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"Investments We Need" - Centre Crest Presentation

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This presentation was given by Centre County Commissioner Michael Pipe on Tuesday, June 18, 2013.

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"Investments We Need" - Centre Crest Presentation

  1. 1. Investments We NeedImproving Centre Crest as aCounty-Operated Facility
  2. 2. Observations• We have not exhausted all options.• We didn’t get into this position overnight and wewon’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 inover 20 years.• A county can operate a nursing home well.
  3. 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 themorale of the staff• Stabilize the County’s contribution to CentreCrest• Decide whether we will do this as a county-operated facility or as a nonprofit organization
  4. 4. How is Centre Crest funded?•  Spreadsheet
  5. 5. Setting the Record StraightIn 2004, Commissioners Dershem and ExarchosDID NOT want to privatize or make Centre Cresta nonprofit. The day after they were electedthey toured Centre Crest and began workingimmediately to improve it as a county-ownedand county-operated home. Throughout theirfirst term in 2004-2007 they contributed$2,800,000 in General Fund revenue to CentreCrest.
  6. 6. “Our View”November 6, 2003 - Centre Daily Times“We commend [Commissioner Steve]Dershem for hitting the ground running.He visited the Centre Crest nursinghome Wednesday to begin talking withofficials there with an eye towardimprovements once he officially takesoffice in January.”
  7. 7. “County in Familiar Centre Crest Discussions”August 12, 2005 – Centre Daily Times“Board of Commissioners ChairmanChris Exarchos said the county has been proactive inaddressing the many concerns of the nursing homesemployees.“He said that when he and fellow RepublicanCommissioner Steve Dershem took office, they visitedthe nursing home during each shift to see whatworkers were up against.“Wages were examined,” he said, “and several postshad salaries significantly boosted to make themcompetitive with local providers.”
  8. 8. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  9. 9. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  10. 10. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  11. 11. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  12. 12. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  13. 13. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  14. 14. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  15. 15. “County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times
  16. 16. “Oks Tentative Budget – Reserve Funds toCover Costs at Centre Crest, Other Deficits”November 15, 2006 – Centre Daily Times“The Centre County Board of Commissionersapproved an $83.7 million tentative 2007 budgetTuesday that has no tax increase but taps intoreserves to cover a $2.2 million deficit. The majorsource of the deficit is Centre Crest nursing home,which accounts for $1.5 million of the projectedshortfall. Chairman Chris Exarchos said the county isworking on strategies to cover costs at Centre Crest .The cost of operating the nursing home, $17.4million this year, is projected to be $18.4 million in2007.
  17. 17. “…[Commissioner] Exarchos noted it will be the sixthconsecutive year without a tax increase but said thatcant continue indefinitely. ‘At some point, there has tobe a tax increase,’ Exarchos said. In fact, 2007 might bethe last year property owners dont see county taxesclimb. The 2007 budget will cut the countys fundbalance from $7.5 million to $5.3 million. Exarchos saidthe county needs to have a $3.5 million to $4 millionreserve to cover expenses that will be reimbursed.Commissioners are also looking into contracting acompany to run Centre Crest s pharmacy as a cost-saving strategy.”“Oks Tentative Budget – Reserve Funds toCover Costs at Centre Crest, Other Deficits”November 15, 2006 – Centre Daily Times
  18. 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. 19. The Tax Facts•  Debt Service/Bond PDF
  20. 20. How would we pay for a new building?• Complete Healthcare Resources’ Proformaestimated a new building would cost$27,700,000.• County would have the debt service available topay 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 newbuilding cost.
  21. 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. 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 newrevenue to Centre County government from the2010 tax increase.
  23. 23. Tax Facts• $5 Million Bond for Capital Improvements–Outpatient Rehabilitation–Much-needed Improvements• Resident Rooms• Cafeteria• Employee Parking• Community Rooms
  24. 24. Outpatient Therapy• On September 17, 2007, Centre Crest receivedletter granting the county a waiver to performoutpatient therapy.• Due to PA Department of Health regulations,we were unable to do outpatient therapywithout constructing another entrance.• Our current therapy provider, Apex, doesoutpatient therapy at other nursing facilities
  25. 25. Current Centre Crest Therapy Profit2012Physical Therapy + $672,810Occupational Therapy + $470,835Speech Therapy + $393,560Total Therapy + $1,537,205
  26. 26. 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
  27. 27. Resident Rooms• Our Resident Rooms are out-of-date. Some ofthe equipment, furniture, and decorationshave been in the facility since the 1970s.– We need to paint the rooms a new color, newfloors, new furniture, new curtains, newdecorations and fixtures, new doors (or at leastnew bump-guards), new signage
