The Genesee County Nursing Home was recently notified of changes to its “Star Rating” by the Centers for Medicare and Medicaid Services. The 160-bed Nursing Home, located at 278 Bank St. in Batavia, has improved its overall rating from 3 stars to 4 and improved in quality measures from 4 stars to 5.

The federal Web site (known as “Nursing Home Compare”) measures many statistics and awards a star rating for every nursing home in the United States. The system is designed to make it easier for consumers to compare the quality of various Homes. Ratings range from 1 star (“Much below average”) to 5 Stars (“Much above average”). The overall rating is a composite of quality measures, staffing, and health department inspections. Ratings are updated monthly.

Genesee County Nursing Home is rated 5 stars for quality measures, 4 stars for staffing, and 2 stars for health inspections – with an overall rating of 4 stars.  The rating covers only the 160-bed skilled nursing portion of the Home.

Administrator Christine Schaller said, “I’m proud and grateful to our staff for the improvements we have made during 2015, and I look forward to even better results in 2016. Our goal is to improve our performance on New York State Department of Health inspections to achieve an overall rating of 5 stars.  

The County-owned Nursing Home and 80-bed Adult Home are scheduled to be sold to Premier Healthcare Management, LLC, this year.

Raymond F. Cianfrini (Alabama Oakfield) 585 948 5201
Robert J. Bausch (Elba Byron Bergen) 585 494 2114
Mike Davis (Pembroke Darien) 585 815 7818
Andrew Young (Town of Batavia) 585 343 4801
Rochelle M. Stein (LeRoy) 585 768 7760
Greg Torry (Alexander Bethany Pavilion) 585 507 8139
Frank Ferrando, Jr. (Batavia City) 585 343 1607
Marianne Clattenburg (Batavia City) 585 343 0428
Edward DeJaneiro, Jr. (Batavia City) 585 343 9240

Steve Hawley gets a pie in his face at the Genesee County Nursing Home during a fundraiser over the weekend that benefited United Way.

Residents and staff raised $744 at the event, which included a hot dog day, open cafe, Easter candy basket raffles and pie throwing into the faces of Hawley, Christine Schaller, Cheryl Schezpanski, Amy Mazerbo, Beth Volk, Joel Chastek and Alisha Rudd.

Photos and information submitted by Amy Mazerbo.

The news of the County Legislature deciding to sell the County Nursing Home was neither shocking nor surprising. The people of Genesee County’s acceptance of the lackadaisical oversight for the home are what have been shocking to me, for a long time. You are correct editor, the county manager has been reporting losses for well over a decade and little has been done. It’s true that a few small contributing fires were put out, but the giant blazing bonfire of taxpayer money was ignored. The issue of the unsustainability of the County Home has been ignored and danced around for years. Assuming that the reason for non-action was a desire to try and keep the home, I tried to propose a solution that would be fiscally prudent, protect the employees and continue coverage for our least fortunate. That too was ignored. I admit I was probably too late, the die had been cast; the fate of the home had already been decided. These problems with government won’t change until voters vote for change. Period.

As a Libertarian and a supporter of free markets I firmly believe that a private operator will do a much better job than public management. It’d be hard for them to do much worse. The bar is pretty darn low in my opinion. I’m not criticizing the employees, I’m pointing a finger at the County Legislature which is and has been responsible for the correct operation of the home and has failed. Hopefully, a new operator will add stability and a more efficient manner to the excellent level of care which already exists. I’m glad to see provisions in the RFP to help make this so.

Now, let’s talk about the proceeds. Assuming the home sells for somewhere near to its assessed value of 10 million dollars added to the average of over 2 million spent each year to make up the operating deficit, spread over the next 10 years would come out to 3 million per year (2 x 10 = 20 million plus the original 10 divided by 10 years) plus interest to be spent on bridges, roads, updates to parks etc.

Yes I expect a tax break on property taxes. The County Home has been used as an excuse to raise taxes, so if it is sold then it should be used as a reason for lowering taxes. You can’t have it both ways. Any debt that the home has caused can be amortized out for more than 10 years, knocking the payments down significantly. The money to be used to pay it off could be found by identifying other areas in which glaring inefficiencies exist. I can make up a list, but not in this letter. Or commit funds to paying off the debt for say 3 years and then reduce the tax. The point is to have a plan that reduces the burden on taxpayers, not a plan to find somewhere else to spend our money.

