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HomeMy WebLinkAboutNursing Home Steering Committee 07-09-01 Ix 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: 07/09/01 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: ACTION ON PREVIOUS MINUTES: 05/23/01 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS_ 1. Status Reports a. County Board Presentation Feedback b. State Budget Update c. Other Issues 2. Competitive Analysis 3. Architect's Update: Preliminary Report 4. County Board Survey Results 5. Potential Strategic Options: Discussion of Components 6. Next Meeting ANNOUNCEMENTS 6 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 Minutes - July 9, 2001 MIN VIES NURSING HOME STEERING COMMITTEE 3 U LY q. 20o 1 Nursing Home Steering Committee met on July 09, 2001 at the St. Croix County Health and ian Services /Health Center complex. IBERS PRESENT: Robert Stephens, Chair ird King Krueger h Swenson �r Wentz ABSENT: none F PRESENT: John Borup, Health and Human Services Director yn Krieger, Nursing Home Administrator i Berg, Secretary ?RS PRESENT: Chuck Whiting, Administrative Coordinator Keefe, Keefe and Associates i Hayes, Keefe and Associates Stephens called the meeting to order at 12:oo noon noting the meeting was properly and y publicized. IDA: Motion A motion was introduced by Wentz, seconded by King, and unanimously ed: That the agenda be approved as circulated. PIES: Motion A motion was introduced by Wentz, seconded by King, and unanimously ed: That the minutes of the 05/23/01 Nursing Home Steering Committee be approved as said the date for the next meeting will be August 09, 2001 at 12:oo noon. said after the presentation at the County Board meeting there was negative reporting in apers, which has an impact on the Nursing Home. He said the physical nature of the g Home building and thus the need for higher labor costs was not included in the Board tation or in the newspaper articles. Committee and the Consultants discussed the feedback from the presentation by Mr. Keefe to County Board June 19. It was noted that some people in the community interpreted the issues ltified as trends applicable only to the St. Croix Health Center Nursing Home, instead of to all sing homes in the state. As the discussion about the study continues, additional information be provided that will help provide a more accurate portrayal of the trends affecting all nursing r. Keefe reported that the Legislature still had to resolve the biennial budget differences, but is probably would occur within the next month. It appeared as if the decision to raid the •oposed IGT Trust Fund for nursing homes would be upheld by the conference committee port, regardless of the reactions of county homes and the Wisconsin Counties Association. The ,T decision will still mean additional funds for the 2001 -03 biennium but less than originally :pected. The major issue, Mr. Keefe noted, was the impact of the proposed termination of IGT ter 2003, which will create a major gap in funding county homes as well as all other nursing >mes— unless the state supplements the IGT funds with new Medicaid funds. Stephens said that IGT funds are lost it will be a County issue, not just a County Nursing Home issue, as fund loss ill affect other departments. Keefe said this is not just a St. Croix County issue as other homes e in financial trouble also. This issue will be brought to the WCA as a high priority on the ;ends for convention. The end of IGT funds will create a financial situation where the State will ive to do something about finances. imittee members indicated they thought County Board members did not have a full erstanding of IGT and the implications for the Nursing Home. Mr. Keefe suggested he could glop an IGT issue paper, once the final state budget is approved, which could explain the 1s of the program and its implications for the Nursing Home. It was agreed he should develop issue paper, as well as include this information in the formal Board presentation. said the care need is going to continue with or without IGT funds. The issue is not just Page 2 of 6 http: // 172.17 .128.87 /Committee/Minutes /2001 /NHSteer /nhsteerO7O901.htm 12/21/2011 Nursing Home Steering Committee Minutes - July 9, 2001 financial situation of the Nursing Home. Keefe circulated a memo to the Committee, identifying the need to develop a mutually erstood definition of the county subsidy to the nursing home. Mr. Keefe noted various rpretations of the amount of the subsidy, and said this issue would need to be reconciled in !r to make assumptions for the financial projections of the strategic options. He said the acial projections should recognize total county contributions to the nursing home, which d be a broader definition of the "county subsidy." Swenson agreed there were both direct and indirect County contributions to the Nursing ne. He identified four areas of direct contributions that he thought should be incorporated as t of the financial projections: 1) the levy amount of approximately $500,000 plus allocated to Nursing Home; 2) the farm fund; 3) the over -run of the levy amount, and 4) the cash over - ft amount in any given year. members also noted the indirect contributions through salaries of non - Nursing Home mel and other county agencies providing services to the Nursing Home. Stephens agreed the financial projections should provide a picture of the "true costs" of the sing Home. Mr. King also noted that the amount of the county levy on the total tax bills was a 11 percentage of the total compared to schools. Keefe presented an analysis of the Nursing Home in comparison with its other nursing home petitors in St. Croix County. (See attached copies of data slides distributed to the Committee.) analysis indicated the nursing home market was extremely fragmented in St. Croix County, 1 