HomeMy WebLinkAboutNursing Home Steering Committee 10-01-01ST. CROIX COUNTY
NOTICE OF COMMITTEE MEETING
TO: Thomas Dorsey, Chairman
St. Croix County Board
FROM: John Borup, 246 -8223
COMMITTEE TITLE: St. Croix County Nursing Home Steering Committee
DATE: 10 /01 /01
TIME: 12:00 noon
LOCATION: St. Croix County Health and Human Services Complex, New Richmond
CALL TO ORDER
ROLL CALL
ADOPTION OF AGENDA
DATE OF NEXT MEETING:
ACTION ON PREVIOUS MINUTES: 09/05/01
ANNOUNCEMENTS
APPOINTMENTS:
UNFINISHED BUSINESS:
1. Financial Analysis
a. Option -l- Status Quo:
b. Option -2- Selling Licensed Beds:
c. Option -3- Modified Option with a Vision for a Care Continuum
2. Discussion of fund balance definition
NEW BUSINESS:
1. Procedural charge of Nursing Home Steering Committee
a. Recommendations /options
2. Future of Nursing Home Steering Committee
ANNOUNCEMENTS & CORRESPONDENCE
POSSIBLE AGENDA ITEMS FOR NEXT MEETING:
ADJOURNMENT
(Agenda not necessarily presented in this order)
SUBMITTED BY: John M. Borup and Chuck Whiting
DATE:
COPIES TO: COUNTY BOARD OFFICE
COUNTY CLERK
NEWS MEDIA /NOTICE
NURSING HOME STEERING COMMITTEE
October 01, 2001
The Nursing Home Steering Committee met on October 01, 2001 at the St. Croix
County Health and Human Services /Health Center complex.
MEMBERS PRESENT: Robert Stephens, Chair
Richard King
Stan Krueger
Esther Wentz
MEMBERS ABSENT: Ralph Swenson, excused
STAFF PRESENT: John Borup, Health and Human Services Director
Carolyn Krieger, Nursing Home Administrator
Judy Ziegler, Accounting Supervisor
Kristie Tellijohn, Director of Nursing -NH
Malva Berg, Secretary
OTHERS PRESENT: Chuck Whiting, Administrative Coordinator
John Dowd, County Board Member
John Keefe, Keefe and Associates
Sandy Hayes, Keefe and Associates
Chair Stephens called the meeting to order at 12:00 noon noting the meeting
was properly and legally publicized.
AGENDA Motion A motion was introduced by Wentz, seconded by King, and
unanimously adopted: That the agenda be approved as circulated.
MINUTES Motion A motion was introduced by King, seconded by Wentz, and
unanimously adopted: That the minutes of the 09/05/01 Nursing Home Steering
Committee be approved as circulated.
The Committee is scheduled to give a presentation regarding the Nursing Home
Study to the full County Board on October 9, 2001. This meeting was
scheduled to provide a final review of the financial projections for each of
the strategic options for the nursing home and discuss the October 9
presentation to the County Board.
Medicaid Formula Update
Keefe provided an update on the Medicaid reimbursement formula process (which
provides most of the funding for the nursing home.) He said the State still
had not finalized its Medicaid rates for the fiscal year beginning last July
1, making it impossible to forecast with precise accuracy anticipated
revenues for the next year. For example, the State has yet to decide how it
will handle the adjustment for labor regions within the state. (The State's
initial plan to go to one statewide labor region would have negatively
impacted St. Croix County.) Among the positive developments, however, was
the State's announcement it would not implement a case mix prospective
payment system (PPS) this year. In addition, it decided to defer at least
for this year the implementation of a price -based rate for direct care
services. It still plans to implement some form of price -based rates for
support services, utilities, and administrative components of the formula.
Nursing Home Steering Committee
Page 2
October 1, 2001
Keefe noted until the State made more definitive information available,
probably around November 1, it would be very difficult for the nursing home
to provide firm revenue estimates for its 2002 budget.
