Relying largely on contracted staff when they couldn’t recruit enough nurses, leaders at Providence Health Care in Washington state could do little more than watch as costs for their 40-bed long-term care unit skyrocketed.

The Providence St. Joseph’s Hospital Long-Term Care Unit is  located in Chewelah, a small town more than an hour from “mid-sized” Spokane, said Ron Rehn, Providence’s chief administrative officer of Providence Health Care, in an email exchange with McKnight’s.

“There simply aren’t enough trained staff across the board, especially nursing and NACs (nurse assessment coordinators),” he explained.

First, Providence limited admissions to save money. When that didn’t do enough to alleviate the pressures, the hospital announced last week that it would close the wing for good. It was down to 25 patients.

Providence has drawn patients from all over Stevens County, and while Rehn declined to provide details, he said his census mix had a “relatively high public payer population.” Knowing that patients had other long-term care options didn’t necessarily make the decision to close and move remaining residents to one-time competitors easier.

“We went through a long and thorough discernment process that involved both leadership and community members,” Rehn said. “We looked at everything from the viewpoint of our mission and came to the difficult decision that we need to better meet the larger healthcare needs of our community.”

Though no final plans have been made, Providence’s designation as a rural Critical Access Hospital may play a role in redeveloping the attached wing. While long-term care was costing the organization more, Medicare and Medicaid would pay more for acute-care and other services at the location.

Rehn told the Chewelah Independent newspaper that leaders may ultimately decide to expand the footprint, possibly to accommodate a mix of in- and out-patient care.