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‘Saving Claremont’: Can a citizens group thwart the sale of a Cumberland County nursing home?

Patriot-News - 6/1/2021

For nearly 200 years, Cumberland County has run its own nursing home. Once commonly referred to as “the poorhouse,” it was a place for the county’s older citizens to be taken care of in their waning years.

But a lot has changed since then, and the original mission of county-owned nursing homes has been waning, as well.

The Claremont Nursing and Rehabilitation Center has grown beyond its poorhouse days and is a full-fledged, skilled nursing facility with even more offerings, but it still has about 80 percent “Medicaid beds” – an industry term for space for low-income senior citizens due to their reliance on the Medicaid program.

Now, with Cumberland County on a track to sell Claremont this summer, a citizens’ group has come forward, opposing the sale. Or at least asking the commissioners to look at alternatives. This brings up two big questions.

Does the county still have a moral obligation to maintain a nursing home?

And can Cumberland County afford to keep Claremont, which is located in Middlesex Township?

Signs popping up around Cumberland County seem to say “yes” to both.

Anyone driving around the county may have seen the 500 or so signs put up by the Citizens Saving Claremont group: “Keep Claremont in County Hands. Pause the Plan.”

But two of the three Cumberland County commissioners say “no” on both counts. Modern, financial realities and the ever-changing landscape of healthcare are making them take another look at the Claremont Nursing and Rehabilitation Center and whether or not the government should be in the nursing-home business.

But the members of Citizens Saving Claremont are arguing the county not only can keep Claremont afloat, but with some effort, investment and leadership, they can make it thrive.

“It has been sustained for 192 years,” said Tim Potts, one of the founding members of Citizens Saving Claremont. “This year, 2021, is the first year that we’ve had to use county money to support Claremont, and that’s only on a temporary basis because of the impact of COVID.”

They’re asking the county commissioners to at least “pause the plan” to sell Claremont, as the sign says, and look at some alternatives.

But that doesn’t change the fact that Claremont is hemorrhaging money, Cumberland County Commissioner Gary Eichelberger said. Projections show it will only get worse and will have to be propped up by taxpayer dollars.

And the completion of a sales agreement could be just days away.

Claremont

Claremont is a 282-bed, skilled nursing facility, offering state-of-the-art therapeutic care for a variety of needs. Claremont provides “transitional care and a full-time rehabilitation center and dementia unit,” according to its website.

It was established in 1829, offering a place for people to go when they’re older. Between the years 1967 to 1997, its name was changed to Cumberland County Nursing Home. In 1997, the name changed to the Claremont Nursing and Rehabilitation Center as it moved into the new era of nursing homes.

As is the nature of nursing homes, the number and demographics of Claremont’s residents change frequently, though the home is far below its capacity. As of April, this was the breakdown of those living at Claremont:

Sex:

Ethnic Groups:

County of Origin:

Cumberland County spokeswoman Samantha Krepps explained that to live at Claremont, residents must qualify for nursing-facility services as defined by the Medical Assistance and Medicare guidelines. Claremont offers equal housing opportunity and accepts admissions without regard to race, color, national origin, ancestry, sex, age, or religious affiliation.

Admission is not limited to residents of Cumberland County, she said.

Cumberland County commissioners are currently negotiating with Allaire Health Services for a potential sale.

But the Citizens Saving Claremont group is asking them to “pause the plan” and look at some alternatives to keep the home in county hands, arguing they can afford it.

Can the county afford to keep Claremont?

Cumberland County officials point out that, years ago, the home had been financially self-sustaining, operating with funds from Medicare and Medicaid, as well as whatever revenue it may earn on its own.

But Medicaid rates have been flat since 2014, and the home has been losing money for about a decade, dwindling the reserves it had built up. It has now gotten to the point of wiping out the home’s reserves with a projected $2.6 million shortfall for 2021. County commissioners say that money has to come from somewhere — taxpayer dollars.

It’s already started. Cumberland County Commissioner Gary Eichelberger said the county has spent $1.3 million this year in taxpayer money to support the home.

Projections show the shortfall will only grow more and more.

“It’s been a jagged line in a downward trend for a long time,” Eichelberger said. Claremont was an issue that came before all five iterations of the board of commissioners he had been a part of for the last 20 years, he said, and a state study conducted on the county’s finances a few years back even highlighted the potential sale of Claremont as an option that should be seriously considered.

“No one should be taken by surprise,” Eichelberger said. “We knew this day was coming.”

While the county’s numbers show a drastic shortfall, Potts argues that it’s due to the pandemic, which hit nursing homes particularly hard. The home lost $1.9 million due to the pandemic and, without that, Claremont would have operated at a profit instead of taking a loss last year, he said, citing county numbers.

The county should at least wait until after the pandemic and see what the financial landscape looks like then, Potts said.

Beyond that, Potts points out the county will be receiving an infusion of $50 million in federal COVID-19 relief from the American Rescue Plan, a portion of which can be used to help replenish Claremont’s reserves.

