For many of its 157 years, Abramson Senior Care had been known for its massive, 5-star rated nursing home, its reputation for serving the Jewish community according to strict Kosher standards, and its broad mission of serving the poor and near-poor in the Philadelphia area.

Today, the landmark nursing home has been sold and Abramson’s patient base has diversified considerably. But the mission remains as the historic nonprofit tries to evolve with the healthcare industry.

Burning through millions of dollars each year to subsidize nursing home care, the Abramson board faced a difficult but familiar decision in 2020: hold on to its long-term care facility or consider selling to refocus and maintain mission while it still could.

Abramson Senior Care’s original facility in 1873.

Gone too are a second, smaller transitional rehab facility, which was sold last fall; home care and hospice services, sold this spring to Bayada; and more than 750 employees, some of whom were absorbed by new owners. It’s been an emotional rollercoaster for those who remain, but to keep the organization on an upward trajectory, Executive Director Robin Brandies, leaders knew they had to take a dramatic step.

“We were created within the Jewish community with the mission of being essentially a safety net for frail and near-poor Jewish seniors so that they wouldn’t fall through the gaps in the medical system as they aged, and that they had somewhere to be cared for,” explained Brandies, who is overseeing Abramson’s transition to a care navigation service. The goal is to remain a vital tool for seniors who need healthcare or social services that might help them stay independent longer.

“The mission of the organization, even as it changed, always stayed the same,” she told McKnight’s Long-Term Care News. “But if the mission is to serve a Medicaid population, it’s getting harder and harder to do that and maintain a high star rating in a nursing home … We closed the nursing home so that we could continue our mission, not to throw away our mission.”

Pennsylvania hadn’t increased its Medicaid rate for a decade in the years leading up to the closure of the main nursing home, and Brandies said the introduction of managed Medicaid in the state also led to fewer referrals, reduced census and patients who were sicker and more costly to care for when they did come. 

Nursing home sold during the pandemic

For a while in the early 2000s, ancillary service lines in hospice and palliative care helped plug the revenue holes created by a Medicaid-heavy nursing home population. But by 2015, nursing home losses had hit $6 million annually, reaching $9 million by early 2020. 

Abramson had already decided to sell when COVID hit; its main facility sold in October 2020. Only for-profit buyers stepped forward, and the facility’s rating has since fallen to 1 star since being taken over by an operator affiliated with Imperial Healthcare Group.

But Abramson is focused on its new strategy, growing partnerships in and beyond the Jewish community as it looks to build its care coordination services. One major challenge: finding the many patients that Brandies says she knows actively need more support.

It used to be they’d be on the waiting list for the nursing home in suburban Horsham.

Now, care managers are working with a Jewish community center, physician practices and others to build a patient network. Nurse practitioners meet with patients in their home, assess their need for services and then play matchmaker with other providers who can meet specific needs. In many cases, they may be helping seniors stay out of a nursing home.

But at its heart, Abramson remains a critical safety net, one with eyes on patients and hands in their care. The other option the organization considered after talking with nonprofit aging services providers was to stop providing care and simply become a grant-making foundation.

“That was a path we seriously considered,” Brandies said. ”But when we looked around at the community and we looked at gaps that we saw in the healthcare system, particularly for people without means, what we saw is that there wasn’t a need for another home care company. There wasn’t a need for another hospice company. There was a need for an organization who could provide the glue, who could help seniors … identify their needs and if they qualify for benefits, to help them get those.”

Ancillary status no more

Today, Abramson’s care management service and its navigators are at the core of the service model, rather than the ancillary they used to be.  

And the organization is gaining financial ground, with a plan to spend about $1.5 million annually that comes from donations and income from its $30 million endowment. It’s also collecting fees from non-poor patients, including two orders of Catholic nuns for whom Abramson is managing care.

“For us to stay in an operational capacity … we had to identify a gap. And if we couldn’t identify a gap, we weren’t going to do this. We would have just become a foundation. So, I think every organization has to kind of dig deep and be honest with themselves about whether they feel like they can provide a service that addresses a gap in this healthcare system that is so fractured,” Brandies said.

“At the end of the day, I think we look at it that care is not about walls. It’s about services. And it’s about keeping people safe and independent,” she added. “You don’t need walls to do that.”