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Ann Lee Home

Hello, Nurse?

Albany County’s plans to transition low-income elderly care from nursing homes to community-based care has some people frightened

By Chet Hardin

Photos by Chris Shields

 

Renee Barchitta spent months searching for a nursing home. Her mother’s mental health had deteriorated to the point where she couldn’t take care of herself anymore. And Barchitta was quickly finding that she couldn’t take care of her mother anymore, either.

“I had this whole system set up for her,” she says. “There were aides coming in. I was washing the floor, going shopping, but I just couldn’t do it all. It got to a point where it wasn’t safe for her.”

Her mother had stopped showering, stopped changing her clothes, and was forgetting to eat.

“When she went to the bathroom, she would make a mess. In the middle of the night, she would call me and say, ‘What am I supposed to do?’ ” she recalls, pausing. “So I knew that she was starting to get dementia.”

It is a traumatic experience to place a parent in a nursing home. Coming to terms with the end of an independent life, the hunt for the best facility affordable, the strain on the family—all of these things, Barchitta says, together can be devastating. For Barchitta, whose mother was not only demonstrating the early signs of dementia, but also had been diagnosed schizophrenic for many years, it was a desperate, seemingly hopeless affair.

“So many places I went to told me they wouldn’t take people with mental-health diagnoses,” she says. “They told me that they wouldn’t take my mother. No one would take her.”

Eventually she was able to place her mother at Ann Lee Home, one of the two long-care facilities operated by Albany County. Ann Lee takes a population that has nowhere else to go, Barchitta says, and it’s true: Nearly 55 percent of the residents in Ann Lee and the Albany County Nursing Home suffer from some form of mental-health illness. The majority of the residents are low-income and supported by Medicaid.

Last year, the Commission on Health Care Facilities in the 21st Century, chaired by Stephen Berger and known popularly as the Berger Commission, released its recommendations on how to tackle the challenge of “right-sizing” the state’s hospitals and nursing homes. Locally, the commission’s report has drawn sharp criticism for recommending the closure of Bellevue Woman’s Hospital in Niskayuna. But also mentioned in this report was the recommendation that Albany County merge its two nursing homes and halve the total bed count of 500. The county will eventually shutter both existing buildings and construct a new, 250-bed facility.

To be in compliance with the recommendation, the county recently began transferring residents of Ann Lee across the street to ACNH. The merger, by law, must be completed by June 2008.

This worries Barchitta. The current census of residents in the two nursing homes totals 330. What will be done with the dozens of extra people? As a member of the Family Council (a group of concerned relatives of nursing residents who act as liaison between the nursing homes’ residents and the staff), she notes the stress the merger has taken on everyone involved—staff, residents and family members.

“Before I started looking at nursing homes, I was never into this. It just wasn’t my experience,” she says. “But now I go almost every day to see my mother, and I’ve gotten friendly with so many of the residents. I have gotten fond of them. It’s not just my mother that I am here for. So many of these people can’t speak for themselves. A few of them, when they got the letter about moving and the merging, they came to me crying and saying, ‘What will happen to me? Will I have a home?’ You feel like you have to save these people.”

Sitting on the second floor of the Albany County Office Building, County Executive Michael Breslin and the newly appointed director of Albany Nursing Home, Gene Larrabee, discuss the future of long-term care for Albany’s elderly. Facing the fiscal realities of the increasingly costly business of delivering medical services and the restructuring dictated by the Berger Commission, the two men see a new paradigm emerging. Less reliance on nursing homes and more reliance on community-based care.

Renee Barchitta

Come June of next year, the critics wonder, what will happen to the roughly 80 extra residents? It is simple, the men say. They just won’t be there. An admissions freeze was put in place April 17 for the nursing homes in an effort to comply with the Berger Commission—no new residents to replace the dwindling numbers.

“If you look at statistical data, a facility the size of Albany County’s normally discharges 10 to 20 people a month,” Larrabee says. Either they to move to a hospital because of an advancing illness, they are rehabilitated and returned home, or they die. “If you look at the industry trends and statistics, there is a good chance that by June of 2008 we will have less than 250 residents, just through natural attrition.”

“There is a constant turnover in a nursing home,” says Breslin. “It is just a fact of life that for many people a nursing home is their last place in life. We are now in a status that when someone leaves, we are not filling [the bed]. . . . It has been estimated by the state, and I agree, that we will meet the 250 by June of next year. And if we don’t, if we fall short, we will work out some kind of solution.”

No one, he adds, will be put out on the street: “I am not going to let that happen.”

Barchitta argues that this doesn’t address the demand for publicly assisted nursing-home care. The numbers will dwindle, obviously, if no new admissions are allowed. But the population of Albany County, she points out, is aging. According to census data, the indigent population is increasing. Eventually, she says, these people may need someplace to go, too.

