When Libby Bowerman retired late last year as chief executive officer of Keswick Multi-Care Center, she said the long-term and memory care facility was well-positioned for "whatever health care is going to become."
But what that would be exactly was still "murky," Bowerman said, predicting a move toward short-term, specialty care, some of it in community-based satellite offices.
"It's the end of an era as I know it, and the future is just not clear," she said.
Now, the future of Keswick falls to Bowerman's successor, Carmel Roques.
And community-based health care, including cardiac rehab and better relations with a once-cantankerous Roland Park community, are in her plans.
Roques, 56, a 20-year Columbia resident, came to Keswick last December after serving as chief operating officer of Richmond-based Virginia United Methodist Homes, a mid-size, multi-site, nonprofit senior living organization. She previously worked for Episcopal Ministries to the Aging, in Eldersburg, the Fairhaven retirement community in Sykesville, the Copper Ridge dementia center in Sykesville, and Catholic Charities.
Unlike Bowerman's 13-year legacy — a $50 million construction spree on the 286-bed Keswick campus and the addition of a memory care unit for dementia patients — Roques said she and Keswick's board of directors have no immediate building plans and that there's really no room to grow anyway at 700 W. 40th Street.
Instead, Keswick "will refocus on community-based health services," Roques said in an interview May 16.
One of the most noteworthy aspects of that new approach is that Keswick plans to take in some former heart patients from Union Memorial Hospital for rehabilitative care.
Roques and Union Memorial officials are working on a plan for Keswick to accept some of the nearby hospital's heart patients. As Roques understands it, the plan calls for Keswick to provide "cardiac rehab" for Union Memorial patients. The nursing staff would be upgraded to include nurses specially trained in cardiac care, Roques said.
For Keswick, "this is a new specialty," Roques said.
Union Memorial spokeswoman Debra Schindler said the hospital would refer congestive heart failure patients to Keswick for "post-acute care," in an effort to reduce readmissions to the hospital.
Keswick and Union Memorial officials were in talks last week and early this week about the plan, and Roques said it would be summer before details are worked out.
Taking in cardiac patients would deepen their relationship. Union Memorial has long referred orthopedic patients to Keswick for rehabilitation after operations such as knee and hip replacements.
"We've been sending our ortho patients there for years," Schindler said. "It's a proven facility. We've had such a good relationship with them over the years."
Roques is also planning to institute a program in which each outpatient at Keswick would be assigned a "wellness coach," who would be the point person for that client's needs, she said.
And she plans to expand the role of Keswick's subsidiary, Keswick at Home, to provide non-nursing services such as providing meals, shopping assistance, transportation and housekeeping, as well as nursing supervision.
"I'm really envisioning that our community services are going to come through our Keswick at Home subsidiary," she said.
She said that if home services become a bigger part of Keswick's business, Keswick might open a satellite office.
Roques said that Keswick, located across the street from the Rotunda mall, has been there for 86 years, and in some ways is refocusing on its original mission to help its clients live "comfortable, happy, useful lives," as envisioned by Keswick's founders.
"We will be a resource for our neighborhood as people age and hopefully age well," she said. "There's never going to be a shortage of elders and there's never going to be a shortage of what they need."
Keswick is also planning to do focus groups this summer for the first time in at least five years, to find out what services seniors want and need, regardless of income level, Roque said.
Keswick officials already know that seniors want to stay close to home.
"They want to live in their communities, not necessarily at home, but in their communities," she said.
Roques also hopes to expand memory care to include psychological services. And she said Keswick is working with Sheppard Pratt to provide diagnostic services in the community.
Overall, Keswick's goal is to provide "a continuum" of health care that so far includes memory care, adult day care, rehab and long-term care.
Unlike Roland Park Place next door, Keswick is not a continuing care retirement center and has no immediate plans to offer assisted living, Roques said.
But like her predecessor, Roques is interested in someday offering retirement living. Keswick tried to buy 17 acres of Baltimore Country Club green space in Roland Park in 2008 for use as a 323-bed retirement community.
But Roland Park community leaders, anxious to stave off development and preserve the parcel as open space, fought the sale bitterly until Bowerman and the board gave up in 2009.
"I've heard a lot about the dustup," Roques said. And she said she understands what Kewsick officials were thinking at the time, because, "That would have helped fill in that piece of (Keswick's) continuum."
Now, the idea of building a retirement center somewhere in the Baltimore area is "not in our immediate plans," Roques said. "But it's not off the table," she added.
She is more concerned for now with making sure Keswick has a good relationship with Roland Park and other area communities. She said she has reached out of the presidents of several area community groups, including Phil Spevak, president of the influential Roland Park Civic League.
She said she asked him, "How can we do more with our neighbors?"
"She reached out to me and we had a nice conversation," Spevak said. "I've always thought Keswick was an important resource in the community."
Spevak said they talked about Keswick's desire for a retirement community and that he told Roques he regretted the issue was so contentious.
The civic league will honor Bowerman at its annual meeting May 22.
Keswick co-sponsored Ciclovia V earlier this month and hopes to co-sponsor the next one, Roques said. She said Keswick is also sponsoring other area events, including a summer picnic at the St. Mary's Outreach Center in Hampden.
"We are a part of this community and will be for a very long time," Roques said.