County Board

This is interesting, but could been seen coming for months:

Andrew Buffenbarger resigned from the Champaign County Nursing Home on Monday, only to start work there Tuesday.

As of Tuesday, he's an employee of Management Performance Associates of the St. Louis, which was hired last week at $15,000 a month to manage the nursing home.

As part of the deal, MPA was to supply an administrator acceptable to the county board, which actually pays his $88,150 salary.

No vote was taken at the most recent county board meeting on whether Buffenbarger was acceptable.

Discuss.

Who are the needy?  Or the poor.  However you want to phrase it. 

That's been a big part of the debate regarding the viability and profitability of the Champaign County Nursing Home.  The debate has been generally focused on Medicaid vs. private pay patients.  Those on medicaid are thought to be poor and more in line with what should be the Nursing Home's mission as a public institution to help those in most need.  Those private pay people can go anywhere and the public nursing home ought not be overloaded with such people.

The reality is much different.  Clearly, a Medicaid resident should be classified as poor.  A few accounting tricks over a lifetime might give you a life of relative affluence while having minimal assets, but this is certainly not the norm.

Private pay individuals are those people that have assets that allow them to afford care.  But many of these people are truly poor, and will only be able to afford care for a limited amount of time.  Here's an example.

Let's say you have income from Social Security of $1200 per month, you've saved $50,000 in IRAs and other retirement funds,  and you've sold your home for a net gain of $100,000.  Under this scenario,  of $150,000 in assets and $1200 in fixed income, I believe that you're a private pay individual.  I'll leave others with more knowledge to fill us in on just how far you  have to "spend down" your assets, but I'm pretty sure it's well below $150,000. 

So your income amounts to about $2,000 per month when you include return on your investment.  Not too bad if you're in assisted living at $2500 per month.  That will last you about 15 years.  But if you're going into a nursing home at $4,000 a month, you'll be tapped out in four years. 

Clearly that person who is private pay is far from being rich.  Not destitute, but clearly a person that fits into the mission of the public Nursing Home to help the "needy".

My experience has been that within the admissions process, assets and income are both given by the prospective resident.  I think this part of the population, those with assets, but undoubtedly on their way to Medicaid, should be included in the discussion on what our mix should be between private pay and Medicaid patients.

WDWS is reporting that the Champaign County Nursing Home has passed an Illinois Department of Public Health inspection, and is now able to remain open past mid-July.

It's a good thing, otherwise that three-year $540,000 consulting contract might look pretty silly.  Same with that $600,000 "loan" to the Nursing Home.

WDWS is reporting that as of late last week, the CCNH still hadn't passed a state-mandated inspection and is still in danger of being shut down by the state on July 16.

Forgive me, but given the history of incompetence with this nursing home, I have little confidence that the County will be able to avoid a shutdown, so I must ask:

• How would a shutdown affect the $600,000 loan being discussed by the County Board tonight? 
• How would a shutdown affect the consulting contract with MPA?

It is no exageration to suggest that the votes tomorrow at the Champaign County Board meeting are among the most critical to ever face the Board.  The two issues are whether to extend a loan to the Nursing Home from the County's General Corp fund in the amount of $592,000 and whether to hire Management Performance Associates to manage the facility.  I've uploaded a copy of the last draft of the MPA contract which you can open below.  Not sure if other revisions are in the works.

The County is in an extremely bad situation.  The Nursing Home continues to put us in a bad fiscal situation.  The bed count has dropped and while some cost saving measures have been put in place, it still looks as if the facility will continue to bleed significant dollars without some action.

The Nursing Home board of Directors has been in existence for a mere six or seven weeks.  They've been handed a bad situation, dug in, and have recommended hiring MPA in a unanimous vote.  With more time, it would have been interesting to see what other options might present themselves, but time is a luxury that has been squandered by this Board. 

On the negative side with MPA is the lack of a guarantee that this will actually turn the situation around.  There is still a union contract to be negotiated, and MPA won't have the final say on that, the County Board will.  Does this contract really give MPA all the tools they need to turn the situation around.

