Downsized City Sees Its Health Care Downsized as Hospital Awaits Demolition


HAMMOND, Ind. — In 1898, three nuns took a prepare to this metropolis alongside the south shore of Lake Michigan to start out a hospital.

They transformed an outdated farmhouse right into a seven-bed medical heart. They handled their first affected person for a damaged leg amid carpenters hammering nails. Surgeons laid their sufferers on a kitchen desk for operations.

The hospital — then named after St. Margaret, recognized for her service to the poor — ultimately grew to become one of many largest within the space. Lots of of hundreds of Indiana and Illinois residents took their first, or final, breaths there.

100 twenty-four years later, the hospital has, in a way, come full circle. This spring, Franciscan Alliance, the nonprofit proprietor — nonetheless affiliated with the identical Catholic order of sisters — plans to demolish many of the 226-bed Franciscan Well being Hammond advanced, leaving solely eight beds, an emergency division, and outpatient companies. The transfer price 83 jobs on the hospital and 110 extra at a long-term acute-care heart that rented house there.

The information stung many on this Rust Belt metropolis of almost 80,000 individuals, who’ve watched companies — and neighbors — flee Hammond for many years. It’s particularly painful, they are saying, as a result of the hospital system has devoted greater than half a billion {dollars} in recent times to new amenities in wealthier, less-diverse communities.

“It’s deplorable {that a} Catholic establishment just like the Franciscans would make a financially motivated determination and depart hundreds of individuals probably in danger,” stated Mayor Thomas McDermott Jr., who complained that he was knowledgeable of the downsizing barely two hours earlier than it was introduced publicly. “I’m not attempting to be alarmist, however persons are gonna die due to this determination. And so they comprehend it.”

Thomas McDermott Jr., mayor of Hammond, Indiana, says he was blindsided by the native hospital’s announcement that it was largely leaving his metropolis of almost 80,000 individuals after 124 years.(Giles Bruce for KHN)

However the bigger query is whether or not Hammond wants a hospital with a whole lot of beds, given the shifts in medical observe and transportation within the 21st century. Solely 50 to 60 of its beds are full on most days, stated hospital CEO Patrick Maloney. One other Franciscan Alliance hospital is just 6 miles away. Far more care at present is being delivered on an outpatient or digital foundation than even 5 years in the past.

And the Hammond web site has had high quality issues. It charges just one out of 5 stars on Medicare.gov, the bottom doable rating and worst of any of the 9 rated hospitals in its county.

“Stewardship of our sources is likely one of the parts of our Catholic mission,” Maloney said in an e-mail. “Key to that’s environment friendly supply of care.”

He famous that Franciscan is investing $45 million to remodel the campus and can proceed to function a medical clinic there for uninsured or underinsured sufferers, in addition to companies like imaging, a medical lab, and prenatal care.

Whereas rural hospital closures usually get extra consideration, cities like Hammond have additionally been vulnerable to shedding medical companies, as well being methods alter to adjustments in care, and choose to put money into locations the place extra individuals have non-public insurance coverage. However the shutdowns increase questions in regards to the altering mission of nonprofit hospitals — and whom they assist.

Because the Nineteen Thirties, the city hospitals most probably to shut are these serving low-income, minority populations, based on analysis by Alan Sager, professor on the Boston College Faculty of Public Well being. He calls giant swaths of Detroit and New York Metropolis “medical wastelands.”

When town hospital in Hartford, Connecticut, contracted within the Seventies, it stored its emergency room working — till that received too costly, Sager stated. “I predict, inside a decade, regardless of the most effective intentions of everybody concerned, it would show financially unsustainable to help an eight-bed hospital plus ER in Hammond,” he stated.

Hammond’s inhabitants is down a few third from its peak within the mid-Twentieth century. Like different former manufacturing hubs within the Midwest and Northeast, town has been hollowed out by deindustrialization and white flight to suburban areas. It’s within the a part of Indiana, affectionately referred to as “the Area,” that’s basically an extension of south Chicago, crisscrossed with freight prepare tracks, dissected by interstates, affected by factories in varied states of decay.

