Wausau Daily Herald, WI

By Jonathan Gneiser, for the Wausau Daily Herald

Traditional nursing homes could be phased out in favor of true rehabilitation centers
and smaller apartment-like assisted living facilities if the state follows a
recommendation from a panel examining the industry in Wisconsin.

Local nursing homes have been moving away from providing traditional services for years, long before the state's Board on Aging and Long Term Care recommended long-term care reform.

At the top of a list of recommendations that the board made to Gov. Jim Doyle and state lawmakers is refocusing nursing home care on rehabilitation efforts.

It's cheaper for the state to pay for long-term care in private homes and
community-based residential facilities than to fund round-the-clock care in a nursing
home. The Long Term Care Board recommends moving more state money to in-home care, which eventually would mean many nursing homes would close.
To survive, nursing homes will have to make changes in their services, area directors
say.

"If you were all long-term care on medical assistance, you'd be out of business," said
Greg Loeser, administrator of the Iola Nursing Home. "You need private-pay, private
insurance and Medicare to sustain your business." The nonprofit facility's marketing strategy in recent years has been recruiting rehabilitation patients. The change was necessary just to break even.

Medicaid clients represent about 70 percent of Wisconsin nursing home residents, said
Bruce Roesler, administrator at Riverview Manor in Wisconsin Rapids.

The cost of caring for a resident on Medicare is about $130 a day at Iola Nursing Home, but Medicare only pays $110, Loeser said. People who pay their own money, or private-pay clients, are charged $145.

"There's such a large percentage on medical assistance, we can't charge the private-pay $200 to make up that shortfall," Loeser said.

Both the rehabilitation wing and the nursing home wing of Kennedy Park Medical and
Rehabilitation Center in Weston are flourishing, said registered nurse Nicole Rakovec.

Despite the growing trend in using assisted living facilities, Rakovec said nursing
homes always will be needed.

"I see nursing homes still thriving 20 years from now," she said.

Nursing home funding has reached a critical point, the board said. The gap between
Medicaid payments and private-pay is increasing each year, according to the report.
Facilities can't break even - much less make a profit - when patients stay indefinitely.

A new Madison-based group, Council for Long Term Care Reform, has been created to
address the issues presented by the board, said Judith Frye, associate administrator for the state's Division of Disability and Elder Services.

- Wausau Daily Herald reporter Elizabeth Putnam contributed to this report.