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It's not your mother's nursing home

Fri, May 21st, 2010
Posted in Health & Wellness

Introductory note from Mr. Samuelson: If it takes a village to raise a child, it takes a community to care for our seniors. This is the first of three articles that talks about how the Harmony and surrounding communities have built, adapted, and continue to support the timeless needs of those with special health concerns. Harmony Community Health Care is changing. Tim Samuelson, the innovative and dedicated administrator of HCHC, tells about the journey from a historical hospital institution to a home-like atmosphere of person-centered care.

No one has a desire to be in a nursing home. Just as no one has a desire to be in a hospital, clinic, rehabilitation center and the like. We simply like being healthy and independent. The need for health care, however, occurs in the lives of everyone.

In all of the health care settings, the desire of the provider is to send the person home as soon as one is able to live independently. As we age, we need more assistance in daily living, and one option is to move to a long-term care setting. A culture change initiative is altering how long-term care services are provided. This change is an effort to move from a culture of institutional and disease management medical services to a culture of home-like and person-first medical services. In other words, culture change in long-term care is a movement from an institutional model of care to a social model of care.

Today we are focused on the culture change towards a person-first, home-like approach to health care. The original philosophy of Harmony Community Health Care was to keep people close to home. That concept has not changed. In January of 1948, a committee chaired by Stanley Todd started to organize the project originated by the Harmony Lions Club. Membership shares for the hospital cost $25 each to people in the community. Soon they had the funds to purchase a building. The first Harmony Community Hospital Association was the Tollef Sanderson home on Center Street and Second Avenue. Local professional care was now available.

In July of 1961, there was a major culture change from home-based physician services to an institutional-based hospital service. Institutional services were funded by new government programs. They consisted of complex, regulatory requirements, no more home visits by the doctor, and new methods of medication administration. To meet these changes, it was necessary to improve the hospital building. A new committee from Harmony, Canton, and the surrounding area was formed to develop a plan for a 40-bed hospital and nursing home facility. The Harmony village paid for the hospital with municipal bonds and leased the building to the Harmony Community Hospital Association. It took two referendum elections to gain community approval for the bond issue. The final vote was 439 - 73. Bonds were issued at 3.65 percent net interest. Obviously, the citizens of Harmony had a sense of community pride working to build a new hospital.

Growth and change continued. In May of 1969, the community celebrated the opening of the new nursing home addition to the hospital. The addition cost $258,308.84 for the 41-bed facility that included three single rooms, 15 double rooms, and two four-bed wards.

By 1984, the Federal Deficit Reduction Act mandated that hospitals and outpatient departments must accept the percentage approved by Medicare as payment in full of hospital costs. Unapproved expenses could only be written off as a loss. The health care culture was changing again. The 1984 regulatory changes meant that people were hospitalized only for the length of time specified by the DRGs (diagnostic related groups). The challenge was to meet the needs of persons who required longer care. Again, unapproved expenses could only be written off as a loss. Hospital recovery stay became short term. Nursing homes developed rehabilitation centers in order to fill the gap of service. In the spectrum of health care, small rural hospitals struggled to stay financially solvent.

In Harmony, the long-term care nursing home was full and the hospital was struggling with empty beds. New options for revenue and for meeting the needs of the growing number of older people brought out new options for care. Respite care, swing(transitional) beds, and adult day care were developed. Such services continue to be provided by HCHC today. In 1988, administrator, Greg Braun proposed an affiliation with Lutheran Health Systems of LaCrosse, Wisconsin. Braun said that the affiliation with Lutheran Health Systems would provide Harmony Community Hospital and Nursing Home with the benefits of improved market share, allow for the continuation of diversified services, including medical care, outreach programs, and respite assistance as well as increased financial stability. To meet the needs of people in this challenging environment, collaborative efforts were necessary. Again, Harmony Health Care Systems looked to the community for support.

Look for more of this story of commitment and change in the next article about collaboration with Lutheran Health Systems and Gundersen Lutheran Clinic.

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