Rock Island County Hope Creek Care Center Board of Directors met March 19.
Rock Island County Hope Creek Care Center Board of Directors met March 19.
Here is the minutes provided by the Board:
1) Call to order and roll call
Committee members present: Jessey Hullon, Gregg Johnson, Michael Kelly, Carol Near, Ginny Shelton, Rod Simmer
Committee members absent: None
Others present: Kenneth Maranda, Hayleigh Covella, Tim Erno, Adrianna Erno, Ed Langdon, Lynda Vogt, Bill Norman, Rhonda Westmorland, Jamie Stiles, Patty Luecke, Carlene Erno, DeAnne Bloomberg, Bill Gabelmann, Tom Dryg, Cassie Baker, Kurt Davis, Bob Westpfahl, Dewayne Cremeens
2) Approval of the minutes from the February 12, 2018 meeting
Motion to approve: Gregg Johnson
2nd: Rod Simmer
3) Public comments
Mr. Hullon noted that there is a pretty full room here today. He asked the folks from the County Board to stand up. Mr. Maranda, Mr. Westpfahl, Mr. Cremeens, and Mr. Langdon stood up. Mr. Hullon recognized Mr. Davis, the acting Administrator for Rock Island County. He also recognized the fine folks from Honkamp Krueger, Mr. Gabelmann and Mr. Dryg.
Mr. Hullon recognized Mr. Norman, who signed up for public comment. Mr. Hullon reminded Mr. Norman that he has three minutes.
Mr. Norman said he passed out his bill from Omnicare. He noted that Ms. Luecke does a real good job and she can’t even read these things. He can’t read them. He asked, “Why don’t you get rid of these people?” They’ve got the same medicine on the same day at two different prices. It’s ridiculous.
Mr. Simmer noted that one is listed as 15 each and one is listed as one each. He can see the discrepancy, but the fact that one is $3.67 and 15 of them is $6.12 is still kind of crazy. Mr. Norman thanked Mr. Simmer and said that’s his point. Mr. Simmer said he sees it all the time and would like to see what their answers are for that. Mr. Norman said no one else understands how it’s billed that way. Mr. Hullon asked Ms. Baker if anyone has addressed Mr. Norman’s concerns. Ms. Baker said yes and explained that Omnicare said they were pulling medication out of a backup box and they are apparently more expensive when you do that. Mr. Hullon asked what that means in English. Ms. Baker explained that when you no longer have medications that you refilled for their specific prescription, you pull it out of the backup box to make sure they still get their medication. Hope Creek will be covering that expense.
Mr. Norman said his next thing is the clothing protectors, alias “bibs,” since you can’t even call them bibs. He asked how come Hope Creek can’t get any that work. He has two suggestions. First, Velcro that’s heat resistant because Hope Creek has to do them in real hot water. The same company makes bibs with snaps. He was told they can’t have bibs that way because some of the patients can’t take them off the back of their neck and they could be considered restraints. Mr. Norman noted that these people can’t even take their own clothes off, so how can they wear clothes they can’t take off? He said, “It’s a piece of material. Come on!” and noted that now they have bibs that don’t stay on.
Mr. Norman said his next thing is he’s curious when he sees the headlines in the paper if there is a reason why Hope Creek is not making any money and other private ones are. Mr. Hullon said number one, they don’t know if the private ones are making money. They don’t have access to the other homes’ financials. They are limited to themselves. He has no idea if the private ones are making money. All he knows is their doors are open just like Hope Creek’s. To answer Mr. Norman’s question, Hope Creek is a county-run home and obviously they have some pretty charged up folks in lieu of the front page coverage Hope Creek has been getting. Mr. Hullon asked Mr. Norman to rest assured that they are working through these details. Mr. Norman said he’s not mad or anything, just curious. Mr. Hullon said he didn’t say Mr. Norman is mad, but his public comment form notes say the home is closing. Mr. Norman said he had to write something down. Mr. Hullon said that’s fine, but there is no truth to that. Closing a facility is a lengthy process and a lot of different things are involved in that. Hope Creek has open meetings of this advisory board. He remembers one time Mr. Johnston asked him in an open Rock Island County Board meeting if he recommends closing Hope Creek and Mr. Hullon told him no. He doesn’t know where that’s coming from. They are entitled to that. He’s sure some of the people are here today with that in back of their minds, but he’s here to say that there is no truth to that. Is Hope Creek having some financial difficulties? Obviously they are, but they are working through that.
