Chicago Tribune from Chicago, Illinois • Page 94

14 Section 1 Chicago Tribune, Tuesday, September 29, 1998 WAREHOUSING THE MENTALLY ILL IN NURSING HOMES Continued from Page 1 I nesses in addition to substance abuse I a -i Hi' U-'V I 3r r4 'A i nm- broker" tries to recruit him for a nursing home. Rev. Leo Barbee arranged the call. i problems. He said he has provided dozens of patients for more than 10 brokers, who call the shelter once a month, asking, "Do you have somebody for me today?" Nursing home administrators sometimes send a van to pick up homeless people, or the shelter provides bus tokens for prospective patients, he said.

Increasingly, hundreds of Illinois homes established as way stations for senior citizens are embracing a new role as long-term care facilities for younger, able-bodied patients with mental illnesses. Propelling this shift is a migration to home or hospice care by the elderly. On Sunday and Monday, the Tribune reported that a growing number of nursing homes have filled empty beds with psychiatric patients who have been treated or discharged from state-funded facilities. Today, at least 562 nursing homes hold about 12,000 psychiatric patients as young as 20 years old. The mixture of two vulnerable populations the elderly and those with mental illnesses has resulted in hundreds of incidents of abuse and assault.

However, rising vacancy rates continue to outpace the number of available patients, compelling dozens of nursing homes to employ people to scout the shelters and hospitals for new patients, said one of the state's largest nursing home owners, Morris Esformes. The Chicago businessman has filled hundreds of beds with psychiatric patients, and he said he also employs three people to scout hospitals and shelters for even more patients. The homeless represent a largely untapped market of prospective patients. They suffer a high rate of mental illness hundreds are believed to be former state psychiatric patients often the product of years of drug or alcohol abuse, Esformes said. Officials at the National Coalition for the Homeless, a Washington, D.C.-based advocacy group, said transfers of homeless people to nursing homes appear to be unique to Chicago, although the homeless have been exploited by other health care organizations over the years.

Every filled bed generates up to $100 a day for nursing home owners, plus an extia $10 a day from the Illinois Department of Public Aid, which provides a financial supplement to homes that accept psychiatric patients, state records show. Officials from Public Aid, which oversees nursing home funding, said there is nothing inappropriate about transferring homeless people to nursing facilities. Before formal admission, both a nursing home doctor and an independent physician under contract to Public Aid must verify that prospective patients suffer a debilitating physical or mental condition that requires treatment, Public Aid officials said. Nursing homes must also document that they have the services and staff to meet patients' needs, whether it is specialized psychotherapy or social activities, state officials said. However, state Department of Public Health inspection reports show that dozens of homes fail to provide adequate care and services for mentally ill patients.

Several other shelter and health care officials contacted by the Tribune said they have been contacted by bed brokers but refuse to deal with them. Sharon Gottlieb, founder and director of the Elders in Distress program, said bed brokers are simply trying to generate new business. "I refuse to do any business with these people," said Gottlieb, a nationally recognized advocate for the homeless and elderly since 1986. "Nobody wanted the homeless before. Now there's a buck to be made." Gottlieb's program, affiliated through Bethany Methodist reunites homeless or elderly people with their families, or directs them to hospitals or, in some cases, assists with selecting a nursing home.

She said the program receives no benefit if patients are accepted at a nursing home. Admitting homeless people often with no documented medical or behavioral records into nursing homes adds a dangerous, unpredictable element to the population, according to Wendy Meltzer, director of the Illinois Citizens for Better Care, a Chicago-based advocacy group that monitors nursing home conditions and assists patients. "The problem is that homes do not know how to provide treatment for these kinds of patients," she said. "It just makes no sense." October 'uprising' In early October last year, five homeless men from the Pacific Garden shelter were transferred to a 55-bed nursing facility called the Sovereign Home, 6159 N. Kenmore Ave.

