Times have changed since the Butler County Care Facility was considered the “last resort” for residents, so now the commissioners are considering getting out of the business.
The county home has long been a drain on county finances for various reasons and now issues have been exacerbated by staff shortages and a shrinking census due to COVID-19. All three county commissioners have for years staunchly maintained they needed to keep the home afloat, but that’s not the case anymore.
There are 37 residents in 109-bed home and Commissioner Don Dixon, who operates a business in the extended health care industry, said “staff is still a challenge.”
“The need is not there like it used to be, like we were the only ones that would take those kind of patients. Now everybody’s looking for residents,” Dixon told the Journal-News. “Occupancy is way down and there is really no need for us to have to provide that service. It’s losing money hand over fist.”
Albert Peters, president of the Ohio County Home Association, said there are 24 county-run nursing homes left in Ohio. The nursing homes were mandated in all 88 counties when the first facility was built in 1830 to serve the infirm, poor and homeless. Many of the facilities closed after the state legislature lifted the mandate and counties opted to let the private sector handle nursing care as government budgets shrank.
County Administrator Judi Boyko said there was a time when county homes were needed, because there were no other other options, especially in rural areas.
“When you talk about county government and its core competency operating a skilled nursing facility is not one of those core competencies...,” Boyko said. “The commissioners, this board and previous boards have contemplated repurposing of the facility to make sure the residents are cared for in any type of transition, but also spending the taxpayers’ money wisely on the core services they must provide.”
The commissioners approved two separate short-term contracts with outside staffing companies totaling $100,000 in the past month. According to the AARP Nursing Home COVID-19 Dashboard, as of the end of February 44.3% of the nursing homes in Ohio are short staffed, the average nationwide was 35.9%.
Since the outbreak of the pandemic and through the end of last year the county spent $1.3 million on outside agency workers. Care Facility Administrator Evelyn McGee said to date they have spent $461,839 on contracted workers.
She said they have both management and front line worker vacancies.
“Like all skilled nursing homes, the Care Facility struggles with attracting and retaining staff for reasons not unique to any one facility,” McGee said. “Almost all facilities are using agency to complement all levels of staffing.”
Through the years the commissioners have had to bail the financially fragile nursing home out with general fund cash infusions, for a variety of reasons. Commissioners transferred a total of $450,000 from the general fund to the nursing home in 2019.
Three years ago, the facility needed a $425,000 subsidy, and in 2016 the commissioners had to loan it $225,000 so payroll could be met through the end of the year. At one time, the county nursing home owed the general fund $1.1 million, a debt the home partially repaid.
“It hasn’t been sustainable, we are regularly infusing dollars there,” Commissioner Cindy Carpenter said adding there are other community needs they should be addressing. “It makes it hard to continue to justify keeping the Care Facility open. What has to happen next is for the commissioners to say a date certain when we’re going to close the facility. We haven’t done that yet.”
Commissioner T.C. Rogers said they won’t just shut the doors, they need to help relocate the current residents, “we have to adhere to procedures and it probably won’t be until the end of the year.”
Boyko said there are specific steps and protocols they must follow once the decision to close is officially made and it will likely take at a minimum six to eight months.
As for the staff, Dixon said they will eventually repurpose the facility — possibly keeping a small footprint for skilled nursing care. The prevailing thought has been to use part of the multi-winged building for an emergency mental health crisis stabilization center. He said there could be other medical related uses that also share the facility.
“They’ll be offered every opportunity there is when we sit down and finally decide how this is going to be used,” Dixon said. “It’s just too early to tell.”
The county home was always considered a last resort because other nursing facilities wouldn’t take people who can’t pay. Rogers said since Medicaid-covered services have been expanded other homes are taking more people in. Dixon agreed and said facilities that didn’t accept Medicaid patients previously are now.
Carpenter said Butler County has a wealth of options now.
“We’re very fortunate in Butler County that we have such a thriving healthcare industry,” she said. “There is a great nursing home community where we have locations in each community so a person may want to put their loved one close to them and has that option.”
COVID-19 isn’t the only culprit in the staffing problem, ever since Chuck Demidovich, who ran the home for more than 20 years, retired in 2017, keeping the top job filled has been a challenge. The county brought in Jennifer Strickland, a consultant with LeaderStat, during Demidovich’s transition to retirement. She took over as administrator but resigned in May 2019.
Professional Review Network ran the home until Chamika Poole was hired in September of that year but she left in October 2020. PRN ran it again for a while until the commissioners brought Demidovich back on an interim basis last fall until McGee was hired in December.