Why do I support the thoughtful handing off of Otsego Manor to a provider that has a record of good care?
• There is a significant shift in policy around long-term care in our state that will change the complexion of skilled nursing facilities.
This shift is starting this year with the move to regional pricing and will continue with all New York state Long-Term Care Medicaid residents being enrolled in Managed Long-Term Care (MLTC) by 2014 in Otsego County. To survive in this world of Managed Long-Term Care, an organization must be able to be flexible, efficient and agile (able to reconfigure quickly).
• County nursing homes are particularly vulnerable to this shift because of the enormous constraints of the Civil Service structure and the outdated labor contracts and past-practice issues that hamstring the organizations’ ability to make the changes needed to survive in this new MLTC environment. By state law, county nursing homes are required to provide millions of dollars of New York state retirement benefits that other organizations are exempt from. Otsego County also provides a generous health insurance benefit to retirees and offers wages for some titles that are outside the averages that the pricing system will allow. Our current contract, which expired Dec. 31, 2011, provides a level of paid time off (PTO) that is over the allowable level of the current and future reimbursement methodology. The quality-of-life design of the building requires more staff. As a result, Otsego Manor today is saddled with more than $3 million of non-reimbursable expenses that must be paid for through contributions from the general fund.
• A nonprofit or for-profit provider would immediately be relieved of these expenses. I am not laying the problems we are facing at the feet of our staff. Even if we would have been successful this year in creating some form of MOU to relieve the Manor financially of some of these un-reimbursable expenses, they would not be enough to keep the gap from growing in future years.
It is painful to see the Manor staff put into this predicament. The reality is, the federal government, the state government and society itself have determined that the staff closest to the residents are undeserving of the very same benefits that the regulators who come into our building receive. The same benefits that the Division of Budget staff and the policy makers who write the volumes of regulations that drive costs up and staff out receive. The people farthest from the residents continue to get the benefits and wages they deserve, but the staff closest to the residents are undeserving of these same benefits. This is verified in the reimbursement methodology. This is the root cause of the financial problems of the Manor, and it’s beyond any tweaking in the labor contract, beyond eliminating all organizational inefficiencies and beyond the capabilities of this county.
I have enormous respect and gratitude to the Otsego County Board of Representatives, both past and present, for its commitment to deliver long-term care to the residents of our county in the most beautiful way. I have even more respect for the Manor staff that has been unwavering in their commitment to change the way care is delivered to our residents. As my slide-show presentation to the board last month stated, “The financial assumptions that were used to determine how the Manor was to be funded have evaporated.”
No one could have predicted the current realities back in 1999 when the vision of the Manor was being created. We have to face the realities of today, and the best way to do that is to diligently pursue the best operator we can find to hand the Manor off to. Our residents will be well-cared-for, our staff will be employed, many with similar wages and a scaled back benefit package consistent with providers in our region. The skilled nursing arena is no longer compatible with county operations. Our original mission was to provide care when no one else would. That mission has been replaced. The percentage of Medicaid residents in for-profit and nonprofit facilities is similar to that of county nursing homes.
Moving to full Medicaid Managed Care by 2014 in Otsego County will ensure that the poorest, frailest county residents will have their needs met. The current model is not sustainable no matter how much we love it. This is the new reality.
EDMOND MARCHI is the director of Otsego Manor.