Show Transcript
Disclaimer: The following transcript was auto-generated and may contain spelling or contextual errors.
You're watching Open Agenda, here's your host, Mike Goldberg.
Welcome to Open Agenda.
I'm your host, Mike Goldberg.
Our panelists today are Joe Scafino of Salisbury, and Trish Melvin of Fruitland.
Thank you both for being here today.
Our topic of discussion is one that's been in the public eye for several weeks now, the
Ticomico Nursing Home and some of the issues that are going on there.
We've had a couple of council meetings where the nursing home was discussed.
There was a press conference held by the county executive.
That was followed by a counter press conference that was held across the street from the nursing
home by some of the stakeholders, employees, families, etc.
And that was followed last week by a town hall meeting.
Coming up on the council meeting to be held on September 15th at 10 o'clock a.m. in the
morning, there is going to be a public hearing in regard to the emergency legislation.
We're going to review some of the information that has previously been revealed through
the various forums.
So we hope you all will stick with us.
We'll be right back.
You're watching Open Agenda.
Welcome back to Open Agenda.
We're going to continue our discussion about the Ticomico Nursing Home and some of the
trials and tribulations that have been occurring there.
So Joe, let me ask you, what is the goal for the county council to be passing the emergency
legislation that they proposed?
Well, the goal is to get some oversight because there hasn't been any for years.
And this is just the first step in that oversight.
They're talking about a committee, forming a committee, which was brought up many years
ago.
Our other departments are, you know, like our, you know, our airport and such have commissions,
people to help guide.
And I would suggest that an advisory board put together for this nursing home with, you
know, the aspects of trying to make sure it stays there.
But I think an advisory board would be excellent.
Something like the SWED board or the airport commission.
My suggestion would be this, and this is just my suggestion, we certainly know that we need
to make the cash infusion because we want to keep operating until we make the longer
term decision.
I think for the council and the executive to make that longer term decision, we really
have to take a very hard look at what are the asset needs?
How much money would have to be invested to reposition this facility?
I think it would be helpful to council if you had a better handle on, look, what investment
in the facility would it take to reposition it in the marketplace and then have a business
plan for, okay, in repositioning it, to Joe's point again, how would we market it?
How would we handle, if you will, the business aspects of how it's operated?
Separate that from the patient care, but from a business standpoint.
Do we actually want for it to become a department?
Doesn't that come with some of its own issues?
I mean, right now the nursing home exists as an unknown sort of entity.
It's not a county department.
It has its own taxpayer identification number, different than what the rest of the county
has, a very unusual circumstance.
Can you offer any clarity on that?
There has to be oversight.
The best way to get oversight is to make it a department.
I mean, the county owns it, the best way to get control and oversight is to make it a
department.
Now, the county executive seems to be disinclined to authorize any emergency legislation.
So what is going to happen once this emergency legislation is put on the table?
What do you think she's going to do?
She has threatened a lawsuit, which would just be a waste of taxpayer dollars.
And there's some question as to whether she has standing or if there's a basis for such
a lawsuit as well, coming from administration.
Well, first, of course, you would have to veto the legislation, and then we would have
to assume that they would have a supermajority of votes on the council to override that legislation,
and that's what may result in a lawsuit.
She has certainly, on at least two occasions, threatened that.
The problems at the nursing home are not a new issue, and in fact, some of the research
you've done, which goes back several years, indicates that this is not the first rodeo
for having problems at the nursing home, and it predates the current executive and the
current council.
Can you enlighten us a little bit as to what your findings were?
Number one, I recommend anybody with an interest in the nursing home to go on the county website
and get the minutes for the November 20, 2018, council work session.
Agenda for the open work session is the status of the LeCombo County Nursing Home.
And Mr. Wayne Strasburg, of course, is here, and Mr. Strasburg, we'll let you introduce
our guests.
Sure.
To my far left is Mr. Jim Crisp.
Jim is a partner with Gross Mendelsohn and has headed up the audit team at the Wicomico
Nursing Home.
And Heather Samus, to my immediate left, is the nursing home director.
And what I gave you today was a series of documents I thought we might touch upon or
be available if you have questions.
So actually, on the top of what I had given you is where Wicomico Nursing Home's operations
are through September 30, 2018.
And basically, what I wanted to focus on is on page 3 of that report.
