Opinion ID: 1653213
Heading Depth: 1
Heading Rank: 5

Heading: the need for services

Text: Since the Department's regulations allow an applicant to identify the population in need, see § 005.01A2, in proceedings before the appeal panel, Manor Care identified Lancaster County as the population in need of its health services. By stipulation, an initial issue was whether Manor Care's facility satisfied an unmet need for long term care services in Lancaster County .... (Emphasis supplied.) We construe this stipulation as a factual admission that Manor Care's proposed service area is Lancaster County, but we do not construe service area to mean [h]ealth service areas or subareas under 182 Neb.Admin. Code, ch. 2, § 002.02A (1983). The appellants seek to enlarge Manor Care's proposed service area to include a 30 mile radius around the City of Lincoln. This service area would include all of Lancaster County, plus portions of Saunders, Seward, Saline, Gage, Otoe, and Cass Counties. Brief for appellant objectors at 23-24. Appellants argue that Manor Care's service area should be enlarged because a substantial number of Lancaster County residents have left the county to reside in nursing homes located in neighboring counties. Rather than demonstrating that Manor Care will serve persons outside Lancaster County, appellants' argument is more persuasive that Manor Care's proposed service area should be accepted and retained rather than enlarged. On the other hand, information that many residents from surrounding counties are moving, or have moved, to Lancaster County for nursing home care might evidence a need to enlarge Manor Care's service area. After reviewing the record, we find that Manor Care's proposed service area is Lancaster County. In the present case, the primary dispute involves a determination of the long-term-bed need in Lancaster County. 182 Neb. Admin. Code, ch. 2, §§ 006.09 et seq. (1983) provide: 006.09 Long-Term Care Beds (Skilled Nursing Facility and Intermediate Care Facility Beds, Excluding ICF-MR Beds). 006.09A The combined occupancy of long-term care beds in the applicant's service area must be 90 percent or greater before long-term care beds may be added. 006.09B A system of alternative services, including either home health services, home aide/homemaker services, or an adult day care center, must be accessible to a majority of the population in the service area of the proposed project before long-term care beds may be added. 006.09C Rural needs and local differences shall be recognized by using the age-gender group needs of the population in any applicant's service area identified under subpart 005.01A2 above. No long-term care beds may be added if the number of beds in the applicant's service area exceeds the need for that area determined by aggregating the bed needs estimated for each sex and age group from the following methodology: Long-Term Bed Population × Utilization Rate Goal Need = Minimum Occupancy Rate Goal The Department's regulations provide: 006.09C1 The population includes the total population of the applicant's service area, disaggregated by age (0-44, 45-64, 65-74, 75-84, 85+) and sex. 006.09C2 The utilization rate is the number of long-term care residents per 1000 persons. The utilization rate goal for each sex and age group is as follows: Age-Sex Utilization Rate Goal 0-44 Female 0.10 Male 0.11 5[sic]-64 Female 2.84 Male 3.00 65-74 Female 14.87 Male 13.82 75-84 Female 69.52 Male 47.35 85 + Female 247.81 Male 173.25 006.09C3 The minimum occupancy rate goal is 90 percent, the goal for the ratio of the total number of patient days to the total annual available bed days. At the appeal panel hearing, the Department supplied information that the projected number of long-term-care residents in Lancaster County for 1990 was 1,437, to which a factor of .9 is applied, resulting in a long-term-care need of 1,597 nursing home beds. As of 1987, there were 1,477 available beds. Deducting 1,477 (available beds in Lancaster County) from 1,597 (projected need) leaves 120 beds which will be needed for long-term care of Lancaster County residents. The appellants argue that the number of existing beds in Lancaster County should include 28 beds which Bethphage Residential Care Center was recertifying and 50 beds in a proposed nursing home at Waverly, in Lancaster County. The state regulations fail to provide a method for calculating existing beds. See §§ 005 and 006. In Department of Health v. Grand Island Health Care, 223 Neb. 587, 598, 391 N.W.2d 582, 589 (1986), we stated that [t]he mere filing of a notice of intent [to apply for a certificate of need] does not, of course, indicate that the facility will be built. In our factual determinations, we have taken an approach that existing beds are only those beds currently available. There is no evidence that Bethphage's recertified 28 beds were available for use. Further, when the appeal panel reviewed Manor Care's application, the administrative process was just beginning for determination whether the proposed Waverly nursing home was entitled to a certificate of need. Administrative and judicial review are two of many contingencies involved in determining whether a nursing home may be built and operated. Accordingly, we find that there were 1,477 existing and available beds in Lancaster County. Thus, we conclude that there is a long-term need of 120 nursing home beds in Lancaster County.