Friday, March 16, 2012

Commissioner: Manor subsidy inefficient

Schoen, senior care providers say levy is harming facility’s finances

Express Staff Writer

Debate over the future of senior care in Blaine County heated up Tuesday as one county commissioner alleged that the Blaine Manor levy was causing Blaine Manor to operate inefficiently.

Commissioner Larry Schoen said during a commissioners meeting that he has heard from two private health care companies—Safe Haven Health Care and BRP Health Care—that the county's subsidy was encouraging Blaine Manor to operate with excess staff and at a low Medicaid reimbursement rate.

"I'm not a skilled-nursing expert," Schoen said in a later interview. "But there is enough focus on this issue that when two separate companies say the same thing, I take it very seriously."

Blaine County is currently subsidizing the Blaine Manor skilled-nursing facility in Hailey via a property tax levy at the rate of $1.9 million over three years. The levy is meant to cover the manor's operating loss, which manor Finance Director Stephanie Jaskowski said mostly comes from the gap between the expense required to run the facility versus how much it is reimbursed for Medicaid patients.

Jaskowski said the manor manages to obtain a very good reimbursement rate—one of the highest in the state—but it still doesn't cover fixed costs. Because the manor is so small, Jaskowski said, fixed costs like staffing and overhead are not spread among as many people as they would be in a larger facility.

"We have about the same staff as a large facility, but they would be able to spread the cost," she said.

The level of staffing is governed and required by the state, she said.

Schoen declined to name specifics when asked how Blaine Manor could be running more efficiently.

"I'm not in a position to demand that Blaine Manor reduce staff," he said. "We're providing the highest quality of care possible given the limited resources of that facility. I'm not qualified to express my personal opinion about whether we could be operating more efficiently—but it could be true."

The efficiency conundrum came to light in the midst of a discussion about what would be the best solution for senior care in Blaine County. The commissioners agreed Tuesday to focus on a public-private partnership, in which the county could help a for-profit or nonprofit facility establish itself with the goal of the facility's eventually taking total control.

Commissioner Tom Bowman said that when Blaine Manor became a stand-alone senior care facility after splitting from St. Luke's Wood River Medical Center in 2001, the county never anticipated that funding the manor would be a long-term solution.

"We never thought we were going to stay in that business," he said. "There is no doubt in my mind that the county liked the idea of not being a part of [senior care operations]."

Bowman said the county was so supportive of giving up a role in senior care that it fronted more than $1 million to the Croy Canyon Ranch Foundation with the goal of helping establish a standalone facility. However, he said, progress has been slower than anticipated.

"Still we are not at the point where we can break ground," he said.

Commissioner Angenie McCleary said she would prefer to focus on providing safe and compassionate senior care, with removing county responsibility as a secondary concern. However, Schoen said doing both is possible, and urged McCleary to eliminate the possibility that the county might have an ongoing support role.

"We have had [private] providers say there is a market for skilled nursing in Blaine County, and they can do it without public subsidy," he said. "I don't understand why you're not willing to do that."

McCleary said she needed more information on the private companies' care methods, business plans and the market.

"I'm hopeful, but until I have that information and I am confident [with that information], I am not willing to eliminate the public option," she said.

Kathleen Eder, executive director of the Croy Canyon Ranch Foundation, said in a later interview that she believes Croy Canyon Ranch is still the best solution for Blaine County.

"We're already in somewhat of a partnership with the county," she said. "We always think we have the best plan, the solution that everyone is looking for. I'm sure [the county] is hopeful that we succeed in some way."

The commissioners decided to issue a request for information to any senior care providers willing to provide an overview of how they would provide care for county seniors, to be submitted by April 23.

County Administrator Derek Voss said the responses would help direct the commissioners' further discussions.

"We just need more information, and now we have a better understanding of the kind of information we need," he said.

Katherine Wutz:

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