“PLEASANT VIEW”
February 23, 1953 to February 23, 2008
A Celebration of Life 55 Years of Caring
Construction began on the 78 bed “Pleasant View Hospital" on February 1, 1952. To get started, a six acre site was donated by the City of Corunna, and shortly after, two additional acres were purchased. It was noted in the Argus Press on May 15, 1952 that the County Board of Supervisors gave their one-day paychecks amounting to $8 to help equip and furnish the new county hospital. A formal opening to the public was made on February 14 and 15, 1953 from 1:00 pm to 4:30 pm.
The original building was built for $486,000 and financed mostly by a $425,000 bond issue repaid in four years. The first admission to the County Hospital was on February 23, 1953, and soon all 30 patients from the County Infirmary on Lyons Road were moved to the new Hospital. Within eight months of opening all of the beds were filled. The phone number was Riverview 3-3491.
The 1953 Social Services Board members were Claude B. Spiess, Chairman, Theodore Strauch and Reverend Father John S. Daniel. Walter L. Merz M.D. was the medical director and Mrs. Irene Hoskins R.N. was the superintendent of nursing. George Gettman as Social Services director was the first administrator of the Hospital.
In 1954 many improvements both in the building and on the grounds were made. The bank along the highway in the front of the building was re-graded and sodded. The service and parking area in the rear of the building was hard surfaced. Many trees and shrubs were planted. Also, a new 25 X 60 foot garage, workshop and storage building were added to the property. Storm windows were installed throughout the building. A new water processing plant was added to remove the corrosive elements from the hospital's water supply.
In 1955 the county Board of Supervisors approved the sale of the county farm and expansion of Pleasant View Hospital. The county farm cattle were sold in 1955 and the proceeds were placed in a special hospital building fund as well as the proceeds from the sale of the machinery and the 120 acres.
In 1956 the costs of operating the hospital increased by about $30,000 from the same period in 1955, primarily due to the hiring of twenty additional employees. Five more nurse aides, an orderly, more laundry help, more kitchen help, and clerical help for the Superintendent of Nurses, were hired so the hospital could meet state requirements. This raised the total number of employees to fifty-one, including three registered nurses, seven housekeepers, eight foodservice employees, twenty-eight nurse aides, three orderlies, a maintenance man and a grounds-keeper.
The hospital provided 26,576 patient care days at a cost of $239,893. That equaled $5.26 per patient per day, or a total average cost to the tax payer of $1.10 per day after the deduction of revenue. The private pay rate was $7.50 per day.
The annual operating budget was $184,000. In January 1957 the Board of Supervisors authorized an additional $25,000 appropriation to meet the payroll at Pleasant View.
On March 23, 1958 at 2:00 pm, an open house was held for the public to explain the need for additional space and beds. The County Infirmary was torn down in 1960 after serving Shiawassee County residents for more than eighty years, first as the county poor house and later as the County Farm and Infirmary.
Groundbreaking for the new East Wings $1,061,581 addition was held on June 10, 1964. Board Chairman Leslie Middleton spoke of his friend, Dr. W.T. Parker, who had made this addition possible, 'He spent his entire life in this community relieving the pains of the sick. In his day he saw fit to use some of the money he made in this area so that sick people could continue to be cared for."
Dr. Parker's bequest, Federal Hill Burton Funds, and money voted by Shiawassee residents made the addition possible.
In 1965 the East wing additions were completed, increasing the number of beds from 78 to 160. Sometime after that some resident rooms along the North South hallway were converted to a pharmacy dispensary, (this was previously in a closet across from food service where the ice machine and drinking water supplies are kept now) nursing office space, and payroll and personnel offices. This reduced the bed capacity to 154. The bed capacity was further reduced to 152 with the 1979-1980 reconstruction of the South Unit.
The following was taken from the annual Social Services Report written by Robert A. Brown Administrator about the facility operation since it summarizes a period of great change in the way long term care became funded in the United States:
PLEASANT VIEW HOSPITAL 1966 ACTIVITIES
Pleasant View Hospital, Shiawassee County Medical Care Facility founded in 1953 for the primary purpose of assuring medical care to the indigent of the county, was during 1966, ushered into a new concept of primary nursing care programs for all citizens of the county when the hospital met and complied with the Federal Government's regulations and qualifications to be designated Shiawassee County's only Extended Care Facility.
The coincidence of completion of the new addition to the hospital early in 1966 (doubling the bed capacity to 160) and the advent of Federal and State hospital insurance late in 1966, gave the hospital not only a problem of utilization of new building and equipment but the combined necessity of planning a new patient care program and policies.