If the home sells for less than it’s assumed (assessed) value, that fault lies as well with the legislature.  A sale or lease or some sort of graduated purchase should have been simmering on the back burner for at least the past year. Interested parties should have openly been invited to propose ideas for a mutually beneficial transition to private management. Instead we are now having a desperation fire sale. I hope we aren’t forced into a fire sale price. Lack of foresight and planning has brought us to this point. I hope this whole mess is well-remembered on Election Day 2015.

I am asking the County Legislature to show us a 10 year plan of how much they will be committing to roads, bridges and other projects. Spread equally amongst the municipalities of the county, so those highway superintendents can start planning the projects they want done. In addition local contractors can have an idea of what work will be let out over the next decade. This can help them decide on equipment purchases, property leases and employment levels.

This 10 year planning can be an economic engine that actually has wheels attached to it, rather than funding the EDC and the uncertainty that goes with their programs. Forecasting a tax decrease over the next 10 years would also be an economic accelerator as it puts more discretionary dollars in everyone’s pockets to spend. Lower tax rates spur housing sales and increase values. It also proves to the citizens of the county, that their government is working for us, not at us. It would signify that we are thought of as partners in government, not just serfs who pay what we are told to pay. Let’s make lemonade, turn a negative into a positive.

Frankly, I’d rather see all the money returned to the taxpayers through property tax reduction and allow the local municipalities to decide how much they want to spend on road maintenance and let the folks in those towns decide what they want to pay for. But I don’t see that happening immediately, so this is the next best thing.

Note that I am not mentioning a specific amount of money to be committed to either roads, bridges and projects or a specific tax decrease amount. Mr. Ferrando and Mr. Cianfrini have said they will be open and transparent. So be open and transparent.

I am also asking, Legislators that you provide this plan to us, the people of Genesee County before you accept a sale of the county home. I ask as well that there be a vote of the public to approve any sale.

Sincerely;

David A. Olsen,

Basom, NY

Chair, Genesee County Libertarian Party

An Open Letter to the People of Genesee County

By David A. Olsen,

Founding Member of the Genesee County Libertarian Party

Dear Friends & Neighbors:

           Dating back to the first half of the 19^th Century, Genesee County has pledged to care for our elderly citizens who are not able to take care of themselves regardless of their wherewithal to pay for the care or not. This is a noble mission and a tradition worthy of being continued. It is the opinion of the author that this promise should continue to be kept and it is our generation’s responsibility to get the GCNH on a path of sustainability and self-reliance. Originally, the County Home was self-sustaining due to the farming engaged in on the same property. That has not been the case for over 50 years. Over the past decade, at least, it has become an increasingly expensive burden for the taxpayers, so much that it is now problematic. By now, May of 2014, it has become obvious to even the most casual observer that the Genesee County Nursing Home is on an unsustainable path. If the people of Genesee County want to preserve the promise made many years ago that care will always be available for those in need for their friends, family and neighbors, then we have to begin thinking differently.

A recommendation follows and I hope the Genesee County Legislature will consider this as a viable suggestion. This letter has been sent to each County Legislator.

           The Genesee County Libertarian Party motto is “Educate. Advocate. Choice.” Part of the Educate segment, in addition to clarifying the principles of libertarianism and proving that it is not a selfish philosophy is to show that we, the people can do good things for our fellow man and without the interference of government and without the immorality of theft by taxation.

           Last year 60,000 of county taxpayers’ dollars were spent with The Center for Governmental Research on a study to provide some recommendations on how to proceed with the GCNH. This was the second study commissioned. The same organization had already completed a study in 2010 at taxpayers’ expense. I am using one of the options from this earlier report as a base: Option 5, which begins on page 91 of the report titled Genesee County Nursing Home Assessment and Analysis of Future Options, November 2010. ( cite: http://www.cgr.org/reports/10_R-1624_Genesee%20County%20NH%20Final%20Report.pdf )

Why a second study was commissioned is unexplainable in my opinion and totally needless. Again, even the most casual observer understands that NY State and the U.S. governments are both broke and view Medicare/Medicaid & Social Security as “entitlements” and therefore a constant subject of debate on how to cut those expenditures back. In other words, they will not be paying more. The unpaid IGT (Inter Governmental Transfer) funds are a case of fool us once, shame on the Federal government, fool us again shame on Genesee County. The promise made will not be kept, so let’s stop expecting those funds in our budgets.

           So what can we do? Please read on.

