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At APD, Aging Is the Future: Hospital’s Strategic Business Plan to Rely on Senior Care

  • On Feb. 12, 2014, Dolly Bickel, left and Ann Bressett smile at one another during a poker game. They are residents of Harvest Hill in Lebanon, N.H. an independent- and assisted-living retirement community run by Alice Peck Day Memorial Hospital. Also playing with them is Lois Clarke, right. <br/>Valley News - Jennifer Hauck

    On Feb. 12, 2014, Dolly Bickel, left and Ann Bressett smile at one another during a poker game. They are residents of Harvest Hill in Lebanon, N.H. an independent- and assisted-living retirement community run by Alice Peck Day Memorial Hospital. Also playing with them is Lois Clarke, right.
    Valley News - Jennifer Hauck Purchase photo reprints »

  • On Feb. 12, 2014, Luke Howe and Marguerite Collier look over their mail after lunch at Harvest Hill, an independent- and assisted-living retirement community run by Alice Peck Day Memorial Hospital in Lebanon, N.H. <br/>Valley News - Jennifer Hauck

    On Feb. 12, 2014, Luke Howe and Marguerite Collier look over their mail after lunch at Harvest Hill, an independent- and assisted-living retirement community run by Alice Peck Day Memorial Hospital in Lebanon, N.H.
    Valley News - Jennifer Hauck Purchase photo reprints »

  • On Feb. 12, 2014, Dolly Bickel, left and Ann Bressett smile at one another during a poker game. They are residents of Harvest Hill in Lebanon, N.H. an independent- and assisted-living retirement community run by Alice Peck Day Memorial Hospital. Also playing with them is Lois Clarke, right. <br/>Valley News - Jennifer Hauck
  • On Feb. 12, 2014, Luke Howe and Marguerite Collier look over their mail after lunch at Harvest Hill, an independent- and assisted-living retirement community run by Alice Peck Day Memorial Hospital in Lebanon, N.H. <br/>Valley News - Jennifer Hauck

Lebanon — Generations of Upper Valley babies have been born at Alice Peck Day Memorial Hospital, which many families have favored for the small, intimate atmosphere compared to its larger cross-town competitor.

But now, Alice Peck Day is steering more toward the other end of life — senior care — as well as what it hopes will be a fruitful collaboration with Dartmouth-Hitchcock.

Caring for the elderly and dying is among the areas where APD is looking to grow, according to the hospital’s strategic plan for the future.

APD officials hope to expand home health care for seniors to help them “age in place,” add services at the assisted living facility, Harvest Hill, for people with memory loss, and possibly partner with Dartmouth-Hitchcock to build an inpatient hospice facility for patients who are dying.

Given the aging population in the Twin States and APD’s experience with elderly care, expanding options for senior care is one way in which the small hospital is preparing itself for changes in the industry.

“The strategy is really around how do we embrace this idea of aging in place, how do we support it?” hospital CEO Sue Mooney said Wednesday to an audience of 50 people at Harvest Hill. “We think it’s the right thing to do. We really believe that’s what elders want and given the demographic in this area, I think a strong statement of support is really the right thing to do for our community.”

Much has been made of the “silver tsunami” in the Twin States. New Hampshire and Vermont have among the oldest populations in the nation, with New Hampshire ranking fourth and Vermont second. The median age in New Hampshire is 41.1 years while Vermont is 41.5, according to 2010 Census data.

However, senior care is just a piece, albeit a big one, of the puzzle APD is assembling to remake itself for the modern age. The strategic plan that APD finalized in December calls for strengthening the relationship with Dartmouth-Hitchcock through a formal affiliation. It also proposes building a new multidisciplinary clinic where APD’s outpatient services would be located, and also where patients with acute care needs could be seen that same day.

Nothing will change with existing services for at least two years, Mooney said. The hospital will continue to handle births, even though an obstetrics task force concluded that the current model would jeopardize APD’s financial health if something did not change. However, APD is pushing ahead on its affiliation with Dartmouth-Hitchcock, which could be finalized at the end of the year, and expanding other services to make sure the hospital remains a stable institution in the community.

