Attachment H - PJDQ for HHCC Staff Quarters.pdf

HOPI HEALTH CARE CENTER (HHCC)

REPLACEMENT QUARTERS PROJECT

PROGRAM JUSTIFICATION DOCUMENT for

STAFF QUARTERS (PJDQ)

INDIAN HEALTH SERVICE

Polacca, Arizona

(PH23KC03Q3)

September 6, 2023

PHOENIX AREA INDIAN HEALTH SERVICE

INDIAN HEALTH SERVICE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Page Intentionally Blank

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PROGRAM JUSTIFICATION DOCUMENT

for STAFF QUARTERS (PJDQ)

HOPI HEALTH CARE CENTER (HHCC)

REPLACEMENT QUARTERS

INDIAN HEALTH SERVICE

Polacca, Arizona

(PH23KC03Q3)

September 6, 2023

PHOENIX AREA INDIAN HEALTH SERVICE

INDIAN HEALTH SERVICE

PUBLIC HEALTH SERVICE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

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PROGRAM JUSTIFICATION DOCUMENT for STAFF QUARTERS Hopi Health Care Center – Replacement Quarters

Polacca, Arizona

RECOMMEND APPROVAL:

Charles Ty Reidhead, M.D., M.P.H. Date Area Director Phoenix Area Indian Health Service Indian Health Service

RECOMMEND APPROVAL:

Steven Raynor, P.E. Date Director Division of Facilities Planning and Construction Office of Environmental Health and Engineering Indian Health Service

APPROVAL:

James Ludington, P.E. Date Director Office of Environmental Health and Engineering Indian Health Service

Michael D. Weahkee -S

Digitally signed by Michael D.

Weahkee -S Date: 2023.04.06 17:10:57 -07'00'

Steven E. Raynor -S Digitally signed by Steven E.

Raynor -S Date: 2023.05.22 10:01:41 -04'00'

James Ludington -S Digitally signed by James Ludington -S Date: 2023.09.06 15:16:21 -04'00'

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Polacca, Arizona

TABLE OF CONTENTS

SECTION PAGE

List of Abbreviations

I. INTRODUCTION

II. GENERAL

III. DESCRIPTION of SERVICE UNIT AND SERVICE AREA

A. Location B. Facility Description C. Access D. Demographics E. Topography and Climate F. Housing and Public Facilities G. Utilities H. Education I. Economy J. Social and Political Profile K. Available Health Care Services

IV. EVALUATION OF STAFF QUARTERS NEEDS

A. Overview B. Staffing Analysis C. Existing Government Quarters D. Local Private Sector Housing Market E. Transient Quarters F. Determination of New Government Quarters Required G. Housing Pattern

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TABLE OF CONTENTS

SECTION PAGE

V. QUARTERS SUMMARY DATA

A. Proposed Project Site B. Proposed Number of Units and Space C. The Net Area Minimum and Maximum D. The Net Area E. Special Quarters Types & Spaces

VI. BATHROOMS

VII. RENTAL RATES

VIII. MAINTENANCE STORAGE

IX. RECREATIONAL IMPROVEMENTS

X. SUSTAINABILITY

XI. PROJECT SCHEDULE

XII. PROJECT BUDGET ESTIMATE

XIII. QUALITY CONTROL

TABS

A. AREA, SERVICE UNIT, and SITE MAPS

B. STAFFING ROSTER and HOUSING PATTERN

C. HOUSING VERIFICATION SURVEY REPORT (HVSR)

D. PROJECT BUDGET ESTIMATE

E. POLACCA and KEAMS CANYON CAMPUSES – MASTER PLAN SUMMARY

REPORT

F. 2017 PJDQ (Amendment #1 to the PJD – Hopi Health Care Center)

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Polacca, Arizona

LIST OF ABBREVIATIONS

ADA Americans with Disabilities Act AI/AN American Indian & Alaskan Native BIA Bureau of Indian Affairs BR Bedroom CEO Chief Executive Officer CRIT Colorado River Indian Tribes DES Division of Engineering Services

(Dallas or Seattle) ft Feet ft2 Square Feet FTE Full Time Employee FY fiscal year GQ Government quarters GSA General Services Administration GSF Gross Square Feet ha Hectares HC Handicapped Accessibility HFAC Health Facilities Advisory Committee HFCPS Health Facilities Construction Priority

HFPM

Health Facilities Planning Manual HSP Health Systems Planning HVAC Heating, ventilation, and air conditioning HVSR Housing Verification Survey Report IHS Indian Health Service JCAHO Joint Commission on the Accreditation of Healthcare Organizations

LP Local private sector housing LPG Liquefied petroleum gas mi Miles mi2 Square Miles NFPA National Fire Protection

Association NP non-local private sector housing OMB Office of Management and Budget PAIHS Phoenix Area Indian Health

Service PIH Parker Indian Hospital PHS Public Health Service PJD Program Justification Document PJDQ Program Justification Document for

Staff Quarters POR Program of Requirements PORQ Program of Requirements for Staff

Quarters REM Remote Location, quarters type RRM IHS Resource Requirements

Methodology SSER Site Selection and Evaluation

Report SF Single Family SU Service Unit TQ Transient Quarters UFAS Uniform Federal Accessibility

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INDIAN HEALTH SERVICE

I. INTRODUCTION

This Program Justification Document for Staff Quarters (PJDQ) presents data and reasoning to justify the following, at the Indian Health Service (IHS) Hopi Health Care Center located in Polacca, AZ (HHCC), and at the HHCC Staff Quarters site in Keams Canyon, AZ (KC):

Existing Quarters Units (59 Total at KC) Continued use of twenty-four (24) Existing Government (Govt) Quarters

(Qtrs) Units, comprised of:

Nineteen (19) existing Govt Qtrs, Permanent, Multi-Family units

(GQ-P-MF) (existing apartment building) Five (5) existing Govt Qtrs, Modular, Single Family units (GQ-M)