Within a week, the men dominated the home and surrounding neighborhood, police and nursing home records show. Employees hid behind doors or huddled together for safety at the nurses station as the homeless men, upset by numerous rules and experiencing withdrawal symptoms common to substance abuse, began breaking equipment and windows, according to interviews with police officers and nursing home employees. The homeless men, ranging in age from 35 to 45, arrived at the home after new owners took over the facility, where up to half of the beds were empty, state Public Health records show. Philip Esformes, the son of Morris I A At Pacific Garden Mission, John Bogan (left), Five homeless men reportedly went on a rampage while at Sovereign Home. Esformes, and Marvin Mermelstein are the primary owners of the home.

Morris Esformes, who leases the property to his son, ranks among the state's largest and wealthiest nursing home owners, with ownership in at least 20 facilities in three states. He entered the business in 1969 and quickly established Chicago homes that accepted mentally ill patients. Aid. Mary Ann Smith, whose 48th Ward includes Sovereign Home, said the patients' disruptions that followed their arrival from Pacific Garden shelter prompted a dozen calls to the police for disturbances both inside and outside the home. Smith, who contacted the home following neighbor complaints, said staff members were unprepared for the level of aggressiveness exhibited by the men, who rebelled at numerous restrictions, such as curfews and bans on drinking and smoking inside the nursing home.

Daily, the men from the shelter left the nursing home and wandered the neighborhood, defecated and urinated on streets, physically accosted pedestrians for money, and were seen drinking in public, Smith said. "When home health care began to take off, nursing homes immediately experienced a 10 to 20 percent vacancy," she said. "So then, they began to fill the beds up with crack and cocaine patients and that is a huge, huge burden for my neighborhood." Susan Lippert, who became Sovereign Home's administrative supervisor in March, said a high number of vacancies resulted in the home accepting a number of homeless men into a facility that had been primarily filled with elderly patients. Lippert could not say how many homeless residents were taken in. All the troublemakers were transferred to other facilities, although most are probably wandering the streets again, Lippert said.

Homeless patients often have trouble adjusting to the economics of living in a nursing homes, she said. Many homeless people are eligible for Social Security benefits, which average $494 monthly, she said. However, those 1 yAte iW '-il I- S. i i I 1 -r- 1 I 'amtm i urn i i utmsnM rim nuinv i famm, mm is Tribune photos by Chris Walker Tribune photos by Chris Walker Barbee, who took over the men's pro- gram early this year, said he is bothered that nursing homes are filling beds for economic reasons, but any method to remove needy people from perilous streets to a safer place is justified, he said. Following the noon service and meal, Barbee called Bogan aside and gently suggested that he might be better off in another facility.

Bogan has been coming to the mission for 10 years. In 1980, at age 19, Bogan said he embarked on a wild night of fun and drinking, then climbed aboard his Kawasaki 900 motorcycle and crashed on Chicago's South Side. He was left -with brain damage and extensive physi-' cal injuries. What about going to a nursing home, Barbee inquired of Bogan. "You can't just get into a nursing home," Bogan responded.

"It's like a fancy condominium, or something." Barbee took Bogan to an office, then called a nursing home representative he later described as a bed broker. Bogan's lower lip quivered as Barbee handed over the telephone, saying, "He wants to talk with you." Bogan rocked gently in his seat, touching a rubber band around his right wrist. "When would I have to go?" he whispered. Finally, after a minute of answering questions, he handed the phone back, summoning the courage to say to Barbee, "I'm not ready to go." Maybe another time, Barbee told Bogan. Later, Barbee would say that he would approach Bogan again and that eventually, Bogan would likely consent, because he "can't live on the streets forever." Nursing home records obtained by the Tribune show that dozens of Pacific Garden residents have already taken themselves off the streets and into nursing homes.

One of them was James Marley. Pacific Garden arranged for the 44-year-old Marley to enter the Emerald Park Health Care Center on May 12 last year. The 249-bed Evergreen Park facilityalso owned by Morris Esformes holds a mixture of mentally ill and geri-, atric residents. Marley was diagnosed with severe schizophrenia, according to a copy of his nursing home file. For the last decade, he lived in shelters or stayed temporarily at the homes of friends or relatives, never staying in one spot long, Marley's sister, Bessie Alexander, said.

