Sacred Heart Medical Center and Holy Family Hospital, both under the umbrella of Spokane-based Providence Services, are seeking state permission to open a 25-bed transitional-care unit at Holy Family.


Holy Family is proposing to spend about $1.2 million to set up the unit, which would occupy about 8,000 square feet of floor space on the hospitals fourth floor. It says the unit would provide a seven- to 10-day interim care environment for patients, often elderly, who arent sick enough to require standard hospital acute care, but who need a higher level of nursing attention than that typically provided at nursing homes.


A Holy Family executive claims that having such a unit there makes sense because it would be less unsettling for patients and more convenient for doctors than moving the patients to long-term care facilities that offer subacute care.


However, executives for a number of private, skilled-nursing facilities on the North Side question the need for the beds, which would be heavily Medicare supported, and say they view the request as a financially motivated effort by the hospitals to make up for declining acute-care patient admissions.


They claim their facilities are equally capable of providing that same degree of care with current beds and staff, and they note that the state already considers Spokane County to have a surplus of licensed skilled-nursing beds, which are used for transitional care. Furthermore, they argue that their fees for such care are lower than what Holy Family would charge, which makes it a taxpayer issue.


The issue is significant because hospital-based transitional care, although established in King County, is new to the Spokane County market, according to a state Department of Health official.


The departments certificate of need program is accepting public comment now on the proposed transitional-care unit at Holy Family. It has scheduled a public hearing on the matter for 9 a.m. Jan. 16 at the Airport Ramada Inn. A decision is expected by March 16.


The joint certificate of need application filed by Sacred Heart and Holy Family is an amended one. The original application was filed in January 1996 and proposed a 50-bed transitional-care unit at Sacred Heart in addition to the 25-bed unit at Holy Family.


That proposal, however, called for moving licensed beds to Spokane from facilities in King and Cowlitz counties that were ceasing operations and was challenged at a public hearing, partly because of Spokane Countys already overbedded status.


Realizing that the state was unlikely to grant the application, Sacred Heart and Holy Family withdrew it so they could look at other options. Under the amended proposal, no new skilled-nursing beds would be added in the county. Holy Family would acquire the transitional-care beds it wants in a transfer from Sacred Heart-owned St. Joseph Care Center. Sacred Heart has dropped its proposal for a 50-bed, transitional-care unit.


Cathy Simchuk, Holy Familys assistant administrator of patient-care services, says shes more optimistic about the amended applications chances than she was about the original applications because of the elimination of the one big concern of the state, which was adding more beds in the county.


Spokane Countys overbedded status is based on its about 2,900 licensed skilled-nursing beds for its about 50,600 residents age 65 and older, which works out to about 57 beds per 1,000 elderly residents, says Karen Nidermayer, an analyst in the Department of Healths certificate of need program. That compares with a target ratio established by the state of about 45 beds per 1,000 elderly residents, which in Spokane County would equate to about 2,280 beds, she says. Thus, the county currently is about 620 beds over the desired ratio, she says.


For that reason, the revised Sacred Heart-Holy Family application is more acceptable than the original was, but they still need to demonstrate the need for those beds, says Nidermayer, who is reviewing the Sacred Heart-Holy Family application.


Thats fine with Holy Familys Simchuk, who says, On that point we feel we present a very strong case. She says, is that it doesnt make sense to move recovering patients away from the hospital to new, unfamiliar settings.


Also, Simchuk claims that patients have told the hospitals they would prefer not to have to move, and, The physicians have told us that its very difficult for them to manage those people with higher-care needs in a long-term setting.


Simchuk further contends that Holy Family has had difficulty finding beds for transitional-care patients at private nursing homes, so, The experience has not matched what the message has been.


Administrators for a number of North Side skilled-nursing facilities who spoke with the Journal in a conference call said most of them oppose the application. They asked not to be identified, since they do business with Holy Family.


However, they challenged Simchuks claims that patients prefer a hospital setting, and they argued that doctors feelings of being inconvenienced should be irrelevant. Also, they asserted that about the only patients the hospitals have had difficulty placing their facilities are ones with psychiatric or other problems whom hospital-owned nursing homes also have been reluctant to care for.


The hospitals are going to take the cream of the crop in terms of residents and leave us with the least profitable stuff, one administrator said.


Nidermayer, the state analyst, says the Sacred Heart-Holy Family application estimates a $438-per-day charge for Medicare patients. One administrator claimed that, On average, we would be significantly lower than that.