River Bluff: On the edge

River Bluff Nursing Home has failed to fully meet the financial recommendations of the River Bluff Nursing Home Task Force’s executive summary nearly four years after the recommendations were made.

The task force recommended in its June 25, 1999, executive summary, the following with regard to River Bluff’s finances: that there be a review of the 1977 court order that forced the nursing home to give preference to those receiving Public Aid, that alternative sources of investment be reviewed, that a foundation and memorial program be established, that the home continue to lobby the state to increase the state Medicaid reimbursement level, that the home consider increasing the nursing home tax rate, and that the home seek support from private nursing homes.

Money, Money, Money

Today, the nursing home remains at the mercy of the 1977 court order, alternative funding sources continue to be reviewed, the foundation and memorial program that was established in 1999 haven’t received any major contributions. Also, the state has cut back the Medicaid reimbursement level by 5.9 percent; the nursing home tax rate remains the same, and no additional support has been provided by private nursing homes.

The task force was created in 1999 at the request of Winnebago County Board Chairman Kris Cohn (R) after the home had struggled with staffing shortages and budget shortfalls. The first part of this series examining River Bluff Nursing Home, its management and its finances examines the 304-bed county facility’s financial struggles and provides a glimpse of the home.

The home’s financial woes have largely been attributed to the home’s restricted ability to generate income as a result of a 1977 court order that forces the nursing home to give preference to residents who receive Public Aid. The overwhelming majority of the home’s patients—98 percent—receive Public Aid. The task force report’s conclusion was that a near-equal population of private-pay and Public Aid residents is needed for River Bluff to break even.

As Phyllis Schwebke, River Bluff administrator, said, “We have a very limited number of private-pay rooms.” She also said the Winnebago County Board’s decision has been, “that they’re not going to try to balance that [court order].”

Schwebke said the nursing home continues to struggle financially. Yet, she added, “As of this point, the nursing home still has money in its fund.”

The nursing home is funded by, among other sources, private-pay and Public Aid patients, a local tax levy that provides funding for building improvements, a River Bluff Nursing Home Foundation fund and memorial program, and state Medicaid reimbursements.

One of the biggest financial hits River Bluff, and all county nursing homes in Illinois, will take is a result of a 5.9 percent decrease in Medicaid reimbursement. River Bluff receives reimbursement from the state for each patient day. River Bluff, which has an occupancy rate of 83,376 patient days, will see a $476,077 decrease in state Medicaid reimbursement.

“Hopefully we’ll come back again, but, with the state finding more and more things it doesn’t have money for, I don’t know how that will happen,” Schwebke said. “But I hope it will. Every nursing home is hurting.”

The home also gets Medicaid funding from the Provider Participation Tax, which is a $3 a day tax that every nursing home provider in the state pays on every licensed bed. That money then goes back to facilities such as River Bluff that accept Public Aid residents. Those facilities that do not accept Public Aid residents do not receive any of that funding.

“So facilities who accept no Public Aid recipients, P.A. Peterson being one of them in Rockford, they’re still paying $3 a day to the state of Illinois for every licensed bed and all of that goes into the Medicaid system,” Schwebke said. “So, in that way, the private nursing homes do support us and every other facility that accepts Public Aid recipients.”

Schwebke said with regard to the task force’s recommendation that River Bluff seek more support from private nursing homes, “I couldn’t think of any way they could do it, and I don’t think the task force had any specific ideas of how they could go about doing it.”

The River Bluff environment

River Bluff Nursing Home is on North Main Street between North Towne Mall and Sportscore 1, across the street from the Singer Home for Mental Health. The nursing home cares for about 260 patients and employs about 330 workers.

Huge trees loom near the entryway and surround the home’s parking lot, which is crumbling and bumpy and appears to be in need of work. White barrels and trees are littered with signs that say, “No Parking,” seeming to make it confusing to visitors as to where to park.

River Bluff sits on a river bluff (hence the name) on the Rock River, although the bluff isn’t visible from the nursing home itself. Large white-globe-topped lights line sidewalks and the parking lot. The building is yellow with brown trim and dark brown bricks. It appears bland in color.

The building’s main entrance is hidden behind a large pine tree. “Watch for ice” signs line the circular drive that leads to the main entrance. An old dinner bell from the 1800’s County Poor Farm commemorates the home’s history and rests on a display in the center of the entryway’s circular drive. Schwebke said the home’s auxiliary (volunteers) built the bell tower. The main cafeteria is located just inside the front doors, which are electronically powered.

An aerial view of the home, on display inside, shows what appear to be four connected crosses with a center.

