Grady hospital officials aim to improve conditions at Crestview nursing home

Crestview is Fulton County's safety-net nursing home, the place for many who are poor, elderly or chronically sick. Many of its approximately 250 residents can't afford to pay, don't have insurance and are below the age when they would receive Medicare. If not for the Crestview, many likely would have nowhere to go, Gove said, as charity beds in nursing homes can be hard to find in metro Atlanta and Crestview is currently at capacity.

The repairs needed are major: leaky windows, walls in need of mold and asbestos removal, and electrical power problems. Sometimes the power goes out in sections. The areas where patients reside are safe and up to code, Gove said. But two units containing about 110 beds are off limits due to electrical and asbestos problems, according to documents obtained by The Atlanta Journal-Constitution.

This month a task force of Grady officials started meeting to craft a long-term solution to the problems at Crestview. Grady officials say they hope to have an answer by the end of the year. That could mean massive renovation, constructing a new facility or finding an existing place to move the residents.

Reaching a solution, however, could require negotiating some difficult politics involving Grady's leadership and that of Fulton County.

Crestview has taken a somewhat different course over the years than Grady hospital. For decades, Crestview served as the community nursing home owned and operated by Fulton County. The county handed it over to the Fulton-DeKalb Hospital Authority in 1991, though the county retained some authority and financial responsibility. The hospital authority, in turn, handed management over to the Grady corporate board as part of the hospital leadership shift in 2008.

Fulton County contributes about $1.5 million a year to the operation of Crestview. Grady funds the remainder of the nursing home's overall budget of $17.4 million a year, and absorbs the annual operating loss of about $4.5 million, Gove said.

Some question the wisdom of fixing up the place, arguing that even after millions are spent, there will still be four people sharing a room and eight people sharing a bathroom.

"If we do repairs over the next three years, and then over the next five years, we would just be continuing to fix it," said Thomas Dortch, chairman of the Fulton-DeKalb Hospital Authority. "Maybe we would be better off with a new facility."

Grady officials estimate that building a new nursing home would cost $35 million.

For now, hopes are high that a solution can be reached.

"The present state (of the facility) and the present funding are not right -- that's minimal funding, losing money every year, and hanging on," said Pete Correll, the chairman of the Grady corporation board of directors.

In a way, the move to deal forthrightly with Crestview reflects the success Grady has had in turning around the health system, which a few years ago was struggling to stay open. Officials acknowledge it would have been inconceivable back then to think of  building a new nursing home, as Grady was tens of millions in debt and facing facility problems across its health system.

Much of that changed when corporate and community leaders came together to save the place in 2007. Led in part by Correll, a former CEO at Georgia-Pacific, the effort prompted the Fulton-DeKalb Hospital Authority to hand over control of the hospital to a new corporate board. The group then embarked on a fund-raising effort that has raised more than $300 million for Grady.

Grady CEO Michael Young recently said the hospital had reached its first financial surplus in a decade, and the donations have helped create a new stroke center, revamped operating units, brought in new beds and upgraded the use of electronic medical records.

Whatever plan is chosen for Crestview, it must be approved by the Grady corporate board, the Fulton-DeKalb Hospital Authority and the Fulton County Commission, three bodies that have sometimes experienced friction.

It remains unclear how much Fulton County might contribute.

Correll, the head of the Grady corporate board, said he could not see any effort going forward without financial assistance from Fulton County.

Unlike other Grady facilities, Crestview does not receive assistance from DeKalb County. Fulton County residents are given priority at Crestview, Gove said.

John Eaves, chairman of the Fulton County Commission, said the county is obligated by contract to participate financially in any major project at Crestview, but he would not commit the county without first seeing the task force's recommendations. He also said the tight economy could create challenges to any funding effort.

As for the $300 million already raised by Grady, Correll said some of that money could be used for Crestview.

Dortch, the head of the hospital authority, said Grady might want to start a separate fund-raising effort for Crestview.

Improving the conditions at Crestview, some officials said, could attract more paying residents and bring down the facility's operating loss.

"We all recognize that Crestview needs some serious investment of dollars," Dortch said. "If we're going to be successful, it's going to be working together."