“Health care as an industry is changing and so we know that APD is going to change,” Mooney said. “There will be an evolution and the organization will look different over time. But we did not want that to occur in sort of a revolutionary fashion.”

Mooney has been making her pitch for APD’s plan at events with hospital staff and with the public over the past month. Wednesday’s presentation was to APD’s “incorporators,” local residents who serve as ambassadors between the hospital and the community.

Their questions yesterday for Mooney ranged from when the hospice facility might be built to what her feelings were on single payer. Mooney didn’t want to talk politics, but still shared her thoughts on why APD needed to evolve.

The current model is unsustainable, for all health care providers and not only APD. And as payment models change, whether through federal health reform or the independent initiatives providers are pursuing, hospitals large and small need to adapt.

Affiliation could help APD survive in a changing world where hospitals are not paid based on the volume of services they provide — called “fee for service” — and instead rewarded for eliminating unnecessary treatments and keeping people healthy, Mooney said. To make the model work, however, providers need a large pool of patients in which to spread risk. Affiliations between hospitals expand the pool.

New London Hospital affiliated with Dartmouth-Hitchcock last year, and both Mt. Ascutney Hospital in Windsor and Cheshire Medical Center in Keene, N.H., are pursuing similar partnerships with the region’s largest health system.

APD’s plan to affiliate with Dartmouth-Hitchcock prompted a number of questions Wednesday.

The details are still being worked out, but it will likely look like one that New London Hospital established, Mooney said. It would not be a merger. The community hospital will remain independent with its own board, though Dartmouth-Hitchcock would retain certain “reserve powers” over major governance decisions.

APD physician Paul Manganiello wondered about how the distinct cultures would meld, so that APD doctors were on the same page as physicians at Dartmouth-Hitchcock when it came to best practices, so that they weren’t overlapping efforts and ordering redundant tests.

It wouldn’t be easy, Mooney said. Physicians are used to having autonomy in their practices. She joked that physicians were the “worst employees in the world” for that reason.

“They are just horrible to deal with because they do whatever the heck they want,” she said.

The hospitals would need to forge a new relationship with physicians, she said, one in which the doctors do not see themselves merely as employees of the hospital, but rather share responsibility for governing it. The hospital is creating a “practitioner operations council” to bring physicians and administrators together to work through organizational questions, she said.

“I think it’s going to take a long, long time, but I think you’ve got to sit down with doctors and say, ‘How are we going to do this?’ ” she said.

Since the proposed affiliation was announced last month, some members of the public have worried about APD losing its tight-knit culture and sense of community. On Facebook, the reaction from Valley News readers was a mix of resignation and concern. One woman who said she had given birth to her two children at APD said she hoped it “wouldn’t lose the personalized care they are known for.”

In a letter to the Valley News published Wednesday, Mooney said she heard similar concerns about the affiliation representing the “beginning of the end” for APD, but said she believed it would help APD “remain a vital and vibrant part of the community for generations to come.”

Others in the room Wednesday agreed, saying that the overall plan — the affiliation, emphasis on senior care, etc. — was the right direction for APD.

“I think it’s terrific,” said Charlotte Houde Quimby, 75, a retired Lebanon resident who started the midwifery program at Dartmouth-Hitchcock. “I think it’s really the direction the institution needs to go in.”

Murray Washburn, of Etna, said he liked the emphasis on seniors’ needs and also the proposed clinic.

“I’m very impressed,” he said.

Mooney’s predecessor, Harry Dorman, was in the audience, as well. Dorman retired a year ago but has continued to watch the changes at his former employer. The strategic planning process began under his command in 2012.

He said APD’s approach was the right one for its patients, employees and the community. He doubted the affiliation would erode APD’s importance to the Upper Valley, citing New London Hospital as evidence.

That small hospital has so far managed to stay relevant to its community since it affiliated with Dartmouth-Hitchcock last year.

Still, he allowed, it would not be the same-old APD.

“It’s going to be different,” he said.

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.