GOLD BEACH – Transition of services from a county department to the Coastal Home Health & Hospice has gone well for patients, staff, and volunteers alike, officials of the nonprofit home care agency report four months after the change took place.

“It was a major undertaking,” Executive Director Lori Kent said. “Our long-term strategic planning of the transition was essential and is contributing to the success.”  

Kent was director of the former Curry County Home Health and Hospice and has been with the agency since 1985. 

“There were problems in transitioning,” Kent said. “One of them was the communication with the (county) commissioners and the lack of their understanding the complexity of the whole process. A lot of things got delayed to the last minutes that should have been done a lot earlier and should have been less of a conflict.”

The Home Health & Hospice provider for Curry County and southern Coos County residents had been evaluating transitioning from a county-based to freestanding agency for nearly nine years. 

Kent said management had identified the financial challenges that lay ahead for Curry County government, as well as for the changing health care field. With an increase in use of services, while insurance payments – primarily Medicare – were decreasing, she said it was necessary to find ways to reduce expenses, streamline operations, and have the ability to respond to opportunities which were not possible operating under a government entity.

Curry County Board of Commissioners, however, were not convinced of the need and declined to transfer the agency several times when the proposals were presented, Kent said. In January 2010, the commissioners re-evaluated the situation and directed the department to proceed with transitioning the agency. 

With the skills and resources of then-Director of Curry County Economic Development Coordinator Susan Brown, the agency and its volunteers formed numerous working committees, identified a new Board of Directors and completed the process for approval of the new 501(c)(3) nonprofit organization, Kent said.

“It’s important to clearly communicate that the board, as well as the staff, feel like we can hold our heads high,” Kent said. 

“A lot of what was said in the position we left the county in and not reporting that to the commissioners and the commissioners being unaware, we know we communicated. And we now know it was not the doom and gloom we feared. We did the best we could do and no one here has anything to be ashamed of,” she said.

 “There was a lot of misinformation,” Kent said.

Under the agreement with Curry County, employees were transferred, maintaining their previous positions. 

“It was not necessary to lay off any staff members with the transfer,” Kent said. 

She said that although there were suggestions made by the Board of Commissioners that staff would need to be reduced, the number of staff were necessary to provide the services needed to the community. 

“We are very pleased to have retained such a strong, experienced staff, and that employment has not been affected.” 

Kent said that the department had reserves set aside for potential unemployment of approximately $59,000, and the county retained those reserves and they were not transferred to Coastal Home Health & Hospice.

A number of changes in operations and processes have been necessary to make the organization sustainable. 

“As a county department, the Home Health and Hospice paid overhead allocations for administrative services to the county, at a cost of approximately $100,000 per year,” Kent said.

She said the department under the county was completely self-funded, receiving no tax support during its years of operations. 

“We’re now doing all our own payroll, human resources, accounting, and related services, which will result in overall savings,” Kent said.

She said that such streamlining efforts will be essential for home care agencies to survive, as extensive cuts in Medicare payments have negatively affected the ability to continue operating for many organizations. 

“We feel it is our opportunity to say we know we have a lot of work ahead of us. It’s hard to be in health care now, especially with Medicare chopping everything,” Kent said.

“It’s been interesting. You don’t just tell Medicare you change ownership, like if you bought a house. The government moves incredibly slowly. We had to obtain attorneys to get through some of this. You can get lost in the government shuffle,” she said. 

Kent said the people who volunteered to be the original board for Coastal put in countless hours making the transition happen, especially Travis Sandusky who offered to be the first board president.

Kent said Gail Hedding has been invaluable.

“Gail has volunteered her financial expertise. She’s a CPA. She especially has expertise in Medicare and health care finance,” Kent said.

“She actually came to me a year before the transition and offered her services because she believes in what we do so much. She saw we were struggling. She has been marvelous. She still serves on a number of subcommittees and is on our finance committee, making sure we see finances from a health care perspective,” Kent said.

The hospice director said there are 20 to 25 volunteers that spent countless hours on the transition, including help in achieving nonprofit status.

“We were in the position we were starting a brand new business without money. It was a miracle it got pulled off,” Kent said. “An operation this size operating without capital was really frightening, but we knew we had to do it.”

The hospice board and the county commissioners met numerous times over the months preceding the transfer. 

“The county indicated that the department had been losing money in the prior fiscal year and had estimated that it would have a loss of as much as $350,000 when all was completed. Negotiations between the two organizations included considerations for this operating deficit, as well as other factors including vacation and sick accrual, payout of leave and more,” Kent said. 

“In the long run, the loss was not at all what had been predicted by the county,” Sandusky said.  

Financial reports provided by Curry County Finance Department show the Home Health department ended the 2010-11 fiscal year in a substantially better position than that estimated earlier, he said.

Coastal Home Health & Hospice took on nearly $67,000 in vacation accrual and agreed to pay Curry County an additional $100,000 with interest. 

“Rather than the home care program costing the county, this actually results in a positive net to the county, which could be more than $25,000 with the interest charges. That does not include the $93,000 in sick leave acquired by CHHH and the unemployment reserves retained by the County,” Sandusky said.

Kent said the department provided more than $100,000 of uncompensated services to individuals who were uninsured, without taxpayer or other compensation.  

“We have always been and will continue to be extremely dependent on donations and fundraisers to meet the needs of those in our community who do not have the health insurance resources needed,” Kent said. 

She said the annual rummage sale, the hospice’s biggest fundraiser, was as good as usual in the first year operated by Coastal.

“We didn’t make quite as much this year, but with the economy and other things, we are extremely pleased we raised $42,000 and had almost as many attendees,” Kent said.

“It continues to be a successful thing. But we’re seeing the need to recruit new and younger volunteers to continue to be successful,” Kent said.

“Everybody is stretched thin. People are very generous with their time and have a lot of opportunities. We are seeing we need more help if we are going to pull it off at that level,” Kent said.

“New people moving to town find it’s a great place to meet new friends. Volunteers say they have met so many good friends working on the rummage sale,” she said.

Kent said the staff is committed and believe in what they do.

“Everyone has had to take on additional responsibilities, make sacrifices, and identified means to improve our services,” she said.  

Additionally, changes in the employee benefit packages were necessary.  

“Under the county, regular employees had health insurance coverage for the employee and family members. With CHHH, employees are required to pay a greater portion of their health care coverage,” she said.

“As a nonprofit organization, employees are not eligible for PERS (Public Employees Retirement System). While a retirement program has been established, the majority of the funding of the accounts is through employee contributions.,” Kent said.

“The PERS program was an excellent benefit for our employees. Unfortunately, agencies such as ours cannot sustain the high costs of such a benefit, and they really don’t exist in the non-government sector,” she said.

“We know we have challenges ahead of us with Medicare and Medicaid reimbursement on the chopping block again,” Kent said. “We’re seeing an increasing number of individuals who simply don’t have insurance.”  

Hospice provides care for those facing a terminal diagnosis, regardless of the patient’s ability to pay.

“We have an extremely strong volunteer Board and a group of support volunteers who are working to assure we continue to operate successfully. The Board is very involved and aware of our operations, finances, and is strategically moving us forward to be successful,” Kent said.

Coastal Home Health & Hospice has offices in Gold Beach, Brookings and Port Orford. The clinical teams consist of nurses, physical, speech, and occupational therapists, home health aides, counselors, and more.  More information about the agency is available by calling the offices at 541-469-0405, 541-332-0273, 541-247-7084 or toll free 800-535-9472.