A timeline or plan for the potential reopening of in-patient service at Close to Home Hospitality House is slow to materialize about nine months after the facility was quietly shut down last year.
But the Close to Home Task Force — consisting of hospital board trustees, administrators and members of the Campbell County Healthcare Foundation — is collaborating to determine what the most sustainable plan for reinstating the services may be, as well as how much financial loss CCH and the Foundation can absorb.
Last week, CCH CFO Mary Lou Tate presented a detailed breakdown of the finances behind Close to Home inpatient services, outpatient hospice services and other national trends to the task force.
Each of the past five fiscal years, the facility lost significant money on its inpatient services, suggesting that to reopen it would mean eating continued losses or exploring a different business plan that would minimize those losses.
In fiscal year 2016, Close to Home had a net loss of $801,012, according to CCH data.
The next year saw a $554,643 loss followed by $329,281, $776,546 and $673,923 losses through fiscal year 2020.
A primary reason for the outsized losses is staffing and average daily census. The facility requires similar staffing regardless of how many of its six beds are occupied. Even with six patients at minimal staffing, Tate said Close to Home would still lose money.
“We cannot break even on inpatient hospice,” she said. “Not even break even.”
In fiscal year 2017 when the Hospice House had a 5.42 average daily census, its highest in the past five years, the facility still lost $554,643.
“We’re asked to be fiscally responsible for all service lines,” Tate said to the task force. “I know you think we’re picking on you, but we’re not. There are a lot of service lines under scrutiny right now to reduce their losses too.”
The elephant in the room
At this point, CCH administrators and the Healthcare Foundation seem aware that almost any plan to reopen Close to Home will be at an operational loss, and whatever that operational loss is will have to be split in some manner between the organizations.
But how much each side is willing to accept is the big question that neither has answered.
“Can I ask the question that probably everybody in the room wants to know?” said foundation member Emily Arthun. “What’s the acceptable number to keep Hospice House open?
“That’s what we’re all in this room for. If there’s not a number, if there’s always going to be a loss, what’s the acceptable loss number for the hospital to continue to support Hospice House?”
The answer to that potentially expensive question went unanswered at the meeting as members of the task force talked around the matter and decided to have a more solid loss projection before throwing out specific dollar amounts for CCH and the foundation.
“Both sides have been waiting for the other side to make a move,” Tate said about putting a figure to the question.
For example, she said if the task force were to agree on a 50/50 split — where the foundation pays half the net loss and CCH covers the rest — the hospital board of trustees would still have to approve that.
“Really looking at it, can the foundation raise $350,000 a year to cover half the loss?” she said.
Before going to the hospital trustees, the task force is returning to the drawing board to devise a plan that could offer a hybrid model, where Close to Home continues to offer inpatient hospice care while also offering other care and services to reduce its loss.
Finding a plan
Kurt Kazanowski of Hospice Advisors compiled a report for CCH that assesses Close to Home and its business model. He offered an alternative plan for how it could reopen in a more financially sustainable manner.
The report, commissioned by CCH earlier this year, determined that Close to Home could run on an altered business model and cut its expected losses to about $170,000 a year. At the time, Tate said that the altered model would more likely yield $300,000 in losses.
Most simply put, the suggested business model would integrate other types of care and more overall patients into Close to Home to hopefully bring more revenue and reduce staffing expenses.
If true, that would still be a significant amount for CCH and the Foundation to haggle over, but less than half what the current $700,000 loss projections are.
“I know there’s a lot of emotion and a lot of ties to this too, but from a finance point, we’re going to spend $700,000 on 57 patients,” Tate said. “As a community, are we willing as a community to spend $700,000 on 57 patients?”
Home Health Hospice Director Ashley Montague described Kazanowski’s proposal as “a model to minimize the RN (registered nurse) involvement in the Hospice House.”
“It can be done, but would also minimize the types of patients that we can serve and have served historically,” Montague said. “From my perspective, knowing community concern, if we open the Hospice House again, and all of a sudden, operationally, I will not be able to accept certain patients, and those patients would have to go to Legacy.”
Higher acuity patients, such as cancer patients, would most likely be the ones unable to use Close to Home, she said.
