Rock Island Today

Rock Island County Hope Creek Care Center Board of Directors met April 16.

Here is the minutes provided by the Board:

1) Call to order and roll call

Members present: Jessey Hullon, Michael Kelly, Carol Near, Rod Simmer (arrived at 5:34 p.m.)

Members absent: Ginny Shelton

Others present: Kenneth Maranda, Kurt Davis, Hayleigh Covella, Drue Mielke, Jamie Stiles, Cassie Baker, Lynda Vogt, Patty Luecke, Deb Kettler, Rhonda Westmorland, Tim Erno, Sarah Hayden, Dewayne Cremeens

Mr. Hullon noted that the Hope Creek Board is down to five members, so three people would be a quorum; they don’t have to wait for Mr. Simmer to come in.

Mr. Hullon noted that it looks like they have some folks in the gallery today. Mr. Drue Mielke is here for the first time. He sees a member who will be joining the Hope Creek Board next meeting: Mr. Erno. The press is here today as well. Mr. Dewayne Cremeens from the County Board is here. Mr. Hullon thanked everyone for coming. He appreciates these folks attending the meetings.

2) Approval of the minutes from the March 19, 2018 meeting

Motion to approve: Michael Kelly

2nd: Carol Near

Voice vote

Motion carried

3) Public comments

There were no public comments.

4) First quarter Quality Assurance Performance Improvement report

Ms. Vogt noted that she is going to make this more educational than anything tonight because she keeps throwing all these stats at the Board without telling them what they mean or where they come from.

Ms. Vogt said she thinks everybody is kind of familiar with the five-star report. They keeps talking about the five-star report all the time, so she will start with an overall on that. When they talk about Hope Creek being a one-star facility at this time, what you need to know is where [this data] is derived from and how current it is. That is what she really wants the members to be familiar with.

Mr. Simmer is present.

Ms. Vogt explained that the Nursing Home Compare data comes from three areas: inspections, minimum data sets (MDS), and claims data. That is where the Nursing Home Compare information comes from. It’s from the last three years of surveys and complaint investigations. The claims data they use there is new data out there. When she gets to the first quarter quality report, she is going to talk a little about that so everyone knows the difference between claims data and the quality indicators. There is a little bit of a difference and she will give a better understanding of where that’s coming from.

Ms. Vogt noted that she wants everyone to understand on the Nursing Home Compare data sheet is the thing that is really misleading. She put this in the packet for everyone to understand that in the Nursing Home Compare data and the five-star report, how old this information is. When County Board members are talking to their constituents or when people are asking about the five-star report, make sure they understand. Like this one, the percentage of short stay residents who improve their ability to move around on their own, that data was taken from 7/1/2016 to 9/30/2017. The next one, the percentage of short stay residents who were re-hospitalized, the data is from 7/1/2015 to 6/30/2016. What she is trying to say, as far as education for everyone to understand, is that this data is not current data for the public. Every time they go out and talk about it with families, they try to make sure the families understand that what they are seeing is old. This report is accessible to anyone in this community, but you have to drill down in the report to get that information. She thinks all they are doing is going in and looking at the comparison and not what it means, where it’s coming from, or how old it is.

The next thing Ms. Vogt wanted to cover is the star ratings. This is where they get the actual star ratings. The reason she included this is it all just changed. Most of the area facilities did take a decrease in stars because of the way this is calculated now. It is all different. The star rating is based on health inspections, quality, and staffing. For the five- star rating, those are the three main things they are looking at. She is not going to go into detail, but this is good information for everyone to know moving forward when they’re talking about these reports. The rest of this is a breakdown of what all these data and statistics are, which is good information for everyone to know.

Ms. Vogt explained that she is going to move on to the Nursing Home Compare. This is actually what is online that the public can get in and look at. It gives you the opportunity to view at least three nursing homes together. Ms. Vogt compared Hope Creek with Friendship Manor and Rosewood Care Center. Hope Creek is a one-star, Friendship Manor is a two-star, and Rosewood Care Center is a three-star. The one she pulled was specifically the quality indicators. What this packet has in it compares Hope Creek to the other facilities. She wants everyone to understand that sometimes there is a perception on the part of the community of what your care is based on your star rating. That is not always true. When you are looking at data that is six months to a year old, be careful how you’re interpreting that data.

Ms. Vogt explained that the first quarter quality indicators are in the packet. The thing there that is also misleading that she wants everyone to understand is on the last sheet. That is the Casper report. She wants the committee to know the difference between these. The Casper report is real-time data. When you look at that, you are looking at January through March in real time data. If she is going to look at something to talk to the public about as far as the survey and indicators, this is what she would want to look at. She doesn’t want to look at the five-star comparison because of the age of that data. In the quality indicators, this data is not going to match what is on Nursing Home Compare because she used the Casper report. She wants real time data to give to the committee, not data that is six months to a year old. When looking at the quality indicators, they are looking at, for the most part, real time data. Ms. Vogt noted that if anyone has questions, they can call. Since she is moving forward with QAPI, she needs everyone to know where they are generating this from.

