November 17, 2002
Not
a Place to Leave a Relative
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Since then, state
inspectors have cited it repeatedly for endangering its residents. With each
new round of violations doing more damage to the home's already tarnished
reputation, the number of empty beds has grown.
Karen Dolan said that her
mother, Mafalda DeRienzo,
spent 24 hours at A. Holly Patterson last May and that they were appalled at
the conditions there. "The place was filthy, her bathroom had blood and
urine splattered on the walls, and they gave her the wrong medication,"
Ms. Dolan said. "I got her out of there as quickly as I could, and I would
never let her stay there again."
With the census at the
nursing home hovering at about 710 residents, officials anticipate a $1.6
million hole in its $70 million budget for next year.
"They clearly face
some pretty overwhelming problems at the nursing home," said Lisanne G. Altmann, a Democrat
who sits on the
The latest blow to the
nursing home came last month when State Health Department officials threatened
to cut off Medicare and Medicaid money for new residents. The home was cited
for a dozen violations, including the failure to adequately monitor two
residents who had assaulted other residents on numerous occasions and failing
to properly treat another patient's bedsores.
The home has submitted a
plan to correct those problems. But Richard Turan,
the president of Nassau Health Care, said the nursing home's problems go well
beyond these immediate issues.
"A lot of it has to
do with deferred maintenance over the years," he said. "It's simply a
very old facility, and it just can't compete with the new facilities that are
out there now."
The corporation has
submitted a plan to the state to build a new nursing home on the 72-acre campus
and raze the existing structure, which was built in 1960. Mr. Turan looks optimistically at a three-year time line for
the new building, and said he was confident that new management and some
"cosmetic changes" at the current building could help turn things
around "We can upgrade A. Holly Patterson into a facility that any one of
us would feel comfortable sending our relatives to," he said.
To begin with, Mr. Turan said, the halls have been repainted, new lighting has
been installed throughout the building and the floors have been buffed.
"The place is cleaner, brighter," he said.
An $80,000 investment in
computerizing the boiler operation will improve maintenance throughout the
building he said, because this will free nine maintenance workers who had been
assigned exclusively to monitoring the boilers' dials and gauges. A new
marketing plan will send representatives into hospitals to recruit new
residents.
The corporation also
recently started a search for a new administrator. In the meantime, Mr. Turan has hired Larry Slatky, a
consultant with more than 30 years' experience as a nursing home administrator
in
Mr. Slatky
said he believed that each of the 1,000 employees at the nursing home was
dedicated but that management and adequate training have been lacking.
"Sometimes you get so tied up in what you do every day that you lose
perspective on where you're going," he said. He is meeting with
supervisors in each department to set new priorities and to make sure that
everyone receives training to meet the state's guidelines.
Rachel Langert, a spokeswoman for the Civil Service Employees
Association, which represents most of the nursing home's employees, said the
home was "in a state of transition right now," but added that
"we're always willing to work with the county to make Patterson a
top-notch facility."
The nursing home has had
a dismal record for years, falling in and out of compliance with numerous state
regulations. The low point came in September 2000 when an 84-year-old resident
choked to death on a hot dog, and state officials temporarily cut off some
government money until the nursing home's administrators could prove they had
improved conditions.
According to a Medicare
survey released last week, only 9 percent of the residents at A. Holly
Patterson require help with basic daily tasks like eating and going to the
bathroom, compared with a state average of 14 percent at other nursing homes.
Nonetheless, Patterson
performed poorly in a number of areas, with 14 percent of its residents
suffering from bedsores, compared with a state average of 9 percent; 26 percent
of its residents were in physical restraints, compared with a state average of
7 percent.
All the bad news angers
residents like Ruth Garone, who has been at the home
since 1996, is president of the residents' council and has high praise for the
staff.
"People complain,
and they magnify everything to the nth degree," she said. "The thing
is it's not your real home, but you have to make it your home. So if you're
open-minded and you work with everybody else, you can get along very well here."
