The document discusses options for improving Centre Crest Nursing Home as a county-operated facility. It proposes constructing an outpatient therapy entrance, renovating resident rooms, redesigning the cafeteria, and expanding employee parking. It also recommends increasing staffing levels through a nurse aide training program and partnering with Complete Healthcare Resources to improve nursing services and marketing. The investments aim to increase occupancy and revenue while decreasing the county's contribution over time by stabilizing operations and improving resident and staff satisfaction at the facility.

1. Investments We Need
Improving Centre Crest as a
County-Operated Facility

2. Observations
• We have not exhausted all options.
• We didn’t get into this position overnight and we
won’t get out of it overnight.
• Multi-faceted approach
– Outpatient Rehabilitation
– Long-Overdue Capital Investments
– CNA Training Program/Reduction Outside Agency Staff
– Ongoing contract with Complete Healthcare Resources
• A county home has not converted to a nonprofit in
over 20 years.
• A county can operate a nursing home well.

3. What do we need to do?
• Continue with a respectful dialogue
• Make sure Centre Crest is not privatized
• Improve the care of the residents and the
morale of the staff
• Stabilize the County’s contribution to Centre
Crest
• Decide whether we will do this as a county-
operated facility or as a nonprofit organization

4. How is Centre Crest funded?
•  Spreadsheet

5. Setting the Record Straight
In 2004, Commissioners Dershem and Exarchos
DID NOT want to privatize or make Centre Crest
a nonprofit. The day after they were elected
they toured Centre Crest and began working
immediately to improve it as a county-owned
and county-operated home. Throughout their
first term in 2004-2007 they contributed
$2,800,000 in General Fund revenue to Centre
Crest.

6. “Our View”
November 6, 2003 - Centre Daily Times
“We commend [Commissioner Steve]
Dershem for hitting the ground running.
He visited the Centre Crest nursing
home Wednesday to begin talking with
officials there with an eye toward
improvements once he officially takes
office in January.”

7. “County in Familiar Centre Crest Discussions”
August 12, 2005 – Centre Daily Times
“Board of Commissioners Chairman
Chris Exarchos said the county has been proactive in
addressing the many concerns of the nursing home's
employees.
“He said that when he and fellow Republican
Commissioner Steve Dershem took office, they visited
the nursing home during each shift to see what
workers were up against.
“Wages were examined,” he said, “and several posts
had salaries significantly boosted to make them
competitive with local providers.”

8. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

9. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

10. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

11. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

12. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

13. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

14. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

15. “County vows to pull Centre Crest out of the red”
October 14, 2005 – Centre Daily Times

16. “Oks Tentative Budget – Reserve Funds to
Cover Costs at Centre Crest, Other Deficits”
November 15, 2006 – Centre Daily Times
“The Centre County Board of Commissioners
approved an $83.7 million tentative 2007 budget
Tuesday that has no tax increase but taps into
reserves to cover a $2.2 million deficit. The major
source of the deficit is Centre Crest nursing home,
which accounts for $1.5 million of the projected
shortfall. Chairman Chris Exarchos said the county is
working on strategies to cover costs at Centre Crest .
The cost of operating the nursing home, $17.4
million this year, is projected to be $18.4 million in
2007.

17. “…[Commissioner] Exarchos noted it will be the sixth
consecutive year without a tax increase but said that
can't continue indefinitely. ‘At some point, there has to
be a tax increase,’ Exarchos said. In fact, 2007 might be
the last year property owners don't see county taxes
climb. The 2007 budget will cut the county's fund
balance from $7.5 million to $5.3 million. Exarchos said
the county needs to have a $3.5 million to $4 million
reserve to cover expenses that will be reimbursed.
Commissioners are also looking into contracting a
company to run Centre Crest 's pharmacy as a cost-
saving strategy.”
“Oks Tentative Budget – Reserve Funds to
Cover Costs at Centre Crest, Other Deficits”
November 15, 2006 – Centre Daily Times

18. Paying for the Investments
• $5 Million Bond in 2013
– 10 year payback
– ~$700,000 in interest
• 2/10 mill increase in Debt Service millage
– 1 mill = ~$3,100,000
– 2/10 mill = ~$620,000

19. The Tax Facts
•  Debt Service/Bond PDF

20. How would we pay for a new building?
• Complete Healthcare Resources’ Proforma
estimated a new building would cost
$27,700,000.
• County would have the debt service available to
pay for the new building beginning in 2021.
– 6 Years of $1,300,000 payments = $7,800,000
– 10 Years of $2,500,000 payments = $25,000,000
– TOTAL = $37,800,000
• NOTE: The above number is not an estimate of a new
building cost.

