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Expert says Kinney Nursing home closure is not a surprise

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GOUVERNEUR — The likely closure of Kinney Nursing Home should not be unexpected because of its size, over-reliance on Medicaid, the advent of Medicaid managed care and need for capital improvements, according to an expert on public health and aging.

“It’s not going to generate a profit, ever. It’s not sustainable,” said Thomas H. Dennison, “I feel badly that Gouverneur’s going to lose its nursing home and for the staff.”

Mr. Dennison is a professor of public administration at Maxwell School of Citizenship and Public Affairs, a professor of public health at Upstate Medical University and an affiliate of the Aging Studies Institute, Syracuse. He was also an administrator at the former E.J. Noble Hospital in Alexandria Bay and is a licensed nursing home administrator.

The state Health Department is reviewing a closure plan for Kinney Nursing Home, a 40-bed facility that is affiliated with Gouverneur Hospital. Gouverneur Hospital took over E.J. Noble Hospital in Gouverneur on Jan. 1.

Kinney Nursing Home has been able to survive for as long as it has because it was carried by E.J. Noble, Mr. Dennison said.

“Health care organizations have an incredible life because they serve the community,” he said. “Its linkage with the community has kept it alive. There was a real symbiosis for a long time. They shared overhead. Nobody in their right mind would build a 40-bed nursing home right now.”

A so-far-informal effort to keep the nursing home open has a lot of supporters. A petition on change.org started by Dayna Leader to begin exploring and advocating for a new, cost effective facility to provide long term health care for community members had 512 supporters Wednesday afternoon.

Among the comments were:

“I think it is important to keep loved ones close to their families so they can have frequent contact,” Heather Bowman, Richville, wrote.

“We need to be the voice of those who are living in nursing homes, that don’t have a voice of their own and that politicians don’t seem to pay enough attention to. They deserve their dignity and we as a society need to make sure that happens,” Lisa Dunkelberg wrote.

“It seems that there is an invisible line that separates the true northern part of the state from that which many call the north such as Albany or at best Syracuse. We need to be counted as part of the state, our elderly are entitled to nursing home care close to their families and not torn away due to our government’s blindness to their needs,” the Rev. Greg Bailey wrote.

Despite the best hopes, Kinney Nursing Home, for years a money-loser, has many strikes against its continued existence, Mr. Dennison said.

Successful nursing homes need to have a blend of self-pay and Medicaid clients.

“You don’t have a big private-pay market,” he said. “Medicaid pays less than costs. If you don’t have a private-pay market, you’re not going to be able to cover your costs.”

Already low reimbursements, coupled with the redesign of the Medicaid system to managed care, will make survival harder.

“Nursing homes are going to find themselves in a place where they have to negotiate with managed home plans, so they won’t even be able to count on the Medicaid rate,” Mr. Dennison said.

The nursing home was also looking at the major expense of adding a sprinkler system. The requirement for a sprinkler system is no longer a waivable item, Mr. Dennison said.

The nursing home is also the wrong size for the future, Mr. Dennison said.

The old rule of thumb was to conjoin a 40-bed nursing home with a 120-bed hospital, he said. As part of an expansion and modernization project, E.J. Noble cut its bed count from 47 to 37. That number included four beds in the obstetrics unit, which no longer exists, so Gouverneur Hospital does not even meet the outmoded model. Since then, the hospital has received a critical-access designation, meaning the hospital cannot have more than 25 beds.

Configurations of hospital and nursing home combinations, each with its own financial challenges, are different now, depending on the setup.

“We haven’t really figured out how to pay for them effectively, but you need more capacity than 40,” Mr. Dennison said.

While Mr. Dennison saw little hope for Kinney Nursing Home to stay open, he was also critical of Health Department alternatives.

Usage of nursing homes for the elderly is on the decline for a number of reasons. However, the correct number of nursing home beds in a region is not clear because it depends on what services are available, including home health providers, he said.

“I think the state Health Department perspective is we have too many nursing home beds, so it’s perfectly fine to have some of these nursing homes close,” he said.

While that may be true in some markets, rural communities do not have the same kind of access to home care that is available in large metropolitan areas, he said.

“The state over the years has had different needs methodologies for nursing home care,” he said. “Some of it is based on what they think it ought to be, not what it is. I take a jaundiced view of their ability to be even somewhat accurate.”

There are ways for nonprofit nursing homes to improve their lot, Mr. Dennison said. For-profit nursing homes have been working together to share back office costs, such as administration, billing and purchasing, while nonprofits continue to struggle on their own.

“You just need to bring your expenses down to a certain point,” he said.

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