Montevue

Less than nine months after Frederick County voted to privatize its two resident care facilities, more than 17 percent of the beds at Montevue Assisted Living are empty.

Fifty-four of Montevue's 75 beds were occupied by subsidy patients as of Wednesday, and another eight by those paying privately, said Diane Grove, a county administrator for the facility.

The number of subsidy patients has fallen through attrition as they leave or die, officials said. Montevue no longer accepts patients who cannot afford to pay the $150 per day on their own, according to Grove and Michael Roles, an administrator for Aurora Health Management, which took over managing the facility in June. 

Medicare and Medicaid do not cover the cost of assisted living at Montevue.

The 13 vacancies are a result of the ebb and flow of the assisted living business as patients come and go, Roles said. Montevue had about 70 patients when he started working there, he said.

“You want to be as full as you can,” he said. “Seventy-two (patients) is where you want to be. ... We can certainly come back.”

Montevue has gotten one to three new paying patients each month since June, Roles said.

Aurora has reached out to Frederick Memorial Hospital, senior centers, home health agencies and other adult care facilities to recruit patients, Roles said. Aurora is also looking at added amenities, including allowing residents to choose paint colors for personal rooms and bring personal furniture, to help attract residents.

“We have plans to do that in the very near future,” Roles said.

The Board of County Commissioners voted in June to sell Montevue and the neighboring Citizens Care and Rehabilitation Center to Aurora, a for-profit company based in Millersville. The $30 million sale has not been finalized and is wrapped up in legal proceedings.

Plaintiffs suing to prevent the sale have argued that it violates the property's deed because the prospective buyers are under no obligation to care for new indigent residents.

Commissioners President Blaine Young said filling beds with subsidy patients would only cost taxpayers more. Montevue has continued to operate at a loss. As of December, the facility had lost a little more than $1 million in fiscal 2014, according to a report made available to the commissioners this month.

“Unfortunately, it is more cost effective to leave them empty than to fill them,” Young said of the vacant Montevue beds.

Young doesn't fault Aurora for unfilled private payer spots, he said; if the county had planned to keep Montevue, it would have had to seek a different balance of subsidy and private pay patients to reach cost effectiveness.

People may have questions about Montevue that are deterring them from choosing it, including "who's in charge, who's running it?" Young said. "What's going to happen once it gets sold?

"I have heard a broad spectrum of concerns when it comes to the nursing center," he said.

Speculation that current subsidy residents will be kicked out or moved to another Aurora-run facility is incorrect, Young said. Maryland code prohibits a subsidy patient from being removed from care, and the board's agreement with Aurora includes a caveat that it can't move a patient to another facility, he said.

Commissioner Kirby Delauter said filling the beds is Aurora's responsibility and will not affect the sale of the property.

“No more than I worry about empty seats at McDonald's. I'm not going to worry about it because it's not going to be taxpayer money,” Delauter said.

Commissioner Billy Shreve is not familiar with a vacancy baseline by which to judge Aurora's rate, he said, but he has been satisfied with how the company has run Montevue so far.

“We hired them and we have to look for improvement, and they've shown improvement so far,” Shreve said.

Roles does not know how many subsidy patients had been turned away in recent months, he said, but current patients can stay as long as necessary. Under an agreement with the county, Aurora will receive $10.7 million over four years to continue to care for subsidy patients at Montevue. After four years, those patients can stay on until their needs are no longer met and they transfer out.

“The bed will stay subsidy for as long as the patient is able to stay in the bed,” Roles said.

Commissioner Paul Smith said a senior needs analysis showed that as many as 400 people in the county would be eligible for subsidy status at Montevue. By freeing the county from covering Montevue's losses, "there's that much money that can be freed up for these people," Smith said. 

Commissioner David Gray is the board's lone opponent of the sale. He doesn't think he's getting the straight story about the deal with Aurora, he said, calling the company's management of Montevue while it also tries to buy it and CCRC a conflict of interest.