Demolition of thirty-five (35) Existing Permanent Quarters Units, consisting of:

Twenty-five (25) existing Govt Qtrs, Permanent, Single Family units

(GQ-P)

Ten (10) existing Govt Qtrs, Permanent, Transient Quarters units

(GQ-P-TQ)

Proposed New Units (93 Total), to be located at either staff quarters site (HHCC or KC):

Thirty-seven (37) Govt Qtrs, Permanent, Single Family units (GQ-P) Forty (40) Govt Qtrs, Permanent, Multi-Family units (GQ-P-MF) Sixteen (16) Govt, Qtrs, Permanent, Transient Quarters units (GQ-P-TQ)

Proposed Grand Total of HHCC Quarters Units 24 Existing Qtrs Units, for Continued Use (incl. 1 HC/accessible unit)

+ 93 New Qtrs Units, Additional Required (incl. 9 HC/accessible units)

117 Total Required Units (incl. 10 HC/accessible units)

This proposal requesting 93 new staff quarters, based on a total of 275 current staff, was developed utilizing planning processes as per the IHS OEHE Technical Handbook, Volume II, Part 13. It reflects the analysis of staff quarters planning from the 2017 OEHE Phoenix Area/HHCC master plan document (TAB E), and a previously approved PJDQ in January 1997, which was approved for 73 new quarters units, based on 239 Total Staff at that time (TAB F). This January 1997 PJDQ was not utilized for quarters development, and thus is hereby superseded by this PJDQ.

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In accordance with the Uniform Federal Accessibility Standards (UFAS), five percent, or at least one unit, whichever is greater, of any new construction is to be designed and constructed so the units can be adapted for use by handicapped occupants.

Title 5, U.S. Code 5911, authorizes Government agencies to provide quarters units and related facilities for use by their employees and authorized transients. Current IHS policy requires, as projects are processed in the Quarters Construction Priority System, all existing house trailers to be replaced. The IHS will provide new staff quarters units 0.2 miles south of the existing HHCC, in Polacca, AZ, and at the existing HHCC Staff Quarters neighborhood in Keams Canyon, AZ, 14 miles east of the HHCC.

This project will ensure the availability of safe, suitable housing for personnel essential to the continuity of the health care delivery system.

This PJDQ authorizes:

The existing Real Property Inventory (RPI) for staff quarters of 51,866 GSF (Gross Square Feet) to be decreased by 33,848 GSF from the demolition of:

Twenty-five (25) existing Govt Qtrs, Permanent, Single Family units (GQ- P)

Ten (10) existing Govt Qtrs, Permanent, Transient Quarters units (GQ-P-

TQ)

Resulting in an RPI of 18,018 GSF (after demolition of said units) Proposed new staff quarters units will then increase the RPI by 106,947 GSF

(“Planned” Total Gross Area), consisting of:

Thirty-seven (37) Govt Qtrs, Permanent, Single Family units (GQ-P) Forty (40) Govt Qtrs, Permanent, Multi-Family units (GQ-P-MF) Sixteen (16) Govt, Qtrs, Permanent, Transient Quarters units (GQ-P-TQ)

This results in a change from 51,866 GSF of Existing Quarters RPI to 124,965 GSF (Existing RPI + “Planned” Total Gross Area of new/additional staff quarters) for staff housing at this health care facility (refer to “Proposed HHCC Staff Quarters Summary” table below).

No additional acreage is sought for this project. Land area for the future HHCC Staff Quarters will be accommodated on two existing HHCC sites, which combined are an estimated 97 total acres (Refer to TAB A for maps and diagrams), consisting of:

18 acres out of a total of 19.2573 total acres at the existing Keams Canyon Staff Quarters Site

79 Acres out of a total of 118.74 total acres at the existing Polacca HHCC site

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PROPOSED HHCC STAFF QUARTERS SUMMARY

*as per Real Property Inventory (RPI) area

Qty. Unit#'s Hsg Type

Bedrooms

Baths

Year Built

Bldg Age

(Years)

Area (Square Feet)

EXISTING Govt Qtrs ‐ Permanent Units (GQ‐P)

67 ‐ 75 & 79 ‐ 81

GQ‐P 2 1

61 ‐ 63 11,520 GSF

76 ‐ 78 & 82 ‐ 84 & 86 ‐ 91

GQ‐P 3

51 ‐ 61 14,128 GSF

1 85 GQ‐P 4 2 1961 61 1,600 GSF

EXISTING Govt Qtrs ‐ Permanent Transient Quarters (GQ‐P‐TQ)

92‐A & 92‐B

95‐1 thru 95‐4

100‐1 thru 100‐

GQ‐P‐TQ 1 1

6,600 GSF

EXISTING Govt Qtrs ‐ Permanent Multi‐Family Structure (GQ‐P‐MF)

103, 105, 107, 109, 111, 113, 115, 117 GQ‐P‐MF Studio 1 2019 3 4,816 GSF

104, 106, 108, 110, 112, 114, 116, 118, 119

GQ‐P‐MF 1 1 2019 3 6,834 GSF

2 101 & 102 GQ‐P‐MF 2 1 2019 3 2,168 GSF

EXISTING Govt Qtrs ‐ Modular Units (GQ‐M)

5 174 thru 178 GQ‐M 2 1 2018 4 4,200 GSF

59 = TOTAL Qty. of EXISTING STAFF QUARTERS UNITS

TOTAL EXISTING RPI for STAFF QUARTERS = 51,866 GSF

‐ TOTAL EXISTING STAFF QUARTERS (RPI) to be DEMOLISHED ‐33,848 GSF

• ALL EXISTING (GQ‐P) UNITS ‐27,248

• ALL EXISTING (GQ‐P‐TQ) UNITS ‐6,600

EXISTING RPI for QUARTERS after Demolition = 18,018 GSF

+ NEW: "Planned" Total Gross Area (PJDQ) 106,947 GSF

37 Single Family Units (GQ‐P) 54,945

40 Multi‐Family Units (GQ‐P‐MF) 39,650

16 Transient Quarters Units (GQ‐P‐TQ) 12,352

93 = TOTAL Qty. NEW STAFF QUARTERS

Proposed Total Staff Quarters Area at HHCC (Existing RPI + "Planned" Total Gross Area)

124,965 GSF

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II. GENERAL

The IHS is the component of the Department of Health and Human Services responsible for the administration of the principal Federal health care programs for American Indian and Alaskan Native (AI/AN) people. The IHS provides a unique health delivery system which is comprehensive for approximately one million AI/AN people, living on or near Federal Indian reservations or in traditional Indian country, such as in the states of Oklahoma and Alaska.

