After decades of providing long-term senior care to residents, Nashville is looking to get out of the nursing home business.
It would be far from the first city to do so. And in fact, Metro officials say it would be one of the last.
Under a plan announced by Mayor Karl Dean last month — and beginning the process of Metro Council approval this week — the city would sell the Bordeaux Long Term Care and Knowles Home Assisted Living facilities to private operators, who will continue their services for at least 10 years. Officials say the era of government-run facilities like these is over. According to the text of the Metro Council ordinance, only 6 percent of the long-term care facilities in the United States are operated by government entities, and "no other large county or municipal government in Tennessee still owns or operates nursing home facilities."
Dean and other supporters are pitching the plan as a way to save taxpayers money, improve care for residents of the facilities, and usher in future development in the area. Privatization would eliminate $10.5 million in annual subsidies to the facilities, and Dean has essentially argued that private companies will be better at the job.
"We can do better by our seniors, our employees, our community and our taxpayers by bringing partners to the table with the specific expertise and resources necessary to help these facilities succeed long term," Dean said in the administration's initial announcement.
The plan has Kentucky-based Signature Healthcare paying $1.3 million to operate 260 licensed beds at the Bordeaux facility, which has 419 licensed beds but currently serves about 220 residents. Signature would also invest $250,000 in improvements to the existing facility and build and operate a new $18 million, 168-bed skilled nursing facility on Dickerson Pike near Skyline Medical Center. Metro subsidies to the Bordeaux facility — about $8.7 million annually — would decrease annually, and be eliminated within three years.
For the Knowles Home, Metro would lease the facility to Autumn Assisted Living Partners, an affiliate of Nashville-based Vision Real Estate Investment Corp. Vision would pay Metro $500,000 for the facility, plus $1,000 annually during the 10-year lease. Approximately $1.8 million in annual Metro subsidies to Knowles would be eliminated beginning July 1 of this year. (Vision also has long-term plans for acquiring and redeveloping a total of 76.6 acres around the campus.)
No residents would be displaced under the plan, and Bordeaux residents would be given the option to stay put or move to Signature's new facility once it's built. Officials say more than 90 percent of the employees at the two facilities "will be offered positions with new employers at the same salary they currently earn." All employees at Knowles will be able to keep their jobs, and Metro officials say they will work to find new positions for 32 non-clinical employees whose jobs will be eliminated at Bordeaux.
Councilman Lonnell Matthews, whose district includes the Bordeaux campus, says he had reservations initially but supports the plan now. He says his initial concerns, including the continued presence of a long-term care facility in the area and the displacement of employees, are being addressed. And the surrounding community, he says, is excited about the possibility of moving forward with a master plan for 300 to 400 acres of land that will be retained by the Metro Parks Department under the plan.
Subsidies to the Metro Nashville Hospital Authority decreased from $47.5 million last fiscal year to $38.7 million in the current one. At-Large Councilman Jerry Maynard, who proposed selling the facilities back in 2009, says Nashville General Hospital should be the priority when it comes to those subsidies. He says he believes Davidson County "has a moral obligation, and by charter a legal obligation, to provide a public safety-net hospital for its residents."
"There are plenty of nursing homes that are privately run, privately owned, that can provide care — high quality care — for our senior citizens," he tells the Scene. "The public safety-net hospital is a different situation where only the county really can provide the resources necessary to provide care regardless of a person's ability to pay.
"We can ensure the delivery of high-quality health care for the patients of General Hospital, while at the same time saving Davidson County taxpayers money," Maynard adds. "That is a win-win."
Residents will also win, officials insist, because they will receive improved care. That hasn't necessarily been the case everywhere. But Maynard points to Signature's track record — and to Metro's strained budget. It's not that Metro Hospital Authority employees have done a poor job, he says, but that they did the best they could with increasingly limited resources.
"Signature as a private entity can provide the resources to remodel Bordeaux, the infusion of necessary cash for capital improvements in order to enhance health care at Bordeaux," he says. "Metro government doesn't have the money to do that."
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