“That’s what they’re for,” Potts said about the funds. “To make government entities whole from the effects of COVID so that there is no local tax impact.”

He agrees with the commissioners that the reserves will continue to dwindle if things are left as is, but that’s where they need to “exert their leadership to solve the problems and restore Claremont to a ‘profitable’ status,” Potts said.

That would also give Claremont time to rebuild its financial health, implement a marketing plan and get back on its feet.

Even without the American Rescue Plan money, covering the shortfall would require a tax increase of about $20 per year per homeowner, Potts said, citing a county number of what it would take to raise $2.6 million again next year.

“That’s one Hershey bar per month,” Potts said – a small price to pay to keep the home in the county’s hands and in county control.

Eichelberger, however, said many efforts have been made over the years to bolster Claremont, but several management teams, outside analysts and a “small army of CPAs” all say the county cannot afford to keep Claremont.

While the county might be receiving $50 million in federal funds for the American Rescue Plan, he said it’s not yet known what the restrictions are on the use of those funds. The county might not even be able to use that money to support Claremont.

“I don’t think it will be carte blanche to subsidize a broken business model,” Eichelberger said. “Some people’s approach to government money is to spend what you got when you got it. That’s not how we do it here in Cumberland County. That’s why we’re as strong as we are.”

He also disputes Potts’ $20 tax-increase figure, calling it “highly speculative.” It relies on the costs at Claremont staying stagnant, which won’t be the case in years beyond this year.

Keeping Claremont would amount to propping up a virtually bankrupt facility with taxpayer dollars, Eichelberger argues.

Is there a moral obligation?

Eichelberger said Cumberland County isn’t going to sell to just anybody. The goal is to find the company that is the best fit for Claremont – one that will deliver the best care to residents and provide the best opportunities for the employees, he said.

“Keeping Claremont as a Medicaid-friendly facility is a top priority of our approach to the negotiation, and Allaire has indicated that they do not see the facility changing in any major way in that regard,” Eichelberger said. “While we cannot simply require that a fixed percentage [of Medicaid beds] be maintained 100% of the time, in perpetuity, we do not see that the standard of meeting local community need changing over the long term. In addition, we have worked to include some safeguards, where able, to see that our goal is met.”

Though it has been more than six months since the county put out a request for proposals from potential buyers, Commissioner Vince DiFilippo said the commissioners have been talking about a potential sale for a long time.

“When I first came into office here over five years ago, there was talk then about potentially selling the nursing home. This is not a knee-jerk reaction,” DiFilippo said. As a new commissioner, he wondered at first why selling the home would even be considered. Now, he sees it differently.

“It’s no longer ‘the poorhouse,’ Medicaid rates are stagnant, costs continue to go up, we can’t compete with the wages private nursing homes offer. That’s part of the reason I think this is the best thing to do,” DiFilippo added.

But opponents said they do not believe whoever takes over the home will provide the same quality of care as the county.

Mark Price, a member of the Citizens Saving Claremont group and a Carlisle-based economist, added the people of Cumberland County deserve a quality place for long-term care, “And the sale of Claremont will push us to the point where half the beds [in Cumberland County] are low-quality beds.”

He defines low-quality beds as living space for seniors in homes with a Medicare rating of 2 stars or less or that have been flagged for abuse. He said right now, 41% of the nursing-home beds in Cumberland County are low-quality beds. The sale of Claremont would potentially leave the county with 55 percent low-quality beds, should Claremont’s rating drop from its current 3 stars.

According to Medicare’s Nursing Home Compare, his 41 percent figure is an accurate statistic. Of Cumberland County’s 17 nursing homes, seven have Medicare ratings of one or two stars.

Private, for-profit providers often have much lower Medicare ratings, Price said, noting that this is the case in Cumberland County. The seven for-profit homes all had 1- or 2-star ratings while the 10 non-profit and public homes, including Claremont, had included four 5-star ratings, three 4-star ratings, two 3-star ratings and one 2-star rating.

“That is a bond between generations,” said former county commissioner Rick Rovegno, who has been active with the Saving Claremont group. “We need to have a facility that provides our neighbors of less fortunate means with a place where they can be assured of care.”

Two of the three county commissioners do not agree.

“The idea that the quality of care is definitely going to suffer is part of the false narrative,” Eichelberger said. “We’ve been working hard to make sure we pick an operator that is capable of caring for the people of Claremont in a challenging environment.”

He added it’s unfair to use the rating system to say the quality of care would go down. Oftentimes, companies buy nursing homes that are struggling, and it takes time to build them back up to a quality home, he said, adding, “To blame the new owner is an abuse of numbers and facts.”

DiFilippo said today’s nursing homes, including Claremont, are more like medical centers and not the “poorhouses” they were once known as. It takes expertise to run them well.

