Strafford County delegation hears report showing multi‑year losses at Riverside Rest Home, discusses privatization and funding options

Members of the Strafford County legislative delegation spent most of their meeting reviewing financial data and policy options for Riverside Rest Home, the county‑owned nursing facility, after a presenter’s report said the home has run persistent operating losses under Medicaid reimbursement.

The presenter summarized Medicaid cost‑report figures and told the group that Riverside posted a Medicaid cost‑report operating loss of about $7.17 million in 2024 and that average annual losses over the past decade run in the mid‑millions. "The Medicaid cost report is effectively telling the county, at current utilization and reimbursement levels, this facility does not work as any sort of business at all," the presenter said. The presenter added that a long record of losses means a major capital investment or rebuilding would "lock in decades of future losses."

Why it matters: Delegation members said the losses are largely structural—tied to Medicaid reimbursement and long‑term shifts that have pushed more cost to county budgets—and that continuing current county ownership effectively spreads operating deficits across the property tax base. The delegation needs to reconcile financial realities with the county’s legal and moral obligation to care for indigent residents who rely on Riverside.

What the figures show: The presenter read year‑by‑year Medicaid cost‑report losses for Riverside from 2015 through 2024 (examples given in the report included roughly $3.4M in 2015, $4.6M in 2016, about $10M in 2022 and $9.95M in 2023, and roughly $7.0M for 2024) and described an average annual operating loss in the range of several million dollars. The speaker characterized these as standardized, federally required accounting statements that reflect actual revenues and expenses for Medicaid‑certified facilities and therefore as evidence of a structural funding gap rather than a one‑time accounting anomaly.

Debate over causes and remedies: Several members urged caution about immediate operational changes that could disrupt care or staffing. One legislator said private facilities can sometimes operate at lower per‑resident cost, citing a private estimate of roughly $160,000 per resident versus a county figure near $230,000, and asked whether a private partner could operate more efficiently. Others replied that wages and benefits at Riverside are comparable to regional facilities and that cutting compensation risks losing experienced staff. The delegation also heard that some potential nonprofit partners (including Catholic Charities) are themselves operating at deficits, limiting transfer options.

Options discussed: Delegation members discussed several possible approaches: seek legislation or state action to increase Medicaid funding; pursue public‑private partnerships with mixed payer models (presenters suggested a roughly 3:1 private‑pay to Medicaid mix to make private operation financially viable); implement a phased drawdown or transfer of specific beds to private or nonprofit operators; or explore targeted vouchers and trusts to subsidize care for indigent residents. The presenter warned regulators and legal constraints would be required to avoid "cherry‑picking" private‑pay residents.

Admissions and reciprocity: The delegation discussed data showing a portion of Riverside residents are from out of county or state, and presenters explained federal and interstate settlement rules can allow reciprocal placements when family caregivers live locally.

Next steps: Members agreed the presenter will circulate a written report within about a week and the delegation will schedule a dedicated meeting (proposed March or April) to review options and a funding section the report will include. The committee asked the delegation to consider how to address an identified operating gap of roughly $7.1 million and what combination of state funding, privatization, or phased strategies would be feasible.

Quotes from the meeting include the presenter: "A Medicaid cost report loss of this size indicates that reimbursement rates are materially below the cost of providing care," and a legislator: "If we want Riverside to close and put 150 people out, where are they going?" The meeting ended with an agreement to finalize and circulate the report and bring the issue to a full delegation meeting for decisions or legislative requests.

What happens next: The delegation will receive the full report, discuss recommended options at a focused delegation meeting, and consider whether to pursue legislative remedies, solicit private partners, or adopt a phased transition plan.

Sources: Meeting transcript of Strafford County legislative delegation informational meeting (presenter report and member discussion).