HomeMy WebLinkAboutRes2019-055 CITY OF SEWARD,ALASKA
RESOLUTION 2019-055 Sponsored by: Meszaros
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEWARD,
ALASKA, APPROVING AMENDMENT NO. 4 TO THE MANAGEMENT
AND OPERATING AGREEMENT BETWEEN THE CITY OF SEWARD
AND PROVIDENCE HEALTH & SERVICES — WASHINGTON, DB/A
PROVIDENCE HEALTH & SERVICES ALASKA
WHEREAS, the City owns real property consisting of land, a hospital building and
Seward Mountain Haven, a long-term care facility, together with other improvements thereon
(collectively, "PSMCC"); and
WHEREAS, Providence Health and Services, Alaska ("Providence") leased the hospital
property and operated a hospital thereon from June 28, 1996 to April 10, 2003 pursuant to a lease
and operating agreement with the City; and
WHEREAS, the City and Providence eliminated the lease agreement and entered into a
management and operating agreement ("Agreement") in April, 2003, when Providence began
operating the collocated hospital and long-term care("LTC") facilities on the City's behalf; and
WHEREAS,the parties desire to amend the Agreement to loosen restrictions imposed on
the operation of Seward Mountain Haven as a result of maintaining certification as a Green
House-certified long-term care facility; and
WHEREAS, the parties agree to embrace and maintain many of the original elements of
the Green House model which are important factors in ensuring the well-being and growth of our
elder population, specifically, we will continue: to empower elders by restoring their choices of
daily living; maintain licensure as a nursing home; coordinate with external service providers as
needed (e.g. hospice); to not require elders to leave Seward Mountain Haven due to increasing
care needs, except in the event that a clinical condition requires hospitalization; and every effort
will be made to care for elders through the end of life. We will continue to: provide a minimum
of a private bedroom and bath for each elder at the Medicaid reimbursement rate currently
available (i.e. will not seek "family" or other supplementation for private rooms provided to
Medicaid funded elders); provide secured exterior areas, a"hearth"area in each home, including
a living room/seating area(sufficient to seat all elders), with a fireplace and an open kitchen, and
a dining area with a single long table sufficient to seat all residents and two visitors; provide
significant window areas open to natural light and in each resident's bedroom, and provide a
public/staff bathroom. Seward Mountain Haven will be a residential/home environment in most
aspects and will maintain programs to learn and honor the end of life wishes of elders, and will
maintain and pain identification and management program. Seward Mountain Haven will
continue to maintain elders who deplete their ability to pay privately (i.e., maintain elders who
are transitioning from private pay to Medicaid), and will be compliant with all local, state and
federal regulations that apply to the approved licensing category; and
CITY OF SEWARD, ALASKA
RESOLUTION 2019-055
WHEREAS, the parties agree that Providence may make the operational and facility
modifications necessary to carry out the highest level of care for the elders and staff, including
allowing for lifts in common areas when necessary for the safety of staff, allowing for mobile
nurse charting stations to improve quality charting and documentation, allowing for efficiency
improvement through outsourcing laundry, activities and housekeeping if necessary to promote
improved direct care of elders, and addressing the identified need for staff to have convenient
break spaces. Providence may also address current challenges associated with the Alaska
climate, such as offering covered walkways or making changes to minimize contact with wild
animals or hazards, as necessary to improve safety of staff,visitors and elders.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF SEWARD,ALASKA,that:
Section 1. The City Council hereby authorizes the city manager to execute and deliver
Amendment No. 4 to the Management and Operating Agreement between the City of Seward,
Alaska and Providence Health & Services — Washington, d/b/a Providence Health & Services
Alaska, as presented at this meeting.
Section 2. This resolution shall take effect immediately upon adoption.
PASSED AND APPROVED by the City Council of the City of Seward,Alaska,this 28th
day of May, 2019.
