Part 4: Crisis in Long-term Care

Nursing homes need to change . . . and need the money to do so

This article submitted by Michael Jacobson on 1/3/00.

Rising life expectancy rates and aging facilities present a two-headed problem to nursing homes.

The life expectancy for Americans has risen by 30 years in the last century. This - along with the upcoming retirement of the baby boomer generation - presents a growing pool of older Americans.

In 1900, the life expectancy of Americans was 47 years. By 1998, Americans could expect to live 77 years. In the future, the expectancy should be even longer as medical science continues to prolong life.

In another decade, the 77 million baby boomers in the nation will start to retire. In the next 30 years, the number of Minnesotans older than 65 will double, according to the Long-Term Care Imperative.

This trend points to a growing need for long-term care. "We all know what our demographics look like," said Tom Kooiman, administrator at the Good Samaritan Care Center in Paynesville and the Hilltop Good Samaritan in Watkins. "We have an aging population. There's going to be a need."

While Minnesota's long-term care facilities face a larger market and an increased demand for certain services, their ability to expand or remodel to meet these future needs is limited.

Because the state had an excess of beds in the early 1980s, the Legislature placed a moratorium on the building of any new beds.

Now facilities face a double-edged sword, according to Willie LaCroix, administrator of the Paynesville Area Health Care System.

A new generation of older Americans will present new demands for nursing homes, and facilities want to transform. "But to do that, you've got to have money," he explained.

Nursing homes are one of the most regulated industries in the nation, Kooiman noted. This not only creates paper work snafus for the staff, the government restrictions have limited change in the industry. "Because we are so regulated we haven't been able to evolve to meet consumer needs," he said.

Koronis Manor project
The Koronis Manor opened 36 years ago in 1964. Its residents generally grew up sharing a room (maybe even a bed) with a sibling, lived through the Great Depression, and were accustomed to taking a weekly bath.

In the coming decades, its residents will have grown up watching television, taking showers, and with very different notions of privacy.

"In all nursing homes, we're going to see a lot of changes in the next decade," architect Richard Engan told the hospital board in December, when the board voted to proceed with a $6.78 million remodeling project at PAHCS.

With more options for care - assisted living and in-home nursing - the skill level in nursing homes is increasing, requiring more room for wheelchairs in dining areas, bathrooms, and tub rooms, Engan added.

At the same time, the environment needs to be improved to a place "where you want to go," said LaCroix.

"One thing no one mandates is to make it feel like a home," added Engan.

Originally, the remodeling plan at the Koronis Manor included a new wing and carried a price tag of almost $3 million. The idea was to build new, larger double rooms and turn the existing rooms to singles to provide more options for privacy.

Right now the Manor has only four private rooms. The plan would have increased that to 28. Even then over half the residents would have had to share a room with a stranger, but at least there would have been greater turnover.

The Good Samaritan Care Center put six beds on layaway last fall to create six more single rooms in their facility. They now have 16 private rooms.

That $3 million plan for the Koronis Manor faced cash flow concerns, but was killed because of the moratorium. PAHCS applied for an exemption, but the state doesn't approve exemptions without a decrease in the number of beds, said LaCroix.

Without that exemption, PAHCS could never have recovered its investment in the facility through their state set reimbursement.

The PAHCS remodeling plan was redone to divide the nursing home project into separate projects. LaCroix hoped to keep the Manor portion of the project below an $800,000 yearly exemption. But the need to redo the roof, to put in a sprinkler system, and to provide the ventilation and sewer and water infrastructure for an extra wing in the future is expected to cost over $1 million.

LaCroix said most of the changes in the upcoming project will not be easily noticed. The dining room will be enlarged, two tub rooms will be added, and three expanded handicap bathrooms will be created, but most of the cost will be above the ceiling or below the floor.

One infrastructure change that represents the expected change in demand is the wiring of the Manor for computer access. Putting in the wiring now, with the other infrastructure, will be less costly and will allow PAHCS ultimately to accommodate residents who want Internet access.

This project will lay the groundwork for more substantial changes to the resident rooms in the future. Eventually the Manor would have more private rooms, more smaller lobbies and patios, and showers instead of baths.

"You don't want to be remodeling too often," said Karen Ampe, director of nursing at the Koronis Manor. "You want to get it right the first time."

Unfortunately, PAHCS wants to do just that, but the long-term care financing doesn't add up.

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