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Administrator's Column
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Foundation Director Column
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In other News...
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Changes should boost medical center's revenue
Good news.
Hillsboro Medical Centerıs financial picture brightened this week. Federal and state officials tentatively confirmed that the local healthcare facility should receive about $125,000 in additional Medicare payments for each of the next three years.
"It's good news," commented administrator Bruce Bowersox. "And we're all
looking for a little of that." It was just last week that the Banner reported that revenue at the medical center was $225,000 behind last year's pace. In 2003, the hospital and
nursing homeıs generated $4.2 million in revenue and paid out the same in
expenses.
While the anticipated revenue boost doesn't erase the red ink, it does give
HMC a much-needed shot in the arm, Bowersox said. "It's obviously good news," noted HMC board president Curt Kaufman. "It's a piece of the overall financial picture. It's a missing piece that is appreciated."
The increased reimbursements were secured through negotiations with the
Department of Health and Human Services. The agreement, as announced by the
state's Congressional delegation, will change the "wage-rate index classification" of certain hospitals outside of Fargo and allow these more rural facilities to receive the same level of reimbursement as Fargo hospitals do now. Kaufman said, "It's encouraging to see that Health and Human Services recognizes the disparity in the way that hospitals are reimbursed, particularly rural hospitals, and are attempting to correct the unfairness of the system."
The change will affect hospitals that are not "critical access" or sole community hospitals that already enjoy better levels of reimbursement. As part of the recently passed prescription drug bill, many rural hospitals in the state got 15 to 20 percent less for the same services as Fargo hospitals because of a difference in how labor costs were calculated. The discrepancy in the "wage index" put many hospitals, like Hillsboro Medical Center, at a great disadvantage in recruiting new staff or retaining
experienced personnel, Bowersox noted. The local administrator had expected the reimbursement level to change, perhaps an increase of $30,000 per year, he indicated.
This week's news was a welcome surprise, he admitted. Several other North Dakota hospitals will also receive higher Medicare reimbursements < Williston, Hettinger, Devils Lake, Cando, Dickinson, Minot and Rugby. Under the deal brokered by Senator Kent Conrad and Congressman Earl Pomeroy, these hospitals will receive the highest Medicare payment rate possible for hospitals in North Dakota. Bowersox said that this fix is critical for many of North Dakota hospitals that operate in smaller towns and compete for labor with urban hospitals in the state and beyond. These more accurate Medicare payments reflect the real cost of doing business, he noted.
After the Medicare reform bill was passed last fall, a discrepancy was found
over the Medicare payment rates assigned to some North Dakota hospitals.
With the new agreement, Health and Human Services issued a revised guidance
that allowed these hospitals to get the higher rate.
Bowersox had received official confirmation from state officials about the reimbursement increase but he did not have complete details, such as when the new rate will take effect March 1 or July 1, he speculated. Bowersox said that in addition to the wage index fix, Medicare payments will be boosted to cover inflation a provision that was on the verge of being cut.
Total payments under the Medicare legislation for Hillsboro Medical Center, including the wage index fix, come to at least $1.16 million, Senator Conradıs office reported. Bowersox could not confirm that figure.
The wage index fix means $44 million in new federal funds for North Dakota
health care providers, according to the Senatorıs press release.
Hillsboro Banner, 02/28/2004
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Medical center ekes out meager profit in '03
Shifting tide.
After three years of solid profits, the Hillsboro Medical Center posted a
mere $438 operating profit in the 2003 fiscal year. Board members and administrator Bruce Bowersox related the bleak financial report at the association's annual meeting Monday. We expect a difficult year ahead, forecast Bowersox, whoıs led the
facility for 20 years. "It's a matter of maintaining our services."
"We are better off than some of our neighbors," Bowersox said, noting that
all rural healthcare facilities share a common struggle with tight budgets.
The figures were no surprise to the boardıs financial committee, which meets
monthly to study the books.
After years of red ink, HMC hit a low in 1999, losing $259,800. Rebounding
in 2000, the ledger showed a $79,876 profit. More black ran in 2001
($169,730 profit) and in 2002 ($160,887).
Remaining profitable has always been a struggle in the facilityıs 50-year
history, pointed out Bowersox. While revenues amounted to $4.2 million in from July 2002 through June 2003 so did expenses. So what changed? This past year a number of circumstances combined to eat up any potential profits, the administrator said. He has hopes that new Medicare regulations will increase state and federal reimbursements to rural hospitals and nursing homes if HMC can successfully lobby for a favorable interpretation of the new rules.
