Hospital Nursing Home May Close

Clough Center in New London Has an Uncertain Future

Valley News Staff Writer
Thursday, May 26, 2016

New London — Three years ago, Fay Bronstein sold her house in the Eastman planned community in Grantham and moved a few blocks from New London Hospital, where Eugene, her husband of 68 years, lives in the attached nursing home.

Eugene Bronstein has Parkinson’s disease, and his wife, then 87 years old, felt unable to continue driving 12 miles each way each day to visit him in the William P Clough Center for Extended Care in New London Hospital — especially in winter.

Fay Bronstein is now 90. Her husband, who is now completely immobile, has lived in Clough for 10 years. He has told his wife that her daily visits keep him alive.

Fay Bronstein has a new worry. New London Hospital, and its corporate parent, Dartmouth-Hitchcock, are about to decide whether to close Clough, where Eugene Bronstein and 33 other patients live and receive care. 

If Clough closes, Fay Bronstein doesn’t know what she will do. She believes her visits are a critical part of her husband’s care, but she doubts that she can manage daily drives to a more distant facility. And, she said in an interview at her dining room table, “I don’t feel I can move again.” 

Bronstein is not alone in her worries. Reports and rumors about the threat that Clough may close have led to what Marie Wiggins, whose mother has lived in Clough since breaking her hip two years ago, described as “an atmosphere of anxiety, confusion and fear” among patients, families and employees.

Michael Willits, the nursing home administrator, acknowledged the anxiety that Clough’s uncertain future has created for families, but said that hospital and nursing home officials have been “trying to talk people through it.”

“We’ve been very proactive in talking to the families and residents,” he said.

While some residents had kind words for Willits, their worries persist.

“I don’t want to be in a position that all of a sudden I have no place to place my husband,” said Nancy Brenner, of Newbury, whose husband, a retired furniture store owner, has received care in Clough for the past four years.

At issue is the future of a brightly lit, recently painted and newly re-carpeted facility where residents share “semi-private” rooms. The website of the U.S. Center for Medicare and Medicaid Services says Clough is licensed to care for up to 56 patients. A license on the wall at Clough lists the capacity as 58 residents.

For the past 18 months, a committee of senior managers from Clough and New London Hospital have been discussing the future of the 45-year-old nursing home. The committee will make a presentation to New London Hospital’s Board of Trustees at its June 16 retreat, according to Karen Zurheide, the hospital’s vice president for community relations and development.

A decision could be reached that day, or be put off, Zurheide said. Because the options had not yet been spelled out for board members, she said, “we can’t say what the presentation to the board will be.” 

Ultimately, the D-H board will have to sign off on any decision about the future of Clough. So far, there has been “no decision and no extensive review of what could be the utilization of the space” that would be left vacant if the nursing home closes, she said.

If it were decided to close Clough, Zurheide said, the management would work with patients and families to find other care: “An individualized plan would be developed for each resident.”

The hospital’s tax return describes the Clough Center as “a warm and caring environment for its residents who benefit from health services personalized to meet individual needs, including special meals, physical, occupational and speech therapy, personalized exercise sessions, and individual attention by highly skilled providers who have immediate access to the comprehensive services of a hospital and pharmacy.”

In an interview, hospital and nursing home managers were more downbeat. It’s “a tired facility,” said Lori Underwood, the hospital’s vice president for quality improvement and patient safety.  “It really needs an upgrade.”

The work needed is what you would expect of a four-decade-old facility, including the heating, ventilation and air conditioning system and windows, she said.

Clough has a two-star, or below-average, overall rating on CMS’ Medicare Nursing Home Compare website. Its health inspection rating is one star, or much below average.

Willits said that the low health inspection rating resulted from a “very challenging survey back in 2013.” That survey found restrictions on residents’ access to the bathrooms at lunchtime and failures to prevent and monitor pressure sores that had resulted in “actual harm” to isolated residents but did not cause “immediate jeopardy.”

The most recent survey, or inspection, was done by New Hampshire’s Health Facilities Administration in November. It found that occasional lapses in care planning and documentation had resulted in the “potential for more than minimal harm” to isolated residents. 

Willits said that the most important thing about the deficiencies identified in the recent inspection was that they did not reflect problems with the “quality of care.”

Clough fared much better on Medicare Nursing Home Compare’s ratings for its staffing levels and care quality and outcomes, both of which received five stars, or much above average ratings.

But Clough is struggling financially, according to managers. Although nursing home expenses are complex, hospital officials estimate that Clough, after including direct and indirect costs, is racking up about $1 million in annual losses, Zurheide said.

A recent tax return from the hospital showed a more positive picture. Clough had revenue of $4 million and expenses of $2.8 million, according to the tax return for the fiscal year that ended June 30.

The tax return showed that revenue exceeded expenses by $4 million, but that by other measures the net was only about $110,000, Zurheide said.

Zurheide said that “regulatory presentation rules determine what gets reported and how it gets reported” in the tax return, and the actual results — which are now included, but not broken out, in the much larger Dartmouth-Hitchcock audited financial statement — weren’t as strong.

Medicaid, the state-federal health insurance program for people who meet income and asset tests, pays for care for about two-thirds of the residents, Willits said.

The pending nursing home decision highlights the influence that D-H, the Lebanon-based health system, has in strategic decisions at its affiliate. At New London Hospital, which is building a new, $9-million clinic in Newport, the CEO is employed by D-H, and one-third of the board members are appointed by D-H, who “must ratify” the others.  

D-H officials were not available for comment on Wednesday.

Eugene Bronstein is a Dartmouth alumnus, his wife said. She noted the important role being played by the hospital with ties to his alma mater in deciding the fate of the nursing home he now depends on for care. 

There is now “a lot of anxiety” inside the walls of Clough, she said. “The insensitivity to the people who are vulnerable” is troubling, she added. Before a nursing home can close, public hearings should be required, she said, adding: “That’s on the record.”

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.