THE CITY OF SEWARD, ALASKA
Davi Squires, Ma r
AYES: Lane, Horn, McClure,Towsley, Seese, Osenga, Squires
NOES: None
ABSENT: None
ABSTAIN: None
ATTEST:
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Brenda Ballow (3' �•�y;;�a�Ja;L:;;'•9 t
City Clerk •
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(City Seal)
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22
climate, including changes such as covered walkways or fencing to minimize contact with wildlife or hazards
and address snow and ice, as necessary to improve safety of staff, visitors and elders.
INTENT:
The intent of this action is to eliminate the requirement that Providence operate Seward Mountain Haven in
complete conformance with official requirements of the Green House model, and to no longer require
certification as a certified Green House Project.
CONSISTENCY CHECKLIST:
Comprehensive Plan (document source here):
Strategic Plan (document source here):
Other (list): Management and Operating Agreement Between
the City of Seward and Providence Health & Services
ATTORNEYREVIEW: YES X NO ---
FISCAL NOTE:
Yes No NIA
X
While there are no direct costs associated with this change, it is expected that making this change will reduce
costs associated with operation of Seward Mountain Haven ( e.g. no longer required to pay annual dues to
Green House Project) and may generate cost efficiencies through allowing outsourcing of services that will
reduce cost and improve direct patient care. The extent of the cost efficiencies is not known at this time.
Finance Department: :Xu� Ju .. ua '1Ji)
RECOMMENDATION: Seward City Council approve Resolution 2019- 055 authorizing Amendment
No. 4 to the Management and Operating Agreement between Providence Health & Services Alaska and the
City of Seward.
23
May 13, 2019
Scott Meszaros
City Manager
City of Seward
410 Adams St.
Seward, AK 99664
Dear Scott,
This spring, I convened a team to review and analyze the status of Seward Mountain
Haven and the requirements of the Greenhouse Project. The team who analyzed: myself,
Rebecca Lawson, Seward Mountain Haven Administrator, Rob Kurtz, former Shabahzim
and current EVS/laundry services lead.
The need for the review stemmed from several sources. First, a check has been written
annually for some years and I wanted to know what we were getting other than the right to
advertise as a Greenhouse. Second, it seemed that the definition of Greenhouse was
different with every person. Most importantly, front line staff told me that we were not a
Greenhouse and that it was disingenuous to represent ourselves as such. Given the lack of
consensus about Greenhouse in Seward, it was important to investigate. This is a summary
of findings.
Attempts to communicate concerns directly with Greenhouse via web search provided little
information. I called and left email messages to people listed and to their “message
board.” I tried contacts obtained from Becky Lawson. I never received a response from
either source.
The acuity of elders at Seward Mountain Haven is a different population than the acuity of
elders the Greenhouse Project was designed to serve. There is no other place in Seward for
elders to move as they decline, so they age in place.
This fragile population requires considerably more therapies, medications, and oversight
than an assisted living facility. This increased need for care delivery is hampered by
Greenhouse rules that restrict lifts in common areas (SMH violates for the sake of staff),
restrictions on charting mechanisms (can lead to lower quality charting due to intervening
activity between care and documentation), and physical separation of nursing staff work
from the elders.
24
Significantly acute patients take more direct care time than the moderately impaired. As a
result, direct caregivers do not have time to do some homelike activities Greenhouse
specifies. Laundry, activities, housekeeping are outsourced, a deviation from Greenhouse.
Greenhouse will not make exceptions for the Alaska climate, regular contact with large
wild animals, or address the needs of caregivers (no staff break space, no lifts in common
areas).
The reduction of staff hours touted by the Greenhouse promotional material is not
documented in actual practice.
Greenhouse promised to gather data from various facilities and synthesize comparative
analyses but there have been few data requests from Greenhouse and few reports. No
evidence has been found that compares cost per elder, hours per elder, elder satisfaction
metrics, or even anecdotal events shared to help other facilities.
Greenhouse presumes that it represents the highest and most perfect form of elder care and
contains no provision to support self-correcting mechanisms for improvement. No system
is perfect. Improvement requires deviation from existing norms which is not tolerated by
the model.
For the reasons enumerated, but particularly for the lack of an imbedded improvement
mechanism, it is our recommendation that Seward Mountain Haven and its elders are best
served by severing the relationship with Greenhouse and retaining its best features so we
can adapt to Seward, Alaska and better accommodate the highly impaired elders who
depend on us.