During the year 1966, Pleasant View Hospital successfully changed from a static-care program to a progressive future-conscious organization that has enveloped the best of previous programs and initiated new policies and practices that prepared us for an expanding need of our services.
Patient daily census increased during the year from 72 to an average of 140. Employee census changed from an average of 35 to a new high average of 165. The hospital employs and houses more people than any one other activity or industry in the Corunna area.
NURSING SERVICES:
The normal demands on direct patient care services was tremendous during 1966 as not only expected due to increase of patient load all during the year, but also due to the necessity for a thorough re-evaluation and necessary corrections to meet the standards of the new health insurance programs, Medicare Title XVIII and Medicaid Title XIX.
Taking many pointers from the basic requirements of qualification procedure for extended care facilities, several key revisions were made to our program which directed more attention and consistency to direct patient care procedures and policies. The most noticeable and progressive being the addition to our staff of a registered nurse as a full time In-Service Educational Instructor. Personnel turnover, which could be traced to new employees’ feelings of insecurity and dissatisfaction due to a previously disorganized plan of orientation and instruction, has now been reduced to an all time low as a direct result of our newly adopted educational program.
Under the indirect supervision of nursing services, our Physical and Diversional Therapy departments increased treatments to an all time maximum case load. Both functions rated highly in overall inspection and compliance reports.
FOOD SERVICE (DIETARY) DEPARTMENT:
This activity has more bearing on the patient's outlook and acceptance of the medical services or any patient service, than any other department. We, therefore, developed the dietary program to its maximum when ordering equipment and related supplies. The number of meals prepared on a daily basis during 1966, naturally increased with the patient and staff census. Qualification as an Extended Care Facility required a very close review of the Dietary area operation. It was considered that our overall operation generally met the Federal and State requirements with the exception that we were to secure the services of a dietitian and to add other staff periodically as census increased to serve meals properly and on time. The services of a dietitian are a requirement to assure nutrition balance and assist in staff programming and purchasing. Meeting all requirements of Medicare and a progressive program are assured in the Dietary Department.
HOUSEKEEPING AND LAUNDRY DEPARTMENT:
From the initial opening of the new addition the housekeeping area responsibilities increased more than double the previous building area. In contemplation of this increase, the need for supplies and equipment to accompany the individual housekeeper at all times was recognized. Mobile supply carts were purchased for each wing area allowing all housekeeping supply and equipment items to be within reach of each housekeeper at all times, in this manner we minimized staff requirement and maintain maximum cleanliness. It became evident in late 1966 when patient census increased to maximum average that our two 30 pound dryers would not be adequate to carry out production. A bottleneck waiting for dryer work to be completed caused extra labor hours, and serious delays in processing clean linens for floor use. This was a recognized potential factor in planning the new laundry and the floor plan was developed leaving one opening for this needed equipment addition.
MAINTENANCE:
The Maintenance Department assumed the responsibility of total maintenance of the countless new equipment items during 1966 and immediately formulated a service program that allowed uninterrupted service to all phases of operation. Maintenance supervision has been found capable of handling all maintenance work, thereby eliminating outside purchased services. Exceptions to this would only occur on refrigeration repair needs or where specialized equipment would be required. A program of repainting patient areas will be initiated.
ADMINISTRATION:
The Social Services Board has been available when emergency discussion and decision became of necessity. Regular Board meeting agendas were arranged to give adequate time and attention to all hospital reports and business. The needs for hospital building, maintenance decisions, or required discussion pertaining to hospital program changes were all equally handled with sincere interest and planning by the Board.
The business office's actual procedures changed very little during 1966 except for increase of work load due to patient and staff increases. Personnel and patient affairs sections were set up to handle the added demand of required services. The added sources of income due to medical insurance payments and details involved to accumulate the billing amounts will require an additional section to the business office. It should be noted here that with careful and expedient handling of cost accounting and subsequent billing to proper sources, the operation of Pleasant View should result in near 100% recovery of expenses from State and Federal insurance and assistance programs.
ACKNOWLEDGEMENT
The Social Services Board, the Director of the Department, the Administrator of Pleasant View Hospital and all employees of the Department, wish to acknowledge and extend thanks to the entire Board of Supervisors and all other County Officers and Departments who so ably and unselfishly gave of their efforts and cooperation with this Department in providing services to the residents of Shiawassee County during this past year.
