Melrose-Wakefield to close rehab unit

Employees at the Cummings Rehab and Nursing Care unit at Melrose-Wakefield Hospital weren’t prepared for the message they received from management who visited the floor on a recent Monday afternoon. 

Jill VanHandorf, RN, charge nurse at Cummings Rehab, said the administrators told employees last Monday, Sept. 10, that their unit was going to be closed.

“We kind of got word that somebody thought we might be closing,” she said. “We asked our administrator and she was unable to say anything to us, so she asked management to come and speak with us.”

VanHandorf said she and other employees were told the 17-bed unit, which provides physical and post-surgery rehab services to Melrose residents and those from other local communities, would be closing Nov. 1 to be converted to a medical-surgical floor.

The 35-40 employees were told that they would all have to reapply for their jobs — though there may not be enough open positions in the Hallmark Health system to absorb all those currently assigned to Cummings. And even more upsetting to some of the employees was the news that all the patients will have to be relocated to available beds at other nursing care facilities once Cummings is shuttered.

Steven Kapfhammer, executive vice president of Melrose-Wakefield Hospital, said the change — still requiring approval from the Department of Public Health (DPH) — stems from the hospital’s need for more medical-surgical beds.

“We have had, during the past year, a number of patients who had to be diverted from our emergency department because we did not have med-surg [medical-surgical] beds or monitored beds available,” Kapfhammer said.

He said the idea is to reduce the time a patient has to wait in the emergency room for an inpatient medical-surgical bed and prevent sending local patients away to other hospitals.

“It becomes very disruptive to a family or a patient when they are forced to go to another facility, either in Boston or up on the North Shore, when we don’t have any med-surg beds,” Kapfhammer said.

Cummings Rehab, open since December 1993, treats mostly Melrose patients needing hip and knee rehabilitation, as well as surgery patients from New England Baptist, Beth Israel and Mass General who had surgery and choose to recover closer to home, according to VanHandorf.

In addition to citing the need for additional medical-surgical beds, VanHandorf said administrators told Cummings employees that the unit’s expenses outweigh its reimbursements, costing the Hallmark Health system money in the long run.

Kapfhammer said transitional care units [TCUs] have had declining reimbursement over the years, resulting in Cummings being one of “the few or last” remaining hospital-based TCUs in the area.

“Reimbursement is very low for this patient population,” he said. “Most of it has moved to nursing care facilities … most SNFs [skilled-nursing facilities] provide TCUs and provide good quality care. We’re trying to forge more developed relationships with local SNF units so if [a patient] does require a SNF unit, they will receive outstanding care.”

VanHandorf said the Cummings unit has three licensed practical nurses (LPN) who may be left without jobs; however, she added that they nurses may be offered jobs with Hallmark Health’s Visiting Nurse Association [VNA], which provides home nursing services.

While some nursing positions can transition to the new medical-surgical unit, other positions specific to a rehabilitation unit — such as social worker and activities director — probably will not have an equivalent job in the Hallmark Health system, VanHandorf said. The Cummings unit is the only rehab unit within the Hallmark system.

Hallmark Health is looking to place the majority of the Cummings staff into open positions within the system, Kapfhammer said, “however, there will be people without a position, we’ll say, specific to a skilled nursing facility.

“I will not have certain roles for certain types of positions. All of my rehab and my occupational therapy staff are able to be absorbed to current inpatient openings that I have in our system because, keep in mind, we’re opening 17 more med-surg beds. It’s just a transition of usage.”

Michelle Rauseo, social worker for Cummings Rehab, said employees on the floor suggested that hospital management reduce the size of the rehab unit to 10 or 12 beds instead of eliminating it completely.

“I wish there was still a way to keep the hospital happy, as well as the staff and the community that we serve,” Rauseo said. “If there’s any way at all to meet in the middle, I think that would be wonderful. I think it’s a rash decision to decide so quickly about this without trying to do something, like make the unit a little bit smaller and see how that goes, to do a test for a few months to see if that would help the situation at all.”

Kapfhammer said hospital administrators did discuss reducing the size of the unit instead of eliminating it completely, but the combination of skills on the nursing staff combined with DPH regulations makes it “very difficult” to have a mixed-use unit.

“Given that I’m anticipating further growth and need for med-surg beds, it made the most sense to convert the entire unit … so the staffing unit can be most appropriate for med-surg patients, not patients receiving skilled nursing facility care,” he said.

Rauseo said she hopes Hallmark can find her another job somewhere in the system, but that the employees have not any heard new information as of this past Tuesday – a week after being told the unit was closing.

“Believe me, I love my job here and I don’t want to have any negativity whatsoever, because if they find me a job in the system, I’ll stay here,” Rauseo said. “They have great benefits and I love the people, but I feel like we should be getting some answers. If some of us aren’t going to be reabsorbed, like myself, I need some time to go out and find what’s available.”

VanHandorf said many of the Cummings Rehab employees have been there since the unit first opened in 1993, providing returning patients with a familiar face and a comfortable atmosphere.

“We just feel it’s a huge loss for the community,” she said. “People come in and know they are going to see the same staff. You’re in a vulnerable situation when you’re sick. When you see people you know, it helps the recovery.”

Rauseo added that the Cummings unit recently underwent a refurbishment thanks to private donations from former patients.

“People love the care here,” she said. “We’ve gotten private donations directly to Cummings because they enjoy our care here so much.”

Both VanHandorf and Rauseo said stand-alone nursing care facilities cannot provide the same level of care as a rehab unit within a hospital. VanHandorf said because Cummings is located within the hospital, nurses can perform blood transfusions, give intravenous fluids and provide medications stand-alone facilities cannot.

Rauseo said Melrose-Wakefield Hospital is slated to have a bone and joint center soon, although the rehab unit will now be closing.

Addressing both points, Kapfhammer said while stand-alone nursing facilities cannot do blood transfusions, they are infrequent within the Cummings unit. In terms of the bone and joint program, he said patients do not require the same level of transitional care or rehabilitation as in the past because of new pre-surgery preparation.

“The concept is they will be discharged from the hospital to home with home care services [through Hallmark Health VNA],” he said.

Patients currently receiving care at Cummings will be moved in late October to facilities such as EPOCH Senior Healthcare in Melrose or Bear Hill Nursing Center in Stoneham, Kapfhammer said.

“I feel very comfortable in the quality of care they’re able to deliver,” he said, noting high marks received by local nursing homes on the DPH Web site (http://www.mass.gov/dph/qtool2/default.htm).

“The majority of our nursing staff, to be frank, has patients in these facilities so they will be able to see the patients who are in those facilities.”