Hospital commissioners vote to close EACC facility

The Adams County Hospital District No. 2 Board of Commissioners met in front of a large crowd on Jan. 12 to discuss the future of the East Adams Care Center facility, resulting in a decision to close while transferring as many patients as possible to the hospital.

Chairman Eric Walker began the meeting with a summary of the facility’s history with the District and then presented the three options the Commissioners reviewed as their final options for EACC.

The Commissioners voted to accept the facility as a donation in August 2014 from Life Care Centers of America, and the facility has been a financial drain on the District ever since, Walker explained. If the District did not accept the donation in 2014, the facility would have closed, he stated.

During the August 2014 meeting, Walker said an overwhelming amount of community members voted in favor of the District accepting the donation. The initial plan had been to review the future of EACC after operating the facility for one year.

The transition of the facility from Life Care took many months, and delayed the Commissioners discussion regarding the facility. In October 2016, the Commissioners moved forward with an application to the state to convert EACC into a wing of the hospital.

This decision prevented patients from being admitted to EACC while the application was reviewed. Walker explained the Commissioners hoped to reduce costs by making the facility a wing, because as a hospital, the reimbursement rate is higher and there is the ability to share staff members between the two facilities.

Walker explained EACC averaged a loss of $1.4 million a year, prior to the decision to convert the facility.

He then continued to present the three options reviewed by the Building Committee.

The first option was to continue on the path the Commissioners had first considered, converting the facility into a wing of the hospital. Walker explained while the reimbursement rate per patient is higher than a skilled nursing home facility, the District would have to complete nearly $3 million of construction at EACC.

“We don’t have $3 million, and we would have to go to the community with a bond,” Walker explained.

The construction work would also not guarantee the conversion would be approved, Walker stated. The District runs the risk of completing construction and not being able to convert the facility into a wing of the hospital, setting the District back even further financially.

Walker said the facility is losing an estimated $3,800 per day while it remains operational. Even with the conversion, Walker stated there is no guarantee the facility will be able to run at a breakeven level.

The decision to continue with the conversion was not recommended by the Building Committee, Walker stated.

The second option allowed EARH to retract their application with the state and begin admitting patients back into the facility. During this time, Walker said they would try to improve the facility, but based on a rough estimate by EACC Administrator Michele Johnstone and CEO/CFO Gary Bostrom, the facility would continue to lose money in the first year.

Walker explained they estimated the facility would lose $300,000 in the first year, and potentially could work down to a loss of $20,000 a year, with the increase of patients at the facility. He said he does not have confidence in those numbers, as Life Care only recorded one year of a positive bottom line during their years of operation.

In order to breakeven, Walker said they estimate the facility would need 35 patients. Before the application to the state for the conversion, the highest recorded number of patients was recorded when the transfer from Life Care occurred.

Walker stated the Building Committee felt this was not a good option for the District.

The third and final alternative, and the one selected by the Building Committee as the best viable option, was to begin accepting intermediate swing bed patients into the hospital and close EACC. Walker said the hospital currently has six patient rooms available, allowing the potential of housing seven to eight patients.

EACC currently has nine patients at the facility, and the option to transfer the patients to the hospital would allow them to stay in Ritzville. The decision to transfer to the hospital is the decision of each individual patient, Walker explained.

The hospital recently completed renovations at the facility, and Walker said during the construction, the contractors capped hook-ups at the north end of the facility. This would allow the hospital to expand and add four additional rooms, if the demand for intermediate swing beds increased.

Walker estimated the new construction would cost $700,000, but would allow for a capacity of up to 16 patients. The decision to expand would be considered later after analyzing the demand for care in the area.

The Building Committee determined it was the District’s responsibility to maintain healthcare options for residents in the area, and they had a moral requirement to offer this service to patients. Walker said they believed the community needed to keep skilled nursing, and accepting patients through the hospital would be the best option.

Bostrom then presented the financial standing of the District and moved the meeting into the public forum portion of the night.

He began by stating in 2014, the CFO side of him encouraged the Commissioners not to accept the Life Care donation, but the CEO side of him believed the District had an obligation to its residents to try to make it work.