On the positive side, MPA has done what appears to be a good job running a very similar Dekalb County facility.  They also run other county owned facilities.  The current web of government regulations suggests that some efficiencies can be gained by having experts handle some of those tasks.  It's no coincidence that so many nursing homes are owned by larger corporations, whose central offices can handle many of the things that seem to not be handled well in Champaign County. The other positive side is that whatever management problems exist at the current facility, I think MPA will deal with.  Doing a bad job for the County will never cost you your job if the County Board makes the decision.  But if its up to someone who's in private business, I believe that it will.

A lot of things could have happened in the last decade, and certainly the last couple years, to prevent this debacle.  Unfortunately, that's blood under the bridge.  Now there are two votes, two critical decisions for the County.  Neither one is easy and both have tremendous consequences for our community.

EDIT:  I should also point out that the Board will no doubt be discussing in closed session the status of our public health violations.  How this impacts the MPA discussion is interesting.  Purely conjecture here, but the hiring of MPA might be seen by Public Health as a good faith effort to address compliance issues.

The CCNH Advisory Board has approved a consulting contract with Management Performance Associates, sending it to the full County Board for approval this week.

The county nursing home's directors worked out their differences Monday to unanimously recommend a management contract for the facility.

Action on the $15,000-a-month contract would still have to be taken by the full Champaign County Board, which meets at 7 p.m. Thursday at the Brookens Center, 1776 E. Washington St., U.

Discuss.

From today's News-Gazette:

Czajkowski pondered a clause in the proposed contract that cited consultant availability as "deemed appropriate by consultants."

"I'm not sure what we're buying under this contract," he said. "What does the contract do to increase the census?"

Nursing home board member Mary Ellen O'Shaughnessey said the board needs to act immediately, but questioned whether Champaign is in the same position as DeKalb and Monroe counties.

"We're in a league of our own," she said, referring to a July 16 deadline by the state to correct problems in its inspections as well as $100,000 a month in losses.

O'Shaughnessey said the 27-member county board had made little progress in solving the nursing home's problems. She asked MPA president Mike Scavotto whether results would be faster under the consulting or the management contract.

"Management," Scavotto answered.

Discuss.

Today's News-Gazette:

Nursing home Administrator Andrew Buffenbarger was directed to improve the home's financial picture by $300,000 by the August full county board meeting, through a combination of cuts and revenue increases.

He was also directed to consult with Washington University Professor Rachel Schwartz, who had examined the nursing home's public records and offered her services to the county for free.

The $592,000 loan was approved by a voice vote at Thursday night's committee meeting. Two Republican board members, Brad Jones of Champaign, the vice chair of the committee, and Chris Doenitz of Mahomet asked that their "no" votes be recorded.

The original plan was to lend the facility $460,000, but committee members decided to transfer a greater sum to avoid having to do the same thing in just a few months.

Even majority Democrats showed signs of bucking future loans to the nursing home.

"I have no confidence in the nursing home finances anymore," said Champaign Democrat Michael Richards. "I will not vote for this tonight unless we do something about the nursing home."

Discuss.

This just keeps getting worse:

McGinty said this week he believes the loan will pass through the committee to seek full county board support June 29.

But it won't be a lovefest for nursing home Administrator Andrew Buffenbarger.

"I've asked Andrew for a realistic assessment of what $460,000 buys us in terms of time. I have a feeling it's not going to last too long," McGinty said.

...

Jones said he and probably one other committee member, Republican Chris Doenitz, could vote against the loan.

"I will not support another transfer," Jones said. "We do not have the money."

He said a report from Champaign County Treasurer Dan Welch convinced him the county no longer has enough money to lend such sums to the nursing home.

"I have not seen enough changes over there. We need to work together with the unions to make changes. We need a solution to contract nurses," Jones said.

Do we even know if the State is going to allow the Nursing Home to remain open past July 16?  Has the CCNH addressed the requirements of the Illinois Department of Public Health?

I've obtained this memo sent to Champaign County Board members outlining the announced plans of each of the County's school districts if the proposed one percent sales tax increase for education facilities passes in November.

