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HomeMy WebLinkAboutNursing Home Steering Committee 05-23-01ST. 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: 05/23/01 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: 04/20/01 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Possible motion to reconsider an action taken at last meeting regarding County Board survey. NEW BUSINESS: 1. Status Reports a. St. Croix developments b. K &A Updates 2. Target Population: Who is served? 3. Historical Utilization: what is the trend? 4. Nursing Home Bed Needs: A discussion of bed banking /downsizing 5. Facility Profile (Optional) 6. Benchmarking Analysis 7. Other Business a. Old issues b. New issues 8. 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 May 23, 2001 The Nursing Home Steering Committee met on May 23, 2001 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Robert Stephens, Chair Stan Krueger Ralph Swenson Esther Wentz MEMBERS ABSENT: Richard King STAFF PRESENT: John Borup, Health and Human Services Director Carolyn Krieger, Nursing Home Administrator Malva Berg, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator John Keefe, Keefe and Associates Mike Edwin, 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 Swenson, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the minutes of the 04/20/01 Nursing Home Steering Committee be approved as circulated. Stephens said the date for the next meeting will be set later in the meeting. Motion A motion was introduced by Stephens, seconded by Wentz, and unanimously adopted: That the Committee reconsider the motion made at the last meeting to not send a survey to the full County Board. Stephens questioned Keefe if the survey was a standard tool he used and if it was valuable to his study. Keefe indicated that yes, it was a standard tool and he obtained valuable information from the survey process. Wentz said if the survey has been used in all studies and is an important tool, then it needs to be sent out. Keefe said some revisions may be needed in the survey questions due to the stage of the study process. The questions may need to be more specific and focused on items such as downsizing, licensing capacity, assisted living, senior housing, etc. Swenson asked how relevant the survey would be to what the committee is studying when the County Board doesn't have the full picture of what is being studied. Keefe said the survey may identify some issues that are not being addressed by the committee at this time. Wentz indicated that questions asked to people not familiar with the nursing home would not know what was being talked about in the survey. The role of the committee is to raise issues and present pros and cons to the County Board so they are able to make decisions.regarding the nursing home. It would be educational to introduce ideas and concepts to the Board. The next County Board meeting is scheduled for June 19 and Stephens asked Keefe if he would be available to attend that meeting. Keefe said he will mail the survey to committee members for review before the June County Board meeting. He will include some definition of terms in the survey. Swenson indicated he would be able to review the survey via e -mail. Keefe said he hopes to have some specific thoughts or assumptions on alternative directions to follow for the study. He said in the near future some choices will need to be made on options for the study. Swenson said the survey should only be sent out only if questions are well defined. Motion A motion was introduced by Wentz, seconded by Swenson, and unanimously adopted: That the Committee rescind the motion made at the last meeting to not send out the survey to the full County Board. Motion A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the Committee approve Keefe to move forward with a revised survey focused around the ten items the committee is charged to study. Keefe will send this survey for review to Committee members with a self- addressed stamped envelope and Committee members will return to Keefe within three to five days. Keefe will re -draft the survey and give to Committee members, for review before giving to the County Board. Borup and Krieger indicated bed banking is on the agenda for the May 24 Health and Human Services Board meeting. The deadline for bed banking and /or downsizing is June 30, 2001. The target is to bank 27 beds. Krieger indicated the current census is 95. Keefe said he has entered a contract with Plunkett Raysich Architects of Milwaukee as part of the Nursing Home study. Keefe indicated he realized committee members requested copies of the presentation prior to the meeting but said it would be helpful to the committee if he reviewed the information as presented. The K &A presentation focused on a facility analysis of St. Croix Nursing Home. Specifically, it included information on the following topics: ➢ The target population of the facility; ➢ The historical utilization trends of the facility; ➢ The nursing home bed need in St. Croix County; ➢ The cost benchmarking analysis of the facility. The slide presentation of the facility analysis contains more detail. A summary of each area follows: 1. Target Population: Who is Served? Mr. Keefe presented a comparison of the resident population at the Nursing Home during the last decade and in the year 2000. Among the findings were: 2 ➢ Resident levels of care had shifted significantly since 1990, with a much higher number of residents requiring higher skilled level care (SNF level) and fewer needing lower levels of care (ICF levels); ➢ In 