By Tina L. Scott
MMC Staff
LINCOLN COUNTY – The results of the online community survey conducted by the Merrill Foto News and Tomahawk Leader are in, and respondents overwhelmingly indicated they want to keep Pine Crest Nursing Home in Merrill as a Lincoln County-owned facility, even if that means increased taxes to do so.
Of course, it wasn’t unanimous, but although the question wasn’t on the survey, in the comments section it quickly became apparent that even more so, Lincoln County residents want to see a referendum to allow everyone in the county to have their voice heard and their vote counted.
The Lincoln County Census Bureau estimates there were 28,376 residents in Lincoln County, Wis., as of July 1, 2022. Of those residents, 17.4% or approximately 4,937 are under age 18 and 23,436 are adults. And Lincoln County has 16,882 active registered voters, according to the Lincoln County Clerk’s office, as of Oct. 2, 2023.
A total of 782 people responded to our survey online. While we requested only Lincoln County residents respond to the survey, that number includes 14 non-residents who responded to the survey anyway. Those 14 respondents represent 1.79% of respondents and did not make any significant difference in the outcome of the survey.
The 768 Lincoln County residents who responded represent 3.27% of the 23,436 adults in Lincoln County and 4.55% of Lincoln County’s active registered voters. While this is a small fraction of Lincoln County residents, the results from those respondents were telling.
A majority of the survey takers were female; approximately 61% were female, and 39% were male.
All respondents were over 18 years old, with the vast majority (97%) over the age of 30. Only 24 “young people” ages 19-30 (3.1% of responses) took the survey. Respondents ages 61-70 years old were the largest category of survey takers (32.9%). More than half (56.7%) were ages 61-80 years old. See graphics for complete results.
Of the 782 total respondents, only 7.3% (57 people) said they currently have a family member residing at Pine Crest Nursing Home. 37.5% said a member of their family had “ever” resided there, and 62.5% of respondents never had a family member at Pine Crest.
Nearly half (49.7%) of respondents felt Pine Crest “residents receive exceptional (five star) care” and the next highest group of respondents (29.8%) thought Pine Crest “residents receive excellent (four stars out of five) care.” Only 1.2 % of responses (nine people) indicated “residents should have better care (two stars out of five),” and a single respondent thought “residents receive poor care (one star out of five).” Just over 12% of respondents said they did not have an opinion on the quality of care residents receive at Pine Crest.
To sell or not to sell; to raise taxes or not to raise taxes?
The responses to the questions most specifically related to the issue at the forefront of the Lincoln County Board of Supervisors, and in the freeform comments section, presented a clear directive from those constituents who answered the survey.
A full 83.6% of respondents said “No,” they did not believe Lincoln County should explore and consider selling Pine Crest to a private entity, thus removing taxpayers from the obligation to support Pine Crest costs and expenses. And 85.3% said “Yes,” they would support an increase in their real estate taxes for five or more years, in order to keep Pine Crest Nursing Home owned by Lincoln County.
In fact, when it came down to the finances, only 14.8% (113 of the 763 people who answered this question) said they would not support any increased taxes for this purpose. The largest majority (39.7% of the 763 responses) said they would be willing to pay on their real estate taxes “whatever amount is required to keep Pine Crest Nursing Home owned by Lincoln County,” another 25.8% said they would be willing to pay $85.00 per $100,000.00 value of their home in additional annual taxes, and 19.7% said they would be willing to pay an additional $100.00 per $100,000.00 of their home’s value each year in taxes for this purpose.
Eighty-five percent support increased taxes, if needed.
15 percent oppose higher taxes
Those in favor of selling the nursing home to a private entity and who did not support an increase in their taxes accounted for only 15% of survey takers.
They offered some of the following comments:
“It is not the responsibility of government to fund a nursing home facility,” one woman said. “Pine Crest has operated at a significant loss ($1/2 million +/yr) for many years, a fact which, under past County management, was hidden. Prior to the misguided expansion of the facility (2016), selling it to be operated by a private entity (still as a nursing home) was briefly considered, but with a small group of vocal opponents showing up at a meeting, the Board caved to their demands. Since then, costs have spiraled out of control. The current Board is doing the right thing by selling it.”
