Faced with a looming crisis in long-term eldercare, San Juan Island voters approved a tax increase levy on Nov. 2 for San Juan Island Hospital District 1 to buy the Village at the Harbor, a privately owned assisted living center in Friday Harbor.
“It is very innovative for the hospital district to take this on,” said hospital district commissioner Trish Lehman, speaking personally and not on behalf of the district. “There is only one other district in Washington that owns an eldercare facility and that one is a skilled nursing facility rather than assisted living, which is what the Village is.”
There are very few such models across the country. If successful, the Village could provide a new concept.
With the tax increase, plans are now underway to move forward to expand staff, expand bed availability and increase training. The tax increase isn’t huge, said Nathan Butler of the Hospital District 1, but it’s meaningful. A homeowner with property worth $500,000 will be paying an additional $180 a year. Butler himself supported the measure because the alternatives of limited long-term care and no local Medicaid beds was unimaginable.
“I am not one who wants to be taxed more, but this is going to be an epically life-changing endeavor,” Evan Perrollaz, administrator for Village at the Harbor, said.
Impossible without taxpayer support
In 2019 approximately 54.1 million adults 65 and older lived in the United States, about one in every seven residents. In the next two decades, the number of adults older than 60 will increase to 74.6 million, who will need a wide variety of assisted care for their daily lives.
Simultaneously, health care providers across the nation are leaving the health profession at an alarming rate.
San Juan County, with 35% of its population 65 or older, according to the Census Bureau, sits in the crosshairs of that pending crisis. Perrollaz and fellow health care professionals organized a group called Blue Sky Dreamers after the only skilled nursing facility, LifeCare, closed in 2017. Since then, San Juan County has had no skilled nurse facility, no long-term Medicaid-accepted care facility and a significantly reduced number of assisted-living beds.
“Trying to do long-term care without public taxpayer support was next to impossible here. Financially it just isn’t practical,” Butler said in explaining the LifeCare closure.
According to Perrollaz, over 20 senior-care facilities across Washington have closed this year, and many more are not far behind.
“This is a critical time. Our health care system is really struggling. Fingers crossed we can get through this,” Perrollaz said. One underlying issue is the bureaucracy that Medicaid reimbursements get caught up in. Payments are often months late, leaving companies thousands of dollars behind.
Sent out of the community
Islanders who rely on Medicaid for long-term care not only have to leave the island, but often end up moving as far away as Olympia or Eastern Washington, Lehman said. Studies have shown elderly in rural communities have a higher desire to remain in their communities.
San Juan County is no different, Lehman said: for locals who have devoted decades of energy and love into their homes and community the idea of being trucked off to die, away from loved ones, away from anything familiar, is heartbreaking.
“If you have that deep connection to the island, having to go off island and die, I can’t think of a worse way to go,” Perrollaz said.
Besides the emotional aspect, keeping patients closer to home has tangible medical benefits as well.
“While it is true sending people to Eastern Washington is cheaper, patients — people with dementia or Alzheimer’s for example — do far better when they are closer to their families and surrounded by familiar things. You cannot replicate that any other way than by actually keeping them in those surroundings,” Butler said.
‘I don’t need it’ … yet
The Blue Sky Dreamers first proposed that the Hospital District 1 assist the Village in accepting Medicaid but Perrollaz suggested buying The Village. The district will take over the Village at the end of February next year, and as part of the hospital district’s plan, the Village will have four to six Medicaid beds. The plan calls for an expansion which would eventually allow the Village up to 30 Medicaid beds.
“What we are doing at the Village is phenomenal,” Perrollaz said “but this is a drop in the bucket with what we need.”
Perrollaz’s neighbor recently developed serious health problems. Private caregiving cost approximately $5,000 a month, and an emergency care team even more. “He was losing everything right in front of my eyes,” Perrollaz said. Fortunately, a group of friends were able to help, and Perrollaz was able to direct the neighbor and his wife to more resources.
