Resident removal: a modern long-term care saga.

Neponsit Health Care Center is a grim pile of institutional brick and concrete on the Atlantic beachfront in the far southeast corner of New York City. Until its rather messy demise late last year, it was home to 279 elderly and cognitively impaired residents and a source of employment for 320 staff members. Owned and operated by the municipal Health and Hospitals Corporation (HHC), Neponsit provided an innovative range of long-term care services to New York City residents. Its offerings included an adult day healthcare program, a 31-bed Alzheimer's specialty facility, a hospice, and a small scheduled short-term stay program where caregivers could stay for a day or two with a home care patient. Survey records from HCFA and New York State indicate that there were no current deficiencies in the quality of care received by the patients.

Nearby residents, however, have been unhappy about sharing the neighborhood with the ugly, 85-year-old facility. Cut off by Jamaica Bay from the rest of New York City, Neponsit is a community of pricey single-family homes and private boat docks, more similar to Long Island oceanfront towns than to Manhattan or the Bronx. The staff of Republican City Councilman Alfonso Stabile attribute their 1994 victory over an entrenched Democratic incumbent, in part, to voter anger over Neponsit Health Care Center's crumbling physical plant. In response to that anger, a committee of the HHC Board of Directors voted to invest money in repairing the facility. That wasn't to be.

On September 7, 1998, a powerful storm hammered New York City. Three days later, HHC requested that the New York State Health Department permit a temporary evacuation of all four buildings of Neponsit "to assess storm damage." In fact, the Capital Committee of the Board of Directors of HHC ordered more than that: a complete engineering assessment of the facility.

The evacuation was executed poorly. Residents were hauled out of their rooms in the middle of the night, in some cases clutching a paper bag of personal possessions. Two residents died while being relocated to acute care facilities; a third was "lost" for weeks. A few residents were moved several times within two or three days when their temporary beds were needed for acute care patients. The nursing home staff also were transferred, but not necessarily to the same locations as their residents.

Frances Tarlton, a spokesperson for the New York State Health Department, explains that the State was willing to believe HHC that the Neponsit facility might be unsafe, but ordered HHC to continue the residents' physical and occupational therapies, as well as other services reimbursed by Medicaid and New York State. According to Tarlton, it quickly became apparent to both HCFA and the State Health Department that many evacuated residents were not receiving the specified care. HCFA imposed a daily fine of $3,050 on HHC until every resident was returned to an appropriate long-term care facility.

Even before city engineers assessed the buildings, though, HHC management expressed doubts about residents ever returning to the nursing home. On October 1, 20 days after the evacuation, HHC President Luis Marcos recommended permanent closing. At first his office claimed that repairs to ensure the safety of residents would cost $51 million. When Neponsit's union representatives denounced the estimate as absurdly high, Dr. Marcos explained that replacement of the roof and facade would cost $9 million - but the "repair" estimate also included widening hallways, increasing the square footage per resident and other changes.

New York Mayor Rudolph Giuliani informed the city's Parks Commission on October 27 that the six acres occupied by Neponsit had been acquired for oceanfront park land, as mandated by a 1906 law governing surplus property of state-chartered corporations. Giuliani's announcement struck many stakeholders as somewhat premature because the Board of Directors of HHC had not voted to close the facility. Advocates for the residents, however, were not surprised when, two days later, the Board of Directors turned a deaf ear to their pleas and voted to accept Dr. Marcos' recommendation for permanent closure. Their first hint of this had been when demolition crews toured the facility to plan the timetable for the destruction of the buildings.

At this writing, in December, the evacuated patients have finally been moved into permanent long-term care and HCFA has stopped adding to HHC's daily fines. Neponsit, however, still stands shuttered and abandoned against the Atlantic gales. A group of attorneys representing the former residents has filed suit against HHC, charging that the closure process was illegal. Public Advocate Mark Green has demanded proof of the need for the September evacuation and argued that Neponsit should authorize an inspection of the property by someone who isn't on the city payroll. Until the suit is resolved, which may be months from now, HHC cannot demolish the facility.

From one standpoint, HHC's closing of the facility may have been a sound business decision. HHC wants to scale back its investment in long-term care; although spokesmen for the city corporation would not answer questions about Neponsit, their press releases feature Dr. Marcos taking credit for closing outdated facilities and cutting HHC's employment rolls. Also, repairing Neponsit would have cost more money than could be recouped by Medicaid reimbursements for the residents. Although HCFA and New York State were satisfied with the facility's quality of care, any private operator would have been facing bankruptcy trying to update four pre-World War I buildings on Medicaid revenue alone.

That being said, State Legislator Audrey Pheffer, a critic of New York City's actions on Neponsit, argues that government fiscal realities offer too few viable choices. Changing a nursing home that the city cannot afford to maintain into a park that the city cannot afford to maintain, according to Pheffer, is no bargain for the neighborhood or the taxpayers. Before September, the aging nursing home at least offered convenient and affordable day care for the frail elderly of the community. Today it offers no more than a fenced-in, desolate perch for sea gulls.