After listening to a Thursday, August 20, 2009 presentation from Tom Kooiman of Pope Associates, an architectural firm specializing in health and long-term care facilities and senior housing, the North Shore Hospital board voted to pursue a feasibility study on alternatives to the Care Center’s current operating model. Thestudy is expected to cost about $3,500.
The trend in long-term care, Kooiman said, is for people to have private rooms with private baths. More people are choosing assisted living and fewer are choosing nursing home care when possible.
Many facilities are offering a continuum of care starting with independent living and moving to assisted living and memory and/or skilled care, Kooiman said. Some assisted living facilities offer “kindred care” where 24-hour nursing services are available as needed. These are more common in wealthy communities and can accommodate husbands and wives who have different needs but want to remain together. Some churches and groups of churches are starting to develop continuing care campuses, Kooiman said.
Nursing homes once funded the hospitals they were attached to, Kooiman said. Now, however, nursing homes attached to critical access hospitals, such as the one in Grand Marais, tend to lose a lot of money. One reason is that these nursing homes tend to offer critical access hospital pay scales but do not get reimbursed by Medicare at the same rate. Howard Abrahamson said the care center has not received an increase in its reimbursement rate in four years.
Nursing homes are moving away from traditional floor plans with long hallways to smaller units that look and feel more like households, Kooiman said. Personnel are cross-trained and spend more time with a smaller number of patients, which both staff and residents prefer. Negative behaviors, falls, and medicine errors decrease in these types of settings.
North Shore Hospital loses about $1,000,000 a year because of the nursing home, Abrahamson said. Some nursing homes are dealing with this type of problem by selling or turning management over to outside companies. Another option to increase reimbursement dollars would be to integrate the clinic and the hospital, Kooiman said.
Dealing with an aging population will be important, Kooiman said, because “the silver tsunami” will start in 2010, when Baby Boomers will start retiring in large numbers.
Paramedic services
Dr. Sandy Stover recommended that the hospital consider hiring paramedics who could help provide advanced life support on ambulances. LifeFlight helicopters are not always available, she said, and the cost of receiving advanced life support from a paramedic on an ambulance would be cheaper for the patient than a helicopter transport. Having paramedics in the field would also enable more to be done for trauma patients before they reach the hospital.
Several community members are now receiving paramedic training, Stover said, adding that the emergency room seems to be getting busier as time goes by.
Ambulance service director Darrell Smith suggested that recruiting paramedics might be easier if they offered a staff position in the emergency room rather than trying to use them only on an oncall basis.
Hospital Administrator Diane Pearson said that she is working with Smith on creating an application for a paramedic position and will discuss it with the board when they have it completed.
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