That Empty Feeling: Local nursing homes close

Feb. 25--Hugs and tears abounded Thursday as the last four residents moved out of Fall Creek Valley Care Center.

The impending shutdown of the nursing home, a fixture on the west edge of Fall Creek for the past 49 years, was announced just 10 days earlier.

"It was a lovely place. I am very sorry it's closing," said Darlene Baglien, who drove to the center as usual Thursday morning, although it was a far cry from her normal daily visit.

This visit was to pack up the belongings of her husband of 49 years, Roger, who was moving from the neighborhood nursing home near the farm the couple worked for decades to Azura Memory Care in Eau Claire in response to the closing announcement.

"Leaving is sad because the workers are great and it's really convenient," Darlene said.

The emotional scene, the kind that has played out during a string of nursing home closures across west-central Wisconsin in recent years, is a sign of the changing face of long-term care in the state.

The final chapter for the Fall Creek nursing home came just two days after the last resident left The Lutheran Home in River Falls and a few weeks after the announcement that the 104-year-old Mount Washington Residence assisted living center in Eau Claire would close this spring. These shutdowns follow the closings of Oakview Care Center in Durand in 2015; Gilman Care Center and Benedictine Manor of Arcadia in 2014; and St. Michael's Evangelical Lutheran Home in Fountain City in 2012, according to data from the state Department of Health Services.

Nursing home advocates maintain that the rash of closures -- at least 20 statewide in the past five years -- are mostly the result of low government reimbursement rates, a shift in state priorities and changing patterns of where seniors elect to receive care. But they warned that if nothing changes to curtail the trend, Wisconsin could be caught short of nursing home beds just when baby boomers are old enough to need them.

The core problem is that two-thirds of state nursing home residents have their care paid for by Medicaid, but the government health insurance system reimburses the skilled nursing centers only for 76 percent of their costs, according to a national study conducted for the American Health Care Association and released last April.

The study, which ranked Wisconsin as having the worst Medicaid reimbursement system for nursing homes in the nation, showed that the state facilities lost an average of $56 a day for each of the estimated 16,490 Medicaid residents served in 2014-15. That translates to an average facility loss on those residents of about $1.1 million, said John Vander Meer, executive director of the Wisconsin Health Care Association, or WHCA, a nonprofit advocacy group for nursing homes.

The squeeze caused the 50-bed Fall Creek Valley Care Center to lose $170,000 last year, prompting owner Jack Halbleib, a nearly 40-year veteran of the industry, to wave the white flag. Even after staff reductions to correspond with declining occupancy rates, Halbleib said, the center was losing $20,000 to $30,000 a month toward the end.

That's not exactly a successful business model, especially when a high level of staffing and service is required to give nursing home residents the quality care they deserve, Halbleib said.

Hope on horizon?

After several years without any substantive increases in the reimbursement rate, Gov. Scott Walker's proposed 2017-19 state budget offers a glimmer of hope for a struggling industry.

The budget calls for a reimbursement rate increase totaling $51.5 million over two years to support the direct care workforce and increased resident acuity in nursing homes, said Department of Health Services spokeswoman Elizabeth Goodsitt. That's about 56 percent of what WHCA and other advocacy groups had called for.

"The governor's budget proposal is an important step in the right direction in addressing this underfunding of skilled nursing facilities," Vander Meer said, adding that the industry's hope is that legislators and members of the Legislature's powerful Joint Finance Committee retain the provision in the final budget.

The boost is important to enable providers, who devote 70 percent of their spending to labor, to better recruit and retain competent staff. At this point, nursing homes are facing a "workforce crisis" in which the most recent industry study indicates that 1 in 7 jobs are unfilled in Wisconsin, Vander Meer said.

"We have to be able to attract enough employees," Vander Meer said. "You can't get a machine to hold your grandmother's hand. It's that human touch that caregivers bring that is so essential to the services our care facilities across the state of Wisconsin provide."