a total of nine nursing homes and none of them having a dominant market share. Most of competitors had fewer than loo licensed beds. a largest market was the Medicaid market, which generally has a negative impact on financials. Croix Nursing Home had 30% of the Medicare market share in 20oo, but it was a generally all market with relatively few residents of the total resident population but Medicare nprised almost all of the admissions and in next year's budget will be 25% of revenue versus �6 for Medical Assistance and 23% for private pay. A conclusion is that a rehab area would be e in new construction as well as an Alzheimer's unit. The areas with greater market potential re dementia care and private pay. comparing the resident population and level of care indicators, the analysis suggested that St. oix Nursing Home was caring for significant numbers of hard -to -care -for residents. In some sas, such as those related to persons with mental illnesses, the Nursing Home was a primary )vider for such residents. In other areas, such as the activities of daily living (ADLs), other :ilities also were serving significant percentages of residents who were totally dependent for sir ADL needs. facilities were taking care of significant numbers of those who were poor (i.e., Medicaid summary, it appears the Nursing Home was meeting its traditional mission of caring for the or, the hard -to -care -for and those not able to care for themselves, but other facilities also were dng care of many of the same populations. The exception appears to be residents whose care ads related to their behavioral conditions, where St. Croix Health Center Nursing Home !med to be caring for a larger share of this type of resident. St. Croix Health Center has the ;hest skill level population of the nursing homes in St. Croix County. Keefe indicated most other nursing homes in St. Croix County are not stand -alone nursing homes but may have a resident care apartment complex (RCAC), assisted living, or community based residential facility (CBRF) associated with the home. Committee recessed from 1:30 to 1:40 PM. Keefe reported on the progress of the architectural evaluation of the Nursing Home. A , esentative of Plunkett Raysich Architects toured the facility June 19, spending a complete day i the administrator and maintenance supervisor of the Nursing Home. The architect was ?lied a copy of the plans and drawing of the facility before his tour. Keefe indicated the architect had identified several issues, including the need to repair the and replace energy inefficient windows through the facility within the next five years. The ing and ventilating systems seemed to be in reasonably good operating condition. The !ntial of installing air conditioning to replace the chilled ventilation system should be ddered. The emergency generation may need replacement within the next 10 years. The Page 3 of 6 http: // 172.17.128.87/ Committee / Minutes /2001/NHSteer /nhsteerO7O901.htm 12/21/2011 Nursing Home Steering Committee Minutes - July 9, 2001 ed exterior basement walls had some signs of paint deterioration, which was likely to need re- painted in the short-term. In several areas, inadequate drainage created some occasional rnally, the architect noted the nurse call system was adequate. The major internal issues dified related to the ramp between the two levels of the Nursing Home, the single elevator, the centralized dining and activity areas. In the architect's opinion, the transporting and ;estion issues associated with the ramp would not be resolved without facility remodeling. potential option identified to address the issue was to build on additions to the existing ;ing units for de- centralized dining areas that also might be used for some limited activities. Keefe noted that the architect would develop estimates of capital budgets for major atenance items, potential remodeling needs, potential new construction of additions to the ity, and complete replacement. The architect would be at the next meeting to present those nates, and respond to questions. Is. Krieger noted that the roof repairs and window replacements were in the 5 -year capital adget. Mr. Stephens noted that the windows have been issues since the building was first pened. It also was noted part of the past problems related to the fact the window frames were .rger than the windows, suggesting the need for customized replacement windows, potentially at higher than normal cost. Keefe said he also had had discussions with the architect about the need to weigh the relative s of remodeling and /or new additions, with a complete facility replacement assuming a usized bed capacity. Depending on the cost of remodeling or a new addition, and the ability tc :essfully eliminate or minimize existing inefficiency issues such as those related to the ramp, Keefe said it might be most cost - effective to replace the nursing home with a smaller, more :ient building. members asked for cost estimates for options be included in the final report. Keefe reported on the survey of County Board members. He said only 17 of 31 members had pleted and returned the survey. He said he considered the responses to date insufficient to elate and report actual numbers related to each response. r. Keefe distributed a memo prepared on the strategic options that could be developed and used the basis of financial projections. (See copy of memo attached to minutes.) He asked for mments and questions from the Committee members because specific assumptions would need be made for each option in order to project the financial results. Keefe identified three areas of potential strategic options: 1. Maintaining the status quo; 2. Getting out of the nursing home business, either by selling the facility and /or bed licenses or simply closing; or 3. Continuing operations, assuming