The county nursing home dramas continue to play out around New York. Here’s another one.

Orange County (NY) Executive, Ed Diana submitted a 2012 budget that only had six months funding for the county nursing home, Valley View Center. The Legislature restored the missing six months funding. However, Diana vetoed the restoration. So now the question is do they have the votes to override? The initial vote, 19-2 certainly suggests they have the votes.

The Times Herald-Record has the story here. And kudos to them for actually tracking down how long it actually takes to sell a county nursing home:

Lawmakers had pushed for additional money because Diana’s plan leaves less than seven months to sell Valley View — if that’s the course the county chooses — and raises the prospect of closing the 360-bed facility or having to find additional money before July if the sale has not been completed.
Out of the four county nursing homes in New York that have been privatized in recent years, none has changed hands in less than 20 months, the Times Herald-Record has found. The longest deal took 28 months.

We’ve seen this ploy before – to sell rather than close – but almost always, it’s a desperate last minute attempt. Thinking that a sale can be pulled off in time to influence the coming year’s budget is either naive or a mask. Even a private sale must go through the State review and approval process and that takes months.

The budgetary part of what Diana’s doing sounds pretty similar to what Gene Levy did in Suffolk County. However, Levy started very early and found a buyer before putting only a partial year’s funding in the county budget. Then however, Suffolk’s Legislature, dragged out the process and the buyer walked.

The fact that the Suffolk buyer walked is telling in another respect. Anyone who knows this business in New York, knows that due to the State’s Medicaid cutbacks and reconfiguring long-term care, it’s a lousy time to be investing in nursing homes, much less offering premium dollars. It’s hard enough for the incumbents to survive and perhaps with a few odd exceptions (like exceptional land value), that opportunity for counties to sell and make anything is past. Indeed, Franklin County is paying the local hospital to take over its nursing home. That’s painful, but at least it’s reality based.

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“We’re on a Roll”

by John W Rodat on December 2, 2011

How could, “we’re on a roll,” not be the quote of the day for budget geeks, especially in New York?

Last night, New York Citizen One (formerly Albany Citizen One, but now renamed in honor of her expanding empire) attended the Audit & Finance Committee of the Albany County Legislature as they finalized their budget recommendations. She captured what’s a pretty typical discussion of the deep technical issues involved in revenue forecasting.

Next up, the Revenue and down there on line #1110 the legislature, the financial geniuses that they are, increase the County Executive’s already optimistic projected sales revenue and use tax by $2,277,707. When Mr. Mendick asks how the legislators can possibly project a higher revenue from sales tax than the already optimistic projection in this economic climate. In all seriousness, Jamie smirks, “best Black Friday in a long time.” Yes, it seems that this budget’s revenue projection was based on news casts from the Friday after Thanksgiving. Stunned, Mr. Mendick asks, “what’s that have to do with the next year?” Per Jamie, “We’re on a roll.” All in favor….the motion passes.

Now this highly technical analysis would be of no consequence except that Albany County is more dependent on sales tax revenue than any other county in New York except one (and that one has few people, but does have Lake George). And it would be of no consequence if there were plenty of money in the bank in the event that they’re wrong, but sadly, that’s not quite the case as Albany County is running out of cash at the end of each year.

No one around that I know can recall the last time the County Legislature did its own sales tax revenue forecasts, but this year, desperate to avoid a monster property tax increase of 19.2 percent and unwilling to cut anything worth noting or real, they’re doing their own forecasts.

Of course, forecasts being forecasts, things may turn out this way. The question is what is one willing to risk, especially when the forecast is based on one day’s experience.

You be the judge. Here’s the history, plus this year’s budgeted amount and the new forecast for 2012. I sure hope they’re right.

Albany County Sales Tax History and Budget 2012.png

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Tax Cap Office Pool

by John W Rodat on December 2, 2011

Office pool open on which local government budgets will have the highest property tax increases in 2012:

By category

  • City (excluding New York City)
  • Town
  • County
  • Overall

$25 for the winner in each category. $50 for the overall winner. (Hey, it’s coming out of my pocket and I’m among the 99 percent.) Ties will share the prize equally. Did I miss anything?

Post a comment with your entry or entries or send me an email. If your entry comes by email, you’ll get the money, but may not get any public praise for your insight. Of course, anonymity may be your intent.

Regrettably, neither I nor my family members can participate. And you folks in the New York State Comptroller’s Office probably shouldn’t either.

