Typical long-term nursing home care of days gone by is giving way to other priorities.

The big announcement this week that RiverView Health is drastically reducing the number of beds in its care center – from 64 to 24 in the nursing home portion of the campus – might have come as a shock to many in the community, but the writing has been on the wall for years. It was just a matter of time before this inevitable solution would be implemented.

     RiverView's news release cites the many challenges skilled nursing facilities across the country are facing today as the motivator for this difficult decision. One need only glance over the past decade's worth of annual financial reports for proof that the care center has been a drain on RiverView's total financial picture, primarily due to the age-old gap between Medicaid reimbursement rates and the actual costs of providing care, which are higher. Money taken in from other healthcare services within the organization, including outpatient procedures, emergency/urgent care treatment, and hospital stays, are what's kept the care center going in recent years.

    As Ross Matlack, president/CEO of RiverView Health said, "we can no longer afford to subsidize this service.”

    There's another glaring factor, though, that has a huge impact on why skilled nursing facilities are hurting, one the RiverView release did not touch on: the market. A generation ago, it was much more common for the elderly to end up in a nursing home the moment it became more difficult to care for themselves. A good chunk of those residents would have been able to stay in their own homes, or with relatives, considerably longer if only they'd had some outside health care assistance to do so. This would have allowed some to even save more of their little nest eggs for their heirs.

    Things have changed with the emphasis on preventive care evolving. Recognizing that people fare much better mentally and physically when living as independently as they can, the push now is to keep them out of the nursing home and in their own apartment or house as long as humanly possible. This goes for both the elderly and disabled. Long-term care, previously tied almost exclusively to nursing homes, now encompasses assisted living services such as health care and housekeeping tasks provided in a person's home, outpatient therapies, and practical education on how to maintain an independent lifestyle. Relatives are providing many of these types of services with no compensation, but they're also increasingly by being covered insurance plans.

    So even as the baby boomers are sliding into that age group with more health problems and people are living longer than ever before, nursing home resident numbers are decreasing. The focus of care in these facilities has become more short-term for patients who need rehabilitation, reserving long-term care for those suffering from memory loss due to Alzheimer's disease, dementia and other conditions.  

    This makes RiverView's decision to specialize in memory care for its long-term beds a great move that could, in the long run, see more positive results. As for the care center building built in the 1970s, perhaps the powers-that-be might consider a conversion into assisted living units.