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Feb 15

Emotional end: County closing nursing home in favor of more beds at hospital

Long Term Weight Loss Comments Off on Emotional end: County closing nursing home in favor of more beds at hospital

Andrew Scheiner/Daily Journal Yesterday, more than 200 residents and supporters of Burlingame Long Term Care came before San Mateo County supervisors (including Carole Groom and Don Horsley, top center) to beg them to not close the facility. Connie Lauer, a six-year resident, (bottom center, sitting next to Sandra Herrick) began crying while explaining how other options like a board and care home are too expensive. Left, a resident, and right, John C. Beiers, county counsel, listen to the supervisors unanimous decision to not renew the lease.

San Mateo County supervisors unanimously agreed not to renew its lease with Burlingame Long Term Care, a decision capping hours of emotional testimony by residents who begged them not to break up their home and others who challenged the image of the facility as physically unsafe and financially draining.

“Please let us stay together because we are a family. I don’t know what I would do if I lose my home and my family,” said center resident Eileen Nolan who has been disabled for 50 years and said she cannot care for herself.

The board’s decision means Burlingame Long Term Care on Trousdale Drive will close in July 2013, its 230 residents relocated and approximately 200 workers laid off. The supervisors called the decision tough but said they need to take a long-range approach to long-term care and financial solvency.

“The needs in our community outstrip our ability to pay for them,” said Supervisor Dave Pine.

Regardless, the board’s final vote was met with loud booing and tears. Several of the residents are Medi-Cal recipients and they worried that the closure means few local options and possibly being forced to relocate far from known surroundings and loved ones.

Prior to yesterday’s decision at the board meeting filled with more than 200 people, Connie Lauer, a six-year resident, began crying while explaining how other options like a board and care home are too expensive.

“I just don’t want to move,” she said.

County officials said they wouldn’t move them if they could help it but they are faced with a $9 million annual loss caused by cuts to reimbursement rates, expensive upkeep and a facility that, while not unsafe, is not modern.

“I know this transition will cause enormous stress and disruption … and I’m extremely sorry,” said Health System Director Jean Fraser, her voice cracking.

A large part of the problem is that Medi-Cal covers hospitalization and nursing care but not at-home care services. Fraser said the county has little choice when it comes to Medi-Cal beds because the program covers hospitalization and nursing care but not at-home services. The county is part of a pilot program for long-term care integration and Fraser is hopeful this will eventually offer all counties flexibility to use those funds in the best and most financially prudent way possible.

“I truly believe every crisis is an opportunity,” Fraser said.

However, as long as the county stays wedded to large institutions its creativity and innovation is stymied, she said.

The current proposal calls for reopening Unit 1B of the San Mateo Medical Center with an extra 32 beds for a total of 64 set aside from short-term patients while long-term residents are placed elsewhere. Dr. Susan Ehrlich, hospital CEO, said the county should use the unutilized space because it pays $1 million a year in debt service.

 Several board members yesterday indicated a preference to add another 96 in the unit for a total of 128 and let Burlingame Long Term Care residents use those. Fraser estimated adding the others would take about nine months and cost approximately $2 million.

That decision will be made at a later date; yesterday, the board only voted on the lease renewal and heard more than three hours of public comment punctuated with poetry and songs.

Esther Nord wondered if her comments would fall on deaf ears because the supervisors had already made up their minds but asked the board to look at the residents as individuals and not just a crowd or a number of beds.

“Today is Valentine’s Day. This place is one big heart. Give us our miracle on Valentine’s Day,” she said.

Over and over, the speakers told the board the nursing home is an asset rather than a liability for the county. Many said the county would be better off revisiting the billing and at least one questioned prior staffing cuts that make it impossible to keep the center from being fully occupied and thereby raise more revenue.

“Was this budget cut a deliberate attempt to right red ink?” asked Barbara Meacham who, with her husband, spoke on behalf of a cousin who resides in the facility.