And if this is some form of illegal wagering, the whole deal is off. I’ll spend the money on bail and all you’ll get is praise.

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Little considered or included in public discussions of property tax caps, or limitations on governmental expenditures are intergovernmental financial relationships. This is not merely a matter of mandates but recognition that very large sums of money flow back and forth between all levels of government. What is expenditure for one level of government is often revenue for another.

For example, in 2009, about 27 percent of county revenue in New York was in the form of State and Federal aid. This excludes operational revenue, such as Medicaid reimbursement for county-provided health services. But while the average was about 27 percent, from county-to-county, State and Federal aid ranged from 13.7 in Lewis County to 39.0 percent in Allegany County. Though they are in different parts of New York, both are relatively rural, thinly populated counties. Yet, they represent the opposite extremes in the use of Federal and State aid as a share of all their revenues outside of property taxes.

At a more detailed level, in 2009, State Aid averaged about 14 percent of county revenues, ranging from a low of 7.2 percent in Lewis County (and 8.5 percent in large, densely populated Nassau County) to a high of 19.5 percent in Yates County. At the same time, Federal Aid averaged about 12 percent and ranged from 6.5 percent again in Lewis County to 25.0 percent in Allegany County. The differences may reflect a wide variety of factors that influence respective shares, but since different services have different reimbursement rules and different expenditure levels, this may include different service mixes. Even when the services are “mandated,” the exact levels and manner of delivery are not. The rules are certainly not mechanical. Even for mandated services, discretion may be subtle at the local level, but it does exist.

Similarly some local levels of government share some of their revenue with even smaller jurisdictions e.g. counties share sales-tax revenue with cities, towns, and villages. In New York State, about one-quarter of local sales tax revenues (excluding the State’s share, which is a uniform four percent statewide) is distributed by counties to cities, towns, and villages. In 2009, about ten percent of counties shared none of their sales tax revenues. At the same time, about 10 percent shared 49 percent or more, up to a maximum of 61.7 percent.

Since there is much variation in sales tax receipts per capita, merely looking at what percentage of a revenue source is shared with other levels of government is insufficient and perhaps misleading. The graphic here shows sales-tax distribution per capita that goes from counties to cities, towns, and villages matched up against the amount per capita that is retained by counties for their own purposes.

NYS County Sales Tax Distribution to Munic 2009.jpg

Counties in the upper left, share little or none of their sales tax revenue and they receive and retain high amounts for each county resident. In the lower left, counties share little, but because their revenue is low, they still don’t have much for their own purposes. In the lower right are counties which share high proportions and they are left with relatively low amounts for themselves.

In the upper right are two counties, Albany and Warren. Relatively few counties may share a higher percentage of their sales tax revenue with local governments, but at the same time, relatively few (eight) counties retain as much for their own purposes as Warren and Albany. On the average, counties received $479 in sales tax revenues for each resident. In contrast, Albany received $755 per resident and Warren $776. Both share relatively high amounts but they still retain relatively high amounts for their own purposes because their sales tax revenues start from a high base. There were only three other counties whose sales tax revenues per capita were in excess of $700.

The average county retained $349 per resident for its own purposes. The lowest was $176 (Madison County) and the highest was $751 (Suffolk County). Albany retained $458 per resident and Warren retained $464.

Clearly, attempts to keep taxes or tax increases low at one level of government may trigger tax increases at another level (though at least that has the political advantage of requiring a different set of elected officials to cut services, increase taxes, or drain reserves. But the relationships are neither mechanical nor standardized. Without careful analysis, expect surprises. And remember what rolls downhill.

Later, we’ll turn the prism and examine what the numbers look like on the receiving end – at the city, town and village level.

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Down is Up; Up is Down

by John W Rodat on November 29, 2011

A year ago, the Albany County Legislature’s Chairman of the Audit & Finance Committee, charged the Commissioner of Management & Budget (me) of artificially suppressing revenue estimates in order to create an argument supporting drastic cuts – that is the revenue numbers were too low. And so with that as backdrop, he and his co-conspirators added over $18.5 million (4.1 percent) in “revenue” offsetting cuts and property tax increases.

Last night, the same person said that I had promised some $7 or $8 million in revenue that never showed up, – that is the revenue numbers were too high. And that that’s why Albany County is in financial trouble, looking at a large property tax increase. Their numbers didn’t pan out, but somehow it’s someone else’s fault.

You’ll understand why this quote from Andrew Lewis Carroll’s, Alice in Wonderland, came to mind.

