Horace Nye, nursing homes, and the morality of government
Residents from Horace Nye have publicly opposed the sale (NCPR file photo)
Tomorrow in Elizabethtown, supervisors are likely to vote on the future of the Horace Nye nursing home, where roughly 100 elderly mostly-poor residents live. They are cared for, in large measure, by taxpayers.
At a rally over the weekend, Moriah town supervisor Tom Scozzafava argued that the home should not be privatized. Caring for elderly, infirm people is “what government is supposed to do,” he argued.
Along with Gerry Morrow from Chesterfield, Scozzafava laid out what was essentially a moral argument for keeping Horace Nye open. Taxpayers looking out for their neighbors is a good thing, they insisted.
A private company looking to turn a profit by caring for society’s most vulnerable citizens? In their estimation, that’s not such a good model. “I guarantee you we will regret this,” Scozzafava said.
This, of course, is the debate in miniature that America has been needing to have for a long time. We talk all the time about high taxes.
And some pundits insist that the greatest possible immorality is using progressive taxation to fleece our neighbors, redistributing wealth from “the job creators” to the less fortunate, the less talented, the less lucky.
That road, many people argue, leads to socialism.
But when you walk through the halls of Horace Nye, and see the fragile elderly souls who live there, you can’t escape the fact that there is another moral dimension to this conversation.
It is a moral question — not merely a fiscal one — whether or not to properly educate our children. It is a moral question whether our mentally ill will be homeless, or properly cared for.
And it is a moral question whether our grandparents will end their lives with dignity and decent care, or in the kind of dire poverty that once waited for most elderly people in America.
These are complicated questions. In the case of Horace Nye, the question isn’t whether to close the home and kick the residents out on the streets.
The question is whether a private company can give comparable levels of care and compassion, while shaving more than $2 million a year from the home’s budget.
A task force convened by Essex County answered that question in the affirmative.
In an interview with the Plattsburgh Press-Republican Sue Montgomery-Corey, town supervisor in Minerva, acknowledged fears that low-income Medicaid patients “would get tossed to the curb” if Horace Nye is privatized.
She added, “I don’t think that would happen here.”
Many other local government leaders have reached the same conclusion. New York has seen a race to privatize nursing homes. So has the North Country.
Government-run homes in Franklin, Saratoga, Warren and Washington County are all being privatized, or being considered for privatization.
The concern here is that local governments facing severe budget and property tax pressure — not just counties, but also school districts and towns — may make big cuts without thinking about the big picture.
What is their core mission? What is the moral dimension of the services that they provide? What’s the long-range plan for which services are “essential” and which programs are “luxuries”?
Have they done enough to contain costs internally? And what about public sector employees, who often earn considerably more than their private sector counterparts? Have they offered significant compromises and concessions?
The good news is that some of this conversation is happening. The Horace Nye sale has prompted rallies, debates, editorials.
The Press-Republican expressed satisfaction recently with the review process in Essex County, noting that whatever “decision the Board of Supervisors makes, they can do so with the knowledge they got neutral, accurate information” from county leaders.
The Glens Falls Post Star also prodded readers to think about “this latest trend in government, ” asking, “Should counties be in the nursing home business? What are the pros and cons from your viewpoint? What is your greatest fear?”
I’ll pose some similar questions to In box readers. Is this a good step that counties are making, using the private sector to help trim costs and provide services more efficiently?
Or do you fear that crucial, moral services could be outsourced in ways we will regret?
And what about other government services? Do you see a moral dimension to some of the programs and services that we provide to our more vulnerable neighbors?
Comments, as always, welcome.
Tags: adirondacks, economy, health, politics
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Maybe a starting point would be to look at examples where we have turned some of our existing services over to privatization. About three years ago our school district tuned the lunch program over to privatization. The results have been nothing but positive. Our budget is in the black and the students are very happy with the meals being served. It can and does work!
There is a blind faith on the part of capitalism that the profit motive is self regulating and can solve all of societies problems if left unencumbered by government oversight. That faith persists in spite of a lot of contrary evidence. I believe the capitalist model is a good one for supplying societies wants but a poor one for societies needs. The success of some things simply can’t be measured in dollars.
