'They just pushed us out.' 32 seniors forced to find new place to live after nursing home closes.

MINDEN - A few days after Christmas, George Piester was told that by the end of February the place he called home for more three years - Hinterlong Living for Seniors - would be shutting down.

"I asked him, (Kearney County Health Services CEO Luke Poore) 'Why?' And he said, 'Losing too much money.' If you are losing money in a place like this, the one thing to do is raise the rate. Raise your rate, but they didn't do that. They just pushed us out," said the 98-year-old Piester, who said Poore visited residents' rooms to make the announcement.

When Maye Dorn, 95, found out the Minden assisted living facility was closing, she wondered if she would have anywhere to go.

"That was what she said to me, 'I don't have a place to go. Will I be kicked out?'" said Dorn's daughter, Gara Hansen. "I told her, 'If worse comes to worse you can come and live with me.' It was just kind of unnerving for her."

Piester and Dorn are two of 32 residents who were living in Hinterlong Living for Seniors and Countryside Living Nursing Home when the Kearney County Health Services Board of Trustees made the decision in early January to shut down both facilities in Minden.

Piester is the last of 11 residents living at Hinterlong.

He has lived in Minden for 72 years.

Piester owned and operated two businesses in the community, and he was the city's mayor from 1994 to 2002. Photos and plaques still adorn Piester's walls at his Hinterlong residence.

The long hallway lined with doors is quiet as Piester makes his way to the lobby. He greets the staff, and heartily shakes Charles Phillips' hand when he learns it is Phillips' last day working at Kearney County Health Services.

"I hate to see you go. It's been a pleasure," Piester said to Phillips, who worked in maintenance at the hospital, medical clinic, assisted living and nursing home facilities.

Piester said he wasn't quite ready to move into an assisted living community when he took up residence at Hinterlong three and a half years ago, but now he isn't ready to leave.

"I hate to give it up. It's a lovely place. People were happy, and they were home," Piester said.

Reimbursements fall short

One of the major problems Minden faced was the cost-base reimbursement methodolgy for Medicare and Medicaid for a Critical Access Hospital, said KCHS CEO Luke Poore. Critical Access Hospital is a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services.

"They consider certain services essential for that methodology, and you could call it nonessentials as well. They don't acknowledge nursing home and assisted living services as services under the Critical Access Hospital reimbursement model. So they are not cost-based. Over time, we have seen the cost of care increase and we have seen (Medicare and Medicaid) revenues decrease," he explained. "It was nothing we had seen in just the last 18 months. This is something that goes back ... we looked back five years when we did our initial review of this, and we had seen substantial losses go from hundreds of thousands of dollars to north of a million dollars in the last three combined. When you look at those substantial negative impacts from a cost report perspective, we knew that we had to make a decision and not a fun one."

The board of trustees was told for the past several years during their annual audit that the Critical Access model wasn't conducive to running a nursing home and assisted living facility, Poore said. Because the board considered the facilities such a valuable asset to the community, they tried to sustain it for as long as possible.

"It wasn't only until the last couple of years that it started to come to a head that it had to be addressed. There wasn't a whole lot of action we could take that would change it because at what point do you start cutting staff, and taking away from patient care or resident care and taking away from the needs of residents? We are not about that here. We wanted to make sure that we can continue to operate and deliver a high-level quality of care," Poore said.

In order to avoid high costs on temporary agency staffing, the facilities made a push to recruit staff and made significant gains in their staffing. In spring 2016, Countryside had 15-20 employees, and by the end of 2017, there were almost 50 people employed there. Yet, KCHS often found themselves competing against larger communities for staff and residents.

"It was just more of an occupancy, having more numbers to cover your cost. I wish that wasn't the way it was. It's nice to have everything under one roof, provide those lower volumes of care, more personalized. The families really enjoy it. Our staff really enjoys it. It's just not really effective with the way we are reimbursed," Poore said.

Trend across Nebraska

When it comes to the closure of assisted living and nursing home facilities in Nebraska, Minden isn't alone.

In the past three years, 25 skilled nursing and assisted living facilities statewide have closed due to inadequate funding for cost of care, according to Seniors Speak Nebraska, a statewide campaign to raise awareness of the increasing needs of the growing senior population. The Nebraska Health Care Association and Leading Age Nebraska cosponsor the website - seniorsspeakne.org.

"We are seeing struggling facilities, especially those facilities that have a higher Medicaid population. Medicaid reimbursement tends to not cover the cost of care," said Cindy Kadavy, senior vice president of Nebraska Health Care Association. "Nursing facilities face a number of pressures. Like any other profession, they struggle for workforce. There is a growing older population but not really followed by the younger population to take care of them. There is a lot of competiton for jobs. Nursing homes have to pay higher wages to try to recruit people."

In Nebraska, 53 percent of nursing facility residents and 25 percent of assisted living residents rely on Medicaid to pay for their care, Kadavy said.

"The trend that we are seeing as people age, they are wanting to stay more in their home and have services in their home. When they are actually ready to move to the nursing home, they are a lot sicker and a lot frailer, and they may have depleted their resources by then," she explained.

