Interview with the New York State Department of Health on LTC issues

[Note: I had the opportunity to speak with Mark Kissinger, the New York State Deputy Commissioner of Long Term Care, and Jacqueline Pappalardi, Director of the Division of Residential Services in the New York State Office of Long Term Care. They answered some of my burning questions about the present and future of nursing homes.]

I understand with the long term care restructuring going on in New York State, there’s a movement from nursing homes toward assisted living, but there will continue to be a need for nursing homes. How would you suggest nursing homes prepare for the future?

People will try to stay at home and at lower levels of care. The more client-centered nursing homes can be, the more helpful it will be to them. We’d suggest they diversify into rehabilitation care. More short-term rehab will help from a financial standpoint.

Are there efforts by the Department of Health to provide guidance for nursing homes? For example, is there anyone at the State Department of Health that nursing home staff can turn to for guidance if they want to start creative new programs?

Jackie meets regularly across the state to talk with the providers and with regional program directors. Regional staff are invited to these meetings and to the central office [in the Albany area]. The staff at the Division of Residential Services, which includes nursing homes, assisted living, and intermediate care, can be reached via email. Every other week there are telephone calls with the Health Department about H1N1, for example. We also put out “Dear Administrator” letters to give guidance.

I see some residents and families afraid to say things to the staff, the line staff afraid of the administration, and the administration afraid of the DOH. Is the DOH afraid of the feds? If so, why?

No, we’re not afraid of the feds at all. We speak weekly with Annette Tucker-Osborne [, Branch Chief at the Centers for Medicare and Medicaid Services]. We work collaboratively with the federal government. The issue of people being afraid to talk to us is definitely out there, but we try to let them know they can call to talk. We have over 9000 calls on an annual basis.

Nursing home staff sometimes comments that Ssate inspections appear to focus on arbitrary criteria. Staff are often puzzled about why certain issues are noted by the state, while others they expected to be problems aren’t seen as such. What’s your perspective on this?

Our staff are trained on state and federal guidelines. It’s not arbitrary. It’s a very set agenda. The nursing staff are very aware of what the guidelines are, and most administrators are very aware of what will be looked at. On a quarterly basis, we discuss the top five deficiencies surveyors find. While it might seem arbitrary to a staff member within one nursing home, things might be seen by surveyors as a systems problem after looking at several nursing homes.

How do you think nursing homes can be improved in general?

Through better management at the administrator level and better communication between certified nursing assistants, nurses, and administration. Examine systems and listen more to residents and staff. Constant quality assurance should be infused into the nursing home practice. The resident really should be at the center, and include their families. We encourage nursing homes to talk about best practices with each other. To facilitate best practices, for example, a chef could come in and talk to staff about meals. A spa-like environment could be created in the bathroom.

Dr. Barbera is an author and a licensed psychologist consulting in long-term care facilities in the New York City area. She frequently lectures on subjects related to psychology, aging, and nursing homes. Dr. Barbera is available for private consulting with organizations, institutions, and individuals around eldercare issues. Visit her personal blog at

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