Written by Katie Rosenberg
It was an unseasonably warm Monday in March. I walked, dodging raindrops, to the front door of Mount View Care Center (Marathon County’s nursing home, operated by North Central Health Care) for a meeting with Senior Nursing Home Operations Executive Kim Gochanour and resident Joy Atchison. It was not unlike the last time I went to Mount View…
Exactly 2 weeks before to say one last goodbye to my grandfather.
Or the last 5 years of visiting him nearly every weekend with my grandmother.
Or even my visits 2 ½ decades ago to visit my great-grandmother, who spent her last year there.
But somehow this time it felt different… I had just been appointed to the Mount View Nursing Home Committee and been named Vice Chair.
I walked in and inhaled the familiar scent of hand sanitizer with a faint hint of the lunch that had been served just a couple of hours ago. As if on autopilot, I turned left and walked past the first-floor lunchroom, past the bulletin boards, past the physical therapy room, and through the glass-encased hallway, where I stood looking through the window toward Evergreen Place.
Through the drizzle, I could see residents sitting by their own window, enjoying the view… or nodding off. It was a spot my grandfather had enjoyed catching a quick catnap in his wheelchair or visiting with my grandma.
My eyes strained, knowing he wasn’t there, but looking for him anyway.
My mind meandered over the last 2 weeks with him, filled with visits from family, looking through old photo albums, and celebrating his meaningful life. That Monday, just 2 weeks earlier, I had sat in his room with my aunt, coming to terms with the idea that my grandpa could be experiencing his last moments on earth. We sat with him, reminiscing, telling stories about him and the antics of his six children. He slept, slowly breathing in and breathing out. We quieted when his breathing slowed and inched closer to his bed…
When he didn’t take another breath, my aunt left briefly and returned with a nurse. She gently checked on him and told us kindly, but without pity, that he had passed on. She gave us a little more time with him while she made plans to contact his doctor.
Good people work at Mount View.
My mind came back to the present, to the glass hallway. I turned around and went back to the main office, which I had passed on my way into the building. While I waited for my meeting, a jovial woman named Joy in a power wheelchair rolled in. She chatted with the other person in the office as though they’d been friends for years. Her soft voice paused only when she needed to catch her breath, and throughout her conversation (and the pauses), the gentle hissing of her tracheostomy tube and equipment kept an underlying rhythm like a metronome.
Joy has lived in Mount View Care Center for just over 4 years. She moved into the “vent unit” after her doctors determined she would need specialized care. Mount View is one of the handful of nursing homes in the state that offers vent care. Joy’s family lives in Green Bay, so it’s not too far for them to travel for a visit.
“If you have to be sick, this is the place to be. It’s as close to being home as you can be,” Joy assured me.
While we chatted, we looked out the window toward Lake Wausau.
Mount View, and the North Central Health Care campus, is situated in one of the more beautiful areas on Wausau’s southeast side. I could see the walking path that curls around the building. Joy said that she couldn’t wait for summer when she could go outside and ride along the path, but until the temperatures were regularly above 40 degrees, she’s not allowed to go outdoors because the cold could cause her trach equipment to malfunction. Her mind raced toward warmer weather anyway.
“The activity department manages to get us out for outings, so you don’t feel like you’re trapped. Your cabin fever is kept at a minimum. If you mention, ‘Gee, it would be really nice if’ — even going fishing! — they take a whole busload of people over to the dock and let you go fishing for the day,” Joy said. “How many hospitals do that?! The only thing that would be really great, that I personally would like, would be if we had a dock of our own, where we could go down and fish.”
Without question, Mount View provides vitally important, high-quality services to the residents.
In the coming year, the Marathon County Board will further examine the role the county will play in the operation of the nursing home. This is no small task, and the group entrusted to lead the effort is the Mount View Care Committee. As explained by Marathon County Administrator Brad Karger:
“Charting the future for Mount View Care Center (MVCC) will be a difficult task for the newly formed committee as we are currently experiencing declining census and escalating financial losses. The industry is constantly changing, and little of it benefits us financially. For example, the growth of assisted living providers and the focus on home-based supportive services has contributed to declining census. A shortage of workers for direct care services contributes to higher compensation costs and sometimes an inability to admit residents due to inadequate staffing.
Additionally, as a county facility, we are often called upon to care for residents who other facilities are unwilling or unable to care for (those with high-care needs and low reimbursements). Additionally, Wisconsin has one of the lowest Medicaid reimbursement levels for nursing home residents in the nation, and most of our residents are funded with Medicaid.
