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Health care center accepting fewer Medicaid residents

ELKHORN — Downsizing continues at Lakeland Health Care Center.

On the heels of the Walworth County board voting to cut the number of residents living at the center, supervisors are nipping at the number of residents on Medicaid.

The squeeze started in 2001 with a reduction of beds from 345 to 295. Then it went to 190.

Supervisors then considered a new, smaller nursing home could save money by housing even fewer patients and by running more efficiently. Facing increasing costs to run a large facility and escalating pressure by taxpayers to limit levy increases, the board decided to fund a building project with 120 beds.

In the summer of 2006, the residential-style, 120-bed facility opened. It is dwarfed by the size of the institutional-like old Lakeland Health Care Center next door.

But a majority of the facility’s long-term care residents are on Medicaid, a government-subsidized insurance for those who can’t afford private care facilities. About 100 of the 120 beds are occupied by residents on Medicaid, said Vicki Gorden, admissions coordinator.

Because Medicaid reimbursements don’t cover the cost of patient care, the county is looking to reduce the number of long-term care beds to 93 next year and 89 by 2009, said Lakeland business office manager Bernadette Janiszewski.

The facility charges $235 per day. Medicaid pays $136 per day. The difference is supported by county taxpayer dollars. About $3.5 million of the 2008 county levy will support Lakeland.

To break even with no taxpayer subsidy, Walworth County would have to charge $307 per resident per day, Janiszewski said.

“One of the real problems here is that Medicaid does not (fully) reimburse for the costs of keeping a patient,” said Health and Human Services Director Linda Seemeyer, who oversees the facility’s operation. “We will still be a safety net for the people in this county. A great majority (of residents) will still be on Medicaid. We need a little more of a mix to alleviate a little more of the burden on the taxpayer.”

Having more short-term care beds means more dollars from Medicare or private-pay residents. Medicare fully funds short-term stays, and many families can support short-term stays with their own insurance or out-of-pocket cash, Seemeyer said.

“It’s a trend in county nursing homes throughout the state,” Gorden said of seeking more private-pay or Medicare patients.

The county is target is to have about 75 percent of beds serve long-term residents on Medicaid. The remaining 25 percent will be short-term stay beds, Gorden said.

Gorden said she’s received complaints about the county accepting fewer long-term care residents.

“It’s difficult when I’m given a number and we have to get to 93 (residents) on Medicaid,” Gorden said. “I tell them, ‘If this is a concern for you, you should contact your county board supervisor.’”

Supervisor Bob Arnold, chairman of the Lakeland Health Care Center board of trustees, said he’s heard no negative comments about the shift.

“We want to take care of the county residents as best we can, but we’d also like to not be totally Medicaid because you lose your shirt on those people,” he said. “Also, we don’t want to be competing too much with the other (private) nursing homes.”

Private nursing homes generally have 45 to 60 percent of residents on Medicaid, Seemeyer said. They accept fewer Medicaid residents because they need to remain solvent, she said.

Seemeyer said it’s not likely the county ever would reach those levels.

“It’s a balancing act for us,” she said. “We have an obligation to the folks in this county to provide a safety net, but we also have an obligation to the taxpayers.”