The home has had a revolving door of both management and front line employees coming and going and that has caused issues because “there hasn’t been consistency from a management perspective.”
“Right now we have to get some foundational things as far as staff training, getting our policies and procedures in line, getting processes and practices in place that are consumer friendly as well as regulatorily in compliance,” McGee told the Journal-News. “Meaning we’re doing things so that the residents are content, their guardians are content and they’re just happy to be here and pleased with the staff.”
Ever since Demidovich, who ran the home for more than 20 years, retired in 2017, keeping the top job filled has been a challenge. The county brought in Jennifer Strickland, a consultant with LeaderStat, during Demidovich’s transition to retirement. She took over as administrator but resigned in May 2019. Professional Review Network ran the home until Chamika Poole was hired in September of that year but she left last October. PRN ran it again for a while until the commissioners brought Demidovich back on an interim basis a few months ago.
The 109-bed facility is one of about 24 county-run nursing homes left in Ohio. The nursing homes were mandated in all 88 counties when the first facility was built in 1830 to serve the infirm, poor and homeless. Many of the facilities closed after the state legislature lifted the mandate and counties opted to let the private sector handle nursing care as government budgets shrank.
According to the AARP Nursing Home COVID-19 Dashboard, 37.7% of nursing homes in Ohio are reporting staff shortages. McGee said she has about five open management positions and roughly 20 front line worker vacancies, about half the staff are outside agency, not county employees. Agency workers cost the county $1.24 million last year and $1.1 million so far this year.
The staffing shortage has been persistent throughout the pandemic. Trying to hire 28 people, the county conducted a drive-thru job fair in the summer of 2020, but only three people showed up. As such, the census at the home is down to 39 residents.
McGee said they have had “numerous” calls from people who want to move their loved ones into the facility but they can’t increase the census until they solve the staffing issue.
“We’re in sort of that limbo state where we need the numbers to bring folks in, but the key is if we could get rid of agency, we could start training our staff, getting our staff ready to receive more people,” McGee said. “So the more we let agency go, the more we’re moving in the right direction.”
While COVID has caused big staffing headaches the virus itself has not, throughout the pandemic. McGee said they currently have no one who has tested positive or showing symptoms.
Through the years the commissioners have had to bail the financially fragile nursing home out with general fund cash infusions, for a variety of reasons. Commissioners transferred a total of $450,000 from the general fund to the nursing home in 2019.
Three years ago, the facility needed a $425,000 subsidy, and in 2016 the commissioners had to loan it $225,000 so payroll could be met through the end of the year. At one time, the county nursing home owed the general fund $1.1 million, a debt the home partially repaid.
Finance Director Angel Burton said the facility hasn’t needed a loan since 2019 because payroll costs were down due to the staffing issue, so the money needed to hire temporary workers hasn’t broken the budget. She said the county “cleaned up” all outstanding general fund loans last year including $300,000 for the Care Facility.
The home has received $919,300 in federal COVID relief funding and they have applied for more. McGee said thanks to the federal help they hopefully won’t need another general fund loan while they bring the census — and revenues from resident payments — numbers back up.
“We did apply for Phase 4 funding from the federal government and that should offset some of the cost once that’s received for staffing, especially the temp agency,” McGee said.
Commissioner Don Dixon, who is in the long-term care business, said he is not certain the nursing home industry will ever fully recover because people just don’t want those types of jobs. They are considering some requests from outside entities to use part of the facility to help the bottom line.
During the height of the heroin epidemic Demidovich pitched using a secured wing of the facility for a detox center. The commissioners dismissed the idea because they didn’t think it was appropriate to house drug addicts with the fragile residents at the home.
“We’re looking at repurposing part of that building and that means looking at doing something with mental health. I don’t know what that’s going to look like yet but we’ve got a couple agencies looking at that so they don’t have to build a new building,” Dixon said.
“I don’t ever foresee it (the census) going back up to 100, it’s just not in the cards. As hard as we’ve tried to run it, it’s just a burden on taxpayers. Now there’s plenty of vacancies at existing facilities out there that will take these kind of people, so I don’t think there’s a better time to right-size it than right now.”
County Administrator Judi Boyko told the Journal-News she has had a difficult time trying to fill the top spot at the nursing home after Poole left. She had two “very attractive” candidates early on but both committed to other jobs before she could make them an offer.
McGee comes to the county with 20-plus years of experience working in long-term care for those with developmental disabilities and quality assurance, skill sets that transfer very well to her new role, according to Boyko.
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