SCHENECTADY — In the 13 months after residents’ families demanded a sitdown with administrators over quality of care, the company that runs a Schenectady nursing home has made a series of changes and upgrades.
Additionally, in his first year on the job, the administrator of the Schenectady Center for Rehabilitation and Nursing has established an open-door policy that some family members say has been noticed and appreciated.
Other improvements have been noted, but some staffing levels for labor-intensive patient care is sometimes still an issue. Though their language and details differ, all parties involved — management, labor and families — point to money as the root cause: Health care is expensive, and so are staff increases that would reduce the shortcomings.
Bronx-based Centers Health Care purchased seven residential facilities in upstate New York from Schenectady-based Capital Living Group in September 2017. The 240-bed Altamont Avenue facility previously known as Capital Living Nursing and Rehabilitation Centre was the flagship of the seven sites, constructed in 2013 at a cost of $39 million.
Soon after the purchase, discontent grew among family members of residents about quality of care during the final months of ownership by Capital Living and the first few months under Centers Health Care.
By December 2017, family members were discussing it openly or privately with The Daily Gazette and attending group meetings with managers at the local and corporate level.
In January 2018, Elie Schiff took over as facility administrator after assignments elsewhere with the parent company.
A year later, he spoke with The Daily Gazette about changes the facility has made in policy and programming.
“I knew that there was a lot of uneasiness with the families and the residents and the staff, too,” he said. “I think we really tried to change the culture.”
This took the form of a letter introducing himself to everyone at the facility or connected to it, and offering an open-door policy to anyone who wanted to talk to him.
Schiff said he spoke with perhaps 50 family members in hallways and his office in his first two months, compiled a list of priorities, then called a group meeting in early spring attended by about 80 family members.
“I think that communications has gone a long, long way” to addressing family concerns, he said. “They all know my door is open.
“Hopefully we can take care of [an issue] but if we can’t, I explain ‘this is why we can’t.’”
The facility also has seen a series of upgrades (see related story). But Schiff said improvement has come from the entire staff, not any single initiative or administrator. "I'm only as good as the parts around me," he said.
Objective measurements of nursing homes are provided by the federal Centers for Medicare & Medicaid Services and state Department of Health.
CMS gives the Schenectady Center an overall 4 out of 5 stars on its multipoint evaluation system, which is "above average." It fares better on some metrics than others. The facility does much better than state and national average on short-term rehab patients needing rehospitalization or emergency room treatment, for example, but worse for long-term residents sustaining major injuries in falls.
DOH gives the facility 5 out of 5 stars on quality of care and 3 or 4 stars in its four other categories.
There's also a subjective evaluation by family members who focus on their one patient while the star ratings look at the facility as a whole.
Neither picture is complete. Tallying a few dozen metrics and arriving at a statistical rating ignores the isolated but critical details that define an individual family’s experience. One family focusing on those details and filtering them through the emotions of watching a loved one’s decline does not reflect the whole facility.
Schenectady Center for Rehabilitation and Nursing averages 97.9 percent occupancy, according to the state Department of Health.
Mark Buddle of Rotterdam, whose father is a resident, said Schiff’s responsiveness has been appreciated.
“Typically, if I call him or email him he gets back to me within hours, usually very concerned and usually with a plan” to address the issue.
“He’s been extraordinary, I really have to say that,” Buddle said. “I don’t know that I’ve dealt with any business or customer service that’s addressed things as quickly.”
Barbara Miller of Rotterdam, whose husband is a resident, also praised Schiff’s responsiveness.
“The administrator, Elie, I’m in his office every week. I believe he’s been pretty good about listening and handling problems as they come up,” she said, adding that he was on-site during last weekend's snowstorm and she heard that he gave some of the staff rides to and from work.
(Schiff said his presence on weekends or holidays when there is a pressing situation like a snowstorm is part of a teamwork philosophy. He and another manager came in as the snow ended last Sunday and gave rides to some staffers who agreed to fill in but had no way to get there.)
