GUARDIAN CARE’S JOURNEY BEGINS
YEARS 1958 - 1971
The story of Guardian Care Nursing and Rehabilitation Center began in 1958 as a small acute care hospital for the black community, during a time of segregation. Built in 1958, by Florida Hospital, on land donated by the late Dr. P. Phillips, the 76 bed, Dr. P. Phillips Memorial Hospital came into existence.
Dr. P. Phillips Memorial Hospital transitioned into a skilled nursing facility in 1964, when segregation ended, and area hospitals became accessible to all races of people. The South Atlantic Conference of the Seventh Day Adventists continued to operate it until 1968, when financial challenges placed it in danger of closing.
In September of 1968, five dedicated communities leaders, recognizing the value of the nursing home to their community’s elderly population, pledged monies from their homes and businesses to spearhead the formation of a non-profit corporation known today as Guardian Care, Inc., d/b/a Guardian Care Skilled Nursing and Rehabilitation Center. Those men were:
Dr. J. Mark Cox
Mr. Charles Hawkins
Mr. Herndon Harrison
Dr. Alfred Bookhardt
Mr. James Collier, Esq.
At a time when Nursing Homes were nowhere near the industry they are today, government reimbursement was limited, and financial challenges followed Guardian Care through the 1970’s, 1980’s, and 1990’s. However, thanks to the leadership and support from other Community Leaders, and Community charities’ during those years, Guardian Care remained in operation.
THOSE CHARITIES SO IMPORTANT DURING THE EARLY YEARS INCLUDED:
The Dr. P. Phillips Foundation
The Edyth Bush Charitable Foundation
Heart of Florida United Way
Harry P. Lieu Foundation,
City of Orlando
Between the years of 1972 - 1996, Guardian Care went through a period of campus growth to better serve the community:
- In 1972, Magruder Village Apartments, a 48-unit senior apartment complex, was developed to serve the community’s low-income seniors.
- In 1986, Guardian Care Convalescent Center expanded from 76 beds to 120 beds.
- In 1999, the portion of the Facility that was a hospital was renovated and brought to nursing home code.
- In 1996, a business office and boardroom addition was added, primarily due to funding and other efforts from Dr. Mark Cox, a major benefactor, and donor to Guardian Care.
Additionally, during the period from 1980 through 1995, Guardian Care earned a superior rating from the State of Florida, under the leadership of:
BOARD MEMBERS INCLUDED AT THIS TIME
NOEL BRIDGET, ADMINISTRATOR
THE NURSING HOME INDUSTRY TRANSITIONS TO A SUBACUTE CARE FACILITY
“PROVIDING HOSPITAL CARE IN A
NURSING HOME SETTING”
The level of care nursing homes needed to provide, by the late 1990s was changing fast and if Guardian Care were to survive, it had to change as well. In the past, patients would remain hospitalized until the majority of their medical issues were diagnosed and treated to resolution. In contrast, by the year 2000, the hospital’s emphasis was stabilizing the patient, minimizing the length of the hospital stay, and postponing complete diagnosis and treatment for the outpatient setting, which was almost always a skilled nursing home.
Over the course of a decade, hospital stays went from an average length of 14 days to 4 days. Those nursing homes that hospitals most relied on for their discharges, became known as “subacute” or “post-acute” providers. Additionally, the cost of a day in a skilled nursing home, on average, was one-third to one-half the cost for Medicare, making subacute care a much more affordable option for Medicare. Many procedures once performed in a hospital intensive care setting, was now being performed in nursing homes.
Unable to change with the industry, by the late 1990s, Guardian Care was again facing a fiscal crisis; census was low and charitable contributions to fund daily operations had all but disappeared, leaving only local churches to offer what financial support they could.
In July 2003, the Guardian Care Board of Directors, at that time, hired Synergy Health Care Services, LLC, a professional nursing home management company, whose CEO had been an executive with the largest provider of subacute care in the industry, to transition Guardian Care into becoming a subacute care provider
With the Board’s support of the subacute transition, which included recruiting more physicians to refer their patients, hiring more Registered Nurses, and providing massive amounts of training on new clinical systems for both the management team and direct caregivers, and performing ongoing audits of the staff’s performance, by 2005, Guardian was distinguishing itself in area hospitals as a top subacute provider.
Also, during the subacute nursing transition, a subacute rehabilitation program was added, complete with state-of-the-art rehab equipment, rarely seen before in nursing homes. A full team of licensed therapists, including speech, occupational and physical therapists, specializing in rehab programs for elderly patients, were providing therapy to residents eager to return home or to a lower level of care, up to 7 days a week, as ordered by the physician.
Guardian Care no longer depended upon charitable contributions to meet the costs of daily operations or for its capital equipment needs. By 2004, its positive cash flow position was allowing Synergy, with Board approval, to replace worn-out furniture, fixtures, and equipment, as well as to move to the Facility into the age of computers and electronic health records for greater privacy, confidentiality, and security of resident health information.
