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by Mark Cheffey
With current revenue not covering rising costs, community rest homes are finding it harder not only to compete, but to stay afloat.
And, with that situation hitting Maple Lawn Nursing Home hard, the Marion County Nursing Home District is seeking voter approval of a property tax increase during the Aug. 2 primary.
If approved by a simple majority of Marion County voters, the district’s tax rate would go from $13 cents per $100 assessed valuation to $35.
During a recent interview, Jesse Soodrum, Maple Lawn’s new administrator, and Lynn Blickhan, the facility’s accounting director, said the rest home is having to cope with higher costs and a continuing need to pay higher wages in order to hold on to personnel as well as find ways to upgrade facilities.
Meanwhile revenue, particularly Medicaid reimbursement and the current tax rate, are not making up the difference.
Right now, Maple Lawn’s daily rate is $175, but it costs $26 more to take care of a resident, with the current Medicaid reimbursement covering just $173.
“So, that’s where the tax levy money comes into play,” Blickhan said. “We’re losing money on Medicaid.”
While private pay residents cover costs for such things as transportation, medical supplies and prescriptions, Medicaid will not cover the items for the majority of residents at Maple Lawn.
Soodrum said the situation is not good for all community-owned rest homes like Maple Lawn in Missouri where Medicaid reimbursement has been flat and staffing issues are difficult and not getting any better.
“Wherever you go, staffing is an issue, and a lot of facilities have closed down,” Soodrum said. “And now with inflation and costs going up, everything is harder.”
Staffing was already an issue before the COVID-19 pandemic hit as Maple Lawn had to close down an entire wing because it was impossible to meet government mandated staffing requirements.
While the facility is licensed for 110 beds, it is now at 57 residents because of the staffing shortage with 33 to 34 on Medicaid.
“If we were to be sustainable from a business perspective, we would really avoid taking Medicaid residents, and that’s not our plan, of course,” Soodrum said.
Currently, Maple Lawn maintains a staff of about 85.
Attaining adequate staffing comes down to pay which requires money.
The ideal situation would be to hire people from the local area, but not only is the pool of available staff low in numbers right, now, but Maple Lawn is also having to compete with other facilities, many of them corporate owned with much more available resources, for the workers who are out there.
“We have to have so many RNs (registered nurses) and CNAs (certified nurses assistants) for the number of residents,” Blickhan said. “And, its 24-hour care, so you have to have these people.”
There are staffing agencies that can provide needed workers, but at rates that corporate owned rest homes can pay but facilities like Maple Lawn can hardly afford.
“It’s almost triple the costs for agency fees of what we would normally pay,” Soodrum said.
In addition, the employees provided by agencies are strangers to the community and the rest home.
“Residents remember certain CNAs who come on a regular basis, and that’s a plus for a hometown facility,” Blickhan said. “We try to keep it normal for our residents.”
Blickhan said Maple Lawn is working to address staffing issues by instituting its own in-house training as a way to retain workers who have a chance for advancement.
The district is also needing to make facility upgrades in order to maintain its licensing.
“We currently have an outdated alarm system, and if it were to go down, we wouldn’t be able to repair it,” Soodrum said, noting a new one will be a major expense.
“And, by regulation, we are supposed to have one,” he said.
Other needed improvements include asphalt/pavement updates, replacing a nursing call system and security cameras and software.
Right now, Maple Lawn’s bed rates are comparable with other nursing homes in the region, but, because the district has never sought a property tax rate increase, and has fallen behind others in Northeast Missouri including ones in Clarence, Clark County, Shelbina, Macon, Knox County and Unionville, which range from 25 cents to 35 cents per $100 assessed valuation.
Selling out to corporations has been a alternative for community owned facilities, but it is far from guaranteed that a private entity would even want to buy Maple Lawn, and Soodrum is skeptical it is a good solution.
“There is a difference between a community owned and a corporate owned facility,”Soodrum said. “Here we have an emphasis on the quality of care. It’s a home-like environment.
“We make sure the transition from home to here is the least traumatic because they are still here in a family place rather than some place far away.”
And, that carries over to staff, many of whom grew up in the area.
“Here we have staff members who have known residents all their lives,” Soodrum said.
The COVID-19 pandemic has had a devastating effect on the health care industry as a whole and the nursing home industry has felt it as well.
COVID was a major factor in reducing the number of available health workers, due to added levels of stress and fears of spreading the virus to residents as well as their families back home.
“The fear factor was high going into a place with a mask on and a shield on, all these protections, and it was scary working in a rest home and it can be very stressful,” Soodrum said. “You want to protect the residents and also yourself, and your family. So, that has scared people away from the industry, I think.”
It also affects the level of service employees can provide, when residents cannot see the faces of their CNAs and nurses.
“If you have a new resident, they haven’t seen their faces,” Soodrum said.
In addition, the pandemic has all but severed Maple Lawn’s vital connections with the community.
Before the pandemic, Maple Lawn enjoyed a steady flow of family and friends coming in to visit and be with residents.
“We have residents here who have family come visit them every day,” Soodrum said.
That ended for a while as rest homes had to be isolated from the public and is still problematic as visitors are required to wear masks and take time to answer all the questions posed by computer kiosk at the facility entrance.
“And, our doors are not always open, unfortunately,” Blickhan said.
Ongoing COVID restrictions continue to limit how many residents a rest home can have when many have to remain isolated and have their own private rooms rather than sharing.
“If they choose not to be vaccinated, they have to be isolated in a private room, which means no roommate and a not sharing a bathroom,” Soodrum said.
Maple Lawn has also been known for its community activities, including annual spaghetti dinner fund-raisers organized by the Ladies Auxiliary or taking residents out into the community to enjoy the fair, parades and other events.
Soodrum said he is optimistic Maple Lawn will be able to resume and even boost its community outreach in the future, and to that end, is hosting a Maple Lawn Hometown Barbecue Wednesday for invited friends of Maple Lawn.