That's the statement of revenue and expenses, and you will see for year-to-date for the
first three months of their fiscal year, which is a year that ends on June 30.
They have experienced another additional loss of $178,000.
So part of the reason we're here today is to talk about the future of the organization
and potentially what might need to be done in order to make this a break-even and hopefully
one day a profitable entity.
So between '17 and '16, probably about $1 million of receivables were written off.
The accounts receivable does not impact your operating profit and loss.
What impacts your operating profit and loss are the receivables that you determined have
to be written off.
Right.
And another document I gave you that looks like this, the nursing scorecard, the facility's
bad debt percentage was almost 5%.
The state as a whole, industry means the entire state of Maryland, every Medicaid nursing
home in the state, which is over 200 nursing homes, they were averaging below 2%.
Of the million dollars that's owed to us, how much do you think we are actually going
to collect out of that?
But right now, if you look on page 11 where it says bad debt expense, of the million dollars
we're only anticipating about $36,000 of it not being collected at this point.
So because it's closer to the state average.
Right.
So.
But again, just as somebody else mentioned, I will tell you in all my experience, in any
healthcare environment, but more so in nursing homes, if you don't stay on top of your receivables
and they start aging, the percentage of collections decreases pretty drastically.
Really the main driver here, which I think is one of the things we wanted to talk about
today is census.
And so one of the things, we've done some feasibility studies.
When the facility was, you're 102 bed facilities.
When the facility was closer to 90 residents on an average, we were making a lot of money.
Now we're down somewhere averaging sometimes between 71 patients to 75.
When we're down that low, based on the current infrastructure, basically the personnel, we're
actually losing money.
When is the last time that the county infused money into the nursing home?
Not during my tenure.
Okay.
It's been a long, long time.
Yeah, not during my tenure.
There was renovations and additions to the nursing home, but it was taken out through
a loan, so the county didn't fund it.
But when they did that, though, they took out a loan, a couple, $4 or $5 million loan,
which they paid off.
The one thing you got to remember, I don't know what happened to the facility before
the '90s, but from that point until today, has been self-sufficient.
Correct.
So it's made money, and again, it's because of the 102 beds, it probably filled about
95 to 98%.
At that session, James Crisp, who was an audit team leader of the nursing home for the auditing
firm Gross Mental Zone, their specialty is healthcare, nursing homes.
So these people know what they're talking about.
He made a presentation.
Council members that participated in the discussion was John Cannon, Joe Holloway, and Ernie
Davis.
When Mr. Crisp opened the meeting, he said, "The reason that we're here today is to talk
about the future of the nursing home and what might potentially need to be done to break
even and hopefully, one day, turn a profit."
It got into many of the same issues that we're facing today, receivables.
A lot of the delays was called Medicare pending, and that's something several of us have mentioned.
When Mr. Lakin mentioned about receivables and 180 days, that's kind of like a straw
man because you're dependent on Medicaid reimbursement, and some years, they're prompt, some years,
they drag their feet.
Steve Lakin, Assistant Director of Administration.
The Wicomico Nursing Home has passed two accounts totaling $1.8 million.
If you include accounts receivable, 30 days or less, that amount balloons to $2.3 million.
There are past due amounts that are 210 days or more totaling almost $800,000.
We will never see that money.
And then what we can conceivably collect is maybe 60 days or less, which is less than
a million dollars.
So we have lost out on a tremendous amount of money.
Also, the facility has for years operated at only a 60 to 65% capacity.
What business can sustain itself operating in this manner?
Joe Holloway in 2018 suggested, "We need to form a committee, an oversight committee."
That sounds familiar, okay?
And Mr. Crisp agreed.
Warren, I would recommend that maybe the county executive's office do think about putting
together a committee to work on this nursing home problem.
I think that would be...
I think it's a good idea, Joe.
We're still seeing how we could put it together so that it works for him and it works for
us.
But certainly, if we were to do something like Joe's suggesting, David is one of the
people who I would look to to really give us advice and give us help.
He said, "A committee would be a great idea, but it needs someone on it who understands
the nursing home industry."
Sure.
You need a variety of people on there.
There's various issues.
One is simply the healthcare issue alone, but then there's the financial issues as well.
And I think we really...
It's important to make a distinction between the two, that this is not just about dollars
and cents, but it's about a facility that cares for our most vulnerable segment of the
population.
