Going Beyond Skilled Nursing Boosts Occupancy to 100% at New York Facility

At the turn of the century, the New York non-profit Fort Hudson Health System saw opportunities to go beyond its roots as a traditional nursing home provider by expanding into independent housing and home and community-based services. It was a vision that drew Andy Cruikshank, Fort Hudson’s CEO, to take on the role in 2000.

That move outside the skilled nursing box ended up helping the system’s 196-bed nursing home stay at 100% occupancy, he told Skilled Nursing News.

“It’s an irony that our services are geared toward keeping people out of the nursing home when that was our core business,” he said.


Expanding services

Fort Hudson, which is based in Fort Edward, N.Y., in upstate Washington County,  was originally incorporated as an 80-bed nursing home in 1969, and it didn’t end up expanding into independent housing until the year 2000. In fact, all of its other services, which include a certified home care service agency, a certified home health agency and a care management program, came after 2000, Cruikshank said.

Fort Hudson’s home care service agency covers five counties and offers 200,000 hours of personal care assistance, while its home health agency covers two counties and sees 1,600 admissions per year, according to Cruikshank. The provider also now has 62 units of independent housing.


The move into senior housing was in its infancy when Cruikshank joined, but Fort Hudson had the goal of going beyond traditional nursing home services to meet seniors’ changing needs. It was a target he found compelling.

“They were seeing what direction they wanted to go, but needed someone that was going to be leading that direction into a sustainable long-term future,” he told SNN. “It was not even the conceptual plans; it was a sense that this organization was willing to take measured risk in order to better meet their mission.”

The health system’s care management program, which currently sits at about 600 clients from the Canadian border to the capital city of Albany, is its biggest growth area. Fort Hudson has seen a steady increase in that client figure quarter-over-quarter, though Cruikshank noted there’s also more turnover as patients move out of the program.

“I think we’re probably 75% to the top of what I would see as a sustainable number, so I don’t see perpetual growth in that,” he explained. “I see evolution in that.”

Care management as a concept can be overused, he acknowledged, and it gets thrown around in health contexts ranging from primary care to acute care. For Fort Hudson, the goal is to look at individuals and keep them out of higher levels of care, by whatever means is right for them.

“That may mean something as basic as housing and food security … it may mean intervening with chronic conditions that become acute, it may mean setting up programs to just manage medication,” he explained.

The majority of people in this program are at home or in the community, and though there’s some clients in nursing homes, Fort Hudson is actively working to have them discharged. In Cruikshank’s experience, family members will often think a loved one needs skilled nursing care, when they could get by with help in the home in specific areas.

Keeping the nursing home full

Fort Hudson expanding services to the home and community might seem to indicate that it’s ignoring the nursing home component of its business, but its SNF has 100% occupancy, and Cruikshank believes that skilled nursing “absolutely” has a place in care management.

In fact, the company expanding outside the traditional nursing home model ended up helping Fort Hudson beat nursing home occupancy trends, which keep moving downward, and buck the wave of non-profits closing up shop in skilled nursing.

The reason for this is the increased number of people Fort Hudson reaches by virtue of its new, non-skilled services, Cruikshank said. Of those people, a certain percentage are inevitably going to require a higher level care than what can be provided in the home, and Fort Hudson is able to provide that.

“It’s allowing us to touch these individuals who, percentage-wise, require skilled nursing,” Cruikshank said. “That’s why we’re full, when our competitors are empty.”

The place of skilled nursing in a world defined by care management is still evolving, he said, noting that hospitals, particularly smaller ones, have been slow to recognize the value of post-acute care.

But the nursing home of tomorrow must integrate their services with other levels of care and then work more closely with upstream partners, whether those are insurers, hospitals, or accountable care organizations, he posited.

“The idea of an independent, standalone nursing home model as being the model to pursue — I think that ship has sailed,” Cruikshank said. “I just don’t think that model in and of itself works. You have to have integrated services.”

Written by Maggie Flynn

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