The day before last week’s primary election, a hot topic for the contested Republican ballot for county commissioner was discussed during last Monday’s meeting of the Monroe County Board.

The current board has faced criticism for its decision last year to lease Oak Hill, the county-owned senior living and rehabilitation center on Hamacher Street in Waterloo, to regional firm Accolade Healthcare.

The lease is believed to be the driving force which compelled voters to elect political newcomer Marvin Wittenauer over the incumbent and current County Board Chairman George Green in the Republican primary election by a significant margin on March 17.

Last Monday’s discussion was the last chance for public comment on the senior care facility prior to this election.

First to speak at this meeting was Monroe County Democratic Central Committee member Scot Luchtefeld. He asked whether a report would be available following a reported forensic audit of the senior living facility from 2016 through 2022.

Monroe County State’s Attorney Ryan Webb explained this audit will remain in “draft form” and is therefore not subject to Freedom of Information Act requests.

Webb added information given to the Republic-Times earlier in the month contained all the pertinent information from the audit – the main difference being it was not on Armanino LLP letterhead – the company that performed the audit.

Next to speak was Nancy Gilbert, who had questions about a reported decline in service at this facility. She cited “many changes” since Accolade took over – including severing ties with local businesses and “no choice” regarding food options.

A Waterloo resident who had an immediate family member stay at Accolade for one month earlier this year called the Republic-Times to confirm Gilbert’s statements about poor food service. 

A current resident of Accolade’s assisted living wing visited the Republic-Times office earlier this week looking to read the online article. This resident offered further testimony about her experience with the way Accolade conducts operations. 

The resident shared she had been admitted to Oak Hill’s Magnolia Terrace in early October, adding she was initially pleased with the accommodations.

The resident reported a drastic change in a matter of weeks, however, as the Accolade group began initiating changes.

The lack of dietary options was compounded with a lack of availability, this resident confirmed.

The resident also shared several stories of the facility running out of food one day, with a staff member offering her one half of a grilled cheese sandwich.

Another resident was allegedly denied food altogether when she arrived at the Accolade cafeteria at about 5:30 p.m., the resident stated, pointing out dinner is generally served from 5-6 p.m.

During last Monday’s meeting, Gilbert told commissioners the Accolade facility “looks like an institution,” and claiming residents are upset about the quality of living since Accolade took over operations on Dec. 1.

Gilbert and others are also upset that the rates charged to residents have already been raised a few short months into the five-year lease.

“Is that how (Accolade) is going to make money to pay the county?” Gilbert asked of the supposed rate hikes.

She also asked about terms of the lease, specifically the purchase option.

During several rounds of public comment following the pending lease agreement, a frequently-voiced concern pointed to a reduction in quality of care provided at facilities owned by private, for-profit companies and increased rates compared to taxpayer-funded senior care centers. 

Green explained at the meeting that Accolade has the option to purchase the facility in Waterloo outright should it decide to renew the first lease term.

Accolade has “five years to prove themselves,” Green added.

Webb added that no sale of the facility would occur “unless and until” this move receives voter approval.

“I don’t understand. Do you think (voters) are really going to pass that?” Gilbert said, referring to the potential sale referendum.

On Tuesday, Accolade of Waterloo Administrator Eli Kamins responded via email to this paper’s request for comment about claims made against the company.

Kamins did not address concerns regarding Accolade’s dietary program and did not respond to an email requesting further comment about these food claims specifically.

He did address the rate changes and offered an overview of the company’s operational philosophy.

“Accolade Healthcare of Waterloo implemented a 5 percent annual rate increase at the beginning of January,” Kamins wrote in the email. “This adjustment is consistent with the standard annual increases… and was communicated directly to residents and their families in advance.”

In response to questions about the removal of some amenities and the unavailability of others, Kamins explained Accolade “discontinued billing separately for items that had previously been charged under county ownership, including wound care supplies, incontinence products, and dietary supplements. By incorporating these necessities into our standard services, residents benefit from fewer ancillary charges and a more predictable monthly cost structure.”

He then hypothetically compared the cost of care at Accolade to Oak Hill.

“If the county would have still been operating (Oak Hill), residents would have still received the 5-6 percent increase while still being charged for” the items Kamins had previously mentioned.

He encouraged anyone with further billing questions to contact him directly.

“Our priority has been to simplify billing, improve transparency, and ensure residents receive comprehensive care without unexpected add-on costs,” Kamins concluded. “We remain committed to open communication with residents, families and the community, and we encourage anyone with specific questions about their billing to contact our administrative team directly so we can address their concerns promptly.”

Continuing to question commissioners last Monday was Pat Kelly, a Democrat running for the county board seat currently held by Green. He will now face Wittenauer in the general election this November.

Kelly asked why previous audits did not reveal any potential wrongdoing.

Webb responded by saying Armanino auditors looked at “every single document” from 2016-2022 available for review, explaining typical audits would not have revealed billing issues.

Webb continued by saying Armanino was brought in following a “whistleblower” report in February 2023.

In reviewing documents from the beginning of 2023, the auditors found “pervasive” billing issues and recommended an exhaustive audit beginning in 2106, Webb said. 

Speaking to “blank” entries that resulted in payment from Medicare, Webb said, “for lack of a better term, it’s fraud.”

Webb later said documentation would be available once the county submits a self-disclosure notice to Medicare.

Webb later reported a self-disclosure of the suspected overpayment had been “signed” and is currently under review for acceptance.

During a quarterly financial report, Monroe County Treasurer Kevin Koenigstein mentioned the county’s “rental” line being funded at more than 180 percent already for the year, due in part to Accolade submitting lease payments in December, January and February. Per the lease agreement, Accolade will pay $750,000 in the first year of the lease with incremental increases in subsequent years.

Commissioner Vicki Koerber said she believed any Accolade lease payments would be placed in a separate account.

After a bit of discussion, action on the matter was delayed to a future meeting.

Koenigstein also noted the March 1 payment from Accolade in the amount of $62,500 “failed to clear” the local financial institution. He said the check was deposited March 2 and returned March 6.

Koenigstein noted  Accolade issued another payment check March 9 that thus far has not been returned.

Kamins sent an email last Monday evening explaining this situation.

“The rent payment process for Accolade is irregular, which caused the system to flag it. As soon as we were notified of the issue late Friday afternoon, we addressed it immediately and rectified it first thing Monday morning,” Kamins wrote. “This was not a cash flow issue, but simply the result of a payment process that differs from the standard procedures typically used in skilled nursing facilities. We hope that in the future we can wire the funds to ensure the county receives them instantaneously.”

The next meeting of the Monroe County Board is scheduled to begin at 8:15 a.m. April 6, at the Monroe County Courthouse.