The Shut Out

Why have Humboldt County's skilled nursing facilities stopped accepting patients

The Spenceleys

Geoff Spenceley speaks with a warm, resonant accent, a remnant of his youth in England. The 93-year-old veteran of World War II has lived in Humboldt County for a quarter century. He has been married to his wife, Queenie, for 70 years. Queenie (her real name, she was born a few weeks before Queen Elizabeth II) was a factory worker during the war. She and Geoff met at a service dance, had a cup of tea, and sparked a courtship that led to a long, devoted marriage. They may spend their remaining days 680 miles apart.

Queenie has been turned away from every skilled nursing facility in Humboldt County. It's not because she's ineligible: The facilities accept MediCal, MediCare and private payment. It's not because they're full: Our research revealed plenty of open beds. It's not because she's too sick: Skilled nursing facilities are intended to serve patients with medical problems such as Queenie's. And it's not for lack of trying. Her husband, with the help of caseworkers, has repeatedly petitioned all six facilities to find a place for his wife. His only remaining choices are to drain their savings by having home health workers attend to his wife at a residential care home, or to send her to a facility in Huntington Beach, where their daughter lives.

"We have a house we've been in for 25 years," Spenceley said. "It's impossible for me to move out of it right away. I really don't want her far away from me. I'm desperate."

Spenceley's experience is not an anomaly. According to a statement from St. Joseph's Hospital, the organization that owns five of the six local skilled nursing facilities recently informed the hospital that the facilities would no longer accept its patients. (A sixth facility, Jerold Phelps in Garberville, has only eight beds and a long waiting list.) The company also severed its contract with the Program of All-Inclusive Care for the Elderly (PACE), leaving the program with nowhere in-county to place clients with needs too great to remain at home. Patients who need skilled nursing are being sent to Redding, Santa Rosa, even to Oregon. Individuals and organizations have been given any number of reasons for the shut out: not enough beds, not enough staff, the facilities are "just not admitting." But the real reason appears to be a game of financial chicken between the Partnership Healthcare Plan of California, the organization responsible for administering MediCal, and a nursing home mogul with a dubious reputation. And in this case, Partnership swerved first.

Due to privacy laws, it is difficult to quantify exactly how many people have been turned away, and how far back the problem goes, but the Journal spoke to patients who had to leave the area as far back as January. Suzi Fregeau, program manager for the longterm care ombudsman program at Area 1 Agency on Aging, said she has received at least a dozen calls from concerned family members who didn't want to send their loved ones far away. She is one of many who believe that the company that owns 449 of the county's 457 MediCal-certified skilled nursing beds has leveraged its monopoly into a higher rate of reimbursement from Partnership.

"They're essentially saying, 'Give us what we want, or we'll take our bat and ball and go home,'" said Fregeau.

Attempts to reach administrators at the facilities or at the main office of their management company, Rockport Healthcare Services, were unsuccessful. Samantha L'allier of the Fortuna Rehabilitation and Wellness Center confirmed that it's "not admitting at the moment," but refused to say why, directing us to public relations representative Sallie Hofmeister. Hofmeister said her client could not comment. Hofmeister also did not respond when asked why individuals and organizations had been told that there was a bed shortage, despite our counting 27 open beds between just two of the facilities.

The rumored bed shortage is just one of the excuses the company has offered. At least one caregiver was told the facilities could not provide the wound care her friend required, despite the fact that is exactly the kind of care they are federally certified and mandated to provide. Rumors have also spread about a staff shortage, which given the county-wide problem of attracting skilled medical staff, is not improbable. Staff turnover in skilled nursing facilities is high; wages are low. If a facility couldn't maintain the amount of licensed staff necessary to meet the needs of its patients, it would make sense to reduce workload in order to meet the mandated ratio of staff time per patient. If that is the case, however, Rockport isn't talking.

The Journal was unable to determine whether non-MediCal patients are still being admitted, although nationally there is a documented trend of such facilities prioritizing higher-paying, shorter-term MediCare patients. In some cases, clients are told there is a "limited number" of MediCal beds, which is illegal. If a facility is MediCal-certified, every bed is a MediCal bed. However, as in any other business, skilled nursing facilities have the right to refuse service to anyone they choose, without stating why.

On June 25, after several days of discussion with Rockport and other companies, Partnership announced it had increased reimbursement by 2 percent for long-term care providers across 14 Northern California counties. Partnership declined to say whether the rate increase was connected to what Fregeau has called "essentially a strike," but in a phone call Robb Lane, Partnership's director of governmental and public affairs, said Rockport had asked for something specific that he could not disclose. Lane said that the meeting and the rate increase were a "strategic intervention" that had been discussed at all levels, and that Partnership was committed to "supporting skilled nursing facilities and to making sure they make enough to run their business."

When asked whether the shut out pressed Partnership's hand, Lane said only, "Our goal has been and always will be to release people in close proximity to their families. I think this rate increase reflects that."

Lane also clarified that once the money reaches the facility, Partnership has no oversight over how it is spent. Those who know the owner of these facilities may be cynical as to how much money will actually be reinvested in patient care. (Continue Reading)

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The Shut Out