Genesee County Nursing Home

Press release:

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.

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.

Press release:

Saving the Genesee County Nursing Home:

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.

In an effort to both save the Genesee County Nursing home some money and maybe find some billing revenue it isn't currently getting, the Public Service Committee approved two contracts Monday to outsource some of the facility's billing.

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.

The recent outbreak of the potentially fatal bacteria commonly called C. diff at United Memorial Medical Center is having a ripple effect on the Genesee County Nursing Home.

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.

Keep it. At least for now.

That's the recommendation of a consultant hired by Genesee County to study the legislature's options for dealing with the increasingly expense-draining county nursing home.

Rochester-based Center for Governmental Research turned over a report this week to the county that said it's not a good time to sell public facilities and the county may not achieve sufficient returns from such a sale.

Genesee County faces an aging population, continued rising expenses and an uncertain future of federal funding for the nursing home. Those same factors would likely keep down the price a private buyer would be willing to pay for the home.

And the county would lose control of the facility and have no recourse if a private owner no longer used the home as a "safety net" for disadvantaged seniors.

There are numerous problems for the home going forward, CGR concludes, and recommends a number of changes in operation of the home.

It also recommends establishing a Nursing Home Board to oversee the operations of the home.

The full 121-page report is available by clicking here.

It's been 20 years since the Genesee County Nursing Home had a new roof, and it's gotten to the point where the facility staff must battle against leaks.

The ceiling tiles are stained in places, and that look can lead to demerits on state inspections, according to County Manager Jay Gsell. Too many demerits, and reimbursements for care get held up.

Today, the Human Services Committee approved a $132,277 bid for a new roof on the front five-story section of the building. The contract, if approved by the full Legislature, will go to Elmer W. Davis, Inc., of Rochester.

According to Legislator Hollis Upson, Elmer W. Davis is currently doing the roofing job on 400 Towers. He said it's one of the few companies in the region with the equipment to handle multi-story roofing jobs.

The highest of the five bids for the project was $247,000. The names of the other five firms who submitted bids were not released at the Human Services meeting, where new Nursing Home Director Charles Rice presented the proposal.

Gsell said the new roof will be a rubberized layer over the existing roof. He said what many homeowners might refer to as a "tear-off" would cost more than $1 million.

It isn't often that residents show up at a meeting of the Genesee County Legislature and lobby representatives on a particular issue, but Wednesday about two dozen people -- mostly employees of the Genesee County Nursing Home -- were on hand to oppose the county hiring a consultant to study the options for dealing with the home.

Regular contributor to The Batavian, Bea McManis, said:

"Most of us were raised here. We worked here. We paid our taxes. We contributed to the well being and the safety net that the county nursing home offers for our seniors. We have not reached that point where we're looking at the county home as our safety net."

The legislature approved a $62,000 contract with Rochester-based Center for Governmental Research. In a memo attached to the contract, CGR outlines a number of possible options for dealing with the financially challenged nursing home that it says it will study fully.

Legislator Jay Grasso said none of Genesee County's seniors will wind up out on the street, regardless of what is ultimately decided regarding the home.

"The County has Medicaid obligations to our seniors," Grasso said. "That won't change no matter what happens. Nobody is going to be kicked out of their home."

(via WBTA)

The county wants to look at a range of options for dealing with its financially troubled nursing home, according to a memo written by a consultant the county plans to hire.

The scope of work planned by the Center for Governmental Research in Rochester is detailed in a memo from its director of human services analysis, Donald E. Pryor. The memo was released at the Ways and Means Committee meeting on Wednesday.

The study will involve numerous interviews with key stakeholders, an examination of past operational and financial history and comparisons with other facilities around the state.

CGR will look at least a dozen options for changing the status of the nursing home, including both keeping the operation as it is or selling it. Even closing it will be an option considered.

"CGR now understands clearly that the County is not currently considering the 'sell' option, and that there are many options that you wish to explore in more detail before you do consider that option, if you indeed ever do," Pryor writes.

"Thus this memo reframes the original proposal in that spirit, with the intent of exploring the implications, pro and con, of a number of options the County may wish to consider along a continuum of possible change, ranging from no change (status quo) to closure of the Nursing Home facility, and many options in between."