Excellent subject. I almost skipped over it, because the whole elderly-infirm-nursing home thing frankly provokes a sense of fear and mild revulsion in me. This was strongly reinforced by watching my mother-in-law slowly fade away in a reasonably well-run not-for-profit nursing home that nevertheless had lots of problems. My greatest fear is to end up in one, quickly exhausting my families financial resources to maintain me in discomfort and helplessness for months or years. Some of those poor folks I saw while visiting her were living hell on earth, and often without friends or relatives often, or ever, visiting them. She seemed reasonably happy, I will admit, until she went into her final, mercifully quick, slide.
But the issue is important to think about. I can support privatization when it has a proven track record and (esp. in the case of relatively helpless groups like children, the mentally disabled, and elderly) strong safeguards are in place. Brian’s story asks excellent questions, but did provide any answers , either in general, or specifically to Horace Nye. I hope someone here can. How well does privatization of nursing homes work?
This is a tough one. If the private buyer can bring better management skills to reduce cost by better and faster decision making then selling it would be good. On the other hand, if the idea is to fire all the employees and hire really low paid non-union employees to take care of paying out of county residents, then it’s not good. The supervisors have to do what’s best for the county residents, which is means looking at both the taxes and taking care of a population that has a lot of poor elderly residents.
FWIW (1). Shortly before I retired about five years ago, I took my Government class to a visit of the Essex Cty govt. complex in E’town. Tom Scozzafava, my school’s Town Supervisor, set the visit up for us. The visit included Horace Nye, and it was clean, apparently well-run, with apparently fairly happy residents.
FWIW (2) If all Republicans were like Tom, I too, would be a Republican.
The Essex County government, whose latest scheme is to raise the county sales tax, has been spectacularly unsuccessful in managing the nursing home, among other fiscal and legislative disasters. Do you really want to entrust care of the elderly to the same people who tried to re-introduce beer sales to the County Fair? The only thing they know how to do is throw our money at problems, which might be tolerable if anything positive resulted from it. They can’t effectively manage the Nursing Home; if they could, this issue would not exist.
The last time I looked, Horace-Nye was considered an excellent nursing home which means probably that the staff there is the strong-suit of the institution.
The mission of having this sort of nursing home is to serve people who need nursing care and cannot afford to go anywhere else (they are certainly not all elderly).
The point of a private for profit organization is to maximize their profits can these two concepts work together?
Certainly a private company could make a case for cost control, but they also must make a profit. Before proceeding I would like to see how exactly they would lower costs and NOT hurt any of the current residents.
I mean sure if you go in and start increasing your revenue through denying entry to the poor or favoring entry to those who have more resources you can clean up the income statement that is for sure, but who cares? You are no longer doing the public mission.
“The concern here is that local governments facing severe budget and property tax pressure — not just counties, but also school districts and towns — may make big cuts without thinking about the big picture.”
Don’t worry, Brian. The next “big cut” will be the first. “Big” could arguably be described as resulting in level, or reduced, taxes.
Business people, at least successful business people, understand how to run an operation without a “blank check” mentality. In this case government needs to provide oversight that ensures resident’s needs are being met while private sector management ensures that money does not continue to be wasted. I think that a public/private “partnership” could be beneficial to all parties.
I agree with Larry. His comment strikes a good balance.
It’s shaky ground to depend on the government to manage things – we won’t step up to the plate.
There have been news accounts of nursing homes taken over by for-profit companies that have been absolute nightmares, hiring unqualified, uncaring staff to warehouse the elderly in horrible conditions. The process has been so cynical that in some cases the companies have set up byzantine ownership structures to make lawsuits seeking damages for mistreatment all but impossible.
I distrust private enterprise at least as much as I mistrust government. It’s interesting that those who advocate the takeover seem confident that government can do a good job of oversight, though being convinced that government can’t actually provide good services.
Remember, you could end up in one of these facilities one day.
Believe me, I am not “confident” that government can do anything correctly. That is, however, what we should be aiming at. Concerned citizens need to keep a close eye on those we entrust with governance.
Five-year-old NYT story does not paint a pretty picture of privatization. Profits: Up
Nursing staff: Down,
Patient deaths: way up.
Could be worst case scenario, of course. Focused on that exemplar of corporate responsibility and good government, Florida. http://www.nytimes.com/2007/09/23/business/23nursing.html?pagewanted=all
I will repeat my earlier point: if the government had been successful running the Nursing Home selling it would not be an issue. Hopefully, they will provide better oversight than they have management.
