Care unit closure impacts nurses, patients
December 27, 2012
For the nurses serving in the Transitional Care Unit of the Sierra Nevada Memorial Hospital, news of the unit's announced closure just before the holidays was devastating.
"There are no severance packages or benefitted positions for any of us to get," said one registered nurse, who requested anonymity. "There's one full-time benefited position and six part-time positions, meaning the rest of us are going to be laid off."
Set to close in February, Sierra Nevada Memorial Hospital's TCU serves as an intermediary "step-down" stage for patients on their way from more intensive hospitalization to a long-term care facility or returning home, providing services not available at home, such as lab work, therapy and intravenous medicines to predominately senior patients.
The unit includes a 17-bed, licensed, skilled nursing facility that has an average of 14 daily patients who stay an average of 14 days each, a large portion of whom are seniors, hospital spokeswoman Debbie Plass said.
Area skilled nursing facilities expect to be able to absorb much of the impact of the closure by meeting patients' needs and also offering employment to laid off workers.
But the prospect of working in a skilled nursing facility leaves lesser pay and no benefits, according to the same RN.
"They're all telling us we can go to (work at) nursing homes," she said. "They pay 35 percent less and don't have benefits. Even if we get a job somewhere else, it's still a big cut. The (Certified Nursing Assistants) have a severance package in their contracts, but the RNs do not.
"I've lived in this community for 15 years, and I have a house here, and I'm going to lose my house. There's no place else to work. I also lose my health care for my entire family March 1."
In offering other positions to those employees affected by the closure, Plass said seniority is one component and that the hospital will do what it can do help employees find positions in other parts of the hospital or at skilled nursing facilities.
"The other thing is that I know it's out of the area, but should an employee decide to go to another location with (Sierra Nevada Memorial Hospital's provider) Dignity Health, all their benefits and wages stay current," Plass said.
Plass said a major reason the hospital is making such a decision to close the TCU is because of the high number of Medicare patients served locally, which results in less reimbursement to the hospital.
"Sixty percent of our patients have Medicare as their insurance coverage, and the reimbursement Medicare gives us for certain types of care has been reduced over the years gradually to the point that our skilled nursing patients couldn't cover the cost of care for that unit," Plass said.
Plass added that the cost of providing such care is higher at Sierra Nevada Memorial because of employee wages and benefits.
One of the frustrations with news of the Transitional Care Unit's closure was its closeness to the holidays, as the hospital announced the decision Dec. 6.
"It would've been nice when we were asking and when we addressed the rumors and we heard 'It's fine. It's fine,'" one nurse said, asking that her name not be published as it might impact her employment options. "To hear about it right before the holidays is an awful time, and we could've prepared, but now it's at the end of the year, and it's chaos."
Another nurse echoed the same sentiment, wishing the message of a potential closure could have been communicated earlier.
"If they knew we were on that boundary a couple months ago, they could have at least told us," the nurse said. "It's a consideration. People could have applied for positions out there."
Plass said the hospital is undergoing a time of change and the decision to close the TCU was made the day before the staff was notified.
"I think over the course of the last few years all the employees know this is a time of change, and there were rumors because this is a time of change and uncertainty for all of us," Plass said. "But there was never a decision made or determined before this time about the TCU."
After meeting with human resources and the union representatives, the registered nurses said they found that their contracts were without severance packages.
Among concerns raised by nurses and patients who spoke with The Union and who had either witnessed donations made specifically to the Transitional Care Unit or donated themselves, was where those funds would now be directed.
Plass said donations made to the hospital's foundation would go to other parts of the hospital.
"If there were donations, many times they are designated for the use of the highest purpose, so it would be up to the foundation and hospital to determine the allocation of the funds," Plass said.
One nurse said she has personally heard patients who were grateful for the facility, which gave them the ability to live with hope.
"So many patients have said that without this facility, they would've given up," she said.
Skilled nursing facilities, while subject to state standards, are unable to offer the same level of personalized attention as the Transitional Care Unit.
"In a skilled nursing (facility), there is one CNA to 10 patients. Here there is one CNA to five. There would be two RNs to 16 or 17 (hospital) patients compared to one RN to 30 or 40. Doctors only come once a month," a nurse said. "Here, there is an elevator to the Emergency Room, a respiratory team, a response team and the ER can immediately respond and doctors can come down."
Plass reminded that such ratios and numbers are subject to and approved by state standards and regulations.
"The skilled nursing facilities meet with state regulations and do have a physical medical director that checks in frequently and oversees patient care," Plass said.
Another nurse said certain types of procedures cannot be done at a skilled nursing facility.
"What worries me is that convalescent homes can't do CT scans, (ultrasound) studies, EKGs, blood transfusions," said another nurse.
Plass said in the event that a patient in a skilled nursing facility could not be accommodated with a certain service can be taken to the hospital's ambulatory care center.
"They can take care of most or all patients that we would have taken care of and still have the ambulatory treatment center if a facility wasn't equipped," Plass said. "We have a transport van that takes them here and brings them back."
TCU patient Pat Wise, who underwent a hip surgery, said she has seen firsthand the difference in care between a nursing home and the TCU.
"When I'm in a nursing home, the doctor can't visit or write orders. Doctors only come around once a month," Wise said. "Skilled nursing is less personal. (At the hospital) we get very personalized one-on-one care and interaction."
The closure will affect 24 nurses in the Transitional Care Unit of the hospital and impact other departments as well, although Plass said she has no definitive numbers yet.
"There are several departments that have been impacted that are having to rearrange staffing schedules and look at hours and so on," Plass said. "I don't know specifically how many hours or people, but I know physical therapy, environmental services, nutritional services and the pharmacy are all looking at hours and how they are going to reallocate them."
The future of the Transitional Care Unit's building is unknown, Plass said, but will likely be used as an office rather than for treatment purposes.
"There are currently no plans for what may go there in the future, but in the future, it will most likely be a clerical function rather than a clinical function," Plass said.
The facility will close Feb. 1.
"Wonderful people (at the TCU) help so much," said patient Sugar Ashe. "I'm just really against closing."
To contact Staff Writer Jennifer Terman, email firstname.lastname@example.org or call (530) 477-4230.
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