“There have been some challenges with receipting, especially the last couple months, because of just the Medicaid, Medicare and the processing of all government functions,” Boyko said. “I’ll be candid we are trending about $1 million expenditures higher than revenues at this point.”
Boyko said she hopes this is a short-term issue, “we’re hoping that once the restoration to all levels of government and we start to see some fluid services, we hope to see reimbursements come in more quickly.”
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The county commissioners have routinely had to give the nursing home cash infusions for a variety of reasons. They approved a $300,000 loan to the home in January after a $300,000 subsidy in December. Multiple issues, from ever-changing Medicaid regulations and rates to internal reimbursement processing problems, have hampered operations at the home that has been financially fragile for years.
Before the coronavirus pandemic struck Boyko said the latest subsidy is a loan and will be repaid to the county general fund.
Commissioner Don Dixon said they might have to dip into the general fund again to see the Care Facility through this unique rough patch. Medicaid and Medicare are federal programs, but money is funneled through the state.
“We don’t know what that’s doing to be because reimbursements are coming in slow from the state,” Dixon said. If the reimbursements are late, the commissioner said the county will “have to step in and advance it.”
Of the facility’s patients, about 35 use Medicaid, about 7 percent use Medicare and the rest use managed care and other forms of insurance, Care Facility Administrator Chamika Poole told the Journal-News previously. She could not be reached for comment on the current situation regarding reimbursements or staffing numbers.
Commissioners authorized payments totaling $450,000 in 2018. The facility needed $425,000 from the general fund the prior year, and in 2016 the commissioners had to loan it $225,000 so payroll could be met through the end of the year. At one time, the county nursing home owed the general fund $1.1 million, a debt the home partially repaid.
Staffing continues to be an issue at the county-run nursing home and the industry in general. At the beginning of April, the home was short about 18 employees, according to Poole. Boyko said she asked Poole to closely monitor the census versus staffing ratios.
“We wanted to reduce perhaps the number of residents that reside over at the Care Facility, we’re trying to do that in the most strategic way,” Boyko said. “Based on the staffing models we’ve studied anywhere between 68 to 70 is probably the residential base that can be served based on the staffing levels we have currently.”
There are currently 74 residents at the 109-bed nursing home. Dixon, who is in the senior living business, said patients come and go on a fairly regular basis, so reducing the population there can be done through attrition rather than asking residents to leave. One wing was already cleared out to prepare in case residents needed to be quarantined. There haven’t been any positive COVID-19 cases.
He said the staff is stretched thin, but the situation isn’t dangerous.
“They are like all the rest of the long-term care people and the hospital people they’re working max,” Dixon said. “They can handle it, but it’s not ideal.”
Staffing has been an issue for a year because the home experienced some upheaval last year. Former administrator Jennifer Strickland left last spring, and a consulting firm ran operations before Poole was hired in September. The home was without a director of nursing for more than a year and a business office manager for about six months.
Poole said previously even with the unemployment skyrocketing daily she has had a hard time finding help.
“I think it could be fear,” Poole said. “They don’t want to put themselves in any more increased risk of catching COVID and bringing it home o their families and loved ones.”