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Saving Nathaniel Witherell

Bob Capazzo

One of the more protracted debates on town issues is the seesaw struggle over what to do about the Nathaniel Witherell nursing home. The issue has been studied and analyzed, with detailed plans created and argued about at length over the past seven years by the Board of Selectmen, the BET, the Board of Health and the RTM. Perhaps it’s not surprising since Greenwich is one of only two towns in the state to operate its own nursing home, and a subsidy from the town is required to maintain it. A plan for renovation and reconstruction developed under the direction of Nathaniel Witherell’s former chairman Ed Kavounis got so far as receiving a certificate of need from the state’s Department of Health, but failed to be approved by the RTM.

Meanwhile, as the future status of the institution has continued in limbo, one after another of its executive directors have come and gone. Questions have been asked as to whether the town should be in the nursing-home business in the first place, or whether Nathaniel Witherell should be privatized or just closed down and the highly valuable land sold off to a developer. The latter alternative is not an option since the property is encumbered by the original 1903 deed of gift to the town from Robert M. Bruce, which specified that the site be restricted solely for use of a hospital. Yet many in Greenwich, including this magazine, believe Nathaniel Witherell, located on twenty-four beautiful landscaped acres on Parsonage Road, with its dedicated staff and volunteer organization, is a genuine treasure and an important asset that the town should preserve and renew. It also happens to be one of only three nursing homes in Connecticut rated five-star by the federal government.

Now at long last, we have reason to hope that a plan to save the institution is at hand. The current board of directors, led by its chairman David Ormsby, in consultation with their very capable executive director Bill Kowalewski, has developed a business plan that presents a less radical alternative than the previous proposal and should answer most of the questions and concerns of the RTM and the BET. Meanwhile, the board of the Nathaniel Witherell and the Greenwich Board of Health have both voted in favor of a charter change that will transfer authority for the execution and oversight of this plan to the nursing home’s board.

In the 104 years since the original Robert Bruce gift, the hospital complex has undergone a continuing metamorphosis. Originally called the Greenwich General Hospital and dedicated to conta- gious diseases, it became the Municipal Hospital in 1917 when the Greenwich Hospital was erected on Perryridge Road. Through a series of generous donations by Mrs. Nathaniel Witherell, a TB pavilion was built, later to become a nurses’ residence, followed by the administration building; and in 1946 her name was given to the complex. Since then the West Wing and the Tower Wing have been added and a series of renovations and conversions have allowed for expansion to the present capacity of 202 beds. In 2000, short-term rehab services were included for the first time.

The patchwork expansion over many years has inevitably resulted in a physical plant that is inefficient and costly to operate. The infrastructure is sorely in need of upgrading, and some older sections could be demolished. Renovation and upgrading are needed for the 1933 administration building and the 1975 tower housing patients. There are ten bedrooms with four residents to a room that need to be converted to doubles. In addition, the plan calls for construction of a new wing accommodating approximately sixty beds, which will create a state-of-the-art short-term rehab facility distinct from long-term care.

The total estimated cost of $36.9 million, of which $14.6 million is new construction, is considerably less than the present- day cost would have been for the 2002 plan that involved complete demolition and replacement. Even so, David Ormsby and Bill Kowalewski would offer no guarantee that some continuing town subsidy may not be needed. Currently, the estimated annual cost to the town is one million dollars, or just .5 percent of our budget. The goal is to make Nathaniel Witherell self-sustaining, but the many variables and imponderables in today’s healthcare economics make projections difficult. What they can predict, however, is that if nothing is done except patching up the present plant, the future maintenance and operating cost to the town will be prohibitive.

The need is also quite predictable. We are all well aware of how much longer people are living today, and the trend will continue. In the first thirty years of this century, the number of those eighty-five and older will double, boosted by increasing life expectancy for that age group. The need for skilled nursing care will continue to grow accordingly. In 1977, only 35 percent of the residents of skilled nursing homes were eighty-five and older. › By 1999 this had increased to 47 percent, and at Nathaniel Witherell today it is 68 percent, while occupancy is running at 96 percent of capacity. Along with these aging trend lines, a greater number of the elderly are living alone, especially women seventy-five-plus who will likely be in need of nursing-home care.

The pattern of healthcare in the elderly is changing. While living longer, they are healthier. The percentage suffering from chronic disability has declined, though the absolute number has increased. Dementia, including Alzheimer’s, and memory loss are the most prevalent disabilities among long-term-care patients. Thirty percent of those age eighty-five and older have memory loss, six times more than those aged sixty-five to sixty-nine. Meanwhile, there has been a surge in the need for short-term rehabilitation or post-acute care following release from a hospital (where patients are discharged when their insurance runs out but often still need professional care). Eighty-five percent of Nathaniel Witherell admissions are for such short-term rehab patients, and the average stay is thirty-nine days versus three and a half years for long-term care.

These statistics have had a significant impact on nursing-home care, and the physical plant of Nathaniel Witherell needs to be restructured to adjust to these new demands. Short-term rehab patients often have special needs requiring separation from long-term residents. Dementia patients need to be separated from those who may have physical disabilities but are mentally acute.

The economic challenge to making Witherell viable and competitive within the nursing-home industry should not be underestimated. On the plus side, it has an excellent staff, an impressive legacy and a fine professional reputation. But because Medicaid payments are set well below costs, Medicare and private pay must cover the deficit. The current mix of these revenue sources compares favorably with area nursing homes but is not weighted heavily enough in favor of  private pay and Medicare to compensate for the higher operating cost of the present facility and the cost of the town’s municipal labor scale, which is substantially higher than at other nursing homes. The plan developed by the Nathaniel Witherell board includes raising combined Medicare and private pay from 37 to 46 percent of total revenue by increasing short-term rehab admissions.

In order to attract Medicare and private pay clients, however, Nathaniel Witherell facilities must be upgraded and made more competitive. This can be accomplished only by extensive renovation and refurbishment, renewal of the infrastructure and the addition of the short-term rehab wing. It is also hoped that negotiations underway with municipal unions will lead to some operational savings in that area.

The vision of the Nathaniel Witherell board is to position the institution as Greenwich’s leading provider of rehabilitation and skilled nursing services for Alzheimer’s and dementia patients, while focusing on a goal of financial self-sufficiency. To help achieve the latter, a separate 501-(c)(3) fundraising entity, “The Friends of Nathaniel Witherell,” is being established, and a search is underway for a director of development.

Future generations will be thankful for the efforts we make now to save this important town asset. We have a social obligation to care for our steadily increasing number of elderly, among whom we may one day be. And we have a further obligation to ourselves: Caring for a family member with dementia or other forms of age-related disability can be an enormous emotional and physical strain, and can also be a financial drain.

We believe the RTM and the citizens of Greenwich should rise to the occasion and support the plan to renew and save our Nathaniel Witherell.