Mercy Living Center In Tupper Lake (Enterprise file photo)

TUPPER LAKE — As Mercy Living Center undergoes a long transfer between Adirondack Health, which has owned the 60-bed nursing home for 16 years, and Menajem “Mark” Salamon, who is preparing to take on full ownership of the facility after getting state approval last week, dozens in the Tupper Lake community are hoping the change in ownership will mean improvements to long-held complaints and allegations of neglect they’ve had there.

State Department of Health spokesperson Erin Clary told the Enterprise on Monday the DOH has granted the sale “contingent approval.”

“(This) means the applicant must submit additional required administrative documents before the project receives final approval,” Clary wrote in an email. “Once these contingencies are satisfied, they will be considered established and eligible to receive their new operating certificate.”

The state’s approval came less than a week after a public meeting of Tupper Lakers and family of Mercy residents on Nov. 12 who said they’ve seen a lack of good service at Mercy and wanted to advocate for better care there.

Salamon came on as an “operational consultant” for Mercy over the summer while they waited for state approval of the sale, and has already made a bunch of changes. In his time consulting there, Salamon said they’ve brought the resident numbers from 30 to around 55; reopened and filled the second floor; installed cameras for safety and security; reduced a reliance on travel nurses and replaced the administrator.

He has promised a slate of improvements as he takes over full operation of the nursing home.

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What are conditions like?

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Only time will tell if this sale improves things in the eyes of the families of residents. But they’re also not waiting around. They want to take things into their own hands, and after meeting twice last week, have proposed establishing a volunteer force to keep seniors company and keep an eye on the care they’re getting there.

On Nov. 12, family of residents brought a litany of complaints about the care their loved ones are getting at Mercy — stories of deteriorating quality of life, health risks, urine-soaked bedsheets going unchanged, dehydrated and lonely parents and a lack of nurses, especially on evenings and weekends.

The state of things at Mercy is quite murky from an outside perspective, depending on who is talking.

To some, Mercy is improving, with new ownership bringing policies and resources Adirondack Health did not have. To others, life at Mercy has gotten worse since the sale was announced, with nurses leaving and disorder in the transition. Some staff working there, and family of some residents, are hesitant to believe things are going to get any better. Others even think things could get worse.

For some family members, there’s a distrust of the nursing home leadership, the result of years of grievances building up. Some of these are complaints about individual employees. Some are more systemic. A common refrain was that the elder care industry has a “broken system” that is much wider than Mercy alone. Many come down to the fact that Mercy is drastically understaffed.

There’s plenty of blame to go around. Everyone’s pointing the finger at someone else — Adirondack Health, Salamon, individual nurses, the state.

Adirondack Health spokesperson Matt Scollin said Adirondack Health could not speak specifically about the anecdotes family members shared. He said people sharing them were emotional, and understandably so, since they were talking about family members. He said he couldn’t address these complaints directly. Scollin said the process for addressing complaints is understaffed, too.

Adirondack Health representatives attended the meeting, hearing complaints and answering some of their questions, while promising to do all they can in the time they have to address these concerns.

Mike Vaillancourt and Barb Denis, who organized the event, met with Salamon the day before and said they were pleasantly surprised by his positive response to the concerns and pleased with what they saw when they popped in for a surprise tour of the nursing home the morning of Nov. 12.

But Salamon’s cheery vision of Mercy does not jive with the image painted by some family members and staff.

A nurse at Mercy who spoke up at the meeting asked to remain anonymous for fear of retribution. They said the glowing review Vaillancourt and Denis gave is not accurate to what they see working there. They said the new owners are “politicians” who know what people want to hear.

At the same time, many worry about Mercy closing. They want it to stay open. It provides jobs for the community, but mostly people said they need a nursing home in Tupper Lake. Many people plan to go there to stay in town as they age. Vaillancourt said they have a duty to care for the people living there. This was the generation who gave them the Tupper Lake they know today, who saw the town forward through the last century.

Family of residents at Mercy have been bringing their concerns to the state Department of Health for years. They say they get no response from the state and they have no faith in the state to address their concerns. They’ve been speaking with the media about the poor conditions they allege their loved ones live in at Mercy for several months now.

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The letter

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This big public meeting on Nov. 12 came about because of a letter to the editor written by Mercy resident Donald Dean Doriguzzi and published in the Tupper Lake Free Press on Nov. 8. Doriguzzi said he has been living there for around a year-and-a-half. He liked it at first, but after seeing staff members quitting or terminated, he voiced his frustration.

“The ranks of the nurses and certified nursing assistants (CNAs) has been gutted to a fraction of the size it was six weeks ago,” Doriguzzi wrote. “Some left in disgust. Some were fired.”

He wrote about times when there were not nurses around, required treatments that are skipped, laundry piling up, food and litter on the floor and smaller food portions.

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Elder advocacy

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Vaillancourt and Denis read this letter and were upset by what it revealed. They started a Facebook page, “Tupper Lake and ADK Region save our Elders,” which quickly gained more than 1,000 members. Then they decided to hold a public meeting to get people together to talk about what to do.

The creation of the Facebook page got them a meeting with Salamon. He said Doriguzzi’s letter was probably all accurate and that he was working to fix these things. Mercy’s new nutritionist, Tony Ranjit, said he’s updating the menu for what people want, making it more “homey.”

“I have a different opinion of the owners now. I think they do care, from what I can tell and from what I’m being told now by the staff,” Vaillancourt said.

The couple wants to make a positive change at Mercy.

