nursing home

As the County wraps up expenses related to the sale of the Genesee County Nursing Home, officials expect to have about $17 million available for funds dedicated to infrastructure, including roads and bridges.

"That's what we said we would do with the money and that's what we're doing," said Marianne Clattenburg, chair of the Ways and Means Committee at yesterday's meeting.

It looks like the proceeds of the $15.2 million sale of the nursing home to Premier Healthcare Management LLC is $10,033,000.

The county is also collecting $7 million in unpaid intergovernmental transfers (federal reimbursement for medical expenses for nursing home patients). This money will also be set aside for infrastructure.

There is still some wrangling with insurance companies, said Treasure Scott German, over money the companies think they are owned and money the county think it is due. There may be additional minor expenses to close out, but those payments will be handled through the general fund.

In other words, the budget line for the nursing home in the county's expense ledger is now officially closed.

County Manager Jay Gsell just announced that as of 7:56 a.m., Genesee County is out of the nursing home business. 

The sale of the Genesee County Nursing Home to Premier Healthcare Management, LLC is complete after state regulators cleared the way for transfer of title. 

The county has received payment in full in the $15.2 million transaction, Gsell said.

A demand put on the company buying the Genesee County Nursing Home by the NYS Department of Health has delayed closing on the title transfer, so in an emergency session this morning, County legislators approved a short-term lease agreement with the buyer.

The agreement will allow Premier Healthcare Management LLC to take over management of the nursing home on Jan. 1.

The county expected to be out of the nursing home business by midnight Dec. 31, so it canceled all of its third-party contracts related to the nursing home effective the last day of the year and told all county employees at the nursing home that they were going off the county's payroll.

This latest wrinkle in the sale process, therefore, caused a bit of turmoil among county officials, said Ray Cianfrini, chairman of the Legislature.

"The fact that this came up at the last minute is disconcerting to all of us," Cianfrini said.

The surprise twist in the plot isn't expected to change the eventual outcome of the sale, Cianfrini said. Officials believe the sale will go through by Jan. 15, but if it doesn't, Premier will pay the county $5,000 per month in rent for January and February. If the deal doesn't close by Feb. 28, rent payments go up to $50,000 a month.

Essentially, Cianfrini said, the health department is trying to nail down assurances that Premier isn't going to acquire the nursing home and the flip it to another buyer who will convert the building into condominiums.

That apparently happened in New York City not long ago, Cianfrini said, so the state is leery of a repeat scenario. Cianfrini doesn't think that is Premier's intention. He said Premier seems intent on establishing a strong presence in Western New York, where it's finding it easier to do business than in NYC.

Premier agreed to pay $15 million to the county to acquire the nursing home, which has been running in the red as a county operation for a decade, with deficits hitting as high as $2 million a year. Premier has already transferred $1.5 million to the county and has agreed to pay another $200,000, which is money the county will keep if the deal, for some reason, doesn't go through.

As County Manager Jay Gsell and the Legislature work on finalizing the 2017 budget, it's been a bit of a nail-biter for county officials wondering if they would be able to close on the sale of the Nursing Home before Dec. 31.

Without the close, the county would need to include nearly $16 million in expenses and offsetting revenue in the budget.

Back in May, the NYS Health Department approved the certificate of need ("CoN" -- a kind of license) 160-bed care facility, but officials had gotten no word on the other CoN for the 80-bed adult home.

All along, Gsell felt the sale would be finalized before the end of the year, but without final approval, there was no way to count on it.

Yesterday, an executive with the prospective Nursing Home buyer, Premier Health LLC, got a phone call from a state official saying the certificate of need was approved and an official letter should be dropped in the mail today.

"At least now we have a very good sense that this is actually going to happen in the calendar year 2016," Gsell said.

Once the letter is in hand, both sides can start working on the details of closing the sale, including transferring employees and contractors, completing paperwork, and finalizing how to handle accounts receivable, among other details.

That will be a three- or four-week process, Gsell said.

