“I can say that we are not closing, but that we are changing,” said Peter Henry, the director of VA facilities at Hot Springs, Fort Meade at Sturgis and several regional clinics.
“I do not foresee a time when we are not in Hot Springs.”
The press release was titled ‘VA Black Hills Health Care Systems plan to expand and enhance services,’ and talked about a recently completed assessment for veterans living in the service area of western S.D., eastern Wyoming and northwestern Nebraska.
“We wanted to be upfront and transparent with the press release,” Henry said. “We wanted people to know that things were being studied and will be changing.”
The vagueness of the release may have touched off some of the questions swirling in the community, speaking in broad terms about BHHCS’s focus and direction, rather than specific plans.
“The release tells people what the plans are – they are that fuzzy,” Henry said. “The focus of our movement is how we can best serve the bulk of our veterans. I am not suggesting that there will be no effects in Hot Springs or Fort Meade, there will be. Fort Meade will be more impacted, but changes will take place here.”
Henry said that the assessment came about because of the changing nature of health care.
“When I came here in 1996, I found a document from the 50th anniversary of the VA,” he said. “That document noted 550 patients in the domiciliary, with 220 hospital patients. I think the dom had 70 patients registered this morning.”
While things will change, those changes will take place in updated buildings, as the VA campus in Hot Springs is undergoing substantial renovations.
“Building Four, the domiciliary, is having an elevator and fire sprinklers installed,” said Deb Eiring, public affairs specialist at the VA in Hot Springs. “There are also remodeling projects taking place in Rehab Medicine, a boiler is being replaced and another elevator is being upgraded.”
Eiring said that changes also are coming that will allow the VA to better serve a growing number of female patients.
“We are living in a fluid world, one that is constantly changing,” Henry said. “And nowhere more than health care is that more true. We are changing with the times; in some cases to stay ahead and in some cases to keep up.”
To understand the direction of the VA in the future, Henry said one has to look at the past.
“It used to be that the dom was a hotel-like place to take care of people who couldn’t take care of themselves,” he said. “Now, the dom is called the Residential Rehabilitation Treatment Program. It is now a place for veterans receiving out-patient treatment.”
The RRTP of today is designed as more of a training center, giving veterans the job and life skills needed to cope in day-to-day life. “But we are pretty finite here in our offerings,” Henry said. “Right now we are bussing folks up to Rapid City for some training we can’t offer here. If you were starting from scratch, that is one thing you would have. Instead of the dom setting, there would be more of a focus on job training, probably with an outside entity.”
Henry said that the focus of healthcare now is keeping people out of the hospital instead of having limitless stays. The VA is one of the leaders in using technology to keep in touch with its patients in their home.
An in-home testing device allows veterans to take readings on things like blood pressure or blood sugar and have those readings transmitted to their medical care expert. “Instead of someone with diabetes or high blood pressure seeing his or her doctor every three months, their readings are monitored every day by a doctor or nurse,” Henry said, citing an example of changes.
“If we started from scratch today and somebody said, ‘Here’s $150 million, provide healthcare to veterans in your region,’ where would you go? The most cost-effective form of healthcare is to go where most of the veterans are.”
In the BHHCS, nearly 30 percent of its patients live in Pennington County, with nine percent in Meade County and seven percent in Fall River County. The Hot Springs campus serves a very broad area, however, with satellite clinics in several Nebraska towns, as well as on the Native American reservations of South Dakota.
“Our largest demographic by far is ‘others,’” Henry said, “which encompasses everything not delineated by county. Native Americans have a high rate of military service and there are around 700 to 800 individuals on two reservations that we serve through the Hot Springs VA.”
The BHHCS is also hindered by having one of the higher overhead cost ratios in the VA system, combined with sliding patient numbers. “Our admissions are down 10 percent over the past four years,” Henry said. “At the same time, ER visits, prescription fills and lab tests numbers have all increased significantly.”
Despite having one of the largest veteran complexes, at just over a million square feet, Hot Springs and Fort Meade saw slightly fewer than 19,000 patients in fiscal year 2008. Sioux Falls, on the other hand, saw roughly 27,000 patients in its 440,000 square-foot facility.
“Our two campuses are linked,” Henry pointed out. “That means two fire departments, two police forces and a collection of very beautiful, historic, yet very old buildings, all of which contributes to a very high overhead.”
Henry said that as decisions are made on the direction that local veterans health care takes, they will be publicized.
“Everything is speculative right now. Things are changing; we are changing with them. Right now it’s just not known what is going to happen.”
Henry recalled a similar scenario, just after he came to Hot Springs in 1996.
“One of the guys wandered in here and said, ‘Boss, you seem to be an honest guy, I can’t believe you would withhold information from us!’ I asked him what he was talking about and he said that he had played golf with a guy that morning who had told him he had seen the documents that ordered the closure of the facility on April 1 of that year.”
In the end, Henry said that he doesn’t have the authority to close down anything.
“Patient numbers are down and healthcare is changing,” he said. “But I don’t foresee a time when the VA doesn’t have a presence in Hot Springs. It will be different, but we’re not leaving.”