Skilled nursing still a hurricane victim

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Seven months after Katrina, shattered infrastructure leaves operators crippled.Talk to various nursing home people in and around New Orleans and not one expresses optimism. There is hope. And there is determination. But optimism is in very short supply.

Seven months after hurricanes Katrina and Rita gutted a major U.S. metropolitan area as no natural disaster ever had done before, good news is surprisingly difficult to find.
"I wouldn't say it's despair. But I will say people have become somewhat frustrated with the federal process," says Joe Donchess, president of the Louisiana Nursing Home Association. "They're waiting for 100-year floodplain maps to come out to get a better idea where they can build. We're waiting for payment for care. We've been given promises from the federal government that they would bring people in to train nurse aides at, at least three sites in New Orleans, and they reneged.
"Our top priority is finding qualified staff to work in the nursing homes," he added.
The staffing shortage in this nook of Louisiana is like no other area of the United States. More than half of the area's pre-storm general population of 450,000 is gone.
"We have hospitals in the area that are crying to discharge elderly people to nursing homes, but we can't accept them because we'd be written up and cited for staffing deficiencies," Donchess said.
Thousands of reconstruction workers commute into the area daily.
"You can drive for miles and miles and see nobody because the houses aren't habitable," explains Karen Contrenchis, president of the Gulf States Association of Homes & Services for the Aging. "For our facilities to get back up and running, you need people, and for people you need housing, and then you need surrounding businesses. It's going slowly, and then when more businesses open, all we're doing is thinning the work pool."
20 facilities not open
Of Contrenchis' 50 member facilities in Louisiana and Mississippi, she said three still were not open as of late March. A few were at 100% capacity, but she guessed that others were around 65% capacity, down from about 90% to 95% before the storms.
Donchess's group has about 260 members, 65 in the "Katrina corridor." He said 17 of them still were not open as of late last month. Most others were just over half full, he estimated, leaving a cumulative total of about 30% capacity.
"People won't move back until they have adequate housing, and that remains an issue right now," Donchess said.
Many seethe about the U.S. Army Corps of Engineers, and other public agencies', lack of preparedness — and post-storm muddling.
"FEMA trailers are the greatest fiasco of the century," said D. Scott Crabtree, CEO and president of Broadway Services Inc., which runs Lambeth House, one of the poshest continuing care retirement communities in New Orleans. Lambeth was virtually undamaged by the storms and flooding because it sits 11 feet above sea level, less than 100 yards from a levee wall.
But despite successfully sheltering in place, residents had to evacuate because water, sewer and many other vital services were going down.
Sleeping on his office floor with firearms at his side, Crabtree and a handful of colleagues kept guard over their $35 million, 12-story facility. Law enforcement officials also found lodging there.
The facility reopened in October (skilled nursing) and November (assisted and independent living). Despite the ability to lure workers with higher wages and benefits, it remains vastly understaffed. Lambeth had only about 35 of its pre-storm staff of 160 working in March; 75 replacement workers had been hired, leaving the facility about 50 workers short.
Inflated wages
Nurse aide pay has risen from $8 per hour to $10 at Lambeth. One provider was offering $13 per hour, well above last year's area average of just over $6, Donchess noted. Competition included Burger King, which was offering about $10 an hour and a $6,000 annual bonus.
Contrenchis hailed Lambeth as a creative success because it arranged for dormitory type accommodations for about 15 employees in a shopping mall its parent company owns next door. (Contrenchis said another good example of creativity was the provider who planned to reopen using a nearby school's kitchen to prepare meals.)
Two big reasons Lambeth was able to continue so well were an "excellent" business interruption insurance policy from St. Paul Travelers and a sound cash reserve, Crabtree said.
Planning ahead
Other providers, like Johnny Raymond of Beaux Bridge, LA, have begun to invest more in equipment. His facility wasn't damaged, but the area is prone to power outages so he's buying an extra $100,000 generator that can run the air conditioning. He's also looking into locations where he can evacuate to as needed.
But like many, he's hoping the Louisiana legislature decides in the coming months that government officials will be given the responsibility of deciding who has to evacuate or not. One way or another, Raymond says he'll take care of his residents.
It's a sense of resolve all area providers are learning to develop, if they haven't already.
But there's only so much they can do on their own. With area rents having doubled or tripled, and not even a "dent" of progress apparent in the area's rebuilding effort, Contrenchis knows the nursing community has plenty to be concerned about.
On top of that, many fear the levees still aren't strong enough. It's uncertain how long some business can continue under current conditions, yet alone if another disaster hits.
Anxiety lingers. Hurricane season starts again June 1.

St. Rita's update
Salvador and Mabel Mangano, owners of St. Rita's nursing home in St. Bernard Parish, decided to do what many other providers did for Hurricane Katrina: shelter in place.
Within days, they were the most infamous nursing home operators in the world. After levees broke, 34 of the Manganos' residents were trapped and drowned inside their facility.
The elderly couple was arrested on 34 counts of negligent homicide by an attorney general who never spoke with them and might now be looking for a way to back out, said Jim Cobb of Emmett, Cobb, New Orleans, the Manganos' lawyer. Authorities said their investigation is ongoing.
The Manganos are living with relatives at an undisclosed location in the New Orleans area, Cobb said. They had to post no bond to be released.
"There's been no court appearance, no arraignment, no screening of charges by the attorney general's office," Cobb said. "There's no hearing or court date. Clearly this is selective prosecution. They had the focus of the nation and they had to blame somebody."
Cobb said there were "probably 20" civil lawsuits already filed against the Manganos, which made more sense than criminal charges. He defended the Manganos' decision making.
"They'd been on this property 20 years – that's a lot of storms. They never had a drop of water in the parking lot. This ground was high and dry for Hurricane Betsy in 1965," Cobb said. "One of our issues is somebody calls and says they've got a couple of buses if they want to evacuate. But since they've got plenty of water, food and medications to shelter in place, the person says OK, (evacuation) wasn't ordered."
Cobb said misinformation abounded after the storms. The Manganos did not abandon the facility but rather stayed onsite "the entire time" with their children, grandchildren, nieces and nephews.
The Manganos also were unaware of the attorney general's initial request for an interview because they were storm evacuees themselves, sleeping on a shelter floor in Dallas, Cobb said.