Mr. Hullon asked if Mr. Norman had anything else to address. Mr. Norman asked for an answer on the bibs. He asked why regular clothes aren’t considered a restraint and a bib is. Ms. Baker explained that state regulations say that if there is any potential risk.Mr. Norman said they can get entangled in the clothes they are wearing. There is no risk at all. Ms. Near added that they can get choked on it. Mr. Norman said they can get choked on what they’re wearing. Ms. Near said yes, but those are their own clothes. Those protectors are given by the facility. Mr. Norman said, “So they can choke on their own clothes but not on our stuff.” Ms. Near said yes, basically. Mr. Simmer said Mr. Norman is absolutely right. There is no difference. Clothing is a lot of times more restrictive. Mr. Norman said to get some bibs or clothing protectors that work.
4) Marketing update
Ms. Baker noted that Ms. Kettler is not here, but she wanted Ms. Baker to hand out the trivia flier to all the Advisory Board members. This is for the upcoming trivia night on October 6. Everybody had requested a flier. Ms. Baker also provided for everyone a spring and summer marketing agenda. Mr. Hullon asked if this trivia night is the one they moved up from last year. Ms. Baker said yes. Mr. Hullon asked how they are advertising it besides giving the flier out to the members here. Ms. Baker said they are advertising mainly on the website. Ms. Kettler has been marketing a lot by going to various businesses and putting out fliers. Word of mouth is what she is utilizing mostly right now. Mr. Johnson suggested any time there is a trivia night is going on somewhere, ask them to drop off these fliers. Ms. Baker said Ms. Kettler was doing that as well. She hears there are habitual trivia goers.
Mr. Gabelmann noted that he and Mr. Dryg have drafts for November through February. Mr. Dryg will talk briefly about February while Mr. Gabelmann hands out the drafts for November through January.
Mr. Dryg explained that the end of the year and beginning of the new fiscal year is always an interesting time with the way things are accounted for and specifically how receipts are pushed back into last year if they relate to last year. If the receipt is received within 60 days but relates to last year, it basically goes toward last year’s fund balance and gets accrued as a receivable. That’s a governmental accounting requirement.
Mr. Dryg noted that on the February balance sheet, Hope Creek’s current assets are $4,162,000 including receivables of $4.2 million with an allowance for doubtful accounts of $1.1 million. Part of the reason these reports are drafts, not finals, is that the county will make a determination based on what that allowance is. Mr. Dryg explained that he is giving the benefit of a monthly amount toward taxes. He takes the taxes Hope Creek will collect for the whole year and accrues 1/12 of that in each month. He has also accrued the Illinois Intergovernmental Transfer (IGT) of $195,000.
Current liabilities are $5,175,000 including the current portion of the bonds that are payable of $665,000. That’s next December 1’s bond principal payment.
Hope Creek has short-term borrowings of $750,000 against the tax anticipation warrant, as recently discussed by Ms. Palmer in the Committee of the Whole meeting, which made that article in the paper. From other funds, Hope Creek has $1.5 million borrowed. Hope Creek is currently borrowing a total of $2.25 million: $750,000 from the bank and $1.5 million from the Liability Insurance Fund.
Mr. Dryg explained that the P&L statement of revenues, expenses, and change in fund balance covers three months. Revenues on an accrual basis were $2,890,000 with operating expenses of $3,472,000 for a net loss of $582,000. Of course Hope Creek needs the tax in there. This is without help from the tax levy. On next page, “other sources” is the tax levy of $660,000 and “other uses” is $373,000 and includes the transfer to the General Fund. Mr. Dryg explained that the county has started to put 1/12 of the Maximus payment, or inter-fund allocation, in the payables. That is part of the reason the payables have increased a little bit and the expenses have increased by that $295,000 change in fund balance. Probably $150,000 of that is accrued to the General Fund for the inter-fund charges. That’s the allocation of expenses from other departments that gets charged to Hope Creek.
Mr. Simmer noted that he is looking at the assets compared to the liabilities and there’s a $1.01 million difference. He asked where that shows up on the P&Ls and how that comes together. Mr. Dryg explained that the interest gets included as an expense. The principal reduction is a reduction of the liability. Within these expenses, they accrued these liabilities. They are disbursed throughout, basically, like in the payables. There is food in there, for example. Mr. Simmer noted that Hope Creek lost $1.1 million between the two for the month of February. Mr. Dryg explained that it relates to more than just this year. Mr. Gabelmann explained that the balance sheet is from day one all the way forward. Mr. Simmer said he thought they went month to month. Mr. Hullon explained that they do on the income statement. The balance sheet is a particular point in time starting from the first day to that particular point in time. Mr. Simmer said he is just looking for that number every month otherwise it’s like Charlie Brown’s teacher. He wants it to be a bit more direct.