The financial issues are only one piece of the total picture, but they’re going to have to be worked through as the public subsidy to MVCC in 2017 is $1.7 million. If we don’t have an effective, future-focused plan, that subsidy could easily balloon to $5 million, and I don’t know where that additional money is going to come from.
Some counties have closed their nursing homes, and if we can’t make MVCC perform financially, that might become our only option. However, big challenges are nothing new to Marathon County, and I’m optimistic that the new Mount View Care Center Committee will find a way forward that meets the needs of Marathon County residents and strategically positions MVCC for success over the next 5 to 10 years.”
In addition to examining whether Marathon County should continue to directly provide nursing home services or contract with private providers for those services, or change the scope of the nursing home services it offers, the MVCC Committee will have to weigh the efficacy of making improvements to the facility itself.
The scenic view outside that Joy and the other residents of Mount View Care Center enjoy stands in contrast to the dated interior of the building. While staff members keep the nursing home clean and safe, it doesn’t look very homey with cinderblock walls and outdated furniture.
When I asked Joy what she would change about her home at Mount View, she hesitated.
“The people make this place what it is. They’re really amazing.” But then she remarked that actually, there was something she would change… “I’ve shared a bathroom ever since I’ve been here.”
Joy said that having a private bathroom would make her feel more at home. Joy isn’t alone in wanting some “homier” touches. Over the past few decades, the strategy for nursing home layouts has changed to accommodate such desires.
“The aesthetics [at MVCC] are an issue for us because it’s very institutional, and people want more homelike settings. Some of our competitors in the area are moving in that direction. We don’t need to be the Taj Mahal, but we do need to be more homelike. The comments I get from my patient satisfaction surveys are, ‘Can you get rid of the furniture from the ’70s? Can you get rid of the cinderblock walls?’ This is their home,” said Kim Gochanour, Senior Nursing Home Operations Executive.
Whether to renovate Mount View is just one of the considerations the new committee I’m on will tackle this year.
According to Mount View Care Center Committee Chair John Robinson:
“We need to take a step back and learn a little bit more about the industry, the trends, and our role. For instance, if we discontinue some of the beds, are there some options for behavioral health or other things? I think we need to go in with our eyes and minds wide open.”
This isn’t the first time the Marathon County Board has considered changes to Mount View. A few years ago, the county voted to renovate the building but later fell short of the votes needed to borrow money for the updates. According to John:
“We’ll be looking at the mission and vision of the county, who we’re serving, and how that ties into the core values, and the cost of bringing the facility up to par to provide those services.”
Kim Gochanour noted that counties that are in the nursing home business gain some financial benefits.
“The state has put in what they call the supplemental payment program. They have about $39.1 million that’s divvied up amongst the county homes and municipalities for patient days of Medicaid,” Kim explained. “We receive about $1.8 million in supplemental funding from the state. The benefit of that is that there is also money that goes into the Medicaid general fund that is used for other programs. It’s used for social services. It’s used for ADRC [Aging and Disability Resource Center]. It’s used for different programs that are not associated with the nursing home. Every time we lose another county nursing home, we also lose that extra Medical Assistance Trust Fund money.”
As the committee discusses potential changes to the residents’ homes and care, committee members will put Marathon County residents at the center. Changes can be unsettling, especially during life transitions that are already stressful. But thankfully the committee is stacked with dedicated members — experts like Kim who have spent 24 years in long-term health care — and other mentors who will guide our work.
At the end of our interview, Kim offered an open invitation to Marathon County residents to stop by Mount View:
“I wish that county residents would tour the nursing home and get the feel of the people who work here and the feel of the residents whom we serve,” she said. “They’re not a forgotten population. I think sometimes people think, ‘Out of sight, out of mind.’ But our residents have valuable input for the county and society, and I think sometimes people forget about that. We need to respect what they bring to the table.”
If you’d like to see all that Mount View Care Center has to offer, please call 715-203-8084 to schedule a tour.
Katie Rosenberg – County Board Supervisor District No. 1
Marathon County Board Supervisor | District 1
Katie Rosenberg is a Marathon County Board Supervisor representing District 1. She is passionate about engaging the community and is active on social media and in organizing neighborhood constituent meetings with her Wausau City Council counterpart, Alderman Pat Peckham. In her free time, you can find Katie enjoying the outdoors with her husband on bike, on roller skates, and in trail shoes. She also enjoys attending all manner of political events, traveling the world, and cooking up a mean vegetarian soup. Email Katie Rosenberg
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