 FRIA and over 30 community, advocacy and union groups are terribly concerned about the work of Governor Pataki’s Commission on Health Care Facilities in the 21st Century. This Commission has been working for over a year to review each of the hospitals and nursing homes in the state to determine which, if any, should be closed or ‘rightsized’ in order to bring efficiencies to the health care system. The Commission’s final report is due to Governor Pataki by December 1, 2006. According to the Commission’s enabling law, its recommendations must be implemented by the state unless the legislature affirmatively votes against them by December 31, 2006.
According to news accounts, the work of the commission will result in the loss of over 800 nursing home beds in New York City alone. Nursing homes play a unique and vital role in the care of the elderly in New York State today. There are over 100,000 nursing home residents being cared for in these state facilities. And, the average occupancy rate for nursing homes in New York City is 94.5%.1 For the most part, our elders are placed there because there is nowhere else for them to live safely.
Supporters of the Commission’s work say that nursing homes are underutilized, are too expensive, and that the state should instead spend the money on providing more services so that the elderly can age in their own homes, rather than in nursing home facilities. They say that new forms of care, such as assisted living, will provide good alternatives.
FRIA heartily supports the de-institutionalization of elder life, but we do not see good, affordable, community alternatives in the near future, particularly for those suffering from Alzheimer’s disease. Alternatives like assisted living are extremely expensive, generally not covered by Medicaid, and not within the financial reach of most New Yorkers. In order for the nursing home population of elderly people to live out their lives in their own homes, every community will need to expand its services dramatically to offer a system of coordinated, individualized services. Services must be free or low fee and include meal management, accessible transportation to and from appointments, appropriate activities, skilled nursing and medical equipment at-home, 24 hour oversight every day, housekeeping, and more – all services found in good nursing homes. An especially intractable problem in New York City is the lack of affordable housing that can accommodate wheelchairs and provide safe, locked space. The lack of services and alternative facilities becomes further aggravated in light of the demographic imperatives facing New York that anticipate a 20% increase in those 85 yrs. and over by 2015 – the very population that needs nursing home care.
How long will it take communities to build this infrastructure of services? Years! – and surely not soon enough if closure recommendations will be implemented this year! And, we must also remember that the Commission will be recommending closure of community hospitals, a mainstay of support and resources for elderly living in the community.
It is important for all of us to read the Commission’s recommendations carefully since, to date, the consumer’s voice in the Commission’s process has been largely excluded. We will need to raise public attention to and oppose those portions that leave our most vulnerable elderly loved ones at risk. We know all too well, that they can not speak up for themselves. We will need to do it for them, and for future generations.
1 Individual homes may experience different rates, for a wide array of reasons, such as facilities need to be modernized, don’t provide high levels of physical therapy, etc. But, it does not necessarily refl ect a lack of need for those beds. The overall state occupancy range is 80-98%. |
 “Rightsizing” – another name for cutbacks? I am not naive. After many years as a nursing home administrator I have learned to be skeptical of government’s “cruel to be kind” cutbacks. That is, curtailing services so that services will improve. In my experience it rarely works that way.
Once again we are being told to buy into the “less is more” government policy of care.
Is this the case with the new law that allows nursing homes to “rightsize” their operations by closing unused beds either permanently or temporarily for up to five years to better meet the needs of the communities they serve?
Throughout my career in long term health care I have seen many seniors spend many years in nursing homes because they lacked adequate and appropriate housing. I have also seen many nursing homes that have not positioned themselves as part of a continuum of care. Many large facilities, such as Cobble Hill Health Center, were developed in the 60’s and 70’s and were designed along a “medical” model of care. This model fails to address the psychosocial needs of the elderly. In addition, many nursing homes are operating in poorly designed buildings with inadequate space for residents to experience the privacy and autonomy that they rightly want and deserve.
In truth, nursing home occupancy has been declining steadily for a number of years and the average length of stay has declined in New York State by over 40% since 2002. So it’s not a stretch to imagine that we need fewer beds if there are fewer people using them. To a nursing home administrator, this decrease in length of stay and declining census should be good news. It means that advances in medicine, rehabilitative services, day centers and a comprehensive home care program have not only extended lifespan but have increased the quality and independence of life.
That is why I feel we must, if we have the compassion and foresight needed to provide optimum care, stop defending a position merely to avoid any retrenchment in the provision of services. We must seek new and viable long-term care options.
This brings me to the “rightsizing” proposal. This idea of eliminating beds enables some of us to rethink our models of care, redesign how we use space, and retool our operations to meet the needs of our residents and, secondarily, the imperatives of the institution. We need to adapt to the changing expectations and demands of our future consumers – the baby boomers, a famously demanding lot. At the same time we must develop a wide array of support services in the community to enable our frail elders to live where they want for as long as they can. Rigid, inflexible hierarchical systems don’t fit this bill.
I know that I want to live in my home and my community for as long as I can. However, if there comes a time when I need to live in a nursing home, I want that home to resemble my life “before” as much as possible. Our challenge is to ensure that nursing homes become an integral – and not peripheral – part of the solution. Indeed, nursing homes should not be the scapegoat and more importantly, they should not be the problem. “Rightsizing” has presented an opportunity – do we stand on the sidelines or seize this moment to create models of care that genuinely respond to the needs of the elderly?
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