Strategic Options Reviewed
Keefe and Hayes reviewed the five strategic options for which financial
analyses were conducted. They were:
➢ Option 1— Status Quo
➢ Option 2— Closing /Selling
➢ Option 3 -A -72 -Bed Replacement
➢ Option 3 -B -90 -Bed Replacement
➢ Option 4— Remodeling (84 Beds)
Final Financial Results Reviewed
At the last meeting on September 5, preliminary financial results were
presented. Updates were made based upon more current information and
committee requests. For example, since the last meeting, the County had
learned there would be a 23% increase in health insurance premium costs. The
fringe benefit expenses for the nursing home were adjusted to reflect the
county's information. Keefe noted that the final State Medicaid rates, as
well as any changes made by the County in the nursing home's 2002 budget,
would not be reflected in the financial results. However, any changes were
likely to affect all options, and the differences among the options would not
be appreciably changed. He said this is useful data but is unable to give
concrete numbers due to Medicaid rates not being finalized but this would
give a reasonable cost estimate of what it will cost to run St. Croix Health
Center in 2002. He said funding for only one year at a time raises a
significant risk to managers and facilities.
Hayes told the Committee that the format of the financial findings had been
revised to reflect the total county contributions to the nursing home,
including the budgeted subsidy and other contributions. As a result, the
financial statements were neither a strict revenue and expense statement nor
a cash flow statement, but a modification of both to reflect the direction
provided by the Committee to focus on the total County contributions.
(A two -page copy of the financial findings and projections is attached. The
second page labeled, "St. Croix County Cash Requirements," reflects the total
County contributions for the year 2000 and projected through 2009.)
The Committee asked several questions to clarify what was reflected and not
reflected in the financial results. Krueger asked how much difference there
was between K &A's financial projections for 2002 and the nursing home budget.
Hayes said, as of the week before the meeting, she had worked with County
staff to reconcile differences and the numbers were within $40,000 of each
other. That was well within the 1 -3% margin of difference that the Committee
had suggested as a guideline, Keefe noted.
i
Ii
Whiting raised several questions about Option 2— Closing /Selling of the
nursing home. He reviewed the list of closing implications prepared for the
Committee, and noted that the full County Board does not fully realize the
ir
Nursing Home Steering Committee
Page 3
October 1, 2001
implications of closing the nursing home. Information regarding implications
of closing the Nursing Home will be included in the County Board
presentation. The cost of IMD relocation will also be included in the County
Board report.
The Committee also discussed the total contributions to the Nursing Home.
The financial projections presented by K &A indicated the amount for the year
2000 was $1.3 million, and for 2001 would be about the same. This is about
twice as much as the budgeted subsidy level which has been the assumed level
of County support, Keefe said. The Committee agreed this was different from
probable expectations of Board members, but that it more accurately reflected
the total picture.
Krueger said if the building was remodeled, the building is still 20 years
old with the labor - intensive ramp. Also if remodeled, the building would not
be set up to handle the dementia clients or attract private pay clients as it
would be in either the 72 or 90 bed options.
There are currently 34 protectively placed residents. This number will be
ongoing as people continue to become wards of the county. Costs will be
ongoing to care for these placements and if the nursing home closes it will
be difficult if not impossible to place the protectively placed population.
Cost of placing this population would be transferred to Health and Human
Services if the Nursing Home no longer existed and Health and Human Services
is funded at a lower level than the Nursing home if residents are not in a
Nursing Home.
County Equity Contribution
Keefe identified one additional variable, which had been analyzed by K &A —the
possibility of making an equity contribution to any option involving capital
costs and new debt.
He noted that during the study, several people had mentioned the large
numbers of acres and value of the County farm land. According to him, the
value of the land was considerable, and in probable demand for development,
once the State Department of Transportation decided where a New Richmond by-
pass highway would be located.
He cited the precedent set by Manitowoc County earlier this year to downsize
its nursing home, sell the land it was on to a local developer, re -build a
smaller facility on another site, and use the $3 million in the sale of the
land to help offset the debt service requirements.
Keefe said that if St. Croix County sold county farm land, it could generate
new funding source to help offset any capital costs and reduce debt.
The Committee did not endorse or reject the suggestion to sell some of the
County farm.
County Board Presentation
The Committee discussed the County Board presentation by K &A of the study
findings, scheduled for 9 a.m. October 9 at the Government Center.
The Committee suggested K &A made a presentation of about 60 minutes, with the
rest of the time set aside for questions and answers by the Board members.
Nursing Home Steering Committee
Page 4
October 1, 2001
Wendt suggested that K &A mentioned the protectively placed residents at the
Nursing Home and they would not go away, even if the Nursing Home closed or
were sold.
Borup also suggested that the study findings be placed in perspective, with
the entire nursing home industry in Wisconsin and elsewhere nearing a crisis.