The organization and delivery of health care by the IHS has its basis in treaties and laws enacted by the Congress of the United States of America and judicial rulings. The Snyder Act of 1921 is the authorizing authority for the IHS and links the IHS services to congressional appropriations which provide for the use of “…such monies as the Congress may from time to time appropriate, for the benefit, care and assistance of Indians…” The Congress has authorized services primarily for members of Federally recognized tribes who live on or near reservations, or in traditional Indian country.

The goal of the IHS is to elevate the health of AI/AN people to the highest possible level. Its mission is threefold: (1) to provide and/or assure the availability of high quality comprehensive and accessible health care services; (2) to provide increasing opportunities for Indians to manage and operate their own health programs; and (3) to serve as an advocate for Indian people.

III. DESCRIPTION OF SERVICE UNIT AND SERVICE AREA

A. Location: This planning project for staff quarters will serve the HHCC, which is located on and serves the Hopi Reservation. The Hopi Reservation is located in the northeastern part of Arizona, spanning Navajo and Coconino counties, and is served by the IHS Phoenix Area as part of the Hopi Service Unit (aka the Keams Canyon Service Unit). Under the control of t he IHS Hopi Service Unit, the HHCC is located in the community of Polacca, AZ, which is located 253 miles northeast o f the headquarters office of the Phoenix Area IHS in Phoenix, AZ. The Hopi Service Unit covers approximately 2,599 square miles and is comprised of the Hopi Reservation located in the northeastern part of Arizona, and the Kaibab Band of Paiute Indians Reservation located in northern Arizona along the Arizona-Utah state border. These two reservations are separated by approximately 200 road miles. The Hopi Service Unit is subdivided into two (2) Service Areas: the Hopi Hospital Service Area and the Kaibab Service Area. The Hopi Hospital Service Area is located in Navajo County (AZ), and the Kaibab Service Area is located in Mohave County (AZ), Coconino County (AZ) and Kane County (UT), and includes the communities listed in the table below. Refer to Tab A for maps showing the location of the reservation and service unit and service area.

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HOPI SERVICE UNIT

(FY 2019 Phx Area Active Users and Census Projections Report)

SERVICE

AREAS

COUNTIES COMMUNITIES

Kaibab

Mohave County, AZ Kaibab

Moccasin

Kane County, UT (part) Kanab

Coconino County, AZ Fredonia

Hopi Hospital

Navajo County, AZ

Bacabi Shipaulovi

Blue Bird Cn Shungopovi

Hotevilla Sichomovi

Keams Canyon Skunk Springs

Kykotsmovi Snowbird

Leupp Spider Mound

Mishongnovi Telehogan

Oraibi, Old Tewa

Polacca Toreva

Second Mesa Walpi

B. Facility Description: The existing 96,840 Gross Square Feet HHCC facility was built in 1999, and is located in Polacca, AZ. It was constructed of a concrete spread footing and pre-cast concrete structural system. The roof membrane was applied on top of pre-cast double-tees, over sloped rigid insulation. The interior walls are composed of metal stud framing and gypsum wallboard. There is a 2-hour separation wall between the Outpatient and Inpatient portions of the facility. The Emergency department is considered part of the inpatient portion of the facility. The entire facility, with the exception of the crawl space, is fully sprinklered. Within the next five years, this facility is expected to undergo renovations and expansion of the Emergency, Primary Care and other various departments.

The existing fifty-nine (59) staff quarters serving this facility are located 14 miles east of the HHCC at the IHS Staff Housing neighborhood, located in Keams Canyon, AZ.

C. Access: The Hopi Health Care Center and Kaibab-Paiute Health Station are designated as a Health Professional Shortage Area (HPSA) by the Health Resources and Services Administration (HRSA) for Primary Care, Mental Health, and Dental Health. Additionally, the Arizona Department of Health Primary Care Area Program designated the Hopi Tribe and Colorado City (which includes the Kaibab-Paiute Indian Reservation) as Arizona Medically Underserved Areas (AzMUA), identifying the region as having inadequate access to health care.1 1Arizona Department of Health Services, March 2020 Arizona Medically Underserved Areas.

https://azdhs.gov/documents/prevention/health-systems-development/data-reports-maps/reports/azmuaannualrpt.pdf

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The HHCC is in a remote, rural area of Navajo County. During winter months, severe road conditions often exist, and closures may occur between the HHCC and other alternative health care facilities. While emergency air transportation is available at the HHCC for patients, it is not an option for those seeking non-emergency, acute, specialty, ancillary and diagnostic care.

Two of the main roadways serving the Hopi Reservation and HHCC consist of:

Arizona State Route 264 (a two lane paved road that extends east-west and bisects the Reservation), and Arizona State Route 87 (a two lane paved road that extends from AZ Route 264, near Second Mesa, southward connecting to Interstate 40 in Winslow, AZ). Most of the communities are located along Route 264, while others are off the main roadway accessed via dirt roads. Access to the HHCC can be difficult for most of the population due to limited public transportation. In the winter months and late summer monsoon season, dirt road conditions are poor due to rain and snow.

