It's all over for the Key West Convalescent Center, but the fallout from its closing has just begun.

A prospective buyer plans to look at the building this week, but even a highly unlikely immediate sale would not stop the last patients from being moved out.

"Monday, we're out of business. We'll move the last 18 residents out Sunday or Monday," Admissions Director Dona Rosado said Wednesday. "After medical records and employee records are boxed up and gone, I'll be done, too."

About 20 patients are now in Plantation Key Convalescent Center in Tavernier, Rosado said, but most patients are now spread out throughout South Florida in other long-term care facilities.

Families who want to visit loved ones will have to drive to Arch Plaza Nursing and Rehabilitation Center and Sinai Plaza Rehabilitation and Nursing Center, both in Miami; or to Homestead Manor Nursing Home or Hialeah Convalescent Center. At least one patient was moved 385 miles to a nursing home in Tampa.

The anguished but unsuccessful fight by patients' families to save the convalescent center is over. The repercussions of that closing, however, are just now being felt.

The hospital next-door no longer has a place to send patients for long-term recovery after they undergo surgery or other procedures. And the center's 120 or so skilled nursing staff, nurses aides and other employees have no idea where they'll find work.

Several of the employees already were facing foreclosure on their homes, convalescent center Director Mark Hunter told The Citizen the week before the center closed.

"That's 120 more people who will have to be on unemployment," he said.

Patients out of luck

The absence of a long-term care facility across the parking lot from Lower Keys Medical Center puts the hospital and physicians in a tough position.

Once car accident victims or other seriously ill patients finish their stay in the hospital's acute care unit, they used to be moved to the convalescent center for extended recovery, physical therapy, and other skilled care. Now that the convalescent center is closed, recovering patients and their families will have to find other places to recover from serious injuries, probably outside the Keys.

"Patients will have to be placed outside our community," said Nicki Will, the hospital's chief executive officer. "My case managers are involved in the placing. I don't know if my patients will have any open beds or not."

Will made it clear that the hospital does not place patients in convalescent centers after they leave the acute care center in the hospital, saying that patients and their doctors determine where to send the patient based on a list of available convalescent centers given to them by a hospital case manager.

"We provide the patients with options," she said. "We take it day by day and do what's best for our patients, but it's clearly difficult not only for patients, but the citizens of our community."

A local doctor who regularly operates on his patients at the hospital said the convalescent center's closing leaves a major gap in post-operative care. Though most patients can obtain in-home care through insurance, some of his patients include elderly people with broken hips and other problems that require around-the-clock care. When families can't care for patients in their homes, patients must have a long-term care facility to help them live day to day as they heal.

"There are other rehab centers in Miami where patients would have to be relocated, but it is a super inconvenience for families to travel back and forth," said Dr. Robert Catana, an orthopedic surgeon who's been in Key West since 1993. "There are no other places in Monroe County that can assist us."

Patients will have to board ambulances or family cars and be driven to other convalescent centers outside the Keys.

"I don't know who can cover it financially -- an ambulance ride would be expensive," Catana said. "Most people would be covered by Medicare [or Medicaid] but it's not certain that would cover the expense. If not by ambulance, the family would have to take the burden of driving them [to Miami] and setting them up."

Ex-employees worry

The mood among the convalescent center's remaining employees was somber the day before Thanksgiving. Instead of being handed a paycheck on Friday as is the custom, staff learned that Tennessee-based MidCare Inc. instead will mail their checks to their homes. That means their pay will arrive too late to pay rent or mortgages before the beginning of the month, said a staff member, who asked not to be named for fear of employer reprimand.

"This is insane," the staff member said. "We need that money; people's rents and everything are going to be late. There will be eviction notices."

Convalescent center employees will be owed another check after this one, the staff member said, to cover work through this week, but she worries they won't get that check.

"They say they'll mail those, too, when they get the money," the employee said.

Employees are not being told much about their options regarding COBRA benefits, the staff member said. The program allows unemployed workers -- for a cost -- to keep their health benefits for 18 months after losing their jobs. Communication with MidCare managers is nonexistent, the staff member said.

"They tell us not to come to work as they need less and less staff," she said. "It's trickling down to nothing, there's no real ending thing to tell us it's over.

"We've been giving people their termination records so they can get unemployment," said Rosado, the admissions director.

Buyer will tour facility

There is a silver lining to all this, Rosado said: A potential buyer will tour the empty convalescent center this week.

MidCare announced it wanted to sell the facility on Nov. 12, the day after the federal Centers for Medicare and Medicaid Services (CMS) cut off Medicaid and Medicare payments to the convalescent center.

The company unsuccessfully used the prospect of a potential sale to petition CMS for a 90-day extension on the convalescent center's closing. CMS refused, saying the owners had been given more than three years to fix problems but nothing had been done.

MidCare will clean and beautify the convalescent center before the potential buyers arrive, Rosado said.

"I am going to be showing the building to some buyers next week; they'll be looking at the building," Rosado said. "I don't know who they are, but they want to take a tour of the building."

Though MidCare Chief Operating Officer Scott Becht wouldn't identify the potential buyer, an aide to Keys Rep. Ron Saunders identified Signature In-Home Care Inc. of Alabama as a possible buyer.

Rosado's mission is to get the former patients back to the convalescent center once the new owners buy the place and obtain a skilled nursing license.

"I want it to sell as quickly as possible to get our residents back home quickly. That's still the plan," she said. "I'm really hoping that when the people come in, they do buy it. My prediction is it will take four to six months. When all is said and done, I'll be coming in with my book of face sheets and tell the new owners, 'Here they are, let's bring them home.' The same stink that was raised when they left can be raised to bring them home."

jguerra@keysnews.com