An offer has been made to potentially reopen the Close to Home Hospice Hospitality House, but Campbell County Health officials have so far remained mum on whether it’s enough to realistically sustain inpatient hospice service in the long term.
The Campbell County Healthcare Foundation said it could contribute $100,000 a year toward the facility’s operational losses, which have been projected at about $700,000 annually if it maintains its business model.
“I’m not really interested in going down the consultant’s way of doing things with the Hospice House,” said foundation member Chris Shelledy. “I don’t think that’s in the foundation’s best interest.
“We had spoken with our executive board and they are willing to put $100,000 a year to this.”
After going into a Close to Home Task Force meeting last Tuesday with plans to discuss alternative business models to sustainably bring back inpatient hospice care to the facility, that idea was quickly nixed in favor of more direct negotiations between local health care entities.
With a round number to work off of, CCH Chief Operating Officer Jerry Klein said that hospital administrators will now bring the offer to the Hospital Board of Trustees. From there, trustees will have to decide if CCH is willing to consider reopening inpatient services at Close to Home with the $100,000 subsidy.
The task force meeting came on the heels of a Campbell County Commission 3-2 vote against CCH affiliating with Colorado-based health care giant UCHealth. Klein said that decision may have made the expected financial losses from operating Hospice House even less palatable.
“The decision by the county commissioners (Tuesday) changed things a little bit, too,” Klein said. “We were hoping for some pretty significant savings out of (an affiliation through) group purchasing and those types of things to where we might have an opportunity to have a little more money in hand to do some things.
“We haven’t even met with the board, so we have to see how they respond.”
Although it will still come down to the hospital board’s decision next week, the task force broached ideas for exit plans about what to do with the facility if it doesn’t reopen. CCH closed Close to Home in September citing its financial drain and a lack of demand for its services.
“It does come down to, there is a building involved in this,” said foundation member Emily Arthun. “If it’s not hospice, what happens to that building? Where does it go? What is the opportunity?”
Further complicating matters, Health Care Foundation Executive Director Nachelle McGrath brought up legal obligations that bind CCH and the nonprofit organization.
“I think we should talk about the elephant in the room,” McGrath said. “I think that’s why we are here. We have a joint contract between the foundation and Campbell County Health.
“It says that CCH shall provide hospice services in the building. Technically, if we wanted to get into it, the hospital is in violation of that contract.”
While neither side expressed interest in going that route, they are aware of the litigious ties connecting CCH, the foundation and Close to Home.
“There are legal interpretations to it and obviously we don’t want to have to go there, but we should at least talk about the future of that building,” McGrath said.
From the beginning, Close to Home was a joint project between CCH, the Health Care Foundation and community donors. The foundation owns the upper level of the building, where inpatient hospice was served and where the hospitality wing is. But CCH owns the lower level that still operates its outpatient hospice care, as well as the land the building is on.
CCH paid $2.5 million of the $7 million project cost, along with allowing use of the land to the foundation. The other $4.5 million for the project came from a combination of about $3.5 million in private donations and grants, along with about $500,000 each from Optional 1% Sales Tax revenue and The Daniels Fund.
Since its closing, maintaining the facility and its utilities costs the foundation about $7,000 to $10,000 a month, McGrath said.
“That’s not sustainable when you can’t continue to raise funds for that,” she said.
Keeping Close to Home shuttered, or potentially selling it, could be “fundraising suicide” for the foundation as well as CCH, McGrath said. Without the facility that the community has invested in consistently throughout the past decade, she said it could hamper CCH’s ability to raise money for its own capital projects.
“I understand that the hospital feels they can justify that $5 million as what rent would look like for 10 years, but the reality is that’s not what the community is going to see this as,” McGrath said. “They’re not going to see justification of their money for something for 10 years.”
Even with a six-figure offer on the table, exit plans for what to do with Close to Home long-term were broached.
“The inevitable, personally, I think is we’re not going to be able to open the Hospice House as it is today,” said CCH Chief Financial Officer Mary Lou Tate.
Any plans to reopen inpatient services at Close to Home is made more difficult by an organizational and industry at-large staffing crisis, Tate said. Getting staff in place, while already struggling to fill nursing positions throughout other departments, would take significant time.
