Cumberland County officials will most likely continue to face pushback from their constituents — both individuals and local governments — even after it completes a prospective agreement to sell Claremont Nursing and Rehabilitation Center, the county-owned nursing home.
Last week, Mechanicsburg Borough became the most recent municipal government to pass a resolution asking the county to put the brakes on the planned sale, and a group that has been skeptical of privatization said it would continue to press the county through the due diligence phase that will likely come after a sale agreement is inked.
“It’s not over until it’s over,” said Tim Potts, one of the organizers of the group Citizens Saving Claremont.
Such an agreement with Allaire Health Services, the prospective buyer for Claremont, is “imminent,” County Commissioner Gary Eichelberger said this week, and could come as soon as Monday.
“The legal teams are on, we believe, the very last comparison of notes,” said Eichelberger, a Republican, who has been the proposed sale’s staunchest defender.
Even after sale terms are formally agreed upon, the deal won’t be fully closed until August or September, and could still fall through in that time, but it’s unlikely, Eichelberger said.
“Allaire has been a very fine partner, and we think they’ll be a great community partner,” Eichelberger said. The continued opposition is “more about making the noise than having an effect,” he said.
Commissioner Vince DiFilippo, also a Republican, said he foresaw an agreement in the next two weeks, and said his position remained that selling Claremont was the best way forward.
“It doesn’t appear there are any major roadblocks,” DiFilippo said.
But Commissioner Jean Foschi, the board’s lone Democrat, was more skeptical of how fast the process would wrap up. She has yet to see a sales agreement draft, Foschi said this week, and no specific price has been proffered, although the county has completed the pre-sale value assessment of the facility as required by law.
Foschi has opposed moving forward with the sale in recent votes, criticizing her Republican colleagues for a process she said was oriented toward a fast sale as the primary solution, without communicating to the public exactly what it might take for the county to retain Claremont and stem its financial decline.
“They’re counting on [the sale] going through, but who knows what will happen,” Foschi said. “We have not done this in a way that helps the public understand the situation.”
The county’s decision in October 2020 to investigate a sale of Claremont came as the nursing home’s financial situation began to deteriorate more rapidly. The facility has run deficits for years, drawing down its account balance, which has since dipped into the red.
Claremont lost $2.15 million in the first quarter of 2021, according to the nursing home’s financial reports, with its operating account now $1.53 million to the negative.
The county’s budget anticipates a $2.6 million cost to the county’s general fund to subsidize Claremont; were the county to retain ownership into 2022, the county’s’ finance department has estimated that a tax increase of 8 to 14% would be needed, which would come out to between $35.12 and $61.46 of additional property tax on a $200,000 home.
Opponents of the sale say a tax subsidy would be worth it to retain public ownership of Claremont and give it more time to get back on its feet, particularly after the COVID-19 pandemic.
While Claremont had faced hurdles prior to the pandemic, the virus rapidly accelerated them. The facility’s average daily patient count for March 2021 was 149 patients in a 282-bed facility. A year earlier, the average headcount was 260.
The ability of Claremont to accept more patients — and the revenue that comes with them — is limited by staff shortages, with dozens of open positions listed on the county’s most recent report.
Privatization would mean that the public would lose oversight of the facility, particularly its quality of care, opponents point out. Claremont would rebuild its staff and patient base under corporate control, as opposed to being supervised by the county commissioners via open public meetings.
Potts said a major concern for his group is that, instead of rebuilding under the steady hand of the county, Claremont could be subject to a revolving door of ownership.
Potts pointed to Franklin County’s formerly county-owned home, which was privatized in 2013, saw its care ratings plummet, and was then re-sold. Susquehanna Group Advisors, the consultant Cumberland County is using for the Claremont sale, also facilitated the 2013 Franklin County divestment.
Those concerns were echoed in the Mechanicsburg Borough Council’s resolution, which asked the county commissioners to “delay and reassess” the sale and to “explore all options available that might allow the operation of Claremont to stay within the county’s structure or will at the very least allow the county to retain oversight and control over quality and delivery of care, especially to the county’s most vulnerable residents.” Other municipalities, including Carlisle and Newville, passed resolutions earlier this year asking the county to re-think its plans, citing similar concerns.
The resolution also urged the county to “accept the assistance that a local foundation has offered to fund an independent evaluation of Claremont aimed to finding ways to improve the efficiency and sustainability of the facility’s operations.”
The Partnership for Better Health, a Carlisle-based nonprofit, has offered to finance a prospectus study for Claremont to quantify possible outcomes and options; Eichelberger has said he doesn’t believe the effort would be fruitful.
County-owned homes, once ubiquitous, are becoming less common in Pennsylvania. Facilities that have been privatized generally have lower ratings on common metrics; a York Dispatch study in 2018 found that 15 formerly county-owned facilities sold since 2005 had an average rating of 1.9 stars out of five on the common scale used by the Centers for Medicare and Medicaid Services, while the state’s 21 county-owned homes averaged 3.1 stars.
Comparing Claremont to Allaire’s four existing homes shows their CMS star ratings roughly on par with each other — two of Allaire’s homes rate worse than Claremont, one better, and one the same.
CMS data also shows that the number of reported deficiencies in the last three years’ inspection periods is roughly the same. Both Claremont and the Allaire facilities, taken in total, had just over seven deficiencies per resident over the three years, or one deficiency per 21 residents on an annual average. Judging on the most recent inspection period alone shows Claremont doing better, with one deficiency per 37 residents, and Allaire faring worse, with one deficiency per 16 residents.
Three of Allaire’s facilities are in New Jersey, and the fourth in Montour County, Pennsylvania. The company is also purchasing a nursing home in Bennington, Vermont, according to the Bennington Banner.
Cost reports for Medicaid rate-setting on file with the Pennsylvania Department of Human Services shows that Allaire’s facility in Montour County, Grandview Nursing and Rehabilitation, spends proportionally less on resident care using the DHS rubric compared to Claremont, at $145.06 per occupied bed-day in 2019 compared to $193.71 at Claremont.
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