Rural providers struggle with staffing and competition

By Avice Meehan

Healthcare in Connecticut continues to evolve – too quickly for some, too slowly for others – as providers consolidate or programs are eliminated. Statewide, the story is about the ongoing consolidation of hospitals and medical practices into three big networks: Hartford Healthcare, Yale-New Haven Health, and Trinity Health of New England. Regional headlines focus on opposition to the proposed closure of the maternity and intensive care units at Sharon Hospital, now part of Nuvance Health.

The same trends can be seen among stand-alone healthcare organizations such as Geer Village in Canaan and Visiting Nurse and Hospice of Litchfield County, with offices in Winsted, Salisbury, and Bantam. The extended Covid pandemic accelerated major changes in these organizations, which have served the community for nearly a century – or more.

Originally founded in 1930 as a hospital, Geer has been a regional hub for elderly residents through its nursing home, subsidized housing for low-income seniors, independent living apartments, transportation network and community services that ranged from adult day care to outpatient physical therapy and a YMCA. 

“We have had to downsize, outsource, and revamp our services,” says Kevin O’Connell, who took over as Geer’s CEO nine years ago. “We have to focus on our core mission in order to survive as a whole.”

The adult day center closed mid-pandemic – It was no longer safe to bring participants together and the program itself was treading water financially. More recently, Geer announced the closing of a popular outpatient physical therapy program and a decision to outsource pharmacy services. 

Even more ambitious plans have been put on hold. Pre-pandemic, Geer was on track to replace its 50-year-old nursing home with a new building that would provide residents with single rooms and updated facilities. The current structure was slated to be converted into senior housing. Geer won a $2 million planning grant from the State of Connecticut for the project, which was originally budgeted at $21 million and is now about $35 million, according to O’Connell.

“We are [now] in a good place, but that doesn’t mean that we wouldn’t be stressed by another challenge,” says O’Connell, who notes that nursing home occupancy has fallen at Geer in the wake of the pandemic, as it did across the nation. “My goal over the next few years is to get back to where we were before the pandemic, to provide programs and services that meet the needs of our community sustainably, and to move our mission forward.”

Recruiting nurses and other specialized staff remains a perennial issue. As O’Connell notes, “people are not knocking down the door to live in Norfolk or North Canaan” and highly qualified staff want competitive salaries. 

This sentiment is echoed by Michael Caselas, executive director of the Visiting Nurse and Hospice of Litchfield County (VNHLC). “The big challenge we all have is staffing,” he says. Finding quality nurses and caregivers in this area is very difficult. The staff we have are getting older, they are retiring. We are trying to replace them from a limited pool, and we are all looking in the same pool.”

Early in the pandemic, Caselas led a successful merger of three separate agencies that provided homecare services across Litchfield County for close to a century or more: Foothills Visiting Nurse and Hospice, VNA Northwest, and Salisbury Visiting Nurse Association, into VNHLC. History was no guarantor of future success and, as individual agencies, they faced a diminishing ability to negotiate with insurance companies or compete against larger players such as Hartford Healthcare, which has its own homecare agency and health plan.

Caselas said that VNHLC, as a combined agency, has been able to achieve efficiencies that enable it to provide high-quality, professional homecare – from home health aides to nurses to therapists – even in small towns such as Norfolk, where only a few patients may need care at any one time and, for the most part, without a waiting list.  He stresses that consolidation has given VNHLC the strength to stand up against the larger conglomerates and has positioned the agency to be able to serve all of Litchfield County.