The Butler County Care Facility recently required another cash infusion from the general fund to make payroll, but county officials say the nursing home is on the path to recovery.
The county commissioners approved a $300,000 loan to the home last month after a $300,000 subsidy in December. Multiple issues, from staffing to reimbursement billing, have hampered operations at the home that has been financially fragile for years.
County Administrator Judi Boyko said the latest subsidy is a loan and will be repaid to the county general fund.
Boyko and the finance and human resources departments have been working with the new facility administrator, Chamika Poole, to address problems.
“There have been a lot of issues on the accounting side … and no, I’m not satisfied where it is,” said Commissioner Don Dixon, who is in the long-term care business. “We put Judi out there to continue the oversight and make some improvements on the accounting side.”
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Commissioner T.C. Rogers said Poole, who has been on the job about four months, faced challenges when she arrived.
“The new management has been diligent and found out that there had to be some protocols enforced that apparently were lax in the operation before,” Rogers said.
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.
The county-run home experienced some upheaval last year. Former administrator Jennifer Strickland left last spring, and a consulting firm ran operations before Poole was hired.
The home was without a director of nursing for more than a year and a business office manager for about six months. Poole started building up her management team on Nov. 25 by hiring an assistant director of nursing, and she added a business office manager a week later. The new director of nursing started on Jan. 6, and the coordinator in charge of reimbursements has been on the job for three weeks.
The commissioners hire the Care Facility administrator, and that administrator hires all other positions.
“That’s been the primary focus, to make sure I have a team,” Poole said. “I really just needed my team but now that I have them, we’re just trying to peel back those layers, and we’re working on systems.”
Poole said she has three administrative vacancies and 18 clinical positions to fill.
“Are any of the care staff working extra hours? Yes, but I think that’s indicative of every long-term care facility and the demands just can’t be met,” Boyko said. “However the clinical employees are not working beyond what lawful provisions and requirements permit.”
Collecting Medicaid and other reimbursements has been another big issue at the home, but Boyko said all the paperwork necessary to get paid is current now.
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Ever-changing regulations and reimbursement rates have plagued long-term facilities. The current Medicaid rate is $181 per day, up from $177 per day last year. Basic care for a resident costs the county about $183 per day.
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. Poole said reimbursement for Medicare and other insurance is patient-driven, according to the services they need.
In 2016, the commissioners hired consultant Plante Moran to study the options for pulling the facility out of the red. Dixon said the county plans to commission another study to get an updated forecast for the facility and recommendations for creating financial stability.
Almost four years ago, Chris Joos, a partner at the business consulting firm, gave the county several scenarios that included a “do nothing” option. He predicted if the county did nothing, the ending cash balance would sink to minus-$2 million, with revenues $1 million below expenses by 2020.
The dire prediction hasn’t come through because the county has made many changes at the facility, including investing more than $1 million renovating the physical plant and reducing staff. The budget in 2015 was $7.3 million, and the spending plan for this year is $5.6 million according to Boyko. Revenues are planned to exceed expenses by $6,199.
The 109-bed facility is one of 20 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.
The commissioners have been vehement they will not close the facility that is a last resort for many residents, but Dixon and Rogers said they could consider other options depending on the Plante Moran report
“I think everything is on the table,” Rogers said. “It’s just that we would like to preserve the operation, in the best interests of the residents that can’t take care of themselves. But there is a reason why now most counties do not have a similar facility.”