Montevue reported one unexpected death in December, which Gray believed was handled by the county with indifference, he said.

Gray wants to consider opening beds to subsidy patients, he said.

“I would like to see this back in the county's hands for the citizens and not in the hands of Aurora.”

Follow Courtney Mabeus on Twitter: @courtmabeus.

(44) comments

OFMV

Obviously Kirby doesn't get that 10.7 million per year for the next 4 years, IS OUR MONEY and they have signed an agreement that failed to designate that the county subsidized beds for our most neediest seniors remain filled during this 4 year period of time. Instead, we have empty beds profiting the contractor and sick seniors with no where to turn. Nice job BOCC. [angry]

dbjanda1

Darth---Clustered Spires is a municipal golf course...Are you saying that all ex-county commissioners use it FREE with only the city taxpayers money subsidizing them ???...Doesn't sound fair....Maybe the County should make them pay like every other non city residents....Me

dbjanda1

Darth---You're right I can't tell the difference between 'people' and a 'spreadsheet' either...Me

darththevader

You're comment has nothing to do with anything.

They have always been lossing money and the article states it's normal to have occupancy fluctuate.

The entire purpose of the article is to entice stupud election year comments

kjswartz

First: Welcome to Frederick County.  I see two new posters to these comment boards.  It is important to have fresh voices and new insights in our discussions.  We have become rather Balkanized with our views.

Montevue and Citizens are not just Frederick County run nursing homes.  These are a nearly 200 years institution that began as a poorhouse that, uhm, ehrrr, ministered to the poor.  The institution has taken on different roles over those many years, before settling on what became world class nursing homes.

The HUD sponsored Taney Housing Projects was demolished many years ago and it was replaced with Section 8 housing.  There weren't many people opposed to that change.  Admittedly, I wasn't aware of any discussion at the time, so feel free to correct me.

But, with the Ten Commandments Monument demise, we saw that there were people interested in preserving what Frederick WAS.  A service organization accepted the responsibility to continue the monument's public display.

There is a proper way to transition the public's treasures into private enterprises.  It is with tacit approval from the county's citizens.

I do not agree with selling Citizens and Montevue in this fashion.  These nursing homes are the pride of Frederick County, and a touchstone to our past all the way back to the Civil War.

ALincoln

Elections have consequences. When you elect an All Republican B oCC what else should you expect. Wealthy developers interests over those of the poor and elderly in this county. That's what Republicans do, it's their MO.

lmamiller613

So, while you're making your broad generalizations, you can look forward to electing an all Democrat county council that will jack our taxes up through the roof paying for every possible social program out there whenever someone whimpers "I'm mistreated" or "Life's not fair" or "I've been discriminated against".

Just like the health care system, our political system and society in general is broken and misguided. No one with any decency or common sense gets into politics any more, because who wants to put up with all the garbage you have to take? We need people who will lead with integrity and not be on either side of this B.S. partisan divide we exist on. Both the far right and the far left are a bunch of [can't say it here on this blog] who have done nothing but destroy everything this country was founded on and should stand for, and created a poisoned atmosphere where people can't say or do anything constructive without some partisan wingnut getting on a comment board and saying "Well, that's what you get for electing a [the opposite of whatever side you're on]". We're Americans, and we all need to take responsibility to fix the problems we face, and stop pointing fingers at the other side and start coming up with responsible solutions.

KellyAlzan

You're correct, Frederick County will be an all democrat ran government, in about 10 years.

And you can thank Ba'Lane Young for that.

With all the new development on the books, who do you think will be moving to Frederick County? The answer is - people from the DC Metro area will be moving to Frederick County, and the DC Metro area is mostly all democrat.

If you wanted to keep Frederick Co a republican County - then you should not have voted for Young and his 3 buddies.

lmamiller613

A perfect example of the pointless political agenda-driven hyperbole that I was referring to earlier that overruns these comment boards. Your comment has nothing to do with the issue at hand, what to do with this more-or-less formerly county run assisted living facility, but more about bashing the current BOCC, because they don't align with your political agenda/viewpoint.

