LIBERTY, NY — To place a parent, an aunt or uncle, or a spouse in long-term care is above all an act of trust. 

The people who work in and run the nursing home or group home or other facility are critically important. What do they think about the elders they care for? They feed people, wash those who cannot wash themselves, keep people safe. 

The people in charge have to balance the needs of the patients with those of the staff, owners, regulators, lawmakers. 

The buck stops with the person behind the desk. 

At Sullivan County’s Adult Care Center, that person is Kayshawn Macharie, who started the job recently.

“The legislature… came away very impressed with not only his approach to resident care but also his steadfast support of the hardworking staff,” said Cat Scott, the chair of the health and human services committee and District 5 legislator, in a statement. 

Macharie’s aunt Ruth served as his adoptive mother and a significant influence. She “played a significant role in shaping who I am today,” he said. “She was strong, wise and incredibly nurturing, someone whose words carried weight not because she spoke loudly, but because she spoke with love and experience.”

Church elders had an influence as well. They “may not have had formal titles, but their lived experience made them our teachers, our historians and often our spiritual anchors.” 

City to country, different and not

Macharie holds nursing home administrative licensure and nursing and social service degrees; he worked in Buffalo, Rochester and the Bronx.

“Sullivan County presents unique challenges and opportunities,” he said. “Unlike New York City, where resources may be more centralized and accessible, rural areas like Sullivan often have to do more with less. There are transportation challenges, fewer specialized services, and sometimes a higher reliance on local government or community-based programs.”

Elders here are connected to their communities. They have the same needs for dignity, love and respect. But meeting those needs requires working with families, faith groups and community organizations, he said.

What staff need

“Staffing continues to be one of the biggest challenges in long-term care,  not just recruitment, but retention,” he said. “Burnout is real. Also, the regulatory pressure is intense, and while oversight is necessary, sometimes it can feel like we’re spending more time on paperwork than on people.”

“To make elder care sustainable, we need to reframe how society views aging and caregiving,” Macharie continued. 

“That includes better pay and support for caregivers, more accessible mental health resources for both staff and residents, and rethinking how we train people,  not just clinically, but emotionally. We also need stronger partnerships between health care systems and long-term care facilities.”

And what residents need

People in care, especially in a nursing home, are sometimes in pain. Some have dementia. Some are frail. Does that make them a burden?

Macharie says no. 

“Even elders who are ill offer something invaluable—their stories, their presence and their wisdom,” he said.

Everyone deserves dignity and compassion, Macharie said. It starts “with how we speak to residents, not just what we say, but how we say it. It’s about asking, not assuming. It’s respecting preferences, cultures, routines and identities.”

In a nursing home, it means “creating spaces that feel like home, not institutions. It’s making sure a resident’s birthday is celebrated, that their meals reflect their preferences, and that they are addressed by their name, not just a room number.”

Staff learn, if they haven’t already, the importance of small acts: “a hand on the shoulder, a smile and listening, can make a huge difference,” he said.