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Giving up nursing homes beds seen as positive move for hospital

The good news is, Kenmare Community Hospital will de-license the 12-bed skilled care unit by the end of the year. And the bad news?

8/26/09 (Wed)

By Caroline Downs

 

The good news is, Kenmare Community Hospital will de-license the 12-bed skilled care unit by the end of the year.

 

And the bad news?

 

None, really. Hospital residents and their families most likely won’t notice any differences, except perhaps to see their rates go down.

 

The announcement to change the status of the nursing home at Kenmare’s hospital came last week after a nearly three-year process, according to hospital administrator Shawn Smothers.

 

Smothers said the decision to de-license the skilled care unit was made by the Trinity Health board of directors, with a consultant review, input from Smothers and an exhaustive study of financial statements from the local hospital.

 

“We’ve been losing $171,000 to $300,000 a year on the nursing home side,” explained Smothers. “How long can you continue at that rate? We want to make sure we have emergency coverage and maintain hospital utilization. We want to continue to provide services from the hospital, the clinic and the wellness center for the community.”

 

Smallest unit in state

With its 12-bed skilled care unit, Kenmare Community Hospital was the smallest nursing home operating in the state. Given the state’s regulations for nursing homes, payment formulas and other factors, patients paid a high cost for their care compared to other facilities.

 

Smothers talked about the nursing requirements as one example. “We have to have a nurse dedicated to that 12-bed unit,” she said. “No one else in the state has a 1-to-12 nurse-patient ratio. We have so many things we have cost-allocated for that department. It will be easier to keep track of the costs. Now, it’s all under the hospital.”

 

Another factor in the decision was the difficulty in recruiting employees for both sides of the hospital. “We don’t have enough nurses to staff now,” Smothers said. “In rural areas, recruitment is going to be an issue.”

 

She explained that overtime, extra shifts and double shifts are used creatively, especially with the specific staffing demands of the skilled care unit. Once those beds have been de-licensed, schedules can be more flexible. No jobs will be eliminated. “No one will be asked to give up their position,” she said.

 

Nothing changes

for residents

For her part, Smothers is coordinating the change with the state health department, the state long-term care association, and state and regional ombudsmen to create a smooth transition. The local hospital advisory board was informed last week, as were residents and their families and the hospital employees.

 

“We hope the process is done by the end of December at the latest,” Smothers said. “But we’re not trying to push anybody out the door.”

 

In fact, none of the current 11 skilled care residents should have to leave. The same level of care will be offered, including IV therapy and physical therapy. Smothers has already spoken with two insurance companies that provide long-term care coverage and confirmed that those policies will be in place for their customers to cover expenses after the 20-day Medicare coverage ends for patients, if skilled service is still needed. “Swing beds are considered nursing home level of care,” Smothers said.

 

By de-licensing the 12 nursing home beds, Kenmare Community Hospital frees itself from the additional mandates and costs associated with skilled care, without having a negative impact on the current residents. “It’s really not going to change anything for the residents,” said Smothers. “In fact, the rates are going to decrease, and everybody who is in the nursing home will pay less.”

 

More private rooms

will be one benefit

The move allows the hospital to open itself to a variety of possibilities. The facility, also rated as a critical access hospital, is licensed for 25 beds but will now have some choice as to how those beds are designated. “This gives us an option for more swing beds,” said Smothers, adding that one plan calls for 21 swing beds and four acute care beds. “These are the same beds we already have, and one way to utilize spare beds to get some private rooms. We’ve had requests for this in the past.”

 

Currently, one private room is available at the hospital.

 

Several plans for renovations are in the works, with Smothers preparing a grant application to cover some of the expenses. The two nurses’ stations will be combined into one office located centrally in the area now used as the day room. “This way, when people come in the front door, there will be someone there,” Smothers said.

 

The emergency room will be moved so it can be accessed directly from an outside entrance. Five or six rooms will be refurbished as private rooms for residents, and all of the hospital’s bathrooms will be updated to meet accessibility codes.

 

Smothers smiled as she finished her list with the installation of new doors and windows for better heating efficiency. “This will not be a fast process,” she said. “We have to get state [health department] approval for these projects.”

 

License can be sold,

held, or transferred

Smothers said no decision has been made yet about the future of the 12 de-licensed beds, with other nursing homes in the state possibly interested in adding those beds to their census. “We can sell them, we can transfer them or we can hold them,” she noted. “We’ll be working with the state health department on that.”

 

As she has reviewed the situation, the only drawback Smothers can see is that at times, the hospital may be limited on admitting a new resident immediately. “But you don’t know what the future brings,” she said. “Our population here can fluctuate.”

 

She mentioned the proliferation of options related to long-term care, including assisted living, basic care and even staying home with care provided. “We never used to have those options,” she said, adding that nursing homes remain necessary when families require those services, too.

 

Smothers explained that Kenmare Community Hospital will maintain its relationships with other facilities in the region to offer resident care at every level. She described how nursing homes in Mohall, Tioga, Crosby and Westhope coordinate patient needs with Kenmare Community Hospital, as well as the Baptist Home of Kenmare with their options for assisted living and basic care. “The network always works together,” she said. “We’ve even had people come from Mayo [Clinic} who were from this area originally and wanted to come back.”

 

The bottom line, for Smothers, is that giving up the skilled care beds brings some financial stability to the hospital without changing the quality of care or services that residents and patients receive. “We had to look at what we could do to maintain our financial solvency and future as a hospital,” she said. “We’re here and we’re keeping the doors open. The hospital will be here, the clinic will be here and the emergency room will be here.”

 

She expressed her appreciation for the resources shared by Trinity Health and the support Trinity has shown Kenmare and its hospital. “I’m proud of what we do here,” Smothers said. “I’m proud of our staff, and I’m proud of our facility. I owe a lot to Kenmare, and I want to make sure the hospital stays here for the community.”

 

Anyone with further questions or concerns about the plan to de-license Kenmare Community Hospital’s skilled care unit is invited to contact Smothers at 701-385-4296 during business hours.