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HomeMy WebLinkAboutNursing Home Steering Committee 08-09-01 I X ST. 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: 08/09/01 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: 09/05/01 -12:00 Noon ACTION ON PREVIOUS MINUTES: 07/09/01 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. Status Reports a. State Budget Update b. Other Issues 2. Architect's Report 3. Financial Analysis a. Definition of Subsidy /County Contribution b. Option -l- Status Quo: 1. Key Assumptions 2. Preliminary Results c. Option -2- Selling Licensed Beds: 1. Re- Location Study -Cost Estimates 2. Other Key Assumptions 3. Preliminary Results d. Option -3- Modified Option with a Vision for a Care Continuum 1. Architect's Capital Cost Estimates 2. Other Key Assumptions 4. Vision for Care Continuum 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 X NURSING HOME STEERING COMMITTEE August 09, 2001 The Nursing Home Steering Committee met on August 09, 2001 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Robert Stephens, Chair Richard King Ralph Swenson Esther Wentz MEMBERS ABSENT: Stan Krueger, excused STAFF PRESENT: John Borup, Health and Human Services Director Carolyn Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Malva Berg, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator John Keefe, Keefe and Associates Sandy Hayes, Keefe and Associates Mike Edwin, Keefe and Associates Larry Schneider, Plunkett Raysich Architects 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 Swenson, seconded by King, and unanimously adopted: That the minutes of the 07/09/01 Nursing Home Steering Committee be approved as circulated. Stephens said the date for the next meeting will be September 05, 2001 at 12:00 noon. State Budget Status John Keefe provided some good news about the state budget. He brought the committee up to date about the IGT reimbursement, labor region reimbursement, and Medicaid PPS reimbursement issues. He said the Governor might make some line item vetoes by the end of August that may improve the IGT picture for counties. He said single labor regions did not make it through the Legislature but changes were still planned, based on a new state study. He said the Medicaid PPS change would become effective, starting with 25% PPS - based reimbursement for the first year, retroactive to July 1, 2001. Keefe said this is a better financial picture for the Nursing Home than it was a few months ago. He anticipates finalization by the end of August. John Borup said the state budget may or may not impact the St. Croix nursing home's budget for 2002. He said the State is on a different fiscal year than St. Croix County. Borup said he gave a document to Stephens and Wentz pertaining to the nursing home's county subsidy allocation request. As is, the home is requesting an allocation of $593,000. This allocation request Y � will be brought to the full Human Services Board at its next meeting. The allocation amount being requested is based on an average daily census of 98, which is an optimistic number Ralph Swenson asked why such an optimistic census number was used, instead of a number more consistent with experience? Borup explained, since the hospital dropped its swing beds, the nursing home should start to see an increase in census. Borup said census dropped after media reports concerning the Nursing Home Steering Committee. Stephens said $593,000 was optimistic, but a goal to achieve. Swenson said he hopes that $593,000 will be enough, but he is not optimistic. Swenson said he would prefer to see a prudent risk assumption in the budget. Keefe said a portion of today's discussion will be regarding the amount that can actually be considered County subsidy. Architect's Report Larry Schneider, Plunkett Raysich Architects, handed out a preliminary architectural assessment packet, and explained the preliminary physical plant evaluation process. He discussed the existing data, his observations, and recommendations of the existing building(s), regarding the interior, exterior, and grounds. Schneider is currently working with Sheboygan County with their consolidation and downsizing and has also worked with Juneau County. Keefe said Schneider has considerable experience with County facilities. Schneider discussed 1) the need for private rooms, 2) inefficiencies with the current two -level building nursing home, 3) market demand for private rooms and bathrooms, and 4) an addition of an elevator to the existing building. He identified other maintenance issues that need to be addressed, including a new generator, new windows, and new roof. He showed the committee drawings of potential remodeling options assuming an 84 -bed facility. He discussed the potential for de- centralizing dining on each unit, to ease the resident transportation inefficiencies with the centralized dining area and lessen staffing needs. Schneider provided preliminary budget estimates pertaining to the following: certain facility maintenance items, remodeling the existing building and site, constructing a new 84 bed nursing facility, and also building a new 60 unit residential care apartment complex (RCAC)- assisted living for seniors. Schneider stated the remodeling and construction numbers are to be used for budget purposes only and will more than likely need to be re- evaluated, as plans are refined. He said it is more efficient to try to maintain one level facility when possible so staff are providing care for