21. The Tax Facts
• 2002-2009 Budgets had no tax increase
• 2010 Budget contained a tax Increase
– 6.54 mills  8.04 mills (6.85 General & 1.19 Debt)
• 2011 Budget contacted a tax Decrease
– 8.04 mills  7.79 mills (6.60 General & 1.19 Debt)
• 1 mill = $3,100,000

22. The Tax Facts
• How much more in revenue was received in…
– 2010 v 2009 … $4,650,000
– 2011 v 2009 … $3,875,000
– 2012 v 2009 … $3,875,000
– 2013 v 2009 … $3,875,000
• From January 1, 2010 to December 31, 2013,
there will have been $16,275,000 of new
revenue to Centre County government from the
2010 tax increase.

23. Tax Facts
• $5 Million Bond for Capital Improvements
–Outpatient Rehabilitation
–Much-needed Improvements
• Resident Rooms
• Cafeteria
• Employee Parking
• Community Rooms

24. Outpatient Therapy
• On September 17, 2007, Centre Crest received
letter granting the county a waiver to perform
outpatient therapy.
• Due to PA Department of Health regulations,
we were unable to do outpatient therapy
without constructing another entrance.
• Our current therapy provider, Apex, does
outpatient therapy at other nursing facilities

25. Current Centre Crest Therapy Profit
2012
Physical Therapy + $672,810
Occupational Therapy + $470,835
Speech Therapy + $393,560
Total Therapy + $1,537,205

31. Costs
• Paving, Excavating, Lighting, Hand-rails,
Awning, New Outside Door, New Inside Door
• Work w/ Apex to contribute to the project
• Revenue increase: $250,000 to $400,000/year

32. Resident Rooms
• Our Resident Rooms are out-of-date. Some of
the equipment, furniture, and decorations
have been in the facility since the 1970s.
– We need to paint the rooms a new color, new
floors, new furniture, new curtains, new
decorations and fixtures, new doors (or at least
new bump-guards), new signage

36. Other capital improvements
• Decorations and furniture inside the building
– Photos and pictures around the building
– Resident room signage, cork boards, lighting, glove
holders, “Notices” by CareTracker machine
• Outside the building
– New welcome sign
– New garden areas
– Expand employee parking area
• Raze the house and pave

37. Broken Windows Theory
• The theory states that maintaining and
monitoring urban environments in a well-
ordered condition may stop further vandalism
and escalation into more serious crime.
• Applied to nursing homes: a clean, well-kept
environment will encourage better care.
• A nursing home that doesn’t continually invest
in the facility will lead to a decline census,
decline in staff morale and decline in resident
care.

48. Café/Social Area

53. Employee Parking Lot

55. Investments We Need
• Construct Outpatient Therapy
Entrance
• Renovate Resident Rooms
• Redesign Cafeteria
• Expand Employee Parking Lot
• Not to Exceed $5,000,000

56. Improvements in Operations
• Increase Census
• Nurse Aide Training Program
• Decrease Utilization of Outside
Nursing Agency Staff
• Bring Complete Healthcare
Resources on as a partner to help
us in nursing and marketing

57. Census Increase
• In 2012, the average census was 214 residents
Net Patient Revenue (Census = 220) + $463,163.10
Nursing - $230,300.40
Pharmacy - $21,286.80
Rehab - $38,281.20
Laundry - $13,183.80
Dietary - $54,640.50
Therapeutic Rec - $13,402.80
Net Income + $92,067.60

58. Nurse Aide Training
• Centre Crest competes with other companies
for nursing staff:
– Mount Nittany, HealthSouth, Hearthside,
Brookline, Hospice Agencies, Nursing Agencies,
Doctor offices, etc.
• Currently the bulk of our CNAs come from CPI
classes, however that’s not enough. (Penn
State-UP graduates LPNs and RNs.)

