April 8, 1999

As The East End Grays, Elder Care Grows

by Barbara Kent

NORTH FORK --The elderly population on Long Island is rapidly increasing and the business of elder living is growing proportionately. The need to locate a nursing home or health care alternative for a loved one rarely comes conveniently after the benefit of meticulous research and on-site scrutiny. The most urgent and common scenario is when an independent parent suddenly falls ill and is hospitalized. If the parent recovers, the family or other primary care-giver is given short notice to find a place that will adequately meet the needs of the newly discharged patient from the hospital whose insurance will no longer pay for the hospital, but who is still too fragile to bring home. The rude awakening is that surprisingly, the patient may be denied admission because the preferred facility has no beds or does not provide the specific medical care the patient needs, or does not accept the patient's insurance. Sometimes, there is no choice at all and the family must take whatever facility will accept the patient, regardless of whether or not it is the most appropriate one. In those cases, the hospital social workers are mandated by law to assist the family in finding an adequate facility. In less compelling situations the family or the functional elder will have more time to establish a comfortable and safe alternative to living home alone.

Determining which is the best suited establishment depends on a multitude of factors... the health of the patient and the level of medical assistance required; whether the stay is to be long term or short term; the cost, and how much insurance will pay; the quality of the site and ease of visitation. Fortunately, Long Island has a plethora of attractive options in elder care living, some of which are quite innovative.
Nursing homes can be long or short term. For those in need of 24 hour medical care, nursing homes provide an around the clock nursing staff, on-call physician and personal aides to assist in daily care such as bathing, feeding and dressing. Some nursing homes provide specialized out-patient medical needs, such as tracheotomy care, dialysis and feeding tubes. Rehabilitation has recently been added to the list of services offered by many nursing homes, with the intention of returning the patient to his or her environment or to a stepped-down level of care facility.

Each nursing home must have the New York state "Statement of Deficiencies and Plan of Correction Survey" available to potential residents and their families. Madeline Butler, administrator of the Riverhead Nursing home nods and acknowledges that the past "stigma" nursing homes have endured is reflected in the name of that certificate. "Always negative," she said, "...never positive." However, you must read it and see how well the nursing home complies with New York state standards. When choosing a nursing home, the most critical issue is to take a tour. Mrs. Butler offered "When you're walking around see the interaction between the residents and the members of the staff. If you hear "Hi, how are you?" look for that openness. Activities are very important for the elderly. See that there is some kind of recreational program going on. This is a big issue for the elderly." Ken Ruthinoski of Greenport, administrator of San Simeon by the Sound agrees with Mrs. Butler. "The most critical issue is to take a tour and look for yourself beyond the window dressing. You have to see what the care is like, what your parents need, ask questions...outside of that, the reputation." He added "...check the survey, it must be posted. All deficiencies are there."
If the potential resident has insurance, cost is less an issue than if it is to be out of pocket. If a person has been in the hospital for 3 days, they will be evaluated for medical eligibility, and if they meet the eligibility requirements, Medicare will pay the full bill for the first 20 days. For the next 80 days, it's $96.00 a day co-pay, or, sometimes private or secondary insurance will pay for it. Ken Ruthinoski, who has a Master's Degree in gerontology said "Insurance companies and the hospitals are driven to move people. The federal and state governments since January have changed the criteria for coverage... It's harder for people to qualify for Medicare. The hospitals used to get paid a flat fee, depending on how long a person really needed to stay there. If the hospital can get that person out faster they would get the same amount of money as if they had been kept in longer. That system has changed now...the hospitals now get paid per diem, by the day...so there isn't the incentive to put them out the door faster now. Hospitals out here especially, will hold on to a person a little longer. The hospital gets a $1,000.00 a day roughly. If an HMO has a contract with us, they may pay the private rate, they may negotiate a little less than that, but they know we're gong to take them anyway. At the worst case scenario, the private rate is $242.00 a day. They get four days out of that $1,000.00 now, for a nursing home. Its just simple math. They want to get them out... They want to get them to a nursing home, and the patients want to get out too, because if the nursing home is run properly, and that is the caveat, if they abide by all the standards and codes, is a lot better place to be than a hospital. Because the hospital regulations are not equal. They can tie people down, put foleys in, put IV's in, and just let them sit there. They are not bound to feed them, or do anything beyond the acute care phase. You come into a nursing home we try to be as restraint free as possible. Anybody who comes in restrained we reduce or eliminate that in a certain period of time or work towards that. In addition if somebody needs to be fed, we feed them, we have to do that."

