Staffing shortages, higher Medicaid reimbursement rates and better financial management could lead to roughly $1 million in savings this fiscal year in the operations of a Dubuque County- owned nursing center.

Taxpayer support for the operations of the long-term-care facility is expected to drop by about $650,000 next fiscal year compared to the current budget.

Sunnycrest Manor officials recently presented updated budget figures and projected revenue and spending to county officials as they work to finalize the county budget for the fiscal year that begins July 1.

While revenue is estimated to drop from about $9.4 million to $9.2 million, the facility is projecting nearly $1.2 million less than budgeted in expenses for the current fiscal year.

“We have not been fully staffed this year, so that’s created (savings from) some openings,” said Sunnycrest Finance Director Emily Gosche.

Sunnycrest Administrator Cris Kirsch said staffing continues to be a challenge — for licensed nursing, dietary aide and housekeeping positions — due to competition with local hospitals, private nursing facilities, hotels and restaurants.

Last year, Sunnycrest officials requested an across-the-board wage increase for nursing staff and a tuition-reimbursement program in hopes of curbing a persistent nursing shortage.

But despite the shortage, Kirsch told county supervisors that staff continues to provide quality care to Sunnycrest’s about 100 residents, noting that the facility has had “no major deficiencies in the most recent surveys of both licensed areas.”

Next fiscal year, Sunnycrest staff anticipate more than $9.6 million in revenue compared to $11.9 million in expenses, equating to a county subsidy of $2.26 million. That compares to a currently budgeted operating subsidy of $2.9 million.

Gosche said she anticipates Sunnycrest will receive about $9.5 million in billed revenue, with higher Medicaid reimbursement rates for skilled nursing that equate to an additional $5 per day per resident.

Rates for care provided to people with intellectual disabilities are projected to increase by $18 per resident per day, she said.

Anticipated increases in expenses are largely tied to cost-of-living wage increases for employees, as well as a potential 10% increase in employee health insurance costs.

Historically, the county has subsidized Sunnycrest to the tune of $3.1 million on average each year.

The facility serves indigent residents who rely on Medicare and Medicaid, but reimbursements from the federal programs do not fully cover expenses.

“Whatever you’re doing there is being done exceptionally well,” said County Supervisor Ann McDonough to Gosche, who started in the newly created position in the spring of 2017.

Fellow Supervisor Dave Baker echoed the sentiment.

“The biggest single positive thing Cris has done is ask for Emily’s position,” he said.