MERRIMACK COUNTY — County staff reported better-than-expected news on ProShare calculations for the Merrimack County nursing home and described ongoing efforts to raise census and align private pay rates to actual cost per day.

Heather, a county nursing-home staff member, told commissioners that a change proposed by state guidance and CMS had threatened roughly a $1.5 million reduction in ProShare funding. Staff adjusted the facility's private rate because the private rate had been below the facility's cost-per-day; the change led to the loss of one resident but otherwise was accepted by most families, Heather said.

"Bottom line, it is good news," Heather said, adding that state officials ultimately did not implement the new formula and that the county's prior corrective action — increasing the private rate to reflect cost-per-day — improves resilience for subsequent years.

Staff reported census numbers as a key driver of costs. As of the 17th of the month the facility's skilled census was 258; later updates in the meeting put the count around 265 after opening additional beds on the transitional care unit and scheduling new admissions. Management said it expects to review cost reports annually (cost reports are submitted each March) and adjust private rates as appropriate in subsequent budget cycles.

Commissioners and staff discussed the human side of increasing census and the operational complexity of filling and maintaining skilled nursing beds — from hospital transfers and discharges to hospice and the impact of natural demographic change. Heather said the administration expects modest cost-per-day improvement as census grows but cautioned that full-capacity costs could rise year-over-year with inflation.

No formal vote was required for the informational ProShare and census update; commissioners thanked staff for the report and asked that the figures be reviewed in the next annual cost report cycle.