Wisconsin counties are promoting nursing properties to for-profits

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• Wisconsin has 36 county-owned nursing properties, greater than any state aside from Indiana.

• However residents in 22 Wisconsin counties misplaced public nursing properties to gross sales or closures over the previous three a long time.

• Six counties — Iowa, Lincoln, Portage, St. Croix, Sauk and Washington — have offered, closed or thought of promoting their nursing properties since 2021. 

• County-owned nursing properties are typically higher staffed, have greater high quality of care and draw fewer complaints than amenities owned by for-profits and nonprofits.

Arlene Meyer is a busy lady. 

The 86-year-old begins every morning by watching the information in her room at Pine Crest Nursing Residence in Merrill, Wisconsin. Then it’s off to the eating corridor for breakfast so she will be able to “BS with all people on the market.” She by no means skips her each day stroll and devours books delivered by the general public library every week — something besides romance or science fiction. 

The occasion calendar in Meyer’s room lists a smorgasbord of different choices: manicures and mimosas, chair Zumba, trivia, Packers watch events and beer pong. Meyer spent a latest Friday at an train class in an space of Pine Crest that later hosted a contented hour with reside music. 

“The idea of previous folks, it’s out,” Meyer stated, including that “the times go by so quick” — an statement that surprises outsiders with duller expectations for nursing residence life.

Meyer moved to Pine Crest in 2023 to get better from pneumonia. She preferred it a lot she stayed completely. The nursing residence’s social media posts present her holding a lizard, stress-free throughout a spa therapy and singing a Willie Nelson track at karaoke — pictures that introduced pleasure to those that know her.

“Sassy Arlene! Adore it!” one particular person commented on a photograph. “Completely satisfied you haven’t modified Arlene,” wrote one other. 

Lincoln County owns Pine Crest, one among 36 county-owned nursing properties in Wisconsin. They are typically higher staffed, have greater high quality of care and draw fewer complaints than amenities owned by for-profits and nonprofits, a WPR/Wisconsin Watch evaluation of U.S. Facilities for Medicare and Medicaid Providers information reveals. 

Wisconsin has extra county-owned nursing properties than any state however Indiana. However maybe not for lengthy. 

Over greater than three a long time, residents in 22 Wisconsin counties misplaced public nursing properties to gross sales or closures. This yr alone not less than 5 counties — together with Lincoln — thought of promoting, began the gross sales course of or offered.

County leaders say they’ve solely two choices whereas going through monetary pressures and staffing shortages: promote or shut the properties. Native organizers disagree, arguing counties ought to proceed offering high-quality take care of low-income older folks and disabled adults. 

Lincoln County’s board voted to promote Pine Crest to a for-profit in the beginning of this yr. After that purchaser backed out, the board is planning to discover a new one.

Meyer worries about potential disruptions at Pine Crest.

“I adore it right here,” she stated. “I sincerely do.”

A flurry of nursing residence gross sales and closures

Meyer, a former Lincoln County Board supervisor, doesn’t personal a cellphone, however she stays updated on native happenings. It didn’t take lengthy earlier than she heard rumblings about promoting Pine Crest. 

“I used to be teed off about it due to a few of these SOBs,” Meyer stated. “They stated, ‘properly, the fee issue.’ Now I take into consideration what jerks have been working this.”

Operating a nursing residence is pricey, and counties aren’t required to take action — one thing officers typically notice throughout recessions and inflationary intervals.

The monetary disaster of 2007 and 2008 was Wisconsin’s busiest stretch for nursing residence gross sales, with 4 counties promoting.

Since inflation began surging in 2021, not less than 5 counties outdoors of Lincoln have offered or thought of promoting: 

• Iowa County closed its nursing residence in 2022 after failing to discover a purchaser.
• A non-public nursing residence chain took over Washington County’s nursing residence in July. 
• The St. Croix County Board thought of promoting earlier than voting towards it.
• Sauk County’s board this yr accredited a sale to a for-profit that also requires state well being division approval. 
• Portage County heard curiosity from one potential purchaser however selected to not promote following public pushback. It is going to determine later this month whether or not to search for a special purchaser.

