Lower Standards

http://www.chicagoreporter.com/index.php/c/Cover_Stories/d/Lower_Standa… Lower Standards By: Jeff Kelly Lowenstein Luzella Roberts knew something was wrong when a nurse in the dialysis room at her nursing home approached her with a syringe and moved it toward her left arm. It was Sept. 25, 2006, and Roberts’ sixth day at International Nursing and Rehab Center in Chicago’s New City neighborhood. There were explicit instructions on her medical chart not to administer dialysis through that arm, said the family’s lawyer Steven M. Levin. Instead, they were to use a catheter that was surgically implanted in Roberts’ right arm. It was there for the dialysis treatments that Roberts, an African American, received three times a week to remove waste from her body, Levin said. But now, the nurse was preparing to insert the needle in Roberts’ left arm. It was the same arm that for 60 years had cooked dinner for her husband, dressed her four children, and had three weeks earlier cupped her newest great-granddaughter. Roberts didn’t have an M.D. or RN behind her name and thought, perhaps, that the medical staff knew something she didn’t. So she kept quiet. An hour went by with the needle still intact. Then two hours. Then three before Roberts’ daughter, Cynthia Wade, stopped by to visit and saw her mother’s arm and face gray and swollen. Wade began screaming at the nurse to remove the needle. As she did, Roberts’ arm began to bleed uncontrollably and she was rushed to the emergency room. An investigation by The Chicago Reporter found that Illinois is arguably the worst state in the nation for black senior citizens seeking quality nursing home care. There is just one home in Illinois rated “excellent” by the federal government when more than 50 percent of the home’s residents are black. In Illinois, these facilities get the worst federal ratings and on average have more violations than facilities where a majority of residents are white. And in Chicago, on average, these homes have more medical malpractice and personal injury lawsuits. People in white homes got better care than those in black homes, even if both were poor. The Reporter also found that the staff at Illinois’ black nursing homes spent less time daily with residents than staff at facilities where a majority of the residents are white. Of that time, black residents got a smaller percentage of time with more-skilled registered nurses than facilities where the residents were white. “It is a real big disgrace and another black eye for the state of Illinois and the city of Chicago,” said state Rep. Monique Davis. “It’s almost like being in Mississippi in 1920.” A facility can lose its certification and Medicaid funding for failing to meet federal standards. But the Reporter investigation found that it rarely happens and has occurred with just five of the nearly 16,000 Medicaid-certified U.S. facilities in the past year. Given the increasing population of seniors nationwide, things could get worse. Experts say the ranks of seniors who need nursing home and other care will increase from about 8 million in 2000 to 19 million in 2050. The Reporter analyzed the records of 15,724 nursing homes listed in the federal Nursing Home Compare ranking database to determine if disparities existed in the quality of care. The overall rating is based on a combination of health inspection results, staffing levels and how well each home performs on 10 important aspects of care, like how well residents maintain their ability to dress themselves and eat. The database includes homes that get some of their money from Medicaid or Medicare, more than 95 percent of all nursing homes. The Reporter found that in Chicago, the worst rating—a one on a five-point scale—was given to 57 percent of black nursing homes, compared with 11 percent of white nursing homes. Excellent ratings were given to no black homes in Chicago and 29 percent of all homes with majority-white residents. White seniors had qualitatively better nursing home options than black seniors—in some cases, even when facilities had the same owner. In Illinois, there is just one excellent-rated nursing home of 51 facilities where more than half of the residents are black. In nine states—Arkansas, Connecticut, Indiana, Kansas, Kentucky, Missouri, Oklahoma, South Carolina and Wisconsin— there are none. Illinois, Indiana and Ohio are the only states in the nation where a majority—more than half—of the black nursing homes were rated poorly among states with more than three black homes. Some say the disparities are the result of staffing levels and qualifications. Nearly 85 percent of the black homes in Chicago received the lowest mark for nursing staff hours. About 21 percent of the white homes got the same score. Administrator Joeann Brew of the Avenue Care Center in the Kenwood neighborhood questioned the ratings because she feels they are given by people who have not stepped inside any nursing homes. But Francine Rico, who has worked as a certified nursing assistant at the South Shore Nursing and Rehab Center for 11 years, said the conditions in these homes negatively impact workers, too. “Quality care comes when you can give enough time and attention for what the residents need,” Rico said. Wendy Meltzer, executive director of the Chicago-based advocacy group Illinois Citizens for Better Care, said Illinois is known to have “ridiculously low” minimum staffing ratios. “We should adopt the minimum suggested federal staffing ratios, which I think would at least double the nursing staff, professional and certified, working in Illinois nursing homes,” she said. The quality of staff is also a concern. The Reporter found that white homes were rated significantly higher for their staffing of registered nurses, who are the most skilled nursing staff. Excellent ratings were given to white homes 21 percent of the time, compared with just 4 percent for black homes. Conversely, black homes scored poorly 73 percent of the time, compared with 11 percent for white homes. The Reporter found that poverty did not reduce inequities. Homes where most people were white got far better care than nursing homes where the majority of residents were black, even if both were poor. The Reporter analyzed the ratings for Chicago homes where more than 75 percent of residents’ care was paid for by Medicaid. A quarter of white homes received an excellent rating, compared with none of the black homes. More than half of the black homes received the worst rating, while 8 percent of white homes earned the same score. Davis said the disparities demand action. “We need to pass legislation or withhold the funding for those locations,” she said. In the past five years, just three Illinois facilities were decertified as a result of their quality ratings. None were located in Chicago; instead Evergreen Park, Homewood and Urbana. Janet