And there's a long history that, in Wicomico County, we take care of that elderly population.
And if we ignore that side of it and we're just looking at the dollars and cents, then
there's going to be a lot of very, very unhappy people like we have right now.
That's only going to get worse, I think.
And again, because they were in financial straits in 2018, as I said, they were looking
at it.
Well, and I think there's also the continuity of care, when you have a lot of employee turnover,
as we are about to see.
And grandma doesn't know who's feeding her dinner that night.
It's very difficult for elderly people.
Because in 2018, they were saying the facility was outdated, needed major upgrades.
And if they really haven't done anything in the intervening eight years, we're that much
more behind the eight ball.
Well, with the capital improvements, such as new roof or any other permanent system,
as the landlord, and essentially the county is the landlord, they would have the obligation
to properly maintain the facility, fix the roof.
Up until 2018, a few years before, they consistently had 95 to 98 beds out of 102 filled.
The last few years, we've had 70 to 75.
And what happened after 2018?
The whole topic just fell off a cliff?
Well, COVID hit, I know.
Yeah.
Trish, the administration, the Giordano administration, has brought up some concerns about the proposed
emergency legislation.
Can you share with us what some of those concerns might be?
I've heard some concerns expressed by Mr. Steve Lakin.
They seem to focus on a couple things, disgruntled employees.
Resident nursing care is not declining, and there has been no reduction of staff since
the new administrator took office in April.
Staffing is also above the minimum state requirements, as has been alleged they are not.
Contrary to public accusations, the administrator is running the facility into the ground.
The exact opposite is actually occurring.
Tina Foskey is addressing many significant longstanding operational deficiencies that
no one except perhaps the former administrator knew about until Tina Foskey arrived and brought
them to the attention of our administration.
Allegedly disgruntled employees and uncollected monies, uncollected debts.
So he's suggesting that the disgruntled employees, that their grievances are not valid because
they're disgruntled employees?
Yeah, by calling them disgruntled, that's how they are being characterized.
But what I've not heard is concerns about the level of care.
You know, I've heard just about disgruntled employees and the financial concerns, but
I've not heard anything said about any increase, decrease in care for the vulnerable patients.
What Steve Lakin was suggesting is that there is no validity to the concerns of the disgruntled
employees.
That's the impression.
They're just throwing stuff out there because they're unhappy.
So clearly right now, the Giordano administration is in damage control mode with Steve Lakin,
the deputy director of administration, trying to spin the circumstances surrounding the
issues at Wicomico Nursing Home, blaming everybody other than the county executive for the problems
and it is only the county executive who has ultimate management responsibility over the
nursing home.
But don't you think that when you have that many disgruntled employees-
Where there's smoke, there's fire.
Yeah, right.
And according to people who have family members in the facility, they do see a change in the
level of care just due to lack of employees.
So you know, there's probably something to it.
So what's the county executive's real beef here then?
When it comes to the charter, it's a lot of question marks.
You know, full financial audit information has not been available for eight years.
So you know, I don't understand and I think it's very difficult to say anything decisively
of what the next steps should be until we get more information.
It's pretty clear that there are some management issues.
Did those management issues, were they just now discovered under the leadership of the
present administrator, Tina Foskey?
It sounds like, based on the audit that you discussed going back several years, that a
lot of the stuff was already known and that the executive branch did not take the appropriate
action to remedy the problems.
Bob Culver was the county exec at the time this 2018 presentation was.
So yeah, and again, a lot of issues in the county, from the landfill, from the dredging,
to the nursing home, the problem didn't start with this county executive.
It goes back to prior administrations.
You know, she's inherited it, but like prior administrations, ignored it or didn't give
it priority that it needed.
Well, the current county executive, Julie Giordano, she has been in office for almost
four years now.
This problem came to light about three and a half years into her administration.
Where was she for those three and a half years?
Why was the public, why was the administration unaware of the problems that are just now
apparently coming to light?
I'm going to say the same reason that the prior administrations.
So how can she reasonably allocate blame to the county council or anybody else when this
is a function of the executive branch?
Is it not the council only funds, they do not manage it, but management is ultimately
the county executive's responsibility.
I know the county executive had the responsibility for hiring and firing the nursing home administrator.
All right?
So the council-
It goes beyond that though, doesn't it?
Yeah.
For overall operation.
But council had no say in that hire.
