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As money runs out, counties walking away from elder care

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The Essex County Board of Supervisors ended more than two years of contentious debate on Tuesday, voting 12-6 to privatize its Horace Nye Nursing Home in Elizabethtown.

Essex County’s move is one example of a growing trend, as counties throughout New York shed money-hemorrhaging elderly care facilities.

“County nursing homes have traditionally served a safety net function,” said Dan Heim, executive vice president of LeadingAge New York, an Albany-based senior citizen advocacy organization.

The public nursing homes have for decades primarily served the aging poor. But a growing number of holes are being punched in that safety net, as local governments, strapped with rising employee benefit costs and constrained by the state’s tax cap, are getting out of the nursing home business.

It’s the poor patients who are dependent on programs like Medicaid that are the problem for the bottom line at public nursing homes. But care for those patients is the concern for those who are opposed to the movement toward privatization.

Washington County supervisors last week moved to reopen negotiations with Centers for Specialty Care, the same company that is buying Horace Nye, for the sale of its Pleasant Valley nursing home in Argyle.

“Somehow, we do have to be concerned for those people who can’t fend for themselves,” said Greenwich Supervisor Sara Idleman, who has opposed the sale of Pleasant Valley.

Between 75 and 80 percent of New York’s nursing home population receives Medicaid, the highest percentage in the nation, Heim said.

The impact of nursing home privatization on the poor is unknown, even as area counties shed their facilities one by one.

No data exists on how many people are left out of the nursing home system in an area after a privatization, Heim said.

“There certainly could be an impact,” he said, adding that his organization is seeking grant money to study the issue.

County facilities have for decades taken poor patients, a population often turned away by the private sector in favor of profit-generating private-pay residents.

Medicaid reimbursement rates vary, depending on the region and the level of care, but are almost always lower than what is actually spent on care for a specific patient.

Horace Nye costs Essex County about $2 million each year, while Washington County subsidizes Pleasant Valley with more than $3 million in tax dollars.

More than 90 percent of the beds at public facilities like Horace Nye and Pleasant Valley are filled with publicly subsidized residents.

The issue of nursing home privatization has come up repeatedly in Warren County and Saratoga County, too. Fulton County has already undertaken privatization.

“Ultimately, private businesses are looking out for their bottom line,” said Johnsburg Supervisor Ron Vanselow.

By design, government is more responsive to public concern, he said.

“I’ve got to run for re-election next year and I can’t let grandpa go unfed,” he said, while giving an example of how government is forced to respond to issues.

Private companies, with a finite number of beds, tend seek out private-pay residents to remain viable, officials said. And even private facilities in the region are struggling.

The Adirondack Medical Center announced earlier this week that it would be reducing the number of nursing home beds at its Uihlein Center in Lake Placid.

Adirondack Medical Center officials said that the nursing home will no longer accept all Medicaid patients, as part of a centerwide reduction in available beds, but a transition to a cheaper home-based care network is in the works.

“The reality is, we lost $1.6 million last year, largely because of inadequate funding of Medicaid,” said Joe Riccio, spokesman for the Adirondack Medical Center.

Riccio said the current Medicaid patients will remain at the center, and the bed reduction will be gradual.

State and local officials are expecting even more pressure on Medicaid-dependent facilities in the near future as Gov. Andrew Cuomo looks to redesign the state’s welfare system.

It’s the next wave of patients in the high-turnover nursing home business who, officials worry, will be left with nowhere to go as money dries up and fewer beds are available.

“I wish I knew what the future was,” Idleman said. “A lot of people thought they’d be taken care of. Now I look at it and maybe not.”


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