Investments We NeedImproving Centre Crest as a

County-Operated Facility

Observations• We have not exhausted all options.

• We didn’t get into this position overnight and we won’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 in over 20 years.

• A county can operate a nursing home well.

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 the

morale of the staff• Stabilize the County’s contribution to Centre

Crest• Decide whether we will do this as a county-

operated facility or as a nonprofit organization

How is Centre Crest funded?

• Spreadsheet

Setting the Record Straight

In 2004, Commissioners Dershem and Exarchos DID NOT want to privatize or make Centre Crest a nonprofit. The day after they were elected they toured Centre Crest and began working immediately to improve it as a county-owned and county-operated home. Throughout their first term in 2004-2007 they contributed $2,800,000 in General Fund revenue to Centre Crest.

“Our View”November 6, 2003 - Centre Daily Times

“We commend [Commissioner Steve] Dershem for hitting the ground running. He visited the Centre Crest nursing home Wednesday to begin talking with officials there with an eye toward improvements once he officially takes office in January.”

“County in Familiar Centre Crest Discussions”August 12, 2005 – Centre Daily Times

“Board of Commissioners Chairman Chris Exarchos said the county has been proactive in addressing the many concerns of the nursing home's employees.

“He said that when he and fellow Republican Commissioner Steve Dershem took office, they visited the nursing home during each shift to see what workers were up against.

“Wages were examined,” he said, “and several posts had salaries significantly boosted to make them competitive with local providers.”

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“County vows to pull Centre Crest out of the red”October 14, 2005 – Centre Daily Times

“Oks Tentative Budget – Reserve Funds to Cover Costs at Centre Crest, Other Deficits”

November 15, 2006 – Centre Daily Times

“The Centre County Board of Commissioners approved an $83.7 million tentative 2007 budget Tuesday that has no tax increase but taps into reserves to cover a $2.2 million deficit. The major source of the deficit is Centre Crest nursing home, which accounts for $1.5 million of the projected shortfall. Chairman Chris Exarchos said the county is working on strategies to cover costs at Centre Crest . The cost of operating the nursing home, $17.4 million this year, is projected to be $18.4 million in 2007.

“…[Commissioner] Exarchos noted it will be the sixth consecutive year without a tax increase but said that can't continue indefinitely. ‘At some point, there has to be a tax increase,’ Exarchos said. In fact, 2007 might be the last year property owners don't see county taxes climb. The 2007 budget will cut the county's fund balance from $7.5 million to $5.3 million. Exarchos said the county needs to have a $3.5 million to $4 million reserve to cover expenses that will be reimbursed. Commissioners are also looking into contracting a company to run Centre Crest 's pharmacy as a cost-saving strategy.”

“Oks Tentative Budget – Reserve Funds to Cover Costs at Centre Crest, Other Deficits”

November 15, 2006 – Centre Daily Times

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

The Tax Facts

• Debt Service/Bond PDF

How would we pay for a new building?

• Complete Healthcare Resources’ Proforma estimated a new building would cost $27,700,000.

• County would have the debt service available to pay 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 new

building cost.

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

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 new revenue to Centre County government from the 2010 tax increase.

Tax Facts

• $5 Million Bond for Capital Improvements–Outpatient Rehabilitation–Much-needed Improvements• Resident Rooms• Cafeteria• Employee Parking• Community Rooms

Outpatient Therapy

• On September 17, 2007, Centre Crest received letter granting the county a waiver to perform outpatient therapy.

• Due to PA Department of Health regulations, we were unable to do outpatient therapy without constructing another entrance.

• Our current therapy provider, Apex, does outpatient therapy at other nursing facilities

Current Centre Crest Therapy Profit2012

Physical Therapy + $672,810

Occupational Therapy + $470,835

Speech Therapy + $393,560

Total Therapy + $1,537,205

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

Resident Rooms

• Our Resident Rooms are out-of-date. Some of the equipment, furniture, and decorations have been in the facility since the 1970s.– We need to paint the rooms a new color, new

floors, new furniture, new curtains, new decorations and fixtures, new doors (or at least new bump-guards), new signage

Other capital improvements

• Decorations and furniture inside the building– Photos and pictures around the building– Resident room signage, cork boards, lighting, glove

holders, “Notices” by CareTracker machine• Outside the building– New welcome sign– New garden areas– Expand employee parking area• Raze the house and pave

Broken Windows Theory

• The theory states that maintaining and monitoring urban environments in a well-ordered condition may stop further vandalism and escalation into more serious crime.