What will be available for the future elderly?

There is an array of support services within the community, Breslin and Larrabee claim, that will be available to mediate the need to enter a nursing home in the first place.

In his 2007 budget proposal, Breslin presented a three-pronged approach to long-term care, centering around one countywide “point of entry,” which will direct residents to available medical and treatment resources. This would provide, the executive said, a “centralized system . . . [to] provide information and assistance, screening and public education.”

Overseeing this POE would be a Long Term Care Council, consisting of representatives of consumer groups, community-based and residential long-term care providers and advocacy groups. And a long-term-care coordinator position would also be established.

Breslin says that much of this care would be provided in-home, and that this new approach will be responsive to needs and desires of the aging population.

“I have not met anybody clamoring to get into a nursing home,” he says.

“The national trend is to place people in the least-restrictive environment possible,” Larrabee agrees. “Now obviously the least-restrictive environment is someone’s home.”

“The county has a great opportunity,” Larrabee continues. “There are all kinds of alternatives to be explored. In other parts of the country, there are group homes for the elderly, foster homes for the elderly, all those kinds of things offer alternatives that are least-restrictive environments.”

Nursing homes, such as Ann Lee, will be more and more viewed as short-term-care facilities. They will not be what they have been historically, Larrabee says, “which is Granny is admitted when she is 82 and she dies when she is 91 and she is there all those years.”

Thirty days to six months, that will be an average stay.

“I am aware,” Breslin says, “that there is concern because there is change. You and I are easily adaptable to change because we have a lot going on in our lives. But when a person goes into a nursing-home facility, they don’t like to see change at all. And the family members like to see it even less. Unfortunately, we are in a circumstance where we have been directed to consolidate two facilities. We will try to make that transition as smooth as possible.”

‘The Berger Commission, to me, is a report that is half-empty,” says Albany County Legislator Shawn Morse (I-Cohoes). “It deals with how we are going to close down nursing homes and hospitals, how we are going to consolidate, how we are going to save money. And then it gives a little sprinkling of how we are going to deal with the issue of nursing homes, which is in-home care. And now they are hurrying up to get everybody to meet this commission’s deadline, well before we are prepared to have in-home care.”

Morse isn’t convinced by the executive’s vision for the future of low-income elderly care. For Morse, it is a question of feasibility. Can the population who needs a nursing home like Ann Lee even be served within the community? Remember, he says, these are low-income people, with little access to transportation. Many of them suffer extreme forms of dementia. How will they receive these promised services?

“Let’s put it in perspective,” he says. “We have a nursing shortage; we can’t get enough nurses, cause we don’t pay ‘em enough. We don’t have enough nurses to take care of a nursing home, now, as it is, which is confined to a certain amount of feet, say 30,000.” ACNH and Ann Lee currently run with a 10-percent deficiency in staffing.

“So how the hell are we going to take care of people spread all across Albany County, from Cohoes to Voorheesville, stopping in their houses everyday?” he asks. “Nobody can tell me. Can you tell me how, when a person is living in their house, how will all of those things that are taken care of in a nursing home be provided?”

While he will accept the executive’s claim that the county won’t abandon the elderly to the streets, Morse’s fear is that when those beds are gone, the county will just ship residents to neighboring counties, or to other states.

“We have families who have spent their whole lives in Albany County whose loved ones have been sent to other parts of the state,” Morse says. “Families have been separated.”

According to the Albany County Medicaid nursing-home roster, nearly 60 county residents are currently living in nursing homes outside of New York state, most in Massachusetts, two in Vermont and another in New Jersey. More than 500 residents live outside of Albany County.

“What we are doing right now is we are taking young folks and forcing them to make tough decisions about the care of their parents, their grandparents, cause people now are going to have to accept the fact that if you can’t afford to pay top dollar to put them in a nursing home, you might to have to send them out-of-state,” Morse says. “Before we close down Ann Lee, before we consolidate the nursing homes, before we tell people our doors are closed and we aren’t taking any new residents, we should have a solid plan that has been tried, tried, and tried again in place that has been proven to provide in-home care, without any glitches. We haven’t done that. There’s not a plan! And it is ridiculous to say we will throw them out first and then take care of them later.”

Everybody has focused on the fight over the Berger Commission’s report on Bellevue Hospital, he adds, because Bellevue has fought back. Both Sen. Hugh Farley (R-Schenectady) and Assemblyman Jim Tedisco (R-Schenectady) have publicly opposed the commission, with Tedisco introducing legislation that would force the state to exempt the hospital. Morse wonders why Albany County hasn’t put up the same fight.

“Albany County has gracefully folded their hands,” he says. “I say we should have sued over the Berger Commission. That would have at least given us some time to come up with a plan.”