Both Buddle and Miller have loved ones with major and complex problems that are difficult to address, and this forms the basis of their opinion that improvements still need to be made, not just at Schenectady Center Rehabilitation and Nursing, but in the long-term care industry overall.
Some levels of care for the elderly and infirm simply require a lot of attention. A greater amount of attention and assistance means more people on the staff, and more money to pay them. Payroll already is the largest single expense.
“I believe this is something everyone [in the nursing home industry] experiences,” Schiff said. “On days when we aren’t staffed where we want to be, family members know what we’re trying to do. Overall, I've been happy with the progress we’ve made. Is every day perfect? No.”
Reimbursement by insurers is simply too low, he added.
“Every insurer is squeezing out every dime, minimum wage is going up, it makes it a challenge to stay afloat while offering competitive wages.”
Buddle said: “It’s certainly better than it was when we first got there, in terms of staffing. The only challenges that remain are the ones [Schiff has] admitted himself. He’s filling the gaps and he’s doing it as well as I can.”
Miller, too, cited staffing levels as the key to quality of care.
“The things that are detrimental to people’s health is staffing,” she said. “The staffing seems to be the biggest problem in these facilities. It’s not just ours, it’s all of them.”
So Miller wants a solution for all of them: Statewide legislation that would mandate minimum levels of staffing at health care facilities. There are measures regulating conditions at puppy mills and mandating staffing ratio at day care centers, she said, and so too should there be for nursing homes.
“I love my dog, but these are people and they deserve just as much,” Miller said.
So-called safe-staffing legislation has been stalled at the state Capitol in recent years, caught between Republican and Democratic priorities and the competing interests of health industry and union lobbyists.
More recently, Gov. Andrew Cuomo in his budget presentation announced a health care staffing study that will seek input from all sides and conduct a cost-benefit analysis of various options. That might delay any new legislative push, at least in the short term: A union, two industry organizations and a legislative aide close to the issue all told The Gazette last week that they are not aware of any imminent movement.
“I just think it’s up to us to be the voice and it’s up to our elected officials and the Health Department and the state to do something about it,” Miller said.
She said she’s in regular contact with the state Department of Health on the subject, and the people who answer the phone have come to know why she’s calling — which is to tell them “They need to look at how many people one person can really give good care to.”
Previously introduced minimum staffing legislation would apply only to registered and licensed practical nurses, and is being backed by the New York State Nurses Association.
Another union, 1199SEIU, represents certified nursing assistants along with support workers at many nursing homes in New York state, and it wants CNAs to be included in any minimum staffing regulation the state imposes.
CNAs provide much of the direct interaction with residents at most nursing homes. At the Schenectady Center, for example, federal statistics show registered nurses average 30 minutes a day with each patient, licensed practical nurses 57 minutes and CNAs 131 minutes. (The LPN time is longer than state and federal averages, the CNA and RN time is shorter.)
In an emailed statement on minimum required staffing, 1199SEIU said:
“We are working to address this crisis through all avenues, including at the bargaining table and with state regulators and elected representatives. We support the staffing study announced by the Governor as a step in the right direction toward ensuring our members are able to provide the best quality care for their patients.”
Meanwhile, 1199SEIU has its own issues with Centers Health Care. It’s been locked in negotiations with the for-profit company for a year, seeking a contract that would cover the Schenectady, Troy, South Glens Falls, Syracuse and New Paltz nursing homes. Union members have held informational pickets outside some of the facilities, including Schenectady on Dec. 19.
The standoff comes down to money, essentially. The union wants increases in salary, health care and retirement benefits, plus job guarantees in the event of another ownership transition. The company wants to control expenses.
Patrick Nelson of Rotterdam, lead cook in the kitchen at Schenectady Center and an on-site leader of 1199SEIU, said there has been some give and take by both sides but the high cost of health insurance appears to be the sticking point.
“They’ve agreed to some things but we want that contract,” he said.
