The League’s Notice:

LEAGUE OF WOMEN VOTERS OF ALBANY COUNTY

Choosing to Stay at Home

  • Participate in a discussion about long term care (e.g., home care and other support services) designed to help Albany county residents remain in their homes.
  • Ask questions of long term care professionals and voice your thoughts about improving long term care community services.

September 27th, 2012
6:30-8:00 pm

St Sophia’s Church
440 Whitehall Road
Albany, NY

Speakers and Agenda

  • Moderator: Barbara Meg Frankel, League of Women of Voters of Albany County
  • Getting Help in the Community: Community Based Services
    Erin M. Stachewicz, LS, Long Term Care Coordinator
    Albany County-NY Connects: Choices for Long Term Care
    Albany County Department of Social Services
  • What’s Missing?
    Richard Iannello, Executive Director
    Albany Guardian Society
  • Using What We’ve Learned
    Paula Hemmings, MSN, RN, Former Care Line Manager for Long term Care Services in Upstate NY Veterans Healthcare System

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In addition to a looming tax increase and other financial challenges, its inability to set a sensible direction on long-term care, Albany County, New York has been suffering from County Comptroller Mike Conners’s release of Social Security numbers (SSNs) of staff of the District Attorney. There’s been some confusion about the sequence of events, but there’s no confusion about the release of SSNs.

No one should be surprised.

Conners did his own, hardly independent, report of the incident and bragged privately to others about how well he had handled the public relations. Note that Conners admits looking at the relevant data before there was a Freedom of Information request. As this was relevant to a campaign for District Attorney, in which he had taken sides, the timing of events may be relevant. Certainly they suggest the possibility that his looking for the data was less an “investigation” than it was using County resources for political meddling. Certainly Conners should have been aware that the bonus program was nothing untoward, but structured to minimize the risk of budget increases. Now, evidently, Conners is annoyed that County Executive, Dan McCoy triggered an investigation by the County Attorney, complete with subpoenas.

What Conners has not told anyone is that this was not an isolated incident. The same staff person, Assistant Comptroller, Anthony Fontanelli, who generated the report with the Social Security numbers, and who is a very senior staff person and who reports directly to Conners, was central to a previous incident, abusing the same, central information system. Moreover Conners didn’t tell you is that Fontanelli previously had his access revoked to the Human Resources module which contains the SSNs, but that his privileges were restored at Conners’s insistence.

And what Conners didn’t tell you is that, having previously failed to deal managerially with a significant problem within his own agency, he is now using the same arguments to again restore Fontanelli’s information system privileges, holding the entire County hostage if he does not get his way.

After the earlier incident, Conners refused to do anything about Fontanelli’s behavior and then insisted that without Fontanelli, his Office could not perform its job. Michael Perrin, then Deputy County Executive directed that Fontanelli’s privileges be restored. Now Fontanelli’s privileges have been once again been restricted. The following is from Conners’s SSN report:

Monday September 17, 2012: Without notice to the Comptroller, County Executive Office staff accessed the administrative protocols of the MUNIS system and reduced a Department of Audit and Control’s employee’s access to the MUNIS. System. As a result, the staff member is unable to complete his civil service duties. His duties include updating and posting the County Budget per the Legislature’s monthly resolutions. He is also unable to access payroll lines to determine funds available for allocation or movement to other lines. These actions are necessary to keep operations moving without issue, as a fiscal control. The employee is now also unable to insure updates are properly entered for year-end reports to the Legislature and budget action.

The information system in question is MUNIS, which is Albany County’s central and most important information system and one of the very few that’s used throughout Albany County government. MUNIS includes all the key financial functions such as budget, general ledger, accounts payable, accounts receivable, and human resources.

Unfamiliar readers should know that at the time, I was the County’s Commissioner of Management & Budget, having responsibility for budget, cash management and information services and technology. Under the County Charter, I worked for the County Executive. To ensure appropriate checks and balances, the County Charter divides financial responsibility between the Comptroller and the Commissioner of Management & Budget.

