For a senior that needs help in Blaine County, options run the gamut from full-time 24-hour skilled nursing care to in-home care for a few hours a week.
But while current debate over senior care has focused on the possible cost to taxpayers, seniors themselves must decide what level of care is necessary—and how to pay for it.
Chrystal Harper, a 106-year-old Bellevue resident, first considered the need for care when she was 93. Harper rolled her car and broke her back in three places, but chose not to go to Blaine Manor. She still refused to move from her Bellevue home 10 years later, when she fell and broke her hip.
"She's very, very independent," said family friend and neighbor Sharon Schrock. "[But] she required care."
Harper isn't alone. As of the 2010 census, more than 11 percent of Blaine County residents are over 65 years old, and have been or will be considering the cost of finding medical care or other assistance as they continue to age.
But at what cost, and what options may be affordable for seniors with different needs?
According to senior care providers, the cost of care varies widely depending on the type and amount of care necessary. Blaine Manor, the county's only skilled nursing facility, is possibly the most expensive option in the valley at $7,000 a month. That's $233 dollars a day, above the state average of $185.
On average, patients see a nurse or nursing assistant for roughly five hours a day, though staff is on call 24 hours a day.
Blaine Manor Administrator Gail Goglia said patients with Medicaid don't pay that full amount—instead, they turn over their Social Security checks to Medicaid, which then foots the bill for room and board.
Medicaid reimbursement does not cover the other services offered by the manor, however, meaning that the facility has to absorb that cost to the tune of more than $600,000 per year.
As a result, the county has been subsidizing the Blaine Manor since 2001, when the facility split from St. Luke's Wood River Medical Center.
A levy on Blaine County taxpayers has raised $1.9 million for the manor's continued functioning, but commissioners have continually stated in public meetings that this funding model isn't sustainable.
A slightly less expensive option for taxpayers and possibly patients is the Blaine County Senior Connection, a nonprofit organization based in Hailey that sends nurses and nursing assistants into the homes of 150 area seniors per day.
"Most people don't need a [full-time] nurse, even in a nursing home," said Senior Connection Executive Director Kimberly Coonis. "Every client has a different level of care, and a different price."
Coonis said the organization charges clients on a sliding scale, covering everyone from people with Medicaid—who pay nothing out of pocket—to private-pay clients who can afford to pay $20 an hour.
For a private-pay patient who needs 24-hour care, that can run up to $13,000 a month. However, Coonis said, most of her patients need only a few hours of care per day or week, and pay between $14 and $16 per nursing hour. She said that rate barely covers the cost of the service.
"It costs $60,000 a month to keep our doors open," she said. "We hang on every month by a thread"—and through county funding and private donations.
The only fully privately funded option in Blaine County and the larger region is an assisted living facility operated by SafeHaven Health Care in Bellevue. Scott Burpee, CEO and president of the company, said SafeHaven operates assisted living and skilled nursing facilities in seven communities, including Wendell, Gooding, Pocatello and Burley.
On average, he said, his patients in Bellevue pay $2,700 a month—though the actual cost to most patients is far less, as 75 percent of them pay through Medicaid.
How can he charge so much less than Blaine Manor's $7,000 per month? Burpee said that because his facility in Bellevue is only for assisted living rather than skilled nursing, he has to comply with far fewer regulations and therefore his overhead is lower.
Patients in his skilled nursing home in Pocatello also pay a similar rate to residents in Bellevue, but he said that's a matter of scale. While Blaine Manor has only 25 beds, Burpee's skilled nursing home in Pocatello has 84, allowing more patients to share the fixed costs associated with a facility—such as an administrator and an activities director.
"[Those costs] are half as much to a person in the 50-bed home than in a 25-bed home," he said. "[Blaine Manor] will never get away from the county subsidy. It's not Blaine Manor's fault, it's simply because they can't pay for all the things the regulations require."
Burpee also said his facilities' business plans are based on the assumption that every patient would be on Medicaid, which prompts him to build to a scale that would make that model feasible.
"We know not all of them are going to be on Medicaid, but every patient that's not on Medicaid is an additional margin," he said.
Naturally, the numbers don't tell the full truth. While Blaine Manor may seem expensive, it provides staff that is on call 24 hours a day, seven days a week, in addition to helping with medication, meals, laundry and other assistance.
"For most of our residents, maybe all of them, they really could not be left alone for any period of time," Goglia said. "They need to be safe—some are very fragile."
Senior Connection might end up being more for some seniors with the ability to pay, but Coonis said many of its patients wish to remain at home at any cost.
Schrock said Harper, who gets care though the Senior Connection, simply doesn't want to live in a senior facility of any sort.
"She keeps saying to me, 'I don't care what happens, I just want to stay in my house,'" Schrock said.
Blaine County Commissioner Tom Bowman said at a county meeting Tuesday that the commissioners seemed to be seeking a "silver bullet" solution for senior care, but questioned whether such a thing was even possible.
A senior care solution, according to the principles set forward by the commissioners, must be affordable for both the county and its residents while providing a high level of senior care.
But making care affordable for seniors themselves might become increasingly challenging because of the recession, Coonis said.
"[Seniors] don't have the savings account, they don't have the home equity they thought they could live on," she said. "They just can't pay for care."
Katherine Wutz: firstname.lastname@example.org