Written In The Stars
The one-star rating of the Chautauqua County Home falls upon everyone associated with the facility, according to County Executive Greg Edwards.
The County Home received the rating from The Centers for Medicare and Medicaid Services, or CMS. CMS provides a Five Star Rating System to more than 15,000 nursing homes throughout the country. It provides an overall rating, as well as ratings for health inspections, nurse staffing and quality measures. The information then is compiled in the U.S. News & World Report’s latest rankings.
The County Home ranked one star overall. It also ranked one star for health inspections and quality measures, while it ranked four stars for staffing.
Representatives from the County Home did not return phone calls for comment. However, Edwards did say that the county has an obligation to deliver the best service with the resources it has.
“Anything I’ve been associated with, I have always wanted to provide the best service and the best performance,” Edwards said. “Certainly having a one-star rated County Home is something that we should be aware of and work on.”
Since 2011, the county has been working toward the privatization of the County Home. Beginning in July 2011, it began meeting with marketing firms, in order to move forward with taking what Edwards says is a taxpayer burden off the county budget.
In November of that same year, the county decided to utilize the firm Marcus & Millichap in marketing the home and finding potential purchasers.
In July 2012, although the firm said many interested groups came forward, Marcus & Millichap announced only two had made formal offers and had been willing to comply with a series of requirements set forth by the legislature. Absolut Care offered a $1.6 million-a-year lease on the home with an option to buy purchase any time $16 million. Altitude Health, out of Chicago, offered $16.5 million in cash for the Dunkirk skilled nursing facility.
Three other area nursing facilities in the area owned by Absolut Care were also ranked by CMS. Absolut of Dunkirk received an overall rating of five stars. Additionally, it had five stars for health inspections, three stars for staffing and two stars for quality measures.
Absolut of Westfield received an overall ranking of four stars from CMS. It received three stars for health inspections, four stars for staffing and three stars for quality measures. And, Absolut of Salamanca received three stars overall from CMS. Additionally, it ranked three stars for health inspections, two stars for staffing and four stars for quality measures.
Altitude Health, owned by William (Avi) Rothner, owns five homes throughout the nation. Although he is listed as a partial owner on several also owned by family members, the five Rothner owns were also ranked well by CMS.
Devon Gables Rehabilitation Center in Arizona received an overall rating of five stars. It received a three-star rating for health inspections, three stars for staffing and four stars for quality measures. Homestead Nursing and Rehabilitation Center in Nebraska received an overall rating of four stars. It received four stars in each health inspections and staffing, and two stars for quality measures.
Foothills Rehabilitation Center, also in Arizona, received an overall rating of four stars. It also had four stars for health inspections and staff ratings, and three stars for quality measures. Lancastor Manor in Nebraska ranked three stars overall. It received two stars for health inspections, four for staffing and three for quality measures.
Rothner’s lowest-rated home is the Golden Plains Rehabilitation Center in Kansas. It has an overall rating of one star. It also received one star for health inspections and staffing, and three stars for quality measures.
In January, 16 county legislators voted in favor of selling the County Home to Altitude Health Services. However, due to a local law dating back to 1975, a supermajority vote of 17 is required in order to sell real property in Chautauqua County.
The 16 legislators who voted in favor of selling the home were: Larry Barmore, R-Gerry; George Borrello, R-Irving; Fred Croscut, R-Sherman; Paula DeJoy, D-Jamestown; Tom Erlandson, D-Frewsburg; John Hemmer, R-Westfield; David Himelein, R-Findley Lake; Vince Horrigan, R-Bemus Point; Victoria James, D-Jamestown; Charles Nazzaro, D-Jamestown; Rod Rogers, G-Forestville; John Runkle, R-Stockton; Robert Stewart, R-Ellington; Mark Tarbrake, R-Ellicott; Paul Wendel, R-Lakewood; and legislative Chairman Jay Gould, R-Ashville.
Voting to keep the home were: Keith Ahlstrom, D-Dunkirk; Lori Cornell, D-Jamestown; William Coughlin, D-Fredonia; Thomas DeJoe, D-Brocton; Robert Duff, R-Sheridan; Shaun Heenan, D-Dunkirk; Timothy Hoyer, D-Jamestown; Bob Scudder, R-Fredonia; and Robert Whitney, D-Jamestown.
