Nursing Home Facilities Often Have Long Waits

When the elderly reach a point at which they are no longer able to care for themselves, their options dwindle significantly.

Most medical experts say the first option in many cases should be using home health care to keep the elderly in their homes. However, there are a number of reasons this arrangement doesn't work, including handicapped accessibility, the severity of the medical condition and a lack of a nearby support network of family or friends.

When that happens, institutional care is probably necessary.

"I am a believer in helping the elderly to stay in their own homes, even as they need help in the activities of daily living," said Dr. Gary R. Berk, chair of family practice at Canton-Potsdam Hospital. "The biggest issue may be access to services. There is a scarcity of assisted living and nursing home openings in St. Lawrence County, especially in the Gouverneur, Canton, Potsdam corridor."

CLOSURES ADD PRESSURE According to Barbara Morrow, vice president of long-term care at Samaritan's Summit Village nursing home and Keep Home, the recent closures of nursing and assisted living homes in Watertown, Carthage and even Oswego County have created added pressure for Summit Village and the Keep Home.

"It's a hard business to be in from a financial standpoint, even with the hospital to back us up," she said. "We recently got into home care ... only mostly in Jefferson county, but it's hard, we're a big county."

With a total of 439 beds, both facilities are running at approximately 98 percent occupancy with waiting lists between four and nine months.

"Just because we have a bed open, it doesn't necessarily mean it fits an applicant's health needs or financial concerns," Ms. Morrow said.

Ms. Morrow stressed the critical need for long-term and end-of-life care, as the needs of each person and family are different.

"The dynamics of families have changed, most households are two-income, which means no one is at home and able to take care of their parents full-time. Many grown children move away from their parents, and (the parents) need a place to go."

When looking into a nursing home, Ms. Morrow said the first concern for most families is the price. While the homes will help applicants enroll in Medicare and Medicaid, cost can be a real barrier, which is why she recommends planning well in advance.

"The biggest thing is to talk about it. It's not always a comfortable conversation, which is why it's important to talk about it before something happens," Ms. Morrow said. "Get a financial plan when you're not under stress, not after."

She also believes in designated health care proxies, in filling out Medical Orders for Life Sustaining Treatments, and getting one's wishes down on paper, even if it doesn't feel pressing.

Tragedy can hit at any moment, and having the decision making out of the way helps reduce stress.

"No one wants their loved one to have to go into a nursing home. People feel guilty ... it's a very emotional thing." Ms. Morrow said. "I tell my staff no one says "I can't wait to go into nursing care," so we have to work to make it the best home we can."

NURSING HOME CLOSURES Several recent closures of nursing and assisted living homes underscore the stress felt by many families looking for quality long-term care for their loved ones, and ups the pressure for other facilities and services scattered across the north country.

Angel's Inn Adult Home closed at the end of July, after nearly 70 years of fighting to stay open.

Mary Ryan-Allen started the home, originally Ryan's Nursing Home, in 1946. Now 93 years old, the owner and operator was faced with a choice - pay hefty fines from the State Department of Health or shutter the supervised care facility.

Established as a 40-bed nursing home and reduced over the years to a 24-bed supervised care facility, Angel's Inn was down to its last five residents and 14 employees.

"After 70 years it's pretty heartbreaking," Mrs. Ryan-Allen said. "It's been a wonderful place that has made a lot of people happy." A July statement from the Department of Health said, "The Department identified serious deficiencies at Angel's Inn which included systemic breakdown in the operations of this facility. The department is working with the operator of the facility to resolve these issues. The Department will continue to hold Angel's Inn and other providers who violate regulations accountable for their actions." According to Mrs. Ryan-Allen, to stay in operation, the home was told to pay a $50,000 lump sum penalty and $1,000 a day in fines. She has faced similar fines and battles with the state in the past, but said this time she chose not to fight it.

In 70 years, the home faced its fair share of hurdles. Mrs. Ryan-Allen fought for ownership and operation of home for decades, since divorcing her first husband and co-owner Robert D. Ryan in the 1970s.

The 7,500-square-foot Pine Street adult home, which has the capacity to house up to 24 people in its 17 rooms, is now in disuse after years of Department of Health violations and subsequent fines for many years.

Angel's Inn faced $21,975 in fines in 2014 for structural and maintenance violations, and in that same year went through three home administrators. At the time, the home noted to a Times reporter that none of the violations was in regard to patient care.

Carthage Area Hospital's skilled nursing unit succumbed to the harsh long-term-care environment earlier this summer as well, announcing in June its plan to close as soon as its remaining 23 residents found new homes.

"Despite our unwavering commitment to quality resident care, it has grown evident in recent years that we are unable to continue to operate the unit," said Rich Duvall, Carthage Area Hospital chief executive officer, in a written news release.

"This, combined with declining cost-based reimbursement for services provided to nursing home residents, has made the hospital's decision essential."

In a previous interview, Mr. Duvall told the Times that hospital officials could see no path that would provide even a break-even income flow. Since that time, proposed changes in federal health-care policies have made the picture even more bleak.

In its petition to close the unit, the hospital cited "long-term financial challenges brought by changing state and federal mandates." Also cited were escalating costs facing smaller skilled nursing facilities that are saddled with a scale of operations that is too small to be competitive.

Most residents were transferred to local facilities assisting in relocation, including the 90-bed Country Manor Nursing and Rehabilitation Center near the hospital, Lewis County General Hospital's 160-bed Residential Health Care Facility, and Samaritan Medical Center'sSummit Village.

Michaud Residential Health Service, a nursing home in Fulton, Oswego County, also officially shuttered Aug. 28, after finishing the relocation of its patients.

Plans to close the 89-bed facility were announced in July amid financial difficulties.