Nursing Assistant Resources On The Web

The nuts and bolts of managing a nursing home with few resources. This is an interesting article, even when I don’t like the actual content.

The St. Croix County Nursing Home will begin cutting the number of full-time nurses on staff as part of a plan to slow operational losses.

Consultants, who reported to the County Board last week, also suggested the county consider downsizing the facility, located in New Richmond, from 72 to 50 beds.

The department will immediately begin to implement the consultants’ operational recommendations with the intention of having the changes made by April 1, said Health and Human Services Committee Vice Chairman Ralph Swenson.

He said the changes will be evaluated for three or four months, and the committee plans to present recommendations to the County Board in August.

Consultant Mary Jo Graham said the Medicaid payments the nursing home receives are “significantly less” than its cost of caring for patients, and as with other county-owned nursing homes, the employee salary/benefit package is “eating them alive.”

The consultants suggested cutting about 10 full-time jobs and filling out schedules with hourly workers who wouldn’t get regular county fringe benefits.

Full-time nurses at the home get fringe benefits equal to 48 percent of their salary as compared to 25 percent for private industry nurses caring for the same type of patients, said Graham.

The county property tax levy for the home was $1.3 million in 2004. The consultants predict that levy will have to be doubled in five years if there are no significant changes in operation or major increases in state and federal reimbursements.

A little over a year ago, the home reduced from 129 to 72 beds. But, said Graham, so far this year the facility averaged only 69.5 patients a day and there are still vacancies at other nursing homes in the county.

The study was done by Graham and Barbara Gunderson, both directors with Wipfli, a national consulting firm.

Repeatedly emphasizing that the quality of care at the home is “excellent,” Graham said she and her associate are recommending nothing except that the operation become more efficient.

Nursing home funding problems are not unique to St. Croix County, said Graham. She said while the trend is to keep only the sickest patients in nursing homes, states haven’t increased their payments to cover the per-day cost of caring for those patients.

Graham said it is hard for a nursing home with less than 100 beds to be efficient, seven Wisconsin nursing homes closed in 2003, nearly 80 percent of all Wisconsin nursing homes received Medicaid payments less than their costs, and there are no nursing home rate increases budgeted for the next two years.

As funding sources diminish, many county boards are questioning their obligation to operate their own nursing homes, said Graham.

The county is legally responsible for care to developmentally disabled, mentally ill, drug dependent and infirm people, but that doesn’t mean it has to directly provide the care, added Gunderson. She said most of the patients at the county home are traditional nursing home patients who could go to private facilities.

“They need to be in a nursing home, but they don’t need to be in a county nursing home,” said Graham.

The consultants suggested integrating “specific task” nurses into the nursing hours, decentralizing the nursing program operation and reducing the number of nurses who are full time and receive the county benefit package.

The savings from reducing staff could be nearly $500,000 a year, according to Graham’s figures. Supervisor Daryl Standafer wondered if the county will have trouble developing a pool of nurses willing to work part time.

“It will take some aggressive work,” agreed Graham. She suggested mothers with children at home or older nurses who want to work fewer hours.

Other alternatives, she said, are to outsource operations and management and sell or close the nursing home.

The consultants estimated that downsizing to 50 beds would save the home about $770,000 a year, but noted that if the county transfers its licensed nursing home beds to another facility, the value at 72 beds is higher than 50 beds.

The consultants also advised that the county make timely decisions about operating the nursing home and have plans for communicating those decisions to all staff, residents and families, doctors, other county agencies and the public.