“Even though we say we’re going to put those dollars in, you’ve got to have the nursing staff to run it and we’re sure not in great shape with that across the system,” Klein said.
Klein also brought up the possibility of selling the facility. Although it is unclear who would be interested in buying it or for what purpose, he said returning the sale money to the foundation could present a silver lining of sorts for donors.
“I don’t know if you can get it sold,” Klein said. “But the truth of the matter is if you sold it, they’re not going to be happy. But if money went back in the pocketbook, I think it might be somewhat more tolerable.”
The task force will meet again after next week’s regular CCH board of trustees meeting. If the board decides it does not have an appetite for eating the extra operational losses on top of the Foundation’s $100,000 offer, then the task force will have to explore exit strategies.
“Being at Close to Home, being at that house was as close to home as I could have ever been during the worst days of my life,” said trustee Lisa Harry, who spent the last days with a loved one there.
“That’s why it means so much to me and why it means so much to the community members who have been able to use the facility,” she said. “That’s why it means that much to those people and the community, because it is the best thing that could possibly happen to you on the worst day of your life.”
Brian Roesner arrived at the field at Dalbey Memorial Park early Monday evening.
He had just finished a 12-hour shift that started at 6 a.m. as a patrol officer for the Gillette Police Department. It was a relatively slow shift for Roesner, who has been with the department since 2007, involving the usual suspects of drunks or probation violators.
It was time for an about-face out of cop mode.
He began unloading baseballs and batting helmets from an equipment bag in the dugout as he prepared for his second job as an assistant Little League baseball coach.
Four of his players in their Indians jerseys warmed up on the outfield grass that had been dampened by a severe thunderstorm that passed through just minutes before.
One of the players approached the coach just outside the first-base dugout.
“Dad, I caught the ball five times in a row!” he exclaimed.
“No pushups for you,” Roesner joked.
Gunnar Roesner, 6, is one of two sons the police officer coaches along with 10 other boys on the machine-pitch Little League team. His other son, 7-year-old Karson, wears No. 3 for the Indians.
As Gunnar and his father talked on the sidelines, another Indians player did pushups in center field after missing a ball while warming up.
On the other side of the field, the team’s opponent, the Mariners, did a pregame chant. The Indians weren’t intimidated, but that’s only because they weren’t looking.
Roesner stood next to his partner as the pair began to assign players to their positions. The team’s head coach, Eric Small, is Roesner’s longtime friend and coworker as an eight-year veteran with the Gillette Police Department.
Small’s job since 2019 has been as a detective investigating crimes. But that can sometimes seem an easy ground ball compared to assigning 6- and 7-year-olds positions on a baseball field.
“I can’t put everyone at pitcher,” Small said as he announced the lineup. The players who were paying attention all grunted with displeasure.
Although the league is machine pitch, many of the young ballplayers still want to play the position. At this level, that means standing behind the machine to field (or chase) any balls that come their way.
“You’re in left field,” Small said to one player, who stood still. Small quickly realized the child didn’t know where left field was.
“Go out there to that patch in the grass,” Small prompted, pointing to a corner of the outfield.
The few parents in the bleachers next to the Indians dugout began to cheer as the players took the field.
Small also has a son on the Indians. Easton Small, 7, settled in at right field.
As head coach, Small is responsible for feeding baseballs into the pitching machine. Since the kids are so young, coaches for both teams stand in the outfield grass instead of the dugout as play got underway.
From his position in right field, Roesner immediately spotted something amiss.
“Get that glove out of your mouth!” Roesner called to Gunnar at second base.
It’s all in a day’s work for Roesner and Small. While their career is to protect and serve the city of Gillette, their job as Little League coaches requires they protect and serve the 12 boys playing for the Indians, including their own sons.
Roesner and Small often are identified by a simple three-letter word: Cop. But off the job, they have an even more important obligation: Dad.
Called to coach
Roesner and Small didn’t wake up one day and arbitrarily decide to coach baseball. Both men said they were pulled into it after the league asked them to help out with their sons’ team.
