What will home health look like in Sitka without a home health department at the local hospital? The top doctor at the Southeast Alaska Regional Health Consortium or SEARHC gave an update on the future of home health services at the Sitka Assembly meeting on Tuesday. While there wasn’t much new information, it was another opportunity for community members to voice concerns, and for SEARHC to address them.
In September, the Southeast Alaska Regional Health Consortium or SEARHC, announced it would be closing its home health department. The news generated concerns– what would happen to end-of-life care in the home? Would patients receive the same level of care? And would that care be more expensive?
In a presentation to the Sitka Assembly on December 12, SEARHC’s Chief Medical Officer Dr. Elliot Bruhl tried to answer those questions.
“The home health department, or agency, no longer exists, but care of patients within the home has continued,” Bruhl said. “It has not stopped. It didn’t stop. Everyone in this community who requires that care that we’re aware of is receiving it and is continuing to receive it.”
Bruhl told the assembly that the care provided to patients in the home would be the same, but it would be through a “home based care” program rather than a stand-alone home health agency.
So what’s the difference? In order to earn a “home health agency” designation from Medicare, the hospital had to meet additional regulations and requirements for administration and maintenance of records. Doing that required around eight staff members to run the program, and Bruhl said there wasn’t enough demand for home health services in Sitka to justify that level of staffing.
“Having eight staff in order to perform care for about 20 visits a week,” Bruhl said. “So that’s the reason for the change. And like all businesses, you know, we have to adjust staffing to reflect the demand for services. I think anybody who’s in business understands that.”
Bruhl said the “home based care” program would be staffed by four people instead of eight– two physical therapists, one occupational therapist and one registered nurse. He said the services will comply with Medicare regulations and will be reimbursed by Medicare, with a 20 percent copay. The home care team would bring in other clinicians in situations where more staff is needed, with services like end-of-life care, for example.
Bruhl said that there many services SEARHC would like to provide, and will if the demand is there. He pointed to recent expansions at the hospital, like upping their staffing for substance use disorder treatment and opening an opioid treatment clinic.
“It’d be great if we could provide dialysis, it’d be great if we could do neurosurgery. There’s just not enough demand for those services to justify staffing in that manner. We adjust staffing all the time, we’ve been increasing our staffing in behavioral health to reflect the fact that there’s a tremendous demand in this community for basic behavioral health,” Bruhl said. “We’ve more than doubled our staff in behavioral health in the last two years.”
Bruhl said he was disappointed in the community response to SEARHC’s announcement about home health. He said some staff had been aggressively confronted with questions about the program. And he said he believed some of the distrust of SEARHC’s motives was rooted in a “deep fault line” created over decades in a town with two hospitals that became a town of one in 2019 when the hospitals merged. And he said the community needed to heal from that history and build trust.
“I have no illusion that the factual information that I’ve presented this evening will mollify some of that anger and resentment,” Bruhl added.
When the assembly opened the floor to public comment, Cindy Litman said Bruhl’s assessment of resentment didn’t apply to her- she supported the merger between SEARHC and Sitka Community. Her concerns about changes to home health were around care and cost.
“Dr. Bruhl talked about a 20% copay, but that is not trivial. Because if you’re having several therapies or visits a week, at a few $100 per visit, that 20% becomes several $100 a month. And that may be fine if you’re a physician or a hospital administrator, but for an average retired person over two years time that would have cost us out of pocket thousands and thousands and thousands of dollars.”
And Auriella Hughes, who worried that end-of-life care in the home would be less feasible under the new structure, said she wasn’t put at ease by Bruhl’s presentation.
“Yes, SEARHC is a business. And it’s not profitable to have a certified home health agency. It doesn’t mean that it’s not the right thing. It is the right thing. It’s just not profitable,” Hughes said. “You do it because it’s a service. You talk a lot about services. That is the service we need.”
Mayor Steven Eisenbeisz thanked Dr. Bruhl for sharing the information and “getting his side of the story out.”
“I appreciate that, because it does sound like you have quite a PR issue on your hands right now,” Eisenbeisz said. “So I look forward to SEARHC continuing to get the word out about the continued services and the new existing services, because I think the angst in the community is very high right now, and I think that’s on you to to try and ease some of that as much as possible.”
One PR opportunity SEARHC passed on was a recent town hall on the future of home health hosted by the Woman’s Club. SEARHC was invited to participate and answer questions, but did not send a representative. Dr. Bruhl said that was because of SEARHC’s “commitment to process.” The avenue SEARHC provides for the public to respond and ask questions is the Community Health Council, which was established when SEARHC merged with the Sitka Community Hospital. Once a year, the group takes public testimony. Bruhl said the next Council meeting is in January.