Looking at the bottom line, the annual report showed that expenses increased
and revenues did not keep pace. Salaries and benefits increased by $208,484. The medical center has about 125 employees and an annual payroll of nearly $2.85 million.
Bowersox noted that wages for healthcare workers must be competitive within
the local job market, which includes Fargo and Grand Forks. Hillsboro doesnıt qualify for the same reimbursement rate as larger city facilities, Bowersox said, meaning the gap between expenses and revenues is whisker-thin. Bowersox is quick to commend the willingness of HMC staff who do what they can to cut operating expenses, such as clocking out early if the work load allows, shaving up to an hourıs pay off their paycheck some days. Changes in the employee health insurance plan are also expected to reduce costs. The cost of supplies, drugs and food increased by $104,332. Software licensing costs increased by $24,000. Insurance increased by $12,000 and fuel costs rose $10,000. In turn, revenues didnıt keep pace with costs.
While the nursing home census remained high through June 2003 (99 percent occupancy of 48 beds), the swing beds and acute care beds were used less.
Already this fall, though, the nursing homeıs census was down. Only 41 beds
were filled in October but the number this week was 46. That is just one indicator that the 2004 fiscal report might look even worse, Bowersox admits.
Neighboring nursing homes have been experiencing lower occupancy rates for
some time. Hillsboro is finally feeling the trend, Bowersox suggested.
The typical nursing home resident is changing, he noted. "A more complex
patient" is the rule today, Bowersox said. Some residents are not checking
in for good, just for a respite. Some enter the home to rehabilitate after
surgery or an illness. Once they are well enough, they return home, he said,
similar to the swing bed patient.
They're able to return home because the community has more resources to
allow them to live independently. What residents want from a nursing home is also changing. More residents demand a private room, Bowersox. HMC offers 48 beds only eight are private. It would require extensive remodeling to accommodate more private rooms.
HMC draws residents from Fargo and Grand Forks many families opt for a
central location for their family member to live. A closer look at the annual report shows that some revenue sources showed decreases laboratory, radiology, electrocardiography and IV therapy while other services posted increased revenues, such as pharmacy, physical therapy, ambulance, occupational therapy, medical supplies and emergency room.
The medical center board of directors newly elected president Curt Kaufman, Kevin Burg, Richard Schlichtmann, Betsy Tate, Deirdre Chandler, Kathy Evenson, Claudia Anderson, Curt Sorenson and Steve Doeden are constantly studying ways to cut expenses and boost revenues. Much of that work focuses on meeting regulations to garner the highest reimbursement possible.
The board noted the accomplishments of the past year new signs , roof repairs, new tubroom, tuckpointing and caulking brick exterior, new computers in PT and radiology; and a new ambulance. Changes are part of HMCıs future, Bowersox said.
Those decisions will be carefully weighed by the board responding to the needs of the residents and patients and working within fiscal realities. Part of that process will be a community needs assessment, according to outgoing board president Kevin Burg. The survey will be factored into a Master Facility Plan that will guide HMC leaders as they define what the community hospital and nursing home will look like in years to come.
Hillsboro Banner, 02/21/2004
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Survey studies community's healthcare needs
As part of a Community Needs Assessment, HMC mailed 300 surveys this week to
residents in Hillsboro, Grandin, Caledonia, Cummings, Blanchard, Halstad, Shelly and Nielsville.
The aim is to determine what people want from their local health care facility, explained HMC administrator Bruce Bowersox.
The questions cover where respondents go for healthcare, what services they
access and future needs as well as determining the demographics of the
random sampling.
The survey also includes an insert with specific questions about HMC such
as if expanded services are desired or if there is a need for assisted living services.
Bowersox said that about 70 percent of the surveys must be returned to generate valid information. The deadline is February 20. The data will be used by the HMC board of directors as they map out long-range plans for the facility.
The last such survey was done about 10 years ago. As with this survey, the
Center for Rural Health located in Grand Forks is assisting with the process.
Hillsboro Banner, 02/07/2004
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Medical center feels financial crunch
Money is tight at Hillsboro Medical Center again. Hillsboroıs community hospital and nursing home have survived more than a half century sometimes profitable, sometimes not but always able to maintain quality local services.
That wonıt change, HMC officials vow. Still, the bottom line is more than a nagging concern it requires constant, daily attention. Itıs a delicate balance, they admit.
"We're not in the sky-is-falling mode," said HMC board president Curt
Kaufman. "We've taken the stance that we need to react, address the problem
and solve it not let it fester and get worse."
After four years of profitable bottom lines as much as $170,000 in 2001 and as little as $438 last year the medical center is feeling more than a pinch. Operating expenses and revenues were virtually even last year $4.2 million. Revenues since July 1, 2003 are down $225,000, more than seven percent less than compared to the same time frame a year ago.
