Rock Island Today

Rock Island County Hope Creek Care Center Board of Directors met February 12.

Here is the minutes provided by the Board:

1) Call to order and roll call

Mr. Hullon noted that the meeting was called to order at 5:49 p.m. due to lack of quorum.

Members present: Jessey Hullon, Gregg Johnson, Michael Kelly, Ginny Shelton

Members absent: Carol Near, Rod Simmer, Bryon Tyson

Others present: Cassie Baker, Rhonda Westmorland, Hayleigh Covella, Lynda Vogt, Patty Luecke, Jamie Stiles, Tom Dryg, Bill Gabelmann, Sherry Brummet

2) Approval of the minutes from the January 8, 2018 meeting

Motion to approve: Ginny Shelton

2nd: Michael Kelly

Voice vote

Motion carried

3) Public comments

There were no public comments.

4) Marketing update

Ms. Baker said she’s going to keep her update short and sweet. Like she was talking about prior to the meeting, she plans to contact the Athletic Director at United Township High School to start a program between the seniors here and community youth by having an Athlete of the Month program. Every quarter, they’ll bring them together, have them come to Hope Creek, give them a little award, present it, and make it kind of a big deal and send pictures to the newspaper and news. It’s a big thing when you have the youth and older community morph together.

Ms. Baker noted that Ms. Kettler is working on some new marketing materials since she is fully out of admissions. She is solely working on marketing. Those definitely need to be revamped. Ms. Baker noted that Ms. Kettler started a new budget in December and they haven’t been able to touch it. She is meeting with Ms. Kettler on that budget this week to decide where to go with it. Ms. Baker noted that they are very open to marketing advice, especially within the local community, TV channels, sports casts, or whatever people know that’s working well for other businesses. She wants to know what works well. She is starting from scratch. She does not have an extensive background in marketing and could use the most help.

Mr. Hullon sked if Ms. Baker remembers what the budget is. Ms. Baker said not off the top of her head, but she can pull it up easily. Mr. Hullon asked if they are still doing stuff with TV-8. Ms. Baker said they are not doing the Olympics. They didn’t feel there would be enough viewing. They did postseason college football. Mr. Hullon asked if there are no TV ads running right now. Ms. Baker said no, it’s over. Mr. Kelly asked if they are going to do the Cubs again. Ms. Baker said oh yeah. They got a lot of referrals from the Cubs. They are not doing the preseason, though. That was too expensive with not a lot of people watching. Mr. Hullon asked Ms. Baker to let him know once they get that marketing plan in place. He does know a lot about marketing.

Ms. Shelton asked if anyone has contacted Churches United. They have youth groups that are always looking for projects. She knows her sister at Silvis Methodist, one year her group collected a lot of things for the Quincy veterans home. It was their project. She thinks the Boy and Girl Scouts are always looking for that as well. They can collect toiletries and that.

Mr. Kelly asked if Ms. Baker has talked to Augustana’s Athletic Department. Ms. Baker said no, she hasn’t reached out to any others. Mr. Kelly noted that they get pretty good crowds. It might be a suggestion to talk to the Augustana Athletic Department. Ms. Shelton suggested bringing Mr. Swanson into a meeting some night. Mr. Hullon said the door is always open.

Ms. Baker noted that Hope Creek was in the newspaper lately and it was a good thing. She doesn’t know if everyone saw it. It was a small article titled, “Hope Creek Brings Shopping to Residents.” Ms. Baker explained that Activities Department Director Kenny Shuman opened up a little shopping market that they put in the closed Unit 3-2. It gives residents the experience of going out and shopping, since especially during the winter months they don’t get to do those sorts of things. They are eating it up. They love it. They buy gifts and trinkets for themselves. They have a new scented bath soap that they go crazy over. The guys are not as ecstatic, so they are looking for ideas that older gentleman might be interested in. maybe the shop doesn’t have the right items. The majority of them shop for their grandkids. The news story was perfect for that. They are getting a lot of donations in, but would like more to build up the store and make it a lasting thing.

Mr. Kelly noted that when his wife read the article in the newspaper, she got a bag for him to bring in and he brought it. She wanted to participate. On that topic, the other good news is the journalist Sarah Hayden who did the hatchet job on Hope Creek six or eight months ago has been following up with other nursing homes and skilled nursing facilities in the area that are getting uncomplimentary reports. He knows other people ask him if he has read those articles and if that’s what goes on. He says it’s a byproduct of being in the business.

