Reflections: Keeping Berks Heim in county hands is a daunting proposition

The future of Berks Heim is being awaited with plenty of hyperventilation and trepidation.

Will the county, because of costs geysering like a natural hot spring, have to sell the nursing home to a nonprofit?

If the county commissioners are forced to do that, many Berks County residents will consider it to be a betrayal of biblical proportion.

It would seem the commissioners would have a better chance of finding the gates out of hell than they do a way out of not selling the facility.

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It’s frustrating because the situation is driven by factors out of their control.

They’re trying to cross breed two seeds – skyrocketing expenses and lagging reimbursement – that grow on opposite sides of a wall.

Cuts to Medicaid funding in the tens of millions of dollars in recent years, exploding health care costs and a philosophical shift from residential to long-term managed care programs are all affecting the bottom line of the county-owned facility.

It is increasingly difficult for local governments to stay in the nursing home business.

If Berks Heim is sold to a nonprofit, there are concerns that the quality of care will suffer.

Our senior citizens deserve better. They once were the lords of their own manor and now the circumstances of aging have forced them to reside in what essentially is a way station for the next life.

No one wants to leave their home. But if you need a nursing home, you want optimal care.

County-owned nursing homes once were the norm in Pennsylvania. Now only 18 of 67 counties statewide still operate their own nursing home facilities because of mounting financial obligations to keep such facilities’ doors open.

The future of the Heim became an urgent matter in August when county officials were told by state officials not to expect an increase in Medicaid reimbursement rates for the next several years.

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials have the power to decide how much to reimburse these facilities.

Medicaid funding accounts for nearly 80 percent of the Heim’s $48 million budget.

The core issue – the Sword of Damocles if you will -- is the decision by the commonwealth to flat fund Medicaid reimbursement.

Having struggled five out of the previous 10 years to survive on a flat reimbursement rate and facing a projected $1.5 million deficit by 2020, the county commissioners began debating whether they should sell the nursing home before it begins to bleed money.

The public understandably has voiced its concerns that selling Berks Heim would eliminate a vital safety net for the elderly with limited means and subject them to a decline in quality care.

Health care costs have grown by more than 30 percent over the last decade while the reimbursement rate has increased by only about 7 percent over the same period, county commissioner Christian Leinbach said.

That amounts to a shortfall of more than $3 million a year that falls on the shoulders of Berks County taxpayers.

Complicating matters is the cost-cutting move by Pennsylvania to gradually switch to a new managed care system, transforming how government-subsidized adults receive medical and long-term care services. Once the system is fully implemented statewide, the state will be redirecting $6 billion annually in Medicaid spending to managed care organizations that will coordinate services and reimburse providers.

That change would come to Berks in 2020.

If the commissioners opt not to sell the Heim, Berks taxpayers will have to shoulder an even bigger shortfall.

When money becomes tighter than a clam with lockjaw, everybody’s jaws clam up.

Granted, this is not strictly a monetary issue. There are the current and future Berks Heim residents to consider.

We have to have a heart for them. Because their hearts already have been strained by leaving their homes for a nursing facility. And a heart can be ambushed only so many times before it demands armor.