County’s plans to transition low-income elderly care from
nursing homes to community-based care has some people frightened
Photos by Chris Shields
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.
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.
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.
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.
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.”
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
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
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.”
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.
have not met anybody clamoring to get into a nursing home,”
national trend is to place people in the least-restrictive
environment possible,” Larrabee agrees. “Now obviously the
least-restrictive environment is someone’s home.”
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.
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
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?
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.
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.
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.
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.
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.”
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
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
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.
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.
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.
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.
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
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.
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.
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.
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.”
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.”