The county will get about $15 million for the nursing home, but after expenses, only about 25 percent of those proceeds will be available for either the general fund or the capital fund.

Gsell was able to share the good news with legislators yesterday during a budget work session.

There were no decisions that came out of yesterday's budget discussion. The legislators have a 292-page, $141 million budget to pore through as they grapple with their options for the tax rate, deficit spending or any big spending cuts that they might make.

Gsell's budget is balanced, but it requires pulling $1 million from reserve funds and reallocating sales tax revenue from future road and bridge repairs to the 2017 general fund.

A $15 million increase in assessed value, of which about $7 million is taxable, for properties in the county, makes the break-even tax rate for the 2016 vs. 2017 tax levy at $9.66 cents per $1,000 of assessed value.

Gsell's budget proposal increases the tax levy by $645,000, the maximum increase under the state's tax cap law.

That would set the 2017 property tax rate from the county at $9.76 per thousand of assessed value, or 10 cents lower than 2016.

The Legislature will consider whether to pass a resolution authorizing them to override the tax cap limit to raise taxes. Because of timing and budget deadline issues, the resolution will need to be passed before they even get to the point of deciding what the tax rate should be.

It's a policy decision for the legislature whether to accept Gsell's budget as proposed, raise taxes to reduce deficit spending, or make significant cuts in non-mandated services, such as parks and law enforcement.

The sale of the Genesee County Nursing home to Premier Healthcare won't exactly lead to the county government pocketing a cool $15.2 million and walking away from the deal scot-free.

Getting disentangled from the white elephant of a facility will take months and cost millions of dollars.

"The costs don't stop on the day of the sale," said County Manager Jay Gsell.

The revenue to the county, as insufficient as it's been for the past decade, stops the day Premier takes over, but some of the costs will drag out, such as final payments to employees' retirement accounts, paying out unclaimed vacations and leaves, paying ongoing workers comp claims, closing out obligations for patient care, among other expenses.

It could be at least a year before the county knows how much of that $15.2 million is left over after all of the expenses are covered.

Right now, best guess, those expenses will eat up at least 75 percent of the sale price, Gsell said.

It will be up to the county legislature to decide what to do with the balance, whether put it back into the general fund, put it into roads and bridges or toward building a new jail.

There are also unpaid bills from patients to be collected. The floating balance of unpaid bills, called accounts receivable, is about $1.3 million.

The county will need to make a decision on how to handle those accounts, whether sell them to Premier at a discount or assign staff -- perhaps more than one staff member, plus attorney time -- to try and collect those payments, or the accounts could be turned over to a contractor for collection. An accountant with Freed Maxick  is working to determine which option might be best for the county.

The county is also owed money from the federal government, which passes through the state, called IGT funds. This money is designed to help county governments fill the gap between revenue and expenses on facilities such as the nursing home. That is money owed the county for expenses already incurred, but by law, the money must be paid to the nursing home, so Premier will need to transfer the money to the county, once the funds are received.

Whatever the final "net proceeds" from the sale might be, the county will never be able to claim it made a "profit" on the sale, Gsell said.  

The sale will close after Premier receives its second regulatory approval, called a certificate of need, from the state's Health Department. One has been approved, for the skilled nursing home, but the other, for the adult home, is still pending.

Gsell expects the deal to close in the fall, meaning between Oct. 1 and the first day of winter.

The nursing home has been bleeding money from the county's general fund for the last 10 years, and to a tune of more than $2.5 million a year for the past five. Those are deficits on operations that will never be recovered.

"We will never be able to use the word 'profit' when it comes to the Genesee County Nursing Home," Gsell said. "That equation has left the building."

The County Legislature has voted to sell the Genesee County Nursing Home to Premier Healthcare Management, LLC, for $15.2 million at the Ways and Means Committee Meeting tonight.

The final details of the contract still have to be finished and signed by the legislature. As an alternative until the contract is finalized, the legislature has issued a letter of intent for the sale and transfer of Genesee County Skilled Nursing Facility and Genesee County Adult Home.

