At Thursday’s public hearing on the future of Greenwich’s nursing home, The Nathaniel Witherell, 42 people signed up to speak, and each was given three minutes.
About 100 people attended via Zoom.
The majority testified to urge the board not to privatize the facility, though those who favored privatization were equally passionate. About 20 people testified against privatization an about 10 people in favor of privatization.
Brad Markowitz, chair of the board’s strategic planning committee, said he had also co chaired the committee formed by the First Selectman to evaluate responses to the Nov 2020 RFP for management services for the Witherell.
He said that 9-member committee unanimously agreed on a recommendation to the First Selectman, an accomplishment he said given the committee’s “widely divergent views.”
He explained that toward the end of the RFP committee’s work, in October 2021, the town attorney issued an opinion stating clearly that the board “had comprehensive power and authority to make all decisions regarding operation and administration of the facility, including whether to sell or lease it.
Prior to that opinion, the board had worked with the understanding that the fate of the facility was in the First Selectman’s hands.
Mr. Markowitz noted that the RFP committee had conducted its deliberations out of the view of the public, and that the process being initiated the board would be transparent.
Markowitz also said his three-member strategic plan committee would consider all proposals and present a plan to the public before proposing it to the board for a vote.
During the hearing David Ormsby, former Witherell Board chair and current leader of the Friends of Nathaniel Witherell, said the idea of transferring operations to Allaire Health Services, a private operator of seven nursing homes in the northeast, meant the Friends group would have to cease fundraising activities.
Andy Duus, who served two terms on the Board of Estimate and Taxation and co-chaired the First Selectman’s committee with Mr. Markowitz, and supported a long term lease of the facility.
He said the goal of the committee that reviewed RFP responses for management services was to find a path to financial stability and independence without compromising quality of care, and that there would be financial incentives for the lessee to achieve defined levels of quality, and the town would have the ability to terminate the lease if quality was not maintained.
Given the events of the past year he said he continued to support the RFP’s objectives and the committee’s recommendations.
Sheilah Smith, co-chair of the Family Council at the Witherell, said the facility remained “phenomenal” and urged the board not to outsource.
“To those who say the town should not be in the nursing home business, I say thank God we are in the nursing home business,” she said.
“It’s been 5 stars until recently when there was extreme pressure from town hall and the current administration to cut the budget,” Ms Smith added. “To outsource to a private entity which will look for further budget cuts in order to pay the town for the privilege of managing the Witherell will affect the care of residents.”
“Outsourcing to a facility like Allaire who owns several one-star facilities in New Jersey is not the answer any more than outsourcing our building department or our skating rink… The difference is the Witherell is a social service and the people in the administration and their rich friends don’t want the town to provide social services. It’s that simple.”
Brian Rabbe also opposed outsourcing. He said the RFP evaluation process used by the town was flawed and criteria did not explicitly include CMS.gov ratings history or patient surveys.
“‘Expected costs’ in the evaluation criteria was only 10 points of 100. If the town’s argument is that financial conditions drive the need for change, why is it only 10% of the evaluation?” he asked.
Rabbe said the RFP evaluation criteria also included ‘cultural fit,’ which he said could not be judged objectively.
“And it included ‘financial strength,’ but documents supporting Allaire’s financial strength are not in the public domain.”
Rabbe said the lease terms were 25 years, with a 25 year renewal at Allaire’s discretion.
“Fifty years is too long. It’s as good as a sale,” Rabbe said. “A sale is not part of this project’s recommended remit.”
Mr. Rabbe said Allaire’s Freehold, NY facility was ranked 2 of 5 overall, and 1 of 3 for long term care, according to US News & World Report, and dispensed anti-psychotic drugs to patients at a rate of 23.1% versus the state average of 18%. And finally, he said Allaire at Freehold was fined nearly $200,000 in January 2021.
“Over-medicating, under performing and fines are not what a lead candidate should offer, and suggest the town’s criteria for evaluation is flawed,” Rabbe said.
Beth Krumeich who served as BET liaison to the Witherell board for many years and was on the team that evaluated RFP bids, urged the board to continue public support. She said her mother in-law resides there and the facility had served the community well for generations.
“I am very aware of the decades long push by a few town officials who are dedicated to the privatization of this valuable facility,” Krumeich said.
“Over the last few years they have sought to starve the facility by reducing the town’s annual contribution. To turn over the facility to a for-profit entity definitely will impact the services provided and the burden will fall on the residents and their families. Adding profits to the operating expenses will reduce necessary expenditures on services, programs and infrastructure. Do not trust the inflated numbers touted by the opposition.”
She noted administration had been working hard to address the deficiencies cited by the CMS in the rating system, and that the staffing model had already been changed and would in part reduce this year’s deficit to an estimated $250,000.
“This small group of misguided people who have been trying to privatize Witherell do so for ideological reasons,” Krumeich said. “They do not want the town to be in the business of operating a skilled nursing facility with a unionized labor force. If you look at Nathaniel Witherell as a social program to serve frail elderly, which is financed largely by non-taxed revenues, the per capita tax burden is minimal and reasonable given the important services provided.”
