November 17, 2002

Not a Place to Leave a Relative



T has been about three years since administrators at the A. Holly Patterson Extended Care Facility in Uniondale could boast that the 889-bed nursing home was filled to capacity.

Since then, state inspectors have cited it repeatedly for endangering its residents. With each new round of violations doing more damage to the home's already tarnished reputation, the number of empty beds has grown.

Karen Dolan said that her mother, Mafalda DeRienzo, spent 24 hours at A. Holly Patterson last May and that they were appalled at the conditions there. "The place was filthy, her bathroom had blood and urine splattered on the walls, and they gave her the wrong medication," Ms. Dolan said. "I got her out of there as quickly as I could, and I would never let her stay there again."

With the census at the nursing home hovering at about 710 residents, officials anticipate a $1.6 million hole in its $70 million budget for next year.

Nassau County officials are watching the nursing home closely because they fear that its continued poor performance could sink the county. The home is part of the Nassau Health Care Corporation, a quasi-private agency created in 1999 to buy the Patterson nursing home and the Nassau County Medical Center from the county. But as part of the deal, Nassau Health Care's $250 million bond debt was guaranteed by the county, and the county cannot afford a default on those debts.

"They clearly face some pretty overwhelming problems at the nursing home," said Lisanne G. Altmann, a Democrat who sits on the County Legislature's health committee. "If that institution fails, it's going to be like dominoes, because its fiscal health is tied to the medical center, and further down the road, if the medical center fails, the county fails, because the medical center's fiscal health is tied to ours."

The latest blow to the nursing home came last month when State Health Department officials threatened to cut off Medicare and Medicaid money for new residents. The home was cited for a dozen violations, including the failure to adequately monitor two residents who had assaulted other residents on numerous occasions and failing to properly treat another patient's bedsores.

The home has submitted a plan to correct those problems. But Richard Turan, the president of Nassau Health Care, said the nursing home's problems go well beyond these immediate issues.

"A lot of it has to do with deferred maintenance over the years," he said. "It's simply a very old facility, and it just can't compete with the new facilities that are out there now."

The corporation has submitted a plan to the state to build a new nursing home on the 72-acre campus and raze the existing structure, which was built in 1960. Mr. Turan looks optimistically at a three-year time line for the new building, and said he was confident that new management and some "cosmetic changes" at the current building could help turn things around "We can upgrade A. Holly Patterson into a facility that any one of us would feel comfortable sending our relatives to," he said.

To begin with, Mr. Turan said, the halls have been repainted, new lighting has been installed throughout the building and the floors have been buffed. "The place is cleaner, brighter," he said.

An $80,000 investment in computerizing the boiler operation will improve maintenance throughout the building he said, because this will free nine maintenance workers who had been assigned exclusively to monitoring the boilers' dials and gauges. A new marketing plan will send representatives into hospitals to recruit new residents.

The corporation also recently started a search for a new administrator. In the meantime, Mr. Turan has hired Larry Slatky, a consultant with more than 30 years' experience as a nursing home administrator in Queens and New Jersey, to help redesign operations.

Mr. Slatky said he believed that each of the 1,000 employees at the nursing home was dedicated but that management and adequate training have been lacking. "Sometimes you get so tied up in what you do every day that you lose perspective on where you're going," he said. He is meeting with supervisors in each department to set new priorities and to make sure that everyone receives training to meet the state's guidelines.

Rachel Langert, a spokeswoman for the Civil Service Employees Association, which represents most of the nursing home's employees, said the home was "in a state of transition right now," but added that "we're always willing to work with the county to make Patterson a top-notch facility."

The nursing home has had a dismal record for years, falling in and out of compliance with numerous state regulations. The low point came in September 2000 when an 84-year-old resident choked to death on a hot dog, and state officials temporarily cut off some government money until the nursing home's administrators could prove they had improved conditions.

According to a Medicare survey released last week, only 9 percent of the residents at A. Holly Patterson require help with basic daily tasks like eating and going to the bathroom, compared with a state average of 14 percent at other nursing homes.

Nonetheless, Patterson performed poorly in a number of areas, with 14 percent of its residents suffering from bedsores, compared with a state average of 9 percent; 26 percent of its residents were in physical restraints, compared with a state average of 7 percent.

All the bad news angers residents like Ruth Garone, who has been at the home since 1996, is president of the residents' council and has high praise for the staff.

"People complain, and they magnify everything to the nth degree," she said. "The thing is it's not your real home, but you have to make it your home. So if you're open-minded and you work with everybody else, you can get along very well here."