residents rather than transporting residents to activities, meal, etc. Stephens said a study might need to be done to determine if there is a high market demand for private rooms in St. Croix's target population. There was a discussion about developing a separate, distinct dementia unit to the nursing home due to high need now and potentially a higher need in the future. Schneider said the remodeling estimates did not address the need for a dedicated dementia unit. After the Architect's presentation, there was a discussion about staffing issues and inefficiencies. It was discussed whether or not a new building E versus re- modeling would reduce operating costs of the home, therefore reducing the county contribution to the home. The committee also discussed possible location of a new nursing home and marketability implications. It was pointed out, there is a need to address the long -term impact of all these issues with the county board. Some maintenance will have to occur to the existing building for some concrete replacement, new windows, roof replacement /repair, new generator, repair of foundation, etc. These will be costly repairs to a building that is very labor intensive. Most of these items are already included in the five -year capital outlay plan. Swenson questioned how often the generator is run in the Nursing Home. Borup said it is tested at least once a month but has been running on a daily basis for the last week when the facility switched to interruptible power. Stephens questioned using a natural gas generator or a diesel generator. Schneider said if there is not a problem starting a diesel generator, he would not switch to natural gas. He said diesel would be less. The current building has 412 square feet per bed and a proposed 84 -bed facility would be at 700 square feet per bed. Schneider said building costs now are at approximately $120 /square foot. It was suggested that the State Engineer be engaged early in the process if building or remodeling as different surveyors have different standards. There is potential for appeal and negotiation with the engineer, but working with the engineer early in the process is the best option. Keefe said there will be a growth in demand for private rooms /private bathrooms in the future. He said there are not many good solutions for private pay dementia clients at this time. He said over 50% of the elderly population has some form of dementia. Keefe said the architect's analysis and cost estimates were useful to help decide the critical issue, if the county remains in the business, of whether it should remodel the existing facility or replace it. Definition of County Nursing Home Subsidy Keefe distributed a memo on defining the county subsidy and other county contributions to the nursing home. The committee discussed the memo, the levy, the county contributions, the nursing homes revenues and expenses, and several other aspects relating to the subsidy issue. The memo identified several issues, which have implications for the financial projections. There was a lack of consensus as to what constitutes County subsidy. Chuck Whiting noted the issues had wider policy implications for the county. Stephens said when the nursing home was built, it was part of the County corporation but actual control /ownership of the buildings belongs to the County corporation. Whiting said the Finance Committee has to take a leadership position in these issues as each department is not on its own. Stephens said Finance is in control of all the land and buildings. The Finance Chair has given directive to nursing home to operate the nursing home as a business and transfer monies as needed. The levy agreed upon at the beginning of the year is not the same as the net expenses over revenues at the end of the year. The County needs to define fund balances, subsidy and set policy. Swenson said there has been some discussion in Finance on the County need to recover or replace monies in the general fund but no conclusion has been reached. 3 versus re- modeling would reduce operating costs of the home, therefore reducing the county contribution to the home. The committee also discussed possible location of a new nursing home and marketability implications. It was pointed out, there is a need to address the long -term impact of all these issues with the county board. Some maintenance will have to occur to the existing building for some concrete replacement, new windows, roof replacement /repair, new generator, repair of foundation, etc. These will be costly repairs to a building that is very labor intensive. Most of these items are already included in the five -year capital outlay plan. Swenson questioned how often the generator is run in the Nursing Home. Borup said it is tested at least once a month but has been running on a daily basis for the last week when the facility switched to interruptible power. Stephens questioned using a natural gas generator or a diesel generator. Schneider said if there is not a problem starting a diesel generator, he would not switch to natural gas. He said diesel would be less. The current building has 412 square feet per bed and a proposed 84 -bed facility would be at 700 square feet per bed. Schneider said building costs now are at approximately $120 /square foot. It was suggested that the State Engineer be engaged early in the process if building or remodeling as different surveyors have different standards. There is potential for appeal and negotiation with the