West Virginia-based Mountain Hospice is starting an assisted living subsidiary. The nonprofit’s first facility is expected to open in November, with plans to add more locations in future years.
Hospices in general expect to see substantial growth in the assisted living setting during 2020, followed by the skilled nursing setting. About 36% of more than 300 hospice providers who responded to a Hospice News survey indicated that the assisted living setting would be their most significant avenue for expansion, followed by nursing or skilled nursing facilities at 33%. Hospitals and memory care facilities yielded the lowest percentages at 9% and 5%, respectively.
For Mountain Hospice, the move is designed to help them compete in an increasingly crowded marketplace in which many small organizations are financially outgunned by large providers.
“It’s getting harder to run a hospice, just as a hospice. I felt that Mountain Hospice needed to have some other revenue stream and diversify our offerings to the communities we serve,” Mountain Hospice CEO Don Trimble told Hospice News. “We’re getting late referrals; every health care provider out there seems to be holding on to their patients as long as they can. We’re getting referrals when people are actually actively dying. They’re dying within hours or days from the time we admit them. That’s incredibly expensive for a hospice, and it’s really difficult on staff to try to operate that way.”
In 2017, nearly 28% of hospice patients had a length of stay of seven days or less, according to the National Hospice & Palliative Care Organization.
Brows have been furrowed in the hospice space due to length of stay as providers seek new ways to engage patients further upstream in the course of their illnesses. One solution many have embraced in recent years is service diversification, including palliative care, home health care, home-based primary care and other offerings.
Mountain Hospice had also considered launching home health services, but no Certificates of Need for those services were available in their region.
Trimble will also serve as CEO of the assisted living subsidiary, which has a separate board of directors from the hospice. Some employees will be shared between the two business segments, and the organization plans to carefully account for the amount of time dual employees spend working in each service. Shared functions will include finance, social services and human resources, among others.
“A lot of hospices in the state of West Virginia built inpatient units to bring in patients during times of crisis, but one of the problems they are finding is they can’t fill those rooms. They have these beautiful facilities, but they can’t get enough residents to fill those rooms,” Trimble said. “I really think that [assisted living] may be something that hospices start to look at, perhaps even converting their inpatient units. There’s a lot of growth potential there.”
Other hospices have indeed entered the assisted living space. Marshall, Minn.-based Prairie Home Hospice & Community Care in February acquired Fieldcrest Assisted Living for an undisclosed sum.
Assisted living overall is proving to be a growth area for hospice. Between 2011 and 2019 hospice utilization overall rose by 35%; however, hospice utilization in assisted living facilities increased by more than 100%, according to a 2019 report from Hospice News sister site Senior Housing News.
Mountain Hospice’s first assisted living facility will be 12,000-square-feet, including 12 resident rooms that can accommodate as many as 24 people. Each room will have 255-square-feet of living space, plus an additional 105-square-feet of bathroom space. Each room will have its own small kitchenette and dinette area as well as closets for storage.
The room size exceeds West Virginia state requirements that mandate that each room must be a minimum of 100-square-feet per resident or 180 square feet for two residents. We’re at 255 for living space and 360 total for the entire room alone. The building will include a chapel that will also be used as a theater and an activity room, as well as two kitchens and a spa in which residents can receive haircuts, styling and other services and amenities.
The grounds will include wooded areas, covered seating spaces, courtyard and a grill. The facility will also offer transportation services to residents. Construction costs are expected to total $3.2 million, most of which was financed via bank loans.
Trimble said he believes that Mountain’s assisted living company will be well-positioned to compete with similar facilities in their area. One other assisted living operator is located in the same country, and two exist in a neighboring country.
“Those facilities run full generally and have waiting lists, so we know there’s a need for assisted living in this area. We’ve actually had many people call already wanting to get on the list to move in,” Trimble said. “Our pricing is comparable and actually a little lower than some of the local ones, and to my knowledge, none of the local assisted living centers have private bathrooms. That’s different from what we see in the area.”
One potential concern is the stigma that sometimes surrounds hospice care. Some operators in the larger assisted living space tend to minimize the visibility of hospice to avoid associating their facilities with the end of life.
“We have made it very clear in our marketing that this is not a hospice inpatient unit or a hospice program in any way,” Trimble said. “That’s not to say that somebody in the facility wouldn’t need the services of hospice, and we’d absolutely offer that to them from any hospice in our area, because everybody deserves a choice. But [the stigma] does worry me. We’re going to have to hit that point hard as we go forward in our marketing.”