In the first nine months of operating EACC, Bostrom said the District lost over $530,000 because of EACC. In the first nine months of 2016, EACC recorded a loss of $855,474.

In September, EACC staff were brought into the hospital payroll because of the potential conversion. Bostrom said the Commissioners and himself respect all the efforts made to keep EACC operational and functional, and if closed, the hospital would try to assimilate the EACC staff.

With the combination of the staff, Bostrom said the cost for pool nurses would dramatically decrease, creating a financial benefit for the District. Financially, Bostrom stated the future of EACC if continued to operate separately is not positive.

The public forum raised concerns about the future of the patients, staff and use of the current EACC facility.

Bostrom said with the closure of EACC, the building would continue to be utilized for the kitchen and laundry facilities. A few potential ideas included using the building for storage, Meals on Wheels, housing for visiting providers or office space.

Community members questioned the liklihood of being able to maintain the facility and what the probability would be of housing 30 residents. Bostrom said while there is a list of individuals showing interest, the facility recorded a high of 29 residents immediately after the donation from Life Care.

Bostrom said the hospital is licensed to host 20 swing bed patients, and the facility has not recorded higher numbers than that in the past year.

He explained the facility has not been actively promoting itself in the past six months, due to the application with the state for conversion and the facility’s inability to admit.

With the closure of EACC, the residents receive a 60-day notice and will be extended the offer to move to the hospital. Bostrom explained the facility would not officially close until the last patient is moved.

Bostrom said they would not close the facility and not accommodate the residents who wished to relocate locally, because they do not want to lay off the entire staff.

With the closure, Bostrom stated they plan to maintain 100 percent of the nursing and dietary staff, and between 50-70 percent of the remaining staff members and administrators.

A primary concern from community members was if the residents would still have access to activities like they do at EACC. Chief Nursing Director Brenda Herr explained it is mandatory to provide activities for all swing bed patients.

The initial plan is to convert the room initially planned for a conference room at the hospital into a dining and activity center for patients. Herr said the brand new facility will serve as a benefit for the residents, and while the rooms will be double occupancy, she said they will still keep them active.

Bostrom also stated the cost for EACC to continue would come from the reserves, and that would hurt the long-term viability of the hospital.

He added Dingus, Zarecor and Associates PLCC completed a cost analysis report showing the hospital should breakeven with the residents at the hospital, because of the higher reimbursement rate.

The rate paid by the patients will not change, Bostrom stated, and the hospital will accept any patient allowed by their individual insurance plan.

After substantial conversation regarding the options for the facility, Walker stated the state has not given a final deadline for the decision to be made, but the Commissioners believed it needed to be at the meeting because of the financial strain on the District.

Each commissioner spoke individually about the issue, sharing their appreciation for the level of care provided through the facility and their regret in having to make a decision to close. Ross Heimbigner, Stacey Plummer, Jerry Snyder and Jerry Crossler all expressed their concern for the financial future of the District, if the facility were to remain open.

Bostrom addressed a question regarding the “big picture” plan for the District, and said the inclusion of the intermediate swing bed patients fits their long-term goal. The initial plan to assimilate the patients is based on the need to stop the financial bleed the District is suffering from because of the facility.

Herr added with the growth of the physical therapy department at EARH, the residents will have access to top of the line care and the addition of staff will be a large benefit to the District. She stated part of her job responsibilities with the District include expanding services, and hosting swing bed patients will allow them to receive care locally.

The Commissioners took an advisory vote and the Jan. 12 meeting, with four votes in favor and Crossler opposed to the closing the EACC with the patients being invited to move to the hospital.

The Commissioners cast their official votes on Jan. 16 at a special board meeting.

With the final decision, the residents at EACC will receive their notice with the invitation to move to EARH. Bostrom stated some of the residents will make the decision to move to other facilities, but he expects multiple residents will make the decision to stay.

During the upcoming year, the Commissioners will review the local demand for intermediate swing bed services and continue to discuss the potential expansion of the hospital to house more patients, if the need arises.