Mr. Hullon noted that Ms. Vogt compared Hope Creek with Rosewood and Friendship Manor on the Casper report. He asked what her analysis was about Hope Creek. Ms. Vogt explained that not knowing what theirs is, it may be somewhat similar but people make changes all the time. They talked last time about performance improvement plans. If you have a successful performance improvement plan, you are moving those indicators in the direction you want them to go in. She doesn’t know what [Friendship Manor and Rosewood] are doing internally, but she thinks there is a better understanding looking at these. Friendship Manor’s perception has always been a really well-received facility. Looking across the board, they are a two-star. That’s telling her that your care is going to be really good somewhere and not to judge it by the star reports. When talking to people in the community, she asked everyone to make sure they explain that when they are looking at this, it doesn’t represent who Hope Creek is and its care level.

Ms. Near asked how long a short stay would be. Ms. Vogt said it has to be 30 days and under. Mr. Hullon asked if that is Medicaid dictated. Ms. Vogt said it comes right from CMS.

5) Marketing update

Mr. Hullon asked if they can hear about admissions before they start taking about marketing. Ms. Stiles provided her admissions report. March was a little better than February. In February, Hope Creek only admitted 17. In March they admitted 21, with 10 being Medicare A, then Managed Care and private pay. There were two long-term Medicaid admitted.

The next page shows non-admissions. These were the referrals Ms. Stiles did not admit for whatever reason. They are marked. For instance, there were two non-public aid applicants with no active numbers. Six were out of network. No contract was one. Five had no coinsurance after 20 days. Three were medically complex. For two of them, Hope Creek had no bariatric bed available; that would be long-term bariatric beds. They do have a bariatric bed for a skilled stay, but if she gives it to a long-term patient she wouldn’t be able to take any more Medicare A patients for bariatric. They denied one for alcohol, one for mental health, and two for aggressive behavior. Three people had sitters. One went home from the hospital. Three are staying where they were. One was for no weekend admissions. Three of them had background checks that were poor. Nobody went to any other skilled nursing home. Ms. Stiles said she is not losing them.

The next page shows the March referrals. This is all the referrals, where everyone came from. She writes down her referrals every day. UnityPoint had 20 referrals. Genesis was down with only five this month. Heartland Skilled Nursing Center had two. IRC (Illini Restorative Care) had two. Peoria OSF had five. Iowa City VA sent six. Seven people came from home. Two were from Manor Care. One came from Springfield, IL. Two were from Aperion. One was from Hammond Henry. One came from Friendship Manor. One was from Muscatine Skilled Nursing Home. Mr. Kelly asked what IRC stands for. Ms. Stiles said it’s Illini Restorative Care, which is actually Genesis.

Ms. Stiles explained that the last page shows where the 21 admits came from. Friendship Manor had one. The top one was people coming from home. Five people came from home. One came from Genesis Illini, one from Hammond Henry, one from Heartland, two from IRC, nine from Trinity, and one came from the University of Iowa. A total of three came from Genesis and nine from UnityPoint. Genesis was down a little bit. She and Ms. Baker are working on that. They have something up their sleeves that they are working on.

Ms. Near said she has a question about non-admissions. She asked if Hope Creek doesn’t take any that have any kind of feeding tubes. Ms. Stiles said they do, just not TPNs. Ms. Near asked if they do NJ tubes. Ms. Stiles said no. Ms. Baker noted that it really depends on what the tube is. Per state guidelines, Hope Creek can’t take TPNs. That’s per state regulations. Mr. Simmer asked if they are not licensed for them or what. Ms. Baker said they are not at that level of skill. Personally, she thinks they are very easy to do. She doesn’t know the justification. Mr. Simmer asked if it’s the unit or the nursing staff that is not skilled. Ms. Baker said she doesn’t know where the justification came from. She just knows it’s in the regulations that they don’t administer TPNs at skilled nursing facilities, or at this one associated with long-term care. Ms. Near asked if they don’t do the NJ feeding tubes. Ms. Baker said no.

Mr. Hullon asked if Ms. Stiles can give a breakdown of the insurance for the nine. He asked who the payers were for those people. Ms. Stiles asked if he meant for non- admissions. Mr. Hullon said no, for the nine on the last page of the packet. Ms. Stiles said she doesn’t have that information available, but on the first page of the admissions packet it shows that 10 are Medicare A. There is a difference between Medicare A and Medicaid. She asked if they are all aware of what Medicare A and Medicaid are. Ms. Hullon asked if she would explain. Ms. Stiles explained that Medicare A is for anyone age 65 or older. Medicare A pays very, very well. Medicaid, on the other hand, is for the underprivileged. They are the ones she talked about last month where she believes the payout is $140/day and a room actually costs $194/day. The Medicare A she talks about, that first number, that’s the one they want to be the highest. Med A is Medicare.

