Days after being elected from County Legislature District 12 which includes the entire Lutheran Campus in Jamestown, came the shocking news that Lutheran was permanently closing its nursing home.

Now is probably a time for many questions rather than definitive answers as to what is going on.

First, with the continuing retirement of the Baby Boomers, is the promise of “continuity of care” by places like Lutheran suddenly passe?

For many decades, middle class people have prepared for retirement living and their “golden years” by buying their way into a retirement community that promised them comfortable housing, then assisted living whenever needed and a skilled nursing home bed if that, unfortunately, was the last place to live.

Those people assured their children and grandchildren, wherever they lived, that their parents or grandparents would be just fine here in Chautauqua County for the rest of their lives no matter what happened. There would be no need to move from Chautauqua County to be closer to family.

What happens to the promise, explicit or implicit, of the “continuity of care” until the end?

Second, we have heard for years about the coming growth of employment in America in all aspects of medical care that would be necessary to care for the aging Baby Boomer generation. Our County’s next-door neighbors in Buffalo and Erie County have seen a huge growth in jobs in the health care industry. Why has Jamestown/Dunkirk and Chautauqua County as a whole not seen a similar growth of employment?

Perhaps a major part of the answer is simple: the 2020 Census showed that while Buffalo and Erie County added population, Chautauqua County sadly, continued its decline from 135,000 people to 128,000, a loss of 7,000 residents (the County population in 1970 was 148,000). Maybe this loss of population has lessened the demand for nursing home beds.

Third, what happens to competition in the nursing home industry here? Most Americans think competition is good. With two major nursing home employers in Southern Chautauqua County, nurses and other health care workers had a choice of where to work. If a nurse could not get along with a supervisor at the nurse’s current employer, for example, that nurse might get hired at the other nursing home and have a better work life.

With competition, people could look at nursing home ratings by government agencies. Nursing home operators had to be concerned about negative ratings, as well.

In the absence of competition will consumers simply have to accept nursing home care regardless of its quality?

Fourth, the population of Chautauqua County has gotten poorer relative to the average for New York or the United States. As a logical result, Chautauqua County nursing homes have a huge percentage of Medicaid patients and relatively few private pay patients. For Western New York, New York State estimates a private pay nursing home patient will pay about $12,000 per month or $144,000 per year.

The truth about New York’s Medicaid support of nursing homes is hard to nail down.

The Empire Center points out that “New York’s per capita Medicaid spending on nursing homes is the highest of any state and double the U.S. average.” For 30 years and more some of Chautauqua County’s elected officials have railed against New York State’s excessive spending on Medicaid. However, as soon as a local hospital or nursing home complains that Medicaid reimbursement rates are too low, many of those same elected officials express sympathy for the hospital or nursing home. There are now Statewide television ads alleging that New York State should increase its Medicaid spending and that the Federal government will pay some of any increase.

It is possible that both arguments are true.

Fifth, nursing homes in New York State are in competition with expanded in home care.

In November 2022 the Empire Center for Public Policy (a business-backed think tank) came out with some hard, cold facts about New York State’s Medicaid program for the elderly and disabled.

In part, to keep elderly people out of nursing homes, the Empire Center found that “New York’s Medicaid program spends roughly $12 billion per year on in-home ‘personal care’ for the elderly and disabled–nearly as much as the other 49 states combined.”

While New York’s spending on in-home care has reduced the nursing home population, the Empire Center found: “Despite heavy investment in home-based care, the share of New Yorkers living in nursing homes has declined more slowly than in other states and remains 29 percent above the U.S. norm.”

Sixth, area nursing homes argue that they cannot find enough employees to fully staff the beds that they have.

While the Nation’s unemployment rate of about 3.5% is near a 50-year low (good news for our country’s workers) the labor shortage in Chautauqua County is different. The New York State Department of Labor statistics for Chautauqua County shows that the Chautauqua County labor force (those working or looking for work) has collapsed. Our labor force has declined from 68,000 in 2010 to 56,000 in 2023, shrinking by 12,000. Reasons for this collapse include a similar sized reduction in employment in the County, retirements, going on Disability, and young families abandoning Chautauqua County to find economic opportunity elsewhere.

Nursing homes join most other employers in Chautauqua County in having a difficult time finding qualified workers.

No one should doubt the financial difficulties of operating a nursing home. Presumably that is why the Chautauqua County Industrial Development Agency awarded a Payment-In-Lieu of Taxes (PILOT) agreement not too long ago for the entire Lutheran campus.

At the same time no one should doubt the disappointment felt by the residents and employees of the Lutheran skilled nursing home and rehabilitation center.

Fred Larson served as Chautauqua County Attorney from 1998-2005 and a Chautauqua County Legislator in 2014.