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County Nursing home running in the red with no hope of breaking even

By Howard B. Owens
Apr 1, 2014, 10:09am

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.”

Jeff Allen

"there’s also 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" So tell me again who is pushing granny off a cliff in a wheelchair?

Apr 1, 2014, 10:16am Permalink
Barb Gray

As someone who has a family member in the Adult Home, I take extreme offense at the comment about those residents being "hard to place". My family member is NOT " HARD TO PLACE", she chose to move there from her
OWN apartment because she was falling and unsafe.

The county has been trying to "unload" the Nursing Home for they claim the state is unofficially telling them to get out.....these folks paid taxes while they lived in Genesee County and now all they want is to be safe as they age.

Apr 1, 2014, 12:39pm Permalink

The Nursing Home must be solvent. So if we spend more than we take in, we must take in more. (Higher Taxes) if need be. Our population is aging. Folks are living longer. Dementia has become an ever present problem with the aging.The young folks leave. One only needs to travel around Batavia during the day and observe. I have heard jokes about the City of Batavia will be empty in 25 years. Everybody will be dead. For now we should be contacting other counties, and see if there are functions that can be combined. Administrative positions that can be eliminated or combined. For Gosh sakes, where are Steve Hawley and Mike Ranzenhofer? Why does it cost so much?? Where does all the money go when residents are stripped of all personal belongings when they are admitted there?? What takes so long to reimburse the home from Federal and State gov't??

Apr 1, 2014, 5:32pm Permalink
Bea McManis

Why would the legislators want to keep the county home open? Look at the number of county positions eliminated. Of course, the money saved will never be reflected in your county tax bill. Our state legislators can find money for the college and the airport but not for the safety net for people who contributed to the county coffers for many years.

Karma has a long list. Just saying.

Apr 2, 2014, 7:52am Permalink
Phil Ricci

There is no long term sustainability with this facility. This is a conversation that has been had for years now. The question is not, "Can the nursing home survive?", because it is clear it will not under its current condition. The question that should be posed is "Is this community willing to pay for its continued survival?". Regardless of personal emotions, this is what has to be asked and approached to.

As the caretaker of my grandparents, I am intimately engaged with the way the state works in regards to our most aged. I have seen first hand how the new regulations will suffocate these facilities further, and how insurance companies will position the payments to benefit their businesses.

These are not easy problems to solve. At the end of the day, the facility will not continue in its current form as is. So the question is what do the residents of Genesee County want? I think it's time to have this discussion very candidly. If we chose to keep our facility, then we must make drastic cuts in other areas (something we should be doing anyway) to pay for it.

I know how the state operates. I know how difficult it is to maintain expenses in an environment where costs are guaranteed to rise 3 -5% every year without local municipalities doing anything.

It is a broken system, and it will continue to die until it finally implodes.

Apr 2, 2014, 11:11am Permalink
George Richardson

So what? You have an obligation to take care of the elderly if you want your fading community to survive. Why would anyone spend their life in a place that will throw them to the dogs once they become takers and not makers? It is your duty as a citizen, I hate paying for things that don't benefit me personally but I shut up and do it anyway.

Apr 3, 2014, 6:02pm Permalink
George Richardson

Jeff, I blame Republicans, Teabaggers and Libertarians IMHO. Running up bills means nothing but hiding from them when they are due is less than nothing.
The reality is: everyone younger than sixty wishes everyone older than sixty would die, until they find that they are sixty themself.

Apr 3, 2014, 6:09pm Permalink
Jeff Allen

Of course you would George, I just don't see what a group of people who engage in odd sexual acts have to do with it, but that is your opinion. Did you lift the last line from Alan Grayson?

Apr 3, 2014, 6:35pm Permalink

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