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Our Island Home Operating at $2.8 million deficit
Town officials say Our Island Home will always operate at a loss given the number of beds and the reimbursement rates from Medicaid and MassHealth, which cover a fraction of the cost that is needed to serve each resident. "It can never be profitable," said Connie Voges, the town's finance director. "It would take 145 beds to break even." In 2007, taxpayers paid $2.8 million dollars or 43 percent of the cost to run the nursing home. The $2.8 million subsidy represents the difference between the total cost of operating Our Island Home - $6.5 million in 2007, according to the cost report town officials submitted to the state that year - and the total revenues received from private pay rates and Medicaid and MassHealth reimbursements - which totaled $3.7 million for that same year.
Home resident - a figure based on the facility's cost report submitted to the state for 2006. The private pay rate was $300 per day for a private room and $280 for a semi-private. Our Island Home's state-approved reimbursement rate for Medicaid was $233 per day; for MassHealth, $270 per day. On February 20, 2008, the Board of Selectmen voted to increase the private pay daily rates to $400 for a private room (the facility has three) and $390 for a semi-private, but even those rates do not cover current costs, said Voges, Ten to 13 beds - or about 22 to 28 percent of the residents in Our Island Home - are private pay, with the balance - 68 to 70 percent of the residents - covered by Medicaid. Medicaid reimbursement remains the same, costing the town $184 per day for each Medicaid patient.
Since this February, there have been four beds open. With eight percent of the beds not generating income for six months, the nursing home has already lost $170,000 in Medicaid reimbursement or $284,700 in private pay. "We weren't taking any new residents in 2007," said Meriam. "Now there are four vacancies." Most people have been on the waiting list for years. "By the time we call them, they are not ready to move into the nursing home, have gone to an offisland nursing home, or have made arrangements to stay in their home," said Meriam. A couple of years ago, the Town of Provincetown got out of the nursing home business. That town operated the 41-bed Cape End Manor and in 2006 transferred the nursing home's license and its 2.2-acre site to the nonprofit New England Deaconess Association, with a deed restriction requiring Deaconess to operate a nursing home on that property. As part of the deal, Deaconess built a brand new $20-million facility - Seashore Point - with 41 nursing home beds and 80 units of assisted living/ independent living, for an aging-in-place experience Deaconess calls "abundant living."
In addition to the day-to-day operating costs, nursing home regulations are constantly changing and getting more difficult to meet. "Nursing homes have more regulations than nuclear power plants," said Meriam. It just may be possible that one day Our Island Home's physical plant may not meet the state and federal codes for operating a nursing home. "It's presumptive to think people are going to want to share a room and a bath," said Meriam of the facility's need to be renovated and offer private rooms. Meriam recounted an incident where a married couple shared a room and after the wife died, she had to tell the husband that someone else would be moving in to share the room. "It was very difficult," she said. "This man's wife just died and somebody else would be in her bed." "We could renovate the building, offer private rooms or find a piece of land to build a new building or offer a cottage concept, with single houses with eight to 10 people in a house," said Meriam. "It's a lot of money for the voters." Our Island Home is built on the waterfront overlooking Nantucket Harbor. It was built in 1981 in the shadow of the former Our Island Home, which is now the Landmark House. There is not enough land on the current site to build a facility where Nantucketers could "age in place" by having independent living apartments and congregate living facilities. The sale or leasing of the residences would subsidize the operation of the nursing home, which is what New England Deaconess was able to do in Provincetown. "Towns aren't used to running nursing homes. They are used to running schools and fire departments," said Meriam of the taxpayers' generosity in subsidizing the nursing home. "We have only 45 people here, which is a portion of the year round population. With discharges, over the course of the year, we might serve 60 people." Our Island Home is here to stay, but it may undergo some changes. "There has been a long standing community commitment. There are some things that are important," said Selectman and former Finance Committee chairman, Rick Atherton. Yet, "We have to find a way to discuss the Our Island Home without finding ourselves criticized for even having the discussion. There may or may not be options. When there is that much money involved and we are looking at overrides, every town department has to be examined," added Atherton. Town manager Libby Gibson said while the concept of a different entity's running the nursing home has been broached over the years, it never reached the point of a study. "It's my understanding, and this is without looking into a detailed analysis of this venture, it would not be profitable enough for another entity to come (and operate the nursing home)," said Gibson. "We've had informal discussions about the various options of selling the land and building something on other town property, but there is some community resistance to that," said Gibson. "We could expand and improve the existing facility and move the Adult Day Care program there and then there is the option of moving the facility some place else. Eventually, we are going to have to sink some money into the facility or figure out another option. There hasn't been a conclusion to the discussion." "It is costly. There are so many infrastructure needs facing the town," added Gibson. "The public safety facility took over and was viewed as one of the most pressing needs." There are not many options for the island's elderly needing round-theclock nursing care. "The options for the elderly in need of care are to be placed in a nursing home off island, in the nursing home here or set up in home services," said Meriam. I |
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