Hillsboro Medical Center / Capital Campaign

Caring for you today – Building for tomorrow

Throughout the 60-year history of Hillsboro Medical Center, we have offered excellence in hospital and nursing home care to the people of Hillsboro and the surrounding communities. We have cared for your children, your parents, your grandparents – and you!

Since 1946, we have responded to your needs – expanding and offering additional services to keep our citizens healthy or to offer care at times of great need. By growing, we have kept up with your demands for better and expanded care.

We are caring for you today – and we need to build for tomorrow. Hillsboro Medical Center is committed to continued quality medical services in our local community and we are very clear about the direction for the future.

It is time once again to grow and respond to the needs of our community. As you read about our “Caring for you today – Building for tomorrow” building project and capital campaign, you will discover our vision for enhanced health care and living services as well as the valuable role you can play in helping us achieve our dream.

In advance, we extend our heartfelt thanks to you for your contribution and your support.

Curt Kaufman Patricia Dirk

Chairman, HMC Board of Trustees Administrator, HMC

We are embarking on the important task of raising $2 million for the expansion and growth of the Hillsboro Medical Center. As you read this information, we hope you will understand why this project is so important – not only to Hillsboro Medical Center but to everyone living in Hillsboro and the surrounding area. It is our hope you will understand why your support is so necessary.

The cost of this exciting project is estimated at $12.5 million. The bulk of this cost will be financed by the Hillsboro Medical Center. The remaining $2 million needs to be raised through the donations of individuals and companies. Although this goal is ambitious, it represents just 16% of the total project. As citizens of the Hillsboro area who will directly benefit from this project, certainly we can step up, raise these funds and make this vision a reality!

Living in this area, we have so much to be proud of. We are a vibrant community that has flourished when other areas have not. We are a strong community that takes care of each other, especially in times of greatest need. Our Hillsboro Medical Center is a key to our strength. It offers much needed services to our citizens and contributes to our economic growth. A community that offers a progressive hospital, nursing home, clinic and assisted living facility is one that will continue to grow into the future.

Thank you for thoughtfully considering the contribution you can make to this capital campaign. Your gift will be an investment in health care and living services for your family, your friends and your neighbors for many years to come!

Mary Ann & Dallas Boeddeker Angela Kritzberger

Co-Chairs, Capital Campaign Steering Committee Executive Director, HHF

Why we are at a crossroads

This project started with the need to bring our nursing home up to required standards. Because of concerns regarding fire proofing and other safety issues, the Hillsboro Medical Center (HMC) Board of Trustees researched solutions. They found it would cost at least $2.2 million to make needed repairs to our current facility. However, this would be a “band-aid” approach that would not create a setting that fulfills the mission and long-range goals of HMC and the community.

The HMC Board of Trustees, guided by experts from Eide Bailly LLP of Fargo, has done a thorough job identifying long-range goals and researching the needs of our community. The Board recruited Health Planning & Management Resources, Inc. (HP&MR) of Edina, Minnesota to conduct a market feasibility study to accurately determine the needs of our surrounding community and analyze the demand for nursing home and assisted living services.

The conclusions were that:

· Health care is changing and improving to provide care centered on the patient and resident. If we do not change and keep up with this consumer demand (your demand for better service), we will not be able to stay in business.

· Care environments are changing to foster a sense of community and belonging, as well as a renewed respect for patients’ and residents’ desire for privacy.

· In the future, there will be federal mandates for electronic patient records and other technological upgrades. HMC chooses to be proactive and address these requirements now, to avoid costly re-dos in the future. We are researching integrated electronic patient record systems, which includes radiology and lab components. The costs for these systems are projected in the range of $700,000.

· Similarly, there will be new federal mandates with regards to facility sprinkler systems that must be addressed. The cost for the sprinkler system in the nursing home alone is approximately $100,000.

· Our community has requested expanded services to include assisted living services. This is a gap in housing options that needs to be filled. Some people have had to leave the Hillsboro area for no other reason than there simply was not the type of housing-with-some-assistance they needed. Others are struggling to stay in their homes when that may no longer be the most healthful or safe option for them.