A number of respondents said the problem lies with management.
“There are two privately owned nursing homes in Tomahawk that are offering excellent services at no cost to the taxpayers. Pine Crest could be run in the same manner,” Charlie Jarvis said.
“I am in favor of the nursing home being privately owned … As a family care social worker, I am in several nursing homes weekly (with)in a three-hour radius surrounding Merrill. Many are privately owned. They are run and managed differently,” another woman said.
“As a former employee of Pine Crest, I think there is no solution under current management,” said a woman who identified herself only as Heather. “Census will continue to be an ongoing problem until there are nurses and CNAs willing to work under the management. Management is the main reason for the staffing issues. Taxing the public at large, with no solution to the staffing issues, will only add a year or more to the eventual closing.”
Others questioned why selling Pine Crest to a private entity was automatically perceived that it would result in poorer quality care for residents.
“I totally support selling Pine Crest to a private company,” one woman said. “Being a long-term healthcare worker, I know privately owned does not at all translate to poor care. Nursing homes are regulated and inspected. Staffing is an issue everywhere and a facility is only as good as the employees caring for the residents.”
“I just can’t come to terms with being okay with our taxes being raised to keep Pine Crest open,” another woman said. “Why not sell it to a company that wants to keep it a nursing home.”
“… We need to stop hemorrhaging money to keep this place afloat” and “It’s time to stop the bleeding” and “I cannot afford higher taxes” were other comments.
“Government should have no part in private enterprise,” Ginny Fedrowitz said. “We, the taxpayers, should not have to support a business with our taxes that is government run. Period.”
“Taxpayers aren’t going to pay additional taxes for both Pine Crest AND schools,” one Merrill resident said. “I feel passing a school referendum in Merrill should be our most important priority.”
“Seems like Pine Crest has been a hot potato for long time now,” Craid Madlun said. “Taxpayers are getting bombarded by ‘it’s only a couple hundred dollars more on your taxes.’ Schools need more operating money, nursing home needs more operating capital, etc.”
“Raising taxes is not a sustainable solution,” one woman said. And another questioned why changes weren’t being made to get the nursing home out of the red.
“What options have been explored that would provide income for the nursing home?” a Merrill man asked. “Lincoln County residents are already under financial strain from issues relating to the post pandemic, such as higher food costs, higher energy costs, higher insurance costs, higher rent, higher taxes, higher housing (rent and ownership), you get the picture?”
“Other healthcare entities like former Sacred Heart Hospital and Holy Cross Hospital have been absorbed into health care systems. Same for the medical clinics. There are efficiencies to be gained within a larger organization,” he said. “Saving Pine Crest in the short term in not the answer. How many times will increases be passed on??”
“My answers reflect the current management of Pine Crest,” another woman who voted to sell the facility and not raise taxes said. “If there is restructuring and plans put in place that produce a balanced budget, I would certainly change my responses to this survey.”
“I worked in accounts receivable and billing years ago prior to the new building,” one woman said. “… Now knowing that 100 rooms are sitting empty is highly suspect! Can’t pay the bills with 80 residents … Why are we not filling those rooms with Assisted Living residents? Please look at Grace Lodge in Rhinelander as an example.”
“Please retain Clifton Larson to evaluate (as suggested in a recent letter to the editor),” Tommy Sanders said.
Increased taxes supported with a caveat
Even some respondents who said they would support a tax increase said changes need to be made.
“The way I understand it, is that Pine Crest is operating way over their budget,” a Merrill woman said. “If we are able to increase the budget a little, (with minor tax increases), that is fine with me. If it is going to require hundreds of dollars of increases in taxes, then I do not support that and feel it maybe should be sold.”
“A society is judged by how it cares for the most vulnerable among them. How can we not care for those who spent their lives caring for us?” Cathy Robinson said. “I have followed this situation closely. It seems there have been options on the table the County Board has chosen to discount. It also seems, that while they were elected to represent our choices, they have instead chosen to prevent our opinions from being heard. Using the statement that the suggested options to keep Pine Crest open are just temporary measures and we will be back in this situation again in a couple of years suggests the future will always be the same as today. We have no way of knowing what the future holds, what other opportunities may arise to solidify the financial foundation of Pine Crest. Our county, our elderly, and those who need Pine Crest deserve the chance to work toward more permanent solutions.”
