St. Joseph’s new interim CEO Zachary Randolph says he is working on “right-sizing” the addiction rehab network to remain sustainable amid financial difficulties.

The two organizations are still hashing out the details of the partnership but plan to share staff, resources and knowledge.

St. Joseph’s has expanded over the last 15 years or so, adding programs and locations, but when Randolph came into the role on Jan. 1, he said the organization was in tough financial shape, reporting its first deficit ever last year. Randolph did not immediately have details on how large the deficit is on Monday.

“St. Joseph’s is struggling financially, but no different than probably any other health provider,” Randolph said. “COVID was not kind to the health system.”

Zachary Randolph, St. Joseph’s interim CEO (Enterprise photo — Aaron Marbone)

This is due to both a loss in revenue and rise in costs, he said, as well as a workforce shortage putting a strain on the industry. He said St. Joseph’s has maintained a strong retention rate — it hasn’t lowered the number of residents it accepts — because staff believe in the mission.

“The unfortunate truth to that is that the need for our services are more relevant than ever because we also know, coming out of the COVID pandemic, substance use and mental health challenges are exponentially higher and increasing by the day,” Randolph said.

For years, he said there has not been equity in funding for behavioral health compared to primary care. Federal parity rules do not apply to behavioral health under Medicare plans, according to the Kaiser Family Foundation nonprofit organization.

“People are in need of more care than ever before when they get here, and we’re not getting paid any more money to provide the care,” Randolph said.

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Citizen Advocates answers call

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In January, Randolph said he was looking for partner organizations that do similar but not redundant work.

On Feb. 3, St. Joseph’s entered a six-month “management services agreement” with Citizen Advocates to contract work on leadership, finance and operations teams between the two organizations.

St. Joseph’s, based in Saranac Lake, has 250 employees and $22 million in annual revenue for its four-county service region. Citizen Advocates, based in Malone has 800 employees and $60 million in annual revenue for its seven-county service region, according to a joint release from the organizations.

Citizen Advocates serves a much wider range of needs, including developmental disabilities and mental health issues as well as addiction.

Randolph and Citizen Advocates President and CEO James Button said this agreement was “born out of solidarity in the face of adversity.” The boards of both organizations have been talking recently and decided the two have similar missions, with different specialties. Randolph and Button said working together allows them to do more, learn more and continue their individual work more efficiently.

“The loss of the essential services (St. Joseph’s) provide(s) would only deepen the mental health and addiction crisis in our region,” Button said in a statement. “When asked to help, Citizen Advocates readily agreed to step in and aid a sister-agency in their time of need.”

The partnership is still in the “early stages of development,” they said. The agreement may be extended at the end of the six months, according to the joint statement.

Former St. Joseph’s CEO Bob Ross, who retired at the end of 2022, said the partnership is good news. He said it will increase efficiency by sharing resources and give the organization the chance to market itself. He said St. Joseph’s has never had a marketing initiative before.

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St. Joseph’s may downsize

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St. Joseph’s has 67 beds at its inpatient facility in Saranac Lake, 25 for its veterans program and 28 at its Rose Hill Adolescent Treatment Program program in Massena. But Randolph said he doesn’t want St. Joseph’s to be known for its volume. He wants to be known for its successes and effectiveness.

“We don’t have to do it all, but what we should do, I’m committed as part of our mission that what we are able to sustainably do, that we do it very well,” he said.

As the organization focuses on its core services, there is potential downsizing.

Randolph said St. Joseph’s has ceased services at a supportive housing unit in Schenectady and is planning to sell it to another provider as it divests in projects outside of the North Country.

He’s looking at current organizational structure and said there is the potential for reorganization, though he was unsure of what extent.

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Staff shortage

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Ross said St. Joseph’s, like many other health care organizations, has faced a severe workforce challenge in recent years. Part of the issue, he said, is that pay needs to increase to attract new staff, but he said state and federal reimbursement rates for the organization haven’t risen.

Randolph said the organization is in need of nurses, mental health clinicians and social workers. He said behavioral health provides a slower pace than a hospital and a more personal culture with clients. He said nurses get to see people bounce back from a “broken state” over the weeks or months residents are there.

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Detox facility moved from new building

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St. Joseph’s opened a 10-bed detox facility in Saranac Lake in March 2022, but it was immediately challenged by a workforce shortage. Randolph said St. Joseph’s needs staff to run the Robert R. Reiss Community Service Center safely. It’s intense care there, he said.

Before the 2022 holiday season, the detox facility was moved to St. Joseph’s main location on Glenwood Drive to be more centralized.

Randolph said often, when people come to St. Joseph’s in-patient program, they have used drugs since their screening and need a higher level of care than is typical in residential settings. Now they can detox, stabilize and move back to the residential buildings nearby.

Randolph said the future use of the now-dormant former detox facility on John Munn Road is up in the air. If it is not reopened as a detox location, he said they’ll need to make a plan for it with approval from local counties and the state Office of Addiction Services and Supports, which regulates the organization.