Submitted by Bill Drake, Harry Fisher and Bob Barolak
Today, Greenwich has an opportunity to preserve and improve The Nathaniel Witherell (TNW) for years to come.
Cost overruns and large taxpayer burden. Bringing professional management to the Witherell has been under consideration for 18 years. In 2004, a Special Committee of the Representative Town Meeting concluded that the Witherell should not be a department of Town government.
The RTM did not approve the recommendations of its Committee, a decision which proved to be very expensive. During 2011-2012, the Witherell’s financial plans provided to the RTM forecast a subsidy from the Town of $1,200,000 annually. Over the subsequent eleven years 2013-2023, the actual Town subsidy has been $33,754,546, or over $20 million greater than what the RTM expected. Supporting the Witherell has been our Town’s biggest cost overrun.
Recent challenges. The Witherell has failed to collect its revenues properly. Amounts due but uncollected have grown from $4.4 million at June 30, 2021 to $9.6 million at June 20, 2022 and are over $11.0 million at present. Simultaneously, the Witherell is having difficulty filling important job openings. “Somebody has to do this job, and it’s not like there’s a long line out the door. It’s a very difficult job,” said Board Chairman Larry Simon recently. More alarming, the Witherell was cited for 16 health deficiencies in its 2022 inspection by the federal Center for Medicare and Medicaid (CMS), the primary oversight agency for nursing homes. Examples: failure to honor the resident’s right to a dignified existence, failure to keep proper records, failure to maintain a safe, clean environment, abuse of one resident by another, failure to report suspected abuse or neglect, failure to provide for resident’s immediate needs within 48 hours, failure to develop a complete care plan within 7 days of assessment, failure to provide basic life support including CPR, failure to provide appropriate care, accident hazards leading to laceration and femur fracture, failure to provide enough food/fluids, failure to provide dialysis, failure to properly store medications, failure to provide food to professional standards, and failure to manage vaccinations. As a result of this inspection, Witherell’s overall rating by CMS was downgraded from 3 stars to 1, the lowest rating. It was 5 stars in 2020.
A poor fit within Town government. Not one of Connecticut’s 169 municipalities find nursing home services to be a proper task for town government. Greenwich and TNW suffer from the decision of Witherell’s founders in 1903 to make it a town department. In contrast, Greenwich Hospital was formed the same year without government involvement. Although both institutions were founded as general hospitals, private ownership has brought extraordinary capabilities, extensive facilities, more advanced care, and hundreds of excellent doctors to Greenwich Hospital. In contrast, under municipal ownership, the Witherell is failing to deliver excellent care and is a financial burden on the taxpayers.
Bringing professional management to the Witherell. In October 2020, at the instigation of the office of First Selectman Fred Camillo, the Town invited “proposals from qualified firms…to assume the management in conjunction with the possible …..lease of the assets of The Nathaniel Witherell…The Town’s objectives are to achieve a high quality level of care, to serve the interests of both residents of TNW and residents of Greenwich, to achieve financial stability and independence of TNW, to bring to an end the need for the Town’s General Fund to provide financial support to TNW and to maximize the proceeds to the town in a sale or lease transaction.” Many responses were received, and narrowed to four good candidates which made final, detailed proposals to lease and manage the Witherell.
Allaire Health Services was judged to be the clear preference by those evaluating the proposals. Allaire’s final proposal is expected to improve organizational performance and in particular clinical quality. Allaire operates seven nursing homes in the Northeast. Allaire has a proven track record of improving nursing homes which were previously owned by municipalities, similar to the Witherell. The proposed lease with Allaire provides for lease payments to the Town which build a strong incentive toward higher quality of care. Allaire commits to maintaining clinical quality at no less than a 3-star level and anticipates quality being at a 5-star level. Allaire also commits to making needed capital investments while eliminating the Town subsidy.
The Allaire lease is very advantageous to the Town. The savings to the Town are expected to be over $27 million over the next 15 years, in addition to the lease rent payments. These savings include property taxes collected and reduction in the Town’s cost of pensions, insurance and management support.
Witherell deserves better and Greenwich deserves better. The millions in public funds spent to cover the Witherell’s perennial deficits are better allocated to the proper functions of our Town such as public schools. Witherell’s quality must be brought back to high standards. If it is to provide excellent care, Witherell needs to be managed by experienced, knowledgeable nursing home professionals.
Harry Fisher and Bill Drake are members of Greenwich’s Board of Estimate and Taxation. Bob Barolak and Mr. Drake were members of the Committee which evaluated the proposals to manage the Witherell. The views expressed are the authors’.
A public hearing on the Witherell is scheduled December 15 at 4:00pm, by zoom.