Vashon Community Care is facing a challenging financial picture, due to state budget cuts that have lowered Medicaid reimbursement rates for some of its residents at a time of unexpected increases in a variety of its expenses, according to two top officials at the center.

Further complicating the center’s financial situation is that the most recent Medicaid cuts, which took effect July 1, came on the heels of difficult budget cuts in recent years. They’re also seen as a harbinger of more to come, VCC officials note, as the state and nation grapple with a depressed economy, an ailing health care system and an aging population. 

“We’re working hard to continue finding ways to do what we do in this climate,” said Lynn Davison the president of the board at Vashon Community Care (VCC). “And do it better,” added Janelle Ansell, the administrator there since January.

Vashon Community Care is the Island’s largest long-term care facility — offering 30 beds in its skilled nursing facility, 39 apartments in its assisted living center, Aspiri Gardens, an adult day program, a new rehabilitation program and other community services.

In a recent interview, Davison and Ansell said the financial challenges have created opportunities for those affliliated with the center to examine its programs and procedures to see what they might do differently to stretch their limited dollars while maintaining a high quality of care. Staff have brought creativity and determination to they problem, the two women said, and while some changes have positive effects, others, such as reducing staff hours and eliminating a position of a valued employee, have been difficult.

Early this year, staff and board were braced for an across-the-board 20 percent cut in Medicaid reimbursement rates. Then, as the Legislature worked on the budget this spring, Ansell said they were expecting a 7.3 percent cut in Medicaid reimbursement rates in its assisted living facility and a 13 percent cut in those rates in the skilled nursing facility. 

Just recently, however, Ansell learned that while the cut to assisted living reimbursement still stands for the center, it has been spared the cuts to skilled nursing, partially because of its designation as a rural care facility.

“It’s a much better picture, Ansell said, “but it is not a rosy picture.”

Indeed, the new Medicaid reimbursement rates for those in the assisted living program will have a big impact on VCC: Only 49 percent of VCC’s costs of providing services to those on Medicaid will now be covered, Ansell said.

This cut comes at a time of other difficulties for the program, which has been struggling with vacancies in the last few years. Lower occupancy rates are part of an industry-wide problem, Davison said, attributed to the deep dip in the real estate market and seniors reluctant to sell their homes at such a time.

To address this trend and fill a need on the Island, VCC officials have elected to increase the number of assisted living residents it takes with Medicaid, upping the number from the previous 30 percent to 40 percent, Davison said. VCC staff are also considering broadening its assisted living services — already high by industry standards — to increase the number of residents there and allow them to be as independent as possible. 

Staff and board also plan to beef up their marketing and outreach efforts to ensure that Islanders fully understand what VCC offers.

“You’ve got to be a good business if you’re a nonprofit to meet your mission,” Davison said.

Other changes in the Medicaid system this year have placed additional strains on VCC’s coffers. Until recently, Medicaid covered the costs of hearing aids, dental services and eyeglasses for Medicaid residents of care facilities. It no longer does, but the centers are still obligated to make sure those needs are met. The lack of government funding for those needed services is “another way the reimbursement system is undercutting good care,” Ansell said.

Many long-term care facilities limit the number of Medicaid residents they accept, but at VCC, accessibility is a cornerstone of the program, and there is no such limit. In its nursing home, which routinely runs at or near capacity, it is common for many residents to be covered by Medicaid, which, under the current budget, is slated to cover only 79 percent of the cost of their care, Ansell said.

Furthering the financial challenges are other unexpectedly high costs — from an increase in health insurance for staff to higher than projected costs for an employment agency that provides certified nursing assistants (CNAs) when needed.

A change in staffing patterns and a stepped-up effort to increase the number of local CNAs — visible simply by driving by and seeing the multitude of signs — will decrease the reliance on the staffing agency and create a more unified team, Ansell said.

While that is a partial solution with positive ripple effects, changes at Break Time, the adult day program, are the opposite. The census is down in that program, which was losing quite a bit of money, Davison said. As a result, it will be reduced from four days a week to three, making it necessary to layoff a staff member, something Ansell said was “hugely painful.” 

In an effort to serve a need on the Island while also bringing in revenue, VCC has decided to more fully implement a rehabilitation program it began as a pilot program some 18 months ago.

The program, with staff now in place, can serve people with a wide range of medical needs, Ansell said, from patients recovering from hip replacement surgery to strokes. Physical, speech and occupation therapies are all offered. Ansell does not expect the program to be profitable this year but hopes it will be by next year.  

In addtion to bringing in much-needed revenue, the program is expected to benefit many Islanders.

 “It’s really challenging for families to go off Island,” Ansell said. “For people to come home (to Vashon), that’s priceless.”

Meanwhile, Ansell and Davison noted, the community has stepped up to counter the effects of these financially difficult times. The board set its fundraising goal at $250,000 last year and met it. It has set the same goal for this year, Davison said. VCC also welcomes people’s time and talent, whether it be serving on the board when vacancies arise, helping with marketing, delivering meals to residents in assisted living or working in VCC’s gardens.

Despite the challenges, staff and board remain committed to quality, resident-centered care, both Ansell and Davison stressed.

“Our goal is to have a well- run, responsible business and broaden our serviecs so that we can meet a broader level of community needs,” Ansell said.

“Everybody has their eyes on the same prize,” Davison said.