By Krissah Thompson
Washington Post Staff Writer
Tuesday, January 13, 2009

Walking through the freshly painted corridors of United Medical Center in Southeast Washington, Cyril Allen prefers not to think back to what the place was like a year ago. Then called Greater Southeast Community Hospital, the ceilings and floors of the top levels were waterlogged and bowed from untended roof leaks. There was no working radiology equipment, and at one point the institution was on the verge of running out of food for patients.

"It's been a revolutionary change," said Allen, the hospital's chief medical officer. "You can smell it. You can see it. The physicians are all coming back."

The smell and sheen of new paint are surface evidence of fundamental changes that the hospital's new owners have begun implementing to revive the once dilapidated building and business. The hospital is being revamped to meet the increasing need for long-term-care facilities for the city's aging and chronically sick.

This month about 50 beds at United Medical Center will be set aside for what is known as long-term acute care: serving patients with heart or lung ailments, those who need complicated wound care or dialysis, and those with other complex sicknesses that require hospitalization for a month or more. This will make United the only hospital in the District with such a facility on-site.

For elderly patients who need even more care, the hospital's sixth and seventh floors have reopened as a 120-bed skilled nursing home. About 150 additional beds are available to receive patients from the hospital's emergency room and for day surgeries and other short stays.

Allen, who in his eight years at the old Greater Southeast watched it nearly die, sees in the renovations hope that the only hospital in Southeast Washington will recover to serve the city's predominantly black neighborhoods in Anacostia and surrounding communities, where there are generally higher rates of chronic disease, overall poor health and premature mortality.

The need for additional long-term acute care and nursing home beds has grown as the regional population has aged and as Medicare and Medicaid press hospitals to discharge patients into more economical long-term facilities.

"Because of [payment issues] related to length of stay, the hospital needs to get you out, and unfortunately some patients go home too quickly, and they can't make it at home and are back in the emergency room," said Brian F. Wells, a corporate director with Specialty Hospitals of America, which owns and operates United Medical Center under a public-private partnership with the D.C. government.

Long-term acute-care hospitals first began to pop up in the 1980s and have become an important part of the health care continuum. The centers, which now number 391 nationwide, serve the growing number of elderly patients with lingering illness who make up about 2 percent of the patient population.

Specialty Hospitals came to the city in 2005 when it bought the Medlink Hospital and Nursing Center on Capitol Hill. The next year, it bought Hadley Memorial Hospital in Southwest Washington. Both are long-term-care facilities. Specialty's analysis of the market projects a need for 1,200 long-term acute-care beds to serve the nine big hospitals in the region, Wells said. Including the 50 new beds at United Medical Center, there are only 199 long-term acute-care beds in the city.

"In the Washington area there is definitely room for growth in terms of long-term acute care," said William Walters, chief executive of the Acute Long Term Hospital Association in Alexandria. "The best [long-term acute-care] hospitals are the ones that specialize in treating patients like those who are on a ventilator [and] . . . that have good relationships with big general hospitals."

To carve out its own niche, United Medical Center has plans to eventually focus its long-term center on high-tech wound care. For now, it faces unique challenges, including an ugly reputation to live down. Officials said they are working hard to convince other local hospitals, patients and their families that the old Greater Southeast, which at one point left sick patients waiting for emergency room care for hours or even days, is now providing quality care. The long-term acute-care center won't thrive if other hospitals and patients' loved ones refuse to have cases transferred to United.

"We have our medical chiefs actively addressing medical staff at other hospitals to let them know what we are doing," Wells said before an open house held for D.C. Council members, local hospital officials and others last month. "We have got a lot of people who are out there talking about all the changes."

The medical chief points out that Specialty plowed $30 million into the hospital last year to reframe it, improve insulation and replace broken radiology equipment. (The money was pulled from its $79 million partnership with the District.) The rooms in United Medical Center's skilled nursing and long-term acute-care centers have been outfitted with new chestnut dresser drawers, televisions and hospital beds. Others in the city's medical community are beginning to take note, said Robert A. Malson, president of the District of Columbia Hospital Association.

"There is a tremendous need for both nursing home beds and long-term acute-care beds in the city, and what [United Medical Center] is doing is reacting to that need and attempting to fill a void that has great importance to the city," Malson said. "They need to be commended for that, and the other hospitals in the area recognize that and are working with them."

Already there is a steady stream of patients from the surrounding community, and the doctors who left when the hospital was close to bankrupt are returning, Allen said. The sight of workers putting together furniture for the new long-term-care center makes him smile.

"I thank God," he said. "Southeast is back."

Comments: thompsonk@washpost.com.