There's no beating around the bush with Dr. Andrew Coates about who provides the best health care for today's elderly and disabled population.
Public care beats private care hands down, says the Medical Director of Albany County Nursing Home.
"The building may be falling down, but the human material inside is first class all the way," he says bluntly. "Albany County residents should be extremely proud to own a facility and have a staff like this."
An outspoken supporter of the 40-year-old county-owned residential health care facility at a time when economic conditions and political forces have been at work to privitize ACNH or close it all together — Dr. Coates sat down recently for an interview to talk about Medical Services for residents.
In his position as Medical Director, Dr. Coates is responsible for overseeing the entire medical staff of Albany County Nursing Home, which includes four physicians, an extensive nursing department and a variety of health care services for residents and their families.
He is board certified in internal medicine, hospice and pallative medicine (a specialize area of health care that focuses on relieving and preventing the suffering of patients). In addition to being ACNH Medical Director, Dr. Coates is an attending physician at Albany Medical Center and St. Peter's Hospital.
For residents who do not have a personal physician or whose personal physician does not follow nursing home patients, the Social Services Department assigns one of four staff physicians to oversee their medical care and treatment. The nursing home is divided into four geographic units with each physician overseeing a team of health care professionals that manage a professional health care plan developed for each individual.
The physicians on staff are responsible for managing patient care, doing regular visits and acute visits, performing periodic examinations, regulating patient medications and taking turns being on call 24-7.
ACNH also provides skilled nursing services 24-7 and boasts one of the highest nursing-to-patient staffing ratios found in the residential health care industry today. Few facilities nationally provide such an extensive array of clinical programming as the ACNH Nursing Department.
"There is a myth out there that all residential health care provided by public facilities is inferior to the care patients receive at private facilities," Dr. Coates says. "That's what the political forces who want to privitize our facility will tell you but it's just not true. It's well established in New York State that public nursing homes, on average, have up to twice as many nurses per patient compared to for-profit nursing homes. It's well established in scientific literature that more nurses per patient corresponds with better patient outcomes. People come to nursing homes for nursing care and the more attention they receive the better off they will be. The secret needs to get out."
"Another factor in terms of service to patients is the quality of the county's nursing home staff," Dr. Coates points out. "In public institutions, the trend has been that the pay might not be as high as private settings but the benefits are far superior. The New York State pension plan (which private facilities can't offer their employees), generally speaking, keeps our staff together longer. So we get a better longevity of employees here than a private institution and that corresponds to better education, better training, more cohesive teamwork and better patient care. Ou quality of care is outstanding and that's why the physicians we have tend to be here for a very long time as well."
"The best way to provide accountable care is through public institutions," Dr. Coates says, "and here is why. If you have a problem with care received at a private nursing home is there a way to directly call the owners of the private nursing home to complain? Do you think you'd get a response? But when 'the people' own the nursing home as they do in a public setting all they have to do is pick up the phone and call their county legislator. I mean, it's not a bad thing to speak up if you don't like something. The legislator can come over, sit down with the administration or the patient and family and get something done about it. That kind of accountability and responsiveness is the most defensible form of care."
"In general, public nursing home care costs less than private care and has better outcomes," Dr. Coates says. "In fact, the mortality rate at for-profit facilities is worse than at the not-for-profits. So an enlightened person should be defending public nursing facilities for that reason alone."
As a way of connecting with the next generation of medical minds and staying on top of the latest health care trends, Albany County Nursing Home is teaming up with Albany Medical College to offer a unique educational partnership. The new program pairs medical students with the nursing home medical team to work with residents and their families and track their care over the course of a year. It's a special elective offered through the college to the entire Albany Medical Center class. The program just got underway and two students — a first-year and a second-year — have recently come on board.
"We have medical students, as part of their studies, who are very interested in working with our population," Dr. Coates says. "And they are very excited to be here."
In this field of care, Dr. Coates adds, it's important for the medical team to meet with the families, clarify the goals of care, the diagnosis and the prognosis, "so everyone is on the same page as the care giving team. We thought medical students would be a great addition to this conversation."
"Many of the county's most vulnerable people are here at this nursing home," Dr. Coates explains. "When you have people who can't speak for themselves or who have no family at all we have a great responsibility to see that their care is appropriate and dignified. In this time of fiscal crisis and cutbacks to all kinds of important programs, I believe it's critically important we stay true to the responsibility we have to our fellow human beings who still need our help the most."
"There has been a great consciousness raising recently in our county about people living in their homes for as long as they can and I think we're all for that," Dr. Coates adds. "But the nursing home still has a crucial role to play at some point in their lives. It's not something we can just wish away and abandon the people who will someday need this facility, even if it's just for a short time."