Lincoln County Healthcare provides both hospital and residential inpatient care in Boothbay Harbor and Damariscotta, as well as assisted and independent living options for seniors (see table).
Beds and types of care
Although patients might not, healthcare professionals distinguish between types of hospital beds and care given in those beds. Acute care inpatient beds are for serious, and usually relatively brief, episodes of illness or trauma.
Skilled care beds, also called swing beds, are for patients who no longer need the more complex care required by acute care patients. Skilled care can also be provided in nursing facilities, such as St. Andrews Village’s Gregory Wing and Cove’s Edge.
Since 2010, LCH has primarily provided skilled nursing care at St. Andrews Hospital and acute inpatient care at Miles Memorial Hospital. Prior to that, both hospitals provided both types of care.
Between 2005 and 2011, most (55 to 65 percent) of Lincoln County’s residents who received acute inpatient care did so in hospitals outside of Lincoln County. In terms of days spent in the hospital, over the same time period, Miles and St. Andrews accounted for about one-third of the acute inpatient days of Lincoln County residents.
On October 1, inpatient services ended at St. Andrews Hospital and are now consolidated at Miles. With this change, peninsula patients lost a close-to-home option for short-term recovery and palliative care. LCH CEO Jim Donovan said St. Andrews Hospital’s skilled bed daily census has averaged 10 patients since 2010, five of whom, on average, have been Boothbay peninsula patients.
Where Boothbay peninsula patients, who in the past received care at St. Andrews, will find inpatient care now and whether there will be enough beds to meet the county’s needs have been a matter of concern and debate since last fall.
Why not keep beds here?
Over the last year, LCH committed to investigating the option of providing more skilled beds in Boothbay Harbor to replace the beds lost at St. Andrews Hospital. “There was a strong desire and mandate from the board to keep beds on the Boothbay peninsula,” said LCH Board Chairman Pete Mundy, who retired from the board on September 30.
Last March, LCH filed a Letter of Intent with the Maine Department of Health and Human Services to increase the number of beds at the Gregory Wing from 30 to 48, at a cost of approximately $550,000 to $1,000,000.
But Donovan said that process ended when their consultants determined there was not enough demonstrated need to meet the state requirements or the large financial investment. “We don’t have waiting lists for beds and the patient volume is not there,” Donovan said.
With St. Andrews Village off the table, Mundy said the board initially pressed to retain skilled beds at their current location at St. Andrews Hospital, but upon further consideration dismissed this as a viable option.
“Looking at the reality of running a five bed unit at St. Andrews Hospital presents the same quality challenges we have faced there over the years,” Mundy said, “There would be no doctor in the building over night. The unit is old and doesn’t meet current code for skilled beds. It would not be safe; it would not be cost effective; it’s simply not good quality.”
“When faced with a hard decision like this, I try to put myself in the shoes of a patient,” current Board Chairman Jeff Curtis said, “I would want to be in a facility that had the staffing and resources to take care of me no matter what developed. A small, five bed hospital would simply not have those resources.”
Can LincolnHealth handle the demand for beds?
Because critical access designation offers significantly higher reimbursement, LincolnHealth chose to operate under St. Andrews Hospital’s Medicare provider agreement with a 25 bed limit, rather than Miles Hospital’s provider agreement, which allowed 38 licensed beds. The choice offers significant financial stability and allows LincolnHealth to reduce patient costs, but it further reduced available hospital beds for Lincoln County.
Donovan said the beds at Miles will be used for acute or skilled care as needed to meet patients’ needs and patients will be able to change from acute to skilled status without leaving their rooms.
Boothbay Region Health and Wellness Foundation President Patty Seybold has repeatedly expressed concern that reducing the number of licensed hospital beds in Lincoln County from 63 to 25 will provide too few beds for the county’s elderly population’s needs.
Are there enough beds to cover the acute and skilled care needs of the county? Past hospital data and recent experience indicate the answer is not always.
Using hospital occupancy data, LCH estimated a need for 23 beds to meet hospital inpatient needs. However, that analysis focused only on acute care bed data. Average acute plus skilled daily census data for Miles and St. Andrews show that in 18 of the last 24 months, the average monthly bed occupancy for the two hospitals when combined exceeded 25 beds (ranged from 20 to 37 over two years).
LCH Hospital Operations VP Cindy Wade said LCH plans to rely more on Cove’s Edge, and to a lesser extent the Gregory Wing, to fill the excess patient demand for skilled care. The Gregory Wing has six beds dually licensed for long-term or skilled care and Cove’s Edge has 22 beds licensed for skilled care.
Including the skilled beds at LCH’s nursing facilities brings the total number of beds licensed for acute and skilled patients to 53. But, occupancy data suggest that at times none of the Gregory Wing or Cove’s Edge’s 28 skilled beds will be available for short-term skilled care.
Occupancy rates at the Gregory Wing and Cove’s Edge have been consistently high for the last 10 years, with only one bed available on average at the Gregory Wing and two to three beds available on average at Cove’s Edge (see table).
Recent experience has verified the data. As of September 20, the Gregory Wing unit was full and last week, all available short-term care beds at the hospital and nursing facilities were full.
“As of September 25, we have capped our acute/swing beds at the allowed number,” Donovan wrote in an email on September 26, “Up until the last month, we have not had difficulties meeting capacity. However, we have had to transfer five patients in the last week to other hospitals due to no bed capacity. The demand is always up and down, and it has been up.”
Donovan said the 25 beds at Miles will be adequate to meet the long-term hospital inpatient needs of the county, but more skilled and nursing beds will be needed to meet the population’s needs.
“Based on the demographics of the county, we expect we will need to increase nursing home beds at some point in the future and probably the best place to do that is at St. Andrews Village,” Donovan said.
Donovan and Wade said they are working to develop a case to expand skilled beds that will meet state requirements. “We will be tracking the growth and change in need for skilled and nursing beds so we are in a position at some point in the future for an expansion at the Gregory Wing,” Donovan said.
When that future will become a reality is not known. In the meantime, there will be times when peninsula patients will not be able to access short-term skilled care and perhaps even acute inpatient care in Lincoln County.
Sue Mello can be reached at 207-844-3629 or email@example.com