Fewer nurses would be kept on staff. Therapy aides and housekeepers would be lost. Patients would find their care disrupted as workers are bumped from one job to another.
State hospitals for the mentally ill are bearing the brunt of Gov. Cuomo's proposed budget cuts, forcing facilities in Buffalo and Gowanda to scramble for ways of lessening the impact on patient care.
"The potential is there for it to affect our staff-to-patient ratio," said C. Richard Orndoff, regional director of the state Office of Mental Health.
For the first time since 1983, the Buffalo Psychiatric Center is faced with cuts that could directly impact its most seriously ill patients.
If Cuomo's plan is approved, the center must lay off 32 people -- in addition to 139 jobs lost through attrition and early retirement the past two years.
Some of the cuts have been offset by a reduction in patients -- from 555 to 443 in two years -- but officials say some impact on patient care is likely.
"These are people providing basic care to patients, ensuring they have a safe and secure environment," said Sue Joffe, spokeswoman for the Buffalo Psychiatric Center.
At the Gowanda Psychiatric Center, the impact is even greater. Cuomo's plan would mean 69 layoffs.
Another 20 jobs at both Gowanda and Buffalo would be lost to attrition.
Barbara Nevergold, president of Buffalo's Board of Visitors, the watchdog group appointed by Gov. Cuomo, criticized the state for targeting the cuts at the mentally ill -- a group with a weak voice in Albany.
"This is a population that cannot advocate for itself," she said. "We're extremely concerned."
While sympathetic, lawmakers are making no promises about help.
"There is a huge amount of money in mental hygiene," said state Sen. Dale Volker, R-Depew. "At some point, mental hygiene will have to take a hit. There's no money for restoration."
Concerns over patient care are compounded by uncertainty over who will be laid off. Union rules give job security to the most senior employees, which means some workers targeted for layoff can take on new jobs, displacing less senior workers.
"We serve a population that depends on consistency in care," said Ms. Joffe. "Any disruption can reverse gains that have been made."