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The battle to save Pine Crest Nursing Home
It sounds eerily similar to what happened with Mount View Care Center in Marathon County not long ago. But Marathon County came to different conclusions
About two dozen residents stood in the lobby of the Lincoln County Services building Monday morning. Many held bright, neon-colored signs plastered with petition papers. Some were elderly residents of the nursing home called Pine Crest.
Pine Crest Nursing Home in the county-run facility charged with taking care of elderly residents, many who can’t afford private nursing homes (or had lived at private nursing homes until their funding ran out).
Some of those gathered either had loved ones in the nursing home, or were residents themselves.
Why were they gathered? Lincoln County’s board last month voted to sell the nursing home, as losses from the home mounted. The County Board came up with options that included cutting costs and increasing revenues; finding alternative uses for the property; selling the facility; or holding a referendum.
Last month, the Lincoln County Board elected to find a broker to sell the facility.
Oddly, it’s not the same set of options presented for Mount View Care Center when faced with similar shortfalls.
Marathon County in 2017 hired a consulting firm, Clifton Allen Larson, to take a look at options for Mount View Care Center. That came as Mount View hadn’t operated in the black since 2012.
And that came after the county scrapped plans for a $15 million upgrade of the facility in 2015. A common refrain from board members asked “Should the county be in the nursing home business at all?” To Lincoln County folks, that might sound familiar.
Why do counties run nursing homes? According to state statutes, counties are charged with taking care of their indigent populations at the end of their life. Though the laws don’t specifically say a county has to run a nursing home, it does need to provide care for people within that description. Running a nursing home was typically cheaper than paying for each individual’s care in private facilities.
But with mounting losses, would it ultimately be cheaper to either privatize the service, or sell the building and fund individuals privately?
Another factor: nursing homes typically lose money on Medicaid patients, but gain money Medicare patients. Mount View had specialized services such as a ventilator unit that helped subsidize the Medicaid patients. Finding that balance is a key to running a nursing home.
One of CLA’s early recommendations, before looking at the broader issue of sell, upgrade or privatize, amounted to this: fix the balance. It meant downsizing the number of long-term patients and increasing the number of short-term ones. Then CEO-Micheal Loy had already implemented some of those recommendations by the time they were presented to the special task force, and already the nursing home had been operating in the black for a couple of months.
So what of Pine Crest? Currently the nursing home has about 80% of its patients on Medicaid. Adding specialized services that cater to Medicare patients would certainly improve finances.
At the time (2017) CLA consultants predicted the numbers of nursing homes in the state would decline in coming years. They were right. According to Wisconsin State Journal, 23 nursing homes closed in the past three years in the state, and 10 of those came in 2022 alone. Assisted living beds also decreased in recent years, and right now are at about the same level as they were in 2018.
That might seem odd considering the “silver tsunami” effect of growing older populations as early baby boomers start to reach nursing home age. But, as the consultant said at the time, there has been a greater emphasis on home care and aging in place, as medicine improves along with home care services.
Marathon County’s solution was to take some of those recommendations for short term financial turnaround, then ultimately build a fully remodeled nursing home along with an entire campus-wide upgrade costing more than $70 million. Work on that remodel is nearly complete, and the Mount View Care Center portion of the remodel has already been completed.
That would have been good news to a resident I interviewed there in 2017, Tom Jablonski. He told me he enjoyed being a resident there. Also, his wife enjoyed the proximity so she could visit him. There was a real possibility at the time that if the county closed Mount View, at least some of its residents would need to be moved outside of the county.
I thought of him when I listened to Pine Crest resident Al Clark, who at 94 was one of the several dozen outside the county meeting room in Lincoln Monday morning. Clark didn’t want to see his home disappear. He along with his wife became residents in 2019, and the nursing home staff were exceedingly patient in handling her as she dealt with Alzheimer’s Disease in her final years, he said.
She never swore in ordinary life, but that changed as Alzheimer’s set in; which the staff took in stride. “I have a nice room at the end of Pine Crest across from a field, and that’s where I’m going to end my life,” Clark said. “Pine Crest gives me a chance to end my golden years in care and comfort.”
Why did Marathon County make the decision to keep Mount View? Because ultimately it proved the best option of the three. Costs to meet its statutory obligations would still have been expensive, without revenues to help off-set those costs, and having a private firm wouldn’t have saved much while giving the county almost no control over what happens there. Because the county is still responsible for those patients, it would have put the county in a potentially dangerous spot, the committee concluded. That committee’s membership included some of the most fiscally conservative board members at the time, yet few disagreed keeping the nursing home was the best decision.
The CLA consultant, Michael Peer, described what the sale process would look like. First would be the hire a broker to sell the property, which Pine Crest is doing now. Mount View had the advantage of being located on Lake Wausau, an advantage Pine Crest doesn’t have. Second would be to move all the residents. That part is difficult, he said, as some patients are difficult to transition.
Even more difficult, he said at the time, is staffing. Once it’s announced that the nursing home will close, Peer said, the best staff will start looking for better jobs and will be the first to leave. People would need to pay large bonuses to get people to stay, and probably offer severance pay, which would be costly.
Peer said every situation is different, but the whole thing taking at least two years is not out of the question. With limited bed space back in 2017, and that situation growing even worse, finding homes for all the residents will be a challenge.
And having a third party operate the home is risky, Peer told the county officials gathered back then. Sometimes it turns out great; other times, they’ve been complete disasters. With the county responsible for what happens there, but with far less control over day to day operations, the liability made most committee members nervous.
Ultimately, Marathon County chose to renovate, while downsizing long-term space (and improving the space for residents). Of the three, it appeared to be the best and least costly option. Then-administrator Brad Karger told the county officials that moving nursing home residents, which undoubtedly would include out-of-county placements, would have cost nearly as much as running the nursing home itself.
It wouldn’t be fair to say Marathon County’s approach was a giant success. It’s hard to tell; COVID plus inflation plus major changes in workforce pay and demand sent NCHC’s finances back into a spiral. The major campus overhaul was supposed to ultimately pay for itself with efficiencies, but the above problems seriously changed the equation.
But that needs to be weighed with what might have happened had the county taken one of the other options.
For residents in Mount View, able to stay in the county, and their families who won’t have to travel far to visit them, it’s almost certain they’re glad the county made the decision it did.
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