D. Demographics: Approximately 14,390 Hopi Tribal members live on and off the Hopi Reservation. 6,946 Enrolled Hopi Tribal members live on the Hopi Reservation. Growth rates from 2000 to 2010 indicate a moderate growth rate of 3.4%. The IHS Hopi Service Unit serves an estimated fiscal year (FY) 2021 population of 6,371 Active Users (Phoenix Area FY 2021 Active Users and Census Projections Report). The Hopi Reservation is comprised of 11-14 Villages near or on First, Second or Third Mesa, including: Bacavi, Hotevilla, Kykotsmovi, Mishungnovi, Moenkopi (Upper and Lower), Oraibi, Shungopavi, Sichomovi, Sipaulovi, Tewa, Walpi, Spider Mound, and Keams Canyon.

The major cities and towns within driving distance of the Hopi Reservation are:

Flagstaff, AZ: Approximately 107 miles southwest from the central Hopi Reservation, population of 76,831 (2020 census)

Winslow, AZ: Approximately 68 miles south from the central Hopi Reservation, population of 9,005 (2020 census)

Tuba City, AZ: Approximately 64 miles west from the central Hopi Reservation, population of 8,072 (2020 census), located on the Navajo Nation

E. Topography and Climate: The Hopi Reservation terrain consists of sandstone and shale mesas that comprise the southern edge of the Black Mesa region, which is approximately 60 miles in diameter. These sandstone mesas and cliff edges are the distinctive features of this landscape, with Hopi pueblos (villages) scattered on the mesas and in the low lying areas below the mesas. The region includes sparse vegetation consisting of cottonwood trees, yucca, sagebrush, greasewood, pinyon pine trees, and juniper trees. The Hopi Land Base consists of 1,862,731 acres, comprised of: Hopi Main Reservation (1,625,686 acres), Moenkopi District Reservation (61,604 acres), and Hopi Three Canyon Ranch Lands (175,441 acres).

Main Reservation Climate: Annual precipitation is almost equally divided between summer monsoons and winter snow storms. The freeze-free period is between 130-180 days. Annual precipitation is from 5 inches in the southern lower elevations to 15 inches in the higher northern Pinyon-Juniper woodland areas atop Black Mesa plateau (The Hopi Tribe, The Official Website, Dept. of Natural Resources).

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F. Housing and Public Facilities: The Tribe (Hopi Tribe Economic Development Corporation, HTEDC) owns and operates a 74 unit apartment complex, which provides housing to Tribal members, Hopi business professionals, and some HHCC staff. However, this housing development falls well short of meeting the housing needs of the Tribe, and there is no documented agreement for Walpi housing to be designated for HHCC staff. The Hopi Tribe’s lack of affordable housing has persisted for decades and continues to be problematic as its population has grown. As per the 2021 Hopi Tribe Comprehensive Economic Development Strategy document, “A BIA Consolidation Report of Tribal Inventories of Housing needs identifies approximately 800 families in need of housing assistance with an additional 300 families needing rehabilitative assistance.”

Though the Tribe has set goals to increase the quantity of affordable housing on the Reservation and is continuing in its efforts, the reality is that housing options are limited or non-existent for Tribal members and non-Tribal members residing/employed on the Hopi Reservation. TAB C of this PJDQ document typically includes a Housing Verification Survey Report (HVSR). However, due to the non-existence of a Local Private Sector housing within the 46 mile vicinity of the HHCC, an HVSR is not included in this PJDQ. An HVSR published in June 1992 (see image below), which determined the same result (no available Local housing options for IHS staff), further explains how long the Hopi Tribe has been without adequate quantities of affordable housing.

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Hopi Tribal members unable to secure housing on the reservation cite a variety of reasons including: a lack of space to build residences in crowded villages, not being able to secure an uncontested land for a home-site, and not being able to secure funding to build or purchase a home. While this factor affects Tribal members, it adds a heightened strain on recruitment and retention of Hopi and Non-Hopi staff needed at other places of employment providing public services, such as Hopi Tribal offices, State and Federally operated schools, and at the IHS HHCC. This is one of, and commonly the main deterrent affecting HHCC’s inability to fill staff vacancies.

Amenities available to the community include:

Police Station Service Stations/Convenience Stores: Fueling stations in Keams

Canyon, Polacca, Kykotsmovi, and Hotevilla Restaurants: Hopi Cultural Center Hopi Department of Transportation: Hopi SENOM Transit System Future Community Developments, include:

► Drinking water infrastructure improvements ► Tourism Development ► Tawa’ovi Community Development Project: Sustainable community northeast of the main reservation ► Hopi Tribal Housing Authority: Rehabilitation and new construction of homes on the reservation ► Hopi Cultural Center: Renovation and expansion ► Hopi Industrial Park: Full development ► Elderly Care Center ► Solar Energy Development

G. Utilities: The following are utilities serving the Hopi Reservation and the respective two staff quarters sites:

Keams Canyon Staff Quarters Site:

Water Service: Bureau of Indian Affairs (BIA) Sewer: Bureau of Indian Affairs (BIA) Electric Service: Arizona Public Service (APS) Telecommunications: Hopi Telecommunications Solid Waste Management: Navajo Sanitation Propane: AmeriGas Satellite TV: Expedition Communications

Polacca Staff Quarters Site (adjacent to the HHCC facility):

Water Service: First Mesa Consolidated Villages Sewer: First Mesa Consolidated Villages Electric Service: Arizona Public Service (APS) Telecommunications: Hopi Telecommunications Solid Waste Management: Navajo Sanitation Propane: AmeriGas Satellite TV: Expedition Communications

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H. Education: The Hopi reservation educational system is served by Head Start, Kindergarten thru 12th grade schools funded by the State of Arizona, Grant Schools, and the Bureau of Indian Education (BIE), and Parochial, including:

Jeddito Public School (Arizona Public School) Keams Canyon (Grant School) Hopi Jr. – Sr. High School (Grant School) Hopi Mission (Parochial School) Hopi Day School (Grant School) First Mesa Day School (Grant School) Second Mesa Day School (Grant School) Hotevilla-Bacavi Community School (Grant School) Moencopi Day School (Grant School)