Hayes noted the number of bankruptcies (10% of Wisconsin nursing homes in
mid -2001) and the high number of facilities (80 %), which had an operating
budget deficit in 2000.
Krueger also asked that the impact of each strategic option on the number of
employees at the nursing home be presented.
Motion A motion was introduced by Wentz, seconded by Stephens and
unanimously adopted: That the meeting be adjourned.
Time: 1:30 PM
Chair:
Attest:
(secretary)
Nursing Home Steering Committee
Page 4
October 1, 2001
Wendt suggested that K &A mentioned the protectively placed residents at the
Nursing Home and they would not go away, even if the Nursing Home closed or
were sold.
Borup also suggested that the study findings be placed in perspective, with
the entire nursing home industry in Wisconsin and elsewhere nearing a crisis.
Hayes noted the number of bankruptcies (10% of Wisconsin nursing homes in
mid -2001) and the high number of facilities (80 %), which had an operating
budget deficit in 2000.
Krueger also asked that the impact of each strategic option on the number of
employees at the nursing home be presented.
Motion A motion was introduced by Wentz, seconded by Stephens and
unanimously adopted: That the meeting be adjourned.
Time: 1:30 PM
Chair:
Attest:
(secretary)
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closing, and continuing expenses to other county
agencies.)
4. Assumptions Specific to Option 3 -A (72 -Bed
Replacement)
Under Option 3 -A, the nursing home would reduce its
licensure to 72 beds and build a new facility on a new
site.
Capital construction costs for the new building are
estimated at $8,234,513.
Financing would be for 100% of remodeling costs, at a
rate of 6% for bonds issued by the county, for a term of
20 years. No equity contribution would be made by the
County. Depreciation is on a 30 -year basis.
Average daily census remains at 90.7 for 2001 and
2002, decreases to 80 during 2003, and then remains
constant in the new building at 71 (98.6 %) in 2004 and
all other years. Payor mix is adjusted to reflect fewer
beds, with the decrease coming from Medicaid. Percent
of Medicare and private pay remain constant, all years.
5. Assumptions Specific to Option 3 -13 (90 -Bed
Replacement)
Under Option 3 -13, the nursing home would reduce its
licensure to 90 beds and build a new facility on a new
site.
Capital construction costs for the new building are
estimated at $10,245,236.
Financing would be for 100% of remodeling costs, at a
rate of 6% for bonds issued by the county, for a term of
20 years. No equity contribution would be made by the
County. Depreciation is on a 30 -year basis.
Average daily census remains at 90.7 for 2001 and
2002, decreases to 89 for 2003 and all other years.
Payor mix is adjusted, with Medicaid decreasing and
Final Financial Summary, by Option 3 9/30/01
Medicare and private pay increasing slightly over the
years.
6. Assumptions Specific to Option 4 (84 -Bed Remodeling)
Under Option 4, the current facility would be re- modeled
and bed licensure would be reduced to 84 beds.
Capital construction costs for the remodeling are
estimated at $3,552,406.
Financing would be for 100% of remodeling costs, at a
rate of 6% for bonds issued by the county, for a term of
20 years. No equity contribution would be made by the
County. Depreciation is on a 15 -year basis.
Average daily census remains at 90.7 for 2001 and
2002, decreases to 83 for 2004 and all other years.
Payor mix is adjusted, with Medicaid decreasing and
Medicare and private pay increasing slightly over the
years.
C. Summary of Financial Projections of Cash Requirements, by
Option
(See attached sheet for year -by -year financial results.)
In 2009, option 1 (status quo) and option 3 -13 (90 -bed
replacement is projected to require the most county
contribution — approximately $2.23 million for both.
Option 4 (remodeling) would require the least county
contribution - -51.79 million.
Option 3 -A (72 -bed replacement) would require a country
contribution of $1.99 million.
If the county made an equity contribution of $3 million (through
sale of county farm lands or other sources) and reduced the
debt for the 72 -bed replacement, the county contribution in
2009 would be less than the remodeling option —at $1.73
million.
Final Financial summary, by Option 4 9/30101
D. Summary of Cumulative County Contributions, by Option
The total cumulative county contribution from 2002 -2009 for
each option is projected to be:
➢ Option 1 -- $14.581 million
➢ Option 2 —Not comparable
➢ Option 3- A-- 514.211 million
➢ Option 3- B-- $15.038 million
➢ Option 4-- $12.328 million
Final Financial Summary, by Option 5 9/30/01
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