NANTUCKET, Mass.—The 11,000 year-round residents of this summer colony off Cape Cod are confronting an emotional question: whether the island is a place where they can grow old.
Nantucket, a ritzy vacation destination whose permanent community is of more modest means, has one nursing home: Our Island Home, a 45-bed facility that is owned and run by the town and with a history that goes back to 1822. It sits on prime town-owned real-estate where its residents can watch boats on Nantucket Harbor. But it runs an annual deficit of about $3 million, needs major repairs and is pressuring the town’s coffers at a time when Nantucket needs other infrastructure to accommodate growth.
“The town is getting to the point where it’s just taking on way too much,” said Donna Hamel, chairwoman of the Nantucket Republican Town Committee. “Should the town be in the nursing-home business? No. They don’t know anything about it.”
Our Island Home is one of roughly 1,100 of the U.S.’s 15,600 nursing homes that are government-owned, a vestige of an era when municipalities ran sanitariums and homes for the indigent. Nantucket now joins cities and towns from New Jersey to Tennessee in wondering whether nursing homes are an essential municipal service like fire, sewers and schools.
As baby boomers turn 65 at an estimated pace of 10,000 people a day, communities are increasingly confronting the questions of how and where to care for the elderly.Some are deciding they don’t expect nursing homes to befinancially independent.
Over the past five years, most New Hampshire counties have rolled their publicly owned nursing homes from the “enterprise” budget column, where services are supported by user fees, to the general fund, said Nicholas Lehman, an analyst with Moody’s Investors Service. In these places, “residents want a nursing-home option for themselves in the future, and they’re willing to pay taxes to support that,” he said.
In these places, “residents want a nursing-home option for themselves in the future, and they’re willing to pay taxes to support that,” he said.
But government-owned and -run facilities often have deficits and have outdated institutional styles that don’t attract the wealthier private-pay customers that offset Medicaid patients, said Jeff Binder, managing director of Senior Living Investment Brokerage Inc. Medicaid payments also face uncertainty, with the new White House budget proposing heavy cuts to the federal-state health program for the poor.
Financial pressures led New Jersey counties to sell their nursing homes to private companies, a move that saved some facilities, according to John Donnadio, executive director of the New Jersey Association of Counties. Only seven New Jersey counties still run nursing homes, down from 14 about five years ago, and “that number is going to drop more,” he said.
But privatizing doesn’t always go smoothly. Three years ago, Nashville began to shift two city-owned long-term-care facilities to private operators after deciding it couldn’t continue chipping in $10.5 million annually for their operation.
The plan hit snags. Local elected officials heard complaints about the conditions and food, and the city cut ties with the for-profit operator that ran one complex. In January, the city brought in an emergency operator to run the assisted-living center. Officials say that despite challenges, conditions have improved and the shift to private operators ultimately saved millions.
For Nantucket, the debate has extra resonance because without a nursing home on the island, residents might have to move.
While the island has swanky shops lining cobblestone streets and multimillion-dollar vacation homes that sit empty for many months of the year, Nantucket Town Manager Elizabeth Gibson says there are year-round residents who are “really struggling,” in part because of the high cost of living.
Elderly year-rounders tend to live at home for as long as possible, but they complain that home-health workers are costly and in short supply. There are fewer options for assisted living or services like memory care. Some seniors move to the mainland, but most don’t want to leave their spouses or community. That leads the elderly who need skilled nursing care to seek out the island’s only nursing home. Even some well-to-do year-round residents find that Our Island Home is their only option.
When Yvonne DuMont Stelle decided she could no longer care for her husband, Donald, who suffers from dementia, the painful decision was made easier knowing that he would be a five-minute drive away.
“It’s a horrible thought to think we wouldn’t have this here,” said Ms. Stelle, who regularly checks in on Donald, 90, and is part of a local group that bring extras, from art classes to live music, to the nursing home.
Ms. Gibson, the town manager, said she doubts many residents would say the nursing home doesn’t belong in the community, but the tension is taxpayers are being asked to support a service that is bleeding money while the community pays heavily for other services.
“It’s probably going to come down to, Can we keep affording it?” Ms. Gibson said.
A nearly completed school was a $40 million-plus project, Ms. Gibson said, and the town has appropriated another $40 million toward sewers and $17 million for a fire station. Town officials also are discussing whether they may have to subsidize housing to recruit employees who can’t afford Nantucket’s high housing prices.
At the annual town meeting in April, taxpayers voted 264-253 against a $30 million proposal to construct a new, modern campus for Our Island Home. Concerns ranged from the cost to the new location to suspicion about a march toward privatization.
But local residents cherish the care that the elderly get at Our Island Home—such as when two staff members drove 91-year-old resident Gladys Soverino and her husband, Malcolm, last October to renew their vows at the Nantucket church where the couple had married 70 years earlier.
“We’re an island,” said Allison Forsgren, a local real-estate broker whose late father lived in the town-owned nursing home. “You have to sort of watch out for people and not let them fall through the cracks.”
The Wall Street Journal
by Jennifer Levitz
May 28, 2017 7:00 a.m. ET
Write to Jennifer Levitz at [email protected]