Among the other options Pryor discusses are bed licenses to a third-party operator, conversion of the nursing home to a free-standing, not-for-profit facility, renegotiating agreements with the employees union, creation of a public benefits corporation, and better marketing of the facility.

"Rather than focus on an RFP process designed to determine the possible interest and viability of entities who may be interested in the possibility of purchasing the County Nursing Home, our revised proposal deletes all reference to that RFP process," Pryor writes. "Instead, the focus of this revised proposal is on an objective assessment of the strengths, limitations and overall implications of a wide range of options for the operation, management and possible disposition of the Nursing Home and its companion Adult Home."

The memo was part of the final contract provided to the Ways and Means Committee for review and approval. The committee unanimously approved sending the contract to the full legislature for review and possible approval.

The memo states that the $62,000 consulting fee will cover all in costs, including travel and any other expenses.

For previous nursing home coverage, click here.

To help the county decide the future of its troubled nursing home, a search committee has recommended Center for Governmental Research as the consultant to study the county's options.

County Manager Jay Gsell said CGR was selected because it has no vested interest in the outcome of the research -- it doesn't own, operate, manage or develop nursing homes or assisted-living facilities.

"The committee looked at the eight proposals and felt that CJR was the most neutral," Gsell said.

CGR will be asked to review the total range of options for the nursing home, which Gsell said could result in 10 to 20 possible recommendations. These include, of course, selling it, as well as having it operate under private-benefit corporations, public authority and management firms.

"The list is almost as creative or as plentiful as anybody in New York State would come up with that would be legal," Gsell said.

When asked what his response would be if some people said the county was still primarily focused on divesting itself completely of the nursing home, Gsell that is not even close to true.

"We can’t even, at this point, entertain that notion," Gsell said. "The county legislature is not prepared to make that kind of assessment, and from the legislators I’ve talked to, that’s not even on their radar screen. I can’t say that somebody hasn’t thought about it or that it's not an option somewhere down the road, but we’re not even close to making that kind of recommendation or having any information to say that’s even one of the top recommendations."

As for CJR, it's a non-profit firm based in Rochester. It's "About" page on its Web site says: 

George Eastman, the visionary leader who created Eastman Kodak, founded a bureau of municipal research in Rochester, NY in 1915 “to get things done for the community” and to serve as an “independent, non-partisan agency for keeping citizens informed.” Over more than nine decades CGR has grown from a bureau focused on the needs of one city into an organization with far broader reach.

Today, the Legislature's Human Services Committee approved the selection of GCR. The Ways and Means Committee will be asked to review the contract before it goes to the full Legislature for approval.

Previous coverage: Click Here.

John Demske, Genesee County Nursing Home administrator, is retiring effective May 14, County Manager Jay Gsell announced late this afternoon to county legislators and staff.

Demske and his wife, Rosemary, intend to stay in the Batavia area and pursue opportunities in education, consulting or private business, said Gsell in an e-mail message.

In an interview after the announcement, Gsell said the county will need to replace Demske immediately, even as the county explores cost-saving options for the nursing home, including possibly selling it. State law requires that the nursing home be managed by a director that is licensed and experienced in running such facilities. When Demske steps aside at 5 p.m. on May 14, a new director must in place and ready to take over.

Demske has been in the long-term-care field, both in the private and public sector, since 1978.

"His son is graduating from college, so one Demske is entering the work force as another one is leaving -- that's what he told me," Gsell said.

Even as Gov. David Paterson plans on cutting $222,000 in funding for the Genesee County Nursing Home, the facility is likely to reap a $490,000 surplus over its projected 2010 budget.

The swing to the positive is the result of the federal government revising Medicaid and Medicare reimbursements for the 2009-10 fiscal year. Thus, an increase of revenue totaling $714,566 will be transfered to the nursing home, according to Administrator John F. Demske.

Meanwhile, the county may also see an increase in IGT (Inter-Governmental Transfer) funding, which was anticipated to come in at $2.185 million.

"I expect that we'll get more than what we put in the budget for our IGT," Demske said. "I believe it may get up to almost $3 million."

That could be a problem for the county, because the county must match the federal IGT, providing about 30 percent of the overall IGT funds.

