Published in the Current and the American Journal
The Viking and Crescent House in Cape Elizabeth will see up to $1 million in renovations in the coming months and will be upgraded to become what its new owner calls “the facility of choice” in the area.
Ray Termini, president, CEO and owner of Haven Healthcare of Cromwell, Conn., met with Viking staff last month to announce the change of management. Haven has a consulting arrangement with the Viking pending state approval of a certificate of need for the change of ownership.
When the approval is complete, three to six months after the application is submitted, Haven will take over management from Duane Rancourt Sr., the current co-owner and administrator of the nursing home.
The certificate of need application has not yet been filed.
As of this month, Termini told the Current, Haven is operating 26 nursing homes throughout New England, with 3,200 patients and a similar number of employees.
Of those, four homes in Connecticut and one in Vermont have had more than one situation where residents were either subjected to “actual harm” or “immediate jeopardy,” since Haven took over management, according to federal documents and information from the Connecticut Department of Public Health.
Each affected one patient or a small number of them, and each has been rectified. Termini told the Current all of his facilities are in compliance.
Two of the problems found by Connecticut inspectors in May 2002 at Haven Health Center of New Haven are representative of the problems.
One patient was given only one-fourth the prescribed amount of a medication. Another resident was not properly restrained or attended while in a shower chair, resulting in the resident “almost falling out” of the chair, and suffering two scrapes on the head.
The nursing home was fined $600 by state authorities. Upon inspection in August 2002, the nursing home was found to have corrected the problems.
The Viking had much more serious problems prior to Haven’s arrival on the scene. In August 2002, Viking resident Shirley Sayre, 77, wandered out of the nursing home and drowned in a culvert across the street. As the family mourned, Viking was hit with an “immediate jeopardy” citation and over $30,000 in fines.
Money tight
Those fines came at a tough point for the nursing home, which faced running out of money by November.
State reimbursements for Medicare were late, and the company faced the tough choice of paying creditors or meeting payroll.
In a time when nursing homes are feeling financial pressure, Termini said Haven succeeds by making their nursing homes more attractive to residents and families than competing facilities.
Most nursing homes, he said, have 10 percent of their patients on private payment, 10 to 12 percent on federally funded Medicare payment and the rest on state-funded Medicaid payments.
Many are also not near full capacity, resulting in overhead costs with no revenue to make up for them.
Medicaid does not pay the full amount for services, forcing Medicaid-dependent homes into financial ruin, Termini said. Medicare pays $315 per day, while Medicaid pays $130 per day, no matter the services a patient requires.
Haven solves the problem by attracting higher-paying customers, and by making sure its homes are full.
“The only way to survive is to decrease dependency on Medicaid,” Termini said. Haven homes have 96 percent occupancy and over 30 percent non-Medicaid patients, he said.
Just that additional margin is enough to make the difference between a successful nursing home and one that is in trouble, he said.
Termini said attracting higher-paying residents takes work and said he will begin renovating the buildings as soon as he takes ownership.
New look, new faces
Resident rooms will get all new surfaces, including paint, flooring and window dressings, as well as electric beds, according to Patrick Keaveny, regional vice president for Haven Healthcare, who will be overseeing the renovation.
Gathering areas also will be renovated, with a new fine-dining area planned for what is now a “sunroom” space, and a bistro area in the assisted-living facility, Keaveny said.
A lounge area, corridor and office space will be converted into a large physical therapy, occupational and speech therapy room.
To staff that room, Haven will be hiring a new physical therapist and assistant, an occupational therapist and assistant, as well as a part-time speech therapist.
To get new blood into the rest of the staff, Keaveny plans to send recruiting mailings out to all the nurses in the area.
The changeover will not involve layoffs, however. “Everybody that has a job (at the Viking and Crescent House) is going to be an employee of Haven Healthcare,” Keaveny said.
All of this is dependent on state approval. While the certificate of need process is usually used for constructing a new healthcare facility, it is also used for transferring ownership, according to Cathy Cobb in the Maine Department of Human Services.
The process determines whether a company is “fit, willing and able to run a nursing home,” she said, and also makes sure costs to the state-funded Medicaid program will not increase.
The process involves an application, an initial hearing and then a public hearing and then a review of the application and any additional information, Cobb said.
Regulators look at the organization applying for the certificate, its financial plans and
the quality of care it provided elsewhere.