Right.
So the administrator of the nursing home could be competent, but if she has a management
style is not conducive to buy-in, that could be what has created the problem that we're
hearing from staff and family members.
Look, we're going to take a little break, and when we come back, we'll get into some
of the particulars of the deputy director of administration's public comments at the
last county council meeting with respect to the nursing home.
We're going to pick that apart a little bit and see where some of the flaws in his logic
are.
So hang out, guys, and I hope you all will stick with us.
We'll be back in just a minute after this break.
Welcome back to Open Agenda.
We're continuing our discussion about the Wicomico Nursing Home.
The public outcry about the issues at the nursing home have been pretty significant,
but they don't seem to be on the same page as the executive branch.
What is the executive branch missing here, if anything, Trish?
Well, from the executive branch, from the administration, I hear comments about the
financial state of the facility and characterizing the complaints as originating from disgruntled
employees.
But we have first-hand accounts of people with parents in the facility who can clearly
and objectively state differences in the level of care that their family members are receiving.
And it's kind of insulting, I think, for the community to be told that this is hearsay
and rumors when, you know, they're hurting.
And Mr. Lakin has made it perfectly clear that he believes that it is all hearsay and
that there is no validity because it's disgruntled employees.
But as you just mentioned, it's not limited to employees.
We're getting the same complaints coming out of family members of residents and volunteers
as well.
Mr. Lakin states that there is no emergency here.
Contrary to assertions made in this chamber and in public, there is no emergency at the
Wicomico Nursing Home.
Is there an emergency or isn't there one?
What do you think?
Yeah, there's definitely an emergency.
You know, right from the outset, the county executive, she lost control of the narrative
by taking a combative stance and, as you've mentioned, dismissing the concerns of employees
and family members, giving the impression that you're full of it, you're making this
up, and again, sticking to the financial end.
Even though she did have some valid points, nobody listened because had she, the proper
way would have been, after hearing all this, said, "I hear your concerns.
Let me look into it."
She could have retained the attention and the narrative, but taking a combative stance
and dismissing, she blew it.
And then, you know, Steve Lakin just piled on.
I mean, it was like a team effort.
Have you ever seen the county executive work cooperatively with the county council to address
a problem?
Well, that door swings both ways, so I don't want to, you know.
It was a second opportunity to address, and that was the town hall meeting.
And I'll give the county executive credit.
She had to know she was going to get lambasted.
I don't think she did know.
I don't think she did know.
She stated at the very beginning that she did not realize that she was going to be on
the panel.
All right.
Good evening, everyone.
This is actually a surprise.
I didn't realize I was going to be in front of everybody, but that's okay.
That's okay.
I have no problem.
I am going to say, for a couple of things, already tonight, there have been some things
that have been misspoken about, and I'm really hoping that tonight serves as a way to serve
all of you with the truth.
I'll tell you what actually surprised me.
It was the first time I've ever seen the county executive become part of a forum where she
could not control the narrative.
She was not in the driver's seat on this, and that's why a lot of information that I
find deeply concerning was revealed, and a lot of misinformation was spread because she
could not control that narrative.
Well, again, I'm going to give her credit for showing up and listening, and I'm also
going to criticize the nursing home administrator, Tina Foskey, who could have cleared up a lot
of these issues.
It was her opportunity firsthand to talk to the people, and she stayed away.
She was invited.
The executive should have compelled her attendance.
She has the authority to do that for whatever reason she did not.
She's the boss, and she should have told her to be there if she was an executive.
She basically hung the executive out to dry.
How is it that your administrator is not here tonight?
How did you allow that to happen?
I'm going to tell you something.
If it were me, he would have been, or she would have been right here to answer the things.
You can't answer this stuff because you don't even know what the heck is going on.
It's really kind of in a way, there's a gaping hole here that could have been filled by this
person to answer for themselves.
How did that happen?
No, I wholeheartedly agree, and I think that it would have been really good for her to
be here as well.
I mean, I was kind of hoping that she would be here, we'll have a conversation tomorrow,
but I wholeheartedly agree.
I think that being here and listening, I think, is part of it, you know what I mean?
And I think that she probably needed to hear some of these things.
And the executive said, "Yeah, you know, she should have been, but who is the boss?"
Another item that Mr. Lakin brought up, he said, "An audit is only as valuable as the
data provided to the auditors."