engineer, but working with the engineer early in the process is the best option. Keefe said there will be a growth in demand for private rooms /private bathrooms in the future. He said there are not many good solutions for private pay dementia clients at this time. He said over 50% of the elderly population has some form of dementia. Keefe said the architect's analysis and cost estimates were useful to help decide the critical issue, if the county remains in the business, of whether it should remodel the existing facility or replace it. Definition of County Nursing Home Subsidy Keefe distributed a memo on defining the county subsidy and other county contributions to the nursing home. The committee discussed the memo, the levy, the county contributions, the nursing homes revenues and expenses, and several other aspects relating to the subsidy issue. The memo identified several issues, which have implications for the financial projections. There was a lack of consensus as to what constitutes County subsidy. Chuck Whiting noted the issues had wider policy implications for the county. Stephens said when the nursing home was built, it was part of the County corporation but actual control /ownership of the buildings belongs to the County corporation. Whiting said the Finance Committee has to take a leadership position in these issues as each department is not on its own. Stephens said Finance is in control of all the land and buildings. The Finance Chair has given directive to nursing home to operate the nursing home as a business and transfer monies as needed. The levy agreed upon at the beginning of the year is not the same as the net expenses over revenues at the end of the year. The County needs to define fund balances, subsidy and set policy. Swenson said there has been some discussion in Finance on the County need to recover or replace monies in the general fund but no conclusion has been reached. 3 After a lengthy discussion, Swenson said he hoped the financial analysis would provide an accurate projection of what it costs the County Home to stay in business. Stephens said the committee should take time to read the memo thoroughly, individually draw some conclusions about the county contribution, and readdress the issue collectively at the next meeting. Sandy Hayes said she would continue to collect financial data and speak with Carolyn Krieger and others. Stephens would like a written definition of fund balance for the next meeting and this will be included on the agenda for 09/05/01. Financial Projections Keefe briefly discussed the status quo option, selling the licensed beds option, and a continuation of care option. Hayes distributed a preliminary projection of the status quo option. Both she and Keefe emphasized the numbers in the preliminary status quo option are preliminary and will change. They said the projection was presented to give the committee a chance to become familiar with the format for the projections. A discussion followed on how the county subsidy and other county contributions would be reflected on the financial statement. The cost report will be used for financial data for the nursing home. The Nursing Home receives two - thirds of IGT funds in December and one -third in May or June. It is not known what IGT funds will be for this year. Medicare dollars have increased dramatically in the Nursing Home in the last two months due to the hospital swingbed unit closure. Borup said if the Nursing Home closes, indirect costs would not go away. There would still be relocation costs, sick leave, vacation time, and unemployment costs. Krieger said the Nursing Home has gone for seven years without a County levy. Stephens would like to know by the next meeting what the cost to the County would be for the Nursing Home to stay in business. Keefe said it would be more difficult to sell the building with the licenses than to just sell the licenses. He said there would not be a lot of revenue from the bed licenses as there is not much of a market for licenses at this time. If the licenses were surrendered, it is possible that some could go for CIP slots to relocate residents in the community. Keefe said the license would yield $42 /day to help support residents in the community, which would not totally fund the residents in the community. These slots would be only for St. Croix County residents. The question was asked if the court could order another nursing home to take a protectively placed person and the answer is no. If the facility did not exist, protective placement care would have to happen at the hospital and would be more costly. Keefe said in an interview with Judge Eric Lundell, Lundell said if the County proposed to close the facility, he would be willing to appear before the County Board to oppose closure as closing the home would be a hardship for the judicial system. The committee also discussed when the final report would be made to the County Board. Whiting said a fund balance overlay with levy amount would be easier for Board members to comprehend. Both the potential for September and October presentations were discussed. 4 All options will be developed further and readdressed at the next meeting. Whiting said a vision of care continuum needs to be developed and addressed after a decision is made on what to do with the Nursing Home. Motion: A motion was introduced by Wentz, seconded by Stephens and unanimously adopted: That the meeting be adjourned. Time: 4:00 PM Chair: Attest: (secretary) 5