“We need to have clear information regarding the current tax base, anticipated future tax base, actual costs to run Pine Crest, and a detailed plan for managing it well in the future if we keep it,” Patty Procknow said. “Pine Crest is a County asset which has been relied upon for a very long time. I would like to see it stay as a County asset but we need a plan for managing it.”
“(I) have 25+ years working as a CFO at three different Wisconsin hospitals and advanced each one from 6-digit annual losses to 7-digit annual profits,” Thomas J. Semling said. “The primary cause was mismanagement and pocket lining.”
“I would support Lincoln County retaining ownership of Pine Crest pending an assessment by an experienced consultant in geriatric services/long-term care specialist who could provide a comprehensive assessment of the quality of the existing services, given the declines that have occurred since the onset of North Central Health Care system assuming the management of the facility,” Mary Jo Rajek said. “An experienced consultant can make recommendations as to how to maximize the potential for long-term care services and revenue-producing programs to offset the expected costs of operations when residents age in place and their care is covered through Medicaid (which has never covered the costs of actual care needs). I have worked in rehabilitation services for over 44 years to include long term care, inpatient rehab services, outpatient rehab services, specialty outpatient clinics for traumatic brain injury, MS, home health, and adult day care. Both of my parents have been residents at Pine Crest … What I have observed since my return to Pine Crest has been nothing short of an administrative debacle since the management takeover by NCHC. Cost cutting measures have directly impacted the quality of care the residents receive with loss of experienced clinicians, chronically short-staffed units, (and) temp staff who do not have the familiarity with the residents (and) their medical complexities and longer-term emotional needs. While the current care may be adequate, it is not remotely the quality it was when my parents were there several years ago.”
“From my perspective, the County Board has been irresponsible in addressing the needs of Pine Crest for years,” she said. “While COVID did have a major impact on the costs of care, there appears to have been prior lack of fiscal responsibility in exploring options to offset rising costs. Expenses for the Special Care Unit were ill planned and demonstrate no awareness of the clinical needs for dementia patients. The prior unit was set up more effectively for safe care of patients suffering from memory loss and safety needs. Anyone who has ever worked in a successful dementia program would never have constructed the new unit in the manner in which it was done with multiple rooms not visible to front-line caregivers. If you bother to check the statistics on fall occurrences at Pine Crest, you will find the majority are occurring on the Special Care Unit. The Rehab Unit, which should be the revenue producer for Pine Crest, now has long-term care patients residing on the unit and a number of beds are being occupied by hospice patients. New rehab patients are strewn about the other remaining units, often sharing a room vs having a private room and similar services as the rehab patients. While rehab services are provided to all residents in the facility, the inefficiencies of having rehab patients placed all over the facility impacts multiple staff services. A sign remains outside the Rehab Unit indicating that is the location of a program that is no longer in existence … it is to be called the West Wing. There has been next to no effective marketing of the rehab program, no community service clinics such as a Falls Screening Clinic, or Stroke Clinic, etc. to pull in potential referrals for both inpatient sub acute or outpatient services. One of my family members who works at a large local hospital has repeatedly indicated that Pine Crest is too slow in their acceptance of patients, often requiring the hospital to send patients elsewhere. Some individuals may be out of network, but the majority of the time it comes down to slow processing. While hospice care is definitely needed, it is unclear why the location of their placement is in a rehab bed, as their stay at the facility may surpass months. We had a Hospice Care Unit which allowed patients and their families access to staff experienced in their care and support needs and private areas to gather or grieve.”
“To add to the fiscal nightmare already in existence,” Rajek said, “there apparently are plans to construct an Ambulatory Dementia Unit where the original Dementia Unit was located. What family member in their right mind would bring their family member to this unit when the fate of Pine Crest is so up in the air? I am supposed to bring my family member to a facility that cannot currently meet their existing staffing needs, much less the needs of ambulatory confused, often agitated and restless, dementia patients. Most of us with experience with dementia patients who are ambulatory or independent in wheelchair use know the programming and service needs of these individuals is above normal staffing. What happens to those residents when they are no longer ambulatory? Do they go to the other Special Care Unit with a reduced level of services and new staff?”