Tim Groshans of Senior Insight and Quality Care Solutions of Aurora said establishing an efficient business model is crucial for profitable operations at skilled nursing and assisted living facilities. Temporary agency staffing can cause a drain on finances, and lack of knowledge of how to run these facilities can lead to a breakdown in the system.

"It's a very complex business model. You have to know what you are doing or you are not going to make it," Groshans said.

Kadavy said many nursing homes have faced closure in Nebraska, but two out of the four nursing homes that closed in 2015 have reopened. Logan Valley Manor Care Center in Lyons reopened as Lyons Living Center and Ainsworth Care Center of Ainsworth reopened as Sandhills Care Center.

Hamilton Manor in Aurora was a facility that was facing closure, but 17 members in the community came together to privatize the skilled nursing facility. After the second month of private ownership, the facility was operating in the black, and they began working on building a new, 64-bed skilled nursing facility.

Kirk Penner, an investor in the Aurora facility and vice president of Penner Patient Care, said, "We gathered private investors together and built a brand new nursing home. We bought the bed licenses from the county. By hiring the right people, the right managers, the right administrators, you don't have to lose money in the long-term care industry. You can turn a profit."

Community outrage

Members of the KCHS board, which is comprised of five members who are appointed by the Kearney County Board of Supervisors, made the decision to move forward with closing the two facilities following a meeting Dec. 27.

The decision came as a surprise to many employees, residents and their families.

Phillips, a facilities' maintenance man, said, "It was stunning. Two days after Christmas. It was a real shock. We had no hint. We didn't know anything was coming."

Polly Worley's father, James Philpot, was a resident at Hinterlong for nine months, and she remembers the exact moment she got the news of the home's closure.

"It happened on Dec. 28 at 3:45 p.m. It was fury at the moment. We put up a little bit of a fight as we could with a town hall meeting. Senator (John) Kuehn was awesome in helping us put that together, making them have an emergency board meeting," she said. "We were hurt. We were furious. We do not think protocol was followed."

Piester said, "The closing of it was terrible because there was no reason for it. They were losing money. If you are losing money, you do something about it. You raise the price."

A town hall meeting was conducted Jan. 3 where family members and citizens expressed their concerns and desires to try to keep the facilities open. Worley said she contacted the state auditor's office to request an audit for the facilities, but she never got any answers. A second meeting was held Jan. 5 where community members continued to voice their greivances about the short notice of the closure and the disruption it caused to the residents' lives. Many pleaded with the board to postpone the vote so they could find another solution other than closure.

At the Jan. 5 meeting, KCHS Board Member Jeff Hanson, said, "I also would say that it was our intent to limit the exposure and protect our facility, residents and staff. There was no way any attempt to mislead or stay secretive. We, as a board, will learn from this and be as transparent as we can be to do our job effectively while keeping the facility, patients and staff in mind."

For many, like Phillips, it felt as if the board already had made their decision before the vote on Jan. 5.

"It's kind of like somebody cutting down your tree in your front yard and coming back and asking if you wanted it cut down. Well, it's already cut down," he said.

On Jan. 5, the board voted to close the facilities.

Poore said the board extended the closure date from Feb. 28, 2018, to April 30, 2018, and every resident has a discharge location. Ninety-five percent of the residents chose to move to Bethany Home in Minden, but some are waiting to move to the facility next month when the home's $8 million renovation is completed. Bethany also had 10-12 job openings that some of the KCHS staff have been able to fill.

Since making the decision to close Hinterlong and Countryside, the board wanted to focus on taking care of the residents and staff. They have not discussed what they plan to do with the two facilities.

"When we get to this summer, we will likely come to visit that and talk about what our options are as far as time, as far as financing and perspectives of that square footage. We don't have any intent of letting it sit. It's a beautiful building and it's good square feet. We definitely want to use all that we can," Poore said.

Looking to the future

Maye Dorn moved from Hinterlong to Bethany last month. When Dorn moved to Hinterlong two and a half years ago, she planned for it to be her final move. Now, she is adjusting to living in a different and much larger facility.

Hansen, her daughter, said, "The move has been hard on her. It has caused confusion. She's not quite up-to-speed yet." She still is adjusting and getting her bearings at Bethany.

"It's just been kind of a hard three months. We are glad that there was a facility that was here. I think Bethany is working hard to accommodate because they know it isn't easy on older people," Hansen said. "It would have been good to have more time to move or accommodate."

Philpot made the move from Hinterlong to Bethany this week, and they were trying to make the best of the situation, said Worley, his daughter.

"It's tough. He's not angry, but he is not wanting to leave. He is probably more toward the sad side of it. Jennifer (Bauer), they made it family," she said. Bauer is the living director at Hinterlong.

As for Piester, Minden's former mayor, he isn't sure if he will continue to stay in the city he's called home all these years. He is eighth on the list for a room in the assisted living unit at Bethany, but he still is deciding whether he wants to take it or move to a residence in Hastings.

"I may just pull up stakes and finally leave Minden," he said.

ashley.bebensee@kearneyhub.com