Public forum slated for Jan. 12 to determine future for EACC

The status of the East Adams Care Center, currently operated by Adams County Public Hospital District No. 2, has now reached a critical decision point.

The District was given the Care Center at no cost in mid-2014 by its then-owner, Life Care Centers of America, who strongly implied that if the District did not accept the Care Center, they would close it. The decision whether to accept it and continue operating it was a difficult one, and the District went to the community for advice in a town-hall meeting on Aug. 14, 2014.

At that meeting, the District made it plain that the Care Center would, under the most optimistic assumptions, barely break even, and was much more likely to remain a continuing loss. The question was whether the District should bear that loss to keep the Care Center open as a community resource.

The decision reached, with the approval of those in attendance at the meeting, was to accept the Center and monitor its finances.

The Care Center has, regrettably, proved to be a larger-than-expected drain on the District’s finances. In mid-2016 the District applied to the state for permission to convert the Care Center from a skilled nursing facility to a part of the hospital. With such a conversion, the District could substantially reduce its losses from the facility, because of the way in which Medicare and Medicaid, the dominant payers for Care Center patients, compensate coverage in Critical-Access Hospitals as opposed to nursing facilities.

The state took months to process the application. During that time, by law the District could not admit new patients to the facility, so the patient population steadily dwindled as patients were released but not replaced. That increased the scope of the running losses at the facility.

After spending all those months, the state informed the District, near the end of the process, that to obtain the conversion permission the District would have to make huge investments in modifying the physical facility.

The state said that a change from nursing facility to hospital status mandated that the physical facility meet all the latest code requirements for hospital buildings, even though it was fine to continue just “as is” if it remained a nursing facility.

The District obtained rough estimates of the cost of the alterations that the state was demanding, and discovered that they would be in the vicinity of three million dollars and perhaps more, as opening up an old building typically uncovers unanticipated further work needs.

At its December 2016 meeting, the District Board of Commissioners agreed that such an amount would be impossible for the District, and would never in any foreseeable future be recovered from operation of that facility, even with the increased income hospital status would bring. That option was thus ruled out.

There followed an attempt by the District to obtain waivers or some other relief from the state’s strict demands, but in a conversation with state representatives on Dec. 27, Gary Bostrom, the District Superintendent, was finally informed that no such waivers were going to be available.

At the Board’s request, Bostrom and Michele Johnston, Interim Nursing-Home Administrator, had come up with the best estimates they could for the projected losses if the Care Center were to be continued as it is, a skilled nursing facility. Bostrom advised the Board that any such estimates are necessarily very rough: basically, informed guesses.

Their tentative estimate was that continuing operations would result in a roughly $300,000 loss for the District in 2017, but thereafter an annual loss running at about $20,000. That assumed that during 2017, the Care Center could ramp up its patient count from the current 10 patients to an average of 25 or so.

The Board now faces three choices. One, continue on the current basis, accepting the 2017 loss as a one-time cost for keeping the Care Center open and the running losses thereafter as simply the cost of providing that service to the community; two, close the Care Center and move the current patients into the hospital, which has enough beds to accommodate them; three, simply close the facility altogether.

The chief factors complicating the decision are the uncertainty of the dollar-loss projections, because they depend on assumptions hard to solidify, and the ability of the hospital to provide not simply the needed beds and medical care, but also the quality-of-life features that medium- or long-term-care patients should have.

Because of the great importance of that decision to both the District and the community it serves, the Board will hold another special town hall meeting to reach its decision. The Board urgently asks that all interested community members attend, to hear details, to ask questions, and especially to contribute views.

The meeting is scheduled for 5:15 p.m. of Thursday, Jan. 12, in the American Legion Hall at 106 West Broadway Avenue in Ritzville.