In November of last year, a Daily News story announced that Coler Hospital would be the next public hospital to shut down. It relied on information from two anonymous sources who claimed knowledge about NYC Health + Hospitals (HHC) planning. Robert DeLuna, from the press office at HHC, emailed us a denial of that claim, “We are committed to maintaining and improving our post-acute care services and have no plans to reduce services.
At last week’s Coler Community Advisory Board’s Legislative Breakfast, rumors that the post-acute care facility would close were further addressed by remarks from Manhattan Borough President Gale Brewer and departing Coler Advisory Board Chair Gladys Dixon. Robert Hughes, the executive director of the hospital, did not speak to the rumors but did acknowledge that not all of the facility’s 815 beds are occupied. He attributed it to “reduced utilization of the hospital due to a shift in the market as to a demand for these types of beds.”
Members of the Coler Advisory Board pose after the presentations
A Market in Transition
As it turns out, it’s not just Coler Hospital; the entire healthcare market is in transition, and HHC’s status as a safety-net system only exacerbates this problem. Many HHC facilities have empty beds, 18 private hospitals have closed in New York City in the last 15 years, hospital stays dropped 5% between 2012 and 2014, and when it comes to Medicaid Managed Care hospital stays, HHC lost market share to other New York City hospitals. While other major systems saw a 5% increase, HHC experienced a 3% decline.
Hughes gave a brief rundown of the hospital’s demographics as part of his presentation and explained that Coler Hospital is “a destination for hard-to-place patients,” and that they admit from every borough besides Staten Island.
He described the scope of services offered at the hospital as “sub-acute care (defined as comprehensive inpatient care designed for someone who has an acute illness, injury or exacerbation of a disease process), rehab, and memory care,” and characterized the hospital’s demographics as “quite different than the typical nursing facility,” at 68% male, with an average age of 62, younger compared to other facilities.
Reflective of the hospital’s safety-net status, he explained that 33% of their residents are uncompensated, for which they don’t receive any payment, and 64% are Medicaid or Medicaid-managed care.
In January, Mayor Bill de Blasio unveiled NYC Care, a healthcare plan for undocumented immigrants and other New Yorkers who do not qualify for insurance. The $100 million investment hopes to guarantee healthcare coverage for all New Yorkers. All patients on NYC Care will have direct access to facilities within the HHC system. In 2016, his office published One New York: Health Care for Our Neighborhoods, a comprehensive report outlining the City’s plan to address a growing Health + Hospitals financial shortfall forecasted, without intervention, to reach $1.8 billion by 2020 and made a series of emergency payments to HHC totaling $497 million.
The thing is, all hospitals cross-subsidize their uninsured and Medicaid patients with those who have commercial insurance, commonly referred to as the payer mix. But because HHC has a smaller share of commercially insured patients seeking treatment at their facilities, the system has less capacity to cross-subsidize.
This, combined with decreases in federal and state funding for the uninsured, a loss of Medicaid patients to other hospitals, and empty beds across facilities, has driven HHC’s’ financial gap.
The legislative breakfast was a good opportunity to rally the troops, so to speak, and explain what Coler does well. Departing Chairperson for the Coler Advisory Board Gladys Dixon, a resident since 1975, explained that “Coler is one of the best, if not the best long term care facility that we have in the City of New York,” and acknowledged that “we don’t know what the 2020 vision is.” By 2020, the HHC’s deficit is forecasted to reach $1.8 billon. “We must keep our facilities for the people who need them the most, the uninsured and the low-insured. We must fight. What we need to do is keep on keeping on.”
Manhattan Borough President Gale Brewer said she was concerned about the future of Coler. “I fight like crazy for constituents and members of the community. I am happy to support the amazing community here. Nurses love Coler.” She said, “I will take my guidance from the community, residents, the staff, and the programs here. The work you do is vital to the City.”
