County not ready to decide nursing home fate
No vote was taken, but it was obvious at last week's meeting that some St. Croix County Board members are ready to get out of the nursing home business.
Last Wednesday county supervisors heard an update on efforts to lead the home toward self-sufficiency, touched on a proposal to turn operations over to private operators and reacted to an investigation into the death of a patient at the home.
While a new staffing plan is expected to save the county nursing home nearly $500,000 a year, the 2007 tax levy for the facility is anticipated to be $1.24 million -- only $69,000 less than this year.
"The truth is, the business model we have here is not sustainable," said Supervisor Daryl Standafer, North Hudson.
He said the facility's personnel costs are too high, and it is critical that the County Board issue a directive to develop an exit strategy.
Health and Human Services Committee Chairwoman Esther Wentz said her committee failed to approve a 2007 budget for the nursing home a week earlier.
But the committee did vote 6-3 to consider seeking proposals for leasing or selling the home.
Wentz emphasized that the vote wasn't unanimous and urged fellow supervisors not to rush into any decisions.
She said the board needs to think long and hard about what it wants to do.
"It shouldn't be done in haste," said Wentz.
"I don't know how many more times we have to pay for a study," responded Supervisor Chuck Struemke, River Falls. He said three studies have already been done, but the budget and losses keep growing.
In December 2005 consultants offered recommendations to implement a new system of scheduling nursing staff.
If the 72-bed home continued operations at 2005 levels, annual salary costs would be $2.84 million. With the changes made this year, projected salary costs are $2.57 million.
The county tax levy for the nursing home was $1.3 million this year. It's expected to be $1.24 million next year.
If the staffing hadn't changed, the county levy would be $1.55 million, said Health and Human Services Director Fred Johnson.
He said the 2005 case mix of patients was 75 percent Medicaid, 7 percent Medicare and 18 percent private pay.
Options from the December 2005 consultant's report include operating the home with the changes made this year, operating a 50-bed facility with an anticipated savings of $773,000 less the cost of layoffs, leasing the nursing home to another operator or selling it.
The $491,000 isn't a savings. It simply reduces the amount taxpayers contribute to the operation, said Standafer.
County leaders were approached earlier this month by representatives of Hudson's Christian Community Home who said CCH is interested in running the county home.
"They must be operating in a way that they don't lose $1.3 million each year," commented Supervisor Ron Raymond. He asked for a report on any mandates requiring that the county operate the home.
There is no mandate for the county to run a nursing home, replied Johnson.
The state's Bureau of Quality Assurance makes sure services are adequate but doesn't care if a facility is operated by a private company, a government entity or a non-profit, said St. Croix County Nursing Home Administrator Bill VanOfferen.
He said state and federal governments keep increasing regulations but make no distinctions between services provided by public or private homes.
Supervisors also complained that they weren't briefed on a nursing home death before it was reported by news media.
A patient died of cardiac arrest. State investigators found the nurse who responded didn't do a complete assessment, didn't provide adequate treatment and violated other procedures.
The incident occurred July 31, and the investigation hadn't been completed when the board met Aug. 15. At that time Johnson told supervisors there had been an incident at the home and warned them that they would be hearing more about it.
Supervisor Sharon Norton-Bauman, Hudson, said she was embarrassed to hear the details first from television and newspaper accounts.
County Board Chairman Buck Malick agreed that he was disappointed with the report at the August meeting.
He said County Board members were essentially told, "There's a big problem, but we won't talk about it."
Budgeting for fines
Supervisors were told the home will surely be assessed state and federal fines over the incident, but county officials don't know what those will be yet.
Fiscal Manager Jennifer Pempek said the department is budgeting $50,000 for 2006 fines and $35,000 for 2007 fines.
The nursing home union contract is the only county bargaining unit contract that is still open for 2006.
Standafer said that when faced with arbitration, county and union negotiators agreed to a 3% increase retroactive to Aug. 1, a 2% increase next Jan. 1 and a 1% increase July 1.
He had expected to ask the board to ratify the agreement during the September meeting. But, said Standafer, union negotiators have not held a member vote on the contract so there is no action requested of the County Board.
Malick said the Health and Human Service Committee action came too late to be included for action on the September County Board agenda. He said it will be on the agenda for the Oct. 31 meeting.