MONTICELLO, NY — A pre-scheduled discussion about the Care Center at Sunset Lake turned timely as the news broke of a COVID outbreak in the facility.

Sullivan County owns the assisted living facility, and hired management consultant Infinite Care to run the facility in 2021. Infinite Care regional director of operations Katie Perez appeared before the Sullivan County Legislature via Zoom on February 16; she was there at the legislature’s request to provide an update on the care center’s operations.

Perez testified to Infinite Care’s efforts to hire additional staff. Over 2022 and into 2023, it retained 94 staff out of 134 total hires, and instituted measures to build morale in the facility.

The care center had seen a dip in its quality measures; there were indications of concern in eight or nine areas. But the care center had seen its star ratings, given by the Centers for Medicare and Medicaid Services, generally increase, and other measures were positive as well, said Perez. “We hadn’t had a survey in three years, [and recently] we had a survey. It went well: we had no harm; we had a few deficiencies in specific areas but they were isolated incidents.”

Legislators pressed Perez about the staffing levels at the facility. “We have people coming to us and talking to us about their loved ones and the care in units when there’s 30 people in a unit,” said legislator Joe Perrello. “They’re saying there’s only two people working in a unit, maybe three—how do three people take care of 30 during dinner [and] bedtime?”

“When people are working on systems and know how to take care of residents in a systematic way… there are ways to do this,” said Perez; other people were in the building beyond the two or three listed who could help. “I’m not gonna say every day is perfect, but we have increased our staffing levels in the facility by a lot more than that were there when we first came.”

The staffing at the facility didn’t keep up with the needs of residents, Catherine Scott, a representative of the care center’s family council, told the legislature at a later meeting. Multiple shifts had seen one certified nursing assistant take care of 35 plus residents; while other members of staff were there to assist, their training and their roles limited what they could do, said Scott.

Perez didn’t have specific information about the ratios of staff to patients in the facility. Nor did she have information about the care center’s financials, a recurring request from the Sullivan County Legislature. The legislature discussed meeting with Sol Klein, managing partner of Infinite Care, to discuss that information.

COVID at the care center

Perez additionally provided legislators with an update on a COVID-19 outbreak at the facility.

Earlier in the week, the care center had reported 20-plus residents testing positive for COVID. As of February 16, 28 residents and four employees tested positive with COVID, said Perez. Four of the 28 were scheduled to come off the positive list on February 17, and six staff members had come off as of February 16.

Legislator Nadia Rajsz asked what impact the COVID outbreak had had on the facility’s staffing. What precautions were taken?

The facility was in contact with the Department of Health epidemiologist, and a virtual walkthrough on February 14 resulted in a few recommendations but overall “they felt like we handled everything the best that we could handle it.”  

The last test date for this outbreak should be March 1, barring any more positive tests, said Perez. When asked if the care center was using rapid tests or PCRs, Perez said it was using rapids, with some PCR follow-up.

Scott raised concerns with the facility’s protocols at the later meeting; her mother (a resident at the facility) had tested positive for COVID, and besides issues with her care the experience exposed, she’d had to push the facility to use a PCR test. “We had gotten a text on the previous Monday [February 6] that they had two cases, then on Wednesday they had four. I was in that building on Wednesday, and I will say that the infection control procedures were not adequate.”

Zero-waste discussed

The legislature also held a public hearing to solicit public input on ways to more sustainably treat the county’s trash.

“We do have some time to do this right, and I’m here to urge you to pursue a zero-waste approach,” said Rebekah Creshkoff, a Sullivan County resident and volunteer for Beyond Plastics.

Zero waste as a policy goal covers the entire process of creating, using and ultimately disposing of goods. It conserves resources through responsible production, consumption, re-use and recovery of materials, said Creshkoff. “It’s about culture change, shifting from a linear economy to a circular one. Yes, that’s bigger than Sullivan County, but other communities are moving in this direction too.”

Zero waste still requires a landfill at the end of its process, one that ideally would be in or close to the county. Creshkoff recommended that the county look into a regional approach, possibly by partnering with Ulster County.

Legislative chair Rob Doherty agreed; if the county reduced the amount of waste it produced, it could keep that waste local without having to ship it out of the area.

Click here for more information on Sullivan County's thoughts on its garbage.