A 2023 Operational Assessment of Gracedale, Paid for By Taxpayers, Collected Dust for Three Years

Northampton County Council's Wednesday discussion with Continuum of Care Director Thomas Carson and Gracedale Administrator Michelle Morton included a detailed discussion of the 2023 Affinity operational assessment. at Gracedale. 

This report was ordered by a previous County Council over former Executive Lamont McClure's veto. Council thought it would be helpful to have some "outside lens" on Gracedale. Tara Zrinski, then a Council member, supported McClure's veto. 

This outside performance audit has pretty much been collecting dust since that time. After Michelle Morton was hired as Administrator in March 2025, it was never provided to her. She told County Council on November 9, 2025, that she had yet to see this report. When she testified before the Investigating Grand Jury on December 30, 2025, she still had failed to read it. 

Carson has. 

He told Council it produces a remarkably candid picture of the problems facing Gracedale. This raises questions about why many of the report's recommendations were not addressed sooner. Carson suggested Gracedale use the 2023 Affinity report as a blueprint and give current management time to implement its recommendations. He noted many of its findings and recommendations are the same issues he has been reporting to now County Executive Tara Zrinski.

Carson plans to meet with Gracedale's administration and nursing leadership and go through the Affinity report line by line to determine what needs to be done. "I'm not going to stand here before this committee and suggest everything is fine when the facts tell us otherwise," he declared. But he also stressed that Gracedale's problems are only a part of "the entire story." He has met employees who have devoted years and even decades to Gracedale and remain deeply committed to its residents.

Carson said employees want leadership that listens, communicates, holds people accountable and is present. His commitment to Council was straightforward: "I will tell you what I know, I will tell you what we are doing about it, and I will be accountable for the results."

Affinity findings that Gracedale had no referral tracking system, was poorly marketing itself and had no formal daily "standout" or shift-turnover meetings, have remained poorly addressed. But the most striking part of Carson's presentation involves employee morale.

The Affinity report said employees felt demoralized by negative media coverage and the frequent public discussion of Gracedale's problems. Carson said that finding remains relevant. He mentioned one employee had told him that she covers the Gracedale logo on her sweatshirt when leaving the facility because she is embarrassed to be identified with Gracedale.

WAGES AND AGENCY STAFFING

Affinity found that Gracedale's wages were noncompetitive. Three years later, that is still the case. Carson said some employees struggle to make ends meet, feel forgotten by the county, and many leave for higher-paying jobs. He described compensation as a "critical" problem.

Carson said the recent increase in nursing-supervisor pay was a step in the right direction and that paying all nursing staff more could result in the elimination of agency nursing. The Affinity report said Gracedale spent approximately $11.3 million on agency staffing in 2022. Now it's roughly twice that amount.

In one positive note, nine people were beginning new-hire orientation last week, the largest number Carson has seen since he arrived a few weeks ago. 

Only one is a nursing supervisor, but Carson "hopes" at least 90% of the supervisor positions are filled by the first quarter of 2027. 

WHY WAS THE 2023 REPORT SHELVED?

Council member Dave Holland asked Carson perhaps the most important question of the evening: Why was Council only discussing a taxpayer-funded 2023 report in October 2026 when it contained apparently relevant concerns?

Carson was unable to answer because he was not at Gracedale in 2023 and could only speculate that someone the report was unneeded.

AGENCY CONTRACT AND RATES

Council member Nadeem Qayyum had questions about the disparity between county and agency hourly rates.

Examples cited during the meeting included:

CNA: $17.88 county versus $36.40 agency.

LPN: $25.50 county versus $53.20 agency.

RN: $32.60 county versus $84 agency.

Morton acknowledged that agency rates are substantially higher.

THE CNA TRAINING PROGRAM WAS STOPPED BY DOH

Council member Lori Vargo Heffner asked what happened to a CNA training program that had once been used to recruit workers. Morton said originally that the program had been placed on hold because too many people were using it to obtain their CNA training and then leaving for jobs elsewhere. She later told the truth, admitting that the state DOH actually removed Gracedale's training certificate as a result of deficiencies, meaning the facility currently is unable to operate the CNA training program. 

Vargo Heffner asked whether Gracedale could require trainees to remain employed for a certain period or repay training costs if they leave. Morton said Pennsylvania law prevents the county from simply imposing such a requirement. She was asked to send the legal authority to Council's Solicitor for review. 

In effect, Gracedale was spending money and staff time training people who were not necessarily staying at Gracedale.

Morton also said Gracedale's population has changed. Whereas the facility had historically been more heavily geriatric, it now has many more residents with mental-health issues and associated behavioral challenges.

Management decided that staff-development resources would be better spent providing additional training to existing employees.

There was also a second problem: following an abuse incident last July, the Department of Health removed Gracedale's training certificate, meaning the facility currently cannot operate the CNA training program.

UNANSWERED QUESTIONS 

Though Carson appeared sincere, he was hesitant and neither he nor Administrator Micheelle Morton were able to answer fully at least seven substantive questions or information requests.

1. How many Gracedale employees are covered by union contracts?

2. How many union positions are filled and how many are vacant?

3. How many employees are outside the union?

4. The biggest unanswered question was posed by Council member Jason Bouletter. How many county-employed nurses are required to operate a 450-bed Gracedale without agency nurses? - Both Carson and Morton looked like deer caught in the headlights when asked a pretty important financial and resident care question.

5. What were the exact dates of the three new Department of Health citations?

6. When will the agency contract receive a formal audit, and what would that audit show?

7. Why were the recommendations in the 2023 Affinity report not fully implemented before 2026?

There were also several questions that initially received incomplete answers and required Council members to press for clarification, particularly concerning agency staffing, the formal shift-change meetings and the CNA training program.

THE BIGGER ISSUE

The testimony creates an interesting paradox.

Carson and Morton both essentially agreed that the Affinity report identified legitimate problems. They also agreed that many of those problems are still relevant. What's troubling is that several problems identified in 2023 — referral tracking, marketing, employee morale, communication, accountability and staffing — remain issues three years later.

And the biggest unanswered question may be the one Carson was asked directly: Why did a taxpayer-funded report identifying these problems in 2023 apparently sit without being fully implemented until the current administration began addressing them?

Carson's answer was essentially that he was employed elsewhere and hence was unable to explain what happened. Morton's explanation was that current management independently identified many of the same issues and has been working on them since she arrived.

That leaves an important accountability question for County Council: Who was responsible for implementing the Affinity recommendations between 2023 and the arrival of the current Gracedale leadership, and why were so many of them still outstanding three years later?

Two words. Lamont McClure. He bristled at the notion of an operational assessment and simply ignored it. 

(More to come on Monday).