Nathaniel Witherall leaders present 16‑month turnaround plan as census collapses and losses mount

At a budget review meeting of the Town of Greenwich Board of Estimate and Taxation, leaders of Nathaniel Witherall told members the nursing facility has experienced a recent collapse in average daily census and must stabilize occupancy to avoid steep fiscal losses.

Peter Kelly, the board chair, said the organization “now have a management team in place” and introduced the board’s focus: a 16‑month turnaround plan beginning March 1. Finance committee chair Brad Radvaki presented enrollment and financial data showing average daily census declined from the high 170s to roughly the mid‑150s over the past 18 months, a drop of about 20 residents. “If we maintain this level, we’re going to be losing $47,000 a month,” Radvaki said, summarizing the current run rate shortfall.

Management attributed the decline primarily to a loss of long‑term (Medicaid) residents while short‑term (Medicare) rehab stays continue to churn quickly. Executives said the facility has turned away memory‑care patients for capacity and placement reasons: Radvaki reported the facility denied about 50 memory‑care admissions in fiscal year 2025 and roughly 25 in the first seven months of the current fiscal year. Executives estimated that accepting even a portion of those denied memory‑care patients could materially improve revenue: the board was shown a model suggesting that converting roughly eight denied dementia patients into admitted residents for a year could yield about $1.1 million in incremental revenue.

John Masterardi, Nathaniel Witherall’s executive director, outlined a conservative stabilization strategy focused on halting the decline first. Key near‑term actions include 7‑day admission coverage, real‑time bed tracking, executive outreach to hospital discharge planners (including at Greenwich and Stanford), expanded evening/weekend admissions, and cross‑unit placement for appropriate non‑behavioral dementia patients combined with staff training to “treat in place” rather than readmit to hospitals. Management said the plan aims for a net increase of approximately two admissions per month during the first four months; if achieved, they projected average daily census could rise from about 157 to roughly 165 by July.

The board and management warned that some constraints are outside local control. A multi‑phase pipe replacement project has taken about 12–16 beds out of service since April 2025 and will continue through staggered work into late 2027, limiting the facility’s ability to shift residents between units. Management also cited industry trends—shorter Medicare Advantage rehab stays and tighter payer‑driven length‑of‑stay policies—that increase short‑term churn and reduce the contribution of rehab patients to census.

Nathaniel Witherall’s leaders stressed internal fixes already in place: coding and MDS documentation improvements raised Medicare daily revenue (management reported a rise from roughly $675 to just over $800 per day), receivables collection improved to an estimated 98–99% collectible, and new clinical leadership was being onboarded (a new director of nursing services, named in the presentation). The board emphasized a four‑month checkpoint to test whether the operational changes increase referrals and admissions enough to materially narrow the loss trajectory.

BET members pressed for contingency planning if the turnaround stalls, including what triggers would prompt consideration of alternative management models or formal steps such as bed reductions (state approvals were cited as required for any certification changes). Management acknowledged those are possibilities but said the immediate focus is conversion of referrals, reducing avoidable readmissions and improving referral partner confidence.

The meeting closed with agreement on follow‑up requests: more detail on the capital and operating budget lines (electric, maintenance, telephone), phasing options for planned capital work, and a formal census check in about four months to determine whether the FY27 budget targets remain realistic.