Strafford County delegation hears Riverside Rest Home describe staffing shortfalls, aging building and financing options

Strafford County delegates and staff at a delegation meeting heard detailed testimony about capacity, staffing and capital shortfalls at Riverside Rest Home and discussed financing options for a new facility and interim uses for the existing building.

The briefing, given by Riverside staff and medical personnel, said the facility now operates about 170 of its 215 licensed beds and keeps separate dementia and behavior units that state rate calculations exclude. Delegates were told staffing shortages keep one entire unit closed, and administrators laid out the staff levels they say would be required to reopen it.

County leaders said the issue matters because counties share a portion of Medicaid costs and rising nursing-home expenses affect local budgets and, ultimately, property taxpayers.

Riverside staff described how federal and state reimbursement rules affect local budgets. “We currently operate 170 of our 215 beds,” said Ray, a Riverside administrator, adding that a 42-bed dementia unit and a 36-bed behavior unit are not included in state acuity counts because the state treats those as atypical, higher-reimbursing populations. Ray and other speakers described skilled-care reimbursement rules under Medicare and Medicaid, including the common 100-day Medicare maximum for post-hospital skilled care and the first 20 days paid in full by Medicare.

Administrators said opening the closed unit would require more nurses and aides. “You need five to six nurses, and around 20 aides,” Ray said, describing a mix of floating nurses and unit-based staff. Delegates pressed for a written cost estimate; Ray agreed to prepare a staffing-cost calculation that would show expected Medicaid reimbursement and the delta the county would need to cover.

Speakers across the session described multiple constraints that shape Riverside’s budget. A presenter said New Hampshire’s Medicaid payment process produces a county share that differs from the full allowable cost, and that the state’s budget decisions and earlier double-billing of federal funds had complicated county revenues. One county official summarized the local share as about $11,000,000 per year and noted a recent 3% budget change would translate to roughly $330,000 for Strafford County, as discussed at the meeting.

Medical staff described the clinical population and operational challenges. “Almost everybody suffers from some degree of dementia, and almost half of those people with dementia require one-on-one care,” Dr. Ed Chollet, a physician who has worked with Riverside for decades, told the delegation. Staff and clinicians said Riverside now accepts more patients with severe psychiatric illnesses and that such residents often need continuous supervision and frequent medication management; the facility also works with regional hospitals on admissions and transfers.

Delegates and staff described the physical limits of the existing building. Speakers said many rooms are double-occupancy, some have only one shower for dozens of residents, the HVAC and plumbing systems have failed at times, and asbestos complicates in-place renovation. “It’s an infectious-disease nightmare,” one presenter said of close quarters and shared rooms during outbreaks.

Because the building needs substantial capital work and because construction costs have risen, speakers discussed a long-term plan for a new nursing home and short-term options for the current property. Possible interim uses raised included converting part of the complex to a warming center or other municipal services; any such arrangement, presenters said, would require formal agreements among municipalities and approval by the county delegation. County staff said they are discussing a memorandum of understanding with municipal partners and stressed that any leases or land transfers would come before the delegation for approval.

Delegates also discussed funding approaches. Speakers reviewed past proposals that relied on a $16.5 million federal/state grant that did not materialize and said the county must consider bonding options, private donations to a county trust, and the feasibility of spreading capital costs without causing a large tax spike. Several delegates recommended a focused next meeting to review a bond plan, previous site studies, and a revised cost estimate.

Before adjourning, Riverside staff and county representatives agreed on two immediate follow-ups: staff will prepare a written estimate showing (1) the cost to staff and open the currently closed unit, (2) the Medicaid reimbursement that might be expected, and (3) the remaining delta the county would need to cover; and the delegation set a follow-up meeting in August to review the numbers and past site plans. No formal vote or appropriation was taken at the session.