Mr. Simmer asked for confirmation that a room costs $190, but the actual cost per day is $256. Ms. Baker said that’s the average. Mr. Simmer noted that if it’s $256, they are still down $60. Ms. Baker confirmed and noted, to play off that, she did get a cost summary report from CMS. That’s what she was sharing in the information she sent to Mr. Davis, if that’s what Mr. Simmer is referring to. In 2016, Hope Creek’s average was $334.31 per resident per day to stay at Hope Creek. That’s when HDG was here. They were a very large expense. The worrisome part of this is that they were such a large expense that it cost one person $334/night to stay here. Ms. Baker noted that they can all imagine the type of hotel they would be staying at for $334/night. It would be very nice. Hope Creek didn’t do anything to offset that, though, with the revenues. She is not saying that is what Hope Creek is dealing with now, but they are dealing with some repercussions of that now. The very next year when HDG was out and they started focusing on expenses, it dropped down to $225.42 per day per resident. That was the 2017 average for the entire year. This year they have decreased expenses furthermore. She doesn’t have that number. It’s a very large report that CMS puts together, not Hope Creek. Hope Creek is trending in the right direction. The average stay costs $195.24. Mr. Simmer asked if that’s what they are paying. Ms. Baker said it’s the average rate per day per resident. Mr. Simmer said that what he has says $256. Ms. Baker said $225. Mr. Simmer said last month, she told the committee that $256 was the average cost per day. He asked what that is about. Ms. Baker said she would have to look at what she sent, but she’s sure that was just her monthly for that one month. She just did a monthly for that.

Ms. Near asked if Medicare pays extra, like if somebody has a Wound VAC. Ms. Stiles said it’s by rungs. Ms. Baker confirmed that it’s by your rung level or acuity. If you come in with all these wounds and need IV therapy and physical therapy, you would be in a higher rung category than someone who has diabetes and didn’t take their medication for a weekend. Ms. Near asked if Medicaid just pays $140 period, no matter if you have four Wound VACs. Ms. Stiles confirmed. Ms. Baker noted that the number does change a little bit; it isn’t always stuck at $140. Ms. Luecke said the number changes quarterly. Mr. Hullon noted that they bill Medicaid and hope to get paid. Mr. Simmer noted that whatever you bill, you aren’t going to get it anyhow. Ms. Near said they’re lucky to get the flat rate. Ms. Luecke explained that there are some really broken processes right now in Medicaid. Mr. Simmer said that’s in insurance in general.

Ms. Baker explained to Mr. Simmer that the $256 had the taxes in it as well, so it is going to be a higher number. She didn’t think to remove taxes this time. Mr. Davis noted that it was $245 in the report. Mr. Hullon asked if it is $245 with the tax. Mr. Davis said yes. Mr. Simmer asked where Mr. Dryg is. Ms. Baker said they aren’t here. Ms. Luecke noted that it’s Tax Day. She knew Mr. Gabelmann wasn’t going to be here, but she thought Mr. Dryg was going to try to make it. Ms. Covella said Mr. Dryg emailed that he was not going to be here either. Mr. Davis explained that the $245 was in the report he got from Ms. Baker and that’s what he sent to the County Board. Mr. Simmer asked if Mr. Dryg said it was $256 and the report said $245.

Mr. Simmer said another thing he had questions on was the sitter. He asked what the sitter thing is. Ms. Stiles explained that if a person is not alert and oriented, in order to keep them safe they have to hire a human. It costs Hope Creek $9,750 a month to pay for a sitter for 24 hours a day. That’s nearly $10,000 on top of the Medicaid bill that Hope Creek is not getting paid. Mr. Simmer asked if Hope Creek gets covered for any of that. Ms. Stiles said Medicaid is going to laugh at you. Medicaid will give you the base. You are going to eat that $9,743. She explained that if they have a sitter, Hope Creek’s policy is if they are sitter-free for 24 hours, Hope Creek would accept them. Trinity has gotten into a position now where they are putting in a tele-sitter, which is a 7-foot tall robot, so they can remove the human being because it is very costly for them and for Hope Creek.

They put in this robot instead. It’s the same thing but they can say the person is “sitter- free.”

Mr. Simmer asked what Hope Creek lost to no weekend admissions. He wants to make sure it wasn’t a Medicare A. Ms. Stiles said no, she wouldn’t. If this is a good admission, she will go into Trinity or whoever called her. She can admit that person from start to finish. She can do everything. Mr. Hullon noted that they had a conversation about this. On the weekends, they were using Hope Creek as a dumping ground. Mr. Simmer said he gets that. Maybe Ms. Stiles should not put that as “no weekends” if she’ll come in on weekends and do it. Maybe she should put it in one of the other spots where it belongs. If she is going to come in and do it, that’s fine. If she’s not going to come in and do it, he doesn’t have a problem with that. But if she can come in for a good one, that’s awesome. Ms. Stiles said without a doubt, from start to finish she can do every bit of it.

Mr. Simmer asked who generally comes from these other homes and why they would send people to Hope Creek. Ms. Stiles explained that nine times out of ten, it’s the patient. After the first 20 days, they get paid 100% of Medicare A. After the 20 days it’s lower. Ms. Luecke said it’s $167.50 coinsurance. They are ACOs, so they don’t want to keep people past 20 days and they get rid of them. Ms. Stiles explained that their group says they have to get these people out in 14 days. That is part of the ACO that Hope Creek is not part of. The ACO wants them in and out in 14 days. At the end of the 14 days, they drop that Medicare A and have to get them out the door. They call Hope Creek and ask if they can take a Medicaid patient. Mr. Simmer said they’re a dumping ground. Ms. Luecke said yep. Ms. Simmer said, unfortunately, that’s what they are doing. They don’t pay for them so they want Hope Creek to pay for them. Mr. Hullon noted that with those ACO functions, they have to play within those confines or they will get dinged. Mr. Simmer asked if that’s the same as when they were sending them back to the hospital to re-up the 20 days. He said those were some of the games they were playing for a while, too. Ms. Vogt noted that now they are tracking and nursing homes are going to get dinged if you send them back and they come back. Once they leave the ACO they don’t care.