Sincerely,
Don Hanna
Administrator
Providence Seward Medical & Care Center
25
1
AMENDMENT NO. 4 TO
MANAGEMENT AND OPERATING AGREEMENT
BETWEEN THE CITY OF SEWARD
AND
PROVIDENCE HEALTH & SERVICES – WASHINGTON
DBA PROVIDENCE HEALTH & SERVICES ALASKA
This Amendment No. 4 (“Amendment No. 4”) to the Management and Operating
Agreement between the City of Seward (“City”) and Providence Health & Services-Washington
dba Providence Health & Services Alaska (“Providence”) is made this 29th day of May, 2019, for
the sole purpose of eliminating the requirement that Seward Mountain Haven Long-Term Care
Facility be operated in accordance with the requirements of the official “Green House Project”.
Providence and the City may be referred to in this Amendment as a “Party” or, collectively, as the
“Parties.”
RECITALS
WHEREAS, the City and Providence are Parties to a Management and Operating
Agreement which became effective June 3, 2013; and
WHEREAS, the Agreement was modified by Amendment No. 1 effective February 15,
2014 to carve off the primary care clinic services and provide for renegotiation of the Annual Fixed
Periodic Fee; and
WHEREAS, the Agreement was further modified by Amendment No. 2 which recognized
that Providence Seward Family Care clinic closed February 15, 2014 and the FQHC opened
March 10, 2014, resulting in an amendment to the Annual Fixed Periodic Fee in Section 7;
and
WHEREAS, the Agreement was further modified by Amendment No. 3 which extended
the term of the Agreement in Section 2 to May 8, 2023 unless sooner terminated as provided within
the Agreement.
AMENDMENT NO. 4
NOW THEREFORE, the parties hereby agree as follows:
1. Revision to Section 5. Sentences 3-6 of the second paragraph in Section
5 to the Agreement are revised as follows:
Deleted = Strikeout Added = Red Underline
“The ‘Green House’ model has been was chosen by the people of Seward for the
new long- term care facility in 2008 due to its emerging reputation as . The ‘Green
House’ represents the latest, state-of-the-art thinking for providing long term care
services, and because of its vast improvement over Seward’s previous institutional
26
2
model of care. After a full decade of operation however, the practical limitations of
the model constrain the ability of staff to best meet the specific needs of fragile elders
with high acuity needs, operate the facility at maximum efficiency and address safety
issues unique to Alaska’s climate (e.g covered walkways). For example, the
increased need for higher care delivery is constrained by certain Greenhouse rules
(e.g. restrictions on lifts in common areas), restrictions on charging mechanisms, and
the physical separation of nursing staff from the elders. From an efficiency
standpoint, some services have been shifted away from the Shabazim (laundry,
activities, housekeeping) in order to provide improved focus on elder care, but
represent deviations from particular requirements of the Green House model.
Fundamentally, the Green House It is a trade-marked concept that provides care in
home-like settings where services are brought to the residents rather than bringing
residents to the services. The parties intend to continue to support many of the
concepts fundamental to the Green House model of care, but find that the nature of
process improvement in Seward requires changes which are not in full conformance
with the Green House model. It is determined therefore, that Seward Mountain
Haven and its elders are best served by retaining many qualities of the Green House
model while no longer seeking to qualify Providence shall use its best efforts to
operate the long-term care facility at full capacity, and to operate the long-term care
facility in accordance with the provisions of the Green House Project, to ensure the
facility’s continued qualification as an official ‘Green House’ so that Seward is better
able to accommodate specific needs of a more vulnerable population of elders with
high acuity, to drive process improvements and seek better operational efficiencies,
and to perform facility modifications which are not entirely consistent with the Green
House model.(see Exhibit A – The ‘Green House’ Specifications).
The Parties have executed this Amendment No. 4 on the date first above written.
