When St. Andrews and Miles Memorial Hospital merged into LincolnHealth in October 2013, Lincoln County not only saw a 24-hour emergency room converted to a 12-hour urgent care, it also lost 38 hospital beds.

To cover the bed shortfall, on Monday, Dec. 1, Lincoln County Healthcare applied to the Maine Department of Health and Human Services for 12 new nursing beds to be located at St. Andrews Village in Boothbay Harbor.

“As part of the Certificate of Need process, LCH will have to prove to the state that the project is not just necessary, but economically sustainable over the long run,” LCH Senior VP of Home Health and Senior Living Judy McGuire said in a press release.

St. Andrews Village’s Gregory Wing currently has 30 nursing beds that are licensed for both short-term skilled care and long-term care. LCH proposes to increase the number of dually licensed beds there to 42 and to build a one-story, 7,500 square foot addition with 12 private rooms, at an estimated cost of $2.8 million.

To cover the increased care needs, LCH will add one additional RN around the clock, two additional CNAs for day and evening hours, and one additional CNA for the night shift, as well as increasing hours for other support staff.

In its application to the state, LCH acknowledges the current unmet needs for inpatient care: “Since the consolidation of inpatient care at the Damariscotta campus, much of the need for community-based skilled nursing and rehabilitation therapy services has not been met locally.”

Between October 2013 and Sept. 30, 2014, LCH estimates it was forced to deny 139 out of 257 skilled nursing bed referrals due to a lack of beds.

Skilled nursing needs also affected LincolnHealth’s ability to provide inpatient care for acute patients. Between Oct. 1, 2013 and March 31, 2014, 34 LincolnHealth emergency department patients were transferred to other hospitals because there were no acute beds available.

The application concludes, “This lack of availability was not because of other acute patients, but due to skilled care patients in swing beds that could not be placed in skilled nursing facilities.”

In its original 2013 Letter of Intent, which was withdrawn, LCH proposed 18 new beds at the Gregory Wing. LCH said it has reduced the number of beds to both meet the anticipated need and financial requirements.

“Our formal demand analysis showed that 12 beds would be a financially feasible number and would accommodate the average number of patients we formerly served on the St. Andrews campus,” LCH VP Scott Shott wrote in an email. “Financial feasibility is one of the primary factors the state uses to approve a Certificate of Need application.”

Shott said LCH investigated the possibility of a two-story addition but rejected this option, primarily due to costs. “A two-story expansion would substantially increase the building cost without any reimbursement until and if beds were placed in service,” Shott wrote. “Provisional infrastructure such as an elevator, would reduce the number of beds available on the first floor.  The ability to share clinical staff between floors is extremely limited by regulation and would greatly increase the cost of care.”

With the projected demographics of Lincoln County, LCH expects, even with the addition of 12 new beds, there will be less nursing beds per 1000 individuals over 65 years old in Lincoln County in 2019 (17) than there are today (18). More beds may be needed in the future, but Shott said they are unlikely to be accommodated at the Village.

“Depending on how long-term care is managed in the future, we may need to add more beds. We will also need to determine the best location for them,” Shott wrote. “Due to conservation easements (at St. Andrews Village), we have limited available land around the existing building and don’t have the physical space to add any more beds.”

The Boothbay Region Health and Wellness Foundation said they were thrilled by the announcement. 

“This is a very happy day for us,” Foundation VP Jane Good said. “The foundation started in April 2014 advocating for the community and we have fought tirelessly for these beds. This means that people will be able to heal, rehabilitate and spend the end of their lives at home. We thank Lincoln County Healthcare for listening to the community.”

“We still have a few steps in the process before we make the final decision to build,” LCH President Jim Donovan said. “But this important milestone signals our very sincere intentions (to both the state and the community) to expand these services in the Boothbay region.”

Shott said DHHS is likely to decide on LCH’s request within three to four months.