“Staff on occasion are asked to provide input only to face further cuts and asked to keep doing more with less, keep documenting more care that they do not have time to provide, (and) keep trying to stay positive amidst the insanity and ignorance of County Board decisions,” she said. “I have worked for for-profit long-term care and rehab facilities and there are certainly pros and cons for that option. The one thing that is clear with those successful programs is that they anticipate the market, they promote their services in advance of financial calamities, they seek grant funding to offset care costs for special programs, they maximize the potential of their facilities whether it be space rental, collaboration with community programs that serve as referral sources; promote and protect or expand their revenue-producing services; and keep their beds filled. Every long-term care facility at one point or another will have an increase in their Medicaid population. This should have been anticipated and efforts should have been taken to beef up the revenue producing side of their programs, long before COVID, and should have been immediately resumed once COVID subsided. What has resulted in North Central and the County’s pathetic fiscal management to date has been chaotic at best, short sighted, and a disservice to the residents at Pine Crest and to the committed staff who make every attempt to provide ongoing quality care in the midst of uncertainty. So much of this angst and fiscal mess could have been minimized had there been informed leadership committed to exploring options proactively in this challenging health care environment. Since that is a moot point at present, what our County needs is a viable quality-focused long-term care facility that meets the needs of its residents. Every effort should be made to keep Pine Crest as an option for care in this community; the alternative will be heartbreaking for so many and an unforgivable loss for years to come.”
“Many (if not most) of the residents at Pine Crest have lived their entire lives in the Merrill area working for low wages and no future retirement pension or 401K,” one Merrill woman said. “They kept Merrill businesses alive. When it came time to sell their homes at a low cost, it was not enough to cover nursing home care. Most households nowadays need two incomes to make ends meet. Families aren’t able to stay home and take care of their elderly parents like they used to. We owe it to our elderly to keep Pine Crest alive … When my mother was a resident until 2011, almost all rooms were double occupancy. Single rooms were for self-pay only. When they added on, everything changed. I think they could make better use of the space and make some of the wings assisted-living only. Less staff needed for some areas. Why not sell the property to the east and help to pay off some of the debt? If Pine Crest is sold, that property is going to be sold to a developer to make a hefty profit.”
“There has got to be a way to make this place profitable once again,” a rural Merrill woman said. “Adding an assisted-living portion would be great, possibly connected daycare options. Try looking for these things in this area. The waiting lists are long and sometimes there are no other options. We need to care for our aging population. … It’s time to brainstorm on how to improve the current situation, not sell it off to a private party.”
“Thank you so much for opening up this line of communication!” Janet Wells said. “Pine Crest has been a part of our community for a long time and should be given a high priority among our valued assets. I believe an unbiased, complete assessment should be made of its management staff and operations and, if they need to be made, changes should be implemented to reduce costs. I am also in favor of portions of the facility that are not occupied by residents being made available for other purposes, such as affordable day care for children; this particular option would generate some income, but more importantly for our community, it would give residents a new purpose and much pleasure and the children opportunities to learn about history as well as life-learned wisdom on life.”
“It is overly simplistic and misleading to ask what citizens are willing to pay without presenting a complete analysis, including expectations of future demand,” a Merrill man said.
Citizens for keeping Pine Crest county-owned
“The community would like to keep Pine Crest community owned because the community is a family, and family care for their own,” Carey Volgman said.
“This facility is vital to the Lincoln County residents,” Linda Huss said. “We live in an area where many come to retire and enjoy the quiet life. Many have grown up here and returned after retirement to be back with family. These people need an affordable place to place aging parents nearby and not a couple hours away. If you interview the younger residents of Lincoln County, you will find that they are smart enough to know that a couple hundred dollars a year is a great investment for quality of life for the senior citizens of this county. It saddens me that the County Board has placed the value of a dollar over the value of caring for the aging and victims of stroke, major heart attacks, etc.”
“I worked over 23 years at Pine Crest and I am now retired,” Susan Thompson said. “I always thought Pine Crest would be there when and if I ever needed it. I am very concerned about having affordable and quality care available if Pine Crest is sold! I hope people in this county care more for their neighbors and family than they do about the almighty dollar!”
