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Monday, December 17, 2007

Health-care center accepting fewer Medicaid residents

Move necessary to alleviate tax burden, officials say

By Mike Heine/The Week

Bit by bit, the Walworth County board voted to downsize the number of residents living at Lakeland Health Care Center.

It started in 2001 with a reduction from 345 beds to 295. Then it went to 190.

Facing increasing costs to run a large facility, and escalating pressure by taxpayers to limit levy increases, the board decided to fund a building project with 120 beds. A new, smaller nursing home could save money with fewer patients and by running more efficiently.

In the summer of 2006, the residential-style, 120-bed facility opened. It dwarfed in comparison to the size of the institutional-like old Lakeland Health Care Center next door.

A downsizing trend continues today, but not with the number of beds or the size of the structure. This has to do with who will be sleeping in them.

Being county-run, Lakeland accepts a majority of long-term care residents on Medicaid, a government-subsidized insurance for those who can't afford private care facilities. Today, about 100 of the 120 beds are slept in by Medicaid residents, said Vicki Gorden, admissions coordinator.

Because Medicaid reimbursements don't cover the full costs of patient care, the county is looking to reduce the number of long-term care beds to 93 next year and 89 by 2009, said Lakeland business office manager Bernadette Janiszewski.

The facility charges $235 per day. Medicaid pays $136 per day. The difference is supported by county taxpayer dollars. About $3.5 million of the 2008 county levy will support Lakeland.

To break even, with no taxpayer subsidy supporting the facility, Walworth County would hypothetically have to charge $307 per resident per day, Janiszewski said.

"One of the real problems here is that Medicaid does not (fully) reimburse for the costs of keeping a patient," said Health and Human Services Director Linda Seemeyer, who oversees the facility's operation. "We will still be a safety net for the people in this county. A great majority (of residents) will still be on Medicaid. We need a little more of a mix to alleviate a little more of the burden on the taxpayer."

Having more short-term care beds means more dollars coming into the county from Medicare or private-pay residents. Medicare fully funds short-term stays and many families can support short-term stays with their own insurance our out-of-pocket cash, Seemeyer said.

"It's a trend in county nursing homes throughout the state," Gorden said of seeking more private-pay or Medicare patients.

The county is targeting about 75 percent of the beds for long-term residents on Medicaid. The remaining 25 percent will be short-term stay beds, Gorden said.

That mix is about the same as other county-run facilities throughout the state, Seemeyer said.

Brewster Village in Outagamie County is 75/25. Manitowoc County's 150-bed facility, which was just sold to a private company, is about 74/26. Countryside Home in Jefferson County, with its 120 beds, is 77/23.

"We're never going to be (fully) private pay or short-term rehab," Gorden said. "We're a county facility and we're proud of that, that we can help people. But we have to stay open."

Gorden said she has received some complaints about the county accepting fewer long-term care residents.

"It's difficult when I'm given a number and we have to get to 93 (residents) on Medicaid," Gorden said. "I tell them, 'If this is a concern for you, you should contact your county board supervisor.'"

Supervisor Bob Arnold, chairman of the Lakeland Health Care Center board of trustees, said he has heard no negative comments about the shift personally or at meetings.

"We want to take care of the county residents as best we can, but we'd also like to not be totally Medicaid because you lose your shirt on those people," he said. "Also, we don't want to be competing too much with the other (private) nursing homes."

Private nursing homes generally have about 45 percent to 60 percent of residents on Medicaid, Seemeyer said. They accept fewer Medicaid residents because they are private and need to make money to remain solvent, she said.

Although there are no guarantees, Seemeyer said it's not likely the county would ever reach those levels.

"It's a balancing act for us," she said. "We have an obligation to the folks in this county to provide a safety net, but we also have an obligation to the taxpayers."

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