But as any business person will tell you, an audit is only as good as the data provided
to the auditors.
It appears this financial information was either withheld from the auditors or inadvertently
overlooked.
That's a whole, no.
This one really made me laugh because haven't we had some issues with the executive branch
when it comes to audits recently?
The executive branch has not complied with the internal auditor's demand for supporting
documentation for the audits of the payment cards or for the grants.
So if anybody is not providing data or quality data, then I would have to say the executive
branch would be guilty as charged on this.
I would agree with...
Perhaps the opposition on the part of the executive is due to the emergency nature of
the legislation, you know, feeling that it puts blame on somebody on the administration.
And I've heard her say that the emergency status is not necessary.
So she has a habit of taking things personally.
Instead of rolling with the punches, it's part of the job.
Just a lot of issues that in my observation, she takes things personally.
And you can't, if you're in elected office, you can't do that because it affects your
job performance and how you come across.
One of the things in Mr. Lakin's public comments at the last council meeting that I found to
be absolutely bizarre was the analogy he was making with the movie The Wizard of Oz.
In closing, my favorite movie is The Wizard of Oz.
One of the great scenes among many is when Dorothy and company finally come face-to-face
with the wizard.
As he's speaking to them, Toto pulls back the curtain to reveal the man curating the
illusion.
But the wizard, undeterred, responds, "Pay no attention to the man behind the curtain.
I am the great and powerful and all-knowing Oz."
I don't think that is actually an applicable analogy there, because if anything, the curtains
have been pulled back on the county executive, and as the executive branch, their failure
to manage the nursing home adequately, hence the problems that we're dealing with today.
And I've not heard a clear definition of how this facility exists as a business entity.
What is it?
Well, we don't know the answer to that, and that's fundamental to the problem here.
Mr. Lakin capped off his public comments with saying, "The facts are on our side, and they
are irrefutable."
The facts are on our side, and they are irrefutable.
Sorry, I would have to refute Mr. Lakin's statement there.
To say that everything that he put on the table is irrefutable is the ultimate in arrogance
there.
He suggests that we, as the executive branch of government, we are not going to work with
others to solve this problem.
We are right.
Anybody who disagrees with us is wrong.
And I'm sorry, that is just not conducive to problem resolution.
It's digging your heels in, and the simple fact is the executive has blamed everybody
but herself for the problems.
She has blamed the council.
She has blamed the employees.
But have you heard her say a single word suggesting that she accepts any of the culpability for
the problems there?
Well, I think it would have gone a long way if she acknowledged the concerns of her constituents.
I mean, there is a room full of constituents in there, and I didn't hear their concerns
really acknowledged, only debated.
And I've heard the executive characterize the patients in the facility as our most vulnerable
population, which I agree.
But that same night, she acknowledged that when she went in 2022 and refused to wear
a mask, she simply would not wear a mask and left.
So how can you consider these people vulnerable and at the same time not want to protect them
with a simple mask during COVID?
We are out of time.
So thank you both for joining us.
We hope to see you again with our next show.
See you next time.
I am the great and powerful and all-knowing Oz.
I'll get you, my pretty, and your little dog, too.
We search for truth in the void between two competing narratives regarding the Wicomico Nursing Home (WNH). Although the nursing home's financial vulnerabilities were identified back in 2018, no long-term solutions were implemented and the problems have steadily grown worse. But county executive Julie Giordano is only now addressing the issues 3 ½ years into her term. Unfortunately, under the direction of the new nursing home administrator hired by Ms. Giordano just 5 months ago, a toxic work environment quickly developed, which has reportedly impacted the quality of resident care. Although the public outcry has been enormous, the Giordano administration's response has been to double-down on its policies and oppose the emergency legislation proposed by the county council, which, among other things, would establish an oversight commission. Now in damage-control mode, at the Sept. 1 council meeting the deputy director of administration, Steve Lakin, blamed everyone but the Giordano administration for the current circumstances at WNH, while delivering a mixture of facts and fantasies regarding the nursing home's operations and finances. Will the executive work cooperatively with the council to develop solutions, or will she impede the process with vetoes and lawsuits as she has threatened? Can WNH's financial difficulties be resolved while maintaining a high standard of care for this vulnerable segment of our population? We'll find out more at the September 15 county council meeting, at which time a public hearing for the emergency legislation will be held.
