DUUS: Strategic Change and The Nathaniel Witherell Board

Submitted by Andy Duus, Co-Chair of the 2021 Nathaniel Witherell RFP Evaluation Committee

The current ‘debate’ in the RTM about nominees proposed by First Selectman Fred Camillo and Selectwoman Lauren Rabin to the Board of The Nathaniel Witherell (“TNW”) reminds me of the film Goundhog Day.

For several decades, we have seen studies by the BET and by the RTM and reports from consultants regarding how to improve the performance of the TNW and whether the Town should continue to own and operate this skilled nursing and rehabilitation center.

Almost three years ago, our First Selectman Fred Camillo courageously initiated a request for proposals for the outside professional management of the facility. To review the proposals, Fred established an Evaluation Committee that comprised balanced bipartisan membership. After almost a year of review and deliberation, the Committee submitted its final report in November 2021. (A copy may be found on the Town website: https://www.greenwichct.gov/2248/RFP-Management-Services-for-The-Nathanie).

Many on the Committee believed that the Town support of its elderly – via a skilled nursing facility – is very much an ethical obligation that is as necessary as other Town services.

But other Committee members observed a difference.  The Town has a natural geographic service monopoly in most of its services, including its public parks, police and fire services, and to a lesser extent its public schools (families of means have the option of private schools).

TNW is an exception. Unlike other Town services, a skilled nursing facility is a complex business operating in a highly competitive industry. Potential users of long-term care and skilled nursing/ rehab services have many options. Moreover, public ownership imposes many operating constraints, and most facilities operate at a loss. TNW is no exception; its financial burden on the Town is large and has significantly increased this past decade.  This is largely why no other town in New England (except Nantucket) owns a nursing facility.

Theoretically, the Town does not need to own and operate a skilled nursing home to assist those citizens who have limited financial resources and require skilled nursing and long-term care services. Rather than the Town owning a facility, it would be more efficient for the Town to make cash payments to those citizens and let them have the freedom to choose where to obtain these services.  

So, what are the advantages of Town-ownership of TNW?  Generally, its quality-of-care performance outcomes and the rates it charges residents and users are similar with those of comparable skilled nursing facilities. Therefore, it appears that the primary benefit of TNW for Greenwich families appears to be its geographic convenience.  This is no small benefit.

I believe that no one on the RFP Evaluation Committee wished to sell the facility and risk seeing this asset diminish in its quality-of-care or disappear from the Town. Therefore, as a creative ‘solve’, the Committee ultimately recommended – unanimously – that the Town negotiate a long-term lease of TNW with one of the responding firms that would operate the facility better than the Town could. Importantly, the Committee also recommended that any lease contain covenants that would have the Town reassume control of the facility if the lessee failed to maintain specified quality standards.  

Historically, the Board of the TNW was considered generally to be an operating board. Although all TNW Board appointments require the recommendation of the Board of Selectmen and approval by the Representative Town Committee, the TNW Board has generally been its advocates.  Therefore, when shortly before the RFP Evaluation Committee submitted its report, Town Counsel advised that the Board of TNW must concur with any strategic recommendation by the Board of Selectmen and the Representative Town Meeting regarding this Town-owned asset.  This interpretation that TNW Board is more than an operating board surprised many and could delay further consideration of a strategic initiative supported.  

At its next meeting, the RTM will consider four recommendations for the TNW Board by the Board of Selectmen.  These will be the first additions to the Board since the current TNW Board Chair, who was my former Co-Chair of the RFP Evaluation Committee, joined last year.  All are knowledgeable and accomplished individuals who will represent the Town’s interests well, and I hope would allow the TNW Board to consider the RFP Evaluation Committee’s recommendations.

Andy Duus
Co-Chair of the 2021 TNW RFP Evaluation Committee