Gayle Kvenvold, president and CEO of St. Paul-based Aging Services of Minnesota, the state’s largest association of aging services organizations, talked to the North Shore Hospital board September 15 about demographic changes that will affect the need for aging services and workers in Minnesota in coming years. With a cabin in Lutsen, she is also familiar with issues related to Cook County North Shore Hospital and Care Center.
People in the know can be found here and there throughout Cook County if you just know where to look. North Shore Hospital Administrator Kimber Wraalstad found one of them and invited her to speak to the hospital board on September 15, 2011.
Gayle Kvenvold is president and CEO of St. Paul-based Aging Services of Minnesota, Minnesota’s largest association of aging services providers, and she has a cabin in Lutsen. She knows a lot about how demographic changes are going to affect the need for services and workers in coming years.
Minnesota has the longest life expectancy of any of the contiguous states, Kvenvold said. In the 30 years between 2000 and 2030, the population of those 65 and older is expected to increase 100-300 percent.
The greatest numbers of senior citizens will be in the St. Cloud/Twin Cities/Rochester corridor, Kvenvold said. A lot of people migrate in their later years, returning to Minnesota from warmer climates and leaving rural areas as their care needs increase.
The workforce will have difficulty keeping up with the needs of older Minnesotans. “We’re often the largest employers in many of the communities where we’re sited,” Kvenvold said.
In the future, reimbursement for services may become based on outcomes such as fall rates, pressure ulcers, and customer satisfaction, Kvenvold said. Costs to the government will stay lower if people can stay at home with their families and receive services there, and integrating services may become a trend.
New technologies may become commonplace: Kvenvold talked about bed pads that monitor body temperature and boots that send electronic signals to people if monitors indicate they are about to fall. Home lighting systems that come on automatically on schedule may become more commonplace, and computers could send daily health checks to health providers.
The number of nursing home beds in Minnesota has been dropping steadily in recent years, going from 45,700 in 1995 to 31,400 in 2011. “Every year, about 800 nursing home beds are closed in Minnesota,” said Kvenvold. People don’t live in nursing homes today as long as they used to, Kvenvold said. In 2009, while the average length of stay was 248 days in Minnesota, half of the stays were below 27.5 days.
Some people believe that some communities have downsized too much, Kvenvold said, but Cook County did a good job getting to the right number of beds when it decreased its licensed capacity from 47 to 37.
Some nursing home closures have resulted from low occupancy rates, aging structures that would cost too much to rehab, and falling operating margins. The operating margins for Minnesota nursing homes attached to hospitals were in the negative numbers in 2010.
When nursing care facilities drop below 93 percent occupancy, Kvenvold said, they get penalized financially. North Shore Care Center’s occupancy has been down in the 80 percents, Wraalstad said, but it is expected to climb up into the 90 percents with the decrease in its licensed capacity. Even with good occupancy rates, reimbursement rates have not kept pace with operating costs. Kvenvold said that in most other states, facilities could charge more for privatepay patients than for Medicare patients, but not in Minnesota.
“It would be a real crisis for this community,” said Kvenvold, “if you couldn’t maintain your care center here.”
Kvenvold outlined several strategies critical access hospitals with care centers employ to keep nursing home services available:
. Downsizing and capturing state incentives to do so;
. Changing the ownership structure;
. Wage and benefit reductions;
. Selling or closing down.
“I haven’t given up on the possibility that we can advocate for some legislative relief,” Kvenvold said. “I have not given up on the notion that advocacy really does make a difference, especially when you have a tale to tell like Cook County does.”
The number of assisted living units, called “housing with services” (HWS), exceeds the number of care center beds in Minnesota by 25,000. Facilities average 40 units, but some are as small as five. The state has been cutting funding for housing with services, Kvenvold said.
To deal with these trends, service providers are trying to increase quality by giving patients more choices, bringing them more services, offering private rooms, engaging especially talented employees, and working in partnership with other service providers. People are being expected to cover more of the cost of their care as time goes by, Kvenvold said.
Care Center Resident Assessment Coordinator Mark Abrahamson said he sees an increasing need for memory care units for people who are physically too functional to need nursing home care. Kvenvold said the concept of adult day care is under-utilized. Places that offer this provide numerous services including things like bathing and physical therapy.
The key to success, Kvenvold said, will be to have a spectrum of services available in the community. She said she thinks North Shore Hospital has “made some really smart moves” in the last year.
Flu shots for employees
Administrator Wraalstad said that employees who decline flu shots this year would need to wear masks on the job. Patients receiving services from healthcare providers with higher employee vaccination rates have lower rates of flu-related illnesses and death, Wraalstad said. “We’re supposed to be leaders in this. People die from the flu,” she said. “It really comes down to protecting our patients.”
Sawtooth Mtn. Clinic endowment
Sawtooth Mountain Clinic board member Joan Abrahamson reported that the Frank Hansen estate has given the clinic $25,000 to start an endowment fund. Hansen was active on the clinic board.
Board member needed
This was Ann Rosenquist’s last meeting as a member of the hospital board. She has moved to Wisconsin. A replacement is still needed. Her district is the east Grand Marais district represented by County Commissioner Fritz Sobanja. The board thanked Rosenquist for her contributions.
Darrell Smith retirement
Administrator Wraalstad’s monthly management report stated, “After 25 years of employment and over 35 years of service to the ambulance [service], Darrell Smith has announced his decision to retire in January 2012. Currently, Darrell serves as the director of the ambulance service and also as our purchasing agent. …Even though he will be bored, we wish Darrell much happiness in his retirement.”
Leave a Reply