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In March, Brenda Dunn's nursing home was in trouble.
Vendors were dropping the facility, forcing her to find others, or to purchase on extended credit. She didn't know whether the Parkview Care Center in West Frankfort would be able to meet its payroll and, at times, asked her employees to hold their paychecks for a few days, breathing a sigh of relief when the money got there.
"Sometimes, we had to run the checks through twice," she said.
Dunn, the facility administrator, was worried.
Public Aid was three months behind in its Medicaid payments to the 59-bed facility, and to all facilities around Illinois. This spells disaster when 90 percent of a nursing home's patients are supported by the state, as is the case with Parkview.
Though Parkview is now financially stable, it was a stroke of luck that saved it. The facility went under new ownership in April because the previous owners "went under." The new owners have more financial backing, which, coupled with a large back payment in May from the state of Illinois, aided to bring the facility back to the surface.
"We are just now getting back on our feet with our vendors, with everything we need," Dunn said. "We were getting ready to be shut off, because the last owners could not afford to pay, because the state was not paying them."
Mike Claffey, spokesman for the Illinois Department of Public Aid, said the state stays about two to three months behind in Medicaid payments to nursing homes and tries to keep things in a 60-day pay cycle. But in May, Illinois was as much as five months behind with some facilities, which prompted a state loan and large amounts of back pay to Illinois nursing homes.
"It's not something we're happy with, but there's no money in the state treasury to pay more promptly," Claffey said.
But Bob Buffington, owner of Raintree Terrace, a 16-bed Carbondale facility for the developmentally disabled, said the state has followed this trend of back pay for at least the last six years.
"This year was nothing new," he said. "Annually, their budget starts to run short about two to three months after the fiscal year ends. Things start going off schedule, progressively going further and further, from October on. By the time it hits January or February, its four or five months out."
Sharon Knock of the Public Aid office said that the department has seen a trend for the past few years of building back payments for Medicaid and breaking large checks in May due to "special circumstances," though she believed it wasn't quite six years.
"In the mid- to late-'90s, when the state had more money, we could keep payment delays minimal," she said. "But given the state of the budget, we've had to back off a bit."
Knock said that while some facilities get paid sooner than others, the average should stay at about three months for most of the year. Some nursing homes are expedited due to the high concentration of Medicaid patients and receive payment sooner.
Even though expedited facilities receive quicker payments, Jerry Neal, president of the SI Healthcare System, which operates five facilities in Central and Southern Illinois, said it still hurts when the state falls behind.
Neal said his three Mount Vernon facilities, which include the Casey Care Center and Jeffersonian Care Center Inc. service about 170 senior citizens and employ slightly more, with 80 percent of their revenue coming from public aid, causing monumental financial deficiencies.
"We had payrolls hit the streets without totally having them covered," he said. "We had vendors that were stretched as far as we were. Some would go along, some we'd have to find new or go on COD, or find other measures."
Neal said that in the health care industry, with the rules and regulations imposed by the department of public health, the facility had no room to budge with the level of care it provided - the residents still need clean linens, still need medical attention and still require a certain level of staffing. And if the facility cannot provide these, it is shut down by public health.
"The costs are mandated," he said. "We don't have the luxury that when cash is tight, we can cut back. We can't cut back below what is required, and we're not going to refuse to take care of someone because they are on public aid. They expect and deserve care."
Along with the reimbursement checks the Department of Public Aid mailed in May, they also sent a new list of requirements that greater restricts the amount of funding a patient can receive.
Sherry Johnson of the West Frankfort Care Center said that Public Aid is now refusing to pay to hold beds for residents while hospitalized or on home visits.
"Yeah, the cost is up, but they made new rules," she said. "Like if a resident goes to a hospital and are on public aid, they stop paying. If I have a resident pass away at 10 minutes 'til midnight, they won't pay for that day."
Johnson said Public Aid used to provide a 10-day bed-hold, in which they would pay to hold a bed if a resident was hospitalized, though they now place that burden on the patients and their families.
"When they held back payments, they were hurting the operators and not the patients," she said. "We had to somehow find the money to buy supplies - I don't know how we did, but we did.
"But in this case, they're hurting the elderly. That's not how I work. I will hold the bed, because I don't think it should be on the family's mind, 'she shouldn't go to the hospital because we might lose her bed,' and then risk greater illness to the resident."
Neal said, that with the Illinois Medicaid system, which is ranked 48th among state payouts, he believes major problems will develop for Illinois' elderly.
"The bottom line is that the profession will not sustain itself under the current system," he said. "When most revenue is down $15 to $20 per day below costs, you can't offset the costs you incur. It's impossible to achieve a decent level of care on $65 a day when your costs are $85 a day."
Neal also noted that Illinois' 58,000 Medicaid nursing home patients are only given $30 per month for basic supplies, including clothes, soap and shampoo.
"If you have a female resident that may be a smoker that wants to get her hair fixed once a month, she's not going to get it done," he said. "There's no way."
Dunn said that amount hasn't been raised since the 1980s, not even to accommodate cost of living increases. She said her facility does a lot of fundraising to help their patients, many of whom do not have family to fall back on, with costs.
"If a lady wants to get her hair fixed, that's all her money," Dunn said. "She wouldn't be able to buy panties or clothes or other necessities."
