St. Luke’s Rehabilitation Institute is trying to walk without crutches in a rocky hospital world.
Since opening almost three years ago, St. Luke’s has lost almost $2.3 million. It streamlined departments and didn’t replaced workers as they left.
That wasn’t enough.
Two weeks ago, the hospital decided to lay off 24 of its 470 employees, including all 10 licensed professional nurses - a dramatic move to help steady its finances.
Those workers, with enough years of rehabilitation experience to fill a textbook, have been offered on-call work. But many are now looking for new jobs, often in other specialties.
“It was the only game in town,” said Tom McCormick, an LPN who’s worked with spinal cord injuries for 10 years.
Despite the financial pains, the 102-bed hospital has cared for the most difficult cases, and has done it well. Patients and families rave about their care.
“I flat-out don’t have anything, nothing bad to say,” said Giles Nuxoll, whose mother was treated at St. Luke’s for Guillain-Barre syndrome, a neurological disorder that can cause paralysis.
“The staff was just excellent. I don’t think you’d find more dedicated people.”
Plagued by decreasing reimbursements and other pressures from managed care, St. Luke’s has had little choice but to cut every hospital corner possible.
This is the reality of a nonprofit hospital specializing in costly, intensive rehabilitation.
St. Luke’s ranks second among hospitals statewide in caring for the most costly patients who stay the longest. The Regional Hospital for Respiratory and Complex Care in Tukwila ranks first, but it’s about one-sixth the size of St. Luke’s.
Although St. Luke’s is a nonprofit facility, it needs to make enough money to buy new equipment, give staff raises, and reinvest in the hospital. It also is paying back the $5 million bond that renovated the hospital. Redoing a single patient bathroom costs $16,500.
The hospital needs to make about $1 million a year. In 1996, its best year so far, the hospital lost about $556,000.
In this environment, St. Luke’s has made tough decisions.
As staff leave, most aren’t replaced. The hospital just merged two stroke units, leaving four total treatment units.
The human resources department absorbed the educational services department. When the human resources director leaves to have a baby, she’ll be replaced by a lesser-paid manager.
The hospital has reduced its four program directors to two.
The library was moved to Sacred Heart Medical Center, and the pain management/worker injury clinic will take over the old St. Luke’s library space. The former pain clinic space will be leased out - the market value is at least $110,000 a year.
St. Luke’s is now trying to negotiate a better rate for supplies and contracted services, and better reimbursement from insurance companies.
The staff cuts were a punch in the stomach for those who remain and those who left. St. Luke’s has always been a small community where employees know each other’s birthdays and spouse’s names.
Former patients visit often, talking to staff or using the gyms. They worry about the quality of patient care.
“If money is the bottom line regarding the reduction of force, it’s going to be difficult to maintain their ability to deliver top-quality care,” said William McGough, an advocate for the disabled who’s used a wheelchair since a diving accident six years ago.
St. Luke’s opened its doors as a community hospital 100 years ago and cultivated a reputation for caring on a first-name basis.
In January 1993, bowing to pressure and health-care reality, the hospital closed and reopened as Deaconess Rehabilitation Institute, which expected to serve regional patients recovering from catastrophic accidents, strokes and cancer.
That name lasted less than two years. In September 1994, the institute’s owner, Empire Health Services, and Sacred Heart Medical Center decided to combine rehabilitation services.
The new facility is owned by Inland Northwest Health Services, which runs joint ventures for the city’s four hospitals.
St. Luke’s is now filled with hurt feelings.
LPN Scott Engeldinger was known as “Vent Man,” a super-nurse who was a whiz with patients on ventilators.
“They’re getting rid of some of truthfully their best people,” said Engeldinger, a single father of two who’s worked in rehabilitation for 10 years. “I feel scared for the staff who’s left there, because their morale is going to be way down. They’re not going to really pour themselves into it like they have been.”
Hospital administrators say they cut LPNs because they’re switching to a patient-care model relying on registered nurses and aides. Registered nurses can perform more medical and supervisory tasks than LPNs.
The move is in line with Sacred Heart and Holy Family Hospital, which have been reducing their ranks of LPNs. Deaconess Medical Center and Valley Hospital and Medical Center haven’t cut theirs.
St. Luke’s staff members left behind say it’s tougher and tougher to care for patients with fewer people. They say the LPNs were excellent nurses with invaluable knowledge.
“It’s kind of like we’ve got teaspoons, and we’re bailing a sinking ship,” said one therapist, who didn’t want to be identified. “We’re all bailing for all we’re worth. But nobody’s fixing the hole at the bottom of the ship.”
If there is a villain here, it is managed care, which aims to cap runaway health-care costs. St. Luke’s is being squeezed by declining reimbursements from Medicaid, Medicare and private insurance, and declining patient stays.
The numbers tell that story.
In 1995, the hospital billed the government and private insurance companies about $7.7 million that wasn’t reimbursed.
In 1996, the unpaid amount jumped by 38 percent to $10.6 million.
Therapists gripe about not being able to get a wheelchair for a quadriplegic, or insurance companies offering only $900 a day for care that costs $2,000 a day, or $2,600 for a wheelchair with a price tag of $26,000.
Patients aren’t staying as long as they once did, meaning less money for the hospital. When St. Luke’s first opened, each patient stayed an average of 18.9 days. By 1996, that average dropped to 16.9 days. In July, it was 13.6 days.
The hospital is trying to adjust to all of the health-care pressures while still delivering quality care, but labor is always the biggest cost.
Those who were let go are grieving for jobs that were more than work.
“You want to know the truth?” McCormick said. “I’ve got more years of experience in rehab than I would say 60 percent of the people in that spinal unit.
“You look around at anyone in a wheelchair, and most likely I was involved in their rehab.”
And even those no longer in wheelchairs.
Mildred Weeks, 60, is now learning how to walk without a wheelchair. She spent eight weeks in St. Luke’s, recovering from Guillain-Barre syndrome.
“I’ve been in the hospital quite a bit, and I’ve never ever had a nurse like Tom,” Weeks said. “I have never ever had anybody that devoted. I thank him for being able to walk.”
, DataTimes ILLUSTRATION: Color Photo