“In my opinion, to save Claremont, we need to get it under new ownership to do that for the long run,” DiFilippo said. “Some people are afraid if the county sells Claremont, we’ll have no place to go when we get old. That’s not true. This notion that if you sell it to a private, for-profit entity, the sky will automatically fall down is not true, either.”

One commissioner opposes the sale

If Cumberland County Commissioner Jean Foschi, who took office in January 2020, were to vote on a sale right now, her vote would be “no,” she said.

While attending county meetings during her campaign and in her early days on the board of commissioners, she knew Claremont was facing financial problems. While she agrees something has to be done, she’s not ready to sell – yet.

Other options should be explored first, Foschi said.

“This bothers me tremendously. There are people in the community saying, ‘Don’t do this.’ No one calls me and tells me ‘selling this is a great idea,’” she said. “As an elected official, it’s my personal belief that it’s my duty to be the voice of the people, and they’re saying, ‘please explore other options.’”

But it’s not going to be easy. She said the commissioners need to do a better job of presenting the facts and the other options to the public, and those facts don’t add up well for Claremont.

It would help the community to know that bolstering Claremont may be a $20 tax increase for the owner of a $200,000 home now, but that amount will increase substantially in the coming years and the costs will continue to increase, she said.

“We’re on track to be $8 million in the red this year unless something changes drastically,” she said. “That’s a reality.”

She would like to look at other options and said she knows any recovery efforts for Claremont would be a heavy lift. She hopes if that can happen that the Citizens Saving Claremont group would help with those efforts.

Many counties have sold their nursing homes

According to the Pennsylvania Department of Health, there are currently 20 nursing homes owned by counties. In 2002, there were 41. Since then, 20 have been sold and one closed.

Next door, Adams County sold its nursing home about a decade ago.

Vicki Huffaker, executive director of the non-profit Adams County Office of Aging, has seen no decrease in the quality of care since the for-profit company, Transitions, took over. In fact, they’ve grown, adding an adult daycare to the facility.

“I’ve never had an issue with them,” she said.

Transitions had been in the running to buy Claremont but dropped out April 15. But in Adams County, Huffaker’s agency works closely with all nursing homes, which includes four for-profit homes and two non-profits, and all offer quality care to their residents, she said.

At the former county home, specifically, she recalls no reports of abuse or neglect from the residents to their ombudsman and recalls no call for protective service workers.

“I know their social work staff, administrator and director of nursing, and we have a good relationship with them,” she said.

Before selling their nursing home, Adam County had been in a situation to that of Cumberland County of trying to keep it afloat, and she said counties are generally not in the business of running them.

“When you have a company that knows how to do it and knows how to do it right, it’s probably more of a benefit,” she said.

Of course, nursing homes can get lost in the shuffle with bigger corporations, she noted.

Running a nursing home is a challenge, no matter who you are, said Pennsylvania Health Care Association CEO and President Zach Shamberg.

“Private sector providers have purchased county homes and instituted stability to the operating environment, the staffing situation and, most importantly, the continuity of care for residents,” he said. “To be clear: operating a nursing home is not easy, especially if an operator’s specialty or expertise is not senior care. In many cases, for-profit and nonprofit providers have a wider network and are positioned to have all of the necessary resources and skill at their disposal. That ultimately leads to higher quality care for residents.”

But the association has no position on the type of ownership – county, for-profit and non-profit. They have members from all of these entities and they all face the same challenges.

Since Medicaid rates have been flat since at least 2014, he said “Financial stability isn’t just a county nursing home concern – it is an industry-wide concern.”

He noted, “This is a larger issue than just the sale of one county home. Why are longtime Pennsylvania providers – counties included – being forced to consider selling their nursing homes? It’s a simple equation: inadequate Medicaid reimbursement, coupled with an existing workforce crisis, a volatile legal climate and a burdensome regulatory climate, has forced providers to reorganize, change ownership or sell their operations altogether.”

What about Claremont?

Though a sale seems likely this summer, the Citizens Saving Claremont group continues to urge the commissioners to save the home that has been here for nearly 200 years.

They have presented a letter with 30 county physicians requesting a “pause” in the plan to allow for better public understanding of what is at stake.

They are proposing a pause until 2023, saying given the county’s financial reserves and incoming COVID-19 relief funds, there is no urgency to sell it this summer. They are asking for a task force that includes citizens to look at the alternatives to a sale. Those alternatives include keeping the facility in county hands but leasing out operations and expanding operations to bring in new revenue.

But Eichelberger said various alternatives have been tried and explored over the years.

No major obstacles have been encountered in negotiating with Allaire, Eichelberger said, adding that the finalization of a sales agreement could be days away.

Once the agreement is reached, it would still be a few months before the real estate transaction is completed, Eichelberger noted.

The county is providing information on the sale process on its website.

Citizens Saving Claremont posted some of their findings on the group’s Facebook page.

©2021 Advance Local Media LLC. Visit pennlive.com. Distributed by Tribune Content Agency, LLC.

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