A levy that finances the Clatsop Care Health District would raise $3.9 million over five years.

The Clatsop Care Health District Board has hired a Salem-based private management firm to manage the district’s day-to-day operations, a decision board members hope will prevent the closure of Astoria’s oldest nursing home.

At a special meeting Friday, the board unanimously approved a contract with Aidan Health Services, Inc. The company will replace CEO Nicole Williams, who was hired by Columbia Memorial Hospital.

The board told an audience of several dozen at Tuesday’s regular meeting that Clatsop Care Health and Rehabilitation Center — known as Clatsop Care Center — on 16th Street would shut down next fiscal year unless Aidan can resolve the facility’s financial troubles. The center is projected to end this fiscal year with an operational deficit of $606,000.

If the care center closed, some residents could be moved to other facilities within the district. The board has discussed selling the Clatsop Care Center building — which it values at $2 million — but is not actively marketing it.

“We’re in crisis mode here. We’re in absolute crisis mode. We’re reacting as fiscally responsible people to try to save the district, in my mind,” Jeff Hazen, a district board member, said. “I want to provide good health care — good, quality health care — and the only way we can do that is to keep the doors open and bring in a management company that has great experience turning around facilities to make them work.”

Aidan’s term begins April 1 and runs through June 2019. The agreement can be renewed in one-year increments. For now, Jessica Klein, the district’s director of human resources, will serve as interim CEO.

“We’re not closing in June. We’re not going to have that happen, so we’ve got to step in,” Mark Remley, an Aidan owner, said. “And if we have to make tough decisions, we’re going to have to make tough decisions for the health of the facility long term.”

The health district encompasses all of the Clatsop County except the cities of Gearhart, Seaside and Cannon Beach. It oversees Clatsop Care Center, Clatsop Retirement Village in Astoria and Clatsop Memory Care Center in Warrenton, and provides in-home care.

The district, and the care center especially, have faced compounding struggles in recent years.

A state law passed in 2013 sought to reduce the number of nursing home beds by relocating patients and residents from nursing homes into less costly community-based care settings.

But, statewide, nursing homes could not sufficiently reduce beds, so facilities like Clatsop Care Center saw cuts in Medicaid reimbursements, which make up a sizable portion of the care center’s budget. Facilities that could not withstand the cuts closed, including Providence Seaside Hospital’s long-term care unit in 2014.

In addition, the state faces a shortage of certified nursing assistants, a staffing limitation that forced Clatsop Care Center to downsize its long-term resident population last year.

One Clatsop Care patient, Ron Meyer, said “the nursing has been good, but the good nurses leave. There’s been a tremendous turnover in this operation.”

Board member Heather Reynolds said she believes Aidan has the wherewithal to attract patients and nurses to the district, and advocate on the district’s behalf.

Aidan’s fees will be 5 percent of patient care revenues for the first six months, then 6 percent thereafter. Based on current figures, this will cost an average of $31,900 a month, then $38,280, according to Amanda Hascall, the district finance director.

Aidan manages seven long-term care facilities: six in Oregon, one in Nevada.

When Williams gave her notice in December, she recommended that the board contract with a management company that specializes in nonprofits and long-term care. The CEO job, she said, had grown too complex and cumbersome for one person.

The board reached out to auditors, Oregon Health Care Association, and LeadingAge — an advocacy group for public long-term care facilities — to compile a list of companies to consider. A board subcommittee narrowed the options down to three.

“Aidan was, far and above, the better option than the two that we did interview,” board member Roy Little said.

Board members visited Aidan’s other sites and contacted references, including “a public long-term care district that, frankly, asked them to leave,” Board Chairwoman Karen Burke said.

In that situation, Burke learned from an administrator that the changes Aidan made at a health district in Eastern Oregon were not popular with the district’s board of directors, which let Aidan go after a year. Burke added, however, that she did not speak with the board members themselves.

Burke said the Clatsop County Health District Board chose not to issue a request for proposal because “there was not enough competition out there that met our needs to justify going through the RFP process.”

The employees will remain district employees. Aidan will answer to the board. “Make no mistake: We’re not the boss here. The board is our boss,” Remley said.