“It is not about burning the place down,” Denis said. “It’s about building it up.”

The first step of action to come out of this meeting was a plan to meet back at the HGA again last Friday to create a committee and start discussing solutions.

Vaillancourt and Denis were satisfied with the turnout. With this many people involved, they felt things have to get better.

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Adirondack Health reaction

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Adirondack Health President and CEO Aaron Kramer said these challenges are never going to go away, but how they are handled can be improved. Speaking with the Enterprise after the Nov. 12 meeting, he said this public attention makes Mercy a more attractive place to work, to see all these people care about the work they’re doing there.

“As difficult as these conversations sometimes are, it’s better than being in a community where no one cares,” Scollin said. “They show up on a Sunday at 2 o’clock, during hunting season, to talk about this stuff.”

It will take a while for Adirondack Health to fully hand over the reins to Salamon, according to Scollin.

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Administrator

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Mercy also had an administrator change three weeks ago. Long-time administrator Madaline Toliver does not work there anymore, Scollin said, but they couldn’t comment on why. She was replaced with Chris Esola.

“We just decided to bring Chris in,” Salamon said.

He said Esola has been making changes to fix problems and improve care.

But some staff say Toliver was fine. The anonymous nurse at the Nov. 12 meeting said she was “a great administrator” who stuck up for nurses.

Esola’s phone extension, 8859, is posted on the front door of the building. He said if people have concerns, they are urged to call him and he said he’ll address them immediately.

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Doctors

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Family of residents said Mercy used to have a doctor in several times a week to speak with patients. Now, it has two doctors from North Country Adult Medicine in Massena who come in once a month visit.

“We made a change to better our care,” Salamon said. It was not about money. It was about care. We believe residents are getting better care now than they ever did.”

But family members were not satisfied with this change. They said residents only get a five minute visit and when they request a doctor in person for a specific health concern, they’re told to wait a week for emergencies. Salamon said doctors are more available than before because they can do virtual visits, but family members were not happy with virtual meetings.

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Why Mercy was sold

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Mercy is at a crossroads. Adirondack Health couldn’t make its financials work, so it’s selling it.

Adirondack Health announced its intentions to sell Mercy in October 2022. In March, it signed an agreement with Salamon and a fellow business partner, Jonathan Gerwitz for them to take over operations at Mercy. The sale of Mercy was announced in August. Salamon plans to rename the facility “Tupper Lake Center for Nursing and Rehabilitation.”

“When I first heard that Adirondack Health had sold Mercy … to a private firm, I knew that there was going to be a change,” said Tupper Lake Free Press Dan McClelland at the Nov. 12 meeting. McClelland previously sat on Mercy’s board for six years. “You know, if you’ve got to make a buck at a business, you’ve got to find ways to make that dollar … so you have to make cuts.

“The nursing home situation in America is badly broken. In order to go to a nursing home you have to impoverish yourself,” McClelland said.

Eventually, many end up “penniless,” he said, and after they can’t afford private pay for care — the more lucrative option for nursing homes — they end up on Medicaid. Welfare, as McClelland called it. But the Medicaid reimbursement rate is well below the cost of the care.

When Adirondack Health acquired Mercy Living Center from the Sisters of Mercy in 2007 the transfer was supposed to get the nursing home a better reimbursement rate.

“In July 2005, Adirondack Health was advised that once it had acquired the Mercy Health Care Nursing Home in Tupper Lake, the facility would meet the criteria for a “hospital-based” nursing home and receive Medicaid reimbursement consistent with that designation, in accordance with state regulations,” Scollin wrote in an email. “Unfortunately, it appears that this higher reimbursement rate never materialized for Adirondack Health.”

McClelland said the facility has been “bleeding money” ever since and is “not financially feasible.”

Scollin said Mercy lost Adirondack Health $5 million this past year.

“The financials of long-term care threatened the entire organization of Adirondack Health,” Kramer said. “We are in a better place because of this sale. We still have work to do. This is a very challenging environment for rural health care.”

Adirondack Health announced its intentions to sell Mercy in October 2022, following a year of multi-million dollar financial losses for the facility. Kramer’s goal was sustainable Mercy and he said he thinks they found a good buyer.

Salamon said he buys “broken” nursing homes and fixes them up and that he’s never sold a nursing home. He told Vaillancourt buying Mercy was a sort of community service and Vaillancourt suspected it might be a business tax write-off.

“He may be using this as a write-off, which is lucky for us, but we sill need make sure we have the level of care for the residents,” Vaillancourt said.

Salamon said it would be a write-off at first, because it is losing money, but he said he’s “not that type of guy” and wants Mercy to make a profit eventually.

In the meantime, Salamon said he and his business partner are “funding the losses.”

Kramer said Salamon has a “track record” of making finances work. Scollin chalked this up to “economies of scale” — he’s buying supplies for dozens of nursing homes, so he gets better prices than Adirondack Health would with one.

He is involved in 20 nursing homes in New York and Connecticut, including one in Massena.

“Most of them are higher than Mercy’s one star,” Kramer said.

Adirondack Health Chief Nursing Officer Dave Mader said during the hospital system’s search for a buyer, Salamon’s were one of only a few to have a star quality rating improve over time.

But some felt that was a pretty low bar to clear.

Salamon said he believes he can turn Mercy around and is confident a change in leadership will mean a positive change in quality of care.

He said he upgraded the building’s boiler and installed new fire alarms. He wants to renovate the building exterior and lobby.

And he plans to ask the state to add more beds in the near future. He believes the building could hold 75 residents.