Nursing Home Thrives By Targeting Residents Others Won’t Take

One of the top nursing homes in the state of Connecticut secured its accolades by specifically taking in patients that other skilled nursing facilities shy away from serving.

The 60 West facility, located in Rocky Hill, Conn., was named to U.S. News & World Report’s list of best nursing homes and was one of the 42 facilities in the state to get a “Top Performing” rating in the publication’s 2018-2019 list of Best Nursing Homes. As of November, 90 of the building’s 95 beds were occupied, defying national occupancy trends.

Operator iCare obtained those accolades — and that almost 95% occupancy — with a focus on an unusual population: Paroled prisoners, either near the end of their lives or with complex medical conditions, who have been compassionately released through a board established by the state of Connecticut for that purpose.

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“The real goal is taking a patient where not only is it going to save money, because it’s a lower-cost environment, but it’s also somebody they would have a challenge placing anywhere else in the community because they did something 20 years ago that’s really egregious,” David Skoczulek, vice president of business development at iCare told Skilled Nursing News.

The project is a joint venture between the state’s Department of Mental Health & Addiction Services (DMHAS) and the Department of Corrections (DOC), with the building itself managed by iCare Health Network. The Manchester, Conn.-based iCare runs 10 SNFs, with approximately 1,300 beds, all in the Nutmeg State.

The nursing home opened in 2013, after iCare emerged as the winner in a request for proposals (RFP) process initiated by Gov. Dannel Malloy, and has been steadily growing ever since. The company has seen success through educating the community about the population that the nursing home serves,  administrator Jessica DeRing told SNN, but the process hasn’t always been easy.

For one, the nursing home has had to combat lawsuits by people living by the nursing home and by the town of Rocky Hill over unease about the residents living at the home. All the lawsuits, though, were eventually resolved.

“There was sort of a knee-jerk reaction that these patients were going to be young and dangerous,” Skoczulek told SNN.

The DOC’s compassionate release review board conducts a stringent approval process, he emphasized, and any patient who comes to 60 West from the DOC has to be deemed a good fit.

The nursing facility takes in referrals from the DOC, DHMAS, or the Connecticut Valley Hospital, a psychiatric facility operated by DHMAS. Over the last five years, 60 West has seen a total of 213 admissions, 79 of which were from the DOC and 84 of which were from DMHAS. The other 50 admissions came from the community.

For the patients from the DOC or DMHAS, many were receiving treatment in a more expensive setting than necessary, Skoczulek explained, and many of them are docile and cognitively impaired.

“It’s not Hannibal Lecter,” he said. “It’s not someone difficult to manage in real time.”

But for most patients with a criminal background, that record makes them exceptionally difficult to place. DeRing, who worked as an administrator at a traditional nursing home for several years, admitted that in her previous position, she would not have considered patients like the ones 60 West takes in.

“The hospitals are desperate because if they’ve got someone who’s got the colorful history, they need somewhere to put them,” she said.

Jeff Crofoot, manager of inpatient care coordination at John H. Stroger Jr. Hospital of Cook County in Illinois, confirmed the difficulty of placing patients in need of skilled care when they have a criminal background.

“It’s not unusual to send out 20, 30 referrals, knowing you’re probably going to get ‘Nos’ from everybody,” he told SNN.

This is particularly frustrating because in many cases, the patient is not staying in the hospital out of medical necessity, Crofoot explained. The likelihood of the hospital even getting reimbursed for the days that patient stays “is essentially zero,” since they don’t need hospital care.

“You’re still using up just as many resources as you would another patient, plus I can’t put another patient in that bed,” he said. “It can also back things up as far as the flow, really, through the hospital. If I have several beds that are full with patients just needing to be placed, that means I have less beds available for emergency-room patients coming through who need to be placed.”

Those factors sometimes lead to excess demand for 60 West’s services, as many hospitals will simply try to send patients who are difficult to manage, rather than residents who are hard to place because of their background. If the patient needs a stay in acute psychiatric facility, for instance, or could not be reasonably managed by another iCare facility, they will not be admitted to 60 West, Skoczulek said.

Several states, including Colorado, Kansas, Massachusetts, and Ohio, have visited the facility at different points in time to look at the program. But for any state or facility that wants to look into serving this population, integration and communication — both inside and outside the facility — is key. The state of Connecticut is closely involved with the 60 West facility, Skoczulek noted, and a SNF that tries to graft this program onto an existing unit could end up disrupting existing staff and patients.

Still, the need for facilities that serve this population isn’t going away, since graying demographic trends are hitting state institutions as much as the general population of nursing homes.

“It’s definitely a niche market that we need everywhere,” Crofoot said. “If we had something around those lines in Illinois, they definitely would be one of my best friends.”

Written by Maggie Flynn

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