The nursing home picture has become increasingly bleak since 2017. I have heard some of our community members are frustrated that we have not yet begun to build a new nursing home out of the flood plain.
Unfortunately due to the increasingly significant disparity between what it costs to care for a Medicaid resident and the real cost of that care Josephine nursing home has operated at a loss for the first time in 10 years.
Washington State has seen a 500% increase in the harshest citations written since 2014. In 2014 Washington nursing home Department of Social and Health Services (DSHS) surveyors wrote 14 Immediate Jeopardy ( IJ the harshest) citations. In 2017 they wrote 92 IJ citations with a significant number of those not meeting federal rules from Centers for Medicaid and Medicare Services (CMS). These IJ citations were written merely for the “Potential” for harm. Centers for Medicaid and Medicare Services has recently put a stop to states, specifically WA State, to writing IJ citations merely for the possibility or “Potential” for harm by updating their Guidance To Surveyors. IJ citations come with daily fines as high as $22,000 per day. And the State may then also put the nursing home in “Stop Placement” which prohibits the nursing home to admit patients until the Stop Placement is cleared. In 2017 Josephine received an IJ citation for the “Potential” for harm and then was put in “Stop Placement”. The State DSHS surveyor is to return no longer than 15 after the nursing home alleges compliance. WAC “…the department shall return within 15 days of allegation of compliance….. We alleged compliance within hours of receiving the citation, then four more time over the course of 40 days. No DSHS surveyor returned to clear our Stop Placement. I asked for help around day 38 from Representative Dave Hayes who called senior management at DSHS on day 39. The reply from senior management at DSHS was “these are very serious citations at Josephine”. A DSHS finally showed up on day 40 to lift our Stop Placement.
It is fact that the citation should have been no more severe than a paperwork correction and certainly not the harshest citation available to DSHS surveyor. And DSHS left us in Stop Placement 25 days past the mandated maximum of 15 days without a revisit. So DSHS survey team not only did not follow Federal rules but failed to follow Washington State law as well. Josephine was not the only nursing home to endure this kind of treatment from the WA State survey team in 2017 and 2018.
Connecting the dots it leads me to the conclusion that a majority of lawmakers in Washington State and upper management at the Department of Health and Human Services is intent on reducing the number of nursing homes and nursing home beds. Washington State nursing homes are underfunded by millions compared to our neighbor to the east, Idaho and directly to the south Oregon. DSHS writes IJ citations at three times the national median and writes twice the number of citations in total as the national median. Twelve nursing homes have closed since 2017 yet the majority of lawmakers seem unconcerned.
I hope I am wrong about this. But until the fiscal and regulatory climate in Washington State improves, Josephine will continue to reduce bed capacity.
Below was my last testimony to Senate Ways and Means committee. Unfortunately to no avail as no additional funding for nursing home Medicaid was added to the Senate budget.
Chair Rolfes and Committee thank you for listening today. My name is Terry Robertson, I am the CEO of Josephine Caring Community. We have been providing care for seniors for 110 years. We are 160 bed nursing home with 100 Medicaid residents. We admit/discharge around 500 patients a year in our short term rehab unit. We also have assisted living and childcare on campus. All being cared for by 300 employees.
In 2008 through Senate Resolution 2748, Josephine was recognized and thanked by the Washington State Senate for 100 years of caring for WA State’s seniors.
- How is it that Idaho Medicaid pays $45/day and Oregon $123/day more than WA when the care needs are the same? If Josephine had an Idaho address we would receive $1,600,000 in Medicaid funding more per year and $4,500,000 if we were located in Oregon.
- In 2017 we were full with 160 residents. In 2018 we closed a unit because we did not have enough nurses to staff it. Today our capacity is 145. We regularly deny admission because we are full. June of 2017 a well funded Behavioral Health hospital opened near us with many of our nurses and nursing assistants going to the higher wages offered there.
- From 2014 to 2017 there was a 500% increase in the number of harshest citations written by DSHS surveyors.
- WA State has some of the highest mandated care giver to resident staffing ratios in the nation.
- From 2017 to 2019 our NAC wages are up 30%. RN/LPN up 10%. All other wages are up 4-6%. Scarcity of nurses and initiative 1443 ($15/hr minimum wage) were contributing factors.
- 2008 to 2016 we contributed $1,000,000 of uncompensated care. The uncompensated care is the disparity between what Medicaid pays us to care for a Medicaid resident and the real cost of that care. That number is $1.6MM for 2018, estimated to be $1.8MM 2019. The Medicaid gap is growing.
- The rising costs of increasing regulatory pressure, scarcity of nurses and nursing assistants with 4% unemployment, $15 minimum wage coupled with a Medicaid rate base period that lags years behind are all reasons why 12 nursing homes have closed since 2017.
A more recent rebase and quality funding would be very helpful to close the Medicaid gap and ensure senior access to care in the future.