In the meantime, dozens of for-profit nursing properties have closed in recent times. 

Lincoln County began debating Pine Crest’s future in 2022 whereas the board sought finances cuts. Then-board chair Dan Friske observed Pine Crest had for years run substantial annual deficits.

That’s been the case for the reason that Nineteen Eighties for county-run nursing properties nationwide, stated Anne Zahradnik, an affiliate professor of well being administration at Marist School.

These remaining “are a holdover from an orientation towards authorities fixing issues,” she added. 

From ‘poor farms’ to nursing properties

Wisconsin’s county governments have a protracted historical past of housing susceptible populations. 

Many ran “poor farms” or “poor homes” for residents experiencing poverty beginning within the 1800s. Most states ultimately created centralized nursing properties to serve older folks and people with disabilities from throughout the state, whereas Wisconsin prioritized maintaining folks near residence. A Wisconsin community of native nursing properties and transformed poor farms began receiving federal Medicaid funding in 1974, in keeping with a Legislative Audit Bureau report.

Nursing properties for many years have been the one long-term care possibility for populations they served, and individuals who relied on authorities help had few selections outdoors of county properties. 

That’s altering as folks more and more age at residence or in assisted dwelling amenities that supply extra independence at a decrease value. Wisconsin’s assisted dwelling choices maintain greater than double the beds of its nursing properties. 

However assisted dwelling, not like nursing properties, can’t take care of individuals who want common medical consideration. Nor do they provide the identical protections towards evictions for residents who depend on Medicaid, the joint state and federal assist program to assist low-income residents afford care. 

Greater than 1 / 4 of nursing residence beds, on common, at for-profit and county-owned nursing properties sit empty, in keeping with federal Medicaid information.

Virtually 40 of Pine Crest’s 120 beds are vacant, however Wisconsin can’t afford to lose them. 

With out nursing properties, hospitals battle to search out housing for his or her sickest sufferers, Zahradnik stated. The Wisconsin Counties Affiliation initiatives a necessity for roughly 10,000 new expert nursing beds by 2035 as state demographics development older. 

To maintain Pine Crest working, Lincoln County’s board debated changing a part of it into assisted dwelling and even knocking it right down to construct a smaller nursing residence with decrease operation prices. Each choices would require up-front cash the county lacks, Friske stated. 

The one remaining possibility the board sees: promoting.

Counties battle to maintain up

Medicaid coverage is sophisticated and steadily adjustments. This system can also be how most nursing residence residents pay for care. 

Lincoln County’s board lacks experience on nursing residence administration, making it arduous to maintain up, Friske stated, echoing officers in different counties.

“We’re horrible at it,” he stated.

Because the board mentioned exiting the nursing home based business, it discovered the county was brief greater than $1 million in anticipated income to cowl one yr’s prices.  

The state has historically backed county-owned nursing properties, and it began rising Medicaid reimbursements in 2022. The change shrunk ongoing county deficits to supply care, wrote Elizabeth Goodsitt, a spokesperson for the Wisconsin Division of Well being Providers, which distributes the nursing residence dietary supplements. 

That was optimistic. However shrinking these deficits meant counties would get smaller lump sum subsidies for working nursing properties – one thing officers in a number of county governments didn’t anticipate, resulting in finances shortfalls.

“Simply once you assume you’re one step forward, you’re two steps again,” Washington County Govt Josh Schoemann stated.

He described the sudden lack of the subsidies as “simply one other brick within the wall” for a nursing residence the county in the end offered to a for-profit this yr.

Lincoln County used federal pandemic funds to cowl the sudden subsidy loss — a short-lived possibility.

Regardless of supporting county-owned nursing properties, state officers don’t at all times successfully talk with counties, stated Rene Eastman, vp of monetary and regulatory providers at LeadingAge Wisconsin, an advocacy group for older adults. 