When asked if then Legacy patients could be effectively swapped into Close to Home, CCH Chief Operating Officer Jerry Klein said that would be counterintuitive for the organization.
“You’re robbing Peter to pay Paul,” he said.
As much as the shuttering of Close to Home was done with CCH’s bottom line in mind, an organizational staffing struggle helped make the decision last year. In the time since, staffing shortages have continued to be an issue.
“We want to get this open, but our biggest obstacle is not only financial, it’s staffing,” said trustee Lisa Harry. “We simply don’t even know how we’re going to staff our service lines that are already in place.”
Klein said that more staffing could give CCH more creative flexibility with its workforce, but that it is too short-staffed to consider that route realistically. For example, rotating nurses throughout the organization is not an option now, especially given the shortage of nurses the Legacy is already experiencing.
“We’re in a staffing crisis throughout the whole facility because we just don’t have enough nurses,” Tate said.
With another meeting planned for Tuesday and comprehensive data on the inpatient and outpatient hospice services, the foundation is there for the task force to weigh its options, review possible plans, then decide to reopen Close to Home or not. But the timeline remains unclear.
“It’s going to take time,” Stuber said. “This is a huge financial responsibility that not only the people in this room, but the community is going to have to lean on.”
The soonest a decision could come would be this summer, but it may take longer than that. If a plan — and a price — is agreed upon, the timeline extends from there. Just finding new staff to provide the inpatient care could take four to six months, Tate said.
The task force decided to meet again Tuesday night, to rehash the consultant’s proposal and make headway toward a sustainable business model that could potentially put patients back inside the Hospice House.
“It’s been sobering,” said Campbell County Healthcare Foundation Executive Director Nachelle McGrath. “Sobering for all of us to learn this. I wish this could have been brought to our attention 18 months ago, when there were issues, when there were concerns, because it’s much easier to problem-solve when something is operating than when it’s shut down and closed, and it’s much more difficult to open it back up.”
Campbell County voters will decide Aug. 17 whether they want Gillette College to become its own community college district. If approved, a board of seven trustees, who will be elected in that special election, will get to set a tax to help fund the district.
Commissioner Del Shelstad has suggested dissolving a couple of special districts and using their mill levies to fund the college. He floated this idea on Facebook earlier this month, and it has been met with criticism from other entities involved.
He wanted to find a way for Gillette College to get a mill levy without increasing the tax burden on local industry. He said that while he supports the college becoming its own district and having local control, he does not like the additional tax that would come with it.
“Let’s get rid of the cemetery district and fund it jointly through the county and the city (of Gillette),” Shelstad wrote. “This would save the tax payers 3 mills.”
Cemetery districts are allowed to levy up to 3 mills. The Campbell County Cemetery District has regularly kept its under 1 mill.
He also suggested selling the hospital to the highest bidder.
“A large hospital corporation would turn our hospital around for the better for our community. This would save an additional 3 mills,” Shelstad wrote, referring to the tax Campbell County Health assesses each year.
He suggested adding the dissolution of the cemetery and hospital districts to the ballot for the special election in August.
“It may not be the best plan, but for my money at least, I have come to the table with something outside of just raising the mil levy an additional 4 mills,” he wrote.
Unsurprisingly, Shelstad’s idea does not sit well with those in the cemetery district.
“He continues to create and fabricate this fantasy of his, and we’ve never understood why, but that’s what he does,” said Jim Hastings, president of the Campbell County Cemetery District board.
Difficult to dissolve
Darin Edmonds, the district’s sexton, said dissolving a special district “is difficult at best,” and that it’s “not a realistic hypothetical possibility” in this situation.
The dissolution of a special cemetery district is governed by the Special District Elections Act. To initiate the process, there must be a petition signed by 25% of the voters who own at least 25% of the assessed valuation of property within the district.
It’s that second requirement — 25% of the assessed valuation — that makes it nearly impossible, Edmonds said.
“Every human being in Campbell County that’s a voter wouldn’t own 25% (combined),” he said, adding that’s because “86% of everything that’s valued here is underground. It’s not owned by a person.”
Commissioners do have the power to begin the dissolution process, but only if the district fails to elect district directors, if the area is not inhabited or if the district fails to comply with department of audit reporting requirements. Once the process has begun, a report must be prepared that identifies how the district’s assets would be handled. Only then can it go to an election.