Section 5 of the contract allows either party to terminate the agreement with 30 days written notice “with cause.” The district can terminate the agreement with 48 hours written notice “in the event of any situation involving immediate jeopardy to resident health and safety that is not cured within such 48-hour period.”

Asked how Aidan would run the district differently than Williams, Remley said he isn’t familiar with Williams’ work.

According to Burke, Remley told the board “it will take (Aidan) a minimum of six months of really evaluating the district’s operations and each of the facilities to determine what kind of cost-effective measures can be done, how we can maximize census, how we can maximize revenues.

“So I think (Remley is) holding back on making any commitment about what they will do until they’ve actually had an opportunity to study what is.”

District employees past and present expressed anxiety at Friday’s meeting toward what they view as a partial privatization of the district’s operations, and whether the move will impact quality of care.

Keyaho Rohlfs, a certified nursing assistant at Clatsop Care Center, said he wanted assurance that Aidan would maintain a high care standard.

“I wish that there was something involved here in which we could guarantee that,” he said. “I haven’t heard it yet from the representatives of the agency. Maybe they have the empathy that can understand how personal this is to us, maybe not; I don’t know. Trust is something that comes with time.”

Allison Sansom, a registered nurse and licensed health care administrator who worked for the district for 12 years, said she supports the board’s decision, and understands the board has “no option but to engage the services of a private firm to turn the operations around at Clatsop Care Center specifically.”

However, Sansom, who is running for board position No. 7, said she worries that the 26-month contract with Aidan suggests a plan to outsource the district’s operations to a for-profit company for the long run.

“The only way to make a profit. I believe … is on the backs of your staff, or to the detriment (of) your residents, and so that is very concerning to me,” Sansom said.

Burke said she would not use the term “privatization” to characterize the agreement.

“I think that we remain a public tax-supported not-for-profit district, and the district board remains in charge of the district and what happens within the district,” she said after the meeting. “We’re simply hiring a management firm to fill those responsibilities of the CEO.”

The board, she said, does not view Aidan as a temporary solution. As would happen with any hire, Aidan will stay “as long as the relationship between the CEO and the board of directors is working, and as long as the district is well-managed.”

Thanking Rohlfs for his comments, Little said the board will meet with Aidan regularly about the quality of care being provided.

“I was actually a nurse’s aide at one time. I know what you do for a living. I’ve done it; I don’t do it now. It’s hard work, and it’s not paid enough,” Little told Rohlfs. “But we support what you do, and we support what you do to make the lives of our residents better. And that’s what we want to do with this contract.”

Remley said that, since Aidan will have a presence at monthly board district meetings, the company must earn its contract every 30 days.

“You’ve got to see improvement, obviously, right off the bat to ensure the long-term success of the contract,” he said.

Pamela Wev, of Astoria, told the board she felt the contract’s initial 26-month term was excessive.

Originally, the contract stipulated a term of 14 months, to end in June 2018. Aidan requested a June 30, 2019, end date instead. Board member Mike Aho questioned why the shorter contract didn’t work for Aidan.

Burke said she agrees with Aidan that 14 months may not be a reasonable time frame to turn the care center around, and to show the district how well Aidan can perform as a management company.

“This didn’t happen overnight, that the health district got into the financial situation that it’s in … I don’t know if 14 months is realistic, given all the factors that have contributed to where it is now, and that will contribute in the future,” she said.

Little said reasonable people can disagree about whether an initial term length is appropriate. “We think that that’s the right way to give Aidan a chance to do what we want them to do.”

After the meeting, Remley said that, with the district under Aidan’s management, “in the first term, I would hope that you would see the district not only be able to stand on its own two feet, but that it will give the board choice in how they move forward from there.”

Remley said Rohlfs “basically hit the nail on the head.”

“We’re going to have to earn his trust over a long period of time,” he said, adding that he has told board members: “Don’t blindly trust me. I’ve got to earn that over time,” he said.

In other communities the company serves, Aidan contracts with third-party companies to conduct customer-satisfaction surveys. Burke said Aidan will do this in Clatsop Care Health District, as well.

“You’ve got to reserve judgment on me,” Remley said. “I can say all the things in the world, of what I want to do and what I want to accomplish. But until I perform, it just doesn’t really mean anything.”