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Scotland County Care Center Issues Statement on Coming Closure

By Echo Menges

Memphis, MO – Friday, December 17, 2021 – The Scotland County Care Center is closing. The NEMOnews Media Group is currently working on a news story about the coming closure for the upcoming print editions and websites of the Memphis Democrat, The Edina Sentinel and The Media in Kahoka.

The following statement was released Friday by the care center announcing the coming closure of the nursing home and residential care facility located in Memphis, MO.

Statement from Scotland County Care Center

On Monday, December 13th the Board of Directors held a special board meeting. This meeting was held to deal with the recent staffing issues along with ongoing financial concerns. It was during this meeting that the difficult decision was made to close the facility operations.

Below is a statement prepared by myself, the administrator. This statement explains the reasons and issues behind this decision. Our staff is working diligently with family members in efforts to relocate residents to an appropriate level of care.

Scotland County Care Center was previously licensed as a 125 bed facility. Population changes have declined over the years, whereby the District closed a wing and changed the licensure to 96 beds. A continued decline had caused a drop in census to around 40 residents. The current census in the nursing home is 37. The Residential Terrace was built to hold 28 residents. The census there has historically been low. The current census in the RCF is seven.

The primary reason for our operations center around “sustainability”. We have been having a problem with financial sustainability and staffing sustainability. A low census transcends to insufficient revenues to cover the cost of operations. For years, the District has been operating at a loss, using “Reserves” to cover our expenses. In addition, the need for significant capital improvement pulled heavily from reserves. In recent years the cost of providing care has skyrocketed due to changes in the minimum wage law, increased costs of goods and services, covid expenses, and most recently the need to pay “Agency Staffing” in order to cover shifts.

Thus far, the minimum wage increase has increased 33% since 2019 and yet our state Medicaid funding has increased 1.3%. This is just an example of how reimbursement has been lacking for some time. Furthermore, we are facing another increase in the minimum wage along with concerns of increased costs due to inflation.

The labor crunch has taken its toll on us just like any other business, maybe even more so given that fewer people want to work in health care with the advent of COVID-19. We are required to have a certain number of certified and licensed nurses in order to care for residents. Therefore, we had to use “Agency Staffing”. In the past fiscal year, the district had paid out nearly $380,000 in agency staffing fees.

The labor shortage threatens our sustainability. Recently I had staffing turnover that left us unable to provide a licensed nurse for 12 shifts in December. I made exhaustive efforts of getting those shifts filled. I called area nursing homes, hospitals, contacted 8 staffing agencies, spoke with the regional Medical Reserve Corpse, SEMA sent urgent message out to 77 licensed nurses in surrounding counties, contacted and posted to websites of Nursing Programs hoping to reach out to their alumni, posted to social media Indeed, Facebook, Zip recruiting, called former licensed nurses, followed up with names board members had given me, called DHSS, and more.

On Monday, December 13, 2021 the board held a special board meeting. We had been meeting weekly. We reviewed the holes in our nursing staff, informed the board of turnover in other key areas, and once again reviewed the finances, projecting how much longer the facility could hold on. Ultimately, there was a motion made and unanimously approved to close the facility because we see no solution to the long term financial problem or the short term staffing shortage.

The board of directors met with our staff the very next day. As required by DHSS, the administrator prepared a closure plan and the proposed letter of discharge as these had to be approved before the district was allowed to officially notify people of the closing.

The facility is required by law to give a 60 day notice (30 days for RCF residents). However, because of the staffing crunch and the potential of not having licensed nurses on duty 24/7 that date could be earlier than the February 15, 2022 closing date.Our facility has put together a team to assist families in finding placement options. We are compelled to assist residents and family members in this process so that we ensure that residents can transition to a location that best meets their needs and preferences. At the same time, we are working to help our employees through this transition. I applaud my staff who have always worked together and “pulled together” extremely well no matter the situation.

The problems of financial sustainability and staffing shortages are widespread. In my search for other facilities I have learned that many homes are not accepting new admissions because they do not have enough staff. This creates a cyclical situation. A facility may need to increase their revenue but cannot do this because they do not have the staff to accept more residents. What they can then pay staff is limited by the revenue they take in, or how much “reserves” they have left. One home in particular is licensed as 125 beds and has a census of 55, yet they are declining all new admission based on their staffing shortage.

I have had conversations with fellow administrators and even conducted a regional meeting where our State Senator and representatives from DHSS were present. They acknowledged the problems have been building long before the COVID epidemic. My last written correspondence concerning the Medicaid reimbursement was that the state is working on a potential “Cost Rebase and Acuity Level of reimbursement” come July 1, 2022.The fact is the Medicaid reimbursement is not enough and something must change soon. or there would be other facility closings. It is becoming more and more difficult for small, rural nursing homes to exist. I know of facilities around us who echo they are running out of reserves, operating on monthly losses, and do not have the staffing they need.

All across the state, nursing homes are trying to recruit administrative staff including Directors of Nursing. In my opinion, a reasonable solution would be a merging of small homes to create regional nursing home districts where the expenses can be concentrated in that there would be need for one Administrator, DON, Office Staff, Dietary, Housekeeping/Laundry, one building to maintain, etc. Should this happen, then the census would be filled providing the revenues necessary to recruit and keep necessary staff.In order to keep other homes from closing, the general public needs to contact their legislators, DHSS, and others to make sure changes are made.

Warmest Regards
Tim Schrage