Recently The Nathaniel Witherell, the town-owned 202 bed skilled nursing home on Parsonage Road, lost its coveted 5-star rating from CMS.
CMS is short for Centers for Medicare & Medicaid Services. It is part of the US Dept of Health and Human Services.
CMS created the five-star quality rating system to help consumers, families, and caregivers compare nursing homes.
Today, the Nathaniel Witherell has a 3-star rating.
It’s been a rough year for all nursing homes due to the pandemic.
Like private nursing homes, the census at the Witherell dipped significantly during the pandemic.
But other nursing homes retained their 5-star rating. Waveny in New Canaan has a 5 star rating. Edgehill has 5 stars. The Osborn in Rye, NY has 5 stars.
After years of operating at a loss, in November 2020 the town issued an Request for Proposal for Management Services for the Nathaniel Witherell for possible purchase or lease of the facility.
With the Witherell being prepared for sale or for a new operator, executive director, John Mastronardi, made some staff cuts.
The facility also grappled with a reluctance of staff to get vaccinated.
Members of the Witherell’s Family Council complained about a series of Covid lockdowns that left their loved ones isolated.
Family members also called into the First Selectman’s radio show on WGCH to complain.
In the community, an “Isolation Kills” rally in March was attended by many, including Witherell families.
At the end of March, Witherell executive director John Mastronardi said just 38.8% of Witherell staff had been vaccinated. Still vaccines remained voluntary.
In May, Mastronardi provided a statement to GFP saying, “a mandate could have a negative impact on our staffing levels, and could spur legal action.”
Ultimately Governor Lamont issued Executive Order No. 13B on Aug 6, 2021 mandating vaccination of all employees working at long-term care facilities in Connecticut.
Fast forward to November 2021.
With the drop in the Witherell’s 5-star rating fresh, the board of directors, including BET liaisons, met via Zoom on Nov 15.
Feedback was favorable toward management.
“You’re in the trenches every day, you’re doing touch duty. Especially this past year …my hats off to you guys,” said BET liaison, Andy Duus.
Beth Krumeich, the other BET liaison, said she was thrilled at the work done in the previous two years under both Masatronardi and Simon’s leadership. “We continue to have an amazing facility. It may have lost a star or two, but it’s still an outstanding facility.”
It was noted the Witherell’s Covid Vaccination rates are now quite high.
Also, as of the Nov 15 meeting, there were no positive cases of Covid among staff or residents at the facility.
Staff and visitors wear masks at all times.
Reached by phone, Larry Simon, who has been the chair of the board of directors at the Witherell for six years, said some of the reasons for star ratings changes are more important than others.
“We had 11 inspections last summer during the worst of Covid. One of the reasons we lost a rating was that our masks weren’t fitted properly. We learned how to do that better.”
He said mask fittings were a fixable problem and did not indicate poor care.
Mr. Simon said last summer was chaotic during Covid, and the entire staff was learning how to use PPE and gowning.
“These things go away. They’re always moving averages. The mask fitting will disappear in the next inspection,” he said. “Things that take longer to go away – things that are more damaging to me – are patient neglect, improper medication, bedsores, failure to treat, and falls. Those are things that are really a sign of bad nursing.”
In a statement via the Witherell’s public relations agency, director John Mastronardi elaborated on the PPE fittings.
He said, per inspections, signage within the facility from one unit to another and numbers of “fit tests” of N-95 masks were deemed insufficient.
“At the time, because of severe supply chain issues, fit-test kits were hard to come by. However, all of that has now been remedied,” he said.
On another positive note, Mastronardi added that, for the first time in nine years, the Witherell was operating in the black.
“We have exceeded our revenue budget by $308,306 in the fiscal year to date. At the Witherell, we continue to provide the finest in senior care to our treasured residents, at our state-of-the art campus in Greenwich,” he added.
By email Greenwich First Selectman Fred Camillo said that he was disappointed the five star rating had dropped, but hoped it would be a temporary setback.
“Overall, I can’t speak highly enough of the job (Mastronardi) and his team have done stabilizing the finances of the facility, getting staff vaccinated, and working on his initiatives in very trying times,” Camillo said. “I have confidence that the current management will work hard to get back up to the five star rating we are accustomed to seeing.”
Family Council member Sheilah Smith, said not so fast.
“This national rating system was developed to help residents in need of long term care chose among nursing homes. Many draw a line in the sand below 4 stars, so three stars is unacceptable. In addition, the cuts the Town recently made to the Witherell budget mean that this rating could go down even lower than 3 stars when Witherell is evaluated again next year.”
Further, she said she was troubled by the 2-star rating in the area of Health Inspections and the lapses cited by the government report in infectious disease control. “All of which were avoidable,” she said.
Ms Smith said she was concerned about the Witherell’s preparedness for new Covid variants and other diseases.
“As recently as Mothers Day, there was a GI outbreak that sickened 38 residents, but went unreported to the authorities for several months,” she added. “The slashing of the star rating happened under a new management team that was put in place by the Witherell Board of Directors in early 2020.”
Ms Smith said the Nathaniel Witherell must develop a new plan immediately to bring back the town-owned nursing home to a 5 star rating.
