Sherwood Oaks Health Center, the only convalescent hospital on the Mendocino Coast, could be shut down in a matter of weeks unless state health authorities send emergency nursing staff, Dr. William Miller told a meeting of the Mendocino Coast Healthcare District board of directors Monday night.
Dr. Miller, who is Chief of Medical Staff at Adventist Health Mendocino Coast Hospital, said state and local officials have held a series of urgent meetings in recent days trying to find a way to keep the struggling facility open.
“If this does not happen, there is a real possibility that the 36 residents will have to be relocated. This would be massively disruptive to the community,” Miller said.
Sherwood Oaks is in the final stages of being sold to Shlomo Rechnitz, California's largest nursing home owner, whose group of companies has come under scrutiny for lapsed licenses, and is the focus of at least one lawsuit over patient care during COVID.
Miller said long-standing problems at Sherwood Oaks have worsened during COVID, particularly an inability to keep adequate staffing, including top positions. He said the director of nursing position there has been unfilled for the past six months, with no prospect of a new hire. Sherwood Oaks longtime chief administrator is retiring this week, Miller said.
In addition to being short staffed, Miller said Sherwood Oaks, which has operated in Fort Bragg since the 1970s, also has about $1.5 million in deferred maintenance and about $2 million in unpaid fees to the state, all of which has pushed the facility to the brink of a forced closure.
Asked by healthcare district board member Norman de Vall if a forced closure could happen as soon as Jan. 1, Miller replied “If there is no relief in nursing, there is that potential… I find it hard to believe the state would allow that to happen.”
The California Department of Public Health has once before sent nursing staff to Sherwood Oaks, during the second surge of COVID in 2020 when seven Sherwood Oaks patients died of the disease. Much of Sherwood Oaks staff — like healthcare workers nationwide — have quit during COVID and, with the national shortage of healthcare workers worsening, there has been little success in hiring new nurses and CNA's (Certified Nursing Assistants). Miller said he does not see that situation changing anytime soon.
He said he has met with officials from the City of Fort Bragg and Mendocino County in recent days, as well as representatives from Adventist Health and the healthcare district, to try to come up with a short-term solution. He said county officials have agreed to take the lead in requesting help from the state. That help, he said, might give another couple of months to establish Sherwood Oaks' operation under new ownership and ease the staffing problems.
The facility, Miller said, is licensed for 76 beds. In recent years, it has operated 55 beds; since COVID, the patient census has dropped to 36, far below the number needed for the facility to break even, he said.
Staffing and licensing issues at California nursing homes are a growing focus among state regulators and lawmakers as COVID has overwhelmed many facilities and laid bare industry-wide problems.
Rechnitz's companies are in the midst of the controversy. A Calmatters report in October - “Shlomo Rechnitz nursing home suit over COVID deaths reflects ‘broken state licensing’ ”— describes a lawsuit against a Rechnitz facility in Redding. The suit represents, among others, the families of 14 patients who died of COVID at Windsor-Redding, which had been operating without a license for five years. Chronic staffing shortages there play a key role, according to the report:
The complaint further alleges that dozens of residents who fell ill were left isolated and neglected due to “extreme understaffing.” One nurse told state inspectors that she alone had to pass out medications to 27 COVID-positive patients, meaning the medications were often late, according to an Oct. 21, 2020, inspection report, also cited in the lawsuit. Another nurse told them that nurses on the COVID unit, or “Red Zone,” were ”stressed, overloaded and tapped out” and unable to take breaks, the report said.
The Calmatters report goes on to describe Rechnitz and his companies:
“Rechnitz, a Los Angeles entrepreneur, was in his mid-30s when he began buying nursing homes 15 years ago. He and his companies, including Brius Healthcare, have acquired at least 81 facilities around California, making him the state’s biggest for-profit nursing home owner.
“Rechnitz and his companies operate more than a quarter of those facilities despite the fact that the California Department of Public Health has not approved — or has outright rejected — their licensing applications, according to state records. In the case of five ‘Windsor’ facilities, including Windsor Redding, Rechnitz and his companies continue to run them after the state’s license denial. The previous owners’ companies, affiliated with the Windsor brand, are still listed in state records as the official license-holders.
“Mark Johnson, an attorney who represents Rechnitz and Brius, said in an emailed statement that he could not comment on pending litigation except to say that: ‘The facility vehemently disagrees with the allegations and it intends to defend the action vigorously’.”
Miller told the Coast healthcare district board that, while the immediate situation at Sherwood Oaks demands more staff, longer-term issues with the facility - everything from needing a new boiler, roof and heating system to a “subsidence” under part of the building, suggest that it is time to build a new nursing home for the Mendocino Coast's 30,000 or so residents. However, he said, that will take years.
A New (Smaller) Coast Hospital?
A much smaller local hospital was discussed at the Mendocino Coast Healthcare District board of directors meeting on December 9.
Representatives of Devenney Group, whom the District board is considering to plan a new or retrofitted hospital that will meet state seismic standards by 2030, presented similar projects they have done in California and Arizona and gave rough cost estimates for a new facility that would take 7-8 years to build, at up to $65 million.
Board members discussed a future coast hospital that would have 6-10 beds instead of the current 24.
All California hospitals are supposed to meet updated seismic standards by the end of the decade, and the board's focus seems to be on building a new, but significantly smaller facility.
The cost of a new hospital on the Mendocino Coast would likely be borne by residents of the healthcare district, although specifics for how to pay for it were not discussed. Executives of Adventist Health, the current operators of the Coast's hospital, had mentioned contributing to rebuilding costs during discussions about affiliation in 2019, but no mention was made of the Adventists’ participation at the Healthcare District board meeting last week.
Board member John Redding said he and Board Chair Jessica Grinberg have talked with Adventist Health about its ideas for a new hospital.
”We have tried to engage them and that has not produced a proposal,” Redding said.
Judson Howe, president of the three hospitals that Adventist Health now operates in Mendocino County, said at the meeting last week that the cost estimates the board were discussing for building a new hospital on the coast seemed low to him. As far as how a new facility could be paid for, Howe said “I think there's going to have to be a big philanthropic lift as well.”
Howe also urged the board to think in terms of a hospital with significantly fewer beds, noting that inpatient care is by far the most expensive type of healthcare service.
”The payers (public and private insurers) in the industry are driving us to lower and lower cost options," Howe said, adding “the future of healthcare is in the home.”
Board member Norman de Vall urged the board to do a study of the district's demographics and needs before deciding on the scale of a new facility.
”Are we going to have a ‘stabilize and transfer’ station? … Do we see that as our future?," he asked.
The board elected new officers. Amy McColley is now Board Chair, Norman de Vall is Vice Chair, and Sara Spring remains Board Secretary. The Board currently has no treasurer because both Jessica Grinberg and John Redding, the current treasurer, refused nominations for the post. Redding recommended that the board hire a chief financial officer because, he said, he has been spending 20-30 hours every week as treasurer on District financial matters.