Ms. Kettler noted that she passed out a pamphlet with “Spring/Summer” on it. They got something very similar last month, but she wasn’t here. This has all the monthly marketing and special events that are happening either here at Hope Creek or that are something Ms. Kettler is involved in out in the community. In fact, she has been networking a lot. She is trying to get more exposure to the Chamber of Commerce. Today she went to her third Chamber meeting in the past month. She is working with them quite a bit. Their new CEO started today. Ms. Kettler asked if Mr. Mielke got a chance to meet him. Mr. Mielke asked if she meant Paul Rumler. He noted that he was with the Chamber prior and he is a great guy. Ms. Kettler said he returned back to the Chamber today.

Ms. Kettler explained that anything in yellow in the packet is an event that is off-property that she will be participating in. The more of those she can do, the better and the cheaper, the better. A lot of them are free, which is good. She is trying to get out, spread the word, and meet people. She is trying to just go out and be involved in the community.

Mr. Kelly noted that some of those, he has noticed, are posted in a little one or two paragraph comment in the newspaper. Ms. Kettler said she got them in the newspaper. She went to online to qconline.com and WQAD to get on their free websites and get the events posted. She did that as well for the job fair this week. She got those put up to get the exposure Hope Creek needs. Mr. Simmer asked what day the job fair is. Ms. Kettler said it is on Thursday here [at Hope Creek].

Ms. Kettler explained that the second page lists the networking things that she is involved in. She has made some really good contacts over the last couple of months. Again, she is getting to meet the Chamber of Commerce. Gwen Tombergs, the Director of Resource and Member Development, came here. Ms. Kettler gave her a tour and she was very impressed with Hope Creek. She said she was very happy she came here and she got a totally different picture than she thought and expected. Ms. Kettler did get to meet with the Veterans Affairs Department Head of Scott County, David L. Woods. She went to Davenport and met him in his office to make contact with the veterans. He was very excited to hear about Hope Creek. Tomorrow Megan Peterson from the Alzheimer’s Association will be here. She is new to the organization, so this will be her first tour tomorrow. There’s also Kindred Home, a home service. Ms. Kettler met with her last week. She has been at Hope Creek quite a bit trying to drum up business for herself, but Ms. Kettler spent an hour or so with her a couple of weeks ago just to touch base with her. Anyone in the community she can meet and talk to is a good networking person. She is planning to go to the VA Hospital now that she has her trifold pamphlets.

Ms. Kettler noted that her next subject is the new trifolds. She has been without printed marketing materials for a while. She finally got these a week or two ago. She got 5,000 to pass out. This is the first of a couple of printed materials she is working on. Again, even though a lot of people are into looking up everything on the internet, a lot of people want something in their hand to look at. The pamphlet has a quick synopsis of what Hope Creek offers, its amenities, and the contact information is on the back with a little map. She has been passing those out for the last couple weeks. Genesis East Case Management has it. Illini Case Management has it. Several doctors’ offices also have it. She took some to the Active Day Senior Center. She went to UnityPoint hospital today in the Emergency Room and got it to them. She passes them out everywhere she can. She thinks she will just take a big box and put it in the back of her car. She gets going and runs out.

For more marketing endeavors, Ms. Kettler is also working on rack cards. Those are one section of a trifold. At doctors’ offices, you always see those racks of different pamphlets. She is working on those with the printer for hospice, rehab, and veterans.

Ms. Kettler reported that Trivia Night is going well. She already has her first raffle basket from Ann’s Hallmark Shop and is excited about that. She has spoken to Mr. Trivia and is mailing fliers to him. He will hand those out at all of the trivia events he has coming up.

Memories in the Making is another event Ms. Kettler is working on with the Alzheimer’s Association. As Mr. Kelly noted earlier, Hope Creek is back on TV for the Chicago Cubs games. She is working on the Facebook and website. She did come up with a couple of advertising campaigns, but she and Ms. Baker have not been able to get together to talk about those yet. They have more advertising they are working on. They are busy trying to spread the good word about Hope Creek and make more contacts. Ms. Kettler noted that she did go to one Chamber event last week. It had 100-150 people and everybody just stood up and talked about their business. The more contacts she can make and the more people they can get in the door to see this great place, the better.

Mr. Kelly asked if Ms. Kettler has more trifolds she can give him. He sees a number of doctors in his weeks and days. Ms. Kettler said she can give him a handful or she can go to whatever doctor’s office he suggests. Mr. Kelly said he can take a handful.

6) Financials

Ms. Baker said she didn’t know Mr. Dryg wasn’t going to be here, but she can put the financials in with her survey update.