Larry – In both health care and education there are examples of excellent public, religious, and private for-profit and non-profit institutions. There are also poorly run terrible examples of all of those. Horace-Nye is a good nursing home, so there is a lot to lose.
This is why we have elected representatives. Thats what government is. There is no simple answer to this one. Somebody has to spend a great deal of time going over lots of details.
Larry, it looks like a classic case of how you measure “success”. If you mean “cheap”, then no, they haven’t been a success. But maybe this isn’t an area in which we want to be cheap. How would you feel about it if your grandmother was a resident?
I don’t know the history of Horace Nye – how and why it was established – but if the county started it I have to assume it was filling a need that was not being met by private enterprise at the time. What has changed that a private company now sees running a facilty like Horace Nye to be profitable?
Is the county totally divorcing itself from the finances of the unit or are they contracting with a private company to run it? If they are selling the facility are they getting value for the building and infrastructure?
What do other counties in NYS do? How many run nursing homes? There are plenty of privately run nursing homes in the state. Are county run nursing homes unique to rural counties?
I just rechecked that ratings on Horace-Nye. It is now rated average.
The notion that private business is so much better at running things than public government is something that has always puzzled me.
How many businesses go out of business every year?
Succeeding in business is not necessarily a high percentage game – just ask any entrepreneur or business owner. There are lots and lots of failures, lots of poorly run companies, lots of businesses just barely making ends meet.
So I am not sure why some people are always so sure a business model will be a better bet.
Dave, It’s that blind faith in capitalism that I mentioned above. In the end though their arguments come down to money, cutting costs and making profits. I find it interesting that the comments in favor of privatization assume that the fiscal problem is the result of government mismanagement. It doesn’t seem to cross their minds that the problems could be the result of something beyond the county’s control. In their minds if the nursing home are in the red it must be government mismanagement and private industry could certainly do a better job.
The Horace-Nye annual deficit costs the average Essex County resident $1 per week.
Who might run nursing home better? County leaders who have never run one (perhaps never even visited one)? Or a business that has run many of them, for years? The County will be better at oversight than operations. This is where the tax cap begins to bite.
The issues under this are pension and health benefits of government employees. They are incredibly rich compared to the private sector. It is politically impossible for elected people to pull back these benefits. The only route is to move the jobs into the private sector, with the same pay and private sector benefits. That’s what is going on, and I am fine with it.
The tax cap forces all this to a head. It was meant to. Watch for similar changes to come to other town and county employment: road crews, back office operations, public health administration, etc.
Dave asked “How many businesses go out of business every year?”
The number that used to be tossed around was 50% in the 1st year and 95% within 5 years. Recent figures from the SBA suggest that slightly over 50% survive 5 years but they concede that it is difficult to say since some businesses don’t formally go out of business , they simply decline into inactivity and never withdraw their business registration. Some others go dormant for a while and then become active again.
It varies also by industry and locale. For instance service industries used to have the worst survival rate and manufacturing the best. Given recent changes in the patterns of job openings I suspect that has reversed. OTOH a manufacturing business may still be in business but has outsourced production and laid off all but a handful of its employees. A good management strategy for profits but not what I would call being a “job creator”. OTOH it’s still in business.
“Is this a good step that counties are making, using the private sector to help trim costs and provide services more efficiently?”
Yes.
“Or do you fear that crucial, moral services could be outsourced in ways we will regret?”
Yes.
“Do you see a moral dimension to some of the programs and services that we provide to our more vulnerable neighbors?”
Of course.
James and David, those figures are probably for all small businesses as a whole. That may be accurate but you probably want to look at this type of business specifically and not lump it in with every gin joint etc.
What is the ratio of “self-pay” to “medicare” residents at Horace-Nye? A nursing will not break even (much less be profitable) based on a high population of medicare residents. Based upon my experience, the medicare rate is 50% to 60% of the self-pay rate. In areas like St. Lawrence County, the demographics tend to be heavy weighted towards medicare residents.
I would expect a privately run nursing home to become very selective when it has an open bed, whereas a gov’t run facility may just take the next applicant on the list regardless of payment rate.
All you have to do is look at the new announcement from “Adirondack Health”– if you’re on Medicaid, good luck!
The problem is that the reason a private company does not ALREADY provide service to elderly medicaid people is that it is not profitable. Yet we still need the service that is what the government is for.
