Here is my column that ran in the Washington County Daily News last week.
Washington County’s Samaritan campus is at a crossroads. The time for tough decisions is upon us.
What should county taxpayers do for the people currently housed in the crumbling edifice of neglected obligations?
The Samaritan Campus is a senior care facility owned and operated by Washington County that provides skilled nursing, assisted living, and a residential care apartment complex for elderly citizens who cannot afford private care. It is funded through Medicare and Medicaid with shortfalls being covered by county taxpayers.
The problem the county is facing is severe, but not unique. The cost of operating Samaritan is far exceeding the funding provided by federal programs. Further, the facility needs a major renovation or rebuilding that will cost tens of millions of dollars.
Last year, Washington County taxpayers were paying nearly $50,000 per resident (about $2 million) to cover expenses and that is without the expense of a new or renovated facility. The ongoing expense for county taxpayers is projected to continue to increase exponentially.
Some have floated the notion that the county could use available money from one-time funds like federal COVID relief funds or opioid settlement funds to rehabilitate or reconstruct the facility. This may be feasible in the short term, but it does not fix the long-term funding problem. Using one-time funds to patch a systemic problem simply obligates future lawmakers to fix something because current lawmakers lack the courage to act.
What is to be done?
First, we must ask ourselves some hard questions. Should county taxpayers provide elder care to citizens who cannot afford it? There is no constitutional prohibition or mandate for county government to provide such a service. If the citizens of Washington County want to subsidize care for seniors, it is a policy decision. To date, county citizens have provided this service, so there is an absolute obligation to the seniors currently being cared for at Samaritan. Whether or not the citizens should carry this obligation moving forward is a separate question.
The second question to ask ourselves is, assuming county taxpayers are committed to providing for the county’s impoverished seniors, should the county own and operate the facility to do so? Experience should guide our answer to this question. Our collective experience is that, with exceedingly rare exception, government is terrible at running things. Government is a convenient, often abused, mechanism for the forced pooling of resources to expend on collective needs, but is pervasively inefficient, ineffective, and unresponsive when in charge of operations. We can see this in action at Samaritan itself, where decades of poor management and neglect have forced the county to this crisis point.
In Wisconsin, only 36 Wisconsin counties currently operate senior care facilities according to the Department of Health Services. The other counties either partner with private facilities to subsidize senior care where needed or forgo the financial obligation altogether. Washington County should transition the current residents to private facilities and support that transition with adequate funding. Using the COVID relief or opioid settlement monies to fund this transition might be necessary.
Whether or not county taxpayers should, or can, subsidize senior care moving forward will take some further thought. In the current arrangement, the taxpayer obligation to seniors is capped by the number of available beds at Samaritan. It is a physical cap. If the taxpayers subsidize senior care in private facilities with flexible capacity, would such a program attract seniors from outside of Washington County and become an unsustainable drain on taxpayer resources? Such potential unintended consequences will need to be mitigated should the county decide to subsidize senior care indefinitely.
One thing is certain. The situation at Samaritan has become intolerable and inexcusable. The caregivers are doing tremendous work but they are understaffed and under-resourced. Washington County is falling short of providing the dignity of care promised to Samaritan’s residents. This year must be a year of decisions and action — not another year of kicking the can down the road.