AGREE TO BY AND BETWEEN:
For CITY OF SEWARD:
_____________________________ __________________________
Scott Meszaros, City Manager Date
For PROVIDENCE HEALTH & SERVICES – WASHINGTON
DBA PROVIDENCE HEALTH & SERVICES ALASKA:
_____________________________ ___________________________
Preston Simmons, Senior Vice President Date
Chief Executive Alaska Region
27
1
AMENDMENT NO. 4 TO
MANAGEMENT AND OPERATING AGREEMENT
BETWEEN THE CITY OF SEWARD
AND
PROVIDENCE HEALTH & SERVICES – WASHINGTON
DBA PROVIDENCE HEALTH & SERVICES ALASKA
This Amendment No. 4 (“Amendment No. 4”) to the Management and Operating
Agreement between the City of Seward (“City”) and Providence Health & Services-Washington
dba Providence Health & Services Alaska (“Providence”) is made this 29th day of May, 2019, for
the sole purpose of eliminating the requirement that Seward Mountain Haven Long-Term Care
Facility be operated in accordance with the requirements of the official “Green House Project”.
Providence and the City may be referred to in this Amendment as a “Party” or, collectively, as the
“Parties.”
RECITALS
WHEREAS, the City and Providence are Parties to a Management and Operating
Agreement which became effective June 3, 2013; and
WHEREAS, the Agreement was modified by Amendment No. 1 effective February 15,
2014 to carve off the primary care clinic services and provide for renegotiation of the Annual Fixed
Periodic Fee; and
WHEREAS, the Agreement was further modified by Amendment No. 2 which recognized
that Providence Seward Family Care clinic closed February 15, 2014 and the FQHC opened
March 10, 2014, resulting in an amendment to the Annual Fixed Periodic Fee in Section 7;
and
WHEREAS, the Agreement was further modified by Amendment No. 3 which extended
the term of the Agreement in Section 2 to May 8, 2023 unless sooner terminated as provided within
the Agreement.
AMENDMENT NO. 4
NOW THEREFORE, the parties hereby agree as follows:
1. Revision to Section 5. Sentences 3-6 of the second paragraph in Section
5 to the Agreement are revised as follows:
Deleted = Strikeout Added = Red Underline
“The ‘Green House’ model was chosen by the people of Seward for the long-term
care facility in 2008 due to its emerging reputation as the latest, state-of-the-art
thinking for providing long term care services, and because of its vast improvement
over Seward’s previous institutional model of care. After a full decade of operation
28
2
however, the practical limitations of the model constrain the ability of staff to best
meet the specific needs of fragile elders with high acuity needs, operate the facility
at maximum efficiency and address safety issues unique to Alaska’s climate (e.g
covered walkways). For example, the increased need for higher care delivery is
constrained by certain Greenhouse rules (e.g. restrictions on lifts in common areas),
restrictions on charging mechanisms, and the physical separation of nursing staff
from the elders. From an efficiency standpoint, some services have been shifted
away from the Shabazim (laundry, activities, housekeeping) in order to provide
improved focus on elder care, but represent deviations from particular requirements
of the Green House model. Fundamentally, the Green House is a trade-marked
concept that provides care in home-like settings where services are brought to the
residents rather than bringing residents to the services. The parties intend to continue
to support many of the concepts fundamental to the Green House model of care, but
find that the nature of process improvement in Seward requires changes which are
not in full conformance with the Green House model. It is determined therefore,
that Seward Mountain Haven and its elders are best served by retaining many
qualities of the Green House model while no longer seeking to qualify as an official
‘Green House’ so that Seward is better able to accommodate specific needs of a more
vulnerable population of elders with high acuity, to drive process improvements and
seek better operational efficiencies, and to perform facility modifications which are
not entirely consistent with the Green House model.
The Parties have executed this Amendment No. 4 on the date first above written.
AGREE TO BY AND BETWEEN:
For CITY OF SEWARD:
_____________________________ __________________________
Scott Meszaros, City Manager Date
For PROVIDENCE HEALTH & SERVICES – WASHINGTON
DBA PROVIDENCE HEALTH & SERVICES ALASKA:
_____________________________ ___________________________
Preston Simmons, Senior Vice President Date
Chief Executive Alaska Region
29