Why? Itıs a simple equation. Fewer patients, requiring less services, generating less revenue, according to administrator Bruce Bowersox. Other rural nursing homes and hospitals had been reporting the trend for more than a year but Hillsboro didnıt start feeling it until about October. "It's part of the continuing trend especially by Medicare to undersupport the cost of providing healthcare in a rural setting," Kaufman
commented.
Hillsboroıs 48-bed nursing home and 20-bed hospital has 125 employees and
an annual payroll of nearly $2.85 million. The facilityıs patient count or census is down. In the nursing home, occupancy was historically very high more than 99 percent in fiscal year 2003. This year, the trend is near 94 percent. Fewer residents generate fewer dollars.
Another unusual statistic, Bowersox noted, is the high number of deaths in
the past year 23 among nursing home patients and 17 hospital patients. Thatıs not counting deaths of regular healthcare patients living at home but accessing services at HMC, the administrator added.
A shrinking patient base? Probably not, Bowersox says, but perhaps a healthier one. Local residents donıt appear to be seeking services elsewhere, but that is a possibility being explored. HMC, with help from UND Center for Rural Health, is conducting a Community Needs Assessment to determine what people want from their local health care facility. Earlier this month, HMC mailed 300 surveys to residents in Hillsboro, Grandin, Caledonia, Cummings, Blanchard, Halstad, Shelly and Nielsville.
The information gathered will be used by the HMC board of directors to determine what changes if any could to be made to better address the needs identified by the community. The data will also allow the board to map out long-range plans for the facility.
HMC officials and staff have been closely monitoring the facilityıs financial situation. Staff have been given regular updates as they all work toward an improved bottom line, Bowersox said. Expenses over the past seven months are about $2.48 million, an increase of only $10,000, Bowersox calculated. He cautioned that such efficiency can be a double edge sword. If a facility reduces its expenses too much, the reimbursement level from Medicare will be adjusted downward. Whatever gains were made in the short-term are lost by lower reimbursements in the long run, he explained.
The HMC staff is working together to soften the fiscal crunch. Every department has a common goal, Bowersox said. The business office works to "maximize reimbursements" from Medicare and insurance companies. The dietary
and housekeeping departments monitor hours closely, voluntarily shaving hours off their own paychecks if the workload allows, saving HMC salary expenses. The nursing staff works both sides of the facility nursing home and hospital when the situation requires.
"We're proud of how our staff works to juggle the responsibilities. It requires a lot of patience on their part," Bowersox said of the center's "good, quality staff."
That quality was evident when the nursing home recently passed its annual inspection by the state health department. Two minor deficiencies were reported neither directly related to patient care. A call light should be installed in a utility room and documentation should be more complete on certain incident reports, the investigators noted.
Hillsboro's nursing home is adjusting to changes already experienced elsewhere in the industry. The typical nursing home patient is changing, Bowersox said, impacting census counts and revenues. Six HMC residents in January were admitted for "therapeutic stays," short-term stays while they recovered from illness, surgery or an injury. Typically, there might have been one or two therapeutic stays in a year at HMC.
More and more options are available to people as they age that allows them
to stay independent longer, Bowersox said. These choices have changed the
role of the local nursing home, he added. To remain profitable, HMC will
have to find ways to respond to those changing needs, he and the board know.
Hillsboro's circumstances are "better than most" rural hospitals or nursing
homes in the region, Bowersox ventured. "All our services are under one
roof," he said. "That's been a positive that's led to success in the past.
They help balance each other out."
For its part, the public can help in two ways by using the healthcare services available locally and by paying their bills promptly. A solid patient base is essential for the future of the medical center, Bowersox noted. Fewer collection problems help maintain a positive cash flow, he added.
Revenues could potentially increase, Bowersox said. Improved reimbursement
levels are anticipated from Medicare, Blue Cross and state long term-care,
he noted, but if patient volume remains low, the gap between profit and expense widens.
In the meantime, HMC continues to respond to changing needs just as itıs
done for more than 50 years.
Hillsboro Banner, 01/17/2004
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Ambitious plan deserves support
Taking chances.
Nothing truly great happens if we donıt take chances. The Hillsboro Medical Center board of directors is taking a brave step with its plan to create a new nursing home and assisted living apartment complex and to renovate the existing hospital and nursing home. The $10 million project is a well-researched approach to meeting the changing demands of our senior citizens.
