 6-foot transition to the first floor from the front entry.

The new shaft was cut into the existing concrete structure, which was reframed with steel, and the below-grade elevator pit and foundations were excavated within the existing building. A side benefit to the original 5-foot difference between the front and rear of the first level was that it provided enough slab-to-structure height clearance to allow the construction equipment inside for this extensive work.  

More challenges ahead
Midway through the project design, the structural engineer made another startling discovery: The concrete-framed structure didn’t meet current seismic code requirements. To strengthen the structure laterally, a new 12-inch-wide concrete shear wall, spanning 23 feet and extending up five floors, was inserted into the existing construction. A foundation footing first had to be built, then a phased process of cutting/re-supporting each of the existing five concrete floors was carried out, as the shear wall was framed and poured.

All new mechanical, electrical, fire protection, and plumbing infrastructure systems had to be installed, as well. One other ramification of raising the first floor was that, subsequently, the floor-to-joist height had been lessened to a point where the ductwork had to be carefully coordinated to attain an 8-foot ceiling height in all spaces. BIM and other drafting software proved beneficial for this task. 

Another challenge that arose during construction was a hard, wind-blown rain storm that soaked the building’s existing west masonry wall. During a walk-through the following day, team members found large pools of standing water on the interior floors. Metal studs had already been placed on the exterior walls, but fortunately no insulation had been installed yet. After various options for how to resolve the issue were considered, an exterior-finish insulating system was installed over the porous brick surface on the west wall. This was a cost-effective solution that could be installed in a timely manner to maintain the project schedule.

Another unforeseen condition was the discovery that there were several large openings in the upper concrete slab floors. These had been previously infilled with drywall and metal joist framing which hid the issue from the visual survey. These openings were reformed with structural steel framing and then infilled with concrete slab, with ceilings finished to conceal it well.

Renovation projects are notorious for hidden infrastructure problems. These issues—exterior water penetration and concealed floor openings—served as classic examples of how even the best facility assessment couldn’t identify such unforeseen conditions.    

When all’s said and done
Additional features of the renovation included use of evidence-based methodologies. Staff visited similar clinics, which determined how the exam room components were to be configured: sink location
s, door swings, and table orientation. The visits also validated the reasoning that a ration of three exam rooms to one physician was preferred. One exam room could be used for an exam while another was being cleaned after an exam, with the third allowing another patient to be prepped for the next exam. This expedited patient flow as well as productivity of the staff.

Walls were specifically arranged to showcase numerous photos of the surrounding inner-city neighborhood that the center serves, while wood tones were incorporated through the flooring, lobby ceiling, doors, and cabinetwork to lessen the clinical nature of the center. The functional spaces were Lean-driven to minimize staff footsteps while maximizing patient care. For example, there are several exam room “pods” and a staff station centrally placed to reduce travel distances. Utility and storage rooms were also strategically placed to facilitate ease of access.

By relocating within one city block of the existing center, FHC was able to lessen inconveniences for patients. And since this historic building is such a prominent landmark in the East Broadway district, it’s also easy to find. While the renovation posed several significant challenges, the end result is a wonderful example of adaptive reuse. It functionally and aesthetically blends a strong sense of neighborhood identity with modern clinical healthcare.


Steve Wiser, AIA, CAH, KSHE, is director of healthcare design at JRA Architects in Louisville, Ky. He can be reached at