Statistics of the Hopi Tribe’s educational level as per 2021 Arizona Department of Health Services, Statistical Profile:

EDUCATIONAL LEVEL Hopi Tribe Navajo

County State (AZ)

Less than 9th Grade Education:

9% 4% 5%

9th – 12th, No Diploma:

4.2% 7.7% 7%

High School Graduate 39% 25.1% 23.8% Some College 24.9% 26.2% 24.9% College or Professional Degree

22.6% 36.1% 39.1%

I. Economy: The major employment sectors on the Reservation from 2000 –

2017, according to the Strategic Land Use Development Plan were:

Manufacturing: 40% Educational, Health and Social Services: 33% Public Administration (incl. Hopi Govt. Services, BIA and IHS): 26% Additional sectors include:

Wholesale and Trade Transportation and Utilities Construction and Agriculture Finance, Insurance and Real Estate

A majority of the jobs on the Reservation are from the public administration sector (Tribal Government, Indian Health Service, and social services). Overall, The Tribe estimates an average unemployment rate of 20% based on studies of the Hopi Villages, but since many Tribal members do not register as being unemployed, the unemployment rate is considered to be much higher. Poverty rates on the Reservation (31%) are nearly twice as high as the State (18%)

Economically, for approximately 40 years the Tribe has heavily relied on its coal leases with Peabody Energy’s mining operations in Black Mesa, AZ, to produce the majority its governmental revenue. With the closure of the Navajo Generating Station in 2019, the Tribe is now faced with an even greater

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On-Reservation Hopi Economy:

Hopi Cultural Center (hotel, restaurant, visitor Center), located on

Second Mesa: Employs approximately 30 staff, and serves the Tourism and Travel industry on the Hopi Reservation

Moenkopi Legacy Inn (hotel), located in Tuba City, AZ Walpi Housing, located adjacent to the HHCC facility: 75 Tribally-owned homes for rent.

Off-Reservation Hopi Economy:

Hopi Three Canyon Ranch, located in Winslow, AZ: Cattle ranching business which operates the Drye, Hart, Clear Creek, Aja, and 26 Bar Ranches

Flagstaff Commercial Properties, located in Flagstaff, AZ:

Continental Plaza Shopping Center, Kachina Square Shopping Center and Heritage Square Shopping Center real estate property investments

Muyawki Inn (hotel, conference hotel), located in Oak Creek/Sedona, Arizona: Hotel with 48 rooms and 1 conference center. 17 staff are employed

Hopi Industrial Park, located on west side of Winslow, AZ: 220-acre mixed-use residential and industrial property

J. Social and Political Profile: Since time immemorial the Hopi have lived in

Hopitutskwa, their homeland located in northern Arizona. The Hopi people are a matrilineal society organized by clan membership. They are recognized as one of the oldest living cultures in documented history, with a strong sense of culture, language, agriculture, art and their indigenous spirituality, which is sustained among their pueblo-style villages atop and around First, Second and Third Mesas.

The Hopi Tribe is a sovereign nation within the United States, who established the Hopi Tribal Council on December 19, 1936, with the adoption of the Hopi Constitution and By-Laws. As such, the Council possesses the authority to represent the Hopi Tribe in all matters for the welfare of the Tribe, and to negotiate with federal, state and local governments, and with other Tribal Councils or Governments of other Tribes. The Council consists of 22 representatives from the Hopi Villages. The Hopi Tribal Government is a unicameral government where all powers are vested in the Tribal Council.

While there is and Executive Branch (Tribal Chairman and Vice Chairman) and Judicial Branch, their powers are limited under the Hopi Constitution.

K. Available Health Care Services: There are no other IHS or non-IHS health care facilities within the IHS accessibility radius for either inpatient or outpatient services. The recently constructed Dilkon Medical Center, approximately 37 miles from the HHCC, has not opened for business, but is expected to open for business in 2023. The nearest IHS alternate source of ambulatory care service is the Pinon Health Center, which is located approximately 36 miles from the HHCC, and requires traveling approximately 13-20 miles of dirt road. Access to

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The nearest non-IHS health care facilities are located in Flagstaff, AZ. Flagstaff is approximately 108 miles from the HHCC, a 1-hour and 40-minute drive time.

The Winslow Indian Health Care Center is an ambulatory care center serving the Winslow service area, including Dilkon and Leupp communities. The Winslow Indian Health Care Center is an independent 638 corporation by the Navajo Nation.

IV. EVALUATION OF STAFF QUARTERS NEEDS

A. Overview: With the construction of the Hopi Health Care Center in 2002, and future expansion/renovation project (A/E design complete), Government staff quarters are needed for Non-Local positions, for which housing is not available.

The shortage of IHS Staff Quarters continues to be problematic for HHCC operations in its entirety, even with 79 vacant positions, out of a total of 275 staff at HHCC. Of these 79 vacant positions, 70 are expected to be Non-Local future hires. This lack of quarters is a primary reason why these vacant positions exist.

HHCC currently has 59 total staff quarters units, of which 35 (59%) Single Family and Transient units are 52 to 64 years old, with ongoing maintenance issues typical of aged structures. The problems prevalent among these aged structures renders quarters units intermittently unavailable at times due to a constant variety maintenance issues. For example, all ten (10) Transient Units are affected by mold issues due to poor on-site water drainage pooling in crawlspaces (especially during monsoon rainy seasons), Unit 67 (a single family 2 bedroom unit) was burned and demolished, and all units continue to be subject to an assortment of necessary ongoing building and underground utility renovations.

These typical issues directly impact HHCC’s mission to adequately house staff, deliver the highest level of healthcare 24 hour/7 days a week to its patients, and severely impede HHCC’s staff recruitment, hiring and retention efforts. Without additional and new staff quarters, these problems are certain to continue.

