Email:info@flhoffman.com

From: Frank L. Hoffman

To: Patricia Outhouse – 518-843-3503 – FAX 843-3537

Date: 1 May 2002

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Meeting Attendance:

The County’s directive to F. L. Hoffman Corporation was to evaluate ways of overcoming the loss of approximately $1,000,000.00 in Federal funding to Montgomery Meadows. As part of this evaluation, we didn’t want to just shift the expenses from Montgomery Meadows to another County Agency such as the Department of Social Services: hence, the reason we wanted this meeting.

We discussed the fact that Montgomery Meadows needs to update their Skilled Nursing Facility care wings in order to provide proper care, as the PRI of the residents continues to increase.

We also discussed that Montgomery Meadows needs to find a way of discharging their residents with a lower PRI, such as PA, PB, and CA residents, to an Assisted Living Facility or an Adult Home with a Licensed Limited Home Health Agency.

Since the preliminary analysis of the existing facility indicated that it is economically impractical to renovate the existing resident wings to meet the future care needs of residents, it is considered more practical to rebuild the Skilled Nursing Wings on the east end of the present facility. Following this construction, Montgomery Meadows would convert the existing Skilled Nursing wings into an Adult Home and establish a Licensed Limited Home Health Care Agency.

In order to accomplish the above, the CON would have to be submitted to NYSDOH. This application would require the recommendation of the County DSS and the Council on Aging. Montgomery Meadows requested that Robert Reidy support this proposed project.

In reference to the Adult Home, both Robert Reidy and Theresa Cranker indicated that there was a big need for dementia beds. With its existing "racetrack" corridor, a renovated (converted) nursing wing would work ideally for dementia residents. We questioned whether DSS thought there would be any problem filling 20-25 dementia beds. They thought there would be no problem. Based upon this confirmation, it is believed that a Montgomery Meadows Adult Home could support 80 beds. Theresa Cranker also indicated that some of the older, small adult homes may close because of inability to upgrade to State requirements. She did not know how many beds would be involved, but that it would definitely have a bearing on the projected Adult Home bed needs.

Robert Reidy said that the County pays 10% of the cost of Medicaid and 25% of a Licensed Limited Home Health Care Agency. Discharging a Nursing Home Medicaid reimbursed resident to an Adult Home with a Licensed Limited Home Health Care Agency could translate into no cost savings to the County, even though the overall cost of care would be less.

This means that in addition to overcoming the loss of Federal Funding, Montgomery Meadows would have to include the added cost to the County for any resident receiving Licensed Limited Home Health Care Agency services in order to avoid increasing County expenses. In other words, the Montgomery Meadows Feasibility Study Report must show plausible ways of lowering costs and increasing income in excess of both the loss of Federal funding and the increased cost to DSS.

Pat Outhouse thought it would be a good idea to aggregate all County geriatric services on the campus of Montgomery Meadows. Robert Reidy said he would have to think that over.

Robert Reidy and Theresa Cranker were also asked whether or not they felt there was any need for physicians’ offices or outpatient physical therapy. They did not believe there was any need, particularly with the closing of Memorial Hospital’s acute care beds, as they would be putting emphasis on outpatient services.

We also asked whether DSS thought there was any need for adult day care services. They did not have sufficient information to advise one way or the other.

Based on Robert Reidy’s support of the proposed project, we indicated we would set up a meeting with NYSDOH to discuss whether or not they would approve establishment of an Adult Home within the renovated Nursing Home. We also requested that Robert Reidy attend the meeting. He said he would.

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