With mounting evidence that the Gallatin Rest Home may never be financially self-sufficient, the Gallatin County Commission is considering whether to ask voters to approve a tax increase to keep the facility open.
The Rest Home has long worked to reduce its costs but has ended each year since 2013 with a deficit. This is partially because Medicaid doesn’t reimburse for the full cost of care and because there are a growing number of costly federal guidelines with which the facility must comply, administrator Darcel Vaughn said.
In the last few months, the Rest Home has made changes that have saved $434,600. Even with continued savings, Vaughn said the Rest Home won’t break even this year or in future years. She urged the commissioners to ask voters for a mill levy, which would provide ongoing funding for the Rest Home.
The commissioners said they see the need but don’t know how much voter support there would be.
“I think we need a mill levy, but it’s a risk,” said Commissioner Joe Skinner. “It’s not a sure thing by any means.”
The county does not yet know how much money it would request and did not set a date for placing the Rest Home on the ballot.
Montana has 11 county-owned long-term care facilities, some of which are supported with mill levies. In nearby Madison County, a 17-mill levy, which now totals about $4 million, provides about half the revenue for the county’s two long-term care facilities — Madison Valley Manor in Ennis and Tobacco Root Mountains Care Center in Sheridan. The remaining revenue comes from residents’ payments for their care.
To save money, the Rest Home has focused on reducing its reliance on outside staffing agencies by hiring its own employees.
This summer, Vaughn hired a few certified nursing assistants, so the Rest Home no longer has to contract with outside agencies to fill these vacancies. The new hires save about $9,450 per month because outside agencies bill for expenses — like housing — that county employees do not have.
The Rest Home now has five staff members from outside agencies, all of whom are licensed practical nurses.
Vaughn is recruiting new employees and is exploring salary increases or other incentives that could attract candidates. Staffing agencies are so expensive that paying county employees more is still a savings over using contract workers, Vaughn said.
Other savings come from a $7,000 reduction in liability insurance, a change to the ways that the Rest Home’s pharmacy provides medication and a restructuring of the dietary department.
In the coming months, the Rest Home may offer new services, such as IV medications, which may bring in additional revenue. The commissioners have also budgeted $25,000 for a consultant to look at the Rest Home’s finances.
“We need to leave no stone unturned when we’re looking for solutions,” Commissioner Don Seifert said.
He added that changes at the Rest Home likely won’t make it self-sustaining, so he and the other commissioners will have to ask voters to give the facility additional tax dollars.
The recent savings at the Rest Home mean a wing that closed in May may soon reopen. After the closure, the Rest Home consolidated its 60 patients into a smaller area, requiring less staff from outside agencies. As the Rest Home has hired its own staff, it has saved enough that reopening the wing won’t be too expensive and would open up 10 additional beds, allowing the facility to accept people on its wait-list, Vaughn said.
Having a wait-list is a change for the Rest Home, which has long seen a decline in its number of residents, partially because of an increase in long-term care options in the Bozeman area. The Rest Home has 94 beds, and for many years, they were all used.
The commissioners have used general fund dollars to subsidize the Rest Home for two years. Last year, they pledged one mill annually — about $295,000 at the time — to the facility. This year, they gave an additional 1.96 mills, bringing their total contribution to $1.05 million. The additional funding contributed to a tight budget and was part of the reason that the commissioners increased taxes this year.