50 Skilled Nursing Home Beds Disappear

Daily Observer

July 26, 1974

Recently 50 skilled nursing home beds disappeared from Toms River. The beds were neither sold, nor were they spirited away furtively in the night, but they are missing nonetheless. As a matter of fact, the beds are where they have always been, in the south wing of the Toms River Convalescent Center.

How can they be missing? The answer is as simple as magic, as deceptive as an optical illusion. The beds have been upgraded from skilled nursing home beds to hospital beds to service the new rehabilitation hospital.

When the new Garden State Rehabilitation Hospital was adjacent to the Toms River Convalescent Center on ground facing the Community Memorial Hospital, permission was granted by the New Jersey State Planning Council for the Convalescent center to donate 50 of its beds to the new hospital. The conversion of beds completed, the community is now minus placement for 50 patients who require the services of a skilled nursing home.

Of course the 50 beds could normally be replaced by any entrepreneur who had the ambition to do so. But in these complex times such a market place solution is not possible. Unless the entrepreneur received a certificate of need from the state he could not receive a license to build. The certificate of need is probably an unconstitutional piece of legislation contrived to protect the monopoly of existing health facilities, or otherwise stated, to prevent reduplication of existing health facilities.

The United States Government which pays the Medicare bills is interested in preserving the status quo because it donated government matching funds under the Hill-Burton law to finance the construction of hospitals and their additions. It does not want to see its investment depreciated by competitive institutions.

The government abhors vacancies in the house its Jack built, and thus clamps a lid on potential competitors until centrally located computers indicate that an increase in hospital beds in the area will be no threat to present hospital occupancy.

Townco Medical Enterprises, Inc. which owns the Toms River Convalescent Center, the Garden State Rehabilitation Hospital, and the Country Manor Nursing home received a certificate of need to build 100 beds at Country Manor to replace those lost at Toms River.

However, the beds were not built according to the officers at Townco because although they applied for permission at the Dover Township Planning Board on January 17, 1973, final approval was not granted until November 30, 1973. Eleven months. The certificate of need from the state for both enterprises was granted February 15, 1972. Townco applied to the Planning Board for the hospital addition first, and then, after approval, applied for the addition of nursing beds.

The inconveniences foisted on the medical community by this temporary loss of 50 skilled nursing home beds is the result of a squeeze by two commissions with divergent missions. If a community must live with the evil of a certificate of need, one would hope that in the process of depriving a community of new beds, it would protect the old.

Because Community Memorial Hospital is filled to the brim, with many patients forced to lie on stretchers in the hall, there is increasing pressure to discharge patients who no longer require the services of a hospital. However, a large percentage of these patients are unable to go home; either because they live alone and are too feeble to care for themselves, or because their families have not got the resources to care for them; or because they still require intensive nursing care.

Normally a physician would transfer such a patient to a nursing home close enough so that he could follow the case. If no beds are available in a nearby nursing home, a physician would be inclined to allow his patient a few more days in the hospital until a bed became available. But Prudential Insurance, which pays Blue Cross and Medicare bills will not pay for the extra days, as long as there is an equivalent facility within a 16 mile radius. This decision is based on the premise that all skilled nursing homes are equivalent and equally desirable.

The financial pressure exercised by Prudential in threatening not to pay for the extra days, forces patients to be transferred to domiciles away from the immediate area. When this happens family relationships are burdened, and the doctor-patient relationship distorted because the patient must find a new physician to care for him at the distant place.

The point of all this is to illustrate how impersonal and depersonalized the system has become; how much our freedom has been usurped by the planners who connive to use computers in the night to dictate to a community the extent of its needs; how the hapless patient, isolated already by illness, is further imprisoned by rules, codes and legislation for which there is no one who can be held accountable, no one who will accept responsibility.

The administrative procedures that bind our health care system result in a haphazard authority, a random construct of stifling law which, while it purports to save the community, will surely strangle the patient.