Nursing homes used to be a place to die. Madeline Butler commented that "The greatest fear I see in the families of our residents is guilt. They say to themselves `here I am putting my mother in a nursing home, and I promised her I'd never do that...'" Increasingly however, nursing homes provide an enriched environment and are a place to live and be rehabilitated. Additionally, Mrs. Butler at the Riverhead Nursing Home noted that there is a "lot" more money from Medicare for rehabilitation than there is in standard nursing home care. At San Simeon, Ken Ruthinoski said "The amount of money we pay for rehabilitation five days a week, is higher than our nursing rate. You're doing more, providing more care for the individual."

After rehabilitation an adult home might be considered. Adult homes are custodial care for residents who may need minimal assistance in personal care, or who might need a protective environment but require less care than a nursing home provides. There are two types of adult home available, private and public. Charles Robb is the administrator of the Henry Perkins Adult Home in Riverhead, a public "hotel" for seniors where they can come and go as they please. The building has exciting history and was once the elegant quarters for socialites like the Rockefellers. Today, the New York Legislator sets the rate for public adult homes at $27.00 a day. Mr. Robb noted "Gaffney gets $27.50 for lunch, we get less than that for 24 hours a day, plus 3 meals...Last year it was 26.37 a day." The owner of the establishment, George Hakiel, isn't in it for the money. He's polish and he wanted a place for his mom and dad, so he bought the hotel." A physician comes in once a week and is paid by medical insurance. A podiatrist, ear doctor, eye doctor and dentist all accept Medicare and Medicaid. The Henry Perkins Home holds 120 beds and is full. They have ambitious plans for a day care extension that will facilitate 100 people 24 hours a day 7 days a week but which has not yet been approved. Mr. Robb had the following statistics to put the cost into perspective: "Medicaid pays $68.00 a day for a senior to have recreation 4 hours a day. $32.00 an hour for an aide to go into the home. It costs more to harbor your dog in the Riverhead Animal Hospital than it is to harbor your parents to live here."

Oyster Ponds Manor is also an adult home housed in a gracious Victorian house in Orient, but it is private and costs between $2,100.00 and $2,700.00 a month. The care there, said Rosanna Tanenbaum, assistant manager, is mainly custodial.

The new wave of elder care, which will probably be the first choice for Boomers who can afford it when the time comes, is a communal affair that begins as a retirement complex that can evolve into an eldercare situation. Peconic Landing is such, a "Lifecare" cooperative which involves continuing care. It is a very different concept, and unlike other elder care options is an investment with equity ownership that can be passed down to the next generation. Residences will be available in size ranging from one bedroom to three bedrooms two car garages a covered patio and a porch. Apartments will also be available, with porches, patios and underground parking. Each unit is purchased, and the equity becomes part of the resident's estate. Annika Shapiro, director of marketing, explained it. "You get your money back, and some...Peconic Landing offers pre-paid long care assurance. Should you need more assistance you are not going to be paying $7,000.00 or $9,000.00 a month, but the same monthly fee when you were living independently. Prepaid on site health care, which includes preventive care, a wellness clinic with a geriatrics nurse practitioner and assisted living, which is called Enriched Housing. If you need a little help, not around the clock care but are a little forgetful and need help with hygiene, meal preparation, help with laundry at no additional cost. Around the clock care for the rest of your life is available and included in that fee." The residents of a Lifecare Community have "Pre-planned where they are going to be taken care of...they will not have to find a nursing home in a crisis situation, and they are having that care in the community they are already a part of, which is a wonderful arrangement. If a resident has been hospitalized they can come home while recovering." Additionally, Peconic Landing is regulated by New York state because it is a nursing care center licensed by the state. They also very carefully make certain that the financial structure complies with all the regulatory agencies.

With the graying of the Baby Boomers, elder care looms as potentially the largest industry of the millennium. Until recently there have been very few options for seniors in New York state. In the last couple of years the state has approved assisted living facilities, and there are numerous types being developed on Long Island in addition to those like the Senior Quarters, Marriot Senior Housing, and other private assisted living options.

c.Bkent, 1999