Belmont Home

The Issue
In 1992, the City of Worcester was confronted with financial problems at Belmont Home, its publicly owned and operated nursing home, that were similar to those at Worcester City Hospital. Since 1955, the City had operated this 184-bed nursing home primarily for elderly infirm persons. It was located in a 1921 building on Belmont Street between Green Hill Park and Worcester State Hospital at the site of the former Belmont Hospital, which had been established to treat patients with tuberculosis and other contagious diseases. In its report the Research Bureau raised questions about the City's continued ownership and operation of a nursing home:

• The building's physical plant was outdated and needed to be replaced. While the cost of constructing a new facility would have been reimbursed through Medicaid over a 20-year period, the City would have had to secure the mortgage and provide a line of credit. The City needed to decide whether overseeing and operating a nursing home was part of basic City services. Given the City's primary responsibility of providing public safety, public education, and street and park maintenance, should it (given fiscal constraints) continue to provide a service much more commonly provided by both profit-making and nonprofit agencies?

• Under the Commonwealth's then-recently altered reimbursement system, Belmont Home's per diem nursing costs in 1991 were 23% higher than the cap established by the Commonwealth for all public medical institutions. This excess was the result of municipal employee union contracts negotiated with the City and pension benefits for retired employees.

• The Commonwealth's decision that in 1993 it would start reimbursing public and private nursing homes at the same rate meant that Belmont Home would have to cut its expenses by about $850,000 or 13%. How could that be done without compromising care or requiring the City to subsidize the deficit?

The Results
In 1995, the City sold the license to build a new nursing home to Christopher House, a private, nonprofit organization based in Boston. A year later, the Belmont Home patients moved into Christopher House of Worcester, a new $9.5 million, 156-bed facility located next to Belmont Home. Today, Christopher House has four units: sub-acute care, medical care, long-term care and Alzheimer's. It has a 96-98% occupancy rate and a constant waiting list. It regularly ranks in the top 50% on the State's Department of Public annual surveys of nursing homes and scores 99% approval on its own family and resident satisfaction surveys. In 1998, Christopher House built an 82-unit assisted living facility at the site as well.