She said Marley stayed a few months at the nursing home but was unhappy because there were few activities to occupy his time. Today, Marley is roaming the streets once again, Alexander said. "The nursing home was really more of a transient hotel for him," she said. ON THE INTERNET For help making an informed choice in long-term care facilities, find resources and a searchable database of Illinois nursing homes at who Is homeless, listens while a "bed Wendy Meltzer, director of the advocacy admitting homeless people into nursing benefits are forfeited if they agree to enter a nursing home because their care paid by state and federal Medicaid dollars. Under state law, any nursing home patient on public assistance programs, such as Medicaid, is allowed to keep only $30 of the Social Security stipend, with the remainder applied toward the patient's nursing home care.

Nursing home advocates said the $30 payment, unchanged since adopted by the legislature in 1985, represents an economic barrier to independence because patients can never save enough money to move out, which should be a goal for younger mentally ill patients. Some patients discharge themselves, which is their right, just to collect their full Social Security payment, and then embark on drug or alcohol binges before returning for readmission, Lippert said. Still struggling with a high vacancy rate, Sovereign Home continues to accept the homeless, Lippert said. Earlier this month, a homeless man who had left for the freedom of the streets had returned, once again, to the familiar confines of the home. "He found that his $494 didn't go as far as he thought it would," Lippert said.

Since the troubles last October, the home has made significant improvements in quality of care and to the building, which include a remodeling of the entrance to better track patient movement. In addition, owners have provided more psychiatric services and activities to patients, according to state inspection records and interviews with patients and employees. The initial rush to fill beds created problems, but difficulties have been eliminated with better training of employees and toughening admission standards, said Sovereign's Morris Esformes. "I have three or four people who work for me who are on my payroll who go to hospitals, who go to various places to see if we can drum up business. Absolutely.

I'm not going to lie about that. But to say that they are commissioned? That's inappropriate." No money or gifts have been provided to anyone in exchange for patients by his employees, he said. "If some of my people, and I wouldn't doubt it, go to Pacific Garden or go to any of these shelters and so forth, I would encourage it. Absolutely. But I Y.

I ft ft '-1 group Illinois Citizens for Better Care, homes Is an extremely risky business. says don't pay off anybody." Esformes, who acknowledged that two of his homes have drawn on men from Pacific Garden to fill beds, said every nursing home employs marketing agents to forge relationships with churches, hospitals, community programs and shelters. He said the state, which authorizes and licenses nursing home beds, has fueled competition by allowing more facilities to open. For example, Lake County has seen an 850-bed increase in the last two years, propelling vacancy rates even higher for many established owners, he said. Esformes noted his homes were not recruiting homeless patients just a few years ago.

"There is a vacancy issue out there," he said. "And people are fighting for patients." Recruiting a hot prospect A woman pounded on an antique piano, strains of a three-chord melody lost over the booming and unabashedly off-key voice of an older gentleman who straightened himself and belted out the joys of embracing Jesus. The 100 or so weary men and women sitting on folding chairs at the Pacific Garden Mission one afternoon this summer had heard it many times before. A few lucky ones with wristwatches anxiously ticked off the minutes between promised salvation and a hot meal waiting in another room. John Bogan, 38, clutched his wood cane with his right hand, tilted his head to the right and smiled toward the stage.

The homeless man had no clue that he was being eyed by Rev. Leo Barbee as a hot prospect for a nursing home bed broker. On a busy day, the privately owned, nonprofit mission holds 600 people within its three buildings at 646 S. State St. Suit-jacketed security men stand at attention at the sidewalk entrance, below a large neon cross.

More than one police officer has dumped a vagrant at a nearby intersection with the instruction, "Walk to the cross." Attendance is mandatory at the 30-minute, nondenominational religious services that precede every meal. First-timers are met by "counselors," most of them homeless men themselves, but on the path to independence. Counselors are told to be on the lookout for people who could live in nursing homes, Barbee said. i chicagotribune.comganureinghomes i.