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Peter McDowell, who has suffered seizures and strokes, undergone several open-heart surgeries, and has a disease that weakens the tissue in his body, takes 26 medications a day. When he couldn't get a nursing bed in Juneau, he stayed in an assisted-living home here and in a nursing wing in a Petersburg hospital.
The assisted-living home was inadequate, and the Petersburg hospital wouldn't have been able to treat some life-threatening situations he's prone to, said Peter's brother Eric McDowell.
"It was a very, very worrisome and chancy situation for the family and especially Pete to be in an inadequate situation and farmed out to a distant town," Eric McDowell said.
Peter McDowell, 63, eventually found a place at Wildflower Court, a private, nonprofit nursing and assisted-living facility that opened next to Bartlett Regional Hospital in summer 2001. It was formerly St. Ann's Care Center downtown, where it was solely a nursing home.
"The quality of the care is outstanding," said Peter McDowell, an accountant who was founding director of the state Office of Management and Budget and one of the first directors of the Alaska Permanent Fund Corp.
Local health care providers say it's not unusual for people to wait for an opening at Wildflower Court, the only state-licensed nursing home in Juneau and one of five in Southeast, or to move to a nursing home out of state.
Wildflower Court has asked the state for permission to convert to nursing beds its 11 assisted-living beds as they become vacant. Wildflower officials say they have 13 people on a waiting list for the 44 nursing beds, but haven't been able to fill the assisted-living wing.
Nursing beds are used by people who are recovering from medical problems such as a broken hip or pneumonia, or have a serious condition such as heart or lung disease, said Wildflower Court administrator Kathy Kloster. The patients also usually need help in daily tasks such as bathing or eating, and often they have lost some of their ability to think and can't learn the new tasks needed to work around their disabilities.
Assisted-living homes serve people, usually elderly, who need help in daily activities such as dressing and preparing meals.
Twenty-eight people in an audience of about 60 spoke Thursday at the downtown library, at times tearfully, at a state hearing on the application.
Linnea Osborne said families that need assisted-living beds face the same stress as families looking for nursing beds.
Janet Reid said her father, who broke his hip at age 90, stayed in his own home until he died at 93, but it was stressful for the family.
It has been a relief to the family that her father-in-law lives in the assisted-living wing at Wildflower Court, she said. "We know that someone is always there."
Matt Robus said he was told this year that his 82-year-old mother, who had broken her shoulders, could live in the assisted-living wing at Wildflower Court only on a temporary basis.
"I question whether a valid try has been made (to fill those beds)," he said. "If we had been given a chance to be permanent, you might have had one more bed filled on the assisted-living side."
Speakers who opposed the conversion of beds said there weren't enough alternatives in Juneau for assisted living. The 48-bed Juneau Pioneers' Home takes only people 65 and older who have lived in Alaska for at least a year. It has a waiting list. Two private five-bed homes often are full and aren't suitable for all clients, speakers said.
Wildflower Court's nursing beds are in demand because it's a regional center and serves a growing population of elderly people, said Lari Ward, a consultant who prepared Wildflower Court's application to convert the beds.
Meanwhile, over the past five years at St. Ann's Care Center and now Wildflower Court, about a third of its patients have been under 50, adding to the demand for beds.
Bartlett Regional Hospital staff said the shortage of nursing home beds causes some patients to remain in the hospital for days or weeks after they should be discharged.
Between May 2001 and April 2002, in an incomplete count of the problem, 19 Bartlett patients stayed a total of 227 unneeded days in the hospital as officials tried to find a place for them in a nursing home, Ward said.
The patients take up acute-care beds in the hospital; Bartlett isn't paid for the extra days by Medicaid or insurers; and the patients can lose Medicare reimbursement for nursing-home care if they don't get into one within 30 days of being hospitalized, officials said.
"This is truly a crisis," said Dr. Julie McCormick, an internal medicine specialist on the Bartlett staff. "We cannot get our patients out of the hospital. If you have to come to the hospital for pneumonia, you may have to go to Seattle."
The underlying problem is financial, several health care providers said in interviews. Although it costs much less to live in an assisted-living home than a nursing home - $5,000 a month versus $15,000 a month - Medicaid doesn't pay for all of the assisted-living costs, as it does with nursing beds.
The result is twofold: many patients can't afford assisted-living homes, leaving their beds unused, and nursing homes can't afford to use a bed for the cheaper service or leave it empty.
"Even assisted-living homes in the Lower 48 are struggling badly because of that reimbursement issue," said Juneau Pioneers' Home administrator Rosemary Gute-Gruening in an interview. The state funds about two-thirds of the costs at Pioneers' Homes, and residents pay the rest.
Wildflower Court borrowed $18 million to build its new facility, officials said. In the application to convert beds, they project a $600,000 operating loss this year but modest surpluses in the near future, when some assisted-living beds would be converted to nursing beds.
Wildflower Court isn't in a position to borrow more money to build a nursing-bed wing, said board President Larry Persily.
"We have to look at the best and highest use" of the beds it has, he said in an interview. "Empty rooms cost us. We have mortgage payments to make on the bonds."
Ted Vadman said he tried for months this year to get a nursing bed at Wildflower Court for his ill wife, Pat. Eventually, he arranged with their insurer to care for her at home.
"There is a lot of stress for the patient and also the patient's family trying to provide medical care for an individual on a 24-hour basis, especially when you're not trained in that field," Vadman said in an interview.
"It was very disappointing, very discouraging, the fact that we had the facility there yet there wasn't space available."
The state will take written comments on the application until Sept. 22 by mail, e-mail or fax. Comments can be sent to David Pierce, Department of Health and Social Services, P.O. Box 110650, Juneau AK 99811-0650, by e-mail at email@example.com, or by fax at 465-2499.
Eric Fry can be reached at firstname.lastname@example.org.