Here is my column that ran in the Washington County Daily News last week.
Washington County’s Samaritan campus is at a crossroads. The time for tough decisions is upon us.
What should county taxpayers do for the people currently housed in the crumbling edifice of neglected obligations?
The Samaritan Campus is a senior care facility owned and operated by Washington County that provides skilled nursing, assisted living, and a residential care apartment complex for elderly citizens who cannot afford private care. It is funded through Medicare and Medicaid with shortfalls being covered by county taxpayers.
The problem the county is facing is severe, but not unique. The cost of operating Samaritan is far exceeding the funding provided by federal programs. Further, the facility needs a major renovation or rebuilding that will cost tens of millions of dollars.
Last year, Washington County taxpayers were paying nearly $50,000 per resident (about $2 million) to cover expenses and that is without the expense of a new or renovated facility. The ongoing expense for county taxpayers is projected to continue to increase exponentially.
Some have floated the notion that the county could use available money from one-time funds like federal COVID relief funds or opioid settlement funds to rehabilitate or reconstruct the facility. This may be feasible in the short term, but it does not fix the long-term funding problem. Using one-time funds to patch a systemic problem simply obligates future lawmakers to fix something because current lawmakers lack the courage to act.
What is to be done?
First, we must ask ourselves some hard questions. Should county taxpayers provide elder care to citizens who cannot afford it? There is no constitutional prohibition or mandate for county government to provide such a service. If the citizens of Washington County want to subsidize care for seniors, it is a policy decision. To date, county citizens have provided this service, so there is an absolute obligation to the seniors currently being cared for at Samaritan. Whether or not the citizens should carry this obligation moving forward is a separate question.
The second question to ask ourselves is, assuming county taxpayers are committed to providing for the county’s impoverished seniors, should the county own and operate the facility to do so? Experience should guide our answer to this question. Our collective experience is that, with exceedingly rare exception, government is terrible at running things. Government is a convenient, often abused, mechanism for the forced pooling of resources to expend on collective needs, but is pervasively inefficient, ineffective, and unresponsive when in charge of operations. We can see this in action at Samaritan itself, where decades of poor management and neglect have forced the county to this crisis point.
In Wisconsin, only 36 Wisconsin counties currently operate senior care facilities according to the Department of Health Services. The other counties either partner with private facilities to subsidize senior care where needed or forgo the financial obligation altogether. Washington County should transition the current residents to private facilities and support that transition with adequate funding. Using the COVID relief or opioid settlement monies to fund this transition might be necessary.
Whether or not county taxpayers should, or can, subsidize senior care moving forward will take some further thought. In the current arrangement, the taxpayer obligation to seniors is capped by the number of available beds at Samaritan. It is a physical cap. If the taxpayers subsidize senior care in private facilities with flexible capacity, would such a program attract seniors from outside of Washington County and become an unsustainable drain on taxpayer resources? Such potential unintended consequences will need to be mitigated should the county decide to subsidize senior care indefinitely.
One thing is certain. The situation at Samaritan has become intolerable and inexcusable. The caregivers are doing tremendous work but they are understaffed and under-resourced. Washington County is falling short of providing the dignity of care promised to Samaritan’s residents. This year must be a year of decisions and action — not another year of kicking the can down the road.
We can see this in action at Samaritan itself, where decades of poor management and neglect have forced the county to this crisis point.
I would say that considering they are still in operation is a testament to good management, considering that nursing home closures have happened across the private, nonprofit, and government sectors. In Wisconsin, 42 nursing homes closed between 2016-2021 Starting in 2020 (that overlaps with the above), 7 homes have closed, with a loss of 2000 beds.
What enterprise is capable of operating on revenues that cover 77% of costs?
Bethesda Lutheran of Watertown was a big player – 600 beds at one time. They left that business about 10 years ago. Razed 6 buildings in various states of repair – when vacated, was costing over a million a year in maintenance & utilities just to keep them from collapsing. They moved their disabled residents to new group homes. Due to COVID staffing issues, they have since divested from that business.
My father was business manager at a nonprofit nursing home. In 1999 they were at 415 licensed beds. Because of the drag on revenues due to Medicaid & Medicare reimbursements, as a strategic move they decided to focus on residential & assisted living facilities, and to unwind the nursing care beds. You can only shift a certain amount of unreimbursed expensed onto the private pay customers or the donor class. By 2002 they were down to 230 beds, with 30% being private residents. Last I heard, they are down to 50 beds.
The bright spot is that thanks to the assisted living facilities and in home care resources, not nearly as many skilled nursing beds are needed as in the past. But there will still be some people that don’t have the resources or family support to provide 24/7 skilled care. That is the group that government may need to provide for.
Another bright spot is that the reimbursement is supposed to be raised to 90%. So, losing 10% is better than losing 23%.
Mark, thanks for the info on Bethesda. I used to work there in the 1980’s, when still all the buildings.