A new report by Hudson Valley Pattern for Progress on planning for the region”™s aging baby boomer population calls on competing hospitals and health care providers to collaborate in planning and forming integrated regional health care delivery systems to provide better and proper care to those residents at lower costs.
Authors of the report, “Aging in the Hudson Valley: Is the Healthcare System Ready,” acknowledged obstacles to that collaboration, especially among hospitals, which are closely regulated by the state and have union workforces to challenge employment cuts as hospitals merge. A national trend of institutional mergers is already playing out in this region from Westchester County to Dutchess County as community hospitals, both the financially healthy and the bankrupt, affiliate with larger and better-financed hospital systems.
Jonathan Drapkin, president and CEO of Pattern for Progress and one of the report”™s principal authors, in a foreword said the planners recognize that the nine-county region”™s 37 hospitals “find themselves in a very difficult position to join this effort. This is not for a lack of desire but that they exist in a competitive environment, one that is highly regulated by the state of New York.”
Drapkin said a “very strong” union presence at hospitals also “makes reform challenging.” Added to that is “a regional economy that often finds hospitals as the largest employer in each county.” Making health care delivery more efficient “might mean reduction in employment which presents its own challenge,” he wrote.
March S. Gallagher, chief strategy officer at Pattern for Progress and the report”™s lead author, said unions such as the New York State Nurses Association could play important roles as the region shifts from hospital-centered care to nursing home and long-term home care and other options for baby boomers. In the booming health care industry, “There are going to be jobs lost in hospitals but there are going to be jobs gained in nonhospital settings,” she said.
The data-heavy report, the third in a series by Pattern for Progress analyzing baby boomers”™ impact on the Hudson Valley in their elder years, was prepared with financial support from the Dyson Foundation and with input from a 17-member health care industry advisory panel led by Dr. Daniel Aronzon, former CEO of Vassar Brothers Medical Center in Poughkeepsie.
“I think the most overall striking finding” of the report “is to learn that we have significant excess hospital beds in the Hudson Valley,” Gallagher said. According to the report”™s executive summary, the region has at least 1,700 excess hospital beds as projected through 2040, when the oldest of the baby boom generation will be in their 90s.
The report noted that acute-care hospitalization is the most expensive daily care in the U.S., with hospital services representing nearly 40 percent of the nation”™s total $2.8 trillion health care expenditure. In the Hudson Valley, the average hospital charge in 2012 for people over 70 was $7,247 per day, Pattern for Progress reported.
Much like the talk of “adaptive reuse” of vacant and underutilized commercial buildings in the region”™s real estate industry, the report”™s authors recommended converting acute care hospital beds and services to “other types of needed beds, including skilled nursing beds, transitional beds, swing beds, hospice beds, outpatient facilities and specialized nursing units.”
While reducing acute care beds, the region also must ensure that critical access hospitals in rural areas have sufficient capacity for patients, the panel advised.
To properly plan for the future, the region needs “an in-depth analysis of those factors driving hospital admissions for seniors, their length of stay and the charges involved,” planners said.
Despite declining admissions at nursing homes and consumers”™ growing preference to avoid that institutional care, the Hudson Valley will need more nursing beds for its baby boomers than the slightly more than 12,000 beds currently available in the region”™s 95 skilled nursing facilities, Gallagher said. The report noted that even with 30 percent reductions in nursing home admission rates, projections show the Hudson Valley will need more than 1,200 additional nursing home beds by 2040. Without continued reductions in admission rates, the need could be much higher.
Finding those skilled nursing beds “will entail conversion of excess hospital beds where financially feasible and new development with the possible creation of specialized memory units, continuing care facilities and other housing alternatives that allow aging in place,” the report”™s authors wrote.
“What this all boils down to is a dramatic need for long-term home health care,” Gallagher said.
Gallagher said the advisory panel concluded that 90 percent of people who avoid admission to a skilled nursing facility will require long-term home health care. The report noted that 23 long-term home health care agencies operate in the region in addition to 152 certified and licensed home health care agencies. But the region lacks adequate home health care capacity even without reductions in nursing home admission rates.
Planners said the region should consider incentives to increase capacity for home health care, which is projected to have the highest job growth rate in the health care sector. Innovation and consolidation are needed to make home health care more efficient and cost-effective, they said.
The report also recommended the start of a “community conversation” about end-of-life care so seniors can avoid expensive hospitalizations.
“Hudson Valley health care providers should create a regional, consistent approach to seek end-of-life directives at an early age from a high proportion of patients,” the report recommended. The region, which has seven hospice agencies, “should increase home-based hospice care as well as take the innovative step to establish hospice beds in institutional settings” so as to reduce the cost of hospice care in locations outside the home.
Addressing behavioral health, the report said that care should be integrated into traditional health care services. The region needs more behavioral health specialists in geriatric needs who are trained to address depression, suicide prevention, prescription drug and other substance abuse, the report said.
The changing health care sector is projected to create 36 percent of all Hudson Valley jobs over the next six years, according to Pattern for Progress planners. They said the region”™s workforce development system must prepare to meet the high demand for home health aides, personal aides and nurses and the growth of new occupations such as care coordinators.
Planners said the region must begin a recruitment program for health professionals, especially in specialties such as behavioral health where the workforce is aging and has no ready replacements.
“We really have to make sure that we”™re recruiting,” Gallagher said. “We need a collaborative and cooperative workforce recruitment effort.”
Gallagher said the Hudson Valley region is starting to see examples of the new affiliations being forged between health care providers around the nation and innovative systems that bring health care insurers and providers “all under a single umbrella.”
Westchester Medical Center in Valhalla last spring acquired the former St. Francis Hospital in Poughkeepsie in a U.S. Bankruptcy Court sale and renamed it the Mid-Hudson Regional Hospital of Westchester Medical Center. In its northward expansion from the Bronx, Montefiore Health System in 2013 acquired in a bankruptcy proceeding Sound Shore Health System”™s community hospitals in New Rochelle and Mount Vernon and New Rochelle nursing home.
Montefiore and White Plains Hospital officials in May signed an affiliation agreement that, pending regulators”™ approval, will make the White Plains hospital the center of a Montefiore health care network in Westchester.
The state”™s largest integrated health care provider, Long Island-based North Shore-LIJ Health System, entered the Westchester and Hudson Valley markets this year when two financially sound community hospitals, Phelps Memorial Hospital Center in Sleepy Hollow and Northern Westchester Hospital in Mount Kisco, announced they plan to affiliate with North Shore-LIJ.
Lawrence Hospital Center in Bronxville, part of the disbanded Stellaris Health Network with White Plains, Phelps and Northern Westchester hospitals, recently merged with New York-Presbyterian Hospital and has been renamed New York-Presbyterian/Lawrence Hospital.
“I think there”™s a lot of scrambling going on in health care to figure out what the proper alignment of collaborative entities is,” said Gallagher.
