Iowa-based Mary Greeley Medical Center has announced the closing of its general inpatient hospice facility, citing financial and operational challenges.

The hospital’s board of trustees recently voted to close the Israel Family Hospice House (IFHH) on Dec. 31.

Among the leading reasons for the closure is that hospice reimbursement rates have not kept pace with increasing demand and operational costs, according to the organization.

“IFHH has operated at a loss for many years, due primarily to insufficient reimbursement rates and increasing overhead costs,” the organization told Hospice News in an email. “We value the individuals and families whose contributions and memories are recognized at IFHH, and we are developing a plan to ensure this legacy is honored as we move forward. We will do everything we can to ensure patients get the hospice-level care they need.”

Some of the 17 employees who provided care at the facility will transition to roles in other areas of Mary Greeley Medical Center’s hospice program, as well as across the hospital’s continuum of care.

Mary Greeley Medical Center’s geographic service region spans 13 counties in central Iowa. Founded in 1916, the 220-bed nonprofit hospital offers hospice, palliative care, home health, rehabilitation, behavioral health and cancer care, among other services.

IFHH has been underutilized for several years. The center has 10 patient rooms, but it has fallen short of reaching its full capacity, with an average daily census of four or five patients. It was “not unusual” for the facility to be closed for several days without any patients to serve, the organization told Hospice News.

GIP patient volume has declined as more patients and families opt for home-based hospice services, the hospital indicated. Mary Greeley Medical Center has seen growing demand for its home hospice services. The hospital has plans to expand support for home-based hospice patients with limited financial resources to ensure sustainable access.

The organization will continue to provide general inpatient hospice and respite services at a few rooms within the hospital or at partnering skilled nursing facilities. The hospital’s home hospice program will also continue to serve patients across a six-county region in its home state. The program’s average daily census hovers around 30 to 40 patients.

Mary Greeley Medical Center has entered a new agreement with the skilled nursing facility Bethany Life to support its GIP hospice program. Services will be offered to patients at two rooms of its facility, The Households of Bethany, in Story City, Iowa. GIP hospice care will be offered through a coordinated collaboration between the two providers.

IFHH is the most recent facility to shutter in the region. The last few years have brought the closure of other general inpatient programs in Des Moines, Mason City, Fort Dodge and Ottumwa, Iowa.

Community concerns have mounted about the closures and a lack of facility-based hospice access.

Terminally ill individuals have a wide range of needs as they approach the end of life and sometimes require higher levels of care. The growing gap of GIP services could result in negative outcomes and increased health disparities, said Dr. David Carlyle, a retired family physician and former co-medical director at Israel Family Hospice House. Carlyle is also a founding member of the American Academy of Hospice and Palliative Medicine (AAHPM).

Closure of IFHH is a “terrible idea,” that will leave patients and families facing difficult decisions at the end of life, Carlyle stated in a letter emailed to the board of Mary Greeley Medical Center shared with Hospice News.

“Most patients could stay at home, but some patients for a variety of reasons required that we admit them to the [Hospice] House because they needed care that was not possible at their homes. That need for extra care shall always be there for some patients,” Carlyle told Hospice News in an email. “Replacing the hospice house with rooms at the hospital will not provide such services; now nor ever. I do not believe designating a couple of rooms at the hospital … will be able to have the total concentrated focus of terminal care in all its permutations that we had when I served there and that we currently have at the Israel Family Hospice House.”

The hospital also faced increased competition for GIP referrals. The number of hospice providers in the region has more than tripled since the Israel Family Hospice House launched in 1999, Mary Greeley Medical Center told Hospice News in an email. Many of the providers contract with local skilled nursing facilities, the organization indicated.

No immediate plans are in place for other uses of the facility, but the hospital is maintaining the property at this time.

The decision to close the hospice facility was difficult and “not made in haste,” said Steve Sullivan, director of marketing and community relations at Mary Greeley Medical Center.

Similar to other general inpatient programs, Israel Family Hospice House has faced several headwinds in recent years that challenged sustainability, Sullivan indicated.

The facility was predominantly supported by a hospice endowment fund that would run out within a few years. The hospital has subsidized the financial operating loss of the facility in part through funding raised by the Mary Greeley Foundation. The foundation provided roughly $1 million in philanthropic donations to support the hospice center, which was not sustainable long-term, Sullivan stated.

Trends of mounting financial, staffing and operational pressures are “not going away,” for general inpatient hospice providers, Sullivan said.

“The level of support needed for the hospice house from the foundation has more than doubled over the past three years,” Sullivan told Hospice News in an email. “For several years, a team of smart, dedicated people have explored ways to sustain the hospice house, including cutting costs and partnering with a similar service. Sadly, no solution has materialized that would significantly ease the impact of these trends. We have a responsibility to be good stewards of our financial resources.”