We believe the HMC leadership is on the right track. They considered a $2 million fix-it plan but soon discovered it amounted to one expensive Band-Aid for a what was seemingly a broken leg. This comprehensive construction and renovation plan looks to the long term and trusts in the future of Hillsboro as a community that will grow.
We applaud their efforts to improve the quality of life for seniors in our community and to establish a top-quality nursing home facility to go with the top-notch staff already serving our community.
The idea of a new and improved nursing home is not new. Itıs been talked about for years. Assisted-living apartments fill an obvious void in the housing options for our elderly. The decision to move forward with this ambitious plan was not made hastily or lightly. Much thought has gone into the concept.
Just like decisions made nearly 60 years ago, the choice to move forward now is not without risks. Hillsboro Community Hospital was born of the post World War II boom as the community worked hand in hand to build a new hospital. Everyone pitched in with donations and muscle, moved by a fiery spirit of working toward a common goal. The hospital and nursing home have struggled over the years to turn a consistent profit but the community has always stood firm in its support, believing in the mission of helping the sick and aged.
The same drive for community betterment built the nursing home in the mid 1960s. It was and is a true community project that continues to benefit the community by providing a safe, caring environment for the elderly.
In the larger picture, HMC helps drive our local economy as one of the townıs largest employers.
As Hillsboro Medical Center grew in the 1990s to include a clinic in the same building as the hospital and nursing home, the community again responded with wholehearted support. We are blessed in this day and age to have a well-equipped and superbly staffed healthcare facility in a community our size.
As we look to the future, the plans devised by the HMC board and their architects hold great promise. A new nursing home that aims to bring the best of ³nursing care² and ³home living² together in one place is a formula for success. Assisted living provides another option for seniors who can no longer live independently but who donıt need the skilled care of a nursing home. Offering seniors options in a local setting guarantees that more will chose to stay ³at home² in Hillsboro in their later years rather than seek those services in other communities.
We strongly urge the community to learn more about the HMC building plan. What we have seen so far promises to make the good care residents receive now even better. An improved environment and a less institutional structure is exactly what most potential residents want. This plan is more than bricks and mortar; it focuses on quality care in a quality structure.
HMC is building on its success and banking on the continued support of the community a community that has known for decades that caring for our family, friends and neighbors is a mission we all share.
Hillsboro Banner Editorial, 1/20/2006
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Medical center plans $10 million expansion project
By MICHELLE MCLEAN
At a crossroads.
Hillsboro Medical Center, the communityıs half-century old hospital and nursing home, is faced with a dilemma whether to repair or to build new.
At the medical centerıs annual meeting Wednesday night, its 53-member board of control reviewed construction proposals and later the board of directors voted to move forward with a $10 million renovation and construction project.
The Health and Humanities Foundation will spearhead fundraising efforts with a goal of $1.2 million to supplement construction loans.
As proposed, new construction would add as much as 46,000 square feet on two floors. The expanded facility would occupy most of the remaining green space on the hospital block along Caledonia Avenue East.
HMCıs age is showing and large-scale, expensive renovations are needed to keep the healthcare center operational, explained new administrator Patty Dirk. The fix-it price was tagged at about $2.2 million just to meet federal and state mandates.
Upgrades would be ³a Band-aid approach² and may not be enough for the facility to remain viable in the long-term, she offered.
Board president Curt Kaufman offered, ³We can fix the Edsel and spend a lot of money doing the repairs. After we spend the money, weıll still have an Edsel. The question is will anyone want to drive it?²
Dirk said it was time to ³reinvest² in the 53-year old hospital and 41-year old nursing home.
After years of discussion and months of study, the HMC board of directors promoted an ambitious remodeling and expansion plan. HMC could remain viable, they suggest, by creating a new and improved nursing home with an adjacent 21-unit assisted living apartment complex on its second floor.
The existing nursing home and hospital would undergo extensive remodeling done in phases. Construction could start as soon as late summer and take 16 months to finish. Architects project an April 2008 completion date. "This is a bold step," offered Dr. Chuck Breen, one of two doctors on staff locally. "We're at a crossroads. We can't keep doing what we're doing."
Architect Jeff Sjoquist of YHR Partners of Moorhead, presented the construction proposal to the boards Wednesday.
The plan received unanimous approval from the board of directors. YHR specializes in design of long-term care facilities, especially renovation of existing ones. YHRıs plan calls for a new 42-bed nursing home (less than the present 48-bed) that structurally emphasizes personal privacy, independence, and community (rather than institutional) living.
The nursing home Sjoquist has designed has three distinct households or wings with 11 to 16 residents living in each household. Upstairs, 21 assisted living apartments would come in a variety of sizes (five efficiencies, eight one-bedrooms and eight two-bedrooms) again in three distinct wings.
