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To what extent should county home be considered profit center?

To the editor,
Generally, I refrain from jumping into letter writing "food fights", but the recent letters by Paula Trombi have led me to do so. Ms. Trombi seems to believe that when four Belknap County representatives voted against approving additional nursing home funding of $200,000., they did so out of either pure meanness, total stupidity, or both. The county commissioners and the nursing home director believe they can use the $200K to attract an additional $400K in Medicare revenue, thereby providing a $200K profit for the county. That profit alone, tells an incomplete tale. Those short term physical, occupational, and speech therapies are high profit services that the county commissioners want to profit on, but doing so will take business away from the open market of health care providers. Is the county nursing home supposed to be a profit center? Should the Belknap County Delegation (the eighteen State Reps) encourage the county commissioners to actively pursue Medicare short term rehabilitation folks and thereby directly compete with marketplace providers? If such expansion is to be allowed, should limits be imposed? What are the long term downsides of such expansion?
During several delegation meetings, the county commissioners said this effort would be for just a "few" Medicare patients", "maybe five or six patients", well, "maybe up to eight patients", and then on June 3rd, hinted that the number would not go "above 10 at any time". How much will it grow if it continues for many years? Will it become such a moneymaker they will want to expand the nursing home to allow for more profits?
The delegation was told that the nursing home normally has spare beds and these Medicare patients will not require any new staff or any physical expansion. I viewed such projections with a jaundiced eye, doubting they would hold true in the long run. Since actual data is not available, it seems reasonable to take some mental excursions as to what could, or even might, become reality. First, if the nursing home now runs with a persistent "free bed" level of six to 10 beds, but could fill those beds with Medicare folks without expanding staff, does that mean it is currently overstaffed? If not, at what point would a continually "full bed" nursing home start triggering some combination of increases in kitchen staff, housekeeping, maintenance, overtime for current staff, or more floor space.
Because of the turmoil the delegation and the commissioners have had for the last six months, I felt that it was necessary to, if not bury the hatchet-to at least lay it down for a few months, so I voted with the majority to fund the Medicare expansion for this year, only. But, I mentioned then and restate now, that I intend to investigate this issue statewide, and try to present a fuller explanation to everyone before the delegation is called on again to approve such funding. However, I fully understand and greatly appreciate the position taken by Representatives Burchell, Cormier, Sylvia, and Worsman and believe that their free market position should be the one we all strive to reach. I hope that during the next few months we, as a delegation, can get all the facts out in the open, and clearly articulate them for ourselves, and for all of the voters of Belknap County. I also know that Representatives Burchell, Cormier, Sylvia, and Worsman are dedicated, serious, and intelligent lawmakers who are very committed to doing what is best for Belknap County. I strongly disagree with Ms. Trombi's message and tone.
Representative Herb Vadney
Belknap District 2
Gilford-Meredith
 
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