With Vietnam-era veterans getting old and thousands of disabled and traumatized veterans from Iraq and Afghanistan needing care, construction of government hospitals and health facilities for veterans is booming.

Two new Department of Veterans Affairs (VA) hospitals are under construction in Las Vegas and Orlando, Fla.—neither previously had VA hos­pitals. Moreover, four new replacement hospitals have been approved—in New Orleans; the Denver area; Louisville, Ky.; and Omaha, Neb.—according to Robert Neary, acting director of the VA's office of construction and facilities management. Project costs range from $560 million in Omaha to $995 million in New Orleans.

The new hospitals are being designed with extensive input from veterans. They feature a variety of energy conservation and renewable energy elements. They'll also include improved privacy—such as separate dressing areas in exam rooms—for the growing number of women veterans, who now comprise 12 percent of the VA patient population.

In addition, the VA has a new polytrauma center under construction in San Antonio, and two replacement Level 1 trauma centers in design stage for Tampa, Fla., and Palo Alto, Calif. And the agency has just completed or is currently building spinal cord injury centers in New York; Milwaukee; Syracuse, N.Y.; Dallas; Minneapolis; Chicago; and Brockton, Mass. Many outpatient clinic projects also are under way.

All told, since the VA completed a major capital asset study in 2004, it has received congressional funding for 81 major health care construction projects—defined as costing more than $10 million—through 2011. The requested VA construction budget for 2011 is $1.15 billion, the same as in 2010. If approved, the 2011 budget would be the fourth in a row exceeding $1 billion—four to five times larger than pre-2004 budgets.

"To some extent this expansion is due to the two wars and the number of veterans returning from service with multiple severe injuries," Neary says. "But the aging population of veterans needs more care, and more veterans are coming to the VA for care than in the past."

Around the country, the VA currently operates 153 hospitals, 951 outpatient and community clinics, 134 nursing homes, 50 residential rehabilitation treatment centers and 232 readjustment counseling offices. Its caseload totals about 900,000 inpatient admissions and 79 million outpatient visits. Administration is handled through 21 Veterans Integrated Service Networks (VISNs) around the country. Neary's central office is in charge of major construction projects, while the VISNs oversee the smaller ones.

Input from veterans is guiding the design of the planned 200-bed VA medical center in the Mid-City neighborhood of New Orleans. Scheduled to open at the end of 2013, the new hospital will replace the old downtown VA facility, which was destroyed during Hurricane Katrina in 2005.

Architecture firm NBBJ conducted workshops with local veterans to determine what they wanted. Doug Parris, an NBBJ partner, says limited mobility, vision problems and colorblindness are major challenges for veterans. Thus, at each entrance there will be an orientation person, wheelchairs and mobility assistance and restrooms. The veterans also wanted to feel honored. So NBBJ is planning a detailed art program that pays tribute to the veterans of different service branches, as well as to the culture of New Orleans.

The New Orleans center is the first major project for which the VA is using the construction manager at-risk contracting model. The Denver-area hospital project also will use that model, Neary says.

The construction manager selected for the New Orleans center is a partnership between Bethesda-based Clark Construction Group and St. Louis-based McCarthy Building Companies.