The Ulster County Golden Hill Health Care Center is a county-operated nursing home full of aging and infirm senior citizens and the facility itself is getting old.
The situation is something of a template for New York state, which has an aging populace and a growing quandary about how to care for the elderly.
“We need a policy on long-term care in the state,” said Stan Wojciechowski, executive director of County Nursing Facilities of New York, an affiliate of the New York State Association of Counties. “We need to set up the infrastructure. It”™s not easy, but there needs to be discussion on a statewide basis.”
Some 35 for-profit nursing homes statewide have closed in recent years due to factors ranging from too-low reimbursement rates for services to ever-changing regulations, he said. But contrary to popular perception, counties are not closing their nursing homes, but are largely continuing the two hundred year tradition of being the senior care option of last resort. Some 36 of New York”™s 62 counties have a county nursing home and some, including Rockland and Columbia, have obtained the  required Certificate of  Need from the state Department of Health as a key step to building new county nursing homes.
But operating a county nursing home is not easy. “There are so many issues,” said Wojciechowski, citing variable reimbursement rates from state and federal sources that usually do not fully meet expenses, plus the aging populace itself, which is arriving far more frail and needing far more services than in the past. And in many counties, the nursing home itself is reaching the end of its operational lifespan.
“Many counties are taking prudent steps in reviewing their nursing home operations. Pretty much every county nursing home in the state has gone through an assessment on what to do,” said Wojciechowski. “And most of them in the end come out and decide to keep the facility.”
Ulster County is going through such a process now. On July 6, the county task force considering the future of the 280-bed facility in Kingston learned that the option of creating a public benefit corporation to assume control of the facility would not necessarily save the county money, but would cede county control over operations there. Although a public benefit facility would operate independently, the county would still be required to plug holes in its budget, which this year amounted to $2 million.
The facility has an annual operating budget of $30 million and has 380 full- and part-time employees. “It  is pretty much full all the time,” said Sheree Cross, director of the Golden Hill Health Care Center. The county taxpayer share of funding has in recent years risen as high as $5 million from the county”™s annual budget of about $350 million.
Moreover, the 50-year-old facility that has operated continuously is also on the verge of breakdowns in major systems such as sewage and water and needs some $80 million in rehabilitation. County taxpayers are likely to pay about $1 million in upkeep repair costs this year, in addition to subsidizing operations.
Yet, there is no clamor for closing it down. The facility serves the neediest senior citizens at their time of greatest vulnerability. As Cross somewhat delicately phrased it, “What we”™ve noticed is there is a shorter-term admission. A lot of admission and discharges of patients who are older and sicker are staying here for less time. So there is a need for nursing home, for those who have come for their last days.”
