Shrunken town sees health care slashed as hospital awaits demolition

HAMMOND, Ind. — In 1898, three nuns took a train to this town along the southern shore of Lake Michigan to open a hospital.

They transformed an old farmhouse into a seven-bed medical center. They treated their first patient for a broken leg amid carpenters hammering nails. Surgeons laid their patients on a kitchen table for operations.

The hospital – then named after St. Margaret, known for her service to the poor – eventually became one of the largest in the region. Hundreds of thousands of Indiana and Illinois residents took their first or last breath there.

One hundred and twenty-four years later, the hospital has kind of come full circle. This spring, Franciscan Alliance, the nonprofit owner – still affiliated with the same Catholic order of nuns – plans to demolish most of the 226-bed Franciscan Health Hammond complex, leaving just eight beds, an emergency department and outpatient services. The move cost 83 jobs at the hospital and another 110 at an acute long-term care center that rented space there.

The news stung many in this Rust Belt town of nearly 80,000 people, which has seen businesses — and neighbors — flee Hammond for decades. It’s especially painful, they say, because the hospital system has spent more than half a billion dollars in recent years on new facilities in more affluent and less diverse communities.

“It is deplorable that a Catholic institution like the Franciscans would make a financially motivated decision and potentially leave thousands of people at risk,” said Mayor Thomas McDermott Jr., who complained about being told of the cuts. workforce barely two hours before its public announcement. . “I’m not trying to be alarmist, but people are going to die because of this decision. And they know it.

But the larger question is whether Hammond needs a hospital with hundreds of beds, given the changes in medical practice and transportation in the 21st century. Only 50 to 60 of its beds are full most days, said hospital CEO Patrick Maloney. Another Franciscan Alliance hospital is only 6 miles away. Today, far more care is delivered on an outpatient or virtual basis than five years ago.

And Hammond’s site had quality issues. It only gives one out of five stars to Medicare.govthe lowest possible score and the worst of any of the nine rated hospitals in his county.

“Managing our resources is one component of our Catholic mission,” Maloney said in an email. “The key to this is the effective delivery of care.”

He noted that Franciscan is investing $45 million to transform the campus and will continue to operate a medical clinic there for uninsured or underinsured patients, as well as services such as imaging, a medical laboratory and prenatal care. .

While rural hospital closures often receive more attention, towns like Hammond have also been prone to losing medical services as health systems adapt to changes in care and choose to invest in places where more people have private insurance . But the closures raise questions about the changing mission of nonprofit hospitals — and who they help.

Since the 1930s, the urban hospitals most likely to close have been those serving low-income minority populations, according to a study by Alan Sager, a professor at the Boston University School of Public Health. He calls large swathes of Detroit and New York “medical wastelands.”

When Hartford, Connecticut, City Hospital entered into a contract in the 1970s, it kept its emergency room in operation — until it became too expensive, Sager said. “I predict that within a decade, despite the best intentions of everyone involved, it will prove financially unsustainable to support an eight-bed hospital plus ER in Hammond,” he said.

Hammond’s population is down about a third from its peak in the mid-20th century. Like other former manufacturing centers in the Midwest and Northeast, the city was hollowed out by deindustrialization and the flight of white people to suburban areas. It’s in the part of Indiana affectionately known as “the area,” which is essentially an extension of south Chicago, criss-crossed by freight railroads, dissected by freeways, littered with factories in various states of disrepair.

On a recent overcast morning, the Franciscan Health Hammond parking lot and surrounding grounds were mostly empty. A handful of people were leaving the hospital. A sign said birthing services had moved to the suburbs.

the Postal code which covers the hospital and its surrounding neighborhood has a poverty rate of 36%, with a median household income of $30,400. Its population is 82% black and/or Latino. The hospital treats a large portion of patients on Medicaid, the government insurance program for low-income people, which typically pays providers a lower rate than Medicare or private insurance.

For Franciscan Alliance, the driving factors behind Franciscan Health Hammond’s shrinkage were the costs needed to maintain aging infrastructure and the expected lower demand for care in that part of “the region,” Maloney said.

He said Hammond residents are welcome at Franciscan Alliance Hospital 6 miles away in Munster, Indiana. The organization has spent at least $133 million in recent years on the facility, located in a wealthier suburb a few blocks from a larger competing hospital.

But for Carlotta Blake-King, a school counselor in Hammond, that’s not close enough, especially since the area doesn’t have much public transportation. “I am an elderly person. I don’t like to drive,” she says. “Not everyone can afford a car.”

Free transportation to medical appointments is however offered by the state Medicaid program and local township trustee’s office.

Franciscan Alliance replaced older hospitals in other communities, albeit a few miles from their original location, spending $333 million on a new medical center in Crown Point, Indiana, and $243 million in Michigan City, Indiana. In 2018, however, it closed a century-old hospital in Chicago Heights, Illinois, a working-class Chicago suburb demographically similar to Hammond.

The missions of many not-for-profit hospital chains like the Franciscan Alliance have evolved. At the turn of the 20th century, hospitals often deliberately moved into less fortunate neighborhoods, with community members contributing time, money, and supplies. When St. Margaret’s opened, for example, local farmers donated food. The Internal Revenue Service has exempted so-called charitable hospitals from paying taxes.

Today, “hospitals operate like corporations, like lucrative business entities, and their decisions are driven largely by financial concerns,” said Ge Bai, professor of accounting and health policy at Johns Hopkins University. “The line between today’s nonprofit hospitals and for-profit hospitals is very, very blurred.”

In 2018, nonprofit hospitals provided less out-of-reimbursement Medicaid and charity care than their for-profit counterparts, Bai’s search found. However, she noted, the Franciscan Alliance spent more than the average nonprofit on both fronts.

Pat Vosti, a retired nurse from Hammond, worked in the cardiology unit, so she knows how critical time is in healthcare. She worries about patients who need to be redirected to other hospitals. “It’s a matter of minutes, but minutes count in some cases, you know?” she says.

However, people have been bypassing Hammond Hospital for years. With its sister campus in Dyer, Indiana, it has just 15% market share, according to a 2016 bond filing, compared to 45% for Franciscan’s Michigan City facility and 38% for Crown Point. .

“Now why they didn’t use it might be a function of management choices made 15, 20 years ago: ‘Don’t build this new emergency room, don’t hire these young doctors, don’t open a substance abuse service,” said Nancy Kane, Adjunct Professor at Harvard TH Chan School of Public Health. “It’s usually a gradual death. These places don’t go bad all of a sudden.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.


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