Mr. Gabelmann explained that on the statement of revenues, expenses, and change in fund balance on an accrual basis, something that is new this year is the accrual on the administrative charges going to the county. As Mr. Dryg mentioned, those are now going into the accounts payable to the tune of about $54,000 a month. Mr. Gabelmann said he wants to hand out a couple of things and show some things relative to that in the financials. The first item he handed out is the current accounts receivable aging report, which will tie into the balance sheet that shows total receivables of $4.25 million. Part of what was in the paper a while ago is that Ms. Palmer mentioned the $2.5 million. That’s where part of these financials is still. That is the “reserve.” Mr. Gabelmann pointed out that on this report, the 210-day column is right at $2.5 million, which is very close to where they’re going. They are still working on this thing. He was just asking Ms. Luecke today about one thing that happens with that old stuff. Mr. Gabelmann asked Ms. Luecke to explain how in February, as an example, there was a $99,000 increase in the 210-day column. Ms. Luecke explained that if Hope Creek has a resident that is Illinois Medicaid pending, it goes into the pending section. If their application gets denied, which takes quite a while if they go to OIG and are investigating, she puts the account into private pay. That money has to go back to the private pay bucket. Mr. Gabelmann said it has to go back to the date it was originally incurred. Ms. Luecke confirmed and explained that last week she had three or four cases that dated back to November 2016. She had to bill the ones that were approved for December 2016 and all of 2017. Mr. Gabelmann said it was about $99,000. He just wanted to point that out.
Mr. Gabelmann explained that his next handout is a brief summary. He thinks everyone on this board has heard him say that cash is still king. You’ve got to have cash to operate. He did a brief summary of the past three months of what’s happened to cash. Cash receipts are shown on top and are broken down into the three primary sources that the county gets: patient deposits including private pay, Medicaid, and every payer source; the IGT; and property taxes. The summary shows what happened here in the past three months. December and January were right around $850,000. In February, there was a severe downturn in cash receipts at only $678,000. Hope Creek got an IGT payment in December of $288,000. A small amount of property tax, which was the tail end of last year’s taxes, came through in January. Mr. Gabelmann explained that the reason he wanted to do this is those sources still provide an average monthly receipt of $926,000 collected. Last Friday, there was a lot of concern about making payroll. Hope Creek didn’t make it. They went negative last Friday. As of today, they are back positive. In March, $794,000 has already been received as of the 19th. That again exemplifies how cash flow going up and down is phenomenal here when they are talking about hundreds of thousands that can come in. That’s the receipts side.
On the expense side, he is going to show what has happened during the last three months. The December payables number is a little. all invoices received are real payables. Mr. Gabelmann asked the Board to put a note on the report that this is the draft. He explained that a lot of December’s invoices get pushed back into the county’s November fiscal year end. They’ve got to do a little more work on this $164,000 December number to get it more realistic. In January and February, you can see where the payroll numbers are. In March, one of the big concerns is that March is a three- payroll month, which he will talk about in a moment. Another thing that happened big time for cash flow was the cost study was paid to the county in January of almost $700,000. That’s the number that is now being accrued and included in the accounts payable to the tune of $55,000/month. That is real money being transferred out of Hope Creek.
Mr. Gabelmann explained that the three month period average is $1.3 million out the door. Of that, $231,000 is the average to the county. That is still $1 million going out compared to the $925,000 that has come in the last three months. He will update this summary on a monthly basis moving forward.
Mr. Gabelmann explained that they’ve known for the past couple of years that right now is the worst cash flow time for Hope Creek. There are multiple reasons, but it’s primarily that the property taxes are not coming in. In taking a look back several years, January, February, and March are the worst cash flow times. The bottom line is, yes, there is still a deficit position. Mr. Gabelmann asked, “Where do we think things are going to go as we do these cash flow projections?” He explained that he had Mr. Dryg strip out any borrowings and any loan repayments for the next cash flow projection, the 12-month projection. He told Mr. Dryg to leave the loan payments and loan proceeds out to see what is actually expected. On the cash receipts, Hope Creek still has that $900,000 sitting there. Mr. Gabelmann explained that he is expecting, without any loan proceeds or any changes in payments or loan proceeds, just based on the normal flow, the next couple months are going to get really bad. When the property taxes come in, things are going to be actually reasonably good even after $216,000 in interest payments. When they project that out through November, it’s going to be pretty much nip and tuck all the way through the end of the year. That does not include any loan repayments, but it does show that based on the current projections it’s possible that it’s really going to break even. That’s not happening today. Hope Creek is going to go deficit this next couple of months. They know it will.
