There are times the situation has created problems for administrators.
"It's hard to manage the day-to-day of the nursing home in a way that is efficient and that's not distracting from the resident care when you're constantly navigating through these different channels and there's ambiguity. When I call the payroll department, for example, and ask them to pay a new nurse a certain amount of money, following the collective agreement, they might say to me, 'No, Horizon doesn't pay that way.' I'm not being treated autonomously from the corporate entity of Horizon Health, even though we are a separate entity. It's a lot for the employees. The processes are such that it's unclear to them if they work for Horizon or Nashwaak Villa. And that creates a lot of tension, at times."
In recent months, Noonan said her board asked the unions that represent her employees to work with them to sort this out. But those unions believe no changes are needed, taking the position that a collective bargaining agreement is in place and the nursing home facilities can simply work within the terms of those contracts.