Custer Care Center to close

Healthcare workforce shortages are being cited as the main reason for Monument Health’s announcement of the upcoming closure of the Custer Care Center, which is currently home to 30 elderly residents from around the area.
Monument Health Custer Hospital President Mark Schmidt announced the closure on Friday in the following prepared statement:
“Due to ongoing staffing challenges at the Custer Care Center, the Monument Health Board of Directors has made the difficult decision to pursue closure of the center.
“There is no target date for closure; the center will remain open until every resident finds alternative placement. Fewer than half of the available beds are currently occupied. Monument Health has a retention and redeployment plan for existing caregivers to meet the needs of residents until they find alternative housing.
“This is neither a financial decision nor a recent development. Given the tight local job market, we’ve relied heavily on traveling nurses, traveling certified nursing aides and international workers to safely maintain care at the Custer facility. With the COVID-19 pandemic, we’re facing intense competition for travelers, and immigration challenges make it nearly impossible at this time to recruit internationally.”
In an interview last Friday afternoon which also included Dr. Lisa Brown, Schmidt said the staffing problem has been a challenge ever since he first came to Custer five years ago when he first served as care center director.
“From day one this has been an opportunity and challenge for us,” said Schmidt. “It ebbed and flowed over time but we recognized it, at least from my perspective, from the first day I started down there.”
While stating that Custer’s unique shortage of affordable housing has contributed to the problem, Schmidt said the staffing shortage is nationwide. He said not only nurses but other healthcare workers are in short supply. He noted that many people moving into the Custer area “are not of workforce age” which has limited the pool of employees to pick from.
Dr. Brown supported Schmidt’s statements about the widespread nature of the issue.
“If you look at what is going on in the long term care industry across the nation,” she said, “staffing has become incredibly difficult and there are nursing homes across the nation closing because of this very same issue. We unfortunately are feeling that here very personally.”
Schmidt said early on the care center was able to take advantage of opportunities to hire international workers to supplement staffing levels but he said many of those opportunities have “ceased” in recent days.
“When those are unavailable and we just don’t have that bandwidth for a local workforce it really hits you twice,” he said.
Schmidt said the current occupancy of the facility, which is less than half the available beds, is a factor of the staffing availability.
“You have to be really careful in long term care,” he said. “You're taking care of people 24/7/365 so you have to really be predictive and monitor your capability to fill beds based on your ability to have your workforce.”
The center currently has 30 residents, about 16 of whom are from the Custer area.
According to Monument spokesman Dan Daley, the total staff at the care center currently is approximately 52 which includes 41 regular caregivers. He said that translates to about 21 percent of the workers being travelers or contractors. There are no international workers at the care center at the present time.
Schmidt said of the current staff some are contract staff, meaning they are traveling health care workers who do not live in the local area.
With regard to relocation of both residents and staff, Schmidt said “We take that very seriously.”
“Our residents and our caregivers are most important to us,” he said, noting that with regard to transitioning residents to other facilities, “we’ll do that compassionately and to the best of our ability.”
While no timeline was given by officials for the closure, Schmidt said state health department regulations require 60 days notice before closing but he acknowledges the process could take considerably longer.
“Obviously we know that it’s gonna take some time to find appropriate locations for 30 residents,” he said. “We’ll take the time to do it the best way we can. We’re committed to taking care of the residents right now and we have a pretty good team of folks who are gonna help us work on that transition.”
Schmidt said the same philosophy applies to helping the current workers find new employment locally. He said leaders have been meeting regularly with the care center administration and caregivers to discuss opportunities that currently exist in Custer in the hospital, clinic and assisted living center or the Hill City and Hot Springs clinics, as well as Monument facilities around the Hills. He said the company is dedicated to rewarding the workers for their efforts and to finding the best fit for each.
Before the announcement of the closure could be made public, Monument officials were working to notify the residents and their families, including those who hold power of attorney. Schmidt said on Friday a document had been drafted and reviewed and was to go out to the affected parties that day. He said announcement would also be made to the care center’s resident council. He said he hoped to have that completed by the end of the day.
Custer mayor Bob Brown said he had been in conversation with Monument officials about the possibility of closure over the past several weeks. He said he as well as council members Todd Pechota and Peg Ryan, who is the Monument liaison, had met with Schmidt several times in the days leading up to the announcement. He said they had discussed alternatives and  had offered the help of the city but to no avail.
Brown said originally Monument had discussed starting by cutting back the occupancy of the care center from 35 to 25 beds.
Schmidt said on Friday a reduction in occupancy had been considered but said it was “evident those challenges weren’t going to get any better or go away and at that point we felt we needed to make the recommendation that we needed to close the facility.”
“It blindsided all of us,” said Brown, “I’m not happy with it. You had STAR Academy and then you had the (Hill City) mill—granted it wasn’t here but it’s still close by.”
Brown said the closure might lead some to leave the community as well.
“How many people are going to have to leave now because they have to move their loved one somewhere else and they don’t want to be that far away?” he asked.
Brown said he had suggested in the meetings that the facility simply cut back on the number of beds, as discussed or combine with the assisted living but he noted the employee shortage turned out to be the deciding factor.
“As a business owner I understand that,” he said, “but there are going to be a lot of people who are unhappy about it.”
Brown also said he asked what the plans were for the facility on Montgomery Street but was not given an answer.
In response to the same question on Friday, Schmidt said the future of the building is uncertain. Asked whether the building, constructed in 1972, might be transformed into individual apartments, Schmidt said that would be limited by the fact that, while each room has a bathroom, there are not showers in the rooms.
Upon learning of the nursing home closure, some have expressed concerns that the Monument Health Assisted Living center on N. 10th might be next, however, Schmidt was quick to squelch such thoughts.
“The assisted living is not affected by this,” he stated, but went on to say, “I will say it also has its workforce challenges looking forward so we have to be really cautious that we don’t run into the same situation.”
The assisted living has 16 resident units and is currently at full occupancy.
The Monument officials refused to state what other local options might be available to the nursing home residents but unless one goes to Rapid City those options appear to be limited.
The only nursing care facility in Hot Springs appears to be the Michael J. Fitzmaurice South Dakota Veterans Home.
Another nearby option would be Weston County Manor in Newcastle, Wyo., however, when contacted Monday, CEO Maureen Cadwell said her facility is experiencing the same staffing shortages and is not taking any new residents at this time. Weston County Manor is listed on its website as a 58-bed certified long-term care facility, however, Cadwell said the population of the home is currently at 40 because of the staffing issues.
Dr. Brown emphasized that the decision to close the facility was not an easy one for administrators or medical professionals like herself.
“I just want to emphasize as a physician who cares for patients we’ve watched this transition over time and this is not a decision that’s been taken lightly at all,” she said. “All kinds of brains have gone into thinking through how to problem solve this and find additional staffing and training programs...and any number of things to look to see how we can improve our staffing opportunities to keep this open.”
“It’s painful for me as a physician to see this close because it is a spectrum of care the community needs,” said Dr. Brown, “but we can’t safely take care of people when we don’t have nursing staff to care for them. From the administrative end of things it’s been very difficult to come to this decision and, as a physician caring for people in this community, it’s difficult to watch this happen. This is time to take a pause, rethink what we need as a community and come together and come up with whatever plan is next but the current one is nonviable.”