Nonetheless, Eastman stated, the latest Medicaid charge reimbursement hikes might ease monetary pressures over time.

“If counties held on for a little bit bit longer, they might actually see the results of that funding infusion, and they’d see the elevated want of their communities,” she stated.

St. Croix County commits to nursing residence

St. Croix County Board Vice Chair Bob Feidler stated his colleagues didn’t severely contemplate promoting its nursing residence. However a dialogue about that risk prompted opponents to flood an August board assembly. 

The board voted towards promoting, deciding that nursing residence income would doubtless develop, aided by greater Medicaid charges and a federal grant to open a dementia wing. 

“Rapidly, we went from what had been a damaging income to barely a optimistic income, to a extra strong projection,” Feidler stated.

Many Lincoln County residents hope their board will attain the identical conclusion. However elevated Medicaid charges alone gained’t cowl wanted prices outdoors of care, like renovating Pine Crest’s  constructing, Friske stated. That will doubtless require a property tax enhance.

“You possibly can’t simply go on a whim, ‘Hey, yeah, we’re going to throw this more money on the property tax,’ ” Friske stated. “Persons are struggling.”

County leaders have traditionally requested voters to help nursing properties by poll measures.

Voters in Inexperienced County, as an example, accredited an April poll measure to proceed funding their nursing residence. 

Portage County voters accredited one referendum in 2018 and a $20 million referendum 4 years later for the development of a brand new nursing residence — renovations that also haven’t began. Rising development prices for the reason that delay imply tens of millions extra are wanted to fund the venture, in keeping with county board members who’ve blocked requires a recent referendum.

In Lincoln County, greater than 80% of respondents to a 2023 Merrill Foto Information and Tomahawk Chief on-line survey opposed promoting Pine Crest.

However the board blocked two efforts to place Pine Crest’s future on the poll.  

How personal properties revenue: Reducing workers, advantages 

Friske had gotten unsolicited calls from brokers even earlier than placing Pine Crest in the marketplace, as have officers in different counties. 

Why purchase a money-losing nursing residence?

For-profits can’t merely construct new amenities. The state determines the necessity for nursing residence beds in several communities — requiring newcomers to usually purchase a license from an entity already working a facility. 

Deficits below authorities possession don’t imply personal corporations can’t flip a revenue.  

They could discover financial savings by rejecting candidates with behavioral points who require costlier care. Counties that personal a nursing residence usually ship higher-needs residents there. Counties that don’t personal a nursing residence nonetheless pay to ship such residents to a different facility that can settle for them. 

Non-public homeowners steadily scale back staffing and advantages upon buying county-owned amenities, Eastman stated. Decrease staffing correlates with poorer care. 

The Facilities for Medicare and Medicaid Providers charges nursing residence workers on a 1 to five scale, contemplating time they spent with residents and turnover. 

The median workers ranking at Wisconsin’s county-owned nursing properties is 5, the best attainable, in keeping with WPR and Wisconsin Watch’s evaluation. That’s in contrast with a median ranking of three at for-profit amenities within the state.

An indication outdoors of the Portage County Well being Care Heart touts its 5-star ranking. Grace Skibicki, a resident of 13 years and a former care heart nurse, acknowledges that as spectacular. 

She expects care to say no if a sequence with a decrease ranking purchases it. She wouldn’t plan to stay round. 

“It’s actually scary since you don’t know what’s going to occur to you,” Skibicki stated.

Employees are additionally ready to see what their future holds.

Nursing residence work could be grueling with modest pay, accounting for important workers turnover throughout the business. However county-owned nursing properties make use of public employees who earn county advantages and entry to one of many nation’s best-funded retirement techniques. Which will clarify why median turnover tendencies at Wisconsin’s county-owned properties (41%) are decrease than they’re at for-profits (51%), WPR and Wisconsin Watch discovered. 

Wisconsin’s for-profit nursing properties drew a median of three substantiated complaints during the last three years, in comparison with a median of zero at county-owned amenities, which additionally fared higher than for-profits and nonprofits in well being inspection and total high quality scores.

