Goshen nursing home’s troubles reflect larger for-profit trend
Now, nearly a year after the home became
The plaintiffs, a current resident of the home and the estate of a deceased resident, accuse the owners of slashing staff so deeply that residents often sat in their own waste, begging visitors for bathroom help, meals and care.
The suit seeks monetary damages, but also asks the court to require the home to provide proper care.
Sapphire's troubles under its new leadership reflect a larger trend, according to nursing home experts.
Facing challenges like inadequate government reimbursements and a lack of self-funded patients,
Trouble began in
They immediately began shedding staff in
As a result, residents were left unattended for hours, medication errors occurred and patients were not kept hydrated, properly nourished and infection-free, according to the DOH.
The lawsuit against Sapphire at
Ramlow's family claims that during a visit, a half-dozen nursing-home residents pleaded with them for food, help eating and diaper changes, and staff was nowhere to be found.
"My family and I believe the administrators at Sapphire have my mother's blood on their hands because she laid there for days, if not weeks, with a urinary tract infection, because she wasn't being changed properly, which turned to sepsis," Guyt said. "You can be for-profit and still care for the residents. You can be efficient in other ways, and still give critical medical attention."
After layoffs late last year, the home provided just 1.9 hours of individual patient care per day from certified nursing assistants, 0.40 hours for licensed practical nurses, and 0.24 from registered nurses -- sharp cuts from 2016 totals under Elant of 2.29 hours from CNAs, 0.88 hours from LPNs and 0.58 hours from RNs, according to the DOH.
Sapphire at
After the ownership transition, "it was horrible," said
In the spring, Sapphire compliance officer
For-profit nursing homes
Across the state, nonprofit nursing homes are increasingly selling to for-profits that are often more willing to make staff cuts to handle the elder-care industry's many challenges, said
"Not-for-profits are mission-based providers, and as such they've got their own philosophy about how they're going to provide care that often manifests in a different staffing pattern, quality-of-life activities and initiatives," Heim said.
All told, 46 percent of
Although Medicare reimbursements are generous, they only pay for a nursing-home patient's first 100 days of care, leaving homes dependent on less generous Medicaid reimbursements thereafter, Heim said. Most people lack the savings for elder care, and underused long-term care insurance is pricey, so Medicaid picks up the slack, he added.
Between 75 percent and 80 percent of all resident days in
Thanks to for-profit operators' staff cuts, homes have become more profitable, Harrington said. After five straight years of increases, the average nursing home was worth
"Believe me, these for-profit owners are not going to lose money," Harrington said. "That's the whole point of cutting all the staff. ... They're in the business of making money."
Yes, Sfregola said, some nursing homes "are struggling for a wide variety of reasons including poor Medicaid reimbursement rates, low census, staffing costs, the cost of medical technology, capital upkeep of the building, mortgages and the high cost of medication."
"However, broad generalities about changes in ownership don't play out across the field," Sfregola said. "The best way to gauge the quality of care provided in skilled nursing centers is by looking at health outcomes for the people under our care."
But while every for-profit nursing-home operator is not a bad actor, Elant's decision to sell its homes illustrates the challenges nonprofits face competing and finding new owners.
Elant's decision to sell
Elant began 33 years ago as the
By 2005, the company had changed its name to Elant and grown into eight interwoven nonprofits operating six nursing homes and other adult-care facilities across the mid-Hudson. At its peak, Elant had a
Today, it operates only the Glen Arden assisted-living facility next to Sapphire's
Other Elant properties offset those losses, but Elant lost
The company's troubles stemmed from maintaining staffing levels that were higher than some local nursing homes, relying on low Medicaid reimbursements and lacking the economies of scale or purchasing power of larger chains, Cornell said.
Adding to Elant's costs, each home operated with its own leaders, not a centralized administration. Crucially, the company's more profitable private-pay patient total also dropped to 8 percent from 17 percent in the firm's final years, Cornell said, leaving Medicaid to make up more of the home's revenue.
"With Medicaid reimbursements reduced by the federal government, between the feds and state, and the overall loss of the private pay market, we just took it on the chin," Cornell said.
In 2015, Elant's board reached agreements with Sapphire's owners to sell the company's four remaining mid-Hudson homes for more than
But the complex sales and state approval processes didn't conclude until September. Today, Cornell attributes the former Elant homes' issues to staff cuts.
"I don't think anyone anticipated these kinds of problems when Elant's homes were sold," said Cornell, who added that
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