Lawrence Gottlieb, a Manhattan bankruptcy lawyer who was appointed chairman of the health care corporation's board in September by County Executive Thomas R. Suozzi, said he was impressed by Mr. Slatky's experience and energy. "He's done some impressive things there in just a short period of time," Mr. Gottlieb said. "I really believe that in two months we will see a different place."

But he agreed that the building must be replaced. "Even with the best management, you can't undo years of neglect to the physical plant," Mr. Gottlieb said. As in many other county buildings, capital improvements at the nursing home were halted more than 10 years ago. While residents at more modern nursing homes have one roommate at most and a private bathroom, many residents at A. Holly Patterson have two or three roommates and share a bathroom with everyone on their hall, as many as 40 residents.

Newer buildings also have spacious dining rooms and recreation areas, but Patterson's cramped dining rooms also double as television rooms and lounges for each 40-resident unit. "This was visionary when it was built," Mr. Slatky said. "But it's not what people want anymore. Now they want the care of a nursing home but the setting of a hotel."

The corporation has proposed a new $179 million, four-building complex that would match the current 889-bed capacity. It would be financed with a bond issue that would be paid off with the Medicare and Medicaid payments of future residents.

The nursing home now gets an average $190 a day per resident in federal, state and county reimbursements, but the rate, which is set by the state, would likely increase by $50 to $100 a day to help offset the higher cost of operating the new building.

But even with a new complex, county and corporation officials say other fundamental changes are needed to ensure the nursing home's survival. Unlike private nursing homes that can choose to turn away residents with behavioral problems or ones who require very high levels of care, A. Holly Patterson retains a mandate to accept all cases.

Rita Wallace, a retired nurse at the nursing home and a board member of the health care corporation, said the population at Patterson has changed significantly in the last decade.

"We're getting a lot more of the very agitated mental patients who really don't have any other place to go," she said. "Other nursing homes won't take them because they can be very disruptive, and that's not something that other patients' families like to see."

Most private nursing homes have populations that are almost entirely geriatric, but nearly 20 percent of the residents at the Patterson home younger than 50. On a recent visit to the home, many of the older residents could be at a sing-along of show tunes or at a flower-arranging session run by volunteers.

But several younger residents were wandering the halls. One man in his 40's stormed around shouting, "They were supposed to shut this place down, and they should!"

Mr. Slatky said that recreational therapists and about 150 volunteers offer a host of daily activities for residents. "But if you're 25, you don't want to hear `let's play bingo' or `sit and watch a musical,' " he said, adding that he plans to develop more activities geared to younger residents.

Roger Corbin, the chairman of the County Legislature's health committee, said the nursing home needed to work more aggressively to place young mental patients in homes better suited to their needs.

"What we're really talking about is the homeless population, and we all have to put our heads together to address that," he said. "A. Holly Patterson ought not to be overwhelmed with that population, and they need to work harder at seeking out organizations that are designed to work with that population."

Mr. Slatky said the home has created a full-time team that includes two psychiatrists, one psychologist and one alcohol and drug counselor to work exclusively with easily agitated residents. The home previously had just one psychiatrist and one psychologist, and they were only part-time.

Corporation officials said they also must focus attention on two looming budget problems. First, a federal program designed to help county-run nursing homes is being phased out, and Patterson faces losing $7.3 million a year from that program.

Gary Bie, the chief financial officer for the health care corporation, said state officials had already started lobbying for ways to make up that lost money.

The nursing home also loses about $2 million a year because it runs a 36-unit bed for AIDS patients, but the state has certified the home for only 20 AIDS beds. The certified AIDS beds are reimbursed at $440 a day, while the additional beds are reimbursed at the regular rate of $190. The corporation has been lobbying to have the additional beds certified.

"There's an obvious need for the beds," Mr. Bie said, "and if we were paid appropriately for all our AIDS patients, we'd be in the black."

(Not quite. The extra payments would bring in a maximum of $1.46 million, and the projected deficit is $1.6 million.)

In addition to the scrutiny of county officials, the nursing home's finances are also monitored monthly by the Nassau Interim Finance Authority, the state board created to oversee the county's finances, precisely because the health care corporation's fiscal health is so closely tied to the county's.

"They've been moving in the right direction, but I think they've got a long way to go," said Richard Kessel, a member of the NIFA board.

He said that by next year, NIFA "is going to want to have real sense that they can run without a deficit." Failing that, he said, the authority and county officials are likely to push hard to have the county get out of the health care business entirely.

"The question ultimately is whether A. Holly Patterson and the entire health care corporation can at least break even and run on its own," Mr. Kessel said.


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