International nurses plan takes next step

McCOOK, Neb. — The Hillcrest Nursing Home Board of Trustees took the next step Wednesday morning in hiring international nurses.

The board voted unanimously at its regular meeting to start the process with an agency that provides international registered nurses, by completing a filing fee. The cost of the fee was not presented at the meeting.

The commitment to do so does not imply a contract, said Hillcrest administrator Brad Cheek, and the board is not under any obligation at this point to hire nurses.

The costs to hire nurses outside the United States is higher than to hire those already in the states, said Hillcrest Director of Nursing, Tammi Simpson.

If the board decides to hire an international RN, the cost, spread over a three-year period, is around $11,700 per nurse. That may sound steep but it’s still less than hiring agency pool nursing, Cheek said. Hillcrest would conduct the interviews, offer a salary and be required to provide housing for 30 days; the nurse would have a three-year contract with the facility.

In response to a question by the board, if the nurse does leave, the agency replaces them, Cheek said. Simpson added that the replacement rate is low with the agency they are working with.

Nurses outside the U.S. graduate in December and July, while nurses inside the U.S. are already working nurses, Simpson clarified. In response to a question from the board as to which she would prefer, Simpson said recent graduates are usually easier to train.

In a later discussion of staffing, Cheek said hiring international nurses is a good for everyone involved, as it helps with the nursing shortage and international nurses want to work in the United States. “Once they’re here, our job is to keep them motivated,” he said.

The board stopped short of hiring international nurses at this time as nurses may be hired from a near-by nursing home that is closing, Cambridge Manor, a long term care facility. Cambridge Manor, with 22 residents, announced its impeding closure Feb. 21, citing Medicaid reimbursements not being sufficient to keep up with rising expenses. That facility will be closed in June.

Hillcrest has already admitted three residents from the facility.

“It’s unfortunate and we don’t like to see it, but it is helping Hillcrest,” acknowledged Hillcrest Business Manager, Renee Wright.

Decreasing Medicaid reimbursements are hurting nursing homes everywhere, Wright said in a discussion with the board, citing a 10 percent reduction over the past two years in Medicaid reimbursements at Hillcrest. For Hillcrest, this means losing $60 per day per Medicaid resident, by providing services but not getting reimbursed adequately for it. Because of Medicare being expanded, this may cut into reimbursements even more, she said.

But Medicaid patients still need a place to stay, she said. Wright said before being admitted, residents and their families must submit financials, so staff can estimate how long their stay will be and work with the family. After supplemental insurance and other means are exhausted, residents are eligible for Medicaid.

Another area where services are provided but not sufficiently compensated is Veteran’s Administration benefits, where costs such as lab x-rays and doctor’s visits are required but not paid for by the VA, she said.

The staff at Hillcrest has been working with the Cambridge staff to make the transition as easy as possible, Cheek said, commending Hillcrest employees for their help in the process.

Admissions at Hillcrest are on an uptick recently, he said, with a total of 10 residents being admitted to Hillcrest by the end of this week.

As of Wednesday, there are 84 residents at Hillcrest. The 100-bed facility is owned by Red Willow County but operates on its own revenue.

Of the 84 residents, 23 are private pay, 11 are Medicare (short stays, up to 100 days, usually rehabilitation from hospitals, ), 47 are Medicaid, one hospice and two residents eligible for VA benefits.

Revenue for the month of January was $566,888, with expenses at $607,207. Medicare payments were lower than expected with the census also lower, Wright said. Another factor, as cited by board member Brian Rokusek during a discussion on financials, was the unexpected expense of $18,000 to replace a heating unit for the dining room.

In other business:

-- the board approved upgrades at the facility, using a $7,500 donation given to the Hillcrest Foundation. These upgrades include completing the installation of the fireplace in the Pine View (special care) area, installing dimmers in the wall sconces for comfortable lighting, new furniture in the lounge area, a bench on the main floor and a television for the exercise room. Another television may be purchased to go above the fireplace in Pine View.

-- The Hillcrest Foundation was the applicant for a grant to purchase a new van for Hillcrest. Maintenance costs will be paid by the nursing home. The grant will cover the $37,000 cost of the van, with Hillcrest providing 20 percent of the cost, at $7,500. This van, that will be wheelchair accessible, will replace one that the board recommended to be salvaged as it is not usable.

-- Hillcrest administrator Brad Cheek said he is in the process of comparing prices of the current buying group the facility belongs to, with other buying groups, to make sure Hillcrest is getting the most equitable price on supplies. A buying group  is an organization made up of small businesses that band together so they can negotiate as a larger group with vendors to receive better pricing and terms on goods and services. 

-- In staffing, new hires include four new certified nursing assistants and one dietary aide. The facility lost two CNAs, one nurses aide in training, a housekeeper and an activity aide.

Hillcrest Board of Trustees are Randy Dean, president. Ann Barger, Vice President, Mike Skolout, treasurer, Brian Rokusek and Mike Eklund. Also attending Wednesday’s meeting was Red Willow County Commissioner, Steve Downer.