  28. 28. Other capital improvements• Decorations and furniture inside the building– Photos and pictures around the building– Resident room signage, cork boards, lighting, gloveholders, “Notices” by CareTracker machine• Outside the building– New welcome sign– New garden areas– Expand employee parking area• Raze the house and pave
  29. 29. Broken Windows Theory• The theory states that maintaining andmonitoring urban environments in a well-ordered condition may stop further vandalismand escalation into more serious crime.• Applied to nursing homes: a clean, well-keptenvironment will encourage better care.• A nursing home that doesn’t continually investin the facility will lead to a decline census,decline in staff morale and decline in residentcare.
  30. 30. Café/Social Area
  31. 31. Employee Parking Lot
  32. 32. Investments We Need• Construct Outpatient TherapyEntrance• Renovate Resident Rooms• Redesign Cafeteria• Expand Employee Parking Lot• Not to Exceed $5,000,000
  33. 33. Improvements in Operations• Increase Census• Nurse Aide Training Program• Decrease Utilization of OutsideNursing Agency Staff• Bring Complete HealthcareResources on as a partner to helpus in nursing and marketing
  34. 34. Census Increase• In 2012, the average census was 214 residentsNet Patient Revenue (Census = 220) + $463,163.10Nursing - $230,300.40Pharmacy - $21,286.80Rehab - $38,281.20Laundry - $13,183.80Dietary - $54,640.50Therapeutic Rec - $13,402.80Net Income + $92,067.60
  35. 35. Nurse Aide Training• Centre Crest competes with other companiesfor nursing staff:– Mount Nittany, HealthSouth, Hearthside,Brookline, Hospice Agencies, Nursing Agencies,Doctor offices, etc.• Currently the bulk of our CNAs come from CPIclasses, however that’s not enough. (PennState-UP graduates LPNs and RNs.)
  36. 36. Current Staffing (census = 214)Shift CNAs/shiftRatio PRD7a-3p 20 1:113.333p-11p 17.5 1:1211p-7a 9 1:24
  37. 37. Ideal Staffing (census=220)Shift CNAs/shiftRatio PRD7a-3p 27.5 1:83.533p-11p 27.5 1:811p-7a 11 1:20
  38. 38. Staffing Challenges• Turnover• Call-offs• Vacation time• Sick time• Leave of absences• Negotiated benefits
  39. 39. What would this cost?• We need to hire additional staff:– 16 more CNAs– xx more LPNs• Based on the data in 2013 Budget, annual costof 0.01 PRD = $22,678• Difference of 0.20 PRD between Current andIdeal Staffing• Estimated cost: ($22,678 x 20) = $453,560
  40. 40. Nurse Staffing• Create an in-house Nurse Aide TrainingProgram• Starting a Nurse Aide Training Program• Partnership between Penn State andPennsylvania Department of Education:Teaching the Educator
  41. 41. Nurse Aide Program
  42. 42. Complete Healthcare Resources• Change Complete Healthcare Resources’ focusfrom transitioning Centre Crest to improving thefacility 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 attheir other homes here at Centre Crest.
  43. 43. 2014 County Contribution2012 County Contribution - $1,000,000CHR contract - $100,000Increase in Nursing Staff - $454,000Hire Retention Specialist - $50,000Outpatient Rehab + $300,000Decrease in Agency Staff + $300,000Increase in Occupancy + $92,000TOTAL - $912,000
  44. 44. Centre Crest Auxiliary• Secured a $5,000 grant to purchase 21 newwheelchairs.• Purchased tables, benches and umbrellas forthe Stanton Court Garden• Completed Kline Way garden• Provision of beauty shop supplies; this allowsthe service to be provided to residents at nocost
  45. 45. Centre Crest Auxiliary• Provide the opportunity for residents to"shop" for their family at Christmastime soeach resident has gifts to give to their familymembers at no cost to the residents.• Purchase birthday and Christmas gifts forresidents without families.• Provide holiday treat gift bags for eachresident.
  46. 46. Centre Crest Auxiliary• Purchase hair curlers for residents that cannotget to the beauty parlor.• Purchase shampoo caps for bedfast residents.• Provide welcome bags to all new residents.• Sponsor annual butterfly releases in thegarden areas.• Purchased commercial blender for the CentreCrest kitchen.
  47. 47. Centre Crest Auxiliary• Assist with welcome social for new residentsand their families.• Purchase outdoor Christmas decorations.• Provide free postage stamps and greetingcards for residents.• Sponsor two entertainments monthly for theresidents enjoyment.• Sponsor employee appreciation events.
  48. 48. Centre Crest Auxiliary• Provided sun setter canopies.• Purchased a digital scale for resident use.• Purchased a resident lift.• Formed Comfort and Love Volunteer Group toaccompany residents through the end of lifestages as well as support to their familiesduring their time of loss.
  49. 49. Centre Crest Auxiliary• Refurbished the first floor living room withnew flooring, furniture, electric fireplace,drapes, and large screen TV.• Manages the Centre Crest Auxiliary Gift Shop.
  50. 50. Wonderful things happen atCentre Crest but we haveroom to improve.
  51. 51. 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
  52. 52. Moving Forward: Long-Term• Continue to work together with my fellowcommissioners to improve Centre Crest.Answer any questions on my majorrecommendations.• Re-Examine the Complete HealthcareResources proforma based on my proposalsand send them a list of questions andclarifications.

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