• Applied to nursing homes: a clean, well-kept environment will encourage better care.

• A nursing home that doesn’t continually invest in the facility will lead to a decline census, decline in staff morale and decline in resident care.

Café/Social Area

Employee Parking Lot

Investments We Need

• Construct Outpatient Therapy Entrance• Renovate Resident Rooms• Redesign Cafeteria• Expand Employee Parking Lot• Not to Exceed $5,000,000

Improvements in Operations

• Increase Census• Nurse Aide Training Program• Decrease Utilization of Outside

Nursing Agency Staff• Bring Complete Healthcare

Resources on as a partner to help us in nursing and marketing

Census Increase• In 2012, the average census was 214 residents

Net 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

Nurse Aide Training

• Centre Crest competes with other companies for nursing staff:– Mount Nittany, HealthSouth, Hearthside,

Brookline, Hospice Agencies, Nursing Agencies, Doctor offices, etc.

• Currently the bulk of our CNAs come from CPI classes, however that’s not enough. (Penn State-UP graduates LPNs and RNs.)

Current Staffing (census = 214)

Shift CNAs/shift

Ratio PRD

7a-3p 20 1:11

3.333p-11p 17.5 1:12

11p-7a 9 1:24

Ideal Staffing (census=220)

Shift CNAs/shift

Ratio PRD

7a-3p 27.5 1:8

3.533p-11p 27.5 1:8

11p-7a 11 1:20

Staffing Challenges

• Turnover• Call-offs• Vacation time• Sick time• Leave of absences• Negotiated benefits

What would this cost?

• We need to hire additional staff:– 16 more CNAs– xx more LPNs

• Based on the data in 2013 Budget, annual cost of 0.01 PRD = $22,678

• Difference of 0.20 PRD between Current and Ideal Staffing

• Estimated cost: ($22,678 x 20) = $453,560

Nurse Staffing

• Create an in-house Nurse Aide Training Program

• Starting a Nurse Aide Training Program• Partnership between Penn State and

Pennsylvania Department of Education: Teaching the Educator

Nurse Aide Program

Complete Healthcare Resources

• Change Complete Healthcare Resources’ focus from transitioning Centre Crest to improving the facility 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 at

their other homes here at Centre Crest.

2014 County Contribution

2012 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

Centre Crest Auxiliary

• Secured a $5,000 grant to purchase 21 new wheelchairs.

• Purchased tables, benches and umbrellas for the Stanton Court Garden

• Completed Kline Way garden• Provision of beauty shop supplies; this allows

the service to be provided to residents at no cost

Centre Crest Auxiliary

• Provide the opportunity for residents to "shop" for their family at Christmastime so each resident has gifts to give to their family members at no cost to the residents.

• Purchase birthday and Christmas gifts for residents without families.

• Provide holiday treat gift bags for each resident.

Centre Crest Auxiliary

• Purchase hair curlers for residents that cannot get to the beauty parlor.

• Purchase shampoo caps for bedfast residents.• Provide welcome bags to all new residents.• Sponsor annual butterfly releases in the

garden areas.• Purchased commercial blender for the Centre

Crest kitchen.

Centre Crest Auxiliary

• Assist with welcome social for new residents and their families.

• Purchase outdoor Christmas decorations.• Provide free postage stamps and greeting

cards for residents.• Sponsor two entertainments monthly for the

residents' enjoyment.• Sponsor employee appreciation events.

Centre Crest Auxiliary

• Provided sun setter canopies.• Purchased a digital scale for resident use.• Purchased a resident lift.• Formed Comfort and Love Volunteer Group to

accompany residents through the end of life stages as well as support to their families during their time of loss.

Centre Crest Auxiliary

• Refurbished the first floor living room with new flooring, furniture, electric fireplace, drapes, and large screen TV.

• Manages the Centre Crest Auxiliary Gift Shop.

Wonderful things happen atCentre Crest but we have

room to improve.

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

Moving Forward: Long-Term

• Continue to work together with my fellow commissioners to improve Centre Crest. Answer any questions on my major recommendations.

• Re-Examine the Complete Healthcare Resources proforma based on my proposals and send them a list of questions and clarifications.