The Chronology as noted at the beginning of this report is indicative of the progressive changes that were initiated and completed in respect to the Social Services Department and the Medical Care Facility during 1966 that will, in all probability, prove to be the proper and appropriate foundation needed to meet any demands of ensuing years.
Your Social Services Board and the Director of your Department of Social Services do not hesitate to claim due recognition for Shiawassee County in the operation of a progressive Social Services Program that incorporates the administration of the public assistance programs. The capabilities and services now being rendered at the Medical Care Facility are recognized as meeting the needs of the county and its residents with dignity and a high quality of professional services.
To facilitate the objectives and goals of the Department of Social Services, your Social Services Board met together or represented the Department on sixty two (62) different occasions during the year.
In conclusion please accept this as an open invitation to contact or visit with any member of the Social Services Board, the Director of the Department, the Administrator of the Medical Care Facility, or visit the office of the Department or the Facility at any time you wish clarification or information related to the programs and operations involved.
You will be most welcome.
Unfortunately Mr. Brown’s optimism in 1966 that the State and Federal financing programs, private pay and insurances would cover the cost of operation was not realized. In 1972, the county voters approved a one half mill to subsidize the operation of the facility. Previously, the county commissioners had approved subsidies, or appropriations, as required from the county general fund. The millage was approved for two years and, according to Administrator Charles Schad, would generate approximately $122,000 per year. At that time, in 1972, the Medicaid program paid $18 per skilled level of care day and $15 for basic care days. The actual cost per patient day was $23 and the millage or county appropriations made up the shortfall in revenue.
In 1974, voters approved a three quarter mill for three years to continue supplementing the operation. Medicaid rates then were $25.90 and $24.90 for skilled and basic care respectively, with the actual cost being $29.66 per day.
In 1977, a 1 mill was approved for 3 years and the same request for 4 years was approved in 1980, 1984, 1988 and 1992. With the approval of an $850,000 bond issue, there was an exiting time of reconstruction and expansion in 1979-1980. The 8 bed ward rooms on the South unit were restructured into 3 bed wards with adjoining bath room facilities and an additional wing of semi private rooms with adjoining bath rooms was added. Included in the upgrade on South were a large in-service room, and a multi purpose day dining room and patio area. There were other remodeled areas as well, the laundry facilities, food service area, cafeteria and windows on the North unit.
In 1996 it was necessary to ask the voters to approve 2 mills to continue the operation. This millage was approved and renewed in 2000 and 2004. Payments have evolved from a simple fee for service to multiple rates based on fees or all inclusive rates. Today Medicaid pays $213.34 for room, board and some over the counter supplies and medications with an offset of $1.63 Maintenance of Effort per day and Medicare pays an all inclusive variable rate that includes among other costs prescription drugs. The Medicare rates range from a high of $590.18 to a low of $149.89 per day (53 separate rates) based on the services needed, and the Private Pay Room and board rate is $225 per day. The average Medicare length of stay is 36 days (of the maximum 100 days available); then residents’ payment plan changes to private pay or they apply for Medicaid. Very few residents have insurance that covers long term care; the facility is now (since 3-10-08) a Blue Cross Blue Shield long term care provider. Insurances also pay various rates.
Changes in healthcare since the 1960’s have improved both the quality and the longevity of life. When medical needs become very complex or when medical needs are complicated by age related dementias and behavior issues, county residents seek long term care to meet their care needs. The cost of care continues to rise without the same increases in State and Federal funding. The majority of the cost comes from wages and benefits paid to our professional and ancillary staff. Our residents and their families expect more sophisticated and higher levels of medical and nursing care regardless of options such as assisted living and hospice and choose the Medical Care Facility model of institutional care over community services. Overall, the trend is to more community supported services, thus our overall decline in resident census; however this trend does congregate the most costly of care services in our Medical Care Facilities. We continue to need the 2 mill operating millage to provide service to our county residents. The millage supplies about 25% of our operating expenses.
The Medical Care Facility is owned and operated by the County, (Social Welfare Act, Act 280 of 1939, 400.58). Statutorily, (Social Welfare Act, Act 280 of 1939, 400.45), its governing board is the 3 member Shiawassee County Human Services Board, formerly known as the Family Independence Agency Board and before that as the Social Services Board. The members are appointed by the County and State. The County appointees are Londa Knauff and Nancy Best. The State appointee is Cynthia Civille.
Their appointments are for three years. The Poor Farm on Lyons Road. Circa 1880-1960. Only a small cemetery remains today.
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