Ms. Baker noted that as everybody has noticed, Hope Creek has been in the news a little bit recently. She does have some supporting information for that. She also did want to talk about the most recent IDPH visit. She did want to state that agency costs for March are down by $17,000. That is a good thing, but it’s not nearly where she wants it to be. She is continuing to negotiate 12-hour shifts with the union and figuring out other staffing issues they have going on.

7) Update on IDPH

Ms. Baker reported that Hope Creek actually had its annual survey last month. They were not expecting it until April. They came on March 6, which she thinks that was a Tuesday, and left on that Friday. They were here for a full four days. This was an annual survey that involved the feds. Hope Creek has never had one before. Ms. Baker noted that it sounds scary, but said not to be scared because there is a justification for that. The state came in and generally their group of surveyors is 6-8 people. They came in and staff noticed it was a larger group and was growing. She asked them what was going on. The feds had come to Hope Creek and were going to oversee the annual survey. The feds came in and explained that they are required to oversee 5% of each state in their jurisdiction. She believes he said that includes Indiana, Illinois, Michigan, and a couple other states around here. They have to go to 5% of the facilities in each state. Hope Creek was chosen this year. There is not a method to the madness or rhyme or reason. They literally just draw you out of a hat. It doesn’t matter what the past surveys look like.

Ms. Baker noted that, considering they had the state and federal inspectors in here overseeing everything, she did not receive the final 2567 report that comes in the mail roughly ten days later, but the preliminary report given to her on the date of exit that Friday had nine deficiencies. Hope Creek obtained nine deficiencies for both the Annual Survey and for Life Safety, which she joked about with her team that they’ll have a competition next year for who can get lower since they are nine and nine.

Ms. Baker explained that she didn’t make a report, but she wanted to talk about past surveys. In 2017, Hope Creek had 15 tags. That included a harm-level tag for the business of the side rails they are all very familiar with. Life Safety had seven tags in 2017. Although that number went up by two tags in Life Safety, the tags are much smaller in comparison of scope and severity. Therefore, she is very happy with nine. They are simple fixes like having too many things plugged into an outlet or a coffee machine that was on but wasn’t plugged into an area that had a breaker. Those are more Mike’s area, but they are very easy fixes.

In 2016, Hope Creek had 11 tags for the Annual Survey and nine in Life Safety. In 2015 it was six for the Annual Survey and nine in Life Safety. 2015 was good year overall for the Annual Survey, but that was the year Hope Creek received the IJ that dropped the star rating that year, which they have been trying to come out of.

Ms. Baker said she’d like to brag and give notice to the nursing staff, supporting staff, dietary, and all the departments in Hope Creek. In 2016 and 2017, although they were high tag years, there was a harm level in there too; 11 and 15 tags don’t want to get too much. There were nine this year and they were all very low level tags. They were not anywhere near harm-level. She is very happy with the outcome of the Annual Survey. Again, she’d like to give notice and thanks to all the staff here. She asked everyone, if they run into any staff, to tell them good job. Although there are not the best reports in the community right now, Hope Creek is having financial struggles and is not hiding that, they are improving their quality. It’s a little disappointing when Hope Creek is in the news for negative things. That does affect the admissions coming in and takes them back several months whenever they have bad press. Ultimately Hope Creek has good quality care and she is happy to say that.

To go along with what Ms. Stiles said in her Admissions update, they are trying to change things up to better financially fit Hope Creek. Hope Creek was never built to make money, but it sure as heck was not built to lose money. They have to figure out what the happy medium is. They are looking at payer sources and seeing how they can move things around. Medicare gives the most money back, depending on the rung level. They want to drive up their Medicare stays. Being not part of ACO really took those down a couple of years, but she thinks the community is starting to see the benefit of not going to a facility that is part of the ACO. She doesn’t know about anyone else, but if she breaks her hip, she is 33 years old and doesn’t know if she could get ready in 14 days and be out of there and be healthy. Something would happen to her again and she wouldn’t be strong enough. She could fall again and she’d be right back in the hospital. Hope Creek is continually picking up those community members when they are left astray by other facilities. They will continue to do that, but they will find balance.

Ms. Baker noted that someone reported in the meeting with the County Board that Hope Creek had a high percentage for Medicaid. It was rated at 63% last year. That’s based on a 245-bed facility through CMS. Right now, they are at exactly 51%. They have dropped the goal down to 45% from 50%. They want to drive up VA, private pay, and skilled stays to offset Medicaid, which only pays a fraction of the actual cost to be here.

Mr. Kelly asked if he could interject one thing. A point he wants to bring up as a nurse is that it takes a bone anywhere from six months to 18 months to heal. It’ll start knitting right away, maybe in weeks if you’re lucky, depending on nutrition status and age, etc. He just wants it on record that most of the clients here are probably in the 18 month category for some of these healings. That’s what’s so problematic and osteoporosis is a major problem.

Ms. Baker said she will be discussing a bit about Central Supply. Mr. Hullon had some questions about Central Supply and dietary and how they are saving money. Before she gets to that, she wants to let everyone know that she continues to negotiate for 12-hour shifts. She also has Kosanas working to negotiate contracts for Medicare and managed care to help get new insurances that are out of network. She’s trying to get them in and trying to open up the market a little more. She will spend some time with Ms. Kettler to help bring those in.