Quoting Buckminster Fuller: “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

          I set a few goals for this project:

1. Continue the mission of GCNH without county tax funds being added every year to meet the operating expenses;
2. End reliance on Government funds outside of Medicare/Medicaid and Social Security;( ie: IGT )
3. Preserve the jobs that actually provide patient care at GCNH;
4. Place the home under professional management and off the county administration workload;
5. Provide future nursing home care for those county residents who cannot afford it.

     The actual cost to the taxpayers is somewhat foggy. By amalgamating versions from the County Manager, County Treasurer, Nursing Home Administrator, various legislators and reports from the Daily News and The Batavian, I concluded: since 2002, County tax funds have been required to cover the GCNH operation yearly. The numbers have gone up and down apparently, and this year they are projected to be around $2.5 million in the red. The county has been forced to borrow at times in anticipation of IGT funds. I don’t know the accumulated cost in interest payments. Regardless, this is not sustainable and is not fair. While it is the author’s opinion that a moral obligation does exist to help provide for the least among us, it is also true that the County Legislature has the moral obligation to ensure that if taxes must be levied, they should be spent in the most efficient manner. Unfortunately, neither of those obligations is being met.

     The best situation, I feel, would be to lease the home to a private operator preferably a nonprofit, but for-profit corporations should not be excluded. The decision to enter into any privatization agreement and who the operator is ultimately should be decided by referendum of Genesee County voters. Currently the income of the GCNH is expected at $15.797 million per year, their budget runs at $18.2 million, about $2.4 million is expected in IGT Funds, which apparently have not been paid since 2011. Let’s just forget the IGT Funds for now; if the federal government decides to send it to us, great, but it’s looking like a write-off from here. It also appears that privately operated nursing homes receive a higher per patient payment from Medicare / Medicaid than do government run homes. Additionally, the home is running at less than full capacity and a new operator would surely try harder to fill the facility. This scenario is based on the info available regarding what the GCNH receives now, so any difference goes to the bottom line of the operator. I expect that the new operator will bring in substantially more revenue than does the current operation, due to the above. Any schemes of making money for the County’s general fund through rental income, sale of bed licenses or debt repayment are not being considered. The mismanagement of other county operations is a separate issue and I am currently only considering the future of the Nursing Home. All proceeds need to be earmarked for the future care of County residents.

    So, here goes:

A..        Lease to be paid by the operator in the amount of $4,739.000 per year for a period of 10 years. This is equal to 30 of $15.797 million (current projected income). Standard business practice is to pay 20 percent of income for rent. This is a highly specialized facility with an existing customer base, so it is surely worth much more. I consider 30 percent to be a discounted rate, and should satisfy the NY Constitutional requirement of “Fair Market Value."

B.        During the 10-year period, the County will return to the operator $1.5 million per year for upkeep and maintenance, operator is responsible for any amount over that and can keep any funds not spent. The operator is responsible to complete needed upkeep and maintenance. Facility shall be inspected quarterly by the County for compliance.

C.        During the 10-year period the County will pay for the care of indigent or underinsured patients in the amount of 1 million dollars the first year and then decreasing by $ 100,000 each following year so that after the 10^th year has passed, there will be no more funding from the County.

D.         This leaves $2.239 million remaining from the proceeds of rent payments. Of that 25 percent ($671,700) shall be placed into a contingency fund each year to be spent on Nursing Home issues only, at the discretion of the County Legislature. (Specific items allowed should be quantified in the lease agreement). The remainder, which would be $1,568,300 the first year and then increasing by the amount withheld from the payments described in C. above shall be placed into a permanent fund, which will accrue interest and will be used to fund the County’s share for care of the necessitous citizens of Genesee County after the 10-year period has ended. This will leave the fund with $19,500 in principle paid in. With an estimate of 2-percent interest being earned, the fund should have approximately 24 million dollars in it. That would be enough to have $300,000 to 400,000 per year removed for patient care and still be sustaining.

E.         At the completion of the 10-year period, the operator will cease lease payments and either the facility could be transferred to their ownership or the County can retain ownership. The facility would then be placed on the tax rolls, or if continued ownership by the county is desired, a payment plan would be drafted in lieu of taxes. Either way the result will be lower than $4.739 million per year. This should provide an incentive for a farsighted operator to take over the operations even if they may lose money in the first few years, which is why I believe that a nonprofit would be the best fit.

