University of Kansas

Closing the Nursing Home


The nursing home was a long-time responsibility of the County.  In fact, the county owned and operated it.  Financially, it was losing money consistently.  Recently, a new county commissioner was elected.  She had pledged to the voters that she would run a tight ship and that all “sacred cows” would be scrutinized in an effort to save county residents money.  She replaced a commissioner who had supported the nursing home, and now there were two commissioners, including the chair of the commission who were known as fiscal conservatives. 


At budget time, the new commissioner, with the chair’s encouragement, requested detailed information about the nursing home.  The staff gave her a lot of information, but she clearly was most interested in whether the nursing home was making or losing money.  It was losing money.  No doubt.  She asked whether it was appropriate for the county to be running a nursing home when there were private providers.


The issue began to attract a lot of attention, including letters to the editor and the threat of a packed house during the budget hearing.  People were split on the issue, but the most active citizens were those who favored the status quo.


The county administrator had prepared a staff report that examined two options.  The first would seek a contract with a private provider to operate the home.  The second would sell the business outright.  The problem apparently was that too many of the residents of the home were unable to pay the full cost of their care.  The county had no choice but to cover the financial losses.  Further, slowly but surely, newer residents were those who were least able to pay.  Those who could pay were choosing other facilities.  There was no foreseeable end to the financial loses given the economic profile of the residents.


The critics of the commissioners contended that it was unfair to show this kind of “callous disregard” for those least able to come to their own defense.  “What will happen to these people?”  There were heart wrenching stories.  But the financial facts could not be denied, and voters were not in a sympathetic mood, according to the majority of the commission.


A further concern was with what would happen to the employees.  Considered county employees, they had benefits most were unlikely to match if they were forced to work elsewhere.  Their spokesperson, a respected member of the clergy pointed out that “some are long-time, dedicated county employees.”  The families of several residents spoke out in favor of the treatment their loved one was receiving.  “Don’t these employees deserve to be treated better?” some argued.


When the nursing home budget came up for review, the room was packed.  Most of those attending, including a contingent of very respected clergy, were opposed to the closing of the home or its privatization.  There were placards in the back of the room blasting the commission, and everyone knew it was going to be a tough evening.


  1. What makes this issue so difficult?
  2. Identify the values that you can find in this case