59. Current Staffing (census = 214)
Shift CNAs/
shift
Ratio PRD
7a-3p 20 1:11
3.333p-11p 17.5 1:12
11p-7a 9 1:24

60. Ideal Staffing (census=220)
Shift CNAs/
shift
Ratio PRD
7a-3p 27.5 1:8
3.533p-11p 27.5 1:8
11p-7a 11 1:20

61. Staffing Challenges
• Turnover
• Call-offs
• Vacation time
• Sick time
• Leave of absences
• Negotiated benefits

62. What would this cost?
• We need to hire additional staff:
– 16 more CNAs
– xx more LPNs
• Based on the data in 2013 Budget, annual cost
of 0.01 PRD = $22,678
• Difference of 0.20 PRD between Current and
Ideal Staffing
• Estimated cost: ($22,678 x 20) = $453,560

63. Nurse Staffing
• Create an in-house Nurse Aide Training
Program
• Starting a Nurse Aide Training Program
• Partnership between Penn State and
Pennsylvania Department of Education:
Teaching the Educator

64. Nurse Aide Program

65. Complete Healthcare Resources
• Change Complete Healthcare Resources’ focus
from transitioning Centre Crest to improving the
facility under county-operation
– Nursing
• Improve the nurse to patient ratio
• Enhance staff appreciation program
• Work with RNACs to enhance MDS reporting
– Admissions/Marketing
• Implement marketing strategies that CHR has done at
their other homes here at Centre Crest.

66. 2014 County Contribution
2012 County Contribution - $1,000,000
CHR contract - $100,000
Increase in Nursing Staff - $454,000
Hire Retention Specialist - $50,000
Outpatient Rehab + $300,000
Decrease in Agency Staff + $300,000
Increase in Occupancy + $92,000
TOTAL - $912,000

75. Centre Crest Auxiliary
• Secured a $5,000 grant to purchase 21 new
wheelchairs.
• Purchased tables, benches and umbrellas for
the Stanton Court Garden
• Completed Kline Way garden
• Provision of beauty shop supplies; this allows
the service to be provided to residents at no
cost

76. Centre Crest Auxiliary
• Provide the opportunity for residents to
"shop" for their family at Christmastime so
each resident has gifts to give to their family
members at no cost to the residents.
• Purchase birthday and Christmas gifts for
residents without families.
• Provide holiday treat gift bags for each
resident.

77. Centre Crest Auxiliary
• Purchase hair curlers for residents that cannot
get to the beauty parlor.
• Purchase shampoo caps for bedfast residents.
• Provide welcome bags to all new residents.
• Sponsor annual butterfly releases in the
garden areas.
• Purchased commercial blender for the Centre
Crest kitchen.

78. Centre Crest Auxiliary
• Assist with welcome social for new residents
and their families.
• Purchase outdoor Christmas decorations.
• Provide free postage stamps and greeting
cards for residents.
• Sponsor two entertainments monthly for the
residents' enjoyment.
• Sponsor employee appreciation events.

79. Centre Crest Auxiliary
• Provided sun setter canopies.
• Purchased a digital scale for resident use.
• Purchased a resident lift.
• Formed Comfort and Love Volunteer Group to
accompany residents through the end of life
stages as well as support to their families
during their time of loss.

80. Centre Crest Auxiliary
• Refurbished the first floor living room with
new flooring, furniture, electric fireplace,
drapes, and large screen TV.
• Manages the Centre Crest Auxiliary Gift Shop.

81. Wonderful things happen at
Centre Crest but we have
room to improve.

82. Moving Forward: Short-Term
• Direct staff to put together a plan for:
– Painting the hallways
– Purchasing new resident signs, “notice” boards,
hallway decorations (picture frames)
• Work with Auxiliary to get Bellefonte photos

83. Moving Forward: Long-Term
• Continue to work together with my fellow
commissioners to improve Centre Crest.
Answer any questions on my major
recommendations.
• Re-Examine the Complete Healthcare
Resources proforma based on my proposals
and send them a list of questions and
clarifications.