Adjacent to the HHCC facility is the Walpi Tribal Housing neighborhood, though a formal agreement does not exist between the Tribe and IHS for any of these units to be designated for HHCC usage. As indicated in TAB B’s Staffing Roster and Housing Pattern analysis, there are staff who have obtained housing at Walpi. However, the overwhelming majority of attempts by recent and current staff seeking housing at Walpi, especially Non-Local staff, remain unsuccessful.

Thus, Walpi Housing is not considered a viable housing option for HHCC staff, presently nor in the future.

With no Local (within 47 road miles) Private Sector, nor federally-owned, nor Hopi Tribal housing options available to HHCC staff, HHCC remains exclusively reliant on its 59 quarters units, which vary in availability due to ongoing maintenance issues and renovations.

Towns in the region with housing options are beyond the one-way 47 road mile radius from the HHCC, and thus not considered “Local” by IHS staff quarters standards. These towns include Winslow, AZ (67 miles from HHCC) and

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Holbrook, AZ (85 miles), which have varied and limited housing availability ‘at best’, are at least 134 roundtrip road miles to/from HHCC, and become problematic during winter/snow seasons.

The proposed additional staff quarters units will be used to meet HHCC’s current and projected needs by focusing on the increasing demand for Multi- Family/Multiplex units, with 2 bedrooms or less. Presently, 51% of the existing quarters are Single Family, 2 to 4 bedroom units (refer to Table VI, Housing Pattern Analysis). With the prevalence of staff not requesting nor requiring larger and more expensive single family rental quarters, the Proposed Overall Unit Mix plans for a decrease to 36% Single Family units, and an increase of Multi- Family/Multiplex units from 32% (existing) to 51% (Proposed Overall Unit Mix).

This proposed mix is also based on the success and staff demand for units in the existing 19 unit apartment building, constructed in 2019. This apartment unit has proven effective in staff recruitment and retention, and possesses the flexibility needed if certain ‘Studio/Efficiency’ units need to be utilized as Transient Units, which would be advantageous to accommodate more Visiting/Contract Specialty Care Providers to meet HHCC’s unmet specialty care need.

The combination of a future HHCC facility expansion/renovation, and having two staff quarters sites (at Keams Canyon and in Polacca, adjacent to the HHCC), will provide an enhanced opportunity for improved and expanded healthcare for the Hopi Tribe, as well as enhance staff recruitment and retention which is a challenge in this remote setting.

Table I shows the number of rental and transient quarters units that will continue to be used and the proposed new quarters units to be provided. IHS Government quarters units are designated as either "rental" or "transient" as defined in Chapter 13 - "Quarters Management Program," Part V, Indian Health Manual.

Rental Quarters Units - Quarters intended for other than transient occupancy by an IHS employee or other authorized person. Persons assigned to rental quarters units are always charged for rent and utilities.

Transient Quarters Units - Quarters units intended for short-term occupancy of up to 90 days. Their purpose is to accommodate official visitors, guests, volunteers, short-term employees and contractors, and other transient personnel. Persons assigned to transient quarters units are charged for rent and utilities.

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TABLE I - STAFF QUARTERS NEEDS

EX

IS

TI

N

G Q

U A

R

TE

R S

U N

IT

S

TO

B

E D

EM

O

'D

NUMBER of GOVERNMENT QUARTERS

UNITS

TOTAL

REQUIRED

EXISTING

FOR

CONTINUED

USE

ADDITIONAL

REQUIRED 1

Single Family Rental 2 (GQ-P & GQ-M)

1 - Bedroom 0 0 12 0 12

2 - Bedroom 12 12 (2) 14 0 14

3 - Bedroom 12 12 (2) 10 0 10

4 - Bedroom 1 1 (2) 1 0 1

Multi-Family/Multiplex Rental (GQ-P-MF) Studio 8 0 24 8 16 1 - Bedroom 9 0 27 9 18

2 - Bedroom 2 0 8 2 6

3 - Bedroom 0 0 0 0 0 4 - Bedroom 0 0 0 0 0

Government Quarters - Modular Rental (GQ-M) 2 - Bedroom 5 0 5 5 0

Subtotal of Rental Units 49 25 101 24 77

(= Item C on

Table V) (= Item D on

Table V) (= Item F on

Table V)

Transient (Multiplex) (GQ-P-TQ)

1 - Bedroom, 1 - Bath Units 10 10 (2) 16 0 16

Subtotal Transient Units 10 10 16 0 16

(= Item G on

(= Item H on

Table V) (= Item I on

TOTAL QUARTERS UNITS 59 35 (2) 117 24 93

(= Items C+G on Table V)

(= Items D+ H on Table

V)

(= Item J on Table V)

Notes for TABLE I:

(1) The "ADDITIONAL REQUIRED" Column reflects a deduction for local private sector housing that is projected to be available for "Non-Local" staff. For the HHCC locale, there are no private sector housing units available (refer to TAB C).

(2) Existing Single Family Rental units and Transient units to be demolished primarily due to age (51-63 yrs), and with staff quarters structures and site utilities in aged/poor condition.

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B. Staffing Analysis: Table II summarizes the planned staffing at the HHCC, as of

December 2021, and the authorized filled housing pattern, as provided in TAB B, which contains a complete listing of planned staffing for the HHCC, and provides information about family sizes, sizes of quarters authorized, and the existing conditions. Below are the definitions of terms used in Table II, TAB B, and elsewhere in this document:

POSITION TITLE: The position title as used in the Program of Requirements

(POR) for the health care facility.

POSITION STATUS: The position status describes the status of employment, as follows:

► FILLED: A currently authorized existing position for which an employee has been hired and is working at the time the data was collected.

► VACANT: A currently authorized existing position for which an employee has not been hired at the time the data was collected.

► NEW: An additional position that has been authorized in addition to existing positions to support a new or improved health care delivery program at the health care facility. This position is vacant at the time the data was collected.

EMPLOYEE STATUS: The employee status identifies if the position is filled or is expected to be filled with a "NON-LOCAL” or a “LOCAL" employee.