Ms. Baker explained that the best thing is when the community understands that when you are successful, there is a good side and a bad side. They have things to work on, but so does everybody else. The new regulations are the biggest regulation changes in the last 20 years. They have to consider that, too. Not everybody is able to understand every rule and regulation exactly how it’s stated and they are going to get penalized for it. That is what it is. Hope Creek has to do their best to stay ahead of the curve, which is what they are doing. They do a lot of mock surveys here and make sure they are going around on the floors and looking for exactly what they look for, so that hopefully they are able to take care of them before the state comes in. Mr. Kelly asked if Ms. Baker will include him in the next mock survey. Ms. Baker said the more, the merrier. She noted that she is also looking for some secret shoppers. She plans to make a list of things she wants people to look at when they come in. Often, staff knows it is management checking on things and they do quick cover up type stuff. She is looking to possibly do some secret shopping. Obviously people would not be paid for it, but she would like assistance with that. Mr. Hullon suggested that family members are always good if staff doesn’t know your family members.

Ms. Baker noted that another thing she has to report is more toward admissions. She gave Ms. Jamie Stiles, the new Admissions Director, the floor. Ms. Stiles put an admissions packet together for everybody, so Ms. Baker cut her marketing report short so she could let Ms. Stiles talk.

Ms. Stiles noted that this is the January folder of monthly admissions. There were 24 admissions. She wishes it were higher. The next to last page shows that January’s admissions in 2018 were at 25; last year in 2017 it was 29; in 2016 it was 33; and in 2015 it was 33. For quite a few years, they were up there pretty high. In 2017 it dropped and in 2018 it dropped even more. She would like to see it back up in the 33-34 range. She and Ms. Baker are going to work on that.

The next page is the monthly non-admission list. There were 31 people who were not admitted for not having active public aid numbers. Three were not admitted due to out of network insurance. Two had no coinsurance, so after the first 20 days of Medicare they had no means to pay. One person had a brand new trach. Two were declined by therapy because they had been here in the past and were noncompliant at the time. There’s no sense bringing them in a second time for them to be noncompliant.

Mr. Kelly asked Ms. Stiles to explain the initials “CHIRP” on the report. Ms. Stiles said CHIRP is the background check. Ms. Baker noted that she doesn’t know what the acronym stands for, but confirmed that it’s the program the use for the background checks. Ms. Stiles explained that she does one for every admit before she even goes forward and says she will accept them. She does a background check on everyone. There was one person whose background check came back bad. There were about six pages worth of information on them. She did not accept them. Mr. Kelly asked what kind of background check they do. Ms. Stiles said criminal and sexual. They do two separate ones. This one was the criminal background.

Ms. Stiles noted that of the remaining non-admissions, five people went to other skilled nursing facilities. One stayed where they were. One expired at the hospital. Mr. Hullon asked if they normally do a triage for the five that went. He noted that Ms. Stiles talked about one of them. He asked, when she triages, what she is finding out as far as why they went to another home. Ms. Stiles said she was only there for two of them. She was in training. There are two of them she knows because they were her patients. One went because of the doctor. The other one was another who broke her heart because he was her patient three times and he chose somewhere else. They offered him a private room. He went to Heartland. It’s kind of hard to fight against a private room. He lives alone. He doesn’t like being bothered by people, so when they offered him a private room he took it.

Mr. Hullon asked what the policy is here. He asked, if they put someone in a private room that’s meant for two and tell them it’s a private room, are they committed to that? Can they not bring in another person? Ms. Stiles explained that normally if someone wants a private room, they are very limited. Hope Creek only has two or three private rooms. Nine times out of ten, they are full. They let people know that Hope Creek has semi-privates with two beds and they will do their best not to put anyone in that room. As they fill up, they do have to put people in and it tends to make people very unhappy and social services has to come in. Mr. Hullon noted that Hope Creek is at 80% occupancy. Ms. Stiles said she probably could have. Ms. Baker said she thinks they got to him sooner and had better words before Hope Creek did. Ms. Stiles was training. Heartland has a whole team. For Hope Creek, again it’s a resource thing. Hope Creek is a not-for-profit working with what they have. Ms. Stiles is communicating, as she explained earlier, with other family members. That’s exactly what Hope Creek needs. At least if things don’t work out at Heartland, they can come right back here. Like she said, the patient has been here before and knows what to compare against. Ms. Shelton said she has a feeling Ms. Baker is right on that.

