Black Hawk County looks at dire option for Country View

Aug. 26--WATERLOO -- A funding crisis is making it difficult for Black Hawk County to keep the Country View care center open.

The Board of Supervisors has learned it may also be difficult to close the county-owned nursing and mental health care facility.

The supervisors met Friday with officials of the Iowa Department of Inspections and Appeals, County Social Services and a representative of the Brighton Consulting Group to discuss what would happen if the board chose to shutter Country View.

Board chairman Frank Magsamen emphasized the discussion was just part of exploring all of the county's options for the financially strapped care center and should not be misconstrued as a step toward closure.

"We want to continue to gather information so the board can make a decision on Country View and the services that it provides," Magsamen said. "This is strictly fact finding and not a decision-making (meeting) as to what we are going to do with the facility."

But Supervisor Craig White feared even the discussion could further distress Country View's 142 residents and 170 employees.

"When this hits the press I'm sure we're going to see a large number of (workers) quickly jump ship and find a different job," White said.

Country View, one of two remaining county-run nursing homes in the state, has exhausted its fund balance, forcing the county to tap $500,000 of general fund reserves to keep paying the bills. The center is projected to require a $1 million to $1.5 million taxpayer subsidy next year, roughly $11 to $16 for the owner of a $100,000 home.

Should the county choose to close Country View, it would need to give 60 days notice and follow a shutdown protocol provided by the Iowa Department of Inspections and Appeals. The county would be responsible for finding suitable placements for all residents and would need to maintain adequate staffing during the transition.

"You have to stay open until you have found everybody a home, said Kathy Kieler, an Inspections and Appeals bureau chief.

Finding those placements could be difficult, said Jeff Steggerda of Brighton Consulting Group.

While there is an abundance of skilled nursing beds in the Cedar Valley, Country View has many residents with mental health issues who are covered under Medicaid. Conversely, ICF/ID clients bring adequate funding to a new facility, but there are fewer of those beds available statewide.

"I believe you're going to have very difficult placement with between 25 to 35 patients," Steggerda said. "I'll do a 'double very difficult to place' with about 15, where you could be operating the entire facility for 15 patients for an extended period of time."

Steggerda said Country View is not a typical nursing home due to its excessive number of Medicaid clients and some of the special needs those clients bring.

More than 90 percent of Country View's nursing clients receive Medicaid, a federal program that currently only reimburses about 80 percent of the patient care costs. The average nursing home has about half of its residents covered under Medicaid and can make up losses through patients paying with private insurance or Medicare.

The county has asked for an exception to the Medicaid rules which, if approved, would reduce the current funding gap from 20 percent to just 5 percent of the current cost of care. But there's no guarantee the proposal will get state approval or be accepted by the managed care organization running the state's Medicaid program.

Bob Lincoln, director of County Social Services for a region including Black Hawk County, said a 5 percent gap would be more manageable.

"There's no question about the need for a place like Country View and the individuals that need that support," Lincoln said. "It's just how we get sustainable funding to continue that."

The supervisors are hoping to reach some decisions about the future of Country View before adopting the fiscal year 2018-19 budget over the winter.

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