Two years ago, the facility needed a $425,000 subsidy, 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 it partially repaid. However, it has continued to need regular infusions of cash as Medicaid reimbursement rates, regulations and audits affected the bottom line.
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“It won’t be the last time,” Commissioner Cindy Carpenter said about the latest general fund loan. “I don’t believe that it’s ever going to pay for itself. I think we’re always going to have to subsidize the Care Facility just because of the nature of the clients that we have there and their ability to pay.”
Commissioner Don Dixon, who is in the nursing home business, said the funding issues aren’t exclusive to the county home. Dropping Medicaid reimbursement rates and a severe shortage of available staff, which bloats overtime hours, are in part to blame, he said.
County Administrator Judi Boyko said the transition from former administrator Chuck Demidovich, who ran the operation for more than 20 years, to Strickland and Poole has not helped the bottom line at the facility. She said she looks forward to working with Poole to instill some new business practices.
“I have recognized it’s all a function of cash flow, so timely submittal of reimbursements of Medicaid or any other form of payment for services is essential in receiving funding to pay the bills,” Boyko said adding “Some of the best management practices that I was hopeful could be implemented, were unable to do that.”
Poole told the Journal-News when she took over there were a number of trouble spots but she is addressing them.
“When I took over it was really difficult to pinpoint where those issues were,” Poole said. “I still have a lot of unanswered questions about where to begin. We’re still trying to find the root cause analysis for a lot of those things now and build on good practices.”
In 2016, the commissioners hired consultant Plante Moran to study the options for pulling the facility out of the red. Chris Joos, a partner at the business consulting firm, gave the county several scenarios that included a “do nothing” option.
He said the county could raise taxes, lease the facility to a third party to run, continue to outsource billing and accounting functions, downsize to 99 beds and spend $500,000 making renovations to the facility so it is more competitive with private providers. Under the plan, the Butler County Care Facility “would be able to reach a healthy cash balance of $1 million by 2019,” Joos wrote.
The county has spent about $1 million upgrading the dark and foreboding facility and hired a consulting firm, whom Strickland worked for before she became the administrator, to address some system and policy issues. The county also reduced 16 positions in 2017, some with reduction in force notifications and others through attrition.
“Depending upon what kind of models we can come up with I don’t know if it will ever be profitable,” Commissioner T.C.Rogers said. “But I think it can be close to paying for itself. But we are providing a service of last resort in some cases and that’s what we have to continue to evaluate. We also see why the vast majority of counties don’t have their own care facility.”
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The 109-bed facility is one of 22 county-run nursing homes left in Ohio. The nursing homes were previously mandated in all 88 counties, but 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.
Given the tough nursing home market, Dixon said next year the county plans to implement some things that should help turn the tide financially.
“When we did the remodel we did distinct wings so we could divide them up and offer different services so we’re going to explore some of that, and see what kind of combinations we can put together and different services we can provide other than nursing,” he said. “What would that be, mental health maybe it could be a number of things.”
The census for nursing home patients has been running in the high 70s and low 80s so Dixon so they will “downsize” the nursing side, but still stay true to the mission.
“The goal has always been to break even but we made the commitment, we’re going to take care of the ones that don’t have anything, nowhere to go, no family, no nothing, no money,” he said. “That’s been the county mission and we’re staying with it.”