Like other skilled nursing homes, the Ararat Nursing Facility is facing a 10 percent cut in state funding this year, but rather than cut staff that could compromise care, the Mission Hills home is making small changes. Retirees are not being replaced. Bedspreads and towels, which the home normally provides, are being supplied by family members instead. “We have to do things smarter,” said Executive Director Margot Babikian. It’s how the best-run nursing facilities around the San Fernando Valley are making ends meet amid some challenging times. While occupancy rates have remained steady, the Valley’s 50 Largest Nursing Homes are all facing significant financial challenges as the state looks to cut back Medi-Cal funding, which accounts on average for two-thirds of the income of most nursing homes, including those of the Valley’s largest. Those cutbacks are the single biggest issue facing nursing homes right now, said Sandra Faay, administrator at the 204-bed San Fernando Post Acute Hospital in Sylmar, the Valley’s fifth largest nursing home, according to the San Fernando Valley Business Journal’s List of the Valley’s Largest Nursing Homes. “Medi-Cal is holding back 10 percent and that’s the hardest thing right now,” Faay said. “We’re managing but it’s very difficult.” The state program provides 84 percent of San Fernando’s funding, so when the Medi-Cal program is cut, the nursing home, like others statewide, is in a tough bind. It can’t easily cut staff because it has to meet state licensing regulations which require that the home maintains a minimum of 3.2 nursing hours per patient day. At Ararat, the Valley’s 9th largest facility with 196 licensed beds, Medi-Cal accounts for 96 percent of payments. The cutbacks are the result of difficult financial decisions by the state to balance reduced tax revenue with ever-increasing costs, including health care. “There is a lot of pressure on nursing homes now because of the state and federal cuts to their budgets,” said Deborah Pacyma, spokeswoman for the California Association of Health Facilities, an association of long-term care facilities. For the typical nursing home, Medi-Cal pays $177.65 a day, which is $12 below what it costs a nursing home to take care of its residents, Pacyma said. Next year, reimbursements are set to remain flat, Pacyma said. Making things tougher still is another trend at nursing homes: sicker patients. “I was here years ago,” recalled Babikian, “and we used to have many residents who could walk around. Today, that’s a rarity.” Patients are sicker because more elderly and disabled people are able, and prefer, to live at home with help. That leaves only those completely unable to take care of themselves for skilled nursing facilities. Another way nursing homes have changed is the turnover in residents. Some 81 percent of people who enter a nursing home are discharged within three months, Pacyma said. “That number keeps growing,” she added. “It’s never been this high.” Hospitals discharge patients much earlier than they once used to, she explained. Nursing homes have become step-down facilities for those patients. Providing such rehab services has helped facilities diversify their services and income stream. The federal Medicare program that covers those services reimburses at a higher daily rate than the state-run Medi-Cal program, Pacyma said. At the Valley’s 50 largest nursing homes, Medicare accounts from zero to 42 percent of reimbursements, with the majority falling in the 10 percent to 20 percent range. At the Valley region’s largest home, the 299-bed Antelope Valley Healthcare in Lancaster, Medicare makes up 17 percent of reimbursements while Medi-Cal accounts for 68 percent, about typical. The home is 76 percent occupied, which is below the state average of 88 percent. The facility provides residents both rehabilitation services along with long term care. The second largest facility on the List is the Joyce Eisenberg Keefer Medical Center, a 239-bed facility in Reseda run by the Los Angeles Jewish Home for the Aged. The facility is 99 percent occupied. The Ararat Nursing Facility is similarly 98 percent occupied, according to the List, though Babikian says the home is typically 100 percent full with a long waiting list of a few hundred people. One reason, she said, is the individual, or person-centered care the home provides, a philosophy that many homes are trying to adopt. The idea is to give residents as much choice as possible in their daily lives. For example, instead of requiring all residents to eat breakfast at a prescribed time, Ararat allows residents to have breakfast any time. The kitchen is open 24 hours a day and some residents are permitted to cook their favorite dishes. “It’s all about individual care here,” Babikian said. “It’s not a mass production.”
