Shaker Place director outlines admissions, payer mix, staffing and financial strains

Mark Olson, executive director of Shaker Place Rehabilitation and Nursing Center, briefed the Albany County committee on admissions patterns, payer mix, staffing and the facility’s financial position.

Olson said Shaker Place recorded 237 new admissions in calendar year 2025, including 134 Albany County residents, and currently houses 248 residents of a 250-bed capacity. He described a payer mix dominated by Medicaid (147 residents) with about 65 private-pay residents, roughly 11 on Medicare Advantage, 10 on traditional Medicare, 10 on hospice private pay and 5 covered by VA benefits. Olson said private-pay rates are “just north of $500 a day.”

The presentation focused on how short-term rehabilitation pathways and payment types shape length of stay. Olson explained that many residents arrive from a hospital stay and use traditional Medicare post-acute benefits (up to 100 days), while Medicare Advantage plans often manage care more tightly and typically shorten nursing-home stays.

Olson highlighted rehabilitation outcomes and capacity decisions: Shaker Place discharged roughly 95 residents last year back to home or assisted living after rehab, and the facility operates multiple unit types (short-term rehab unit, long-term care units and a locked memory-care unit). He said bed location, roommate and gender-matching rules for semi-private rooms and infection-control restrictions affect who can be admitted immediately.

On clinical criteria, Olson described the committee-based admissions review process (daily meetings with nursing, medical, social work and finance staff) and cited required documentation such as a PRI completed by an RN, clinical histories, vaccination records and medication lists. He emphasized behavioral and psychotropic-medication considerations, saying the facility avoids admitting individuals whose behaviors would endanger others unless an appropriate secure placement is available.

Olson reviewed patient- and family-satisfaction data from Pinnacle, reporting a short-stay recommendation rate that respondents rated 4 or 5 (12 surveys per month; about 144 per year), a long-term satisfaction score of 97.1% and a responsible-party satisfaction score of 97.9%. He described using verbatim comments to guide improvements, including service changes intended to raise dining ratings.

On staffing, Olson said the facility has increased full-time staffing since 2023, reduced reliance on per-diem and outside agency staff, and trained and certified 61 CNAs since March 2025 (about 40 remain employed). He warned that 24/7 one-to-one staffing for a small number of residents significantly reduces available staff for other assignments.

Turning to finances, Olson said the recent state budget restored part of a prior cut to the capital component of nursing-home Medicaid rates and included larger Medicaid rate increases that he estimated could add north of $2 million to Shaker Place revenue this year. Despite that, Olson reported the facility runs an approximate $6 million annual operating deficit and holds about 50 days cash on hand, and he said some capital reimbursements may not flow through the Medicaid rate until 2028 because of phased timing.

Committee members asked about sample sizes for satisfaction surveys, dining-service improvements and guidance for families whose loved ones do not meet admission criteria. Olson answered that Pinnacle conducts 12 surveys monthly, that dining changes (serving on nursing units) are intended to improve meal experience, and that families sometimes must seek specialized placements beyond the local region for extreme behavioral cases but can return to consider Shaker Place later if conditions change.

The committee did not take formal action on the presentation; Olson provided handouts for members and offered to share additional materials with the committee.