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To build or not to build? Nursing home questions remain

NEW RICHMOND - The St. Croix County Board is on record as supporting the construction of a new nursing home to replace an aging facility at the St. Croix Health Center campus in New Richmond.

But while the majority of county supervisors have voted to endorse the idea (12-7 according to a vote taken last month), paving the way for actual construction of such a facility is fraught with challenges.

At a special meeting of the St. Croix County Health and Human Services Board Monday, HHS Board Chairman Fred Horne said he called the gathering to discuss the "next steps" involved in making a new facility a reality.

"We can't just sit on our laurels," he said. "We need to move forward."

If a new nursing home is to be constructed, County Administrator Pat Thompson said the first order of business is for the county to apply for a state "property incentive" program that would help pay for some of the costs involved with building and maintaining a new facility.

He said the deadline for applying with the state is the end of 2012.

To complete the application process, Thompson reported that the county needs to hire an architectural consultant to draft a preliminary building design for the proposed new building. An updated business plan would also need to be completed to meet the requirements of the state program. The cost of completing the preliminary design and a business plan could reach $20,000, Thompson estimated.

Under the state program, if the county reduces the number of licensed beds it has, improves the care provided by nursing home residents and accomplishes all of that without increasing care costs, the local nursing home could receive enhanced reimbursement rates from Medicaid and additional incentive payments from the state.

To help the facility reduce its dependence upon the county tax levy, HHS Board members have previously suggested that the nursing home reduce the number of licensed beds from 50 to 40 and build a new building. Previous board members have also been in favor of adding a new assisted-living component to any new nursing home project to help boost the facility's overall profitability.

HHS Board members have also suggested the addition of health care services that could bring in more revenue for the facility.

Thompson said it's time the county put together a reasonable business plan that can be evaluated prior to debate about a new facility is completed.

HHS Board member Tim Hood asked if there was money available in the nursing home or Health & Human Services budget to cover the cost of the design and business plan work.

Thompson said the nursing home's financial picture is under "great stress" and would not be able to absorb the cost. The HHS budget might be able to cover the cost, he said, but more study is needed.

Thompson said the HHS Board could request that the county Administration Committee release contingency funds to pay for the consulting services.

The board eventually approved a motion (with Hood the only member voting no) to proceed with the state application, along with design and business plan work, with the necessary funds coming from HHS. If that is not possible, Thompson was directed to seek contingency funds from the Administration Committee.

Even if the county receives state incentive payments, Hood asked if borrowing would be required if a new building were to be constructed.

Thompson said it would. "We would have to issue some sort of debt," he answered.

Hood said any bonding debt the county would incur for the approximate $7 million building project would require a three-fourth's vote of the current county board. Hood said he doesn't think there are enough votes to approve such bonding for the nursing home.

"Can we get to reality?" he asked. "That's not going to happen."

Talk about bonding options is premature, Thompson said. The business plan and cost estimates are needed before the case for a new nursing home building can be fully considered, he added.

"We're putting the cart before the horse," he said.

Hood countered that it made no sense spending money on design and business plans if bonding for such a project is not likely to pass. He added that he could "almost guarantee" that a bonding vote would fail if brought before the current county board.

In related discussion, Tammy Funk, county human resources director, said discussions about wage and benefit concessions among nursing home employees are ongoing.

To reduce the facility's reliance on county tax dollars, Funk said such cuts will be necessary whether a new building is constructed or not.

The nursing home has also named Social Services Director Lisa Leahy as the part-time, interim director of the facility. She replaces a nursing home consulting company which had been guiding the facility for several months.

Leahy continues to serve in her role as social service director, but has taken on the added responsibility as well, Thompson reported.

"I'm glad that she's here," Thompson said.