JCHC’s Position on VA Skilled Nursing Facility being in Buffalo

Outside Picture of AHCC

Johnson County Residents,

We want to share with all of you why Johnson County Healthcare Center is opposed to the VA Skilled Nursing Facility being in Buffalo.

We at Johnson County Healthcare Center fully support a new Veteran’s Skilled Nursing Facility in Wyoming, but don’t feel Buffalo is the best place for it.

Brenda Gorm, Amie Holt Care Center Director of Nursing, has shared with our legislature that Amie Holt “is a good place to work and we provide quality care for our residents, but we have struggled with consistently having adequate CNA staffing for as long as I can remember (over 28 years).”

Amie Holt offers CNA classes.  Not only is the course free to students, but the facility pays an hourly rate for them to take the class and we pay all testing expenses.

Amie Holt would like to have more classes, but it takes months to find a few interested, qualified individuals who would like to become CNAs.

Amie Holt only has a 38% retention rate from our 2017 and 2018 classes.  We have conducted exit interviews when these staff left and determined it is not a negative work environment that is causing them to leave.  What we have found is that they left for the following reasons:

  1. Some left for less physically challenging work, such as assisted living or home care.
  2. Some left to pursue different positions outside of nursing home CNA.
  3. Some were terminated. Not everyone is cut out to be a CNA.
  4. Some go on to nursing school, as we pay the full tuition.
  5. Approximately 1/3 have moved from the area for personal reasons.

Amie Holt has managed by having our current CNAs working overtime and/or having less staff on duty than we would like.

Amie Holt has not seen anyone relocate for a CNA position. It is rare for someone to travel from out of town when they have ample opportunities close to home.

Amie Holt has had to freeze admissions at times including twice in the last year, because we didn’t have enough staff to care for residents of our community.  Potential residents who need nursing home care in our community have had to go out of Johnson County for Nursing Home Care or stay in our hospital for months, waiting for admissions to re-open.

The Department of Health published a Wyoming Veterans’ State Home Needs Analysis.  On page 19 of the report, Buffalo received high points for having a low median CNA wage of $12.16/hour.

During the Transportation, Highways & Military Affairs Committee meeting on October 23, 2018, the Administrator of Green House in Sheridan testified that they pay CNAs $15/hour, plus differential pay.

After we testified at the meeting a Senator was visiting with us and suggested that we should raise our CNA wages to $15/hour if we wanted to be competitive and keep staff, but offered no solutions of how to do so.

The new veteran’s facility will receive $417/day per Medicaid resident.

Amie Holt’s current Medicaid rate is $194/day.  Our cost is $277/day.  Medicaid is the main payment source for 60% of our residents.  This $83/day difference for these residents totals an annual loss of $590,418 dollars that is subsidized by the facility.

If Medicaid rates don’t increase or Johnson County residents don’t want to pay more in taxes, the facility would have to absorb the cost of increasing CNA wages as well.  Although our CNAs work very hard and we wish we could give them an increase of $3/hour as the Senator suggested, this would cost another $177,000 per year.

We are not sure we could sustain those costs indefinitely.  Worst case scenario could be closing our nursing home.  Alternatively we may need to look at reducing the number of residents that we serve at Amie Holt.  Today we are at 100% occupancy.  Any reduction would displace a Johnson County Resident to another community as there are no other options for Long Term Care in our community.

The new Veteran’s facility is projected to need 30-35 CNAs.

We understand that workforce issues are a concern throughout the state in every industry, which is all the more reason not to further challenge a community that is already struggling with its only Long Term Care Facility.

Consider the existing CNA workforce, and the likely impact of needing 30-35 more CNAs:

  • Buffalo has 104 CNAs
  • Casper has 861 CNAs
  • Sheridan has 527 CNAs

The report published by the department of health describes the workforce impact like throwing a rock into a pond (thus disrupting a system).   The larger the pond the smaller the ripples.  Buffalo has the second lowest CNA labor pool out of the 12 locations initially considered.  Buffalo’s pond is very small and thus the ripples felt by placing the facility in our community would be much larger.

The solution we’ve heard for Buffalo is to have Sheridan College amp up CNA programs, offering more in Buffalo.  This still doesn’t provide interested, qualified individuals – the resource we are lacking.

Buffalo is a beautiful location, the cost to build the new facility would be lower here, and the current Veterans’ Home residents would have continuity of care as they moved into long-term care – we do not dispute any of these facts.  But Buffalo doesn’t have a large enough workforce to support the new facility.  If it is built in Buffalo, it will likely be at the expense of the residents of Amie Holt and those in the community that don’t qualify for the new Veteran’s Facility.

Residents have come to Amie Holt from the current Veteran’s Home for long-term care and have done well.  In this way, they have been able to stay in their community.

Only 5 of our residents would qualify to live in the new Veteran’s facility.  Since Amie Holt is the only long-term care facility in town, the rest would need to leave the community if our nursing home closed or reduced its capacity.

Johnson County Healthcare Center has always, and will always, care for our veterans – in the nursing home as well as in the hospital.

There are better alternatives in the state for the location of a Veteran’s Skilled Nursing Facility.

To learn more about the proposed facility or view the Level 1 & 2 Study completed go to: Veteran’s Home Study


Mark Schueler, Board Chair
Nicole Hobbs, CEO

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