Only four remain in Custer Care Center

Jason Ferguson

Less than 60 days after Monument Health announced its plans to close Custer Care Center and relocate the 35 residents at the facility to other nursing homes, only four residents remain at the facility.
Mark Schmidt, president of the Custer Market for Monument Health, said a wide net has been cast seeking a facility for the four who remain at the center, and Monument’s plan is to have them placed in different facilities by Feb. 10, which would be the end of the 60-day notice for closure that residents and their families were given by Monument Health.
Schmidt said Monument expected the transition to take months, but said the relocations have gone surprisingly well, aided by the graciousness and compassion of other area facilities, whether it be in the Northern Hills, Wyoming or elsewhere.
“We recognized challenges other nursing homes were having, and we expected this would be quite a process,” Schmidt said. “Facilities were very gracious to us. We’re very pleased with the process.”
Some residents have been moved to Monument’s assisted living facility in Custer, which Schmidt stressed is not changing or closing. Others were moved to facilities as close by as possible.
As far as employees of the facility, Schmidt estimated there were roughly 39 employees who were non-contracted (traveling) employees at the time the closure was announced. Since that time, those employees were visited by Monument Health recruiters and staff to have questions answered on a variety of topics, including whether or not they could or would want to redeploy elsewhere in the Monument Health system, retirement or looking for a job elsewhere. Schmidt said the majority of the caregivers were able to redeploy within Monument’s Custer Market (Custer, Hot Springs, Hill City) while some have decided to retire and others have decided to seek another line of work.
“We reached out and compassionately met with each one,” Schmidt said. “The two things I cared most about were our caregivers and residents and I think we’ve done everything we can to make this the best transition it can be.”
As far as the future of the building, Schmidt said Monument does not have a set plan. Monument has looked inward at possible uses for the building, pointing out it was constructed as a care center, and as such, using it for another purpose would likely require a significant investment in terms of renovation.
There is no formal contract between the city and Monument for ownership or operation of the nursing home as the contract was not with the city, but rather, with Custer Community Health Services (CCHS), a nonprofit organization that at one time owned the old hospital building as well as the nursing home, and Regional ran the facilties through a lease with CCHS. Prior to that the city owned the buildings, but somewhere along the line transferred ownership to that nonprofit. Past Community Health Services officials do say the city was involved with all of CCHS’s dealings with Regional/Monument, however.
Around 2016, CCHS and Regional/Monument worked out a merger agreement and Regional/Monument took over possession of those buildings and the city’s payments began to go to Monument instead of CCHS. This was brought on by a needed renovation project at the buildings that came in massively over estimates, which in turn caused the nonprofit to ask Monument to take over the buildings. CCHS subsequently dissolved and its remaining funds, around $294,000, were put toward the $4 million the city agreed to pay.
Schmidt acknowledged many in the community have approached Monument about the possibility of continuing to have a nursing home in the building, and there have been ongoing discussions with City of Custer Mayor Bob Brown as to that possibility. On Friday Monument Health officials will meet with city representatives to continue dialogue with regard to the future of the building. The only thing set in stone, Schmidt said, is the food service in the care center will continue to supply meals for the hospital and assisted living.
“We’re still looking at other ideas,” he said. “We need to work through that. There is no plan in place right now.”
Custer residents have made no secret of their desire to see the facility remain a nursing home. Schmidt said it’s a loaded question as to his opinion on whether the City of Custer can support a nursing home.
“It’s fair to say the reason we have had to come to this point is related to workforce,” he said. “The discussion would be recruiting and retaining a sustainable workforce.”
The inability to keep an adequate workforce at the facility was given as the chief reason for the impending closure when Monument announced that decision. Since then, some former employees of Custer Care Center have derided that stance, saying good employees were driven away from the center by an impossible work environment and poor care center leadership.
Schmidt said everyone has a perception of their relationship with their employer, and he does not challenge anyone’s perception one way or the other.
“We all work under the same missions and values, and we expect all our caregivers to work under those,” she said.
The issue of pay has also been brought up as a reason for many people leaving, as Certified Nursing Assistants at the facility make a great deal less than a traveling Registered Nurse (although the latter requires much more schooling).
The traveling nurses are required to fill in he gaps, Schmidt said, and while they used to exist to shore up loose ends, they are becoming more and more common not just at Monument, but across the health care industry.
An article at beckershos shows the pandemic intensified health care facilities’ reliance on traveling nurses and highlighted the gap between full-time workers’ pay and lucrative temporary contracts.
While the average salary for a traveling nurse can vary based on location, regional demand, hospital type and specialty, the compensation for a traveling nurse has increased significantly compared to pre-pandemic, Bill Morgan, president of the Orlando, Fla.-based travel nurse staffing firm Jackson Nurse Professionals, told Becker’s in September.
Meanwhile, hospitals and health systems have offered bonuses, increased wages and made other investments in employee retention for their staff workers. Still, the compensation gap between hospital employed nurses and travel or agency nurses remains stark.
The COVID-19 pandemic has created a situation where volumes are consistently higher than normal, the article states. And while rates for a travel or agency nurse have traditionally been higher than those of a hospital staff nurse, the current demand has pushed travel rates to record highs.
Pay for travel nurses has always been higher for the same reasons hospitals pay float pool nurses more, said Dr. Kathy Sanford, DBA, RN, chief nursing officer at Chicago-based CommonSpirit Health.
“Nurses are specialists and they work on a particular type of unit, and sometimes one unit’s census will be down and another unit's census will be up,” she said. Float pool nurses are willing to shift to different units that need help and it’s not a favorite thing for nurses to do. You have to pay them a little extra to be willing to learn different types of nursing and be willing to float.”
Simply put, the article states hospitals can’t afford to pay full-time staff wages that were meant for temporary assignments.
“The bottom line is it would not be sustainable for hospitals to pay the kind of dollars that they’re paying right now for travel nurses in the long run. Because nurses are our backbone … they’re our heart, but they’re also our backbone. They’re the majority of our staff,” Sanford said.
If any entity decides it would like to open a nursing home in Custer, it will have to go through the state to do so. When considering the need for additional beds or new facilities, the Department of Health of Human Services utilizes the 2015 Evaluation of Long-Term Care Options for South Dakota report that was prepared by Abt Associates, Inc. and data from the most recent occupancy report.
In 1988 the state enacted, through HB 1186, a moratorium on nursing home beds due to skyrocketing costs. The moratorium was extended for 14 years through legislative actions before being extended indefinitely in 2005. The moratoriums excluded reservations.
In 2012 legislation passed to reallocate  unused nursing home beds to identified areas of need through the statutory Request for Proposals (RFP) process. The Department of Health may authorize a facility to have additional beds or may authorize the construction of a new nursing facility, so long as the total number of nursing facility beds statewide does not exceed the total number of beds in existence when the moratorium was extended indefinitely. Therefore, the beds that are eligible for redistribution come from nursing facilities that have closed since 2005 or from facilities that have voluntarily relinquished excess beds. To date, there have been 12 nursing facilities that have closed sine 2005, accounting for a total of 731 beds, and a total of 431 beds have voluntarily been relinquished by existing facilities.
The state will allow for 7,623 beds with around 6,462 occupied. In 2019, SB 61 was approved, which provided that if an existing facility closes, beds from that facility will be held for 18 months from the closure date and made available for use by an entity licensed to operate a nursing facility.
In region two of the state, which covers Martin, Custer, Hot Springs, and Kadoka, 291 licensed beds are available, of which 4.5 percent are unoccupied.

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