There are approximately 1,300 licensed skilled nursing facilities in California providing over 3 million people with care every year. As the population ages, the number of Californians spending time in a long term care nursing facility has grown. According to the California Health Care Foundation, the number of skilled nursing patients rose 7.2% from 2003 to 2007.
The Central Valley is home to several skilled nursing facilities, all offering a variety of care to its patients.
Meadowood Health and Rehabilitation Center is located within the 34 acre O’Connor Woods retirement community campus in Stockton. The Center provides both short-term and long-term residents with 24-hour skilled nursing care.
The 100-bed facility offers services not found elsewhere in the area.
“We are one of the skilled nursing facilities in Stockton with a secured dementia unit and as far as I know, the only facility providing aquatic therapy,” said Cathy Otte, Meadowood Administrator.
The resident centered memory care unit is called Harmony and provides up to twenty residents with care unique to those suffering from all forms of dementia. The secured area recently has been remodeled and re-landscaped to offer a calm setting for patients and their visiting families.
Meadowood’s therapeutic pool is available to resident patients, those receiving out-patient care, and members of the outside community that wish to join O’Connor Woods’ fitness programs.
“The benefit of aquatic therapy is that patients who are not able to bear weight after a hip or knee replacement, for example, can do exercises in the pool that they couldn’t do regularly. This often helps speed the healing and therapy process,” said Otte.
Vienna Nursing and Rehabilitation Center is located in Lodi near Lodi Memorial Hospital. This 150-bed facility provides 24-hour skilled care for chronically ill or short-term residents, as well as inpatient and outpatient rehabilitation services such as physical, occupational and speech therapy.
The facility provides Lodi’s only freestanding rehabilitation clinic offering inpatient and outpatient treatment. Vienna is also proud of a new therapy path under construction.
“We are the only facility in the region to feature a garden-like “texture path” that allows our residents and rehab patients to practice their mobility on a variety of surfaces including grass, river rock, stepping stones and a small bridge. This area is currently under construction, along with the expansion of Vienna’s rehabilitation center,” said Corey Wright, Vienna Nursing and Rehabilitation Center’s Administrator.
Long-term care providers have not escaped an impact from the troubled economy. While patient demand climbs, the dynamics of paying for skilled nursing care services have become complicated. Payment and reimbursement is expected to become especially complex with the not so distant onset of national health care reform.
Skilled nursing facilities currently receive payment for services either through government insurance programs such as Medicare or Medi-Cal or HMO and private payments. According to the California Association of Health Facilities (CAHF), 66% of California’s nursing facility residents rely solely on Medi-Cal to pay for their care, while Medicare covers less than 12% of all skilled nursing care in California.
The reported average cost per patient day for a skilled nursing facility in 2007 was approximately $210. In California, Medi-Cal reimburses skilled nursing facilities an average of $162 per day.
The fact that these insurance options are government-operated and play such a large role in the payment process for skilled nursing services is cause for concern.
“Medicare and Medi-Cal help both our patients as well as Vienna’s business model, as 60% of our business is covered by these insurance types. Of course, we are at the whim of federal and state budgets and when these are not in place, cash flow is disturbed resulting in myriad problems,” said Wright.
Meadowood Health and Rehabilitation Center is not Medi-Cal certified and relies on Medicare, HMO, and private pay, says Otte. The poor performing economy has resulted in a change of patient type at Meadowood.
“We have seen a decrease in private pay patients as a result of the economy, so we have increased the number of Medicare-certified beds we offer,” she said.
Along with carefully controlling expenses, the recipe has been successful and the facility’s business operations have faired well, Otte noted.
Vienna Nursing and Rehabilitation Center has turned to new offerings as its way of counteracting the negative economy.
“Vienna has seen this time as an opportunity to expand our services beyond nursing care. Earlier this year, Vienna added a new rehabilitation center to the facility. Demand has been so strong that we’ve purchased space adjacent to our building and we are in the process of tripling the size of our rehabilitation services with a new 2,500 square-foot gymnasium, occupational therapy and treatment rooms,” said Wright.
Still, looming national health care reform policies promise an uncertainty that all health care providers will need to reckon with. Although Wright says it is too soon to tell what the new legislation’s direct impact on Vienna’s business will be, the reform is here to stay.
“We are always at the mercy of federal and state health care reform. It’s been going on in our industry for decades. I believe our industry is proactive and always rises to the occasion and adapts in order to continue providing quality health care to those we serve,” he said.
One of the provisions within the reform will directly affect skilled nursing facilities. Accountable Care Organizations (ACOs) are part of the Patient Protection and Affordable Care Act signed into law in March 2010. They are defined roughly as groups of health care providers that are cost-accountable for the care they provide for a grouping of Medicare and Medicaid patients.
Skilled nursing facilities will take part within the ACO structure, and according to Otte, the ACO will be part of how these facilities receive referrals from hospitals.
“This is when our readmission rates to hospitals will come into play,” she said.
As part of the cost-accountability nature of ACOs, hospitals will not be reimbursed if they discharge a patient that is then re-hospitalized for the same condition within a 30-day period.
Otte says that because the ACO will be a part of how skilled nursing facilities receive referrals from hospitals, Meadowood is diligently tracking and analyzing its hospital readmission rates now.
“The unknown of the reform and the future of healthcare in general will be our major challenges moving forward,” said Otte.
For Vienna Nursing and Rehabilitation Center, the challenges are different every year.
“We’ve been locally owned and operated since 1967 — and I’ve worked at Vienna since 1987 — so I’ve found that each year brings unique challenges and opportunities,” said Wright.
Vienna’s owners continue to invest in the facility. They are tripling the facility’s rehabilitation services with new space, equipment and therapists.
“The challenge will be to attract new rehabilitation patients while continuing to deliver quality care in the most comfortable and modern environment possible,” Wright said.
Challenges and uncertainty aside, both Otte and Wright see the future as promising.
“Vienna’s management is very optimistic about the coming year and beyond. Given the continuously increasing demands for rehabilitation services and geriatric care, our expanding facility is poised for success,” said Wright.