Peggy Heppelmann urged the board to privatize. She said there was no guarantee that a town owned facility offered better care than a privately run facility.
“Recently, it has come to light that Nathaniel Witherell has an accounts receivable shortfall of more than $10 million. Bad debt and debt collection are an operating expense,” Heppelmann said. “Only in a fantasy world would anyone claim that Nathaniel Witherell is operating at a profit, or that a $3 million annual subsidy against a projected $1.2 million subsidy is a budget cut. The cost might be worth it if the town was running a high quality nursing home, but the Witherell has gone from 5 stars from 1 star over a short period of time.”
“Union restrictions prevent us from offering the right salaries to hire competent executive management and they prevent us from firing incompetent or toxic employees,” Heppelmann continued. “The decline from 3 stars from 1 star has been attributed to the new Director of Nursing who demoralized staff, leading to poor patient care. Union termination procedures require a two-year performance documentation exercise, and patients suffer.”
Lucia Jansen, chair of the RTM budget overview committee said her committee’s views represented a broad based perspective, since it included 12 delegates representing each area of town.
“For years the BOC has been concerned with the millions of dollars in losses, difficult staffing issues, and documented this in our annual BOC budget goals letter,” Jansen said. “The catalyst for BOC’s urgency for action by the Witherell board was this past summer’s lowering of the coveted 5-star rating to 1-star due to the 16 dramatic patient care infractions.”
Jansen said the BOC was startled to learn of the new $11 million accounts receivable shortfall brought to the board’s attention by outside oversight.
Ms Jansen said the town did not have the internal expertise to run a nursing home and that her committee voted 10-1-1 to recommend to the town to consider privatization.
Sally Bednar, a banker with a CPA, had reviewed the Witherell’s financial statements with interest.
She urged that the town privatize but not lose ownership.
“I think the historical roots of Nathaniel Witherell were to provide healthcare to Greenwich senior residents, and I do find great comfort that we have a place like this in town, whether it’s for myself or some family member,” she said.
However, she added that with 56% of residents at Witherell being from Greenwich and 15% from Stamford, Greenwich was providing public support and subsidizing non-residents.
“All of us likely went to college, and at one point your college probably managed a book store and a cafeteria. You’d have a hard time today finding a university or college that manages a bookstore or cafeteria,” Bednar said.
State Rep Steve Meskers (D-150) said he did not accept the premise that the Witherell needed to break even and urged the board to consider maintaining it as a town facility.
“What we have to define is the quality and level of service we want to provide to our seniors in this town,” he said. “As I understand, about 85% of people who are residents there are either residents of this town or relatives to residents of this town.”
“In a town with a budget of $470 million, is a subsidy of $2, $3 or $4 million reasonable to take care of people at the end of life? The question of service to our elders is something we need to consider,” Meskers said.
Felix Andreoni said he’d worked in nursing homes about 30 years, including private facilities.
“The data shows that privately owned nursing homes are less likely to put patient care at the forefront of their concern, and instead they focus on profit. Private ownership of nursing homes most likely would not improve conditions.”
Andreoni said he could share many stories about private nursing homes where he had worked, that he said, “I wouldn’t put my dog in.”
He commended executive director John Mastronardi for speaking out against privatization.
“This man truly cares about the residents in that facility. I have every confidence that this man will bring this facility back to a 5-star rating.”
Fred DeCaro said he had been appointed vice chair of the RTM special committee on Nathaniel Witherell back in 2003.
“That committee was created because the Witherell lost an average of about $1 million a year over the previous 10 years, and at that time the board was proposing to build a new facility as a cure-all for its problems”
He likened that idea to ‘the field of dreams’– “If you build it, self-paid patients would come – who would in turn subsidize the needy elderly.”
“We proceeded to study the Witherell’s operation and the plan to rebuild the facility,” DeCaro said. “Here’s what we said in 2004. The Witherell’s track record provided little foundation for believing that cost effective operations could be achieved on a sustained basis if the Witherell continued as a town department.”
“Cost effective management of a nursing home operating in a dynamic environment is impeded by the budget appropriation, purchasing, hiring, collective bargaining, accounting and legal processes and procedures of municipal government,” DeCaro added.
Further he said the committee predicted in a follow up report in 2007 that the revised plan to renovate and double down on the rehab business would not be successful and would force the town to have to subsidize the Witherell over most of its next 30 years.
“To quote the report: ‘The risk is that the subsidy would become substantial, especially if salary expense becomes more in line with historical experience and Medicare and Medicaid rates rise less rapidly than projected.'”
“These are not blips,” DeCaro said. “This is not a one-time thing. I’ve heard seven directors of the Witherell talk about turnaround plans in the last 22 years. The theme is the same. This is a government trying to run a business. We have done this poorly by any financial measure for more than three decades, as evidenced by the ballooning of accounts receivable.”