None of my comments on this post have anything to do with "keeping Frederick Co a republican county". At this point, it's irrelevant whether Republicans or Democrats are running the county, the state, or our federal government. No one is offering constructive solutions to the problems we face, because our politics and agendas have become so polarized and "us vs. them". We need more "all of us" in the conversation, because that is exactly who is swirling around in the cesspool that we've become -- all of us.

kjswartz

There is a difference with electing an all Republican BoCC, and electing THIS BoCC. Only one seated commissioner is receptive to public comments. The other four are tea party / Libertarians, who will sell out Frederick County treasures.

darththevader

The headline could have just read "Business as usual". Ocupancy is either going up or down and they are losing money. This isn't news

elymus43

The county has money for animals, but does not have funds to help the elderly?????????????

ALincoln

Aren't there county funded golf courses? Let the gated McMansion community hit a little white ball around, but kick the poor and elderly out of Montevue. This is what happens when you elect an All Republican BoCC......

darththevader

Name one county funded golf coarse. You're making stuff up

elymus43

I hope the Charter Government is better than the present BOCC. I thought Citizens and Montevue were run much better under county control than Aurora.

MCEDDE21

The original plan for Citizens and Montevue called for self-sustaining or even profitable operations within two years of start-up in July, 2012. The new and expanded facilities would continue with 60 County-subsidized residents and 15, full-pay residents at MALF. The Board of Trustees was in charge and, in April and May, 2013, showed profitable operations for the first time.

Blaine Young, however, disrupted the plan--disbanding the BoT and installing Aurora Management in June, 2013. Since then, the finances have deteriorated and the problems have mounted.

Last month, between January 14 – February 4, both facilities were quarantined due to a severe viral outbreak. At least 61 of the elderly and immune-compromised residents were affected with nausea, diarrhea, vomiting, and dehydration. At least three residents died. (The County and Aurora refuse to provide information requested under the Public Information Act.)

Medicare does not pay for assisted living. In most cases, Medicaid will not pay for assisted living and, in no case, for any time beyond 90 days. Those who qualify for assistance at MALF must exhaust their assets, including Social Security payments or Veterans benefits every month, although they are allowed to retain roughly $100/month for personal use.

When compared to government operated assisted living homes, privately owned facilities have been shown to provide sub-standard care, all the while charging price-gouging rates.

At present, Frederick County subsidizes 54 residents at Montevue because they don’t have the means to live anywhere else. As Commissioner Smith says, we have at least 400 more County residents who need and qualify for County assistance. Aurora has already cut off aid for six of them and, as Executive Administrator Mike Roles here says again: They’re going to cut off everybody else as soon as they can.

drcaviness

Ah, facts and explanations. Thank you.

Are there any statements of fact in stevebruns comment that are in dispute?

If you respond to my question, try to leave emotions and opinions out of the response. I have to base my own opinion on facts, not the opinion of someone else.

darththevader

The financies have deteriorated since Aurora??? Really??? It was hemoraging money for years. This isn't anything new

drcaviness

The paragraph you are questioning is "Blaine Young, however, disrupted the plan--disbanding the BoT and installing Aurora Management in June, 2013. Since then, the finances have deteriorated and the problems have mounted."

In the first sentence if you remove the phrase "however, disrupted the plan" it becomes a statement of fact. There was a BoT, Young performed an action, the BoT was no more.

However, the sentence "Since then, the finances have deteriorated and the problems have mounted" is, strictly speaking, opinion. Stevebruns is allowed to have opinions.

drcaviness

Actually I mistyped slightly. The sentence "Since then, the finances have deteriorated and the problems have mounted" less of an opinion and more of an interpretation. An examination of the books and the finances would reveal profit/loss figures.

