<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:st1="urn:schemas-microsoft-com:office:smarttags" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv=Content-Type content="text/html; charset=utf-8">
<meta name=Generator content="Microsoft Word 11 (filtered medium)">
<!--[if !mso]>
<style>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style>
<![endif]--><o:SmartTagType
namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="State"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="City"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="PlaceType"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="PlaceName"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="place"/>
<!--[if !mso]>
<style>
st1\:*{behavior:url(#default#ieooui) }
</style>
<![endif]-->
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"Arial Narrow";
panose-1:2 11 5 6 2 2 2 3 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman";}
h2
{mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
font-size:18.0pt;
font-family:"Times New Roman";
font-weight:bold;}
p.MsoEnvelopeReturn, li.MsoEnvelopeReturn, div.MsoEnvelopeReturn
{margin:0in;
margin-bottom:.0001pt;
font-size:10.0pt;
font-family:"Arial Narrow";
color:black;}
a:link, span.MsoHyperlink
{color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{color:blue;
text-decoration:underline;}
p
{mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
font-size:12.0pt;
font-family:"Times New Roman";}
span.EmailStyle21
{mso-style-type:personal-reply;
font-family:Arial;
color:navy;}
@page Section1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.Section1
{page:Section1;}
-->
</style>
</head>
<body lang=EN-US link=blue vlink=blue>
<div class=Section1>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Donovan,<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Please notice that the yellow portion on
the architect’s rendering is planned for skilled nursing. Gritman will try to
find an organization that will operate skilled nursing or assisted living in
the 17,000 square foot upper eastern portion. It would be an ideal place for
skilled nursing or assisted living and would work well with Gritman Adult Day
Health planned for the green section. A larger version of the architect’s
rendering is displayed in the Gritman lobby.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>However, the more Gritman learns about skilled
nursing, assisted living, reimbursement rates, county homes, etc., the more apparent
that it may be very difficult to find an operator. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>It’s easy to point fingers at the Latah
County Commissioners and Latah Health Services for letting the facility fail. But
reality, history and government mandates can clearly explain why this happened.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>At one time, nearly every county in the State
of <st1:State w:st="on"><st1:place w:st="on">Idaho</st1:place></st1:State> had
a ‘County Home.’ Now there are only two remaining, both highly subsidized by
taxpayers. The <st1:place w:st="on"><st1:PlaceName w:st="on">Boundary</st1:PlaceName>
<st1:PlaceType w:st="on">County</st1:PlaceType></st1:place> facility receives
about $300,000 annually in county taxpayer subsidies. The <st1:place w:st="on"><st1:PlaceName
w:st="on">Blaine</st1:PlaceName> <st1:PlaceType w:st="on">County</st1:PlaceType></st1:place>
facility receives about $750,000 annually in county taxpayer subsidies. A
similar taxpayer subsidy would have been needed to keep Latah Health Services
open. Would the taxpayers of <st1:place w:st="on"><st1:PlaceName w:st="on">Latah</st1:PlaceName>
<st1:PlaceType w:st="on">County</st1:PlaceType></st1:place> vote to subsidize
LHS that much? The Latah County Commissioners didn’t think so. With the
reversionary clause in place, <st1:place w:st="on"><st1:PlaceName w:st="on">Latah</st1:PlaceName>
<st1:PlaceType w:st="on">County</st1:PlaceType></st1:place> voters would have
had to approve a multi-million dollar bond to renovate the facility and then
several hundreds of thousands of dollars for operations. It’s very doubtful
the voters of <st1:PlaceName w:st="on">Latah</st1:PlaceName> <st1:PlaceType
w:st="on">County</st1:PlaceType> would have approved, similar to the voters of
other <st1:State w:st="on"><st1:place w:st="on">Idaho</st1:place></st1:State>
counties where their county homes have gone out of business.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>This is a sad reality but is an indication
of the healthcare changes that started in the 1990’s. Medicare and Medicaid do
not reimburse enough to pay the costs of indigent care in facilities. Most skilled
care/assisted living operators try to mix Medicaid residents with private pay
residents in order to survive. There are at least 50 extra licensed but vacant
beds in the other facilities in <st1:place w:st="on"><st1:City w:st="on">Moscow</st1:City></st1:place>.