The earlier incident was grave. I detailed it at the time in a letter to Conners, dated September 1, 2009 (PDF). The earlier incident involved:

  • Most importantly, Conners’s papering over and excusing a significant security breach and a breach of trust by his own senior staff. This was particularly egregious because, among other things, it was an attempt to increase the budget for his own agency. Whether he induced it, tacitly or explicitly approved it, or created on organizational culture where such behavior is considered acceptable, even normal, I don’t know. But he is certainly responsible for his organization’s behaviors and failures.
  • At least in my judgement, violation of the County Charter by the Comptroller’s staff. By intruding into the Budget module, where he did not have system privileges, Fontanelli was also intruding into the Budget process, where the Comptroller does not have Charter responsibilities. Here too, this is Conners’s responsibility.
  • Violation of the County’s information technology security policies by the Comptroller’s staff. In many private sector organizations, the violations were of a nature that would have led to immediate firing – as in the employee would have been escorted to the exits immediately without making it to the end of the day. These violations including Fontanelli’s giving himself at the highest level (5), access to the Human Services and Budget modules of MUNIS, the County’s central information system.
  • Using this unauthorized access, Fontanelli’s secretly changing the Comptroller’s budget, long after the County Charter mandated deadline. Other staff of Conners, William Curran, whether knowing that it was based on a lie or not, then sent a Fontanelli generated report to Budget staff that because of the date-time stamp, proved the unauthorized intrusion. Note that Curran is Executive Deputy Comptroller, ranks even higher than Fontanelli, suggesting that at the highest level of Mike Conners’s Department of Audit & Control, this is standard behavior. So is the failure to actually read the reports they generate and to consider their implications.
  • Fontanelli’s secretly changing the budgets of two other County agencies, long after the County Charter mandated deadline, and one, the Sheriff’s without the Sheriff’s knowledge. That was to hide $275,000 in “revenue” in the Sheriff’s budget. Neither the Sheriff nor his staff was aware of this change. Moreover, without getting into the technical details, this was a means for the Comptroller to hide “revenue.” It may or may not have been real revenue, but it was well hidden and Conners had previously “found” exactly the same type of revenue and, playing the “hero,” offered it to the Legislature to reduce the need for reductions, and undermining the budget process where he now asserts there is a “structural deficit.” That is most certainly true, but ironic as this behavior contributed to it. The other changes were to the Probation Department’s budget were small, of a technical nature, but also unknown to the Probation Director.

Among other things, I specifically recommended to Conners at the time that he should:

  • Re-evaluate Mr. Fontanelli’s role in your Department, particularly as to whether he should continue to have any role in MUNIS.
  • Assign Mr. Fontanelli’s responsibilities to another person or persons in your Department.

Conners did neither.

In short, Conners didn’t tell you that the Social Security Number incident is strikingly similar to the earlier event, involving the same staff, misuse of the same information system, the same excuses, the same management failures, and the same holding the entire County hostage to avoid any restrictions, reforms or penalties. Conners clearly did nothing to remedy a significant problem within his own agency, leading directly to the Social Security Number release.

Conners’s hostage taking succeeded the last time in getting Fontanelli’s system privileges restored. It should not this time. This time, Conners should take responsibility for his own managerial failings. So should the County Legislature.

Note 1: Conners did respond to my letter, but I do not have a copy. It used a lot of words, but clarified nothing except his insistence that the office for which he was responsible could not function without Fontanelli, effectively saying that he could not manage his own agency.

Note 2: Even before the above incident, there was another about which I know relatively little and which was probably more about Fontanelli’s carelessness, if not incompetence, but probably not abuse. In that incident, Fontanelli, destroyed some files being prepared by Human Resources for the transition from one fiscal year to another. Then rather than seeking help, or testing a solution, he destroyed all of the individual salary files necessary for the first payroll of the new year. Human Resources staff spent a lost, angry weekend rebuilding the entire payroll individual line by individual line. Except to note that I should have been more sensitive to the question of what Fontanelli was doing in the HR module, I’ll defer to others to detail that debacle.

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Key committee of Public Health and Health Planning Council (PHHPC) voted unanimously a short time ago to disapprove Albany County’s application to build a new nursing home.

More details later.

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Another quote of the day. Mine. Pretty obnoxious, huh?

In this case, the day was March 20, 2012. this is what I said when the Albany County Legislature first became aware of the projected costs for a new nursing home that their own leadership had submitted to the State as part of a certificate of need application and their leadership then tried desperately to cover their tracks by claiming the projections were not theirs and weren’t accurate anyway.

Whatever the reason, by disowning the financial projections and by saying that the projections are false, Shawn Morse and the leadership of the Albany County Legislature have just about guaranteed that their certificate of need application to build a new nursing home will be disapproved.

There were other pathways. But the Albany County Legislature was steadfast! And it steadfastly refused to see them. Or take them.

