MONTICELLO, NY — The afflictions undermining long-term care facilities across the country—privatization, staffing shortages, dwindling subsidies—are also causing a crisis for Sullivan County’s adult care center.

Nadia Rajsz (D-2), the legislature chair, had in the past supported and voted for keeping the Sunset Lake Adult Care Center under county control. She now joins Republican legislators in wanting to hand control to the private consulting company Infinite Care—despite concerning reports of negligence and a decreased rating under its watch. 

Rajsz and Joseph Perrello (R-7), Nicholas Salomone Jr. (R-4), Amanda Ward (R-8), and Terry Blosser-Bernardo (R-9) signed a March 11 letter, on county letterhead, urging Mark Furnish, director of the NYS Department of Health (DOH), to transfer responsibility for Sunset Lake and all of its operations to Infinite Care. The state has held off on making its decision since last summer.

County manager Joshua Potosek drew up the letter urging the transfer. He said operating the care center would be an enormous financial burden on the scale of a 10 percent tax levy. 

“By maintaining the facility’s current ownership structure, the financial burden remains with the county, putting the future of the facility in jeopardy,” the letter states.

It says Infinite Care has “made remarkable advancements across crucial areas of care” that “have not yet translated into an improved overall CMS [Centers for Medicare & Medicaid Services] star rating. They have made the facility a better place to live. Given the advancements observed there can be no doubt that gaining overall operational control of the facility will allow Sunset to make even greater improvements to the care sector.”

Infinite Care has been operating the care center since 2020. The DOH must approve the certificate of need before liability for the care center can be officially transferred to the private company.

‘You should be ashamed’

Members of the Sullivan County Senior Legislative Action Committee, which advocates for loved ones residing at the adult care center, vigorously disagreed with the letter’s assessment.

“This has been a pattern going on for years where it’s gotten worse and worse and worse,” Star Hesse of Narrowsburg told legislators. “Reports have been filed and complaints have been made. And it just rolls along without anybody looking at it or doing anything about it.”

Others said they had expected more from the new legislature, which has five new members on its nine-member board.

“You were supposed to be the leaders of change,” Lise Kennedy told them.

After the meeting, Kennedy told the River Reporter through tears she’d hoped that, with a new legislature in place, she could stop coming to their meetings.

Lou Setren was equally dismissive. “Same people, different suits,” he said.

“How could you in good faith sign off on something like this when we have made every effort to make you aware of the conditions that the residents and staff face at the facility? This has become Doherty 2.0; you should be ashamed,” Setren said, referring to the controversial former legislature’s chair, Robert Doherty.

Legislator Cat Scott (D-5) said Sullivan County remains responsible for the center and its deteriorating care. She pointed to her close knowledge of the facility. “My mother was a resident for almost seven years until her death on December 6,” she said. “And I can say that my mother experienced neglect. I have photographic evidence of the neglect that my mother suffered as a result of bed sores that she had for months and months and months. Her wheelchair being caked in dirt and food. Take a look at her hair.”

She said she didn’t file a complaint with the DOH because the county is the operator of record. “If there were any findings on those, the county would be held accountable,” she said. “But at this point in time, I think the county needs to be held accountable.”

Some legislators expressed their impatience with Scott.

“I’ve heard this already from you twice,” said Perrello. “I’m sick of hearing about this.”

Perrello and Salomone said the staffing shortages affecting the quality of care are not unique to Sunset Lake.

“We’re trying to hear everybody, but we’re hearing the same thing, the same theme,” said Rajsz.

Other members of the public said they were angered by the secrecy of the legislators’ letter and asked why it wasn’t voted on publicly. “I’m disagreeing on the way the letter went,” said Luis Alvarez (D-6). “It should have been brought here in committee.”

Rajsz responded, “The letter was sent out by email for everybody to look at; five of us responded. You guys did not want to sign, correct? You knew about it. Everybody.”

“It should have been here first!” said Alvarez.

The money crunch

During the full board meeting, Christopher McCarthy, a financial auditor at the adult care center, explained why so many skilled nursing facilities are in such dire straits. Most patients in these facilities are on Medicaid. And in New York from 2012 to 2022, the federal government based its Medicaid reimbursement rates on 2007 rates. 

“There was no inflation factor built into those 2007 prices when they were established, so that means the Medicaid system has been paying you and the other 600 nursing homes in the state of New York based on 2007 prices with no inflation factor,” said McCarthy. “The first time that New York State actually built in an inflation factor was in 2023, of 7.5 percent. We know from 2007 to 2023 inflation is running around 47 percent.”

The Medicaid system in the state budget “really hasn’t accounted for inflation well,” he said. A podiatrist’s visit, for example, costs more in 2024 than it did in 2007, leaving the nursing home responsible for the shortfall.

The problem is most acute when caring for patients with Alzheimer’s and other forms of dementia, who can be difficult to place, “The Medicaid system doesn’t really reimburse the true cost of care for those patients,” said McCarthy, leading many facilities to turn them away. “And those are the patients burning out home care, individual personnel with home care, and family members trying to canvass care for someone who’s in that condition.”

An emotional exchange

Although the legislature remains ultimately responsible for the care center, the Sunset Lake LLC, run by members appointed by the legislature, has the authority to negotiate a sale and partnership contracts. The LLC was initially formed to facilitate a sale.

The legislature approved a motion by Scott to appoint legislator Matt McPhillips (D-1) to the LLC. McPhillips said the legislature should directly oversee the care center. “We want to be answerable to the people,” he said.

An emotional exchange then ensued between Scott and Elwin Wood, the LLC’s chair.

“Your staffing problems are the same thing that’s going on at Achieve and Roscoe,” Wood said, referring to other nursing homes in the county. “Staff is jumping from one place to the other. If somebody raises their price by $2 an hour. That’s where they go.”

Scott countered: “What I’m saying is that the people who are in their care deserve to have care.” She talked about residents in saturated diapers and bed linens. “They don’t deserve to be served cold food. They don’t deserve bed sores. They don’t deserve to be dehydrated.”

Wood then asked, “Why didn’t you remove your mother?”

Scott explained that her mother had dementia. “And when you moved her from one facility to the next, it took her a minimum of three months to recover, to stabilize her emotionally and mentally,” she said, as tears came into her eyes. “Thank you for bringing that up. And where was I going to bring her? For referring that my mother’s care neglect is the result of my decision. I love that.”

“Yeah,” said Wood. “The problem is there’s too many emotions in this.

Don’t sit here and tell me I don’t have experience because I’m not taking that from your experience in a system that doesn’t exist anymore.” 

“I’ll tell you right here,” Wood continued, “I don’t believe the county should be in the long term-care business.”