April 13, 2008

Close to Home
Columbia Basin operators work to create a home, not institution

By ED COX
of The Dalles Chronicle

The progress made at Columbia Basin Care Facility during the last five years is all over the walls.

It’s in the broad, colorful striping that brightens the remodeled hallways, in the inset paintings of gorge landscapes that decorate the elevators, in the individualized room decor and the homey wallpaper that adorn dining rooms, TV rooms, sitting rooms and any number of other common areas.

And you miss it when you walk from a remodeled wing into one of three not yet done. There, the lighting is flourescent, insufficient; the feeling cold, institutional.
“It’ll never be really home-like” says manager Ron Bell of the largely refurbished facility, “but you try to do things...”

To de-institutionalize it, is what he’s just finished saying. That was the motivation behind nixing the trays in the downstairs dining room and instituting a menu-based service.

It was also part of the motivation, nearly three years ago, for re-opening the upstairs floor. Demand didn’t justify it, but those running the facility wanted to open up more space for private rooms and the kind of common areas that make a home more livable.

It’s all part of a “culture change” at the institution that is placing quality of life alongside quality of care.

And it’s made a facility that was once a “poor farm” in the words of one of its board members and a “warehouse” in the words of another into something quite different.

“It doesn’t smell like a nursing home,” says Bell, reciting one of the many positive reactions he receives about the facility.

But those are only the most noticeable things that have happened at the home over the past five years or so. Less visible are a recent roof replacement, the earlier swapping out of an antiquated backup generator and the placement of electric beds in all rooms.

And less visible still are the administrative and financial struggles the facility survived in the years before that, when its direction was first handed over to a private, non-profit organization.

And the passion of those who would not let it close.

The home was built by the county in 1964, added onto in 1973 and was the only remaining county-operated nursing home in the state at the time the reins of operation were turned over in 1997. And for good reason: it was losing its owners over $200,000 a year, a number that was projected to rise quickly to $500,000.

The county, unable to afford it but loathe to relinquish local control, sought community help rather than a private buyer. Five people — Mike Courtney, Linda Omeg, John Byers, Guy Mosier, and David Huntington — responded to the call; of those, the first three remain on the board, having been joined mid-way by a fourth, Carla Chamberlain.

When they arrived, board members found threadbare sheets, a generator too old for replacement parts, a shabby parking lot and scruffy lawn — in addition to the financial mess.

“I think we’ve done pretty well to go as far as we have,” says current chair Byers, perhaps with a flair for understatement.

But it’s a success story that almost wasn’t.

According to Courtney, the board went through three or four managers that didn’t work out. By then, they were having to borrow against accounts receivable just to make payroll each month, and were probably two to three months from having to close the doors and send 50 or more patients outside the community.

It was then, in practically the darkest hour, that Byers was approached by Troy Anderson. Anderson had been the operations manager for 11 homes run by Evergreen, including the one in The Dalles, before striking out on his own as Aidan Healthcare, Inc. and purchasing a home in Albany and another in southwest Oregon.

He needed a third to make viable some things he was trying to do. Columbia Basin wasn’t for sale, but the board, after much conversation, contracted with Anderson for operations. He turned right around and hired Ron and Monica Bell, who were working at Evergreen, as on-site managers.

The combination has been formidable. Under the Bells, Columbia Basin received two citation-free surveys in the first two years.

“You don’t get three in a row,” Courtney says, explaining that Medicare gets really tough on the surveyors if they don’t turn up something. The most recent survey, he said, yielded three “nickle-and-dime” things. All have praised the “caring atttude” that Courtney says the couple have infused the facility with.

Immediate changes at the home under the new management also included a significant reduction in payroll. Within 2-3 months, the nursing home that almost closed was in the black.

Courtney credits Anderson with that.

“He’s good,” Courtney says. “He understands the business very well. And he’s very compassionate, unlike a lot of nursing home folks.”

Compassion — and passion — are clearly what drives the board, even if Courtney was forced to conclude that the seasoned businesspeople who sit on it didn’t know how to run a nursing home.

They do, however, know something about the kind of environment they’d like to see — and that’s because they’ve all experienced it at close proximity.

Courtney, Byers and Chamberlain have all had a parent live and die at Columbia Basin, and many of Chamberlain’s friends and relatives have also passed through its doors. Meanwhile, Omeg’s father-in-law and grandmother were both at the home, in the early 1990s and in 1974, respectively.

All agree the care was excellent, but that changes made more recently would have improved the quality of life for their loved ones.

“It could have been something more pleasant for her,” says Chamberlain of her mother, who was in a three-bed ward. “But that’s the way things were,” she says of the room sharing.

“That’s the way it’s been, and it’s not the way it should be,” says Bell. He’s working on an effective way to partition what are now two-bed rooms and would like to make all of them private, not just the 12 that are reserved mostly for short-term, Medicare patients.

“Privacy is important,” he says.

Omeg agrees. “None of us want to live in an institution,” she says, before noting that baby-boomers have different, higher expectations — ones that include choice, flexibility and more individualized living.

“We’re not running the warehouse anymore,” Courtney says simply.

The board members, all of whom have been involved with charities in some way, have at least three common — and connected — passions: caring for what Courtney calls the “truly needy,” keeping patients as close as possible to their loved ones, and maintaining the highest possible standards of care and life quality.

It was the first that inspired the drive to keep Columbia Basin open as a community facility, accessible to more than just private-pay patients, who make up less than 20 percent of the population.

The second was also behind the drive to keep it local (“I don’t want to drive to Gresham to see my grandma,” says Omeg) and is also inspiring one vision for expansion: on-site housing for spouses of patients.

As for the third, it undergirds all the rest — and informs all the board does, as it pours any unencumbered revenue back into the project.

Board members are keenly aware that the old and infirm have ever-more options these days and that, for most, a nursing home will be the one of last resort.
But that doesn’t mean it should be something to dread, they say.

“It should be the kind of place people want to go to,” Byers insists. “And if you can do that, it’s a good deal.”