Staff recruitment and staff retention suffers without a contract, Nelson said, and that leads to short staffing, which leads to the concerns raised by family members.
“Our experience has actually carried them in a number of ways,” he said of the employees present when Centers Health Care took over. “Not only did they acquire the facility, they also acquired a lot of talent and a lot of skill, and they haven't fairly compensated us for that.”
Asked about his sense of the management-labor atmosphere there, the 22-year dietary worker allowed that “It’s not a terrible work environment.”
Schiff wouldn’t comment in detail on the ongoing negotiations but did say his open-door policy extends to employees and their union representatives.
And he noted that the pressures limiting wage increases are probably worse for companies smaller than his: A larger company has more resources and greater leverage to control costs than a small one does.
“We see a lot of the smaller companies have been bought out,” Schiff said. “The long-term care industry is getting tougher and tougher to be successful in.”
LeadingAge New York President James Clyne said staffing is a never-ending struggle. His organization represents the nonprofit continuing care industry but the issues are the same on the for-profit side, he said: Some nursing home jobs are physically or emotionally demanding, and there are more-lucrative or less-stressful options elsewhere.
As a result, there is steady staff turnover.
“It’s all about recruiting and retaining staff. It is easily the biggest issue,” Clyne said. “We’re always recruiting at almost all levels.”
(The salary range for CNAs at the five Centers facilities locked in contract negotiation is $11.79 to $12.50 an hour, according to 1199SEIU. Upstate minimum wage is $11.10.)
Clyne said the good news is that there’s a path to better pay and duties in these facilities for anyone who wants to move up the ladder from aide to CNA to LPN to RN, if they’re able to invest time in education.
LeadingAge New York is not in favor of the minimum staffing legislation, Clyne said. He is cautiously optimistic about other potential changes in this legislative session, particularly the prospect of raising Medicare reimbursement rates for the first time in a decade.
“That’s balanced with a lot of potential cuts, though,” he added.
Centers Health Care has made multiple additions to the Schenectady Center for Nursing since acquiring the former Capital Living property in the summer of 2017.
The Altamont Avenue facility’s administrator, Elie Schiff, said the Bronx-based parent corporation gives on-site managers autonomy in tailoring each of its facilities to meet the needs of its patients and families as well as the specific conditions of the local market.
In this case, he said, the physical plant is so new and the director of maintenance is so good that there’s no need to invest in repairs or modernization. So the company put money instead into other initiatives. Here is some of what has changed, and a couple of changes planned this year:
- In-service training for staff, staff-appreciation lunches, employee-of-the-month awards and longevity honors have been added as morale boosters.
- Video-interactive equipment from Jintronix was installed to make the repetitive motions of physical therapy more fun to engage in. “You’re getting that therapy and more with a much more exciting experience,” Schiff said.
- Coffee was upgraded to Starbucks.
- Netflix was added to television options, giving families another way to spend time together during visits. The addition grew from a Spanish-speaking resident’s request for Telemundo.
- A cocktail hour replaced bingo night.
- The facility has tried to integrate into the community by hosting blood, clothing and food drives, and by hosting arson survivor Safyre Terry to wash 5,000 plush animals in the on-site laundry.
- Live music was added at dinnertime.
- Management staff was hired, including a nurse manager, assistant director of nursing, assistant administrator, dietitian and staff educator.
- The Good Outcomes Program, or GO, was initiated to make short-term rehab a better experience with better outcomes. The GO Unit creates a team environment where residents gain inspiration from each other, with weekday availability of an attending physician and nurse practitioner plus 24-hour presence of a registered nurse. A new therapeutic gym and an activities-of-daily-living suite complete the picture. The idea, Schiff recalls, was “Let’s bundle a package from A to Z and make it as homelike for these surgical candidates who want to have a decent experience for a few weeks before they go home.”
- Looking ahead, Schiff hopes to have a pharmacy up and running nearby, “whether it’s rented space in our basement or a few blocks away.”
- Additional outdoor improvements are planned this year, though details are not yet finalized.