County leaders this month issued a warning that persistent nursing shortages and a dwindling number of residents have created economic pitfalls that could endanger the facility in the years to come.
The six-story nursing home in Hempfield has served Westmoreland County's aging and disabled residents for decades.
Now home to 240 residents, in mid-August it was at less than 59% capacity. For the past two years, the facility has lowered its resident capacity to reflect ongoing difficulties in meeting required staffing thresholds, according to county officials.
"We're trying to build it back up," county Commissioner Sean Kertes said. "We want to see it be successful, but, at the end of the day, you just don't know."
Director Abby Steele acknowledged budgets over the past two years reflect the changing economic times. The current $55 million budget is based on a maximum capacity of 250 residents. The facility is licensed to house 408 residents.
Commissioners insist no money from the county general fund is used to pay for operations at the nursing home, which relies on state and federal reimbursements as its primary revenue sources. About 90% of its revenues are generated through per diems paid by Medicaid and Medicare, Steele said.
According to budget figures, Westmoreland Manor ended 2024 with a $6.4 million deficit that was covered through a surplus it has built up over the years.
Steele attributed last year's financial difficulties to increased expenses in several areas: increased use of private nursing staff contracted to make up for staff shortages; higher retirement and employee health insurance costs; inflationary increases in food costs and salaries; and lower returns on intergovernmental transfers used to pay the bills while awaiting reimbursements.
Westmoreland County Finance Director Meghan McCandless said the county essentially loans Westmoreland Manor funds each year to pay for its operations and payroll and is paid back through federal and state reimbursements. More than $13.7 million was fronted from the county's general fund via transfers made in January and June.
As of Monday, the county is still owed $12.1 million.
"We anticipate the balance will continue to decline through year-end," McCandless said.
Lower interest rates this year, along with additional cost savings, have helped improve finances. Steele said the facility is expected to finish in the black this year by about $545,000.
Meanwhile, the surplus is expected to hold at about $3.9 million heading into 2026.
Westmoreland Manor is among the largest of the 23 county-owned nursing homes in Pennsylvania, according to data from the Centers for Medicare & Medicaid Services. Five county-owned facilities -- in Bucks, Berks, Lehigh, Northampton and Delaware -- have daily occupancy greater than Westmoreland Manor, which has averaged 229 residents over the past year.
Allegheny County operates four nursing homes -- the Kane Community Living Centers -- in Pittsburgh, McKeesport, Ross and Scott.
Steele said the recent round of federal budget cuts are not expected to have an immediate impact on the facility's finances.
For years, it was home to more residents and operated at or near capacity. Steele said the facility listed 374 residents in January 2020 but saw its population decline during the coronavirus pandemic.
"Nursing home admissions followed a gradual downward trajectory from 2017, but covid‑19 intensified that trend. Fear made families hesitant to admit loved ones, which led to increased demand for home- and community-based care," Steele said.
Staffing shortages also contributed to the population loss. Before and during the pandemic, Westmoreland Manor routinely augmented its staff with nursing supplied by private agencies. While that practice continues, county leaders have taken steps they hope will increase its roster of nurses and aides.
Last month, the county's salary board approved a staffing revision to create more 12-hour nursing shifts, a move officials said was designed to improve hiring. Steele said 22 of the home's 70 full-time nurses work 12-hour shifts. The facility also operates with about 100 aides on staff. There are 22 vacant nursing positions and 43 unfilled aide slots.
"This would allow us to continue to provide high-quality care to our current residents and to accept new admissions as our census grows," Steele said of the expansion of 12-hour shifts.
Commissioners are hopeful the shift adjustments and signing bonuses, which first were implemented during the pandemic, lead to an increase in occupancy, and, ultimately, financial gains.
"It's stable now, but there is a cloud of uncertainty about what is going to happen," county Commissioner Ted Kopas said.
Financial concerns about a decade earlier prompted commissioners at that time to consider a potential sale of Westmoreland Manor to a private operator. A 2013 study set a potential sale price at $32 million. Kopas was on the board at that time and opposed a sale.
He would not rule out a sale if economic factors deteriorate.
"It almost entirely runs on reimbursements, but clearly there is reason for concern and that is troubling. As long as the nursing home remains self-sufficient and not costing taxpayers anything, nothing should change," Kopas said. "Should that change, I'll have to rethink my views."