and
September 29,
2004
3:00 p.m.
CEM Board: Robert Cabral,
Rev. Henry J. Dahl (recused absence), Marilyn Downey, Patrick Patrick (excused
absence), Katherine Perry, and Dr. Janet Whelan (excused absence).
Marilyn
Downey welcomed and thanked everyone with a few opening remarks.
Ruth
Gilbert called the Finance Committee meeting to order at 3:00 p.m.
Dennis
Anderson passed out a three-page packet entitled “Administrative Update.” He then went over the packet as a
presentation to the group.
1.
Land Exchange - Dennis assured everyone that the land will not be transferred
until all approvals are in place and a contract has been executed with the selected
bidder.
2.
Zoning – Dennis indicated that
changing zoning to allow a 44 ft. height to support a three-story structure is
key to this plan and it requires Town Meeting
approval.
3.
IGT Status – While progress has been
made on securing these funds, the Manor is unlikely to receive the level of
funding assumed in the projections shared with Town Meeting in April 2004. The formula for the reimbursement rate is
still under consideration at the state level i.e., Upper Payment Limits
approach. Nothing definite can now be
said regarding the reimbursement rate and several scenarios are being
discussed.
4.
FY 2004 Fiscal Update – Actual receipts were
$109,000 less than projected and the census decline was considerable in the
last two quarters of FY 2004.
5.
FY 2005 Fiscal Update – The low census is
continuing which contributed to an expense reduction from 53.4 FTEs in FY 2004
to the current target of 41-43 FTEs by the end of October 2004. Dennis said every cost-reduction avenue has
been tried i.e., job consolidation, hours worked reduction, and lay-offs. He also said that the “B” budget is under
review entailing a further negotiation of vendor agreements.
6.
Entities Update - There have been four real
contacts who may or may not be interested in responding to an RFP. One was a “not-for-profit” and the other
three were “for-profit” entities. The
proposed timeline is that the RFPs will be sent out on October 11th,
opened on December 10th, and entity selection will take place on
January 15, 2005. These possible
entities are being asked to consider interim management, which could happen on
July 1, 2005, but is not a requirement of the RFP.
7.
Personnel Impact of
Downsizing
– It doesn’t even have to be said that any time there are lay-offs and/or
reductions in hours worked the consequences are poor morale and overall
unhappiness of the personnel involved.
8.
Admissions and Referral
Development –
Rachel Butler is visiting the Cape Cod Hospital at least once a week to try to
secure discharged patients for the CEM.
Dennis Anderson told the group that “lies” about the status of the Manor
have been told to prospective patients e.g., “the manor is closing,” the manor
can’t do service X,” etc. An attempt is
also being made to entice short-term stays and not necessarily “end of life”
admissions. The CEM also is marketing
IV therapy as a specialty.
9.
Other – The following pluses were
expounded upon: a planned sewer hook-up
and an improvement of the Activities Program.
The
Finance Committee members asked a number of questions of the Cape End Manor
Board as well as from Dennis Anderson and Eileen Thomas.
Ann
Maguire was most interested in the legal options for reimbursement and when
they would have to be filed. She also
asked persistent questions about the census; it is now 33 and Dennis projects a
bump of 8 in the near future.
Ruth
Gilbert opined that all the projections presented did not help with the 2005
budget.
Mark
Leach asked why, when employees are laid off, the projected savings do not
materialize. Dennis explained it had to
do with payment of unused time to the laid off employee and any overtime
incurred.
Matthew
Clark, in considering the Massachusetts-wide decline in skilled nursing home
census, asked if the manor was still getting the same share of discharges? Dennis said that CEM was getting 1 out of
every 100 discharges and now is getting 1 out of every 157 discharges. Dennis indicated that unfair competition
from other facilities combined with the manor’s having dropped the ball on
referral develop-ment led to this decline in share, but that efforts were
underway to address both causes.
Robert
Vetrick wondered why other nursing homes had more referrals and Dennis, once
again, said that representatives present in the hospital lied about the
Provincetown facility saying it was closing, etc.
Matthew
asked, - “Given the consensus of the two boards that this RFP process was the
last hope of saving the manor, what work had been done on some of the
worst-case options – including offering the license to a for-profit operator and
allowing them over time to transfer operations down Cape that Dennis had
discussed with the Finance Committee prior to the April Town Meeting?” Dennis indicated that some of the initial
enthusiasm from for-profits had cooled when they learned that the union came
with the license. Matthew cautioned
Dennis to be careful about adding geographic restrictions to the license as
these restrictions might increase the cost to the Town in a worst-case closure
situation.
Robert
Cabral in defense of the current low census told a story about a hypothetical
man who shot his parents and then threw himself on the mercy of the court
because he was now an orphan? The
point, I think, was to say that the dirge of “low census” - “declining morale”
– “closure” becomes a self-fulfilling prophecy and if we continue in this vein
it may happen.
Ann
said that the only reason we talk about the census is that the budget is based
on that – the census.
Ruth
Gilbert said that you have to talk about census to see how the short-fall will
be funded.
Matthew
Clark said that the original financial model used at April Town Meeting assumed
that the manor would have Medicare patients.
Currently, the manor has 80% Medicaid and 20% private pay. Plugging these numbers into the earlier financial
model leads to much larger deficits that would need to be funded by
taxpayers. Dennis acknowledged the need
to update the earlier projections and committed to provide them to both boards
well in advance of the next meeting.
Keith
Bergman said there may be further tweaking of the zoning regulation because the
property is in the historic district.
Ruth
Gilbert, the Chair, decided to have the next meeting on the same subject on
Tuesday, October 12th at 2:00 p.m. in the Judge Welsh Hearing Room. It is asked that the CEM Board join the
meeting at 3:00 p.m. It was agreed.
The
meeting adjourned at 4:50 p.m.
Respectfully
submitted,
Evelyn
Rogers Gaudiano
Approved by ____________________________on
______________, 2004
Ruth Gilbert