Blair County commissioners aren't the only ones talking this year about selling a county-owned nursing facility.
Earlier this month, the topic surfaced in Beaver County, when commissioners told the home's unionized employees to find $5 million in savings - or the home would be sold.
Monroe County commissioners also discussed selling their nursing home until October, then backed away when employees voted to have their 2013 pay increase cut from 2.5 to 1.5 percent.
In May, Chester County commissioners faced a standing-room only crowd where speaker after speaker protested the idea of selling the county-owned nursing home, Pocopson House, to a private operator. In response, the commissioners sought a study to explore the options of having a nonprofit corporation run the home on the county's behalf.
Butler County commissioners began 2012 with an ongoing discussion about selling their county nursing home. In March, they reached a consensus to retain the home after reviewing figures indicating that operating losses were shrinking and after union leaders allowed the facility's laundry to be outsourced.
In Blair County, the topic surfaced in early October, when commissioners revealed they had informational meetings with a Chicago real estate investment company that could market Valley View Home, a facility the county built and opened in 1954.
By the end of October, commissioners had hired the Chicago firm, Marcus & Millichap, to solicit and identify potential buyers and named a Harrisburg attorney, Louis J. Capozzi Jr., who specializes in health care, regulatory compliance and related issues, to provide assistance.
History of county homes
At one time, 50 of Pennsylvania's 67 counties operated nursing homes, according to the state Department of Health.
Today, 28 counties run 33 nursing homes, Michael J. Wilt, executive director of the Pennsylvania Association of County-Affiliated Homes, said Thursday.
The other counties either closed or sold theirs, usually to for-profit nursing home management companies such as Grane Healthcare of Pittsburgh, which bought Cambria County's Laurel Crest Rehabilitation & Special Care Center at the end of 2009; and Guardian Health Care of Nanticoke, which bought Carbon County's Weatherwood Nursing Home and Rehabilitation Center in 2010; or to out-of-state companies like Millennium Management of Miami, Fla., which bought the Lackawanna County Health Care Center in 2010.
The last sale was in August 2011, Wilt said, when commissioners in Adams County sold their nursing home to Transitions Healthcare Gettsyburg, a for-profit limited liability corporation.
"From a consumer perspective, this is a troubling trend," Public Policy and Advocacy Director Robyn Grant of the National Consumer Voice for Quality Long-Term Care said. "We know from research that for-profit facilities have more violations of federal nursing home regulations than government-owned facilities."
The study Grant quoted, "Nursing Facilities, Staffing, Residents and Facility Deficiencies," 2005 through 2010, by researchers at the University of California, San Francisco, also reported more violations at for-profit nursing facilities than ones run by not-for-profit organizations.
More than one study has reached that conclusion, Wilt said, but he has seen "mixed results" from watching sales of county-owned nursing facilities in Pennsylvania.
Some sales have been "relatively painless" and turned over to owners who maintained or improved quality of care, Wilt said. Other sales have generated intense discord with employees union and a decline in care for the residents.
Within a year of being sold, homes formerly owned by Lackawanna and Cambria counties were on the government's "Special Focus Facilities" list of the worst nursing homes in the country, Wilt said.
That list, maintained by the Centers for Medicaid and Medicare Services, tracks serious quality care issues at nursing facilities and improvement efforts.
As of November, the former Cambria County facility was deemed to be "recently graduated" after being on the list for 22 months. The former Lackawanna County home was still on the list as of November, although under the "shown improvement" category.
Money, or the lack of it, is generally the driving factor behind discussions about selling county nursing homes.
"I think the financial pressures are there for all homes," Wilt said, "no matter whether it's a county facility, a for-profit or a nonprofit facility."
Concerns about the future
While Valley View Home's financial picture has improved, commissioners admit to concerns about the facility's future and its ability to generate enough Medicare and Medicaid reimbursements to cover its operating expenses. They had the same concerns when they hired Affinity Healthcare Services of Indiana in January 2008 to manage the home, at first on a temporary basis, then later through a signed contract that covers the company's $186,600 annual fee.
Affinity will not be a bidder for Valley View Home, company President Denise McGowan-Hatter said recently.
"We are there to do what's within the terms of our contract," she said. "We don't own any facilities. ... We're there to assist with whatever their requests are."
