We decay. It happens slowly — our knuckles swell, our eyes cloud with cataracts, we forget names that we used to speak with love. Or it happens quickly, at the pace of a rogue clot or a reckless driver. For most of us, the day comes when managing our bodies requires the assistance of others. This is the reality for hundreds of elderly and disabled people living in Humboldt County who can no longer care for themselves, and depend on the staff at skilled nursing facilities. On Sept. 8, the residents of the Eureka Rehabilitation and Wellness Facility, those cognizant and mobile enough to attend, gathered in the sunny day room along with concerned family members to hear why that facility and two others locally may be shutting down, forcing almost 200 patients into an uncertain future, and possibly into care hundreds of miles away.
The potential closure of the facilities — Eureka, Seaview and Pacific Rehabilitation and Wellness — would cut the number of local skilled nursing beds by more than half and came as a surprise to many patients and caregivers. The management company for all five of Humboldt's major facilities — Rockport Healthcare Company – did not notify patients before the information leaked to local media in late July. The company has stated that it lost $5 million in revenue due to staffing shortages over the last year because it has had to recruit and house temporary employees from out of the area. State guidelines mandate 3.2 hours of patient care per patient per day, and a lack of skilled medical staff on the North Coast (combined, alleges the company, with the lure of cash wages in the black market marijuana industry) has made meeting this minimum level of staffing incompatible with Rockport's bottom line.
Vincent Hambright, CEO for Rockport Healthcare, faced down the crowd of patients with a pallid smile. He explained to those assembled that he had recently visited a grower's co-op to better understand the local marijuana industry. Asking that people hold questions until the end, he explained the dynamics of marijuana trimming as people crossed arms and tapped toes.
"That's my competition, that's what I'm dealing with," he concluded. "Your market is one of the most unusual I have ever seen. To have both a workforce shortage and a higher cost of housing is unusual for us."
Hambright said that, while the cost of living in Humboldt County is on par with the Bay Area, reimbursement rates for MediCal are structured for "a more rural area" and don't offer a rate competitive enough to recruit sufficient staff. But this claim is directly refuted by public information on reimbursement rates available through the Office of Statewide Health Planning and Development, which shows the five facilities owned by Rockport in Humboldt are paid more per day per patient than the state average. In fact, according to research conducted by staff at state Sen. Mike McGuire's office, Partnership Healthplan, the local MediCal distributor, has markedly raised reimbursement rates to the region over the last two years, by as much as 20 percent for some facilities.
As Hambright talked, Catherine Pugel waited, quivering with rage. Her father, John Catudal, sat next to her on a modified gurney. Pugel said that explaining the situation to her father, who has been at the facility for three years, has been challenging. Catudal and his wife of 52 years, Ellie, share a room at Eureka Rehabilitation. Ellie Catudal is in the late stages of Alzheimer's. Pugel attributes her continued survival to being able to wake up next to her husband every day, and to the efforts of staff members who have become like family to her parents. The staff call them "Ma and Pa," she said.
When the floor opened up for questions, Pugel had many. Why, she asked, were she and other families only informed of the meeting – held in the middle of a weekday – one day prior? If, as Hambright alleged, there was "no timeline" to move patients from closing facilities, why was she told by the administrator that if the California Department of Public Health approves Rockport's application to shut down the facility, she will get 30-days notice to move her parents?
"The thought of having to relocate my parents while working, it's frustrating," she said later in a phone interview. "It's not just one thing. This is about a lot of things. My mom has Alzheimer's, she's in the final stages. Will a transfer kill her? Will such a transfer be traumatic? These are the things we are now looking at."
Pugel and others contradicted Hambright's assertion that the company had staved off understaffing by paying for expensive, out-of-town staff. In the meeting, she confronted the CEO, saying that staff taking care of her parents had personally said they were overworked, understaffed, tired.
"We are not understaffed," Hambright insisted at the meeting.
"Excuse me, you are," said a large, mustachioed man, who received an alarmed call from his mother-in-law in the middle of the night the week prior. He said he and his wife had to personally come down to the facility and change her soiled diapers because there was only one person on staff for the entire wing. "You are understaffed. You need to do something about this. And I want you to know – I don't go away."
"I hope you don't," said Hambright, with a chuckle. "I would be foolish to think I could make every family and every patient happy. We remain committed to this community."
Several residents present at the meeting chipped in with their own accounts of understaffing, including a man whose toes had been amputated and who said his bandages hadn't been changed in two days due to a lack of a wound care nurse.
"To be honest, we are tired of the excuses," said McGuire, reached by phone the day after the meeting. "Rockport needs to stand up and do their damned job."
McGuire, who has been involved with a working group that includes the local ombudsman office, representatives from Partnership and the California Department of Healthcare Services, said all of the agencies involved had received different stories and that Rockport lied to county officials in August about working with his staff.
"We met with them today for the first time," he said during the Sept. 9 interview. "I have never seen a situation like this, in all of my time, handled so poorly. I have never seen a corporation lie like this one has."
In a fiery letter to CDPH asking the department reject Rockport's closure plans, McGuire charged that Rockport's management has never accepted invitations to attend numerous meetings on healthcare workforce development over the last two years. Further, the letter cites $931,370 in retroactive reimbursements granted by Partnership and alleges that Partnership has identified "rampant under billing" by Rockport, but the company has failed to work with Partnership's claims staff to identify billing corrections. McGuire also states that Partnership has committed to consider further rate increases for Rockport, so long as they are tied to quality of care. The letter closes by lambasting the incomplete nature of Rockport's relocation plans, which include available space locally for just 44 of the 190 people who would potentially be displaced by the closure.
"What we know is that mortality rates rise when they are transferred out of a facility," said McGuire, referring to "transfer trauma," in which elderly people in ill health fail to acclimate to the stress of moving from one place to another. Should the residents of the Rockport facilities be forced to move, they will likely have to travel hundreds of miles to skilled nursing facilities in other parts of the state.
The California Department of Public Health ultimately agreed with McGuire and other members of the working group, sending a letter to Hambright requesting a closure plan with a detailed timeline for family members, more details about how the company will address transfer trauma, and specific information on where the remaining 146 residents who cannot be placed locally will go.
But while the CDPH and local officials can slow the process, they ultimately cannot prevent Rockport, a private company, from closing its doors.
"Basically, as far as preventing them from closing, it's not anything we can do," said Cathy Mudge, spokesperson for state Assemblymember Jim Wood. "The state has certain requirements. We had a lengthy meeting with the Department of Public Health and they said we don't have the authority to prevent them from closing as long as they meet the requirements."
Mudge added that Wood is already considering legislation to address this issue, with an emphasis on how skilled nursing closures affect rural areas.
McGuire also said that, while Rockport has announced its commitment to keeping its local workers employed after the closure, the county Department of Employee Development has told him at least six Rockport workers have had their hours reduced to the point that they have had to seek new employment, contradicting, he said, the claim that they do not have enough staff.
Pugel mourns the thought of severing the bonds her parents have formed in their new home. One of the employees who has become close to the family often brings her baby in to visit with "Pa."
"He holds that baby like it's his own child," she said. "The thought of pulling them out of that and pushing them into a new location ... I don't know. Will it be the same? I know for certain there's a greater risk of them dying sooner."