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Adirondack Health Chief Senior Services Officer Marc Walker talks with Uihlein Living Center resident Peggy Forkey at the Lake Placid nursing home in November of last year. Photo: Chris Knight via <a href="http://adirondackdailyenterprise.com/page/content.detail/id/536629/Nursing-homes-in-the-red.html">Adirondack Daily Enterprise</a>
Adirondack Health Chief Senior Services Officer Marc Walker talks with Uihlein Living Center resident Peggy Forkey at the Lake Placid nursing home in November of last year. Photo: Chris Knight via Adirondack Daily Enterprise

Can the North Country make nursing homes work?

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Many nursing homes around the state are seeing big financial losses, and the situation is the same, if not worse, here in the North Country.

That's sparked a dialogue in the last few months among the region's long-term care leaders about ways they can partner, share services or even consolidate under one organization. Leaders of at least eight to 10 of the region's nursing homes have been involved in these talks.

Some long-term care advocates believe North Country nursing homes are at a tipping point.

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Reported by

Chris Knight
Adirondack Correspondent

Adirondack Health CEO Chandler Ralph sits at a large conference table in her office. She thumbs through several pages of documents before finding what she's looking for – a spreadsheet containing a list of numbers.

"Minus 16 percent, minus five percent, minus 44 percent, minus 34 percent, minus 14 percent, minus 18 percent – oh, here's a five percent."

The numbers, Ralph explained, are the operating margins, revenue minus expenses, of a list of North Country nursing homes.

A shortfall in Medicaid reimbursements at nursing homes across the North Country, like Mercy Living Center in Tupper Lake, seen here Tuesday, has sparked talks among nursing home administrators about ways they can partner. Photo: Jessica Collier via <a href="http://adirondackdailyenterprise.com/page/content.detail/id/536629/Nursing-homes-in-the-red.html">Adirondack Daily Enterprise</a>
A shortfall in Medicaid reimbursements at nursing homes across the North Country, like Mercy Living Center in Tupper Lake, seen here Tuesday, has sparked talks among nursing home administrators about ways they can partner. Photo: Jessica Collier via Adirondack Daily Enterprise
Ralph said the figures were provided at a recent meeting of North Country nursing home administrators coordinated by LeadingAge New York, an organization that represents nursing homes across the state, "They brought us together, showed us this chart and said we're going to lose our nursing homes in the North Country if we don't do something."

Ralph said shortfalls in Medicaid reimbursement are driving the region's long-term care facilities into the red. Adirondack Health's two nursing homes, in Lake Placid and Tupper Lake, have lost a combined $11.6 million over the last six years.

Nursing homes run by nonprofits like Adirondack Health aren't the only ones feeling this pain. Many private, for-profit nursing homes in the region are in the same crunch.

"We get reimbursed less than $7 per hour for each Medicaid patient. That's less than minimum wage, and these patients literally need hour-to-hour care," says Paul Richards, administrator of Meadowbrook Healthcare, a 200-bed nursing and rehabilitation facility in Plattsburgh.

"The model's broken for nursing home reimbursement," he said. "Nursing homes have been relying on Medicaid, and it just doesn't pay the bill. With all the overhead, they're all drowning."

Some say the financial challenges faced by nursing homes in the North Country are more acute than in other parts of New York. Dan Heim is LeadingAge's executive vice president. He said, "They tend to be smaller facilities, on average, than other nursing homes in the state."

"They tend to serve a population whose needs are somewhat different because of the socioeconomic variables in the region, and as a consequence, their payments from the Medicaid program tend to be lower."

If nothing changes, nursing home advocates and administrators say there will be even fewer options for long-term care in the region. Heim said, "Some of the facilities are reaching kind of a breaking point," Heim said. "We could see downsizing of facility beds. We could see closures. We most certainly will see changes in ownership."

Some of those things are already happening. Essex County officials recently signed a contract to sell Horace Nye Nursing Home in Elizabethtown to the Bronx-based Centers for Specialty Care.

Franklin County is transferring operations of its Malone nursing home to Alice Hyde Medical Center.

And Adirondack Health is cutting the number of beds at its Lake Placid nursing home by nearly 100.

The common challenges faced by North Country nursing home administrators have prompted at least two meetings since the start of the year to discuss the future of long-term care in the region.

Heim said nothing has been decided yet, but all options are on the table. "We've brainstormed a number of ideas, certainly looking at how the facilities are governed and operated, whether or not there's a potential for shared services, group purchasing, group negotiation with managed care plans."

Richards said he doubts the chances of any kind of merger of for-profit nursing homes, but "there's enough nonprofit nursing homes in the Adirondack region that that might make sense if people can put their differences and territorial rights aside. Because if you don't do something like that and have shared ownership or shared services, the ma-and-pop approach won't survive."

State officials are listening. State Health Department Commissioner Nirav Shah was among those who attended the group's most recent gathering two weeks ago in Saranac Lake.

Sen. Betty Little said she's hopeful the talks will bear fruit."The intent of these discussions is really good," Little said, "to look at how they can help each other, how they can join together and how they can save, and yet still provide the necessary services in the North Country."

The nursing home leaders involved have committed to continue meeting on a monthly basis.

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