“If I ever need to go to a nursing home, I would want to stay in the town I live in,” Linda Proft said. “Merrill is my home. I don’t want to live anywhere else. It would be hard enough just leaving my house, but to leave my town too would just be too much.”
“Keeping Pine Crest a County-owned care facility would be beneficial to those who reside in Lincoln County because Pine Crest accepts more patients who are on a fixed or a lower income,” Taylor Polak said. “Instead of funds being solely sourced from property taxes, an increase of County sales tax would spread the need for funds across anyone who shops in Lincoln County. A sales tax increase of 0.5% would be a great start. This is an increase of 50 cents per every $100.00 spent. This would solve the issues of those who only own property supporting the cost of Pine Crest. With a County-wide increase of sales tax, sufficient funds would be allotted to keep Pine Crest County owned. Keeping a County-owned nursing home in Lincoln County will allow fixed- or lower-income residents a safe place when they are in need of a nursing home.”
“One risk of selling Pine Crest to a private entity is the cost of staying there increased, (which could cause) fixed or lower income residents to be evicted,” she said. “Another risk would be the potential of Pine Crest closing, resulting in Lincoln County residents (having to look) elsewhere when they are in need of a nursing home. If a Lincoln County resident enters a nursing home in a different county, there is a potential of the entire family to move out of the area.”
“Property taxes here are very low compared to other places we’ve lived, both in and out of state-as well as other locations in Wisconsin,” Sarah Litzer said. “I have no children, but have never begrudged the amount of property taxes we pay in order to fund schools. I consider it an investment to make my community more livable and the same is true for property taxes we pay that fund the many services our community offers, even if we don’t avail ourselves of those services. No taxes equals no services, a foolish choice for people living together in our present-day society. We are retired and live on a ‘fixed’ income, but we continue to choose to live here because of the services available and the relatively low cost of living. People who have never lived anywhere else seem to lack this perspective.”
“A recommendation I have for the County Board,” Polak said, “is they should take a look at how other county-owned facilities are run and funded. How do they stay open and afloat? Why are they receiving more funds than Lincoln County? What can Lincoln County do to earn more government funding?”
“Pine Crest has been a staple in this community for as long as I am alive,” Adam Wegner said. “It has affected my family from both standpoints from employment to care. I have family members that have worked at Pine Crest for many years. I have also had family members that received care for many years, as well. It was affordable care and in my hometown! If this facility is sold to a private company, or even worse vacated, it would be a terrible thing. Some of my family could possibly be out of work or out of care. I think that the County should stay in ownership of it and, as a County resident, it is a great value to have it. Not only for myself in the future or possibly my family members. If Pine Crest gets sold, who is to say that it will provide the care it does now or stay around. I like the fact it is close to family. If I would have to travel far to see family in care, it would be a great inconvenience …”
“I have worked at a few health care facilities in Merrill and surrounding areas, Pine Crest included, and out of all the health care places (where) I have worked, Pine Crest was the one I loved working at the most,” Melissa from Merrill said. “When North Central took over, things started going downhill and, as employees, we no longer felt like we mattered; we were/are more just like a body or a number. Between NCHC causing several issues and due to other unforeseen events in my personal life, I had to resign from my position as a CNA at Pine Crest at the end of June 2023. It would be a shame for Pine Crest to be shut down or for it to be under new ownership, as no one knows what would happen with a new owner. There also really is not anywhere else for us to take our elderly residents. Over the 7.5 years I worked at Pine Crest, we had several residents from surrounding nursing and assisted-living homes come to us with horrible bed sores and pressure ulcers from not being repositioned or taken care of properly. At Pine Crest, we did and do all we/they can to help heal the wounds, and most recover enough to no longer be bed ridden.”
“Pine Crest is the only 5-star rated long term care facility in the area,” Tricia Hoffman said. “Compared to the other privately owned facilities in Lincoln (and Oneida) County, this would be the only facility I would want myself or other family members to reside in if we needed it. I have heard nothing but glowing reports about this facility, and though it may run a deficit financially, it is a valuable resource for our county, and I would be willing to pay extra property taxes to help keep it County owned, as I fear once it becomes under private ownership, quality of care will begin to decline. It is hard to find a long-term care facility that people rave about in a positive manner, but Pine Crest has accomplished this, and we should not just ‘throw it away’ to the highest bidder.”