But I am curious, when did the care of our elderly become a profit center? As someone approaching that time in my life I am saddened that my care as I slide towards death and my death itself will be a source of profit for someone. When did we pass through the looking glass?

lmamiller613

Regarding your question about "when did the care of our elderly become a profit center?".......well, any business is in business to make money. If they don't, they won't be in business any longer. This includes health care facilities, funeral homes. And higher up on that list is pharmaceutical companies and insurance companies.

Where things got sideways and run off the rails is when advances in technology and medicine starting jumping by leaps and bounds, and what was impossible or incurable years ago is now treatable and/or manageable. Things like heart disease, diabetes, cancer, et.al. used to claim many people at a relatively young age. People can now treat or manage these diseases, leading to longer life spans. Adding more gasoline to the fire is the general shift in population demographics as the "baby boomer" generation ages from middle age to retirement / elderly status.

Health care, due to its increasing reliance on technology and expensive diagnostic machines, becomes more expensive to administer. With a graying /aging population, health insurance companies pay out more money for treatment and care, which is not what they are in business to do (they are supposed to collect more than they pay out, invest & grow the money, and make bazillions for their shareholders).

This all worked as long as a never ending stream of government and employer funded subsidies flowed into the system, and the legalized Ponzi scheme that is Social Security "worked" because there were more people paying into the system than taking money out. But now, as the government money is shrinking, employers are dumping costs for insurance plans onto their employees or totally eliminating benefits, and a large swath of the population is rocketing towards retirement, the house of cards is collapsing and the money to pay for all this has to come from somewhere. And therein lies the whole problem with the current system. It has to fundamentally change to work. The question is how to do that without disenfranchizing large groups of people. There are no easy answers on this one.

lmamiller613

And, if what you are saying is correct, a couple clarifications, please:

1) So, what led the BOCC to come to the decision to switch from the Board of Trustees to this Aurora Management? And, I'd like a balanced/fair explanation of facts, not the usual hyperbole that exists on these boards about how mean/evil/incompetent the BOCC is. As Sgt. Friday would say, just the facts, please.......

2) If Medicare/Medicaid in fact does not help pay for assisted living expenses, that only underscores and emphasizes my original comments on the fact that the current system is hopelessly broken and needs serious reform. An elderly patient in need of assisted living services should not have to liquidate their entire reserve of assets and hand them over lock, stock, and barrel to one of these places, and receive the substandard level of care they currently receive in return. Not saying they shouldn't have some liability to pay on their own, but again, using the model I laid out below, costs should be reasonable and controlled, and adhere to an established level of service/care. And insurance providers should be on the hook for paying the lion's share of those costs. That's what insurance is for.

drcaviness

Your paragraph 1: I would like more transparency and accurate reporting of the facts and circumstances also.

The following is my opinions, not facts.

To add to your paragraph 2: In my opinion, we must walk a careful line here. Since the Affordable Care Act has kept the management of health care money in the hands of the market place, it will do none of us any good if we harm or destroy the insurance companies. Unless we fundamentally change health care in America, it remains a partnership between the insurance companies, the government at all levels, the medical industry and the people being subjected to everyone else's tender mercies. We, the silent, the powerless.

This whole arraignment has not seemed like a partnership at all for a very long time, and as far as I can tell no one is interested in making the partnership work. We (including me) squabble over money, over power and over who should do what with what, while the true subjects of our discussion still need oxygen, fluids, bed pans and our mercy. Shame on us all for forgetting that.

lmamiller613

And 3) I still stand behind my original viewpoint that local governments should not be in the business of running these types of facilities (unless the Federal Government decides to cede their current level of control / oversight / taxation on these matters to local governments). Government's role should be to establish the standards of care and overarching regulations that govern how assisted living facilities are to be operated and paid. Asking taxpayers to shovel more money into this rapidly expanding sinkhole is not going to solve the problem.

kjswartz

You are right, but there are always exceptions to the rule. Montevue and Citizens falls under "exception" and shouldn't be palmed off as failed business ventures. They were NGOs providing valuable public services, with some taxpayer funding.