Ms. Baker reported that the job fair is on April 19 and she will leave a stack of fliers. They have a lot of information at the bottom regarding what Hope Creek pays per hour. They put that on the flier because Hope Creek pays very well for a long-term care facility in the Quad Cities. They are very close to matching the hospitals in the area, if not above them per hour. The CNAs here alone make $12.46/hour to start, which is well above what other CNAs make anywhere else. That doesn’t include their shift differentials and annual increases.

Ms. Baker explained that the Skilled Nursing Facility Care Program is what Ms. Stiles was talking about earlier when she said they have something up their sleeves. They are basically trying to work another avenue with these. Ms. Baker provided a flier about the Skilled Nursing Facility Care Program that the hospitals, this one is specifically from UnityPoint, give to all of their patients. If you just look at it at a glance, you can see there is a list of “Preferred Facilities in the Quad Cities and Muscatine Region.” You will also notice that Hope Creek is not on there. They are on the back page. Ms. Baker said they wanted to know why. If you read the back page, it says on top “Non-Network Facilities in the Quad Cities and Muscatine Region.” She asked Mr. Simmer what his first assumption would be based on what it says up there. Mr. Simmer said his first assumption would be that they are probably not going to pay for it. Ms. Baker agreed. She said she probably wouldn’t even look at that page. She’d flip right back to the front to see who is in network. She doesn’t know if this is exactly with the ACO, but it’s misleading. She is going to be forthcoming with this information, knowing that this is being handed out, and tell people, “Yes, you might receive paperwork from the hospital that we are non-network. That does not mean we can’t have you come here or pay for your healthcare or that your insurance can’t cover it. It just means we aren’t preferred.” She asked Ms. Baker if this is direct from the ACO. Ms. Kettler said yes. Ms. Near asked what ACO stands for again. Ms. Baker said it’s “Accountable Care Organization.”

Ms. Baker explained that one thing on her agenda is basically just clearing the air. She is very much for open transparency. People reading this, the first thing they’ll assume is their health care is not going to be taken care of if they go to any of these places. That is not true. Mr. Simmer asked where to get the qualifications for preferred providers. Ms. Baker said the criteria have changed. First you had to be a minimum of a three-star facility, but she hears that has dropped. She is not certain on that. Ms. Vogt noted that Friendship Manor is on there with two stars now. She added that the length of stay on a skilled stay had to be 14 days. Ms. Kettler said the readmission rate was a qualification. Ms. Vogt noted that Hope Creek’s readmission rate is one of the best in the state. Ms. Baker said when Hope Creek has someone here, they take care of them so they don’t have to go back to the hospital and the readmission rates reflect that. That is not the only thing they care about. You have to have that five-star rating. They don’t want to do business with someone with one star, though Hope Creek’s one-star rating is not reflective of the actual true business they are providing or the care they provide.

Ms. Near asked if she can take some career fair fliers for the group finishing the CNA program at Blackhawk. Ms. Baker told her to take as many as she wants.

Ms. Baker noted that Mr. Hullon had asked who orders the products at Central Supply and also about dietary. She explained that Central Supply has a person in there and a Stockroom Clerk is going to be reinstated, but that’s not official. That was a much needed position that the union brought to management’s attention. That needs to be reinstated and they will be doing that. How you are hired for those positions is the most senior and qualified employees apply, then they take the test to see if they have the qualifications. Mr. Hullon asked if the qualification is just based on seniority. Ms. Baker said it is based on seniority and the assessment.

Ms. Baker reported that oxygen tank expenses, pad usage, and decreases in stock supplies are what they have saved on overall. Oxygen usage, she brought up last time. She doesn’t have the numbers on her, but Hope Creek is saving on a daily basis on oxygen. Before, they weren’t even tracking or charging for oxygen in the past. They are working on pad usage savings right now. Laurie Muting, the Central Supply Clerk, is doing a phenomenal job. In the past she has not been provided with the skills needed to do her job appropriately. She is more organized, is getting structured in her days, and is holding employees accountable. Pad usage was through the roof. She didn’t know how to get that under control besides through education, which she did and she constantly audited it. She is now ordering 10 cases fewer per month. That doesn’t seem like a lot, but they are $34/case. It’s a small win overall at roughly $4,080 annual savings, but small wins add up. That’s just a small example of what they are continuing to do on a daily basis.

Kitchen orders and food waste management is coming in on 4/25. That was requested by Mr. Hullon and is an amazing idea. The TPC chef will come in and review inventory, provide waste management advice, and help improve the overall the functionality of the department. Managers are stating they are very well aware that they have waste and need to manage it. This is going to be a big help for them to get them understanding the processes. Mr. Hullon asked why it has taken this long to get that. Ms. Baker said she can’t answer that. She has been here since November and keeps working on correcting things.

Ms. Baker noted that they also did not have a line item created for the Dietary Department for meal ticket sales. Hope Creek must have darn good food because those ticket sales are through the roof. A lot of employees and family members are buying those food tickets. They are starting to track those. They also opened it up to provide two meal tickets for any new resident who stays here, so two loved ones or family members can visit them and eat their first meal free of charge. That is just another PR way to help make people more comfortable when they first come.

