Commentary: Moving forward for a new Strafford County nursing home

The Strafford County Commissioners’ vision of a new nursing home for the county has been much disparaged in letters to the editor and at several public hearings. As NH State Representatives and members of the Strafford County Delegation, we have been dismayed by the misinformation presented to the public by some Republican members of the delegation, and the aggressive nature of the personal attacks against the three County Commissioners, the County Administrator, and the architects.

These attacks seem intended to malign the commissioners for political gain rather than to present viable solutions toward building a much-needed new nursing home. The new nursing home should not be a partisan issue, but the Republican caucus has made it into one.

Misconception #1: We can just renovate the old one. Riverside Rest Home is a tired old building with poor insulation and no air conditioning. It has asbestos and other old toxic building materials that make it unsafe to renovate while still occupied as a nursing home. Renovation work is often much more expensive and time consuming than building from scratch, especially true with the complex needs and requirements of a nursing home. Yet this is repeatedly offered as a viable option by the Republican caucus.

Misconception #2: It does not have to cost so much. The new nursing home will have to be built to current Medicaid and Medicare (CMS) requirements that include the long overdue stipulation that residents have a private room and bathroom. Many of us experience the emotionally devastating experience of moving a parent into long term care. The indignity of having to spend their final weeks or months sharing a room with a stranger is one of the hardest parts. The current Riverside Rest home has only shared rooms with each room sharing a toilet with an adjacent room thus 4 people use the same toilet, and 42 share the same shower. To house the same number of residents, the new nursing home will need to be twice as big just to meet the new single room requirements.

Square foot construction costs of similar projects now underway are comparable to the first two plans. The new standards are more expensive but necessary and unavoidable. The Republican caucus claims we can build something cheaper by referring to projects built 15 or 20 years ago, often comparing apples with oranges, facilities that have no heating plant or laundry facilities, or are assisted living facilities not nursing homes. The Carroll County nursing home is touted as a cost-effective facility to build but is designed for high staffing levels that in our current labor market would be impossible to meet, nor in our County budget to afford.

Misconception #3: It does not have to be so nice because it’s for poor people. This attitude is one we find most offensive. Everyone deserves to live (and die) with dignity, regardless of how well off or poor they were throughout their lives. Yes, the county nursing home is the facility of last resort, but that does not mean everyone who ends up there was always poor. In fact, the majority are not.

For example, Rep. LaMontagne’s mother worked full-time until retirement and even bought herself Long Term Care (LTC) Insurance while in her 40’s. Because of her prolonged need for assisted living, she has, at age 89, already maxed out her LTC benefit. She is now in what is called the “pay down” period in which she is spending all her remaining assets. When those are gone, and she ends up in a nursing home, she may end up on Medicaid to pay for it. Most of us, despite preparing for retirement, do not have the resources to cover LTC in skilled nursing for an extended time. The “indigent” in our county nursing home could be any of us.

Misconception #4: The commissioners want to build the “Taj Majal” It’s true that in some architectural drawings there was an indoor water feature and a mini golf course. In the latter instance, the architect sketched a one-hole putting green because Riverside already has one, a simple outdoor activity that some residents enjoy. It is not an extravagant expense to have a minimum of recreational opportunity. Most of the features poo-poohed by the Republican delegates are actually essential features of any nursing home: a beauty salon, a financial office, mailboxes, a place for residents to visit with family.

The best concept of both proposals was the incorporation of essential services in a “main street” environment: the beauty salon, the bank, the post office, the café, and a library function as all the above in an open area, not hidden off hallways in boxes. Creatively providing these services in a way that enhances a sense of community and neighborhood rather than institutionalism is a wise, not extravagant, investment.

The nursing home’s biggest challenge right now is finding enough staff. Creating a facility that houses an on-siteday care would have great appeal in attracting working parents. Allowing old folks to look out the window at children playing will bring joy to their day. Also, some of these services (the hair salon and daycare) operate as independent proprietors and will not add to the county payroll.