Ms. Stiles explained that the next page is the 2017 admissions and where they came from for the entire year. There were 256. Of that, 50 came from home; one came from Aperion; one came from Florida; one from Friendship Manor; two from Galesburg College; one from Genesis East. Ms. Stiles noted that she has already beaten that record and admitted two from Genesis East. There were 20 from Genesis Illini; five from Genesis West; three from Henry; three from Heartland; 12 from Heritage Words; seven from Illini Restorative; two from Lighthouse; two from Park Vista; two from OSF Peoria; three from Rosewood; one from Sunrise of Naperville; and 12 from the UnityPoint ER. Ms. Stiles noted that Unity Point Rock Island is definitely the highest at 114. University of Iowa had eight and the VA Hospital had eight. Trinity is definitely. Mr. Hullon noted that they are 44% of the business for the 256.

Mr. Kelly asked how they are doing this year. Ms. Stiles asked if he meant from Trinity and noted that she doesn’t have it broken down where they came from on this report. Mr. Kelly asked if it’s been helpful so far. Ms. Stiles said yes and noted that Trinity is very kind to Hope Creek. As far as Genesis, honestly, Illini is hard to compete with because they have Illini Restorative Care and can roll them right down the hall. Then again, they are in the ACO. Ms. Stiles admitted one right from IRC. He did 12 days of therapy for a right hip fracture. Ms. Stiles noted that she doesn’t know about anyone else, but she’s not going to recover in 12 days of therapy. He had been a patient of hers before and his wife called her. She went over to visit. She admitted him here as private pay and got him started on the restorative program with Mandy. He is already up and walking and doing well. She got him to the physical therapy department and she is trying to get him in under Medicare B to get him more therapy there. Again she’s fighting the ACO, but she got him in the long run. He’s here right now as a private pay and is getting therapy.

Mr. Hullon noted that there are three private rooms and asked if they can save those for private pay. Ms. Baker said they have a waiting list for them. Mr. Hullon said he’s sure they do.

Ms. Stiles noted that the last couple of pages are just the January admissions and discharges. For discharges, there were 24. For admissions, there were 25. Mr. Kelly asked for the present census. Ms. Baker said she believes it’s 169. It’s staying right around 170. She and Ms. Stiles have a goal to be around 180 this month. They are trying to grow by 10 each month until they can’t anymore. Mr. Hullon said that’s aggressive. Ms. Baker said they are doing their darndest to be aggressive.

Ms. Shelton asked how they did this flu season and if there was an outbreak or an unusual number of people. Ms. Baker said it was not unusual. Although the actual influenza was worse and everyone was more scared, Hope Creek had fewer numbers than last year and did a very good job keeping under control. Out of the people who had it, she’d say 90% came from the hospital and came with it.

5) Financials

Mr. Gabelmann noted that there is no statement this month because with the early meetings, those are hard to do. Hopefully next month they will get caught up with the quarterly. He will report the cash flow and the results of a meeting last Friday. Mr. Hullon said there are no numbers on last Friday’s meeting and asked Mr. Gabelmann to pass on that completely and talk about the cash flow.

Mr. Gabelmann reported that in the bank at the end of January, there was $345,000. Collected during the month of January on receivables was $882,000. That is staying fairly consistent. They have adjusted the cash flow projections to be $900,000 of cash coming in every month, $730,000 of payroll going out, and approximately $340,000 of vendor bills being paid. With that, and with the intergovernmental transfer that is supposed to come in next month, the IGT from the state, it appears it’s going to be pretty tight in March, in particular relative to the fact that March is another three payroll month. There is $1,045,000 going out in payroll. That is still every two weeks, but it still hits and makes it look pretty bad. By the end of March, depending on timing especially from the state, there could be a shortage. There is still room left on the tax anticipation warrant and on the interfund loan. With the tax anticipation warrant draw down, which was also used to pay back the administrative cost reimbursement of almost $700,000, the county somewhat committed to the fact that they would have available cash for a shortage until the cash receipts come in. It is going to be tight; it always is.

On the other side of the $900,000, the last few months of billings have been $960,000 or $970,000. If those collections start coming back relative to when they go out the door, even though aging runs late you’d expect every month to collect for two to three months behind. It starts to catch up. Hope Creek shut that wing down last fall, so they started scaling back payables. Last month, vendor payments of only $250,000 went out the door. Part of that is managing cash flow. It’s not looking drastic or serious. He thinks there are going to be the cash shortages they warned the county about last month if the county took the tax anticipation warrant advance and repaid the administrative costs. They had to be prepared, which they signed up for back then. That’s going to run stable, he and Mr. Dryg believe, for the next few months as long as the cash receipts come in and the state continues to keep payments going. Mr. Dryg handed out the 12-month projection report. Mr. Gabelmann noted that it stays fairly stable even through May, when the next bond payment of $200,000-some is due.