The term “NON-LOCAL” refers to those IHS employees residing greater than 47 miles (75 kilometers) by road from the health care facility at the time of acceptance of their employment. For vacant and new positions, the employee status is a realistic estimate taking into account the type of positions to be filled, the availability of qualified personnel from the local area, and past experience in recruiting and retaining personnel.

Sample Calculation:

Ratio to determine Non‐Local estimate for New and Vacant Positions

Current Non‐

Local Staff

= = 165 = 0.60

Current Total Staff

Estimate for New Non‐Locals = 0 * 0.60 = 0

Estimate for Vacant Non‐Locals = 79 * 0.60 = 47.4

The Sample Calculation for “Estimate for Vacant Non-Locals” projects 47.4 Non-Locals to fill vacancies, which was revised to 70 staff (refer to Table II) based on HHCC executive staff’s review of: staffing history, past experience in recruiting and retaining personnel, and vetting each Vacant position (refer to TAB B) regarding the availability of qualified personnel from the local area.

This increase from 47.4 to 70 projected Non-Local staff to fill vacancies, is also due to the general housing shortage on the Hopi Reservation where it is common for Hopi Tribal members (HHCC staff and prospective HHCC staff) living 47 road miles or more from HHCC to not have housing on their

PJDQ for Staff Quarters HHCC - Replacement Quarters Page 24 of 220 reservation. Thus, upon being hired at HHCC, even they would be considered among the Non-Local pool of hired employees.

OCCUPIED HOUSING TYPE: The occupied housing type is provided only for currently filled positions at the health care facility. It indicates whether that staff member currently resides in Government quarters, in local private sector housing, or in non-local private sector housing.

► GOVERNMENT QUARTERS (GQ): This includes existing IHS quarters units which are IHS owned or leased and located 47 road miles or less from the health care facility. It also includes other Government quarters units owned or leased by other Government agencies located 47 road miles or less from the health care facility, which are available to IHS for occupancy by IHS staff (of which there are none regarding HHCC housing options). This category includes:

GQ-P: GOVERNMENT QUARTERS – PERMANENT, for permanent structures

GQ-P-MF: GOVERNMENT QUARTERS – PERMANENT – MULTI-

FAMILY, for permanent structures

GQ-P-TQ: GOVERNMENT QUARTERS – PERMANENT –

TRANSIENT QUARTERS, for permanent structures GQ-M: GOVERNMENT QUARTERS – MODULAR, for modular structures GQ-T: GOVERNMENT QUARTERS – HOUSE TRAILER, for house trailer units

► LOCAL PRIVATE SECTOR HOUSING (LP): This is all types of housing units, except Government quarters units, located 47 road miles or less from the health care facility, which the employee owns, rents, or otherwise occupies. This category includes:

GTP: GOVERNMENT TRAILER PAD, for Government house trailer pad PTP: PRIVATE TRAILER PAD, for private house trailer pad

► NON-LOCAL PRIVATE SECTOR HOUSING (NP): This is all types of housing units, except Government quarters units, located more than 47 road miles from the health care facility, which the employee owns, rents, or otherwise occupies.

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C. Existing Government Quarters Units:

Information concerning the status of these existing Government quarters units is not provided in a Housing Verification Survey Report (HVSR) within this PJDQ document.

An HVSR was not included since a Local Private Sector housing market to serve HHCC staff does not exist. As described in TAB C, as per IHS Phoenix Area Realty Specialist, “there is no non-reservation community within the 46 miles of the Hopi Health Care Center with private housing available to the general public. Nor, is there housing available to IHS staff on the reservation, outside of the 59 federally owned quarters units located on the Keams Canyon site…” The lack of housing on the Hopi Reservation is a decades-long problem studied and documented by the Hopi Tribal Government and BIA, and in a previous IHS HVSR published in June 1992 (also refer to Section III, F).

In addition, an HVSR with detailed information of each quarters unit was not included due the fact that 35 of the existing 59 quarters units are in significant need of replacement due to age (aged 52 to 64 years old), major deficiencies and being in either “poor” condition, with continued maintenance and repairs as needed to keep them in “fair” condition to be habitable. These units are past their expected useful lifespan, due to the prevalence of building, underground utilities, operational equipment (HVAC/Electrical) problems/concerns, which are not economically feasible to renovate versus construction of a replacement unit.

For existing permanent staff quarters units, when the costs of repairs exceeds 50% of the replacement cost for that unit, the existing permanent quarters unit has been identified as not being “Available for Continued Use” and is identified in this project for replacement. Current IHS policy requires, as projects are processed in the Quarters Construction Priority System, that existing house trailer units be identified as not being “Available for Continued Use” as staff quarters. Accordingly, this project identifies all house trailers for replacement. All structures identified as not being “Available for Continued Use” as staff quarters will be disposed of in accordance with established procedures.

Table III summarizes the mix of existing Government quarters units which are “Available for Continued Use” by non-local IHS employees. In determining the projected supply of Government quarters units which may be reasonably expected for non-local IHS employees at a particular location, all existing IHS Government quarters units were counted that were located 47 road miles or less from the health care facility. This total was reduced by the number that were classified as either "poor" or "obsolete/ substandard," were determined to be unfeasible to renovate, and were determined, in accordance with the above stated policy, as not being “Available for Continued Use.” Other Government quarters units located 47 road miles or less from the health care facility, which were counted only to the extent they are available to IHS for occupancy by IHS staff, are identified separately in Table III.