Misconception #5. The Commissioners want to compete with the private sector. When the new county nursing home is built, it will attract residents of all pay levels because it will have private rooms and will be brand new. This initial competition will be short-lived as private nursing homes in the area will eventually renovate and expand their facilities so that they also offer private rooms to meet the most current CMS standards. The county nursing home, by taking all the people whom the private sector will not take, is what allows the latter to stay profitable. The private sector can’t make money on Medicaid only residents. This is the way it has always been.

Misconception #6. The new nursing home will cost us more to run. The new proposals include on-site rehabilitative and skilled nursing capability. The Republicans suggest that these features are luxuries that county taxpayers cannot afford. Having our own capability to offer these services will allow continuity of care when Riverside residents need, in the short-term, a higher level of care following an illness or injury. In our current facility, these residents must be sent elsewhere while keeping their room open at Riverside, for which the county receives no compensation.

Including these services in-house will generate additional revenue, not cost us more money. At the delegationworkshop on the nursing home in November, we heard testimony from an independent consultant hired to prepare revenue projections. Her presentation supported the position that not only can we afford them, but the revenue from these services will reduce costs to taxpayers to care for our Medicaid-only LTC residents. Representative Len Turcotte had the gall at this public workshop to tell the consultant, former head of the NH Department of Health and Human Services Lori Shibinette, that “I don’t believe your numbers.” We do believe them. Building a bare minimum facility as the Republicans demand would be penny wise and pound foolish and will negatively impact the ability to control future county tax rate. Effective Medicare billing practices result in decreased staffing costs and increased revenue. This is a sensible long-term strategy for any new nursing home plan.

Misconception # 7: The County Commissioners have been sneaky and have wasted money. Rep. Cliff Newton claimed in his March 18th LTE that there have been no public hearings on the nursing home, which is completely false. We have attended 3 of them in the last 18 months. The subcommittee established to work on the nursing home was quickly expanded to include the entire delegation, as requested by Republican delegates, to discuss details of the proposed designs. We had two lengthy sessions last fall.

The Republicans claim there has been a lack of transparency and trust and throw around terms like lies and deception because they were not informed about an incomplete, low-ball design bid, and squandering money to pay for site evaluation. The money spent already has given us valuable information: complete soil assessment, wetlands mapping, geo-borings, and archeology testing of the entire county property. The County Administrator has been completely open with the delegation about costs, financial projections, and proposals.

Plans were set back when the above studies indicated the initial site would be unsuitable. It’s true that at times the process seemed rushed. There was much effort to get a proposal funded and underway to obtain the $15 million in ARPA funding to meet a deadline imposed by the governor’s GOPHER committee. Because of Republican obstructionism, we failed to proceed with approving the bond and lost that ARPA money. They continue to insist upon an arbitrary low overall building cost, are fixed on one nursing home model (Carroll County), and demand to chair the project subcommittee despite being the minority party of the delegation.

The Democratic caucus has taken the approach of 1) accept the overall concept that we need a new nursing home, 2) approve the bond so we might move forward, and 3) continue to work with the architects, public, and commissioners on the best plan to build meet CMS guidelines and standards of care that maximizes staff efficiency and contains costs, 4) wait to actually issue the bonds after these plans are approved by the delegation. The ARPA funds are gone, and we are back to the drawing board with plans but at least we now have specific information about where and exactly how big the footprint of the new facility can be. We can move forward if the Republican delegation were to have a more open mind to accept that figures provided about building costs in this day and age and revenue projections are real not made-up numbers. And that our mandate is not to build a “poor house” but a quality facility that we all might need. We have complete confidence that the County Administrator and Commissioners will apply for any federal and state funds to support this project to limit the cost to taxpayers. Like building the new county jail over a decade ago, they will deliver.

Democratic Representatives Jessica LaMontagne (Dover), Allan Howland (Durham), and Chuck Grassie (Rochester) are members of the Strafford County Delegation.

This article originally appeared on Portsmouth Herald: Commentary: Moving forward for a new Strafford County nursing home