CASH WOES RATTLE NURSING HOME

Employees, residents at Saratoga County's Maplewood fear future

LEIGH HORNBECK
Section: Main,  Page: A1

Date: Sunday, May 20, 2012

BALLSTON SPA -- Vincent Granitto, 80, better known as Jimmy, has a smile for everyone and a kiss for all the ladies at the Maplewood Nursing Home.


Using a walker and wearing a golf cap, he makes his way through the hallways to visit with the residents lined up at the hair salon each morning, or goes in and out of daily games of bingo and through the lobby a couple times a day to chat with the people socializing there. For the lucky ones, he will sing a few bars. A stroke five years ago slurred his speech, but his singing voice is still strong. He's partial to Sinatra, but he likes Elvis, too.


Granitto's story -- raising two daughters, a career in New Jersey for Pepsi Co. as a quality control engineer, a move to Malta after he retired, the hard decision to follow his wife, Sally, into the nursing home -- is one of hundreds hidden behind the nondescript walls of Maplewood, a public nursing home owned by Saratoga County.


When Sally died in February, Granitto donated the money he received in her memory, about $1,000, to Maplewood because he's anxious about the future of the last place he will ever call home. Granitto and several others interviewed said their wills are written to benefit the nursing home. Granitto, like most other residents of Maplewood, rely on Medicaid to pay for their care. They know there won't be much money to leave behind when they go, but they feel helpless to do more.


The facility is millions of dollars in the red each year, largely due to its reliance on reimbursement from Medicaid that falls far short of covering the actual daily costs of running it. The Board of Supervisors hired Harris Beach, a law firm that will study Maplewood and give the board a recommendation by the end of summer on what to do next. Selling the nursing home to a private owner is a possibility.


The story is a common one. After running at an operating deficit of at least $41 million over the last four years, the Albany County Legislature is seeking approval from the state Department of Health to build a new, 200-bed, $71 million nursing home. Reimbursement rates from Medicaid are higher for patients who live in new buildings. The DOH has so far withheld a decision amid projections the new facility could lose as much as $26 million each year.


In Schenectady County, the Glendale Nursing Home will be rebuilt on Hetcheltown Road for $50.5 million. The Fulton County Board of Supervisors sold its nursing home earlier this year and Washington County supervisors will sell the county home there to a private owner.


Granitto, fellow residents, their families and staff at Maplewood worry that if the nursing home is sold, the quality of care will suffer.


Maplewood has been in financial straits for nearly a decade, as Medicaid reimbursement has fallen. It costs nearly $330 per day to care for residents of the nursing home, Medicaid only pays for about $160 of it, and most of the residents rely on Medicaid to pay for their care. Of the 255 patients living at Maplewood now, only 34 pay privately.


The uncertainty may lead to early retirement for Pia Kellogg, 57. A certified nursing assistant, Kellogg has worked at Maplewood for 35 years. She loves her job, she said, and she knows the value of her benefits package, free to workers hired before 2001.


CNAs are closest to the residents. They empty bedpans, help patients get in and out of bed, dress, comb their hair and brush their teeth. During the course of the day, they listen to residents' fears about the future. There are 315 full-time employees at the nursing home and almost all of them belong to the Civil Service Employees Union. A group of the workers meet each week to talk about the situation.


Kellogg has a dim outlook of the future. She doesn't go to the weekly meetings. The nursing home will be sold, she said, nothing can change that.


Saratoga Springs Supervisor Joanne Yepsen said the board must take responsibility for failing to act sooner on Maplewood. The time is long overdue to explore options that will bring in more money. Day and short-term rehabilitation services, as well as adult day care, are ways other nursing homes pay the bills, Yepsen said. Building a new nursing home or expanding the existing facility should be part of the discussion, she said.


"It is my preference that it remains a public nursing home," Yepsen said. "But we can't afford it anymore."


Rumors about what the board will do to solve the financial problems at Maplewood swirl through the nursing home.


"We try not to talk about it around them, but the residents read the paper, they know," said Maria Lopez, 46, a licensed practical nurse and a Maplewood employee for more than 10 years.


Kay Bussiere, 85, resents the uncertainty that surrounds the future of the nursing home. She raised two daughters, ran her own business and outlived two husbands. She paid her taxes, she said.


"They have the racetrack, they could have raised the sales tax," Bussiere said, referring to a defunct plan the board briefly considered to close the county's budget gap. "If they close the nursing home, I won't have anywhere to go."


Throughout the history of the county, there has always been a place for the poor elderly to go. Between the 1820s and 1960s, senior citizens lived at the County Farm, where the jail and animal shelter are now located. After that, a former tuberculosis sanatorium was set up as the Homestead Infirmary off Route 29. In 1967, the board built the nursing home.


While Saratoga County had a healthy surplus -- approaching $30 million -- county leaders moved money around to bail out the nursing home each year. Things changed as the county's financial outlook darkened in recent years and the surplus dwindled. The board will pay Harris Beach $50,000 to help guide their decisions on the nursing home. The firm has consulted on one other county nursing home, in Ulster County. It recommended selling the home to a private owner.


John Cromie, 64, a Ballston Spa lawyer whose 98-year-old mother, Tarsilla Cromie, has Alzheimer's disease and lives at Maplewood, also worries about what will happen if the home is sold to a private owner. Profit is not the motivation at the home now, Cromie said, and the home is staffed by caring workers, like the ones caring for the wives of Bob Nelson and Don Boucher.


Rebecca Boucher and Cheryl Nelson are completely dependent on the people around them. Boucher, 81, has Alzheimer's disease. Nelson, 63, has frontotemporal dementia. Nelson started showing symptoms six years ago. Now, she cannot walk, talk or feed herself. She is receiving hospice care at the nursing home. In the 11/2 years she has lived at Maplewood, Bob has missed only two days by her side -- days he couldn't get out of his driveway in Clifton Park because of snow. He doesn't know if she recognizes him or not. He holds her hand, because he doesn't know what else to do.


It's the same for Don Boucher. It's been 15 years since Becky's "last good year." Boucher said she recognizes him on some days, others she doesn't. Boucher, 80, visits almost every day and together the couples spend mornings in the lobby of the nursing home. Everyone knows the women's names, Nelson said. The staff brings their own clothes to work for the residents. A member of the maintenance staff said Cheryl would be more comfortable with a foam block between her feet and the bottom of her wheelchair, and provided one.


Laura Vigneau, an occupational therapist's assistant and Maplewood employee since 2002, is the activities director at the home. There is no money in the budget for entertainment, so the staff holds garage and bake sales to raise money. The residents love almost any kind of musical performance, she said, and flock to church services and bingo. When they tell her they're worried about the future of Maplewood, she tells them they will never lose their home, and wishes they didn't have to worry.


"These people worked and raised families in our communities," Vigneau said. "It's a shame we don't think our county governments should each take care of their own people."


lhornbeck@timesunion.com - 518-454-5352 - @leighhornbeck





Strong numbers


Statistics kept by the state Department of Health show Maplewood Manor scores higher than many other facilities of its kind in New York. A summary of the last three years.


Standard health deficiencies: 11 Statewide average: 17


Life safety code deficiencies 9: Statewide average: 7


Total deficiencies: 20 Statewide average: 24


Deficiencies related to actual harm or immediate jeopardy: 0 Statewide average: 1


Percentage of deficiencies related to actual harm or immediate jeopardy: 0% Statewide average: 4%


Source: NYS Department of Health