Low wages affect patient care, say employees at The Grand Guilderland

The Enterprise — Elizabeth Floyd Mair

Certified nursing assistant Chrystal Kelley, center, marching with her daughter Jayda, 7, said that the staffing shortage created by low wages at The Grand Guilderland “creates neglect.”

GUILDERLAND — Workers marched last Thursday in a circle at the edge of the nursing-home property on Route 146 in Guilderland Center, chanting, “We gotta feed our children, we gotta pay our rent. Ask Jeremy Strauss where our money went.”

Strauss is the chief executive officer of the Grand Healthcare System, which owns and manages the facility. He did not return a call for comment this week, but Regional Vice President of The Grand Healthcare System Bruce Gendron told The Enterprise, “We as the employer, while we disagree with their position, we respect their right to voice their concerns and do informational picketing.”

He also said, “It’s always a balance between doing what we can for the employees in terms of wages and benefits, and balancing that with the challenges of operating a skilled nursing facility with Medicare and Medicaid funds, which don’t always increase at the same rate as the cost-of-living increases or the supply and demand of staff increases.”

In order to hire well-qualified certified nursing assistants and licensed practical nurses, the facility raised the starting wage for these positions, said Ruthie Young of Local 1199 Service Employees International Union, but then refused to pay the difference to those already working there, although it is contractually obligated to do so. Young is the administrative organizer for the facility.

Starting wages for a CNA or LPN are now $13 an hour, said Young. They were previously $11.25. Employees are leaving “left and right” because new hires are making the same amount as or more than long-term employees, including those who helped the company to get out of “special focus” status in November 2016, said Young; she is the administrative organizer for the facility.

Asked about this, Gendron said that the facility had increased the pay of all incumbent employees to at least the new minimum starting wage and had insured that no one would make less than a new hire with equivalent experience.

What is possible, Gendron said, is that “an incumbent with two years of experience makes less than a new hire with 15 years of experience, for example.”

He added, “Previous to the current agreement, this was not the case. At that time, all new hires started at the minimum new-hire rate. This made it nearly impossible to attract seasoned staff.”


The Enterprise — Elizabeth Floyd Mair 
Debra Fletcher, who has worked at the nursing home in Guilderland Center for 14 years, complained that the facility’s health insurance does not cover visits to urgent-care facilities. As a result, she said, she recently had to go to a more expensive emergency room when she got sick on a weekend and her regular doctor’s office was closed.


Young said that the facility’s inability to maintain staff has caused an overreliance on per-diem CNAs and LPNs, which creates a problem in continuity of care and makes it harder for the facility to boost its quality-of-care indicators.

The dispute is over employees’ belief that they should get another increase on top of the one that the facility made, Gendron said. If that cannot be settled, he said, it will go to an arbitrator whose decision will be binding on both parties.

Gendron said that the facility does rely on per-diem staff to “fill in some of the gaps that we have, as it continues to be difficult to recruit.” He said this problem is not unique to The Grand Guilderland but is felt at hospitals, skilled-nursing facilities, and home health-care companies throughout the Northeast; the reason, he said, is because “there are not as many people entering the field as there are positions available.”

Despite The Grand’s efforts to rebrand the nursing home and improve its public image since it began to manage the facility in October 2014 and then took ownership in November 2016, representatives of SEIU said last week that low wages are resulting in quick employee turnover and short staffing, to the detriment of patient care.

Picketing last took place at The Grand Guilderland in June 2015. The picketers said then that say the managers of the nursing home, the Grand Healthcare System, had repeatedly violated the contract they entered into on Dec. 1, 2014. Local 1199 SEIU represented 110 workers at The Grand Guilderland at that time.

Complaints in 2015 included the Grand Healthcare System not paying for health insurance or for overtime work or for work on holidays.

But those disputes were all successfully resolved, 1199 SEIU’s Berman told The Enterprise for a story in March 2016. The New York State Department of Labor stepped in to do an audit and The Grand Healthcare “made whole” anyone whom the department identified as having been shortchanged, Gendron told The Enterprise at the time.

The facility had 127 beds when it first unionized in 2002, and, under different management, had 170 workers. Those in the union include certified nursing assistants, licensed practical nurses, dietary workers, and workers in housekeeping and maintenance.

The Grand Healthcare system has invested over $1 million in upgrades to the facility, now known as The Grand Rehabilitation and Nursing at Guilderland, which was formerly the Guilderland Center Nursing Home.


Since June 2015, the facility had been on the national government’s list of the worst nursing homes in the country. The “special focus facility” list of the Centers for Medicare and Medicaid names nursing homes that have had more problems than others, more serious problems than others, and a pattern of problems that persists over time. Being placed on the list means additional on-site inspections; listed facilities must improve within 18 to 24 months or lose their eligibility for participating in Medicare and Medicaid.

