They say that knowledge is power. I strongly agree with this, so I urge the residents of this county, along with our legislators and county executive to join me in remembering some of the facts that are inherent in selling the County Home to a private owner.
As a reminder to those who may have missed my other letters regarding this issue, I am a former admissions coordinator from a local privately owned, for-profit nursing home; so I'm fairly knowledgeable on what I'm speaking about. I also currently have a loved one at the County Home.
Here are the facts and a few questions that should arise from these facts for our citizens and legislators to hold up for discussion with any prospective buyer of our County Home.
Photo by Katie Atkins
VestraCare representatives Shannon Cayea-Delker, administrator, and Edward Farbenblum, executive vice president, spoke to members of the Chautauqua County Legislature earlier this month on its proposal to purchase the County Home.
First, a privately owned nursing facility is in the business to make money. It's done by having the number of privately paying patients - those who pay around $4,800 per month in the case of the Chautauqua County Home at 65 percent to 70 percent.
In plain English, a greater number of the beds in a 250-bed facility need to be held privately. This should prompt our legislature and citizens to ask the following question: How does VestraCare propose to find such a large amount of private-pay patients in this, one of the poorest counties in the state?
If, in fact, those private pay patients are found, the answer to my previous question is that when a Medicaid patient expires, the bed will be given to a private pay patient. When a Medicaid reimbursed patient goes to the hospital and exceeds 30 days in the hospital, the new owners of the County Home will forfeit that bed from the Medicaid patient to a private pay patient. This is known as "expiring a bed-hold." And, if this isn't cold-hearted enough, the Affordable Care Act - ObamaCare - has stipulations and loopholes that will cut this 30-day bed hold in half. Thus, turning over more Medicaid beds allowing the opportunity for them to become "private pay" beds, thus ensuring that 60 percent to 75 percent ratio I mentioned above.
If you're not getting it, this is a numbers game and the folks that don't have the large numbers in the bank are being winnowed out. Pay attention, it becomes more grim. It's also a good bet that when VestraCare or any other private corporation says "we want the current residents to stay on" it is because they are aware of these very laws. They will "keep" any residents as long as they are private pay or they don't go to the hospital for over 30 days. Otherwise, it's a crap shoot.
Secondly, because we are one of the poorest counties in the state, what happens to the Medicaid patients that are currently or will be in our local hospitals should they need placement in a nursing facility?
Answer: If they are in the hospital awaiting admission to a care facility, they will continue to do just that - wait. They will be passed over by the VestraCare admissions folks, any other for profit nursing facilities in the hopes of achieving either a private-pay patient or a patient that has a high reimbursement from the state (for example, a rehab patient or someone that is chronically ill for the long term like a dialysis patient, etc.)
The third question may be "What happens after these local Medicaid/Medicare, SSI patients sit for so long in the hospital after being passed over by VestraCare?" Legally, the insurance companies (or the Affordable Care Act) will tell the hospital "get them out or we quit paying for their stay" (sadly, it happens every day and it's been this way for almost 25 years). So, it will then be incumbent upon our local hospitals to place these folks anywhere within a 50-mile radius of this area that they can find a Medicaid bed in a skilled facility.
As I've stated before; it's legal. You will now have to travel to Buffalo, Niagara Falls, or Jamestown to see your loved one. They will be placed in a facility where they know nobody. The sad ramification of this is that when family doesn't come often due to distance, etc. their care often becomes sub-par for those residents.
Fourthly and finally, if the County Home is sold, the staffing that currently exists there will be replaced. After all, the union employees (yes, the ones that are offering to cut their "perks" to save their jobs and the excellent care currently given at the County Home) will be replaced with folks that will take the jobs for lower pay. I've seen it before numerous times. You lower the pay, you lower the standards. Not only will our local economy suffer, the residents will suffer.
It's important to remember that there is no "do over" here. Once the County Home is sold, that's it. If the next owner doesn't make the cash he or she desires, they will eventually sell. The process will become more convoluted and watered down and our local residents and work force will be winnowed out. This is basic math, a fact of life, and sadly, in the nursing home industry, it happens often.
I urge legislators and County Executive Horrigan to actually take the suggestion of the CSEA president. Sit down together and re-vamp the contracts that the current County Home employees are offering to rework to save their jobs, and the quality of care of the residents of this county.
We still have the time to work together to save this. This won't be easy, but ask any person from the generation of residents of our County Home and they'll tell you that hard work and sacrifice has a payoff. We may just have an opportunity here to build a model of success for other counties across the country that are struggling with this same issue.
Melanie Mann is a Fredonia resident.