It was troubling and yet not expected to read this morning about the issues Loretto is having with its finances. Any time you have to bring in an outside consulting firm (once again, a company went outside to find something instead of using qualified consultants living in the area) to help them find money, which indirectly means they’ve brought in hatchet people to look for positions to cut.

For those who don’t know, Loretto is a nursing home facility, although these days they’re all trying to change their image by calling themselves long term care providers. It’s a not-for-profit organization which means it’s beholden to the community and not anyone on Wall Street, and all profits are supposed to go back into the facility. It relies mainly on Medicaid money to survive and unfortunately, those in Albany could care less about either the aged or the disabled (or pretty much anyone else in the state that relies on Medicaid money) and thus the lament of facilities like Loretto, which is uber large by any normal nursing home standards.

The problem with Loretto and most other nursing homes is twofold. One, it’s an industry that’s often mismanaged, though it’s not totally their fault, because of the oppressive state regulations they have to follow to get the money that they do get. True, regulations are in place supposedly to make sure the residents are cared for properly, but they’re really not.

That’s because of the second problem; not enough workers to take care of the needs of the residents. I don’t say this as a health care consultant, which I am; I say this as a person who knew someone who was a resident in this facility for about 18 months, and someone who had to see my grandmother’s care at a nursing home in Rochester for 3 months last year. I also oversaw the billing of a nursing home in Newark, NY almost 11 years ago and was corporate compliance officer of both the hospital and the nursing home attached to it; I know of what I speak.

Some may not like this but the real heroes of nursing homes are CNAs, or certified nursing assistants. It’s one of the hardest positions to handle in the country, as well as poorly paid for what they do. If you have an impression that the elderly are quiet and sedate and would mind their manners, you’d be sadly mistaken. Those who end up in nursing homes do so because they can’t take care of themselves. Some have dementia issues; some can barely more. Many are needy and their families don’t visit them all that often.

he people who are more direct with them than anyone else, including doctors and nurses, are CNAs. It’s physically a tough job. They have to lift and move while being careful not to hurt themselves. They have to try to help them use the bathroom and clean up all messes. They often have to feed and push and pull and help put on and take off clothes of residents. And they have to sometimes put up with verbal and physical abuse from these residents, some of whom aren’t sure what it is they’re doing, and aren’t allowed to retaliate. I could probably tell stories, and I’m sure they can as well, but they’re not allowed to; I’ll tell one.

Once I visited my wife’s friend that was in Loretto. When I got on the floor, the area was literally flooded with senior citizens, there was no one at the front desk, no one in what I thought was the lunch area, and residents either sitting around in wheelchairs or walking around, very slowly, but unwatched. A few of them asked me for water, which I was ready to go get until my wife told me I’m not allowed because I didn’t know their medical conditions and maybe they weren’t allowed water. That was sad. The same condition permeated when I left; still no one around, and I wouldn’t have been surprised if I’d later heard that a resident had figured out the elevator, gone down, and walked out, never to be seen again. It didn’t happen though.

Job cuts, eh? Who will they cut? There aren’t enough CNAs now, no matter what the bean counters say. If there aren’t enough CNAs then there probably aren’t enough nurses. If there aren’t enough nurses then there probably aren’t enough doctors. You never, and I mean NEVER, cut billing staff, the people who bring in your money, unless they’re incompetent, but maybe you outsource outstanding receivables to a cash acceleration company if there is a problem. Maybe you cut administrative positions; I don’t know, and I don’t know how many people they have. How many positions would they have to cut to reach $784,000 and still have enough leadership to run the place? For that matter how much did they pay an outside consulting firm to come from Philadelphia & pay for all expenses when there are consultants in town that probably could have helped them? I’m just saying…

Loretto and other nursing homes in the central New York area have some big and tough decisions to make. The baby boomer population is a large one, so this is an issue that’s not going away any time soon. Maybe it’s time to lobby Albany for some assistance. Maybe it’s time for some radical thinking; who knows. I know this; as one of the last round of baby boomers, with no kids to rely on to help me if I make it that far, I fear for my future.

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