Where Will They Go? Washington Nursing Home For Brain Injured Patients To Close

Updated Feb. 14, 2020

For nearly half a century, people with severe brain injuries have found a home in a nursing facility housed in a Swiss Chalet-style former tuberculosis hospital in Snohomish, Washington.

Delta Rehabilitation Center began as a traditional nursing home in 1959, but found its calling serving brain-injured clients in 1975 after the owners’ 20-year-old son suffered a debilitating traumatic brain injury in a car crash.

Over the decades, Delta Rehab developed a reputation as one of the few facilities in Washington willing and able to serve the unique, long-term care needs of these often younger and sometimes difficult-to-manage patients.

But now, after years of financial challenges, the third generation, family-run nursing home is preparing to close its doors. The facility’s staff was notified of the impending closure Wednesday afternoon.

“This decision breaks my heart,” said Delta’s current owner and administrator Chris Walsh in a statement. “The closing of Delta Rehab will be a bad day for our 103 residents and over 200 longtime staff and volunteers.”

Walsh, whose grandparents founded Delta Rehab, took over operations from his parents in 1978. It’s his brother, Michael, who was the facility’s first brain injured patient and is still a resident there today.

Walsh said the decision to close the facility comes as he and his wife are dealing with health issues and have decided to retire. He said efforts to sell the nursing home were unsuccessful.

“No buyer would want a nursing home that’s 100 percent Medicaid,” said Walsh, referring to the state’s insurance program for low-income individuals.

It’s not yet clear where the facility’s residents will end up.

Delta Rehab is the 21st skilled nursing facility in Washington to close or convert to assisted-living since February 2017, according to the Washington Health Care Association (WHCA), which represents for-profit nursing home operators. The rash of closures has been blamed on low Medicaid reimbursement rates coupled with higher operating costs.

In response to the crisis, state lawmakers are advancing legislation this year to recalculate nursing home Medicaid rates annually, instead of biennially. The bill would also allow the nursing home cost data that’s used to set the rates to be adjusted for inflation. The industry clearly hopes the announced closure of Delta Rehab, coming in the middle of Washington’s legislative session, will serve to further jolt lawmakers. 

In a letter Wednesday, Dale and Deb Murphy of LeadingAge Washington, the trade group for nonprofit nursing homes, urged lawmakers to act this year to “stabilize the skilled nursing sector.”

“While it’s too late to save Delta Rehab and the 20 facilities that announced closure in the last three years, it’s not too late to save other facilities that are barely surviving,” the pair wrote.

Since 2017, an estimated 1000 nursing home residents in Washington have been forced to relocate after their facility closed or converted. As disruptive as those moves have been, the shuttering of Delta Rehab — because of the unique needs of its residents — presents additional challenges that may test the ability of Washington’s Department of Social and Health Services (DSHS) to find appropriate alternate placements.

“We were saddened to learn that the facility will be closing,” said Assistant DSHS Secretary Bill Moss in a statement. “We will provide all the assistance we can during this difficult time for residents and their families.”

Moss added that DSHS would work to transition residents to the long-term care setting of their choice.

Washington has historically struggled to find sufficient placements for people with traumatic brain injuries, especially those with complex behaviors. Between 2014 and 2017, Washington’s Medicaid program sent 16 hard-to-place brain injured patients to a facility in Oklahoma where some of them remained for years. One of the patients, upon their return from Oklahoma, was placed at Delta Rehab.

Dale, of the WHCA, predicted that many of Delta Rehab’s brain-injured clients will be transferred to adult family homes.

“The thought of these individuals being individually placed in adult family homes is heartbreaking to me,” Dale said.

In their letter to lawmakers, Dale and Murphy noted that Delta Rehab sought to provide “age- and gender-appropriate stimulus” to its population of mostly younger men who had suffered traumatic head injuries.

“The center’s activity calendar was packed year round with events including fireworks displays, rock music concerts, holiday festivals, and the seven Santa Clauses required to handle the annual Christmas Party for 300 residents and staff,” they wrote.

“There’s not another facility like Delta and that’s the heartbreak of all of this,” Dale said in an interview.

But Delta Rehab’s glory days also appear to have faded in recent years. Since 2017, the facility has racked up 11 enforcement letters from DSHS and nearly $50,000 in fines related to deficiencies of care.

Additionally, once a five-star rated facility, Delta Rehab is now a two-star facility that appears on a January 2020 list of nursing homes nationally that have a “history of serious quality issues or are included in a special program to stimulate improvements in their quality of care.”

Specifically, Delta Rehab is on a list of facilities that are candidates for the federal government’s “Special Focus Facility” program. Walsh acknowledged the last few years have been “rough.” He blamed new nursing home regulations that took effect under the Obama administration, challenges with maintaining 100-year-old buildings and the state’s low Medicaid reimbursements.

“If you are underfunded, you don’t have the wherewithal to, obviously, be a premiere facility,” Walsh said.

However, Walsh pushed back on the federal government’s rating system — calling it “faulty as hell” — and rejected the implication that Delta Rehab is a troubled facility. He said his nursing home gets dinged by inspectors because it has a higher use of psychotropic medications which are used to treat the brain-injured residents.

“[Regulators] don’t want the elderly being drugged and that’s very understandable,” Walsh said. “But we do not have geriatric people.” 

Delta Rehab’s future has long been imperiled. In 2009, in the throes of the Great Recession, the facility faced possible closure after the state cut Medicaid reimbursement rates as part of a sweeping effort to balance the budget.

In September of that year, Walsh provided a profit and loss statement that showed Delta Rehab was running $70,000 in the red for the year, even before the rate cut kicked in. Since then, with an average reimbursement rate of $183 a day — one of the lowest in the state, according to Walsh — it’s been touch-and-go financially.

“We’re always underwater, we have never made a profit,” Walsh said. “We were more concerned about taking care of people than making money.”

Walsh said after the nursing home closes, he plans to sell the property which is located in a residential neighborhood in the fast-growing city of Snohomish.

In some respects, it’s a come full circle moment. Walsh said in the 1950s his grandparents fought off developers who wanted to purchase the old sanatorium and the land it sits on.

As of Wednesday morning, Walsh had not yet told his brother Michael, Delta Rehab’s first brain injured resident, about the closure. He planned to deliver that news later in the day.

“My brother’s pretty sharp,” Walsh said. “He’s not going to be happy about it.”

NOTE: This story has been updated to clarify that Delta Rehab is on a list of candidates for the federal government’s Special Focus Facility (SFF)  list, but not currently in the SFF program.