and CAITLIN COOK
and CAITLIN COOK
Faced with a choice of closing the respiratory care unit or closing the entire facility, the administrator of Valley Renaissance Healthcare Center in Boardman chose the first option.
That decision was approved last week at an Ohio Department of Health appeals hearing, and Valley was officially allowed out of the respiratory care business.
Fourteen residents of the respiratory unit were informed Oct. 12 that they would need to relocate due to the closure, and most had. But two residents, Mike Fishel and Doris Floyd, appealed the decision.
Hearing officer Donald Jaffe of Cleveland sided with the nursing home, concluding that because Valley Renaissance was terminating its respiratory care unit, it wouldn’t be able to meet the needs or ensure the welfare of those residents any longer.
“They said their choice was either keep the status quo — they said to do that, it would be a financial collapse,” said Jaffe.
Besides closing the respi- ratory unit, the facility’s restructuring plans include closing the first and third floors and laying off 50 percent of its staff. It’s unclear how many employees will be let go, but the number of residents will be reduced from 99 to 45.
As far as Fishel is concerned, this will be the third time he has had to move because a respiratory unit has closed. Originally from Summit County, he lived in facilities in Akron and Canton facilities before moving to the Boardman facility.
Valley Renaissance residents who received discharge notices were given three possible locations – Caprice Healthcare in North Lima, Beachwood Pointe near Cleveland and Canal Pointe in Akron. The latter two are operated by Valley Renaissance’s parent company, Provider Services, which also owns more than 100 other facilities across Ohio according to its website.
Fishel has moved out of Valley Renaissance. Attempts to contact him by email were unsuccessful.
Doris Floyd’s plans were not available. More than half of the 14 ventilator patients had left before the hearing.
The hearing outcome reflects a growing trend of facilities absorbing cuts in Medicaid and Medicare reimbursements by eliminating higher-cost care specialty units.
Nationally, there was a surge of closures between 2009 and 2011, said Gene Gantt, chairman of the long-term care section of the American Association for Respiratory Care.
“We had seen a trend of [respiratory care programs] closing down after 1998, when reimbursement changed. Now we’re starting to see some of the units closing in states where reimbursement is lower than the cost of care for these patients,” said Gantt.
“The data we have on Ohio vent units doesn’t seem to support that national trend,” said Tess Pollock, public information officer for the Ohio Health Department.
From 2006-08, there were 44 respiratory units in the state.
That number dropped to 34 in 2008-09 and remained steady until 2011-12 when there was a spate of closures leading to just 24 units in the state.
Ohio underwent Medi-caid cuts in 1999 and 2011.
Medicare and Medicaid use a formula that includes levels of patient care, local tax rates and quality measures to determine how much each facility will be reimbursed each day.
Michael Rescineto, the administrator of Valley Renaissance, said the cuts at Valley Renaissance resulted in a 6.66 percent decrease in per diem Medicaid funding.
So, while the facility received $160 per patient each day in 2011, it now receives $152 per patient each day.
The losses have been adding up.
Rescineto testified that in 2010, the facility lost $136,000.
In 2011, the number increased to $504,000.
So far this year, the facility is $218,000 in the red.
Also, the cost of supplies for the respiratory unit increased 33 percent.
“The Medicaid reimbursements haven’t kept pace,” Jaffe said.
“As the individual who started the Respiratory Program 11 years ago here at Valley Renaissance Healthcare Center, it was an extremely tough decision for me to make to discontinue this service ... At no point will a resident be left without a place to go,” said Rescineto in a written statement when word became known of the unit’s closing.
Janet Lowder, a certified elder law attorney with the National Elder Law Foundation, explained that closing a costly respiratory unit wouldn’t hurt the facility financially with penalties or affect its license.
“Ventilator care is unique in that it requires such specialized care, and it is a costly program to run. Long-term care facilities are not required to offer this type of program. It doesn’t hurt their license if they don’t have a ventilator program.”
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