The operators chose not to use them because a higher mix of Medicaid patients
would make it difficult to survive.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>The Kaiser Family Foundation has done
several studies on Medicare and the uninsured. These papers outline the forced
progression away from assisted living and skilled nursing facilities because of
costs in favor of Home & Community Based Services (HCBS). Gritman Adult
Day Health and Gritman Home Health are considered HCBS’s. The Medicare
Modernization Act of 2003 further emphasizes reduced funding for care
facilities. Yesterday, President Bush announced that he wants more Medicare
and Medicaid cuts. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>I believe there is a clear picture for the
government to continue Medicare and Medicaid cuts and more encouragement for
Home & Community Based Services, wellness programs, etc. These services
are what Gritman is planning for the facility and all without <st1:place w:st="on"><st1:PlaceName
w:st="on">Latah</st1:PlaceName> <st1:PlaceType w:st="on">County</st1:PlaceType></st1:place>
taxpayer subsidy.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Gritman respects the decision of the
voters on Tuesday and will hold that decision in highest regard.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>B. J. Swanson<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<div>
<div class=MsoNormal align=center style='margin-left:.5in;text-align:center'><font
size=3 face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal style='margin-left:.5in'><b><font size=2 face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;font-weight:bold'>From:</span></font></b><font
size=2 face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'>
vision2020-bounces@moscow.com [mailto:vision2020-bounces@moscow.com] <b><span
style='font-weight:bold'>On Behalf Of </span></b>Donovan Arnold<br>
<b><span style='font-weight:bold'>Sent:</span></b> Sunday, February 04, 2007
3:03 AM<br>
<b><span style='font-weight:bold'>To:</span></b> Saundra Lund; 'vision2020';
odrawhorn@dnews.com<br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: [Vision2020] Daily
News, Saturday,3 February 2007: Gritman outlines its plans for LHS</span></font><o:p></o:p></p>
</div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'><o:p> </o:p></span></font></p>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>"The 17,000-square-foot upper-eastern portion of
the building is vacant, but Swanson hopes it eventually will be leased to an
assisted-living facility. We have talked with three different companies,â€
Swanson said. “The problem is the mix of patients.†<o:p></o:p></span></font></p>
<div>
<div>
<div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Housing private patients, as opposed to Medicaid
patients, would be more workable, she said." <o:p></o:p></span></font></p>
</div>
</div>
</div>
</div>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>What about <em><b><i><font face="Times New Roman"><span
style='font-weight:bold'>skilled nursing</span></font></i></b></em>? It appears
that Gritman is not interested in bringing back the skilled nursing facility,
the largest and most important part. <strong><b><font face="Times New Roman">Assisted
Living</font></b></strong> is not the problem, skilled is. Skilled requires
licensed nursing staff and skilled is where the super majority of LHS
residents resided, they are in need of level 3-5 care. <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Assisted living is much fewer in number, generally
level 1 or 2 care level and don't need licensed nurses or certified nursing
staff on the premise to care for them. <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>My belief is that Gritman will not bring skilled
nursing back because there is no profit in government funded Skilled
Nursing , only Private Pay Assisted, they only thing they want to provide. <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Where are Skilled Medicaid Patients to go, they
were the ones that LHS serviced? Privately insured assisted living folks don't
have the real problems.. Gritman is ignoring the people that are being
short changed here, the level 4 and 5 care people that are on government
provided care.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Gritman can expect to get about 2-3K a month per
resident in assisted living, a large profit paying little in wages and medical
costs. With Skilled Nursing, they see about 5K a month but, skilled nursing
requires licensed nurses and certified nursing staffing, and higher medical
care costs, making it not profitable. <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Donovan J <st1:City w:st="on"><st1:place w:st="on">Arnold</st1:place></st1:City><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>CNA<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Former LHS Employee<br>
<br>
<o:p></o:p></span></font></p>
</div>
</div>
</body>
</html>