The letter of intent is needed so Premier can meet the Department of Health's application deadline for licenses and certificates of need. The entire process can take anywhere from six to nine months.

Premier owns several nursing home facilities and is a well known for-profit healthcare corporation in New York.

"There will be no reduction in the quality of care at our nursing home, which is our biggest concern,” Legislature Chairman Ray Cianfrini said. “The fact that they can do it at a profit is something I give them credit for. They have a different set of parameters that they work within that allows them to do that. This is not the only nursing home they own so they have the economy of scale they can use to make profits. That doesn't bother me at all."

Members of the legislature were impressed after touring their facilities and talking with residents.

Legislator Marianne Clattenburg said she believes Premier can provide advancements to the nursing home that the county couldn’t do.

“What struck me was their willingness to make investments,” Clattenburg said. “We saw one facility that had a multimillion-dollar dialysis unit installed after they had taken over the building.”

Finding a qualified buyer for the nursing home has been an extensive process.

“It was a long thorough process,” said Legislator Frank Ferrando Jr.. “Right from the beginning nothing happened rashly or quickly. Places were visited and questions were asked. We interviewed eight from a list of 14 that were original applicants. I’m very confident this is going to be a real plus for our community.”

When the contract is finalized, Premier plans to seek community input and will hold community meetings and forums for families and employees.

According to county officials, after debts are paid the county hopes to net $6.7 million from the sale.

The County Legislature is poised to accept what County Manager Jay Gsell characterized as the "highest and best offer" from a qualified buyer on the Genesee County Nursing Home.

The county received eight purchase proposals, Gsell said, and the recommended buyer is not only well qualified but also submitted the highest bid.

The details of the purchase agreement are not yet public and more details should be available when the Legislature meets in a special Committee of the Whole Meeting following the 4:30 p.m. Ways and Means Committee meeting Wednesday, in the Old Courthouse.

For years, county officials have maintained the nursing home is a multimillion-dollar drain on the county's budget and that state officials have been maneuvering counties toward the sale of such facilities by strangling state aid. Financial disclosures provided to potential buyers show the nursing home's losses have been piling up, with losses of $2.9 million in 2011, $3.7 in 2012 and $4.3 million in 2013.

A non-government agency (whether a not-for-profit group or for-profit company) will have greater flexibility in generating revenue than the highly regulated government-owned facility, plus have greater leeway in reducing expenses, and it won't be facing a squeeze on funding from the State of New York, according to county officials.

The anticipated vote by the Legislature is just the first step in a long process that could last up to nine months to complete the sale.

While Gsell said legislators have been doing their due diligence to ensure the anticipated buyer is qualified, the state has its own investigative process before it will OK transferring what's called a "certificate of need" to the new owner. The nursing home has two such certificates.

"At this point, with the deadlines the state has on financing nursing homes, especially adult operations like we have, the Legislature would like to start that process now," Gsell said. "The state conducts what it calls a character and compliance review and that could take six to nine months. That's what other counties have been through, including our neighbor to the north."

While Gsell would not at this time disclose the name of the buyer, citing purchase agreement restrictions, he said it is a company based in New York. That's one of the details that could be made public Wednesday.

For previous nursing home coverage, click here.

Via The Batavian's news partner, WBTA

The flu virus has been detected among patients in the Genesee County Nursing Home and some staff members are also beginning to show symptoms.

Due to the contagious nature of the flu, visitors will not be allowed at the facility until further notice.

The flu is very hazardous to the elderly and should not be taken lightly, officials said.

The nursing home is working with the New York State Department of Health to limit the spread of the virus. Families should contact their Social Workers with any questions.

So far, one potential bidder for the Genesee County Nursing Home has submitted a letter stating an intent to make an offer on the 260-bed facility.

Interested buyers have until Sept. 23 to submit a letter of intent and until Oct. 6 to submit proposals.