Others suggested pulling the health care districts in to help and the cost of BLTC was often contrasted with the price tag of a new county jail.

The crowd repeatedly told the board a “tsunami” of aging Baby Boomers is poised to worsen the problem of too-few beds and at least one told the supervisors to consider their own future.

“You people will be in our position someday and there won’t be any place for you,” said Anna Tupou, a resident of four years.

The emotional hearing echoed similar meetings nearly a decade ago when San Mateo County took over the 281-bed nursing facility in 2003 at the request of the Department of Health Services. The state had put the facility into receivership because the operator faced bankruptcy and the county stepped in rather than risk patients being shipped as far away as Oregon.

The home never turned into a moneymaker for the county and in July 2011 the civil grand jury recommended the county cut ties. The county responded by hiring consultant Lawrence Funk whose December 2011 report recommending not renewing the lease for financial and safety reasons came under fire yesterday.

Mario Muzzi, who owns the building with this brother Vincent, reiterated to the board many of the points made in a 12-page letter he delivered last week to address the consultant’s report. Muzzi, who said he prefers to inform rather than advocate, said Funk is just wrong in his conclusion that the center is not physically fit.

“If the building was unsafe, they would have shut us down,” Muzzi said, referencing the state licensing process.

Muzzi also offered the board a financial carrot for a change of heart.

“If the county is considering staying, we will reduce our lease,” Muzzi said.

The offer was met with loud cheering and standing.

Vincent Muzzi also made the offer and expressed frustration at Funk’s report, in particular the figures stated about the number of Medi-Cal beds available in the county. Instead of 1,500, Muzzi said the number is actually 887.

“They are wrong and I resent that the county has not corrected it,” Muzzi said.

Members of the San Mateo County Ombudsman Office also urged the board to keep the facility open and warned of a 20 percent death rate due to moving. Even those who don’t die often lose weight, are emotionally distressed and frequently fall, said Judith Guilfoyle.

“The transfer trauma has already started,” she said.

BLTC also acts as safety net for the homeless, younger adults and the mentally ill — three populations not well served by other providers, said Executive Director Tippy Irwin.

The county has lost eight homes in the last decade and the county has half the beds per capita as the rest of the state, Irwin said.

Even opening the full 96 beds at the hospital will not be enough, leaving approximately 100 residents needing placement, she said.

Although several speakers argued the facility would benefit from full occupancy, Fraser said the opposite is actually true because, even not counting rent and utilities, it runs at a deficit in part by not pushing residents to leave when their time is up or force payments from those who do not make them. As a result, Fraser, said the county is spending $2 million in rent and another $1 million on upkeep without getting more beds or modern conditions.

“Frankly, more patients means a greater loss,” Fraser said.

Part of the financial challenge, too, is that the state charges hospital-run nursing homes more because they believe residents are receiving an increased level of care even if — as is the local case — that doesn’t happen, Ehrlich said.

The rate of Medi-Cal reimbursement was a strong theme in yesterday’s hearing, with debate remaining on just how much — or how little — the county stands to receive. A federal lawsuit currently has cuts on hold but Ehrlich said the county is still seeing the cuts enforced.

“So this is the reality we are dealing with today,” Ehrlich said.

Once the state approves the county’s transition plan, a team will go to work figuring out the necessary moves.

The assessment process will include individual evaluations by doctors, social workers and other caregivers, said Lisa Mancini, director of aging and adult services for San Mateo County.

Mancini pointed to the long lead time as a plus because nursing home beds open up sporadically and having recommendations in place ahead of time makes it more likely a resident will end up somewhere they wish to be.

“Rest assured, we will not exit Burlingame until we have an appropriate home for everybody,” Mancini said.

Michelle Durand can be reached by email: michelle@smdailyjournal.com or by phone: (650) 344-5200 ext. 102.

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Emotional end: County closing nursing home in favor of more beds at hospital

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