Mr. Gabelmann asked if the IGT came in yet. Ms. Luecke said no. Mr. Dryg said they’re expecting it to. Mr. Gabelmann explained that another IGT payment is expected this month as part of the three month cycle. It could be another $190,000. Looking back, it was $200,000-something back in December. It fluctuates. They only expect $190,000, but if it’s another $288,000 that’s a major change in one period. The next couple of months are going to be extremely tight. He imagines that last Friday when the payroll was issued, the county must have covered the deficit for Hope Creek. Mr. Davis confirmed that the county used the Working Cash Fund to cover it. Mr. Gabelmann noted that today, that theoretically must have been repaid. Mr. Davis said he’d have to check with Ms. Palmer. Mr. Gabelmann explained that it is due to the timing of deposits. He wanted to show where some of the money has gone and what’s going on as far as where the receipts are. He knows January and February receipts were not up. The other side is that the billings really weren’t bad for February on the receivable side. It was up over $900,000 again. Based on that, it looks like it has an opportunity.
Mr. Hullon noted that for 3/31/18, the report shows beginning cash of $136,000 and change. He asked if that’s a set number or draft number. Mr. Gabelmann said it’s the actual number and will tie into the February financials. Mr. Hullon asked if Mr. Gabelmann is picking up the -$158,387.19 going into June and where he is picking that up from. Mr. Gabelmann explained that it’s the beginning cash plus expected receipts minus the expenses. The bottom line is the end of the month for the -$158,000 projection. Part of that is because March 28 or whatever that Friday is will be the third payroll of the month.
Mr. Hullon asked where Mr. Gabelmann is coming up with his number for claims. Mr. Gabelmann said it’s an average based on what was paid in the past. In February, no payments or very few payments were made because of the cash position. Hope Creek has been managing cash flow partially by not paying claims. Mr. Hullon asked if by claims, Mr. Gabelmann really means accounts payable. Mr. Gabelmann said yes. Ms. Luecke said it’s payments to the vendors. Mr. Simmer asked if that’s behind by about $2 million. Mr. Gabelmann said $1.4 million, $160,000 of which is to the county for the new accrual on the administrative allocation. Hope Creek owes vendors $1.25 million. That’s still up. Mr. Simmer said it’s $1.4 million with that, then. Mr. Dryg noted that it was $1.1 million this time last year. Mr. Simmer said it went up. Mr. Gabelmann noted that it went up with the addition of the $164,000. The county is expecting that payment. Mr. Simmer said the county doesn’t have any money, either. Mr. Simmer noted that that’s the payables. He asked how much money they have in the tax anticipation warrants. Mr. Gabelmann said Hope Creek owes $750,000 on a TAW and $1.5 million to the Liability Fund, so $2.25 million.
Mr. Simmer asked, after looking at these projections of where it’s headed, where Hope Creek is going to come up with the $3,750,000. That’s almost $4 million. He asked where Hope Creek is going to come up with that the way this is going. Mr. Gabelmann said revenue has to come in and expenses have to go down.
Ms. Baker noted that Ms. Ewert was kind enough to draft a letter to send to Illinois Medicaid. They owe Hope Creek $982,000. She did write a letter stating financial hardship. The letter even stated that Hope Creek was not able to meet payroll. Ms. Baker said she has been networking and there are other county facilities that have done the same thing in the past and have been provided that money. She is hoping that will help. Mr. Simmer said some people have talked to Senator Anderson to do that. With Ms. Ewert and Ms. Palmer doing that, they are still looking at $3-4 million. Ms. Baker said she is happy to talk more on expenses and revenues and share some ideas staff has. Mr. Hullon asked her to do that when they’re done with financials. Mr. Gabelmann said that’s the end of what he planned on presenting. They are showing where they think it is and where it’s going. The other side is when they get back to the property taxes, it comes back up. Does it take care of the backlog completely? No, it does not take care of the numbers Mr. Simmer came up with. What he’s talking about is a year ago in November, payables were $1.1 million and the debt borrowed.Mr. Dryg explained that Hope Creek is going to collect $2.6 million on the levy. There’s a $350,000 difference between that and what Hope Creek has borrowed against it. From a pure cash perspective, the delta Hope Creek can borrow against is going to go towards it. Mr. Simmer asked if the TAW is maxed out. Mr. Gabelmann said no. They’re at $750,000 of the $2.25 million. Mr. Hullon said the ratio is maxed out.