Ms. Near noted that the pads are disposables and asked if they have thought of using reusables. Ms. Baker explained that to her, that’s a big infection control issue. She doesn’t know enough about reusables. Mr. Hullon agreed that those would create a hygiene situation. He asked if they even have facilities in laundry to handle them and what the cost to bring them in would be. Mr. Kelly added that the caustic chemicals they have to use get problematic.

Mr. Hullon asked when TPC is bringing their person in. Ms. Baker said on the 25thof this month. Mr. Hullon asked who they are meeting with and if it’s the Dietary Manager. Ms. Baker said yes, and herself.

Mr. Davis noted that the members have Honkamp & Krueger’s report in their packets. Mr. Dryg did say if they have any questions to give him a call. Mr. Hullon said they can save their questions for the next meeting. Today is the last day for taxes, so with them being CPAs they’ll give them a pass.

Motion to re-evaluate financials at the next meeting: Michael Kelly 2nd: Rod Simmer Voice vote Motion carried

Mr. Hullon noted that he is missing the aging report. Ms. Luecke said she’s got it. She didn’t know it wasn’t in the packet. Mr. Hullon asked her to make copies for everybody.

Ms. Baker noted that at the last meeting, someone asked about the scope and severity of tags. She has the paperwork that comes attached to the 2567 form. It talks about every tag you get and the reason why you got each one. Each one is a different scope or severity of a tag. The darker ones are the bad ones. You don’t want those. They include harm-level and above. The light colored are the okay ones. You are still going to have to write a plan of correction on all of them besides the Level A. If you are going to get a tag, an A Tag is what you want. They are very easy; you don’t even have to write a plan of correction on them. Mr. Hullon asked where the jeopardy tags are. Ms. Baker said the jeopardies are on top. Tags J, K, and L are immediate threats to resident safety. Those resulted in death.

Ms. Luecke provided the Actuals Aging Report and the Cash Aging Report for the month. Mr. Hullon asked what the census is. Ms. Baker noted that they took a hit this last week and half. Census is at 167. It was at almost 180 two weeks ago. Now it’s right back down. Mr. Hullon asked for the top two reasons. He asked if people passed away and why they took a hit. Ms. Baker said, quite honestly, it’s the negative press.

Mr. Simmer noted that he was going to quiz Ms. Baker on the numbers game. He noted that they took in 21. Ms. Stiles noted that was last month. Last week was not pretty. Mr. Simmer asked if they are still losing more than they are gaining and how much it dropped from last month to this month. Ms. Baker explained that it was up from last month to this month, but the last two weeks they just really.Mr. Simmer asked where they’re at. Ms. Baker said if you compare today to the same time last month, the census is down by three. It was up by 10, but they lost them all just recently because of the things that are happening.

Ms. Baker noted that in talking to Mr. Davis a little bit too, the whole story obviously isn’t painted all the time. That happens. They have to work with that. They can, on the flip side, be open and transparent if there are questions about what Hope Creek provides to the community. They have borrowed money. It’s no lie that they had to borrow money, but they have also had to borrow money for the last how many years that they’ve been open. They have to come up with the difference between this year and any other. That’s where they want to go, not that they’re out of money. Well yeah, Hope Creek has been out of money every year that they’ve done this. Also, they have to ask how much time they are taking to pay it back to the county. That is never brought forward. Hope Creek wouldn’t still be here if they weren’t paying something back. That information needs to be put out there as well.

Mr. Simmer noted that last month he had census at 167 of 210 possible beds with a $256/day average, which Ms. Baker said today is $245. The payer mix was 56% Medicaid; 12 Medicare patients; and private, semi, and Memory Care were approximately 66 between the three of them. He asked what the breakdown this month is. Mr. Hullon asked if they can start with the public aid. Ms. Baker said she knows the Medicaid is at 51%. She would have to calculate each one of the others out. The current total is 173. Mr. Simmer asked how many are Medicare patients. Ms. Baker said this report says there are 11 out of 174 for March. She would have to give it to him daily. She has it on the whiteboard behind them. She has a daily total; she would just have to calculate it. Mr. Simmer asked if she can email or text that to him. He asked how the 167 total breaks down. He asked if there are 84 Medicaid. Ms. Baker said she knows that one. She did that one on purpose right before she came in here. It is 51% for sure for Medicaid.

Mr. Kelly noted that last month, he was talking with the accountants, Mr. Dryg and Mr. Gabelmann, and sometimes it’s forgotten that Hope Creek has ratcheted down its debt for the bond issue. That sometimes gets overlooked. It’s been paid off 50-60%. He thinks it’s $10 million or $12 million. Sometimes it’s overlooked that Hope Creek is making headway with some of its issues and that they continue to move in the correct direction. He doesn’t think they get enough fanfare for that. Ms. Baker agreed and said thank you.

Mr. Hullon asked Ms. Luecke what she is bringing in. Ms. Luecke said she’s bringing in every penny she can get. She did want to share that she has been using L&M Accounts and she had someone that she had to send to collections. Mr. Hullon said that’s very good. Ms. Luecke explained that this person’s daughter was paying a portion of her mother’s stay. The resident passed away. L&M put a lien on her home. Ms. Luecke got a call from the attorney last week and Hope Creek’s share will be $39,000. L&M will get $21,000 for handling it.

