The San Juan Islands’ only live-in facility, with 24-hour nursing, is set to close at the end of November, but the community isn’t going down without a fight.
“I hope that we end up with a strong community-wide effort to figure out how to proceed with the goal to keep patients that need this care on island, not on the mainland,” said local retired doctor John Geyman at a community meeting.
About 100 people attended the citizen-led workshop to discuss options to save the Life Care Center of the San Juans, on Sept. 25 at the Mullis Community Senior Center.
Todd W. Fletcher, vice president of western operations for Life Care Centers of America, previously told the Journal the center will close on Nov. 30 due to financial hardship and a lack of qualified staff.
At the meeting, several attendees explained that the center was losing profits, quoting Life Care directors who allegedly pointed to low Medicaid reimbursements, as well as a drop in residents below the minimum number needed to stay afloat. However, no Life Care directors substantiated this information with the Journal.
Attendees at the meeting brainstormed ways to save the center.
Bill Williams, the chairman of San Juan Island’s hospital district, said funds to cover the services Life Care has provided could be subsidized through taxes. Citizens could vote on a new district property tax levy, or increase an existing one for a certain period of time.
San Juan County Public Hospital District No. 1 has one levy to subsidize Emergency Medical Services and one to subsidize the island’s hospital, Planned Parenthood, Prevention Coalition, and EMS’s paramedicine program. The hospital district covers the islands of San Juan, Brown, Pearl, Henry, Spieden, Stuart, and Johns.
Town of Friday Harbor Administrator Duncan Wilson spoke for his table members when he suggested implementing a county-wide tax, instead of one for the island’s hospital district. A roughly $.20 tax levy per $1,000 of assessed property value would generate roughly $1.24 million annually, he explained. Wilson said this would cost about $100 for a $500,000 house, per year. He added that he was not speaking as a town representative and exact costs to fund the facility would need to be calculated before exact levy figures were set.
The San Juan County Auditor told the Journal that levy funds could not be collected until 2019, if it passed in one of the next possible elections in 2018. The last election in 2017 is in November and ballots can no longer be edited.
Other solutions proposed by attendees of that meeting included: Merging a new skilled nursing facility with childcare; forming a nonprofit to oversee the facility to fundraise and receive government funding; and creating a task force to find solutions, that could possibly include all of the county’s public hospital districts.
At the public hospital district meeting a few days later, Commissioner Mark Schwinge announced that a task force has already been formed. So far, it includes members such as Life Care of San Juans’ Executive Director Janice Fisher and Administrator of the Village at the Harbour Evan Perrollaz. Williams suggested the task force could present updates to the hospital district board.
During that meeting’s public comment section, Fisher noted that the center is licensed in the state for 85 beds; if the facility closed and lost that licensure it would be “almost next to impossible to get those beds back.” In Washington, skilled nursing facilities have to prove the need for requested beds to serve patients.
At the Sept. 25 meeting, a Life Care Center employee explained that about 30 patients were turned away in the last few months because there was not enough staff to serve them. Fewer admitted residents would create less revenue.
One reason for the limited staff is because the state banned the center from training Certified Nursing Assistants for two years, starting in April 2016, after receiving a citation. CNAs are caregivers who take patients’ vital signs, as well as dress and feed them.
According to officials at Washington’s Department of Social and Health Services, the federally regulated citation did not prevent the facility from hiring certified staff, only training them onsite. However, the island’s isolation prevents the facility’s access to already certified nursing assistants, while the citation halted training interested employees already on the island.
DSHS officials said that, each day, the state requires about three hours of varied certified, direct-care staff per resident in skilled nursing facilities like Life Care. The center received the citation after an annual inspection in April 2016 concluded that it provided “substandard care.” The center received the same citation in October 2015.
The April 2016 inspection stated that a male resident with memory loss continuously entered a female resident’s room. He yelled profanities at her in her room twice in one week, during March 2016, stated the DSHS report, prompting her to call the police. He had made several previous attempts to enter her room, continued the report, and the woman felt the center’s staff had not done enough to prevent the occurrence. The man had a friend who lived in the woman’s room before her, but he recently passed away. The report stated the facility made no documented effort to help him grieve.
A San Juan County deputy reviewed the issue with staff, continued the report, and later, a social worker made “alterations” to the woman’s door to prevent the man from entering. DSHS staff questioned why the social worker would alienate the woman from other residents, but he assured them the woman “likes to stay in her room anyway.”
When interviewed by DSHS staff, Fisher and the director of nursing were unaware the man had tried to enter the room more than once, stated the report.
Life Care officials would not comment on the specifics of the report, but Fletcher issued the following statement:
“With any survey from the state department that we receive, we immediately respond with plans of correction…to correct the areas found to be deficient. It is very rare that any nursing facility receives a perfect state survey. Our residents and the care that they receive is always our top priority.”
Since the citation, the facility’s staff had implemented safety plans and education to prevent a similar incident, stated the report. DSHS could not confirm whether the sanction to prevent training CNAs onsite would carry over to a new nursing home owner.
Whether the facility is sold or closed and then re-opened, the process to meet state and federal regulations is lengthy. DSHS staff said requirements include completing a certificate of need with the state department of health; becoming licensed as a nursing home through DSHS; and becoming certified with the federal Centers for Medicare and Medicaid Services, if the provider wishes to receive payment from those sources. Variables such as these prevented DSHS staff from explaining how long it would take to re-open the center.
Since 1997, Life Care Center has offered 24-hour nursing, serving patients with diseases such as Alzheimer’s and Parkinson’s and inpatient and outpatient rehabilitation. It opened as a nursing home, under different ownership, in 1967. Life Care operates 220 skilled nursing facilities in the U.S.