Nursing home closure brought to county

Some people in Custer County want answers from Monument Health regarding the upcoming closure of the Custer Care Center (nursing home) with the City of Custer. They want to enlist the county’s help in getting those answers, as well.
At the Dec. 22 meeting of the Custer County Commission, Lea Anne McWhorter came before the commission during its public comment time to talk about the situation, saying while she realizes it’s not a county issue in terms of money, she believes it’s an issue that will affect the entire county.
Monument Health announced Dec. 10 it plans to close the center, which has around 30 residents presently. Those residents will eventually be relocated, and the facility shuttered. Monument Health cited a workforce shortage as the reason for closing the facility.
McWhorter said the 2020 census shows that 42 perent of the county residents are 60 or older, and a significant number of those people will eventually find their way to a nursing home.
McWhorter said part of the reason she and her husband, Rob, moved back to Custer was they knew they would receive quality healthcare and that a nursing home was available in town. It was a nursing home her father had been in, she said, and he had a wonderful experience there.
McWhorter wondered what the economic impact on Custer would be with the closure, as well as the impact on those living there and those currently working at the facility.
“There are a  lot of things going on there,” she said.
McWhorter encouraged the city and county to demand an independent audit of the books of the nursing home to see “where we are standing and why they are taking the actions they are.”
Whether the city had any leverage to demand an audit of the nursing home was discussed, as was  an apparent lack of contract between the city and Monument Health (at that time Regional Health) regarding operation and financing of the nursing home, hospital, etc.
Ten years ago, the city entered into an agreement with Custer Community Health Services, Inc. (CCHS), to pay $4 million (apparently toward support of construction of the new hospital, although that is not explicitly stated in any documentation) as a continuation of a subsidy the city had paid CCHS for years. However, the amount was lowered from around $400,000 to $347,000 annually.
Because of that financial assistance, many in the crowd felt the city did have a right to know the facility’s financials.
“If you’re paying them four million, you can demand an audit,” commissioner Mark Hartman said.
It appears the reason 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 CCHS, a nonprofit organization that at one time owned the old hospital building as well as the nursing home, and Regional ran the facilites through a lease with CCHS. Prior to that the city owned the buildings, but somewhere along the line transferred onwership 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.
Ryan said beside the $4 million agreeement, there is no agreement between the city and Monument, and that agreement does not mention anything about the nursing home or the assisted living facilities or how they will be used, etc.
“They own that building,” she said. “Right now, as far as I know, they have no plans to sell it.”
Some reversionary verbiage may be included in the documents (wording that states the building be turned back over to the city if it isn’t used for health care) but they are being studied by city attorneys and it is unclear to what, if any, extent there is such verbiage.
McWhorter said she felt there should be a public information meeting held by Monument to explain the decision to close the facility, as well as how long it has been considered and what they plan to do with the building. She said at a recent economic development meeting Monument Health officials did not indicate there were any  problems at the Custer Care Center.
“They gave a glowing report,” she said. “Within two weeks the announcement came out the nursing home was going to close.”
McWhorter added the new hospital does not have a kitchen, and that all the meals for patients in the hospital are prepared at the Custer Care Facility kitchen.
Ryan said it is that reason, the need for the kitchen, that Monument Health does not have any plans to sell the facility once it closes.
Ryan said the city does have its attorney looking over documents, resolutions, agreements, etc., that were crafted between the entities over the years to see if the city has any leverage over how the building is used in the future.
Once the attorney finishes analyzing the agreements, Ryan said, the city will have a better idea of what it can request from Monument Health.
Monument’s pay scale at the facility was also discussed, as some questioned how Monument can pay CNAs so little as compared to travel nurses, who receive no benefits but do receive housing and can make as much as $150 an hour. CNAs average anywhere from $13 an hour to $20 an hour.
Ryan said Monument has said the reason they have to hire so many traveling nurses is they can’t get enough local help, and that they have indicated they were willing to pay more for permanent staff.
“My own experience with nursing homes is that it’s a revolving door,” she said. “It’s a national problem. Not everybody can do that job. It’s not really a local problem, and it’s not really a rural problem. There have to be ways to address this issue, but nobody knows.”
Custer County Library director Doris Ann Mertz was on the hospital board for years, and said the nursing home was constantly in the red, and that travel nurses and foreign nurses were needed to continue to operate the facility. That, in turn, caused the facility to sink further into debt.
“It’s always been a struggle up there,” she said, adding at times locals quit because “management was not fun to work with.” She said the hospital and other facilities did well enough to keep the nursing home in operation.
“They never found a solution,” she said.
The problem was exacerbated, she said, when the state began to levy fines when the facility would keep people there it felt the facility wasn’t equipped to deal with, such as those with severe dementia. The fines weren’t small, either, she said.
“We couldn’t keep serving the peole we were wanting to serve,” she said. “When you’re already in the red (the fines) make it hard.”
Hartman said there are thousands of nursing homes that operate successfully across the nation, and he feels the city should demand the building back and a search be conducted for another company to operate a nursing home there.
“I think things need addressed. The agreement needs to be addressed and the building needs to be addressed,” McWhorter said. “The last thing we need is for the City of Custer to have another (empty) building.”