So far, some 25 to 30 potential buyers have expressed interest in the nursing home, County Manager Jay Gsell said, but there's still just the one written intent to submit a bid.

The nursing home has been dragging down county finances for years, and financial disclosures included in the RFP package show the facility losing $2.9 million in 2011, $3.7 in 2012 and $4.3 million in 2013.

A non-government agency (whether a not-for-profit group or for-profit company) will have greater flexibility in generating revenue than the highly regulated government-owned facility, have greater leeway in reducing expenses, and won't be facing a squeeze on funding from the State of New York, according to county officials.

The county Legislature decided to sell the home to escape the ongoing financial drain on the budget.

The RFP states the facility will be sold to the most qualified, responsible bidder who meets a range of criteria. The highest bid won't necessarily win the purchase contract.

The current assessed value of the nursing home, on Bank Street, is $10.9 million.

Of course, currently no taxes are collected on the government-owned property.

Serious bidders will be invited to pre-proposal site visits Sept. 24, 25, 26 and 29.

Bids must include a $100,000 refundable deposit and provide financial statements and a letter of credit indicating not only the ability to close on the final purchase price, but to operate the facility at the current level or improved level of services after the purchase is completed.

The purchaser will be prohibited from involuntarily transferring or evicting any current resident of the nursing home.

Bidders must agree that the RFP process is subjective and the Legislature has the final say on whether to accept or reject any and all bids, and the county reserves to right to enter into negotiations with a bidder to modify a proposal.

The company must provide a company history, executive bios, information and qualifications on employees, experience with similar facilities, and plan for a smooth transfer of ownership.

There will be no public bid opening and bids won't become public until after a proposal is accepted by the Legislature. It's up to the company to declare any portion of the proposal that would be exempt from public disclosure under the Freedom of Information Law.

The sale of the nursing home has generated a little public opposition. There is a "Save the Genesee County Nursing home in Batavia NY" group on Facebook with 166 members currently.

The complete RFP package is available on the county's Web site.

In a move that will make it possible for the county to sell its nursing home, the Ways and Means Committee on Wednesday approved a resolution declaring the facility "surplus property."

The nursing home is running at an annual deficit of $4 million and the state is doing everything it can, according to legislators, to ensure it continues operating at a loss so it will be sold.

County Legislature Chairman Ray Cianfrini said the county really has no choice but to sell the nursing home.

The county approached UMMC about buying the nursing home and the hospital's board had no interest in acquiring it.

The county also sent out at least 30 letters, Cianfrini said, to nonprofit agencies to see if any of them wanted to run it and there were no affirmative responses.

"We're pretty much down to our last option, which is to see if there's interest from a for-profit group that would want to buy our facility," Cianfrini said.

A private company would receive higher Medicare and Medicaid reimbursements, be able to reduce personnel expenses (potentially, no union, and lower pension costs), accept a wider variety of patients, thereby increasing revenue, and seek other money-making opportunities not available to a government agency.

If the county keeps the nursing home, or is unable to sell it, the burden on local taxpayers is only expected to grow as the state cuts off just about all of the remaining subsidies it provides to the county to help maintain the nursing home.

Cattaraugus and Orleans counties recently successfully sold their nursing homes, Cianfrini said, so the legislature is hopeful the same thing will happen here.

"We're looking at it from the standpoint that it's fiscally irresponsible for us to try to continue to operate it," Cianfrini said.

New York will finally pay off some of their IOUs to the county.

County Treasurer Scott German learned Tuesday that $4.1 million in funds meant to cover 2013 Nursing Home expenses will be transferred to the county Aug. 13.

That's the good news. We'll get to the bad news shortly.

The $4.1 million is what is known as an Inter-Governmental Transfer. It's money that originates with the federal government and sent to the states so the states can transfer it to county governments that run nursing homes. The money is meant to help offset the difference in reimbursement fees between Medicaid and Medicare (it's more complicated than that, but that's the easy explanation).

In June, the county received $4.3 million in back IGT payments from 2012.

