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Board endorses nursing home downsizing

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news River Falls, 54022
River Falls Wisconsin 2815 Prairie Drive / P.O. Box 25 54022

Tempers flared as a special meeting of the St. Croix County Health and Human Services Board was called to order April 4.

But by the end of the 90-minute gathering, however, things had calmed considerably.

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The meeting was called by Chairperson Esther Wentz, who was concerned about action taken earlier by county officials to begin downsizing the St. Croix County Health Center nursing home operation.

Wentz and others on the HHS Board were under the impression that they would have the ultimate say about the number of licensed beds the nursing home would have, yet no official vote of the board had taken place.

So when Health and Human Services Director Fred Johnson held a meeting with employees at the end of March informing them that the nursing home would be downsizing to 50 beds from its 72-bed state license, Wentz said people were upset.

Johnson told the HHS board that the proposal to reduce the nursing home's size to 50 beds has been on the HHS Board's agenda for months, and he is simply following through with the implementation of that plan.

Board member Richard "Buzz" Marzolf said he was concerned about the draft minutes from a March 21 HHS Board meeting, which he felt did not accurately reflect what was discussed at that time. He said he felt the minutes were "tampered with" after the fact to pave the way for the downsizing before the HHS Board had a chance to officially weigh in.

Wentz said she also was disturbed that the HHS Board was out of the loop when it came to the implementation of the operational changes.

"The downsizing of the nursing home should be up to this board," she said. "All of us thought the decision would be ours."

Heather Wolske, assistant corporation counsel for St. Croix County, explained that the nursing home dust-up probably can be traced to St. Croix County's decision to hire a county administrator to help guide the operation of its 20 departments. Wisconsin statutes give an administrator considerable managerial powers. The HHS Board's oversight responsibilities have changed since County Administrator Pat Thompson was hired last year, she said.

"Before, the board had more authority. Now... not so much. The board governs the policy," she said. "It's up to Fred (Johnson) and Pat (Thompson) to stay within the budget."

As a consequence, Wolske said, Johnson was merely making a decision on the operational efficiency of the nursing home when the move toward a 50-bed facility commenced. It's his duty to make sure the nursing home operates within its established budget, Wolske said, and it has been running a huge deficit for months. 

County Administrator Pat Thompson said he takes responsibility for the operational decision, noting that the tension that has resulted is unfortunate.

"The tension -- you could cut it like a knife," he told the HHS Board. "I don't want to create tension. I don't like that."

Yet, Thompson reported, it's his job to make sure every department stays within their set budget. If they aren't, Thompson said he works with managers to get back on track.

In the case of the nursing home, the expected 2011 budget overrun will likely be near $400,000. That's even after a budgeted $360,000 subsidy from county's levy dollars to help keep the facility's financials afloat.

"I know that this is a very passionate issue, as it should be," Thompson said. "We're dealing with people's lives here."

But unless the full St. Croix County Board approves a budget amendment that allows for more money to be spent in a particular department, Thompson said he tries to operate within the confines of the currently established numbers.

"Any department head could make a good argument to overrun their budget," he noted.

With that budget pressure in mind, Thompson said managers agreed that the effort to move toward a 50-bed facility was a good idea. The beds have yet to be officially "de-licensed" through the state, but once they are the local nursing home can increase its revenue and cut expenses.

With a 50-bed nursing home, Johnson said, the required annual county subsidy would likely fall to about $298,000, which is below the $330,000 in levy dollars voters were told would be required when they voted in favor of last week's referendum to continue support of the facility.

If the downsizing to 50 beds is a managerial decision, HHS Board member Fred Horne asked if the closing of the nursing could also bypass the board's oversight.

Wolske said it wouldn't.

"You're removing a program completely if you're closing," she said. "I believe the closing of the nursing home would be a board decision."

In the end, the HHS Board voted 5-4 in favor of a motion to recommend and support the downsizing of the nursing home to 50 licensed beds.

Leon Berenschot, Linda Luckey, Dr. Lisa Ramsay, Deb Rasmussen and Alfred Schrank voted in favor. Wentz, Roger Larson, Horne and Marzolf voted against the motion.

Former county board member Ron Raymond applauded the vote, noting that discussion about downsizing the nursing home has been going on for years. He said it was better to decide it now rather than wait for a new board to be sworn in a month from now.

"I think you have to swallow hard and make a decision," he told the HHS board. "You did. I think it's good you didn't kick the can down the road."

Following the meeting, Johnson said there is not yet a specific timeline for the delicensing of the nursing home down to 50 beds.

Thompson said the human resources department will be working closely with management and nursing home employees to work out future work schedules as the facility downsizes.

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