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County commissioners question nursing home break-even plan

May 08, 2014
OSSIPEE — During the 2014 county budget-setting season, the County Delegation subcommittee, along with Mountain View Community administrator Howie Chandler worked out a plan for the nursing home to break even in 2018, and possibly sooner.

The plan was presented to the full county delegation and the subcommittee chairman Rep. Chris Ahlgren (R-Wolfeboro) and Chandler indicated the county commissioners were part of the process in creating the plan. Carroll County Commissioner David Sorensen also indicated to this reporter back in March that he was pleased with the prospect of the nursing home budget breaking even after being in the red during its decades of existence.

To make the plan work, it is not just a matter of keeping all 103 rooms in home occupied but instead is a calculated cost plan that considers a varied mix of payment methods. Some rooms are private pay, some through Medicare and Medicaid and some will be kept open to accept short-term rehabilitation or "skilled care" residents.

But at the April 30 commissioner's meeting, County Commissioners David Sorensen and David Babson indicated it was something pushed onto them by the delegation and they weren't completely sold on the idea. "We're just puppets," said Babson.

MVC Director Becky Mason told commissioners the home receives calls daily from hospitals looking to send patients there who are in need of skilled/rehabilitation care. If no beds are available at MVC, the hospitals will call other nursing homes.

The plan to break even includes a patient pay mix of 10 percent skilled care rate, 65 percent Medicaid, and 25 percent private pay. Mason said it is the difference between receiving payment of $600 per day for skilled patients versus $148 per day.

Sorensen asked his fellow commissioners if the three-member board had approved the pay mix policy during the budget process. "Did we approve that policy? I don't remember approving the policy," said Sorensen. "I question the legality of that. I don't know if we have a waiting list of people that need to come to a home and we are holding a bed strictly because we can get more money from a skilled person. I question the legality of that," said Sorensen.

Chandler said there is no law under the health and human service purview that prevents the county from setting a desired mix.

"I have been opponent of the waiting list policy since I got here. I think there is nothing illegal about it but it seems unethical. We've taken tax payer money to build this place," said Babson, citing longtime county residents should not have to wait if they need to move to the county home.

"I don't want to give the impression this was board approval. It was delegation approval, subcommittee of the delegation set that limit," said Sorensen.

"The delegation appropriates the money and the commission actually operates. While the delegation can make the recommendation it is up to the commissioners to embrace it or not," said Chandler.

"Yes, but we've got big brother looking over our shoulder, said Babson, referring to the County Delegation.

The County Delegation will hold its next meeting May 19 beginning at 9 a.m. at the county administration building on Water Village Road in Ossipee. The meeting will include the review of the first quarter 2014 budget. Also likely to be a matter of discussion is that 22 nurses are out on leave under Family Medical Leave Act. According to Chandler and Mason this is causing staffing crunches, with nurses doing overtime shifts and, having to call in temporary nurses from a staffing agency.

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