County Manager Jay Gsell told the committee that "it's a careful balance" to get the right amount of IGT funding and not put the whole county budget in the red.

After hearing the report during today's Human Services Committee meeting, County Legislature Chair Mary Pat Hancock said, "Good for you. Not terrific for us."

The county relies on IGT funds to meet the nursing home's operational expenses because revenue from patients -- both Medicaid funded and private patients -- tends to fall well short of the facility's needs.

In an e-mail conversation between The Batavian and Gsell recently, Gsell said the nursing home hasn't technically been profitable for years, relying as it does on IGT funding to close revenue gaps.

"In the true sense of an enterprise fund in municipal accounting, the Genesee County Nursing Home is not 'profitable.'" Gsell said. "It does not generate enough of its own revenue to meet all its expenses in any given budget year."

Demske said today the IGT funds are essential to operating the nursing home and were designed specifically to assist county-run nursing homes, which must deal with the high costs associated with a union labor force.

Late last year, county officials put out a bid proposal to explore options for dealing with rising costs of the nursing home, including the potential loss of IGT funding after 2012 and whether to sell the home to a private company or nonprofit corporation.

The county is now reviewing eight proposals from consultants and a committee will make a ranked recommendation to the Legislature, Gsell said.

Photo: John Demske gives his report today to the Human Services Committee on the state of the nursing home.

BATAVIA, NY -- Contrary to the perception that might be out there, there is no "for sale" sign hanging on the Genesee County Nursing Home.

That doesn't mean the county couldn't seek a buyer, but according to County Manager Jay Gsell, the only thing the county is doing right now is looking for a consultant to help it study options for dealing with escalating costs associated with the home.

One of those options is sale, which is what has former legislature candidate Chris Charvella so concerned.

Charvella has been drafted to organize and speak for a group of concerned citizens -- including some residents of the home -- seeking to block any possible sale, even before the option is fully studied.

"I realize it's not set in stone," Charvella said. "But our county government has a history of looking for sale as the first option rather than fully considering other options."

The local businessman is pretty convinced that given the option, the legislature would seek a buyer for the home pretty quickly.

"The County Legislature's first duty is to the taxpaying citizens and this is an essential service," Charvella said. "We have people who pay taxes here their entire lives and expect this safety-net option."

Human Services Committee Chairwoman Esther Leadley said that, of course, sale is an option. It has to be, she said, if the Legislature is to act responsibly in protecting the interests of taxpayers.

The county is in a difficult position, she said.

"This has been coming at us like a freight train and we're sitting on the tracks," Leadley said. "The taxpayers are sitting on the tracks and we can't let them stay there. This is something that we're not rah-rah to do. It is something that we've got to look at."

Last month, the county put out a request-for-proposal seeking bids from potential consultants. The RFP spells out clearly what the county is looking for:

"Genesee County, New York, a non-chartered county government located in western New York between Buffalo and Rochester is seeking a professional service/consultant to assist the County in evaluating its options for the operation, management and/or sale of its 160 bed Skilled Nursing Facility and adjoined 80 bed Public Adult Home which comprise a complete long term care facility located at 278 Banks Street, Batavia, NY 14020.  Said service/consultant will be asked to assist the County in outlining options for future public and/or private ownership/operation of the present 240 bed facility and to help the County develop a strategy and plan of action for going forward with said facility and residents."

The big-cost bullet the county is looking to dodge, according to Gsell, is escalating personnel costs, especially in regard to benefits.

"Public employees cost more than private-sector employees and that's the kind of thing we will factor in where this going," Gsell said.

Gsell said that he wouldn't expect any current employees to lose their jobs if the facility was sold or operation was turned over to a private company. Because of the skills and experience required for such a facility, any new provider would almost certainly need to keep the current staff.

He also said the level of service would unlikely change, because of all the state mandates on such a facility.

Charvella isn't convinced service wouldn't suffer.

"If the margins are so thin, then a private company is going to pay more attention to the bottom line rather than patient care," Charvella said.

If the county did sell or lease the facility, Gsell said the local government would still have a substantial cost burden associated with its ongoing operation. The county would still pay more than $1.6 million in social services, such as its share of Medicaid payments, to keep the facility open. The consultant will be asked what the ongoing costs to the county will be with any of the possible options.