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2/15/2007
It's just plain expensive
It’s expensive for counties to the in the nursing home business. Plain and simple, the challenge is the extremely generous benefit packages provided to state and county workers. And taxpayers need to know that. (FoxPolitics has urged the privatizing of Calumet County nursing home, Homestead Rehabilitation Center.)
Only 39 counties (of 72) in Wisconsin run nursing homes. Many are struggling to pay the bills, despite (in some cases) heavy taxpayer subsidies with property taxes. Calumet must determine, how, short of selling theirs, they will afford it.
First, just a few facts
- No state or local government is mandated to provide nursing home care, except to developmentally disabled citizens.
- Of late, the state has strongly encouraged developmentally disabled residents to be cared for in the most integrated community setting, such as community-based residential facilities (CBRF’s) - much smaller than a nursing home and with a home-like atmosphere.
- County nursing homes are not the last nursing home of choice. Regardless of method of pay, if a nursing home can provide the necessary service, they cannot turn a patient away. Yes, there is evidence that in some counties, the county nursing home houses a higher number of difficult patients. But this is clearly not the case in most counties, and certainly not in the counties without nursing homes. It must be remembered that the number of private and/or not-for-profit nursing homes in Wisconsin vastly exceeds the number of county nursing homes - and most homes house populations widely diverse in need and difficulty.
- The vast majority of nursing homes are paid via the same system, accepting private pay, Medicare and Medicaid patients.
- Quality of care varies from nursing home to nursing home, but a county-owned nursing home does not necessarily provide higher quality care than any given private facility.
Brown County
Supervisors continue their fight with lame duck Executive Carol Kelso. Kelso has repeatedly vetoed County Board efforts to build a new nursing home; she is working to maintain an agreement with the state to reduce the number of Brown County-owned nursing beds, serving developmentally disabled county residents in the least restrictive environment possible, per state and federal laws. Like Calumet County, eliminating nursing home beds is very difficult politically for many boards. County supervisors are moving forward to build a $16.7M facility.
Manitowoc County
The brand new 150-bed Manitowoc nursing home is operating with a $2M property taxpayer subsidy, and is still $500,000 short of what they need to properly fund the building. A new facility was completed in 2002, reducing inefficiencies and staffing compared to the old facility, and shifting more costs from operations to debt. That was critical, as Manitowoc residents, several years ago, denied spending more local tax money for a county nursing home. Building the new facility bought some time, but doesn’t look as though it’s solving the problem. Rumblings have begun about a possible sale of their brand new facility.
Sheboygan County
Sheboygan County has the dubious distinction of owning and operating more nursing beds than any county in the state. According to Supervisor Mike Vandersteen, the board has been supportive of privatizing one of its two nursing homes. The discussion was made productive and constructive by a citizens task force and a professional study, both of which looked at the pros and cons to selling one of the nursing homes. The county has since found a quality partner to purchase Sunny Ridge and are moving forward with that plan.
Politically, it’s very difficult to close county homes. I understand that. Politicians hear many of us who believe the county-owned nursing home is the nursing home of last resort, that private homes will turn people away. That simply can’t be allowed to be the case, especially in areas where ample options for care exist.
Privatizing a nursing home can address the very generous benefit costs provided to state and county workers. One of the counties quoted benefit costs of about 55% for a county-run home, and conversely, benefit costs of closer to 25 and 30% of total labor costs for a privately run facility. Property taxpayers can simply not afford super high benefit costs when competitive organizations can operate as effectively, but at a lower cost.
COMMENTS
Jo, Jo, Jo,
Not only is it expensive, it is WRONG for the county to be "competing" with private enterprise! Nursing homes in the Appleton Area have empty beds. County owned homes should not be taking patients from the private homes.
Dale (Thu Feb 15 08:04:51 2007)
Was just wondering why you did not have information on Outagamie or Winnabago County in your article? Both of these are large counties in the heart of the Fox Politics coverage area. I had looked at privatizing the Outagamie County program several years ago while I was on the county board. We even went so far as to have potential buyers come in and tour our facility. I felt at the time and still do that they were more interested in the easier cases and not the developmentally disabled tougher cases.
I also tried to get the County Executive(Toby Paltzer) to discuss a combined facility with Brown County before we built ours. I don't think he ever seriously looked at it. A regional facility makes more sense and would be cost competitive since you would not have to duplicate administration. We just have to get over our parochial nature. Mike Thomas
Mike Thomas (Thu Feb 15 10:35:23 2007)
I respectfully disagree with the opinions expressed regarding county-managed nursing facilities. Some may be better than others, but their intent is still the same. Unlike private nursing homes, they are certainly not "in it" to profit and make money.
Originally, these facilities were built to "house" those that were unwanted and/or abandoned by their families. They used to be called mental instiutions. It wasn't that long ago that when a child was born with deformaties, or showed signs of acute behavior problems, that parents were encouraged/advised to place them in an institutional setting. Many families felt ashamed about having such a child, and chose to isolate and punish them on their own. We now have technology that tries to predict possible abnormalities and disorders, and allows/encourages parents to terminate pregnancies based on these predictions. They are told how burdensome it could be physically, financially, and emotionally to take the risk; and what life would be like, and how unfair it would be for their child.
The questions I have are many, and I pose them to you as well. Where does the value of life itself enter in? What about quality of life? What can we, and should we, do as a society? Do we help the incapacitated, homeless and mentally ill, or should we let them live on the streets, and fend for themselves? What would be the consequences of that decision? Would our streets and neighborhoods be safer for our children?
Many county facilities have expanded their services to help cover costs and reduce the financial tax burden on the community. Having to leave one's home is very difficult, and it is the high quality of care and services provided that help individuals, and their families, accept this change. If private nursing homes have open beds, and are struggling financially, they need to look within their own operation, instead of looking at others to blame. I have been to other facilities that are obviously not held to the same high standards county facilities are, and I've always wondered why.
I'd also like to know why the county/state is willing to build duplexes,and manage programs for the developmentally disabled, but is ready to put the mentally ill out on the streets? Our homeless population is something that few acknowledge. If private nursing homes truly accept, and do not deny their services to anyone, there would be no empty beds.
Lori Hassell (Fri Feb 16 02:29:45 2007)
I am not that familiar with services around, but has consideration been given to offering half-day or full-day
"Elder Care" run in conjunction with the Manitowoc County Program? Even "drop off respite care" for spouses and families caring for an aging family members would be an awesome service to provide and perhaps might help the budget?
Interesting. Is there a reason you think this service should be offered by the county as opposed to by private operators, perhaps with a sliding scale reimbursement schedule that might be subsidized by the county? JE
Nancy Lindgren (Sat Nov 10 14:05:22 2007)
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