“I know from my experience as co-chair of the Witherell Family Council, that many family members are reluctant to comment on these matters out of fear of retaliation by the facility, in particular by management,” she added.
“The politicians can window dress this all they want. However, remember that 80 Witherell residents got Covid and another 17 died of Covid at the time when Witherell had multiple citations for improper infection control measures, including failure to use available PPE,” Smith continued.
(Covid deaths are reported by the CT Dept of Health down to Greenwich)
“More serious responses are needed in the discussion of how or even if Witherell leadership plans to restore the 5-star rating,” Smith added.
Mr. Simon explained that with 180 patients and 242 staff, and turnover of both, there was a lot of work, especially during the pandemic.
“I’m not making any excuses for anybody,” he said. “The board looks at the stars, and overall the Nathaniel Witherell has a very good reputation for nursing care.”
He also said the fate of the Witherell was in the First Selectman’s hands, but that he was optimistic because many efficiencies had been found. Further, he noted that RFPs had been issued for a new pharmacy, therapy and food service.
“I think we have found a formula to make money and be a five star facility,” he said. “If you go to a one or two star facility it’s really depressing, but there are a lot of facilities like that. You make more money by having lower costs.”
“We have sent a recommendation to (Camillo) based on responses to the RFP. The motivation for the RFP came from a lot of people on the RTM who said it cost the town too much, but if we’re making money, and more money than any of the respondents (to the RFP) would give us, there’s no interest in getting rid of the Witherell.”
Family Council co-chair Amy Badini said throughout the pandemic, CNAs and nursing staff were amazing, but the loss of family caregivers was impossible to put a price on.
“The national legislation – the Essential Caregiver’s Act – recognizes that the loss of family caregivers in the facility has had a negative impact on the building in general. Caregivers worked in tandem with the CNAs to provide additional support.”
“It’s a win-win for everyone – for the residents and for the staff,” Badini said. “The nursing home industry is hemorrhaging staff and money. It’s to their benefit to bring families back in.”
Mr. Simon said the census at the Witherell had grown recently.
And, he said it might grow further based on the recent closure of Regal care on King Street. Also, Greenwich Woods on King Street has been exploring options with Planning & Zoning, including an 8-30g affordable housing development.
He noted that if Greenwich Woods were to close, the Witherell’s census might expand further, pushing the Witherell further into the black. He noted each Medicaid patient generates over $100,000 a year.
“The future for nursing homes is particularly poor,” Simon said. “But for us, we’re in a very good demographic area with a high Medicaid rate. We get a lot of discharges from Greenwich Hospital and Stamford…If we were in western Texas, for example, a rural area with a small Medicaid rate, and competing with people to pay nurses, you can never make money.”
Another source of funds for the Witherell, though likely to be a one-off, is the money from the State of Connecticut. Every nursing home got money from the state to pay higher wages.
“This is what Governor Lamont did when 1199 (the New England Health Care Employees Union, District 1199, Service Employees International Union) threatened to strike. He did it through a 5% increase in the Medicaid rate. Considering we probably have the highest Medicaid rate in the state, proportionally we got the most money,” Simon said.
“The state (is offering) $542,000 each year for both fiscal 2022 and fiscal 2023 to pay the people more,” he said. “We pay dietary people $13 an hour. You can imagine the line out the door to make $13, but if we can pay $18, people may take the jobs.”
Mr. Simon noted that state money cannot be used for bonuses, and the money hasn’t been paid to staff yet.
“First there needs to be an agreement with the unions,” he said.
As for the frustrated families, Mr. Simon sympathized. He said the worst part of the pandemic was the inability to have visitors in the building, but, he said that was in response to guidance from CMS.
“We haven’t had an infection in a long time. There are more visits allowed,” he continued. “I wish I could get all the residents vaccinated, but some refused. There’s about 10 or 11 who are not vaccinated out of 180. Only four of the staff out of 242 are not vaccinated. They were given religious exemptions. They have to wear a mask at all times.”
“But it took a lot of effort on many people’s part to convince the staff they that they needed to get vaccinated,” he said, adding that ultimately the Governor mandated it.
In the end, Mr. Simon said one part-time staff member who declined to get vaccinated was let go.
“The pandemic was devastating to us in terms of the census, which went from 190 to 130 because we didn’t admit anyone,” he said.
As for the frustration of family members, Mr. Simon said, “They’re very unhappy they couldn’t come visit whenever they wanted. In many ways they were correct that the isolation was worse than Covid, and finally CMS realized that and loosened the visitation requirements. It’s terrible to have nobody able to visit you.”
As of Tuesday, visitors to the facility are not required to be vaccinated. They are however required to be masked, as are all residents and staff.
Also, as of Tuesday, the Witherell website features its former five-star rating. Mr. Simon said that will be removed.
Town Issues RFP for Management Services In Conjunction with Possible Sale of Nathaniel Witherell
Nov 9, 2020
“Isolation Kills, Too” Rally Advocates for Residents of Long-Term Care Facilities Suffering from Social Isolation
March 9, 2021
Pressure Mounts on Witherell Staff to Get Vaccinated; Staff Cuts Announced
March 23, 2021
Town Owned Nursing Home: Balancing Finances, Staff Reductions, Vaccine Reluctance, Patient Safety Amid Covid
May 2, 2021