Schwebke gave a tour of the “B” unit, or “Blue Jay” unit, which is to the right of the main offices. The B unit is where there is the most need for Medicare-certified staff, Schwebke said.

The walls in the hallways are yellow on the bottom and white on the top, and the floors are composed of yellow tiles. The home has a somewhat light odor to it as the smell of the cafeteria food seems to permeate throughout the home. The home is also humid and relatively quiet.

The B unit, and all units, open up to a garden area. Most rooms are two-bed rooms, although some are private. There’s a TV lounge with a fish tank in the middle of each unit. Each unit also has one larger room, which Schwebke said is usually used for married couples. There are also unit dining rooms, where Schwebke said most patients eat.

Recently reworked unit nurse stations sit near the middle of the wing, just past the dining area. Each unit has an activity assistant and social services assistant, Schwebke said. Most rooms have a view of the garden area, although some look out onto the parking lot.

“It’s a nice site for this facility,” Schwebke said. “Most rooms look out to green, although some do have a view of the parking lot.” She compared River Bluff to a home she worked at in Boone County where some of the rooms looked out onto a cemetery. “So, I guess if you look at it that way, it’s not so bad,” Schwebke said.

A tiny chapel with two pews sits on the opposite side of the building from the B unit. Church services are held every Sunday, and some choose to have their memorial services there, Schwebke said.

Connected to the chapel and on the opposite side of the cafeteria as the front entrance, is the recreation room, which has tile flooring and a shuffleboard grid. The rec room offers limited cable TV access and an indoor live bird observatory (professionally maintained), an organ, a phone, a piano and a separate activity room. A courtyard sits just off the rec room that is only accessible to employees through a coded keypad. The courtyard has plant boxes that Schwebke said some residents and staff maintain in spring and summer.

Schwebke said the home also has beauty volunteers who do hair and nails for residents. There’s also a clothing and gift shop maintained by the River Bluff auxiliary that’s just off the back end of the cafeteria, not far from the rec room. All of the clothing is donated and is free to residents. “It really helps with those who come in with no clothes or anyone to get them things,” Schwebke said. “Our auxiliary people are really wonderful people.”

Schwebke said the auxiliary also collects a wish list from every resident around Christmas time and then hires a fleet of Santas to deliver presents to residents. “It’s really a wonderful thing,” Schwebke said.

While on the tour, Schwebke greeted many patients by first name, and they returned the favor with warm regards. One in the special needs rehab room said from her wheelchair, “thanks, thanks, thanks, thanks, thanks,” to Schwebke.

Schwebke discussed a recent conversation she had with a kennel worker at Winnebago County Animal Services: “I’m a big dog lover, but I told her I don’t believe that people who work at the animal shelter should make more money than a CNA does. Her response was, ‘Phyllis, you realize that they have to put little kitties and puppies to sleep, that’s really hard.’ And I said, ‘I would find that very difficult to do. I would be a bad kennel worker because I would end up with a kennel at my house.’

“But my staff get to know and love the people they take care of,” Schwebke continued. “They treat them with the respect of adults, but they provide the same kind of care to many of them that we provide newborns. They know them, they love them, they know their stories, they know their families, they bring their own families in to meet them, they share their kids’ report cards with them, and then they sit there and they hold their hands with them when they die, and they clean their bodies up. And they consider it a privilege to do it. They do a great job. And I’m proud of the work they do every day. Have we had some problems? Yes. But we work as hard as we can to do the best that we can all of the time.”


River Bluff started as the County Poor Farm in the 1800s. Additions to the home in 1920 and 1930 established it as the County Hospital. In the 1940s and 1950s, the hospital was used to treat victims of the polio epidemic. In June 1970, a referendum was passed by voters in Winnebago County allowing the new nursing home to be built at its current location. Construction was completed in June 1971, and 200 residents were transferred from the old home to the current facility. Schwebke said the home still struggles to overcome the County Home image.

“We have people who walk in the door and say, ‘It doesn’t stink’,” Schwebke said. “They expect county homes to look like something out of Dickens when they walk through the door, and we don’t look like that.

“I have a resident who’s a little confused, but she’s one of those pleasantly confused people—she’s confused enough to not really realize that she’s confused. And she was sitting in the main dining room one day, and a new resident came and sat at her table, and she grabbed her arm and said, ‘Oh, honey, you’ll love it here, it’s just like a country club.’ And I thought, well, isn’t that sweet, it’s just like a country club. But it’s much nicer than most people anticipate. We’re working on it, but it’s still the case.”

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