Mr. Langdon noted that he has a question about the vendors. He asked if Hope Creek is about four months behind on paying vendors. Mr. Dryg said they are maybe three months behind in total, but that’s a generalization. Mr. Gabelmann said it’s three to four months. Some are out to four months. Mr. Hullon noted that the main vendor that is four months behind is the food vendor. That bill goes back to a small amount in October and into November. Generally, he believes it’s been 90 days. Mr. Simmer noted that this is a three payroll month, so they’re not doing anything this month. Next month they have to. People need to eat. Mr. Hullon said he thinks there’s an ultimatum for this month if he’s following the emails correctly. Ms. Luecke said they’re still talking and she’s still saying her prayers every night that she’ll see another state check come in.
Mr. Gabelmann noted that the other side of a three payroll month is that the bottom line is every two weeks there is still a payroll, it just happens to be three hitting in one month. Mr. Hullon noted that when you owe money for 130 days, that doesn’t hold water.
6) Update on IDPH
Ms. Baker said she has nothing to report on IDPH. Mr. Hullon asked her to present her other stuff.
Ms. Baker explained that staffing is one of the biggest expenses for Hope Creek. It’s especially been rough these last holidays. Obviously, they want to make sure they are getting the word out there. The idea of Hope Creek is that its nurses, CNAs, and staff are underpaid and overworked. She wants to change that culture and mindset.
Hope Creek offers RNs a starting wage of $25/hour, the same as the local hospitals unless they have changed in the last three months. LPNs start at $19.57/hour. These have all been increased three or four dollars in the last year. August 2017 was when the raises went up. Hope Creek’s employees also have shift differentials. Second and third shift LPNs get an extra $1.20; RNs get $1.40; and CNAs get $1.00 extra per hour for second and third shifts. In comparison to other facilities in the area, Hope Creek Care Center has the same or above hourly wages than any other long term care centers in the Quad Cities other than the hospitals or acute settings. Those do start at $25/hour. The only other long-term care facility that has higher hourly wages is Aperion Care right down the road. Aspen, Manor Care, Generations, and St. Anthony’s offer the same rate as Hope Creek, but do not offer shift differentials or the benefits Hope Creek has to offer.
Mr. Simmer asked what the starting rate for CNAs is now. Ms. Baker said she has that in her office and can get it, but she thinks it’s close to $13.00. Mr. Simmer said he knows Heritage or Heartland did just go over $10 for CNAs, and that’s the highest one he knows right now. Hope Creek’s CNAs are quite well paid, let alone the benefits package they get is very good. He tries to tell every CNA he knows that this is a great opportunity and they’d make twice the money here and get a benefits package. The rates for RNs and LPNs sound like what he’s hearing elsewhere.
Ms. Baker said they are getting the word out. It’s on Indeed, Monster, Hope Creek’s website, the newspaper, and on the news, but that’s not enough. There is a nationwide deficit, but they have to find those. Hope Creek is a not-for-profit. They work for the county. They don’t have a ton of money to work with, so they have to find other avenues to bring in these staff members. They are dancing with the idea of possibly switching from eight to 12-hour shifts for nursing staff. A lot of facilities in the area have done it already and it has proven to work very well and be cost efficient. Mr. Simmer asked how the union is responding to that. Ms. Baker said they are working together. It’s progressing along. She would say the preliminary final meeting will be this week on Thursday. Mr. Kelly asked if they’ll do an MOU. Ms. Baker said she’s not really sure they need that for this one. Mr. Maranda explained that the union has a wage opener from last December. The County Board members know this because he announced it. Hope Creek has a wage opener and he will be in discussion with them. Mr. Morga’s leaving backed it up a little bit.