Ms. Luecke also has an example of what they go through sometimes. Hope Creek has a resident whose family was misusing her funds. That wasn’t very wise because when he went to the VA to get more help, they called Ms. Luecke and she shared the information that he was not paying the bill. It came down to a federal investigation. The federal investigator was here last week. Her funds are now coming directly to Hope Creek. That’s not only her VA, but her Social Security as well. Ms. Luecke noted that sometimes they are like the FBI. She is continuing to work daily with Illinois Medicaid. The system is just broken. Mr. Hullon noted that the number was $965,000 and some cents for last month. He asked what Ms. Luecke could do with that money in her coffers. Mr. Hullon asked what she collected last month. Ms. Luecke said $961,000. Mr. Hullon noted that is below her usual. Ms. Luecke noted that census is down, so she didn’t hit her $1.1 million.

Mr. Hullon noted that this aging report has been a problem for him. They have to collect the money that people owe Hope Creek. He asked if it’s a County Board issue that they draw a line here someplace. This is not the first time he has brought this up here. He said to pick a number: 120 days, 210 days, 150 days. He asked if they can turn all of those into collections. No one is going to pay. There are some isolated incidents he is sure Ms. Luecke is working on. He knows the accountants are not here today and they come up with their numbers for what they want to carry on the books. Mr. Hullon believes they should clear this money off they books. He asked if they can please clean them up and get them off. He doesn’t know if the whole County Board has to approve it or if they can make a decision here or if the Administration at Hope Creek can decide. They need to get the dead money off the books and perhaps even try to collect some of it. Then at least they can see realistic numbers to see where exactly they are in the financial position here. The report is showing $4.3 million in aging. They have $2 million sitting in 210+ days. Half that money, they’re not going to get. Mr. Davis asked if Honkamp & Krueger didn’t have a recommended number of days per payer source. Mr. Hullon said no. He has been pushing for that. They have their own formula but it is not working for him. That’s not how private enterprises run. He wants it changed. He doesn’t know if the County Board is going to change it, but he wants it changed. If they owe money, go get them. If you can’t get the money, give it to L&M to go get it. Mr. Hullon explained that someone told him at one point that he can’t make that decision here. They are back to politics again in this room. Mr. Maranda suggested making a recommendation at the Finance committee. Mr. Simmer asked if they do that to the Sheriff. Mr. Davis said he can reach out to Ms. Palmer tomorrow and see what she says. Mr. Simmer said he thought they were going to clean it up a long time ago and they keep dragging it out. Mr. Hullon said no one wants to make a decision. Mr. Mielke said it would be more reflective of reality. Mr. Simmer agreed and said they have to get a real picture. Mr. Davis asked if Mr. Hullon can send him his recommendation. Mr. Hullon said he has it, but Ms. Luecke is telling him that she will have it. Mr. Simmer asked if it’s by date or dollar. Mr. Hullon said by date. Mr. Hullon and Mr. Near suggested 150 days. Mr. Simmer noted that if Ms. Luecke knows if they have a case that’s in the works, she can take it up to so many days. They need a hardline of so many days. He doesn’t care. They have to do something.

Ms. Baker noted that her 51% number was incorrect. It’s actually 61%. There are 19 hospice Medicaid residents that she didn’t include with the regular, so they are at 102 Medicaid total. That equals 61% of the facility. To be frank with that, it’s one of those things they are trying to find a fine balance with. Do they leave a bed open and not make any money or do they get a portion of Medicaid? Mr. Hullon said to leave the bed open because they are not making money. It’s costing money. Ms. Baker noted that they are making some money because they keeping the same amount of staff on the floor generally. Mr. Hullon said they might not need that much staff. Ms. Baker said it depends on the acuity. She agrees, but then it would change on a daily basis. They really want to have the same numbers across the board and keep the census in check with staffing, not vice versa. She asked if she should leave the bed open or fill it. If it stays open and they do not get referrals or get continued bad press, they don’t get Medicare As or people from home. All they have to rely on is other people’s referrals. They could be missing out on $140/bed. She knows that’s not a lot. Mr. Simmer noted that they’re missing out on the tax, too. Ms. Baker thinks that is a discussion at the next board meeting that she could use advice on. Mr. Simmer said they need to know the acuity too. If you have a 2:1 or 3:1 ratio, that will make a difference on taking three Medicaid compared to taking one Medicare. They want three Medicaid to one Medicare. Ms. Baker said it’s tough, especially when there’s a staffing crisis. It’s tough to justify when they are spending as much as they are saving for agency to cover. Mr. Simmer said if they expect 102, they should average what it would take for 102 at normal levels of staffing. Mr. Hullon said they’ll table that.

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

Mr. Hullon thanked the Hope Creek staff. He said he knows they are doing an outstanding job. They will deal with the press as they best can. He knows they do the best job they can. Mr. Kelly thanked the Board members for being here.

9) Adjourn

Chair Jessey Hullon adjourned the meeting at 6:35 p.m.

Motion to adjourn: Michael Kelly

2nd: Carol Near

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