Of the $8.4 million IGT received, the taxpayers of Genesee County paid an amount equal to 50 percent, or $4.2 million, as a local match.

But that isn't all of the bad news.

County Manager Jay Gsell said the feds are phasing out the IGT program. The Aug. 13 payment is probably one of the last two or three the county will ever receive.

No program has been announced to replace it.

Once there's no IGT -- and if there's no program to replace it -- the local share cost of running the Genesee County Nursing Home will likely be at least $3 million a year, and that figure is growing each year, German said. The operating deficit will need to be funded by local taxpayers.

Of the $4.3 million received in June, $2 million went into the general fund to pay off money the Nursing Home borrowed from the general fund.

Some of that IGT money will be used to pay off a $5.8 million Revenue Anticipation Note (RAN -- a short-term loan based on the promise of anticipated revenue).

The $4.1 million the county receives Aug. 13 should pay off the rest of the RAN, a loan that must be retired by November.

If for some reason, there is a shortfall, the county will either need money from the general fund or another loan, German said, to pay off this RAN.

But it's anticipated there will be a $200,000 surplus from the IGT payment, which will be gobbled up by Nursing Home expenses in short order. The county will then need to borrow more money to cover Nursing Home expenses with no guarantee the feds or the state will help with the expense at a later date.

The County Legislature met with an attorney today who is helping them explore options for dealing with the Nursing Home. The meeting was held in close session and was purely informational for the legislators, Gsell said.

There’s a lot of red ink flowing at 278 Bank Street these days.

That’s the location of the Genesee County Nursing Home, owned and operated by the County of Genesee, so when it’s in the red, local taxpayers are picking up the bill.

The annual, out-of-pocket deficit for the county is $1.5 million.

That’s after current management has trimmed expenses more than $860,000 on an annual $19 million budget.

“Running a New York State nursing home is a very risky business,” said Christine Schaller, nursing home administrator during a meeting Monday of the county’s Human Services Committee. “It’s risky even for private owners.”

As it stands now, the nursing home is $4.7 million in the red. That figure includes not just the operational deficit that county taxpayers fund, but the lack of reimbursements from the state and federal governments.

The feds owe the county $2.7 million in what’s known as IGT funds (inter-government transfers). The last IGT payment from the feds (which flows through Albany) was in January 2013 and only covered money owned from 2011.

The NYS Department of Health owes the county $650,000.

The rate of pay from Medicaid for patients is $80 to $100 less than the actual expense of care for those patients, plus Medicaid rates were cut by 2 percent in 2013.

The nursing home has also been forced to write off $487,000 in unpaid insurance claims.

There’s little left to trim from expenses and still maintain the home’s four-star rating and there’s no realistic way to increase revenue.

One of the biggest expenses for the county is the Adult Home (formerly known as the Domiciliary).  Residents there are considered “hard to place.” It’s the residency of last resort for those unable to care for themselves. It’s licensed as a public home, so residents cannot access Medicaid or Social Security insurance to pay for care. The county pays $101 per day for each resident (about 40 currently, out of 80 beds). That’s a $1.3 million annual expense.

“In some cases, nobody is paying us for the care we provide,” said County Manager Jay Gsell. “Once we take a resident in, we are not allowed to discharge them for lack of payment.”

The county tried to relicense that section of the home as an assisted living program, making patients eligible for Medicaid and SSI, but the state denied the request.

Gsell said the message from the state is clear: Get out of the nursing home business.

“They haven’t put that statement out there to counties, ‘get out,’ but they’re doing everything they can to tell us, ‘why are you doing it?’ ” Gsell said.

Schaller agreed.

“It would be political suicide for them to say, ‘close the nursing homes,’ but they’re doing everything they can to push us out,” she said.

The county helps cover some of the $4.7 million deficit created by the nursing home with what’s known as a RAN (revenue anticipation note). It’s a temporary loan that the county will repay once Medicaid and IGT payments are received.