Humpty Dumpty: “When I use a word it means just what I choose it to mean neither more nor less.”

Alice: “The question is whether you can make words mean so many different things.”

Humpty Dumpty: “The question is which is to be master that’s all.”

Of course, we remember what happened to Humpty, don’t we?

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Like cluster bombs, Mitt Romney is indifferent to indiscriminate “collateral damage.”

I’ve been doing some research on private equity firms and the more I see, the more I suspect that they’re just another version of the rapacious financial practices of the last couple decades. They may be better disguised than “collateralized debt obligations” and other financial gimmicks, but it’s the same game nevertheless. More on that later.

But in the meantime, that’s where Mitt Romney is from. That’s how he’s wired. Here’s a New York Times (11/26/2011) editorial on Romney on foreclosures.

Since the housing bubble began to burst six years ago, prices nationwide have fallen by a third. Nearly $7 trillion of home equity has been wiped out. Currently, some 14.7 million homeowners owe $700 billion more on their mortgages than their homes are worth. Going forward, prices are likely to fall further as banks put a backlog of foreclosed properties on the market. As home prices fall and more homeowners sink underwater, there will be more foreclosures and more price declines. So what is Mitt Romney’s response? Bring it on.

In interviews and in the Republican presidential debates, Mr. Romney has said that the cure for foreclosures is for the government to get out of the way and let the process run its course. Once prices hit bottom, investors and want-to-be homeowners would presumably swoop in and prices would stabilize.

The argument might have some red-meat appeal, playing off the notion that any owners who lose their homes are getting what they deserve. It is wrong on several counts … efficiency … logic … danger … fairness.

Romney sets up a straw man, and the Times rightly slaps him down, “At a recent debate, Mr. Romney was asked why he was willing to risk further huge losses in home equity by pushing foreclosures. ‘What would you do instead?’ he replied. ‘Have the federal government go out and buy all the homes in America?’

No one is suggesting that. What is needed is a set of policies — rentals, forbearance, principal write-downs and refinancings — on a scale that tackles the problem.”

It’s no wonder that the populist wing of the Republican Party won’t warm up to him. It’s not his lack of principles that’s truly scary. It’s what he does believe in that’s frightening.

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Patient Patronage

by John W Rodat on November 23, 2011

Not generally recognized in the county nursing home business is a second form of political patronage, namely “patient patronage.”

Sure County Legislators and other politicians call when they want a job for a friend, family, or constituent. No surprise there. This practice was pretty much suppressed in Albany County government for the first dozen years of Michael Breslin’s term as County Executive. But it’s been increasing as the Legislature seized control of the ability to hire and Dan McCoy, the current Chairman of the Legislature and County Executive-elect has already shown that’s how he operates and intends to operate.

What the public is likely not aware of, is that local politicians do the same thing to get a patient admitted to the Nursing Home and to get other public services. In this morning’s Times Union, Gary Domalewicz, the Chairman of the Legislature’s Nursing Home Facilities Committee explicitly admitted it. Referring to a threat to close the Nursing Home unless, the Property Tax Cap is overridden, Domalewicz said:

We are not going to shut down our nursing home and send our elderly seniors and longtime Democrats out on the street. (Emphasis added.)

By “longtime,” Domalewicz means, a regular, somebody we know.

Read the whole story here. On many levels, it’s pathetic.

So if you’re a “longtime Democrat,” you get favored in receiving public services. Everyone else needing help, wait in line. Makes me ashamed to be a Democrat.

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As expected, key members of the State Senate, told Saratoga County officials not to plan on a local sales tax increase (which requires permission from the State Legislature and Governor), to balance the County budget.

It was unlikely from the beginning. The State approved extensions of existing taxes during the current year, but approved no increases. Next year is an election year for State legislators and it’s been hard to imagine why they would approve such increases just a few months before an election.

So County officials went back to the drawing board and proposed increasing property taxes. They also proposed substantial budget reductions and extending the requirement that County employees contribute 15 percent of health benefit costs to those who had previously been exempted. Already employed by the County at the time the requirement was imposed, they had been exempted while the requirement was imposed on new employees.

As health benefits are collectively bargained, the extension of the health benefit cost share to remaining employees would have to be agreed to by the relevant unions. Implicitly and hinted at, the alternative is layoffs. We’ve seen this tradeoff before and it’s always interesting to watch the internal dynamics within the unions. The leadership tends to be senior, and thus exempt from the requirement. Those most susceptible to layoffs are the most junior. Inevitably this produces tensions between more senior and more junior union members.

