HomeMy WebLinkAbout07242017 City Council Work Session Notes - MountainHaven Spr
WORK SESSION NOTES ON 1Dasin -j�arul pl
3.t,uOYd_ M-67) �
M ✓ 1
Purpose: C °9 �-evrrl (a veC-/
Present: ,f'u lAt i t Gi n Council Members Present: C
y ` c4 it ►, Kt i I, A h�evrno-f, ►�—C lure
ErcGli►1o1Z4/ uiVCS, eO O.gvand0.-
Called by: A' Time: Ce',W fTy-) Date: I/z�{7/ i
CGu.I�C I
�******************************************************
Joe- foy ciAmmayt cOcu r l4 is Qdl oUt-
ta Ua it unfi I6
L q w v LOartl� ( c -)16 -t1) Yliaict a n dru i a�5
AM M i)le) or) Clift rTliter 1
ClialC\ Airbrdsi a ni e-X HO -
MtW je Sin 1111 '
c a��► d i, v i odC(
,priv►denCe
Dv . Mc610(
Seward City Council Work Session
July 24, 2017
Seward Mountain Haven
Operational Consideration—Increasing Census
Situation: The census at Seward Mountain Haven (SMH) has declined over the last several years.
Recent efforts have increased the rate of admissions, but overall census has remained steady at an
average daily census of 26. Management continues exploring improvement of services and alternative
models of operating the facility to improve census.
Background: SMH is licensed for 40 long term care (LTC) beds, also known as nursing home beds and
is Alaska's only LTC facility using the Green House Project model of care. The census was at a high of
38 in 2012, but has since slowly decreased and has not been above 34 since November of 2014.
Focused efforts to improve outreach and the admission process has resulted in 17 new elders since
September 2016, however,due to increased discharges, our net census has only increased by 2 during
this period. Achieving a high census helps ensure that we provide excellent care to as many elders as
possible, helps ensure financial viability to continue our mission, and helps meet debt service
obligations for the construction of SMH.
Assessment: Evaluating referral information,especially reasons for declining referrals, provides
information towards how we might increase census. Based on 2017 referrals,the top reasons for
declining referrals were:
Reason for declining referral %of total declinations
Could not meet elder's medical needs 46% (89 of 197 referrals)
Elder did not meet nursing home level of care 23% (46 of 197 referrals)
Could not meet elder's behavioral/psychiatric needs 11% (22 of 197 referrals)
In reviewing the specific medical and behavioral health needs of these declined referrals,we are
working towards implementing services that would increase the types of elders that can be cared for
at SMH. To date,we have added wound care services, IV therapy services and have become a center
of excellence for memory care and continue to look at other services.
In regards to those referrals that did not meet nursing home level of care, adding assisted living could
provide a home to a portion of those referrals and meet a need currently underserved in the
community. This would require new licensing and further evaluation of its operating and financial
impact.
Recommendation: Continue to evaluate and add additional medical and behavioral health services
that broaden SMH services and increase the number of nursing home referrals we can accept. Further
evaluate assisted living as a new service, separate from nursing home care.
Financial Consideration—Reimbursement Rebasing Analysis
Situation: Seward Mountain Haven (SMH) has experienced financial challenges in recent years,
primarily as a result of a census lower than is required to cover debt service. Management is exploring
alternative models of operating the facility to improve financial performance and improve debt service
capability.
Background: SMH is a component of Seward Medical and Care Center, which produces a single cost
report. Analysis of alternative models requires assessing impact to Medicare& Medicaid
requirements, as well as impact to inpatient, outpatient and long-term care (LTC)costs in the cost
report. Of particular importance is the Medicaid "85% rule",which can impact reimbursement if
average occupancy in the rebasing period falls below 85%. SMH currently operates with an average
daily census of 26; 85%occupancy would be a census of 34 residents. 2017 is a Medicaid rebasing
year for SMH, making the 85% rule a critical element of consideration.
Assessment: Management has considered three possible scenarios for operating the facility:
Scenario Description 5 year
Incremental
NPV
Maintain 40 LTC beds Continue to focus on filling LTC beds ($23K)
30 LTC/10 ALF beds, Change one building to operate as assisted living facility $454K
effective 10/1/17 (ALF) effective 10/1/17
30 LTC/10 ALF beds, Change one building to operate as assisted living facility $619K
effective 4/1/18 effective 4/1/18
Notes:
• The scenario to maintain 40 LTC beds assumes no change in census from current operations.
• Changing LTC beds licensure can only occur at the beginning of a quarter, by communication
with the state 45 days in advance.
• In the scenarios to move to 10 assisted living beds,the model assumes no reduction in costs of
operations between LTC and ALF. This requires further exploration.
• In the scenarios to move to 10 assisted living beds,there should be further exploration of
opportunities to improve reimbursement, prior to the next rebasing cycle.
• All scenarios assume Medicaid will continue its historical reimbursement practices for both long
term care and assisted living facilities.
• Moving to assisted living facility will not fully cover debt service of Seward Mountain Haven, but
is an improvement over current census.
Recommendation: Continue to monitor LTC census. Decision to change operating model for Seward
Mountain Haven should be delayed until 2018. Continue to explore need for assisted living in the
community and compare likelihood to maintain ALF census v LTC census. Evaluate cost structure for
ALF to further refine financial opportunity.