Nursing Homes Take New Roles as Hospitals Struggle

By E.B. SOLOMONT, Staff Reporter of the Sun
April 14, 2008

As New York hospitals wrestle with cutbacks and budget constraints, nursing homes are finding a new role in treating patients who are well enough to be sent home but need additional care.

In a departure from their traditional role, nursing homes statewide in recent years have seen an influx of patients seeking short-term, rehabilitative care, as cash-strapped hospitals treat and discharge patients as quickly as possible. With increasing turnover rates at nursing homes, a number of facilities citywide are responding to the demand, taking on costly renovation projects that shrink the number of long-term beds but add space devoted to short-term care. Last week, the Margaret Tietz Nursing and Rehabilitation Center in Queens broke ground on a $3 million expansion of its rehabilitation space, part of a $14 million top-to-bottom renovation of the facility.

A $250 million renovation is in the works for the Jewish Home & Hospital Lifecare System's Upper West Side nursing home. Three weeks ago, the nursing home filed a certificate of need with the state's Department of Health to demolish two of its existing five buildings, and to construct a 150-foot "green" facility on West 106 Street.

Village Care of New York in Greenwich Village is also among those planning major changes. It recently entered the "demolition phase" of construction for a $37.5 million building on Houston Street that will have 105 beds — down from 200 — as well as 64 rehabilitation slots.

"The nursing home of the new world, we believe, is as much a health center as it is a long-term care institute," Village Care's CEO, Arthur Webb, said. In 2007, he said, Village Care admitted close to 650 patients, up from 94 in 2000. In response, he said, "We need to make sure we're turning around people, getting them rehabilitated, and back home with the proper supports."

According to a recent report by the United Hospital Fund, the number of patients entering nursing homes for short-term stays increased to 104,723 in 2006 from 67,777 in 2000. Between 1996 and 2005, the report found, the number of patients staying less than two months more than tripled, to more than 135,000 from about 39,000. At the same time, the number of long-term residents in nursing homes declined slightly, to 135,932 in 2006 from 140,970 in 2000.

"This movement toward short-term care is a response in part to financial pressures on hospitals to decrease length of stay and move patients out, and in part to decreased demand for long-term care beds, as other options have become more available for the elderly and disabled," the report's author, Thomas Dennison, a professor at Syracuse University, wrote. Still, nursing homes have not been immune to the financial pinch felt by hospitals, and 30 nursing facilities statewide have closed in the past five years.

"The city facilities are facing tremendous financial constraints," the president of the Association of Homes and Services for the Aging, Carl Young, said. "Con Ed doesn't cut them any slack just because they're not for profit." Restorations in nursing home funding in the state budget was "essential," he said, but "it's not as if anybody is going to be awash in money."

Instead, industry leaders said the move to "diversify" their services — by offering home care, day care, assisted living, and rehabilitation — reflects an attempt by some facilities to stay afloat.

"As part of the plan to rebuild, the obvious first question is how many nursing home beds do you rebuild," the president and CEO of the Jewish Home & Hospital Lifecare System, Audrey Weiner, said. While reducing the number of beds to 408 from 514, the nursing home plans to add home and day care slots. By adding those options, Ms. Weiner said, "we think we can continue to respond to the needs of the community."

For many, rehabilitation services are seen as lucrative. Administrators said they lose money on long-term residents because Medicaid reimbursement rates are low, but some said Medicare — which pays for patients getting rehabilitation therapy — pays better. While reimbursement rates vary by facility, one nursing home administrator said he earns $400 each day for rehabilitation patients, compared to $250 each day for nursing home residents.

As a result, there also has been increased competition among facilities seeking to attract and admit "good patients," or those with the most potential to be treated and discharged.

"If you don't give them an answer in half an hour, they go somewhere else," the manager of patient flow at the Rusk Institute Rehabilitation Network, Susan Finkelstein, said. The network was formed in 2006 as a partnership between the Rusk Institute of Rehabilitation Medicine and seven nursing homes and rehabilitation centers citywide, including Margaret Tietz.

As in the case of Village Care, high turnover rate is driving changes at Margaret Tietz, which was founded in 1971 as a nursing home for Holocaust survivors. In 2007, the center admitted 921 patients, up from 60 in 1997, the center's director, Gerald Hart, said. "The consumers in 2008 are not the consumers of 2000, are not the consumers of 1995," he said. "Our goal is to get people here, get them healthy, and get them back home."