A look at the county’s nursing center renovation project, and what it might mean


I have a dark red brick on my mantel that came from the old DeKalb County Home, now known as DeKalb County Nursing and Rehabilition Center (DCNRC). On one side of the brick is a sketch of the Home, on another a short history of the facility in dates and names.

The brick tells me that DCRNC’s previous location on Sycamore Road was demolished in the year 2000, which means it has taken the county more than 15 years to bring to light chronic logistical issues at the “new” place that create congested hallways and risk cold food.

I asked myself, “Why now?” And this is where I landed:

Also planned is an addition to the north of the existing structure, adding 18 single-occupancy rooms. These rooms will be the Medicare rooms, but also help the facility keep up with the times.

Presenting the addition as almost an afterthought to a primary mission of logistical remediation is hilarious to me. It’s actually much more likely that the desire for the addition kicked off the project. Because money.

See, the money these days comes from capturing short-term rehab dollars from Medicare A patients, which are those making short-term stays. Facilities compete for these patients, and private rooms can provide an edge.

But it’s not just nursing facilities wanting a bigger piece of the action. Hospitals do, too. And what nearly every hospital needs to consider in these modern, managed-care times is pulling inpatient rehab facilities into its Accountable Care Organization (ACO) arrangement as one strategy to help maximize the Medicare dollars it takes in.

So the timing of the DCRNC plans with the establishment of Northwestern Medicine in DeKalb is probably not coincidental. Northwestern has absorbed, amoeba-like, some 20 healthcare facilities in DeKalb and Sycamore, and more than 30 countywide. One possible reason for this behavior is to create a service area containing enough Medicare beneficiaries to qualify for ACO formation and an attendant contract deal with the Centers for Medicare and Medicaid Services (CMS).

It still looks to me, then, like the county may be thinking of upgrading DCRNC, at least in part, to create an inpatient rehab facility attractive to an ACO centered around Northwestern Kishwaukee Hospital.

There’s nothing inherently wrong with the idea, and actually they’d be stupid not to talk about the possibility.

Next step is to bring this into the public arena, to talk about the public money involved, and other pros and cons.