All this red ink, and no reason to believe things will get better. There’s plenty on the horizon to worry about. The Affordable Health Care Act is changing how long-term care is paid for and managed, the UMMC/Rochester General merger could divert referrals from the nursing home to RGH-run facilities, labor costs are going up, and there are indications the feds will stop IGT reimbursements completely in a year or two.

“We’ve been paring costs in a lot of different areas as far as running the facility,” Gsell said. “The problem is, we can’t pare costs down to the deficit and we certainly can’t find additional, new, enhanced revenue to make up the difference either. That’s the bottom line.”

Press release:

The Genesee County Legislature, working with its consulting attorneys for long-term care planning -- Bond, Schoeneck & King -- is continuing a process of due diligence regarding the future of the Genesee County Nursing Home. This review has been made necessary by changes made by New York State in the long-term care fiscal and programmatic environment. Most critically, New York State is mandating that long-term care facilities begin moving to a managed care model.

The legislature has established three committees to keep moving the analysis and option review process forward expeditiously. They are comprised of members of the County Legislature and select administrative and community stakeholders on an “as needed basis."

The Long Term Care Sustainability Committee will be comprised initially of Raymond Cianfrini, Robert Bausch and Marianne Clattenburg; the Operations/Redesign Committee includes Annie Lawrence, Edward DeJaneiro and Gregg Torrey; The Community Engagement/Education Committees core members are Rochelle Stein, Frank Ferrando and Andrew Young. The overall focus is on the future role of the County’s 240 bed facility/services and to preserve the continuity, quality and accessibility to long-term care in Genesee County.

With the advent of mandatory Managed Care, New York State Department of Health has imposed fiscal constraints on all long-term care providers across the State, including regional reimbursement-rate formulas and the predominance of Medicaid as the principle revenue source for most New York State-based nursing homes. Time is of the essence to develop and articulate a strategy in 2014 which the Genesee County Legislature is pursuing posthaste.

In announcing the appointments and the start of the committee process, newly elected Chairman of the Genesee County Legislature Raymond F. Cianfrini stated: “Once again, changes made in Albany dictate that our county government work diligently to protect our taxpayers while insuring the availability of critical services to our community. Our charge to these committees and our consultants is that we devise a plan to insure that quality long-term care continue to be available and accessible in our community.”

Cost-saving measures at the Genesee County Nursing Home could mean that spending at the facility in 2013 will be as much as $896,700 below budget.

Changes include such measures as converting the little cafe at the facility to vending machines, greater use of nurse practitioners and reductions in non-direct care staffing.

"In what really is an increasingly very regulated and scrutinized environment, we're still offering a very good quality of care, but we're also being more circumspect in controlling our expenses," said County Manager Jay Gsell. "That's the only way you survive in the nursing home business, whether you're private, nonprofit, whatever, particularly in the State of New York."

The nursing home is also facing cuts in Medicaid and Medicare. But in moving therapy from independent contractors to a single contractor -- Freedom Therapy -- the county is not only saving money, but also getting a greater rate of reimbursement from the federal government.

The single-vendor system has allowed the home to increase its care rating, which means a greater reimbursement rate from the feds.

The effort to lower expenses has been led by Nursing Home Administrator Chris Schaller and Director of Finance David Lockwood.

Schaller was hired by the contractor that runs the nursing home and Lockwood came down from Orleans County about a year ago, Gsell said, and "has brought a lot of new ideas."

Technological upgrades have also allowed nursing home management to provide monthly reports to department managers about expenses.

That means, Gsell said, managers get real-time information to compare spending against the previous month or previous year on everything from supplies to overtime.

"We now have information that if it tells us (we're spending more) we can say, 'what are we going to do about that,' " Gsell said.

Meanwhile, the county has continued to invest in the nursing home, making sure the facility is in good repair and up to date.

To keep the quality of the facility at "four out of five stars," Gsell said, it's important to maintain the number of patients in the skilled nursing floor at a high level.

