Neighbors of Dunn County Report: more people age 65+ and fewer nursing homes
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By LeAnn R. Ralph
MENOMONIE — In 2020, almost 17 percent of the residents in Dunn County were 65 years and older, but since 2016, 12 nursing homes within 50 miles of Dunn County have closed.
In 2010, 12 percent of Dunn County’s population was 65 years and older, while in 2020, 16.9 percent of Dunn County residents were 65 years and older, and by 2040, the projection is that 26.3 percent of Dunn County residents will be 65 years and older, said Carmen Myer, the administrator for the Neighbors of Dunn County, during her report to the Dunn County Board at the November 12 meeting.
All together, 66 nursing homes in Wisconsin have closed since 2016, she said.
The 12 nursing homes that have closed since 2016 that were located within 50 miles of Dunn County included three local nursing homes that closed in 2023: the Colfax Health and Rehabilitation Center; Pioneer Health and Rehabilitation Center in Prairie Farm; and Heritage of Elmwood, Myer said.
Colfax Health and Rehab was previously a not-for-profit facility and has since been sold and now is a for-profit assisted living facility with no skilled nursing beds.
Other nursing homes that have closed within 50 miles were located in River Falls, Fall Creek, Rice Lake, Strum, Dallas, Eau Claire, Pepin and Altoona.
When nursing homes close within 50 miles of Dunn County, that means people sometimes have loved ones in facilities that could be more than a hundred miles away, said Gary Stene, county board supervisor from Colfax.
The distance away from home for the nursing home resident, and the travel distance to visit a family member, creates additional stress on nursing home residents and families, he said.
76.4 million
There are 76.4 million “Baby Boomers” in the United States, which refers to people who were born between 1946 and 1964, Myer said.
By 2029, all of them will be age 65 and older, she said.
The number of Baby Boomers in the United States is roughly 25 percent of the entire population.
In 2029, the United States Census Bureau projects that 63.1 million Baby Boomers will still be alive, Myer said.
In 1990, there were 3.1 million United States citizens who were age 65 and older, or 4.1 percent of the population. In 2020, there were 55.8 million people in the United States who were age 65 and older, or 16.8 percent of the population, she said.
From 2010 to 2020, there was an increase of 15.5 million people who were 65 and older, which was twice as rapid an increase as the previous decade, Myer said.
In addition, life expectancy has increased, although there was a dip in life expectancy due to the Covid-19 pandemic, she said.
According to the Centers For Disease Control and Prevention, there are 15,600 nursing homes in the United States with 1.7 million beds, Myer said.
Nursing home beds of 1.7 million for 76.4 million Baby Boomers works out to be enough nursing home beds for 2 percent of the Baby Boomer population.
Decline in beds
The number of nursing home beds in Wisconsin is decreasing steadily between nursing homes closing and facilities de-licensing some of their available beds, Meyer said.
After a facility de-licenses beds, there is no way to get those beds back because there is a moratorium on nursing homes beds in Wisconsin, she said.
If the Neighbors dropped the 15 beds in the closed household, the Neighbors would not be able to get those beds back if staffing became available to open it, Meyer said.
There were 28,710 nursing home beds in Wisconsin in 2020, and by October of 2023, there were 25,891 nursing home beds, she said.
The moratorium on nursing home beds in Wisconsin has been in place for a long time. A study was conducted this year, and based on the results of the study, the decision was made to continue the moratorium, Myer said, adding that she does not understand the rational because more nursing home beds are needed.
The priority of those in a decision-making capacity want people to stay in places that are less restrictive than a nursing home, so there is a push for Community Based Residential Facilities (CBRF) which is a form of assisted living, she said.
A CBRF admits and can provide care for elderly people, for people with dementia, for people with developmental disabilities, traumatic brain injury and drug and alcohol abuse as well as correctional clients and the terminally ill, according to the Senior Planning Inc. website.
The people who reside at a CBRF receive care and treatment or services above the level of room and board and may include up to three hours per week of nursing care for each resident, the website states.
A skilled nursing facility, on the other hand, offers medical care for residents, 24-hour supervision and help with daily activities. Rehabilitation services include physical therapy, occupational therapy and speech therapy, according to the Elegant Care Villa website.
Three out of four
Dunn County has four skilled nursing facilities, and the Neighbors has three of the four skilled nursing facilities, Meyer said.
There are 174 skilled nursing facility beds in Dunn County, and the Neighbors has 137 of those beds, she noted.
The Neighbors’ skilled nursing beds account for nearly 80 percent of the skilled nursing beds available in Dunn County.
The Neighbors of Dunn County actually has three skilled nursing facilities with 137 beds located across nine “houses,” Myer said.
The county’s nursing home was located at one time in what is now the Government Center, which had a much more institutional feel with the hallways and other parts of the structure, she said.
Among the nine houses that make up the Neighbors, two are for post-acute rehabilitation (with one house currently closed); two houses are for memory care; and five of the houses are for long-term care, Myer said.
The current number of residents at the Neighbors is 110, and in the last year, 246 residents were served. Because one of the houses is closed, that means the remaining houses are usually “very full,” she said.
The reason that one of the households at the Neighbors is closed is 100 percent due to the lack of available staffing, Myer said.
The Neighbors has referrals to fill those beds, but the Neighbors does not having the staffing to support filling those beds, she said.
The only way to staff the closed house would be through a staffing agency “and that is extremely expensive,” Myer said.
