Delegation to nursing home: 2/3 is enough

LACONIA — Presuming that staffing shortages and low occupancy levels at the Belknap County Nursing Home will continue through the year, the County Delegation has approved a budget which it says is adequate to operate the facility based on current staff and patient levels.

The delegation appropriated $12,078,270 to operate the facility that is licensed to care for 94 patients, but currently has 58. The amount approved was 10% below the amount the County Commission had sought — $13,452,140.

The three-member County Commission oversees the day-to-day operation of the county's agencies, while the delegation, made up of the 18 state representatives from Belknap County, sets the yearly budget.

The commission had sought the higher figure, saying it would enable the home to be more successful in hiring staff, as well as to begin admitting patients which in turn would result in increased revenue from Medicaid and private insurance which would help offset operating costs.

But many on the delegation said that scenario was unrealistic and would make the budget unnecessarily high.

They said with COVID still ongoing there was little likelihood that the patient census would get anywhere near the home’s licensed capacity this year. They also doubted the home would be able to make any significant progress in filling staff vacancies, especially in the nursing area, given the chronic nursing shortage.

“Where are you going to find them?” delegation chair, state Rep. Mike Sylvia, asked Nursing Home Director Shelley Richardson after she told the delegation that additional money was necessary if the home hoped to be effective in recruiting nurses to fill vacant positions, especially when other area health-care facilities pay their nurses more.

In response to a question from Sylvia, Richardson acknowledged that other health-care facilities in the area are struggling to hire nurses too.

She said there are 21 open full-time nursing positions at the home at this time — 10 for registered nurses, and 11 for licensed nursing assistants.

The commission recently approved a bonus pay plan and also increased the pay scale for county employees in hopes of retaining workers, especially in the nursing home.

Whereas the commissioners had requested $7.6 million to cover pay and benefits for the nursing staff, the delegation authorized $6.3 million.

State Rep. Ray Howard said nurses who were unwilling to commit to the nursing home regardless of the pay were largely to blame for the situation in which the home finds itself.

“They are playing a game. They should have more conscience to care for the elderly,” he said.

The number of patients at the nursing home has been declining since the outbreak of COVID almost two years ago, in part because of a temporary freeze on admissions due to the pandemic as well as departure of nurses to better-paying jobs or retirement and the difficulty in hiring replacements.

Richardson said there are currently 58 patients in the home, and more than 90 people on the waiting list.

Some on the delegation said it was crucial to get the nursing home back to full capacity.

“We should be working to get more people into the nursing home,” said state Rep. Jonathan Mackie.

State Rep. Tim Lang said the nursing home budget as proposed by the Executive Committee would leave the nursing home seriously underfunded.

“They need to find $470,000,” he said. “That is unconscionable.”

But Sylvia disputed that characterization.

“To say it’s under-funded is your opinion,” he told Lang.

Sylvia said there was enough money in the budget to operate all county departments properly through the end of the year. Any department that finds itself running short later in the year can request a supplemental appropriation, he said.

“We are not giving them the money to pay their employees,” state Rep. Mike Bordes said.

Sylvia replied, “They need to manage their budget. That’s what they’re paid for.”

County Commission Chair Peter Spanos said the decision on the nursing home budget left the facility “short-changed at the worst possible time.”

He said the current state of uncertainty is all the more reason to make sure that the home has the funds to enable it to get back to full operation as soon as possible.

On Thursday he said he fully expected that the nursing home will be running short of money in various areas that will require the commissioners to ask the full delegation for supplemental appropriations as the year goes on.

The bottom line of the budget as approved is $36,062,270. Of that figure, $20,476,023 will be offset by revenue, leaving $15,586,247 to be raised by taxes.

In approving the budget, the delegation also ordered county commissioners to get prior authority from the executive committee or delegation whenever they want to transfer more than $2,500 from one budget area to another.

State Rep. Norm Silber initially wanted the transfer authority threshold to be $1,000, but agreed to the higher amount when some other delegation members objected, arguing the lower figure would be unwieldy.

“The policy is meant to assure money appropriated is spent for the purpose for which it was appropriated,” Sylvia said.

He said transfer policy “has been abused in the recent past,” an allusion to the County Commission.

“This is cumbersome, inefficient, and a clumsy way to do business,” Spanos said as the transfer policy was being debated.

On Thursday he denied Sylvia’s assertion that the commission had been flouting the policy which last year required the commission to get permission to move more than $1,000 from one budget area to another.

At the delegation meeting Silber said the commission had disregarded the policy when, he stated, it prematurely approved payment of a bill for food service at the nursing home at a time when there was insufficient money in the area of the nursing home budget which covers dietary services.

Spanos said that assertion was untrue and that the commission has abided by the transfer policy as set by the delegation.

The process for transferring funds from one part of the county budget to another has been a point of contention for several years and resulted in a court case in 2014 in which a judge found the county delegation could limit the ability of commissioners to make such transfers.

Unlike other county departments, the nursing home budget is subdivided into 11 areas and the delegation treats each of those areas as a separate department when it comes to applying the transfer policy.