Guess what?

Their organization was funded through two world wars and a Great Depression. There is real history behind Montevue & Citizens that shouldn't be readily dismissed. Even with all the budget crisises over nearly 200 years, the foundation stayed intact.

It is a shame that an esteemed institution died even after very significant public support to keep these nursing homes as Frederick County Public institutions!

sue1955

Whoa! What's behind the situation about "an unexpected death in December?" In a facility comprised of elderly, what is "an unexpected death?" Even if a person is doing well for their age and state of health, one can still die. So, what was meant by that statement?

MCEDDE21

From Stop the Sale of Montevue/Citizens (on Facebook), February 13, 2014:

Roles: Unexpected Death at New Citizens is the NORM; and Three-week Viral Outbreak is "ORDINARY"

At last week's BoCC meeting, CCRC Administrator Mike Roles discussed the Citizens Care Clinical Indicator's Report, released to STS, yesterday. (We present, below, the relevant page showing one unexpected death which occurred in December.)

At the meeting, Roles casually mentioned the death but glossed over the fact that it had been "unexpected". He reported it to state and federal authorities as required but told the Board that the event was “NOT out of the ordinary… just something… an incident that happened that was unfortunate…”

Let's take this step by step: In the first place, Roles is confusing the issue by using a "double negative". To say that the death IS NOT out of the ordinary is to say that it IS ordinary; It is the norm; It is nothing to worry about.

In the second place, this death was UNEXPECTED. By definition, it was OUT OF THE NORM and was, therefore, something we need to worry about.

Mr. Roles also allowed that there had been a "GI issue" at the facilities. Here, however, he not only glossed over the facts, he ignored them completely: 1. According to the News Post, scores of patients with compromised immune systems were affected; 2. The symptoms were consistent with Norovirus (although no one from Aurora Management or the County Health Department will confirm that information); and 3. Both facilities were quarantined for three weeks.

Indeed, Roles simply said that there had been no new admissions for two weeks and that employee absences were up. By contrast with his assessment of the unexpected death, Roles concluded that the "GI issue" WAS "out of the ordinary". In effect, he was saying that the three-week quarantine was different from the unexpected death issue because we 'see these things all the time... Just because the virus lasts two to three days--during which our patients with compromised immune systems suffer severe diarrhea, vomiting, and dehydration--doesn't mean that this is anything to worry about.'

So, in the end, if anyone gets sick and dies at the new Citizens, that's what you should expect. There's nothing unusual about any of it--the way Roles sees it, at least.

lmamiller613

Most of today's commenters don't have it quite right. First, the people who need the services of Montevue are elderly, and not the same folks living on the streets or out of their cars.

Second, taxpayers of the county should not be subsidizing the costs of these facilities ---for a second time through their county taxes --- when you are already subsidizing this through your Federal taxes that pay the costs for Medicare / Medicaid.

The fact of the matter is not "evil" county commissioners who have turned their back on the elderly of the county, but that the entire health care system and how we handle it for the elderly and aging is completely and totally broken. For the prices they ask to house someone at one of these places, there is no reason why proper care cannot be provided. But at every step of the way, from the drug companies to the medical equipment supply companies to the the companies that run these facilities (and if you want to truly point a finger and call someone "evil", there is a good place to start), everyone makes an exhorbitant profit, and who suffers? The elderly who are forced to pay these ridiculous prices. Then, with all the changes resulting from the implementation of Obamacare, insurance is paying less and less (while costing more), and shifting more of the cost burden onto the consumer.

