Strafford County nursing home vote faces deadline for federal funds: Will it pass?

DOVER — Strafford County's plan for a new $146 million nursing home is expected to go to a vote of the county's delegation of state representatives in December. Leaders are facing a deadline to qualify for $15 million in federal American Rescue Plan Act funds.

The Strafford County delegation met Wednesday night for a workshop session as they continued to hash out details for the nursing home, considering plans from Strafford County commissioners that have been scaled back from the original $170 million proposal that was rejected last year.

Questions from the delegation focused on the design of the building for potential cost-cutting changes to the new nursing home, which would be built on County Farm Road, replacing the existing Riverside Rest Home. County commissioners hope to convert the existing nursing home, also on County Farm Road, into a transitionary facility to help the homeless population.

Money is an issue for state reps

A presentation made by Stephen Maceroni, director of Public Financial Management (advisors to the delegation) focused on the current market conditions and how that might impact bonding the project.

Maceroni gave an overview of the market, and said interest rates increased over the summer but noted there had been a nice rally in the market lately, indicating the possibility that inflation is going down and could positively affect municipal rates.

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Maceroni also talked about the two types of bonds the municipality could choose, and how they would work.

It seemed clear at the work session the delegation is looking to cut costs. Among the ideas were simplifying the design of the building and reducing some of the amenities.

When it was suggested the architects return to the drawing board and find ways to reduce costs, County Commission Chair George Maglaras reminded the delegation if they vote to approve the revised plan in December, the county is eligible for the full $15 million in ARPA funds. If not, the money will be lost, he said.

Maglaras said, after the meeting, he is aiming for a Dec. 20 meeting of the delegation, where a vote could be taken. He said perhaps another work session might be needed before then.

"We need to spend $40 million by December 2025 to get that $15 million," he said. "And if they wait to say, February, we'd only be eligible for $10 million, and would need to spend $30 million to get the funding. So obviously, we are hoping for a positive vote next month. We could spend that required amount by buying things such as steel and the heating systems in advance of construction, storing them for the right time."

Republican support will be needed for nursing home to pass, rep. says

State Rep. Peter Schmidt, D-Dover, chairs the delegation. He said he hopes the nursing home project is passed because it is needed.

"The current Riverside Rest Home is tired," said Schmidt. "There are many services we could be offering that we have to send out, because we do not have the room and the 50-year-old building is not able to be upgraded enough to meet codes needed to offer more. We can't open up the walls to expand there. There is asbestos, and it would become a hazardous site that could not allow the current population in there. Where would they go? We could be saving money and offering better care and earning more revenue. The staff there does excellent work and we need to give them the tools they need to do their jobs."

Schmidt said the clock is ticking for the ARPA funds.

"We have $15 million on the table," Schmidt said. "If we do not decide by mid-December, we lose that. Without a two-thirds vote, the project will not get built. We do not have enough votes on the Democratic side. We need some support from our Republican colleagues."

There are 38 members of the delegation, including 14 Republicans. Schmidt said a two-thirds vote of representatives is required to pass the measure. Maglaras said it must be two-thirds of representatives who participate in the vote.

"Nursing home life is changing," said Schmidt. "People are living longer and their standards of living are changing. Many are staying home longer and when they come to us, they still want a good quality of life. We are trying to provide that, and at the same time, allocating Riverside to help address our homeless populations."

"We worked really hard to accommodate their thoughts," said County Administrator Ray Bower. "We are trying to do this without impacting the integrity of what we are trying to accomplish."

A look at the nursing home plan

The plan calls for a single five-story building with 285,000 square feet of space and 215 beds. A nursing station would be located at the center of each floor.

Maglaras has touted the plan's "Main Street concept." The front area of the first floor would include a lobby, chapel, community/meeting room, barber, post office, clothing boutique and a café in an atrium-style area open up to the fifth floor.

Support services, like dietary, housekeeping, receiving and the necessary mechanicals, would be at the rear of the property. Two elevators, a public one in the front of the building and a service elevator in the rear, are included. Administration, including social services and infection control, would be on the second floor. Admission services would be in the front of the first floor.

The estimated $146 million cost for the new version of the project includes the building, grounds, furniture, fixtures and equipment. Commissioners are working on ways to reduce the impact to taxpayers, including no tax impact for the first year.

Maglaras said their plans call for not bonding the entire amount at once, but to do so in increments, as money is needed, using bond anticipation notes, a sort of line of credit approach.

"Interest rates are high right now, so if we did this, we could watch the market and bond the project at the best time," said Maglaras. "We could start with something like $5 million for site prep work for the first year."

Bower said the plan is rather than having one bond to fund the entire project, to do a series of smaller bonds, in increments.

Schmidt said he feels the project should be looked at much like the jail was when the county built it 25 years ago.

"We created a space we needed, and more," he said. "We take in contract detainees, like ICE and other federal prisoners. The county is paid for that, and it helps fund services. We can look at the nursing home along similar lines, where can we bring in revenue. We could take more Medicaid patients but right now we do not have the space, do not have the necessary facility."

Bower said the county hired Lori Shibinette, who was the commissioner of the state Department of Health and Human Services during the coronavirus pandemic. She is helping develop plans for the project. A registered nurse, Shibinette previously was the chief executive officer of the Merrimack County Nursing Home, where she also had served as clinical director.

Bower said Shibinette created a three-year plan, showing the time needed to get the new facility up to full-capacity operations.

"In year one, we want to make sure the (bond anticipation note) does not impact taxes," he said. "In year two, we think we'd break even and in year three, we should begin to show profit. It's a very achievable goal."

A report detailing revenue projections for the new nursing home notes how limitations at the Riverside Rest Home affect the county's ability to open up new beds and attract and retain qualified staff.

The report indicates the number of patients is down, because of space limitations and programs the staff cannot run at the current location but would with a new facility. They project a return of nearly 74% of population in year one in a new nursing home, nearly 84% in year two and a return to almost 100% by year three.

If all went well with the December vote, construction could begin on the new facility in late summer 2024.

"The price to do this will never go down," said Schmidt. "We need this, and I am hopeful we do it."

After rejecting a bond for the project last year, the delegation authorized spending more than $6 million for the planning and design of the less expensive alternative.

This article originally appeared on Fosters Daily Democrat: Strafford County nursing home vote faces deadline for federal funds