Small had never before wanted to coach his son in any of the sports he plays.
“I always thought that it’d be difficult coaching my own kid,” Small said. “I don’t think they listen to dads as good as they could listen to other folks.”
That all changed when a Gillette Little League board member called Small and asked him to coach. A similar phone call reached Roesner.
“They were short on coaches, so I accepted the opportunity,” Small said. “And now here I am.”
Roesner played baseball when he was a kid. When it came down to it, he wants his own sons to have the same opportunities to play, even if that means volunteering his time in the dugout.
Roesner was off duty and out of uniform on Monday night. But earlier in the season, the police officer was working the night shift and using his lunch break to coach.
That meant showing up to the ballpark in uniform.
“I got some different looks from people originally. I think they were wondering, ‘Why is there a police officer on the field?’” Roesner said. “But once people realized I was out there coaching, I didn’t really have any comments or anything. I heard a lot of people that sounded pretty supportive of it.”
The police department was supportive of Roesner using his lunch break to coach. All the department required was that Roesner remain on-call in case he was needed, which he never was.
Roesner’s shifts were recently rotated so his work day now ends at 6 p.m. But when he was working nights, Roesner was grateful to have Small as his coaching partner.
“It works pretty good with us both being in the same career field,” Roesner said. “We both obviously understand the schedules and having to leave in the middle of games for calls or something.”
Coaching a few Little League games here and there is a great change of pace to take both officers’ minds off the stresses of working in law enforcement.
“You’re just not really thinking about that kind of stuff that you have to deal with out here,” Roesner said. “You’re thinking about the kids and making sure that they have fun and that they learn something.”
Plenty of hiccups
The Mariners jumped out to an early 5-2 lead after the first inning. After scoring two runs on offense, it was the Indians’ turn to take the field again.
But after just one pitch in the top of the second, a typical Little League hiccup was thrown at Roesner and Small.
“I have to go to the bathroom,” Gunnar said from second base.
“You’re going to have to wait a second, bud,” Small said. “You shouldn’t have drank all that water.”
Simon LeBlanc was at bat for the Mariners. After hitting a foul ball down the first base line, LeBlanc retrieved the ball himself to throw it back to his coach on the pitching mound.
“Good hustle,” Small said to LeBlanc. “You wanna throw on one of our jerseys?”
After LeBlanc reached base safely, perhaps the most hustle play of the night came from Gunnar at second base. Between batters, Gunnar ran off the field and toward the bathroom.
You won’t see that at a Major League ballpark.
The time commitment for Roesner and Small isn’t just coaching the Indians on game days. There are a lot of behind-the-scenes responsibilities Little League coaches often didn’t learn about until they’re on the job.
“I was a little naive to a lot of the behind-the-scenes stuff that goes on. I thought, ‘Why not come out here and coach some kids?’” Small said. “But there’s more to it. You have to have a lot of involvement with the parents because we as coaches can’t do everything.
“We need their help, and for the most part everyone is pulling their fair share.”
Some of those responsibilities include parents running the scoreboard and keeping statistics. Coaches also are responsible for getting parents to take turns running the concession stand and bringing post-game snacks.
Outside the dugout on Monday, a little girl and her mom unpacked a cooler full of the all-important post-game snacks.
One by one, the girl lined up red and blue Gatorades on the muddy cement. Next to each sports drink she placed a large sugar cookie with white and red frosting in the shape of a baseball.
“How much time is left in the game?” the Indians right fielder asked Roesner going into the fourth inning with the Indians and Mariners deadlocked at 10.
“They bat and we bat and then we’re done,” Roesner said.
The sky had turned from a post-storm magenta to nearly pitch black.
“It’s been like 10 hours,” the right fielder complained.
“I know,” Roesner said. “It’s a long game.”
Fathers and sons
Roesner and Small initially wanted to stay as far away as possible when it came to coaching their sons on the field. But now that they both have sideline access to their baseball careers, it’s paying dividends and adds an extra layer to what fatherhood is about.
Easton loves playing for his dad but needed a few seconds to think about what he finds most enjoyable about playing for the Indians.