7) Discuss options for private room availability
Ms. Baker noted that then flip side of Item 6 is she also wanted to talk a little about how to bring more residents into Hope Creek. They are getting some good feedback from local hospitals that they haven’t received in the past. They are doing a lot more networking. Ms. Baker noted that one of the big things is that Hope Creek doesn’t accept a lot of managed care contracts in the area and needs to. Right now they are going through the list of all managed cares they can be part of and looking at contracts and negotiating with them. They do have Kosanas, the company Hope Creek contracts with for the skilled therapy department, and they are more than happy to help negotiate those contracts. Hope Creek makes more money and Kosanas makes more money, so it’s good teamwork.
Ms. Baker announced that they are also looking at changing the building two Medicare Unit into private rooms instead of dual rooms. She thinks that will make the facility much more marketable. She always hears that Hope Creek is beautiful facility, but people would rather go to a facility that is not as beautiful and have their own room rather than share with another individual, especially if they are only going to be here 20 days for skilled stays. Generally, that’s why Hope Creek sees some decline in admissions and why other facilities win over Hope Creek. That is something she is looking to that very, very soon. It is easy to do. She doesn’t plan to decertify beds. That costs more and it takes time to recertify if they ever need them again, so she is keeping them certified if Hope Creek does need them.
Ms. Baker explained that the ER at Genesis Hospital has let staff know that Hope Creek is one of the only facilities in the area that does not offer its own transportation from the hospital. Genesis is too busy during the day dealing with emergencies with the ambulances, so they can’t bring people to Hope Creek. They are sending them to other facilities that can pick them up. She reached out to the State’s Attorney’s Office and they advised not doing this immediately, but there are steps they can take to be able to do this. This is something that will be in the works in the next three months, hopefully, but it could take up to six months. Mr. Kelly asked what the holdup is. Ms. Baker said liability issues.
Ms. Baker noted that the only other thing she wanted to add is that oxygen was a big expense to the facility. It’s a small win, which she thinks is just as important to say: Hope Creek dropped oxygen rates from last year to this year by 57%. That’s a big thing. They are finally sending the correct bills to the correct people in order to pay for those oxygen tanks. She will say that in the past, oxygen was given out and it was free oxygen for everybody. Not anymore. She wanted to let the committee know that this is one of the main things that has been taken care of. The next thing on her central supply agenda is pad usage. Adult Depends are a very large cost to the facility. Dietary is going to be at the same time focusing on bread and coffee and feeding supplements. Those are the top three expenditures in dietary.
Mr. Hullon asked what the census is. Ms. Stiles said 177. Mr. Simmer asked if that’s out of 240. Mr. Hullon said it’s out of 210. Ms. Baker said they’re at 80% occupancy. If you compare admissions from last year, the facility is Even Steven. Admissions are not the problem right now. Expenses versus revenues are the problem. Right now for someone to stay here, it costs Hope Creek $256/day. Mr. Hullon asked what the revenue is. Ms. Luecke said $194 for a semiprivate, for Memory Care it’s $219, and for a private room it is $214 per day. Ms. Baker explained that this tells her that for the average cost per day, they have way to many expenses for the amount they are getting.
Mr. Hullon asked what the wonderful state of Illinois pays the facility. Ms. Luecke said $137, but she just found out today that they are getting a raise to $140 on April 1. Mr. Hullon noted that the state pays $137 when it costs this home $256. Ms. Shelton noted that it has to do with that bed tax.
Mr. Simmer asked what Medicare comes in at. Ms. Luecke said approximately $500/day on average. Ms. Baker noted that Hope Creek has too high expenses and needs to increase revenues. Obviously doing the private rooms is going to help, but she thinks they need to look at the case mix too. She thinks they need to increase Medicare stays and privates to help alleviate some of this.
Mr. Hullon asked what Ms. Baker’s plan is to reduce for overheads and labor. Ms. Baker said she is looking at current staffing ratios and residents. February was a bad month overall for Hope Creek. They had very high acuity. On average, they had 6-8 people on constant one-on-one, which is a very large expense for the facility. That’s when you have someone sitting by a resident’s side day in and day out. They have to do that in order to not get tags and make sure residents are safe and taken care of. Mr. Simmer asked if, for those higher acuities, they can charge more for that because the residents need more care. Ms. Baker said she wishes. She read Hope Creek’s contract and it doesn’t state that. The State’s Attorney’s Office is remaking that contract. However, when they just returned it they returned one contract. They need two separate contracts for skilled stays and long-terms. This is a contract that has been going on for over a year now and Hope Creek is missing out on the one-on-ones because of it. There are a lot of things and details that need to be cleaned up before they can see any changes.