On a latest overcast morning, Franciscan Well being Hammond’s parking storage and surrounding tons have been largely empty. A sprinkling of individuals trickled out of the hospital. An indication suggested that birthing companies had moved to the suburbs.

The ZIP code that covers the hospital and its surrounding neighborhood has a poverty charge of 36%, with a median family earnings of $30,400. Its inhabitants is 82% Black and/or Latino. The hospital treats a big share of sufferers on Medicaid, the federal government insurance coverage program for low-income individuals, which usually pays well being care suppliers a decrease charge than Medicare or non-public insurance coverage.

For Franciscan Alliance, the driving components in shrinking Franciscan Well being Hammond have been the prices required to take care of the ageing infrastructure, and fewer demand for care anticipated in that a part of “the Area,” Maloney stated.

He stated Hammond residents are welcome at Franciscan Alliance’s hospital 6 miles away in Munster, Indiana. The group has spent a minimum of $133 million in recent times on that facility, situated in a wealthier suburb just a few blocks from a bigger, competing hospital.

However for Carlotta Blake-King, a Hammond college board trustee, that’s not shut sufficient, particularly because the space doesn’t have a lot mass transit. “I’m a senior citizen. I don’t wish to drive,” she stated. “All people can’t afford a automobile.”

Carlotta Blake-King is seen sitting on a park bench. Her hands are folded in her lap.
Carlotta Blake-King, a Hammond, Indiana, resident and college board member, says senior residents like herself might not need ― or have the ability — to drive to a hospital 6 miles away as Franciscan Well being Hammond shutters most of its inpatient companies.(Giles Bruce for KHN)

Free transportation to medical appointments, although, is obtainable by way of the state’s Medicaid program and local township trustee office.

Franciscan Alliance has changed older hospitals in different communities, albeit just a few miles from their unique areas, spending $333 million on a brand new medical heart in Crown Level, Indiana, and $243 million in Michigan Metropolis, Indiana. In 2018, nevertheless, it shuttered a century-old hospital in Chicago Heights, Illinois, a working-class Chicago suburb demographically just like Hammond.

The missions of many nonprofit hospital chains like Franciscan Alliance have advanced. Across the flip of the Twentieth century, hospitals usually intentionally arrange store in less-fortunate neighborhoods, with group members offering time, cash, and provides. When St. Margaret opened, for instance, native farmers donated meals. The Inner Income Service exempted so-called charity hospitals from paying taxes.

At this time, “hospitals are working as firms, as moneymaking enterprise entities, and their choices are largely pushed by monetary issues,” stated Ge Bai, a professor of accounting and well being coverage at Johns Hopkins College. “The road between the present nonprofit hospitals and for-profit hospitals may be very, very murky.”

In 2018, nonprofit hospitals supplied much less unreimbursed Medicaid and charity care than their for-profit counterparts, Bai’s research found. Nevertheless, she famous, Franciscan Alliance spent greater than the typical nonprofit on each fronts.

Pat Vosti, a retired nurse from Hammond, labored within the cardiology unit, so she is aware of how time is of the essence in well being care. She’s involved about sufferers who must be diverted to different hospitals. “It’s a matter of minutes, however minutes depend in some cases, you already know?” she stated.

Nevertheless, individuals have been bypassing the Hammond hospital for years. Together with its sister campus in Dyer, Indiana, it has solely a 15% market share, based on a 2016 bond submitting, in contrast with 45% for Franciscan’s Michigan Metropolis facility and 38% for Crown Level.

“Now, why they haven’t been utilizing it may very well be a perform of administration selections made 15, 20 years in the past: ‘Don’t construct that new ER, don’t recruit these younger docs, don’t open a service for substance abuse,’” stated Nancy Kane, an adjunct professor on the Harvard T.H. Chan Faculty of Public Well being. “That is normally a gradual dying. These locations don’t instantly go dangerous.”

This story was produced by KHN (Kaiser Well being Information), a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is likely one of the three main working packages at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering data on well being points to the nation.

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