The solution

With their studies completed and the vision determined, HMC and the Health and Humanities Foundation (HHF) are seeking financial support for a building project that will:

· Build a new nursing home where the care plan will convert from a medical model (“nursing” home with long halls and hospital-like rooms) to resident-directed care. We will renovate the physical environment to create HOME, where elders receive assistance and support in a de-institutionalized setting; where privacy is honored and individualism is embraced. This will create an environment that each of us would welcome living in. It will also create greater efficiencies for our staff, making Hillsboro Medical Center as great a place to work as it is to live and to receive care.

· Renovate our hospital to meet today’s needs for efficiency, safety and privacy

· Build assisted living options for our seniors

Exciting Changes … For our entire facility

This is an exciting time! New models of living and providing health and human services are being explored and implemented. Led by human compassion and economic foresight, facilities such as Hillsboro Medical Center are taking a common sense approach to living and caring for elders to create long-term care communities where elders choose to live their lives, with staff who enjoy assisting them. This same philosophy guides our hospital care for our patients.

We are working with the Action Pact organization to implement our renewed philosophy of care for our residents and patients. Action Pact, through a program called Culture Change, focuses on changes for nursing homes but we will take that approach and incorporate it into our care plan for assisted living and the hospital as well as the nursing home.

Action Pact teaches that nursing homes need to be staffed by familiar caregivers who help their community’s residents live lives of meaning, value and joy. Residents have their private spaces as well as family gathering places and an opportunity to live life with a measure of independence and responsibility. The goal is to insure these communities provide the best personal, health and medical services anyone will need, including those with serious medical or health issues.

Such a plan involves not just a change in the physical space but in the manner in which staff provides care. Staff consistently interact with each resident so the resident can establish long-term relationships with their caregivers. Staff and residents together prepare and eat meals, visit or participate in activities. Days are informal, as would happen in one’s own home, resulting in a truly rewarding and satisfying daily life for elders – and for staff. Residents sleep, eat and participate in activities of their choosing on their own schedules rather than one that has been set for them.

To the extent that we can, given a patient’s need for specific medical services, we will also incorporate this culture in our hospital. Our vision is for a complete consistency and continuum of care, whether we are with our patients in the hospital or our residents in the nursing home or assisted living.

Our caregivers and medical staff have always provided the best in care to our residents and our patients. Now that excellent care will be enhanced with a new approach to living and providing health care!

Exciting Changes … To our Hospital

Currently, our hospital is a 20-bed facility but it has inadequate, inefficient space that does not fully accommodate the needs of our patients and the needs of our staff to offer medical services. Our plans will provide improvements in space, privacy, safety and equipment.

We need to have private patient rooms with private bathrooms. Our family waiting areas need not only more physical space but need to be places where families and patients find greater comfort in a less confining environment. Currently, spaces such as the pharmacy and emergency room are too small to accommodate the equipment that is needed for patient care. Increasing our swing bed capacity will be an important change because of the anticipated growth in the number of patients needing this type of care.

We are proud of our medical staff and the excellence in services we offer. It is very important that the physical space and equipment also be of the highest quality, for the benefit of our patients. Our goal is to continue to provide the high quality of medical services the community has come to know and expect.

Exciting Changes … To our Nursing Home

At this time, our nursing home looks like a traditional nursing home. We are so very proud of the care given by our staff but we want to eliminate the long sterile hallway and provide an environment that feels like home and functions as one.

Our plan calls for two “households,” each with a kitchen, dining area, living room and private, personalized bedrooms. There will be additional storage and private bathrooms. There will be two households instead of one so that fewer residents are in each setting, providing more private living space and promoting more small group or family interaction. Smaller households will provide more individualized attention to our residents and allow greater flexibility in the care we provide. Together, we will build a home that you would love to live in or have your loved ones live in!

Exciting Changes … Offering Assisted Living

At present, Hillsboro lacks an assisted living facility for our senior citizens. We consistently see residents who do not need the full services of a nursing home but are no longer able to live independently on their own. Without an assisted living facility, too many of these citizens are trying to manage by staying at home, which is neither safe nor a healthful circumstance, or they are leaving our community. Our vision is to build a beautiful facility that will provide the independence so many people cherish (a home of their own!) yet will also provide the assistance needed to live a secure, healthful life. Assisted services can include emergency medical assistance, personal care, meals and activities. Residents will be able to choose the services they want or need and they will benefit from living in a facility that is connected to the healthcare center and a chapel.