Guardian Care quickly became known by area hospitals for providing high-quality subacute care. Coupled with high customer satisfaction ratings, Guardian Care, consistently ran an occupancy not less than 93% overall with strong participation in the Medicare Program; compared to the state-wide occupancy rate of just above 85% at that time.
BOARD MEMBERS INCLUDED AT THIS TIME
Dr. Alzo Reddick
Dr. Alfred Bookhardt
Commissioner Daisy Lynum
YEARS 2012 – 2020
PREPARING TO CARE FOR
THE BABY BOOM GENERATION
By 2012, Guardian Care was in its fifth (5th) decade of continuous service in the Washington Shores Community and a strong subacute provider of care. However, the nursing home industry was about to change dramatically.
The “baby boom” generation, those born directly following World War II, between the years 1946 to 1964, were beginning to enroll in Medicare, and the sheer numbers that followed were projected to put a tremendous strain on the Medicare and Medicaid Programs. According to The U.S. Census Bureau, approximately 75 million Americans make up the baby boom generation. The first of their generation would reach 65, beginning in 2011, and the remainder by 2029.
After the cost of hospitalizations, nursing home stays, present the second-highest cost to the Medicare and Medicaid Programs. Preparation for baby boomers began around 1995, when the Federal Government, allowed states to divert a portion of their Medicaid funding, previously earmarked for nursing home stays, to incentivize private companies to provide more services to seniors outside of a nursing home setting, in their own homes and outpatient settings in the community. These programs became known as “home and community-based services”.
In addition, many States, including Florida, moved the administration of their Medicaid programs to Managed Care Organizations whose goal was and continues to be today, reducing the occurrence and length of nursing homestays.
Many of the same managed care insurance organizations, contracted with Medicare to offer what is now commonly known as Medicare Advantage Plans. Private insurance companies offered Medicare enrollees, lower premiums, to case manage their Medicare benefits. On average, these PPOs and HMOs pay nursing homes 15% to 20% less than traditional Medicare. By 2012, 30% of Medicare-eligible Floridians had chosen Medicare Advantage Plans over traditional Medicare.
By now, Guardian Care Nursing and Rehabilitation Center had been financially stable for several years, but the same could not be said for Magruder Apartments, as the Nursing Home had been subsidizing its operation for several years. Additionally, the portion of the nursing home, built in 1958 was long past its useful life and not only was it difficult to market, but the upkeep on its antiquated systems was very costly. The portion of the facility built in 1986 was also in need of significant renovation to be marketable to younger seniors who found themselves with many newer facilities to choose from for their stay.
After much research and discussion, the Guardian Care Redevelopment Committee decided on a plan. Once redevelopment was completed, it would move Guardian Care from a single nursing home to provide a continuum of care for seniors:
Outreach to all charities in the area, as well as a search for state and federal grants for funding of new development could not be found as the U.S. was now in its fourth year of a recession that began in 2008. However, despite the recession, “HUD” The Department of Housing and Urban Development was still guaranteeing loans to qualified organizations wishing to provide affordable housing and senior care in economically distressed areas. Although HUD financing is greatly preferable to harder to get and higher-cost commercial bank financing, the application process itself, which is done in 2 parts, could take at least 2 years or more to complete. But once completed, a Guardian Care Senior Care Campus would be positioned to succeed for many years to come. It would be composed of the following:
- With the purchase of some available property abutting Guardian Care’s property line to the south, a modern replacement nursing facility would be built on the grounds now occupied by Magruder Village. It would have more private accommodations and more amenities that seniors were coming to expect. It would be smaller than the current nursing home and have modern efficient systems to reduce overhead costs significantly.
- The portion of the original hospital would be demolished, leaving the newer section of the existing facility to be converted into a 52-bed affordable Assisted Living Facility once the new nursing home opened.
- Guardian Care would become a provider of “home and community-based services”, by purchasing and renovating a vacant physician’s office, across a residential street from the current nursing home into an Adult Day Healthcare Center. The Center would provide care for seniors living in their homes or the home of a loved one. Later, it could be a platform for providing services to seniors in their homes.
Understanding the redevelopment process would be lengthy and the nursing home would have to fund much of the “soft costs” for permits, inspections, architectural plans, etc., for the application alone, a decision was made to renovate the newer section of the facility, its subacute care unit, to enhance the marketability of the Facility and produce the cash flow needed to secure the HUD Financing. This was also the portion of the facility that would later be converted into an assisted living facility.
In 2021, two of the three phases of the redevelopment plan will be completed, a newly built 104-bed skilled nursing and rehabilitation center to replace the existing facility and Guardian Care Day Healthcare Center for Seniors. An adult daycare center licensed to care for up to 45-guests per day.
The Guardian Care Day Healthcare center is not currently open due to COVID-19 public health emergency. With increased vaccine distributions, our goal is to open the Fall of 2021.