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Nursing homes recapture $14M

News-Monitor - 5/13/2017

Long term care was looking for $21 million to be reinstated by the North Dakota Legislature after the state enacted sweeping cuts last year to virtually all state programs.

They received about $14.2 million at the session's close.

In a way, Sen. Jim Dotzenrod, D-District 26, considers this a victory considering the limited funds that were available during this biennium.

At crossover, long term care only was looking at recovering $12 million from the $25.1 million that nursing homes lost after North Dakota imposed a 4.05 percent cut last year, so finding another $2.2 million was not easy and took all the way to the session's waning moments.

Majority leaders at the House and Senate promised to find additional funding for long term care, a necessity because nursing homes cannot make money. Facilities like St. Gerard's Community of Care at Hankinson annually operate in a deficit, so losing the $152, 560.28 from the allotment cuts, which is calculated as a loss of $12.12 a day, per resident, was going to be devastating, reported administrators earlier in the session.

With the reinstated funding, St. Gerard's will recapture $6.60 per day, per resident, which comes from rebasing rates, implementing an efficiency incentive and restoring the 3 percent operating margin that raises to 4 percent on Jan. 1, 2018, said Administrator Jill Foertsch.

"We knew we had to do something. We thought with the level of cuts that were put in place, if they would have stayed at the same level, that would have closed some nursing homes. We didn't get the full $21 million, but we were close," Dotzenrod said.

Even with the new rate structure in place, the nursing home will still be operating in a deficit, just not as much as it expected, which comes as a relief to Foertsch.

The two feel like legislators made long term care a priority, but there just wasn't enough money to go around, which distresses Assistant Administrator Sister Mary Louise.

"I find it very hard to understand. I was overwhelmed with where we were, then to come to this session and be told the money just isn't there," she added, thinking it would have been better to put a road project or two on hold to fund priority programs such as long term care.

The big three in terms of state funding are K-12 public education, department of human services budget, of which nursing homes fall under, and higher education. Other than public education, all other programs did see funding decreases this year, Dotzenrod said.

The loss of funds comes when Foertsch worries about keeping her skilled personnel on staff. Sanford Health is opening its new hospital at Fargo soon and is trying to tempt skilled nursing staff - both registered nurses and certified nursing assistants.

"There's a big push for nurses up there . it's not such a long distance to drive. We need, well we don't have a lot of money, I don't have any money, but yet I need to keep my staff that I have," Foertsch said, difficult to do when Sanford is offering signing bonuses.

She can't cut a cook because St. Gerard's only has one cook on duty each day. And the facility can't decrease its housekeeping staff.

Looking to the future, the North Dakota Long Term Care Association will be working with Human Services to look at the rate setting system, to see if any improvements can be made, Foertsch said. This a very intricate system since rates are different for each nursing home resident, based on their level of care and other factors.

That was confusing to legislators because the rate setting system is so complex, Dotzenrod said.

St. Gerard's has always depended on fundraising to offset expenses. That will not change anytime soon. It worries Foertsch that since the facility had such a good Giving Hearts Day in February, people will think donations are not necessary. To the contrary, donations are even more important now, she said, since St. Gerard's used the largest portion ever from Giving Hearts Day to put into its operating budget. It also used funds to update the first floor's fire sprinkler system to make the nursing home compliant with new regulations, while other funds were put into the foundation.

"We've always put some funds from Giving Hearts Day for operating funds. But never this much," Foertsch stressed.

No matter what, St. Gerard's board of directors and administrators are committed to carrying on their mission. The doors will not close, but the facility is watching expenses.

St. Gerard's is watching staff overtime carefully. If someone calls in sick, they look at whether it's necessary to replace them on the schedule and may even send staff home early if it's quiet on a shift.

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