“That’s a hard one to figure out,” Easton said. “My favorite part is playing for my dad. I like when he gets excited when I hit the ball.”
Karson Roesner thinks his dad makes a fine Little League coach. But Karson knows his father’s responsibilities go well beyond the baseball diamond.
“He likes to protect us,” Karson said about why he thinks his dad is a good police officer. “He likes to protect other people, too.”
The Mariners scored five runs in the top of the fourth inning to take a 15-10 lead. Down to their last three outs, the Indians went down in order to lose the game and fall to 2-7-1 on the season.
Roesner and Small gathered the players next to first base. The Indians plopped into the grass. A handful of players took large bites of their baseball cookies.
“It’s two hours past everybody’s bedtime by now, so I’ll make this quick,” Small told the players. “This was by far the best game you guys have played this year.”
Some players smiled to each other, revealing teeth temporarily stained with frosting and red Gatorade.
“Don’t be sad about that loss,” Roesner said, pointing to the scoreboard. “You guys played your hearts out. I’m proud of each and every one of you.”
The speech is reminiscent of a generic post-game pep-talk from any coach. But at the Little League level, Roesner and Small meant every word.
The pair of policemen don’t hang out at Dalbey Park for trophies. They aren’t there to win championships or to have bragging rights about posting perfect records.
Roesner and Small coach the Indians to teach the boys about life, in particular their own sons.
“We’re just trying to reinforce to them that it’s not always about winning,” Small said. “As much as I’m competitive myself as a coach and I’d like to win every game, losing with grace is something to be treasured as well.”
The Indians left the field not thinking much about the loss. They had played their best game of the season and had nothing to hang their heads about.
Small and Roesner surveyed the dugout one last time to make sure nothing was left behind. They were the first two to step onto field No. 5 on Monday night and three hours later were the last to leave.
Their jobs for the day were done. Another day spent protecting and serving in the office and on the field.
After the Campbell County Commissioners voted down the potential affiliation between Campbell County Health and Colorado-based UCHealth last week, CCH officials are regrouping for another attempt to sway the commission while also bracing for the worst if the effort ultimately fails again.
On Tuesday, commissioners voted 3-2 against the affiliation, effectively corralling CCH’s hopes of partnering with the large nonprofit health care organization to gain access to greater purchasing power, a more streamlined and functional electronic medical records system and ultimately saving millions of dollars on its bottom line.
“I thought it would pass,” said CCH board of trustees chairman Adrian Gerrits about the approval from the commission. “I think maybe we didn’t give the commissioners enough time or maybe didn’t get them involved early enough.”
Because of a technicality in state law, the hospital board could not go ahead with the affiliation on its own without the commission’s approval. The statute reads that “whenever the board of trustees of a county memorial hospital or special hospital district deems it in the best interests of the county they may, with the approval and consent of the board of county commissioners, lease or enter into a contract for the operation of the hospital with any person, group, association or corporation.”
With the unexpected denial now in hindsight, hospital administrators and trustees are preparing for a second push for affiliation in the coming months.
“I don’t see it as a final decision by any means,” Gerrits said.
CCH CEO Colleen Heeter said she was disappointed by the commissioners’ decision. One of the sticking points for commissioners, and some in the public, was that Heeter would become a UCHealth employee under the agreement, while continuing to be paid by and report to CCH and its board of trustees.
“I would not have somebody on my outfit that was running things that works for somebody else. That doesn’t set well with me,” said Commission Chairman Bob Maul.
“The skepticism I understand,” Heeter said. “But at the end of the day, to keep us in control in the community, it’s a great opportunity for us. We’re not going to stop, we’re going to re-educate. Our concern is, will UCHealth be there?”
It is unclear when CCH will get another chance to bring the affiliation to another vote, but a quick turnaround is crucial for financial decision-making for the organization’s near future.
Gaining access to EPIC, a preferred electronic medical records system, is a major incentive for CCH to affiliate with UCHealth. Without the affiliation, CCH Chief Financial Officer Mary Lou Tate said it would have to pay up to $2 million to upgrade its current system, Meditech.