Lawrence Gottlieb, a
But he agreed that the
building must be replaced. "Even with the best management, you can't undo
years of neglect to the physical plant," Mr. Gottlieb said. As in many
other county buildings, capital improvements at the nursing home were halted
more than 10 years ago. While residents at more modern nursing homes have one
roommate at most and a private bathroom, many residents at A. Holly Patterson
have two or three roommates and share a bathroom with everyone on their hall,
as many as 40 residents.
Newer buildings also have
spacious dining rooms and recreation areas, but Patterson's cramped dining
rooms also double as television rooms and lounges for each 40-resident unit.
"This was visionary when it was built," Mr. Slatky
said. "But it's not what people want anymore. Now they want the care of a
nursing home but the setting of a hotel."
The corporation has
proposed a new $179 million, four-building complex that would match the current
889-bed capacity. It would be financed with a bond issue that would be paid off
with the Medicare and Medicaid payments of future residents.
The nursing home now gets
an average $190 a day per resident in federal, state and county reimbursements,
but the rate, which is set by the state, would likely increase by $50 to $100 a
day to help offset the higher cost of operating the new building.
But even with a new
complex, county and corporation officials say other fundamental changes are
needed to ensure the nursing home's survival. Unlike private nursing homes that
can choose to turn away residents with behavioral problems or ones who require
very high levels of care, A. Holly Patterson retains a mandate to accept all
cases.
Rita Wallace, a retired
nurse at the nursing home and a board member of the health care corporation,
said the population at Patterson has changed significantly in the last decade.
"We're getting a lot
more of the very agitated mental patients who really don't have any other place
to go," she said. "Other nursing homes won't take them because they
can be very disruptive, and that's not something that other patients' families
like to see."
Most private nursing
homes have populations that are almost entirely geriatric, but nearly 20 percent
of the residents at the Patterson home younger than 50. On a recent visit to
the home, many of the older residents could be at a sing-along of show tunes or
at a flower-arranging session run by volunteers.
But several younger
residents were wandering the halls. One man in his 40's stormed around
shouting, "They were supposed to shut this place down, and they should!"
Mr. Slatky
said that recreational therapists and about 150 volunteers offer a host of
daily activities for residents. "But if you're 25, you don't want to hear
`let's play bingo' or `sit and watch a musical,' " he said, adding that he
plans to develop more activities geared to younger residents.
Roger Corbin, the
chairman of the
"What we're really
talking about is the homeless population, and we all have to put our heads
together to address that," he said. "A. Holly Patterson ought not to
be overwhelmed with that population, and they need to work harder at seeking
out organizations that are designed to work with that population."
Mr. Slatky
said the home has created a full-time team that includes two psychiatrists, one
psychologist and one alcohol and drug counselor to work exclusively with easily
agitated residents. The home previously had just one psychiatrist and one
psychologist, and they were only part-time.
Corporation officials
said they also must focus attention on two looming budget problems. First, a
federal program designed to help county-run nursing homes is being phased out,
and Patterson faces losing $7.3 million a year from that program.
Gary Bie,
the chief financial officer for the health care corporation, said state officials
had already started lobbying for ways to make up that lost money.
The nursing home also
loses about $2 million a year because it runs a 36-unit bed for AIDS patients,
but the state has certified the home for only 20 AIDS beds. The certified AIDS
beds are reimbursed at $440 a day, while the additional beds are reimbursed at
the regular rate of $190. The corporation has been lobbying to have the
additional beds certified.
"There's an obvious
need for the beds," Mr. Bie said, "and if
we were paid appropriately for all our AIDS patients, we'd be in the black."
(Not quite. The extra
payments would bring in a maximum of $1.46 million, and the projected deficit
is $1.6 million.)
In addition to the
scrutiny of county officials, the nursing home's finances are also monitored
monthly by the Nassau Interim Finance Authority, the state board created to
oversee the county's finances, precisely because the health care corporation's
fiscal health is so closely tied to the county's.
"They've been moving
in the right direction, but I think they've got a long way to go," said
Richard Kessel, a member of the NIFA board.
He said that by next
year, NIFA "is going to want to have real sense that they can run without
a deficit." Failing that, he said, the authority and county officials are
likely to push hard to have the county get out of the health care business
entirely.
"The question
ultimately is whether A. Holly Patterson and the entire health care corporation
can at least break even and run on its own," Mr. Kessel
said.