My Name Is Gil Thisse. I Am the Director of Operations of Rehabilitation Associates, Inc

December 19, 2016

My name is Gil Thisse. I am the Director of Operations of Rehabilitation Associates, Inc., and I am currently the Administrator of the Timothy Daniels House in Holliston, Mass. I grew up in our family business. I have been working in long term care my entire life. I have been employed in nursing homes since 1977. I have been practicing as a licensed nursing home administrator for 23 years.

The Timothy Daniels House was originally built in 1850. This 40-bed, CMS 5-Star rated SNF, is the only health care facility in the town of Holliston. The last renovation of the building was completed in 2009. This is a HUD-insured project, with a 40-year mortgage. If the current “grandfathered” construction status is eliminated, this facility will no longer be in compliance with DPH licensure regulations. The closure of this facility would inevitably cause a default on our mortgage, the elimination of 50 jobs in this small town, and the up-rooting of 25 long-term residents to whom this house is their home, almost all of whom have ties to the local community. This is just one example of one building.

We own and operate nine skilled nursing facilities, all in Massachusetts. Without the grandfathered construction provision, eight out of the 9 would be out of compliance.

My dad founded Rehabilitation Associates in 1966. We provide holistic, person-centered nursing and rehabilitative care in small, home-like facilities. We are now celebrating our 50th year providing much needed services to frail, elderly, and disabled citizens of our communities, and their families.

When my dad founded the business, nursing homes were actually homes. The average size of a nursing home in Massachusetts in 1966 was around 40 beds or less. They were privately owned, and operated by nurses. With a Master’s degree in Education (EdM), and a Certificate of Advanced Graduate Studies in Rehabilitation Counseling, my dad became involved in rehabilitation. He worked as a rehab counselor at Boston State Hospital, and became Executive Director of PROP (the Patient Rehabilitation Occupational Program.) Meanwhile, the de-institutionalization of the state mental hospital system was in full force. Dad was involved with implementing innovative programs being developed to try to successfully integrate state hospital patients into the community. He started his business, Rehabilitation Associates, to educate nursing home owners on how to address psychiatric issues in the elderly. With 2 colleagues as partners, he bought a 27-bed facility in 1968. This was the beginning of our story.

In the late 1960’s, Title XVIII and Title XIX of the Social Security Act were passed, and Medicaid and Medicare became law. The government became a primary payor. Publicly traded corporations were launched. Regulations mounted. The business became complicated. The majority of the old, proprietary, mom-and-pop, family-run homes in Massachusetts were sold, their licenses combined , and there ensued a construction boom of large, multi-unit “Facilities”.

We took a different route. Instead of combining licenses into large institutional facilities, we acquired small homes, renovating them and keeping them going. They remained in their residential neighborhoods, providing long term care to generations of families from their communities. My dad’s life-work, and now my family’s, has been to preserve the small, community-based SNF’s in which we so strongly believe. Despite the financial limitations of our small, home-like buildings, we have been able to continually adjust to the evolving healthcare system. For 50 years we have complied with every new regulation. All of our buildings are fully sprinklered. All buildings have automatic generator back-up power. All became Medicare certified in 1994. All became JCAHO accredited by 2012. Over the years we added many administrative positions to comply with the ever-growing stack of regulations and reporting requirements from the myriad of federal and state authorities. We built an in-house rehab team who knows their patients, providing second-to-none short-term, post-acute rehab, in many cases to repeat customers from the local neighborhoods. We partner with Hospices to provide amazing palliative and end of life care. And, yes, 50 years later, we actually still provide holistic, person-centered care of people with dementia, even though, due to our home-like buildings we are now barred by DPH regulations from using the words “dementia care” in our brochures.

Regardless of the new regulatory hurdles, and increasingly inadequate payment from government and commercial payors, we have always believed that our homes will survive, because of our staff’s dedication to the residents, and our good, word-of-mouth reputation for quality of care and quality of life.

Unfortunately, the removal of our grandfathered status is a hurdle which we could not overcome. It would be physically impossible for our buildings to comply with modern construction specifications. Our buildings are historic. We have several buildings that were built before 1900. One was built in 1650. Several others were built in the 1800’s. Another, built in 1956, was the first-ever newly constructed nursing facility in New England. It won design awards for its innovative design. While all of our buildings have been renovated to various extents, they all still contain space which does not and could not physically comply with new construction regulations, due to space limitations, zoning setbacks, etc.

Here are a few facts about our family-owned business.

 SERVICES

 We own and operate the ONLY nursing facility in each of the following towns:

BLACKSTONE, BRIDGEWATER; HOLLISTON; MEDFIELD; SOUTH NATICK; and UXBRIDGE .

If our buildings were forced to close, all of our long-term residents would be forced to relocate to other towns.

 We operate some of the SMALLEST freestanding nursing facilities in the state. Our small facilities allow a uniquely holistic quality of care, and a quality of life where everyone knows everyone like a true family.

 COST

 Many of these older facilities have little to NO debt, (six of our facilities have no mortgages) allowing for much less capital cost to MassHealth and the taxpayers, than very expensive newer construction.  JOBS

 My company employs over 500 people in the Commonwealth, providing approximately 50 jobs in each of our facilities, in each of our towns. We are the largest employer in many of the nine towns in which we operate.

We have been told by Mass Senior Care that over 140 Skilled Nursing Facilities will be affected if this removal of our grandfathered status is implemented. I sincerely believe that it is not the goal of the Commissioner, the Department of Public Health, or Governor Baker, to close 140 established businesses providing thousands of jobs, and much needed services to thousands of citizens throughout the state.

To whomever has the power to promulgate regulations, I urge you to please consider our jobs, our communities, and the future of the healthcare infrastructure in our 9 towns, and to continue our grandfathered status, and allow these homes, these facilities, these established, long-standing resources in our communities, to continue to operate, providing valuable, long-term jobs to the people of these towns, and serving the Commonwealth’s most frail, needy, and vulnerable citizens, in the same communities where they have lived their lives.

Respectfully submitted,

Gilbert M. Thisse II Director of Operations Rehabilitation Associates, Inc. 80 Access Rd., Norwood, MA 02062 ph(781)762-0703 x21 fax(781)762-2099 www.rehabassociates.com