Please pardon my hopefully not premature celebration. And here’s hoping I don’t jinx the right decision by New York State.

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Time to put on your big boy pants, Danny:

Face reality, Mr. McCoy – Times Union Editorial (perhaps I’m taking a liberty here, but in its entirety):

THE ISSUE:
The state shows every sign of denying the county’s quest to build a new nursing home.

THE STAKES:
The elderly, especially those who are poor, still need care — so find better ways to provide it.

Nothing Albany County Executive Dan McCoy can do today is more important than taking seriously what state Health Department officials are saying: that the county should not build a new nursing home.

Given how emotional an issue this is for voters, it’s not surprising that it’s hard to track where officials stand. Mr. McCoy, for one, used to want a new nursing home, and the state previously suggested tentative approval.

But the Health Department staff’s recommendation that the state reject the county’s application to build a new $71-million facility provides both a fiscally credible and a politically convenient solution. It’s a way out of this mess for a county executive who is putting the finishing touches on a 2013 budget that must confront a looming $35 million deficit. How can he not embrace such authoritative opposition to the proposed new facility — which is projected to lose another $24 million a year? Taxpayers can’t possibly pay for that.

No longer can Mr. McCoy be among those pushing what the county can’t afford. That was his view when Mr. McCoy was merely chairman of the County Legislature. Now, as the county executive, he must lead, not hide behind indecision and conflicting comments.

That doesn’t mean abdicating the responsibility to care for the elderly who are both poor and sick, as Mr. McCoy’s successor as chairman, Shawn Morse, among others, is forever reminding us. It means finding more economical ways to provide that care.

Mr. McCoy, for instance, has raised the idea of transferring operation of the aging and money-losing 400-bed facility, which now houses just 250 patients, to a local development corporation. He also needs to be exploring a more integrated system of home and community care, as a means of solving this ongoing fiscal dilemma. He needs to get a better grasp of how many county residents will need the more specialized levels of nursing care, and see if it’s possible for the county to work with private nursing homes to provide that care, even for families that can’t afford it.

That’s a very sensitive issue, especially when it involves Alzheimer’s patients and other hard-to-place people. It requires pushing harder than ever for a state takeover of the Medicaid funding that puts such a fiscal strain on seemingly every county in New York.

There’s some urgency to just how and when Mr. McCoy ought to speak up. A Health Department committee that received the officials’ recommendation meets today in New York City. The Public Health and Health Planning Council, the outfit that will finally rule on the county’s still pending application for approval of a new nursing home, meets Oct. 11.

It’s time to stop pretending that the issue is how the state is handling the county’s application — which still seems to be the dodge employed by Mr. McCoy and Mr. Morris (sic, it’s Morse) — and take a look at the hard numbers. Mr. McCoy’s own transition team recommended closure, and his predecessor, Michael Breslin, initially did, too, before giving in to the County Legislature’s fiscally irresponsible path. Now is the time to accept reality.

Barring an extraordinary turnaround, the state won’t sign off on putting Albany County taxpayers at such fiscal risk. So let’s see some realistic alternatives on the table.

For God’s sake, McCoy, the State is about to give you cover and the Times-Union just did. Take advantage of them. Face up to this. Same goes for you County Legislators, especially those of you who said behind closed doors that you didn’t really care, but you couldn’t say so in public and were just waiting for the State to reject the proposal.

By the way, though it may be elsewhere such as in Saratoga, a local development corporation is not a solution for Albany County. It might once have offered a pathway to a solution, but not likely now. More on that later.

Also by the way, great timing! County budget must be submitted by the County Executive no later than October 10. The final State decision will come on October 11. But the final State decision is very unlikely to differ from what is decided later today.

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A couple of reactions to the latest Albany County attempt to build a new nursing home. Perhaps we’ll get into details later, but the only real change from the last version of the County’s application to the latest revision is an increased revenue estimate because they think the managed long-term care changes the State is forcing as part of Medicaid reform, will generate more Medicaid revenue. More? Did we miss something about the point of Medicaid reform? We though it was to spend less, not more money.

So anyway, here are some reactions to Albany County’s latest.

One of New York’s premier health care finance experts and institutional advisors:

My partner showed me the story in the newspaper. When I saw the projected $24 million loss, I said, that must be a typo.

Nope. That’s what Albany County considers an improvement.

From the administrator of another nursing home in the county (a good one, by the way):

My nursing home is about the same size as the Albany County Nursing Home. My total budget is about the same as what they lose every year.

