Butler County Care Facility finding niche in difficult industry

Butler County has put more than $1 million into upgrades and repairs for the Butler County Care Facility. Most of the updates have been completed. NICK GRAHAM/STAFF
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Butler County has put more than $1 million into upgrades and repairs for the Butler County Care Facility. Most of the updates have been completed. NICK GRAHAM/STAFF

The beleaguered Butler County Care Facility is very close to breaking even, for the first time in a long time, but outside pressures continue to frustrate enduring financial stability.

At one time the county nursing home owed the general fund $1.1 million, a debt the home repaid partially but has continued to need regular infusions of cash as Medicaid rates, regulations and audits continually tinker with the bottom line. Care Facility Administrator Jennifer Strickland said it is nearly impossible — with a half a year to go and many unknown variables — to predict where the bottom line will land at year’s end, but she is estimating a deficit of $100,000 to $200,000.

Those variables include an anticipated one percent state hike in Medicaid rates and maybe two percent on the Medicare end of the revenue equation. She’ll know for sure come July 1. Plus, they are close to a decision on offering the South Wing as a secure residence for the growing demographic of dementia patients.

RELATED: Butler County nursing home chips away at debt while dealing with external challenges

The 109-bed facility is one of only about 25 county-run nursing homes — down from 34 in 2015 — left in Ohio. The nursing homes were mandated in all 88 counties when the first facility was built in 1830 to serve the infirm, poor and homeless. Many of the facilities closed after the state legislature lifted the mandate and counties opted to let the private sector handle nursing care as government budgets shrank.

The three county commissioners have remained stalwart in their responsibility to provide care for those who have nowhere else to go.

Commissioner Cindy Carpenter has said the county’s facility is often a last resort for some residents.

“There are many referrals made to the county care facility for individuals who are refused by other facilities,” she said. “We are taking care of complicated cases. Some may be mentally ill and also medically fragile or have skilled nursing needs and other issues in their lives, and our care facility has been a resource to accept individuals that can’t find admission to other nursing homes.”

After several years of bailing out the facility with taxpayer dollars, the commissioners hired a consultant to offer ideas on how the facility could be self-sustaining. Then they brought in Strickland, a consultant with LeaderStat LLC, to work with and eventually replace former administrator Chuck Demidovich, who retired last September.

Just a few years ago, the county nursing home hadn’t a prayer to attract new clientele. It was a dark, foreboding place, with dingy paint, dark lighting, shabby furniture, malfunctioning equipment, structural challenges and other issues.

“It’s like a house that’s extremely well lived in,” Strickland said during a recent tour of the revamped facility.

Today the first two phases of the facility face-lift are just about complete — new roof, chiller, fresh cream-colored paint throughout, new ceiling tiles, lighting, flooring, furniture and redesigned spaces to create an open feel, to name a few improvements — and the final phase that includes a new $275,000 parking lot, generator, patio furniture — the outdoor patios are new too — and some odds and ends are all that’s left.

Sharon McCracken, who has worked for the home for 27 years — first full and now part-time — said she remembers well working on medical records in a window-less space in the basement.

“It was dark, dingy, dirty, depressing,” McCracken said. “This is open, light, beautiful, I love working over here, it’s wonderful.”

The commissioners have been diverting some Community Development Block Grant money — $400,464 since 2015 — away from other projects to the Care Facility. About $310,000 is pencilled in so far this year for the parking lot and other items.

Commissioner Don Dixon, who is in the nursing home business himself, said they are close — perhaps a couple weeks — to approving the creation of new segregated male and female secure dementia patient wings, which would be a niche in industry.

“I think we’re going to go that way, there seems to be a larger need on the dementia side than the long-term care side right now…,” he said. “I don’t know any (dementia facilities) that are really designed to separate men and women, to have their own distinct needs. It’s a real need. I think we can make some progress as far as our census goes if we move in that direction.”

The census at the 109-bed facilities has been hovering in the low nineties or an 84 percent occupancy rate. According to a 2017 report by the National Investment Center for Seniors Housing & Care, occupancy rates in nursing homes are anemic, dropping from 83.5 percent in the fourth quarter of 2016 to 82 percent by the end of last year.

Maintaining a high census is key to whether the home can hold it’s own or not.

“We are down a little bit, part of our struggle is census in nursing homes in general is down over the last six months,” County Administrator Charlie Young said. “We would like to be around 95 or 96 and we’ve been staying around 90 or 91. That difference of five or six patients is really what we need to get to a break-even point. Five patients, it’s roughly $1,000 a day.”

Strickland said part of the drop in census industry-wide is due to the managed health care push to have patients go home with a home health care provider rather than to a skilled nursing home for rehab upon release from a hospital stay.

MORE: Care Facility hit with more challenges

Another pressure that popped up last year was a decision by Medicaid to audit past billing statements — dating back almost a decade — and bill facilities they deemed were over-reimbursed.

The Butler County facility was dinged $114,000 for back billings. As part of the Affordable Care Act, Medicaid started doing audits of payments made to nursing homes from previous years. If a facility can’t for some reason provide adequate documentation for a particular reimbursement, the government asks for the money back.

“In most cases it is definitely not a case where the facility has done anything wrong,” Strickland said last year when the Medicaid bill arrived. “It’s just an effort to recoup as much money as possible.”

Strickland said they are currently working through the latest “take back” billings so they aren’t sure what they might owe yet. With the new technology the home has employed, Strickland said they now have iron-clad documentation of care that Medicaid shouldn’t be able to quibble with.

Dixon said the facility is “night and day” compared to a few years ago and the work is not over.

“The business model has changed a lot and will continue to change in that field,” he said. “We just have to be able to adapt and change with it. We’re doing a pretty good job at that. We’ve some ways to go yet but we’ll get there. It’s an industry that’s really in flux.”