In terms of bringing in money, Wesley Woods Center is a loser—big time. In 2005–2006 alone, it lost more than $1.6 million. But in terms of services provided to the elderly and the chronically ill of many ages, it is hard to imagine a more successful organization, as illustrated in the stories that follow.
     The reasons that this key component of Emory Healthcare loses money each year are fairly straightforward. Seniors are the most rapidly growing segment of the population, the ones most likely to have complex, overlapping health problems, the ones least likely to have either personal resources or adequate medical insurance. Although some Wesley Woods patients and residents do have adequate insurance or ample resources, the center receives little or no reimbursement for services it provides to the majority of more than 30,000 older adults and chronically ill patients served each year in its hospital, outpatient clinics, and nursing care and retirement facilities.

  Jorge Fernandez, 36, worked as a cook in a small restaurant until his long-standing diabetes severely damaged his vision, making handling hot pots and pans too dangerous. Let go from his job, he was still looking for other work when double vision and blinding pain suddenly brought him to his knees. The emergency department at a north Atlanta hospital transferred him to Emory University Hospital. There, before doctors had even finished evaluating him, Jorge suffered cardiac arrest and possible cerebral injury.
     For the next five months in the neuro ICU, Jorge was surrounded by a swirl of people, a frenzied pace, and a buzz of incomprehensible English words. With around-the-clock care, he appeared to regain function, but he remained on a ventilator. His clinicians believed that he needed to be transferred to a long-term acute care facility. Other patients—some paying, some not—badly needed space in the unit, and the neuro ICU clinicians believed they had done all they could for Jorge.
     Jorge's Medicaid benefits had long since run out, and he and his wife had never had health insurance, despite their having always worked two or more jobs since arriving in the United States 15 years earlier. The unreimbursed costs of his care in the neuro ICU were approaching $1 million.
     A team of physicians, nurses, hospital administrators, social workers, and chaplains worked with the family to determine what should happen next. Every long-term acute care facility that Emory asked to take Jorge said no. The facility at Wesley Woods Hospital said yes. Emory Healthcare would continue to cover the costs of his care, which administrators anticipated would go on for years. But even they had not fully appreciated the experience and skill of the ventilator care team at Wesley Woods. Jorge arrived there on a Thursday afternoon. By Saturday morning, he was breathing on his own. After a week, he began physical rehabilitation, where the earlier accomplishments of his neurologists began to shine through. Three weeks later, he was able to return home to his wife and two children.

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