(Published Friday, February 9, 2007 11:55:50 AM CST)
A d v e r t i s e m e n t
Memo sent from Sherry Gunderson, county nursing home administrator, to the Rock County Board Health Services Committee addressing her rationale for downsizing Rock Haven
Rock Haven
February 6, 2007
Memo to: Health Services Committee members
From: Sherry Gunderson
Re: Downsizing from 156 to 130 beds
1. Rationale for moving forward with this plan in 2007.
a. This is one more step in preparing Rock Haven for success in the future.
1. The literature and research supports smaller nursing homes. Nursing homes with 100-125 residents are more efficient and provide higher quality outcomes for residents.
2. The average nursing home census in Wisconsin is 95 beds.
3. Sufficient nursing homes remain in Rock County. With the increase in assisted living facilities and community funding for home care, more elderly will stay in the community.
4. Changes in Medicaid funding now focus on a Resource Utilization Group (RUG) rate. We will no longer be able to serve the healthy old as they will not meet Medicaid skill level. We have been denying admission to Rock County citizens who do not meet the level of skill required by the Medicaid program for the past three years.
5. On a good note, the State plans to use the Medicaid money gained from closing nursing home beds to better fund community funding.
b. The nursing home of the future will care for residents who are medically complex, require short-term rehabilitation or who have mid to late stage dementia with behavioral concerns. We already serve residents with these concerns and are recognized for that care in our community.
c. Many of these residents require private rooms. A down size will give us the private rooms that we need for this complex resident population.
d. Current staffing vacancies would allow us to move staff into critical positions while ensuring that positions remain for all current staff. This will also reduce overtime and mandation related to our current vacancy rate.
e. A reduction in FTE will serve us well as Wisconsin faces the projected shortage in nurses and other nursing personnel. Since BTC no longer has a LPN program and we have no BSN programs in our area, we are limited to hiring Associate Degree s. In addition, BTC now requires all RN students to take the nursing assistant course. Many of these students never plan to work as nursing assistants and their participation in the course limits enrollment to others.
f. Anticipated resident discharges would allow this process to move quickly without the need to for any residents to be involuntarily discharged from the facility. It appears that we could reach our goal in March.
2. Response to nursing home survey issues in 2006
a. Creation of 6 RN positions responsible for completion of the Minimum Data Set (generates Medicare and Medicaid reimbursement rates), physician rounds and admissions would prevent the care issues that resulted in our survey concerns in 2006.
b. Creating smaller units for residents with dementia will increase our ability to keep all residents safe.
2. Decrease from 50 to 42 beds in order to have 8 more private rooms for
our medically complex residents with infections, equipment needs.
a. North wing- continues with 14 residents.
b. East wing- becomes 15 private rooms (gives up 6 beds).
c. South wing- decrease to 13 residents (gives up 2 beds).
3. Change daily staffing pattern to reflect loss of eight beds while maintaining a PPD (number of nurse plus aide hours per patient per day on the unit) of 4.9.
b. RH 2
1. Chronic mental illness, mid stage dementia.
2. Decrease from 51 to 44 beds in order to have 7 more private rooms for
residents who do not do well with others.
a. North wing- continues with 15 residents.
b. East wing- becomes 15 private rooms (give up 5 beds).
c. South wing- decrease to 14 residents (gives up 2 beds).
3. Change daily staffing patterns to reflect the loss of seven beds while maintaining a PPD of 4.3.
c. RH 3
1. Mid to late stage dementia.
2. Decrease from 55 to 44 beds in order to close the west wing to resident
care and add more private rooms for medically complex or behavioral
residents.
a. North wing- continues with 15 residents.
b. East wing- reopen 312 and 326, becomes 15 private rooms (decreases 5 beds).
c. South wing- reopen 337 A and B, increase from 12 to 14 residents. d. West wing- move the Head Nurse (326), Social worker (312), MDS nurse, w/c scale (337), staff report room and lockers to west.
3. Change daily staffing pattern to reflect loss of eleven beds. while maintaining a PPD of 4.7.
4. Continue to provide 50% of the activity staff time on this unit while the remainder of time is shared by RH I and RH 2.
4. Staff reduction as a result of this downsize
a. Nursing
1. 1.0 Head Nurse -vacant
2. 7.0 FTE LPN/MA
a. 2.8 MA will return to aide positions
b. 2.8 LPN hours are vacant
c. 2.6 RN hours are vacant
3. 16.1 Aide- from 114 to 94 positions
a. Decrease from 61 to 46 full-time positions
b. Decrease from 53 to 48 part-time positions
c. 16 positions are vacant
d. Movement into our internal pool is an option, staff will carry seniority to the pool.
b. Social services- reduce 1.0 MSSW with a retirement in late 2007
c. Unit clerk- no change, plan for cross training with administrative team
d. Recreational therapy
1. 1. 0 ATA -vacant
e. Environmental services
1. 1.0 ES worker -vacant
f. Finance
1. 1.0 Accountant - vacant
g. Dietary
1. Reduce overtime by not filling for one call-off each shift.
h. Maintenance- no change
i. Materials- no change
5. Cost savings- we hope to accomplish this downsize while staying within the 2007 budget.
a. Total revenue lost (26 beds at Medicaid rate) = $1,221,234
b. Total savings in wages, benefits and food, laundry, med supplies, disposables = $1,421,686