The Patients’ Perspective
Ramon "King Tito Love" Cruz, resident since 1998, said that “When you’re here, you meet people that have been through the same thing. Your rehab will be better, your attitude will be better. There are people here that really encourage you.” Cruz spent the first few years after his 1993 injury at Bronx-Lebanon Hospital, a private hospital, last in the news in 2017 after a former resident entered the building with an AR-15 rifle concealed under a lab coat, shot other medical staff, and was ultimately found dead from a self-inflicted gunshot wound.
Ramon "King Tito Love" Cruz, in red, performs with The Reality Poets, at the library last month
“I wish that when I first got hurt, I would have come straight here. It would have been much better,” explained Cruz who says he has his own radio show at Coler. “I found a purpose here. This place is awesome. And on the Island, you feel like you’re in the suburbs. I have jewelry on and I’ll fall asleep anywhere. Nobody touches me. Everybody respects my space. People look out for each other here. It’s a nice community.” Of Bronx-Lebanon, located in the middle of the South Bronx, Cruz says, “I was trying to get away from all of that. Going outside, you didn’t even get respect from the police,” he says and shared a story about a patient who went outside and got his sneakers stolen from right off his feet.
For those reasons he says he didn’t see progress until he came here. “This place really brings the best out in people,” he says, listing the Angelica program that holds four to five events throughout the year, and the OPEN DOORS program, based in Coler, that supports the creativity and leadership of people who have been harmed by gun violence and inspires action for safer, more just communities, of which he is a member, as examples.
Not only that, but he said he wasn’t even supplied a wheelchair at Bronx-Lebanon and is thrilled with his “top-of-the-line chair” he received through the Wheelchair Charities program at Coler.
Another patient, Andres “Jay” Molina, lived in Henry J. Carter Specialty Hospital and Nursing Facility, built to replace the former Goldwater Hospital located where the Cornell Tech campus currently is, for two and a half years. In March of 2016, he was moved to Coler. “When I got better, they sent me over here. If I could go back there to thank them I would kiss their feet,” he said, “Thank you for sending me to Coler.”
In the three years he’s been here, he says he’s seen units close, open, and then close again. In his view, the fact that the beds aren’t all occupied is not a red flag and not an indicator that something sinister is being planned behind the scenes. Though the auditorium was damaged during Superstorm Sandy and it still hasn’t been renovated. “I’ve been sick and this is what I call home,” he says of Coler.
Jennilie Brewster, OPEN DOORS’ project lead, says, “The guys have had this ripple effect on making Coler a more vibrant place.” The garden renovation that occured last summer, when over 100 Google employees came for the day, was a wonderful positive change and a great example of “what community can do,” said Brewster.
In his remarks, Executive Director Robert Hughes said, “We are very blessed here to have a community advisory board that is really truly engaged to what goes on here.” He explained that Coler has been in existence since 1952, and has a well-deserved reputation for providing high quality care. “In the quality component we have five stars. We perform well at the state level, in the first quintile in the state quality pool.”
Gladys Dixon, front, Robert Hughes (r) and Gale Brewer, middle
Some programs offered at Coler are of world renown, including memory care that uses music as a modality to improve quality of life. Patients have iPads with curated playlists that serve to reduce behaviors, agitation, and reliance on psychotropic medication.
Additionally, the facility itself has a lot of amenities, including chapels, a computer lab with technology and adaptive devices, a library, and a gift shop.
Gale Brewer explained the role of borough president in discussions about HHC. “Land Use and Zoning are always a challenge in terms of what the city looks like.” While her office, along with CB8, the City Council, and the mayor’s office all play a role in the land use process, and try to look at it in a holistic way, it’s often done piecemeal as there hasn’t been a plan since the 1960’s. “We try to work with HHC as often as we can. We are pleased that yesterday’s lawsuit was won by the disabled community and every new subway has to have an elevator”.
To complete her remarks, Brewer said, “I think we need to work together. I know that Coler has integrated with Roosevelt Island. Every person I talk to loves Coler. They love seeing your presence as part of their community. We are ready to be part of whatever decision you make about your future.”