Flat funding and growing demands: a nursing home administrator's dilemma

Five percent can make the difference between staying in a job—or in business—or not.

I’m reproducing here with permission the complete letter of testimony one nursing home administrator, Bonnie Zabel, gave to the state Joint Finance Committee during its budget hearings around the state last month. The letter came across my desk in The Wisconsin Longterm Care Workforce Alliance newsletter April 15.

It speaks eloquently for itself, and I suspect for many.

Joint Finance Committee

My name is Bonnie Zabel and I am the administrator at Marquardt Memorial Manor in Watertown, Wisconsin. We are a not for profit organization affiliated with the Moravian Church. I’ve been employed at Marquardt for almost 20 years, as Director of Nursing and now Administrator for 13 years.

Marquardt is a 140 bed skilled nursing facility, which is part of a retirement community of approximately 600 seniors. We also have independent senior apartments, assisted living, home health, supportive home care and hospice.

Twenty years ago our private pay rates and our T-19 rates were equal. Our T-19 reimbursement has doubled over that time and our private pay rate has tripled to cover our T-19 deficits.

We are currently 66% T-19. Our actual costs are $185 per day and T-19 pays us $125 per day. We lose $2,000,000 per year by serving Medicaid seniors.

Watertown is a blue collar farming community. Our seniors are not wealthy. People are moving into our apartments @ age 85. They utilize our support services and enter the skilled facility at 90+. Their retirement savings have typically been exhausted after 20+ years of retirement. At this point they require excessive skilled services.

Our 140 residents:
3 can dress independently
25 can feed themselves independently
15 can toilet independently
21 can transfer independently
98.5 % have unstable medical conditions
83.8 % have no discharge potential

This population is very labor intensive. Besides their physical and medical needs, dementia is a factor for most. Staff endure wandering, hitting, kicking spitting, biting on a daily basis- in addition to the physically demanding work. These are not sought after jobs. They deserve a living wage and benefits.

Our health insurance rose 17% this month. Routine costs are up 6%. Utilities are through the roof.

Federal legislation created Medicaid. The Federal government pays 60% of the costs. The state of Wisconsin has increased GPR spending on Medicaid only 1 time since 1993. What other cost center has to fund their own increases? $13.8 million dollars of that self funding has been diverted to other state budget needs. The governor is proposing 3-5% increases to care management organizations, Family Care etc., but 2% for skilled nursing facilities. How can you justify that? Do our seniors have no value at the end of life? We need 5% just to stay in business.

Legislation is in place requiring that you provide Medicaid. Without adequate reimbursement, more and more facilities are limiting or eliminating entirely T-19 services. The choice is yours. If you can’t fund it, eliminate the legislation that created it. We could return to the poor farms of the 50’s.

I invite any of you to visit my facility to see your constituents whom we serve. We have a mission and so do you.

Thank you.