There's no real new information in this, but it is a very useful summary of plans.  You can read the whole thing yourself, but you'll note that every district which has existing debt is currently promising to use sales tax revenue to abate or eliminate that debt (and reduce property taxes as a consequence), although the amounts vary.

Key information to remember (taken from the memo):

Each of the Boards of Education of the 14 school districts in Champaign County has passed a resolution requesting that the Champaign County Board put the question of imposing a 1% sales tax for school facility purposes for submission to the voters of Champaign County at the November 4, 2008, election. If this resolution passes and the County Board implements the full 1% sales tax, the revenue can be used for the following purposes:

• Pay for projects as you go
• Leverage revenue for current needs (use revenue to pay for bonds)
• Retire existing debt issued for capital purposes (abate taxes)
• Any combination of the above

Discuss.

This may be old news, but I didn't see either a post or a NG story on it:  the Illinois Supreme Court has declined to hear an appeal in the petition challenge court case involving Democratic County Board member Brendan McGinty, which means that he will remain on the ballot for November's election.

UPDATE:  I missed it - the NG story is here.  Sorry!

Someone pointed this out in today's Open Thread, and while I haven't quite gotten my blogging groove back, I had to post it:

Some people showing up for jury duty at the Champaign County Courthouse in Urbana this morning were sent home, not because there were no trials for them to hear but because construction had displaced them.

"We've got no place to put these jurors," an irritated Presiding Judge Tom Difanis said this morning. "What am I going to do with them? Have them stand in the construction area?"

Tuckpointing on the old courthouse began last week in advance of the renovation of the courthouse bell tower. The work means that the jury assembly room, on the first floor of the old courthouse at the west end of the courthouse complex, will be out of commission for several months.

"They (county administrators) had their timetable, and we just merely suggested that they make a place for us to put our jurors and they haven't," Difanis said this morning. "I've been with Champaign County going on 36 years. It really doesn't surprise me we're this inept."

Emphasis added.

The Gazette article

WICD reported during their 10 O'Clock newscast that Champaign County will consider a settlement with the Illinois Health Facilities Planning Board. The County originally faced a fine of $50,000 due to a County Co-administrator's failure to properly comply with various regulations during the delayed construction of the new Champaign County Nursing Home. The settlement calls for the County to provide $19,000 in free services to area senior citizens - health screenings, diabetes testing, etc. Sounds like a great deal, doesn't it? $19,000 is a whole lot better than $50,000, right?

Well, as is always the case with anything involving CCNH, and specifically the County Board Facilities Committee, chaired by Steve Beckett, you have to read the fine print. We have $19,000 in taxpayer dollars spent on senior services to comply with the settlement, then you add the $26,000 in attorney fees through February, and all the sudden this settlement isn't looking all rosey, is it? Just wait until we get the bill for March, April and May!

I'd also point out that the settlement and legal fees for this issue alone will be greater than the salary of three full time employees (at $9.62/hr) who are about to be laid off at CCNH. 

Somehow though, Denny Inman still has his ($100,000+/yr) job. Sad.

That's what one expert told me when I told this expert how much we had paid to Duane Morris.  Never in 20 years had this person seen a fee that high.  And the person I was talking to does big projects.  I mean big projects.  I've got links to a number of State Agency Reports below on projects (no this person didn't do all these projects, but this person works on projects like these) in just the last 6 months that are over $250 million below.  This person told me that you wouldn't see fees as high as $400,000 on any of these, and some of these actually had opposition. 

Our project was a layup in the open court.  There is no way to justify the fee we paid.  And no, I still haven't heard back from Julia Rietz about all those State's Attorneys that highly recommended this firm or with a list of their previous work that would justify hiring them.

Central Dupage, $256 Mill

Rush Hospital, $617 Mill

Children's Memorial Hospital, 1 Billion!!

Elmhurst Memorial, $475 Mill

Edward Plainfield Hospital, $249 Mill

Advocate Hospital, $251 Mill

University of Chicago, $785 Mill

Silver Cross Hospital, $397 Mill

Yesterday I wrote about the case of the Rock Island nursing home where they did their Certificate of Need work in house.  As I said then, it was perfectly reasonable to seek outside help for our project, the question is why should we have paid so much for it.  Well, today's subject is Charles Foley.

