Ballston Spa nursing home placed on federal watch list

PHOTOGRAPHER: Peter R. Barber

The Saratoga Center for Rehab & Skilled Nursing Care in Ballston Spa is pictured on Tuesday.

BALLSTON SPA — Federal regulators have placed a Ballston Spa nursing home on a watch list of the most troubled facilities in the nation.

Saratoga Center for Rehab and Skilled Nursing Care became a Special Focus Facility in April, a little more than four years after Saratoga County completed the sale of what was then Maplewood Manor nursing home to Long Island-based Zenith Care Health.

At any given time, just 88 of the 15,000 nursing homes in the United States are on the SFF list maintained by the Centers for Medicare and Medicaid Services, which is part of the U.S. Department of Health and Human Services. Roughly 400 other nursing homes are identified as candidates for SFF listing, but there are only 88 slots for the SFF program, which entails more frequent and rigorous inspections.

Saratoga Center apparently was on the SFF candidate list until recently — a U.S. senator from Pennsylvania on Monday released a candidate list dated April that includes it. Also listed as SFF candidates in the Capital Region were Diamond Hill Nursing and Rehabilitation Center in Troy and Bethlehem Care Center in Delmar. Cooperstown Center for Nursing and Rehabilitation was listed as recently having graduated after 27 months in the SFF program.

In an emailed statement Thursday, Danielle Zastawny, CEO of Saratoga Center for Rehab and Skilled Nursing Care, said:
“Saratoga Center for Rehab and Skilled Nursing Care is in a transition period, as we are poised to welcome new and experienced ownership.

“We look forward to the additional investment of resources that will enhance the patient experience. Our professional staff has been providing quality care during this time, and we will continue making the improvements that our residents and staff deserve.”

Both the federal CMS and the state Department of Health maintain online databases that allow the public to compare the strengths and weaknesses of nursing homes within a given geographic area. The state and feds use different metrics and sometimes arrive at different ratings. Here are their remarks on the Saratoga Center:

FEDERAL REPORT CARD

Average daily population: 205.
Citations in most recent health inspection (April 2018): 13, compared with 4.9 average statewide.
Complaints in the last three years that resulted in a citation: 29.
Fire safety citations: 7.0, compared with 3.5 average statewide.
Hours per patient worked by nurses and physical therapists were lower than state and national average, though not radically lower.
For long-term residents, the rates of urinary tract infections, reported pain, emergency room visits and hospitalization were all better than state and national averages.
The rate of flu shots and pneumonia shots was worse than state and national averages, as were the percentage of residents with mobility problems or ability to conduct daily activities.
The federal government fined it once in the last three years: $150,077 on Sept. 8, 2017.
Because it’s on the watchlist, it gets no rating on CMS scale of one to five stars.

STATE REPORT CARD

Occupancy rate is 76 percent.

The facility gets an overall rating of two stars out of five, which breaks down to:

One star each for preventative care and resident status;
Three stars for resident safety;
Four stars each for quality of care and quality of life.

The facility compares very poorly on complaints and citations vs. the statewide average:

There were 243 complaints from May 1, 2015, to April 30, 2019. That’s 1.24 complaints per occupied bed vs. a statewide average of 0.44.
There were 96 citations during that period vs. a statewide average of 32. Eighteen of the citations were life-safety code violations and 78 were standard health citations. There were six citations related to actual harm or immediate jeopardy vs. a statewide average of one such violation.

The state took no enforcement actions against the facility from May 1, 2009, to April 30, 2019.

PRIVATIZATION OPPOSED

Saratoga Center for Rehab and Skilled Nursing Care is the former Maplewood Manor, which Saratoga County leaders decided to sell and get out of the nursing home business after years of subsidizing its operating losses with county tax dollars.

The Civil Service Employees Association fought the proposal as it was debated, and led opposition at public hearings. But the union was unsuccessful. In early 2015, the deal was completed.

CSEA asserted Tuesday that residents and employees alike suffer when public nursing homes are privatized and become for-profit facilities — in general statewide and in Ballston Spa specifically.

Working conditions and living conditions are directly linked, said Therese Assalian, Capital Region spokeswoman for the CSEA.

“What comes often with privatization is a lack of continuity,” she said. “In a nursing home setting, what works best is continuity of care, and that means staff.”

CSEA represents about 45 employees at the facility, mostly social workers, licensed practical nurses and certified nursing assistants. Before privatization, it represented about twice that number. Many employees left because their salary and benefits under the facility’s new owners weren’t as good as when they were county employees, Assalian said. Morale is low and turnover is high, she added.

Multiple New York counties, most citing the high cost, have divested themselves of running nursing homes, including Saratoga County’s neighbors to the west, Fulton and Montgomery counties.

But Assalian said it’s a misconception that counties can’t afford to run a nursing home, providing better-paying jobs for employees and better conditions for needy residents in the process. She held up as an example Saratoga County’s neighbor to the south, Schenectady County. It recommitted itself to public nursing care when it built a new Glendale Home in 2014 at a cost of $45 million, and each year it spends millions on operating costs not covered by federal reimbursement.

When visiting the Saratoga Center, Assalian said, “You will meet people who have lived in the county their entire life, raised their family there, paid their taxes there, ran businesses there, contributed to the economy there. We believe there is an obligation, some might even say a moral obligation, to care for vulnerable residents.

“What I’d like to point to as a very successful model of dedication to county residents is the Schenectady County model.”

The public and former public nursing homes in the Capital Region do not rate particularly well on the federal and state five-star scales:

Albany County Nursing Home (county-run): one-star federal, three-star state.
Fulton Center For Rehabilitation and Nursing (private, formerly county-run Fulton County Nursing Home): Two-star federal, two-star state.
Glendale Home (run by Schenectady County): Two-star federal, two-star state.
River Ridge Living Center (private, formerly Montgomery Meadows, run by Montgomery County): one-star federal, three-star state.
Saratoga Center for Rehab and Skilled Nursing Care (former Saratoga County-run Maplewood Manor): No federal rating because of SFF status, two-star state rating.
Van Rensselaer Manor (run by Rensselaer County): Two-star federal, three-star state.

WHAT’S NEXT

The Special Focus Facility program was created in 1998 and uses an expanded schedule of inspections to bring about change at individual facilities.

The federal CMS identifies quality of care as a critical issue, and has issued a five-part plan to address it that calls for focusing on strengthening requirements for nursing homes, working with states to enforce statutory and regulatory requirements, increasing transparency of nursing home performance and promoting improved health outcomes for nursing home residents.

It noted that about 2,900 of the 15,000 nursing facilities nationwide get only a one-star health inspection rating.

In a posting about Saratoga Center on its website, the New York state Department of Health says:

“This facility has been designated as a Special Focus Facility (SFF) by the Centers for Medicare and Medicaid Services (CMS). This designation identifies nursing homes whose quality of care has consistently demonstrated failure to maintain compliance, as well as a history of facility practices that have resulted in harm to residents, as measured by recent survey experience. Facilities under this designation have two certification surveys per year by the Department. There must be significant improvements during this designation, otherwise serious consequences can be imposed on this facility. Significant improvement is where no harm has occurred to residents according to the survey history during that time frame. The Department and CMS will identify whether the Special Focus Facility designation can be removed, or whether additional actions are needed.”