Nursing Home Receivership Raises Concerns Over Shortage of Respiratory Beds

One of two skilled nursing facilities in Connecticut with a respiratory unit was placed into voluntary receivership on November 5, raising concerns about access to such care in the state.

The Republican-American first reported the news over the weekend.

The state Department of Social Services (DSS) placed Waterbury Gardens for Nursing and Rehabilitation under the control of Timothy Coburn, who will decide whether to sell or close the facility.

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There is an appeal scheduled for November 20, but Mordy Lahasky, the former owner, told the publication that he would not contest the decision, adding that the receivership was voluntary.

“We’re not happy with what happened but we’re happy that [Coburn’s] the receiver and it looks very promising,” Lahasky told the Republican-American.

The attorney for the owners asked a receiver to be appointed on November 1, reporting that the facility could not meet payroll for the following week, DSS spokesman David Dearborn said in an e-mail provided to Skilled Nursing News.

Lahasky, other co-owners of the facility, and the New England Health Care Employees Union District 1199 had raised the issue of viability earlier this year, due to a retroactive rate change to Medicaid reimbursements that date back to July 2016.

The facility’s payments dropped from more than $466 per patient per day to $365 or less per patient per day, and Lahasky said in August that the change would cost the SNF more than $2.2 million.

SEIU District 1199 President Rob Baril called for the facility to be sold, citing the “unique” services provided at the SNF.

“Cutting these health care services in the Waterbury community would be highly detrimental to white, black, and brown residents and workers,” Baril said, according to the Republican-American.

However, a letter dated October 30 from Kathleen Brennan, the deputy commissioner for DSS, raised doubts about demand for those services. According to that letter, the facility’s reduced occupancy in its specialized long-term care (SLTC) unit is related to its “self-imposed freeze on new admissions to the SLTC beginning on or about April 19, 2018.”

The 30-bed unit had 18 beds open as of October 17 of this year, and Waterbury Gardens was told by the DSS that they had to submit a written proposal including documentation to support demand for a 30-bed SLTC, as well as a plan to boost staffing and a fill schedule, if they wanted to resume admissions to the SLTC.

Waterbury provided a proposal to expand the SLTC to a 30-bed unit on July 16, as well as the documentation required. That documentation included a referral form from January 2, 2018, to April 25, 2019, that logged 65 referrals in that time period. According to DSS, these were each denied because “no vent bed” was available, with 43 of the 65 denials taking place during the “self-imposed freeze on admissions.”

“Based on the documentation provided, at no time during the period January 2, 2018, through April 25, 2019, did Waterbury Gardens have a waitlist for admission,” Brennan wrote in the letter. “Further, despite the continued decrease in Waterbury Gardens’ census, the Department has no indication that there is an unmet need, as we have not received any requests from hospitals for assistance with discharging people who require ventilator care.”

As a result, the proposal for 30 SLTC beds was rejected by DSS, which led to DSS terminating 15 beds from the 30-bed SLTC unit. The total of 150 “chronic and convalescent nursing home beds” at Waterbury was not affected by that termination, Brennan said.

Dearborn provided a copy of the October 30 letter to SNN.

Coburn will decide the facility’s fate based on whether or not it can become financially viable, Dearborn told the Republican-American. He added that care should stay “entirely appropriate” due to the state guaranteeing sufficient funding during receivership.

The receivership represents a key opportunity to evaluate the facility and the demand for the services provides, Matt Barrett, the president and CEO of the Connecticut Association of Health Care Facilities, stressed to SNN.

“The statute requires the receiver to evaluate the viability of the facility as a first and central question,” he said. “It leads to the second question, which is: Should the receiver be organizing and trying to sell the facility?”

While he declined to comment on the specifics of the October 30 letter without broader context, Barrett emphasized the importance of drilling down “to the micro level” to get a clear picture of demand for a specific type of service, including ventilator care.

It’s not unheard for the state’s occupancy data to be skewed by rooms that were altered, or a disparity between licensed beds and the number of beds actually in service in a given SNF, he noted.

“The state’s information is valuable, but this is an opportunity for a new independent evaluation by the receiver — because the receiver is actually the court,” he said.

It’s too early to tell whether or not the demand for ventilator care will be affected, but the importance of the question is so great that the SNF sector would want assurance that the demand has been thoroughly vetted, he said.

“If you get that wrong, the consequences are harsh and perhaps traumatic for nursing home residents,” Barrett said.

The other SNF in the state that has a respiratory unit, Genesis HealthCare’s (NYSE: GEN) Village Green of Bristol, was also penalized under the rate change for low occupancy. This was due to the SNF’s specialty units, including ventilator and pulmonary care services, Genesis spokesperson Lori Mayer told the Republican-American.

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