The Southeast Alaska Regional Health Consortium is closing its home health department in Sitka at the end of September. While the organization maintains that the closure is largely an administrative move, and that outpatient services — and in-home care — should be unaffected, some Sitkans are concerned that both the expense and quality of end-of-life care will change dramatically.
Sitkan Cindy Litman’s home smells like warm flour and butter. She’s just pulled a few trays of cookies out of the oven. Her three cats lounge in a living room filled with books and art and photographs. This is the home she and her late husband Tony shared in his final years.
Tony was diagnosed with Atypical Parkinson’s Disease in 2014. At the time, they were living in a two-story home in Sitka.
“He got to the point where he couldn’t navigate the stairs in our house, and our bedrooms and full bath were upstairs,” Litman says. “It was a pretty small lot, and we weren’t really able to make the changes we would need to make the house accessible.”
They decided to move to Olympia, Washington, to be near family and easier access to the specialized care Tony needed. And while they had better access to neurologists and cardiologists, Litman says the experience taught her how fragmented healthcare in America is.
“What was striking to me was that there was no coordination of care between those different doctors, so he would see one person and they would have no idea what the other health providers were doing,” Litman says. “And even though the health care was, I’m sure, considered good, it felt very alienating.”
And they missed Sitka, the community that had been their home for over a decade. Nine months later, friends back home were selling a house that would accommodate Tony’s changing mobility. Even though they worried that there were no practitioners specializing in Parkinson’s in Sitka, they jumped on the opportunity and moved back.
That’s when they learned about what was then Sitka Community Hospital’s home health program.
“It was my first experience, really, with coordinated care. They were much more in tune to his situation than his primary care physician,” Litman says. “If it seemed like his medicine needed tweaking, or if he needed another kind of therapy or a swallowing test, they were right on top of it. These changes happened very frequently as his situation changed.”
Tony passed away on Valentine’s Day in 2019. Two months later, Sitka Community Hospital was acquired by the Southeast Alaska Regional Health Consortium, or SEARHC.
“The point of home health and post acute care, community based care, is we bring a comprehensive team to you,” says Emily Rivas. She was the first clinical manager for SEARHC’s home health department, which was created in 2018, a year before the SCH acquisition.
“From an allocation of resources standpoint, there’s not a lot of duplication, because there’s one plan of care, and everybody works together on that,” Rivas says. “The communication is pretty tight, we’re supposed to meet and discuss the patients as a whole, looking at their long term plan, chronic disease processes, build relationships, encourage better health habits.”
“We will sit down and do your medication box, but then also take a look at your medications and see, ‘Well 27 medications is just too gosh darn much. Let me call your cardiologist, diabetes doctor, and your primary and see if we can’t get rid of some of this and make it a little bit easier.’”
Like its predecessor at Sitka Community Hospital, SEARHC’s Home Health department provided everything from physical and occupational therapy to skilled nursing and end-of-life care in a home setting for anywhere from a dozen to 25 patients at a time. But this summer, SEARHC announced it would be closing the office.
“It’s an administrative structure that creates some possibilities in terms of care, but also limits some possibilities in terms of care,” says SEARHC’s Chief Medical Officer Dr. Elliot Bruh. He says it’s the home health “structure” they’re getting rid of, but not the service.
“There’s some types of care that people need in a home environment that don’t qualify under that type of program. And then there’s other kinds of care that we’ve been providing,” Bruhl says. “There’s been a lot of issues that we’ve been struggling with, and we’ve decided that we’re going to close that entity, that structure, but that doesn’t mean that we’re going to stop caring for patients, or that we somehow can’t provide care to patients.”
Bruhl says SEARHC is closing the office mainly due to federal regulations that make operating it challenging and inefficient. He says the regulations are directed at larger cities and larger hospitals with more resources that can more easily sustain full home health programs with separate medical staffs.
“I would kind of describe it like building an international airport in a location where what you really need is an airstrip,” Bruhl says.
Bruhl says SEARHC will continue to provide service referrals in the home environment through both its Mountainside Urgent Care Clinic and the hospital’s outpatient clinic. And although it’s never had a formal hospice program,the home health department has been providing some end-of-life services. Bruhl says they’ll still be able to do that. Right now they’re working through the logistics.
“We also provide really intensive types of end of life care in the hospital,” Bruhl says. “And I think we’re anticipating that we may, at times, project that care also into our long-term care facility when we need to. So our intention is not to abandon that care, abandon patients or leave patients who need that type of care without access to those services, it’s just we’re not going to provide it through this department.”
Litman says the care her husband received through home health ensured the best quality of life possible, even as his health declined.
“When I think about even the last few years, when his mobility was so restricted, he lived a rich life. We had company, we had Christmas with all the grandchildren and their children,” Litman says. “The idea that he would be in a skilled nursing home for that time, to me, just seems cruel and horrifying.”
And expensive. Litman says Tony’s home health costs were far less than had he lived in a skilled nursing facility – and Medicare covered the bills. She is skeptical that the same level of care will be provided outside of the home health umbrella, and she feels that the decision is primarily driven by finances.
“If you think about someone like Tony, if they had been in skilled nursing for two years, it would have been a million dollars. I mean, I can’t even imagine how much money that would have cost instead,” she says. “Medicare pays for home health because home health has been shown to be so effective in keeping people out of the hospital, that even part A, which is the hospitalization part of of Medicare, will pay for home health services. So it it concerns me that this is driven by by money, rather than by medical needs of people.”
Rivas, who left SEARHC in 2020 and now works as a hospice nurse in Oregon, says home health helps create better continuity of care, and doesn’t think the outcomes for patients can be replicated through outpatient services. She’s disappointed that the program she helped establish is going away.
“In a town of 9000, what we put together was much better than nothing, and it would just be really unfortunate to have that integrated,” Rivas says. “It takes time for people to build trust, especially in a community like Sitka, and to have that now, and then have it go away, it’s gonna be really hard to change yet again, in such a short period of time.”
SEARHC’S Home Health has eight staff, both medical and administrative, who were notified about the closure in July. Bruhl says all will be offered jobs in other departments beginning in October.