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Medicare numbers raise concern among Hillcrest officials
McCOOK, Neb. — The dwindling numbers of Medicare residents is concerning to the administrator at Hillcrest Nursing Home.
If numbers continue to decrease, it may necessitate a reduction in staff, said Hillcrest administrator Brad Cheek at the Hillcrest Board of Trustees meeting Wednesday morning. However, if Medicare numbers then start to increase, staff members may not be able to be recruited back, he added.
Current census at the facility as of Wednesday was 76 residents, with seven Medicare residents. Last year at this time, there were 15 Medicare residents. The facility has the capacity for 100. Other residents include one for hospice, 25 for private pay, 39 for Medicaid and four residents VA-eligible.
The nursing home is owned by Red Willow County but operates on its own revenue.
Medicare is a federal health insurance program for those who are 65 years old or older. Workers and employers pay into it with each pay period. Part A helps pay for inpatient hospital stays, stays in skilled nursing facilities after surgery, hospice care and some home health care, according to Medicare.gov. For nursing homes, Medicare patients are usually for short-term rehabilitative care after surgery.
A lot of it has to do with the “balancing act” of offsetting Medicaid with Medicare and private pay, Cheek told the Gazette today, with Medicaid rates affecting other rates. Despite a little headway made in last year’s Nebraska Legislature session, what Cheek called a “bandaid,” nursing homes are still “grossly underpaid for Medicaid rates,” he said. “It’s heartbreaking…we need to take care of our older residents but the state needs to do the right thing.”
“We’re not done with the battle yet.”
Other factors impacting the decline in Medicare patients in nursing homes include more people going home after surgery and using home health, said board member Brian Rokusek. More people are working into their 70s and using employee insurance instead of Medicare, said Hillcrest business manager, Renee Wright.
Discharge dates and how the patient is classified at the hospital also have an effect. It used to be patients had three days to recover from surgery but many are being discharged after two, especially in ortho cases, said Sydney Baumann, the nurse who oversees the physical therapy department at Hillcrest. Medicare only covers skilled nursing care after surgery for patients who have a three-day inpatient hospital stay. In a related issue, there is a class-action lawsuit being pursued about hospitals allegedly classifying patients for observation status instead of inpatient, Cheek said.
Rokusek also mentioned that Hillcrest’s respite program for care givers is not being marketed enough. “People need that time off…(the respite program) is something we need to promote.”
Cheek added that Hillcrest’s adult daycare is another area that needs to be better marketed.
Other business discussed at the board meeting included:
| — | the statement of operations was reviewed, with expenses coming in over budget. This was due to the low census count at the facility, typical for this time of year, along with three payroll periods in July, said board president, Randy Dean. Each payroll costs about $165,000, Wright said. In addition, July also had a high number of overtime hours due to employees taking vacations, Cheek said. On a positive note, Dean noted that departments were near budget and there were no large expenses. “Everyone stayed close to budget,” he said. Factoring in the depreciation numbers, total numbers for July weren’t that bad, he said. |
| — | an auditor recommended that payroll deductions for supplemental insurance premiums be initiated the same month as when the employee enrolls. |
| — | board members had a brief discussion on whether to allow employees to “cash out” vacation days. Currently there is a “use it or lose it” policy; before that, employees could cash out vacation days, the only problem being the majority were taken in December, causing a huge bump in expenses for that month. Brad Cheek, administrator, was in favor of employees being able to cash out vacation days, seeing it as an employee benefit and that employees are “only taking what is already owed them.” Still, Cheek said he would like to have it done in a way so there isn’t a large spike of vacation pay-outs at the same time. Rokusek told the board that there could be “potential problems” and wants to make sure there is no risk. Find a way to do it, he said, but still be in compliance with the IRS and the Department of Labor about taxes. The board ultimately decided to table the decision until the next board meeting in September, when board members Mike Skolout and Mike Eklund, absent from Wednesday’s meeting, could attend. |
| -- | Randy Dean updated the board on recent Hillcrest Foundation Board activities. Thanks to funding from the foundation, the upstairs living room area has been refurbished, with new paint, texturing and new furniture. The foundation also covered expenses to create a “Serenity Room” from a former resident room, where family members can meet with a pastor or for quiet time. The Hillcrest Foundation is funded through donations. |
| -- | Physical therapy staff asked the board about the report compiled from a recent visit by consultants and the reason behind the visit. Board president Randy Dean said he has not seen the report yet but offered to make it an agenda item for the next meeting and share the results with the physical therapy staff. Brad Cheek said the consultants were brought in to “optimize all the therapies” being utilized at Hillcrest, to find out what is being done now and what can be done in the future. The state will implement a new pay system for reimbursements starting in October and the consultants evaluated the kind of procedures needed for correct reimbursements, Cheek said. “It will be a good thing and help everyone,” he said of the new system. |
At the close of the meeting on Wednesday, Brian Rokusek requested a closed session for discussion of a personnel issue.
—The board voted unanimously to offer to employees an ambulance insurance policy, an employee-paid supplemental insurance program.