"When the occupancy goes down, we lose way more money than we're already losing," Gsell said.

The focus on expense reduction is important not just because state and federal revenue is shrinking, but because there may still come a day when the County Legislature decides to put the nursing home up for sale.

"When the Legislature does want to look and see what an outside group could do, we think we're putting our best foot forward," Gsell said.

UPDATE: A little information I didn't have last night: The nursing home is still projected to run at a gross deficit of $2.5 million for 2013.

CORRECTIONS: County Treasurer Scott German sent along these corrections: The IGT is a federal program, it is a state pass-thru. The amount of the IGT is yet to be determined by the state and the feds. Also, 50% of the IGT amount is paid be Genesee County taxpayers directly, it's a 50% match."

The Genesee County Nursing Home owes $3.2 million to the county's general fund, Treasurer Scott German told the Ways and Means Committee today.

Unless the state does the unexpected and transfers money owed to the nursing home before December, the county will need to seek a temporary loan to make its annual pension fund payment due by the end of the year.

"It's possible (the state payment) could happen this year, but it's doubtful," German said. "It's more likely to happen in the second or third quarter of next year."

The state owes the nursing home about $3.2 million in intergovernment transfer funds, and the county also expects to be paid about $500,000 from the nursing home for the indirect services it provides to help keep the facility operational.

Chairwoman Mary Pat Hancock said she gets a lot of confused questions from constituents about the state of the county's budget, because they read that sales tax is up $540,000 over budget, or the county got more revenue in the tax lien auction than anticipated.

It's situations like this, Hancock said, that put the county in such a dire financial position.

"It’s very hard for our constituents to understand what’s going on," Hancock said. "We should have more money than we do and we have less than anybody thinks."

Hancock added later, "We cling to the good news, but the fact of the matter is this is a crisis, a financial crisis."

The county will need to keep paying the nursing home bills, German said, regardless of how long it takes the state to reimburse the expense.

An outside consultant's ongoing study of what Genesee County should do with its nursing home is proceeding as planned and on schedule, according to County Manager Jay Gsell.

The point needed to be made, Gsell said, because as the Center for Governmental Research works through its interviews, researchers are encountering questions and rumors about the status of the report.

The rumors have been as wild as suggesting that the county is looking at purchasing UMMC, which Gsell said isn't going to happen.

To remind everybody what CGR is up to, Gsell issued a "status report" to the local media today.

Full report after the jump:

The due diligence process focused on the future fiscal and operational viability of the Genesee County Nursing Home is continuing on schedule with an expected comprehensive report by the Center for Governmental Research (CGR), the outside consultant retained by the county earlier this year, to be delivered in September or October 2010.

Over the past four months CGR has engaged a broad cross section of county legislators and management staff; nursing home administration, staff and local union representatives; residents and their family members; nursing home contracted service providers and community healthcare professionals and business representatives in their fact-gathering and opinion-seeking process.

CGR conversations are also anticipated with the New York State Department of Health’s regional and state representatives as part of their review and development of the options for the long-term future of the county’s 240-bed nursing home and related services environment. This includes a detailed analysis of a variety of historical financial and descriptive data about the Genesee County Nursing Home and its various component programs and services.

Possible long-range options include:

• Continued county ownership and operation as a county department;

• Continued county ownership and operation as a county department with significant fiscal and operational changes;

• Solicit through a Request for Proposal for a contract with a third party for management, operation and streamlining of facility costs;

• Or solicit through a Request for Proposal process potential alternative ownership and/or operational agreements.

Closure is not an option being considered by the county, and all of the above options would include the ultimate goal of ensuring that the long-term institutional care needs of a diverse group of Genesee County residents are met.

The county’s commitment to quality care and a pleasant living and working environment for years to come is evidenced by the debt obligations and facility improvements it continues to make on behalf of the nursing home.

A significant capital investment was made in the facility in 2000 and capital investments continue today with necessary infrastructure projects such as roof replacement and reconnection to the National Grid electric services.