For receivable items, Mr. Gabelmann noted that Ms. Luecke is working diligently and they are working on getting some information, too. They continue to go from there. Mr. Hullon asked how far behind Hope Creek is on paying its bills. Mr. Gabelmann said they’re still right at $900,000 in payables. That’s staying fairly level, though. It’s not growing. It’s staying fairly consistent. Mr. Kelly asked if that’s about 90 days. Mr. Gabelmann said yes.

Mr. Hullon explained, to pick up a point from what Mr. Gabelmann was saying, that there was a meeting here on Friday and it goes back to HDG. If some of the members remember, the advisory board kept asking them if they had converted the accounting system and it took them forever. Ms. Luecke very diligently was doing some bookkeeping and found out it was not done efficiently. They are trying to reconcile those numbers and don’t have much of anything to go on. A year and a half later, Hope Creek is still being haunted by HDG. In short, that’s what Mr. Gabelmann was alluding to. There’s not much to talk about right now and there might not be much to talk about period. Mr. Gabelmann explained that the bottom line is the cash coming in has to come in. Where it’s at is the thing they’re trying to identify. That was still running at $860,000- some last month. Billings come in at $960,000 net of contractual. Mr. Hullon asked if they think it’s about $1 million. Ms. Luecke said it’s pretty close.

6) Update on IDPH

Ms. Baker reported that Hope Creek has not had any state surveyors in the building since December. Mr. Hullon asked if there have been no complaints. Ms. Baker said there were no complaints. Since the annual survey, there have been eight visits and zero have had any negative outcomes. That tells her that Hope Creek’s quality is improving and they are investigating appropriately and have the right answers when they come. Mr. Hullon asked when they are going to come back. Ms. Baker said since Hope Creek had a survey in June, the window is in May or July that they can come. They come either the month before or after, not the same month. Mr. Kelly asked, after they depart, when Hope Creek will get.Ms. Baker said that 10 days later, they get the survey information.

Mr. Hullon asked if the facility is still at one star. Ms. Baker said they have two stars currently. Mr. Kelly asked if they can get up to three. Ms. Baker said not necessarily. There are a lot of portions. One is the quality indicators. That’s a big portion of the star rating. They also look at any infractions Hope Creek has had in the past. The IJ tag is still weighing heavily. It’s a point system. She doesn’t truly understand the algorithm of that point system. It’s very detailed. Mr. Kelly asked if the IJ will be gone. Ms. Baker said no. This IJ is the one Hope Creek just got in June. The old regulations state that it stays on Hope Creek’s license for three years. From her understanding, they are trying to be more lenient on that because so many homes are closing down now. The fines are too high. Facilities can’t bring their star rating up and they go out of business. They are really trying to change that right now. There are a lot of good things going on. Ms. Shelton noted that they always find something wrong when they come. Ms. Baker agreed that they have an intention when they come. They are going to get tags no matter what. No facility is perfect by any means. For a facility this size, you should expect a minimum of six or eight tags. If you don’t, the survey team is not doing its due diligence.

7) Review of QAPI Plan

Ms. Vogt said she’s not sure how many people know what QAPI is, but it’s the Quality Assurance Performance Improvement. When you have a QAPI plan, you also have to have an overseer of your QAPI plan. The second part of the handout she provided is the quality indicators for 2017. Hope Creek just finished the last quarter. They have a Quality Council in place that meets monthly. They go over things like medication errors, events, and a whole litany of things they look at every single month. Then that goes to the Continuous Quality Improvement Council that meets quarterly and is overseen by the Medical Director. At that point, they talk about quality indicators as far as what needs to change and what the indicators are.

Ms. Vogt noted that some of these indicators are set in stone, more or less. Looking at the indicators, anything shaded in grey goes into the five-star report. Right now, Hope Creek is a two-star facility. These go onto the CMS website that the community has access to so they can gauge Hope Creek against other facilities in the area. The problem with these indicators, which they keep educating everybody on, is they are anywhere from 6-18 months old. They are not real time data. Ms. Vogt asked the committee to be careful when they look at the ones in grey. Those are 5-star quality comparison results. The other indicators come off the CASPA report month to month.