Using taxpayer money to shovel into this ever-deepening hole in the current broken system is not the answer. There needs to be national standards of care, and reasonable prices for providing that level of care, established. (What that means is, that all parties who expect to receive payment under this model must fully disclose their pricing structure and actual costs, along with all markups and profit, which would be capped at a reasonable amount such as the prime interest rate plus a certain margin, just as consumers are charged). Then, Medicare and/or private insurance should be required BY LAW to pay that cost at 100%. That is how you provide care to those who need it in a reasonable and affordable manner.

mandsk53

Good point. Japan has such a national system and it works well. Standardized costs resulted in a capitalist market producing quality health care equipment at a lower cost. Then again, their culture is different and their CEO's are not paid 400 times more than the workers. Our culture may be, and probably is, the problem.

darththevader

So are they "standardized costs", "a capitalist market", or "lower costs"? It can't be all 3

Butterfly1234

It is very sad. My Mom has dementia and that was the only hope I had when it comes time to placing her in a facility. I too would like to know what it is going to be like in the future. If you don't have any money, you are screwed.
Please everyone...we need to band together. The rich don't care because their money will take care of them.

Dwasserba

What's being done for the 400 who qualify for subsidized beds but aren't getting them?

kjswartz

The 400 citizens who qualify had a better chance with Citizens & Montevue than with Aurora Incorporated in a different state.

thump1202

"Less than nine months after Frederick County voted to privatize..."

i take offense to this, the county never voted on this issue.

mandsk53

I fear aging. We are dehumanized and our lifetime contributions marginalized as middle aged local officials refer to us as "beds" and a body count that equates to a budgetary drain on tax payer dollars. Is this the 1930's? Business, wealth, and greed have supplanted humanity? The care of humans is analogous to fast food restaurants? Karma will get you.

stevem90999

Welcome to the New World Order. [sad]

MCEDDE21

Astounding! Young hired Aurora to fix the financial problems. Now, after nine months the problems are getting worse and Young says: "It's not THEIR fault!" Well, commissioner: Whose fault is it?

2ndAffirmative

If the subsidy beds are empty before the $3 million paid by the county is totally expended does Aurora keep the money? The plot thickens.

briancaps

Wow, Blaine said it's cheaper to leave the beds empty, meals in an institutional setting average $2 a meal, so to leave the bed empty or pay $6 a day for an indigent individual who really needs the help. What others costs go up by filling the bed? More direct care workers? probably not. Does electric bill go up? very little. A small expenditure on personal items, soap shampoo, toothbrush and paste. Private pay, i.e. insurance is $150 a day or $4,500 a month no wonder they only have 8 private pay residents and 3 new since June. What happens to the facility after the 54 subsidized residents as they "leave or die", does this beautiful building sit empty or house 8 residents because it is so expensive? How many employees would be laid off and join the ranks of the unemployed? It looks like Blaine Young and Aurora are walking all over the 1825 deed to help the indigent of the county. I hope the courts rule in favor of the citizens

japorciento

"Unfortunately," Young said. "It's more cost effective to let the old folks die and I really mean that." "They're going to die anyway," Smith added. "The faster we get them out of the way, the sooner we can give the money to the developers who can help us win elections." Delauter said, "They can go and fill the empty seats at McDonald's... I don't care what happens... Hey, Shreve! Wake up! Some reporter wants to talk to you!"

armillary

[beam]

Love your style. I'm a big fan of Andy Borowitz as well:
http://www.newyorker.com/online/blogs/borowitzreport

japorciento

[thumbup] Indeed, it seems the more likely possibility is that every dark cloud has an even darker lining. Blaine can most assuredly smile even though YOUR heart is breaking.

business

[thumbup]

Newthinking7

And in the mean time. more people are living in there cars, In your Neighborhoods. All except the neighborhoods of the elected folks.
Leagaly in Frederick county, there is nothing you can do about it.
No ability to curb any degredation.
Take a look at the house nexto toZion road and 180 , next to the comercial buildings. houses lots and lots of folks homeless from Virginia. Owned by yet another entreprenuer landscaper.
Ask the folks next door if they are happy.

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