EAST GREENWICH – Culture change takes time. Since roughly 1996, there has been a legislative moratorium on constructing new beds for nursing homes in Rhode Island, a product of the R.I. General Assembly’s attempt to deal with what was then seen as a glut of beds.

The moratorium has been renewed on a regular basis, with the most recent renewal extending it through 2016.

However, a percentage of beds from any nursing home that closed after Jan. 1, 2010, can be issued by the R.I. Department of Health for the purposes of creating resident-directed, long-term culture change facilities.

The agency had accumulated a pool of some 116 beds that can be repurposed as a result of facilities having closed down since 2010.

Last week, on Sept. 17, the agency, as the result of a competitive bidding process, awarded 48 beds to Saint Elizabeth Home in East Greenwich to construct four long-term, resident-directed homes, housing up to 12 residents each.

The new complex will be built in partnership with the Green House Project, a national organization, ushering in a new model of care for how long-term care is delivered in Rhode Island, according to President and CEO Steven J. Horowitz of Saint Elizabeth Community, the parent company of Saint Elizabeth Home.

The non-profit firm now operates facilities at 10 Rhode Island locations, including affordable apartments for independent seniors, adult day centers, affordable assisted living and skilled nursing and rehab centers.

Each of the four new resident-directed, long-term care “homes” will have 12 private bedrooms with private bathrooms, private showers, as well as a shared living space centered around a hearth, according to Saint Elizabeth officials. There will be a dining table that seats 12 in the kitchen area. The four new homes will share a central courtyard.

Mary C. Rossetti, director of Community Outreach at Saint Elizabeth Community, told ConvergenceRI that she could not offer any specific details about financing, ground-breaking, completion or design of the project. “It all depends when we get the Certificate of Need [from the state],” Rossetti said. “We’re hoping for an expeditious review. We’d like to have it happen yesterday.”

As soon as the certificate is granted, answers to questions about design and financing can be given, Rossetti continued. “We can’t hire an architectural firm before the Certificate of Need is granted,” she said. Saint Elizabeth is talking with a number of architectural firms, but Rossetti didn’t know if a Rhode Island firm would be hired.

In terms of funding, she continued, Saint Elizabeth is looking at all types of funding streams that might be available, including a capital campaign.

A waiting list for applicants
Currently, Saint Elizabeth Home has 120 beds, with 40 designated for memory care needs, and 28 for short-term rehabilitation. The remaining 52 beds serve the long-term care population.

The waiting list for a long-term care bed at Saint Elizabeth Home is well over a year, according to Rossetti. For males in need of memory care, the wait is much longer, because there are fewer turnovers in male beds.

Rossetti anticipated that there will be a great demand for the new residences, with its new kind of resident-directed care.

Open bidding process
The award of 48 beds to Saint Elizabeth Home was the first time that the accumulated beds were offered in an open application process to existing nursing homes in Rhode Island, according to Raymond Rusin, Implementation Director of Policy and Program at the R.I. Department of Health, who helped to oversee the bidding process.

Three facilities applied; Rusin said he expected a second round of competitive awards to be undertaken in the not too distant future.

Rusin noted that the demographics in Rhode Island were changing, with a significantly higher percentage of elderly in the general population. “The number of people who will be 65, 75 and 85 over the next 10 to 20 years will be increasing, and an increasing percentage will need skilled nursing care – from rehabilitation to long-term care,” he told ConvergenceRI.

The problem with the ongoing moratorium, Rusin continued, was that it served to stalemate innovation, making it more difficult for Rhode Island to progress along the journey toward culture change.

The new award of 48 beds to Saint Elizabeth Home, with its partnership with the Green House Project and smaller housing models, with residents having more of a say in the how the care is delivered, is a positive step forward, Rusin said.

Number one in nursing home care
Rusin praised the fact that Rhode Island was rated the number-one state in nursing home care, moving from number-two in 2013 to number-one in 2014.
• Rhode Island was ranked in the top five in all regulatory measures and in ombudsman complaints – a feat it accomplished for the second consecutive year.
• One-third of Rhode Island’s nursing home inspections were deficiency free, an 8 percent increase over the previous year and one of the best records in the nation.
• Rhode Island surveyors cited the lowest percentage of severe deficiencies for the second year in a row – 97 percent of nursing homes free of actual harm or immediate jeopardy to residents.

One area where Rhode Island needs to make considerable improvement is in professional nursing hours per resident, for which it received a failing grade, according to the report card.

“It’s great to see Rhode Island at the top of a national survey for a change,” said Virginia Burke, head of Rhode Island Health Care Association, the state’s association of skilled nursing facilities. “I’m very proud to represent these facilities, which have a culture of continuous quality improvement.”

Burke also praised the leadership of Catherine Taylor, the former director of the R.I. Division of Elderly Affairs, who stepped down to run for Lt. Governor. Taylor, Burke continued, “has always been a staunch supporter of our elders, and of our work to provide them with top notch care.”