MONTICELLO, NY — The future of the county’s certified home health agency (CHHA) was mapped out in the third paragraph of the last page of the August 13 resolution on the transfer of the care center. 

“Sullivan County Certified Home Health Agency ownership and operation shall be transferred to any third-party operator selected by the Sunset Lake Local Development Corporation and approved by the Sullivan County Legislature.”

CHHA nurses perform home visits for nursing care, some of it complicated. They clean wounds, change catheters, help with rehab at home and make sure you’re doing okay if you got out of the hospital and aren’t back on your feet yet. 

The county’s public health department, hands full with a worsening pandemic, testified to the importance of the agency and the critical need for CHHA staff. Concerned residents and former patients spoke in support, over and over. 

And now it appears the CHHA might stay put. 

At the presentations by the three management companies hoping to win the contract for the care center, legislator Ira Steingart asked, “Is no relationship at all [between the care center and the CHHA] a killer for you wanting to take over the nursing facility?” 

“It’s not a killer for us wanting to take over the nursing facility,” said Jeremy Strauss, CEO of The Grand Healthcare System. “On one condition, that if and when... you choose to sell the CHHA, we have first right of refusal. We’ll work with the county running the CHHA, and we’ll all work together. But I can’t have it that we’re running the nursing home and, all of a sudden, you’re going to sell the CHHA to somebody else.” 

Legislators quickly clarified that the CHHA was not for sale. It sounded as though plans were shifting: Was the CHHA for lease or not? It was complicated, Steingart said, due to legal issues: If the CHHA was funneling patients to the one nursing home, what did that mean for other care homes in the county? 

“I can see a conflict of interest, of you having the CHHA when we have other nursing homes, and we’re constantly giving CHHA releases to one facility,” Steingart said. “I haven’t discussed it with my peers yet, but I want to make sure it’s not a deal-killer. I don’t think the CHHA needs help in the first place; everything I’m hearing is just great things.” 

Originally, the CHHA was included because it also needed new management, legislative chairman Rob Doherty said in an interview that took place last fall. But the revenue stream was complicated, involving Medicare and Medicaid reimbursement, and the CHHA nurses were also necessary for other work within public health. Privately run CHHAs make money because they can select higher-reimbursement or centrally located clients: good for the bottom line, but bad for those in need of care who don’t qualify. 

Perhaps the presentations on the centrality of the CHHA to public health and the emotional commenters had effected a change. Perhaps the legal issues that Steingart outlined were a factor. (Although he added that he could be overruled, so it’s not set in stone yet.) 

Still, “legislators are seriously discussing keeping the CHHA where it is and hiring a consultant to advise on its operations,” county director of communications Dan Hust confirmed on January 22.

“It is welcome news that the Sullivan County Legislature has had a change of heart about leasing with an eye to sell the Sullivan County CHHA,” said Carol Ryan, former county director of public health and member of the Health Services Advisory Board. “I can confirm that Sullivan County residents are far better served by the wonderful county public health nurses and other staff who visit their homes and provide education and care without an eye to profit. These are truly altruistic employees who serve the county residents, cradle to grave, with expertise and love.”