St. Croix County Board Committee of the Whole recommends keeping nursing home
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by LeAnn R. Ralph
HUDSON — The St.Croix County Board Committee of the Whole has recommended “Option B” which includes keeping the county nursing home facility, opening the Kitty Rhoades Memorial Memory Care Center again and requiring that $500,000 be put toward debt service payments.
About two-thirds of county residents voted in favor of keeping the county nursing home facility in referendum questions in November of 2008 and again in April of 2012, said Ken Witt, county administrator, at the Committee of the Whole meeting August 27.
The county subsequently borrowed $20 million to build the new health care campus in New Richmond, and the loan will be paid off in 2035, he said.
Early in the county’s history, there was a disagreement about the location of the county seat, so it was decided that Hudson would be the county seat, and the “insane asylum” would be located in New Richmond, which is why the county nursing home facility is in New Richmond, Witt explained.
In 2024, the debt service payments for the nursing home facility cost $26 in property taxes for a property valued at $400,000, and next year, if the health care campus does not put money toward the debt service payment, the cost would be $40 for a property valued at $400,000, Witt said.
Out of the original bond issue for $20 million in 2015/2016, $4,520,000 in principal has been paid off, and $4,051,448 in interest has been paid, he said.
There is $15,480,000 in principal remaining, and $2,398,530 in interest payments remaining, Witt said, noting that at first, the county paid off more interest than principal, and that if he had been county manager at the time, he would have recommended paying off the principal first.
The average interest rate has been 2.3 percent, and in 2024, the interest rate is 4.47 percent, he said.
Fund balance
Projections from Wipfli LLC indicated the nursing home facility would have a deficit of $53,831 in 2023, but in reality, the facility had $429,276 available for debt service, Witt said.
The nursing home facility has had a positive cash flow since 2016 and is now capable of contributing money toward the debt service payments, he said.
In 2011, no tax levy went to subsidizing the nursing home facility, and in 2021, the facility started with a positive fund balance, and the fund balance has increased three years in a row, Witt said.
St. Croix County Board policy requires the nursing home facility to have between 10 percent and 13 percent of operating costs in the fund balance, plus or minus 3 percent, he said.
In 2023, the fund balance was above what the county policy states, so the nursing home facility can now contribute toward the debt service payments, Witt said.
St. Croix County has 50 percent of 412 nursing home beds in the county, and all facilities, both county and private, were at 66 percent capacity during the last audit, he said
There are 455 Community Based Residential Facility beds (assisted living) in the county, and St. Croix County has 58 beds, Witt said.
Medicaid
Medicaid accounts for 44 percent of the payments at the county facility, while private pay accounts for 34 percent and Medicare accounts for 22 percent. The Medicare patients are there for rehabilitation and then will be going back home or to another facility,Witt said.
The cost for skilled nursing care at the St. Croix County nursing home facility is $320 per day, while the Medicaid rate is $479 per day and the Medicare rate is $650 per day, he said.
The Medicare rate is higher because the patients require a higher level of service, Witt noted.
Cathy Leaf, county board supervisor, asked when the Medicaid payments had increased.
Sandy Hackenmueller , health care campus administrator, said that for years, Wisconsin was 48th out of 50 states in Medicaid reimbursements.
The Medicaid reimbursement rate increased last year and is now set up for regular increases. The rate last year was about half the rate that is being paid this year, she said.
Kitty Rhoades
The Kitty Rhoades Memorial Memory Care Center which has 10 beds for dementia patients, has been closed since the beginning of the Covid-19 pandemic.
Private pay for people in dementia crisis would be $650 per day, and family care would be $650 per day, Witt said.
St. Croix County has received a grant from the state of Wisconsin for $500,000 to help re-open the Kitty Rhoades facility, and some of that money would go toward financial incentives to hire people to work at the facility, he said.
Bob Rohret, director of Health and Human Services, said the original grant had been for $373,000 and comes from American Rescue Plan Acts funds. St. Croix County received an additional $70,000 because the facility could be opened quickly.
The day before the Committee of the Whole meeting, St. Croix County was awarded an additional $300,000 because another facility could not take advantage of the grant, so St. Croix County has received another $300,000 for a total of about $750,000, he said.
The Kitty Rhoades facility will act as a dementia stabilization crisis unit where people will be able to stay for 28 days to stabilize them, and then they will find longer term care elsewhere beyond the stabilization, Rohret said.
People from St. Croix County who could have benefitted from the Kitty Rhoades facility have been sent to Clark County, so the St. Croix County facility will serve surrounding counties too, Witt said.
The grant funds for opening the Kitty Rhoades facility must be spent by March of 2025.
Debt service
Because the new Medicaid rate has just gone into effect, the amount of $500,000 from the nursing home facility toward debt service may be increased, Witt said, adding that he recommends reviewing the revenue every year or two.
Bob Feidler, vice-chair of the St. Croix County Board who is chair of the Committee of the Whole, asked if the board was in consensus about removing the option of selling the nursing home facility and removing the option of reviewing the possibility of selling the facility every two or three years.
The St. Croix County Board agreed by consensus.
Earlier in the meeting, Witt had pointed out that if the county board was going to consider selling the nursing home, the facility would have to be appraised, and part of the consideration would be have to be whether the sale price would exceed the debt owed for the nursing home.
One county board member asked about the percentage of property taxes going to the county’s nursing home facility.
On the property tax bill, about 20 percent is for all of the county services, and 50 to 60 percent goes to the school districts, Witt said.
Tax relief
In 11 years, when the debit is paid off for the nursing home facility, then there will be a “profit” that can go towards taxpayer relief, Witt said.
The revenue from the county nursing home that exceeds expenses could go toward paying off other county debt, or it could be used to reduce the county’s property tax levy.
Witt said he would build the comments received from the county board into the budget for 2025 and then present the budget at the Committee of the Whole meeting in October.
Ryan Shirley, county board supervisor, said he wanted the issue of opening the Kitty Rhoades facility to go to the Committee on Administration for a breakdown of costs and a plan for opening the facility.
The grant falls under the direction of the health and human services board, Witt said.
The application for the grant breaks down the costs of opening the Kitty Rhoades facility and is very detailed, said Heather Amos, St. Croix County corporation counsel.
Several county board supervisors expressed concern about the “soft costs” associated with the nursing home facility, such as the time Human Resources spends in evaluating applications for people to work at the facility or Information Technology for servicing computers at the nursing home facility.
Witt said that prior to this, when the nursing home facility was not profitable, the county budget had absorbed the soft costs, but now that the facility was profitable, he could assess those soft costs and look at charging them to the nursing home facility.
Witt noted that his time in preparing to give a report on the nursing home facility was a soft cost as was the Committee of the Whole meeting to discuss the nursing home facility.
Following the Committee of the Whole presentation and county board supervisor comments, the committee listened to public comments.
All of the 10 so people who spoke during public comments were in favor of the county keeping the nursing home facility.
One woman said her dad, a World War II veteran who is 101, was having trouble staying in his own home at the age of 98 because he had been falling and likely would not be alive today if it were not for the excellent care he has received at the St. Croix County nursing home facility.