Josh McGrath, chairman of the Our Community Our College PAC, wrote a letter to the editor in response to Shelstad’s post, saying that an independent college district can exist alongside other county services.
“With great respect to County Commissioner Del Shelstad and his service to our community, residents DO NOT need to cut funding to other key community resources to support an independent Gillette College,” McGrath wrote.
The election is about building a stronger community, not about cutting funding, McGrath added.
Edmonds said dissolving the cemetery district would not save local taxpayers 3 mills.
“It would save the taxpayers 0.9 mills. The other 2.1 are not assessed,” he said, adding that it’s impossible to take a special district’s mills and give it to another entity.
“If the cemetery district doesn’t have (the mill levy), no one has it,” he said.
Hastings said he hasn’t heard from anyone, other than Shelstad, about this issue.
“There’s hardly any discussion, and it’s all created by the misinformation that Del Shelstad continues to publish,” Hastings said. “He doesn’t want the truth, he wants his story.”
Shelstad suggested dissolving the cemetery district and funding it with the city through a joint powers board, similar to Cam-plex and the Campbell County Fire Department. This would require both entities to increase their budgets, Edmonds said.
“I don’t know that the city and county have a whole extra amount of money,” he said.
Commissioner Colleen Faber said she doesn’t think a joint powers cemetery board would be possible. Among the largest challenges would be figuring out how to divide the finances between the city and county. Mount Pisgah, by far the biggest and most costly cemetery, is within city limits. But there are several other cemeteries that are out in the county.
Shelstad also said that in researching state statute, commissioners have the right to veto line items in special district budgets.
“Rather than bring it to the people that we get rid of the cemetery district, maybe we start scrutinizing all of our districts more,” he said.
Edmonds said this is “simply not true.” Commissioners can only do that for special districts that they appoint board members for, such as the Weed and Pest District.
Shelstad said that when he first became a commissioner, he heard about the cemetery district and its reserve account. He put that in the back of his mind, but recently started looking more closely at it when he realized that more than half of the district’s mill levy goes toward reserves.
The cemetery’s FY2021 budget was about $4.5 million and about $3.5 million of that came from the mill levy, which was at 0.86 mills.
Of the money raised by the mill levy, $1.464 million went toward operating costs, while $1.955 million went toward the district’s reserve account. In FY20, $2.15 million of the levy’s $4.16 million was set aside for reserves.
“If you’ve got already $50 million in reserves, why do you keep assessing part of your mill levy for your savings account?” he asked.
Edmonds said the cemetery district has about $29.2 million in reserves, and a little more than half of that is set aside for the construction of Mount Nebo, the cemetery that will be built for when Mount Pisgah reaches full capacity.
There also are reserve accounts for emergency costs, the maintenance of the district’s water system and beautification.
Faber also questioned the amount in these accounts. She wondered if the district is at “a point where they don’t need to put money in reserves.”
“That’s where I’d ask the cemetery board take a close look at if they really need to be doing that,” Faber said.
Even though the district levies less than a third of what it’s allowed, it could levy about half a mill if it didn’t put anything into reserves. And with the fossil fuel industry struggling, that would be a welcome change, Faber said.
“Every time we raise mills, it impacts coal, oil and gas,” she said. “We’re just at a time now where it’s really important.”
Edmonds said the cemetery district invests money to earn income off of the interest. It’s following in the footsteps of the city and county.
“We modeled our approach after them,” Edmonds said. “They’re also forever entities, they don’t go paycheck to paycheck, fiscal year to fiscal year. They have to do things forever. Ours is no different.”
“Why is it that the cemetery district is the only entity that Del thinks shouldn’t have reserves?” Hastings asked.
Mount Nebo will be an expensive project. In 2018, it was estimated that to build it all at once would cost between $40 million and $54 million.
“We can do it with a plan like this, done over decades, or we can wait until we need the cemetery and hope the public will approve a bond issue, that we have to pay interest on, instead of earn interest on,” Hastings said.
Shelstad often uses Facebook as a platform to engage with people and get their feelings on various issues. He said he’s gotten mostly positive feedback on this latest idea, and that people have thanked him for “thinking outside the box, coming up with at least something.”