The resolution was re-introduced to legislators during their February meeting. However, once again, not enough votes were secured for the sale.
Earlier this month, Edwards announced that Rothner’s offer was officially off the table.
“I have been working with Marcus & Millichap to help Altitude recognize that I do not believe that they are a viable purchaser, given what the vote was and particularly given some of the comments that were made by some of the legislators who were in opposition to them coming to buy the facility,” Edwards said. “So, we are moving on to other offers.”
However, so far, Marcus & Millichap has been unsuccessful at bringing any other offers to the county.
“I know (Marcus & Millichap is) working with people out there, trying to secure offers and that people are being contacted and reviewing the County Home as a potential asset,” Edwards said. “I have not received any formal offers from anybody yet to follow up the Altitude offer.”
PLACING BLAME AND MOVING FORWARD
While Edwards believes the responsibility to improve star rating falls upon everyone associated with the facility, Lori Cornell, D-Jamestown, places the blame back on the county executive.
“It is my understanding that the County Home’s low star rating may largely be attributed to the poor administration of the home under the current County Executive,” Cornell said. “The independent analysis of the County Home to date – including the 2008 Nazzaro report, the 2011 Harmony report and the more recent CGR report – have all pointed to gross inefficiencies that have cost taxpayers unnecessarily. And until the last few months, Greg Edwards has done very little to correct these administrative shortfalls. I would venture to guess that the home did not have such a poor financial report card when Andy Goodell was county executive.”
However, Cornell also said that, when it comes to star ratings, her and Rothner may see eye to eye.
“Star ratings could probably be one of the few areas that Avi Rothner and I even agree on. It would appear to me that they can be somewhat manipulated and not a fair characterization of the quality of a given facility.”
Vince Horrigan, R-Bemus Point, agreed with Cornell, also stating that while the CMS ratings provide a consistent level of measurement, there is often more to the home than the ratings may suggest.
“As we all know, the Medicare-Medicaid reimbursement is really critical to these nursing homes,” Horrigan said. “It is a measurement of various aspects of the home, including the health (inspections), the quality and the overall ratings and staffing. So, these ratings, while they don’t tell everything, are clearly one way to measure nursing homes across the board, kind of an apples-to-apples measurement. But, I’m always cautioned that there is always more to the quality of a nursing home that individuals should look at when determining what to do or where to, say, put a family member.”
Edwards also emphasized Cornell and Horrigan’s points, stating that although CMS has a recognized rating system, it is not a perfect system. He said he meets regularly with Tim Hellwig, County Home administrator, to go over the operations and provide support.
“It’s a difficult rating to work on, because it does take into account the three most recent state inspections,” Edwards said. “We work very hard to have good state inspections. We have, in fact, a flawless review two years ago in one of the rating services that came through. Scoring 100 out of 100 is a pretty good score. But, with regard to the way that they measure them through this medicare.gov site for their nursing home profiles, certainly we don’t rate as high as we would like.”
BEYOND THE STARS
Although they are on different sides of whether to sell the County Home, when it comes to the star ratings, Cornell and Horrigan are in agreement that there is often more to any facility than the stars may suggest.
“I think the bottom line is, whether a nursing home is one star, three stars or five stars, the kind of care that is provided and the visible dedication of the staff who provide it (is most important),” Cornell said. “When it comes to the Chautauqua County Home, my experience has been that it has very high family satisfaction. You go talk with any family in Dunkirk and Fredonia, and they will tell you, I think 99 percent of the time, that they would prefer that their family member, if possible, in their aged years have the opportunity to reside in the County Home maybe over other facilities in the north county area.”
Horrigan agreed, saying that the star rating is an objective measure to compare nursing homes, but he said he appreciates that it is not the only measure that should be used.
“We have some very quality nursing homes here in Chautauqua County that maybe have lower star ratings than others,” he said. “It’s one measurement, but there are others. I don’t want to give the impression that because the County Home is rated at one star that it’s a terrible home, because I don’t think that’s accurate. The ratings should be used in the context that they are. They give measurements by medicare.gov. My bigger concern is the financial aspect and the opportunity we have to privatize to keep the County Nursing Home operating without the significant losses that are occurring.”