MADISON -- The age wave predicted to sweep across Minnesota from 2020 to 2030 reached rural Lac qui Parle County 10 years ago.
By the turn of the century, more than 20 percent of its population was 65 or older, and those age 80 and older represented one of its fastest growing segments.
All the while, the area saw a steady decline in population as young people left for opportunities elsewhere.
No one was quite sure how these demographics would impact rural health care, but one thing had already been decided at Madison Lutheran Home.
"You can't stand still,'' said Scott Larson, CEO of the nonprofit Madison Lutheran Home Inc. The organization's goal then was as it remains today: "We want to position ourselves so that we are the facility of choice.''
Ten years and $7.3 million in capital investment later, Madison Lutheran Home is celebrating.
The campus was to have held an open house Sunday to showcase its transformation, but put the event on hold over concerns about exposing nursing home residents to influenza.
The nonprofit organization oversees a campus housing Madison Lutheran Home, Madison Hospital, Lac qui Parle Clinic and an assisted living facility called Hilltop Residence.
All have seen big changes, the most visible of which are in the nursing home. What Larson described as an institutional appearance has been replaced by a decidedly home-like decor.
But the transformation goes well beyond the cosmetic. The nursing home has been downsized from 175 to 87 beds. Most of its multi-occupant resident rooms have been remodeled into single rooms to provide greater privacy.
Its role has changed too. In the last 10 months, its resident population has had a 50 percent turnover. The facility increasingly serves as a rehabilitation center for elderly who return to their homes thanks to the care.
Those receiving long-term care in the nursing home are those most in need. Ten years ago, 80 percent of its residents were classified as mobile, and only 20 percent required the aid of wheelchairs. Today it is the exact reverse of that, said Larson.
As the population has aged, so has the level of acuity inpatients served by the health care system. That's especially evident at the hospital, a critical access facility. It has downsized by half to 12 beds, but those beds are in need. Last year's 464 admissions represented 1,609 days of patient care.
Despite predictions that small, rural health facilities would largely serve as emergency centers, the Madison Hospital and Lac qui Parle Clinic invested in expanding outpatient services. The most prominent example is a new on-site CT scanner. It replaces a mobile unit that visited the hospital twice a month. The CT unit is seeing steady use, and no one benefits more than the patients, according to Larson.
Digital images are sent instantly to radiologists in the Twin Cities, and patients and their physicians in Madison have the benefits of same-day imagery and analysis.
Thanks to a major grant, the campus is also well ahead of many rural facilities in the transition to electronic medical records. Personal computers are available in patient and exam rooms, allowing nurses and doctors to instantly share data. Even the nursing home is wired to offer Internet and wireless Internet access for residents and care providers alike.
Larson said the clinic and hospital have also retained and expanded the roster of specialists offering on-site care. Services ranging from speech and physical therapy to orthopedics and urology have seen steady demand. The Lac qui Parle Clinic recorded 7,500 visits in the previous year.
The clinic has seen major renovation work to expand and improve the exam and laboratory and office space, but Larson said nothing is as important as the retention of its five primary care providers. The clinic and hospital are served by three medical doctors, a nurse practitioner and physician's assistant. All but one have been with the system for a decade or longer.
No different than other rural facilities, the ability to recruit new physicians remains the biggest area of concern for the future, according to Larson.
Reimbursement rates for nursing home care remain a source of much concern for rural facilities as well, he noted. The nursing home slipped into the red last year, but is on track to show some black ink at the end of this year, he said.
The last 10 years have also seen a growing relationship develop among longtime competitors. The Madison facilities work closely with the Dawson and Appleton health care centers in a variety of areas; the collaboration made possible the grant funding for the major computer software upgrades.
Current projections indicate that the area's demographics will plateau in 2015. While he's well aware that large-scale economic and societal forces shape the county's demographics, Larson said he can't help but believe that the health care centers have played a positive role for the county. The availability of quality, on-site health care makes the area a more attractive place to live for both senior citizens and young families.
That's not to ignore the direct economic importance of the health care campus. It employs more than 240 people -- or 160 full-time equivalents -- while providing more than $7 million annually in wages and benefits.