Translation? They spend twice what I spend to serve the same number of patients.

From the New York State Health Department’s analysis of Albany County’s revised CON application:

Project cost of $70,938,554 exceeds reimbursable project cost by 27%.

Translation? The proposed capital cost of the new building would be $19.1 million more more than we would even consider having Medicaid pay for. And that doesn’t include what we typically require sponsors to contribute as equity.

More from the State Health Deparment’s analysis:

The projected operating loss is almost 50% of operating expenses and the projected incremental loss of $5,561,364, combined with a loss of $6,100,000 in inter-governmental transfers, creates an incremental budget shortfall that would require an almost two percent increase in the total Albany County operating budget, assuming no other changes.

Translation? 50%? That loss is grotesque even before the proposed increased loss. And heads up on inter-governmental transfers. Don’t count on them for the future. And by the way, that amount may by itself be two percent of the County budget, but it alone would generate a 7.7 percent increase in County property taxes. With the additional loss of IGT, which the Health Department appears to expect, the property tax increase would be 11.4 percent.

Still more from the Health Department:

As previously mentioned, the facility incurred a loss of $18,597,505 in 2011. This application proposes a loss of $24,158,769 during the third year after project completion, which is an incremental loss of $5,561,364 when compared with the 2011 operations. As a result, it does not appear that this application will improve the financial performance of the facility.

Translation? Building a new nursing home doesn’t make things better for the County; it makes them worse.

More from the Health Department:

Budgeted revenues are the applicant’s estimates of managed care rates with the implementation of long term care Medicaid mandatory managed care and are based on Albany County Nursing Home’s managed care rate experience to date. The resulting revenues are slightly greater than previously presented budgets. Department staff’s assessment is that the assumed rates are at the high end of what may be considered reasonable.

Translation? The Health Department doesn’t believe the numbers the County submitted. I don’t either. I do love the Department’s euphemism though.

From one of New York’s leading figures on Medicaid managed long-term care:

They think they are gong to make $2 million MORE in revenue under managed care?!

Translation? She doesn’t believe the numbers either.

And still more from the State:

Budgeted expenses have not changed from figures presented in December and April and reflect increased staffing for new proposed programs. While specialty staff may well be needed for the proposed vent bed and behavioral units, projected staffing levels are questionable given the reduced certified bed count from 250 beds to 200 beds.

Translation? The proposed different program mix should require a different staffing mix, but the County did not address that at all. And Albany’s operating costs are too high anyway.

Part of the justification for a new nursing home in its revised Albany County CON application:

ACNH has a significant population of residents who have low PRI scores. Under a system of managed care, it is highly likely these residents would be placed in a less expensive community setting.

Translation? These patients don’t really need to be institutionalized. Though we don’t reflect it in our financial projections, we’re likely to have fewer patients. (The PRI is a patient review instrument, the assessment tool used by all nursing homes in New York.)

Attorney who represents persons with disabilities, referring to the above mentioned “significant population of residents who have low PRI scores:

Under Title II of the Americans with Disabilities Ace, a governmental entity has an obligation to provide services to persons with disabilities in the most integrated setting appropriate to their needs. It does not matter whether it is under a managed care or fee-for-service model, as long as there are community based services available. Not saying it would be an easy case, but combine it with the County’s elimination of EISEP funding and the RSS program, and we may have something DOJ would sink its teeth into.

Translation? While pushing nursing home care as the only alternative and, at the same time, reducing the County budget for home and community based services, Albany County is opening itself to an Olmstead based lawsuit. And I would say deservedly so.

State Health Department summary analysis and recommendation regarding the CON application:

With its previous project deferral actions, the PHHPC gave the applicant the opportunity to develop a more cost efficient and sustainable nursing home project, not just for the citizens of Albany County, but for the regional health care system. The applicant’s resulting, revised operating budget and project budget are not substantially improved from those previously presented to PHHPC. As such, it appears that the applicant has not adequately addressed the PHHPC’s expressed concerns over financial feasibility in a Medicaid managed care environment and disapproval is recommended.

Translation? Pretty much speaks for itself.

Jordan Carleo-Evangelist, reporter for Albany Times-Union, quoting Mike Conners, Albany County Comptroller:

No question that Danny (County Executive Dan McCoy) has lost the enthusiasm for owning and running a nursing home.

Duh. Amazing what having to deal with reality will do to you.

