Financial challenges due to pandemic plague HHHS

By Sue Tiffin
Haliburton Highlands Health Services is facing significant financial challenges due to the extra costs incurred during the pandemic, one of those challenges being related to the Haliburton assessment centre.
The assessment centre, where COVID-19 tests are conducted for people in Haliburton County, was set up in the parking lot of the Haliburton Family Medical Centre at the end of March. A trailer is now in place as an assessment centre to be used during the colder months.
“We’ve had to figure out an alternative for getting us through the winter months, given that we’ve been using a tent for sort of a drive-through assessment centre model,” said Carolyn Plummer, HHHS CEO at a board meeting held virtually on Oct. 29.

HHHS has now shifted that operation fully into the trailer that has been on-site at the assessment centre for operation during the winter months, alongside the clinic within the Haliburton Family Medical Centre building for those who are symptomatic or moderately symptomatic to be further assessed when they come in for their testing. HHHS has been paying a rental fee for the tent and trailer since the beginning of April.
“We have certainly had to fund a number of different elements of that centre including the trailer rental, the tent rental up to the present time, and we’ve provided staffing in-kind and there’s been some staffing expenses as well,” said Plummer. “So there’s some significant costs associated with running that centre and at this point the province has been talking about a funding model that was to be effective as of the first of October. We do not yet have confirmation of funding for our assessment centre, but the funding model that’s been shared with us suggests that they will be paying the assessment centre an equivalent of $38/swab, with a minimum swab number of 200 swabs per week. So if we have under 200 swabs a week we’re supposed to be guaranteed the equivalent funding for 200 swabs per week.”

“Even with that,” Plummer said, “that amount is not going to be sufficient to cover our current operating costs for the centre, and right now we are also experiencing increased costs with the modifications we’ve had to make to the trailer and some of the changes we’ve had to make to get us through the winter.”
Additionally, the HHHS team is facing a proposed rental payment for the use of the parking lot, which is owned by the municipality, as the site for the assessment centre.
“So that’s going to be adding to our ongoing operating costs at a time when we’re really not even certain whether we’re going to be able to get sufficient funding from the province to cover those,” said Plummer.
Board member Irene Odell questioned the situation.
“…I’m kind of surprised, because this is a service to our community,” she said. “We’ve been very lucky that our numbers are low, and when people do get it they can get testing very quickly. Where would they have to go if this has to shut down because we can’t afford to keep it up and running?”
Plummer said to her knowledge there are testing sites in Bancroft, Lindsay, Peterborough and Bracebridge.
“It’s quite a travel for folks, especially coming into the winter months,” she said.

“How far have you escalated this within Dysart?” asked Odell. “I would think council would want to weigh in on this a bit.”
“We have been discussing with the mayor, she’s been attending our assessment centre team meetings, and so she’s certainly aware of the circumstances that we’re facing right now,” said Plummer.
“It’s disappointing,” said Odell.
Plummer would not disclose the amount of rent being proposed, but said the HHHS team was waiting on confirmation from Ontario Health East to see what would be paid and what wouldn’t.

After the meeting, she told the Echo via email: “The rental fees for the trailer and the tent were built into the initial cost estimate we included when we submitted an application to Ontario Health to have an assessment centre in Haliburton; since [we] did receive approval to open our centre, we believe these costs will be covered. In addition to the initial cost estimate, each organization involved with the operation of the assessment centre has been contributing in-kind resources to keep it running and to ensure our community has local access to this critical service. The proposed rental fee for use of the parking lot is a new fee, so we are concerned that it may not be covered. We do appreciate that we have been able to use the parking lot to date without paying rent.”
The location of the assessment centre was deemed to be convenient for residents as well as HHHS staff. Plummer said team members had looked at alternative spaces for where the centre might move for the winter months.
“And it became very evident, very quickly, how important it is to have the centre close to the other health services,” she said. The family medical centre beside the hospital, and the assessment centre in that area allows for a two-pronged assessment centre approach, Plummer said, with the symptomatic clinic indoors and the rest of the centre happening outside in the trailer enables the team to keep “those two populations apart, but having really easy and quick access to the medical centre and to the emergency department if we need it, if someone shows up with really severe symptoms and is in rough shape.”
“It is disappointing because it is such a good service for the community,” said Odell, asking how the board might support Plummer and the HHHS team.

Board member David O’Brien supported Odell’s comments.
“We are fighting COVID as a community, and we’re doing it as a whole community and we’re doing it together as a community,” he said. “Really, to think you should have to charge us to do that service for our community, absolutely ridiculous, in my mind.”
Plummer noted the rental fee proposed includes the cost to cover hydro, which she said she thought was fair.
“Hydro is quite acceptable, I agree, and that’s where it should stop,” said O’Brien.
A meeting with Ontario Health East is booked this week, Plummer said, to talk about the funding challenges HHHS has been having with the centre under the proposed model.
“They have said they’re going to help help centres that can’t cover their operating costs, but we just don’t know exactly what that means or what it will look like yet,” she said. “Hopefully it’ll be good news and we won’t have to worry about this.”
Additional financial update
Plummer spoke to significant incremental costs HHHS, alongside all other hospitals in the province, have had in response to putting precautions in place due to the pandemic.
“We have been reimbursed for those for the months of March and April, for any of those costs that are reimbursable, but we have only received March and April and nothing since then and the costs are fairly significant, they’re over $350,000 a month being spent just on COVID alone, and so it’s really challenging to continue,” said Plummer. “It’s really creating some cash flow challenges for us. At the moment, we did recently receive that funding reimbursement for March and April and we’re OK for now but it won’t take long, just a matter of weeks, before we’re back in a crunch again. We’re really hoping that the government continues with its reimbursements.”
Plummer said HHHS has been “actively advocating” for those reimbursements to be made “sooner rather than later,” as have other hospitals across the province.
“We’re continuing to push on that front,” she said.

HHHS has also lost revenue as a result of the COVID-19 pandemic, an amount that totals more than $350,000.
“Unfortunately the government has indicated that lost revenue is not a recoverable expense for COVID-19,” said Plummer, noting that the loss is creating a significant deficit in the current year operations and that advocacy work was underway “for funding for these cost pressures.”
Grateful for grant,
disappointed in amount
While Haliburton Highlands Health Services will receive $22,000 through the province’s Health Infrastructure Renewal Fund Exceptional Circumstances Program Grant to help replace air-conditioning units at the Haliburton site, Plummer said HHHS had applied for $1.5 million worth of upgrades, so though she is grateful for the funding, it falls short of what is needed.
“We had applied for $1.5 million worth of upgrades that need to happen urgently and received $22,000 so we were rather disappointed with that outcome to say the least, and again we are advocating for some policy changes to that funding model in order to help organizations such as ours to be able to have a good solid funding plan for keeping our infrastructure up to date,” she said.
These items included laundry equipment replacement at both sites, boiler replacement at both sites, lighting upgrades at the Haliburton site and ventilation duct replacement at the Minden site, according to Plummer’s report.

“We have found a way to proceed with some of those more urgent issues that need addressing, so we are continuing ahead despite the lack of funding and we’re continuing to advocate and hopefully we’ll get those expenses covered,” she said.