Wells, policy director for the National Citizens’ Coalition for Nursing Home Reform, said that shuttering facilities won’t solve the problem because residents often get sent to worse facilities. State and federal authorities have taken little action against poorly rated black homes in Illinois. The International Nursing and Rehab Center, where Roberts began her ordeal, is the only majority-black facility in Illinois to make a federal list of homes that chronically have poor ratings. As of May, the home, along with three others, had been on the watch list for 52 consecutive months—longer than any other nursing home in the nation. “That’s why those homes should be stripped of their funding,” said state Rep. LaShawn Ford, whose Austin neighborhood is predominantly black and has close to 11,000 black senior citizens. “That’s blatant racism,” he said. “A lot of the times the owners of these nursing homes treat them [just] as a business. It has to be more of a mission than a business.” In 2005, when the International Nursing and Rehab Center first appeared on the list, Cynthia and Earl Wade weren’t thinking about nursing homes. They were coming up on their 25th wedding anniversary and wanted to travel. That’s when Cynthia Wade’s father died. After 60 years of marriage, Wade’s mother, Luzella Roberts, was a widow. Wade set up a bedroom in the couple’s house and shared evening cocktails of Welch’s grape juice with her mother, listening to old R&B favorites like The Platters on a record player. Wade had worked 30 years as an administrative assistant for Central Baptist Church and the Chicago Public Schools, but realized that she couldn’t take care of her mother and work a full-time job. So, she quit. After a few months, Wade realized that she couldn’t care for her mother, even being home all day. The couple started looking for a nursing home. It wouldn’t be permanent—just 10 days so that Wade could get a break. The Wades considered homes in the suburbs, thinking they were better. But they were too far to visit frequently. Someone suggested they check out International Nursing and Rehab Center. Wade toured the building, saw the dialysis machine and said the home looked acceptable. Wade did not know that the home had been sued multiple times since 2004. The five-star rating system in Nursing Home Compare would not be created for another two years. With incomplete information, Wade admitted Roberts on Sept. 19, 2006. Since 2004, International Nursing and Rehab Center has been the subject of 18 lawsuits in Cook County. It is the fourth highest of the city’s 92 nursing homes analyzed. Seven of the lawsuits were for medical malpractice or personal injury, and several involved residents’ deaths. In November 2008, Levin filed a complaint on behalf of Brenda Dawson of Chicago. Her husband, James Yearwood, was a quadriplegic who required a ventilator and tracheotomy tube to breathe. The complaint alleged that a nurse, whose job it was to change the oxygen supply, failed to do so on May 9, 2008. Yearwood went a day without breathing on the ventilator. On May 26, 2008, he died. South Shore resident Pat Reynolds visits friends and family members at half a dozen nursing homes. During her visits, Reynolds said staff sometimes did not feed residents dinner. At another facility, Reynolds saw a woman fall and not get picked up by staff for more than 10 minutes. A woman from Reynolds’ church was living at the Renaissance at South Shore and complained about sitting in her feces without help, Reynolds said. In February, members of the family council at the Renaissance facility at 87th Street sent a letter to Administrator Juli Foy identifying 11 issues they wanted addressed. Foy did not respond, according to Lurleatha Ward, the group’s vice president. When contacted by the Reporter, Foy said she responded to the issues raised in the letter. The switch to poorer care for black seniors began in the mid-1930s, when the Social Security Act, which provided money to poor seniors, led to the growth of forprofit homes. This trend accelerated dramatically with the 1965 passage of the landmark Medicaid legislation. Susan Reed, a professor and urban health policy researcher at DePaul University’s School for New Learning, said the new law gave federal money to for-profit homes and had stricter licensing requirements that homes that were older and operated on smaller budgets, like the Jane Dent Home on the city’s South Side, struggled to fulfill. This meant that many nonprofit homes on the city’s South and West sides shut down or moved to the North Side. For-profit homes have increased their presence in black neighborhoods. In Chicago, all but one, or 97 percent, of the 30 majority-black homes are for-profit. Schwab Rehabilitation Hospital in North Lawndale was the exception. By contrast, 29 percent of the 45 majority-white homes were nonprofit. Nationally and locally, for-profit homes have received lower ratings than nonprofit facilities. In Chicago, 24 of the city’s 75 for-profit homes received the lowest rating from Nursing Home Compare, while none of the 17 nonprofit homes earned the same mark. By contrast, six of the nonprofit facilities received the top rating, and just eight of the for-profit homes got the same marks. Vincent Mor, professor and chairman of the Department of Community Health at the Brown University Alpert Medical School, said the reasons for these different ratings vary. “There are big differences in staffing, case mix, location in the country, and [nonprofits] don’t pay real estate or business tax so [they] can re-invest that money,” Mor said. It was Sept. 25, 2006, and Luzella Roberts’ sixth day at the nursing home, when she was rushed to the hospital. On Oct. 10, Roberts went to the operating room for a procedure to stem the bleeding in her arm. The procedure seemed to work, but about a week later, the bleeding returned. On Oct. 19, Roberts returned to the operating room. And again on Oct. 25. “I was hoping that [the bleeding] would stop and things would go back to normal,” Wade said. The songs her mother loved no longer moved her. Her smile disappeared and was replaced by a blank expression. “Even though she was there, she wasn’t there,” Wade said. The physician said they could do nothing more. On Oct. 29, Luzella was placed on hospice. Two days later, she died. Lawyers for the nursing home declined to comment. A manager and owners in a statement to the Reporter denied knowledge of the incident. Wade filed a lawsuit July 25, 2008, alleging that the home’s negligence led to her mother’s death. Depositions are currently being taken, and Wade is seeking at least $50,000 in damages. “I miss my mother,” Wade said. “People have to be accountable for what they are doing to another person.” Stephanie Behne, Jennifer Fernicola, Mike Jakubisin, Marian Wang and Jessica Young helped research this article.