Nursing home’s future in doubt

Nathan Oster

Citing hundreds of thousands in operational losses last year alone, Three Rivers Health says it is considering the closure of its 37-bed Bonnie Bluejacket Memorial Nursing Home as a step toward ensuring the viability of its hospital, clinic and emergency room services.

Officials from Three Rivers (formerly South Big Horn County Hospital) shared the news with family members of the 21 people currently living at the facility late last week and met with them personally in two separate gatherings Monday.  

A public meeting has been slated for Tuesday, Aug. 30 at 7 p.m. at the Greybull High School auditorium.  CEO Rick Schroeder is expected to lead the “open, informal” discussion on the facility’s future.  The school’s north and east doors will be open for members of the public wishing to attend.

Schroeder emphasized in an interview earlier this week that no decisions have been made.

“All of our efforts right now are focused on what we can do to keep it open,” he said.

He conceded, however, that the situation is dire.

The biggest factor, he said, is that the amount of money the facility receives in federal and state Medicaid reimbursements has not come close to keeping up with the skyrocketing cost of everything from staffing to food and supplies.  Seventy-five percent of its current residents are on Medicaid, he said.

A table presented by Three Rivers shows the gap widening over the past five years.

In Fiscal Year 2017, the district was expending $194.28 per resident day, but receiving $188.71 in reimbursements per patient day.  The resulting operating daily loss of $5.57 per resident day led to an annual operating loss of about $54,289.

While per-resident-day reimbursements have generally held steady over the past five years, reaching a high point of $197.77 per patient day in FY 2022, costs have risen by almost 50% over the same time period. In FY 2018, the per patient day cost was $202.88. In FY 2019, $227.59.  In FY 2020, $250.39.  In FY 2021, $271.58.  And in FY 2022, $304.93.

The facility’s bottom line reflects the widening gap.  Three Rivers reports annual nursing home losses of $130,559 for FY 2018, $419,060 for FY 2019, $579,250 for FY 2020, $679,074 in FY 2021 and $909,684 in FY 2022. 

“Everything we do has increased in cost over what it was six years ago,” said Schroeder.

To keep the doors of the nursing home open, the hospital has in the last year alone subsidized it to the tune of almost $1 million.  That, in turn, has led to a re-evaluation of this service and whether to continue it.

“We are exploring this option now and will have a final decision in the coming months, with the intent of creating a sustainable model that helps us continue to meet the health care needs of our community as a critical access hospital,” said a statement provided by Three Rivers Health.

Schroeder emphasized that it “isn’t just a local issue,” pointing to seven different care centers in Montana that have either closed or are in the process of closing.  “I don’t know of any states that aren’t haven’t this kind of problem,” he said.

Schroeder said Three Rivers hasn’t been using traveling nurses — who typically cost more — in the nursing home.  They are being used exclusively on the hospital/ER/clinic side.  While that’s driven up staffing costs, Schroeder maintains that the hospital, clinic and ER are doing very well on their own.  The problem is that gains on the hospital/ER/clinic side must be used to offset nursing home losses, he said.

In its statement, Three Rivers indicated it was “exploring other sources of financial support to ensure the ongoing sustainability of our hospital operations.”  Schroeder expanded on that in an interview Tuesday, saying Three Rivers reached out to the Wyoming Department of Health and is applying for a $500,000 distressed facilities grant through the American Rescue Plan Act (ARPA). 

Schroeder said Three Rivers is also exploring what it would take to qualify as a distressed facility and thereby qualify for a higher reimbursement rate from Medicaid.