Executive committee refuses county budget transfer, cuts nursing home by $1.4M

LACONIA — The Belknap County Executive Committee declined the approval of a budget transfer to cover a contractual payment for dining services on a 2-2 vote on Jan. 25.

Belknap County Commissioners requested a $29,017 transfer in nursing home funds from full-time nursing wages to contracted dining services, with County Administrator Debra Shackett noting that there was plenty of money available in the nursing account because of staff shortages.

The county had paid the December bill for food service to both the nursing home and the jail on Jan. 21, after receiving the bill on Jan. 14.

Rep. Barbara Comtois asked why they had not waited another week to allow the executive committee to approve the money transfer before overspending the budget. Referring to previous months’ expenditures, she argued that the commissioners should have anticipated how much the December bill would be and avoided exceeding the budget.

Rep. Michael Sylvia said he has a long record of asking to approve transfers before problems occur, “and here we are again.”

Commissioner Glen Waring said, “We operate under an understanding that this board would approve transfers when they were going to be over-expended. This bill had to be paid, and it was a matter of timing. There can be animosity on whether we properly anticipated the cost, but the bill has to be paid under a contractual obligation.”

Rep. Norm Silber suggested that it might be time to bring the commissioners’ continued transgressions to the attention of Judge James O’Neill, saying the court had laid out the executive committee’s role in controlling budgetary matters.

Rep. Ray Howard said he would vote in favor of the transfer, but under protest, and he agreed that going to court may be necessary.

Howard and Comtois voted to approve the transfer, while Sylvia and Silber voted against it.

Turning to the nursing home budget, there was agreement between the commissioners and the executive committee that some areas could be cut because of unfilled nursing positions and a resident count that ranged between 60 and 70% of full occupancy. However, a recent pay increase that had been implemented to attract and retain nurses became a matter of contention.

The county commission had to submit its budget to the state Department of Revenue Administration and the county delegation by Nov. 30, 2021, but decided in December to implement a pay raise. The budget presentation on Tuesday included a separate column to list the increased labor costs under the new rate structure.

Executive committee members objected that they had never been asked to approve the raises, and they noted that a wage study that had been authorized has not yet been completed.

Waring said that the nursing shortage may require further incentives to attract and maintain staff.

Vaccine mandates

Nursing Home Administrator Shelley Richardson discussed the current staffing problems and the potential to lose more nurses if the government requires booster shots for those now considered fully vaccinated.

Eleven staff members have received medical or religious exemptions from the vaccine mandate, while the other staff members have received the two required shots. Richardson said about 60% of the remaining nurses are likely to leave if the federal government also requires the booster shot.

“Because they’ve already taken the original shots, they cannot apply for an exemption, because it’s kind of a moot point at this time,” Richardson said. “Once you have taken the shot, you’ve taken the shot. But people have changed their minds because they’ve seen either side getting COVID. So some people that did take the shot previously have decided they did their part. They’ve seen people get sick, even though they’ve had the booster, and they don’t want to do it.”

If more nurses quit, the nursing home may have to transfer patients elsewhere, at county cost, but every nursing home is facing the same problem and they may not be able to find a place that can take new patients.

Richardson said the vaccine and testing mandate also is creating problems with vendors, leading to higher prices. Some vendors want to avoid taking the required COVID test because, if they test positive, they are not allowed to enter the building, and may run into trouble with their bosses. That reduces the number of vendors who can serve the nursing home, leading other vendors to charge higher prices.

Yet visitors are allowed to see residents even if they are not vaccinated to provide patients with necessary companionship.

The executive committee raised the idea of no longer accepting Medicare and Medicaid funds in order to avoid the federal vaccine mandate. It might help with staffing because of all the nurses who are looking for work after leaving their jobs at facilities requiring shots. Seeking more private-pay clients also could help with the nursing home finances, they suggested.

Richardson noted that the nursing home cannot accept more private-pay patients because of its obligation to serve low-income residents, and there already is a waiting list to get in.

The committee observed that any budget would be a guessing game with all of the uncertainty about the staffing and patient load.

Budget reductions

They proceeded to go down the budget, reducing both expenses and revenue projections to reach what they considered the most reasonable projection for the coming year. Howard said they likely will have to return and make budget adjustments later in the year when they have a better idea of the trends.

Full-time nursing wages were reduced from the proposed figure of $3,216,970 to $2,750,000; the previous year’s budget was $2,480,000.

Incentive pay was reduced from $150,000 to $100,000.

Part-time wages were reduced from $702,900 to $500,000, less than the 2021 figure of $650,000.

Sick-time incentive was reduced from $15,730 to $3,674. Last year, the budget figure was $6,829.

Health insurance was reduced from $1,502,850 to $1,250,000, up from $1,144,000 in 2021.

Payroll tax was reduced from $331,470 to $275,000; it was $271,000 in 2021.

Retirement was reduced from $510,385 to $440,000, up from $353,360 in 2021.

The commission had requested $450,000 for contracted nursing services; the executive committee reduced it to $300,000, down from $400,000 last year.

The amount for oxygen was reduced from $41,787 to $30,000, while last year the figure was $39,000.

The line for total nursing services, proposed at $7,614,529, was reduced to $6,341,111.

The total for all nursing home expenses stands at $12,076,103, while the commission had proposed spending $13,452,140.

The executive board was scheduled to meet again on Wednesday night to fine-tune and finish its budget work.