By Jonathan Austin / The Virgin Islands Daily News, St.Thomas/TNS
WITH no federally certified nursing home in the territory, residents are left wondering what is available for seniors and others in need of nursing home care.
The US Census Bureau said slightly more than 5 percent of the 65-plus population in the nation occupy nursing homes, congregate care, assisted living, and board-and-care homes. About 4.2 percent are in nursing homes at any given time.
With a territory population of about 105,000, the census statistics suggest the territory has 18,595 people age 65 or older.
If the nationwide standard nursing-home occupancy averages is 4.2 percent of those people, that means 781 territory residents need to be in a nursing home “at any given time.”
Yet, the territory has zero federally approved nursing homes. Sea View Nursing Home lost its Medicare and Medicaid provider agreement last year after what the federal Centers for Medicare and Medicaid Services—or CMS—described as years of serious quality-of-care and safety deficiencies.
CMS set repeated deadlines for when it would stop covering Medicaid services at the facility. Sea View’s federally funded patients were removed from the facility in September, and Gov. Kenneth Mapp has said he could offer no assurances that the patients will be allowed back in Sea View.
“Weekly, Sea View gets requests from families who have love ones at home who need placement in a nursing home setting, and we also receive calls from families who want to bring their loves back home to the islands,” said Adeline Williams-Connor, the administrator at Sea View. “There is a great need when you consider that the population is getting older. There is a need for many more nursing home beds in the territory,” she said.
“I think the 781 potential residents in the territory may be a conservative number,” Williams-Connor said. “There may be younger persons who have other disabilities or conditions that may require nursing-home services. She said if you have facilities averaging 40 beds, “then that would translate to about 20 facilities that would be needed on the islands. Or the territory would need facilities with larger numbers of bed space,” she said.
Richard Mollet, director of the Long Term Care Community Coalition, a New York-based watchdog and advocate for long-term care residents, said last week he knew of no other community of 100,000 people in the nation that didn’t have a single federally approved nursing- home bed.
“It’s very disturbing there is no nursing home access,” Mollet said. He said nursing homes provide care for postsurgery recuperation for people of all ages. “Regarding postacute care, nursing homes have a lot to offer for that. If you need 24-hour-a-day supervision and skilled nursing, you belong in a nursing home. The fact that’s not available—where are those people going? That is very troubling.”
Asked to comment on what can be done to provide nursing-home care for residents, Anita Roberts, the commissioner designee at the VI Department of Human Services, didn’t have much to offer.
“The Mapp administration welcomes any entity that will stimulate any economic development, particularly one that addresses the needs of our growing elderly population. This is not a problem that government alone can solve. We welcome all private-sector assistance,” she said.
Senate Majority Leader Sammuel Sanes said, “it’s not a good feeling” to know that there are no qualified nursing homes in the territory. “There’s an uneasiness, knowing there’s not an adequate place,” he said last month. Sanes, who has a background in counseling and social services, said the Herbert Grigg Home for the Aged, on Saint Croix, “in my opinion is one of the best places I have seen.”
He said recent government conversations suggest an expansion at Grigg and “there are plans in motion to not only improve quality of life for our elderly but also in terms of housing them,” he said. “We really need to expedite whatever it takes to be CMS certified,” which would mean a facility could again get federal funding for nursing-home beds, he said. “This is something that needs to be our front burner. This needs to be prioritized.”
Sen. Kurt Vialet, the chairman of the Committee on Health, Hospitals and Human Services, said the problems with Sea View were “very unfortunate, and something has to be done to provide nursing home services in the territory. “Money is not enough; we can’t continue pouring money into a money pit,” he said last month. “It’s unfortunate that this incident took place. But I believe it was a wake-up call” He said the government is “now obligated to expedite and do whatever is necessary to address this problem.”
Danielle Liss, a spokesman for the Centers for Medicare and Medicaid Services, Region II, told The Daily News that “if a facility wants to participate in the Medicare program, CMS will determine whether the facility meets all of the conditions of participation. That is CMS’ role.”
Region II covers New York, New Jersey and the Caribbean islands. Asked about what other US communities lack certified skilled nursing beds and if she knew how many VI residents are housed in stateside facilities, she replied: “I’ve been advised that you should submit a formal request under the Freedom of Information Act.”
Mollet, with the New York advocacy coalition, said CMS’s response is troubling by not altogether unexpected. He said that regional office “has been very, very poor in responding to the needs of residents in New York, New Jersey, Puerto Rico and the Virgin Islands.
“I don’t have a lot of sense that they are very invested in making sure people have access to appropriate services,” he said. He said studies show CMS fails to do enough of what’s called ‘look-behind’ inspections, where the federal agency chooses 5 percent of the nursing homes inspected by state agencies for follow-up inspections. The surprise inspections, usually done a few weeks after the state agencies graded the facility, regularly “find four times as many problems as the state does,” he said. “Not only do they find the same problems, they find four times as many problems,” he said.
Yet, Mollet said CMS has not been performing those critical checks on the nursing-home system. He said travel restrictions are in place, so the agency might not be performing “look-behind” inspections in Puerto Rico and the US Virgin Islands.
“You just get a sense of the lax nature of the system,” and the territory is “bearing the brunt of that in many ways,” he said. “Obviously, it’s something to be concerned about,” he said.
Williams-Connor, the Sea View administrator, said many communities in the states are coming up with alternatives to housing people in nursing homes. “In some areas on the mainland there are creative ways being looked at how to take care of the elders, including keeping elders at home in familiar setting, and paying families for in-house care services in the home settings, and/or adult day care options. This supplements the available nursing-home beds,” she said.
“There are various creative options being explored across the nation, that we may look at in a comprehensive manner, to determine what is best for the territory,” she said. “We, as a territory, have to look closely at our territory health plan and see what options are available to address this growing need,” she added. Vialet said the government should seek investors to build nursing homes that cater to continentals, as long as the facility is required to provide nursing home beds for territory residents. He said such medical tourism could be very valuable.
“We have to stop thinking about traditional tourism. Our weather here is great, for the most part.” Seniors in northern climates “would love to come here,” he said. “I think it’s a viable idea to establish nursing homes” or assisted living facilities for retirees from the states, he said. “People want to invest, want to be in a warm climate. Basically, they want to run away from the cold.”