“I don’t look at it as causing trouble,” he added.
Shelstad said he was just trying to start a discussion on different ways to fund the college without more taxes. He knew it would raise some eyebrows.
“I thought my idea was probably about as radical as you could be,” he said. “I did that on purpose, because that’s how I think the conversation should start.”
He said he hoped to “massage” it down to a more workable solution.
“He has never called any of the board members, as far as I know. He’s never come into a meeting, never come into the office and asked for information,” Hastings said.
Edmonds said situations and debates like these just come with the territory.
“If you’re a public entity, you’re subject to scrutiny,” he said.
But he added that Shelstad’s idea feels like the cemetery is being singled out, and “that’s one of the things the trustees find so irritating.
“Why are they (the commissioners) picking on us? It’s more like a playground bully.”
A man who fired three shots into a nearby apartment, hitting one person in the head, because he saw people with “glowing eyes” last August will serve eight to 13 years in prison.
Zachary Manning, 34, had pleaded guilty to one count of attempted manslaughter, and he was sentenced Thursday afternoon by District Judge Thomas W. Rumpke.
Manning will receive credit for 313 days served.
On Aug. 2, Manning fired three shots from his custom Olympic Arms AR-15 after he saw people with glowing eyes and thought a neighboring apartment building was being invaded. He said cars had shown up and appeared to be surrounding the apartment. He got out his AR, loaded it and waited on the balcony in a prone position, according to an affidavit of probable cause.
Manning had been hallucinating due to a mixture of alcohol and prescription drugs, said his public defender, Jefferson Coombs.
On the night before the shooting, Manning was experiencing withdrawal symptoms after trying to quit alcohol cold turkey, Coombs said. He was sweating and had nausea and an irregular heartbeat. He was taken to the hospital and was prescribed Lorazepam.
The hospital’s discharge form for Manning told him to take the prescription medication for four days, and that he “should never drink alcohol again,” Coombs said.
But Manning took the pills and drank alcohol, and he started to hallucinate.
“It looked like they were kidnapping people and before they started pulling people out, it seemed like all the cars had hooked to the houses and was trying to pull them (off) their foundations,” he told police, according to court documents.
He said police arrived “and at least two to three people had come running out of the house, their eyes were glowing and they fell. They presented a shot, and I took it,” according to the affidavit.
The victim, a 22-year-old, told police that he and his girlfriend were in their apartment at about 10 p.m. when they heard a gunshot and went outside to investigate. A neighbor pointed toward Manning’s balcony.
The two went back inside and heard another gunshot. The victim felt himself get hit. Then they heard another shot fired through their front door, according to the affidavit.
The victim’s wound required stitches on the left side of the head.
At the sentencing, Manning’s cousin, Julie Manning, said Zachary had a tough childhood. Both of his parents were alcoholics and divorced when he was young, and he and his siblings were subject to long custody battles.
But he was able to overcome this and get an associate’s degree and serve in the U.S. Army, from which he was honorably discharged.
His aunt, Karen Tuttle, said this situation was out of character for Manning, and that he’s a caring, helpful person who has always wanted to do good.
Julie Manning said her cousin would “benefit greatly” from Adult Treatment Court and was disappointed when she learned he was not a candidate for that program. She also worried about the negative effects prison would have on him.
Coombs said Manning took responsibility for his actions when it would have been “so easy for him to not do that.” He did not want to go the route of pleading not guilty using mental illness or intoxication as a defense.
And Julie Manning said Zachary refused to let his family hire an attorney to defend him.
Coombs asked Rumpke to sentence Manning to 7-10 years or 8-11 years in prison. Prosecuting attorney Nathan Henkes recommended a 10- to 13-year sentence.
Henkes said that in the moment when Manning pulled the trigger, his “intent was to kill a human being.”
While Manning “appears to have learned his lesson,” Henkes said the sentence needs to be harsh enough to deter other people from firing shots in crowded residential areas.
Rumpke commended Manning for accepting responsibility for the crime, but said the seriousness of his actions, which were “calculated and purposeful,” weighed heavily in his decision.
“But for the grace of God, this case doesn’t involve a corpse,” Rumpke said.