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Closure Of Skilled Nursing Center Puts North County In A Bind

Palomar Health will close one of its skilled nursing facilities in Escondido in a few weeks. Palomar officials said cuts to Medi-Cal reimbursement rates are forcing them to take this step.

Closure Of Skilled Nursing Center Puts North County In A Bind
A skilled nursing center in Escondido that's treated thousands of patients over the last 30 years is closing, leaving a gap in the county's safety net.

The closure of the 96-bed facility could have some painful repercussions.

The Palomar Continuing Care Center opened its doors in Escondido in the early 1970s.


Since then, it’s cared for thousands of people who’ve needed skilled nursing care after being discharged from the hospital.

The facility has never been a profit center because nearly 80 percent of its patients are on Medi-Cal. The state program for the poor pays healthcare providers a low rate.

To make matters worse, in 2011, when California was mired in a budget crisis, state lawmakers made the Medi-Cal payment rate even lower. After numerous legal challenges, the 9th U.S. Circuit Court of Appeals ruled earlier this year the pay cut could go forward.

For the Continuing Care Center, that means a loss of around $7 million a year. Palomar’s Steve Gold said the facility just can’t afford to keep its doors open.

"There isn’t any practical way to do that, without some subsidization from some other corners of the health system," Gold explained. "But because of very, very significant changes in healthcare, we all have to consider obvious changes to the way we operate. And this is one of them."


The center has had a 97 percent occupancy rate, but since early July, it has stopped admitting new patients.

Relocating their remaining patients is a major challenge.

The facility’s medical director, Dr. Teja Singh, said it’s a terrible situation.

"Patients are crying, families are crying, staff is upset, and we have to find places for these people to go," Dr. Singh said.

Dr. Singh added he’s not confident all of their patients will find another place.

"One of the things that we used to do is, in this particular facility, is take patients without any insurance, who are undocumented or unfunded, without any money, and we would care for them," Singh said. "And we’d give them top quality of care just like any other person. And we also have patients with all kinds of insurances. For the less fortunate folks, it’s going to be difficult, ‘cause a lot of places won’t take them, and they’re gonna have nowhere to go."

Joyce Israel has been at the center since last December. She was surprised when she was told she’ll have to leave. Israel is trying to take it in stride.

"I look at it— that’s the way things are, and one has to go along with it," she shrugged.

Patients aren’t the only ones that are being displaced. Nursing director Joel Alberto said 130 staff members have to find other jobs.

"Some of them have been here for 20 years, just as long as some of the residents have been here, and many of them are emotionally attached," Alberto pointed out. "So keeping them motivated to maintain a high level of performance is something that’s ongoing every day, and also being strong for the residents as well."

Palomar officials have reached out to 23 different nursing homes in the county to see if they’d be willing to take on some of their patients.

Unfortunately, some of them don’t accept people on Medi-Cal and some aren’t able to handle patients with complex medical issues.

Palomar’s Steve Gold said he’s concerned about who will fill the void.

"If we’re not available to care for the Medi-Cal populations that we have, will a majority of the other facilities provide that care?," he wondered. "And I raise that as a question mark. I’m not sure. And I hope that happens. But that’s the kind of silent safety net that facilities like this have provided for the years that we’ve been in operation."

After Palomar’s center closes, San Diego County will only have three hospital-based skilled nursing facilities that can provide high levels of medical care round-the-clock: Villa Pomerado, Edgemoor and Villa Coronado. If they’re full, some patients might be able find a place in Riverside or Orange Counties.

But there are no guarantees.