The overall design inside and out emphasizes a residential feel rather than an institutional look, Sjoquist said.
The audience also heard from Marilyn Oelfke, senior director of longterm care at Perham Memorial Hospital and Home, who outlined "a culture change" that is taking place in nursing homes. The focus is on the residents' quality of life and "de-institutionalizing" the setting -- exactly what Sjoquist's design fosters. Perham's facility, which is very similar to Hillsboro's in size and make-up, began making changes five years ago and moved into its new nursing home quarters last summer, she said. The changes in environment and model of care did not result in additional staff, she noted.
Oelfke pointed out that "quality of care" was not an issue at Perham. "We werenıt a bad facility . . . but we wanted to improve the quality of life in a long-term care setting."
Sjoquist's blueprints fit this new model of care called the "household model," Oelfke said. The old model, used in most nursing homes including Hillsboro's, relies on an institutional environment and rigid routines. It's often characterized by long corridors bordered on each side by double rooms with shared bathrooms, a communal dining room and strict schedules. The traditional clinical model requires nursing home residents to "accept and adapt," Oelfke said, "to change their whole way of life." The household model responds more to a resident's personal needs.
Oelfke admitted that as a nurse for 38 years she understood the clinical model but knew in her heart that that kind of nursing home "would never take care of me. How do you want to be cared for?" she asked. The change in culture also helps erase "the stigma of the nursing home as a place to go to die," she added. A household model divides a nursing home into smaller physical units and allows the residents and staff to interact "as family," Oelfke said. It strikes a better balance between home and nursing, she said.
The proposed design offers 26 single rooms and eight "territorial" double rooms all with separate bathrooms. Residents in each household would be cared for by permanently assigned staff who are cross-trained as certified nursing assistants, housekeepers and dietary aids, Oelfke said. Caregivers would get to know residents and their needs better.
"They become friends," Oelfke said. Rigid routines are made flexible. Residents are given more choices and control over their schedules and activities. "You give control back to the resident and the bedside staff is empowered to make decisions," Oelfke added.
Each unit has its own kitchen and dining room-- gathering places for what can become a close knit community, she added.
The Perham facility has a nurse who serves as a clinical coordinator for medical issues and a household coordinator who focuses on the social and environmental aspects. "The residents and the staff manage themselves," Oelfke explained.
Quality of life is improved through the closely connected relationships between residents and primary staff, she said.
Residents who were once forced to adapt to the nursing home environment are now encouraged to demand what makes them happy, Oelfke said.
New nursing home residents who didn't have to adapt as much to a new lifestyle were less resistant to caregivers, Oelfke noted. When allowed to sleep and eat on their own schedule, residents were more alert and needed less assistance and medication, she added. Residents' families say they feel less guilty about placing a loved one in the nursing home and they feel more comfortable visiting Perham's new nursing home and its homey households, Oelfke reported.
While hesitant to change at first, nursing home staff soon favored the flexibility of being universally trained, Oelfke said.
"It's a common sense approach," she concluded.
Architect Sjoquist pointed out that there were practical as well as financial advantages to building the assisted living apartments with the nursing home. HMC expects to increase its nursing home census and gain ground by offering the assisted living option in such close proximity. The new construction design also features a basement to provide much needed storage space and room for mechanical equipment, Sjoquist noted.
Other first-floor amenities include a chapel for 20 people and a barber and beauty shop. On the second-floor apartment level, each of the three wings would have a shared lounge and an activity room plus one larger communal dining room and kitchen.
Finance and fundraising committees will be named soon to begin the next phase of planning, Dirk said.
Hillsboro Banner, 1/20/2006
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Socialize for a good cause
What better treat could there be on an autumn day than homemade pie?
Thatıs why weıre hoping you will join us Sunday, October 29, anytime from 2 to 4 p.m. for the Hillsboro Medical Center Activities Departmentıs 24th annual Pie & Ice Cream Social! Drop by the nursing home dining area and enjoy great pie, yummy ice cream, coffee, lemonade and visiting with your friends!
The Social also features a raffle the prize is a beautiful queen-size quilt and crafts will be for sale. The HMC Auxiliary will be baking all the pies but if you would like to bake and donate a baked good or create and donate a craft, we welcome your donations! Contact Nancy Gehrke at 636-3232.
All proceeds from the Social go to the purchase of supplies or items that our nursing home residents will enjoy. Past proceeds have been used to purchase the lovely grandfather clock that is now in the Sunroom and the big screen TV in the activity area. Plan on being at the nursing home on the 29th for a fun afternoon and a great cause!
