There’s a lot of red ink flowing at 278 Bank Street these days.
That’s the location of the Genesee County Nursing Home, owned and operated by the County of Genesee, so when it’s in the red, local taxpayers are picking up the bill.
The annual, out-of-pocket deficit for the county is $1.5 million.
That’s after current management has trimmed expenses more than $860,000 on an annual $19 million budget.
“Running a New York State nursing home is a very risky business,” said Christine Schaller, nursing home administrator during a meeting Monday of the county’s Human Services Committee. “It’s risky even for private owners.”
As it stands now, the nursing home is $4.7 million in the red. That figure includes not just the operational deficit that county taxpayers fund, but the lack of reimbursements from the state and federal governments.
The feds owe the county $2.7 million in what’s known as IGT funds (inter-government transfers). The last IGT payment from the feds (which flows through Albany) was in January 2013 and only covered money owned from 2011.
The NYS Department of Health owes the county $650,000.
The rate of pay from Medicaid for patients is $80 to $100 less than the actual expense of care for those patients, plus Medicaid rates were cut by 2 percent in 2013.
The nursing home has also been forced to write off $487,000 in unpaid insurance claims.
There’s little left to trim from expenses and still maintain the home’s four-star rating and there’s no realistic way to increase revenue.
One of the biggest expenses for the county is the Adult Home (formerly known as the Domiciliary). Residents there are considered “hard to place.” It’s the residency of last resort for those unable to care for themselves. It’s licensed as a public home, so residents cannot access Medicaid or Social Security insurance to pay for care. The county pays $101 per day for each resident (about 40 currently, out of 80 beds). That’s a $1.3 million annual expense.
“In some cases, nobody is paying us for the care we provide,” said County Manager Jay Gsell. “Once we take a resident in, we are not allowed to discharge them for lack of payment.”
The county tried to relicense that section of the home as an assisted living program, making patients eligible for Medicaid and SSI, but the state denied the request.
Gsell said the message from the state is clear: Get out of the nursing home business.
“They haven’t put that statement out there to counties, ‘get out,’ but they’re doing everything they can to tell us, ‘why are you doing it?’ ” Gsell said.
“It would be political suicide for them to say, ‘close the nursing homes,’ but they’re doing everything they can to push us out,” she said.
The county helps cover some of the $4.7 million deficit created by the nursing home with what’s known as a RAN (revenue anticipation note). It’s a temporary loan that the county will repay once Medicaid and IGT payments are received.
All this red ink, and no reason to believe things will get better. There’s plenty on the horizon to worry about. The Affordable Health Care Act is changing how long-term care is paid for and managed, the UMMC/Rochester General merger could divert referrals from the nursing home to RGH-run facilities, labor costs are going up, and there are indications the feds will stop IGT reimbursements completely in a year or two.
“We’ve been paring costs in a lot of different areas as far as running the facility,” Gsell said. “The problem is, we can’t pare costs down to the deficit and we certainly can’t find additional, new, enhanced revenue to make up the difference either. That’s the bottom line.”