Clallam County Public Hospital District (Forks Community Hospital (FCH) owns and operates a long-term care (LTC) facility connected to the main hospital.

At its July 26, 2022, meeting, the Board of Commissioners adopted a resolution to move forward with transitioning the long-term care beds to “non-skilled swing beds.” The decision was made after an extensive investigation into how best to address nearly $5 million in losses related to long-term care services combined in 2020 and 2021, with over $2 million in losses expected in 2022.

The term “swing bed” relates to how patient care is reimbursed from Medicare and Medicaid by patients occupying the beds and the services provided. The swing bed program permits hospitals to use their beds interchangeably between intermediate, skilled, or non-skilled nursing care for patients. The program started in the early 1960s, and as a result, hospitals located in rural, frontier, and underserved areas have been able to meet the need for long-term care services.

“As a direct result of how Critical Access Hospitals (CAH) are reimbursed for LTC beds, FCH has experienced significant and unrecoverable financial losses,” said Heidi Anderson, FCH CEO. “The shortfall of reimbursement for the wide range of essential services provided to LTC residents has required FCH to cover this debt with revenues generated from other operations; a practice that is not sustainable or fiscally responsible going forward, and so, I applaud the Board for making this difficult but necessary decision,” she added.

Months of discussion about the situation, an extensive study by health finance experts, and guidance from the organization’s legal counsel led to the adoption of Resolution 2022-520, which instructed Administrator Heidi Anderson to conduct further evaluation and report back on additional findings.

In a status report provided to the Board at its July meeting, Anderson relayed that she conducted multiple conversations and exchanged information with state health officials, the Washington Hospital Association, which carefully monitors and provides assistance on these matters, elected representatives, as well as CMS and other agencies relative to the matter. In Anderson’s report, she stated, “I am requesting that the Board bring forth a resolution that would grant full authority to begin the process of transitioning the FCH long-term care operations, converting its beds to the permissible classification of swing beds by CMS.”

The transition process is estimated to take 120 days. Although individuals currently occupying long-term care beds will not experience any changes in their care and comfort, the process is comprehensive. It requires approval from several agencies before the shift can occur.

In preparation for the decision to move forward, FCH has been preparing community education material to start a broader conversation about the future of healthcare services for the West End. “It is essential that our staff and community understand that this transition is a part of a broader plan to ensure that FCH has the best opportunity to remain viable and grow and enhance our services and facilities,” Anderson said. “With the state of rural health in general, it’s critical that we are strategic and think long term for the sake of our community. The only way to address our aging facilities, remain competitive in our wages, attract, and recruit new providers, and work to grow services to invest revenues that will multiply.” Anderson also said that FCH continues actively discussing, planning, and developing feasible senior care and aging-in-place solutions.

A special website was launched to provide education and information about the long-term care transition, the first of what Anderson hopes to be several strategic steps FCH can take to ensure sustainability. The website address is healthierwestend.org.

The Healthier West End (HWE) framework is designed not just to address the challenges FCH is facing today; its focus is to do everything possible to remain a viable public hospital despite the conditions it has no control over. On healthierwestend.org, community members are encouraged to join the conversation and ask questions about the LTC transition and future plans related to the six strategic plan objectives detailed on the website.