While youıre joining us for pie and ice cream, we hope youıll take a moment to visit with us and look at the architectural plans for our new building project. As most of you know from reading The Banner, the Hillsboro Medical Center is beginning a $12.5 million construction project that will build a new nursing home, renovate our community hospital and build a needed assisted living facility.
At this time, we are working hard to put all the necessary plans in place to undertake this huge project. Our HMC Board of Trustees, HMC staff and I have been and will continue to work with the architects to design a facility that will more than meet the needs of our residents and patients. We have also been ³doing our homework² with regards to financing and the other elements that go into a project such as this one.
In spring of 2007, our hard work will culminate in the start of construction for the new facility! Our architects and contractor tell us the work should be completed 24 months after we break ground. Between now and groundbreaking, the Health and Humanities Foundation and a team of community volunteers will be raising some of the needed funds.
Of the approximately $12.5 million that will be needed to build, $10.5 million will be financed. The remaining $2 million must be raised through private donations from individuals, businesses and service organizations. Although that is a lot of money to raise, it is only 16 percent of the entire project. Our Health and Humanities Foundation, led by executive director Angela Kritzberger, is in charge of raising these funds. We are pleased to announce that Dallas and Mary Ann Boeddeker are our Capital Campaign Co-Chairs and they will lead our effort to raise $2 million. The other members of the Capital Campaign Steering Committee are Roger and Marlene Diehl, Kathy Evenson, Rich Gehrke, Randy Habeck, Kathy Hamre, Jack Hansen, Jenny Jacobson, Francis Kritzberger and Michelle McLean.
If you ever have questions or want more information about this exciting building project, I hope you will contact me. I can be reached by phone at 636-3201. You can also visit with any of our HMC Board of Trustees members. They are: Curt Kaufman (Board President), Claudia Anderson, Steve Doeden, Kathy Evenson, Jason Hauff, Kay Keller, Kay Malme, Brenda Muller and Curt Sorenson.
I want to commend the Board and the Steering Committee volunteers for the tireless hours they have already put into this project. We can all be proud of these outstanding Hillsboro leaders.
Donıt forget! We hope to see all of you on Sunday, October 29 for the Pie & Ice Cream Social!
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December 22, 2006
HMC project responds to community needs
By MICHELLE MCLEAN
Necessary.
Common sense.
Community project.
Hillsboro Medical Center has undertaken an ambitious $12.5 million construction project a new nursing home, new assisted living apartments and a remodeled hospital.
True to their 60-year history, the community hospital and nursing home are growing in direct response to community needs. In return, the community is being asked to respond to a plea for financial support - a request to help raise $2 million. As in the past, this latest HMC building project has been embraced by community leaders. A small army of volunteers is now leading a campaign to raise $2 million locally. The remainder of the construction costs will be financed by HMC.
At the head of the building project's 12-member steering committee are husband-and-wife team Dallas and Mary Ann Boeddeker. Long-time local residents, they both see the project as a necessity.
"We need this for our community," Mary Ann said. "We canıt do without it."
A progressive healthcare facility paired with a top-notch school system, a solid business sector and a growing residential base all speak to Hillsboroıs promising future, Boeddeker intimates.
Anticipating a spring 2007 groundbreaking and two years of phased-in construction, the steering committee has been charged with leading the capital campaign. The campaign started quietly in September as personal contacts are being made with local residents, initiated by committee members and completed by HMC foundation director Ang Kritzberger and campaign manager Susan Wee.
A broader-based public campaign will start with the new year.
The personal approach is vital to garner financial and personal support, Boeddeker said. "We need every individualıs help. We need everyone to give generously when asked."
Donors are being asked to consider a five-year pledge, not a one-time gift. A real commitment is important to see the project through, Boeddeker said.
The project has a three-prong goal: 1) Renovate the hospital to meet todayıs needs for efficiency, safety and privacy; 2) build a new nursing home based on a new philosophy of individualized care; and 3) build a new assisted living facility with exciting options for seniors.
The project started when the HMC board identified areas of the nursing home that needed to be brought up to required state and federal standards. A "Band-aid" approach to fix immediate needs would have cost at least $2.2 million, yet not address future needs, the board reasoned. There was more that needed to be done.
After extensive study, the board set long-term goals that embraced the communityıs needs for improved services. "Caring for you today. Building for tomorrow" became the theme. Architects developed a building plan that creates a new 36-bed nursing home and a new 16-unit assisted living complex and revamps the existing facility to provide additional swing beds and to update nearly all departments in the hospital all on the existing medical center site at Caledonia Avenue and 3rd Street SE.
