As Frederick County Prepares to Leave the Elder-Care Business, What Duty Does Local Government Have in Caring for its Most Valuable Citizens?
On a June morning last year, politicians, business people and other local officials gathered just off Rosemont Avenue for a happy occasion: The ribbon-cutting ceremony for the newly built, county-owned Citizens Care and Rehabilitation Center and Montevue Assisted Living facilities, at a cost of $30 million.
By moving from cramped, outdated buildings next door, Citizens and Montevue continued a legacy of local government providing for its neediest and most vulnerable citizens. Montevue’s history dates back to 1871, when the county opened Montevue Hospital to care for the poor and elderly, among others, who fell into society’s margins. Of the current 71 residents at Montevue, 60 receive a county-paid subsidy, based on income level, to cover their cost to live there.
The move was a celebratory time for the staff and residents, and an emotional one, too. Diane Grove, administrator at Montevue, made sure she was in the entrance lobby the following month when the first residents arrived from the old facility. One of Montevue’s residents was so stunned by her glimmering new surroundings that she took Grove’s arm. “She said, ‘We don’t belong here. We didn’t deserve this,’” Grove recalls, her eyes tearing at the memory.
But even as Citizens and Montevue gloried in a new day, old problems lingered and were actually growing. They were, simply put, bleeding money—a shortfall that cost the county an average of $4 million a year before the move and was about to jump to $7 million a year with the added debt payments to cover the cost of the new building.
The issue will take center stage this month when the County Commissioners host a public hearing about a proposal to sell Citizens and Montevue for $30 million to a private company and get the county out of the eldercare business. The proposal has been met with an emotional opposition that fears the county is turning its back on the patients and employees. “It’s the only facility of its type,” Frederick businesswoman Cindy Powell says. “There’s nowhere else for these people to go.”
On the other side are supporters of the sale, led by several County Commissioners who cite the fiscal responsibility they have to the taxpayers. The sale would save the county an estimated $1.5 million the first year and reach $6.5 million by the fifth year. This can be done while protecting the current residents and employees, they say. “It’s not an easy decision,” says County Commissioners President Blaine Young. “Nobody wants to hurt the employees or the patients. We just have to realize that [operating elder-care facilities] is not something that we do well.”
Business As Usual
Bob Aims, executive administrator of Citizens and Montevue, leads a morning tour, noting the state-of-theart care amenities you might expect from facilities less than a year old. Unlike the archaic vision of a “nursing home,” Citizens does not have an antiseptic, institutional feel. There are splashes of color on the walls, carpeting in the hallways and wood flooring in the dining rooms. Standing in a space that performs double duty as a chapel and community room, Aims says with a smile, “This is Bingo Central.”
Citizens and Montevue share this 156,000-squarefoot building that sits across Rosemont Avenue from Fort Detrick. Though they both use the same support staff and many services, they are two separate operations: Citizens is a traditional nursing home in that it provides a high level of care—sometimes called “hospital light”—while Montevue is an assisted-living facility that typically has healthier residents with greater mobility.
Further along in his tour, Aims runs into one of Citizens’ 164 residents, an elderly man rolling his wheelchair through one of the common living areas.
“Are we taking good care of you?” Aims asks.
“Reasonably well,” the resident responds.
“Well, I will take that, for early in the morning,” Aims says with a laugh.
Despite the political storm around them, it’s mostly business as usual at these facilities. Bingo games are still the main attraction on a full calendar of events posted on fliers and flat-screen monitors. Citizens’ annual wheelchair races, a favorite among the residents and staff, were held in May; that they were well-attended was a positive sign to Aims that the impending sale had not overwhelmed the mood.
“We live this every day. This is not a job; this is a way of life.” – Diane Grove, administrator at Montevue Assisted Living
Citizens also celebrated a recent triumph when one of its residents, having spent four months in its ventilation unit, was able to breathe on his own and go home. “This has been a very successful program for us,” Aims says as he shows off one of the ventilation rooms.
But the residents read the newspapers, and the level of anxiety increases with each headline. The staff feel it, too, wondering what their futures hold if the facilities are sold. On one recent day, one of Montevue’s residents approached Grove, the administrator, and asked, “Do you have a job today?” Grove responded, “Today, I do.” Then the subject is changed. “We don’t want them to feel anxious,” Grove says later in the day, “so we don’t focus on it.”