Getting the Right Start

“Rightsizing” our building project is the first key to our anticipated success. The Administrator, the HMC Board of Trustees and Eide Bailly LLP spent a great deal of time analyzing historical and future data to determine the appropriate size of the organization and of each unit. Occupancy of the nursing home, census of the hospital and swing beds, length of stay and number of admissions and discharges are critical factors that were considered in determining that we need a 36-bed nursing home, additional swing beds, the appropriate blend of acute and observation rooms in the hospital and 16 apartments in the assisted living unit.

Questions & Answers:

· Why is this happening now?

Our nursing home is in need of mandated updates that need to be corrected in 2007. It will be more efficient and smarter in the long run to address all our current needs. Delaying other projects will only result in increased construction and equipment costs.

· What is the timeframe?

Our capital campaign began in September 2006. Groundbreaking will take place in the spring of 2007. Anticipated completion of the project will be 24 months from the time of groundbreaking.

· Do we need an assisted living facility?

HMC contracted with Health Planning & Management Resources, Inc. (HP&MR) of Edina, Minnesota to complete a market feasibility study to analyze the demand for skilled nursing home beds, assisted living and basic care (hospital) beds in our area.

This study showed a definite need for assisted living in our area. We are “losing” people to other counties and communities because they are moving away to receive the assisted living services they need. Those needing to move away most often would prefer to remain in their hometown of Hillsboro.

· What is Kelleher Manor? How does that differ from assisted living?

Kelleher Manor, which opened in 2000, is a 14-apartment facility offering a congregate living setting. There are opportunities for residents to eat and enjoy activities together. However, residents must be able to live independently.

· Who does Hillsboro Medical Center serve?

People from throughout Traill County and parts of Grand Forks and Cass Counties in North Dakota and Norman and Polk Counties in Minnesota are served by HMC – through the clinic, hospital and nursing home. We hope in the future to make assisted living an option for them as well.

· The target population for the hospital is all ages within the service area. Our hospital census averages 438 in-patients per year.

· The target population for the nursing home and assisted living is men and women, generally, but not limited to, 65 years of age and older. The nursing home will have 36 beds (32 private rooms and 2 double rooms) and the assisted living facility will have 16 apartments.

· Is the medical staff in support of this project?

Our medical team is in full support. One of the great strengths of HMC is its medical team. Dr. Charles Breen and Dr. Tim Luithle are committed to our community. We do not face the difficulty many smaller communities have in recruiting and retaining doctors. This stability is a great strength that benefits patients. In addition to Drs. Breen and Luithle, we have the services of a physician assistant, Ann Owens.

· How is the project being financed?

HMC will request bids from financing companies and choose one to work with.

· How will the state of North Dakota property (asset per bed) limits affect the financing of this project?

This is a very important issue and is key to our financing. Currently, North Dakota lags behind other states, particularly our neighbor state of Minnesota, in property limits (also known as “asset per bed limit”). The current property limits for nursing facilities are not sufficient. The current limits were established twelve years ago (1994) and are minimally inflated each year by the Consumer Price Index. Since 2000, building costs have increased almost 30%. To better meet the needs of residents, meet regulations and plan for the future, we need the property limit “rebased.” The gap between the cost of construction and what the state allows for construction creates a financing concern as it leads to unallowed depreciation and interest of roughly $145,000 per year. At this time, North Dakota property limits provide $69,525 for a double room and $93,165 for a single room. This compares with Minnesota’s rates of $101,806 for a double room and $152,710 for a single room. Our staff and Board members are actively working with other nursing homes around the state, through the North Dakota Long Term Care Association, in asking our governor and state legislators to increase these numbers so we are in line with Minnesota. This adjusted property limit will give HMC and other North Dakota nursing facilities the ability to cash flow these necessary improvement projects, making them much more attractive to, and attainable from, financing companies.