The assisted living option is one thatıs noticably missing in Hillsboro, Boeddeker said. Itıs also the one aspect of the building plan that seems to have drawn the most positive response.
One gentleman, Kritzberger said, points to the blueprints on display at the nursing home and tells how he has picked out his room.
"We know people are leaving Hillsboro to move into assisted living elsewhere," Boeddeker said. "This will bring people home."
HMC leaders often point to the high quality of healthcare that patients and residents receive in the current facility now the facility needs to be updated to match that quality of care, they believe.
"Our facility is showing it's age," noted Phyllis Leraas, resident care coordinator and registered nurse. "We are cramped for working space but more of an issue is that our residents are cramped for space."
The 42-year-old nursing home was built to provide 25 double rooms along an endless, sterile corridor a standard nursing home design in its day. Todayıs residents want private rooms and more personal, home-like space. The institutional model of care - routine, communal living with a lack of privacy - is outdated and needs to be changed, HMC leaders believe. That "culture change" is already in the works at HMC one of the first nursing homes in the state to adopt the revolutionary care model that incorporates a 'Person First' philosophy in a 'household' environment.
The pride of HMC's nursing home is its personal care for residents, who are like a second family. CNA Kathi Floberg said, "The nursing home is such a special place. We are like a family but this (change) will make us all become even closer."
Translating a sense of individuality is difficult if a building and a daily routine require residents to conform.
Enhanced living space will also allow residents to live more as individuals. Using the "household model" of care, nursing home staff believe residents will feel more "At home."
The physical nature of the proposed nursing home creates a home-like environment. Two "households" of 18 residents will live - not in double rooms opening into a long hallway - but in private rooms that surround shared living space. A living room, a dining room and even a kitchen that lends itself to a less structured daily life.
"It is building a home, instead of a nursing home," pointed out Allison Krogstad, occupational therapist and OT manager.
Residents can wake when they want, eat breakfast when they choose and opt for whatever activities they're in the mood for.
"It supports the person's ability and encourages the person to participate in occupations that they enjoy and tasks they used to do at home," noted Krogstad.
Instead of conforming to the institution's schedule, the staff works to accommodate the residents' personal choices.
To incorporate the change in structure, HMC is implementing Person First Values. The "common sense" approach enhances the quality care HMC is already known for, said Patricia Dirk, HMCıs administrator.
Some of the guiding principles are:
Put the person before the task.
Know the person you care for.
Provide for the spirit, body and mind.
Begin decision-making with the person.
Accept risk as a normal part of life.
Believe that all people are growing and learning.
Leraas describes the changes as "de-institutionalizing" HMC.
"Instead of the day centered around the staffıs schedule, it puts the residents' requests, lifestyle and interest first," she added.
"We're honoring individuality," Dirk said, a complete turnaround from the old formula of "institutionalizing" people's behavior.
Some of those changes have already been implemented. Residents can wake later if they wish and take their breakfast when theyıre ready. Bathtimes have also been rescheduled to better suit residentsı wishes. Seemingly simple changes but dramatic in an institution like a nursing home, Dirk noted.
Dirk said the changes, while gradual, have not been easy. She credits the staff with being open-minded and motivated to "make this the best possible place to live."
In the new nursing home, staff will be assigned to one of the two households so they will interact with the same residents on a regular basis. Caregivers will become more familiar to residents.
The households will operate much like families with shared meals, shared activities and shared decision-making. Single, larger rooms will offer more privacy and space for individual expression.
Boeddeker said her mother Evelyn Veen, 90, has been a resident of the local nursing home for over a year. Veen says her caregivers are always happy and smiling. She enjoys the pleasant laughter of her roommate Grace Cotton.
Her wish list in the new facility is short and simple - a window of her own in her own bigger room, space for visitors to sit and chat with her privately, and a kitchen where she can make homemade vegetable soup.
Veen's daughter knows these things - these simple everyday things we take for granted - will be possible in the new nursing home.
A little history . . . .
The hospital was built in 1953 for $80,000 with much of the work done by volunteers in the community. A 50-bed nursing home was built adjacent in 1964 with gathering spaces added in 1981 and 1982.
In its last major building project more than 10 years ago, HMC added a clinic, a three-stall ambulance garage and an expanded physical therapy department; remodeled much of the hospital; and upgraded mechanical systems. The public contributed $450,000 toward the $1.5 million project.
As the communityıs second largest employer, HMC has 135 full-time and part-time staff with a payroll nearing $3 million a year.
Hillsboro Banner, December 22, 2006
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January 26, 2007, Hillsboro Banner
Medical center lays groundwork for $12.5 million construction project to start this spring
HMC posts profit
By MICHELLE MCLEAN
Black ink.