With eight of the houses open, the Neighbors generates better revenue than if the ninth house was opened with staffing agency personnel, she said.
Agency registered nurses start out at a base rate of $80 per hour, and that does not include over-time, holidays or other benefits. Agency staff would be the only option right now to open the closed household, Myer said.
CNA training
The closed household at the Neighbors is not sitting idle, however.
The ninth house is the site for a Certified Nursing Assistant (CNA) training program, Myer said.
If the ninth house were opened, would the CNA training program still have a place to be? asked Michelle Bachand, county board supervisor from Menomonie.
There is a CNA training room in the household. Right now, the training program uses more of the household than it normally would, but if the house was opened again, then the CNA training program would revert back to only being in the training area, Myer said.
The Neighbors of Dunn County also provides other training opportunities besides onsite CNA training.
There are a number of clinical internships at the Neighbors, such as UW-Stout dietetics students; the Mayo Health System residency program; and students and completing CNA and nursing clinicals through the Chippewa Valley Technical College, Myer said.
What happens?
When people need a skilled nursing facility, but there are no beds available, where do they go?
Sometimes people go home when they are not ready to go home, Meyer said.
People also go to a lower level of care when they really need a skilled nursing facility, she said.
And sometimes people also go to a skilled nursing home facility that is outside of their home community, Meyer said, noting that sometimes people also stay in the hospital.
When people go home but they are not yet ready to go home, they often end up back in the hospital. Going home too soon results in falls, worsening of wounds, injuries and infections, she said.
The same is true of people who are not yet ready for an assisted living facility but end up in assisted living because there are no skilled nursing beds available, Meyer said.
When people are moved outside of their home community, then their loved ones have to drive hours, and the person cannot be in their home community, she said.
Hospitals
Staying in the hospital when there are no skilled nursing beds available has become even more difficult because there is a shortage of hospital beds, Meyer said.
Hospitals will call and “beg” the Neighbors to provide care for people who cannot go home, she said.
The problem of a shortage of hospital beds is now compounded because two nearby hospitals have closed. While more hospital beds are needed, there are fewer available, she said.
Earlier this year, HSHS Sacred Heart Hospital in Eau Claire closed as did HSHS St. Joseph’s Hospital in Chippewa Falls.
In addition to the two hospitals, 19 Prevea Clinics in the Chippewa Valley also closed.
Ownership
There are three types of nursing home ownership.
For-profit nursing homes make up 54 percent of the total, while not-for-profit nursing homes account for 32 percent, and government-owned nursing homes, either owned by a county or the state, account for 14 percent of the nursing homes, Meyer said.
Not-for-profit and government nursing homes are often grouped together as “mission driven” facilities, she said.
The not-for-profit and government nursing homes “are there to serve residents,” and additional revenue not needed for expenses goes into making the facility better rather than contributing to a company’s profits, Meyer said.
For-profit nursing homes are more likely to have deficiencies that end up in citations and also have lower “star ratings” from the Centers for Medicaid and Medicare Services (CMS), she said.
CMS star ratings range from one to five, with five being the highest rating available.
For-profit nursing homes also are more likely to be “special focus facilities” which means the facility has a number of significance compliance issues, and they also have lower staff ratings, Meyer said.
Not-for-profit and government-owned nursing homes have higher quality measures, the residents have fewer pressure injuries (also known as bed sores), and have fewer deficiencies resulting in citations, she said.
In Wisconsin, for-profit nursing homes have an average CMS star rating of 2.7, while not-for profit nursing homes have an average star rating of 3.1, and government-owned facilities have an average star rating of 4.1, Meyer said.
Prior to being sold, when Colfax Health and Rehab was a not-for-profit facility, according to the Aging Choices website, CHRC had received a short-stay five-star rating from Medicare and a three-star, and then a four-star rating for long-term stays.
According to the Neighbors annual report for 2020-2021, the Central household, East household and West household had all received five-star ratings.
Financial outlook
Over the years since the Neighbors opened in 2013, the financial outlook has gone up and down, Meyer said.
When comparing revenues versus expenses, and not including depreciation, most years the Neighbors has had an operating surplus, she said.
In the past two years, the Neighbors had a loss that was partially offset by a profit of $1.5 million in 2021, Meyer said.
The Neighbors is projected to be “in the black” for 2024 with a $1.2 million operating surplus, and a surplus of $577,000 when depreciation is included, she said.
The future for the Neighbors has a positive outlook. For the next five years, the Neighbors is projected to be in the black when considering rates, expenses and inflation, Meyer said.
For a number of years, Wisconsin ranked 48th out of 50 states for Medicaid reimbursement.
The Medicaid reimbursement rate increased last year and is now set up for regular increases.
The Medicaid reimbursement rate last year in Wisconsin was about half the rate that is being paid this year.
According to the Wisconsin Department of Health Services, “the vast majority of nursing home residents do meet Wisconsin’s criteria for Medicaid payment of a nursing home stay according to their MDS assessments.”
Better benefits?
Stene asked Meyer if offering better pay and benefits would help to attract more staff for the Neighbors.
Offering better pay and benefits “could help,” Meyer said.
The biggest problem, though, is that the community does not have enough nursing staff to go around, she said.
Nursing “is a hard job,” and “quite a few have gone to work in other industries,” Meyer said.
The other problem is that the Neighbors operates under the same pay and benefits structure of the whole county, so the pay and benefits cannot be adjusted only for employees at the Neighbors, she said.
