As nursing and long-term care facilities struggle with staff and finances exacerbated by the pandemic, a longtime Manhattan nonprofit is moving to sell its 105-bed nursing home and rehabilitation center in the West Village.
And the would-be buyer has already begun making changes affecting personnel and patient care, workers and a recent resident told THE CITY.
Cuts have come to staff and food service since Cassena Care, a Long Island-based, for-profit health facility operator, took over this spring at VillageCare Rehabilitation & Nursing Center at 214 W. Houston St., workers said.
In recent months, too few staffers have been scheduled to adequately care for patients, according to health workers. Residents wait up to a half-hour for help using the bathroom, or often sit in soiled bedpans, they say. And meals, they add, have become puny and unappetizing.
“It’s like they just don’t care. It’s just a business to them,” staffer Monique Henderson said, referring to Cassena.
Henderson is VillageCare’s lead environmental specialist in charge of housekeeping and has worked with the nonprofit for more than 23 years. All around her, colleagues are feeling the effects of the management switch, she said, which began in late March according to records submitted to the state Department of Health.
“The morale is very low, and they’re not putting no effort into making sure that the residents are content or the staff is happy,” she said of Cassena.
The pending sale would be VillageCare’s second offloading of a health facility in Manhattan within six years.
The nonprofit’s 2015 $28 million sale of the Rivington House on the Lower East Side — previously home to people living with HIV and AIDS — set off a years-long scandal and investigation of the buyer, Allure Group, by the state attorney general.
Ultimately, the AG ordered Allure Group to pay $2 million in penalties and restitution for its role in the closure of Rivington.
‘I Lost 10 Pounds’
The proposed sale of the West Houston location still has to be approved by the state health department and its Public Health and Health Planning Council, or PHHPC, before it is finalized.
VillageCare filed its project application, via a document known as a “certificate of need,” with the state on March 31. The record names Pasquale DeBenedictis and Alex Solovey — both principals at Cassena — as the primary members of a limited liability corporation through which the pending sale will be managed.
When PHHPC will review the proposal is unclear. The project does not appear on the Council’s upcoming agendas and a Department of Health spokesperson said only that it is “under review.”
But much has already changed, according to workers and Roberta Singer, 80, who said she experienced the management switch under Cassena first-hand this summer.
Singer, a survivor of 9/11-related cancer, said she has stayed at VillageCare four separate times since 2016.
Her rehabilitation visits the first three times were satisfactory enough to make her a repeat customer, she said. But when she arrived in June of this year for her fourth visit — immobile and using a wheelchair following a hysterectomy — she reported having a very different experience.
“The place has gone so downhill since I was here the last time,” she told THE CITY. “It just was startling.”
Her calls for help to use the bathroom, for example, would go unanswered for 25 or 30 minutes, she said. The workers, especially certified nursing assistants, or CNAs, were chronically short-staffed, they told her.
The food quality, too, had sunk: One dinner consisted of two pieces of bread and a small spoonful of tuna salad, and on the Fourth of July, dinner was a single hot dog, she said.
“I lost 10 pounds,” Singer said. “I don’t think it’s because I was working out.”
Cassena Care did not respond to multiple inquiries from THE CITY, and DeBenedictis and Solovey were not reachable.
‘A Red Flag’
The company currently runs 15 nursing and rehabilitation facilities in the New York tri-state area, including nine within the five boroughs.
The company has three open lawsuits against it that all allege the care operator is responsible for injuries and pain suffered by three former residents at its Morningside facility in The Bronx and at the Upper East Side Rehab and Nursing Center in Manhattan, court papers show.
Cassena sought arbitration or dismissal of all three suits, records show.
Those cases don’t give a clear picture, however, of what care at Cassena may look like, said Richard Mollot, executive director of the health advocacy group Long-Term Care Community Coalition (LTCCC) — because lawsuits represent only a small fraction of patients.
“Mostly, people don’t sue,” he said.
Cassena’s nine city facilities, however, all scored low or middling marks in a critical metric: staffing levels as compiled by the U.S. Centers for Medicare and Medicaid Services nursing home database.
Mollot said that figure is one of the most reliable, at-a-glance data points available to measure quality in a nursing facility.
On West Houston Street, VillageCare currently has an above-average, four-star rating for staffing levels, out of five. In comparison, Cassena’s city locations all have two or three stars, the federal data shows.
“That, to me, is a red flag,” Mollot said.
A Refocusing of Resources
Rob Goldman, a spokesperson for VillageCare, said the decision to sell the West Houston Street facility was made because many of the people who would normally have stayed there “are choosing to receive their rehabilitation services at home and at outpatient facilities.”
“After a very thorough assessment and analysis of all options, VillageCare has concluded that it can best sustain its mission of providing services to chronically ill and vulnerable New Yorkers by focusing its resources on its programs that support individuals in their homes,” he said.
