MONTICELLO, NY — The requests for proposals (RFPs) are being prepared. There’s a general timeline in place. The role of outside counsel was discussed.

Wednesday, September 30’s meeting of the LDC for the Care Center at Sunset Lake and Certified Home Health Agency (CHHA) demonstrated the progress the board has made in its first month of life. It also showed where there are still areas of disagreement.

So, read on for a summary, by topic:

The CHHA

Legislator and board member Nadia Rajsz asked why outsourcing management of the CHHA is necessary. The county’s certified home health agency (which is part of the department of public health) was added on to the August 13 vote to begin the process of leasing the care center; it has been a controversial point ever since.

Both nursing homes and home health care are going to go through significant changes in the post-COVID-19 era, LDC chair Lowell Feldman said. Survival means caring for rehab patients or short-term residents who need care. Facilities receive higher reimbursement for these patients.  And “home health care is going to be caring for a different clientele,” Feldman said. 

Another concern for nursing homes is that they may need more space to accommodate patients with COVID-19. CDC guidance suggests “a dedicated floor, unit, or wing in the facility or a group of rooms at the end of the unit that will be used to cohort residents with COVID-19.” Transferring patients to another facility owned (or managed) by the same company would also be an option. 

The RFPs

The RFPs will be sent out soon and there was considerable discussion about what should go into them. Both Feldman and county attorney Michael McGuire stressed putting out a “broad-spectrum RFP,” as Feldman put it, a wide net to catch as much interest as possible. 

Discussion bounced back a few times over the course of the meeting to what should be in them and whether specifics could turn off applicants. 

Board member Bill Chellis argued for making sure the RFPs required prioritizing county residents.

“You’re going to have a problem doing that,” said McGuire. An operator will want to concentrate on filling the beds, to stay solvent. “You may scare away some operators.” He suggested that a number of beds be reserved for county residents, if the others are already filled. This would be put into the contract, not the RFP. 

Nadia Rajsz suggested that prioritizing county residents be made a qualifier in the RFP. 

The members discussed whether this should come up in the RFP, during the interview, or in the contract. Would a prioritization for county residents in the RFP limit the applicant pool?  Albee Bockman asked if this had ever been an issue; Feldman thought it could be, but didn’t “think it would be a major deterrent.” He pointed out that these days “the census of most facilities is nowhere near capacity.” 

Any official bidders yet?

No. 

Outside counsel

This won’t be needed until the RFPs are in, McGuire said. Then “we’ve got some real heavy lifting to do.”  They would work “on contracts, do the closing and transfer.” 

Application fees

A non-refundable application fee of $150,000 was discussed; a large fee would weed out candidates with limited resources.

Such a fee would also discourage smaller operators or not-for-profits, Chellis said. “I’m not inclined to entertain the idea of a franchise” in a chain of nursing homes. 

 “The likelihood of an undercapitalized entity is that they would fail,” said McGuire. “You don’t want a big-box situation; you do want someone who is proven in the field.”  He added that start-up costs would be higher than $150k

A refundable fee of $100,000 was approved.

The timeline

Something everyone wants to know, whether you offer directors and officers insurance or you work at the care center. There was a bit of discussion, and COVID-19-related restrictions would limit tours of the building, complicating matters further. The board considered virtual tours, and schematics of the building are available.

But a timeline of sorts can be assumed. RFPs go out soon, applicants have time to read them over and ask questions. If the county responses to questions went out by Thursday, November 5, applications would be due Friday, November 20—less ominous than Friday the 13th, one deadline up for consideration.