Sonomans make plea for skilled nursing facility at Sonoma Valley Hospital

Sonoma resident Geetal Beugelmans turned to the standing-room-only crowd at a meeting on Sonoma Valley Hospital’s skilled nursing facility Thursday and said, “Let’s work together to keep this place open.”

About 70 people, some with signs reading “SNF Strong,” showed up for the informational meeting about the money-losing facility, which may be closed or transferred. Hospital officials project an $880,000 operational loss for the SNF in the fiscal year 2019.

“We know you oppose the closure, and obviously your constructive comments and suggestions are welcome,” said Jane Hirsch, a Sonoma Valley Health District board member and chair of the task force studying the facility.

“Our goal is to find a sustainable way to keep (the SNF) open,” she added.

All 14 residents who addressed the meeting pleaded for the facility to stay open. Some of the speakers said they had received care there, while others’ loved ones or patients had done so.

“Many of my patients have stayed at the SNF,” said Beugelmans, a nurse whose company is Elder Health Consultants. She said the hospital’s skilled nursing facility is superior to the other skilled nursing offerings in the immediate area. One thing that sets it apart, she said, is that patients have access to a physician at all times because it is located in a hospital.

“That’s not saying if your nurse (in a different Sonoma facility) calls and says the patient needs a doctor, they won’t come,” Beugelmans elaborated in an interview after the meeting. “They will come, but at SNF there is a doctor on the premises at all times.”

In what could be a signal as to the SNF’s eventual future, representatives of the two other such facilities in the immediate area – Broadway Villa and Sonoma Post-Acute, both located in Sonoma - gave presentations at the meeting, noting that their facilities have the capacity to take more patients.

Healing at Home, the hospital’s home care service, was transferred to Hospice By the Bay, a regional not-for-profit organization, this month. Healing at Home lost $578,000 in the fiscal year 2018.

In another money-saving move, the hospital board in July voted to close the obstetrics department, which lost $600,000 in the fiscal year 2018.

The hospital has struggled to bolster the skilled nursing facility’s financial position, introducing a cost-reduction program in 2014, Mark Kobe, the hospital’s chief nursing officer, reported at the meeting.

The cost-reduction program initially succeeded, but succeeding changes in costs and reimbursement once again soured the financial picture at the 27-bed facility, Kobe said.

“In 2018, rising labor costs contributed to the reversal in gains,” Kobe said. “We were losing people. Some left because of salary,” necessitating salary increases for nursing, physical therapy and occupational therapy.

As costs rose, revenue dropped. The reasons are complicated, but stem from lower reimbursement from Medicare and Medi-Cal.

Moving ahead, the task force will focus efforts on ways to bring costs down, Hirsch said in an interview.

“We will reduce staffing,” which brings down salary costs, usually one of any establishment’s biggest financial burdens, regardless of type. The reduction won’t cause the facility to fall below state standards for the amount of care available to patients.

“This standard is 4.5 hours of care per patient-day, and we were running at 6.4 hours per patient day,” Hirsch said.

At the end of Thursday’s meeting, Hirsch told the audience she did not foresee a decision on the facility until at least the end of the year, in order to evaluate the financial impact of the staffing changes and other attempts to save money.

“Stay tuned. I appreciate your strong feelings,” she said.

Reach Janis Mara at janis.mara@sonomanews.com.