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Commissioners moving toward selling county's nursing home

Meadville Tribune - 3/4/2023

Mar. 4—SAEGERTOWN — Citing a projected $5.5 million dollar operating deficit by 2024, continued staffing challenges and low insurance reimbursement rates, county commissioners are looking to put the Crawford County Care Center up for sale.

Commissioners Friday confirmed to the Tribune the county is looking to sell the county-owned and operated nursing home to "a buyer with a proven track record of following CMS (Centers for Medicare and Medicaid Services) and (Pennsylvania) Department of Health standards."

The 157-bed nursing home facility formally is not on the market as yet, though Crawford County Care Center administration and employees were informed of the move toward a sale this week.

Commissioners have been in contact with commercial real estate broker Walker & Dunlop Inc. and will seek advertise for request for sale proposals in the coming weeks.

Commissioners Eric Henry, Francis Weiderspahn Jr. and Christopher Soff all said it would be a rigorous process with ample research and vetting of prospective buyers.

"We're not looking to sell to substandard care or somebody with a poor track record," said Henry, who is chairman of commissioners. "We're proud of our employees. They've done a wonderful job and to maintain a five-star (CMS) rating through all of this is nothing short of impressive. We will not sell to a (firm with a) subpar CMS rating."

The earliest any sale would expect to be completed — if at all — would be July, according to commissioners.

"We have no deals, we have no buyers at this point," Henry stressed. "But, if we don't sell, we'll reset and continue to operate the home. But, we will have to make some significant changes in operations."

Low insurance reimbursement rates coupled with a low patient census and staffing shortages have put the care center in a financial hole, according to commissioners.

Only 82 of the 157 beds at the nursing home are occupied, commissioners said. Of those 82 patients, 69 of them, or 84 percent of them, are Medicaid patients, rather than privately insured.

Medicaid is a state medical care plan funded by the federal government that pays for public assistance recipients.

The financial problem is the Medicaid medical assistance reimbursement rate paid to the county doesn't cover the county's costs of care per patient, commissioners said.

It currently costs the county $294 a day per occupied bed, with the Medicaid reimbursement rate is only $179 a day, commissioners said.

It's a difference of $115 a day per Medicaid patient and at the current census of 84 percent, or 69 residents, being Medicaid patients — that's a deficit of $7,935 a day for the care center.

One wing of the nursing home is shut down because the home is having trouble finding enough nursing staff — even if there was an increase in nursing home population.

"The staff gives exemplary care to the residents, but we're short-staffed," Soff said.

Soff and the other two commissioners said the county is losing employees because it can't compete with current wage rates of private sector nursing homes. However, the county's benefit package offers health insurance and a traditional pension, commissioners said.

The home has had to use overtime to cover necessary skilled care positions; and hire registered nurses to fill nursing positions that could be filled by license practical nurses. Registered nurses are paid more than license practical nurses, but LPNs can't be found, commissioners said.

The county nursing home has a staff of 77 full-time workers, but could use another seven nurses — either LPNs or registered nurses, another nine or 10 certified nurse aides, or CNAs, Tonya Moyer, the home's administrator, said. It also could use another half dozen per diem workers in support staff.

There are 134 workers altogether counting the 77 full-time workers plus another 57 per diem workers who are registered nurses, LPNs, CNAs or support personnel who are called on an as-needed basis to fill in, Moyer said.

The combination of low reimbursement rates and staffing challenges has added up to a financial strain on the care center — ultimately which could impact county taxpayers if not addressed, commissioners said.

The care center, which is supposed to be self-sufficient, had what would have been a $2.4 million deficit in 2022.

The county was able to use some its American Rescue Plan Act (ARPA) funds to temporarily increase employee wages and cover some costs of care, but the ARPA funding ended in December 2022.

Meanwhile, the care center has a $2.4 million deficit projected for this year and another $3.1 million deficit predicted for 2024 — if nothing is done.

"One thing we've not done is allocate money and increase taxes strictly to infuse cash into the home," Soff said.

If the county would continue to operate the care center, Soff said the county would need a property tax increase of about 2 mills of tax just to cover this year's projected $2.4 million deficit. Another increase then would be needed to cover the home's projected 2024 deficit, Soff said.

Commissioners said a private entity should be able to operate the home without a loss due to different regulations and reimbursement rates for private sector and government-run facilities.

Commissioners said they've explained the financial situation to Crawford County Care Center staff.

"We're asking them to stay the course," Henry said. "We want the same staff to take care of the residents with the same level of care they're getting now. We're hoping to find a good partner that will offer them more wages."

Keith Gushard can be reached at (814) 724-6370 or by email at kgushard@meadvilletribune.com.

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