A Legacy of Care
Cindy Powell’s connection with Citizens and Montevue extends back to her days as the first full-time director of the Community Foundation of Frederick County, when she helped establish funds to support them. Last year, she wrote the book Heroic Work: The Story of Montevue Yesterday and Today that details the history of the Rosemont Avenue site.
Powell says the county’s history of assisting lowincome residents with health care services dates as far back as the late 1700s, when an “almshouse” was operated in the Bentztown area, and later on Patrick Street. The almshouses cared for the homeless, elderly, chronically ill and those suffering from mental disorders, among others.
In 1828, the county purchased 94 acres from Elias and Catherine Brunner for $5,313.75—including the current Rosemount Avenue property—under a deed that stipulated the land be used “for the use and benefit of the poor of Frederick County and for no other use, intent or purpose whatsoever forever.”
A half century later, the county built Montevue Hospital on the site, replacing the latest almshouse, and continued the tradition by serving poor residents, as well as the physically and developmentally disabled. And in an era when Jim Crow could extend to health care, Montevue was often the only choice for African- American patients, including expectant mothers who used its maternity ward.
Montevue today has a narrower mission as senior care center and serves fewer people, but it still continues the legacy that began with the early almshouse. It’s only one of two assisted-living centers in the state owned by a county government—Wicomico County has the other— and the only one that provides a county-paid subsidy to assist its residents.
And while there is a waitlist of dozens of seniors wanting a subsidized room in Montevue, they fit into a limited demographic: those over the age of 80 who don’t have the financial means for private assisted living, who cannot live by themselves but are not sick, and who don’t have family or other living options. “At the end of the day, that is a relatively small group of seniors,” Powell says.
The group might be small, but it’s also costly. While Citizens’ resident costs are covered mostly through Medicaid and private insurance, 60 of Montevue’s residents cannot afford the $145-per-day cost and require the subsidy. As a result, the county has put more than $50 million into operating the centers since 2000, mostly due to employee costs and the Montevue subsidies. Add to that the debt accrued with the $30 million new building, which Young points out is more expensive than an elementary school.
“We’re losing more money now than when we were in the old facility,” he says.
No one disagrees that Citizens and Montevue have cost the county a lot of money. The debate centers on how to stop the red ink.
Young believes the best solution is to sell the building, take the employees off the county books, and let private enterprise do what the public sector hasn’t accomplished. But he says Citizens and Montevue will only be sold if the buyer meets several conditions, which include keeping the current subsidized residents, maintaining patient care and retaining the current staff with current pay and comparable benefits. To that end, the commissioners rejected the highest bidder because they had concerns with the provider’s ability to maintain patient care, he says.
Those who want to keep them publicly owned maintain the centers could make money, if operated properly. They say Citizens, with high-demand amenities such as the ventilation unit and dementia care can be marketed and operated in a way that would maximize its profitability and cover the costs of the Montevue subsidies. “I’m not a Pollyanna,” Powell says. “I believe in making things work and making them work correctly.”
What frustrates Powell and others is the earnings potential of Citizens rests in its new facility, but the commissioners expressed their desire to sell the building just months after it opened. “It has not been given a chance,” she says.
In fact, the whole saga has a fait accompli feel to her and others opposed to selling Montevue and Citizens. Some, like Powell, insist political ideology—not public policy—is the driving force behind the sale. They point to the lack of a complete, unbiased review in the financial viability of Citizens and Montevue. They also wonder why the county initiated a needs-assessment study of the senior population after the County Commissioners had already stated their intention to sell.
“Give us a chance because we just got in here,” Grove says.
Young says one problem with the plan to maximize Citizens to benefit the county is it doesn’t account for the debt service on the building the county would still be responsible for. But perhaps more importantly, there is no guarantee it will work, he says. “The problem is, there is no certainty in that.”
On the other hand, there is no doubt a sale would take the county off the hook for the building, the employee costs (including costly retirement expenses) and the Montevue subsidies, while putting the facilities in the capable hands of those experienced in the industry, Young says. “We think there is no question this is dealt with better in the private sector.”
Nonetheless, he maintains the sale is not a foregone conclusion. He says the commissioners could still decide to keep Citizens and Montevue, but that would then open the conversation to the county taking over full control of the centers from the current board of trustees that oversee the operations.
“I don’t think it’s a done deal,” Young says of the purchase proposal. “I think it’s a strong offer that the commissioners and the community need to debate.”