Infirmary beds going unfilled due to paperwork delays under new policy

PHOTOGRAPHER: Stephen Williams

A year-old policy intended to reduce bad debt at Saratoga County’s Maplewood Manor nursing home is resulting in dozens of beds remaining empty.

They’re empty because the admissions process has become burdensome, as the county seeks to avoid accepting non-paying patients.

There are currently at least 39 beds at the 277-bed nursing home in Ballston Spa sitting empty, at a time when the county is wrestling with whether to sell the facility to end its annual multimillion-dollar losses.

The vacant beds appear to be a direct result of a policy adopted in November 2011 requiring that those seeking admission to the nursing home — or, in most cases, their families — fill out a complete Medicaid application before admission.

Before the policy, Maplewood Manor was almost always full, other than beds that opened up due to normal patient turnover.

The intent of the policy was to stop a mountain of bad debt the county was incurring. People admitted to the facility often don’t have enough money to pay for their care, but in some cases their families never complete the application process to qualify them for Medicaid, the government care reimbursement program.

The resulting bad debt — between $750,000 and $1 million — is one reason the nursing home loses nearly $10 million a year, but far from the only factor. Medicaid reimbursements are less than the actual cost of patient care.

“The system itself is broken,” said Public Health Committee member Jean Raymond, R-Edinburg.

The new Medicaid application requirement is resulting in a backlog of hospital patients — particularly at Saratoga Hospital — who remain under hospital care because they haven’t filled out the paperwork necessary to get into a Medicaid-accepting nursing home.

In some cases, local people end up in nursing homes outside the area whose paperwork requirements aren’t as strict, county officials acknowledge.

Whether the empty beds are a positive or negative for the county is being debated.

“Right now we’re not sure if its a good thing or bad thing. It’s a balancing act,” said Supervisor Arthur Wright, R-Hadley, chairman of the county Public Health Committee.

Since the new policy took effect, Wright said the county has taken on no new bad debt at the infirmary.

There’s an argument for leaving the beds empty, even if residents qualified for Medicaid.

“We lose more than we take in on each bed,” said Supervisor Patti Southworth, I-Ballston.

But there’s also an argument for filling the beds, and getting at least some government reimbursement to cover the infirmary’s $28 million budget.

“It doesn’t make any business sense to me,” said Supervisor Joanne Yepsen, D-Saratoga Springs. “We could take more patients than we are.”

Yepsen said Saratoga Hospital officials would like to work with the county to try to speed the nursing home admissions process. She said the hospital already works closely with the private nonprofit Wesley Health Care Center in Saratoga Springs, which has a nursing home.

The committee on Monday directed Maplewood Manor Director Diane Brown to talk with hospital officials about what more might be done.

Brown said the reduced number of nursing home residents hasn’t meant any staff cuts so far, but it has reduced the infirmary’s overtime costs.

County Administrator Spencer Hellwig said the Medicaid application process became significantly more difficult last year when the federal Department of Health and Human Services began requiring Medicaid applicants produce five years of financial records, rather than just three years, and that has made it more difficult for families to do the paperwork.

“None of these things are anything we have any control over,” Hellwig said.

The debate over empty beds and admissions policies is taking place a month after an outside consultant hired by the county recommended the county take preliminary steps toward selling it to a private operator as a way of ending the $10 million-a-year financial drain on the county budget.

Wright said the committee will decide in October whether to take the first step toward a sale — hiring someone to estimate the worth of Maplewood Manor in the current nursing home market.