Skilled nursing in the Central Valley

By Craig W. Anderson

The Central Valley has more than 20 skilled nursing facilities but what does “skilled nursing” mean, exactly? As there are approximately 1,400 licensed nursing facilities in California caring for more than 250,000 residents each year with 85 percent age 65 or older, it’s a business worth examining.

According to the California Association of Health Facilities (CAHF) a certified skilled nursing facility is “a place that provides those age 65 or over and many disabled people with daily skilled nursing care or skilled rehabilitation services, plus other medical services. And it has been certified under the Medicare Act to have met high standards for care.”

Skilled nursing facilities are needed because they provide the needed level of medical and round-the-clock nursing care for patients who do not require the specialized care of a hospital and in comparison, at a greatly reduced cost. This also frees up hospital beds.

The Turlock Nursing & Rehabilitation Center represents a typical Central Valley operation with 143 beds, a staff of 165 and the experience gained from 22 years in the business.

“In the Central Valley the industry is pretty stable regarding available facilities,” said Michael Darouze, administrator for the Turlock facility. “It’s difficult to build new residences due to strict government regulations that mandate the medical equipment and other special elements specific to skilled nursing operations.”

He made it clear that the regulations weren’t capricious but based on the type of construction and needs of a population requiring medical services.

Today’s skilled nursing operation is very much a one-stop for all needs, short or long term, according to Rhonda Kuntz, administrator for Lodi’s Arbor Convalescent Hospital which is part of the Pleasant Care and Emmanuel Convalescent Hospitals group with 25 locations across California and one in Nevada.

“There is always a consistency of residents needing care and as long as they need care, we’ll be here to give that care,” Ms. Kuntz said. “Arbor provides all of the needed therapies and services in our convalescent hospital.”

Founded in 1984, Arbor also has the Arbor Place Residential Care facility in Lodi and between the two locations they have 149 beds and 135 staff members.

Ms. Kuntz said the primary challenge she observes is meeting the needs of the wide diversity of residents requiring care. “Compatibility with roommates and other residents when everyone has different backgrounds and viewpoints along with differing expectations of the overall environment…we must meet the needs of everyone here and that makes for very interesting work.”

Anna Liza, director of nursing at the Beverly Chateau Convalescent Hospital in Stockton, said, “Our facility is good for everyone as we provide fair care” in meeting the diverse needs and opinions of the 99 residents.

She said the rising costs of operation don’t affect the service to the residents but that, too, is a constant hurdle to overcome. As part of the Beverly Living Centers – with two more Stockton locations – Ms. Liza explained that she has a passion for her work and expects her staff to feel the same.

“We screen our staff and conduct three interviews,” she said. “We choose the right person, one who is team oriented and shows the same passion of service to our residents.”

These operations are paid via Medical and Medicare which is important as it means they are certified under the Medicare program and therefore meet a number of standards, including: one or more physicians on call at all times; 24 hour nursing care services; protecting resident’s rights, maintain a high quality of care; have hospital transfer available; appropriate drug dispensing; maintain records; provide rehabilitation services; and serve adequate food to meet patients’ dietary needs, along with others.

Medicare parts A and B can help pay for skilled nursing care if a medical professional certifies the patient needs skilled nursing or rehabilitation services on a daily basis.

However, Medicare part A does not pay for skilled nursing facility services after the 100th day in a benefit period. If a patient cannot afford to pay for the care at this point, they may qualify for help under the state’s medical assistance plan.

With daily costs ranging from $136 to $165 some sort of financial aid and insurance is usually needed.

“There is a financial component for us as the care givers in that food and energy costs keep increasing and we have to achieve a balance by providing our care at a level that’s affordable,” said Mr. Darouze. “And that is becoming more difficult.”

He commented that finding qualified, licensed staff is “very hard but staff turnaround isn’t bad once we get them in the door. Our retention numbers are good.”

As do the other skilled nursing operations, Turlock Nursing & Rehabilitation Center conducts special activities for residents including a Father’s Day get together, a 4th of July bbq with family, residents and staff along with balloon volleyball games with other facilities once a month.

The Catholic Church also conducts weekly on site services.

Mr. Darouze is concerned about having enough beds to accommodate the future Baby Boomer generation who will become residents of his, and other, skilled nursing facilities.

He added that “our goals is to send people home and definitely to avoid the stereotype that once someone is here, they never leave.” In 2007 more than 300 healthier residents were sent back home or to assisted living facilities.

Regarding the future, Ms. Liza said every company has different procedures but that the Chateau Convalescent Hospital will continue to provide “excellent service to residents” including having 24 hour RN’s on site.

Ms. Kuntz confirmed the skilled nursing business is “very stable in the Central Valley” but perhaps a bit too stable as the last facility was constructed in 1997.

But with the state looking to cut 10 percent from the skilled nursing sector she said, “That would be a real hit that would significantly affect our budget.”

She agreed that retaining skilled employees can be difficult but can be done with a work environment that is fair, well managed and aware of the needs of both residents and employees.

The future may require more facilities be built to handle the anticipated rush of Baby Boomers into skilled nursing operations but for now their continued success in the Central Valley seems assured.