Nursing properties owned by Lincoln, Portage and Sauk counties all charge above common, however county officers consider personal homeowners might run them higher.  

Counties battle to make fast selections the fast-changing business requires, Friske stated.

Potential patrons named in Lincoln, Portage and Sauk counties all personal a number of amenities throughout the state. Two personal amenities in different states. That setup makes it simpler for them to fund repairs or convert rooms to assisted dwelling rapidly with out repeatedly asking taxpayers. 

Care & Rehab Firm, which initially sought to purchase Pine Crest, owns six amenities in Wisconsin and Minnesota. Two share Pine Crest’s “a lot above common” federal ranking, however two others acquired “under common” scores.  

Folks for Pine Crest

Dora Gorski saved her husband Ken at residence for so long as attainable. 

Ken, a father, veteran, martial arts teacher and first responder, was typically too proud to confess to falling — even when Dora woke as much as discover him on the bottom.

She initially acquired assist from neighbors and residential well being aides who warned her about his worsening dementia. Ken ultimately ended up hospitalized and in want of a wheelchair. 

When Dora realized she’d don’t have any option to get him into their home upon their return, Pine Crest was her first name.

The lady in admissions knew Ken, who had taught her youngsters aikido. As soon as he moved in, a upkeep employee acknowledged Ken as his former martial arts trainer. A caretaker instructed Dora she knew Ken, too — having labored with him as a phlebotomist. 

It turned out that Arlene Meyer, a fellow first responder who had lengthy recognized Ken, lived down the corridor.

“It was individuals who not simply knew him as a doddering previous man who’s barely capable of discuss,” Dora stated. “They knew him as a revered teacher.”

Two weeks earlier than Ken’s demise in December 2023, Pine Crest hosted his ninetieth birthday celebration. His youngsters, former college students and pals, together with Meyer, packed a neighborhood room. 

“That meant so much to Ken,” stated Dora, who nonetheless participates in a bunch known as “Folks For Pine Crest,” which opposes a sale.

“We personal it. It’s our place. All of us take satisfaction in it being right here,” she stated.

The group spent 2023 urging the Lincoln County Board to maintain the nursing residence. Their flurry of petitions, yard indicators, T-shirts, public testimonies, cellphone calls and emails didn’t work. The board voted to promote to Care & Rehab.

However an legal professional and ally on the county board observed a language downside within the sale settlement and sued the county to halt the sale.

Care & Rehab backed out earlier than the case might transfer ahead, providing Folks For Pine Crest a reprieve. 

However Friske, who misplaced reelection this spring, sees a ticking clock. He expects Pine Crest will face a fiscal disaster that can pressure a closure except it sells. 

He resents any suggestion that his board colleagues don’t care about those that rely upon Pine Crest.

“The county board shouldn’t be a congressman from Missouri, Arkansas and Texas, telling Wisconsin how one can reside,” Friske stated. “What’s taking place right here is pals and neighbors who’re elected to the county board. They reside right here, their households are right here, we’re all right here.”

Lincoln County has simply two different nursing properties, each in Tomahawk and with decrease federal scores.

Dora Gorski, who lives 20 minutes from Pine Crest, stated the brief distance allowed her to eat breakfast with Ken most mornings. That routine would have been powerful to take care of — doubling the size of her drive — had he lived in one among Lincoln County’s two personal amenities or the state veterans residence in King, Wisconsin.

The county hopes to maintain some nursing residence beds in Merrill, stated present Lincoln County chair Jesse Boyd, however they gained’t be county-owned. He agrees with Friske’s monetary outlook. 

“Proper now, we’re drowning,” he stated. 

The county now has lined up a few potential patrons for Pine Crest.

If a sale proceeds? Pine Crest gained’t be the identical, Gorski expects. For now it’s “filled with neighbors and pals and folks from our neighborhood, individuals who love us and know us,” she stated.  

“You don’t discover that in some huge metropolis, and also you don’t discover that in a non-public, for-profit nursing residence.”

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