“You have got to have staff.”
Orchard Manor Committee Member Diane Nelson came back to the heart of the matter after a portion of her committee had heard a report from Patrick Carroll from Wipfli consultants about options for the county nursing home, which is about half-occupied due to a shortage of staff.
The report compared the fiscal impact on whether the nursing home remained focused on being what it has been, or if it added assisted living to its empty space. The report presented gave few options on how to solve the greater dilemma of finding adequate staff to fill the needed roles.
Currently, Orchard manor is sitting at less than half capacity.
Orchard Manor has seen the impact of a lack of qualified workers strike the institution in two ways - it limits the number of people who can be residents, and it has increased the cost of their outside services they are paying for, as they are contracting out to fill roles like CNAs.
In the past, Orchard Manor had been spending an average of $275,000 in outside services, according to Carroll. Because of the dearth of CNAs, Orchard Manor has seen that cost increase to $874,000 last year, and it is projected to nearly double to $1.435 million by 2027.
Likely seeing the issues that nursing homes are dealing with on staffing, as well as increased costs due to inflation, the state has put in two straight years of increases into Medicaid reimbursements for nursing homes, including a massive increase of 27 percent this year.
“We have never seen it,” Carroll said of the increases.
While the state is reducing its supplemental payment program, which is meant to help publicly-run nursing homes with losses, Carroll said the result is the nursing home will have more funding overall, there will be more money, and the projections are the budget for Orchard Manor will be in the positive in future years.
Because of this, and the projections in the future, Carroll said it made more sense to stay as a nursing home, than create a nursing home/assisted living center hybrid.
“If you had staff available, you would pick the skilled nursing facility,” Carroll said of whether to choose between being a nursing home or to add assisted living.
However, staffing demands were exactly why the county was looking at options.
The idea behind looking at assisted living was that such programs are not as labor-intensive as a skilled nursing home.
Another thought about adding assisted living space is to get people in the door, and familiar with the facility. Erdenberger noted other reports show that demand for skilled nursing care will remain the same for the next decade, and that switching some of that unused space into assisted living will mean people who are looking for that type of facility with get to feel familiar with Orchard Manor for if or when they would need to shift into a skilled nursing home.
Carroll felt the impact would be minimal as assisted living facilities are beginning to offer more specific support for needs of residents.
As far as what was presented Tuesday, there were few options given on ways to increase staffing at the facility, and what was presented was thought to be nominal at best.
Carroll talked about the possibility of creating two different wage schedules for CNA staff, one for those using the county insurance plan, and for those who do not. Carroll noted that when it comes to CNAs, they tend to be younger, and therefore they would still be covered by their parents’ insurance plans. Carroll stated that to incentivize them to do so, the county could create another wage schedule for those employees, paying them more.
Personnel Director Joyce Roling thought the impact would be very minimal. She noted that in the case of high school-age CNAs, they are not taking insurance right now anyway, and they often do not work the minimum of 30 hours to qualify for county health insurance.
“I’m not so sure how much that would save us,” Roling stated.
Another item Carroll discussed was making it easier for people to apply to the facility, stating it took him 15 minutes to find the place to apply.
“If it takes that long, they will apply somewhere else,” Carroll stated.
Carroll also pointed out that there are a lot of residents in the state who are looking for longterm care for their loved ones who suffer from cognitive issues like Alzheimers and dementia, as well as other psychotic issues.
“That population is underserved across the state,” Carroll stated. “I think you could increase residency present day if you could find staff.”
Erdenberger agreed, and noted that based on the referrals she receives from doctors and specialists, the demand for support programs is there.
The meeting was held on a Tuesday, varying from the committee’s normal Wednesday meeting day. Because there were only two members of the committee there - Nelson was joined by Donald Splinter as well as County Board Chairperson Robert Keeney - the meeting did not have a quorum. The only item on the agenda was to review the Wipfli report, and since no action was being taken (any action would require a quorum), they continued on to get the information to move forward.
