Hospice of Laramie will not be providing any inpatient care for an undetermined amount of time, though it is still providing outpatient services in the community.
One factor leading to the suspension of inpatient services is finances, Board of Directors president Mario Rampulla said.
As a nonprofit, Hospice of Laramie takes on difficult cases, both in the complexity of care particular patients present, as well as having some that are unable to pay the daily cost of being in a hospice facility. Medicare pays a per diem rate, then insurance in some cases covers out-of-pocket costs. Some patients hospice takes on are “charity cases,” where Rampulla said hospice has reduced rates, having an impact on the organization’s bottom line. And while Medicaid covers some hospice costs, it doesn’t cover room and board. One of the things being examined, Rampulla said, is whether rates will need to increase when the facility re-opens its doors.
“That’s one of the difficulties we face is the expenses have to be covered by income,” Rampulla said. “And a lot of times a business model based on patient care, and sometimes those patients can’t afford the cost or the reimbursement or room rate, you have to reduce the amount that you can recover because the patient simply doesn’t have enough money to pay. We’ve taken on a lot of those cases, and sometimes that leads to stresses on the organization, both from a case management and financial standpoint.”
Additionally, Terri Longhurst, executive director of Hospice of Laramie, died unexpectedly Feb. 20. After serving as director for a decade and wearing “many different hats” at hospice, Rampulla said it left a lot of issues to address moving forward.
“From a business model perspective, and especially due to recent events, we thought it was appropriate to close our doors, so to speak, for a temporary period of time to try to address all of the issues that present themselves in the wake of Terri’s death,” he said. “Moving to an outpatient hospice provider for a period of time allows us to continue to look at our business model and think about how to fill those very big shoes she left behind.”
Through the last two years since opening the facility, Rampulla said the total number of patients, both inpatient and outpatient, that hospice has served at any given time has been as high as 20 and as low as 3-4. The number receiving outpatient services since no longer taking on inpatient cases has fluctuated between 6-12.
On the staffing side, there were approximately 23 staff members when hospice was operating with inpatient and outpatient services under Longhurst, said Jeff Senn, director of operations. A majority of those positions, he said, were part-time and “as needed.” Now the employee count is about half, consisting of about 14 staff members classified as full-time, part-time or as needed. Many staff members working at hospice considered it a second job, said clinical director Genna Trogden.
Overall, Rampulla said he thinks it’s accurate to say that most staff members hospice lost did not consider that job their primary source of income.
Stemming from the inability to currently provide inpatient care does present a tangential opportunity given the preparations for a potential outbreak of the novel coronavirus, commonly called COVID-19, Rampulla said. The empty medical facility with handwashing stations in every room and independent HVAC systems could provide beds for patients should the local hospital be overburdened with people needing care.
“From our standpoint it’s easier to quarantine people and control the spread of disease because of the way and the regulations that the facility was built under,” Rampulla said.
So between the COVID-19 pandemic and needing time to re-tool operations at hospice, Rampulla said the board and staff are probably looking at a three to four month time period to rebuild staff and successfully re-open the facility. But with the way things change day-to-day, or even minute-by-minute with the spread of COVID-19, it can be hard to say anything for certain.
“Right now, we’re continuing operations as they are, probably the way the public is living, on a day-to-day basis, crossing our fingers we get to June and move on with our lives,” Rampulla said. “The board is still developing its plan and business model to deal with the organization going forward in absence of Terri and trying to put together the business plan so that when we get ready to start to move forward with opening up the facility, we do so in a deliberate and thoughtful fashion so that when we do open up the doors, we don’t have to go through this again.”
Those interested in supporting Hospice of Laramie can find a donate button at www.hospiceoflaramie.org or send contributions to Hospice of Laramie, 1754 Centennial Dr., Laramie, Wyoming, 82072.