The facility has consistently been rated sub-par in terms of care over the years, based on inspections by the state’s Department of Health.

From April 2011 to March 2015, it had 54 more “standard health deficiencies” than the average nursing home, 22 more life-safety deficiencies, and 65 more total deficiencies. Twelve percent of the deficiencies found were related to “actual harm or immediate jeopardy,” according to an inspection report from the Department of Health.

Despite the improvements it has made, the Guilderland facility’s overall ranking is still “much below average,” according to the Centers for Medicare and Medicaid Services. The Guilderland facility had more than twice the national or New York average, or both, in categories of “percentage of short-stay residents who got antipsychotic medication for the first time,” “percentage of long-stay residents experiencing one or more falls with major injury,” and “percentage of long-stay high-risk residents with pressure ulcers.”

Particularly striking was the “percentage of long-stay residents who have symptoms of depression.” The national average is 8.6 percent, the statewide average is 5.1 percent, and the average at The Grand Guilderland is 36.6 percent.

“It is going to be hard to move that star rating for a while,” Gendron said, explaining that this was a function of the way the ranking works. Having been in special focus continues to affect a facility for up to 36 months, he said, adding that he believes the quality measures are a better reflection of “the progress that’s being made over time.”

The Guilderland Grand currently has a ranking, for its quality measures, of “below average,” which is better than its overall ranking of “much below average.”

Among its quality measures, some are better than the national or state averages, including its percentage of short-stay residents who report moderate to severe pain, percentage of short-stay residents who needed and got a vaccine to prevent pneumonia, and its percentage of long-stay residents with a urinary tract infection.

Quality-of-care issues affect the entire Grand Healthcare system, said Mindy Berman, communications director of 1199 SEIU.

Staff concerns

Chrystal Kelley, a per-diem certified nursing assistant, said, “I would like the wages to be more competitive.” She added, “I would like to see our staffing shortage addressed.”

Asked what effect the staffing shortage has on patients, Kelley said, “It creates neglect, to be honest.” She said that besides a litany of problems for patients — including call bells not being answered, and an increased incidence of bedsores, skin breakdown, and urinary tract infections — it also creates burnout among the staff. “Now you have unhappy residents and employees,” she concluded.

Kelley said that there is no law governing how many patients a single certified nursing assistant can care for, as there would be for teacher-child ratio in a daycare. She said that the ratio during the night shift can be one CNA for 42 patients.

Listening to Kelley, Andrea Gonzalez, who has worked at the facility for over five years, said, “How do you think that the staff feel, going home at night feeling that they can’t provide these individuals the care they need?”

Debra Fletcher, a CNA who said she works 50 or 60 hours a week at The Grand Guilderland and has worked there for 14 years, said that the facility’s health insurance “sucks” and that, on a recent weekend, she went to two different urgent-care facilities, hoping to be seen, only to hear that her insurance was not accepted there. She wound up going to the emergency room.

Albany County Legislator Paul Miller of McKownville joined employees on the picket line Thursday. Reached on Friday, Miller said he believes that many large companies take care of their stockholders and administrators first, before “the little people who work for them.”

Miller said he was glad that the Albany County Nursing Home had remained under county management, despite discussion in past years about privatizing it, because he said that it was better for residents if it was not a for-profit organization.

Gendron said that he didn’t know Miller and had never spoken with him, but that he didn’t think that not-for-profit nursing homes are necessarily better than private. Publicly-run nursing homes are having a hard time of it, too, Gendron said, noting that he had worked on both sides.

He cited, off the cuff, about a dozen county nursing homes in the state that have been sold to private enterprises, because, he said, “They couldn’t make it work.” A lot of those county homes — he said there are dozens and dozens that have been sold — “didn’t have a good record of quality care, didn’t have a good record of stewardship of the public monies that they were operating, and didn’t necessarily have a good track record with employees.

Berman of 1199 SEIU said of The Grand Guilderland, “You might think, ‘They just bought it, so let it get off its feet,’ but that’s not the case, because it’s the same at all these places,” referring to the six nursing-home facilities within the Grand Healthcare system; the others are in Poughkeepsie, Chittenango, Pawling, Queens, and Rome.

The star ratings for the other facilities in The Grand Healthcare System is, in fact, mixed. The Grand at Pawling is rated “above average,” while the one at Queens is “much above average.” Meanwhile, the facilities at Poughkeepsie and Rome are “below average,” and that at Chittenango is “much below average.”

Gendron said that Poughkeepsie, Rome, and Chittenango provide “excellent care,” that none of them had ever been on the special-focus list, and that it “would take a much longer discussion to explain the inequities of the NYS survey process between upstate and downstate.”

He added, “By this time next year, we’ll hopefully be close to settling on a brand-new contract, and a lot of this information will be behind us anyway, because we’ll be negotiating a new three- or four-year contract at that point.”

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