Changing market

In River Falls, The Lutheran Home administrator Spencer Beard watched with regret as the last residents moved out Tuesday from the 50-bed center that has been providing long-term care since 1975. The facility averaged about 41 residents in 2015, and that number dropped to about 34 early in 2016.

"The economics just don't make sense anymore," Beard said.

The closing, announced in December by the Belle Plaine, Minn.-based The Lutheran Home Association, leaves Pierce County's largest community with only one nursing home.

"Now people waiting to get into a nursing home here have only one choice, and they have to hope they can get in," Beard said.

The story is similar in Fall Creek, where residents seeking nursing home care now need to look in Augusta, Eau Claire or other nearby communities.

While there have been a couple of high-profile nursing home closures lately, Goodsitt said, the number is not drastically outside the general trend that has been going on for decades -- deinstitutionalization of patients with lower care needs and increased availability of home and community-based service options for those who can succeed in less intrusive settings.

One possible factor in the closure of nursing homes is the expansion of the state's Family Care program, which over time eliminates waiting lists for residents attempting to access home and community-based services, and focuses efforts on diverting Medicaid recipients from nursing homes, Goodsitt said.

"The program allows frail elders and adults with disabilities to get services they need, yet remain in their homes, fostering independence and improving quality of life," she said.

But that strategy has come at a cost, Halbleib said.

"The state has starved nursing homes to utilize that money to create alternatives to nursing homes with the thought that it's better to give seniors more choices," he said. "The options are a good thing, but the impact on traditional nursing homes has been brutal."

The concern is that without more payment reform there may not be enough nursing homes around for those with serious health conditions who need that level of medical care, Halblieb said.

"Wisconsin state government has moved in a direction of emphasizing community-based care, and we understand that as a policy choice," Vander Meer said. "But ultimately there will always be a need for 24/7, 365 days-a-year skilled nursing care because of our aging population and the significant needs of these higher acuity patients, and I think part of the challenge is finding the right balance."

Without significant nursing home payment reform, Beard said, more seniors likely will continue seeking care at assisted living centers that provide lower staffing levels and less medical care. Beard said he fears that could result in an increase in falls, medication errors, and abuse and neglect issues.

'Silver tsunami'

All of this is happening at a time when baby boomers are moving toward an age where they are more likely to need long-term care of some sort.

The state Department of Administration projects that the 65-and-older population in Wisconsin will nearly double from 777,500 in 2010 to 1.54 million in 2040, and the 85-and-older population will soar 140 percent from 118,500 to 283,500 in the same period.

"The number of aging baby boomers is going to shoot off like a rocket, and we need to be sure we have an adequate supply of long-term care in all of its forms and fashions to meet the demands so we can effectively and compassionately care for our grandparents and our parents," Vander Meer said.

Beard's fear is that at the same time demand for skilled nursing care is increasing, supply will continue decreasing.

"There already are just fewer places for our community members to go," Beard said, predicting more nursing homes in the region will be forced out of business in 2017.

Vander Meer suggested the problem could be most acute in rural areas, where smaller nursing homes such as many of those that have closed recently in the region have a particularly hard time making ends meet under the current reimbursement system.

"As we approach the silver tsunami of aging baby boomers, we need to be careful in a lot of rural areas of Wisconsin that we're not leading to a fundamental access problem," Vander Meer said.

With the closing of Fall Creek Valley Care Center just 4.2 miles from her house, Darlene Baglien is already feeling the effects of less access -- and wondering if she'll still be able to visit her 82-year-old husband as often now that he had to move to an Eau Claire facility that is 15 miles away.

Roger Baglien, who is diagnosed with Parkinson's disease, suffered a spinal injury from a fall on their farm in 1980 and then sustained a head injury when a piece of farm equipment fell on his head in 2004, forcing him to endure a five-hour brain surgery. He had been in and out of the nursing home for a couple of years before becoming a steady resident for the past five months, Darlene said.

"I went in every day and fed him, and I could go home and come back in if he had a bad day," Darlene said. "With the new place, I'm not sure if I can still do that."

Contact: 715-833-9209, [email protected], @ealscoop on Twitter

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