Changes to come at HLRC

A few weeks ago, Hi-Line Retirement Center administrator Duane Murray wrote a letter in the PCN "Letters to the Editor" section explaining that many nursing homes have struggled to stay open even before COVID-19 was an issue, this week the PCN was able to catch up with Murray to talk about many of the changes that HLRC will be going through in hopes to stop the facility from shutting its doors.

Since his letter, Murray said that HLRC has started its change from a CMS (Center for Medicare & Medicaid Service) Skilled Nursing Facility to becoming an assisted living facility, which will become official on Monday, August 1.

Part of HLRC's new direction also includes a change to their current facility, which in a little over a month will become two separate facilities.

"The current assisted living and a different licensed facility where the nursing home is," Murray said. "The reason is so that we can meet the needs of the community a little better because we can license each facility for five Category B residents."

According to Murray, Category B includes traditional nursing home residents who are in need of heavier care.

Currently, HLRC has six residents that they consider Category B residents. In all, there are 27 residents at HLRC that are in need of assisted care.

"In the glory days, there would be 60, and pre-COVID, we were averaging 42," Murray said. "We could cash-flow at 42. Of course, at 27, you can't."

After the first two years of COVID, the facility has been averaging 30 residents.

Murray said that, in addition to low census, the requirements for a CMS facility are difficult to meet in rural America.

"Regardless of how big or small you are, you have to have a dietician on staff, you have to have an M.D. on staff, you have to have a pharmacist on staff, a MDS Nurse, Infection Control Nurse," Murray said. You have to have a lot of entities that are very difficult. Plus you have to have an R.N. on staff for a minimum of eight hours a day, and that is supposed to be increasing to having an RN present for 24 hours a day."

He said that a lot of days, HLRC has challenges meeting the RN requirement.

"As time goes on, the census has been down and I don't really see it rebounding a lot," Murray said. "We may be able to rebound some, but I don't see our census bouncing back to over 40 consistently."

Murray said that they had to start looking at alternatives, asking himself, what could the facility do to stay open and maintain services to the community as well as protect the jobs of the current employees at HLRC.

"You can continue as a Skilled Nursing Facility and continue to lose money every month, or you could try something different," Murray said.

Another thing that could keep numbers low for HLRC is the potential expansion of home-based assisted living services.

"There is a lot of talk about expanding home-based services to reduce the number of people in nursing homes," Murray said. "So now is the time to try and jump from a Skilled Nursing Facility to an Assisted Living Facility, but there is no guarantee that the money will actually materialize or when it will materialize."

Murray said that if HLRC continues its course as SNF, it will fail at some point.

"The way that I see it is, you can continue to do business as usual and lose money every month until you run out of money and you close the doors, or you can try to go a different direction and try something a little more creative and hope that it works."

Murray said that when he started running the facility five years ago, the facility was in bankruptcy, and there were doubters.

"There were a lot of people that thought that we couldn't make it work, and we made it work," Murray said. "Unfortunately, times are changing and you have to be able to change with the times. We are going to try to change with the times, weather the storm, and continue to provide service to the community."

As far as the building plans, the center will be physically split into two buildings that will be independent of each other. This will allow residents in the apartment wing (independent living) a chance to continue to live where they do. Both buildings can hold up to five Category B patients, as mentioned before.

Prior to the changes, HLRC was able to house 56 residents in the nursing home but to function as an Assisted Living facility, the rooms have been converted.

"We have converted all double rooms to private rooms," Murray said. "By converting them to private rooms, it limits us to 29."

Murray said that it is very different to market double occupancy rooms.

"In assistant living, you are trying to provide a more home-like environment," Murray said. "People expect or want their own room. They don't like to share rooms. I don't want to share a room."

One common question has been what the definition of assisted living is and will the change require current residents to leave.

"We are not anticipating that we are going to displace any of the current residents," Murray said.

He also explained who is covered under the new assisted living parameters; everyone currently at HLRC.

"Assisted living can vary greatly, from just some supervision, all the way to extensive and heavy care like Category B," Murray said. "The level of care can vary a lot."

In changing to a pair of assisted living facilities, HLRC will abide by state regulations, rather than the more complicated federal regulations.

"The biggest difference is that the nursing homes are regulated by the federal government, while assisted living facilities are regulated by the state," Murray said. "So the rules and regulations are a lot different... and user-friendly."