“One of the big arguments I heard against the levy was ‘well, I don’t need it, why should I pay for it?’. The problem is, sure, you don’t need it now, but you will,” Perrollaz said. Like his neighbor, that need can happen quickly.
“No one knows they need senior care until they need it,” Perrollaz said, no one wants to move into a retirement home. “No one has ever visited the Village at the Harbor and said they couldn’t wait to move in,” Perrollaz said.
Lehman pointed out that there is funding for Medicaid in the Build Back Better bill, which the Village could qualify for when the Medicaid beds are available.
Training new caregivers
One of the top priorities after acquiring the Village, will be pay raises and benefits for the staff.
“It has been particularly bad this year, but I have lost a lot of good employees because I could not pay competitive wages,” Perrolliaz said. According to Lehman a significant number of health care professionals do not have health care benefits, which is one of the reasons nurses and caregivers are changing careers.
One of the hospital district’s goals is to attract people, especially young people, into the field.
“We are hoping to be able to train home-care aides at the Village,” Perrollaz said. People now can get licensed online, but, Perrollaz said he isn’t a fan of online training because there are some things you have to do hands-on to learn properly, like how to lift someone up safely. It is a profession that needs to be learned in person to truly be successful, Perrollaz said.
The future Village training hub would be accessible to people on all the islands interested in being licensed for home-care careers. The Village could work with local high schools and with the San Juan County Economic Development Council to engage youth who are interested in home care.
Once the Village becomes an established home-care agency, Perrollaz said, the facility will be a one-stop shop, he said, for anyone in need of a home-care aid.
From substandard to safe
As a home-care aide, Perrollaz said islanders would be shocked at the substandard living of many of the islands’ elderly. Many who should not be living alone live alone on boats. Others are living in extremely remote areas with little access to health or emergency care. One man he took care of did not have hot water.
Lehman, who had been a home-care aide for 13 years, said she cried every time she saw one patient. “He didn’t have hot water, the floors were atrocious, rotten, caving in, but he wanted to live like that,” she said.
“We can’t make decisions for them and they are not always going to make the decision you want them to make,” Perrollaz said. However, with more trained people involved, the more this group of elderly citizens can be checked on.
A larger, professional home-care work force could work with the hospital district’s paramedicine program, Lehman said. Two EMTs do safety and welfare checks now on 30-40 people. The EMTs deliver medicine and, while not administering any medications, check to ensure that the person is taking their medicine correctly.
“The program keeps a lot of people out of the hospital, keeps people safe, which saves money as well as lives,’ Lehman said.
If the paramedicine program and newly trained home-care aides coordinated, they could do safety checks on even more people.
Doctors are also fans of the program, Butler said; “Imagine being a doctor and having a patient who needs more resources than you are able to provide.”
EMTs also do a safety assessment of the patient’s house and the entire program is very low-cost. While the paramedicine program EMTs spend perhaps a few hours a week with a patient, a home-care aide could spend hours each day.
Be engaged, check in
Lehman and Perrollaz both say that the main thing citizens could do to help the elderly is to engage and check in on them.
“I would like to see more community members helping neighbors,” Lehman said. “It’s so easy to forget when you are comfortable that there are those around you who do not have what they need.”
Lehman also encourages volunteering. Volunteering during the pandemic can be done safely — the Village recently had a volunteer play piano. Lehman said she will never forget one woman in the ’70s and ’80s who came from Orcas with her kids to volunteer at the old convalescent center. The little family often put smiles on the faces of those that lived there.
“By helping them, you really are helping your future self,” Lehman said.
The doors to the Village, under the Hospital District’s ownership, will open March 1, according to Butler, should everything go according to plan.
“It is super exciting,” he said. “All [the hospital district’s] services will be more robust running them together. We are appreciative of the support and we will do our best to deliver.”
— Reporting and photography by Heather Spaulding
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