2000, the nursing home had more residents with a diagnosis of dementia, fewer with diagnoses of chronically mentally ill (reflecting more CMIs living in the community), and slightly more with medical conditions (reflecting the homes' certification as a Medicare facility; ➢ The resident age increased slightly during the last decade, especially for those 85 or older; ➢ The percentage of residents with complete dependence for assistance with activities of daily living (ADLs) increased in each area — bathing, dressing, transferring, toileting, and eating; ➢ More than half of the residents (54 %) in 2000 had occasional or frequent occurrences of bladder incontinence and more than a third (36 %) had occasional or frequent occurrences of bowel incontinence; and ➢ The current staffing shortages will become chronic issues, and the shortages will intensify over the next two decades, based on K&A's caregiver ratios. K&A's overall conclusion was that the residents at the Nursing Home had a higher level of acuity and more care needs than a decade ago. In addition, the staffing shortage will make it harder and harder to attract and retain qualified people to care for residents. 2. Historical utilization Trends K&A reviewed utilization trends of the Nursing Home from 1990 to 2000. The data showed: ➢ Occupancy has steadily declined from 93.8% in 1990 to 72.1% in 2000; ➢ Average daily census has steadily declined from 121 in 1990 to 93 in 2000; and ➢ Empty beds have steadily increased from 8 in 1990 to 36 in 2000. 3. Nursing Home Bed Need K &A reviewed the need for nursing home beds in St. Croix County. It found: ➢ In 2000, there were 698 licensed nursing home beds located in St. Croix County, with St. Croix Nursing Home's 129 beds being the largest of any facility in the county; ➢ Wisconsin's nursing home use rates (the number of all persons per 1000 population in a nursing home) have steadily declined since 1984, with the rates for those 95+ decreasing by 25%, for those 85 -94 by 59 %, and for those 75-84 63 %; By applying the statewide use rates to the St. Croix county's population, it was determined there was a bed need for 315 beds in 2000, and a bed excess of 383. Mr. Keefe noted other factors impact on the actual use rate, including the nursing homes in River Falls, which are included in 3 the total beds. However, the River Falls elderly population outside of St. Croix County was not included in the calculation. This would increase bed need. The committee requested that a bed need estimated be developed that included Pierce County. In 2000, the average daily census of the nine nursing homes in the county was 573. At that level, there still were 125 excess beds in the county. Mr. Keefe said the use trends suggested a need to consider not only bed banking this year, but the potential for de- licensing beds for the Nursing Home. He concluded, given the trends, that the licensed capacity (129 beds) of St. Croix Nursing Home was not likely to be fully utilized under current conditions. Stephens questioned the advantage to delicense over banking beds. If the facility had more private rooms, it may be more marketable. Also less staff may be needed in one area compared to having residents scattered throughout the facility. In 1982 the State of Wisconsin declared a moratorium on nursing home beds. If beds are banked, the facility can request beds back and receive them back after 18 months, 10% of the remainder of the beds are decertified on January 1 of each year. There is no advantage to bed banking compared to delicensing except the facility has more flexibility with bed banking concept in case the situation in the facility changes in the next year. Delicensing could possibly allow making an addition to the building that would be more scaled to the needs of the client. The deadline for banking beds is June 30, 2001 and requires full County Board action. Whiting asked if licensed beds can be sold. Keefe answered that all the licensed beds can be sold but no individual or partial bed licenses can be sold. The committee questioned the worth of a licensed bed on the market. Keefe answered there has been no price in the last three years due to no demand as there is no profit in the nursing home business. The committee questioned what would happen to high level of care clients if the County nursing home went out of business. Would private nursing homes be able to care for the high -level care clients? Unless the Medicaid formula is changed or these residents are subsidized by Health and Human Services it is unlikely that these residents will be accepted by private homes. Stephens asked if it is necessary to have a county nursing home or would the private sector serve just as well with a subsidy? Stephens said the committee needs more information to answer this question. Keefe said the private sector would not be able to care for clients as they are cared for now but that some people would be able to be taken care of with a subsidy. Keefe said the subsidy would not come from the state. The county is funding the facility now. 4. Cost Benchmarking Analysis The benchmarking analysis was based upon a summary of Medicaid cost reports for all nursing homes in the state, made available through the Wisconsin Association of Homes and Services for the Aging, the not -for- profit nursing home trade association. (St. Croix Nursing Home is a member of WAHSA.) The analysis was based on 1999 data, the latest year available. It compares St. Croix Nursing Home with 1) all nursing homes in the state; 2) 4 all government homes (primarily county homes); 3) all