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Windsor Hospital to Close Nursing Home

Windsor — Nearly two dozen nursing home residents in Windsor must find a new place to live in the coming months after Mt. Ascutney Hospital and Health Center announced it would close its nursing home Sept. 1 because of lower funding from Medicare.

The 25-bed facility had been facing financial difficulties for years, but a 2 percent cut in the hospital’s Medicare funding scheduled to take effect April 1 pushed the situation over the top and forced Mt. Ascutney to cease providing nursing home care, hospital CEO Kevin Donovan Donovan said yesterday.

Hospital officials informed the nursing home residents, their families and staff Tuesday night and told the rest of the hospital yesterday morning. In all, 23 residents and 35 full- and part-time staff will be affected, Donovan said.

The decrease in Medicare funding is part of the federal spending cuts known as sequestration, and will result in about $500,000 less annual revenue for Mt. Ascutney. Donovan said the hospital was also hampered by a 3 percent revenue growth cap set by the Green Mountain Care Board, the regulatory authority created by the state in 2011 to oversee hospital budgets and help rein in health care costs. The cap restricts the hospital’s ability to boost patient revenue in other areas in order to make up the Medicare shortfall.

The decision to close the nursing home was a difficult one, Donovan said. But, when looking at how Mt. Ascutney could absorb Medicare cuts with the least amount of impact to the community, the nursing home was the obvious choice.

“We need to continue to focus on where the greatest demand is and where people have the greatest need,” Donovan said. “It doesn’t mean (nursing care) is not a great service. It doesn’t mean we don’t provide wonderful care. ... It just really means, unfortunately, if we want to stay open, sustainable long term, we need to focus on where the greatest community need and impact are.”

Mt. Ascutney sees about 15,000 patients at its physician provider clinics every year and 11,500 at the hospital, Donovan said. There are also 4,000 patients who come through the emergency room. That compares to the approximately 33 nursing home residents who are admitted to Mt. Ascutney every year.

Closing the nursing home will improve the hospital’s bottom line by $1.2 million, Donovan said. That money will go to other services, including an expansion of its inpatient rehabilitation program. That program will occupy the nursing home space when it closes.

The priority now, however, is finding new places for the 23 residents to live, Donovan said. Mt. Ascutney has been working with the state and local organizations to place them in other homes.

Residents’ relocation will be handled on a case by case basis, Donovan said, and depend largely on a person’s needs and what is available.

Nursing home administrator Barbara Voorhees said information packets would be sent out to residents and their families soon to help them learn about the other places where they might relocate. She is encouraging them to visit other long-term care facilities and make a list of their favorites so that Mt. Ascutney can help refer them to a place that will suit their needs.

“One of the things I can do is help that process go the smoothest it can,” she said. “We don’t want families to have to worry about all the details they shouldn’t have to worry about.”

The options for nursing home care in Vermont have dwindled over the years as the state shifts emphasis toward less intensive home-based and assisted living situations.

Two other Vermont nursing homes closed last year — McGirr Rehabilitation and Nursing Care Center in Bellows Falls, and Prospect Nursing Home in North Bennington. As of last December, there were 3,237 licensed nursing home beds in the state, including those that do not accept Medicaid, according to the latest figures available from the Vermont Department of Disabilities, Aging and Independent Living. That number is down from 3,475 in 2005.

The state has a goal to have half of its residents with long-term care needs in nursing homes, and the other half in less-intensive, home and assisted living communities.

Vermont has just about achieved that equilibrium, said Laura Pelosi, who handles government relations for the Vermont Health Care Association, a group that represents nursing homes in the state. The concern now should be on maintaining quality of care and making sure the state has enough beds to support Vermont’s growing elderly population.

“The focus on the number of beds really isn’t appropriate,” Pelosi said. “With the aging population and high acuity we have at nursing homes, we need that resource to remain viable. ... Our perspective is that the focus should be on quality and not bed reduction.”

The revenue growth cap, while perhaps challenging to hospitals, is not the only financial pressure they face, said Green Mountain Care Board Chairwoman Anya Rader Wallack. Every hospital needs to look at ways of cutting costs and being more efficient, and the cap is one way of pushing hospitals to do that, she said.

“We’re very concerned with the fact that health care costs have been growing faster than income growth and our ability to pay for health care,” she said.

Mt. Ascutney has been working with other nursing homes to see who might be able to accept residents over the next four months. The ability of other providers to do so could become an issue, however.

Cedar Hill Continuing Care Community in Windsor is one of the organizations Mt. Ascutney has been working with. Cedar Hill has 39 nursing beds, 38 of which are currently occupied, said Patricia Horn, Cedar Hill’s administrator and co-owner. Five Cedar Hill residents are there on a short-term basis for rehabilitation, which would open up a few beds, but Horn said she could not take on all of Mt. Ascutney’s residents.

“No one thinks we could accommodate all 23 residents,” Horn said. “And not all of them will want to come to Cedar Hill. This is really going to be a decision by the residents and the families.”

Cedar Hill is hoping to build a two-story addition that would add 40 beds for assisted living and memory impairment care. Also, Mt. Ascutney is exploring the potential to transfer 11 licensed nursing home beds to Cedar Hill, Donovan said. All of this requires further planning and regulatory approval from the state that is unlikely to be finished by Sept. 1.

Even if the state signed off on the transfer of beds to Cedar Hill, the nursing home would need to make sure it was financially viable, Horn said.

“When Mt. Ascutney started talking to us, we said of course we’ll consider it,” she said. “But we have to see financially if it’s feasible.”

Nursing home care is very expensive, requiring staff and facilities that less intensive options don’t. Voorhees said 80 percent of Mt. Ascutney residents are on Medicaid, which does not reimburse the full cost of care. And as reimbursements continue to get cut, the financial outlook for nursing homes gets dimmer.

Mt. Ascutney has cut the number of nursing home beds several times over the years, going from 66 originally down to 50, and then reducing the number to 25 in 2007.

Donovan hopes to retain as much of the staff as possible. Existing employees will get first consideration for any open positions elsewhere in the hospital.

“My hope and my desire is that as many of those 35 people that work here today can still continue to work here on Sept. 1, albeit maybe in different roles or departments than they do today,” he said.

One of them is Mary Desmarais, who has worked at the nursing home for 39 years. As a case manager, she helps admit and discharge patients from the facility, enroll them in Medicaid and attends to their other needs.

Yesterday was a difficult one for Desmarais and the rest of the staff, some of whom have family members in the nursing home. Desmarais is proud of the work she has done and the level of care the nursing home has been able to provide. Large banners proclaiming it U.S. News and World Report’s “Best Nursing Homes 2011” still hang around the hospital.

Desmarais said she hoped to continue working at the hospital. She understands the financial pressures on Mt. Ascutney, and while she wasn’t surprised at the closing, she was nevertheless disappointed.

She will be working with patients and their families to find other accommodations over the coming months, even as she navigates her own questions about where she’ll work after the facility closes.

“Personally, it’s difficult,” she said, her eyes reddening. “It certainly has been a lifelong passion. I would say I’m very dedicated to this facility. ...

“It’s been wonderful.”

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