‘We have the worst-rated municipally run facility in a 100-mile radius,” says Mike Conners, Albany County comptroller, speaking of the county nursing homes. He draws his data from an official Medicare report. “And, by the way, I stopped looking further than that because I was so disappointed.”

Between 2005 and 2006, ACNH registered 11 deficiency ratings, double the state average for nursing homes in New York, he says. It has been twice placed in immediate-jeopardy status, a rating given by the state to a facility when there is a perceived threat to the lives of residents. The most recent immediate- jeopardy flagging was due to the deaths of two residents. Both had not been resuscitated, due to miscommunication, when it would have been medically appropriate to do so.

On Friday, Conners made a preliminary investigation of the nursing homes in preparation for an audit. Scouring the halls of Ann Lee, he found in the laundry room deteriorating portions of the ceiling, with exposed pipes and plaster hanging broken and crumbling. There’s a blanket splayed across the floor to soak up the water dripping from the ceiling, and the sewage pipes stained with brown water.

In ACNH, he claims, there was a used shower stall in a state of disrepair, tiles broken apart and scattered on the ill-maintained floor.

“As chief fiscal officer of Albany County,” Conners says, “I did a walk-through of the facilities and found conditions at the Albany County Nursing Home that are detrimental to the residents. I notified the executive branch of these conditions, and will be asking the Capital Projects Committee for $2 million to initiate immediate repairs of the facilities.”

He doesn’t blame the staff of the homes, he is quick to point out, but the bungled management at the upper levels.

Care and maintenance conditions at Albany County nursing homes are something that Conners has watched closely during his three terms as comptroller. His father spent time in ACNH in the 1990s.

In 2002, Conners’ office prepared a preliminary report in which it alleged widespread mismanagement of both ACNH and Ann Lee.

In his report he alleged, among other things, that routine housekeeping duties were lacking, that Occupational Safety and Health Administration violations were present in the Ann Lee laundry room, that ACNH failed to follow state Department of Health guidelines for infection control, the facilities lacked chair alarms and other safety items, and that the county had “engaged in financial transactions, which diverted resources from the facilities.”

The list of infractions goes on and on.

“The reason we did this report in 2002, is that in July of 2001, I had a former caregiver for my father call me up and say ‘Michael, I only got eight Depends for my shift for eight beds,” he says. It wasn’t the first claim of mismanagement he had heard.

“We were killing people, running a bad business, doing a bad job, screwing things up. . . . And what year was this?” Conners asks. “2002. What year is it now? 2007. Five years later, two more immediate jeopardies since, dozens of other deficiencies,” and it is still mismanaged.

June Maniscalco, chair of the Family Council for ACNH, has seen these sorts of maintenance issues firsthand.

“At Ann Lee, there were rooms on the first and second floors that when it rained, water leaked into the room. And those rooms were occupied. I remember this one poor old woman,” she says. “Complaints had been made for months to the administration.”

Eventually, Maniscalco took photos of the leaking ceilings and presented them to the Legislature.

“Nothing scares a politician,” she muses, “more than photos.”

After showing the photos to the Legislature, all the repairs were made within a week.

Although she thinks that something needs to be done about the nursing-home facilities, she doesn’t agree with constructing a new, smaller building. She sees the move as a recipe for disaster.

“Just five years ago, they said they needed 525 beds,” she says. “Now we are going to build this home half that size that will be outdated in no time. And when they will build this small, state-of-the-art facility that no one except the well-connected will be able to get into, it will be just like all the other nursing homes in the area. You will have to know somebody to get in.”

That is her biggest fear—that a resource that has been devoted to the indigent will be co-opted and shifted to being a resource for the wealthy.

Maniscalco certainly couldn’t afford private nursing-home care. She and her husband sat down and did the math. With their life savings, they would be able to maintain just one of them in a nursing home for three years.

“You are talking $80,000 a year, or better. Or better,” she says. “That is what it cost us for our mother, $80,000 a year. Could we afford the insurance? We priced the insurance for nursing-home health care, and no, we can’t afford it.”

Nobody thinks that maybe one day they will need nursing-home care, but for her, it is a looming reality.

“My grandmother had Alzheimer’s,” she says. “My mother had Alzheimer’s, my aunts had Alzheimer’s. My odds aren’t looking too good.”

As for the community-based care championed by Breslin, she isn’t convinced, either.

“Forget the fact that Mr. Breslin talks about all this great home health care. My mother had Alzheimer’s. It took us eight agencies before we found someone who was reliable and honest. But that was only for three hours a day of care. You need around-the-clock care for demented people.”

“Mr. Breslin says that we are going to have better home health care,” she adds. “Well, the fact is, we don’t have it now. We are not going to have it for the next five years. Oh, it’s there if you got money. But what is going to happen to the people with no money? Nobody has an answer for it.”

chardin@metroland.net


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