Nursing home’s survival dominates county budget discussion

LACONIA — Chronic staffing shortages, compounded by COVID restrictions, have created an unsustainable state of affairs at the Belknap County Nursing home, prompting officials to seriously question the long-term viability of the facility.

That concern was repeatedly raised as the county commissioners examined the proposed $13.4 million budget for the nursing home. The commissioners met with Nursing Home Administrator Shelley Richardson as she presented her suggested budget for more than an hour — twice as much time as the commissioners spent with any of the other nine county departments at Saturday’s eight-hour budget review.

The budgets proposed by department heads total $33.5 million — 5.3 percent higher than the current budget of $31.8 million.

The commissioners decided to hold off making a formal recommendation on the overall budget, and scheduled another budget workshop session for Thursday, Nov. 18, at 2 p.m.

Among the other budget proposals presented Saturday were:

— Sheriff’s Department: $2.8 million

— Corrections Department: $5 million

— Administration: $1.7 million

— County Attorney: $1.3 million

While the commissioners examined various line items in Richardson’s proposed budget — which is 16 percent higher than the current budget of $11.6 million — their major concern was how the home can continue to function, considering it has been struggling for months to maintain an adequate staff to enable it to operate at two-thirds capacity.

“We need to do something if we are going to save this place,” Commissioner Hunter Taylor said of the nursing home. “And it’s very much worth saving.”

Richardson, the commissioners, and County Administrator Debra Shackett said the facility has not been able to hire people to fill vacant positions because the pay it is offering is not competitive. In many instances nurses can make twice as much money working at private nursing homes, or other health-care facilities in the area.

The starting pay for a nursing assistant at the county home is just under $14 an hour, while the average rate of pay for nurses in the area is $31 an hour, Richardson said.

Adding to the staffing crisis is the federal mandate that health-care workers in facilities which receive federal funding be vaccinated against COVID. Richardson said there are 36 people working at the nursing home who are unvaccinated and she fears that many of those will quit rather than be inoculated. Two have already told her their last day will be Dec. 5 when the regulation is due to take effect.

Faced with the prospect of a significant staff reduction Richardson said she is considering a number of options, including closing another section of the nursing home which would mean moving 19 residents to other facilities, or moving all the residents to the Merrimack County Nursing Home, and send the staff to work at the Boscawen facility.

Commissioners hoped boosting nursing employees pay would help to retain staff. The staffing shortage is creating a surplus in the Nursing Home budget which is expected to amount to close to $1 million when the fiscal year ends on Dec. 31.

Commissioner Glen Waring suggested using about $700,000 of that amount to pay the 100 nursing home employees one-time bonuses.

The county is currently doing a wage study which is due to be completed next May.

Shackett said that given the responsibilities that county employees have, the amount they are paid is “disgraceful.”

“We’re comparing our employees (pay wise) to people who are making burgers and delivering pizzas,” she said.

But Waring noted that raising the pay of workers at the nursing home won’t solve the problem entirely, given the nationwide shortage of nurses.

Richardson said that she does not foresee any new admissions to the nursing home next year. Meanwhile, there are currently more than 70 names on the home’s waiting list, Richardson said. Further underscoring the urgency of the situation, the home received 19 patient referrals from area hospitals last Wednesday, Thursday, and Friday, she added.

The commissioners agreed to support Richardson’s suggested budget. But commission Chair Peter Spanos expected some serious push back from the County Delegation which sets the county budget.

Responding to Richardson’s question of whether he thought the delegation would support her budget proposal, Spanos replied, “If push comes to shove I think it’s going to be approved, but it’s going to get nasty.”

Waring stressed that most of the home’s budget is offset by revenues it receives through reimbursements, mainly from Medicaid. The amount of the $13.5 million budget that would be raised by property taxes is about $1 million, he pointed out.

Spanos said while the closing of the nursing home is not imminent, the situation is dire.

“It’s not going to close tomorrow or next year,” he said Monday. “But whether if things continue as they are we will be able to sustain the nursing home in five or 10 years is really questionable. This crisis was brought to a head by COVID,” he continued, ”but it was bubbling below the surface before the pandemic.”

Looking at the proposed county budget overall, the biggest increases are in new staffing requests, contractual agreements (wages and benefits), and the general cost of living increases for goods and services which the county buys.

In addition, the Sheriff and Corrections departments want to purchase new vehicles.

The commissioners have asked each department head to prepare a cover letter explaining any significant increases or new programs included in their 2022 recommendations.