Frequently Asked Questions about the Manitowoc County Health Care Center Herald Times Reporter May 28, 2007 (This is the fourth in a series of FAQs about the MCHCC.) Why does the county executive want to sell the MCHCC? County Executive Bob Ziegelbauer's key points: The county Health Care Center is losing nearly $3 million annually and the burden on county taxpayers is growing. Losses at the Health Care Center have been growing for several years, but no meaningful action has been taken by the county to deal with it. Continued losses threaten the county's ability to provide key services in other areas. Manitowoc County is not mandated to operate a nursing home. In recent years, the mission of the Health Care Center has changed dramatically. It no longer is the primary place to provide services to those in the care of the county. No one at the Health Care Center will be required to move. Manitowoc County will continue to meet its responsibilities to provide indigent care. The cost of the care is much less than the millions of dollars being lost at the Health Care Center. The Health Care Center would continue to operate and provide high quality care to county residents under the management of a private-sector operator, chosen by and meeting the requirements of Manitowoc County. Manitowoc County has limited resources to provide services. Personnel costs countywide continue to rise at an alarming rate. The growth of health insurance costs exceeds the growth of tax revenues. This threatens the financial viability of county government. Doing nothing is not an option. Continuing the pattern of losses at the Health Care Center would require huge tax increases, which law prohibits unless approved by the voters through referendum. What is the resolution before the county Board of Supervisors? The Manitowoc County Board of Supervisors states its intent to sell the operations of the Manitowoc County Health Care Center to a private operator in 2008 and to sell or lease the building, equipment, and real estate to the operator. The Manitowoc County Board of Supervisors authorizes the county executive to seek, secure, and bring a proposal to sell the operations of the Manitowoc County Health Care Center to a private operator in 2008 and to sell or lease the building, equipment, and real estate to the new operator before the County Board. What is Manitowoc County's current budget situation? Manitowoc County has to contend with state-imposed limits on property taxes to fund its operations. In 2005, the Legislature enacted a two-year cap on property-tax increases. Under the tax cap, Manitowoc County was allowed to levy — and did — $26,462,274 in its 2006 annual budget. In 2006, the county was allowed to levy $26,935,270 for its 2007 annual budget. The county levied $26,920,541 in its 2007 adopted annual budget. Todd Reckelberg, county comptroller, said he expects that the county will be subject to a tax-levy cap for the 2008 annual budget. Frequently Asked Questions about Manitowoc County Health Care Center Herald Times Reporter May 27, 2007 (This is the third in a series of FAQs about the MCHCC.) How many people work at the MCHCC? The Health Care Center was budgeted for 155.4 full-time equivalents in 2007. It employs 183 people. Of those, 102 are full-time and 81 are part-time. What are the average salaries and benefits for staff? According to the Manitowoc County Personnel Department: In May 2007, Manitowoc County Health Care Center unionized employees ratified a new health insurance plan and a labor contract from 2006 through 2010. Prior to the new agreement, union employees were paid wages under a 2005 contract. Employees will be paid back pay for scheduled wage increases. The employees are contracted to have received a 3 percent pay increase for 2006 and a 3 percent pay increase for 2007. Below is a list of average wages and salary for direct service MCHCC staff. 104 certified nursing assistants — 2005 rate: $12.26 per hour, 2006 rate: $12.63, 2007 rate: $13.01 per hour. 15 non-union registered nurse supervisors — $50,000 per year 5 nursing coordinators — $53,000 per year 10 licensed practical nurses — 2005 rate: $16.61 per hour, 2006 rates: $17.11 per hour, 2007 rates: $17.62 per hour. 1 social worker: $40,000 per year. 1 director of social services: $47,000 per year. Health Insurance: Under the new health insurance plan, unionized MCHCC employees would have the choice of a health savings account or a health reimbursement account, which would go into effect Aug. 1. Blue Cross and Blue Shield will remain the county's health insurance provider for employees. Health savings accounts are high-deductible health plans. The county fully funds the annual deductible — $1,500 for a single plan and $3,000 for a family plan. Employees pay no premium and they have no out-of-pocket deductible expenses after they are reimbursed by their health savings account for medical expenses. After meeting the deductible, all eligible in-network expenses are covered by insurance. Any remaining balance on the health savings account can be rolled over to the next year. Health reimbursement accounts are identical in insurance coverage and deductible levels to health savings accounts. The county-funded annual deductible is $1,500 for a single plan and $3,000 for a family plan. Under a health reimbursement account, however, the county pays for the health care services from the account. Any remaining balance would not be available to the employee. Employees also must pay the difference between the county-funded health savings account premium and health reimbursement account premiums. Retirement benefits: Manitowoc County pays an amount equal to 10.6 percent of MCHCC employee's wages into the Wisconsin Retirement System. Frequently Asked Questions about the Manitowoc County Health Care Center Herald Times Reporter May 26, 2007 (This is the second in a series of FAQs about the MCHCC.) Who does the MCHCC serve? Services are available only to Manitowoc County residents, with few exceptions, according to Michael Thomas, MCHCC