She hid things from herself, she admits. Annastine Duncan was used to seeing her husband as the strong man he had once been, one of the first leaders of Pittsburgh's Great Race, a dedicated father, former football player and city worker.
Then Leonard Duncan, his memory clouded, wandered off for the last time. When Annastine and her children found him -- alive and safe, thankfully -- they reluctantly took the advice of a case worker and visited the new memory unit that had opened at Kane Regional Center at Glen Hazel.
"We had heard about Kane," Ms. Duncan said, making clear that the county-run nursing home didn't have the best reputation among her friends. "But when we visited, I think we were so pleasantly surprised. We said, 'This place is OK!' "
Mr. Duncan is exactly the kind of resident Kane executive director Dennis Biondo is trying to attract. As assisted care facilities fight among each other for clients -- and the limited stream of Medicare dollars they bring -- Kane has launched a new marketing and building push to rebrand itself as the affordable option in both short-term and long-term care.
Residents need to see Kane as more than just the nursing home of last resort, Mr. Biondo says. And while caring for seniors in need will always be at the core of its mission, he believes most folks would leap at the deal he's offering -- if they only knew about it.
"We don't shy away from the fact that we're the facility that is [in] your hometown community," he said. "We've just had to keep with competition and to keep up with really what the industry wants, what the residents of the county need."
This year, the county spent $187,000 on an advertising campaign to promote the Kane system, which has regional centers in Glen Hazel, McKeesport, Ross and Scott. The money went to about a dozen billboards scattered throughout the area -- "Kane Is More Than Able" -- as well as radio spots and Port Authority ads.
Among other things, the billboards hype Kane's wound care, short-term rehabilitation and memory units, three areas county administrators hope can bring new growth to the system. With between 80 and 90 percent of Kane's residents paying for their care through Medicaid, leaders are eager to offer services that will tap into new funding streams, including Medicare.
These days, care facilities live and die by Medicare reimbursements. Since Medicaid rarely covers the full cost of caring for a nursing home resident -- facilities usually lose about $9,500 a year on these patients, according to the Pennsylvania Health Care Association -- facilities have come to rely on extra money generated by Medicare payments, which are usually for shorter-term treatments, to fill the gaps in their budgets.
"The face of nursing home is somewhat changing in many communities to be much more of a shorter-stay operation," said Stuart Shapiro, executive director of the PHCA. "They admit many patients who are there for a shorter stay -- they have intensive rehabilitative services, and then they go home."
Kane's total population has held relatively steady, at 88.7 percent occupancy. County leaders have said they'd like to get the occupation rate up to 91 percent or higher, filling most of the system's 1,076 beds.
But competition has increased. Private nursing homes are increasingly willing to accept patients on public support, a population they would have turned away before. Kane is being squeezed from both ends, by new demands by residents on one side and competitors more than willing to take their business on the other.
In response, Mr. Biondo is adding a second dementia ward in the system's Scott center, a twin to Mr. Duncan's residence in Glen Hazel. Once it is up and running, it'll have enough beds for 45 people.
He's also pitching Kane as a place to rehabilitate after a surgery, such as a joint replacement.
"The long-term part of it is not where you see it headed. It's headed toward rehabilitation," he said.
Some, including Mr. Shapiro, believe the county should get out of the health care business. Instead of spending money to renovate old facilities, he said, why not contract with private or nonprofit competitors, who have more flexibility than their county counterparts?
Mr. Biondo says that's a political question better left to elected officials. And so far, county leaders have shown little appetite for privatizing or shutting down Kane facilities, citing new advertising as a more appropriate strategy.
"We believe that campaign was appropriate to have us compete with a lot of other centers," county Manager William McKain told county council Tuesday night at a budget hearing. "We do believe Kane has a unique niche."
Ms. Duncan would agree. She originally thought about taking her husband to a facility in Sewickley, but dropped those plans as soon as she saw the comforts at Glen Hazel.
She visits him six days a week. She knows the staff, including Mr. Biondo, by name. And she always knows that he's safe.
"I'm really happy with the care he's getting here," she said.
Andrew McGill: firstname.lastname@example.org or 412-263-1497.