Source: Lake Geneva Regional News

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Nursing home no longer ‘new’ facility

by Dave Bretl - Walworth County Administrator

August 04, 2011

A friend of mine chastised me the other day for not keeping up with the times. We were comparing children's photos and when it was my turn, I pulled out pictures of my three kids that were at least six years out of date. I could have still saved myself from the scolding when he inquired whether I chose to keep such outdated photos out of a sense of nostalgia. Not thinking quickly enough, I confessed that I kept such old pictures because, until he pointed it out, they really didn't seem that far out of date to me. My friend was right and I promptly replaced the pictures with newer ones learning, once again, that time passes by much more quickly than I realize.

I recently experienced the same phenomenon when I read an announcement regarding the fifth anniversary of the county's skilled nursing facility. Since its opening in 2006, I have always referred to the Lakeland Health Care Center as the new nursing home. Like the pictures in my wallet, however, enough time has passed that I should probably drop the word "new" when I talk about it. It was five years ago, this past July, that residents made the short move down Highway NN from the old nursing home to the present facility, culminating one of the more emotional and complicated issues that I have been involved in during 10 years with Walworth County.

While our current nursing home is celebrating its fifth birthday, the county's involvement in caring for its elderly dates back much further. Our current skilled care program can trace its roots to 1852. That year the County Board voted to levy a tax of one-and-one-half mills on each dollar assessed for the purpose of establishing a poor farm to care for all individuals who were unable to care for themselves. In an era before pensions and Social Security, many of the poor were also, not surprisingly, elderly. During the past century, the county's poor farm evolved into at least four distinct programs including a hospital, nursing home, human services department and farm. The county eventually sold the hospital and got out of the farming business in 2001 opting, instead, to rent its tillable land to a farmer.

Walworth County continued, however, to operate its nursing home. At its height of operations, the county was licensed for 327 beds. As the facility, which was constructed in 1962 and expanded in 1978, began to show its age, the board would periodically study the future of the program. Some supervisors advocated remodeling the facility or building a new home. Others favored getting out of the skilled nursing care business, altogether. The debate would typically end in a draw with the board pledging its commitment to continue the program while failing to appropriate the necessary funds to upgrade or replace the facility.

We might still be studying the program had the state and federal government not made significant changes to nursing home funding about 10 years ago. For many years, the Lakeland Health Care Center operated as an enterprise fund. Ideally, this meant that monthly receipts from residents paying for their care, together with reimbursement from the federal government in the form of Medicare and Medicaid payments, would offset the cost of providing care. Over the years, however, those federal reimbursements became increasingly inadequate to cover the cost of care. As a result, the county needed to levy more and more property taxes to make up for this shortfall.

For several years, a revenue source known as the Intergovernmental Transfer Program (ITP) provided some temporary relief. In 2002, however, the federal government announced major changes to ITP. The upshot of these changes meant that the county would need to dramatically increase its financial support in order to operate its health care center. By that time, we were licensed to operate 245 beds. In 2002, the county levied $1.6 million to fund nursing home operations. Absent a change in the program, that levy was projected to increase to $6.2 million in 2006 given the loss of ITP dollars. Faced with tax caps and state mandates to provide other services, continued operation of the Lakeland Health Care Center, in its present form, would have been nearly impossible. The board spent the next 18 months studying and debating the issue ultimately deciding, in February 2004, to reduce the number of licensed beds from 235 to 120. That decision cleared the way for the construction of the now not-so-new Lakeland Health Care Center, which opened its doors on July 19, 2006, at a total cost of just over $15.1 million.

The goal of the downsizing and new construction was to reduce and stabilize the amount of property tax dollars that would be needed to support the program. We hoped that when the doors opened, our cost to operate the health care center would be $3.5 million. This figure was expected to grow over time, albeit at a more manageable pace. So far our projections have been on target. The appropriation for 2011 was just under $3.7 million. I make a special point, in each annual budget, to highlight nursing home finances. The promise to live within our financial goal was integral to the decision to build a new facility. Meeting this goal is important, not only to maintain the integrity of that decision, but to be able to provide this important service for years to come.

The opinions expressed in this column are those of the author and not necessarily those of the Walworth County Board of Supervisors.