Ms. Vogt explained that the Quality Council meets monthly and the CQI meets quarterly. This advisory board will look at these quarterly reports for input. Hope Creek will put together performance improvement plans. When they see these QIs, red is where Hope Creek is out of the Illinois state average. They will look at the indicators and determine which ones they need to put together performance improvement plans on. Then they can move those within the Illinois or national averages. She is starting one on pain management. That is one that she knows in May they are more than likely going to be looking at. Probably in April, she is going to show the advisory board that performance improvement plan so they can get an idea of how that works and how they will move the indicator into range.

Ms. Vogt continued that the one she was going to show is related to what Ms. Stiles shared. On the first page is the residents who were hospitalized after a nursing home admit. She asked the committee to understand that Hope Creek is doing extremely well at 15.5 on that indicator. The Illinois average is 22.5. The national average is about 25. Hope Creek is doing really well. She’d like the Board to understand that what Ms. Stiles was talking about with ACOs is so true. One reason Hope Creek cannot get into the ACO is because way back when they had conversations with Glen Roebuck, they were told that with the ACO on skilled visits Hope Creek would have to have an average stay of under 16 days. Hope Creek is at 22.8 days. You can look at that one of two ways. Either Hope Creek gives quality of care or Hope Creek ships them out in 16 days and they come back. The ACOs are not bothering to tell you that they don’t get dinged on that. Hope Creek does. They are tracking nursing homes now. That started in October. It’s not as easy as they can’t get into an ACO; maybe Hope Creek doesn’t want to get into an ACO if it might affect quality of care to some degree. It’s a balance.

Ms. Baker noted that Hope Creek here for the community. This is a county-run nursing home. It has to be available to community members. The last thing Ms. Baker wants to do is have someone show up to a board meeting and say, “I was at Hope Creek. They didn’t get me ready. They sent me back home. What’s going on with your nursing home?” Ms. Vogt explained that one time Hope Creek actually had them come present and tried keeping it down to 16 days. Hope Creek was discharging people they could still have been collecting on and it was hitting the bottom line. They have to be careful what they do with those.

Mr. Hullon asked if Hope Creek is part of any ACO now. Ms. Vogt said no. Mr. Hullon pointed out that yet, Trinity/UnityPoint still sends Hope Creek stuff. They have an ACO. Hope Creek is getting 44% of its business from them. That’s something they should at least have on the back burner if Hope Creek gets 44% of their business from them. Ms. Baker said she doesn’t know if Trinity is the big driver on this. She thinks it’s more Genesis. Glen Roebuck is the big driver and he is a Genesis employee. She thinks it’s more Genesis-driven. Mr. Kelly said they are a cohost as opposed to Genesis because of the way Genesis runs the show. Ms. Baker said it seems like it. Mr. Hullon noted that Genesis also has Illini Restorative Care. Mr. Kelly said they do a lot of Iowa.

8) Board of Directors member opportunity for brief comments (no decisions will be made)

Mr. Kelly said he wanted to reiterate that he’s happy to see Hope Creek wasn’t the only skilled nursing facility for the elderly cited in the local newspapers and Illinois Department of Health. Sarah Hayden, the same journalist, is going forward with what is going on at other facilities, so a tip of his hat to her for her journalism. Mr. Hullon said not to forget she’s also the reason Hope Creek is struggling on census and has to go back recreate a new aura, so to speak, about Hope Creek after her hit piece on. Ms. Baker noted that when she spoke to Ms. Hayden when they were going through the quarterly review with the newspaper, she made it a very firm point to let her know that it will be an ongoing quarterly thing for the newspaper. They will be looking at the survey results quarterly and posting them for all the nursing homes and care facilities in the area. Mr. Kelly said he’s glad to hear that.

Mr. Kelly noted that another thing is there was the positive story about Hope Creek that was in the newspaper with Ken Shuman, the Activity Director, and others. People from the public have come to him about this, so it’s not all doom and gloom. The sky is not falling.

Ms. Shelton noted that they have had several problems at the Illinois veterans’ home in Quincy. She asked if that has made a difference in Iowa City’s referrals. Ms. Baker said no. Ms. Shelton said that’s something they should stress. Hope Creek is much closer. Ms. Baker agreed that’s a good discussion to have. She is going to be visiting Peoria and getting Hope Creek’s name out there, absolutely.

9) Adjourn

Motion to adjourn: Gregg Johnson

2nd: Michael Kelly

Meeting adjourned at 6:25 p.m. by Chair Jessey Hullon.

http://www.rockislandcounty.org/CountyBoard.aspx?id=41261#HCBOD