MONTICELLO, NY — The podiatrist had not visited the adult care center in months. As a result, one resident had to wear a larger-size shoe on one foot to accommodate their untrimmed toenails. 

Another resident reported being in pain for similarly unkempt toenails.

“I’m getting feedback from residents and families about services that aren’t being provided,” said District 5 legislator Cat Scott at last week’s Sullivan County Legislature meeting. “It’s a dignity issue.”

She said staffing shortages at the Care Center at Sunset Lake, the county-owned skilled nursing facility, mean that patients are not being dressed or changed, and that their beds are not being made. She said she has the photographs to prove it. 

“This is a public facility, and Sullivan County still holds the Certificate of Need,” said Scott.

The delay has confused the issue of who is accountable for the day-to-day operations of the facility. Meanwhile, resident care is falling between the cracks.

Scott is also a member of the Sunset Lake Local Development Corporation (LDC).

From four stars to one

The NYS Department of Health issues a Certificate of Need whenever health care facilities in the state are built, acquired, or expanded. They regulate developers and purchasers to ensure their plans fulfill the community’s needs.

Sullivan County owned the adult care center until 2021, when the previous legislature agreed to sell the building and transfer ownership and all operations to Infinite Care, a private company. Since October 2021, when Infinite Care took over operations, the care center has gone from a four-star to a one-star rating, according to medicare.gov. 

The transfer of the Certificate of Need from the county to Infinite Care has been delayed multiple times. In late August 2023, the health department and NYS Public Health and Health Planning Council (PHHPC) deferred the decision to its November meeting. That meeting was also postponed. 

“According to our rules of the legislature, this committee has oversight of the division which includes the adult care center,” said Scott, “and at this time I don’t feel like there is any oversight that is occurring, which I find highly problematic.”

She said it was unfair to ask questions of the county health commissioner, John Liddle, that he doesn’t have the answers to.

“That’s why I want the administrator here to answer questions,” she said.

Scott said she has asked the Sunset Lake director, Infinite Care CEO Sal Klein, to attend legislature meetings to answer questions. But, at a recent working session, Klein and the regional director of operations refused.

“They said they don’t want to come to meetings because they don’t want to be bashed or listen to accusations,” said Scott. “And they cannot make their administration, meaning their director or administrator of nursing, come to these meetings.”

Liddle confirmed that these employees are technically county employees, but they also report to Infinite Care.

Scott countered, “If I requested a department head to come, a county employee, and that was refused, would there be a consequence for that?” 

There was a pause.

Officials then jumped in — District 3 legislator Brian McPhillips, assistant county manager Michelle Huck, deputy county attorney Thomas Cawley, and legislature chair Nadia Rajsz  — to urge that conversations about personnel and private medical situations not be discussed publicly.

Care erodes even as the county pays and pays

Another problem, as Scott discovered, is that Infinite Care is not reimbursing the county, as it is obliged to do.

“We are paying all the bills now?” she asked. 

“Correct,” said the county manager, Joshua Potosek.

“So Infinite Care reimburses us?” Scott asked.

“That’s the way based on the contract...is structured,” said Potosek.

“Has that occurred?” Scott asked.

“No,” Potosek answered.

If the county were to operate the care center, it would cost around $7 million, Potosek said. He estimated it would amount to a roughly 10 percent tax increase.

As it stands now, Sullivan County is footing the bill.

Before the meeting ended, Scott stated clearly she opposes the contract that hands operations over to Infinite Care. The county is permitted to end the contract with Infinite Care with 30 days’ notice. 

Rajsz asked the legislators to stick around to speak with county lawyers. Deputy county attorney Tom Cawley said his office could privately advise the legislature about what they can and cannot say publicly about the performance of Infinite Care and other county personnel.

Elwin Wood, chair of the Sunset Lake Local Development Corporation (LDC), announced that its next meeting will be held at 1 p.m. on Thursday, March 21, in the legislative hearing room of the Sullivan County Government Center in Monticello (see sidebar for 2024 meeting schedule).