· How was the $2 million capital campaign goal determined?

Eide Bailly LLP serves as a financial consultant to HMC. Through thorough analysis, they determined that $2 million of the project must be raised through private contributions.

· What will happen if the goal is not met?

Our plan is to complete the majority of fundraising prior to groundbreaking. As the capital campaign progresses, the HMC Board of Trustees will make prudent decisions regarding the progress of construction. If the $2 million fundraising goal is not met, they will prioritize the elements of the building project and make the decisions necessary to move forward as much as possible. Some segments of the project may need to be postponed. However, we feel very confident that this community will offer its full support and we will achieve our goal.

· What is the relationship between HMC and MeritCare?

MeritCare manages and staffs the clinic that is housed in the HMC facility; MeritCare pays rent to HMC for that space. In 2000, HMC began contracting with MeritCare for the services of its Administrator. With increasing federal and state regulations for nursing homes and hospitals (healthcare is one of the most regulated industries in the United States), it became imperative that HMC utilize the resources of a large health system. In addition, we benefit from this collaboration because of other resources we can utilize when needed (information technology, bio-medical services, credentialing, compliance, education, infection control, quality management and the purchase of supplies that cannot be purchased locally). We enjoy the benefits of our hometown facility united with the resources of a larger health system.

· Should space be allocated for a childcare program?

HMC will be researching community demand for childcare. If there is sufficient community need, we will explore options with private providers and/or established programs for providing childcare for working parents.

· What is the economic impact of Hillsboro Medical Center to Hillsboro?

It is huge. HMC is Hillsboro’s second largest employer (after American Crystal Sugar Company). In addition to the jobs that are created for local citizens, there is the impact of HMC’s use of local services and businesses (such as pharmacy, phone company, etc.) which in turn generates economic impact.

· Did HMC explore options of building on another site?

Yes. The conclusion was that moving to another site would not be financially feasible. There were also concerns with moving the clinic so soon after it was established. Splitting services between two sites was also not a good option; having all services within one campus setting will most effectively serve the needs of our patients and residents.

· Will additional staff need to be hired? How does that affect operational costs?

Action Pact, the organization assisting us with our Culture Change, is helping us determine staffing needs based on our new model of care and, with blended staff roles and greater efficiencies, our goal is to be budget neutral. “Blended staff roles” refers to the cross-training that will be done so that one staff person will do various tasks rather than being limited to one specific task. Because of this, for those services we presently provide (nursing home and hospital), there will be no need for additional staff. For the assisted living facility, residents will pay for the services they receive and those fees will cover the cost of additional staff.

· Why is the purchase of Electronic Patient Record equipment important?

The advantages of using electronic patient records, digital radiography and electronic lab systems are many but most important are accuracy and better response time for our patients. Health care providers across the country recognize the benefits of electronic health records as do the Institute of Medicine, the American Academy of Family Physicians and the American College of Physicians. Health information technology systems that enhance access to patient information (information that is readily available regardless of the site at which the patient is receiving care) and promote the use of reference data to support decisions regarding patient care, hold the promise of improving the quality, safety and efficiency of healthcare delivery.

A message from our physicians:

The possibilities this building project brings are truly exciting. The theme of the project, “Caring for you today – Building for tomorrow” accurately reflects the mission and vision for Hillsboro Medical Center.

We are proudly caring for you today. It is our privilege to serve as your physicians, providing the medical care you need and expect, for yourself and for your family. We must build for tomorrow, to keep up with the expectations you have for your health care. We need to be competitive with other regional health care centers so you can receive more care close to home. The expansion and addition to our facility will help us provide care for our patients locally.

Personally, we plan on being in Hillsboro and caring for patients for many years to come. This community has a proud heritage that makes living and working here special.

“Caring for you today – Building for tomorrow” is a great opportunity for Hillsboro Medical Center and for the community. We are fully supporting this campaign and we ask you to join us. Thank you for the confidence and support you give us as your hometown physicians – and thank you for your generous gift to this important campaign.

Charles Breen, M.D. Tim Luithle, M.D.

Hillsboro Medical Center Hillsboro Medical Center