Originally published in Island Ad-Vantages, January 6, 2022
Island Nursing Home Task Force Executive Summary
Editor’s note: This executive summary, dated December 16, 2021, is provided by the Island Nursing Home Task Force.
The Island Nursing Home Task Force was created by the Board of INH in September 2021 to review nursing home regulations and establish time oriented goals for the future of INH. The Task Force adopted as its mission:
To evaluate and recommend to the Board a long-term sustainable plan for reopening the INH facility to serve seniors from the Island and the Blue Hill Peninsula.
Consistent with this mission statement, the goal of the task force was to define a sustainable mix of skilled nursing, long-term care, residential, and rehabilitation services for seniors that could be implemented at INH as soon as possible. Regulatory restrictions on INH’s operating license require a restart of nursing home services as early as October 2022 and no later than February 2023, absent any extensions of those dates.
The Task Force has met weekly since its creation. It divided its focus on the three structural cornerstones that are the foundations for reopening of INH: staffing, housing, and management. To that end, three subcommittees of the Task Force were created: Recruitment and Retention, Affordable Housing, and Operations and Management. These subcommittees have met at least weekly for the past two months. Their members have interviewed or met with representatives of staffing agencies, builders, real estate agents, media, and representatives from other nursing home facilities to independently verify and build on information shared by INH’s Board, management, staff, accountants and attorneys.
After consideration of other options and possible affiliations, the Management and Operations subcommittee concluded that professional consulting services were needed to advise the Task Force and the Board on developing a viable plan for reopening INH. The Board agreed and recently entered into an agreement engaging Covenant Health System as its consultant. Members of the Task Force and the Board have had many conversations with Covenant including a recent joint meeting with Philip Hickey, System Vice President of Covenant, who will be its hands-on representative for INH, as well as his boss, Gerard Foley, President of Covenant. Covenant has recently toured the facility and met key retained INH personnel. It is hoped by all that Covenant will find reopening to be a viable alternative and that it and the INH Board can proceed with Covenant’s taking on an advisory role in the reopening. It is intended that the INH Board will continue to maintain its role in any advisory/management agreement. The relationship with Covenant can bring access to staffing solutions, joint buying of supplies and equipment and support for INH management and advisory services that was so in need when INH was relying on its own resources. If a viable plan for reopening is developed, the Board can then decide the form a continuing relationship with Covenant might take.
The one important area in which Covenant cannot be helpful is in the critical need for affordable housing. Access to affordable housing for INH staff is an area where the communities on the Island and Peninsula must come together, surface existing housing resources and ultimately plan, finance and construct affordable housing to be available for INH staff. The creation of new housing could be under the auspices of the INH Board if it should acquire the housing development and management expertise, but is probably better handled through an experienced developer such as Island Workforce Housing or a private housing developer. After reviewing staffing requirements presented by the Recruitment and Retention subcommittee, the Affordable Housing subcommittee recommends development of as many as 20 new housing units. A reopening capital campaign should include not less than $2 million for construction of new housing representing approximately 35% of the total estimated cost. The balance, or an additional $3.5 million, hopefully can be financed by obtaining a long-term amortizing loan secured by the project. Such a project is likely to take two to three years to complete. The interim staff housing needs must be filled using existing housing resources from the communities. Some indication of local availability of housing for such a period has come forward and hopefully more will follow.
A strong INH Board is critically important in the reopening of the nursing home. Engagement with the consultant, developing new management and staffing, and getting the support of the communities to raise the capital necessary to fund the reopening and needed housing objectives require a strong committed Board. Through the travails of the past few months, the Board has lost some members and recently added some new members. Continuity of membership and purpose are essential for the Board to attract the community support necessary for a plan to reopen. The Task Force recommends that the Board engage a consultant to assist the Board in organization and governance and in focusing on the need to add additional knowledgeable community members to provide expertise in development, housing and community relations. The strength and commitment of the Board will be a key consideration in Covenant’s conclusions as to the viability of INH for the future. The Island and Peninsula communities definitely believe INH is a treasure, but will look to the leadership of the Board to show that it is worthy of their support.
Recruitment and staffing
The numbers and qualifications of staff needed for a reopened INH are dependent on the mix of skilled nursing, long-term care, residential and rehabilitation services that the Board, in concert with the Consultant and the management team, determines to be the most viable combination. Staffing requirements would be smaller initially as INH reopens, but would ramp up quickly as more beds and services and resident count increased. Based on discussions with retained staff, the Recruitment and Retention subcommittee estimates that staffing needs other than direct care can be recruited locally. Nursing and direct care staff (RNs, LPNs, CNAs, CNA-Ms, and PSS/CRMAs) will require a combination of locally recruited staffing and long-term contract staffing. Hopefully, a number of former direct care staff can be brought back to INH and that should constitute a recruitment priority. Based on staffing ratios over the past three years, contracted staff have made up as much as two-thirds of direct care staff. Discussions with Covenant and Infinity Care Partners indicate that nursing staff are available from qualified Filipino nurses who come fully licensed with 3-year minimum contracts. Some direct care staff other than nurses may be sourced from abroad as well. Plans are underway to expand the CNA students in the Island Adult education program to attract more local candidates. Other concerns discussed by the subcommittee in its full report include consideration of wage and benefit packages (including affordable housing support), and scheduling. A critical concern expressed by former staff involves being forced to take double shifts when employee child care wasn’t available for scheduled staff or illness created absences. The Covid 19 pandemic has definitely placed increased burdens on INH staff in this regard. Staff communication with management and the Board have created additional issues that must be addressed in any reopening plan. INH has traditionally had a strong feeling of teamwork and “family.” It is important to bring that atmosphere back to the facility.
Critical issues for immediate attention
The Task Force believes that certain cornerstones must be laid in the next 45-60 days as prerequisites to any reopening plan:
The Board and retained staff must work closely with Covenant to provide it with necessary historical information and show Covenant the strength of community support of the Board and of a plan to reopen INH.
The Board must come together as a cohesive group dedicated to reopening INH and convince the Island and Blue Hill Peninsula communities of its ability, focus and commitment to do so.
The Board, Covenant and retained staff must develop a plan for reopening INH including a timetable for staffing, resident mix, licensing and operations.
The Board needs to develop an operating and capital fund raising plan for reopening in the range of $1 million and seek the support of key major donors to be included in the process.
The Board must review potential affordable housing building sites, select a developer, research needs and plan a fund raising campaign for as much as $2 million for affordable housing for INH staff. Key potential donors should be identified and included in the planning.
Continued solicitation by Board and retained staff of community housing resources is necessary to bridge the 2 to 3 year gap before new housing can be constructed and becomes available.
Plans for bringing nurses from the Philippines need to be finalized and related contracts and deposits signed and made.
INH needs to work with the CNA training programs to recruit and finance participants and remain in contact with former employees and keep them involved in reopening plans.
The INH Task Force
Samuel Harrington, Chair
Genevieve McDonald, Vice Chair
Roberta Greenlaw Johnson
Gwyn Firth Murray