Saratoga County officials, facing dwindling reserves and a stubborn recession, are simultaneously faced with decisions regarding both the long-term and short-term future of the Maplewood Manor nursing home.
Not only is the county-run facility expected to lose $10 million in 2013, as projected by a recently released report, it is not operating at full capacity, with 39 of its 277 beds empty.
Status quo not an option
Members of the Board of Supervisors and the county’s Public Health Committee are now poring over a 149-page independent report conducted by Harris Beach and the Arthur Webb Group that was commissioned as the county mulls how to handle public nursing home options.
“The report actually listed four (options), these are things that have been done in other counties. Some counties have actually sold the license in the home, in others they’ve changed the level of care scaled to assisted living,” said County Administrator Spencer Hellwig.
Constructing a new facility was also offered as a possibility in the report, as was keeping the current course. It is increasingly clear, however, the latter option is unfeasible.
“Staying status quo, that’s really not a viable option,” said Arthur Wright, chairman of the Public Health Committee.
A portion of the report reads, “The Maplewood fiscal crisis had grown to the point that the operating deficit was having a significant negative impact on the county’s fund balance … to the point where the financial drain of Maplewood was manifesting itself in difficult policy choices for the decision-makers in the county government.”
It is expected the Public Health Committee will hand in a recommendation on the nursing home’s future in October.
“We’re not under any kind of (time) constraints at this point but we’re losing eight, nine, 10 million dollars a year, so I mean we’re kind of under the gun now,” said Wright.
Taxes, layoffs off the table
Hellwig said the report also suggests a tax increase of 20 percent would be needed to cover the $10 million annual loss, or a staff reduction at the home by up to one third, or about 100 employees. He added neither are feasible options.
Committee members are still finding their way through the report, and as such Wright is fielding questions by committee members as they roll in.
“I think we’re still absorbing the information … This is one of the biggest decisions this board will ever make,” said Wright. “When (it) is made, it’s going to be made with as much information as we know.”
Once questions have been brought to the table, the committee will sit down with Harris Beach to discuss the issues before a final decision on the home’s fate is made.
15 percent of beds empty
While a decision on what to do with Maplewood Manor as a whole is pending, Public Health Committee members at a Monday, Sept. 10 meeting discussed a more pressing concern. There are 39 empty beds at the facility, nearly 15 percent of the total capacity.
Diane Brown, an administrator for Maplewood Manor, presented an update to the situation to the committee.
“Since July 1, we’ve only had nine admissions. Our admissions are down 38 percent this year with only 54 admissions year-to-date,” Brown said. She added of those admissions, 35 percent came from other nursing homes, adult homes or private homes and those patients would not meet the criteria for Medicare coverage.
Committee member and Saratoga Springs Supervisor Joanne Yepsen pointed to the recent report on Maplewood Manor, which indicates a more than 200-bed shortage in the county.
“There was a clear need for a Maplewood-type facility in Saratoga County. New York State’s Department of Health has identified a bed need of 1,004, with a current capacity of 789, leaving an unmet need of 215. The assessment also found Maplewood provides quality care to its residents, a fact that was noticeable during a tour of the facility,” reads the report.
Brown said she doesn’t think the facility was under bedded to the extent reflected in the report. The committee discussed ways to fill the beds at Maplewood Manor, such as drawing more patients from Saratoga Hospital.
“I just don’t see why we’re not taking the 28 to 34 patients at Saratoga Hospital who are currently waiting for a bed,” said Yepsen. She said in 2010 there were 98 patients admitted to the home from the hospital, and in 2011that number was 57. So far for this year, 23 patients from the hospital have been admitted.
Medicaid at heart of gap
“We’re losing more than we’re gaining by taking them, they’re the at-risk people for nonpayment,” said Ballston Supervisor Patti Southworth.
Southworth said the county loses approximately $750,000 in this manner from patients who are not Medicaid eligible. The Harris Beach report found 82 percent of Maplewood patients are covered by Medicaid, but “in 2010 ,the daily cost per patient was $317, while the Medicaid reimbursement rate for such patients was $160 per day, leaving a deficit per patient, per day of $157. As this report indicates, that dynamic will only get worse with time.”
“The state reimbursement has not kept pace with the cost, and not kept up the county bearing the brunt of this,” said Supervisor Thomas Wood, chairman of the Board of Supervisors.
According to Brown, the current cost for one patient per day at Maplewood Manor for a private room is $342. For a semi-private room, the rate is $322.
“I feel we provide excellent care here. We have a very low employee turnover rate and that has a positive impact on our care. Staff has become family to many residents. Our biggest asset is our employees,” said Brown.
The full Maplewood Manor report is available atsaratogacountyny.gov.