I would rather see one of the numerous not for profits around the north country providing nursing care, take this on rather than a for profit entity. I am pro business and we need to do more in the NC to support private enterprise, but this is not part of that this is a safety net issue. Come on these are poor old people who are not going to get better and are not going to have any more money. If a for profit entity can do better than the current system in serving them I would like to see how? Walker alluded to it above, you will make more money by slowly getting rid of your medicaid only patients, that is how it is done.
Don’t mean to get things off track, but everyone realizes that Obama care is talking about paying LESS than current medicare and medicaid does. Who is going to serve anyone? Without cost control nothing really changes.
“All you have to do is look at the new announcement from “Adirondack Health”– if you’re on Medicaid, good luck!
For folks over 65 in the US we basically have the Canadian system that some people support for the whole country. We don’t live in Canada.
most nursing home residents are medicaid recipient (there are a number of attorneys and financial planners that specialize in helping transfer their assets so that medicaid will cover their nursing home care) as the cost of nursing home care is quite expensive. so any north country nursing home that refuses medicaid patients probably wont have enough patients to cover the cost of running the facility.
The truth is most people dont want to go into nursing homes and we should look at alternatives that enable people to stay at home. This is controversial to say, but I also think we spend a lot of money extending the lives of many people who would rather not live in nursing homes and instead rather die in their homes with (what they see as) more dignity.
Walker:
My late grandmother was a nursing home resident. My opinions on this topic are heavily influenced by that experience and subsequent experience with another family member. Smarmy jerks like you just can’t accept that other people may have legitimate, relevant opinions that differ from yours. Get over yourself and quit the gratuitous, thinly veiled insults. They don’t do anything to advance the discussion and serve only to incite destructive argument which is, perhaps, your goal. You might at least be clever about it and come up with some original material.
I’m sorry, Larry, but it sure sounds like you’re saying that you think the county should have spent less on your grandmother’s care?
How, exactly, were your opinions on this topic “heavily influenced by that experience”?
First thing you need to do, Walker, is stop putting words in people’s mouths. Then, you need to read and understand their comments. Finally, it would really help the discussion if you could refrain from asking stupid, pointless questions, unless, of course, that’s your attempt at the cleverness I suggested. If it is, I give you points (but not too many) for trying.
Larry, would you care to mention exactly what your first hand experience taught you? I still have no idea, after re-reading your comments very carefully.
To all:
I understand my sparring with Walker, while mildly amusing (to me, at least), does nothing to advance legitimate debate, which is, I think, the point of these blogs. However, I can’t stay silent any longer in the face of the mean-spirited commentary of small-minded people who think their’s are the only opinions that matter or are based on fact. Disingenuous comments and questions, baseless supposition about people’s meanings and hackneyed cliches are not debate; they are the brainless mutterings of people who like the sound of their own voices. I’m sick of it and suspect many others are as well. Let’s get back to exchanging ideas.
Walker:
I would not. My comments stand as written. My purpose here is not to improve reading comprehension.
Larry, this is what you wrote:
“The Essex County government, whose latest scheme is to raise the county sales tax, has been spectacularly unsuccessful in managing the nursing home, among other fiscal and legislative disasters.
“Business people, at least successful business people, understand how to run an operation without a “blank check” mentality. In this case government needs to provide oversight that ensures resident’s needs are being met while private sector management ensures that money does not continue to be wasted.
“Believe me, I am not “confident” that government can do anything correctly.
“I will repeat my earlier point: if the government had been successful running the Nursing Home selling it would not be an issue.”
I don’t think I’ve omitted anything pertinent. Talk about cliches!
I don’t see how I’ve been a “smarmy jerk” and I don’t see how I’ve put words in your mouth. It appears to me that it is you who “just can’t accept that other people may have legitimate, relevant opinions that differ from their own” and are being a jerk. I have made no “gratuitous, thinly veiled insults.”
You have said nothing about the nursing home being badly run, only that it cost too much. Correct me if I’m wrong.
I’ll give you one thing—your insults are right out front!
Kids, don’t make me pull this car over!
He started it!!!!
The essence of being a smarmy jerk is not realizing that you are one.
Ah, Larry, there we agree!
That’s it. Both of you go to your rooms!
Aw Dad, that’s not fair!!!