Sources said that leadership at VillageCare privately indicated to staff that the sale was necessary to stave off the facility’s closure.
The nonprofit said a lack of demand from AIDS patients was to blame when it closed Rivington House in 2014, The Village Voice reported at the time.
In addition to the West Houston Street facility, the nonprofit — led by CEO Emma DeVito, who makes $954,000 a year, according to the company’s most recent tax documents — also runs a senior living residence on West 46th Street and a managed long-term care health plan, VillageCareMAX.
An Industry on Life-Support
Even before the COVID-19 outbreak, many nursing homes across the country struggled financially and were left vulnerable as profit-seeking owners and investors moved into the industry.
Now, their situation has worsened as money woes mount as patients count drop — and health workers, especially women, leave the field.
In New York, VillageCare is not alone in selling to a for-profit operator.
A 2019 report by LTCCC showed that between 2003 and 2017, for-profit nursing home ownership had “grown from under a 50% share of the market to over 60%” in New York State.
The same report studied the overall quality of care between for-profit and nonprofit providers, taking into account staffing ratios, inspection ratings, complaint records and a number of other metrics. The conclusion: Nonprofits and government-owned providers “performed better, as a whole” than for-profit groups.
VillageCare was born from an effort in the 1970s “to rescue and reorganize a for-profit nursing home slated for closure,” the nonprofit’s website reads.
Back then, Greenwich Village residents organized to push elected officials to save the Village Nursing Home at 607 Hudson St. with a combination of city tax dollars, State Dormitory Authority bonds and $275,000 raised by the group Caring Community, according to newspaper reports from 1978.
That location, however, shuttered in the mid-2000s in a development deal between VillageCare and luxury condominium developers. About 10 residents from Hudson Street moved to the West Houston Street facility, but only two remain today, according to a CNA at VillageCare who spoke to THE CITY on condition of anonymity for fear of jeopardizing her job.
Those two remaining permanent residents make the VillageCare facility, technically, a nursing home. But it functions primarily as a rehabilitation center, which is more profitable — because nursing home patients are covered by Medicaid, while rehab patients are largely covered by Medicare.
“Medicaid pays, on average, about $225 a day. Medicare rates can range from $400 to $800 a day,” said Mollot of LTCCC.
It’s unclear exactly what type of patients Cassena will take in if it becomes the sole operator.
Goldman of VillageCare said the agreement with Cassena aims to “transfer operation of VCRN in the most seamless manner possible to ensure that the facility remains open and available to those in need of its services.”
He said that while the transition is pending approval from the state health department, the West Houston Street location “remains under VillageCare’s management, working with Cassena Care on a consultant basis.”
The Sick and The Tired
To VillageCare workers, however, Cassena’s day-to-day involvement has gone far past consultation.
As soon as Cassena stepped in, Henderson said VillageCare made personnel changes, got rid of the previous food service staff — and boosted the patient count.
“All of a sudden, the residents started coming in. They opened up the sixth floor unit again. And the business started booming,” she said.
Federal data tracking nursing homes shows VillageCare dipped to just 46% of capacity in June 2020 and dropped to that level again in December, amid the pandemic.
But in the last week of April 2021, after Cessena stepped in, the facility filled to 89% and hasn’t fallen below that level since.
The staffing does not match that high patient count, however, workers say. Under VillageCare’s leadership, three CNAs would work on a floor during the day and two on the night shift. Now, since Cessena came in, two work during the day and just one at night, employees said.
Low staffing is a chronic complaint from health workers across the country, especially among CNAs, said Dennis Short, senior policy analyst for the health worker union SEIU 1199, which represents workers at VillageCare.
“It’s almost always the biggest issue that they face: that there’s not enough staff to provide the care that is required and that the residents need,” he told THE CITY.
The challenges of the job drive sky-high turnover in the field. This year, a UCLA-Harvard study of payroll data among nursing home workers found CNAs had a turnover rate of 129%.
“The industry will tell you that there’s a crisis in staffing, [that] there’s not enough workers to staff the building. If you talk to workers, what they will tell you is that the crisis is actually keeping workers,” Short said. “New hires come in the door and the work is so difficult that only a fraction of them stay.”
The VillageCare CNA said she recently asked her union about retiring early — because the work has become so tough in the last few months.
“I tell them I want to leave because I fear that I’ll get injured,” she told THE CITY.
She has found herself trying to lift patients out of bed, or attempting to bathe them, by herself. She must work so quickly, she can hardly cover patient requests, let alone linger for a chat.
“You have to be compassionate and you have to be a caring individual to stay in this field,” she said.
“Right now, I’m just tired. I don’t even feel like going to that job anymore. I’m being honest to you. I don’t feel like being there no more — because when the patient wants certain things and they can’t get it, and you can’t give them what they need? It’s overwhelming.”