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Life Amongst the 47 Percent

by John W Rodat on September 19, 2012

Mac McClelland, of Mother Jones, visits her father, a college friend, and others in Ohio’s War on the Middle Class, “Wherein I go home, watch public servants get axed, visit the warehouse of unbearable sorrow, hang with jobless thirty somethings living in abandoned homes, and consider whether my generation is flat-out screwed.”

I’d forgotten that Ohio’s Governor Kasich had spent some time at Lehman Brothers. It figures.

Here are some quotes from McClelland, which should give you the flavor. Her father says:

“Recessions,” as my father sometimes puts it, “don’t affect people like me.

But he’s seen the other side and he’s neither fool nor heartless. He also says:

You know, you used to be able to survive blue collar,” he says. “Now, the blue-collar guy, they just crush the life out of him. It’s very depressing.

More regarding a college friend who’s actually trying to be decent while managing a logistic center:

Quite literally, her workers are as disposable as the products they’re shipping.

And another:

Before this, they were renting half of a duplex at a reasonable $400 a month. But Randal has been out of work for a long time now, and there’s not much point in paying rent when this house is just standing here empty. It’s something of a trend to occupy abandoned homes in the post-housing-crash world, and Randal’s sort of a pro at this point. His grandmother also lost her house a little while back. She was disabled; when she worked at an auto plant in her 30s, a piece of sheet metal that flew off a rack sliced off both her feet. She took out a mortgage on her paid-for house after her husband died; later, she couldn’t keep up with the payments and had to leave. It was foreclosed on and emptied, but Randal stayed on. “They probably won’t get around to coming and throwing anybody out for a long time,” he says. “At the rate houses foreclose around here, they can’t keep up.”

A partial summary:

This is just one more in a long series of highly depressing conversations I’ve had over the last month. I’m reporting from Ohio, for God’s sake, not the Third World, yet still my interviewees are sweating over how they’ll manage to survive despite living in the richest country in the history of the world. Because some politicians are passing some greedy and indecent and inhumanely neglectful and inconsiderate laws.

Yes, there’s a class war. But it’s the reverse of the usual and the reverse of how most political commentators have superficially described it in recent years. It’s top down. It’s not only about concentrating more wealth at the top, it’s about concentrating more political as well as economic power at the top and about how that all interacts and is self-reinforcing.

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Beth Noveck talks about much more than data. Think networks, and not just electronic ones, to open up government.

TED talk takes about 18 minutes.

Watch it.

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Will get to the substance in a later posting. But this is verbatim from the State Health Department’s recommendation to the Public Health and Health Planning Council.

Albany County Nursing Home, a 250-bed county owned residential health care facility (RHCF), requests approval to construct a 200-bed replacement facility and certify a 30-slot adult day health care program (ADHCP). The 200-bed facility would consist of 180 RHCF beds and 20 ventilator-dependent beds.

Currently, the facility does not consist of any ventilator dependent beds. This new facility will be constructed on land adjacent to the existing facility, which has reached the end of its useful life. The County is proposing that this new facility will address deficiencies in the existing building, including a lack of air conditioning, storage space and sprinkler system.

This project had been deferred by the PHHPC from its December 2011 and April 2012 agendas. On April 5, 2012, the Establishment and Project Review Committee requested that the applicant reassess the cost of its project in light of the two percent real property tax cap legislation and submit an analysis of what the financial impact will be on the facility given the reimbursement system transition to a managed care reimbursement methodology. As a result, the Establishment and Project Review Committee deferred this application until the applicant performs the analysis and submits new budgets demonstrating the capability to operate in a financial feasible manner in a mandatory managed long term care environment. This new reimbursement methodology is to be implemented in 2014. The applicant has submitted revised budgets, which will be discussed in a subsequent section.

Total project costs are estimated at $70,938,554.

DOH Recommendation

Disapproval.

Financial Summary

Project costs will be met via General Obligation County
Bonds (30 yrs. @ 4.00%).

Budget:
Revenues: $26,655,018
Expenses: $50,813,787
Gain/(Loss): $(24,158,769)

The projected operating deficit is proposed to be funded by Albany County. Given PHHPC members’ expressed concerns over the cost and financial feasibility of this project and the applicant’s insufficient response to those concerns, disapproval is recommended.

Committee meeting is this coming Thursday, September 20, 2012 in NYC.

Good!

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Quote of the day from Brene Brown:

Stories are just data with a soul.

And more personal stuff in a 20 minutes on Youtube talk, such as on vulnerability, along with research observations.

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