Columbia County Health System in early stages of planning for assisted living facility
Creating smaller units of housing key to meeting individual needs
January 30, 2020
DAYTON—Columbia County Health Sytstem CEO Shane McGuire has announced plans to fill a gap in care for people who don’t need skilled nursing care, but who fail to thrive at home, with an option for assisted living.
The plan is to have two “units” built and located just to the north end of the CCHS campus. This would place residents close to the walking paths and health system resources, such as dietary services, he said.
“We have had conversations with more than one developer that would be willing to fund the construction of units in a phased fashion. The idea is that they would lease the facility to the Health System to operate,” McGuire said.
Each of the two “units” would house eight to ten people. He said five to seven additional “units” could be added at a later time, depending on the number of case mix requirements, and needs.
Case mix refers to people living with dementia, men or women who prefer gender-specific living arrangements and those who don’t mind a gender mixed living arrangement.
McGuire said working to create the right “fit” has a positive impact on overall patient satisfaction.
“People with dementia might require a more tactile environment with specific design elements that can sometimes aid in slowing down the progression of disease, or, at the very least, provide comforts to a mind that may not be wholly functioning,” said McGuire. “There could be other design elements needed to keep the early onset memory residents safe, that will not suit all residents.”
“The challenge with designing services for a small community is that there is not a large enough case group of any type to fill an entire wing, or 20-bed unit. This is why we are focused on smaller footprint designs,” he said.
McGuire said aging is often not as linear as people sometimes think. Many people age safely at home and don’t require a high level of support. Statistics show that 69 percent of people 65 and older will develop a disability before they die, and 35 percent of those will eventually need some form of care facility.
Five percent of people between the ages of 65 and 69 will have some form of moderate to severe memory impairment, which increases to 32 percent for people 85, and older.
Four percent of the population in Columbia County is over the age of 85, he added.
“While many feel that memory care is ‘heavy care lift’, in actuality it does not meet skilled criteria of care and actually meets an assisted living level of care,” said McGuire.
“A resident may come to us after failing to thrive at home and meet skilled criteria of care, and hospice in some cases, only to make a rebound under good care,” he said. We have had people stop meeting skilled criteria, but no longer have a home to move back to, or should move into assisted living. It is quite common for a resident to move between care areas, as aging creates a cycle of setbacks and recoveries. Being able to move a patient from assisted living, to acute in-patient care, for something like pneumonia, to skilled nursing and back to assisted living, as health and strength return is really an ideal scenario.”
McGuire said over the past four years there has been increased scrutiny from the State on what admissions qualify as meeting criteria for skilled nursing.
He said Medicaid has reduced the number of nursing home residents in the State of Washington from 17,225 to about 9,800. The reduction has been offset through State programs that favor in-home and community support systems, which have been used to great effect in urban settings. But rural areas, like ours, have lagged behind in creating community resources.
The State regulates assisted living facilities.
“To be sure, the daily rate will be lower than the current skilled nursing rate, but the State has also agreed to pay our Public Hospital District a higher daily rate for assisted living than they normally would, knowing that we are taking care of higher skilled needs patients, and that our workforce will remain largely skilled, as it is,” McGuire said.
“Many assisted living facilities can use lower licensed level care providers to reduce operational costs, but this is not the goal of our project,” he said.
McGuire said this plan provides an opportunity to reduce current losses for skilled nursing care for the health system, with losses averaging $1.6 million a year, and to care for the same people, while breaking close to even, financially.
“We are not looking for a profit, necessarily, but we are looking to sustain the level of care we currently provide while being able to add services for even more people in the community,” he said.
“Our board is very passionate about the concept of aging in place, and they have a strong desire to keep people in the community as they age,” said McGuire.
In fact, the Hospital District Commissioners and administration created a five-year Strategic Plan, in 2016, and Goal One was to implement new programs that meet community needs, including addressing gaps in service for people aging in our communities. A design concept for assisted living was to be accomplished in Year Two, with a facility developed in Year Five.
McGuire said he hopes to present some assisted living “solutions” and a cost analysis for the commissioners to consider at their annual retreat in April. The Board will need to approve the project in order for it to move forward, he said.