Commissioners have praised Affinity for its management and expertise that has helped improve the home's finances. But a significant part of the home's financial improvements, according to Commissioner Terry Tomassetti, is a result of the home's competition with the private sector, such as HealthSouth Rehabilitation Hospital of Altoona for Medicare-paying patients.
Tomassetti also points to Valley View Home's shortfall in support of the county's pension fund as evidence to be considered in assessing the home's financial picture.
"It only pays about $78,000 of its annual share of the pension contribution obligation, leaving an annual shortage of $1.5 million that the home does not pay and the county cannot pay," Tomassetti said.
Commissioner Diane Meling summed up her concern about the home's future during the Nov. 27 meeting where she referred to Garvey Manor, which built an expanded nursing and residential facility along Logan Boulevard. The county will never have the money to bring Valley View Home to that level, she said.
Commissioner Ted Beam Jr. also admits to concerns about Valley View's financial future, but he has offered no commitment toward selling the home. At Tuesday's meeting, Beam asked when the county begins incurring expenses with Marcus & Millichap.
That questioned prompted Tomassetti to ask Beam where he stands.
"I'm not quite ready to say," Beam replied, explaining that if he decides against the sale, he wants to do so before the county begins incurring expenses.
Solicitor Nathan Karn said the county owes nothing to Marcus & Millichap until a sale is achieved.
Tomassetti predicts that a new owner will be in a position to consider expanding the home, which would mean more care and more jobs for local residents.
With county ownership, Tomassetti said the home is a future liability for the county's general fund and county taxpayers - for a service counties are no longer mandated to provide.
Valley View Home employees and the Altoona division of the American Youth Soccer Organization said they, along with the home's residents and community, will pay the price if commissioners sell the home and the nearby 8 acres of ground that the AYSO has leased for 22 years.
Service Employees International Union representative Nathan Williams said he is familiar with the labor troubles that developed immediately after Grane Healthcare bought Cambria County's home, in addition to the decline in care that Wilt mentioned.
Grane hired 207 of the former Cambria County employees, but didn't hire an additional 80 applicants for reasons that generated complaints filed by the Equal Employment Opportunity Commission. The company also was found in violation of federal labor law by contending that it didn't have to bargain with the 200-member Laborers International Union. It then was ordered in February 2011 to rehire and issue back pay to five employees dismissed due to union activity.
"That is the poster child of what can go wrong," Williams said.
Those employees who weren't hired left Cambria County with greater than anticipated costs in unemployment compensation, Cambria County Controller Ed Cernic Jr. said.
And the employees who went to work for the new owner were hired at lower wages and offered health insurance and pensions plans that didn't measure up to what the county offered, Cernic added.
Nurse aide and Service Employees International Union secretary-treasurer Sharon Pope said she feels betrayed by the Blair County commissioners.
"For years and years, we've tried to work with the commissioners, to do what's best for the home and the residents," Pope said. "We took a pay freeze one year and we've worked out different ways to settle contracts in the past."
Soccer fields in jeopardy
The Altoona division of the American Youth Soccer Organization is also angry because of the commissioners' recent decision to include the neighboring grounds in the proposed sale. AYSO members, with help from volunteers and local businesses, converted the former hilly area into soccer fields that have been used by thousands of players for 22 years.
AYSO representatives asked commissioners Tuesday to slow down on the efforts to sell the home and the soccer grounds so options can be considered.
"Once the land is gone, it's gone," architect Steve Parks, who helped create the field, told them.
Commissioners are expected Tuesday to continue working and possibly vote on a request for proposals that Marcus & Millichap will distribute to potential buyers. The language is expected to state the commissioners' desire for a buyer to continue operating Valley View as a nursing home, to give admission preference to Blair County residence and to consider language that will maintain a minimum number of skilled nursing care beds.
Commissioners also agreed to include language requiring a potential buyer to make the soccer fields available to AYSO through the conclusion of the 2013 season in October.
But all the language in the request for proposal, along with a price, will be subject to negotiation between potential buyers and commissioners, expected to occur in the early months of next year.
"What's the rush?" Parks asked commissioners on Tuesday.
"We have to start somewhere," Meling said.