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Community-based health care


Fri, Jul 2nd, 2010
Posted in Health & Wellness

Health care needs occur in the lives of everyone. In the previous article, we explored the community efforts to keep health care close to home. The advent of Medicare and Medicaid encouraged the development of hospitals and nursing homes in small communities. Hospitals and nursing homes in larger cities were reimbursed at a higher rate than those in small towns. The discrepancy made it difficult for the smaller institutions to remain open, and many of them were forced to close. The people of the Harmony area were determined to keep health care close to home.

After Greg Braun was hired as hospital administrator, he began looking into possible collaborations with other institutions. The people of Harmony saw the advantages of affiliation with a large medical network. Affiliation with Lutheran Health Systems brought new opportunities to our local hospital.

In a July 1988 article, Greg Braun said, "Since Medicare changes in 1984, small rural hospitals have been treated at a big disadvantage in comparison to big city hospitals. If Lutheran Health System accepts the proposed affiliation with the Harmony Community Hospital and Nursing Home, the venture will be an addition to a Lutheran Health System network of healthcare facilities including nursing homes, hospitals and facilities for the handicapped in Iowa, Minnesota, and Wisconsin. Lutheran Health System is a parent corporation that merges health care systems to the benefit of everyone involved." The Lutheran Health System held two of the ten director positions on the Harmony Community Healthcare Board of Directors.

In the ten years from 1984 through 1994, Harmony Community Healthcare transitioned from being a city owned facility to being wholly owned by the Hospital Association with a lease agreement to the city. Additionally, there was the change in Medicare and Medicaid funding programs that focused on payment for the level of care determined by a complex system of patient care review. In July 1994, there was an announcement that Tweeten Lutheran Health Care Center of Spring Grove and Harmony Community Healthcare of Harmony were making plans to develop joint ventures for physical, occupational, and speech therapies, house calls, in-home counseling, community education, transportation, and specialty home health care. Bob Schmidt, administrator in Spring Grove, commented in an article saying, "We feel that the movement in health care is to maintain people at home, independently, rather than in an acute or long-term care setting. The federal and state governments are starting to explore this. We want to be proactive and offer people more choice, and the latest in health care initiatives."

These two administrators were clearly ahead of their time. They had visionary ideas for the benefit of retaining health care near home. The problem they encountered was that then and now the money to support community-based health care services continues to go to institutions of care and does not follow the person needing the services. In short, the money just wasn't in place to support the entrepreneurial efforts of these two administrators.

Despite all of these efforts and creative alternatives to support community based care, borrowing to pay operational costs had its toll on Harmony Community Healthcare. The census remained low, reimbursement was not friendly to small, rural health care settings, and debt began to accumulate. In August 2003, the hospital was closed and beds were converted to nursing home use. The nursing home had a loan with the city of Harmony with an outstanding balance of $100,000 and annual payments of $20,000. Additionally, Harmony Community Healthcare had a debt of $800,000 with Lutheran Health Systems/Gundersen Lutheran. New administration, support from the community and Gundersen Lutheran began the change toward financial stability. A News-Record article dated August 21, 2003, quoted new administrator Mike Maher as saying that Gundersen Lutheran was considering forgiving half of the debt.

Gundersen Lutheran did forgive a significant portion of the debt and by October 2010 the remainder of the loan will be paid in full. Currently, all the debt to the city of Harmony has been paid.

In November 2003, Mike Maher wrote a letter to the editor. In the letter he thanked the community and leadership team of Harmony Community Healthcare for a year that ended in the black "in spite of a record low census!" At that time, funds had been spent to improve the facility with stucco added to the exterior of the building, bricks replaced, and trees planted. Hospital rooms were remodeled with paint and new flooring, creating eight private rooms in the 45-unit nursing home. Physical, occupational, and speech therapy departments were moved to what once was a four-bed ward. Outpatient therapy was available for the first time to the community at large. It also should be noted that many of these improvements were made possible by a $9,500 gift from the Harmony Hospital Foundation. The Foundation has existed since the beginning of Harmony Healthcare and is one of the major donors. Hospital auxiliaries also have made significant contributions, of which the most recent was 40 cushioned folding chairs for resident rooms.

In February of 2009, Tim Samuelson took leadership as administrator of Harmony Community Healthcare. The person-centered concept of care is a major priority for everyone in the community. Relationships and the physical environment are critical to providing a home-like atmosphere. In the current environment of government limits for the cost of care for elders, private donations for the improvement to the building and grounds of Harmony Community Healthcare will be important.

Even though challenged by government reimbursement, the future looks promising for Harmony Community Healthcare. Healthcare continues to focus on maintaining elders in their homes or in community-based settings like Heritage Grove until long-term nursing care is completely necessary. Collaboration with other providers is becoming the "buzz" idea and Harmony Community Healthcare has the advantage of a long-standing collaborative arrangement with Gundersen Lutheran and Tweeten Spring Grove Healthcare. There could not be a better base from which to spring forward in to a new century of care services. The best part is that we continue to provide quality health care near home. It is no longer your grandmother's nursing home.

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