the need for a licensed bed downsizing plus addressing current facility design and inefficiency issues. e Committee raised several questions about the second option, especially the specifics related selling. If sale were the preferred option, committee members asked if it would assume selling building as well as the licensed beds? If the building were sold, it was suggested the Human rvices Department in the 1974 building also would have to be sold. . Keefe indicated it would be difficult, in today's nursing home market, to attract many buyers the nursing home. If the County required any buyer to acquire the building as well as the !nsed beds, the pool of potential buyers would diminish even more. He said he thought it was ikely any buyer would want to acquire the building, because of the same issues related to fficiencies in design and staffing that currently exists. For the financial projection purposes, he 1 he thought the most realistic option was to assume the sale of the licensed beds only, with the lding remaining under county ownership. State law requires if beds are sold, all beds be sold at time. Beds cannot be sold separately. It was agreed the future use of the buildings and perty was beyond the scope of the study, but deserved separate evaluation. the licensed beds only are sold, it was suggested some County Board members would have her questions about what to do with the buildings. r. Whiting noted the complexity of the issues, and suggested that the options should not be er- simplified. County Board members needed to know about the complexities and implications any decisions they might take. Committee members said that the report would need to clearly ell out the pros and cons, as well as the assumptions made and reasons for not including other sumptions. Mr. Keefe said that would be part of the report. Page 4 of 6 http: // 172.17.128.87/ Committee / Minutes /2001/NHSteer /nhsteerO7O901.htm 12/21/2011 Nursing Home Steering Committee Minutes - July 9, 2001 discussing the continued operations option, Mr. Keefe said assumptions needed to be made >t about the target populations served and bed size. He indicated the target population should :us on the traditional county home mission to serve the hard -to- care -for, which would include emphasis on those with dementia and other behavioral conditions. Medicare should be itinued, and efforts made to attract more private pay if possible. bed size, he indicated a licensed capacity of about 8o -90 beds seemed realistic. !r this option, it would be essential to address the facility design and inefficiency issues. The tect's cost estimates would be used to determine if remodeling with a new addition or facility cement would be more appropriate. Krueger said a new facility would cut down on the )er of staff needed to care for residents and this payback for salaries would be a savings rds a new building. He said window repair /replacement and roof repair /replacement will to occur to the current building within five years if a new facility is not considered. He Toned whether remodeling costs would be so high that it would be more cost effective to a new building. The architect will report at the meeting on August 9. her issues to address included whether to develop a continuum of long -term care services and develop new housing and services for seniors and specialized populations. Mr. Keefe said he )ught it was unlikely new housing and services would be developed by the County within a five - 3r period. As a result, those costs would not be included in the five -year financial projections, hough preliminary market assessments about the potential of such services would be veloped as part of the study. )tential partnerships for the Nursing Home as well as any new services also were discussed. Mr. :efe thought there were some potential partners for the County, although many private - oviders (not- for -profit as well as for - profit) have reservations about partnering with a county. committee members indicated an interest in identifying potential partners. biting said the Nursing Home will continue to operate as is for 2002. The budget for 2002 is ie to the County Board in August before the study is complete. He also indicated there will be an °ction in the spring for the County Board. ;efe will provide a range of options, not just one option. ephens said the sale of the building is not an option. Stephens felt the committee should certain the value of the building for use outside of a nursing home. ie Committee questioned how many FTE positions could be reduced if a new facility was built. was the consensus of the Committee the current building would still be staffing intensive even if ds are downsized. hiting said the Nursing Home study is just the beginning of the process. was agreed the next Committee meeting would be August 9. Krueger was excused for the igust 9 meeting. At that time, Mr. Keefe said the agenda would focus on i) the architectural sessment, 2) issues related to defining county contributions /levy costs for the Nursing Home A 3) the preliminary financial projections. Committee also agreed to meet on September 5 for a final meeting on the study options and Committee discussed whether to schedule a presentation to the full County Board as part of regular September meeting or a special meeting in September or October. It was agreed to uss the choices with the Finance Committee and make a decision at the next meeting. )hens said the committee may extend into 2002 to follow up on recommendations from the asked if there were any other issues to bring before the Committee. tion: A motion was introduced by Wentz, seconded by King, and unanimously adopted: That meeting be adjourned. 3 :35 FM Page 5 of 6 http: // 172.17.128.87 /Committee/Minutes /2001 /NHSteer /nhsteerO7O9O l .htm 12/21/2011