Jo Ann Hupal talked about the Witherell’s low staff turnover and said it would be “the worst kind of mistake” if the town would divest itself from owning and operation the facility.
“Private, long term care facilities are notorious for having high staff turnover. This is a detriment to the residents. Low staff turnover is critical for the residents because the staff needs to be able to automatically recognize any changes in a resident, which only is possible if staff is there consistently.”
“To be a member of a community means we all pay for certain services we don’t use. That’s what a community does,” Hupal said.
Hupal quoted Mahatma Gandhi saying, ‘The true measure of any society can be found in how it treats its most vulnerable members.’
Bill Drake said when Mr. Bruce and Mrs. Witherell made their generous gifts to found the Witherell, their objectives were to create a facility of quality at their expense, not at the expense of the residents of Greenwich.
“You board members know the Witherell’s weaknesses and failings in finance and management – and most important, quality: the 16 citations and reduction to one-star. But the Witehrell is a poor fit within town government.”
“One example, our town wage scale requires us to pay well above market for nursing personnel and too little for senior management,” Mr. Drake said. “And the town subsidy of the Witherell’s buses have cost the taxpayers $33 million since 2012. Those figures are from the town comptroller today.”
He said the committee of 8 members worked for a year-and-a-half, and Allaire was the clear preference.
“They received six first-place votes and two second-place votes as the preferred provider. Please have a little confidence in what your colleagues who have met Allaire and worked with them observed. Allaire has a proven track record of improving nursing homes that were previously owned by municipalities.”
Amy Badini, co-chair of the Family Council disputed those who say the town should not be in the business of owning a nursing home. “The problem is that it is not a business. It is a service.”
“It’s one of the services in town that actually does bring income in, helping to partially fund it with a little bit of subsidy,” she said, adding the true number of residents who some connection to the town of Greenwich was more like 90%.
“Though my mother did not live in Greenwich, I have lived in Greenwich and I am thankful that she can be in my neighborhood,” Badini said.
“For those who say that it’s town management that’s caused the 1-star rating I have to chuckle because for all those 100 years it was 5-star when the town was management. I’m not sure how you reconcile that,” Badini said.
Peter Quigley said a ‘municipal enterprise’ should be created to run the Witherell. He said the town golf course already operated this self-sustaining model and didn’t cost the town anything.
“A municipal enterprise is paid for by user funds, donations, grants, bonds. It’s self funded and self-sustaining. It’s a pretty simple formula, but you have to get it organized here.”
Andrew Cattell said it was not true that the town would always have to subsidize the Witherell. “It’s not a law of nature. A decade ago the Witherell had zero town subsidy.”
He said his wife’s grandmother enjoyed her experience at the Witherell.
“The Witherell is special. It’s a special town service no other Connecticut town offers. The town has has Greenwich Point. It has the Griff. It’s got an ice rink and it has got the Nathaniel Witherell. Remove the Witherell from town control and Greenwich starts looking a little more unremarkable.”
Cattell said the takeover candidate Allaire operated 11 properties.
“Medicare ranks them low overall. Zero 5-star overall ratings, one 4-star, two 3-star, 6 two-star and 2 one-star. The feds have also fined Allaire properties over $500,000, so if Allaire is the top pick, folks, I don’t even want to think about who came in second.”
“I mentioned the Griff and the ice rink before. I don’t golf. I don’t skate. I’ll likely never use those town services, and that’s okay. But I know one thing for certain. One day, with luck, every person in Greenwich will need a service like the Witherell because time comes for us all.”
Jessica Kristoff testified that when her grandmother Frances Kristoff broke her hip at 98 and moved from the hospital to the Witherell, her family expected a certain quality of care, but were disappointed.
“When she entered Nathaniel Witherell, she was in a completely different place mentally and emotionally than when she left, under the care of Dr. Walsh, my grandmother almost died.”
“It saddens me to hear all the beautiful stories of the other residents who experienced a completely different experience. I’m happy they experienced good quality care, but I find it concerning that we had the extreme opposite experience. And then, later, Dr. Walsh, the medical director of the Witherell was fined in his own private practice. This was brought to the attention of the Witherell nursing director and Dr. Walsh was permitted to continue his practice at the facility without modification.”
Tony Correale said he was a longtime Greenwich resident and tax payer and has had the privilege of serving as a chaplain at there for over 20 years.
“Our vision of the future is incomplete, out of focus and shortsighted when we choose to place our values in money and finance alone,” Correale said. “I share in the highest ideals of a community that values and cares about all of its citizens at every stage of their lives, a community that should never lose sight of its moral and civic responsibility, a community that can and should seize this opportunity to once again demonstrate how to be a truly caring community by fully supporting and funding Nathaniel Witherell, one of our most essential services.”
Going forward, Mr. Markowitz said his three-member strategic plan committee would consider all proposals and ultimately present a plan to the public before proposing it to the board for a vote.