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APD Transitions Extended Care Facility to Skilled Nursing Unit

September 4, 2008 — Alice Peck Day Health Systems Corp. announced on Thursday, September 4, that it will no longer be accepting long term care patients at its Extended Care Facility, and that the facility will be phasing out long term care over the next 18 months to focus on providing skilled nursing and rehabilitative services.

“APD has a deep and successful history of providing long term care to the community,” APD President and CEO Harry G. Dorman, III, FACHE, said. “This was a difficult decision for our Health Systems Board to make, but after careful evaluation of cost and revenue, along with the growing demand for skilled nursing and rehabilitative care, we feel that the transition will help to sustain the hospital and better serve the Upper Valley’s changing needs.”

The landscape for long term care has changed. More care is being offered at home, with facility-based care increasingly used for short term stays and rehabilitation. The federal government and the state of New Hampshire have developed an increasing number of initiatives to keep people in their homes as they age, and short term skilled nursing and rehabilitative care are vital parts of this picture. “More and more resources are being expended in community-based care, focused on keeping people at home as long as possible, which is often the most favorable option for people,” explained Elizabeth Pomeroy, Administrator of the ECF. “Unfortunately, this means residents require much more support when they come to long term care, and they require more resources at greater expense.” APD has also seen a consistently increasing trend in the numbers of skilled nursing and rehabilitative referrals with more complex needs. The transition to a dedicated skilled nursing and rehabilitative unit will give the facility more resources to address this growing demand.

Over the last five years, APD has seen dramatic changes in its case mix and reductions in payments toward long term care. These changes have placed a significant financial strain on the health systems in recent years, with an annual loss of more than $800,000 in fiscal year 2007 alone. “As a small facility, it’s difficult to maintain a stable balance between short term and long term residential care, which means low reimbursements affect us more dramatically,” said Pomeroy. “Transitioning to a skilled nursing facility will give us greater financial stability, enabling us to continue providing high quality care.”

Pomeroy noted that the ECF is working to ensure that its 38 current long term care residents will find homes in other facilities over the next 18 months. “We have a great team of highly skilled staff who will work closely with residents and their families  (along with other highly regarded long term care, assisted living, and group home facilities) to find the most appropriate housing and care options. We will work diligently to maintain as normal a routine as possible for our residents during this transition.  It is our sincerest hope that we can honor the facility preferences and requests of our residents and their loved ones. We will fully support their transition and help them get settled into another facility. We do not plan to move residents receiving palliative care with a prognosis of 6 months unless they request a transfer.”

The ECF will continue to accept skilled nursing and rehabilitative patients during the transition. The Woodlands and Harvest Hill, APD’s retirement communities, operate independently of the ECF and will not be affected. After the transition is complete, the ECF will be a smaller facility with expanded rehabilitation services on-site.

There will be an overall staff reduction as part of the transition plan that will be addressed through the elimination of vacancies as a first step. “At this time, the earliest we anticipate that any staffed position might be eliminated is April 2009,” said Pomeroy. “We will encourage our staff to apply for other positions at APD, and there will be opportunities for staff to stay with the ECF and strengthen their clinical skills as we enhance the type of care we provide and strengthen our ability to provide increasingly complex care to the growing number of patients who are referred to us.” All employees will be supported throughout the transition. 

“We realize that this transition will be very difficult for our residents and staff,” Dorman said. “But we feel it is the best way to continue our mission of providing high quality health care to our community as a financially viable institution that responds to the Upper Valley’s changing needs.”