F.         The operator shall be offered to purchase County employee benefits for their employees, so as to continue the employment of the current staff for a period of 10 years. A benefit buyout plan should be established for any current employees who remain past the 10-year period and their pension converted to a 401K. I don’t think it wise to demand that wage levels be mandated for the operator, nor should we demand certain staffing levels. Those things are controlled by the State of NY anyway. We can however assist with the high cost of employee health benefits. A large majority (around 70 percent) of the GCNH budget as reported by the County is attributed to “Salary /Fringe” -- this could help alleviate those costs enough for the new operator to function at the reduced income of $12,558,900 (minimum) the first year (70 percent of $15,797 plus the $2.5 million refund from the County) without necessarily reducing the paychecks of employees. Especially in light of the fact that the operator will both earn more per patient and is expected to have more residents at the home.

            I’m sure there are laws and regulations which I am unaware of and are not factored in. I know the employees are represented by a union. Unions renegotiate contracts all the time, so that shouldn’t be an obstacle. This is why I am sending this to the Legislators so they can research those issues. This is a starting point and I believe the base premise used here is sound and workable.

      Thus the Genesee County Nursing Home is saved, the employees keep their jobs, taxpayers are no longer paying for the operation of the home, the County Administration is no longer spending time and effort on the home, a new private employer has come to town and most importantly the mission of the home to be there as a safety net for County residents will continue.

With Liberty and Justice for All,

David A. Olsen

Batavia's Girl Scouts and Brownies sang Christmas carols this evening for residents of the Genesee County Nursing Home.

Christine Schaller, nursing home administrator, presented the contract proposals to the legislators.

She said she was motivated to help the nursing home operate more efficiently so it can continue to serve the community.

The first contract is with Beth Platt & Associates for physician billing.

When nursing home residents see a physician, the doctor files an "encounter form" with the nursing home and staff must figure out which insurance company receives the claim and complete the proper paperwork. Different companies have different forms and different software.

Currently, the process costs the nursing home about $6 per claim. The billing service will charge $2 per claim.

"We would like to outsource this to a company that does this all of the time," Schaller said. "It will be faster and cheaper."

Schaller also said that physician billing for the Genesee County Nursing Home is about one-third the revenue of similarly sized operations.

"It should be more than it is," Schaller said. "I don't know why it is what it is."

It's possible there will be no new revenue found by outsourcing billing, but the contractor might find a reason billing is lower than expected and bring the figure up.

The second contract is for billing for rehab stays for nursing home patients.

The contract is for $48 an hour, or an estimated annual cost of $12,480, with MDS Consultant.

Again, between Medicaid, Medicare and the half dozen other insurance providers, billing can be complicated and it's possible the nursing home isn't receiving all the revenue it should for these stays.

Both contracts will also help the nursing home meet corporate compliance standards, which will go over well with state auditors when they visit.

"I can't guarantee this, but I think we're going to generate more revenue than the services are going to cost," Schaller said.

Nursing Home Administrator Charles Rice told the legislature's Ways and Means Committee on Wednesday afternoon that "a lot of people are coming out of the hospital now" with C. diff.

After the meeting, Rice and the Nursing Home's Nursing Director Dawn Canale backed down from that statement. Rice and Canale said the Nursing Home has always been on alert for C. diff, but recent media reports about the C. diff outbreak at UMMC has the Nursing Home stepping up its infection control measures.

No Nursing Home residents have C. diff, Rice said, and Canale explained that any potential transfer patient from UMMC who tests positive for C. diff is not accepted as a resident at the Nursing Home.

Asked if there has been a spike recently in the number of potential transfers who test positive for C. diff, Canale said, "I don't want to say that," adding, "because two or three to me is a lot, but to you guys ..."  Canale's statement trailed off.

Canale said that every transfer from the hospital is screened and must have two negative tests for C. diff before becoming a resident at the Nursing Home.

"They always tell us (if a patient had C. diff) and we always make sure they’ve been treated and they're not contagious," Canale said.

If a person had C. diff but has recovered, the patient can be transferred, but the resident is either given a room with an other former C. diff patient or given a private room.

"We don't unnecessarily expose our fragile residents," Rice said. "Most of the time they've been treated, but we still keep a good eye on them."

Dealing with the outbreak of C. diff has been difficult, Rice said, because there is limited bed space in the Nursing Home and special precautions must be taken to separate potential C. diff carriers from other residents.

Rice also said that employees are given extra instructions on infection control and extra attention is given to disinfecting the facility.