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Twenty-four (24) quarters units have been designated by HHCC to be “Available for Continued Use,” which were recently constructed, in good condition, located at the Keams Canyon Staff Quarters Site, and are as follows:

Single Family Rental (GQ-M)

► Unit #174: Single Family Unit, 2 Bedroom, 1 Bath, built in 2018, 840 ft2 ► Unit #175: Single Family Unit, 2 Bedroom, 1 Bath, built in 2018, 840 ft2 ► Unit #176: Single Family Unit, 2 Bedroom, 1 Bath, built in 2018, 840 ft2 ► Unit #177: Single Family Unit, 2 Bedroom, 1 Bath, built in 2018, 840 ft2 ► Unit #178: Single Family Unit, 2 Bedroom, 1 Bath, built in 2018, 840 ft2

Multi-Family / Multiplex (GQ-P-MF) (Existing 19 Unit Apartment Building)

► Unit #101: Multi-Family Unit, 2 Bedroom, 1 Bath, built in 2019, 1,084 ft2 ► Unit #102: Multi-Family Unit, 2 Bedroom, 1 Bath, built in 2019, 1,084 ft2 ► Unit #103: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #104: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #105: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #106: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #107: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #108: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #109: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #110: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #111: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #112: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #113: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #114: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #115: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #116: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #117: Multi-Family Unit, Studio, 1 Bath, built in 2019, 602 ft2 ► Unit #118: Multi-Family Unit, 1 Bedroom, 1 Bath, built in 2019, 758 ft2 ► Unit #119: Multi-Family Unit, 1 Bedroom, 1 Bath, HC (Accessible) Unit, built in 2019, 770 ft2

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TABLE III: EXISTING GOVERNMENT QUARTERS UNITS AVAILABLE

FOR CONTINUED USE

TYPE of

UNIT

NUMBER OF UNITS

Hopi Hlth Care Center OTHER LOCATIONS TOTAL

RENTAL TRANSIENT RENTAL TRANSIENT RENTAL TRANSIENT

Single Family Rental (GQ-M)

2 - Bedroom 5 0 5

3 - Bedroom 0 0 0

4 - Bedroom 0 0 0

Multi-Family / Multiplex (GQ-P-MF) (from Existing 19 Unit Apartment Building)

Studio 8 0 0 0 8 0

1 - Bedroom 9 0 9

2 - Bedroom 2 0 2

3 - Bedroom 0 0 0

TOTAL

EXISTING

GOVERNMENT

QUARTERS

UNITS

AVAILABLE

FOR

CONTINUED

USE

24 0 0 0 24 0

NOTES for TABLE III:

1.) Of the Existing 59 Qtrs Units, 35 Units are 51-63 years old, deemed not suitable for continued use, and planned for demolition.

2.) Note not used.

D. Local Private Sector Housing Market:

The HVSR report is a survey of the private sector housing units available for sale and rent in communities located 46 miles or less from the health care facility. The surveyed communities (including the community in which the health care facility is located) consist of all local "recognized" communities and other local communities where a "demonstrated preference" to reside is indicated. Populations and distances (based on road miles using the most efficient time route) are included in the report.

See the latest HSVR guidelines, OEHE Technical handbook Chapter 13-8 - Housing Verification Survey Report for a detailed explanation.

As explained in TAB C, and HVSR is not included in this PJDQ, due to there being no non-reservation community within 46 miles of the HHCC with private sector housing available to the general public, and no housing available to IHS staff on the Hopi Reservation, except for the 59 HHCC staff quarters units.

A "recognized" community is an incorporated or unincorporated city or town (located 46 road miles or less from the health care facility) having a year-round population of 1,500 or more.

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A "demonstrated preference" community is one with a population of less than 1,500 that is located 46 road miles or more from the health care facility, and where a demonstrated preference to reside is indicated by non-local IHS staff currently residing in this community. Non-local refers to employees who resided more than 46 road miles from the health care facility at the time of their employment in that facility.

It is normally assumed that 25 percent of the housing units for sale or rent from the local housing market will be suitable, available, and affordable to non-local IHS employees. Where more than one IHS facility is within 46 miles of the community, the total number of private sector quarters units (i.e., the average vacancy rate determined in the housing verification survey) will be used to calculate housing available for each nearby facility. The vacancy rate is a recurring rate to which the local economy will continue to adjust and which will remain constant over time.

Therefore, available vacant private sector housing is not prorated among nearby facility locations. However, if the survey team considers a 25% adjustment factor either too high or too low for a specific community, a more accurate factor is to be recommended and supported with justification in the HVSR.

The information from the HVSR regarding the number of housing units within the local private sector housing market which may reasonably be expected to be suitable, available, and affordable to Non-Local IHS employees is summarized in a Table IV, “Local Private Sector Housing Market.” The table contains the names of the communities with their respective distances from the health care facility, population, and projected private housing units available. The table shows an adjustment factor, usually 0.25 or 0.10 (described above) for each community which is multiplied by the projected private housing units available to yield the housing units available for IHS non-local staff.

TABLE IV: LOCAL PRIVATE SECTOR HOUSING MARKET1

COMMUNITY

AVERAGE

DISTANCE

from

HEALTH

CARE

FACILITY

(miles)

POPULATION

PROJECTED

PRIVATE

HOUSING

UNITS

AVAILABLE

ADJUSTMENT

FACTOR 2

HOUSING

UNITS

AVAILABLE for

IHS NON-

LOCAL STAFF

N/A 3 0 0 0 0.25 0

TOTAL HOUSING UNITS AVAILABLE for IHS NON-LOCAL STAFF3 0

NOTES for TABLE IV:

1.) Information for this table is not taken from an HVSR. An HVSR is not included in this PJDQ as per reasons described in TAB C.

2.) Normally it is assumed the 25% of the housing units available for sale or rent from the local housing market will be suitable, available, and affordable to Non-Local IHS employees. When the HVSR survey team considers that a 25% adjustment factor is either too high or too low for a specific community, a more accurate factor is used with supporting justification for such being provided in the HVSR.

3.) No LP (Local Private Sector) housing available. No adjustment required in this case.

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E. Transient Quarters

There is a need for a total of sixteen (16) Transient Quarters Units at the HHCC, of which: twelve (12) are TQ 1-Bedroom Remote (REM) type units, and four (4) are TQ 1-Bedroom (REM) (HC) accessible…