Foley is not an attorney, but is an expert on the Certificate of Need process.  Foley charges a flat fee, based on the complexity of the project.  He quotes you the fee up front.  DeKalb paid him about $30,000 for their CON about ten years ago.  Monroe County is paying him about $35,000 for their current project.  From what I've heard, his fees range from $25,000 to $50,000.  We have paid $400,000, and the work has been bad, although Ms. Rietz insists that these attorneys are not "out to get us" and come "highly recocmmended".

Foley's name stood out because of his work on some public projects.  But there is one other notable item when it comes to Foley.  Our attorney's apparently relied on Foley's expertise in moving our own CON through the process.  Here is a link to a portion of a memo from Neville Bilimoria to the County written just prior to our February 2004 hearing on our Certificate of Need.  Here is a portion of what it says.

I spoke with Chuck about logistics also. He is going to be at the IHFPB meeting on some of his own projects outside of Champaign County's. We agreed that he would sit directly behind us and not be sworn in for the IHFPB meeting. He will be available if we need him to answer questions during the testimonial phase.

That's right.  Champaign County paid $400,000 to "experts" who have to have a guy who makes $35,000 sitting behind them.  That would be like paying me $5 million to coach the Illinois basketball team, but Bruce Weber sits behind me.  Perhaps nothing else better demonstrates just how clueless this firm we hired was.

Oh, and the memo was given to me by a County Board member.

That was the response of more than one expert I talked to in the last week about the costs of obtaining our Certificate of Need and subsequent work.  That's even after some of the complicating issues.  Of the $600,000 that we have paid Duane Morris, approximately $400,000 was related to our Certificate of Need, alterations to the same, and then followup work on our final cost report and compliance.

So what's the going rate for doing this work from people who actually do this work?  How about $25,000-$50,000.  That's right.  And some of these experts actually work for, can you believe it, a FLAT fee.  For example, DeKalb County, a county which we are looking to as a model for our own, paid about $30,000 to their consultant for their Certificate of Need 9 years ago.

As one person put it to me,  it appears that we paid for the education of Duane Morris.  This becomes painfully obvious when you consider that they weren't even aware of the impact of the new rules on our project. 

I have no idea why we have this firm representing us.  And after hiring them, I have no idea why we kept them after their deficiencies became painfully obvious.  Earlier this week I gave Julia Rietz a letter asking her for examples of other work that Duane Morris has done along the lines of what we were asking them to do.  I also asked for some names of the State's Attorneys who so highly recommended their services.  I'll let you know if and when she responds.  The audio below is Ms. Rietz with another empassioned attorney defense.

I wrote yesterday about Julia Rietz and the attorneys she supports.  I’ll add a little more perspective later on the outrageous fees they’ve charged us overall.  But today I want to focus just on the costs associated with the fine from the Illinois Health Facilities Planning Board.

If you recall, last year the County Board learned that they would be subject to fines for failing to inform the Illinois Health Facilities Planning Board about changes they made in the Nursing Home project after it was approved.  I predicted that it would happen a year earlier and even suggested on more than one occasion that our legal counsel was not doing a good job for us.  In my mind, they were the primary cause for our fine for their failure to properly inform us of our obligations under the new rules as well as to give us sound advice about the old rules.

For a year and half it’s been clear to me that this firm was in over their head.  They claimed to be experts but weren’t.  Even hiring someone away from the HFPB didn’t seem to help us.  So the idea that somehow their incompetence would result in us paying $50,000 seemed ridiculous.

At the County Facilities meeting on Tuesday, we were tol that we have apparently reached a deal on the fine with the HFPB.  It will be discussed at the full County Board meeting next week.

But perhaps the most outrageous part of this whole thing is what we are going to pay to try to get out of this fine.  In the months of November, December, January and February, Duane Morris had already charged us $26,529.42 to try to fight the fine.  That figure doesn’t include probably another thousand or so dollars in the October billing that appears to be related to our compliance problems.  And it doesn't include the amount they are going to bill us in March, April and May for the completion of this whole mess.