Mr. Simmer said he doesn’t see any possible win on this if $256/day is the cost. Ms. Baker noted that she took that from Hope Creek’s February’s expenses. Mr. Simmer said that’s as good as anything. The only thing that covers anything is Medicare. Ms. Baker noted that in 2017, the cost was $285/day for the whole year on average. Mr. Hullon said it is trending better. Ms. Baker said her point is that they need to keep decreasing expenses. They are doing that and they have all seen proof of that. They need to look more so at the case mix and who they are bringing in now.
Ms. Baker noted that the home’s quality of care has improved. The facility has gone from one star to two stars. The state been in nine times and Hope Creek has not received anything from them to date.
Mr. Hullon noted that when he sat with the food folks, there were a couple of questions he had specifically asked the food vendors. Ms. Baker noted that Ms. Luecke has been following up on those. Mr. Hullon asked if she has answers to his questions. He noted that he specifically asked for a vendor-managed inventory where they would manage the inventory for Hope Creek and keep the facility’s staff out of it. He asked for that because at that point in time, none of the people who were in this room could give him an answer for how much food is being thrown out. He asked if the vendors have come back with that answer for him. Ms. Luecke said no and reminded Mr. Hullon that [the food vendor representative] was going to be gone. He was out of town all last week. She also sent him information to get the answer to Mr. Hullon’s other question.
Mr. Hullon said he asked if the other areas in the facility had inventory and who is managing that inventory for Hope Creek. He asked Ms. Baker if she has taken a look at that. Ms. Baker said yes. She does know who is managing that. Mr. Hullon asked if she has instituted any kind of check on that to see how they are managing that inventory of medication, pads, and whatever. Ms. Baker said it’s on her to-do list. Mr. Hullon asked if he can expect to hear something on that next month. Ms. Baker said yes. Mr. Hullon explained that outside of cutting staffing, the next option is cutting the inventory of food, medications, toilet paper, and that stuff. It’s unfortunate, but it comes down to that. They need to look at those kinds of things and how exactly they are managing that. He expects something next month on that. Ms. Baker said they are checking all the shelves. They are looking at expirations and stocking the oldest first like at the store. They are making sure they are not overstocking. There was a lot of overstocking. Now they are only ordering when items are needed and projecting out, not over-projecting.
Mr. Hullon asked about the folks in charge of these departments. Ms. Baker said she’s honing in on them. Mr. Hullon asked what kind of talent and education they will need to be in that area and manage those inventories. He wants to hear that next month.
Mr. Simmer asked what the facility’s Medicaid percentage is right now. Ms. Luecke said she thinks it’s at 56%. Ms. Baker confirmed that it is over 50%. Mr. Simmer said that’s at $140/day when it costs $256. Mr. Hullon noted that $140/day is with the raise; otherwise it’s $139. It’s a no-brainer. Mr. Simmer noted that Governor Rauner is going to be in town.
Mr. Hullon asked how their rainmaker is doing. Ms. Stiles reported that the census is looking better. Her numbers are not as high as she would have liked. She brought in 17 last month. Five were Medicare and three were managed private pays. Everything on the top of the report is a good number. The things on the bottom are not so good and she is keeping them low.
Ms. Stiles noted that the non-admission list is on the second page. It shows people who were not admitted and the reason why they were not admitted.
The third page is a new addition. Ms. Stiles explained that she added referrals. As Mr. Hullon pointed out, Trinity gave Hope Creek 44% of its income last year. Genesis gave Hope Creek 20 patients the entire year last year. Last month, Genesis gave Hope Creek 15 referrals and Trinity gave 20. On the next page, Genesis gave 5 and Trinity gave 6 in one month. Ms. Stiles said she has started rebuilding a relationship with Genesis. Genesis was also talking to her about the fact that Hope Creek is the only facility that does not transport new admits. Every other facility will come pick up their new admits and bring them in. Hope Creek has to wait until later in the evening and then [Genesis] charges the families. They said it’s an inconvenience. Ms. Stiles said she brought that to Ms. Baker and she is working on it. They are building a relationship with Genesis, which is a good thing.
Mr. Simmer asked what “SN” stands for on the report. Ms. Stiles said “skilled nursing.” Mr. Simmer noted that someone went to another SN on the admission list. Heartland gave Hope Creek three. He asked why they didn’t admit them and they went to another SN. He also asked if “too complicated” is part of the other three that did come in. Ms. Stiles noted that she discussed this at last month’s meeting. She had two patients. One went to Heartland. She was heartbroken because he was her patient. He has been here three times. He went to Heartland because they went and offered him a private room. Mr. Simmer noted that Heartland gave Hope Creek three, though. Ms. Stiles confirmed. She explained that another lady went there because her family worked there. Since then, she’s moved here.