administrator. Roughly 75 percent of the residents at the Health Care Center are on Medicaid. The remaining residents are Medicare, private pay and veterans, according to recent MCHCC census figures. The center provides nursing home care for the medical-geriatric; long-term residential and program services for the mentally disabled; and short-term respite care, according to the Manitowoc County Official Directory. How many people does the MCHCC serve? The center serves about 500 people per year with 130 residents receiving constant care at the center throughout the year, according to Thomas, the center's administrator. The MCHCC admits and discharges from 15 to 20 people per month, he said. What caregiver-to-patient ratio does the law require for nursing homes? According Wisconsin statue 50.04 (2) (d) and 50.04 (2) (d) 1-3: Each nursing home, other than nursing homes that primarily serve the developmentally disabled, shall provide at least the following hours of service: 1. For each resident in need of intensive skilled nursing care, 3.25 hours per day, of which a minimum of 0.65 hour shall be provided by a registered nurse or licensed practical nurse. 2. For each resident in need of skilled nursing care, 2.5 hours per day, of which a minimum of 0.5 hour shall be provided by a registered nurse or licensed practical nurse. 3. For each resident in need of intermediate or limited nursing care, 2.0 hours per day, of which a minimum of 0.4 hour shall be provided by a registered nurse or licensed practical nurse. What is the ratio at the MCHCC? What is the ratio at other nursing homes in the county? According to the state Department of Health and Family Services: Nursing staff hours per resident per day is the average hours worked by the licensed nurses or nursing assistants divided by the total number of residents. The amount of care given to each resident varies. Below are nursing staff hours per residents per day at nursing homes in Manitowoc County according to the U.S. Department of Health and Family Services Medicare Web site: MCHCC, Manitowoc: Registered nurse staff hours per resident per day: 1 hour and 7 minutes. Nursing aid staff hours per resident per day: 3 hours and 8 minutes. Hamilton Memorial Home, Two Rivers: Registered nurse staff hours per resident per day: 55 minutes. Nursing aid staff hours per resident per day: 2 hours and 8 minutes. North Ridge Medical and Rehabilitation Center, Manitowoc: Registered nurse staff hours per resident per day: 1 hour and 8 minutes. Nursing aid staff hours per resident per day: 2 hours and 49 minutes. River's Bend Health and Rehabilitation Center, Manitowoc: Registered nurse staff hours per resident per day: 1 hour. Nursing aid staff hours per resident per day: 2 hours and 13 minutes. Shady Lane Nursing Care Center, Manitowoc: Registered nurse staff hours per resident per day: 1 hour and 1 minute. Nursing aid staff hours per resident per day: 2 hours and 34 minutes. St. Mary's Home for the Aged at Felician Village, Manitowoc: Registered nurse staff hours per resident per day: 50 minutes. Nursing aid staff hours per resident per day: 2 hours and 41 minutes. May 25, 2007 Frequently Asked Questions about Manitowoc County Health Care Center Manitowoc Herald-Times Reporter (This is the first of several installments of FAQs that will be published in the Herald Times Reporter.) What is the Manitowoc County Health Care Center? The Manitowoc County Health Care Center is a 150-bed nursing home the county opened in 2003 at 2021 S. Alverno Road, Manitowoc. What is the mission statement of the MCHCC? As adopted by the county board on July 1, 1998: "To serve those who either select the center as a personal choice or who were unable to obtain services from other providers within the county. To compliment all other health services for the elderly and disabled by serving those who have a care intensity that would prohibit those providers from delivering such care. To serve as the safety net for those citizens not being served by other providers because the cost of care exceeds the reimbursement level, they have behavior issues that other providers cannot accept, or the level of care they require is of a high acuity and they need specialty services, which the Health Care Center is able to provide." Has the mission of the MCHCC changed? Michael Thomas, administrator of the Health Care Center, and County Executive Bob Ziegelbauer disagree on whether the mission has changed. Thomas says it has not. The MCHCC no longer serves the developmentally disabled on a long-term basis, Thomas said, but they are served on a short-term basis for stabilization. The MCHCC has chosen to exercise a portion of its mission statement that allows it to serve more profitable Medicare patients. Ziegelbauer says the mission of the Health Care Center has changed dramatically. He says the Health Care Center is no longer the primary place to provide services to those in the care of the county and only a few are now at the facility. Those people will remain the county's responsibility, he said. MCHCC lost $2.89 million in 2006 Herald Times Reporter May 26, 2007 MANITOWOC — The Manitowoc County Health Care Center lost $2.89 million in 2006, based on preliminary audited financial statements released by County Comptroller Todd Reckelberg on Friday. The MCHCC had requested and was budgeted for a projected $2.36 million operational loss in 2006, Reckelberg said. The $524,000 needed to cover the additional loss in 2006 was taken from the center's assets and from the county's general fund, according to Reckelberg. The county had projected, in pre-audited figures, for the center's deficit to exceed $2.9 million in 2006. County Executive Bob Ziegelbauer has proposed to sell MCHCC operations in 2008 and to negotiate a lease or sale of the real estate to a new operator. Ziegelbauer has said the county cannot afford to continue operating the center because of its annual deficits. He also has said the county would continue to provide mandated health-care services if the center were sold to a private operator.