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Today, the Committee charged with reviewing applications for health facility construction projects for New York’s Public Health and Health Planning Committee took up Albany County’s certificate of need application to build a new nursing home.

After considerable discussion and an emotional appeal by a patient’s family member and one County Legislator, the Committee voted to defer action.

The discussion started with questions posed by Committee members, in particular two people with nursing home and assisted living experience from Western New York. They politely but forcefully noted that the projected losses and questioned whether the County was really prepared to cover a $26 million loss. The Deputy County Executive, who had not planned to speak, but who was effectively forced to, responded that yes that was the County’s intent.

Another Committee member asked about the status of the pending revised Medicaid rates. The Director of the Office of Health Systems Management responded that the rates should be published next week. He also noted that since the new rate calculation methodology applies the same price regionally to all facilities, that generally it is assumed that government sponsored nursing homes, which are typically the most expensive, would suffer the most under the new rates. Should this happen, it’s likely that Albany’s deficit would be even larger.

A Committee member asked the Deputy County Executive whether he had known about the new rates and then asked whether the County might want some more time to get the rates, evaluate the effects, and perhaps reconsider since it could means millions more in losses. He said that he was aware that the new methodology and “been around” for a while but that he was unaware that new rates were going to be published. On that, at least outwardly, he seemed genuinely surprised. Then he said that yes, the County could use some more time.

A motion was offered to defer action on the application and the Chairman was ready for a vote, when the patient family member and the Legislator insisted they wanted their opportunity to speak. They made impassioned, perhaps angry arguments, that the project should be approved regardless. When a Committee member asked the about whether the risk of millions in additional losses might be of concern and worth review, a woman sitting behind me, also a patient family member, said of the Legislature, “they won’t care.” That’s regrettably true of some Legislators, but these are the same people who are right now having trouble putting a budget together.

The Committee voted unanimously to defer action.

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The Administrator of a non-profit nursing home in Albany County reminded me yesterday that what the area really needs is more assisted living, residential capacity. Right now there is only one facility in the County that accepts Medicaid for Assisted Living, a less patient restrictive, more homelike, and much less expensive type of program than skilled nursing facilities. And that one facility has no more than 50 beds available for Medicaid clients.

The Administrator mentioned above emphasizes that increased assisted living capacity is important not so much as an alternative to nursing home care at the time of admission but rather when a patient (typically post-hospitalization) has gone through a month or two of rehab and is ready, both physically and mentally to move to a less restrictive setting. Some such patients still require assistance which can be provided at home or in an assisted living facility and the choice depends on the specific needs, preferences, and social (not medical) circumstances of the patient, such as do they have family or other social supports. However, since there is just that one assisted living facility in Albany, with less than 50 beds, there is no place to discharge the patient to. Time passes, the patient settles in and after a while the window of opportunity closes. Had there been sufficient alternatives, the patient could have settled in to a less restrictive, more homelike, and much less expensive facility.

When Michael Breslin put his long term care plan together, long-term care plan (the PDF of the plan can be found at Albany County 2009 LTC_Plan.pdf or possibly here) it explicitly included a trade-off to help resolve this problem. New York’s current policy is for thousands of skilled nursing beds to be traded in for assisted living beds. However, New York will not approve new assisted living capacity unless a comparable number of nursing home beds are closed. There were a number (at least five) organizations interested in developing and/or operating new assisted living capacity in Albany County. So Breslin proposed such a swap.

The Albany County Legislature never considered it.

Why bring it up again? Because driven by the Legislature’s preferences, the County’s sole concern is with its own facility. The current Albany County Nursing Home has 250 beds. The proposed new one has 200 plus 30 adult day health slots. Under the State’s rules offering to approve new assisted living capacity when existing skilled nursing beds were closed, there was an opportunity to offer another operator the opportunity to add new assisted living capacity. The County’s CON application left on the table those potential new assisted living beds.

The County proposal, now before the State, never even considered the option. The County Legislature claims to be most concerned about the community. They had an opportunity here, at zero cost to County taxpayers, to see an alternative program expanded. All they had to do was offer it and go through the process of finding an appropriate operator/s with which to jointly approach the State. Their failure reveals their ignorance, which is bad enough, or worse that only concern is their own sandbox and nobody else can play in it.

Another opportunity lost.

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