There's no place like the county nursing home

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor

In March, an analysis piece about the future of the county nursing home appeared in the print version of McKnight's Long-Term Care News. After working on it for six months, I eagerly awaited the feedback and debate I was sure would follow.

A week later, the story, which was also posted online, had clocked in about 11 web-page views, and I'm pretty sure half of those came from members of my family.

In the frame of one's life, this is not a massive tragedy. Still, as I was licking my wounds, it bolstered my spirits when I received an email from Kay Sheiss of Frederick County, MD, who was working with a group to try to save their county facility, Montevue. She distributed the McKnight's story, and the Frederick News-Post ended up writing an editorial in which it name-checked the article. It's always exciting when you feel that someone somewhere gleaned some value from your work, especially given the reluctance of many sources to comment for the story.

To that end, whether you are an employee, resident, citizen or legislator, I thought I'd share what I learned when working on the story, given that this week in Albany, NY, the commissioner suggested selling the local home; in Nebraska, Otoe County commissioners agreed to sell their home to the facility managers; and in Danville, IL, the county is considering bids for Vermilion Manor Nursing Home.

As an objective reporter, I don't have an opinion related to whether individual counties should or should not sell their nursing home. Everything from the county budget structure to the geographic location to the case mix should be considered.

Still, there were a few themes that emerged: one, a lack of historical context related to how a lot of these homes were created as almshouses for the poor, or how some thrived through the 20th century by being self-sustaining farms. Many of these homes were built in the 1970s, as recently created Medicare and Medicaid funding made them possible. Almost all have an interesting history: Sheiss was kind enough to send me a copy of “Heroic Work: The Story of Montevue Yesterday and Today.” Through funding from the Friends of Citizen Care & Rehabilitation and the Montevue Assisted Living Fund, Sheiss and Cynthia A. Powell have produced a solid example of local history. That history, good and bad, is worth remembering for counties making a decision.

But the other prevailing, and more discouraging, theme I saw was a cognitive dissonance around funding the county home. The subtitle is, “How no one likes math.” Often, the structure of a particular story around a county nursing home would go as such: County has run out of money to keep subsidizing the home. County considers selling the home. Public revolts, demands they keep it afloat. Nasty debate ensues, often for about a decade. At that point, no one wants to buy the facility.

The problem is not making room in the county budget to fund a county nursing home. That's fine. The problem is no one wants to say: Okay, we'll keep it open even though we know the Medicare and Medicaid funding won't be enough. That means we can't build a new high school, or have to cut out all parks and recreation services, or have to slash our local police force. If you don't like that, we'll raise taxes.

Not to mention that the difference between capital and operating budgets make people's eyes glaze over, so forget about finding money to repair the roof or repave the parking lot at old facilities.

There are counties that have found a compromise by finding a non-profit entity to take over the facility, that have been able to find new revenue streams by building a rehab unit or assisted living, or who have outsourced the management while retaining ownership. There are legislators on both sides of the issue trying to find a solution, and they are to be commended. But far more need to start an honest conversation about the county nursing home before racking up millions to keep it going.


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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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