It appears to be pure accident that Adirondack Health announced the elimination of sixty long-term nursing home beds at Uihlein in Lake Placid, just as Essex County supervisors were preparing to vote today on the likely sale of the Horace Nye home in Elizabethtown.
Accident or no, the two events should be a wake-up call.
The long, steady erosion in government and taxpayer resources for elder care in New York State has reached a tipping point, at least here in the North Country.
For years, Medicaid reimbursements have been far too low to pay for the rising costs of those people — the old and the infirm — who need the sort of intense, nurse-assisted care that these facilities provide.
Adirondack Health, based in Saranac Lake, is losing more than $1 million a year on the Uihlein facility. Essex County is losing $2 million annually at Horace Nye.
That kind of red ink is clearly unsustainable. And it’s time to talk honestly and bluntly about what that means.
Chandler Ralph, CEO of Adirondack Health, did that yesterday. She said point-blank that in future many poor, Medicaid-eligible people will be turned away from Uihlein.
“We will still take Medicaid recipients, but it won’t be all comers like it is now. We can’t afford it,” she said.
And in fact, the situation appears far more serious than that. Of the 60 remaining beds at Uihlein, 15 will be used for people in short-term rehabilitative care. That leaves just 45 beds for all long-term nursing care in Lake Placid.
It seems likely that many of those beds will go to people with independent means, folks who can afford to pay far more for their care than Medicaid.
In Essex County, meanwhile, the conversation has been less blunt, less clear.
Town supervisors have suggested that the for-profit company that is expected to take over Horace Nye would continue to accept the poor, high-needs Medicaid patients who drive up costs without bringing in much revenue.
But why would they?
If a well-run, efficient, locally-rooted non-profit like Adirondack Health can’t make the numbers work — with salaries and benefits for staff already well below those offered at Horace Nye — why would a New York City-based corporation take on those kinds of residents?
So if I’m right — if in the very near future there are simply far fewer beds in our region for low-income elderly people with dementia and other serious medical needs — what happens to them?
In her comments this week, Ralph suggested that families in the North Country will have to do far more to care for their own seniors.
That won’t be easy in an age when everyone has to have a job — sometimes two or three jobs — to make ends meet. This isn’t the 1950s, when Mom could afford to stay home to look after the kids and grandpa.
To help families cope, Ralph called for creation of a new, better integrated network of service providers that might help people remain comfortable in their homes much longer. It’s a creative and compelling idea.
But as Ralph acknowledged, that effort is just getting underway. The first organizational meeting is scheduled for next month.
And particularly for the truly poor in the North Country, these developments at Uihlein and Horace could mean real, painful and immediate changes — right now.
In the weeks and months ahead, many families will find that there are simply fewer good options when a senior finally reaches the point where they need nursing care. For some there will likely be no good options anywhere close to home.
There’s a saying that you get what you pay for. And right now, this is the safety net for the elderly that we’re willing to pay for.