There are plenty of reasons why owning a nursing home no longer makes sense for Suffolk or any other municipality, but County Executive Steve Bellone has yet to offer them.
He's focused on the financial drag the John J. Foley Skilled Nursing Home has become to Suffolk's operating budget.
The argument hasn't worked with lawmakers and the county union representing nursing home employees. And threats to close the Yaphank home, as Bellone made in his State of the County address last month, and to fast-track closure of the nursing home within two months haven't been effective either.
Instead of continuing to escalate the fight with lawmakers and unions, Bellone needs to begin an open, honest public policy debate. Yes, the county has a deficit. But the twin reality is that Foley, with 264 beds, is too small to access enough state and federal health funding to remain afloat as a public entity.
The nursing home, which made sense when it was founded decades ago as part of a municipal effort to expand health care services to residents, has been left standing still in a fast-moving, ever-changing health care environment.
Nassau once was in the business of providing direct health care to residents. What is now known as the A. Holly Patterson Extended Care Facility was opened even before the Nassau University Medical Center was built.
Nassau considered selling the nursing home twice, during budget crises. Former County Executive Thomas Gulotta, a Republican, in the 1990s decided instead to transfer the home, along with the hospital, to a public benefit corporation. His successor, Thomas Suozzi, a Democrat, considered shuttering or scaling down the nursing home, which in the early 2000s was plagued by allegations of staff members bringing prostitutes into the building and a series of incidents involving abysmal patient care.
Gulotta was looking to cut costs. Suozzi's issue was that the financial problems of the county hospital and the nursing home -- should they, as was feared, become insolvent -- would bring down the county, which backed the multimillion-dollar bonds that funded creation of the public-private corporation.
Ultimately, Suozzi was persuaded to keep the nursing home, which like the hospital is run by NuHealth Nassau Health Care Corp. and staffed by unionized county employees.
But the county demanded significant changes in a deal that offered limited, short-term financial help to the corporation. Since then, NHHC has concentrated on securing significantly more federal and state revenue and cutting costs at Patterson, while transforming it into a facility serving paying residents.
Foley's capacity is half of Patterson's, which makes it ineligible for the level of funding Patterson now receives. Another issue is that Foley stands alone -- unlike Patterson, which is part of a health care circle that includes corporation-run NUMC and community health care clinics.
Then there's the rapidly evolving state of health care. If Foley is to prosper in a nursing home market that currently has excess capacity, it would require considerably more expertise than a municipality can provide. Obamacare, with its emphasis on outpatient care for the elderly when possible, also is on the horizon.
None of this absolves Suffolk of responsibility for the health and well-being of its residents and employees. Both can, and should, be part of any resolution. The bottom line is that the state of care is changing, and Foley will have to change, too.