Navigator Homes continues public hearing

At its Thursday meeting, the Martha’s Vineyard Commission took up a continued public hearing for the proposed skilled nursing facility, Navigator Homes, in Edgartown.

The project is slated to feature 66 beds for senior residents, in addition to 48 workforce housing units on its 26-acre site at 490 Edgartown Road, which will be subdivided — half will go to Martha’s Vineyard Hospital, and half to Navigator Homes.

The facility is set to replace Windemere Nursing and Rehabilitation Center, which is currently the only nursing home on the Island. 

After being met with concerns by both commissioners and abutters at their last public hearing, regarding materials used in the building construction, wastewater, and the entrance to the development — among other things — project representatives presented some changes on Thursday. 

The project initially called for vinyl siding on workforce housing units, which was received unfavorably by commissioners, and prompted changes to the material that will be used, from synthetic to natural. 

However, newly raised issues concerning septic system effectiveness and daily fees for seniors prompted lengthy discussions.

After being required to submit additional nitrogen mitigation plans, MVH/Navigator Homes provided a revised proposal that involves upgrading 14 systems within the watershed, seven of which will be installed within the first year of operation. DRI coordinator Alex Elvin said that MVC staff are satisfied with the plan, but the facility would need to allow for testing during the first two years in order to determine actual nitrogen output, which would dictate if, and how many, more systems would be needed. 

Commissioner Ben Robinson noted that plans to avoid medical waste ending up in the septic system are appreciated, but inquired about how the facility will go about preventing pharmaceuticals from entering Sengekontacket Pond. On pharmaceuticals, he said, “quite a bit of what we digest passes through our bodies unused, and this is going to be a site that sort of concentrates that.”

Robinson pointed to studies that have already shown traces of pharmaceuticals in shellfish through the wastewater system, and asked if there is a way to make sure it could be filtered out. 

“You’re going to have a concentrated number of elders that are likely to be on pharmaceuticals,” he said, adding that the project presents an opportunity to try to quell the damage to an already fragile ecosystem. 

The attorney representing the project, Geoghan Coogan, said the facility “is not a hospital; there’s not a lot of pumping of IVs and high-concentrated materials like that … we’re talking Advil, Tylenol, things that we do in our own homes.” 

Ed Pesce, civil engineer, added that the advanced denitrifying septic system is akin to a “mini treatment plant,” which is dissimilar to typical residential systems. He said the systems that will be installed will —  “as a biological activity — help treat the wastewater and continue to degrade the amount of any residuals left in the wastewater.”

Robinson said the septic systems slated for the facility are meant to reduce nitrogen offloading, not pharmaceuticals, and asked again whether it would be possible to find ways to ensure that nearby waters are not contaminated.

Pesce said many people take daily medications, and in his opinion, high concentrations of pharmaceuticals left untreated are unlikely. “I don’t think it’s that big [of] a problem,” he said. “But to answer your question, we don’t have any additional information.” 

Robinson said it would be “worth at least a surface level of research” to get those answers.

Navigator Homes president and CEO David McDonough chimed in, stating that the wastewater “will be sampled regularly,” and the MVC would be allowed access to the results. “It’s a good point, Ben,” he said, “there may not be a lot of knowledge on that topic, but we should be in a position to collect that, and give you updates on what kinds of chemicals do flow through [the septic system], if any.”

Commissioner Doug Sederholm commented that “there are a lot of seniors on this Island already, who live with septic systems and take medications, every day … I’m one of them.” 

Sederholm also acknowledged that the 66-bed facility would increase concentration of pharmaceuticals. But, he said, “it’s everywhere.”

Commissioners moved on, with commissioner Michael Kim asking about whether facility models such as the one proposed often have long waiting lists, and inquired as to how much seniors would be paying to reside there. 

“I recall that approximately half the beds are self-pay, and half the beds will be partially paid by Medicare,” he said.

McDonough said the private pay rate will be $600 per day, and the Medicaid, “set by the state,” $320 per day for long-term care. Medicare, for short-term stays, he said, $689 per day. 

Commissioner Trip Barnes expressed bewilderment regarding the rates. “In 30 days, that would be $18,000 a month,” said Barnes, “do the math, and in a year, it’s like a quarter of a million bucks or more … Where are you going to get all these high-paying patients?”

Even with Medicaid assistance, Barnes said, “that’s still a big number — it sort of competes with having round-the-clock care at the house.” 

McDonough said the rates are “completely comparable” to that of similar facilities off-Island. 

He said there are a number of seniors who can afford the rates who have had no choice but to leave the Island due to the current lack of adequate facilities. He highlighted the need for social connectivity, and said those who move off-Island are often subject to being “completely isolated.” He said studies have shown that senior isolation drastically lowers life expectancy for the potential residents. With the same rates, he said, seniors residing at Navigator Homes have a longer life expectancy. 

Barnes noted that even paying a fraction of that price for care for his mother in the past, it was a financial stretch, around $6,000, “and I moved a lot of refrigerators to pay that,” he said. 

“Thinking if it was $18,000,” he said, “that’s [$216,000] a year — and for two different people. And boy, I could have hired two lovely people for that kind of dough — put them up in the house to take care … It’s just a cuckoo figure, my God.” 

Kim agreed, and reiterated that if Navigator Homes aims to increase life expectancy, families will be forced to spend millions of dollars for the care from the facility. 

Pivoting to another topic, commissioner Jeff Agnoli asked project reps about the priority habitat, which the project has been moved partially out of. “I think you’re still using five of the 18 acres,” of the designated priority habitat, he said. “It’s my understanding that in order to keep the status of a priority habitat, there has to be monitoring of the species that triggered that designation, every five years or so.” Agnoli said without effective monitoring, that habitat could be lost, “and would allow future workforce development to take place in that area.” He asked if there are any plans in place to ensure maintaining the area’s priority habitat status. 

Per the MVC’s environmental report, “the USFWS lists only one federally threatened or endangered species known to possibly exist in the woodland forest project area,” which is the Northern long-eared bat, designated as a threatened species; however, the area is home to a wide array of other local vegetation and wildlife species. 

Pesce said he’s been in touch with Massachusetts Division of Fisheries Wildlife Natural Heritage and Endangered Species staff, and “they agreed to allow us to incur some disturbance of the habitat area while we set aside some acreage for a conservation restriction.”

Additionally, Pesce said the land being used for the project is considered to be “under the threshold of a take.” 

Commissioner Fred Hancock said that when approving “campus kinds of developments,” the MVC prefers to know about the building schedule, particularly how long construction will take.

“I think it would be important to have your answer to that on the record,” he said. 

Pesce said Navigator Homes plans to build the structures “right away.” 

Edward Olivier, on behalf of MVH, said the project is restricted from building in phases, and would need to be constructed at the same time as the Navigator Homes portion of the project, but hopes to start and finish the project in a timely manner. “We’re chomping at the bit to get this thing going … We need employee housing — badly,” he said.

Sederholm closed the public hearing Thursday, but decided to leave the written record open until Nov. 3 at 5 pm.