Belknap County nursing home reports staffing gains, 67% occupancy; boiler and kitchen renovations planned

Shelley, the Belknap County nursing home administrator, told the county commissioners that the facility is currently caring for 63 residents, or about 67% occupancy, and that the Medicaid rate recently increased to $283.34 per diem.

The update covered staffing, training and facility projects. Shelley said the home has no vacant administrative positions and listed current nursing and support staffing levels and recent hires: 102 employees overall (a mix of full-time, part-time, registry and agency staff), 28 hires in 2024 and 11 hires so far in 2025. She said agency staffing has dropped from about 12–14 last year to 7–8 now, which the home attributes to reduced reliance on agency workers and to savings from internal staffing changes. "We have 1 Medicaid pending right now," Shelley said, and added that the facility saw several retirements and separations in the period reported.

Shelley identified several ongoing quality-improvement projects tied to federal/state nursing-home measures, including review of medications (noting antipsychotic use for behavior), catheter-associated urinary tract infection risk related to residents with Foley catheters, and standard infection-prevention work; she described some of those measures as dependent on resident needs rather than wholly within the facility’s control. "It's very difficult to change," Shelley said of some of the clinical measures tied to case mix.

On facilities work, she said the nursing home recently completed final inspection on a new boiler system. The contractor is scheduled to switch the site to the new boiler during a day when hot water will be off for about three hours to confirm the transition goes smoothly; the nursing home plans to schedule baths early and use disposable trays for lunch while the switch occurs. Shelley said kitchen renovation templating is complete for kitchenettes, the nurses' station, the staff development office and the therapy countertop, and that cabinet and countertop selections are set pending a start date from the vendor. A new kitchen steamer bid has been awarded and the facility is awaiting installation scheduling.

On dining services and resident meals, Shelley said the county’s current meal contractor, Glendale Dining Services, was sold to a company identified in the report as Witsons (owner Paul Whitcomb). She said the new contractor is honoring the county's 2025 contract while the county issues a new RFP this week to address meal and staffing challenges, including limited dining-room service on weekends. "The dining room is not open [for full service] on weekends," Shelley said; she added that families may use the family room, activity room or cafe and that staff meals remain available on weekends.

Shelley reviewed recruitment partnerships and student clinical placements: Plymouth High School recently completed clinicals, Hewitt students started clinicals in March, and the county nursing home is working with Lakes Region Community College on RN and LNA program pipelines and tuition assistance. She said some staff members are pursuing LPN study with tuition reimbursement and return-to-work incentives. She described incentive programs used during staffing shortages (weekend stipends and emergency-shift pay), noting the county spent about $17,000–$20,000 on incentive programs during recent pay periods but that mandatory staff coverage was rarely required in the January–March period.

Commissioners asked whether the nursing home's current occupancy approached the 2025 budget assumption; Shelley said the budget used a 70% occupancy assumption and that current levels "are getting towards that 70%." Commissioners also asked about the facility’s five-star quality measures; Shelley said the facility shows strong scores in several segments but that some measures depend on resident case mix and therefore are difficult to change quickly.

The county commissioners thanked Shelley for the report.