The Washington state Department of Health has denied a joint certificate of need application by Sacred Heart Medical Center and Holy Family Hospital for a 25-bed transitional-care unit at Holy Family.


In transitional care, a short-term, rehabilitative environment is provided for patients, often elderly, who arent sick enough to require standard hospital acute care, but who need a high level of skilled-nursing care and ready access to diagnostic tests and treatments.


The department ruled that the hospitals, which are affiliates under Providence Services, failed to demonstrate a need for the transitional-care beds, given that there are a number of community skilled-nursing facilities here capable of providing such care and that have available beds. It also ruled that the project could increase health-care costs here because the other skilled-nursing facilities appear able to provide comparable care at a lower rate.


Cathy Simchuk, Holy Familys assistant administrator of patient-care services, says the hospital disagrees with the state findings on both counts and has asked for an adjudicative proceeding, or appeal hearing, which means an administrative law judge would decide the matter.


The issue is significant because hospital-based transitional care, although established in King County, has yet to be introduced in Spokane County.


In its certificate of need application, Holy Family had proposed to spend about $1.2 million to set up the transitional-care unit, which it said would occupy about 14,000 square feet of floor space on the North Side hospitals fourth floor.


Holy Family contends that having such a unit in the hospital makes sense because it would be close to ancillary services there, and would be less unsettling for patients and more convenient for doctors than moving patients to long-term care facilities offering subacute care.


However, executives for a number of such facilities on the North Side have questioned the need for the beds, which would be heavily Medicare supported, and have said 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 the same degree of transitional care 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 what would be used for the proposed transitional care.


Holy Family claims that it has tried unsuccessfully in the past to place some patients who require high levels of care with some of the skilled-nursing facilities here. Administrators for some of those facilities counter, however, that about the only patients the hospitals have had difficulty placing at any of their facilities are ones with psychiatric or other problems who belong in fully attended hospital beds or intensive-care units.


Holy Familys Simchuk disputes that, saying, It appears to us that (for the appeal) were going to have to make an even longer list of cases that are being denied.


On the cost issue, she asserts, the state is failing to consider that while Holy Familys anticipated per-day rate for patients may be higher than those of the community skilled-nursing facilities, its average length of stay is expected to be shorter.


Regarding whether there is need for the beds, Simchuk notesand the state acknowledgesthat the transitional-care unit wouldnt add to the total number of skilled-nursing beds in the county. Holy Family is proposing to reduce its number of acute-care beds by 25 once the transitional-care beds are added, which would keep the hospitals total licensed capacity at 272 beds.


Sacred Heart and Holy Family filed an original joint certificate of need application in January 1996, proposing 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 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 an amended proposal filed last fall, Sacred Heart dropped its proposal for the 50-bed unit and Holy Family said it would obtain the 25 transitional-care beds it wants in a transfer from Sacred Heart-owned St. Joseph Care Center, a 265-bed facility.


Holy Family had hoped that eliminating what it perceived to be the states biggest concern, which was adding more beds in the county, would improve the likelihood of getting the transitional-care unit approved.


Spokane Countys overbedded status is based on its current ratio of about 55 licensed skilled-nursing beds for every 1,000 residents over age 65. That compares with a target ratio established by the state of about 45 beds-per-thousand. The state as a whole currently exceeds that ratio as well, which means that the addition of any new skilled nursing beds in the state this year is unlikely, although the state is projected to fall back under the ratio slightly next year and by more than 350 beds in the year 2000.


The state estimates, however, that Spokane County will remain above the 45 beds-per-thousand ratio at least through year 2005, when it is projected still to be at 53 beds-per-thousand, which translates into a surplus of 425 beds. It currently has a total of about 2,800 beds, distributed among 25 facilities.