So we're likely to have legal fees in excess of $30,000, perhaps even $40,00.  Plus, we’re likely to still have to pay a fine.  It is very likely that the total package will exceed the original fine.

But no one should be outraged, no should ask questions, and certainly no one should think they’re out to get us.

RSW mentioned this in a previous post and some of you might have  heard some of these comments on WDWS.  I've put a media file link below that hopefully you can listen to, although I'm hardly a pro in such things.  The gist of it is that Julia Rietz at last week's County Facilities meeting tore into those who would dare to question how much our attorneys are charging us.  There's a lot to get into here, and I'm going to try to do it over the next couple days.  Suffice it to say in this post that we've now paid Duane Morris over $600,000 to represent us on various issues related to the nursing home.  Not only should County Board members be questioning that, they'd be remiss if they didn't.

From yesterday's News-Gazette:

The Champaign County Nursing Home, which will have to borrow money from the county to stay afloat, could save money by altering its mix of clients to reduce Medicaid patients – which would go against its tradition of serving the poor.

About 60 percent of its residents are on Medicaid, up from 48 percent in 2000, the first year for which Administrator Andrew Buffenbarger has census records.

About 28 percent are private paid and 10 percent Medicare, which has a higher level of reimbursement.

Taking care of the less-well-off has been part of the county's mission since it ran a poor farm on the same site as county offices.

But the rising proportion of Medicaid residents is hard on the nursing home's finances, Buffenbarger said, because "Medicaid reimbursement is considerably lower than the cost of services."

In other words, if Buffenbarger filled every bed in the new $24 million facility with Medicaid patients, the nursing home would lose even more than the up to $100,000 a month it has lost in the last two years. Instead, the home has run with about 80 of 243 beds empty recently.

Additionally, Medicaid reimbursement has not only been cut by $600,000, it's months behind.

Discuss.

UPDATE:  Big E has more thoughts here.

Some apparently expect the home to run on at least a break-even basis. But if that is the case, why is government involved at all? Is there a lack of private nursing home companies out there? Not likely. Why in the world would an impotent county government imagine that it is in a better position than a professional private company to run this operation? If the goal is to minimize expense to taxpayers, sell the damn thing to a professional operator and cut your losses.

It is not a little ironic that the idea of booting impoverished Medicaid recipients is being floated. If the goal of the facility is to provide refuge to those who would otherwise be out in the cold, this step would be absolutely contraindicated.

So what's it going to be, you dummies? A decision to provide heavily-subsidized care, or to make the facility a self-sufficient enterprise? The choices could not be more stark, but resolution will require courage and clear-thinking. I, for one, am not holding my breath.

If you caught last month's County Board meeting you would have heard  Brad Jones suggest that we use the Nursing Home Construction Fund to make this year's Nursing Bond Payment.  It probably confused a good number of people including most Board members.  But it comes down to this.  The County borrowed an extra $4 million for the nursing home to cover the costs of mold and HVAC repairs as well as increased legal fees and various cost overruns. This extra bond payment is being made out of the General Corp fund that had a fund balance last week of $70,000 (that's with receiving a loan from another County fund).  Since there is still about $700,000 unspent from the bond sale, this makes a lot of sense.

At the finance meeting last week, they passed unanimously a resolution to do exactly what Jones suggested.  But he didn't stop there.  In light of the goofy expenditure for the new sign at the Nursing Home, the resolution passed cuts off all expenditures from the fund except for legal fees.  There won't be any way for someone to spend the remaining money (about $400,000) on anything akin to the pricey sign that just went up.  So next year we can make another payment from this fun, although the hope at that time will be that we'll have a nice settlement that will pay off a good portion of the $4 million.

This is on the consent agenda for the County Board meeting later this month.  That means it's likely to pass without discussion.  But it's a good move initiated by Jones and a nice response to the dual problems of a depleted County fund balance and outrageous spending decisions.