Testimonies/Reports

Regional Hearing: Report of the Commission on Healthcare Facilities in the 21st Century

Testimony before the State Assembly Health Committee on the Report of the Commission on Health Care Facilities in the 21st Century, December 11, 2006, Syracuse, N.Y.

Good afternoon. My name is Stacy Gantt. I am a registered nurse and a member of the New York State Nurses Association. I work at the Van Duyn Home and Hospital, which has served the residents of Onondaga County for 182 years.

When the Commission was created by law in late 2005, it was based on a foregone conclusion that hospitals and nursing homes needed to be “right-sized.” It then was charged with finding data to support that assumption.
The result, as could be expected, is a flawed document which, if implemented, will hurt more than it heals. NYSNA urges the State Legislature to reject these recommendations and use this opportunity to undertake a comprehensive review of the state’s healthcare delivery system. At very least, the time period for implementing the recommendations should be extended to allow more time for public input and a thorough analysis of the impact of these proposals.

Our concern is that state leaders will implement these recommendations as a “quick fix” and fail to take other steps that are needed for true healthcare reform in New York.

We disagree with the statement in the report’s executive summary that “a fundamental driver of the crisis in our healthcare delivery system is excess capacity.” Without any documentation, the report claims that “hospitalizations expand in relation to the number of available beds” and accuses healthcare facilities of admitting patients solely to generate revenue. In my experience, this simply is not true.

In general, NYSNA sees the following major problems with the Commission’s report:

1. The recommendations concern only hospitals and nursing homes.
   The continuum of care extends beyond these facilities to home care, ambulatory care, psychiatric facilities, and so on. These settings must be included in any plan to revamp our state’s healthcare system. It is potentially devastating, for example, to close nursing home beds and not provide funding to expand and improve noninstitutional care for the elderly, disabled, and mentally ill.
   
   
2. The report appears to assume that certified beds are staffed beds.
   The facilities where our members work are understaffed rather than overstaffed. A report released last January by Governor-Elect Spitzer found that a majority of nursing homes in the state were staffed below federal guidelines. Thousands NYSNA members have filed protests over the past five years claiming that their patient load was too high and they were concerned about being able to provide safe care.
   
   
3. The report does not address the inevitable displacement of nurses and its effect on the nursing shortage.
   Closing and downsizing facilities will result in nurses losing their current jobs. We expect that thousands of RNs will be displaced if these recommendations are implemented in full. Registered nurses are skilled professionals. Many are certified in a nursing specialty. In order to move into other positions, they will require education – not just “retraining” – to perform effectively in a new role. Unless there is a program in place to meet the unique needs of these nurses, they will be lost to the profession and the nursing shortage will worsen.
   
   
4. The report appears to be biased in favor of privately operated facilities.
   By recommending that public facilities merge with private ones, the report ignores the vital role played by publicly operated hospitals and nursing homes. These facilities allow government to fulfill its responsibility to ensure that the needy, the uninsured, and the underinsured are not left without care. Back in the 1970s, when AIDS patients were being turned away from private hospitals, public hospitals admitted them and cared for them. Public healthcare facilities are a safety net we can’t afford to lose.
   
   
5. The recommendations favor large healthcare corporations.
   As has been noted in the media, small hospitals rather than large corporations have been targeted for closure. These facilities serve unique populations. It makes no sense to claim huge savings from closing these hospitals when the impact on jobs and the economy in nearby communities will put added demands on the social services and public health insurance programs such as Medicaid.

As a caregiver at Van Duyn, I am aware of its importance to Onondaga County. Because it is operated by the county, no one is turned away who needs care. It is the safety net for the elderly, the infirm, the uninsured, and underinsured that have nowhere else to go. It is a valuable asset to the community.

This asset is desperately needed. As reported by the Commission’s own regional advisory committee, Van Duyn’s occupancy rate is over 95 percent. It is more than a nursing home, with a traumatic brain injury unit and a rehabilitation unit where residents receive a higher level of care. Under our expert care, residents’ conditions improve, a fact that the Commission cites as a costly problem.

It is true that Van Duyn has faced financial difficulties. We believe these issues were resolved, however, through an agreement with the state that would have put it in the black within a few years. In our last contract negotiation, the RNs at Van Duyn agreed to a minimal pay increase and were willing to make other concessions to keep the facility viable. These efforts, along with our hard work and commitment to our residents, have been thrown aside by the Commission.

Finally, if state legislators approve this report, it will be causing unnecessary hardship for the very people who put them in office. Van Duyn residents are residents, not patients. Van Duyn is their home. Now they are asking us, “Will I have to leave? Will you still be taking care of me?”

Many of the nurses’ aides at Van Duyn are single parents who are working very hard to feed and shelter their families. If this consolidation leads to layoffs, as we believe they will, these workers will have very few employment alternatives in the Syracuse area. Has the Legislature determined the cost to taxpayers when these workers need social services, housing, and health coverage?

NYSNA and its members urge the Legislature to reject the “quick fix” and make the tough decisions that will truly reform health care and reduce costs:

• Create a system of universal healthcare coverage in New York to make affordable care available to everyone – one of the policy recommendations made by the Commission itself. It has been demonstrated in national studies that health coverage based on private, for-profit insurance companies is horribly expensive and does not improve the quality of health care.
• Invest in ensuring an adequate nursing workforce now and in the future. Nurses are the most numerous healthcare providers and staffing shortages lead to more patient complications, longer hospital stays, and higher costs.
• Develop an effective system for monitoring and disclosing the quality of care provided in hospitals and nursing homes. Of particular value are patient outcomes that are specifically related to nursing care.

Thank you for the opportunity to submit testimony. NYSNA looks forward to working with the legislature to take the steps necessary to make health care in New York a model for the nation.

For more information, contact Governmental Affairs at 518.782.9400, ext. 283 or by e-mail.