similarly sized nursing homes 100 -149 beds, and 4) all homes in the high labor regions of the state. K&A's analysis included comparisons of a range of specific cost indicators, including the following (the complete slide presentation is attached as an appendix): ➢ The total cost per day for St. Croix Nursing Home was $138.05, compared with $128.66 for government homes, $127.20 for high labor region homes, $118.27 for all homes, and $117.26 for 100 -149 bed homes; ➢ The total cost per day of direct care services for St. Croix Nursing Home was $83.17, compared with $77.95 for government homes, $67.78 for high labor region homes, $63.46 for 100 -149 bed homes, and $62.56 for all homes; ➢ Nursing labor costs per day (the largest portion of the direct care services) also were higher for St. Croix Nursing Home ($72.35), compared with $67.42 for government homes, $56.74 for high labor region homes, $52.77 for 100 -149 bed homes, and $52.40 for all homes; and ➢ Support services costs per day also were higher at St. Croix Nursing Home, but administration and capital costs were lower than all the benchmarks except other government homes. The Nursing Home's hourly wages paid to nursing and other staff members generally were higher than the benchmark facilities. Fringe benefits provided the greatest contrast to the benchmarks, with St. Croix Nursing Home's fringe benefits adding 37.8% to every dollar spent for wages. Although this was comparable to government homes' 38.3 %, it was twice as great as the 19.2% for all homes, 18.9% for 100 -149 bed homes, and 18.6% for high labor region homes. Pensions, health insurance, and workers compensation are the three fringe benefit components that provide for the greatest difference. Of these, pension contributions are about 8 -10 times greater than other facilities — except for other government homes. Average nursing hours per day also were compared. The hours for registered nurses and aides were higher than most other benchmarks, although those for LPNs were comparable or somewhat lower. Mr. Keefe noted this would not be surprising, given that the county facility is caring for persons with higher care needs and more behavioral conditions that other nursing homes prefer to let the county home care for. One example is the visits by the facility psychiatrist every other week. For the approximately 25 residents he sees during his visits, there is additional nurse staff work in updating charts, changing medications, and implementing other physician's orders. In addition, the current facility design (two stories, one elevator, a ramp between sections of the building) all contribute to the need for higher staffing levels, he noted. Mr. Keefe concluded the analysis by noting that the key cost areas contributing to higher expenses are controlled for the most part by decisions made outside of the nursing home. Conversely, the Nursing Home administration has minimal or no control over most factors contributing to the higher costs. 5 He also noted there was at least one positive tradeoff resulting from the higher costs. The higher costs, attributable primarily to higher wages and fringe benefits, had contributed to lower staff turnover and higher staff retention. This in turn created more continuity of care and can be assumed to help create a better quality of care than in facilities with higher turnover and lower retention. Keefe indicated that the State is talking about eliminating the high labor regions, which would impact St. Croix Health Center. Krieger said 1999 was a breakeven year for St. Croix Health Center and no funds were received from the County funds for the Nursing Home. She said 2000 was the first year the Nursing Home received funds from the County. Borup questioned the status of IGT with the update that occurred last month. IGT will continue for one additional year to reach the 2004 fiscal year. Keefe will be at the June 19 County Board meeting. He said the major forces impacting the facility are staffing, bed need and regulations and changes in the industry. June is a benchmark time for the study. A summary of information presented to the Committee and a status report will be given to the Board. The survey will also be presented to the Board. Keefe will be in the area to interview staff and others on June 18 and 19. He requested Committee members to schedule individual time with him on June 18 to have a one -to -one interview. Keefe said he would prefer to conduct the interviews at St. Croix Health Center as it would be more time saving for him. He will identify some basic issues that will be covered. Swenson asked what the context of the presentation at the County Board meeting would be. Stephens will introduce Keefe at the meeting. Keefe said he will preserve the neutrality of the study. He will give a summary of the process and indicate issues still left to be dealt with. Keefe indicated the architect will probably have an assessment done by July but the assessment will not include dollar costs by then. The next meeting of the Nursing Home Steering Committee is tentatively scheduled for July 9 at noon. Keefe indicated it is possible the results of the survey will be available at the next meeting on July 9. Swenson questioned whether or not it will be necessary to hold multiple meetings per month as it gets closer to the end of the study. Stephens asked if there were any other issues to bring before the Committee. Motion A motion was introduced by Wentz, seconded by Krueger, and unanimously adopted: That the meeting be adjourned. Time: 2:50 PM Chair: Attest: (secretary) 6