Summary of Nursing Home Administrators’ Survey
To assess viability,sustainability, and operating procedures of nursing homes with 50 or less skilled beds, a survey (by the Citizens To Save Golden Manor) was sent to 29 of the 35 other facilities in North Dakota. The other six facilities which were not surveyed included specialized facilities connected to large hospitals and Golden Manor in Steele. The surveys were sent the administrator of the nursing facility and 15 other of the administrators returned the surveys and two when called responded by phone for a rate of 52%.
When asked if they foresaw their facility remaining viable for the next 5 to 10 years or longer, 13 of the 15 administrators responded yes and 2 said they were unsure. Thus, 87 of the respondents fully expect their particular facility will be operating in future years. 13 of the 15 facilities reported they were non-profit organizations. 6 reported being independently operated, 3 stated they were part of a chain, 1 reported being a state run facility, and 5 did not respond to the question.
When asked if the facility was operating “in the black”, 69% indicated they were presently operating in the black while 23% indicated they were operating in the red and one of the administrators chose not to respond to the question. 4 of the administrators indicated that they also use supplemental income in the form of donations, gifts, grants, and fundraising events to update or buy additional equipment. When asked if the facility was able to maintain an occupancy rate of 90% or better 69% indicated their facility was able to keep their census at that level while 31% of the administrators indicated that they were operating at an occupancy rate of 89% or less. Obviously, the key to operating in the black is maintaining an occupancy rate of 90% or better since that is the occupancy rate required for full reimbursement from the state of North Dakota. When asked if their facilities had a waiting list, only 5 indicated that they had a waiting list with 2 or 4 people on the waiting list. Several of the administrators mentioned the stress that comes with trying to manage a facility when the census drops below 90% level and just how unpredictably and quickly it can happen.
When asked about staffing problems, most indicated finding adequate nursing staff was a chronic problem with a shortage of CNA’s being the most critical need. To remedy staffing shortages, the administrators mentioned the fallowing remedies:
Paying a premium such as $3-$5 per for overtime
Bonuses for picking up extra shifts
Providing referral bonuses
Higher pay on week ends
A flex position for on-call hours who must work a minimum of 3 shifts p/month
Paying $30 an hour for casuals
Using contract nurses (very expensive)
Using a higher wage rate for call in pay
Paying a higher shift differential rate
When asked if their facility provided benefits, 92% of the administrators indicated that their facility offered benefits with health insurance being the most common benefit listed. Other benefits that some of the facilities provided are: dental insurance, life insurance, disability insurance, AFLAC, sick leave, paid time off, vacation time, retirement, day care, education/CEU training.
Because of the wording of the question in regards to cooperatives and outsourcing, there was some confusion as to what was meant by the terms cooperative and outsourcing. For example, 5 of the facilities are managed by Good Samaritan Society and likewise several of the facilities are a part of a medical complex. However, 8 of the administrators said they were part of a cooperative. The copperative efforts mentioned were sharing an administrator, purchasing supplies, and sharing of dietary and laundry staff, and specialists such as physical therapists, doctors and social workers. In regards to outsourcing, 4 indicated that they used some outsource services such as payroll and accounting. More exploration and a rewording of the question would have to be completed before any definite answers could be accessed.
Finally in regards to whether we should expect to pay between $70,00 and $80,00 for administrator, 1 administrator thought the figure was too low, 7 thought the figure was accurate, 4 thought it was too high and 3 chose not to respond to the question.
The results of the survey indicate that it is possible to profitably operate a 50-bed or less nursing facility. It is interesting to note that the majority of the facilities (13/15) in the survey are non-profit organization. The key to operating at a profit margin is to maintain an occupancy rate of 90% or greater in order to receive full-reimbursement from the sate. Staffing problems are another issue of concern with a shortage of CNA ’s being a universal problem. Although there was some confusion about the terms cooperative and outsourcing, it appears as if most of the facilities have not formed cooperatives nor do they outsource many of their services or operations. The exception being facilities not only in North Dakota, but other states as well. Corporate offices for Good Samaritan provide the same soft ware to all their facilities and manage the financials for each facility. Those facilities that have cooperative arrangements mentioned the sharing of being cost effective. In regards to hiring of an administrator the range of $70,00 to $80,00 seems to be realistic.