“Pine Crest Nursing Home is a shining star in Merrill … No one wants higher taxes. However, some things are worth paying for,” Louise Doescher said. “… We will all grow old. Investing in Pine Crest is an investment in our future to be living in a loving and comfortable environment in our old age, when we can no longer take care of ourselves. I hope that we get together and work to save Pine Crest.”
“County-funded Pine Crest is a need in our community,” a Tomahawk woman said. “The amount of elderly needing care has declined, (but) the solution is not to sell out to a privately funded business. Find another solution.”
“The primary flaw in this survey is that the only options that the survey offers for saving Pine Crest are property tax increases,” a Merrill woman said. “This makes it feel as though the survey makers have already accepted the inaccurate claim of the Pine Crest Ad Hoc Committee that no other options were worth seriously exploring. That’s too bad – this survey idea was a good step toward impartial journalism. But obviously, it could be even better.”
One woman summarized a common thread running throughout the responses.
“People in this County paid for years for this nursing home,” she said. “For many, it was all of their working life so far. Now it could be taken away from them, and that is not fair.”
Referendum
The one thing both sides of this issue seem to totally agree on is this: “I think the matter should be addressed through a referendum. I am disappointed in the County Board’s indifference to resident concerns,” Brian Riese said.
The County Board’s refusal to, thus far, put the matter to a referendum, has those with opinions on both sides of the issue frustrated and upset.
“Why does the County Board refuse to put this matter up for a referendum?” one respondent asked.
Many others had similar comments.
“Honesty and transparency are essential when deciding this very important issue,” Eileen Guthrie said.
“I believe that the voters should have the right to decide on the selling of Pine Crest,” another woman said.
“Unfortunately, in the modern political climate, elected politicians often forget their mission is to govern the will of the people and not their own misguided political allegiances,” Bruce Sunde said. “Denying the opportunity for citizen referendum is the epitome of political arrogance and voter marginalization. The current political notion of ‘we know better than the people who sent us here’ certainly can be rectified at the ballot box.”
“In my opinion, the County Board made a mistake by not allowing the people of this County to vote on an issue that is very personal,” Tyler Frederick said. “If the Board just allowed it to go to a vote by the people, then either the people would vote yes to increase in property taxes or vote no to not increase taxes. The yes vote gives the County money to continue the ownership of Pine Crest and no vote means they can now look at other options.”
“Pine Crest is a vital asset for our community,” a Merrill man said. “I’m sure a significant portion of residents would not be able to live there if it went private. I feel that it would be worth exploring options for selling to a private entity, but only after all other options are exhausted. This really should be something to be voted on by a referendum of some sort. Give County residents the chance to make the decision since it will be coming directly from their pockets.”
“I believe it is irresponsible of our elected officials to make such an important decision for the residents of Lincoln County without a referendum informing them of how their electorate feels about this issue,” a Merrill man said. “No one wants their taxes to go up, but there is an obligation of the citizens to take care of each other. I am not sure a private entity has the same understanding.”
“I definitely feel the matter should go to referendum,” Shirley Engel said. “I would like the County to retain Pine Crest, but feel everyone should have a chance to express their opinion.”
“(I’m) disappointed the elected officials have not listened to people in the community. They have lost all trust for me,” a Merrill woman said.
Many others made similar comments.
“I understand the complexity of this issue, and understand this is a tough issue. But listen to those who have elected you.”
“Listen to your constituents,” Gwen Cotter said.
“There should be a referendum re the selling of Pine Crest,” Nadine Appel said. “… Like others around the county, I find the Board’s action suspicious and perhaps nefarious. The people should decide. … Why the speed to sell? What’s behind the reasoning and the benefit to those saying sell. The people of Lincoln County deserve a say and options.”
“If Pine Crest is sold, there will be no turning back,” she said. “Time to put the brakes on and rethink this whole decision with the public’s input. Thank you for providing this survey.”