Mr. Simmer asked why there are no weekend admissions for Hope Creek. Ms. Baker explained that they do not do weekend admissions as of right now. That has been something since maybe November of last year. Mr. Simmer asked why. Ms. Baker explained that Hope Creek was getting dumped on over the weekends. The hospitals would call the Admissions person and say they had someone. Well, the Admissions person doesn’t work seven days a week all day and couldn’t go lay eyes on the patient. They show up and it would be someone with Stage 4 wounds and who is schizophrenic or other diagnoses Hope Creek can’t deal with as a skilled nursing facility. Mr. Simmer said they are ones where Hope Creek would not meet their needs. Ms. Baker confirmed. She noted that they do not deny weekend admissions. If they have someone who they think would be a good fit with easy flow over, Ms. Stiles is open to that. Ms. Stiles noted that she has trained on everything, from doing the admissions by herself by computer to everything. She can admit anybody at any given time. Ms. Baker explained that it’s less risk for Hope Creek not to take admissions on weekends. Mr. Simmer noted that as far as families go, it’s easier on the weekend to get them moved. Ms. Baker noted that St. Anthony’s has two or three admissions nurses. It does make a difference when you have a bigger team. Mr. Simmer said if they are only missing one, that’s not a big deal unless they were Medicare. It’s about quality not quantity right now. One or two Medicare would be helpful to Hope Creek.
8) Board of Directors member opportunity for brief comments (no decisions will be made)
Mr. Simmer noted that he knows Hope Creek is doing a good job getting numbers. He thinks they’ve done quite a good job. They’re looking at the $219 being the best that they get paid other than Medicare. He asked how many Medicare patients Hope Creek has. Ms. Baker said 12 out of a goal of 15. Mr. Simmer said he’s just trying to make this right in his head and there’s no way. They are addressing and accounting for usage needs, oxygen, and Depends. He doesn’t see it ever getting up to $256/day, even with the $2.4 million levy. They’ve got to see where to balance this out. Mr. Dryg asked if Mr. Simmer is counting the tax contributions. Mr. Simmer said he is counting the levy, yes. Mr. Dryg asked if he’s counting it in the rate per day. Ms. Baker said she just did the total expenses in February. It was very simplified.
Mr. Dryg explained that they’re looking at charging someone $210. The state is going to give Hope Creek $800,000 for the IGT. Taking 177 residents multiplied by 365 days in a year is just shy of 65,000. $800,000 divided by that 65,000 is $12/resident/day on top of the $210. That’s $12 that Hope Creek is not charging residents. It comes from the state. Then there is the $2.6 million from taxpayers. Dividing that out the same way, you get about $40. That adds another $52 besides what Hope Creek is getting from its residents. Mr. Dryg asked if that makes sense and noted that it’s not going to get Hope Creek there, but it’s still something that was missing from the total.
Mr. Simmer noted that last year they had statements on how much on average Hope Creek lost and what Hope Creek got. He thinks there was a loss of $360,441. Mr. Gabelmann said he hasn’t done that yet. Mr. Simmer said it would be interesting to see if what they lost on average last year includes this stuff. Mr. Gabelmann said yes it does. This is purely cash received versus expenses incurred. The other side they don’t see yet is the bond payments and interest payments. Mr. Simmer asked if this isn’t all in. Mr. Gabelmann said it’s just for the first three months. Mr. Simmer asked if there’s one for last year all in. Mr. Gabelmann said he hasn’t done that. Mr. Simmer said he would like to see that because it will be interesting to see apples to apples. He knows the other things add up. To see it on the sheet and say that at this time next year, god willing Hope Creek will still be here, he wants to see where they’re at and what’s going on. They are not going to kick the can down the road anymore if there is no road to kick the can down. Ms. Palmer and Ms. Ewert are smart ladies and he is impressed with what they are doing, but he’s not happy with where things are at right now. This is not a good position to be in and they have to look at the real facts.
Ms. Shelton told everyone that they are doing a wonderful job and keep up the good work. They’ve come a long way in the last six months.
Motion to adjourn: Gregg Johnson
2nd: Michael Kelly
Chair Jessey Hullon adjourned the meeting at 6:28 p.m.