Hillsboro Medical Center ended the 2006 fiscal year in the black. The news was ³very positive² at the community hospital and nursing homeıs annual meeting Wednesday night.
The auditorıs report showed a $97,000 operating gain - a healthy turnaround from a $155,000 loss last year.
As of June 30, 2006, the report showed an overall healthy bottom line for the 53-year-old medical facility. The good financial news has continued since the 2006 books were closed six months ago, said HMC board president Curt Kaufman. The black ink continues to flow, he offered.
Lisa Giese, senior manager for the accounting firm Eide Bailey, told those attending the meeting of the facilityıs board of control that the financial report reflected "overall very positive gains."
She added that, compared to other medical centers of Hillsboro's size, "you're right on track."
Giese pointed out an increase in revenues from $4.1 million last year to $4.7 million this year. Gains were made primarily because the nursing home had more residents and the hospital lab and radiology department were busier.
Another plus was that "discounts" or deductions by insurance companies were less.
Expenses also increased, she noted, from $4.3 million to $4.7 million. Salaries paid to the medical center's 135 full-time and part-time employees were up, the report showed. The increase was due in part, Giese said, because of an increased patient load, overtime pay and the need to pay wages competitive with larger cities.
Building project
HMC administrator Patricia Dirk said the past year has been "exciting" as the medical center's board, administration, staff and community volunteers have geared up for the largest building project in the facilityıs history. Approved at last yearıs annual meeting, the $12.5 million project will bring to fruition five years of intensive discussion and planning.
As created by YHR Partners, the architectural plans call for a 16-unit assisted living apartment complex, a new 36-bed nursing home and a remodeled hospital.
Dirk said the plans were driven by a market study done a few years ago when the public identified four specific needs in the facility - more privacy, more storage, more home-like living and an assisted living option.
The board studied building new at a different location, Dirk said but cost estimates doubled compared to building on the present block. A two-story design developed for the nursing home and assisted living wings.
In an effort to "right size," the nursing home sold the licenses for six beds, dropping from 48 to 42 beds in the long-term care facility. Six more beds may be sold to reflect the typical occupancy rate in the nursing home.
A capital campaign for the project has already raised about $390,000 toward a $2 million goal, announced Ang Kritzberger, executive director of the HMC Foundation, which is coordinating the fundraising for the project.
One-on-one donation calls have been made by members of the steering committee for the past several months. A public campaign will begin soon, Kritzberger said.
Donors are being asked to consider a five-year pledge to the project, she added.
In her call for support, Kritzberger said, "We're a community of doers."
Kaufman said, "This is a big project as you can see. Weıre excited about the project and weıre anxious to get this going."
Bids will be let in late February or early March, Dirk said. Nor-Sun, Inc. of Baxter, Minn. will serve as construction manager. Eide Bailey will continue as financial advisors for the project.
Dirk said the timeline for the project calls for excavation of the new nursing home and assisted living complex sites to begin simultaneously in March.
Some nursing home residents and offices in the west end of the nursing home will be relocated so that portion can be demolished, Dirk said.
Groundbreaking is set for May, she added.
Dr. Chuck Breen, family physician on staff, praised the leadership provided by Dirk, Kaufman and the board of trustees. "We are blessed" with good leadership, he said.
Kaufman said that HMC is "blessed" with a good medical staff, administration and employees, good working relationships, and a good partnership with MeritCare.
While independent, HMC contracts with MeritCare for a variety of services including administration. "Weıre able to use their expertise," Kaufman explained.
Board changes
Three people were nominated for seats on the HMC Board of Trustees Kari Cotton, Chris McInnes and Kathy Evenson, all of Hillsboro. Evenson is seeking another term on the nine-member board.
Cotton and McInnes will replace Curt Sorenson of Halstad and Claudia Anderson of Hillsboro, who both completed two three-year terms.
The HMC Foundation, formerly Health and Humanities Foundation, continues as the fundraising arm for the medical center. A restructuring has created a seven-member foundation board and a five-member Hillsboro Manor Housing Board. The housing board now oversees the operation of Kelleher Manor, a senior congregate complex built by HHF.
More reports
Other departments associated with HMC also provided reports to the annual meeting including the ambulance squad and the auxiliary.
Deb Knecht reported that the squad had 14 active members providing 24-hour coverage for the community. The squad filed 204 run reports in between July 1, 2005 and June 30, 2006. She noted that the ambulance service was able to secure about $10,000 in Homeland Security grants for two new notebook computers in their ambulances.
The auxiliary reported its continued efforts to raise funds to refurnish resident rooms.
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