“We don’t want to invest if this is eventually going to go through, but at the same time we can’t wait too much longer because there’s certain functionality that we have to adopt and it’s only available in Meditech expanse,” Tate said.
Even for new hospital board trustees, Gerrits said it can take about a year to get a grasp of CCH finances, making it understandable that some commissioners would have questions and concerns about the affiliation.
“They’ve got a county to run, they don’t have the time to really sit down and understand our finances and our decisions,” Gerrits said. “That’s why we have a separate board, right?
“I think it’s a difficult gap to bridge between what we feel is right for the hospital and what we can pass on to them as being right for the hospital. I think there’s a gap there that we need to close.”
A few reservations
For the affiliation to go forward, CCH needs to sway one commissioner.
Maul, who cast the deciding vote to break a 2-2 tie, said he felt he didn’t have enough information to vote yes.
“The information we got was, in my opinion, not complete, and pretty spotty,” Maul said.
Commissioner Colleen Faber also was a no and said it was “very difficult” for her to vote that way, but she wasn’t comfortable with “having this come before us this quickly.”
Both Maul and Faber said they were surprised that the commissioners needed to vote on it, something they learned just a few weeks ago.
“I would’ve definitely been more involved if I knew that it was going to come to a vote,” Faber said.
Faber said that in her conversations with local medical providers and residents, they were split 50-50 on whether affiliation is a good move for CCH.
“I can’t say I’m not in favor of a good portion of it,” she said. “I think we’ve got to be as close to 100% on it as we can.”
She said she recognizes the benefits of an affiliation, and that she wants this to be a “win for the hospital” as much as possible.
“(It’s) not quite over the last hurdle for me, but it’s close,” she said.
Both Maul and Faber said they are open to working with the hospital in whatever route they choose to go from here.
Maul said there was discussion on whether the commissioners should table the issue instead of voting Tuesday.
“It seemed like they wanted an answer right now,” Maul said. “Sometimes you got to be careful about the answer you want right now, because it might not be the one you want.”
Among the hospital board trustees, Alan Stuber has been a longstanding and lone vote against affiliation. Throughout the negotiations and discussions, he questioned what UCHealth stands to gain from the deal and has not felt satisfied that the answer to that is known.
“An affiliation isn’t our Band-Aid,” Stuber said. “We have things that we need to fix whether we have an affiliation or not.”
Trustee Lisa Harry said she is concerned about what the ramifications may be if the affiliation doesn’t ultimately happen.
“I’m deeply disappointed that they (the commissioners) did not trust the work that we have been doing to get this process going,” she said in a text message. “I’m concerned what will happen to us going forward.”
The commissioners’ willingness to revisit the issue is matched by CCH administrators and trustees anxious to assuage their lingering concerns.
“While it’s disappointing, I think this is going to give us more fuel to move forward and try to get their questions answered because we can’t sustain where we’re at right now,” Tate said.
If it fails?
Although health officials remain optimistic that an affiliation can eventually happen, they also are preparing for the worst-case scenario that it doesn’t.
“I think we’re going to have to look into difficult decisions,” Gerrits said. If the affiliation ultimately fails, “We’re going to have to start looking more like a for-profit hospital.”
Gerrits named the Legacy Living and Rehabilitation Center as an example. The long-term care facility loses about $5 million a year, which CCH accepts because of the facility’s role in the community.
“What would a for-profit hospital do here? They would make it so Legacy is half-cash pay and half-Medicaid, even if that means not giving preference to county members,” he said.
The 3 mills of property tax the hospital receives is a minority portion of the organization’s budget, Tate said, yet it drives the majority of CCH decisions.
“We’re a not-for-profit and we’re able to take on some of that bad debt ... but our mill levy is 5% of our revenue,” Heeter said. “So, do we go back to the commissioners and say we’re going to assess 6 mills?”
While Heeter and trustees have said before that there is no interest in levying more taxes, they also have been clear that not affiliating could force their hand with some hard decisions.
“We’re a very comprehensive medical facility for the size of town we are. We’re going to have to figure out where we cut services that are the least painful and most beneficial to our bottom line,” Gerrits said. “Hopefully, that’s not the case.”