Closure of Turlock facility threatens severe nursing home shortage in south Stanislaus County

Closure of the 145-bed Brandel Manor will eliminate 30% of the nursing home beds in Turlock, which threatens to create a dire shortage of those services in southern Stanislaus County.

Last week, Brandel’s owner announced to residents, families and employees that the nursing home and Cypress Assisted Living on North Olive Avenue will close due to issues of financial viability and workforce challenges.

The owner, Covenant Living Communities of Illinois, said patients have started to move from the facilities. As of Friday, 93 patients remained at Brandel Manor and the 49-bed Cypress had 16 residents, Covenant said.

Six patients from Brandel and six from Cypress have been relocated.

Others are concerned because they have no idea where they’ll end up. “I don’t know if I can be moved to another place in Turlock,” said Glenda Takhar, a long-term resident at Brandel. “There is only so many beds available. I am very concerned. I don’t think it’s right the way they have done this.”

Takhar, 70, who broke her hip and suffered nerve damage from surgery, said she doesn’t have family in Turlock for support other than her Christian family.

Operations will continue until all residents have relocated

In anticipation of the closure, Brandel and Cypress stopped accepting referrals. It will take longer than the 60-day notice period to vacate the nursing home and Cypress because of patients’ rights to choose another facility or place to live.

“Covenant Living has provided all residents and their families and representatives with a thorough listing of skilled nursing facilities and assisted living communities in the area, which they can use to select from when deciding about where to relocate,” Covenant Living said.

“Ultimately it is their choice. We are providing assistance in helping to make those moves,” the organization said. The actual closure date is unknown and operations will continue until all the residents have relocated, Covenant Living said.

The California Department of Public Health will monitor the nursing home closure and transfer of medically frail patients, a process that has proven difficult in other places. The closure process typically includes social workers to assist every patient and family in choosing a new facility.

Brandel Manor and Cypress were formerly owned by Emanuel Medical Center, which was sold to Dallas-based Tenet Healthcare Corp. in 2014. The sale of Emanuel began a dismantling of a small, faith-based health system that long provided health services in southern Stanislaus County.

A sister facility, Swedish Covenant Hospital of Chicago, was sold a few years ago and now Brandel is being shuttered. A related nonprofit, Covenant Living Communities, which owns 19 upscale retirement centers in 10 states, has operated Brandel in the 10 years since the sale of Emanuel.

The Covenant Living center of Turlock, Brandel and Cypress are across North Olive Avenue from Emanuel. The closure of Brandel does not affect CovenantCare Home Health and Hospice.

Emanuel CEO talks impact, efforts

Hospitals regularly transfer patients to nursing homes for the appropriate level of care or rehabilitative care following surgery or a medical crisis.

Murali Naidu, chief executive officer of Emanuel Medical Center, released a statement recognizing the closure of Brandel Manor will have an impact on health services.

“The pending closure is a significant loss to the community,” Naidu said. “We are working proactively and collaboratively with Brandel and the other area skilled nursing providers to minimize the impact of this closure. Unfortunately the loss of 145 skilled nursing beds in the community will likely result in increased lengths of stay for patients who need further care but not at the acute level.”

Naidu said these types of closures are a ripple effect of pressure on the overall healthcare system, caused by increased financial and regulatory burdens. “Together, we will continue to do everything in our power to minimize disruptions and identify alternative placement options,” he said.

For 10 years, the purchase agreement for acquiring Emanuel obligated Tenet Healthcare to contribute $600,000 annually to expand senior health services in the Turlock area, including “facility and service improvements” at Brandel Manor and Cypress. The state attorney general added that condition as part of a required state review of the private-sector acquisition of the nonprofit hospital.

Annual donations from Tenet came to an end

Covenant Living said last week the end of the 10-year agreement, providing $6 million in contributions from Tenet, was not a factor in the decision to close Brandel. Covenant said the contributions initially were given to Covenant Living for programs and projects at the retirement complex in Turlock and Brandel, Cypress, CovenantCare at Home and the hospice service.

In later years, the contributions funded grants for senior service agencies in the area, Covenant said.

Jeff Lewis, chief executive officer of Legacy Health Endowment, said he didn’t know how much nursing home capacity exists in Turlock for absorbing patients from Brandel. Legacy, which was created from the net proceeds of the sale of Emanuel, says its mission is to improve the health and healthcare of residents within the hospital’s historic service area in Stanislaus and northern Merced County.

“Anytime I think of Brandel Manor, it’s a best-in-class nursing home,” Lewis said. “I blame the state of California for not reimbursing nursing homes enough for the services they provide. Until the state and federal government recognize the value of these facilities, you will see more of this happen.”

Rachel Young, a former nursing director at Brandel Manor who’s critical of the closure decision, estimated that around 20 patients at Brandel can be moved to other nursing home beds in Turlock. The rest are faced with finding a bed at facilities in Modesto, San Joaquin County or outside the region.

Nursing home patients have rights and don’t have to accept a transfer outside the region or outside the state, Young said.

In Turlock, other skilled nursing centers include the 144-bed Turlock Nursing and Rehabilitation Center, 99-bed Main West Postacute Care, 31-bed Bel-Air Lodge Convalescent Hospital, 33-bed North Starr Postacute Care and 50-bed Covenant Living.

C.J. Singh, admissions coordinator for Main West Postacute Care, formerly Elness Convalesent, said Monday it accepted two patients moving from Brandel — one in Turlock and the other at its Ceres facility.

“We are working with Brandel to see what we have open,” Singh said. “I am not sure what we have in Turlock. There are only four skilled nursing facilities and we own two of those. I don’t have a whole lot.”

Young noted that other nursing homes may not accept patient transfers to their long-term beds. Facilities tend to reserve long-term beds for their own patients who are not ready to go home after rehab care, she said. Nursing homes receive lower Medi-Cal payments for patients in long-term care but more substantial payments from Medicare or health insurance for patients needing rehab treatment.

Young said other nursing homes may react to Brandel’s closure by designating more rehabilitative care beds for hospital transfers, leaving fewer beds for patients needing long-term care.

Why not seek buyer for the facilities?

Critics of the decision to close Brandel said it could be sold or leased to another nursing home operator. In the nursing home industry, existing buildings are sought-after because of the prohibitive costs of constructing new facilities under current regulations.

Covenant Living said the decision to close Brandel was based on a thorough analysis and evaluation of options. “Given the aging physical plant and significant capital improvements needed, operating costs and workforce challenges, closure was the most viable option,” Covenant said.

The owner said Brandel has dedicated employees who have committed to staying on and caring for patients as long as they are needed.

Covenant said some family members have chosen to have their loved ones move closer to them, with one resident being transferred to Southern California and another to Texas. As the first residents were transferred, “employees chose the opportunity to celebrate their relationships and create a ‘walk of honor’ by flanking the sides of the hallway to wave goodbye.”

Covenant said it hasn’t determined what will happen to the Brandel and Cypress facilities.

Corey Egel, spokesman for the California Association of Health Facilities, said by email that many nursing homes across the state are facing financial and workforce challenges. The nursing home industry in California lost 17,000 employees, or 12% of its workforce, during the devastation of the COVID-19 pandemic and is still 3,000 employees below the level of early 2020, Egel said.