These investments are being made in spite of ongoing and projected $1 to $3 million-plus annual operating deficits and the state and federal governments’ continued capping or reducing daily reimbursement rates under Medicare and Medicaid.

The engagement of CGR as an outside, neutral expert in researching and profiling alternatives to the current deficit-financed public-sector legacy is a commitment to being as prudent, responsible and strategic as possible for the nursing home’s residents, employees and the county’s taxpayers.

The present analysis and outlining of options is an accepted standard practice engaged continuously by private business and industry. The county should be no less prudent or proactive when it comes to this heavily regulated, 24 hours/7 days per week operation. Its maintenance and upkeep are paramount to this critical piece of our community’s healthcare continuum.

Jay A. Gsell
Genesee County Manager

Rather than hire a new county employee to replace John Demske, who retires May 14 as director of the Genesee County Nursing Home, a county committee is recommending the Legislature approve a contract with a consultant to provide nursing-home supervision.

The Legislature is being asked to vote on a contract with Insource Healthcare Solutions, out of Buffalo, at a special meeting at 5:30 p.m., Wednesday.

The contract would authorize the county to pay Insource $11,000 per month -- the same cost as a full-time county employee being placed in the position, according County Manager Jay Gsell.

"We felt this was a very good way for us to get new administration in place," Gsell said.

By state law, a licensed administrator who has been approved by the state Department of Health must supervise the nursing home every single day its doors are open, so the county must have Demske's replacement in place on May 15.

Gsell said there never really was a search for a full-time county employee to replace Demske. With the county currently studying its options for the future of the financially troubled nursing home, it made more sense, Gsell said, to have an administration firm handle those duties for now.

"Because we're in the process of studying what our options are, for us to go through the process of hiring another employee and all the things that involves, that right now, getting a licensed administrator ... is a good way for us to have a fairly seamless transition," Gsell said.

The actual administrator Charles Rice, is an employee of Insource currently working at a private facility in Jamestown.

If the Legislature approves the contract with Insource on Wednesday, Rice's credentials would be submitted to the state for approval. Gsell said that process takes about a week.

By law, the initial term of the contract cannot be longer than the term of the current Legislature, so the contract with Insource is for 18 months. Gsell said it will contain language allowing for renewals on an annual basis for another three or four years.

Genesee County isn't the only county in New York struggling with what to do with its nursing home in an era of skyrocketing costs and dwindling resources.

All 36 counties in the state with nursing homes are facing the same issues, according to a press release from the New York State Association of Counties.

“We need to address following questions. Should counties be in the long-term care business? If the answer to that question is yes, then we need to develop funding formulas or financing mechanisms that do not require annual property tax increases to keep them open,” said NYSAC President Tom Santulli.

The NYSAC statement says:

Counties are in a crisis and are confronted with unique challenges with the health and fiscal stability of public nursing homes. Those challenges include complying with the unfunded mandates such as Wicks Law and contributing to growing public employee pension rates and healthcare costs.

To help counties address the issues, NYSAC is hosting a nursing home summit May 25 in Ulster County. The summit will address:

• Long term care reimbursement and the NYS budget crisis,
• The current fiscal health of county nursing homes in New York State,
• Challenges of operating a county-owned nursing facility,
• Analysis of the state’s population demographics, relative to housing needs, and
• Alternatives to institutional long-term care including home/community-based alternatives.

The press release concludes:

“County-owned nursing homes are in state of transition. The state’s indecisiveness about the role of counties in long-term care, and their temporary fixes are not solving the problems we are facing. They are Band-Aids but they are not addressing the structural deficiencies,” said Stephen J. Acquario, executive director of NYSAC.

There's now a time line in place for the Center for Governmental Research to conduct its study on the future of the Genesee County Nursing Home.

It starts with meetings of key stakeholders at the nursing home and ends with a final report delivered to the County Legislature in September.

During the process, CGR consultants will meet regularly with the legislature's steering committee.

The full time line is available here (pdf).